Angeles Secord

Overview:

My primary research interest has focused on angiogenesis, molecular signatures, clinical trial development, and ovarian cancer. My fundamental goal is to develop a strong translational research program at Duke University in the Gynecologic Oncology Division where knowledge we glean from our basic science research can be incorporated into our clinical trial program. Specifically on anti-angiogenic therapy and molecular tumor signatures to direct therapy in patients with ovarian cancer to determine if a strategy that incorporates both clinical and genomic information can improve clinical outcome, minimize unnecessary toxicity, and impact positively on quality of life.
In addition I am interested in robotic-assisted laparoscopic surgery for women with endometrial, ovarian, and cervical cancers as well as for benign gynecologic conditions.

Positions:

Professor of Obstetrics and Gynecology

Obstetrics and Gynecology, Gynecologic Oncology
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

M.D. 1994

University of Washington

Resident, Obstetrics & Gynecology

Duke University

Grants:

NCI National Clinical Trials Network U10 (Year 5)

Administered By
Duke Cancer Institute
Awarded By
National Institutes of Health
Role
Co-Principal Investigator
Start Date
End Date

Women with BRCA-mutated Advanced Stage Ovarian Cancer

Administered By
Duke Clinical Research Institute
Role
Co Investigator
Start Date
End Date

Assessing the relevance of weighted values in the ASCO value framework in ovarian cancer patients

Administered By
Obstetrics and Gynecology, Gynecologic Oncology
Role
Investigator
Start Date
End Date

Predictive value of the IL6 pathway to direct anti-angiogenic therapy in advanced ovarian cancer

Administered By
Obstetrics and Gynecology, Gynecologic Oncology
Role
Principal Investigator
Start Date
End Date

Blood-based Angiome Profiling to Direct Bevacizumab Therapy in Ovarian Cancer

Administered By
Obstetrics and Gynecology, Gynecologic Oncology
Awarded By
National Institutes of Health
Role
Principal Investigator
Start Date
End Date

Publications:

Nomogram for Predicting Individual Survival After Recurrence of Advanced-Stage, High-Grade Ovarian Carcinoma.

OBJECTIVE: To analyze clinical prognostic factors for survival after recurrence of high-grade, advanced-stage ovarian-peritoneal-tubal carcinoma and to develop a nomogram to predict individual survival after recurrence. METHODS: We retrospectively analyzed patients treated in multicenter Gynecologic Oncology Group protocols for stage III and IV ovarian-peritoneal-tubal carcinoma who underwent primary debulking surgery, received chemotherapy with paclitaxel and a platinum compound, and subsequently developed recurrence. Prognostic factors affecting survival were identified and used to develop a nomogram, which was both internally and externally validated. RESULTS: There were 4,739 patients included in this analysis, of whom, 84% had stage III and 16% had stage IV ovarian carcinoma. At a median follow-up of 88.8 months (95% CI 86.2-92.0 months), the vast majority of patients (89.4%) had died. The median survival after recurrence was 21.4 months (95% CI 20.5-21.9 months). Time to recurrence after initial chemotherapy, clear cell or mucinous histology, performance status, stage IV disease, and age were significant variables used to develop a nomogram for survival after recurrence, which had a concordance index of 0.67. The time to recurrence alone accounted for 85% of the prognostic information. Similar results were found for patients who underwent second look laparotomy and had a complete pathologic response or received intraperitoneal chemotherapy. CONCLUSION: For individuals with advanced-stage ovarian carcinoma who recur after standard first-line therapy, estimated survivals after recurrence are closely related to the time to recurrence after chemotherapy and prognostic variables can be used to predict subsequent survival. CLINICAL TRIAL REGISTRATION: ClinialTrials.gov, NCT00002568, NCT00837993, NCT00002717, NCT01074398, and NCT00011986.
Authors
Rose, PG; Java, JJ; Salani, R; Geller, MA; Secord, AA; Tewari, KS; Bender, DP; Mutch, DG; Friedlander, ML; Van Le, L; Method, MW; Hamilton, CA; Lee, RB; Wenham, RM; Guntupalli, SR; Markman, M; Muggia, FM; Armstrong, DK; Bookman, MA; Burger, RA; Copeland, LJ
MLA Citation
Rose, Peter G., et al. “Nomogram for Predicting Individual Survival After Recurrence of Advanced-Stage, High-Grade Ovarian Carcinoma..” Obstet Gynecol, vol. 133, no. 2, Feb. 2019, pp. 245–54. Pubmed, doi:10.1097/AOG.0000000000003086.
URI
https://scholars.duke.edu/individual/pub1364794
PMID
30633128
Source
pubmed
Published In
Obstet Gynecol
Volume
133
Published Date
Start Page
245
End Page
254
DOI
10.1097/AOG.0000000000003086

Prospective Evaluation of Lymph Node Processing at Staging Surgery for High-grade Endometrial Cancer.

