Rebecca Previs

Positions:

Assistant 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. 2009

University of Virginia School of Medicine

Residency, Obstetrics And Gynecology

Duke University School of Medicine

Fellow, Gynecologic Oncology

University of Texas MD Anderson Cancer Center

Grants:

Evaluation of homologous recombination deficiency in uterine serous cancer

Administered By
Obstetrics and Gynecology, Gynecologic Oncology
Awarded By
Myriad Genetics, Inc.
Role
Principal Investigator
Start Date
End Date

Publications:

Molecular Classification to Prognosticate Response in Medically Managed Endometrial Cancers and Endometrial Intraepithelial Neoplasia.

BACKGROUND: The aim of this study was to evaluate whether molecular classification prognosticates treatment response in women with endometrial cancers and endometrial intraepithelial neoplasia (EIN) treated with levonorgestrel intrauterine system (LNG-IUS). METHODS: Patients treated with LNG-IUS for endometrial cancer or EIN from 2013 to 2018 were evaluated. Using immunohistochemistry and single gene sequencing of POLE, patients were classified into four groups as per the Proactive Molecular Risk Classifier for Endometrial cancer (ProMisE): POLE-mutated, mismatch repair-deficient (MMRd), p53 wild type (p53wt), and p53-abnormal (p53abn). Groups were assessed relative to the primary outcome of progression or receipt of definitive treatment. RESULTS: Fifty-eight subjects with endometrioid endometrial cancer or EIN treated with LNG-IUS were included. Of these, 22 subjects (37.9%) had endometrial cancer and 36 subjects (62.1%) had EIN. Per the ProMisE algorithm, 44 patients (75.9%) were classified as p53wt, 6 (10.3%) as MMRd, 4 (6.9%) as p53abn, and 4 (6.9%) as POLE-mutated. Of the 58 patients, 11 (19.0%) progressed or opted for definitive therapy. Median time to progression or definitive therapy was 7.5 months, with p53abn tumors having the shortest time to progression or definitive therapy. CONCLUSIONS: Molecular classification of endometrial cancer and EIN prior to management with LNG-IUS is feasible and may predict patients at risk of progression.
Authors
Puechl, AM; Spinosa, D; Berchuck, A; Secord, AA; Drury, KE; Broadwater, G; Wong, J; Whitaker, R; Devos, N; Corcoran, DL; Strickland, KC; Previs, RA
MLA Citation
Puechl, Allison M., et al. “Molecular Classification to Prognosticate Response in Medically Managed Endometrial Cancers and Endometrial Intraepithelial Neoplasia.Cancers (Basel), vol. 13, no. 11, June 2021. Pubmed, doi:10.3390/cancers13112847.
URI
https://scholars.duke.edu/individual/pub1484762
PMID
34200374
Source
pubmed
Published In
Cancers
Volume
13
Published Date
DOI
10.3390/cancers13112847

Health Care Access Measures and Palliative Care Use by Race/Ethnicity among Metastatic Gynecological Cancer Patients in the United States.

