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Tan L, Tran B, Tie J, Markman B, Ananda S, Tebbutt NC, Michael M, Link E, Wong SQ, Chandrashekar S, Guinto J, Ritchie D, Koldej R, Solomon BJ, McArthur GA, Hicks RJ, Gibbs P, Dawson SJ, Desai J. A Phase Ib/II Trial of Combined BRAF and EGFR Inhibition in BRAF V600E Positive Metastatic Colorectal Cancer and Other Cancers: The EVICT (Erlotinib and Vemurafenib In Combination Trial) Study. Clin Cancer Res 2023; 29:1017-1030. [PMID: 36638198 PMCID: PMC10011885 DOI: 10.1158/1078-0432.ccr-22-3094] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 11/02/2022] [Accepted: 01/11/2023] [Indexed: 01/15/2023]
Abstract
PURPOSE BRAF V600E mutant metastatic colorectal cancer represents a significant clinical problem, with combination approaches being developed clinically with oral BRAF inhibitors combined with EGFR-targeting antibodies. While compelling preclinical data have highlighted the effectiveness of combination therapy with vemurafenib and small-molecule EGFR inhibitors, gefitinib or erlotinib, in colorectal cancer, this therapeutic strategy has not been investigated in clinical studies. PATIENTS AND METHODS We conducted a phase Ib/II dose-escalation/expansion trial investigating the safety/efficacy of the BRAF inhibitor vemurafenib and EGFR inhibitor erlotinib. RESULTS Thirty-two patients with BRAF V600E positive metastatic colorectal cancer (mCRC) and 7 patients with other cancers were enrolled. No dose-limiting toxicities were observed in escalation, with vemurafenib 960 mg twice daily with erlotinib 150 mg daily selected as the recommended phase II dose. Among 31 evaluable patients with mCRC and 7 with other cancers, overall response rates were 32% [10/31, 16% (5/31) confirmed] and 43% (3/7), respectively, with clinical benefit rates of 65% and 100%. Early ctDNA dynamics were predictive of treatment efficacy, and serial ctDNA monitoring revealed distinct patterns of convergent genomic evolution associated with acquired treatment resistance, with frequent emergence of MAPK pathway alterations, including polyclonal KRAS, NRAS, and MAP2K1 mutations, and MET amplification. CONCLUSIONS The Erlotinib and Vemurafenib In Combination Trial study demonstrated a safe and novel combination of two oral inhibitors targeting BRAF and EGFR. The dynamic assessment of serial ctDNA was a useful measure of underlying genomic changes in response to this combination and in understanding potential mechanisms of resistance.
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Affiliation(s)
- Lavinia Tan
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Ben Tran
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia.,Division of Personalized Oncology, Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia
| | - Jeanne Tie
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia.,Division of Personalized Oncology, Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia
| | - Ben Markman
- Monash Health, Melbourne, Victoria, Australia
| | - Sumi Ananda
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Niall C Tebbutt
- Olivia Newton John Cancer Wellness and Research Centre, Melbourne, Victoria, Australia
| | - Michael Michael
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Emma Link
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia.,Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Stephen Q Wong
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia
| | | | - Jerick Guinto
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - David Ritchie
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,ACRF Translational Research Laboratory, Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Medicine, University of Melbourne, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Rachel Koldej
- ACRF Translational Research Laboratory, Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Medicine, University of Melbourne, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Benjamin J Solomon
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Grant A McArthur
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Rodney J Hicks
- The University of Melbourne Department of Medicine, St Vincent's Hospital, Melbourne, Victoria, Australia.,Centre for Cancer Research, The University of Melbourne, Parkville, Victoria, Australia
| | - Peter Gibbs
- Division of Personalized Oncology, Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia
| | - Sarah-Jane Dawson
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia.,Centre for Cancer Research, The University of Melbourne, Parkville, Victoria, Australia
| | - Jayesh Desai
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia
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Kasivisvanathan V, Murphy D, Link E, Lawrentschuk N, O’Brien J, Buteau J, Roberts M, Francis R, Tang C, Vela I, Thomas P, Rutherford N, Martin J, Frydenberg M, Shakher R, Wong LM, Taubman K, Lee S, Hsiao E, Nottage M, Kirkwood I, Iravani A, Williams S, Hofman M. Baseline PSMA PET-CT is prognostic for treatment failure in men with intermediate-to-high risk prostate cancer: 54 months follow-up of the proPSMA randomised trial. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01275-7] [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: 02/12/2023]
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Lee AHH, Oo J, Cabalag CS, Link E, Duong CP. Increased risk of diaphragmatic herniation following esophagectomy with a minimally invasive abdominal approach. Dis Esophagus 2022; 35:6373570. [PMID: 34549284 DOI: 10.1093/dote/doab066] [Citation(s) in RCA: 2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 08/16/2021] [Accepted: 09/04/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Diaphragmatic herniation is a rare complication following esophagectomy, associated with risks of aspiration pneumonia, bowel obstruction, and strangulation. Repair can be challenging due to the presence of the gastric conduit. We performed this systematic review and meta-analysis to determine the incidence and risk factors associated with diaphragmatic herniation following esophagectomy, the timing and mode of presentation, and outcomes of repair. METHODS A systematic search using Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines was performed using four major databases. A meta-analysis of diaphragmatic herniation incidence following esophagectomies with a minimally invasive abdominal (MIA) approach compared with open esophagectomies was conducted. Qualitative analysis was performed for tumor location, associated symptoms, time to presentation, and outcomes of postdiaphragmatic herniation repair. RESULTS This systematic review consisted of 17,052 patients from 32 studies. The risk of diaphragmatic herniation was 2.74 times higher in MIA esophagectomy compared with open esophagectomy, with pooled incidence of 6.0% versus 3.2%, respectively. Diaphragmatic herniation was more commonly seen following surgery for distal esophageal tumors. Majority of patients (64%) were symptomatic at diagnosis. Presentation within 30 days of operation occurred in 21% of cases and is twice as likely to require emergent repair with increased surgical morbidity. Early diaphragmatic herniation recurrence and cardiorespiratory complications are common sequelae following hernia repair. CONCLUSIONS In the era of MIA esophagectomy, one has to be cognizant of the increased risk of diaphragmatic herniation and its sequelae. Failure to recognize early diaphragmatic herniation can result in catastrophic consequences. Increased vigilance and decreased threshold for imaging during this period is warranted.
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Affiliation(s)
- Adele Hwee Hong Lee
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - June Oo
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Carlos S Cabalag
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Emma Link
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, Australia
| | - Cuong Phu Duong
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, Australia
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Conduit C, Kichenadasse G, Harris CA, Gurney H, Ferguson T, Parnis F, Goh JC, Morris MF, Underhill C, Pook DW, Davis ID, Roncolato F, Harrison ML, Begbie S, Joshua AM, Link E, Hovey EJ, Gedye C. Sequential immunotherapy in rare variant renal cell carcinomafinal report of UNISoN (ANZUP 1602): Nivolumab then ipilimumab + nivolumab in advanced nonclear cell renal cell carcinoma. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.4537] [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: 11/20/2022] Open
Abstract
4537 Background: Immune checkpoint immunotherapy (ICI) is active against many cancers. Many people are failed by PD1 inhibition alone, but not all patients benefit, nor require combination ICI treatment. UNISoN (NCT03177239) previously reported outcomes in people with non-clear cell renal cell carcinoma (nccRCC) receiving nivolumab (N) monotherapy, and N plus ipilimumab (I) in those whose cancers progressed after N alone. We present the final planned report. Methods: Population, Intervention, Analysis: Participants (pts) with advanced nccRCC with good performance status (ECOG 0/1) received N 240mg q2w alone (Part 1). Those with cancers refractory to N at 3 months were offered combination I (1mg/kg) + N (3mg/kg) q3w for up to 4 doses, followed by N 240mg q2w for a maximum total of 12 months of N (Part 2). UNISoN was powered to identify a clinically-relevant objective tumor response rate (OTRR) of 30% (assuming 15% was not relevant) among people receiving I+N in Part 2. Results: 85 pts with a representative spectrum of nccRCC histologies were enrolled and received N. Amongst the total population enrolled to UNISoN Part 1/2, mOS was 24 (16-28) months and 12m OS was 65% (54%-74%); of those proceeding to Part 2, the mOS was 10 (6-17) months only. Overall, 17% (10%-27%; 14/83) and 10% (3%-23%; 4/41) of pts experienced a response from N alone or I+N, respectively. 41 pts refractory to N received I+N. Overall in Part 2, the median time on treatment was 2.1 (95% CI 1.8, 2.8) months, the median number of cycles was 3; median follow-up at final analysis was 22 (16-30) months. In this population, the median PFS was 2.6 (2.2-3.8) months and 12m PFS was 11% (4%-23%). 13% (7%-22%) of patients were free of progression or death at 24 months. The primary endpoint was not met; only 80% of pts failed by N were assessable for response in Part 2. Overall tumor responses from N alone or I+N were more common in pts with papillary histology; pts with chromophobe histology had poor outcomes. No late toxicity safety signals were observed. Conclusions: Some pts with nccRCC benefit from N alone, or addition of I when disease is inadequately controlled by N alone, however most pts have limited benefit from ICI. More effective therapeutic options are needed for the majority of people with rare variant renal cell carcinomas. Novel markers of response are required to more rapidly predict pts who will progress on N. Translational research to identify predictive biomarkers of response is ongoing. Clinical trial information: NCT03177239.
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Affiliation(s)
- Ciara Conduit
- Australian & New Zealand Urogenital and Prostate (ANZUP) Cancer Trials Group, Camperdown, Australia
| | | | - Carole A. Harris
- St. George Hospital Cancer Care Center, Kingsford, NSW, Australia
| | | | | | | | - Jeffrey C. Goh
- Department of Oncology, Royal Brisbane and Women’s Hospital, Brisbane, QLD, Australia
| | | | - Craig Underhill
- Border Medical Oncology Research Unit, Albury Wodonga Regional Cancer Centre & Rural Medical School, Albury Campus, University of New South Wales, Albury-Wodonga, NSW, Australia
| | | | - Ian D. Davis
- Eastern Health Clinical School, Monash University, Box Hill, VIC, Australia
| | | | | | | | - Anthony M. Joshua
- Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Emma Link
- Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, Melbourne, Australia
| | | | - Craig Gedye
- Calvary Mater Newcastle, Waratah, NSW, Australia
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5
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Liu Z, Martin JH, Liauw W, McLachlan SA, Link E, Matera A, Thompson M, Jefford M, Hicks RJ, Cullinane C, Hatzimihalis A, Campbell I, Crowley S, Beale PJ, Karapetis CS, Price T, Burge ME, Michael M. Evaluation of pharmacogenomics and hepatic nuclear imaging-related covariates by population pharmacokinetic models of irinotecan and its metabolites. Eur J Clin Pharmacol 2021; 78:53-64. [PMID: 34480602 DOI: 10.1007/s00228-021-03206-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 08/13/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Body surface area (BSA)-based dosing of irinotecan (IR) does not account for its pharmacokinetic (PK) and pharmacodynamic (PD) variabilities. Functional hepatic nuclear imaging (HNI) and excretory/metabolic/PD pharmacogenomics have shown correlations with IR disposition and toxicity/efficacy. This study reports the development of a nonlinear mixed-effect population model to identify pharmacogenomic and HNI-related covariates that impact on IR disposition to support dosage optimization. METHODS Patients had advanced colorectal cancer treated with IR combination therapy. Baseline blood was analysed by Affymetrix DMET™ Plus Array and, for PD, single nucleotide polymorphisms (SNPs) by Sanger sequencing. For HNI, patients underwent 99mTc-IDA hepatic imaging, and data was analysed for hepatic extraction/excretion parameters. Blood was taken for IR and metabolite (SN38, SN38G) analysis on day 1 cycle 1. Population modelling utilised NONMEM version 7.2.0, with structural PK models developed for each moiety. Covariates include patient demographics, HNI parameters and pharmacogenomic variants. RESULTS Analysis included (i) PK data: 32 patients; (ii) pharmacogenomic data: 31 patients: 750 DMET and 22 PD variants; and (iii) HNI data: 32 patients. On initial analysis, overall five SNPs were identified as significant covariates for CLSN38. Only UGT1A3_c.31 T > C and ABCB1_c.3435C > T were included in the final model, whereby CLSN38 reduced from 76.8 to 55.1%. CONCLUSION The identified UGT1A3_c.31 T > C and ABCB1_c.3435C > T variants, from wild type to homozygous, were included in the final model for SN38 clearance.
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Affiliation(s)
- Zheng Liu
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.,Clinical Pharmacology, Department of Medicine, The Royal Children's Hospital Melbourne, Melbourne, Australia.,Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, VIC, Australia
| | - Jennifer H Martin
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Winston Liauw
- Department of Medical Oncology, St. George's Hospital, Sydney, Australia
| | - Sue-Anne McLachlan
- Department of Medical Oncology, St. Vincent's Hospital, Melbourne, Australia
| | - Emma Link
- Biostatistics and Clinical Trials Centre, Peter MacCallum Cancer Centre, Melbourne, Australia.,Department of Oncology, Sir Peter MacCallum, University of Melbourne, Melbourne, Australia
| | - Anetta Matera
- Biostatistics and Clinical Trials Centre, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Michael Thompson
- Department of Nuclear Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Michael Jefford
- Department of Oncology, Sir Peter MacCallum, University of Melbourne, Melbourne, Australia.,Department of Medical Oncology, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC, 3000, Australia
| | - Rod J Hicks
- Department of Oncology, Sir Peter MacCallum, University of Melbourne, Melbourne, Australia.,Department of Nuclear Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Carleen Cullinane
- Department of Oncology, Sir Peter MacCallum, University of Melbourne, Melbourne, Australia.,Translational Research Laboratory, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Athena Hatzimihalis
- Translational Research Laboratory, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Ian Campbell
- Department of Oncology, Sir Peter MacCallum, University of Melbourne, Melbourne, Australia.,Victorian Breast Cancer Research Cooperative (VBCRC) Cancer Genetics Laboratory, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Simone Crowley
- Previously Victorian Breast Cancer Research Cooperative (VBCRC) Cancer Genetics Laboratory, The Murdoch Children's Research Institute, The Royal Children's Hospital, Peter MacCallum Cancer Centre), MelbourneMelbourne, Australia
| | - Phillip J Beale
- Department of Medical Oncology, Concord and Royal Prince Alfred Hospital, Sydney, Australia
| | - Christos S Karapetis
- Department of Medical Oncology, Flinders Medical Centre, Flinders Centre for Innovation in Cancer, Adelaide, Australia
| | - Timothy Price
- Department of Medical Oncology, The Queen Elizabeth Hospital, Adelaide, Australia
| | - Mathew E Burge
- Department of Medical Oncology, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Michael Michael
- Department of Oncology, Sir Peter MacCallum, University of Melbourne, Melbourne, Australia. .,Department of Medical Oncology, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC, 3000, Australia.
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Czerwinski F, Link E, Rosset M, Baumann E, Suhr R. Patientenzentrierte Sicht auf die Qualität der Arzt-Patienten-Kommunikation. Das Gesundheitswesen 2021. [DOI: 10.1055/s-0041-1732272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- F Czerwinski
- Institut für Journalistik und Kommunikationsforschung, [HC]
2 Hanover Center for Health Communication, Hochschule für Musik, Theater und Medien
| | - E Link
- Institut für Journalistik und Kommunikationsforschung, [HC]
2 Hanover Center for Health Communication, Hochschule für Musik, Theater und Medien
| | - M Rosset
- Institut für Journalistik und Kommunikationsforschung, [HC]
2 Hanover Center for Health Communication, Hochschule für Musik, Theater und Medien
| | - E Baumann
- Institut für Journalistik und Kommunikationsforschung, [HC]
2 Hanover Center for Health Communication, Hochschule für Musik, Theater und Medien
| | - R Suhr
- Stiftung Gesundheitswissen
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Gedye C, Pook DW, Krieger LEM, Harris CA, Goh JC, Kichenadasse G, Gurney H, Underhill C, Parnis F, Joshua AM, Ferguson T, Roncolato F, Harrison ML, Begbie S, Morris MF, Hovey EJ, George M, Prithviraj P, Link E, Davis ID. Ipilimumab + nivolumab in people with rare variant renal cell carcinoma refractory to nivolumab alone: Part 2 of UNISON (ANZUP 1602) nivolumab then ipilimumab + nivolumab in advanced non-clear cell renal cell carcinoma. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.4565] [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: 11/20/2022] Open
Abstract
4565 Background: Immunotherapy targeting PD1 is active across many cancers, but many people are failed by PD1 inhibition alone. UNISON (ANZUP 1602/NCT03177239) has previously reported the activity and outcomes of nivolumab monotherapy in people with nccRCC (OTRR 17%, PFS6 45%; part 1), and here we report the outcomes of combining ipilimumab (I) and nivolumab (N), in people whose cancers are refractory to N alone (part 2). Methods: Participants (pts) with advanced nccRCC with good performance status (ECOG 0/1), were initially enrolled and took N alone. 41 pts refractory to N were offered the combination I (1mg/kg) + N (3mg/kg) every 3 weeks for up to 4 doses. Pts with disease control after N, or N + I could continue N for up to 1 year. UNISON was powered to distinguish a clinically relevant improvement in objective tumour response rate (OTRR) from 15% to 30% in people taking I+N in part 2. Results: 85 pts were enrolled and received N. 41 pts were refractory to N, were well enough to take I+N, and had a representative spectrum of nccRCC histologies (n=41; papillary 44%, chromophobe 20%, Xp11 translocation 12%, RCC unclassified 7%, other 17%). The median time on treatment was 2.1 months, the median number of doses was 3; median follow up at the time of reporting was 20.3 months. The OTRR of I+N in pts refractory to N was 10% with 1 complete and 3 partial responses. Stable disease was experienced by 36% of pts and disease progression by 52%. The disease control rate at 6 months was 45% (95% CI: 34%, 56%). The median PFS was 2.6 months (95% CI: 2.2, 3.8). The 6 month progression-free survival (PFS) was 25% (95% CI: 13-39). Only 14% of patients were free of progression at 12 months. The safety of I+N appeared similar to previous reports. 68% of pts experienced serious adverse events, 34% treatment related SAE. One pt died from refractory pneumonitis. 11 pts (27%) experienced treatment delays or permanent treatment discontinuation. Conclusions: The primary endpoint of the study was not met. A minority of pts with nccRCC refractory to nivolumab derive benefit from combination I+N but many pts remain refractory to immunotherapy. No new safety issues were identified. More effective therapeutic options are needed for people with rare variant renal cell carcinoma. Clinical trial information: NCT03177239.
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Affiliation(s)
- Craig Gedye
- Calvary Mater Newcastle, Waratah, NSW, Australia
| | | | | | - Carole A. Harris
- St. George Hospital Cancer Care Center, Kingsford, NSW, Australia
| | - Jeffrey C. Goh
- Royal Brisbane and Women's Hospital, Herston and University of Queensland, St. Lucia, QLD, Australia
| | | | - Howard Gurney
- Department of Clinical Medicine, Macquarie University, Sydney, NSW, Australia
| | - Craig Underhill
- UNSW Rural Medical School, Albury Campus, Albury-Wodonga, Australia
| | | | | | | | | | | | | | | | | | | | | | - Emma Link
- Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Ian D. Davis
- Eastern Health Clinical School, Monash University, Box Hill, VIC, Australia
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Michael M, Liauw W, McLachlan SA, Link E, Matera A, Thompson M, Jefford M, Hicks RJ, Cullinane C, Hatzimihalis A, Campbell IG, Rowley S, Beale PJ, Karapetis CS, Price T, Burge ME. Pharmacogenomics and functional imaging to predict irinotecan pharmacokinetics and pharmacodynamics: the predict IR study. Cancer Chemother Pharmacol 2021; 88:39-52. [PMID: 33755789 DOI: 10.1007/s00280-021-04264-8] [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: 12/03/2020] [Accepted: 03/16/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Irinotecan (IR) displays significant PK/PD variability. This study evaluated functional hepatic imaging (HNI) and extensive pharmacogenomics (PGs) to explore associations with IR PK and PD (toxicity and response). METHODS Eligible patients (pts) suitable for Irinotecan-based therapy. At baseline: (i) PGs: blood analyzed by the Affymetrix-DMET™-Plus-Array (1936 variants: 1931 single nucleotide polymorphisms [SNPs] and 5 copy number variants in 225 genes, including 47 phase I, 80 phase II enzymes, and membrane transporters) and Sanger sequencing (variants in HNF1A, Topo-1, XRCC1, PARP1, TDP, CDC45L, NKFB1, and MTHFR), (ii) HNI: pts given IV 250 MBq-99mTc-IDA, data derived for hepatic extraction/excretion parameters (CLHNI, T1/2-HNI, 1hRET, HEF, Td1/2). In cycle 1, blood was taken for IR analysis and PK parameters were derived by non-compartmental methods. Associations were evaluated between HNI and PGs, with IR PK, toxicity, objective response rate (ORR) and progression-free survival (PFS). RESULTS N = 31 pts. The two most significant associations between PK and PD with gene variants or HNI parameters (P < 0.05) included: (1) PK: SN38-Metabolic Ratio with CLHNI, 1hRET, (2) Grade 3+ diarrhea with SLC22A2 (rs 316019), GSTM5 (rs 1296954), (3) Grade 3+ neutropenia with CLHNI, 1hRET, SLC22A2 (rs 316019), CYP4F2 (rs2074900) (4) ORR with ALDH2 (rs 886205), MTHFR (rs 1801133). (5) PFS with T1/2-HNI, XDH (rs 207440), and ABCB11 (rs 4148777). CONCLUSIONS Exploratory associations were observed between Irinotecan PK/PD with hepatic functional imaging and extensive pharmacogenomics. Further work is required to confirm and validate these findings in a larger cohort of patients. AUSTRALIAN NEW ZEALAND CLINICAL TRIALS REGISTRY (ANZCTR) NUMBER ACTRN12610000897066, Date registered: 21/10/2010.
