Bridget Koontz

Overview:

Clinical: Board-certified in radiation treatment for all cancer locations/types.
Research: The long-term goal of Dr. Koontz’s research is to minimize treatment-related side effects of radiotherapy.  To that end she has a laboratory studying the mechanisms of radiation induced erectile dysfunction and testing interventions to treat and prevent this devastating side effect of radiotherapy.  Her clinical research investigates optimizing prostate cancer treatment and utilizes collaborations with colleagues in surgery and psychiatry to pursue further understanding of how sexual dysfunction develops after radiotherapy and how to improve patient-provider interactions regarding the sexuality and intimacy consequences of cancer therapy.

Positions:

Associate Professor of Radiation Oncology

Radiation Oncology
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

B.S. 1998

Allegheny College

M.D. 2002

Harvard University

Internship

University of North Carolina, Chapel Hill, School of Medicine

Residency Training, Radiation Oncology

Duke University School of Medicine

Grants:

Movember Foundation GAP6 project

Administered By
Pathology
Awarded By
Movember Foundation
Role
Principal Investigator
Start Date
End Date

Trimodality Approach to Unfavorable Localized Prostate Cancer: a prospective trial of Neoadjuvant Pembrolizumab, ADT, and Prostate SBRT followed by Radical Prostatectomy

Administered By
Duke Cancer Institute
Awarded By
Merck & Co., Inc.
Role
Principal Investigator
Start Date
End Date

A prospective, Phase 3, multi-center, single-arm, imaging study investigating the safety and diagnostic performance of rhPSMA-7.3 (18F) PET ligand in men with suspected prostate cancer recurrence based on elevated PSA following prior therapy

Administered By
Duke Cancer Institute
Awarded By
Blue Earth Diagnostics
Role
Principal Investigator
Start Date
End Date

Publications:

PET-directed local or systemic therapy intensification in prostate cancer patients with post-prostatectomy biochemical recurrence: A trial of the ECOG-ACRIN Cancer Research Group (EA8191).

<jats:p> TPS267 </jats:p><jats:p> Background: Radiation therapy (RT) to the prostate bed and pelvic nodes with short-term androgen deprivation therapy (STAD) is considered a standard of care (SOC) salvage therapy (ST) paradigm for prostate cancer (PC) patients (pts) with post-prostatectomy (RP) biochemical recurrence (BCR). Fluciclovine-PET/CT imaging is FDA-approved in this setting, with improved accuracy for detection of metastases (mets) not identified with conventional imaging (CIM). Given greater sensitivity and specificity of PET, its findings are being increasingly but variably applied to justify modification or omission of SOC therapies without high-level evidence of clinical benefit. PET may help identify candidates for local or systemic treatment intensification of otherwise non-tailored SOC. Earlier detection of mets with molecular imaging has led to increasing use of focally ablative met-directed RT, to delay or enhance systemic therapy through better local control. There is also interest in earlier use of advanced systemic therapy; apalutamide (Apa) is a nonsteroidal antiandrogen with established efficacy in improving overall and radiographic progression-free survival (PFS) for non-metastatic castrate-resistant and metastatic castration-sensitive PC, and potential activity for low-volume mets. This study will evaluate whether pts with PET-detected lesions benefit from such local or systemic treatment intensification approaches. Methods: PC pts with post-RP BCR (PSA&gt;0.5ng/mL; &gt;0.2 if RP within 12 mos), and negative CIM who are candidates for SOC ST (RT to prostate bed and pelvic nodes + STAD) and undergo SOC baseline PET are eligible. The study will initially use <jats:sup>18</jats:sup>F-fluciclovine but permit additional radiotracers based on FDA approval and availability. Based on institutional clinical interpretation of the SOC PET, pts will be placed in Cohort 1 (PET-negative) or 2 (PET-positive for extra-pelvic mets). Cohort 1 will be randomized to SOC ST +/- Apa for 6 months and Cohort 2 will be randomized to SOC ST and Apa +/- met-directed RT to PET-positive lesions. The primary endpoint is PFS, defined as time from randomization to radiographic progression on CIM, symptomatic disease or death. Primary objectives are to evaluate whether addition of Apa to SOC ST and addition of met-directed RT to SOC ST and Apa could prolong PFS in Cohorts 1 and 2, respectively. For Cohort 1, 480 pts will be randomized with 85% power to distinguish 5-year PFS rate of 90% (Apa arm) vs. 80% (SOC arm) using one-sided stratified logrank test with type I error of 0.025. For Cohort 2, 324 pts will be randomized with 85% power to distinguish 5-year PFS rate of 76.5% in experimental arm from 61.5% in control arm. Secondary endpoints include overall and event-free survival, toxicity, and PET progression. Trial was activated on October 8, 2020; NCT04423211. Acknowledgement: This study was conducted by the ECOG-ACRIN Cancer Research Group (Peter J. O'Dwyer, MD and Mitchell D. Schnall, MD, PhD, Group Co-Chairs) and supported by the National Cancer Institute of the National Institutes of Health under the following award numbers: U10CA180794, U10CA180820, U10CA180868, U10CA180888, U10CA180821, UG1CA233196, UG1CA233253, UG1CA233277, UG1CA233328, and UG1CA233330. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Mention of trade names, commercial products, or organizations does not imply endorsement by the U.S. government. Clinical trial information: NCT 04423211. </jats:p>
Authors
Vapiwala, N; Chen, Y-H; Cho, SY; Duan, F; Kyriakopoulos, C; Shevrin, DH; McKay, RR; Koontz, BF; Yu, EY; Beylergil, V; McConathy, J; Liu, G; Mankoff, DA; Wong, TZ; Carducci, MA
MLA Citation
Vapiwala, Neha, et al. “PET-directed local or systemic therapy intensification in prostate cancer patients with post-prostatectomy biochemical recurrence: A trial of the ECOG-ACRIN Cancer Research Group (EA8191).Journal of Clinical Oncology, vol. 39, no. 6_suppl, American Society of Clinical Oncology (ASCO), 2021, pp. TPS267–TPS267. Crossref, doi:10.1200/jco.2021.39.6_suppl.tps267.
URI
https://scholars.duke.edu/individual/pub1480426
Source
crossref
Published In
Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology
Volume
39
Published Date
Start Page
TPS267
End Page
TPS267
DOI
10.1200/jco.2021.39.6_suppl.tps267