Palliative care improves quality-of-life and extends survival, however, is underutilized among gynecological cancer patients in the United States (U.S.). Our objective was to evaluate associations between healthcare access (HCA) measures and palliative care utilization among U.S. gynecological cancer patients overall and by race/ethnicity. We used 2004-2016 data from the U.S. National Cancer Database and included patients with metastatic (stage III-IV at-diagnosis) ovarian, cervical, and uterine cancer (n = 176,899). Palliative care was defined as non-curative treatment and could include surgery, radiation, chemotherapy, and pain management, or any combination. HCA measures included insurance type, area-level socioeconomic measures, distance-to-care, and cancer treatment facility type. We evaluated associations of HCA measures with palliative care use overall and by race/ethnicity using multivariable logistic regression. Our population was mostly non-Hispanic White (72%), had ovarian cancer (72%), and 24% survived <6 months. Five percent of metastatic gynecological cancer patients utilized palliative care. Compared to those with private insurance, uninsured patients with ovarian (aOR: 1.80,95% CI: 1.53-2.12), and cervical (aOR: 1.45,95% CI: 1.26-1.67) cancer were more likely to use palliative care. Patients with ovarian (aOR: 0.58,95% CI: 0.48-0.70) or cervical cancer (aOR: 0.74,95% CI: 0.60-0.88) who reside >45 miles from their provider were less likely to utilize palliative care than those within <2 miles. Ovarian cancer patients treated at academic/research programs were less likely to utilize palliative care compared to those treated at community cancer programs (aOR: 0.70, 95%CI: 0.58-0.84). Associations between HCA measures and palliative care utilization were largely consistent across U.S. racial-ethnic groups. Insurance type, cancer treatment facility type, and distance-to-care may influence palliative care use among metastatic gynecological cancer patients in the U.S.
Authors
Islam, JY; Saraiya, V; Previs, RA; Akinyemiju, T
MLA Citation
Islam, Jessica Y., et al. “Health Care Access Measures and Palliative Care Use by Race/Ethnicity among Metastatic Gynecological Cancer Patients in the United States.Int J Environ Res Public Health, vol. 18, no. 11, June 2021. Pubmed, doi:10.3390/ijerph18116040.
URI
https://scholars.duke.edu/individual/pub1483885
PMID
34199732
Source
pubmed
Published In
International Journal of Environmental Research and Public Health
Volume
18
Published Date
DOI
10.3390/ijerph18116040

SARS-CoV-2 vaccination in gynecologic oncology

Authors
Alholm, Z; Spinosa, D; Previs, RA; Shuey, SL; O'Malley, DM; Randall, L; Slomovitz, B; Monk, BJ
MLA Citation
Alholm, Z., et al. “SARS-CoV-2 vaccination in gynecologic oncology.” European Journal of Gynaecological Oncology, vol. 42, no. 2, Apr. 2021, pp. 402–04. Scopus, doi:10.31083/j.ejgo.2021.02.2491.
URI
https://scholars.duke.edu/individual/pub1482687
Source
scopus
Published In
European Journal of Gynaecological Oncology
Volume
42
Published Date
Start Page
402
End Page
404
DOI
10.31083/j.ejgo.2021.02.2491

Macrophage depletion through colony stimulating factor 1 receptor pathway blockade overcomes adaptive resistance to anti-VEGF therapy.

Anti-angiogenesis therapy has shown clinical benefit in patients with high-grade serous ovarian cancer (HGSC), but adaptive resistance rapidly emerges. Thus, approaches to overcome such resistance are needed. We developed the setting of adaptive resistance to anti-VEGF therapy, and performed a series of in vivo experiments in both immune competent and nude mouse models. Given the pro-angiogenic properties of tumor-associated macrophages (TAMs) and the dominant role of CSF1R in macrophage function, we added CSF1R inhibitors following emergence of adaptive resistance to anti-VEGF antibody. Mice treated with a CSF1R inhibitor (AC708) after anti-VEGF antibody resistance had little to no measurable tumor burden upon completion of the experiment while those that did not receive a CSF1R inhibitor still had abundant tumor. To mimic clinically used regimens, mice were also treated with anti-VEGF antibody and paclitaxel until resistance emerged, and then a CSF1R inhibitor was added. The addition of a CSF1R inhibitor restored response to anti-angiogenesis therapy, resulting in 83% lower tumor burden compared to treatment with anti-VEGF antibody and paclitaxel alone. Collectively, our data demonstrate that the addition of a CSF1R inhibitor to anti-VEGF therapy and taxane chemotherapy results in robust anti-tumor effects.
Authors
Lyons, YA; Pradeep, S; Wu, SY; Haemmerle, M; Hansen, JM; Wagner, MJ; Villar-Prados, A; Nagaraja, AS; Dood, RL; Previs, RA; Hu, W; Zhao, Y; Mak, DH; Xiao, Z; Melendez, BD; Lizee, GA; Mercado-Uribe, I; Baggerly, KA; Hwu, P; Liu, J; Overwijk, WW; Coleman, RL; Sood, AK
MLA Citation
Lyons, Yasmin A., et al. “Macrophage depletion through colony stimulating factor 1 receptor pathway blockade overcomes adaptive resistance to anti-VEGF therapy.Oncotarget, vol. 8, no. 57, Nov. 2017, pp. 96496–505. Pubmed, doi:10.18632/oncotarget.20410.
URI
https://scholars.duke.edu/individual/pub1482686
PMID
29228548
Source
pubmed
Published In
Oncotarget
Volume
8
Published Date
Start Page
96496
End Page
96505
DOI
10.18632/oncotarget.20410

Primary cytoreductive surgery for advanced stage endometrial cancer: a systematic review and meta-analysis.

