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Cook RW, Alsina KM. Reply to Augsburger et al: Selection Bias May Impact Reported Metastasis Risk for 15-Gene Expression Profile Class 1A/B Patients. Ocul Oncol Pathol 2023; 9:66-67. [PMID: 37600849 PMCID: PMC10433088 DOI: 10.1159/000529561] [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] [Received: 10/27/2022] [Accepted: 01/23/2023] [Indexed: 08/22/2023] Open
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Bailey CN, Martin BJ, Petkov VI, Schussler NC, Stevens JL, Bentler S, Cress RD, Doherty JA, Durbin EB, Gomez SL, Gonsalves L, Hernandez BY, Liu L, Morawski BM, Schymura MJ, Schwartz SM, Ward KC, Wiggins C, Wu XC, Goldberg MS, Siegel JJ, Cook RW, Covington KR, Kurley SJ. 31-Gene Expression Profile Testing in Cutaneous Melanoma and Survival Outcomes in a Population-Based Analysis: A SEER Collaboration. JCO Precis Oncol 2023; 7:e2300044. [PMID: 37384864 PMCID: PMC10530886 DOI: 10.1200/po.23.00044] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 04/12/2023] [Accepted: 05/15/2023] [Indexed: 07/01/2023] Open
Abstract
PURPOSE The DecisionDx-Melanoma 31-gene expression profile (31-GEP) test is validated to classify cutaneous malignant melanoma (CM) patient risk of recurrence, metastasis, or death as low (class 1A), intermediate (class 1B/2A), or high (class 2B). This study aimed to examine the effect of 31-GEP testing on survival outcomes and confirm the prognostic ability of the 31-GEP at the population level. METHODS Patients with stage I-III CM with a clinical 31-GEP result between 2016 and 2018 were linked to data from 17 SEER registries (n = 4,687) following registries' operation procedures for linkages. Melanoma-specific survival (MSS) and overall survival (OS) differences by 31-GEP risk category were examined using Kaplan-Meier analysis and the log-rank test. Crude and adjusted hazard ratios (HRs) were calculated using Cox regression model to evaluate variables associated with survival. 31-GEP tested patients were propensity score-matched to a cohort of non-31-GEP tested patients from the SEER database. Robustness of the effect of 31-GEP testing was assessed using resampling. RESULTS Patients with a 31-GEP class 1A result had higher 3-year MSS and OS than patients with a class 1B/2A or class 2B result (MSS: 99.7% v 97.1% v 89.6%, P < .001; OS: 96.6% v 90.2% v 79.4%, P < .001). A class 2B result was an independent predictor of MSS (HR, 7.00; 95% CI, 2.70 to 18.00) and OS (HR, 2.39; 95% CI, 1.54 to 3.70). 31-GEP testing was associated with a 29% lower MSS mortality (HR, 0.71; 95% CI, 0.53 to 0.94) and 17% lower overall mortality (HR, 0.83; 95% CI, 0.70 to 0.99) relative to untested patients. CONCLUSION In a population-based, clinically tested melanoma cohort, the 31-GEP stratified patients by their risk of dying from melanoma.
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Affiliation(s)
| | | | - Valentina I. Petkov
- Surveillance Research Program, Division of Cancer Control & Population Sciences, National Cancer Institute, Bethesda, MD
| | | | | | | | - Rosemary D. Cress
- Public Health Institute, Cancer Registry of Greater California, Sacramento, CA
| | - Jennifer A. Doherty
- Hunstman Cancer Institute, University of Utah, Salt Lake City, UT
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT
| | - Eric B. Durbin
- Cancer Research Informatics Shared Resource Facility, Markey Cancer Center, Kentucky Cancer Registry, University of Kentucky, KY
| | - Scarlett L. Gomez
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA
| | - Lou Gonsalves
- Connecticut Tumor Registry, Connecticut Department of Public Health, Hartford, CT
| | | | - Lihua Liu
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | | | - Maria J. Schymura
- Bureau of Cancer Epidemiology, New York State Department of Health, Albany, NY
- School of Public Health Epidemiology & Biostatistics, University at Albany, State University of New York, New York, NY
| | - Stephen M. Schwartz
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA
| | | | - Charles Wiggins
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM
| | - Xiao-Cheng Wu
- Louisiana State University, School of Medicine, New Orleans, LA
| | - Matthew S. Goldberg
- Castle Biosciences, Inc, Friendswood, TX
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, Mount Sinai, NY
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Cook RW, Alsina KM. Variability of High-risk Uveal Melanoma Survival Estimates Across Studies Based on 15-Gene Expression Profiling. JAMA Ophthalmol 2023; 141:212. [PMID: 36547988 DOI: 10.1001/jamaophthalmol.2022.5506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Jarell A, Gastman BR, Dillon LD, Hsueh EC, Podlipnik S, Covington KR, Cook RW, Bailey CN, Quick AP, Martin BJ, Kurley SJ, Goldberg MS, Puig S. Optimizing treatment approaches for patients with cutaneous melanoma by integrating clinical and pathologic features with the 31-gene expression profile test. J Am Acad Dermatol 2022; 87:1312-1320. [PMID: 35810840 DOI: 10.1016/j.jaad.2022.06.1202] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 06/24/2022] [Accepted: 06/26/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Many patients with low-stage cutaneous melanoma will experience tumor recurrence, metastasis, or death, and many higher staged patients will not. OBJECTIVE To develop an algorithm by integrating the 31-gene expression profile test with clinicopathologic data for an optimized, personalized risk of recurrence (integrated 31 risk of recurrence [i31-ROR]) or death and use i31-ROR in conjunction with a previously validated algorithm for precise sentinel lymph node positivity risk estimates (i31-SLNB) for optimized treatment plan decisions. METHODS Cox regression models for ROR were developed (n = 1581) and independently validated (n = 523) on a cohort with stage I-III melanoma. Using National Comprehensive Cancer Network cut points, i31-ROR performance was evaluated using the midpoint survival rates between patients with stage IIA and stage IIB disease as a risk threshold. RESULTS Patients with a low-risk i31-ROR result had significantly higher 5-year recurrence-free survival (91% vs 45%, P < .001), distant metastasis-free survival (95% vs 53%, P < .001), and melanoma-specific survival (98% vs 73%, P < .001) than patients with a high-risk i31-ROR result. A combined i31-SLNB/ROR analysis identified 44% of patients who could forego sentinel lymph node biopsy while maintaining high survival rates (>98%) or were restratified as being at a higher or lower risk of recurrence or death. LIMITATIONS Multicenter, retrospective study. CONCLUSION Integrating clinicopathologic features with the 31-GEP optimizes patient risk stratification compared to clinicopathologic features alone.
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Affiliation(s)
- Abel Jarell
- Northeast Dermatology Associates, PC, Portsmouth, New Hampshire
| | | | - Larry D Dillon
- Surgical Oncology & General Surgery, Colorado Springs, Colorado
| | - Eddy C Hsueh
- Department of Surgery, St Louis University, St Louis, Missouri
| | - Sebastian Podlipnik
- Dermatology Department, Hospital Clínic Barcelona, University of Barcelona, IDIBAPS, Barcelona, Spain. & Centro de investigaciones Biomédicas en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III, Barcelona, Spain
| | - Kyle R Covington
- Research and Development, Castle Biosciences, Inc, Friendswood, Texas
| | - Robert W Cook
- Research and Development, Castle Biosciences, Inc, Friendswood, Texas.
| | | | - Ann P Quick
- Research and Development, Castle Biosciences, Inc, Friendswood, Texas
| | - Brian J Martin
- Research and Development, Castle Biosciences, Inc, Friendswood, Texas
| | - Sarah J Kurley
- Research and Development, Castle Biosciences, Inc, Friendswood, Texas
| | | | - Susana Puig
- Dermatology Department, Hospital Clínic Barcelona, University of Barcelona, IDIBAPS, Barcelona, Spain. & Centro de investigaciones Biomédicas en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III, Barcelona, Spain
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Cook RW, Goldberg MS. Comments on Post-Publication Discussion of "Evaluation of a Gene Expression Profiling Assay in Primary Cutaneous Melanoma". Ann Surg Oncol 2022; 29:5239-5240. [PMID: 35380310 PMCID: PMC9246785 DOI: 10.1245/s10434-022-11651-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 03/04/2022] [Indexed: 11/29/2022]
Affiliation(s)
| | - Matthew S Goldberg
- Castle Biosciences, Inc., Friendswood, TX, USA
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Dillon LD, McPhee M, Davidson RS, Quick AP, Martin B, Covington KR, Zolochevska O, Cook RW, Vetto JT, Jarell AD, Fleming MD. Expanded evidence that the 31-gene expression profile test provides clinical utility for melanoma management in a multicenter study. Curr Med Res Opin 2022; 38:1267-1274. [PMID: 35081854 DOI: 10.1080/03007995.2022.2033560] [Citation(s) in RCA: 2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 01/20/2022] [Accepted: 01/21/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE National Comprehensive Cancer Network (NCCN) guidelines for cutaneous melanoma (CM) recommend physicians consider increased surveillance for patients who typically have lower melanoma survival rates (stages IIB-IV as determined by the American Joint Committee on Cancer (AJCC), 8th edition). However, up to 15% of patients identified as having a low recurrence risk (stages I-IIA) experience disease recurrence, and some patients identified as having a high recurrence risk will not experience any recurrence. The 31-gene expression profile test (31-GEP) stratifies patient recurrence risk into low (Class 1) and high (Class 2) and has demonstrated risk-appropriate impact on disease management and clinical decisions. METHODS Five-year plans for lab work, frequency of clinical visits, and imaging pre- and post-31-GEP test results were assessed for a cohort of 509 stage I-III patients following an interim subset analysis of 247 patients. RESULTS After receiving 31-GEP results, 50.6% of patients had a change in management plans in at least one of the following categories-clinical visits, lab work, or surveillance imaging. The changes aligned with the risk predicted by the 31-GEP for 76.1% of patients with a Class 1 result and 78.7% of patients with a Class 2 result. A Class 1 31-GEP result was associated with changes toward low-intensity management recommendations, while a Class 2 result was associated with changes toward high-intensity management recommendations. CONCLUSION The 31-GEP can stratify patient recurrence risk in patients with CM, and clinicians understand and apply the prognostic ability of the 31-GEP test to alter patient management in risk-appropriate directions.
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Affiliation(s)
- Larry D Dillon
- Larry D. Dillon Surgical Oncology and General Surgery, Colorado Springs, CO, USA
| | - Michael McPhee
- Breast Cancer Program, Advent Health Cancer Institute, Orlando, FL, USA
| | - Robert S Davidson
- Department of Surgical Oncology, Morton Plant Mease Healthcare, FL, USA
| | - Ann P Quick
- Castle Biosciences, Inc, Friendswood, TX, USA
| | | | | | | | | | - John T Vetto
- Department of Neurology, Surgical Oncology, Oregon Health & Science University, Portland, OR, USA
| | - Abel D Jarell
- Department of Dermatology, Northeast Dermatology Associates, P.C., Portsmouth, NH, USA
| | - Martin D Fleming
- Department of Surgical Oncology, The University of Tennessee Health Science Center, Memphis, TN, USA
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Wisco OJ, Marson JW, Litchman GH, Brownstone N, Covington KR, Martin BJ, Quick AP, Siegel JJ, Caruso HG, Cook RW, Winkelmann RR, Rigel DS. Improved cutaneous melanoma survival stratification through integration of 31-gene expression profile testing with the American Joint Committee on Cancer 8th Edition Staging. Melanoma Res 2022; 32:98-102. [PMID: 35254332 PMCID: PMC8893124 DOI: 10.1097/cmr.0000000000000804] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 12/14/2021] [Indexed: 11/26/2022]
Abstract
Cutaneous melanoma (CM) survival is assessed using averaged data from the American Joint Committee on Cancer 8th edition (AJCC8). However, subsets of AJCC8 stages I-III have better or worse survival than the predicted average value. The objective of this study was to determine if the 31-gene expression profile (31-GEP) test for CM can further risk-stratify melanoma-specific mortality within each AJCC8 stage. This retrospective multicenter study of 901 archival CM samples obtained from patients with stages I-III CM assessed 31-GEP test predictions of 5-year melanoma-specific survival (MSS) using Kaplan-Meier and Cox proportional hazards. In stage I-III CM population, patients with a Class 2B result had a lower 5-year MSS (77.8%) than patients with a Class 1A result (98.7%) and log-rank testing demonstrated significant stratification of MSS [χ2 (2df, n = 901) = 99.7, P < 0.001). Within each stage, 31-GEP data provided additional risk stratification, including in stage I [χ2 (2df, n = 415) = 11.3, P = 0.004]. Cox regression multivariable analysis showed that the 31-GEP test was a significant predictor of melanoma-specific mortality (MSM) in patients with stage I-III CM [hazard ratio: 6.44 (95% confidence interval: 2.61-15.85), P < 0.001]. This retrospective study focuses on Class 1A versus Class 2B results. Intermediate results (Class 1B/2A) comprised 21.6% of cases with survival rates between Class 1A and 2B, and similar to 5-year MSS AJCC stage values. Data from the 31-GEP test significantly differentiates MSM into lower (Class 1A) and higher risk (Class 2B) groups within each AJCC8 stage. Incorporating 31-GEP results into AJCC8 survival calculations has the potential to more precisely assess survival and enhance management guidance.
