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Williams IA, Morris PG, Forristal K, Stone J, Gillespie DC. Illness representations of people with later-onset functional seizures. Epilepsy Behav 2024; 152:109666. [PMID: 38382188 DOI: 10.1016/j.yebeh.2024.109666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 01/22/2024] [Accepted: 01/23/2024] [Indexed: 02/23/2024]
Abstract
PURPOSE Although functional seizures can start at any age, little is known about the individuals for whom onset occurs after the age of 40. It has been proposed that health-related traumatic events are more relevant causal factors for people with 'later-onset functional seizures' than for those whose functional seizures begin earlier in life, however, the illness representations of people with later-onset functional seizures have not yet been investigated. This study aimed to understand the experiences and illness representations of people with later-onset functional seizures. METHODS This was a mixed-methods study. People with later-onset functional seizures were recruited via a neurologist's caseload and online membership-led organisations. Semi-structured interview transcripts were analysed using Template Analysis according to the Common-Sense Model (CSM). Self-report measures of demographic and clinical details were collected to characterise the sample and verify themes. RESULTS Eight people with later-onset functional seizures participated in the study. Illness representations relating to all domains of the CSM as well as an additional theme of 'Triggers' were identified. Functional seizures were characterised as a mysterious brain disorder analogous to a computer malfunction and involving involuntary movements associated with alterations in consciousness. Perceptions of duration were indefinite, and triggers were unknown or at the extremes of autonomic arousal. Half of the sample identified health-related events/trauma as causal. Opinions were divided on 'cumulative life stress' as a causal factor. Most perceived themselves to have limited or no control but having 'control' over seizures was conceptualised as different to reducing their likelihood, frequency, or impact. Later-onset functional seizures were viewed as being more detrimental for caring and financial responsibilities but to have advantages for acceptance. CONCLUSIONS This is the first study to assess the illness representations of people with later-onset functional seizures. Many themes were similar to those identified in samples including people with earlier-onset functional seizures. Health-related trauma or events were the most strongly endorsed perceived causal factor, but with the exception of 'consequences', all representations were characterised by uncertainty. Clinicians should hold in mind the interaction between life stage and the consequences of later-onset functional seizures.
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Affiliation(s)
- I A Williams
- Department of Clinical Neurosciences, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK; Department of Clinical and Health Psychology, The University of Edinburgh, Teviot Place, Edinburgh EH8 9AG, UK.
| | - P G Morris
- Department of Clinical and Health Psychology, The University of Edinburgh, Teviot Place, Edinburgh EH8 9AG, UK
| | - K Forristal
- Department of Clinical Neurosciences, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK
| | - J Stone
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh EH16 4SB, UK
| | - D C Gillespie
- Department of Clinical Neurosciences, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK; Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh EH16 4SB, UK
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Dowling GP, Toomey S, Bredin P, Parker I, Mulroe E, Marron J, McLoughlin O, Teiserskiene A, Power C, O'Shea AM, Greally M, Morris PG, Duke D, Hill ADK, Hennessy BT. Neoadjuvant trastuzumab deruxtecan (T-DXd) with response-directed definitive therapy in early stage HER2-positive breast cancer: a phase II study protocol (SHAMROCK study). BMC Cancer 2024; 24:91. [PMID: 38233810 PMCID: PMC10792949 DOI: 10.1186/s12885-024-11851-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 01/06/2024] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND The current standard of care in the neoadjuvant setting for high-risk HER2-positive (HER2 +) breast cancer is to combine systemic chemotherapy with dual HER2 blockade, trastuzumab and pertuzumab. Targeted therapies have significantly improved outcomes for patients with HER2-positive breast cancer. To improve treatment-associated toxicity, chemotherapy-sparing approaches are currently being investigated. Trastuzumab deruxtecan (T-DXd) is an HER2-directed antibody-drug-conjugate (ADC) with promising results in the metastatic setting for HER2-positive breast cancer. The SHAMROCK study investigates neoadjuvant T-DXd in early stage HER2-positive breast cancer, using pathological complete response (pCR) rate as the primary endpoint. METHODS This is a phase II open-label, single arm, adaptive multi-centre trial of T-DXd in the neoadjuvant setting in stage 2-3 HER2-positive breast cancer. Eligible patients will receive 5.4 mg/kg of T-DXd intravenously every 3 weeks for up to 6 cycles. A repeat biopsy will performed after 2 cycles for the RNA disruption index (RDI) score assessment. According to their likelihood of pCR, as determined by the RDI score, patients will either undergo 4 or 6 cycles of T-DXd prior to imaging. Patients with imaging complete response (iCR) after either 4 or 6 cycles will proceed to surgery. Patients who do not achieve iCR will either undergo further systemic therapy or proceed to surgery. DISCUSSION The SHAMROCK study is a chemotherapy-sparing approach to curative intent treatment, investigating neoadjuvant T-DXd. We hypothesise that neoadjuvant T-DXd will have a high pCR rate and be associated low toxicity in early stage HER2-positive breast cancer. TRIAL REGISTRATION EudraCT Number: 2022-002485-32; ClinicalTrials.gov identifier: NCT05710666; Cancer Trials Ireland study number: CTRIAL-IE 22-01.
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Affiliation(s)
- Gavin P Dowling
- Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, 123 St Stephen's Green, Dublin 2, Ireland.
- Beaumont RCSI Cancer Centre, Beaumont Hospital, Dublin, Ireland.
| | - Sinead Toomey
- Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, 123 St Stephen's Green, Dublin 2, Ireland
| | - Philip Bredin
- Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, 123 St Stephen's Green, Dublin 2, Ireland
- Beaumont RCSI Cancer Centre, Beaumont Hospital, Dublin, Ireland
| | | | | | | | | | | | - Colm Power
- Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, 123 St Stephen's Green, Dublin 2, Ireland
- Beaumont RCSI Cancer Centre, Beaumont Hospital, Dublin, Ireland
| | | | - Megan Greally
- Beaumont RCSI Cancer Centre, Beaumont Hospital, Dublin, Ireland
| | - Patrick G Morris
- Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, 123 St Stephen's Green, Dublin 2, Ireland
- Beaumont RCSI Cancer Centre, Beaumont Hospital, Dublin, Ireland
| | - Deirdre Duke
- Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, 123 St Stephen's Green, Dublin 2, Ireland
- Beaumont RCSI Cancer Centre, Beaumont Hospital, Dublin, Ireland
| | - Arnold D K Hill
- Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, 123 St Stephen's Green, Dublin 2, Ireland
- Beaumont RCSI Cancer Centre, Beaumont Hospital, Dublin, Ireland
| | - Bryan T Hennessy
- Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, 123 St Stephen's Green, Dublin 2, Ireland
- Beaumont RCSI Cancer Centre, Beaumont Hospital, Dublin, Ireland
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3
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Pfeiler G, Hlauschek D, Mayer EL, Deutschmann C, Kacerovsky-Strobl S, Martin M, Meisel JL, Zdenkowski N, Loibl S, Balic M, Park H, Prat A, Isaacs C, Bajetta E, Balko JM, Bellet-Ezquerra M, Bliss J, Burstein H, Cardoso F, Fohler H, Foukakis T, Gelmon KA, Goetz M, Haddad TC, Iwata H, Jassem J, Lee SC, Linderholm B, Los M, Mamounas EP, Miller KD, Morris PG, Munzone E, Gal-Yam EN, Ring A, Shepherd L, Singer C, Thomssen C, Tseng LM, Valagussa P, Winer EP, Wolff AC, Zoppoli G, Machacek-Link J, Schurmans C, Huang X, Gauthier E, Fesl C, Dueck AC, DeMichele A, Gnant M. Impact of BMI in Patients With Early Hormone Receptor-Positive Breast Cancer Receiving Endocrine Therapy With or Without Palbociclib in the PALLAS Trial. J Clin Oncol 2023; 41:5118-5130. [PMID: 37556775 DOI: 10.1200/jco.23.00126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 01/20/2023] [Revised: 05/03/2023] [Accepted: 06/21/2023] [Indexed: 08/11/2023] Open
Abstract
PURPOSE BMI affects breast cancer risk and prognosis. In contrast to cytotoxic chemotherapy, CDK4/6 inhibitors are given at a fixed dose, irrespective of BMI or weight. This preplanned analysis of the global randomized PALLAS trial investigates the impact of BMI on the side-effect profile, treatment adherence, and efficacy of palbociclib. METHODS Patients were categorized at baseline according to WHO BMI categories. Neutropenia rates were assessed with univariable and multivariable logistic regression. Time to early discontinuation of palbociclib was analyzed with Fine and Gray competing risk models. Unstratified Cox models were used to investigate the association between BMI category and time to invasive disease-free survival (iDFS). 95% CIs were derived. RESULTS Of 5,698 patients included in this analysis, 68 (1.2%) were underweight, 2,082 (36.5%) normal weight, 1,818 (31.9%) overweight, and 1,730 (30.4%) obese at baseline. In the palbociclib arm, higher BMI was associated with a significant decrease in neutropenia (unadjusted odds ratio for 1-unit change, 0.93; 95% CI, 0.91 to 0.94; adjusted for age, race ethnicity, region, chemotherapy use, and Eastern Cooperative Oncology Group at baseline, 0.93; 95% CI, 0.92 to 0.95). This translated into a significant decrease in treatment discontinuation rate with higher BMI (adjusted hazard ratio [HR] for 10-unit change, 0.75; 95% CI, 0.67 to 0.83). There was no significant improvement in iDFS with the addition of palbociclib to ET in any weight category (normal weight HR, 0.84; 95% CI, 0.63 to 1.12; overweight HR, 1.10; 95% CI, 0.82 to 1.49; and obese HR, 0.95; 95% CI, 0.69 to 1.30) in this analysis early in follow-up (31 months). CONCLUSION This preplanned analysis of the PALLAS trial demonstrates a significant impact of BMI on side effects, dose reductions, early treatment discontinuation, and relative dose intensity. Additional long-term follow-up will further evaluate whether BMI ultimately affects outcome.
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Affiliation(s)
- Georg Pfeiler
- Department of Gynecology and Gynecological Oncology, Medical University of Vienna, Vienna, Austria
| | | | | | - Christine Deutschmann
- Department of Gynecology and Gynecological Oncology, Medical University of Vienna, Vienna, Austria
| | | | - Miguel Martin
- Hospital General Universitario Gregorio Marañón, Universidad Complutense, Madrid, Spain
| | | | | | - Sibylle Loibl
- German Breast Group, Neu-Isenburg, Germany
- Goethe University Frankfurt/M, Frankfurt/M, Germany
- Centre for Haematology and Oncology/Bethanien, Frankfurt/M, Germany
| | - Marija Balic
- Division of Oncology, Department of Internal Medicine, Medical University Graz, Graz, Austria
| | - Haeseong Park
- Siteman Cancer Center, Washington University, St Louis, MO
| | - Aleix Prat
- Department of Medical Oncology, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | | | - Emilio Bajetta
- Gruppo I.T.M.O., Monza, Italy
- Fondazione Policlinico di Monza, Monza, Italy
| | - Justin M Balko
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN
| | | | - Judith Bliss
- The Institute of Cancer Research, London, United Kingdom
| | - Harold Burstein
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Fatima Cardoso
- Breast Unit, Champalimaud Clinical Center/Champalimaud Foundation, Lisbon, Portugal
| | - Hannes Fohler
- Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria
| | - Theodoros Foukakis
- Breast Center, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
- Department of Oncology/Pathology, Karolinska Institute, Stockholm, Sweden
| | | | | | - Tufia C Haddad
- Mayo Clinic College of Medicine and Science, Rochester, MN
| | | | - Jacek Jassem
- Department of Oncology and Radiotherapy, Medical University of Gdańsk, Gdańsk, Poland
| | - Soo-Chin Lee
- Department of Haematology-Oncology, National University Cancer Institute (NCIS), Singapore, Singapore
- Cancer Science Institute (CSI), Singapore, Singapore
- National University of Singapore (NUS), Singapore, Singapore
| | - Barbro Linderholm
- Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Oncology, Institution of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Maartje Los
- St Antonius Ziekenhuis Nieuwegein, Utrecht, the Netherlands
| | | | - Kathy D Miller
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN
| | - Patrick G Morris
- Cancer Trials Ireland, Dublin, Ireland
- Beaumont RCSI Cancer Centre, Dublin, Ireland
| | | | - Einav Nili Gal-Yam
- The Talpiot Medical Leadership Program, Breast Oncology Institute, Sheba Medical Center, Ramat-Gam, Israel
| | - Alistair Ring
- Royal Marsden Hospital, NHS Foundation Trust, London, United Kingdom
| | - Lois Shepherd
- Canadian Cancer Trials Group, Queen's University, Kingston, ON, Canada
| | - Christian Singer
- Department of Gynecology and Gynecological Oncology, Medical University of Vienna, Vienna, Austria
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | | | - Ling-Ming Tseng
- Taipei-Veterans General Hospital, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | | | - Eric P Winer
- Yale Cancer Center, Smilow Cancer Network, Yale University, New Haven, CT
| | | | - Gabriele Zoppoli
- Gruppo Oncologico Italiano di Ricerca Clinica (GOIRC), Università degli Studi di Genova, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | | | | | | | | | - Christian Fesl
- Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria
| | - Amylou C Dueck
- Alliance Statistics and Data Center, Mayo Clinic, Phoenix, AZ
| | | | - Michael Gnant
- Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
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Cosgrove N, Eustace AJ, O'Donovan P, Madden SF, Moran B, Crown J, Moulton B, Morris PG, Grogan L, Breathnach O, Power C, Allen M, Walshe JM, Hill AD, Blümel A, O'Connor D, Das S, Milewska M, Fay J, Kay E, Toomey S, Hennessy BT, Furney SJ. Predictive modelling of response to neoadjuvant therapy in HER2+ breast cancer. NPJ Breast Cancer 2023; 9:72. [PMID: 37758711 PMCID: PMC10533568 DOI: 10.1038/s41523-023-00572-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 07/26/2023] [Indexed: 09/29/2023] Open
Abstract
HER2-positive (HER2+) breast cancer accounts for 20-25% of all breast cancers. Predictive biomarkers of neoadjuvant therapy response are needed to better identify patients with early stage disease who may benefit from tailored treatments in the adjuvant setting. As part of the TCHL phase-II clinical trial (ICORG10-05/NCT01485926) whole exome DNA sequencing was carried out on normal-tumour pairs collected from 22 patients. Here we report predictive modelling of neoadjuvant therapy response using clinicopathological and genomic features of pre-treatment tumour biopsies identified age, estrogen receptor (ER) status and level of immune cell infiltration may together be important for predicting response. Clonal evolution analysis of longitudinally collected tumour samples show subclonal diversity and dynamics are evident with potential therapy resistant subclones detected. The sources of greater pre-treatment immunogenicity associated with a pathological complete response is largely unexplored in HER2+ tumours. However, here we point to the possibility of APOBEC associated mutagenesis, specifically in the ER-neg/HER2+ subtype as a potential mediator of this immunogenic phenotype.
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Affiliation(s)
- Nicola Cosgrove
- Genomic Oncology Research Group, Department of Physiology and Medical Physics, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Alex J Eustace
- School of Biotechnology, National Institute for Cellular Biotechnology, Dublin City University, Dublin, Ireland
| | - Peter O'Donovan
- Genomic Oncology Research Group, Department of Physiology and Medical Physics, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Stephen F Madden
- Data Science Centre, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Bruce Moran
- Conway Institute, University College Dublin, Dublin, Ireland
| | - John Crown
- Department of Medical Oncology, St Vincent's University Hospital, Dublin, Ireland
| | - Brian Moulton
- Clinical Oncology Development Europe, Dublin, Ireland
| | - Patrick G Morris
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
| | - Liam Grogan
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
| | - Oscar Breathnach
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
| | - Colm Power
- Department of Surgery, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Michael Allen
- Department of Surgery, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Janice M Walshe
- Department of Medical Oncology, St Vincent's University Hospital, Dublin, Ireland
| | - Arnold D Hill
- Department of Surgery, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Anna Blümel
- School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Darren O'Connor
- School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Sudipto Das
- School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Małgorzata Milewska
- Medical Oncology Group, Department of Molecular Medicine, Royal College of Surgeons in Ireland, Dublin, 9, Ireland
| | - Joanna Fay
- RCSI Biobank Service, RCSI University of Medicine and Health Sciences, Beaumont Hospital, Dublin, 9, Ireland
| | - Elaine Kay
- Department of Pathology, RCSI University of Medicine and Health Sciences, Beaumont Hospital, Dublin, 9, Ireland
| | - Sinead Toomey
- Medical Oncology Group, Department of Molecular Medicine, Royal College of Surgeons in Ireland, Dublin, 9, Ireland
| | - Bryan T Hennessy
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland.
- Medical Oncology Group, Department of Molecular Medicine, Royal College of Surgeons in Ireland, Dublin, 9, Ireland.
| | - Simon J Furney
- Genomic Oncology Research Group, Department of Physiology and Medical Physics, RCSI University of Medicine and Health Sciences, Dublin, Ireland.
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Conlon E, Fitzgerald C, Hintze J, Elhassan EAE, Sexton DJ, O'Leary E, O'Kelly P, O'Neill JO, Egan J, Houlihan DD, Murray D, McCormick PA, Morris PG, Raghallaigh SN, Little D, Conlon PJ, Moloney FJ, O'Neill JP. High frequency and mortality of head and neck malignancy in organ transplant recipients in Ireland - A national cohort study. Am J Otolaryngol 2023; 44:103827. [PMID: 36933332 DOI: 10.1016/j.amjoto.2023.103827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 02/26/2023] [Indexed: 03/11/2023]
Abstract
BACKGROUND Solid organ transplant recipients are recognized to carry a high burden of malignancy and frequently this cancer develops in the head and neck region. Furthermore, cancer of the head and neck post-transplant carries a significantly increased mortality. In this study, we aim to conduct a national retrospective cohort study to investigate the impact of head and neck cancer in terms of frequency and mortality in a large group of solid organ transplant recipients over a 20 year time span and compare the mortality in transplant patients to non-transplant patients with head and neck cancer. METHODS Patients in the Republic of Ireland who underwent solid organ transplantation between 1994 and 2014 who developed post-transplant head and neck malignancy were identified from the records of two prospective, national databases (National Cancer Registry of Ireland (NCRI) and The Irish Transplant Cancer Group database) working in conjunction with each other. Incidence of head and neck malignancy post-transplant was compared with the general population by means of standardised incidence ratios (SIR). Cumulative incidence of all cause and cancer related mortality from head and neck keratinocytic was undertaken by a competing risks analysis. RESULTS A total of 3346 solid organ transplant recipients were identified, 2382 (71.2 %) kidney, 562 (16.8 %) liver, 214 (6.4 %) cardiac and 188 (5.6 %) lung. During the period of follow up of 428 patients developed head and neck cancer, representing (12.8 %) of the population. 97 % of these patients developed keratinocytic cancers, specifically, of head and neck. The frequency of post-transplant head and neck cancer was related to the duration of immunosuppression with 14 % of patients developing cancer at 10 years and 20 % having developed at least one cancer by 15 years. 12 (3 %) patients developed non-cutaneous head and neck malignancy. 10 (0.3 %) patients died due to head and neck keratinocytic malignancy post-transplant. Competing risk analysis demonstrated that organ transplantation conferred a strong independent effect of death, compared to non-transplant patients with head and neck keratinocytes. This applied specifically for kidney (HR 4.4, 95 % CI 2.5-7.8) and heart transplants (HR 6.5, 95 % CI 2.1-19.9), and overall, across the four transplant categories (P < 0.001). The SIR of developing keratinocyte cancer varied based on primary tumor site, gender, and type of transplant organ. CONCLUSION Transplant patients demonstrate a particularly high rate of head and neck keratinocyte cancer with a very high rate of associated mortality. Physicians should be cognizant of the increased rate of malignancy in this population and monitor for red flag signs/symptoms.
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Affiliation(s)
- Eoin Conlon
- Department of Otolaryngology, Head and Neck Surgery, Beaumont Hospital & The Royal College of Surgeons in Ireland, Dublin, Ireland.
| | - Conall Fitzgerald
- Department of Otolaryngology, Head and Neck Surgery, Beaumont Hospital & The Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Justin Hintze
- Department of Otolaryngology, Head and Neck Surgery, Beaumont Hospital & The Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Elhussein A E Elhassan
- Royal College of Surgeons in Ireland, Dublin, Ireland; Department of Transplant Urology and Nephrology, National Kidney Transplant Service, Beaumont Hospital Dublin, Dublin, Ireland
| | - Donal J Sexton
- Department of Transplant Urology and Nephrology, National Kidney Transplant Service, Beaumont Hospital Dublin, Dublin, Ireland
| | | | - Patrick O'Kelly
- Department of Transplant Urology and Nephrology, National Kidney Transplant Service, Beaumont Hospital Dublin, Dublin, Ireland
| | - Jim O O'Neill
- National Heart Transplant Center, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Jim Egan
- National Lung Transplantation Center, Mater Misericordiae University Hospital Dublin, Ireland
| | - Diarmaid D Houlihan
- National Liver Transplant Center, St Vincent's University Hospital, Dublin, Ireland
| | | | - P Aiden McCormick
- National Liver Transplant Center, St Vincent's University Hospital, Dublin, Ireland
| | - Patrick G Morris
- Royal College of Surgeons in Ireland, Dublin, Ireland; Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
| | | | - Dilly Little
- Department of Transplant Urology and Nephrology, National Kidney Transplant Service, Beaumont Hospital Dublin, Dublin, Ireland
| | - Peter J Conlon
- Royal College of Surgeons in Ireland, Dublin, Ireland; Department of Transplant Urology and Nephrology, National Kidney Transplant Service, Beaumont Hospital Dublin, Dublin, Ireland
| | - Fergal J Moloney
- Department of Dermatology, School of Medicine, Mater Misericordiae University Hospital, University College Dublin, Dublin, Ireland
| | - James Paul O'Neill
- Department of Otolaryngology, Head and Neck Surgery, Beaumont Hospital & The Royal College of Surgeons in Ireland, Dublin, Ireland; Royal College of Surgeons in Ireland, Dublin, Ireland
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6
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Kunitake JA, Sudilovsky D, Johnson LM, Loh HC, Choi S, Morris PG, Jochelson MS, Iyengar NM, Morrow M, Masic A, Fischbach C, Estroff LA. Biomineralogical signatures of breast microcalcifications. Sci Adv 2023; 9:eade3152. [PMID: 36812311 PMCID: PMC9946357 DOI: 10.1126/sciadv.ade3152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Microcalcifications, primarily biogenic apatite, occur in cancerous and benign breast pathologies and are key mammographic indicators. Outside the clinic, numerous microcalcification compositional metrics (e.g., carbonate and metal content) are linked to malignancy, yet microcalcification formation is dependent on microenvironmental conditions, which are notoriously heterogeneous in breast cancer. We interrogate multiscale heterogeneity in 93 calcifications from 21 breast cancer patients using an omics-inspired approach: For each microcalcification, we define a "biomineralogical signature" combining metrics derived from Raman microscopy and energy-dispersive spectroscopy. We observe that (i) calcifications cluster into physiologically relevant groups reflecting tissue type and local malignancy; (ii) carbonate content exhibits substantial intratumor heterogeneity; (iii) trace metals including zinc, iron, and aluminum are enhanced in malignant-localized calcifications; and (iv) the lipid-to-protein ratio within calcifications is lower in patients with poor composite outcome, suggesting that there is potential clinical value in expanding research on calcification diagnostic metrics to include "mineral-entrapped" organic matrix.
