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Kim JW, Lee HJ, Lee JY, Park SR, Kim YJ, Hwang IG, Kyun Bae W, Byun JH, Kim JS, Kang EJ, Lee J, Shin SJ, Chang WJ, Kim EO, Sa JK, Park KH. Phase II study of nivolumab in patients with genetic alterations in DNA damage repair and response who progressed after standard treatment for metastatic solid cancers (KM-06). J Immunother Cancer 2024; 12:e008638. [PMID: 38485184 PMCID: PMC10941126 DOI: 10.1136/jitc-2023-008638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Immune-modulating antibodies targeting programmed cell death protein 1/programmed death-ligand 1 (PD-1/PD-L1) have demonstrated promising antitumor efficacy in various types of cancers, especially highly mutated ones. Genetic alterations in DNA damage response and repair (DDR) genes can lead to genetic instability, often accompanied by a high tumor mutation burden (TMB). However, few studies have validated the aberration of DDR genes as a predictive biomarker for response to immune-modulating antibodies. METHODS The KM-06 open-label, multicenter, single-arm, phase II trial evaluated the safety and efficacy of nivolumab in refractory solid cancers with DDR gene mutations assessed by clinically targeted sequencing. Nivolumab (3 mg/kg) was administered every 2 weeks until disease progression, unacceptable toxicity, or for 24 months. The primary endpoint was the objective response rate (ORR) as per RECIST V.1.1 criteria. RESULTS A total of 48 patients were enrolled in the study (median age 61, 58.3% male). The most common cancer type was colorectal cancer (41.7%), followed by prostate and biliary tract cancer (8.3% each). Eight patients achieved a partial response as their best overall response, resulting in an ORR of 17.8%. The disease control rate was 60.0%. The median progression-free survival was 2.9 months. Treatment-related adverse events of any grade and grade ≥3 occurred in 44 (91.7%) and 4 (8.3%) patients, respectively. Clinically targeted sequencing data inferred both TMB and microsatellite instability (MSI). Using a TMB cut-off of 12 mut/Mb, there were significant differences in overall survival (p=0.00035), progression-free survival (p=0.0061), and the best overall response (p=0.05). In the RNA sequencing analysis, nivolumab responders showed activation of the interleukin signaling pathway. Patients who experienced early progression presented high epithelial-mesenchymal transition signaling pathway activation. The responders exhibited a marked increase in PD-1-/Ki67+CD8 T cells at the early stage of treatment (C3D1) compared with non-responders (p=0.03). CONCLUSIONS In this phase II trial, nivolumab demonstrated moderate efficacy and manageable toxicity in patients with solid cancer harboring DDR gene mutations. A high TMB (>12 mut/Mb) and MSI score (>2.5) determined through clinically target sequencing presented significant discriminatory power for the nivolumab response. TRIAL REGISTRATION NUMBER NCT04761744.
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Affiliation(s)
- Ju Won Kim
- Division of Hemato-Oncology, Department of Internal Medicine, Korea University College of Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Hyo Jin Lee
- Division of Hemato-Oncology, Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Ji Yoon Lee
- Department of Biomedical Informatics and Department of Biomedical Sciences, Korea University College of Medicine, Seoul, Republic of Korea
| | - Sook Ryun Park
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yu Jung Kim
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - In Gyu Hwang
- Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine and Graduate School of Medicine, Dongjak-gu, Republic of Korea
| | - Woo Kyun Bae
- Division of Hemato-Oncology, Department of Internal Medicine, Chonnam National University Medical School & Hwasun Hospital, Hwasun, Republic of Korea
| | - Jae Ho Byun
- Division of Oncology, Department of Internal Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon, Republic of Korea
| | - Jung Sun Kim
- Division of Hemato-Oncology, Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Eun Joo Kang
- Division of Hemato-Oncology, Department of Internal Medicine, Korea University College of Medicine, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Jeeyun Lee
- Division of Hemato-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Suwon, Republic of Korea
| | - Sang Joon Shin
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seodaemun-gu, Republic of Korea
| | - Won Jin Chang
- Division of Hemato-Oncology, Department of Internal Medicine, Korea University College of Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Eun-Ok Kim
- Medical Science Research Center, College of Medicine, Korea University, Seongbuk-gu, Republic of Korea
| | - Jason K Sa
- Department of Biomedical Informatics and Department of Biomedical Sciences, Korea University College of Medicine, Seoul, Republic of Korea
| | - Kyong Hwa Park
- Division of Hemato-Oncology, Department of Internal Medicine, Korea University College of Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
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Wang P, Xia L. RC48-ADC treatment for patients with HER2-expressing locally advanced or metastatic solid tumors: a real-world study. BMC Cancer 2023; 23:1083. [PMID: 37946161 PMCID: PMC10636982 DOI: 10.1186/s12885-023-11593-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 10/30/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND RC48-antibody-drug conjugates (ADC) link humanized anti-HER2 immunoglobulin with monomethyl auristatin E (MMAE). Clinical trials suggest promising antitumor activity in HER2-expressing solid tumors. This study probes RC48-ADC's efficacy and safety in patients with HER2-expressing advanced or metastatic solid tumors. METHOD Data was collected from 23 advanced cancer patients treated with RC48-ADC at our oncology center between July 2021 and December 2022. These patients exhibited at least 1 + expression of HER2 immunohistochemistry, had previously experienced at least one failed systemic chemotherapy, and were treated with RC48-ADC until the occurrence of intolerable adverse reactions or disease progression. The primary endpoint was the disease control rate (DCR), and secondary endpoints included progression-free survival (PFS), objective response rate (ORR), and safety. RESULTS 23 of 25 screened patients received RC48 treatment. The ORR was 43.5% (95% CI, 23.2-63.7%) with a median PFS of 6.0 months (95% CI, 4.8-7.4). In the low-to-medium HER2 expression subgroup, ORR was 37.5%, median PFS 5.75 months. In the high HER2 expression subgroup, ORR was 57.1%, median PFS 7 months. For the cohort combining RC48 with PD-1 inhibitors, ORR was 53.8%, median PFS 8 months. In the concurrent local radiation therapy subgroup, ORR was 40.0%, median PFS 6.0 months. Treatment-related adverse events (TRAEs) were anemia (60.8%), leukopenia (56.2%), raised transaminases (52.17%), and neutropenia (43.5%). Five patients (21.7%) experienced Grade 3 symptoms, including anemia (21.7%) and neutropenia (14.0%). No Grade 4 adverse reactions or deaths were reported. CONCLUSION RC48-ADC shows promising efficacy and manageable safety in HER2-expressing advanced or metastatic solid tumor patients.
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Affiliation(s)
- Ping Wang
- Department of Cancer Center, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 401336, China
| | - Lei Xia
- Department of Cancer Center, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 401336, China.
- Tianjin Key Laboratory of Radiation Medicine and Molecular Nuclear Medicine, Institute of Radiation Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, 300110, China.
- Department of Radiation Oncology, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin, 300060, China.
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Im C, Sharafeldin N, Yuan Y, Wang Z, Sapkota Y, Lu Z, Spector LG, Howell RM, Arnold MA, Hudson MM, Ness KK, Robison LL, Bhatia S, Armstrong GT, Neglia JP, Yasui Y, Turcotte LM. Polygenic Risk and Chemotherapy-Related Subsequent Malignancies in Childhood Cancer Survivors: A Childhood Cancer Survivor Study and St Jude Lifetime Cohort Study Report. J Clin Oncol 2023; 41:4381-4393. [PMID: 37459583 PMCID: PMC10522108 DOI: 10.1200/jco.23.00428] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 04/26/2023] [Accepted: 05/18/2023] [Indexed: 08/07/2023] Open
Abstract
PURPOSE Chemotherapeutic exposures are associated with subsequent malignant neoplasm (SMN) risk. The role of genetic susceptibility in chemotherapy-related SMNs should be defined as use of radiation therapy (RT) decreases. PATIENTS AND METHODS SMNs among long-term childhood cancer survivors of European (EUR; N = 9,895) and African (AFR; N = 718) genetic ancestry from the Childhood Cancer Survivor Study and St Jude Lifetime Cohort Study were evaluated. An externally validated 179-variant polygenic risk score (PRS) associated with pleiotropic adult cancer risk from the UK Biobank Study (N > 400,000) was computed for each survivor. SMN cumulative incidence comparing top and bottom PRS quintiles was estimated, along with hazard ratios (HRs) from proportional hazards models. RESULTS A total of 1,594 survivors developed SMNs, with basal cell carcinomas (n = 822), breast cancers (n = 235), and thyroid cancers (n = 221) being the most frequent. Although SMN risk associations with the PRS were extremely modest in RT-exposed EUR survivors (HR, 1.22; P = .048; n = 4,630), the increase in 30-year SMN cumulative incidence and HRs comparing top and bottom PRS quintiles was statistically significant among nonirradiated EUR survivors (n = 4,322) treated with alkylating agents (17% v 6%; HR, 2.46; P < .01), anthracyclines (20% v 8%; HR, 2.86; P < .001), epipodophyllotoxins (23% v 1%; HR, 12.20; P < .001), or platinums (46% v 7%; HR, 8.58; P < .01). This PRS also significantly modified epipodophyllotoxin-related SMN risk among nonirradiated AFR survivors (n = 414; P < .01). Improvements in prediction attributable to the PRS were greatest for epipodophyllotoxin-exposed (AUC, 0.71 v 0.63) and platinum-exposed (AUC,0.68 v 0.58) survivors. CONCLUSION A pleiotropic cancer PRS has strong potential for improving SMN clinical risk stratification among nonirradiated survivors treated with specific chemotherapies. A polygenic risk screening approach may be a valuable complement to an early screening strategy on the basis of treatments and rare cancer-susceptibility mutations.
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Affiliation(s)
- Cindy Im
- Department of Pediatrics, University of Minnesota, Minneapolis, MN
| | - Noha Sharafeldin
- Hematology Oncology Division, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL
| | - Yan Yuan
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Zhaoming Wang
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN
- Department of Computational Biology, St Jude Children's Research Hospital, Memphis, TN
| | - Yadav Sapkota
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN
| | - Zhanni Lu
- Department of Pediatrics, University of Minnesota, Minneapolis, MN
| | - Logan G. Spector
- Department of Pediatrics, University of Minnesota, Minneapolis, MN
| | - Rebecca M. Howell
- Department of Radiation Physics, University of Texas at MD Anderson Cancer Center, Houston, TX
| | - Michael A. Arnold
- Department of Pathology and Laboratory Medicine, University of Colorado and Children's Hospital Colorado, Anschutz Medical Campus, Aurora, CO
| | - Melissa M. Hudson
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN
| | - Kirsten K. Ness
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN
| | - Leslie L. Robison
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN
| | - Smita Bhatia
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL
| | - Gregory T. Armstrong
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN
| | - Joseph P. Neglia
- Department of Pediatrics, University of Minnesota, Minneapolis, MN
| | - Yutaka Yasui
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN
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Lee JW, Oh H, You JY, Lee ES, Lee JH, Song SE, Lee NK, Jung SP, An JS, Cho KR, Kim CY, Park KH. Therapy-related myeloid neoplasm in early breast cancer patients treated with adjuvant chemotherapy. Eur J Cancer 2023; 191:112952. [PMID: 37473463 DOI: 10.1016/j.ejca.2023.112952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 06/14/2023] [Accepted: 06/15/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND Long-term complications are becoming more important as the survival rate of breast cancer improves. Treatment-related myeloid neoplasm is an important long-term complication in breast cancer survivors as it has a poor prognosis. OBJECTIVE We evaluated the incidence and risk factors for the development of treatment-related acute myeloid leukaemia (AML)/myelodysplastic syndrome (MDS) in patients treated with early breast cancer. METHODS We accessed the national Korean database to identify 153,565 patients diagnosed with breast cancer between January 2007 and October 2016 who underwent surgery for breast cancer. We estimated the cumulative incidence of AML/MDS and analysed the risk factors for developing AML/MDS. RESULTS Of 153,575 patients, 79,321 received anthracycline-based adjuvant therapy, 14,317 received adjuvant therapy without anthracyclines and 46,657 did not receive adjuvant chemotherapy. Overall, 120 developed AML (105 in the anthracycline group, 9 in the non-anthracycline group and 6 in the control group), and 128 developed MDS (96, 9 and 23 in each group). The 10-year cumulative incidence of AML/MDS was the highest in the anthracycline group (0.221% and 0.199%), followed by the non-anthracycline group (0.122% and 0.163%) and the control group (0.024% and 0.089%). The risk of developing AML/MDS was significantly higher in patients treated with anthracyclines (hazard ratio [HR] 9.531; p < 0.0001 for AML and HR 2.559; p < 0.0001 for MDS) compared to patients in the control group. CONCLUSION This study found that anthracycline-based adjuvant therapy significantly increased the risk of AML/MDS in Korean breast cancer patients, with the risk persisting for at least 10 years. While the cumulative incidence was low, the long-term risks of AML/MDS should be taken into account considering the poor outcomes associated with these neoplasms.
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MESH Headings
- Humans
- Female
- Breast Neoplasms/complications
- Leukemia, Myeloid, Acute/chemically induced
- Leukemia, Myeloid, Acute/drug therapy
- Leukemia, Myeloid, Acute/epidemiology
- Myelodysplastic Syndromes/chemically induced
- Myelodysplastic Syndromes/epidemiology
- Chemotherapy, Adjuvant/adverse effects
- Combined Modality Therapy
- Anthracyclines
- Neoplasms, Second Primary/chemically induced
- Neoplasms, Second Primary/epidemiology
- Neoplasms, Second Primary/drug therapy
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
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Affiliation(s)
- Ji Won Lee
- Division of Medical Oncology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, South Korea
| | - Hoonji Oh
- Department of Biostatistics, Korea University College of Medicine, Seoul, South Korea
| | - Ji Young You
- Division of Breast and Endocrine, Department of Surgery, Departments of Breast Surgery, Korea University Anam Hospital, Seoul, South Korea
| | - Eun-Shin Lee
- Division of Breast and Endocrine, Department of Surgery, Departments of Breast Surgery, Korea University Anam Hospital, Seoul, South Korea
| | - Jung Hyun Lee
- Department of Pathology, Korea University Anam Hospital, Seoul, South Korea
| | - Sung Eun Song
- Department of Radiology, Korea University Anam Hospital, Seoul, South Korea
| | - Nam Kwon Lee
- Department of Radiation Oncology, Korea University Anam Hospital, Seoul, South Korea
| | - Seung Pil Jung
- Division of Breast and Endocrine, Department of Surgery, Departments of Breast Surgery, Korea University Anam Hospital, Seoul, South Korea
| | - Jung Seok An
- Department of Pathology, Korea University Anam Hospital, Seoul, South Korea
| | - Kyu Ran Cho
- Department of Radiology, Korea University Anam Hospital, Seoul, South Korea
| | - Cheol Yong Kim
- Department of Radiation Oncology, Korea University Anam Hospital, Seoul, South Korea
| | - Kyong Hwa Park
- Division of Medical Oncology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, South Korea.
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LoRusso P, Yamamoto N, Patel MR, Laurie SA, Bauer TM, Geng J, Davenport T, Teufel M, Li J, Lahmar M, Gounder MM. The MDM2-p53 Antagonist Brigimadlin (BI 907828) in Patients with Advanced or Metastatic Solid Tumors: Results of a Phase Ia, First-in-Human, Dose-Escalation Study. Cancer Discov 2023; 13:1802-1813. [PMID: 37269344 PMCID: PMC10401071 DOI: 10.1158/2159-8290.cd-23-0153] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 05/04/2023] [Accepted: 05/23/2023] [Indexed: 06/05/2023]
Abstract
Brigimadlin (BI 907828) is an oral MDM2-p53 antagonist that has shown encouraging antitumor activity in vivo. We present phase Ia results from an open-label, first-in-human, phase Ia/Ib study investigating brigimadlin in patients with advanced solid tumors (NCT03449381). Fifty-four patients received escalating doses of brigimadlin on day 1 of 21-day cycles (D1q3w) or days 1 and 8 of 28-day cycles (D1D8q4w). Based on dose-limiting toxicities during cycle 1, the maximum tolerated dose was selected as 60 mg for D1q3w and 45 mg for D1D8q4w. The most common treatment-related adverse events (TRAE) were nausea (74.1%) and vomiting (51.9%); the most common grade ≥3 TRAEs were thrombocytopenia (25.9%) and neutropenia (24.1%). As evidence of target engagement, time- and dose-dependent increases in growth differentiation factor 15 levels were seen. Preliminary efficacy was encouraging (11.1% overall response and 74.1% disease control rates), particularly in patients with well-differentiated or dedifferentiated liposarcoma (100% and 75% disease control rates, respectively). SIGNIFICANCE We report phase Ia data indicating that the oral MDM2-p53 antagonist brigimadlin has a manageable safety profile and shows encouraging signs of efficacy in patients with solid tumors, particularly those with MDM2-amplified advanced/metastatic well-differentiated or dedifferentiated liposarcoma. Further clinical investigation of brigimadlin is ongoing. See related commentary by Italiano, p. 1765. This article is highlighted in the In This Issue feature, p. 1749.
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Affiliation(s)
- Patricia LoRusso
- Yale University School of Medicine, Yale Cancer Center, New Haven, Connecticut
| | - Noboru Yamamoto
- National Cancer Center Hospital, Department of Experimental Therapeutics, Tokyo, Japan
| | - Manish R. Patel
- Sarah Cannon Research Institute, Florida Cancer Specialists and Research Institute, Sarasota, Florida
| | | | - Todd M. Bauer
- Sarah Cannon Research Institute Tennessee Oncology, Nashville, Tennessee
| | - Junxian Geng
- Boehringer Ingelheim Pharmaceuticals Inc., Ridgefield, Connecticut
| | | | - Michael Teufel
- Boehringer Ingelheim Pharmaceuticals Inc., Ridgefield, Connecticut
| | - Jian Li
- Boehringer Ingelheim Pharmaceuticals Inc., Ridgefield, Connecticut
| | - Mehdi Lahmar
- Boehringer Ingelheim International GmbH, Ingelheim am Rhein, Germany
| | - Mrinal M. Gounder
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical School, New York, New York
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Dote S, Inose R, Goto R, Kobayashi Y, Muraki Y. Risk of a second cancer and infection in patients with indolent B-cell lymphoma exposed to first-line bendamustine plus rituximab: A retrospective analysis of an administrative claims database. Hematol Oncol 2023; 41:354-362. [PMID: 36792059 DOI: 10.1002/hon.3128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 12/31/2022] [Accepted: 02/13/2023] [Indexed: 02/17/2023]
Abstract
Bendamustine has a potent immunosuppressive effect because it causes T-cell lymphopenia, which might lead to a second primary malignancy (SPM) and would increase the risk of infection. Using the Medical Data Vision administrative claims database, we compared the cumulative incidence of SPM, infections within 6 months, and overall survival (OS) among untreated patients with indolent B-cell lymphomas (iBCL) who received rituximab-based chemotherapy between 2009 and 2020. Patients with grade 3b follicular lymphoma or a previous history of malignancy were excluded. Eligible 5234 patients were assigned to three cohorts: rituximab monotherapy (N = 780), RCHOP/RCVP/RTHPCOP (doxorubicin replaced with pirarubicin) (N = 2298), or bendamustine/rituximab (BR) (N = 2156). There were 589 recorded SPMs, of which myelodysplastic syndromes were the most common (1.7%). The cumulative incidence of SPM was significantly higher in patients treated with BR than in those treated with rituximab monotherapy (p < 0.01) or RCHOP/RCVP/RTHPCOP (p < 0.0001): the 5-year cumulative incidence function was 18.1%, 12.5%, and 12.9%, respectively. In the Fine-Gray subdistribution hazards model, BR showed a significantly higher cumulative incidence of SPM than RCHOP/RCVP/RTHPCOP (subhazard ratio, 1.33; 95% confidence interval [CI], 1.10-1.61). Furthermore, in sensitivity analysis, a nested case-control study using an entire cohort showed consistent results: the SPM odds ratios (95% CI) of first-line bendamustine, bendamustine after first-line, and any-line bendamustine were 1.43 (1.14-1.78), 1.26 (0.96-1.64), and 1.33 (1.09-1.62), respectively. Regarding infections, adjusted odds ratios (95% CI) of BR compared to RCHOP/RCVP/RTHPCOP were as follows: cytomegalovirus infection, 13.7 (4.88-38.4); bacterial pneumonia, 0.63 (0.50-0.78); and pneumocystis pneumonia, 0.24 (0.11-0.53). There was no significant difference in OS between RCHOP/RCVP/RTHPCOP and BR in patients with follicular, mantle cell, marginal zone, or lymphoplasmacytic lymphomas. In conclusion, treatment strategies that consider the risk of SPM and infections after chemotherapy are warranted in patients with iBCL.
