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Adams RA, Botha MH. Cervical cancer prevention in Southern Africa: A review of national cervical cancer screening guidelines in the Southern African development community. J Cancer Policy 2024; 40:100477. [PMID: 38593950 DOI: 10.1016/j.jcpo.2024.100477] [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: 12/18/2023] [Revised: 04/05/2024] [Accepted: 04/05/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND Cervical cancer poses a significant burden, particularly in low-and-middle income countries (LMIC) with limited access to healthcare. High-income countries have made progress in prevention, while LMIC face unacceptably high incidence and mortality rates, often lacking official screening recommendations. We analysed the presence and content of cervical cancer screening guidelines for the secondary prevention of cervical cancer in the Southern African Development Community (SADC) and compared it to the current World Health Organization (WHO) guidelines for screening and treatment of cervical pre-cancer lesions for cervical cancer prevention. METHODS A review of national cervical cancer guidelines across the SADC region was conducted. Data was obtained from government websites, international cancer control platforms, and WHO resources. Search terms included "cervical cancer" and "cervical cancer control guidelines", amongst others. There were no limitations on publication years, and the most recent versions of the guidelines were analysed, regardless of language. Each guideline was assessed for specific screening and treatment recommendations, in relation to the current WHO guidelines. Points were assigned for each data element. RESULTS While most countries contributed data to this analysis there was a notable absence of adherence to the WHO guidelines. The most common screening method was naked eye visual inspection. There was a consensus on the age of screening initiation. Most countries recommended treatment by cryotherapy and loop excision. CONCLUSION Effective cervical cancer screening programmes, guided by evidence-based recommendations, can enhance early intervention and outcomes. This study highlights the need for standardized and evidence-based cervical cancer screening guidelines in the SADC region, to reduce the burden of cervical cancer and improve the health outcomes of women in these areas.
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Affiliation(s)
- R A Adams
- Department of Obstetrics and Gynaecology and Unit for Gynaecological Oncology, Clinical Building, Faculty of Medicine and Health Sciences, Francie Van Zijl, Stellenbosch University, 7505, South Africa.
| | - M H Botha
- Department of Obstetrics and Gynaecology and Unit for Gynaecological Oncology, Clinical Building, Faculty of Medicine and Health Sciences, Francie Van Zijl, Stellenbosch University, 7505, South Africa
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Margalit O, Harmsen WS, Shacham-Shmueli E, Voss MM, Boursi B, Wagner AD, Cohen R, Olswold CL, Saltz LB, Goldstein DA, Hurwitz H, Tebbutt NC, Kabbinavar FF, Adams RA, Chibaudel B, Grothey A, Yoshino T, Zalcberg J, de Gramont A, Shi Q, Lenz HJ. Corrigendum to "Evaluating sex as a predictive marker for response to bevacizumab in metastatic colorectal carcinoma: Pooled analysis of 3369 patients in the ARCAD database" Eur J Cancer. 2023 Jan;178:162-170. Eur J Cancer 2023; 194:113339. [PMID: 37813779 DOI: 10.1016/j.ejca.2023.113339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/11/2023]
Affiliation(s)
- Ofer Margalit
- Tel-Aviv University, Tel-Aviv, Israel; Sheba Medical Center, Ramat-Gan, Israel.
| | - William S Harmsen
- Department of Quantitative Science Research, Mayo Clinic, Rochester, MN, USA
| | | | - Molly M Voss
- Department of Quantitative Science Research, Mayo Clinic, Scottsdale, AZ, USA
| | - Ben Boursi
- Tel-Aviv University, Tel-Aviv, Israel; Sheba Medical Center, Ramat-Gan, Israel
| | - Anna D Wagner
- Department of Oncology, Division of Medical Oncology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Romain Cohen
- Department of Quantitative Science Research, Mayo Clinic, Rochester, MN, USA; Sorbonne University, INSERM, Unité Mixte de Recherche Scientifique 938, Centre de Recherche Saint-Antoine, Equipe Instabilité des Microsatellites et Cancer, Equipe labellisée par la Ligue Nationale contre le Cancer, Paris, France; Sorbonne University, Department of Medical Oncology, Saint-Antoine Hospital, AP-HP, Paris, France
| | - Curtis L Olswold
- Department of Quantitative Science Research, Mayo Clinic, Rochester, MN, USA
| | | | | | | | - Niall C Tebbutt
- University of Melbourne, Melbourne, Australia; Austin Health, Heidelberg, Victoria, Australia
| | - Fairooz F Kabbinavar
- David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, CA, USA
| | | | - Benoist Chibaudel
- Department of Medical Oncology, Franco-British Institute, Levallois-Perret, France
| | | | - Takayuki Yoshino
- Department of Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - John Zalcberg
- Department of Medical Oncology, Alfred Health and School of Public Health, Monash University, Melbourne, Australia
| | - Aimery de Gramont
- Department of Medical Oncology, Franco-British Institute, Levallois-Perret, France
| | - Qian Shi
- Department of Quantitative Science Research, Mayo Clinic, Rochester, MN, USA
| | - Heinz-Josef Lenz
- Department of Gastrointestinal Oncology, Keck School of Medicine at USC, Los Angeles, CA, USA
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Ou FS, Ahn DH, Dixon JG, Grothey A, Lou Y, Kasi PM, Hubbard JM, Van Cutsem E, Saltz LB, Schmoll HJ, Goldberg RM, Venook AP, Hoff P, Douillard JY, Hecht JR, Hurwitz H, Punt CJA, Koopman M, Bokemeyer C, Fuchs CS, Diaz-Rubio E, Tebbutt NC, Cremolini C, Kabbinavar FF, Bekaii-Saab T, Chibaudel B, Yoshino T, Zalcberg J, Adams RA, de Gramont A, Shi Q. Evaluation of Intratumoral Response Heterogeneity in Metastatic Colorectal Cancer and Its Impact on Patient Overall Survival: Findings from 10,551 Patients in the ARCAD Database. Cancers (Basel) 2023; 15:4117. [PMID: 37627145 PMCID: PMC10452983 DOI: 10.3390/cancers15164117] [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: 06/16/2023] [Revised: 07/30/2023] [Accepted: 08/09/2023] [Indexed: 08/27/2023] Open
Abstract
Metastatic colorectal cancer (mCRC) is a heterogeneous disease that can evoke discordant responses to therapy among different lesions in individual patients. The Response Evaluation Criteria in Solid Tumors (RECIST) criteria do not take into consideration response heterogeneity. We explored and developed lesion-based measurement response criteria to evaluate their prognostic effect on overall survival (OS). PATIENTS AND METHODS Patients enrolled in 17 first-line clinical trials, who had mCRC with ≥ 2 lesions at baseline, and a restaging scan by 12 weeks were included. For each patient, lesions were categorized as a progressing lesion (PL: > 20% increase in the longest diameter (LD)), responding lesion (RL: > 30% decrease in LD), or stable lesion (SL: neither PL nor RL) based on the 12-week scan. Lesion-based response criteria were defined for each patient as follows: PL only, SL only, RL only, and varied responses (mixture of RL, SL, and PL). Lesion-based response criteria and OS were correlated using stratified multivariable Cox models. The concordance between OS and classifications was measured using the C statistic. RESULTS Among 10,551 patients with mCRC from 17 first-line studies, varied responses were noted in 51.6% of patients, among whom, 3.3% had RL/PL at 12 weeks. Among patients with RL/SL, 52% had stable disease (SD) by RECIST 1.1, and they had a longer OS (median OS (mOS) = 19.9 months) than those with SL only (mOS = 16.8 months, HR (95% CI) = 0.81 (0.76, 0.85), p < 0.001), although a shorter OS than those with RL only (mOS = 25.8 months, HR (95% CI) = 1.42 (1.32, 1.53), p < 0.001). Among patients with SL/PL, 74% had SD by RECIST 1.1, and they had a longer OS (mOS = 9.0 months) than those with PL only (mOS = 8.0 months, HR (95% CI) = 0.75 (0.57, 0.98), p = 0.040), yet a shorter OS than those with SL only (mOS = 16.8 months, HR (95% CI) = 1.98 (1.80, 2.18), p < 0.001). These associations were consistent across treatment regimen subgroups. The lesion-based response criteria showed slightly higher concordance than RECIST 1.1, although it was not statistically significant. CONCLUSION Varied responses at first restaging are common among patients receiving first-line therapy for mCRC. Our lesion-based measurement criteria allowed for better mortality discrimination, which could potentially be informative for treatment decision-making and influence patient outcomes.
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Affiliation(s)
- Fang-Shu Ou
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN 55905, USA
| | - Daniel H Ahn
- Division of Medical Oncology, Mayo Clinic, Phoenix, AZ 85259, USA
| | - Jesse G Dixon
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN 55905, USA
| | - Axel Grothey
- West Cancer Center, University of Tennessee, Memphis, TN 38104, USA
| | - Yiyue Lou
- Vertex Pharmaceuticals, Boston, MA 02210, USA
| | - Pashtoon M Kasi
- Division of Hematology and Oncology, University of Iowa, Iowa City, IA 52242, USA
| | | | - Eric Van Cutsem
- Department of Gastroenterology/Digestive Oncology, University Hospitals Gasthuisberg Leuven and KU Leuven, 3000 Leuven, Belgium
| | - Leonard B Saltz
- Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Hans-Joachim Schmoll
- Department of Internal Medicine, Clinic for Internal Medicine IV, Martin-Luther-University Halle/Saale, 06120 Halle, Germany
| | - Richard M Goldberg
- West Virginia University Cancer Institute, West Virginia University, Morgantown, WV 26506, USA
| | - Alan P Venook
- Department of Medicine, The University of California San Francisco, San Francisco, CA 94143, USA
| | - Paulo Hoff
- Department of Clinical Oncology, University of Sao Paulo, Sao Paulo 05508-010, Brazil
| | - Jean-Yves Douillard
- Department of Medical Oncology, University of Nantes Medical School, 44035 Nantes, France
| | | | - Herbert Hurwitz
- Duke Cancer Institute, Duke University, Durham, NC 27710, USA
| | - Cornelis J A Punt
- Julius Center, University Medical Centre Utrecht, Utrecht University, 3584 CG Utrecht, The Netherlands
| | - Miriam Koopman
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, 3584 CX Utrecht, The Netherlands
| | - Carsten Bokemeyer
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section of Pneumology, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
| | | | - Eduardo Diaz-Rubio
- Department of Oncology, Hospital Clínico San Carlos, 28040 Madrid, Spain
| | - Niall C Tebbutt
- Sydney Medical School, University of Sydney, Sydney, NSW 2050, Australia
| | - Chiara Cremolini
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy
| | | | | | - Benoist Chibaudel
- Department of Medical Oncology, Franco-British Institute, 92300 Levallois-Perret, France
| | - Takayuki Yoshino
- Department of Gastrointestinal Oncology, National Cancer Center Hospital East, Chiba 277-8577, Japan
| | - John Zalcberg
- School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Richard A Adams
- Centre for Trials Research, Cardiff University, Cardiff CF14 4YS, UK
- Velindre Cancer Center, Velindre NHS Trust, Cardiff CF14 2TL, UK
| | - Aimery de Gramont
- Department of Medical Oncology, Franco-British Institute, 92300 Levallois-Perret, France
| | - Qian Shi
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN 55905, USA
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Margalit O, Harmsen WS, Shacham-Shmueli E, Voss MM, Boursi B, Wagner AD, Cohen R, Olswold CL, Saltz LB, Goldstein DA, Hurwitz H, Tebbutt NC, Kabbinavar FF, Adams RA, Chibaudel B, Grothey A, Yoshino T, Zalcberg J, de Gramont A, Shi Q, Lenz HJ. Evaluating sex as a predictive marker for response to bevacizumab in metastatic colorectal carcinoma: Pooled analysis of 3,369 patients in the ARCAD database. Eur J Cancer 2023; 178:162-170. [PMID: 36446161 DOI: 10.1016/j.ejca.2022.10.022] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 10/21/2022] [Accepted: 10/23/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Previous studies suggest a possible sex-specific response to bevacizumab in metastatic colorectal carcinoma (mCRC), showing a benefit in males, while the effect in females is less significant. METHODS Data from 3369 patients with mCRC enrolled on four first-line randomised trials testing chemotherapy with or without bevacizumab (2000-2007) were pooled. Association between sex and progression-free survival and overall survival (OS) was evaluated by stratified Cox regression model, adjusted for potential confounders. Predictive value was evaluated by interaction effect between sex and treatment. In a pre-planned secondary analysis, analyses were stratified using an age cut point of 60 years to evaluate the possible role of menopausal-related effects. RESULTS Bevacizumab was associated with an improved median OS in males and females, with a 2.3- and 0.6-months benefit, respectively. Stratified by age, bevacizumab resulted in improved OS in males at both age categories. In females at or above the age of 60 (n = 731), bevacizumab resulted in improved OS. However, in females below the age of 60 (n = 634), OS benefit did not reach statistical significance (adjusted hazard ratio = 0.94, 95% confidence interval 0.74-1.20). CONCLUSIONS Our results confirmed the OS benefit from the addition of bevacizumab to first-line chemotherapy in mCRC in both sexes. Among females, the benefit was less than 1 month. For females under the age of 60, there was no survival benefit. These findings could be used to relieve financial toxicity or be redistributed within healthcare systems for other health-related purposes.
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Affiliation(s)
- Ofer Margalit
- Sheba Medical Center, Ramat-Gan, Israel; Tel-Aviv University, Tel-Aviv, Israel.
| | - William S Harmsen
- Department of Quantitative Science Research, Mayo Clinic, Rochester, MN, USA
| | | | - Molly M Voss
- Department of Quantitative Science Research, Mayo Clinic, Scottsdale, AZ, USA
| | - Ben Boursi
- Sheba Medical Center, Ramat-Gan, Israel; Tel-Aviv University, Tel-Aviv, Israel
| | - Anna D Wagner
- Department of Oncology, Division of Medical Oncology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Romain Cohen
- Department of Quantitative Science Research, Mayo Clinic, Rochester, MN, USA; Sorbonne University, Department of Medical Oncology, Saint-Antoine Hospital, AP-HP, F-75012 Paris, France; Sorbonne University, INSERM, Unité Mixte de Recherche Scientifique 938, Centre de Recherche Saint-Antoine, Equipe Instabilité des Microsatellites et Cancer, Equipe labellisée par la Ligue Nationale contre le Cancer, F-75012 Paris, France
| | - Curtis L Olswold
- Department of Quantitative Science Research, Mayo Clinic, Rochester, MN, USA
| | | | | | | | - Niall C Tebbutt
- University of Melbourne, Australia; Austin Health, Heidelberg, Victoria, Australia
| | - Fairooz F Kabbinavar
- David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, CA, USA
| | | | - Benoist Chibaudel
- Department of Medical Oncology, Franco-British Institute, Levallois-Perret, France
| | | | - Takayuki Yoshino
- Department of Gastrointestinal Oncology, National Cancer Center Hospital East, Japan
| | - John Zalcberg
- Department of Medical Oncology, Alfred Health and School of Public Health, Monash University, Melbourne, Australia
| | - Aimery de Gramont
- Department of Medical Oncology, Franco-British Institute, Levallois-Perret, France
| | - Qian Shi
- Department of Quantitative Science Research, Mayo Clinic, Rochester, MN, USA
| | - Heinz-Josef Lenz
- Department of Gastrointestinal Oncology, Keck School of Medicine at USC, Los Angeles, CA, USA
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Franko J, Yin J, Adams RA, Zalcberg J, Fiskum J, Van Cutsem E, Goldberg RM, Hurwitz H, Bokemeyer C, Kabbinavar F, Curtis A, Meyers J, Chibaudel B, Yoshino T, de Gramont A, Shi Q. Trajectories of body weight change and survival among patients with mCRC treated with systemic therapy: Pooled analysis from the ARCAD database. Eur J Cancer 2022; 174:142-152. [PMID: 35994794 DOI: 10.1016/j.ejca.2022.07.021] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 07/14/2022] [Accepted: 07/17/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Higher body mass index is associated with a higher incidence of colorectal cancer (CRC) but also with improved survival in metastatic CRC (mCRC). Whether weight change after mCRC diagnosis is associated with survival remains largely unknown. METHODS We analysed individual patient data for previously untreated patients enrolled in five phase 3 randomised trials conducted between 1998 and 2006. Weight measurements were prospectively collected at baseline and up to 59.4 months after diagnosis. We used stratified multivariable Cox models to assess the prognostic associations of weight loss with overall and progression-free survival, adjusting for other factors. The primary end-point was a difference in overall survival (OS) between populations with weight loss and stable or increasing weight. FINDINGS Data were available for 3504 patients. The median weight change at 3 months was -0.54% (IQR -3.9 … +1.5%). We identified a linear trend of increasing risk of death associated with progressive weight loss. Unstratified median OS was 20.5, 18.0, and 11.9 months (p < 0.001) for stable weight or gain, <5% weight loss, and ≥5% weight loss at 3 months, respectively. Weight loss was associated with a higher risk of death (<5% loss: aHR 1.18 [1.06-1.30], p < 0.002; ≥5% loss: aHR 1.87 [1.67-2.1], p < 0.001) as compared to stable or increasing weight at 3 months post-baseline (reference), while adjusting for age, sex, performance, and a number of metastatic sites. INTERPRETATION Patients losing weight during systemic therapy for metastatic colorectal cancer have significantly shorter OS. The degree of weight loss is proportional to the observed increased risk of death and remains evident among underweight, normal weight, and obese individuals. On-treatment weight change could be used as an intermediate end-point. FUNDING The creation and management of the database containing the individual patient data from the original randomised trials is supported by the Aide et Recherche en Cancérologie Digestive Foundation.
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Affiliation(s)
- Jan Franko
- MercyOne Medical Center, Des Moines, IA, USA.
| | - Jun Yin
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | | | - John Zalcberg
- School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia
| | - Jack Fiskum
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Eric Van Cutsem
- Digestive Oncology, University Hospitals Gasthuisberg Leuven and KU Leuven, Leuven, Belgium
| | | | | | - Carsten Bokemeyer
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | | | - Jeffery Meyers
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Benoist Chibaudel
- Department of Medical Oncology, Hôpital Franco-Britannique - Fondation Cognacq-Jay, Levallois-Perret, France
| | - Takayuki Yoshino
- Department of Gastrointestinal Oncology, National Cancer Center Hospital East, Japan
| | - Aimery de Gramont
- Department of Medical Oncology, Hôpital Franco-Britannique - Fondation Cognacq-Jay, Levallois-Perret, France
| | - Qian Shi
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
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Brown SR, Hinsley S, Hall E, Hurt C, Baird RD, Forster M, Scarsbrook AF, Adams RA. A Road Map for Designing Phase I Clinical Trials of Radiotherapy-Novel Agent Combinations. Clin Cancer Res 2022; 28:3639-3651. [PMID: 35552622 PMCID: PMC9433953 DOI: 10.1158/1078-0432.ccr-21-4087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 01/26/2022] [Accepted: 04/28/2022] [Indexed: 01/07/2023]
Abstract
Radiotherapy has proven efficacy in a wide range of cancers. There is growing interest in evaluating radiotherapy-novel agent combinations and a drive to initiate this earlier in the clinical development of the novel agent, where the scientific rationale and preclinical evidence for a radiotherapy combination approach are high. Optimal design, delivery, and interpretation of studies are essential. In particular, the design of phase I studies to determine safety and dosing is critical to an efficient development strategy. There is significant interest in early-phase research among scientific and clinical communities over recent years, at a time when the scrutiny of the trial methodology has significantly increased. To enhance trial design, optimize safety, and promote efficient trial conduct, this position paper reviews the current phase I trial design landscape. Key design characteristics extracted from 37 methodology papers were used to define a road map and a design selection process for phase I radiotherapy-novel agent trials. Design selection is based on single- or dual-therapy dose escalation, dose-limiting toxicity categorization, maximum tolerated dose determination, subgroup evaluation, software availability, and design performance. Fifteen of the 37 designs were identified as being immediately accessible and relevant to radiotherapy-novel agent phase I trials. Applied examples of using the road map are presented. Developing these studies is intensive, highlighting the need for funding and statistical input early in the trial development to ensure appropriate design and implementation from the outset. The application of this road map will improve the design of phase I radiotherapy-novel agent combination trials, enabling a more efficient development pathway.
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Affiliation(s)
- Sarah R. Brown
- Leeds Cancer Research UK Clinical Trials Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, United Kingdom
| | - Samantha Hinsley
- Clinical Trials Unit Glasgow, University of Glasgow, Glasgow, United Kingdom
| | - Emma Hall
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, United Kingdom
| | - Chris Hurt
- Centre for Trials Research, Cardiff University, Cardiff, United Kingdom
| | | | | | - Andrew F. Scarsbrook
- Radiotherapy Research Group, Leeds Institute of Medical Research at St James's, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
| | - Richard A. Adams
- Centre for Trials Research, Cardiff University and Velindre Cancer Centre, Cardiff, United Kingdom
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Hauke DJ, Roth V, Karvelis P, Adams RA, Moritz S, Borgwardt S, Diaconescu AO, Andreou C. Increased Belief Instability in Psychotic Disorders Predicts Treatment Response to Metacognitive Training. Schizophr Bull 2022; 48:826-838. [PMID: 35639557 PMCID: PMC9212107 DOI: 10.1093/schbul/sbac029] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND HYPOTHESIS In a complex world, gathering information and adjusting our beliefs about the world is of paramount importance. The literature suggests that patients with psychotic disorders display a tendency to draw early conclusions based on limited evidence, referred to as the jumping-to-conclusions bias, but few studies have examined the computational mechanisms underlying this and related belief-updating biases. Here, we employ a computational approach to understand the relationship between jumping-to-conclusions, psychotic disorders, and delusions. STUDY DESIGN We modeled probabilistic reasoning of 261 patients with psychotic disorders and 56 healthy controls during an information sampling task-the fish task-with the Hierarchical Gaussian Filter. Subsequently, we examined the clinical utility of this computational approach by testing whether computational parameters, obtained from fitting the model to each individual's behavior, could predict treatment response to Metacognitive Training using machine learning. STUDY RESULTS We observed differences in probabilistic reasoning between patients with psychotic disorders and healthy controls, participants with and without jumping-to-conclusions bias, but not between patients with low and high current delusions. The computational analysis suggested that belief instability was increased in patients with psychotic disorders. Jumping-to-conclusions was associated with both increased belief instability and greater prior uncertainty. Lastly, belief instability predicted treatment response to Metacognitive Training at the individual level. CONCLUSIONS Our results point towards increased belief instability as a key computational mechanism underlying probabilistic reasoning in psychotic disorders. We provide a proof-of-concept that this computational approach may be useful to help identify suitable treatments for individual patients with psychotic disorders.
