Goode, Ellen L.

Abstract Purpose: Chemotherapy resistance remains a major challenge in the treatment of ovarian cancer. We hypothesize that germline polymorphisms might be associated with clinical outcome. Experimental Design: We analyzed approximately 2.8 million genotyped and imputed SNPs from the iCOGS experiment for progression-free survival (PFS) and overall survival (OS) in 2,901 European epithelial ovarian cancer (EOC) patients who underwent first-line treatment of cytoreductive surgery and chemotherapy regardless of regimen, and in a subset of 1,098 patients treated with ≥4 cycles of paclitaxel and carboplatin at standard doses. We evaluated the top SNPs in 4,434 EOC patients, including patients from The Cancer Genome Atlas. In addition, we conducted pathway analysis of all intragenic SNPs and tested their association with PFS and OS using gene set enrichment analysis. Results: Five SNPs were significantly associated (P ≤ 1.0 × 10−5) with poorer outcomes in at least one of the four analyses, three of which, rs4910232 (11p15.3), rs2549714 (16q23), and rs6674079 (1q22), were located in long noncoding RNAs (lncRNAs) RP11-179A10.1, RP11-314O13.1, and RP11-284F21.8, respectively (P ≤ 7.1 × 10−6). ENCODE ChIP-seq data at 1q22 for normal ovary show evidence of histone modification around RP11-284F21.8, and rs6674079 is perfectly correlated with another SNP within the super-enhancer MEF2D, expression levels of which were reportedly associated with prognosis in another solid tumor. YAP1- and WWTR1 (TAZ)-stimulated gene expression and high-density lipoprotein (HDL)-mediated lipid transport pathways were associated with PFS and OS, respectively, in the cohort who had standard chemotherapy (pGSEA ≤6 × 10−3). Conclusions: We have identified SNPs in three lncRNAs that might be important targets for novel EOC therapies. Clin Cancer Res; 21(23); 5264–76. ©2015 AACR.

Abstract Background: Common genetic variants identified by genome-wide association studies and follow-up genotyping initiatives only explain a small proportion of the heritability of epithelial ovarian cancer (EOC). We hypothesized that some of the missing heritability may be explained by rare (minor allele frequency (MAF) <0.5%) and low-frequency (MAF 0.5-5%) protein-coding variants that are not well captured by genotyping arrays that focus on common variants. Methods: To examine the association between uncommon variants and EOC susceptibility, we genotyped 7,060 EOC cases and 6,712 controls from the Ovarian Cancer Association Consortium using the Affymetrix Axiom Exome Genotyping Array. This platform contains 300,785 putative functional coding variants selected from exome sequences of 12,000+ individuals representing multiple ethnicities and complex traits. After performing quality control (QC), we used unconditional logistic regression treating the number of minor alleles carried as an ordinal variable (log-additive model) to evaluate SNP-EOC risk associations. Genotype cluster plots were visually inspected for top-ranking variants to determine assay success, and allele frequencies of samples from the 1000 Genomes Project and other cohorts were evaluated for QC purposes. Results: A total of 13,318 samples (97%) passed QC, and 12,779 eligible samples (6,293 invasive serous and endometrioid cases and 6,486 controls) were included in the analyses. 280,737 (93%) of the 300,785 attempted markers were successfully genotyped and had call rates >90%. After removing 31,436 monomorphic markers, the 249,301 remaining markers were included in association analyses. We confirmed variants at previously reported EOC susceptibility loci (9p22, 3q25, 17cen-q21.3, and 8q24), with p-values between 10-5 and 10-11. Several correlated low-frequency non-synonymous variants (MAF=5%) residing in a novel EOC susceptibility gene at 3q25.31 were risk-associated. The most significant variant at 3q25.31 had an OR=1.36 and p = 5.58x10-8. Also noteworthy is a rare variant at 15q15.1-q21.1 (MAF=0.5%) that introduces