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Jalali A, Gard G, Banks S, Dunn C, Wong HL, Wong R, Lee M, Gately L, Loft M, Shapiro JD, Kosmider S, Tie J, Ananda S, Yeung JM, Jennens R, Lee B, McKendrick J, Lim L, Khattak A, Gibbs P. Initial experience of TAS-102 chemotherapy in Australian patients with Chemo-refractory metastatic colorectal cancer. Curr Probl Cancer 2021; 46:100793. [PMID: 34565601 DOI: 10.1016/j.currproblcancer.2021.100793] [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: 05/06/2021] [Revised: 08/09/2021] [Accepted: 08/20/2021] [Indexed: 11/24/2022]
Abstract
For patients with refractory metastatic colorectal cancer (mCRC) treatment with Trifluridine/Tipiracil, also known as TAS-102, improves overall survival. This study aims to investigate the efficacy and safety of TAS-102 in a real-world population from Victoria, Australia. A retrospective analysis of prospectively collected data from the Treatment of Recurrent and Advanced Colorectal Cancer (TRACC) registry was undertaken. The characteristics and outcomes of patients receiving TAS-102 were assessed and compared to those enrolled in the registration study (RECOURSE). Across 13 sites, 107 patients were treated with TAS-102. The median age was 60 years (range: 31-83), compared to 63 for RECOURSE. Comparing registry TAS-102-treated and RECOURSE patients, 75% vs 100% were ECOG performance status 0-1, 74% vs 79% had initiated treatment more than 18 months from diagnosis of metastatic disease and 36% vs 49% were RAS wild-type. Median time on treatment was 10.4 weeks (range: 1.7-32). Median progression-free survival (PFS) was 3.3 months compared to 2 months in RECOURSE, while median overall survival was the same at 7.1 months. Two patients (2.3%) had febrile neutropenia and there were no treatment-related deaths, where TAS-102 dose at treatment initiation was at clinician discretion.TRACC registry patients treated with TAS-102 were younger than those from the RECOURSE trial, with similar overall survival observed. Less strict application of RECIST criteria and less frequent imaging may have contributed to an apparently longer PFS.
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Affiliation(s)
- A Jalali
- Division of Personalised Oncology, Walter and Eliza Hall Institute of Medical Research, VIC, Australia; Department of Medical Oncology, Western Health, VIC, Australia; Department of Medical Oncology, Latrobe Regional Hospital, VIC, Australia.
| | - G Gard
- Division of Personalised Oncology, Walter and Eliza Hall Institute of Medical Research, VIC, Australia
| | - S Banks
- Division of Personalised Oncology, Walter and Eliza Hall Institute of Medical Research, VIC, Australia
| | - C Dunn
- Division of Personalised Oncology, Walter and Eliza Hall Institute of Medical Research, VIC, Australia
| | - H L Wong
- Division of Personalised Oncology, Walter and Eliza Hall Institute of Medical Research, VIC, Australia; Department of Medical Oncology, Peter MacCallum Cancer Centre, VIC, Australia
| | - R Wong
- Division of Personalised Oncology, Walter and Eliza Hall Institute of Medical Research, VIC, Australia; Department of Medical Oncology, Eastern Health, VIC, Australia; Eastern Health Clinical School, Monash University, VIC, Australia
| | - M Lee
- Division of Personalised Oncology, Walter and Eliza Hall Institute of Medical Research, VIC, Australia; Department of Medical Oncology, Western Health, VIC, Australia; Department of Medical Oncology, Eastern Health, VIC, Australia; Eastern Health Clinical School, Monash University, VIC, Australia
| | - L Gately
- Division of Personalised Oncology, Walter and Eliza Hall Institute of Medical Research, VIC, Australia
| | - M Loft
- Division of Personalised Oncology, Walter and Eliza Hall Institute of Medical Research, VIC, Australia
| | - J D Shapiro
- Department of Medical Oncology, Cabrini Hospital, VIC, Australia
| | - S Kosmider
- Department of Medical Oncology, Western Health, VIC, Australia
| | - J Tie
- Division of Personalised Oncology, Walter and Eliza Hall Institute of Medical Research, VIC, Australia; Department of Medical Oncology, Western Health, VIC, Australia; Department of Medical Oncology, Peter MacCallum Cancer Centre, VIC, Australia
| | - S Ananda
- Division of Personalised Oncology, Walter and Eliza Hall Institute of Medical Research, VIC, Australia; Department of Medical Oncology, Western Health, VIC, Australia; Department of Medical Oncology, Peter MacCallum Cancer Centre, VIC, Australia; Department of Medical Oncology, Epworth Health, VIC, Australia
| | - J M Yeung
- Department of Surgery, Western Health, University of Melbourne, VIC, Australia; Western Health Chronic Disease Alliance, Western Health, VIC, Australia
| | - R Jennens
- Department of Medical Oncology, Epworth Health, VIC, Australia
| | - B Lee
- Division of Personalised Oncology, Walter and Eliza Hall Institute of Medical Research, VIC, Australia; Department of Medical Oncology, Peter MacCallum Cancer Centre, VIC, Australia; Department of Medical Oncology, Northern Health, VIC, Australia
| | - J McKendrick
- Department of Medical Oncology, Eastern Health, VIC, Australia; Department of Medical Oncology, Epworth Health, VIC, Australia
| | - L Lim
- Department of Medical Oncology, Eastern Health, VIC, Australia
| | - A Khattak
- Department of Medical Oncology, Fiona Stanley Hospital, WA, Australia
| | - P Gibbs
- Division of Personalised Oncology, Walter and Eliza Hall Institute of Medical Research, VIC, Australia; Department of Medical Oncology, Western Health, VIC, Australia
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Song X, Whittington Z, Johnson-Wu C, McKendrick J. PCN73 Is Time to Access Novel Cancer Therapies in Asia Accelerating? A Preliminary Investigation. Value Health Reg Issues 2020. [DOI: 10.1016/j.vhri.2020.07.123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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André T, Vernerey D, Im SA, Bodoky G, Buzzoni R, Reingold S, Rivera F, McKendrick J, Scheithauer W, Ravit G, Fountzilas G, Yong WP, Isaacs R, Österlund P, Liang JT, Creemers GJ, Rakez M, Van Cutsem E, Cunningham D, Tabernero J, de Gramont A. Bevacizumab as adjuvant treatment of colon cancer: updated results from the S-AVANT phase III study by the GERCOR Group. Ann Oncol 2019; 31:246-256. [PMID: 31959341 DOI: 10.1016/j.annonc.2019.12.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 12/03/2019] [Accepted: 12/15/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The bevacizumab-Avastin® adjuVANT (AVANT) study did not meet its primary end point of improving disease-free survival (DFS) with the addition of bevacizumab to oxaliplatin-based chemotherapy in stage III colon cancer (CC). We report here the long-term survival results (S-AVANT). PATIENTS AND METHODS Patients with curatively resected stage III CC were randomly assigned to FOLFOX4, FOLFOX4-bevacizumab, or XELOX-bevacizumab. RESULTS A total of 2867 patients were randomized: FOLFOX4: n = 955, FOLFOX4-bevacizumab: n = 960, XELOX-bevacizumab: n = 952. With a median of 6.73 years follow-up (interquartile range 5.51-10.54), 672 patients died, of whom 198 (20.7%), 250 (26.0%), and 224 (23.5%) were in the FOLFOX4, FOLFOX4-bevacizumab, and XELOX-bevacizumab arms, respectively. The 10-year overall survival (OS) rates were 74.6%, 67.2%, and 69.9%, (P = 0.003) and 5-year disease-free survival (DFS) rates were 73.2%, 68.5%, and 71.0% (P = 0.174), respectively. OS and DFS hazard ratios were 1.29 [95% confidence interval (CI) 1.07-1.55; P = 0.008] and 1.16 (95% CI 0.99-1.37; P = 0.063) for FOLFOX4-bevacizumab versus FOLFOX4 and 1.15 (95% CI 0.95-1.39; P = 0.147) and 1.1 (95% CI 0.93-1.29; P = 0.269) for XELOX-bevacizumab versus FOLFOX4, respectively. CC-related deaths (n = 542) occurred in 157 (79.3%) patients receiving FOLFOX4, 205 (82.0%) receiving FOLFOX4-bevacizumab, and 180 (80.4%) receiving XELOX-bevacizumab (P = 0.764), while non-CC-related deaths occurred in 41 (20.7%), 45 (18.0%), and 44 (19.6%) patients, respectively. Cardiovascular-related and sudden deaths during treatment or follow-up were reported in 13 (6.6%), 17 (6.8%), and 14 (6.3%) patients, in the FOLFOX4, FOLFOX4-bevacizuamb, and XELOX-bevacizumab arms, respectively (P = 0.789). Treatment arm, sex, age, histological differentiation, performance status, T/ N stages, and localization of primary tumor were independent prognostic factors of OS in stage III. CONCLUSIONS S-AVANT confirms the initial AVANT report. No benefit of the bevacizumab addition to FOLFOX4 adjuvant therapy in patients with stage III CC was observed in terms of DFS with a negative effect in OS, without increase in non-CC related deaths. CLINICAL TRIAL IDENTIFICATION NCT00112918.
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Affiliation(s)
- T André
- Sorbonne Université and, Department of Medical Oncology, Saint-Antoine Hospital, Paris, France.
