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Tay RY, Fernández-Gutiérrez F, Foy V, Burns K, Pierce J, Morris K, Priest L, Tugwood J, Ashcroft L, Lindsay CR, Faivre-Finn C, Dive C, Blackhall F. Prognostic value of circulating tumour cells in limited-stage small-cell lung cancer: analysis of the concurrent once-daily versus twice-daily radiotherapy (CONVERT) randomised controlled trial. Ann Oncol 2019; 30:1114-1120. [PMID: 31020334 PMCID: PMC6637373 DOI: 10.1093/annonc/mdz122] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The clinical significance of circulating tumour cells (CTCs) in limited-stage small-cell lung cancer (LS-SCLC) is not well defined. We report a planned exploratory analysis of the prevalence and prognostic value of CTCs in LS-SCLC patients enrolled within the phase III randomised CONVERT (concurrent once-daily versus twice-daily chemoradiotherapy) trial. PATIENTS AND METHODS Baseline blood samples were enumerated for CTCs using CellSearch in 75 patients with LS-SCLC who were enrolled in the CONVERT trial and randomised between twice- and once-daily concurrent chemoradiation. Standard statistical methods were used for correlations of CTCs with clinical factors. Log-rank test and Cox regression analyses were applied to establish the associations of 2, 15 and 50 CTC thresholds with progression-free survival (PFS) and overall survival (OS). An optimal CTC count threshold for LS-SCLC was established. RESULTS CTCs were detected in 60% (45/75) of patients (range 0-3750). CTC count thresholds of 2, 15 and 50 CTCs all significantly correlate with PFS and OS. An optimal CTC count threshold in LS-SCLC was established at 15 CTCs, defining 'favourable' and 'unfavourable' prognostic risk groups. The median OS in <15 versus ≥15 CTCs was 26.7 versus 5.9 m (P = 0.001). The presence of ≥15 CTCs at baseline independently predicted ≤1 year survival in 70% and ≤2 years survival in 100% of patients. CONCLUSION We report the prognostic value of baseline CTC count in an exclusive LS-SCLC population at thresholds of 2, 15 and 50 CTCs. Specific to LS-SCLC, ≥15 CTCs was associated with worse PFS and OS independent of all other factors and predicted ≤2 years survival. These results may improve disease stratification in future clinical trial designs and aid clinical decision making. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT00433563.
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Affiliation(s)
- R Y Tay
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester
| | | | - V Foy
- Clinical and Experimental Pharmacology Group, CRUK Manchester Institute
| | - K Burns
- Division of Molecular and Clinical Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health
| | - J Pierce
- Clinical and Experimental Pharmacology Group, CRUK Manchester Institute
| | - K Morris
- Clinical and Experimental Pharmacology Group, CRUK Manchester Institute
| | - L Priest
- Clinical and Experimental Pharmacology Group, CRUK Manchester Institute
| | - J Tugwood
- Cancer Research UK Manchester Institute; Manchester Centre for Cancer Biomarker Sciences, University of Manchester, Manchester
| | - L Ashcroft
- Manchester Academic Health Science Centre Trials Co-ordination Unit
| | - C R Lindsay
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester; Division of Molecular and Clinical Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health
| | - C Faivre-Finn
- Division of Molecular and Clinical Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health; Department of Radiotherapy Related Research, The Christie NHS Foundation Trust, Manchester, UK
| | - C Dive
- Cancer Research UK Manchester Institute; Manchester Centre for Cancer Biomarker Sciences, University of Manchester, Manchester
| | - F Blackhall
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester; Division of Molecular and Clinical Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health.
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Bayman N, Appel W, Ashcroft L, Baldwin DR, Bates A, Darlison L, Edwards JG, Ezhil V, Gilligan D, Hatton M, Jegannathen A, Mansy T, Peake MD, Pemberton L, Rintoul RC, Snee M, Ryder WD, Taylor P, Faivre-Finn C. Prophylactic Irradiation of Tracts in Patients With Malignant Pleural Mesothelioma: An Open-Label, Multicenter, Phase III Randomized Trial. J Clin Oncol 2019; 37:1200-1208. [PMID: 30920878 DOI: 10.1200/jco.18.01678] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
PURPOSE Prophylactic irradiation to the chest wall after diagnostic or therapeutic procedures in patients with malignant pleural mesothelioma (MPM) has been a widespread practice across Europe, although the efficacy of this treatment is uncertain. In this study, we aimed to determine the efficacy of prophylactic radiotherapy in reducing the incidence of chest wall metastases (CWM) after a procedure in MPM. METHODS After undergoing a chest wall procedure, patients with MPM were randomly assigned to receive prophylactic radiotherapy (within 42 days of the procedure) or no radiotherapy. Open thoracotomies, needle biopsies, and indwelling pleural catheters were excluded. Prophylactic radiotherapy was delivered at a dose of 21 Gy in three fractions over three consecutive working days, using a single electron field adapted to maximize coverage of the tract from skin surface to pleura. The primary outcome was the incidence of CWM within 6 months from random assignment, assessed in the intention-to-treat population. Stratification factors included epithelioid histology and intention to give chemotherapy. RESULTS Between July 30, 2012, and December 12, 2015, 375 patients were recruited from 54 centers and randomly assigned to receive prophylactic radiotherapy (n = 186) or no prophylactic radiotherapy (n = 189). Participants were well matched at baseline. No significant difference was seen in the incidence of CWM at 6 months between the prophylactic radiotherapy and no radiotherapy groups (no. [%]: 6 [3.2] v 10 [5.3], respectively; odds ratio, 0.60; 95% CI, 0.17 to 1.86; P = .44). Skin toxicity was the most common radiotherapy-related adverse event in the prophylactic radiotherapy group, with 96 patients (51.6%) receiving grade 1; 19 (10.2%), grade 2; and 1 (0.5%) grade 3 radiation dermatitis (Common Terminology Criteria for Adverse Events, version 4.0). CONCLUSION There is no role for the routine use of prophylactic irradiation to chest wall procedure sites in patients with MPM.
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Affiliation(s)
- Neil Bayman
- 1 The Christie National Health Service Foundation Trust, Manchester, United Kingdom
| | - Wiebke Appel
- 2 Lancashire Teaching Hospitals National Health Service Foundation Trust, Preston, United Kingdom
| | - Linda Ashcroft
- 1 The Christie National Health Service Foundation Trust, Manchester, United Kingdom
| | - David R Baldwin
- 3 Nottingham University Hospitals National Health Service Trust, Nottingham, United Kingdom
| | - Andrew Bates
- 4 University Hospital Southampton National Health Service Foundation Trust, Southampton, United Kingdom
| | - Liz Darlison
- 5 University Hospitals of Leicester National Health Service Trust, Leicester, United Kingdom
| | - John G Edwards
- 6 Sheffield Teaching Hospitals National Health Service Foundation Trust, Sheffield, United Kingdom
| | - Veni Ezhil
- 7 Royal Surrey County Hospital, National Health Service Foundation Trust, Guildford, United Kingdom
| | - David Gilligan
- 8 Cambridge University Hospital National Health Service Foundation Trust, Cambridge, United Kingdom
| | - Matthew Hatton
- 6 Sheffield Teaching Hospitals National Health Service Foundation Trust, Sheffield, United Kingdom
| | - Apurna Jegannathen
- 9 University Hospitals of North Midlands National Health Service Trust, Stoke-on-Trent, United Kingdom
| | - Talal Mansy
- 10 South Tees Hospitals National Health Service Foundation Trust, Middlesbrough, United Kingdom
| | - Michael D Peake
- 5 University Hospitals of Leicester National Health Service Trust, Leicester, United Kingdom
| | - Laura Pemberton
- 1 The Christie National Health Service Foundation Trust, Manchester, United Kingdom
| | - Robert C Rintoul
- 11 Cancer Research UK Cambridge Centre, Cambridge, United Kingdom
| | - Michael Snee
- 12 Leeds Teaching Hospitals National Health Service Trust, Leeds, United Kingdom
| | - W David Ryder
- 1 The Christie National Health Service Foundation Trust, Manchester, United Kingdom
| | - Paul Taylor
- 13 Manchester University National Health Service Foundation Trust, Manchester, United Kingdom
| | - Corinne Faivre-Finn
- 1 The Christie National Health Service Foundation Trust, Manchester, United Kingdom.,14 University of Manchester, Manchester, United Kingdom
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Jayson GC, Zhou C, Backen A, Horsley L, Marti-Marti K, Shaw D, Mescallado N, Clamp A, Saunders MP, Valle JW, Mullamitha S, Braun M, Hasan J, McEntee D, Simpson K, Little RA, Watson Y, Cheung S, Roberts C, Ashcroft L, Manoharan P, Scherer SJ, Del Puerto O, Jackson A, O'Connor JPB, Parker GJM, Dive C. Plasma Tie2 is a tumor vascular response biomarker for VEGF inhibitors in metastatic colorectal cancer. Nat Commun 2018; 9:4672. [PMID: 30405103 PMCID: PMC6220185 DOI: 10.1038/s41467-018-07174-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 10/04/2018] [Indexed: 12/22/2022] Open
Abstract
Oncological use of anti-angiogenic VEGF inhibitors has been limited by the lack of informative biomarkers. Previously we reported circulating Tie2 as a vascular response biomarker for bevacizumab-treated ovarian cancer patients. Using advanced MRI and circulating biomarkers we have extended these findings in metastatic colorectal cancer (n = 70). Bevacizumab (10 mg/kg) was administered to elicit a biomarker response, followed by FOLFOX6-bevacizumab until disease progression. Bevacizumab induced a correlation between Tie2 and the tumor vascular imaging biomarker, Ktrans (R:-0.21 to 0.47) implying that Tie2 originated from the tumor vasculature. Tie2 trajectories were independently associated with pre-treatment tumor vascular characteristics, tumor response, progression free survival (HR for progression = 3.01, p = 0.00014; median PFS 248 vs. 348 days p = 0.0008) and the modeling of progressive disease (p < 0.0001), suggesting that Tie2 should be monitored clinically to optimize VEGF inhibitor use. A vascular response is defined as a 30% reduction in Tie2; vascular progression as a 40% increase in Tie2 above the nadir. Tie2 is the first, validated, tumor vascular response biomarker for VEGFi.
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Affiliation(s)
- Gordon C Jayson
- The Christie NHS Foundation Trust and Division of Cancer Sciences, University of Manchester, Manchester, M20 4BX, UK.