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Affiliation(s)
| | - Daniel Sudilovsky
- Department of Pathology and Laboratory Medicine, Cayuga Medical Center at Ithaca, Ithaca, NY 14850, USA
- Pathology Department, Kingman Regional Medical Center, Kingman, AZ 86409, USA
- Pathology Department, Western Arizona Medical Center, Bullhead City, AZ 86442, USA
- Pathology Department, Yuma Regional Medical Center, Yuma, AZ 85364, USA
| | - Lynn M. Johnson
- Cornell Statistical Consulting Unit, Cornell University, Ithaca, NY 14850, USA
| | - Hyun-Chae Loh
- Department of Civil and Environmental Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Siyoung Choi
- Nancy E. and Peter C. Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY 14850, USA
| | - Patrick G. Morris
- Medical Oncology Service, Beaumont Hospital, Dublin, Ireland
- Breast Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center/Evelyn H. Lauder Breast and Imaging Center, New York, NY 10065, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY 10021, USA
| | - Maxine S. Jochelson
- Department of Radiology, Memorial Sloan Kettering Cancer Center/Evelyn H. Lauder Breast and Imaging Center, New York, NY 10065, USA
| | - Neil M. Iyengar
- Department of Medicine, Weill Cornell Medical College, New York, NY 10021, USA
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Monica Morrow
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Admir Masic
- Department of Civil and Environmental Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
- Corresponding author. (L.A.E.); (C.F.); (A.M.)
| | - Claudia Fischbach
- Nancy E. and Peter C. Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY 14850, USA
- Kavli Institute at Cornell for Nanoscale Science, Cornell University, Ithaca, NY 14850, USA
- Corresponding author. (L.A.E.); (C.F.); (A.M.)
| | - Lara A. Estroff
- Department of Materials Science and Engineering, Cornell University, Ithaca, NY 14850, USA
- Kavli Institute at Cornell for Nanoscale Science, Cornell University, Ithaca, NY 14850, USA
- Corresponding author. (L.A.E.); (C.F.); (A.M.)
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Rashed A, Fitzpatrick OM, Easty DJ, Coyne Z, Collins D, Mallet V, Milewski M, Egan K, Breathnach OS, Grogan L, Hennessy BT, Morris PG. An observational study of dose dense chemotherapy with lipegfilgrastim support in early breast cancer. BMC Cancer 2023; 23:171. [PMID: 36803350 PMCID: PMC9942277 DOI: 10.1186/s12885-023-10603-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 02/02/2023] [Indexed: 02/22/2023] Open
Abstract
PURPOSE Breast cancer is one of the most prevalent malignant diseases in women. The development of dose dense chemotherapy regimens has improved clinical outcomes but has been associated with increased hematological toxicity. Currently there is a paucity of data on the use of lipegfilgrastim in dose dense AC treatment in early breast cancer. The purpose of this study was to assess the use of lipegfilgrastim in the treatment of early breast cancer and to examine the incidence of treatment-related neutropenia during the dose dense AC phase and subsequent paclitaxel treatment. METHODS This was a single arm, non-interventional, prospective study. The primary endpoint was to determine the rate of neutropenia defined as ANC of < 1.0 × 109/L, during four cycles of dose dense AC with lipegfilgrastim support. The secondary endpoints were the incidence of febrile neutropenia, (temperature > 38 °C and ANC < 1.0 × 109/L), treatment delays, premature treatment cessation and toxicity. RESULTS Forty-one participants were included in the study. Of the 160 planned dose dense AC treatments, 157 were administered, and 95% (152/160) of these were given on time. The rate of treatment delay was 5% (95% CI 2.2 to 9.9%) due to infection (4) and mucositis (1). Four (10%) patients developed febrile neutropenia. The most frequently occurring adverse event was grade 1 bone pain. CONCLUSION Lipegfilgrastim is an effective option in the prophylaxis of chemotherapy-induced neutropenia, and its use in everyday anti-cancer treatment can be considered.
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Affiliation(s)
- Ahmed Rashed
- grid.414315.60000 0004 0617 6058Medical Oncology Department, Beaumont Hospital, Dublin, Ireland ,grid.4912.e0000 0004 0488 7120Cancer Clinical Trials and Research Unit, Beaumont RCSI Cancer Centre, Dublin, Ireland ,grid.417310.00000 0004 0617 7384Medical Oncology Department, Our Lady of Lourdes Hospital, Drogheda, Co. Louth Ireland
| | - Orla M Fitzpatrick
- Medical Oncology Department, Beaumont Hospital, Dublin, Ireland. .,Cancer Clinical Trials and Research Unit, Beaumont RCSI Cancer Centre, Dublin, Ireland.
| | - David J Easty
- grid.417310.00000 0004 0617 7384Medical Oncology Department, Our Lady of Lourdes Hospital, Drogheda, Co. Louth Ireland
| | - Zac Coyne
- grid.414315.60000 0004 0617 6058Medical Oncology Department, Beaumont Hospital, Dublin, Ireland ,grid.4912.e0000 0004 0488 7120Cancer Clinical Trials and Research Unit, Beaumont RCSI Cancer Centre, Dublin, Ireland
| | - Dearbhaile Collins
- grid.414315.60000 0004 0617 6058Medical Oncology Department, Beaumont Hospital, Dublin, Ireland ,grid.4912.e0000 0004 0488 7120Cancer Clinical Trials and Research Unit, Beaumont RCSI Cancer Centre, Dublin, Ireland
| | - Victoria Mallet
- grid.4912.e0000 0004 0488 7120Cancer Clinical Trials and Research Unit, Beaumont RCSI Cancer Centre, Dublin, Ireland
| | - Maciej Milewski
- grid.4912.e0000 0004 0488 7120Cancer Clinical Trials and Research Unit, Beaumont RCSI Cancer Centre, Dublin, Ireland
| | - Keith Egan
- grid.4912.e0000 0004 0488 7120Cancer Clinical Trials and Research Unit, Beaumont RCSI Cancer Centre, Dublin, Ireland
| | - Oscar S Breathnach
- grid.414315.60000 0004 0617 6058Medical Oncology Department, Beaumont Hospital, Dublin, Ireland ,grid.4912.e0000 0004 0488 7120Cancer Clinical Trials and Research Unit, Beaumont RCSI Cancer Centre, Dublin, Ireland
| | - Liam Grogan
- grid.414315.60000 0004 0617 6058Medical Oncology Department, Beaumont Hospital, Dublin, Ireland ,grid.4912.e0000 0004 0488 7120Cancer Clinical Trials and Research Unit, Beaumont RCSI Cancer Centre, Dublin, Ireland
| | - Bryan T Hennessy
- grid.414315.60000 0004 0617 6058Medical Oncology Department, Beaumont Hospital, Dublin, Ireland ,grid.4912.e0000 0004 0488 7120Cancer Clinical Trials and Research Unit, Beaumont RCSI Cancer Centre, Dublin, Ireland ,grid.417310.00000 0004 0617 7384Medical Oncology Department, Our Lady of Lourdes Hospital, Drogheda, Co. Louth Ireland
| | - Patrick G Morris
- grid.414315.60000 0004 0617 6058Medical Oncology Department, Beaumont Hospital, Dublin, Ireland ,grid.4912.e0000 0004 0488 7120Cancer Clinical Trials and Research Unit, Beaumont RCSI Cancer Centre, Dublin, Ireland ,grid.417310.00000 0004 0617 7384Medical Oncology Department, Our Lady of Lourdes Hospital, Drogheda, Co. Louth Ireland
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8
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Fitzpatrick OM, Murphy C, Duignan E, Egan K, Hennessy BT, Grogan L, Murphy A, Breathnach OS, Naidoo J, Morris PG. Correction to: The cost of cancer care: how far would you go for a trial? Ir J Med Sci 2023; 192:357. [PMID: 35150383 PMCID: PMC10074517 DOI: 10.1007/s11845-022-02950-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Orla M Fitzpatrick
- Cancer Clinical Trials and Research Unit, Medical Oncology Department, Beaumont RCSI Cancer Centre, Beaumont Hospital, Dublin, Ireland.
| | - Catherine Murphy
- Cancer Clinical Trials and Research Unit, Medical Oncology Department, Beaumont RCSI Cancer Centre, Beaumont Hospital, Dublin, Ireland
| | - Erica Duignan
- Cancer Clinical Trials and Research Unit, Medical Oncology Department, Beaumont RCSI Cancer Centre, Beaumont Hospital, Dublin, Ireland
| | - Keith Egan
- Cancer Clinical Trials and Research Unit, Medical Oncology Department, Beaumont RCSI Cancer Centre, Beaumont Hospital, Dublin, Ireland
| | - Bryan T Hennessy
- Cancer Clinical Trials and Research Unit, Medical Oncology Department, Beaumont RCSI Cancer Centre, Beaumont Hospital, Dublin, Ireland
| | - Liam Grogan
- Cancer Clinical Trials and Research Unit, Medical Oncology Department, Beaumont RCSI Cancer Centre, Beaumont Hospital, Dublin, Ireland
| | - Adrian Murphy
- Cancer Clinical Trials and Research Unit, Medical Oncology Department, Beaumont RCSI Cancer Centre, Beaumont Hospital, Dublin, Ireland
| | - Oscar S Breathnach
- Cancer Clinical Trials and Research Unit, Medical Oncology Department, Beaumont RCSI Cancer Centre, Beaumont Hospital, Dublin, Ireland
| | - Jarushka Naidoo
- Cancer Clinical Trials and Research Unit, Medical Oncology Department, Beaumont RCSI Cancer Centre, Beaumont Hospital, Dublin, Ireland
| | - Patrick G Morris
- Cancer Clinical Trials and Research Unit, Medical Oncology Department, Beaumont RCSI Cancer Centre, Beaumont Hospital, Dublin, Ireland
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Mc Laughlin RA, Almeraikhi M, Alkaabi H, Bligh F, Cluxton C, Mcmahon D, Fitzpatrick O, Conroy MR, Hennessy BT, O'Neill B, Naidoo J, Breathnach OS, Grogan W, Murphy AG, Morris PG. Neoadjuvant chemoradiation in elderly Irish patients with esophageal cancer: A review of the clinical outcomes and toxicity. J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.4_suppl.335] [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: 01/25/2023] Open
Abstract
335 Background: In locally advanced esophageal cancer, neoadjuvant chemo-radiotherapy improves survival compared with surgery alone. In the Chemo-Radiotherapy for Oesophageal cancer followed by Surgery Study (CROSS), the median age was 60. However, 1/3 of patients diagnosed with esophageal cancer are over 70 years. The CROSS outcomes are therefore limited in its application to older patients. The objective of this study is to report and compare the outcomes and tolerability in elderly patients (≥70 years), who underwent neoadjuvant chemo-radiation for esophageal cancer with younger patients < 70 years. Methods: A retrospective analysis of patients treated with neoadjuvant chemo-radiation for esophageal cancer between 1st January 2015 and 1st January 2021 was completed. Baseline characteristics and haematological toxicities were reported. Pathological response was reported. Survival was estimated using the Kaplan-Meier method. Results: In total 105 patients were included; 35 (33%) were ≥ 70 years and 70 (67%) patients were < 70 years. In the elderly cohort, the median age was 75 (70-86) and the younger cohort median age was 60 (29-69). 73% of patients in each cohort were male. 31 (89%) of older adults experienced any grade of anaemia compared with 45 (64%) of the younger cohort. Only one patient experienced ≥ grade 3 anaemia in each cohort. 18(51%) and 33(47%) of older and younger patients respectively experienced any grade of neutropenia. 5(14%) older and 7(10%) younger patients experienced ≥ grade 3 neutropenia. 15(43%) and 43(61%) of older and younger patients experienced any grade of thrombocytopenia. No patients experienced ≥ grade 3 thrombocytopenia. 80% of the older and 86% of the younger cohort proceeded to surgery. 3(11%) and 17(29%) of the older and younger cohorts respectively who underwent surgery achieved a complete pathological response. There was no difference in overall survival (OS) between the cohorts (p=0.48). There was also no difference in progression free survival (PFS) between the cohorts. Conclusions: In conclusion, we confirm that neoadjuvant chemo-radiation is tolerable in patients ≥ 70 when compared with patients < 70 years. Both OS and PFS is similar in both cohorts. We recommend the use of neoadjuvant therapy in appropriately selected patients ≥ 70 years.
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Affiliation(s)
| | - Majid Almeraikhi
- School of Medicine Royal College of Surgeons Ireland, Dublin, Ireland
| | - Humaid Alkaabi
- School of Medicine Royal College of Surgeons Ireland, Dublin, Ireland
| | - Fianait Bligh
- School of Medicine Royal College of Surgeons Ireland, Dublin, Ireland
| | | | | | | | | | | | - Brian O'Neill
- St. Luke's Radiation Oncology Network, Dublin, Ireland
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Mc Laughlin RA, Devoy C, moloney C, Bennett K, Mcmahon D, Conroy MR, Fitzpatrick O, Egan K, Grogan W, Breathnach OS, Morris PG, Murphy AG, Naidoo J, Tangney M, Hennessy BT. A prospective translational study investigating the association of gut microbiome (GM) diversity with pathological complete response (pCR) after neoadjuvant treatment in early stage rectal and esophageal cancers. J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.4_suppl.tps819] [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: 01/25/2023] Open
Abstract
TPS819 Background: The gut microbiome (GM) is thought to influence host immunity by modulating multiple immunologic pathways. Studies have suggested that dysbiosis of the GM confers a predisposition to certain malignancies and influences response to immune checkpoint inhibitors. However, little is known about how the GM diversity influences complete pathological response to neoadjuvant therapy in gastrointestinal (GI) tumours. We hypothesize that a more diverse GM constitution at baseline will lead to improved pathological response at the time of definitive surgery. Methods: We designed a cross-institutional multi-center translational study investigating the impact of the GM diversity on the efficacy of neoadjuvant therapy in GI cancers by assessing its association with pathological response. The study population will consist of patients with an early-stage rectal or esophageal cancer due to commence neoadjuvant therapy (including chemotherapy and chemoradiation) and planned for definitive surgery. Patients who received prior chemotherapy/monoclonal antibodies/immune checkpoint inhibitors or radiation will be excluded. The study assessments will include fecal sampling of the GM prior to neoadjuvant therapy, upon completion and again six months post completion of therapy. Fecal samples will be analysed by 16S RNA sequencing. Pathological response will be examined at time of surgery and patients will be classified as responders (complete pathological response) or non-responders. The primary endpoint of the study is to examine the association between the GM diversity and pathological response. 120 patients will be recruited over 18 months. Results: Species richness (Alpha Diversity) will be analysed using the Shannon diversity index and Jaccard similarity index to calculate beta diversity. Classification and clustering analysis will be performed with Principal Component Analysis (PCA) and Random Forest analysis. Comparison of taxa or functions between clinical cohorts will be performed using the two tailed Z test and corrected using the false discovery rate to determine Q-values. The association between GM and complete pathological response will be examined using logistic regression analysis adjusting for potential confounding factors. Adjusted odds ratios (OR) and 95% confidence intervals will be presented. Conclusions: This study will show preliminary insights into the role of GM as a potential biomarker for neoadjuvant therapy efficacy in patients with GI cancers. Recruitment is on-going.
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Affiliation(s)
| | | | | | - Kathleen Bennett
- Department of Data Science, Royal College of Surgeons of Ireland, Dublin, Ireland
| | | | | | | | - Keith Egan
- Beaumont RCSI Cancer Centre, Dublin, Ireland
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11
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Cronin C, McLaughlin R, Lane L, Brett FM, Jansen M, Bermingham N, Wyse G, Grogan L, Morris PG, O’Reilly S. Case report: BRAF-inhibitor therapy in BRAF-mutated primary CNS tumours including one case of BRAF-mutated Rosai-Dorfman disease. Front Med (Lausanne) 2022; 9:1070828. [PMID: 36619621 PMCID: PMC9813211 DOI: 10.3389/fmed.2022.1070828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 11/29/2022] [Indexed: 12/24/2022] Open
Abstract
BRAF V600E oncogene mutations have been reported in multiple central nervous system (CNS) tumor types, and emerging evidence supports the use of targeted therapy in BRAF-mutated gliomas. BRAF oncogene mutations have been recently identified in Rosai-Dorfman disease (RDD)-a rare non-Langerhans cell histiocytosis. This series describes three patients from two neurosurgical centers in Ireland with BRAF V600E-mutated CNS tumors. The study participants include a 19-year-old male patient with ganglioglioma with anaplastic features, a 21-year-old male patient with CNS involvement of RDD, and a 28-year-old female patient with ganglioglioma with anaplastic features. Two patients received radiation with concurrent temozolomide before BRAF-targeted therapy. This case series describes clinical and radiological responses to BRAF-targeted therapy in BRAF V600E-mutated gliomas across multiple tumor grades and is only the second published report of response to targeted therapy in BRAF-mutated RDD. The durability of disease control with BRAF-targeted therapy was generally superior to that achieved with chemoradiation; one patient has experienced ongoing disease control for 5 years. The reported case of treatment response in BRAF-mutated RDD supports the strategy of genotyping and utilization of targeted therapy in this rare disease. The optimal sequencing of BRAF-targeted therapy in BRAF-mutated gliomas/glioneuronal tumors remains unclear, and further prospective studies are required to guide the use of genome-matched therapy in this patient population.
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Affiliation(s)
- Christopher Cronin
- 1Department of Medical Oncology, Cork University Hospital, Cork, Ireland,*Correspondence: Christopher Cronin,
| | - Ronan McLaughlin
- 2Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
| | - Louise Lane
- 3Department of Neuropathology, Beaumont Hospital, Dublin, Ireland
| | | | - Michael Jansen
- 4Department of Neuropathology, Cork University Hospital, Cork, Ireland
| | - Niamh Bermingham
- 4Department of Neuropathology, Cork University Hospital, Cork, Ireland
| | - Gerald Wyse
- 5Department of Radiology, Cork University Hospital, Cork, Ireland
| | - Liam Grogan
- 2Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
| | | | - Seamus O’Reilly
- 1Department of Medical Oncology, Cork University Hospital, Cork, Ireland
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12
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Mcmahon D, Hussein A, Mangleburg H, Nichianain A, Fitzpatrick O, McLaughlin RA, Conroy MR, Marks SJ, Naidoo J, Grogan W, Murphy AG, Breathnach OS, Hennessy BT, Morris PG. Toxicity of concurrent and adjuvant temozolomide in patients with glioblastoma multiforme (GBM). J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e14037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e14037 Background: (MGMT) promotor is prognostic and predictive of temozolomide (TMZ) benefit in newly diagnosed GBM. It has been suggested that MGMT methylation is associated with TMZ toxicity in some cancers such as melanoma but is not clearly defined in GBM. Methods: To investigate this, a retrospective electronic chart review of patients (pts) with resected GBM in a tertiary neurosurgical referral center from 1 July 2017 – 31 Dec 2020 was conducted. Hematological toxicities during TMZ with RT (concurrent) and subsequent TMZ (adjuvant) were assessed and graded by CTCAE V5.0. Toxicity was compared by MGMT methylation status. Results: In a 3.5 year period, 417 GBM resections were performed. Of these, 186 (45%) patients received at least 1 dose of TMZ in our institution: 180 pts received concurrent TMZ, 6 pts received adjuvant only. MGMT was methylated, unmethylated and unknown in 72, 97 and 17 pts respectively. In the concurrent and adjuvant phases respectively, thrombocytopenia incidence was 20%(N=14) and 52%(N=25) in the methylated group and 15%(N=15) and 51%(N=37) in the unmethylated group. In the adjuvant phase, incidence of ≥ grade 3 thrombocytopenia was 8%(N=4), in the methylated patients and 9%(N=7) for those unmethylated. Neutropenia incidence was low in the concurrent phase, however in the adjuvant phase was 29%(N=14) in the methylated group and 23%(N=17) in the unmethylated group. ≥G3 incidence was 10%(N=5) and 3%(N=2) respectively. Conclusions: In this retrospective study, a higher incidence of hematological toxicity was not seen in pts with MGMT methylated tumors. Methylation of the DNA repair enzyme O(6)-methylguanine-DNA methyltransferase.[Table: see text]
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Affiliation(s)
| | | | | | | | | | | | | | | | - Jarushka Naidoo
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | - William Grogan
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
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13
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Ryan DJ, Toomey S, Smyth R, Madden SF, Workman J, Cummins R, Sheehan K, Fay J, Naidoo J, Breathnach OS, Morris PG, Grogan L, O'Brien ME, Sulaiman I, Hennessy BT, Morgan RK. Exhaled Breath Condensate (EBC) analysis of circulating tumour DNA (ctDNA) using a lung cancer specific UltraSEEK oncogene panel. Lung Cancer 2022; 168:67-73. [DOI: 10.1016/j.lungcan.2022.04.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 04/26/2022] [Accepted: 04/29/2022] [Indexed: 10/18/2022]
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14
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Prior L, Keegan NM, Furney SJ, Walshe JM, Gullo G, Crown J, Kennedy MJ, Smith D, McCaffrey J, Kelly CM, Egan K, Kerr J, Given M, Sheehy N, O'Donovan P, Hernando A, Teiserskiene A, Parker I, Kay E, McDermott R, Keane MM, O'Reilly S, Grogan L, Breathnach O, Morris PG, Toomey S, Hennessy BT. Abstract P5-16-08: Phase Ib/II trial evaluating safety and efficacy of copanlisib (PI3K inhibitor) and trastuzumab in pre-treated advanced HER2-positive breast cancer: Results from the PantHER study. Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-p5-16-08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: De novo and acquired resistance to HER2 directed therapy is frequently encountered. Upregulation of the phosphatidylinositol-3-kinase (PI3K) pathway is an important mediator of treatment resistance. This can occur through an activating mutation of the PIK3CA gene or PTEN loss. PIK3CA mutations are present in approximately 20% of HER2 positive breast cancers and as such, the PI3K pathway has emerged as an attractive target for restoring sensitivity to HER2 directed therapy. Methods: We performed a single arm, multicentre, open label Phase Ib/II trial. Patients (pts) with advanced HER2-positive breast cancer whose disease had progressed on at least 1 line of Trastuzumab/T-DM1 based treatment in the metastatic setting were eligible if they met following criteria: ECOG PS ≤ 2 and adequate organ function. Pts with treated, controlled brain metastases were permitted to enrol. Exclusion criteria included uncontrolled hypertension or diabetes mellitus. Pts on Phase IB were treated according to a 6+6 study design with a dose escalation schedule of Copanlisib IV (level 1 = 45mg, level 2 = 60mg) on Day 1, 8 and 15 of a 28-day cycle along with a fixed dose of Trastuzumab 2mg/kg weekly. Phase II treatment was the MTD (maximum tolerated dose) of Copanlisib in combination with Trastuzumab. Archival tumour tissue, voluntary biopsies and serial plasma samples were collected for genomic sequencing. Primary endpoints were MTD (Phase I) and clinical benefit rate (CBR) which was defined as complete response (CR) or partial response (PR) at any time point; or stable disease (SD) lasting at least 24 weeks (Phase II). Secondary endpoints included safety and tolerability, tumor response rate, duration of response, time to treatment failure (TTF) and progression free (PFS) and overall survival (OS). Results: Twelve pts were enrolled in Phase IB. No dose limiting toxicity was observed. The MTD was established as Copanlisib 60mg and Trastuzumab 2mg/kg. Fourteen pts were enrolled in Phase II (6 pts treated at the MTD in Phase IB were included in the final Phase II analysis resulting in a total of 20 pts). The median number of lines of prior treatment in the metastatic setting was 3 (1-8). The most common grade 3-4 toxicities encountered in the Phase Ib/II cohorts included hypertension (n=7, 27%), hyperglycaemia (n=2, 8%) and vomiting (n=2, 8%). Three pts discontinued treatment due to toxicity. The median follow-up for the Phase II cohort was 7.5 months (95% CI 6.0-14.5). PR was observed in 4 pts (20%) and SD (at any time point) was seen in 8 pts (40%). The CBR was 30% (n=6). The duration of response was 15.0 weeks (95% CI 4.9 - 16.1). The median TTF was 11.9 weeks (95% CI 7.5 - 21.1). The median PFS was 3.0 mo (95% CI 0.2 - 5.8) and OS was 14.0 mo (95% CI 5.2-22.8). At the time of analysis, 9 of 20 patients were alive. PIK3CA mutations were detectable in the archival tissue of 11 of 26 pts (42%). PIK3CA hotspot mutations (H1047R, E542K and E545K) were detectable in the plasma of all 26 pts at various points throughout treatment. Pre and post treatment biopsies of 2 pts in the Phase IB trial revealed somatic mutations in DNAH3 and TRRAP, the latter of which encodes a PI3K-like protein kinase. Targeted next generation sequencing was performed on the circulating tumour DNA of 20 pts in the Phase II cohort taken before, during and after treatment to further validate these findings and to assess for other mechanisms of response or resistance. The final translational results will be presented at the meeting. Conclusions: The combination of Copanlisib and Trastuzumab is a safe and tolerable regimen and is associated with clinical efficacy in a heavily pre-treated metastatic HER2-positive breast cancer population. Translational studies may have identified novel resistance biomarkers in this pt cohort.
