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Pancreatic Neoplasms: HELP
Articles by Mary Frances Mulcahy
Based on 10 articles published since 2010
(Why 10 articles?)
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Between 2010 and 2020, M. Mulcahy wrote the following 10 articles about Pancreatic Neoplasms.
 
+ Citations + Abstracts
1 Review Therapy of locally advanced pancreatic adenocarcinoma: unresectable and borderline patients. 2011

Kircher, Sheetal M / Krantz, Seth B / Nimeiri, Halla S / Mulcahy, Mary F / Munshi, Hidayatullah G / Benson, Al B. ·Division of Hematology/Oncology, Northwestern University, Chicago, IL 60611, USA. ·Expert Rev Anticancer Ther · Pubmed #21999129.

ABSTRACT: Systemic chemotherapy for advanced pancreatic cancer is commonly used in practice; however, the optimal strategy for both neoadjuvant and adjuvant therapy in this disease remains controversial. A particular challenge remains in patients who are considered to be locally advanced and either unresectable or borderline resectable. Offering optimal neoadjuvant therapy to this group of patients may give them the opportunity to have a curative surgical approach. This article will discuss the potential role of neoadjuvant therapy in borderline, potentially resectable pancreatic cancer. It will also discuss areas of interest in potential targets as the biology of pancreatic adenocarcinoma is further explored.

2 Review The effects of bevacizumab on postoperative complications in patients undergoing colorectal and pancreatic cancer resection. 2010

Cheon, E C / Small, W / Strouch, M J / Krantz, S B / Rademaker, A / Mulcahy, M F / Benson, A B / Bentrem, D J / Talamonti, M S. ·Department of Surgery, Mount Sinai Hospital, University of Illinois at Chicago, Chicago, Illinois, USA. ·J Surg Oncol · Pubmed #20812264.

ABSTRACT: Bevacizumab (Avastin™; rhuMab VEGF), a monoclonal antibody targeting vascular endothelial growth factor (VEGF), has seen increased use in the perioperative treatment of colorectal and pancreatic cancer. Little is known, however, regarding its impact on surgical outcomes in patients undergoing resection. The objective of this review was to examine if the addition of bevacizumab to existing neoadjuvant regimens increases morbidity after cancer resection.

3 Clinical Trial Addition of algenpantucel-L immunotherapy to standard adjuvant therapy for pancreatic cancer: a phase 2 study. 2013

Hardacre, Jeffrey M / Mulcahy, Mary / Small, William / Talamonti, Mark / Obel, Jennifer / Krishnamurthi, Smitha / Rocha-Lima, Caio S / Safran, Howard / Lenz, Heinz-Joseph / Chiorean, E Gabriela. ·Department of Surgery, University Hospitals Seidman Cancer Center and Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH 44106, USA. jeffrey.hardacre@UHhospitals.org ·J Gastrointest Surg · Pubmed #23229886.

ABSTRACT: BACKGROUND: Despite continued investigation, limited progress has been made in the adjuvant treatment of resected pancreatic cancer. Novel or targeted therapies are needed. METHODS: Multi-institutional, open-label, dose-finding, phase 2 trial evaluating the use of algenpantucel-L (NewLink Genetics Corporation, Ames, IA) immunotherapy in addition to chemotherapy and chemoradiotherapy in the adjuvant setting for resected pancreatic cancer (ClinicalTrials.gov identifier, NCT00569387). The primary outcome was 12-month disease-free survival. Secondary outcomes included overall survival and toxicity. RESULTS: Seventy patients were treated with gemcitabine and 5-fluorouracil-based chemoradiotherapy as well as algenpantucel-L (mean 12 doses, range 1-14). After a median follow-up of 21 months, the 12-month disease-free survival was 62 %, and the 12-month overall survival was 86 %. The most common adverse events were injection site pain and induration. CONCLUSIONS: The addition of algenpantucel-L to standard adjuvant therapy for resected pancreatic cancer may improve survival. A multi-institutional, phase 3 study is ongoing (ClinicalTrials.gov identifier, NCT01072981).

4 Clinical Trial Change in the growth rate of localized pancreatic adenocarcinoma in response to gemcitabine, bevacizumab, and radiation therapy on MDCT. 2011

Rezai, Pedram / Yaghmai, Vahid / Tochetto, Sandra M / Galizia, Mauricio S / Miller, Frank H / Mulcahy, Mary F / Small, William. ·Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA. ·Int J Radiat Oncol Biol Phys · Pubmed #21570199.