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Affiliation(s)
- Satoshi Dote
- Department of Pharmacy, Kyoto-Katsura Hospital, Kyoto, Japan
- Department of Clinical Pharmacoepidemiology, Kyoto Pharmaceutical University, Kyoto, Japan
| | - Ryo Inose
- Department of Clinical Pharmacoepidemiology, Kyoto Pharmaceutical University, Kyoto, Japan
| | - Ryota Goto
- Department of Clinical Pharmacoepidemiology, Kyoto Pharmaceutical University, Kyoto, Japan
| | - Yuka Kobayashi
- Department of Pharmacy, Kyoto-Katsura Hospital, Kyoto, Japan
| | - Yuichi Muraki
- Department of Clinical Pharmacoepidemiology, Kyoto Pharmaceutical University, Kyoto, Japan
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Reulen RC, Winter DL, Diallo I, Veres C, Llanas D, Allodji RS, Bagnasco F, Bárdi E, Feijen EAM, Alessi D, Fidler-Benaoudia MM, Høgsholt S, Teepen JC, Linge H, Haddy N, Byrne J, Debiche G, Grabow D, Gudmundsdottir T, Fauchery R, Zrafi W, Michel G, Øfstaas H, Kaatsch P, Vu-Bezin G, Jenkinson H, Kaiser M, Skinner R, Cole T, Waespe N, Sommer G, Nordenfelt S, Jankovic M, Lähteenmäki Taalas T, Maule MM, van der Pal HJH, Ronckers CM, van Leeuwen FE, Kok JL, Terenziani M, Winther Gunnes M, Wiebe T, Sacerdote C, Jakab Z, Haupt R, Lähteenmäki PM, Zadravec Zaletel L, Kuehni CE, Winther JF, Kremer LCM, Hjorth L, de Vathaire F, Hawkins MM. Risk Factors for Primary Bone Cancer After Childhood Cancer: A PanCare Childhood and Adolescent Cancer Survivor Care and Follow-Up Studies Nested Case-Control Study. J Clin Oncol 2023; 41:3735-3746. [PMID: 37235821 DOI: 10.1200/jco.22.02045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 02/09/2023] [Accepted: 04/10/2023] [Indexed: 05/28/2023] Open
Abstract
PURPOSE Radiation to the bone and exposure to alkylating agents increases the risk of bone cancer among survivors of childhood cancer, but there is uncertainty regarding the risks of bone tissue radiation doses below 10 Gy and the dose-response relationship for specific types of chemotherapy. METHODS Twelve European countries contributed 228 cases and 228 matched controls to a nested case-control study within a cohort of 69,460 5-year survivors of childhood cancer. Odds ratios (ORs) of developing bone cancer for different levels of cumulative radiation exposure and cumulative doses of specific types of chemotherapy were calculated. Excess ORs were calculated to investigate the shape and extent of any dose-response relationship. RESULTS The OR associated with bone tissue exposed to 1-4 Gy was 4.8-fold (95% CI, 1.2 to 19.6) and to 5-9 Gy was 9.6-fold (95% CI, 2.4 to 37.4) compared with unexposed bone tissue. The OR increased linearly with increasing dose of radiation (Ptrend < .001) up to 78-fold (95% CI, 9.2 to 669.9) for doses of ≥40 Gy. For cumulative alkylating agent doses of 10,000-19,999 and ≥20,000 mg/m2, the radiation-adjusted ORs were 7.1 (95% CI, 2.2 to 22.8) and 8.3 (95% CI, 2.8 to 24.4), respectively, with independent contributions from each of procarbazine, ifosfamide, and cyclophosphamide. Other cytotoxics were not associated with bone cancer. CONCLUSION To our knowledge, we demonstrate-for the first time-that the risk of bone cancer is increased 5- to 10-fold after exposure of bone tissue to cumulative radiation doses of 1-9 Gy. Alkylating agents exceeding 10,000 mg/m2 increase the risk 7- to 8-fold, particularly following procarbazine, ifosfamide, and cyclophosphamide. These substantially elevated risks should be used to develop/update clinical follow-up guidelines and survivorship care plans.
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Affiliation(s)
- Raoul C Reulen
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - David L Winter
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Ibrahim Diallo
- Radiation Epidemiology Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France
| | - Cristina Veres
- Radiation Epidemiology Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France
| | - Damien Llanas
- Radiation Epidemiology Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France
| | - Rodrigue S Allodji
- Radiation Epidemiology Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France
| | | | - Edit Bárdi
- St Anna Children's Hospital, Vienna, Austria
| | | | | | | | | | | | | | - Nadia Haddy
- Radiation Epidemiology Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France
| | | | - Ghazi Debiche
- Radiation Epidemiology Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France
| | | | | | - Romain Fauchery
- Radiation Epidemiology Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France
| | - Wael Zrafi
- Radiation Epidemiology Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France
| | | | | | | | - Giao Vu-Bezin
- Radiation Epidemiology Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Jeanette F Winther
- Department of Clinical Medicine, Faculty of Health, Aarhus University and University Hospital, Aarhus, Denmark
| | | | | | - Florent de Vathaire
- Radiation Epidemiology Team, Center for Research in Epidemiology and Population Health, INSERM U1018, University Paris Saclay, Gustave Roussy, Villejuif, France
| | - Michael M Hawkins
- Centre for Childhood Cancer Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
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8
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Wu W, Li S, Xu K, Meng Z. Hazard ratios of second primary malignancy after radioiodine for differentiated thyroid carcinoma: a large-cohort retrospective study. Endokrynol Pol 2023; 74:260-270. [PMID: 37335064 DOI: 10.5603/ep.a2023.0028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 03/02/2023] [Indexed: 06/21/2023]
Abstract
INTRODUCTION The objective of this study is to evaluate the benefits of radioactive iodine (RAI) treatment and the risk of second primary malignancy (SPM) in RAI-treated patients. MATERIAL AND METHODS The cohort for this analysis consisted of individuals diagnosed with a first primary differentiated thyroid carcinoma (DTC), reported by the Surveillance, Epidemiology, and End Results (SEER) database in 1988-2016. Overall survival (OS) difference was estimated by Kaplan-Meier curves and log-rank test, and hazard ratios (HR) were obtained by Cox proportional-hazards model to evaluate the association between RAI and SPM. RESULTS Among 130,902 patients, 61,210 received RAI and 69,692 did not, and a total of 8604 patients developed SPM. We found that OS was significantly higher in patients who received RAI than in those who did not (p < 0.001). DTC survivors treated with RAI had increased risk of SPM in females (p = 0.043), particularly for SPM occurring in the ovary (p = 0.039) and leukaemia (p < 0.0001). The risk of developing SPM was higher in the RAI group than in the non-RAI group and the general population, and the incidence increased with age. CONCLUSIONS Increased risk of SPM occurs in female DTC survivors treated with RAI, which become more obvious with increasing age. Our research findings were beneficial to the formulation of RAI treatment strategies and the prediction of SPM for patients with thyroid cancer of different genders and different ages.
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Affiliation(s)
- Weiming Wu
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin, China
| | - Shujie Li
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin, China
| | - Ke Xu
- Tianjin Key Laboratory of Lung Cancer Metastasis and Tumour Microenvironment, Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Zhaowei Meng
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin, China.
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9
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Diamond B, Ziccheddu B, Maclachlan K, Taylor J, Boyle E, Ossa JA, Jahn J, Affer M, Totiger TM, Coffey D, Chandhok N, Watts J, Cimmino L, Lu SX, Bolli N, Bolton K, Landau H, Park JH, Ganesh K, McPherson A, Sekeres MA, Lesokhin A, Chung DJ, Zhang Y, Ho C, Roshal M, Tyner J, Nimer S, Papaemmanuil E, Usmani S, Morgan G, Landgren O, Maura F. Tracking the evolution of therapy-related myeloid neoplasms using chemotherapy signatures. Blood 2023; 141:2359-2371. [PMID: 36626250 PMCID: PMC10273163 DOI: 10.1182/blood.2022018244] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 11/22/2022] [Accepted: 12/19/2022] [Indexed: 01/11/2023] Open
Abstract
Patients treated with cytotoxic therapies, including autologous stem cell transplantation, are at risk for developing therapy-related myeloid neoplasms (tMN). Preleukemic clones (ie, clonal hematopoiesis [CH]) are detectable years before the development of these aggressive malignancies, although the genomic events leading to transformation and expansion are not well defined. Here, by leveraging distinctive chemotherapy-associated mutational signatures from whole-genome sequencing data and targeted sequencing of prechemotherapy samples, we reconstructed the evolutionary life-history of 39 therapy-related myeloid malignancies. A dichotomy was revealed, in which neoplasms with evidence of chemotherapy-induced mutagenesis from platinum and melphalan were hypermutated and enriched for complex structural variants (ie, chromothripsis), whereas neoplasms with nonmutagenic chemotherapy exposures were genomically similar to de novo acute myeloid leukemia. Using chemotherapy-associated mutational signatures as temporal barcodes linked to discrete clinical exposure in each patient's life, we estimated that several complex events and genomic drivers were acquired after chemotherapy was administered. For patients with prior multiple myeloma who were treated with high-dose melphalan and autologous stem cell transplantation, we demonstrate that tMN can develop from either a reinfused CH clone that escapes melphalan exposure and is selected after reinfusion, or from TP53-mutant CH that survives direct myeloablative conditioning and acquires melphalan-induced DNA damage. Overall, we revealed a novel mode of tMN progression that is not reliant on direct mutagenesis or even exposure to chemotherapy. Conversely, for tMN that evolve under the influence of chemotherapy-induced mutagenesis, distinct chemotherapies not only select preexisting CH but also promote the acquisition of recurrent genomic drivers.
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Affiliation(s)
- Benjamin Diamond
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL
| | | | - Kylee Maclachlan
- Division of Myeloma, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Justin Taylor
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL
| | - Eileen Boyle
- Myeloma Research Program, New York University Langone, Perlmutter Cancer Center, New York, NY
| | - Juan Arango Ossa
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jacob Jahn
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL
| | - Maurizio Affer
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL
| | | | - David Coffey
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL
| | - Namrata Chandhok
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL
| | - Justin Watts
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL
| | - Luisa Cimmino
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL
| | - Sydney X. Lu
- Division of Hematology, Stanford Hospital and Clinics, Stanford University, Stanford, CA
| | - Niccolò Bolli
- Department of Oncology and Onco-Hematology, Università degli Studi di Milano, Milan, Italy
- Hematology Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Kelly Bolton
- Division of Oncology, Washington University School of Medicine, St. Louis, MO
| | - Heather Landau
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jae H. Park
- Department of Medicine, Memorial Hospital, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Karuna Ganesh
- Department of Medicine, Memorial Hospital, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Andrew McPherson
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Alexander Lesokhin
- Division of Myeloma, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - David J. Chung
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Yanming Zhang
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Caleb Ho
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Mikhail Roshal
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jeffrey Tyner
- Division of Hematology and Medical Oncology, Oregon Health & Science University, Portland, OR
| | - Stephen Nimer
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL
| | - Elli Papaemmanuil
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Saad Usmani
- Division of Myeloma, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Gareth Morgan
- Myeloma Research Program, New York University Langone, Perlmutter Cancer Center, New York, NY
| | - Ola Landgren
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL
| | - Francesco Maura
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL
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10
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Wang R, Shallis RM, Stempel JM, Huntington SF, Zeidan AM, Gore SD, Ma X, Podoltsev NA. Second malignancies among older patients with classical myeloproliferative neoplasms treated with hydroxyurea. Blood Adv 2023; 7:734-743. [PMID: 35917456 PMCID: PMC9989521 DOI: 10.1182/bloodadvances.2022008259] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/15/2022] [Accepted: 07/15/2022] [Indexed: 11/20/2022] Open
Abstract
Patients with classical Philadelphia chromosome-negative myeloproliferative neoplasms (MPNs), including polycythemia vera (PV), essential thrombocythemia (ET), and primary and secondary myelofibrosis (MF), are known to have an increased risk of second malignancies (SMs). Hydroxyurea (HU) is a guideline-recommended cytoreductive therapy for patients at high risk for MPNs. Controversy exists as to whether HU use is associated with a higher risk of SMs, including acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS). We conducted a retrospective cohort study of older patients diagnosed with MPN (age ≥66 years) between 2010 and 2017 and included the data in the Surveillance, Epidemiology, and End Results Medicare-linked database. Multivariable competing risk analyses adjusting for patient characteristics were used to assess the impact of HU on the development of SM. We identified 4023 patients (1688 with PV, 1976 with ET, and 359 with MF) with a median age of 77 (interquartile range [IQR], 71-83) years at the time of MPN diagnosis. After a median follow-up of 3.25 (IQR, 2.10-5.00) years, 489 patients developed an SM (346 solid, 73 lymphoid, and 70 myeloid malignancies). The cumulative incidence probability of SM was 19.88% (95% confidence interval [CI], 17.16%-22.75%) among 2683 HU users and 22.31% (95% CI, 17.51%-27.47%) among 1340 nonusers, respectively (Gray's test, P < .01). We did not identify significant differences in the incidence of solid or hematologic SMs, including AML/MDS (hazard ratio, 1.33; 95% CI, 0.77-2.29; P = .30), between HU users and nonusers. Our results suggest that the use of HU does not increase the risk of SM in older patients with MPN.
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Affiliation(s)
- Rong Wang
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University, New Haven, CT
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT
| | - Rory M. Shallis
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University, New Haven, CT
- Department of Internal Medicine (Hematology), Yale School of Medicine, New Haven, CT
| | - Jessica M. Stempel
- Department of Internal Medicine (Hematology), Yale School of Medicine, New Haven, CT
| | - Scott F. Huntington
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University, New Haven, CT
- Department of Internal Medicine (Hematology), Yale School of Medicine, New Haven, CT
| | - Amer M. Zeidan
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University, New Haven, CT
- Department of Internal Medicine (Hematology), Yale School of Medicine, New Haven, CT
| | - Steven D. Gore
- Department of Internal Medicine (Hematology), Yale School of Medicine, New Haven, CT
| | - Xiaomei Ma
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University, New Haven, CT
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT
| | - Nikolai A. Podoltsev
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University, New Haven, CT
- Department of Internal Medicine (Hematology), Yale School of Medicine, New Haven, CT
- Correspondence: Nikolai A. Podoltsev, Department of Internal Medicine, Section of Hematology, Yale School of Medicine, 37 College St, New Haven, CT 06510;
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11
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Wong SK, Blum SM, Sun X, Da Silva IP, Zubiri L, Ye F, Bai K, Zhang K, Ugurel S, Zimmer L, Livingstone E, Schadendorf D, Serra-Bellver P, Muñoz-Couselo E, Ortiz C, Lostes J, Huertas RM, Arance A, Pickering L, Long GV, Carlino MS, Buchbinder EI, Vázquez-Cortés L, Jara-Casas D, Márquez-Rodas I, González-Espinoza IR, Balko JM, Menzies AM, Sullivan RJ, Johnson DB. Efficacy and safety of immune checkpoint inhibitors in young adults with metastatic melanoma. Eur J Cancer 2023; 181:188-197. [PMID: 36680880 DOI: 10.1016/j.ejca.2022.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 12/14/2022] [Accepted: 12/15/2022] [Indexed: 12/28/2022]
Abstract
BACKGROUND The integration of immune checkpoint inhibitors (ICI) for the treatment of melanoma has resulted in remarkable and durable responses. Given the potential role of immunosenescence, age may contribute to differential ICI efficacy and toxicity. While older patients have been studied in detail, outcomes from ICI in young patients (≤40 years) are not well characterised. METHODS We performed a multi-institutional, retrospective study of patients with advanced melanoma treated with anti-PD-1 monotherapy or ICI combination (ipilimumab and anti-PD-1). Response rates, survival, and toxicities were examined based on age comparing those under 40 years of age with older patients (age 41-70 and ≥ 71 years). RESULTS A total of 676 patients were included: 190 patients (28%) aged ≤40 years, 313 (46%) between ages 41-70, and 173 patients (26%) aged ≥71. Patients ≤40 years had higher response rates (53% vs 38%, p = 0.035) and improved progression-free survival (median 13.7 vs 4.0 months, p = 0.032) with combination ICI compared to monotherapy. Progression-free survival was similar among groups while overall survival was inferior in patients >70 years, who had low response rates to combination therapy (28%). ICIs had a similar incidence of severe toxicities, though hepatotoxicity was particularly common in younger patients vs. patients >40 with monotherapy (9% vs. 2%, p = 0.007) or combination ICI (37% vs. 10%, p < 0.001). CONCLUSIONS ICIs had comparable efficacy between younger and older patients, although outcomes were superior with combination ICI compared to monotherapy in patients aged ≤40 years. Toxicity incidence was similar across age groups, though organs affected were substantially different.