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Affiliation(s)
- Michael Michael
- Department of Medical Oncology, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC, 3000, Australia.
| | - Winston Liauw
- Department of Medical Oncology, St. George's Hospital, Sydney, Australia
| | - Sue-Anne McLachlan
- Department of Medical Oncology, St. Vincent's Hospital, Melbourne, Australia
| | - Emma Link
- Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Annetta Matera
- Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Michael Thompson
- Division of Nuclear Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Michael Jefford
- Department of Medical Oncology, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC, 3000, Australia
| | - Rod J Hicks
- Division of Nuclear Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Carleen Cullinane
- Translational Research Laboratory, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Athena Hatzimihalis
- Translational Research Laboratory, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Ian G Campbell
- Cancer Genetics Laboratory, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Simone Rowley
- Cancer Genetics Laboratory, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Phillip J Beale
- Department of Medical Oncology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Christos S Karapetis
- Department of Medical Oncology, Flinders Medical Centre, Flinders Centre for Innovation in Cancer, Adelaide, Australia
| | - Timothy Price
- Department of Medical Oncology, The Queen Elizabeth Hospital, Adelaide, Australia
| | - Mathew E Burge
- Department of Medical Oncology, Royal Brisbane and Women's Hospital, Brisbane, Australia
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Chua BH, Link E, Kunkler I, Olivotto I, Westenberg AH, Whelan T, Gruber G. Abstract GS2-04: A randomized phase III study of radiation doses and fractionation schedules in non-low risk ductal carcinoma in situ (DCIS) of the breast (BIG 3-07/TROG 07.01). Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-gs2-04] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: Wholebreast irradiation (WBI) after breast conserving surgery for DCIS reduces therisk of local recurrence including invasive recurrence. The objective of BIG3-07/TROG 07.01 is to test radiation dose escalation to the tumor bed (tumorbed boost) and fractionation sensitivity of whole breast irradiation (WBI) inpatients with non-low risk DCIS treated with breast conserving therapy.
Methods: BIG3-07/TROG 07.01 is an international, multicenter, randomized, controlled, phase 3 trial. Eligible women were ≥18 years ofage with completely resected non-low risk DCIS defined as age <50 years orage ≥50 years plus at least one of the risk factors for local recurrence (palpable tumor,multifocal disease, tumor size ≥ 1.5cm, intermediate or high nuclear grade, central necrosis, comedo histologyand/or surgical margin <10 mm). Patients were randomized to have tumor bedboost (16 Gy in 8 daily fractions) or no boost following conventional WBI (50Gy in 25 daily fractions) or hypofractionated WBI (42.5 Gy in 16 dailyfractions) in one of three randomization categories selected by centers priorto study activation. Randomization A was a 4-arm randomization of no boost vs. boostfollowing conventional WBI vs. hypofractionated WBI. Patients in RandomizationB and Randomization C were assigned no boost or boost following conventional WBIand hypofractionated WBI, respectively. The primary endpoint was time to localrecurrence, analyzed by intention to treat. The trial was designed to detect a3% difference in 5-year free-from- local recurrence rates between the no boostand boost groups (93% vs 96%; hazard ratio, 0.56) with 90% power and 2-sidedalpha level of 5%. The primary effect of boost was assessed on all randomizedpatients. The secondary effect of WBI dose-fractionation and the interactionbetween boost and WBI dose-fractionation were assessed on patients in RandomizationA and additionally on all patients.
Results: BetweenJune 2007 and June 2014, 1608 patients were randomized to have no boost (805patients) or boost (803 patients) after WBI. Conventional WBI was given in 831 patients(no boost in 416 patients; boost in 415 patients). Hypofractionated WBI wasgiven in 777 patients (no boost in 389 patients; boost in 388 patients). Adjuvantendocrine therapy was planned in 106 patients (13%) in the no boost group and105 patients (13%) in the boost group. Median follow-up was 6.6 years. The 5-yearfree-from- local recurrence rates were 93% in the no boost group and 97% in theboost group (hazard ratio, 0.47; 95% confidence interval [CI], 0.31 to 0.72;P<0.001). Forty-four percent and 45% of LRs were invasive in the no boostgroup and boost group, respectively. The effect of boost did not vary significantlyby age, tumor size, nuclear grade, surgical margin or endocrine therapy. Therewere no significant differences in the 5-year free-from- local recurrence ratesbetween the conventional WBI group and hypofractionated WBI group inRandomization A (94% vs. 94%, P=0.84) and in all randomized patients (95% vs.95%, P=0.89). The test for interaction between boost and dose-fractionation wasnot significant in Randomization A or in all randomized patients (both P=0.89).The rates of grade ≥2 breastpain (12% vs. 16%, P=0.84) and skin and subcutaneous tissue fibrosis (6% vs.15%, P=0.14) did not differ significantly between the groups.
Conclusions: Inwomen with non-low risk DCIS treatedwith breast conserving surgery, the addition of tumor bed boost followingconventional or hypofractionated WBI reduced local recurrence rates. There wasno difference in local recurrence rates between conventional WBI andhypofractionated WBI. (Registered with ClinicalTrials.gov, NCT00470236.)
Citation Format: Boon Hui Chua, Emma Link, Ian Kunkler, Ivo Olivotto, Antonia Helen Westenberg, Timothy Whelan, Guenther Gruber, Breast International Group (BIG)-aisbl, Trans Tasman Radiation Oncology Group, Scottish Cancer Trials Breast Group, Canadian Cancer Trials Group, European Organization for Research and Treatment of Cancer, International Breast Cancer Study Group, Cancer Trials Ireland. A randomized phase III study of radiation doses and fractionation schedules in non-low risk ductal carcinoma in situ (DCIS) of the breast (BIG 3-07/TROG 07.01) [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr GS2-04.
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Affiliation(s)
| | - Emma Link
- 2Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Ian Kunkler
- 3University of Edinburgh, Edinburgh, United Kingdom
| | | | | | | | - Guenther Gruber
- 7Klinik Hirslanden, Institute for Radiotherapy, Zurich, Switzerland
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10
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Hofman MS, Lawrentschuk N, Francis RJ, Tang C, Vela I, Thomas P, Rutherford N, Martin JM, Frydenberg M, Shakher R, Wong LM, Taubman K, Ting Lee S, Hsiao E, Roach P, Nottage M, Kirkwood I, Hayne D, Link E, Marusic P, Matera A, Herschtal A, Iravani A, Hicks RJ, Williams S, Murphy DG. Prostate-specific membrane antigen PET-CT in patients with high-risk prostate cancer before curative-intent surgery or radiotherapy (proPSMA): a prospective, randomised, multicentre study. Lancet 2020; 395:1208-1216. [PMID: 32209449 DOI: 10.1016/s0140-6736(20)30314-7] [Citation(s) in RCA: 943] [Impact Index Per Article: 235.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 02/02/2020] [Accepted: 02/04/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Conventional imaging using CT and bone scan has insufficient sensitivity when staging men with high-risk localised prostate cancer. We aimed to investigate whether novel imaging using prostate-specific membrane antigen (PSMA) PET-CT might improve accuracy and affect management. METHODS In this multicentre, two-arm, randomised study, we recruited men with biopsy-proven prostate cancer and high-risk features at ten hospitals in Australia. Patients were randomly assigned to conventional imaging with CT and bone scanning or gallium-68 PSMA-11 PET-CT. First-line imaging was done within 21 days following randomisation. Patients crossed over unless three or more distant metastases were identified. The primary outcome was accuracy of first-line imaging for identifying either pelvic nodal or distant-metastatic disease defined by the receiver-operating curve using a predefined reference-standard including histopathology, imaging, and biochemistry at 6-month follow-up. This trial is registered with the Australian New Zealand Clinical Trials Registry, ANZCTR12617000005358. FINDINGS From March 22, 2017 to Nov 02, 2018, 339 men were assessed for eligibility and 302 men were randomly assigned. 152 (50%) men were randomly assigned to conventional imaging and 150 (50%) to PSMA PET-CT. Of 295 (98%) men with follow-up, 87 (30%) had pelvic nodal or distant metastatic disease. PSMA PET-CT had a 27% (95% CI 23-31) greater accuracy than that of conventional imaging (92% [88-95] vs 65% [60-69]; p<0·0001). We found a lower sensitivity (38% [24-52] vs 85% [74-96]) and specificity (91% [85-97] vs 98% [95-100]) for conventional imaging compared with PSMA PET-CT. Subgroup analyses also showed the superiority of PSMA PET-CT (area under the curve of the receiver operating characteristic curve 91% vs 59% [32% absolute difference; 28-35] for patients with pelvic nodal metastases, and 95% vs 74% [22% absolute difference; 18-26] for patients with distant metastases). First-line conventional imaging conferred management change less frequently (23 [15%] men [10-22] vs 41 [28%] men [21-36]; p=0·008) and had more equivocal findings (23% [17-31] vs 7% [4-13]) than PSMA PET-CT did. Radiation exposure was 10·9 mSv (95% CI 9·8-12·0) higher for conventional imaging than for PSMA PET-CT (19·2 mSv vs 8·4 mSv; p<0·001). We found high reporter agreement for PSMA PET-CT (κ=0·87 for nodal and κ=0·88 for distant metastases). In patients who underwent second-line image, management change occurred in seven (5%) of 136 patients following conventional imaging, and in 39 (27%) of 146 following PSMA PET-CT. INTERPRETATION PSMA PET-CT is a suitable replacement for conventional imaging, providing superior accuracy, to the combined findings of CT and bone scanning. FUNDING Movember and Prostate Cancer Foundation of Australia. VIDEO ABSTRACT.
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Affiliation(s)
- Michael S Hofman
- Molecular Imaging and Therapeutic Nuclear Medicine, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia.
| | - Nathan Lawrentschuk
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia; Department of Surgery, Austin Health, Melbourne, VIC, Australia; Urological Society of Australia and New Zealand, NSW, Australia
| | - Roslyn J Francis
- Department of Nuclear Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia; University of Western Australia, Faculty of Health and Medical Sciences, Perth, WA, Australia; ARTnet, NSW, Australia
| | - Colin Tang
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Perth, Australia
| | - Ian Vela
- Department of Urology, Princess Alexandra Hospital, Australian Prostate Cancer Research Centre-Queensland, Queensland University of Technology, Translational Research Institute, Brisbane, QLD, Australia
| | - Paul Thomas
- Department of Nuclear Medicine, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia; Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Natalie Rutherford
- Department of Nuclear Medicine, Hunter New England Health, Newcastle, NSW, Australia
| | - Jarad M Martin
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
| | - Mark Frydenberg
- Department of Surgery, Monash University and Cabrini Institute, Cabrini Health, Melbourne, VIC, Australia
| | - Ramdave Shakher
- Monash Health Imaging, Monash Health, Melbourne, VIC, Australia
| | - Lih-Ming Wong
- Department of Urology and Surgery, St Vincent's Health Melbourne, University of Melbourne, Melbourne, VIC, Australia
| | - Kim Taubman
- Department of Medical Imaging, PET/CT and St Vincent's Private Radiology, St Vincent's Health, Melbourne, VIC, Australia
| | - Sze Ting Lee
- Department of Molecular Imaging and Therapy, Austin Health, Melbourne, VIC, Australia
| | - Edward Hsiao
- University of Sydney, Department of Nuclear Medicine and PET, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Paul Roach
- University of Sydney, Department of Nuclear Medicine and PET, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Michelle Nottage
- Clinical and Research Imaging Centre, South Australian Health and Medical Research Institute, Adelaide, SA, Australia; Dr Jones and Partners Medical Imaging, Adelaide, SA, Australia
| | - Ian Kirkwood
- Department of Nuclear Medicine and PET, Royal Adelaide Hospital, Adelaide, SA, Australia; Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Dickon Hayne
- UWA Medical School, University of Western Australia, Perth, WA, Australia
| | - Emma Link
- Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
| | - Petra Marusic
- Molecular Imaging and Therapeutic Nuclear Medicine, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Anetta Matera
- Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Alan Herschtal
- Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Amir Iravani
- Molecular Imaging and Therapeutic Nuclear Medicine, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
| | - Rodney J Hicks
- Molecular Imaging and Therapeutic Nuclear Medicine, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
| | - Scott Williams
- Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia; Australian and New Zealand Urogenital and Prostate Cancer Trials Group, NSW, Australia
| | - Declan G Murphy
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
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Weickhardt AJ, Foroudi F, Lawrentschuk N, Galleta L, Seegum A, Herschtal A, Link E, McJannett MM, Liow ECH, Grimison PS, Zhang AY, Patanjali NI, Ng S, Goodwin R, Tang C, Chen C, Hovey EJ, Hruby G, Guminski AD, Davis ID. Pembrolizumab with chemoradiotherapy as treatment for muscle invasive bladder cancer: A planned interim analysis of safety and efficacy of the PCR-MIB phase II clinical trial (ANZUP 1502). J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.6_suppl.485] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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
485 Background: In patients (pts) with muscle invasive bladder (MIBC) suitable for curative definitive chemoradiotherapy (CRT), we hypothesise that the addition of pembrolizumab may be safe and improve efficacy. A pre-planned safety analysis was performed after the first 10 of planned 30 pts were enrolled and completed treatment. Methods: Patients with maximally resected non-metastatic MIBC and ECOG 0-1, who desire bladder preservation or are ineligible for cystectomy were treated with 64Gy in 32 daily radiation fractions to the whole bladder alone over 6.5 weeks in combination with 6 concurrent doses of weekly cisplatin at 35mg/m2 IV. Pembrolizumab was commenced concurrently with radiation and given flat-dose 200mg IV q21 days for 7 doses. Surveillance cystoscopy, urine cytology and CT chest-abdomen-pelvis were performed 12 & 24 weeks post CRT. The primary endpoint is feasibility, defined by a satisfactory low rate of unacceptable toxicity of a) G3-4 non-urinary adverse events (AE) or b) failure of completion of planned CRT according to defined parameters. Secondary endpoints include complete cystoscopic response without metastatic disease at 12 & 24 weeks, loco-regional PFS, metastatic DFS, and overall survival. A 2-stage design was planned, with accrual to be halted if >5 of the first 10 pts experienced unacceptable toxicity up to 12 weeks post treatment. Results: All 10 pts completed the course of CRT and pembrolizumab without alteration in radiation dose or schedule. 1 patient had a dose of cisplatin withheld. 4/10 pts experienced G3-4 non-urinary adverse events within 12 weeks of completing treatment. One immune related AE interrupted pembrolizumab delivery (G2 nephritis). By week 24, 9/10 pts achieved a complete cystoscopic response to treatment post CRT and were free of distant metastatic disease. Conclusions: Interim results indicate that pembrolizumab and CRT shows satisfactory safety, and promising efficacy. There were no unexpected safety signals. Follow up of these and additional pts will better define the efficacy and safety of the combination. Enrolment is ongoing with 20 pts recruited out of a planned total of 30. Clinical trial information: NCT02662062.
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Affiliation(s)
| | - Farshad Foroudi
- Olivia Newton-John Cancer Wellness and Research Centre, Austin Health, Melbourne, Australia
| | - Nathan Lawrentschuk
- Olivia Newton-John Cancer Wellness and Research Centre, Austin Health, Melbourne, Australia
| | - Laura Galleta
- Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Amanda Seegum
- Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Alan Herschtal
- Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Emma Link
- Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Margaret Mary McJannett
- Australian and New Zealand Urogenital and Prostate Cancer Trials Group, Camperdown, NSW, Australia
| | | | | | | | | | - Siobhan Ng
- Sir Charles Gairdner Hospital, Perth, Australia
| | | | - Colin Tang
- Sir Charles Gairdner Hospital, Perth, Australia
| | - Colin Chen
- Prince of Wales Hospital, Sydney, Australia
| | | | - George Hruby
- Department of Radiation Oncology, Royal North Shore Hospital, St Leonards, NSW, Australia
| | | | - Ian D. Davis
- Monash University Eastern Health Clinical School, Melbourne, Australia
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12
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Terai M, Londin E, Rochani A, Link E, Lam B, Kaushal G, Bhushan A, Orloff M, Sato T. Expression of Tryptophan 2,3-Dioxygenase in Metastatic Uveal Melanoma. Cancers (Basel) 2020; 12:E405. [PMID: 32050636 PMCID: PMC7072257 DOI: 10.3390/cancers12020405] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 01/24/2020] [Accepted: 02/04/2020] [Indexed: 12/19/2022] Open
Abstract
Uveal melanoma (UM) is the most common primary eye malignancy in adults and up to 50% of patients subsequently develop systemic metastasis. Metastatic uveal melanoma (MUM) is highly resistant to immunotherapy. One of the mechanisms for resistance would be the immune-suppressive tumor microenvironment. Here, we have investigated the role of tryptophan 2,3-dioxygenase (TDO) in UM. Both TDO and indoleamine 2,3-dioxygenase (IDO) catalyze tryptophan and produce kynurenine, which could cause inhibition of T cell immune responses. We first studied the expression of TDO on tumor tissue specimens obtained from UM hepatic metastasis. High expression of TDO protein was confirmed in all hepatic metastasis. TDO was positive in both normal hepatocytes and the tumor cells with relatively higher expression in tumor cells. On the other hand, IDO protein remained undetectable in all of the MUM specimens. UM cell lines established from metastasis also expressed TDO protein and increasing kynurenine levels were detected in the supernatant of MUM cell culture. In TCGA database, higher TDO2 expression in primary UM significantly correlated to BAP1 mutation and monosomy 3. These results indicate that TDO might be one of the key mechanisms for resistance to immunotherapy in UM.
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Affiliation(s)
- Mizue Terai
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107, USA; (E.L.); (B.L.); (M.O.); (T.S.)
| | - Eric Londin
- Computational Medicine Center, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107, USA;
| | - Ankit Rochani
- Department of Pharmaceutical Sciences, Jefferson College of Pharmacy, Thomas Jefferson University, Philadelphia, PA 19107, USA; (A.R.); (G.K.); (A.B.)
| | - Emma Link
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107, USA; (E.L.); (B.L.); (M.O.); (T.S.)
- College of Medicine, Drexel University, Philadelphia, PA 19129, USA
| | - Bao Lam
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107, USA; (E.L.); (B.L.); (M.O.); (T.S.)
| | - Gagan Kaushal
- Department of Pharmaceutical Sciences, Jefferson College of Pharmacy, Thomas Jefferson University, Philadelphia, PA 19107, USA; (A.R.); (G.K.); (A.B.)
| | - Alok Bhushan
- Department of Pharmaceutical Sciences, Jefferson College of Pharmacy, Thomas Jefferson University, Philadelphia, PA 19107, USA; (A.R.); (G.K.); (A.B.)
| | - Marlana Orloff
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107, USA; (E.L.); (B.L.); (M.O.); (T.S.)
| | - Takami Sato
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107, USA; (E.L.); (B.L.); (M.O.); (T.S.)
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Lung MS, Hicks RJ, Pavlakis N, Link E, Jefford M, Thomson B, Wyld DK, Liauw W, Akhurst T, Kuru N, Michael M. The INTERNET STUDY: A phase II study of everolimus in patients with fluorodeoxyglucose ( 18 F) positron-emission tomography positive intermediate grade pancreatic neuroendocrine tumors. Asia Pac J Clin Oncol 2020; 16:150-157. [PMID: 32030887 DOI: 10.1111/ajco.13307] [Citation(s) in RCA: 2] [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: 05/03/2019] [Accepted: 01/07/2020] [Indexed: 12/24/2022]
Abstract
AIMS This multicenter phase II trial evaluates the efficacy of everolimus in poor prognosis grade 2 (G2) pancreatic neuroendocrine tumors (PNETs), defined by 2-[fluorine-18]fluoro-2-deoxy-d-glucose (FDG) positron-emission tomography (PET) avidity. FDG-PET avidity in NETs is associated with a significantly higher risk of death, outperforming Ki-67 index or liver metastases as a poor prognostic factor. We hypothesized that everolimus has efficacy in patients with FDG-PET-avid G2 PNETs and prospectively evaluated progression-free survival (PFS) and response in the first-line setting. METHODS Patients with FDG-PET-avid G2 advanced PNET received everolimus 10 mg daily until disease progression. Patients were staged every 12 weeks with CT/MRI and FDG-PET and every 24 weeks with Gallium 68 (68Ga) 1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetic acid (DOTA)-octreotate (DOTATATE, GaTate) PET. The primary endpoint was PFS at 6 months. Overall survival rate, PET/structural imaging response and toxicity were also measured. RESULTS Nine patients were accrued from December 2012 to February 2015. Median treatment duration was 13.8 months. The estimated PFS rate at 6 months was 78%. The best response on CT/MRI was stable disease in nine patients (100%) and partial response on FDG-PET in five patients (55.5%). Treatment-related adverse effects were consistent with previous studies of everolimus. CONCLUSION Everolimus is active with prolonged disease control in poor prognosis FDG-avid G2 PNETs. Treatment individualization based on functional imaging warrants further evaluation.
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Affiliation(s)
- Mei Sim Lung
- Neuroendocrine Unit, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Division of Cancer Medicine, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Rodney J Hicks
- Neuroendocrine Unit, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Centre for Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC, Australia
| | - Nick Pavlakis
- Department of Medical Oncology, Royal North Shore Hospital, St. Leonards, NSW, Australia
| | - Emma Link
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC, Australia.,Biostatistics and Clinical Trials Centre, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre Building, Melbourne, VIC, Australia
| | - Michael Jefford
- Neuroendocrine Unit, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Division of Cancer Medicine, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC, Australia
| | - Benjamin Thomson
- Neuroendocrine Unit, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,University of Melbourne Department of Surgery, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - David K Wyld
- Department of Medical Oncology, Royal Brisbane and Women's Hospital, QLD, Australia.,School of Medicine, University of Queensland, QLD, Australia
| | - Winston Liauw
- Department of Medical Oncology, Cancer Care Centre, Kogarah, NSW, Australia
| | - Timothy Akhurst
- Neuroendocrine Unit, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Centre for Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC, Australia
| | - Narmatha Kuru
- Biostatistics and Clinical Trials Centre, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre Building, Melbourne, VIC, Australia
| | - Michael Michael
- Neuroendocrine Unit, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Division of Cancer Medicine, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC, Australia
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Pham T, Pereira L, Roth S, Galletta L, Link E, Akhurst T, Solomon B, Michael M, Darcy P, Sampurno S, Heriot A, Ramsay R, Desai J. First-in-human phase I clinical trial of a combined immune modulatory approach using TetMYB vaccine and Anti-PD-1 antibody in patients with advanced solid cancer including colorectal or adenoid cystic carcinoma: The MYPHISMO study protocol (NCT03287427). Contemp Clin Trials Commun 2019; 16:100409. [PMID: 31650066 PMCID: PMC6804811 DOI: 10.1016/j.conctc.2019.100409] [Citation(s) in RCA: 5] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 06/30/2019] [Accepted: 07/09/2019] [Indexed: 11/04/2022] Open
Abstract
Background MYB is a transcription factor that is overexpressed in colorectal cancer (CRC) and also a driver mutation in adenoid cystic carcinoma (AdCC). Therefore, the MYB protein is an ideal target to vaccinate against to aid recruitment of tumour infiltrating lymphocytes (TILs) against these tumours. The Peter MacCallum Cancer Centre (Melbourne, Australia) has engineered a DNA vaccine, TetMYB, based on the pVAX1 plasmid vector carrying a fusion construct consisting of the universal tetanus toxin T-cell epitopes flanking an inactivated MYB gene. Methods This prospective first-in-human phase I single-arm multi-centre clinical trial involves patients with metastatic CRC or AdCC. Stage 1 will evaluate the safety profile of escalating doses of TetMYB vaccine, given sequentially and in combination with an anti-PD-1 inhibitory antibody, to determine the maximum tolerated dose (MTD). Stage 2 will assess the MTD in an expanded cohort. The calculated sample size is 32 patients: 12 in Stage 1 and 20 in Stage 2. The expected total duration of the trial is 3 years with 15 months of recruitment followed by a minimum of 18 months follow-up. Discussion MYB transcription factor is aberrantly overexpressed in a range of epithelial cancers, not limited to the above tumour types. Based on promising pre-clinical data of vaccine-induced tumour clearance and establishment of anti-tumour memory, we are embarking on this first-in-human trial. If successful, the results from this trial will allow progression to a Phase II trial and validation of this breakthrough immunotherapeutic approach, not only in CRC and AdCC, but other MYB over-expressing cancers. Trial registration ClinicalTrials.gov ID: NCT03287427. Registered: September 19, 2017.