| | - Cong Zhou
- Division of Cancer Sciences, Manchester Cancer Research Centre, University of Manchester, Manchester, M20 4GJ, UK
| | - Alison Backen
- Clinical and Experimental Pharmacology Group, Cancer Research UK Manchester Institute & Manchester Centre for Cancer Biomarker Sciences, Manchester, M20 4BX, UK
| | - Laura Horsley
- The Christie NHS Foundation Trust and Division of Cancer Sciences, University of Manchester, Manchester, M20 4BX, UK
| | - Kalena Marti-Marti
- The Christie NHS Foundation Trust and Division of Cancer Sciences, University of Manchester, Manchester, M20 4BX, UK
| | - Danielle Shaw
- Clatterbridge Cancer Centre, Liverpool, CH63 4JY, UK
| | - Nerissa Mescallado
- The Christie NHS Foundation Trust and Division of Cancer Sciences, University of Manchester, Manchester, M20 4BX, UK
| | - Andrew Clamp
- Manchester Academic Health Science Centre, Trials Co-ordination Unit, The Christie NHS Foundation Trust, Withington Hall Block C, Wilmslow Road, Manchester, M20 4BX, UK
| | - Mark P Saunders
- Manchester Academic Health Science Centre, Trials Co-ordination Unit, The Christie NHS Foundation Trust, Withington Hall Block C, Wilmslow Road, Manchester, M20 4BX, UK
| | - Juan W Valle
- The Christie NHS Foundation Trust and Division of Cancer Sciences, University of Manchester, Manchester, M20 4BX, UK
| | - Saifee Mullamitha
- Manchester Academic Health Science Centre, Trials Co-ordination Unit, The Christie NHS Foundation Trust, Withington Hall Block C, Wilmslow Road, Manchester, M20 4BX, UK
| | - Mike Braun
- Manchester Academic Health Science Centre, Trials Co-ordination Unit, The Christie NHS Foundation Trust, Withington Hall Block C, Wilmslow Road, Manchester, M20 4BX, UK
| | - Jurjees Hasan
- Manchester Academic Health Science Centre, Trials Co-ordination Unit, The Christie NHS Foundation Trust, Withington Hall Block C, Wilmslow Road, Manchester, M20 4BX, UK
| | - Delyth McEntee
- Manchester Academic Health Science Centre, Trials Co-ordination Unit, The Christie NHS Foundation Trust, Withington Hall Block C, Wilmslow Road, Manchester, M20 4BX, UK
| | - Kathryn Simpson
- Clinical and Experimental Pharmacology Group, Cancer Research UK Manchester Institute & Manchester Centre for Cancer Biomarker Sciences, Manchester, M20 4BX, UK
| | - Ross A Little
- Imaging Sciences, University of Manchester, Manchester, M13 9PT, UK
| | - Yvonne Watson
- Imaging Sciences, University of Manchester, Manchester, M13 9PT, UK
| | - Susan Cheung
- Imaging Sciences, University of Manchester, Manchester, M13 9PT, UK
| | - Caleb Roberts
- Imaging Sciences, University of Manchester, Manchester, M13 9PT, UK
| | - Linda Ashcroft
- Manchester Academic Health Science Centre, Trials Co-ordination Unit, The Christie NHS Foundation Trust, Withington Hall Block C, Wilmslow Road, Manchester, M20 4BX, UK
| | - Prakash Manoharan
- The Christie NHS Foundation Trust and Division of Cancer Sciences, University of Manchester, Manchester, M20 4BX, UK
| | - Stefan J Scherer
- Novartis Pharmaceuticals Corporation, One Health Plaza, 337, East Hanover, NJ, 07936-1080, USA
| | - Olivia Del Puerto
- Del Puerto Limited, 23 Porters Wood; Saint Albans, Hertfordshire, AL3 6PQ, UK
| | - Alan Jackson
- Imaging Sciences, University of Manchester, Manchester, M13 9PT, UK
| | - James P B O'Connor
- Division of Cancer Sciences, Manchester Cancer Research Centre, University of Manchester, Manchester, M20 4GJ, UK
| | - Geoff J M Parker
- Imaging Sciences, University of Manchester, Manchester, M13 9PT, UK
- Bioxydyn Ltd, Manchester, M15 6SZ, UK
| | - Caroline Dive
- Clinical and Experimental Pharmacology Group, Cancer Research UK Manchester Institute & Manchester Centre for Cancer Biomarker Sciences, Manchester, M20 4BX, UK
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Haslett K, Blackhall F, Koh P, Ashcroft L, Asselin M, Harris C, Jackson A, Manoharan P, Mullan D, Ryder W, Taylor B, Faivre-Finn C. PO-0753: Phase I trial evaluating MEK inhibitor selumetinib with concomitant thoracic radiotherapy in NSCLC. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31063-6] [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: 11/16/2022]
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Haslett K, Ashcroft L, Bayman N, Franks K, Groom N, Hanna G, Harden S, Harris C, Harrow S, Hatton M, McCloskey P, McDonald F, Ryder D, Faivre-Finn C. PO-0752: Isotoxic Intensity Modulated Radiotherapy in stage III NSCLC – A feasibility study. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31062-4] [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: 10/14/2022]
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Howell A, Ashcroft L, Fallowfield L, Eccles DM, Eeles RA, Ward A, Brentnall AR, Dowsett M, Cuzick JM, Greenhalgh R, Boggis C, Motion J, Sergeant JC, Adams J, Evans DG. RAZOR: A Phase II Open Randomized Trial of Screening Plus Goserelin and Raloxifene Versus Screening Alone in Premenopausal Women at Increased Risk of Breast Cancer. Cancer Epidemiol Biomarkers Prev 2018; 27:58-66. [PMID: 29097444 DOI: 10.1158/1055-9965.epi-17-0158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 03/16/2017] [Accepted: 10/17/2017] [Indexed: 11/16/2022] Open
Abstract
Background: Ovarian suppression in premenopausal women is known to reduce breast cancer risk. This study aimed to assess uptake and compliance with ovarian suppression using the luteinizing hormone releasing hormone (LHRH) analogue, goserelin, with add-back raloxifene, as a potential regimen for breast cancer prevention.Methods: Women at ≥30% lifetime risk breast cancer were approached and randomized to mammographic screening alone (C-Control) or screening in addition to monthly subcutaneous injections of 3.6 mg goserelin and continuous 60 mg raloxifene daily orally (T-Treated) for 2 years. The primary endpoint was therapy adherence. Secondary endpoints were toxicity/quality of life, change in bone density, and mammographic density.Results: A total of 75/950 (7.9%) women approached agreed to randomization. In the T-arm, 20 of 38 (52%) of women completed the 2-year period of study compared with the C-arm (27/37, 73.0%). Dropouts were related to toxicity but also the wish to have established risk-reducing procedures and proven chemoprevention. As relatively few women completed the study, data are limited, but those in the T-arm reported significant increases in toxicity and sexual problems, no change in anxiety, and less cancer worry. Lumbar spine bone density declined by 7.0% and visually assessed mammographic density by 4.7% over the 2-year treatment period.Conclusions: Uptake is somewhat lower than comparable studies with tamoxifen for prevention with higher dropout rates. Raloxifene may preserve bone density, but reduction in mammographic density reversed after treatment was completed.Impact: This study indicates that breast cancer risk reduction may be possible using LHRH agonists, but reducing toxicity and preventing bone changes would make this a more attractive option. Cancer Epidemiol Biomarkers Prev; 27(1); 58-66. ©2017 AACR.
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Affiliation(s)
- Anthony Howell
- Genesis Breast Cancer Prevention Centre, University Hospital of South Manchester, Manchester, United Kingdom
| | - Linda Ashcroft
- Trials Centre, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Lesley Fallowfield
- Sussex Health Outcomes Research and Education in Cancer (SHORE-C), Brighton and Sussex Medical School, University of Sussex, Falmer, United Kingdom
| | - Diana M Eccles
- Faculty of Medicine, Princess Anne Hospital, University of Southampton, Southampton, United Kingdom
| | - Rosalind A Eeles
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, United Kingdom
| | - Ann Ward
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, United Kingdom
- Department of Clinical Oncology, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Adam R Brentnall
- Centre for Cancer Prevention, Queen Mary, University of London, London, United Kingdom
| | - Mitchell Dowsett
- Department of Academic Biochemistry, Institute of Cancer Research, London, United Kingdom
| | - Jack M Cuzick
- Centre for Cancer Prevention, Queen Mary, University of London, London, United Kingdom
| | - Rosemary Greenhalgh
- Genesis Breast Cancer Prevention Centre, University Hospital of South Manchester, Manchester, United Kingdom
| | - Caroline Boggis
- Genesis Breast Cancer Prevention Centre, University Hospital of South Manchester, Manchester, United Kingdom
| | - Jamie Motion
- Genesis Breast Cancer Prevention Centre, University Hospital of South Manchester, Manchester, United Kingdom
| | - Jamie C Sergeant
- Genesis Breast Cancer Prevention Centre, University Hospital of South Manchester, Manchester, United Kingdom
| | - Judith Adams
- Department of Radiology, University of Manchester, Manchester, United Kingdom
| | - D Gareth Evans
- Genesis Breast Cancer Prevention Centre, University Hospital of South Manchester, Manchester, United Kingdom.
- Division of Evolution and Genomic Science, Department of Genomic Medicine, Manchester Academic Health Science Centre, Central Manchester Foundation Trust, The University of Manchester, St. Mary's Hospital, Manchester, United Kingdom
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Haslett K, Ashcroft L, Bayman N, Franks K, Groom N, Hannah G, Harden S, Harris C, Harrow S, Hatton M, McCloskey P, McDonald F, Ryder W, Faivre-Finn C. Isotoxic intensity modulated radiotherapy (IMRT) in stage III non-small cell lung cancer (NSCLC) – a feasibility study. Lung Cancer 2018. [DOI: 10.1016/s0169-5002(18)30172-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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8
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Haslett K, Blackhall F, Koh P, Ashcroft L, Asselin M, Harris C, Jackson A, Manoharan P, Mullan D, Ryder D, Taylor M, Faivre-Finn C. MA 17.14 Phase I Trial Evaluating MEK Inhibitor Selumetinib with Concomitant Thoracic Radiotherapy in Non-Small-Cell Lung Cancer. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.620] [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: 11/25/2022]
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Bayman N, Appel W, Ashcroft L, Baldwin D, Bates A, Darlison L, Edwards J, Ezhil V, Gilligan D, Hatton M, Mansy T, Peake M, Pemberton L, Rintoul R, Ryder D, Taylor P, Faivre-Finn C. OA 02.03 Prophylactic Irradiation of Tracts (PIT) in Patients with Pleural Mesothelioma: Results of a Multicenter Phase III Trial. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.330] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Faivre-Finn C, Snee M, Ashcroft L, Appel W, Barlesi F, Bhatnagar A, Bezjak A, Cardenal F, Fournel P, Harden S, Le Pechoux C, McMenemin R, Mohammed N, O'Brien M, Pantarotto J, Surmont V, Van Meerbeeck JP, Woll PJ, Lorigan P, Blackhall F. Concurrent once-daily versus twice-daily chemoradiotherapy in patients with limited-stage small-cell lung cancer (CONVERT): an open-label, phase 3, randomised, superiority trial. Lancet Oncol 2017; 18:1116-1125. [PMID: 28642008 PMCID: PMC5555437 DOI: 10.1016/s1470-2045(17)30318-2] [Citation(s) in RCA: 328] [Impact Index Per Article: 46.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 04/21/2017] [Accepted: 04/25/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Concurrent chemoradiotherapy is the standard of care in limited-stage small-cell lung cancer, but the optimal radiotherapy schedule and dose remains controversial. The aim of this study was to establish a standard chemoradiotherapy treatment regimen in limited-stage small-cell lung cancer. METHODS The CONVERT trial was an open-label, phase 3, randomised superiority trial. We enrolled adult patients (aged ≥18 years) who had cytologically or histologically confirmed limited-stage small-cell lung cancer, Eastern Cooperative Oncology Group performance status of 0-2, and adequate pulmonary function. Patients were recruited from 73 centres in eight countries. Patients were randomly assigned to receive either 45 Gy radiotherapy in 30 twice-daily fractions of 1·5 Gy over 19 days, or 66 Gy in 33 once-daily fractions of 2 Gy over 45 days, starting on day 22 after commencing cisplatin-etoposide chemotherapy (given as four to six cycles every 3 weeks in both groups). The allocation method used was minimisation with a random element, stratified by institution, planned number of chemotherapy cycles, and performance status. Treatment group assignments were not masked. The primary endpoint was overall survival, defined as time from randomisation until death from any cause, analysed by modified intention-to-treat. A 12% higher overall survival at 2 years in the once-daily group versus the twice-daily group was considered to be clinically significant to show superiority of the once-daily regimen. The study is registered with ClinicalTrials.gov (NCT00433563) and is currently in follow-up. FINDINGS Between April 7, 2008, and Nov 29, 2013, 547 patients were enrolled and randomly assigned to receive twice-daily concurrent chemoradiotherapy (274 patients) or once-daily concurrent chemoradiotherapy (273 patients). Four patients (one in the twice-daily group and three in the once-daily group) did not return their case report forms and were lost to follow-up; these patients were not included in our analyses. At a median follow-up of 45 months (IQR 35-58), median overall survival was 30 months (95% CI 24-34) in the twice-daily group versus 25 months (21-31) in the once-daily group (hazard ratio for death in the once daily group 1·18 [95% CI 0·95-1·45]; p=0·14). 2-year overall survival was 56% (95% CI 50-62) in the twice-daily group and 51% (45-57) in the once-daily group (absolute difference between the treatment groups 5·3% [95% CI -3·2% to 13·7%]). The most common grade 3-4 adverse event in patients evaluated for chemotherapy toxicity was neutropenia (197 [74%] of 266 patients in the twice-daily group vs 170 [65%] of 263 in the once-daily group). Most toxicities were similar between the groups, except there was significantly more grade 4 neutropenia with twice-daily radiotherapy (129 [49%] vs 101 [38%]; p=0·05). In patients assessed for radiotherapy toxicity, was no difference in grade 3-4 oesophagitis between the groups (47 [19%] of 254 patients in the twice-daily group vs 47 [19%] of 246 in the once-daily group; p=0·85) and grade 3-4 radiation pneumonitis (4 [3%] of 254 vs 4 [2%] of 246; p=0·70). 11 patients died from treatment-related causes (three in the twice-daily group and eight in the once-daily group). INTERPRETATION Survival outcomes did not differ between twice-daily and once-daily concurrent chemoradiotherapy in patients with limited-stage small-cell lung cancer, and toxicity was similar and lower than expected with both regimens. Since the trial was designed to show superiority of once-daily radiotherapy and was not powered to show equivalence, the implication is that twice-daily radiotherapy should continue to be considered the standard of care in this setting. FUNDING Cancer Research UK (Clinical Trials Awards and Advisory Committee), French Ministry of Health, Canadian Cancer Society Research Institute, European Organisation for Research and Treatment of Cancer (Cancer Research Fund, Lung Cancer, and Radiation Oncology Groups).
