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Habib S, Osborn G, Willsmore Z, Chew MW, Jakubow S, Fitzpatrick A, Wu Y, Sinha K, Lloyd-Hughes H, Geh JLC, MacKenzie-Ross AD, Whittaker S, Sanz-Moreno V, Lacy KE, Karagiannis SN, Adams R. Tumor associated macrophages as key contributors and targets in current and future therapies for melanoma. Expert Rev Clin Immunol 2024:1-17. [PMID: 38533720 DOI: 10.1080/1744666x.2024.2326626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 02/29/2024] [Indexed: 03/28/2024]
Abstract
INTRODUCTION Despite the success of immunotherapies for melanoma in recent years, there remains a significant proportion of patients who do not yet derive benefit from available treatments. Immunotherapies currently licensed for clinical use target the adaptive immune system, focussing on Tcell interactions and functions. However, the most prevalent immune cells within the tumor microenvironment (TME) of melanoma are macrophages, a diverse immune cell subset displaying high plasticity, to which no current therapies are yet directly targeted. Macrophages have been shown not only to activate the adaptive immune response, and enhance cancer cell killing, but, when influenced by factors within the TME of melanoma, these cells also promote melanoma tumorigenesis and metastasis. AREAS COVERED We present a review of the most up-to-date literatureavailable on PubMed, focussing on studies from within the last 10 years. We also include data from ongoing and recent clinical trials targeting macrophages in melanoma listed on clinicaltrials.gov. EXPERT OPINION Understanding the multifaceted role of macrophages in melanoma, including their interactions with immune and cancer cells, the influence of current therapies on macrophage phenotype and functions and how macrophages could be targeted with novel treatment approaches, are all critical for improving outcomes for patients with melanoma.
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Affiliation(s)
- Shabana Habib
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, London, UK
| | - Gabriel Osborn
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, London, UK
| | - Zena Willsmore
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, London, UK
| | - Min Waye Chew
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, London, UK
| | - Sophie Jakubow
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, London, UK
| | - Amanda Fitzpatrick
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, London, UK
- Oncology Department, Guy's and St Thomas' Hospital, London, UK
- Breast Cancer Now Research Unit, School of Cancer & Pharmaceutical Sciences, King's College London, Innovation Hub, Guy's Hospital, London, UK
| | - Yin Wu
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, London, UK
- Oncology Department, Guy's and St Thomas' Hospital, London, UK
- Peter Gorer Department of Immunobiology, School of Immunology & Microbial Sciences, King's College London, London, UK
| | - Khushboo Sinha
- St John's Institute of Dermatology, Guy's, King's and St. Thomas' Hospitals NHS Foundation Trust, London, England
| | - Hawys Lloyd-Hughes
- Department of Plastic Surgery, Guy's, King's and St. Thomas' Hospitals, London, England
| | - Jenny L C Geh
- St John's Institute of Dermatology, Guy's, King's and St. Thomas' Hospitals NHS Foundation Trust, London, England
- Department of Plastic Surgery, Guy's, King's and St. Thomas' Hospitals, London, England
| | | | - Sean Whittaker
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, London, UK
| | - Victoria Sanz-Moreno
- The Breast Cancer Now Toby Robins Research Centre, Division of Breast Cancer Research, The Institute of Cancer Research, London
| | - Katie E Lacy
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, London, UK
| | - Sophia N Karagiannis
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, London, UK
- Breast Cancer Now Research Unit, School of Cancer & Pharmaceutical Sciences, King's College London, Innovation Hub, Guy's Hospital, London, UK
| | - Rebecca Adams
- St. John's Institute of Dermatology, School of Basic & Medical Biosciences, King's College London, London, UK
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2
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Fitzpatrick A, Iravani M, Mills A, Vicente D, Alaguthurai T, Roxanis I, Turner NC, Haider S, Tutt ANJ, Isacke CM. Genomic profiling and pre-clinical modelling of breast cancer leptomeningeal metastasis reveals acquisition of a lobular-like phenotype. Nat Commun 2023; 14:7408. [PMID: 37973922 PMCID: PMC10654396 DOI: 10.1038/s41467-023-43242-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 11/03/2023] [Indexed: 11/19/2023] Open
Abstract
Breast cancer leptomeningeal metastasis (BCLM), where tumour cells grow along the lining of the brain and spinal cord, is a devastating development for patients. Investigating this metastatic site is hampered by difficulty in accessing tumour material. Here, we utilise cerebrospinal fluid (CSF) cell-free DNA (cfDNA) and CSF disseminated tumour cells (DTCs) to explore the clonal evolution of BCLM and heterogeneity between leptomeningeal and extracranial metastatic sites. Somatic alterations with potential therapeutic actionability were detected in 81% (17/21) of BCLM cases, with 19% detectable in CSF cfDNA only. BCLM was enriched in genomic aberrations in adherens junction and cytoskeletal genes, revealing a lobular-like breast cancer phenotype. CSF DTCs were cultured in 3D to establish BCLM patient-derived organoids, and used for the successful generation of BCLM in vivo models. These data reveal that BCLM possess a unique genomic aberration profile and highlight potential cellular dependencies in this hard-to-treat form of metastatic disease.
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Affiliation(s)
- Amanda Fitzpatrick
- The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, UK
- Comprehensive Cancer Centre, School of Cancer & Pharmaceutical Sciences, King's College London, London, UK
| | - Marjan Iravani
- The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, UK
| | - Adam Mills
- The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, UK
| | - David Vicente
- The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, UK
| | | | - Ioannis Roxanis
- The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, UK
| | - Nicholas C Turner
- The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, UK
- The Royal Marsden NHS Foundation Trust, London, UK
| | - Syed Haider
- The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, UK
| | - Andrew N J Tutt
- The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, UK
- Breast Cancer Now Research Unit, Guy's Hospital, King's College London, London, UK
- Oncology and Haematology Directorate, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Clare M Isacke
- The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, UK.
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Batista MFFV, Eiriz I, Fitzpatrick A, Le Du F, Braga S, Alpuim Costa D. Refining Therapy in Patients with HER2-Positive Breast Cancer with Central Nervous System Metastasis. Breast Care (Basel) 2022; 17:524-532. [PMID: 36590149 PMCID: PMC9801402 DOI: 10.1159/000526431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 08/07/2022] [Indexed: 01/04/2023] Open
Abstract
Background Brain metastasis (BM) is a major clinical problem in metastatic breast cancer (MBC), occurring in 50% of patients with human epidermal growth factor receptor 2-positive (HER2+) breast cancer. Historically omitted from clinical trials, recent studies of novel HER2-targeted agents have focused on HER2+ BM patients, addressing stable but also progressing BM and leptomeningeal carcinomatosis (LMC). Summary This review aimed to summarize the most relevant data on treating patients with HER2+ BM and LMC. Key Messages The treatment paradigm for patients with HER2+ MBC has changed. Local therapies play an important role, but accumulating evidence on the intracranial activity and clinical benefit of anti-HER2 targeting therapies might lead to a shift in the paradigm on treating BM in the next few years towards more widespread use of systemic therapy.
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Affiliation(s)
| | - Inês Eiriz
- Oncology Department, Hospital Professor Doutor Fernando Fonseca EPE, Amadora, Portugal
| | - Amanda Fitzpatrick
- Oncology Department, Guy's and St Thomas' Hospital, London, UK
- Oncology Department, The Institute of Cancer Research, London, UK
| | - Fanny Le Du
- Oncology Department, CRLCC Eugène Marquis, Rennes, France
| | - Sofia Braga
- Oncology Department, Hospital Professor Doutor Fernando Fonseca EPE, Amadora, Portugal
- Haematology and Oncology Department, CUF Oncologia, Lisbon, Portugal
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O'Halloran A, Fitzpatrick A, Feeney J, De Looze C, Kenny RA. 143 ASSOCIATIONS BETWEEN NTPROBNP AND COGNITION IN THE IRISH LONGITUDINAL STUDY ON AGEING (TILDA). Age Ageing 2022. [DOI: 10.1093/ageing/afac218.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Cardiovascular insults increase the risk for future neurological diseases in late life. NT-proB-type Natriuretic Peptide (NTproBNP) is a hormone released in response to pressure changes inside the heart, often related to heart failure and other cardiac problems. We investigated whether levels of this biomarker are related to cognition in older adults from the Irish Longitudinal Study on Ageing (TILDA), a nationally representative cohort of adults aged 50 years and older living in Ireland.
Methods
NTproBNP levels were measured in 4,963 participants, mean age 62.6 years and 53.4% women, from blood drawn during wave 1 of the study (2009-2011). Cognitive outcomes collected at wave 1 included: memory function (the sum of scores of immediate word recall, delayed recall and prospective memory), a measure of global cognitive function (the Montreal Cognitive Assessment - MoCA), and a measure of semantic fluency (the Animal Naming task). Both NTproBNP and the MoCA scores were log-transformed to correct for skewedness.
Results
Cross-sectional analyses using multivariable linear regression found that NTproBNP was significantly and negatively associated with memory (std coeff. –0.049, std error 0.057, p=.001) and the MoCA (std coeff –0.034, std error .002, p=0.027) after adjusting for age, gender, education, and depressive symptoms. After further adjustment for cardiovascular risk factors (hypertension, high cholesterol, current smoking and problem drinking) and prevalent cardiovascular diseases (heart failure, myocardial infarction, angina pectoris, stroke, and transient ischemic attack), the associations remained for both cognitive measures (memory: std coeff –0.047, std error 0.061, p=.003; MoCA: std coeff. –0.036, std error .002, p=.029). No significant associations were found for the Animal Naming task (full model std coeff. –0.016, std error 0.087, p=0.37).
Conclusion
These results suggest that NTproBNP may be a useful early indicator for declines in some domains of cognitive function in older adults, with and without current cardiovascular diseases. Additional research is needed to evaluate the predictive value of this biomarker.
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Affiliation(s)
- A O'Halloran
- University of Dublin, Trinity College , Dublin, Ireland
| | | | - J Feeney
- University of Dublin, Trinity College , Dublin, Ireland
| | - C De Looze
- University of Dublin, Trinity College , Dublin, Ireland
| | - RA Kenny
- University of Dublin, Trinity College , Dublin, Ireland
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Fitzpatrick A, Bartram A, Rockall L, Mitchell A, Palmer K, Crusz S, Plowman N, Lewis R. Survival and Prognostic Factors in Melanoma Brain Metastasis (MBM) Treated With Stereotactic Radiosurgery (SRS). Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac200.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
AIMS
Brain metastasis is a frequent complication in melanoma, ultimately affecting 40–60% of patients with metastatic disease1. In the era of immune checkpoint and small molecule inhibitor therapy, there is a need to identify patient, tumour and treatment characteristics which may predict an improved prognosis in patients receiving stereotactic radiosurgery (SRS) for melanoma brain metastases (MBM).
METHOD
Retrospective casenote review was carried out for all patients receiving SRS, including gammaknife and cyberknife, for MBM between 2014 – 2020 at Barts Cancer Centre. Overall survival (OS) was calculated using the Kaplan-Meier method. Differences between groups were assessed using the Log-rank (Mantel-Cox) test.
RESULTS
93 patients were treated with SRS for MBM, with a median of 15 patients treated per year. The median age at treatment decision was 60 years (range 26 – 90): 59% were male; 41% female. Median number of lesions treated was 2 (range 1 – 15). Survival data was available for 74 patients: median overall survival for all patients was 9.5 months, with no significant survival difference by gender nor treatment year (pre-2017 vs. post-2017). However, treatment of 1-2 brain lesions carried a better prognosis compared to 3 or more lesions (median 12.2 vs. 5.7 months, p = 0.0292).
CONCLUSION
Initial analysis reveals an improved overall survival when fewer MBM are present. Further analyses will examine the impact of the following factors on patient survival: status of extracranial metastases, symptomatic vs. asymptomatic brain metastasis, intratumoral haemorrhage, systemic therapy pre- and post-SRS, and corticosteroid use during and after SRS.
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6
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Mitchell A, Palmer K, Fitzpatrick A, Bartram A, Rockall L, Lewis R, Plowman N, Lowe H, Scandura G, Panday P. Survival and Prognostic Factors in Brain Metastases from Breast Cancer Treated with Stereotactic Radiotherapy. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac200.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
AIMS
Intracranial metastases are common in patients with breast cancer. Stereotactic radiotherapy (SRT) can improve overall survival (OS) in selected patients; however there is uncertainty over the presence of prognostic indicators in this cohort. Here, we aim to determine whether the number of brain metastases, receptor status and presence of extracranial disease affected OS.
METHOD
Retrospective analysis was performed for all patients receiving SRT for brain metastases from breast cancer between 2014-2020 at Barts Cancer Centre. Overall survival (OS) was calculated using the Kaplan-Meier method. Differences between groups were assessed using the Log-rank (Mantel-cox) test.
RESULTS
109 patients with a histopathologically confirmed diagnosis of breast cancer were included. The median age at treatment was 52 years (IQR:46-60). Of 103 patients with documented receptor status, 22 patients were ER+/HER2+, 32 ER+/HER2-, 20 ER-/HER2+ and 29 triple-negative. 68/105 patients had extra-cranial metastatic disease at treatment with SRT. A median of 2 lesions were treated per patient (range:1-15). Median OS for all patients was 67.4 weeks. Median OS was 91.4 weeks for ER+/HER2+ patients, 64.9 weeks for ER+/HER- patients, 71.4 weeks for ER-/HER2+ and 37 weeks for ER-/HER2- (p=0.001). Median OS was 55.1 weeks for patients with extra-cranial metastatic disease and 91.4 weeks in those without (p=0.017). Median OS was 72.1 weeks in patients with 1-2 brain metastases and 53.7 in those with extensive (3+) brain metastases, however this was not statistically significant (p=0.892).
CONCLUSION
A trend towards worse OS in patients with triple-negative receptor status and extra-cranial metastatic disease at treatment with SRT warrants further investigation.
