You are here

Stevenson, Marvaretta Miesha

Positions:

Assistant Professor of Medicine

Medicine, Medical Oncology
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

M.D. 2004

M.D. — Medical University of South Carolina School of Medicine

News:

Duke oncologist touts new screening for lung cancer

April 20, 2015 — The News & Observer

Publications:

Occult primary, version 3.2014; Featured updates to the NCCN guidelines

The NCCN Guidelines for Occult Primary tumors provide recommendations for the evaluation, workup, management, and follow-up of patients with occult primary tumors (cancers of unknown primary). These NCCN Guidelines Insights summarize major discussion points of the 2014 NCCN Occult Primary panel meeting. The panel discussed gene expression profiling (GEP) for the identification of the tissue of origin and concluded that, although GEP has a diagnostic benefit, a clinical benefit has not been demonstrated. The panel recommends against GEP as standard management, although 20% of the panel believes the diagnostic benefit of GEP warrants its routine use. In addition, the panel discussed testing for actionable mutations (eg, ALK) to help guide choice of therapy, but declined to add this recommendation. © National Comprehensive Cancer Network, Inc. 2014.

Authors
Ettinger, DS; Handorf, CR; Agulnik, M; Bowles, DW; Cates, JM; Cristea, M; Dotan, E; Eaton, KD; Fidias, PM; Gierada, D; Weldon Gilcrease, G; Godby, K; Iyer, R; Lenzi, R; Phay, J; Rashid, A; Saltz, L; Schwab, RB; Shulman, LN; Smerage, JB; Stevenson, MM; Varadhachary, GR; Zager, JS; Zhen, W; Bergman, MA; Freedman-Cass, DA
MLA Citation
Ettinger, DS, Handorf, CR, Agulnik, M, Bowles, DW, Cates, JM, Cristea, M, Dotan, E, Eaton, KD, Fidias, PM, Gierada, D, Weldon Gilcrease, G, Godby, K, Iyer, R, Lenzi, R, Phay, J, Rashid, A, Saltz, L, Schwab, RB, Shulman, LN, Smerage, JB, Stevenson, MM, Varadhachary, GR, Zager, JS, Zhen, W, Bergman, MA, and Freedman-Cass, DA. "Occult primary, version 3.2014; Featured updates to the NCCN guidelines." JNCCN Journal of the National Comprehensive Cancer Network 12.7 (July 1, 2014): 969-974.
Source
scopus
Published In
Journal of the National Comprehensive Cancer Network : JNCCN
Volume
12
Issue
7
Publish Date
2014
Start Page
969
End Page
974

Tumor acquisition for biomarker research in lung cancer.

The biopsy collection data from two lung cancer trials that required fresh tumor samples be obtained for microarray analysis were reviewed. In the trial for advanced disease, microarray data were obtained on 50 patient samples, giving an overall success rate of 60.2%. The majority of the specimens were obtained through CT-guided lung biopsies (N = 30). In the trial for early-stage patients, 28 tissue specimens were collected from excess tumor after surgical resection with a success rate of 85.7%. This tissue procurement program documents the feasibility in obtaining fresh tumor specimens prospectively that could be used for molecular testing.

Authors
Stevenson, M; Christensen, J; Shoemaker, D; Foster, T; Barry, WT; Tong, BC; Wahidi, M; Shofer, S; Datto, M; Ginsburg, G; Crawford, J; D'Amico, T; Ready, N
MLA Citation
Stevenson, M, Christensen, J, Shoemaker, D, Foster, T, Barry, WT, Tong, BC, Wahidi, M, Shofer, S, Datto, M, Ginsburg, G, Crawford, J, D'Amico, T, and Ready, N. "Tumor acquisition for biomarker research in lung cancer." Cancer investigation 32.6 (July 2014): 291-298.
PMID
24810245
Source
epmc
Published In
Cancer Investigation (Informa)
Volume
32
Issue
6
Publish Date
2014
Start Page
291
End Page
298
DOI
10.3109/07357907.2014.911880

Occult primary, version 3.2014.