Citation Format: Lisa Prior, Niamh M Keegan, Simon J Furney, Janice M Walshe, Giuseppe Gullo, John Crown, M John Kennedy, Diarmuid Smith, John McCaffrey, Catherine M Kelly, Keith Egan, Jennifer Kerr, Mark Given, Niall Sheehy, Peter O'Donovan, Andres Hernando, Ausra Teiserskiene, Imelda Parker, Elaine Kay, Ray McDermott, Maccon M Keane, Seamus O'Reilly, Liam Grogan, Oscar Breathnach, Patrick G Morris, Sinead Toomey, Bryan T Hennessy. Phase Ib/II trial evaluating safety and efficacy of copanlisib (PI3K inhibitor) and trastuzumab in pre-treated advanced HER2-positive breast cancer: Results from the PantHER study [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P5-16-08.
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Affiliation(s)
- Lisa Prior
- Department of Molecular Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Niamh M Keegan
- Department of Molecular Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Simon J Furney
- Genomic Oncology Research Group, Department of Physiology & Medical Physics, Centre for Systems Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Janice M Walshe
- Department of Medical Oncology, St Vincent's University Hospital, Dublin, Ireland
| | - Giuseppe Gullo
- Department of Medical Oncology, St Vincent's University Hospital, Dublin, Ireland
| | - John Crown
- Department of Medical Oncology, St Vincent's University Hospital, Dublin, Ireland
| | - M John Kennedy
- Department of Medical Oncology, St James's Hospital, Dublin, Ireland
| | - Diarmuid Smith
- Department of Endocrinology, Beaumont Hospital, Dublin, Ireland
| | - John McCaffrey
- Department of Medical Oncology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Catherine M Kelly
- Department of Medical Oncology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Keith Egan
- Cancer Clinical Trials & Research Unit, Beaumont Hospital, Dublin, Ireland
| | - Jennifer Kerr
- Department of Radiology, Beaumont Hospital, Dublin, Ireland
| | - Mark Given
- Department of Radiology, Beaumont Hospital, Dublin, Ireland
| | - Niall Sheehy
- Department of Radiology, St James’s Hospital, Dublin, Ireland
| | - Peter O'Donovan
- Genomic Oncology Research Group, Department of Physiology & Medical Physics, Centre for Systems Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | | | | | - Elaine Kay
- Department of Pathology, Beaumont Hospital, Dublin, Ireland
| | | | - Maccon M Keane
- Department of Medical Oncology, Galway University Hospital, Galway, Ireland
| | - Seamus O'Reilly
- Department of Medical Oncology, Cork University Hospital, Cork, Ireland
| | - Liam Grogan
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
| | - Oscar Breathnach
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
| | - Patrick G Morris
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
| | - Sinead Toomey
- Department of Molecular Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Bryan T Hennessy
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
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15
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Hennessy MA, Coyne ZL, O'Halloran PJ, Mullally W, Dablouk M, MacNally S, Morris PG. Prognostic factors influencing survival following re-resection for isocitrate dehydrogenase (IDH) -wildtype glioblastoma multiforme - Data from a national neuro-oncology registry. J Clin Neurosci 2021; 95:142-150. [PMID: 34929638 DOI: 10.1016/j.jocn.2021.12.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 11/25/2021] [Accepted: 12/07/2021] [Indexed: 11/26/2022]
Abstract
The role of surgical resection in recurrent Glioblastoma Multiforme (GBM) remains unclear. We aimed to investigate survival outcomes and associated prognostic factors in patients undergoing surgical re-resection for recurrent IDH-wildtype GBM in a national neuro-oncology center. We evaluated all patients who underwent re-resection for recurrent GBM following adjuvant treatment between 2015 and 2018. 32 patients were eligible for inclusion. 19 (59%) were male,median age at re-resection was 53. Median time from initial surgery to re-resection was 13.5 months. Median overall survival (OS) was 28.6 months from initial surgery and 9.5 months from re-resection. MGMT methylation was significantly associated with improved OS from initial surgery, 40 months versus 19.1 months, (p = 0.004), and from re-resection, 9.47 months versus 6.93 months, (p = 0.028). A late re-resection was associated with improved OS compared to an early re-resection, 44.1 months versus 15.7 months, (p = 0.002). There was a trend for improved outcomes in younger patients, median OS from initial surgery 44.1 months for <53 years compared to 21.7 months for patients ≥53, (p = 0.099). Higher Karnofsky Performance Status (KPS) at re-resection was associated with improved median OS, 9.5 months versus 4.1 months for KPS ≥70 and <70 respectively, (p = 0.013). Furthermore, there was a trend for improved OS with greater extent of re-resection, however this did not reach statistical significance, possibly due to small sample size. Re-resection for recurrent GBM was associated with improved OS in those with good performance status and could be considered in carefully selected cases.
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Affiliation(s)
- Maeve A Hennessy
- Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland; Dept. of Medical Oncology, Beaumont Hospital, Dublin, Ireland
| | - Zachary L Coyne
- Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland; Dept. of Medical Oncology, Beaumont Hospital, Dublin, Ireland
| | - Philip J O'Halloran
- Dept. of Neurosurgery, Beaumont Hospital, Dublin, Ireland; Royal College of Surgeons in Ireland, Dublin, Ireland
| | - William Mullally
- Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland; Dept. of Medical Oncology, Beaumont Hospital, Dublin, Ireland
| | | | | | - Patrick G Morris
- Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland; Dept. of Medical Oncology, Beaumont Hospital, Dublin, Ireland; Royal College of Surgeons in Ireland, Dublin, Ireland.
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16
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Linehan A, Fitzpatrick O, Cowzer D, Hennessy MA, Coyne ZL, Nolan A, Clarke M, Dhonaill RN, Hennessy BT, Morris PG, Grogan L, Breathnach O. COVID-19-related mortality in cancer patients in an Irish setting. Ir J Med Sci 2021; 191:2013-2018. [PMID: 34697787 PMCID: PMC8545357 DOI: 10.1007/s11845-021-02815-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 09/18/2021] [Indexed: 12/24/2022]
Abstract
Background The COVID-19 pandemic has impacted significantly on healthcare across the globe. It has been reported to have higher incidence and be associated with worse outcomes in patients with cancer. Aim To examine the characteristics of patients with cancer who were diagnosed with COVID-19 and to identify factors which may predict a poorer outcome. Methods Patients attending oncology services in Beaumont Hospital who were diagnosed with COVID-19 between March and May 2020 were included. Demographics and outcomes were determined by chart review. Results Twenty-seven patients were included in the study. The median age was 62; 59% were male. Ten patients (37%) died all of whom had metastatic or incurable locally advanced disease. Patients with lung cancer had a higher rate of COVID-19 and poorer outcomes. Those with a performance status (PS) ≥ 3 were more likely to die than those with PS ≤ 2. Compared to those who recovered, patients who died had a higher number of organs affected by cancer and a higher mean Palliative Prognostic Score. Conclusion Patients attending oncology services during the initial phase of the COVID-19 pandemic had an increased rate of SARS-CoV-2 infection and a higher mortality rate than the general population. Those who died had more advanced cancer as demonstrated by poorer performance status, a greater burden of metastatic disease and a higher Palliative Prognostic Score.
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Affiliation(s)
- Anna Linehan
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
- Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland
| | - Orla Fitzpatrick
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
- Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland
| | - Darren Cowzer
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
- Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland
| | - Maeve A Hennessy
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
- Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland
| | - Zac L Coyne
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
- Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland
| | - Amy Nolan
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
- Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland
| | - Maeve Clarke
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
- Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland
| | - Roisin Ni Dhonaill
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
- Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland
| | - Bryan T Hennessy
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
- Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland
| | - Patrick G Morris
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
- Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland
| | - Liam Grogan
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
- Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland
| | - Oscar Breathnach
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
- Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland
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17
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Smyth RJ, Thomas V, Fay J, Ryan R, Nicholson S, Morgan RK, Grogan L, Breathnach O, Morris PG, Toomey S, Hennessy BT, Furney SJ. Tumour Genome Characterization of a Rare Case of Pulmonary Enteric Adenocarcinoma and Prior Colon Adenocarcinoma. J Pers Med 2021; 11:jpm11080768. [PMID: 34442412 PMCID: PMC8398793 DOI: 10.3390/jpm11080768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 07/22/2021] [Accepted: 07/31/2021] [Indexed: 11/17/2022] Open
Abstract
Pulmonary enteric adenocarcinoma (PEAC) is a rare variant of lung adenocarcinoma first described in the early 1990s in a lung tumour with overlapping lung and small intestine features. It is a rare tumour with fewer than 300 cases described in the published literature and was only formally classified in 2011. Given these characteristics the diagnosis is challenging, but even more so in a patient with prior gastrointestinal malignancy. A 68-year-old Caucasian female presented with a cough and was found to have a right upper lobe mass. Her history was significant for a pT3N1 colon adenocarcinoma. The resected lung tumour showed invasive lung adenocarcinoma but also features of colorectal origin. Immuno-stains were strongly and diffusely positive for lung and enteric markers. Multi-region, whole-exome sequencing of the mass and archival tissue from the prior colorectal cancer showed distinct genomic signatures with higher mutational burden in the PEAC and very minimal overlap in mutations between the two tumours. This case highlights the challenge of diagnosing rare lung tumours, but more specifically PEAC in a patient with prior gastro-intestinal cancer. Our use of multi-region, next-generation sequencing revealed distinct genomic signatures between the two tumours further supporting our diagnosis, and evidence of PEAC intra-tumour heterogeneity.
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Affiliation(s)
- Robert J. Smyth
- Department of Molecular Medicine, Royal College of Surgeons in Ireland, D02 YN77 Dublin, Ireland; (R.J.S.); (J.F.); (L.G.); (O.B.); (P.G.M.); (S.T.)
- Department of Medical Oncology, Beaumont Hospital, D09 V2N0 Dublin, Ireland
| | - Valentina Thomas
- Genomic Oncology Research Group, Department of Physiology & Medical Physics, Royal College of Surgeons in Ireland, D02 YN77 Dublin, Ireland;
- Centre for Systems Medicine, Royal College of Surgeons in Ireland, D02 YN77 Dublin, Ireland
| | - Joanna Fay
- Department of Molecular Medicine, Royal College of Surgeons in Ireland, D02 YN77 Dublin, Ireland; (R.J.S.); (J.F.); (L.G.); (O.B.); (P.G.M.); (S.T.)
| | - Ronan Ryan
- Department of Histopathology, St James’s Hospital, D08 NHY1 Dublin, Ireland; (R.R.); (S.N.)
| | - Siobhan Nicholson
- Department of Histopathology, St James’s Hospital, D08 NHY1 Dublin, Ireland; (R.R.); (S.N.)
| | - Ross K. Morgan
- Department of Respiratory Medicine, Beaumont Hospital, Dublin and Royal College of Surgeons of Ireland, D02 YN77 Dublin, Ireland;
| | - Liam Grogan
- Department of Molecular Medicine, Royal College of Surgeons in Ireland, D02 YN77 Dublin, Ireland; (R.J.S.); (J.F.); (L.G.); (O.B.); (P.G.M.); (S.T.)
- Department of Medical Oncology, Beaumont Hospital, D09 V2N0 Dublin, Ireland
| | - Oscar Breathnach
- Department of Molecular Medicine, Royal College of Surgeons in Ireland, D02 YN77 Dublin, Ireland; (R.J.S.); (J.F.); (L.G.); (O.B.); (P.G.M.); (S.T.)
- Department of Medical Oncology, Beaumont Hospital, D09 V2N0 Dublin, Ireland
| | - Patrick G. Morris
- Department of Molecular Medicine, Royal College of Surgeons in Ireland, D02 YN77 Dublin, Ireland; (R.J.S.); (J.F.); (L.G.); (O.B.); (P.G.M.); (S.T.)
- Department of Medical Oncology, Beaumont Hospital, D09 V2N0 Dublin, Ireland
| | - Sinead Toomey
- Department of Molecular Medicine, Royal College of Surgeons in Ireland, D02 YN77 Dublin, Ireland; (R.J.S.); (J.F.); (L.G.); (O.B.); (P.G.M.); (S.T.)
| | - Bryan T. Hennessy
- Department of Molecular Medicine, Royal College of Surgeons in Ireland, D02 YN77 Dublin, Ireland; (R.J.S.); (J.F.); (L.G.); (O.B.); (P.G.M.); (S.T.)
- Department of Medical Oncology, Beaumont Hospital, D09 V2N0 Dublin, Ireland
- Correspondence: (B.T.H.); (S.J.F.)
| | - Simon J. Furney
- Genomic Oncology Research Group, Department of Physiology & Medical Physics, Royal College of Surgeons in Ireland, D02 YN77 Dublin, Ireland;
- Centre for Systems Medicine, Royal College of Surgeons in Ireland, D02 YN77 Dublin, Ireland
- Correspondence: (B.T.H.); (S.J.F.)
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18
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Prior L, O'Dwyer R, Farooq AR, Greally M, Ward C, O'Leary C, Aslam R, Darwish W, Ahmed N, Othman EC, Watson G, Kelly D, Gleeson J, Kiely L, Hassan A, Walsh EM, O'Reilly D, Jones A, Featherstone H, Lim M, Murray H, Hennessy BT, Smyth LM, Leonard G, Grogan L, Breathnach O, Calvert P, Horgan AM, Coate L, Jordan EJ, O'Mahony D, Gupta R, Keane MM, Westrup J, Duffy K, O'Connor M, Morris PG, Kennedy MJ, O'Reilly S, McCaffrey J, Kelly CM, Carney D, Gullo G, Crown J, Higgins MJ, Walsh PM, Walshe JM. Pregnancy-associated breast cancer: evaluating maternal and foetal outcomes. A national study. Breast Cancer Res Treat 2021; 189:269-283. [PMID: 34125341 DOI: 10.1007/s10549-021-06263-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 05/13/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE Pregnancy-associated breast cancer (PABC) is defined as breast cancer diagnosed during the gestational period (gp-PABC) or in the first postpartum year (pp-PABC). Despite its infrequent occurrence, the incidence of PABC appears to be rising due to the increasing propensity for women to delay childbirth. We have established the first retrospective registry study of PABC in Ireland to examine specific clinicopathological characteristics, treatments, and maternal and foetal outcomes. METHODS This was a national, multi-site, retrospective observational study, including PABC patients treated in 12 oncology institutions from August 2001 to January 2020. Data extracted included information on patient demographics, tumour biology, staging, treatments, and maternal/foetal outcomes. Survival data for an age-matched breast cancer population over a similar time period was obtained from the National Cancer Registry of Ireland (NCRI). Standard biostatistical methods were used for analyses. RESULTS We identified 155 patients-71 (46%) were gp-PABC and 84 (54%) were pp-PABC. The median age was 36 years. Forty-four patients (28%) presented with Stage III disease and 25 (16%) had metastatic disease at diagnosis. High rates of triple-negative (25%) and HER2+ (30%) breast cancer were observed. We observed an inferior 5-year overall survival (OS) rate in our PABC cohort compared to an age-matched breast cancer population in both Stage I-III (77.6% vs 90.9%) and Stage IV disease (18% vs 38.3%). There was a low rate (3%) of foetal complications. CONCLUSION PABC patients may have poorer survival outcomes. Further prospective data are needed to optimise management of these patients.
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Affiliation(s)
- Lisa Prior
- Department of Medical Oncology, St Vincent's University Hospital, Dublin, Ireland.
| | - Richard O'Dwyer
- Department of Medical Oncology, Galway University Hospital, Galway, Ireland
| | | | - Megan Greally
- Department of Medical Oncology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Cian Ward
- Department of Medical Oncology, St Vincent's University Hospital, Dublin, Ireland
| | - Connor O'Leary
- Department of Medical Oncology, University Hospital Waterford, Waterford, Ireland
| | - Razia Aslam
- Department of Medical Oncology, St James' Hospital, Dublin, Ireland
| | - Waseem Darwish
- Department of Medical Oncology, Letterkenny University Hospital, Letterkenny, Ireland
| | - Nada Ahmed
- Department of Medical Oncology, Galway University Hospital, Galway, Ireland
| | - Elly Che Othman
- Department of Medical Oncology, Beacon Hospital, Dublin, Ireland
| | - Geoffrey Watson
- Department of Medical Oncology, University Hospital Limerick, Limerick, Ireland
| | - Deirdre Kelly
- Department of Medical Oncology, Cork University Hospital, Cork, Ireland
| | - Jack Gleeson
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
| | - Lisa Kiely
- Department of Medical Oncology, St Vincent's University Hospital, Dublin, Ireland
| | - Anees Hassan
- Department of Medical Oncology, Tallaght University Hospital, Dublin, Ireland
| | - Elaine M Walsh
- Department of Medical Oncology, Galway University Hospital, Galway, Ireland
| | - David O'Reilly
- Department of Medical Oncology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Alfred Jones
- Department of Medical Oncology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Hannah Featherstone
- Department of Medical Oncology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Marvin Lim
- Department of Medical Oncology, St Vincent's University Hospital, Dublin, Ireland
| | - Hazel Murray
- Department of Medical Oncology, St Vincent's University Hospital, Dublin, Ireland
| | - Bryan T Hennessy
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
| | - Lillian M Smyth
- Department of Medical Oncology, St Vincent's University Hospital, Dublin, Ireland
| | - Gregory Leonard
- Department of Medical Oncology, Galway University Hospital, Galway, Ireland
| | - Liam Grogan
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
| | - Oscar Breathnach
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
| | - Paula Calvert
- Department of Medical Oncology, University Hospital Waterford, Waterford, Ireland
| | - Anne M Horgan
- Department of Medical Oncology, University Hospital Waterford, Waterford, Ireland
| | - Linda Coate
- Department of Medical Oncology, University Hospital Limerick, Limerick, Ireland
| | - Emmet J Jordan
- Department of Medical Oncology, University Hospital Waterford, Waterford, Ireland
| | - Deirdre O'Mahony
- Department of Medical Oncology, Cork University Hospital, Cork, Ireland
| | - Rajnish Gupta
- Department of Medical Oncology, University Hospital Limerick, Limerick, Ireland
| | - Maccon M Keane
- Department of Medical Oncology, Galway University Hospital, Galway, Ireland
| | - Jennifer Westrup
- Department of Medical Oncology, Beacon Hospital, Dublin, Ireland
| | - Karen Duffy
- Department of Medical Oncology, Letterkenny University Hospital, Letterkenny, Ireland
| | - Miriam O'Connor
- Department of Medical Oncology, University Hospital Waterford, Waterford, Ireland
| | - Patrick G Morris
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
| | - M John Kennedy
- Department of Medical Oncology, St James' Hospital, Dublin, Ireland
| | - Seamus O'Reilly
- Department of Medical Oncology, Cork University Hospital, Cork, Ireland
| | - John McCaffrey
- Department of Medical Oncology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Catherine M Kelly
- Department of Medical Oncology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Desmond Carney
- Department of Medical Oncology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Giuseppe Gullo
- Department of Medical Oncology, St Vincent's University Hospital, Dublin, Ireland
| | - John Crown
- Department of Medical Oncology, St Vincent's University Hospital, Dublin, Ireland
| | - Michaela J Higgins
- Department of Medical Oncology, Mater Misericordiae University Hospital, Dublin, Ireland
| | | | - Janice M Walshe
- Department of Medical Oncology, St Vincent's University Hospital, Dublin, Ireland
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19
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Eustace AJ, Madden SF, Fay J, Collins DM, Kay EW, Sheehan KM, Furney S, Moran B, Fagan A, Morris PG, Teiserskiene A, Hill AD, Grogan L, Walshe JM, Breathnach O, Power C, Duke D, Egan K, Gallagher WM, O'Donovan N, Crown J, Toomey S, Hennessy BT. The role of infiltrating lymphocytes in the neo-adjuvant treatment of women with HER2-positive breast cancer. Breast Cancer Res Treat 2021; 187:635-645. [PMID: 33983492 PMCID: PMC8197702 DOI: 10.1007/s10549-021-06244-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 04/22/2021] [Indexed: 11/28/2022]
Abstract
Background Pre-treatment tumour-associated lymphocytes (TILs) and stromal lymphocytes (SLs) are independent predictive markers of future pathological complete response (pCR) in HER2-positive breast cancer. Whilst studies have correlated baseline lymphocyte levels with subsequent pCR, few have studied the impact of neoadjuvant therapy on the immune environment. Methods We performed TIL analysis and T-cell analysis by IHC on the pretreatment and ‘On-treatment’ samples from patients recruited on the Phase-II TCHL (NCT01485926) clinical trial. Data were analysed using the Wilcoxon signed-rank test and the Spearman rank correlation. Results In our sample cohort (n = 66), patients who achieved a pCR at surgery, post-chemotherapy, had significantly higher counts of TILs (p = 0.05) but not SLs (p = 0.08) in their pre-treatment tumour samples. Patients who achieved a subsequent pCR after completing neo-adjuvant chemotherapy had significantly higher SLs (p = 9.09 × 10–3) but not TILs (p = 0.1) in their ‘On-treatment’ tumour biopsies. In a small cohort of samples (n = 16), infiltrating lymphocyte counts increased after 1 cycle of neo-adjuvant chemotherapy only in those tumours of patients who did not achieve a subsequent pCR. Finally, reduced CD3 + (p = 0.04, rho = 0.60) and CD4 + (p = 0.01, rho = 0.72) T-cell counts in 'On-treatment' biopsies were associated with decreased residual tumour content post-1 cycle of treatment; the latter being significantly associated with increased likelihood of subsequent pCR (p < 0.01). Conclusions The immune system may be ‘primed’ prior to neoadjuvant treatment in those patients who subsequently achieve a pCR. In those patients who achieve a pCR, their immune response may return to baseline after only 1 cycle of treatment. However, in those who did not achieve a pCR, neo-adjuvant treatment may stimulate lymphocyte influx into the tumour. Supplementary Information The online version contains supplementary material available at 10.1007/s10549-021-06244-1.