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Affiliation(s)
- D J Hauke
- To whom correspondence should be addressed; 250 College St., 12th Floor, Toronto, ON M5T 1R8, Canada; tel: +1 (416) 535-8501 ext. 30585, fax: +1 416-583-1207, e-mail:
| | - V Roth
- Department of Mathematics and Computer Science, University of Basel, Basel, Switzerland
| | - P Karvelis
- Krembil Centre for Neuroinformatics, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - R A Adams
- Centre for Medical Image Computing, Department of Computer Science, University College London, London, UK,Max Planck Centre for Computational Psychiatry and Ageing Research, University College London, London, United Kingdom
| | - S Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - S Borgwardt
- Department of Psychiatry and Psychotherapy, Translational Psychiatry Unit, University of Lübeck, Lübeck, Germany,Center of Brain, Behaviour and Metabolism, University of Lübeck, Lübeck, Germany
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Speirs V, Cox A, Chelala C, James JA, Adams RA, Jones JL. A biobank perspective on use of tissue samples donated by trial participants. Lancet Oncol 2022; 23:e205. [DOI: 10.1016/s1470-2045(22)00186-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 03/14/2022] [Indexed: 10/18/2022]
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Papamichael D, Lopes GS, Olswold CL, Douillard JY, Adams RA, Maughan TS, Van Cutsem E, Venook AP, Lenz HJ, Heinemann V, Kaplan R, Bokemeyer C, Chibaudel B, Grothey A, Yoshino T, Zalcberg J, De Gramont A, Shi Q. Efficacy of anti-epidermal growth factor receptor agents in patients with RAS wild-type metastatic colorectal cancer ≥ 70 years. Eur J Cancer 2022; 163:1-15. [PMID: 35033994 DOI: 10.1016/j.ejca.2021.12.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 08/20/2021] [Revised: 11/29/2021] [Accepted: 12/01/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE Colorectal cancer (CRC) affects many older adults. We investigated the efficacy and safety of adding anti-epidermal growth factor receptor (EGFR) agents to doublet chemotherapy (DC) in older patients. METHODS Patients with RAS wild-type (WT) metastatic CRC (mCRC) receiving first-line DC + anti-EGFR (n = 1191) or DC alone (n = 729) from seven trials in the Aide de Recherche en Cancerologie Digestive database were included. The prognostic and predictive effects of age were investigated. Progression-free and overall survival (OS) were evaluated between age groups (≥70 vs <70) for DC + anti-EGFR. In addition, outcomes were compared between DC+/-anti-EGFR within age groups in three trials with a DC alone arm. Subsequently, the same analysis was conducted for left-sided tumours. Adverse events grade ≥3 (G3+) were compared between age groups. RESULTS Older (vs younger) patients receiving DC + anti-EGFR had similar progression-free survival (PFS) (8.7 vs 10.3 months; hazard ratio (HR) = 1.20 [0.96-1.49];p = 0.107) but inferior OS (21.3 vs 26.3; HR = 1.36 [1.08-1.72];p = 0.011). DC + anti-EGFR (vs DC alone) improved OS (23.9 vs 20.3; HR = 0.82 [0.70-0.95];p = 0.008) and PFS (11.2 vs 8.9; HR = 0.70 [0.60-0.82];p < 0.001) in younger but not older patients: OS (24.7 vs 17.6; HR [95% confidence interval {CI}] = 0.77 [0.58-1.04];p = 0.092) and PFS (9.1 vs 8.7; HR [95% CI] = 0.85[0.63-1.15];p = 0.287). In left-sided 'only' tumours, the following outcomes for older (vs younger) patients were observed. For DC + anti-EGFR, PFS 9 versus 11.2 months; HR1.10 (95% CI 0.83-1.46); p = 0.52, OS 25.6 vs 30.3 HR 1.32 (95% CI 0.97-1.79), p = 0.086. For DC + anti-EGFR (vs DC alone), PFS and OS for younger patients were 11.9 vs 9.2 months HR 0.60 (95% CI 0.47-0.78) p < 0.001 and 24.1 versus 23.3 months HR 0.84 (95% CI 0.67-1.04), respectively. For older patients, PFS and OS were 13.1 versus 8.5 months, HR 0.51 (95% CI, 0.28-0.93), P = 0.027 and 26.3 versus 16.5 months HR 0.49 (95% CI, 0.28-0.85), respectively. There was no significant difference in toxicity among different age groups. CONCLUSIONS Older (vs younger) patients with mCRC RAS WT patients had comparable toxicity and efficacy with the addition of anti-EGFR agents to chemotherapy.
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Affiliation(s)
| | - Guilherme S Lopes
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Curt L Olswold
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Jean-Yves Douillard
- University of Nantes, And Integrated Centers of Oncology ICO René Gauducheau Cancer, Nantes, France
| | | | | | - Eric Van Cutsem
- Digestive Oncology, University Hospitals Gasthuisberg Leuven and University of Leuven, Leuven, Belgium
| | - Alan P Venook
- Helen Diller Family Comprehensive Cancer Center, USA
| | - Heinz-Josef Lenz
- Department of Gastrointestinal Onocology, Keck School of Medicine at USC, Los Angeles, CA, USA
| | - Volker Heinemann
- Department of Medicine III, University Hospital, Ludwig Maximilian University, Munich, Germany
| | - Richard Kaplan
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - Carsten Bokemeyer
- Department of Oncology, Haematology and Bone Marrow Transplantation with Section of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Axel Grothey
- West Cancer Center and Research Institute, OneOncology, Germantown, TN, USA
| | - Takayuki Yoshino
- Department of Gastrointestinal Oncology, National Cancer Center Hospital East, Japan
| | - John Zalcberg
- School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia
| | | | - Qian Shi
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
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10
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Hanna CR, O'Cathail SM, Graham JS, Saunders M, Samuel L, Harrison M, Devlin L, Edwards J, Gaya DR, Kelly CA, Lewsley LA, Maka N, Morrison P, Dinnett L, Dillon S, Gourlay J, Platt JJ, Thomson F, Adams RA, Roxburgh CSD. Correction to: Durvalumab (MEDI 4736) in combination with extended neoadjuvant regimens in rectal cancer: a study protocol of a randomised phase II trial (PRIME-RT). Radiat Oncol 2021; 16:230. [PMID: 34857017 PMCID: PMC8638219 DOI: 10.1186/s13014-021-01941-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Catherine R Hanna
- Cancer Research UK Glasgow Clinical Trials Unit, Beatson West of Scotland Cancer Centre, Institute of Cancer Sciences, University of Glasgow, Level 0, 1053 Great Western Road, Glasgow, G12 0YN, UK.
| | - Sean M O'Cathail
- Beatson West of Scotland Cancer Centre, Institute of Cancer Sciences, University of Glasgow, 1053 Great Western Road, Glasgow, G12 0YN, UK
| | - Janet S Graham
- Beatson West of Scotland Cancer Centre, Institute of Cancer Sciences, University of Glasgow, 1053 Great Western Road, Glasgow, G12 0YN, UK
| | - Mark Saunders
- The Christie NHS Foundation Trust, Wilmslow Rd, Manchester, M20 4BX, UK
| | | | - Mark Harrison
- Mount Vernon Cancer Centre, Rickmansworth Rd, Northwood, HA6 2RN, UK
| | - Lynsey Devlin
- Beatson West of Scotland Cancer Centre, 1053 Great Western Road, Glasgow, G12 0YN, UK
| | - Joanne Edwards
- Institute of Cancer Sciences, University of Glasgow, Garscube Estate, Switchback Road, Bearsden, G61 1QH, UK
| | - Daniel R Gaya
- Gastroenterology Unit, Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, 4th Floor Walton Building, Castle Street, Glasgow, G4 0SF, UK
| | - Caroline A Kelly
- Cancer Research UK Glasgow Clinical Trials Unit, Beatson West of Scotland Cancer Centre, Institute of Cancer Sciences, University of Glasgow, Level 0, 1053 Great Western Road, Glasgow, G12 0YN, UK
| | - Liz-Anne Lewsley
- Cancer Research UK Glasgow Clinical Trials Unit, Beatson West of Scotland Cancer Centre, Institute of Cancer Sciences, University of Glasgow, Level 0, 1053 Great Western Road, Glasgow, G12 0YN, UK
| | - Noori Maka
- Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, 1345 Govan Road, Glasgow, G51 4TF, UK
| | - Paula Morrison
- Snr Pharmacist Clinical Trials Oncology R&I, Research and Innovation, Dykebar Hospital, NHS Greater Glasgow and Clyde, Ward 11, Grahamston Road, Paisley, PA2 7DE, UK
| | - Louise Dinnett
- Cancer Research UK Glasgow Clinical Trials Unit, Beatson West of Scotland Cancer Centre, Institute of Cancer Sciences, University of Glasgow, Level 0, 1053 Great Western Road, Glasgow, G12 0YN, UK
| | - Susan Dillon
- Cancer Research UK Glasgow Clinical Trials Unit, Beatson West of Scotland Cancer Centre, Institute of Cancer Sciences, University of Glasgow, Level 0, 1053 Great Western Road, Glasgow, G12 0YN, UK
| | - Jacqueline Gourlay
- Cancer Research UK Glasgow Clinical Trials Unit, Beatson West of Scotland Cancer Centre, Institute of Cancer Sciences, University of Glasgow, Level 0, 1053 Great Western Road, Glasgow, G12 0YN, UK
| | - Jonathan J Platt
- Department of Radiology, NHS Greater Glasgow and Clyde, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF, UK
| | - Fiona Thomson
- Institute of Cancer Sciences, University of Glasgow, Glasgow, G61 1QH, UK
| | - Richard A Adams
- Centre for Trials Research Cardiff University Heath Park, Cardiff University and Velindre NHS Trust, Cardiff, UK
| | - Campbell S D Roxburgh
- Institute of Cancer Sciences, Glasgow Royal Infirmary, University of Glasgow, Room 2.57, Level 2, New Lister Building, Glasgow, G31 2ER, UK
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11
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Seligmann JF, Fisher DJ, Brown LC, Adams RA, Graham J, Quirke P, Richman SD, Butler R, Domingo E, Blake A, Yates E, Braun M, Collinson F, Jones R, Brown E, de Winton E, Humphrey TC, Parmar M, Kaplan R, Wilson RH, Seymour M, Maughan TS. Inhibition of WEE1 Is Effective in TP53- and RAS-Mutant Metastatic Colorectal Cancer: A Randomized Trial (FOCUS4-C) Comparing Adavosertib (AZD1775) With Active Monitoring. J Clin Oncol 2021; 39:3705-3715. [PMID: 34538072 PMCID: PMC8601321 DOI: 10.1200/jco.21.01435] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 07/27/2021] [Accepted: 08/16/2021] [Indexed: 12/18/2022] Open
Abstract
PURPOSE Outcomes in RAS-mutant metastatic colorectal cancer (mCRC) remain poor and patients have limited therapeutic options. Adavosertib is the first small-molecule inhibitor of WEE1 kinase. We hypothesized that aberrations in DNA replication seen in mCRC with both RAS and TP53 mutations would sensitize tumors to WEE1 inhibition. METHODS Patients with newly diagnosed mCRC were registered into FOCUS4 and tested for TP53 and RAS mutations. Those with both mutations who were stable or responding after 16 weeks of chemotherapy were randomly assigned 2:1 between adavosertib and active monitoring (AM). Adavosertib (250 mg or 300 mg) was taken orally once on days 1-5 and days 8-12 of a 3-week cycle. The primary outcome was progression-free survival (PFS), with a target hazard ratio (HR) of 0.5 and 80% power with a one-sided 0.025 significance level. RESULTS FOCUS4-C was conducted between April 2017 and Mar 2020 during which time 718 patients were registered; 247 (34%) were RAS/TP53-mutant. Sixty-nine patients were randomly assigned from 25 UK hospitals (adavosertib = 44; AM = 25). Adavosertib was associated with a PFS improvement over AM (median 3.61 v 1.87 months; HR = 0.35; 95% CI, 0.18 to 0.68; P = .0022). Overall survival (OS) was not improved with adavosertib versus AM (median 14.0 v 12.8 months; HR = 0.92; 95% CI, 0.44 to 1.94; P = .93). In prespecified subgroup analysis, adavosertib activity was greater in left-sided tumors (HR = 0.24; 95% CI, 0.11 to 0.51), versus right-sided (HR = 1.02; 95% CI, 0.41 to 2.56; interaction P = .043). Adavosertib was well-tolerated; grade 3 toxicities were diarrhea (9%), nausea (5%), and neutropenia (7%). CONCLUSION In this phase II randomized trial, adavosertib improved PFS compared with AM and demonstrates potential as a well-tolerated therapy for RAS/TP53-mutant mCRC. Further testing is required in this sizable population of unmet need.
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Affiliation(s)
- Jenny F. Seligmann
- Leeds Institute of Medical Research, University of Leeds, Leeds, United Kingdom
| | | | | | - Richard A. Adams
- Centre for Trials Research University and Velindre NHS Trust, Cardiff, United Kingdom
| | | | - Philip Quirke
- Leeds Institute of Medical Research, University of Leeds, Leeds, United Kingdom
| | - Susan D. Richman
- Leeds Institute of Medical Research, University of Leeds, Leeds, United Kingdom
| | - Rachel Butler
- Bristol Genetics Laboratory, Bristol, United Kingdom
| | - Enric Domingo
- MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford, United Kingdom
| | - Andrew Blake
- MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford, United Kingdom
| | - Emma Yates
- MRC Clinical Trials Unit at UCL, London, United Kingdom
| | | | - Fiona Collinson
- Leeds Institute of Medical Research, University of Leeds, Leeds, United Kingdom
| | - Rob Jones
- School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Ewan Brown
- Western General Hospital, Edinburgh, United Kingdom
| | | | - Timothy C. Humphrey
- MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford, United Kingdom
| | - Mahesh Parmar
- MRC Clinical Trials Unit at UCL, London, United Kingdom
| | | | | | - Matthew Seymour
- Leeds Institute of Medical Research, University of Leeds, Leeds, United Kingdom
| | - Timothy S. Maughan
- MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford, United Kingdom
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12
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Adams RA, Fisher DJ, Graham J, Seligmann JF, Seymour M, Kaplan R, Yates E, Parmar M, Richman SD, Quirke P, Butler R, Brown E, Collinson F, Falk S, Wasan H, Shiu KK, Middleton G, Samuel L, Wilson RH, Brown LC, Maughan TS. Capecitabine Versus Active Monitoring in Stable or Responding Metastatic Colorectal Cancer After 16 Weeks of First-Line Therapy: Results of the Randomized FOCUS4-N Trial. J Clin Oncol 2021; 39:3693-3704. [PMID: 34516759 PMCID: PMC8601309 DOI: 10.1200/jco.21.01436] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 08/04/2021] [Accepted: 08/16/2021] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Despite extensive randomized evidence supporting the use of treatment breaks in metastatic colorectal cancer (mCRC), they are not universally offered to patients despite improvements in quality of life without detriment to overall survival (OS). FOCUS4-N was set up to explore the impact of oral maintenance therapy in patients who are responding to first-line therapy. METHODS FOCUS4 was a molecularly stratified trial program that registered patients with newly diagnosed mCRC. The FOCUS4-N trial was offered to patients in whom a targeted subtrial was unavailable or biomarker tests failed. Patients were randomly assigned using a 1:1 ratio between maintenance capecitabine and active monitoring (AM). The primary outcome was progression-free survival (PFS) with secondary outcomes including OS toxicity and tolerability. RESULTS Between March 2014 and March 2020, 254 patients were randomly assigned (127 to capecitabine and 127 to AM) across 88 UK sites. Baseline characteristics were balanced. There was strong evidence of efficacy for PFS (hazard ratio = 0.40; 95% CI, 0.21 to 0.75; P < .0001), but no significant improvement in OS (hazard ratio, 0.93; 95% CI, 0.69 to 1.27; P = .66) was observed. Compliance with treatment was good, and toxicity from capecitabine versus AM was as expected with grade ≥ 2 fatigue (25% v 12%), diarrhea (23% v 13%), and hand-foot syndrome (26% v 3%). Quality of life showed little difference between the groups. CONCLUSION Despite strong evidence of disease control with maintenance therapy, OS remains unaffected and FOCUS4-N provides additional evidence to support the use of treatment breaks as safe management alternatives for patients who are stable or responding to first-line treatment for mCRC. Capecitabine without bevacizumab may be used to extend PFS in the interval after 16 weeks of first-line therapy.
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Affiliation(s)
- Richard A. Adams
- Centre for Trials Research Cardiff University and Velindre NHS Trust, Cardiff, United Kingdom
| | | | - Janet Graham
- University of Glasgow and Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | - Jenny F. Seligmann
- Leeds Institute of Medical Research, University of Leeds, Leeds, United Kingdom
| | - Matthew Seymour
- Leeds Institute of Medical Research, University of Leeds, Leeds, United Kingdom
| | | | - Emma Yates
- MRC Clinical Trials Unit at UCL, London, United Kingdom
| | - Mahesh Parmar
- MRC Clinical Trials Unit at UCL, London, United Kingdom
| | - Susan D. Richman
- Leeds Institute of Medical Research, University of Leeds, Leeds, United Kingdom
| | - Philip Quirke
- Leeds Institute of Medical Research, University of Leeds, Leeds, United Kingdom
| | - Rachel Butler
- Bristol Genetics Laboratory, Bristol, United Kingdom
| | - Ewan Brown
- Western General Hospital, Edinburgh, United Kingdom
| | - Fiona Collinson
- Leeds Institute of Medical Research, University of Leeds, Leeds, United Kingdom
| | - Stephen Falk
- Bristol Cancer Institute, Bristol, United Kingdom
| | | | - Kai-Keen Shiu
- University College Hospital London, London, United Kingdom
| | | | | | - Richard H. Wilson
- University of Glasgow and Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | | | - Timothy S. Maughan
- MRC Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, Oxford, United Kingdom
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13
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Hanna CR, O’Cathail SM, Graham JS, Saunders M, Samuel L, Harrison M, Devlin L, Edwards J, Gaya DR, Kelly CA, Lewsley LA, Maka N, Morrison P, Dinnett L, Dillon S, Gourlay J, Platt JJ, Thomson F, Adams RA, Roxburgh CSD. Durvalumab (MEDI 4736) in combination with extended neoadjuvant regimens in rectal cancer: a study protocol of a randomised phase II trial (PRIME-RT). Radiat Oncol 2021; 16:163. [PMID: 34446053 PMCID: PMC8393812 DOI: 10.1186/s13014-021-01888-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 04/06/2021] [Accepted: 08/16/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Advances in multi-modality treatment of locally advanced rectal cancer (LARC) have resulted in low local recurrence rates, but around 30% of patients will still die from distant metastatic disease. In parallel, there is increasing recognition that with radiotherapy and systemic treatment, some patients achieve a complete response and may avoid surgical resection, including in many cases, the need for a permanent stoma. Extended neoadjuvant regimes have emerged to address these concerns. The inclusion of immunotherapy in the neoadjuvant setting has the potential to further enhance this strategy by priming the local immune microenvironment and engaging the systemic immune response. METHODS PRIME-RT is a multi-centre, open label, phase II, randomised trial for patients with newly diagnosed LARC. Eligible patients will be randomised to receive either: short course radiotherapy (25 Gray in 5 fractions over one week) with concomitant durvalumab (1500 mg administered intravenously every 4 weeks), followed by FOLFOX (85 mg/m2 oxaliplatin, 350 mg folinic acid and 400 mg/m2 bolus 5-fluorouracil (5-FU) given on day 1 followed by 2400 mg/m2 5-FU infusion over 46-48 h, all administered intravenously every 2 weeks), and durvalumab, or long course chemoradiotherapy (50 Gray to primary tumour in 25 fractions over 5 weeks with concomitant oral capecitabine 825 mg/m2 twice per day on days of radiotherapy) with durvalumab followed by FOLFOX and durvalumab. The primary endpoint is complete response rate in each arm. Secondary endpoints include treatment compliance, toxicity, safety, overall recurrence, proportion of patients with a permanent stoma, and survival. The study is translationally rich with collection of bio-specimens prior to, during, and following treatment in order to understand the molecular and immunological factors underpinning treatment response. The trial opened and the first patient was recruited in January 2021. The main trial will recruit up to 42 patients with LARC and commence after completion of a safety run-in that will recruit at least six patients with LARC or metastatic disease. DISCUSSION PRIME-RT will explore if adding immunotherapy to neoadjuvant radiotherapy and chemotherapy for patients with LARC can prime the tumour microenvironment to improve complete response rates and stoma free survival. Sequential biopsies are a key component within the trial design that will provide new knowledge on how the tumour microenvironment changes at different time-points in response to multi-modality treatment. This expectation is that the trial will provide information to test this treatment within a large phase clinical trial. Trial registration Clinicaltrials.gov NCT04621370 (Registered 9th Nov 2020) EudraCT number 2019-001471-36 (Registered 6th Nov 2020).