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Affiliation(s)
- Selina K Wong
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Steven M Blum
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA; Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Xiaopeng Sun
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Inês P Da Silva
- University of Sydney, Melanoma Institute Australia, Sydney, Australia
| | - Leyre Zubiri
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Fei Ye
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kun Bai
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kevin Zhang
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Selma Ugurel
- University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Lisa Zimmer
- University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | | | - Dirk Schadendorf
- University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | | | - Eva Muñoz-Couselo
- University Hospital Vall D'Hebron, Vall D'Hebron Institute of Oncology, Barcelona, Spain
| | - Carolina Ortiz
- University Hospital Vall D'Hebron, Vall D'Hebron Institute of Oncology, Barcelona, Spain
| | - Julia Lostes
- University Hospital Vall D'Hebron, Vall D'Hebron Institute of Oncology, Barcelona, Spain
| | | | - Ana Arance
- Hospital Clinic de Barcelona, Barcelona, Spain
| | - Lisa Pickering
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Georgina V Long
- University of Sydney, Melanoma Institute Australia, Sydney, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Royal North Shore and Mater Hospitals, Sydney, Australia
| | - Matteo S Carlino
- University of Sydney, Melanoma Institute Australia, Sydney, Australia; Westmead and Blacktown Hospitals, Melanoma Institute Australia, Sydney, Australia
| | | | | | | | | | | | - Justin M Balko
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Alexander M Menzies
- University of Sydney, Melanoma Institute Australia, Sydney, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Royal North Shore and Mater Hospitals, Sydney, Australia
| | - Ryan J Sullivan
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Douglas B Johnson
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
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12
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Mangana J, Zihler D, Bossart S, Brönnimann D, Zachariah R, Gérard CL. Treatment reality of patients with BRAF-mutant advanced/metastatic melanoma in Switzerland in the era of choice. Melanoma Res 2022; 32:366-372. [PMID: 35855650 PMCID: PMC9997623 DOI: 10.1097/cmr.0000000000000843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 06/06/2022] [Indexed: 11/26/2022]
Abstract
Cutaneous melanoma represents a major cause of cancer death in Europe. Without adequate therapy, the 5-year survival rate is 15-20% in distant metastatic disease. Evaluating the status quo of treatment standards in advanced melanoma and rationale for therapy decisions in Switzerland between January 2016 and September 2018. In this retrospective, anonymized registry, data of male and female patients with unresectable advanced/metastatic BRAF-positive cutaneous melanoma treated in first-, second- and third-line with registered substances were analyzed using descriptive statistics. Forty-one patients (56.1% male) were included providing a total of 70 treatment lines (first-line: n = 41; second-line: n = 18; and third-line: n = 11). Within the patients presenting with stage III or IV melanoma, immunotherapy with checkpoint inhibitors was more frequently administered as first-line treatment than targeted therapy (TT) (70.7% vs. 29.3%). Across all lines, patients received TT in 47.1% (predominantly combined BRAF-MEK-inhibition) and immunotherapy in 52.9% of the cases (anti-PD-1 monotherapy in 62.2% and anti-PD-1/anti-CTLA-4 combinations in 37.8%). Most commonly, the treatment type was switched from TT to immunotherapy or vice versa upon disease progression. The most frequent rationales for prescribing either TT or immunotherapy were physician's preference (40.0%) or remission pressure (28.6%), respectively. Disease progression led to treatment discontinuation more frequently than undesired events. Patients in Switzerland with unresectable advanced or metastatic BRAF-mutant melanoma predominantly receive guideline-recommended treatments. IO was used as predominant front-line therapy, with TT/immunotherapy switch being the predominant treatment principle. Sequencing studies are underway to identify the optimal treatment regimen for those patients. 32: 366-372 Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.
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Affiliation(s)
| | - Deborah Zihler
- Kantonsspital Aarau AG, Abteilung für Onkologie, Hämatologie und Transfusionsmedizin, Aarau
| | - Simon Bossart
- Universitätsspital Bern, Universitätsklinik für Dermatologie, Bern
| | - Daniel Brönnimann
- Incyte Biosciences International Sàrl, Medical Affairs Department, Morges
| | - Ralph Zachariah
- Kantonsspital Winterthur, Medizinische Onkologie und Hämatologie, Winterthur
| | - Camille Léa Gérard
- Precision Oncology Center, Lausanne University Hospital (CHUV), Lausanne, Switzerland
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13
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D'Angelo SP, Richards AL, Conley AP, Woo HJ, Dickson MA, Gounder M, Kelly C, Keohan ML, Movva S, Thornton K, Rosenbaum E, Chi P, Nacev B, Chan JE, Slotkin EK, Kiesler H, Adamson T, Ling L, Rao P, Patel S, Livingston JA, Singer S, Agaram NP, Antonescu CR, Koff A, Erinjeri JP, Hwang S, Qin LX, Donoghue MTA, Tap WD. Pilot study of bempegaldesleukin in combination with nivolumab in patients with metastatic sarcoma. Nat Commun 2022; 13:3477. [PMID: 35710741 PMCID: PMC9203519 DOI: 10.1038/s41467-022-30874-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [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: 10/18/2021] [Accepted: 05/23/2022] [Indexed: 12/15/2022] Open
Abstract
PD-1 blockade (nivolumab) efficacy remains modest for metastatic sarcoma. In this paper, we present an open-label, non-randomized, non-comparative pilot study of bempegaldesleukin, a CD122-preferential interleukin-2 pathway agonist, with nivolumab in refractory sarcoma at Memorial Sloan Kettering/MD Anderson Cancer Centers (NCT03282344). We report on the primary outcome of objective response rate (ORR) and secondary endpoints of toxicity, clinical benefit, progression-free survival, overall survival, and durations of response/treatment. In 84 patients in 9 histotype cohorts, all patients experienced ≥1 adverse event and treatment-related adverse event; 1 death was possibly treatment-related. ORR was highest in angiosarcoma (3/8) and undifferentiated pleomorphic sarcoma (2/10), meeting predefined endpoints. Results of our exploratory investigation of predictive biomarkers show: CD8 + T cell infiltrates and PD-1 expression correlate with improved ORR; upregulation of immune-related pathways correlate with improved efficacy; Hedgehog pathway expression correlate with resistance. Exploration of this combination in selected sarcomas, and of Hedgehog signaling as a predictive biomarker, warrants further study in larger cohorts.
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Affiliation(s)
- Sandra P D'Angelo
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York City, NY, USA.
- Department of Medicine, Weill Cornell Medical College, New York City, NY, USA.
- Parker Institute for Cancer Immunotherapy, Memorial Sloan Kettering Cancer Center, New York City, NY, USA.
| | - Allison L Richards
- Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - Anthony P Conley
- Department of Sarcoma Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Hyung Jun Woo
- Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - Mark A Dickson
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York City, NY, USA
| | - Mrinal Gounder
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York City, NY, USA
| | - Ciara Kelly
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York City, NY, USA
| | - Mary Louise Keohan
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York City, NY, USA
| | - Sujana Movva
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York City, NY, USA
| | - Katherine Thornton
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York City, NY, USA
| | - Evan Rosenbaum
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York City, NY, USA
| | - Ping Chi
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York City, NY, USA
| | - Benjamin Nacev
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York City, NY, USA
- Laboratory of Chromatin Biology and Epigenetics, The Rockefeller University, New York City, NY, USA
| | - Jason E Chan
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - Emily K Slotkin
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - Hannah Kiesler
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - Travis Adamson
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - Lilan Ling
- Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - Pavitra Rao
- Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - Shreyaskumar Patel
- Department of Sarcoma Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jonathan A Livingston
- Department of Sarcoma Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Samuel Singer
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - Narasimhan P Agaram
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - Cristina R Antonescu
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - Andrew Koff
- Program in Molecular Biology, Memorial Sloan Kettering Cancer, New York City, NY, USA
| | - Joseph P Erinjeri
- Department of Interventional Radiology, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - Sinchun Hwang
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - Li-Xuan Qin
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - Mark T A Donoghue
- Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - William D Tap
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York City, NY, USA
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Modi S, Gibson T, Vigneswaran G, Patel S, Wheater M, Karydis I, Gupta S, Takhar A, Pearce N, Ottensmeier C, Stedman B. Chemosaturation with percutaneous hepatic perfusion of melphalan for metastatic uveal melanoma. Melanoma Res 2022; 32:103-111. [PMID: 35254333 PMCID: PMC8893121 DOI: 10.1097/cmr.0000000000000806] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 01/04/2022] [Indexed: 11/26/2022]
Abstract
Uveal melanoma, the most common primary ocular malignancy in adults, carries a poor prognosis: 50% of patients develop the metastatic disease with a 10-25% 1-year survival and no established standard of care treatment. Prior studies of melphalan percutaneous hepatic perfusion (M-PHP) have shown promise in metastatic uveal melanoma (mUM) patients with liver predominant disease but are limited by small sample sizes. We contribute our findings on the safety and efficacy of the procedure in the largest sample population to date. A retrospective analysis of outcome and safety data for all mUM patients receiving M-PHP was performed. Tumour response and treatment toxicity were evaluated using RECIST 1.1 and Common Terminology Criteria for Adverse Events v5.03, respectively. 250 M-PHP procedures were performed in 81 patients (median of three per patient). The analysis demonstrated a hepatic disease control rate of 88.9% (72/81), a hepatic response rate of 66.7% (54/81), and an overall response rate of 60.5% (49/81). After a median follow-up of 12.9 months, median overall progression-free (PFS) and median overall survival (OS) were 8.4 and 14.9 months, respectively. There were no fatal treatment-related adverse events (TRAE). Forty-three grade 3 (29) or 4 (14) TRAE occurred in 23 (27.7%) patients with a significant reduction in such events between procedures performed in 2016-2020 vs. 2012-2016 (0.17 vs. 0.90 per patient, P < 0.001). M-PHP provides excellent response rates and PFS compared with other available treatments, with decreasing side effect profile with experience. Combination therapy with systemic agents may be viable to further advance OS.
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Affiliation(s)
- Sachin Modi
- Department of Interventional Radiology, University Hospital Southampton NHS Foundation Trust
| | - Tom Gibson
- Department of Interventional Radiology, University Hospital Southampton NHS Foundation Trust
| | - Ganesh Vigneswaran
- Department of Interventional Radiology, University Hospital Southampton NHS Foundation Trust
- University of Southampton
| | - Shian Patel
- Department of Interventional Radiology, University Hospital Southampton NHS Foundation Trust
| | - Matthew Wheater
- Department of Medical Oncology, University Hospital Southampton NHS Foundation Trust
| | - Ioannis Karydis
- University of Southampton
- Department of Medical Oncology, University Hospital Southampton NHS Foundation Trust
| | - Sanjay Gupta
- Department of Anaesthesia, University Hospital Southampton NHS Foundation Trust
| | - Arjun Takhar
- Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton
| | - Neil Pearce
- Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton
| | - Christian Ottensmeier
- Institute of Systems, Molecular and Integrative Biology (ISMIB), University of Liverpool, Liverpool, UK
| | - Brian Stedman
- Department of Interventional Radiology, University Hospital Southampton NHS Foundation Trust
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Kim M, Kim H, Park S, Joo J, Kim IJ, Kim BH. Risk factors for second primary malignancies following thyroid cancer: a nationwide cohort study. Eur J Endocrinol 2022; 186:561-571. [PMID: 35286279 DOI: 10.1530/eje-21-1208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 03/14/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Thyroid cancer survivors have a high risk of second primary malignancies (SPMs). We aimed to evaluate the site-specific incidence, prognosis, and risk factors for metachronous SPMs following thyroid cancer. DESIGN A nationwide cohort study. METHODS This study included data from the Korea National Health Insurance Service (between 2002 and 2018). Exposure to diagnostic radiation was defined by the number of computed tomography (CT) and positron emission tomography-CT scans after the index date. A cumulative radioactive iodine (RAI) dose >100 mCi was considered high-dose RAI. RESULTS During the median 6 years of follow-up, among 291 640 patients, 13 083 (4.5%) developed SPMs. Thyroid cancer survivors had a 26% increased risk of SPMs compared with the general population (standardized incidence ratio: 1.26; 95% CI: 1.22-1.29). Furthermore, those with SPMs had a significantly poorer survival rate than those without SPMs (hazard ratio: 11.85; 95% CI: 11.21-12.54; P < 0.001). Significantly elevated risks were observed in myeloid leukemia and 13 solid cancer sites: lip, salivary gland, small intestine, larynx, lung, mediastinum and pleura, mesothelium, breast, corpus uteri, ovary, prostate, kidney, and bladder. Frequent diagnostic medical radiation exposure and high-dose RAI therapy were independent risk factors for several SPMs, including the cancer of salivary gland, lung, mediastinum and pleura, breast, kidney, and bladder, as well as myeloid leukemia. CONCLUSIONS Frequent diagnostic radiation exposure and high-dose RAI therapy are independent risk factors for SPM following thyroid cancer. Clinicians need to consider minimizing unnecessary diagnostic radiation exposure and administering a high dose RAI only when justified in patients with thyroid cancer.
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Affiliation(s)
- Mijin Kim
- Department of Internal Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Hyereen Kim
- Hyereen Kim's Internal Medicine Clinic, Yangsan, Korea
| | - Sojeong Park
- Data Science Team, Hanmi Pharmaceuticals Co., Ltd., Seoul, Korea
| | - Jaeeun Joo
- Data Science Team, Hanmi Pharmaceuticals Co., Ltd., Seoul, Korea
| | - In Ju Kim
- Department of Internal Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Bo Hyun Kim
- Department of Internal Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
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16
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Short NJ, Venugopal S, Qiao W, Kadia TM, Ravandi F, Macaron W, Dinardo CD, Daver N, Konopleva M, Borthakur G, Shpall EJ, Popat U, Champlin RE, Mehta R, Al-Atrash G, Oran B, Jabbour E, Garcia-Manero G, Issa GC, Montalban-Bravo G, Yilmaz M, Maiti A, Kantarjian H. Impact of frontline treatment approach on outcomes in patients with secondary AML with prior hypomethylating agent exposure. J Hematol Oncol 2022; 15:12. [PMID: 35093134 PMCID: PMC8800349 DOI: 10.1186/s13045-022-01229-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 01/19/2022] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Treated secondary acute myeloid leukemia (ts-AML)-i.e., AML arising from a previously treated antecedent hematologic disorder-is associated with very poor outcomes. The optimal frontline treatment regimen for these patients is uncertain. METHODS We retrospectively analyzed 562 patients who developed AML from preceding myelodysplastic syndrome or chronic myelomonocytic leukemia for which they had received a hypomethylating agent (HMA). Patients with ts-AML were stratified by frontline AML treatment with intensive chemotherapy (IC, n = 271), low-intensity therapy (LIT) without venetoclax (n = 237), or HMA plus venetoclax (n = 54). RESULTS Compared with IC or LIT without venetoclax, HMA plus venetoclax resulted in higher CR/CRi rates (39% and 25%, respectively; P = 0.02) and superior OS (1-year OS 34% and 17%, respectively; P = 0.05). The benefit of HMA plus venetoclax was restricted to patients with non-adverse risk karyotype, where HMA plus venetoclax resulted in a median OS of 13.7 months and 1-year OS rate of 54%; in contrast, for patients with adverse risk karyotype, OS was similarly dismal regardless of treatment approach (median OS 3-5 months). A propensity score analysis accounting for relevant clinical variables confirmed the significant OS benefit of HMA plus venetoclax, as compared with other frontline treatment approaches. In a landmark analysis, patients with ts-AML who underwent subsequent hematopoietic stem cell transplantation (HSCT) had superior 3-year OS compared to non-transplanted patients (33% vs. 8%, respectively; P = 0.003). CONCLUSIONS The outcomes of ts-AML are poor but may be improved with use of an HMA plus venetoclax-based regimen, followed by HSCT, particularly in those with a non-adverse risk karyotype.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Bridged Bicyclo Compounds, Heterocyclic/therapeutic use
- Female
- Hematopoietic Stem Cell Transplantation
- Humans
- Leukemia, Myeloid, Acute/chemically induced
- Leukemia, Myeloid, Acute/therapy
- Leukemia, Myelomonocytic, Chronic/complications
- Leukemia, Myelomonocytic, Chronic/drug therapy
- Male
- Middle Aged
- Myelodysplastic Syndromes/complications
- Myelodysplastic Syndromes/drug therapy
- Neoplasms, Second Primary/chemically induced
- Neoplasms, Second Primary/therapy
- Retrospective Studies
- Sulfonamides/therapeutic use
- Young Adult
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Affiliation(s)
- Nicholas J Short
- Department of Leukemia, Unit 428, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA.
| | - Sangeetha Venugopal
- Department of Leukemia, Unit 428, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA
| | - Wei Qiao
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Tapan M Kadia
- Department of Leukemia, Unit 428, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA
| | - Farhad Ravandi
- Department of Leukemia, Unit 428, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA
| | - Walid Macaron
- Department of Leukemia, Unit 428, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA
| | - Courtney D Dinardo
- Department of Leukemia, Unit 428, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA
| | - Naval Daver
- Department of Leukemia, Unit 428, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA
| | - Marina Konopleva
- Department of Leukemia, Unit 428, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA
| | - Gautam Borthakur
- Department of Leukemia, Unit 428, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA
| | - Elizabeth J Shpall
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Uday Popat
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Richard E Champlin
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Rohtesh Mehta
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Gheath Al-Atrash
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Betul Oran
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Elias Jabbour
- Department of Leukemia, Unit 428, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA
| | - Guillermo Garcia-Manero
- Department of Leukemia, Unit 428, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA
| | - Ghayas C Issa
- Department of Leukemia, Unit 428, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA
| | - Guillermo Montalban-Bravo
- Department of Leukemia, Unit 428, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA
| | - Musa Yilmaz
- Department of Leukemia, Unit 428, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA
| | - Abhishek Maiti
- Department of Leukemia, Unit 428, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA
| | - Hagop Kantarjian
- Department of Leukemia, Unit 428, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA
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17
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Pich O, Cortes-Bullich A, Muiños F, Pratcorona M, Gonzalez-Perez A, Lopez-Bigas N. The evolution of hematopoietic cells under cancer therapy. Nat Commun 2021; 12:4803. [PMID: 34376657 PMCID: PMC8355079 DOI: 10.1038/s41467-021-24858-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 06/29/2021] [Indexed: 02/08/2023] Open
Abstract
Chemotherapies may increase mutagenesis of healthy cells and change the selective pressures in tissues, thus influencing their evolution. However, their contributions to the mutation burden and clonal expansions of healthy somatic tissues are not clear. Here, exploiting the mutational footprint of some chemotherapies, we explore their influence on the evolution of hematopoietic cells. Cells of Acute Myeloid Leukemia (AML) secondary to treatment with platinum-based drugs show the mutational footprint of these drugs, indicating that non-malignant blood cells receive chemotherapy mutations. No trace of the 5-fluorouracil (5FU) mutational signature is found in AMLs secondary to exposure to 5FU, suggesting that cells establishing the leukemia could be quiescent during treatment. Using the platinum-based mutational signature as a barcode, we determine that the clonal expansion originating the secondary AMLs begins after the start of the cytotoxic treatment. Its absence in clonal hematopoiesis cases is consistent with the start of the clonal expansion predating the exposure to platinum-based drugs.
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Affiliation(s)
- Oriol Pich
- Institute for Research in Biomedicine (IRB Barcelona), The Barcelona Institute of Science and Technology, Barcelona, Spain
| | - Albert Cortes-Bullich
- Hematology and Hemotherapy Department, Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | - Ferran Muiños
- Institute for Research in Biomedicine (IRB Barcelona), The Barcelona Institute of Science and Technology, Barcelona, Spain
| | - Marta Pratcorona
- Hematology and Hemotherapy Department, Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | - Abel Gonzalez-Perez
- Institute for Research in Biomedicine (IRB Barcelona), The Barcelona Institute of Science and Technology, Barcelona, Spain.
- Research Program on Biomedical Informatics, Universitat Pompeu Fabra, Barcelona, Catalonia, Spain.
| | - Nuria Lopez-Bigas
- Institute for Research in Biomedicine (IRB Barcelona), The Barcelona Institute of Science and Technology, Barcelona, Spain.
- Research Program on Biomedical Informatics, Universitat Pompeu Fabra, Barcelona, Catalonia, Spain.
- Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain.
