Rhonda Bitting

Positions:

Associate Professor of Medicine

Medicine, Medical Oncology
School of Medicine

member of the duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

M.D. 2005

Vanderbilt University

Residency, Internal Medicine

University of California San Francisco, School of Medicine

Fellowship, Hematology And Oncology

Duke University

Grants:

Publications:

NCCN Guidelines® Insights: Prostate Cancer, Version 1.2023.

The NCCN Guidelines for Prostate Cancer address staging and risk assessment after a prostate cancer diagnosis and include management options for localized, regional, recurrent, and metastatic disease. The NCCN Prostate Cancer Panel meets annually to reevaluate and update their recommendations based on new clinical data and input from within NCCN Member Institutions and from external entities. These NCCN Guidelines Insights summarizes much of the panel's discussions for the 4.2022 and 1.2023 updates to the guidelines regarding systemic therapy for metastatic prostate cancer.
Authors
Schaeffer, EM; Srinivas, S; Adra, N; An, Y; Barocas, D; Bitting, R; Bryce, A; Chapin, B; Cheng, HH; D'Amico, AV; Desai, N; Dorff, T; Eastham, JA; Farrington, TA; Gao, X; Gupta, S; Guzzo, T; Ippolito, JE; Kuettel, MR; Lang, JM; Lotan, T; McKay, RR; Morgan, T; Netto, G; Pow-Sang, JM; Reiter, R; Roach, M; Robin, T; Rosenfeld, S; Shabsigh, A; Spratt, D; Teply, BA; Tward, J; Valicenti, R; Wong, JK; Berardi, RA; Shead, DA; Freedman-Cass, DA
MLA Citation
Schaeffer, Edward M., et al. “NCCN Guidelines® Insights: Prostate Cancer, Version 1.2023.J Natl Compr Canc Netw, vol. 20, no. 12, Dec. 2022, pp. 1288–98. Pubmed, doi:10.6004/jnccn.2022.0063.
URI
https://scholars.duke.edu/individual/pub1560868
PMID
36509074
Source
pubmed
Published In
J Natl Compr Canc Netw
Volume
20
Published Date
Start Page
1288
End Page
1298
DOI
10.6004/jnccn.2022.0063

Trajectories in muscular strength and physical function among men with and without prostate cancer in the health aging and body composition study.

OBJECTIVES: To examine and compare changes in strength and physical function from pre- to post-diagnosis among men with prostate cancer (PC, [cases]) and matched non-cancer controls identified from the Health, Aging and Body Composition (Health ABC) study. MATERIALS AND METHODS: We conducted a longitudinal analysis of 2 strength and 3 physical function-based measures among both cases and controls, identified from a large cohort of community living older adults enrolled in the Health ABC study. We plotted trajectories for each measure and compared cases vs. controls from the point of diagnosis onwards using mixed-effects regression models. For cases only, we examined predictors of poor strength or physical function. RESULTS: We identified 117 PC cases and 453 matched non-cancer controls (50% African Americans). At baseline, there were no differences between cases and controls in demographic factors, comorbidities or self-reported physical function; however, cases had slightly better grip strength (44.6 kg vs. 41.0 kg, p<0.01), quadriceps strength (360.5 Nm vs. 338.7 Nm, p = 0.02) and Health ABC physical performance battery scores (2.4 vs. 2.3, p = 0.01). All men experienced similar declines in strength and physical function over an equivalent amount of time. The loss of quad strength was most notable, with losses of nearly two-thirds of baseline strength over approximately 7 years of follow up. CONCLUSIONS: Among both cases and controls, strength and physical function decline with increasing age. The largest declines were seen in lower body strength. Regular assessments should guide lifestyle interventions that can offset age- and treatment-related declines among men with PC.
Authors
Lucas, AR; Bitting, RL; Fanning, J; Isom, S; Rejeski, WJ; Klepin, HD; Kritchevsky, SB
MLA Citation
Lucas, Alexander R., et al. “Trajectories in muscular strength and physical function among men with and without prostate cancer in the health aging and body composition study.Plos One, vol. 15, no. 2, 2020, p. e0228773. Pubmed, doi:10.1371/journal.pone.0228773.
URI
https://scholars.duke.edu/individual/pub1432406
PMID
32053654
Source
pubmed
Published In
Plos One
Volume
15
Published Date
Start Page
e0228773
DOI
10.1371/journal.pone.0228773

Safety, tolerability and efficacy of agonist anti-CD27 antibody (varlilumab) administered in combination with anti-PD-1 (nivolumab) in advanced solid tumors.