a stop codon in a gene belonging to the tyrosine kinase family (OR=0.39, CI=0.26-0.58, p = 4.52x10-6). We also identified a more common synonymous coding variant in a phosphatase at 6q21.3 that was associated with increased risk (OR=1.22, CI=1.13-1.33, p = 1.84x10-6, MAF=9.6%). Population stratification and gene-based analyses are underway to further examine the impact of the newly-identified variants on EOC risk. A meta-analysis to include data from an additional 2104 EOC cases and 2516 controls genotyped with Illumina's HumanExome Beadchip rare variant array is also underway. Functional analysis of the most promising variants will follow. Conclusions: Preliminary data from this large-scale study reveals novel rare and low-frequency variants that may influence susceptibility to epithelial ovarian cancer. Citation Format: Jennifer Permuth-Wey, Y. Ann Chen, Zhihua Chen, Andrew Berchuck, Georgia Chenevix-Trench, Jennifer Doherty, Simon Gayther, Ellen L. Goode, Edwin Iversen, Alvaro N.A. Monteiro, Leigh Pearce, Paul D.P. Pharoah, Catherine M. Phelan, Ailith Pirie, Susan Ramus, Mary Ann Rossing, Joellen M. Schildkraut, Thomas A. Sellers, on behalf of the Ovarian Cancer Association Consortium. Exome genotyping array identifies rare and low-frequency variants that may be associated with ovarian cancer risk. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 946. doi:10.1158/1538-7445.AM2014-946

Abstract Background: The standard treatment for epithelial ovarian cancer (EOC) patients with advanced disease is initial debulking surgery followed by carboplatin-paclitaxel combination therapy. Unfortunately, even with modern chemotherapy, most patients with advanced disease relapse and die of EOC. One of the biggest challenges in the treatment of EOC is the large inter-patient variation in clinical response and toxicity observed for taxane and platinum therapies. Purpose: To determine pharmacogenomic markers related to carboplatin-paclitaxel therapy with 33 Epstein-Barr virus (EBV) transformed lymphoblastoid cell lines (LCLs) derived from EOC patients for which genome-wide genetic information exists. Methods: The 33 LCLs were treated with increasing concentrations of carboplatin and/or paclitaxel, followed by MTT cytotoxicity and Caspase3/7 assays. Using the measurements of MTT absorbance or Caspase3/7 fluorescence, dose response curves were fit to estimate the in vitro drug response (MTT or caspase3/7) for each LCL and treatment (paclitaxel, carboplatin, and combination) using the inflection point of the fitted curve (i.e.., the MTT IC50 or effective dose that kills 50% of the cells). The six in vitro phenotypes where then associated with genome-wide SNP data, imputed up to the markers in the 1000 Genomes Project. Results: Genetic association analysis of carboplatin, paclitaxel and combination therapy cell viability, as measured by MTT, found one SNP, rs202167095 within HS3ST4, in common with all three phenotypes (p < 0.0001). HS3ST4 is regulated by TRF2 and activates natural killer cells. Furthermore, TRF2 maintains telomere integrity and is involved in activating DNA damage response (DDR) pathway.. Similarly, three SNPs were found to be associated with the three Caspase3/7 activities: SNPs on chromosome 3 (rs13098237 and rs13098239), and a SNP on chromosome 10 (rs138004421 within LINC00858). Lastly, SNPs in the following genes were associated with carboplatin IC50 with p < 1x10-6 (i.e., the top associated SNPs with any drug response phenotype): JAKMIP3 (p=2.3x10-7), TSHZ3 (p = 4.9x10-7) and TGFA (p=3.6x10-7). JAKMIP3 has been implicated in some cancers and interacts with other janus kinases and JAK-STAT pathways, while TSHZ3 inhibits the expression of CASP4, thus limiting cell apoptosis. Lastly, TGFA codes for a growth factor that is a ligand for epidermal growth factor receptor, which activates a signaling pathway for cell proliferation, differentiation and development. Conclusions: Identifying genetic loci associated with response to platinum-taxane therapies will ultimately improve clinicians' ability to tailor therapy decisions for EOC patients. This research discovered novel candidate genes for which further research is needed to understand the mechanism by which they impact clinical response. Citation Format: Brooke L. Fridley, Taraswi M. Ghosh, Alice Wang, Ellen L. Goode, Jatinder Lamba. In vitro pharmacogenomic study of ovarian cancer finds novel genetic variants associated with response to platinum and taxane therapies. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 5565. doi:10.1158/1538-7445.AM2014-5565

