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Yang C, Xie J, Chen Q, Yuan Q, Shang J, Wu H, Yang Y, Wang M, Shu X, Yue J, Tu D, Lin Y, Zheng R, Wu X. Knowledge, Attitude, and Practice About Antibiotic Use and Antimicrobial Resistance Among Nursing Students in China: A Cross Sectional Study. Infect Drug Resist 2024; 17:1085-1098. [PMID: 38525475 PMCID: PMC10960542 DOI: 10.2147/idr.s454489] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 03/06/2024] [Indexed: 03/26/2024] Open
Abstract
Purpose The knowledge, attitude, and practices (KAP) concerning antibiotics by healthcare students have the potential impact on controlling antibiotic abuse and antimicrobial resistance (AMR) growth. This study aims to evaluate the levels and explore the associated factors with KAP on antibiotic use and AMR in Chinese nursing students. Methods A cross-sectional survey using a self-administered questionnaire consisting of demographics and selected features and KAP on antibiotic use and AMR was conducted to measure KAP levels among nursing students at various universities in Hubei Province, China. The logistic regression analyses were performed to analyze the potential factors associated with the KAP. Results The survey eventually included a total of 1959 nursing students. The mean scores for KAP were 57.89 ±26.32, 55.00 ±12.50, and 71.88 ±15.63, respectively. Regarding knowledge, 54.3% of participants were unaware that antibiotic was ineffective against viral infections. Regarding attitude, 36% of participants agreed that current antibiotic abuse existed; 96.2% of participants thought it necessary to set up a special course on antibiotics. Regarding practice, only 48.4% of participants usually purchased antibiotics with a prescription. Multivariable analyses indicated that lack of discussion on AMR in school courses was an independent risk factor against KAP, respectively. The main knowledge sources of antibiotic being outside the classroom was an independent risk factor related to knowledge and practice. The average score >80 points was an independent protective factor related to knowledge and practice. Conclusion The KAP level on antibiotic use and AMR among Hubei nursing students was general and required further strengthening. Nursing students with risk factors should be prioritized in educational interventions. The findings of our study pointed out some directions for tailored interventions to improve the training on antibiotics.
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Affiliation(s)
- Chaoping Yang
- Nursing Department, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Jing Xie
- Department of Pediatric Nephrology, Rheumatology, and Immunology, Maternal and Child Health Hospital of Hubei Province, Hubei University of Medicine, Shiyan, Hubei, People’s Republic of China
| | - Qianjun Chen
- Department of Pediatric Nephrology, Rheumatology, and Immunology, Maternal and Child Health Hospital of Hubei Province, Hubei University of Medicine, Shiyan, Hubei, People’s Republic of China
| | - Qiongyin Yuan
- Obstetrical department, Huanggang Maternal and Child Health Hospital, Hubei, People’s Republic of China
| | - Jianping Shang
- Department of Pediatric Nephrology, Rheumatology, and Immunology, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Haibo Wu
- School of Health and Nursing, Wuchang University of Technology, Wuhan, People’s Republic of China
| | - Youhua Yang
- Department of Basic Medical Sciences, School of Medicine, Jianghan University, Wuhan, People’s Republic of China
| | - Mingfang Wang
- Department of Pediatric Gastroenterology, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Xiaolan Shu
- Department of Pediatric Intensive Care Unit (PICU), Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Jing Yue
- Emergency Department, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, People’s Republic of China
| | - Danna Tu
- Department of Pediatric Cardiology, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Ying Lin
- Nursing Department, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Ronghao Zheng
- Department of Pediatric Nephrology, Rheumatology, and Immunology, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Xiaolin Wu
- Department of Pediatric Nephrology, Rheumatology, and Immunology, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
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Gan Y, Feng Y, Zhou X, Li H, Wang G, Aini M, Shu J, Tu D. Serum levels of angiotensin-converting enzyme 2 in children with Kawasaki disease. Clin Exp Med 2022:10.1007/s10238-022-00933-x. [PMID: 36344782 PMCID: PMC10390598 DOI: 10.1007/s10238-022-00933-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 10/25/2022] [Indexed: 11/09/2022]
Abstract
AbstractKawasaki disease (KD) has replaced rheumatic fever as the main cause of acquired heart disease in Japanese, American, and Chinese children. Polymorphisms in angiotensin-converting enzyme may be associated with susceptibility to KD, but the association of angiotensin-converting enzyme 2 (ACE2) with vascular endothelial injury in KD and the possibility for prognosis of vascular injury in KD by evaluating changes in serum ACE2 have not yet been assessed. Thus, this study aimed to investigate ACE2 levels in patients with KD to further explore the relationship between ACE2 and vascular injury in KD. Blood samples were collected from 49 children with KD before intravenous immunoglobulin treatment and 28 healthy children in the same period as the control group. Clinical data were collected from the patients and serum ACE2 levels of all participants were measured using an enzyme-linked immunosorbent assay. Serum ACE2 levels were significantly higher in the KD group than in the control group, and were negatively correlated with platelet levels in patients with KD. Serum ACE2 levels are related to the pathogenesis of KD and may be used as a potential serum marker for KD diagnosis.
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Gong W, Tang W, Luo L, Zhang F, Cai C, Zhang J, Wu X, Shang J, Shu X, Wang T, Tu D, Jin Z, Zheng R. Trends and Correlation Between Antimicrobial Resistance and Antibiotics Consumption in a Specialist Children’s Hospital from 2016 to 2021. Infect Drug Resist 2022; 15:5679-5689. [PMID: 36193295 PMCID: PMC9526424 DOI: 10.2147/idr.s381604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 09/15/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose To explore the trends and correlation between antibiotics consumption and antimicrobial resistance in children in a specialist hospital from 2016–2021 in China. Patients and Methods This retrospective study investigated data on the consumption of antibiotics and antimicrobial resistance in children. Antibiotics consumption was expressed as defined daily doses (DDDs)/1000 patient-days based on the Guidelines for Anatomical Therapeutic Chemical. The trends in antibiotics consumption and antimicrobial resistance rates were analyzed by linear regression, while Spearman correlation analysis was employed to evaluate their correlations. Results An increasing trend in the annual consumption of carbapenems and monobactams was detected (all P<0.05). A significant upward trend was detected in the annual resistance rates of Enterococcus faecium to ciprofloxacin, Streptococcus pneumonia to ceftriaxone, Acinetobacter baumannii to carbapenems, Enterobacter cloacae to carbapenems, Pseudomonas aeruginosa to ceftazidime, and Escherichia coli to cefepime, while the annual resistance rates of Escherichia coli to carbapenems had a significant downward trend (all P<0.05). The consumption of cephalosporin/β-lactamase inhibitor (C/BLI) combinations and carbapenems had significant positive correlations with the resistance rates of Acinetobacter baumannii to carbapenems (r=0.763, P<0.001; r=0.806, P<0.001), Enterobacter cloacae to carbapenems (r=0.675, P<0.001; r=0.417, P=0.043), and Pseudomonas aeruginosa to ceftazidime (r=0.625, P=0.001; r=0.753, P<0.001), respectively. Also, increasing consumption of monobactams was related to the upward resistance rates of Acinetobacter baumannii to carbapenems (r=0.557, P=0.005) and Enterobacter cloacae to carbapenems (r=0.507, P= 0.011). Conclusion This study demonstrated significant positive associations between antibiotics consumption and specific antimicrobial resistance rates. The current findings pointed out some directions to pursue in controlling the prevalence of certain resistant bacterial strains in children.
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Affiliation(s)
- Wenting Gong
- Department of pharmacy, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Wen Tang
- Department of Pediatric Intensive Care Unit, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Lan Luo
- Department of Child Health, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Furong Zhang
- Department of pharmacy, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Chenyang Cai
- Department of pharmacy, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Jiangyan Zhang
- Department of pharmacy, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Xiaolin Wu
- Department of Pediatric Nephrology, Rheumatology, and Immunology, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Jianping Shang
- Department of Pediatric Nephrology, Rheumatology, and Immunology, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Xiaolan Shu
- Department of Pediatric Intensive Care Unit, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Ting Wang
- Department of Pediatric Neurology, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Danna Tu
- Department of Pediatric Cardiology, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Zhengjiang Jin
- Department of Clinical Laboratory, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
- Zhengjiang Jin, Department of Clinical Laboratory, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, 745 Wu luo Road, Hongshan District, Wuhan, 430070, Hubei Province, People’s Republic of China, Email
| | - Ronghao Zheng
- Department of Pediatric Nephrology, Rheumatology, and Immunology, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
- Correspondence: Ronghao Zheng, Department of Pediatric Nephrology, Rheumatology, and Immunology, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, 745 Wu luo Road, Hongshan District, Wuhan, 430070, Hubei Province, People’s Republic of China, Tel +86 02787169267, Email
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Mates M, Bedard P, Hilton J, Gelmon K, Srikanthan A, Awan A, Song X, Lohrisch C, Robinson A, Tu D, Hagerman L, Zhang S, Drummond-Ivars N, Li I, Rastgou L, Edwards J, Bray M, Rushton M, Gaudreau PO. 38MO IND.236: A Canadian Cancer Trial Group (CCTG) phase Ib trial of combined CFI-402257 and weekly paclitaxel (Px) in patients with HER2-negative (HER2-) advanced breast cancer (BC). Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.01.053] [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: 10/22/2022] Open
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Zheng R, Zhou Y, Qiu M, Yan Y, Yue J, Yu L, Lei X, Tu D, Hu Y. Prevalence and associated factors of depression, anxiety, and stress among Hubei pediatric nurses during COVID-19 pandemic. Compr Psychiatry 2021; 104:152217. [PMID: 33217635 PMCID: PMC7654390 DOI: 10.1016/j.comppsych.2020.152217] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 09/10/2020] [Accepted: 10/16/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic is putting healthcare workers across the world in an unprecedented situation. The purpose of this study was to evaluate the levels of depression, anxiety, and stress among Hubei pediatric nurses during the COVID-19 pandemic and to analyze the potential factors associated with them. MATERIALS AND METHODS A self-designed online questionnaire survey, which consisted of the demographic and selected features, the occupational protection knowledge, attitudes, and practices of COVID-19, and the Chinese version of Depression, Anxiety, and Stress Scale, were used to assess the levels of depression, anxiety, and stress among Hubei pediatric nurses during COVID-19 pandemic. The logistic regression analyses were performed to analyze the potential factors associated with depression, anxiety, and stress. RESULTS A total of 617 pediatric nurses were included in the survey. A considerable proportion of pediatric nurses reported symptoms of depression (95 [15.4%]), anxiety (201 [32.6%]), and stress (111 [18.0%]). Results of multivariable logistic regression analyses indicated that the good occupational protection practices (for depression: OR = 0.455, 95%CI: 0.281 to 0.739; for anxiety: OR = 0.597, 95%CI: 0.419 to 0.851; for stress: OR = 0.269, 95%CI: 0.166 to 0.438) and the personal protective equipment (PPE) meeting work requirements (for depression: OR = 0.438, 95%CI: 0.246 to 0.778; for anxiety: OR = 0.581, 95%CI: 0.352 to 0.959; for stress: OR = 0.504, 95%CI: 0.283 to 0.898) were independent protective factors against depression, anxiety, and stress, respectively. Yet, working in an isolation ward or fever clinic was an independent risk factor associated with depression, anxiety, and stress, respectively (for depression: OR = 1.809, 95%CI: 1.103 to 2.966; for anxiety: OR = 1.864, 95%CI: 1.221 to 2.846; for stress: OR = 2.974, 95%CI: 1.866 to 4.741). Having suspected or confirmed COVID-19 patients in the departments (OR = 1.554, 95%CI: 1.053 to 2.294) and coming in contact with the patient's bodily fluids or blood (OR = 1.469, 95%CI: 1.031 to 2.095) were independent risk factors for anxiety, while >3 times of training for COVID-19 related information was an independent protective factor for depression (OR = 0.592, 95%CI: 0.360 to 0.974). Moreover, >10 years of working was an independent risk factor for stress (OR = 1.678, 95%CI: 1.075 to 2.618). CONCLUSION During the COVID-19 outbreak, a considerable proportion of Hubei pediatric nurses had psychological problems. The pediatric nurses endorsing the higher number of risk factors should be given special attention and necessary psychological intervention. Improving the levels of PPE so as to meet the work requirements and intensifying occupational protection practices might help safeguard pediatric nurses from depression, anxiety, and stress.
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Affiliation(s)
- Ronghao Zheng
- Department of Pediatric, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei province, People's Republic of China
| | - Yuren Zhou
- Wuhan University School Of Health Sciences, Wuhan, Hubei province, People's Republic of China
| | - Ming Qiu
- Department of Pediatric, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei province, People's Republic of China
| | - Yiwen Yan
- Wuhan University School Of Health Sciences, Wuhan, Hubei province, People's Republic of China
| | - Jing Yue
- Emergency Department, Maternal and Child Health Hospital of Hubei Province, Wuhan, Hubei province, People's Republic of China
| | - Liping Yu
- Wuhan University School Of Health Sciences, Wuhan, Hubei province, People's Republic of China
| | - Xinyun Lei
- Department of Nursing, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei province, People's Republic of China
| | - Danna Tu
- Department of Pediatric, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei province, People's Republic of China
| | - Yongqun Hu
- Department of Pediatric, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei province, People's Republic of China.
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Tu D, Shu J, Wu X, Li H, Xia Z, Zhang Y, Fang Y, Shen S, Guan W, Wang H, Huang Z, Wang G, Zhou X, Deng F. Immunological detection of serum antibodies in pediatric medical workers exposed to varying levels of SARS-CoV-2. J Infect 2020; 82:159-198. [PMID: 32721505 PMCID: PMC7382336 DOI: 10.1016/j.jinf.2020.07.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 07/22/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Danna Tu
- Department of Pediatrics, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430070, Hubei, China
| | - Junhua Shu
- Department of Pediatrics, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430070, Hubei, China
| | - Xiaoli Wu
- State Key Laboratory of Virology and National Virus Resource Center, Wuhan Institute of Virology, Chinese Academy of Sciences, Wuhan 430071, Hubei, China; University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Heng Li
- Department of Pediatrics, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430070, Hubei, China
| | - Zhi Xia
- Department of Pediatrics, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430070, Hubei, China
| | - Yanfang Zhang
- State Key Laboratory of Virology and National Virus Resource Center, Wuhan Institute of Virology, Chinese Academy of Sciences, Wuhan 430071, Hubei, China
| | - Yaohui Fang
- State Key Laboratory of Virology and National Virus Resource Center, Wuhan Institute of Virology, Chinese Academy of Sciences, Wuhan 430071, Hubei, China; University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Shu Shen
- State Key Laboratory of Virology and National Virus Resource Center, Wuhan Institute of Virology, Chinese Academy of Sciences, Wuhan 430071, Hubei, China
| | - Wuxiang Guan
- State Key Laboratory of Virology and National Virus Resource Center, Wuhan Institute of Virology, Chinese Academy of Sciences, Wuhan 430071, Hubei, China
| | - Hualin Wang
- State Key Laboratory of Virology and National Virus Resource Center, Wuhan Institute of Virology, Chinese Academy of Sciences, Wuhan 430071, Hubei, China
| | - Zhaoxuan Huang
- Department of Pediatrics, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430070, Hubei, China
| | - Guirong Wang
- Department of Pediatrics, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430070, Hubei, China
| | - Xiaoqin Zhou
- Department of Pediatrics, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430070, Hubei, China
| | - Fei Deng
- State Key Laboratory of Virology and National Virus Resource Center, Wuhan Institute of Virology, Chinese Academy of Sciences, Wuhan 430071, Hubei, China
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Nehra J, Bradbury PA, Ellis PM, Laskin J, Kollmannsberger C, Hao D, Juergens RA, Goss G, Wheatley-Price P, Hotte SJ, Gelmon K, Tinker AV, Brown-Walker P, Gauthier I, Tu D, Song X, Khan A, Seymour L, Smoragiewicz M. A Canadian cancer trials group phase IB study of durvalumab (anti-PD-L1) plus tremelimumab (anti-CTLA-4) given concurrently or sequentially in patients with advanced, incurable solid malignancies. Invest New Drugs 2020; 38:1442-1447. [PMID: 32020438 DOI: 10.1007/s10637-020-00904-7] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 01/27/2020] [Indexed: 11/25/2022]
Abstract
Background The IND.226 study was a phase Ib study to determine the recommended phase II dose of durvalumab + tremelimumab in combination with standard platinum-doublet chemotherapy. Sequential administration of multiple agents increases total chair time adding costs overall and inconvenience for patients. This cohort of the IND.226 study evaluated the safety and tolerability of durvalumab + tremelimumab given either sequentially (SEQ) or concurrently (CON). Methods Patients with advanced solid tumours were enrolled and randomised to either SEQ tremelimumab 75 mg IV over 1 h followed by durvalumab 1500 mg IV over 1 h q4wks on the same day, or CON administration over 1 h. The serum pharmacokinetic profile of SEQ versus CON of durvalumab and tremelimumab administration was also evaluated. Results 14 patients either received SEQ (n = 7pts) or CON (n = 7 pts). There were no infusion related reactions. Drug related adverse events (AEs) were mainly low grade and manageable, and comparable in frequency between SEQ/CON- fatigue (43%/57%), rash (43%/43%), pruritus (43%/29%) and nausea (14%/29%). One patient in each cohort discontinued treatment due to toxicity. The PK profiles of durvalumab and tremelimumab were similar between CON and SEQ, and to historical reference data. Conclusions Concurrent administration of durvalumab and tremelimumab over 1 h is safe with a comparable PK profile to sequential administration.