ABSTRACT: PURPOSE: To depict treatment response to chemoradiotherapy by comparing tumor growth rate between treated and untreated patients and to compare depicted response with objective response according to the Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 guideline. METHODS AND MATERIALS: This Health Insurance Portability and Accountability Act-compliant, retrospective study was approved by the institutional review board. Volume doubling time (DT) of histologically confirmed locally advanced pancreatic adenocarcinoma was calculated in 16 patients treated with chemoradiotherapy and 10 untreated patients by incorporating interscan interval (Δt) and tumor volume at baseline (V0) and follow-up (V1) obtained by semiautomated segmentation into the following equation: DT = Δt · log 2/log (V1/V0). Reciprocal of doubling time (RDT), which is the linear representation of tumor growth rate, was calculated by use of the following equation: RDT = 365/DT. The lowest RDT value of 2.42 in untreated patients was considered as the cutoff value for depiction of treatment response. Depicted response rate was defined as the proportion of patients with an RDT value of less than 2.42. Depicted response was compared with objective response according to the RECIST 1.1 guideline. The significance level was set at p < 0.05. RESULTS: There was a significant difference in mean RDT between treated (range, -7.12 to 3.27; mean, -1.27; median, -1.30) and untreated (range, 2.42 to 10.74; mean, 5.33; median, 4.26) patients (p < 0.05). Reciprocal of doubling time was less than 2.42 in 14 treated patients, which corresponded to a depicted response rate of 87.50% as opposed to the objective response rate of 18.75% according to the RECIST 1.1 guideline (p < 0.05) and carbohydrate antigen 19-9 response rate of 62.50% (p > 0.05). Carbohydrate antigen 19-9 response was concordant with RDT and RECIST response in 12 patients (75.00%) (κ, 0.38) and 9 patients (56.25%) (κ, 0.24), respectively. CONCLUSIONS: There was a significant difference between depicted response according to RDT and objective response according to RECIST. Reciprocal of doubling time might serve as a valuable biomarker for evaluation of treatment response when depiction of small changes in tumor size is concerned.

5 Clinical Trial Phase II trial of full-dose gemcitabine and bevacizumab in combination with attenuated three-dimensional conformal radiotherapy in patients with localized pancreatic cancer. 2011

Small, William / Mulcahy, Mary F / Rademaker, Alfred / Bentrem, David J / Benson, Al B / Weitner, Bing Bing / Talamonti, Mark S. ·Department of Radiation Oncology, Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois 60611, USA. wsmall@nmff.org ·Int J Radiat Oncol Biol Phys · Pubmed #20598452.

ABSTRACT: PURPOSE: To evaluate response rate, survival, and toxicity in patients with nonmetastatic pancreatic cancer treated with gemcitabine, bevacizumab, and radiotherapy. METHODS AND MATERIALS: Patients received three cycles of therapy over 10 weeks. In total, treatment consisted of intravenous (IV) gemcitabine, 1,000 mg/m(2), every 1 to 2 weeks (7 doses), IV bevacizumab, 10 mg/kg every 2 weeks (5 doses), and 36 Gy of radiotherapy (2.4-Gy fractions during cycle two). Response was assessed by cross-sectional imaging and carbohydrate antigen 19-9 (CA 19-9) levels. Patients with resectable tumors underwent surgery 6 to 8 weeks after the last dose of bevacizumab. Maintenance gemcitabine and bevacizumab doses were delivered to patients who had unresected tumors and no progression. RESULTS: Twenty-eight of the 32 enrolled patients completed all three cycles. The median follow-up was 11.07 months. Most grade 3 or 4 toxicities occurred in the initial treatment phase; the most frequent toxicities were leukopenia (21%), neutropenia (17%), and nausea (17%). At week 10, 1 patient (4%) had a complete response, 2 patients (7%) had partial responses, 21 patients (75%) had stable disease, and 4 patients (14%) had progressive disease. The median pretreatment and posttreatment CA 19-9 levels (25 patients) were 184.3 and 57.9 U/ml, respectively (p = 0.0006). One of 10 patients proceeding to surgery experienced a major complication. Two of 6 patients undergoing resection had complete pathologic responses. The median progression-free and overall survival durations were 9.9 months and 11.8 months, respectively. CONCLUSIONS: The combination of full-dose gemcitabine, bevacizumab, and radiotherapy was active and was not associated with a high rate of major surgical complications.