| | - D Vernerey
- Methodology and Quality of Life Unit in Oncology, University Hospital of Besançon, INSERM UMR 1098, Besançon, France
| | - S A Im
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - G Bodoky
- Department of Medical Oncology, Combined Szent István and Szent László Hospitals, Budapest, Hungary
| | - R Buzzoni
- Department of Medical Oncology, Istituto Nazionale dei Tumori di Milano - Fondazione IRCCS, Milan, Italy
| | - S Reingold
- Department of Medical Oncology, William Osler Health Centre Brampton Civic Hospital, Brampton, Canada
| | - F Rivera
- Department of Medical Oncology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - J McKendrick
- Department of Medical Oncology, Eastern Health, Box Hill Hospital, Melbourne, Australia
| | - W Scheithauer
- Department of Medical Oncology, Vienna General Hospital (AKH), Medizinische Universität Wien, Vienna, Austria
| | - G Ravit
- Division of Oncology, Tel Aviv Sourasky Medical Center, Tel-Aviv University, Tel Aviv, Israel
| | - G Fountzilas
- Department of Medical Oncology, Papageorgiou Hospital Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - W P Yong
- Department of Hematology-Oncology, National University of Singapore, Singapore, Singapore
| | - R Isaacs
- Department of Medical Oncology, Palmerston North & Crest Hospitals, Palmerston North, New Zealand
| | - P Österlund
- Department of Oncology, Helsinki and Tampere University Hospitals, University of Helsinki, Helsinki/Tampere, Finland
| | - J T Liang
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - G J Creemers
- Department of Medical Oncology, Catharina Hospital, Eindhoven, The Netherlands
| | - M Rakez
- Statistical Unit, ARCAD Foundation, Levallois-Perret, France
| | - E Van Cutsem
- Department of Internal Medicine, University Hospitals Gasthuisberg Leuven and KU Leuven, Leuven, Belgium
| | - D Cunningham
- Department of Medicine, The Institute of Cancer Research/Royal Marsden NHS Foundation Trust, Sutton, UK
| | - J Tabernero
- Department of Medical Oncology, Vall d'Hebron University Hospital and Institute of Oncology (VHIO), UVic, IOB-Quiron, CIBERONC, TTD Group, Barcelona, Spain
| | - A de Gramont
- Statistical Unit, ARCAD Foundation, Levallois-Perret, France; Department of Medical Oncology, Franco-British Institute, Levallois-Perret, France
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André T, Vernerey D, Im SA, Bodoky G, Buzzoni R, Reingold S, Rivera F, McKendrick J, Scheithauer W, Geva R, Fountzilas G, Yong W, Isaacs R, Österlund P, Liang JT, Creemers GJ, Van Cutsem E, Cunningham D, Tabernero J, De Gramont A. Bevacizumab as adjuvant treatment for colon cancer: Updated results from the AVANT phase III study by the GERCOR group. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz246.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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McKendrick J, Malcolm B, Sheahan K, Katsoulis I, Song X, van Loon J. Impact of licensing and reimbursement discrepancies on patient access to cancer treatments across Europe and Canada. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx440.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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6
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Bird T, Michael M, Bressel M, Chu J, Chander S, Cooray P, McKendrick J, Jefford M, Heriot A, Steel M, Leong T, Ngan S. FOLFOX and intensified split-course chemoradiation as initial treatment for rectal cancer with synchronous metastases. Acta Oncol 2017; 56:646-652. [PMID: 28301974 DOI: 10.1080/0284186x.2017.1296584] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Optimal initial management of rectal carcinoma with synchronous metastases (RCSM) is controversial - both for patients being treated with curative and palliative intent. This study aims to evaluate the use of an upfront treatment strategy combining FOLFOX chemotherapy with split-course pelvic chemoradiation (FOLFOX + CRT) for patients with RCSM. MATERIAL AND METHODS An analysis of all patients who commenced treatment with FOLFOX + CRT at our institutions between January 2009 and June 2014 was performed. The regimen consisted of a total of 12 weeks of treatment with split-course pelvic chemoradiation (50.4Gy with concurrent oxaliplatin and 5-FU) alternating with FOLFOX chemotherapy. Restaging imaging was performed following treatment, with subsequent management as per local standard of care. RESULTS 78 patients (15 with resectable liver-only metastases) were identified. 77 (99%) completed at least 45Gy of radiation and 87% completed ≥75% of planned dose intensity of both oxaliplatin and 5FU. Two (2.6%) patients died within 30 days of treatment. Rates of radiological complete or partial response for local and metastatic disease were 90% and 66%, respectively. 24% patients had radiological disease progression of metastatic disease. Median overall survival for patients with unresectable metastatic disease at baseline was 23 months (95%CI: 19-28). 12 patients underwent radical surgery to both the rectum and liver and had an estimated 3-year overall survival rate of 62% (95%CI: 37-100). For those patients who did not proceed to rectal surgery, only 7% required palliative re-irradiation or surgery at a later date and all >20months from initial treatment. CONCLUSIONS In patients with unresectable metastatic disease, FOLFOX + CRT provides durable pelvic control for the majority without the need for additional local treatment. For patients with an advanced primary tumor and synchronous resectable liver-only metastases, FOLFOX + CRT can be considered a feasible and tolerable upfront treatment option.
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Affiliation(s)
- T. Bird
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - M. Michael
- Department of Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - M. Bressel
- Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - J. Chu
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - S. Chander
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - P. Cooray
- Department of Medical Oncology, Eastern Health, Box Hill, Melbourne, Australia
| | - J. McKendrick
- Department of Medical Oncology, Eastern Health, Box Hill, Melbourne, Australia
| | - M. Jefford
- Department of Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - A. Heriot
- Department of Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - M. Steel
- Department of Surgical Oncology, Eastern Health, Box Hill, Melbourne, Australia
| | - T. Leong
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - S. Ngan
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
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Ngan S, Bressel M, Chu J, McKendrick J, Chander S, Cooray P, Jefford M, Wong R, Steel M, Leong T, Heriot A, Michael M. A 12-week regimen with interdigitating FOLFOX/bevacizumab and pelvic chemoradiation for synchronous primary and metastatic rectal cancer. The CHROME B trial. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw370.51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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8
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Monnickendam G, Mortaki K, McKendrick J. Methodological differences and the appropriate application of oncology value frameworks to assess clinical value. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw377.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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9
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Oh P, Hovingh G, Gandra S, McKendrick J, Dent R, Wieffer H, Catapano A, Rosenson R, Stroes E. Identification and management of canadian patients with symptoms of statin intolerance: Results from a real-world clinical practice survey. Atherosclerosis 2016. [DOI: 10.1016/j.atherosclerosis.2016.07.156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Jalali A, Ha F, Chong G, Grigg A, McKendrick J, Schwarer A, Doig R, Hamid A, Hawkes E. 3215 Outcome of ABVD chemotherapy in an Australian population of Hodgkin lymphoma (HL). Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)31792-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Michael M, Chander S, McKendrick J, MacKay JR, Steel M, Hicks R, Heriot A, Leong T, Cooray P, Jefford M, Zalcberg J, Bressel M, McClure B, Ngan SY. Phase II trial evaluating the feasibility of interdigitating folfox with chemoradiotherapy in locally advanced and metastatic rectal cancer. Br J Cancer 2014; 111:1924-31. [PMID: 25211659 PMCID: PMC4229632 DOI: 10.1038/bjc.2014.487] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Revised: 07/29/2014] [Accepted: 08/13/2014] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Patients (pts) with metastatic rectal cancer and symptomatic primary, require local and systemic control. Chemotherapy used during chemoradiotherapy (CRT) is adequate for radiosensitisation, but suboptimal for systemic control. The aim of this phase II study was to assess tolerability, local/systemic benefits, of a novel regimen delivering interdigitating intensive chemotherapy with radical CRT. METHODS Eligible pts had untreated synchronous symptomatic primary/metastatic rectal cancer. A total of 12 weeks of treatment with split-course pelvic CRT (total 50.4 Gy with concurrent oxaliplatin and 5-FU infusion) alternating with FOLFOX chemotherapy. All pts staged with CT, MRI and FDG-PET pre and post treatment. RESULTS Twenty-six pts were treated. Rectal primary MRI stage: T3 81% and T4 15%. Liver metastases in 81%. Twenty-four pts (92%) completed the 12-week regimen. All patients received planned RT dose, and for both agents over 88% of patients achieved a relative dose intensity of >75%. Grade 3 toxicities: neutropenia 23%, diarrhoea 15%, and radiation skin reaction 12%. Grade 4 toxicity: neutropenia 15%. FDG-PET metabolic response rate for rectal primary 96%, and for metastatic disease 60%. CONCLUSIONS Delivery of interdigitating chemotherapy with radical CRT was feasible to treat both primary and metastatic rectal cancer. High completion and response rates were encouraging.
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Affiliation(s)
- M Michael
- Division of Cancer Medicine, Lower Gastrointestinal Tumour Service, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- The Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Melbourne, Victoria, Australia
| | - S Chander
- Division of Radiation Oncology, Lower Gastrointestinal Tumour Service, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - J McKendrick
- Department of Medical Oncology, Box Hill Hospital, Melbourne, Victoria, Australia
| | - J R MacKay
- Division of Surgical Oncology, Lower Gastrointestinal Tumour Service, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - M Steel
- Department of Surgery, Box Hill Hospital, Melbourne, Victoria, Australia
| | - R Hicks
- The Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Melbourne, Victoria, Australia
- Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - A Heriot
- Division of Surgical Oncology, Lower Gastrointestinal Tumour Service, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - T Leong
- Division of Radiation Oncology, Lower Gastrointestinal Tumour Service, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - P Cooray
- Department of Medical Oncology, Box Hill Hospital, Melbourne, Victoria, Australia
| | - M Jefford
- Division of Cancer Medicine, Lower Gastrointestinal Tumour Service, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- The Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Melbourne, Victoria, Australia
| | - J Zalcberg
- Division of Cancer Medicine, Lower Gastrointestinal Tumour Service, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - M Bressel
- Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - B McClure
- Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - S Y Ngan
- Division of Radiation Oncology, Lower Gastrointestinal Tumour Service, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
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Field K, Wong HL, Shapiro J, Kosmider S, Tie J, Bae S, Yip D, McKendrick J, Nott L, Desai J, Harold M, Lipton L, Stefanou G, Lim L, Parente P, Gibbs P. Developing a national database for metastatic colorectal cancer management: perspectives and challenges. Intern Med J 2014; 43:1224-31. [PMID: 23834128 DOI: 10.1111/imj.12230] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [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: 02/02/2013] [Accepted: 06/27/2013] [Indexed: 02/06/2023]
Abstract
BACKGROUND The changing treatment landscape for metastatic colorectal cancer creates multiple potential treatment strategies. An Australian-centric database capturing comprehensive information across a range of treatment locations would create a valuable resource enabling multiple important research questions to be addressed. AIMS To establish a collection of a consensus dataset capturing treatment and outcomes at multiple public and private hospitals across Australia. METHODS An electronic database was developed by a panel of clinicians, to capture an agreed dataset for patients with newly diagnosed metastatic colorectal cancer. Of particular interest were clinician decision-making, the impact of comorbidities and the frequency of major adverse events. RESULTS Since July 2009, data collection has been established at six public and eight private hospitals across three Australian states and territories. Successful linkage and analysis, with support from BioGrid Australia, of selected data on the initial 864 patients demonstrates that data can be captured from diverse sites, including public and private practice, that multiple factors impact on treatment delivered and outcomes achieved and that comprehensive data on rare but important adverse events can be captured. As a clinical research tool, the project has been highly successful, generating multiple presentations at national and international conferences related to a diverse range of research questions. CONCLUSIONS Multistate, project-specific data collection involving large numbers of patients is achievable. Providing invaluable insight into the routine clinical management of metastatic colorectal cancer in the era of targeted therapies, this also creates a significant resource for research, including many questions not being addressed by clinical trials.
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Affiliation(s)
- K Field
- Medical Oncology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
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Wong HL, Field K, Harol M, Tran B, Tie J, Shapiro J, Wong R, Yip D, Nott L, Richardson G, McKendrick J, Gibbs P. P0183 Resection of colorectal cancer metastases in routine practice. Eur J Cancer 2014. [DOI: 10.1016/j.ejca.2014.03.227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Twelves C, Scheithauer W, McKendrick J, Seitz JF, Van Hazel G, Wong A, Díaz-Rubio E, Gilberg F, Cassidy J. Capecitabine versus 5-fluorouracil/folinic acid as adjuvant therapy for stage III colon cancer: final results from the X-ACT trial with analysis by age and preliminary evidence of a pharmacodynamic marker of efficacy. Ann Oncol 2012; 23:1190-1197. [PMID: 21896539 DOI: 10.1093/annonc/mdr366] [Citation(s) in RCA: 130] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND This multicenter randomized trial compared oral capecitabine with bolus i.v. 5-fluorouracil (5-FU)/folinic acid (FA) as adjuvant therapy for stage III colon cancer. PATIENTS AND METHODS Patients were assigned to 24 weeks of capecitabine 1250 mg/m(2) twice daily on days 1-14 every 3 weeks or 5-FU/FA (Mayo Clinic regimen). The primary end point was disease-free survival (DFS). RESULTS The intent-to-treat population received capecitabine (n = 1004) or 5-FU/FA (n = 983). With a median follow-up of 6.9 years, capecitabine was at least equivalent to 5-FU/FA in terms of DFS [hazard ratio (HR) = 0.88; 95% confidence interval (CI) 0.77-1.01] and overall survival (OS) (HR = 0.86; 95% CI 0.74-1.01); the 95% CI upper limits were significantly less than the predefined noninferiority margins of 1.20 (P < 0.0001) and 1.14 (P < 0.001), respectively. This pattern was maintained in all subgroups, including patients aged ≥ 70 years. Preplanned multivariate analyses showed that capecitabine had statistically significant beneficial effects on DFS (P = 0.021) and OS (P = 0.020) versus 5-FU/FA. A post hoc analysis suggested that the occurrence of hand-foot syndrome may be associated with better outcomes in capecitabine recipients. CONCLUSION Oral capecitabine is an effective alternative to bolus 5-FU/FA as adjuvant treatment of patients with stage III colon cancer with efficacy benefits maintained at 5 years and in older patients.