OBJECTIVE: Endometrial cancer uncommonly presents at an advanced stage and little prospective evidence exists to guide the management thereof. We aimed to summarize the evidence about primary cytoreductive surgery in the treatment of advanced stage endometrial cancer. DATA SOURCES: MEDLINE, Embase, and Scopus databases were searched from inception to September 11, 2020, using search terms representing the themes "endometrial cancer," "advanced stage," and "primary cytoreductive surgery." STUDY ELIGIBILITY CRITERIA: We included full-text, English reports that included ≥10 patients undergoing primary cytoreductive surgery for advanced stage endometrial cancer and that reported on the outcomes of primary cytoreductive surgery and survival rates based on the residual disease burden. METHODS: Two reviewers independently screened the studies and with disagreements between the reviewers resolved by a third reviewer. Data were extracted using a standardized form. The percentage of cases reaching maximal (no gross residual disease) and optimal (<1 cm or <2 cm residual disease) cytoreduction were assessed by summing binomials proportions, and the association with survival was assessed using an inverse variance-weighted meta-analysis of logarithmic hazard ratios. RESULTS: From 1219 unique records identified, 34 studies were selected for inclusion. Studies consisted of single or multi-institutional cohorts of patients collected over a period of 6 to 24 years and included various mixes of histologies (endometrioid, serous, clear cell, and carcinosarcoma) and disease stages (III or IV). In a meta-analysis of the extent of residual disease after primary cytoreductive surgery, we found that 52.1% of cases reached no gross residual disease status (n=18 studies; 1329 patients) and 75% reached <1 cm residual disease status (n=27 studies; 2343 patients). The proportion of cytoreduction for both thresholds was lower for studies of stage IV vs stage III to IV disease (41.4% vs 69.8% for no gross residual disease; 63.2% vs 82.2% for <1 cm residual disease) but did not vary notably by histology. In a meta-analysis of the reported hazard ratios, submaximal (any gross residual disease vs no gross residual disease) and suboptimal (≥1 cm vs <1 cm) cytoreduction thresholds were associated with worse progression-free survival (submaximal hazard ratio, 2.16; 95% confidence interval, 1.45-3.21; I2=68%; suboptimal hazard ratio, 2.55; 95% confidence interval, 1.93-3.37; I2=63%) and overall survival rates (submaximal hazard ratio, 2.57; 95% confidence interval, 2.13-3.10; I2=1%; suboptimal hazard ratio, 2.62; 95% confidence interval, 2.20-3.11; I2=15%). Sensitivity analyses limited to high-quality studies demonstrated consistent results. CONCLUSION: Among cases of advanced stage endometrial cancer undergoing primary cytoreductive surgery, a significant proportion of patients are left with residual disease, which is associated with worse survival outcomes. Further investigations about the roles of neoadjuvant chemotherapy and primary cytoreductive surgery in prospective trials is warranted in this population.
Authors
Albright, BB; Monuszko, KA; Kaplan, SJ; Davidson, BA; Moss, HA; Huang, AB; Melamed, A; Wright, JD; Havrilesky, LJ; Previs, RA
MLA Citation
Albright, Benjamin B., et al. “Primary cytoreductive surgery for advanced stage endometrial cancer: a systematic review and meta-analysis.Am J Obstet Gynecol, vol. 225, no. 3, Sept. 2021, pp. 237.e1-237.e24. Pubmed, doi:10.1016/j.ajog.2021.04.254.
URI
https://scholars.duke.edu/individual/pub1482001
PMID
33957111
Source
pubmed
Published In
American Journal of Obstetrics and Gynecology
Volume
225
Published Date
Start Page
237.e1
End Page
237.e24
DOI
10.1016/j.ajog.2021.04.254