The NCCN Guidelines for Occult Primary tumors provide recommendations for the evaluation, workup, management, and follow-up of patients with occult primary tumors (cancers of unknown primary). These NCCN Guidelines Insights summarize major discussion points of the 2014 NCCN Occult Primary panel meeting. The panel discussed gene expression profiling (GEP) for the identification of the tissue of origin and concluded that, although GEP has a diagnostic benefit, a clinical benefit has not been demonstrated. The panel recommends against GEP as standard management, although 20% of the panel believes the diagnostic benefit of GEP warrants its routine use. In addition, the panel discussed testing for actionable mutations (eg, ALK) to help guide choice of therapy, but declined to add this recommendation.

Authors
Ettinger, DS; Handorf, CR; Agulnik, M; Bowles, DW; Cates, JM; Cristea, M; Dotan, E; Eaton, KD; Fidias, PM; Gierada, D; Gilcrease, GW; Godby, K; Iyer, R; Lenzi, R; Phay, J; Rashid, A; Saltz, L; Schwab, RB; Shulman, LN; Smerage, JB; Stevenson, MM; Varadhachary, GR; Zager, JS; Zhen, WK; Bergman, MA; Freedman-Cass, DA; National Comprehensive Cancer Network,
MLA Citation
Ettinger, DS, Handorf, CR, Agulnik, M, Bowles, DW, Cates, JM, Cristea, M, Dotan, E, Eaton, KD, Fidias, PM, Gierada, D, Gilcrease, GW, Godby, K, Iyer, R, Lenzi, R, Phay, J, Rashid, A, Saltz, L, Schwab, RB, Shulman, LN, Smerage, JB, Stevenson, MM, Varadhachary, GR, Zager, JS, Zhen, WK, Bergman, MA, Freedman-Cass, DA, and National Comprehensive Cancer Network, . "Occult primary, version 3.2014." Journal of the National Comprehensive Cancer Network : JNCCN 12.7 (July 2014): 969-974.
PMID
24994917
Source
epmc
Published In
Journal of the National Comprehensive Cancer Network : JNCCN
Volume
12
Issue
7
Publish Date
2014
Start Page
969
End Page
974
DOI
10.6004/jnccn.2014.0093

Development of a virtual multidisciplinary lung cancer tumor board in a community setting.

PURPOSE: Creating an effective platform for multidisciplinary tumor conferences can be challenging in the rural community setting. The Duke Cancer Network created an Internet-based platform for a multidisciplinary conference to enhance the care of patients with lung cancer. This conference incorporates providers from different physical locations within a rural community and affiliated providers from a university-based cancer center 2 hours away. An electronic Web conferencing tool connects providers aurally and visually. METHODS: Conferences were set up using a commercially available Web conferencing platform. The video platform provides a secure Web site coupled with a secure teleconference platform to ensure patient confidentiality. Multiple disciplines are invited to participate, including radiology, radiation oncology, thoracic surgery, pathology, and medical oncology. Participants only need telephone access and Internet connection to participate. RESULTS: Patient histories and physicals are presented, and the Web conferencing platform allows radiologic and histologic images to be reviewed. Treatment plans for patients are discussed, allowing providers to coordinate care among the different subspecialties. Patients who need referral to the affiliated university-based cancer center for specialized services are identified. Pertinent treatment guidelines and journal articles are reviewed. On average, there are 10 participants with one to two cases presented per session. CONCLUSION: The use of a Web conferencing platform allows subspecialty providers throughout the community and hours away to discuss lung cancer patient cases. This platform increases convenience for providers, eliminating travel to a central location. Coordination of care for patients requiring multidisciplinary care is facilitated, shortening evaluation time before definitive treatment plan.