Interim analysis of STARTAR: A phase II salvage trial of androgen receptor (AR) inhibition with androgen deprivation therapy (ADT) and apalutamide with radiation therapy (RT) followed by docetaxel in men with PSA recurrent prostate cancer (PC) after radic

<jats:p> 90 </jats:p><jats:p> Background: ADT with salvage RT improves survival for men with PSA recurrence after RP. Current standard duration of ADT for high risk PSA recurrence is up to 2 years with RT; therefore shortening but intensifying systemic therapy may improve outcomes. The STREAM trial showed 6 mo of enzalutamide added to ADT/RT had a 3-year progression free survival (PFS) of 53% in high risk patients including lymph node (LN) positive. Given that docetaxel improves survival in men with mHSPC, we evaluated the combination of salvage RT, ADT/apalutamide and docetaxel in this setting. Methods: STARTAR is a multicenter phase 2 trial for salvage treatment of PSA recurrent PC following RP conducted within the US Dept. of Defense Prostate Cancer Clinical Trials Consortium (DOD PCCTC). Key inclusion criteria included PC with Gleason 7 with T3/positive margin/1-4 positive LNs or Gleason 8-10 disease and PSA relapse within 4 years of RP (min PSA 0.2 ng/mL to max PSA 4 ng/mL). Men with up to 4 positive resected LNs were eligible. Men started ADT with apalutamide, continued with RT (66-74 Gy to the prostate bed +/- pelvic LNs over 6-8 weeks), and finally completed docetaxel 75mg/m2 IV q3 weeks for 6 cycles. Men were treated with ADT and apalutamide for approximately 9 months. The primary endpoint was PSA PFS at 36 months. This interim analysis evaluated secondary endpoints of 1-year PSA recurrence, testosterone recovery, and safety of this treatment sequence. Results: From 3/2018 to 12/2019, 39 men were enrolled at Duke, Wake Forest, Cornell, and the GU Research Network. With a data cutoff in 9/2020, median follow up from enrollment was 14 months. Baseline patient characteristics included Gleason 4+3 = 7 in 54% and Gleason 8-10 in 46%, and 23% LN positive; median PSA at the time of enrollment was 0.58 ng/mL (range 0.21-3.40) and the median time from RP to enrollment was 7 mo (range 2-98). At 1 year, there have been no progression events with 38% (12/31) of men with post-treatment testosterone recovery into normal range (recovery time median 10 mos [1-17 mos]). Common adverse events (AEs) of any-grade at least possibly related to the regimen were 98% hot flashes, 88% fatigue, 77% alopecia, 57% dysgeusia, and 53% rash (28% grade 1; 15% grade 2, 10% grade 3), with neutropenia as the most common grade 3/4 AE (27/39 men, 70%) with two grade 3 febrile neutropenia. Conclusions: In this first phase 2 trial of ADT, apalutamide, radiation, and 6 cycles docetaxel in the salvage setting for high risk PSA recurrence, short term outcomes are excellent with no recurrences at 12 months of follow-up. This salvage treatment was well tolerated in the majority of men with the exception of a high rate of drug rashes and neutropenia related to the course of treatment, in line with known safety profiles of the study agents. Clinical trial information: NCT03311555. </jats:p>
Authors
Zhang, T; Koontz, BF; Tagawa, ST; Nagar, H; Bitting, RL; Frizzell, B; Nordquist, LT; Rasmussen, J; Wilder, R; Anand, M; Winters, C; Riggan, C; Fernandez, E; Healy, P; Oyekunle, T; Wu, Y; McNamara, MA; Harrison, MR; George, DJ; Armstrong, AJ
MLA Citation
