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Ko J, Roze des Ordons A, Ballard M, Shenkier T, Simon JE, Fyles G, Lefresne S, Hawley P, Chen C, McKenzie M, Sanders J, Bernacki R. Exploring the value of structured narrative feedback within the Serious Illness Conversation-Evaluation Exercise (SIC-Ex): a qualitative analysis. BMJ Open 2024; 14:e078385. [PMID: 38286701 PMCID: PMC10826582 DOI: 10.1136/bmjopen-2023-078385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 01/11/2024] [Indexed: 01/31/2024] Open
Abstract
OBJECTIVES The Serious Illness Conversation Guide (SICG) has emerged as a framework for conversations with patients with a serious illness diagnosis. This study reports on narratives generated from open-ended questions of a novel assessment tool, the Serious Illness Conversation-Evaluation Exercise (SIC-Ex), to assess resident-led conversations with patients in oncology outpatient clinics. DESIGN Qualitative study using template analysis. SETTING Three academic cancer centres in Canada. PARTICIPANTS 7 resident physicians (trainees), 7 patients from outpatient cancer clinics, 10 preceptors (raters) consisting of medical oncologists, palliative care physicians and radiation oncologists. INTERVENTIONS Each trainee conducted an SIC with a patient, which was videotaped. The raters watched the videos and evaluated each trainee using the novel SIC-Ex and the reference Calgary-Cambridge Guide (CCG) initially and again 3 months later. Two independent coders used template analysis to code the raters' narrative comments and identify themes/subthemes. OUTCOME MEASURES How narrative comments aligned with elements of the CCG and SICG. RESULTS Template analysis yielded four themes: adhering to SICG, engaging patients and family members, conversation management and being mindful of demeanour. Narrative comments identified numerous verbal and non-verbal elements essential to SICG. Some comments addressing general skills in engaging patients/families and managing the conversation (eg, setting agenda, introduction, planning, exploring, non-verbal communication) related to both the CCG and SICG, whereas other comments such as identifying substitute decision maker(s), affirming commitment and introducing Advance Care Planning were specific to the SICG. CONCLUSIONS Narrative comments generated by SIC-Ex provided detailed and nuanced insights into trainees' competence in SIC, beyond the numerical ratings of SIC-Ex and the general communication skills outlined in the CCG, and may contribute to a more fulsome assessment of SIC skills.
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Affiliation(s)
- Jenny Ko
- Department of Medical Oncology, BC Cancer Agency Abbostford Centre, Abbotsford, British Columbia, Canada
| | - Amanda Roze des Ordons
- Department of Critical Care Medicine and Division of Palliative Medicine; Department of Anesthesiology, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Mark Ballard
- Department of Internal Medicine, Chilliwack General Hospital, Chilliwack, British Columbia, Canada
| | - Tamara Shenkier
- Department of Medical Oncology, BC Cancer Agency Vancouver Centre, Vancouver, British Columbia, Canada
| | - Jessica E Simon
- Department of Oncology and Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Gillian Fyles
- Pain and Symptom Management/Palliative Care Program, BC Cancer Agency Sindi Ahluwalia Hawkins Centre for the Southern Interior, Kelowna, British Columbia, Canada
| | - Shilo Lefresne
- Department of Radiation Oncology, BC Cancer Agency Vancouver Centre, Vancouver, British Columbia, Canada
| | - Philippa Hawley
- Department of Palliative Care, BC Cancer Agency, Vancouver, British Columbia, Canada
| | - Charlie Chen
- Department of Oncology and Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Michael McKenzie
- Department of Radiation Oncology, BC Cancer Agency Vancouver Centre, Vancouver, British Columbia, Canada
| | - Justin Sanders
- Department of Palliative Care, McGill University, Montreal, Quebec, Canada
| | - Rachelle Bernacki
- Department of Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
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2
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Zaikova E, Cheng BYC, Cerda V, Kong E, Lai D, Lum A, Bates C, den Brok W, Kono T, Bourque S, Chan A, Feng X, Fenton D, Gurjal A, Levasseur N, Lohrisch C, Roberts S, Shenkier T, Simmons C, Taylor S, Villa D, Miller R, Aguirre-Hernandez R, Aparicio S, Gelmon K. Circulating tumour mutation detection in triple-negative breast cancer as an adjunct to tissue response assessment. NPJ Breast Cancer 2024; 10:3. [PMID: 38182588 PMCID: PMC10770342 DOI: 10.1038/s41523-023-00607-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 12/02/2023] [Indexed: 01/07/2024] Open
Abstract
Circulating tumour DNA (ctDNA) detection via liquid biopsy is an emerging alternative to tissue biopsy, but its potential in treatment response monitoring and prognosis in triple negative breast cancer (TNBC) is not yet well understood. Here we determined the prevalence of actionable mutations detectable in ctDNA using a clinically validated cancer gene panel assay in patients with TNBC, without recurrence at the time of study entry. Sequencing of plasma DNA and validation of variants from 130 TNBC patients collected within 7 months of primary treatment completion revealed that 7.7% had detectable residual disease with a hotspot panel. Among neoadjuvant treated patients, we observed a trend where patients with incomplete pathologic response and positive ctDNA within 7 months of treatment completion were at much higher risk of reduced progression free survival. We propose that a high risk subset of early TNBC patients treated in neoadjuvant therapy protocols may be identifiable by combining tissue response and sensitive ctDNA detection.
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Affiliation(s)
- Elena Zaikova
- Molecular Oncology, BC Cancer, 675 W10th Avenue, Vancouver, Canada
| | - Brian Y C Cheng
- Molecular Oncology, BC Cancer, 675 W10th Avenue, Vancouver, Canada
| | - Viviana Cerda
- Molecular Oncology, BC Cancer, 675 W10th Avenue, Vancouver, Canada
| | - Esther Kong
- Molecular Oncology, BC Cancer, 675 W10th Avenue, Vancouver, Canada
| | - Daniel Lai
- Molecular Oncology, BC Cancer, 675 W10th Avenue, Vancouver, Canada
| | - Amy Lum
- Molecular Oncology, BC Cancer, 675 W10th Avenue, Vancouver, Canada
| | - Cherie Bates
- Molecular Oncology, BC Cancer, 675 W10th Avenue, Vancouver, Canada
| | - Wendie den Brok
- Medical Oncology, BC Cancer, 600 W10th Avenue, Vancouver, Canada
| | - Takako Kono
- Molecular Oncology, BC Cancer, 675 W10th Avenue, Vancouver, Canada
| | - Sylvie Bourque
- Medical Oncology, BC Cancer, 13750 96 Ave, Surrey, Canada
| | - Angela Chan
- Medical Oncology, BC Cancer, 13750 96 Ave, Surrey, Canada
| | - Xioalan Feng
- Medical Oncology, BC Cancer, 2410 Lee Ave, Victoria, Canada
| | - David Fenton
- Medical Oncology, BC Cancer, 2410 Lee Ave, Victoria, Canada
| | - Anagha Gurjal
- Medical Oncology, BC Cancer, 32900 Marshall Rd, Abbotsford, Canada
| | | | | | - Sarah Roberts
- Medical Oncology, BC Cancer, 1215 Lethbridge St, Prince George, Canada
| | - Tamara Shenkier
- Medical Oncology, BC Cancer, 600 W10th Avenue, Vancouver, Canada
| | | | - Sara Taylor
- Medical Oncology, BC Cancer, 399 Royal Ave, Kelowna, Canada
| | - Diego Villa
- Medical Oncology, BC Cancer, 600 W10th Avenue, Vancouver, Canada
| | - Ruth Miller
- Imagia Canexia Health, 204-2389 Health Sciences Mall, Vancouver, Canada
| | | | - Samuel Aparicio
- Molecular Oncology, BC Cancer, 675 W10th Avenue, Vancouver, Canada.
| | - Karen Gelmon
- Medical Oncology, BC Cancer, 600 W10th Avenue, Vancouver, Canada.
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3
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Le D, Ingledew PA, Shenkier T, Brain A. 143: Virtual Health in Cancer Care: Results from a Semi-Structured Interview –Survey of Oncology Health Care Providers. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)08857-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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4
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Sawatzky B, Edwards CM, Walters-Shumka AT, Standfield S, Shenkier T, Harris SR. A perspective on adverse health outcomes after breast cancer treatment in women with spinal cord injury. Spinal Cord 2021; 59:700-704. [PMID: 33828245 DOI: 10.1038/s41393-021-00628-2] [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: 09/04/2020] [Revised: 11/17/2020] [Accepted: 11/19/2020] [Indexed: 01/31/2023]
Abstract
Aging women face increased risks of both breast cancer and spinal cord injury (SCI). Unique treatment challenges for this population warrant consideration. Despite advances in breast cancer treatments, significant adverse health outcomes continue to occur. Cancer treatments can be detrimental to the quality of life of able-bodied women, but more so for women living with pre-existing SCI. The goal of this Perspective Paper is to inform rehabilitation professionals about the needs of women with SCI treated for breast cancer. Specific objectives were: (1) give an overview of breast cancer treatment-related adverse outcomes that need special attention in women with SCI; and (2) inspire researchers to study the consequences of breast cancer-related health conditions in women with SCI. We identified SCI-specific considerations for undergoing breast cancer surgery, chemotherapy, radiation and endocrine therapy. This paper attempts to raise awareness regarding these issues due to the lack of research attention they have received.
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Affiliation(s)
- Bonita Sawatzky
- Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada. .,International Collaboration on Repair Discoveries, Vancouver, BC, Canada.
| | - Celine M Edwards
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | | | - Shira Standfield
- School of Architecture and Landscape Architecture, University of British Columbia, Vancouver, BC, Canada
| | - Tamara Shenkier
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada.,Medical Oncology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Susan R Harris
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
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5
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Ko JJ, Ballard MS, Shenkier T, Simon J, Roze des Ordons A, Fyles G, Lefresne S, Hawley P, Chen C, McKenzie M, Ghement I, Sanders JJ, Bernacki R, Jones S. Serious Illness Conversation-Evaluation Exercise: A Novel Assessment Tool for Residents Leading Serious Illness Conversations. Palliat Med Rep 2020; 1:280-290. [PMID: 34223487 PMCID: PMC8241377 DOI: 10.1089/pmr.2020.0086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2020] [Indexed: 11/28/2022] Open
Abstract
Background/Objectives: The serious illness conversation (SIC) is an evidence-based framework for conversations with patients about a serious illness diagnosis. The objective of our study was to develop and validate a novel tool, the SIC-evaluation exercise (SIC-Ex), to facilitate assessment of resident-led conversations with oncology patients. Design: We developed the SIC-Ex based on SIC and on the Royal College of Canada Medical Oncology milestones. Seven resident trainees and 10 evaluators were recruited. Each trainee conducted an SIC with a patient, which was videotaped. The evaluators watched the videos and evaluated each trainee by using the novel SIC-Ex and the reference Calgary-Cambridge guide (CCG) at months zero and three. We used Kane's validity framework to assess validity. Results: Intra-class correlation using average SIC-Ex scores showed a moderate level of inter-evaluator agreement (range 0.523–0.822). Most evaluators rated a particular resident similar to the group average, except for one to two evaluator outliers in each domain. Test–retest reliability showed a moderate level of consistency among SIC-Ex scores at months zero and three. Global rating at zero and three months showed fair to good/very good inter-evaluator correlation. Pearson correlation coefficients comparing total SIC-Ex and CCG scores were high for most evaluators. Self-scores by trainees did not correlate well with scores by evaluators. Conclusions: SIC-Ex is the first assessment tool that provides evidence for incorporating the SIG guide framework for evaluation of resident competence. SIC-Ex is conceptually related to, but more specific than, CCG in evaluating serious illness conversation skills.