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Affiliation(s)
- C Twelves
- University of Leeds and St James's Institute of Oncology Hospital, Leeds Cancer Research UK Centre, Leeds, UK.
| | - W Scheithauer
- Department of Internal Medicine I, Medical University Vienna, Vienna, Austria
| | - J McKendrick
- Department of Haematology and Medical Oncology, Box Hill Hospital, Melbourne, Australia
| | - J-F Seitz
- Digestive Oncology Unit, Hôpital La Timone, Université de la Méditerranée, Marseille, France
| | - G Van Hazel
- Perth Oncology, Mount Medical Centre, Perth, Australia
| | - A Wong
- Department of Medical Oncology, Tom Baker Cancer Centre, Calgary, Canada
| | - E Díaz-Rubio
- Department of Medical Oncology, Hospital Clínico San Carlos, Madrid, Spain
| | - F Gilberg
- F. Hoffmann-La Roche Inc., Basel, Switzerland
| | - J Cassidy
- Department of Medical Oncology, University of Glasgow, Glasgow, UK
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Tabernero J, Van Cutsem E, Lakomy R, Prausova J, Ruff P, Van Hazel G, Moiseyenko V, Ferry D, McKendrick J, Soussan-Lazard K, Boelle E, Allegra C. Results From VELOUR, a Phase 3 Study of Aflibercept (A) Versus Placebo (pbo) in Combination with FOLFIRI for the Treatment of Patients (pt) with Previously Treated Metastatic Colorectal Cancer (MCRC). Eur J Cancer 2011. [DOI: 10.1016/s0959-8049(11)70105-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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16
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Lewin J, Haydon A, McKendrick J, Millar J, Schwarz M, Shapiro J. 7168 POSTER Health Related Quality of Life (QOL) Assessment In Stage 1 Semlnomatous Germ Cell Tumour Patients Treated With Either Adjuvant Carboplatin Chemotherapy, Adjuvant Radiotherapy or High Intensity Chemotherapy. Eur J Cancer 2011. [DOI: 10.1016/s0959-8049(11)72083-4] [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: 11/27/2022]
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17
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Nqan S, McKendrick J, Bressel M, Leong T, Cooray P, Heriot A, Steel M, Chander S, McClure B, Michael M. 6050 POSTER A 12-week Regimen With Interdigitating FOLFOX Chemotherapy and Pelvic Chemoradiation for Simultaneous Primary and Metastatic Rectal Cancer. Eur J Cancer 2011. [DOI: 10.1016/s0959-8049(11)71695-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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18
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Thompson R, McKendrick J. Robert Duncan McKendrick. West J Med 2009. [DOI: 10.1136/bmj.b1947] [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: 11/04/2022]
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Melichar B, Koralewski P, Ravaud A, Pluzanska A, Bracarda S, Szczylik C, Chevreau C, Filipek M, Delva R, Sevin E, Négrier S, McKendrick J, Santoro A, Pisa P, Escudier B. First-line bevacizumab combined with reduced dose interferon-α2a is active in patients with metastatic renal cell carcinoma. Ann Oncol 2008; 19:1470-1476. [DOI: 10.1093/annonc/mdn161] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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20
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McLachlan S, Fisher R, McClure B, Beresford J, McKendrick J, Mackay J, Solomon M, Burmeister B, Hartopeanu C, Ngan S. A comparison of quality of life in patients with T3 rectal cancer receiving short course versus long course preoperative radiation. A Trans-Tasman Radiation Oncology Group Trial (TROG 01.04). J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.4097] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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21
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Twelves C, Scheithauer W, McKendrick J, Nowacki M, Seitz J, Van Hazel G, Wong A, Diaz-Rubio E, Cassidy J. 1LB 5-year overall survival update from the X-ACT trial of capecitabine vs. 5-FU/LV as adjuvant treatment for stage-III colon cancer. EJC Suppl 2007. [DOI: 10.1016/s1359-6349(07)70094-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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22
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McKendrick J, Cerri KH, Lloyd A, D'Ausilio A, Dando S, Chinn C. Cost effectiveness of olanzapine in prevention of affective episodes in bipolar disorder in the United Kingdom. J Psychopharmacol 2007; 21:588-96. [PMID: 17050661 DOI: 10.1177/0269881106068395] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [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] [Indexed: 11/16/2022]
Abstract
This study evaluated the cost effectiveness of olanzapine compared with lithium as maintenance therapy for patients with bipolar I disorder (BP1) in the UK. A Markov model was developed to assess costs and outcomes from the perspective of the UK National Health Service over a 1-year period. Patients enter the model after stabilization of a manic episode and are then treated with olanzapine or lithium. Using the findings of a recent randomized clinical trial, the model considers the monthly risk of manic or depressive episodes and of dropping out from allocated therapy. health care resources associated with acute episodes were derived primarily from a recent UK chart review. Costs of maintenance therapy and monitoring were also considered. Key factors influencing cost effectiveness were identified and included in a stochastic sensitivity analysis. The model estimated that, compared to lithium, olanzapine significantly reduced the annual number of acute mood episodes per patient from 0.81 to 0.58 (difference -0.23; 95% CI: -0.34, -0.12). Per patient average annual care costs fell by 799 UK pounds (95% CI: - 1,824 UK pounds, 59 UK pounds) driven by reduced inpatient days--but the cost difference was not statistically significant. Sensitivity analysis found the results to be robust to plausible variation in the model's parameters. The model estimated that using olanzapine instead of lithium as maintenance therapy for BP1 would significantly reduce the rate of acute mood events resulting in reduced hospital costs. Based on available evidence, there is a high likelihood that olanzapine would reduce costs of care compared to lithium.
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Affiliation(s)
- J McKendrick
- Eli Lilly and Company Ltd., Lilly House, Priestley Road, Basingstoke, Hampshire, UK.
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23
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Seshadri T, Gook D, Lade S, Spencer A, Grigg A, Tiedemann K, McKendrick J, Mitchell P, Stern C, Seymour JF. Lack of evidence of disease contamination in ovarian tissue harvested for cryopreservation from patients with Hodgkin lymphoma and analysis of factors predictive of oocyte yield. Br J Cancer 2006; 94:1007-10. [PMID: 16570049 PMCID: PMC2361234 DOI: 10.1038/sj.bjc.6603050] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Ovarian cryopreservation is a promising technique to preserve fertility in women with Hodgkin lymphoma (HL) treated with chemotherapy. Thus, the aim of this study was to examine harvested ovarian tissue for subclinical involvement by HL by morphology/immunohistochemistry, and to define patient and treatment factors predictive of oocyte yield. This was a retrospective analysis of 26 ovarian tissue samples harvested for cryopreservation from women with HL. Histology, immunohistochemistry and follicle density (number mm−3) was examined. Disease status and preharvest chemotherapy details were obtained on 24 patients. The median age was 22 years (range 13–29). Seven of 24 patients had infradiaphragmatic disease at time of harvest. Nine of 20 patients had received chemotherapy preharvest (ABVD (Adriamycin®, Bleomycin, Vinblastine and Dacarbazine)=7, other regimens=2). The seven receiving ABVD showed no difference in follicle density compared to patients not receiving treatment (n=14); (median=1555 vs 1620 mm3P=0.97). Follicle density measurement showed no correlation with patient age (R2=0.0001, P=0.99). There was no evidence of HL involvement in the 26 samples examined (95% CI=0–11%). In conclusion, subclinical involvement of HL has not been identified in ovarian tissue, even when patients have infradiaphragmatic disease. Furthermore, the quality of tissue harvested does not appear to be adversely affected by patient's age or prior ABVD chemotherapy.
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Affiliation(s)
- T Seshadri
- Monash Medical Centre, Clayton, Victoria 3168, Australia
| | - D Gook
- Royal Women's Hospital, and Melbourne IVF, East Melbourne, Victoria 3002, Australia
| | - S Lade
- The Peter MacCallum Cancer Centre, Department of Haematology and Medical Oncology Level 5, Locked Bag 1, A’Beckett st, East Melbourne, Victoria 8006, Australia
| | - A Spencer
- Alfred Hospital, Prahran, Victoria 3181, Australia
| | - A Grigg
- Royal Melbourne Hospital, Parkville, Victoria 3052, Australia
| | - K Tiedemann
- Royal Children's Hospital, Parkville, Victoria 3052, Australia
| | - J McKendrick
- Box Hill Hospital, Box Hill, Victoria 3128, Australia
| | - P Mitchell
- Austin Hospital, Heidelberg, Melbourne, Victoria, 3084, Australia
| | - C Stern
- Royal Women's Hospital, and Melbourne IVF, East Melbourne, Victoria 3002, Australia
| | - J F Seymour
- The Peter MacCallum Cancer Centre, Department of Haematology and Medical Oncology Level 5, Locked Bag 1, A’Beckett st, East Melbourne, Victoria 8006, Australia
- The Peter MacCallum Cancer Centre, Department of Haematology and Medical Oncology Level 5, Locked Bag 1, A’Beckett st, East Melbourne, Victoria 8006, Australia. E-mail:
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24
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Chaplin R, Barley M, Cooper SJ, Kusel Y, McKendrick J, Stephenson D, Obuaya T, Stockton-Henderson J, O'Brien LS, Burns T. The impact of intellectual functioning on symptoms and service use in schizophrenia. J Intellect Disabil Res 2006; 50:288-94. [PMID: 16507033 DOI: 10.1111/j.1365-2788.2006.00837.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
BACKGROUND This study aims to evaluate differences in the clinical profiles and use of psychiatric services by people with schizophrenia with and without borderline intellectual functioning. Both groups in this study were receiving standard community psychiatric care. METHODS A naturalistic sample of 372 people with schizophrenia completed the National Adult Reading Test. Data were collected prospectively over 18 months on psychiatric symptoms and service use. Three hundred and thirteen had normal intellectual functioning (mean age 43, range 20-76 years) and 59 had borderline or lower intellectual functioning (mean age 45, range 21-81 years). This was defined by a National Adult Reading Test error score of more than 40. RESULTS People with borderline or lower intellectual functioning had a lower quality of life, more severe psychotic symptoms, reduced functioning and fewer antidepressant prescriptions. There were no significant differences in service use including hospital admission. CONCLUSIONS People with schizophrenia and borderline or lower intellectual functioning are a more disabled group within general adult psychiatric services who should be the focus of initiatives for improved service delivery.
