Neoplasms

Blood and Lymph Conditions

Immune System Diseases

All Conditions

Infections

Rare Diseases

Lymphoma

Leukemia

Leukemia, T-Cell

Virus Diseases

Leukemia-Lymphoma, Adult T-Cell

Neoplasms by Histologic Type

Lymphoproliferative Disorders

Lymphatic Diseases

Immunoproliferative Disorders

Hematologic Diseases

Leukemia, Lymphoid

Lymphosarcoma

Adult T-cell Leukemia/lymphoma

Human T-cell Leukemia Virus Type 1

Leukemia, T-cell, Chronic

This study will identify chemical and protein markers in the blood of people who carry the human T-lymphotropic virus type I (HTLV-I), a virus associated with various pathologies, including an increased risk in adults of a rare and aggressive cancer called adult T cell leukemia/lymphoma (ATL). The study will also examine differences in these markers before and after the onset of ATL.

ATL has been reported in every area where HTLV-1 is common, including the Caribbean and parts of Japan, West Africa, the Middle East, South America, and Pacific Melanesia. Risk factors for the disease are largely unknown and seem to vary among those affected in different endemic regions. People who acquire the infection early in life are thought to be at higher risk than those who are infected later. In Japan, men seem to be at greater risk than women, but the same is not evident among the black population in the Caribbean and Brazil.

Findings from this study will increase understanding of the cause of ATL and identify differences in tumor characteristics and the course of disease across geographical areas.

Study subjects are drawn from among participants in eight studies of HTLV-1 carriers, including the 1) Jamaica Mother-Infant Cohort Study, 2) Jamaica Family Study, 3) Jamaica Food Handlers Study, 4) Miyazaki Cohort Study in Japan, 5) Nagasaki Cohort Study in Japan, 6) Japan Public Health Center-based Prospective Study on Cancer and Cardiovascular Disease, 7) HTLV Outcome Studies in the United States, and 8) GIPH Cohort Study in Brazil.

Stored blood samples previously collected from patients in the above studies who did and did not develop ATL will be analyzed for immunologic and genetic factors.

To characterize molecular markers for risk of adult T-cell leukemia/lymphoma (ATL), whose incidence rate differs greatly across geographic areas, we propose to examine the prevalence and level of viral and host immune response markers as well as the protein expression pattern of 57 subjects who subsequently developed ATL and 171 matched control subjects who participated in various prospective studies of carriers of human T-lymphotropic virus type I (HTLV-I). Informative markers to be studied include provirus load, HTLV-I antibody titer, anti-Tax protein, clonality of HTLV-I infected lymphocytes (viral markers), total immunoglobulin E (IgE), C-reactive protein (CRP), neopterin, soluble CD30, soluble interleukin-2 receptor (sIL2-R), EBV antibody profile (host immune markers), and proteomics. These markers were selected based on the measurability on the majority of specimens, availability of validated assays, relevance to the biology of T-cell malignancies, and has been used in a cross-sectional comparison of HTLV-I carriers and non-carriers from Japan and the Caribbean. We will utilize central laboratory and validated, standard assays for all specimens. The results, unlinked to personal identifiers, will be analyzed using generalized estimating equation. The findings will further our understanding of the etiology of ATL, and of differences in natural history of HTLV-I infection across geographic areas.

While pursuing the same theme of trying to identify host and viral markers associated with ATL, the unique aspect of this proposal is to pool ATL cases, an extremely rare malignancy, from multiple epidemiologic studies through international collaboration, in order to achieve adequate statistical power and to perform valid comparison of tumor characteristics across geographic areas.

Study of Adult T-Cell Leukemia/Lymphoma Among Carriers of HTLV-1

Prediagnostic Markers of Adult T-Cell Leukemia/Lymphoma Among Carriers of Human T-Lymphoma Virus Type I: A Collaborative Study

National Cancer Institute (NCI)

Urinary Tract, Sexual Organs, and Pregnancy Conditions

Gland and Hormone Related Diseases

Symptoms and General Pathology

Ovarian Neoplasms

Carcinoma, Ovarian Epithelial

Neoplastic Cells, Circulating

Carcinoma

Endocrine Gland Neoplasms

Ovarian Diseases

Adnexal Diseases

Genital Diseases, Female

Genital Diseases

Urogenital Diseases

Female Urogenital Diseases

Pregnancy Complications

Female Urogenital Diseases and Pregnancy Complications

Genital Neoplasms, Female

Urogenital Neoplasms

Endocrine System Diseases

Gonadal Disorders

Neoplasms, Glandular and Epithelial

Ovarian Cancer

Ovarian Epithelial Cancer

Women diagnosed with a pelvic mass (defined as a simple, complex or a solid ovarian cyst / pelvic mass) who are scheduled for a laparotomy or laparoscopy for removal of the pelvic mass. Must have a pelvic imaging study performed within 60 days prior to surgery and a research blood draw within 60 days prior to surgery.