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Rätze MAK, Koorman T, Sijnesael T, Bassey-Archibong B, van de Ven R, Enserink L, Visser D, Jaksani S, Viciano I, Bakker ERM, Richard F, Tutt A, O'Leary L, Fitzpatrick A, Roca-Cusachs P, van Diest PJ, Desmedt C, Daniel JM, Isacke CM, Derksen PWB. Correction: Loss of E-cadherin leads to Id2-dependent inhibition of cell cycle progression in metastatic lobular breast cancer. Oncogene 2022; 41:3507-3509. [PMID: 35610485 PMCID: PMC9232389 DOI: 10.1038/s41388-022-02355-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Max A K Rätze
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Thijs Koorman
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Thijmen Sijnesael
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Robert van de Ven
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Lotte Enserink
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Daan Visser
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Sridevi Jaksani
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ignacio Viciano
- Institute for Bioengineering of Catalonia (IBEC), the Barcelona Institute of Technology (BIST), Barcelona, Spain
| | - Elvira R M Bakker
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - François Richard
- Laboratory for Translational Breast Cancer Research, Katholieke Universiteit, Leuven, Belgium
| | - Andrew Tutt
- The Breast Cancer Now Research Unit, King's College London, London, United Kingdom
- Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, United Kingdom
| | - Lynda O'Leary
- Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, United Kingdom
| | - Amanda Fitzpatrick
- Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, United Kingdom
| | - Pere Roca-Cusachs
- Institute for Bioengineering of Catalonia (IBEC), the Barcelona Institute of Technology (BIST), Barcelona, Spain
| | - Paul J van Diest
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Christine Desmedt
- Laboratory for Translational Breast Cancer Research, Katholieke Universiteit, Leuven, Belgium
| | - Juliet M Daniel
- Department of Biology, McMaster University, Hamilton, ON, Canada
| | - Clare M Isacke
- Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, United Kingdom
| | - Patrick W B Derksen
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands.
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Fitzpatrick A, Iravani M, Mills A, Childs L, Alaguthurai T, Clifford A, Garcia-Murillas I, Van Laere S, Dirix L, Harries M, Okines A, Turner NC, Haider S, Tutt ANJ, Isacke CM. Assessing CSF ctDNA to improve diagnostic accuracy and therapeutic monitoring in breast cancer leptomeningeal metastasis. Clin Cancer Res 2021; 28:1180-1191. [PMID: 34921020 DOI: 10.1158/1078-0432.ccr-21-3017] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 10/23/2021] [Accepted: 12/14/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE Cerebrospinal fluid (CSF) cytology is the gold standard diagnostic test for breast cancer leptomeningeal metastasis (BCLM), but has impaired sensitivity, often necessitating repeated lumbar puncture to confirm or refute diagnosis. Further, there is no quantitative response tool to assess response or progression during BCLM treatment. EXPERIMENTAL DESIGN Facing the challenge of working with small volume samples and the lack of common recurrent mutations in breast cancers, cell-free DNA was extracted from CSF and plasma of patients undergoing investigation for BCLM (n=30). ctDNA fraction was assessed by ultra-low pass whole genome sequencing (ulpWGS), which does not require prior tumor sequencing. RESULTS In this proof-of-concept study ctDNA was detected (fraction {greater than or equal to}0.10) in CSF of all 24 BCLM+ patients (median ctDNA fraction 0.57), regardless of negative cytology or borderline MRI imaging, whereas CSF ctDNA was not detected in the 6 BCLM- patients (median ctDNA fraction 0.03, P<0.0001). Plasma ctDNA was only detected in patients with extracranial disease progression or who had previously received whole brain radiotherapy. ctDNA fraction was highly concordant with mutant allele fraction measured by tumor mutation-specific ddPCR assays (r=0.852, P<0.0001). During intrathecal treatment, serial monitoring (n=12 patients) showed that suppression of CSF ctDNA fraction was associated with longer BCLM survival (P=0.034) and rising ctDNA fraction was detectable up to 12 weeks before clinical progression. CONCLUSION Measuring ctDNA fraction by ulpWGS is a quantitative marker demonstrating potential for timely and accurate BCLM diagnosis and therapy response monitoring, with the ultimate aim to improve management of this poor prognosis patient group.
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Affiliation(s)
- Amanda Fitzpatrick
- Breast Cancer Now Toby Robins Research Centre, Institute of Cancer Research
| | - Marjan Iravani
- The Breast Cancer Now Toby Robins Research Centre, Institute of Cancer Research
| | - Adam Mills
- The Breast Cancer Now Toby Robins Research Centre, Institute of Cancer Research
| | - Lucy Childs
- Department of Clinical Radiology, Guy's and St Thomas' NHS Foundation Trust
| | | | - Angela Clifford
- Breast Cancer Now Research Unit, Guy's Hospital, King's College London
| | - Isaac Garcia-Murillas
- Breast Cancer Now Research Centre, Institute of Cancer Research and The Royal Marsden Hospital
| | - Steven Van Laere
- Translational Cancer Research Unit, Oncology Center, General Hospital Sint-Augustinus
| | - Luc Dirix
- Translational Cancer Research Unit, Oncology Center, AZ Sint-Augustinus
| | - Mark Harries
- Clinical Oncology, Guy's and St Thomas' NHS Foundation Trust
| | | | - Nicholas C Turner
- Breast Unit, The Royal Marsden NHS Foundation Trust, and Breast Cancer Now Research Centre, The Institute of Cancer Research
| | - Syed Haider
- The Breast Cancer Now Research Centre, Institute of Cancer Research
| | - Andrew N J Tutt
- Division of Breast Cancer Research, Institute of Cancer Research London
| | - Clare M Isacke
- The Breast Cancer Now Toby Robins Research Centre, Institute of Cancer Research
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Sflomos G, Schipper K, Koorman T, Fitzpatrick A, Oesterreich S, Lee AV, Jonkers J, Brunton VG, Christgen M, Isacke C, Derksen PWB, Brisken C. Atlas of Lobular Breast Cancer Models: Challenges and Strategic Directions. Cancers (Basel) 2021; 13:5396. [PMID: 34771558 PMCID: PMC8582475 DOI: 10.3390/cancers13215396] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 10/18/2021] [Accepted: 10/21/2021] [Indexed: 12/14/2022] Open
Abstract
Invasive lobular carcinoma (ILC) accounts for up to 15% of all breast cancer (BC) cases and responds well to endocrine treatment when estrogen receptor α-positive (ER+) yet differs in many biological aspects from other ER+ BC subtypes. Up to 30% of patients with ILC will develop late-onset metastatic disease up to ten years after initial tumor diagnosis and may experience failure of systemic therapy. Unfortunately, preclinical models to study ILC progression and predict the efficacy of novel therapeutics are scarce. Here, we review the current advances in ILC modeling, including cell lines and organotypic models, genetically engineered mouse models, and patient-derived xenografts. We also underscore four critical challenges that can be addressed using ILC models: drug resistance, lobular tumor microenvironment, tumor dormancy, and metastasis. Finally, we highlight the advantages of shared experimental ILC resources and provide essential considerations from the perspective of the European Lobular Breast Cancer Consortium (ELBCC), which is devoted to better understanding and translating the molecular cues that underpin ILC to clinical diagnosis and intervention. This review will guide investigators who are considering the implementation of ILC models in their research programs.
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Affiliation(s)
- George Sflomos
- ISREC—Swiss Institute for Experimental Cancer Research, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), 1015 Lausanne, Switzerland
| | - Koen Schipper
- The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London SW3 6JB, UK; (K.S.); (A.F.); (C.I.)
| | - Thijs Koorman
- Department of Pathology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands; (T.K.); (P.W.B.D.)
| | - Amanda Fitzpatrick
- The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London SW3 6JB, UK; (K.S.); (A.F.); (C.I.)
| | - Steffi Oesterreich
- Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, PA 15261, USA; (S.O.); (A.V.L.)
- Magee Women’s Cancer Research Institute, Pittsburgh, PA 15213, USA
- Cancer Biology Program, Women’s Cancer Research Center, UPMC Hillman Cancer Center, Pittsburgh, PA 15232, USA
| | - Adrian V. Lee
- Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, PA 15261, USA; (S.O.); (A.V.L.)
- Magee Women’s Cancer Research Institute, Pittsburgh, PA 15213, USA
- Cancer Biology Program, Women’s Cancer Research Center, UPMC Hillman Cancer Center, Pittsburgh, PA 15232, USA
| | - Jos Jonkers
- Division of Molecular Pathology, The Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands;
- Oncode Institute, 1066 CX Amsterdam, The Netherlands
| | - Valerie G. Brunton
- Edinburgh Cancer Research UK Centre, Institute of Genetics and Cancer, University of Edinburgh, Crewe Road South, Edinburgh EH4 2XU, UK;
| | - Matthias Christgen
- Institute of Pathology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany;
| | - Clare Isacke
- The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London SW3 6JB, UK; (K.S.); (A.F.); (C.I.)
| | - Patrick W. B. Derksen
- Department of Pathology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands; (T.K.); (P.W.B.D.)
| | - Cathrin Brisken
- ISREC—Swiss Institute for Experimental Cancer Research, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), 1015 Lausanne, Switzerland
- The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London SW3 6JB, UK; (K.S.); (A.F.); (C.I.)
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Whittaker T, Abdelrazek M, Fitzpatrick A, Froud J, Kelly J, Williamson J, Williams G. 732 Delay to Elective Colorectal Cancer Surgery and its Potential Implications During the Covid-19 Pandemic: A Systematic Review and Metanalysis. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Aim
The ongoing Covid-19 pandemic has interrupted the surgical treatment of colorectal cancer (CRC). This systematic review will assess literature concerning the risk of delay of elective surgery for CRC patients, focusing on overall survival (OS) and disease-free survival (DFS).
Method
A systematic review was performed as per PRISMA guidelines (PROSPERO ID: CRD42020189158). Medline, EMBASE and Scopus were searched. Delay to elective surgery was defined as the period between CRC diagnosis and the day of surgery. Metanalyses of the outcome’s OS and DFS were conducted. Forest plots, funnel plots, and tests of heterogeneity were produced. An estimated Number Needed to Harm (NNH) was calculated for statistically significant pooled Hazard Ratios (HRs).
Results
Of 3753 articles identified, seven met the inclusion criteria. Encompassing 314560 patients, three of the seven studies showed that a delay to elective resection is associated with poorer OS or DFS. OS was assessed at a one-month delay, the HR for six datasets was 1.13 (95%CI 1.02-1.26, p = 0.020) and at three months the pooled HR for three datasets was 1.57 (95%CI 1.16-2.12, p = 0.004). Estimated NNHs for a delay at one month and three months were 35 and 10 respectively. Delay was non-significantly negatively associated with DFS on meta-analysis.
Conclusions
This review recommends that elective surgery for CRC patients is not postponed, as evidence suggests delays from diagnosis are associated with poorer outcomes. Focused research is essential so that patient groups can be prioritized based on risk factors for future pandemics.
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Affiliation(s)
- T Whittaker
- Cardiff University School of Medicine, Cardiff, United Kingdom
| | - M Abdelrazek
- Cardiff University School of Medicine, Cardiff, United Kingdom
| | - A Fitzpatrick
- Cardiff University School of Medicine, Cardiff, United Kingdom
| | - J Froud
- Cardiff University School of Medicine, Cardiff, United Kingdom
| | - J Kelly
- Cardiff University School of Medicine, Cardiff, United Kingdom
| | | | - G Williams
- Royal Gwent Hospital, Newport, United Kingdom
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11
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Cheng VWT, Heywood R, Zakaria R, Burger R, Fitzpatrick A, Zucker K, Sanghera P, Doherty GJ, Palmieri C, Jenkinson MD. P14.70 BMScope: A systematic mapping review of brain/leptomeningeal metastasis clinical studies from 2010 to 2020. Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab180.177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
Brain metastasis (BM) and leptomeningeal disease (LMD) are typified by a poor prognosis and are an area of unmet clinical need. Historically, patients with central nervous system (CNS) disease have been excluded from systemic therapy clinical trials, particularly with active/leptomeningeal disease. However, increasing prevalence of CNS metastasis is leading to greater interest in BM/LMD. We performed a descriptive analysis of clinical studies investigating BM/LMD management, published between Jan 2010 to Mar 2020.
METHODS
A comprehensive, customised search strategy was devised for 12 online bibliographic databases, using the following concepts: “clinical study”, “brain metastasis”, “leptomeningeal disease”, “intervention”, “patient-related outcome”. Double screening for inclusion/exclusion was performed on the Rayyan QCRI web application. Published abstracts were also screened for inclusion from ASCO, ESMO, SNO and EANO between 2015–2020. Following full text screening, conflicts were resolved by consensus and data were extracted using an online standardised tool. Data analysis and data visualisation were performed on the R statistical package.
RESULTS
Overall, 33118 published studies were double screened; 2632 full publications and 628 abstracts were included. Of these, 14.7% reported on unique interventional clinical trials (phase 2 = 267; phase 3 = 80). More than three times the number of clinical trials investigating systemic agents as the sole therapy for BM/LMD were published in Q1 2020 compared to the whole of 2010 (16 vs 5). 42.5% of clinical trials employed a form of local therapy (brain targeted radiotherapy or neurosurgery). Studies reported on patients with BM (n = 2738), LMD (n = 110) or both (n = 119). The majority of studies were performed in North America, Europe or East Asia (88.5% vs 11.5% rest of the world). The top 3 nations involved in published studies were the USA (n = 1155), China (n = 351) and Germany (n = 334). Network analysis demonstrated increasing links between countries. In line with expected BM prevalence, the main tumour sites studied were lung (23.4%), gastrointestinal (17.5%), breast (15%) and melanoma (12.5%). A rising trend of published BM/LMD studies over time was noted, with 83 observational studies/10 clinical trials in 2010 vs. 454 observational studies/80 clinical trials in 2019.
CONCLUSION
These findings demonstrate that over the last decade there has been a growth in BM/LMD research; likely reflecting an increasing disease prevalence, availability of novel and potentially CNS active agents, as well as more advanced local therapy modalities. BM/LMD clinical research is dominated by a few geographical regions and nations; however, there is an apparent shift to more international collaboration. This comprehensive mapping exercise will enable targeted systematic reviews of the existing evidence base on BM/LMD management.
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Affiliation(s)
- V W T Cheng
- Leeds Institute of Medical Research, Leeds, United Kingdom
| | - R Heywood
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - R Zakaria
- The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - R Burger
- King’s College Hospital NHS Foundation Trust, London, United Kingdom
| | - A Fitzpatrick
- Institute of Cancer Research, London, United Kingdom
| | - K Zucker
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - P Sanghera
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - G J Doherty
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - C Palmieri
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - M D Jenkinson
- The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
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12
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Fitzpatrick A, Iravani M, Okines A, Mills A, Harries M, Tutt A, Isacke C. LMD-18. Detection and serial monitoring of CSF ctDNA in breast cancer leptomeningeal disease (BCLM). Neurooncol Adv 2021. [PMCID: PMC8351201 DOI: 10.1093/noajnl/vdab071.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background CSF cytology is the gold standard diagnostic test for BCLM, but is hampered by a low sensitivity, often necessitating repeated lumbar puncture to confirm or refute the diagnosis. Furthermore, during the treatment of BCLM, there is no robust quantitative response tool to guide treatment decisions. Material and Methods cfDNA was obtained from CSF and plasma in patients with breast cancer undergoing investigation for BCLM (n = 28) and during subsequent intrathecal treatment (n = 13). Ultra low pass whole genome sequencing (ulpWGS) and estimation of the ctDNA fraction was performed. Results were validated by mutation-specific digital droplet PCR (ddPCR). Results 22/28 cases had confirmed BCLM by positive MRI and/or CSF cytology. The remaining 6/28 had suspected but non-confirmed BCLM, and at median 20 months follow up, these patients were BCLM-free. CSF ctDNA fraction was significantly elevated (median 57.5, IQR 38.3 - 84.9%) in confirmed BCLM compared to 6 non-confirmed BCLM (median 5.0, IQR 0.0 - 6.7%) (p <0.0001). ctDNA fraction was detected in BCLM confirmed cases regardless of negative cytology or MRI. Plasma ctDNA fraction was only detected in extra-cranial disease progression. ctDNA fraction was concordant with mutant allele fraction measured by ddPCR (n = 118 samples). Serial CSF ctDNA fraction during intrathecal treatment showed dynamic changes, while CSF cytology and MRI were often unchanged or equivocal. Early reduction in CSF ctDNA fraction was associated with longer responses to intrathecal therapy. Further, rising ctDNA fraction during intrathecal chemotherapy could be detected up to 6 weeks before relapse in neurological symptoms, cytology or MRI. Conclusion Measuring CSF ctDNA fraction is a sensitive diagnostic test for BCLM and could lead to more timely and accurate diagnosis. During intrathecal chemotherapy, CSF ctDNA also provides a quantitative response biomarker to help guide clinical management in this difficult treatment scenario.