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Affiliation(s)
- R Chaplin
- Royal College of Psychiatrists-College Research Unit, London, UK.
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25
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Filik R, Sipos A, Kehoe PG, Burns T, Cooper SJ, Stevens H, Laugharne R, Young G, Perrington S, McKendrick J, Stephenson D, Harrison G. The cardiovascular and respiratory health of people with schizophrenia. Acta Psychiatr Scand 2006; 113:298-305. [PMID: 16638074 DOI: 10.1111/j.1600-0447.2006.00768.x] [Citation(s) in RCA: 101] [Impact Index Per Article: 5.6] [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] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To examine the cardiovascular and respiratory health of people with severe mental illness (SMI) and compare findings with the Health Surveys for England. METHOD A prospective, multi-centre observational prevalence study of 602 patients with schizophrenia-related psychoses carried out in six locations across the UK over 24 months. RESULTS Compared with general population subjects, people with SMI reported higher rates of angina and respiratory symptoms and had poor lung function. Much of this increased risk could be explained by lifestyle risk factors; there were increased levels of obesity among younger people with SMI. CONCLUSION Key indicators of the cardiovascular and respiratory health of people with SMI are poor compared with those of the general population. Care plans should prioritize interventions to attenuate lifestyle risk factors. Evidence of increasing obesity in younger patients is of particular concern, predicting even greater health needs in the future.
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Affiliation(s)
- R Filik
- Division of Psychiatry, University of Bristol, Bristol, UK.
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26
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Burns T, Christova L, Cooper S, Harrison G, McKendrick J, Laugharne R, Obuaya T, McCreadie R, O'Brien S, Perrington S, Stephenson D. Maintenance antipsychotic medication patterns in outpatient schizophrenia patients: a naturalistic cohort study. Acta Psychiatr Scand 2006; 113:126-34. [PMID: 16423164 DOI: 10.1111/j.1600-0447.2005.00622.x] [Citation(s) in RCA: 16] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Newer antipsychotics are increasingly used in schizophrenia maintenance. The UK change has been slow with little known on switching patterns. We aimed to investigate antipsychotic prescribing patterns in schizophrenia patients. METHOD A naturalistic six-site cohort sample of 600 patients were interviewed by researchers at 6-monthly intervals for 2 years to record their clinical and social functioning; use of services and medication for the preceding 6 months was obtained by structured extraction from clinical case notes. RESULTS Alterations in antipsychotic medication were frequent in this group, mainly during periods of inpatient care. Atypical prescribing increased steadily, though slowly, across the period. Polypharmacy was less than anticipated. CONCLUSION Inpatient care remains the main forum for switching of antipsychotics. The UK maintains a slow shift to atypical antipsychotics.
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Affiliation(s)
- T Burns
- University of Oxford, Oxford, UK.
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27
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Michael M, Wirth A, Ball DL, MacManus M, Rischin D, Mileshkin L, Solomon B, McKendrick J, Milner AD. A phase I trial of high-dose palliative radiotherapy plus concurrent weekly Vinorelbine and Cisplatin in patients with locally advanced and metastatic NSCLC. Br J Cancer 2005; 93:652-61. [PMID: 16222311 PMCID: PMC2361626 DOI: 10.1038/sj.bjc.6602759] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
The role of concurrent chemoradiotherapy (CRT) in patients with non-small-cell lung cancer (NSCLC) unsuitable for radical therapy but who require locoregional treatment has not been defined. The aims of this phase I trial were thus to develop a novel regimen of weekly chemotherapy concurrent with high-dose palliative RT (40 Gy/20 fractions) and assess its tolerability, objective and symptomatic response rates. Eligible patients had stage I–IIIB NSCLC unsuitable for radical RT or limited stage IV disease, ECOG PS⩽1 and required locoregional therapy. Treatment was RT (40 Gy/20 fractions/5 per week) and weekly Vinorelbine plus Cisplatin escalated in six planned dose levels (DLs). At 4 weeks post-RT, patients received two cycles of Cisplatin 80 mg m−2 day 1+Vinorelbine 25 mg m−2 days 1, 8, 15. Dose-limiting toxicities (DLTs) were defined in the CRT phase. Disease-related symptoms were assessed by the Lung Cancer Symptom Scale. In all, 24 patients accrued, stage IIIB (n=12) and IV disease (n=10). The highest administered dose was at DL 4, Vinorelbine 30 mg m−2+Cisplatin 20 mg m−2 with DLTs of grade 4 neutropenia in two of three patients. No grade 3 or 4 nonhaematological toxicities were observed. The overall radiological response rate was 65% (n=23: complete response 4% and partial response 61%) and infield FDG-PET responses were seen in 89% (n=18). There was an improvement or stabilisation of symptoms and quality of life. Dose level 3, Vinorelbine 25 mg m−2+Cisplatin 20 mg m−2, is recommended for further assessment. This regimen was tolerable and produced meaningful responses for patients for whom locoregional control is required, but who are unsuitable for radical CRT.
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Affiliation(s)
- M Michael
- The Division of Haematology and Medical Oncology, Peter MacCallum Cancer Centre, Locked Bag 1, A'Beckett St, Victoria 8006, Australia.
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Imrie K, Belch A, Pettengell R, Rueda A, McKendrick J, Solal-Céligny P, Offner F, Bence-Buckler I, Walewski J, Raposo J, Marcus R. Rituximab plus CVP chemotherapy vs. CVP alone as first-line treatment for follicular lymphoma: Treatment effect according to baseline prognostic factors. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.6525] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [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)
- K. Imrie
- Toronto-Sunnybrook Regional Cancer Ctr, Toronto, ON, Canada; Cross Cancer Institute, Edmonton, AB, Canada; St. George’s Hosp Medcl Sch, London, United Kingdom; Hospital Clinico Universitario de Malaga, Malaga, Spain; Box Hill Hosp, Box Hill, Australia; Clinique Victor Hugo, Le Mans, France; Univ Ziekenhuis Gent, Ghent, The Netherlands; The Ottawa Hosp, Ottawa, ON, Canada; M. Sklodowska-Curie Memorial Institute, Warszawa, Poland; Hosp Santa Maria, Lisboa, Portugal; Addenbrooke’s Hosp, Cambridge, United
| | - A. Belch
- Toronto-Sunnybrook Regional Cancer Ctr, Toronto, ON, Canada; Cross Cancer Institute, Edmonton, AB, Canada; St. George’s Hosp Medcl Sch, London, United Kingdom; Hospital Clinico Universitario de Malaga, Malaga, Spain; Box Hill Hosp, Box Hill, Australia; Clinique Victor Hugo, Le Mans, France; Univ Ziekenhuis Gent, Ghent, The Netherlands; The Ottawa Hosp, Ottawa, ON, Canada; M. Sklodowska-Curie Memorial Institute, Warszawa, Poland; Hosp Santa Maria, Lisboa, Portugal; Addenbrooke’s Hosp, Cambridge, United
| | - R. Pettengell
- Toronto-Sunnybrook Regional Cancer Ctr, Toronto, ON, Canada; Cross Cancer Institute, Edmonton, AB, Canada; St. George’s Hosp Medcl Sch, London, United Kingdom; Hospital Clinico Universitario de Malaga, Malaga, Spain; Box Hill Hosp, Box Hill, Australia; Clinique Victor Hugo, Le Mans, France; Univ Ziekenhuis Gent, Ghent, The Netherlands; The Ottawa Hosp, Ottawa, ON, Canada; M. Sklodowska-Curie Memorial Institute, Warszawa, Poland; Hosp Santa Maria, Lisboa, Portugal; Addenbrooke’s Hosp, Cambridge, United
| | - A. Rueda
- Toronto-Sunnybrook Regional Cancer Ctr, Toronto, ON, Canada; Cross Cancer Institute, Edmonton, AB, Canada; St. George’s Hosp Medcl Sch, London, United Kingdom; Hospital Clinico Universitario de Malaga, Malaga, Spain; Box Hill Hosp, Box Hill, Australia; Clinique Victor Hugo, Le Mans, France; Univ Ziekenhuis Gent, Ghent, The Netherlands; The Ottawa Hosp, Ottawa, ON, Canada; M. Sklodowska-Curie Memorial Institute, Warszawa, Poland; Hosp Santa Maria, Lisboa, Portugal; Addenbrooke’s Hosp, Cambridge, United
| | - J. McKendrick
- Toronto-Sunnybrook Regional Cancer Ctr, Toronto, ON, Canada; Cross Cancer Institute, Edmonton, AB, Canada; St. George’s Hosp Medcl Sch, London, United Kingdom; Hospital Clinico Universitario de Malaga, Malaga, Spain; Box Hill Hosp, Box Hill, Australia; Clinique Victor Hugo, Le Mans, France; Univ Ziekenhuis Gent, Ghent, The Netherlands; The Ottawa Hosp, Ottawa, ON, Canada; M. Sklodowska-Curie Memorial Institute, Warszawa, Poland; Hosp Santa Maria, Lisboa, Portugal; Addenbrooke’s Hosp, Cambridge, United
| | - P. Solal-Céligny
- Toronto-Sunnybrook Regional Cancer Ctr, Toronto, ON, Canada; Cross Cancer Institute, Edmonton, AB, Canada; St. George’s Hosp Medcl Sch, London, United Kingdom; Hospital Clinico Universitario de Malaga, Malaga, Spain; Box Hill Hosp, Box Hill, Australia; Clinique Victor Hugo, Le Mans, France; Univ Ziekenhuis Gent, Ghent, The Netherlands; The Ottawa Hosp, Ottawa, ON, Canada; M. Sklodowska-Curie Memorial Institute, Warszawa, Poland; Hosp Santa Maria, Lisboa, Portugal; Addenbrooke’s Hosp, Cambridge, United