Authors
Stevenson, MM; Irwin, T; Lowry, T; Ahmed, MZ; Walden, TL; Watson, M; Sutton, L
MLA Citation
Stevenson, MM, Irwin, T, Lowry, T, Ahmed, MZ, Walden, TL, Watson, M, and Sutton, L. "Development of a virtual multidisciplinary lung cancer tumor board in a community setting." J Oncol Pract 9.3 (May 2013): e77-e80.
PMID
23942505
Source
pubmed
Published In
Journal of Oncology Practice
Volume
9
Issue
3
Publish Date
2013
Start Page
e77
End Page
e80
DOI
10.1200/JOP.2013.000882

Development of a virtual multidisciplinary lung cancer tumor board in a community setting

Authors
Stevenson, MM; Irwin, T; Lowry, T; Ahmed, MZ; Walden, TL; Sutton, L
MLA Citation
Stevenson, MM, Irwin, T, Lowry, T, Ahmed, MZ, Walden, TL, and Sutton, L. "Development of a virtual multidisciplinary lung cancer tumor board in a community setting." JOURNAL OF CLINICAL ONCOLOGY 30.34 (December 1, 2012).
Source
wos-lite
Published In
Journal of Clinical Oncology
Volume
30
Issue
34
Publish Date
2012

Retraction: characterizing the clinical relevance of an embryonic stem cell phenotype in lung adenocarcinoma.

Authors
Stevenson, M; Mostertz, W; Acharya, CR; Kim, W; Walters, K; Barry, W; Higgins, K; Tuchman, SA; Crawford, J; Vlahovic, G; Ready, N; Onaitis, M; Potti, A
MLA Citation
Stevenson, M, Mostertz, W, Acharya, CR, Kim, W, Walters, K, Barry, W, Higgins, K, Tuchman, SA, Crawford, J, Vlahovic, G, Ready, N, Onaitis, M, and Potti, A. "Retraction: characterizing the clinical relevance of an embryonic stem cell phenotype in lung adenocarcinoma." Clin Cancer Res 18.6 (March 15, 2012): 1818-.
PMID
22355011
Source
pubmed
Published In
Clinical cancer research : an official journal of the American Association for Cancer Research
Volume
18
Issue
6
Publish Date
2012
Start Page
1818
DOI
10.1158/1078-0432.CCR-12-0337

A pathway-based approach to identify molecular biomarkers in cancer

Many examples highlight the power of gene expression profiles, or signatures, to provide an understanding of biological phenotypes. This is best seen in the context of cancer, where expression signatures have tremendous power to identify new cancer subtypes and to predict clinical outcomes. Gene expression profiles have been developed to personalize medicine, accurately predicting disease recurrence and tumor response to therapy. The use of these signatures as surrogate phenotypes allows us to link diverse experimental systems, which dissect the complexity of biological systems, with the in vivo setting in a way that was not previously feasible. Taken together, these new genomic tools provide the opportunity to develop rational strategies for treating the individual cancer patient. © 2011 Society of Surgical Oncology.

Authors
Stevenson, M; Potti, A
MLA Citation
Stevenson, M, and Potti, A. "A pathway-based approach to identify molecular biomarkers in cancer." Annals of Surgical Oncology 19.SUPPL. 3 (2012): S620-S624.
PMID
22048630
Source
scival
Published In
Annals of Surgical Oncology
Volume
19
Issue
SUPPL. 3
Publish Date
2012
Start Page
S620
End Page
S624
DOI
10.1245/s10434-011-1855-4

Characterizing the developmental pathways TTF-1, NKX2-8, and PAX9 in lung cancer (Proceedings of the National Academy of Sciences of the United States of America (2009) 106, 13 (5312-5317) DOI: 10.1073/pnas.0900827106)

Authors
Hsu, DS; Acharya, CR; Balakumaran, BS; Riedel, RF; Kim, MK; Stevenson, M; Tuchman, S; Mukherjee, S; Barry, W; Dressman, HK; al, E
MLA Citation
Hsu, DS, Acharya, CR, Balakumaran, BS, Riedel, RF, Kim, MK, Stevenson, M, Tuchman, S, Mukherjee, S, Barry, W, Dressman, HK, and al, E. "Characterizing the developmental pathways TTF-1, NKX2-8, and PAX9 in lung cancer (Proceedings of the National Academy of Sciences of the United States of America (2009) 106, 13 (5312-5317) DOI: 10.1073/pnas.0900827106)." Proceedings of the National Academy of Sciences of the United States of America 108.35 (2011): 14705--.
Source
scival
Published In
Proceedings of the National Academy of Sciences of USA
Volume
108
Issue
35
Publish Date
2011
Start Page
14705-
DOI
10.1073/pnas.1111196108