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Affiliation(s)
| | | | | | - Adam Mills
- Institute of Cancer Research, London, UK
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13
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Rätze MAK, Koorman T, Sijnesael T, Bassey-Archibong B, van de Ven R, Enserink L, Visser D, Jaksani S, Bakker E, Richard F, Tutt A, Steele R, Pettitt S, Lord CJ, Fitzpatrick A, Isacke C, van Diest PJ, Desmedt C, Daniel JM, Derksen PW. Abstract LB246: E-cadherin loss drives Id2-dependent dampening of cell cycle progression and predicts increased susceptibility to CDK4/6 inhibition in lobular breast cancer. Cancer Res 2021. [DOI: 10.1158/1538-7445.am2021-lb246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Invasive lobular breast carcinoma (ILC) is a low grade and mostly chemo-refractory luminal-type breast cancer that has been linked to sustained proliferative quiescence and long-term latency relapses (15-20 years). Loss of E-cadherin causes metastatic lobular breast cancer, partly through acquisition of anchorage independence. It is however still unknown how ILC cells control the balance between proliferative indolence and cell cycle re-entry at the metastatic site. We show here that E-cadherin loss leads to upregulation of Id2 through p120-catenin/Kaiso-dependent transcriptional derepression. Anchorage independent conditions further exacerbate p120-driven Id2 expression, leading to a sustained G0/G1 cell cycle arrest through binding of cytosolic Id2 to hypo-phosphorylated Rb. Intriguingly, we find that E-cadherin inactivation causes increased sensitivity to CDK4/6 inhibition in mouse and human breast cancer cell lines and primary tumor organoids. Finally, we find that Id2 expression is elevated in human ILC when compared to ductal breast cancers. Based on these data, we propose that combined E-cadherin loss and cytosolic Id2 expression can be used for the differential diagnosis of ILC and represent a candidate predictive biomarker pair for cell cycle targeting drug efficacy.
Citation Format: Max Antonius Klaus Rätze, Thijs Koorman, Thijmen Sijnesael, Blessing Bassey-Archibong, Robert van de Ven, Lotte Enserink, Daan Visser, Sridevi Jaksani, Elvira Bakker, François Richard, Andrew Tutt, Rebecca Steele, Stephen Pettitt, Christopher J. Lord, Amanda Fitzpatrick, Clare Isacke, Paul J. van Diest, Christine Desmedt, Juliet M. Daniel, Patrick W.B. Derksen. E-cadherin loss drives Id2-dependent dampening of cell cycle progression and predicts increased susceptibility to CDK4/6 inhibition in lobular breast cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr LB246.
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Affiliation(s)
| | - Thijs Koorman
- 1University Medical Center Utrecht, Utrecht, Netherlands
| | | | | | | | - Lotte Enserink
- 1University Medical Center Utrecht, Utrecht, Netherlands
| | - Daan Visser
- 1University Medical Center Utrecht, Utrecht, Netherlands
| | | | - Elvira Bakker
- 1University Medical Center Utrecht, Utrecht, Netherlands
| | | | - Andrew Tutt
- 4King's College London, London, United Kingdom
| | - Rebecca Steele
- 5The Institute of Cancer Research, London, United Kingdom
| | | | | | | | - Clare Isacke
- 5The Institute of Cancer Research, London, United Kingdom
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14
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Lythgoe MP, Cheng VWT, McKenzie HS, Kwan A, Konstantis A, Ma R, Teo PJ, Fitzpatrick A. V6 PRIMROSE: A national trainee collaborative-led, multicentre prospective audit on the care of breast cancer patients with central nervous system disease in the UK. BJS Open 2021. [PMCID: PMC8030215 DOI: 10.1093/bjsopen/zrab034.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PRIMROSE A national trainee collaborative-led, multicentre prospective audit on the care of breast cancer patients with central nervous system disease in the UK Mark P Lythgoe1, Vinton WT Cheng2, Hayley S McKenzie3, Amy Kwan4, Apostolos Konstantis5, Ruichong Ma6, Pei J Teo7, Amanda Fitzpatrick8, Laura Woodhouse9 & Carlo Palmieri10 on behalf of the BNTRC† and PRIMROSE study group 1Imperial College Healthcare NHS Trust, London, 2Leeds Cancer Centre, Leeds, 3University of Southampton, Southampton, 4University of Sheffield, Sheffield, 5The Princess Alexandra NHS Trust, Harlow 6Oxford University Hospitals NHS Trust, Oxford, 7Worcestershire Acute Hospitals NHS Trust, Worcester, 8Institute of Cancer Research, London, 9The Christie NHS Foundation Trust, Manchester, 10University of Liverpool, Liverpool, †British Neurosurgical Trainee Research Collaborative Introduction Breast cancer is the commonest cancer in the UK and the 4th leading cause of cancer-related death. Breast cancer brain metastases (BCBM) are a poor prognostic indicator and associated with very poor survival and only a minority of patients survive >1 year despite oncological treatment. The rising prevalence of patients with BCBM represent an increasing unmet healthcare need. However, in the UK there is a paucity of data about prevalence, survival and management. Guidance on managing brain metastases is improving, however it is unclear how this has been applied in the context of BCBM and whether recommended standards are uniformly applied across the UK Methods PRIMROSE is a trainee collaborative-led initiative to estimate BCBM prevalence, assess current practice (comparing national/international standards) and determine long term outcomes/sequalae. Anonymised data is being pooled via secure REDCap database collating demographics, clinico-pathological information, prior treatment, BCBM treatment and other key variables. All UK hospitals can register, with recruitment driven by trainees via the UK Breast Cancer Trainees Research Collaborative Group and British Neurosurgical Trainee Research Collaborative. Senior oversight will be provided by a local consultant oncologist or neurosurgeon. Results Opened in Jan 2020, 180 datasets have been entered, despite significant disrupted due to COVID-19 from Feburary to May). Over 25 sites are open/in the process of joining. Trainee networks have been established in all regions of the UK with the exception of Yorkshire and The Humber, East of England and North East England. Promotion of the network has occurred at significant oncology conferences (e.g. San Antonio Breast Meeting, and National Cancer Research Institute). We plan to expand to all major UK neurosurgical and oncology centres by December 2020, with data collection completed by December 2021. Conclusions PRIMROSE demonstrates the utility of trainee collaborative networks in rapidly organising large-scale multicentre data collection to understand care of patients at a national level. Such information will be important for identifying current pactice and act as a benchmark for improving local service delivery for patients with BCBM.
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15
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Fitzpatrick A, Iravani M, Mills A, Knight E, Alaguthurai T, Shah V, Okines A, Turner N, Harries M, Haider S, Tutt A, Isacke C. Abstract PD13-03: Genomic profiling of breast cancer leptomeningeal metastasis (BCLM) reveals a divergent evolution and therapeutic targets. Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-pd13-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Leptomeningeal metastasis remains a devastating development in breast cancer, with a median survival of 3-4 months, no widely accepted standard treatment, and limited access to trials of novel therapies. In addition, lack of access to leptomeningeal metastatic material hampers the pre-clinical investigation of the disease process and molecular drivers. This project uses CSF as a liquid biopsy to characterise BCLM, through genomic analysis of the cell-free DNA (cfDNA), and the development of pre-clinical BCLM models by the expansion of CSF disseminated tumour cells.
Methods: CSF (surplus to clinical requirements) and blood were collected from patients undergoing evaluation of leptomeningeal metastasis. cfDNA was extracted from CSF and plasma, and subjected to ultra-low pass whole genome sequencing (ulpWGS) to assess tumour-derived cfDNA fraction. Samples with >10% tumour fraction underwent whole exome sequencing, along with matched archival primary tumour, archival extra-cranial metastatic site(s) and germline DNA. CSF cells were expanded in vitro (to establish 3D patient-derived organoids (PDOs).
Results: Cohort demographics are shown in Table 1. Whole exome sequencing (WES) in 21 patients reveals that 65.2% of variants found in CSF cfDNA were not shared with the primary tumour or other matched samples. Phylogenetic analysis shows a divergent evolution from extra-cranial metastatic sites, represented by plasma cfDNA (n = 12) and/or metastatic site tissue DNA (n = 7). The most frequently mutated cancer-associated genes in CSF were MUC16 (12/21), TP53 (11/21), CDH1 (10/21), and KMT2D (7/21). The common occurrence of CDH1 loss-of-function mutations was in keeping with the large number of lobular cases, however were also discovered in CSF of two cases with E-cadherin positive ductal primary tumours. Furthermore, mutations (including frameshift indels) in JAK family proteins (JAK1, JAK3 and TYK2) were present in 5/21 cases, and were private to CSF in 4/21. Potential actionable gene alterations private to CSF include; IDH2 (3/21), GLI1 (3/21), PIK3CA (2/21) and PTCH1 (2/21). Further, there was an enrichment for somatic BRCA1/2 mutations (5/21, 2 private to CSF) indicating potential for platinum and/or PARP inhibitor therapy in these individuals. Patient-derived organoids (PDOs) were established using CSF tumour cells from 3 ER+/HER2- and 2 TNBC BCLM cases. WES of PDOs revealed high concordance with genomic variants identified in the matched CSF cfDNA. Therapeutic compound testing revealed 3/5 PDOs did not display sensitivity to methotrexate, the most commonly used BCLM intrathecal treatment. Patient-derived xenograft (PDX) models have been established by mammary fat pad, intraductal, intracardiac and intracerebroventricular injection routes.
Conclusion/future plans: WES of CSF cfDNA provides insight into genomic changes in BCLM, including the divergent evolution, and BCLM specific alterations, some of which are potentially targetable. Parallel PDO and PDX models are being used to validate potential drivers and therapeutic targets. Treatment options beyond intrathecal methotrexate are urgently needed and in future might be molecularly tailored based on alterations discovered by CSF cfDNA sequencing.
Table 1. Clinical demographicsDemographicsMedian, years (range)Age at BC diagnosis45 (24 – 66)Time from primary BC to BCLM4.7 (0.7 – 14.7)Time from first metastasis to BCLM1.2 (0.0 – 6.5)Histological Typen (%)Lobular10 (48)Ductal8 (38)Mixed ductal/lobular3 (14)Immuno-histochemical phenotypen (%)ER+ HER2-13 (62)TNBC5 (24)ER+ HER2+2 (9)ER- HER2+1 (5)Metastatic sitesn (%)No other metastatic sites (BCLM only)3 (14)Bone12 (57)Serosal8 (38)Brain6 (29)Liver4 (19)Ovary4 (19)
Citation Format: Amanda Fitzpatrick, Marjan Iravani, Adam Mills, Eleanor Knight, Thanussuyah Alaguthurai, Vandna Shah, Alicia Okines, Nick Turner, Mark Harries, Syed Haider, Andrew Tutt, Clare Isacke. Genomic profiling of breast cancer leptomeningeal metastasis (BCLM) reveals a divergent evolution and therapeutic targets [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PD13-03.
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Affiliation(s)
- Amanda Fitzpatrick
- 1Division of Breast Cancer Research, Institute of Cancer Research, London, United Kingdom
| | - Marjan Iravani
- 1Division of Breast Cancer Research, Institute of Cancer Research, London, United Kingdom
| | - Adam Mills
- 1Division of Breast Cancer Research, Institute of Cancer Research, London, United Kingdom
| | - Eleanor Knight
- 1Division of Breast Cancer Research, Institute of Cancer Research, London, United Kingdom
| | - Thanussuyah Alaguthurai
- 2Breast Cancer Now Research Unit, Guy's Hospital, King's College London, London, United Kingdom
| | - Vandna Shah
- 2Breast Cancer Now Research Unit, Guy's Hospital, King's College London, London, United Kingdom
| | - Alicia Okines
- 3Breast Unit, The Royal Marsden Hospital, London, United Kingdom
| | - Nick Turner
- 3Breast Unit, The Royal Marsden Hospital, London, United Kingdom
| | - Mark Harries
- 4Guy's & St Thomas' Hospitals NHS Foundation Trust, London, United Kingdom
| | - Syed Haider
- 1Division of Breast Cancer Research, Institute of Cancer Research, London, United Kingdom
| | - Andrew Tutt
- 1Division of Breast Cancer Research, Institute of Cancer Research, London, United Kingdom
| | - Clare Isacke
- 1Division of Breast Cancer Research, Institute of Cancer Research, London, United Kingdom
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16
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Hopkinson M, Nicholson G, Weaving D, Hendricks S, Fitzpatrick A, Naylor A, Robertson C, Beggs C, Jones B. Rugby league ball carrier injuries: The relative importance of tackle characteristics during the European Super League. Eur J Sport Sci 2021; 22:269-278. [PMID: 33210564 DOI: 10.1080/17461391.2020.1853817] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Rugby league carries a high injury incidence with 61% of injuries occurring at tackles. The ball carrier has a higher injury incidence than the defender, therefore understanding mechanisms occurring during injurious tackles are important. Given the dynamic, open nature of tackling, characteristics influencing tackle outcome likely encompass complex networks of dependencies. This study aims to identify important classifying characteristics of the tackle related to ball carrier injurious and non-injurious events in rugby league and identify the characteristics capability to correctly classify those events. Forty-one ball carrier injuries were identified and 205 matched non-injurious tackles were identified as controls. Each case and control were analysed retrospectively through video analysis. Random forest models were built to (1) filter tackle characteristics possessing relative importance for classifying tackles resulting in injurious/non-injurious outcomes and (2) determine sensitivity and specificity of tackle characteristics to classify injurious and non-injurious events. Six characteristics were identified to possess relative importance to classify injurious tackles. This included 'tackler twisted ball carrier's legs when legs were planted on ground', 'the tackler and ball carrier collide heads', 'the tackler used body weight to tackle ball carrier', 'the tackler has obvious control of the ball carrier' 'the tackler was approaching tackle sub-maximally' and 'tackler's arms were below shoulder level, elbows were flexed'. The study identified tackle characteristics that can be modified in attempt to reduce injury. Additional injury data are needed to establish relationship networks of characteristics and analyse specific injuries. Sensitivity and specificity results of the random forest were 0.995 and 0.525.