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Affiliation(s)
- Catherine R. Hanna
- Cancer Research UK Glasgow Clinical Trials Unit, Beatson West of Scotland Cancer Centre, Institute of Cancer Sciences, University of Glasgow, Level 0, 1053 Great Western Road, Glasgow, G12 0YN UK
| | - Sean M. O’Cathail
- Beatson West of Scotland Cancer Centre, Institute of Cancer Sciences, University of Glasgow, 1053 Great Western Road, Glasgow, G12 0YN UK
| | - Janet S. Graham
- Beatson West of Scotland Cancer Centre, Institute of Cancer Sciences, University of Glasgow, 1053 Great Western Road, Glasgow, G12 0YN UK
| | - Mark Saunders
- The Christie NHS Foundation Trust, Wilmslow Rd, Manchester, M20 4BX UK
| | | | - Mark Harrison
- Mount Vernon Cancer Centre, Rickmansworth Rd, Northwood, HA6 2RN UK
| | - Lynsey Devlin
- Beatson West of Scotland Cancer Centre, 1053 Great Western Road, Glasgow, G12 0YN UK
| | - Joanne Edwards
- Institute of Cancer Sciences, University of Glasgow, Garscube Estate, Switchback Road, Bearsden, G61 1QH UK
| | - Daniel R. Gaya
- Gastroenterology Unit, Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, 4th Floor Walton Building, Castle Street, Glasgow, G4 0SF UK
| | - Caroline A. Kelly
- Cancer Research UK Glasgow Clinical Trials Unit, Beatson West of Scotland Cancer Centre, Institute of Cancer Sciences, University of Glasgow, Level 0, 1053 Great Western Road, Glasgow, G12 0YN UK
| | - Liz-Anne Lewsley
- Cancer Research UK Glasgow Clinical Trials Unit, Beatson West of Scotland Cancer Centre, Institute of Cancer Sciences, University of Glasgow, Level 0, 1053 Great Western Road, Glasgow, G12 0YN UK
| | - Noori Maka
- Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, 1345 Govan Road, Glasgow, G51 4TF UK
| | - Paula Morrison
- Snr Pharmacist Clinical Trials Oncology R&I, Research & Innovation, Dykebar Hospital, NHS Greater Glasgow & Clyde, Ward 11, Grahamston Road, Paisley, PA2 7DE UK
| | - Louise Dinnett
- Cancer Research UK Glasgow Clinical Trials Unit, Beatson West of Scotland Cancer Centre, Institute of Cancer Sciences, University of Glasgow, Level 0, 1053 Great Western Road, Glasgow, G12 0YN UK
| | - Susan Dillon
- Cancer Research UK Glasgow Clinical Trials Unit, Beatson West of Scotland Cancer Centre, Institute of Cancer Sciences, University of Glasgow, Level 0, 1053 Great Western Road, Glasgow, G12 0YN UK
| | - Jacqueline Gourlay
- Cancer Research UK Glasgow Clinical Trials Unit, Beatson West of Scotland Cancer Centre, Institute of Cancer Sciences, University of Glasgow, Level 0, 1053 Great Western Road, Glasgow, G12 0YN UK
| | - Jonathan J. Platt
- Department of Radiology, NHS Greater Glasgow and Clyde, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF UK
| | - Fiona Thomson
- Institute of Cancer Sciences, University of Glasgow, Glasgow, G61 1QH UK
| | - Richard A. Adams
- Centre for Trials Research Cardiff University Heath Park, Cardiff University and Velindre NHS Trust, Cardiff, UK
| | -
Campbell S. D. Roxburgh
- Institute of Cancer Sciences, Glasgow Royal Infirmary, University of Glasgow, Room 2.57, Level 2, New Lister Building, Glasgow, G31 2ER UK
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14
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Germetaki T, Nicholls C, Adams RA, Braun M, Rogan J, Moghadam S, Lenfert E, Lukas A, Edelstein DL, Jones FS, Saunders MP. Blood-based RAS mutation testing: concordance with tissue-based RAS testing and mutational changes on progression. Future Oncol 2020; 16:2177-2189. [PMID: 32716216 DOI: 10.2217/fon-2020-0523] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Aim: To determine the concordance between plasma and tissue RAS mutation status in metastatic colorectal cancer patients to gauge whether blood-based testing is a viable alternative. We also evaluated the change in mutation status on progression. Materials/methods: RAS testing was performed on plasma from patients commencing first-line therapy (OncoBEAM™ RAS CEIVD kit). Results were then compared with formalin-fixed paraffin embedded tumor samples. Results: The overall percentage agreement (concordance) was 86.0% (86/100), which demonstrates that blood-based testing is an alternative to tissue-based testing. Reproducibility was 100% between three laboratories and 20% showed changes in their RAS mutational status on progression. Conclusion: These results show good concordance between tissue and plasma samples and suggest the need for longitudinal plasma testing during treatment to guide management decisions.
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Affiliation(s)
- Theodora Germetaki
- Department of Medical & Clinical Oncology, The Christie Hospital, 550 Wilmslow Road, Manchester M20 4BX, UK
| | - Camille Nicholls
- Department of Medical & Clinical Oncology, The Christie Hospital, 550 Wilmslow Road, Manchester M20 4BX, UK
| | - Richard A Adams
- Department of Medical Oncology, Velindre Hospital, Velindre Road, Cardiff, Wales CF14 2TL, UK
| | - Michael Braun
- Department of Medical & Clinical Oncology, The Christie Hospital, 550 Wilmslow Road, Manchester M20 4BX, UK
| | - Jane Rogan
- Department of Medical & Clinical Oncology, The Christie Hospital, 550 Wilmslow Road, Manchester M20 4BX, UK
| | - Sharzad Moghadam
- Department of Medical & Clinical Oncology, The Christie Hospital, 550 Wilmslow Road, Manchester M20 4BX, UK
| | - Eva Lenfert
- Sysmex Inostics GmbH, Falkenried 88, Hamburg 20251, Germany
| | - Antje Lukas
- Sysmex Inostics GmbH, Falkenried 88, Hamburg 20251, Germany
| | | | | | - Mark P Saunders
- Department of Medical & Clinical Oncology, The Christie Hospital, 550 Wilmslow Road, Manchester M20 4BX, UK
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15
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Rao S, Sclafani F, Eng C, Adams RA, Guren MG, Sebag-Montefiore D, Benson A, Bryant A, Peckitt C, Segelov E, Roy A, Seymour MT, Welch J, Saunders MP, Muirhead R, O’Dwyer P, Bridgewater J, Bhide S, Glynne-Jones R, Arnold D, Cunningham D. International Rare Cancers Initiative Multicenter Randomized Phase II Trial of Cisplatin and Fluorouracil Versus Carboplatin and Paclitaxel in Advanced Anal Cancer: InterAAct. J Clin Oncol 2020; 38:2510-2518. [PMID: 32530769 PMCID: PMC7406334 DOI: 10.1200/jco.19.03266] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2020] [Indexed: 01/02/2023] Open
Abstract
PURPOSE To compare cisplatin plus fluorouracil (FU) versus carboplatin plus paclitaxel in chemotherapy-naïve advanced anal cancer to establish the optimal regimen. PATIENTS AND METHODS Patients who had not received systemic therapy for advanced anal cancer were randomly assigned 1:1 to intravenous cisplatin 60 mg/m2 (day 1) plus FU 1,000 mg/m2 (days 1-4) every 21 days or carboplatin (area under the curve, 5; day 1) plus paclitaxel 80 mg/m2 (days 1, 8, and 15) every 28 days for 24 weeks, until disease progression, intolerable toxicity, or withdrawal of consent. Primary end point was objective response rate (ORR). Primary and secondary end points were assessed in a hierarchic model to compare the regimens and pick the winner. RESULTS We conducted an international multicenter randomized phase II study in 60 centers between December 2013 and November 2017. Median follow-up was 28.6 months. A total of 91 patients were randomly assigned: 46 to cisplatin plus FU and 45 to carboplatin plus paclitaxel. ORR was 57% (95% CI, 39.4% to 73.7%) for cisplatin plus FU versus 59% (95% CI, 42.1% to 74.4%) for carboplatin plus paclitaxel. More serious adverse events were noted in the cisplatin plus FU arm (62%) compared with the carboplatin plus paclitaxel arm (36%; P = .016). Median progression-free survival was 5.7 months (95% CI, 3.3 to 9.0 months) for cisplatin plus FU compared with 8.1 months (95% CI, 6.6 to 8.8 months) for carboplatin plus paclitaxel. Median overall survival was 12.3 months for cisplatin plus FU (95% CI, 9.2 to 17.7 months) compared with 20 months (95% CI, 12.7 months to not reached) for carboplatin plus paclitaxel (hazard ratio, 2.00; 95% CI, 1.15 to 3.47; P = .014). CONCLUSION This is the first international randomized trial to our knowledge conducted in chemotherapy-naïve advanced anal cancer. Although there was no difference in ORR, the association with clinically relevant reduced toxicity and a trend toward longer survival suggest that carboplatin plus paclitaxel should be considered as a new standard of care.
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Affiliation(s)
- Sheela Rao
- Royal Marsden Hospital, London, United Kingdom
| | | | - Cathy Eng
- MD Anderson Cancer Center, Houston, TX
| | | | | | | | - Al Benson
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL
| | | | | | - Eva Segelov
- Monash Health and Monash University, Melbourne, VIC, Australia
| | - Amitesh Roy
- Flinders University and Flinders Medical Centre, Adelaide, SA, Australia
| | | | | | | | | | - Peter O’Dwyer
- Eastern Cooperative Oncology Group–American College of Radiology Imaging Network, Philadelphia, PA
| | | | - Shree Bhide
- Institute of Cancer Research, London, United Kingdom
| | | | - Dirk Arnold
- Eastern Cooperative Oncology Group–American College of Radiology Imaging Network, Philadelphia, PA
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16
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Tang AM, Hamunime N, Adams RA, Kanyinga G, Fischer-Walker C, Agolory S, Prybylski D, Mutenda N, Sughrue S, Walker DD, Rennie T, Zahralban-Steele M, Kerrigan A, Hong SY. Introduction of an Alcohol-Related Electronic Screening and Brief Intervention (eSBI) Program to Reduce Hazardous Alcohol Consumption in Namibia's Antiretroviral Treatment (ART) Program. AIDS Behav 2019; 23:3078-3092. [PMID: 31444711 PMCID: PMC6801208 DOI: 10.1007/s10461-019-02648-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Alcohol is the most widely abused substance in Namibia and is associated with poor adherence and retention in care among people on antiretroviral therapy (ART). Electronic screening and brief interventions (eSBI) are effective in reducing alcohol consumption in various contexts. We used a mixed methods approach to develop, implement, and evaluate the introduction of an eSBI in two ART clinics in Namibia. Of the 787 participants, 45% reported some alcohol use in the past 12 months and 25% reported hazardous drinking levels. Hazardous drinkers were more likely to be male, separated/widowed/divorced, have a monthly household income > $1000 NAD, and report less than excellent ART adherence. Based on qualitative feedback from participants and providers, ART patients using the eSBI for the first time found it to be a positive and beneficial experience. However, we identified several programmatic considerations that could improve the experience and yield in future implementation studies.
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Affiliation(s)
- A M Tang
- School of Medicine, Tufts University, Boston, MA, USA.
- Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Avenue, MV248, Boston, MA, 02111, USA.
| | - N Hamunime
- Government of Namibia, Ministry of Health and Social Services, Windhoek, Namibia
| | - R A Adams
- Government of Namibia, Ministry of Health and Social Services, Windhoek, Namibia
| | - G Kanyinga
- Government of Namibia, Ministry of Health and Social Services, Windhoek, Namibia
| | | | - S Agolory
- U.S. Centers for Disease Control & Prevention, Atlanta, GA, USA
| | - D Prybylski
- U.S. Centers for Disease Control & Prevention, Atlanta, GA, USA
| | - N Mutenda
- Government of Namibia, Ministry of Health and Social Services, Windhoek, Namibia
| | - S Sughrue
- School of Medicine, Tufts University, Boston, MA, USA
| | - D D Walker
- School of Social Work, University of Washington, Seattle, WA, USA
| | - T Rennie
- School of Pharmacy, University of Namibia, Windhoek, Namibia
| | | | - A Kerrigan
- School of Medicine, Tufts University, Boston, MA, USA
| | - S Y Hong
- U.S. Centers for Disease Control & Prevention, Atlanta, GA, USA
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17
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Salem ME, Yin J, Weinberg BA, Renfro LA, Pederson LD, Maughan TS, Adams RA, Van Cutsem E, Falcone A, Tebbutt NC, Seymour MT, Díaz-Rubio E, Aranda E, Bokemeyer C, Heinemann V, Wasan H, de Gramont A, Grothey A, Shi Q, Sargent DJ, Marshall JL. Clinicopathological differences and survival outcomes with first-line therapy in patients with left-sided colon cancer and rectal cancer: Pooled analysis of 2879 patients from AGITG (MAX), COIN, FOCUS2, OPUS, CRYSTAL and COIN-B trials in the ARCAD database. Eur J Cancer 2018; 103:205-213. [PMID: 30268921 DOI: 10.1016/j.ejca.2018.08.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 08/22/2018] [Indexed: 01/09/2023]
Abstract
PURPOSE Patients with left-sided colon tumours have better survival and respond differently to biologics compared with patients with right-sided tumours. Left-sided colon tumours and rectal cancers are often grouped together. Herein, we examined the clinicopathological differences and outcomes between left-sided colon and rectal cancers. PATIENTS AND METHODS Data from 2879 metastatic colorectal cancer patients enrolled on six first-line clinical trials during 2004-2010 were pooled. Patients were included if the primary tumour origin was clearly defined. Progression-free survival (PFS) and overall survival (OS) were compared in the two groups after adjusting for patient and tumour characteristics, metastatic sites and the first-line regimen. RESULTS In total, 1374 patients with metastatic left-sided colon cancer and 1505 patients with metastatic rectal cancers were evaluated. Left-sided colon cancer patients were more likely to be female (40.1% versus 32.6%; P < 0.0001) and older (31.0% ≥ 70 years versus 25.8%; P = 0.0033) compared with rectal cancers patients. Patients with left-sided colon cancer had higher rates of liver metastases (80.9% versus 72.3%, P < 0.0001) but lower rates of lung metastases (34.2% versus 53.8%, P < 0.0001). KRAS mutations were slightly less frequent among left-sided tumours (34.8% versus 40.5%; P = 0.0103). Patients with left-sided tumours had approximately similar PFS (median 7.4 versus 6.9 months; hazard ratio [HR] 0.92, 95% confidence interval [CI] 0.87-1.03; P = 0.1998) and OS (median 17.4 versus 16.6 months; HR 0.99, 95% CI 0.91-1.07; P = 0.7597) compared with rectal cancer patients. CONCLUSION The site of tumour origin within the left side was not prognostic of outcomes. Moreover, neither bevacizumab nor cetuximab impacted, differently, the findings of the comparisons in outcomes between patients with left-sided colon tumours or rectal cancers.
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Affiliation(s)
- Mohamed E Salem
- Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC, USA.
| | - Jun Yin
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Benjamin A Weinberg
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Lindsay A Renfro
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Levi D Pederson
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | | | | | - Eric Van Cutsem
- Digestive Oncology, University Hospitals Leuven and KU Leuven, Leuven, Belgium
| | | | | | - Matthew T Seymour
- Gastrointestinal Cancer Research Unit, Cookridge Hospital, Leeds, UK
| | - Eduardo Díaz-Rubio
- Department Oncology, Hospital Clínico San Carlos, CIBERONC, Madrid, Spain
| | - Enrique Aranda
- Reina Sofia Hospital, University of Cordoba, Maimonides Institute of Biomedical Research, CIBERONC, Avenida de Menendez Pidal, Cordoba, Spain
| | - Carsten Bokemeyer
- Department of Oncology, Haematology and Bone Marrow Transplantation with Section of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Volker Heinemann
- Comprehensive Cancer Center, Ludwig-Maximilians-University of Munich, Munich, Germany
| | | | - Aimery de Gramont
- Department of Medical Oncology, Franco-British Institute, Levallois-Perret, France
| | - Axel Grothey
- Medical Oncology, West Cancer Center, Germantown, TN, USA
| | - Qian Shi
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Daniel J Sargent
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - John L Marshall
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
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18
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West H, Coffey M, Wagner MJ, McLeod HL, Colley JP, Adams RA, Fleck O, Maughan TS, Fisher D, Kaplan RS, Harris R, Cheadle JP. Role for Nucleotide Excision Repair Gene Variants in Oxaliplatin-Induced Peripheral Neuropathy. JCO Precis Oncol 2018; 2:1-18. [PMID: 35135151 DOI: 10.1200/po.18.00090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023] Open
Abstract
PURPOSE Oxaliplatin forms part of routine treatment of advanced colorectal cancer; however, it often causes severe peripheral neuropathy, resulting in treatment discontinuation. We sought to determine the molecular and cellular mechanism underlying this toxicity. PATIENTS AND METHODS We exome resequenced blood DNA samples from nine patients with advanced colorectal cancer who had severe peripheral neuropathy associated with oxaliplatin (PNAO) within 12 weeks of treatment. We Sanger sequenced the ERCC4 and ERCC6 open reading frames in 63 patients with PNAO and carried out targeted genotyping in 1,763 patients without PNAO. We tested the functionality of ERCC4 variants using viability and DNA repair assays in Schizosaccharomyces pombe and human cell lines after exposure to oxaliplatin and ultraviolet light. RESULTS Exome resequencing identified one patient carrying a novel germline truncating mutation in the nucleotide excision repair (NER) gene ERCC4. This mutation was functionally associated with sensitivity to oxaliplatin (P = 3.5 × 10-2). We subsequently found that multiple rare ERCC4 nonsynonymous variants were over-represented in affected individuals (P = 7.7 × 10-3) and three of these were defective in the repair of ultraviolet light-induced DNA damage (P < 1 × 10-3). We validated a role for NER genes in PNAO by finding that multiple rare ERCC6 nonsynonymous variants were similarly over-represented in affected individuals (P = 2.4 × 10-8). Excluding private variants, 22.2% of patients (14 of 63 patients) with PNAO carried Pro379Ser or Glu875Gly in ERCC4 or Asp425Ala, Gly446Asp, or Ser797Cys in ERCC6, compared with 8.7% of unaffected patients (152 of 1,750 patients; odds ratio, 3.0; 95% CI, 1.6 to 5.6; P = 2.5 × 10-4). CONCLUSION Our study provides evidence for a role of NER genes in PNAO, together with mechanistic insights.