A Pathway-Based Approach to Identify Molecular Biomarkers in Cancer

Many examples highlight the power of gene expression profiles, or signatures, to provide an understanding of biological phenotypes. This is best seen in the context of cancer, where expression signatures have tremendous power to identify new cancer subtypes and to predict clinical outcomes. Gene expression profiles have been developed to personalize medicine, accurately predicting disease recurrence and tumor response to therapy. The use of these signatures as surrogate phenotypes allows us to link diverse experimental systems, which dissect the complexity of biological systems, with the in vivo setting in a way that was not previously feasible. Taken together, these new genomic tools provide the opportunity to develop rational strategies for treating the individual cancer patient. © 2011 Society of Surgical Oncology.

Authors
Stevenson, M; Potti, A
MLA Citation
Stevenson, M, and Potti, A. "A Pathway-Based Approach to Identify Molecular Biomarkers in Cancer." Annals of Surgical Oncology (2011): 1-5.
Source
scival
Published In
Annals of Surgical Oncology
Publish Date
2011
Start Page
1
End Page
5
DOI
10.1245/s10434-011-1855-4

Age- and sex-specific genomic profiles in non-small cell lung cancer.

CONTEXT: Gene expression profiling may be useful in examining differences underlying age- and sex-specific outcomes in non-small cell lung cancer (NSCLC). OBJECTIVE: To describe clinically relevant differences in the underlying biology of NSCLC based on patient age and sex. DESIGN, SETTING, AND PATIENTS: Retrospective analysis of 787 patients with predominantly early stage NSCLC performed at Duke University, Durham, North Carolina, from July 2008 to June 2009. Lung tumor samples with corresponding microarray and clinical data were used. All patients were divided into subgroups based on age (< 70 vs > or = 70 years old) or sex. Gene expression signatures representing oncogenic pathway activation and tumor biology/microenvironment status were applied to these samples to obtain patterns of activation/deregulation. MAIN OUTCOME MEASURES: Patterns of oncogenic and molecular signaling pathway activation that are reproducible and correlate with 5-year recurrence-free patient survival. RESULTS: Low- and high-risk patient clusters/cohorts were identified with the longest and shortest 5-year recurrence-free survival, respectively, within the age and sex NSCLC subgroups. These cohorts of NSCLC demonstrate similar patterns of pathway activation. In patients younger than 70 years, high-risk patients, with the shortest recurrence-free survival, demonstrated increased activation of the Src (25% vs 6%; P<.001) and tumor necrosis factor (76% vs 42%; P<.001) pathways compared with low-risk patients. High-risk patients aged 70 years or older demonstrated increased activation of the wound healing (40% vs 24%; P = .02) and invasiveness (64% vs 20%; P<.001) pathways compared with low-risk patients. In women, high-risk patients demonstrated increased activation of the invasiveness (99% vs 2%; P<.001) and STAT3 (72% vs 35%; P<.001) pathways while high-risk men demonstrated increased activation of the STAT3 (87% vs 18%; P<.001), tumor necrosis factor (90% vs 46%; P<.001), EGFR (13% vs 2%; P = .003), and wound healing (50% vs 22%; P<.001) pathways. Multivariate analyses confirmed the independent clinical relevance of the pathway-based subphenotypes in women (hazard ratio [HR], 2.02; 95% confidence interval [CI], 1.34-3.03; P<.001) and patients younger than 70 years (HR, 1.83; 95% CI, 1.24-2.71; P = .003). All observations were reproducible in split sample analyses. CONCLUSIONS: Among a cohort of patients with NSCLC, subgroups defined by oncogenic pathway activation profiles were associated with recurrence-free survival. These findings require validation in independent patient data sets.