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Affiliation(s)
- Jenny J Ko
- Department of Medical Oncology, University of British Columbia, BC Cancer-Abbotsford, Abbotsford, British Columbia, Canada
| | - Mark S Ballard
- Department of Internal Medicine, Chilliwack General Hospital, Chilliwack, British Columbia, Canada
| | - Tamara Shenkier
- Department of Medical Oncology, BC Cancer-Vancouver, Vancouver, British Columbia, Canada
| | - Jessica Simon
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada
| | | | - Gillian Fyles
- BC Centre for Palliative Care, Vancouver, British Columbia, Canada
| | - Shilo Lefresne
- Department of Radiation Oncology, BC Cancer-Vancouver, Vancouver, British Columbia, Canada
| | - Philippa Hawley
- Pain and Symptom Management/Palliative Care Program, BC Cancer-Vancouver, Vancouver, British Columbia, Canada
| | - Charlie Chen
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada
| | - Michael McKenzie
- Department of Radiation Oncology, BC Cancer-Vancouver, Vancouver, British Columbia, Canada
| | | | - Justin J Sanders
- Ariadne Labs, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Rachelle Bernacki
- Ariadne Labs, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Scott Jones
- Vancouver Coastal Health, Vancouver, British Columbia, Canada
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6
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Bland KA, Kirkham AA, Bovard J, Shenkier T, Zucker D, McKenzie DC, Davis MK, Gelmon KA, Campbell KL. Effect of Exercise on Taxane Chemotherapy-Induced Peripheral Neuropathy in Women With Breast Cancer: A Randomized Controlled Trial. Clin Breast Cancer 2019; 19:411-422. [PMID: 31601479 DOI: 10.1016/j.clbc.2019.05.013] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 05/10/2019] [Accepted: 05/24/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Chemotherapy-induced peripheral neuropathy (CIPN) is a dose-limiting adverse effect of taxanes. We sought to evaluate the effect of exercise on taxane CIPN in women with breast cancer. PATIENTS AND METHODS Women (n = 27) were randomized to immediate exercise (IE, during taxane chemotherapy) or delayed exercise (DE, after chemotherapy). Supervised aerobic, resistance, and balance training was offered 3 days a week for 8-12 weeks. CIPN symptoms and quality of life were assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ) C30 and CIPN20 (scored from 0 to 100). The percentage of participants reporting moderate to severe sensory symptoms ('3/4' or '4/4' for CIPN20 sensory items) was also evaluated, along with clinical sensory testing at the lower limb (vibration sense and pinprick). Taxane treatment adherence, including relative dose intensity, was extracted from patient medical records. Assessments occurred at: baseline (before taxane chemotherapy), pre-cycle 4 (before the final taxane cycle), the end of chemotherapy, and follow-up (10-15 weeks after chemotherapy). RESULTS No differences in the EORTC QLQ CIPN20 symptom scores were detected between groups at any time point. At pre-cycle 4, there was a significant difference between groups in patient-reported moderate to severe numbness in the toes or feet (IE: n = 1, 9%, DE: n = 7, 50%, P = .04) and impaired vibration sense in the feet (IE: n = 2, 18%, DE: n = 10, 83%, P < .01). Overall global health status/quality of life was higher in IE compared to DE at the end of chemotherapy (P = .05), yet both groups had worse CIPN20 sensory (Δ24.3 ± 4.6, P < .01) and motor symptom scores (Δ10.5 ± 1.9, P < .01) relative to baseline. By the end of chemotherapy, no differences between groups were found for moderate to severe numbness in the toes or feet (P = 1.0) or impaired vibration sense in the feet (P = .71). More IE participants received ≥ 85% relative dose intensity (IE: n = 12, 100%, DE: n = 10, 67%, P < .05). CONCLUSION Exercise may attenuate CIPN over the course of taxane chemotherapy and possibly improve taxane adherence in women with breast cancer. These findings, as well as whether exercise can attenuate CIPN by the end of taxane chemotherapy, should be confirmed in larger trials.
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Affiliation(s)
- Kelcey A Bland
- Rehabilitation Sciences, University of British Columbia, Vancouver, Canada
| | - Amy A Kirkham
- Department of Biomedical Engineering, University of Alberta, Edmonton, Canada
| | - Joshua Bovard
- School of Kinesiology, University of British Columbia, Vancouver, Canada
| | | | - David Zucker
- Swedish Cancer Institute, Swedish Medical Center, Seattle, WA
| | - Donald C McKenzie
- School of Kinesiology, University of British Columbia, Vancouver, Canada
| | - Margot K Davis
- Division of Cardiology, Gordon & Leslie Diamond Health Care Centre, University of British Columbia, Vancouver, Canada
| | | | - Kristin L Campbell
- Rehabilitation Sciences, University of British Columbia, Vancouver, Canada; Department of Physical Therapy, University of British Columbia, Vancouver, Canada.
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7
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Zadravec K, Bland KA, Kirkham AA, Bovard J, Shenkier T, Zucker D, Davis MK, McKenzie DC, Gelmon KA, Campbell KL. Adherence And Attendance During Versus After Chemotherapy In Exercise Influence On Taxane Side Effects. Med Sci Sports Exerc 2019. [DOI: 10.1249/01.mss.0000563450.54362.57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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8
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Bland KA, Kirkham AA, Bovard JM, McKenzie DC, Davis MK, Shenkier T, Gelmon KA, Zucker D, Campbell KL. Effect of Exercise During Versus After Chemotherapy for Breast Cancer on Fatigue and Quality Of Life. Med Sci Sports Exerc 2019. [DOI: 10.1249/01.mss.0000560503.59726.88] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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9
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Shenkier T, Lohrisch C, Simmons C, Dotts A, McTaggart-Cowan H, Houlihan E, Johnston C, Le D, Gelmon K, Chia S. After breast cancer: A nurse practitioner led model of care for women on adjuvant endocrine treatment. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz101.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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10
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Zhao EY, Shen Y, Pleasance E, Kasaian K, Leelakumari S, Jones M, Bose P, Ch'ng C, Reisle C, Eirew P, Corbett R, Mungall KL, Thiessen N, Ma Y, Schein JE, Mungall AJ, Zhao Y, Moore RA, Den Brok W, Wilson S, Villa D, Shenkier T, Lohrisch C, Chia S, Yip S, Gelmon K, Lim H, Renouf D, Sun S, Schrader KA, Young S, Bosdet I, Karsan A, Laskin J, Marra MA, Jones SJM. Homologous Recombination Deficiency and Platinum-Based Therapy Outcomes in Advanced Breast Cancer. Clin Cancer Res 2018; 23:7521-7530. [PMID: 29246904 DOI: 10.1158/1078-0432.ccr-17-1941] [Citation(s) in RCA: 100] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 08/14/2017] [Accepted: 09/26/2017] [Indexed: 11/16/2022]
Abstract
Purpose: Recent studies have identified mutation signatures of homologous recombination deficiency (HRD) in over 20% of breast cancers, as well as pancreatic, ovarian, and gastric cancers. There is an urgent need to understand the clinical implications of HRD signatures. Whereas BRCA1/2 mutations confer sensitivity to platinum-based chemotherapies, it is not yet clear whether mutation signatures can independently predict platinum response.Experimental Design: In this observational study, we sequenced tumor whole genomes (100× depth) and matched normals (60×) of 93 advanced-stage breast cancers (33 platinum-treated). We computed a published metric called HRDetect, independently trained to predict BRCA1/2 status, and assessed its capacity to predict outcomes on platinum-based chemotherapies. Clinical endpoints were overall survival (OS), total duration on platinum-based therapy (TDT), and radiographic evidence of clinical improvement (CI).Results: HRDetect predicted BRCA1/2 status with an area under the curve (AUC) of 0.94 and optimal threshold of 0.7. Elevated HRDetect was also significantly associated with CI on platinum-based therapy (AUC = 0.89; P = 0.006) with the same optimal threshold, even after adjusting for BRCA1/2 mutation status and treatment timing. HRDetect scores over 0.7 were associated with a 3-month extended median TDT (P = 0.0003) and 1.3-year extended median OS (P = 0.04).Conclusions: Our findings not only independently validate HRDetect, but also provide the first evidence of its association with platinum response in advanced breast cancer. We demonstrate that HRD mutation signatures may offer clinically relevant information independently of BRCA1/2 mutation status and hope this work will guide the development of clinical trials. Clin Cancer Res; 23(24); 7521-30. ©2017 AACR.
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Affiliation(s)
- Eric Y Zhao
- Canada's Michael Smith Genome Sciences Centre, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Yaoqing Shen
- Canada's Michael Smith Genome Sciences Centre, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Erin Pleasance
- Canada's Michael Smith Genome Sciences Centre, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Katayoon Kasaian
- Canada's Michael Smith Genome Sciences Centre, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Sreeja Leelakumari
- Canada's Michael Smith Genome Sciences Centre, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Martin Jones
- Canada's Michael Smith Genome Sciences Centre, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Pinaki Bose
- Canada's Michael Smith Genome Sciences Centre, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Carolyn Ch'ng
- Canada's Michael Smith Genome Sciences Centre, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Caralyn Reisle
- Canada's Michael Smith Genome Sciences Centre, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Peter Eirew
- Department of Molecular Oncology, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Richard Corbett
- Canada's Michael Smith Genome Sciences Centre, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Karen L Mungall
- Canada's Michael Smith Genome Sciences Centre, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Nina Thiessen
- Canada's Michael Smith Genome Sciences Centre, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Yussanne Ma
- Canada's Michael Smith Genome Sciences Centre, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Jacqueline E Schein
- Canada's Michael Smith Genome Sciences Centre, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Andrew J Mungall
- Canada's Michael Smith Genome Sciences Centre, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Yongjun Zhao
- Canada's Michael Smith Genome Sciences Centre, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Richard A Moore
- Canada's Michael Smith Genome Sciences Centre, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Wendie Den Brok
- Department of Medical Oncology, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Sheridan Wilson
- Department of Medical Oncology, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Diego Villa
- Department of Medical Oncology, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Tamara Shenkier
- Department of Medical Oncology, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Caroline Lohrisch
- Department of Medical Oncology, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Stephen Chia
- Department of Medical Oncology, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Stephen Yip
- Department of Pathology and Laboratory Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Karen Gelmon
- Department of Medical Oncology, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Howard Lim
- Department of Medical Oncology, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Daniel Renouf
- Department of Medical Oncology, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Sophie Sun
- Department of Medical Oncology, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Kasmintan A Schrader
- Department of Molecular Oncology, British Columbia Cancer Agency, Vancouver, British Columbia, Canada.,Department of Medical Genetics, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Sean Young
- Canada's Michael Smith Genome Sciences Centre, British Columbia Cancer Agency, Vancouver, British Columbia, Canada.,Department of Pathology and Laboratory Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Ian Bosdet
- Canada's Michael Smith Genome Sciences Centre, British Columbia Cancer Agency, Vancouver, British Columbia, Canada.,Department of Pathology and Laboratory Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Aly Karsan
- Canada's Michael Smith Genome Sciences Centre, British Columbia Cancer Agency, Vancouver, British Columbia, Canada.,Department of Pathology and Laboratory Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Janessa Laskin
- Department of Medical Oncology, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Marco A Marra
- Canada's Michael Smith Genome Sciences Centre, British Columbia Cancer Agency, Vancouver, British Columbia, Canada.,Department of Medical Genetics, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Steven J M Jones
- Canada's Michael Smith Genome Sciences Centre, British Columbia Cancer Agency, Vancouver, British Columbia, Canada. .,Department of Medical Genetics, The University of British Columbia, Vancouver, British Columbia, Canada
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Bland KA, Kirkham AA, Bovard J, Shenkier T, Zucker D, Davis MK, McKenzie DC, Gelmon KA, Campbell KL. Effect of Exercise on Chemotherapy-Induced Peripheral Neuropathy Symptoms in Women with Breast Cancer. Med Sci Sports Exerc 2018. [DOI: 10.1249/01.mss.0000536350.37199.5c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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12
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Dosani M, Schrader KA, Nichol A, Sun S, Shenkier T, Lohn Z, Aubertin G, Tyldesley S. Severe Late Toxicity After Adjuvant Breast Radiotherapy in a Patient with a Germline Ataxia Telangiectasia Mutated Gene: Future Treatment Decisions. Cureus 2017; 9:e1458. [PMID: 28929041 PMCID: PMC5593749 DOI: 10.7759/cureus.1458] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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] [Indexed: 11/26/2022] Open
Abstract
Ataxia telangiectasia mutated (ATM) gene mutations may confer increased sensitivity to ionizing radiation and increased risk of late toxicity for cancer patients. We present the case of a 55-year-old female treated with adjuvant breast and regional nodal radiation following lumpectomy and axillary lymph node dissection for stage II invasive ductal carcinoma of the breast. She developed severe telangiectasia, fibrosis, induration, chest wall pain (with evidence of rib fractures on imaging), and painful limitation in her range of motion at the shoulder. She was subsequently found to have a likely pathogenic germline ATM gene mutation. At relapse, she elected to pursue systemic therapy alone for intracranial metastases.
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Affiliation(s)
- Maryam Dosani
- Radiation Oncology, BC Cancer Agency, Vancouver Centre
| | | | - Alan Nichol
- Radiation Oncology, BC Cancer Agency, Vancouver Centre
| | - Sophie Sun
- Hereditary Cancer Program, BC Cancer Agency, Vancouver Centre
| | | | - Zoe Lohn
- Hereditary Cancer Program, BC Cancer Agency, Vancouver Centre
| | - Gudrun Aubertin
- Hereditary Cancer Program, BC Cancer Agency, Vancouver Centre
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Zhao EY, Shen Y, Pleasance E, Kasaian K, Jones MR, Ch'ng C, Reisle C, Eirew P, Mungall K, Thiessen N, Ma Y, Fok A, Mungall AJ, Zhao Y, Moore R, Villa D, Shenkier T, Lohrisch C, Chia S, Yip S, Gelmon K, Lim H, Sun S, Schrader KA, Young S, Karsan A, Roscoe R, Laskin J, Marra MA, Jones SJ. Abstract 2473: Breast cancer whole genomes link homologous recombination deficiency (HRD) with therapeutic outcomes. Cancer Res 2017. [DOI: 10.1158/1538-7445.am2017-2473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Homologous recombination deficiency (HRD) is common in cancer - germline BRCA1 & BRCA2 mutations account for 5-10% of breast cancers and confer 85% lifetime risk. HRD cancers exhibit genomic instability and sensitivity to platinum-based therapy and PARP inhibitors. While not all causes of HRD are known, recent sequencing efforts have revealed genome-wide somatic mutation signatures that characterize the HRD genomic instability phenotype, also known as “BRCA-ness”. This provides a promising new assay to predict sensitivity to platinum-based therapy. Here, we integrate two whole-genome sequencing metrics to assess their association with therapeutic outcomes in a breast cancer cohort.