| | - F. Offner
- Toronto-Sunnybrook Regional Cancer Ctr, Toronto, ON, Canada; Cross Cancer Institute, Edmonton, AB, Canada; St. George’s Hosp Medcl Sch, London, United Kingdom; Hospital Clinico Universitario de Malaga, Malaga, Spain; Box Hill Hosp, Box Hill, Australia; Clinique Victor Hugo, Le Mans, France; Univ Ziekenhuis Gent, Ghent, The Netherlands; The Ottawa Hosp, Ottawa, ON, Canada; M. Sklodowska-Curie Memorial Institute, Warszawa, Poland; Hosp Santa Maria, Lisboa, Portugal; Addenbrooke’s Hosp, Cambridge, United
| | - I. Bence-Buckler
- Toronto-Sunnybrook Regional Cancer Ctr, Toronto, ON, Canada; Cross Cancer Institute, Edmonton, AB, Canada; St. George’s Hosp Medcl Sch, London, United Kingdom; Hospital Clinico Universitario de Malaga, Malaga, Spain; Box Hill Hosp, Box Hill, Australia; Clinique Victor Hugo, Le Mans, France; Univ Ziekenhuis Gent, Ghent, The Netherlands; The Ottawa Hosp, Ottawa, ON, Canada; M. Sklodowska-Curie Memorial Institute, Warszawa, Poland; Hosp Santa Maria, Lisboa, Portugal; Addenbrooke’s Hosp, Cambridge, United
| | - J. Walewski
- Toronto-Sunnybrook Regional Cancer Ctr, Toronto, ON, Canada; Cross Cancer Institute, Edmonton, AB, Canada; St. George’s Hosp Medcl Sch, London, United Kingdom; Hospital Clinico Universitario de Malaga, Malaga, Spain; Box Hill Hosp, Box Hill, Australia; Clinique Victor Hugo, Le Mans, France; Univ Ziekenhuis Gent, Ghent, The Netherlands; The Ottawa Hosp, Ottawa, ON, Canada; M. Sklodowska-Curie Memorial Institute, Warszawa, Poland; Hosp Santa Maria, Lisboa, Portugal; Addenbrooke’s Hosp, Cambridge, United
| | - J. Raposo
- Toronto-Sunnybrook Regional Cancer Ctr, Toronto, ON, Canada; Cross Cancer Institute, Edmonton, AB, Canada; St. George’s Hosp Medcl Sch, London, United Kingdom; Hospital Clinico Universitario de Malaga, Malaga, Spain; Box Hill Hosp, Box Hill, Australia; Clinique Victor Hugo, Le Mans, France; Univ Ziekenhuis Gent, Ghent, The Netherlands; The Ottawa Hosp, Ottawa, ON, Canada; M. Sklodowska-Curie Memorial Institute, Warszawa, Poland; Hosp Santa Maria, Lisboa, Portugal; Addenbrooke’s Hosp, Cambridge, United
| | - R. Marcus
- Toronto-Sunnybrook Regional Cancer Ctr, Toronto, ON, Canada; Cross Cancer Institute, Edmonton, AB, Canada; St. George’s Hosp Medcl Sch, London, United Kingdom; Hospital Clinico Universitario de Malaga, Malaga, Spain; Box Hill Hosp, Box Hill, Australia; Clinique Victor Hugo, Le Mans, France; Univ Ziekenhuis Gent, Ghent, The Netherlands; The Ottawa Hosp, Ottawa, ON, Canada; M. Sklodowska-Curie Memorial Institute, Warszawa, Poland; Hosp Santa Maria, Lisboa, Portugal; Addenbrooke’s Hosp, Cambridge, United
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Twelves C, Wong A, Nowacki M, McKendrick J, van Hazel G, Douillard JY, Díaz-Rubio E, Cassidy J, Maroun J. Updated efficacy findings from the X-ACT phase III trial of capecitabine (X) vs. bolus 5-FU/LV as adjuvant therapy for patients (pts) with Dukes’ C colon cancer. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.3521] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [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)
- C. Twelves
- Leeds Univ and Bradford NHS Hosp Trust, Leeds, Bradford, United Kingdom; Tom Baker Cancer Ctr, Calgary, AB, Canada; Maria Sklodowska-Curie Memorial Cancer Ctr, Warsaw, Poland; Box Hill Hosp, Melbourne, Australia; Mount Medcl Ctr, Perth, Australia; Ctr R Gauducheau, St. Herblain, France; Hosp Clínico San Carlos, Madrid, Spain; Glasgow Univ, Glasgow, United Kingdom; Ottawa Regional Cancer Ctr, Ottawa, ON, Canada
| | - A. Wong
- Leeds Univ and Bradford NHS Hosp Trust, Leeds, Bradford, United Kingdom; Tom Baker Cancer Ctr, Calgary, AB, Canada; Maria Sklodowska-Curie Memorial Cancer Ctr, Warsaw, Poland; Box Hill Hosp, Melbourne, Australia; Mount Medcl Ctr, Perth, Australia; Ctr R Gauducheau, St. Herblain, France; Hosp Clínico San Carlos, Madrid, Spain; Glasgow Univ, Glasgow, United Kingdom; Ottawa Regional Cancer Ctr, Ottawa, ON, Canada
| | - M. Nowacki
- Leeds Univ and Bradford NHS Hosp Trust, Leeds, Bradford, United Kingdom; Tom Baker Cancer Ctr, Calgary, AB, Canada; Maria Sklodowska-Curie Memorial Cancer Ctr, Warsaw, Poland; Box Hill Hosp, Melbourne, Australia; Mount Medcl Ctr, Perth, Australia; Ctr R Gauducheau, St. Herblain, France; Hosp Clínico San Carlos, Madrid, Spain; Glasgow Univ, Glasgow, United Kingdom; Ottawa Regional Cancer Ctr, Ottawa, ON, Canada
| | - J. McKendrick
- Leeds Univ and Bradford NHS Hosp Trust, Leeds, Bradford, United Kingdom; Tom Baker Cancer Ctr, Calgary, AB, Canada; Maria Sklodowska-Curie Memorial Cancer Ctr, Warsaw, Poland; Box Hill Hosp, Melbourne, Australia; Mount Medcl Ctr, Perth, Australia; Ctr R Gauducheau, St. Herblain, France; Hosp Clínico San Carlos, Madrid, Spain; Glasgow Univ, Glasgow, United Kingdom; Ottawa Regional Cancer Ctr, Ottawa, ON, Canada
| | - G. van Hazel
- Leeds Univ and Bradford NHS Hosp Trust, Leeds, Bradford, United Kingdom; Tom Baker Cancer Ctr, Calgary, AB, Canada; Maria Sklodowska-Curie Memorial Cancer Ctr, Warsaw, Poland; Box Hill Hosp, Melbourne, Australia; Mount Medcl Ctr, Perth, Australia; Ctr R Gauducheau, St. Herblain, France; Hosp Clínico San Carlos, Madrid, Spain; Glasgow Univ, Glasgow, United Kingdom; Ottawa Regional Cancer Ctr, Ottawa, ON, Canada
| | - J.-Y. Douillard
- Leeds Univ and Bradford NHS Hosp Trust, Leeds, Bradford, United Kingdom; Tom Baker Cancer Ctr, Calgary, AB, Canada; Maria Sklodowska-Curie Memorial Cancer Ctr, Warsaw, Poland; Box Hill Hosp, Melbourne, Australia; Mount Medcl Ctr, Perth, Australia; Ctr R Gauducheau, St. Herblain, France; Hosp Clínico San Carlos, Madrid, Spain; Glasgow Univ, Glasgow, United Kingdom; Ottawa Regional Cancer Ctr, Ottawa, ON, Canada
| | - E. Díaz-Rubio
- Leeds Univ and Bradford NHS Hosp Trust, Leeds, Bradford, United Kingdom; Tom Baker Cancer Ctr, Calgary, AB, Canada; Maria Sklodowska-Curie Memorial Cancer Ctr, Warsaw, Poland; Box Hill Hosp, Melbourne, Australia; Mount Medcl Ctr, Perth, Australia; Ctr R Gauducheau, St. Herblain, France; Hosp Clínico San Carlos, Madrid, Spain; Glasgow Univ, Glasgow, United Kingdom; Ottawa Regional Cancer Ctr, Ottawa, ON, Canada
| | - J. Cassidy
- Leeds Univ and Bradford NHS Hosp Trust, Leeds, Bradford, United Kingdom; Tom Baker Cancer Ctr, Calgary, AB, Canada; Maria Sklodowska-Curie Memorial Cancer Ctr, Warsaw, Poland; Box Hill Hosp, Melbourne, Australia; Mount Medcl Ctr, Perth, Australia; Ctr R Gauducheau, St. Herblain, France; Hosp Clínico San Carlos, Madrid, Spain; Glasgow Univ, Glasgow, United Kingdom; Ottawa Regional Cancer Ctr, Ottawa, ON, Canada
| | - J. Maroun
- Leeds Univ and Bradford NHS Hosp Trust, Leeds, Bradford, United Kingdom; Tom Baker Cancer Ctr, Calgary, AB, Canada; Maria Sklodowska-Curie Memorial Cancer Ctr, Warsaw, Poland; Box Hill Hosp, Melbourne, Australia; Mount Medcl Ctr, Perth, Australia; Ctr R Gauducheau, St. Herblain, France; Hosp Clínico San Carlos, Madrid, Spain; Glasgow Univ, Glasgow, United Kingdom; Ottawa Regional Cancer Ctr, Ottawa, ON, Canada
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Spencer A, Horvath N, Gibson J, Prince HM, Herrmann R, Bashford J, Joske D, Grigg A, McKendrick J, Prosser I, Lowenthal R, Deveridge S, Taylor K. Prospective randomised trial of amifostine cytoprotection in myeloma patients undergoing high-dose melphalan conditioned autologous stem cell transplantation. Bone Marrow Transplant 2005; 35:971-7. [PMID: 15778725 DOI: 10.1038/sj.bmt.1704946] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.0] [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: 11/08/2022]
Abstract
In this prospective multicentre trial, 90 patients undergoing autologous stem cell transplantation (ASCT) were randomised to receive (n=43) or not receive (n=47) amifostine 910 mg/m(2) prior to melphalan 200 mg/m(2). Patients were monitored for regimen-related toxicity, engraftment, supportive care, response and survival. Both groups underwent ASCT at a median of 8 months from diagnosis and were matched for disease characteristics, prior therapy and pre-ASCT disease responsiveness. Amifostine infusional side-effects were frequent, occurring in 65% of patients, but of mild severity. Amifostine use was associated with a reduction in the median grade of oral mucositis (1 vs 2, P=0.01) and the frequency of severe (WHO grades 3 or 4) mucositis (12 vs 33%, P=0.02), but no reduction in the requirement for parenteral nutrition or analgesic use. Conversion to complete remission post-ASCT occurred in 30 and 14% of the amifostine and control groups, respectively (P=0.09). With a median follow-up of 35 months, there was no statistically significant difference between the median progression-free or overall survival times for the two groups. We conclude that amifostine can be safely administered prior to high-dose melphalan and significantly reduces the frequency and severity of therapy-induced oral mucositis.
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Affiliation(s)
- A Spencer
- Clinical Haematology & BMT, The Alfred Hospital, Melbourne, Australia.