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MESH Headings
- Adult
- Aged
- Antibodies, Monoclonal/administration & dosage
- Antibodies, Monoclonal/adverse effects
- Antibodies, Monoclonal/blood
- Antibodies, Monoclonal/pharmacokinetics
- Antibodies, Monoclonal, Humanized/administration & dosage
- Antibodies, Monoclonal, Humanized/adverse effects
- Antibodies, Monoclonal, Humanized/blood
- Antibodies, Monoclonal, Humanized/pharmacokinetics
- Antineoplastic Agents, Immunological/administration & dosage
- Antineoplastic Agents, Immunological/adverse effects
- Antineoplastic Agents, Immunological/blood
- Antineoplastic Agents, Immunological/pharmacokinetics
- Antineoplastic Combined Chemotherapy Protocols/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Antineoplastic Combined Chemotherapy Protocols/pharmacokinetics
- Female
- Humans
- Immune Checkpoint Inhibitors/administration & dosage
- Immune Checkpoint Inhibitors/adverse effects
- Immune Checkpoint Inhibitors/blood
- Immune Checkpoint Inhibitors/pharmacokinetics
- Male
- Middle Aged
- Neoplasms/blood
- Neoplasms/drug therapy
- Neoplasms/metabolism
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Affiliation(s)
- J Nehra
- Canadian Cancer Trials Group, Queen's University, 10 Stuart Street, Kingston, ON, K7L3N6, Canada
| | - P A Bradbury
- Division of Medical Oncology, Princess Margaret Cancer Centre, Toronto, Canada
| | - P M Ellis
- Department of Oncology - Division of Medical Oncology, Juravinski Cancer Centre, Hamilton, Canada
| | - J Laskin
- Division of Medical Oncology, BCCA Vancouver Cancer Centre, Vancouver, Canada
| | - C Kollmannsberger
- Division of Medical Oncology, BCCA Vancouver Cancer Centre, Vancouver, Canada
| | - D Hao
- Department of Oncology - Section of Medical Oncology, Tom Baker Cancer Centre University of Calgary, Calgary, Canada
| | - R A Juergens
- Department of Oncology - Division of Medical Oncology, Juravinski Cancer Centre, Hamilton, Canada
| | - G Goss
- Division of Medical Oncology, The Ottawa Hospital Cancer Centre, Ottawa, Canada
| | - P Wheatley-Price
- Division of Medical Oncology, The Ottawa Hospital Cancer Centre, Ottawa, Canada
| | - S J Hotte
- Department of Oncology - Division of Medical Oncology, Juravinski Cancer Centre, Hamilton, Canada
| | - K Gelmon
- Division of Medical Oncology, BCCA Vancouver Cancer Centre, Vancouver, Canada
| | - A V Tinker
- Division of Medical Oncology, BCCA Vancouver Cancer Centre, Vancouver, Canada
| | - P Brown-Walker
- Canadian Cancer Trials Group, Queen's University, 10 Stuart Street, Kingston, ON, K7L3N6, Canada
| | - I Gauthier
- Canadian Cancer Trials Group, Queen's University, 10 Stuart Street, Kingston, ON, K7L3N6, Canada
| | - D Tu
- Canadian Cancer Trials Group, Queen's University, 10 Stuart Street, Kingston, ON, K7L3N6, Canada
| | - X Song
- Clinical Pharmacology & Safety Sciences, AstraZeneca, Gaithersburg, MD, USA
| | - A Khan
- Clinical Pharmacology & Safety Sciences, AstraZeneca, Gaithersburg, MD, USA
| | - Lesley Seymour
- Canadian Cancer Trials Group, Queen's University, 10 Stuart Street, Kingston, ON, K7L3N6, Canada.
| | - M Smoragiewicz
- Canadian Cancer Trials Group, Queen's University, 10 Stuart Street, Kingston, ON, K7L3N6, Canada
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Loree J, Jonker D, Feilotter H, Kennecke H, Brohawn P, Banks K, Quinn K, Tu D, O’Callaghan C, Chen E. Impact of clonality and DNA repair mutations on plasma tumour mutation burden (pTMB) and immunotherapy efficacy in microsatellite stable (MSS) metastatic colorectal cancer (mCRC) in CCTG CO.26. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz246.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Juergens R, Ellis P, Tu D, Hao D, Laurie S, Mates M, Goss G, Goffin J, Bradbury P, Tehfe M, Kollmansberger C, Brown-Walker P, Smoragiewicz M, Tsao M, Seymour L. MA11.04 Platinum Doublet + Durvalumab +/- Tremelimumab in Patients with Advanced NSCLC: A CCTG Phase IB Study - IND.226. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.586] [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: 10/25/2022]
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Hotte S, Winquist E, Chi K, Ellard S, Sridhar S, Emmenegger U, Salim M, Iqbal N, Canil C, Kollmannsberger C, Hansen A, Lalani AKA, Gingerich J, Finch D, Cabanero M, Wyatt A, Tu D, Vera-Badillo F, Seymour L, Smoragiewicz M. CCTG IND 232: A phase II study of durvalumab with or without tremelimumab in patients with metastatic castration resistant prostate cancer (mCRPC). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz394.044] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Hao D, Ellis P, Laurie S, Juergens R, Mates M, Bradbury P, Tsao M, Tehfe M, Kollmannsberger C, Goffin J, Wheatley-Price P, Hilton J, Robinson A, Brown-Walker P, Tu D, Smoragiewicz M, Seymour L. Pharmacokinetic (PK) and updated survival data from the Canadian cancer trials group IND.226 study of durvalumab ± tremelimumab in combination with platinum-doublet chemotherapy. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz244.036] [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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12
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Fontana E, Nyamundanda G, Cunningham D, Jonker D, Siu L, Tu D, Sclafani F, Eason K, Ragulan C, Hulkki-Wilson S, Loree J, Giordano M, Lawrence P, Shapiro J, Cremolini C, Starling N, Pietrantonio F, Trusolino L, O’Callaghan C, Sadanandam A. Association between transit-amplifying signature and outcomes of patients treated with anti-epidermal growth factor receptor (EGFR) therapy in colorectal cancer. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz246.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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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13
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Cheung WY, Kornelsen EA, Mittmann N, Leighl NB, Cheung M, Chan KK, Bradbury PA, Ng RCH, Chen BE, Ding K, Pater JL, Tu D, Hay AE. The economic impact of the transition from branded to generic oncology drugs. ACTA ACUST UNITED AC 2019; 26:89-93. [PMID: 31043808 DOI: 10.3747/co.26.4395] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Economic evaluations are an integral component of many clinical trials. Costs used in those analyses are based on the prices of branded drugs when they first enter the market. The effect of genericization on the cost-effectiveness (ce) or cost-utility (cu) of an intervention is unknown because economic analyses are rarely updated using the costs of generic drugs. Methods We re-examined the ce or cu of regimens previously evaluated in Canadian Cancer Trials Group (cctg) studies that included prospective economic evaluations and where genericization has occurred or is anticipated in Canada. We incorporated the new costs of generic drugs to characterize changes in ce or cu. We also determined acceptable cost levels of generic drugs that would make regimens reimbursable in a publicly funded health care system. Results The four randomized controlled trials included (representing 1979 patients) were cctg br.10 (early lung cancer, adjuvant vinorelbine-cisplatin vs. observation, n = 172), cctg br.21 (metastatic lung cancer, erlotinib vs. placebo, n = 731), cctg co.17 (metastatic colon cancer, cetuximab vs. best supportive care, n = 557), and cctg ly.12 (relapsed or refractory lymphoma, gemcitabine-dexamethasone-cisplatin vs. cytarabine-dexamethasone-cisplatin, n = 619). Since the initial publication of those trials, the genericization of vinorelbine, erlotinib, cetuximab, and cisplatin has taken place or is expected in Canada. Costs of generics improved the ces and cus of treatment significantly. For example, genericization of erlotinib ($1460.25 per 30 days) resulted in an incremental cost-effectiveness ratio (icer) of $45,746 per life-year gained compared with $94,638 for branded erlotinib. Likewise, genericization of cetuximab ($275.80 per 100 mg) produced an icer of $261,126 per quality-adjusted life-year (qaly) gained compared with $299,613 for branded cetuximab. Decreases in the cost of generic cetuximab to $129.39 and $63.51 would further improve the icer to $150,000 and $100,000 per QALY respectively. Conclusions Genericization of a costly oncology drug can modify the ce and cu of a regimen significantly. Failure to revisit economic analyses with the costs of generics could be a missed opportunity for funding bodies to optimize value-based allocation of health care resources. At current levels, the costs of generics might not be sufficiently low to sustain publicly funded health care systems.
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Affiliation(s)
| | | | | | | | - M Cheung
- University of Toronto, Toronto, ON
| | - K K Chan
- University of Toronto, Toronto, ON
| | | | - R C H Ng
- University of Toronto, Toronto, ON
| | - B E Chen
- Queen's University, Kingston, ON
| | - K Ding
- Queen's University, Kingston, ON
| | | | - D Tu
- Queen's University, Kingston, ON
| | - A E Hay
- Queen's University, Kingston, ON
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14
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Ethier JL, Parulekar W, Shepherd L, Summers L, Strasser-Weippl K, Tu D, Amir E. Abstract P4-14-03: Influence of competing risks of death on the interpretation of adjuvant endocrine therapy trials for breast cancer. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p4-14-03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Early stage, hormone sensitive breast cancer is associated generally with a good prognosis, with only a minority of patients expected to die of breast cancer. Death from causes other than breast cancer can dilute the patients at risk of breast cancer events and result in over-estimation of risk of recurrence and consequently the benefit from breast cancer therapy, a so-called immortal time bias. The MA.17R trial (Goss et al 2016) evaluated the role of extending adjuvant treatment with letrozole from 5 to 10 years. Here we determine the effect of analyzing the MA.17R trial using methods accounting for competing risks.
Methods: We compared conventional and competing risk methods for disease-free survival (DFS) and for distant recurrence-free survival (DRFS). In Kaplan-Meier analyses death from any cause was considered an event while cumulative incidence functions (CIFs) assumed death without recurrence to be a competing risk. The complement of the survival function (one minus the survival function) was used to estimate incidence of the primary event of interest. This was compared to estimates obtained using CIFs accounting for the occurrence of competing events.
Results: Non-breast cancer death was the most common event defining DFS and DRFS. Over the course of follow-up, there was increasing discrepancy between the risk of disease recurrence measured using Kaplan-Meier and CIF. Among letrozole treated patients the estimated distant recurrence at 5 years of follow-up was 5.4% using CIF and 9.6% using Kaplan-Meier. At 10 years of follow-up, the estimated distant recurrence was 8.4% using CIF and 20.0% using Kaplan-Meier. Similar results were observed for the placebo group (8.5% vs 12.1% at 5 years and 14.8% vs 27.3% at 10 years), and in patients with baseline cardiovascular disease (see Table). Benefit from letrozole on DFS and DRFS was greater when accounting for competing risk (hazard ratio [HR] for DFS 0.66, 95%CI 0.48-0.90; DFRS HR 0.75, 0.50-1.14) compared to the conventional method (DFS HR 0.79, 0.62-0.99; DRFS HR 0.91, 0.70-1.18). In women with baseline cardiovascular risk, the benefits of extended adjuvant letrozole when considering competing risk (DFS HR 0.38, 0.16-0.89; DRFS HR 0.46, 0.16-1.35) were also greater than those observed in the conventional analysis (DFS HR 0.55, 0.32-0.93; DRFS HR 0.59, 0.33-1.04). Treatment with extended letrozole did not influence non-breast cancer death in women who died with disease recurrence (HR 1.06, 0.74 -1.50) or in those with competing risk or censored from the analysis (HR 1.05, 0.73 -1.49).
Conclusion: Over the course of follow-up, estimates of DFS and DRFS differ increasingly if measured using Kaplan-Meier or CIF, with CIF estimates of risk being substantially lower. Using a competing risk model, the reduction in distant recurrence at 8 years with extended letrozole is less than 1%. Additional competing risk analyses of the MA.17 (Goss 2006) and MA.27 (Goss 2013) trials are ongoing.
Cumulative incidence of disease recurrence in patients with baseline cardiovascular riskTime (years)CIF (%)1-KM (%)Letrozole11.51.534.46.555.813.8Placebo13.53.538.311.8512.520.3
Citation Format: Ethier J-L, Parulekar W, Shepherd L, Summers L, Strasser-Weippl K, Tu D, Amir E. Influence of competing risks of death on the interpretation of adjuvant endocrine therapy trials for breast cancer [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 P4-14-03.
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Affiliation(s)
- J-L Ethier
- Cancer Centre of Southeastern Ontario, Kingston, ON, Canada; Canadian Cancer Trials Group, Kingston, ON, Canada; Center for Oncology, Hematology and Palliative Care, Wilhelminen Hospital, Vienna, Austria; Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - W Parulekar
- Cancer Centre of Southeastern Ontario, Kingston, ON, Canada; Canadian Cancer Trials Group, Kingston, ON, Canada; Center for Oncology, Hematology and Palliative Care, Wilhelminen Hospital, Vienna, Austria; Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - L Shepherd
- Cancer Centre of Southeastern Ontario, Kingston, ON, Canada; Canadian Cancer Trials Group, Kingston, ON, Canada; Center for Oncology, Hematology and Palliative Care, Wilhelminen Hospital, Vienna, Austria; Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - L Summers
- Cancer Centre of Southeastern Ontario, Kingston, ON, Canada; Canadian Cancer Trials Group, Kingston, ON, Canada; Center for Oncology, Hematology and Palliative Care, Wilhelminen Hospital, Vienna, Austria; Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - K Strasser-Weippl
- Cancer Centre of Southeastern Ontario, Kingston, ON, Canada; Canadian Cancer Trials Group, Kingston, ON, Canada; Center for Oncology, Hematology and Palliative Care, Wilhelminen Hospital, Vienna, Austria; Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - D Tu
- Cancer Centre of Southeastern Ontario, Kingston, ON, Canada; Canadian Cancer Trials Group, Kingston, ON, Canada; Center for Oncology, Hematology and Palliative Care, Wilhelminen Hospital, Vienna, Austria; Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - E Amir
- Cancer Centre of Southeastern Ontario, Kingston, ON, Canada; Canadian Cancer Trials Group, Kingston, ON, Canada; Center for Oncology, Hematology and Palliative Care, Wilhelminen Hospital, Vienna, Austria; Princess Margaret Cancer Centre, Toronto, ON, Canada
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15
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La A, Nguyen T, Tran K, Sauble E, Tu D, Gonzalez A, Kidane TZ, Soriano C, Morgan J, Doan M, Tran K, Wang CY, Knutson MD, Linder MC. Mobilization of iron from ferritin: new steps and details. Metallomics 2019; 10:154-168. [PMID: 29260183 DOI: 10.1039/c7mt00284j] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Much evidence indicates that iron stored in ferritin is mobilized through protein degradation in lysosomes, but concerns about this process have lingered, and the mechanistic details of its aspects are lacking. In the studies presented here, 59Fe-labeled ferritin was induced by preloading hepatic (HepG2) cells with radiolabeled Fe. Placing these cells in a medium containing desferrioxamine resulted in the loss of ferritin-59Fe, but adding high concentrations of reducing agents or modulating the internal GSH concentration failed to alter the rates of ferritin-59Fe release. Confocal microscopy showed that Fe deprivation increased the movement of ferritin into lysosomes and hyperaccumulation was observed when lysosomal proteolysis was inhibited. It also resulted in the rapid movement of DMT1 to lysosomes, which was inhibited by bafilomycin. Ferrihydrite crystals isolated from purified rat liver/spleen ferritin were solubilized at pH 5 and 7 by GSH, ascorbate, citrate and lysosomal fluids obtained from livers and J774a.1 macrophages. The inhibition of DMT1/Nramp2 and siRNA knockdown of Nramp1 each reduced the transfer of 59Fe from lysosomes to the cytosol; and hepatocyte-specific knockout of DMT1 in mice prevented the release of Fe from the liver responding to EPO treatment, but did not inhibit lysosomal ferritin degradation. We conclude that ferritin-Fe mobilization does not occur through changes in cellular concentrations of reducing/chelating agents but by the coordinated movement of ferritin and DMT1 to lysosomes, where the ferrihydrite crystals exposed by ferritin degradation dissolve in the lysosomal fluid, and the reduced iron is transported back to the cytosol via DMT1 in hepatocytes, and by both DMT1 and Nramp1 in macrophages, prior to release into the blood or storage in ferritin.
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Affiliation(s)
- A La
- Department of Chemistry and Biochemistry, California State University, Fullerton, CA 92834-6866, USA.
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Sud S, O'Callaghan C, Jonker C, Karapetis C, Price T, Tebbutt N, Shapiro J, Van Hazel G, Pavlakis N, Gibbs P, Jeffrey M, Siu L, Gill S, Wong R, Jonker D, Tu D, Goodwin R. Hypertension as a predictor of advanced colorectal cancer outcome and cetuximab treatment response. ACTA ACUST UNITED AC 2018; 25:e516-e526. [PMID: 30607118 DOI: 10.3747/co.25.4069] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background Adrenergic receptor stimulation is involved in the development of hypertension (htn) and has been implicated in cancer progression and dissemination of metastases in various tumours, including colon cancer. Adrenergic antagonists such as beta-blockers (bbs) demonstrate inhibition of invasion and migration in colon cancer cell lines and have been associated with decreased mortality in colorectal cancer (crc). We examined the association of baseline htn and bb use with overall (os) and progression-free survival (pfs) in patients with pretreated, chemotherapy refractory, metastatic crc (mcrc). We also examined baseline htn as a predictor of cetuximab efficacy. Methods Using data from the Canadian Cancer Trials Group co.17 study [cetuximab vs. best supportive care (bsc)], we coded baseline htn and use of anti-htn medications, including bbs, for 572 patients. The chi-square test was used to assess the associations between those variables and baseline characteristics. Cox regression models were used for univariate and multivariate analyses of os and pfs by htn diagnosis and bb use. Results Baseline htn, bb use, and anti-htn medication use were not found to be prognostic for improved os. Baseline htn and bb use were not significant predictors of cetuximab benefit. Conclusions In chemorefractory mcrc, neither baseline htn nor bb use is a significant prognostic factor. Baseline htn and bb use are not predictive of cetuximab benefit. Further investigation to determine whether baseline htn or bb use have a similarly insignificant impact on prognosis in patients receiving earlier lines of treatment remains warranted.