Methods: Whole-genome sequencing of 47 breast cancer tumors (100x coverage) and matched normals (60x) was performed on an Illumina HiSeq. Alignment, assembly, SNV calling, and loss of heterozygosity (LOH) detection were performed with BWA, ABySS, Strelka, and APOLLOH respectively. SNV signatures were deciphered by non-negative matrix factorization with Monte Carlo resampling. An HRD score comprised of LOH, telomeric allelic imbalance (TAI), and large scale transition (LST) counts was computed. Clinical endpoints were obtained by retrospective review of treatment and imaging reports. Analysis is ongoing in an independent validation cohort of 62 sequenced cases.
Results: The HRD-linked SNV signature was significantly associated with radiographic clinical response (CR) to platinum-based therapy (p=0.015). Logistic regression demonstrated a 59% improved odds of CR to platinum-based therapy per 1000 somatic SNVs attributed to HRD (odds ratio 1.16-2.50). Tumors carried up to 10,246 such SNVs and all patients with CR were among the top quartile. The LOH-TAI-LST score was correlated with SNV signature (r=0.6, p=7×10-6) and associated with CR (p=0.025). Notably, elevated HRD signatures associated with CR were identified in tumors with wild-type BRCA1/BRCA2 or variants of unknown significance. Tumors with above median HRD signatures were associated with a 69-day longer time to treatment failure and an 18% daily decreased probability of treatment failure per 1000 HRD-attributed SNVs (hazard ratio 0.71-0.95, p = 0.007).
Discussion: We found that HRD mutation signatures are associated with clinical response and longer time to treatment failure with platinum-based therapy. While similar benefits were observed in patients with somatic bi-allelic loss of BRCA1/BRCA2, such cases are less common (8% of our cohort) compared to those with elevated HRD signature. Thus, mutation signature methods may identify patients who stand to benefit from platinum-based therapy missed by BRCA screening alone.
Citation Format: Eric Y. Zhao, Yaoqing Shen, Erin Pleasance, Katayoon Kasaian, Martin R. Jones, Carolyn Ch'ng, Caralyn Reisle, Peter Eirew, Karen Mungall, Nina Thiessen, Yussanne Ma, Alexandra Fok, Andrew J. Mungall, Yongjun Zhao, Richard Moore, Diego Villa, Tamara Shenkier, Caroline Lohrisch, Stephen Chia, Stephen Yip, Karen Gelmon, Howard Lim, Sophie Sun, Kasmintan A. Schrader, Sean Young, Aly Karsan, Robyn Roscoe, Janessa Laskin, Marco A. Marra, Steven J. Jones. Breast cancer whole genomes link homologous recombination deficiency (HRD) with therapeutic outcomes [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 2473. doi:10.1158/1538-7445.AM2017-2473
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Affiliation(s)
- Eric Y. Zhao
- 1Canada's Michael Smith Genome Sciences Centre, Vancouver, British Columbia, Canada
| | - Yaoqing Shen
- 1Canada's Michael Smith Genome Sciences Centre, Vancouver, British Columbia, Canada
| | - Erin Pleasance
- 1Canada's Michael Smith Genome Sciences Centre, Vancouver, British Columbia, Canada
| | - Katayoon Kasaian
- 1Canada's Michael Smith Genome Sciences Centre, Vancouver, British Columbia, Canada
| | - Martin R. Jones
- 1Canada's Michael Smith Genome Sciences Centre, Vancouver, British Columbia, Canada
| | - Carolyn Ch'ng
- 1Canada's Michael Smith Genome Sciences Centre, Vancouver, British Columbia, Canada
| | - Caralyn Reisle
- 1Canada's Michael Smith Genome Sciences Centre, Vancouver, British Columbia, Canada
| | - Peter Eirew
- 2British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Karen Mungall
- 1Canada's Michael Smith Genome Sciences Centre, Vancouver, British Columbia, Canada
| | - Nina Thiessen
- 1Canada's Michael Smith Genome Sciences Centre, Vancouver, British Columbia, Canada
| | - Yussanne Ma
- 1Canada's Michael Smith Genome Sciences Centre, Vancouver, British Columbia, Canada
| | - Alexandra Fok
- 1Canada's Michael Smith Genome Sciences Centre, Vancouver, British Columbia, Canada
| | - Andrew J. Mungall
- 1Canada's Michael Smith Genome Sciences Centre, Vancouver, British Columbia, Canada
| | - Yongjun Zhao
- 1Canada's Michael Smith Genome Sciences Centre, Vancouver, British Columbia, Canada
| | - Richard Moore
- 1Canada's Michael Smith Genome Sciences Centre, Vancouver, British Columbia, Canada
| | - Diego Villa
- 2British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Tamara Shenkier
- 2British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Caroline Lohrisch
- 2British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Stephen Chia
- 2British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Stephen Yip
- 3The University of British Columbia, Vancouver, British Columbia, Canada
| | - Karen Gelmon
- 2British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Howard Lim
- 2British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Sophie Sun
- 2British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | | | - Sean Young
- 3The University of British Columbia, Vancouver, British Columbia, Canada
| | - Aly Karsan
- 1Canada's Michael Smith Genome Sciences Centre, Vancouver, British Columbia, Canada
| | - Robyn Roscoe
- 1Canada's Michael Smith Genome Sciences Centre, Vancouver, British Columbia, Canada
| | - Janessa Laskin
- 2British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Marco A. Marra
- 1Canada's Michael Smith Genome Sciences Centre, Vancouver, British Columbia, Canada
| | - Steven J. Jones
- 1Canada's Michael Smith Genome Sciences Centre, Vancouver, British Columbia, Canada
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Kridel R, Telio D, Villa D, Sehn LH, Gerrie AS, Shenkier T, Klasa R, Slack GW, Tan K, Gascoyne RD, Connors JM, Savage KJ. Diffuse large B-cell lymphoma with testicular involvement: outcome and risk of CNS relapse in the rituximab era. Br J Haematol 2016; 176:210-221. [DOI: 10.1111/bjh.14392] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 07/31/2016] [Indexed: 02/03/2023]
Affiliation(s)
- Robert Kridel
- Centre for Lymphoid Cancer; British Columbia Cancer Agency; Vancouver BC Canada
| | - David Telio
- Centre for Lymphoid Cancer; British Columbia Cancer Agency; Vancouver BC Canada
- Department of Medical Oncology; University of British Columbia; Vancouver BC Canada
| | - Diego Villa
- Centre for Lymphoid Cancer; British Columbia Cancer Agency; Vancouver BC Canada
- Department of Medical Oncology; University of British Columbia; Vancouver BC Canada
| | - Laurie H. Sehn
- Centre for Lymphoid Cancer; British Columbia Cancer Agency; Vancouver BC Canada
- Department of Medical Oncology; University of British Columbia; Vancouver BC Canada
| | - Alina S. Gerrie
- Centre for Lymphoid Cancer; British Columbia Cancer Agency; Vancouver BC Canada
- Department of Medical Oncology; University of British Columbia; Vancouver BC Canada
| | - Tamara Shenkier
- Department of Medical Oncology; University of British Columbia; Vancouver BC Canada
| | - Richard Klasa
- Centre for Lymphoid Cancer; British Columbia Cancer Agency; Vancouver BC Canada
- Department of Medical Oncology; University of British Columbia; Vancouver BC Canada
| | - Graham W. Slack
- Centre for Lymphoid Cancer; British Columbia Cancer Agency; Vancouver BC Canada
- Department of Pathology; British Columbia Cancer Agency; Vancouver BC Canada
| | - King Tan
- Centre for Lymphoid Cancer; British Columbia Cancer Agency; Vancouver BC Canada
| | - Randy D. Gascoyne
- Centre for Lymphoid Cancer; British Columbia Cancer Agency; Vancouver BC Canada
- Department of Pathology; British Columbia Cancer Agency; Vancouver BC Canada
| | - Joseph M. Connors
- Centre for Lymphoid Cancer; British Columbia Cancer Agency; Vancouver BC Canada
- Department of Medical Oncology; University of British Columbia; Vancouver BC Canada
| | - Kerry J. Savage
- Centre for Lymphoid Cancer; British Columbia Cancer Agency; Vancouver BC Canada
- Department of Medical Oncology; University of British Columbia; Vancouver BC Canada
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15
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Kansara R, Villa D, Gerrie AS, Klasa R, Shenkier T, Scott DW, Slack GW, Gascoyne RD, Connors JM, Sehn LH, Savage KJ. Site of central nervous system (CNS) relapse in patients with diffuse large B-cell lymphoma (DLBCL) by the CNS-IPI risk model. Br J Haematol 2016; 179:508-510. [PMID: 27443424 DOI: 10.1111/bjh.14229] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Roopesh Kansara
- Centre for Lymphoid Cancer and Department of Medical Oncology, British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Diego Villa
- Centre for Lymphoid Cancer and Department of Medical Oncology, British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Alina S Gerrie
- Centre for Lymphoid Cancer and Department of Medical Oncology, British Columbia Cancer Agency, Vancouver, BC, Canada.,Leukemia/Bone Marrow Transplant Program of British Columbia, British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Richard Klasa
- Centre for Lymphoid Cancer and Department of Medical Oncology, British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Tamara Shenkier
- Centre for Lymphoid Cancer and Department of Medical Oncology, British Columbia Cancer Agency, Vancouver, BC, Canada
| | - David W Scott
- Centre for Lymphoid Cancer and Department of Medical Oncology, British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Graham W Slack
- Centre for Lymphoid Cancer and Department of Pathology, British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Randy D Gascoyne
- Centre for Lymphoid Cancer and Department of Pathology, British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Joseph M Connors
- Centre for Lymphoid Cancer and Department of Medical Oncology, British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Laurie H Sehn
- Centre for Lymphoid Cancer and Department of Medical Oncology, British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Kerry J Savage
- Centre for Lymphoid Cancer and Department of Medical Oncology, British Columbia Cancer Agency, Vancouver, BC, Canada
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16
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Hapgood G, Zheng Y, Sehn LH, Villa D, Klasa R, Gerrie AS, Shenkier T, Scott DW, Gascoyne RD, Slack GW, Parsons C, Morris J, Pickles T, Connors JM, Savage KJ. Evaluation of the Risk of Relapse in Classical Hodgkin Lymphoma at Event-Free Survival Time Points and Survival Comparison With the General Population in British Columbia. J Clin Oncol 2016; 34:2493-500. [DOI: 10.1200/jco.2015.65.4194] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Studies in classical Hodgkin lymphoma (cHL) typically measure the time to events from diagnosis. We evaluated the risk of relapse at event-free survival time points in cHL and compared the risk of death to expected mortality rates in British Columbia (BC). Methods The BC Cancer Agency Lymphoid Cancer Database was screened to identify all patients age 16 to 69 years diagnosed with cHL between 1989 and 2012 treated with the chemotherapy regimen of doxorubicin, bleomycin, vinblastine, and dacarbazine (or equivalent). We compared the observed mortality to the general population using age-, sex-, and calendar period–generated expected mortality rates from BC life-tables. Relative survival was calculated using a conditional approach and expressed as a standardized mortality ratio of observed-to-expected deaths. Results One thousand four hundred two patients were identified; 749 patients were male (53%), the median age was 32 years, and 68% had advanced-stage disease. The median follow-up time was 8.4 years. Seventy-two percent of relapses occurred within the first 2 years of diagnosis. For all patients, the 5-year risk of relapse from diagnosis was 18.1% but diminished to 5.6% for patients remaining event free at 2 years. For advanced-stage patients who were event free at 2 years, the 5-year risk of relapse was only 7.6%, and for those who were event free at 3 years, it was comparable to that of limited-stage patients (4.1% v 2.5%, respectively; P = .07). Furthermore, international prognostic score ≥ 4 and bulky disease were no longer prognostic in patients who were event free at 1 year. Although the relative survival improved as patients remained in remission, it did not normalize compared with the general population. Conclusion Patients with cHL who are event free at 2 years have an excellent outcome regardless of baseline prognostic factors. All patients with cHL had an enduring increased risk of death compared with the general population.