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18
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Coorens THH, Collord G, Lu W, Mitchell E, Ijaz J, Roberts T, Oliver TRW, Burke GAA, Gattens M, Dickens E, Nangalia J, Tischkowitz M, Anderson J, Shlien A, Godfrey AL, Murray MJ, Behjati S. Clonal hematopoiesis and therapy-related myeloid neoplasms following neuroblastoma treatment. Blood 2021; 137:2992-2997. [PMID: 33598691 PMCID: PMC8160503 DOI: 10.1182/blood.2020010150] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 02/04/2021] [Indexed: 12/21/2022] Open
Affiliation(s)
| | - Grace Collord
- Wellcome Sanger Institute, Hinxton, United Kingdom
- Department of Haematology, University College London Hospital, London, United Kingdom
- Department of Haematology, University College London Cancer Institute, London, United Kingdom
| | - Wanhua Lu
- Cambridge University Hospitals National Health Service (NHS) Foundation Trust, Cambridge, United Kingdom
| | - Emily Mitchell
- Wellcome Sanger Institute, Hinxton, United Kingdom
- Cambridge University Hospitals National Health Service (NHS) Foundation Trust, Cambridge, United Kingdom
- Department of Haematology, University of Cambridge, Cambridge, United Kingdom
| | - Jannat Ijaz
- Wellcome Sanger Institute, Hinxton, United Kingdom
| | - Thomas Roberts
- Cambridge University Hospitals National Health Service (NHS) Foundation Trust, Cambridge, United Kingdom
| | | | - G A Amos Burke
- Cambridge University Hospitals National Health Service (NHS) Foundation Trust, Cambridge, United Kingdom
| | - Michael Gattens
- Cambridge University Hospitals National Health Service (NHS) Foundation Trust, Cambridge, United Kingdom
| | - Emmy Dickens
- Cambridge University Hospitals National Health Service (NHS) Foundation Trust, Cambridge, United Kingdom
| | - Jyoti Nangalia
- Wellcome Sanger Institute, Hinxton, United Kingdom
- Cambridge University Hospitals National Health Service (NHS) Foundation Trust, Cambridge, United Kingdom
- Department of Haematology, University of Cambridge, Cambridge, United Kingdom
- Cambridge Stem Cell Institute, Cambridge, Cambridgeshire, United Kingdom
| | - Marc Tischkowitz
- Department of Medical Genetics, National Institute for Health Research Cambridge Biomedical Research Centre, University of Cambridge, Cambridge, United Kingdom
| | - John Anderson
- University College London Great Ormond Street Institute of Child Health, London, United Kingdom
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Adam Shlien
- The Hospital for Sick Children, Toronto, ON, Canada; and
| | - Anna L Godfrey
- Cambridge University Hospitals National Health Service (NHS) Foundation Trust, Cambridge, United Kingdom
| | - Matthew J Murray
- Cambridge University Hospitals National Health Service (NHS) Foundation Trust, Cambridge, United Kingdom
- Department of Pathology and
| | - Sam Behjati
- Wellcome Sanger Institute, Hinxton, United Kingdom
- Cambridge University Hospitals National Health Service (NHS) Foundation Trust, Cambridge, United Kingdom
- Department of Paediatrics, University of Cambridge, Cambridge, United Kingdom
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19
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Thomas-Teinturier C, Oliver-Petit I, Pacquement H, Fresneau B, Allodji RS, Veres C, Bolle S, Berchery D, Demoor-Goldschmidt C, Haddy N, Diallo I, de Vathaire F. Influence of growth hormone therapy on the occurrence of a second neoplasm in survivors of childhood cancer. Eur J Endocrinol 2020; 183:471-480. [PMID: 32738133 DOI: 10.1530/eje-20-0369] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 07/29/2020] [Indexed: 11/08/2022]
Abstract
CONTEXT Growth hormone (GH) deficiency is a common late effect of cranial irradiation. However, concerns have been raised that GH treatment might lead to an increased risk of a second neoplasm (SN). OBJECTIVE To study the impact of GH treatment on the risk of SN in a French cohort of survivors of childhood cancer (CCS) treated before 1986. DESIGN AND SETTING Cohort study and nested case-control study. PARTICIPANTS Of the 2852 survivors, with a median follow-up of 26 years, 196 had received GH therapy (median delay from cancer diagnosis: 5.5 years). MAIN OUTCOME MEASURES Occurrence of SN. RESULTS In total, 374 survivors developed a SN, including 40 who had received GH therapy. In a multivariate analysis, GH treatment did not increase the risk of secondary non-meningioma brain tumors (RR: 0.6, 95% CI: 0.2-1.5, P = 0.3), secondary non-brain cancer (RR: 0.7, 95% CI: 0.4-1.2, P = 0.2), or meningioma (RR: 1.9, 95% CI: 0.9-4, P = 0.09). Nevertheless, we observed a slight non-significant increase in the risk of meningioma with GH duration: 1.6-fold (95% CI: 1.2-3.0) after an exposure of less than 4 years vs 2.3-fold (95% CI: 0.9-5.6) after a longer exposure (P for trend = 0.07) confirmed by the results of a case-control study. CONCLUSION This study confirms the overall safety of GH use in survivors of childhood cancer, which does not increase the risk of a SN. The slight excess in the risk of meningioma in patients with long-term GH treatment is non-significant and could be due to difficulties in adjustment on cranial radiation volume/dose and/or undiagnosed meningioma predisposing conditions.
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Affiliation(s)
- Cécile Thomas-Teinturier
- Cancer and Radiation, CESP, Unit 1018 INSERM, Villejuif, France
- University Paris-Saclay, Villejuif, France
- Department of Pediatric Endocrinology, AP-HP, Université Paris Saclay, site Bicetre, Le Kremlin Bicêtre, France
| | | | | | - Brice Fresneau
- Cancer and Radiation, CESP, Unit 1018 INSERM, Villejuif, France
- University Paris-Saclay, Villejuif, France
- Department of Pediatrics Oncology, Institut Gustave Roussy, Villejuif, France
| | - Rodrigue Sétchéou Allodji
- Cancer and Radiation, CESP, Unit 1018 INSERM, Villejuif, France
- University Paris-Saclay, Villejuif, France
- Department of Research Gustave Roussy, Villejuif, France
| | - Cristina Veres
- Cancer and Radiation, CESP, Unit 1018 INSERM, Villejuif, France
- University Paris-Saclay, Villejuif, France
- Department of Research Gustave Roussy, Villejuif, France
| | - Stephanie Bolle
- Department of Radiotherapy Oncology, Institut Gustave Roussy, Villejuif, France
| | | | - Charlotte Demoor-Goldschmidt
- Cancer and Radiation, CESP, Unit 1018 INSERM, Villejuif, France
- University Paris-Saclay, Villejuif, France
- Department of Pediatrics Oncology, CHU Angers, Angers, France
| | - Nadia Haddy
- Cancer and Radiation, CESP, Unit 1018 INSERM, Villejuif, France
- University Paris-Saclay, Villejuif, France
- Department of Research Gustave Roussy, Villejuif, France
| | - Ibrahima Diallo
- Cancer and Radiation, CESP, Unit 1018 INSERM, Villejuif, France
- University Paris-Saclay, Villejuif, France
- Department of Research Gustave Roussy, Villejuif, France
| | - Florent de Vathaire
- Cancer and Radiation, CESP, Unit 1018 INSERM, Villejuif, France
- University Paris-Saclay, Villejuif, France
- Department of Research Gustave Roussy, Villejuif, France
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20
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Choi YH, Byun HJ, Lee JH, Park JH. Multiple cherry angiomas and pyogenic granuloma in a patient treated with ramucirumab and paclitaxel. Indian J Dermatol Venereol Leprol 2020; 86:199-202. [PMID: 32031107 DOI: 10.4103/ijdvl.ijdvl_184_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Young Hwan Choi
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun Jeong Byun
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong Hee Lee
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji-Hye Park
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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21
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Anand K, Ensor J, Pingali SR, Hwu P, Duvic M, Chiang S, Miranda R, Zu Y, Iyer S. T-cell lymphoma secondary to checkpoint inhibitor therapy. J Immunother Cancer 2020; 8:e000104. [PMID: 32114498 PMCID: PMC7057430 DOI: 10.1136/jitc-2019-000104] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2019] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Murine model suggests programmed cell death-1 (PD-1), an immune checkpoint not only plays role in tumor escape but is also a tumor suppressor for T-cells. But until, no reports of secondary T-cell lymphoma postuse of immune checkpoint inhibitors (ICIs) has been reported. Herein, we present a hitherto unreported phenomenon of secondary T-cell lymphoma when PD-1 inhibitor was used in a patient diagnosed with a tumor of epithelial origin. CASE REPORT A man in mid-70s presented with biopsy-proven metastatic tumor of epithelial origin. Patient received carboplatin in combination with paclitaxel for four cycles leading to partial remission. The patient was subsequently switched to pembrolizumab due to persistent disease in the mediastinum. After four cycles of PD-1 inhibitor, patient presented with progression of disease and was diagnosed with biopsy-proven peripheral T-cell lymphoma-not otherwise specified. Based on the reported tumor suppressor function of PD-1 in murine models, we hypothesized that the use of PD-1 inhibitor caused clonal proliferation of abnormal T-cell clone leading to T-cell lymphoma. T-cell receptor (TCR) sequencing was performed by TCRβ sequencing and T-cell clones from pre-ICI treatment specimen were compared with post-ICI treatment specimens. We show that one of the T-cell clones present in pre-ICI treatment specimen at a low frequency of had massive expansion to become most dominant clone in post-ICI treatment specimens leading to lymphoma. Moreover, targeted exome sequencing revealed a new TET2 mutation in the clone representing the lymphoma.Next, we retrospectively reviewed the Food and Drug Administration (FDA) Adverse Events Reporting System (FAERS), the pharmacovigilance database from 2012 to 2018 to find the reported incidence of this phenomenon and calculated the reporting OR (ROR) for disproportionality analysis for risk of T-cell lymphoma due to checkpoint inhibitors compared with other drugs. In FAERS, the incidence of T-cell lymphoma post-ICIs (pembrolizumab, nivolumab and ipilimumab) was found to be 0.02% with 17% mortality. The ROR probability of risk of T-cell lymphoma compared with other drugs in pharmacovigilance database was increased at 1.91. CONCLUSIONS T-cell lymphoma is a rare sequela of ICIs with high mortality. Larger studies with long-term follow-up of patients receiving ICIs is needed.
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Affiliation(s)
- Kartik Anand
- Houston Methodist Cancer Center, Houston, Texas, USA
| | - Joe Ensor
- Houston Methodist Research Institute, Houston, Texas, USA
| | | | - Patrick Hwu
- University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Division of Cancer Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Madeleine Duvic
- University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | - Roberto Miranda
- University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Youli Zu
- Houston Methodist Cancer Center, Houston, Texas, USA
| | - Swaminathan Iyer
- University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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22
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Watt GP, Reiner AS, Smith SA, Stram DO, Capanu M, Malone KE, Lynch CF, John EM, Knight JA, Mellemkjær L, Bernstein L, Brooks JD, Woods M, Liang X, Haile RW, Riaz N, Conti DV, Robson M, Duggan D, Boice JD, Shore RE, Tischkowitz M, Orlow I, Thomas DC, Concannon P, Bernstein JL. Association of a Pathway-Specific Genetic Risk Score With Risk of Radiation-Associated Contralateral Breast Cancer. JAMA Netw Open 2019; 2:e1912259. [PMID: 31560388 PMCID: PMC6777239 DOI: 10.1001/jamanetworkopen.2019.12259] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 12/03/2022] Open
Abstract
IMPORTANCE Radiation therapy for breast cancer is associated with increased risk of a second primary contralateral breast cancer, but the genetic factors modifying this association are not well understood. OBJECTIVE To determine whether a genetic risk score comprising single nucleotide polymorphisms in the nonhomologous end-joining DNA repair pathway is associated with radiation-associated contralateral breast cancer. DESIGN, SETTING, AND PARTICIPANTS This case-control study included a case group of women with contralateral breast cancer that was diagnosed at least 1 year after a first primary breast cancer who were individually matched to a control group of women with unilateral breast cancer. Inclusion criteria were receiving a first invasive breast cancer diagnosis prior to age 55 years between 1985 and 2008. Women were recruited through 8 population-based cancer registries in the United States, Canada, and Denmark as part of the Women's Environment, Cancer, and Radiation Epidemiology Studies I (November 2000 to August 2004) and II (March 2010 to December 2012). Data analysis was conducted from July 2017 to August 2019. EXPOSURES Stray radiation dose to the contralateral breast during radiation therapy for the first breast cancer. A novel genetic risk score comprised of genetic variants in the nonhomologous end-joining DNA repair pathway was considered the potential effect modifier, dichotomized as high risk if the score was above the median of 74 and low risk if the score was at or below the median. MAIN OUTCOMES AND MEASURES The main outcome was risk of contralateral breast cancer associated with stray radiation dose stratified by genetic risk score, age, and latency. RESULTS A total of 5953 women were approached for study participation, and 3732 women (62.7%) agreed to participate. The median (range) age at first diagnosis was 46 (23-54) years. After 5 years of latency or more, among women who received the first diagnosis when they were younger than 40 years, exposure to 1.0 Gy (to convert to rad, multiply by 100) or more of stray radiation was associated with a 2-fold increased risk of contralateral breast cancer compared with women who were not exposed (rate ratio, 2.0 [95% CI, 1.1-3.6]). The risk was higher among women with a genetic risk score above the median (rate ratio, 3.0 [95% CI, 1.1-8.1]), and there was no association among women with a genetic risk score below the median (rate ratio, 1.3 [95% CI, 0.5-3.7]). Among younger women with a high genetic risk score, the attributable increased risk for contralateral breast cancer associated with stray radiation dose was 28%. CONCLUSIONS AND RELEVANCE This study found an increased risk of contralateral breast cancer that was attributable to stray radiation exposure among women with a high genetic risk score and who received a first breast cancer diagnosis when they were younger than 40 years after 5 years or more of latency. This genetic risk score may help guide treatment and surveillance for women with breast cancer.
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Affiliation(s)
- Gordon P. Watt
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Anne S. Reiner
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Susan A. Smith
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston
| | - Daniel O. Stram
- Department of Preventive Medicine, University of Southern California, Los Angeles
| | | | | | | | - Esther M. John
- Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California
| | - Julia A. Knight
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada
- Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | | | - Leslie Bernstein
- Beckman Research Institute, City of Hope National Medical Center, Duarte, California
| | - Jennifer D. Brooks
- Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Meghan Woods
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Xiaolin Liang
- Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Nadeem Riaz
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - David V. Conti
- Department of Preventive Medicine, University of Southern California, Los Angeles
| | - Mark Robson
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - David Duggan
- Translational Genomics Research Institute, An Affiliate of City of Hope, Phoenix, Arizona
| | - John D. Boice
- National Council on Radiation Protection and Measurements, Bethesda, Maryland
- Vanderbilt University, Nashville, Tennessee
| | - Roy E. Shore
- New York University School of Medicine, New York
| | | | - Irene Orlow
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Duncan C. Thomas
- Department of Preventive Medicine, University of Southern California, Los Angeles
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23
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Joly F, Ahmed-Lecheheb D, Thiery-Vuillemin A, Orillard E, Coquan E. [Side effects of chemotherapy for testicular cancers and post-cancer follow-up]. Bull Cancer 2019; 106:805-811. [PMID: 31171345 DOI: 10.1016/j.bulcan.2019.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 04/15/2019] [Accepted: 04/15/2019] [Indexed: 01/30/2023]
Abstract
Testicular cancers are the most frequent and the most curable cancers in young men. Treatments of these cancers represent a great success with cure rate over to 95 %. However, chemotherapy side effects may occur during or after several years post-treatment. This review aimed to highlight complications and physical and psychological side effects occurring mainly after chemotherapy treatment for testicular cancer, and to propose a personalized post-cancer plan specific for patients treated for testicular cancer. Treatments of these cancers can cause short-term complications (asthenia, nausea, vomiting, alopecia..). These side effects disappear within a few months after the end of the treatments. Late complications may occur several years post-treatment. Cardiovascular disease, metabolic syndrome and secondary neoplasia represent the most severe late effects among patients treated for testicular cancer. Given the increased incidence of these chemotherapy-induced side effects, it is indispensable to establish a specific follow up which must include a particular vigilance on the risk of occurrence of second cancer, a follow-up of the cardio-vascular risk factors, pulmonary and auditory follow-up, and early detection of psychosocial disorders.
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Affiliation(s)
- Florence Joly
- UNICANCER, Centre François Baclesse, Clinical Research Department and Medical Department, avenue général Harris, 14076 Caen, France; Inserm, U1086, 14076 Caen, France; Université de Caen Basse-Normandie, UMR-S1077, 14000 Caen, France; CHU de Caen, Department of Oncology, 14000 Caen, France.
| | - Djihane Ahmed-Lecheheb
- UNICANCER, Centre François Baclesse, Clinical Research Department and Medical Department, avenue général Harris, 14076 Caen, France; Inserm, U1086, 14076 Caen, France
| | | | - Emeline Orillard
- CHU Jean-Minjoz, Département Oncologie médicale, Boulevard Fleming, 25030 Besançon, France
| | - Elodie Coquan
- UNICANCER, Centre François Baclesse, Clinical Research Department and Medical Department, avenue général Harris, 14076 Caen, France
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24
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Narazaki T, Nakashima Y, Tsukamoto Y, Tsuda M, Masuda T, Kimura D, Takamatsu A, Ohshima K, Shiratsuchi M, Ogawa Y. Transformation of follicular lymphoma to double-hit lymphoma during adjuvant chemotherapy for concurrent ovarian carcinoma. Int J Hematol 2019; 110:375-380. [PMID: 31104212 DOI: 10.1007/s12185-019-02656-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 05/07/2019] [Accepted: 05/07/2019] [Indexed: 11/25/2022]
Abstract
The frequency of multiple primary malignant neoplasms (MPMN) is increasing due to population aging. Since consensus guidelines for the treatment of MPMN are lacking, treatment strategies are determined by disease status on a per-patient basis. In this report, we describe a case of MPMN with follicular lymphoma (FL) grade 1 that transformed to double-hit lymphoma during adjuvant chemotherapy for concurrent ovarian carcinoma. A 64-year-old woman was diagnosed with MPMN of FL and endometrioid carcinoma by staging laparotomy and lymph node biopsy. She received four cycles of adjuvant chemotherapy (carboplatin and paclitaxel) for endometrioid carcinoma, but during chemotherapy, the FL grade 1 transformed to double-hit lymphoma. We speculate that adjuvant chemotherapy for endometrioid carcinoma may have triggered the transformation of FL in the present case.