Authors
Mostertz, W; Stevenson, M; Acharya, C; Chan, I; Walters, K; Lamlertthon, W; Barry, W; Crawford, J; Nevins, J; Potti, A
MLA Citation
Mostertz, W, Stevenson, M, Acharya, C, Chan, I, Walters, K, Lamlertthon, W, Barry, W, Crawford, J, Nevins, J, and Potti, A. "Age- and sex-specific genomic profiles in non-small cell lung cancer." JAMA 303.6 (February 10, 2010): 535-543.
PMID
20145230
Source
pubmed
Published In
JAMA : the journal of the American Medical Association
Volume
303
Issue
6
Publish Date
2010
Start Page
535
End Page
543
DOI
10.1001/jama.2010.80

Characterizing the clinical relevance of an embryonic stem cell phenotype in lung adenocarcinoma.

PURPOSE: Cancer cells possess traits reminiscent of those ascribed to normal stem cells. It is unclear whether these phenotypic similarities are the result of a common biological phenotype, such as regulatory pathways. EXPERIMENTAL DESIGN: Lung cancer cell lines with corresponding gene expression data and genes associated with an embryonic stem cell identity were used to develop a signature of embryonic stemness (ES) activity specific to lung adenocarcinoma. Biological characteristics were elucidated as a function of cancer biology/oncogenic pathway dysregulation. The ES signature was applied to three independent early-stage (I-IIIa) lung adenocarcinoma data sets with clinically annotated gene expression data. The relationship between the ES phenotype and cisplatin (current standard of care) sensitivity was evaluated. RESULTS: Pathway analysis identified specific regulatory networks [Ras (P = 0.0005), Myc (P = 0.0224), wound healing (P < 0.0001), chromosomal instability (P < 0.0001), and invasiveness (P < 0.0001)] associated with the ES phenotype. The prognostic relevance of the ES signature, as related to patient survival, was characterized in three cohorts [CALGB 9761 (n = 82; P = 0.0001), National Cancer Institute Director's Challenge Consortium (n = 442; P = 0.0002), and Duke (n = 45; P = 0.06)]. The ES signature was not prognostic in prostate, breast, or ovarian adenocarcinomas. Lung tumors (n = 569) and adenocarcinoma cell lines (n = 31) expressing the ES phenotype were more likely to be resistant to cisplatin (P < 0.0001 and P = 0.006, respectively). CONCLUSIONS: Lung adenocarcinomas that share a common gene expression pattern with normal human embryonic stem cells were associated with decreased survival, increased biological complexity, and increased likelihood of resistance to cisplatin. This indicates the aggressiveness of these tumors.

Authors
Stevenson, M; Mostertz, W; Acharya, C; Kim, W; Walters, K; Barry, W; Higgins, K; Tuchman, SA; Crawford, J; Vlahovic, G; Ready, N; Onaitis, M; Potti, A
MLA Citation
Stevenson, M, Mostertz, W, Acharya, C, Kim, W, Walters, K, Barry, W, Higgins, K, Tuchman, SA, Crawford, J, Vlahovic, G, Ready, N, Onaitis, M, and Potti, A. "Characterizing the clinical relevance of an embryonic stem cell phenotype in lung adenocarcinoma." Clin Cancer Res 15.24 (December 15, 2009): 7553-7561.
PMID
19996213
Source
pubmed
Published In
Clinical cancer research : an official journal of the American Association for Cancer Research
Volume
15
Issue
24
Publish Date
2009
Start Page
7553
End Page
7561
DOI
10.1158/1078-0432.CCR-09-1939

Age-specific differences in oncogenic pathway dysregulation and anthracycline sensitivity in patients with acute myeloid leukemia.