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Affiliation(s)
- A J Eustace
- National Institute for Cellular Biotechnology, Dublin City University, Dublin, Ireland.
| | - S F Madden
- Data Science Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - J Fay
- Department of Histopathology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - D M Collins
- National Institute for Cellular Biotechnology, Dublin City University, Dublin, Ireland
| | - E W Kay
- Department of Histopathology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - K M Sheehan
- Department of Histopathology, Royal College of Surgeons in Ireland, Dublin, Ireland.,Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - S Furney
- Department of Physiology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - B Moran
- Conway Institute, University College Dublin, Dublin, Ireland
| | - A Fagan
- Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - P G Morris
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
| | | | - A D Hill
- Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - L Grogan
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
| | - J M Walshe
- Department of Medical Oncology, St Vincent's University Hospital, Dublin, Ireland
| | - O Breathnach
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
| | - C Power
- Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - D Duke
- Department of Radiology, Beaumont Hospital, Dublin, Ireland
| | - K Egan
- Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland
| | - W M Gallagher
- Conway Institute, University College Dublin, Dublin, Ireland
| | - N O'Donovan
- National Institute for Cellular Biotechnology, Dublin City University, Dublin, Ireland
| | - J Crown
- National Institute for Cellular Biotechnology, Dublin City University, Dublin, Ireland.,Cancer Trials Ireland, Dublin, Ireland
| | - S Toomey
- Medical Oncology Group, Department of Molecular Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - B T Hennessy
- Cancer Trials Ireland, Dublin, Ireland.,Medical Oncology Group, Department of Molecular Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
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20
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Subbaramaiah K, Morris PG, Zhou XK, Morrow M, Du B, Giri D, Kopelovich L, Hudis CA, Dannenberg AJ. Retraction: Increased Levels of COX-2 and Prostaglandin E2 Contribute to Elevated Aromatase Expression in Inflamed Breast Tissue of Obese Women. Cancer Discov 2021; 11:1306. [PMID: 33947719 DOI: 10.1158/2159-8290.cd-21-0224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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21
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Keogh RJ, Milewski M, Browne K, Egan K, Hennessy MA, Coyne Z, Cowzer D, Linehan A, Hennessy BT, Grogan L, Morris PG, Breathnach OS. An exploration of the impact of ethanol diluent on breath alcohol concentration in patients receiving paclitaxel chemotherapy. Cancer Chemother Pharmacol 2021; 88:307-312. [PMID: 33944970 DOI: 10.1007/s00280-021-04279-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 04/14/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE This study aimed to provide a better understanding of the impact of paclitaxel chemotherapy on breath alcohol in an Irish population. METHODS Patients attending the Oncology Day Unit at Beaumont Hospital were invited to participate on the day of their treatment. The brand of paclitaxel used was Actavis Pharma Inc and contained 6 mg/mL paclitaxel in 50% Ethanol/ 50% Cremophor EL. Breath alcohol concentration was measured using the AlcoSense ™ Breathalyser on three separate visits. The primary end-point was the number of patients who were above the legal threshold for drink driving in Ireland. RESULTS In total, 50 patients were recruited. 36 (68%) were female. The most common diagnosis was breast cancer (56%). Ten (20%) patients had metastatic disease and 4 (8%) had liver metastases. The mean paclitaxel dose administered was 118 mg. The mean amount of ethanol infused was 7.7 g. 27 patients had a detectable breath alcohol level on at least one visit. The mean breath alcohol concentration was 2 mcg/100 mL or 0.02 mg/L of breath. The maximum concentration of ethanol in exhaled breath was 11 mcg/100 mL or 0.11 mg/L which is 50% of the statutory limit for drink driving in Ireland. A weak correlation was observed between ethanol concentration in exhaled breath and the total amount of ethanol administered. Although no patient exceeded the general limit for drink driving in Ireland, three (6%) participants had a breath alcohol concentration above the threshold for professional, learner or novice drivers. CONCLUSION Although definitive conclusions are limited by relatively small numbers, it seems unlikely that weekly paclitaxel infusions pose any significant risk to patients driving.
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Affiliation(s)
- R J Keogh
- Department of Medical Oncology, Beaumont Hospital, Dublin 9, Ireland.
| | - M Milewski
- Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin 9, Ireland
| | - K Browne
- Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin 9, Ireland
| | - K Egan
- Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin 9, Ireland
| | - M A Hennessy
- Department of Medical Oncology, Beaumont Hospital, Dublin 9, Ireland
| | - Z Coyne
- Department of Medical Oncology, Beaumont Hospital, Dublin 9, Ireland
| | - D Cowzer
- Department of Medical Oncology, Beaumont Hospital, Dublin 9, Ireland
| | | | - B T Hennessy
- Department of Medical Oncology, Beaumont Hospital, Dublin 9, Ireland.,Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin 9, Ireland.,Royal College of Surgeons Ireland, Dublin, Ireland
| | - L Grogan
- Department of Medical Oncology, Beaumont Hospital, Dublin 9, Ireland.,Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin 9, Ireland
| | - P G Morris
- Department of Medical Oncology, Beaumont Hospital, Dublin 9, Ireland.,Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin 9, Ireland.,Royal College of Surgeons Ireland, Dublin, Ireland
| | - O S Breathnach
- Department of Medical Oncology, Beaumont Hospital, Dublin 9, Ireland.,Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin 9, Ireland.,Royal College of Surgeons Ireland, Dublin, Ireland
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22
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Murray SL, Daly FE, O'Kelly P, O'Leary E, Deady S, O'Neill JP, Dudley A, Rutledge NR, McCormick A, Houlihan DD, Williams Y, Morris PG, Ni Raghallaigh S, Moloney FJ, Sexton DJ, Conlon PJ. The impact of switching to mTOR inhibitor-based immunosuppression on long-term non-melanoma skin cancer incidence and renal function in kidney and liver transplant recipients. Ren Fail 2021; 42:607-612. [PMID: 32605413 PMCID: PMC7946013 DOI: 10.1080/0886022x.2020.1785499] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background Solid organ transplantation is associated with increased risk of non-melanoma skin cancer. Studies with short follow up times have suggested a reduced occurrence of these cancers in recipients treated with mammalian target of rapamycin inhibitors as maintenance immunosuppression. We aimed to describe the occurrence of skin cancers in renal and liver transplant recipients switched from calcineurin inhibitor to sirolimus-based regimes. Methods We performed a retrospective study of sirolimus conversion within the Irish national kidney and liver transplant programs. These data were linked with the National Cancer Registry Ireland to determine the incidence of NMSC among these recipients. The incidence rate ratio (IRR) for post versus pre-conversion NMSC rates are referred in this study as an effect size with [95% confidence interval]. Results Of 4,536 kidney transplants and 574 liver transplants functioning on the 1 January 1994 or transplanted between 1 January 1994 and 01 January 1994 and 01 January 2015, 85 kidney and 88 liver transplant recipients were transitioned to sirolimus-based immunosuppression. In renal transplants, the rate of NMSC was 131 per 1000 patient years pre-switch to sirolimus, and 68 per 1000 patient years post switch, with adjusted effect size of 0.48 [0.31 − 0.74] (p = .001) following the switch. For liver transplant recipients, the rate of NMSC was 64 per 1,000 patient years pre-switch and 30 per 1,000 patient years post switch, with an adjusted effect size of 0.49 [0.22 − 1.09] (p .081). Kidney transplant recipients were followed up for a median 3.4 years. Liver transplants were followed for a median 6.6 years. Conclusions In this study, the conversion of maintenance immunosuppression from calcineurin inhibitors to mTOR inhibitors for clinical indications did appear to reduce the incidence of NMSC in kidney and liver transplant recipients.
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Affiliation(s)
- Susan L Murray
- Department of Nephrology & Transplantation, Beaumont Hospital, Dublin, Ireland.,Department of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Fergus E Daly
- Department of Nephrology & Transplantation, Beaumont Hospital, Dublin, Ireland
| | - Patrick O'Kelly
- Department of Nephrology & Transplantation, Beaumont Hospital, Dublin, Ireland
| | - Eamonn O'Leary
- National Cancer Registry Ireland, Cork Airport Business Park, Cork, Ireland
| | - Sandra Deady
- National Cancer Registry Ireland, Cork Airport Business Park, Cork, Ireland
| | - James P O'Neill
- Department of Otolaryngology, Head & Neck Surgery, Beaumont Hospital, and Royal College of Surgeons, Ireland, Ireland
| | - Alexander Dudley
- Hepatology & Liver Transplant Department, St Vincent's University Hospital, Dublin, Ireland
| | - Nicholas R Rutledge
- Hepatology & Liver Transplant Department, St Vincent's University Hospital, Dublin, Ireland
| | - Aiden McCormick
- Hepatology & Liver Transplant Department, St Vincent's University Hospital, Dublin, Ireland
| | - Diarmuid D Houlihan
- Hepatology & Liver Transplant Department, St Vincent's University Hospital, Dublin, Ireland
| | - Yvonne Williams
- Department of Nephrology & Transplantation, Beaumont Hospital, Dublin, Ireland
| | | | | | - Fergal J Moloney
- Department of Dermatology, Mater Misericordia University Hospital University College, Dublin, Ireland
| | - Donal J Sexton
- Department of Nephrology & Transplantation, Beaumont Hospital, Dublin, Ireland
| | - Peter J Conlon
- Department of Nephrology & Transplantation, Beaumont Hospital, Dublin, Ireland.,Department of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
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23
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Mezynski MJ, Farrelly AM, Cremona M, Carr A, Morgan C, Workman J, Armstrong P, McAuley J, Madden S, Fay J, Sheehan KM, Kay EW, Holohan C, Elamin Y, Rafee S, Morris PG, Breathnach O, Grogan L, Hennessy BT, Toomey S. Targeting the PI3K and MAPK pathways to improve response to HER2-targeted therapies in HER2-positive gastric cancer. J Transl Med 2021; 19:184. [PMID: 33933113 PMCID: PMC8088633 DOI: 10.1186/s12967-021-02842-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 04/18/2021] [Indexed: 12/24/2022] Open
Abstract
Background Aberrant PI3K signalling is implicated in trastuzumab resistance in HER2-positive gastric cancer (GC). The role of PI3K or MEK inhibitors in sensitising HER2-positive GCs to trastuzumab or in overcoming trastuzumab resistance is unclear. Methods Using mass spectrometry-based genotyping we analysed 105 hotspot, non-synonymous somatic mutations in PIK3CA and ERBB-family (EGFR, ERBB2, ERBB3 and ERBB4) genes in gastric tumour samples from 69 patients. A panel of gastric cell lines (N87, OE19, ESO26, SNU16, KATOIII) were profiled for anti-proliferative response to the PI3K inhibitor copanlisib and the MEK1/2 inhibitor refametinib alone and in combination with anti-HER2 therapies. Results Patients with HER2-positive GC had significantly poorer overall survival compared to HER2-negative patients (15.9 months vs. 35.7 months). Mutations in PIK3CA were only identified in HER2-negative tumours, while ERBB-family mutations were identified in HER2-positive and HER2-negative tumours. Copanlisib had anti-proliferative effects in 4/5 cell lines, with IC50s ranging from 23.4 (N87) to 93.8 nM (SNU16). All HER2-positive cell lines except SNU16 were sensitive to lapatinib (IC50s 0.04 µM–1.5 µM). OE19 cells were resistant to trastuzumab. The combination of lapatinib and copanlisib was synergistic in ESO-26 and OE-19 cells (ED50: 0.83 ± 0.19 and 0.88 ± 0.13, respectively) and additive in NCI-N87 cells (ED50:1.01 ± 0.55). The combination of copanlisib and trastuzumab significantly improved growth inhibition compared to either therapy alone in NCI-N87, ESO26 and OE19 cells (p < 0.05). Conclusions PI3K or MEK inhibition alone or in combination with anti-HER2 therapy may represent an improved treatment strategy for some patients with HER2-positive GC, and warrants further investigation in a clinical trial setting. Supplementary Information The online version contains supplementary material available at 10.1186/s12967-021-02842-1.
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Affiliation(s)
- M Janusz Mezynski
- Medical Oncology Group, Department of Molecular Medicine, Royal College of Surgeons in Ireland, RCSI Smurfit Building, Beaumont Hospital, Dublin 9, Ireland
| | - Angela M Farrelly
- Medical Oncology Group, Department of Molecular Medicine, Royal College of Surgeons in Ireland, RCSI Smurfit Building, Beaumont Hospital, Dublin 9, Ireland
| | - Mattia Cremona
- Medical Oncology Group, Department of Molecular Medicine, Royal College of Surgeons in Ireland, RCSI Smurfit Building, Beaumont Hospital, Dublin 9, Ireland
| | - Aoife Carr
- Medical Oncology Group, Department of Molecular Medicine, Royal College of Surgeons in Ireland, RCSI Smurfit Building, Beaumont Hospital, Dublin 9, Ireland
| | - Clare Morgan
- Medical Oncology Group, Department of Molecular Medicine, Royal College of Surgeons in Ireland, RCSI Smurfit Building, Beaumont Hospital, Dublin 9, Ireland
| | - Julie Workman
- Medical Oncology Group, Department of Molecular Medicine, Royal College of Surgeons in Ireland, RCSI Smurfit Building, Beaumont Hospital, Dublin 9, Ireland
| | - Paul Armstrong
- Medical Oncology Group, Department of Molecular Medicine, Royal College of Surgeons in Ireland, RCSI Smurfit Building, Beaumont Hospital, Dublin 9, Ireland
| | - Jennifer McAuley
- Medical Oncology Group, Department of Molecular Medicine, Royal College of Surgeons in Ireland, RCSI Smurfit Building, Beaumont Hospital, Dublin 9, Ireland
| | - Stephen Madden
- Data Science Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Joanna Fay
- Department of Histopathology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Katherine M Sheehan
- Department of Histopathology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Elaine W Kay
- Department of Histopathology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Ciara Holohan
- Department of Medical Oncology, St. James's Hospital, Dublin, Ireland
| | - Yasir Elamin
- Medical Oncology Group, Department of Molecular Medicine, Royal College of Surgeons in Ireland, RCSI Smurfit Building, Beaumont Hospital, Dublin 9, Ireland
| | - Shereen Rafee
- Department of Medical Oncology, St. James's Hospital, Dublin, Ireland
| | - Patrick G Morris
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
| | - Oscar Breathnach
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
| | - Liam Grogan
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
| | - Bryan T Hennessy
- Medical Oncology Group, Department of Molecular Medicine, Royal College of Surgeons in Ireland, RCSI Smurfit Building, Beaumont Hospital, Dublin 9, Ireland.,Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
| | - Sinead Toomey
- Medical Oncology Group, Department of Molecular Medicine, Royal College of Surgeons in Ireland, RCSI Smurfit Building, Beaumont Hospital, Dublin 9, Ireland.
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24
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Linehan AS, Fitzpatrick OM, Morris PG. Profile of Trastuzumab Deruxtecan in the Management of Patients with HER2-Positive Unresectable or Metastatic Breast Cancer: An Evidence-Based Review. Breast Cancer (Dove Med Press) 2021; 13:151-159. [PMID: 33658846 PMCID: PMC7920506 DOI: 10.2147/bctt.s245024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 01/15/2021] [Indexed: 12/22/2022]
Abstract
Trastuzumab deruxtecan is a novel antibody–drug conjugate for the treatment of advanced solid tumors, including breast cancer, which overexpress or have amplification of the human epidermal growth factor receptor 2 (HER2). The novel structure of this exciting new agent means that it can deliver a highly potent cytotoxic agent to HER2-expressing tissues resulting in selective killing of cancer cells. In phase I and II trials, trastuzumab deruxtecan has shown impressive response rates in heavily pretreated populations, including patients who had received prior treatment with trastuzumab emtansine, another highly active antibody–drug conjugate. The most common side effects are gastrointestinal and hematological. Importantly, a high rate of interstitial lung disease was seen in early trials, but this appears manageable in most patients with corticosteroids. In light of its efficacy, this promising new drug may change the treatment paradigm of HER2-positive breast cancer.
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Affiliation(s)
- Anna S Linehan
- Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland
| | - Orla M Fitzpatrick
- Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland
| | - Patrick G Morris
- Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland.,Department of Medical Oncology, Royal College of Surgeons in Ireland, Dublin, Ireland
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25
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Keogh RJ, Aslam R, Hennessy MA, Coyne Z, Hennessy BT, Breathnach OS, Grogan L, Morris PG. One year of procarbazine lomustine and vincristine is poorly tolerated in low grade glioma: a real world experience in a national neuro-oncology centre. BMC Cancer 2021; 21:140. [PMID: 33557783 PMCID: PMC7869199 DOI: 10.1186/s12885-021-07809-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 01/13/2021] [Indexed: 11/10/2022] Open
Abstract
Background Following optimal local therapy, adjuvant Procarbazine, Lomustine and Vincristine (PCV) improves overall survival (OS) in low-grade glioma (LGG). However, 1 year of PCV is associated with significant toxicities. In the pivotal RTOG 9802 randomised control trial, approximately half of the patients discontinued treatment after 6 months. As patients on clinical trials may be fitter, we aimed to further explore the tolerability of PCV chemotherapy in routine clinical practice. Methods We conducted a retrospective study between 2014 and 2018 at a National Neuro-Oncology centre. Patients who had received PCV during this time period were included. The primary objective was to assess tolerability of treatment. Secondary objectives included evaluation of treatment delays, dose modifications and toxicities. Results Overall, 41 patients were included, 24 (58%) were male and 21 (51%) aged ≥40 years. 38 (93%) underwent surgical resection and all patients received adjuvant radiotherapy prior to chemotherapy. The median number of cycles completed was 3,2,4 for procarbazine, lomustine and vincristine respectively. Only 4 (10%) completed all 6 cycles of PCV without dose modifications. There was a universal decline in dose intensity as cycles of chemotherapy progressed. Dose intensity for cycle 1 versus cycle 6 respectively: procarbazine (98% versus 46%), lomustine (94% versus 48%) and vincristine (93% versus 50%). Haematological toxicities were common. Six (14%) patients experienced Grade III-IV thrombocytopaenia and 13 (31%) experienced Grade III-IV neutropaenia. Conclusion Toxicities are frequently observed with the PCV regimen in clinical practice. It might be preferable to adjust doses from the start of chemotherapy to improve tolerability or consider alternative chemotherapy, particularly in older patients with LGG.
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Affiliation(s)
- Rachel J Keogh
- Department of Medical Oncology, Beaumont Hospital, Dublin 9, Ireland
| | - Razia Aslam
- Department of Medical Oncology, Beaumont Hospital, Dublin 9, Ireland
| | - Maeve A Hennessy
- Department of Medical Oncology, Beaumont Hospital, Dublin 9, Ireland
| | - Zac Coyne
- Department of Medical Oncology, Beaumont Hospital, Dublin 9, Ireland
| | - Bryan T Hennessy
- Department of Medical Oncology, Beaumont Hospital, Dublin 9, Ireland.,Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin 9, Ireland.,Royal College of Surgeons Ireland, Dublin, Ireland
| | - Oscar S Breathnach
- Department of Medical Oncology, Beaumont Hospital, Dublin 9, Ireland.,Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin 9, Ireland.,Royal College of Surgeons Ireland, Dublin, Ireland
| | - Liam Grogan
- Department of Medical Oncology, Beaumont Hospital, Dublin 9, Ireland.,Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin 9, Ireland.,Royal College of Surgeons Ireland, Dublin, Ireland
| | - Patrick G Morris
- Department of Medical Oncology, Beaumont Hospital, Dublin 9, Ireland. .,Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin 9, Ireland. .,Royal College of Surgeons Ireland, Dublin, Ireland.
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26
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Hennessy MA, Linehan A, Cowzer D, Coyne ZL, Fitzpatrick O, Barrett F, Ni Dhonaill R, Hennessy BT, Grogan L, Morris PG, Breathnach OS. Chemotherapy in the Covid-19 era: the patient's perception. Ir J Med Sci 2021; 190:1303-1308. [PMID: 33449325 PMCID: PMC7809239 DOI: 10.1007/s11845-020-02457-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 12/03/2020] [Indexed: 12/20/2022]
Abstract
Background The Covid-19 pandemic poses significant challenges for the management of patients with cancer. In our institution, we adapted our delivery of outpatient systemic anti-cancer therapy (SACT) by introducing a number of ‘risk-reducing’ measures including pre-assessment screening. Aims We sought to evaluate the experience and perceptions of patients with cancer undergoing SACT during the Covid-19 pandemic. Methods Patients on SACT during the Covid-19 pandemic were eligible for participation. Data were collected by anonymous survey over a 1 week period during the most intensive phase of government restrictions. Patients were asked questions under three headings: perceived risk of infection exposure, changes to treatment plan and psychological impact of Covid-19. Results One hundred patients were assessed, 60% were male, 41% were > 65 years of age and 67% had advanced cancer. Eleven percent of patients were living alone. Fifty-seven percent reported feeling at increased risk in general of contracting Covid-19. Sixty-eight percent of patients did not feel worried about contracting Covid-19 in the hospital. Ninety-two percent of patients reported wanting to continue on SACT as originally planned. Fifty-eighty percent felt isolated and 40% reported increased anxiety. Conclusion Though patients on active treatment for cancer during the Covid-19 pandemic reported increased anxiety and feelings of isolation due to Covid-19, the majority of patients wanted to continue SACT as originally planned. Patients would benefit from enhanced psycho-oncological supports in the event of a prolonged Covid-19 pandemic.
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Affiliation(s)
- Maeve A Hennessy
- Medical Oncology Department, Beaumont Hospital, Dublin, Ireland.,Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland
| | - Anna Linehan
- Medical Oncology Department, Beaumont Hospital, Dublin, Ireland.,Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland
| | - Darren Cowzer
- Medical Oncology Department, Beaumont Hospital, Dublin, Ireland.,Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland
| | - Zachary L Coyne
- Medical Oncology Department, Beaumont Hospital, Dublin, Ireland.,Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland
| | | | - Fiona Barrett
- Medical Oncology Department, Beaumont Hospital, Dublin, Ireland
| | | | - Bryan T Hennessy
- Medical Oncology Department, Beaumont Hospital, Dublin, Ireland.,Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland
| | - Liam Grogan
- Medical Oncology Department, Beaumont Hospital, Dublin, Ireland.,Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland
| | - Patrick G Morris
- Medical Oncology Department, Beaumont Hospital, Dublin, Ireland.,Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland
| | - Oscar S Breathnach
- Medical Oncology Department, Beaumont Hospital, Dublin, Ireland. .,Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland.