To determine whether the processing of additional adipose tissue collected during lymph node (LN) dissection results in the identification of additional LNs during endometrial cancer (EC) staging and to determine if the division of LNs into nodal basin-specific specimens has an effect on the number of LNs identified during EC staging. A prospective randomized controlled trial was performed on women with high-grade EC undergoing surgical staging. Subjects were randomized to collection of LNs into nodal basin-specific containers on the randomized side versus simple labeling on the nonrandomized side. The total number of LNs and total number of LNs with metastases on the randomized versus the nonrandomized side were compared. The remaining adipose tissue from each LN specimen was submitted for histologic examination. We analyzed the number of LNs with and without metastases identified from additional adipose tissue. Of 120 consented subjects, 56 had sufficient data for analysis. The additional adipose tissue contained 7.5 additional LNs per patient on average (range: 0-26). In 2/54 total cases (3.7%) and 2/5 cases with nodal metastases (40%), the additional adipose contained LNs with metastases. In both cases, metastases were also detected in grossly identified LN candidates. The mean number of LNs identified was not significantly different based on method of collection (P=0.22). The mean number of LNs containing metastases per side was not significantly different (P=0.58). Processing of adipose tissue does increase the total number of LNs identified, however, it does not influence EC stage. No difference in LN counts was noted with basin-specific collection.
Authors
Davidson, BA; Ehrisman, J; Abbott, S; Harmon, Z; Secord, AA; Berchuck, A; Lee, PS; Valea, FA; Li, X; Havrilesky, LJ; Hall, AHS
MLA Citation
Davidson, Brittany A., et al. “Prospective Evaluation of Lymph Node Processing at Staging Surgery for High-grade Endometrial Cancer..” Int J Gynecol Pathol, vol. 37, no. 3, May 2018, pp. 252–55. Pubmed, doi:10.1097/PGP.0000000000000418.
URI
https://scholars.duke.edu/individual/pub1121608
PMID
28700428
Source
pubmed
Published In
Int J Gynecol Pathol
Volume
37
Published Date
Start Page
252
End Page
255
DOI
10.1097/PGP.0000000000000418

Driver Fusions and Their Implications in the Development and Treatment of Human Cancers.

Gene fusions represent an important class of somatic alterations in cancer. We systematically investigated fusions in 9,624 tumors across 33 cancer types using multiple fusion calling tools. We identified a total of 25,664 fusions, with a 63% validation rate. Integration of gene expression, copy number, and fusion annotation data revealed that fusions involving oncogenes tend to exhibit increased expression, whereas fusions involving tumor suppressors have the opposite effect. For fusions involving kinases, we found 1,275 with an intact kinase domain, the proportion of which varied significantly across cancer types. Our study suggests that fusions drive the development of 16.5% of cancer cases and function as the sole driver in more than 1% of them. Finally, we identified druggable fusions involving genes such as TMPRSS2, RET, FGFR3, ALK, and ESR1 in 6.0% of cases, and we predicted immunogenic peptides, suggesting that fusions may provide leads for targeted drug and immune therapy.
Authors
Gao, Q; Liang, W-W; Foltz, SM; Mutharasu, G; Jayasinghe, RG; Cao, S; Liao, W-W; Reynolds, SM; Wyczalkowski, MA; Yao, L; Yu, L; Sun, SQ; Fusion Analysis Working Group,; Cancer Genome Atlas Research Network,; Chen, K; Lazar, AJ; Fields, RC; Wendl, MC; Van Tine, BA; Vij, R; Chen, F; Nykter, M; Shmulevich, I; Ding, L
MLA Citation
Gao, Qingsong, et al. “Driver Fusions and Their Implications in the Development and Treatment of Human Cancers..” Cell Rep, vol. 23, no. 1, Apr. 2018, pp. 227-238.e3. Pubmed, doi:10.1016/j.celrep.2018.03.050.
URI
https://scholars.duke.edu/individual/pub1311446
PMID
29617662
Source
pubmed
Published In
Cell Reports
Volume
23
Published Date
Start Page
227
End Page
238.e3
DOI
10.1016/j.celrep.2018.03.050

ASCO Value Framework Highlights the Relative Value of Treatment Options in Ovarian Cancer.