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Ngan SYK, Michael M, Mackay J, McKendrick J, Leong T, Lim Joon D, Zalcberg JR. A phase I trial of preoperative radiotherapy and capecitabine for locally advanced, potentially resectable rectal cancer. Br J Cancer 2004; 91:1019-24. [PMID: 15305186 PMCID: PMC2747703 DOI: 10.1038/sj.bjc.6602106] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The purpose of the study was to determine the maximum-tolerated dose (MTD) of oral capecitabine, combined with concurrent, standard preoperative pelvic radiotherapy, when given twice daily, from Monday to Friday throughout the course of radiotherapy, for locally advanced potentially resectable rectal cancer. Maximum-tolerated dose was defined as the total (given in two equally divided doses) oral dose of capecitabine that caused treatment-related grade 3 or 4 toxicity in one-third or more of the patients treated. Radiotherapy involved 50.4 Gy given in 28 fractions in 5 weeks and 3 days. Eligible patients had a newly diagnosed clinical stage T3–4 N0–2 M0 rectal adenocarcinoma located within 12 cm of the anal verge suitable for curative resection. Surgery was performed 4–6 weeks from completion of preoperative chemoradiotherapy. In all, 28 patients were enrolled in the study at predefined dose levels: 850 mg m−2 day−1 (n=3), 1000 mg m−2 day−1 (n=6), 1250 mg m−2 day−1 (n=3), 1650 mg m−2 day−1 (n=3), 1800 mg m−2 day−1 (n=8) and 2000 mg m−2 day−1 (n=5). The mean age was 62.3 years (range: 33–80 years). Five patients were female and 23 male. The median distance of tumour from the anal verge was 6 cm (range: 1–11 cm). Endorectal ultrasound was performed in 93% of patients. A total of 26 patients (93%) had T3 disease and two patients had resectable T4 disease. Dose-limiting toxicity (DLT) developed in one patient at dose level 1000 mg m−2 day−1 (RTOG grade 3 cystitis). Two of the five patients at dose level 2000 mg m−2 day−1 had a total of three DLT (grade 3 perineal skin reaction, grade 3 diarrhoea and grade 3 dehydration). Dose escalation of capecitabine was ceased at 2000 mg m−2 day−1 after reaching MTD. None of the eight patients at dose level 1800 mg m−2 day−1 developed DLT. All except one patient underwent surgery. A total of 15 patients had the clinical T stage reduced by at least one stage in pathologic specimens. Five patients (19%) achieved a pathologic complete response. We conclude that the MTD of capecitabine was reached at a dose level of 2000 mg m−2 day−1, given as 1000 mg m−2 twice daily, from Monday to Friday throughout the course of preoperative pelvic irradiation of 50.4 Gy. For patients with resectable rectal cancer receiving concurrent, full dose radiotherapy, the recommended dose of capecitabine for further study is 1800 mg m−2 day−1 when given in this schedule.
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Affiliation(s)
- S Y K Ngan
- Division of Radiation Oncology, Peter MacCallum Cancer Centre, St Andrews Place, East Melbourne, Victoria 3002, Australia.
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McCreadie RG, Stevens H, Henderson J, Hall D, McCaul R, Filik R, Young G, Sutch G, Kanagaratnam G, Perrington S, McKendrick J, Stephenson D, Burns T. The dental health of people with schizophrenia. Acta Psychiatr Scand 2004; 110:306-10. [PMID: 15352933 DOI: 10.1111/j.1600-0447.2004.00373.x] [Citation(s) in RCA: 95] [Impact Index Per Article: 4.8] [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] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To examine the dental health of community dwelling people with schizophrenia and to compare results with those in the general population. METHOD Dental health of 428 people with schizophrenia in six different areas of the UK was assessed by a self-report questionnaire. RESULTS Compared with the general population, significantly more of the younger patients were edentate (3-39% vs. 1-20%) and fewer had more than 20 teeth (70% vs. 83%). None of four dental health targets had been achieved in the patient population. More patients had last visited the dentist because of trouble with their teeth; fewer had visited for a check-up. Fewer patients cleaned their teeth daily; this group had more negative symptoms. CONCLUSION The dental health of people with schizophrenia is poor. Community mental health teams should encourage them to attend their community dentist regularly.
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Affiliation(s)
- R G McCreadie
- Department of Clinical Research, Crichton Royal Hospital, Dumfries, UK.
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Cassidy J, Scheithauer W, McKendrick J, Kröning H, Nowacki MP, Seitz JF, Twelves C, Van Hazel G, Wong A, Díaz-Rubio E. Capecitabine (X) vs bolus 5-FU/leucovorin (LV) as adjuvant therapy for colon cancer (the X-ACT study): positive efficacy results of a phase III trial. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.3509] [Citation(s) in RCA: 16] [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)
- J. Cassidy
- Glasgow University, Glasgow, United Kingdom; Vienna University Medical School, Vienna, Austria; Box Hill Hospital, Box Hill, Australia; Stadtisches Klinikum, Magdeburg, Germany; The Maria-Sklodowska-Curie Memorial Cancer Center, Warsaw, Poland; CHU Timone, Marseille, France; Tom Connors Cancer Centre, University of Bradford, Bradford, United Kingdom; The Mount Hospital Perth and Sir Charles Gairdner, Nedlands, Australia; Tom Baker Cancer Centre, Calgary, AB, Canada; Hospital Clínico Universitario San
| | - W. Scheithauer
- Glasgow University, Glasgow, United Kingdom; Vienna University Medical School, Vienna, Austria; Box Hill Hospital, Box Hill, Australia; Stadtisches Klinikum, Magdeburg, Germany; The Maria-Sklodowska-Curie Memorial Cancer Center, Warsaw, Poland; CHU Timone, Marseille, France; Tom Connors Cancer Centre, University of Bradford, Bradford, United Kingdom; The Mount Hospital Perth and Sir Charles Gairdner, Nedlands, Australia; Tom Baker Cancer Centre, Calgary, AB, Canada; Hospital Clínico Universitario San
| | - J. McKendrick
- Glasgow University, Glasgow, United Kingdom; Vienna University Medical School, Vienna, Austria; Box Hill Hospital, Box Hill, Australia; Stadtisches Klinikum, Magdeburg, Germany; The Maria-Sklodowska-Curie Memorial Cancer Center, Warsaw, Poland; CHU Timone, Marseille, France; Tom Connors Cancer Centre, University of Bradford, Bradford, United Kingdom; The Mount Hospital Perth and Sir Charles Gairdner, Nedlands, Australia; Tom Baker Cancer Centre, Calgary, AB, Canada; Hospital Clínico Universitario San
| | - H. Kröning
- Glasgow University, Glasgow, United Kingdom; Vienna University Medical School, Vienna, Austria; Box Hill Hospital, Box Hill, Australia; Stadtisches Klinikum, Magdeburg, Germany; The Maria-Sklodowska-Curie Memorial Cancer Center, Warsaw, Poland; CHU Timone, Marseille, France; Tom Connors Cancer Centre, University of Bradford, Bradford, United Kingdom; The Mount Hospital Perth and Sir Charles Gairdner, Nedlands, Australia; Tom Baker Cancer Centre, Calgary, AB, Canada; Hospital Clínico Universitario San
| | - M. P. Nowacki
- Glasgow University, Glasgow, United Kingdom; Vienna University Medical School, Vienna, Austria; Box Hill Hospital, Box Hill, Australia; Stadtisches Klinikum, Magdeburg, Germany; The Maria-Sklodowska-Curie Memorial Cancer Center, Warsaw, Poland; CHU Timone, Marseille, France; Tom Connors Cancer Centre, University of Bradford, Bradford, United Kingdom; The Mount Hospital Perth and Sir Charles Gairdner, Nedlands, Australia; Tom Baker Cancer Centre, Calgary, AB, Canada; Hospital Clínico Universitario San
| | - J. F. Seitz
- Glasgow University, Glasgow, United Kingdom; Vienna University Medical School, Vienna, Austria; Box Hill Hospital, Box Hill, Australia; Stadtisches Klinikum, Magdeburg, Germany; The Maria-Sklodowska-Curie Memorial Cancer Center, Warsaw, Poland; CHU Timone, Marseille, France; Tom Connors Cancer Centre, University of Bradford, Bradford, United Kingdom; The Mount Hospital Perth and Sir Charles Gairdner, Nedlands, Australia; Tom Baker Cancer Centre, Calgary, AB, Canada; Hospital Clínico Universitario San
| | - C. Twelves
- Glasgow University, Glasgow, United Kingdom; Vienna University Medical School, Vienna, Austria; Box Hill Hospital, Box Hill, Australia; Stadtisches Klinikum, Magdeburg, Germany; The Maria-Sklodowska-Curie Memorial Cancer Center, Warsaw, Poland; CHU Timone, Marseille, France; Tom Connors Cancer Centre, University of Bradford, Bradford, United Kingdom; The Mount Hospital Perth and Sir Charles Gairdner, Nedlands, Australia; Tom Baker Cancer Centre, Calgary, AB, Canada; Hospital Clínico Universitario San
| | - G. Van Hazel
- Glasgow University, Glasgow, United Kingdom; Vienna University Medical School, Vienna, Austria; Box Hill Hospital, Box Hill, Australia; Stadtisches Klinikum, Magdeburg, Germany; The Maria-Sklodowska-Curie Memorial Cancer Center, Warsaw, Poland; CHU Timone, Marseille, France; Tom Connors Cancer Centre, University of Bradford, Bradford, United Kingdom; The Mount Hospital Perth and Sir Charles Gairdner, Nedlands, Australia; Tom Baker Cancer Centre, Calgary, AB, Canada; Hospital Clínico Universitario San
| | - A. Wong
- Glasgow University, Glasgow, United Kingdom; Vienna University Medical School, Vienna, Austria; Box Hill Hospital, Box Hill, Australia; Stadtisches Klinikum, Magdeburg, Germany; The Maria-Sklodowska-Curie Memorial Cancer Center, Warsaw, Poland; CHU Timone, Marseille, France; Tom Connors Cancer Centre, University of Bradford, Bradford, United Kingdom; The Mount Hospital Perth and Sir Charles Gairdner, Nedlands, Australia; Tom Baker Cancer Centre, Calgary, AB, Canada; Hospital Clínico Universitario San
| | - E. Díaz-Rubio
- Glasgow University, Glasgow, United Kingdom; Vienna University Medical School, Vienna, Austria; Box Hill Hospital, Box Hill, Australia; Stadtisches Klinikum, Magdeburg, Germany; The Maria-Sklodowska-Curie Memorial Cancer Center, Warsaw, Poland; CHU Timone, Marseille, France; Tom Connors Cancer Centre, University of Bradford, Bradford, United Kingdom; The Mount Hospital Perth and Sir Charles Gairdner, Nedlands, Australia; Tom Baker Cancer Centre, Calgary, AB, Canada; Hospital Clínico Universitario San
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Scheithauer W, McKendrick J, Begbie S, Borner M, Burns WI, Burris HA, Cassidy J, Jodrell D, Koralewski P, Levine EL, Marschner N, Maroun J, Garcia-Alfonso P, Tujakowski J, Van Hazel G, Wong A, Zaluski J, Twelves C. Oral capecitabine as an alternative to i.v. 5-fluorouracil-based adjuvant therapy for colon cancer: safety results of a randomized, phase III trial. Ann Oncol 2004; 14:1735-43. [PMID: 14630678 DOI: 10.1093/annonc/mdg500] [Citation(s) in RCA: 193] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Oral capecitabine achieves a superior response rate with an improved safety profile compared with bolus 5-fluorouracil-leucovorin (5-FU/LV) as first-line treatment for patients with metastatic colorectal cancer. We report here the results of a large phase III trial investigating adjuvant oral capecitabine compared with 5-FU/LV (Mayo Clinic regimen) in Dukes' C colon cancer. PATIENTS AND METHODS Patients aged 18-75 years with resected Dukes' C colon carcinoma were randomized to receive 24 weeks of treatment with either oral capecitabine 1250 mg/m(2) twice daily, days 1-14 every 21 days (n = 993), or i.v. bolus 5-FU 425 mg/m(2) with i.v. leucovorin 20 mg/m(2) on days 1-5, repeated every 28 days (n = 974). RESULTS Patients receiving capecitabine experienced significantly (P <0.001) less diarrhea, stomatitis, nausea/vomiting, alopecia and neutropenia, but more hand-foot syndrome than those receiving 5-FU/LV. Fewer patients receiving capecitabine experienced grade 3 or 4 neutropenia, febrile neutropenia/sepsis and stomatitis (P <0.001), although more experienced grade 3 hand-foot syndrome than those treated with 5-FU/LV (P <0.001). Capecitabine demonstrates a similar, favorable safety profile in patients aged <65 years or > or = 65 years old. CONCLUSIONS Based on its improved safety profile, capecitabine has the potential to replace 5-FU/LV as standard adjuvant treatment for patients with colon cancer. Efficacy results are expected to be available in Keywords: Adjuvant treatment, capecitabine, chemotherapy, colorectal cancer
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Affiliation(s)
- W Scheithauer
- Klinik für Innere Medizin I, Vienna University Medical School, Vienna, Austria.