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Affiliation(s)
- Toan Pham
- Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, Australia.,Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia.,Department of Surgery, University of Melbourne, Melbourne, Australia
| | - Lloyd Pereira
- Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Sara Roth
- Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Laura Galletta
- Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Emma Link
- Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Tim Akhurst
- Division of Medical Imaging, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Ben Solomon
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia.,Division of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Michael Michael
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia.,Division of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Phillip Darcy
- Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Shienny Sampurno
- Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Alexander Heriot
- Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, Australia.,Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia.,Department of Surgery, University of Melbourne, Melbourne, Australia
| | - Robert Ramsay
- Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia.,Department of Pathology, University of Melbourne, Melbourne, Australia
| | - Jayesh Desai
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia.,Division of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
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Terai M, Link E, Gonsalves CF, Eschelman DJ, Adamo RD, Danielson M, Orloff MM, Sato T. Abstract 4052: Cytokines and chemokines production after radiosphere treatment for uveal melanoma patients with hepatic metastases. Cancer Res 2019. [DOI: 10.1158/1538-7445.am2019-4052] [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
Uveal melanoma (UM) is the most common primary intraocular malignancy in adults. Despite successful treatments for primary UM, up to 50% of patients subsequently develop systemic metastasis, often in the liver. Treatment options are limited after development of hepatic metastasis, and the median survival of patients is reported to be 6 to 12 months. Immune-checkpoint blockades have not proved effective in the management of metastatic UM. We have conducted a phase 2 clinical trial using 90Y resin microspheres (radiosphere) (SIR-Spheres, Sirtex Medical) for uveal melanoma patients with liver-dominant metastasis [NCT NCT01473004]. In this clinical trial, patients with liver dominant metastasis were enrolled to arm A (n=24): no previously liver-direct treatment, and arm B (n=23): second line treatment after failing immunoembolization (IE). Blood samples were collected and processed before therapy (baseline), 1 hour after completion of therapy, at 1 month, and 3 months after therapy. Serum levels of cytokines and chemokines were analyzed by Bead-based Multiplex assay using the Luminex technology (MilliporeSigma). All of the samples were tested using a panel of 11 cytokines: interleukin (IL)-10, IL-1 beta, IL-6, IL-8, IP-10, MCP-1, TNF-alpha, TGF-beta1, CXCL9, HMGB-1, and HGF by Luminex FLEXMAP 3D. IL-8 levels were increased at 1 and 3 months after radiosphere (RE) treatment in both arms compared to baseline (paired T-test, P<0.05). Pretreatment IL-8 levels were 8.75 ± 2.1 pg/mL in arm A and 22.02 ± 8.3 pg/mL in arm B, respectively. IL-8 levels at 1 and 3 months were 20.1 ± 6.5 and 16.2 ± 4.2 pg/mL in arm A and 31.8 ± 9.3 and 40.2 ± 11.2 pg/mL in arm B, respectively. IP-10, MCP-1 and CXCL9 were also increased at 1 or 3 month after treatment in both arms, compared to the baseline levels (paired T-test, P<0.05). The pattern of these cytokine productions were similar in both arms suggesting that this is most likely related to chronic inflammation after RE treatment rather than previous therapies. We also analyzed the correlation of cytokines level with clinical responses in all patients. There was no significant difference in cytokines levels in partial response (PR), stable disease (SD), and progress disease (PD) except HMGB-1 levels prior to treatment between PR (15.6 ± 2.7 pg/mL) and PD (30.5 ± 6.4 pg/mL) (unpaired T-test, P<0.05). There is no significant difference in any cytokines and chemokines levels at baseline between arm A and B. In addition, there were no significant treatment-related change in other inflammatory cytokines, such as IL-6, TNF-alpha, and IL-10. In contrast to IE, RE did not produce robust inflammatory cytokine responses. However, baseline HMGB-1 and increase in IL-8 and IFN-gamma-related chemokines after RE treatments might be used to predictive clinical response and development of chronic inflammation after radiosphere.
Citation Format: Mizue Terai, Emma Link, Carin F. Gonsalves, David J. Eschelman, Rober D. Adamo, Meggie Danielson, Marlana M. Orloff, Takami Sato. Cytokines and chemokines production after radiosphere treatment for uveal melanoma patients with hepatic metastases [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 4052.
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Affiliation(s)
- Mizue Terai
- 1Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA
| | - Emma Link
- 1Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA
| | | | | | | | - Meggie Danielson
- 1Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA
| | - Marlana M. Orloff
- 1Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA
| | - Takami Sato
- 1Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA
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Yonis G, Cabalag CS, Link E, Duong CP. Utility of routine oral contrast study for detecting postesophagectomy anastomotic leak - a systematic review and meta-analysis. Dis Esophagus 2019; 32:5373139. [PMID: 30855088 DOI: 10.1093/dote/doz011] [Citation(s) in RCA: 5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Oral contrast studies are used to detect anastomotic leak (AL) postesophagectomy. However, recent evidence suggests oral contrast studies have low sensitivity in detecting ALs, and their false positive results can lead to unnecessary prolonged hospital stay. The objective of this study was to determine if oral contrast studies should be used routinely post-esophagectomy for cancer. A systematic literature search was conducted for studies published between January 1990 and June 2018. Data extracted for analyses included type of esophagectomy, operative morbidity (such as AL and pneumonia), mortality rates, timing of contrast study, and type of oral contrast used. The sensitivity, specificity, and positive and negative predictive values of routine oral contrast studies to detect AL were calculated using the aforementioned variables. Two hundred and forty-seven studies were reviewed with 16 studies included in the meta-analysis. Postoperative oral contrast study was performed in 94.0% of cases between day 5 and 7. The rates of early and delayed leaks were 2.4% (1.8%-3.3%) and 2.8% (1.8%-4.4%), respectively. Routine contrast studies have a sensitivity and specificity of 0.44 (0.32-0.57) and 0.98 (0.95-0.99), respectively. Analysis of covariates revealed that sensitivity is reduced in centers with a higher volume of cases (greater than 15 per year: 0.50 [0.34-0.75; p = 0.0008]) and specificity was higher in centers with a lower leak rate. Given its poor sensitivity and inability to detect early/delayed AL, oral contrast study should be used selectively with endoscopy and/or computerized tomography scan to assess surgical anastomoses following esophagectomy.
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Affiliation(s)
- G Yonis
- University of Edinburgh, Edinburgh, UK
| | - C S Cabalag
- Division of Cancer Surgery, Peter MacCallum Cancer Centre (Victorian Comprehensive Cancer Centre)
| | - E Link
- Division of Cancer Surgery, Peter MacCallum Cancer Centre (Victorian Comprehensive Cancer Centre).,Department of Biostatistics, Peter MacCallum Cancer Centre (Victorian Comprehensive Cancer Centre)
| | - C P Duong
- Division of Cancer Surgery, Peter MacCallum Cancer Centre (Victorian Comprehensive Cancer Centre)
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Michael M, Wong R, Gill SS, Goldstein D, Ngan S, Heriot AG, Link E, Farrell M, Neeson PJ, Ramsay RG, Wilson K, Mitchell C, Tie J, Pavlakis N, Zalcberg JR, Segelov E. Phase II trial PD-L1/PD-1 blockade avelumab with chemoradiotherapy for locally advanced resectable T3B-4/N1-2 rectal cancer: The Ave-Rec trial. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.tps3622] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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
TPS3622 Background: Standard neoadjuvant long course chemoradiotherapy (LCCRT) for locally advanced rectal cancer (LARC) results in a complete pathological response rate of 10-30%: but 20-40% of patients (pts) are non-responders, 10-15% have local recurrence. Tumoural immune infiltrates are predictive of response. Preclinical studies show that radiotherapy (RT) via interferon signaling is immuno-stimulatory, enhancing local/distant tumour cell death. RT also stimulates PDL1 production and the immunosuppressive activity of myeloid derived suppressor cells. Hence PDL1 inhibition may be required to enhance the immuno-stimulatory effects of RT. Hypothesis: In pts with resectable LARC, the anti-PDL1 antibody Avelumab post LCCRT may enhance the pathological/imaging response rates whilst potentially reducing local/distant relapse rates. Methods: (1) Trial Design: Phase II single arm trial, across 6 Australian sites (2) Endpoints: (a) Primary; Pathological response rate post-LCCRT, as documented by central pathologist, (b) Secondary; MRI/FDG PET imaging responses at 8 weeks post LCCRT (pre-surgery). Toxicity. (c) Exploratory; Tumoural immune cell subsets/checkpoint expression (by multiplex immunohistochemistry and in-vitro functional assays) and ctDNA analysis at baseline and during treatment. Distant relapse-free survival and the documentation of sites of relapse. (3) Sample size: An increase in the proportion of pathological complete responses by > 25% (from 10% to 35%) will be considered clinically important. Power = 90%, α = 0.05, 41 pts are required– an additional 4 pts to allow for drop-out. Total sample size = 45pts. Treatment: All pts to receive standard LCCRT (50.4Gy RT plus 5FU [225mg/m2/day/CI] or Capecitabine [825mg/m2 BID on RT days] over 5.5 weeks). Post LCCRT (prior to surgery), pts receive 4 cycles Avelumab (10mg/kg, q2 weeks). Surgical resection 10-12 weeks post LCCRT. Fresh tumour biopsy and ctDNA sampling pre LCCRT, pre Cycle 1 Avelumab and at surgery. Response by FDG PET and pelvic MRI pre surgery. Pts to be followed up for 2 years. Major Inclusion Criteria: Pts with LARC, MRI stage T3b-4/N1-2/M0, planned for LCCRT followed by curative resection, tumoural lower border within 12cm from the anal verge, measurable disease (RECIST1.1), ECOG 0-1, adequate organ function and no contraindications to Avelumab therapy. Current Enrolment: 11 of the planned 45 patients enrolled. Clinical trial information: NCT03299660.
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Affiliation(s)
- Michael Michael
- Division of Cancer Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Rachel Wong
- Eastern Health, Monash University, Melbourne, Australia
| | | | - David Goldstein
- Prince of Wales Hospital, University of New South Wales, Cancer Survivors Centre, Randwick, Australia
| | - Sam Ngan
- Peter MacCallum Cancer Centre, Melbourne, Australia
| | | | - Emma Link
- Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Maria Farrell
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | | | | | - Kasmira Wilson
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | | | - Jeanne Tie
- Department of Medical Oncology, Western Health, Melbourne, Australia
| | - Nick Pavlakis
- Northern Cancer Institute, St Leonards, Sydney, Australia
| | | | - Eva Segelov
- Department of Medical Oncology, Monash Health, Melbourne, VIC, Australia
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18
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Khot A, Brajanovski N, Cameron DP, Hein N, Maclachlan KH, Sanij E, Lim J, Soong J, Link E, Blombery P, Thompson ER, Fellowes A, Sheppard KE, McArthur GA, Pearson RB, Hannan RD, Poortinga G, Harrison SJ. First-in-Human RNA Polymerase I Transcription Inhibitor CX-5461 in Patients with Advanced Hematologic Cancers: Results of a Phase I Dose-Escalation Study. Cancer Discov 2019; 9:1036-1049. [PMID: 31092402 DOI: 10.1158/2159-8290.cd-18-1455] [Citation(s) in RCA: 96] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 04/11/2019] [Accepted: 05/10/2019] [Indexed: 11/16/2022]
Abstract
RNA polymerase I (Pol I) transcription of ribosomal RNA genes (rDNA) is tightly regulated downstream of oncogenic pathways, and its dysregulation is a common feature in cancer. We evaluated CX-5461, the first-in-class selective rDNA transcription inhibitor, in a first-in-human, phase I dose-escalation study in advanced hematologic cancers. Administration of CX-5461 intravenously once every 3 weeks to 5 cohorts determined an MTD of 170 mg/m2, with a predictable pharmacokinetic profile. The dose-limiting toxicity was palmar-plantar erythrodysesthesia; photosensitivity was a dose-independent adverse event (AE), manageable by preventive measures. CX-5461 induced rapid on-target inhibition of rDNA transcription, with p53 activation detected in tumor cells from one patient achieving a clinical response. One patient with anaplastic large cell lymphoma attained a prolonged partial response and 5 patients with myeloma and diffuse large B-cell lymphoma achieved stable disease as best response. CX-5461 is safe at doses associated with clinical benefit and dermatologic AEs are manageable. SIGNIFICANCE: CX-5461 is a first-in-class selective inhibitor of rDNA transcription. This first-in-human study establishes the feasibility of targeting this process, demonstrating single-agent antitumor activity against advanced hematologic cancers with predictable pharmacokinetics and a safety profile allowing prolonged dosing. Consistent with preclinical data, antitumor activity was observed in TP53 wild-type and mutant malignancies.This article is highlighted in the In This Issue feature, p. 983.
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Affiliation(s)
- Amit Khot
- Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Natalie Brajanovski
- Cancer Research Division, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Donald P Cameron
- The ACRF Department of Cancer Biology and Therapeutics, The John Curtin School of Medical Research, Australian National University, Australian Capital Territory, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
| | - Nadine Hein
- The ACRF Department of Cancer Biology and Therapeutics, The John Curtin School of Medical Research, Australian National University, Australian Capital Territory, Australia
| | - Kylee H Maclachlan
- Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Cancer Research Division, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
| | - Elaine Sanij
- Cancer Research Division, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia.,Department of Pathology, University of Melbourne, Parkville, Victoria, Australia
| | - John Lim
- Senhwa Biosciences, Inc., New Taipei City, Taiwan, Republic of China
| | - John Soong
- Senhwa Biosciences, Inc., New Taipei City, Taiwan, Republic of China
| | - Emma Link
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia.,Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Piers Blombery
- Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia.,Department of Pathology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Ella R Thompson
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia.,Department of Pathology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Andrew Fellowes
- Cancer Research Division, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Department of Pathology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Karen E Sheppard
- Cancer Research Division, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia.,Department of Biochemistry and Molecular Biology, University of Melbourne, Parkville, Victoria, Australia
| | - Grant A McArthur
- Cancer Research Division, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia.,Department of Medicine, St. Vincent's Hospital, University of Melbourne, Parkville, Victoria, Australia
| | - Richard B Pearson
- Cancer Research Division, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia.,Department of Biochemistry and Molecular Biology, University of Melbourne, Parkville, Victoria, Australia.,Department of Biochemistry and Molecular Biology, Monash University, Clayton, Victoria, Australia
| | - Ross D Hannan
- Cancer Research Division, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,The ACRF Department of Cancer Biology and Therapeutics, The John Curtin School of Medical Research, Australian National University, Australian Capital Territory, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia.,Department of Biochemistry and Molecular Biology, University of Melbourne, Parkville, Victoria, Australia.,Department of Biochemistry and Molecular Biology, Monash University, Clayton, Victoria, Australia.,School of Biomedical Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - Gretchen Poortinga
- Cancer Research Division, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia. .,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia.,Department of Medicine, St. Vincent's Hospital, University of Melbourne, Parkville, Victoria, Australia
| | - Simon J Harrison
- Clinical Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Victoria, Australia. .,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
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Abstract
Abstract
Uveal (eye) melanoma (UM) is the most common primary eye malignancy in adults. Despite effective treatments for primary UM, up to 50% of patients subsequently develop systemic metastasis, predominantly in the liver. Once hepatic metastasis develops, the survival of UM patients is generally short and currently available treatments fail to show meaningful improvement of their survival. Metastatic uveal melanoma (MUM) is highly resistant to traditional systemic therapies, including immunotherapy. Immune checkpoint blockades approved for metastatic cutaneous melanoma (MCM) such as anti-CTLA4 antibody and anti-PD-1 antibody have shown only marginal clinical benefit in MUM (response rates <5%). We have reported that, while PD-1 expression was seen in both MCM and MUM, there was a stark difference in PD-L1 expression between these two types of melanoma (MCM vs. MUM, 20.8% vs. 0%) (ASCO 2016, A Javed, et al). It is of note that, of 6 MCM specimens obtained from hepatic metastasis, none expressed PD-L1. These results indicate the presence of unique immune microenvironment in the liver, harboring melanoma metastasis. One of the factors dominant in the liver is tryptophan 2,3-dioxygenase (TDO). TDO and indoleamine 2,3-dioxygenase (IDO) catalyze tryptophan and produce kynurenine, a metabolite that reportedly inhibits anti-tumor T cell immune responses. Recent studies have revealed that TDO is constitutively expressed in a wide variety of cancer cells. Investigation on TCGA data indicates expression of TDO2 in 62% of primary UM. 42% of samples showed increased TDO2 expression (RPKM >= 1 RPKM), while TDO2 message is not present in 1/3 of the samples. Expression of TDO2 in primary UM correlated to poor survival (Cox regression hazard ratio 0.7, p=0.04). Moreover, TDO2 expression correlated to patients with BAP1 mutations (p=0.00071) and differences between patients with monosomy 3 and disomy 3 (p=0.00017). We further investigated whether MUM cell lines and MUM tumor specimens express TDO. We detected TDO protein in all of 4 MUM cell lines by Western blotting. Although inducible by exogenous IFN-gamma, IDO1 protein was not detected in any of these MUM cell lines without stimulation. TDO mRNA was increased 3.5 fold by stimulating MUM cells with recombinant human TNF-alpha. All MUM cell lines possess TNF-alpha receptors. We have also investigated TDO and IDO1 proteins in 10 MUM specimens obtained from hepatic metastasis by immuno-histochemical staining. TDO was positive in both normal hepatocytes as well as tumor themselves in all MUM specimens. Interestingly, the intensity of TDO staining is much stronger in MUM, compared to the surrounding liver tissues. On the other hand, IDO1 protein was not positive in any of MUM tissues obtained from liver metastasis. These results indicate that expression of TDO by MUM cells might be one of the key mechanisms for escape from T-cell immune surveillance in hepatic metastasis from primary UM.
Citation Format: Mizue Terai, Emma Link, Eric Link, Bao Lam, Marlana Orloff, Takami Sato. Expression of tryptophan -2, 3-dioxygense (TDO) in metastatic uveal melanoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 3805.
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Affiliation(s)
- Mizue Terai
- Sidney Kimmel Medical Collegen of Thomas Jefferson University, Philadelphia, PA
| | - Emma Link
- Sidney Kimmel Medical Collegen of Thomas Jefferson University, Philadelphia, PA
| | - Eric Link
- Sidney Kimmel Medical Collegen of Thomas Jefferson University, Philadelphia, PA
| | - Bao Lam
- Sidney Kimmel Medical Collegen of Thomas Jefferson University, Philadelphia, PA
| | - Marlana Orloff
- Sidney Kimmel Medical Collegen of Thomas Jefferson University, Philadelphia, PA
| | - Takami Sato
- Sidney Kimmel Medical Collegen of Thomas Jefferson University, Philadelphia, PA
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Michael M, Pook DW, Ganju V, Link E, Toner GC, Hicks RJ, Matera A, Thompson M, Cullinane C, Campbell I, Burge M, Karapetis CS. The utility of genomics and functional imaging to predict Sunitinib PK and PD: The Predict SU study. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.2563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Michael Michael
- Division of Cancer Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia
| | | | - Vinod Ganju
- Peninsula and Southeast Oncology, Frankston, Australia
| | - Emma Link
- Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Guy C. Toner
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Australia, Melbourne, Australia
| | - Rodney J Hicks
- Department of Cancer Imaging, Peter MacCallum Cancer Centre, Australia, Melbourne, Australia
| | | | | | | | - Ian Campbell
- Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Matthew Burge
- Royal Brisbane and Women Hospital, and University of Queensland, Herston, Australia
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Michael M, Liauw W, McLachlan SA, Link E, Matera A, Thompson M, Jefford M, Hicks R, Cullinane C, Campbell I, Beale P, Karapetis C, Price T, Burge M. Hepatic functional imaging and genomics to predict irinotecan pharmacokinetics and pharmacodynamics: The PREDICT IR study. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx367.038] [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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Michael M, Liauw W, McLACHLAN SA, Link E, Matera A, Thompson M, Jefford M, Hicks RJ, Cullinane C, Campbell I, Beale PJ, Karapetis CS, Price T, Burge ME. The utility of genomics and functional imaging to predict irinotecan pharmacokinetics and pharmacodynamics: The PREDICT IR study. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.2564] [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
2564 Background: BSA-based dosing of Irinotecan (IR), does not account for its pharmacokinetic (PK) and pharmacodynamic (PD) variability. Given IR’s unique metabolism, functional hepatic nuclear imaging (HNI) with probes for hepatic transporters correlated with its PK. This study further evaluated the utility of HNI combined with extensive excretory/metabolic/PD pharmacogenomics (PG) to predict IR PK and PD in patients (pts) treated with FOLFIRI to enable dose individualization. Methods: Eligible pts had advanced colorectal cancer, suitable for 1st/2nd-line FOLFIRI± Bevacizumab. Pts had blood analyzed by Affymetrix DMET™ Plus Array and additional SNPs were genotyped. For HNI, pts were given IV 250MBq 99mTc-IDA and imaging data analyzed for hepatic extraction/excretion parameters (clearance [CL], 1hour retention [1hRET], deconvulutional CL [DeCL], hepatic extraction fraction [HEF]). Pts treated with chemotherapy, q2-weekly, and restaged after 4 cycles. Blood taken for IR and metabolite (SN38, SN38G) analysis on day 1 cycle 1, PK parameters derived by non-compartmental analysis. Statistical correlations were evaluated between (i) IDA HNI and (2) PGs, with IR PK, toxicity, objective response (ORR) and progression-free survival (PFS). Results: 32 pts analysed, 31 pts completed 4 cycles. (1) PK correlates: (a) HNI CL and 1hRET with SN38 Metabolic CL, (P = 0.04) and (b) HNI DeCL with IR AUC(0-∞) (P = 0.04). (2) Grade 3+ diarrhea (N = 4, 13%) predicted by SN38 AUC(0-∞) and Metabolic CL (P = 0.04), and gene variants for SCL22A2 and -28A3, ABCC2, UGT2B17, CYP2C18 and DPYD (P < 0.05). (3) Grade 3+ neutropenia (N = 9, 28%) predicted by SN38 PK exposure (P < 0.02), HNI CL and 1hRET (P < 0.0001) and variants for SLC7A7-, SLC22A2-, CHST1-, UGT1A1-, -2B7, ABCB1. (4) ORR (N = 6, 20%) predicted by Methylene tetrahydrofolate reductase (MTHFR) 677C > T (P = 0.002), SN38 exposure (P < 0.003), and variants in metabolic/transporter genes (P < 0.05). (5) PFS by SN38 PK exposure, MTHFR 677C > T, HNI CL, HNI HEF and variants in PK genes (P < 0.05). Conclusions: Hepatic functional imaging with extensive pharmacogenomics correlate with Irinotecan PK and PD enabling the development of nomograms to individualize dosing. Clinical trial information: ACTRN12610000898055.