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Affiliation(s)
- S Sud
- Division of Medical Oncology, Department of Medicine, The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, ON
| | - C O'Callaghan
- ncic Clinical Trials Group, Queen's University, Kingston, ON
| | - C Jonker
- Division of Medical Oncology, Department of Medicine, The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, ON
| | - C Karapetis
- Flinders University and Flinders Medical Centre, Flinders Centre for Innovation in Cancer, Bedford Park, SA
| | - T Price
- The Queen Elizabeth and University of Adelaide, Adelaide, SA
| | | | - J Shapiro
- Department of Medical Oncology, Monash University, Melbourne, VIC
| | | | - N Pavlakis
- Royal North Shore Hospital, Northern Clinical School, University of Sydney, St. Leonards, NSW
| | - P Gibbs
- Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - M Jeffrey
- Oncology Service, Christchurch Hospital, Christchurch, N.Z
| | - L Siu
- Princess Margaret Cancer Centre, University of Toronto, Toronto, ON
| | - S Gill
- University of British Columbia, BC Cancer, Vancouver, BC
| | - R Wong
- CancerCare Manitoba, Winnipeg, MB
| | - D Jonker
- Division of Medical Oncology, Department of Medicine, The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, ON
| | - D Tu
- ncic Clinical Trials Group, Queen's University, Kingston, ON
| | - R Goodwin
- Division of Medical Oncology, Department of Medicine, The Ottawa Hospital Cancer Centre, University of Ottawa, Ottawa, ON
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17
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Hilton J, Cescon D, Bedard P, Ritter H, Tu D, Soong J, Gelmon K, Aparicio S, Seymour L. CCTG IND.231: A phase 1 trial evaluating CX-5461 in patients with advanced solid tumors. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy048.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [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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18
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Provencher DM, Gallagher CJ, Parulekar WR, Ledermann JA, Armstrong DK, Brundage M, Gourley C, Romero I, Gonzalez-Martin A, Feeney M, Bessette P, Hall M, Weberpals JI, Hall G, Lau SK, Gauthier P, Fung-Kee-Fung M, Eisenhauer EA, Winch C, Tu D, MacKay HJ. OV21/PETROC: a randomized Gynecologic Cancer Intergroup phase II study of intraperitoneal versus intravenous chemotherapy following neoadjuvant chemotherapy and optimal debulking surgery in epithelial ovarian cancer. Ann Oncol 2018; 29:431-438. [PMID: 29186319 PMCID: PMC6658709 DOI: 10.1093/annonc/mdx754] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [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] [Indexed: 01/13/2023] Open
Abstract
Background The purpose of this multistage, adaptively, designed randomized phase II study was to evaluate the role of intraperitoneal (i.p.) chemotherapy following neoadjuvant chemotherapy (NACT) and optimal debulking surgery in women with epithelial ovarian cancer (EOC). Patients and methods We carried out a multicenter, two-stage, phase II trial. Eligible patients with stage IIB-IVA EOC treated with platinum-based intravenous (i.v.) NACT followed by optimal (<1 cm) debulking surgery were randomized to one of the three treatment arms: (i) i.v. carboplatin/paclitaxel, (ii) i.p. cisplatin plus i.v./i.p. paclitaxel, or (iii) i.p. carboplatin plus i.v./i.p. paclitaxel. The primary end point was 9-month progressive disease rate (PD9). Secondary end points included progression-free survival (PFS), overall survival (OS), toxicity, and quality of life (QOL). Results Between 2009 and 2015, 275 patients were randomized; i.p. cisplatin containing arm did not progress beyond the first stage of the study after failing to meet the pre-set superiority rule. The final analysis compared i.v. carboplatin/paclitaxel (n = 101) with i.p. carboplatin, i.v./i.p. paclitaxel (n = 102). The intention to treat PD9 was lower in the i.p. carboplatin arm compared with the i.v. carboplatin arm: 24.5% (95% CI 16.2% to 32.9%) versus 38.6% (95% CI 29.1% to 48.1%) P = 0.065. The study was underpowered to detect differences in PFS: HR PFS 0.82 (95% CI 0.57-1.17); P = 0.27 and OS HR 0.80 (95% CI 0.47-1.35) P = 0.40. The i.p. carboplatin-based regimen was well tolerated with no reduction in QOL or increase in toxicity compared with i.v. administration alone. Conclusion In women with stage IIIC or IVA EOC treated with NACT and optimal debulking surgery, i.p. carboplatin-based chemotherapy is well tolerated and associated with an improved PD9 compared with i.v. carboplatin-based chemotherapy. Clinical trial number clinicaltrials.gov, NCT01622543.
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Affiliation(s)
- D M Provencher
- Institut du Cancer de Montréal, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Canada
| | | | - W R Parulekar
- Canadian Cancer Trials Group (CCTG), Queen's University, Kingston, Canada
| | - J A Ledermann
- University College London Cancer Institute, London, UK
| | - D K Armstrong
- Johns Hopkins University School of Medicine, Baltimore, USA
| | - M Brundage
- Cancer Centre of Southeastern Ontario, Kingston, Canada
| | - C Gourley
- Edinburgh Cancer Research UK Centre, MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - I Romero
- Secretaria del Área Clínica de Oncología Ginecológica, Instituto Valenciano de Oncología, València
| | | | - M Feeney
- University College London Cancer Institute, London, UK
| | - P Bessette
- Gynecologic Oncology Division, Centre Hospitalier de l'Université de Montréal, Sherbrooke, Canada
| | - M Hall
- Department of Obstetrics and Gynaecology, Mount Vernon Cancer Centre, Northwood, UK
| | - J I Weberpals
- Division of Gynaecologic Oncology, The Ottawa Hospital, Ottawa, Canada
| | - G Hall
- Leeds Institute of Cancer and Pathology, St James's University Hospital, Leeds, UK
| | - S K Lau
- Division of Gynecologic Oncology, Segal Cancer Center, SMBD Jewish General Hospital, McGill University, Montréal, Canada
| | - P Gauthier
- Gynecologic Oncology Division, Centre Hospitalier de l'Université de Montréal, Sherbrooke, Canada
| | - M Fung-Kee-Fung
- Division of Gynaecologic Oncology, The Ottawa Hospital, Ottawa, Canada
| | - E A Eisenhauer
- Canadian Cancer Trials Group (CCTG), Queen's University, Kingston, Canada
| | - C Winch
- Canadian Cancer Trials Group (CCTG), Queen's University, Kingston, Canada
| | - D Tu
- Canadian Cancer Trials Group (CCTG), Queen's University, Kingston, Canada
| | - H J MacKay
- Division of Medical Oncology & Hematology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada.
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19
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Provencher DM, Gallagher CJ, Parulekar WR, Ledermann JA, Armstrong DK, Brundage M, Gourley C, Romero I, Gonzalez-Martin A, Feeney M, Bessette P, Hall M, Weberpals JI, Hall G, Lau SK, Gauthier P, Fung-Kee-Fung M, Eisenhauer EA, Winch C, Tu D, MacKay HJ. OV21/PETROC: a randomized Gynecologic Cancer Intergroup phase II study of intraperitoneal versus intravenous chemotherapy following neoadjuvant chemotherapy and optimal debulking surgery in epithelial ovarian cancer. Ann Oncol 2018. [PMID: 29186319 DOI: 10.1093/annonc/mdx754] [] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background The purpose of this multistage, adaptively, designed randomized phase II study was to evaluate the role of intraperitoneal (i.p.) chemotherapy following neoadjuvant chemotherapy (NACT) and optimal debulking surgery in women with epithelial ovarian cancer (EOC). Patients and methods We carried out a multicenter, two-stage, phase II trial. Eligible patients with stage IIB-IVA EOC treated with platinum-based intravenous (i.v.) NACT followed by optimal (<1 cm) debulking surgery were randomized to one of the three treatment arms: (i) i.v. carboplatin/paclitaxel, (ii) i.p. cisplatin plus i.v./i.p. paclitaxel, or (iii) i.p. carboplatin plus i.v./i.p. paclitaxel. The primary end point was 9-month progressive disease rate (PD9). Secondary end points included progression-free survival (PFS), overall survival (OS), toxicity, and quality of life (QOL). Results Between 2009 and 2015, 275 patients were randomized; i.p. cisplatin containing arm did not progress beyond the first stage of the study after failing to meet the pre-set superiority rule. The final analysis compared i.v. carboplatin/paclitaxel (n = 101) with i.p. carboplatin, i.v./i.p. paclitaxel (n = 102). The intention to treat PD9 was lower in the i.p. carboplatin arm compared with the i.v. carboplatin arm: 24.5% (95% CI 16.2% to 32.9%) versus 38.6% (95% CI 29.1% to 48.1%) P = 0.065. The study was underpowered to detect differences in PFS: HR PFS 0.82 (95% CI 0.57-1.17); P = 0.27 and OS HR 0.80 (95% CI 0.47-1.35) P = 0.40. The i.p. carboplatin-based regimen was well tolerated with no reduction in QOL or increase in toxicity compared with i.v. administration alone. Conclusion In women with stage IIIC or IVA EOC treated with NACT and optimal debulking surgery, i.p. carboplatin-based chemotherapy is well tolerated and associated with an improved PD9 compared with i.v. carboplatin-based chemotherapy. Clinical trial number clinicaltrials.gov, NCT01622543.
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Affiliation(s)
- D M Provencher
- Institut du Cancer de Montréal, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Canada
| | | | - W R Parulekar
- Canadian Cancer Trials Group (CCTG), Queen's University, Kingston, Canada
| | - J A Ledermann
- University College London Cancer Institute, London, UK
| | - D K Armstrong
- Johns Hopkins University School of Medicine, Baltimore, USA
| | - M Brundage
- Cancer Centre of Southeastern Ontario, Kingston, Canada
| | - C Gourley
- Edinburgh Cancer Research UK Centre, MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - I Romero
- Secretaria del Área Clínica de Oncología Ginecológica, Instituto Valenciano de Oncología, València
| | | | - M Feeney
- University College London Cancer Institute, London, UK
| | - P Bessette
- Gynecologic Oncology Division, Centre Hospitalier de l'Université de Montréal, Sherbrooke, Canada
| | - M Hall
- Department of Obstetrics and Gynaecology, Mount Vernon Cancer Centre, Northwood, UK
| | - J I Weberpals
- Division of Gynaecologic Oncology, The Ottawa Hospital, Ottawa, Canada
| | - G Hall
- Leeds Institute of Cancer and Pathology, St James's University Hospital, Leeds, UK
| | - S K Lau
- Division of Gynecologic Oncology, Segal Cancer Center, SMBD Jewish General Hospital, McGill University, Montréal, Canada
| | - P Gauthier
- Gynecologic Oncology Division, Centre Hospitalier de l'Université de Montréal, Sherbrooke, Canada
| | - M Fung-Kee-Fung
- Division of Gynaecologic Oncology, The Ottawa Hospital, Ottawa, Canada
| | - E A Eisenhauer
- Canadian Cancer Trials Group (CCTG), Queen's University, Kingston, Canada
| | - C Winch
- Canadian Cancer Trials Group (CCTG), Queen's University, Kingston, Canada
| | - D Tu
- Canadian Cancer Trials Group (CCTG), Queen's University, Kingston, Canada
| | - H J MacKay
- Division of Medical Oncology & Hematology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada.
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Li H, Hu K, Gao S, Tu D, You J, Gao X. Oxymatrine suppresses MOVAS proliferation induced by platelet-derived growth factor via G0/G1 arrest. Biomed Res 2018. [DOI: 10.4066/biomedicalresearch.29-17-2929] [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: 11/09/2022]
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21
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Juergens R, Hao D, Laurie S, Ellis P, Mates M, Bradbury P, Tehfe M, Kollmannsberger C, Arnold A, Goffin J, Wheatley-Price P, Hilton J, Robinson A, Tu D, Brown-Walker P, Seymour L. MA 10.01 Durvalumab ± Tremelimumab with Platinum-Doublets in Non-Small Cell Lung Cancer: Canadian Cancer Trials Group Study IND.226. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.533] [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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22
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Bernstein V, Ellard SL, Dent SF, Tu D, Mates M, Dhesy-Thind SK, Panasci L, Gelmon KA, Salim M, Song X, Clemons M, Ksienski D, Verma S, Simmons C, Lui H, Chi K, Feilotter H, Hagerman LJ, Seymour L. A randomized phase II study of weekly paclitaxel with or without pelareorep in patients with metastatic breast cancer: final analysis of Canadian Cancer Trials Group IND.213. Breast Cancer Res Treat 2017; 167:485-493. [PMID: 29027598 DOI: 10.1007/s10549-017-4538-4] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 10/10/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Pelareorep, a serotype 3 reovirus, has demonstrated preclinical and early clinical activity in breast cancer and synergistic cytotoxic activity with microtubule targeting agents. This multicentre, randomized, phase II trial was undertaken to evaluate the efficacy and safety of adding pelareorep to paclitaxel for patients with metastatic breast cancer (mBC). METHODS Following a safety run-in of 7 patients, 74 women with previously treated mBC were randomized either to paclitaxel 80 mg/m2 intravenously on days 1, 8, and 15 every 4 weeks plus pelareorep 3 × 1010 TCID50 intravenously on days 1, 2, 8, 9, 15, and 16 every 4 weeks (Arm A) or to paclitaxel alone (Arm B). Primary endpoint was progression-free survival (PFS). Secondary endpoints were objective response rate, overall survival (OS), circulating tumour cell counts, safety, and exploratory correlative analyses. All comparisons used a two-sided test at an alpha level of 20%. Survival analyses were adjusted for prior paclitaxel. RESULTS Final analysis was performed after a median follow-up of 29.5 months. Pelareorep was well tolerated. Patients in Arm A had more favourable baseline prognostic variables. Median adjusted PFS (Arm A vs B) was 3.78 mo vs 3.38 mo (HR 1.04, 80% CI 0.76-1.43, P = 0.87). There was no difference in response rate between arms (P = 0.87). Median OS (Arm A vs B) was 17.4 mo vs 10.4 mo (HR 0.65, 80% CI 0.46-0.91, P = 0.1). CONCLUSIONS This first, phase II, randomized study of pelareorep and paclitaxel in previously treated mBC did not show a difference in PFS (the primary endpoint) or RR. However, there was a significantly longer OS for the combination. Further exploration of this regimen in mBC may be of interest.
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Affiliation(s)
- V Bernstein
- BC Cancer Agency, Victoria, BC, V8R 6V5, Canada.
| | | | - S F Dent
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - D Tu
- Canadian Cancer Trials Group, Kingston, ON, Canada
| | - M Mates
- Cancer Centre of Southeastern Ontario, Kingston, ON, Canada
| | | | - L Panasci
- Jewish General Hospital, Montreal, QC, Canada
| | | | - M Salim
- Allan Blair Cancer Centre, Regina, SK, Canada
| | - X Song
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - M Clemons
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - D Ksienski
- BC Cancer Agency, Victoria, BC, V8R 6V5, Canada
| | - S Verma
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - C Simmons
- BC Cancer Agency, Vancouver, BC, Canada
| | - H Lui
- Canadian Cancer Trials Group, Kingston, ON, Canada
| | - K Chi
- BC Cancer Agency, Vancouver, BC, Canada
| | | | - L J Hagerman
- Canadian Cancer Trials Group, Kingston, ON, Canada
| | - L Seymour
- Canadian Cancer Trials Group, Kingston, ON, Canada
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23
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Zhai SL, Zhou X, Lin T, Zhang H, Wen XH, Zhou XR, Jia CL, Tu D, Zhu XL, Chen QL, Wei WK, Lv DH. Reappearance of buffalo-origin-like porcine circovirus type 2 strains in swine herds in southern China. New Microbes New Infect 2017; 17:98-100. [PMID: 28417007 PMCID: PMC5388935 DOI: 10.1016/j.nmni.2017.02.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 12/23/2016] [Revised: 02/10/2017] [Accepted: 02/28/2017] [Indexed: 12/20/2022] Open
Abstract
Previously, we identified three porcine circovirus type 2 (PCV2) strains in buffalo meat samples from southern China. In this study, we confirmed the reappearance of those buffalo-origin-like PCV2 strains in swine herds in this region, which supported the possible cross-species infection of PCV2 between buffalos and pigs under field conditions.
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Affiliation(s)
- S-L Zhai
- Guangdong Key Laboratory of Animal Disease Prevention, Animal Disease Diagnostic Center, Institute of Animal Health, Guangdong Academy of Agricultural Sciences, Guangzhou, China
| | - X Zhou
- Guangdong Key Laboratory of Animal Disease Prevention, Animal Disease Diagnostic Center, Institute of Animal Health, Guangdong Academy of Agricultural Sciences, Guangzhou, China.,College of Veterinary Medicine, South China Agricultural University, Guangzhou, China
| | - T Lin
- Department of Chemistry and Biochemistry, South Dakota State University, Brookings, SD, USA
| | - H Zhang
- Guangdong Key Laboratory of Animal Disease Prevention, Animal Disease Diagnostic Center, Institute of Animal Health, Guangdong Academy of Agricultural Sciences, Guangzhou, China.,College of Veterinary Medicine, South China Agricultural University, Guangzhou, China
| | - X-H Wen
- Guangdong Key Laboratory of Animal Disease Prevention, Animal Disease Diagnostic Center, Institute of Animal Health, Guangdong Academy of Agricultural Sciences, Guangzhou, China
| | - X-R Zhou
- Guangdong Key Laboratory of Animal Disease Prevention, Animal Disease Diagnostic Center, Institute of Animal Health, Guangdong Academy of Agricultural Sciences, Guangzhou, China
| | - C-L Jia
- Guangdong Key Laboratory of Animal Disease Prevention, Animal Disease Diagnostic Center, Institute of Animal Health, Guangdong Academy of Agricultural Sciences, Guangzhou, China
| | - D Tu
- Guangdong Key Laboratory of Animal Disease Prevention, Animal Disease Diagnostic Center, Institute of Animal Health, Guangdong Academy of Agricultural Sciences, Guangzhou, China
| | - X-L Zhu
- Guangdong Key Laboratory of Animal Disease Prevention, Animal Disease Diagnostic Center, Institute of Animal Health, Guangdong Academy of Agricultural Sciences, Guangzhou, China
| | - Q-L Chen
- Guangdong Key Laboratory of Animal Disease Prevention, Animal Disease Diagnostic Center, Institute of Animal Health, Guangdong Academy of Agricultural Sciences, Guangzhou, China
| | - W-K Wei
- Guangdong Key Laboratory of Animal Disease Prevention, Animal Disease Diagnostic Center, Institute of Animal Health, Guangdong Academy of Agricultural Sciences, Guangzhou, China
| | - D-H Lv
- Guangdong Key Laboratory of Animal Disease Prevention, Animal Disease Diagnostic Center, Institute of Animal Health, Guangdong Academy of Agricultural Sciences, Guangzhou, China
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24
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Tinker A, Hirte H, Provencher D, Butler M, Ritter H, Tu D, Paralejas P, Grenier N, Hahn S, Ramsahai J, Seymour L. Dose ranging study of monalizumab (IPH2201) in patients with gynecologic malignancies: A trial of the Canadian Cancer Trials Group (CCTG): IND221. Eur J Cancer 2016. [DOI: 10.1016/s0959-8049(16)32889-1] [Citation(s) in RCA: 2] [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: 11/25/2022]
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25
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Morgen EK, Lenz HJ, Jonker DJ, Tu D, Milano G, Graziano F, Zalcberg J, Karapetis CS, Dobrovic A, O'Callaghan CJ, Liu G. Germline polymorphisms as biomarkers of tumor response in colorectal cancer patients treated with anti-EGFR monoclonal antibodies: a systematic review and meta-analysis. Pharmacogenomics J 2016; 17:535-542. [PMID: 27897268 PMCID: PMC9536193 DOI: 10.1038/tpj.2016.56] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 05/23/2016] [Accepted: 06/15/2016] [Indexed: 02/06/2023]
Abstract
Studies of germline polymorphisms as predictors of tumor response to anti-epidermal growth factor receptor (EGFR) monoclonal antibody agents in metastatic colorectal cancer have reported inconsistent results. We performed a systematic review of studies from 1990 to September 2015, followed by random-effects meta-analyses for polymorphisms examined in at least three studies. Of 87 studies, 40 passed the criteria for systematic review and 23 for meta-analysis. The polymorphisms suitable for meta-analysis were CCND1 (rs17852153), COX2 (rs20417), EGF (rs4444903), EGFR (rs712829, rs11543848, 3'UTR CA repeat), FCGR2A (rs1801274), FCGR3A (rs396991), IL8 (rs4073), KRAS (rs61764370) and VEGFA (rs3025039). Meta-analysis yielded nominal significance (at α=0.05) for rs4444903 and rs11543848, but showed no significant results after multiple testing correction; this was unchanged by sensitivity analyses to address subgroups, funnel-plot asymmetries, and study quality. This highlights a tendency for lack of replication in the face of initial positive results, and possibly the unsuitability of relying on tumor response as a surrogate marker in this setting.