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Affiliation(s)
- M Hopkinson
- Carnegie Applied Rugby Research (CARR) Centre, Carnegie School of Sport, Leeds Beckett University, Leeds, UK
| | - G Nicholson
- Carnegie Applied Rugby Research (CARR) Centre, Carnegie School of Sport, Leeds Beckett University, Leeds, UK
| | - D Weaving
- Carnegie Applied Rugby Research (CARR) Centre, Carnegie School of Sport, Leeds Beckett University, Leeds, UK.,Leeds Rhinos Rugby League Club, Leeds, UK
| | - S Hendricks
- Carnegie Applied Rugby Research (CARR) Centre, Carnegie School of Sport, Leeds Beckett University, Leeds, UK.,Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town and the Sports Science Institute of South Africa, Cape Town, South Africa
| | - A Fitzpatrick
- Faculty of Health, The University of Bolton, Bolton, UK
| | - A Naylor
- Faculty of Health, The University of Bolton, Bolton, UK
| | - C Robertson
- Faculty of Health, The University of Bolton, Bolton, UK
| | - C Beggs
- Carnegie Applied Rugby Research (CARR) Centre, Carnegie School of Sport, Leeds Beckett University, Leeds, UK
| | - B Jones
- Carnegie Applied Rugby Research (CARR) Centre, Carnegie School of Sport, Leeds Beckett University, Leeds, UK.,Leeds Rhinos Rugby League Club, Leeds, UK.,England Performance Unit, The Rugby Football League, Leeds, UK.,School of Science and Technology, University of New England, Armidale, Australia.,Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town and the Sports Science Institute of South Africa, Cape Town, South Africa
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17
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Sharma V, Al Saikhan L, Park C, Hughes A, Gu H, Saeed S, Boguslavskyi A, Carr-White G, Chambers J, Chowienczyk P, Jain M, Jessop H, Turner C, Bassindale-Maguire G, Baig W, Kidambi A, Abdel-Rahman ST, Schlosshan D, Sengupta A, Fitzpatrick A, Sandoval J, Hickman S, Procter H, Taylor J, Kaur H, Knowles C, Wheatcroft S, Witte K, Gatenby K, Willis JA, Kendler-Rhodes A, Slegg O, Carson K, Easaw J, Kandan SR, Rodrigues JCL, MacKenzie-Ross R, Hall T, Robinson G, Little D, Hudson B, Pauling J, Redman S, Graham R, Coghlan G, Suntharalingam J, Augustine DX, Nowak JWM, Masters AT. Report from the Annual Conference of the British Society of Echocardiography, October 2018, ACC Liverpool, Liverpool. Echo Res Pract 2020; 7:M1. [PMID: 33112840 PMCID: PMC8693154 DOI: 10.1530/erp-20-0037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- V Sharma
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - L Al Saikhan
- MRC Unit for Lifelong Health and Aging at UCL, Department of Population Science & Experimental Medicine, UCL Institute of Cardiovascular Science, University College London, London, UK.,Department of Cardiac Technology, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - C Park
- MRC Unit for Lifelong Health and Aging at UCL, Department of Population Science & Experimental Medicine, UCL Institute of Cardiovascular Science, University College London, London, UK
| | - A Hughes
- MRC Unit for Lifelong Health and Aging at UCL, Department of Population Science & Experimental Medicine, UCL Institute of Cardiovascular Science, University College London, London, UK
| | - H Gu
- British Heart Foundation Centre, King's College London, London, UK
| | - S Saeed
- Haukeland University Hospital, Bergen, Norway
| | - A Boguslavskyi
- British Heart Foundation Centre, King's College London, London, UK
| | - G Carr-White
- British Heart Foundation Centre, King's College London, London, UK.,Cardiothoracic Centre, St Thomas' Hospital, London, UK
| | - J Chambers
- Cardiothoracic Centre, St Thomas' Hospital, London, UK
| | - P Chowienczyk
- British Heart Foundation Centre, King's College London, London, UK
| | - M Jain
- Yorkshire Heart Centre, Leeds General Infirmary, Leeds, UK
| | - H Jessop
- Yorkshire Heart Centre, Leeds General Infirmary, Leeds, UK
| | - C Turner
- Yorkshire Heart Centre, Leeds General Infirmary, Leeds, UK.,Department of Cardiology, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | - W Baig
- Yorkshire Heart Centre, Leeds General Infirmary, Leeds, UK
| | - A Kidambi
- Yorkshire Heart Centre, Leeds General Infirmary, Leeds, UK
| | | | - D Schlosshan
- Yorkshire Heart Centre, Leeds General Infirmary, Leeds, UK
| | - A Sengupta
- Department of Cardiology, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - A Fitzpatrick
- Department of Cardiology, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - J Sandoval
- Department of Cardiology, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - S Hickman
- Department of Cardiology, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - H Procter
- Department of Cardiology, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - J Taylor
- Department of Cardiology, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - H Kaur
- Department of Cardiology, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - C Knowles
- Department of Cardiology, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - S Wheatcroft
- Department of Cardiology, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - K Witte
- Department of Cardiology, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - K Gatenby
- Department of Cardiology, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - J A Willis
- Royal United Hospitals Bath, NHS Foundation Trust, Bath, UK
| | | | - O Slegg
- Royal United Hospitals Bath, NHS Foundation Trust, Bath, UK
| | - K Carson
- Royal United Hospitals Bath, NHS Foundation Trust, Bath, UK
| | - J Easaw
- Royal United Hospitals Bath, NHS Foundation Trust, Bath, UK
| | - S R Kandan
- Royal United Hospitals Bath, NHS Foundation Trust, Bath, UK
| | | | | | - T Hall
- Royal United Hospitals Bath, NHS Foundation Trust, Bath, UK
| | - G Robinson
- Royal United Hospitals Bath, NHS Foundation Trust, Bath, UK
| | - D Little
- Royal United Hospitals Bath, NHS Foundation Trust, Bath, UK
| | - B Hudson
- Royal United Hospitals Bath, NHS Foundation Trust, Bath, UK
| | - J Pauling
- Royal United Hospitals Bath, NHS Foundation Trust, Bath, UK
| | - S Redman
- Royal United Hospitals Bath, NHS Foundation Trust, Bath, UK
| | - R Graham
- Royal United Hospitals Bath, NHS Foundation Trust, Bath, UK
| | - G Coghlan
- Department of Cardiology, Royal Free Hospital, London, UK
| | - J Suntharalingam
- Royal United Hospitals Bath, NHS Foundation Trust, Bath, UK.,University of Bath, Bath, UK
| | - D X Augustine
- Royal United Hospitals Bath, NHS Foundation Trust, Bath, UK
| | - J W M Nowak
- Royal United Hospitals Bath, NHS Foundation Trust, Bath, UK
| | - A T Masters
- University Hospitals Bristol NHS Foundation Trust, Bristol, UK
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Fitzpatrick A, Iravani M, Okines A, Harries M, Tutt A, Isacke C. 87MO Assessing tumour fraction of CSF cfDNA improves diagnostic accuracy and therapeutic monitoring in breast cancer leptomeningeal metastasis (BCLM). Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Cheng VWT, McKenzie HS, Kwan A, Konstantis A, Ma R, Teo PJ, Fitzpatrick A, Mehta S, Mukhopadhyay A, Palmieri C. Abstract OT3-10-02: A breast cancer trainees research collaborative group prospective study of treatment and outcomes related to central nervous system disease secondary to breast cancer in the United Kingdom. Cancer Res 2020. [DOI: 10.1158/1538-7445.sabcs19-ot3-10-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: Breast cancer brain metastasis (BCBM) is a particular feature of HER2-positive and triple negative breast cancer (BC) and is becoming more common. This reflects the improved survival of patients living with metastatic breast cancer as well as increased cross-sectional imaging of the central nervous system with magnetic resonance imaging (1). The development of BCBM on the background of adequately controlled extracranial disease is an increasingly prevalent clinical scenario. BCBM causes significant morbidity and mortality; unfortunately the efficacy of systemic treatment is extremely limited and, at present, no systemic therapies are specifically approved for the treatment of BCBM (2). Basic and translational research to understand the pathophysiology of BCBM remains limited by a lack of access to annotated clinical material. Such research is needed if preventative and novel treatment strategies are to be developed. Moreover, there is currently a lack of basic contemporaneous information regarding the incidence and management of BCBM in the UK, how it may vary across the country and its impact on patient outcomes. Finally, clinical studies have been hampered by a lack of a central resource to aid feasibility work and to identify potentially eligible patients. Study design: PRIMROSE will use the trainee collaborative model to establish an observational prospective UK cohort of newly diagnosed BCBM. Data collected will include routine clinico-pathological information, prior adjuvant and metastatic treatment as well as BCBM-related information including presentation, management and outcome. Anonymised data will be collated in a secure central REDCap database. All hospitals in the UK will be eligible to register patients driven by trainees from all specialties via the UK Breast Cancer Trainees Research Collaborative Group (BCTRCG) network. Eligibility criteria: Inclusion criteria: male or female patients aged >16 years of age, with histologically and/or cytologically confirmed BC with involvement of the brain parenchyma. There are no formal exclusion criteria. Patients with leptomeningeal disease will be registered, with data being collected in a separate project (PRIMROSE-LMD). Aims: The overarching objectives include defining the prevalence, management and outcome of BCBM in the UK. Endpoints: *Primary Endpoint: Overall survival from initial diagnosis of CNS involvement. Secondary Endpoints will include: 1. Time to initial CNS involvement from initial diagnosis of MBC; 2. Therapeutic interventions for management of CNS disease; 3. Time to intracranial tumour progression (for each line of therapy given for CNS disease); 4. Overall survival from MBC diagnosis; 5. Cause of death: progressive CNS disease versus progressive disease at other sites. *Information will be presented for the whole cohort as well as by breast cancer subtype Patient accrual: Patient accrual is due to commence in July 2019 and continue will for 2 years in the first instance. There is no predefined target accrual. Contact information: Study lead: Prof Carlo Palmieri; c.palmieri@liverpool.ac.uk References: (1) Witzel I, Oliveira-Ferrer L, Pantel K, Müller V, Wikman H. Breast cancer brain metastases: biology and new clinical perspectives. Breast Cancer Res. 2016 (2) Kotecki N, Lefranc F, Devriendt D, Awada A. Therapy of breast cancer brain metastases: challenges, emerging treatments and perspectives. Ther Adv Med Oncol. 2018
Citation Format: Vinton WT Cheng, Hayley S McKenzie, Amy Kwan, Apostolos Konstantis, Ruichong Ma, Pei J Teo, Amanda Fitzpatrick, Shaveta Mehta, Arunima Mukhopadhyay, Carlo Palmieri, on Behalf of the PRIMROSE Study Group and the BCTRCG. A breast cancer trainees research collaborative group prospective study of treatment and outcomes related to central nervous system disease secondary to breast cancer in the United Kingdom [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr OT3-10-02.
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Affiliation(s)
| | | | - Amy Kwan
- 3University of Sheffield, Sheffield, United Kingdom
| | | | - Ruichong Ma
- 5Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| | - Pei J Teo
- 6Worcestershire Acute Hospitals NHS Trust, Worcester, United Kingdom
| | | | - Shaveta Mehta
- 8Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, United Kingdom
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Fitzpatrick A, Tutt A. Controversial issues in the neoadjuvant treatment of triple-negative breast cancer. Ther Adv Med Oncol 2019; 11:1758835919882581. [PMID: 31700549 PMCID: PMC6826917 DOI: 10.1177/1758835919882581] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 09/09/2019] [Indexed: 12/12/2022] Open
Abstract
Triple-negative breast cancer (TNBC), as a collective group of heterogenous tumours, displays the highest rate of distant recurrence and lowest survival from metastatic disease across breast cancer subtypes. However, a subset of TNBC display impressive primary tumour response to neoadjuvant chemotherapy, translating to reduction in future relapse and increased overall survival. Maximizing early treatment response is crucial to improving the outlook in this subtype. Numerous systemic therapy strategies are being assessed in the neoadjuvant setting and the current paradigm of generic chemotherapy components in regimens for high-risk breast cancers, regardless of biological subtype, is changing. Therapeutic approaches with evidence of benefit include platinum drugs, polyadenosine diphosphate ribose polymerase (PARP) inhibitors, immunotherapy and second adjuvant therapy for those not achieving pathological complete response. Importantly, molecular testing can identify subgroups within TNBC, such as deoxyribonucleic acid (DNA) homologous recombination repair deficiency, lymphocyte-predominant tumours, and TNBC type 4 molecular subtypes. Clinical trials that address the interaction between these biomarkers and treatment approaches are a priority, to identify subgroups benefiting from additional therapy.
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Affiliation(s)
- Amanda Fitzpatrick
- Breast Cancer Now Research Centre, The Institute of Cancer Research, 237 Fulham Road, London SW3 6JB, UK
| | - Andrew Tutt
- Breast Cancer Now Research Centre, Institute of Cancer Research, London, UK Faculty of Life Sciences and Medicine, King's College London, London, UK
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Fitzpatrick A, Konstantis A, Palmieri C. Prospective Observational Study in Patients with Metastatic Breast Cancer Involving the Central Nervous System (PRIMROSE). Clin Oncol (R Coll Radiol) 2019. [DOI: 10.1016/j.clon.2019.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Rudd K, Hantrakun V, Boonsri C, Somayaji R, Fitzpatrick A, Day N, Teparrukkul P, Limmathurotsakul D, West T. SEPSIS MANAGEMENT IN ADULTS ADMITTED TO A THAI REGIONAL REFERRAL HOSPITAL. Chest 2019. [DOI: 10.1016/j.chest.2019.02.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Fitzpatrick A, Isacke C, Tutt A. Abstract P1-19-04: Withdrawn. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p1-19-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
This abstract was withdrawn by the authors.
Citation Format: Fitzpatrick A, Isacke C, Tutt A. Withdrawn [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-19-04.