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Affiliation(s)
- Corinne Faivre-Finn
- Division of Molecular and Clinical Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Department of Radiotherapy Related Research, The Christie NHS Foundation Trust, Manchester, UK.
| | | | - Linda Ashcroft
- Manchester Academic Health Science Centre Trials Co-ordination Unit, The Christie NHS Foundation Trust, Manchester, UK
| | - Wiebke Appel
- Rosemere Cancer Centre, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Fabrice Barlesi
- Multidisciplinary Oncology & Therapeutic Innovations Department, Aix Marseille Univ, Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - Adityanarayan Bhatnagar
- Department of Clinical Oncology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Andrea Bezjak
- Canadian Cancer Trials Group, Princess Margaret Cancer Center, Toronto, ON, Canada
| | - Felipe Cardenal
- GECP, Department of Medical Oncology, Institut Català'Oncologia, L'Hospitalet (Barcelona), Barcelona, Spain
| | - Pierre Fournel
- GFPC, Département d'Oncologie Médicale, Institut de Cancérologie Lucien Neuwirth, Saint-Étienne, France
| | - Susan Harden
- Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Cecile Le Pechoux
- Département d'Oncologie Radiothérapie, Gustave Roussy Cancer Campus, Villejuif, France
| | - Rhona McMenemin
- Northern Centre for Cancer Care, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Nazia Mohammed
- Beatson West of Scotland Cancer Centre, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Mary O'Brien
- Department of Medicine, Royal Marsden NHS Foundation Trust, Surrey, UK
| | - Jason Pantarotto
- Division of Radiation Oncology, University of Ottawa, Ottawa, ON, Canada
| | - Veerle Surmont
- Department of Respiratory Medicine/Thoracic Oncology, Ghent University Hospital, Ghent, Belgium
| | | | - Penella J Woll
- Department of Oncology & Metabolism, University of Sheffield, Sheffield, UK
| | - Paul Lorigan
- Division of Molecular and Clinical Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Fiona Blackhall
- Division of Molecular and Clinical Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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Bundred NJ, Ashton S, Riches K, Ashcroft L, Evans A, Todd C, Bramley M, Hodgkiss T, Purushotham A, Keeley V. Abstract PD4-02: A study to determine the optimal method of detection and threshold for lymphoedema intervention: A multi-centre prospective study. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-pd4-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction
Lymphoedema, a complication of nodal surgery in 30-40% of patients, reduces quality of life for sufferers. This prospective, multi-centre study compared multi-frequency bioimpedance spectroscopy (BIS, ImpediMed) with a validated perometer method to determine which test is more sensitive for detecting lymphoedema after axillary clearance and identify the factors predicting lymphoedema development.
Material and methods
Participants (n = 629) undergoing axillary clearance at 9 UK centres underwent pre-operative and arm volume measurements post-surgery (1, 3, 6, 9 & 12 months, then 6 monthly) by arm perometry, BIS measurements (L-Dex) and recorded self-reported symptoms via questionnaires. Follow-up was a minimum of two years from surgery. Change in arm volume was calculated using relative arm volume change (RAVC) with >10% increase defined as lymphoedema. The predictors of lymphoedema development and optimal method for its detection were assessed using Cox Regression, Log Rank and Kaplan-Meier survival analyses.
Results
In total, 629 women underwent axillary surgery, with a median age of 56 (range 22 to 90) years; 80% were ER positive and received endocrine therapy, 78% received radiotherapy and 65% received chemotherapy. Lymphoedema was detected by 24 months in 124 (20%) women by perometry. Using the LDex >10 cut-off score, bioimpedance sensitivity was 71% and specificity was 89% (PPV 47%) compared to RAVC changes. Women who had an RAVC >5%-<10% at six months developed lymphoedema in 44% of cases by two years, whereas those who had less than 3% RAVC developed lymphoedema in 9% of cases (p=>0.000001). Twenty-six per cent of ER negative patients developed lymphoedema compared to 19% ER positive cancer patients.
The type (taxane versus no taxane) and whether chemotherapy was neo-adjuvant or adjuvant did not predict lymphoedema development.
Univariate analysis revealed BMI (p=0.003), ER negativity (p=<0.010), absence of endocrine therapy (p=0.034), number of nodes involved (p=0.001) and an increase in RAVC >5%-<10% (p<0.005) all predicted lymphoedema development by two years. On multivariate analysis, RAVC >5%-<10% after six months (HR 5.51 95% CI 3.05 – 9.94) along with number of nodes involved (HR 1.06 95% CI 1.03 – 1.09) and BMI HR 1.04 (1.04 – 1.09) were included in the model for predicting lymphoedema development at two years.
Conclusions
This is the first report; ER negative cancer is associated with an increased risk of lymphoedema after axillary node clearance. Arm measurements should be taken from baseline in all patients undergoing axillary surgery and increases greater than 3% should lead to further surveillance to prevent lymphoedema development. Perometer measurement is the optimal technique for measuring and predicting the development of lymphoedema.
A threshold RAVC of >5%-<10% after six months predicts lymphoedema in 44% of patients by two years.
(Funded by NIHR Programme Grant).
Citation Format: Bundred NJ, Ashton S, Riches K, Ashcroft L, Evans A, Todd C, Bramley M, Hodgkiss T, Purushotham A, Keeley V. A study to determine the optimal method of detection and threshold for lymphoedema intervention: A multi-centre prospective study [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr PD4-02.
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Affiliation(s)
- NJ Bundred
- University Hospital of South Manchester NHS Foundation Trust, Wythenshawe, Manchester, United Kingdom; Derby Hospitals NHS Foundation Trust, Derby, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, Dorset, United Kingdom; The University of Manchester, Manchester, United Kingdom; Pennine Acute Hospitals NHS Trust, Crumpsall, Manchester, United Kingdom; Kings College London, London, United Kingdom
| | - S Ashton
- University Hospital of South Manchester NHS Foundation Trust, Wythenshawe, Manchester, United Kingdom; Derby Hospitals NHS Foundation Trust, Derby, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, Dorset, United Kingdom; The University of Manchester, Manchester, United Kingdom; Pennine Acute Hospitals NHS Trust, Crumpsall, Manchester, United Kingdom; Kings College London, London, United Kingdom
| | - K Riches
- University Hospital of South Manchester NHS Foundation Trust, Wythenshawe, Manchester, United Kingdom; Derby Hospitals NHS Foundation Trust, Derby, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, Dorset, United Kingdom; The University of Manchester, Manchester, United Kingdom; Pennine Acute Hospitals NHS Trust, Crumpsall, Manchester, United Kingdom; Kings College London, London, United Kingdom
| | - L Ashcroft
- University Hospital of South Manchester NHS Foundation Trust, Wythenshawe, Manchester, United Kingdom; Derby Hospitals NHS Foundation Trust, Derby, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, Dorset, United Kingdom; The University of Manchester, Manchester, United Kingdom; Pennine Acute Hospitals NHS Trust, Crumpsall, Manchester, United Kingdom; Kings College London, London, United Kingdom
| | - A Evans
- University Hospital of South Manchester NHS Foundation Trust, Wythenshawe, Manchester, United Kingdom; Derby Hospitals NHS Foundation Trust, Derby, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, Dorset, United Kingdom; The University of Manchester, Manchester, United Kingdom; Pennine Acute Hospitals NHS Trust, Crumpsall, Manchester, United Kingdom; Kings College London, London, United Kingdom
| | - C Todd
- University Hospital of South Manchester NHS Foundation Trust, Wythenshawe, Manchester, United Kingdom; Derby Hospitals NHS Foundation Trust, Derby, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, Dorset, United Kingdom; The University of Manchester, Manchester, United Kingdom; Pennine Acute Hospitals NHS Trust, Crumpsall, Manchester, United Kingdom; Kings College London, London, United Kingdom
| | - M Bramley
- University Hospital of South Manchester NHS Foundation Trust, Wythenshawe, Manchester, United Kingdom; Derby Hospitals NHS Foundation Trust, Derby, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, Dorset, United Kingdom; The University of Manchester, Manchester, United Kingdom; Pennine Acute Hospitals NHS Trust, Crumpsall, Manchester, United Kingdom; Kings College London, London, United Kingdom
| | - T Hodgkiss
- University Hospital of South Manchester NHS Foundation Trust, Wythenshawe, Manchester, United Kingdom; Derby Hospitals NHS Foundation Trust, Derby, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, Dorset, United Kingdom; The University of Manchester, Manchester, United Kingdom; Pennine Acute Hospitals NHS Trust, Crumpsall, Manchester, United Kingdom; Kings College London, London, United Kingdom
| | - A Purushotham
- University Hospital of South Manchester NHS Foundation Trust, Wythenshawe, Manchester, United Kingdom; Derby Hospitals NHS Foundation Trust, Derby, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, Dorset, United Kingdom; The University of Manchester, Manchester, United Kingdom; Pennine Acute Hospitals NHS Trust, Crumpsall, Manchester, United Kingdom; Kings College London, London, United Kingdom
| | - V Keeley
- University Hospital of South Manchester NHS Foundation Trust, Wythenshawe, Manchester, United Kingdom; Derby Hospitals NHS Foundation Trust, Derby, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, Dorset, United Kingdom; The University of Manchester, Manchester, United Kingdom; Pennine Acute Hospitals NHS Trust, Crumpsall, Manchester, United Kingdom; Kings College London, London, United Kingdom
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Fernandez-Gutierrez F, Foy V, Burns K, Pierce J, Morris K, Priest L, Tugwood J, Ashcroft L, Faivre-Finn C, Dive C, Blackhall F. OA05.07 Prognostic Value of Circulating Tumor Cells in Limited-Disease Small Cell Lung Cancer Patients Treated on the CONVERT Trial. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2016.11.255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Khoja L, Nolan K, Mekki R, Milani A, Mescallado N, Ashcroft L, Hasan J, Edmondson R, Winter-Roach B, Kitchener HC, Mould T, Hutson R, Hall G, Clamp AR, Perren T, Ledermann J, Jayson GC. Improved Survival from Ovarian Cancer in Patients Treated in Phase III Trial Active Cancer Centres in the UK. Clin Oncol (R Coll Radiol) 2016; 28:760-765. [PMID: 27401967 DOI: 10.1016/j.clon.2016.06.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 05/31/2016] [Accepted: 06/01/2016] [Indexed: 11/22/2022]
Abstract
AIMS Ovarian cancer is the principal cause of gynaecological cancer death in developed countries, yet overall survival in the UK has been reported as being inferior to that in some Western countries. As there is a range of survival across the UK we hypothesised that in major regional centres, outcomes are equivalent to the best internationally. MATERIALS AND METHODS Data from patients treated in multicentre international and UK-based trials were obtained from three regional cancer centres in the UK; Manchester, University College London and Leeds (MUL). The median progression-free survival (PFS) and overall survival were calculated for each trial and compared with the published trial data. Normalised median survival values and the respective 95% confidence intervals (ratio of pooled MUL data to trial median survival) were calculated to allow inter-trial survival comparisons. This strategy then allowed a comparison of median survival across the UK, in three regional UK centres and in international centres. RESULTS The analysis showed that the trial-reported PFS was the same in the UK, in the MUL centres and in international centres for each of the trials included in the study. Overall survival was, however, 45% better in major regional centre-treated patients (95% confidence interval 9-73%) than the median overall survival reported in UK trials, whereas the median overall survival in MUL centres equated with that achieved in international centres. CONCLUSION The data suggest that international survival statistics are achieved in UK regional cancer centres.
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Affiliation(s)
- L Khoja
- The Christie NHS Foundation Trust and Institute of Cancer Sciences, University of Manchester, Manchester, UK
| | - K Nolan
- St James's Institute of Oncology and Leeds Institute of Cancer Medicine and Pathology, Leeds Teaching Hospitals Trust, Leeds, UK
| | - R Mekki
- St James's Institute of Oncology and Leeds Institute of Cancer Medicine and Pathology, Leeds Teaching Hospitals Trust, Leeds, UK
| | - A Milani
- UCL Hospitals NHS Foundation Trust and UCL Cancer Institute, London, UK
| | - N Mescallado
- The Christie NHS Foundation Trust and Institute of Cancer Sciences, University of Manchester, Manchester, UK
| | - L Ashcroft
- Medical Statistics, Manchester Academic Health Sciences Clinical Trials Unit, Manchester, UK
| | - J Hasan
- The Christie NHS Foundation Trust and Institute of Cancer Sciences, University of Manchester, Manchester, UK
| | - R Edmondson
- Department of Gynaecological Oncology and Institute of Cancer Sciences, St Marys Hospital and University of Manchester, Manchester, UK
| | - B Winter-Roach
- The Christie NHS Foundation Trust and Institute of Cancer Sciences, University of Manchester, Manchester, UK
| | - H C Kitchener
- Department of Gynaecological Oncology and Institute of Cancer Sciences, St Marys Hospital and University of Manchester, Manchester, UK
| | - T Mould
- UCL Hospitals NHS Foundation Trust and UCL Cancer Institute, London, UK
| | - R Hutson
- St James's Institute of Oncology and Leeds Institute of Cancer Medicine and Pathology, Leeds Teaching Hospitals Trust, Leeds, UK
| | - G Hall
- St James's Institute of Oncology and Leeds Institute of Cancer Medicine and Pathology, Leeds Teaching Hospitals Trust, Leeds, UK
| | - A R Clamp
- The Christie NHS Foundation Trust and Institute of Cancer Sciences, University of Manchester, Manchester, UK
| | - T Perren
- St James's Institute of Oncology and Leeds Institute of Cancer Medicine and Pathology, Leeds Teaching Hospitals Trust, Leeds, UK
| | - J Ledermann
- UCL Hospitals NHS Foundation Trust and UCL Cancer Institute, London, UK
| | - G C Jayson
- The Christie NHS Foundation Trust and Institute of Cancer Sciences, University of Manchester, Manchester, UK.