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Affiliation(s)
- Taisuke Narazaki
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Yasuhiro Nakashima
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Yasuhiro Tsukamoto
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Mariko Tsuda
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Toru Masuda
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Daisaku Kimura
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Akiko Takamatsu
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Koichi Ohshima
- Department of Pathology, Kurume University School of Medicine, Kurume, Japan
| | - Motoaki Shiratsuchi
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Yoshihiro Ogawa
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
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25
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Lyons AB, Mitchell DA, Moy RL. Topical chemotherapy for numerous superficial basal cell carcinomas years after isolated limb perfusion for melanoma. Cutis 2019; 103:298-299. [PMID: 31233581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
MESH Headings
- Administration, Cutaneous
- Aged, 80 and over
- Antimetabolites, Antineoplastic/administration & dosage
- Antineoplastic Agents, Alkylating/adverse effects
- Carcinoma, Basal Cell/chemically induced
- Carcinoma, Basal Cell/drug therapy
- Chemotherapy, Adjuvant
- Chemotherapy, Cancer, Regional Perfusion/adverse effects
- Fluorouracil/administration & dosage
- Humans
- Male
- Mechlorethamine/adverse effects
- Melanoma/drug therapy
- Melanoma/surgery
- Neoplasms, Second Primary/chemically induced
- Neoplasms, Second Primary/drug therapy
- Skin Neoplasms/chemically induced
- Skin Neoplasms/drug therapy
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Affiliation(s)
- Alexis B Lyons
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan, USA
| | - Daniel A Mitchell
- Fincher, Chipps Facial Plastics and Dermatology, Beverly Hills, California, USA
| | - Ronald L Moy
- Fincher, Chipps Facial Plastics and Dermatology, Beverly Hills, California, USA
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26
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Parekh V, Sobanko J, Miller CJ, Karakousis G, Xu W, Letrero R, Elenitsas R, Xu X, Elder DE, Amaravadi R, Schuchter LM, Nathanson KL, Wilson MA, Chu EY. NRAS Q61R and BRAF G466A mutations in atypical melanocytic lesions newly arising in advanced melanoma patients treated with vemurafenib. J Cutan Pathol 2019; 46:190-194. [PMID: 30552700 PMCID: PMC6367041 DOI: 10.1111/cup.13401] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 11/26/2018] [Accepted: 12/07/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND BRAF inhibition has improved overall survival in patients with BRAF mutant melanoma, but this is associated with a range of known and predictable cutaneous side effects, including squamous cell carcinomas associated with RAS mutations. METHODS We identified three severely dysplastic nevi, one atypical intraepidermal melanocytic proliferation, and four melanoma in situ lesions, newly arising in four patients undergoing treatment with vemurafenib. To characterize mutations in these atypical melanocytic lesions, we used a custom iPlex panel detecting 74 mutations in 13 genes known to play a role in melanoma pathogenesis. RESULTS We identified an NRAS mutation at codon 61 (Q61R) and a rare BRAF exon 11 mutation (G466A) in atypical melanocytic lesions that arose in patients treated with vemurafenib. CONCLUSION There appears to be development or accelerated growth of atypical melanocytic lesions in the setting of BRAF inhibition. Our results underscore the need for careful surveillance for melanocytic lesions in patients on BRAF inhibitor therapy and shed light on potential mechanisms for melanoma pathogenesis in the context of BRAF pathway blockade. Further studies are warranted to show a causal relationship.
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Affiliation(s)
- Vishwas Parekh
- Department of Pathology, City of Hope Medical Center, Duarte, CA
| | - Joseph Sobanko
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Boulevard,1 Floor South Pavilion, Philadelphia, PA 19104
| | - Christopher J. Miller
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Boulevard,1 Floor South Pavilion, Philadelphia, PA 19104
| | - Giorgos Karakousis
- Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, 3400 Spruce Street, 4 Silverstein, Philadelphia, PA 19104
| | - Wei Xu
- Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
- Hematology/Oncology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Boulevard, 12 Penn Tower, Philadelphia, PA
| | - Richard Letrero
- Translational Medicine and Human Genetics, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, 351 BRB 2/3, 421 Curie Blvd, Philadelphia, PA 19104
| | - Rosalie Elenitsas
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Boulevard,1 Floor South Pavilion, Philadelphia, PA 19104
| | - Xiaowei Xu
- Department of Pathology, Perelman School of Medicine at the University of Pennsylvania, 3400 Spruce Street, 6 Founders, Philadelphia, PA 19104
| | - David E. Elder
- Department of Pathology, Perelman School of Medicine at the University of Pennsylvania, 3400 Spruce Street, 6 Founders, Philadelphia, PA 19104
| | - Ravi Amaravadi
- Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
- Hematology/Oncology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Boulevard, 12 Penn Tower, Philadelphia, PA
| | - Lynn M. Schuchter
- Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
- Hematology/Oncology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Boulevard, 12 Penn Tower, Philadelphia, PA
| | - Katherine L. Nathanson
- Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
- Translational Medicine and Human Genetics, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, 351 BRB 2/3, 421 Curie Blvd, Philadelphia, PA 19104
| | - Melissa A. Wilson
- Sidney Kimmel Cancer Center, Thomas Jefferson University, 1025 Walnut Street, Philadelphia, PA 19107
| | - Emily Y. Chu
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Boulevard,1 Floor South Pavilion, Philadelphia, PA 19104
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27
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Abstract
The incidence of secondary malignancies following chemotherapy is progressively increasing, mostly due to prolonged survival of patients treated for primary cancer. So far, only 3 cases of solid cancer following busulphan administration have been reported. We describe the case of a patient who developed a renal cancer after 4 years of busulphan treatment for chronic myeloid leukemia. Immunosuppression rather than mutagenesis seems to be responsible for the emergence of second solid cancers in patients receiving busulphan.
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Affiliation(s)
- A Iurlo
- Istituto di Scienze Mediche, Padiglione Granelli, Università degli Studi, Milan, Italy
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28
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Abstract
Unconventional treatments are commonly considered by the scientific community to have unproven efficacy but at least no toxicity. Here we report on the case of a breast cancer patient with lung and liver metastases who developed acute myeloid leukemia after treatment with Di Bella multitherapy, leading rapidly to death due to cerebral hemorrhage. Although an increased susceptibility to malignancy could not be excluded, we considered the possible etiologic role of the treatment received. The drug most likely to be associated with the development of leukemia was the cyclophosphamide contained in the Di Bella multitherapy regimen at a dose of 50 mg daily. The clinical features of this leukemia were therefore compared with those expected for secondary leukemia related to alkylating agents. A preceding myelodysplastic phase and the development of the leukemia after the intake of a cumulative cyclophosphamide dose of 15 g were typical chacteristics of secondary leukemia, but the interval between the start of therapy and the onset of leukemia was only 10 months. We conclude that long-term low-dose cyclophosphamide may have leukemogenic potential and the latency period may be shorter than that commonly reported.
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Affiliation(s)
- C Sacco
- Division of Oncology, Santa Maria Hospital, Udine, Italy.
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29
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Krzyzanowska-Mittermayer K, Mattsson AF, Maiter D, Feldt-Rasmussen U, Camacho-Hübner C, Luger A, Abs R. New Neoplasm During GH Replacement in Adults With Pituitary Deficiency Following Malignancy: A KIMS Analysis. J Clin Endocrinol Metab 2018; 103:523-531. [PMID: 29228199 DOI: 10.1210/jc.2017-01899] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Accepted: 11/30/2017] [Indexed: 01/27/2023]
Abstract
CONTEXT Data on the association between growth hormone (GH) replacement in patients with GH deficiency (GHD) after malignancies and new neoplasms show conflicting results. OBJECTIVE To clarify the incidence of new malignant neoplasm in childhood-onset (CO) and adult-onset (AO) adult cancer survivors (CSs). DESIGN Retrospective comparison of CO-CS and AO-CS with CO idiopathic GHD (IGHD) and AO nonfunctioning pituitary adenoma (NFPA) patients and with the general population [standardized incidence ratio (SIR)]. SETTING Data from the Pfizer International Metabolic Database study (KIMS). PATIENTS CO-CS [n = 349; 50.4% females; mean baseline (MBL) IGF-I standard deviation score (SDS), -2.4], IGHD (n = 619; 35.7% females; MBL IGF-I SDS, -3.4), AO-CS (n = 174; 42.5% females; MBL IGF-I SDS, -1.4), and NFPA (n = 2449; 38.1% females; MBL IGF-I SDS, -1.0). MAIN OUTCOME MEASURES SIRs of malignant neoplasms. RESULTS After a median follow-up of 5.9 years (2192 patient-years), 15 CO-CS (4.3%) had developed 16 new neoplasms. The SIR was 10.4 [95% confidence interval (CI), 5.9 to 16.9] and 6.5 (95% CI, 3.0 to 12.4) after exclusion of seven patients with skin cancers. In IGHD, three malignant neoplasms (0.5%) were observed after a median follow-up of 5.4 years (3908 patient-years; SIR, 0.47; 95% CI, 0.09 to 1.37). New malignant neoplasms occurred in three AO-CS (1.7%; SIR, 1.1; 95% CI, 0.2 to 3.2) and 146 NFPA patients (153 cases, 6.0%; SIR, 1.1; 95% CI, 0.9 to 1.2) after a median follow-up of 4.9 (1024 patient-years) and 5.6 years (15,215 patient-years). CONCLUSIONS The risk of second malignant neoplasms was increased in CO-CS but not in AO-CS, which illustrates the need to closely follow patients on GH replacement because of a prior malignancy.
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Affiliation(s)
| | | | - Dominique Maiter
- UCL St Luc Hospital, Department of Endocrinology and Nutrition, Brussels, Belgium
| | - Ulla Feldt-Rasmussen
- Copenhagen University, Rigshospitalet, Department of Endocrinology, Copenhagen, Denmark
| | | | - Anton Luger
- Division of Endocrinology and Metabolism, Department of Medicine III, Medical University and General Hospital of Vienna, Vienna, Austria
| | - Roger Abs
- Antwerp Centre for Endocrinology, Antwerp, Belgium
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30
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Davick JJ, Gaughan E, Barry M, Gru AA. Primary Cutaneous Small/Medium CD4+ T-CELL Lymphoproliferative Disorder Occurring in a Patient With Metastatic Melanoma. Am J Dermatopathol 2018; 40:60-63. [PMID: 28719434 DOI: 10.1097/dad.0000000000000960] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 11/26/2022]
Abstract
Therapeutic agents designed to stimulate the immune system are now cornerstones in the treatment of metastatic melanoma. These drugs promote lymphocyte growth and survival, which could plausibly result in clinical lymphoproliferative disorders. We report the case of a 62-year-old female with metastatic melanoma who developed primary cutaneous small/medium CD4 T-cell lymphoproliferative disorder (PC-SMTCL) after treatment with vemurafenib and recombinant high-dose interleukin-2 (IL-2). The patient developed a painless red papule behind the ear. A biopsy showed a dense population of CD4 lymphocytes with a T-follicular helper cell phenotype. Molecular studies confirmed the presence of a clonal population of T cells, and the process was classified as PC-SMTCL. The patient was diagnosed with metastatic melanoma approximately 3 years before the development of the cutaneous lymphoma and had been treated with vemurafenib followed by 2 courses of IL-2. The patient's last course of IL-2 was completed in April of 2013. She developed the cutaneous lymphoma behind her ear in December of 2015. An association between PC-SMTCL and vemurafenib treatment for advanced melanoma has been reported previously in one patient; however, an association between PC-SMTCL and IL-2 treatment has not been documented. The immunostimulatory properties of IL-2 or vemurafenib may be responsible for the development of PC-SMTCL in our patient. Additionally, antigenic stimulation of the immune system by melanoma itself could contribute to clonal selection of lymphocytes.
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Affiliation(s)
- Jonathan J Davick
- Department of Pathology, University of Virginia Medical Center, Charlottesville, VA
| | - Elizabeth Gaughan
- Division of Hematology and Oncology, Department of Medicine, University of Virginia Medical Center, Charlottesville, VA
| | | | - Alejandro A Gru
- Department of Pathology, University of Virginia Medical Center, Charlottesville, VA
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31
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Abstract
CONTEXT Testicular germ-cell tumors (GCT) are highly curable. A multidisciplinary approach, including cisplatin-based chemotherapy has resulted in cure in the majority of patients with GCT. Thus, the life expectancy of survivors will extend to many decades post-diagnosis. Late treatment toxicities associated with cisplatin-based chemotherapy may impact their future health. OBJECTIVE To systematically evaluate evidence regarding the long-term toxicity of cisplatin in GCT survivors. EVIDENCE ACQUISITION We carried out a critical review of PubMed/Medline in February 2017 according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement. Identified reports were reviewed according to the Consolidated Standards of Reporting Trials (CONSORT) criteria. Eighty-three publications were selected for inclusion in this analysis. EVIDENCE SYNTHESIS Included reports evaluated long-term toxicities of cisplatin-based chemotherapy in GCT survivors. Studies reporting neuro- and ototoxicity, secondary malignancies, cardiovascular, renal and pulmonary toxicities, hypogonadism and infertility were found. Seven studies (8%) reported genetic underpinnings of long-term toxicities and 3 (4%) and 14 (19%) studies correlated long-term toxicities with circulating platinum levels and cumulative dose of cisplatin, respectively. Significant risks for long-term toxicities associated with cisplatin and platinum-based regimens were reported. The cumulative dose of cisplatin and circulating platinum were reported as risk factors. Several single-nucleotide polymorphisms identified patients susceptible to cisplatin compared with wild-type individuals. CONCLUSIONS GCT survivors cured with cisplatin-based chemotherapy are at risk for long-term side-effects. Detection of single-nucleotide polymorphisms could be a valuable tool for predicting long-term toxicities. PATIENT SUMMARY Herein, this article summarizes the available evidence of long-term toxicity of cisplatin-based chemotherapy in GCT survivors and provide insights from Indiana University.
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Affiliation(s)
- M Chovanec
- Division of Hematology Oncology, Indiana University Simon Cancer Center, Indianapolis, USA;; 2nd Department of Oncology, Faculty of Medicine, Comenius University, Bratislava, Slovakia;; National Cancer Institute, Bratislava, Slovakia
| | - M Abu Zaid
- Division of Hematology Oncology, Indiana University Simon Cancer Center, Indianapolis, USA
| | - N Hanna
- Division of Hematology Oncology, Indiana University Simon Cancer Center, Indianapolis, USA
| | - N El-Kouri
- Division of Hematology Oncology, Indiana University Simon Cancer Center, Indianapolis, USA
| | - L H Einhorn
- Division of Hematology Oncology, Indiana University Simon Cancer Center, Indianapolis, USA
| | - C Albany
- Division of Hematology Oncology, Indiana University Simon Cancer Center, Indianapolis, USA;.
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32
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Tao L, Clarke CA, Rosenberg AS, Advani RH, Jonas BA, Flowers CR, Keegan THM. Subsequent primary malignancies after diffuse large B-cell lymphoma in the modern treatment era. Br J Haematol 2017; 178:72-80. [PMID: 28542862 PMCID: PMC5487277 DOI: 10.1111/bjh.14638] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 12/22/2016] [Indexed: 01/07/2023]
Abstract
With the addition of rituximab and other treatment advances, survival after diffuse large B-cell lymphoma (DLBCL) has improved, but subsequent primary malignancies (SPMs) have emerged as an important challenge for DLBCL survivorship. We calculated standardized incidence ratios (SIRs) and 95% confidence intervals (CIs) for SPMs among 23 879 patients who survived at least 1 year after a first primary DLBCL diagnosed during 1989-2012, compared to the general population in California. Cumulative incidence (CMI) of SPMs, accounting for the competing risk of death, also was calculated. We found that the incidence of acute myeloid leukaemia (AML) nearly doubled in the post-rituximab era [SIR (95% CI) 4·39 (2·51-7·13) pre- (1989-2000) and 8·70 (6·62-11·22) post-rituximab (2001-2012)]. Subsequent thyroid cancer was rare pre-rituximab, but increased substantially after 2001 [0·66 (0·08-2·37) vs. 2·27(1·44-3·41)]. The 5-year CMI for all SPMs (4·77% pre- vs. 5·41% post-rituximab, P = 0·047), AML (0·15% vs. 0·41%, P = 0·003), thyroid cancer (0·03% vs. 0·15%, P = 0·003) and melanoma (0·25% vs. 0·42%, P = 0·020) were greater in DLBCL patients diagnosed in the post- versus pre-rituximab period. This study provides insight into the changing pattern of SPM occurrence after the introduction of rituximab, which may elucidate the aetiology of SPMs and should guide future cancer surveillance efforts among DLBCL patients.
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MESH Headings
- Adolescent
- Adult
- Aged
- Antineoplastic Agents/adverse effects
- Antineoplastic Agents/therapeutic use
- California/epidemiology
- Female
- Follow-Up Studies
- Humans
- Incidence
- Leukemia, Myeloid, Acute/chemically induced
- Leukemia, Myeloid, Acute/epidemiology
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/epidemiology
- Male
- Melanoma/chemically induced
- Melanoma/epidemiology
- Middle Aged
- Neoplasms, Second Primary/chemically induced
- Neoplasms, Second Primary/epidemiology
- Registries
- Rituximab/adverse effects
- Rituximab/therapeutic use
- Thyroid Neoplasms/chemically induced
- Thyroid Neoplasms/epidemiology
- Young Adult
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Affiliation(s)
- Li Tao
- Cancer Prevention Institute of California, Fremont, CA, USA
| | - Christina A Clarke
- Cancer Prevention Institute of California, Fremont, CA, USA
- Department of Health Research and Policy (Epidemiology), Stanford University School of Medicine, Stanford, CA, USA
| | - Aaron S Rosenberg
- Center for Oncology Hematology Outcomes Research and Training (COHORT), Division of Hematology and Oncology, Department of Internal Medicine, University of California Davis School of Medicine, Sacramento, CA, USA
| | | | - Brian A Jonas
- Center for Oncology Hematology Outcomes Research and Training (COHORT), Division of Hematology and Oncology, Department of Internal Medicine, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Christopher R Flowers
- Department of Hematology and Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Theresa H M Keegan
- Center for Oncology Hematology Outcomes Research and Training (COHORT), Division of Hematology and Oncology, Department of Internal Medicine, University of California Davis School of Medicine, Sacramento, CA, USA
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Child CJ, Zimmermann AG, Jia N, Robison LL, Brämswig JH, Blum WF. Assessment of Primary Cancer Incidence in Growth Hormone-Treated Children: Comparison of a Multinational Prospective Observational Study with Population Databases. Horm Res Paediatr 2016; 85:198-206. [PMID: 26913923 DOI: 10.1159/000444124] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 01/15/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Although results of the majority of clinical studies have shown no association between growth hormone (GH) treatment in childhood and risk of primary cancer, concerns remain regarding the potential influence of GH therapy on neoplastic cell growth. This study evaluated the incidence of primary malignancies in a large observational study of paediatric GH treatment. METHODS Primary cancer incidence was assessed in a cohort of 19,054 GH-treated children without a reported prestudy history of malignancy in the observational Genetics and Neuroendocrinology of Short Stature International Study (GeNeSIS). The standardised incidence ratio (SIR) for primary cancer in GH-treated children was determined by comparing cancer incidence in the GeNeSIS study population with incidence rates for country-, age-, and sex-matched cohorts of the general population. RESULTS During a mean follow-up of 3.4 years in GeNeSIS (64,705 person-years), 13 incident potential primary cancers were identified in GH-treated patients. The SIR (95% confidence interval) for all observed cancers was 1.02 (0.54-1.75), and the crude incidence was 20.1 (10.7-34.4) cases per 100,000 person-years. CONCLUSION Acknowledging the relatively short follow-up in our study, GH-treated children without a history of previous malignancy did not have a higher risk of all-site primary cancer during the study when compared to general-population cancer registries.