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Affiliation(s)
- A Fitzpatrick
- Institute of Cancer Research, London, United Kingdom; Breast Cancer Now Research Unit, King's College, London, United Kingdom
| | - C Isacke
- Institute of Cancer Research, London, United Kingdom; Breast Cancer Now Research Unit, King's College, London, United Kingdom
| | - A Tutt
- Institute of Cancer Research, London, United Kingdom; Breast Cancer Now Research Unit, King's College, London, United Kingdom
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Kijewska M, Viski C, Turrell F, Fitzpatrick A, van Weverwijk A, Gao Q, Iravani M, Isacke CM. Using an in-vivo syngeneic spontaneous metastasis model identifies ID2 as a promoter of breast cancer colonisation in the brain. Breast Cancer Res 2019; 21:4. [PMID: 30642388 PMCID: PMC6332688 DOI: 10.1186/s13058-018-1093-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 12/21/2018] [Indexed: 12/26/2022] Open
Abstract
Background Dissemination of breast cancers to the brain is associated with poor patient outcome and limited therapeutic options. In this study we sought to identify novel regulators of brain metastasis by profiling mouse mammary carcinoma cells spontaneously metastasising from the primary tumour in an immunocompetent syngeneic host. Methods 4T1 mouse mammary carcinoma sublines derived from primary tumours and spontaneous brain and lung metastases in BALB/c mice were subject to genome-wide expression profiling. Two differentially expressed genes, Id2 and Aldh3a1, were validated in in-vivo models using mouse and human cancer cell lines. Clinical relevance was investigated in datasets of breast cancer patients with regards to distant metastasis-free survival and brain metastasis relapse-free survival. The role of bone morphogenetic protein (BMP)7 in regulating Id2 expression and promoting cell survival was investigated in two-dimensional and three-dimensional in-vitro assays. Results In the spontaneous metastasis model, expression of Id2 and Aldh3a1 was significantly higher in 4T1 brain-derived sublines compared with sublines from lung metastases or primary tumour. Downregulation of expression impairs the ability of cells to colonise the brain parenchyma whereas ectopic expression in 4T1 and human MDA-MB-231 cells promotes dissemination to the brain following intracardiac inoculation but has no impact on the efficiency of lung colonisation. Both genes are highly expressed in oestrogen receptor (ER)-negative breast cancers and, within this poor prognosis sub-group, increased expression correlates with reduced distant metastasis-free survival. ID2 expression also associates with reduced brain metastasis relapse-free survival. Mechanistically, BMP7, which is present at significantly higher levels in brain tissue compared with the lungs, upregulates ID2 expression and, after BMP7 withdrawal, this elevated expression is retained. Finally, we demonstrate that either ectopic expression of ID2 or BMP7-induced ID2 expression protects tumour cells from anoikis. Conclusions This study identifies ID2 as a key regulator of breast cancer metastasis to the brain. Our data support a model in which breast cancer cells that have disseminated to the brain upregulate ID2 expression in response to astrocyte-secreted BMP7 and this serves to support metastatic expansion. Moreover, elevated ID2 expression identifies breast cancer patients at increased risk of developing metastatic relapse in the brain. Electronic supplementary material The online version of this article (10.1186/s13058-018-1093-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Magdalena Kijewska
- The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, 237 Fulham Road, London, SW3 6JB, UK.,Present address: Oncology Cell Therapy DPU, GSK, Gunnels Wood Road, Stevenage, SG1 2NY, UK
| | - Carmen Viski
- The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, 237 Fulham Road, London, SW3 6JB, UK
| | - Frances Turrell
- The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, 237 Fulham Road, London, SW3 6JB, UK
| | - Amanda Fitzpatrick
- The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, 237 Fulham Road, London, SW3 6JB, UK
| | - Antoinette van Weverwijk
- The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, 237 Fulham Road, London, SW3 6JB, UK.,Present address: Division of Tumor Biology & Immunology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066, CX, Amsterdam, The Netherlands
| | - Qiong Gao
- The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, 237 Fulham Road, London, SW3 6JB, UK
| | - Marjan Iravani
- The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, 237 Fulham Road, London, SW3 6JB, UK
| | - Clare M Isacke
- The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, 237 Fulham Road, London, SW3 6JB, UK.
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Miller L, Jenny N, Rawlings A, Arnold A, Fitzpatrick A, Lopez O, Odden M. SEX DIFFERENCES IN THE ASSOCIATION BETWEEN PENTRAXIN 3 AND COGNITIVE DECLINE: THE CARDIOVASCULAR HEALTH STUDY. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.2614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - N Jenny
- University of Vermont, Burlington, VT, USA
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Harrington L, Ehlert A, Jenny N, Lopez O, Cushman M, Fitzpatrick A, Mukamal K, Jensen M. HEMOSTATIC PARAMETER LEVELS AND DEMENTIA RISK IN THE CARDIOVASCULAR HEALTH STUDY. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.2608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - A Ehlert
- Harvard T.H. Chan School of Public Health
| | - N Jenny
- University of Vermont Larner College of Medicine
| | | | - M Cushman
- University of Vermont Larner College of Medicine
| | | | - K Mukamal
- Beth Israel Deaconess Medical Center
| | - M Jensen
- Harvard T.H. Chan School of Public Health
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Djonlagic I, Weng J, Johnson D, Marani S, Purcell S, Fitzpatrick A, Frazier-Wood A, Seeman T, Nguyen H, Luchsinger J, Rapp S, Redline S. 0754 ASSOCIATIONS BETWEEN SLEEP EFFICIENCY AND COGNITIVE FUNCTION IN THE MULTI-ETHNIC STUDY OF ATHEROSCLEROSIS (MESA). Sleep 2017. [DOI: 10.1093/sleepj/zsx050.753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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LaTemple D, Simmons J, Bixler B, Fitzpatrick A, Rogers L, Bleecker E. P131 Clinician knowledge, confidence, and need for education in severe asthma management. Ann Allergy Asthma Immunol 2016. [DOI: 10.1016/j.anai.2016.09.141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Böhm S, Montfort A, Pearce OMT, Topping J, Chakravarty P, Everitt GLA, Clear A, McDermott JR, Ennis D, Dowe T, Fitzpatrick A, Brockbank EC, Lawrence AC, Jeyarajah A, Faruqi AZ, McNeish IA, Singh N, Lockley M, Balkwill FR. Neoadjuvant Chemotherapy Modulates the Immune Microenvironment in Metastases of Tubo-Ovarian High-Grade Serous Carcinoma. Clin Cancer Res 2016; 22:3025-36. [PMID: 27306793 DOI: 10.1158/1078-0432.ccr-15-2657] [Citation(s) in RCA: 101] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 02/01/2016] [Indexed: 11/16/2022]
Abstract
PURPOSE The purpose of this study was to assess the effect of neoadjuvant chemotherapy (NACT) on immune activation in stage IIIC/IV tubo-ovarian high-grade serous carcinoma (HGSC), and its relationship to treatment response. EXPERIMENTAL DESIGN We obtained pre- and posttreatment omental biopsies and blood samples from a total of 54 patients undergoing platinum-based NACT and 6 patients undergoing primary debulking surgery. We measured T-cell density and phenotype, immune activation, and markers of cancer-related inflammation using IHC, flow cytometry, electrochemiluminescence assays, and RNA sequencing and related our findings to the histopathologic treatment response. RESULTS There was evidence of T-cell activation in omental biopsies after NACT: CD4(+) T cells showed enhanced IFNγ production and antitumor Th1 gene signatures were increased. T-cell activation was more pronounced with good response to NACT. The CD8(+) T-cell and CD45RO(+) memory cell density in the tumor microenvironment was unchanged after NACT but biopsies showing a good therapeutic response had significantly fewer FoxP3(+) T regulatory (Treg) cells. This finding was supported by a reduction in a Treg cell gene signature in post- versus pre-NACT samples that was more pronounced in good responders. Plasma levels of proinflammatory cytokines decreased in all patients after NACT. However, a high proportion of T cells in biopsies expressed immune checkpoint molecules PD-1 and CTLA4, and PD-L1 levels were significantly increased after NACT. CONCLUSIONS NACT may enhance host immune response but this effect is tempered by high/increased levels of PD-1, CTLA4, and PD-L1. Sequential chemoimmunotherapy may improve disease control in advanced HGSC. Clin Cancer Res; 22(12); 3025-36. ©2016 AACR.
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Affiliation(s)
- Steffen Böhm
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom. Medical Oncology, Barts Health NHS Trust, London, United Kingdom
| | - Anne Montfort
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
| | - Oliver M T Pearce
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
| | - Joanne Topping
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
| | - Probir Chakravarty
- Bioinformatics Core, The Francis Crick Institute, London, United Kingdom
| | - Gemma L A Everitt
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
| | - Andrew Clear
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
| | - Jackie R McDermott
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom. Department of Pathology, Barts Health NHS Trust, London, United Kingdom
| | - Darren Ennis
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom. Wolfson Wohl Cancer Research Centre, Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Thomas Dowe
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
| | | | - Elly C Brockbank
- Gynaecological Oncology, Barts Health NHS Trust, London, United Kingdom
| | | | - Arjun Jeyarajah
- Gynaecological Oncology, Barts Health NHS Trust, London, United Kingdom
| | - Asma Z Faruqi
- Department of Pathology, Barts Health NHS Trust, London, United Kingdom
| | - Iain A McNeish
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom. Wolfson Wohl Cancer Research Centre, Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Naveena Singh
- Department of Pathology, Barts Health NHS Trust, London, United Kingdom
| | - Michelle Lockley
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom. Medical Oncology, Barts Health NHS Trust, London, United Kingdom
| | - Frances R Balkwill
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom.
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Böhm S, Faruqi A, Said I, Lockley M, Brockbank E, Jeyarajah A, Fitzpatrick A, Ennis D, Dowe T, Santos JL, Cook LS, Tinker AV, Le ND, Gilks CB, Singh N. Chemotherapy Response Score: Development and Validation of a System to Quantify Histopathologic Response to Neoadjuvant Chemotherapy in Tubo-Ovarian High-Grade Serous Carcinoma. J Clin Oncol 2015; 33:2457-63. [DOI: 10.1200/jco.2014.60.5212] [Citation(s) in RCA: 155] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose To develop and validate a histopathologic scoring system for measuring response to neoadjuvant chemotherapy in interval debulking surgery specimens of stage IIIC to IV tubo-ovarian high-grade serous carcinoma. Patients and Methods A six-tier histopathologic scoring system was proposed and applied to a test cohort (TC) of 62 patients treated with neoadjuvant chemotherapy and interval debulking surgery. Adnexal and omental sections were independently scored by three pathologists. On the basis of TC results, a three-tier chemotherapy response score (CRS) system was developed and applied to an independent validation cohort of 71 patients. Results The initial system showed moderate interobserver reproducibility and prognostic stratification of TC patients when applied to the omentum but not to the adnexa. Condensed to a three-tier score, the system was highly reproducible (kappa, 0.75). When adjusted for age, stage, and debulking status, the score predicted progression-free survival (PFS; score 2 v 3; median PFS, 11.3 v 32.1 months; adjusted hazard ratio, 6.13; 95% CI, 2.13 to 17.68; P < .001). The three-tier CRS system applied to omental samples from the validation cohort showed high reproducibility (kappa, 0.67) and predicted PFS (CRS 1 and 2 v 3: median, 12 v 18 months; adjusted hazard ratio, 3.60; 95% CI, 1.69 to 7.66; P < .001). CRS 3 also predicted sensitivity to first-line platinum therapy (94.3% negative predictive value for progression < 6 months). A Web site was established to train pathologists to use the CRS system. Conclusion The CRS system is reproducible and shows prognostic significance for high-grade serous carcinoma. Implementation in international pathology reporting has been proposed by the International Collaboration on Cancer Reporting, and the system could potentially have an impact on patient care and research.
