Ricklie Ann Julian

Interests

Research

early phase clinical trial development in head and neck/thoracic malignancies; cancer prevention

Teaching

non-small cell lung cancer, small cell lung cancer, mesothelioma; head and neck cancer; cutaneous squamous cell carcinoma

Courses

No activities entered.

Scholarly Contributions

Journals/Publications

• Bauman, J. E., Saba, N. F., Roe, D., Bauman, J. R., Kaczmar, J., Bhatia, A., Muzaffar, J., Julian, R., Wang, S., Bearelly, S., Baker, A., Steuer, C., Giri, A., Burtness, B., Centuori, S., Caulin, C., Klein, R., Saboda, K., Obara, S., & Chung, C. H. (2023). Randomized Phase II Trial of Ficlatuzumab With or Without Cetuximab in Pan-Refractory, Recurrent/Metastatic Head and Neck Cancer. Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 41(22), 3851-3862.
  More info

  Primary or acquired resistance to cetuximab, an antiepidermal growth factor receptor monoclonal antibody (mAb), minimizes its utility in recurrent/metastatic head and neck squamous cell carcinoma (HNSCC). Aberrant hepatocyte growth factor/cMet pathway activation is an established resistance mechanism. Dual pathway targeting may overcome resistance.
• Bauman, J. E., Julian, R., Saba, N. F., Wise-Draper, T. M., Adkins, D. R., O'Brien, P., Fidler, M. J., Gibson, M. K., Duvvuri, U., Heath-Chiozzi, M., Alvarado, D., Gedrich, R., Golden, P., & Cohen, R. B. (2022). Phase II Trial of CDX-3379 and Cetuximab in Recurrent/Metastatic, HPV-Negative, Cetuximab-Resistant Head and Neck Cancer. Cancers, 14(10).
  More info

  In phase I development, CDX-3379, an anti-ErbB3 monoclonal antibody, showed promising molecular and antitumor activity in head and neck squamous cell carcinoma (HNSCC), alone or in combination with cetuximab. Preliminary biomarker data raised the hypothesis of enhanced response in tumors harboring mutations. This phase II, multicenter trial used a Simon 2-stage design to investigate the efficacy of CDX-3379 and cetuximab in 30 patients with recurrent/metastatic, HPV-negative, cetuximab-resistant HNSCC. The primary endpoint was objective response rate (ORR). Secondary endpoints included ORR in patients with somatic mutations, progression-free survival (PFS), overall survival (OS), and safety. Thirty patients were enrolled from March 2018 to September 2020. The ORR in genomically unselected patients was 2/30 (6.7%; 95% confidence interval [CI], 0.8-22.1). Median PFS and OS were 2.2 (95% CI: 1.3-3.6) and 6.6 months (95% CI: 2.7-7.5), respectively. Tissue was available in 27 patients including one of two responders. ORR was 1/10 (complete response; 10%; 95% CI 0.30-44.5) in the -mutated versus 0/17 (0%; 95% CI: 0-19.5) in the -wildtype cohorts. Sixteen patients (53%) experienced treatment-related adverse events (AEs) ≥ grade 3. The most common AEs were diarrhea (83%) and acneiform dermatitis (53%). Dose modification was required in 21 patients (70%). The modest ORR coupled with excessive, dose-limiting toxicity of this combination precludes further clinical development. Dual ErbB3-EGFR inhibition remains of scientific interest in HPV-negative HNSCC. Should more tolerable combinations be identified, development in an earlier line of therapy and prospective evaluation of the hypothesis warrant consideration.
• Groysman, M., Yi, S. K., Robbins, J. R., Hsu, C. C., Julian, R., Bauman, J. E., Baker, A., Wang, S. J., & Bearelly, S. (2022). The impact of socioeconomic and geographic factors on access to transoral robotic/endoscopic surgery for early stage oropharyngeal malignancy. American journal of otolaryngology, 43(1), 103243.
  More info

  To evaluate the role of social and geographic factors on the likelihood of receiving transoral robotic surgery (TORS) or non-robotic transoral endoscopic surgery treatment in early stage oropharyngeal squamous cell carcinoma (OPSCC).
• Julian, R., Savani, M., & Bauman, J. E. (2021). Immunotherapy Approaches in HPV-Associated Head and Neck Cancer. Cancers, 13(23).
  More info