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Ngan S, Fisher R, Burmeister B, Rischin D, Mackay J, Kneebone A, Joseph D, McKendrick J, Goldstein D, McClure B, Lim Joon D. Delayed relapse following preoperative chemoradiation and surgery for rectal cancer. Int J Radiat Oncol Biol Phys 2003. [DOI: 10.1016/s0360-3016(03)01035-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Nowacki M, Kröning H, Cervantes A, Husseini F, McKendrick J, Schuller J, Twelves C, Wong A, Zaluski J, Douillard JY. 1089 Improved safety of capecitabine vs bolus 5-FU/leucovorin (LV) as adjuvant therapy for colon cancer (the X-ACT phase III study). EJC Suppl 2003. [DOI: 10.1016/s1359-6349(03)91115-3] [Citation(s) in RCA: 3] [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: 11/28/2022] Open
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Mead G, Sydes M, Walewski J, Grigg A, Hatton C, Norbert P, Guarnaccia C, Lewis M, McKendrick J, Stenning S, Wright D. An international evaluation of CODOX-M and CODOX-M alternating with IVAC in adult Burkitt’s lymphoma: results of United Kingdom Lymphoma Group LY06 study Ann Oncol 2002; 13: 1264–1274. Ann Oncol 2002. [DOI: 10.1093/annonc/mdf353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [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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Mead GM, Sydes MR, Walewski J, Grigg A, Hatton CS, Pescosta N, Guarnaccia C, Lewis MS, McKendrick J, Stenning SP, Wright D, Norbert P. An international evaluation of CODOX-M and CODOX-M alternating with IVAC in adult Burkitt's lymphoma: results of United Kingdom Lymphoma Group LY06 study. Ann Oncol 2002; 13:1264-74. [PMID: 12181251 DOI: 10.1093/annonc/mdf253] [Citation(s) in RCA: 246] [Impact Index Per Article: 11.2] [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: 01/21/2023] Open
Abstract
BACKGROUND Burkitt's lymphoma (BL) is a rare and rapidly progressive form of B-cell non-Hodgkin's lymphoma. Cyclophosphamide, vincristine, doxorubicin, high-dose methotrexate (CODOX-M)/ifosfamide, etoposide and high-dose cytarabine (IVAC) is a highly effective alternating non-cross-resistant regimen developed by Magrath et al. (Magrath I., Adde M., Shad A. et al. J Clin Oncol 1996; 14: 925-934) at the US National Cancer Institute. The aim was to confirm these results in a larger, international, multi-centre study using International Prognostic Index-based criteria to assign prognostic groups, whilst slightly simplifying the protocol. PATIENTS AND METHODS A phase II study where: (i) low risk (LR) patients were treated with three cycles of modified CODOX-M; and (ii) high risk (HR) patients received treatment with four cycles of alternating modified CODOX-M and IVAC chemotherapy. Target of 60 patients, fit for protocol treatment, from 16 to 60 years of age with locally diagnosed, non-HIV-related, non-organ-transplant-related BL. RESULTS Results are given for 52 of 72 registered patients whose pathological eligibility was confirmed by central pathology review: 12 LR plus 40 HR. The majority of patients (n = 41) completed protocol treatment, but toxicity was severe, especially myelosuppression and mucositis. Overall, 2-year event-free survival (EFS) was 64.6% (95% CI 50.4% to 78.9%) and 2-year overall survival (OS) was 72.8% (95% CI 59.4% to 86.3%). For LR, 2-year EFS was 83.3% and OS was 81.5%. For HR, 2-year EFS was 59.5% and OS was 69.9%. CONCLUSIONS This study confirms high cure rates with this CODOX-M/IVAC approach.
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Affiliation(s)
- G M Mead
- Wessex Medical Oncology Unit, Royal South Hants Hospital, Southampton, UK
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Abstract
The reported incidence of Johne's disease has been increasing in the east of Scotland since 1993. A postal questionnaire survey was sent to 127 farms to identify potential risk factors for Johne's disease in relation to wildlife and farm management practices, and 86 returns were obtained. Of 22 farms which had been assumed to be free of the disease, on the basis of information held by local veterinary centres, seven (32 per cent) reported cases of Johne's disease in the 1990s, indicating that the disease is under-reported. Logistic regression analyses showed that eight of 63 potentially explanatory variables were significant at the 5 per cent level in affecting the likelihood of farms reporting Johne's disease. Of these, large numbers of livestock and rabbits, and access of wildlife to feed stores were the clearest and most consistent risk factors associated with the disease. The application of manure to grazing pasture, the type of water supply for the cattle and the numbers of crows were also related to the presence of Johne's disease but the nature of these relationships was less clear. Only 38 per cent of the farms reported taking any control measures to combat Johne's disease, but three of the control measures were relevant to risk factors identified as significant by the survey, namely maintaining a clean water supply, controlling rabbits and not spreading manure on to grazing pasture.
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Affiliation(s)
- M J Daniels
- Animal Nutrition and Health Department, Scottish Agricultural College, Edinburgh
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Lees M, Aristides M, Maniadakis N, McKendrick J, Botwood N, Stephenson D. Economic evaluation of gemcitabine alone and in combination with cisplatin in the treatment of nonsmall cell lung cancer. Pharmacoeconomics 2002; 20:325-337. [PMID: 11994042 DOI: 10.2165/00019053-200220050-00004] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
OBJECTIVE To evaluate the cost effectiveness of gemcitabine in the treatment of nonsmall cell lung cancer (NSCLC). METHODS Gemcitabine was compared with best supportive care and gemcitabine/cisplatin was compared with three standard chemotherapies and four other novel chemotherapy combinations. Costs and effectiveness measures were based on resource and outcome data from previously reported clinical trials. All direct costs associated with NSCLC treatment were included and adjusted to year 2000 values. PERSPECTIVE UK National Health Service. RESULTS Gemcitabine plus best supportive care was associated with an incremental cost per progression-free life year gained of pound sterling5228 compared with best supportive care alone. In comparison with standard chemotherapies, gemcitabine/cisplatin was associated with an incremental cost per progression-free life year gained of pound sterling1751 versus etoposide/cisplatin and cost per 1-year survival gain of pound sterling5681 versus mitomycin/vinblastine/platinum. Incremental cost per tumour response was pound sterling2032 relative to etoposide/cisplatin, pound sterling5169 relative to mitomycin/ifosfamide/cisplatin and pound sterling6240 relative to mitomycin/vinblastine/platinum. Compared with four novel (newer) combination chemotherapies gemcitabine/ cisplatin showed cost savings in each case, with the same or better outcome. Thus, gemcitabine/cisplatin showed improved cost effectiveness and dominance. Sensitivity analyses showed the results were robust to variations to the values of key parameters. CONCLUSION Gemcitabine alone or in combination with cisplatin was assessed to be a cost-effective or cost-saving therapy when compared with best supportive care, standard chemotherapy regimens and novel chemotherapy combinations. Chemotherapy regimens containing gemcitabine therefore represent good value for money and efficient use of healthcare resources in the treatment of advanced NSCLC.
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Affiliation(s)
- M Lees
- M-TAG, Sydney, New South Wales, Australia
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Van Cutsem E, Twelves C, Cassidy J, Allman D, Bajetta E, Boyer M, Bugat R, Findlay M, Frings S, Jahn M, McKendrick J, Osterwalder B, Perez-Manga G, Rosso R, Rougier P, Schmiegel WH, Seitz JF, Thompson P, Vieitez JM, Weitzel C, Harper P. Oral capecitabine compared with intravenous fluorouracil plus leucovorin in patients with metastatic colorectal cancer: results of a large phase III study. J Clin Oncol 2001; 19:4097-106. [PMID: 11689577 DOI: 10.1200/jco.2001.19.21.4097] [Citation(s) in RCA: 793] [Impact Index Per Article: 34.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
PURPOSE To compare the efficacy and safety of orally administered capecitabine (Xeloda; Roche Laboratories, Inc, Nutley, NJ), a novel fluoropyrimidine carbamate designed to mimic continuous fluorouracil (5-FU) infusion but with preferential activation at the tumor site, with that of intravenous (IV) 5-FU plus leucovorin (5-FU/LV) as first-line treatment for metastatic colorectal cancer. PATIENTS AND METHODS We prospectively randomized 602 patients to treatment with capecitabine 1,250 mg/m(2) administered twice daily days 1 to 14 every 3 weeks, or to the 4-weekly Mayo Clinic regimen (5-FU/LV) until disease progression or unacceptable toxicity. RESULTS The primary objective, to demonstrate at least equivalent response rates in the two treatment groups, was met. The overall response rate was 18.9% for capecitabine and 15.0% for 5-FU/LV. In the capecitabine and 5-FU/LV groups, respectively, median time to disease progression was 5.2 and 4.7 months (log-rank P =.65); median time to treatment failure was 4.2 and 4.0 months (log-rank P =.89); and median overall survival was 13.2 and 12.1 months (log-rank P =.33). The toxicity profiles of both treatments were typical of fluoropyrimidines. However, capecitabine led to significantly lower incidences (P <.00001) of stomatitis and alopecia, but a higher incidence of cutaneous hand-foot syndrome (P <.00001). Capecitabine also resulted in lower incidences (P <.00001) of grade 3/4 stomatitis and neutropenia, leading to a lower incidence of grade 3/4 neutropenic fever and sepsis. Only grade 3 hand-foot syndrome (P <.00001) and uncomplicated grade 3/4 hyperbilirubinemia (P <.0001) were reported more frequently with capecitabine. CONCLUSION Oral capecitabine achieved an at least equivalent efficacy compared with IV 5-FU/LV. Capecitabine demonstrated clinically meaningful safety advantages and the convenience of an oral agent.
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Affiliation(s)
- E Van Cutsem
- Department of Internal Medicine, University Hospital Gasthuisberg, Leuven, Belgium.
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Buzza MS, Hirst CE, Bird CH, Hosking P, McKendrick J, Bird PI. The granzyme B inhibitor, PI-9, is present in endothelial and mesothelial cells, suggesting that it protects bystander cells during immune responses. Cell Immunol 2001; 210:21-9. [PMID: 11485349 DOI: 10.1006/cimm.2001.1806] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Proteinase inhibitor 9 (PI-9) is a 42-kDa human intracellular serpin present in cytotoxic lymphocytes (CLs). PI-9 is an extremely efficient inhibitor of the pro-apoptotic CL granule proteinase granzyme B and is thought to function in the cytosol of CLs to protect against apoptosis induced by endogenously expressed or released granzyme B, particularly during target cell killing. Here we show by immunohistochemistry that PI-9 is also present in endothelial cells, in every tissue examined. Cultured endothelial cells express functional PI-9 (as assessed by binding to recombinant granzyme B) localized to the cytoplasm and nucleus. Immunohistochemistry also showed PI-9 in mesothelial cells, and this was confirmed by analysis of primary cells cultured from pleural and serous effusions. Granzyme B expression was not detected in either endothelial or mesothelial cells. In both cell types, PI-9 is up-regulated at the mRNA and protein level by exposure to the phorbol ester PMA, consistent with a response to inflammatory stimuli. We postulate that PI-9 is present in these lining cell types to protect against misdirected, free granzyme B released during a local immune response.