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Affiliation(s)
- Michael Michael
- Division of Cancer Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia
| | | | | | - Emma Link
- Peter MacCallum Cancer Centre, Melbourne, Australia
| | | | | | | | - Rodney J Hicks
- Department of Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Australia
| | | | - Ian Campbell
- Peter MacCallum Cancer Centre, Melbourne, Australia
| | | | | | - Timothy Price
- The Queen Elizabeth Hospital Campus, CALHN, Woodville, Australia
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Bradstock KF, Link E, Di Iulio J, Szer J, Marlton P, Wei AH, Enno A, Schwarer A, Lewis ID, D'Rozario J, Coyle L, Cull G, Campbell P, Leahy MF, Hahn U, Cannell P, Tiley C, Lowenthal RM, Moore J, Cartwright K, Cunningham I, Taper J, Grigg A, Roberts AW, Benson W, Hertzberg M, Deveridge S, Rowlings P, Mills AK, Gill D, Bardy P, Campbell L, Seymour JF. Idarubicin Dose Escalation During Consolidation Therapy for Adult Acute Myeloid Leukemia. J Clin Oncol 2017; 35:1678-1685. [PMID: 28368672 DOI: 10.1200/jco.2016.70.6374] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Purpose Higher doses of the anthracycline daunorubicin during induction therapy for acute myeloid leukemia (AML) have been shown to improve remission rates and survival. We hypothesized that improvements in outcomes in adult AML may be further achieved by increased anthracycline dose during consolidation therapy. Patients and Methods Patients with AML in complete remission after induction therapy were randomly assigned to receive two cycles of consolidation therapy with cytarabine 100 mg/m2 daily for 5 days, etoposide 75 mg/m2 daily for 5 days, and idarubicin 9 mg/m2 daily for either 2 or 3 days (standard and intensive arms, respectively). The primary end point was leukemia-free survival (LFS). Results Two hundred ninety-three patients 16 to 60 years of age, excluding those with core binding factor AML and acute promyelocytic leukemia, were randomly assigned to treatment groups (146 to the standard arm and 147 to the intensive arm). Both groups were balanced for age, karyotypic risk, and FLT3-internal tandem duplication and NPM1 gene mutations. One hundred twenty patients in the standard arm (82%) and 95 patients in the intensive arm (65%) completed planned consolidation ( P < .001). Durations of severe neutropenia and thrombocytopenia were prolonged in the intensive arm, but there were no differences in serious nonhematological toxicities. With a median follow-up of 5.3 years (range, 0.6 to 9.9 years), there was a statistically significant improvement in LFS in the intensive arm compared with the standard arm (3-year LFS, 47% [95% CI, 40% to 56%] v 35% [95% CI, 28% to 44%]; P = .045). At 5 years, the overall survival rate was 57% in the intensive arm and 47% in the standard arm ( P = .092). There was no evidence of selective benefit of intensive consolidation within the cytogenetic or FLT3-internal tandem duplication and NPM1 gene mutation subgroups. Conclusion An increased cumulative dose of idarubicin during consolidation therapy for adult AML resulted in improved LFS, without increased nonhematologic toxicity.
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Affiliation(s)
- Kenneth F Bradstock
- Kenneth F. Bradstock and Warwick Benson, Westmead Hospital, University of Sydney; Arno Enno, Sandra Deveridge, and Philip Rowlings, Calvary Mater Newcastle Hospital, Newcastle; Luke Coyle, Royal North Shore Hospital, St Leonards; Campbell Tiley, Central Coast Health, Gosford; John Moore, St Vincent's Hospital; Mark Hertzberg, Prince of Wales Hospital, Sydney; Kimberly Cartwright, Wollongong Hospital, Wollongong; Ilona Cunningham, Concord Repatriation General Hospital, Concord; John Taper, Nepean Hospital, Penrith, New South Wales; Emma Link, Juliana Di Iulio, and John F. Seymour, Peter MacCallum Cancer Centre; Jeff Szer, Andrew Grigg, Andrew W. Roberts, and John F. Seymour, University of Melbourne; Andrew H. Wei, Monash University; Anthony Schwarer, Box Hill Hospital; Lynda Campbell, Victorian Cancer Cytogenetics Service, Melbourne; Jeff Szer, Andrew Grigg, and Andrew W. Roberts, Royal Melbourne Hospital, Parkville; Phillip Campbell, Deakin University School of Medicine, Geelong, Victoria; Paula Marlton, Anthony K. Mills, and Devinder Gill, University of Queensland, Brisbane, Queensland; Ray M. Lowenthal, University of Tasmania, Hobart, Tasmania; Ian D. Lewis and Peter Bardy, Royal Adelaide Hospital; Uwe Hahn, Queen Elizabeth Hospital, Adelaide, South Australia; James D'Rozario, The Canberra Hospital, Garran, Canberra, Australia Capital Territory; Gavin Cull, Sir Charles Gairdner Hospital; Michael F. Leahy, University of Western Australia; and Paul Cannell, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Emma Link
- Kenneth F. Bradstock and Warwick Benson, Westmead Hospital, University of Sydney; Arno Enno, Sandra Deveridge, and Philip Rowlings, Calvary Mater Newcastle Hospital, Newcastle; Luke Coyle, Royal North Shore Hospital, St Leonards; Campbell Tiley, Central Coast Health, Gosford; John Moore, St Vincent's Hospital; Mark Hertzberg, Prince of Wales Hospital, Sydney; Kimberly Cartwright, Wollongong Hospital, Wollongong; Ilona Cunningham, Concord Repatriation General Hospital, Concord; John Taper, Nepean Hospital, Penrith, New South Wales; Emma Link, Juliana Di Iulio, and John F. Seymour, Peter MacCallum Cancer Centre; Jeff Szer, Andrew Grigg, Andrew W. Roberts, and John F. Seymour, University of Melbourne; Andrew H. Wei, Monash University; Anthony Schwarer, Box Hill Hospital; Lynda Campbell, Victorian Cancer Cytogenetics Service, Melbourne; Jeff Szer, Andrew Grigg, and Andrew W. Roberts, Royal Melbourne Hospital, Parkville; Phillip Campbell, Deakin University School of Medicine, Geelong, Victoria; Paula Marlton, Anthony K. Mills, and Devinder Gill, University of Queensland, Brisbane, Queensland; Ray M. Lowenthal, University of Tasmania, Hobart, Tasmania; Ian D. Lewis and Peter Bardy, Royal Adelaide Hospital; Uwe Hahn, Queen Elizabeth Hospital, Adelaide, South Australia; James D'Rozario, The Canberra Hospital, Garran, Canberra, Australia Capital Territory; Gavin Cull, Sir Charles Gairdner Hospital; Michael F. Leahy, University of Western Australia; and Paul Cannell, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Juliana Di Iulio
- Kenneth F. Bradstock and Warwick Benson, Westmead Hospital, University of Sydney; Arno Enno, Sandra Deveridge, and Philip Rowlings, Calvary Mater Newcastle Hospital, Newcastle; Luke Coyle, Royal North Shore Hospital, St Leonards; Campbell Tiley, Central Coast Health, Gosford; John Moore, St Vincent's Hospital; Mark Hertzberg, Prince of Wales Hospital, Sydney; Kimberly Cartwright, Wollongong Hospital, Wollongong; Ilona Cunningham, Concord Repatriation General Hospital, Concord; John Taper, Nepean Hospital, Penrith, New South Wales; Emma Link, Juliana Di Iulio, and John F. Seymour, Peter MacCallum Cancer Centre; Jeff Szer, Andrew Grigg, Andrew W. Roberts, and John F. Seymour, University of Melbourne; Andrew H. Wei, Monash University; Anthony Schwarer, Box Hill Hospital; Lynda Campbell, Victorian Cancer Cytogenetics Service, Melbourne; Jeff Szer, Andrew Grigg, and Andrew W. Roberts, Royal Melbourne Hospital, Parkville; Phillip Campbell, Deakin University School of Medicine, Geelong, Victoria; Paula Marlton, Anthony K. Mills, and Devinder Gill, University of Queensland, Brisbane, Queensland; Ray M. Lowenthal, University of Tasmania, Hobart, Tasmania; Ian D. Lewis and Peter Bardy, Royal Adelaide Hospital; Uwe Hahn, Queen Elizabeth Hospital, Adelaide, South Australia; James D'Rozario, The Canberra Hospital, Garran, Canberra, Australia Capital Territory; Gavin Cull, Sir Charles Gairdner Hospital; Michael F. Leahy, University of Western Australia; and Paul Cannell, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Jeff Szer
- Kenneth F. Bradstock and Warwick Benson, Westmead Hospital, University of Sydney; Arno Enno, Sandra Deveridge, and Philip Rowlings, Calvary Mater Newcastle Hospital, Newcastle; Luke Coyle, Royal North Shore Hospital, St Leonards; Campbell Tiley, Central Coast Health, Gosford; John Moore, St Vincent's Hospital; Mark Hertzberg, Prince of Wales Hospital, Sydney; Kimberly Cartwright, Wollongong Hospital, Wollongong; Ilona Cunningham, Concord Repatriation General Hospital, Concord; John Taper, Nepean Hospital, Penrith, New South Wales; Emma Link, Juliana Di Iulio, and John F. Seymour, Peter MacCallum Cancer Centre; Jeff Szer, Andrew Grigg, Andrew W. Roberts, and John F. Seymour, University of Melbourne; Andrew H. Wei, Monash University; Anthony Schwarer, Box Hill Hospital; Lynda Campbell, Victorian Cancer Cytogenetics Service, Melbourne; Jeff Szer, Andrew Grigg, and Andrew W. Roberts, Royal Melbourne Hospital, Parkville; Phillip Campbell, Deakin University School of Medicine, Geelong, Victoria; Paula Marlton, Anthony K. Mills, and Devinder Gill, University of Queensland, Brisbane, Queensland; Ray M. Lowenthal, University of Tasmania, Hobart, Tasmania; Ian D. Lewis and Peter Bardy, Royal Adelaide Hospital; Uwe Hahn, Queen Elizabeth Hospital, Adelaide, South Australia; James D'Rozario, The Canberra Hospital, Garran, Canberra, Australia Capital Territory; Gavin Cull, Sir Charles Gairdner Hospital; Michael F. Leahy, University of Western Australia; and Paul Cannell, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Paula Marlton
- Kenneth F. Bradstock and Warwick Benson, Westmead Hospital, University of Sydney; Arno Enno, Sandra Deveridge, and Philip Rowlings, Calvary Mater Newcastle Hospital, Newcastle; Luke Coyle, Royal North Shore Hospital, St Leonards; Campbell Tiley, Central Coast Health, Gosford; John Moore, St Vincent's Hospital; Mark Hertzberg, Prince of Wales Hospital, Sydney; Kimberly Cartwright, Wollongong Hospital, Wollongong; Ilona Cunningham, Concord Repatriation General Hospital, Concord; John Taper, Nepean Hospital, Penrith, New South Wales; Emma Link, Juliana Di Iulio, and John F. Seymour, Peter MacCallum Cancer Centre; Jeff Szer, Andrew Grigg, Andrew W. Roberts, and John F. Seymour, University of Melbourne; Andrew H. Wei, Monash University; Anthony Schwarer, Box Hill Hospital; Lynda Campbell, Victorian Cancer Cytogenetics Service, Melbourne; Jeff Szer, Andrew Grigg, and Andrew W. Roberts, Royal Melbourne Hospital, Parkville; Phillip Campbell, Deakin University School of Medicine, Geelong, Victoria; Paula Marlton, Anthony K. Mills, and Devinder Gill, University of Queensland, Brisbane, Queensland; Ray M. Lowenthal, University of Tasmania, Hobart, Tasmania; Ian D. Lewis and Peter Bardy, Royal Adelaide Hospital; Uwe Hahn, Queen Elizabeth Hospital, Adelaide, South Australia; James D'Rozario, The Canberra Hospital, Garran, Canberra, Australia Capital Territory; Gavin Cull, Sir Charles Gairdner Hospital; Michael F. Leahy, University of Western Australia; and Paul Cannell, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Andrew H Wei
- Kenneth F. Bradstock and Warwick Benson, Westmead Hospital, University of Sydney; Arno Enno, Sandra Deveridge, and Philip Rowlings, Calvary Mater Newcastle Hospital, Newcastle; Luke Coyle, Royal North Shore Hospital, St Leonards; Campbell Tiley, Central Coast Health, Gosford; John Moore, St Vincent's Hospital; Mark Hertzberg, Prince of Wales Hospital, Sydney; Kimberly Cartwright, Wollongong Hospital, Wollongong; Ilona Cunningham, Concord Repatriation General Hospital, Concord; John Taper, Nepean Hospital, Penrith, New South Wales; Emma Link, Juliana Di Iulio, and John F. Seymour, Peter MacCallum Cancer Centre; Jeff Szer, Andrew Grigg, Andrew W. Roberts, and John F. Seymour, University of Melbourne; Andrew H. Wei, Monash University; Anthony Schwarer, Box Hill Hospital; Lynda Campbell, Victorian Cancer Cytogenetics Service, Melbourne; Jeff Szer, Andrew Grigg, and Andrew W. Roberts, Royal Melbourne Hospital, Parkville; Phillip Campbell, Deakin University School of Medicine, Geelong, Victoria; Paula Marlton, Anthony K. Mills, and Devinder Gill, University of Queensland, Brisbane, Queensland; Ray M. Lowenthal, University of Tasmania, Hobart, Tasmania; Ian D. Lewis and Peter Bardy, Royal Adelaide Hospital; Uwe Hahn, Queen Elizabeth Hospital, Adelaide, South Australia; James D'Rozario, The Canberra Hospital, Garran, Canberra, Australia Capital Territory; Gavin Cull, Sir Charles Gairdner Hospital; Michael F. Leahy, University of Western Australia; and Paul Cannell, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Arno Enno
- Kenneth F. Bradstock and Warwick Benson, Westmead Hospital, University of Sydney; Arno Enno, Sandra Deveridge, and Philip Rowlings, Calvary Mater Newcastle Hospital, Newcastle; Luke Coyle, Royal North Shore Hospital, St Leonards; Campbell Tiley, Central Coast Health, Gosford; John Moore, St Vincent's Hospital; Mark Hertzberg, Prince of Wales Hospital, Sydney; Kimberly Cartwright, Wollongong Hospital, Wollongong; Ilona Cunningham, Concord Repatriation General Hospital, Concord; John Taper, Nepean Hospital, Penrith, New South Wales; Emma Link, Juliana Di Iulio, and John F. Seymour, Peter MacCallum Cancer Centre; Jeff Szer, Andrew Grigg, Andrew W. Roberts, and John F. Seymour, University of Melbourne; Andrew H. Wei, Monash University; Anthony Schwarer, Box Hill Hospital; Lynda Campbell, Victorian Cancer Cytogenetics Service, Melbourne; Jeff Szer, Andrew Grigg, and Andrew W. Roberts, Royal Melbourne Hospital, Parkville; Phillip Campbell, Deakin University School of Medicine, Geelong, Victoria; Paula Marlton, Anthony K. Mills, and Devinder Gill, University of Queensland, Brisbane, Queensland; Ray M. Lowenthal, University of Tasmania, Hobart, Tasmania; Ian D. Lewis and Peter Bardy, Royal Adelaide Hospital; Uwe Hahn, Queen Elizabeth Hospital, Adelaide, South Australia; James D'Rozario, The Canberra Hospital, Garran, Canberra, Australia Capital Territory; Gavin Cull, Sir Charles Gairdner Hospital; Michael F. Leahy, University of Western Australia; and Paul Cannell, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Anthony Schwarer
- Kenneth F. Bradstock and Warwick Benson, Westmead Hospital, University of Sydney; Arno Enno, Sandra Deveridge, and Philip Rowlings, Calvary Mater Newcastle Hospital, Newcastle; Luke Coyle, Royal North Shore Hospital, St Leonards; Campbell Tiley, Central Coast Health, Gosford; John Moore, St Vincent's Hospital; Mark Hertzberg, Prince of Wales Hospital, Sydney; Kimberly Cartwright, Wollongong Hospital, Wollongong; Ilona Cunningham, Concord Repatriation General Hospital, Concord; John Taper, Nepean Hospital, Penrith, New South Wales; Emma Link, Juliana Di Iulio, and John F. Seymour, Peter MacCallum Cancer Centre; Jeff Szer, Andrew Grigg, Andrew W. Roberts, and John F. Seymour, University of Melbourne; Andrew H. Wei, Monash University; Anthony Schwarer, Box Hill Hospital; Lynda Campbell, Victorian Cancer Cytogenetics Service, Melbourne; Jeff Szer, Andrew Grigg, and Andrew W. Roberts, Royal Melbourne Hospital, Parkville; Phillip Campbell, Deakin University School of Medicine, Geelong, Victoria; Paula Marlton, Anthony K. Mills, and Devinder Gill, University of Queensland, Brisbane, Queensland; Ray M. Lowenthal, University of Tasmania, Hobart, Tasmania; Ian D. Lewis and Peter Bardy, Royal Adelaide Hospital; Uwe Hahn, Queen Elizabeth Hospital, Adelaide, South Australia; James D'Rozario, The Canberra Hospital, Garran, Canberra, Australia Capital Territory; Gavin Cull, Sir Charles Gairdner Hospital; Michael F. Leahy, University of Western Australia; and Paul Cannell, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Ian D Lewis
- Kenneth F. Bradstock and Warwick Benson, Westmead Hospital, University of Sydney; Arno Enno, Sandra Deveridge, and Philip Rowlings, Calvary Mater Newcastle Hospital, Newcastle; Luke Coyle, Royal North Shore Hospital, St Leonards; Campbell Tiley, Central Coast Health, Gosford; John Moore, St Vincent's Hospital; Mark Hertzberg, Prince of Wales Hospital, Sydney; Kimberly Cartwright, Wollongong Hospital, Wollongong; Ilona Cunningham, Concord Repatriation General Hospital, Concord; John Taper, Nepean Hospital, Penrith, New South Wales; Emma Link, Juliana Di Iulio, and John F. Seymour, Peter MacCallum Cancer Centre; Jeff Szer, Andrew Grigg, Andrew W. Roberts, and John F. Seymour, University of Melbourne; Andrew H. Wei, Monash University; Anthony Schwarer, Box Hill Hospital; Lynda Campbell, Victorian Cancer Cytogenetics Service, Melbourne; Jeff Szer, Andrew Grigg, and Andrew W. Roberts, Royal Melbourne Hospital, Parkville; Phillip Campbell, Deakin University School of Medicine, Geelong, Victoria; Paula Marlton, Anthony K. Mills, and Devinder Gill, University of Queensland, Brisbane, Queensland; Ray M. Lowenthal, University of Tasmania, Hobart, Tasmania; Ian D. Lewis and Peter Bardy, Royal Adelaide Hospital; Uwe Hahn, Queen Elizabeth Hospital, Adelaide, South Australia; James D'Rozario, The Canberra Hospital, Garran, Canberra, Australia Capital Territory; Gavin Cull, Sir Charles Gairdner Hospital; Michael F. Leahy, University of Western Australia; and Paul Cannell, Royal Perth Hospital, Perth, Western Australia, Australia
| | - James D'Rozario
- Kenneth F. Bradstock and Warwick Benson, Westmead Hospital, University of Sydney; Arno Enno, Sandra Deveridge, and Philip Rowlings, Calvary Mater Newcastle Hospital, Newcastle; Luke Coyle, Royal North Shore Hospital, St Leonards; Campbell Tiley, Central Coast Health, Gosford; John Moore, St Vincent's Hospital; Mark Hertzberg, Prince of Wales Hospital, Sydney; Kimberly Cartwright, Wollongong Hospital, Wollongong; Ilona Cunningham, Concord Repatriation General Hospital, Concord; John Taper, Nepean Hospital, Penrith, New South Wales; Emma Link, Juliana Di Iulio, and John F. Seymour, Peter MacCallum Cancer Centre; Jeff Szer, Andrew Grigg, Andrew W. Roberts, and John F. Seymour, University of Melbourne; Andrew H. Wei, Monash University; Anthony Schwarer, Box Hill Hospital; Lynda Campbell, Victorian Cancer Cytogenetics Service, Melbourne; Jeff Szer, Andrew Grigg, and Andrew W. Roberts, Royal Melbourne Hospital, Parkville; Phillip Campbell, Deakin University School of Medicine, Geelong, Victoria; Paula Marlton, Anthony K. Mills, and Devinder Gill, University of Queensland, Brisbane, Queensland; Ray M. Lowenthal, University of Tasmania, Hobart, Tasmania; Ian D. Lewis and Peter Bardy, Royal Adelaide Hospital; Uwe Hahn, Queen Elizabeth Hospital, Adelaide, South Australia; James D'Rozario, The Canberra Hospital, Garran, Canberra, Australia Capital Territory; Gavin Cull, Sir Charles Gairdner Hospital; Michael F. Leahy, University of Western Australia; and Paul Cannell, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Luke Coyle
- Kenneth F. Bradstock and Warwick Benson, Westmead Hospital, University of Sydney; Arno Enno, Sandra Deveridge, and Philip Rowlings, Calvary Mater Newcastle Hospital, Newcastle; Luke Coyle, Royal North Shore Hospital, St Leonards; Campbell Tiley, Central Coast Health, Gosford; John Moore, St Vincent's Hospital; Mark Hertzberg, Prince of Wales Hospital, Sydney; Kimberly Cartwright, Wollongong Hospital, Wollongong; Ilona Cunningham, Concord Repatriation General Hospital, Concord; John Taper, Nepean Hospital, Penrith, New South Wales; Emma Link, Juliana Di Iulio, and John F. Seymour, Peter MacCallum Cancer Centre; Jeff Szer, Andrew Grigg, Andrew W. Roberts, and John F. Seymour, University of Melbourne; Andrew H. Wei, Monash University; Anthony Schwarer, Box Hill Hospital; Lynda Campbell, Victorian Cancer Cytogenetics Service, Melbourne; Jeff Szer, Andrew Grigg, and Andrew W. Roberts, Royal Melbourne Hospital, Parkville; Phillip Campbell, Deakin University School of Medicine, Geelong, Victoria; Paula Marlton, Anthony K. Mills, and Devinder Gill, University of Queensland, Brisbane, Queensland; Ray M. Lowenthal, University of Tasmania, Hobart, Tasmania; Ian D. Lewis and Peter Bardy, Royal Adelaide Hospital; Uwe Hahn, Queen Elizabeth Hospital, Adelaide, South Australia; James D'Rozario, The Canberra Hospital, Garran, Canberra, Australia Capital Territory; Gavin Cull, Sir Charles Gairdner Hospital; Michael F. Leahy, University of Western Australia; and Paul Cannell, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Gavin Cull