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Affiliation(s)
- E K Morgen
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada.,Department of Pathobiology and Laboratory Medicine, University of Toronto, Toronto, Ontario, Canada
| | - H-J Lenz
- USC/Norris Comprehensive Cancer Center, Los Angeles, CA, USA
| | - D J Jonker
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - D Tu
- Canadian Cancer Trials Group, Queen's University, Kingston, Ontario, Canada
| | - G Milano
- Laboratoire d'Oncopharmacologie EA 3836, Centre Antoine Lacassagne, Nice, France
| | - F Graziano
- Division of Medical Oncology, Azienda "Ospedali Riuniti Marche Nord", Pesaro, Italy
| | - J Zalcberg
- Cancer Research Program, School of Public Health and Preventive Medicine, Faculty of Medicine, Monash University, Melbourne, Victoria, Australia
| | - C S Karapetis
- Flinders University and Flinders Medical Centre, Adelaide, South Australia, Australia
| | - A Dobrovic
- Translational Genomics and Epigenomics Laboratory, Olivia Newton-John Cancer Research Institute, Heidelberg, Victoria, Australia.,School of Cancer Medicine, La Trobe University, Bundoora, Victoria, Australia.,Department of Pathology, University of Melbourne, Parkville, Victoria, Australia
| | - C J O'Callaghan
- Canadian Cancer Trials Group, Queen's University, Kingston, Ontario, Canada
| | - G Liu
- Departments of Medicine and Medical Biophysics, University of Toronto, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Au JK, Tan X, Sidani M, Stanasel I, Roth DR, Koh CJ, Seth A, Gargollo PC, Tu D, Gonzales ET, Smith TG, Janzen N. Imaging characteristics associated with failure of nonoperative management in high-grade pediatric blunt renal trauma. J Pediatr Urol 2016; 12:294.e1-294.e6. [PMID: 27160977 DOI: 10.1016/j.jpurol.2016.02.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 02/28/2016] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Some children who sustain high-grade blunt renal injury may require operative intervention. In the present study, it was hypothesized that there are computed tomography (CT) characteristics that can identify which of these children are most likely to need operative intervention. MATERIALS AND METHODS A retrospective review was performed of all pediatric blunt renal trauma patients at a single level-I trauma center from 1990 to 2015. Inclusion criteria were: children with American Association for the Surgery of Trauma (AAST) Grade-IV or V renal injuries, aged ≤18 years, and having available CT images with delayed cuts. The CTs were regraded according to the revised AAST grading system proposed by Buckley and McAninch in 2011. Radiographic characteristics of renal injury were correlated with the primary outcome of any operative intervention: ureteral stent, angiography, nephrectomy/renorrhaphy, and percutaneous nephrostomy/drain. RESULTS One patient had a Grade-V injury and 26 patients had Grade-IV injuries. Nine patients (33.3%) underwent operative interventions. Patients in the operative intervention cohort were more likely to manifest a collecting system filling defect (P = 0.040) (Fig. A) and lacked ureteral opacification (P = 0.010). The CT characteristics, including percentage of devascularized parenchyma, medial contrast extravasation, intravascular contrast extravasation, perirenal hematoma distance and laceration location, were not statistically significant. Of the 21 patients who had a collecting system injury, eight (38.1%) needed ureteral stents. Renorrhaphy was necessary for one patient. Although the first operative intervention occurred at a median of hospital day 1 (range 0.5-2.5), additional operative interventions occurred from day 4-16. Thus, it is prudent to closely follow-up these patients for the first month after injury. Two patients with complex renal injuries had an accessory renal artery resulting in well-perfused upper and lower pole fragments, and were managed nonoperatively without readmission (Fig. B). CONCLUSIONS Collecting system defects and lack of ureteral opacification were significantly associated with failure of nonoperative management. A multicenter trial is needed to confirm these findings and whether nonsignificant CT findings are associated with operative intervention. In the month after renal injury, these patients should be mindful of any changes in symptoms, and maintain a low index of suspicion for an emergency room visit. For the physician, close follow-up and appropriate counseling of these high-risk patients is advised.
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Affiliation(s)
- J K Au
- Baylor College of Medicine, Division of Pediatric Urology and Texas Children's Hospital, Clinical Care Center, 6701 Fannin Street, 6th Floor, Houston, TX 77030, USA.
| | - X Tan
- Department of Urology, Baylor College of Medicine, 7200 Cambridge Street, 10th Floor, Suite A10.136, Houston, TX 77030, USA
| | - M Sidani
- Department of Urology, Baylor College of Medicine, 7200 Cambridge Street, 10th Floor, Suite A10.136, Houston, TX 77030, USA
| | - I Stanasel
- Baylor College of Medicine, Division of Pediatric Urology and Texas Children's Hospital, Clinical Care Center, 6701 Fannin Street, 6th Floor, Houston, TX 77030, USA
| | - D R Roth
- Baylor College of Medicine, Division of Pediatric Urology and Texas Children's Hospital, Clinical Care Center, 6701 Fannin Street, 6th Floor, Houston, TX 77030, USA
| | - C J Koh
- Baylor College of Medicine, Division of Pediatric Urology and Texas Children's Hospital, Clinical Care Center, 6701 Fannin Street, 6th Floor, Houston, TX 77030, USA
| | - A Seth
- Baylor College of Medicine, Division of Pediatric Urology and Texas Children's Hospital, Clinical Care Center, 6701 Fannin Street, 6th Floor, Houston, TX 77030, USA
| | - P C Gargollo
- Department of Urology, 200 1st St SW, Rochester, MN 55902, USA
| | - D Tu
- Baylor College of Medicine, Division of Pediatric Urology and Texas Children's Hospital, Clinical Care Center, 6701 Fannin Street, 6th Floor, Houston, TX 77030, USA
| | - E T Gonzales
- Baylor College of Medicine, Division of Pediatric Urology and Texas Children's Hospital, Clinical Care Center, 6701 Fannin Street, 6th Floor, Houston, TX 77030, USA
| | - T G Smith
- Department of Urology, Baylor College of Medicine, 7200 Cambridge Street, 10th Floor, Suite A10.136, Houston, TX 77030, USA
| | - N Janzen
- Baylor College of Medicine, Division of Pediatric Urology and Texas Children's Hospital, Clinical Care Center, 6701 Fannin Street, 6th Floor, Houston, TX 77030, USA
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27
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Jonker D, Nott L, Yoshino T, Gill S, Shapiro J, Ohtsu A, Zalcberg J, Vickers M, Wei A, Gao Y, Tebbutt N, Markman B, Esaki T, Koski S, Hitron M, Magoski N, Simes J, Li C, Tu D, O'Callaghan C. A randomized phase III study of napabucasin [BBI608] (NAPA) vs placebo (PBO) in patients (pts) with pretreated advanced colorectal cancer (ACRC): the CCTG/AGITG CO.23 trial. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw370.03] [Citation(s) in RCA: 6] [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: 11/13/2022] Open
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28
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Diakos C, Tu D, Gebski V, Yip S, Wilson K, Karapetis C, O'Callaghan C, Shapiro J, Tebbutt N, Jonker D, Siu L, Wong R, Doyle C, Strickland A, Price T, Simes J, Clarke S. Is the derived neutrophil to lymphocyte ratio (dNLR) an independent prognostic marker in patients with metastatic colorectal cancer (mCRC)? Analysis of the CO.17 and CO.20 studies. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw370.136] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
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29
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Vickers MM, Lee C, Tu D, Wheatley-Price P, Parulekar W, Brundage MD, Moore MJ, Au H, O'Callaghan CJ, Jonker DJ, Ringash J, Goldstein D. Significance of baseline and change in quality of life scores in predicting clinical outcomes in an international phase III trial of advanced pancreatic cancer: NCIC CTG PA.3. Pancreatology 2016; 16:1106-1112. [PMID: 27600995 DOI: 10.1016/j.pan.2016.08.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 08/29/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND There is insufficient information regarding the prognostic significance of baseline and change in quality of life (QoL) scores on overall survival (OS) in advanced pancreatic cancer. METHODS QoL was assessed prospectively using the EORTC QLQ-C30 as part of the PA.3 trial of gemcitabine + erlotinib (G + E) vs. gemcitabine + placebo (G + P). Relevant variables and QoL scores at baseline and change at 8 weeks were analyzed by Cox stepwise regression to determine predictors of OS. RESULTS 222 of 285 patients (pts) treated with G + E and 220 of 284 pts treated with G + P completed baseline QoL assessments. In a multivariable Cox analysis combining all pts, better QoL physical functioning (PF) score independently predicted longer OS (HR 0.86; CI: 0.80-0.93), as did non-white race (HR 0.64; CI: 0.44-0.95), PS 0-1 (HR 0.65; CI: 0.50-0.85), locally advanced disease (HR 0.55; CI: 0.43-0.71) and G + E (HR 0.78; CI: 0.64-0.96). Improvement in physical function at week 8 also predicted for improved survival (HR 0.89; CI: 0.81-0.97 for 10 point increase in score, p = 0.02). CONCLUSION In addition to clinical variables, patient reported QoL scores at baseline and change from baseline to week 8 added incremental predictive information regarding survival for advanced pancreatic cancer patients.
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Affiliation(s)
- M M Vickers
- The Ottawa Hospital Cancer Center, Ottawa, ON, Canada.
| | - C Lee
- NHMRC Clinical Trials Centre, The University of Sydney, Camperdown, NSW, Australia
| | - D Tu
- NCIC Clinical Trials Group, Queen's University, Kingston, ON, Canada
| | | | - W Parulekar
- NCIC Clinical Trials Group, Queen's University, Kingston, ON, Canada
| | | | - M J Moore
- BC Cancer Agency, Vancouver, BC, Canada
| | - H Au
- NCIC Clinical Trials Group, Queen's University, Kingston, ON, Canada
| | - C J O'Callaghan
- NCIC Clinical Trials Group, Queen's University, Kingston, ON, Canada
| | - D J Jonker
- The Ottawa Hospital Cancer Center, Ottawa, ON, Canada
| | - J Ringash
- Princess Margaret Cancer Centre and the University of Toronto, Toronto, ON, Canada
| | - D Goldstein
- Prince of Wales Hospital, Randwick, NSW, Australia
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Liedke PER, Tu D, Shepherd L, Chavarri-Guerra Y, Pritchard KI, Stearns V, Goss PE. New onset vasomotor symptoms but not musculoskeletal symptoms associate with clinical outcomes on extended adjuvant letrozole - Analyses from NCIC CTG MA.17. Breast 2016; 27:99-104. [PMID: 27058233 DOI: 10.1016/j.breast.2016.02.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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: 10/02/2015] [Revised: 01/14/2016] [Accepted: 02/22/2016] [Indexed: 11/30/2022] Open
Abstract
PURPOSE New onset symptoms on adjuvant aromatase inhibitors for hormone receptor positive early breast cancer may associate with clinical outcomes. We performed this exploratory analysis of the association of new onset musculoskeletal (MSK) and vasomotor (VM) symptoms with clinical outcomes in the NCIC CTG MA.17 trial 5 years of extended adjuvant endocrine therapy with letrozole after tamoxifen. METHODS Symptoms were collected at baseline, 1, 6, and every 12 months on study. Multivariate Cox Models adjusting for age, nodal status, duration of tamoxifen and prior chemotherapy were used to compare disease-free survival (DFS), distant disease-free survival (DDFS), and overall survival (OS) based on data collected before, and after, the unblinding between women with VM or MSK symptoms and those without. RESULTS Data post-unblinding showed new VM symptoms on extended letrozole significantly improved DFS and DDFS when occurring 1 month (DFS HR 0.52, 95% CI, 0.28-0.96; p = 0.04; DDFS HR 0.49, 95% CI, 0.24-0.99; p = 0.046) and 6 months (DFS HR 0.43, 95% CI, 0.24-0.78; p = 0.006; DDFS HR 0.44, 95% CI, 0.22-0.85; p = 0.02) after treatment initiation. Those with new VM symptoms at 12 months also had a significantly better DFS (HR 0.47, 95% CI 0.26, 0.84; P = 0.01) and a trend in improved DDFS. Only a trend to improved OS was found for those with VM symptoms 6 month after treatment. No significant improvement was found for those with new MSK symptoms at any time point or for any endpoint. CONCLUSIONS New onset VM symptoms with extended letrozole may be useful in predicting treatment benefit.
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Affiliation(s)
- P E R Liedke
- Department of Clinical Oncology, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil; Mãe de Deus Cancer Institute, Hospital Mãe de Deus, Porto Alegre, RS, Brazil; Brazilian Breast Cancer Study Group, Porto Alegre, RS, Brazil; Massachusetts General Hospital Cancer Center, Avon International Breast Cancer Research Program, Boston, MA, USA
| | - D Tu
- Canadian Cancer Trials Group, Queen's University, Ontario, Canada
| | - L Shepherd
- Canadian Cancer Trials Group, Queen's University, Ontario, Canada
| | - Y Chavarri-Guerra
- Department of Hematology-Oncology, Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán, Mexico; Massachusetts General Hospital Cancer Center, Avon International Breast Cancer Research Program, Boston, MA, USA
| | - K I Pritchard
- Canadian Cancer Trials Group, Queen's University, Ontario, Canada; Sunnybrook Odette Cancer Center, University of Toronto, Toronto, ON, Canada
| | - V Stearns
- Kimmel Cancer Center at Johns Hopkins, Breast Cancer Program, Baltimore, MD, USA
| | - P E Goss
- Canadian Cancer Trials Group, Queen's University, Ontario, Canada; Massachusetts General Hospital Cancer Center, Avon International Breast Cancer Research Program, Boston, MA, USA
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Weberpals JI, Amin MS, Chen BE, Tu D, Spaans JN, Squire JA, Eisenhauer EA, Virk S, Ma D, Duciaume M, Hoskins P, LeBrun DP. First application of the Automated QUantitative Analysis (AQUA) technique to quantify PTEN protein expression in ovarian cancer: A correlative study of NCIC CTG OV.16. Gynecol Oncol 2016; 140:486-93. [PMID: 26775196 DOI: 10.1016/j.ygyno.2016.01.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 12/04/2015] [Revised: 01/09/2016] [Accepted: 01/11/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Platinum resistance is a dominant cause of poor outcomes in advanced ovarian cancer (OC). A mechanism of platinum resistance is the inhibition of apoptosis through phosphatidylinositol 3 kinase (PI3K) pathway activation. The role of phosphatase and tensin homolog (PTEN), a negative regulator of this pathway, as a tumor biomarker is unclear. Quantitative analysis of PTEN expression as an alternative to immunohistochemistry has not been considered. PATIENTS AND METHODS In 238 patient tumors from the NCIC-CTG trial OV.16, PTEN protein expression was quantified by Automated QUantitative Analysis (AQUA). Cox model was used to study the association between PTEN expression and clinical outcomes using a minimum p-value approach in univariate analysis. Multivariate analysis was used to adjust for clinical and pathological parameters. RESULTS PTEN scores (range 13.9-192.3) of the 202 samples that passed quality control were analyzed. In univariate analysis, there was a trend suggesting an association between PTEN expression by AQUA as a binary variable (low ≤61 vs high >61) and progression free survival (HR=0.77, p=0.083), and in multivariate analysis, this association approached significance (HR=0.74, p=0.059). The relationship between quantitative PTEN expression and PFS differed (p=0.01 for interaction) by the extent of surgical debulking (residual disease (RD) <1cm or ≥1cm), with a numerically superior PFS in patients with high PTEN (23.5 vs 14.9m) only when RD<1cm (p=0.19). There was no association between PTEN levels and overall survival. CONCLUSIONS AQUA is a novel method to measure PTEN expression. Further study of PTEN as a biomarker in OC is warranted.