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Affiliation(s)
- Steffen Böhm
- Steffen Böhm, Asma Faruqi, Ian Said, Michelle Lockley, Elly Brockbank, Arjun Jeyarajah, Amanda Fitzpatrick, and Naveena Singh, Barts Health National Health Service Trust; Steffen Böhm, Michelle Lockley, Darren Ennis, and Thomas Dowe, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Jennifer L. Santos, Anna V. Tinker, and Nhu D. Le, British Columbia Cancer Agency; C. Blake Gilks, University of British Columbia, Vancouver, BC, Canada; and Linda S. Cook, University of New
| | - Asma Faruqi
- Steffen Böhm, Asma Faruqi, Ian Said, Michelle Lockley, Elly Brockbank, Arjun Jeyarajah, Amanda Fitzpatrick, and Naveena Singh, Barts Health National Health Service Trust; Steffen Böhm, Michelle Lockley, Darren Ennis, and Thomas Dowe, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Jennifer L. Santos, Anna V. Tinker, and Nhu D. Le, British Columbia Cancer Agency; C. Blake Gilks, University of British Columbia, Vancouver, BC, Canada; and Linda S. Cook, University of New
| | - Ian Said
- Steffen Böhm, Asma Faruqi, Ian Said, Michelle Lockley, Elly Brockbank, Arjun Jeyarajah, Amanda Fitzpatrick, and Naveena Singh, Barts Health National Health Service Trust; Steffen Böhm, Michelle Lockley, Darren Ennis, and Thomas Dowe, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Jennifer L. Santos, Anna V. Tinker, and Nhu D. Le, British Columbia Cancer Agency; C. Blake Gilks, University of British Columbia, Vancouver, BC, Canada; and Linda S. Cook, University of New
| | - Michelle Lockley
- Steffen Böhm, Asma Faruqi, Ian Said, Michelle Lockley, Elly Brockbank, Arjun Jeyarajah, Amanda Fitzpatrick, and Naveena Singh, Barts Health National Health Service Trust; Steffen Böhm, Michelle Lockley, Darren Ennis, and Thomas Dowe, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Jennifer L. Santos, Anna V. Tinker, and Nhu D. Le, British Columbia Cancer Agency; C. Blake Gilks, University of British Columbia, Vancouver, BC, Canada; and Linda S. Cook, University of New
| | - Elly Brockbank
- Steffen Böhm, Asma Faruqi, Ian Said, Michelle Lockley, Elly Brockbank, Arjun Jeyarajah, Amanda Fitzpatrick, and Naveena Singh, Barts Health National Health Service Trust; Steffen Böhm, Michelle Lockley, Darren Ennis, and Thomas Dowe, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Jennifer L. Santos, Anna V. Tinker, and Nhu D. Le, British Columbia Cancer Agency; C. Blake Gilks, University of British Columbia, Vancouver, BC, Canada; and Linda S. Cook, University of New
| | - Arjun Jeyarajah
- Steffen Böhm, Asma Faruqi, Ian Said, Michelle Lockley, Elly Brockbank, Arjun Jeyarajah, Amanda Fitzpatrick, and Naveena Singh, Barts Health National Health Service Trust; Steffen Böhm, Michelle Lockley, Darren Ennis, and Thomas Dowe, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Jennifer L. Santos, Anna V. Tinker, and Nhu D. Le, British Columbia Cancer Agency; C. Blake Gilks, University of British Columbia, Vancouver, BC, Canada; and Linda S. Cook, University of New
| | - Amanda Fitzpatrick
- Steffen Böhm, Asma Faruqi, Ian Said, Michelle Lockley, Elly Brockbank, Arjun Jeyarajah, Amanda Fitzpatrick, and Naveena Singh, Barts Health National Health Service Trust; Steffen Böhm, Michelle Lockley, Darren Ennis, and Thomas Dowe, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Jennifer L. Santos, Anna V. Tinker, and Nhu D. Le, British Columbia Cancer Agency; C. Blake Gilks, University of British Columbia, Vancouver, BC, Canada; and Linda S. Cook, University of New
| | - Darren Ennis
- Steffen Böhm, Asma Faruqi, Ian Said, Michelle Lockley, Elly Brockbank, Arjun Jeyarajah, Amanda Fitzpatrick, and Naveena Singh, Barts Health National Health Service Trust; Steffen Böhm, Michelle Lockley, Darren Ennis, and Thomas Dowe, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Jennifer L. Santos, Anna V. Tinker, and Nhu D. Le, British Columbia Cancer Agency; C. Blake Gilks, University of British Columbia, Vancouver, BC, Canada; and Linda S. Cook, University of New
| | - Thomas Dowe
- Steffen Böhm, Asma Faruqi, Ian Said, Michelle Lockley, Elly Brockbank, Arjun Jeyarajah, Amanda Fitzpatrick, and Naveena Singh, Barts Health National Health Service Trust; Steffen Böhm, Michelle Lockley, Darren Ennis, and Thomas Dowe, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Jennifer L. Santos, Anna V. Tinker, and Nhu D. Le, British Columbia Cancer Agency; C. Blake Gilks, University of British Columbia, Vancouver, BC, Canada; and Linda S. Cook, University of New
| | - Jennifer L. Santos
- Steffen Böhm, Asma Faruqi, Ian Said, Michelle Lockley, Elly Brockbank, Arjun Jeyarajah, Amanda Fitzpatrick, and Naveena Singh, Barts Health National Health Service Trust; Steffen Böhm, Michelle Lockley, Darren Ennis, and Thomas Dowe, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Jennifer L. Santos, Anna V. Tinker, and Nhu D. Le, British Columbia Cancer Agency; C. Blake Gilks, University of British Columbia, Vancouver, BC, Canada; and Linda S. Cook, University of New
| | - Linda S. Cook
- Steffen Böhm, Asma Faruqi, Ian Said, Michelle Lockley, Elly Brockbank, Arjun Jeyarajah, Amanda Fitzpatrick, and Naveena Singh, Barts Health National Health Service Trust; Steffen Böhm, Michelle Lockley, Darren Ennis, and Thomas Dowe, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Jennifer L. Santos, Anna V. Tinker, and Nhu D. Le, British Columbia Cancer Agency; C. Blake Gilks, University of British Columbia, Vancouver, BC, Canada; and Linda S. Cook, University of New
| | - Anna V. Tinker
- Steffen Böhm, Asma Faruqi, Ian Said, Michelle Lockley, Elly Brockbank, Arjun Jeyarajah, Amanda Fitzpatrick, and Naveena Singh, Barts Health National Health Service Trust; Steffen Böhm, Michelle Lockley, Darren Ennis, and Thomas Dowe, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Jennifer L. Santos, Anna V. Tinker, and Nhu D. Le, British Columbia Cancer Agency; C. Blake Gilks, University of British Columbia, Vancouver, BC, Canada; and Linda S. Cook, University of New
| | - Nhu D. Le
- Steffen Böhm, Asma Faruqi, Ian Said, Michelle Lockley, Elly Brockbank, Arjun Jeyarajah, Amanda Fitzpatrick, and Naveena Singh, Barts Health National Health Service Trust; Steffen Böhm, Michelle Lockley, Darren Ennis, and Thomas Dowe, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Jennifer L. Santos, Anna V. Tinker, and Nhu D. Le, British Columbia Cancer Agency; C. Blake Gilks, University of British Columbia, Vancouver, BC, Canada; and Linda S. Cook, University of New
| | - C. Blake Gilks
- Steffen Böhm, Asma Faruqi, Ian Said, Michelle Lockley, Elly Brockbank, Arjun Jeyarajah, Amanda Fitzpatrick, and Naveena Singh, Barts Health National Health Service Trust; Steffen Böhm, Michelle Lockley, Darren Ennis, and Thomas Dowe, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Jennifer L. Santos, Anna V. Tinker, and Nhu D. Le, British Columbia Cancer Agency; C. Blake Gilks, University of British Columbia, Vancouver, BC, Canada; and Linda S. Cook, University of New
| | - Naveena Singh
- Steffen Böhm, Asma Faruqi, Ian Said, Michelle Lockley, Elly Brockbank, Arjun Jeyarajah, Amanda Fitzpatrick, and Naveena Singh, Barts Health National Health Service Trust; Steffen Böhm, Michelle Lockley, Darren Ennis, and Thomas Dowe, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Jennifer L. Santos, Anna V. Tinker, and Nhu D. Le, British Columbia Cancer Agency; C. Blake Gilks, University of British Columbia, Vancouver, BC, Canada; and Linda S. Cook, University of New
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Saeed Y, Anwar A, Fitzpatrick A. 38 * Effectiveness of ECG-based triage in older patients with TLoC attending a rapid access blackouts triage clinic: conduction tissue abnormalities predict a higher mortality, recurrent TLoC and a good response to cardiac pacing. Europace 2014. [DOI: 10.1093/europace/euu239.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Shih J, Fitzpatrick A. Alternaria Sensitiziation is Associated with Increased Airway Hyperresponsiveness and Sinusitis in Children with Severe Asthma. J Allergy Clin Immunol 2012. [DOI: 10.1016/j.jaci.2011.12.724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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DeMuth K, Stecenko A, Sullivan K, Fitzpatrick A. Treatment With Antacid Medication Increases Odds Of Diagnosis Of Food Allergy. J Allergy Clin Immunol 2011. [DOI: 10.1016/j.jaci.2010.12.722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Kuznetsov VA, Kozhurina AO, Plusnin AV, Szulik M, Sredniawa B, Streb W, Lenarczyk R, Stabryla-Deska J, Sedkowska A, Kowalski O, Kalarus Z, Kukulski T, Katova TM, Nesheva A, Simova I, Hristova K, Kostova V, Boiadjiev L, Dimitrov N, Papamichalis Michalis MP, Sitafidis George SG, Dimopoulos Basilios BD, Kelepesis Glafkos GK, Economou Dimitrios DE, Skoularigis John JS, Triposkiadis Filippos FT, Attenhofer Jost CH, Pfyffer M, Naegeli B, Levis P, Faeh-Gunz A, Brunner-Larocca HP, Velasco Del Castillo MS, Cacicedo A, Onaindia JJ, Gonzalez Ruiz J, Subinas A, Alarcon JA, Quintana O, Rodriguez I, Laraudogoitia E, Lam YY, Henein MY, Mazzone A, Vianello A, Perlini S, Corciu AI, Cappelli S, Cerillo A, Chiappino D, Berti S, Glauber M, Herrmann S, Niemann M, Stoerk S, Strotmann J, Voelker W, Ertl G, Weidemann F, Yong ZY, Boerlage - Van Dijk K, Koch KT, Vis MM, Bouma BJ, Henriques JPS, Cocchieri R, De Mol BAJM, Piek JJ, Baan J, Keenan NGJ, Cueff C, Cimadevilla C, Brochet E, Lepage L, Detaint D, Iung B, Vahanian A, Messika-Zeitoun D, Otsuka T, Suzuki M, Yoshikawa H, Hashimoto G, Osaki T, Tsuchida T, Matsuyama M, Yamashita H, Ozaki S, Sugi K, Garcia Alonso CJ, Vallejo Camazon N, Ferrer Sistach E, Camara ML, Lopez Ayerbe J, Bosch Carabante C, Espriu Simon M, Gual Capllonch F, Bayes Genis A, Deswarte G, Vanesson C, Polge AS, Huchette D, Modine T, Marboeuf P, Lamblin N, Bauters C, Deklunder G, Le Tourneau T, Agricola A, Gullace M, Stella S, D'amato R, Slavich M, Oppizzi M, Ancona M, Margonato A, Le Ven F, Etienne Y, Jobic Y, Frachon I, Castellant P, Fatemi M, Blanc JJ, Muratori M, Montorsi P, Maffessanti F, Gripari P, Teruzzi G, Ghulam Ali S, Fusini L, Celeste F, Pepi M, Goebel B, Haugaa K, Meyer K, Otto S, Lauten A, Jung C, Edvardsen T, Figulla HR, Poerner TC, Aksoy H, Okutucu S, Evranos B, Aytemir K, Kaya EB, Kabakci G, Tokgozoglu L, Ozkutlu H, Oto A, Valeur N, Pedersen HH, Videbaek R, Hassager C, Svendsen JH, Kober L, Tigen MK, Karaahmet T, Gurel E, Pala S, Dundar C, Basaran Y, Caldararu CI, Ene E, Dorobantu M, Vatasescu RG, Tigen MK, Karaahmet T, Gurel E, Dundar C, Basaran Y, Tigen MK, Karaahmet T, Gurel E, Dundar C, Pala S, Basaran Y, Tigen MK, Pala S, Karaahmet T, Dundar C, Gurel E, Basaran Y, Cikes M, Bijnens B, Gasparovic H, Siric F, Velagic V, Lovric D, Samardzic J, Ferek-Petric B, Milicic D, Biocina B, Kjaergaard J, Ghio S, St John Sutton M, Hassager C, Moreau O, Kervio G, Thebault C, Leclercq C, Donal E, Mornos C, Rusinaru D, Petrescu L, Cozma D, Ionac A, Pescariu S, Dragulescu SI, Petrovic MZ, Vujisic-Tesic B, Milasinovic G, Petrovic MT, Nedeljkovic I, Zamaklar-Trifunovic D, Calovic Z, Jelic V, Boricic M, Petrovic I, Kuchynka P, Palecek T, Simek S, Nemecek E, Horak J, Hulinska D, Schramlova J, Vitkova I, Aster V, Linhart A, Paluszkiewicz L, Guersoy D, Ozegowski S, Spiliopoulos S, Koerfer R, Tenderich G, Gaggl M, Heinze G, Sunder-Plassmann G, Graf S, Zehetmayer M, Voigtlaender T, Mannhalter C, Paschke E, Fauler G, Mundigler G, Tesic M, Trifunovic D, Djordjevic-Dikic A, Petrovic O, Nedeljkovic I, Petrovic M, Boricic M, Beleslin B, Vujisic-Tesic B, Ostojic M, Trifunovic D, Tesic M, Vujisic-Tesic B, Petrovic O, Petrovic M, Nedeljkovic I, Boricic M, Draganic G, Ostojic M, Correia CE, Rodrigues B, Santos LF, Moreira D, Gama P, Nunes L, Nascimento C, Dionisio O, Santos O, Prinz C, Oldenburg O, Bitter T, Piper C, Horstkotte D, Faber L, Nemes A, Gavaller H, Csanady M, Forster T, Calcagnino M, O'mahony C, Tsovolas K, Lambiase PD, Elliott P, Olezac AS, Bensaid A, Nahum J, Teiger E, Dubois-Rande JL, Gueret P, Lim P, Prinz C, Langer C, Oldenburg O, Horstkotte D, Faber L, Kansal M, Surapaneni P, Sengupta PP, Lester SJ, Ommen SR, Ressler SW, Hurst RT, Monivas Palomero V, Mingo Santos S, Mitroi C, Garcia Lunar I, Garcia Pavia P, Gonzalez Mirelis J, Ruiz Bautista L, Castro Urda V, Toquero Ramos J, Fernandez Lozano I, Sommer A, Poulsen SH, Mogensen J, Thuesen L, Egeblad H, Montisci R, Ruscazio M, Vacca A, Garau P, Tuveri F, Soro C, Matthieu A, Meloni L, Kosmala W, Przewlocka-Kosmala M, Wojnalowicz A, Mysiak A, Marwick TH, Yotti R, Ripoll C, Bermejo J, Benito Y, Mombiela T, Rincon D, Barrio A, Banares R, Fernandez-Aviles F, Tomaszewski A, Kutarski A, Tomaszewski M, Ticulescu R, Vriz O, Sparacino L, Popescu BA, Ginghina C, Nicolosi GL, Carerj S, Antonini-Canterin F, Agricola E, Slavich M, Stella S, Ancona M, Oppizzi M, Bertoglio L, Melissano G, Margonato A, Chiesa R, Garcia Blas S, Iglesias Del Valle D, Lopez Fernandez T, Gomez De Diego JJ, Monedero Martin MC, Dominguez FJ, Moreno Yanguela M, Lopez Sendon JL, Adhya S, Murgatroyd FD, Monaghan M, Spinarova L, Meluzin J, Hude P, Krejci J, Podrouzkova H, Pesl M, Panovsky R, Dusek L, Orban M, Korinek J, Hammerstingl C, Schwiekendik M, Nickenig G, Momcilovic D, Lickfett L, Beladan CC, Calin A, Rosca M, Popescu BA, Muraru D, Voinea F, Popa E, Matei F, Curea F, Ginghina C, Di Salvo G, Pacileo G, Gala S, Castaldi B, D'aiello AF, Mormile A, Baldini L, Russo MG, Calabro R, Halvorsen PS, Dahle G, Bugge JF, Bendz B, Aaberge L, Rein KA, Fiane A, Bergsland J, Fosse E, Aakhus S, Koopman LP, Chahal N, Slorach C, Hui W, Sarkola T, Manlhiot C, Bradley TJ, Jaeggi ET, Mccrindle BW, Mertens L, Di Salvo G, Pacileo G, Castaldi B, Gala S, Baldini L, D'aiello FA, Mormilw A, Rea A, Russo MG, Calabro R, Calin A, Rosca M, O'Connor K, Romano G, Magne J, Beladan CC, Ginghina C, Pierard L, Lancellotti P, Popescu BA, Arita T, Ando K, Isotani A, Soga Y, Iwabuchi M, Nobuyoshi M, Hammerstingl C, Momcilovic D, Wiesen M, Nickenig G, Skowasch D, Mornos C, Cozma D, Rusinaru D, Ionac A, Pescariu S, Dragulescu SI, Niemann M, Breunig F, Beer M, Herrmann S, Strotmann J, Hu K, Voelker W, Ertl G, Wanner C, Weidemann F, Morel MA, Bernard