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Affiliation(s)
- Hannah West
- Hannah West, Michelle Coffey, James P. Colley, Richard A. Adams, Rebecca Harris, and Jeremy P. Cheadle, School of Medicine, Cardiff University, Cardiff; Oliver Fleck, North West Cancer Research Institute, Bangor University, Bangor; Timothy S. Maughan, Cancer Research UK/Medical Research Council Oxford Institute for Radiation Oncology, University of Oxford, Oxford; David Fisher and Richard S. Kaplan, Medical Research Council Clinical Trials Unit, London, United Kingdom; Michael J. Wagner, Institute for Pharmacogenomics and Individualized Therapy, University of North Carolina, Chapel Hill, NC; and Howard L. McLeod, DeBartolo Family Personalized Medicine Institute, Moffitt Cancer Center, Tampa, FL
| | - Michelle Coffey
- Hannah West, Michelle Coffey, James P. Colley, Richard A. Adams, Rebecca Harris, and Jeremy P. Cheadle, School of Medicine, Cardiff University, Cardiff; Oliver Fleck, North West Cancer Research Institute, Bangor University, Bangor; Timothy S. Maughan, Cancer Research UK/Medical Research Council Oxford Institute for Radiation Oncology, University of Oxford, Oxford; David Fisher and Richard S. Kaplan, Medical Research Council Clinical Trials Unit, London, United Kingdom; Michael J. Wagner, Institute for Pharmacogenomics and Individualized Therapy, University of North Carolina, Chapel Hill, NC; and Howard L. McLeod, DeBartolo Family Personalized Medicine Institute, Moffitt Cancer Center, Tampa, FL
| | - Michael J Wagner
- Hannah West, Michelle Coffey, James P. Colley, Richard A. Adams, Rebecca Harris, and Jeremy P. Cheadle, School of Medicine, Cardiff University, Cardiff; Oliver Fleck, North West Cancer Research Institute, Bangor University, Bangor; Timothy S. Maughan, Cancer Research UK/Medical Research Council Oxford Institute for Radiation Oncology, University of Oxford, Oxford; David Fisher and Richard S. Kaplan, Medical Research Council Clinical Trials Unit, London, United Kingdom; Michael J. Wagner, Institute for Pharmacogenomics and Individualized Therapy, University of North Carolina, Chapel Hill, NC; and Howard L. McLeod, DeBartolo Family Personalized Medicine Institute, Moffitt Cancer Center, Tampa, FL
| | - Howard L McLeod
- Hannah West, Michelle Coffey, James P. Colley, Richard A. Adams, Rebecca Harris, and Jeremy P. Cheadle, School of Medicine, Cardiff University, Cardiff; Oliver Fleck, North West Cancer Research Institute, Bangor University, Bangor; Timothy S. Maughan, Cancer Research UK/Medical Research Council Oxford Institute for Radiation Oncology, University of Oxford, Oxford; David Fisher and Richard S. Kaplan, Medical Research Council Clinical Trials Unit, London, United Kingdom; Michael J. Wagner, Institute for Pharmacogenomics and Individualized Therapy, University of North Carolina, Chapel Hill, NC; and Howard L. McLeod, DeBartolo Family Personalized Medicine Institute, Moffitt Cancer Center, Tampa, FL
| | - James P Colley
- Hannah West, Michelle Coffey, James P. Colley, Richard A. Adams, Rebecca Harris, and Jeremy P. Cheadle, School of Medicine, Cardiff University, Cardiff; Oliver Fleck, North West Cancer Research Institute, Bangor University, Bangor; Timothy S. Maughan, Cancer Research UK/Medical Research Council Oxford Institute for Radiation Oncology, University of Oxford, Oxford; David Fisher and Richard S. Kaplan, Medical Research Council Clinical Trials Unit, London, United Kingdom; Michael J. Wagner, Institute for Pharmacogenomics and Individualized Therapy, University of North Carolina, Chapel Hill, NC; and Howard L. McLeod, DeBartolo Family Personalized Medicine Institute, Moffitt Cancer Center, Tampa, FL
| | - Richard A Adams
- Hannah West, Michelle Coffey, James P. Colley, Richard A. Adams, Rebecca Harris, and Jeremy P. Cheadle, School of Medicine, Cardiff University, Cardiff; Oliver Fleck, North West Cancer Research Institute, Bangor University, Bangor; Timothy S. Maughan, Cancer Research UK/Medical Research Council Oxford Institute for Radiation Oncology, University of Oxford, Oxford; David Fisher and Richard S. Kaplan, Medical Research Council Clinical Trials Unit, London, United Kingdom; Michael J. Wagner, Institute for Pharmacogenomics and Individualized Therapy, University of North Carolina, Chapel Hill, NC; and Howard L. McLeod, DeBartolo Family Personalized Medicine Institute, Moffitt Cancer Center, Tampa, FL
| | - Oliver Fleck
- Hannah West, Michelle Coffey, James P. Colley, Richard A. Adams, Rebecca Harris, and Jeremy P. Cheadle, School of Medicine, Cardiff University, Cardiff; Oliver Fleck, North West Cancer Research Institute, Bangor University, Bangor; Timothy S. Maughan, Cancer Research UK/Medical Research Council Oxford Institute for Radiation Oncology, University of Oxford, Oxford; David Fisher and Richard S. Kaplan, Medical Research Council Clinical Trials Unit, London, United Kingdom; Michael J. Wagner, Institute for Pharmacogenomics and Individualized Therapy, University of North Carolina, Chapel Hill, NC; and Howard L. McLeod, DeBartolo Family Personalized Medicine Institute, Moffitt Cancer Center, Tampa, FL
| | - Timothy S Maughan
- Hannah West, Michelle Coffey, James P. Colley, Richard A. Adams, Rebecca Harris, and Jeremy P. Cheadle, School of Medicine, Cardiff University, Cardiff; Oliver Fleck, North West Cancer Research Institute, Bangor University, Bangor; Timothy S. Maughan, Cancer Research UK/Medical Research Council Oxford Institute for Radiation Oncology, University of Oxford, Oxford; David Fisher and Richard S. Kaplan, Medical Research Council Clinical Trials Unit, London, United Kingdom; Michael J. Wagner, Institute for Pharmacogenomics and Individualized Therapy, University of North Carolina, Chapel Hill, NC; and Howard L. McLeod, DeBartolo Family Personalized Medicine Institute, Moffitt Cancer Center, Tampa, FL
| | - David Fisher
- Hannah West, Michelle Coffey, James P. Colley, Richard A. Adams, Rebecca Harris, and Jeremy P. Cheadle, School of Medicine, Cardiff University, Cardiff; Oliver Fleck, North West Cancer Research Institute, Bangor University, Bangor; Timothy S. Maughan, Cancer Research UK/Medical Research Council Oxford Institute for Radiation Oncology, University of Oxford, Oxford; David Fisher and Richard S. Kaplan, Medical Research Council Clinical Trials Unit, London, United Kingdom; Michael J. Wagner, Institute for Pharmacogenomics and Individualized Therapy, University of North Carolina, Chapel Hill, NC; and Howard L. McLeod, DeBartolo Family Personalized Medicine Institute, Moffitt Cancer Center, Tampa, FL
| | - Richard S Kaplan
- Hannah West, Michelle Coffey, James P. Colley, Richard A. Adams, Rebecca Harris, and Jeremy P. Cheadle, School of Medicine, Cardiff University, Cardiff; Oliver Fleck, North West Cancer Research Institute, Bangor University, Bangor; Timothy S. Maughan, Cancer Research UK/Medical Research Council Oxford Institute for Radiation Oncology, University of Oxford, Oxford; David Fisher and Richard S. Kaplan, Medical Research Council Clinical Trials Unit, London, United Kingdom; Michael J. Wagner, Institute for Pharmacogenomics and Individualized Therapy, University of North Carolina, Chapel Hill, NC; and Howard L. McLeod, DeBartolo Family Personalized Medicine Institute, Moffitt Cancer Center, Tampa, FL
| | - Rebecca Harris
- Hannah West, Michelle Coffey, James P. Colley, Richard A. Adams, Rebecca Harris, and Jeremy P. Cheadle, School of Medicine, Cardiff University, Cardiff; Oliver Fleck, North West Cancer Research Institute, Bangor University, Bangor; Timothy S. Maughan, Cancer Research UK/Medical Research Council Oxford Institute for Radiation Oncology, University of Oxford, Oxford; David Fisher and Richard S. Kaplan, Medical Research Council Clinical Trials Unit, London, United Kingdom; Michael J. Wagner, Institute for Pharmacogenomics and Individualized Therapy, University of North Carolina, Chapel Hill, NC; and Howard L. McLeod, DeBartolo Family Personalized Medicine Institute, Moffitt Cancer Center, Tampa, FL
| | - Jeremy P Cheadle
- Hannah West, Michelle Coffey, James P. Colley, Richard A. Adams, Rebecca Harris, and Jeremy P. Cheadle, School of Medicine, Cardiff University, Cardiff; Oliver Fleck, North West Cancer Research Institute, Bangor University, Bangor; Timothy S. Maughan, Cancer Research UK/Medical Research Council Oxford Institute for Radiation Oncology, University of Oxford, Oxford; David Fisher and Richard S. Kaplan, Medical Research Council Clinical Trials Unit, London, United Kingdom; Michael J. Wagner, Institute for Pharmacogenomics and Individualized Therapy, University of North Carolina, Chapel Hill, NC; and Howard L. McLeod, DeBartolo Family Personalized Medicine Institute, Moffitt Cancer Center, Tampa, FL
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19
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Madi A, Fisher D, Maughan TS, Colley JP, Meade AM, Maynard J, Humphreys V, Wasan H, Adams RA, Idziaszczyk S, Harris R, Kaplan RS, Cheadle JP. Pharmacogenetic analyses of 2183 patients with advanced colorectal cancer; potential role for common dihydropyrimidine dehydrogenase variants in toxicity to chemotherapy. Eur J Cancer 2018; 102:31-39. [PMID: 30114658 DOI: 10.1016/j.ejca.2018.07.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 06/29/2018] [Accepted: 07/08/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Inherited genetic variants may influence response to, and side-effects from, chemotherapy. We sought to generate a comprehensive inherited pharmacogenetic profile for oxaliplatin and 5FU/capecitabine therapy in advanced colorectal cancer (aCRC). METHODS We analysed more than 200 potentially functional, common, inherited variants in genes within the 5FU, capecitabine, oxaliplatin and DNA repair pathways, together with four rare dihydropyrimidine dehydrogenase (DPYD) variants, in 2183 aCRC patients treated with oxaliplatin-fluoropyrimidine chemotherapy with, or without, cetuximab (from MRC COIN and COIN-B trials). Primary end-points were response, any toxicity and peripheral neuropathy. We had >85% power to detect odds ratios (ORs) = 1.3 for variants with minor allele frequencies >20%. RESULTS Variants in DNA repair genes (Asn279Ser in EXO1 and Arg399Gln in XRCC1) were most associated with response (OR 1.9, 95% confidence interval [CI] 1.2-2.9, P = 0.004, and OR 0.7, 95% CI 0.5-0.9, P = 0.003, respectively). Common variants in DPYD (Cys29Arg and Val732Ile) were most associated with toxicity (OR 0.8, 95% CI 0.7-1.0, P = 0.008, and OR 1.6, 95% CI 1.1-2.1, P = 0.006, respectively). Two rare DPYD variants were associated with increased toxicity (Asp949Val with neutropenia, nausea and vomiting, diarrhoea and infection; IVS14+1G>A with lethargy, diarrhoea, stomatitis, hand-foot syndrome and infection; all ORs > 3). Asp317His in DCLRE1A was most associated with peripheral neuropathy (OR 1.3, 95% CI 1.1-1.6, P = 0.003). No common variant associations remained significant after Bonferroni correction. CONCLUSIONS DNA repair genes may play a significant role in the pharmacogenetics of aCRC. Our data suggest that both common and rare DPYD variants may be associated with toxicity to fluoropyrimidine-based chemotherapy.
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Affiliation(s)
- Ayman Madi
- Division of Cancer and Genetics, School of Medicine, Cardiff University, Heath Park, Cardiff, CF14 4XN, UK
| | - David Fisher
- MRC Clinical Trials Unit, Aviation House, 125 Kingsway, London, WC2B 6NH, UK
| | - Timothy S Maughan
- Division of Cancer and Genetics, School of Medicine, Cardiff University, Heath Park, Cardiff, CF14 4XN, UK
| | - James P Colley
- Division of Cancer and Genetics, School of Medicine, Cardiff University, Heath Park, Cardiff, CF14 4XN, UK
| | - Angela M Meade
- MRC Clinical Trials Unit, Aviation House, 125 Kingsway, London, WC2B 6NH, UK
| | - Julie Maynard
- Division of Cancer and Genetics, School of Medicine, Cardiff University, Heath Park, Cardiff, CF14 4XN, UK
| | - Vikki Humphreys
- Division of Cancer and Genetics, School of Medicine, Cardiff University, Heath Park, Cardiff, CF14 4XN, UK
| | - Harpreet Wasan
- Imperial College Healthcare NHS Trust, Hammersmith Hospital, Du Cane Road, London, W12 0HS, UK
| | - Richard A Adams
- Division of Cancer and Genetics, School of Medicine, Cardiff University, Heath Park, Cardiff, CF14 4XN, UK
| | - Shelley Idziaszczyk
- Division of Cancer and Genetics, School of Medicine, Cardiff University, Heath Park, Cardiff, CF14 4XN, UK
| | - Rebecca Harris
- Division of Cancer and Genetics, School of Medicine, Cardiff University, Heath Park, Cardiff, CF14 4XN, UK
| | - Richard S Kaplan
- MRC Clinical Trials Unit, Aviation House, 125 Kingsway, London, WC2B 6NH, UK
| | - Jeremy P Cheadle
- Division of Cancer and Genetics, School of Medicine, Cardiff University, Heath Park, Cardiff, CF14 4XN, UK.
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20
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Goey KKH, Sørbye H, Glimelius B, Adams RA, André T, Arnold D, Berlin JD, Bodoky G, de Gramont A, Díaz-Rubio E, Eng C, Falcone A, Grothey A, Heinemann V, Hochster HS, Kaplan RS, Kopetz S, Labianca R, Lieu CH, Meropol NJ, Price TJ, Schilsky RL, Schmoll HJ, Shacham-Shmueli E, Shi Q, Sobrero AF, Souglakos J, Van Cutsem E, Zalcberg J, van Oijen MGH, Punt CJA, Koopman M. Consensus statement on essential patient characteristics in systemic treatment trials for metastatic colorectal cancer: Supported by the ARCAD Group. Eur J Cancer 2018; 100:35-45. [PMID: 29936065 DOI: 10.1016/j.ejca.2018.05.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Revised: 05/15/2018] [Accepted: 05/17/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND Patient characteristics and stratification factors are key features influencing trial outcomes. However, there is substantial heterogeneity in reporting of patient characteristics and use of stratification factors in phase 3 trials investigating systemic treatment of metastatic colorectal cancer (mCRC). We aimed to develop a minimum set of essential baseline characteristics and stratification factors to include in such trials. METHODS We performed a modified, two-round Delphi survey among international experts with wide experience in the conduct and methodology of phase 3 trials of systemic treatment of mCRC. RESULTS Thirty mCRC experts from 15 different countries completed both consensus rounds. A total of 14 patient characteristics were included in the recommended set: age, performance status, primary tumour location, primary tumour resection, prior chemotherapy, number of metastatic sites, liver-only disease, liver involvement, surgical resection of metastases, synchronous versus metachronous metastases, (K)RAS and BRAF mutation status, microsatellite instability/mismatch repair status and number of prior treatment lines. A total of five patient characteristics were considered the most relevant stratification factors: RAS/BRAF mutation status, performance status, primary tumour sidedness and liver-only disease. CONCLUSIONS This survey provides a minimum set of essential baseline patient characteristics and stratification factors to include in phase 3 trials of systemic treatment of mCRC. Inclusion of these patient characteristics and strata in study protocols and final study reports will improve interpretation of trial results and facilitate cross-study comparisons.
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Affiliation(s)
- Kaitlyn K H Goey
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Halfdan Sørbye
- Department of Oncology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Science, Haukeland University Hospital, Bergen, Norway
| | - Bengt Glimelius
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | | | - Thierry André
- Department of Medical Oncology, Hôpital St Antoine; Sorbonne Universités, UMPC Paris 06, Paris, France
| | - Dirk Arnold
- Asklepios Tumorzentrum Hamburg, Asklepios Klinik Altona, Hamburg, Germany
| | - Jordan D Berlin
- Vanderbilt-Ingram Cancer Center, Vanderbilt University, Nashville, TN, USA
| | - György Bodoky
- Department of Medical Oncology, St. Laszlo Hospital, Budapest, Hungary
| | - Aimery de Gramont
- Department of Medical Oncology, Institut Hospitalier Franco Britannique, Levallois-Perret, Paris, France
| | - Eduardo Díaz-Rubio
- Department of Medical Oncology, Hospital Clínico San Carlos, Universidad Complutense, CIBERONC, Madrid, Spain
| | - Cathy Eng
- Department of Medical Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Alfredo Falcone
- Department of Medical Oncology, University of Pisa, Pisa, Italy
| | - Axel Grothey
- Division of Medical Oncology, Mayo Clinic, Rochester, MN, USA
| | - Volker Heinemann
- Medical Department III, Comprehensive Cancer Center, University Clinic Munich, Munich, Germany
| | | | - Richard S Kaplan
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - Scott Kopetz
- Department of Medical Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | | | | | - Neal J Meropol
- Flatiron Health, New York, NY, USA; Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH, USA
| | - Timothy J Price
- Department of Medical Oncology, The Queen Elizabeth Hospital, Australia
| | | | - Hans-Joachim Schmoll
- Division Clinical Oncology Research, University Clinic Halle, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | | | - Qian Shi
- Department of Health Science Research, Mayo Clinic, Rochester, MN, USA
| | | | - John Souglakos
- Department of Medical Oncology, University General Hospital of Heraklion, Heraklion, Greece
| | - Eric Van Cutsem
- Department of Digestive Oncology, University Hospitals Gasthuisberg Leuven and KU Leuven, Leuven, Belgium
| | - John Zalcberg
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Martijn G H van Oijen
- Department of Medical Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Cornelis J A Punt
- Department of Medical Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Miriam Koopman
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
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21
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Rose GA, Davies RG, Davison GW, Adams RA, Williams IM, Lewis MH, Appadurai IR, Bailey DM. The cardiopulmonary exercise test grey zone; optimising fitness stratification by application of critical difference. Br J Anaesth 2018; 120:1187-1194. [PMID: 29793585 DOI: 10.1016/j.bja.2018.02.062] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 02/08/2018] [Accepted: 03/06/2018] [Indexed: 10/17/2022] Open
Abstract
BACKGROUND Cardiorespiratory fitness can inform patient care, although to what extent natural variation in CRF influences clinical practice remains to be established. We calculated natural variation for cardiopulmonary exercise test (CPET) metrics, which may have implications for fitness stratification. METHODS In a two-armed experiment, critical difference comprising analytical imprecision and biological variation was calculated for cardiorespiratory fitness and thus defined the magnitude of change required to claim a clinically meaningful change. This metric was retrospectively applied to 213 patients scheduled for colorectal surgery. These patients underwent CPET and the potential for misclassification of fitness was calculated. We created a model with boundaries inclusive of natural variation [critical difference applied to oxygen uptake at anaerobic threshold (V˙O2-AT): 11 ml O2 kg-1 min-1, peak oxygen uptake (V˙O2 peak): 16 ml O2 kg-1 min-1, and ventilatory equivalent for carbon dioxide at AT (V̇E/V̇CO2-AT): 36]. RESULTS The critical difference for V˙O2-AT, V˙O2 peak, and V˙E/V˙CO2-AT was 19%, 13%, and 10%, respectively, resulting in false negative and false positive rates of up to 28% and 32% for unfit patients. Our model identified boundaries for unfit and fit patients: AT <9.2 and ≥13.6 ml O2 kg-1 min-1, V˙O2 peak <14.2 and ≥18.3 ml kg-1 min-1, V˙E/V˙CO2-AT ≥40.1 and <32.7, between which an area of indeterminate-fitness was established. With natural variation considered, up to 60% of patients presented with indeterminate-fitness. CONCLUSIONS These findings support a reappraisal of current clinical interpretation of cardiorespiratory fitness highlighting the potential for incorrect fitness stratification when natural variation is not accounted for.
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Affiliation(s)
- G A Rose
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, UK.
| | - R G Davies
- Department of Anaesthetics, University Hospital of Wales, Cardiff, UK
| | - G W Davison
- Sport and Exercise Sciences Research Institute, Ulster University, Newtownabbey, NI, UK
| | - R A Adams
- School of Medicine, Cardiff University, Velindre Cancer Centre, Cardiff, UK
| | - I M Williams
- Department of Surgery, University Hospital of Wales, Cardiff, UK
| | - M H Lewis
- Department of Surgery, Royal Glamorgan Hospital, Llantrisant, UK
| | - I R Appadurai
- Department of Anaesthetics, University Hospital of Wales, Cardiff, UK
| | - D M Bailey
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, UK.
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22
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Lawler M, Alsina D, Adams RA, Anderson AS, Brown G, Fearnhead NS, Fenwick SW, Halloran SP, Hochhauser D, Hull MA, Koelzer VH, McNair AGK, Monahan KJ, Näthke I, Norton C, Novelli MR, Steele RJC, Thomas AL, Wilde LM, Wilson RH, Tomlinson I. Critical research gaps and recommendations to inform research prioritisation for more effective prevention and improved outcomes in colorectal cancer. Gut 2018; 67:179-193. [PMID: 29233930 PMCID: PMC5754857 DOI: 10.1136/gutjnl-2017-315333] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 10/24/2017] [Accepted: 10/25/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Colorectal cancer (CRC) leads to significant morbidity/mortality worldwide. Defining critical research gaps (RG), their prioritisation and resolution, could improve patient outcomes. DESIGN RG analysis was conducted by a multidisciplinary panel of patients, clinicians and researchers (n=71). Eight working groups (WG) were constituted: discovery science; risk; prevention; early diagnosis and screening; pathology; curative treatment; stage IV disease; and living with and beyond CRC. A series of discussions led to development of draft papers by each WG, which were evaluated by a 20-strong patient panel. A final list of RGs and research recommendations (RR) was endorsed by all participants. RESULTS Fifteen critical RGs are summarised below: RG1: Lack of realistic models that recapitulate tumour/tumour micro/macroenvironment; RG2: Insufficient evidence on precise contributions of genetic/environmental/lifestyle factors to CRC risk; RG3: Pressing need for prevention trials; RG4: Lack of integration of different prevention approaches; RG5: Lack of optimal strategies for CRC screening; RG6: Lack of effective triage systems for invasive investigations; RG7: Imprecise pathological assessment of CRC; RG8: Lack of qualified personnel in genomics, data sciences and digital pathology; RG9: Inadequate assessment/communication of risk, benefit and uncertainty of treatment choices; RG10: Need for novel technologies/interventions to improve curative outcomes; RG11: Lack of approaches that recognise molecular interplay between metastasising tumours and their microenvironment; RG12: Lack of reliable biomarkers to guide stage IV treatment; RG13: Need to increase understanding of health related quality of life (HRQOL) and promote residual symptom resolution; RG14: Lack of coordination of CRC research/funding; RG15: Lack of effective communication between relevant stakeholders. CONCLUSION Prioritising research activity and funding could have a significant impact on reducing CRC disease burden over the next 5 years.
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Affiliation(s)
- Mark Lawler
- Centre for Cancer Research and Cell Biology, Queen’s University Belfast, Belfast, UK
| | | | | | - Annie S Anderson
- Research into Cancer Prevention and Screening, University of Dundee, Dundee, UK
| | - Gina Brown
- Department of Radiology, Royal Marsden Hospital, Sutton, UK
| | | | - Stephen W Fenwick
- Hepatobiliary Surgery Unit, Aintree University Hospital, Liverpool, UK
| | - Stephen P Halloran
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Daniel Hochhauser
- Department of Oncology, University College London Cancer Institute, London, UK
| | - Mark A Hull
- Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK
| | - Viktor H Koelzer
- Molecular and Population Genetics Laboratory, University of Oxford, Oxford, UK
| | - Angus G K McNair
- Centre for Surgical Research, University of Bristol, Bristol, UK
| | - Kevin J Monahan
- Family History of Bowel Cancer Clinic, Imperial College London, London, UK
| | - Inke Näthke
- School of Life Sciences, University of Dundee, Dundee, UK
| | - Christine Norton
- Florence Nightingale Faculty of Nursing and Midwifery, King’s College London, London, UK
| | - Marco R Novelli
- Research Department of Pathology, University College London Medical School, London, UK
| | - Robert J C Steele
- Research into Cancer Prevention and Screening, University of Dundee, Dundee, UK
| | - Anne L Thomas
- Leicester Cancer Research Centre, University of Leicester, Leicester, UK
| | - Lisa M Wilde
- Bowel Cancer UK, London, UK
- Atticus Consultants Ltd, Croydon, UK
| | - Richard H Wilson
- Centre for Cancer Research and Cell Biology, Queen’s University Belfast, Belfast, UK
| | - Ian Tomlinson
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
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23
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Madi A, Fisher D, Maughan TS, Colley JP, Meade AM, Tejpar S, Van den Bosch B, Maynard J, Humphreys V, Wasan H, Adams RA, Idziaszczyk S, Harris R, Kaplan RS, Cheadle JP. Comprehensive pharmacogenetic profiling of the epidermal growth factor receptor pathway for biomarkers of response to, and toxicity from, cetuximab. J Med Genet 2017; 54:567-571. [PMID: 28283541 DOI: 10.1136/jmedgenet-2016-104317] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 01/16/2017] [Accepted: 02/06/2017] [Indexed: 11/04/2022]
Abstract
BACKGROUND Somatic mutations in the epidermal growth factor receptor (EGFR) intracellular signalling pathways predict non-response to cetuximab in the treatment of advanced colorectal cancer (aCRC). We hypothesised that common germline variants within these pathways may also play similar roles. METHODS We analysed 54 potentially functional, common, inherited EGFR pathway variants in 815 patients with aCRC treated with oxaliplatin-fluoropyrimidine chemotherapy plus cetuximab. Primary endpoints were response and skin rash (SR). We had >85% power to detect ORs=1.6 for variants with minor allele frequencies >20%. RESULTS We identified five potential biomarkers for response and four for SR, although none remained significant after correction for multiple testing. Our initial data supported a role for Ser313Pro in PIK3R2 in modulating response to cetuximab-in patients with KRAS wild-type CRCs, 36.4% with one allele encoding proline responded, as compared with 71.2% homozygous for allele encoding serine (OR 0.23, 95% CI 0.09 to 0.56, p=0.0014), and this association was predictive for cetuximab (pinteraction=0.017); however, independent replication failed to validate this association. No previously proposed predictive biomarkers were validated. CONCLUSIONS Our study highlights the need to validate potential pharmacogenetic biomarkers. We did not find strong evidence for common germline biomarkers of cetuximab response and toxicity.