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Affiliation(s)
| | | | - Graham H. Litchman
- Department of Dermatology, St. John’s Episcopal Hospital, Far Rockaway, New York
| | | | - Kyle R. Covington
- Research and Development, Castle Biosciences, Inc., Friendswood, Texas
| | - Brian J. Martin
- Research and Development, Castle Biosciences, Inc., Friendswood, Texas
| | - Ann P. Quick
- Research and Development, Castle Biosciences, Inc., Friendswood, Texas
| | | | - Hillary G. Caruso
- Research and Development, Castle Biosciences, Inc., Friendswood, Texas
| | - Robert W. Cook
- Research and Development, Castle Biosciences, Inc., Friendswood, Texas
| | | | - Darrell S. Rigel
- Department of Dermatology, Mount Sinai Ichan School of Medicine, New York, New York, USA
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Borman S, Wilkinson J, Meldi-Sholl L, Johnson C, Carter K, Covington KR, Fitzgerald AL, Kurley SJ, Farberg AS, Goldberg MS, Monzon FA, Oelschlager K, Cook RW. Analytical validity of DecisionDx-SCC, a gene expression profile test to identify risk of metastasis in cutaneous squamous cell carcinoma (SCC) patients. Diagn Pathol 2022; 17:32. [PMID: 35216597 PMCID: PMC8876832 DOI: 10.1186/s13000-022-01211-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 01/25/2022] [Indexed: 12/30/2022] Open
Abstract
Background To improve identification of patients with cutaneous squamous cell carcinoma (SCC) at high risk for metastatic disease, the DecisionDx-SCC assay, a prognostic 40-gene expression profile (40-GEP) test, was developed and validated. The 40-GEP assay utilizes RT-PCR gene expression analysis on primary tumor biopsy tissue to evaluate the expression of 34 signature gene targets and 6 normalization genes. The test provides classifications of low risk (Class 1), moderate risk (Class 2A), and high risk (Class 2B) of metastasis within 3 years of diagnosis. The primary objective of this study was to validate the analytical performance of the 40-gene expression signature. Methods The repeatability and reproducibility of the 40-GEP test was evaluated by performance of inter-assay, intra-assay, and inter-operator precision experiments along with monitoring the reliability of sample and reagent stability for class call concordance. The technical performance of clinical orders from September 2020 through July 2021 for the 40-GEP test was assessed. Results Patient hematoxylin and eosin (H&E) stained slides were reviewed by a board-certified pathologist to assess minimum acceptable tumor content. Class specific controls (Class 1 and Class 2B) were evaluated with Levey-Jennings analysis and demonstrated consistent and reproducible results. Inter-assay, inter-operator and intra-assay concordance were all ≥90%, with short-term and long-term RNA stability also meeting minimum concordance requirements. Of the 2586 orders received, 93.5% remained eligible for testing, with 97.1% of all tested samples demonstrating actionable class call results. Conclusion DecisionDx-SCC demonstrates a high degree of analytical precision, yielding high concordance rates across multiple performance experiments, along with exhibiting robust technical reliability on clinical samples.
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Affiliation(s)
| | | | | | | | | | - Kyle R Covington
- Castle Biosciences, Inc, 505 S. Friendswood Dr., Ste 400, Friendswood, TX, 77546, USA
| | - Alison L Fitzgerald
- Castle Biosciences, Inc, 505 S. Friendswood Dr., Ste 400, Friendswood, TX, 77546, USA
| | - Sarah J Kurley
- Castle Biosciences, Inc, 505 S. Friendswood Dr., Ste 400, Friendswood, TX, 77546, USA
| | | | - Matthew S Goldberg
- Castle Biosciences, Inc, 505 S. Friendswood Dr., Ste 400, Friendswood, TX, 77546, USA.,Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Federico A Monzon
- Castle Biosciences, Inc, 505 S. Friendswood Dr., Ste 400, Friendswood, TX, 77546, USA
| | | | - Robert W Cook
- Castle Biosciences, Inc, 505 S. Friendswood Dr., Ste 400, Friendswood, TX, 77546, USA.
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Podlipnik S, Boada A, López-Estebaranz JL, Martín-González MM, Redondo P, Martin B, Quick AP, Bailey CN, Kurley SJ, Cook RW, Puig S. Using a 31-Gene Expression Profile Test to Stratify Patients with Stage I-II Cutaneous Melanoma According to Recurrence Risk: Update to a Prospective, Multicenter Study. Cancers (Basel) 2022; 14:cancers14041060. [PMID: 35205808 PMCID: PMC8870692 DOI: 10.3390/cancers14041060] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/28/2022] [Accepted: 02/15/2022] [Indexed: 01/27/2023] Open
Abstract
Simple Summary Many people with skin cancer will have their cancer come back. The 31-gene expression profile (31-GEP) test can help predict if a cancer has a low (Class 1) or high (Class 2) chance of returning. This study looked at 86 patients with early skin cancer to see how well the 31-GEP test predicted if their cancer would return. None of the patients with a Class 1 GEP result had their cancer return within 3 years, but one-fourth of patients with a Class 2 result did. This study showed that the 31-GEP test can help predict if a patient’s skin cancer will return. Accurate risk prediction can help doctors make better treatment plans for patients with skin cancer. Abstract Background: Fifteen to forty percent of patients with localized cutaneous melanoma (CM) (stages I–II) will experience disease relapse. The 31-gene expression profile (31-GEP) uses gene expression data from the primary tumor in conjunction with clinicopathologic features to refine patient prognosis. The study’s objective was to evaluate 31-GEP risk stratification for disease-free survival (DFS) in a previously published cohort with longer follow-up. Methods: Patients with stage IB–II CM (n = 86) were prospectively tested with the 31-GEP. Follow-up time increased from 2.2 to 3.9 years. Patient outcomes were compared using Kaplan-Meier and Cox regression analysis. Results: A Class 2B result was a significant predictor of 3-year DFS (hazard ratio (HR) 8.4, p = 0.008) in univariate analysis. The 31-GEP significantly stratified patients by risk of relapse (p = 0.005). A Class 2B result was associated with a lower 3-year DFS (75.0%) than a Class 1A result (100%). The 31-GEP had a high sensitivity (77.8%) and negative predictive value (95.0%). Conclusions: The 31-GEP is a significant predictor of disease relapse in patients with stage IB–II melanoma and accurately stratified patients by risk of relapse.
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Affiliation(s)
- Sebastian Podlipnik
- Department of Dermatology, Hospital Clinic of Barcelona, 08036 Barcelona, Spain; (S.P.); (S.P.)
| | - Aram Boada
- Department of Dermatology, Hospital Universitari Germans Trias i Pujol, Institut d’investigació Germans Trias Badalona, 08916 Barcelona, Spain;
| | - Jose L. López-Estebaranz
- Department of Dermatology, Hospital Universitario Fundación Alcorcón, Alcorcón, 28922 Madrid, Spain;
| | | | - Pedro Redondo
- Department of Dermatology, University Clinic of Navarra, 31008 Pamplona, Spain;
| | - Brian Martin
- Castle Biosciences, Inc., Friendswood, TX 77546, USA; (B.M.); (A.P.Q.); (C.N.B.); (S.J.K.)
| | - Ann P. Quick
- Castle Biosciences, Inc., Friendswood, TX 77546, USA; (B.M.); (A.P.Q.); (C.N.B.); (S.J.K.)
| | - Christine N. Bailey
- Castle Biosciences, Inc., Friendswood, TX 77546, USA; (B.M.); (A.P.Q.); (C.N.B.); (S.J.K.)
| | - Sarah J. Kurley
- Castle Biosciences, Inc., Friendswood, TX 77546, USA; (B.M.); (A.P.Q.); (C.N.B.); (S.J.K.)
| | - Robert W. Cook
- Castle Biosciences, Inc., Friendswood, TX 77546, USA; (B.M.); (A.P.Q.); (C.N.B.); (S.J.K.)
- Correspondence:
| | - Susana Puig
- Department of Dermatology, Hospital Clinic of Barcelona, 08036 Barcelona, Spain; (S.P.); (S.P.)
- Department of Dermatology, University of Barcelona, IDIBAPS, 08007 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras, CIBERER, Instituto de Salud Carlos III, 46010 Barcelona, Spain
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Alsina KM, Sholl LM, Covington KR, Arnal SM, Durante MA, Decatur CL, Stone JF, Oelschlager KM, Harbour JW, Monzon FA, Cook RW, Borman S. Analytical Validation and Performance of a 7-Gene Next-Generation Sequencing Panel in Uveal Melanoma. Ocul Oncol Pathol 2021; 7:428-436. [PMID: 35083209 PMCID: PMC8739387 DOI: 10.1159/000518829] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 07/31/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Gene expression profiling (GEP) is widely used for prognostication in patients with uveal melanoma (UM). Because biopsy tissue is limited, it is critical to obtain as much genomic information as possible from each sample. Combined application of both GEP and next-generation sequencing (NGS) allows for analysis of RNA and DNA from a single biopsy sample, offers additional prognostic information, and can potentially inform therapy selection. This study evaluated the analytical performance of a targeted custom NGS panel for mutational profiling of 7 genes commonly mutated in UM. METHODS One hundred five primary UM tumors were analyzed, including 37 formalin-fixed paraffin-embedded (FFPE) and 68 fine-needle aspiration biopsy specimens. Sequencing was performed on the Ion GeneStudio S5 platform to an average read depth of >500X per region of interest. RESULTS The 7-gene panel achieved a positive percent agreement of 100% for detection of both single-nucleotide variants and insertions/deletions, with a technical positive predictive value of 98.8% and 100%, respectively. Intra-assay and inter-assay concordance studies confirmed the assay's reproducibility and repeatability. DISCUSSION/CONCLUSION The 7-gene panel is a robust, highly accurate NGS test that can be successfully performed, along with GEP, from a single small-gauge needle biopsy sample or FFPE specimen.
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Affiliation(s)
- Katherina M. Alsina
- Castle Biosciences, Inc., Friendswood, TX (Headquarters) and (Laboratory), Phoenix, Arizona, USA
| | - Lauren M. Sholl
- Castle Biosciences, Inc., Friendswood, TX (Headquarters) and (Laboratory), Phoenix, Arizona, USA
| | - Kyle R. Covington
- Castle Biosciences, Inc., Friendswood, TX (Headquarters) and (Laboratory), Phoenix, Arizona, USA
| | - Suzzette M. Arnal
- Castle Biosciences, Inc., Friendswood, TX (Headquarters) and (Laboratory), Phoenix, Arizona, USA
| | - Michael A. Durante
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Christina L. Decatur
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - John F. Stone
- Castle Biosciences, Inc., Friendswood, TX (Headquarters) and (Laboratory), Phoenix, Arizona, USA
| | - Kristen M. Oelschlager
- Castle Biosciences, Inc., Friendswood, TX (Headquarters) and (Laboratory), Phoenix, Arizona, USA
| | - J. William Harbour
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Federico A. Monzon
- Castle Biosciences, Inc., Friendswood, TX (Headquarters) and (Laboratory), Phoenix, Arizona, USA
| | - Robert W. Cook
- Castle Biosciences, Inc., Friendswood, TX (Headquarters) and (Laboratory), Phoenix, Arizona, USA
| | - Sherri Borman
- Castle Biosciences, Inc., Friendswood, TX (Headquarters) and (Laboratory), Phoenix, Arizona, USA
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Jarell A, Skenderis B, Dillon LD, Dillon K, Martin B, Quick AP, Siegel JJ, Rackley BB, Cook RW. The 31-gene expression profile stratifies recurrence and metastasis risk in patients with cutaneous melanoma. Future Oncol 2021; 17:5023-5031. [PMID: 34587770 DOI: 10.2217/fon-2021-0996] [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] [Indexed: 11/21/2022] Open
Abstract
Aim: Sentinel node biopsy is a prognostic indicator of melanoma recurrence. We hypothesized that adding the primary melanoma molecular signature from the 31-gene expression profile (31-GEP) test could refine the risk of recurrence prognosis for patients with stage I-III melanoma. Materials & methods: Four hundred thirty-eight patients with stage I-III melanoma consecutively tested with the 31-GEP were retrospectively analyzed. The 31-GEP stratified patients as low-risk (Class 1A), intermediate-risk (Class 1B/2A) or high risk (Class 2B) of recurrence or metastasis. Results: The 31-GEP significantly stratified patient risk for recurrence-free survival (p < 0.001), distant metastasis-free survival (p < 0.001) and melanoma-specific survival (p < 0.001) and was a significant, independent predictor of metastatic recurrence (hazard ratio: 5.38; p = 0.014). Conclusion: The 31-GEP improves prognostic accuracy in stage I-III melanoma.