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Affiliation(s)
- J I Weberpals
- Centre for Cancer Therapeutics, Ottawa Hospital Research Institute, Canada; Division of Gynecologic Oncology, The Ottawa Hospital, Ottawa, Ontario, Canada.
| | - M S Amin
- Department of Laboratory Medicine, Mayo Clinic, Rochester, MN, USA
| | - B E Chen
- NCIC-CTG, Kingston, Ontario, Canada
| | - D Tu
- NCIC-CTG, Kingston, Ontario, Canada
| | - J N Spaans
- Centre for Cancer Therapeutics, Ottawa Hospital Research Institute, Canada
| | - J A Squire
- Department of Pathology and Forensic Medicine, Ribeirão Preto Medical School, University of Sao Paulo, Ribeirão Preto, Brazil
| | - E A Eisenhauer
- NCIC-CTG, Kingston, Ontario, Canada; Department of Oncology, Queen's University, Kingston, Ontario, Canada
| | - S Virk
- NCIC-CTG, Kingston, Ontario, Canada; Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ontario, Canada
| | - D Ma
- Department of Mathematics and Statistics, Queen's University, Kingston, Ontario, Canada
| | - M Duciaume
- Centre for Cancer Therapeutics, Ottawa Hospital Research Institute, Canada
| | - P Hoskins
- BC Cancer Centre, Vancouver, British Columbia, Canada
| | - D P LeBrun
- Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ontario, Canada
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32
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Brulé SY, Jonker DJ, Karapetis CS, O'Callaghan CJ, Moore MJ, Wong R, Tebbutt NC, Underhill C, Yip D, Zalcberg JR, Tu D, Goodwin RA. Location of colon cancer (right-sided versus left-sided) as a prognostic factor and a predictor of benefit from cetuximab in NCIC CO.17. Eur J Cancer 2015; 51:1405-14. [PMID: 25979833 DOI: 10.1016/j.ejca.2015.03.015] [Citation(s) in RCA: 237] [Impact Index Per Article: 26.3] [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: 11/12/2014] [Revised: 03/10/2015] [Accepted: 03/14/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND Right- and left-sided colon cancers (RC, LC) differ with respect to biology, pathology and epidemiology. Previous data suggest a mortality difference between RC and LC. We examined if primary tumour side also predicts for outcome in chemotherapy refractory, metastatic colon cancer (MCC). We also compared RC versus LC as a predictor of efficacy of epidermal growth factor receptor (EGFR) inhibition with cetuximab. METHODS Reanalyzing NCIC CO.17 trial (cetuximab versus best supportive care [BSC]), we coded the primary tumour side as RC (caecum to transverse colon) or LC (splenic flexure to rectosigmoid). The association between tumour side and baseline characteristics was assessed. Cox regression models determined factors affecting overall survival (OS) and progression free survival (PFS). RESULTS Patients with RC (150/399) had more poorly differentiated, mutant KRAS, mutated PIK3CA and wild-type BRAF tumours, fewer liver and lung metastases, and shorter interval between diagnosis and study entry. Among BSC patients, tumour side was not prognostic for PFS (hazard ratios (HR) 1.07 [0.79-1.44], p = 0.67) or OS (HR 0.96 [0.70-1.31], p = 0.78). Among wild-type KRAS patients, those with LC had significantly improved PFS when treated with cetuximab compared to BSC (median 5.4 versus 1.8 months, HR 0.28 [0.18-0.45], p < 0.0001), whereas those with RC did not (median 1.9 versus 1.9 months, HR 0.73 [0.42-1.27], p = 0.26), [interaction p = 0.002]. CONCLUSION In refractory MCC, tumour location within the colon is not prognostic, but is strongly predictive of PFS benefit from cetuximab therapy. Additional research is needed to understand the molecular differences between RC and LC and their interaction with EGFR inhibition.
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Affiliation(s)
- S Y Brulé
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada
| | - D J Jonker
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada; NCIC Clinical Trials Group, Kingston, Canada
| | - C S Karapetis
- Flinders Medical Centre and Flinders Centre for Innovation in Cancer, Flinders University, Adelaide, Australia
| | | | - M J Moore
- Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Canada
| | - R Wong
- CancerCare Manitoba, Winnipeg, MB, Canada
| | - N C Tebbutt
- Austin Health and University of Melbourne, Heidelberg, Australia
| | | | - D Yip
- Canberra and Calvary Hospitals, Canberra, Australia
| | - J R Zalcberg
- Division of Cancer Medicine, Peter McCallum Cancer Centre, Melbourne, Australia
| | - D Tu
- NCIC Clinical Trials Group, Kingston, Canada
| | - R A Goodwin
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada.
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Jamal R, Goodwin RA, Tu D, Walsh W, Lacombe D, Eisenhauer EA. Performance of multinomial designs in comparison with response-based designs in non-randomized phase II trials of targeted cancer agents. Ann Oncol 2013; 24:1936-1942. [PMID: 23553058 DOI: 10.1093/annonc/mdt122] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND In phase II trials of cytotoxic agents, a multinomial phase II design incorporating early progression and response end points was shown to perform more efficiently than designs based only on response. We undertook a study to evaluate the performance of these designs in trials of targeted agents using the actual phase II data. PATIENTS AND METHODS Using best response data from sequentially enrolled patients in 15 NCIC Clinical Trials Group and 7 European Organization for Research and Treatment of Cancer trials of targeted agents, we determined that trials would have been stopped at the end of stage I of accrual by applying rules generated by the multinomial and Fleming designs. Two variants of the multinomial design were studied: to stop accrual after stage I of enrolment, Variant A required either response or progression criteria to be met, whereas Variant B required that both response and progression criteria to be met. RESULTS Using early progression, null/alternate hypotheses of 60% and 40% (60/40), the multinomial A variant recommended early stopping more often than the Fleming design. In most of the cases, this recommendation was correct given the final trial outcome. In contrast, the multinomial B variant never led to recommendations for early stopping and changing progression hypotheses did not improve the performance of this design. CONCLUSIONS The multinomial A design using 60/40 hypotheses carried out better than the Fleming design in appropriately stopping trials of inactive targeted agents early. The multinomial B design was not useful for early stopping decisions. The multinomial A design may be favored over response-based designs in phase II trials of targeted agents.
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Affiliation(s)
- R Jamal
- Department of Hematology-Oncology, Notre-Dame Hospital, CHUM, University of Montreal, Montreal.
| | - R A Goodwin
- General Division, Ottawa Health Research Institute, Ottawa
| | - D Tu
- NCIC Clinical Trials Group, Queen's University, Kingston, Canada
| | - W Walsh
- NCIC Clinical Trials Group, Queen's University, Kingston, Canada
| | - D Lacombe
- European Organization for Research and Treatment of Cancer, Brussels, Belgium
| | - E A Eisenhauer
- Department of Oncology, Kingston General Hospital, Queen's University Cancer Centre of Southeastern Ontario, Kingston, Canada
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Tinker AV, Ellard S, Welch S, Moens F, Allo G, Tsao MS, Squire J, Tu D, Eisenhauer EA, MacKay H. Phase II study of temsirolimus (CCI-779) in women with recurrent, unresectable, locally advanced or metastatic carcinoma of the cervix. A trial of the NCIC Clinical Trials Group (NCIC CTG IND 199). Gynecol Oncol 2013; 130:269-74. [PMID: 23672928 DOI: 10.1016/j.ygyno.2013.05.008] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [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: 04/08/2013] [Revised: 05/03/2013] [Accepted: 05/04/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVE HPV infection has been associated with deregulation of the PI3K-Akt-mTOR pathway in invasive cervical carcinomas. This 2-stage phase II study assessed the activity of the mTOR inhibitor, temsirolimus, in patients with measurable metastatic and/or locally advanced, recurrent carcinoma of the cervix. METHODS Temsirolimus 25mg i.v. was administered weekly in 4 week cycles. One response among the first 18 patients was required to proceed to the second stage of accrual. Correlative molecular studies were performed on archival tumor tissue. RESULTS Thirty-eight patients were enrolled. Thirty-seven patients were evaluable for toxicity and 33 for response. One patient experienced a partial response (3.0%). Nineteen patients had stable disease (57.6%) [median duration 6.5 months (range 2.4-12.0mo)]. The 6-month progression free survival rate was 28% (95% CI: 14-43%). The median progression free survival was 3.52 months [95% CI (1.81-4.70)]. Adverse effects were mild-moderate in most cases and similar to other temsirolimus studies. No toxicity>grade 3 was observed. Assessment of PTEN and PIK3CA by IHC, copy number analyses and PTEN promoter methylation status did not reveal subsets associated with disease stability. CONCLUSION Single agent temsirolimus has modest activity in cervical carcinoma with about two-thirds of patients exhibiting stable disease. Molecular markers for treatment benefit remain to be identified.
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Affiliation(s)
- A V Tinker
- BC Cancer Agency, Vancouver Clinic, Vancouver, BC, Canada.
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Yan Y, Li X, Blanchard A, Bramwell VHC, Pritchard KI, Tu D, Shepherd L, Myal Y, Penner C, Watson PH, Leygue E, Murphy LC. Expression of both estrogen receptor-beta 1 (ER-β1) and its co-regulator steroid receptor RNA activator protein (SRAP) are predictive for benefit from tamoxifen therapy in patients with estrogen receptor-alpha (ER-α)-negative early breast cancer (EBC). Ann Oncol 2013; 24:1986-93. [PMID: 23579816 DOI: 10.1093/annonc/mdt132] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [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: 01/03/2023] Open
Abstract
BACKGROUND Roles of Estrogen Receptor-beta 1 (ER-β1) and its co-regulator Steroid Receptor RNA Activator Protein (SRAP) in breast cancer remain unclear. Previously, ER-β1 and SRAP expression were found positively correlated in breast cancer and, therefore, expression of these two molecules could characterize cancers with a distinct clinical outcome. PATIENTS AND METHODS ER-β1 and SRAP expression was determined by immunohistochemistry (IHC) in tissue microarrays from a randomized, placebo-controlled trial (NCIC-CTG-MA12), designed to determine the benefit of tamoxifen following chemotherapy in premenopausal early breast cancer (EBC). Expression was dichotomized into low and high using median IHC scores. Relationships with survival used Cox modeling. RESULTS In the whole cohort, ER-β1 and SRAP were not prognostic. However, high ER-β1 and SRAP significantly predicted tamoxifen responsiveness [overall survival, interaction test, P = 0.03; relapse-free survival (RFS), interaction test, P = 0.01]. Stratification by ER-α-status found predictive benefit only in ER-α-negative cases. The difference in RFS between tamoxifen and placebo was greater in patients whose tumors expressed both high SRAP and ER-β1[hazard ratio = 0.07; 95% confidence interval (CI) 0.01-0.41; P = 0.003] versus those with low SRAP or ER-β1 (interaction test, P = 0.02). The interaction test was not significant in ER-α-positive cohorts. CONCLUSIONS This study provides evidence that both ER-β1 and SRAP could be predictive biomarkers of tamoxifen benefit in ER-α-negative premenopausal EBC.
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Affiliation(s)
- Y Yan
- Department of Biochemistry and Medical Genetics, Manitoba Institute of Cell Biology, CancerCare Manitoba, University of Manitoba, Winnipeg, Canada
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Goss PE, Ingle JN, Martino S, Robert NJ, Muss HB, Livingston RB, Davidson NE, Perez EA, Chavarri-Guerra Y, Cameron DA, Pritchard KI, Whelan T, Shepherd LE, Tu D. Impact of premenopausal status at breast cancer diagnosis in women entered on the placebo-controlled NCIC CTG MA17 trial of extended adjuvant letrozole. Ann Oncol 2013; 24:355-361. [PMID: 23028039 PMCID: PMC3551482 DOI: 10.1093/annonc/mds330] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Revised: 07/10/2012] [Accepted: 07/11/2012] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND MA17 showed improved outcomes in postmenopausal women given extended letrozole (LET) after completing 5 years of adjuvant tamoxifen. PATIENTS AND METHODS Exploratory subgroup analyses of disease-free survival (DFS), distant DFS (DDFS), overall survival (OS), toxic effects and quality of life (QOL) in MA17 were performed based on menopausal status at breast cancer diagnosis. RESULTS At diagnosis, 877 women were premenopausal and 4289 were postmenopausal. Extended LET was significantly better than placebo (PLAC) in DFS for premenopausal [hazard ratio (HR) = 0.26, 95% confidence interval (CI) 0.13-0.55; P = 0.0003] and postmenopausal women (HR = 0.67; 95% CI 0.51-0.89; P = 0.006), with greater DFS benefit in those premenopausal (interaction P = 0.03). In adjusted post-unblinding analysis, those who switched from PLAC to LET improved DDFS in premenopausal (HR = 0.15; 95% CI 0.03-0.79; P = 0.02) and postmenopausal women (HR = 0.45; 95% CI 0.22-0.94; P = 0.03). CONCLUSIONS Extended LET after 5 years of tamoxifen was effective in pre- and postmenopausal women at diagnosis, and significantly better in those premenopausal. Women premenopausal at diagnosis should be considered for extended adjuvant therapy with LET if menopausal after completing tamoxifen.
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Affiliation(s)
- P E Goss
- Cancer Center, Massachusetts General Hospital, Boston.
| | - J N Ingle
- Division of Medical Oncology, Department of Oncology, Mayo Clinic, Rochester
| | - S Martino
- Breast Cancer Division, Los Angeles Clinic and Research Institute, Santa Monica
| | - N J Robert
- Virgina Cancer Specialists, Inova Fairfax Hospital, Virgina
| | - H B Muss
- Department of Medicine and Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill
| | | | - N E Davidson
- Cancer Institute and UPMC Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh
| | - E A Perez
- Mayo Clinic Cancer Center, Jacksonville, USA
| | | | - D A Cameron
- Edinburgh Breast Unit, Western General Hospital and, University of Edinburgh, Edinburgh, UK
| | - K I Pritchard
- Sunnybrook Odette Regional Cancer Centre, University of Toronto, Toronto
| | - T Whelan
- Department of Oncology, McMaster University, Hamilton
| | - L E Shepherd
- National Cancer Institute of Canada, Clinical Trials Group, Kingston, Canada
| | - D Tu
- National Cancer Institute of Canada, Clinical Trials Group, Kingston, Canada
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Vickers MM, Karapetis CS, Tu D, O'Callaghan CJ, Price TJ, Tebbutt NC, Van Hazel G, Shapiro JD, Pavlakis N, Gibbs P, Blondal J, Lee U, Meharchand JM, Burkes RL, Rubin SH, Simes J, Zalcberg JR, Moore MJ, Zhu L, Jonker DJ. Association of hypomagnesemia with inferior survival in a phase III, randomized study of cetuximab plus best supportive care versus best supportive care alone: NCIC CTG/AGITG CO.17. Ann Oncol 2012; 24:953-60. [PMID: 23144444 DOI: 10.1093/annonc/mds577] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Cetuximab-induced hypomagnesemia has been associated with improved clinical outcomes in advanced colorectal cancer (CRC). We explored this relationship from a randomized clinical trial of cetuximab plus best supportive care (BSC) versus BSC alone in patients with pretreated advanced CRC. PATIENTS AND METHODS Day 28 hypomagnesemia grade (0 versus ≥1) and percent reduction (<20% versus ≥20%) of Mg from baseline was correlated with outcome. RESULTS The median percentage Mg reduction at day 28 was 10% (-42.4% to 63.0%) for cetuximab (N = 260) versus 0% (-21.1% to 25%) for BSC (N = 251) [P < 0.0001]. Grade ≥1 hypomagnesemia and ≥20% reduction from baseline at day 28 were associated with worse overall survival (OS) [hazard ratio, HR 1.61 (95% CI 1.12-2.33), P = 0.01 and 2.08 (95% CI 1.32-3.29), P = 0.002, respectively] in multivariate analysis including grade of rash (0-1 versus 2+). Dyspnea (grade ≥3) was more common in patients with ≥20% versus < 20% Mg reduction (68% versus 45%; P = 0.02) and grade 3/4 anorexia were higher in patients with grade ≥1 hypomagnesemia (81% versus 63%; P = 0.02). CONCLUSIONS In contrast to prior reports, cetuximab-induced hypomagnesemia was associated with poor OS, even after adjustment for grade of rash.
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Affiliation(s)
- M M Vickers
- Department of Oncology, Tom Baker Cancer Centre, Calgary, Canada
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Gordon RM, Payne B, Firoz T, Magee L, Sawchuck D, Tu D, Vidler M, von Dadelszen P. PP164. Magnesium sulphate for prevention and treatment of eclampsia in low and middle income countries: Systematic review of tested regimens. Pregnancy Hypertens 2012; 2:328. [PMID: 26105485 DOI: 10.1016/j.preghy.2012.04.275] [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: 10/28/2022]
Abstract
INTRODUCTION Magnesium sulphate (MgSO4) is regarded as the most effective prophylactic and therapeutic agent for eclampsia. Although well studied and widely used in high income countries (HICs), MgSO4 is under utilized in low and middle income countries (LMICs) due to many factors including lack of adequately trained health care providers, supplies for administration, or the MgSO4 itself, in addition to fear of potential adverse effects. OBJECTIVES To systematically review the dosing and effectiveness of MgSO4 regimens administered in LMICs to women with pre-eclampsia or eclampsia. METHODS We searched Medline, EMBASE, IPA, CINAHL, CDSR and CENTRAL databases for English language randomized controlled trials (RCT) and observational studies of MgSO4 regimens administered in LMICs to women with pre-eclampsia or eclampsia. Two authors independently reviewed search results and extracted relevant data from eligible studies. No quality assessment was performed. RESULTS Twenty two papers (7 RCT and 15 observational studies) from 12 LMIC met our inclusion criteria, of which 21 were conducted in hospital settings. Two studied MgSO4 for eclampsia prevention ,14 for eclampsia treatment and 6 studied MgSO4 for both. In 20 studies, both loading and maintenance MgSO4 dosing was administered, with intravenous (IV) or combined IV and intramuscular (IM) loading doses of 4-15g and IV or IM maintenance doses up to 2g/h. Five studies used only the IV route of administration, while the remainder coupled IV with IM administration. All studies were effective at preventing the initiation and/or recurrence of eclamptic seizures. One study of 265 women with eclampsia found that MgSO4 loading dose administration in the community (4g IV over 20min plus 3g IM in each buttock) before referral and administration of maintenance therapy in hospital was more effective in decreasing recurrent eclampsia compared with the standard practice of referral to hospital where the initial dose of MgSO4 was administered [RR of 0.23, 95% CI 0.11, 0.49]. The two studies of 4g IV plus 10g IM loading dose-only regimens did not show a significant reduction in eclamptic seizures compared with identical loading dose plus 5g/4h IM maintenance dose regimens [RR of 1.38, 95% CI of 0.23, 8.45]. However the combined sample size was small (N=180 women). CONCLUSION In LMICs, most studies of MgSO4 for pre-eclampsia or eclampsia were conducted in high level health care facilities and administered MgSO4 by the IV route, at least in part. The one study of community administration of a MgSO4 loading dose showed this approach to be effective. There are limited data to support loading dose-only regimens.
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Affiliation(s)
- R M Gordon
- Obstetrics and Gynaecology, Vancouver, Canada
| | - B Payne
- Obstetrics and Gynaecology, Vancouver, Canada
| | - T Firoz
- Department of Medicine, The University of British Columbia, Vancouver, Canada
| | - L Magee
- Department of Medicine, The University of British Columbia, Vancouver, Canada; Department of Specialized Women's Health, British Columbia Women's Hospital & Health Centre, Vancouver, Canada; Child and Family Research Institute, Vancouver, Canada
| | - D Sawchuck
- Obstetrics and Gynaecology, Vancouver, Canada
| | - D Tu
- Child and Family Research Institute, Vancouver, Canada
| | - M Vidler
- Obstetrics and Gynaecology, Vancouver, Canada
| | - P von Dadelszen
- Obstetrics and Gynaecology, Vancouver, Canada; Child and Family Research Institute, Vancouver, Canada; Maternal and Fetal Medicine, British Columbia Women's Hospital & Health Centre, Vancouver, Canada
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Goss PE, Richardson H, Ingle JN, Chlebowski RT, Fabian CJ, Garber JE, Sarto GE, Hiltz A, Tu D, Cheung AM. P4-11-13: Influence of Two Years of Exemestane on Bone Mineral Density in Postmenopausal Women at Increased Risk of Developing Breast Cancer; a Companion Study to the NCIC CTG MAP.3 Trial. Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-p4-11-13] [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
Exemestane significantly reduced invasive and preinvasive breast cancers in postmenopausal women at increased risk for breast cancer in the NCIC CTG MAP3 trial with no serious toxicities, including excess fractures or osteoporosis.