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Affiliation(s)
- Ayman Madi
- Division of Cancer and Genetics, School of Medicine, Cardiff University, Heath Park, Cardiff, UK
| | | | - Timothy S Maughan
- Division of Cancer and Genetics, School of Medicine, Cardiff University, Heath Park, Cardiff, UK
| | - James P Colley
- Division of Cancer and Genetics, School of Medicine, Cardiff University, Heath Park, Cardiff, UK
| | | | - Sabine Tejpar
- Laboratory of Molecular Digestive Oncology, Department of Oncology, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Ben Van den Bosch
- Laboratory of Molecular Digestive Oncology, Department of Oncology, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Julie Maynard
- Division of Cancer and Genetics, School of Medicine, Cardiff University, Heath Park, Cardiff, UK
| | - Vikki Humphreys
- Division of Cancer and Genetics, School of Medicine, Cardiff University, Heath Park, Cardiff, UK
| | - Harpreet Wasan
- Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Richard A Adams
- Division of Cancer and Genetics, School of Medicine, Cardiff University, Heath Park, Cardiff, UK
| | - Shelley Idziaszczyk
- Division of Cancer and Genetics, School of Medicine, Cardiff University, Heath Park, Cardiff, UK
| | - Rebecca Harris
- Division of Cancer and Genetics, School of Medicine, Cardiff University, Heath Park, Cardiff, UK
| | | | - Jeremy P Cheadle
- Division of Cancer and Genetics, School of Medicine, Cardiff University, Heath Park, Cardiff, UK
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24
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Franko J, Shi Q, Meyers JP, Maughan TS, Adams RA, Seymour MT, Saltz L, Punt CJA, Koopman M, Tournigand C, Tebbutt NC, Diaz-Rubio E, Souglakos J, Falcone A, Chibaudel B, Heinemann V, Moen J, De Gramont A, Sargent DJ, Grothey A. Prognosis of patients with peritoneal metastatic colorectal cancer given systemic therapy: an analysis of individual patient data from prospective randomised trials from the Analysis and Research in Cancers of the Digestive System (ARCAD) database. Lancet Oncol 2016; 17:1709-1719. [PMID: 27743922 DOI: 10.1016/s1470-2045(16)30500-9] [Citation(s) in RCA: 387] [Impact Index Per Article: 48.4] [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: 06/13/2016] [Revised: 08/25/2016] [Accepted: 08/25/2016] [Indexed: 12/18/2022]
Abstract
BACKGROUND Patients with peritoneal metastatic colorectal cancer have reduced overall survival compared with patients with metastatic colorectal cancer without peritoneal involvement. Here we further investigated the effect of the number and location of metastases in patients receiving first-line systemic chemotherapy. METHODS We analysed individual patient data for previously untreated patients enrolled in 14 phase 3 randomised trials done between 1997 and 2008. Trials were included if protocols explicitly pre-specified and solicited for patients with peritoneal involvement in the trial data collection process or had done a formal peritoneum-focused review of individual pre-treatment scans. We used stratified multivariable Cox models to assess the prognostic associations of peritoneal metastatic colorectal cancer with overall survival and progression-free survival, adjusting for other key clinical-pathological factors (age, sex, Eastern Cooperative Oncology Group (ECOG) performance score, primary tumour location [colon vs rectum], previous treatment, and baseline BMI). The primary endpoint was difference in overall survival between populations with and without peritoneal metastases. FINDINGS Individual patient data were available for 10 553 patients. 9178 (87%) of 10 553 patients had non-peritoneal metastatic colorectal cancer (4385 with one site of metastasis, 4793 with two or more sites of metastasis), 194 (2%) patients had isolated peritoneal metastatic colorectal cancer, and 1181 (11%) had peritoneal metastatic colorectal cancer and other organ involvement. These groups were similar in age, ethnic origin, and use of targeted treatment. Patients with peritoneal metastatic colorectal cancer were more likely than those with non-peritoneal metastatic colorectal cancer to be women (565 [41%] of 1371 vs 3312 [36%] of 9169 patients; p=0·0003), have colon primary tumours (1116 [84%] of 1334 patients vs 5603 [66%]; p<0·0001), and have performance status of 2 (136 [10%] vs 521 [6%]; p<0·0001). We recorded a higher proportion of patients with mutated BRAF in patients with peritoneal-only (eight [18%] of 44 patients with available data) and peritoneal metastatic colorectal cancer with other sites of metastasis (34 [12%] of 289), compared with patients with non-peritoneal metastatic colorectal cancer (194 [9%] of 2230; p=0·028 comparing the three groups). Overall survival (adjusted HR 0·75, 95% CI 0·63-0·91; p=0·003) was better in patients with isolated non-peritoneal sites than in those with isolated peritoneal metastatic colorectal cancer. Overall survival of patients with two of more non-peritoneal sites of metastasis (adjusted HR 1·04, 95% CI 0·86-1·25, p=0.69) and those with peritoneal metastatic colorectal cancer plus one other site of metastasis (adjusted HR 1·10, 95% CI 0·89-1·37, p=0·37) was similar to those with isolated peritoneal metastases. Compared with patients with isolated peritoneal metastases, those with peritoneal metastases and two or more additional sites of metastasis had the shortest survival (adjusted HR 1·40; CI 1·14-1·71; p=0·0011). INTERPRETATION Patients with peritoneal metastatic colorectal cancer have significantly shorter overall survival than those with other isolated sites of metastases. In patients with several sites of metastasis, poor survival is a function of both increased number of metastatic sites and peritoneal involvement. The pattern of metastasis and in particular, peritoneal involvement, results in prognostic heterogeneity of metastatic colorectal cancer. FUNDING None.
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Affiliation(s)
- Jan Franko
- Division of Surgical Oncology, Mercy Medical Center, Des Moines, IA, USA.
| | - Qian Shi
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Jeffrey P Meyers
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | | | | | - Matthew T Seymour
- Gastrointestinal Cancer Research Unit, Cookridge Hospital, Leeds, UK
| | - Leonard Saltz
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Cornelis J A Punt
- Department of Medical Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | | | | | - Niall C Tebbutt
- Sydney Medical School, the University of Sydney, NSW, Australia
| | | | - John Souglakos
- University of Crete, School of Medicine, Heraklion, Greece
| | | | - Benoist Chibaudel
- Department of Medical Oncology, Franco-British Institute, Levallois-Perret, France
| | - Volker Heinemann
- University of Munich, Department of Medical Oncology and Comprehensive Cancer Center, Munich, Germany
| | - Joseph Moen
- Department of Biostatistics, University of Iowa, Iowa City, IA, USA
| | - Aimery De Gramont
- Department of Medical Oncology, Franco-British Institute, Levallois-Perret, France
| | - Daniel J Sargent
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Axel Grothey
- Department of Oncology, Mayo Clinic, Rochester, MN, USA
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25
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Sharma RA, Plummer R, Stock JK, Greenhalgh TA, Ataman O, Kelly S, Clay R, Adams RA, Baird RD, Billingham L, Brown SR, Buckland S, Bulbeck H, Chalmers AJ, Clack G, Cranston AN, Damstrup L, Ferraldeschi R, Forster MD, Golec J, Hagan RM, Hall E, Hanauske AR, Harrington KJ, Haswell T, Hawkins MA, Illidge T, Jones H, Kennedy AS, McDonald F, Melcher T, O'Connor JPB, Pollard JR, Saunders MP, Sebag-Montefiore D, Smitt M, Staffurth J, Stratford IJ, Wedge SR. Clinical development of new drug-radiotherapy combinations. Nat Rev Clin Oncol 2016; 13:627-42. [PMID: 27245279 DOI: 10.1038/nrclinonc.2016.79] [Citation(s) in RCA: 209] [Impact Index Per Article: 26.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
In countries with the best cancer outcomes, approximately 60% of patients receive radiotherapy as part of their treatment, which is one of the most cost-effective cancer treatments. Notably, around 40% of cancer cures include the use of radiotherapy, either as a single modality or combined with other treatments. Radiotherapy can provide enormous benefit to patients with cancer. In the past decade, significant technical advances, such as image-guided radiotherapy, intensity-modulated radiotherapy, stereotactic radiotherapy, and proton therapy enable higher doses of radiotherapy to be delivered to the tumour with significantly lower doses to normal surrounding tissues. However, apart from the combination of traditional cytotoxic chemotherapy with radiotherapy, little progress has been made in identifying and defining optimal targeted therapy and radiotherapy combinations to improve the efficacy of cancer treatment. The National Cancer Research Institute Clinical and Translational Radiotherapy Research Working Group (CTRad) formed a Joint Working Group with representatives from academia, industry, patient groups and regulatory bodies to address this lack of progress and to publish recommendations for future clinical research. Herein, we highlight the Working Group's consensus recommendations to increase the number of novel drugs being successfully registered in combination with radiotherapy to improve clinical outcomes for patients with cancer.
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Affiliation(s)
- Ricky A Sharma
- UCL Cancer Institute, University College London, 72 Huntley Street, London WC1E 6DD, UK
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Martin D Forster
- UCL Cancer Institute, University College London, 72 Huntley Street, London WC1E 6DD, UK
| | - Julian Golec
- Vertex Pharmaceuticals (Europe) Ltd, Abingdon, UK
| | | | - Emma Hall
- The Institute of Cancer Research/The Royal Marsden NIHR Biomedical Research Centre, London, UK
| | | | - Kevin J Harrington
- The Institute of Cancer Research/The Royal Marsden NIHR Biomedical Research Centre, London, UK
| | | | | | | | | | | | - Fiona McDonald
- The Institute of Cancer Research/The Royal Marsden NIHR Biomedical Research Centre, London, UK
| | | | | | | | | | | | | | - John Staffurth
- Cardiff University and Velindre Cancer Centre, Cardiff, UK
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26
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Weber AM, Drobnitzky N, Devery AM, Bokobza SM, Adams RA, Maughan TS, Ryan AJ. Phenotypic consequences of somatic mutations in the ataxia-telangiectasia mutated gene in non-small cell lung cancer. Oncotarget 2016; 7:60807-60822. [PMID: 27602502 PMCID: PMC5308618 DOI: 10.18632/oncotarget.11845] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [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: 02/26/2016] [Accepted: 07/27/2016] [Indexed: 12/20/2022] Open
Abstract
Mutations in the Ataxia-telangiectasia mutated (ATM) gene are frequently found in human cancers, including non-small cell lung cancer (NSCLC). Loss of ATM function confers sensitivity to ionising radiation (IR) and topoisomerase inhibitors and may thus define a subset of cancer patients that could get increased benefit from these therapies. In this study, we evaluated the phenotypic consequences of ATM missense changes reported in seven NSCLC cell lines with regard to radiosensitivity and functionality of ATM signalling. Our data demonstrate that only 2/7 NSCLC cell lines (H1395 and H23) harbouring ATM missense mutations show a functional impairment of ATM signalling following IR-exposure. In these two cell lines, the missense mutations caused a significant reduction in ATM protein levels, impairment of ATM signalling and marked radiosensitivity. Of note, only cell lines with homozygous mutations in the ATM gene showed significant impairment of ATM function. Based on these observations, we developed an immunohistochemistry-based assay to identify patients with loss or reduction of ATM protein expression in a clinical setting. In a set of 137 NSCLC and 154 colorectal cancer specimens we identified tumoral loss of ATM protein expression in 9.5% and 3.9% of cases, respectively, demonstrating the potential utility of this method.
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Affiliation(s)
- Anika Maria Weber
- Department of Oncology, Cancer Research UK and Medical Research Council Oxford Institute for Radiation Oncology, University of Oxford, Oxford, UK
| | - Neele Drobnitzky
- Department of Oncology, Cancer Research UK and Medical Research Council Oxford Institute for Radiation Oncology, University of Oxford, Oxford, UK
| | - Aoife Maire Devery
- Department of Oncology, Cancer Research UK and Medical Research Council Oxford Institute for Radiation Oncology, University of Oxford, Oxford, UK
| | - Sivan Mili Bokobza
- Department of Oncology, Cancer Research UK and Medical Research Council Oxford Institute for Radiation Oncology, University of Oxford, Oxford, UK
| | - Richard A. Adams
- Institute of Cancer & Genetics, Cardiff University, School of Medicine, Cardiff, UK
| | - Timothy S. Maughan
- Department of Oncology, Cancer Research UK and Medical Research Council Oxford Institute for Radiation Oncology, University of Oxford, Oxford, UK
| | - Anderson Joseph Ryan
- Department of Oncology, Cancer Research UK and Medical Research Council Oxford Institute for Radiation Oncology, University of Oxford, Oxford, UK
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27
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Abstract
During this investigation, a model of tourniquet-induced forearm ischaemia-reperfusion injury is employed to investigate the role of leucocytes in damage to the vascular endothelium during ischaemia-reperfusion injury. Leucocyte entrapment is investigated by measuring the concentration of leucocytes in venous blood leaving the arm. Neutrophil and monocyte leucocyte subpopulations are isolated by density gradient centrifugation techniques. Cell surface expression of CD11b and the intracellular production of hydrogen peroxide are measured via flow cytometry. Plasma concentrations of elastase and von Willebrand factor (vWF) are measured using enzyme-linked immunosorbemt assay (ELISA) techniques. During ischaemia-reperfusion, there was an increase in CD11b cell surface expression on neutrophils (P=0.040) and monocytes (P=0.049), and a decrease in peripheral blood leucocytes (P=0.019). There was an increase in the intracellular production of hydrogen peroxide by leucocyte subpopulations (P=0.027 [neutrophils], P=0.091 [monocytes]) and in the plasma elastase concentration (P=0.05). There was also a trend to increasing plasma concentration of vWF (P=0.0562), which was measured as a marker of endothelial damage. Ischaemia-reperfusion results in increased adhesiveness, entrapment and activation of leucocytes. Even following a mild ischaemic insult, this leucocyte response was followed immediately by evidence of endothelial damage. These results may have important implications for understanding the development of chronic diseases that involve mild ischaemic episodes.
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Affiliation(s)
- S F Hughes
- Pathology Department, North Wales Medical Centre, Llandudno, Wales, UK.
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28
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Seligmann JF, Fisher D, Smith CG, Elliott F, Richman S, Quirke P, Maughan T, Cheadle J, Adams RA, Seymour MT, Middleton GW. Exploring outcomes of RAS-mutant ( RAS mut) advanced colorectal cancer (aCRC) treated with chemotherapy: Analysis from 2254 patients (pts) in randomised clinical trials (RCTs). J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.3561] [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)
| | - David Fisher
- Clinical Trials Unit, Medical Research Council, London, United Kingdom
| | | | | | | | | | - Tim Maughan
- University of Oxford, Oxford, United Kingdom
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29
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Forde C, McMullan R, Clarke M, Wilson RH, Plummer ER, Thomas AL, Barnes RA, Adams RA, Chau I, Grayson M, McDowell C, Agus A, Brown E, Storey DJ, McAuley D, Coyle V. The EASI-SWITCH trial: Early switch to oral antibiotic therapy in patients with low risk neutropenic sepsis. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.tps10143] [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)
- Caroline Forde
- Centre for Cancer Research and Cell Biology, Queen's University Belfast, Belfast, United Kingdom
| | - Ronan McMullan
- Centre for Infection and Immunity, Queen's University Belfast, Belfast, United Kingdom
| | - Mike Clarke
- Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom
| | - Richard H. Wilson
- Centre for Cancer Research and Cell Biology, Queen's University Belfast, Belfast, United Kingdom
| | | | | | | | | | - Ian Chau
- Royal Marsden NHS Foundation Trust, London and Sutton, United Kingdom
| | - Margaret Grayson
- Northern Ireland Cancer Research Consumer Forum, Belfast, United Kingdom
| | - Cliona McDowell
- Northern Ireland Clinical Trials Unit, Belfast, United Kingdom
| | - Ashley Agus
- Northern Ireland Clinical Trials Unit, Belfast, United Kingdom
| | - Ewan Brown
- Western General Hospital, Edinburgh, United Kingdom
| | | | - Danny McAuley
- Northern Ireland Clinical Trials Unit, Belfast, United Kingdom
| | - Victoria Coyle
- Centre for Cancer Research and Cell Biology, Queen's University Belfast, Belfast, United Kingdom
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30
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Glynne-Jones R, Meadows HM, Lopes A, Adams RA, Samuel LM, Hill J, Renehan A, Hawkins MA, Sebag-Montefiore D. Salvage surgery with abdominoperineal excision of the rectum (APER) following loco-regional failure after chemoradiation (CRT) using mitomycin (MMC) or cisplatin (CisP), with or without maintenance 5FU/CisP chemotherapy (CT) in squamous cell carcinoma of the anus (SCCA) and the impact on long-term outcomes: Results of ACT II. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.3523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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)
| | | | - Andre Lopes
- Cancer Research UK and University College London Cancer Trials Centre, London, United Kingdom
| | | | - Leslie M. Samuel
- Aberdeen Royal Infirmary, University of Aberdeen, Aberdeen, United Kingdom
| | - James Hill
- Manchester Royal Infirmary, Manchester, United Kingdom
| | - Andrew Renehan
- The Christie Hospital NHS Foundation Trust, Manchester, United Kingdom
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31
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Franko J, Shi Q, Meyers JP, Heinemann V, Falcone A, Tebbutt NC, Maughan T, Seymour M, Saltz L, Tournigand C, Diaz-Rubio E, Sougklakos I, Chibaudel B, Moen J, De Gramont A, Adams RA, Sargent DJ, Grothey A. Prognostic value of isolated peritoneal versus other metastatic sites in colorectal cancer (CRC) patients treated by systemic chemotherapy: Findings from 9,265 pts in the ARCAD database. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.4_suppl.656] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
656 Background: Patients (pts) with peritoneal metastases from CRC (pmCRC) have reduced OS compared to mCRC pts without peritoneal involvement. Here we further investigated the impact of number and location of metastases among pts receiving first-line systemic chemotherapy. Methods: Individual patient data were available on 9,265 pts (median age 64; 63% male; 93% ECOG PS 0-1; 68% colon primary tumor; brain metastases excluded) enrolled onto 12 first-line randomized trials (4 tested targeted regimens). Stratified multivariable Cox models were used to assess the associations with overall survival (OS); adjusted hazard ratios (HRadj) and 95% confidence intervals are reported (CI). Results: There were 7,963 (86%) pts with non-pmCRC (3,904 with one disease site; 4,059 with ≥2 disease sites), 191 (2%) pts with isolated pmCRC, and 1,111 (12%) non-isolated pmCRC. These groups were similar in age, race, and use of targeted chemotherapy. Compared to non-pmCRC, pts with pmCRC were more likely to be female (41% vs. 36%, p<.001), have colon primary tumors (85% vs. 67%, p<.0001), and have PS2 (10% vs. 6%, p<.0001). Compared to isolated pmCRC, pts with solitary non-peritoneal sites (both M1a) had significantly better OS (HRadj=0.78; CI, 0.64-0.94, p=.009) while pts with ≥2 non-peritoneal sites had similar OS (HRadj=1.06; CI 0.88-1.28, p=.535). OS of pts with pmCRC with a single other disease site (n=446) was similar to isolated pmCRC (HRadj=1.13; CI 0.91-1.40, p=.28), but those with pmCRC + ≥2 additional disease sites (n=665) had shortest survival (HRadj=1.44; CI 1.17-1.77, p<.001). A combination of peritoneal and liver metastases (n=821; HRadj=1.37, CI 1.12-1.67, p=.002) was associated with poorer survival compared with isolated pmCRC; but combination with extrahepatic sites (n=290; HRadj=1.15, CI 0.91-1.45, p=.25) was not. Conclusions: pmCRC pts have significantly worse survival than those with other solitary site mCRC. Among those with multiple disease sites, poorer survival is a function of increased number of metastatic sites and peritoneal involvement, which indicates prognostic heterogeneities among M1b pts.
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Affiliation(s)
| | | | | | - Volker Heinemann
- Department of Internal Medicine III and Comprehensive Cancer Center, Klinikum Grosshadern, Ludwig-Maximilians University of Munich, Munich, Germany
| | | | | | - Tim Maughan
- University of Oxford, Oxford, United Kingdom
| | - Matthew Seymour
- Gastrointestinal Cancer Research Unit, Cookridge Hospital, Leeds, United Kingdom
| | - Leonard Saltz
- Memorial Sloan Kettering Cancer Center, New York, NY
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Eng C, Adams RA, Kachnic LA, Das P, Ernst RD, Rodriguez-Bigas MA, Dupont E, Benson AB. Post-treatment surveillance in locally advanced squamous cell carcinoma (SCCA) of the anal canal: A global subspecialist survey. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.4_suppl.573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
573 Background: Squamous cell carcinoma of the anal canal will be diagnosed in 28,000 individuals globally. Considered a rare cancer, the incidence of anal carcinoma continues to rise annually. Majority of patients present with locally advanced disease in which concurrent chemoradiation (CRT) will be provided with curative intent. The Anal Cancer IRCI Working Group was created to pursue novel approaches to the diagnosis, treatment, and surveillance of patients. Yet, surveillance following completion of CRT is not well established and varies as per NCCN (v2.2015) and ESMO guidelines. Methods: A 22-question survey provided to anonymous international GI subspecialists in various fields. Questions pertained to timing and type of diagnostic imaging, surveillance interval, approach to detection of complete response (CR), and prevention of sexual dysfunction. Results: Survey distribution was initiated in March 2015 and still ongoing. Thus far, 96 physicians responded. Conclusions: Carcinoma of the anal canal continues to rise in incidence annually. Surveillance following completion of CRT is warranted; however, global variability in practice patterns for surveillance exists. As such, the IRCI Anal Cancer Working Group intends to provide an international consensus surveillance statement. [Table: see text]
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Affiliation(s)
- Cathy Eng
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - Prajnan Das
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | | | - Al Bowen Benson
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL
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Renfro LA, Loupakis F, Adams RA, Seymour MT, Heinemann V, Schmoll HJ, Douillard JY, Hurwitz H, Fuchs CS, Diaz-Rubio E, Porschen R, Tournigand C, Chibaudel B, Falcone A, Tebbutt NC, Punt CJA, Hecht JR, Bokemeyer C, Van Cutsem E, Goldberg RM, Saltz LB, de Gramont A, Sargent DJ, Lenz HJ. Body Mass Index Is Prognostic in Metastatic Colorectal Cancer: Pooled Analysis of Patients From First-Line Clinical Trials in the ARCAD Database. J Clin Oncol 2016; 34:144-50. [PMID: 26503203 PMCID: PMC5070548 DOI: 10.1200/jco.2015.61.6441] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
PURPOSE In recent retrospective analyses of early-stage colorectal cancer (CRC), low and high body mass index (BMI) scores were associated with worsened outcomes. Whether BMI is a prognostic or predictive factor in metastatic CRC (mCRC) is unclear. PATIENTS AND METHODS Individual data from 21,149 patients enrolled onto 25 first-line mCRC trials during 1997 to 2012 were pooled. We assessed both prognostic and predictive effects of BMI on overall survival and progression-free survival, and we accounted for patient and tumor characteristics and therapy type (targeted v nontargeted). RESULTS BMI was prognostic for overall survival (P < .001) and progression-free survival (P < .001), with an L-shaped pattern. That is, risk of progression and/or death was greatest for low BMI; risk decreased as BMI increased to approximately 28 kg/m(2), and then it plateaued. Relative to obese patients, patients with a BMI of 18.5 kg/m(2) had a 27% increased risk of having a PFS event (95% CI, 20% to 34%) and a 50% increased risk of death (95% CI, 43% to 56%). Low BMI was associated with poorer survival for men than women (interaction P < .001). BMI was not predictive of treatment effect. CONCLUSION Low BMI is associated with an increased risk of progression and death among the patients enrolled on the mCRC trials, with no increased risk for elevated BMI, in contrast to the adjuvant setting. Possible explanations include negative effects related to cancer cachexia in patients with low BMI, increased drug delivery or selection bias in patients with high BMI, and potential for an interaction between BMI and molecular signaling pathways.