  Immunotherapy approaches for head and neck squamous cell carcinoma (HNSCC) are rapidly advancing. Human papillomavirus (HPV) has been identified as a causative agent in a subset of oropharyngeal cancers (OPC). HPV-positive OPC comprises a distinct clinical and pathologic disease entity and has a unique immunophenotype. Immunotherapy with anti-PD1 checkpoint inhibitors has exhibited improved outcomes for patients with advanced HNSCC, irrespective of HPV status. To date, the clinical management of HPV-positive HNSCC and HPV-negative HNSCC has been identical, despite differences in the tumor antigens, immune microenvironment, and immune signatures of these two biologically distinct tumor types. Numerous clinical trials are underway to further refine the application of immunotherapy and develop new immunotherapy approaches. The aim of this review is to highlight the developing role of immunotherapy in HPV-positive HNSCC along with the clinical evidence and preclinical scientific rationale behind emerging therapeutic approaches, with emphasis on promising HPV-specific immune activators that exploit the universal presence of foreign, non-self tumor antigens.
• Chung, C. H., Caulin, C., Baker, A., Bearelly, S., Wang, S., Julian, R. A., Saba, N. F., Roe, D., Bauman, J. E., Bauman, J. R., Kaczmar, J. M., Burtness, B., Muzaffar, J., Steuer, C. E., Bhatia, A. K., Giri, A., Stabile, L. P., & Centuori, S. (2020). Randomized, phase II study of ficlatuzumab with or without cetuximab in patients with pan-refractory, recurrent/metastatic (R/M) head and neck squamous cell carcinoma (HNSCC).. Journal of Clinical Oncology, 38(15_suppl), TPS6594-TPS6594. doi:10.1200/jco.2020.38.15_suppl.tps6594
• Zimmerman, S., Das, A., Wang, S., Julian, R., Gandhi, L., & Wolf, J. (2019). 2017-2018 Scientific Advances in Thoracic Oncology: Small Cell Lung Cancer. Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer, 14(5), 768-783.
  More info

  SCLC remains an aggressive, deadly cancer with only modest effect on survival from standard chemotherapy. However, with the advent of immunotherapy and comprehensive genomic and transcriptomic profiling, multiple new targets are showing promise in the clinical arena, and just recently programmed death ligand 1 inhibition has been shown to improve the efficacy of standard chemotherapy in extended-disease SCLC. Our increasing understanding of the interactions between different pathways will enable more tailored immunotherapy and targeted therapies based on specific biomarkers and rational combinations. Here we discuss the preclinical and clinical strides in 2017 and 2018 that put us on the threshold of a new era in therapeutics and will, it is hoped, translate into significant improvements in survival.
• Sabari, J. K., Julian, R. A., Ni, A., Halpenny, D., Hellmann, M. D., Drilon, A. E., Li, B. T., Poirier, J. T., Rudin, C. M., & Rekhtman, N. (2018). Outcomes of advanced pulmonary large cell neuroendocrine carcinoma stratified by RB1 loss, SLFN11 expression, and tumor mutational burden.. Journal of Clinical Oncology, 36(15_suppl), e20568-e20568. doi:10.1200/jco.2018.36.15_suppl.e20568
  More info

  e20568Background: LCNEC is a biologically heterogeneous disease comprised of distinct subgroups characterized by genomic signatures of either SCLC or NSCLC (e.g. RB1 loss or retained). We assessed ...
• Chretien, K. C., Swenson, R., Yoon, B., Julian, R., Keenan, J., Croffoot, J., & Kheirbek, R. (2015). Tell Me Your Story: A Pilot Narrative Medicine Curriculum During the Medicine Clerkship. Journal of general internal medicine, 30(7), 1025-8.
  More info

  Narrative medicine educational interventions may enhance patient-centered care, yet most educational interventions do not involve actual patient-provider interactions, nor do they assess narrative competence, a key skill for its practice. An experiential narrative medicine curriculum for medical students was developed and piloted.

Poster Presentations

• Bauman, J., Saba, N., Roe, D., Bauman, J., Kaczmar, J., Bhatia, A., Muzaffar, J., Julian, R., Wang, S., Bearelly, S., Baker, A., Steuer, C., Giri, A., Burtness, B., Centuori, S. M., Caulin, C., Saboda, K., Obara, S., & Chung, C. (2021, May/Spring). Randomized, phase II study of ficlatuzumab with or without cetuximab in pan-refractory, advanced head and neck squamous cell carcinoma (HNSCC).
  . ASCO.