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Abstract
Therapy-related myeloid neoplasms (t-MN) combine t-MDS and therapy related acute myeloid leukemia (t-AML) patients in one entity because of their similar pathogenesis, rapid progression from t-MDS to t-AML, and their equally poor prognosis. Treatment with epipodophyllotoxins like etoposide has been associated with a short interval between treatment and development of t-AML, with fusion oncogenes like KMT2A/MLL-MLLT3 and a better prognosis. In contrast, treatment with alkylating agents has been associated with a longer latency, an initial MDS phase, adverse cytogenetics, and a poor prognosis. The pathogenesis of t-MN can be explained by direct induction of an oncogene through chromosomal translocations, induction of genetic instability, or selection of a preexisting treatment-resistant hematopoietic stem cell clone. Recent evidence has highlighted the importance of the last mechanism and explains the high frequency of TP53 mutations in patients with t-MN. After previous cytotoxic therapy, patients present with specific vulnerabilities, especially evident from the high nonrelapse mortality in patients with t-MN after allogeneic hematopoietic cell transplantation. Here, the prognostic impact of currently known risk factors and the therapeutic options in different patient subgroups will be discussed.
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MESH Headings
- Antineoplastic Agents, Alkylating/adverse effects
- Antineoplastic Agents, Alkylating/therapeutic use
- Disease-Free Survival
- Hematopoietic Stem Cells/metabolism
- Histone-Lysine N-Methyltransferase/genetics
- Histone-Lysine N-Methyltransferase/metabolism
- Humans
- Leukemia, Myeloid, Acute/drug therapy
- Leukemia, Myeloid, Acute/genetics
- Leukemia, Myeloid, Acute/metabolism
- Leukemia, Myeloid, Acute/mortality
- Myeloid-Lymphoid Leukemia Protein/genetics
- Myeloid-Lymphoid Leukemia Protein/metabolism
- Neoplasms, Second Primary/chemically induced
- Neoplasms, Second Primary/genetics
- Neoplasms, Second Primary/metabolism
- Oncogene Proteins, Fusion/genetics
- Oncogene Proteins, Fusion/metabolism
- Survival Rate
- Translocation, Genetic/drug effects
- Tumor Suppressor Protein p53/genetics
- Tumor Suppressor Protein p53/metabolism
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35
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Jonas BA, Johnson C, Gratzinger D, Majeti R. Alkylator-Induced and Patient-Derived Xenograft Mouse Models of Therapy-Related Myeloid Neoplasms Model Clinical Disease and Suggest the Presence of Multiple Cell Subpopulations with Leukemia Stem Cell Activity. PLoS One 2016; 11:e0159189. [PMID: 27428079 PMCID: PMC4948781 DOI: 10.1371/journal.pone.0159189] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 06/03/2016] [Indexed: 11/19/2022] Open
Abstract
Acute myeloid leukemia (AML) is a heterogeneous group of aggressive bone marrow cancers arising from transformed hematopoietic stem and progenitor cells (HSPC). Therapy-related AML and MDS (t-AML/MDS) comprise a subset of AML cases occurring after exposure to alkylating chemotherapy and/or radiation and are associated with a very poor prognosis. Less is known about the pathogenesis and disease-initiating/leukemia stem cell (LSC) subpopulations of t-AML/MDS compared to their de novo counterparts. Here, we report the development of mouse models of t-AML/MDS. First, we modeled alkylator-induced t-AML/MDS by exposing wild type adult mice to N-ethyl-N-nitrosurea (ENU), resulting in several models of AML and MDS that have clinical and pathologic characteristics consistent with human t-AML/MDS including cytopenia, myelodysplasia, and shortened overall survival. These models were limited by their inability to transplant clinically aggressive disease. Second, we established three patient-derived xenograft models of human t-AML. These models led to rapidly fatal disease in recipient immunodeficient xenografted mice. LSC activity was identified in multiple HSPC subpopulations suggesting there is no canonical LSC immunophenotype in human t-AML. Overall, we report several new t-AML/MDS mouse models that could potentially be used to further define disease pathogenesis and test novel therapeutics.
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Affiliation(s)
- Brian A. Jonas
- Department of Internal Medicine, Division of Hematology and Oncology, University of California Davis Comprehensive Cancer Center, University of California Davis School of Medicine, Sacramento, CA, United States of America
| | - Carl Johnson
- Department of Medicine, Division of Hematology, Cancer Institute, and Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA, United States of America
| | - Dita Gratzinger
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, United States of America
| | - Ravindra Majeti
- Department of Medicine, Division of Hematology, Cancer Institute, and Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA, United States of America
- * E-mail:
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36
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Martínez A, Martínez-Ramirez M, Martínez-Caballero D, Beneit P, Clavel J, Figueroa G, Verdú J. Radioimmunotherapy for non-Hodgkin's lymphoma; positioning, safety, and efficacy of 90Y-Ibritumomab. 10 years of experience and follow-up. Rev Esp Med Nucl Imagen Mol 2016; 36:13-19. [PMID: 27422155 DOI: 10.1016/j.remn.2016.05.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 05/05/2016] [Accepted: 05/06/2016] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Radioimmunotherapy (RIT) is one of the therapies directed against molecular targets in non-Hodgkin's lymphoma (NHL). OBJECTIVE To evaluate the positioning, safety, and effectiveness of RIT with 90Y-Ibritumomab in NHL patients. METHOD A retrospective study was conducted on patients with NHL who received RIT with 90Y-Ibritumomab. An evaluation was made of the concordance with clinical guidelines, toxicity as rated by the Common Terminology Criteria for Adverse Events (CTCAE), and effectiveness was assessed based on response to treatment, overall survival (OS), and progression-free survival (PFS). RESULTS RIT was requested in 26 patients, of whom 21 (11 women, mean age 56±10 years) were included in the study, with the following distribution: Follicular NHL, 67%, Mantle NHL, 14%, Diffuse large B-cell NHL, 9.5%, and Transformed NHL 9.5%. Twelve patients with refractory NHL, 7 for consolidation response, and 2 transplant conditioning, were treated. Adverse effects were observed in 71% of patients, which were usually manageable and transient, and with the most common being thrombocytopenia. At 3-4 months, overall response rate was 76.2% (71.4% complete and 4.8% partial response), and 19% had progression of disease. With a median follow up of 70 months, the OS was 96±8 months, and the PFS was 54±11 months. CONCLUSION RIT showed a moderate correlation with clinical guidelines, and is probably underused. Adverse effects were common, mild, and manageable. The data show a high complete response rate and an increase in the OS and PFS.
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Affiliation(s)
- A Martínez
- Servicio de Medicina Nuclear, Hospital Universitario San Juan de Alicante, Alicante, España.
| | - M Martínez-Ramirez
- Servicio de Medicina Nuclear, Hospital Universitario San Juan de Alicante, Alicante, España
| | - D Martínez-Caballero
- Servicio de Medicina Nuclear, Hospital Universitario San Juan de Alicante, Alicante, España
| | - P Beneit
- Servicio de Hematología, Hospital Universitario San Juan de Alicante, Alicante, España
| | - J Clavel
- Servicio de Medicina Nuclear, Hospital Universitario San Juan de Alicante, Alicante, España
| | - G Figueroa
- Servicio de Medicina Nuclear, Hospital Universitario San Juan de Alicante, Alicante, España
| | - J Verdú
- Servicio de Medicina Nuclear, Hospital Universitario San Juan de Alicante, Alicante, España
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37
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Yu KK, Dasanu CA. Rapidly Fatal Dissemination of Merkel Cell Carcinoma in a Patient Treated with Alemtuzumab for Chronic Lymphocytic Leukemia. Conn Med 2016; 80:353-358. [PMID: 27509643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Alemtuzumab is FDA-approved for the treatment of chronic lymphocytic leukemia (CLL). Nonetheless, its use for this indication has fallen out of favor due to serious concerns for infectious complications and increased risks of second malignancies from the profound and lasting immunosuppression. We report here in a patient with a rapidly progressive metastatic Merkel cell carcinoma (MCC) who was previously treated with alemtuzumab and fludarabine for CLL. He developed profound lymphopenia and hypogammaglobulinemia. While the risk of MCC is increased in CLL, its rapid dissemination has not been previously reported with fludarabine alone. In light of the rapidly fatal outcome in our patient due to MCC, we advise caution with the use of alemtuzumab. In patients treated with alemtuzumab for nononcologic indications, aggressive surveillance for cutaneous malignancies should be implemented until its safety profile can be further characterized.
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Senatore FJ, Dasanu CA. Synchronous gastric and ampullary adenocarcinomas in a hairy cell leukemia patient treated with pentostatin eight years prior. J Oncol Pharm Pract 2016; 22:543-7. [PMID: 25712625 DOI: 10.1177/1078155215574140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Hairy cell leukemia patients are at increased risk for second malignancies, including both solid and lymphoid neoplasms. Along with other factors, multiple immune defects present in hairy cell leukemia likely contribute to subsequent carcinogenesis. We report herein a case of synchronous high-grade gastric and ampullary adenocarcinomas in a patient with a history of hairy cell leukemia treated eight years prior with pentostatin. We include a review of immune alterations induced by both hairy cell leukemia and its therapies, and link them with the occurrence of second cancers in these patients.
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Affiliation(s)
- Frank J Senatore
- Department of Medicine, University of Connecticut Health Center, Farmington, CT, USA
| | - Constantin A Dasanu
- Lucy Curci Cancer Center, Eisenhower Medical Center/University of Southern California, Rancho Mirage, CA, USA
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39
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Schaapveld M, Aleman BMP, van Eggermond AM, Janus CPM, Krol ADG, van der Maazen RWM, Roesink J, Raemaekers JMM, de Boer JP, Zijlstra JM, van Imhoff GW, Petersen EJ, Poortmans PMP, Beijert M, Lybeert ML, Mulder I, Visser O, Louwman MWJ, Krul IM, Lugtenburg PJ, van Leeuwen FE. Second Cancer Risk Up to 40 Years after Treatment for Hodgkin's Lymphoma. N Engl J Med 2015; 373:2499-511. [PMID: 26699166 DOI: 10.1056/nejmoa1505949] [Citation(s) in RCA: 400] [Impact Index Per Article: 44.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Survivors of Hodgkin's lymphoma are at increased risk for treatment-related subsequent malignant neoplasms. The effect of less toxic treatments, introduced in the late 1980s, on the long-term risk of a second cancer remains unknown. METHODS We enrolled 3905 persons in the Netherlands who had survived for at least 5 years after the initiation of treatment for Hodgkin's lymphoma. Patients had received treatment between 1965 and 2000, when they were 15 to 50 years of age. We compared the risk of a second cancer among these patients with the risk that was expected on the basis of cancer incidence in the general population. Treatment-specific risks were compared within the cohort. RESULTS With a median follow-up of 19.1 years, 1055 second cancers were diagnosed in 908 patients, resulting in a standardized incidence ratio (SIR) of 4.6 (95% confidence interval [CI], 4.3 to 4.9) in the study cohort as compared with the general population. The risk was still elevated 35 years or more after treatment (SIR, 3.9; 95% CI, 2.8 to 5.4), and the cumulative incidence of a second cancer in the study cohort at 40 years was 48.5% (95% CI, 45.4 to 51.5). The cumulative incidence of second solid cancers did not differ according to study period (1965-1976, 1977-1988, or 1989-2000) (P=0.71 for heterogeneity). Although the risk of breast cancer was lower among patients who were treated with supradiaphragmatic-field radiotherapy not including the axilla than among those who were exposed to mantle-field irradiation (hazard ratio, 0.37; 95% CI, 0.19 to 0.72), the risk of breast cancer was not lower among patients treated in the 1989-2000 study period than among those treated in the two earlier periods. A cumulative procarbazine dose of 4.3 g or more per square meter of body-surface area (which has been associated with premature menopause) was associated with a significantly lower risk of breast cancer (hazard ratio for the comparison with no chemotherapy, 0.57; 95% CI, 0.39 to 0.84) but a higher risk of gastrointestinal cancer (hazard ratio, 2.70; 95% CI, 1.69 to 4.30). CONCLUSIONS The risk of second solid cancers did not appear to be lower among patients treated in the most recent calendar period studied (1989-2000) than among those treated in earlier periods. The awareness of an increased risk of second cancer remains crucial for survivors of Hodgkin's lymphoma. (Funded by the Dutch Cancer Society.).
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Affiliation(s)
- Michael Schaapveld
- From the Departments of Epidemiology (M.S., A.M.E., I.M., I.M.K., F.E.L.), Radiation Oncology (B.M.P.A.), and Hematology (J.P.B.), Netherlands Cancer Institute, and the Department of Hematology, VU University Medical Center Amsterdam (J.M.Z.), Amsterdam, the Netherlands Comprehensive Cancer Organization (M.S., I.M., O.V., M.W.J.L.) and the Departments of Radiation Oncology (J.R.) and Hematology (E.J.P.), University Medical Center Utrecht, Utrecht, the Departments of Radiation Oncology (C.P.M.J.) and Hematology (P.J.L.), Erasmus Medical Center Cancer Institute, Rotterdam, the Department of Radiation Oncology, Leiden University Medical Center, Leiden (A.D.G.K.), the Department of Radiation Oncology, Radboud University Medical Center (R.W.M.M., P.M.P.P.), and the Department of Education and Science, Canisius-Wilhelmina Hospital (I.M.), Nijmegen, the Department of Hematology, Radboud University Medical Center, Nijmegen-Rijnstate, Arnhem (J.M.M.R.), the Departments of Hematology (G.W.I.) and Radiation Oncology (M.B.), University Medical Center Groningen, Groningen, the Department of Radiation Oncology, Dr. Bernard Verbeeten Institute, Tilburg (P.M.P.P.), and the Department of Radiotherapy, Catharina Hospital, Eindhoven (M.L.L.) - all in the Netherlands
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40
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Worden F, Fassnacht M, Shi Y, Hadjieva T, Bonichon F, Gao M, Fugazzola L, Ando Y, Hasegawa Y, Park DJ, Shong YK, Smit JWA, Chung J, Kappeler C, Meinhardt G, Schlumberger M, Brose MS. Safety and tolerability of sorafenib in patients with radioiodine-refractory thyroid cancer. Endocr Relat Cancer 2015; 22:877-87. [PMID: 26370187 PMCID: PMC4570090 DOI: 10.1530/erc-15-0252] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Effective adverse event (AE) management is critical to maintaining patients on anticancer therapies. The DECISION trial was a multicenter, randomized, double-blind, placebo-controlled, Phase 3 trial which investigated sorafenib for treatment of progressive, advanced, or metastatic radioactive iodine-refractory, differentiated thyroid carcinoma. Four hundred and seventeen adult patients were randomized (1:1) to receive oral sorafenib (400 mg, twice daily) or placebo, until progression, unacceptable toxicity, noncompliance, or withdrawal. Progression-free survival, the primary endpoint of DECISION, was reported previously. To elucidate the patterns and management of AEs in sorafenib-treated patients in the DECISION trial, this report describes detailed, by-treatment-cycle analyses of the incidence, prevalence, and severity of hand-foot skin reaction (HFSR), rash/desquamation, hypertension, diarrhea, fatigue, weight loss, increased serum thyroid stimulating hormone, and hypocalcemia, as well as the interventions used to manage these AEs. By-cycle incidence of the above-selected AEs with sorafenib was generally highest in cycle 1 or 2 then decreased. AE prevalence generally increased over cycles 2-6 then stabilized or declined. Among these AEs, only weight loss tended to increase in severity (from grade 1 to 2) over time; severity of HFSR and rash/desquamation declined over time. AEs were mostly grade 1 or 2, and were generally managed with dose interruptions/reductions, and concomitant medications (e.g. antidiarrheals, antihypertensives, dermatologic preparations). Most dose interruptions/reductions occurred in early cycles. In conclusion, AEs with sorafenib in DECISION were typically grade 1 or 2, occurred early during the treatment course, and were manageable over time.