Purpose: To provide additional information on the effect of exemestane on bone loss in women at high risk for breast cancer, within a subset of women participating on the NCIC CTG MAP.3B study. The primary hypothesis is that exemestane does not induce clinically significant bone loss in postmenopausal women at increased risk of developing breast cancer at 2 years. The primary objective of this companion study is to examine the effect of exemestane on lumbar spine and total hip BMD by DEXA at 2 years in women participating in the MAP3 trial.
Methods: The MAP.3B bone sub-study registered women from the main MAP. 3 trial from May 2008 to March 2010. Eligible women had to have an acceptable quality BMD scan by DEXA taken within 12 months prior to randomization to MAP.3. A BMD T-score >-2.0 SD (i.e. better than 2 standard deviations below the average peak BMD of a young adult woman) was established as the study population cutoff. A questionnaire including information on height, falls, fractures, lifestyle information including physical activity, tobacco and alcohol use was completed at baseline, 12 months, 24 months and at last visit. Fasting serum for bone biomarkers was collected at 12 months and total hip and L1-L4 (postero-anterior) spine BMD were measured 2 years after randomization on the same Lunar or Hologic scanner. The primary objective was to determine differences in hip and spine BMD at 2 years. Secondary outcomes include number of skeletal fractures and development of osteoporosis 2 years after randomization and changes in bone biomarkers at 1 year after randomization. For the analysis of the primary endpoints, the upper limit of a one sided 95% confidence interval for the difference in mean percentage changes between placebo and exemestane will be calculated for the BMD by DEXA at each site. We will conclude that exemestane does not induce significant bone loss in postmenopausal women at increased risk of developing breast cancer at 2 years when the upper limit is less than 3% for both sites. Similar confidence interval approach will be used to analyze the secondary endpoints.
Results: Between May 2008 and March 2010, 238 postmenopausal women were recruited. Median age was 61.8 years, and the majority of women were Caucasian (91%), with approximately 20% of the participants reporting a recent fall (within past 12 months) and another 13% reporting a recent fracture prior to randomization. We will report results from the primary as well as the secondary endpoints at the SABCS meeting.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P4-11-13.
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Affiliation(s)
- PE Goss
- 1Massachusetts General Hospital Cancer Center, Boston, MA; Queen's University, Kingston, ON, Canada; Mayo Clinic, Rochester, MN; Los Angeles Biomedical Research Institute, Torrance, CA; University of Kansas Medical Center, Westwood, KS; Dana Farber Cancer Institute, Boston, MA; Center for Women's Health and Health Research, Madison, WI; General Hospital, Toronto, ON, Canada
| | - H Richardson
- 1Massachusetts General Hospital Cancer Center, Boston, MA; Queen's University, Kingston, ON, Canada; Mayo Clinic, Rochester, MN; Los Angeles Biomedical Research Institute, Torrance, CA; University of Kansas Medical Center, Westwood, KS; Dana Farber Cancer Institute, Boston, MA; Center for Women's Health and Health Research, Madison, WI; General Hospital, Toronto, ON, Canada
| | - JN Ingle
- 1Massachusetts General Hospital Cancer Center, Boston, MA; Queen's University, Kingston, ON, Canada; Mayo Clinic, Rochester, MN; Los Angeles Biomedical Research Institute, Torrance, CA; University of Kansas Medical Center, Westwood, KS; Dana Farber Cancer Institute, Boston, MA; Center for Women's Health and Health Research, Madison, WI; General Hospital, Toronto, ON, Canada
| | - RT Chlebowski
- 1Massachusetts General Hospital Cancer Center, Boston, MA; Queen's University, Kingston, ON, Canada; Mayo Clinic, Rochester, MN; Los Angeles Biomedical Research Institute, Torrance, CA; University of Kansas Medical Center, Westwood, KS; Dana Farber Cancer Institute, Boston, MA; Center for Women's Health and Health Research, Madison, WI; General Hospital, Toronto, ON, Canada
| | - CJ Fabian
- 1Massachusetts General Hospital Cancer Center, Boston, MA; Queen's University, Kingston, ON, Canada; Mayo Clinic, Rochester, MN; Los Angeles Biomedical Research Institute, Torrance, CA; University of Kansas Medical Center, Westwood, KS; Dana Farber Cancer Institute, Boston, MA; Center for Women's Health and Health Research, Madison, WI; General Hospital, Toronto, ON, Canada
| | - JE Garber
- 1Massachusetts General Hospital Cancer Center, Boston, MA; Queen's University, Kingston, ON, Canada; Mayo Clinic, Rochester, MN; Los Angeles Biomedical Research Institute, Torrance, CA; University of Kansas Medical Center, Westwood, KS; Dana Farber Cancer Institute, Boston, MA; Center for Women's Health and Health Research, Madison, WI; General Hospital, Toronto, ON, Canada
| | - GE Sarto
- 1Massachusetts General Hospital Cancer Center, Boston, MA; Queen's University, Kingston, ON, Canada; Mayo Clinic, Rochester, MN; Los Angeles Biomedical Research Institute, Torrance, CA; University of Kansas Medical Center, Westwood, KS; Dana Farber Cancer Institute, Boston, MA; Center for Women's Health and Health Research, Madison, WI; General Hospital, Toronto, ON, Canada
| | - A Hiltz
- 1Massachusetts General Hospital Cancer Center, Boston, MA; Queen's University, Kingston, ON, Canada; Mayo Clinic, Rochester, MN; Los Angeles Biomedical Research Institute, Torrance, CA; University of Kansas Medical Center, Westwood, KS; Dana Farber Cancer Institute, Boston, MA; Center for Women's Health and Health Research, Madison, WI; General Hospital, Toronto, ON, Canada
| | - D Tu
- 1Massachusetts General Hospital Cancer Center, Boston, MA; Queen's University, Kingston, ON, Canada; Mayo Clinic, Rochester, MN; Los Angeles Biomedical Research Institute, Torrance, CA; University of Kansas Medical Center, Westwood, KS; Dana Farber Cancer Institute, Boston, MA; Center for Women's Health and Health Research, Madison, WI; General Hospital, Toronto, ON, Canada
| | - AM Cheung
- 1Massachusetts General Hospital Cancer Center, Boston, MA; Queen's University, Kingston, ON, Canada; Mayo Clinic, Rochester, MN; Los Angeles Biomedical Research Institute, Torrance, CA; University of Kansas Medical Center, Westwood, KS; Dana Farber Cancer Institute, Boston, MA; Center for Women's Health and Health Research, Madison, WI; General Hospital, Toronto, ON, Canada
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Hertel PB, Tu D, Ejlertsen B, Jensen MB, Balslev E, Jiang S, O'Malley FP, Pritchard KI, Shepherd LE, Bartels A, Brünner N, Nielsen TO. P1-06-07: TIMP-1 in Combination with HER2 and TOP2A for Prediction of Benefit from Adjuvant Anthracyclines in High Risk Breast Cancer Patients. Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-p1-06-07] [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
Purpose: HER2 amplification, TOP2A aberrations and absence of TIMP-1 (Tissue Inhibitor of Metalloproteinase-1) expression in breast carcinomas have been associated with incremental benefit from anthracycline-containing adjuvant chemotherapy in several reports. In the DBCG 89D trial, we demonstrated that the predictive value of these markers improved when they were combined in a profile and the present study was undertaken to validate these findings in NCIC CTG MA.5, a similar but independent clinical trial.
Design: TIMP-1 was examined by immunohistochemistry in archival tumor tissue from 403 of 716 premenopausal high-risk patients with known HER2 and TOP2A status who were randomized to CEF or CMF in the MA.5 trial. Patients were classified according to 2 predefined marker profiles — the HT profile (HER2, TIMP-1) and the 2T profile (TOP2A, TIMP-1) and the statistical analyses were performed as closely as possible to the analytical approach used previously in the MA.5 trial and when analysing the biomarker profiles in the DBCG 89D trial.
Results: 98 (24%) patients had no TIMP-1 staining of tumor cells, 27% were HER2 amplified, and 18% were TOP2A aberrant. 44% of patients were classified as HT responsive (HER2-positive and/or TIMP-1 negative) and 37% as 2T responsive (TOP2A aberrant and/or TIMP-1 negative). There was no heterogeneity in treatment effect of CEF versus CMF according to TIMP-1. In HT responsive patients, CEF was superior to CMF with improved RFS (adjusted HR, 0.64; 95% CI, 0.42 to 0.98) and a borderline-significant improvement in OS (adjusted HR, 0.66; 95% CI, 0.42 to 1.04). A significant HT profile versus treatment interaction was detected for OS (P=0.03). In 2T responsive patients, CEF was superior to CMF with borderline significant improvement in RFS (adjusted HR, 0.67; 95% CI, 0.43 to 1.03), and with improvement in OS (adjusted HR, 0.58; 95% CI, 0.36 to 0.93). A significant 2T profile versus treatment interaction was detected for OS (P=0.01).
Conclusion: In the MA.5 trial, we have validated the HT and 2T profiles as predictors of incremental benefit from anthracycline-containing chemotherapy. The proportion of patients categorized as anthracycline responsive increases from 18–27% using individual markers to 37–44% when combining TIMP-1 with either HER2 or TOP2A. Patients with responsive profiles had a 34–42% relative reduction in mortality when treated with CEF. In contrast, patients with non-responsive profiles (56-63% of patients) had no incremental benefit from CEF compared with CMF. All 3 biomarkers are easily applied in the pathology lab and as such could be used in daily clinical practice to select patients for anthracycline or non-anthracycline containing adjuvant chemotherapy.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P1-06-07.
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Affiliation(s)
- PB Hertel
- 1Faculty of Life Sciences, Univ of Copenhagen, Copenhagen, Denmark; National Cancer Institute of Canada, Kingston, ON, Canada; Rigshospitalet, Copenhagen, Denmark; Danish Breast Cancer Cooperative Group, Copenhagen, Denmark; Herlev Hospital, Herlev, Copenhagen, Denmark; Mount Sinai Hospital, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada; University of British Columbia Vancouver, Vancouver, BC, Canada
| | - D Tu
- 1Faculty of Life Sciences, Univ of Copenhagen, Copenhagen, Denmark; National Cancer Institute of Canada, Kingston, ON, Canada; Rigshospitalet, Copenhagen, Denmark; Danish Breast Cancer Cooperative Group, Copenhagen, Denmark; Herlev Hospital, Herlev, Copenhagen, Denmark; Mount Sinai Hospital, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada; University of British Columbia Vancouver, Vancouver, BC, Canada
| | - B Ejlertsen
- 1Faculty of Life Sciences, Univ of Copenhagen, Copenhagen, Denmark; National Cancer Institute of Canada, Kingston, ON, Canada; Rigshospitalet, Copenhagen, Denmark; Danish Breast Cancer Cooperative Group, Copenhagen, Denmark; Herlev Hospital, Herlev, Copenhagen, Denmark; Mount Sinai Hospital, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada; University of British Columbia Vancouver, Vancouver, BC, Canada
| | - M-B Jensen
- 1Faculty of Life Sciences, Univ of Copenhagen, Copenhagen, Denmark; National Cancer Institute of Canada, Kingston, ON, Canada; Rigshospitalet, Copenhagen, Denmark; Danish Breast Cancer Cooperative Group, Copenhagen, Denmark; Herlev Hospital, Herlev, Copenhagen, Denmark; Mount Sinai Hospital, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada; University of British Columbia Vancouver, Vancouver, BC, Canada
| | - E Balslev
- 1Faculty of Life Sciences, Univ of Copenhagen, Copenhagen, Denmark; National Cancer Institute of Canada, Kingston, ON, Canada; Rigshospitalet, Copenhagen, Denmark; Danish Breast Cancer Cooperative Group, Copenhagen, Denmark; Herlev Hospital, Herlev, Copenhagen, Denmark; Mount Sinai Hospital, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada; University of British Columbia Vancouver, Vancouver, BC, Canada
| | - S Jiang
- 1Faculty of Life Sciences, Univ of Copenhagen, Copenhagen, Denmark; National Cancer Institute of Canada, Kingston, ON, Canada; Rigshospitalet, Copenhagen, Denmark; Danish Breast Cancer Cooperative Group, Copenhagen, Denmark; Herlev Hospital, Herlev, Copenhagen, Denmark; Mount Sinai Hospital, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada; University of British Columbia Vancouver, Vancouver, BC, Canada
| | - FP O'Malley
- 1Faculty of Life Sciences, Univ of Copenhagen, Copenhagen, Denmark; National Cancer Institute of Canada, Kingston, ON, Canada; Rigshospitalet, Copenhagen, Denmark; Danish Breast Cancer Cooperative Group, Copenhagen, Denmark; Herlev Hospital, Herlev, Copenhagen, Denmark; Mount Sinai Hospital, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada; University of British Columbia Vancouver, Vancouver, BC, Canada
| | - KI Pritchard
- 1Faculty of Life Sciences, Univ of Copenhagen, Copenhagen, Denmark; National Cancer Institute of Canada, Kingston, ON, Canada; Rigshospitalet, Copenhagen, Denmark; Danish Breast Cancer Cooperative Group, Copenhagen, Denmark; Herlev Hospital, Herlev, Copenhagen, Denmark; Mount Sinai Hospital, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada; University of British Columbia Vancouver, Vancouver, BC, Canada
| | - LE Shepherd
- 1Faculty of Life Sciences, Univ of Copenhagen, Copenhagen, Denmark; National Cancer Institute of Canada, Kingston, ON, Canada; Rigshospitalet, Copenhagen, Denmark; Danish Breast Cancer Cooperative Group, Copenhagen, Denmark; Herlev Hospital, Herlev, Copenhagen, Denmark; Mount Sinai Hospital, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada; University of British Columbia Vancouver, Vancouver, BC, Canada
| | - A Bartels
- 1Faculty of Life Sciences, Univ of Copenhagen, Copenhagen, Denmark; National Cancer Institute of Canada, Kingston, ON, Canada; Rigshospitalet, Copenhagen, Denmark; Danish Breast Cancer Cooperative Group, Copenhagen, Denmark; Herlev Hospital, Herlev, Copenhagen, Denmark; Mount Sinai Hospital, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada; University of British Columbia Vancouver, Vancouver, BC, Canada
| | - N Brünner
- 1Faculty of Life Sciences, Univ of Copenhagen, Copenhagen, Denmark; National Cancer Institute of Canada, Kingston, ON, Canada; Rigshospitalet, Copenhagen, Denmark; Danish Breast Cancer Cooperative Group, Copenhagen, Denmark; Herlev Hospital, Herlev, Copenhagen, Denmark; Mount Sinai Hospital, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada; University of British Columbia Vancouver, Vancouver, BC, Canada
| | - TO Nielsen
- 1Faculty of Life Sciences, Univ of Copenhagen, Copenhagen, Denmark; National Cancer Institute of Canada, Kingston, ON, Canada; Rigshospitalet, Copenhagen, Denmark; Danish Breast Cancer Cooperative Group, Copenhagen, Denmark; Herlev Hospital, Herlev, Copenhagen, Denmark; Mount Sinai Hospital, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada; University of British Columbia Vancouver, Vancouver, BC, Canada
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Maunsell E, Richardson H, Ingle JN, Ales-Martinez JE, Chlebowski RT, Fabian CJ, Sarto GE, Garber JE, Pujol P, Hiltz A, Tu D, Goss PE. S6-1: Menopause-Specific and Health-Related Qualities of Life among Post-Menopausal Women Taking Exemestane for Prevention of Breast Cancer: Results from the NCIC CTG MAP.3 Placebo-Controlled Randomized Controlled Trial. Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-s6-1] [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: Exemestane, a steroidal aromatase inhibitor, reduced the incidence of invasive breast cancers by 65% among 4560 post-menopausal randomized to exemestane or placebo for 5 years on MAP.3. Differences in quality of life (QOL) were judged to be minimal, but only summary information was reported.
Purpose: To provide more detailed information about effects of exemestane on menopause-specific and health-related qualities of life.
Method: Participation in quality of life assessment was an eligibility criterion. Menopause-specific and health-related qualities of life were assessed using the MENQOL (4 scales; physical, vasomotor, psychosocial, sexual) and SF-36 (8 scales; physical health, role function — physical, bodily pain, general health, vitality, social function, role function — emotional, mental health, and 2 summary scales) instruments, respectively at baseline, 6 months and then yearly after randomization. Compliance with QOL questionnaire completion at each follow-up visit ranged from 93–98%, and did not differ by group. Change scores for each MENQOL and SF-36 scale, calculated for each assessment time relative to baseline, were compared using the Wilcoxon Rank-Sum test. Summary scores were used to summarize the QOL scores observed at each time point for each SF-36 dimension and overall mental (MCS) and physical component summaries (PCS) and MENQOL domains. Clinically important worsening of MENQOL change scores was defined as an increase of ≥0.5/8 points. SF-36 change scores were considered worsened if scores decreased by ≥ 5 points from baseline.
Results: Both groups were balanced on scores for MENQOL and SF-36 at baseline. Median follow-up was 35 months and the proportion of women who stopped study medication early for toxicity reasons was 15% in the exemestane arm and 11% in the placebo arm. There was a statistically significant difference in change scores for vasomotor symptoms among women on exemestane during the first 4 years (p-values <0.01), compared to placebo. However, no between-group differences in vasomotor change met the criterion for clinical importance. Women on exemestane had statistically poorer sexual functioning (mean change = −0.02, SD=1.37) compared to placebo (mean change = −0.12, SD=1.32) during the first 6 months on study (p-value = 0.03) but the differences were not statistically significant thereafter or clinically important at any time. Among the 8 SF-36 scales, only bodily pain was statistically different between exemestane and placebo for the first 24 months on study medication (p-value <0.01), but no between-group difference in change scores exceeded 5 points. Overall SF-36 PCS and MCS assessing changes in overall physical and mental health-related QOL did not differ significantly by group at any assessment.
Conclusion: Our assessment that early differences in vasomotor symptoms and pain were probably not clinically important is supported by the observation of no between-group differences when overall physical and mental health-related QOL changes were compared. Exemestane does not appear to have a major negative impact on the quality of life among these women.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr S6-1.