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Affiliation(s)
- Greg Hapgood
- Greg Hapgood, Laurie H. Sehn, Diego Villa, Richard Klasa, Alina S. Gerrie, Tamara Shenkier, David W. Scott, Randy D. Gascoyne, Graham W. Slack, Joseph M. Connors, and Kerry J. Savage, British Columbia Cancer Agency Centre for Lymphoid Cancer; Yvonne Zheng, Cancer Surveillance and Outcomes, Population Oncology; Christina Parsons, James Morris, and Tom Pickles, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Yvonne Zheng
- Greg Hapgood, Laurie H. Sehn, Diego Villa, Richard Klasa, Alina S. Gerrie, Tamara Shenkier, David W. Scott, Randy D. Gascoyne, Graham W. Slack, Joseph M. Connors, and Kerry J. Savage, British Columbia Cancer Agency Centre for Lymphoid Cancer; Yvonne Zheng, Cancer Surveillance and Outcomes, Population Oncology; Christina Parsons, James Morris, and Tom Pickles, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Laurie H. Sehn
- Greg Hapgood, Laurie H. Sehn, Diego Villa, Richard Klasa, Alina S. Gerrie, Tamara Shenkier, David W. Scott, Randy D. Gascoyne, Graham W. Slack, Joseph M. Connors, and Kerry J. Savage, British Columbia Cancer Agency Centre for Lymphoid Cancer; Yvonne Zheng, Cancer Surveillance and Outcomes, Population Oncology; Christina Parsons, James Morris, and Tom Pickles, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Diego Villa
- Greg Hapgood, Laurie H. Sehn, Diego Villa, Richard Klasa, Alina S. Gerrie, Tamara Shenkier, David W. Scott, Randy D. Gascoyne, Graham W. Slack, Joseph M. Connors, and Kerry J. Savage, British Columbia Cancer Agency Centre for Lymphoid Cancer; Yvonne Zheng, Cancer Surveillance and Outcomes, Population Oncology; Christina Parsons, James Morris, and Tom Pickles, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Richard Klasa
- Greg Hapgood, Laurie H. Sehn, Diego Villa, Richard Klasa, Alina S. Gerrie, Tamara Shenkier, David W. Scott, Randy D. Gascoyne, Graham W. Slack, Joseph M. Connors, and Kerry J. Savage, British Columbia Cancer Agency Centre for Lymphoid Cancer; Yvonne Zheng, Cancer Surveillance and Outcomes, Population Oncology; Christina Parsons, James Morris, and Tom Pickles, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Alina S. Gerrie
- Greg Hapgood, Laurie H. Sehn, Diego Villa, Richard Klasa, Alina S. Gerrie, Tamara Shenkier, David W. Scott, Randy D. Gascoyne, Graham W. Slack, Joseph M. Connors, and Kerry J. Savage, British Columbia Cancer Agency Centre for Lymphoid Cancer; Yvonne Zheng, Cancer Surveillance and Outcomes, Population Oncology; Christina Parsons, James Morris, and Tom Pickles, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Tamara Shenkier
- Greg Hapgood, Laurie H. Sehn, Diego Villa, Richard Klasa, Alina S. Gerrie, Tamara Shenkier, David W. Scott, Randy D. Gascoyne, Graham W. Slack, Joseph M. Connors, and Kerry J. Savage, British Columbia Cancer Agency Centre for Lymphoid Cancer; Yvonne Zheng, Cancer Surveillance and Outcomes, Population Oncology; Christina Parsons, James Morris, and Tom Pickles, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - David W. Scott
- Greg Hapgood, Laurie H. Sehn, Diego Villa, Richard Klasa, Alina S. Gerrie, Tamara Shenkier, David W. Scott, Randy D. Gascoyne, Graham W. Slack, Joseph M. Connors, and Kerry J. Savage, British Columbia Cancer Agency Centre for Lymphoid Cancer; Yvonne Zheng, Cancer Surveillance and Outcomes, Population Oncology; Christina Parsons, James Morris, and Tom Pickles, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Randy D. Gascoyne
- Greg Hapgood, Laurie H. Sehn, Diego Villa, Richard Klasa, Alina S. Gerrie, Tamara Shenkier, David W. Scott, Randy D. Gascoyne, Graham W. Slack, Joseph M. Connors, and Kerry J. Savage, British Columbia Cancer Agency Centre for Lymphoid Cancer; Yvonne Zheng, Cancer Surveillance and Outcomes, Population Oncology; Christina Parsons, James Morris, and Tom Pickles, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Graham W. Slack
- Greg Hapgood, Laurie H. Sehn, Diego Villa, Richard Klasa, Alina S. Gerrie, Tamara Shenkier, David W. Scott, Randy D. Gascoyne, Graham W. Slack, Joseph M. Connors, and Kerry J. Savage, British Columbia Cancer Agency Centre for Lymphoid Cancer; Yvonne Zheng, Cancer Surveillance and Outcomes, Population Oncology; Christina Parsons, James Morris, and Tom Pickles, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Christina Parsons
- Greg Hapgood, Laurie H. Sehn, Diego Villa, Richard Klasa, Alina S. Gerrie, Tamara Shenkier, David W. Scott, Randy D. Gascoyne, Graham W. Slack, Joseph M. Connors, and Kerry J. Savage, British Columbia Cancer Agency Centre for Lymphoid Cancer; Yvonne Zheng, Cancer Surveillance and Outcomes, Population Oncology; Christina Parsons, James Morris, and Tom Pickles, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - James Morris
- Greg Hapgood, Laurie H. Sehn, Diego Villa, Richard Klasa, Alina S. Gerrie, Tamara Shenkier, David W. Scott, Randy D. Gascoyne, Graham W. Slack, Joseph M. Connors, and Kerry J. Savage, British Columbia Cancer Agency Centre for Lymphoid Cancer; Yvonne Zheng, Cancer Surveillance and Outcomes, Population Oncology; Christina Parsons, James Morris, and Tom Pickles, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Tom Pickles
- Greg Hapgood, Laurie H. Sehn, Diego Villa, Richard Klasa, Alina S. Gerrie, Tamara Shenkier, David W. Scott, Randy D. Gascoyne, Graham W. Slack, Joseph M. Connors, and Kerry J. Savage, British Columbia Cancer Agency Centre for Lymphoid Cancer; Yvonne Zheng, Cancer Surveillance and Outcomes, Population Oncology; Christina Parsons, James Morris, and Tom Pickles, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Joseph M. Connors
- Greg Hapgood, Laurie H. Sehn, Diego Villa, Richard Klasa, Alina S. Gerrie, Tamara Shenkier, David W. Scott, Randy D. Gascoyne, Graham W. Slack, Joseph M. Connors, and Kerry J. Savage, British Columbia Cancer Agency Centre for Lymphoid Cancer; Yvonne Zheng, Cancer Surveillance and Outcomes, Population Oncology; Christina Parsons, James Morris, and Tom Pickles, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Kerry J. Savage
- Greg Hapgood, Laurie H. Sehn, Diego Villa, Richard Klasa, Alina S. Gerrie, Tamara Shenkier, David W. Scott, Randy D. Gascoyne, Graham W. Slack, Joseph M. Connors, and Kerry J. Savage, British Columbia Cancer Agency Centre for Lymphoid Cancer; Yvonne Zheng, Cancer Surveillance and Outcomes, Population Oncology; Christina Parsons, James Morris, and Tom Pickles, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
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17
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Moccia AA, Hitz F, Hoskins P, Klasa R, Power MM, Savage KJ, Shenkier T, Shepherd JD, Slack GW, Song KW, Gascoyne RD, Connors JM, Sehn LH. Gemcitabine, dexamethasone, and cisplatin (GDP) is an effective and well-tolerated salvage therapy for relapsed/refractory diffuse large B-cell lymphoma and Hodgkin lymphoma. Leuk Lymphoma 2016; 58:324-332. [DOI: 10.1080/10428194.2016.1193852] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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18
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Hitz F, Connors JM, Gascoyne RD, Hoskins P, Moccia A, Savage KJ, Sehn LH, Shenkier T, Villa D, Klasa R. Outcome of patients with primary refractory diffuse large B cell lymphoma after R-CHOP treatment. Ann Hematol 2015; 94:1839-43. [PMID: 26246466 DOI: 10.1007/s00277-015-2467-z] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 07/20/2015] [Indexed: 10/23/2022]
Abstract
Primary refractory diffuse large B cell lymphoma (DLBCL) following R-CHOP chemotherapy is a major concern. We identified 1126 patients with DLBCL treated with R-CHOP from 2000 to 2009, of whom 166 (15 %) had primary refractory disease. Of the 75/166 (45 %) who were age <70 years and had been planned for stage-directed curative therapy, 43 (57 %) were primary nonresponders and 32 (43 %) relapsed within 3 months of completing R-CHOP. Thirty of 75 (40 %) patients had serious comorbidity and organ dysfunction precluding intensive treatment and had palliative treatment only. Twelve of 45 (27 %) patients responded to second-line treatment and underwent ASCT. The median overall survival for the 75 patients was 10 months with only seven patients alive without evidence of disease at follow-up ranging from 14 to 106 months. Primary refractory DLBCL after R-CHOP has a very poor outcome with only anecdotal survivors independent of the intended treatment approach.
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Affiliation(s)
- Felicitas Hitz
- Medical Oncology, Oncology/Haematology, Kantonsspital St. Gallen, 9007, St. Gallen, Switzerland. .,British Columbia Cancer Agency Centre for Lymphoid Cancer, Vancouver, Canada. .,Istituto Oncologico della Svizzera Italiana, Bellinzona, Switzerland.
| | - J M Connors
- British Columbia Cancer Agency Centre for Lymphoid Cancer, Vancouver, Canada
| | - R D Gascoyne
- British Columbia Cancer Agency Centre for Lymphoid Cancer, Vancouver, Canada.,Division of Pathology, British Columbia Cancer Agency and the University of British Columbia, Vancouver, Canada
| | - P Hoskins
- British Columbia Cancer Agency Centre for Lymphoid Cancer, Vancouver, Canada
| | - A Moccia
- British Columbia Cancer Agency Centre for Lymphoid Cancer, Vancouver, Canada.,Istituto Oncologico della Svizzera Italiana, Bellinzona, Switzerland
| | - K J Savage
- British Columbia Cancer Agency Centre for Lymphoid Cancer, Vancouver, Canada
| | - L H Sehn
- British Columbia Cancer Agency Centre for Lymphoid Cancer, Vancouver, Canada
| | - T Shenkier
- British Columbia Cancer Agency Centre for Lymphoid Cancer, Vancouver, Canada
| | - D Villa
- British Columbia Cancer Agency Centre for Lymphoid Cancer, Vancouver, Canada
| | - R Klasa
- British Columbia Cancer Agency Centre for Lymphoid Cancer, Vancouver, Canada
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19
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Sun S, Gelmon KA, Chia S, Lohrisch C, Shenkier T, Villa D, Shen Y, Jones M, Pleasance E, Kasaian K, Eirew P, Leelakumari S, Ma Y, Ng T, Yip S, Jones SJM, Marra MA, Laskin JJ. Abstract 1122: Personalized oncogenomics in advanced stage breast cancer. Cancer Res 2015. [DOI: 10.1158/1538-7445.am2015-1122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background
Breast cancer is a complex disease with clinical, pathological, and molecular heterogeneity. Recent studies have identified several subtypes of breast cancers driven by specific molecular pathways that can be inhibited by targeted drugs. We studied the feasibility of using molecular data from whole genome and transcriptome sequencing of breast cancers to guide treatment.
Methods
Patients were consented as part of the Personalized Onco-Genomics (POG) study at the British Columbia Cancer Agency. Fresh tumor, blood for normal DNA, and archival tumor were collected. Tissue and blood samples were sequenced using the Ion Torrent AmpliSeq panel, followed by comprehensive DNA and RNA sequencing. In-depth bioinformatic analyses were performed. Somatic mutations, copy number changes, structural variants and gene expression were characterized. Results from genomic analyses were reviewed in a multi-disciplinary team.
Results
From August 2012 to October 2014, tissue samples from 30 patients with advanced stage breast cancer were analyzed. The median age at diagnosis was 53 years (range 32-75). The median number of lines of cytotoxic therapy prior to sequencing was 2 (range 0-10). All cases were invasive ductal carcinoma; 63% were ER+ and HER2-; 27% triple negative; 7% ER+ and HER2+; and 3% ER- and HER2+. The most frequently mutated genes were TP53 (67%), PI3KCA (23%), ESR1 (20%), ATM (10%), ARID1A (10%), and BRCA1/2 (10%). Somatic mutations in other genes of interest including HER2, PARP1, NF1, BAP1, PTEN, NOTCH1, were also identified. Molecular data were informative for patient care and/or actionable to guide treatment in 57% (17/30) of cases.
Conclusion
The use of whole genome sequencing technology to identify valuable molecular information to guide personalized breast cancer treatment is feasible. Further studies are warranted to evaluate the usefulness of genome-wide sequencing of breast cancers in clinical practice.
Citation Format: Sophie Sun, Karen A. Gelmon, Stephen Chia, Caroline Lohrisch, Tamara Shenkier, Diego Villa, Yaoqing Shen, Martin Jones, Erin Pleasance, Katayoon Kasaian, Peter Eirew, Sreeja Leelakumari, Yusanne Ma, Tony Ng, Stephen Yip, Steven JM Jones, Marco A. Marra, Janessa J. Laskin. Personalized oncogenomics in advanced stage breast cancer. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 1122. doi:10.1158/1538-7445.AM2015-1122
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Affiliation(s)
- Sophie Sun
- 1British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Karen A. Gelmon
- 1British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Stephen Chia
- 1British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Caroline Lohrisch
- 1British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Tamara Shenkier
- 1British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Diego Villa
- 1British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Yaoqing Shen
- 2Canada's Michael Smith Genome Sciences Centre, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Martin Jones
- 2Canada's Michael Smith Genome Sciences Centre, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Erin Pleasance
- 2Canada's Michael Smith Genome Sciences Centre, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Katayoon Kasaian
- 2Canada's Michael Smith Genome Sciences Centre, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Peter Eirew
- 2Canada's Michael Smith Genome Sciences Centre, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Sreeja Leelakumari
- 2Canada's Michael Smith Genome Sciences Centre, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Yusanne Ma
- 2Canada's Michael Smith Genome Sciences Centre, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Tony Ng
- 1British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Stephen Yip
- 1British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Steven JM Jones
- 2Canada's Michael Smith Genome Sciences Centre, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Marco A. Marra
- 2Canada's Michael Smith Genome Sciences Centre, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Janessa J. Laskin
- 1British Columbia Cancer Agency, Vancouver, British Columbia, Canada
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Hay K, Lee B, Goktepe O, Connors JM, Sehn LH, Savage KJ, Klasa R, Shenkier T, Gerrie A, Villa D. Impact of time from diagnosis to initiation of curative chemotherapy on survival of patients with diffuse large B-cell lymphoma. Leuk Lymphoma 2015; 57:276-282. [PMID: 26010123 DOI: 10.3109/10428194.2015.1055480] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Although it is generally regarded appropriate to start chemotherapy promptly after a diagnosis of diffuse large B-cell lymphoma (DLBCL), the optimal time from diagnosis to treatment (TDT) is unknown. A total of 689 patients diagnosed with DLBCL and treated with ≥ 1 cycle of CHOP-R with curative intent during 2003-2008 in British Columbia were identified: 347 (50%) TDT ≤ 4 weeks, 277 (40%) TDT 5-8 weeks, 65 (10%) TDT > 8 weeks. For the respective TDT groups, 5-year OS estimates were 61%, 74%, 63% (p = 0.006); 5-year PFS 57%, 70%, 61% (p = 0.006); and 5-year DSS 64%, 80%, 77% (p <0.001). In multivariate analysis, TDT >8 weeks was associated with worse OS (HR 1.20 (95% CI 1.03, 1.41), p = 0.020), PFS (HR 1.33 (95% CI 1.15, 1.54), p < 0.001), and DSS (HR 1.40 (95% CI 1.10, 1.78), p = 0.006). Clinicians should endeavor to initiate curative chemotherapy as soon as possible after a diagnosis of DLBCL is established.