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MESH Headings
- Adenocarcinoma, Follicular/drug therapy
- Adenocarcinoma, Follicular/enzymology
- Adenocarcinoma, Follicular/radiotherapy
- Adenoma, Oxyphilic/drug therapy
- Adenoma, Oxyphilic/enzymology
- Adenoma, Oxyphilic/radiotherapy
- Aged
- Antineoplastic Agents/adverse effects
- Antineoplastic Agents/therapeutic use
- Carcinoma, Papillary/drug therapy
- Carcinoma, Papillary/enzymology
- Carcinoma, Papillary/radiotherapy
- Diarrhea/chemically induced
- Diarrhea/drug therapy
- Diarrhea/epidemiology
- Disease-Free Survival
- Drug Eruptions/drug therapy
- Drug Eruptions/epidemiology
- Drug Eruptions/etiology
- Drug Resistance, Neoplasm
- Dyspnea/chemically induced
- Dyspnea/epidemiology
- Fatigue/chemically induced
- Fatigue/epidemiology
- Female
- Humans
- Hypertension/chemically induced
- Hypertension/drug therapy
- Hypertension/epidemiology
- Hypocalcemia/chemically induced
- Hypocalcemia/epidemiology
- Incidence
- Iodine Radioisotopes/therapeutic use
- Male
- Middle Aged
- Neoplasms, Second Primary/chemically induced
- Neoplasms, Second Primary/epidemiology
- Niacinamide/adverse effects
- Niacinamide/analogs & derivatives
- Niacinamide/therapeutic use
- Phenylurea Compounds/adverse effects
- Phenylurea Compounds/therapeutic use
- Prevalence
- Protein Kinase Inhibitors/adverse effects
- Protein Kinase Inhibitors/therapeutic use
- Radiopharmaceuticals/therapeutic use
- Sorafenib
- Thyroid Neoplasms/drug therapy
- Thyroid Neoplasms/enzymology
- Thyroid Neoplasms/radiotherapy
- Weight Loss/drug effects
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Affiliation(s)
- Francis Worden
- Division of Hematology/OncologyUniversity of Michigan Comprehensive Cancer Center, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, Michigan 48109, USAEndocrine UnitDepartment of Medicine I, University Hospital, University of Würzburg, Würzburg, GermanyComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, GermanyDepartment of Medical OncologyCancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaBeijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted DrugsBeijing, ChinaRadiotherapy DepartmentMedical University, Sofia, BulgariaInstitut BergonieBordeaux, FranceTianjin Medical University Cancer HospitalTianjin, ChinaFondazione IRCCS Ca' GrandaMilan, ItalyDepartment of Pathophysiology and TransplantationUniversity of Milan, Milan, ItalyNagoya University HospitalNagoya, JapanAichi Cancer Center HospitalNagoya, JapanSeoul National University College of MedicineSeoul, KoreaAsan Medicine CenterSeoul, KoreaDepartment of Internal MedicineRadboud University Nijmegen Medical Center, Nijmegen, The NetherlandsBayer HealthCare PharmaceuticalsMontville, New Jersey, USABayer Pharma AGBerlin, GermanyInstitut Gustave RoussyVillejuif, FranceDepartment of Otorhinolaryngology: Head and Neck SurgeryAbramson Cancer Center of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Martin Fassnacht
- Division of Hematology/OncologyUniversity of Michigan Comprehensive Cancer Center, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, Michigan 48109, USAEndocrine UnitDepartment of Medicine I, University Hospital, University of Würzburg, Würzburg, GermanyComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, GermanyDepartment of Medical OncologyCancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaBeijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted DrugsBeijing, ChinaRadiotherapy DepartmentMedical University, Sofia, BulgariaInstitut BergonieBordeaux, FranceTianjin Medical University Cancer HospitalTianjin, ChinaFondazione IRCCS Ca' GrandaMilan, ItalyDepartment of Pathophysiology and TransplantationUniversity of Milan, Milan, ItalyNagoya University HospitalNagoya, JapanAichi Cancer Center HospitalNagoya, JapanSeoul National University College of MedicineSeoul, KoreaAsan Medicine CenterSeoul, KoreaDepartment of Internal MedicineRadboud University Nijmegen Medical Center, Nijmegen, The NetherlandsBayer HealthCare PharmaceuticalsMontville, New Jersey, USABayer Pharma AGBerlin, GermanyInstitut Gustave RoussyVillejuif, FranceDepartment of Otorhinolaryngology: Head and Neck SurgeryAbramson Cancer Center of the University of Pennsylvania, Philadelphia, Pennsylvania, USA Division of Hematology/OncologyUniversity of Michigan Comprehensive Cancer Center, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, Michigan 48109, USAEndocrine UnitDepartment of Medicine I, University Hospital, University of Würzburg, Würzburg, GermanyComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, GermanyDepartment of Medical OncologyCancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaBeijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted DrugsBeijing, ChinaRadioth
| | - Yuankai Shi
- Division of Hematology/OncologyUniversity of Michigan Comprehensive Cancer Center, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, Michigan 48109, USAEndocrine UnitDepartment of Medicine I, University Hospital, University of Würzburg, Würzburg, GermanyComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, GermanyDepartment of Medical OncologyCancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaBeijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted DrugsBeijing, ChinaRadiotherapy DepartmentMedical University, Sofia, BulgariaInstitut BergonieBordeaux, FranceTianjin Medical University Cancer HospitalTianjin, ChinaFondazione IRCCS Ca' GrandaMilan, ItalyDepartment of Pathophysiology and TransplantationUniversity of Milan, Milan, ItalyNagoya University HospitalNagoya, JapanAichi Cancer Center HospitalNagoya, JapanSeoul National University College of MedicineSeoul, KoreaAsan Medicine CenterSeoul, KoreaDepartment of Internal MedicineRadboud University Nijmegen Medical Center, Nijmegen, The NetherlandsBayer HealthCare PharmaceuticalsMontville, New Jersey, USABayer Pharma AGBerlin, GermanyInstitut Gustave RoussyVillejuif, FranceDepartment of Otorhinolaryngology: Head and Neck SurgeryAbramson Cancer Center of the University of Pennsylvania, Philadelphia, Pennsylvania, USA Division of Hematology/OncologyUniversity of Michigan Comprehensive Cancer Center, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, Michigan 48109, USAEndocrine UnitDepartment of Medicine I, University Hospital, University of Würzburg, Würzburg, GermanyComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, GermanyDepartment of Medical OncologyCancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaBeijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted DrugsBeijing, ChinaRadioth
| | - Tatiana Hadjieva
- Division of Hematology/OncologyUniversity of Michigan Comprehensive Cancer Center, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, Michigan 48109, USAEndocrine UnitDepartment of Medicine I, University Hospital, University of Würzburg, Würzburg, GermanyComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, GermanyDepartment of Medical OncologyCancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaBeijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted DrugsBeijing, ChinaRadiotherapy DepartmentMedical University, Sofia, BulgariaInstitut BergonieBordeaux, FranceTianjin Medical University Cancer HospitalTianjin, ChinaFondazione IRCCS Ca' GrandaMilan, ItalyDepartment of Pathophysiology and TransplantationUniversity of Milan, Milan, ItalyNagoya University HospitalNagoya, JapanAichi Cancer Center HospitalNagoya, JapanSeoul National University College of MedicineSeoul, KoreaAsan Medicine CenterSeoul, KoreaDepartment of Internal MedicineRadboud University Nijmegen Medical Center, Nijmegen, The NetherlandsBayer HealthCare PharmaceuticalsMontville, New Jersey, USABayer Pharma AGBerlin, GermanyInstitut Gustave RoussyVillejuif, FranceDepartment of Otorhinolaryngology: Head and Neck SurgeryAbramson Cancer Center of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Françoise Bonichon
- Division of Hematology/OncologyUniversity of Michigan Comprehensive Cancer Center, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, Michigan 48109, USAEndocrine UnitDepartment of Medicine I, University Hospital, University of Würzburg, Würzburg, GermanyComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, GermanyDepartment of Medical OncologyCancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaBeijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted DrugsBeijing, ChinaRadiotherapy DepartmentMedical University, Sofia, BulgariaInstitut BergonieBordeaux, FranceTianjin Medical University Cancer HospitalTianjin, ChinaFondazione IRCCS Ca' GrandaMilan, ItalyDepartment of Pathophysiology and TransplantationUniversity of Milan, Milan, ItalyNagoya University HospitalNagoya, JapanAichi Cancer Center HospitalNagoya, JapanSeoul National University College of MedicineSeoul, KoreaAsan Medicine CenterSeoul, KoreaDepartment of Internal MedicineRadboud University Nijmegen Medical Center, Nijmegen, The NetherlandsBayer HealthCare PharmaceuticalsMontville, New Jersey, USABayer Pharma AGBerlin, GermanyInstitut Gustave RoussyVillejuif, FranceDepartment of Otorhinolaryngology: Head and Neck SurgeryAbramson Cancer Center of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ming Gao
- Division of Hematology/OncologyUniversity of Michigan Comprehensive Cancer Center, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, Michigan 48109, USAEndocrine UnitDepartment of Medicine I, University Hospital, University of Würzburg, Würzburg, GermanyComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, GermanyDepartment of Medical OncologyCancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaBeijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted DrugsBeijing, ChinaRadiotherapy DepartmentMedical University, Sofia, BulgariaInstitut BergonieBordeaux, FranceTianjin Medical University Cancer HospitalTianjin, ChinaFondazione IRCCS Ca' GrandaMilan, ItalyDepartment of Pathophysiology and TransplantationUniversity of Milan, Milan, ItalyNagoya University HospitalNagoya, JapanAichi Cancer Center HospitalNagoya, JapanSeoul National University College of MedicineSeoul, KoreaAsan Medicine CenterSeoul, KoreaDepartment of Internal MedicineRadboud University Nijmegen Medical Center, Nijmegen, The NetherlandsBayer HealthCare PharmaceuticalsMontville, New Jersey, USABayer Pharma AGBerlin, GermanyInstitut Gustave RoussyVillejuif, FranceDepartment of Otorhinolaryngology: Head and Neck SurgeryAbramson Cancer Center of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Laura Fugazzola
- Division of Hematology/OncologyUniversity of Michigan Comprehensive Cancer Center, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, Michigan 48109, USAEndocrine UnitDepartment of Medicine I, University Hospital, University of Würzburg, Würzburg, GermanyComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, GermanyDepartment of Medical OncologyCancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaBeijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted DrugsBeijing, ChinaRadiotherapy DepartmentMedical University, Sofia, BulgariaInstitut BergonieBordeaux, FranceTianjin Medical University Cancer HospitalTianjin, ChinaFondazione IRCCS Ca' GrandaMilan, ItalyDepartment of Pathophysiology and TransplantationUniversity of Milan, Milan, ItalyNagoya University HospitalNagoya, JapanAichi Cancer Center HospitalNagoya, JapanSeoul National University College of MedicineSeoul, KoreaAsan Medicine CenterSeoul, KoreaDepartment of Internal MedicineRadboud University Nijmegen Medical Center, Nijmegen, The NetherlandsBayer HealthCare PharmaceuticalsMontville, New Jersey, USABayer Pharma AGBerlin, GermanyInstitut Gustave RoussyVillejuif, FranceDepartment of Otorhinolaryngology: Head and Neck SurgeryAbramson Cancer Center of the University of Pennsylvania, Philadelphia, Pennsylvania, USA Division of Hematology/OncologyUniversity of Michigan Comprehensive Cancer Center, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, Michigan 48109, USAEndocrine UnitDepartment of Medicine I, University Hospital, University of Würzburg, Würzburg, GermanyComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, GermanyDepartment of Medical OncologyCancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaBeijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted DrugsBeijing, ChinaRadioth
| | - Yuichi Ando
- Division of Hematology/OncologyUniversity of Michigan Comprehensive Cancer Center, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, Michigan 48109, USAEndocrine UnitDepartment of Medicine I, University Hospital, University of Würzburg, Würzburg, GermanyComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, GermanyDepartment of Medical OncologyCancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaBeijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted DrugsBeijing, ChinaRadiotherapy DepartmentMedical University, Sofia, BulgariaInstitut BergonieBordeaux, FranceTianjin Medical University Cancer HospitalTianjin, ChinaFondazione IRCCS Ca' GrandaMilan, ItalyDepartment of Pathophysiology and TransplantationUniversity of Milan, Milan, ItalyNagoya University HospitalNagoya, JapanAichi Cancer Center HospitalNagoya, JapanSeoul National University College of MedicineSeoul, KoreaAsan Medicine CenterSeoul, KoreaDepartment of Internal MedicineRadboud University Nijmegen Medical Center, Nijmegen, The NetherlandsBayer HealthCare PharmaceuticalsMontville, New Jersey, USABayer Pharma AGBerlin, GermanyInstitut Gustave RoussyVillejuif, FranceDepartment of Otorhinolaryngology: Head and Neck SurgeryAbramson Cancer Center of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Yasuhisa Hasegawa
- Division of Hematology/OncologyUniversity of Michigan Comprehensive Cancer Center, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, Michigan 48109, USAEndocrine UnitDepartment of Medicine I, University Hospital, University of Würzburg, Würzburg, GermanyComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, GermanyDepartment of Medical OncologyCancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaBeijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted DrugsBeijing, ChinaRadiotherapy DepartmentMedical University, Sofia, BulgariaInstitut BergonieBordeaux, FranceTianjin Medical University Cancer HospitalTianjin, ChinaFondazione IRCCS Ca' GrandaMilan, ItalyDepartment of Pathophysiology and TransplantationUniversity of Milan, Milan, ItalyNagoya University HospitalNagoya, JapanAichi Cancer Center HospitalNagoya, JapanSeoul National University College of MedicineSeoul, KoreaAsan Medicine CenterSeoul, KoreaDepartment of Internal MedicineRadboud University Nijmegen Medical Center, Nijmegen, The NetherlandsBayer HealthCare PharmaceuticalsMontville, New Jersey, USABayer Pharma AGBerlin, GermanyInstitut Gustave RoussyVillejuif, FranceDepartment of Otorhinolaryngology: Head and Neck SurgeryAbramson Cancer Center of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Do Joon Park
- Division of Hematology/OncologyUniversity of Michigan Comprehensive Cancer Center, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, Michigan 48109, USAEndocrine UnitDepartment of Medicine I, University Hospital, University of Würzburg, Würzburg, GermanyComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, GermanyDepartment of Medical OncologyCancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaBeijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted DrugsBeijing, ChinaRadiotherapy DepartmentMedical University, Sofia, BulgariaInstitut BergonieBordeaux, FranceTianjin Medical University Cancer HospitalTianjin, ChinaFondazione IRCCS Ca' GrandaMilan, ItalyDepartment of Pathophysiology and TransplantationUniversity of Milan, Milan, ItalyNagoya University HospitalNagoya, JapanAichi Cancer Center HospitalNagoya, JapanSeoul National University College of MedicineSeoul, KoreaAsan Medicine CenterSeoul, KoreaDepartment of Internal MedicineRadboud University Nijmegen Medical Center, Nijmegen, The NetherlandsBayer HealthCare PharmaceuticalsMontville, New Jersey, USABayer Pharma AGBerlin, GermanyInstitut Gustave RoussyVillejuif, FranceDepartment of Otorhinolaryngology: Head and Neck SurgeryAbramson Cancer Center of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Young Kee Shong
- Division of Hematology/OncologyUniversity of Michigan Comprehensive Cancer Center, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, Michigan 48109, USAEndocrine UnitDepartment of Medicine I, University Hospital, University of Würzburg, Würzburg, GermanyComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, GermanyDepartment of Medical OncologyCancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaBeijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted DrugsBeijing, ChinaRadiotherapy DepartmentMedical University, Sofia, BulgariaInstitut BergonieBordeaux, FranceTianjin Medical University Cancer HospitalTianjin, ChinaFondazione IRCCS Ca' GrandaMilan, ItalyDepartment of Pathophysiology and TransplantationUniversity of Milan, Milan, ItalyNagoya University HospitalNagoya, JapanAichi Cancer Center HospitalNagoya, JapanSeoul National University College of MedicineSeoul, KoreaAsan Medicine CenterSeoul, KoreaDepartment of Internal MedicineRadboud University Nijmegen Medical Center, Nijmegen, The NetherlandsBayer HealthCare PharmaceuticalsMontville, New Jersey, USABayer Pharma AGBerlin, GermanyInstitut Gustave RoussyVillejuif, FranceDepartment of Otorhinolaryngology: Head and Neck SurgeryAbramson Cancer Center of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Johannes W A Smit
- Division of Hematology/OncologyUniversity of Michigan Comprehensive Cancer Center, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, Michigan 48109, USAEndocrine UnitDepartment of Medicine I, University Hospital, University of Würzburg, Würzburg, GermanyComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, GermanyDepartment of Medical OncologyCancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaBeijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted DrugsBeijing, ChinaRadiotherapy DepartmentMedical University, Sofia, BulgariaInstitut BergonieBordeaux, FranceTianjin Medical University Cancer HospitalTianjin, ChinaFondazione IRCCS Ca' GrandaMilan, ItalyDepartment of Pathophysiology and TransplantationUniversity of Milan, Milan, ItalyNagoya University HospitalNagoya, JapanAichi Cancer Center HospitalNagoya, JapanSeoul National University College of MedicineSeoul, KoreaAsan Medicine CenterSeoul, KoreaDepartment of Internal MedicineRadboud University Nijmegen Medical Center, Nijmegen, The NetherlandsBayer HealthCare PharmaceuticalsMontville, New Jersey, USABayer Pharma AGBerlin, GermanyInstitut Gustave RoussyVillejuif, FranceDepartment of Otorhinolaryngology: Head and Neck SurgeryAbramson Cancer Center of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - John Chung
- Division of Hematology/OncologyUniversity of Michigan Comprehensive Cancer Center, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, Michigan 48109, USAEndocrine UnitDepartment of Medicine I, University Hospital, University of Würzburg, Würzburg, GermanyComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, GermanyDepartment of Medical OncologyCancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaBeijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted DrugsBeijing, ChinaRadiotherapy DepartmentMedical University, Sofia, BulgariaInstitut BergonieBordeaux, FranceTianjin Medical University Cancer HospitalTianjin, ChinaFondazione IRCCS Ca' GrandaMilan, ItalyDepartment of Pathophysiology and TransplantationUniversity of Milan, Milan, ItalyNagoya University HospitalNagoya, JapanAichi Cancer Center HospitalNagoya, JapanSeoul National University College of MedicineSeoul, KoreaAsan Medicine CenterSeoul, KoreaDepartment of Internal MedicineRadboud University Nijmegen Medical Center, Nijmegen, The NetherlandsBayer HealthCare PharmaceuticalsMontville, New Jersey, USABayer Pharma AGBerlin, GermanyInstitut Gustave RoussyVillejuif, FranceDepartment of Otorhinolaryngology: Head and Neck SurgeryAbramson Cancer Center of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Christian Kappeler
- Division of Hematology/OncologyUniversity of Michigan Comprehensive Cancer Center, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, Michigan 48109, USAEndocrine UnitDepartment of Medicine I, University Hospital, University of Würzburg, Würzburg, GermanyComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, GermanyDepartment of Medical OncologyCancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaBeijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted DrugsBeijing, ChinaRadiotherapy DepartmentMedical University, Sofia, BulgariaInstitut BergonieBordeaux, FranceTianjin Medical University Cancer HospitalTianjin, ChinaFondazione IRCCS Ca' GrandaMilan, ItalyDepartment of Pathophysiology and TransplantationUniversity of Milan, Milan, ItalyNagoya University HospitalNagoya, JapanAichi Cancer Center HospitalNagoya, JapanSeoul National University College of MedicineSeoul, KoreaAsan Medicine CenterSeoul, KoreaDepartment of Internal MedicineRadboud University Nijmegen Medical Center, Nijmegen, The NetherlandsBayer HealthCare PharmaceuticalsMontville, New Jersey, USABayer Pharma AGBerlin, GermanyInstitut Gustave RoussyVillejuif, FranceDepartment of Otorhinolaryngology: Head and Neck SurgeryAbramson Cancer Center of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Gerold Meinhardt
- Division of Hematology/OncologyUniversity of Michigan Comprehensive Cancer Center, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, Michigan 48109, USAEndocrine UnitDepartment of Medicine I, University Hospital, University of Würzburg, Würzburg, GermanyComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, GermanyDepartment of Medical OncologyCancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaBeijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted DrugsBeijing, ChinaRadiotherapy DepartmentMedical University, Sofia, BulgariaInstitut BergonieBordeaux, FranceTianjin Medical University Cancer HospitalTianjin, ChinaFondazione IRCCS Ca' GrandaMilan, ItalyDepartment of Pathophysiology and TransplantationUniversity of Milan, Milan, ItalyNagoya University HospitalNagoya, JapanAichi Cancer Center HospitalNagoya, JapanSeoul National University College of MedicineSeoul, KoreaAsan Medicine CenterSeoul, KoreaDepartment of Internal MedicineRadboud University Nijmegen Medical Center, Nijmegen, The NetherlandsBayer HealthCare PharmaceuticalsMontville, New Jersey, USABayer Pharma AGBerlin, GermanyInstitut Gustave RoussyVillejuif, FranceDepartment of Otorhinolaryngology: Head and Neck SurgeryAbramson Cancer Center of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Martin Schlumberger
- Division of Hematology/OncologyUniversity of Michigan Comprehensive Cancer Center, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, Michigan 48109, USAEndocrine UnitDepartment of Medicine I, University Hospital, University of Würzburg, Würzburg, GermanyComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, GermanyDepartment of Medical OncologyCancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaBeijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted DrugsBeijing, ChinaRadiotherapy DepartmentMedical University, Sofia, BulgariaInstitut BergonieBordeaux, FranceTianjin Medical University Cancer HospitalTianjin, ChinaFondazione IRCCS Ca' GrandaMilan, ItalyDepartment of Pathophysiology and TransplantationUniversity of Milan, Milan, ItalyNagoya University HospitalNagoya, JapanAichi Cancer Center HospitalNagoya, JapanSeoul National University College of MedicineSeoul, KoreaAsan Medicine CenterSeoul, KoreaDepartment of Internal MedicineRadboud University Nijmegen Medical Center, Nijmegen, The NetherlandsBayer HealthCare PharmaceuticalsMontville, New Jersey, USABayer Pharma AGBerlin, GermanyInstitut Gustave RoussyVillejuif, FranceDepartment of Otorhinolaryngology: Head and Neck SurgeryAbramson Cancer Center of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Marcia S Brose
- Division of Hematology/OncologyUniversity of Michigan Comprehensive Cancer Center, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, Michigan 48109, USAEndocrine UnitDepartment of Medicine I, University Hospital, University of Würzburg, Würzburg, GermanyComprehensive Cancer Center MainfrankenUniversity of Würzburg, Würzburg, GermanyDepartment of Medical OncologyCancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaBeijing Key Laboratory of Clinical Study on Anticancer Molecular Targeted DrugsBeijing, ChinaRadiotherapy DepartmentMedical University, Sofia, BulgariaInstitut BergonieBordeaux, FranceTianjin Medical University Cancer HospitalTianjin, ChinaFondazione IRCCS Ca' GrandaMilan, ItalyDepartment of Pathophysiology and TransplantationUniversity of Milan, Milan, ItalyNagoya University HospitalNagoya, JapanAichi Cancer Center HospitalNagoya, JapanSeoul National University College of MedicineSeoul, KoreaAsan Medicine CenterSeoul, KoreaDepartment of Internal MedicineRadboud University Nijmegen Medical Center, Nijmegen, The NetherlandsBayer HealthCare PharmaceuticalsMontville, New Jersey, USABayer Pharma AGBerlin, GermanyInstitut Gustave RoussyVillejuif, FranceDepartment of Otorhinolaryngology: Head and Neck SurgeryAbramson Cancer Center of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Teng CJ, Huon LK, Hu YW, Yeh CM, Chao Y, Yang MH, Chen TJ, Hung YP, Liu CJ. Secondary Primary Malignancy Risk in Patients With Cervical Cancer in Taiwan: A Nationwide Population-Based Study. Medicine (Baltimore) 2015; 94:e1803. [PMID: 26512575 PMCID: PMC4985389 DOI: 10.1097/md.0000000000001803] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
To evaluate the risk of secondary primary malignancy (SPM) in patients with cervical cancer using a nationwide population-based dataset.Patients newly diagnosed with cervical cancer between 1997 and 2011 were identified using Taiwan's National Health Insurance database. Patients with antecedent malignancies were excluded. Standardized incidence ratios (SIRs) for SPM were calculated by comparing with the cancer incidence in the general population. Risk factors for cancer development were analyzed using Cox proportional hazard models.During the 14-year study period (follow-up of 223,062 person-years), 2004 cancers developed in 35,175 patients with cervical cancer. The SIR for all cancers was 1.56 (95% confidence interval, 1.50-1.63, P < 0.001). SIRs for follow-up periods of >10, 5 to 10, 1 to 5, and <1 year were 1.37, 1.51, 1.34, and 2.59, respectively. After the exclusion of SPM occurring within 1 year of cervical cancer diagnosis, SIRs were significantly higher for cancers of the esophagus (2.05), stomach (1.38), colon, rectum, and anus (1.36); lung and mediastinum (2.28), bone and soft tissue (2.23), uterus (3.76), bladder (2.26), and kidneys (1.41). Multivariate analysis showed that age ≥60 was a significant SPM risk factor (hazard ratio [HR] 1.59). Different treatments for cervical cancer, including radiotherapy (HR 1.41) and chemotherapy (HR 1.27), had different impacts on SPM risk. Carboplatin and fluorouracil independently increased SPM risk in cervical cancer patients.Patients with cervical cancer are at increased risk of SPM development. Age ≥60 years, chemotherapy, and radiotherapy are independent risk factors. Carboplatin and fluorouracil also increased SPM risk independently. Close surveillance of patients at high risk should be considered for the early detection of SPMs.