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Ashcroft L, Watts C. ICT Skills for Information Professionals in Developing Countries: perspectives from a study of the electronic information environment in Nigeria. IFLA Journal 2016. [DOI: 10.1177/0340035205052638] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Changes in the provision of information brought about through the emergence of electronic information resources have created subsequent changes in the skills needed by information professionals. Information professionals are now expected to be aware of and capable of using emerging information communication technologies, as well as having essential communication skills. Professional bodies, such as CILIP in the UK and the ALA in the US, recognize the importance of continuing professional development in order to keep skills and expertise up-to-date for all aspects of work. The necessity of ICT skills has a clear impact on reference service professionals, with the emergence of digital reference services. A research project carried out at Liverpool John Moores University into the provision of electronic information in Nigeria identified a significant skills gap amongst information professionals. Collaboration and strategic management of resources may be key to alleviating this problem.
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Affiliation(s)
- Linda Ashcroft
- School of Business Information, Liverpool John Moores University, 98 Mount Pleasant, Liverpool L3 5UZ, UK
| | - Chris Watts
- School of Business Information at Liverpool John Moores University
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Faivre-Finn C, Snee M, Ashcroft L, Appel W, Barlesi F, Bhatnagar A, Bezjak A, Cardenal F, Fournel P, Harden S, Le Pechoux C, McMenemin RM, Mohammed N, O'Brien ME, Pantarotto JR, Surmont V, Van Meerbeeck J, Woll PJ, Lorigan P, Blackhall FH. CONVERT: An international randomised trial of concurrent chemo-radiotherapy (cCTRT) comparing twice-daily (BD) and once-daily (OD) radiotherapy schedules in patients with limited stage small cell lung cancer (LS-SCLC) and good performance status (PS). J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.8504] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Corinne Faivre-Finn
- The University of Manchester, Institute of Cancer Sciences, Manchester, United Kingdom
| | - Michael Snee
- St James Institute of Oncology, Leeds, United Kingdom
| | - Linda Ashcroft
- MAHSC-Trials Coordination Unit, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Wiebke Appel
- Lancashire Teaching Hospitals NHS Foundation Trust, Manchester, United Kingdom
| | - Fabrice Barlesi
- Aix-Marseille University, Assistance Publique Hopitaux de Marseille, Marseille, France
| | | | - Andrea Bezjak
- National Cancer Institute of Canada Clinical Trials Group, Kingston, Toronto, ON, Canada
| | - Felipe Cardenal
- Department of Medical Oncology, Catalan Institute of Oncology, Hospitalet (Barcelona), Spain
| | - Pierre Fournel
- GFPC (France), Institut de Cancérologie de la Loire, St. Priest En Jarez, France
| | - Susan Harden
- Addenbrookes Hospital, Cambridge, United Kingdom
| | | | | | - Nazia Mohammed
- Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | | | | | | | | | | | - Paul Lorigan
- University of Manchester and The Christie NHS FT, Manchester, United Kingdom
| | - Fiona Helen Blackhall
- The University of Manchester, Institute of Cancer Sciences, Manchester, United Kingdom
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Haslett K, Franks K, Hanna GG, Harden S, Hatton M, Harrow S, McDonald F, Ashcroft L, Falk S, Groom N, Harris C, McCloskey P, Whitehurst P, Bayman N, Faivre-Finn C. Protocol for the isotoxic intensity modulated radiotherapy (IMRT) in stage III non-small cell lung cancer (NSCLC): a feasibility study. BMJ Open 2016; 6:e010457. [PMID: 27084277 PMCID: PMC4838675 DOI: 10.1136/bmjopen-2015-010457] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 01/14/2016] [Accepted: 01/26/2016] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION The majority of stage III patients with non-small cell lung cancer (NSCLC) are unsuitable for concurrent chemoradiotherapy, the non-surgical gold standard of care. As the alternative treatment options of sequential chemoradiotherapy and radiotherapy alone are associated with high local failure rates, various intensification strategies have been employed. There is evidence to suggest that altered fractionation using hyperfractionation, acceleration, dose escalation, and individualisation may be of benefit. The MAASTRO group have pioneered the concept of 'isotoxic' radiotherapy allowing for individualised dose escalation using hyperfractionated accelerated radiotherapy based on predefined normal tissue constraints. This study aims to evaluate whether delivering isotoxic radiotherapy using intensity modulated radiotherapy (IMRT) is achievable. METHODS AND ANALYSIS Isotoxic IMRT is a multicentre feasibility study. From June 2014, a total of 35 patients from 7 UK centres, with a proven histological or cytological diagnosis of inoperable NSCLC, unsuitable for concurrent chemoradiotherapy will be recruited. A minimum of 2 cycles of induction chemotherapy is mandated before starting isotoxic radiotherapy. The dose of radiation will be increased until one or more of the organs at risk tolerance or the maximum dose of 79.2 Gy is reached. The primary end point is feasibility, with accrual rates, local control and overall survival our secondary end points. Patients will be followed up for 5 years. ETHICS AND DISSEMINATION The study has received ethical approval (REC reference: 13/NW/0480) from the National Research Ethics Service (NRES) Committee North West-Greater Manchester South. The trial is conducted in accordance with the Declaration of Helsinki and Good Clinical Practice (GCP). The trial results will be published in a peer-reviewed journal and presented internationally. TRIAL REGISTRATION NUMBER NCT01836692; Pre-results.
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Affiliation(s)
- Kate Haslett
- Radiotherapy Related Research, The Christie NHS Foundation Trust, Manchester, UK
| | - Kevin Franks
- Leeds Cancer Centre, St. James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Gerard G Hanna
- Department of Clinical Oncology, Centre for Cancer Research and Cell Biology, Queen's University of Belfast, Belfast, UK
| | - Susan Harden
- Department of Clinical Oncology, Cambridge University Hospitals NHS Foundation Trust, Addenbrookes Hospital, Cambridge, UK
| | - Matthew Hatton
- Department of Clinical Oncology, Weston Park Hospital, Sheffield, UK
| | - Stephen Harrow
- Department of Clinical Oncology, Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - Fiona McDonald
- Department of Radiotherapy, The Royal Marsden, NHS Foundation Trust, London, UK
| | - Linda Ashcroft
- Manchester Academic Health Science Centre Trials Co-ordination Unit (MAHSC-CTU), The Christie NHS Foundation Trust, Manchester, UK
| | - Sally Falk
- Manchester Academic Health Science Centre Trials Co-ordination Unit (MAHSC-CTU), The Christie NHS Foundation Trust, Manchester, UK
| | - Nicki Groom
- Radiotherapy Trials Quality Assurance Team, Mount Vernon Hospital, Northwood, UK
| | - Catherine Harris
- Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Manchester, UK
| | - Paula McCloskey
- Department of Clinical Oncology, Northern Ireland Cancer Centre, Belfast, UK
| | - Philip Whitehurst
- Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Manchester, UK
| | - Neil Bayman
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Corinne Faivre-Finn
- Radiotherapy Related Research, The Christie NHS Foundation Trust, Manchester, UK
- The University of Manchester, Manchester Academic Health Science Centre, Institute of Cancer Sciences, Manchester Cancer Research Centre (MCRC), Manchester, UK
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Bayman N, Ardron D, Ashcroft L, Baldwin DR, Booton R, Darlison L, Edwards JG, Lang-Lazdunski L, Lester JF, Peake M, Rintoul RC, Snee M, Taylor P, Lunt C, Faivre-Finn C. Protocol for PIT: a phase III trial of prophylactic irradiation of tracts in patients with malignant pleural mesothelioma following invasive chest wall intervention. BMJ Open 2016; 6:e010589. [PMID: 26817643 PMCID: PMC4735163 DOI: 10.1136/bmjopen-2015-010589] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 12/02/2015] [Accepted: 12/07/2015] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Histological diagnosis of malignant mesothelioma requires an invasive procedure such as CT-guided needle biopsy, thoracoscopy, video-assisted thorascopic surgery (VATs) or thoracotomy. These invasive procedures encourage tumour cell seeding at the intervention site and patients can develop tumour nodules within the chest wall. In an effort to prevent nodules developing, it has been widespread practice across Europe to irradiate intervention sites postprocedure--a practice known as prophylactic irradiation of tracts (PIT). To date there has not been a suitably powered randomised trial to determine whether PIT is effective at reducing the risk of chest wall nodule development. METHODS AND ANALYSIS In this multicentre phase III randomised controlled superiority trial, 374 patients who can receive radiotherapy within 42 days of a chest wall intervention will be randomised to receive PIT or no PIT. Patients will be randomised on a 1:1 basis. Radiotherapy in the PIT arm will be 21 Gy in three fractions. Subsequent chemotherapy is given at the clinicians' discretion. A reduction in the incidence of chest wall nodules from 15% to 5% in favour of radiotherapy 6 months after randomisation would be clinically significant. All patients will be followed up for up to 2 years with monthly telephone contact and at least four outpatient visits in the first year. ETHICS AND DISSEMINATION PIT was approved by NRES Committee North West-Greater Manchester West (REC reference 12/NW/0249) and recruitment is currently on-going, the last patient is expected to be randomised by the end of 2015. The analysis of the primary end point, incidence of chest wall nodules 6 months after randomisation, is expected to be published in 2016 in a peer reviewed journal and results will also be presented at scientific meetings and summary results published online. A follow-up analysis is expected to be published in 2018. TRIAL REGISTRATION NUMBER ISRCTN04240319; NCT01604005; Pre-results.
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Affiliation(s)
- N Bayman
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - D Ardron
- The National Cancer Research Institute (NCRI) Consumer Liaison Group, London, UK
| | - L Ashcroft
- Manchester Academic Health Science Centre Trials Co-ordination Unit (MAHSC-CTU), The Christie NHS Foundation Trust, Manchester, UK
| | - D R Baldwin
- Respiratory Medicine Unit, David Evans Research Centre, Nottingham University Hospitals NHS Trust, Nottingham City Hospital Campus, Nottingham, UK
| | - R Booton
- Respiratory and Allergy Research Group, Institute of Inflammation & Repair, The University of Manchester North West Lung Centre, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK
| | - L Darlison
- Mesothelioma UK Charitable Trust, c/o Glenfield Hospital, Leicester, UK
- Department of Respiratory Medicine, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester, UK
| | - J G Edwards
- Department of Cardiothoracic Surgery, Chesterman Unit, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust UK, Sheffield, UK
| | | | - J F Lester
- Department of Clinical Oncology, Velindre NHS Trust UK, Cardiff, UK
| | - M Peake
- Department of Respiratory Medicine, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester, UK
- National Cancer Intelligence Network, (NCIN), Public Health England, London, UK
| | - R C Rintoul
- Department of Thoracic Oncology, Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - M Snee
- Department of Clinical Oncology, Leeds Teaching Hospital NHS Trust, St James Hospital, Leeds, UK
| | - P Taylor
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK
- Department Pulmonary Oncology, Wythenshawe Hospital Manchester, Manchester, UK
| | - C Lunt
- Manchester Academic Health Science Centre Trials Co-ordination Unit (MAHSC-CTU), The Christie NHS Foundation Trust, Manchester, UK
| | - C Faivre-Finn
- The University of Manchester, Manchester Academic Health Science Centre, Institute of Cancer Sciences, Manchester Cancer Research Centre (MCRC), Manchester, UK
- Radiotherapy Related Research, The Christie NHS Foundation Trust, Manchester, UK
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Faivre-Finn C, Falk S, Ashcroft L, Bewley M, Lorigan P, Wilson E, Groom N, Snee M, Fournel P, Cardenal F, Bezjak A, Blackhall F. Protocol for the CONVERT trial-Concurrent ONce-daily VErsus twice-daily RadioTherapy: an international 2-arm randomised controlled trial of concurrent chemoradiotherapy comparing twice-daily and once-daily radiotherapy schedules in patients with limited stage small cell lung cancer (LS-SCLC) and good performance status. BMJ Open 2016; 6:e009849. [PMID: 26792218 PMCID: PMC4735219 DOI: 10.1136/bmjopen-2015-009849] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 10/30/2015] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Concurrent ONce-daily VErsus twice-daily RadioTherapy (CONVERT) is the only multicentre, international, randomised, phase III trial open in Europe and Canada looking at optimisation of chemoradiotherapy (RT) in limited stage small cell lung cancer (LS-SCLC). Following on from the Turrisi trial of once-daily versus twice-daily (BD) concurrent chemoradiotherapy, there is a real need for a new phase III trial using modern conformal RT techniques and investigating higher once-daily radiation dose. This trial has the potential to define a new standard chemo-RT regimen for patients with LS-SCLC and good performance status. METHODS AND ANALYSIS 447 patients with histologically or cytologically proven diagnosis of SCLC were recruited from 74 centres in eight countries between 2008 and 2013. Patients were randomised to receive either concurrent twice-daily RT(45 Gy in 30 twice-daily fractions over 3 weeks) or concurrent once-daily RT(66 Gy in 33 once-daily fractions over 6.5 weeks) both starting on day 22 of cycle 1. Patients are followed up until death. The primary end point of the study is overall survival and secondary end points include local progression-free survival, metastasis-free survival, acute and late toxicity based on the Common Terminology Criteria for Adverse Events V.3.0, chemotherapy and RTdose intensity. ETHICS AND DISSEMINATION The trial received ethical approval from NRES Committee North West-Greater Manchester Central (07/H1008/229). There is a trial steering committee, including independent members and an independent data monitoring committee. Results will be published in a peer-reviewed journal and presented at international conferences. TRIAL REGISTRATION NUMBER ISRCTN91927162; Pre-results.