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Affiliation(s)
- Lindsay A Renfro
- Lindsay A. Renfro and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Fotios Loupakis and Alfredo Falcone, Azienda Ospedaliero-Universitaria Pisana and Università di Pisa, Pisa, Italy; Richard Adams, Cardiff University, Cardiff; Matthew T. Seymour, St James's Hospital and University of Leeds, Leeds, United Kingdom; Volker Heinemann, University of Munich, Munich; Hans-Joachim Schmoll, University Clinic Halle (Saale), Halle; Rainer Porschen, Klinikum Bremen-Ost Klinik für Innere Medizin, Bremen; Carsten Bokemeyer, University Hospital Cancer Center, University Hospital, Hamburg-Eppendorf, Germany; Jean-Yves Douillard, Institut de Cancerologie, Centre René Gauducheau, Nantes; Christophe Tournigand, University of Paris Est Creteil, Henri-Mondor Hospital, Créteil; Benoist Chibaudel and Aimery de Gramont, Franco-British Institute, Levallois-Perret, France; Herbert Hurwitz, Duke University Medical Center, Durham, NC; Charles S. Fuchs, Dana-Farber Cancer Institute Boston, MA; Eduardo Diaz-Rubio, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain; Niall C. Tebbutt, Austin Health, Heidelberg, Victoria, Australia; Cornelis J.A. Punt, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; J. Randolph Hecht, David Geffen School of Medicine at the University of California at Los Angeles; Heinz-Josef Lenz, University of Southern California/Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles, CA; Eric Van Cutsem, University Hospital Leuven, Leuven, Belgium; Richard M. Goldberg, Ohio State University, Columbus, OH; and Leonard B. Saltz, Memorial Sloan-Kettering Cancer Center, New York, NY.
| | - Fotios Loupakis
- Lindsay A. Renfro and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Fotios Loupakis and Alfredo Falcone, Azienda Ospedaliero-Universitaria Pisana and Università di Pisa, Pisa, Italy; Richard Adams, Cardiff University, Cardiff; Matthew T. Seymour, St James's Hospital and University of Leeds, Leeds, United Kingdom; Volker Heinemann, University of Munich, Munich; Hans-Joachim Schmoll, University Clinic Halle (Saale), Halle; Rainer Porschen, Klinikum Bremen-Ost Klinik für Innere Medizin, Bremen; Carsten Bokemeyer, University Hospital Cancer Center, University Hospital, Hamburg-Eppendorf, Germany; Jean-Yves Douillard, Institut de Cancerologie, Centre René Gauducheau, Nantes; Christophe Tournigand, University of Paris Est Creteil, Henri-Mondor Hospital, Créteil; Benoist Chibaudel and Aimery de Gramont, Franco-British Institute, Levallois-Perret, France; Herbert Hurwitz, Duke University Medical Center, Durham, NC; Charles S. Fuchs, Dana-Farber Cancer Institute Boston, MA; Eduardo Diaz-Rubio, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain; Niall C. Tebbutt, Austin Health, Heidelberg, Victoria, Australia; Cornelis J.A. Punt, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; J. Randolph Hecht, David Geffen School of Medicine at the University of California at Los Angeles; Heinz-Josef Lenz, University of Southern California/Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles, CA; Eric Van Cutsem, University Hospital Leuven, Leuven, Belgium; Richard M. Goldberg, Ohio State University, Columbus, OH; and Leonard B. Saltz, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Richard A Adams
- Lindsay A. Renfro and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Fotios Loupakis and Alfredo Falcone, Azienda Ospedaliero-Universitaria Pisana and Università di Pisa, Pisa, Italy; Richard Adams, Cardiff University, Cardiff; Matthew T. Seymour, St James's Hospital and University of Leeds, Leeds, United Kingdom; Volker Heinemann, University of Munich, Munich; Hans-Joachim Schmoll, University Clinic Halle (Saale), Halle; Rainer Porschen, Klinikum Bremen-Ost Klinik für Innere Medizin, Bremen; Carsten Bokemeyer, University Hospital Cancer Center, University Hospital, Hamburg-Eppendorf, Germany; Jean-Yves Douillard, Institut de Cancerologie, Centre René Gauducheau, Nantes; Christophe Tournigand, University of Paris Est Creteil, Henri-Mondor Hospital, Créteil; Benoist Chibaudel and Aimery de Gramont, Franco-British Institute, Levallois-Perret, France; Herbert Hurwitz, Duke University Medical Center, Durham, NC; Charles S. Fuchs, Dana-Farber Cancer Institute Boston, MA; Eduardo Diaz-Rubio, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain; Niall C. Tebbutt, Austin Health, Heidelberg, Victoria, Australia; Cornelis J.A. Punt, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; J. Randolph Hecht, David Geffen School of Medicine at the University of California at Los Angeles; Heinz-Josef Lenz, University of Southern California/Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles, CA; Eric Van Cutsem, University Hospital Leuven, Leuven, Belgium; Richard M. Goldberg, Ohio State University, Columbus, OH; and Leonard B. Saltz, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Matthew T Seymour
- Lindsay A. Renfro and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Fotios Loupakis and Alfredo Falcone, Azienda Ospedaliero-Universitaria Pisana and Università di Pisa, Pisa, Italy; Richard Adams, Cardiff University, Cardiff; Matthew T. Seymour, St James's Hospital and University of Leeds, Leeds, United Kingdom; Volker Heinemann, University of Munich, Munich; Hans-Joachim Schmoll, University Clinic Halle (Saale), Halle; Rainer Porschen, Klinikum Bremen-Ost Klinik für Innere Medizin, Bremen; Carsten Bokemeyer, University Hospital Cancer Center, University Hospital, Hamburg-Eppendorf, Germany; Jean-Yves Douillard, Institut de Cancerologie, Centre René Gauducheau, Nantes; Christophe Tournigand, University of Paris Est Creteil, Henri-Mondor Hospital, Créteil; Benoist Chibaudel and Aimery de Gramont, Franco-British Institute, Levallois-Perret, France; Herbert Hurwitz, Duke University Medical Center, Durham, NC; Charles S. Fuchs, Dana-Farber Cancer Institute Boston, MA; Eduardo Diaz-Rubio, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain; Niall C. Tebbutt, Austin Health, Heidelberg, Victoria, Australia; Cornelis J.A. Punt, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; J. Randolph Hecht, David Geffen School of Medicine at the University of California at Los Angeles; Heinz-Josef Lenz, University of Southern California/Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles, CA; Eric Van Cutsem, University Hospital Leuven, Leuven, Belgium; Richard M. Goldberg, Ohio State University, Columbus, OH; and Leonard B. Saltz, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Volker Heinemann
- Lindsay A. Renfro and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Fotios Loupakis and Alfredo Falcone, Azienda Ospedaliero-Universitaria Pisana and Università di Pisa, Pisa, Italy; Richard Adams, Cardiff University, Cardiff; Matthew T. Seymour, St James's Hospital and University of Leeds, Leeds, United Kingdom; Volker Heinemann, University of Munich, Munich; Hans-Joachim Schmoll, University Clinic Halle (Saale), Halle; Rainer Porschen, Klinikum Bremen-Ost Klinik für Innere Medizin, Bremen; Carsten Bokemeyer, University Hospital Cancer Center, University Hospital, Hamburg-Eppendorf, Germany; Jean-Yves Douillard, Institut de Cancerologie, Centre René Gauducheau, Nantes; Christophe Tournigand, University of Paris Est Creteil, Henri-Mondor Hospital, Créteil; Benoist Chibaudel and Aimery de Gramont, Franco-British Institute, Levallois-Perret, France; Herbert Hurwitz, Duke University Medical Center, Durham, NC; Charles S. Fuchs, Dana-Farber Cancer Institute Boston, MA; Eduardo Diaz-Rubio, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain; Niall C. Tebbutt, Austin Health, Heidelberg, Victoria, Australia; Cornelis J.A. Punt, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; J. Randolph Hecht, David Geffen School of Medicine at the University of California at Los Angeles; Heinz-Josef Lenz, University of Southern California/Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles, CA; Eric Van Cutsem, University Hospital Leuven, Leuven, Belgium; Richard M. Goldberg, Ohio State University, Columbus, OH; and Leonard B. Saltz, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Hans-Joachim Schmoll
- Lindsay A. Renfro and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Fotios Loupakis and Alfredo Falcone, Azienda Ospedaliero-Universitaria Pisana and Università di Pisa, Pisa, Italy; Richard Adams, Cardiff University, Cardiff; Matthew T. Seymour, St James's Hospital and University of Leeds, Leeds, United Kingdom; Volker Heinemann, University of Munich, Munich; Hans-Joachim Schmoll, University Clinic Halle (Saale), Halle; Rainer Porschen, Klinikum Bremen-Ost Klinik für Innere Medizin, Bremen; Carsten Bokemeyer, University Hospital Cancer Center, University Hospital, Hamburg-Eppendorf, Germany; Jean-Yves Douillard, Institut de Cancerologie, Centre René Gauducheau, Nantes; Christophe Tournigand, University of Paris Est Creteil, Henri-Mondor Hospital, Créteil; Benoist Chibaudel and Aimery de Gramont, Franco-British Institute, Levallois-Perret, France; Herbert Hurwitz, Duke University Medical Center, Durham, NC; Charles S. Fuchs, Dana-Farber Cancer Institute Boston, MA; Eduardo Diaz-Rubio, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain; Niall C. Tebbutt, Austin Health, Heidelberg, Victoria, Australia; Cornelis J.A. Punt, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; J. Randolph Hecht, David Geffen School of Medicine at the University of California at Los Angeles; Heinz-Josef Lenz, University of Southern California/Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles, CA; Eric Van Cutsem, University Hospital Leuven, Leuven, Belgium; Richard M. Goldberg, Ohio State University, Columbus, OH; and Leonard B. Saltz, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Jean-Yves Douillard
- Lindsay A. Renfro and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Fotios Loupakis and Alfredo Falcone, Azienda Ospedaliero-Universitaria Pisana and Università di Pisa, Pisa, Italy; Richard Adams, Cardiff University, Cardiff; Matthew T. Seymour, St James's Hospital and University of Leeds, Leeds, United Kingdom; Volker Heinemann, University of Munich, Munich; Hans-Joachim Schmoll, University Clinic Halle (Saale), Halle; Rainer Porschen, Klinikum Bremen-Ost Klinik für Innere Medizin, Bremen; Carsten Bokemeyer, University Hospital Cancer Center, University Hospital, Hamburg-Eppendorf, Germany; Jean-Yves Douillard, Institut de Cancerologie, Centre René Gauducheau, Nantes; Christophe Tournigand, University of Paris Est Creteil, Henri-Mondor Hospital, Créteil; Benoist Chibaudel and Aimery de Gramont, Franco-British Institute, Levallois-Perret, France; Herbert Hurwitz, Duke University Medical Center, Durham, NC; Charles S. Fuchs, Dana-Farber Cancer Institute Boston, MA; Eduardo Diaz-Rubio, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain; Niall C. Tebbutt, Austin Health, Heidelberg, Victoria, Australia; Cornelis J.A. Punt, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; J. Randolph Hecht, David Geffen School of Medicine at the University of California at Los Angeles; Heinz-Josef Lenz, University of Southern California/Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles, CA; Eric Van Cutsem, University Hospital Leuven, Leuven, Belgium; Richard M. Goldberg, Ohio State University, Columbus, OH; and Leonard B. Saltz, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Herbert Hurwitz
- Lindsay A. Renfro and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Fotios Loupakis and Alfredo Falcone, Azienda Ospedaliero-Universitaria Pisana and Università di Pisa, Pisa, Italy; Richard Adams, Cardiff University, Cardiff; Matthew T. Seymour, St James's Hospital and University of Leeds, Leeds, United Kingdom; Volker Heinemann, University of Munich, Munich; Hans-Joachim Schmoll, University Clinic Halle (Saale), Halle; Rainer Porschen, Klinikum Bremen-Ost Klinik für Innere Medizin, Bremen; Carsten Bokemeyer, University Hospital Cancer Center, University Hospital, Hamburg-Eppendorf, Germany; Jean-Yves Douillard, Institut de Cancerologie, Centre René Gauducheau, Nantes; Christophe Tournigand, University of Paris Est Creteil, Henri-Mondor Hospital, Créteil; Benoist Chibaudel and Aimery de Gramont, Franco-British Institute, Levallois-Perret, France; Herbert Hurwitz, Duke University Medical Center, Durham, NC; Charles S. Fuchs, Dana-Farber Cancer Institute Boston, MA; Eduardo Diaz-Rubio, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain; Niall C. Tebbutt, Austin Health, Heidelberg, Victoria, Australia; Cornelis J.A. Punt, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; J. Randolph Hecht, David Geffen School of Medicine at the University of California at Los Angeles; Heinz-Josef Lenz, University of Southern California/Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles, CA; Eric Van Cutsem, University Hospital Leuven, Leuven, Belgium; Richard M. Goldberg, Ohio State University, Columbus, OH; and Leonard B. Saltz, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Charles S Fuchs
- Lindsay A. Renfro and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Fotios Loupakis and Alfredo Falcone, Azienda Ospedaliero-Universitaria Pisana and Università di Pisa, Pisa, Italy; Richard Adams, Cardiff University, Cardiff; Matthew T. Seymour, St James's Hospital and University of Leeds, Leeds, United Kingdom; Volker Heinemann, University of Munich, Munich; Hans-Joachim Schmoll, University Clinic Halle (Saale), Halle; Rainer Porschen, Klinikum Bremen-Ost Klinik für Innere Medizin, Bremen; Carsten Bokemeyer, University Hospital Cancer Center, University Hospital, Hamburg-Eppendorf, Germany; Jean-Yves Douillard, Institut de Cancerologie, Centre René Gauducheau, Nantes; Christophe Tournigand, University of Paris Est Creteil, Henri-Mondor Hospital, Créteil; Benoist Chibaudel and Aimery de Gramont, Franco-British Institute, Levallois-Perret, France; Herbert Hurwitz, Duke University Medical Center, Durham, NC; Charles S. Fuchs, Dana-Farber Cancer Institute Boston, MA; Eduardo Diaz-Rubio, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain; Niall C. Tebbutt, Austin Health, Heidelberg, Victoria, Australia; Cornelis J.A. Punt, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; J. Randolph Hecht, David Geffen School of Medicine at the University of California at Los Angeles; Heinz-Josef Lenz, University of Southern California/Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles, CA; Eric Van Cutsem, University Hospital Leuven, Leuven, Belgium; Richard M. Goldberg, Ohio State University, Columbus, OH; and Leonard B. Saltz, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Eduardo Diaz-Rubio
- Lindsay A. Renfro and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Fotios Loupakis and Alfredo Falcone, Azienda Ospedaliero-Universitaria Pisana and Università di Pisa, Pisa, Italy; Richard Adams, Cardiff University, Cardiff; Matthew T. Seymour, St James's Hospital and University of Leeds, Leeds, United Kingdom; Volker Heinemann, University of Munich, Munich; Hans-Joachim Schmoll, University Clinic Halle (Saale), Halle; Rainer Porschen, Klinikum Bremen-Ost Klinik für Innere Medizin, Bremen; Carsten Bokemeyer, University Hospital Cancer Center, University Hospital, Hamburg-Eppendorf, Germany; Jean-Yves Douillard, Institut de Cancerologie, Centre René Gauducheau, Nantes; Christophe Tournigand, University of Paris Est Creteil, Henri-Mondor Hospital, Créteil; Benoist Chibaudel and Aimery de Gramont, Franco-British Institute, Levallois-Perret, France; Herbert Hurwitz, Duke University Medical Center, Durham, NC; Charles S. Fuchs, Dana-Farber Cancer Institute Boston, MA; Eduardo Diaz-Rubio, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain; Niall C. Tebbutt, Austin Health, Heidelberg, Victoria, Australia; Cornelis J.A. Punt, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; J. Randolph Hecht, David Geffen School of Medicine at the University of California at Los Angeles; Heinz-Josef Lenz, University of Southern California/Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles, CA; Eric Van Cutsem, University Hospital Leuven, Leuven, Belgium; Richard M. Goldberg, Ohio State University, Columbus, OH; and Leonard B. Saltz, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Rainer Porschen
- Lindsay A. Renfro and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Fotios Loupakis and Alfredo Falcone, Azienda Ospedaliero-Universitaria Pisana and Università di Pisa, Pisa, Italy; Richard Adams, Cardiff University, Cardiff; Matthew T. Seymour, St James's Hospital and University of Leeds, Leeds, United Kingdom; Volker Heinemann, University of Munich, Munich; Hans-Joachim Schmoll, University Clinic Halle (Saale), Halle; Rainer Porschen, Klinikum Bremen-Ost Klinik für Innere Medizin, Bremen; Carsten Bokemeyer, University Hospital Cancer Center, University Hospital, Hamburg-Eppendorf, Germany; Jean-Yves Douillard, Institut de Cancerologie, Centre René Gauducheau, Nantes; Christophe Tournigand, University of Paris Est Creteil, Henri-Mondor Hospital, Créteil; Benoist Chibaudel and Aimery de Gramont, Franco-British Institute, Levallois-Perret, France; Herbert Hurwitz, Duke University Medical Center, Durham, NC; Charles S. Fuchs, Dana-Farber Cancer Institute Boston, MA; Eduardo Diaz-Rubio, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain; Niall C. Tebbutt, Austin Health, Heidelberg, Victoria, Australia; Cornelis J.A. Punt, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; J. Randolph Hecht, David Geffen School of Medicine at the University of California at Los Angeles; Heinz-Josef Lenz, University of Southern California/Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles, CA; Eric Van Cutsem, University Hospital Leuven, Leuven, Belgium; Richard M. Goldberg, Ohio State University, Columbus, OH; and Leonard B. Saltz, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Christophe Tournigand
- Lindsay A. Renfro and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Fotios Loupakis and Alfredo Falcone, Azienda Ospedaliero-Universitaria Pisana and Università di Pisa, Pisa, Italy; Richard Adams, Cardiff University, Cardiff; Matthew T. Seymour, St James's Hospital and University of Leeds, Leeds, United Kingdom; Volker Heinemann, University of Munich, Munich; Hans-Joachim Schmoll, University Clinic Halle (Saale), Halle; Rainer Porschen, Klinikum Bremen-Ost Klinik für Innere Medizin, Bremen; Carsten Bokemeyer, University Hospital Cancer Center, University Hospital, Hamburg-Eppendorf, Germany; Jean-Yves Douillard, Institut de Cancerologie, Centre René Gauducheau, Nantes; Christophe Tournigand, University of Paris Est Creteil, Henri-Mondor Hospital, Créteil; Benoist Chibaudel and Aimery de Gramont, Franco-British Institute, Levallois-Perret, France; Herbert Hurwitz, Duke University Medical Center, Durham, NC; Charles S. Fuchs, Dana-Farber Cancer Institute Boston, MA; Eduardo Diaz-Rubio, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain; Niall C. Tebbutt, Austin Health, Heidelberg, Victoria, Australia; Cornelis J.A. Punt, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; J. Randolph Hecht, David Geffen School of Medicine at the University of California at Los Angeles; Heinz-Josef Lenz, University of Southern California/Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles, CA; Eric Van Cutsem, University Hospital Leuven, Leuven, Belgium; Richard M. Goldberg, Ohio State University, Columbus, OH; and Leonard B. Saltz, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Benoist Chibaudel
- Lindsay A. Renfro and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Fotios Loupakis and Alfredo Falcone, Azienda Ospedaliero-Universitaria Pisana and Università di Pisa, Pisa, Italy; Richard Adams, Cardiff University, Cardiff; Matthew T. Seymour, St James's Hospital and University of Leeds, Leeds, United Kingdom; Volker Heinemann, University of Munich, Munich; Hans-Joachim Schmoll, University Clinic Halle (Saale), Halle; Rainer Porschen, Klinikum Bremen-Ost Klinik für Innere Medizin, Bremen; Carsten Bokemeyer, University Hospital Cancer Center, University Hospital, Hamburg-Eppendorf, Germany; Jean-Yves Douillard, Institut de Cancerologie, Centre René Gauducheau, Nantes; Christophe Tournigand, University of Paris Est Creteil, Henri-Mondor Hospital, Créteil; Benoist Chibaudel and Aimery de Gramont, Franco-British Institute, Levallois-Perret, France; Herbert Hurwitz, Duke University Medical Center, Durham, NC; Charles S. Fuchs, Dana-Farber Cancer Institute Boston, MA; Eduardo Diaz-Rubio, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain; Niall C. Tebbutt, Austin Health, Heidelberg, Victoria, Australia; Cornelis J.A. Punt, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; J. Randolph Hecht, David Geffen School of Medicine at the University of California at Los Angeles; Heinz-Josef Lenz, University of Southern California/Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles, CA; Eric Van Cutsem, University Hospital Leuven, Leuven, Belgium; Richard M. Goldberg, Ohio State University, Columbus, OH; and Leonard B. Saltz, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Alfredo Falcone
- Lindsay A. Renfro and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Fotios Loupakis and Alfredo Falcone, Azienda Ospedaliero-Universitaria Pisana and Università di Pisa, Pisa, Italy; Richard Adams, Cardiff University, Cardiff; Matthew T. Seymour, St James's Hospital and University of Leeds, Leeds, United Kingdom; Volker Heinemann, University of Munich, Munich; Hans-Joachim Schmoll, University Clinic Halle (Saale), Halle; Rainer Porschen, Klinikum Bremen-Ost Klinik für Innere Medizin, Bremen; Carsten Bokemeyer, University Hospital Cancer Center, University Hospital, Hamburg-Eppendorf, Germany; Jean-Yves Douillard, Institut de Cancerologie, Centre René Gauducheau, Nantes; Christophe Tournigand, University of Paris Est Creteil, Henri-Mondor Hospital, Créteil; Benoist Chibaudel and Aimery de Gramont, Franco-British Institute, Levallois-Perret, France; Herbert Hurwitz, Duke University Medical Center, Durham, NC; Charles S. Fuchs, Dana-Farber Cancer Institute Boston, MA; Eduardo Diaz-Rubio, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain; Niall C. Tebbutt, Austin Health, Heidelberg, Victoria, Australia; Cornelis J.A. Punt, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; J. Randolph Hecht, David Geffen School of Medicine at the University of California at Los Angeles; Heinz-Josef Lenz, University of Southern California/Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles, CA; Eric Van Cutsem, University Hospital Leuven, Leuven, Belgium; Richard M. Goldberg, Ohio State University, Columbus, OH; and Leonard B. Saltz, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Niall C Tebbutt
- Lindsay A. Renfro and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Fotios Loupakis and Alfredo Falcone, Azienda Ospedaliero-Universitaria Pisana and Università di Pisa, Pisa, Italy; Richard Adams, Cardiff University, Cardiff; Matthew T. Seymour, St James's Hospital and University of Leeds, Leeds, United Kingdom; Volker Heinemann, University of Munich, Munich; Hans-Joachim Schmoll, University Clinic Halle (Saale), Halle; Rainer Porschen, Klinikum Bremen-Ost Klinik für Innere Medizin, Bremen; Carsten Bokemeyer, University Hospital Cancer Center, University Hospital, Hamburg-Eppendorf, Germany; Jean-Yves Douillard, Institut de Cancerologie, Centre René Gauducheau, Nantes; Christophe Tournigand, University of Paris Est Creteil, Henri-Mondor Hospital, Créteil; Benoist Chibaudel and Aimery de Gramont, Franco-British Institute, Levallois-Perret, France; Herbert Hurwitz, Duke University Medical Center, Durham, NC; Charles S. Fuchs, Dana-Farber Cancer Institute Boston, MA; Eduardo Diaz-Rubio, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain; Niall C. Tebbutt, Austin Health, Heidelberg, Victoria, Australia; Cornelis J.A. Punt, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; J. Randolph Hecht, David Geffen School of Medicine at the University of California at Los Angeles; Heinz-Josef Lenz, University of Southern California/Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles, CA; Eric Van Cutsem, University Hospital Leuven, Leuven, Belgium; Richard M. Goldberg, Ohio State University, Columbus, OH; and Leonard B. Saltz, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Cornelis J A Punt