Within 60 days prior to the pelvic mass evaluation procedure, each subject must have a pelvic imaging study (e.g. ultrasound, CT scan, MRI, etc.) conducted and read to visualize the pelvic mass according to the current standard of care. Results of the pelvic imaging study(ies) will be recorded.

Pelvic imaging

Within 60 days prior to, or on the day of the pelvic mass surgery, collect up to 35mL of whole blood into one 5mL SST tube, which must be drawn first, followed by three separate 10mL EDTA tubes.

Blood draw

A laparotomy or laparoscopic procedure will be performed by a qualified individual for excision of the pelvic mass. Representative tissue samples will be taken from the excised pelvic mass and evaluated in pathology departments within each institution according to institutional guidelines. Results from the histopathological evaluation will be recorded, including the final diagnosis along with histological sub-type, and if available, stage and grade of cancer where disease is identified.

laparotomy or laparoscopy

Shane Booth, Ph.D.

ANGLE has developed the Parsortix™ Cell Separation System (Parsortix), an automated system capable of harvesting rare circulating cells for analysis from a sample of peripheral blood based on cellular size and deformability. In a small pilot study, scientists at the Medical University of Vienna demonstrated that measurement of a combination of mRNA markers extracted from CTCs captured using the Parsortix system could be used to identify women with ovarian cancer. This study is designed to provide specimens for optimization of an assay using clinical and biomarker information (i.e. demographics, imaging results and/or serum tumor markers) in combination with mRNA extracted from rare cells in the blood of women presenting with a pelvic mass for the detection of malignancy.

Primary Objective: Optimization of an assay for the differentiation of women with benign pelvic masses from those with malignant pelvic masses using mRNA markers extracted from CTCs isolated from whole blood. Multiple serum tumor markers and mRNA markers will be measured, and the results will be compared to the actual clinical diagnosis made for each patient through other recognized methods (e.g. histopathology). The blood samples collected in the course of this study will be used to finalize the selection of mRNA and/or serum tumor markers to be evaluated in future prospective studies.

Exploratory Objective: Use statistical modeling to determine the need for and/or preliminary design of a mathematical algorithm to combine the multiple serum tumor and/or mRNA markers for estimation of the risk of ovarian cancer.

This study is exploratory in nature and is designed to be hypothesis generating to support the design of future studies. A total of 200 women diagnosed with a pelvic mass (defined as a simple, complex or a solid ovarian cyst / pelvic mass) who are scheduled for a laparotomy or laparoscopy for removal of the pelvic mass will be enrolled for evaluation of the primary and exploratory endpoints. An initial evaluation of the data will be conducted after identification of 15 evaluable subjects with histopathologically confirmed ovarian cancer. It is estimated that 50 - 100 subjects will be required to obtain a minimum of 15 evaluable subjects with histopathologically confirmed ovarian cancer. The remainder of the women enrolled (expected to be \~100 - 150 subjects) will be used to verify the findings from the initial evaluation (i.e. correlation of the markers with the absence or presence of malignancy) and to refine the assay/algorithm.

Within 60 days prior to surgery, each subject must have a pelvic imaging study (e.g. ultrasound, CT scan, MRI, etc.) conducted and read to visualize the pelvic mass according to the current standard of care. Results of the pelvic imaging study(ies) will be recorded.

Within 60 days prior to, or on the day of the pelvic mass surgery, collect up to 35mL of peripheral blood into one 5mL SST tube, which must be drawn first, followed by three separate 10mL EDTA tubes. Serum from SST tube will be prepared at the local study center and used for protein biomarker testing. The EDTA tubes will be shipped to the Medical University of Vienna, where the blood will be pooled and equal volumes processed using two different separation methods on the Parsortix™ system to capture and harvest rare cells. The harvested material from the EDTA tubes will be lysed, and total RNA will be extracted from the cell lysate for evaluation of multiple gene targets using quantitative PCR (qPCR).