- Kenneth F. Bradstock and Warwick Benson, Westmead Hospital, University of Sydney; Arno Enno, Sandra Deveridge, and Philip Rowlings, Calvary Mater Newcastle Hospital, Newcastle; Luke Coyle, Royal North Shore Hospital, St Leonards; Campbell Tiley, Central Coast Health, Gosford; John Moore, St Vincent's Hospital; Mark Hertzberg, Prince of Wales Hospital, Sydney; Kimberly Cartwright, Wollongong Hospital, Wollongong; Ilona Cunningham, Concord Repatriation General Hospital, Concord; John Taper, Nepean Hospital, Penrith, New South Wales; Emma Link, Juliana Di Iulio, and John F. Seymour, Peter MacCallum Cancer Centre; Jeff Szer, Andrew Grigg, Andrew W. Roberts, and John F. Seymour, University of Melbourne; Andrew H. Wei, Monash University; Anthony Schwarer, Box Hill Hospital; Lynda Campbell, Victorian Cancer Cytogenetics Service, Melbourne; Jeff Szer, Andrew Grigg, and Andrew W. Roberts, Royal Melbourne Hospital, Parkville; Phillip Campbell, Deakin University School of Medicine, Geelong, Victoria; Paula Marlton, Anthony K. Mills, and Devinder Gill, University of Queensland, Brisbane, Queensland; Ray M. Lowenthal, University of Tasmania, Hobart, Tasmania; Ian D. Lewis and Peter Bardy, Royal Adelaide Hospital; Uwe Hahn, Queen Elizabeth Hospital, Adelaide, South Australia; James D'Rozario, The Canberra Hospital, Garran, Canberra, Australia Capital Territory; Gavin Cull, Sir Charles Gairdner Hospital; Michael F. Leahy, University of Western Australia; and Paul Cannell, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Phillip Campbell
- Kenneth F. Bradstock and Warwick Benson, Westmead Hospital, University of Sydney; Arno Enno, Sandra Deveridge, and Philip Rowlings, Calvary Mater Newcastle Hospital, Newcastle; Luke Coyle, Royal North Shore Hospital, St Leonards; Campbell Tiley, Central Coast Health, Gosford; John Moore, St Vincent's Hospital; Mark Hertzberg, Prince of Wales Hospital, Sydney; Kimberly Cartwright, Wollongong Hospital, Wollongong; Ilona Cunningham, Concord Repatriation General Hospital, Concord; John Taper, Nepean Hospital, Penrith, New South Wales; Emma Link, Juliana Di Iulio, and John F. Seymour, Peter MacCallum Cancer Centre; Jeff Szer, Andrew Grigg, Andrew W. Roberts, and John F. Seymour, University of Melbourne; Andrew H. Wei, Monash University; Anthony Schwarer, Box Hill Hospital; Lynda Campbell, Victorian Cancer Cytogenetics Service, Melbourne; Jeff Szer, Andrew Grigg, and Andrew W. Roberts, Royal Melbourne Hospital, Parkville; Phillip Campbell, Deakin University School of Medicine, Geelong, Victoria; Paula Marlton, Anthony K. Mills, and Devinder Gill, University of Queensland, Brisbane, Queensland; Ray M. Lowenthal, University of Tasmania, Hobart, Tasmania; Ian D. Lewis and Peter Bardy, Royal Adelaide Hospital; Uwe Hahn, Queen Elizabeth Hospital, Adelaide, South Australia; James D'Rozario, The Canberra Hospital, Garran, Canberra, Australia Capital Territory; Gavin Cull, Sir Charles Gairdner Hospital; Michael F. Leahy, University of Western Australia; and Paul Cannell, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Michael F Leahy
- Kenneth F. Bradstock and Warwick Benson, Westmead Hospital, University of Sydney; Arno Enno, Sandra Deveridge, and Philip Rowlings, Calvary Mater Newcastle Hospital, Newcastle; Luke Coyle, Royal North Shore Hospital, St Leonards; Campbell Tiley, Central Coast Health, Gosford; John Moore, St Vincent's Hospital; Mark Hertzberg, Prince of Wales Hospital, Sydney; Kimberly Cartwright, Wollongong Hospital, Wollongong; Ilona Cunningham, Concord Repatriation General Hospital, Concord; John Taper, Nepean Hospital, Penrith, New South Wales; Emma Link, Juliana Di Iulio, and John F. Seymour, Peter MacCallum Cancer Centre; Jeff Szer, Andrew Grigg, Andrew W. Roberts, and John F. Seymour, University of Melbourne; Andrew H. Wei, Monash University; Anthony Schwarer, Box Hill Hospital; Lynda Campbell, Victorian Cancer Cytogenetics Service, Melbourne; Jeff Szer, Andrew Grigg, and Andrew W. Roberts, Royal Melbourne Hospital, Parkville; Phillip Campbell, Deakin University School of Medicine, Geelong, Victoria; Paula Marlton, Anthony K. Mills, and Devinder Gill, University of Queensland, Brisbane, Queensland; Ray M. Lowenthal, University of Tasmania, Hobart, Tasmania; Ian D. Lewis and Peter Bardy, Royal Adelaide Hospital; Uwe Hahn, Queen Elizabeth Hospital, Adelaide, South Australia; James D'Rozario, The Canberra Hospital, Garran, Canberra, Australia Capital Territory; Gavin Cull, Sir Charles Gairdner Hospital; Michael F. Leahy, University of Western Australia; and Paul Cannell, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Uwe Hahn
- Kenneth F. Bradstock and Warwick Benson, Westmead Hospital, University of Sydney; Arno Enno, Sandra Deveridge, and Philip Rowlings, Calvary Mater Newcastle Hospital, Newcastle; Luke Coyle, Royal North Shore Hospital, St Leonards; Campbell Tiley, Central Coast Health, Gosford; John Moore, St Vincent's Hospital; Mark Hertzberg, Prince of Wales Hospital, Sydney; Kimberly Cartwright, Wollongong Hospital, Wollongong; Ilona Cunningham, Concord Repatriation General Hospital, Concord; John Taper, Nepean Hospital, Penrith, New South Wales; Emma Link, Juliana Di Iulio, and John F. Seymour, Peter MacCallum Cancer Centre; Jeff Szer, Andrew Grigg, Andrew W. Roberts, and John F. Seymour, University of Melbourne; Andrew H. Wei, Monash University; Anthony Schwarer, Box Hill Hospital; Lynda Campbell, Victorian Cancer Cytogenetics Service, Melbourne; Jeff Szer, Andrew Grigg, and Andrew W. Roberts, Royal Melbourne Hospital, Parkville; Phillip Campbell, Deakin University School of Medicine, Geelong, Victoria; Paula Marlton, Anthony K. Mills, and Devinder Gill, University of Queensland, Brisbane, Queensland; Ray M. Lowenthal, University of Tasmania, Hobart, Tasmania; Ian D. Lewis and Peter Bardy, Royal Adelaide Hospital; Uwe Hahn, Queen Elizabeth Hospital, Adelaide, South Australia; James D'Rozario, The Canberra Hospital, Garran, Canberra, Australia Capital Territory; Gavin Cull, Sir Charles Gairdner Hospital; Michael F. Leahy, University of Western Australia; and Paul Cannell, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Paul Cannell
- Kenneth F. Bradstock and Warwick Benson, Westmead Hospital, University of Sydney; Arno Enno, Sandra Deveridge, and Philip Rowlings, Calvary Mater Newcastle Hospital, Newcastle; Luke Coyle, Royal North Shore Hospital, St Leonards; Campbell Tiley, Central Coast Health, Gosford; John Moore, St Vincent's Hospital; Mark Hertzberg, Prince of Wales Hospital, Sydney; Kimberly Cartwright, Wollongong Hospital, Wollongong; Ilona Cunningham, Concord Repatriation General Hospital, Concord; John Taper, Nepean Hospital, Penrith, New South Wales; Emma Link, Juliana Di Iulio, and John F. Seymour, Peter MacCallum Cancer Centre; Jeff Szer, Andrew Grigg, Andrew W. Roberts, and John F. Seymour, University of Melbourne; Andrew H. Wei, Monash University; Anthony Schwarer, Box Hill Hospital; Lynda Campbell, Victorian Cancer Cytogenetics Service, Melbourne; Jeff Szer, Andrew Grigg, and Andrew W. Roberts, Royal Melbourne Hospital, Parkville; Phillip Campbell, Deakin University School of Medicine, Geelong, Victoria; Paula Marlton, Anthony K. Mills, and Devinder Gill, University of Queensland, Brisbane, Queensland; Ray M. Lowenthal, University of Tasmania, Hobart, Tasmania; Ian D. Lewis and Peter Bardy, Royal Adelaide Hospital; Uwe Hahn, Queen Elizabeth Hospital, Adelaide, South Australia; James D'Rozario, The Canberra Hospital, Garran, Canberra, Australia Capital Territory; Gavin Cull, Sir Charles Gairdner Hospital; Michael F. Leahy, University of Western Australia; and Paul Cannell, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Campbell Tiley
- Kenneth F. Bradstock and Warwick Benson, Westmead Hospital, University of Sydney; Arno Enno, Sandra Deveridge, and Philip Rowlings, Calvary Mater Newcastle Hospital, Newcastle; Luke Coyle, Royal North Shore Hospital, St Leonards; Campbell Tiley, Central Coast Health, Gosford; John Moore, St Vincent's Hospital; Mark Hertzberg, Prince of Wales Hospital, Sydney; Kimberly Cartwright, Wollongong Hospital, Wollongong; Ilona Cunningham, Concord Repatriation General Hospital, Concord; John Taper, Nepean Hospital, Penrith, New South Wales; Emma Link, Juliana Di Iulio, and John F. Seymour, Peter MacCallum Cancer Centre; Jeff Szer, Andrew Grigg, Andrew W. Roberts, and John F. Seymour, University of Melbourne; Andrew H. Wei, Monash University; Anthony Schwarer, Box Hill Hospital; Lynda Campbell, Victorian Cancer Cytogenetics Service, Melbourne; Jeff Szer, Andrew Grigg, and Andrew W. Roberts, Royal Melbourne Hospital, Parkville; Phillip Campbell, Deakin University School of Medicine, Geelong, Victoria; Paula Marlton, Anthony K. Mills, and Devinder Gill, University of Queensland, Brisbane, Queensland; Ray M. Lowenthal, University of Tasmania, Hobart, Tasmania; Ian D. Lewis and Peter Bardy, Royal Adelaide Hospital; Uwe Hahn, Queen Elizabeth Hospital, Adelaide, South Australia; James D'Rozario, The Canberra Hospital, Garran, Canberra, Australia Capital Territory; Gavin Cull, Sir Charles Gairdner Hospital; Michael F. Leahy, University of Western Australia; and Paul Cannell, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Ray M Lowenthal
- Kenneth F. Bradstock and Warwick Benson, Westmead Hospital, University of Sydney; Arno Enno, Sandra Deveridge, and Philip Rowlings, Calvary Mater Newcastle Hospital, Newcastle; Luke Coyle, Royal North Shore Hospital, St Leonards; Campbell Tiley, Central Coast Health, Gosford; John Moore, St Vincent's Hospital; Mark Hertzberg, Prince of Wales Hospital, Sydney; Kimberly Cartwright, Wollongong Hospital, Wollongong; Ilona Cunningham, Concord Repatriation General Hospital, Concord; John Taper, Nepean Hospital, Penrith, New South Wales; Emma Link, Juliana Di Iulio, and John F. Seymour, Peter MacCallum Cancer Centre; Jeff Szer, Andrew Grigg, Andrew W. Roberts, and John F. Seymour, University of Melbourne; Andrew H. Wei, Monash University; Anthony Schwarer, Box Hill Hospital; Lynda Campbell, Victorian Cancer Cytogenetics Service, Melbourne; Jeff Szer, Andrew Grigg, and Andrew W. Roberts, Royal Melbourne Hospital, Parkville; Phillip Campbell, Deakin University School of Medicine, Geelong, Victoria; Paula Marlton, Anthony K. Mills, and Devinder Gill, University of Queensland, Brisbane, Queensland; Ray M. Lowenthal, University of Tasmania, Hobart, Tasmania; Ian D. Lewis and Peter Bardy, Royal Adelaide Hospital; Uwe Hahn, Queen Elizabeth Hospital, Adelaide, South Australia; James D'Rozario, The Canberra Hospital, Garran, Canberra, Australia Capital Territory; Gavin Cull, Sir Charles Gairdner Hospital; Michael F. Leahy, University of Western Australia; and Paul Cannell, Royal Perth Hospital, Perth, Western Australia, Australia
| | - John Moore
- Kenneth F. Bradstock and Warwick Benson, Westmead Hospital, University of Sydney; Arno Enno, Sandra Deveridge, and Philip Rowlings, Calvary Mater Newcastle Hospital, Newcastle; Luke Coyle, Royal North Shore Hospital, St Leonards; Campbell Tiley, Central Coast Health, Gosford; John Moore, St Vincent's Hospital; Mark Hertzberg, Prince of Wales Hospital, Sydney; Kimberly Cartwright, Wollongong Hospital, Wollongong; Ilona Cunningham, Concord Repatriation General Hospital, Concord; John Taper, Nepean Hospital, Penrith, New South Wales; Emma Link, Juliana Di Iulio, and John F. Seymour, Peter MacCallum Cancer Centre; Jeff Szer, Andrew Grigg, Andrew W. Roberts, and John F. Seymour, University of Melbourne; Andrew H. Wei, Monash University; Anthony Schwarer, Box Hill Hospital; Lynda Campbell, Victorian Cancer Cytogenetics Service, Melbourne; Jeff Szer, Andrew Grigg, and Andrew W. Roberts, Royal Melbourne Hospital, Parkville; Phillip Campbell, Deakin University School of Medicine, Geelong, Victoria; Paula Marlton, Anthony K. Mills, and Devinder Gill, University of Queensland, Brisbane, Queensland; Ray M. Lowenthal, University of Tasmania, Hobart, Tasmania; Ian D. Lewis and Peter Bardy, Royal Adelaide Hospital; Uwe Hahn, Queen Elizabeth Hospital, Adelaide, South Australia; James D'Rozario, The Canberra Hospital, Garran, Canberra, Australia Capital Territory; Gavin Cull, Sir Charles Gairdner Hospital; Michael F. Leahy, University of Western Australia; and Paul Cannell, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Kimberly Cartwright
- Kenneth F. Bradstock and Warwick Benson, Westmead Hospital, University of Sydney; Arno Enno, Sandra Deveridge, and Philip Rowlings, Calvary Mater Newcastle Hospital, Newcastle; Luke Coyle, Royal North Shore Hospital, St Leonards; Campbell Tiley, Central Coast Health, Gosford; John Moore, St Vincent's Hospital; Mark Hertzberg, Prince of Wales Hospital, Sydney; Kimberly Cartwright, Wollongong Hospital, Wollongong; Ilona Cunningham, Concord Repatriation General Hospital, Concord; John Taper, Nepean Hospital, Penrith, New South Wales; Emma Link, Juliana Di Iulio, and John F. Seymour, Peter MacCallum Cancer Centre; Jeff Szer, Andrew Grigg, Andrew W. Roberts, and John F. Seymour, University of Melbourne; Andrew H. Wei, Monash University; Anthony Schwarer, Box Hill Hospital; Lynda Campbell, Victorian Cancer Cytogenetics Service, Melbourne; Jeff Szer, Andrew Grigg, and Andrew W. Roberts, Royal Melbourne Hospital, Parkville; Phillip Campbell, Deakin University School of Medicine, Geelong, Victoria; Paula Marlton, Anthony K. Mills, and Devinder Gill, University of Queensland, Brisbane, Queensland; Ray M. Lowenthal, University of Tasmania, Hobart, Tasmania; Ian D. Lewis and Peter Bardy, Royal Adelaide Hospital; Uwe Hahn, Queen Elizabeth Hospital, Adelaide, South Australia; James D'Rozario, The Canberra Hospital, Garran, Canberra, Australia Capital Territory; Gavin Cull, Sir Charles Gairdner Hospital; Michael F. Leahy, University of Western Australia; and Paul Cannell, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Ilona Cunningham
- Kenneth F. Bradstock and Warwick Benson, Westmead Hospital, University of Sydney; Arno Enno, Sandra Deveridge, and Philip Rowlings, Calvary Mater Newcastle Hospital, Newcastle; Luke Coyle, Royal North Shore Hospital, St Leonards; Campbell Tiley, Central Coast Health, Gosford; John Moore, St Vincent's Hospital; Mark Hertzberg, Prince of Wales Hospital, Sydney; Kimberly Cartwright, Wollongong Hospital, Wollongong; Ilona Cunningham, Concord Repatriation General Hospital, Concord; John Taper, Nepean Hospital, Penrith, New South Wales; Emma Link, Juliana Di Iulio, and John F. Seymour, Peter MacCallum Cancer Centre; Jeff Szer, Andrew Grigg, Andrew W. Roberts, and John F. Seymour, University of Melbourne; Andrew H. Wei, Monash University; Anthony Schwarer, Box Hill Hospital; Lynda Campbell, Victorian Cancer Cytogenetics Service, Melbourne; Jeff Szer, Andrew Grigg, and Andrew W. Roberts, Royal Melbourne Hospital, Parkville; Phillip Campbell, Deakin University School of Medicine, Geelong, Victoria; Paula Marlton, Anthony K. Mills, and Devinder Gill, University of Queensland, Brisbane, Queensland; Ray M. Lowenthal, University of Tasmania, Hobart, Tasmania; Ian D. Lewis and Peter Bardy, Royal Adelaide Hospital; Uwe Hahn, Queen Elizabeth Hospital, Adelaide, South Australia; James D'Rozario, The Canberra Hospital, Garran, Canberra, Australia Capital Territory; Gavin Cull, Sir Charles Gairdner Hospital; Michael F. Leahy, University of Western Australia; and Paul Cannell, Royal Perth Hospital, Perth, Western Australia, Australia
| | - John Taper
- Kenneth F. Bradstock and Warwick Benson, Westmead Hospital, University of Sydney; Arno Enno, Sandra Deveridge, and Philip Rowlings, Calvary Mater Newcastle Hospital, Newcastle; Luke Coyle, Royal North Shore Hospital, St Leonards; Campbell Tiley, Central Coast Health, Gosford; John Moore, St Vincent's Hospital; Mark Hertzberg, Prince of Wales Hospital, Sydney; Kimberly Cartwright, Wollongong Hospital, Wollongong; Ilona Cunningham, Concord Repatriation General Hospital, Concord; John Taper, Nepean Hospital, Penrith, New South Wales; Emma Link, Juliana Di Iulio, and John F. Seymour, Peter MacCallum Cancer Centre; Jeff Szer, Andrew Grigg, Andrew W. Roberts, and John F. Seymour, University of Melbourne; Andrew H. Wei, Monash University; Anthony Schwarer, Box Hill Hospital; Lynda Campbell, Victorian Cancer Cytogenetics Service, Melbourne; Jeff Szer, Andrew Grigg, and Andrew W. Roberts, Royal Melbourne Hospital, Parkville; Phillip Campbell, Deakin University School of Medicine, Geelong, Victoria; Paula Marlton, Anthony K. Mills, and Devinder Gill, University of Queensland, Brisbane, Queensland; Ray M. Lowenthal, University of Tasmania, Hobart, Tasmania; Ian D. Lewis and Peter Bardy, Royal Adelaide Hospital; Uwe Hahn, Queen Elizabeth Hospital, Adelaide, South Australia; James D'Rozario, The Canberra Hospital, Garran, Canberra, Australia Capital Territory; Gavin Cull, Sir Charles Gairdner Hospital; Michael F. Leahy, University of Western Australia; and Paul Cannell, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Andrew Grigg
- Kenneth F. Bradstock and Warwick Benson, Westmead Hospital, University of Sydney; Arno Enno, Sandra Deveridge, and Philip Rowlings, Calvary Mater Newcastle Hospital, Newcastle; Luke Coyle, Royal North Shore Hospital, St Leonards; Campbell Tiley, Central Coast Health, Gosford; John Moore, St Vincent's Hospital; Mark Hertzberg, Prince of Wales Hospital, Sydney; Kimberly Cartwright, Wollongong Hospital, Wollongong; Ilona Cunningham, Concord Repatriation General Hospital, Concord; John Taper, Nepean Hospital, Penrith, New South Wales; Emma Link, Juliana Di Iulio, and John F. Seymour, Peter MacCallum Cancer Centre; Jeff Szer, Andrew Grigg, Andrew W. Roberts, and John F. Seymour, University of Melbourne; Andrew H. Wei, Monash University; Anthony Schwarer, Box Hill Hospital; Lynda Campbell, Victorian Cancer Cytogenetics Service, Melbourne; Jeff Szer, Andrew Grigg, and Andrew W. Roberts, Royal Melbourne Hospital, Parkville; Phillip Campbell, Deakin University School of Medicine, Geelong, Victoria; Paula Marlton, Anthony K. Mills, and Devinder Gill, University of Queensland, Brisbane, Queensland; Ray M. Lowenthal, University of Tasmania, Hobart, Tasmania; Ian D. Lewis and Peter Bardy, Royal Adelaide Hospital; Uwe Hahn, Queen Elizabeth Hospital, Adelaide, South Australia; James D'Rozario, The Canberra Hospital, Garran, Canberra, Australia Capital Territory; Gavin Cull, Sir Charles Gairdner Hospital; Michael F. Leahy, University of Western Australia; and Paul Cannell, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Andrew W Roberts
- Kenneth F. Bradstock and Warwick Benson, Westmead Hospital, University of Sydney; Arno Enno, Sandra Deveridge, and Philip Rowlings, Calvary Mater Newcastle Hospital, Newcastle; Luke Coyle, Royal North Shore Hospital, St Leonards; Campbell Tiley, Central Coast Health, Gosford; John Moore, St Vincent's Hospital; Mark Hertzberg, Prince of Wales Hospital, Sydney; Kimberly Cartwright, Wollongong Hospital, Wollongong; Ilona Cunningham, Concord Repatriation General Hospital, Concord; John Taper, Nepean Hospital, Penrith, New South Wales; Emma Link, Juliana Di Iulio, and John F. Seymour, Peter MacCallum Cancer Centre; Jeff Szer, Andrew Grigg, Andrew W. Roberts, and John F. Seymour, University of Melbourne; Andrew H. Wei, Monash University; Anthony Schwarer, Box Hill Hospital; Lynda Campbell, Victorian Cancer Cytogenetics Service, Melbourne; Jeff Szer, Andrew Grigg, and Andrew W. Roberts, Royal Melbourne Hospital, Parkville; Phillip Campbell, Deakin University School of Medicine, Geelong, Victoria; Paula Marlton, Anthony K. Mills, and Devinder Gill, University of Queensland, Brisbane, Queensland; Ray M. Lowenthal, University of Tasmania, Hobart, Tasmania; Ian D. Lewis and Peter Bardy, Royal Adelaide Hospital; Uwe Hahn, Queen Elizabeth Hospital, Adelaide, South Australia; James D'Rozario, The Canberra Hospital, Garran, Canberra, Australia Capital Territory; Gavin Cull, Sir Charles Gairdner Hospital; Michael F. Leahy, University of Western Australia; and Paul Cannell, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Warwick Benson