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27
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Ryan DJ, Toomey S, Madden SF, Casey M, Breathnach OS, Morris PG, Grogan L, Branagan P, Costello RW, De Barra E, Hurley K, Gunaratnam C, McElvaney NG, OBrien ME, Sulaiman I, Morgan RK, Hennessy BT. Use of exhaled breath condensate (EBC) in the diagnosis of SARS-COV-2 (COVID-19). Thorax 2021; 76:86-88. [PMID: 33097604 PMCID: PMC7590263 DOI: 10.1136/thoraxjnl-2020-215705] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [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] [Received: 07/02/2020] [Revised: 10/07/2020] [Accepted: 10/08/2020] [Indexed: 12/24/2022]
Abstract
False negatives from nasopharyngeal swabs (NPS) using reverse transcriptase PCR (RT-PCR) in SARS-CoV-2 are high. Exhaled breath condensate (EBC) contains lower respiratory droplets that may improve detection. We performed EBC RT-PCR for SARS-CoV-2 genes (E, S, N, ORF1ab) on NPS-positive (n=16) and NPS-negative/clinically positive COVID-19 patients (n=15) using two commercial assays. EBC detected SARS-CoV-2 in 93.5% (29/31) using the four genes. Pre-SARS-CoV-2 era controls (n=14) were negative. EBC was positive in NPS negative/clinically positive patients in 66.6% (10/15) using the identical E and S (E/S) gene assay used for NPS, 73.3% (11/15) using the N/ORF1ab assay and 14/15 (93.3%) combined.
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Affiliation(s)
- Daniel J Ryan
- Department of Molecular Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
- Department of Respiratory Medicine, Beaumont Hospital, Dublin, Ireland
| | - Sinead Toomey
- Department of Molecular Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Stephen F Madden
- Data Science Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Michelle Casey
- Department of Respiratory Medicine, Beaumont Hospital, Dublin, Ireland
| | | | | | - Liam Grogan
- Department of Oncology, Beaumont Hospital, Dublin, Ireland
| | - Peter Branagan
- Department of Respiratory Medicine, Beaumont Hospital, Dublin, Ireland
| | | | - Eoghan De Barra
- Department of International Health and Tropical Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Killian Hurley
- Department of Respiratory Medicine, Beaumont Hospital, Dublin, Ireland
| | - Cedric Gunaratnam
- Department of Respiratory Medicine, Beaumont Hospital, Dublin, Ireland
| | - Noel G McElvaney
- Department of Respiratory Medicine, Beaumont Hospital, Dublin, Ireland
| | | | - Imran Sulaiman
- Department of Respiratory Medicine, Beaumont Hospital, Dublin, Ireland
| | - Ross K Morgan
- Department of Respiratory Medicine, Beaumont Hospital, Dublin, Ireland
| | - Bryan T Hennessy
- Department of Molecular Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
- Department of Oncology, Beaumont Hospital, Dublin, Ireland
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28
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Krop I, Abramson V, Colleoni M, Traina T, Holmes F, Garcia-Estevez L, Hart L, Awada A, Zamagni C, Morris PG, Schwartzberg L, Chan S, Gucalp A, Biganzoli L, Steinberg J, Sica L, Trudeau M, Markova D, Tarazi J, Zhu Z, O'Brien T, Kelly CM, Winer E, Yardley DA. A Randomized Placebo Controlled Phase II Trial Evaluating Exemestane with or without Enzalutamide in Patients with Hormone Receptor–Positive Breast Cancer. Clin Cancer Res 2020; 26:6149-6157. [DOI: 10.1158/1078-0432.ccr-20-1693] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 07/30/2020] [Accepted: 09/22/2020] [Indexed: 11/16/2022]
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29
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Mullally WJ, Keane F, Nolan A, Grogan L, Breathnach OS, Hennessy BT, Collins DC, Morris PG. Lack of familiarity with genetic testing among patients in Ireland with Cancer. Ir J Med Sci 2020; 190:547-553. [PMID: 32813148 DOI: 10.1007/s11845-020-02333-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 07/26/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cancer gene panel testing is available in Ireland. The need for a clear strategy to deal with patient information generated from tumour genomic testing is recognised as a challenge in the National Cancer Strategy. However, the public's attitude and opinions regarding these results is not known in Ireland. AIMS This prospective questionnaire study assessed the knowledge and opinions of patients in a national oncology centre, surrounding cancer gene panel testing. METHODS An anonymised modified validated questionnaire was completed by volunteering patients in the medical oncology department. It comprised 14 questions which assessed patient's familiarity, intention, benefits and concerns associated with tumour genetic testing using a four-point Likert scale. Patients recorded their primary cancer diagnosis and family cancer history. RESULTS Eighty-four patients completed the questionnaire with 77 (92%) patients declaring their primary cancer diagnosis. The median age was 56 (range 26 to 83) years. Overall, 42% (n = 35) of oncology patients were familiar/somewhat familiar with testing and 90% (n = 76) stated they would avail of genetic testing if available. Patients with breast cancer were no more likely to avail of genetic testing when compared with the non-breast cancer cohort (n = 21 vs. 56, p = 0.58) though they identified concerns with potential discrimination. CONCLUSION This is the first prospective Irish study to assess opinions surrounding cancer gene results. Addressing patient's lack of information as regards genetic testing is the first step in establishing a national cancer genetics testing programme in Ireland.
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Affiliation(s)
| | - Fergus Keane
- Beaumont Hospital, Beaumont Rd., Dublin 9, Ireland
| | - Amy Nolan
- Beaumont Hospital, Beaumont Rd., Dublin 9, Ireland
| | - Liam Grogan
- Beaumont Hospital, Beaumont Rd., Dublin 9, Ireland
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30
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Kearns C, Feighery R, Mc Caffrey J, Higgins M, Smith M, Murphy V, O’Reilly S, Horgan AM, Walshe J, McDermott R, Morris PG, Keane M, Martin M, Murphy C, Duffy K, Mihai A, Armstrong J, O’Donnell DM, Gallagher WM, Kelly CM, Kelly CM. Understanding and Attitudes toward Cancer Clinical Trials among Patients with a Cancer Diagnosis: National Study through Cancer Trials Ireland. Cancers (Basel) 2020; 12:cancers12071921. [PMID: 32708702 PMCID: PMC7409272 DOI: 10.3390/cancers12071921] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 07/11/2020] [Accepted: 07/13/2020] [Indexed: 11/16/2022] Open
Abstract
Cancer clinical trials (CCTs) are critical to translation and development of better therapies to improve outcomes. CCTs require adequate patient involvement but accrual rates are low globally. Several known barriers impede participation and knowing how subpopulations differ in understanding of CCTs can foster targeted approaches to aid accrual and advance cancer treatments. We conducted the first nationwide survey of 1089 patients attending 14 Irish cancer centres, assessing understanding of fundamental concepts in CCT methodology and factors that influence participation, to help tailor patient support for accrual to CCTs. Two-thirds (66%) of patients reported never having been offered a CCT and only 5% of those not offered asked to participate. Misunderstanding of clinical equipoise was prevalent. There were differences in understanding of randomisation of treatment by age (p < 0.0001), ethnicity (p = 0.035) and marital status (p = 0.013), and 58% of patients and 61% previous CCT participants thought that their doctor would ensure better treatment in CCTs. Females were slightly more risk averse. Males indicated a greater willingness to participate in novel drug trials (p = 0.001, p = 0.003). The study identified disparities in several demographics; older, widowed, living in provincial small towns and fewer years-educated patients had generally poorer understanding of CCTs, highlighting requirements for targeted support in these groups.
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Affiliation(s)
- Cathriona Kearns
- UCD Conway Institute Dublin, D04V1W8 Dublin, Ireland;
- Cancer Trials Ireland, Innovation House, Old Finglas Road, Glasnevin, D11KXN4 Dublin, Ireland; (R.F.); (V.M.); (S.O.); (A.M.H.); (J.W.); (R.M.); (P.G.M.); (M.K.); (M.M.); (C.M.); (K.D.); (A.M.); (J.A.); (D.M.O.)
- Correspondence: (C.K.); (C.M.K.)
| | - Ronan Feighery
- Cancer Trials Ireland, Innovation House, Old Finglas Road, Glasnevin, D11KXN4 Dublin, Ireland; (R.F.); (V.M.); (S.O.); (A.M.H.); (J.W.); (R.M.); (P.G.M.); (M.K.); (M.M.); (C.M.); (K.D.); (A.M.); (J.A.); (D.M.O.)
| | - John Mc Caffrey
- UCD School of Medicine, Mater Misericordiae University Hospital Dublin, D07AX57 Dublin, Ireland; (J.M.C.); (M.H.); (M.S.); (C.M.K.)
- Cancer Trials Ireland, Innovation House, Old Finglas Road, Glasnevin, D11KXN4 Dublin, Ireland; (R.F.); (V.M.); (S.O.); (A.M.H.); (J.W.); (R.M.); (P.G.M.); (M.K.); (M.M.); (C.M.); (K.D.); (A.M.); (J.A.); (D.M.O.)
| | - Michaela Higgins
- UCD School of Medicine, Mater Misericordiae University Hospital Dublin, D07AX57 Dublin, Ireland; (J.M.C.); (M.H.); (M.S.); (C.M.K.)
- Cancer Trials Ireland, Innovation House, Old Finglas Road, Glasnevin, D11KXN4 Dublin, Ireland; (R.F.); (V.M.); (S.O.); (A.M.H.); (J.W.); (R.M.); (P.G.M.); (M.K.); (M.M.); (C.M.); (K.D.); (A.M.); (J.A.); (D.M.O.)
| | - Martina Smith
- UCD School of Medicine, Mater Misericordiae University Hospital Dublin, D07AX57 Dublin, Ireland; (J.M.C.); (M.H.); (M.S.); (C.M.K.)
- Cancer Trials Ireland, Innovation House, Old Finglas Road, Glasnevin, D11KXN4 Dublin, Ireland; (R.F.); (V.M.); (S.O.); (A.M.H.); (J.W.); (R.M.); (P.G.M.); (M.K.); (M.M.); (C.M.); (K.D.); (A.M.); (J.A.); (D.M.O.)
| | - Verena Murphy
- Cancer Trials Ireland, Innovation House, Old Finglas Road, Glasnevin, D11KXN4 Dublin, Ireland; (R.F.); (V.M.); (S.O.); (A.M.H.); (J.W.); (R.M.); (P.G.M.); (M.K.); (M.M.); (C.M.); (K.D.); (A.M.); (J.A.); (D.M.O.)
| | - Seamus O’Reilly
- Cancer Trials Ireland, Innovation House, Old Finglas Road, Glasnevin, D11KXN4 Dublin, Ireland; (R.F.); (V.M.); (S.O.); (A.M.H.); (J.W.); (R.M.); (P.G.M.); (M.K.); (M.M.); (C.M.); (K.D.); (A.M.); (J.A.); (D.M.O.)
- Cork University Hospital, T12DFK4 Cork, Ireland
| | - Anne M. Horgan
- Cancer Trials Ireland, Innovation House, Old Finglas Road, Glasnevin, D11KXN4 Dublin, Ireland; (R.F.); (V.M.); (S.O.); (A.M.H.); (J.W.); (R.M.); (P.G.M.); (M.K.); (M.M.); (C.M.); (K.D.); (A.M.); (J.A.); (D.M.O.)
- University Hospital Waterford, X91ER8E Waterford, Ireland
| | - Janice Walshe
- Cancer Trials Ireland, Innovation House, Old Finglas Road, Glasnevin, D11KXN4 Dublin, Ireland; (R.F.); (V.M.); (S.O.); (A.M.H.); (J.W.); (R.M.); (P.G.M.); (M.K.); (M.M.); (C.M.); (K.D.); (A.M.); (J.A.); (D.M.O.)
- St. Vincent University Hospital, D04YN63 Dublin, Ireland
| | - Ray McDermott
- Cancer Trials Ireland, Innovation House, Old Finglas Road, Glasnevin, D11KXN4 Dublin, Ireland; (R.F.); (V.M.); (S.O.); (A.M.H.); (J.W.); (R.M.); (P.G.M.); (M.K.); (M.M.); (C.M.); (K.D.); (A.M.); (J.A.); (D.M.O.)
- Adelaide & Meath Hospital Incorporating the National Children’s Hospital (AMNCH), D24KNE0 Dublin, Ireland
| | - Patrick G. Morris
- Cancer Trials Ireland, Innovation House, Old Finglas Road, Glasnevin, D11KXN4 Dublin, Ireland; (R.F.); (V.M.); (S.O.); (A.M.H.); (J.W.); (R.M.); (P.G.M.); (M.K.); (M.M.); (C.M.); (K.D.); (A.M.); (J.A.); (D.M.O.)
- Beaumont Hospital, D09A0KH Dublin, Ireland
| | - Maccon Keane
- Cancer Trials Ireland, Innovation House, Old Finglas Road, Glasnevin, D11KXN4 Dublin, Ireland; (R.F.); (V.M.); (S.O.); (A.M.H.); (J.W.); (R.M.); (P.G.M.); (M.K.); (M.M.); (C.M.); (K.D.); (A.M.); (J.A.); (D.M.O.)
- Galway University Hospital, SW4794 Galway, Ireland
| | - Michael Martin
- Cancer Trials Ireland, Innovation House, Old Finglas Road, Glasnevin, D11KXN4 Dublin, Ireland; (R.F.); (V.M.); (S.O.); (A.M.H.); (J.W.); (R.M.); (P.G.M.); (M.K.); (M.M.); (C.M.); (K.D.); (A.M.); (J.A.); (D.M.O.)
- Sligo General Hospital, F91H684 Sligo, Ireland
| | - Conleth Murphy
- Cancer Trials Ireland, Innovation House, Old Finglas Road, Glasnevin, D11KXN4 Dublin, Ireland; (R.F.); (V.M.); (S.O.); (A.M.H.); (J.W.); (R.M.); (P.G.M.); (M.K.); (M.M.); (C.M.); (K.D.); (A.M.); (J.A.); (D.M.O.)
- Bon Secours Hospital, T12DV56 Cork, Ireland
| | - Karen Duffy
- Cancer Trials Ireland, Innovation House, Old Finglas Road, Glasnevin, D11KXN4 Dublin, Ireland; (R.F.); (V.M.); (S.O.); (A.M.H.); (J.W.); (R.M.); (P.G.M.); (M.K.); (M.M.); (C.M.); (K.D.); (A.M.); (J.A.); (D.M.O.)
- Letterkenny General Hospital, F92FC82 Donegal, Ireland
| | - Alina Mihai
- Cancer Trials Ireland, Innovation House, Old Finglas Road, Glasnevin, D11KXN4 Dublin, Ireland; (R.F.); (V.M.); (S.O.); (A.M.H.); (J.W.); (R.M.); (P.G.M.); (M.K.); (M.M.); (C.M.); (K.D.); (A.M.); (J.A.); (D.M.O.)
- Beacon Hospital, D18AK68 Dublin, Ireland
| | - John Armstrong
- Cancer Trials Ireland, Innovation House, Old Finglas Road, Glasnevin, D11KXN4 Dublin, Ireland; (R.F.); (V.M.); (S.O.); (A.M.H.); (J.W.); (R.M.); (P.G.M.); (M.K.); (M.M.); (C.M.); (K.D.); (A.M.); (J.A.); (D.M.O.)
- St. Luke’s Radiation Oncology Network, St Luke’s Hospital, Rathgar, D06HH36 Dublin, Ireland
| | - Dearbhaile M. O’Donnell
- Cancer Trials Ireland, Innovation House, Old Finglas Road, Glasnevin, D11KXN4 Dublin, Ireland; (R.F.); (V.M.); (S.O.); (A.M.H.); (J.W.); (R.M.); (P.G.M.); (M.K.); (M.M.); (C.M.); (K.D.); (A.M.); (J.A.); (D.M.O.)
- St. James’s Hospital, D08W9RT Dublin, Ireland
| | - William M. Gallagher
- UCD Conway Institute Dublin, D04V1W8 Dublin, Ireland;
- Cancer Trials Ireland, Innovation House, Old Finglas Road, Glasnevin, D11KXN4 Dublin, Ireland; (R.F.); (V.M.); (S.O.); (A.M.H.); (J.W.); (R.M.); (P.G.M.); (M.K.); (M.M.); (C.M.); (K.D.); (A.M.); (J.A.); (D.M.O.)
| | - Ciara M. Kelly
- UCD School of Medicine, Mater Misericordiae University Hospital Dublin, D07AX57 Dublin, Ireland; (J.M.C.); (M.H.); (M.S.); (C.M.K.)
- Cancer Trials Ireland, Innovation House, Old Finglas Road, Glasnevin, D11KXN4 Dublin, Ireland; (R.F.); (V.M.); (S.O.); (A.M.H.); (J.W.); (R.M.); (P.G.M.); (M.K.); (M.M.); (C.M.); (K.D.); (A.M.); (J.A.); (D.M.O.)
| | - Catherine M. Kelly
- UCD Conway Institute Dublin, D04V1W8 Dublin, Ireland;
- UCD School of Medicine, Mater Misericordiae University Hospital Dublin, D07AX57 Dublin, Ireland; (J.M.C.); (M.H.); (M.S.); (C.M.K.)
- Cancer Trials Ireland, Innovation House, Old Finglas Road, Glasnevin, D11KXN4 Dublin, Ireland; (R.F.); (V.M.); (S.O.); (A.M.H.); (J.W.); (R.M.); (P.G.M.); (M.K.); (M.M.); (C.M.); (K.D.); (A.M.); (J.A.); (D.M.O.)
- Correspondence: (C.K.); (C.M.K.)
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Coyne ZL, Hennessy M, Duke D, Hill A, Grogan L, Breathnach O, Hennessy B, Morris PG. Patient demographics and management challenges in an Irish symptomatic breast cancer unit. Ir J Med Sci 2020; 189:1237-1241. [PMID: 32436172 DOI: 10.1007/s11845-020-02245-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 04/28/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Breast cancer is the most common cancer in women. Beaumont Hospital is a nationally designated symptomatic breast cancer unit, independent of the national screening programme, BreastCheck. AIMS We hypothesised that patients attending symptomatic breast cancer units differ from national registry data and aimed to characterise this in a retrospective study. METHODS A prospective database of patients diagnosed with breast cancer was maintained between 2014 and 2017. Multiple patient and tumour demographics were analysed retrospectively and compared with data from the National Cancer Registry. RESULTS In total, 944 patients were diagnosed with breast cancer, 379 (40%) were aged < 50, 206 (22%) 50-64, 208 (22%) 65-75 and 151 (16%) > 75 years respectively. Expectedly, older patients (≥ 65 years) had a higher proportion of oestrogen receptor-positive, HER2-negative breast cancer (72%). Triple negative breast cancer was relatively more common (17%) among younger patients. These patients received more intensive chemotherapy: 118 (64%) received combination anthracycline-taxane chemotherapy, in comparison with only 14 (21%) of older patients. Patients generally presented at a later stage compared with national registry data: stage II 491 (52%) and stage III 179 (19%) versus stage II (50%) and stage III (13%). CONCLUSION Patients attending the symptomatic breast cancer unit Beaumont Hospital have different demographics compared with the national registry data. This presents particular challenges for management.
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Affiliation(s)
- Zac L Coyne
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland.
- Department of Breast Surgery, Beaumont Hospital, Dublin, Ireland.
- Department of Radiology, Beaumont Hospital, Dublin, Ireland.
- Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland.
- Royal College of Surgeons Ireland, Dublin, Ireland.
| | - Maeve Hennessy
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
- Department of Breast Surgery, Beaumont Hospital, Dublin, Ireland
- Department of Radiology, Beaumont Hospital, Dublin, Ireland
- Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland
- Royal College of Surgeons Ireland, Dublin, Ireland
| | - Deirdre Duke
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
- Department of Breast Surgery, Beaumont Hospital, Dublin, Ireland
- Department of Radiology, Beaumont Hospital, Dublin, Ireland
- Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland
- Royal College of Surgeons Ireland, Dublin, Ireland
| | - Arnold Hill
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
- Department of Breast Surgery, Beaumont Hospital, Dublin, Ireland
- Department of Radiology, Beaumont Hospital, Dublin, Ireland
- Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland
- Royal College of Surgeons Ireland, Dublin, Ireland
| | - Liam Grogan
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
- Department of Breast Surgery, Beaumont Hospital, Dublin, Ireland
- Department of Radiology, Beaumont Hospital, Dublin, Ireland
- Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland
- Royal College of Surgeons Ireland, Dublin, Ireland
| | - Oscar Breathnach
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
- Department of Breast Surgery, Beaumont Hospital, Dublin, Ireland
- Department of Radiology, Beaumont Hospital, Dublin, Ireland
- Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland
- Royal College of Surgeons Ireland, Dublin, Ireland
| | - Bryan Hennessy
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
- Department of Breast Surgery, Beaumont Hospital, Dublin, Ireland
- Department of Radiology, Beaumont Hospital, Dublin, Ireland
- Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland
- Royal College of Surgeons Ireland, Dublin, Ireland
| | - Patrick G Morris
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
- Department of Breast Surgery, Beaumont Hospital, Dublin, Ireland
- Department of Radiology, Beaumont Hospital, Dublin, Ireland
- Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland
- Royal College of Surgeons Ireland, Dublin, Ireland
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coyne Z, Cowzer D, Hennessy M, Linehan A, Hennessy BT, Grogan W, Breathnach OS, Morris PG. Cannabis and cancer: Examining the use and perceived benefits in an Irish cancer cohort. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e24178] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e24178 Background: Medicinal cannabis is currently approved for symptom control in cancer patients. There is limited evidence to suggest cannabis is efficacious in the treatment of cancer. In this study we aim to characterise the extent of cannabis use in patients receiving anti-cancer therapies and what impact they think cannabis use has on their cancer. Methods: An anonymous survey was distributed to patients with cancer attending the Beaumont Hospital Oncology Day Unit for anti-cancer therapy over a period of 4 weeks. Results: 175 patients completed the survey. 166 (95%) of patients said they would be comfortable talking to their oncologist about cannabis use. 161 (92%) felt their oncologist should prescribe cannabis as part of their cancer treatment. 17% thought cannabis would cure their cancer. 38% thought cannabis would slow the growth of their cancer and 33% thought cannabis would treat cancer related symptoms. 42 (24%) of all patients had tried some form of cannabis at least once in their life. 26 (15%) were actively taking CBD (Cannabidiol) oil as part of their treatment independently of any healthcare professional guidance. More females (15) were taking CBD compared to males (11). A higher proportion of patients < 50 years (14) were taking CBD during their treatment. 30% of patients using CBD had breast cancer and 23% had a primary CNS malignancy. Of the patients taking CBD, 20 (77%) patients felt it would cure or slow cancer growth and 10 (38%) patients believed it would help with cancer related symptoms. Conclusions: Patients with cancer appear to have a positive attitude towards cannabis as part of their treatment despite limited evidence to support this. With the increasing availability of cannabis-based products globally, medical oncologists must now take into consideration patient’s attitude towards cannabis while treating their cancer. [Table: see text]
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Affiliation(s)
- zac coyne
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
| | - Darren Cowzer
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
| | - Maeve Hennessy
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
| | - Anna Linehan
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
| | | | - William Grogan
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
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Cowzer D, Hennessy M, Linehan A, coyne Z, Creegan D, Glynn E, Hennessy BT, Morris PG, Grogan W, Breathnach OS. Patient knowledge and expectations of anti-cancer treatments in the advanced disease setting. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e24187] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e24187 Background: Systemic treatments can improve symptom burden and prolong life in patients with advanced cancer. However, these therapies come with associated toxicities and in some cases can result in reduced quality of life for patients with no possibility of cure. International data has suggested that this cohort of patients have a poor understanding surrounding the goals of treatment in the advanced disease setting. We aimed to evaluate the expectations for cure and palliation from systemic therapies among patients with advanced, incurable cancer in our institution. Methods: Patients on active treatment attending the Oncology Day Ward completed anonymous questionnaires over a four week period. Personal demographics, decision making for treatment and expectation of benefit and toxicity was assessed. Analysis was carried out on patients assessed to have advanced metastatic disease. Results: 254 patients completed the questionnaire. 217 patients were assessed to have metastatic/incurable disease based on responses. 57% were male, 56% were age 30-64 and 35% had completed university level education. 42% of patients stated that treatment was very likely or somewhat likely to cure their cancer. Among patients who reported that a cure was very likely, there were more men (62%) compared to women (38%), more patients were aged less than 65 (62%) compared to over 65 (38%) and more patients had only completed elementary school level education (71%) compared to university level education (29%). Most patients (84%) felt treatment was either very likely or somewhat likely to help them live longer. 68% of patients felt treatment would help them with problems related to their cancer and 33% of patients felt that treatment was very likely to have side effects or complications. 22% of patients stated that doctors made decisions without their input. Conclusions: Many patients receiving treatment for incurable cancers do not understand that it is unlikely to be curative. Male gender, younger age and a lower level of education appears to be associated with unrealistic expectations. This could compromise their ability to make informed treatment decisions. More effective communication around goals of treatment and end of life care may help to improve patients understanding and expectations around the outcomes of chemotherapy.