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Affiliation(s)
- Kevin Hay
- a Department of Medicine , University of British Columbia , Vancouver , BC , Canada
| | - Benny Lee
- b Faculty of Medicine, University of British Columbia , Vancouver , BC , Canada
| | - Ozge Goktepe
- c Cancer Surveillance & Outcomes, British Columbia Cancer Agency , Vancouver , BC , Canada
| | - Joseph M Connors
- d Division of Medical Oncology, University of British Columbia, and the British Columbia Cancer Agency Centre for Lymphoid Cancer , Vancouver , BC , Canada
| | - Laurie H Sehn
- d Division of Medical Oncology, University of British Columbia, and the British Columbia Cancer Agency Centre for Lymphoid Cancer , Vancouver , BC , Canada
| | - Kerry J Savage
- d Division of Medical Oncology, University of British Columbia, and the British Columbia Cancer Agency Centre for Lymphoid Cancer , Vancouver , BC , Canada
| | - Richard Klasa
- d Division of Medical Oncology, University of British Columbia, and the British Columbia Cancer Agency Centre for Lymphoid Cancer , Vancouver , BC , Canada
| | - Tamara Shenkier
- d Division of Medical Oncology, University of British Columbia, and the British Columbia Cancer Agency Centre for Lymphoid Cancer , Vancouver , BC , Canada
| | - Alina Gerrie
- d Division of Medical Oncology, University of British Columbia, and the British Columbia Cancer Agency Centre for Lymphoid Cancer , Vancouver , BC , Canada.,e Leukemia/Bone Marrow Transplantation Program of BC , Vancouver , BC , Canada
| | - Diego Villa
- d Division of Medical Oncology, University of British Columbia, and the British Columbia Cancer Agency Centre for Lymphoid Cancer , Vancouver , BC , Canada
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Schneider BP, Li L, Shen F, Miller KD, Radovich M, O'Neill A, Gray RJ, Lane D, Flockhart DA, Jiang G, Wang Z, Lai D, Koller D, Pratt JH, Dang CT, Northfelt D, Perez EA, Shenkier T, Cobleigh M, Smith ML, Railey E, Partridge A, Gralow J, Sparano J, Davidson NE, Foroud T, Sledge GW. Genetic variant predicts bevacizumab-induced hypertension in ECOG-5103 and ECOG-2100. Br J Cancer 2014; 111:1241-8. [PMID: 25117820 PMCID: PMC4453857 DOI: 10.1038/bjc.2014.430] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Revised: 06/26/2014] [Accepted: 07/08/2014] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Bevacizumab has broad anti-tumour activity, but substantial risk of hypertension. No reliable markers are available for predicting bevacizumab-induced hypertension. METHODS A genome-wide association study (GWAS) was performed in the phase III bevacizumab-based adjuvant breast cancer trial, ECOG-5103, to evaluate for an association between genotypes and hypertension. GWAS was conducted in those who had experienced systolic blood pressure (SBP) >160 mm Hg during therapy using binary analysis and a cumulative dose model for the total exposure of bevacizumab. Common toxicity criteria (CTC) grade 3-5 hypertension was also assessed. Candidate SNP validation was performed in the randomised phase III trial, ECOG-2100. RESULTS When using the phenotype of SBP>160 mm Hg, the most significant association in SV2C (rs6453204) approached and met genome-wide significance in the binary model (P=6.0 × 10(-8); OR=3.3) and in the cumulative dose model (P=4.7 × 10(-8); HR=2.2), respectively. Similar associations with rs6453204 were seen for CTC grade 3-5 hypertension but did not meet genome-wide significance. Validation study from ECOG-2100 demonstrated a statistically significant association between this SNP and grade 3/4 hypertension using the binary model (P-value=0.037; OR=2.4). CONCLUSIONS A genetic variant in SV2C predicted clinically relevant bevacizumab-induced hypertension in two independent, randomised phase III trials.
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Affiliation(s)
- B P Schneider
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - L Li
- Department of Medical & Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - F Shen
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - K D Miller
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - M Radovich
- Department of General Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - A O'Neill
- Department of Biostatistics and Computational Biology, Dana Farber Cancer Institute, Boston, MA 02215, USA
| | - R J Gray
- Department of Biostatistics and Computational Biology, Dana Farber Cancer Institute, Boston, MA 02215, USA
| | - D Lane
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - D A Flockhart
- Indiana Institute for Personalized Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - G Jiang
- Department of Medical & Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Z Wang
- Department of Medical & Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - D Lai
- Department of Medical & Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - D Koller
- Department of Medical & Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - J H Pratt
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - C T Dang
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - D Northfelt
- Department of Medicine, Mayo Clinic, Scottsdale, AZ 85054, USA
| | - E A Perez
- Mayo Clinic, Jacksonville, FL 32224, USA
| | - T Shenkier
- BCCA – Vancouver Cancer Center, Vancouver, BC, V5Z 4E6, USA
| | - M Cobleigh
- Department of Internal Medicine , Rush-Presbyterian-St. Luke's Medical Center, Chicago, IL 60612, USA
| | - M L Smith
- Research Advocacy Network, Plano, TX 75093, USA
| | - E Railey
- Research Advocacy Network, Plano, TX 75093, USA
| | - A Partridge
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA 02215, USA
| | - J Gralow
- University of Washington, Seattle, WA 98195, USA
| | - J Sparano
- Department of Oncology, Montefiore Hospital and Medical Center, Bronx, NY 10467, USA
| | - N E Davidson
- Cancer Institute and University of Pittsburgh Cancer Center, Pittsburgh, PA 15232, USA
| | - T Foroud
- Department of Medical & Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - G W Sledge
- Department of Medicine, Stanford University, Stanford, CA 94305, USA
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Lee B, Goktepe O, Hay K, Connors JM, Sehn LH, Savage KJ, Shenkier T, Klasa R, Gerrie A, Villa D. Effect of place of residence and treatment on survival outcomes in patients with diffuse large B-cell lymphoma in British Columbia. Oncologist 2014; 19:283-90. [PMID: 24569946 DOI: 10.1634/theoncologist.2013-0343] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [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] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND We examined the relationship between location of residence at the time of diagnosis of diffuse large B-cell lymphoma (DLBCL) and health outcomes in a geographically large Canadian province with publicly funded, universally available medical care. PATIENTS AND METHODS The British Columbia Cancer Registry was used to identify all patients 18-80 years of age diagnosed with DLBCL between January 2003 and December 2008. Home and treatment center postal codes were used to determine urban versus rural status and driving distance to access treatment. RESULTS We identified 1,357 patients. The median age was 64 years (range: 18-80 years), 59% were male, 50% were stage III/IV, 84% received chemotherapy with curative intent, and 32% received radiotherapy. There were 186 (14%) who resided in rural areas, 141 (10%) in small urban areas, 183 (14%) in medium urban areas, and 847 (62%) in large urban areas. Patient and treatment characteristics were similar regardless of location. Five-year overall survival (OS) was 62% for patients in rural areas, 44% in small urban areas, 53% in medium urban areas, and 60% in large urban areas (p = .018). In multivariate analysis, there was no difference in OS between rural and large urban area patients (hazard ratio [HR]: 1.0; 95% confidence interval [CI]: 0.7-1.4), although patients in small urban areas (HR: 1.4; 95% CI: 1.0-2.0) and medium urban areas (HR: 1.4; 95% CI: 1.0-1.9) had worse OS than those in large urban areas. CONCLUSION Place of residence at diagnosis is associated with survival of patients with DLBCL in British Columbia, Canada. Rural patients have similar survival to those in large urban areas, whereas patients living in small and medium urban areas experience worse outcomes.
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Affiliation(s)
- Benny Lee
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Leukemia/Bone Marrow Transplantation Program of British Columbia, Vancouver, British Columbia, Canada
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Shenkier T. Do We Need Another Selective Estrogen Receptor Modulator for the Adjuvant Treatment of Breast Cancer? Curr Oncol 2013; 20:191-2. [DOI: 10.3747/co.20.1466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
In this issue of Current Oncology, Qin and colleagues from the Sun Yat-sen University Cancer Centre in Guangzhou, China, report their experience using toremifene as adjuvant treatment for 396 premenopausal women with early endocrine-responsive breast cancer at a mean follow-up of 6.9 years. [...]
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Mak V, Hamm J, Chhanabhai M, Shenkier T, Klasa R, Sehn LH, Villa D, Gascoyne RD, Connors JM, Savage KJ. Survival of patients with peripheral T-cell lymphoma after first relapse or progression: spectrum of disease and rare long-term survivors. J Clin Oncol 2013; 31:1970-6. [PMID: 23610113 DOI: 10.1200/jco.2012.44.7524] [Citation(s) in RCA: 302] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION A number of novel therapies are under investigation in relapsed or refractory peripheral T-cell lymphoma (PTCL); however, their relative impact on outcome is unknown. We examined the survival of patients with PTCL after relapse or progression in the absence of hematopoietic stem-cell transplantation and explored factors influencing survival. The three most common subtypes encountered in North America were evaluated: PTCL not otherwise specified (PTCL-NOS), angioimmunoblastic T-cell lymphoma (AITL), and anaplastic large-cell lymphoma (ALCL; anaplastic lymphoma kinase [ALK] positive and ALK negative. PATIENTS AND METHODS After exclusions, 153 patients were analyzed (PTCL-NOS, n = 79 [52%]; AITL, n = 38 [25%]; ALK-positive ALCL, n = 11 [7%]; ALK-negative ALCL, n = 27 [16%; including ALK status unknown, n = 1]). RESULTS Median time from initial diagnosis to relapse or progression after primary therapy was 6.7 months, and median age at relapse was 66 years (ALK-positive ALCL, 39 years). Median overall survival (OS) and median progression-free survival (PFS) after relapse or progression (second PFS) were 5.5 and 3.1 months, respectively, and were only marginally better in patients who received chemotherapy at relapse (n = 89 [58%]; 6.5 and 3.7 months, respectively). Patients with good performance status (PS) of 0 or 1 (n = 47) at relapse who received chemotherapy had a more favorable OS (P < .001; median OS, 13.7 months) and PFS (P = .006; median second PFS, 5.0 months), which remained significant in multivariate analysis (OS: hazard ratio [HR], 2.09; P = .002; second PFS: HR, 1.66; P = .030). CONCLUSION Most patients with relapsed or refractory PTCL have poor outcomes with short survival. Select patients with good PS have more favorable outcomes with standard chemotherapy.
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Affiliation(s)
- Vivien Mak
- Princess Margaret Hospital, Hong Kong, China
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25
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Davidson JA, Cromwell I, Ellard SL, Lohrisch C, Gelmon KA, Shenkier T, Villa D, Lim H, Sun S, Taylor S, Taylor M, Czerkawski B, Hayes M, Ionescu DN, Yoshizawa C, Chao C, Peacock S, Chia SK. A prospective clinical utility and pharmacoeconomic study of the impact of the 21-gene Recurrence Score® assay in oestrogen receptor positive node negative breast cancer. Eur J Cancer 2013; 49:2469-75. [PMID: 23611660 DOI: 10.1016/j.ejca.2013.03.009] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Revised: 03/02/2013] [Accepted: 03/05/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE The primary purpose of this study was to measure the impact of the 21-gene Recurrence Score® result on systemic treatment recommendations and to perform a prospective health economic analysis in stage I-II, node-negative, oestrogen receptor positive (ER+) breast cancer. METHODS Consenting patients with ER+ node negative invasive breast cancer and their treating medial oncologists were asked to complete questionnaires about treatment preferences, level of confidence in those preferences and a decisional conflict scale (patients only) after a discussion of their diagnosis and risk without knowledge of the Recurrence Score. At a subsequent visit, the assay result and final treatment recommendations were discussed prior to both parties completing a second set of questionnaires. A Markov health state transition model was constructed, simulating the costs and outcomes experienced by a hypothetical 'assay naïve' population and an 'assay informed' population. RESULTS One hundred and fifty-six patients across two cancer centres were enrolled. Of the 150 for whom successful assay results were obtained, physicians changed their chemotherapy recommendations in 45 cases (30%; 95% confidence interval (CI) 22.8-38.0%); either to add (10%; 95% CI 5.7-16.0%) or omit (20%; 95% CI 13.9-27.3%) adjuvant chemotherapy. There was an overall significant improvement in physician confidence post-assay (p<0.001). Patient decisional conflict also significantly decreased following the assay (p<0.001). The simulation model found an incremental cost-effectiveness ratio of Canadian Dollars (CAD) $6630/quality-adjusted life years (QALY). CONCLUSION Within the context of a publicly funded health care system, the Recurrence Score assay significantly affects adjuvant treatment recommendations and is cost effective in ER+ node negative breast cancer.