Laparotomy or laparoscopy for removal of the pelvic mass will be performed by a qualified individual. Tissue samples will be sent to the local pathology department for histological examination in accordance with standard institutional practices. Results of the histopathological evaluation will be recorded, including the final diagnosis along with histological sub-type, and if available, stage and grade of ovarian cancer where disease is identified.

Subjects will be considered negative for ovarian cancer:

* if the subject undergoes surgery and no mass is identified, or;
* if the histopathological findings are negative for cancer (i.e. benign conditions).

Subjects will be considered positive for ovarian cancer:

* if the histological examination of the tissue taken at the time of surgery confirms the presence of ovarian, primary peritoneal and/or fallopian tube cancers.

For the purposes of enrollment, subjects diagnosed with a malignancy other than an ovarian cancer as well as those diagnosed with low malignant potential (LMP) / borderline tumors will not be counted as an ovarian cancer. However, two separate analyses of the final study data will be conducted: one where subjects diagnosed with other cancers are excluded from the analysis of the primary endpoint and the subjects diagnosed with LMP / borderline tumors are classified as being negative for malignancy, and a second where subjects diagnosed with other cancers and those diagnosed with LMP / borderline tumors are classified as being positive for malignancy.

Demographical and clinical data may be summarized using descriptive statistics. Continuous variables may be summarized using the number of observations, mean, standard deviation, coefficient of variation, median, and range as appropriate. Categorical values may be summarized using the number of observations and percentages as appropriate.

The association of the markers (i.e. serum protein markers and mRNA markers) with the histopathological diagnosis will be assessed using appropriate statistical methods (e.g., logistic regression, analysis of variance \[ANOVA\], etc.), depending on the endpoints. Analyses may be performed within and between various histopathological diagnosis sub-groups. Other clinical covariates (such as imaging results and subject demographics) may also be included in the modeling.

An initial evaluation of the correlation of the markers with the histopathological diagnosis will be performed after the identification of 15 subjects with histopathologically verified ovarian cancer. The final cohort of patients will be used to verify the findings from the initial evaluation (i.e. correlation of the markers with the absence or presence of malignancy) and to refine the assay/algorithm. Bootstrap analyses may be utilized on the entire set of 200 subjects to finalize an assay/algorithm for further study.

All excess components (i.e. serum, plasma, RNA, DNA, cells, etc.) generated from the peripheral blood samples collected for research testing under this study be stored frozen at the Medical University of Vienna for up to 10 years for possible use in future research, including but not limited to, serum biomarker analyses, genomic evaluations and genetic studies pertaining to cancer and other disease processes.

Evaluation of Multiple Biomarkers to Estimate Risk of Ovarian Cancer in Patients With a Pelvic Mass.

ANG-001 Pelvic Mass Training Study: Evaluation of Multiple Circulating Tumor Cell-derived RNA Markers to Estimate Risk of Ovarian Cancer in Patients Presenting With a Pelvic Mass.

Tissue samples taken from the pelvic mass will be evaluated in the local institutional pathology department according to institutional guidelines. Results from the histopathological evaluation, including the final diagnosis (i.e. benign, malignant, etc.), histopathology description, and, if malignant, clinical or surgical staging and tumor subtype, will be recorded.

Blood from EDTA tubes will be pooled and processed on the Parsortix System to capture and harvest rare cells. The captured rare cells will be eluted (harvested) and lysed, and total RNA will be extracted from the cell lysate for evaluation of multiple gene targets using quantitative PCR (qPCR).

Serum from SST tube will be used for protein biomarker testing.

Medical University of Vienna

Charite University, Berlin, Germany

Vivantes Netzwerk für Gesundheit GmbH

Angle plc

Women diagnosed with a pelvic mass (ovarian, uterine, retroperitoneal, etc.) who are scheduled for an imaging guided biopsy, surgical biopsy or surgical excision for evaluation of their pelvic mass. Must have a pelvic imaging study performed within 60 days prior to surgery and a research blood draw within 30 days prior to surgery.

Within 30 days prior to, or on the day of the pelvic mass evaluation procedure, collect up to 35mL of whole blood into one 5mL SST tube, which must be drawn first, followed by three separate 10mL EDTA tubes.