- Kenneth F. Bradstock and Warwick Benson, Westmead Hospital, University of Sydney; Arno Enno, Sandra Deveridge, and Philip Rowlings, Calvary Mater Newcastle Hospital, Newcastle; Luke Coyle, Royal North Shore Hospital, St Leonards; Campbell Tiley, Central Coast Health, Gosford; John Moore, St Vincent's Hospital; Mark Hertzberg, Prince of Wales Hospital, Sydney; Kimberly Cartwright, Wollongong Hospital, Wollongong; Ilona Cunningham, Concord Repatriation General Hospital, Concord; John Taper, Nepean Hospital, Penrith, New South Wales; Emma Link, Juliana Di Iulio, and John F. Seymour, Peter MacCallum Cancer Centre; Jeff Szer, Andrew Grigg, Andrew W. Roberts, and John F. Seymour, University of Melbourne; Andrew H. Wei, Monash University; Anthony Schwarer, Box Hill Hospital; Lynda Campbell, Victorian Cancer Cytogenetics Service, Melbourne; Jeff Szer, Andrew Grigg, and Andrew W. Roberts, Royal Melbourne Hospital, Parkville; Phillip Campbell, Deakin University School of Medicine, Geelong, Victoria; Paula Marlton, Anthony K. Mills, and Devinder Gill, University of Queensland, Brisbane, Queensland; Ray M. Lowenthal, University of Tasmania, Hobart, Tasmania; Ian D. Lewis and Peter Bardy, Royal Adelaide Hospital; Uwe Hahn, Queen Elizabeth Hospital, Adelaide, South Australia; James D'Rozario, The Canberra Hospital, Garran, Canberra, Australia Capital Territory; Gavin Cull, Sir Charles Gairdner Hospital; Michael F. Leahy, University of Western Australia; and Paul Cannell, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Mark Hertzberg
- Kenneth F. Bradstock and Warwick Benson, Westmead Hospital, University of Sydney; Arno Enno, Sandra Deveridge, and Philip Rowlings, Calvary Mater Newcastle Hospital, Newcastle; Luke Coyle, Royal North Shore Hospital, St Leonards; Campbell Tiley, Central Coast Health, Gosford; John Moore, St Vincent's Hospital; Mark Hertzberg, Prince of Wales Hospital, Sydney; Kimberly Cartwright, Wollongong Hospital, Wollongong; Ilona Cunningham, Concord Repatriation General Hospital, Concord; John Taper, Nepean Hospital, Penrith, New South Wales; Emma Link, Juliana Di Iulio, and John F. Seymour, Peter MacCallum Cancer Centre; Jeff Szer, Andrew Grigg, Andrew W. Roberts, and John F. Seymour, University of Melbourne; Andrew H. Wei, Monash University; Anthony Schwarer, Box Hill Hospital; Lynda Campbell, Victorian Cancer Cytogenetics Service, Melbourne; Jeff Szer, Andrew Grigg, and Andrew W. Roberts, Royal Melbourne Hospital, Parkville; Phillip Campbell, Deakin University School of Medicine, Geelong, Victoria; Paula Marlton, Anthony K. Mills, and Devinder Gill, University of Queensland, Brisbane, Queensland; Ray M. Lowenthal, University of Tasmania, Hobart, Tasmania; Ian D. Lewis and Peter Bardy, Royal Adelaide Hospital; Uwe Hahn, Queen Elizabeth Hospital, Adelaide, South Australia; James D'Rozario, The Canberra Hospital, Garran, Canberra, Australia Capital Territory; Gavin Cull, Sir Charles Gairdner Hospital; Michael F. Leahy, University of Western Australia; and Paul Cannell, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Sandra Deveridge
- Kenneth F. Bradstock and Warwick Benson, Westmead Hospital, University of Sydney; Arno Enno, Sandra Deveridge, and Philip Rowlings, Calvary Mater Newcastle Hospital, Newcastle; Luke Coyle, Royal North Shore Hospital, St Leonards; Campbell Tiley, Central Coast Health, Gosford; John Moore, St Vincent's Hospital; Mark Hertzberg, Prince of Wales Hospital, Sydney; Kimberly Cartwright, Wollongong Hospital, Wollongong; Ilona Cunningham, Concord Repatriation General Hospital, Concord; John Taper, Nepean Hospital, Penrith, New South Wales; Emma Link, Juliana Di Iulio, and John F. Seymour, Peter MacCallum Cancer Centre; Jeff Szer, Andrew Grigg, Andrew W. Roberts, and John F. Seymour, University of Melbourne; Andrew H. Wei, Monash University; Anthony Schwarer, Box Hill Hospital; Lynda Campbell, Victorian Cancer Cytogenetics Service, Melbourne; Jeff Szer, Andrew Grigg, and Andrew W. Roberts, Royal Melbourne Hospital, Parkville; Phillip Campbell, Deakin University School of Medicine, Geelong, Victoria; Paula Marlton, Anthony K. Mills, and Devinder Gill, University of Queensland, Brisbane, Queensland; Ray M. Lowenthal, University of Tasmania, Hobart, Tasmania; Ian D. Lewis and Peter Bardy, Royal Adelaide Hospital; Uwe Hahn, Queen Elizabeth Hospital, Adelaide, South Australia; James D'Rozario, The Canberra Hospital, Garran, Canberra, Australia Capital Territory; Gavin Cull, Sir Charles Gairdner Hospital; Michael F. Leahy, University of Western Australia; and Paul Cannell, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Philip Rowlings
- Kenneth F. Bradstock and Warwick Benson, Westmead Hospital, University of Sydney; Arno Enno, Sandra Deveridge, and Philip Rowlings, Calvary Mater Newcastle Hospital, Newcastle; Luke Coyle, Royal North Shore Hospital, St Leonards; Campbell Tiley, Central Coast Health, Gosford; John Moore, St Vincent's Hospital; Mark Hertzberg, Prince of Wales Hospital, Sydney; Kimberly Cartwright, Wollongong Hospital, Wollongong; Ilona Cunningham, Concord Repatriation General Hospital, Concord; John Taper, Nepean Hospital, Penrith, New South Wales; Emma Link, Juliana Di Iulio, and John F. Seymour, Peter MacCallum Cancer Centre; Jeff Szer, Andrew Grigg, Andrew W. Roberts, and John F. Seymour, University of Melbourne; Andrew H. Wei, Monash University; Anthony Schwarer, Box Hill Hospital; Lynda Campbell, Victorian Cancer Cytogenetics Service, Melbourne; Jeff Szer, Andrew Grigg, and Andrew W. Roberts, Royal Melbourne Hospital, Parkville; Phillip Campbell, Deakin University School of Medicine, Geelong, Victoria; Paula Marlton, Anthony K. Mills, and Devinder Gill, University of Queensland, Brisbane, Queensland; Ray M. Lowenthal, University of Tasmania, Hobart, Tasmania; Ian D. Lewis and Peter Bardy, Royal Adelaide Hospital; Uwe Hahn, Queen Elizabeth Hospital, Adelaide, South Australia; James D'Rozario, The Canberra Hospital, Garran, Canberra, Australia Capital Territory; Gavin Cull, Sir Charles Gairdner Hospital; Michael F. Leahy, University of Western Australia; and Paul Cannell, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Anthony K Mills
- Kenneth F. Bradstock and Warwick Benson, Westmead Hospital, University of Sydney; Arno Enno, Sandra Deveridge, and Philip Rowlings, Calvary Mater Newcastle Hospital, Newcastle; Luke Coyle, Royal North Shore Hospital, St Leonards; Campbell Tiley, Central Coast Health, Gosford; John Moore, St Vincent's Hospital; Mark Hertzberg, Prince of Wales Hospital, Sydney; Kimberly Cartwright, Wollongong Hospital, Wollongong; Ilona Cunningham, Concord Repatriation General Hospital, Concord; John Taper, Nepean Hospital, Penrith, New South Wales; Emma Link, Juliana Di Iulio, and John F. Seymour, Peter MacCallum Cancer Centre; Jeff Szer, Andrew Grigg, Andrew W. Roberts, and John F. Seymour, University of Melbourne; Andrew H. Wei, Monash University; Anthony Schwarer, Box Hill Hospital; Lynda Campbell, Victorian Cancer Cytogenetics Service, Melbourne; Jeff Szer, Andrew Grigg, and Andrew W. Roberts, Royal Melbourne Hospital, Parkville; Phillip Campbell, Deakin University School of Medicine, Geelong, Victoria; Paula Marlton, Anthony K. Mills, and Devinder Gill, University of Queensland, Brisbane, Queensland; Ray M. Lowenthal, University of Tasmania, Hobart, Tasmania; Ian D. Lewis and Peter Bardy, Royal Adelaide Hospital; Uwe Hahn, Queen Elizabeth Hospital, Adelaide, South Australia; James D'Rozario, The Canberra Hospital, Garran, Canberra, Australia Capital Territory; Gavin Cull, Sir Charles Gairdner Hospital; Michael F. Leahy, University of Western Australia; and Paul Cannell, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Devinder Gill
- Kenneth F. Bradstock and Warwick Benson, Westmead Hospital, University of Sydney; Arno Enno, Sandra Deveridge, and Philip Rowlings, Calvary Mater Newcastle Hospital, Newcastle; Luke Coyle, Royal North Shore Hospital, St Leonards; Campbell Tiley, Central Coast Health, Gosford; John Moore, St Vincent's Hospital; Mark Hertzberg, Prince of Wales Hospital, Sydney; Kimberly Cartwright, Wollongong Hospital, Wollongong; Ilona Cunningham, Concord Repatriation General Hospital, Concord; John Taper, Nepean Hospital, Penrith, New South Wales; Emma Link, Juliana Di Iulio, and John F. Seymour, Peter MacCallum Cancer Centre; Jeff Szer, Andrew Grigg, Andrew W. Roberts, and John F. Seymour, University of Melbourne; Andrew H. Wei, Monash University; Anthony Schwarer, Box Hill Hospital; Lynda Campbell, Victorian Cancer Cytogenetics Service, Melbourne; Jeff Szer, Andrew Grigg, and Andrew W. Roberts, Royal Melbourne Hospital, Parkville; Phillip Campbell, Deakin University School of Medicine, Geelong, Victoria; Paula Marlton, Anthony K. Mills, and Devinder Gill, University of Queensland, Brisbane, Queensland; Ray M. Lowenthal, University of Tasmania, Hobart, Tasmania; Ian D. Lewis and Peter Bardy, Royal Adelaide Hospital; Uwe Hahn, Queen Elizabeth Hospital, Adelaide, South Australia; James D'Rozario, The Canberra Hospital, Garran, Canberra, Australia Capital Territory; Gavin Cull, Sir Charles Gairdner Hospital; Michael F. Leahy, University of Western Australia; and Paul Cannell, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Peter Bardy
- Kenneth F. Bradstock and Warwick Benson, Westmead Hospital, University of Sydney; Arno Enno, Sandra Deveridge, and Philip Rowlings, Calvary Mater Newcastle Hospital, Newcastle; Luke Coyle, Royal North Shore Hospital, St Leonards; Campbell Tiley, Central Coast Health, Gosford; John Moore, St Vincent's Hospital; Mark Hertzberg, Prince of Wales Hospital, Sydney; Kimberly Cartwright, Wollongong Hospital, Wollongong; Ilona Cunningham, Concord Repatriation General Hospital, Concord; John Taper, Nepean Hospital, Penrith, New South Wales; Emma Link, Juliana Di Iulio, and John F. Seymour, Peter MacCallum Cancer Centre; Jeff Szer, Andrew Grigg, Andrew W. Roberts, and John F. Seymour, University of Melbourne; Andrew H. Wei, Monash University; Anthony Schwarer, Box Hill Hospital; Lynda Campbell, Victorian Cancer Cytogenetics Service, Melbourne; Jeff Szer, Andrew Grigg, and Andrew W. Roberts, Royal Melbourne Hospital, Parkville; Phillip Campbell, Deakin University School of Medicine, Geelong, Victoria; Paula Marlton, Anthony K. Mills, and Devinder Gill, University of Queensland, Brisbane, Queensland; Ray M. Lowenthal, University of Tasmania, Hobart, Tasmania; Ian D. Lewis and Peter Bardy, Royal Adelaide Hospital; Uwe Hahn, Queen Elizabeth Hospital, Adelaide, South Australia; James D'Rozario, The Canberra Hospital, Garran, Canberra, Australia Capital Territory; Gavin Cull, Sir Charles Gairdner Hospital; Michael F. Leahy, University of Western Australia; and Paul Cannell, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Lynda Campbell
- Kenneth F. Bradstock and Warwick Benson, Westmead Hospital, University of Sydney; Arno Enno, Sandra Deveridge, and Philip Rowlings, Calvary Mater Newcastle Hospital, Newcastle; Luke Coyle, Royal North Shore Hospital, St Leonards; Campbell Tiley, Central Coast Health, Gosford; John Moore, St Vincent's Hospital; Mark Hertzberg, Prince of Wales Hospital, Sydney; Kimberly Cartwright, Wollongong Hospital, Wollongong; Ilona Cunningham, Concord Repatriation General Hospital, Concord; John Taper, Nepean Hospital, Penrith, New South Wales; Emma Link, Juliana Di Iulio, and John F. Seymour, Peter MacCallum Cancer Centre; Jeff Szer, Andrew Grigg, Andrew W. Roberts, and John F. Seymour, University of Melbourne; Andrew H. Wei, Monash University; Anthony Schwarer, Box Hill Hospital; Lynda Campbell, Victorian Cancer Cytogenetics Service, Melbourne; Jeff Szer, Andrew Grigg, and Andrew W. Roberts, Royal Melbourne Hospital, Parkville; Phillip Campbell, Deakin University School of Medicine, Geelong, Victoria; Paula Marlton, Anthony K. Mills, and Devinder Gill, University of Queensland, Brisbane, Queensland; Ray M. Lowenthal, University of Tasmania, Hobart, Tasmania; Ian D. Lewis and Peter Bardy, Royal Adelaide Hospital; Uwe Hahn, Queen Elizabeth Hospital, Adelaide, South Australia; James D'Rozario, The Canberra Hospital, Garran, Canberra, Australia Capital Territory; Gavin Cull, Sir Charles Gairdner Hospital; Michael F. Leahy, University of Western Australia; and Paul Cannell, Royal Perth Hospital, Perth, Western Australia, Australia
| | - John F Seymour
- Kenneth F. Bradstock and Warwick Benson, Westmead Hospital, University of Sydney; Arno Enno, Sandra Deveridge, and Philip Rowlings, Calvary Mater Newcastle Hospital, Newcastle; Luke Coyle, Royal North Shore Hospital, St Leonards; Campbell Tiley, Central Coast Health, Gosford; John Moore, St Vincent's Hospital; Mark Hertzberg, Prince of Wales Hospital, Sydney; Kimberly Cartwright, Wollongong Hospital, Wollongong; Ilona Cunningham, Concord Repatriation General Hospital, Concord; John Taper, Nepean Hospital, Penrith, New South Wales; Emma Link, Juliana Di Iulio, and John F. Seymour, Peter MacCallum Cancer Centre; Jeff Szer, Andrew Grigg, Andrew W. Roberts, and John F. Seymour, University of Melbourne; Andrew H. Wei, Monash University; Anthony Schwarer, Box Hill Hospital; Lynda Campbell, Victorian Cancer Cytogenetics Service, Melbourne; Jeff Szer, Andrew Grigg, and Andrew W. Roberts, Royal Melbourne Hospital, Parkville; Phillip Campbell, Deakin University School of Medicine, Geelong, Victoria; Paula Marlton, Anthony K. Mills, and Devinder Gill, University of Queensland, Brisbane, Queensland; Ray M. Lowenthal, University of Tasmania, Hobart, Tasmania; Ian D. Lewis and Peter Bardy, Royal Adelaide Hospital; Uwe Hahn, Queen Elizabeth Hospital, Adelaide, South Australia; James D'Rozario, The Canberra Hospital, Garran, Canberra, Australia Capital Territory; Gavin Cull, Sir Charles Gairdner Hospital; Michael F. Leahy, University of Western Australia; and Paul Cannell, Royal Perth Hospital, Perth, Western Australia, Australia
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Quach H, Fernyhough L, Henderson R, Corbett G, Baker B, Browett P, Blacklock H, Forsyth C, Underhill C, Cannell P, Trotman J, Neylon A, Harrison S, Link E, Swern A, Cowan L, Dimopoulos MA, Miles Prince H. Upfront lower dose lenalidomide is less toxic and does not compromise efficacy for vulnerable patients with relapsed refractory multiple myeloma: final analysis of the phase II RevLite study. Br J Haematol 2017; 177:441-448. [DOI: 10.1111/bjh.14562] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Accepted: 11/18/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Hang Quach
- Faculty of Medicine; University of Melbourne; Victoria Australia
- Department of Haematology; St. Vincent's Hospital Melbourne; Melbourne Vic. Australia
| | | | - Ross Henderson
- Department of Medicine; Royal North Shore Hospital; Saint Leonards NSW Australia
| | - Gillian Corbett
- Department of Medicine; Tauranga Hospital; Tauranga New Zealand
| | - Bart Baker
- Department of Haematology; Palmerston North Hospital; Palmerston North New Zealand
| | - Peter Browett
- Department of Medicine; Auckland Hospital; Auckland New Zealand
| | - Hilary Blacklock
- Department of Medicine; Middlemore Hospital; Auckland New Zealand
| | - Cecily Forsyth
- Department of Haematology; Gosford Hospital; North Gosford NSW Australia
| | - Craig Underhill
- Department of Medicine; Border Medical Oncology; Albury-Wodonga Vic. Australia
| | - Paul Cannell
- Department of Medicine; Royal Perth Hospital; Perth WA Australia
| | - Judith Trotman
- Department of Medicine; Concord Hospital; Concord NSW Australia
| | - Annette Neylon
- Department of Medicine; Dunedin Hospital; Dunedin New Zealand
| | - Simon Harrison
- Faculty of Medicine; University of Melbourne; Victoria Australia
- Haematology Service; Peter MacCallum Cancer Centre; Vic. Australia
| | - Emma Link
- Centre for Biostatistics and Clinical Trials; Peter MacCallum Cancer Centre; Victoria Vic. Australia
| | | | - Linda Cowan
- Centre for Biostatistics and Clinical Trials; Peter MacCallum Cancer Centre; Victoria Vic. Australia
| | - Meletios A. Dimopoulos
- Department of Clinical Therapeutics; University of Athens School of Medicine; Athens Greece
| | - H. Miles Prince
- Faculty of Medicine; University of Melbourne; Victoria Australia
- Haematology Service; Peter MacCallum Cancer Centre; Vic. Australia
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Hughes RE, Holland LR, Zanino D, Link E, Michael N, Thompson KE. Prevalence and Intensity of Pain and Other Physical and Psychological Symptoms in Adolescents and Young Adults Diagnosed with Cancer on Referral to a Palliative Care Service. J Adolesc Young Adult Oncol 2016; 4:70-5. [PMID: 26812554 DOI: 10.1089/jayao.2014.0015] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE While adolescent and young adult (AYA) oncology is recognized as a distinct specialty, there remains a paucity of literature documenting symptomatology in this cohort. This study aimed to identify the prevalence, severity, and mechanism of pain and other symptoms in AYA patients referred to a palliative care service in a specialist Australian cancer center. METHODS A retrospective design analyzed the case file data of 33 eligible AYA patients aged 15-25 years old at diagnosis and two randomly selected control groups of patients >25 years old: unmatched and matched for diagnosis and sex. All cases were referred to the palliative care service between July 2009 and June 2012. Descriptive statistics, analysis of Edmonton Symptom Assessment Scale (ESAS) and Edmonton Classification System of Cancer Pain (ECS-CP) data, and non-parametric tests were performed. RESULTS The most common malignancies among the AYA patients were sarcoma and hematological cancers. All AYA patients reported pain syndrome on the ECS-CP compared with 85% of the matched controls (p=0.018). An age group effect was found for mechanisms of pain (p=0.035). A trend toward more neuropathic pain among AYA cases was also found (59% vs. 39%). The most common ESAS symptoms in AYAs were pain (91%), diminished well-being (76%), fatigue (75%), and decreased appetite (67%). CONCLUSION AYA cancer patients appear to experience a unique symptom profile with high symptom prevalence and complexity. Further research is warranted to identify determinants and inform integration of supportive and palliative care services for this unique patient cohort.
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Affiliation(s)
- Rachel E Hughes
- 1 ONTrac at Peter Mac, Victorian Adolescent and Young Adult Oncology Service, Peter MacCallum Cancer Centre , East Melbourne, Victoria, Australia
| | - Lucy R Holland
- 1 ONTrac at Peter Mac, Victorian Adolescent and Young Adult Oncology Service, Peter MacCallum Cancer Centre , East Melbourne, Victoria, Australia
| | - Diana Zanino
- 2 Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre , East Melbourne, Victoria, Australia
| | - Emma Link
- 2 Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre , East Melbourne, Victoria, Australia
| | | | - Kate E Thompson
- 1 ONTrac at Peter Mac, Victorian Adolescent and Young Adult Oncology Service, Peter MacCallum Cancer Centre , East Melbourne, Victoria, Australia
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Kenealy M, Patton N, Filshie R, Nicol A, Ho SJ, Hertzberg M, Mills T, Prosser I, Link E, Cowan L, Zannino D, Seymour JF. Results of a phase II study of thalidomide and azacitidine in patients with clinically advanced myelodysplastic syndromes (MDS), chronic myelomonocytic leukemia (CMML) and low blast count acute myeloid leukemia (AML). Leuk Lymphoma 2016; 58:298-307. [PMID: 27268068 DOI: 10.1080/10428194.2016.1190971] [Citation(s) in RCA: 8] [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: 10/21/2022]
Abstract
Single agent azacitidine or immunomodulatory drugs are effective in myelodysplastic syndrome (MDS), with differing target mechanisms and toxicities. Objectives of this ALLG MDS3 study in clinically advanced MDS, AMML and low blast AML were to establish safety, response and quality of life of azacitidine and thalidomide. Patients received azacitidine (75mg/m2/d sc 7days every 28 days), and oral thalidomide up to 100mg/d for maximum 12months. Eighty patients registered; median age 68 years (range 42-82), 49% IPSS int2-high. With 36.5 months follow up, patients received median 9 cycles azacitidine, 6.1mths thalidomide. Nonhematologic toxicity grade 3+ in 85%, commonly infections. Overall response rate was 63%; 26% CR were unaffected by IPSS. Median response duration 26.3months; overall survival was 28.1months. This combination azacitidine and thalidomide in clinically advanced MDS, CMML and low-blast AML was tolerable without unexpected toxicity and encouraging responses support further investigation of combination approaches with hypomethylating agent and immunomodulatory drug.