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Affiliation(s)
- J A Davidson
- Medical Oncology, British Columbia Cancer Agency (BCCA), Vancouver, Canada
| | - I Cromwell
- Canadian Centre for Applied Research in Cancer Control, British Columbia Cancer Research Centre, Vancouver, Canada
| | | | - C Lohrisch
- Medical Oncology, British Columbia Cancer Agency (BCCA), Vancouver, Canada
| | - K A Gelmon
- Medical Oncology, British Columbia Cancer Agency (BCCA), Vancouver, Canada
| | - T Shenkier
- Medical Oncology, British Columbia Cancer Agency (BCCA), Vancouver, Canada
| | - D Villa
- Medical Oncology, British Columbia Cancer Agency (BCCA), Vancouver, Canada
| | - H Lim
- Medical Oncology, British Columbia Cancer Agency (BCCA), Vancouver, Canada
| | - S Sun
- Medical Oncology, British Columbia Cancer Agency (BCCA), Vancouver, Canada
| | - S Taylor
- Medical Oncology, BCCA, Kelowna, Canada
| | - M Taylor
- Medical Oncology, BCCA, Kelowna, Canada
| | | | - M Hayes
- Pathology, BCCA, Vancouver, Canada
| | | | | | - C Chao
- Genomic Health Inc., Redwood City, CA, USA
| | - S Peacock
- Canadian Centre for Applied Research in Cancer Control, British Columbia Cancer Research Centre, Vancouver, Canada; School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - S K Chia
- Medical Oncology, British Columbia Cancer Agency (BCCA), Vancouver, Canada.
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Hui D, Proctor B, Donaldson J, Shenkier T, Hoskins P, Klasa R, Savage K, Chhanabhai M, Gascoyne RD, Connors JM, Sehn LH. Prognostic implications of extranodal involvement in patients with diffuse large B-cell lymphoma treated with rituximab and cyclophosphamide, doxorubicin, vincristine, and prednisone. Leuk Lymphoma 2010; 51:1658-67. [DOI: 10.3109/10428194.2010.504872] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Chia SK, Lohrisch C, Gelmon K, Kennecke H, Pansegrau G, Taylor M, Attwell A, Jepson D, Hayes M, Shenkier T. Phase II trial of neoadjuvant sequential FEC100 followed by docetaxel and capecitabine for HER2-negative locally advanced breast cancer (LABC): A multicenter study from British Columbia. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
598 Background: Anthracyclines and taxanes are now standard of care for LABC. Phase III trials have demonstrated pathological complete responses of the breast (pCR) of 20–34% in studies of primary operable and LABC. Recent trials in the HER-2 negative population reported pCR rates of 20–29%.We have completed a multi-centre phase II trial of a neoadjuvant sequential anthracycline and taxane combination regimen in a HER-2 negative LABC population. Methods: Women with HER-2 negative stage IIB-IIIC breast cancer were enrolled. Treatment consisted of 4 cycles of FEC100 (5-FU 500 mg/m2, epirubicin 100 mg/m2, cyclophosphamide 500 mg/m2) followed by 4 cycles of XT (docetaxel 75 mg/m2 and capecitabine 1,000 mg/m2 PO BID x 14 days q3 weekly). Hormone receptor positive cases were prescribed standard endocrine therapy. A correlative translational component with baseline and interval biopsies and serum collection was also performed. Results: A total of 51 patients (27% stage IIB; 43% IIIA; 20% IIIB; and 10% IIIC) were accrued across 4 BCCA centres from November 2004-December 2007. Median age was 54 years (33–67 years). 59% of tumours were ER positive. There were no primary progressors on FEC100, though 2 patients had significant toxicities requiring early discontinuation. 3 patients (6%) developed clinical progression on XT. The majority of patients (79%) on XT required a dose reduction or delay. There were 5 episodes (10%) of febrile neutropenia. 15 patients (29%) underwent adjuvant radiotherapy prior to surgery. The pCR rate (breast and axilla) for the entire study population was 22% (11/51). In the ER+ and triple negative subtypes the pCR (breast and axilla) was 13% and 42%, respectively. Conclusions: This multi-centre phase II trial demonstrates activity for neoadjuvant anthracyclines followed by combination docetaxel/capecitabine in a HER-2 negative LABC population. Though the pCR rate was greater in the triple negative cohort, significant improvements are still required across the biological subtypes in HER-2 negative LABC. [Table: see text]
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Affiliation(s)
- S. K. Chia
- BC Cancer Agency, Vancouver, BC, Canada; BC Cancer Agency, Surrey, BC, Canada; BC Cancer Agency, Kelowna, BC, Canada; BC Cancer Agency, Victoria, BC, Canada
| | - C. Lohrisch
- BC Cancer Agency, Vancouver, BC, Canada; BC Cancer Agency, Surrey, BC, Canada; BC Cancer Agency, Kelowna, BC, Canada; BC Cancer Agency, Victoria, BC, Canada
| | - K. Gelmon
- BC Cancer Agency, Vancouver, BC, Canada; BC Cancer Agency, Surrey, BC, Canada; BC Cancer Agency, Kelowna, BC, Canada; BC Cancer Agency, Victoria, BC, Canada
| | - H. Kennecke
- BC Cancer Agency, Vancouver, BC, Canada; BC Cancer Agency, Surrey, BC, Canada; BC Cancer Agency, Kelowna, BC, Canada; BC Cancer Agency, Victoria, BC, Canada
| | - G. Pansegrau
- BC Cancer Agency, Vancouver, BC, Canada; BC Cancer Agency, Surrey, BC, Canada; BC Cancer Agency, Kelowna, BC, Canada; BC Cancer Agency, Victoria, BC, Canada
| | - M. Taylor
- BC Cancer Agency, Vancouver, BC, Canada; BC Cancer Agency, Surrey, BC, Canada; BC Cancer Agency, Kelowna, BC, Canada; BC Cancer Agency, Victoria, BC, Canada
| | - A. Attwell
- BC Cancer Agency, Vancouver, BC, Canada; BC Cancer Agency, Surrey, BC, Canada; BC Cancer Agency, Kelowna, BC, Canada; BC Cancer Agency, Victoria, BC, Canada
| | - D. Jepson
- BC Cancer Agency, Vancouver, BC, Canada; BC Cancer Agency, Surrey, BC, Canada; BC Cancer Agency, Kelowna, BC, Canada; BC Cancer Agency, Victoria, BC, Canada
| | - M. Hayes
- BC Cancer Agency, Vancouver, BC, Canada; BC Cancer Agency, Surrey, BC, Canada; BC Cancer Agency, Kelowna, BC, Canada; BC Cancer Agency, Victoria, BC, Canada
| | - T. Shenkier
- BC Cancer Agency, Vancouver, BC, Canada; BC Cancer Agency, Surrey, BC, Canada; BC Cancer Agency, Kelowna, BC, Canada; BC Cancer Agency, Victoria, BC, Canada
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Schneider BP, Wang M, Radovich M, Sledge GW, Badve S, Thor A, Flockhart DA, Hancock B, Davidson N, Gralow J, Dickler M, Perez EA, Cobleigh M, Shenkier T, Edgerton S, Miller KD. Association of vascular endothelial growth factor and vascular endothelial growth factor receptor-2 genetic polymorphisms with outcome in a trial of paclitaxel compared with paclitaxel plus bevacizumab in advanced breast cancer: ECOG 2100. J Clin Oncol 2008; 26:4672-8. [PMID: 18824714 PMCID: PMC2653128 DOI: 10.1200/jco.2008.16.1612] [Citation(s) in RCA: 497] [Impact Index Per Article: 31.1] [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: 01/22/2008] [Accepted: 06/13/2008] [Indexed: 12/27/2022] Open
Abstract
PURPOSE No biomarkers have been identified to predict outcome with the use of an antiangiogenesis agent for cancer. Vascular endothelial growth factor (VEGF) genetic variability has been associated with altered risk of breast cancer and variable promoter activity. Therefore, we evaluated the association of VEGF genotype with efficacy and toxicity in E2100, a phase III study comparing paclitaxel versus paclitaxel plus bevacizumab as initial chemotherapy for metastatic breast cancer. PATIENTS AND METHODS DNA was extracted from tumor blocks of patients from E2100. Three hundred sixty-three samples were available to evaluate associations between genotype and outcome. Genotyping was performed for selected polymorphisms in VEGF and VEGF receptor 2. Testing for associations between each polymorphism and efficacy and toxicity was performed. RESULTS The VEGF-2578 AA genotype was associated with a superior median overall survival (OS) in the combination arm when compared with the alternate genotypes combined (hazard ratio = 0.58; 95% CI, 0.36 to 0.93; P = .023). The VEGF-1154 A allele also demonstrated a superior median OS with an additive effect of each active allele in the combination arm but not the control arm (hazard ratio = 0.62; 95% CI, 0.46 to 0.83; P = .001). Two additional genotypes, VEGF-634 CC and VEGF-1498 TT, were associated with significantly less grade 3 or 4 hypertension in the combination arm when compared with the alternate genotypes combined (P = .005 and P = .022, respectively). CONCLUSION Our data support an association between VEGF genotype and median OS as well as grade 3 or 4 hypertension when using bevacizumab in metastatic breast cancer.
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Miller K, Wang M, Gralow J, Dickler M, Cobleigh M, Perez EA, Shenkier T, Cella D, Davidson NE. Paclitaxel plus bevacizumab versus paclitaxel alone for metastatic breast cancer. N Engl J Med 2007; 357:2666-76. [PMID: 18160686 DOI: 10.1056/nejmoa072113] [Citation(s) in RCA: 2249] [Impact Index Per Article: 132.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND In an open-label, randomized, phase 3 trial, we compared the efficacy and safety of paclitaxel with that of paclitaxel plus bevacizumab, a monoclonal antibody against vascular endothelial growth factor, as initial treatment for metastatic breast cancer. METHODS We randomly assigned patients to receive 90 mg of paclitaxel per square meter of body-surface area on days 1, 8, and 15 every 4 weeks, either alone or with 10 mg of bevacizumab per kilogram of body weight on days 1 and 15. The primary end point was progression-free survival; overall survival was a secondary end point. RESULTS From December 2001 through May 2004, a total of 722 patients were enrolled. Paclitaxel plus bevacizumab significantly prolonged progression-free survival as compared with paclitaxel alone (median, 11.8 vs. 5.9 months; hazard ratio for progression, 0.60; P<0.001) and increased the objective response rate (36.9% vs. 21.2%, P<0.001). The overall survival rate, however, was similar in the two groups (median, 26.7 vs. 25.2 months; hazard ratio, 0.88; P=0.16). Grade 3 or 4 hypertension (14.8% vs. 0.0%, P<0.001), proteinuria (3.6% vs. 0.0%, P<0.001), headache (2.2% vs. 0.0%, P=0.008), and cerebrovascular ischemia (1.9% vs. 0.0%, P=0.02) were more frequent in patients receiving paclitaxel plus bevacizumab. Infection was more common in patients receiving paclitaxel plus bevacizumab (9.3% vs. 2.9%, P<0.001), but febrile neutropenia was uncommon (<1% overall). CONCLUSIONS Initial therapy of metastatic breast cancer with paclitaxel plus bevacizumab prolongs progression-free survival, but not overall survival, as compared with paclitaxel alone. (ClinicalTrials.gov number, NCT00028990 [ClinicalTrials.gov].).
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Affiliation(s)
- Kathy Miller
- Indiana University Cancer Center, Indianapolis, USA.
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Sehn LH, Berry B, Chhanabhai M, Fitzgerald C, Gill K, Hoskins P, Klasa R, Savage KJ, Shenkier T, Sutherland J, Gascoyne RD, Connors JM. The revised International Prognostic Index (R-IPI) is a better predictor of outcome than the standard IPI for patients with diffuse large B-cell lymphoma treated with R-CHOP. Blood 2006; 109:1857-61. [PMID: 17105812 DOI: 10.1182/blood-2006-08-038257] [Citation(s) in RCA: 984] [Impact Index Per Article: 54.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
AbstractDiffuse large B-cell lymphoma (DLBCL) is a heterogeneous entity, with patients exhibiting a wide range of outcomes. The addition of rituximab to CHOP chemotherapy (R-CHOP)has led to a marked improvement in survival and has called into question the significance of previously recognized prognostic markers. Since randomized controlled trials of R-CHOP in DLBCL have included select subgroups of patients, the utility of the International Prognostic Index (IPI) has not been reassessed. We performed a retrospective analysis of patients with DLBCL treated with R-CHOP in the province of British Columbia to assess the value of the IPI in the era of immunochemotherapy. The IPI remains predictive, but it identifies only 2 risk groups. Redistribution of the IPI factors into a revised IPI (R-IPI) provides a more clinically useful prediction of outcome. The R-IPI identifies 3 distinct prognostic groups with a very good (4-year progression-free survival [PFS] 94%, overall survival [OS] 94%), good (4-year PFS 80%, OS 79%), and poor (4-year PFS 53%, OS 55%) outcome, respectively (P < .001). The IPI (or R-IPI) no longer identifies a risk group with less than a 50% chance of survival. In the era of R-CHOP treatment, the R-IPI is a clinically useful prognostic index that may help guide treatment planning and interpretation of clinical trials.