PURPOSE: The ASCO value framework allows physicians and patients to compare the relative value of novel treatments. Our aim was to assess the value of three frontline ovarian cancer therapies by using this framework. METHODS: From phase III, randomized controlled clinical trial (RCT) data, the net health benefits (NHBs) for three frontline ovarian cancer treatment options-dose-dense paclitaxel (Japanese Gynecologic Oncology Group study JGOG 3016), intraperitoneal (IP)/intravenous (IV) chemotherapy (Gynecologic Oncology Group [GOG] study GOG 172), and concurrent plus maintenance bevacizumab (GOG 218 and the Seventh International Collaborative Ovarian Neoplasm study [ICON7])-were calculated. The ASCO value framework calculates the NHB by using six criteria: clinical benefit, toxicity, tail of the curve, symptom palliation, treatment-free interval, and quality of life. Clinical benefit calculation uses ASCO-assigned importance weights for overall survival and progression-free survival. The maximum possible NHB points is 180. NHBs were presented alongside the drug-acquisition cost (DAC) of each therapy. A benefit-cost ratio of NHB points per additional cost was calculated. RESULTS: The NHB of dose-dense paclitaxel was 38, at an additional cost of $16 per cycle. IP cisplatin/IV + IP paclitaxel received 29 NHB points, at an additional cost of $1,629 per cycle. Concurrent plus maintenance bevacizumab received 24 NHB points, at an additional cost of $7,581 per cycle (GOG 218) or six NHB points ($3,790 per cycle; ICON7). The ratios of NHB points-to-dollar were as follows: dose-dense paclitaxel, 2.4 (highest); IP chemotherapy, 0.018; and bevacizumab, 0.003 (lowest). CONCLUSION: Using the ASCO value framework, we constructed value snapshots of three major frontline therapeutic options in ovarian cancer. Dose-dense paclitaxel provided the highest additional value when analysis accounted for NHB and cost. However, additional research is needed to include individual patient preferences and provide personalized value assessments.
Authors
Foote, J; Secord, AA; Liang, M; Cohn, DE; Jewell, E; Havrilesky, LJ
MLA Citation
Foote, Jonathan, et al. “ASCO Value Framework Highlights the Relative Value of Treatment Options in Ovarian Cancer..” J Oncol Pract, vol. 13, no. 12, Dec. 2017, pp. e1030–39. Pubmed, doi:10.1200/JOP.2017.025106.
URI
https://scholars.duke.edu/individual/pub1279538
PMID
29016225
Source
pubmed
Published In
J Oncol Pract
Volume
13
Published Date
Start Page
e1030
End Page
e1039
DOI
10.1200/JOP.2017.025106

Does time interval between surgery and intraperitoneal chemotherapy administration in advanced ovarian cancer carry a prognostic impact? An NRG Oncology/Gynecologic Oncology Group study ancillary study.

OBJECTIVES: To determine the relationship of the time from surgery to intraperitoneal (IP) chemotherapy (TSIC) initiation with survival of patients with stage III epithelial ovarian cancer (EOC) patients using ancillary data from cooperative group clinical trials. METHODS: Data from 420 patients with stage III EOC treated with IP chemotherapy under GOG-0114 and 172 were reviewed. The Cox proportional hazards model was used to evaluate independent prognostic factors and estimate their covariate-adjusted effects on PFS and OS. RESULTS: The median TSIC was 62.5days (interquartile range 28-83). The median TSIC was longer for patients in GOG-0114 vs those in GOG-172 (83 vs 26days, p<0.001). TSIC was significantly associated (p=0.049) with PFS: each 10% increase in TSIC (days) decreases the risk of progression by 3%. TSIC was not significantly associated with OS in this model. In a linear regression model, gross residual disease was significantly associated with shorter TSIC (R2 -0.141, 95%CI -0.217, -0.064, p<0.001). When only data from GOG-172 were considered, no statistical significant association was found between TSIC and PFS or OS. CONCLUSIONS: In this ancillary data study, TSIC was not associated with improved OS in patients with stage III epithelial ovarian cancer. TSIC was significantly associated with PFS for the entire cohort, suggesting increase in PFS with longer TSIC. However, this was not found when only data from GOG 172 or GOG 114 were analyzed separately. Hence, the relationship between IP chemotherapy initiation and time from surgery needs to be studied further.
Authors
Garcia-Soto, AE; Java, JJ; Nieves Neira, W; Pearson, JM; Cohn, DE; Lele, SB; Tewari, KS; Walker, JL; Alvarez Secord, A; Armstrong, DK; Copeland, LJ
MLA Citation
Garcia-Soto, Arlene E., et al. “Does time interval between surgery and intraperitoneal chemotherapy administration in advanced ovarian cancer carry a prognostic impact? An NRG Oncology/Gynecologic Oncology Group study ancillary study..” Gynecol Oncol, vol. 143, no. 3, Dec. 2016, pp. 484–89. Pubmed, doi:10.1016/j.ygyno.2016.10.003.
URI
https://scholars.duke.edu/individual/pub1169095
PMID
27726923
Source
pubmed
Published In
Gynecol Oncol
Volume
143
Published Date
Start Page
484
End Page
489
DOI
10.1016/j.ygyno.2016.10.003