Imaging guided biopsy, surgical biopsy or surgical excision for evaluation of the pelvic mass will be performed by a qualified individual. Tissue samples will be sent to the local pathology department for histological examination in accordance with standard institutional practices. Results of the histopathological evaluation will be recorded, including the final diagnosis along with histological sub-type, and if available, stage and grade of cancer where disease is identified.

Imaging guided biopsy, surgical biopsy or surgical excision

Richard G Moore, MD

ANGLE has developed the Parsortix™ Cell Separation System (Parsortix), an automated system capable of harvesting rare circulating cells for analysis from a sample of peripheral blood based on cellular size and deformability. In a small pilot study, scientists at the Medical University of Vienna demonstrated that measurement of a combination of mRNA markers extracted from CTCs captured using the Parsortix system could be used to identify women with ovarian cancer. This study is designed to provide specimens for optimization of an assay using clinical and biomarker information (i.e. demographics, imaging results and/or serum tumor markers) in combination with mRNA extracted from rare cells in the blood of women presenting with a pelvic mass for the detection of malignancy.

Primary Objective: Optimization of an assay/algorithm for the differentiation of women with benign pelvic masses from those with malignant pelvic masses using clinical and biomarker information (i.e. demographics, imaging results and/or serum tumor markers) in combination with mRNA markers extracted from rare cells isolated from whole blood. Multiple serum protein markers and mRNA markers will be measured, and the results will be compared to the actual clinical diagnosis made for each subject through other recognized methods (i.e. histopathology). Statistical modeling will be used to combine the clinical information, serum protein markers and/or mRNA markers for estimation of the risk of malignancy. If successful, the resulting risk algorithm will be evaluated in future, appropriately powered, prospective studies.

Exploratory Objective: Use statistical modeling to determine the need for and/or preliminary design of a mathematical algorithm to combine the clinical information, serum protein markers and/or mRNA markers for estimation of the risk of malignancy.

This study is exploratory in nature and is designed to be hypothesis generating to support the design of future studies. Women diagnosed with a pelvic mass (ovarian, uterine, retroperitoneal, etc.) who are scheduled for an imaging guided biopsy, surgical biopsy or surgical excision for evaluation of their pelvic mass. It is estimated that approximately 200 women will be enrolled for evaluation of the primary and exploratory endpoints. Enrollment into the study will continue beyond 200 women if necessary to obtain a minimum of 50 evaluable women with a histopathologically confirmed malignancy, including ovarian, fallopian, peritoneal, endometrial, cervical, etc.

Within 60 days prior to the pelvic mass evaluation procedure, each subject must have a pelvic imaging study (e.g. ultrasound, CT scan, MRI, etc.) conducted and read to visualize the pelvic mass according to the current standard of care. Results of the pelvic imaging study(ies) will be recorded.

Within 30 days prior to, or on the day of the pelvic mass evaluation procedure, collect up to 35mL of whole blood into one 5mL SST tube, which must be drawn first, followed by three separate 10mL EDTA tubes. Serum from SST tube will be used for protein biomarker testing. Blood from EDTA tubes will be pooled and processed on the Parsortix™ System to capture and harvest rare cells. The captured rare cells will be eluted (harvested) and lysed, and total RNA will be extracted from the cell lysate for evaluation of multiple gene targets.

Imaging guided biopsy, surgical biopsy or surgical excision for evaluation of the pelvic mass will be performed by a qualified individual. Tissue samples will be sent to the local pathology department for histological examination in accordance with standard institutional practices. Results of the histopathological evaluation will be recorded, including the final diagnosis along with histological sub-type, and if available, stage, of cancer where disease is identified. Where possible, representative fresh frozen tissue samples from the pelvic mass will be obtained for research purposes for evaluation of the same mRNA gene targets used in the cell harvests.

Subjects will be considered negative for malignancy:

* if the subject undergoes surgery and no mass is identified, or;
* if the histopathological findings are negative for malignancy (i.e. benign conditions).

Subjects will be considered positive for malignancy:

* if the histological examination of the tissue taken at the time of the biopsy or surgery confirms the presence of a malignancy (i.e. ovarian, primary peritoneal, fallopian tube, endometrial, uterine, cervical, metastatic cancers, etc.).