BACKGROUND: Phase 1/2 dose-escalation and expansion study evaluating varlilumab, a fully human agonist anti-CD27 mAb, with nivolumab in anti-PD-1/L1 naïve, refractory solid tumors. METHODS: Phase 1 evaluated the safety of varlilumab (0.1-10 mg/kg) with nivolumab (3 mg/kg) administered once every 2 weeks. Phase 2 evaluated varlilumab regimens (3 mg/kg once every 2 weeks, 3 mg/kg once every 12 weeks, and 0.3 mg/kg once every 4 weeks) with nivolumab 240 mg once every 2 weeks in tumor-specific cohorts. Primary objective was safety; key clinical endpoints included objective response rate (ORR) and overall survival rate at 12 months (OS12) (glioblastoma (GBM) only). Exploratory objectives included determination of effects on peripheral blood and intratumoral immune signatures. RESULTS: 175 patients were enrolled (36 in phase 1 and 139 in phase 2). Phase 1 dose-escalation proceeded to the highest varlilumab dose level without determining a maximum tolerated dose. In phase 2, ORR were ovarian 12.5%, squamous cell carcinoma of the head and neck 12.5%, colorectal cancer 5%, and renal cell carcinoma 0%; GBM OS12 was 40.9%. Increased tumor PD-L1 and intratumoral T cell infiltration were observed in ovarian cancer patients, with increases of ≥5% associated with better progression-free survival. The most common treatment related adverse events were fatigue (18%), pruritus (16%), and rash (15%). CONCLUSION: Varlilumab and nivolumab were well tolerated, without significant toxicity beyond that expected for each agent alone. Clinical activity was observed in patients that are typically refractory to anti-PD-1 therapy, however, overall was not greater than expected for nivolumab monotherapy. Treatment was associated with proinflammatory changes in the tumor microenvironment, particularly in ovarian cancer where the changes were associated with better clinical outcomes. TRIAL REGISTRATION NUMBER: NCT02335918.
Authors
Sanborn, RE; Pishvaian, MJ; Callahan, MK; Weise, A; Sikic, BI; Rahma, O; Cho, DC; Rizvi, NA; Sznol, M; Lutzky, J; Bauman, JE; Bitting, RL; Starodub, A; Jimeno, A; Reardon, DA; Kaley, T; Iwamoto, F; Baehring, JM; Subramaniam, DS; Aragon-Ching, JB; Hawthorne, TR; Rawls, T; Yellin, M; Keler, T
MLA Citation
Sanborn, Rachel E., et al. “Safety, tolerability and efficacy of agonist anti-CD27 antibody (varlilumab) administered in combination with anti-PD-1 (nivolumab) in advanced solid tumors.J Immunother Cancer, vol. 10, no. 8, Aug. 2022. Pubmed, doi:10.1136/jitc-2022-005147.
URI
https://scholars.duke.edu/individual/pub1532507
PMID
35940825
Source
pubmed
Published In
Journal for Immunotherapy of Cancer
Volume
10
Published Date
DOI
10.1136/jitc-2022-005147

Homologous Recombination Repair Gene Variants and Outcomes Among Patients With Prostate Cancer Treated With Poly (ADP-ribose) Polymerase Inhibitors.