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Affiliation(s)
- E Maunsell
- 1Université Laval, Quebec City, QC, Canada; Queen's University, Kingston, ON, Canada; Mayo Clinic, Rochester, MN; Hospital Ntra Sra Sonsoles, Avila, Spain; Los Angeles Biomedical Research Institute, Torrance, CA; University of Kansas Medical Center, Westwood, KS; Center for Women's Health and Health Research, Madison, WI; Dana Farber Cancer Institute, Boston, MA; CHU-Hopital Arnaud de Villeneuve, Montpellier, France; Massachusetts General Hospital Cancer Center, Boston, MA
| | - H Richardson
- 1Université Laval, Quebec City, QC, Canada; Queen's University, Kingston, ON, Canada; Mayo Clinic, Rochester, MN; Hospital Ntra Sra Sonsoles, Avila, Spain; Los Angeles Biomedical Research Institute, Torrance, CA; University of Kansas Medical Center, Westwood, KS; Center for Women's Health and Health Research, Madison, WI; Dana Farber Cancer Institute, Boston, MA; CHU-Hopital Arnaud de Villeneuve, Montpellier, France; Massachusetts General Hospital Cancer Center, Boston, MA
| | - JN Ingle
- 1Université Laval, Quebec City, QC, Canada; Queen's University, Kingston, ON, Canada; Mayo Clinic, Rochester, MN; Hospital Ntra Sra Sonsoles, Avila, Spain; Los Angeles Biomedical Research Institute, Torrance, CA; University of Kansas Medical Center, Westwood, KS; Center for Women's Health and Health Research, Madison, WI; Dana Farber Cancer Institute, Boston, MA; CHU-Hopital Arnaud de Villeneuve, Montpellier, France; Massachusetts General Hospital Cancer Center, Boston, MA
| | - JE Ales-Martinez
- 1Université Laval, Quebec City, QC, Canada; Queen's University, Kingston, ON, Canada; Mayo Clinic, Rochester, MN; Hospital Ntra Sra Sonsoles, Avila, Spain; Los Angeles Biomedical Research Institute, Torrance, CA; University of Kansas Medical Center, Westwood, KS; Center for Women's Health and Health Research, Madison, WI; Dana Farber Cancer Institute, Boston, MA; CHU-Hopital Arnaud de Villeneuve, Montpellier, France; Massachusetts General Hospital Cancer Center, Boston, MA
| | - RT Chlebowski
- 1Université Laval, Quebec City, QC, Canada; Queen's University, Kingston, ON, Canada; Mayo Clinic, Rochester, MN; Hospital Ntra Sra Sonsoles, Avila, Spain; Los Angeles Biomedical Research Institute, Torrance, CA; University of Kansas Medical Center, Westwood, KS; Center for Women's Health and Health Research, Madison, WI; Dana Farber Cancer Institute, Boston, MA; CHU-Hopital Arnaud de Villeneuve, Montpellier, France; Massachusetts General Hospital Cancer Center, Boston, MA
| | - CJ Fabian
- 1Université Laval, Quebec City, QC, Canada; Queen's University, Kingston, ON, Canada; Mayo Clinic, Rochester, MN; Hospital Ntra Sra Sonsoles, Avila, Spain; Los Angeles Biomedical Research Institute, Torrance, CA; University of Kansas Medical Center, Westwood, KS; Center for Women's Health and Health Research, Madison, WI; Dana Farber Cancer Institute, Boston, MA; CHU-Hopital Arnaud de Villeneuve, Montpellier, France; Massachusetts General Hospital Cancer Center, Boston, MA
| | - GE Sarto
- 1Université Laval, Quebec City, QC, Canada; Queen's University, Kingston, ON, Canada; Mayo Clinic, Rochester, MN; Hospital Ntra Sra Sonsoles, Avila, Spain; Los Angeles Biomedical Research Institute, Torrance, CA; University of Kansas Medical Center, Westwood, KS; Center for Women's Health and Health Research, Madison, WI; Dana Farber Cancer Institute, Boston, MA; CHU-Hopital Arnaud de Villeneuve, Montpellier, France; Massachusetts General Hospital Cancer Center, Boston, MA
| | - JE Garber
- 1Université Laval, Quebec City, QC, Canada; Queen's University, Kingston, ON, Canada; Mayo Clinic, Rochester, MN; Hospital Ntra Sra Sonsoles, Avila, Spain; Los Angeles Biomedical Research Institute, Torrance, CA; University of Kansas Medical Center, Westwood, KS; Center for Women's Health and Health Research, Madison, WI; Dana Farber Cancer Institute, Boston, MA; CHU-Hopital Arnaud de Villeneuve, Montpellier, France; Massachusetts General Hospital Cancer Center, Boston, MA
| | - P Pujol
- 1Université Laval, Quebec City, QC, Canada; Queen's University, Kingston, ON, Canada; Mayo Clinic, Rochester, MN; Hospital Ntra Sra Sonsoles, Avila, Spain; Los Angeles Biomedical Research Institute, Torrance, CA; University of Kansas Medical Center, Westwood, KS; Center for Women's Health and Health Research, Madison, WI; Dana Farber Cancer Institute, Boston, MA; CHU-Hopital Arnaud de Villeneuve, Montpellier, France; Massachusetts General Hospital Cancer Center, Boston, MA
| | - A Hiltz
- 1Université Laval, Quebec City, QC, Canada; Queen's University, Kingston, ON, Canada; Mayo Clinic, Rochester, MN; Hospital Ntra Sra Sonsoles, Avila, Spain; Los Angeles Biomedical Research Institute, Torrance, CA; University of Kansas Medical Center, Westwood, KS; Center for Women's Health and Health Research, Madison, WI; Dana Farber Cancer Institute, Boston, MA; CHU-Hopital Arnaud de Villeneuve, Montpellier, France; Massachusetts General Hospital Cancer Center, Boston, MA
| | - D Tu
- 1Université Laval, Quebec City, QC, Canada; Queen's University, Kingston, ON, Canada; Mayo Clinic, Rochester, MN; Hospital Ntra Sra Sonsoles, Avila, Spain; Los Angeles Biomedical Research Institute, Torrance, CA; University of Kansas Medical Center, Westwood, KS; Center for Women's Health and Health Research, Madison, WI; Dana Farber Cancer Institute, Boston, MA; CHU-Hopital Arnaud de Villeneuve, Montpellier, France; Massachusetts General Hospital Cancer Center, Boston, MA
| | - PE Goss
- 1Université Laval, Quebec City, QC, Canada; Queen's University, Kingston, ON, Canada; Mayo Clinic, Rochester, MN; Hospital Ntra Sra Sonsoles, Avila, Spain; Los Angeles Biomedical Research Institute, Torrance, CA; University of Kansas Medical Center, Westwood, KS; Center for Women's Health and Health Research, Madison, WI; Dana Farber Cancer Institute, Boston, MA; CHU-Hopital Arnaud de Villeneuve, Montpellier, France; Massachusetts General Hospital Cancer Center, Boston, MA
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Vickers MM, Powell ED, Asmis TR, Jonker DJ, Hilton JF, O'Callaghan CJ, Tu D, Parulekar W, Moore MJ. Comorbidity, age and overall survival in patients with advanced pancreatic cancer - results from NCIC CTG PA.3: a phase III trial of gemcitabine plus erlotinib or placebo. Eur J Cancer 2011; 48:1434-42. [PMID: 22119354 DOI: 10.1016/j.ejca.2011.10.035] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2011] [Revised: 09/07/2011] [Accepted: 10/24/2011] [Indexed: 11/13/2022]
Abstract
BACKGROUND The effect of comorbidity, age and performance status (PS) on treatment of advanced pancreatic cancer is poorly understood. We examined these factors as predictors of outcome in advanced pancreatic cancer patients treated with gemcitabine +/- erlotinib. PATIENTS AND METHODS Comorbidity was evaluated by two physicians using the Charlson Comorbidity Index (CCI) and correlated with clinical outcome data from the NCIC Clinical Trials Group (NCIC CTG) PA.3 clinical trial. RESULTS Five hundred and sixty-nine patients were included; 47% were aged ≥ 65 years old, 36% had comorbidity (CCI>0). In multivariate analysis, neither age (p=0.22) nor comorbidity (p=0.21) was associated with overall survival. The baseline presence of better PS and lower pain intensity scores was associated with better overall survival (p < 0.0001 and p=0.01, respectively). An improvement in survival with the addition of erlotinib therapy was seen in patients age < 65 (adjusted hazard ratio (HR) 0.73, p=0.01) or in the presence of comorbidity (adjusted HR 0.72, p=0.03). However, neither age nor CCI score was predictive of erlotinib benefit after test for interaction. Patients treated with gemcitabine plus erlotinib who were ≥ 65 years of age or those with comorbidity had a higher rate of infections ≥ grade 3. CONCLUSION Low baseline pain intensity and better PS were associated with improved overall survival, while age and comorbidity were not independent prognostic factors for patients treated with gemcitabine-based therapy.
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Affiliation(s)
- M M Vickers
- Department of Oncology, Tom Baker Cancer Centre, Alberta, Canada.
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Sgroi D, Carney E, Richardson E, Steffel L, Binns SN, Finkelstein DM, Shepherd LE, Kesty NC, Schnabel C, Erlander MG, Ingle JN, Porter P, Paik S, Muss HB, Pritchard KI, Tu D, Goss PE. Prediction of late recurrences by breast cancer index in the NCIC CTG MA.17 cohort. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.27_suppl.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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
2 Background: The MA.17 trial demonstrated that extended adjuvant endocrine therapy with letrozole after 5-y of tamoxifen markedly reduced the risk of recurrence in women with ER+ early stage breast cancer. This trial provides an opportunity to assess the ability of biomarkers to predict late recurrences in ER+ breast cancer. The Breast Cancer Index (BCI), a continuous risk index based on the combination of HOXB13:IL17BR (H:I) and the molecular grade index (MGI), estimates the individual risk of recurrence in ER+ breast cancer patients. In this study, the prognostic utility of BCI to predict late recurrences was examined. Methods: FFPE tumor blocks were collected from patients who experienced a breast cancer recurrence up to unblinding of MA.17. Controls were matched 2:1 for age, tumor size, nodal status and prior chemotherapy, and were disease free for longer than cases. All cases were reviewed for standard histopathology and evaluated using the real-time RT-PCR BCI assay. Results: Patient characteristics for the case-control study were similar to that from the overall study. Characteristics for cases (N=83) and controls (N=166) were not significantly different except for treatment. A higher percentage of controls compared to cases tended to be categorized as low risk by BCI (58% vs 43%), while a lower percentage of controls than cases tended to be categorized as high risk by BCI (34% vs 24%). In univariate analysis, treatment, BCI, H:I and HOXB13, but not tumor grade or MGI, were significant predictors of late recurrence. After adjusting for standard variables (age, tumor grade and treatment), BCI (OR 2.37; P=0.03), H:I (OR 2.55; P=0.04) and HOXB13 (OR 1.35; P=0.02) remained significant predictors of recurrence. HOXB13 expression at diagnosis predicted patient benefit from extended endocrine therapy with letrozole. Conclusions: In this case-controlled study, the data demonstrate that BCI is a significant predictor of late recurrences in ER+ patients following 5-y of tamoxifen. The prognostic performance of BCI to predict late recurrences was largely dependent on HOXB13 expression. The integration of H:I and MGI within BCI provides prognostic utility for both early and late recurrences.
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Affiliation(s)
- D. Sgroi
- Massachusetts General Hospital, Boston, MA; NCIC Clinical Trials Group, Queen's University, Kingston, ON, Canada; bioTheranostics, Inc., San Diego, CA; Mayo Clinic, Rochester, MN; Fred Hutchinson Cancer Research Center, Seattle, WA; National Surgical Adjuvant Breast and Bowel Project, Pittsburgh, PA; University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC; Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada; NCIC Clinical Trials Group, Kingston, ON,
| | - E. Carney
- Massachusetts General Hospital, Boston, MA; NCIC Clinical Trials Group, Queen's University, Kingston, ON, Canada; bioTheranostics, Inc., San Diego, CA; Mayo Clinic, Rochester, MN; Fred Hutchinson Cancer Research Center, Seattle, WA; National Surgical Adjuvant Breast and Bowel Project, Pittsburgh, PA; University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC; Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada; NCIC Clinical Trials Group, Kingston, ON,
| | - E. Richardson
- Massachusetts General Hospital, Boston, MA; NCIC Clinical Trials Group, Queen's University, Kingston, ON, Canada; bioTheranostics, Inc., San Diego, CA; Mayo Clinic, Rochester, MN; Fred Hutchinson Cancer Research Center, Seattle, WA; National Surgical Adjuvant Breast and Bowel Project, Pittsburgh, PA; University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC; Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada; NCIC Clinical Trials Group, Kingston, ON,
| | - L. Steffel
- Massachusetts General Hospital, Boston, MA; NCIC Clinical Trials Group, Queen's University, Kingston, ON, Canada; bioTheranostics, Inc., San Diego, CA; Mayo Clinic, Rochester, MN; Fred Hutchinson Cancer Research Center, Seattle, WA; National Surgical Adjuvant Breast and Bowel Project, Pittsburgh, PA; University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC; Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada; NCIC Clinical Trials Group, Kingston, ON,
| | - S. N. Binns
- Massachusetts General Hospital, Boston, MA; NCIC Clinical Trials Group, Queen's University, Kingston, ON, Canada; bioTheranostics, Inc., San Diego, CA; Mayo Clinic, Rochester, MN; Fred Hutchinson Cancer Research Center, Seattle, WA; National Surgical Adjuvant Breast and Bowel Project, Pittsburgh, PA; University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC; Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada; NCIC Clinical Trials Group, Kingston, ON,
| | - D. M. Finkelstein
- Massachusetts General Hospital, Boston, MA; NCIC Clinical Trials Group, Queen's University, Kingston, ON, Canada; bioTheranostics, Inc., San Diego, CA; Mayo Clinic, Rochester, MN; Fred Hutchinson Cancer Research Center, Seattle, WA; National Surgical Adjuvant Breast and Bowel Project, Pittsburgh, PA; University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC; Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada; NCIC Clinical Trials Group, Kingston, ON,
| | - L. E. Shepherd
- Massachusetts General Hospital, Boston, MA; NCIC Clinical Trials Group, Queen's University, Kingston, ON, Canada; bioTheranostics, Inc., San Diego, CA; Mayo Clinic, Rochester, MN; Fred Hutchinson Cancer Research Center, Seattle, WA; National Surgical Adjuvant Breast and Bowel Project, Pittsburgh, PA; University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC; Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada; NCIC Clinical Trials Group, Kingston, ON,
| | - N. C. Kesty
- Massachusetts General Hospital, Boston, MA; NCIC Clinical Trials Group, Queen's University, Kingston, ON, Canada; bioTheranostics, Inc., San Diego, CA; Mayo Clinic, Rochester, MN; Fred Hutchinson Cancer Research Center, Seattle, WA; National Surgical Adjuvant Breast and Bowel Project, Pittsburgh, PA; University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC; Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada; NCIC Clinical Trials Group, Kingston, ON,
| | - C. Schnabel
- Massachusetts General Hospital, Boston, MA; NCIC Clinical Trials Group, Queen's University, Kingston, ON, Canada; bioTheranostics, Inc., San Diego, CA; Mayo Clinic, Rochester, MN; Fred Hutchinson Cancer Research Center, Seattle, WA; National Surgical Adjuvant Breast and Bowel Project, Pittsburgh, PA; University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC; Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada; NCIC Clinical Trials Group, Kingston, ON,
| | - M. G. Erlander
- Massachusetts General Hospital, Boston, MA; NCIC Clinical Trials Group, Queen's University, Kingston, ON, Canada; bioTheranostics, Inc., San Diego, CA; Mayo Clinic, Rochester, MN; Fred Hutchinson Cancer Research Center, Seattle, WA; National Surgical Adjuvant Breast and Bowel Project, Pittsburgh, PA; University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC; Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada; NCIC Clinical Trials Group, Kingston, ON,
| | - J. N. Ingle
- Massachusetts General Hospital, Boston, MA; NCIC Clinical Trials Group, Queen's University, Kingston, ON, Canada; bioTheranostics, Inc., San Diego, CA; Mayo Clinic, Rochester, MN; Fred Hutchinson Cancer Research Center, Seattle, WA; National Surgical Adjuvant Breast and Bowel Project, Pittsburgh, PA; University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC; Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada; NCIC Clinical Trials Group, Kingston, ON,
| | - P. Porter
- Massachusetts General Hospital, Boston, MA; NCIC Clinical Trials Group, Queen's University, Kingston, ON, Canada; bioTheranostics, Inc., San Diego, CA; Mayo Clinic, Rochester, MN; Fred Hutchinson Cancer Research Center, Seattle, WA; National Surgical Adjuvant Breast and Bowel Project, Pittsburgh, PA; University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC; Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada; NCIC Clinical Trials Group, Kingston, ON,
| | - S. Paik
- Massachusetts General Hospital, Boston, MA; NCIC Clinical Trials Group, Queen's University, Kingston, ON, Canada; bioTheranostics, Inc., San Diego, CA; Mayo Clinic, Rochester, MN; Fred Hutchinson Cancer Research Center, Seattle, WA; National Surgical Adjuvant Breast and Bowel Project, Pittsburgh, PA; University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC; Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada; NCIC Clinical Trials Group, Kingston, ON,
| | - H. B. Muss
- Massachusetts General Hospital, Boston, MA; NCIC Clinical Trials Group, Queen's University, Kingston, ON, Canada; bioTheranostics, Inc., San Diego, CA; Mayo Clinic, Rochester, MN; Fred Hutchinson Cancer Research Center, Seattle, WA; National Surgical Adjuvant Breast and Bowel Project, Pittsburgh, PA; University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC; Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada; NCIC Clinical Trials Group, Kingston, ON,
| | - K. I. Pritchard
- Massachusetts General Hospital, Boston, MA; NCIC Clinical Trials Group, Queen's University, Kingston, ON, Canada; bioTheranostics, Inc., San Diego, CA; Mayo Clinic, Rochester, MN; Fred Hutchinson Cancer Research Center, Seattle, WA; National Surgical Adjuvant Breast and Bowel Project, Pittsburgh, PA; University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC; Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada; NCIC Clinical Trials Group, Kingston, ON,
| | - D. Tu
- Massachusetts General Hospital, Boston, MA; NCIC Clinical Trials Group, Queen's University, Kingston, ON, Canada; bioTheranostics, Inc., San Diego, CA; Mayo Clinic, Rochester, MN; Fred Hutchinson Cancer Research Center, Seattle, WA; National Surgical Adjuvant Breast and Bowel Project, Pittsburgh, PA; University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC; Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada; NCIC Clinical Trials Group, Kingston, ON,
| | - P. E. Goss
- Massachusetts General Hospital, Boston, MA; NCIC Clinical Trials Group, Queen's University, Kingston, ON, Canada; bioTheranostics, Inc., San Diego, CA; Mayo Clinic, Rochester, MN; Fred Hutchinson Cancer Research Center, Seattle, WA; National Surgical Adjuvant Breast and Bowel Project, Pittsburgh, PA; University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC; Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada; NCIC Clinical Trials Group, Kingston, ON,
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Mackay HJ, Provencheur D, Heywood M, Tu D, Eisenhauer EA, Oza AM, Meyer R. Phase ii/iii study of intraperitoneal chemotherapy after neoadjuvant chemotherapy for ovarian cancer: ncic ctg ov.21. ACTA ACUST UNITED AC 2011; 18:84-90. [PMID: 21505599 DOI: 10.3747/co.v18i2.725] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [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: 11/15/2022]
Abstract
Three large randomized clinical trials have shown a survival benefit in women with stage iii epithelial ovarian cancer (eoc) who receive intraperitoneal (IP) chemotherapy after optimal primary debulking surgery. The most recent Gynecologic Oncology Group study, gog 172, showed an improvement in median overall survival of approximately 17 months. That result led to a U.S. National Cancer Institute (nci) clinical announcement recommending that IP chemotherapy be considered for this group of women with eoc. However, IP chemotherapy is associated with increased toxicity, and rates for completion of treatment are low (42% in gog 172). The optimal IP regimen and duration of treatment has yet to be defined. Women undergoing chemotherapy before optimal debulking surgery were not included in the studies or in the nci clinical announcement. The National Cancer Institute of Canada Clinical Trials Group has developed a protocol for a randomized phase ii/iii study which will examine whether IP platinum-taxane-based chemotherapy benefits women who have received neoadjuvant chemotherapy before optimal surgical debulking. To address whether the less systemically toxic carboplatin can be substituted for cisplatin IP, the first phase of the study will have 3 arms: 1 intravenous-only, and 2 IP-containing regimens. At the end of the first stage, and provided that IP therapy is feasible to administer in this patient population, one of the IP regimens, either IP carboplatin or IP cisplatin, will proceed into a phase iii comparison with the intravenous arm. This exciting new study has gathered international support.