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Affiliation(s)
- Chung-Jen Teng
- From the Institute of Public Health, National Yang-Ming University, Taipei (C-JT, Yi-PH); Division of Oncology and Hematology, Department of Medicine, Far Eastern Memorial Hospital, New Taipei City (C-JT); School of Medicine, National Yang-Ming University (C-JT, Y-WH, YC, M-HY, T-JC, Yi-PH, C-JL); Department of Otolaryngology-Head and Neck Surgery, Cathay General Hospital (L-KH); School of Medicine, Fu Jen Catholic University (L-KH); Department of Oncology (Y-WH, YC); Department of Family Medicine (C-MY, T-JC); Division of Gastroenterology and Hepatology, Department of Medicine (YC); Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital (M-HY, Yi-PH, C-JL); and Institute of Biopharmaceutical Sciences, National Yang-Ming University, Taipei, Taiwan (C-JL)
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Treatment of childhood cancers: late effects. Prescrire Int 2015; 24:236-9. [PMID: 26594727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
In France, about 1 in 1000 young adults aged 20 to 30 years is a survivor of childhood cancer and is thus faced with late effects of their cancer and its treatment (radiation therapy and/or chemotherapy). What are the late effects of childhood cancer therapy? A systematic review by the Scottish Intercollegiate Guidelines Network (SIGN) provides useful information based on European and North American data. Cancer treatments can have many long-term consequences that depend on the drugs and doses used, radiation therapy protocols and irradiated organs, and age at the time of treatment. Cytotoxic drugs and radiation can both cause infertility. Abdominopelvic radiation therapy in girls has been linked to an increased risk of premature delivery and other complications of pregnancy. No increase in birth defects has been reported among children born to childhood cancer survivors. Anthracyclines and radiation therapy can cause cardiomyopathy. Neck irradiation can lead to thyroid disorders, and cranial irradiation to growth retardation. Chemotherapy can cause osteonecrosis and loss of bone density, but without an increased risk of fracture. The risk of cognitive impairment and structural abnormalities of the brain is higher when the child is younger or receives a high cumulative dose of cranial irradiation or total irradiation dosage. Some cytotoxic drugs can damage the kidneys. Cranial radiation therapy can cause long-term neuroendocrine disorders and growth disorders, especially when the dose exceeds 18 Gy. Cytotoxic drugs (alkylating agents, etoposide, etc.) and radiation therapy can cause second cancers of a different histological type. One analysis of second cancers showed a median time to onset of 7 years for solid tumours and 2.5 years for lymphoma and leukaemia. Better knowledge of the late effects of childhood cancer therapy can help orient the choice of treatment towards less harmful options or, if necessary, implement measures aimed at preventing late adverse effects. Childhood cancer survivors must be monitored into adulthood in order to detect such effects.
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Nguyen JC, Kubik MJ, Broome HE, Curtin PT, Dell'Aquila ML, Wang HY. Successful treatment of both double minute of C-MYC and BCL-2 rearrangement containing large B-cell lymphoma with subsequent unfortunate development of therapy-related acute myeloid leukemia with t(3;3)(q26.2;q21). Pathol Res Pract 2015; 211:883-91. [PMID: 26300063 DOI: 10.1016/j.prp.2015.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Revised: 06/25/2015] [Accepted: 07/13/2015] [Indexed: 11/16/2022]
Abstract
Double minute chromosomes (DMs), although relatively frequently encountered in solid tumors, are rare in hematologic neoplasms such as acute myeloid leukemia (AML), and even rarer in lymphoid neoplasms. t(3;3)(q26.2;q21) is a very rare genetic alteration observed in myeloid neoplasm. Herein we report an interesting and unique case of concomitant C-MYC DMs and t(14;18)-containing large B-cell lymphoma, which was successfully treated with R-hyper-CVAD; unfortunately, the patient has developed a therapy-related AML (t-AML) 2 years since the start of his lymphoma treatment. His t-AML contains both t(3;3)(q26.2;q21) and monosomy 7, and the patient died of AML 10 months after the initial diagnosis of t-AML despite clinical remission. To the best of our knowledge, this is the first reported case of C-MYC DM-containing de novo large B-cell lymphoma, which was successfully treated with complete remission, but unfortunately died of t-AML harboring t(3;3)(q21;q26).
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MESH Headings
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Chromosomes, Human, Pair 3
- Fatal Outcome
- Flow Cytometry
- Genes, bcl-2
- Genes, myc
- Humans
- Immunohistochemistry
- In Situ Hybridization, Fluorescence
- Karyotyping
- Leukemia, Myeloid, Acute/chemically induced
- Leukemia, Myeloid, Acute/genetics
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/genetics
- Male
- Middle Aged
- Mutation
- Neoplasms, Second Primary/chemically induced
- Neoplasms, Second Primary/genetics
- Translocation, Genetic
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Affiliation(s)
- John C Nguyen
- Department of Pathology, University of California San Diego Health System, La Jolla, CA 92093-0960, United States
| | - Melanie J Kubik
- Department of Pathology, University of California San Diego Health System, La Jolla, CA 92093-0960, United States
| | - H Elizabeth Broome
- Department of Pathology, University of California San Diego Health System, La Jolla, CA 92093-0960, United States
| | - Peter T Curtin
- Division of Hematology, Department of Medicine, University of California San Diego Health System, La Jolla, CA 92093-0960, United States
| | - Marie L Dell'Aquila
- Department of Pathology, University of California San Diego Health System, La Jolla, CA 92093-0960, United States
| | - Huan-You Wang
- Department of Pathology, University of California San Diego Health System, La Jolla, CA 92093-0960, United States.
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Suzuki K, Takahashi H. [The epidemiology of multiple myeloma]. Nihon Rinsho 2015; 73:7-12. [PMID: 25626296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
We investigated epidemiology of multiple myeloma (MM), referring to recent papers. This article includes three points: 1) the progression rate of monoclonal gammopathy of undetermined significance (MGUS) to MM, 2) the effect of radiation to prevalence of MM, and 3) secondary malignancy after chemotherapy used to treat MM. The risk of progression from MGUS to MM is 1% per year. The researches of atomic bomb showed that there is no increase of risk of MM after radiation exposure. In contrast, studies investigating workers in nuclear power plants point out that radiation exposure over 50 mSv increases risk of MM. The incidence of secondary malignancy after chemotherapy used to treat MM was about 5%. This article will help to review recent researches about epidemiology of MM.
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Minoia C, Sgherza N, Loseto G, Greco G, Buquicchio C, Merchionne F, Toldo C, Galise I, Melpignano A, Tarantini G, Pavone V, Guarini A. Azacitidine in the front-line treatment of therapy-related myeloid neoplasms: a multicenter case series. Anticancer Res 2015; 35:461-466. [PMID: 25550588] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND/AIM A continued increase in the incidence of therapy-related myeloid neoplasms (t-MN) is expected due to the improvement of chemotherapeutic treatments for solid and haematological malignancies. The use of 5-azacytidine (AZA) is emerging in these patients. We, therefore, analyzed the outcome of patients with t-MN ineligible for intensive chemotherapy treated in the front-line with AZA. PATIENTS AND METHODS We retrospectively collected clinical data from consecutive patients with t-MN treated in the front-line with AZA at five Haematology Centers. Response to therapy, overall survival (OS) and safety were considered. RESULTS The overall response rate was of 35.7% with a median OS of 9.6 months. Patients who were heavily pre-treated for their primary malignancy (more than 3 lines of chemotherapy) presented a significant inferior OS (4.9 months). The principal reported toxicity was haematological with severe infections occurring in a minority of patients. Fatigue was the most common extra-haematological toxicity. CONCLUSION New aspects emerged on the management of t-MN. AZA may represent a reasonable choice for patients ineligible for intensive treatment, with the exception of heavily pre-treated patients who presented -anyway- a worse outcome.
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Affiliation(s)
- Carla Minoia
- Haematology Unit, IRCCS National Cancer Research Centre "Giovanni Paolo II", Bari, Italy
| | - Nicola Sgherza
- Haematology Unit, IRCCS National Cancer Research Centre "Giovanni Paolo II", Bari, Italy
| | - Giacomo Loseto
- Haematology Unit, IRCCS National Cancer Research Centre "Giovanni Paolo II", Bari, Italy
| | | | | | | | - Chandrakala Toldo
- Internal Medicine Unit, Hematology department, "S. Chiara di Trento" Hospital, Trento, Italy
| | - Ida Galise
- Registro Tumori Puglia, IRCCS National Cancer Research Centre "Giovanni Paolo II", Bari, Italy
| | | | | | - Vincenzo Pavone
- Haematology Unit, "G. Panico" Hospital, Tricase, Lecce, Italy
| | - Attilio Guarini
- Haematology Unit, IRCCS National Cancer Research Centre "Giovanni Paolo II", Bari, Italy
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Makita S, Maruyama D. [Second primary malignancies after the treatment of multiple myeloma]. Nihon Rinsho 2015; 73:162-166. [PMID: 25626323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Outcome of the patients with multiple myeloma has improved significantly in the last decade, mainly because of the introduction of new agents such as thalidomide, bortezomib and lenalidomide. Improvements in survival among patients with multiple myeloma suggest that the incidence of second primary malignancies (SPMs) may increase in the future. Many factors could affect increasing the risk of SPMs, such as treatment factors, myeloma related factors, host genetic factors, and so on. Especially, previous clinical trials suggested that extended exposure to the melphalan and lenalidomide containing regimens are the important risk factors of SPMs. Although numbers of SPMs are small, for individual patients who develop SPMs, the outcomes are devastating. Therefore, we need to discuss not only the efficacy but also the risks of SPMs associated with the treatment in the patients with multiple myeloma in new agents era.
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47
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MESH Headings
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Breast Neoplasms/drug therapy
- Breast Neoplasms/genetics
- Carcinoma in Situ/drug therapy
- Carcinoma in Situ/genetics
- Carcinoma, Ductal, Breast/drug therapy
- Carcinoma, Ductal, Breast/genetics
- Cyclophosphamide/adverse effects
- Docetaxel
- Epirubicin/adverse effects
- Female
- Fluorouracil/adverse effects
- Genes, BRCA2
- Humans
- Leukemia, Myeloid, Acute/chemically induced
- Leukemia, Myeloid, Acute/genetics
- Middle Aged
- Neoplasm Recurrence, Local/drug therapy
- Neoplasms, Second Primary/chemically induced
- Neoplasms, Second Primary/genetics
- Taxoids/adverse effects
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Affiliation(s)
- Armin Rashidi
- Division of Oncology, Washington University School of Medicine, 660 S. Euclid Ave., Campus Box 8056, St. Louis, MO, 63110, USA,
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48
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Cohen DN, Lumbang WA, Boyd AS, Sosman JA, Zwerner JP. Spindle cell squamous carcinoma during BRAF inhibitor therapy for advanced melanoma: an aggressive secondary neoplasm of undetermined biologic potential. JAMA Dermatol 2014; 150:575-7. [PMID: 24577111 DOI: 10.1001/jamadermatol.2013.7784] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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49
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Bendle M, Pealing J, Papanastasopoulos P, Bower M. Liposomal anthracycline chemotherapy and the risk of second malignancies in patients with Kaposi's sarcoma (KS). Cancer Chemother Pharmacol 2014; 74:611-5. [PMID: 25055936 DOI: 10.1007/s00280-014-2538-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 07/10/2014] [Indexed: 02/04/2023]
Abstract
PURPOSE People living with HIV (PLWH) are at increased risk of cancer, both non-AIDS- and AIDS-defining malignancies (NADM and ADM). Systemic chemotherapy also predisposes to secondary cancers. The potential contribution of systemic liposomal anthracycline chemotherapy (SLAC) to the development of second cancers in PLWH is unknown. METHODS Since 1998, we have treated 495 PLWH and Kaposi's sarcoma (KS) with a stage-stratified approach including 163 who received SLAC as first-line treatment for KS. Subsequent ADM and NADM diagnosed in this population were recorded. RESULTS More patients who received SLAC had T1 stage disease (p < 0.0001) and lower CD4 cell counts (p < 0.0001) in line with the stage-stratified treatment, but there were no significant differences in age (p = 0.29), gender (p = 0.18), prior AIDS-defining illness (p = 0.45), plasma HIV viral load (p = 0.15), or HHV8 viral load (p = 0.39) between the two groups. During a median follow-up of 4.6 years (maximum 15 years) from KS diagnosis, 28 patients developed a second cancer (5 ADM and 23 NADM). The 5-year cumulative risk of second cancer is 5.8 % (95 % CI 3.0-8.6 %), and there is no significant difference in the rate between those treated with SLAC and those not (log rank p = 0.19). Most patients (n = 131) were treated with daunoxome (liposomal daunorubicin) chemotherapy, and there was no significant correlation between risk of second cancer and cumulative dose of daunoxome (p = 0.23). CONCLUSION Although the risk of second cancer after a diagnosis of KS in PLWH is high, systemic liposomal anthracycline chemotherapy does not appear to increase the risk.
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Affiliation(s)
- M Bendle
- Department of Oncology, Chelsea and Westminster Hospital, 369 Fulham Road, London, SW10 9NH, UK
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50
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Schwartz B, Benadjaoud MA, Cléro E, Haddy N, El-Fayech C, Guibout C, Teinturier C, Oberlin O, Veres C, Pacquement H, Munzer M, N'guyen TD, Bondiau PY, Berchery D, Laprie A, Hawkins M, Winter D, Lefkopoulos D, Chavaudra J, Rubino C, Diallo I, Bénichou J, de Vathaire F. Risk of second bone sarcoma following childhood cancer: role of radiation therapy treatment. Radiat Environ Biophys 2014; 53:381-90. [PMID: 24419490 PMCID: PMC3996275 DOI: 10.1007/s00411-013-0510-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Accepted: 12/23/2013] [Indexed: 05/16/2023]
Abstract
Bone sarcoma as a second malignancy is rare but highly fatal. The present knowledge about radiation-absorbed organ dose-response is insufficient to predict the risks induced by radiation therapy techniques. The objective of the present study was to assess the treatment-induced risk for bone sarcoma following a childhood cancer and particularly the related risk of radiotherapy. Therefore, a retrospective cohort of 4,171 survivors of a solid childhood cancer treated between 1942 and 1986 in France and Britain has been followed prospectively. We collected detailed information on treatments received during childhood cancer. Additionally, an innovative methodology has been developed to evaluate the dose-response relationship between bone sarcoma and radiation dose throughout this cohort. The median follow-up was 26 years, and 39 patients had developed bone sarcoma. It was found that the overall incidence was 45-fold higher [standardized incidence ratio 44.8, 95 % confidence interval (CI) 31.0-59.8] than expected from the general population, and the absolute excess risk was 35.1 per 100,000 person-years (95 % CI 24.0-47.1). The risk of bone sarcoma increased slowly up to a cumulative radiation organ absorbed dose of 15 Gy [hazard ratio (HR) = 8.2, 95 % CI 1.6-42.9] and then strongly increased for higher radiation doses (HR for 30 Gy or more 117.9, 95 % CI 36.5-380.6), compared with patients not treated with radiotherapy. A linear model with an excess relative risk per Gy of 1.77 (95 % CI 0.6213-5.935) provided a close fit to the data. These findings have important therapeutic implications: Lowering the radiation dose to the bones should reduce the incidence of secondary bone sarcomas. Other therapeutic solutions should be preferred to radiotherapy in bone sarcoma-sensitive areas.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Bone Neoplasms/chemically induced
- Bone Neoplasms/epidemiology
- Bone Neoplasms/etiology
- Child
- Child, Preschool
- Cohort Studies
- Dose-Response Relationship, Radiation
- Female
- Humans
- Infant
- Infant, Newborn
- Male
- Middle Aged
- Models, Statistical
- Neoplasms, Radiation-Induced/chemically induced
- Neoplasms, Radiation-Induced/epidemiology
- Neoplasms, Radiation-Induced/etiology
- Neoplasms, Second Primary/chemically induced
- Neoplasms, Second Primary/epidemiology
- Neoplasms, Second Primary/etiology
- Radiotherapy/adverse effects
- Radiotherapy Dosage
- Risk
- Sarcoma/chemically induced
- Sarcoma/epidemiology
- Sarcoma/etiology
- Survivors
- Young Adult
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Affiliation(s)
- Boris Schwartz
- Radiation Epidemiology Group, Unit 1018 INSERM, Institut Gustave Roussy, Rue Camille Desmoulins, 94805, Villejuif, France,
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