YF, Descotes-Genon V, Meneveau N, Schiele F, Vitarelli A, Bernardi M, Scarno A, Caranci F, Padella V, Dettori O, Capotosto L, Vitarelli M, De Cicco V, Bruno P, Bajraktari G, Lindqvist P, Gustafsson U, Holmgren A, Henein MY, Hassan M, Said K, Baligh E, Farouk H, Osama D, Elmahdy MF, Elfaramawy A, Sorour K, Luckie M, Zaidi A, Fitzpatrick A, Khattar RS, Schwartz J, Huttin O, Popovic B, Zinzius PY, Christophe C, Marcon O, Groben L, Juilliere Y, Chabot F, Selton-Suty C, Krastev B, Kinova ETK, Zlatareva NIZ, Goudev ARG, Teske AJ, De Boeck BW, Mohames Hoesein FA, Van Driel V, Loh P, Cramer MJ, Doevendans PA, Dillenburg F, Mertens L, Abd El Salam KM, Ho EMM, Hall M, Hemeryck L, Bennett K, Scott K, King G, Murphy RT, Mahmud A, Brown AS, Dalen H, Thorstensen A, Romundstad PR, Aase SA, Stoylen A, Vatten L, Bochenek T, Wita K, Tabor Z, Doruchowska A, Lelek M, Trusz-Gluza M, Hamodraka E, Paraskevaidis I, Karamanou A, Michalakeas C, Vrettou H, Kapsali E, Tsiapras D, Lekakis I, Anastasiou-Nana M, Kremastinos D, Sirugo L, Bottari VE, Licciardi S, Blundo A, Atanasio A, Monte IP, Park CS, Kim JH, Cho JS, Kim MJ, Cho EJ, Ihm SH, Jung HO, Jeon HK, Youn HJ, Kim KS, Fontana A, Taravella L, Zambon A, Trocino G, Giannattasio C, Kalinin A, Alekhin M, Bahs G, Lejnieks A, Kalvelis A, Kalnins A, Shipachovs P, Zakharova E, Blumentale G, Trukshina M, Biering-Sorensen T, Mogelvang R, Haahr-Pedersen S, Schnohr P, Sogaard P, Skov Jensen J, Gargani L, Agoston G, Capati E, Badano L, Moreo A, Costantino MF, Caputo ML, Mondillo S, Sicari R, Picano E, Malev EG, Timofeev EV, Reeva SV, Zemtsovsky EV, Piazza R, Enache R, Roman-Pognuz A, Muraru D, Popescu BA, Leiballi E, Pecoraro R, Antonini-Canterin F, Ginghina C, Nicolosi GL, Sadeghian H, Lotfi_Tokaldany M, Rezvanfard M, Kasemisaeid A, Majidi S, Montazeri M, Saber-Ayad M, Nassar YS, Farhan A, Moussa A, El-Sherif A, Cooper RM, Somauroo JD, Shave RE, Williams KL, Forster J, George C, Bett T, Gaze DC, George KP, Mansencal N, Dupland A, Caille V, Perrot S, Bouferrache K, Vieillard-Baron A, Jouffroy R, Cioroiu SG, Alexe OS, Bobescu E, Rus H, Schiano Lomoriello V, Esposito R, Santoro A, Raia R, Farina F, Ippolito R, Galderisi M, Aburawi EH, Malcus P, Thuring A, Maxedius A, Pesonen E, Nair SV, Joyce E, Lee L, Shrimpton J, Newman E, James PR, Jurcut C, Caraiola S, Jurcut RO, Giusca S, Nitescu D, Amzulescu MS, Copaci I, Popescu BA, Tanasescu C, Ginghina C, Silva Marques J, Silva D, Ferreira F, Ferreira PC, Almeida AG, Martim Martins J, Lopes MG, Bergenzaun L, Chew M, Ersson A, Gudmundsson P, Ohlin H, Borowiec A, Dabrowski R, Wozniak J, Jasek S, Chwyczko T, Kowalik I, Musiej-Nowakowska E, Szwed H, Wen YL, Tian J, Yan L, Cheng H, Yang H, Luo B, Wang J, Kozman H, Villarreal D, Liu K, Karavidas A, Tsiachris D, Lazaros G, Matzaraki V, Xylomenos G, Levendopoulos G, Arapi S, Perpinia A, Matsakas E, Pyrgakis V, Liu YW, Su CT, Tsai WC, Huang JW, Hung KY, Chen JH, Larsson M, Kremer F, Kouznetsova T, Bjallmark A, Lind B, Brodin LA, D'hooge J, Santoro A, Caputo M, Antonelli G, Lisi M, Giacomin E, Mondillo S, Moustafa S, Alharthi M, Kansal M, Deng Y, Chandrasekaran K, Mookadam F, Hayashi SY, Bjallmark A, Larsson M, Nascimento MM, Lindholm B, Lind B, Seeberger A, Nowak J, Riella MC, Brodin LA, Theodosis A, Fousteris E, Tsiaousis G, Krommydas A, Margetis P, Katidis Z, Beldekos D, Argirakis S, Melidonis A, Foussas S, Khaleva O, Onyshchenko O, Lukaschuk E, Sherwi N, Nikitin N, Cleland JGF, Risum N, Jons C, Olsen NT, Valeur N, Kronborg MB, Jensen MT, Fritz-Hansen T, Bruun NE, Hojgaard MV, Sogaard P, Petrini J, Yousry M, Rickenlund A, Liska J, Franco-Cereceda A, Hamsten A, Eriksson P, Caidahl K, Eriksson MJ, Elmstedt N, Lind B, Ferm-Widlund K, Westgren M, Brodin LA, Szymczyk E, Kasprzak JD, Wozniakowski B, Rotkiewicz A, Szymczyk K, Stefanczyk L, Michalski B, Lipiec P, Ring L, Eller T, Deegan P, Rusk R, Urbano Moral JA, Arias JA, Kuvin JT, Patel AR, Pandian NG, Bellsham-Revell H, Bell AJ, Miller O, Greil GF, Simpson J, Moustafa S, Kansal M, Alharthi M, Deng Y, Chandrasekaran K, Mookadam F, Ancona R, Comenale Pinto S, Caso P, Severino S, Nunziata L, Roselli T, Calabro R, Dussault C, Donal E, Lafitte S, Habib G, Reant P, Derumeaux G, Thibault H, Gueret P, Lim P, Kaladaridis A, Agrios IA, Pamboucas CP, Mesogitis SM, Vasiladiotis NV, Bramos DB, Toumanidis STT, Martiniello AR, Santangelo G, Caso P, Pedrizzetti G, Tonti G, Cioppa C, Cavallaro M, Calvi V, Chianese R, Calabro R. Poster session I * Thursday 9 December 2010, 08:30-12:30. European Journal of Echocardiography 2010. [DOI: 10.1093/ejechocard/jeq136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Lockington D, Imrie F, Gillen J, Fitzpatrick A, Willison H. Visual improvement in established central retinal vein occlusion with long-standing macular edema following systemic eculizumab treatment. Can J Ophthalmol 2010; 45:649. [DOI: 10.3129/i10-060] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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Kinnunen PJ, Tavares AR, de Melo AC, Sternberg C, Burke WJ, Roe CM, Morris JC, Fitzpatrick A, Isabel Behrens M, Bennett DA. CANCER LINKED TO ALZHEIMER DISEASE BUT NOT VASCULAR DEMENTIA. Neurology 2010; 75:1215; author reply 1216. [DOI: 10.1212/wnl.0b013e3181f001fb] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Fitzpatrick A, Hardikar S, Atkinson H, Kritchevsky S, Opez O, Rapp S, Nahin R, Williamson J. 078 PROSPECTIVE ASSOCIATIONS OF GAIT SPEED WITH DEMENTIA AND ITS SUBTYPES IN OLDER ADULTS. Parkinsonism Relat Disord 2010. [DOI: 10.1016/s1353-8020(10)70079-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Postgate AJ, Will OC, Fraser CH, Fitzpatrick A, Phillips RKS, Clark SK. Capsule endoscopy for the small bowel in juvenile polyposis syndrome: a case series. Endoscopy 2009; 41:1001-4. [PMID: 19816839 DOI: 10.1055/s-0029-1215175] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
Juvenile polyposis syndrome is one of the hamartomatous polyposis syndromes and demonstrates phenotypic heterogeneity. All patients with juvenile polyposis develop colorectal polyps and are at risk of colorectal cancer. Small-bowel involvement is variably described. Small-intestinal cancer is reported but is rare and there is no evidence-based protocol for small-intestinal surveillance. This case series reports the small-bowel capsule endoscopy findings and genetic mutational analyses of ten adults (7-male; median age 39.2 years, interquartile range 37.4 - 42.0 years) with documented juvenile polyposis syndrome. Two patients had small-bowel polyps beyond the range of standard gastroscopy identified at capsule endoscopy: a 6-mm ileal polyp in one, and 10-mm and 6-mm ileal polyps in the second (histology unknown). Duodenal polyps were detected in a third patient at capsule endoscopy. Three further patients had previously documented duodenal polyps at surveillance gastroscopy. A SMAD4 mutation was identified in seven patients but there was no obvious association with gastric/small-bowel polyp burden. In conclusion, capsule endoscopy provided information additional to conventional endoscopy in patients with juvenile polyposis syndrome and was well tolerated. However, no lesions requiring clinical intervention were identified and polyp numbers were small. Capsule endoscopy may appropriately be used as a baseline investigation for the identification of patients with large or dense small-bowel polyps for whom ongoing small-bowel investigation would be recommended. Patients in whom polyps are confined to the colon are unlikely to require ongoing small-bowel review.
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Affiliation(s)
- A J Postgate
- Wolfson Unit for Endoscopy, St. Mark's Hospital, Imperial College, London HA1 3UJ, UK
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Hamid T, Rose S, Clifford A, Homa S, Garratt C, Clarke B, Cooper P, Fitzpatrick A, Petkar S, McHugh C. FP35-WE-01 Value of long term cardiac rhythm monitoring by an implantable ECG loop recorder (ILR) in patients presenting to the neurologist with transient loss of consciousness (T-LOC). J Neurol Sci 2009. [DOI: 10.1016/s0022-510x(09)70450-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Saxton J, Snitz BE, Lopez OL, Ives DG, Dunn LO, Fitzpatrick A, Carlson MC, Dekosky ST. Functional and cognitive criteria produce different rates of mild cognitive impairment and conversion to dementia. J Neurol Neurosurg Psychiatry 2009; 80:737-43. [PMID: 19279031 PMCID: PMC2698042 DOI: 10.1136/jnnp.2008.160705] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To compare rates of mild cognitive impairment (MCI) and rates of progression to dementia using different MCI diagnostic systems. METHODS MCI was investigated at baseline in 3063 community dwelling non-demented elderly in the Ginkgo Evaluation of Memory (GEM) study who were evaluated every 6 months to identify the presence of dementia. Overall MCI frequency was determined using (1) a Clinical Dementia Rating (CDR) score of 0.5 and (2) neuropsychological (NP) criteria, defined by impairment on standard cognitive tests. RESULTS 40.2% of participants met CDR MCI criteria and 28.2% met NP MCI criteria (amnestic MCI = 16.6%). 15.7% were classified as MCI by both criteria and 47.4% as normal by both. Discordant diagnoses were observed in 24.5% who met NP normal/CDR MCI and in 12.4% who met NP MCI/CDR normal. Factors associated with CDR MCI among NP normal included lower education, lower NP scores, more instrumental activities of daily living impairment, greater symptoms of depression and subjective health problems. Individuals meeting NP MCI/CDR normal were significantly more likely to develop dementia over the median follow-up of 6.1 years than those meeting NP normal/CDR MCI. CONCLUSIONS Different criteria produce different MCI rates and different conversion rates to dementia. Although a higher percentage of MCI was identified by CDR than NP, a higher percentage of NP MCI progressed to dementia. These findings suggest that the CDR is sensitive to subtle changes in cognition not identified by the NP algorithm but is also sensitive to demographic and clinical factors probably leading to a greater number of false positives. These results suggest that identifying all individuals with CDR scores of 0.5 as Alzheimer's disease is not advisable.
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Affiliation(s)
- J Saxton
- Department of Neurology, University of Pittsburgh, 3471 Fifth Avenue, Suite 811, Pittsburgh, PA 15213, USA.
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Mitro P, Kirsch P, Gajek J, Zysko D, Mazurek W, Ruiz GA, Chirife R, Tentori C, Nogues M, Grancelli H, Nur-Mammadova G, Mustafaev I, Gajek J, Zysko D, Mazurek W, Sredniawa B, Cebula S, Musialik-Lydka A, Kowalczyk J, Sliwinska A, Sedkowska A, Wozniak A, Kalarus Z, Pietrucha AZ, Wojewodka-Zak E, Bzukala I, Wnuk M, Mroczek-Czernecka D, Konduracka E, Piwowarska W, Peppes V, Kontomerkos D, Parisi T, Dimopoulos M, Antoniou A, Freitas JP, Santos RM, Boomsma F, Maciel MJ, Iacoviello M, Forleo C, Guida P, Ciccone MM, D'andria V, Sorrentino S, Panunzio M, Favale S, Candeias R, Silva J, Santos A, Marques N, Jesus I, Gomes V, Gajek J, Zysko D, Mazurek W, Olendrzynski LUK, Kramarz EK, Kubik LK, Zysko D, Gajek J, Mazurek W, Tahir T, Rose S, Garratt C, Clarke B, Cooper P, Fitzpatrick A, Petkar S, Fuca G, Dinelli M, Gianfranchi L, Corbucci G, Alboni P, Leiria TLL, Kus T, Godin B, Ayala-Paredes F, Lemieux A, Sturmer ML, Stanczyk A, Gatzoulis K, Karystinos G, Gialernios T, Sotiropoulos H, Sideris S, Dilaveris P, Arsenos P, Stefanadis C, Maggi R, Kohno R, Abe H, Otsuji Y. Poster Session 4: Syncope. Europace 2009. [DOI: 10.1093/europace/euq238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Postgate A, Tekkis P, Fitzpatrick A, Bassett P, Fraser C. The impact of experience on polyp detection and sizing accuracy at capsule endoscopy: implications for training from an animal model study. Endoscopy 2008; 40:496-501. [PMID: 18556804 DOI: 10.1055/s-2007-995590] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND STUDY AIMS Indications for capsule endoscopy include polyp surveillance in Peutz-Jeghers syndrome and potentially colorectal examination and bowel cancer screening. The ability to detect and accurately size polyps associated with these conditions is critical when deciding which patients require further investigation or therapy. Inexperience may affect the ability of capsule endoscopists to perform these skills resulting in sub-optimal patient care. We assessed the performance of volunteers with different levels of endoscopy and capsule endoscopy experience using an animal-based polyp model. PATIENTS AND METHODS Thirty-six artificial polyps were sewn onto the luminal surface of porcine small bowel through which a capsule was propelled. Video images generated by the capsule were then shown to five expert capsule endoscopists, seven consultant gastroenterologists, seven trainee gastroenterologists, six endoscopy nurses, six gastrointestinal radiologists, and six nonmedical participants. Polyp detection rates and sizing accuracy were calculated according to each group and compared. RESULTS Expert capsule endoscopists had the highest polyp detection rate (91%) but only noncapsule endoscopy experience was independently correlated with improved polyp detection and sizing accuracy (OR missing polyp--endoscopy experience 1.0, no experience 1.96 [95% CI 1.29 - 2.97], P = 0.002; ratio of estimated to actual size--endoscopy experience 1.0, no experience 1.43 [95% CI 1.22 - 1.66], P < 0.001). Both expert capsule endoscopists and experienced endoscopists tended to underestimate polyp size more than novices, particularly for large polyps (OR capsule expert to non-expert: 2.39 vs. 1.0 [95% CI 1.73 - 3.29], P < 0.001). CONCLUSIONS Polyp detection rates and sizing accuracy during capsule endoscopy improve with endoscopic experience. However large polyps, which are the most clinically relevant, are least-accurately sized, and capsule endoscopy experts and experienced endoscopists are the most likely to underestimate the size of these polyps. Training to improve performance in these measures for capsule endoscopy novices as well as experts is required.