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Affiliation(s)
- Corinne Faivre-Finn
- Manchester Academic Health Science Centre, Institute of Cancer Sciences, Manchester Cancer Research Centre (MCRC), The University of Manchester, Manchester, UK
- Radiotherapy Related Research, The Christie NHS Foundation Trust, Manchester, UK
| | - Sally Falk
- Manchester Academic Health Science Centre Trials Coordination Unit (MAHSC-CTU), The Christie NHS Foundation Trust, Manchester, UK
| | - Linda Ashcroft
- Manchester Academic Health Science Centre Trials Coordination Unit (MAHSC-CTU), The Christie NHS Foundation Trust, Manchester, UK
| | - Michelle Bewley
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Paul Lorigan
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Elena Wilson
- Department of Oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Nicki Groom
- Radiotherapy Trials Quality Assurance Team, Mount Vernon Hospital, Northwood, UK
| | | | - Pierre Fournel
- Institut de Cancérologie Lucien Neuwirth, Saint-Priest en Jarez, France
| | - Felipe Cardenal
- Department of Medical Oncology, Catalan Institute of Oncology, L'Hospitalet, Barcelona, Spain
| | - Andrea Bezjak
- Department of Radiation Oncology, Princess Margaret Hospital, Toronto, Ontario, Canada
| | - Fiona Blackhall
- Manchester Academic Health Science Centre, Institute of Cancer Sciences, Manchester Cancer Research Centre (MCRC), The University of Manchester, Manchester, UK
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK
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Bayman N, Ardron D, Ashcroft L, Baldwin D, Booton R, Darlison L, Edwards J, Lang-Lazdunski L, Lester J, Peake M, Rintoul R, Snee M, Taylor P, Chappell B, Lunt C, Faivre-Finn C. 193 PIT: a phase III trial of Prophylactic Irradiation of Tracts in patients with malignant pleural mesothelioma following invasive chest wall intervention. Lung Cancer 2016. [DOI: 10.1016/s0169-5002(16)30210-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Haslett K, Ashcroft L, Bramley R, Wilson B, Livsey J, Asselin M, Bayman N, Burt P, Chan C, Coote J, Falk S, Harris M, Jackson A, Laviste G, Lee L, Pemberton L, Sheikh H, Blackhall F, Faivre-Finn C. 186 Using electronic patient records as an effective tool to screen and improve recruitment to a Phase 1 trial in non-small cell lung cancer. Lung Cancer 2016. [DOI: 10.1016/s0169-5002(16)30203-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Pérez-Zanón N, Sigró J, Domonkos P, Ashcroft L. Comparison of HOMER and ACMANT homogenization methods using a central Pyrenees temperature dataset. Adv Sci Res 2015. [DOI: 10.5194/asr-12-111-2015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Abstract. The aim of this research is to compare the results of two modern multiple break point homogenization methods, namely ACMANT and HOMER, over a Pyrenees temperature dataset in order to detect differences between their outputs which can affect future studies. Both methods are applied to a dataset of 44 monthly maximum and minimum temperature series placed around central Pyrenees and covering the 1910–2013 period. The results indicate that the automatic method ACMANT produces credible results. While HOMER detects more breaks supported by metadata, this method is also more dependent on the user skill and thus sensitive to subjective errors.
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Krebs MG, Renehan AG, Backen A, Gollins S, Chau I, Hasan J, Valle JW, Morris K, Beech J, Ashcroft L, Saunders MP, Dive C. Circulating Tumor Cell Enumeration in a Phase II Trial of a Four-Drug Regimen in Advanced Colorectal Cancer. Clin Colorectal Cancer 2015; 14:115-22.e1-2. [PMID: 25680623 DOI: 10.1016/j.clcc.2014.12.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 12/16/2014] [Accepted: 12/19/2014] [Indexed: 01/11/2023]
Abstract
BACKGROUND Multidrug regimens are active against advanced colorectal cancer (ACRC). However, the increased toxicity requires the use of biomarkers to select the patients who will derive the most benefit. We assessed circulating tumor cells (CTCs) as a prognostic biomarker in patients treated with a 4-drug regimen. PATIENTS AND METHODS A single-arm phase II trial (Erbitux Study of CPT11, Oxaliplatin, UFToral Targeted-therapy [eSCOUT]) was undertaken in patients with previously untreated KRAS wild-type ACRC using a regimen of irinotecan, oxaliplatin, and tegafur-uracil with leucovorin and cetuximab. Baseline CTCs were enumerated using CellSearch. The endpoints were an objective response rate (ORR) and overall survival (OS). We modeled our results and compared them with those modeled for the capecitabine, oxaliplatin, bevacizumab +/- cetuximab (CAIRO2) trial, stratifying patients a priori into low (< 3) and high (≥ 3) CTC groups. RESULTS For 48 eligible patients, the best ORR from the 4-drug regimen was 71%, with a disease control rate of 98%. The median OS for patients with a high and low CTC count was 18.7 and 22.3 months (log-rank test, P = .038), respectively. In our modeled data, for patients with a low CTC count, no differences were found between the median OS in the eSCOUT trial and that in the CAIRO2 trial (22.2 vs. 22.0 months). However, for the high CTC group, a clinically relevant improvement was seen in median OS (eSCOUT vs. CAIRO2, 18.7 vs. 13.7 months; P = .001). CONCLUSION These data are hypothesis generating-for patients with ACRC, stratification by CTC count can identify those who might benefit the most from an intensive 4-drug regimen, avoiding high-toxicity regimens in low CTC groups. This hypothesis warrants validation in a phase III biomarker-driven trial.
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Affiliation(s)
- Matthew G Krebs
- Clinical and Experimental Pharmacology, Cancer Research UK Manchester Institute, Manchester, UK; The Christie NHS Foundation Trust, Manchester, UK; Institute of Cancer Sciences, University of Manchester, Manchester, UK
| | - Andrew G Renehan
- Clinical and Experimental Pharmacology, Cancer Research UK Manchester Institute, Manchester, UK; Institute of Cancer Sciences, University of Manchester, Manchester, UK
| | - Alison Backen
- Clinical and Experimental Pharmacology, Cancer Research UK Manchester Institute, Manchester, UK
| | | | - Ian Chau
- The Royal Marsden Hospital, London, UK
| | | | - Juan W Valle
- The Christie NHS Foundation Trust, Manchester, UK; Institute of Cancer Sciences, University of Manchester, Manchester, UK
| | - Karen Morris
- Clinical and Experimental Pharmacology, Cancer Research UK Manchester Institute, Manchester, UK
| | | | | | | | - Caroline Dive
- Clinical and Experimental Pharmacology, Cancer Research UK Manchester Institute, Manchester, UK
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Rafii S, Gourley C, Ang JE, Kumar R, Geuna E, Rye T, Ashcroft L, Powell B, Shapira-Frommer R, Friedlander M, Chen LM, Matulonis U, Kaufman B, De Greve J, Oza AM, Banerjee SN, Gore ME, Molife LR, Kaye SB, Yap TA. What clinical factors influence advanced BRCA1/2 mutant ovarian cancer patient (BMOC pt) outcomes to poly(ADP-ribose) polymerase inhibitor (PARPi) treatment? J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.5546] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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)
- Saeed Rafii
- The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Charlie Gourley
- University of Edinburgh Cancer Research UK Centre, Edinburgh, United Kingdom
| | - Joo Ern Ang
- Royal Marsden Hospital, Sutton Surrey, United Kingdom
| | - Rajiv Kumar
- The Royal Marsden Hospital, London, United Kingdom
| | - Elena Geuna
- The Institute Of Cancer Research and Royal Marsden, Osasco, Italy
| | - Tzyvia Rye
- University of Edinburgh Clinical Trials Unit, Edinburgh, United Kingdom
| | - Linda Ashcroft
- Clinical Trials Unit, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | | | | | | | | | | | - Bella Kaufman
- Sheba Medical Center; affiliated with Sackler Faculty of Medicine (Tel Aviv Univ), Ramat Gan, Israel
| | | | - Amit M. Oza
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | | | | | | | - Stanley B. Kaye
- The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom
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Bundred NJ, Stockton C, Riches K, Ashcroft L, Evans A, Skene A, Bramley M, Hodgkiss T, Purushotham A, Keeley V. Abstract P6-08-07: Optimal method of detection and threshold for early intervention to prevent lymphoedema: A multi-centre prospective study. Cancer Res 2015. [DOI: 10.1158/1538-7445.sabcs14-p6-08-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction
Women who undergo axillary surgery are at risk of developing lymphoedema. Early detection is recommended by measuring arm volume from a baseline before surgery to enable early intervention. The optimal measurement method to enable early detection and time to intervention are unclear. This prospective multi-centre study compares multi-frequency bioimpedance spectroscopy (BIS, ImpediMed) with the validated perometer method to determine which test is more sensitive for detecting the optimal threshold to prevent lymphoedema.
Methods
Participants (N = 960) undergoing axillary clearance at 9 UK centres have pre-operative and regular arm volume measurements post-surgery (1, 3, 6, 9 & 12 months, then 6 monthly), by the validated arm perometry compared with BIS (L-Dex) measurements as well as self-reported symptoms questionnaire. Change in arm volume was calculated using relative arm volume change (RAVC). The predictors of lymphoedema development and optimal method were assessed.
Results
Currently 612 patients, median age 55 (range 24 to 90) years, have 6 month follow-up data and 327 have 18 month follow-up data. Seventy six percent were ER positive and received endocrine therapy, 84% percent received radiotherapy and 67% received chemotherapy in addition to surgery. Lymphoedema by 18 months was detected in 19% (n=79) of women by perometry (≥10% RAVC) and a change in L-Dex of 10 was observed in 31% of women. A moderate correlation between perometer and BIS at 3 months (r=0.40) and 6 months (r=0.60), with a sensitivity of 73% and specificity of 84% was found.
Univariate analysis revealed a threshold for early intervention to prevent lymphoedema was RAVC ≥5%-<10% (p=0.03). Multivariate analysis indicated that Oestrogen Receptor (ER) negative breast cancer (p=0.01, hazard ratio (HR)=0.43, 95% confidence interval (CI)=0.24 to 0.84), number of positive nodes (p=0.01, HR=1.05, 95% CI=1.01 to 1.09) and a measurement of ≥5%-<10% (p=0.04, HR=1.67, 95% CI=1.03 to 3.54) at 6 months after surgery predicted development of lymphoedema. Further investigation of why ER negative patients are at increased risk of developing lymphoedema is planned.
Conclusions
The optimal threshold for early intervention to prevent progression to lymphoedema is ≥5%-<10% relative arm volume change by perometry. Further data on the sensitivity of BIS will be obtained in this study. Arm volume measurements remain necessary before and after ANC to allow early intervention.
(Funded by NIHR Programme Grant).
Citation Format: Nigel J Bundred, Charlotte Stockton, Katie Riches, Linda Ashcroft, Abigail Evans, Anthony Skene, Maria Bramley, Tracey Hodgkiss, Arnie Purushotham, Vaughan Keeley, BEA Investigators. Optimal method of detection and threshold for early intervention to prevent lymphoedema: A multi-centre prospective study [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P6-08-07.