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Affiliation(s)
- Darren Cowzer
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
| | - Maeve Hennessy
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
| | - Anna Linehan
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
| | - zac coyne
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
| | - Daniel Creegan
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
| | - Emily Glynn
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
| | | | | | - William Grogan
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
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Hennessy MA, Morris PG. Optimizing Anti-HER2 Therapy in early breast cancer: updates from the KRISTINE trial. Ann Palliat Med 2020; 9:504-509. [PMID: 32233616 DOI: 10.21037/apm.2020.02.03] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 02/01/2020] [Indexed: 11/06/2022]
Affiliation(s)
- Maeve A Hennessy
- Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland; Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
| | - Patrick G Morris
- Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland; Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland; Royal College of Surgeons in Ireland, Dublin, Ireland.
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Toomey S, Carr A, Mezynski MJ, Elamin Y, Rafee S, Cremona M, Morgan C, Madden S, Abdul-Jalil KI, Gately K, Farrelly A, Kay EW, Kennedy S, O'Byrne K, Grogan L, Breathnach O, Morris PG, Eustace AJ, Fay J, Cummins R, O'Grady A, Kalachand R, O'Donovan N, Kelleher F, O'Reilly A, Doherty M, Crown J, Hennessy BT. Identification and clinical impact of potentially actionable somatic oncogenic mutations in solid tumor samples. J Transl Med 2020; 18:99. [PMID: 32087721 PMCID: PMC7036178 DOI: 10.1186/s12967-020-02273-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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] [Received: 09/06/2019] [Accepted: 02/14/2020] [Indexed: 12/13/2022] Open
Abstract
Background An increasing number of anti-cancer therapeutic agents target specific mutant proteins that are expressed by many different tumor types. Successful use of these therapies is dependent on the presence or absence of somatic mutations within the patient’s tumor that can confer clinical efficacy or drug resistance. Methods The aim of our study was to determine the type, frequency, overlap and functional proteomic effects of potentially targetable recurrent somatic hotspot mutations in 47 cancer-related genes in multiple disease sites that could be potential therapeutic targets using currently available agents or agents in clinical development. Results Using MassArray technology, of the 1300 patient tumors analysed 571 (43.9%) had at least one somatic mutation. Mutations were identified in 30 different genes. KRAS (16.5%), PIK3CA (13.6%) and BRAF (3.8%) were the most frequently mutated genes. Prostate (10.8%) had the lowest number of somatic mutations identified, while no mutations were identified in sarcoma. Ocular melanoma (90.6%), endometrial (72.4%) and colorectal (66.4%) tumors had the highest number of mutations. We noted high concordance between mutations in different parts of the tumor (94%) and matched primary and metastatic samples (90%). KRAS and BRAF mutations were mutually exclusive. Mutation co-occurrence involved mainly PIK3CA and PTPN11, and PTPN11 and APC. Reverse Phase Protein Array (RPPA) analysis demonstrated that PI3K and MAPK signalling pathways were more altered in tumors with mutations compared to wild type tumors. Conclusions Hotspot mutational profiling is a sensitive, high-throughput approach for identifying mutations of clinical relevance to molecular based therapeutics for treatment of cancer, and could potentially be of use in identifying novel opportunities for genotype-driven clinical trials.
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Affiliation(s)
- Sinead Toomey
- Medical Oncology Lab, Department of Molecular Medicine, Royal College of Surgeons in Ireland, RCSI Smurfit Building, Beaumont Hospital, Dublin, Ireland.
| | - Aoife Carr
- Medical Oncology Lab, Department of Molecular Medicine, Royal College of Surgeons in Ireland, RCSI Smurfit Building, Beaumont Hospital, Dublin, Ireland
| | - Mateusz Janusz Mezynski
- Medical Oncology Lab, Department of Molecular Medicine, Royal College of Surgeons in Ireland, RCSI Smurfit Building, Beaumont Hospital, Dublin, Ireland
| | - Yasir Elamin
- Medical Oncology Lab, Department of Molecular Medicine, Royal College of Surgeons in Ireland, RCSI Smurfit Building, Beaumont Hospital, Dublin, Ireland
| | - Shereen Rafee
- Department of Medical Oncology, St. James's Hospital Dublin, Dublin, Ireland
| | - Mattia Cremona
- Medical Oncology Lab, Department of Molecular Medicine, Royal College of Surgeons in Ireland, RCSI Smurfit Building, Beaumont Hospital, Dublin, Ireland
| | - Clare Morgan
- Medical Oncology Lab, Department of Molecular Medicine, Royal College of Surgeons in Ireland, RCSI Smurfit Building, Beaumont Hospital, Dublin, Ireland
| | - Stephen Madden
- Data Science Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Khairun I Abdul-Jalil
- Medical Oncology Lab, Department of Molecular Medicine, Royal College of Surgeons in Ireland, RCSI Smurfit Building, Beaumont Hospital, Dublin, Ireland
| | - Kathy Gately
- Department of Medical Oncology, St. James's Hospital Dublin, Dublin, Ireland
| | - Angela Farrelly
- Medical Oncology Lab, Department of Molecular Medicine, Royal College of Surgeons in Ireland, RCSI Smurfit Building, Beaumont Hospital, Dublin, Ireland
| | - Elaine W Kay
- Department of Pathology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Susan Kennedy
- Department of Pathology, St. Vincent's University Hospital, Dublin, Ireland.,Department of Pathology, Royal Victoria Eye and Ear Hospital, Dublin, Ireland
| | - Kenneth O'Byrne
- Department of Medical Oncology, St. James's Hospital Dublin, Dublin, Ireland.,Princess Alexandra Hospital, Brisbane, Australia
| | - Liam Grogan
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
| | - Oscar Breathnach
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
| | - Patrick G Morris
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
| | - Alexander J Eustace
- Medical Oncology Lab, Department of Molecular Medicine, Royal College of Surgeons in Ireland, RCSI Smurfit Building, Beaumont Hospital, Dublin, Ireland
| | - Joanna Fay
- Department of Pathology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Robert Cummins
- Department of Pathology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Anthony O'Grady
- Department of Pathology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Roshni Kalachand
- Medical Oncology Lab, Department of Molecular Medicine, Royal College of Surgeons in Ireland, RCSI Smurfit Building, Beaumont Hospital, Dublin, Ireland
| | - Norma O'Donovan
- National Institute for Cellular Biotechnology, Dublin City University, Dublin, Ireland
| | - Fergal Kelleher
- Department of Medical Oncology, St. Vincent's University Hospital, Dublin, Ireland
| | - Aine O'Reilly
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
| | - Mark Doherty
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
| | - John Crown
- National Institute for Cellular Biotechnology, Dublin City University, Dublin, Ireland.,Department of Medical Oncology, St. Vincent's University Hospital, Dublin, Ireland
| | - Bryan T Hennessy
- Medical Oncology Lab, Department of Molecular Medicine, Royal College of Surgeons in Ireland, RCSI Smurfit Building, Beaumont Hospital, Dublin, Ireland.,Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
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Mullally WJ, Bracken-Clarke D, Padmore A, O'Reilly S, O’Mahony D, Walshe J, Kennedy J, Gupta R, Kelly C, O'Connor M, Duffy K, Keane M, Hennessy BT, Morris PG. Abstract P3-08-56: The impact of the 21 gene recurrence score (RS) on chemotherapy prescribing in estrogen receptor positive (ER+), lymph node positive (LN+) breast cancer (BC) in Ireland: A national, multi-centre, prospective study. Cancer Res 2020. [DOI: 10.1158/1538-7445.sabcs19-p3-08-56] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The 21 gene recurrence score (OncotypeDx ®) is reimbursed in Ireland to guide adjuvant treatment decisions for ER+, LN-negative, human epidermal growth factor receptor 2 (HER2)-negative BC. There is emerging evidence supporting the clinical utility of this test in patients with LN+ disease. Although the exact cut-off for chemotherapy has not been defined in this population, SEER data support the omission of chemotherapy for patients with RS <18 and the WSG Plan B randomised prospective study suggested excellent 5- year outcomes in patients with RS ≤11 treated with hormone therapy alone. However, the RS has not yet been reimbursed for patients with LN+ disease in Ireland. Methods: The Oncotype DX Breast Recurrence Score test N+ Access Programme (PONDx) aimed to collect real-life data on the use of the 21 gene RS in patients with LN+ ER+, HER2- early stage breast cancer. The PONDx study was conducted between March 2018 and May 2019 across the national oncology centres to determine the extent to which use of the RS could alter chemotherapy recommendations. Eligible patients had 1-3 LN+, HR+ and HER2- BC and were deemed possible candidates for chemotherapy. Anonymous questionnaires were completed by a Consultant Oncologist after the RS test was available. Data on patient demographics, tumour characteristics and treatment recommendations were collected.
Results: In total, 294 patients were enrolled across the - nine centres. Complete data is available on 123 patients (range 38 to 75, median 54 years), which included two male patients. Of the remaining 121 (98%) patients, 49 (40%) were premenopausal, 26 (21%) perimenopausal and 46 (37%) postmenopausal. The median tumour size was 38 mm (Range 7 to 58 mm). There were 101 (82%) patients with invasive ductal carcinoma, 17 (14%) with lobular carcinoma and 5 (4%) classified as other breast histology. Seventeen patients (14%) had grade 1, 74 (60%) grade 2 and 32 (26%) grade 3 disease. There were 79 (64%) patients with 1 LN+, 35 (29%) with 2 LN+ and 9 (7%) with 3 LN+ status. Overall access to the 21 gene RS test led to a 32% reduction in chemotherapy, 112 (91%) to 72 (59%) patients. This was most notable in patients with ductal histology (91 vs 61) and grade 2 breast cancer (66 vs 41) representing a 24.4% and 20.3% reduction, respectively. Similarly patients with 1 LN+ (71 vs 46) and 2 LN+ (34 vs 21) represented a 20.3% and 9.7% reduction, respectively. This study also identified four patients aged less than 40, for whom chemotherapy was not recommended. The biggest reduction in chemotherapy occurred in women aged over 50 (62 vs 36) at 21.1%. Overall, in 65% of cases, medical oncologists deemed the RS test result significantly changed treatment recommendations. Conclusion: These findings are consistent with results from similar studies in other countries. Broader access to the 21-gene RS could result in a reduction in the use of chemotherapy in Ireland.
Citation Format: William J Mullally, Dara Bracken-Clarke, Andrew Padmore, Seamus O'Reilly, Deirdre O’Mahony, Janice Walshe, John Kennedy, Rajnish Gupta, Cathy Kelly, Miriam O'Connor, Karen Duffy, Maccon Keane, Bryan T Hennessy, Patrick G Morris. The impact of the 21 gene recurrence score (RS) on chemotherapy prescribing in estrogen receptor positive (ER+), lymph node positive (LN+) breast cancer (BC) in Ireland: A national, multi-centre, prospective study [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P3-08-56.
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Affiliation(s)
| | | | - Andrew Padmore
- 3Genomic Health Inc, 301 Penobscot Drive, Redwood City, CA
| | | | | | - Janice Walshe
- 4St. Vincent's University Hospital, Dublin 4, Ireland
| | | | | | - Cathy Kelly
- 7Mater Misericordiae University Hospital, Dublin 7, Ireland
| | | | - Karen Duffy
- 9Letterkenny University Hospital, Letterkenny, Ireland
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Keegan NM, Furney S, Walshe J, Gullo G, Kennedy J, Bulger K, McCaffrey J, Kelly CM, Egan K, O'Donovan P, Hernando A, Teiserskiene A, Parker I, Farrelly AM, Carr A, Calzaferri G, McDermott R, Keane MM, Grogan L, Breathnach OS, Morris PG, Toomey S, Hennessy BT. Abstract P1-19-24: A phase Ib trial of copanlisib in combination with trastuzumab in pretreated recurrent or metastatic HER2-positive breast cancer “PantHER”. Cancer Res 2020. [DOI: 10.1158/1538-7445.sabcs19-p1-19-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background Activation of the phosphoinositide -3 kinase (PI3K) pathway is a resistance mechanism to anti-HER2 targeted therapy. This trial was conducted to determine the maximum tolerated dose (MTD) of copanlisib, an oral pan-class I PI3K inhibitor, combined with trastuzumab for patients with advanced HER2 positive breast cancer resistant to anti-HER2 therapy. Patients and Methods In this phase Ib open label dose escalation study, using a 6 + 6 design, patients with advanced HER2-positive breast cancer who had disease progression following at least one prior line of HER2 therapy in the metastatic setting were treated with a dose escalation schedule of copanlisib (dose level 1 =45mg or dose level 2 = 60mg) IV on days 1, 8 and 15 of a 28 day cycle along with a fixed dose of trastuzumab 2mg/kg weekly after a loading dose of 4mg/kg in cycle 1. Archival tumour tissue, voluntary serial tumour biopsies and serial plasma samples were collected for genomic sequencing. Results Twelve patients were enrolled. MTD was determined as copanlisib 60mg plus trastuzumab 2mg/kg weekly. There was no dose limiting toxicity. The most common treatment-related adverse events (AE) of any grade experienced in more than 2 patients were hyperglycemia (58%), fatigue (58%), nausea (58%) and hypertension (50%). Confirmed stable disease at 16 weeks was observed in 6 (50%) participants. PIK3CA mutations were detected in archival tumour tissue of 6 (50%) patients and did not appear to influence likelihood of clinical benefit. PIK3CA mutations were detected in serial plasma ctDNA of all 12 patients and fluctuated over the course of treatment. Next-Generation Sequencing (NGS) analysis identified novel somatic mutations in the TTRAP gene, which encodes a PI3K-like protein kinase, detected only in tumour samples obtained at metastatic time points. Additionally, NGS analysis demonstrated clear temporal genomic heterogeneity with decreasing PIK3CA mutation variant allele frequency (VAF) post therapy Conclusions The combination of copanlisib and trastuzumab was safely administered with good overall tolerability in this trial. Preliminary anti-tumour stability was observed in patients with heavily pre-treated metastatic HER2 positive breast cancer. Translational studies identified a number of potential biomarkers for further study in the now initiated phase 2 clinical trial.
Citation Format: Niamh M Keegan, Simon Furney, Janice Walshe, Giuseppe Gullo, John Kennedy, Kyran Bulger, John McCaffrey, Catherine M Kelly, Keith Egan, P O'Donovan, Andres Hernando, Ausra Teiserskiene, Imelda Parker, Angela M Farrelly, Aoife Carr, Giulio Calzaferri, Ray McDermott, Maccon M Keane, Liam Grogan, Oscar S Breathnach, Patrick G Morris, Sinead Toomey, Bryan T Hennessy. A phase Ib trial of copanlisib in combination with trastuzumab in pretreated recurrent or metastatic HER2-positive breast cancer “PantHER” [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P1-19-24.
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Affiliation(s)
| | - Simon Furney
- 2Genomic Oncology Research Group, Department of Physiology & Medical Physics, Center for Systems Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Janice Walshe
- 3Department of Medical Oncology, St Vincent's University Hospital, Dublin 4, Ireland
| | - Giuseppe Gullo
- 3Department of Medical Oncology, St Vincent's University Hospital, Dublin 4, Ireland
| | - John Kennedy
- 4Department of Medical Oncology, St James's Hospital, Dublin 8, Ireland
| | - Kyran Bulger
- 5Department of Medical Oncology, Midland Regional Hospital, Tullamore, Ireland
| | - John McCaffrey
- 6Department of Medical Oncology, Mater Misericordia University Hospital, Dublin 7, Ireland
| | - Catherine M Kelly
- 6Department of Medical Oncology, Mater Misericordia University Hospital, Dublin 7, Ireland
| | - Keith Egan
- 7Cancer Clinical Trials & Research Unit, Beaumont Hospital, Dublin 9, Ireland
| | - P O'Donovan
- 8Genomic Oncology Research Group, Department of Physiology & Medical Physics, Centre for Systems Medicine, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Andres Hernando
- 9Cancer Trials Ireland, Innovation House, Glasnevin, Dublin 11, Ireland
| | | | - Imelda Parker
- 9Cancer Trials Ireland, Innovation House, Glasnevin, Dublin 11, Ireland
| | - Angela M Farrelly
- 10Department of Molecular Medicine, Royal College of Surgeons in Ireland, Dublin 9, Ireland
| | - Aoife Carr
- 10Department of Molecular Medicine, Royal College of Surgeons in Ireland, Dublin 9, Ireland
| | - Giulio Calzaferri
- 11Department of Medical Oncology, St Vincent's University Hospital, Dublin 4, Ireland, Dublin 4, Ireland
| | - Ray McDermott
- 9Cancer Trials Ireland, Innovation House, Glasnevin, Dublin 11, Ireland
| | - Maccon M Keane
- 12Department of Medical Oncology, Galway University Hospital, Galway, Ireland
| | | | | | | | - Sinead Toomey
- 10Department of Molecular Medicine, Royal College of Surgeons in Ireland, Dublin 9, Ireland
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Sexton DJ, O'Kelly P, O'Leary E, Murray S, Deady S, Daly F, Egan J, Houlihan DD, McCormick PA, Morris PG, Ni Raghallaigh S, Moloney FJ, O'Neill JP, Conlon PJ. Variation in Nonmelanoma Skin Cancer Incidence by Treatment Modality Among Patients Receiving Multiple Kidney Transplants. JAMA Dermatol 2020; 155:594-598. [PMID: 30725084 DOI: 10.1001/jamadermatol.2018.4660] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Importance Existing data suggest that nonmelanoma skin cancer (NMSC) is more common in renal transplant recipients than in maintenance dialysis patients. However, whether the risk of NMSC varies as the treatment modality for end-stage kidney disease (ESKD) changes between dialysis and transplantation is not well described. Objective To determine whether the incidence of NMSC is attenuated during periods of graft loss with a return to dialysis in those who receive multiple kidney transplants. Design, Setting, and Participants Retrospective analysis of data from recipients of kidney transplants from the Irish National Kidney Transplant Service database, linked with the Irish Cancer Registry, from 1994 to 2014. All analysis took place between January 10, 2018 and March 31, 2018. Standardized incidence ratios (SIRs) were calculated for NMSC incidence in comparison with the general population using Irish census data as the denominator. Incidence of NMSC was calculated with modality of treatment for ESKD varying over time; incidence rates and rate ratios associated with dialysis intervals were calculated using Poisson regression; and disease was defined according to International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes for cancer diagnosis. Exposures Kidney transplantation. Main Outcomes and Measures Incidence rates per 1000 patient-years and incident rate ratios of NMSC after kidney transplant. Results Data from the records of 3821 deceased or living donor kidney transplant recipients were assessed; 2399 (62.8%) male and 1422 (37.2%) female recipients; mean (SD) age at time of first data recorded, 41.9 (16.0) years. A total of 3433 recipients were included who had a functioning transplant on January 1, 1994, or received a transplant after that date up to December 31, 2014: 3215 received 1 transplant, 522 a second kidney transplant, and 84 had 3 or more kidney transplants. Periods of treatment with a functioning transplant were associated with a higher incidence of NMSC diagnosis than periods of graft failure: adjusted incidence rate ratio (aIRR), 2.19 (95% CI, 1.56-3.07), P < .001. The aIRRs of NMSC fell from 41.7 (95% CI, 39.38-44.15) per 1000 patient-years in the first transplant to 19.29 (95% CI, 13.41-27.76) in the dialysis period following the first allograft failure. Incidence similarly rose and fell following each subsequent consecutive transplant. Conclusions and Relevance In recipients of multiple kidney transplants, while the incidence of NMSC fell during periods defined by transplant failure, there was residual elevated risk. While ascertainment bias may have contributed to the observed trends, the stagnant incidence of invasive cancer overall highlights the need for continued cancer surveillance during graft failure.