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Affiliation(s)
- Laurie H Sehn
- Division of Medical Oncology, British Columbia Cancer Agency and the University of British Columbia, Vancouver, Canada.
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Ramadan KM, Shenkier T, Sehn LH, Gascoyne RD, Connors JM. A clinicopathological retrospective study of 131 patients with primary bone lymphoma: a population-based study of successively treated cohorts from the British Columbia Cancer Agency. Ann Oncol 2006; 18:129-135. [PMID: 17018705 DOI: 10.1093/annonc/mdl329] [Citation(s) in RCA: 130] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Primary bone lymphoma (PBL) is a distinct clinicopathological entity. Although PBL has been reviewed in several small studies, few reflect recent improvements in primary treatment. METHODS We used the British Columbia Cancer Agency Lymphoid Cancer Database to identify all patients with PBL (1983-2005). All were staged in a uniform manner and treated with era-specific protocols. RESULTS We identified 131 patients with a median age of 63 years (18-87). One third had disease in long bones and another one third had disease in the spine, of which half presented with spinal cord compression. Patients with diffuse large-cell lymphoma (DLCL) (n=103, 79%) had 5- and 10-year overall survivals (OS) of 62% and 41%, respectively. Multivariate analysis identified three prognostic groups: age<60 with International Prognostic Index (IPI) 1-3 (n=43), age>or=60 with IPI 0-3 (n=23) and age>or=60 with IPI 4-5 (n=33), with markedly different 5-year OS of 90%, 61% and 25%, respectively (P<0.0001). Neither primary site nor pathological fracture at presentation had an impact on OS. The 3-year progression-free survival in patients who received rituximab plus combination chemotherapy with cyclophosphamide, doxorubicin, vincristine and prednisone (CHOPR) chemotherapy was 88% compared with 52% in those who received CHOP-like chemotherapy without rituximab (P=0.005). The 10-year OS for those with advanced-stage disease who received irradiation plus chemotherapy was 25% versus 56% for those who received chemotherapy alone (P=0.025). Patients received irradiation if spinal cord compression was present or residual disease at the end of chemotherapy was thought to require it. CONCLUSIONS PBL is usually of DLCL type and has an improved outcome with CHOPR. Younger patients with good IPI score have a favorable prognosis.
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Affiliation(s)
| | | | | | - R D Gascoyne
- Division of Pathology, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
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Grimm S, Pulido J, Jahnke K, Schiff D, Hall A, Shenkier T, Siegal T, Nancy D, Batchelor T, Abrey L. Primary intraocular lymphoma (PIOL): An International Primary CNS Lymphoma Collaborative group report. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.1534] [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
1534 Background: PIOL is a hemopoietic tumor that arises in the retina, vitreous or optic nerve head, and carries a high risk of ocular and CNS relapse. The natural history and optimal management are unknown. Methods: A retrospective series of 81 patients with PIOL was assembled from 15 centers in 7 countries. Only patients with isolated ocular lymphoma were included; none had brain, spinal cord, or systemic lymphoma at diagnosis. Results: The median age at diagnosis was 65 (24–85). 58% were women. The median ECOG performance status was 0, and only three had a score > 1. The median latency from symptom onset to diagnosis was 6 months (0– 36). Slit lamp exam was positive in 51, negative in 6, and not reported in 24. Vitrectomy was positive in 72 and negative in 2. 6 had a positive choroidal or retinal biopsy and 1 had no ocular surgery. CSF cytology was positive in 10 (17%), negative in 48, and unknown in 23. 21 received local therapy at diagnosis: 6 intra-ocular methotrexate (400 ug), 14 ocular radiation (median 3600 cGy), and 1 both modalities. 52 received more extensive therapy including systemic chemotherapy alone in 20 and a combination of chemotherapy and radiotherapy in 32. 5 received no treatment and details are unknown in 3. 47 patients (58%) relapsed a median of 19 months (0.5–180) after initial therapy. Sites of relapse included brain 47%, eyes 30%, brain and eyes 15%, and systemic 8%. Patients treated with ocular therapy alone did not have an increased risk of failing in the brain (p = 0.6). Progression free survival (PFS) and overall survival (OS) were 29.6 and 57 months respectively and were unaffected by the choice of therapy. CNS disease was the cause of death in 19/33 (58%). Conclusions: In this series, treatment type did not affect sites of relapse, PFS or OS in patients with PIOL. To minimize toxicity, the best initial therapy should be limited to intraocular chemotherapy or focal radiotherapy. Prospective clinical trials are needed to improve our understanding and treatment of this disease. No significant financial relationships to disclose.
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Affiliation(s)
- S. Grimm
- Memorial Sloan-Kettering Cancer Center, New York, NY; Mayo Clinic, Rochester, MN; Charité Universitätsmedizin Berlin, Berlin, Germany; University of Virginia, Charlottesville, VA; Royal Melbourne Hospital, Melbourne, Australia; British Columbia Cancer Agency, Vancourver, BC, Canada; Hadassah Hebrew University Hospital, Jerusalem, Israel; Oregon Health Sciences University, Portland, OR; Massachusetts General Hospital, Boston, MA
| | - J. Pulido
- Memorial Sloan-Kettering Cancer Center, New York, NY; Mayo Clinic, Rochester, MN; Charité Universitätsmedizin Berlin, Berlin, Germany; University of Virginia, Charlottesville, VA; Royal Melbourne Hospital, Melbourne, Australia; British Columbia Cancer Agency, Vancourver, BC, Canada; Hadassah Hebrew University Hospital, Jerusalem, Israel; Oregon Health Sciences University, Portland, OR; Massachusetts General Hospital, Boston, MA
| | - K. Jahnke
- Memorial Sloan-Kettering Cancer Center, New York, NY; Mayo Clinic, Rochester, MN; Charité Universitätsmedizin Berlin, Berlin, Germany; University of Virginia, Charlottesville, VA; Royal Melbourne Hospital, Melbourne, Australia; British Columbia Cancer Agency, Vancourver, BC, Canada; Hadassah Hebrew University Hospital, Jerusalem, Israel; Oregon Health Sciences University, Portland, OR; Massachusetts General Hospital, Boston, MA
| | - D. Schiff
- Memorial Sloan-Kettering Cancer Center, New York, NY; Mayo Clinic, Rochester, MN; Charité Universitätsmedizin Berlin, Berlin, Germany; University of Virginia, Charlottesville, VA; Royal Melbourne Hospital, Melbourne, Australia; British Columbia Cancer Agency, Vancourver, BC, Canada; Hadassah Hebrew University Hospital, Jerusalem, Israel; Oregon Health Sciences University, Portland, OR; Massachusetts General Hospital, Boston, MA
| | - A. Hall
- Memorial Sloan-Kettering Cancer Center, New York, NY; Mayo Clinic, Rochester, MN; Charité Universitätsmedizin Berlin, Berlin, Germany; University of Virginia, Charlottesville, VA; Royal Melbourne Hospital, Melbourne, Australia; British Columbia Cancer Agency, Vancourver, BC, Canada; Hadassah Hebrew University Hospital, Jerusalem, Israel; Oregon Health Sciences University, Portland, OR; Massachusetts General Hospital, Boston, MA
| | - T. Shenkier
- Memorial Sloan-Kettering Cancer Center, New York, NY; Mayo Clinic, Rochester, MN; Charité Universitätsmedizin Berlin, Berlin, Germany; University of Virginia, Charlottesville, VA; Royal Melbourne Hospital, Melbourne, Australia; British Columbia Cancer Agency, Vancourver, BC, Canada; Hadassah Hebrew University Hospital, Jerusalem, Israel; Oregon Health Sciences University, Portland, OR; Massachusetts General Hospital, Boston, MA
| | - T. Siegal
- Memorial Sloan-Kettering Cancer Center, New York, NY; Mayo Clinic, Rochester, MN; Charité Universitätsmedizin Berlin, Berlin, Germany; University of Virginia, Charlottesville, VA; Royal Melbourne Hospital, Melbourne, Australia; British Columbia Cancer Agency, Vancourver, BC, Canada; Hadassah Hebrew University Hospital, Jerusalem, Israel; Oregon Health Sciences University, Portland, OR; Massachusetts General Hospital, Boston, MA
| | - D. Nancy
- Memorial Sloan-Kettering Cancer Center, New York, NY; Mayo Clinic, Rochester, MN; Charité Universitätsmedizin Berlin, Berlin, Germany; University of Virginia, Charlottesville, VA; Royal Melbourne Hospital, Melbourne, Australia; British Columbia Cancer Agency, Vancourver, BC, Canada; Hadassah Hebrew University Hospital, Jerusalem, Israel; Oregon Health Sciences University, Portland, OR; Massachusetts General Hospital, Boston, MA
| | - T. Batchelor
- Memorial Sloan-Kettering Cancer Center, New York, NY; Mayo Clinic, Rochester, MN; Charité Universitätsmedizin Berlin, Berlin, Germany; University of Virginia, Charlottesville, VA; Royal Melbourne Hospital, Melbourne, Australia; British Columbia Cancer Agency, Vancourver, BC, Canada; Hadassah Hebrew University Hospital, Jerusalem, Israel; Oregon Health Sciences University, Portland, OR; Massachusetts General Hospital, Boston, MA
| | - L. Abrey
- Memorial Sloan-Kettering Cancer Center, New York, NY; Mayo Clinic, Rochester, MN; Charité Universitätsmedizin Berlin, Berlin, Germany; University of Virginia, Charlottesville, VA; Royal Melbourne Hospital, Melbourne, Australia; British Columbia Cancer Agency, Vancourver, BC, Canada; Hadassah Hebrew University Hospital, Jerusalem, Israel; Oregon Health Sciences University, Portland, OR; Massachusetts General Hospital, Boston, MA
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Abrey LE, Batchelor TT, Ferreri AJM, Gospodarowicz M, Pulczynski EJ, Zucca E, Smith JR, Korfel A, Soussain C, DeAngelis LM, Neuwelt EA, O'Neill BP, Thiel E, Shenkier T, Graus F, van den Bent M, Seymour JF, Poortmans P, Armitage JO, Cavalli F. Report of an international workshop to standardize baseline evaluation and response criteria for primary CNS lymphoma. J Clin Oncol 2005; 23:5034-43. [PMID: 15955902 DOI: 10.1200/jco.2005.13.524] [Citation(s) in RCA: 563] [Impact Index Per Article: 29.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Standardized guidelines for the baseline evaluation and response assessment of primary CNS lymphoma (PCNSL) are critical to ensure comparability among clinical trials for newly diagnosed patients. The relative rarity of this tumor precludes rapid completion of large-scale phase III trials and, therefore, our reliance on the results of well-designed phase II trials is critical. To formulate this recommendation, an international group of experts representing hematologic oncology, medical oncology, neuro-oncology, neurology, radiation oncology, neurosurgery, and ophthalmology met to review current standards of reporting and to formulate a consensus opinion regarding minimum baseline evaluation and common standards for assessing response to therapy. The response guidelines were based on the results of neuroimaging, corticosteroid use, ophthalmologic examination, and CSF cytology. A critical issue that requires additional study is the optimal method to assess the neurocognitive impact of therapy and address the quality of life of PCNSL survivors. We hope that these guidelines will improve communication among investigators and comparability among clinical trials in a way that will allow us to develop better therapies for patients.
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Affiliation(s)
- Lauren E Abrey
- Department of Neurology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
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Panades M, Olivotto IA, Speers CH, Shenkier T, Olivotto TA, Weir L, Allan SJ, Truong PT. Evolving Treatment Strategies for Inflammatory Breast Cancer: A Population-Based Survival Analysis. J Clin Oncol 2005; 23:1941-50. [PMID: 15774787 DOI: 10.1200/jco.2005.06.233] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose To determine if mastectomy (Mx) use, chemotherapy (CT) intensity, or treatment sequence of CT, radiation therapy (RT), and Mx have improved outcome for inflammatory breast cancer (IBC). Patients and Methods A retrospective analysis of 485 patients with IBC diagnosed in British Columbia between 1980 and 2000 analyzed locoregional relapse-free survival (LRFS) and breast cancer–specific survival (BCSS) by treatment intent and treatment received. Curative intent was defined as delivery of more than four cycles of anthracycline-based CT plus locoregional RT in patients without distant metastases. Results Median follow-up among survivors was 6.5 years. Median BCSS was 1.0 and 3.2 years for patients with distant metastases at diagnosis or those who were curatively treated, respectively. Among patients treated curatively (n = 308), there were no significant differences in LRFS or BCSS with timing of Mx before or after CT/RT, time between diagnosis and RT, or the sequence of RT and CT. Patients receiving more intensive CT had improved 10-year BCSS compared with standard CT (43.7% v 26.3%; P = .04). Ten-year LRFS for patients having Mx after CT, Mx before CT, and without Mx was 62.8%, 58.6%, and 34.4%, respectively (P = .0001); the corresponding 10-year BCSS was 36.9%, 19.9%, and 22.5%, respectively (P = .005). On multivariate analysis, Mx was associated with improved LRFS (P = .04). Independent prognostic factors for BCSS were menopausal status (P = .02), estrogen receptor status (P = .02), and CT type (P = .05). Conclusion This retrospective analysis suggested that mastectomy, in conjunction with CT and RT, seemed to enhance locoregional control, whereas modern CT regimens seemed to improve BCSS.