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Affiliation(s)
- A Postgate
- Wolfson Unit for Endoscopy, St. Mark's Hospital, Imperial College London, London, UK.
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Huizinga JD, Liu LWC, Fitzpatrick A, White E, Gill S, Wang XY, Zarate N, Krebs L, Choi C, Starret T, Dixit D, Ye J. Deficiency of intramuscular ICC increases fundic muscle excitability but does not impede nitrergic innervation. Am J Physiol Gastrointest Liver Physiol 2008; 294:G589-94. [PMID: 18096611 DOI: 10.1152/ajpgi.00130.2007] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The motility of the gastrointestinal tract is generated by smooth muscle cells and is controlled to a large extent by an intrinsic neural network. A gap of approximately 200 nm usually separates nerve varicosities from smooth muscle cells, which suggests that direct innervation of the smooth muscle by synapses does not occur. Enteric nerves do make synapse-like contact with proposed regulatory cells, the interstitial cells of Cajal (ICC), which in turn may be in gap junction contact with smooth muscle cells. The role played by ICC in enteric innervation is controversial. Experimental evidence has been presented in vitro for the hypothesis that nitrergic inhibitory innervation is strongly reduced in the absence of ICC. However, in vivo data appear to dispute that. The present report provides evidence that explains the discrepancy between in vivo and in vitro data and provides evidence that inhibitory neurotransmitters can reach smooth muscle cells without hindrance when ICC are absent. The fundic musculature shows increased responses to substance P-mediated innervation and shows marked spontaneous activity, which is consistent with increased muscle excitability.
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Affiliation(s)
- Jan D Huizinga
- Intestinal Disease Research Program, Department of Medicine, McMaster University, Hamilton, ON, L8N 3Z5, Canada.
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Lee *H, Fitzpatrick A, Golden S, Schreiner P, Diez-Roux A, Ni H, Lyketsos C. Prevalence of Depressive Symptoms Among Middle-Aged and Older Adults Across Four Ethnic Groups in the Multi-Ethnic Study Of Atherosclerosis (MESA). Am J Epidemiol 2006. [DOI: 10.1093/aje/163.suppl_11.s220-b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Lopez OL, Becker JT, Jagust WJ, Fitzpatrick A, Carlson MC, DeKosky ST, Breitner J, Lyketsos CG, Jones B, Kawas C, Kuller LH. Neuropsychological characteristics of mild cognitive impairment subgroups. J Neurol Neurosurg Psychiatry 2006; 77:159-65. [PMID: 16103044 PMCID: PMC2077558 DOI: 10.1136/jnnp.2004.045567] [Citation(s) in RCA: 128] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2004] [Revised: 07/07/2005] [Accepted: 07/08/2005] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To describe the neuropsychological characteristics of mild cognitive impairment (MCI) subgroups identified in the Cardiovascular Health Study (CHS) cognition study. METHODS MCI was classified as MCI-amnestic type (MCI-AT): patients with documented memory deficits but otherwise normal cognitive function; and MCI-multiple cognitive deficits type (MCI-MCDT): impairment of at least one cognitive domain (not including memory), or one abnormal test in at least two other domains, but who had not crossed the dementia threshold. The MCI subjects did not have systemic, neurological, or psychiatric disorders likely to affect cognition. RESULTS MCI-AT (n = 10) had worse verbal and non-verbal memory performance than MCI-MCDT (n = 28) or normal controls (n = 374). By contrast, MCI-MCDT had worse language, psychomotor speed, fine motor control, and visuoconstructional function than MCI-AT or normal controls. MCI-MCDT subjects had memory deficits, though they were less pronounced than in MCI-AT. Of the MCI-MCDT cases, 22 (78.5%) had memory deficits, and 6 (21.5%) did not. MCI-MCDT with memory disorders had more language deficits than MCI-MCDT without memory disorders. By contrast, MCI-MCDT without memory deficits had more fine motor control deficits than MCI-MCDT with memory deficits. CONCLUSIONS The most frequent form of MCI was the MCI-MCDT with memory deficits. However, the identification of memory impaired MCI groups did not reflect the true prevalence of MCI in a population, as 16% of all MCI cases and 21.5% of the MCI-MCDT cases did not have memory impairment. Study of idiopathic amnestic and non-amnestic forms of MCI is essential for an understanding of the aetiology of MCI.
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Affiliation(s)
- O L Lopez
- Department of Neurology, University of Pittsburgh, School of Medicine, PA 15213, USA.
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Lopez OL, Kuller LH, Becker JT, Jagust WJ, DeKosky ST, Fitzpatrick A, Breitner J, Lyketsos C, Kawas C, Carlson M. Classification of vascular dementia in the Cardiovascular Health Study Cognition Study. Neurology 2006; 64:1539-47. [PMID: 15883314 DOI: 10.1212/01.wnl.0000159860.19413.c4] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To describe the diagnostic classification of subjects with incident vascular dementia (VaD) participating in the Cardiovascular Health Study (CHS) Cognition Study. METHODS The CHS classified 480 incident cases between 1994 and 1999 among 3,608 CHS participants who had brain MRI in 1992 through 1994 and in 1997 through 1998. The patients were diagnosed before and after reviewing the brain MRI. RESULTS The pre-MRI classification showed that 52 participants had VaD and 76 had both Alzheimer disease (AD) and VaD. The post-MRI classification showed that the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) criteria classified 61 subjects as having VaD, the National Institute of Neurological Disorders and Stroke-Association Internationale pour la Recherche et l'Enseignement en Neurosciences (NINDS-AIREN) criteria classified 43 subjects as having probable VaD and 10 as possible VaD, and the State of California Alzheimer's Disease Diagnostic and Treatment Center (ADDTC) criteria classified 117 as having probable VaD and 96 as possible. The combination of the ADDTC and National Institute of Neurological and Communication Disorders and Stroke-Alzheimer's Disease and Related Disorders Association criteria was used to examine the spectrum of vascular disease in dementia. The dementia was attributable to only vascular factors in 56 cases (probable VaD); VaD coexisted with AD in 61 cases, although the VaD component was the leading cause of dementia (probable VaD with AD); AD was the leading cause of dementia in 61 cases (possible VaD and probable AD); and in 29 cases, it was not clear that either AD or VaD was the primary diagnosis (possible AD and possible VaD). CONCLUSIONS None of the clinical criteria for VaD identified the same group of subjects. The diagnosis of vascular dementia is difficult in epidemiologic studies because poststroke dementia can be due to Alzheimer disease (AD) and evidence of vascular disease can be found in the MRI of dementia cases without clinical strokes. Whether the clinical progression is related to AD pathology or vascular disease is difficult to establish.
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Affiliation(s)
- O L Lopez
- Departments of Neurology, University of Pittsburgh School of Medicine, PA, USA.
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Kuller LH, Lopez OL, Jagust WJ, Becker JT, DeKosky ST, Lyketsos C, Kawas C, Breitner JCS, Fitzpatrick A, Dulberg C. Determinants of vascular dementia in the Cardiovascular Health Cognition Study. Neurology 2006; 64:1548-52. [PMID: 15883315 PMCID: PMC3378359 DOI: 10.1212/01.wnl.0000160115.55756.de] [Citation(s) in RCA: 130] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE The authors evaluated 3,375 participants without dementia at the time of MRI in 1991 to 1994 over 5.7 years for incident dementia and type of dementia. METHODS Incidence of and risk factors for vascular dementia (VaD) were measured using both pre-MRI and modified State of California Alzheimer's Disease Diagnostic and Treatment Centers (ADDTC) post-MRI review and further classified Alzheimer disease (AD) by the National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association (NINCDS-ADRDA) criteria. RESULTS Approximately 44% (213) of 480 incident dementia cases were classified as possible or probable VaD by ADDTC. The incidence of VaD increased with age and was greater in blacks than whites. Risk factors for VaD included age, Modified Mini-Mental State Examination, high white matter grade, number of MRI infarcts, ventricular size, and history of stroke. CONCLUSIONS Vascular disease in the brain is prevalent among incident dementia cases. There is a substantial overlap between cases classified as Alzheimer disease by Neurological and Communicative Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association and vascular dementia (VaD) by modified State of California Alzheimer's Disease Diagnostic and Treatment Centers criteria. The substantial contribution of vascular disease would be missed without inclusion of MRI. Treatment of risk factors for VaD could have an important impact on incidence of dementia.
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Affiliation(s)
- L H Kuller
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA 15213, USA.
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Seabra AB, Fitzpatrick A, Paul J, De Oliveira MG, Weller R. Topically applied S-nitrosothiol-containing hydrogels as experimental and pharmacological nitric oxide donors in human skin. Br J Dermatol 2005; 151:977-83. [PMID: 15541075 DOI: 10.1111/j.1365-2133.2004.06213.x] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Nitric oxide (NO) has a wide range of functions in the skin, and topical NO donors have several potential clinical applications. However, currently available donors are either unstable on the skin surface, release low concentrations of NO, or have a short duration of action. Endogenous S-nitrosothiols (RSNOs) store and transport NO within the body and can be used as exogenous sources of NO. OBJECTIVES To study in vitro and in vivo the chemical and biological behaviour of two RSNO species, S-nitrosoglutathione (GSNO) and S-nitroso-N-acetylcysteine (SNAC), in an easily applied hydrogel, and to correlate dermal nitrite concentration with erythema following application of the RSNOs. To assess the suitability of GSNO and SNAC as biologically effective NO donors for clinical research and as potential therapeutic agents. METHODS/PATIENTS GSNO (0.3 mol g(-1)) and SNAC (0.6 mol g(-1)) were incorporated in Synperonic F-127 hydrogels (Uniquema, Belgium). The in vitro kinetics of decomposition were measured by spectrophotometry at 37 degrees C. The RSNO-containing hydrogels were applied to the forearm skin of eight subjects. Blood flow was measured by laser Doppler for 3 h following application of NO donors and dermal nitrite simultaneously measured in microdialysate in four subjects. RESULTS The mean peak blood flow achieved was 250. At blood flow values of < 250, dermal nitrite correlated closely with blood flow and could be defined by the equation: blood flow = (nitrite concentration x 0.66) + 120, (P = 0.013). At higher blood flows there was a paradoxical fall in dermal nitrite concentration. CONCLUSIONS Topical RSNOs produce a consistent, sustained and biologically effective release of NO on human skin in vivo, which offers advantages over currently available topical NO donors. Dermal nitrite concentration--the oxidation product of NO--is directly correlated with blood flow at low and moderate levels of blood flow. At high levels of blood flow, there is a reduction in dermal nitrite, which is presumed to be due to increased blood scavenging.
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Affiliation(s)
- A B Seabra
- Instituto de Química, Universidade Estadual de Campinas, CP 6154, CEP 13084-971, Campinas, SP, Brazil
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Kuppens IELM, Bosch TM, van Maanen MJ, Rosing H, Fitzpatrick A, Beijnen JH, Schellens JHM. Oral bioavailability of docetaxel in combination with OC144-093 (ONT-093). Cancer Chemother Pharmacol 2004; 55:72-8. [PMID: 15316750 DOI: 10.1007/s00280-004-0864-4] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2004] [Accepted: 05/25/2004] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Docetaxel given orally as monotherapy results in low bioavailability of <10%. Previous studies have indicated that the intestinal efflux pump P-glycoprotein (P-gp) prevents uptake from the gut resulting in low systemic exposure to docetaxel. The purpose of this study was to determine the degree of enhancement of the oral uptake of docetaxel on combination with orally administered OC144-093, a potent P-gp inhibitor. Furthermore, the safety of combined treatment was determined and whether known functional genetic polymorphisms of the MDR1 gene could be associated with variability in docetaxel pharmacokinetics was also investigated. PATIENTS AND METHODS A proof of concept study was carried out in 12 patients with advanced solid tumors. Patients were randomized to receive one course of 100 mg oral docetaxel combined with 500 mg OC144-093 followed 2 weeks later by a second i.v. course of docetaxel at a flat dose of 100 mg, without OC144-093, or vice versa. This was followed by standard i.v. docetaxel treatment if indicated. RESULTS The apparent relative oral bioavailability of docetaxel was 26+/-8%. Orally administered docetaxel combined with oral OC144-093 resulted in a Cmax of 415+/-255 ng ml(-1), an AUC0-infinity of 844+/-753 ng h ml(-1) and kel of 0.810+/-0.296 h(-1). These values differed significantly from those following i.v. administration of docetaxel, with a Cmax of 2124+/-1054 ng ml(-1), an AUC0-infinity of 2571+/-1598 ng h ml(-1) and a kel of 1.318+/-0.785 h(-1) (P=0.003, P=0.006, P=0.016). The study medication was well tolerated and most of the adverse events possibly or probably related to OC144-093 and docetaxel were of CTC grade 1 and 2. One patient had a homozygous 3435T/T mutation, which is associated with low intestinal P-gp expression, and two other patients had a homozygous mutation on exon 21. CONCLUSION The relative apparent bioavailability of 26% was most likely caused by a significant effect of OC144-093 on the oral uptake of docetaxel. Large intrapatient and interpatient (pharmacokinetic) variation was found after oral as well as after i.v. administration of docetaxel. Higher plasma levels were observed after 100 mg i.v. docetaxel than after 100 mg oral docetaxel plus 500 mg oral OC144-093. The safety of the oral combination was good. More patients should be evaluated to determine the effect of P-gp single nucleotide polymorphisms on oral pharmacokinetic values of docetaxel.
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Affiliation(s)
- I E L M Kuppens
- Department of Medical Oncology, Antoni van Leeuwenhoek Hospital/The Netherlands Cancer Institute, Amsterdam, The Netherlands.
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