6 Clinical Trial Gemcitabine plus bevacizumab compared with gemcitabine plus placebo in patients with advanced pancreatic cancer: phase III trial of the Cancer and Leukemia Group B (CALGB 80303). 2010

Kindler, Hedy Lee / Niedzwiecki, Donna / Hollis, Donna / Sutherland, Susan / Schrag, Deborah / Hurwitz, Herbert / Innocenti, Federico / Mulcahy, Mary Frances / O'Reilly, Eileen / Wozniak, Timothy F / Picus, Joel / Bhargava, Pankaj / Mayer, Robert J / Schilsky, Richard L / Goldberg, Richard M. ·University of Chicago Cancer Research Center, Chicago, IL 60637-1470, USA. hkindler@medicine.bsd.uchicago.edu ·J Clin Oncol · Pubmed #20606091.

ABSTRACT: PURPOSE: The combination of gemcitabine plus bevacizumab produced a 21% response rate and a median survival of 8.8 months in a multicenter phase II trial in patients with metastatic pancreatic cancer. These encouraging data led Cancer and Leukemia Group B (CALGB) to conduct a double-blind, placebo-controlled, randomized phase III trial of gemcitabine/bevacizumab versus gemcitabine/placebo in advanced pancreatic cancer patients. PATIENTS AND METHODS: Eligible patients had no prior therapy for advanced disease, Eastern Cooperative Oncology Group (ECOG) performance status 0 to 2, no tumor invasion of adjacent organs, and no increased bleeding risk. The primary end point was overall survival. Patients were stratified by performance status, extent of disease, and prior radiotherapy. Patients received gemcitabine at 1,000 mg/m(2) over 30 minutes on days 1, 8, and 15 every 28 days and bevacizumab at 10 mg/kg or placebo on days 1 and 15 every 28 days. RESULTS: Between June 2004 and April 2006, 602 patients were enrolled onto the study and 535 were treated. Median overall survival was 5.8 months for gemcitabine/bevacizumab and 5.9 months for gemcitabine/placebo (P = .95). Median progression-free survival was 3.8 and 2.9 months, respectively (P = .07). Overall response rates were 13% and 10%, respectively. Patients with a performance status of 0, 1, and 2 survived a median of 7.9, 4.8, and 2.4 months, respectively. The only statistically significant differences in grades 3 and 4 toxicity occurred for hypertension (10% v 3%; P < .001) and proteinuria (5% v 1%; P = .002); venous thrombosis grade > or = 3 was equivalent in both arms (14% and 15%, respectively). CONCLUSION: The addition of bevacizumab to gemcitabine does not improve survival in advanced pancreatic cancer patients.

7 Article Ipilimumab and Gemcitabine for Advanced Pancreatic Cancer: A Phase Ib Study. 2020

Kamath, Suneel D / Kalyan, Aparna / Kircher, Sheetal / Nimeiri, Halla / Fought, Angela J / Benson, Al / Mulcahy, Mary. ·Division of Hematology and Oncology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA. · Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois, USA. · Developmental Therapeutics Program, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA. · Division of Biostatistics, Department of Preventative Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA. ·Oncologist · Pubmed #31740568.

ABSTRACT: BACKGROUND: Pancreatic ductal adenocarcinoma (PDAC) remains resistant to chemotherapy and immunotherapy individually because of its desmoplastic stroma and immunosuppressive tumor microenvironment. Synergizing cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4) immune checkpoint blockade with chemotherapy could overcome these barriers. Here we present results of a phase Ib trial combining ipilimumab and gemcitabine in advanced PDAC. MATERIALS AND METHODS: This was a single-institution study with a 3 + 3 dose-escalation design. The primary objective was to determine the maximum tolerated dose (MTD). Secondary objectives included determining the toxicity profile, objective response rate (ORR), median progression-free survival (PFS), and overall survival (OS). RESULTS: Twenty-one patients were enrolled, 13 during dose escalation and 8 at the MTD. The median age was 66 years, 62% were female, 95% had stage IV disease, and 67% had received at least one prior line of therapy. The primary objective to establish the MTD was achieved at doses of ipilimumab 3 mg/kg and gemcitabine 1,000 mg/m CONCLUSION: Gemcitabine and ipilimumab is a safe and tolerable regimen for PDAC with a similar response rate to gemcitabine alone. As in other immunotherapy trials, responses were relatively durable in this study. IMPLICATIONS FOR PRACTICE: Gemcitabine and ipilimumab is a safe and feasible regimen for treating advanced pancreatic cancer. Although one patient in this study had a relatively durable response of nearly 20 months, adding ipilimumab to gemcitabine does not appear to be more effective than gemcitabine alone in advanced pancreatic cancer.