Abstract Both genetic and epigenetic factors influence the development and progression of epithelial ovarian cancer (EOC). However, there is an incomplete understanding of the interrelationship between these factors and whether they interact to impact disease risk. Given that the development of ovarian cancer is complex, we aimed to identify DNA methylation marks that are candidates for mediating ovarian cancer genetic risk. We used 214 cases and 214 age-matched controls from the Mayo Clinic Ovarian Cancer Study. Pretreatment, blood-derived DNA was profiled for genome-wide methylation (Illumina Infinium HumanMethylation27 BeadArray) and single nucleotide polymorphisms (SNPs, Illumina Infinium HD Human610-Quad BeadArray). We employed a three-step filtering procedure, followed by the Causal Inference Test (CIT), to distinguish CpG sites that mediate genetic risk, from those that are consequential or independently acted on by genotype. Controlling for the estimated distribution of immune cells and other key covariates, we identified 1,993 out of 25,926 (7.7%) CpGs that were significantly differentially methylated between cases and controls (FDR, q < 0.05). The relationship between methylation and case-control status among these 1,993 CpGs was found to be highly consistent with the results of an independent study. Implementation of the CIT test revealed 13 CpG/SNP pairs, comprising 13 unique CpGs and 17 unique SNPs, which represent potential methylation-mediated relationships between genotype and EOC risk. These findings provide additional insight into EOC etiology and may serve as novel biomarkers for EOC susceptibility. Citation Format: Devin C. Koestler, Prabhakar Chalise, Mine S. Cicek, Julie M. Cunningham, Sebastian Armasu, Melissa C. Larson, Jeremy Chien, Matthew Block, Kimberly R. Kalli, Thomas A. Sellers, Ellen L. Goode, Brooke L. Fridley. Integrative genomic analysis identifies epigenetic marks that mediate genetic risk for epithelial ovarian cancer. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 260. doi:10.1158/1538-7445.AM2014-260

Abstract Primary and acquired chemotherapy resistance remains a major challenge in the treatment of ovarian cancer. We hypothesize that heritable polymorphisms might be associated with clinical outcome. Through the Ovarian Cancer Association Consortium, we have collected detailed clinical data from a large number of ovarian cancer patients. We have conducted association analyses of progression-free survival (PFS) and overall survival (OS) for 2,901 European women with ovarian carcinoma for ∼8 million imputed SNPs with minor allele frequency ≥ 0.02 and good imputation quality (imputation r2 ≥ 0.3) from the iCOGS experiment (Pharoah et al Nat Genet. 2013). Cox regression models adjusted for known prognostic factors were used to assess the log-additive effects of SNPs on PFS and OS in 2,825 patients who underwent cytoreductive surgery and received any chemotherapy (‘all chemo’) and in the subset of 1,098 patients who underwent cytoreductive surgery followed by ≥ 4 cycles of carboplatin AUC 5 or 6 and paclitaxel 175 or 135 mg/m2 intravenously (‘standard chemo’). We identified five SNPs at four loci that were significantly associated with outcome (p ≤ 10-7) in at least one of four analyses (Table). Analysis of expression data for genes within a 1Mb region flanking each lead SNP indicates significant associations between