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Affiliation(s)
- Donal J Sexton
- Department of Nephrology and Kidney Transplantation, Beaumont Hospital Dublin, Ireland.,Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Patrick O'Kelly
- Department of Nephrology and Kidney Transplantation, Beaumont Hospital Dublin, Ireland
| | - Eamonn O'Leary
- National Cancer Registry Ireland, Cork Airport Business Park, Cork, Ireland
| | - Susan Murray
- Department of Nephrology and Kidney Transplantation, Beaumont Hospital Dublin, Ireland
| | - Sandra Deady
- National Cancer Registry Ireland, Cork Airport Business Park, Cork, Ireland
| | - Fergus Daly
- Department of Nephrology and Kidney Transplantation, Beaumont Hospital Dublin, Ireland
| | - Jim Egan
- National Lung Transplantation Center, Mater University Hospital, Dublin, Ireland
| | - Diarmaid D Houlihan
- National Liver Transplant Center, St Vincent's University Hospital, Dublin, Ireland
| | - P Aiden McCormick
- National Liver Transplant Center, St Vincent's University Hospital, Dublin, Ireland
| | | | | | - Fergal J Moloney
- Department of Dermatology, Mater Misericordiae University Hospital, University College Dublin, School of Medicine, Dublin, Ireland
| | - James Paul O'Neill
- Royal College of Surgeons in Ireland, Dublin, Ireland.,Department of Otolaryngology-Head and Neck Surgery, Beaumont Hospital, Dublin, Ireland
| | - Peter J Conlon
- Department of Nephrology and Kidney Transplantation, Beaumont Hospital Dublin, Ireland.,Royal College of Surgeons in Ireland, Dublin, Ireland
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Kennedy SP, O'Neill M, Cunningham D, Morris PG, Toomey S, Blanco-Aparicio C, Martinez S, Pastor J, Eustace AJ, Hennessy BT. Preclinical evaluation of a novel triple-acting PIM/PI3K/mTOR inhibitor, IBL-302, in breast cancer. Oncogene 2020; 39:3028-3040. [PMID: 32042115 PMCID: PMC7118022 DOI: 10.1038/s41388-020-1202-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [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] [Received: 03/28/2019] [Revised: 01/20/2020] [Accepted: 01/30/2020] [Indexed: 11/09/2022]
Abstract
The proviral integration of Moloney virus (PIM) family of protein kinases are overexpressed in many haematological and solid tumours. PIM kinase expression is elevated in PI3K inhibitor-treated breast cancer samples, suggesting a major resistance pathway for PI3K inhibitors in breast cancer, potentially limiting their clinical utility. IBL-302 is a novel molecule that inhibits both PIM and PI3K/AKT/mTOR signalling. We thus evaluated the preclinical activity of IBL-302, in a range of breast cancer models. Our results demonstrate in vitro efficacy of IBL-302 in a range of breast cancer cell lines, including lines with acquired resistance to trastuzumab and lapatinib. IBL-302 demonstrated single-agent, anti-tumour efficacy in suppression of pAKT, pmTOR and pBAD in the SKBR-3, BT-474 and HCC-1954 HER2+/PIK3CA-mutated cell lines. We have also shown the in vivo single-agent efficacy of IBL-302 in the subcutaneous BT-474 and HCC-1954 xenograft model in BALB/c nude mice. The combination of trastuzumab and IBL-302 significantly increased the anti-proliferative effect in HER2+ breast cancer cell line, and matched trastuzumab-resistant line, relative to testing either drug alone. We thus believe that the novel PIM and PI3K/mTOR inhibitor, IBL-302, represents an exciting new potential treatment option for breast cancer, and that it should be considered for clinical investigation.
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Affiliation(s)
- Sean P Kennedy
- Medical Oncology Group, Department of Molecular Medicine, Royal College of Surgeons Ireland, Smurfit Building Beaumont Hospital, Beaumont, Dublin, Ireland.
| | - Michael O'Neill
- Inflection Biosciences, Anglesea House, Blackrock, Dublin, Ireland
| | | | - Patrick G Morris
- Medical Oncology Group, Department of Molecular Medicine, Royal College of Surgeons Ireland, Smurfit Building Beaumont Hospital, Beaumont, Dublin, Ireland.,Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland
| | - Sinead Toomey
- Medical Oncology Group, Department of Molecular Medicine, Royal College of Surgeons Ireland, Smurfit Building Beaumont Hospital, Beaumont, Dublin, Ireland
| | - Carmen Blanco-Aparicio
- Experimental Therapeutics Programme, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - Sonia Martinez
- Experimental Therapeutics Programme, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - Joaquin Pastor
- Experimental Therapeutics Programme, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - Alex J Eustace
- Molecular Therapeutics for Cancer in Ireland, National Institute for Cellular Biotechnology, Dublin City University, Dublin, Ireland
| | - Bryan T Hennessy
- Medical Oncology Group, Department of Molecular Medicine, Royal College of Surgeons Ireland, Smurfit Building Beaumont Hospital, Beaumont, Dublin, Ireland.,Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland.,Cancer Trials Ireland, Innovation House, Old Finglas Road, Botanic, Dublin, Ireland
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40
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Gleeson JP, Keane F, Keegan NM, Mammadov E, Harrold E, Alhusaini A, Harte J, Eakin-Love A, O'Halloran PJ, MacNally S, Hennessy BT, Breathnach OS, Grogan L, Morris PG. Similar overall survival with reduced vs. standard dose bevacizumab monotherapy in progressive glioblastoma. Cancer Med 2019; 9:469-475. [PMID: 31756059 PMCID: PMC6970030 DOI: 10.1002/cam4.2616] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 09/30/2019] [Accepted: 10/03/2019] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Bevacizumab has demonstrated activity in glioblastoma (GBM), but the true benefits and optimal dose-schedule are debated. A lower dose-schedule than standard-dose bevacizumab (10 mg/kg 2-weekly) might offer similar benefits with lower costs. At our Institution, patients are randomly assigned at time of primary diagnosis to Neuro-Oncologists, who have varying practices in terms of bevacizumab dose-schedule upon progression. METHODS In a retrospective analysis we examined overall survival (OS), measured from first administered bevacizumab dose until death, according to dose-schedule. Patients with de novo WHO Grade IV GBM who received standard- or reduced-dose (5 mg/kg 2-weekly) bevacizumab were included. MGMT methylation status and time from diagnosis to bevacizumab start were examined as prognostic variables. Clinical benefit and a comparative cost analysis were assessed. RESULTS In total, 1127 bevacizumab doses were administered to 118 patients [Median: 7, Range: 1-44]. Median OS (mOS) was 5.8 months. 69 (59%) patients received standard-dose bevacizumab (mOS: 5.97 months) and 49 patients received reduced-dose (mOS: 5.7 months). No statistically significant difference in OS between dosing schedule was seen (HR: 1.11, P-value: .584). Patients with MGMT methylated tumors (43%) had improved OS compared to those with unmethylated tumors; 7.03 vs 4.97 months (HR: 0.61, P-value: .027). If all patients were treated with reduced-dose bevacizumab, an estimated €2.4M cost reduction would be observed. CONCLUSIONS In this retrospective study, reduced-dose bevacizumab schedule resulted in similar OS to standard-dose bevacizumab monotherapy with substantial cost savings. MGMT methylation appears to convey a survival benefit in the setting of bevacizumab treatment for progressive GBM.
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Affiliation(s)
- Jack Patrick Gleeson
- Medical Oncology Department, Beaumont Hospital, Dublin, Ireland.,Medical Oncology Department, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Fergus Keane
- Medical Oncology Department, Beaumont Hospital, Dublin, Ireland
| | - Niamh M Keegan
- Medical Oncology Department, Beaumont Hospital, Dublin, Ireland.,Medical Oncology Department, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Emin Mammadov
- Medical Oncology Department, Beaumont Hospital, Dublin, Ireland
| | - Emily Harrold
- Medical Oncology Department, Beaumont Hospital, Dublin, Ireland.,Medical Oncology Department, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Abdullah Alhusaini
- Medical Oncology Department, Beaumont Hospital, Dublin, Ireland.,Royal College of Surgeons of Ireland (RCSI), Dublin, Ireland
| | - Jeffrey Harte
- Medical Oncology Department, Beaumont Hospital, Dublin, Ireland.,Royal College of Surgeons of Ireland (RCSI), Dublin, Ireland
| | | | | | | | - Bryan T Hennessy
- Medical Oncology Department, Beaumont Hospital, Dublin, Ireland.,Royal College of Surgeons of Ireland (RCSI), Dublin, Ireland.,Cancer Clinical Trials and Research Unit, RCSI Hospital Group, Beaumont Hospital, Dublin, Ireland
| | - Oscar S Breathnach
- Medical Oncology Department, Beaumont Hospital, Dublin, Ireland.,Royal College of Surgeons of Ireland (RCSI), Dublin, Ireland.,Cancer Clinical Trials and Research Unit, RCSI Hospital Group, Beaumont Hospital, Dublin, Ireland
| | - Liam Grogan
- Medical Oncology Department, Beaumont Hospital, Dublin, Ireland.,Royal College of Surgeons of Ireland (RCSI), Dublin, Ireland.,Cancer Clinical Trials and Research Unit, RCSI Hospital Group, Beaumont Hospital, Dublin, Ireland
| | - Patrick G Morris
- Medical Oncology Department, Beaumont Hospital, Dublin, Ireland.,Royal College of Surgeons of Ireland (RCSI), Dublin, Ireland.,Cancer Clinical Trials and Research Unit, RCSI Hospital Group, Beaumont Hospital, Dublin, Ireland
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O'Neill JP, Sexton DJ, O'Leary E, O'Kelly P, Murray S, Deady S, Daly F, Williams Y, Dean B, Fitzgerald C, Murad A, Mansoor N, O'Neill JO, Egan J, Houlihan DD, McCormick PA, Morris PG, Ni Raghallaigh S, Little D, Moloney FJ, Conlon PJ. Post-transplant malignancy in solid organ transplant recipients in Ireland, The Irish Transplant Cancer Group. Clin Transplant 2019; 33:e13669. [PMID: 31310037 DOI: 10.1111/ctr.13669] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 06/09/2019] [Accepted: 06/26/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Solid organ transplant recipients are at increased risk of cancer compared to the general population. To date, this risk in Ireland has not been investigated. We conducted a national registry study of cancer incidence following solid organ transplantation. METHODS National centers for solid organ transplantation supplied their respective registry databases to cross-reference with episodes of malignancy from the National Cancer Registry Ireland (NCRI) between 1994 and 2014. Standardized incidence of cancer post-transplant was compared to the general population by means of standardized incidence ratios (SIRs), and between solid organ transplant types by incidence rate ratios. RESULTS A total of 3346 solid organ transplant recipients were included in this study. Kidney transplant recipients constituted the majority of participants (71.2%), followed by liver (16.8%), heart (6.4%), and lung (5.6%) transplants. The most common cancers within the composite of all transplant recipients included the following (SIR [95% CI]): squamous and basal cell carcinoma (20.05 [17.97, 22.31] and 7.16 [6.43, 7.96], respectively), non-Hodgkin lymphoma (6.23 [4.26, 8.59]), and renal cell carcinoma (3.36 [1.96, 5.38]). CONCLUSIONS This study reports the incidence of cancer following solid organ transplantation in Ireland. These results have significant national policy implications for surveillance, and early diagnosis in this patient group.
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Affiliation(s)
- James Paul O'Neill
- Department of Otolaryngology, Head and Neck Surgery, Beaumont Hospital & The Royal College of Surgeons in Ireland, Dublin, Ireland.,Royal College of Surgeons Ireland, Dublin, Ireland
| | - Donal J Sexton
- Department of Transplant Urology and Nephrology, National Kidney Transplant Service, Beaumont Hospital Dublin, Dublin, Ireland
| | | | - Patrick O'Kelly
- Department of Transplant Urology and Nephrology, National Kidney Transplant Service, Beaumont Hospital Dublin, Dublin, Ireland
| | - Susan Murray
- Department of Transplant Urology and Nephrology, National Kidney Transplant Service, Beaumont Hospital Dublin, Dublin, Ireland
| | | | - Fergus Daly
- Department of Transplant Urology and Nephrology, National Kidney Transplant Service, Beaumont Hospital Dublin, Dublin, Ireland
| | - Yvonne Williams
- Department of Transplant Urology and Nephrology, National Kidney Transplant Service, Beaumont Hospital Dublin, Dublin, Ireland
| | - Ben Dean
- Department of Transplant Urology and Nephrology, National Kidney Transplant Service, Beaumont Hospital Dublin, Dublin, Ireland
| | - Conall Fitzgerald
- Department of Otolaryngology, Head and Neck Surgery, Beaumont Hospital & The Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Aizuri Murad
- Department of Dermatology, School of Medicine, Mater Misericordiae University Hospital, University College Dublin, Dublin, Ireland
| | - Nazish Mansoor
- Department of Dermatology, School of Medicine, Mater Misericordiae University Hospital, University College Dublin, Dublin, Ireland
| | - Jim O O'Neill
- National Heart Transplant Center, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Jim Egan
- National Lung Transplantation Center, Mater University Hospital Dublin, Dublin, Ireland
| | - Diarmaid D Houlihan
- National Liver Transplant Center, St Vincent's University Hospital, Dublin, Ireland
| | - P Aiden McCormick
- National Liver Transplant Center, St Vincent's University Hospital, Dublin, Ireland
| | - Patrick G Morris
- Royal College of Surgeons Ireland, Dublin, Ireland.,Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
| | | | - Dilly Little
- Department of Transplant Urology and Nephrology, National Kidney Transplant Service, Beaumont Hospital Dublin, Dublin, Ireland
| | - Fergal J Moloney
- Department of Dermatology, School of Medicine, Mater Misericordiae University Hospital, University College Dublin, Dublin, Ireland
| | - Peter J Conlon
- Royal College of Surgeons Ireland, Dublin, Ireland.,Department of Transplant Urology and Nephrology, National Kidney Transplant Service, Beaumont Hospital Dublin, Dublin, Ireland
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He F, Springer NL, Whitman MA, Pathi SP, Lee Y, Mohanan S, Marcott S, Chiou AE, Blank BS, Iyengar N, Morris PG, Jochelson M, Hudis CA, Shah P, Kunitake JAMR, Estroff LA, Lammerding J, Fischbach C. Hydroxyapatite mineral enhances malignant potential in a tissue-engineered model of ductal carcinoma in situ (DCIS). Biomaterials 2019; 224:119489. [PMID: 31546097 DOI: 10.1016/j.biomaterials.2019.119489] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 09/06/2019] [Accepted: 09/11/2019] [Indexed: 01/21/2023]
Abstract
While ductal carcinoma in situ (DCIS) is known as a precursor lesion to most invasive breast carcinomas, the mechanisms underlying this transition remain enigmatic. DCIS is typically diagnosed by the mammographic detection of microcalcifications (MC). MCs consisting of non-stoichiometric hydroxyapatite (HA) mineral are frequently associated with malignant disease, yet it is unclear whether HA can actively promote malignancy. To investigate this outstanding question, we compared phenotypic outcomes of breast cancer cells cultured in control or HA-containing poly(lactide-co-glycolide) (PLG) scaffolds. Exposure to HA mineral in scaffolds increased the expression of pro-tumorigenic interleukin-8 (IL-8) among transformed but not benign cells. Notably, MCF10DCIS.com cells cultured in HA scaffolds adopted morphological changes associated with increased invasiveness and exhibited increased motility that were dependent on IL-8 signaling. Moreover, MCF10DCIS.com xenografts in HA scaffolds displayed evidence of enhanced malignant progression relative to xenografts in control scaffolds. These experimental findings were supported by a pathological analysis of clinical DCIS specimens, which correlated the presence of MCs with increased IL-8 staining and ductal proliferation. Collectively, our work suggests that HA mineral may stimulate malignancy in preinvasive DCIS cells and validate PLG scaffolds as useful tools to study cell-mineral interactions.
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Affiliation(s)
- Frank He
- Nancy E. and Peter C. Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY, 14853, USA
| | - Nora L Springer
- Nancy E. and Peter C. Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY, 14853, USA; Department of Diagnostic Medicine/Pathobiology, Kansas State University College of Veterinary Medicine, Manhattan, KS, 66506, USA
| | - Matthew A Whitman
- Nancy E. and Peter C. Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY, 14853, USA
| | - Siddharth P Pathi
- Nancy E. and Peter C. Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY, 14853, USA
| | - Yeonkyung Lee
- Nancy E. and Peter C. Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY, 14853, USA
| | - Sunish Mohanan
- Department of Biomedical Sciences, Baker Institute for Animal Health, Cornell University, Ithaca, NY, 14853, USA
| | - Stephen Marcott
- Nancy E. and Peter C. Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY, 14853, USA
| | - Aaron E Chiou
- Nancy E. and Peter C. Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY, 14853, USA
| | - Bryant S Blank
- Cornell Center for Animal Resources and Education, College of Veterinary Medicine, Cornell University, Ithaca, NY, 14853, USA
| | - Neil Iyengar
- Breast Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center/Evelyn H. Lauder Breast and Imaging Center, New York, NY, 10065, USA
| | - Patrick G Morris
- Breast Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center/Evelyn H. Lauder Breast and Imaging Center, New York, NY, 10065, USA
| | - Maxine Jochelson
- Department of Radiology, Memorial Sloan Kettering Cancer Center/Evelyn H. Lauder Breast and Imaging Center, New York, NY, 10065, USA
| | - Clifford A Hudis
- Breast Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center/Evelyn H. Lauder Breast and Imaging Center, New York, NY, 10065, USA
| | - Pragya Shah
- Nancy E. and Peter C. Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY, 14853, USA; Weill Institute for Cell and Molecular Biology, Cornell University, Ithaca, NY, 14853, USA
| | - Jennie A M R Kunitake
- Department of Materials Science and Engineering, Cornell University, Ithaca, NY, 14853, USA
| | - Lara A Estroff
- Department of Materials Science and Engineering, Cornell University, Ithaca, NY, 14853, USA; Kavli Institute at Cornell for Nanoscale Science, Cornell University, Ithaca, NY, 14853, USA
| | - Jan Lammerding
- Nancy E. and Peter C. Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY, 14853, USA; Weill Institute for Cell and Molecular Biology, Cornell University, Ithaca, NY, 14853, USA
| | - Claudia Fischbach
- Nancy E. and Peter C. Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY, 14853, USA; Kavli Institute at Cornell for Nanoscale Science, Cornell University, Ithaca, NY, 14853, USA.
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Hassan A, Gullo G, O'Reilly S, Ruiz-Borrego M, Toomey S, Grogan L, Breathnach O, Morris PG, Walshe JM, Crown J, O'Mahony D, Falcon A, Egan K, Hernando A, Teiserskiene A, Kelly CM, Coate L, Hennessy BT. Abstract OT3-06-01: Phase Ib clinical trial of co PANlisib in combination with Trastuzumab emtansine (T-DM1) in pre-treated unresectable locally advanced or metastatic HER2-positive bre Ast cancer (BC) “PANTHERA”-CTRIAL-IE 17-13. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-ot3-06-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background:The phosphoinositide 3 kinase (PI3K) pathway is important in the oncogenic function of HER2. Aberrant activation of PI3K is implicated in resistance to trastuzumab and other HER2-targeted therapies and is frequent, with up to 22% of HER2 positive breast cancer having a PIK3CA mutation. Copanlisib is a pan-class 1 PI3K inhibitor administered i.v. with low nanomolar activity against both PI3Kα and PI3Kβ. Copanlisib has been shown to re-sensitise trastuzumab resistant cell lines to trastuzumab with synergism seen in some cell lines between copanlisib and HER2 targeted therapy.
Trial design: This is a phase Ib open label, single arm adaptive, multi-centre trial of copanlisib in combination with T-DM1. Eligible patients will receive T-DM1 at 3.6mg/kg i.v. on day 1 of a 21-day cycle plus copanlisib. Copanlisib will be administered i.v. according to the dose escalation scheme (dose level 1 is 45mg on days 1 and 8, dose level 2 is 60mg on days 1 and 8, dose level 3 is 60mg on days 1, 8, and 15). Dose level -1 will be 45 mg on day 1 in case dose de-escalation is needed. We will enrol 3 to 6 patients per dose level. All patients in each level must have completed at least the first cycle of therapy before enrolment in the next dose level. Patients not completing the first cycle for a reason other than toxicity will be replaced. Dose escalation and determination of the Maximum Tolerated Dose (MTD) will be based on the occurrence of Dose Limiting Toxicities (DLT).
Eligibility criteria:Eligible patients are those with unresectable locally advanced or metastatic HER2-positive BC who previously received trastuzumab and a taxane, separately or in combination. Participants must have adequate organ function and ECOG PS ≤ 2
Objectives:The primary objective is to determine the MTD for copanlisib in combination with T-DM1 in patients with pre-treated unresectable locally advanced or metastatic HER2-positive BC. Secondary objectives include evaluating the safety, efficacy and cardiotoxicity in patients treated with this regimen. Exploratory objectives include examining for predictive biomarkers in tumour tissue and blood or plasma and to examine molecular tumour adaptation to clinical trial therapy.
Statistical methods: Patients will be accrued in cohorts of 3 patients according to a standard 3+3 algorithm, with dose escalation and determination of MTD based on the occurrence of DLT, using the usual threshold probability of 33%. The final dose level will be expanded to include a total of 6 additional patients (expansion cohort).
Present accrual and target accrual:The trial will start accrual in October 2018. Maximum of 24 patients will be enrolled.
Citation Format: Hassan A, Gullo G, O'Reilly S, Ruiz-Borrego M, Toomey S, Grogan L, Breathnach O, Morris PG, Walshe JM, Crown J, O'Mahony D, Falcon A, Egan K, Hernando A, Teiserskiene A, Kelly CM, Coate L, Hennessy BT. Phase Ib clinical trial of coPANlisib in combination with Trastuzumab emtansine (T-DM1) in pre-treated unresectable locally advanced or metastatic HER2-positive breAst cancer (BC) “PANTHERA”-CTRIAL-IE 17-13 [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr OT3-06-01.