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Affiliation(s)
- Abel Jarell
- Northeast Dermatology Associates, PC, Portsmouth, NH 03801, USA
| | - Basil Skenderis
- Coastal Surgical Specialists, PC, Virginia Beach, VA 23455, USA
| | - Larry D Dillon
- Surgical Oncology & General Surgery, Colorado Springs, CO 80907, USA
| | - Kelsey Dillon
- Surgical Oncology & General Surgery, Colorado Springs, CO 80907, USA
| | - Brian Martin
- Castle Biosciences, Inc. Friendswood, TX 77546, USA
| | - Ann P Quick
- Castle Biosciences, Inc. Friendswood, TX 77546, USA
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12
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Whitman ED, Koshenkov VP, Gastman BR, Lewis D, Hsueh EC, Pak H, Trezona TP, Davidson RS, McPhee M, Guenther JM, Toomey P, Smith FO, Beitsch PD, Lewis JM, Ward A, Young SE, Shah PK, Quick AP, Martin BJ, Zolochevska O, Covington KR, Monzon FA, Goldberg MS, Cook RW, Fleming MD, Hyams DM, Vetto JT. Integrating 31-Gene Expression Profiling With Clinicopathologic Features to Optimize Cutaneous Melanoma Sentinel Lymph Node Metastasis Prediction. JCO Precis Oncol 2021; 5:PO.21.00162. [PMID: 34568719 PMCID: PMC8457832 DOI: 10.1200/po.21.00162] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 06/22/2021] [Accepted: 08/04/2021] [Indexed: 11/30/2022] Open
Abstract
National guidelines recommend sentinel lymph node biopsy (SLNB) be offered to patients with > 10% likelihood of sentinel lymph node (SLN) positivity. On the other hand, guidelines do not recommend SLNB for patients with T1a tumors without high-risk features who have < 5% likelihood of a positive SLN. However, the decision to perform SLNB is less certain for patients with higher-risk T1 melanomas in which a positive node is expected 5%-10% of the time. We hypothesized that integrating clinicopathologic features with the 31-gene expression profile (31-GEP) score using advanced artificial intelligence techniques would provide more precise SLN risk prediction.
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Affiliation(s)
- Eric D Whitman
- Carol G. Simon Cancer at Morristown Medical Center, Atlantic Health System, Morristown, NJ
| | | | | | - Deri Lewis
- Medical City Dallas Hospital, Dallas, TX
| | - Eddy C Hsueh
- Department of Surgery, St Louis University, St Louis, MO
| | - Ho Pak
- General Surgery Abington Memorial Hospital, Abington, PA
| | | | | | | | | | - Paul Toomey
- Florida State University College of Medicine, Bradenton, FL
| | | | | | - James M Lewis
- University of Tennessee Graduate School of Medicine, Knoxville, TN
| | - Andrew Ward
- University of Tennessee Graduate School of Medicine, Knoxville, TN
| | | | | | | | | | | | | | | | | | | | - Martin D Fleming
- Division of Surgical Oncology, The University of Tennessee Health Science Center, Memphis, TN
| | | | - John T Vetto
- Oregon Health & Science University, Portland, OR
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13
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Martin BJ, Covington KR, Quick AP, Cook RW. Risk Stratification of Patients with Stage I Cutaneous Melanoma Using 31-Gene Expression Profiling. J Clin Aesthet Dermatol 2021; 14:E61-E63. [PMID: 34980974 PMCID: PMC8675338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND While patients with localized cutaneous melanoma (CM) generally have good five-year melanoma-specific survival rates, identifying patients with localized disease at a high risk of recurrence could allow them access to additional follow-up or surveillance. OBJECTIVE We sought to examine the prognostic value of the 31-gene expression profile (31-GEP) test for the risk of recurrence in stage I CM patients according to 31-GEP main class (low risk: Class 1 vs. high-risk: Class 2) and the lowest and highest risk 31-GEP subclasses (Class 1A vs. Class 2B). METHODS Data from a previously described meta-analysis detailing the 31-GEP results for patients with stage I CM (N = 623) were re-analyzed to determine 31-GEP accuracy. RESULTS Patients with stage I CM and a Class 1 31-GEP result were less likely to have a recurrence (15/556; 2.7% vs. 6/67; 9.0%; p=0.018) than patients with a Class 2 result and had a higher five-year recurrence-free survival (RFS) (96% vs. 85%). Patients with a Class 2 result were 2.8 times as likely to experience a recurrence (positive likelihood ratio: 2.82; 95% confidence interval: 1.38-5.77). In a subset of patients with stage I CM stratified further into 31-GEP subclasses (n = 206), patients with a Class 1A result had a higher five-year RFS than those with a Class 2B result (98% vs. 73%). Patients with a Class 2B result were also 6.5 times as likely to experience a recurrence (positive likelihood ratio: 6.45; 95% confidence interval: 2.44-17.00) than those with a Class 1A result, and the 31-GEP had a negative predictive value of 96.3% (95% confidence interval: 92.3%-98.4%). CONCLUSION The 31-GEP test significantly differentiates between low and high recurrence risk in patients with stage I CM.
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Affiliation(s)
- Brian J Martin
- All authors are employees with Castle Biosciences, Inc. in Friendswood, Texas
| | - Kyle R Covington
- All authors are employees with Castle Biosciences, Inc. in Friendswood, Texas
| | - Ann P Quick
- All authors are employees with Castle Biosciences, Inc. in Friendswood, Texas
| | - Robert W Cook
- All authors are employees with Castle Biosciences, Inc. in Friendswood, Texas
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14
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Newman JG, Hall MA, Kurley SJ, Cook RW, Farberg AS, Geiger JL, Koyfman SA. Adjuvant therapy for high-risk cutaneous squamous cell carcinoma: 10-year review. Head Neck 2021; 43:2822-2843. [PMID: 34096664 PMCID: PMC8453797 DOI: 10.1002/hed.26767] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 04/29/2021] [Accepted: 05/18/2021] [Indexed: 12/16/2022] Open
Abstract
Standard of care for high-risk cutaneous squamous cell carcinoma (cSCC) is surgical excision of the primary lesion with clear margins when possible, and additional resection of positive margins when feasible. Even with negative margins, certain high-risk factors warrant consideration of adjuvant therapy. However, which patients might benefit from adjuvant therapy is unclear, and supporting evidence is conflicting and limited to mostly small retrospective cohorts. Here, we review literature from the last decade regarding adjuvant radiation therapy and systemic therapy in high-risk cSCC, including recent and current trials and the role of immune checkpoint inhibitors. We demonstrate evidence gaps in adjuvant therapy for high-risk cSCC and the need for prognostic tools, such as gene expression profiling, to guide patient selection. More large-cohort clinical studies are needed for collecting high-quality, evidence-based data for determining which patients with high-risk cSCC may benefit from adjuvant therapy and which therapy is most appropriate for patient management.
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Affiliation(s)
- Jason G. Newman
- Department of Otorhinolaryngology – Head and Neck SurgeryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Mary A. Hall
- Research and Development, Castle Biosciences, Inc.FriendswoodTexasUSA
| | - Sarah J. Kurley
- Research and Development, Castle Biosciences, Inc.FriendswoodTexasUSA
| | - Robert W. Cook
- Research and Development, Castle Biosciences, Inc.FriendswoodTexasUSA
| | - Aaron S. Farberg
- Section of DermatologyBaylor University Medical CenterDallasTexasUSA
| | - Jessica L. Geiger
- Department of Hematology and Medical OncologyCleveland ClinicClevelandOhioUSA
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15
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Hsueh EC, DeBloom JR, Lee JH, Sussman JJ, Covington KR, Caruso HG, Quick AP, Cook RW, Slingluff CL, McMasters KM. Long-Term Outcomes in a Multicenter, Prospective Cohort Evaluating the Prognostic 31-Gene Expression Profile for Cutaneous Melanoma. JCO Precis Oncol 2021; 5:PO.20.00119. [PMID: 34036233 PMCID: PMC8140806 DOI: 10.1200/po.20.00119] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 01/23/2021] [Accepted: 02/02/2021] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Current guidelines for postoperative management of patients with stage I-IIA cutaneous melanoma (CM) do not recommend routine cross-sectional imaging, yet many of these patients develop metastases. Methods that complement American Joint Committee on Cancer (AJCC) staging are needed to improve identification and treatment of these patients. A 31-gene expression profile (31-GEP) test predicts metastatic risk as low (class 1) or high (class 2). Prospective analysis of CM outcomes was performed to test the hypotheses that the 31-GEP provides prognostic value for patients with stage I-III CM, and that patients with stage I-IIA melanoma and class 2 31-GEP results have metastatic risk similar to patients for whom surveillance is recommended. MATERIALS AND METHODS Two multicenter registry studies, INTEGRATE (ClinicalTrials.gov identifier:NCT02355574) and EXPAND (ClinicalTrials.gov identifier:NCT02355587), were initiated under institutional review board approval, and 323 patients with stage I-III CM and median follow-up time of 3.2 years met inclusion criteria. Primary end points were 3-year recurrence-free survival (RFS), distant metastasis-free survival (DMFS), and overall survival (OS). RESULTS The 31-GEP was significant for RFS, DMFS, and OS in a univariate analysis and was a significant, independent predictor of RFS, DMFS, and OS in a multivariable analysis. GEP class 2 results were significantly associated with lower 3-year RFS, DMFS, and OS in all patients and those with stage I-IIA disease. Patients with stage I-IIA CM and a class 2 result had recurrence, distant metastasis, and death rates similar to patients with stage IIB-III CM. Combining 31-GEP results and AJCC staging enhanced sensitivity over each approach alone. CONCLUSION These data provide a rationale for using the 31-GEP along with AJCC staging, and suggest that patients with stage I-IIA CM and a class 2 31-GEP signature may be candidates for more intense follow-up.
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Affiliation(s)
- Eddy C Hsueh
- Department of Surgery, St Louis University, St Louis, MO
| | | | - Jonathan H Lee
- Allegheny Health Network Cancer Institute, Pittsburgh, PA
| | | | | | | | | | | | - Craig L Slingluff
- Department of Surgery and Cancer Center, University of Virginia School of Medicine, Charlottesville, VA
| | - Kelly M McMasters
- Department of Surgical Oncology, James Graham Brown Cancer Center, University of Louisville School of Medicine, Louisville, KY
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16
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Manning LK, Srivastava M, Bingham J, Curran GC, Westermann T, Cook RW. Neuronal inclusions resembling Negri bodies in the thalamus of a red kangaroo (Macropus rufus). Aust Vet J 2021; 99:178-180. [PMID: 33559148 DOI: 10.1111/avj.13057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 12/15/2020] [Accepted: 01/10/2021] [Indexed: 11/30/2022]
Abstract
Eosinophilic intracytoplasmic neuronal inclusions resembling Negri bodies, but not associated with lyssaviral infection, were detected in the ventrolateral thalamus of a young-adult, male red kangaroo (Macropus rufus). Similar neuronal inclusions, also with a regional distribution in the brain, have been reported as an incidental, possibly age-related finding in other animal species.
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Affiliation(s)
- L K Manning
- Department of Primary Industries, Elizabeth Macarthur Agricultural Institute, Menangle, New South Wales, 2568, Australia
| | - M Srivastava
- Department of Primary Industries, Elizabeth Macarthur Agricultural Institute, Menangle, New South Wales, 2568, Australia
| | - J Bingham
- CSIRO Australian Centre for Disease Preparedness, East Geelong, Victoria, 3219, Australia
| | - G C Curran
- Animal and Climate Investigations, Broken Hill, New South Wales, 2880, Australia
| | - T Westermann
- Department of Primary Industries, Elizabeth Macarthur Agricultural Institute, Menangle, New South Wales, 2568, Australia
| | - R W Cook
- Department of Primary Industries, Elizabeth Macarthur Agricultural Institute, Menangle, New South Wales, 2568, Australia
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17
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Wysong A, Covington KR, Kurley SJ, Johnson C, Cook RW, Newman JG, Schmults CD, Arron ST. 13813 Development and validation of a multigene signature for identification of cutaneous squamous cell carcinoma patients at high risk for regional or distant metastases. J Am Acad Dermatol 2020. [DOI: 10.1016/j.jaad.2020.06.140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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18
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Hyams DM, Covington KR, Johnson CE, Plasseraud KM, Cook RW. Integrating the melanoma 31-gene expression profile test with surgical oncology practice within national guideline and staging recommendations. Future Oncol 2020; 17:517-527. [PMID: 33021104 DOI: 10.2217/fon-2020-0827] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 11/21/2022] Open
Abstract
Aim: Define changes in clinical management resulting from the use of the prognostic 31-gene expression profile (31-GEP) test for cutaneous melanoma in a surgical oncology practice. Patients & methods: Management plans for 112 consecutively tested patients with stage I-III melanoma were evaluated for duration and number of clinical visits, blood work and imaging. Results: 31-GEP high-risk (class 2; n = 46) patients received increased management compared with low-risk (class 1; n = 66) patients. Test results were most closely associated with follow-up and imaging. Of class 1 patients, 65% received surveillance intensity within guidelines for stage I-IIA patients; 98% of class 2 patients received surveillance intensity equal to stage IIB-IV patients. Conclusion: We suggest clinical follow-up and metastatic screening be adjusted according to 31-GEP test results.
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Affiliation(s)
- David M Hyams
- Desert Surgical Oncology, Rancho Mirage, CA 92270, USA
| | | | | | | | - Robert W Cook
- Castle Biosciences, Inc., Friendswood, TX 77546, USA
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19
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O'Connor TW, Finlaison DS, Manning LK, Hazelton MS, Spiers ZB, Pinczowski P, Bolin EM, Kemsley PD, Horadagoda NU, Dart AJ, Cook RW, Kirkland PD. Encephalomyocarditis virus infection in alpacas. Aust Vet J 2020; 98:486-490. [PMID: 32794196 DOI: 10.1111/avj.12962] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 04/27/2020] [Accepted: 04/29/2020] [Indexed: 11/28/2022]
Abstract
Encephalomyocarditis virus (EMCV) infection was detected by real-time reverse transcription PCR (qRT-PCR) in four adult alpacas (Vicugna pacos) from two properties on the Far North Coast of New South Wales (NSW) in April and May 2018 and in two adult alpacas from a third property on the Central Coast of NSW in October 2018. Viral RNA was detected in a range of samples, including blood, fresh body organs and mucosal swabs. EMCV was isolated from the blood and body organs of five of these alpacas. These animals displayed a range of clinical signs, including inappetence, colic, recumbency and death. Necropsy findings included multifocal to coalescing areas of myocardial pallor, pulmonary congestion and oedema, hepatic congestion and serosal effusion. Histopathological changes comprised acute, multifocal myocardial degeneration and necrosis, with mild, neutrophilic and lymphocytic inflammation (5/5 hearts) and mild, perivascular neutrophilic meningoencephalitis (1/3 brains). This is the first report of disease due to EMCV in alpacas under farm conditions, and it identifies EMCV infection as a differential diagnosis for acute disease and death in this camelid species. In addition to the samples traditionally preferred for EMCV isolation (fresh heart, brain and spleen), blood samples are also appropriate for EMCV detection by qRT-PCR assay.