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Affiliation(s)
- Nigel J Bundred
- 1University Hospital of South Manchester NHS Foundation Trust
| | | | | | | | | | - Anthony Skene
- 7Royal Bournemouth & Christchurch Hospitals NHS Foundation Trust
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Bundred NJ, Stockton C, Keeley V, Riches K, Ashcroft L, Evans A, Skene A, Purushotham A, Bramley M, Hodgkiss T. Comparison of multi-frequency bioimpedance with perometry for the early detection and intervention of lymphoedema after axillary node clearance for breast cancer. Breast Cancer Res Treat 2015; 151:121-9. [PMID: 25850535 DOI: 10.1007/s10549-015-3357-8] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 03/23/2015] [Indexed: 12/31/2022]
Abstract
The importance of early detection of lymphoedema by arm volume measurements before surgery and repeated measurements after surgery in women undergoing axillary node clearance (ANC) in order to enable early intervention is recognised. A prospective multi-centre study was performed which studied the difference between multi-frequency bioimpedance electrical analysis (BIS) and perometer arm measurement in predicting the development of lymphoedema. Women undergoing ANC underwent pre-operative and regular post-operative measurements of arm volume by both methods. The primary endpoint is the incidence of lymphoedema (≥10 % arm volume increase compared to contralateral arm by perometer) at 2 and 5 years after ANC. The threshold for intervention in lymphoedema was also assessed. Out of 964 patients recruited, 612 had minimum 6 months follow-up data. Using 1-month post-operative measurements as baseline, perometer detected 31 patients with lymphoedema by 6 months (BIS detected 53). By 6 months, 89 % of those with no lymphoedema reported at least one symptom. There was moderate correlation between perometer and BIS at 3 months (r = 0.40) and 6 months (r = 0.60), with a sensitivity of 73 % and specificity of 84 %. Univariate and multivariate analyses revealed a threshold for early intervention of ≥5 to <10 % (p = 0.03). Threshold for early intervention to prevent progression to lymphoedema is ≥5 to <10 % but symptoms alone do not predict lymphoedema. The modest correlation between methods at 6 months indicates arm volume measurements remain gold standard, although longer term follow-up is required.
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Affiliation(s)
- Nigel J Bundred
- University Hospital of South Manchester, 2nd Floor Education and Research Centre, Southmoor Road, Wythenshawe, Manchester, M23 9LT, UK,
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Thomson DJ, Ho KF, Ashcroft L, Denton K, Betts G, Mais KL, Garcez K, Yap BK, Lee LW, Sykes AJ, Rowbottom CG, Slevin NJ. Dose intensified hypofractionated intensity-modulated radiotherapy with synchronous cetuximab for intermediate stage head and neck squamous cell carcinoma. Acta Oncol 2015; 54:88-98. [PMID: 25279959 DOI: 10.3109/0284186x.2014.958528] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [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: 01/23/2023]
Abstract
BACKGROUND For stage II and III head and neck squamous cell carcinoma (HNSCC) treated with radiotherapy alone, loco-regional recurrence is the main cause of treatment failure. Strategies to improve loco-regional control should not be at the expense of increased late normal tissue toxicity. We investigated dose-intensified hypofractionated intensity-modulated radiotherapy (IMRT) with synchronous cetuximab. MATERIAL AND METHODS In a phase I/II trial, 27 patients with stage III or high risk stage II HNSCC were recruited. They received three dose level simultaneous integrated boost IMRT, 62.5 Gy in 25 daily fractions to planning target volume one over five weeks with synchronous cetuximab. The primary endpoint was acute toxicity. Secondary endpoints included: late toxicity and quality of life; loco-regional control, cause-specific and overall survival. RESULTS Radiotherapy was completed by 26/27 patients; for one (4%) the final fraction was omitted due to skin toxicity. All cycles of cetuximab were received by 23/27 patients. Grade 3 acute toxicities included: pain (81%), oral mucositis (78%) and dysphagia (41%). There were few grade 3 physician-recorded late toxicities, including: pain (11%), problems with teeth (8%) and weight loss (4%). At 12 months, only one (4%) patient required a feeding tube, inserted prior to treatment due to dysphagia. The maximal/peak rates of patient-reported late toxicities included: severe pain (11%), any dry mouth (89%) and swallowing dysfunction that required a soft/liquid diet (23%). At 12 months, all quality of life and most symptoms mean scores had resolved to baseline or were only a little worse; dry mouth, sticky saliva and dentition scores remained very much worse. At a median follow-up of 47 months, there were five (18.5%) loco-regional recurrences and the overall cause-specific survival was 79% (95% CI 53-92). CONCLUSIONS This regimen is safe with acceptable acute toxicity, low rates of late toxicity and impact on quality of life at 12 months following treatment. Further evaluation is recommended.
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Affiliation(s)
- David J Thomson
- Department of Clinical Oncology, The Christie NHS Foundation Trust , Manchester , UK
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Bayman N, Ardron D, Ashcroft L, Baldwin D, Booton R, Darlison L, Edwards J, Lang-Lazdunski L, Lester J, Peake M, Rintoul R, Snee M, Taylor P, Lunt C, Faivre-Finn C. 183: PIT: a phase III trial of prophylactic irradiation of tracts in patients with malignant pleural mesothelioma following invasive chest wall intervention. Lung Cancer 2015. [DOI: 10.1016/s0169-5002(15)50177-3] [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: 12/01/2022]
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Thomson D, Ho K, Ashcroft L, Denton K, Mais K, Garcez K, Yap B, Lee L, Sykes A, Rowbottom C, Slevin N. Dose Intensified Hypofractionated IMRT With Synchronous Cetuximab for Intermediate-Stage Head and Neck Squamous Cell Carcinoma (HNSCC): Results From the Phase 1/2 INTENSE Trial. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Bundred N, Stockton C, Riches K, Ashcroft L, Bramley M, Hodgkiss T, Purushotham A, Keeley V. Prediction of a threshold for intervention in breast cancer-related lymphoedema: A multi-centre prospective study. Eur J Surg Oncol 2014. [DOI: 10.1016/j.ejso.2014.02.034] [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] Open
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Bayman N, Ardron D, Ashcroft L, Baldwin D, Booton R, Darlison L, Edwards J, Lang-Lazdunski L, Lester J, Peake M, Rintoul R, Snee M, Taylor P, Lunt C, Faivre-Finn C. 216 PIT: A phase III trial of Prophylactic Irradiation of Tracts in patients with malignant pleural mesothelioma following invasive chest wall intervention. Lung Cancer 2014. [DOI: 10.1016/s0169-5002(14)70216-8] [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: 11/25/2022]
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Faivre-Finn C, Ashcroft L, Bezjak A, Bhatnagar A, Cardenal F, Falk S, Fournel P, Groom N, Harden S, Pechoux CL, Lorigan P, McMenemin R, Mohammed N, O'Brien M, Padovani L, Snee M, Surmont V, Wilson E, Blackhall F. 185 CONVERT – a successful international collaboration between the UK NCRI, Groupe Français de Pneumo-Cancérologie, Spanish Lung Cancer Group, EORTC and NCI Canada. Lung Cancer 2014. [DOI: 10.1016/s0169-5002(14)70186-2] [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: 10/25/2022]
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Bundred NJ, Stockton C, Fellows K, Keeley V, Riches K, Ashcroft L, Purushotham A, Bramley M, Hodgkiss T. Abstract P3-09-09: Comparison of multi-frequency bioimpedance with perometry for the early detection of lymphoedema after axillary node clearance. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-p3-09-09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction
Women who undergo axillary clearance are at risk of developing lymphoedema. Early detection is recommended by arm volume measurements from a baseline before surgery but the optimal test is unclear. This prospective multi-centre study compares multi-frequency bioimpedance spectroscopy (BIS, ImpediMed) with the validated perometer method to determine which test is more sensitive for detecting lymphoedema within 24 months of surgery. Results from 441 women with up to six months follow-up are reported here to determine whether the timing of arm measurement affects results.
Methods
Participants (N = 441) undergoing Axillary Clearance underwent pre-operative and subsequent regular measurements post-surgery (1, 3, 6, 9 & 12 months, then 6 monthly), of arm volume by perometry and BIS measurements as well as self-reported symptoms of swelling, numbness or heaviness. The primary endpoint of lymphoedema was defined as ≥10% increase in volume compared to the contralateral arm by perometry.
Results
We report the data from 441 patients with 6 month follow-up data, their median age is 55 years ranging from 27 to 90 years. Eighty percent of patients were ER positive and received endocrine therapy as well as surgery. Eighty percent also underwent radiotherapy to the breast or chest wall, while 70% received chemotherapy in addition to surgery. Mean percentage increase in arm volume by perometry at 6 months was 2.03% with a moderate correlation between perometry and BIS at 3 months (r = 0.38) and 6 months (r = 0.37). In 441 patients with 6 months follow-up, the gold standard perometry detected lymphoedema in 44 (10%) patients by 6 months compared to the contralateral arm, whereas BIS measured using the unit L-Dex was positive (showed an increase of an L-Dex of 10) in 103 (21%) patients. Of the 99 patients with 18 months follow-up, 24% have lymphoedema as detected by perometry. When compared with the baseline measurements for perometry and BIS, the month 1 measurements detected fewer cases of lymphoedema by 6 months, 11 (42%) fewer for perometry and 18 (30%) fewer for BIS. 25% of patients reported symptoms before surgery. While 100% of those with lymphoedema at 6 months post-surgery reported symptoms, 23% with no lymphoedema also reported at least one symptom at 6 months.
Conclusions
Pre-operative measurements should be used as baseline to enable accurate monitoring of lymphoedema development. Symptoms alone are not an accurate predictor of current or future lymphoedema and arm sleeves should not be prescribed for symptoms without measuring arm volume change compared to the contralateral arm. The modest correlation between perometry and BIS at 6 months suggests arm volume measurements remain necessary before and after ANC for monitoring, although longer term follow-up data is required to determine the most sensitive method of predicting lymphoedema.(Funded by NIHR Programme Grant).
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P3-09-09.
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Affiliation(s)
- NJ Bundred
- University Hospital of South Manchester, Manchester, United Kingdom; Derby Hospitals NHS Foundation Trust, Derby, United Kingdom; The Christie Hospital NHS Foundation Trust, Manchester, United Kingdom; Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom; The Pennine Acute Hospitals NHS Trust, Manchester, United Kingdom
| | - C Stockton
- University Hospital of South Manchester, Manchester, United Kingdom; Derby Hospitals NHS Foundation Trust, Derby, United Kingdom; The Christie Hospital NHS Foundation Trust, Manchester, United Kingdom; Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom; The Pennine Acute Hospitals NHS Trust, Manchester, United Kingdom
| | - K Fellows
- University Hospital of South Manchester, Manchester, United Kingdom; Derby Hospitals NHS Foundation Trust, Derby, United Kingdom; The Christie Hospital NHS Foundation Trust, Manchester, United Kingdom; Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom; The Pennine Acute Hospitals NHS Trust, Manchester, United Kingdom
| | - V Keeley
- University Hospital of South Manchester, Manchester, United Kingdom; Derby Hospitals NHS Foundation Trust, Derby, United Kingdom; The Christie Hospital NHS Foundation Trust, Manchester, United Kingdom; Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom; The Pennine Acute Hospitals NHS Trust, Manchester, United Kingdom
| | - K Riches
- University Hospital of South Manchester, Manchester, United Kingdom; Derby Hospitals NHS Foundation Trust, Derby, United Kingdom; The Christie Hospital NHS Foundation Trust, Manchester, United Kingdom; Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom; The Pennine Acute Hospitals NHS Trust, Manchester, United Kingdom
| | - L Ashcroft
- University Hospital of South Manchester, Manchester, United Kingdom; Derby Hospitals NHS Foundation Trust, Derby, United Kingdom; The Christie Hospital NHS Foundation Trust, Manchester, United Kingdom; Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom; The Pennine Acute Hospitals NHS Trust, Manchester, United Kingdom
| | - A Purushotham
- University Hospital of South Manchester, Manchester, United Kingdom; Derby Hospitals NHS Foundation Trust, Derby, United Kingdom; The Christie Hospital NHS Foundation Trust, Manchester, United Kingdom; Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom; The Pennine Acute Hospitals NHS Trust, Manchester, United Kingdom
| | - M Bramley
- University Hospital of South Manchester, Manchester, United Kingdom; Derby Hospitals NHS Foundation Trust, Derby, United Kingdom; The Christie Hospital NHS Foundation Trust, Manchester, United Kingdom; Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom; The Pennine Acute Hospitals NHS Trust, Manchester, United Kingdom
| | - T Hodgkiss
- University Hospital of South Manchester, Manchester, United Kingdom; Derby Hospitals NHS Foundation Trust, Derby, United Kingdom; The Christie Hospital NHS Foundation Trust, Manchester, United Kingdom; Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom; The Pennine Acute Hospitals NHS Trust, Manchester, United Kingdom
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Mehmood Q, Ashcroft L, Bayman N, Blackhall F, Burt P, Chittalia A, Coote J, Fenemore J, Halkyard E, Harris M, Lee L, Pemberton L, Sheikh H, Taylor P, Faivre-Finn C. 184 Toxicities and compliance to treatment in locally advanced non-small cell lung cancer (LA-NSCLC) treated with concurrent chemoradiotherapy (cCTRT) at the Christie NHS Foundation Trust. Lung Cancer 2013. [DOI: 10.1016/s0169-5002(13)70184-3] [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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Faivre-Finn C, Falk S, Ashcroft L, Wilson E, Groom N, Wilkinson D, Appel W, Bhatnagar A, Harden S, Hatton M, McMenemin R, Mohammed N, O'Brien M, Snee M. 181 CONVERT – the challenges of opening a multi-centre radiotherapy trial in the UK. Lung Cancer 2013. [DOI: 10.1016/s0169-5002(13)70181-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Robinson H, McCloskey P, Nair U, Ashcroft L, Bayman N, Burt P, Chittalia A, Coote J, Harris M, Lee L, Pemberton L, Sheikh H, Faivre-Finn C. 173 Assessing CT changes post stereotactic ablative body radiotherapy (SABR) using the criteria proposed by Senan et al. Lung Cancer 2013. [DOI: 10.1016/s0169-5002(13)70173-9] [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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Motion J, Ashcroft L, Dowsett M, Cuzick J, Hickman J, Evans G, Eccles D, Eeles R, Greenhalgh R, Affen J, Bundred S, Boggis C, Sergeant J, Fallowfield L, Adams J, Howell A. Abstract P1-09-05: The RAZOR trial: a phase II prevention trial of screening plus goserilin and raloxifene versus screening alone in pre-menopausal women at increased risk of breast cancer. Cancer Res 2012. [DOI: 10.1158/0008-5472.sabcs12-p1-09-05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Observational studies indicate that oophorectomy at about age 40 reduces breast cancer risk by approximately a half in high risk women. Widespread use of risk reducing oophorectomy is unlikely to be acceptable to these women. We explored the feasibility of giving goserelin to produce reversible ovarian suppression together with raloxifene to maintain bone mineral density (BMD).