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Affiliation(s)
- Melita Kenealy
- a Department of Haematology , Cabrini Health , Melbourne , Australia.,b Department of Haematology , Peter MacCallum Cancer Centre , Melbourne , Australia.,c Melbourne University , Melbourne , Australia
| | - Nigel Patton
- d Royal Adelaide Hospital , Adelaide , Australia
| | | | - Andrew Nicol
- f Greenslopes Private Hospital , Brisbane , Australia
| | | | - Mark Hertzberg
- h Department of Haematology , Prince of Wales Hospital and University of New South Wales , Sydney , Australia
| | - Tony Mills
- i Princess Alexandra Hospital , Brisbane , Australia
| | | | - Emma Link
- b Department of Haematology , Peter MacCallum Cancer Centre , Melbourne , Australia
| | - Linda Cowan
- b Department of Haematology , Peter MacCallum Cancer Centre , Melbourne , Australia
| | - Diana Zannino
- k Australasian Leukaemia and Lymphoma Group , Melbourne , Australia
| | - John F Seymour
- b Department of Haematology , Peter MacCallum Cancer Centre , Melbourne , Australia.,c Melbourne University , Melbourne , Australia
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27
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Berg A, Filipiak‐Pittroff B, Schulz H, Hoffmann U, Link E, Sußmann M, Schnappinger M, Brüske I, Standl M, Krämer U, Hoffmann B, Heinrich J, Bauer C, Koletzko S, Berdel D, Thiering E, Tiesler C, Flexeder C, Zeller C, Werkstetter K, Klümper C, Sugiri D. Allergic manifestation 15 years after early intervention with hydrolyzed formulas--the GINI Study. Allergy 2016; 71:210-9. [PMID: 26465137 PMCID: PMC4738469 DOI: 10.1111/all.12790] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [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] [Accepted: 10/11/2015] [Indexed: 01/14/2023]
Abstract
Background Data on the long‐term impact of hydrolyzed formulas on allergies are scarce. Objective To assess the association between early intervention with hydrolyzed formulas in high‐risk children and allergic outcomes in adolescence. Methods GINI trial participants (n = 2252) received one of four formulas in the first four months of life as breastmilk substitute if necessary: partial or extensive whey hydrolyzate (pHF‐W, eHF‐W), extensive casein hydrolyzate (eHF‐C) or standard cow′s milk formula (CMF) as reference. Associations between these formulas and the cumulative incidence and prevalence of parent‐reported physician‐diagnosed asthma, allergic rhinitis (AR) and eczema, as well as spirometric indices and sensitization, were examined using generalized linear models. Results Between 11 and 15 years, the prevalence of asthma was reduced in the eHF‐C group compared to CMF (odds ratio (OR) 0.49, 95% confidence interval (CI) 0.26–0.89), which is consistent with the spirometric results. The cumulative incidence of AR was lower in eHF‐C (risk ratio (RR) 0.77, 95% CI 0.59–0.99]) and the AR prevalence in pHF‐W (OR 0.67, 95% CI 0.47–0.95) and eHF‐C (OR 0.59, 95% CI 0.41–0.84). The cumulative incidence of eczema was reduced in pHF‐W (RR 0.75, 95% CI 0.59–0.96) and eHF‐C (RR 0.60, 95% CI 0.46–0.77), as was the eczema prevalence between 11 and 15 years in eHF‐C (OR 0.42, 95% CI 0.23–0.79). No significant effects were found in the eHF‐W group on any manifestation,nor was there an effect on sensitization with any formula. Conclusion In high‐risk children, early intervention using different hydrolyzed formulas has variable preventative effects on asthma, allergic rhinitis and eczema up to adolescence.
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Affiliation(s)
- A. Berg
- Department of Pediatrics Marien‐Hospital Wesel, Research Institute Wesel Germany
| | - B. Filipiak‐Pittroff
- Department of Pediatrics Marien‐Hospital Wesel, Research Institute Wesel Germany
| | - H. Schulz
- Institute of Epidemiology I Helmholtz Zentrum Munich German Research Center for Environmental Health (GmbH) Neuherberg Germany
- Comprehensive Pneumology Center Munich (CPC‐M) Munich Germany
| | - U. Hoffmann
- Institute of Epidemiology I Helmholtz Zentrum Munich German Research Center for Environmental Health (GmbH) Neuherberg Germany
- Department of Pediatrics Technical University of Munich Munich Germany
| | - E. Link
- IUF – Leibniz Research Institute for Environmental Medicine at the Heinrich‐Heine‐University Düsseldorf Germany
| | - M. Sußmann
- Institute of Epidemiology I Helmholtz Zentrum Munich German Research Center for Environmental Health (GmbH) Neuherberg Germany
| | - M. Schnappinger
- Institute of Epidemiology I Helmholtz Zentrum Munich German Research Center for Environmental Health (GmbH) Neuherberg Germany
| | - I. Brüske
- Institute of Epidemiology I Helmholtz Zentrum Munich German Research Center for Environmental Health (GmbH) Neuherberg Germany
| | - M. Standl
- Institute of Epidemiology I Helmholtz Zentrum Munich German Research Center for Environmental Health (GmbH) Neuherberg Germany
| | - U. Krämer
- IUF – Leibniz Research Institute for Environmental Medicine at the Heinrich‐Heine‐University Düsseldorf Germany
| | - B. Hoffmann
- IUF – Leibniz Research Institute for Environmental Medicine at the Heinrich‐Heine‐University Düsseldorf Germany
- Medical Faculty Deanery of Medicine Heinrich‐Heine University Düsseldorf Germany
| | - J. Heinrich
- Institute of Epidemiology I Helmholtz Zentrum Munich German Research Center for Environmental Health (GmbH) Neuherberg Germany
- Comprehensive Pneumology Center Munich (CPC‐M) Munich Germany
| | - C.‐P. Bauer
- Department of Pediatrics Technical University of Munich Munich Germany
- LVA Oberbayern Munich Germany
| | - S. Koletzko
- Dr von Hauner Children's Hospital Ludwig‐Maximilians‐University University of Munich Medical Center Munich Germany
| | - D. Berdel
- Department of Pediatrics Marien‐Hospital Wesel, Research Institute Wesel Germany
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Khot A, Brajanovski N, Cameron D, Hein N, McArthur G, Lim J, O'Brien S, Ryckman D, Yu G, Link E, Donohoe C, Snowden A, Hannan R, Harrison S. A Phase 1, Open-Label, Dose Escalation, Safety, Pharmacokinetic and Pharmacodynamic Study of a first in class Pol1 inhibitor (CX-5461) in Patients with Advanced Haematologic Malignancies (HM). Clinical Lymphoma Myeloma and Leukemia 2015. [DOI: 10.1016/j.clml.2015.07.578] [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] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Harrison SJ, Khot A, Brajanovski N, Cameron D, Hein N, McArthur GA, Lim JK, O'Brien S, Ryckman DM, Yu GI, Link E, Donohoe C, Snowden A, Kuru N, Hannan R. A phase 1, open-label, dose escalation, safety, PK and PD study of a first in class Pol1 inhibitor (CX-5461) in patients with advanced hematologic malignancies (HM). J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.e22212] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Amit Khot
- Peter MacCallum Cancer Centre, East Melbourne, Australia
| | | | - Don Cameron
- Peter MacCallum Cancer Centre, East Melbourne, Australia
| | - Nadine Hein
- Peter MacCallum Cancer Centre, East Melbourne, Australia
| | | | | | | | | | | | - Emma Link
- Peter MacCallum Cancer Centre, East Melbourne, Australia
| | - Carrie Donohoe
- Peter MacCallum Cancer Centre, East Melbourne, Australia
| | - Alicia Snowden
- Peter MacCallum Cancer Centre, East Melbourne, Australia
| | - Narmatha Kuru
- Peter MacCallum Cancer Centre, East Melbourne, Australia
| | - Ross Hannan
- Peter MacCallum Cancer Centre, East Melbourne, Australia
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Harrison SJ, Quach H, Link E, Feng H, Dean J, Copeman M, Van De Velde H, Schwarer A, Baker B, Spencer A, Catalano J, Campbell P, Augustson B, Romeril K, Prince HM. The addition of dexamethasone to bortezomib for patients with relapsed multiple myeloma improves outcome but ongoing maintenance therapy has minimal benefit. Am J Hematol 2015; 90:E86-91. [PMID: 25651830 DOI: 10.1002/ajh.23967] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2014] [Revised: 01/30/2015] [Accepted: 02/02/2015] [Indexed: 01/31/2023]
Abstract
Despite the common practice of combining dexamethasone (Dex) with bortezomib (Bz) in patients with multiple myeloma (MM), until now there has been few prospective trials undertaken. We undertook a trial that recapitulated the original APEX study except that dexamethasone was incorporated from cycle 1. We also incorporated an exploratory maintenance component to the study. Twenty sites enrolled 100 relapsed/or refractory MM patients utilizing eight 21 day cycles of IV Bz [1.3 mg/m(2) ; Day (D) 1, 4, 8, 11] and three 35 day cycles; Bz (1.3 mg/m(2) ; Day (D) 1, 8, 15, 22). Our study was registered at www.clinicaltrials.gov (NCT00335348). Patients with stable disease or better received maintenance Bz (1.3 mg/m(2) ) every 14 days until progression. Dexamethasone (20 mg) was given for 2 days with each Bz dose. A prospectively defined matched-analysis of primary (overall response rate; ORR) and secondary endpoints [Complete Response (CR) and time to progression (TTP)] compared our cohort to those on the Bz arm of the APEX trial. The addition of Dex improved ORR by 20% (56% vs. 36%) [odds ratio 0.44 (0.24-0.80)]. The median TTP was also significantly longer (10.1 vs. 5.1 months) (hazard ratio 0.50, 95% CI: 0.35-0.72, P = 0.0002) and our landmark analysis demonstrated that this was largely due to the early use of dexamethasone, as we were unable to demonstrate any benefit of bortezomib/dexamethasone maintenance therapy.
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Affiliation(s)
- Simon J. Harrison
- Peter MacCallum Cancer Centre; East Melbourne Australia
- Sir Peter MacCallum Department of Oncology; University of Melbourne; Parkville Australia
| | - Hang Quach
- St Vincents Hospital; Melbourne Australia
| | - Emma Link
- Peter MacCallum Cancer Centre; East Melbourne Australia
| | - Huaibao Feng
- Janssen Research & Development; Raritan, New Jersey
| | - Joanne Dean
- Peter MacCallum Cancer Centre; East Melbourne Australia
| | | | | | | | - Bartrum Baker
- Palmerston North Hospital; Palmerston North New Zealand
| | | | | | - Philip Campbell
- The Andrew Love Cancer Centre; Geelong Hospital; Geelong Australia
| | | | | | - Henry Miles Prince
- Peter MacCallum Cancer Centre; East Melbourne Australia
- Sir Peter MacCallum Department of Oncology; University of Melbourne; Parkville Australia
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Kaneko Y, Murray WK, Link E, Hicks RJ, Duong C. Improving patient selection for 18F-FDG PET scanning in the staging of gastric cancer. J Nucl Med 2015; 56:523-9. [PMID: 25745094 DOI: 10.2967/jnumed.114.150946] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 02/10/2015] [Indexed: 12/17/2022] Open
Abstract
UNLABELLED Standard pretreatment staging for gastric cancer includes CT of the chest, abdomen, and pelvis; gastroscopy; and laparoscopy. Although (18)F-PET combined with CT has proven to be a useful staging tool in many cancers, some gastric cancers are not (18)F-FDG-avid and its clinical value is still debatable. METHODS Gastric cancer patients who underwent staging (18)F-FDG PET scans from 2002 to 2013 at the Peter MacCallum Cancer Center were retrospectively analyzed, and a systematic review was also conducted using PubMed between 2000 to March 2014 to investigate clinicopathologic parameters associated with (18)F-FDG avidity. A pretreatment PET scoring system was developed from predictors of (18)F-FDG avidity. RESULTS Both the retrospective analysis of the patients and the systematic literature review showed similar significant predictors of (18)F-FDG avidity, including large tumor size, non-signet ring cell carcinoma type, and glucose transporter 1-positive expression on immunohistochemistry. A PET scoring system was developed from these clinicopathologic parameters that allowed (18)F-FDG-avid tumors to be detected with a sensitivity of 85% and a specificity of 71%. CONCLUSION A pretreatment PET scoring system can assist in the selection of patients with gastric adenocarcinoma when staging (18)F-FDG PET is being considered.
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Affiliation(s)
- Yui Kaneko
- Department of Surgical Oncology, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
| | - William K Murray
- Department of Pathology, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
| | - Emma Link
- Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia; and
| | - Rodney J Hicks
- Department of Cancer imaging, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
| | - Cuong Duong
- Department of Surgical Oncology, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
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Bradstock KF, Link E, Collins M, Di Iulio J, Lewis ID, Schwarer A, Enno A, Marlton P, Hahn U, Szer J, Cull G, Seymour JF. A randomized trial of prophylactic palifermin on gastrointestinal toxicity after intensive induction therapy for acute myeloid leukaemia. Br J Haematol 2014; 167:618-25. [DOI: 10.1111/bjh.13086] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 07/02/2014] [Indexed: 11/28/2022]
Affiliation(s)
| | - Emma Link
- Biostatistics and Clinical Trials; Peter MacCallum Cancer Centre; Melbourne Vic. Australia
| | - Marnie Collins
- Biostatistics and Clinical Trials; Peter MacCallum Cancer Centre; Melbourne Vic. Australia
| | - Juliana Di Iulio
- Biostatistics and Clinical Trials; Peter MacCallum Cancer Centre; Melbourne Vic. Australia
| | - Ian D. Lewis
- Division of Haematology; SA Pathology and University of Adelaide; Adelaide SA Australia
| | | | - Arno Enno
- Mater Hospital; Newcastle NSW Australia
| | - Paula Marlton
- Princess Alexandra Hospital and School of Medicine; University of Queensland; Brisbane Qld Australia
| | - Uwe Hahn
- Queen Elizabeth Hospital; Adelaide SA Australia
| | - Jeff Szer
- Royal Melbourne Hospital; Parkville Vic. Australia
| | - Gavin Cull
- Sir Charles Gairdiner Hospital; Perth WA Australia
| | - John F. Seymour
- Department of Haematology; Peter MacCallum Cancer Centre; East Melbourne Vic. Australia
- University of Melbourne; Parkville Vic. Australia
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Foo M, Link E, Leong T, Chu J, Lee MT, Chander S, Tran PK, Tomaszewski JM, Michael M, Heriot A, Ngan SY. Impact of advancing age on treatment and outcomes in anal cancer. Acta Oncol 2014; 53:909-16. [PMID: 24456502 DOI: 10.3109/0284186x.2013.876513] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Chemoradiotherapy (CRT) for squamous cell carcinoma of the anus (SCCA) may cause significant toxicity, and concerns exist about its tolerability in the elderly. The authors compared tolerability and outcomes across the age groups following CRT for SCCA. METHODS Single-institution retrospective analysis of patients with localized SCCA treated with CRT. CRT was standardized at 50.4-54 Gy, with concurrent infusional 5-fluorouracil and mitomycin C. Patients were arbitrarily categorized into three groups: Group 1 - age < 50 years; Group 2 - age ≥ 50 and < 70 years; and Group 3 - age ≥ 70 years. RESULTS Of 284 patients identified, 278 were evaluable. The number of patients in each age group was: Group 1 - 51; Group 2 - 140; and Group 3 - 93. Baseline and treatment characteristics, tumor stage, rates of overall acute toxicity, need for unplanned treatment breaks and chemotherapy delivery were largely similar across the age groups. However, nine patients in Group 3 did not complete CRT, compared with five and none in Groups 1 and 2, respectively (p = 0.006). In addition, five patients in Group 3 had diarrhea requiring treatment break, compared with none in the other two groups (p = 0.004). At a median follow-up 5.3 years, there was no significant difference in overall survival (p = 0.11), disease-free survival (p = 0.22) or local-recurrence free survival (p = 0.34), across the three age groups. CONCLUSIONS CRT is safe and tolerable in the elderly age group, and provides equivalent disease control rates compared with the younger age group. Age alone should therefore not preclude aggressive curative treatment.
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Affiliation(s)
- Marcus Foo
- Division of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre , Melbourne, Victoria , Australia
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Herbert KE, Demosthenous L, Wiesner G, Link E, Westerman DA, Came N, Ritchie DS, Harrison S, Seymour JF, Prince HM. Plerixafor plus pegfilgrastim is a safe, effective mobilization regimen for poor or adequate mobilizers of hematopoietic stem and progenitor cells: a phase I clinical trial. Bone Marrow Transplant 2014; 49:1056-62. [PMID: 24887382 DOI: 10.1038/bmt.2014.112] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Revised: 03/05/2014] [Accepted: 03/25/2014] [Indexed: 01/18/2023]
Abstract
The safety, kinetics and efficacy of plerixafor+pegfilgrastim for hematopoietic stem and progenitor cell (HSPC) mobilization are poorly understood. We treated 12 study patients (SP; lymphoma n=10 or myeloma n=2) with pegfilgrastim (6 mg SC stat D1) and plerixafor (0.24 mg/kg SC nocte from D3). Six SP were 'predicted poor-mobilizers' and six were 'predicted adequate-mobilizers'. Peripheral blood (PB) CD34(+) monitoring commenced on D3. Apheresis commenced on D4. Comparison was with 22 historical controls (HC; lymphoma n=18, myeloma n=4; poor mobilizers n=4), mobilized with pegfilgrastim alone. Eight (67%) SP had PB CD34(+) count ⩽5 × 10(6)/L D3 post pegfilgrastim; all SP surpassed this threshold the morning after plerixafor. In SP, PBCD34(+) counts peaked D4 6/12 (50%), remaining ⩾5 × 10(6)/L for 4 days in 8/12 (67%). All SP successfully yielded target cell numbers (⩾2 × 10(6)/kg) within four aphereses. After maximum four aphereses, median total CD34+ yield was higher in SP than HC; 8.0 (range 2.4-12.9) vs 4.8 (0.4-14.0) × 10(6)/kg (P=0.04). Seven of twelve (58%) SP achieved target yield after one apheresis. Flow cytometry revealed no tumor cells in PB or apheresis product of SP. Plerixafor+pegfilgrastim was well tolerated with bone pain (n=2), diarrhoea (n=2) and facial paraesthesiae (n=3). Plerixafor+pegfilgrastim is a simple, safe and effective HSPC mobilization regimen in myeloma and lymphoma, in both poor and good mobilizers, and is superior to pegfilgrastim alone.
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Affiliation(s)
- K E Herbert
- Department of Haematology, Peter MacCallum Cancer Centre, St Andrew's Place, East Melbourne, Victoria, Australia
| | - L Demosthenous
- Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
| | - G Wiesner
- Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
| | - E Link
- Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
| | - D A Westerman
- Department of Pathology, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
| | - N Came
- Department of Pathology, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
| | - D S Ritchie
- 1] Department of Haematology, Peter MacCallum Cancer Centre, St Andrew's Place, East Melbourne, Victoria, Australia [2] Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - S Harrison
- 1] Department of Haematology, Peter MacCallum Cancer Centre, St Andrew's Place, East Melbourne, Victoria, Australia [2] Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - J F Seymour
- 1] Department of Haematology, Peter MacCallum Cancer Centre, St Andrew's Place, East Melbourne, Victoria, Australia [2] Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - H M Prince
- 1] Department of Haematology, Peter MacCallum Cancer Centre, St Andrew's Place, East Melbourne, Victoria, Australia [2] Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia
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Tomaszewski JM, Gavriel H, Link E, Boodhun S, Sizeland A, Corry J. Aggressive behavior of Cutaneous squamous cell carcinoma in patients with chronic lymphocytic leukemia. Laryngoscope 2014; 124:2043-8. [DOI: 10.1002/lary.24586] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Revised: 12/17/2013] [Accepted: 01/06/2014] [Indexed: 02/06/2023]
Affiliation(s)
| | - Haim Gavriel
- Department of Surgery; Peter MacCallum Cancer Centre; Melbourne Australia
| | - Emma Link
- Centre for Biostatistics and Clinical Trials; Peter MacCallum Cancer Centre; Melbourne Australia
| | - Sholeh Boodhun
- Department of Surgery; Peter MacCallum Cancer Centre; Melbourne Australia
| | - Andrew Sizeland
- Department of Surgery; Peter MacCallum Cancer Centre; Melbourne Australia
| | - June Corry
- Department of Radiation Oncology; Peter MacCallum Cancer Centre; Melbourne Australia
- Department of Pathology; University of Melbourne; Melbourne Australia
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Kron T, Willis D, Link E, Lehman M, Campbell G, O'Brien P, Chua B. Can We Predict Plan Quality for External Beam Partial Breast Irradiation: Results of a Multicenter Feasibility Study (Trans Tasman Radiation Oncology Group Study 06.02). Int J Radiat Oncol Biol Phys 2013; 87:817-24. [DOI: 10.1016/j.ijrobp.2013.07.036] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Revised: 07/19/2013] [Accepted: 07/22/2013] [Indexed: 11/29/2022]
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Tourani SS, Cabalag C, Link E, Chan STF, Duong CP. Laparoscopy and peritoneal cytology: important prognostic tools to guide treatment selection in gastric adenocarcinoma. ANZ J Surg 2013; 85:69-73. [PMID: 23647832 DOI: 10.1111/ans.12197] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND Previous studies have suggested that patients with occult peritoneal metastases not seen on preoperative imaging have poor prognosis. In this study, we aim to evaluate the utility and impact of staging laparoscopy and peritoneal cytology in patients with gastric adenocarcinoma. METHODS A retrospective analysis of patients with gastric adenocarcinoma managed at two major metropolitan hospitals in Melbourne, Australia, between January 1999 and July 2010 was undertaken. The main outcome measures were the number of patients in whom laparoscopy and/or peritoneal cytology changed treatment intent, and the overall survival of patients with occult metastases detected by laparoscopy/cytology. RESULTS Staging laparoscopy as an independent procedure was performed in 74.3% (148/199) of patients who had neither unequivocal metastases (M1) on preoperative imaging nor early T1 disease on endoscopic ultrasound. Laparoscopy/cytology detected occult metastases in 38 (25.6%) patients (27 macroscopic M1 and 11 microscopic M1 with positive peritoneal cytology only), leading to change in the treatment intent in 37 cases. The median overall survivals of patients with metastatic disease detected at staging laparoscopy (8.3 months, 95% confidence interval (CI) 5.4-16.5) or on peritoneal cytology (4.9 months, 95% CI 4.2-48) were as poor as those with M1 disease seen on preoperative imaging (6.7 months, 95% CI 4.2-8.9), P = 0.97. CONCLUSIONS Laparoscopy and peritoneal cytology add incremental value to modern imaging in the staging of gastric adenocarcinomas by detecting occult metastatic disease. Their utility needs to be optimized to allow better treatment selection for gastric cancer patients.