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Affiliation(s)
- T W O'Connor
- NSW Department of Primary Industries, Elizabeth Macarthur Agricultural Institute, Woodbridge Road, Menangle, New South Wales, 2568, Australia
| | - D S Finlaison
- NSW Department of Primary Industries, Elizabeth Macarthur Agricultural Institute, Woodbridge Road, Menangle, New South Wales, 2568, Australia
| | - L K Manning
- NSW Department of Primary Industries, Elizabeth Macarthur Agricultural Institute, Woodbridge Road, Menangle, New South Wales, 2568, Australia
| | - M S Hazelton
- NSW Department of Primary Industries, Elizabeth Macarthur Agricultural Institute, Woodbridge Road, Menangle, New South Wales, 2568, Australia
| | - Z B Spiers
- NSW Department of Primary Industries, Elizabeth Macarthur Agricultural Institute, Woodbridge Road, Menangle, New South Wales, 2568, Australia
| | - P Pinczowski
- NSW Department of Primary Industries, Elizabeth Macarthur Agricultural Institute, Woodbridge Road, Menangle, New South Wales, 2568, Australia
| | - E M Bolin
- North Coast Local Land Services, 24-26 Mulgi Drive, South Grafton, New South Wales, 2460, Australia
| | - P D Kemsley
- North Coast Local Land Services, 24-26 Mulgi Drive, South Grafton, New South Wales, 2460, Australia
| | - N U Horadagoda
- University Veterinary Teaching Hospital Camden, University of Sydney, 410 Werombi Road, Camden, New South Wales, 2570, Australia
| | - A J Dart
- University Veterinary Teaching Hospital Camden, University of Sydney, 410 Werombi Road, Camden, New South Wales, 2570, Australia
| | - R W Cook
- NSW Department of Primary Industries, Elizabeth Macarthur Agricultural Institute, Woodbridge Road, Menangle, New South Wales, 2568, Australia
| | - P D Kirkland
- NSW Department of Primary Industries, Elizabeth Macarthur Agricultural Institute, Woodbridge Road, Menangle, New South Wales, 2568, Australia
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20
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Farberg AS, Hall MA, Douglas L, Covington KR, Kurley SJ, Cook RW, Dinehart SM. Integrating gene expression profiling into NCCN high-risk cutaneous squamous cell carcinoma management recommendations: impact on patient management. Curr Med Res Opin 2020; 36:1301-1307. [PMID: 32351136 DOI: 10.1080/03007995.2020.1763284] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Objective: To integrate gene expression profiling into the management of high-risk cutaneous squamous cell carcinoma (cSCC) within the National Comprehensive Cancer Network (NCCN) guidelines to improve risk-aligned management recommendations.Methods: A cohort of 300 NCCN-defined high-risk cSCC patients, along with the American Joint Committee on Cancer (AJCC) T stage, Brigham and Women's Hospital (BWH) T stage, and known patient outcomes were analyzed. Risk classifications using a validated 40-gene expression profile (40-GEP) test and T stage were applied to NCCN patient management guidelines. Risk-directed patient management recommendations within the NCCN guidelines framework were aligned based on risk for metastasis.Results: Of the 300 NCCN high-risk cSCC patients, 159 (53.0%) were 40-GEP Class 1 and AJCC T1-T2, and 173 (57.7%) were Class 1 and BWH T1-2a, indicating low risk for metastasis and, thereby, suggesting low management intensity. The 40-GEP integration suggested high intensity management for only 24 (8.0%) patients (all Class 2B), and moderate intensity management for the remainder of the cohort.Conclusions: The 40-GEP test can be integrated within existing NCCN guideline recommendations for managing cSCC patients to help refine risk-directed management decisions. Integration of the 40-GEP test would allow >50% of this NCCN-defined high-risk cohort to be managed with the lowest intensity recommendations within the broad NCCN guidelines. High intensity management was deemed risk-appropriate for a small subpopulation (8.0%). This study demonstrates that the 40-GEP test, in combination with T stage, has clinical utility to impact patient management decisions in NCCN high-risk cSCC for improving risk-aligned management within the NCCN guidelines framework.
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Affiliation(s)
- Aaron S Farberg
- Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Dermatology, Arkansas Dermatology Skin Cancer Center, Little Rock, AR, USA
| | - Mary A Hall
- Research and Development, Castle Biosciences, Inc, Friendswood, TX, USA
| | - Leah Douglas
- Dermatology, Baylor College of Medicine, Houston, TX, USA
| | - Kyle R Covington
- Research and Development, Castle Biosciences, Inc, Friendswood, TX, USA
| | - Sarah J Kurley
- Research and Development, Castle Biosciences, Inc, Friendswood, TX, USA
| | - Robert W Cook
- Research and Development, Castle Biosciences, Inc, Friendswood, TX, USA
| | - Scott M Dinehart
- Dermatology, Arkansas Dermatology Skin Cancer Center, Little Rock, AR, USA
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21
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Litchman GH, Fitzgerald AL, Kurley SJ, Cook RW, Rigel DS. Impact of a prognostic 40-gene expression profiling test on clinical management decisions for high-risk cutaneous squamous cell carcinoma. Curr Med Res Opin 2020; 36:1295-1300. [PMID: 32372702 DOI: 10.1080/03007995.2020.1763283] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objective: To determine how results from a prognostic 40-gene expression profiling (40-GEP) test would impact clinician management decisions and how their choices would align with a National Comprehensive Cancer Network (NCCN) compliant, risk-directed management plan for high-risk cutaneous squamous cell carcinoma (cSCC).Methods: Clinicians attending a national dermatology conference were presented with 40-GEP test validation data. They were asked to rate clinicopathological features and molecular test results to assess their opinion of how concerning each is to cSCC prognosis. When presented with vignettes describing patients with NCCN-defined high-risk features, clinicians were asked to select a treatment plan using pre-test (no 40-GEP results), then, post-test (40-GEP Class 1, 2A, or 2B results) methodology along with corresponding metastasis rates for each test group.Results: Risk factors deemed of highest concern for metastatic outcomes were a Class 2B 40-GEP result, perineural invasion, immunosuppression, invasion beyond subcutaneous fat, and tumor diameter >1 cm on the scalp. When presented with a 40-GEP result that indicated reduced risk of metastasis (Class 1), clinicians altered their treatment management plan accordingly. Specifically, there was significant reduction in the recommendations for sentinel lymph node biopsy, adjuvant radiation or chemotherapy, follow-up time, and nodal imaging. By comparison, when a 40-GEP result indicated an increased risk of metastasis (Class 2B), significant risk-appropriate increases in management intensity was observed for the aforementioned clinical decisions.Conclusion: Integration of 40-GEP results impacted management decisions in a significant and risk-appropriate manner for high-risk cSCC patient scenarios, while remaining aligned with national guidelines for patient management.
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22
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Greenhaw BN, Covington KR, Kurley SJ, Yeniay Y, Cao NA, Plasseraud KM, Cook RW, Hsueh EC, Gastman BR, Wei ML. Reply to Problematic methodology in a systematic review and meta-analysis of DecisionDx-Melanoma. J Am Acad Dermatol 2020; 83:e359-e360. [PMID: 32526325 DOI: 10.1016/j.jaad.2020.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 06/01/2020] [Indexed: 11/18/2022]
Affiliation(s)
| | | | | | | | - Nhat Anh Cao
- Veterans Affairs Medical Center, San Francisco, California
| | | | | | | | | | - Maria L Wei
- University of California, San Francisco, California; Veterans Affairs Medical Center, San Francisco, California
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23
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Gerami P, Covington KR, Zolochevska O, Quick AP, Cook RW, Wayne JD. Performance of a prognostic 31-gene expression profile test in patients with node-negative cutaneous melanoma. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e22071] [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
e22071 Background: The National Comprehensive Cancer Network guidelines recommend considering sentinel lymph node biopsy (SLNB) for cutaneous melanoma (CM) patients with a 5-10% risk of SLN positivity and offering it to those with > 10% risk. However, SLNB limitations include identification of only 1/3 of patients who end up with distant metastasis and a regional metastasis false negative rate ranging from 5-21% indicating a need to detect the risk of metastasis in patients with a negative SLNB. The 31 gene expression profile (31GEP) test uses the molecular biology of the primary tumor to predict 5-year recurrence-free (RFS), distant metastasis-free (DMFS), melanoma-specific (MSS), and overall survival (OS). Therefore, the objective of this study is to determine whether the 31GEP can stratify risk for patients with SLN-negative results to help guide CM management. Methods: 607 primary CM tumors were collected from patients with SLN-negative status who were enrolled in multi-center IRB-approved studies. Tumors were staged according to the AJCC 8th edition and analyzed by 31GEP testing to differentiate low-risk (Class 1A), intermediate-risk (Class 1B/2A), and high-risk (Class 2B) tumor biology. Clinical data were recorded and Kaplan-Meier (KM) and Cox regression analyses were performed to assess the relationship between 31GEP class and patient outcomes including RFS, DMFS, MSS, and OS. Results: KM analysis for 5yr RFS, DMFS, MSS, and OS stratified by 31GEP class are listed in Table. Multivariate Cox regression analysis demonstrated that the 31GEP Class 2B status was an independent predictor of RFS, DMFS, MSS, and OS with hazard ratios of 4.4 (95% CI, 2.7-7.2; p < 0.001), 4.4 (95% CI, 2.3-8.5; p < 0.001), 15.6 (95% CI, 3.4-71.2; p < 0.001), and 5.4 (95% CI, 2.6-10.9; p < 0.001), respectively. Conclusions: The results indicate that the 31GEP can stratify risk for a subset of patients with SLNB-negative results with the highest 5-year survival rates being associated with a Class 1A result. Moreover, GEP Class 2B is a significant independent predictor of metastatic risk in patients who are node negative. [Table: see text]
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Affiliation(s)
- Pedram Gerami
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | | | | | | | - Jeffrey D. Wayne
- Northwestern University Feinberg School of Medicine, Chicago, IL
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24
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Schmults C, Covington KR, Kurley SJ, Cook RW. Implications of a prognostic 40-gene expression profile (40-GEP) test for high-risk cutaneous squamous cell carcinoma (cSCC) on staging-based risk assessment and adjuvant therapy trial design. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e22091] [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
e22091 Background: Deaths due to cSCC are expected to exceed melanoma-specific deaths. With the demonstration of effective therapies for advanced cSCC, and as treatment of patients in the adjuvant setting is considered, accurate prognosis is critical. For improved identification of ‘high-risk’ patients, with biologically aggressive disease capable of metastasis, a prognostic 40-gene expression profile (40-GEP) test was validated using an independent cohort of patients with high-risk cSCC and known clinical outcomes. The test identified three groups with increasing metastasis risk profiles: Class 1 (low risk), Class 2A (high risk), and Class 2B (highest risk) having metastasis rates of 8.9%, 20.4%, and 60%, respectively. Multivariable analysis demonstrated prognostic efficacy of the 40-GEP test alone and in combination with clinicopathological staging systems. This study evaluated risk stratification with concurrent consideration of the 40-GEP result and the Brigham and Women’s Hospital (BWH) stage. The primary objective was evaluation of the potential impact of the 40-GEP on adjuvant clinical trial design. Methods: To determine if a 40-GEP Class 2B result could optimize clinical trial accrual, metastasis rates of BWH high-risk T stage patients (T2b-T3) alone and in combination with 40-GEP results from the validation cohort were used for two-arm trial sample size calculations. Results: Metastasis rates for cases with T2b-T3 tumors increased from 35.1% to 71.4% when selecting for T2b-T3 cases with a 40-GEP Class 2B result. To provide 80% power to detect hazard ratio of 0.6 with 3 years of follow-up (alpha = 0.05), in line with improvement rates by addition of radiation to surgery, 434 T2b-T3 patients are required for randomization. However, sample size could be reduced by 51% to 214 patients by focusing enrollment on T2b-T3 patients with a 40-GEP Class 2B result. Conclusions: These results support the incorporation of the 40-GEP test into selection processes for patients with T2b-T3 tumors who are at the highest risk for metastasis and appropriate for adjuvant clinical trials.