- Lindsay A. Renfro and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Fotios Loupakis and Alfredo Falcone, Azienda Ospedaliero-Universitaria Pisana and Università di Pisa, Pisa, Italy; Richard Adams, Cardiff University, Cardiff; Matthew T. Seymour, St James's Hospital and University of Leeds, Leeds, United Kingdom; Volker Heinemann, University of Munich, Munich; Hans-Joachim Schmoll, University Clinic Halle (Saale), Halle; Rainer Porschen, Klinikum Bremen-Ost Klinik für Innere Medizin, Bremen; Carsten Bokemeyer, University Hospital Cancer Center, University Hospital, Hamburg-Eppendorf, Germany; Jean-Yves Douillard, Institut de Cancerologie, Centre René Gauducheau, Nantes; Christophe Tournigand, University of Paris Est Creteil, Henri-Mondor Hospital, Créteil; Benoist Chibaudel and Aimery de Gramont, Franco-British Institute, Levallois-Perret, France; Herbert Hurwitz, Duke University Medical Center, Durham, NC; Charles S. Fuchs, Dana-Farber Cancer Institute Boston, MA; Eduardo Diaz-Rubio, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain; Niall C. Tebbutt, Austin Health, Heidelberg, Victoria, Australia; Cornelis J.A. Punt, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; J. Randolph Hecht, David Geffen School of Medicine at the University of California at Los Angeles; Heinz-Josef Lenz, University of Southern California/Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles, CA; Eric Van Cutsem, University Hospital Leuven, Leuven, Belgium; Richard M. Goldberg, Ohio State University, Columbus, OH; and Leonard B. Saltz, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - J Randolph Hecht
- Lindsay A. Renfro and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Fotios Loupakis and Alfredo Falcone, Azienda Ospedaliero-Universitaria Pisana and Università di Pisa, Pisa, Italy; Richard Adams, Cardiff University, Cardiff; Matthew T. Seymour, St James's Hospital and University of Leeds, Leeds, United Kingdom; Volker Heinemann, University of Munich, Munich; Hans-Joachim Schmoll, University Clinic Halle (Saale), Halle; Rainer Porschen, Klinikum Bremen-Ost Klinik für Innere Medizin, Bremen; Carsten Bokemeyer, University Hospital Cancer Center, University Hospital, Hamburg-Eppendorf, Germany; Jean-Yves Douillard, Institut de Cancerologie, Centre René Gauducheau, Nantes; Christophe Tournigand, University of Paris Est Creteil, Henri-Mondor Hospital, Créteil; Benoist Chibaudel and Aimery de Gramont, Franco-British Institute, Levallois-Perret, France; Herbert Hurwitz, Duke University Medical Center, Durham, NC; Charles S. Fuchs, Dana-Farber Cancer Institute Boston, MA; Eduardo Diaz-Rubio, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain; Niall C. Tebbutt, Austin Health, Heidelberg, Victoria, Australia; Cornelis J.A. Punt, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; J. Randolph Hecht, David Geffen School of Medicine at the University of California at Los Angeles; Heinz-Josef Lenz, University of Southern California/Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles, CA; Eric Van Cutsem, University Hospital Leuven, Leuven, Belgium; Richard M. Goldberg, Ohio State University, Columbus, OH; and Leonard B. Saltz, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Carsten Bokemeyer
- Lindsay A. Renfro and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Fotios Loupakis and Alfredo Falcone, Azienda Ospedaliero-Universitaria Pisana and Università di Pisa, Pisa, Italy; Richard Adams, Cardiff University, Cardiff; Matthew T. Seymour, St James's Hospital and University of Leeds, Leeds, United Kingdom; Volker Heinemann, University of Munich, Munich; Hans-Joachim Schmoll, University Clinic Halle (Saale), Halle; Rainer Porschen, Klinikum Bremen-Ost Klinik für Innere Medizin, Bremen; Carsten Bokemeyer, University Hospital Cancer Center, University Hospital, Hamburg-Eppendorf, Germany; Jean-Yves Douillard, Institut de Cancerologie, Centre René Gauducheau, Nantes; Christophe Tournigand, University of Paris Est Creteil, Henri-Mondor Hospital, Créteil; Benoist Chibaudel and Aimery de Gramont, Franco-British Institute, Levallois-Perret, France; Herbert Hurwitz, Duke University Medical Center, Durham, NC; Charles S. Fuchs, Dana-Farber Cancer Institute Boston, MA; Eduardo Diaz-Rubio, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain; Niall C. Tebbutt, Austin Health, Heidelberg, Victoria, Australia; Cornelis J.A. Punt, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; J. Randolph Hecht, David Geffen School of Medicine at the University of California at Los Angeles; Heinz-Josef Lenz, University of Southern California/Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles, CA; Eric Van Cutsem, University Hospital Leuven, Leuven, Belgium; Richard M. Goldberg, Ohio State University, Columbus, OH; and Leonard B. Saltz, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Eric Van Cutsem
- Lindsay A. Renfro and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Fotios Loupakis and Alfredo Falcone, Azienda Ospedaliero-Universitaria Pisana and Università di Pisa, Pisa, Italy; Richard Adams, Cardiff University, Cardiff; Matthew T. Seymour, St James's Hospital and University of Leeds, Leeds, United Kingdom; Volker Heinemann, University of Munich, Munich; Hans-Joachim Schmoll, University Clinic Halle (Saale), Halle; Rainer Porschen, Klinikum Bremen-Ost Klinik für Innere Medizin, Bremen; Carsten Bokemeyer, University Hospital Cancer Center, University Hospital, Hamburg-Eppendorf, Germany; Jean-Yves Douillard, Institut de Cancerologie, Centre René Gauducheau, Nantes; Christophe Tournigand, University of Paris Est Creteil, Henri-Mondor Hospital, Créteil; Benoist Chibaudel and Aimery de Gramont, Franco-British Institute, Levallois-Perret, France; Herbert Hurwitz, Duke University Medical Center, Durham, NC; Charles S. Fuchs, Dana-Farber Cancer Institute Boston, MA; Eduardo Diaz-Rubio, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain; Niall C. Tebbutt, Austin Health, Heidelberg, Victoria, Australia; Cornelis J.A. Punt, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; J. Randolph Hecht, David Geffen School of Medicine at the University of California at Los Angeles; Heinz-Josef Lenz, University of Southern California/Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles, CA; Eric Van Cutsem, University Hospital Leuven, Leuven, Belgium; Richard M. Goldberg, Ohio State University, Columbus, OH; and Leonard B. Saltz, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Richard M Goldberg
- Lindsay A. Renfro and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Fotios Loupakis and Alfredo Falcone, Azienda Ospedaliero-Universitaria Pisana and Università di Pisa, Pisa, Italy; Richard Adams, Cardiff University, Cardiff; Matthew T. Seymour, St James's Hospital and University of Leeds, Leeds, United Kingdom; Volker Heinemann, University of Munich, Munich; Hans-Joachim Schmoll, University Clinic Halle (Saale), Halle; Rainer Porschen, Klinikum Bremen-Ost Klinik für Innere Medizin, Bremen; Carsten Bokemeyer, University Hospital Cancer Center, University Hospital, Hamburg-Eppendorf, Germany; Jean-Yves Douillard, Institut de Cancerologie, Centre René Gauducheau, Nantes; Christophe Tournigand, University of Paris Est Creteil, Henri-Mondor Hospital, Créteil; Benoist Chibaudel and Aimery de Gramont, Franco-British Institute, Levallois-Perret, France; Herbert Hurwitz, Duke University Medical Center, Durham, NC; Charles S. Fuchs, Dana-Farber Cancer Institute Boston, MA; Eduardo Diaz-Rubio, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain; Niall C. Tebbutt, Austin Health, Heidelberg, Victoria, Australia; Cornelis J.A. Punt, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; J. Randolph Hecht, David Geffen School of Medicine at the University of California at Los Angeles; Heinz-Josef Lenz, University of Southern California/Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles, CA; Eric Van Cutsem, University Hospital Leuven, Leuven, Belgium; Richard M. Goldberg, Ohio State University, Columbus, OH; and Leonard B. Saltz, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Leonard B Saltz
- Lindsay A. Renfro and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Fotios Loupakis and Alfredo Falcone, Azienda Ospedaliero-Universitaria Pisana and Università di Pisa, Pisa, Italy; Richard Adams, Cardiff University, Cardiff; Matthew T. Seymour, St James's Hospital and University of Leeds, Leeds, United Kingdom; Volker Heinemann, University of Munich, Munich; Hans-Joachim Schmoll, University Clinic Halle (Saale), Halle; Rainer Porschen, Klinikum Bremen-Ost Klinik für Innere Medizin, Bremen; Carsten Bokemeyer, University Hospital Cancer Center, University Hospital, Hamburg-Eppendorf, Germany; Jean-Yves Douillard, Institut de Cancerologie, Centre René Gauducheau, Nantes; Christophe Tournigand, University of Paris Est Creteil, Henri-Mondor Hospital, Créteil; Benoist Chibaudel and Aimery de Gramont, Franco-British Institute, Levallois-Perret, France; Herbert Hurwitz, Duke University Medical Center, Durham, NC; Charles S. Fuchs, Dana-Farber Cancer Institute Boston, MA; Eduardo Diaz-Rubio, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain; Niall C. Tebbutt, Austin Health, Heidelberg, Victoria, Australia; Cornelis J.A. Punt, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; J. Randolph Hecht, David Geffen School of Medicine at the University of California at Los Angeles; Heinz-Josef Lenz, University of Southern California/Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles, CA; Eric Van Cutsem, University Hospital Leuven, Leuven, Belgium; Richard M. Goldberg, Ohio State University, Columbus, OH; and Leonard B. Saltz, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Aimery de Gramont
- Lindsay A. Renfro and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Fotios Loupakis and Alfredo Falcone, Azienda Ospedaliero-Universitaria Pisana and Università di Pisa, Pisa, Italy; Richard Adams, Cardiff University, Cardiff; Matthew T. Seymour, St James's Hospital and University of Leeds, Leeds, United Kingdom; Volker Heinemann, University of Munich, Munich; Hans-Joachim Schmoll, University Clinic Halle (Saale), Halle; Rainer Porschen, Klinikum Bremen-Ost Klinik für Innere Medizin, Bremen; Carsten Bokemeyer, University Hospital Cancer Center, University Hospital, Hamburg-Eppendorf, Germany; Jean-Yves Douillard, Institut de Cancerologie, Centre René Gauducheau, Nantes; Christophe Tournigand, University of Paris Est Creteil, Henri-Mondor Hospital, Créteil; Benoist Chibaudel and Aimery de Gramont, Franco-British Institute, Levallois-Perret, France; Herbert Hurwitz, Duke University Medical Center, Durham, NC; Charles S. Fuchs, Dana-Farber Cancer Institute Boston, MA; Eduardo Diaz-Rubio, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain; Niall C. Tebbutt, Austin Health, Heidelberg, Victoria, Australia; Cornelis J.A. Punt, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; J. Randolph Hecht, David Geffen School of Medicine at the University of California at Los Angeles; Heinz-Josef Lenz, University of Southern California/Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles, CA; Eric Van Cutsem, University Hospital Leuven, Leuven, Belgium; Richard M. Goldberg, Ohio State University, Columbus, OH; and Leonard B. Saltz, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Daniel J Sargent
- Lindsay A. Renfro and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Fotios Loupakis and Alfredo Falcone, Azienda Ospedaliero-Universitaria Pisana and Università di Pisa, Pisa, Italy; Richard Adams, Cardiff University, Cardiff; Matthew T. Seymour, St James's Hospital and University of Leeds, Leeds, United Kingdom; Volker Heinemann, University of Munich, Munich; Hans-Joachim Schmoll, University Clinic Halle (Saale), Halle; Rainer Porschen, Klinikum Bremen-Ost Klinik für Innere Medizin, Bremen; Carsten Bokemeyer, University Hospital Cancer Center, University Hospital, Hamburg-Eppendorf, Germany; Jean-Yves Douillard, Institut de Cancerologie, Centre René Gauducheau, Nantes; Christophe Tournigand, University of Paris Est Creteil, Henri-Mondor Hospital, Créteil; Benoist Chibaudel and Aimery de Gramont, Franco-British Institute, Levallois-Perret, France; Herbert Hurwitz, Duke University Medical Center, Durham, NC; Charles S. Fuchs, Dana-Farber Cancer Institute Boston, MA; Eduardo Diaz-Rubio, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain; Niall C. Tebbutt, Austin Health, Heidelberg, Victoria, Australia; Cornelis J.A. Punt, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; J. Randolph Hecht, David Geffen School of Medicine at the University of California at Los Angeles; Heinz-Josef Lenz, University of Southern California/Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles, CA; Eric Van Cutsem, University Hospital Leuven, Leuven, Belgium; Richard M. Goldberg, Ohio State University, Columbus, OH; and Leonard B. Saltz, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Heinz-Josef Lenz
- Lindsay A. Renfro and Daniel J. Sargent, Mayo Clinic, Rochester, MN; Fotios Loupakis and Alfredo Falcone, Azienda Ospedaliero-Universitaria Pisana and Università di Pisa, Pisa, Italy; Richard Adams, Cardiff University, Cardiff; Matthew T. Seymour, St James's Hospital and University of Leeds, Leeds, United Kingdom; Volker Heinemann, University of Munich, Munich; Hans-Joachim Schmoll, University Clinic Halle (Saale), Halle; Rainer Porschen, Klinikum Bremen-Ost Klinik für Innere Medizin, Bremen; Carsten Bokemeyer, University Hospital Cancer Center, University Hospital, Hamburg-Eppendorf, Germany; Jean-Yves Douillard, Institut de Cancerologie, Centre René Gauducheau, Nantes; Christophe Tournigand, University of Paris Est Creteil, Henri-Mondor Hospital, Créteil; Benoist Chibaudel and Aimery de Gramont, Franco-British Institute, Levallois-Perret, France; Herbert Hurwitz, Duke University Medical Center, Durham, NC; Charles S. Fuchs, Dana-Farber Cancer Institute Boston, MA; Eduardo Diaz-Rubio, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain; Niall C. Tebbutt, Austin Health, Heidelberg, Victoria, Australia; Cornelis J.A. Punt, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; J. Randolph Hecht, David Geffen School of Medicine at the University of California at Los Angeles; Heinz-Josef Lenz, University of Southern California/Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles, CA; Eric Van Cutsem, University Hospital Leuven, Leuven, Belgium; Richard M. Goldberg, Ohio State University, Columbus, OH; and Leonard B. Saltz, Memorial Sloan-Kettering Cancer Center, New York, NY
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Hutchinson RA, Adams RA, McArt DG, Salto-Tellez M, Jasani B, Hamilton PW. Epidermal growth factor receptor immunohistochemistry: new opportunities in metastatic colorectal cancer. J Transl Med 2015; 13:217. [PMID: 26149458 PMCID: PMC4492076 DOI: 10.1186/s12967-015-0531-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [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: 01/24/2015] [Accepted: 05/12/2015] [Indexed: 02/06/2023] Open
Abstract
The treatment of cancer is becoming more precise, targeting specific oncogenic drivers with targeted molecular therapies. The epidermal growth factor receptor has been found to be over-expressed in a multitude of solid tumours. Immunohistochemistry is widely used in the fields of diagnostic and personalised medicine to localise and visualise disease specific proteins. To date the clinical utility of epidermal growth factor receptor immunohistochemistry in determining monoclonal antibody efficacy has remained somewhat inconclusive. The lack of an agreed reproducible scoring criteria for epidermal growth factor receptor immunohistochemistry has, in various clinical trials yielded conflicting results as to the use of epidermal growth factor receptor immunohistochemistry assay as a companion diagnostic. This has resulted in this test being removed from the licence for the drug panitumumab and not performed in clinical practice for cetuximab. In this review we explore the reasons behind this with a particular emphasis on colorectal cancer, and to suggest a way of resolving the situation through improving the precision of epidermal growth factor receptor immunohistochemistry with quantitative image analysis of digitised images complemented with companion molecular morphological techniques such as in situ hybridisation and section based gene mutation analysis.
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Affiliation(s)
- Ryan A Hutchinson
- Centre for Cancer Research and Cell Biology, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7AE, Northern Ireland, UK.
- Waring Laboratory, Department of Pathology, Centre for Translational Pathology, University of Melbourne, Parkville, 3010, VIC, Australia.
| | - Richard A Adams
- Institute of Cancer and Genetics, Cardiff University School of Medicine, Institute of Medical Genetics Building, Heath Park, Cardiff, CF14 4XN, UK.
| | - Darragh G McArt
- Centre for Cancer Research and Cell Biology, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7AE, Northern Ireland, UK.
| | - Manuel Salto-Tellez
- Centre for Cancer Research and Cell Biology, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7AE, Northern Ireland, UK.
| | - Bharat Jasani
- Department of Biomedical Sciences, Nazarbayev University School of Medicine, Astana, 010000, Kazakhstan.
| | - Peter W Hamilton
- Centre for Cancer Research and Cell Biology, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7AE, Northern Ireland, UK.
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Ng T, Weitsman G, Barber P, Lawler K, Rowley M, Elshtein G, Rodriguez-justo M, Jasani B, Pugh SA, Bridgewater JA, Primrose JN, Fisher D, Adams RA, Maughan T, Vojnovic B, Coolen A. Use of FLIM histology-based HER2-HER3 heterodimer quantification and a Bayesian latent class proportional hazards model to predict cetuximab response in the COIN and new EPOC trials. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.e14535] [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)
- Tony Ng
- Kings College London, London, United Kingdom
| | | | - Paul Barber
- University of Oxford, Oxford, United Kingdom
| | | | - Mark Rowley
- King's College London, London, United Kingdom
| | | | | | - Bharat Jasani
- School of Medicine, Cardiff University, Cardiff, United Kingdom
| | | | | | - John Neil Primrose
- University Surgery, University of Southampton, Southampton, United Kingdom
| | - David Fisher
- University College London, London, United Kingdom
| | | | - Tim Maughan
- University of Oxford, Oxford, United Kingdom
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Seligmann JF, Fisher D, Elliott F, Richman S, Butler R, Cheadle J, Adams RA, Quirke P, Maughan T, Seymour MT, Middleton GW. Exploring the poor outcomes of BRAF mutant (BRAF mut) advanced colorectal cancer (aCRC): Analysis from 2,530 patients (pts) in randomized clinical trials (RCTs). J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.3509] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [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)
| | - David Fisher
- University College London, London, United Kingdom
| | | | | | - Rachel Butler
- Institute of Medical Genetics, Cardiff, United Kingdom
| | | | | | | | - Tim Maughan
- University of Oxford, Oxford, United Kingdom
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Glynne-Jones R, Meadows HM, Lopes A, Adams RA, Sebag-Montefiore D. Compliance to chemoradiation (CRT) using mitomycin (MMC) or cisplatin (CisP), with or without maintenance 5FU/CisP chemotherapy (CT) in squamous cell carcinoma of the anus (SCCA) according to radiotherapy (RT) dose, overall treatment time (OTT) and chemotherapy (CT) and their impact on long-term outcome: Results of ACT II. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.3518] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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)
| | | | - Andre Lopes
- Cancer Research UK & UCL Cancer Trials Centre, London, United Kingdom
| | | | - David Sebag-Montefiore
- St. James's Institute of Oncology, St. James's University Hospital, Leeds, United Kingdom
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Adams RA, Homburger F, Russfield AB, Soto E. Methylcholanthrene-induced metastatic mammary carcinoma in several inbred hamster strains. Prog Exp Tumor Res 2015; 24:408-13. [PMID: 538260 DOI: 10.1159/000402116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Homburger F, Adams RA, Soto E, Van Dongen CG. Susceptibility and resistance to chemical carcinogens in inbred Syrian hamsters. Prog Exp Tumor Res 2015; 24:215-21. [PMID: 395569 DOI: 10.1159/000402098] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Adams RA, Homburger F. Design and logistics of lifetime carcinogenesis bioassay using Syrian hamsters. Prog Exp Tumor Res 2015; 26:202-7. [PMID: 6844641 DOI: 10.1159/000407261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Sclafani F, Adams RA, Eng C, Benson AB, Glynne-Jones R, Sebag-Montefiore D, Arnold D, Roy AC, Guren MG, Segelov E, Seymour MT, Bryant A, Peckitt C, Cunningham D, Bridgewater JA, Welch J, O'Dwyer PJ, Dupont E, McConnell A, Rao S. InterAACT: An international multicenter open label randomized phase II advanced anal cancer trial comparing cisplatin (CDDP) plus 5-fluorouracil (5-FU) versus carboplatin (CBDCA) plus weekly paclitaxel (PTX) in patients with inoperable locally recurrent (ILR) or metastatic disease. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.3_suppl.tps792] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS792 Background: Metastatic squamous cell carcinoma of the anus (SCCA) is a rare condition with 5-year overall survival (OS) rate of 32%. CDDP/5-FU is commonly used in the first-line treatment of patients with ILR or metastatic disease. This practice is based on retrospective series and data from randomised trials are lacking. Recent retrospective studies showed promising activity of CBDCA/PTX in this setting. Methods: InterAACT is an international, multicentre, open label, randomised phase II trial comparing two chemotherapy regimens in patients with ILR or metastatic SCCA. Eligible patients are randomised in a 1:1 ratio to CDDP (60 mg/mq, D1q21) plus 5-FU (1000 mg/mq/24h, D1-4q21) or CBDCA (AUC 5, D1q28) plus PTX (80 mg/mq, D1,8,15q28). Stratification factors are: performance status, extent of disease, HIV status and country. The primary endpoint is response rate (RR). Secondary endpoints include progression-free survival, OS, toxicity and quality of life. Based on a RR estimate of 40% in the CDDP/5-FU arm 80 patients are to be recruited to detect 10% difference in RR between the two arms with 80% power (phase II selection trial design). Correlative biomarker analyses are planned in tumour tissue and blood samples. The trial is sponsored by The Royal Marsden NHS Foundation Trust and endorsed by the International Rare Cancer Initiative (IRCI) group. Approximately 50 centres in the UK, Europe (EORTC), Scandinavia, US (ECOG-ACRIN) and Australia (AGITG) are estimated to participate and recruitment is anticipated to be completed within 3 years. Recruitment started in December 2013. As of September 16, 2014, 6 sites in the UK are open to recruitment and 6 patients have been randomised (3 to CDDP/5-FU and 3 to CBDCA/PTX). InterAACT aims to provide the first randomised evidence for the treatment of ILR and metastatic SCCA, to identify the optimal chemotherapy backbone to combine with targeted agents in future studies and to confirm the feasibility of conducting an international multicentre trial for this rare tumour. Clinical trial information: NCT02051868.