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Affiliation(s)
- Miguel Panades
- Breast Cancer Outcomes Unit, BC Cancer Agency-Vancouver Island Centre, 2410 Lee Avenue, Victoria, BC, Canada
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Shenkier T. Treatment of locally advanced breast cancer. CMAJ 2004. [DOI: 10.1503/cmaj.1040848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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36
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Shenkier T, Weir L, Levine M, Olivotto I, Whelan T, Reyno L. Clinical practice guidelines for the care and treatment of breast cancer: 15. Treatment for women with stage III or locally advanced breast cancer. CMAJ 2004; 170:983-94. [PMID: 15023926 PMCID: PMC359433 DOI: 10.1503/cmaj.1030944] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE To define the optimal treatment for women with stage III or locally advanced breast cancer (LABC). EVIDENCE Systematic review of English-language literature retrieved from MEDLINE (1984 to June 2002) and CANCERLIT (1983 to June 2002). A nonsystematic review of the literature was continued through December 2003. RECOMMENDATIONS The management of LABC requires a combined modality treatment approach involving surgery, radiotherapy and systemic therapy. Systemic therapy: chemotherapy. Operable tumours. Patients with operable stage IIIA disease should be offered chemotherapy. They should receive adjuvant chemotherapy following surgery, or primary chemotherapy followed by locoregional management. Chemotherapy should contain an anthracycline. Acceptable regimens are 6 cycles of FAC, CAF, CEF or FEC. Taxanes are under intense investigation. Inoperable tumours. Patients with stage IIIB or IIIC disease, including those with inflammatory breast cancer and those with isolated ipsilateral internal mammary or supraclavicular lymph-node involvement, should be treated with primary anthracycline-based chemotherapy. Acceptable chemotherapy regimens are FAC, CAF, CEF or FEC. Taxanes are under intense investigation. Patients with stage IIIB or IIIC disease who respond to primary chemotherapy should be treated until the response plateaus or to a maximum of 6 cycles (minimum 4 cycles). Patients with stage IIIB disease should then undergo definitive surgery and irradiation. The locoregional management of patients with stage IIIC disease who respond to chemotherapy should be individualized. In patients with stage IIIB or IIIC disease who achieve maximum response with fewer than 6 cycles, further adjuvant chemotherapy can be given following surgery and irradiation. Patients whose tumours do not respond to primary chemotherapy can be treated with taxane chemotherapy or can proceed directly to irradiation followed by modified radical mastectomy, if feasible. Systemic therapy: hormonal therapy. Operable and inoperable tumours. Tamoxifen for 5 years should be recommended to pre- and postmenopausal women whose tumours are hormone responsive. Locoregional management. Operable tumours. Patients with stage IIIA disease should receive both modified radical mastectomy (MRM) and locoregional radiotherapy if feasible. They may be managed with MRM followed by chemotherapy and locoregional radiotherapy, or chemotherapy first followed by MRM and locoregional radiotherapy. Breast-conserving surgery is currently not a standard approach. Locoregional radiotherapy should be delivered to the chest wall and to the supraclavicular and axillary nodes. The role of internal mammary irradiation is unclear. Inoperable tumours. Patients with stage IIIB disease who respond to chemotherapy should receive surgery plus locoregional radiotherapy. The locoregional management of patients with stage IIIC disease who respond to chemotherapy is unclear and should be individualized. Patients whose disease remains inoperable following chemotherapy should receive locoregional radiotherapy with subsequent surgery, if feasible. VALIDATION The authors' original text was revised by members of the Steering Committee on Clinical Practice Guidelines for the Care and Treatment of Breast Cancer. Subsequently, feedback was provided by 9 oncologists from across Canada. The final document was approved by the steering committee. SPONSOR The Steering Committee on Clinical Practice Guidelines for the Care and Treatment of Breast Cancer was convened by Health Canada. Completion date: December 2003.
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Vandenberg T, Gelmon K, Panasci L, Crump M, Norris B, Tomiak A, Shenkier T, Douglas L, Matthews S, Seymour L. A phase II trial of zd0473 in patients with metastatic breast cancer. A National Cancer Institute of Canada clinical trials group study (NCIC CTG-IND 129). Eur J Cancer 2001. [DOI: 10.1016/s0959-8049(01)81200-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Weisenburger DD, Gascoyne RD, Bierman PJ, Shenkier T, Horsman DE, Lynch JC, Chan WC, Greiner TC, Connors JM, Vose JM, Armitage JO, Sanger WG. Clinical significance of the t(14;18) and BCL2 overexpression in follicular large cell lymphoma. Leuk Lymphoma 2000; 36:513-23. [PMID: 10784396 DOI: 10.3109/10428190009148399] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Follicular large cell lymphoma (FLCL) is an aggressive disease that responds to anthracycline-containing chemotherapy much like diffuse large B-cell lymphoma (DLBCL). Since the t(14;18) and/or bcl2 protein expression are less common in FLCL than in its low-grade counterparts, we sought to determine whether these features were predictive of survival as in DLBCL. We studied 50 patients with FLCL who were treated with curative intent. The t(14;18) was found by cytogenetic analysis in 56% of the patients and bcl2 protein was expressed by the tumor cells in 73%, but neither was predictive of survival. However, abnormalities of chromosome 17p and the presence of trisomy 21 were adverse predictors of survival, as were a number of clinical features. We conclude that neither the absence of the t(14;18) nor the lack of bcl2 expression explain the good response of a subset of patients with FLCL to curative therapy.
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MESH Headings
- Aged
- Biomarkers, Tumor
- Chromosomes, Human, Pair 14
- Chromosomes, Human, Pair 18
- Female
- Genes, bcl-2
- Genetic Markers
- Humans
- Lymphoma, Follicular/genetics
- Lymphoma, Follicular/pathology
- Lymphoma, Follicular/physiopathology
- Male
- Middle Aged
- Prognosis
- Survival Analysis
- Translocation, Genetic
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Affiliation(s)
- D D Weisenburger
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha 68198-3135, USA
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Gelmon KA, Tolcher A, O'Reilly S, Campbell C, Bryce C, Shenkier T, Ragaz J, Ayers D, Nakashima L, Rielly S, Dulude H. A phase I-II study of bi-weekly paclitaxel as first-line treatment in metastatic breast cancer. Ann Oncol 1998; 9:1247-9. [PMID: 9862057 DOI: 10.1023/a:1008445123416] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Single-agent bi-weekly paclitaxel was studied as first-line metastatic treatment for breast cancer in a phase I-II trial. PATIENTS AND METHODS Thirty-eight women with metastatic breast cancer were enrolled. Thirty-seven are evaluable for toxicity, 35 for response. RESULTS The MTD was defined at 160 mg/m2 q two weeks with dose limiting toxicity in two patients consisting of hematological toxicity (1) and neurotoxicity (2). Twenty patients were treated at 150 mg/m2, the recommended dose. Response rates were two CRs and nine PRs (overall 61%) at the RD of 150 mg/m2 and three CRs and 11 PRs for an overall RR of 67% for the two top doses. CONCLUSIONS The good drug tolerance, response rates, and convenience over weekly treatment suggest this may be a worthwhile regimen.
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Affiliation(s)
- K A Gelmon
- British Columbia Cancer Agency, Vancouver Centre, Canada
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Hoskins PJ, Le N, Gascoyne RD, Klasa R, Shenkier T, O'Reilly S, Connors JM. Advanced diffuse large-cell lymphoma treated with 12-week combination chemotherapy: natural history of relapse after initial complete response and prognostic variables defining outcome after relapse. Ann Oncol 1997; 8:1125-32. [PMID: 9426332 DOI: 10.1023/a:1008263602334] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
PURPOSE To define both the natural history of and prognostic factors affecting outcome post relapse from a complete response in advanced stage diffuse large-cell lymphoma. PATIENTS AND METHODS A total of 468 patients aged 17-74 years received the 12-week duration chemotherapy regimens MACOP-B, VACOP-B and ACOP-12 between 1 April 1981 and 31 December 1995 for advanced stage diffuse large, mixed or immunoblastic lymphoma. Of these 402 entered a complete remission, 97 (24%) of whom subsequently relapsed. Initial staging data, follow-up, and relapse information were analyzed to define the natural history of relapse and also subjected to univariate and multivariate correlation with overall (OS) and failure free survival (FFS). RESULTS Eleven percent of the relapses were low grade. All other relapses were of intermediate grade with 75% occurring within the first two years, the remainder up until the eleventh year. Median and five-year OS from the time of relapse for intermediate grade relapse were 12 months and 20%; for FFS they were eight months and 18% respectively. Adverse independent factors, for both OS and FFS were: less than one year to relapse, decreasing performance status at relapse, and more than three nodal sites at relapse. CONCLUSIONS Low-grade relapse is not uncommon in patients who initially presented with diffuse large cell lymphoma. As the management of low- and intermediate grade disease is so different biopsy proof of the nature of the relapse is of value. The prognostic factors identified need to be taken into consideration when analyzing results from trials of secondary treatment so as to avoid erroneous conclusions about comparative treatment efficacy.
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Affiliation(s)
- P J Hoskins
- Division of Medical Oncology, British Columbia Cancer Agency, Vancouver Centre
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Abstract
Malignant lymphomas (ML) with t(3;14) or variant t(2;3) and t(3;22) have recently been recognized. These translocations have been shown to associate predominantly with B-cell diffuse large cell lymphoma (DLCL) and less frequently with follicular lymphoma (FL). The molecular alterations associated with these translocations involve one of the immunoglobulin gene (Ig) loci and a recently cloned gene, bcl-6 located at 3q27 which codes for a zinc-finger protein that may function as a transcription factor. We have identified by cytogenetic analysis 22 cases of ML with a 3q27/Ig translocation. The pathologic diagnoses of these cases include DLCL, FL, small non-cleaved non-Burkitt lymphoma and chronic lymphocytic leukaemia. Molecular analysis confirmed a bcl-6 rearrangement in 10/12 cases tested. The karyotype in 5/22 cases revealed the t(3;14) or variant in association with another lymphoma-specific translocation, t(14;18) in three cases and t(8;14) in two cases. ML with dual translocations that implicate Ig genes in the deregulation of proto-oncogenes are being increasingly recognized and may represent distinct subtypes or 'hybrid' forms of malignant lymphoma.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Blotting, Southern
- Chromosomes, Human, Pair 14
- Chromosomes, Human, Pair 18
- Chromosomes, Human, Pair 3
- Chromosomes, Human, Pair 8
- DNA-Binding Proteins/genetics
- Female
- Genes, Immunoglobulin
- Humans
- Immunoglobulin Heavy Chains/genetics
- Karyotyping
- Lymphoma, B-Cell/genetics
- Male
- Middle Aged
- Proto-Oncogene Proteins/genetics
- Proto-Oncogene Proteins c-bcl-2
- Proto-Oncogene Proteins c-bcl-6
- Transcription Factors/genetics
- Translocation, Genetic
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Affiliation(s)
- D E Horsman
- Division of Laboratory Medicine, British Columbia Cancer Agency, Vancouver, Canada
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Shore S, Irvin CG, Shenkier T, Martin JG. Mechanisms of histamine-induced contraction of canine airway smooth muscle. J Appl Physiol Respir Environ Exerc Physiol 1983; 55:22-6. [PMID: 6885574 DOI: 10.1152/jappl.1983.55.1.22] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
We studied the effects of atropine (10(-10) to 10(-6) M), tetrodotoxin (TTX) (10(-6) g/ml), and neostigmine (10(-7) M) on the histamine dose-response curve of canine tracheal smooth muscle (TSM) in vitro. Pretreatment with atropine or TTX reduced base-line tension in some TSM samples, whereas neostigmine invariably caused contraction of TSM. All concentrations of atropine reduced the maximum isometric tension produced by histamine (Tmax). With 10(-6), 10(-8), and 10(-10) M atropine, Tmax was 57, 74, and 88%, respectively, of its value in paired control samples. Atropine, 10(-9) to 10(-6) M, increased the concentration of histamine which produced 20% of Tmax, whereas 10(-6) M also increased the concentration required to produce 50% of Tmax. TTX reduced tension produced by low concentrations of histamine but had no effect at higher concentrations. Neostigmine shifted the histamine dose-response curve and caused greater tension for any given histamine concentration; Tmax increased by 30% (P less than 0.05). Our data are consistent with spontaneous release of acetylcholine from cholinergic nerves in the airway tissue and suggest that histamine either accelerates this release or interacts supra-additively with the acetylcholine at the smooth muscle.
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