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Wysong A, Newman JG, Covington KR, Kurley SJ, Ibrahim SF, Farberg AS, Bar A, Cleaver NJ, Somani AK, Panther D, Brodland DG, Zitelli J, Toyohara J, Maher IA, Xia Y, Bibee K, Griego R, Rigel DS, Meldi Plasseraud K, Estrada S, Sholl LM, Johnson C, Cook RW, Schmults CD, Arron ST. Validation of a 40-gene expression profile test to predict metastatic risk in localized high-risk cutaneous squamous cell carcinoma. J Am Acad Dermatol 2020; 84:361-369. [PMID: 32344066 DOI: 10.1016/j.jaad.2020.04.088] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [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: 01/20/2020] [Revised: 03/22/2020] [Accepted: 04/15/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Current staging systems for cutaneous squamous cell carcinoma (cSCC) have limited positive predictive value for identifying patients who will experience metastasis. OBJECTIVE To develop and validate a gene expression profile (GEP) test for predicting risk for metastasis in localized, high-risk cSCC with the goal of improving risk-directed patient management. METHODS Archival formalin-fixed paraffin-embedded primary cSCC tissue and clinicopathologic data (n = 586) were collected from 23 independent centers in a prospectively designed study. A GEP signature was developed using a discovery cohort (n = 202) and validated in a separate, nonoverlapping, independent cohort (n = 324). RESULTS A prognostic 40-GEP test was developed and validated, stratifying patients with high-risk cSCC into classes based on metastasis risk: class 1 (low risk), class 2A (high risk), and class 2B (highest risk). For the validation cohort, 3-year metastasis-free survival rates were 91.4%, 80.6%, and 44.0%, respectively. A positive predictive value of 60% was achieved for the highest-risk group (class 2B), an improvement over staging systems, and negative predictive value, sensitivity, and specificity were comparable to staging systems. LIMITATIONS Potential understaging of cases could affect metastasis rate accuracy. CONCLUSION The 40-GEP test is an independent predictor of metastatic risk that can complement current staging systems for patients with high-risk cSCC.
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Affiliation(s)
- Ashley Wysong
- University of Nebraska Medical Center, Omaha, Nebraska
| | | | | | | | | | - Aaron S Farberg
- Icahn School of Medicine at Mount Sinai, New York, New York; Arkansas Dermatology Skin Cancer Center, Little Rock, Arkansas
| | - Anna Bar
- Oregon Health & Science University, Portland, Oregon
| | | | | | - David Panther
- Zitelli and Brodland, P.C. Skin Cancer Center, Pittsburgh, Pennsylvania
| | - David G Brodland
- Zitelli and Brodland, P.C. Skin Cancer Center, Pittsburgh, Pennsylvania
| | - John Zitelli
- Zitelli and Brodland, P.C. Skin Cancer Center, Pittsburgh, Pennsylvania
| | | | - Ian A Maher
- University of Minnesota, Minneapolis, Minnesota
| | - Yang Xia
- Brooke Army Medical Center, San Antonio, Texas
| | - Kristin Bibee
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | | | | | - Sarah Estrada
- Castle Biosciences, Inc, Phoenix, Arizona; Affiliated Dermatology, Scottsdale, Arizona
| | | | | | | | | | - Sarah T Arron
- University of California San Francisco, San Francisco, California.
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Greenhaw BN, Covington KR, Kurley SJ, Yeniay Y, Cao NA, Plasseraud KM, Cook RW, Hsueh EC, Gastman BR, Wei ML. Molecular risk prediction in cutaneous melanoma: A meta-analysis of the 31-gene expression profile prognostic test in 1,479 patients. J Am Acad Dermatol 2020; 83:745-753. [PMID: 32229276 DOI: 10.1016/j.jaad.2020.03.053] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 02/07/2020] [Accepted: 03/16/2020] [Indexed: 01/15/2023]
Abstract
BACKGROUND Multiple studies have reported on the accuracy of the prognostic 31-gene expression profile test for cutaneous melanoma. Consistency of the test results across studies has not been systematically evaluated. OBJECTIVE To assess the robustness of the prognostic value of the 31-gene expression profile. METHODS Raw data were obtained from studies identified from systematic review. A meta-analysis was performed to determine overall effect of the 31-gene expression profile. Clinical outcome metrics for the 31-gene expression profile were compared with American Joint Committee on Cancer staging. RESULTS Three studies met inclusion criteria; data from a novel cohort of 211 patients were included (n = 1,479). Five-year recurrence-free and distant metastasis-free survival rates were 91.4% and 94.1% for Class 1A patients and 43.6% and 55.5% for Class 2B patients (P < .0001). Meta-analysis results showed that Class 2 was significantly associated with recurrence (hazard ratio 2.90; P < .0001) and distant metastasis (hazard ratio 2.75; P < .0001). The 31-gene expression profile identified American Joint Committee on Cancer stage I to III patient subsets with high likelihood for recurrence and distant metastasis. Sensitivity was 76% (95% confidence interval 71%-80%) and 76% (95% confidence interval 70%-82%) for each end point, respectively. When 31-gene expression profile and sentinel lymph node biopsy results were considered together, sensitivity and negative predictive value for distant metastasis-free survival were both improved. CONCLUSION The 31-gene expression profile test consistently and accurately identifies melanoma patients at increased risk of metastasis, is independent of other clinicopathologic covariates, and augments current risk stratification by reclassifying patients for heightened surveillance who were previously designated as being at low risk.
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Affiliation(s)
| | | | | | - Yildiray Yeniay
- University of California-San Francisco, San Francisco, California
| | - Nhat Anh Cao
- San Francisco Veterans Affairs Medical Center, San Francisco, California
| | | | | | | | | | - Maria L Wei
- University of California-San Francisco, San Francisco, California; San Francisco Veterans Affairs Medical Center, San Francisco, California.
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Hsueh EC, DeBloom JR, Cook RW, McMasters K. Three-year survival outcomes in a prospective cohort evaluating a prognostic 31-gene expression profile (31-GEP) test for cutaneous melanoma (CM). J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.9519] [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: 11/20/2022] Open
Abstract
9519 Background: A 31-GEP test is a validated prognostic tool for predicting the risk of metastasis in CM, classifying patients (pts) as Class 1 (low risk) or Class 2 (high risk). Here we report updated survival analysis from two clinical registry studies (NCT02355574/NCT02355587) designed to prospectively evaluate outcomes in patients for whom the GEP test was part of their clinical care. Methods: Eleven US dermatologic and surgical centers participated using IRB-approved protocols. Participants were CM pts ≥16 years old who had successful 31-GEP test results. Recurrence-free (RFS), distant metastasis-free (DMFS) and overall survival (OS) were assessed using Kaplan-Meier and Cox regression analysis. Results: At data censoring, 340 pts were accrued who had completed at least one follow-up visit. Median age was 58 years (range 18-87), 53.5% were male, median Breslow thickness was 1.2mm (range 0.2-12mm), 18.2% (62/340) were ulcerated, and 11.2% (38/340) had a positive sentinel lymph node (SLN). Median follow-up was 3.2 years for pts without an event. Six percent (16/265) of Class 1 pts had a recurrence compared to 33% (25/75) of Class 2 pts (p < 0.001). Three-year RFS was 96%, 91%, 80%, and 62% for Class 1A, 1B, 2A, and 2B, respectively (p < 0.001). Three-year DMFS was 97%, 93%, 84%, and 80% for Class 1A, 1B, 2A, and 2B, respectively (p < 0.001). Three-year OS was 98%, 90%, 96%, and 74% for Class 1A, 1B, 2A, and 2B, respectively (p < 0.001). Class 2 was an independent predictor of RFS and OS in multivariate analysis (respective HRs: 2.28 and 3.70, p < 0.05). Conclusions: Consistent with results from previous studies, this analysis demonstrates that the GEP test complements conventional staging and improves the ability to identify high-risk CM pts. These results support use of the test for guiding decisions related to follow-up, surveillance, and treatment in CM pts. Clinical trial information: NCT02355574/NCT02355587.
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Vetto JT, Hsueh EC, Gastman BR, Dillon LD, Monzon FA, Cook RW, Keller J, Huang X, Fleming A, Hewgley P, Gerami P, Leachman S, Wayne JD, Berger AC, Fleming MD. Guidance of sentinel lymph node biopsy decisions in patients with T1–T2 melanoma using gene expression profiling. Future Oncol 2019; 15:1207-1217. [DOI: 10.2217/fon-2018-0912] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Aim: Can gene expression profiling be used to identify patients with T1–T2 melanoma at low risk for sentinel lymph node (SLN) positivity? Patients & methods: Bioinformatics modeling determined a population in which a 31-gene expression profile test predicted <5% SLN positivity. Multicenter, prospectively-tested (n = 1421) and retrospective (n = 690) cohorts were used for validation and outcomes, respectively. Results: Patients 55–64 years and ≥65 years with a class 1A (low-risk) profile had SLN positivity rates of 4.9% and 1.6%. Class 2B (high-risk) patients had SLN positivity rates of 30.8% and 11.9%. Melanoma-specific survival was 99.3% for patients ≥55 years with class 1A, T1–T2 tumors and 55.0% for class 2B, SLN-positive, T1–T2 tumors. Conclusion: The 31-gene expression profile test identifies patients who could potentially avoid SLN biopsy.
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Affiliation(s)
- John T Vetto
- Division of Surgical Oncology, Knight Cancer Institute, Oregon Health & Science University, Portland, OR 97239, USA
| | - Eddy C Hsueh
- Department of Surgery, St Louis University, St Louis, MO 63110, USA
| | - Brian R Gastman
- Department of Plastic Surgery, Cleveland Clinic Lerner Research Institute, Cleveland, OH 44915, USA
| | - Larry D Dillon
- Larry D Dillon Surgical Oncology & General Surgery, Colorado Springs, CO 80907, USA
| | | | - Robert W Cook
- Castle Biosciences, Inc., Friendswood, TX 77546, USA
| | - Jennifer Keller
- Department of Surgery, St Louis University, St Louis, MO 63110, USA
| | - Xin Huang
- Division of Surgical Oncology, Department of Surgery, The University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - Andrew Fleming
- Division of Surgical Oncology, Department of Surgery, The University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - Preston Hewgley
- Division of Surgical Oncology, Department of Surgery, The University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - Pedram Gerami
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago IL 60611, USA
- Skin Cancer Institute, Northwestern University, Lurie Comprehensive Cancer Center, Chicago, IL 60611, USA
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago IL 60611, USA
| | - Sancy Leachman
- Department of Dermatology, Knight Cancer Institute, Oregon Health & Science University, Portland, OR 97239, USA
| | - Jeffrey D Wayne
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago IL 60611, USA
- Skin Cancer Institute, Northwestern University, Lurie Comprehensive Cancer Center, Chicago, IL 60611, USA
- Department of Surgical Oncology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Adam C Berger
- Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PA 19017, USA
| | - Martin D Fleming
- Division of Surgical Oncology, Department of Surgery, The University of Tennessee Health Science Center, Memphis, TN 38163, USA
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Gastman BR, Zager JS, Messina JL, Cook RW, Covington KR, Middlebrook B, Gerami P, Wayne JD, Leachman S, Vetto JT. Performance of a 31-gene expression profile test in cutaneous melanomas of the head and neck. Head Neck 2019; 41:871-879. [PMID: 30694001 PMCID: PMC6667900 DOI: 10.1002/hed.25473] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 03/23/2018] [Accepted: 07/05/2018] [Indexed: 12/19/2022] Open
Abstract
Background We report the performance of a gene expression profile test to classify the recurrence risk of cutaneous melanoma tumors of the head and neck as low‐risk Class 1 or high‐risk Class 2. Methods Of note, 157 primary head and neck cutaneous melanoma tumors were identified. Survival analyses were performed using Kaplan‐Meier and Cox methods. Results Gene expression profile class and node status stratified tumors into significantly different 5‐year survival groups by Kaplan‐Meier method (P < .0001 for all end points), and both were independent predictors of recurrence in multivariate analysis. Overall, 74% of distant metastases and 88% of melanoma‐specific deaths had Class 2 risk. Conclusion The gene expression profile test identifies cases at increased risk for metastasis and death independent of a clinically or pathologically negative nodal status, suggesting that incorporation of this molecular tool could improve clinical management of patients with head and neck cutaneous melanoma, especially in those with a negative sentinel lymph node biopsy.
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Affiliation(s)
- Brian R Gastman
- Department of Plastic Surgery, Cleveland Clinic Lerner Research Institute, Cleveland, Ohio
| | - Jonathan S Zager
- Department of Cutaneous Oncology, H. Lee Moffitt Cancer Center, Tampa, Florida
| | - Jane L Messina
- Department of Anatomic Pathology, H. Lee Moffitt Cancer Center, Tampa, Florida
| | - Robert W Cook
- Research & Development, Castle Biosciences, Inc., Friendswood, Texas
| | - Kyle R Covington
- Research & Development, Castle Biosciences, Inc., Friendswood, Texas
| | | | - Pedram Gerami
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Skin Cancer Institute, Northwestern University, Lurie Comprehensive Cancer Center, Chicago, Illinois
| | - Jeffrey D Wayne
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Department of Surgical Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Sancy Leachman
- Department of Dermatology, Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon
| | - John T Vetto
- Division of Surgical Oncology, Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon
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Hyams DM, Cook RW, Buzaid AC. Identification of risk in cutaneous melanoma patients: Prognostic and predictive markers. J Surg Oncol 2019; 119:175-186. [PMID: 30548543 PMCID: PMC6590387 DOI: 10.1002/jso.25319] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 11/15/2018] [Indexed: 12/23/2022]
Abstract
New therapeutic modalities for melanoma promise benefit in selected individuals. Efficacy appears greater in patients with lower tumor burden, suggesting an important role for risk-stratified surveillance. Robust predictive markers might permit optimization of agent to patient, while low-risk prognostic markers might guide more conservative management. This review evaluates protein, gene, and multiplexed marker panels that may contribute to better risk assessment and improved management of patients with cutaneous melanoma.