Objectives: The primary study objective was adherence to treatment. Secondary objectives were uptake of randomisation, side effects/quality of life and measures of effect on bone and in serum.
Methods: Recruitment was from 3 UK Family History Clinics. Consenting women at ≥ 1 in 3 lifetime risk of breast cancer were randomised to control or monthly subcutaneous goserelin 3.6 mg and raloxifene 60 mg/d orally for two years. Questionnaires (Endocrine Symptom Checklist, Trait & State Anxiety, Sexual Activity & Cancer Worry) measuring toxicity/quality of life were administered by nurses. Dual energy X-ray absorptiometry (DXA) BMD measurements were performed in the treatment arm annually. Lipids and collagen breakdown products were measured by standard methods.
Results: 75 of 511 (14.7%) women approached agreed to randomisation (38 to treatment and 37 to control). The major reason for non-entry was fear of side effects (85%). Median age was 37 and 35 years, for the experimental (A) and control arm (B), respectively. Median follow up is 8.8 years. 20/38 in arm A and 27/37 of controls completed the 24 m study. 18/38 women in arm A withdrew (13 [34%] because of side effects) and 10/37 in arm B for various reasons including the desire for risk reducing surgery (n = 4). No significant differences were seen in the Endocrine Symptom Sub-scale, State or Trait anxiety or Cancer Worry. However, Hot flushes, night and cold sweats (together p <0.005), vaginal dryness (p = 0.006); loss of interest in sex, dyspareunia and reduced sexual pleasure (together p < 0.005) were significantly more in arm A. Despite this, 11 of 23 women in arm A when asked would have been happy to complete a potential five years of treatment. BMD declined by 3–7% and Ctx significantly increased (p < 0.005 each) but both returned to baseline by year 3. Lipids were unchanged. 4 women later developed breast cancer in arm B and 2 in arm A.
Conclusions: Uptake and adherence to treatment was relatively low in this group of women at high risk. The major reason for low uptake was fear of side effects and these were the major reason for drop out from treatment. Raloxifene did not maintain BMD. This approach to breast cancer prevention induced significant symptoms and bone loss, thus methods to ameliorate these need to be developed if ovarian suppression is to play a role in breast cancer prevention.
Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P1-09-05.
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Affiliation(s)
- J Motion
- University Hospital South Manchester, Manchester, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; Royal Marsden Hospital, London, United Kingdom; Queen Mary, University of London, United Kingdom; Princess Anne Hospital, Southampton, United Kingdom; The Institute of Cancer Research, Royal Marsden Hospital, London, United Kingdom; University of Sussex - (SHORE-C), Brighton, United Kingdom; University of Manchester, United Kingdom; Manchester Royal Infirmary, Manchester, United Kingdom
| | - L Ashcroft
- University Hospital South Manchester, Manchester, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; Royal Marsden Hospital, London, United Kingdom; Queen Mary, University of London, United Kingdom; Princess Anne Hospital, Southampton, United Kingdom; The Institute of Cancer Research, Royal Marsden Hospital, London, United Kingdom; University of Sussex - (SHORE-C), Brighton, United Kingdom; University of Manchester, United Kingdom; Manchester Royal Infirmary, Manchester, United Kingdom
| | - M Dowsett
- University Hospital South Manchester, Manchester, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; Royal Marsden Hospital, London, United Kingdom; Queen Mary, University of London, United Kingdom; Princess Anne Hospital, Southampton, United Kingdom; The Institute of Cancer Research, Royal Marsden Hospital, London, United Kingdom; University of Sussex - (SHORE-C), Brighton, United Kingdom; University of Manchester, United Kingdom; Manchester Royal Infirmary, Manchester, United Kingdom
| | - J Cuzick
- University Hospital South Manchester, Manchester, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; Royal Marsden Hospital, London, United Kingdom; Queen Mary, University of London, United Kingdom; Princess Anne Hospital, Southampton, United Kingdom; The Institute of Cancer Research, Royal Marsden Hospital, London, United Kingdom; University of Sussex - (SHORE-C), Brighton, United Kingdom; University of Manchester, United Kingdom; Manchester Royal Infirmary, Manchester, United Kingdom
| | - J Hickman
- University Hospital South Manchester, Manchester, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; Royal Marsden Hospital, London, United Kingdom; Queen Mary, University of London, United Kingdom; Princess Anne Hospital, Southampton, United Kingdom; The Institute of Cancer Research, Royal Marsden Hospital, London, United Kingdom; University of Sussex - (SHORE-C), Brighton, United Kingdom; University of Manchester, United Kingdom; Manchester Royal Infirmary, Manchester, United Kingdom
| | - G Evans
- University Hospital South Manchester, Manchester, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; Royal Marsden Hospital, London, United Kingdom; Queen Mary, University of London, United Kingdom; Princess Anne Hospital, Southampton, United Kingdom; The Institute of Cancer Research, Royal Marsden Hospital, London, United Kingdom; University of Sussex - (SHORE-C), Brighton, United Kingdom; University of Manchester, United Kingdom; Manchester Royal Infirmary, Manchester, United Kingdom
| | - D Eccles
- University Hospital South Manchester, Manchester, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; Royal Marsden Hospital, London, United Kingdom; Queen Mary, University of London, United Kingdom; Princess Anne Hospital, Southampton, United Kingdom; The Institute of Cancer Research, Royal Marsden Hospital, London, United Kingdom; University of Sussex - (SHORE-C), Brighton, United Kingdom; University of Manchester, United Kingdom; Manchester Royal Infirmary, Manchester, United Kingdom
| | - R Eeles
- University Hospital South Manchester, Manchester, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; Royal Marsden Hospital, London, United Kingdom; Queen Mary, University of London, United Kingdom; Princess Anne Hospital, Southampton, United Kingdom; The Institute of Cancer Research, Royal Marsden Hospital, London, United Kingdom; University of Sussex - (SHORE-C), Brighton, United Kingdom; University of Manchester, United Kingdom; Manchester Royal Infirmary, Manchester, United Kingdom
| | - R Greenhalgh
- University Hospital South Manchester, Manchester, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; Royal Marsden Hospital, London, United Kingdom; Queen Mary, University of London, United Kingdom; Princess Anne Hospital, Southampton, United Kingdom; The Institute of Cancer Research, Royal Marsden Hospital, London, United Kingdom; University of Sussex - (SHORE-C), Brighton, United Kingdom; University of Manchester, United Kingdom; Manchester Royal Infirmary, Manchester, United Kingdom
| | - J Affen
- University Hospital South Manchester, Manchester, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; Royal Marsden Hospital, London, United Kingdom; Queen Mary, University of London, United Kingdom; Princess Anne Hospital, Southampton, United Kingdom; The Institute of Cancer Research, Royal Marsden Hospital, London, United Kingdom; University of Sussex - (SHORE-C), Brighton, United Kingdom; University of Manchester, United Kingdom; Manchester Royal Infirmary, Manchester, United Kingdom
| | - S Bundred
- University Hospital South Manchester, Manchester, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; Royal Marsden Hospital, London, United Kingdom; Queen Mary, University of London, United Kingdom; Princess Anne Hospital, Southampton, United Kingdom; The Institute of Cancer Research, Royal Marsden Hospital, London, United Kingdom; University of Sussex - (SHORE-C), Brighton, United Kingdom; University of Manchester, United Kingdom; Manchester Royal Infirmary, Manchester, United Kingdom
| | - C Boggis
- University Hospital South Manchester, Manchester, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; Royal Marsden Hospital, London, United Kingdom; Queen Mary, University of London, United Kingdom; Princess Anne Hospital, Southampton, United Kingdom; The Institute of Cancer Research, Royal Marsden Hospital, London, United Kingdom; University of Sussex - (SHORE-C), Brighton, United Kingdom; University of Manchester, United Kingdom; Manchester Royal Infirmary, Manchester, United Kingdom
| | - J Sergeant
- University Hospital South Manchester, Manchester, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; Royal Marsden Hospital, London, United Kingdom; Queen Mary, University of London, United Kingdom; Princess Anne Hospital, Southampton, United Kingdom; The Institute of Cancer Research, Royal Marsden Hospital, London, United Kingdom; University of Sussex - (SHORE-C), Brighton, United Kingdom; University of Manchester, United Kingdom; Manchester Royal Infirmary, Manchester, United Kingdom
| | - L Fallowfield
- University Hospital South Manchester, Manchester, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; Royal Marsden Hospital, London, United Kingdom; Queen Mary, University of London, United Kingdom; Princess Anne Hospital, Southampton, United Kingdom; The Institute of Cancer Research, Royal Marsden Hospital, London, United Kingdom; University of Sussex - (SHORE-C), Brighton, United Kingdom; University of Manchester, United Kingdom; Manchester Royal Infirmary, Manchester, United Kingdom
| | - J Adams
- University Hospital South Manchester, Manchester, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; Royal Marsden Hospital, London, United Kingdom; Queen Mary, University of London, United Kingdom; Princess Anne Hospital, Southampton, United Kingdom; The Institute of Cancer Research, Royal Marsden Hospital, London, United Kingdom; University of Sussex - (SHORE-C), Brighton, United Kingdom; University of Manchester, United Kingdom; Manchester Royal Infirmary, Manchester, United Kingdom
| | - A Howell
- University Hospital South Manchester, Manchester, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; Royal Marsden Hospital, London, United Kingdom; Queen Mary, University of London, United Kingdom; Princess Anne Hospital, Southampton, United Kingdom; The Institute of Cancer Research, Royal Marsden Hospital, London, United Kingdom; University of Sussex - (SHORE-C), Brighton, United Kingdom; University of Manchester, United Kingdom; Manchester Royal Infirmary, Manchester, United Kingdom
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Quinn AM, Blackhall F, Wilson G, Danson S, Clamp A, Ashcroft L, Brierley J, Hasleton P. Extrapulmonary small cell carcinoma: a clinicopathological study with identification of potential diagnostic mimics. Histopathology 2012; 61:454-64. [PMID: 22687056 DOI: 10.1111/j.1365-2559.2012.04247.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS To evaluate the clinicopathological features of small cell carcinoma arising outside the lung. METHODS AND RESULTS Thirty-seven cases with a pathology diagnosis of extrapulmonary small cell carcinoma (EPSCC) were selected. The clinical notes were reviewed and tumour blocks were selected for a fresh haematoxylin and eosin (H&E) section and immunohistochemical stains. The most common tumour locations were cervix and bladder. Twenty-five cases (68%) were finally diagnosed as EPSCC, nine of which were found with coexisting non small cell carcinoma. Two cases (5%) were diagnosed as large cell neuroendocrine carcinoma (LCNEC) of the cervix. The remainder was classified as 10 poorly differentiated carcinomas (PDCs) (27%). Positive staining for thyroid transcription factor 1 (TTF-1) was noted in nine cases of EPSCC and in none of the cases of PDC (P = 0.034). Synaptophysin immunoreactivity was found in 20 cases of EPSCC and two cases of PDC with neuroendocrine differentiation (P = 0.002), as well as two cases of LCNEC. 34βE12 was positive in eight cases of SCC and two cases of PDC. CONCLUSIONS Based on this series, EPSCC may be overdiagnosed. Immunohistochemistry for TTF-1, used in combination with synaptophysin, may help to discriminate EPSCC from PDC.
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Affiliation(s)
- Anne Marie Quinn
- Department of Pathology, Manchester Royal Infirmary, Manchester, UK.