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Affiliation(s)
- Saam S Tourani
- Department of Surgery, Western Health, Footscray, Victoria, Australia
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Dickinson M, Herbert K, Sardjono C, Le T, Link E, Zannino D, Ruell S, Seymour J, Kenealy M, Prince H. P-276 High doses of eltrombopag are well-tolerated in conjunction with azacitidine and demonstrate encouraging activity in patients with MDS and AML. Leuk Res 2013. [DOI: 10.1016/s0145-2126(13)70323-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Hopewell JC, Parish S, Offer A, Link E, Clarke R, Lathrop M, Armitage J, Collins R. Impact of common genetic variation on response to simvastatin therapy among 18 705 participants in the Heart Protection Study. Eur Heart J 2012; 34:982-92. [PMID: 23100282 PMCID: PMC3612775 DOI: 10.1093/eurheartj/ehs344] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Aims Statins reduce LDL cholesterol (LDL-C) and the risk of vascular events, but it remains uncertain whether there is clinically relevant genetic variation in their efficacy. This study of 18 705 individuals aims to identify genetic variants related to the lipid response to simvastatin and assess their impact on vascular risk response. Methods and results A genome-wide study of the LDL-C and apolipoprotein B (ApoB) response to 40 mg simvastatin daily was performed in 3895 participants in the Heart Protection Study, and the nine strongest associations were tested in 14 810 additional participants. Selected candidate genes were also tested in up to 18 705 individuals. There was 90% power to detect differences of 2.5% in LDL-C response (e.g. 42.5 vs. 40% reduction) in the genome-wide study and of 1% in the candidate gene study. None of the associations from the genome-wide study was replicated, and nor were significant associations found for 26 of 36 candidates tested. Novel lipid response associations with variants in LPA, CELSR2/PSRC1/SORT1, and ABCC2 were found, as well as confirmatory evidence for published associations in LPA, APOE, and SLCO1B1. The largest and most significant effects were with LPA and APOE, but were only 2–3% per allele. Reductions in the risk of major vascular events during 5 years of statin therapy among 18 705 high-risk patients did not differ significantly across genotypes associated with the lipid response. Conclusions Common genetic variants do not appear to alter the lipid response to statin therapy by more than a few per cent, and there were similar large reductions in vascular risk with simvastatin irrespective of genotypes associated with the lipid response to simvastatin. Consequently, their value for informing clinical decisions related to maximizing statin efficacy appears to be limited.
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Affiliation(s)
- Jemma C Hopewell
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), University of Oxford, Oxford, UK.
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40
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Senthi S, Link E, Chua BH. Cosmetic Outcome and Seroma Formation After Breast-Conserving Surgery With Intraoperative Radiation Therapy Boost for Early Breast Cancer. Int J Radiat Oncol Biol Phys 2012; 84:e139-44. [DOI: 10.1016/j.ijrobp.2012.03.015] [Citation(s) in RCA: 3] [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] [Received: 08/28/2011] [Revised: 02/26/2012] [Accepted: 03/06/2012] [Indexed: 10/27/2022]
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Gregory DL, Hicks RJ, Hogg A, Binns DS, Shum PL, Milner A, Link E, Ball DL, Mac Manus MP. Effect of PET/CT on management of patients with non-small cell lung cancer: results of a prospective study with 5-year survival data. J Nucl Med 2012; 53:1007-15. [PMID: 22677701 DOI: 10.2967/jnumed.111.099713] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [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] Open
Abstract
UNLABELLED We investigated the incremental management impact and prognostic value of staging with (18)F-FDG PET/CT in patients with non-small cell lung cancer (NSCLC) being considered for potentially curative therapies. METHODS Information on 168 consecutive patients with NSCLC being considered for surgery or definitive radiotherapy with curative intent before PET/CT was entered into a prospective database. The pre-PET/CT management plan, based on conventional imaging (conventional CT, appropriately supplemented by bone scintigraphy or other modalities), was defined prospectively by referring clinicians before PET/CT results became available. After PET/CT, actual clinical management was recorded, and patients were followed up until 5 y or death. The appropriateness of PET/CT management plans was assessed by biopsy when available, clinical follow-up, and survival analysis. RESULTS Stage was discordant on PET/CT and conventional imaging in 50.6% of patients (41.1% upstaged, 9.5% downstaged), with high management impact (change in treatment modality or curative intent) in 42.3% of patients. Both conventional imaging stage and PET/CT stage were strongly predictive of overall survival (OS) but there were greater differences between hazard rates and separations in the OS curves for stage groupings determined using PET/CT. OS was also strongly predicted by PET/CT-directed choice of therapy (P < 0.0001). CONCLUSION PET/CT frequently affects patient management and strongly predicts OS in NSCLC, supporting the appropriateness of such changes.
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Affiliation(s)
- Deborah L Gregory
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
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Pilgrim CHC, Satgunaseelan L, Pham A, Murray W, Link E, Smith M, Usatoff V, Evans PM, Banting S, Thomson BN, Phillips WA, Michael M. Correlations between histopathological diagnosis of chemotherapy-induced hepatic injury, clinical features, and perioperative morbidity. HPB (Oxford) 2012; 14:333-40. [PMID: 22487071 PMCID: PMC3384853 DOI: 10.1111/j.1477-2574.2012.00454.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [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] [Indexed: 02/06/2023]
Abstract
BACKGROUND Chemotherapy has in some series been linked with increased morbidity after a hepatectomy. Hepatic injuries may result from the treatment with chemotherapy, but can also be secondary to co-morbid diseases. The aim of the present study was to draw correlations between clinical features, treatment with chemotherapy and injury phenotypes and assess the impact of each upon perioperative morbidity. PATIENTS AND METHODS Retrospective samples (n= 232) were scored grading steatosis, steatohepatitis and sinusoidal injury (SI). Clinical data were retrieved from medical records. Correlations were drawn between injury, clinical features and perioperative morbidity. RESULTS Injury rates were 18%, 4% and 19% for steatosis, steatohepatitis and SI, respectively. High-grade steatosis was more common in patients with diabetes [odds ratio (OR) = 3.33, P= 0.01] and patients with a higher weight (OR/kg = 1.04, P= 0.02). Steatohepatitis was increased with metabolic syndrome (OR = 5.88, P= 0.02). Chemotherapy overall demonstrated a trend towards an approximately doubled risk of high-grade steatosis and steatohepatitis although not affecting SI. However, pre-operative chemotherapy was associated with an increased SI (OR = 2.18, P= 0.05). Operative morbidity was not increased with chemotherapy, but was increased with steatosis (OR = 2.38, P= 0.02). CONCLUSIONS Diabetes and higher weight significantly increased the risk of steatosis, whereas metabolic syndrome significantly increased risk of steatohepatitis. The presence of high-grade steatosis increases perioperative morbidity, not administration of chemotherapy per se.
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Affiliation(s)
- Charles HC Pilgrim
- Division of Cancer Surgery, University of Melbourne, St. Vincent's HospitalMelbourne,Department of Surgery, University of Melbourne, St. Vincent's HospitalMelbourne,Hepatopancreaticobiliary Service, Upper Gastrointestinal Surgery, The Alfred HospitalMelbourne, Australia
| | - Laveniya Satgunaseelan
- Hepatopancreaticobiliary Service, Upper Gastrointestinal Surgery, The Alfred HospitalMelbourne, Australia
| | - Alan Pham
- Department of Pathology, The Alfred HospitalMelbourne, Australia
| | - William Murray
- Department of Pathology, University of Melbourne, St. Vincent's HospitalMelbourne
| | - Emma Link
- Centre for Biostatistics and Clinical Trials, University of Melbourne, St. Vincent's HospitalMelbourne
| | - Marty Smith
- Hepatopancreaticobiliary Service, Upper Gastrointestinal Surgery, The Alfred HospitalMelbourne, Australia
| | - Val Usatoff
- Hepatopancreaticobiliary Service, Upper Gastrointestinal Surgery, The Alfred HospitalMelbourne, Australia
| | - Peter M Evans
- Hepatopancreaticobiliary Service, Upper Gastrointestinal Surgery, The Alfred HospitalMelbourne, Australia
| | - Simon Banting
- Division of Cancer Surgery, University of Melbourne, St. Vincent's HospitalMelbourne,Department of Surgery, University of Melbourne, St. Vincent's HospitalMelbourne
| | - Benjamin N Thomson
- Division of Cancer Surgery, University of Melbourne, St. Vincent's HospitalMelbourne
| | - Wayne A Phillips
- Division of Cancer Surgery, University of Melbourne, St. Vincent's HospitalMelbourne,Department of Surgery, University of Melbourne, St. Vincent's HospitalMelbourne
| | - Michael Michael
- Division of Cancer Medicine, Peter MacCallum Cancer Centre, University of Melbourne, St. Vincent's HospitalMelbourne,Department of Medicine, University of Melbourne, St. Vincent's HospitalMelbourne
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Tischer CG, Hohmann C, Thiering E, Herbarth O, Müller A, Henderson J, Granell R, Fantini MP, Luciano L, Bergström A, Kull I, Link E, von Berg A, Kuehni CE, Strippoli MPF, Gehring U, Wijga A, Eller E, Bindslev-Jensen C, Keil T, Heinrich J. Meta-analysis of mould and dampness exposure on asthma and allergy in eight European birth cohorts: an ENRIECO initiative. Allergy 2011; 66:1570-9. [PMID: 21923669 DOI: 10.1111/j.1398-9995.2011.02712.x] [Citation(s) in RCA: 123] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Several cross-sectional studies during the past 10 years have observed an increased risk of allergic outcomes for children living in damp or mouldy environments. OBJECTIVE The objective of this study was to investigate whether reported mould or dampness exposure in early life is associated with the development of allergic disorders in children from eight European birth cohorts. METHODS We analysed data from 31 742 children from eight ongoing European birth cohorts. Exposure to mould and allergic health outcomes were assessed by parental questionnaires at different time points. Meta-analyses with fixed- and random-effect models were applied. The number of the studies included in each analysis varied based on the outcome data available for each cohort. RESULTS Exposure to visible mould and/or dampness during first 2 years of life was associated with an increased risk of developing asthma: there was a significant association with early asthma symptoms in meta-analyses of four cohorts [0-2 years: adjusted odds ratios (aOR), 1.39 (95% CI, 1.05-1.84)] and with asthma later in childhood in six cohorts [6-8 years: aOR, 1.09 (95% CI, 0.90-1.32) and 3-10 years: aOR, 1.10 (95% CI, 0.90-1.34)]. A statistically significant association was observed in six cohorts with symptoms of allergic rhinitis at school age [6-8 years: aOR, 1.12 (1.02-1.23)] and at any time point between 3 and 10 years [aOR, 1.18 (1.09-1.28)]. CONCLUSION These findings suggest that a mouldy home environment in early life is associated with an increased risk of asthma particularly in young children and allergic rhinitis symptoms in school-age children.
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Affiliation(s)
- C G Tischer
- Helmholtz Centre Munich, German Research Centre for Environmental Health, Institute of Epidemiology I, Neuherberg, Germany
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44
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Pilgrim CHC, Brettingham-Moore K, Pham A, Murray W, Link E, Smith M, Usatoff V, Evans PM, Banting S, Thomson BN, Michael M, Phillips WA. mRNA gene expression correlates with histologically diagnosed chemotherapy-induced hepatic injury. HPB (Oxford) 2011; 13:811-6. [PMID: 21999595 PMCID: PMC3238016 DOI: 10.1111/j.1477-2574.2011.00365.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Chemotherapy-induced hepatic injuries (CIHI) are an increasing problem facing hepatic surgeons. It may be possible to predict the risk of developing CIHI by analysis of genes involved in the metabolism of chemotherapeutics, previously established as associated with other forms of toxicity. METHODS Quantitative reverse transcriptase-polymerase chain reaction methodology (q-RT-PCR) was employed to quantify mRNA expression of nucleotide excision repair genes ERCC1 and ERCC2, relevant in the neutralization of damage induced by oxaliplatin, and genes encoding enzymes relevant to 5-flurouracil metabolism, [thymidylate synthase (TS), thymidine phosphorylase (TP) and dihydropyrimidine dehydrogenase (DPD)] in 233 hepatic resection samples. mRNA expression was correlated with a histopathological injury scored via previously validated methods in relation to steatosis, steatohepatitis and sinusoidal obstruction syndrome. RESULTS Low-level DPD mRNA expression was associated with steatosis [odds ratio (OR) = 3.95, 95% confidence interval (CI) = 1.53-10.19, P < 0.003], especially when stratified by just those patients exposed to chemotherapy (OR = 4.48, 95% CI = 1.31-15.30 P < 0.02). Low expression of ERCC2 was associated with sinusoidal injury (P < 0.001). There were no further associations between injury patterns and target genes investigated. CONCLUSIONS Predisposition to the development of CIHI may be predictable based upon individual patient expression of genes encoding enzymes related to the metabolism of chemotherapeutics.
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Affiliation(s)
- Charles HC Pilgrim
- Division of Cancer SurgeryMelbourne, Victoria, Australia,Department of SurgeryMelbourne, Victoria, Australia,Department of Hepatopancreaticobiliary Service, Upper Gastrointestinal Surgery, The Alfred HospitalMelbourne, Victoria, Australia
| | | | - Alan Pham
- Department of Pathology, The Alfred HospitalMelbourne, Victoria, Australia
| | | | - Emma Link
- Division of Cancer SurgeryMelbourne, Victoria, Australia
| | - Marty Smith
- Department of Hepatopancreaticobiliary Service, Upper Gastrointestinal Surgery, The Alfred HospitalMelbourne, Victoria, Australia
| | - Val Usatoff
- Department of Hepatopancreaticobiliary Service, Upper Gastrointestinal Surgery, The Alfred HospitalMelbourne, Victoria, Australia
| | - Peter M Evans
- Department of Hepatopancreaticobiliary Service, Upper Gastrointestinal Surgery, The Alfred HospitalMelbourne, Victoria, Australia
| | - Simon Banting
- Division of Cancer SurgeryMelbourne, Victoria, Australia,Department of SurgeryMelbourne, Victoria, Australia
| | | | - Michael Michael
- Division of Cancer Medicine, Peter MacCallum Cancer CentreMelbourne, Victoria, Australia,Department of Medicine, University of Melbourne (St. Vincent's Hospital, Melbourne)Melbourne, Victoria, Australia
| | - Wayne A Phillips
- Division of Cancer SurgeryMelbourne, Victoria, Australia,Department of SurgeryMelbourne, Victoria, Australia
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Pilgrim CHC, Brettingham-Moore K, Pham A, Murray W, Link E, Smith M, Usatoff V, Evans PM, Banting S, Thomson BN, Michael M, Phillips WA. Genetic correlations with chemotherapy-induced hepatic injury. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.3045] [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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Yeung JMC, Kalff V, Hicks RJ, Drummond E, Link E, Taouk Y, Michael M, Ngan S, Lynch AC, Heriot AG. Metabolic response of rectal cancer assessed by 18-FDG PET following chemoradiotherapy is prognostic for patient outcome. Dis Colon Rectum 2011; 54:518-25. [PMID: 21471751 DOI: 10.1007/dcr.0b013e31820b36f0] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Complete pathological response has proven prognostic benefits in patients with locally advanced rectal cancer treated with neoadjuvant chemoradiotherapy. Sequential 18-FDG PET may be an early surrogate for pathological response to chemoradiotherapy. OBJECTIVES The aim of this study was to identify whether metabolic response measured by FDG PET following chemoradiotherapy is prognostic for tumor recurrence and survival following neoadjuvant therapy and surgical treatment for primary rectal cancer. METHODS Patients with primary rectal cancer treated by long-course neoadjuvant chemoradiotherapy followed by surgery had FDG PET performed before and 4 weeks after treatment, before surgical resection was performed. Retrospective chart review was undertaken for patient demographics, tumor staging, recurrence rates, and survival. RESULTS : Between 2000 and 2007, 78 patients were identified (53 male, 25 female; median age, 64 y). After chemoradiotherapy, 37 patients (47%) had a complete metabolic response, 26 (33%) had a partial metabolic response, and 14 (18%) had no metabolic response as assessed by FDG PET (1 patient had missing data). However, only 4 patients (5%) had a complete pathological response. The median postoperative follow-up period was 3.1 years during which 14 patients (19%) had a recurrence: 2 local, 9 distant, and 3 with both local and distant. The estimated percentage without recurrence was 77% at 5 years (95% CI 66%-89%). There was an inverse relationship between FDG PET metabolic response and the incidence of recurrence within 3 years (P = .04). Kaplan-Meier analysis of FDG PET metabolic response and overall survival demonstrated a significant difference in survival among patients in the 3 arms: complete, partial, and no metabolic response (P = .04); the patients with complete metabolic response had the best prognosis. CONCLUSION Complete or partial metabolic response on PET following neoadjuvant chemoradiotherapy and surgery predicts a lower local recurrence rate and improved survival compared with patients with no metabolic response. Metabolic response may be used to stratify prognosis in patients with rectal cancer.
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Affiliation(s)
- J M C Yeung
- Department of Surgical Oncology, Peter MacCallum Cancer Centre, St. Andrew's Place, East Melbourne, Victoria, Australia
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Day FL, Link E, Thursky K, Rischin D. Current hepatitis B screening practices and clinical experience of reactivation in patients undergoing chemotherapy for solid tumors: a nationwide survey of medical oncologists. J Oncol Pract 2011; 7:141-7. [PMID: 21886492 PMCID: PMC3092651 DOI: 10.1200/jop.2010.000133] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2010] [Indexed: 01/29/2023] Open
Abstract
PURPOSE Universal screening for chronic hepatitis B virus (HBV) before chemotherapy has been recommended by the Centers for Disease Control. We sought to determine the practice of Australian oncologists with regard to HBV screening in patients with solid tumors (STs) and their clinical experience of HBV reactivation (HBVR). METHODS A survey was sent to all consultant members of the Medical Oncology Group of Australia. One hundred eighty-eight responses (63% response rate) were received. We also reviewed the incidence of HBV in patients with STs screened at the Peter MacCallum Cancer Centre (Melbourne, Australia). RESULTS Fifty-three percent of medical oncologists screen for HBV, but only 19% screen all patients. The most common reasons given for performing screening were anecdotal experience of HBVR (46%) and perceived sufficient evidence for screening of some patient subgroups (42%). Sixty-five percent of those who screened did so only in subgroups, usually selecting patients on the basis of ethnicity (82%). Oncologists who did not screen most commonly cited inadequate evidence for a benefit of screening (72%). Twenty-two percent of oncologists had witnessed one or more HBVR events, representing one event per 45 years of respondents' practice. HBVR events reported (n = 54) consisted of asymptomatic liver test abnormalities only (44%), symptomatic hepatitis (28%), decompensated liver failure (19%), and death (7%). In 206 patients with STs screened for HBV, 1.0% (n = 2) were HBV surface antigen positive, and 14.9% hepatitis B core antibody positive. CONCLUSION The majority of Australian medical oncologists have not adopted universal HBV screening before chemotherapy. Further evidence of the benefit and cost effectiveness of universal screening in patients with STs will be required to alter practice.
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Affiliation(s)
- Fiona L. Day
- Department of Medical Oncology, Centre for Biostatistics and Clinical Trials, and Department of Infectious Diseases, Peter MacCallum Cancer Centre; University of Melbourne, Melbourne, Victoria, Australia
| | - Emma Link
- Department of Medical Oncology, Centre for Biostatistics and Clinical Trials, and Department of Infectious Diseases, Peter MacCallum Cancer Centre; University of Melbourne, Melbourne, Victoria, Australia
| | - Karin Thursky
- Department of Medical Oncology, Centre for Biostatistics and Clinical Trials, and Department of Infectious Diseases, Peter MacCallum Cancer Centre; University of Melbourne, Melbourne, Victoria, Australia
| | - Danny Rischin
- Department of Medical Oncology, Centre for Biostatistics and Clinical Trials, and Department of Infectious Diseases, Peter MacCallum Cancer Centre; University of Melbourne, Melbourne, Victoria, Australia
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Cramer C, Link E, Bauer CP, Hoffmann U, von Berg A, Lehmann I, Herbarth O, Borte M, Schaaf B, Sausenthaler S, Wichmann HE, Heinrich J, Krämer U. Association between attendance of day care centres and increased prevalence of eczema in the German birth cohort study LISAplus. Allergy 2011; 66:68-75. [PMID: 20716321 DOI: 10.1111/j.1398-9995.2010.02446.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Day care centre attendance is much more common in East than in West Germany. Although there is evidence that early day care might be protective against atopic diseases, several studies have shown a higher prevalence of childhood eczema in East Germany compared to West Germany. OBJECTIVES To compare prevalence and cumulative incidence of eczema in a birth cohort study in East and West Germany and to identify risk factors that are associated with eczema, which might explain regional differences. METHODS We used data from the ongoing population-based birth cohort study Influence of Life-style factors on the development of the Immune System and Allergies in East and West Germany Plus the influence of traffic emissions and genetics. In 1997, 3097 children from study areas in East and West Germany were recruited. Cumulative incidence and 1-year prevalences of eczema up to the age of 6 years were determined from yearly questionnaires. Cox regression and generalized estimating equations/logistic regression were used to quantify regional differences and to identify risk factors that might explain them. RESULTS Prevalence and incidence of eczema were higher in children living in East Germany than those living in West Germany. We identified 11 risk factors that showed significant regional differences. From these factors, only 'day care attendance during the first 2 years of life' was significantly associated with eczema (odds ratio 1.56, 95% confidence interval CI 1.31-1.86). The regional differences in eczema could be explained by differences in early day care utilization. CONCLUSION Day care centre attendance is associated with an increased prevalence and incidence of eczema. Regional differences in eczema prevalence could be explained by regional differences in utilization of early day care.
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Affiliation(s)
- C Cramer
- IUF-Institut für Umweltmedizinische Forschung, Düsseldorf, Germany.
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Day FL, Link E, Thursky K, Rischin D. Prechemotherapy hepatitis B virus (HBV) screening in medical oncology patients: A national survey. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.9121] [Citation(s) in RCA: 2] [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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50
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Heriot AG, Day FL, Link E, Leong T, Lynch AC, Michael M, Hicks R, Hogg A, Ngan S. Utility of post-treatment FDG-PET in predicting outcomes in anal cancer managed with chemoradiotherapy. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.4105] [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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