PURPOSE: To define the biology driving the aggressive nature of acute myeloid leukemia (AML) in elderly patients. PATIENTS AND METHODS: Clinically annotated microarray data from 425 patients with newly diagnosed de novo AML from two publicly available data sets were analyzed after age-specific cohorts (young or= 55 years; n = 144) were prospectively identified. Gene expression analysis was conducted utilizing gene set enrichment analysis, and by applying previously defined and tested signature profiles reflecting dysregulation of oncogenic signaling pathways, altered tumor environment, and signatures of chemotherapy sensitivity. RESULTS: Elderly AML patients as expected had worse overall survival and event-free survival compared with younger patients. Analysis of oncogenic pathways revealed that older patients had higher probability of RAS, Src, and tumor necrosis factor (TNF) pathway activation (all P < .0001). Older patients were also less sensitive to anthracycline compared with younger patients with AML (P < .0001). Hierarchical clustering revealed that younger AML patients in cluster 2 had clinically worse survival, with high RAS, Src, and TNF pathway activation and in turn were less sensitive to anthracycline compared with patients in cluster 1. However, among elderly patients with AML, those in cluster 1 also demonstrated high RAS, Src, and TNF pathway activation but this did not translate into differences in survival or anthracycline sensitivity. CONCLUSION: AML in the elderly represents a distinct biologic entity characterized by unique patterns of deregulated signaling pathway variations that contributes to poor survival and anthracycline resistance. These insights should enable development and adjustments of clinically meaningful treatment strategies in the older patient population.

Authors
Rao, AV; Valk, PJM; Metzeler, KH; Acharya, CR; Tuchman, SA; Stevenson, MM; Rizzieri, DA; Delwel, R; Buske, C; Bohlander, SK; Potti, A; Löwenberg, B
MLA Citation
Rao, AV, Valk, PJM, Metzeler, KH, Acharya, CR, Tuchman, SA, Stevenson, MM, Rizzieri, DA, Delwel, R, Buske, C, Bohlander, SK, Potti, A, and Löwenberg, B. "Age-specific differences in oncogenic pathway dysregulation and anthracycline sensitivity in patients with acute myeloid leukemia." J Clin Oncol 27.33 (November 20, 2009): 5580-5586.
PMID
19858393
Source
pubmed
Published In
Journal of Clinical Oncology
Volume
27
Issue
33
Publish Date
2009
Start Page
5580
End Page
5586
DOI
10.1200/JCO.2009.22.2547

Characterizing the developmental pathways TTF-1, NKX2-8, and PAX9 in lung cancer.

We investigated the clinical implications of lung developmental transcription factors (TTF-1, NKX2-8, and PAX9) that we recently discovered as cooperating oncogenes activated by way of gene amplification at chromosome 14q13 in lung cancer. Using stable transfectants of human bronchial epithelial cells, RNA expression profiles (signatures) representing activation of the biological pathways defined by each of the 3 genes were determined and used to risk stratify a non-small-cell lung cancer (NSCLC) clinical data set consisting of 91 early stage tumors. Coactivation of the TTF-1 and NKX2-8 pathways identified a cluster of patients with poor survival, representing approximately 20% of patients with early stage NSCLC, whereas activation of individual pathways did not reveal significant prognostic power. Importantly, the poor prognosis associated with coactivation of TTF-1 and NKX2-8 was validated in 2 other independent clinical data sets. Furthermore, lung cancer cell lines showing coactivation of the TTF-1 and NKX2-8 pathways were shown to exhibit resistance to cisplatin, the standard of care for the treatment of NSCLC. This suggests that the cohort of patients with coactivation of TTF-1 and NKX2-8 pathways appears to be resistant to standard cisplatin therapy, suggesting the need for alternative therapies in this cohort of high-risk patients.

Authors
Hsu, DS; Acharya, CR; Balakumaran, BS; Riedel, RF; Kim, MK; Stevenson, M; Tuchman, S; Mukherjee, S; Barry, W; Dressman, HK; Nevins, JR; Powers, S; Mu, D; Potti, A
MLA Citation
Hsu, DS, Acharya, CR, Balakumaran, BS, Riedel, RF, Kim, MK, Stevenson, M, Tuchman, S, Mukherjee, S, Barry, W, Dressman, HK, Nevins, JR, Powers, S, Mu, D, and Potti, A. "Characterizing the developmental pathways TTF-1, NKX2-8, and PAX9 in lung cancer." Proc Natl Acad Sci U S A 106.13 (March 31, 2009): 5312-5317.
PMID
19279207
Source
pubmed
Published In
Proceedings of the National Academy of Sciences of USA
Volume
106
Issue
13
Publish Date
2009
Start Page
5312
End Page
5317
DOI
10.1073/pnas.0900827106
Show More