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Goss PE, Ingle JN, Ales-Martinez J, Cheung A, Chlebowski RT, Wactawski-Wende J, McTiernan A, Robbins J, Johnson K, Martin L, Winquist E, Sarto G, Garber JE, Fabian CJ, Pujol P, Maunsell E, Farmer P, Gelmon KA, Tu D, Richardson H. Exemestane for primary prevention of breast cancer in postmenopausal women: NCIC CTG MAP.3—A randomized, placebo-controlled clinical trial. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.18_suppl.lba504] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [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
LBA504 Background: Limited efficacy and serious toxicities have limited uptake of tamoxifen or raloxifene as preventatives of breast cancer. Aromatase inhibitors (AIs) prevent contralateral breast cancers more than tamoxifen in adjuvant trials and have fewer serious side effects. This is the first report of an AI used in primary prevention. Methods: NCIC CTG MAP.3 is a randomized trial designed to detect a 65% reduction in annual incidence of invasive breast cancer (IBC) on exemestane (E) versus placebo (P). Eligible postmenopausal women had ≥ one of the following risk factors: Gail score >1.66%, prior ADH, ALH, LCIS or DCIS with mastectomy, age over 60. Health-related and menopause-specific quality of life (QOL) were assessed by SF-36 and MENQOL questionnaires. Results: From 2004-2010, 4,560 women were randomized: age 62.5 yrs (37-90); Gail Score 2.3 % (0.6-21); BMI 28.0 kg/m2 (15.9-65.4). Risk factors included: age >60 yrs (49%); Gail score >1.66 (40%); and prior ADH, ALH, LCIS or DCIS with mastectomy (11%). At median follow-up of 35 months there were 11 IBCs on E and 32 on P (annual incidence 0.19% vs 0.55%; HR= 0.35, 95% CI 0.18-0.70, p = 0.002); ductal (10E/27P), lobular (1E/5P). Most tumors were ER positive (7E/27P); Her2/neu negative (10E/26P); TNM stage T1 (8E/28P), N0 (7E/22P), M0 (11E/30P). E was superior in all subgroups: by Gail score, age, BMI, prior LCIS and DCIS. The annual incidence rate of IBC or DCIS was 0.35% E and 0.77% P (HR=0.47;95% CI 0.27-0.79; p = 0.004) based on 64 IBCs or DCISs (20E/44P). Clinical bone fractures, osteoporosis, hypercholesterolemia or cardiovascular events were equal in both arms. No clinically meaningful differences in QOL were detected. Conclusions: Exemestane significantly reduced invasive and pre-invasive breast cancers in postmenopausal women at increased risk for breast cancer with no serious toxicities. Exemestane should be considered a new option for primary prevention of breast cancer. Supported by the Canadian Cancer Society; Pfizer Inc. PEG supported in part by Avon Foundation.
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Affiliation(s)
- P. E. Goss
- Massachusetts General Hospital, Boston, MA; Mayo Clinic, Rochester, MN; Hosp Ruber Internacional, Madrid, Spain; Universtiy Health Network, Toronto, ON, Canada; Harbor-UCLA Medical Center, Torrance, CA; University of Buffalo, Buffalo, NY; Fred Hutchinson Cancer Research Center, Seattle, WA; University of California, Davis, Sacramento, CA; University of Tennessee Health Science Center, Memphis, TN; George Washington University School of Medicine, Washington, DC; London Health Sciences Centre, London, ON,
| | - J. N. Ingle
- Massachusetts General Hospital, Boston, MA; Mayo Clinic, Rochester, MN; Hosp Ruber Internacional, Madrid, Spain; Universtiy Health Network, Toronto, ON, Canada; Harbor-UCLA Medical Center, Torrance, CA; University of Buffalo, Buffalo, NY; Fred Hutchinson Cancer Research Center, Seattle, WA; University of California, Davis, Sacramento, CA; University of Tennessee Health Science Center, Memphis, TN; George Washington University School of Medicine, Washington, DC; London Health Sciences Centre, London, ON,
| | - J. Ales-Martinez
- Massachusetts General Hospital, Boston, MA; Mayo Clinic, Rochester, MN; Hosp Ruber Internacional, Madrid, Spain; Universtiy Health Network, Toronto, ON, Canada; Harbor-UCLA Medical Center, Torrance, CA; University of Buffalo, Buffalo, NY; Fred Hutchinson Cancer Research Center, Seattle, WA; University of California, Davis, Sacramento, CA; University of Tennessee Health Science Center, Memphis, TN; George Washington University School of Medicine, Washington, DC; London Health Sciences Centre, London, ON,
| | - A. Cheung
- Massachusetts General Hospital, Boston, MA; Mayo Clinic, Rochester, MN; Hosp Ruber Internacional, Madrid, Spain; Universtiy Health Network, Toronto, ON, Canada; Harbor-UCLA Medical Center, Torrance, CA; University of Buffalo, Buffalo, NY; Fred Hutchinson Cancer Research Center, Seattle, WA; University of California, Davis, Sacramento, CA; University of Tennessee Health Science Center, Memphis, TN; George Washington University School of Medicine, Washington, DC; London Health Sciences Centre, London, ON,
| | - R. T. Chlebowski
- Massachusetts General Hospital, Boston, MA; Mayo Clinic, Rochester, MN; Hosp Ruber Internacional, Madrid, Spain; Universtiy Health Network, Toronto, ON, Canada; Harbor-UCLA Medical Center, Torrance, CA; University of Buffalo, Buffalo, NY; Fred Hutchinson Cancer Research Center, Seattle, WA; University of California, Davis, Sacramento, CA; University of Tennessee Health Science Center, Memphis, TN; George Washington University School of Medicine, Washington, DC; London Health Sciences Centre, London, ON,
| | - J. Wactawski-Wende
- Massachusetts General Hospital, Boston, MA; Mayo Clinic, Rochester, MN; Hosp Ruber Internacional, Madrid, Spain; Universtiy Health Network, Toronto, ON, Canada; Harbor-UCLA Medical Center, Torrance, CA; University of Buffalo, Buffalo, NY; Fred Hutchinson Cancer Research Center, Seattle, WA; University of California, Davis, Sacramento, CA; University of Tennessee Health Science Center, Memphis, TN; George Washington University School of Medicine, Washington, DC; London Health Sciences Centre, London, ON,
| | - A. McTiernan
- Massachusetts General Hospital, Boston, MA; Mayo Clinic, Rochester, MN; Hosp Ruber Internacional, Madrid, Spain; Universtiy Health Network, Toronto, ON, Canada; Harbor-UCLA Medical Center, Torrance, CA; University of Buffalo, Buffalo, NY; Fred Hutchinson Cancer Research Center, Seattle, WA; University of California, Davis, Sacramento, CA; University of Tennessee Health Science Center, Memphis, TN; George Washington University School of Medicine, Washington, DC; London Health Sciences Centre, London, ON,
| | - J. Robbins
- Massachusetts General Hospital, Boston, MA; Mayo Clinic, Rochester, MN; Hosp Ruber Internacional, Madrid, Spain; Universtiy Health Network, Toronto, ON, Canada; Harbor-UCLA Medical Center, Torrance, CA; University of Buffalo, Buffalo, NY; Fred Hutchinson Cancer Research Center, Seattle, WA; University of California, Davis, Sacramento, CA; University of Tennessee Health Science Center, Memphis, TN; George Washington University School of Medicine, Washington, DC; London Health Sciences Centre, London, ON,
| | - K. Johnson
- Massachusetts General Hospital, Boston, MA; Mayo Clinic, Rochester, MN; Hosp Ruber Internacional, Madrid, Spain; Universtiy Health Network, Toronto, ON, Canada; Harbor-UCLA Medical Center, Torrance, CA; University of Buffalo, Buffalo, NY; Fred Hutchinson Cancer Research Center, Seattle, WA; University of California, Davis, Sacramento, CA; University of Tennessee Health Science Center, Memphis, TN; George Washington University School of Medicine, Washington, DC; London Health Sciences Centre, London, ON,
| | - L. Martin
- Massachusetts General Hospital, Boston, MA; Mayo Clinic, Rochester, MN; Hosp Ruber Internacional, Madrid, Spain; Universtiy Health Network, Toronto, ON, Canada; Harbor-UCLA Medical Center, Torrance, CA; University of Buffalo, Buffalo, NY; Fred Hutchinson Cancer Research Center, Seattle, WA; University of California, Davis, Sacramento, CA; University of Tennessee Health Science Center, Memphis, TN; George Washington University School of Medicine, Washington, DC; London Health Sciences Centre, London, ON,
| | - E. Winquist
- Massachusetts General Hospital, Boston, MA; Mayo Clinic, Rochester, MN; Hosp Ruber Internacional, Madrid, Spain; Universtiy Health Network, Toronto, ON, Canada; Harbor-UCLA Medical Center, Torrance, CA; University of Buffalo, Buffalo, NY; Fred Hutchinson Cancer Research Center, Seattle, WA; University of California, Davis, Sacramento, CA; University of Tennessee Health Science Center, Memphis, TN; George Washington University School of Medicine, Washington, DC; London Health Sciences Centre, London, ON,
| | - G. Sarto
- Massachusetts General Hospital, Boston, MA; Mayo Clinic, Rochester, MN; Hosp Ruber Internacional, Madrid, Spain; Universtiy Health Network, Toronto, ON, Canada; Harbor-UCLA Medical Center, Torrance, CA; University of Buffalo, Buffalo, NY; Fred Hutchinson Cancer Research Center, Seattle, WA; University of California, Davis, Sacramento, CA; University of Tennessee Health Science Center, Memphis, TN; George Washington University School of Medicine, Washington, DC; London Health Sciences Centre, London, ON,
| | - J. E. Garber
- Massachusetts General Hospital, Boston, MA; Mayo Clinic, Rochester, MN; Hosp Ruber Internacional, Madrid, Spain; Universtiy Health Network, Toronto, ON, Canada; Harbor-UCLA Medical Center, Torrance, CA; University of Buffalo, Buffalo, NY; Fred Hutchinson Cancer Research Center, Seattle, WA; University of California, Davis, Sacramento, CA; University of Tennessee Health Science Center, Memphis, TN; George Washington University School of Medicine, Washington, DC; London Health Sciences Centre, London, ON,
| | - C. J. Fabian
- Massachusetts General Hospital, Boston, MA; Mayo Clinic, Rochester, MN; Hosp Ruber Internacional, Madrid, Spain; Universtiy Health Network, Toronto, ON, Canada; Harbor-UCLA Medical Center, Torrance, CA; University of Buffalo, Buffalo, NY; Fred Hutchinson Cancer Research Center, Seattle, WA; University of California, Davis, Sacramento, CA; University of Tennessee Health Science Center, Memphis, TN; George Washington University School of Medicine, Washington, DC; London Health Sciences Centre, London, ON,
| | - P. Pujol
- Massachusetts General Hospital, Boston, MA; Mayo Clinic, Rochester, MN; Hosp Ruber Internacional, Madrid, Spain; Universtiy Health Network, Toronto, ON, Canada; Harbor-UCLA Medical Center, Torrance, CA; University of Buffalo, Buffalo, NY; Fred Hutchinson Cancer Research Center, Seattle, WA; University of California, Davis, Sacramento, CA; University of Tennessee Health Science Center, Memphis, TN; George Washington University School of Medicine, Washington, DC; London Health Sciences Centre, London, ON,
| | - E. Maunsell
- Massachusetts General Hospital, Boston, MA; Mayo Clinic, Rochester, MN; Hosp Ruber Internacional, Madrid, Spain; Universtiy Health Network, Toronto, ON, Canada; Harbor-UCLA Medical Center, Torrance, CA; University of Buffalo, Buffalo, NY; Fred Hutchinson Cancer Research Center, Seattle, WA; University of California, Davis, Sacramento, CA; University of Tennessee Health Science Center, Memphis, TN; George Washington University School of Medicine, Washington, DC; London Health Sciences Centre, London, ON,
| | - P. Farmer
- Massachusetts General Hospital, Boston, MA; Mayo Clinic, Rochester, MN; Hosp Ruber Internacional, Madrid, Spain; Universtiy Health Network, Toronto, ON, Canada; Harbor-UCLA Medical Center, Torrance, CA; University of Buffalo, Buffalo, NY; Fred Hutchinson Cancer Research Center, Seattle, WA; University of California, Davis, Sacramento, CA; University of Tennessee Health Science Center, Memphis, TN; George Washington University School of Medicine, Washington, DC; London Health Sciences Centre, London, ON,
| | - K. A. Gelmon
- Massachusetts General Hospital, Boston, MA; Mayo Clinic, Rochester, MN; Hosp Ruber Internacional, Madrid, Spain; Universtiy Health Network, Toronto, ON, Canada; Harbor-UCLA Medical Center, Torrance, CA; University of Buffalo, Buffalo, NY; Fred Hutchinson Cancer Research Center, Seattle, WA; University of California, Davis, Sacramento, CA; University of Tennessee Health Science Center, Memphis, TN; George Washington University School of Medicine, Washington, DC; London Health Sciences Centre, London, ON,
| | - D. Tu
- Massachusetts General Hospital, Boston, MA; Mayo Clinic, Rochester, MN; Hosp Ruber Internacional, Madrid, Spain; Universtiy Health Network, Toronto, ON, Canada; Harbor-UCLA Medical Center, Torrance, CA; University of Buffalo, Buffalo, NY; Fred Hutchinson Cancer Research Center, Seattle, WA; University of California, Davis, Sacramento, CA; University of Tennessee Health Science Center, Memphis, TN; George Washington University School of Medicine, Washington, DC; London Health Sciences Centre, London, ON,
| | - H. Richardson
- Massachusetts General Hospital, Boston, MA; Mayo Clinic, Rochester, MN; Hosp Ruber Internacional, Madrid, Spain; Universtiy Health Network, Toronto, ON, Canada; Harbor-UCLA Medical Center, Torrance, CA; University of Buffalo, Buffalo, NY; Fred Hutchinson Cancer Research Center, Seattle, WA; University of California, Davis, Sacramento, CA; University of Tennessee Health Science Center, Memphis, TN; George Washington University School of Medicine, Washington, DC; London Health Sciences Centre, London, ON,
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O'Callaghan CJ, Tu D, Karapetis CS, Au H, Moore MJ, Tebbutt NC, Trudeau MG, Price TJ, Yip D, Jonker DJ. The relationship between the development of rash and clinical and health-related quality of life outcomes by KRAS mutation status in patients with colorectal cancer treated with cetuximab in NCIC CTG CO.17. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.3588] [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: 11/20/2022] Open
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Cheang MCU, Voduc D, Tu D, Jiang S, Leung S, Chia SKL, Shepherd LE, Levine MN, Pritchard KI, Vickery T, Davies S, Stijleman IJ, Davis C, Parker JS, Ellis MJ, Bernard PS, Perou CM, Nielsen TO. The responsiveness of intrinsic subtypes to adjuvant anthracyclines versus nonanthracyclines in NCIC.CTG MA.5 randomized trial. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.1032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Elimova E, O'Callaghan CJ, Tu D, Karapetis CS, Price TJ, Zhu L, Zalcberg JR, Simes J, Jonker DJ. Cetuximab (CET)-related hypersensitivity reactions (HSRs): An analysis of timing, demographics, and outcomes from the AGITG/NCIC CTG CO.17 trial. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.3624] [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: 11/20/2022] Open
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Van Hazel GA, Tu D, Tebbutt NC, Jonker DJ, Price TJ, O'Callaghan C, Zalcberg JR, Taylor M, Strickland AH, Tomiak AT, Yip D, Simes J, Yadav SK, Links M, Burnell MJ, Jefford M, Karapetis CS. Early change in tumor size from waterfall plot analysis and RECIST response as predictor of overall survival (OS) in advanced, chemotherapy-refractory colorectal cancer (ACRC): NCIC CTG/AGITG CO.17 study. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.3602] [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: 11/20/2022] Open
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Hilton JF, Seymour L, Le Maitre A, Tu D, Shepherd FA, Bradbury PA. An evaluation of the possible interaction of gastric acid suppressive medication and the EGFR tyrosine kinase inhibitor erlotinib. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.7523] [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: 11/20/2022] Open
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