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Affiliation(s)
- David M. Hyams
- Desert Surgical Oncology, Eisenhower Medical CenterRancho MirageCalifornia
| | - Robert W. Cook
- R&D and Medical Affairs, Castle Biosciences, IncFriendswoodTexas
| | - Antonio C. Buzaid
- Oncology Center, Hospital Israelita Albert EinsteinSão PauloBrazil
- Centro Oncológico Antonio Ermírio de Moraes, Beneficência Portuguesa de São PauloSão PauloBrazil
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Gastman BR, Cook RW. Response to: "Use of a prognostic gene expression profile test for T1 cutaneous melanoma: Will it help or harm patients?". J Am Acad Dermatol 2018; 80:e163-e164. [PMID: 30586615 DOI: 10.1016/j.jaad.2018.12.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 12/18/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Brian R Gastman
- Department of Plastic Surgery, Cleveland Clinic Lerner Research Institute, Cleveland, Ohio
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Gastman BR, Gerami P, Kurley SJ, Cook RW, Leachman S, Vetto JT. Identification of patients at risk of metastasis using a prognostic 31-gene expression profile in subpopulations of melanoma patients with favorable outcomes by standard criteria. J Am Acad Dermatol 2018; 80:149-157.e4. [PMID: 30081113 DOI: 10.1016/j.jaad.2018.07.028] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 07/25/2018] [Accepted: 07/30/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND A substantial number of patients who relapse and die from cutaneous melanoma (CM) are categorized as being at low risk by traditional staging factors. The 31-gene expression profile (31-GEP) test independently stratifies metastatic risk of patients with CM as low (Class 1, with 1A indicating lowest risk) or high (Class 2,with 2B indicating highest risk). OBJECTIVE To assess risk prediction by the 31-GEP test within 3 low-risk (according to the American Joint Committee on Cancer) populations of patients with CM: those who are sentinel lymph node (SLN) negative, those with stage I to IIA tumors, and those with thin (≤1 mm [T1]) tumors. METHODS A total of 3 previous validation studies provided a nonoverlapping cohort of 690 patients with 31-GEP results, staging information, and survival outcomes. Kaplan-Meier and Cox regression analysis were performed. RESULTS The results included the identification of 70% of SLN-negative patients who experienced metastasis as Class 2, the discovery of reduced recurrence-free survival for patients with thin tumors and Class 2B biology compared with that of those with Class 1A biology (P < .0001); and determination of the 31-GEP test as an independent predictor of risk compared with traditional staging factors in patients with stage I to IIA tumors. LIMITATIONS Diagnoses spanned multiple versions of pathologic staging criteria. CONCLUSIONS The 31-GEP test identifies high-risk patients who are likely to experience recurrence or die of melanoma within low-risk groups of subpopulations of patients with CM who have SLN-negative disease, stage I to IIA tumors, and thin tumors.
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Affiliation(s)
- Brian R Gastman
- Department of Plastic Surgery, Cleveland Clinic Lerner Research Institute, Cleveland, Ohio
| | - Pedram Gerami
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Skin Cancer Institute, Northwestern University Lurie Comprehensive Cancer Center, Chicago, Illinois
| | | | | | - Sancy Leachman
- Department of Dermatology, Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon
| | - John T Vetto
- Division of Surgical Oncology, Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon
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Schmults C, Arron ST, Wysong A, Covington KR, Cook RW, Newman J. A multi-gene risk signature for improved identification of cutaneous squamous cell carcinoma (cSCC) patients with a high risk of recurrence. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.9577] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Sarah T Arron
- University of California, San Francisco, San Francisco, CA
| | - Ashley Wysong
- University of Southern California Keck School of Medicine, Los Angeles, CA
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Hsueh EC, Vetto JT, Leachman SA, Monzon FA, Cook RW, Berger AC, Gastman B, Fleming MD. Gene expression profiling with a 31-gene test to identify a population of melanoma patients with a low sentinel lymph node biopsy positive rate. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e21611] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - John T. Vetto
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR
| | | | | | | | - Adam C. Berger
- Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, PA
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Gastman B, Kurley S, Covington KR, Cook RW. Performance of a 31-gene expression profile melanoma test in clinically relevant clinicopathologic subgroups. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.9583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Dillon LD, Gadzia JE, Davidson RS, McPhee M, Covington KR, Cook RW, Johnson C, Monzon FA, Milanese ED, Vetto J, Jarell AD, Fleming MD. Prospective, Multicenter Clinical Impact Evaluation of a 31-Gene Expression Profile Test for Management of Melanoma Patients. ACTA ACUST UNITED AC 2018. [DOI: 10.25251/skin.2.2.3] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Objective: A 31-gene expression profile (GEP) test that has been clinically validated identifies melanoma patients with low (Class 1) or high (Class 2) risk of metastasis based on primary tumor biology. This study aimed to prospectively evaluate the test impact on clinical management of melanoma patients.Methods: Physicians at 16 dermatology, surgical or medical oncology centers examined patients to assess clinical features of the primary melanoma. Recommendations for clinical follow-up and surveillance were collected. Following consent of the patient and performance of the GEP test, recommendations for management were again collected, and pre- and post-test recommendations were assessed to determine changes in management resulting from the addition of GEP testing to traditional clinicopathologic risk factors. Results: Post-test management plans changed for 49% (122 of 247) of cases in the study when compared to pre-test plans. Thirty-six percent (66 of 181) of Class 1 cases had a management change, compared to 85% (56 of 66) of Class 2 cases. GEP class was a significant factor for change in care during the study (p<0.001), with Class 1 accounting for 91% (39 of 43) of cases with decreased management intensity, and Class 2 accounting for 72% (49 of 68) of cases with increases.Conclusions: The reported study show that the 31-gene GEP test improves net health outcomes in the management of cutaneous melanoma. Physicians used test results to guide risk-appropriate changes that match the biological risk of the tumor, including directing more frequent and intense surveillance to high-risk, Class 2 patients.
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Cook RW, Middlebrook B, Wilkinson J, Covington KR, Oelschlager K, Monzon FA, Stone JF. Analytic validity of DecisionDx-Melanoma, a gene expression profile test for determining metastatic risk in melanoma patients. Diagn Pathol 2018; 13:13. [PMID: 29433548 PMCID: PMC5809902 DOI: 10.1186/s13000-018-0690-3] [Citation(s) in RCA: 27] [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: 11/07/2017] [Accepted: 02/02/2018] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The DecisionDx-Melanoma test provides prognostic information for patients with cutaneous melanoma (CM). Using formalin-fixed paraffin-embedded primary tumor tissue, the RT-PCR-based test classifies patients into a low- (Class 1) or high-risk (Class 2) category for recurrence based on expression of 31 genes. The current study was designed to assess the analytical validity of this test. METHODS Inter-assay, inter-instrument, and inter-operator studies were performed to evaluate reliability of the 31-gene expression test results, sample stability and reagent stability. From March 2013 through June 2016, the gene expression test was performed on 8244 CM tumors. De-identified data from Pathology Reports were used to assess technical success. RESULTS Robust sample and reagent stability was observed. Inter-assay concordance on 168 specimens run on 2 consecutive days was 99% and matched probability scores were significantly correlated (R2 = 0.96). Inter-instrument concordance was 95%, and probability scores had a correlation R2 of 0.99 (p < 0.001). From 8244 CM specimens submitted since 2013, 85% (7023) fulfilled pre-specified tumor content parameters. In these samples with sufficient tumor requirements, the technical success of the test was 98%. CONCLUSION DecisionDx-Melanoma is a robust gene expression profile test that demonstrates strong reproducibility between experiments and has high technical reliability on clinical samples.
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Affiliation(s)
- Robert W Cook
- Castle Biosciences, Inc., 820 S. Friendswood Dr., Suite 201, Friendswood, TX, 77546, USA.
| | - Brooke Middlebrook
- Castle Biosciences, Inc., 820 S. Friendswood Dr., Suite 201, Friendswood, TX, 77546, USA
| | | | - Kyle R Covington
- Castle Biosciences, Inc., 820 S. Friendswood Dr., Suite 201, Friendswood, TX, 77546, USA
| | | | - Federico A Monzon
- Castle Biosciences, Inc., 820 S. Friendswood Dr., Suite 201, Friendswood, TX, 77546, USA
| | - John F Stone
- , 3737 N. 7th St. #160, Phoenix, 85014, Phoenix, USA
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Zager JS, Gastman BR, Leachman S, Gonzalez RC, Fleming MD, Ferris LK, Ho J, Miller AR, Cook RW, Covington KR, Meldi-Plasseraud K, Middlebrook B, Kaminester LH, Greisinger A, Estrada SI, Pariser DM, Cranmer LD, Messina JL, Vetto JT, Wayne JD, Delman KA, Lawson DH, Gerami P. Performance of a prognostic 31-gene expression profile in an independent cohort of 523 cutaneous melanoma patients. BMC Cancer 2018; 18:130. [PMID: 29402264 PMCID: PMC5800282 DOI: 10.1186/s12885-018-4016-3] [Citation(s) in RCA: 94] [Impact Index Per Article: 15.7] [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: 03/17/2017] [Accepted: 01/22/2018] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND The heterogeneous behavior of patients with melanoma makes prognostication challenging. To address this, a gene expression profile (GEP) test to predict metastatic risk was previously developed. This study evaluates the GEP's prognostic accuracy in an independent cohort of cutaneous melanoma patients. METHODS This multi-center study analyzed primary melanoma tumors from 523 patients, using the GEP to classify patients as Class 1 (low risk) and Class 2 (high risk). Molecular classification was correlated to clinical outcome and assessed along with AJCC v7 staging criteria. Primary endpoints were recurrence-free (RFS) and distant metastasis-free (DMFS) survival. RESULTS The 5-year RFS rates for Class 1 and Class 2 were 88% and 52%, respectively, and DMFS rates were 93% versus 60%, respectively (P < 0.001). The GEP was a significant predictor of RFS and DMFS in univariate analysis (hazard ratio [HR] = 5.4 and 6.6, respectively, P < 0.001 for each), along with Breslow thickness, ulceration, mitotic rate, and sentinel lymph node (SLN) status (P < 0.001 for each). GEP, tumor thickness and SLN status were significant predictors of RFS and DMFS in a multivariate model that also included ulceration and mitotic rate (RFS HR = 2.1, 1.2, and 2.5, respectively, P < 0.001 for each; and DMFS HR = 2.7, 1.3 and 3.0, respectively, P < 0.01 for each). CONCLUSIONS The GEP test is an objective predictor of metastatic risk and provides additional independent prognostic information to traditional staging to help estimate an individual's risk for recurrence. The assay identified 70% of stage I and II patients who ultimately developed distant metastasis. Its role in consideration of patients for adjuvant therapy should be examined prospectively.
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Affiliation(s)
- Jonathan S Zager
- Department of Cutaneous Oncology, Moffitt Cancer Center, 10920 N. McKinley Drive room 4123, Tampa, FL, 33612, USA
| | - Brian R Gastman
- Department of Plastic Surgery, Cleveland Clinic Lerner Research Institute, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Sancy Leachman
- Department of Dermatology, Knight Cancer Institute, Oregon Health & Science University, 3303 S.W. Bond Avenue, Portland, OR, 97239, USA
| | - Rene C Gonzalez
- Department of Medical Oncology, University of Colorado School of Medicine, 12801 E. 17th Avenue, Aurora, CO, 80045, USA
| | - Martin D Fleming
- Department of Surgical Oncology, The University of Tennessee Health Science Center, 910 Madison, Suite 303, Memphis, TN, 38163, USA
| | - Laura K Ferris
- Department of Dermatology, University of Pittsburgh Medical Center, 3601 Fifth Avenue, Pittsburgh, PA, 15213, USA
| | - Jonhan Ho
- Department of Pathology, University of Pittsburgh Medical Center, 3708 Fifth Avenue, Suite 500.94, Pittsburgh, PA, 15213, USA
| | - Alexander R Miller
- START Center for Cancer Care, 4383 Medical Drive, San Antonio, TX, 78229, USA
| | - Robert W Cook
- Castle Biosciences, Inc., 820 S. Friendswood Drive, Suite 201, Friendswood, TX, 77546, USA
| | - Kyle R Covington
- Castle Biosciences, Inc., 820 S. Friendswood Drive, Suite 201, Friendswood, TX, 77546, USA
| | | | - Brooke Middlebrook
- Castle Biosciences, Inc., 820 S. Friendswood Drive, Suite 201, Friendswood, TX, 77546, USA
| | - Lewis H Kaminester
- Dermatology North Palm Beach, 840 U.S. Highway Number One, North Palm Beach, FL, 33408, USA
| | - Anthony Greisinger
- Research & Development, Kelsey Research Foundation, 5615 Kirby Drive, Suite 660, Houston, TX, 77005, USA
| | - Sarah I Estrada
- Affiliated Dermatology, 20401 North 73rd Street, Suite 230, Scottsdale, AZ, 85255, USA
| | - David M Pariser
- Pariser Dermatology Specialists, Virginia Clinical Research, Inc., 6160 Kempsville Circle, Suite 200A, Norfolk, VA, 23502, USA.,Eastern Virginia Medical School, P.O. Box 1980, Norfolk, VA, 23501-1980, USA
| | - Lee D Cranmer
- Department of Sarcoma Medical Oncology, Seattle Cancer Care Alliance, 825 Eastlake Avenue E, Seattle, WA, 98109, USA
| | - Jane L Messina
- Department of Anatomic Pathology, Moffitt Cancer Center, 10920 N. McKinley Drive, Tampa, FL, 33612, USA
| | - John T Vetto
- Division of Surgical Oncology, Knight Cancer Institute, Oregon Health & Science University, 3303 S.W. Bond Avenue, Portland, OR, 97239, USA
| | - Jeffrey D Wayne
- Department of Surgical Oncology, Northwestern University Feinberg School of Medicine, 251 East Huron Street, Chicago, IL, 60611, USA.,Department of Dermatology, Northwestern University Feinberg School of Medicine, 676 North St. Clair Street, Suite 1600, Chicago, IL, 60611, USA.,Skin Cancer Institute, Northwestern University, Lurie Comprehensive Cancer Center, 420 East Superior Street, Chicago, IL, 60611, USA
| | - Keith A Delman
- Department of Surgery, Emory University Winship Cancer Institute, 1364 Clifton Road NE, Atlanta, GA, 30322, USA
| | - David H Lawson
- Department of Hematology and Medical Oncology, Emory University Winship Cancer Institute, 550 Peachtree Street NE, Atlanta, GA, 30308, USA
| | - Pedram Gerami
- Skin Cancer Institute, Northwestern University, Lurie Comprehensive Cancer Center, 420 East Superior Street, Chicago, IL, 60611, USA. .,Departments of Dermatology and Pathology, Northwestern University Feinberg School of Medicine, 676 North St. Clair Street, Arkes 1600, Chicago, IL, 60611, USA.