nearby genes and ovarian cancer survival. Of particular interest is the heat shock protein crystalline αB (CRYAB) at 11q23.1. We have also identified significant associations with KIAA1598 and RAVER2. Further analysis of these loci in a larger genotyped sample is necessary to definitively identify SNP(s) associated with outcome. Our study adds to the growing evidence that genetic variants are associated with ovarian cancer prognosis. Table: SNPs associated with ovarian cancer outcome and gene expression Overall Survival (P)*Progression-Free Survival (P)*Lead SNPChromosome LocusImputation R²Expression AnalysisAll chemoStandard chemoAll chemoStandard chemors1429768671p31.30.742.14E-0512.69E-044.68E-055.11E-073.64E-09rs559375217q32.30.600.198.58E-082.32E-052.80E-031.85E-03rs7885346210q26.110.602.23E-0724.57E-036.57E-081.65E-016.85E-03rs1089121911q23.10.841.53E-0531.51E-059.50E-081.50E-042.32E-04rs3579103211q23.10.811.53E-0531.66E-055.88E-086.46E-051.87E-04*P-values are adjusted for known confounders of ovarian cancer outcomes; FIGO stage, grade, histology, residual disease, and additionally for age at diagnosis for OS.1 RAVER2; 2 KIAA1598; 3 CRYAB Citation Format: Sharon E. Johnatty, Jonathan Tyrer, Jonathan Beesley, Bo Gao, Yi Lu, Stuart MacGregor, Anna deFazio, Paul Pharoah, Ellen Goode, Georgia Chenevix-Trench. Identification of genetic loci associated with ovarian cancer prognosis. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 3286. doi:10.1158/1538-7445.AM2014-3286

Abstract An ovarian cancer Genome Wide Association Study (GWAS) identified 9p22.2 as a novel susceptibility locus with the most statistically significant single nucleotide polymorphisms (SNPs) located in an intergenic region near the Basonuclin 2 (BNC2) gene, which codes for a putative transcription regulator containing three pairs of zinc finger (ZF) domains. The minor alleles are protective in terms of ovarian cancer susceptibility. However, the molecular mechanisms by which these SNPs modify susceptibility remain largely unknown. The significant SNPs in the 9p22.2 locus lie in non-coding regions and therefore are hypothesized to affect the activity of regulatory elements and modify the expression of a target gene(s). In order to test this hypothesis we conducted fine mapping for the locus which delimited a ∼74kb region containing SNPs with a p-value less than 10-8. FAIRE-Seq and ChIP-Seq experiments for histone markers conducted in immortalized ovarian surface epithelial cells (IOSE) and fallopian tube epithelial cells (IFTE) were used to prioritize functional SNP candidates which overlap with regulatory elements. Luciferase assays tested the ability of these regulatory elements to activate transcription. Chromosome conformation capture (3C) experiments demonstrate a physical interaction between the BNC2 promoter and candidate regulatory elements containing risk-associated SNPs. Methylation Quantification at Trait Loci (mQTL) revealed an association between decreased methylation at the BNC2 promoter and the protective minor alleles. Expression analysis shows decreased expression of BNC2 in cancer versus normal tissue implicating tumor suppressor function of BNC2. Therefore the protective minor allele likely increases expression of BNC2 which in turn contains tumor suppressing properties that decrease ovarian cancer risk. BNC2 protein is in complex with transcriptional regulatory proteins, in particular the NURD complex components. Moreover, BNC2 acts as a transcriptional repressor in in vitro transfection assays indicating that it functions in transcriptional repression. We then used protein binding microarrays and CHIP-Seq experiments to identify its putative DNA binding motifs and its downstream target genes. Analysis of this data suggests that BNC2 functions in a regulatory transcription network that impacts on genes implicated in ovarian cancer with enrichment for genes in the TGF-beta response pathway. Citation Format: Melissa A. Buckley, Howard C. Shen, Gustavo A. Mendoza-Fandino, Nicholas T. Woods, Anxhela Gjyshi, Juliet French, Kate Lawrenson, Honglin Song, Jonathan Tyrer, Renato S. Carvalho, Alexandra Valle, Ann Chen, Sean Yoder, Gregory Bloom, Ya-Yu Tsai, Ally Yang, Timothy R. Hughes, Xiaotao Qu, Mine Cicek, Melissa Larson, Ellen Goode, Brooke Fridley, Susan Ramus, Georgia Chenevix-Trench, Paul Pharoah, Thomas A. Sellers, Simon Gayther, Alvaro N.A. Monteiro, Ovarian Cancer Association Consortium. Functional analysis of the 9p22 locus implicates the transcriptional regulation of BNC2 as a mechanism in ovarian cancer predisposition. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 3285. doi:10.1158/1538-7445.AM2014-3285

Abstract Background Genome-wide association studies (GWAS) previously identified 8 new risk loci for all subtypes of epithelial ovarian carcinoma (EOC) and one specific to invasive serous EOC. One locus, at 2q31, was also associated with invasive mucinous EOC (mEOC) at P=7.3 x 10-7 (Nat Genet 2010:874). Here, we report new risk loci for mEOC, which is thought to develop from a borderline mucinous tumor. These loci may provide clues to the molecular basis of the disease. Methods We used genotype data from 4 GWAS of EOC and from multiple case-control studies in the Ovarian Cancer Association Consortium that had been genotyped using the iCOGS custom SNP panel (210k SNPs) developed for the Collaborative Oncological Gene-environment Study. We imputed genotypes of common variation across the genome using the 1000 Genomes Project reference panel and tested for association using log-additive unconditional regression models. Results Genotypes were available for 1,643 combined invasive and borderline mEOC and for 1,002 invasive-only mEOC of European ancestry. Three loci in new regions, and one locus in a previously published region, with minor allele frequency (MAF) > 1% and P ≤ 10-7 were found. The imputed SNP rs72831838 (imputation r2=0.67, MAF=0.15) is located at 2q13 in an intron of the PAX8 (paired box 8) gene (all mEOC OR=1.35, P=4.2 x 10-8 and invasive-only OR=1.43, P=9.6 x 10-8). PAX8 is a transcription factor and may be a Müllerian lineage marker that distinguishes carcinomas of gynecologic origin from other sites. The imputed variant at chr19:39745695 (imputation r2=0.61, MAF=0.32) is an insertion/deletion polymorphism located at 19q13.2 and falls within the MSRB1P1 (methionine sulfoxide reductase B1 pseudogene 1). This locus was associated with decreased risk (all mEOC OR=0.74, P = 2.1 x 10-9 and invasive-only OR=0.79, P = 8.1 x 10-5) and is enriched with the H3K27Ac histone mark that identifies active enhancers of gene expression. The imputed SNP rs6425050 (imputation r2=0.45, MAF=0.19) is located at 1q25 (all mEOC OR=1.38, P=4.7 x 10-8 and invasive-only OR=1.41, P=1.6x10-6). This SNP is intronic to PLA2G4A (phospholipase A2, group IVA), which encodes an enzyme that hydrolyzes membrane phospholipids for eicosanoid metabolism and signaling. None of these loci were associated with other EOC histological subtypes at P ≤ 10-7. The genotyped SNP, rs711830 (MAF=0.32), is located at 2q31.1 in the 3′ region of the HOXD3 homeobox gene (all mEOC OR=1.30, P=7.5 x 10-12 and invasive-only OR=1.26, P=7.8 x 10-7). This SNP is highly correlated (r2=0.99) with rs2072590, which is located 5.3kb upstream and previously reported by us to be associated with mEOC and invasive serous EOC (Nat Genet 2010:874). The HOXD3 locus is highly conserved and may also be a marker of Müllerian cell type origin. Conclusions The 3 new loci for mEOC require confirmation by genotyping. Fine mapping and functional analysis of all loci is needed in order to determine their likely target genes. Citation Format: Linda E. Kelemen, Jonathan Tyrer, Catherine M. Phelan, Susan J. Ramus, Andrew Berchuck, Simon A. Gayther, Ellen L. Goode, Celeste L. Pearce, Joellen M. Schildkraut, Georiga Chenevix-Trench, Alvaro N. Monteiro, Marc T. Goodman, Thomas A. Sellers, Paul PD Pharoah. GWAS identifies risk variants for mucinous ovarian carcinoma. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 3283. doi:10.1158/1538-7445.AM2014-3283