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Thomson D, Denton K, Ashcroft L, Bonington S, Sykes A, Lee L, Yap B, Silva P, Mais K, Slevin N. PO-0733 PHASE II STUDY OF SORAFENIB IN ADVANCED SALIVARY ADENOID CYSTIC CARCINOMA: INITIAL OUTCOME AND TOXICITY. Radiother Oncol 2012. [DOI: 10.1016/s0167-8140(12)71066-6] [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: 11/28/2022]
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Colaco R, Sheikh H, Lorigan P, Blackhall F, Hulse P, Califano R, Ashcroft L, Taylor P, Thatcher N, Faivre-Finn C. Omitting elective nodal irradiation during thoracic irradiation in limited-stage small cell lung cancer – Evidence from a phase II trial. Lung Cancer 2012; 76:72-7. [DOI: 10.1016/j.lungcan.2011.09.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2011] [Revised: 09/14/2011] [Accepted: 09/22/2011] [Indexed: 11/27/2022]
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Howell S, Armstrong A, Ashcroft L. 251 Retrospective Analysis of the Relative Efficacy and Toxicity of Nab-paclitaxel and Docetaxel in Metastatic Breast Cancer. Eur J Cancer 2012. [DOI: 10.1016/s0959-8049(12)70318-0] [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: 11/16/2022]
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Bayman N, Ashcroft L, Falk S, Stones N, Ardron D, Baldwin D, Darlison L, Edwards J, Lester J, Peake M, Rintoul R, Snee M, Taylor P, Faivre-Finn C. 69 PIT: A phase III trial of prophylactic irradiation of tracks in patients with malignant pleural mesothelioma following invasive chest wall intervention. Lung Cancer 2012. [DOI: 10.1016/s0169-5002(12)70070-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Robinson H, Shrimali R, Webster G, Koh P, Helbrow J, Bayman N, Burt P, Chittalia A, Harris M, Lander H, Coote J, Lee L, Pemberton L, Sheikh H, Ashcroft L, Faivre-Finn C. 146 One year on: early report of intensity modulated radiotherapy (IMRT) for locally advanced lung cancer at the Christie. Lung Cancer 2012. [DOI: 10.1016/s0169-5002(12)70147-2] [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: 11/16/2022]
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Helbrow J, Koh P, Shrimali R, Blackhall F, Bayman N, Burt P, Chittalia A, Harris M, Lander H, Lee L, Pemberton L, Sheikh H, Summers Y, Taylor P, Ashcroft L, Swindell R, Webster G, Faivre-Finn C. 164 Clinical characteristics and radiotherapy planning parameters as predictors of radiation-induced oesophageal toxicity following radical radiotherapy (rRT) for small cell (SCLC) and non-small cell lung cancer (NSCLC). Lung Cancer 2012. [DOI: 10.1016/s0169-5002(12)70165-4] [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: 10/14/2022]
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Helbrow J, Koh P, Shrimali R, Blackhall F, Bayman N, Burt P, Chittalia A, Harris M, Lander H, Lee L, Pemberton L, Sheikh H, Summers Y, Taylor P, Ashcroft L, Swindell R, Webster G, Faivre-Finn C. 165 Clinical characteristics and radiotherapy planning parameters as predictors of radiation-induced pulmonary toxicity following radical radiotherapy (rRT) for small cell (SCLC) and non-small cell lung cancer (NSCLC). Lung Cancer 2012. [DOI: 10.1016/s0169-5002(12)70166-6] [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: 11/29/2022]
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Abstract
PurposeThis paper aims to provide an overview of the current situation regarding ebooks in both academic and public librariesDesign/methodology/approachThe approach takes the form of a review of the literature, drawing together findings from various published ebook surveys conducted over the past three yearsFindingsIt was found that there is a need for libraries to raise awareness about the ebooks they offer and how they offer them.Practical implicationsThe paper points up the importance of librarians having accurate knowledge about their users' concerns, which can be complex over the spectrum of ebooks, in order to obtain the “best deal”.Originality/valueThe paper draws together viewpoints from academic libraries, public libraries and ebook suppliers.
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Challberg J, Ashcroft L, Lalloo F, Eckersley B, Clayton R, Hopwood P, Selby P, Howell A, Evans DG. Menopausal symptoms and bone health in women undertaking risk reducing bilateral salpingo-oophorectomy: significant bone health issues in those not taking HRT. Br J Cancer 2011; 105:22-7. [PMID: 21654687 PMCID: PMC3137416 DOI: 10.1038/bjc.2011.202] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Women at high ovarian cancer risk, especially those with mutations in BRCA1/BRCA2, are encouraged to undergo bilateral risk-reducing salpingo-oophorectomy (BRRSPO) prior to the natural menopause. The decision to use HRT to cover the period of oestrogen deprivation up to 50 years of age is difficult because of balancing the considerations of breast cancer risk, bone and cardiovascular health. METHODS We reviewed by questionnaire 289 women after BRRSPO aged ≤48 years because of high ovarian cancer risk; 212 (73%) of women responded. RESULTS Previous HRT users (n=67) had significantly worse endocrine symptom scores than 67 current users (P=0.006). A total of 123 (58%) of women had ≥24 months of oestrogen deprivation <50 years with 78 (37%) never taking HRT. Bone density (DXA) evaluations were available on 119 (56%) women: bone loss with a T score of ≤-1.0 was present in 5 out of 31 (16%) women with no period of oestrogen deprivation <50 years compared with 37 out of 78 (47%) of those with ≥24 months of oestrogen deprivation (P=0.03). INTERPRETATION Women undergoing BRRSPO <50 years should be counselled concerning the risks/benefits of HRT, taking into consideration the benefits on symptoms, bone health and cardiovascular health, and that the risks of breast cancer from oestrogen-only HRT appear to be relatively small.
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Affiliation(s)
- J Challberg
- Department of Genetic Medicine, The University of Manchester, Manchester Academic Health Science Centre, Central Manchester Foundation Trust, St Mary's Hospital, 6th Floor, Oxford Road, Manchester M13 9WL, UK
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48
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Sheikh H, Colaco R, Lorigan P, Blackhall F, Califano R, Ashcroft L, Taylor P, Thatcher N, Faivre-Finn C. Use of G-CSF during concurrent chemotherapy and thoracic radiotherapy in patients with limited-stage small-cell lung cancer safety data from a phase II trial. Lung Cancer 2011; 74:75-9. [PMID: 21353720 DOI: 10.1016/j.lungcan.2011.01.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2010] [Revised: 12/23/2010] [Accepted: 01/26/2011] [Indexed: 02/02/2023]
Abstract
There is paucity of data in the literature regarding the safety of combining granulocyte colony stimulating factor (G-CSF) during chemo-radiotherapy (CTRT) in lung cancer patients. The ASCO 2006 recommendations advise against use of CSFs during concomitant mediastinal CTRT. The only randomised study evaluating CSFs in this context showed significant increase in grade 3/4 thrombocytopenia and an excess of pulmonary toxic deaths. In the context of a phase II trial, 38 patients with limited-stage small cell lung cancer were randomised to receive once-daily (66 Gy in 33 fractions) or twice-daily (45 Gy in 30 fractions) radiotherapy. Radiotherapy (RT) was given concurrently with cisplatin and etoposide. G-CSF was given as primary or secondary prophylaxis or as a therapeutic measure during an episode of febrile neutropenia according to local protocols. Common terminology criteria for adverse events (CTCAE) v3.0 was used to record toxicity. Thirteen (34%) of 38 patients received G-CSF concurrently with RT. With a median follow-up of 16.9 months, there were no treatment related deaths reported. Seven (54%) patients experienced grade 3/4 thrombocytopenia and 5 (38%) experienced grade 3/4 anaemia. Thirty-one percent required platelet transfusions. No episodes of bleeding were observed. There were no cases of grade 3/4 acute pneumonitis. These data suggests that with modern three-dimensional (3D) conformal RT, G-CSF administration concurrently with CTRT does not result in the increase risk of pulmonary toxicity, but does increase the risk of thrombocytopenia. Whether the risks of thrombocytopenia are outweighed by the outcome of timely early concurrent CTRT is being evaluated prospectively in the ongoing phase III CONVERT trial (NCT00433563) in which G-CSF is permitted during thoracic irradiation.
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Affiliation(s)
- Hamid Sheikh
- Dept of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
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49
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Thompson AM, Johnson A, Quinlan P, Hillman G, Fontecha M, Bray SE, Purdie CA, Jordan LB, Ferraldeschi R, Latif A, Hadfield KD, Clarke RB, Ashcroft L, Evans DG, Howell A, Nikoloff M, Lawrence J, Newman WG. Comprehensive CYP2D6 genotype and adherence affect outcome in breast cancer patients treated with tamoxifen monotherapy. Breast Cancer Res Treat 2010; 125:279-87. [PMID: 20809362 DOI: 10.1007/s10549-010-1139-x] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2010] [Accepted: 08/18/2010] [Indexed: 12/15/2022]
Abstract
The association between CYP2D6 genotype and outcome in breast cancer patients treated with adjuvant tamoxifen remains controversial. We assessed the influence of comprehensive versus limited CYP2D6 genotype in the context of tamoxifen adherence and co-medication in a large cohort of 618 patients. Genotyping of 33 CYP2D6 alleles used two archival cohorts from tamoxifen-treated women with invasive breast cancer (Dundee, n = 391; Manchester, n = 227). Estimates for recurrence-free survival (RFS) were calculated based on inferred CYP2D6 phenotypes using Kaplan-Meier and Cox proportional hazard models, adjusted for nodal status and tumour size. Patients with at least one reduced function CYP2D6 allele (60%) or no functional alleles (6%) had a non-significant trend for worse RFS: hazard ratio (HR) 1.52 (CI 0.98-2.36, P = 0.06). For post-menopausal women on tamoxifen monotherapy, the HR for recurrence in patients with reduced functional alleles was 1.96 (CI 1.05-3.66, P = 0.036). However, RFS analysis limited to four common CYP2D6 allelic variants was no longer significant (P = 0.39). The effect of CYP2D6 genotype was increased by adjusting for adherence to tamoxifen therapy, but not significantly changed when adjusted for co-administration of potent inhibitors of CYP2D6. Comprehensive genotyping of CYP2D6 and adherence to tamoxifen therapy may be useful to identify breast cancer patients most likely to benefit from adjuvant tamoxifen.
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Affiliation(s)
- Alastair M Thompson
- Department of Surgery and Molecular Oncology, University of Dundee, Dundee DD1 9SY, UK.
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50
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Wheatley-Price P, Blackhall F, Lee SM, Ma C, Ashcroft L, Jitlal M, Qian W, Hackshaw A, Rudd R, Booton R, Danson S, Lorigan P, Thatcher N, Shepherd FA. The influence of sex and histology on outcomes in non-small-cell lung cancer: a pooled analysis of five randomized trials. Ann Oncol 2010; 21:2023-2028. [PMID: 20332134 DOI: 10.1093/annonc/mdq067] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Some non-small-cell lung cancer (NSCLC) surgical series have indicated that the positive prognostic effect of female sex is limited to patients with adenocarcinoma. We carried out a retrospective analysis to investigate the role of sex and histology on efficacy, toxicity, and dose delivery after chemotherapy. PATIENT AND METHODS Individual patient data were pooled from five randomized, phase III, advanced NSCLC chemotherapy trials. Primary outcomes were response rate, overall survival (OS), toxicity, and dose delivery. A secondary analysis examined survival by sex in histological subgroups. RESULTS Of 2349 patients, 34% were women. Women had a higher response rate to chemotherapy (42% versus 40%, P = 0.01) and longer survival than men (median OS 9.6 versus 8.6 months, P = 0.002). The difference in OS remained after adjusting for age, stage, performance status, and histology (hazard ratio 0.83, 95% confidence interval 0.74-0.92, P = 0.0005). Upon further examination, longer survival in women was only seen in patients with adenocarcinoma (test for interaction P = 0.006). There were no differences in hematological toxicity or transfusions. Women experienced more grade 3-4 emesis than men (P < 0.0001) and more dose delays (P = 0.02) or dose reductions (P < 0.0001). CONCLUSION The positive prognostic effect among women is confirmed in patients receiving platinum-based chemotherapy but appears confined to those with adenocarcinoma histology.
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Affiliation(s)
- P Wheatley-Price
- Princess Margaret Hospital/University Health Network, Toronto, Ontario, Canada.
| | | | - S-M Lee
- University College Hospital, London
| | - C Ma
- Princess Margaret Hospital/University Health Network, Toronto, Ontario, Canada
| | | | - M Jitlal
- Cancer Research UK and University College London Cancer Trials Centre, London
| | - W Qian
- Medical Research Council Clinical Trials Unit, London
| | - A Hackshaw
- Cancer Research UK and University College London Cancer Trials Centre, London
| | - R Rudd
- St Bartholomew's Hospital, London
| | | | - S Danson
- Weston Park Hospital, Sheffield, UK
| | | | | | - F A Shepherd
- Princess Margaret Hospital/University Health Network, Toronto, Ontario, Canada
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