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Schuitevoerder D, Heath M, Cook RW, Covington KR, Fortino J, Leachman S, Vetto JT. Impact of Gene Expression Profiling on Decision-Making in Clinically Node Negative Melanoma Patients after Surgical Staging. J Drugs Dermatol 2018; 17:196-199. [PMID: 29462228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
INTRODUCTION The surgeon's role in the follow-up of pathologic stage I and II melanoma patients has traditionally been minimal. Melanoma genetic expression profile (GEP) testing provides binary risk assessment (Class 1-low risk, Class 2-high risk), which can assist in predicting metastasis and formulating appropriate follow up. We sought to determine the impact of GEP results on the management of clinically node negative cutaneous melanoma patients staged with sentinel lymph node biopsy (SLNB). METHODS A retrospective review of prospectively gathered data consisting of patients seen from September 2015 - August 2016 was performed to determine whether GEP class influenced follow-up recommendations. Patients were stratified into four groups based on recommended follow-up plan: Dermatology alone, Surgical Oncology, Surgical Oncology with recommendation for adjuvant clinical trial, or Medical and Surgical Oncology. RESULTS Of ninety-one patients, 38 were pathologically stage I, 42 stage II, 10 stage III, and 1 stage IV. Combining all stages, GEP Class 1 patients were more likely to be followed by Dermatology alone and less like to be followed by Surgical Oncology with recommendation for adjuvant trial compared to Class 2 patients (P less than 0.001). Among stage 1 patients, Class 1 were more likely to follow up with Dermatology alone compared to Class 2 patients (82 vs. 0%; P less than 0.001). Among stage II patients, GEP Class 1 were more likely to follow up with Dermatology alone (21 vs 0%) and more Class 2 patients followed up with surgery and recommendations for adjuvant trial (36 vs 64%; P less than 0.05). There was no difference in follow up for stage III patients based on the GEP results (P=0.76). CONCLUSION GEP results were significantly associated with the management of stage I-II melanoma patients after staging with SLNB. For node negative patients, Class 2 results led to more aggressive follow up and management. J Drugs Dermatol. 2018;17(2):196-199.
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Hsueh EC, DeBloom JR, Lee J, Sussman JJ, Covington KR, Middlebrook B, Johnson C, Cook RW, Slingluff CL, McMasters KM. Erratum to: Interim analysis of survival in a prospective, multi-center registry cohort of cutaneous melanoma tested with a prognostic 31-gene expression profile test. J Hematol Oncol 2017; 10:160. [PMID: 28982385 PMCID: PMC5628449 DOI: 10.1186/s13045-017-0524-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 09/14/2017] [Indexed: 11/10/2022] Open
Affiliation(s)
- Eddy C Hsueh
- Department of Surgery, St. Louis University, St. Louis, MO, USA
| | | | - Jonathan Lee
- Northside Melanoma and Sarcoma Specialists of Georgia, Atlanta, GA, USA
| | - Jeffrey J Sussman
- Department of Surgery, University of Cincinnati Cancer Institute, Cincinnati, OH, USA
| | - Kyle R Covington
- Castle Biosciences, Inc., 820 S. Friendswood Drive Suite 201, Friendswood, TX, USA
| | - Brooke Middlebrook
- Castle Biosciences, Inc., 820 S. Friendswood Drive Suite 201, Friendswood, TX, USA
| | - Clare Johnson
- Castle Biosciences, Inc., 820 S. Friendswood Drive Suite 201, Friendswood, TX, USA
| | - Robert W Cook
- Castle Biosciences, Inc., 820 S. Friendswood Drive Suite 201, Friendswood, TX, USA.
| | - Craig L Slingluff
- Department of Surgery and Cancer Center, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Kelly M McMasters
- Department of Surgical Oncology, James Graham Brown Cancer Center, University of Louisville School of Medicine, Louisville, KY, USA
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Hsueh EC, DeBloom JR, Lee J, Sussman JJ, Covington KR, Middlebrook B, Johnson C, Cook RW, Slingluff CL, McMasters KM. Interim analysis of survival in a prospective, multi-center registry cohort of cutaneous melanoma tested with a prognostic 31-gene expression profile test. J Hematol Oncol 2017; 10:152. [PMID: 28851416 PMCID: PMC5576286 DOI: 10.1186/s13045-017-0520-1] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 08/18/2017] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND A 31-gene expression profile (GEP) test that provides risk classification of cutaneous melanoma (CM) patients has been validated in several retrospective studies. The objective of the reported study was a prospective evaluation of the GEP performance in patients enrolled in two clinical registries. METHODS Three-hundred twenty two CM patients enrolled in the EXPAND (NCT02355587) and INTEGRATE (NCT02355574) registries met the criteria of age ≥ 16 years, successful GEP result and ≥1 follow-up visit for inclusion in this interim analysis. Primary endpoints were recurrence-free (RFS), distant metastasis-free (DMFS), and overall survival (OS). RESULTS Median follow-up was 1.5 years for event-free patients. Median age for subjects was 58 years (range 18-87) and median Breslow thickness was 1.2 mm (range 0.2-12.0). Eighty-eight percent (282/322) of cases had stage I/II disease and 74% (237/322) had a SLN biopsy. Seventy-seven percent (248/322) had class 1 molecular profiles. 1.5-year RFS, DMFS, and OS rates were 97 vs. 77%, 99 vs. 89%, and 99 vs. 92% for class 1 vs. class 2, respectively (p < 0.0001 for each). Multivariate Cox regression showed Breslow thickness, mitotic rate, and GEP class to significantly predict recurrence (p < 0.01), while tumor thickness was the only significant predictor of distant metastasis and overall survival in this interim analysis. CONCLUSIONS Interim analysis of patient outcomes from a combined prospective cohort supports the 31-gene GEP's ability to stratify early-stage CM patients into two groups with significantly different metastatic risk. RFS outcomes in this real-world cohort are consistent with previously published analyses with retrospective specimens. GEP testing complements current clinicopathologic features and increases identification of high-risk patients. TRIAL REGISTRATION ClinicalTrials.gov, NCT02355574 and NCT02355587.
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Affiliation(s)
- Eddy C. Hsueh
- Dept. of Surgery, St. Louis University, St. Louis, MO USA
| | | | - Jonathan Lee
- Northside Melanoma and Sarcoma Specialists of Georgia, Atlanta, GA USA
| | - Jeffrey J. Sussman
- Dept. of Surgery, University of Cincinnati Cancer Institute, Cincinnati, OH USA
| | - Kyle R. Covington
- Castle Biosciences, Inc., 820 S. Friendswood Drive Suite 201, Friendswood, TX USA
| | - Brooke Middlebrook
- Castle Biosciences, Inc., 820 S. Friendswood Drive Suite 201, Friendswood, TX USA
| | - Clare Johnson
- Castle Biosciences, Inc., 820 S. Friendswood Drive Suite 201, Friendswood, TX USA
| | - Robert W. Cook
- Castle Biosciences, Inc., 820 S. Friendswood Drive Suite 201, Friendswood, TX USA
| | - Craig L. Slingluff
- Dept. of Surgery and Cancer Center, University of Virginia School of Medicine, Charlottesville, VA USA
| | - Kelly M. McMasters
- Dept. of Surgical Oncology, James Graham Brown Cancer Center, University of Louisville School of Medicine, Louisville, KY USA
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Plasseraud KM, Wilkinson JK, Oelschlager KM, Poteet TM, Cook RW, Stone JF, Monzon FA. Gene expression profiling in uveal melanoma: technical reliability and correlation of molecular class with pathologic characteristics. Diagn Pathol 2017; 12:59. [PMID: 28778171 PMCID: PMC5545042 DOI: 10.1186/s13000-017-0650-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [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: 04/18/2017] [Accepted: 07/24/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND A 15-gene expression profile test has been clinically validated and is widely utilized in newly diagnosed uveal melanoma (UM) patients to assess metastatic potential of the tumor. As most patients are treated with eye-sparing radiotherapy, there is limited tumor tissue available for testing, and technical reliability and success of prognostic testing are critical. This study assessed the analytical performance of the 15-gene expression test for UM and the correlation of molecular class with pathologic characteristics. METHODS Inter-assay, intra-assay, inter-instrument/operator, and inter-site experiments were conducted, and concordance of the 15-gene expression profile test results and associated discriminant scores for matched tumor samples were evaluated. Technical success was determined from de-identified clinical reports from January 2010 - May 2016. Pathologic characteristics of enucleated tumors were correlated with molecular class results. RESULTS Inter-assay concordance on 16 samples run on 3 consecutive days was 100%, and matched discriminant scores were strongly correlated (R2 = 0.9944). Inter-assay concordance of 46 samples assayed within a one year period was 100%, with an R2 value of 0.9747 for the discriminant scores. Intra-assay concordance of 12 samples run concurrently in duplicates was 100%; discriminant score correlation yielded an R2 of 0.9934. Concordance between two sites assessing the same tumors was 100% with an R2 of 0.9818 between discriminant scores. Inter-operator/instrument concordance was 96% for Class 1/2 calls and 90% for Class 1A/1B calls, and the discriminant scores had a correlation R2 of 0.9636. Technical success was 96.3% on 5516 samples tested since 2010. Increased largest basal diameter and thickness were significantly associated with Class 1B and Class 2 vs. Class 1A signatures. CONCLUSIONS These results show that the 15-gene expression profile test for UM has robust, reproducible performance characteristics. The technical success rate during clinical testing remains as high as first reported during validation. As molecular testing becomes more prevalent for supporting precision medicine efforts, high technical success and reliability are key characteristics when testing such limited and precious samples. The performance of the 15-gene expression profile test in this study should provide confidence to physicians who use the test's molecular classification to inform patient management decisions.
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Affiliation(s)
- Kristen M Plasseraud
- Castle Biosciences, Inc., 820 S. Friendswood Drive, Suite 201, Friendswood, TX, 77546, USA
| | - Jeff K Wilkinson
- Castle Biosciences Laboratory, 3737 N. 7th St, Suite 160, Phoenix, AZ, 85014, USA
| | | | - Trisha M Poteet
- Castle Biosciences Laboratory, 3737 N. 7th St, Suite 160, Phoenix, AZ, 85014, USA
| | - Robert W Cook
- Castle Biosciences, Inc., 820 S. Friendswood Drive, Suite 201, Friendswood, TX, 77546, USA
| | - John F Stone
- Castle Biosciences Laboratory, 3737 N. 7th St, Suite 160, Phoenix, AZ, 85014, USA
| | - Federico A Monzon
- Castle Biosciences, Inc., 820 S. Friendswood Drive, Suite 201, Friendswood, TX, 77546, USA.
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Cook RW, Abraham LA, McCowan CI. Disseminated peripheral neuroblastoma in a Rhodesian Ridgeback dog. Aust Vet J 2017; 95:129-133. [PMID: 28346666 DOI: 10.1111/avj.12565] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 01/27/2016] [Accepted: 03/13/2016] [Indexed: 11/30/2022]
Abstract
CASE REPORT A 4-year-old neutered male Rhodesian Ridgeback dog with right-sided Horner's syndrome, bilateral laryngeal paralysis, neck pain and bilateral hindlimb ataxia was euthanased following deterioration of its neurological status. Necropsy examination revealed an off-white retropharyngeal neoplastic mass (100 × 30 × 30 mm) attached to the base of the skull on the right side and macroscopic nodular metastases in the spleen and three vertebral bodies (C6, C7 and T6), including a nodule attached to the dura at C7. Histological evidence of neuroblastic tumour was detected in these macroscopic lesions, a regional lymph node, bone marrow of a femur and all 15 vertebral bodies (C1-T8) examined, including the three with macroscopic metastases, and in the lumens of small blood vessels in the lungs and liver. Ganglion cell differentiation was detected only in the primary retropharyngeal mass, one splenic nodule and the C7 dural nodule. Neoplastic cells were immunoreactive to neurofilament protein (ganglion cells only), vimentin and synaptophysin, and were negative for S100 protein, GFAP, CD3 and Pax5. CONCLUSION The diagnosis was disseminated peripheral neuroblastoma, differentiating subtype (International Neuroblastoma Pathology Classification), with likely primary involvement of the right cranial cervical ganglion. This appears to be the first report of neuroblastoma in a dog with widespread occult haematogenous metastasis to bone marrow.