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Affiliation(s)
- A Hassan
- RCSI, Dublin 9, Ireland; Beaumont Hospital, Dublin 9, Ireland; St Vincent's University Hospital, Dublin 4, Ireland; Cork University Hospital, Cork, Ireland; Hospital Universitario Virgen Del Rocío, Sevilla, Spain; GEICAM, Spanish Breast Cancer Group, Madrid, Spain; Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland; Cancer Trials Ireland, Dublin, Ireland; Mater Misericordiae University Hospital, Dublin, Ireland
| | - G Gullo
- RCSI, Dublin 9, Ireland; Beaumont Hospital, Dublin 9, Ireland; St Vincent's University Hospital, Dublin 4, Ireland; Cork University Hospital, Cork, Ireland; Hospital Universitario Virgen Del Rocío, Sevilla, Spain; GEICAM, Spanish Breast Cancer Group, Madrid, Spain; Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland; Cancer Trials Ireland, Dublin, Ireland; Mater Misericordiae University Hospital, Dublin, Ireland
| | - S O'Reilly
- RCSI, Dublin 9, Ireland; Beaumont Hospital, Dublin 9, Ireland; St Vincent's University Hospital, Dublin 4, Ireland; Cork University Hospital, Cork, Ireland; Hospital Universitario Virgen Del Rocío, Sevilla, Spain; GEICAM, Spanish Breast Cancer Group, Madrid, Spain; Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland; Cancer Trials Ireland, Dublin, Ireland; Mater Misericordiae University Hospital, Dublin, Ireland
| | - M Ruiz-Borrego
- RCSI, Dublin 9, Ireland; Beaumont Hospital, Dublin 9, Ireland; St Vincent's University Hospital, Dublin 4, Ireland; Cork University Hospital, Cork, Ireland; Hospital Universitario Virgen Del Rocío, Sevilla, Spain; GEICAM, Spanish Breast Cancer Group, Madrid, Spain; Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland; Cancer Trials Ireland, Dublin, Ireland; Mater Misericordiae University Hospital, Dublin, Ireland
| | - S Toomey
- RCSI, Dublin 9, Ireland; Beaumont Hospital, Dublin 9, Ireland; St Vincent's University Hospital, Dublin 4, Ireland; Cork University Hospital, Cork, Ireland; Hospital Universitario Virgen Del Rocío, Sevilla, Spain; GEICAM, Spanish Breast Cancer Group, Madrid, Spain; Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland; Cancer Trials Ireland, Dublin, Ireland; Mater Misericordiae University Hospital, Dublin, Ireland
| | - L Grogan
- RCSI, Dublin 9, Ireland; Beaumont Hospital, Dublin 9, Ireland; St Vincent's University Hospital, Dublin 4, Ireland; Cork University Hospital, Cork, Ireland; Hospital Universitario Virgen Del Rocío, Sevilla, Spain; GEICAM, Spanish Breast Cancer Group, Madrid, Spain; Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland; Cancer Trials Ireland, Dublin, Ireland; Mater Misericordiae University Hospital, Dublin, Ireland
| | - O Breathnach
- RCSI, Dublin 9, Ireland; Beaumont Hospital, Dublin 9, Ireland; St Vincent's University Hospital, Dublin 4, Ireland; Cork University Hospital, Cork, Ireland; Hospital Universitario Virgen Del Rocío, Sevilla, Spain; GEICAM, Spanish Breast Cancer Group, Madrid, Spain; Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland; Cancer Trials Ireland, Dublin, Ireland; Mater Misericordiae University Hospital, Dublin, Ireland
| | - PG Morris
- RCSI, Dublin 9, Ireland; Beaumont Hospital, Dublin 9, Ireland; St Vincent's University Hospital, Dublin 4, Ireland; Cork University Hospital, Cork, Ireland; Hospital Universitario Virgen Del Rocío, Sevilla, Spain; GEICAM, Spanish Breast Cancer Group, Madrid, Spain; Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland; Cancer Trials Ireland, Dublin, Ireland; Mater Misericordiae University Hospital, Dublin, Ireland
| | - JM Walshe
- RCSI, Dublin 9, Ireland; Beaumont Hospital, Dublin 9, Ireland; St Vincent's University Hospital, Dublin 4, Ireland; Cork University Hospital, Cork, Ireland; Hospital Universitario Virgen Del Rocío, Sevilla, Spain; GEICAM, Spanish Breast Cancer Group, Madrid, Spain; Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland; Cancer Trials Ireland, Dublin, Ireland; Mater Misericordiae University Hospital, Dublin, Ireland
| | - J Crown
- RCSI, Dublin 9, Ireland; Beaumont Hospital, Dublin 9, Ireland; St Vincent's University Hospital, Dublin 4, Ireland; Cork University Hospital, Cork, Ireland; Hospital Universitario Virgen Del Rocío, Sevilla, Spain; GEICAM, Spanish Breast Cancer Group, Madrid, Spain; Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland; Cancer Trials Ireland, Dublin, Ireland; Mater Misericordiae University Hospital, Dublin, Ireland
| | - D O'Mahony
- RCSI, Dublin 9, Ireland; Beaumont Hospital, Dublin 9, Ireland; St Vincent's University Hospital, Dublin 4, Ireland; Cork University Hospital, Cork, Ireland; Hospital Universitario Virgen Del Rocío, Sevilla, Spain; GEICAM, Spanish Breast Cancer Group, Madrid, Spain; Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland; Cancer Trials Ireland, Dublin, Ireland; Mater Misericordiae University Hospital, Dublin, Ireland
| | - A Falcon
- RCSI, Dublin 9, Ireland; Beaumont Hospital, Dublin 9, Ireland; St Vincent's University Hospital, Dublin 4, Ireland; Cork University Hospital, Cork, Ireland; Hospital Universitario Virgen Del Rocío, Sevilla, Spain; GEICAM, Spanish Breast Cancer Group, Madrid, Spain; Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland; Cancer Trials Ireland, Dublin, Ireland; Mater Misericordiae University Hospital, Dublin, Ireland
| | - K Egan
- RCSI, Dublin 9, Ireland; Beaumont Hospital, Dublin 9, Ireland; St Vincent's University Hospital, Dublin 4, Ireland; Cork University Hospital, Cork, Ireland; Hospital Universitario Virgen Del Rocío, Sevilla, Spain; GEICAM, Spanish Breast Cancer Group, Madrid, Spain; Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland; Cancer Trials Ireland, Dublin, Ireland; Mater Misericordiae University Hospital, Dublin, Ireland
| | - A Hernando
- RCSI, Dublin 9, Ireland; Beaumont Hospital, Dublin 9, Ireland; St Vincent's University Hospital, Dublin 4, Ireland; Cork University Hospital, Cork, Ireland; Hospital Universitario Virgen Del Rocío, Sevilla, Spain; GEICAM, Spanish Breast Cancer Group, Madrid, Spain; Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland; Cancer Trials Ireland, Dublin, Ireland; Mater Misericordiae University Hospital, Dublin, Ireland
| | - A Teiserskiene
- RCSI, Dublin 9, Ireland; Beaumont Hospital, Dublin 9, Ireland; St Vincent's University Hospital, Dublin 4, Ireland; Cork University Hospital, Cork, Ireland; Hospital Universitario Virgen Del Rocío, Sevilla, Spain; GEICAM, Spanish Breast Cancer Group, Madrid, Spain; Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland; Cancer Trials Ireland, Dublin, Ireland; Mater Misericordiae University Hospital, Dublin, Ireland
| | - CM Kelly
- RCSI, Dublin 9, Ireland; Beaumont Hospital, Dublin 9, Ireland; St Vincent's University Hospital, Dublin 4, Ireland; Cork University Hospital, Cork, Ireland; Hospital Universitario Virgen Del Rocío, Sevilla, Spain; GEICAM, Spanish Breast Cancer Group, Madrid, Spain; Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland; Cancer Trials Ireland, Dublin, Ireland; Mater Misericordiae University Hospital, Dublin, Ireland
| | - L Coate
- RCSI, Dublin 9, Ireland; Beaumont Hospital, Dublin 9, Ireland; St Vincent's University Hospital, Dublin 4, Ireland; Cork University Hospital, Cork, Ireland; Hospital Universitario Virgen Del Rocío, Sevilla, Spain; GEICAM, Spanish Breast Cancer Group, Madrid, Spain; Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland; Cancer Trials Ireland, Dublin, Ireland; Mater Misericordiae University Hospital, Dublin, Ireland
| | - BT Hennessy
- RCSI, Dublin 9, Ireland; Beaumont Hospital, Dublin 9, Ireland; St Vincent's University Hospital, Dublin 4, Ireland; Cork University Hospital, Cork, Ireland; Hospital Universitario Virgen Del Rocío, Sevilla, Spain; GEICAM, Spanish Breast Cancer Group, Madrid, Spain; Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland; Cancer Trials Ireland, Dublin, Ireland; Mater Misericordiae University Hospital, Dublin, Ireland
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Doherty MK, O'Connor E, Hannon D, O'Reilly A, Yen D, Redmond M, Grogan LM, Hennessy BT, Breathnach OS, Morris PG. Absence of thyroid transcription factor-1 expression is associated with poor survival in patients with advanced pulmonary adenocarcinoma treated with pemetrexed-based chemotherapy. Ir J Med Sci 2018; 188:69-74. [PMID: 29948461 DOI: 10.1007/s11845-018-1839-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 05/31/2018] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Adenocarcinoma is the commonest histologic subtype of lung cancer and is often identified by immunohistochemical staining for thyroid transcription factor-1 (TTF-1). However, up to 20% of lung adenocarcinomas do not express TTF-1, and there is uncertainty regarding the significance of this. We aimed to evaluate the prognostic effect of TTF-1 expression status on survival in patients treated with pemetrexed-based chemotherapy for advanced adenocarcinoma of the lung. METHODS This retrospective study included patients treated with pemetrexed-based chemotherapy for stage IIIB/IV lung adenocarcinoma, who had known TTF-1 expression status. Clinical and demographic data were obtained from medical records. Overall survival (OS) was estimated using the Kaplan-Meier method, and differences in survival between groups assessed using the Cox proportional hazards model. RESULTS Forty-four patients were identified with documented TTF-1 expression: 35 with TTF-1-positive and 9 with TTF-1-negative disease. Patients in the TTF-1-negative group had poorer performance scores than those in the TTF-1-positive group (ECOG 2: 67 vs 20%, p = 0.008), and received less chemotherapy (median cycles 2 vs 4, p = 0.009), and were fewer in treatment with doublet regimens (22 vs 69%, p = 0.013). OS was significantly shorter in the TTF-1-negative group than in the TTF-1-positive group (2.4 vs 11.5 months, HR 8.38, p < 0.0001). CONCLUSIONS In this group of patients treated with pemetrexed-based chemotherapy for advanced pulmonary adenocarcinoma, absence of TTF-1 expression was associated with an aggressive tumor phenotype, poorer performance status, and poor survival. This subgroup of patients should be recognized as having a distinct clinical course, with limited benefit from standard chemotherapy.
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Affiliation(s)
- Mark K Doherty
- Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland
| | - Emer O'Connor
- Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland
| | - David Hannon
- Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland
| | - Aine O'Reilly
- Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland
| | - Daphne Yen
- Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland
| | - Maeve Redmond
- Department of Pathology, Beaumont Hospital, Dublin, Ireland
| | - Liam M Grogan
- Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
| | - Bryan T Hennessy
- Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland
- Royal College of Surgeons of Ireland, Dublin, Ireland
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
| | - Oscar S Breathnach
- Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
| | - Patrick G Morris
- Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland.
- Royal College of Surgeons of Ireland, Dublin, Ireland.
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland.
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Gleeson JP, Keegan NM, Morris PG. Neoadjuvant pertuzumab, T-DM1, weekly paclitaxel and possible anthracyclines in HER2 positive early breast cancer treatment—questions from the KRISTINE study. Transl Cancer Res 2018. [DOI: 10.21037/tcr.2018.04.14] [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: 11/06/2022]
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Keegan NM, Walshe JM, Toomey S, Gullo G, Kennedy MJ, Bulger KN, McCaffrey J, Kelly CM, Crown J, Egan K, Kerr J, Teiserskiene A, Hernando A, Parker I, McDermott R, Keane MM, Grogan W, Breathnach OS, Morris PG, Hennessy B. A phase Ib trial of copanlisib and tratuzumab in pretreated recurrent or metastatic HER2-positive breast cancer “PantHER”. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.1036] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [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)
| | | | - Sinead Toomey
- Department of Molecular Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | | | | | - John McCaffrey
- Mater Misericordiae University Hospital, Dublin, Ireland
| | | | - John Crown
- NSABP/NRG Oncology, and The IIrish Cooperative Oncology Research Group, Dublin, Ireland
| | - Keith Egan
- Department of Medical Oncology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | | | | | - Imelda Parker
- Mater Misericordiae University Hospital, Dublin, Ireland
| | | | | | - William Grogan
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
| | | | | | - Bryan Hennessy
- Beaumont Hospital, Royal College of Surgeons in Ireland, Dublin, Ireland
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Gleeson JP, Greene JP, Mullally WJ, Brady C, Goggin C, Dennehy C, Power DG, Hennessy B, Breathnach OS, Bambury RM, O'Reilly S, Grogan W, Collins DC, Morris PG, O'Mahony D. Cost saving analysis of reduced-dose versus standard-dose bevacizumab in recurrent glioblastoma. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e18910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | - Bryan Hennessy
- Beaumont Hospital, Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | | | | | - William Grogan
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
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Kunitake JAMR, Choi S, Nguyen KX, Lee MM, He F, Sudilovsky D, Morris PG, Jochelson MS, Hudis CA, Muller DA, Fratzl P, Fischbach C, Masic A, Estroff LA. Correlative imaging reveals physiochemical heterogeneity of microcalcifications in human breast carcinomas. J Struct Biol 2018; 202:25-34. [PMID: 29221896 PMCID: PMC5835408 DOI: 10.1016/j.jsb.2017.12.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 09/26/2017] [Accepted: 12/02/2017] [Indexed: 02/02/2023]
Abstract
Microcalcifications (MCs) are routinely used to detect breast cancer in mammography. Little is known, however, about their materials properties and associated organic matrix, or their correlation to breast cancer prognosis. We combine histopathology, Raman microscopy, and electron microscopy to image MCs within snap-frozen human breast tissue and generate micron-scale resolution correlative maps of crystalline phase, trace metals, particle morphology, and organic matrix chemical signatures within high grade ductal carcinoma in situ (DCIS) and invasive cancer. We reveal the heterogeneity of mineral-matrix pairings, including punctate apatitic particles (<2 µm) with associated trace elements (e.g., F, Na, and unexpectedly Al) distributed within the necrotic cores of DCIS, and both apatite and spheroidal whitlockite particles in invasive cancer within a matrix containing spectroscopic signatures of collagen, non-collagen proteins, cholesterol, carotenoids, and DNA. Among the three DCIS samples, we identify key similarities in MC morphology and distribution, supporting a dystrophic mineralization pathway. This multimodal methodology lays the groundwork for establishing MC heterogeneity in the context of breast cancer biology, and could dramatically improve current prognostic models.
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Affiliation(s)
- Jennie A M R Kunitake
- Department of Materials Science and Engineering, Cornell University, Ithaca, NY 14853, USA
| | - Siyoung Choi
- Nancy E. and Peter C. Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY 14853, USA
| | - Kayla X Nguyen
- School of Applied and Engineering Physics, Cornell University, Ithaca, NY 14853, USA
| | - Meredith M Lee
- Department of Materials Science and Engineering, Cornell University, Ithaca, NY 14853, USA
| | - Frank He
- Nancy E. and Peter C. Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY 14853, USA
| | - Daniel Sudilovsky
- Department of Pathology and Laboratory Medicine, Cayuga Medical Center at Ithaca, Ithaca, NY 14850, USA; Department of Pathology, Upstate Medical University, SUNY, Binghamton, NY 13904, USA
| | - Patrick G Morris
- Breast Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center/Evelyn H. Lauder Breast and Imaging Center, New York, NY 10065, USA
| | - Maxine S Jochelson
- Department of Radiology, Memorial Sloan Kettering Cancer Center/Evelyn H. Lauder Breast and Imaging Center, New York, NY 10065, USA
| | - Clifford A Hudis
- Breast Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center/Evelyn H. Lauder Breast and Imaging Center, New York, NY 10065, USA
| | - David A Muller
- School of Applied and Engineering Physics, Cornell University, Ithaca, NY 14853, USA; Kavli Institute at Cornell for Nanoscale Science, Cornell University, Ithaca, NY 14853, USA
| | - Peter Fratzl
- Department of Biomaterials, Max Planck Institute of Colloids and Interfaces, Research Campus Potsdam-Golm, 14424 Potsdam, Germany
| | - Claudia Fischbach
- Nancy E. and Peter C. Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY 14853, USA; Kavli Institute at Cornell for Nanoscale Science, Cornell University, Ithaca, NY 14853, USA.
| | - Admir Masic
- Department of Civil and Environmental Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.
| | - Lara A Estroff
- Department of Materials Science and Engineering, Cornell University, Ithaca, NY 14853, USA; Kavli Institute at Cornell for Nanoscale Science, Cornell University, Ithaca, NY 14853, USA.
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Morris PG, Rota S, Cadoo K, Zamora S, Patil S, D'Andrea G, Gilewski T, Bromberg J, Dang C, Dickler M, Modi S, Seidman AD, Sklarin N, Norton L, Hudis CA, Fornier MN. Phase II Study of Paclitaxel and Dasatinib in Metastatic Breast Cancer. Clin Breast Cancer 2018; 18:387-394. [PMID: 29680193 DOI: 10.1016/j.clbc.2018.03.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 03/10/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Overexpression and activation of tyrosine kinase Src has been linked to breast carcinogenesis and bone metastases. We showed the feasibility of combining the SRC inhibitor dasatinib with weekly paclitaxel in patients with metastatic breast cancer (MBC) and herein report the subsequent phase II trial. PATIENTS AND METHODS Patients had received ≤ 2 chemotherapy regimens for measurable, HER2-negative MBC. Patients received paclitaxel and dasatinib (120 mg daily) and were assessed according to Response Evaluation Criteria in Solid Tumors for overall response rate (ORR), the primary end point. Secondary end points included progression-free survival (PFS) and overall survival (OS). A 30% ORR (n = 55) was deemed worthy of further investigation. Exploratory biomarkers included N-telopeptide (NTX) and plasma vascular epidermal growth factor (VEGF) receptor 2 as predictors of clinical benefit. RESULTS From March 2010 to March 2014, 40 patients, including 2 men enrolled. The study was stopped early because of slow accrual. Overall, 32 patients (80%) had estrogen receptor-positive tumors and 23 (58%) had previously received taxanes. Of the 35 assessable patients, 1 (3%) had complete response and 7 (20%) partial response, resulting in an ORR of 23%. The median PFS and OS was 5.2 (95% confidence interval [CI], 2.9-9.9) and 20.6 (95% CI, 12.9-25.2) months, respectively. As expected, fatigue (75%), neuropathy (65%), and diarrhea (50%) were common side effects, but were generally low-grade. Median baseline NTX was similar in patients who had clinical benefit (8.2 nmol BCE) and no clinical benefit (10.9 nmol BCE). Similarly, median baseline VEGF levels were similar between the 2 groups; 93.0 pg/mL versus 83.0 pg/mL. CONCLUSION This phase II study of dasatinib and paclitaxel was stopped early because of slow accrual but showed some clinical activity. Further study is not planned.
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Affiliation(s)
- Patrick G Morris
- Breast Medicine Service, Memorial Sloan Kettering Cancer Center, New York, NY; Weill Cornell Medical College, New York, NY; Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland; Royal College of Surgeons of Ireland, Dublin, Ireland
| | - Selene Rota
- Department of Medical Oncology, IRCCS Humanitas Clinical and Research Institute, Rozzano, Milan, Italy
| | - Karen Cadoo
- Breast Medicine Service, Memorial Sloan Kettering Cancer Center, New York, NY; Weill Cornell Medical College, New York, NY
| | - Stephen Zamora
- Breast Medicine Service, Memorial Sloan Kettering Cancer Center, New York, NY; Weill Cornell Medical College, New York, NY
| | - Sujata Patil
- Breast Medicine Service, Memorial Sloan Kettering Cancer Center, New York, NY; Weill Cornell Medical College, New York, NY
| | - Gabriella D'Andrea
- Breast Medicine Service, Memorial Sloan Kettering Cancer Center, New York, NY; Weill Cornell Medical College, New York, NY
| | - Theresa Gilewski
- Breast Medicine Service, Memorial Sloan Kettering Cancer Center, New York, NY; Weill Cornell Medical College, New York, NY
| | - Jacqueline Bromberg
- Breast Medicine Service, Memorial Sloan Kettering Cancer Center, New York, NY; Weill Cornell Medical College, New York, NY
| | - Chau Dang
- Breast Medicine Service, Memorial Sloan Kettering Cancer Center, New York, NY; Weill Cornell Medical College, New York, NY
| | - Maura Dickler
- Breast Medicine Service, Memorial Sloan Kettering Cancer Center, New York, NY; Weill Cornell Medical College, New York, NY
| | - Shanu Modi
- Breast Medicine Service, Memorial Sloan Kettering Cancer Center, New York, NY; Weill Cornell Medical College, New York, NY
| | - Andrew D Seidman
- Breast Medicine Service, Memorial Sloan Kettering Cancer Center, New York, NY; Weill Cornell Medical College, New York, NY
| | - Nancy Sklarin
- Breast Medicine Service, Memorial Sloan Kettering Cancer Center, New York, NY; Weill Cornell Medical College, New York, NY
| | - Larry Norton
- Breast Medicine Service, Memorial Sloan Kettering Cancer Center, New York, NY; Weill Cornell Medical College, New York, NY
| | - Clifford A Hudis
- Breast Medicine Service, Memorial Sloan Kettering Cancer Center, New York, NY; Weill Cornell Medical College, New York, NY
| | - Monica N Fornier
- Breast Medicine Service, Memorial Sloan Kettering Cancer Center, New York, NY; Weill Cornell Medical College, New York, NY.
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Gucalp A, Zhou XK, Cook ED, Garber JE, Crew KD, Nangia JR, Bhardwaj P, Giri DD, Elemento O, Verma A, Wang H, Lee JJ, Vornik LA, Mays C, Weber D, Sepeda V, O'Kane H, Krasne M, Williams S, Morris PG, Heckman-Stoddard BM, Dunn BK, Hudis CA, Brown PH, Dannenberg AJ. A Randomized Multicenter Phase II Study of Docosahexaenoic Acid in Patients with a History of Breast Cancer, Premalignant Lesions, or Benign Breast Disease. Cancer Prev Res (Phila) 2018; 11:203-214. [PMID: 29453232 DOI: 10.1158/1940-6207.capr-17-0354] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 01/02/2018] [Accepted: 02/02/2018] [Indexed: 12/12/2022]
Abstract
Obesity, a cause of subclinical inflammation, is a risk factor for the development of postmenopausal breast cancer and is associated with poorer cancer outcomes. Docosahexaenoic acid (DHA), an omega-3 fatty acid, possesses anti-inflammatory properties. We hypothesized that treatment with DHA would reduce the expression of proinflammatory genes and aromatase, the rate-limiting enzyme for estrogen biosynthesis, in benign breast tissue of overweight/obese women. A randomized, placebo-controlled, double-blind phase II study of DHA given for 12 weeks to overweight/obese women with a history of stage I-III breast cancer, DCIS/LCIS, Paget's disease, or proliferative benign breast disease was carried out. In this placebo controlled trial, the primary objective was to determine whether DHA (1,000 mg by mouth twice daily) reduced breast tissue levels of TNFα. Secondary objectives included evaluation of the effect of DHA on breast tissue levels of COX-2, IL1β, aromatase, white adipose tissue inflammation, and gene expression by RNA-seq. Red blood cell fatty acid levels were measured to assess compliance. From July 2013 to November 2015, 64 participants were randomized and treated on trial (32 women per arm). Increased levels of omega-3 fatty acids in red blood cells were detected following treatment with DHA (P < 0.001) but not placebo. Treatment with DHA did not alter levels of TNFα (P = 0.71), or other biomarkers including the transcriptome in breast samples. Treatment with DHA was overall well-tolerated. Although compliance was confirmed, we did not observe changes in the levels of prespecified biomarkers in the breast after treatment with DHA when compared with placebo. Cancer Prev Res; 11(4); 203-14. ©2018 AACRSee related editorial by Fabian and Kimler, p. 187.
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Affiliation(s)
- Ayca Gucalp
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York. .,Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Xi K Zhou
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, New York
| | - Elise D Cook
- Department of Clinical Cancer Prevention, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Judy E Garber
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Katherine D Crew
- Departments of Medicine/Epidemiology, New York-Presbyterian/Columbia University Medical Center, New York, New York
| | - Julie R Nangia
- Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Priya Bhardwaj
- Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Dilip D Giri
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Olivier Elemento
- Departments of Physiology and Biophysics/Computational Biomedicine, Weill Cornell Medical College, New York, New York
| | - Akanksha Verma
- Departments of Physiology and Biophysics/Computational Biomedicine, Weill Cornell Medical College, New York, New York
| | - Hanhan Wang
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, New York
| | - J Jack Lee
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Lana A Vornik
- Department of Clinical Cancer Prevention, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Carrie Mays
- Department of Clinical Cancer Prevention, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Diane Weber
- Department of Clinical Cancer Prevention, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Valerie Sepeda
- Department of Clinical Cancer Prevention, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Holly O'Kane
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Margaret Krasne
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Samantha Williams
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Patrick G Morris
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Barbara K Dunn
- Division of Cancer Prevention, National Cancer Institute, Bethesda, Maryland
| | - Clifford A Hudis
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.,American Society of Clinical Oncology, Alexandria, Virginia
| | - Powel H Brown
- Department of Clinical Cancer Prevention, University of Texas MD Anderson Cancer Center, Houston, Texas
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