Zhang, Tian, et al. “Interim analysis of STARTAR: A phase II salvage trial of androgen receptor (AR) inhibition with androgen deprivation therapy (ADT) and apalutamide with radiation therapy (RT) followed by docetaxel in men with PSA recurrent prostate cancer (PC) after radical prostatectomy (RP).Journal of Clinical Oncology, vol. 39, no. 6_suppl, American Society of Clinical Oncology (ASCO), 2021, pp. 90–90. Crossref, doi:10.1200/jco.2021.39.6_suppl.90.
URI
https://scholars.duke.edu/individual/pub1480286
Source
crossref
Published In
Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology
Volume
39
Published Date
Start Page
90
End Page
90
DOI
10.1200/jco.2021.39.6_suppl.90

NRG Oncology Updated International Consensus Atlas on Pelvic Lymph Node Volumes for Intact and Postoperative Prostate Cancer.

PURPOSE: In 2009, the Radiation Therapy Oncology Group (RTOG) genitourinary members published a consensus atlas for contouring prostate pelvic nodal clinical target volumes (CTVs). Data have emerged further informing nodal recurrence patterns. The objective of this study is to provide an updated prostate pelvic nodal consensus atlas. METHODS AND MATERIALS: A literature review was performed abstracting data on nodal recurrence patterns. Data were presented to a panel of international experts, including radiation oncologists, radiologists, and urologists. After data review, participants contoured nodal CTVs on 3 cases: postoperative, intact node positive, and intact node negative. Radiation oncologist contours were analyzed qualitatively using count maps, which provided a visual assessment of controversial regions, and quantitatively analyzed using Sorensen-Dice similarity coefficients and Hausdorff distances compared with the 2009 RTOG atlas. Diagnostic radiologists generated a reference table outlining considerations for determining clinical node positivity. RESULTS: Eighteen radiation oncologists' contours (54 CTVs) were included. Two urologists' volumes were examined in a separate analysis. The mean CTV for the postoperative case was 302 cm3, intact node positive case was 409 cm3, and intact node negative case was 342 cm3. Compared with the original RTOG consensus, the mean Sorensen-Dice similarity coefficient for the postoperative case was 0.63 (standard deviation [SD] 0.13), the intact node positive case was 0.68 (SD 0.13), and the intact node negative case was 0.66 (SD 0.18). The mean Hausdorff distance (in cm) for the postoperative case was 0.24 (SD 0.13), the intact node positive case was 0.23 (SD 0.09), and intact node negative case was 0.33 (SD 0.24). Four regions of CTV controversy were identified, and consensus for each of these areas was reached. CONCLUSIONS: Discordance with the 2009 RTOG consensus atlas was seen in a group of experienced NRG Oncology and international genitourinary radiation oncologists. To address areas of variability and account for new data, an updated NRG Oncology consensus contour atlas was developed.
Authors
Hall, WA; Paulson, E; Davis, BJ; Spratt, DE; Morgan, TM; Dearnaley, D; Tree, AC; Efstathiou, JA; Harisinghani, M; Jani, AB; Buyyounouski, MK; Pisansky, TM; Tran, PT; Karnes, RJ; Chen, RC; Cury, FL; Michalski, JM; Rosenthal, SA; Koontz, BF; Wong, AC; Nguyen, PL; Hope, TA; Feng, F; Sandler, HM; Lawton, CAF
MLA Citation
Hall, William A., et al. “NRG Oncology Updated International Consensus Atlas on Pelvic Lymph Node Volumes for Intact and Postoperative Prostate Cancer.Int J Radiat Oncol Biol Phys, vol. 109, no. 1, Jan. 2021, pp. 174–85. Pubmed, doi:10.1016/j.ijrobp.2020.08.034.
URI
https://scholars.duke.edu/individual/pub1460042
PMID
32861817
Source
pubmed
Published In
Int J Radiat Oncol Biol Phys
Volume
109
Published Date
Start Page
174
End Page
185
DOI
10.1016/j.ijrobp.2020.08.034