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Affiliation(s)
- R W Cook
- Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Werribee, Victoria, Australia
| | - L A Abraham
- Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Werribee, Victoria, Australia
| | - C I McCowan
- Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Werribee, Victoria, Australia
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Ferris LK, Farberg AS, Middlebrook B, Johnson CE, Lassen N, Oelschlager KM, Maetzold DJ, Cook RW, Rigel DS, Gerami P. Identification of high-risk cutaneous melanoma tumors is improved when combining the online American Joint Committee on Cancer Individualized Melanoma Patient Outcome Prediction Tool with a 31-gene expression profile-based classification. J Am Acad Dermatol 2017; 76:818-825.e3. [PMID: 28110997 DOI: 10.1016/j.jaad.2016.11.051] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 11/16/2016] [Accepted: 11/20/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND A significant proportion of patients with American Joint Committee on Cancer (AJCC)-defined early-stage cutaneous melanoma have disease recurrence and die. A 31-gene expression profile (GEP) that accurately assesses metastatic risk associated with primary cutaneous melanomas has been described. OBJECTIVE We sought to compare accuracy of the GEP in combination with risk determined using the web-based AJCC Individualized Melanoma Patient Outcome Prediction Tool. METHODS GEP results from 205 stage I/II cutaneous melanomas with sufficient clinical data for prognostication using the AJCC tool were classified as low (class 1) or high (class 2) risk. Two 5-year overall survival cutoffs (AJCC 79% and 68%), reflecting survival for patients with stage IIA or IIB disease, respectively, were assigned for binary AJCC risk. RESULTS Cox univariate analysis revealed significant risk classification of distant metastasis-free and overall survival (hazard ratio range 3.2-9.4, P < .001) for both tools. In all, 43 (21%) cases had discordant GEP and AJCC classification (using 79% cutoff). Eleven of 13 (85%) deaths in that group were predicted as high risk by GEP but low risk by AJCC. LIMITATIONS Specimens reflect tertiary care center referrals; more effective therapies have been approved for clinical use after accrual. CONCLUSIONS The GEP provides valuable prognostic information and improves identification of high-risk melanomas when used together with the AJCC online prediction tool.
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Affiliation(s)
- Laura K Ferris
- Department of Dermatology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
| | | | | | | | | | | | | | | | - Darrell S Rigel
- Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York
| | - Pedram Gerami
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Robert H. Lurie Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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De Rienzo A, Cook RW, Wilkinson J, Gustafson CE, Amin W, Johnson CE, Oelschlager KM, Maetzold DJ, Stone JF, Feldman MD, Becich MJ, Yeap BY, Richards WG, Bueno R. Validation of a Gene Expression Test for Mesothelioma Prognosis in Formalin-Fixed Paraffin-Embedded Tissues. J Mol Diagn 2016; 19:65-71. [PMID: 27863259 DOI: 10.1016/j.jmoldx.2016.07.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 07/08/2016] [Accepted: 07/28/2016] [Indexed: 10/20/2022] Open
Abstract
A molecular test performed using fresh-frozen tissue was proposed for use in the prognosis of patients with pleural mesothelioma. The accuracy of the test and its properties was assessed under Clinical Laboratory Improvement Amendments-approved guidelines using FFPE tissue from an independent multicenter patient cohort. Concordance studies were performed using matched frozen and FFPE mesothelioma samples. The prognostic value of the test was evaluated in an independent validation cohort of 73 mesothelioma patients who underwent surgical resection. FFPE-based classification demonstrated overall high concordance (83%) with the matched frozen specimens, on removal of cases with low confidence scores, showing sensitivity and specificity in predicting type B classification (poor outcome) of 43% and 98%, respectively. Concordance between research and clinical methods increased to 87% on removal of low confidence cases. Median survival times in the validation cohort were 18 and 7 months in type A and type B cases, respectively (P = 0.002). Multivariate classification adding pathologic staging information to the gene expression score resulted in significant stratification of risk groups. The median survival times were 52 and 14 months in the low-risk (class 1) and intermediate-risk (class 2) groups, respectively. The prognostic molecular test for mesothelioma can be performed on FFPE tissues to predict survival, and can provide an orthogonal tool, in combination with established pathologic parameters, for risk evaluation.
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Affiliation(s)
- Assunta De Rienzo
- Thoracic Surgery Oncology Laboratory and the International Mesothelioma Program, Division of Thoracic Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | | | - Jeff Wilkinson
- DNA Diagnostics Laboratory, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Corinne E Gustafson
- Thoracic Surgery Oncology Laboratory and the International Mesothelioma Program, Division of Thoracic Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Waqas Amin
- National Mesothelioma Virtual Bank, Pittsburgh, Pennsylvania; Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | | | | | - John F Stone
- DNA Diagnostics Laboratory, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Michael D Feldman
- National Mesothelioma Virtual Bank, Pittsburgh, Pennsylvania; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michael J Becich
- National Mesothelioma Virtual Bank, Pittsburgh, Pennsylvania; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Beow Y Yeap
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - William G Richards
- Thoracic Surgery Oncology Laboratory and the International Mesothelioma Program, Division of Thoracic Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Raphael Bueno
- Thoracic Surgery Oncology Laboratory and the International Mesothelioma Program, Division of Thoracic Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
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Cook RW, Bingham J, Besier AS, Bayley CL, Hawes M, Shearer PL, Yamada M, Bergfeld J, Williams DT, Middleton DJ. Atypical scrapie in Australia. Aust Vet J 2016; 94:452-455. [PMID: 27807855 DOI: 10.1111/avj.12529] [Citation(s) in RCA: 17] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 03/06/2016] [Accepted: 04/14/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND Since its initial detection in Norway in 1998, atypical scrapie ('atypical/Nor98 scrapie') has been reported in sheep in the majority of European countries (including in regions free of classical scrapie) and in the Falkland Islands, the USA, Canada, New Zealand and Australia. CASE SERIES The diagnosis in Australia of atypical scrapie in four Merino and one Merino-cross sheep showing clinical signs of neurological disease was based on the detection of grey matter neuropil vacuolation (spongiform change) in the brain (particularly in the molecular layer of the cerebellar cortex) and associated abnormal prion protein (PrPSc ) deposition in both grey and white matter. Changes were minimal in the caudal brainstem, the predilection site for lesions of classical scrapie. CONCLUSION The distinctive lesion profile of atypical scrapie in these five sheep highlights the diagnostic importance of routine histological evaluation of the cerebellum for evidence of neuropil vacuolation and associated PrPSc deposition in adult sheep with suspected neurological disease.
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Affiliation(s)
- R W Cook
- Regional Veterinary Laboratory, NSW Department of Primary Industries, Wollongbar, New South Wales 2480, Australia
| | - J Bingham
- CSIRO, Australian Animal Health Laboratory, Geelong, Victoria, Australia
| | - A S Besier
- Animal Health Laboratories, Department of Agriculture and Food, South Perth, Western Australia, Australia
| | - C L Bayley
- Gribbles Veterinary Pathology, Clayton, Victoria, Australia
| | - M Hawes
- Department of Economic Development, AgriBio Centre, Bundoora, Victoria, Australia
| | - P L Shearer
- Elizabeth Macarthur Agricultural Institute, NSW Department of Primary Industries, Menangle, New South Wales, Australia
| | - M Yamada
- CSIRO, Australian Animal Health Laboratory, Geelong, Victoria, Australia
| | - J Bergfeld
- CSIRO, Australian Animal Health Laboratory, Geelong, Victoria, Australia
| | - D T Williams
- CSIRO, Australian Animal Health Laboratory, Geelong, Victoria, Australia
| | - D J Middleton
- CSIRO, Australian Animal Health Laboratory, Geelong, Victoria, Australia
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Berger AC, Davidson RS, Poitras JK, Chabra I, Hope R, Brackeen A, Johnson CE, Maetzold DJ, Middlebrook B, Oelschlager KM, Cook RW, Monzon FA, Miller AR. Clinical impact of a 31-gene expression profile test for cutaneous melanoma in 156 prospectively and consecutively tested patients. Curr Med Res Opin 2016; 32:1599-604. [PMID: 27210115 DOI: 10.1080/03007995.2016.1192997] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Revised: 05/17/2016] [Accepted: 05/18/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE DecisionDx-Melanoma * is a 31-gene expression profile test that predicts the risk of metastasis in patients with primary cutaneous melanoma (CM). This study was designed to ascertain clinical management changes determined by the test outcome, which classifies CM patients being at low (Class 1) or high (Class 2) risk for recurrence. RESEARCH DESIGN AND METHODS Medical charts were reviewed from 156 CM patients from six institutions (three dermatology and three surgical oncology practices) who were consecutively tested between May 2013 and December 2015. Clinical management data that were compiled and compared before and after receipt of the 31-gene expression test result included frequency of physical exams, frequency and modality of imaging, and referrals to surgical and medical oncologists. RESULTS Forty-two percent of patients were Stage I, 47% were Stage II and 8% were Stage III. Overall, 95 patients (61%) were Class 1 and 61 (39%) were Class 2. Documented changes in management were observed in 82 (53%) patients, with the majority of Class 2 patients (77%) undergoing management changes compared to 37% of Class 1 patients (p < 0.0001 by Fisher's exact test). The majority (77/82, 94%) of these changes were concordant with the risk indicated by the test result (p < 0.0001 by Fisher's exact test), with increased management intensity for Class 2 patients and reduced management intensity for Class 1 patients. CONCLUSIONS Molecular risk classification by gene expression profiling has clinical impact and influences physicians to direct clinical management of CM patients. The vast majority of the changes implemented after the receipt of test results were reflective of the low or high recurrence risk associated with the patient's molecular classification. Because follow-up data was not collected for this patient cohort, the study is limited for the assessment of the impact of gene expression profile based management changes on healthcare resource utilization and patient outcome.
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Affiliation(s)
- Adam C Berger
- a Thomas Jefferson University Hospital , Philadelphia , PA , USA
| | | | | | | | - Richard Hope
- e Lubbock Dermatology and Skin Cancer Center , Lubbock , TX , USA
| | - Amy Brackeen
- e Lubbock Dermatology and Skin Cancer Center , Lubbock , TX , USA
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Plasseraud KM, Cook RW, Tsai T, Shildkrot Y, Middlebrook B, Maetzold D, Wilkinson J, Stone J, Johnson C, Oelschlager K, Aaberg TM. Clinical Performance and Management Outcomes with the DecisionDx-UM Gene Expression Profile Test in a Prospective Multicenter Study. J Oncol 2016; 2016:5325762. [PMID: 27446211 PMCID: PMC4944073 DOI: 10.1155/2016/5325762] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 05/04/2016] [Accepted: 05/12/2016] [Indexed: 12/31/2022]
Abstract
Uveal melanoma management is challenging due to its metastatic propensity. DecisionDx-UM is a prospectively validated molecular test that interrogates primary tumor biology to provide objective information about metastatic potential that can be used in determining appropriate patient care. To evaluate the continued clinical validity and utility of DecisionDx-UM, beginning March 2010, 70 patients were enrolled in a prospective, multicenter, IRB-approved study to document patient management differences and clinical outcomes associated with low-risk Class 1 and high-risk Class 2 results indicated by DecisionDx-UM testing. Thirty-seven patients in the prospective study were Class 1 and 33 were Class 2. Class 1 patients had 100% 3-year metastasis-free survival compared to 63% for Class 2 (log rank test p = 0.003) with 27.3 median follow-up months in this interim analysis. Class 2 patients received significantly higher-intensity monitoring and more oncology/clinical trial referrals compared to Class 1 patients (Fisher's exact test p = 2.1 × 10(-13) and p = 0.04, resp.). The results of this study provide additional, prospective evidence in an independent cohort of patients that Class 1 and Class 2 patients are managed according to the differential metastatic risk indicated by DecisionDx-UM. The trial is registered with Clinical Application of DecisionDx-UM Gene Expression Assay Results (NCT02376920).
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Affiliation(s)
| | | | - Tony Tsai
- Retinal Consultants, Sacramento, CA 95819, USA
| | | | | | | | | | - John Stone
- Castle Biosciences, Friendswood, TX 77546, USA
| | | | | | - Thomas M. Aaberg
- Michigan State University Medical School and Retina Specialists of Michigan, Grand Rapids, MI 49546, USA
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Meldi K, Cook RW, Tsai T, Shildkrot Y, Middlebrook B, Maetzold D, Johnson C, Oelschlager KM, Aaberg T. A prospective, multi-center study to evaluate the performance and clinical utility of a 15-gene expression profile for uveal melanoma. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.9575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | | | - Thomas Aaberg
- Retina Specialists of Michigan and Michigan State University Medical School, Grand Rapids, MI
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Berger AC, Miller AR, Chabra I, Davidson RS, Hope R, Brackeen A, Poitras JK, Oelschlager KM, Cook RW, Johnson C, Monzon FA. Impact of prognostic genomic classification of melanoma with a 31-gene expression profile on clinical decision-making in a retrospective cohort. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e21066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Adam C. Berger
- Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, PA
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