8 Article Hypofractionated Conformal Radiotherapy with Concurrent Full-Dose Gemcitabine Versus Standard Fractionation Radiotherapy with Concurrent Fluorouracil for Unresectable Pancreatic Cancer: a Multi-Institution Experience. 2016

Rakhra, Sunpreet / Strauss, Jonathan B / Robertson, John / McGinn, Cornelius J / Kim, Thomas / Huang, Jiayi / Blake, Andrew / Helenowski, Irene / Hayes, John P / Mulcahy, Mary / Small, William. ·Department of Radiation Oncology, The Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA. · Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI, USA. · Department of Radiation Oncology, Maine Medical Center, Portland, ME, USA. · Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA. · Northwestern University Cancer Biostatistics Core, Chicago, IL, USA. · Division of Hematology/Oncology, The Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA. · Department of Radiation Oncology, Cardinal Bernardin Cancer Center, Stritch School of Medicine, Loyola University Chicago, 2160 S 1st Ave Maguire Center, Rm 2932, Maywood, IL, 60153, USA. wmsmall@lumc.edu. ·J Gastrointest Cancer · Pubmed #27112332.

ABSTRACT: PURPOSE/OBJECTIVE(S): The purpose of this study was to compare oncologic outcomes and toxicity profile of hypofractionated conformal radiotherapy (RT) with concurrent full-dose gemcitabine versus standard fractionation RT with concurrent 5-fluorouracil (5-FU) in the treatment of unresectable non-metastatic pancreatic cancer. MATERIALS/METHODS: Patients with unresectable non-metastatic adenocarcinoma of the pancreas treated at three institutions were included. All patients were treated with chemoradiotherapy (CRT) consisting of either hypofractionated RT to the gross disease concurrent with a full-dose gemcitabine-based regimen versus standard fractionation RT to the tumor and elective nodes concurrent with 5-FU. End points included rates of gastrointestinal (GI) toxicities, overall survival (OS), and distant metastasis free survival (DMFS). RESULTS: From January 1999 to December 2009, 170 patients were identified (118 RT/gemcitabine, 52 RT/5-FU). There were no differences in demographic or clinical factors. Acute GI toxicities (grades <3 versus ≥3) were 82.2 and 17.8 %, respectively, for patients treated with RT/gemcitabine and 78.9 and 21.2 % for those treated with RT/5-FU (p = 0.67). Late GI toxicities (grades <3 versus ≥3) were 88.1 and 11.9 %, respectively, for RT/gemcitabine and 80.8 and 19.2 % for RT/5-FU (p = 0.23). OS for RT/gemcitabine and RT/5-FU were 52 versus 36 % at 1 year and 14 versus 6 % at 2 years favoring the RT/gemcitabine group (p = 0.02). DMFS at 1 and 2 years for RT/gemcitabine were 41 and 11 % versus 24 and 4 % for RT/5-FU (p = 0.02). CONCLUSIONS: RT/gemcitabine was equivalent in toxicity to RT/5-FU but was associated with superior OS and DMFS. When RT is used in the treatment of unresectable pancreatic cancer, hypofractionated conformal RT with concurrent full-dose gemcitabine may be the preferred approach.

9 Article Quantitative Sensory Testing at Baseline and During Cycle 1 Oxaliplatin Infusion Detects Subclinical Peripheral Neuropathy and Predicts Clinically Overt Chronic Neuropathy in Gastrointestinal Malignancies. 2016

Reddy, Sangeetha M / Vergo, Maxwell T / Paice, Judith A / Kwon, Nancy / Helenowski, Irene B / Benson, Al B / Mulcahy, Mary F / Nimeiri, Halla S / Harden, Robert N. ·Division of Hematology/Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX. Electronic address: smreddy1@mdanderson.org. · Geisel School of Medicine, Section of Palliative Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH. · Division of Hematology/Oncology, Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL. · Department of Biobehavioral Sciences, Columbia University, New York, NY. · Department of Preventive Medicine, Northwestern University, Chicago, IL. · Center for Pain Studies, Rehabilitation Institute of Chicago and Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL. ·Clin Colorectal Cancer · Pubmed #26337211.