The role of radiation treatment in metastatic prostate cancer.

Authors
MLA Citation
Koontz, Bridget F. “The role of radiation treatment in metastatic prostate cancer.Clin Adv Hematol Oncol, vol. 18, no. 11, Nov. 2020, pp. 707–09.
URI
https://scholars.duke.edu/individual/pub1467026
PMID
33406062
Source
pubmed
Published In
Clinical Advances in Hematology & Oncology : H&O
Volume
18
Published Date
Start Page
707
End Page
709

Through COVID-Colored Glasses: New Perspectives on Same Data.

Authors
MLA Citation
Koontz, Bridget F. “Through COVID-Colored Glasses: New Perspectives on Same Data.Int J Radiat Oncol Biol Phys, vol. 108, no. 2, Oct. 2020, p. 338. Pubmed, doi:10.1016/j.ijrobp.2020.07.011.
URI
https://scholars.duke.edu/individual/pub1460043
PMID
32890503
Source
pubmed
Published In
Int J Radiat Oncol Biol Phys
Volume
108
Published Date
Start Page
338
DOI
10.1016/j.ijrobp.2020.07.011

Research Areas:

Adult
Aged
Androgen Antagonists
Animals
Antibodies, Monoclonal
Biological Markers
Bone Neoplasms
Brachytherapy
Breast Neoplasms
Chemotherapy, Adjuvant
Clinical Trials as Topic
Combined Modality Therapy
Disease Models, Animal
Disease-Free Survival
Dose-Response Relationship, Radiation
Epidemiologic Methods
Erectile Dysfunction
Follow-Up Studies
Head and Neck Neoplasms
Health Facilities
Heart Diseases
Hospitals
Humans
Indicators and Reagents
Indium Radioisotopes
Inflammation
Lymph Nodes
Lymphatic Irradiation
Male
Mammary Glands, Human
Matched-Pair Analysis
Middle Aged
Models, Molecular
Morbidity
NADPH Oxidase
NADPH Oxidases
Neoadjuvant Therapy
Neoplasm Grading
Neoplasm Invasiveness
Neoplasm Recurrence, Local
Neoplasm Staging
Neoplasms, Hormone-Dependent
Neoplasms, Radiation-Induced
North Carolina
Organ Specificity
Oxidative Stress
Palliative Care
Patient Care Team
Patient Selection
Pelvis
Penile Erection
Penile Prosthesis
Penis
Preoperative Care
Prostate
Prostate-Specific Antigen
Prostatectomy
Prostatic Neoplasms
Radiation Dosage
Radiation Injuries
Radiation Injuries, Experimental
Radiosurgery
Radiotherapy
Radiotherapy Dosage
Radiotherapy Planning, Computer-Assisted
Radiotherapy, Adjuvant
Radiotherapy, Conformal
Radiotherapy, High-Energy
Rats
Rats, Sprague-Dawley
Retrospective Studies
Risk Assessment
Risk Factors
Salvage Therapy
Soft Tissue Neoplasms
Survival Rate
Tomography, X-Ray Computed
Treatment Outcome
Tumor Markers, Biological
Urinary Bladder