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Affiliation(s)
| | | | - Cathy Eng
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Al Bowen Benson
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL
| | | | - David Sebag-Montefiore
- St. James's Institute of Oncology, St. James's University Hospital, Leeds, United Kingdom
| | - Dirk Arnold
- Hubertus Wald Tumor Center, University Cancer Center Hamburg, Hamburg, Germany
| | | | | | - Eva Segelov
- St. Vincent's Clinical School, University of New South Wales, Sydney, Australia
| | | | - Annette Bryant
- Royal Marsden NHS Foundation Trust, London and Surrey, United Kingdom
| | - Clare Peckitt
- Royal Marsden NHS Foundation Trust, London and Surrey, United Kingdom
| | - David Cunningham
- Royal Marsden NHS Foundation Trust, London and Surrey, United Kingdom
| | | | - Jack Welch
- National Cancer Institute at the National Institutes of Health, Bethesda, MD
| | - Peter J. O'Dwyer
- Abramson Cancer Center of the University of Pennsylvania, Philadelphia, PA
| | | | | | - Sheela Rao
- Royal Marsden NHS Foundation Trust, London and Surrey, United Kingdom
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Ciardiello F, Seufferlein T, Tabernero J, Taieb J, Moiseyenko V, Ma B, Lopez GA, Esser R, Adams RA. Regional variation in physicians’ awareness, understanding, and use of personalized medicine in the treatment of cancer and perception of patient (pt) education. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.3_suppl.574] [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
574 Background: A multinational survey of oncologists was conducted to assess the awareness and use of biomarkers in clinical practice (Ciardiello et al, ESMO 2014). These data explore regional variations as well as perceived level of “cancer literacy” among pts. Methods: Ten-minute online interviews were conducted with practicing oncology specialists (3 to 35 years of experience, treating > 15 pts/month) from 12 representative countries in Europe, South America, and Asia. Results: In total, 895 interviews were completed; numerous regional differences were observed. While most physicians use biomarkers (90%), there were marked regional variations. KRAS was the most frequent test. Among the 10% of physicians not using biomarkers, local availability of testing, speed of obtaining results, and cost were cited as the main reasons. The majority of Chinese doctors indicated that physician training (82%) and better biomarker information for pts (83%) would enable them to use biomarkers more often (global averages: 38% and 34%, respectively). Striking variation was seen in physicians’ assessment of pts’ knowledge of cancer biology, treatment options, use of biomarkers, and involvement in their own treatment plans. Only 38% of German physicians believed their pts know that tumors can be tested to help decide which treatment to give (global average: 73%). Only 21% of Saudi Arabian physicians believed the treatment decision process is shared between the doctor and/or multidisciplinary team and pt (global average: 82%). While physicians felt specialist nurses were the best source of information for pts, only 45% globally believed pts had access to these nurses (ranging from 19% in Russia to 83% in the UK). Conclusions: These data demonstrate wide global use of biomarkers but with regional variations reflecting cultural and local practice. Perception of pt cancer literacy and pt access to information also differs widely. Most physicians agree, however, that pts require more information to understand their disease better and become involved in treatment decisions.
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Affiliation(s)
| | | | | | - Julien Taieb
- European Hospital Georges Pompidou, Paris, France
| | | | - Brigette Ma
- State Key Laboratory of Oncology in South China, Sir Y K Pao Centre for Cancer, Department of Clinical Oncology, Hong Kong Cancer Institute and Prince of Wales Hospital, The Chinese University of Hong Kong, Sha Tin, Hong Kong
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Muirhead R, Adams RA, Gilbert DC, Glynne-Jones R, Harrison M, Sebag-Montefiore D, Hawkins MA. Anal cancer: developing an intensity-modulated radiotherapy solution for ACT2 fractionation. Clin Oncol (R Coll Radiol) 2014; 26:720-1. [PMID: 25183394 DOI: 10.1016/j.clon.2014.08.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 07/07/2014] [Indexed: 11/17/2022]
Affiliation(s)
- R Muirhead
- The Gray Institute for Radiation Oncology & Biology, Oxford, UK.
| | - R A Adams
- School of Medicine, Cardiff University, Cardiff, UK
| | - D C Gilbert
- Sussex Cancer Centre, Royal Sussex County Hospital, Brighton, UK
| | | | | | | | - M A Hawkins
- The Gray Institute for Radiation Oncology & Biology, Oxford, UK
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Sommeijer DW, Shi Q, Saad ED, Coart E, Buyse ME, Burzykowski T, Meyers JP, Maughan T, Adams RA, Seymour MT, Saltz L, Goldberg RM, Douillard JY, Schmoll HJ, Punt CJA, Tournigand C, Chibaudel B, De Gramont A, Sargent DJ, Zalcberg JR. Early predictors of prolonged overall survival (OS) in patients (pts) on first-line chemotherapy (CT) for metastatic colorectal cancer (mCRC): An ARCAD study with individual patient data (IPD) on 10,962 pts. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.3538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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)
- Dirkje Willemien Sommeijer
- NHMRC Clinical Trials Centre, Sydney; Flevohospital, Almere; Academic Medical Centre, Amsterdam, Netherlands
| | | | | | - Elisabeth Coart
- International Drug Development Institute, Louvain la Neuve, Belgium
| | - Marc E. Buyse
- International Drug Development Institute (IDDI), Louvain la Neuve, Belgium
| | | | | | - Tim Maughan
- Gray Institute for Radiation Oncology and Biology, University of Oxford, Oxford, United Kingdom
| | | | | | - Leonard Saltz
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - Richard M. Goldberg
- The Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, OH
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Renfro LA, Loupakis F, Adams RA, Seymour MT, Schmoll HJ, Douillard JY, Hurwitz H, Fuchs CS, Diaz-Rubio E, Porschen R, Tournigand C, Falcone A, Tebbutt NC, Hecht JR, Punt CJA, Goldberg RM, Saltz L, De Gramont A, Sargent DJ, Lenz HJ. Body mass index (BMI) as prognostic in metastatic colorectal cancer (mCRC): A pooled analysis of 21 first-line trials in the ARCAD database. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.3537] [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)
| | - Fotios Loupakis
- U.O. Oncologia Medica 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | | | | | | | | | | | | | | | | | | | - Alfredo Falcone
- U.O. Oncologia Medica 2, Azienda Ospedaliero-Universitaria Pisana, Istituto Toscano Tumori, Pisa, Italy
| | | | - J. Randolph Hecht
- David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA
| | | | - Richard M. Goldberg
- The Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, OH
| | - Leonard Saltz
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
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Maughan TS, Meade AM, Adams RA, Richman SD, Butler R, Fisher D, Wilson RH, Jasani B, Taylor GR, Williams GT, Sampson JR, Seymour MT, Nichols LL, Kenny SL, Nelson A, Sampson CM, Hodgkinson E, Bridgewater JA, Furniss DL, Roy R, Pope MJ, Pope JK, Parmar M, Quirke P, Kaplan R. A feasibility study testing four hypotheses with phase II outcomes in advanced colorectal cancer (MRC FOCUS3): a model for randomised controlled trials in the era of personalised medicine? Br J Cancer 2014; 110:2178-86. [PMID: 24743706 PMCID: PMC4007241 DOI: 10.1038/bjc.2014.182] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [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: 11/21/2013] [Revised: 02/27/2014] [Accepted: 03/13/2014] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Molecular characteristics of cancer vary between individuals. In future, most trials will require assessment of biomarkers to allocate patients into enriched populations in which targeted therapies are more likely to be effective. The MRC FOCUS3 trial is a feasibility study to assess key elements in the planning of such studies. PATIENTS AND METHODS Patients with advanced colorectal cancer were registered from 24 centres between February 2010 and April 2011. With their consent, patients' tumour samples were analysed for KRAS/BRAF oncogene mutation status and topoisomerase 1 (topo-1) immunohistochemistry. Patients were then classified into one of four molecular strata; within each strata patients were randomised to one of two hypothesis-driven experimental therapies or a common control arm (FOLFIRI chemotherapy). A 4-stage suite of patient information sheets (PISs) was developed to avoid patient overload. RESULTS A total of 332 patients were registered, 244 randomised. Among randomised patients, biomarker results were provided within 10 working days (w.d.) in 71%, 15 w.d. in 91% and 20 w.d. in 99%. DNA mutation analysis was 100% concordant between two laboratories. Over 90% of participants reported excellent understanding of all aspects of the trial. In this randomised phase II setting, omission of irinotecan in the low topo-1 group was associated with increased response rate and addition of cetuximab in the KRAS, BRAF wild-type cohort was associated with longer progression-free survival. CONCLUSIONS Patient samples can be collected and analysed within workable time frames and with reproducible mutation results. Complex multi-arm designs are acceptable to patients with good PIS. Randomisation within each cohort provides outcome data that can inform clinical practice.
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Affiliation(s)
- T S Maughan
- CRUK/MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford OX3 7DQ, UK
| | - A M Meade
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London WC2B 6NH, UK
| | - R A Adams
- Cardiff University and Velindre Cancer Centre, Cardiff, UK
| | - S D Richman
- Leeds Institute of Cancer and Pathology, University of Leeds, Leeds LS9 7TF, UK
| | - R Butler
- University Hospital of Wales, Cardiff CF14 4XW, UK
| | - D Fisher
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London WC2B 6NH, UK
| | - R H Wilson
- Centre for Cancer Research and Cell Biology, Queen's University Belfast, Belfast BT9 7AE, UK
| | - B Jasani
- Institute of Cancer and Genetics, Cardiff University, Cardiff CF14 4XN, UK
| | - G R Taylor
- Leeds Institute of Cancer and Pathology, University of Leeds, Leeds LS9 7TF, UK
| | - G T Williams
- Institute of Cancer and Genetics, Cardiff University, Cardiff CF14 4XN, UK
| | - J R Sampson
- Institute of Cancer and Genetics, Cardiff University, Cardiff CF14 4XN, UK
| | - M T Seymour
- St James's Institute of Oncology, University of Leeds, Leeds LS9 7TF, UK
| | - L L Nichols
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London WC2B 6NH, UK
| | - S L Kenny
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London WC2B 6NH, UK
| | - A Nelson
- Wales Cancer Trials Unit, Cardiff University, Cardiff CF14 4YS, UK
| | - C M Sampson
- Wales Cancer Trials Unit, Cardiff University, Cardiff CF14 4YS, UK
| | - E Hodgkinson
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S5 7AU, UK
| | | | - D L Furniss
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S5 7AU, UK
| | - R Roy
- Department of Oncology, Castle Hill Hospital, East Riding of Yorkshire HU16 5JQ, UK
| | - M J Pope
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London WC2B 6NH, UK
| | - J K Pope
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London WC2B 6NH, UK
| | - M Parmar
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London WC2B 6NH, UK
| | - P Quirke
- Leeds Institute of Cancer and Pathology, University of Leeds, Leeds LS9 7TF, UK
| | - R Kaplan
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London WC2B 6NH, UK
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Affiliation(s)
- Rob Glynne-Jones
- Centre for Cancer Treatment, Mount Vernon Hospital, Northwood, Middlesex, United Kingdom
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48
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Smith CG, Fisher D, Claes B, Maughan TS, Idziaszczyk S, Peuteman G, Harris R, James MD, Meade A, Jasani B, Adams RA, Kenny S, Kaplan R, Lambrechts D, Cheadle JP. Somatic profiling of the epidermal growth factor receptor pathway in tumors from patients with advanced colorectal cancer treated with chemotherapy ± cetuximab. Clin Cancer Res 2013; 19:4104-13. [PMID: 23741067 PMCID: PMC3732482 DOI: 10.1158/1078-0432.ccr-12-2581] [Citation(s) in RCA: 82] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE To study the somatic molecular profile of the EGF receptor (EGFR) pathway in advanced colorectal cancer, its relationship to prognosis, the site of the primary and metastases, and response to cetuximab. EXPERIMENTAL DESIGN We used Sequenom and Pyrosequencing for high-throughput somatic profiling of the EGFR pathway in 1,976 tumors from patients with advanced colorectal cancer from the COIN trial (oxaliplatin and fluoropyrimidine chemotherapy ± cetuximab). Correlations between mutations, clinicopathologic, response, and survival data were carried out. RESULTS Sequenom and Pyrosequencing had 99.0% (9,961/10,063) genotype concordance. We identified 13 different KRAS mutations in 42.3% of advanced colorectal cancers, 2 BRAF mutations in 9.0%, 4 NRAS mutations in 3.6%, and 5 PIK3CA mutations in 12.7%. 4.2% of advanced colorectal cancers had microsatellite instability (MSI). KRAS and PIK3CA exon 9, but not exon 20, mutations cooccurred (P = 8.9 × 10(-4)) as did MSI and BRAF mutations (P = 5.3 × 10(-10)). KRAS mutations were associated with right colon cancers (P = 5.2 × 10(-5)) and BRAF mutations with right (P = 7.2 × 10(-5)) and transverse colon (P = 9.8 × 10(-6)) cancers. KRAS mutations were associated with lung-only metastases (P = 2.3 × 10(-4)), BRAF mutations with peritoneal (P = 9.2 × 10(-4)) and nodal-only (P = 3.7 × 10(-5)) metastases, and MSI (BRAF(WT)) with nodal-only metastases (P = 2.9 × 10(-4)). MSI (BRAF(WT)) was associated with worse survival (HR = 1.89, 95% CI 1.30-2.76, P = 8.5 × 10(-4)). No mutations, subsets of mutations, or MSI status were associated with response to cetuximab. CONCLUSIONS Our data support a functional cooperation between KRAS and PIK3CA in colorectal tumorigenesis and link somatic profiles to the sites of metastases. MSI was associated with poor prognosis in advanced disease, and no individual somatic profile was associated with response to cetuximab in COIN.
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Affiliation(s)
- Christopher G. Smith
- Institute of Cancer and Genetics, School of Medicine, Cardiff University, CF14 4XN, UK
| | - David Fisher
- MRC Clinical Trials Unit, Aviation House, 125 Kingsway, London, WC2B 6NH, UK
| | - Bart Claes
- Vesalius Research Center, VIB, Leuven, B3000, Belgium
- Laboratory for Translational Genetics, Department of Oncology, University of Leuven, Leuven, B3000, Belgium
| | - Timothy S. Maughan
- Gray Institute for Radiation Oncology and Biology, University of Oxford, Oxford, OX3 7DQ, UK
| | - Shelley Idziaszczyk
- Institute of Cancer and Genetics, School of Medicine, Cardiff University, CF14 4XN, UK
| | - Gilian Peuteman
- Vesalius Research Center, VIB, Leuven, B3000, Belgium
- Laboratory for Translational Genetics, Department of Oncology, University of Leuven, Leuven, B3000, Belgium
| | - Rebecca Harris
- Institute of Cancer and Genetics, School of Medicine, Cardiff University, CF14 4XN, UK
| | - Michelle D. James
- Institute of Cancer and Genetics, School of Medicine, Cardiff University, CF14 4XN, UK
| | - Angela Meade
- MRC Clinical Trials Unit, Aviation House, 125 Kingsway, London, WC2B 6NH, UK
| | - Bharat Jasani
- Institute of Cancer and Genetics, School of Medicine, Cardiff University, CF14 4XN, UK
| | - Richard A. Adams
- Institute of Cancer and Genetics, School of Medicine, Cardiff University, CF14 4XN, UK
| | - Sarah Kenny
- MRC Clinical Trials Unit, Aviation House, 125 Kingsway, London, WC2B 6NH, UK
| | - Richard Kaplan
- MRC Clinical Trials Unit, Aviation House, 125 Kingsway, London, WC2B 6NH, UK
| | - Diether Lambrechts
- Vesalius Research Center, VIB, Leuven, B3000, Belgium
- Laboratory for Translational Genetics, Department of Oncology, University of Leuven, Leuven, B3000, Belgium
| | - Jeremy P. Cheadle
- Institute of Cancer and Genetics, School of Medicine, Cardiff University, CF14 4XN, UK
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Madi A, Fisher D, Maughan T, Colley J, Meade AM, Maynard J, Humpreys V, Wasan H, Adams RA, Idziaszczyk S, Harris R, Nichols LL, Kaplan RS, Cheadle J. Comprehensive pharmacogenetic profiling of advanced colorectal cancer. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.3509] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
3509 Background: Inherited genetic factors may influence a patient’s response to, and side effects from, chemotherapy and biological therapies. Here, we sought to generate a comprehensive inherited pharmacogenetic profile for advanced colorectal cancer (aCRC). Methods: We analysed 260 potentially functional coding region and promoter variants in genes within the 5-FU, capecitabine, oxaliplatin, EGFR and DNA repair pathways in 2183 patients with aCRC treated with oxaliplatin-fluoropyrimidine chemotherapy ± cetuximab (from the MRC COIN and COIN-B trials). Primary outcomes assessed were 12-week response, skin rash (SR) (for those receiving cetuximab), dose-reduction or delay in treatment due to any toxicity and peripheral neuropathy (PN). Results: For variants with minor allele frequencies >20%, we had >85% power to detect an effect on response / toxicity with an OR of 1.3. In patients treated with chemotherapy + cetuximab, 5 and 4 coding region variants in the EGFR pathway were associated with response and SR, respectively. The most significant associations were with variants in members of phosphatidylinositol 3-kinase regulatory subunit. In patients treated with chemotherapy ± cetuximab, 8 coding region variants in the 5-FU, capecitabine, oxaliplatin or DNA repair pathways were associated with response, 8 with any toxicity and 5 with PN. The most significant associations for response were with variants in DNA repair genes and, for any toxicity, with common variants in DPYD. Conclusions: Our study highlights the difficulty in identifying inherited biomarkers for the treatment of aCRC - despite using samples from the largest reported randomised trial for aCRC, with considerable power to detect alleles of small effects, none of the associations remained significant after rigorous correction for multiple testing.
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Affiliation(s)
- Ayman Madi
- Northern Centre for Cancer Care, Newcastle Upon Tyne, United Kingdom
| | - David Fisher
- Clinical Trials Unit, Medical Research Council, London, United Kingdom
| | - Tim Maughan
- Gray Institute for Radiation Oncology and Biology, University of Oxford, Oxford, United Kingdom
| | | | - Angela M. Meade
- Clinical Trials Unit, Medical Research Council, London, United Kingdom
| | | | | | - Harpreet Wasan
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | | | | | | | - Laura L. Nichols
- Medical Research Council Clinical Trials Unit, London, United Kingdom
| | - Richard S. Kaplan
- Medical Research Council Clinical Trials Unit, London, United Kingdom
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Shiu KK, Maughan T, Wilson RH, Adams RA, Pugh C, Brown L, Fisher D, Wasan H, Middleton GW, Steward WP, Kaplan RS. FOCUS4: A prospective molecularly stratified, adaptive multicenter program of randomized controlled trials for patients with colorectal cancer (CRC). J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.tps3645] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS3645 Background: Targeted therapies based on somatic gene mutations or activated pathways have inhibited progression of some cancers. However, although various targets are identifiable in CRC, KRAS mutation is currently the only validated predictive biomarker for selection of a targeted therapy. FOCUS4 is a rolling phase II-III trial for testing in a staged way both the utility of molecular stratification and the efficacy of novel agents in subpopulations of mCRC patients. It is also a trial of a new strategy for testing stratified approaches to therapy in any biologically complex tumour type using a Multi-Arm, Multi-Stage design. Methods: The study population consists of subjects with newly diagnosed inoperable mCRC. Subjects receive first-line chemotherapy for 16 weeks. During this time the tumour is tested for BRAF/PIK3CA/KRAS/NRAS mutations and PTEN loss. Subjects with responding or stable disease on CT, who would normally be candidates for a treatment break, are then randomised to four coherent biomarker-based subgroups: FOCUS4-A: BRAF mutant, FOCUS4-B: PIK3CA mutant or complete loss of PTEN on IHC, FOCUS4-C: KRAS or NRAS mutant, FOCUS4-D: All wild type (no mutations of BRAF, PIK3CA, KRAS or NRAS). For each subgroup, a relevant novel agent or combination is to be tested in an adaptive double-blind placebo controlled randomised trial design with multiple interim analyses for early termination if there is no strong evidence of worthwhile activity. There will also be a 5thsubgroup FOCUS4-N testing maintenance capecitabine for unclassifiable tumours or for patients whose marker defined cohort is temporarily suspended. The primary endpoint is progression free survival. Promising results in any biomarker defined cohort will then be tested for response in cohorts without the biomarker. Within the overall trial, biomarker developments can be accommodated with changes in the distribution of the cohorts or testing of new targeted agents. Enrolment will commence in May 2013. Upto 3400 patients will be registered over a 4-5 year period depending on which cohorts pass their staged interim analyses and proceed to later stages, including an overall survival endpoint. Clinical trial information: 2012-005111-12.
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Affiliation(s)
- Kai-Keen Shiu
- Medical Research Council Clinical Trials Unit, London, United Kingdom
| | - Tim Maughan
- Gray Institute for Radiation Oncology and Biology, University of Oxford, Oxford, United Kingdom
| | | | | | - Cheryl Pugh
- Clinical Trials Unit, Medical Research Council, London, United Kingdom
| | - Louise Brown
- Medical Research Council Clinical Trials Unit, London, United Kingdom
| | - David Fisher
- Clinical Trials Unit, Medical Research Council, London, United Kingdom
| | - Harpreet Wasan
- Hammersmith Hospital, Imperial College Healthcare Trust, London, United Kingdom
| | | | | | - Richard S. Kaplan
- Medical Research Council Clinical Trials Unit, London, United Kingdom
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