For the purposes of enrollment, subjects diagnosed with low malignant potential (LMP) / borderline tumors will be considered as benign (negative for malignancy). However, two separate analyses of the final study data will be conducted: one where subjects diagnosed with low malignant potential (LMP) / borderline tumors are classified as being negative for malignancy and a second time where these subjects are classified as being positive for malignancy.

For subjects diagnosed with a malignancy, a bi-annual medical record review will be performed for up to 5 years after their enrollment into the study to collect information regarding their treatment response, chemotherapy sensitivity and resistance, time to recurrence, time to progression and overall survival.

An algorithm for the prediction of benign vs. malignant disease will be constructed using the clinical information, serum biomarkers and mRNA markers. Additional analyses may be performed within and between various histopathological diagnosis sub-groups. The variable selection and algorithm construction will be done using various statistical methods, such as logistic regression, hierarchal clustering, classification and regression trees (CART), ROC curve evaluation, sensitivity/specificity analysis, visual plotting for determination of thresholds, etc. The inputs for evaluation may include continuous variables (e.g. age, ovary and dominant mass dimensions, serum biomarker results, mRNA expression levels, etc.), categorical variables (e.g. age groups, biomarker results by ranges, mRNA expression levels by ranges, etc.), and/or binary variables (e.g. presence or absence of particular risk factors and/or imaging features, age above or below a particular threshold, menopausal status, biomarker results above or below a particular threshold, mRNA expression levels above or below a particular threshold, etc.). A threshold for the resulting algorithm(s) output to differentiate between benign and malignant disease (or a subgroup thereof, such as epithelial ovarian cancer patients only) will be selected to optimize the sensitivity at a set specificity (e.g. maximize sensitivity at a minimum specificity level of \>80%).

Upon completion of the long-term follow-up period, the association of the clinical data and markers with the subject's treatment response, chemotherapy sensitivity and resistance, time to recurrence, time to progression and overall survival will be assessed using the appropriate statistical methods (e.g. 2x2 tables, correlation analyses, Cox hazards regression, Kaplan-Meier plotting, etc.).

All excess components (i.e. serum, RNA, DNA, cells, etc.) generated from the whole blood and tissue samples collected for research testing, as well as any remaining tissue samples collected under this study, will be stored frozen at the Targeted Therapeutics Laboratory at the Wilmot Cancer Institute indefinitely for possible use in future research, including but not limited to, biomarker analyses, genomic evaluations and genetic studies pertaining to cancer and other disease processes.

Evaluation of Multiple Protein and Molecular Biomarkers to Estimate Risk of Cancer in Gynecology Patients Presenting With a Pelvic Mass.

ANG-003 EMBER Study: Evaluation of Multiple Protein and Molecular Biomarkers to Estimate Risk of Cancer in Gynecology Patients Presenting With a Pelvic Mass.

For subjects diagnosed with a malignancy, a bi-annual medical record review will be performed for up to 5 years after their enrollment into the study to collect information regarding their treatment response, chemotherapy sensitivity and resistance, time to recurrence, time to progression and overall survival.

Tissue samples taken from the pelvic mass will be evaluated in the URMC GYN pathology department according to institutional guidelines. Results from the histopathological evaluation, including the final diagnosis (i.e. benign, malignant, etc.), histopathology description, and, if malignant, clinical or surgical staging and tumor subtype, will be recorded.

Blood from EDTA tubes will be pooled and processed on the Parsortix™ System to capture and harvest rare cells. The captured rare cells will be eluted (harvested) and lysed, and total RNA will be extracted from the cell lysate for evaluation of multiple gene targets.

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization
Study of Adult T-Cell Leukemia/Lymphoma Among Carriers of HTLV-1	NCT00339638	Human T-Lymphom...		-	National Institutes of Health Clinical Center (CC)
Evaluation of Multiple Biomarkers to Estimate Risk of Ovarian Cancer in Patients With a Pelvic Mass.	NCT02785731	Ovarian Neoplas...	Pelvic imaging Blood draw laparotomy or l...	18 Years -	Angle plc
Evaluation of Multiple Protein and Molecular Biomarkers to Estimate Risk of Cancer in Gynecology Patients Presenting With a Pelvic Mass.	NCT02781272	Ovarian Neoplas...	Pelvic imaging Blood draw Imaging guided ...	18 Years -	Angle plc

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