Abstract Purpose: To analyze the effect of germline mutations in BRCA1 and BRCA2 on mortality in patients with ovarian cancer up to 10 years after diagnosis. Experimental Design: We used unpublished survival time data for 2,242 patients from two case–control studies and extended survival time data for 4,314 patients from previously reported studies. All participants had been screened for deleterious germline mutations in BRCA1 and BRCA2. Survival time was analyzed for the combined data using Cox proportional hazard models with BRCA1 and BRCA2 as time-varying covariates. Competing risks were analyzed using Fine and Gray model. Results: The combined 10-year overall survival rate was 30% [95% confidence interval (CI), 28%–31%] for non-carriers, 25% (95% CI, 22%–28%) for BRCA1 carriers, and 35% (95% CI, 30%–41%) for BRCA2 carriers. The HR for BRCA1 was 0.53 at time zero and increased over time becoming greater than one at 4.8 years. For BRCA2, the HR was 0.42 at time zero and increased over time (predicted to become greater than 1 at 10.5 years). The results were similar when restricted to 3,202 patients with high-grade serous tumors and to ovarian cancer–specific mortality. Conclusions: BRCA1/2 mutations are associated with better short-term survival, but this advantage decreases over time and in BRCA1 carriers is eventually reversed. This may have important implications for therapy of both primary and relapsed disease and for analysis of long-term survival in clinical trials of new agents, particularly those that are effective in BRCA1/2 mutation carriers. Clin Cancer Res; 21(3); 652–7. ©2014 AACR.

Abstract Tumor infiltrating regulatory T cells (Tregs) appear to play a role in survival in a number of solid tumors, including ovarian cancer. We assessed genetic variation via tag SNPs (N=749) in 25 Treg associated genes (CD28, CTLA4, FOXP3, IDO1, IL10, IL10RA, IL15, 1L17RA, IL23A, IL23R, IL2RA, IL6, IL6R, IL8, LGALS1, LGALS9, MAP3K8, STAT5A, STAT5B, TGFB1, TGFB2, TGFB3, TGFBR1, TGRBR2, and TGFBR3) in relation to ovarian cancer survival. SNPs were selected based on r2 ≥ 0.8, MAF ≥ 0.05, 5 kb upstream and downstream from the gene. We had SNP and outcome data for ovarian cancer from 10,084 combined ovarian cancer cases, including 5,248 high grade serous, 1,452 endometrioid, 661 mucinous, and 795 clear cell cases of European descent across multiple studies from the Ovarian Cancer Association Consortium (OCAC). Cox proportional hazards regression modeling was used to estimate per-allele hazard ratios (HRs) and 95% confidence intervals (CIs) for associations with overall survival, adjusting for age at diagnosis, population substructure PCs, study site, histology (for the all case analysis), tumor stage, tumor grade and oral contraceptive use. The strongest associations were found for endometrioid histologic subtype and IL2RA SNPs (maximum r2=0.67) rs11256497 [HR=1.42, 95% CI: 1.22-1.64; p=5.7 x 10−6], rs791587 [HR=1.36, 95% CI: 1.17-1.57; p=6.2 x 10−5], rs2476491 [HR=1.40, 95% CI: 1.19-1.64; p=5.6 x 10−5], and rs10795763 [HR=1.35, 95% CI: 1.17-1.57; p=7.9 x 10−5], as well as clear cell ovarian cancer and CTLA4 SNP rs231775 [HR=0.67, 95% CI: 0.54-0.82; p=9.3 x 10−5]. No other associations were observed at p<1 x 10−4. Overall, this study provided evidence that variation in genes related to Tregs, particularly IL2RA and CTLA4, influence ovarian cancer survival. Citation Format: Bridget Charbonneau, Keith Knutson, Robert A. Vierkant, Julie M. Cunningham, Zachary C. Fogarty, Kimberly R. Kalli, Matthew J. Maurer, Ann L. Oberg, Brooke L. Fridley, Claudia C. Preston, Paul D.P. Pharoah, Susan J. Ramus, Catherine M. Phelan, Kunle Odunsi, Kirsten Moysich, Ellen L. Goode. Polymorphisms in regulatory T cell related genes and ovarian cancer survival. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 4844. doi:10.1158/1538-7445.AM2013-4844