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Affiliation(s)
- M S Buzza
- Department of Biochemistry and Molecular Biology, Monash University, Victoria, 3800, Australia
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Botwood N, McKendrick J, Aristides M, Lees M, Maniadakis N, Wein W, Stephenson D. Economic evaluation of Gemzar/cisplatin relative to other cisplatin based treatments for non small cell lung (NSCLC) cancer in the UK. Eur J Cancer 2001. [DOI: 10.1016/s0959-8049(01)81349-6] [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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Abstract
BACKGROUND Patients with depression are often not prescribed antidepressants for an adequate period of time. AIMS The impact of antidepressant prescribing patterns on the risk of relapse or recurrence of depression is examined. METHOD The MediPlus UK Primary Care Database was used to identify patients treated for depression with a selective serotonin reuptake inhibitor (SSRI). Records were used to construct hierarchical prescription patterns (less than 120 days, switching/augmentation, upward titration, or stable use) as indicators for the occurrence of relapse or recurrence of depression. RESULTS Patients with stable use experienced the lowest risk of relapse or recurrence. Factors significantly associated with increased risk include prior use of anxiolytic medications, more comorbid conditions and younger age. CONCLUSIONS The SSRI prescription pattern most consistent with recommended depression treatment guidelines was associated with the lowest risk of relapse or recurrence.
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Affiliation(s)
- A J Claxton
- Eli Lilly and Company, Indianapolis, IN 46285, USA.
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Rischin D, Smith J, Millward M, Lewis C, Boyer M, Richardson G, Toner G, Gurney H, McKendrick J. A phase II trial of paclitaxel and epirubicin in advanced breast cancer. Br J Cancer 2000; 83:438-42. [PMID: 10945487 PMCID: PMC2374646 DOI: 10.1054/bjoc.2000.1306] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Initial trials of paclitaxel and doxorubicin in advanced breast cancer yielded high response rates but significant cardiac toxicity was observed. In this phase II trial we investigated the efficacy and safety of paclitaxel combined with epirubicin. Patients with advanced breast cancer, performance status 0-2, measurable disease, and a normal left ventricular ejection fraction, who may have received adjuvant chemotherapy were treated with epirubicin 75 mg m(-2) followed by a 3-h infusion of paclitaxel 175 mg m(-2) repeated every 3 weeks. Forty-three eligible patients were treated at six centres. 67% patients received the maximum of six cycles. The response rate was 54% (95% CI 38-69%), 12% CR and 42% PR. Estimated median progression-free survival was 6.9 months (95% CI 5.4-10.0) and estimated median overall survival was 17.9 months (95% CI 14.2-25.7). Four patients had a decrease in the left ventricular ejection fraction (LVEF) of > or =20% of baseline value, and in two patients the LVEF decreased to below the lower limit of normal, but no patient developed clinical evidence of cardiac failure. Grade 4 neutropenia occurred in 56% cycles, but only 4% of cycles were complicated by febrile neutropenia. Grade 3 or 4 non-haematologic toxicity was uncommon. In conclusion, paclitaxel 175 mg m(-2) and epirubicin 75 mg m(-2) is a well tolerated, promising regimen for the treatment of advanced breast cancer.
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Affiliation(s)
- D Rischin
- Division of Haematology and Medical Oncology, Peter MacCallum Cancer Institute, Melbourne, Australia
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Thompson C, Peveler RC, Stephenson D, McKendrick J. Compliance with antidepressant medication in the treatment of major depressive disorder in primary care: a randomized comparison of fluoxetine and a tricyclic antidepressant. Am J Psychiatry 2000; 157:338-43. [PMID: 10698807 DOI: 10.1176/appi.ajp.157.3.338] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.2] [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] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Many claims have been made for superior compliance with selective serotonin reuptake inhibitors (SSRIs) compared with tricyclic antidepressants, but to date meta-analyses have not confirmed reduced dropouts in randomized controlled trials. The authors used a randomized study design to evaluate differential compliance with antidepressant medications in a primary care setting. METHOD A total of 152 patients treated in 10 primary care practices in the United Kingdom were included in a randomized, open-label, parallel-group study of fluoxetine and dothiepin at therapeutic doses for 12 weeks. Compliance was assessed by using pill count, patient questionnaires, and the Medication Event Monitoring System. RESULTS The level of compliance with fluoxetine was numerically higher than the level of compliance with dothiepin on all three primary outcome measures, although the differences were not significant. In a secondary analysis using data from the Medication Event Monitoring System, both a survival analysis for length of time without a gap in medicine taking and a derived compliance index showed a significant advantage to fluoxetine. Patients in the fluoxetine group reported superior response on the health transition scale of the 36-item Short-Form Health Survey Questionnaire and numerically greater improvement on the Hamilton Depression Rating Scale. In both treatment arms patients with a superior compliance index were more likely to have improved in Hamilton depression scale scores by the last study visit. CONCLUSIONS This study supports recent meta-analyses of SSRIs versus tricyclic antidepressants in finding no significant differences in crude indices of compliance between fluoxetine and dothiepin, despite marked differences in side effect profile and dose regimen. However, both a survival analysis and a new measure that takes account of prolonged periods of noncompliance distinguished between the treatments and was associated with improvement in both groups.
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Affiliation(s)
- C Thompson
- Department of Mental Health, University of Southampton, England.
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McKendrick J, Duthie T. Relative effectiveness of gemcitabine in the treatment for pancreatic cancer — A pragmatic approach. Eur J Cancer 1999. [DOI: 10.1016/s0959-8049(99)80995-2] [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: 11/24/2022]
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Talbot SM, Westerman DA, Grigg AP, Toner GC, Wolf M, Bishop J, McKendrick J, Zalcberg J, Levi J, Fox RM, Green MD. Phase I and subsequent phase II study of filgrastim (r-met-HuG-CSF) and dose intensified cyclophosphamide plus epirubicin in patients with non-Hodgkin's lymphoma and advanced solid tumors. Ann Oncol 1999; 10:907-14. [PMID: 10509151 DOI: 10.1023/a:1008353522601] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [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: 11/12/2022] Open
Abstract
BACKGROUND To define a maximum tolerated dose (MTD) for the combination of epirubicin and cyclophosphamide with filgrastim (r-met-HuG-CSF) in patients with advanced solid tumors and non-Hodgkin's lymphoma (NHL). PATIENTS AND METHODS Thirty-five patients with advanced solid tumors were enrolled in stages I and II. Twenty-one patients were treated in stage I in sequential cohorts of at least three patients at increasing dosage levels of cyclophosphamide and epirubicin, for up to six cycles every 21 days. At the completion of stage I, a MTD for epirubicin was established. Fourteen patients were treated in stage II, in cohorts of three or more. The epirubicin dose remained constant at the MTD dosage from stage I. Cyclophosphamide was further dose-escalated to establish its MTD. Twenty-one patients with previously untreated non-Hodgkin's lymphoma were treated in stage III with the MTD established in the prior stages. RESULTS The MTD in stage I was epirubicin 150 mg/m2 and cyclophosphamide 1500 mg/m2 with cumulative neutropenia as the dose-limiting toxicity (DLT). Cumulative thrombocytopenia prevented further dose-escalation of cyclophosphamide in stage II. The stage III regimen consisted of six, 21-day cycles of epirubicin 150 mg/m2, cyclophosphamide 1500 mg/m2, vincristine 2 mg, and prednisolone 100 mg for five days with filgrastim support. Nineteen of twenty-one patients (90%) completed six cycles of treatment, eight (38%) without dose reduction. Common toxicity criteria (CTC) grade 4 neutropenia (neutrophil nadir < 0.5 x 10(9)/l) was documented in 85 of 118 cycles (72%). Neutropenic fever was documented in 17 of 21 patients (81%) on at least one occasion. Severe thrombocytopenia (< 25 x 10(9)/l) was seen in fourteen of 118 cycles (12%) and increased with cycle number. There was no significant non-hematological toxicity. CONCLUSION Significant dose-escalation of epirubicin and cyclophosphamide was possible with filgrastim support. The MTD achieved was approximately double that of standard-dose therapy. This study forms the basis of an ongoing randomized study evaluating dose-intensification in intermediate grade NHL.
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Affiliation(s)
- S M Talbot
- Royal Melbourne Hospital, Parkville, Australia
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Affiliation(s)
- P A Campbell
- Austin and Repatriation Medical Centre, Melbourne, Victoria, Australia
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Toner GC, Green M, Bishop JF, McKendrick J, Cebon J, Sheridan WP, Lockbaum P, O'Byrne J, Fox RM. Dose escalation study of carboplatin and cyclophosphamide with filgrastim support: a phase I study. Am J Clin Oncol 1998; 21:263-9. [PMID: 9626795 DOI: 10.1097/00000421-199806000-00012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [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: 02/07/2023]
Abstract
This clinical trial was designed to explore dose escalation of carboplatin and cyclophosphamide when supported with filgrastim. Twenty-seven patients who had advanced solid tumors received up to six cycles of treatment; a total of 92 cycles of chemotherapy were delivered. Two control groups received standard-dose carboplatin (300 mg/m2) and cyclophosphamide (600 mg/m2), with and without filgrastim. Subsequently, the doses of both carboplatin and cyclophosphamide were increased simultaneously by 50% of the standard dose in sequential cohorts. Doses of up to 2.5 times the standard dose were explored. A final dose of carboplatin, 600 mg/m2, and cyclophosphamide, 1,500 mg/m2, was tested in 4 patients. The duration of neutropenia was brief, even at the highest dose levels. The mean duration of grade 3 or 4 neutropenia was 5.8 days at standard dose without filgrastim and 5.4 days at 2.5 times standard dose with filgrastim. More severe neutropenia was more prolonged at higher doses but remained brief in duration. The mean duration of neutropenia of less than 100 x 10(6)/l was 0.4 days at standard dose without filgrastim and 1.3 days at 2.5 times standard dose. There was no evidence of cumulative neutropenia over repeated cycles of treatment. In contrast, thrombocytopenia was both dose limiting and cumulative. The mean duration of grade 3 or 4 thrombocytopenia was 1.6 days at standard dose and 9.6 days at 2.5 times standard dose. An average of 2.3 platelet transfusions per cycle of treatment was required at the highest dose. Thrombocytopenia was worse with repetitive cycles of therapy. The mean duration of grade 3 or 4 thrombocytopenia was 2.2 days after the first cycle of chemotherapy and 7.8 days after cycle four. The maximum tolerated dose, as defined prospectively, was not reached but further dose escalation was not thought to be warranted because of the severity of thrombocytopenia. When supported with filgrastim, carboplatin and cyclophosphamide can be administered safely with substantially increased dose and acceptable toxicity.
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Affiliation(s)
- G C Toner
- Division of Hematology and Medical Oncology, Peter MacCallum Cancer Institute, Melbourne, Australia
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