PURPOSE: Poly ADP-ribose polymerase inhibitors (PARPi) are used for patients with advanced prostate cancer bearing alterations in homologous recombination repair (HRR) genes. We sought to characterize HRR gene variants and describe real-world outcomes for patients on PARPi. METHODS: The US Department of Veterans Affairs' National Precision Oncology Program's database was reviewed to identify patients who underwent somatic DNA sequencing and were prescribed a PARPi before May 15, 2020. Somatic and germline variants within HRR genes were reported, and pathogenicity was reviewed via OncoKB. In patients treated with PARPi for > 4 weeks, the rate of those achieving a 30% decrease in prostate-specific antigen (PSA30) and composite progression-free survival (PFS) were compared between patients bearing pathogenic variants of BRCA2 and patients without these variants using Mann-Whitney and log-rank tests, respectively. RESULTS: Forty-eight patients bearing 67 total HRR gene variants were prescribed PARPi for prostate cancer. Twenty-one patients (43.8%) were found to have at least one pathogenic HRR gene variant. Eight (16.6%) were referred to genetic counseling, and five (10.4%) were ultimately confirmed with germline variants. The median PFS was 4.0 months, and PSA30 was 25.6% (11 of 43) for all 43 evaluable patients. Patients with pathogenic BRCA2 variants (n = 13) had higher PSA30 (69.2% v 4.0%; P < .001) and longer PFS (7.2 v 2.8 months; P = .0291) than those without. CONCLUSION: In a real-world setting, heavily pretreated patients with prostate cancer and pathogenic BRCA2 variants have a significant PSA response rate and a PFS > 7 months with PARPi. This work emphasizes the importance of determining pathogenicity and origin of HRR alterations to better inform clinical treatment decisions and highlights the need for provider education and other decision support tools.
Authors
Price, MJ; Vashistha, V; Winski, D; Kelley, MJ; Bitting, RL; Montgomery, B
MLA Citation
Price, Meghan J., et al. “Homologous Recombination Repair Gene Variants and Outcomes Among Patients With Prostate Cancer Treated With Poly (ADP-ribose) Polymerase Inhibitors.Jco Precis Oncol, vol. 6, Apr. 2022, p. e2100461. Pubmed, doi:10.1200/PO.21.00461.
URI
https://scholars.duke.edu/individual/pub1519395
PMID
35476551
Source
pubmed
Published In
Jco Precision Oncology
Volume
6
Published Date
Start Page
e2100461
DOI
10.1200/PO.21.00461

Feasibility of home-based exercise training in men with metastatic castration-resistant prostate cancer.

BACKGROUND: Home-based training increases accessibility to exercise and mitigates the side effects of hormone therapy for prostate cancer (PC). However, it is unknown if men with more advanced disease are willing to partake in such interventions. PURPOSE: To determine the feasibility of a home-based exercise intervention in men with metastatic castration-resistant prostate cancer (mCRPC). METHODS: mCRPC patients on androgen receptor signaling inhibitors (ARSI) were prescribed a 12-week, home-based exercise intervention using resistance bands and walking. Feasibility was assessed using recruitment, retention, adherence, and outcome capture. Physiological changes and patient reported outcomes were assessed before and after the intervention. RESULTS: Of the 62 referrals, 47 were eligible with 22 men performing baseline testing (47% recruitment rate) and 16 completing the intervention (73% retention). Task completion was >86% for all physiological tests. Walking adherence was 80% and resistance training was 63%, the latter falling short of the study target (75%). Training increased thigh muscle cross-sectional area by 22%, time to exhaustion by 19% (both p < 0.05) and peak oxygen uptake by 6% (p = 0.057). Improvements in short physical performance battery scores and 400 m walk demonstrated moderate effect sizes that did not reach significance. CONCLUSIONS: Home-based exercise is feasible during ARSI treatment for mCRPC. Greater endurance capacity and localized hypertrophy appear as the primary improvements following training. These preliminary findings suggest home-based training may increase exercise accessibility, with important lessons that will inform subsequent trials investigating the efficacy of home-based exercise interventions during mCRPC.
Authors
Hanson, ED; Alzer, M; Carver, J; Stopforth, CK; Lucas, AR; Whang, YE; Milowsky, MI; Bartlett, DB; Harrison, MR; Bitting, RL; Deal, AM; Stoner, L; Hackney, AC; Battaglini, CL
MLA Citation
Hanson, Erik D., et al. “Feasibility of home-based exercise training in men with metastatic castration-resistant prostate cancer.Prostate Cancer Prostatic Dis, Mar. 2022. Pubmed, doi:10.1038/s41391-022-00523-8.
URI
https://scholars.duke.edu/individual/pub1513151
PMID
35306542
Source
pubmed
Published In
Prostate Cancer Prostatic Dis
Published Date
DOI
10.1038/s41391-022-00523-8

Research Areas:

Clinical Trials as Topic
Gene Expression
Individualized Medicine
Neoplasm Staging
Neoplastic Cells, Circulating
Precision Medicine
Prognosis
Prostate
Signal Transduction
Treatment Outcome
Tumor Markers, Biological