ABSTRACT: PURPOSE: Oxaliplatin neurotoxicity has a spectrum of manifestations from an often reversible acute neurotoxicity to a more irreversible "stocking and glove" chronic neuropathy that is associated with high morbidity. Quantitative sensory testing (QST) is a noninvasive psychometric testing method that can potentially be used in the clinic setting to measure subclinical neurologic changes early on to identify patients that will experience chronic oxaliplatin-induced peripheral neuropathy at 1 year. PATIENTS AND METHODS: Thirty patients with gastrointestinal malignancies who were receiving oxaliplatin were recruited. QST and patient-reported outcomes were assessed at baseline; during infusion cycles 1, 2, 4, and 6; and at 1 year. National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE), version 4.0, chronic neuropathy scores were assessed at the 1-year time point. The variables at each time point were evaluated for prediction of 1-year chronic neuropathy scores. RESULTS: We found that patients with preexisting subclinical neuropathy were more likely to experience grades 2 and 3 chronic neuropathy than were those who did not have this condition (heat detection threshold, Spearman correlation coefficient (rs) = 0.39; P = .037; pellet retrieval time, rs = 0.47; P = .024). Patients in whom thermal and cutaneous sensory deficits developed with cycle 1 infusion were also more likely to experience grades 2 and 3 neuropathy at 1 year (cold detection threshold, rs = 0.50; P = .007; heat detection threshold, rs = 0.39; P = .042; cutaneous detection threshold, rs = 0.42; P = .043). CONCLUSION: QST provides a noninvasive, commercially available, and feasible clinical test to select patients, even before oxaliplatin treatment, who are likely to experience moderate to severe chronic peripheral neuropathy.

10 Article 25-Hydroxyvitamin D levels and survival in advanced pancreatic cancer: findings from CALGB 80303 (Alliance). 2014

Van Loon, Katherine / Owzar, Kouros / Jiang, Chen / Kindler, Hedy L / Mulcahy, Mary F / Niedzwiecki, Donna / O'Reilly, Eileen M / Fuchs, Charles / Innocenti, Federico / Venook, Alan P / Anonymous5520802. ·Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA (KVL, APV); Department of Biostatistics and Bioinformatics, Duke University, Durham, NC (KO, DN); Alliance Statistics and Data Center, Duke University, Durham, NC (KO, CJ, DN); The University of Chicago Medical Center, Chicago, IL (HLK); Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL (MFM); Memorial Sloan-Kettering Cancer Center, New York, NY (EMO); Dana-Farber Cancer Institute, Boston, MA (CF); University of North Carolina Institute for Pharmacogenomics and Individualized Therapy, Eshelman School of Pharmacy, School of Medicine, Lineberger Comprehensive Cancer Center, Chapel Hill, NC (FI) katherine.vanloon@ucsf.edu. · Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA (KVL, APV); Department of Biostatistics and Bioinformatics, Duke University, Durham, NC (KO, DN); Alliance Statistics and Data Center, Duke University, Durham, NC (KO, CJ, DN); The University of Chicago Medical Center, Chicago, IL (HLK); Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL (MFM); Memorial Sloan-Kettering Cancer Center, New York, NY (EMO); Dana-Farber Cancer Institute, Boston, MA (CF); University of North Carolina Institute for Pharmacogenomics and Individualized Therapy, Eshelman School of Pharmacy, School of Medicine, Lineberger Comprehensive Cancer Center, Chapel Hill, NC (FI). ·J Natl Cancer Inst · Pubmed #25099612.

ABSTRACT: BACKGROUND: Data from animal and cell-line models suggest that vitamin D metabolism plays an important role in pancreatic tumor behavior. Although vitamin D deficiency has been implicated in numerous cancers, the vitamin D status of patients with advanced pancreatic cancer and the effect of baseline vitamin D levels on survival are unknown. METHODS: Participants in this correlative study (CALGB 151006) were enrolled in CALGB 80303, which was a randomized trial of patients with advanced pancreatic cancer that demonstrated no difference in overall survival (OS) among patients treated with gemcitabine plus placebo vs gemcitabine plus bevacizumab. We measured baseline serum 25-hydroxyvitamin D (25[OH]D) levels and examined associations between baseline 25(OH)D levels and progression-free survival and OS using the Cox rank score test. All statistical tests were two-sided. RESULTS: Of 256 patients with available serum, the median 25(OH)D level was 21.7ng/mL (range 4 to 77). 44.5% of patients were vitamin D deficient (25[OH]D <20ng/mL), and 32.4% were insufficient (25[OH]D ≥20 and <30ng/mL). 25(OH)D levels were lower in black patients compared with white patients, and patients of other/undisclosed race (10.7 vs 22.4 vs 20.9ng/mL, P < .001). Baseline 25(OH)D levels were not associated with PFS (HR = 1.00, 95% CI = 0.99 to 1.01, P = .60) or OS (HR = 1.00, 95% CI = 0.99 to 1.01, P = .95). CONCLUSION: Vitamin D deficiency was highly prevalent among patients with a new diagnosis of advanced pancreatic cancer. Black patients had statistically significantly lower 25(OH)D levels than white patients. In this cohort of patients with advanced pancreatic cancer receiving gemcitabine-based chemotherapy, baseline 25(OH)D levels were not associated with PFS or OS.