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Vogt KS, Johnson J, Coleman R, Simms-Ellis R, Harrison R, Shearman N, Marran J, Budworth L, Horsfield C, Lawton R, Grange A. Can the Reboot coaching programme support critical care nurses in coping with stressful clinical events? A mixed-methods evaluation assessing resilience, burnout, depression and turnover intentions. BMC Health Serv Res 2024; 24:343. [PMID: 38491374 PMCID: PMC10941361 DOI: 10.1186/s12913-023-10468-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 12/12/2023] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND Critical care nurses (CCNs) are routinely exposed to highly stressful situations, and at high-risk of suffering from work-related stress and developing burnout. Thus, supporting CCN wellbeing is crucial. One approach for delivering this support is by preparing CCNs for situations they may encounter, drawing on evidence-based techniques to strengthen psychological coping strategies. The current study tailored a Resilience-boosting psychological coaching programme [Reboot] to CCNs. Other healthcare staff receiving Reboot have reported improvements in confidence in coping with stressful clinical events and increased psychological resilience. The current study tailored Reboot for online, remote delivery to CCNs (as it had not previously been delivered to nurses, or in remote format), to (1) assess the feasibility of delivering Reboot remotely, and to (2) provide a preliminary assessment of whether Reboot could increase resilience, confidence in coping with adverse events and burnout. METHODS A single-arm mixed-methods (questionnaires, interviews) before-after feasibility study design was used. Feasibility was measured via demand, recruitment, and retention (recruitment goal: 80 CCNs, retention goal: 70% of recruited CCNs). Potential efficacy was measured via questionnaires at five timepoints; measures included confidence in coping with adverse events (Confidence scale), Resilience (Brief Resilience Scale), depression (PHQ-9) and burnout (Oldenburg-Burnout-Inventory). Intention to leave (current role, nursing more generally) was measured post-intervention. Interviews were analysed using Reflexive Thematic Analysis. RESULTS Results suggest that delivering Reboot remotely is feasible and acceptable. Seventy-seven nurses were recruited, 81% of whom completed the 8-week intervention. Thus, the retention rate was over 10% higher than the target. Regarding preliminary efficacy, follow-up measures showed significant increases in resilience, confidence in coping with adverse events and reductions in depression, burnout, and intention to leave. Qualitative analysis suggested that CCNs found the psychological techniques helpful and particularly valued practical exercises that could be translated into everyday practice. CONCLUSION This study demonstrates the feasibility of remote delivery of Reboot and potential efficacy for CCNs. Results are limited due to the single-arm feasibility design; thus, a larger trial with a control group is needed.
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Affiliation(s)
- K S Vogt
- Bradford Institute for Health Research, Bradford Royal Infirmary, Temple Bank House, Duckworth Lane, Bradford, BD9 6RJ, UK.
- Department of Psychology, University of Leeds, Leeds, LS2 9JT, UK.
- Department of Primary Care & Mental Health, Institute of Population Health, University of Liverpool, Eleanor Rathbone Building, Liverpool, L69 7ZA, UK.
| | - J Johnson
- Bradford Institute for Health Research, Bradford Royal Infirmary, Temple Bank House, Duckworth Lane, Bradford, BD9 6RJ, UK
- Department of Psychology, University of Leeds, Leeds, LS2 9JT, UK
- School of Population Health, University of New South Wales, Sydney, 2052, Australia
| | - R Coleman
- Bradford Institute for Health Research, Bradford Royal Infirmary, Temple Bank House, Duckworth Lane, Bradford, BD9 6RJ, UK
- School of Health and Wellbeing: College of Medical, Veterinary and Life Sciences, University of Glasgow, Clarice Pears Building, Glasgow, G12 8TB, UK
| | - R Simms-Ellis
- Bradford Institute for Health Research, Bradford Royal Infirmary, Temple Bank House, Duckworth Lane, Bradford, BD9 6RJ, UK
- Department of Psychology, University of Leeds, Leeds, LS2 9JT, UK
| | - R Harrison
- School of Population Health, University of New South Wales, Sydney, 2052, Australia
- Centre for Health Systems and Safety Research: Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - N Shearman
- Leeds Teaching Hospitals NHS Trust, Great George Street, Leeds, LS1 3EX, UK
- Mid Yorkshire Teaching NHS Trust, Wakefield, UK
| | - J Marran
- Bradford Institute for Health Research, Bradford Royal Infirmary, Temple Bank House, Duckworth Lane, Bradford, BD9 6RJ, UK
| | - L Budworth
- Bradford Institute for Health Research, Bradford Royal Infirmary, Temple Bank House, Duckworth Lane, Bradford, BD9 6RJ, UK
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- NIHR Yorkshire & Humber Patient Safety Research Collaboration, Bradford Teaching Hospitals Foundation Trust, Bradford, UK
| | - C Horsfield
- West Yorkshire Adult Critical Care Network, Leeds Teaching Hospitals, Leeds, UK
| | - R Lawton
- Bradford Institute for Health Research, Bradford Royal Infirmary, Temple Bank House, Duckworth Lane, Bradford, BD9 6RJ, UK
- Department of Psychology, University of Leeds, Leeds, LS2 9JT, UK
| | - A Grange
- Bradford Institute for Health Research, Bradford Royal Infirmary, Temple Bank House, Duckworth Lane, Bradford, BD9 6RJ, UK
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Rebeiro BM, Triambak S, Garrett PE, Ball GC, Brown BA, Menéndez J, Romeo B, Adsley P, Lenardo BG, Lindsay R, Bildstein V, Burbadge C, Coleman R, Diaz Varela A, Dubey R, Faestermann T, Hertenberger R, Kamil M, Leach KG, Natzke C, Nzobadila Ondze JC, Radich A, Rand E, Wirth HF. ^{138}Ba(d,α) Study of States in ^{136}Cs: Implications for New Physics Searches with Xenon Detectors. Phys Rev Lett 2023; 131:052501. [PMID: 37595245 DOI: 10.1103/physrevlett.131.052501] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 07/07/2023] [Indexed: 08/20/2023]
Abstract
We used the ^{138}Ba(d,α) reaction to carry out an in-depth study of states in ^{136}Cs, up to around 2.5 MeV. In this Letter, we place emphasis on hitherto unobserved states below the first 1^{+} level, which are important in the context of solar neutrino and fermionic dark matter (FDM) detection in large-scale xenon-based experiments. We identify for the first time candidate metastable states in ^{136}Cs, which would allow a real-time detection of solar neutrino and FDM events in xenon detectors, with high background suppression. Our results are also compared with shell-model calculations performed with three Hamiltonians that were previously used to evaluate the nuclear matrix element (NME) for ^{136}Xe neutrinoless double beta decay. We find that one of these Hamiltonians, which also systematically underestimates the NME compared with the others, dramatically fails to describe the observed low-energy ^{136}Cs spectrum, while the other two show reasonably good agreement.
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Affiliation(s)
- B M Rebeiro
- Department of Physics and Astronomy, University of the Western Cape, P/B X17, Bellville 7535, South Africa
- Department of Physics, McGill University, Montréal, Québec H3A 2T8, Canada
| | - S Triambak
- Department of Physics and Astronomy, University of the Western Cape, P/B X17, Bellville 7535, South Africa
| | - P E Garrett
- Department of Physics and Astronomy, University of the Western Cape, P/B X17, Bellville 7535, South Africa
- Department of Physics, University of Guelph, Guelph, Ontario N1G 2W1, Canada
| | - G C Ball
- TRIUMF, 4004 Wesbrook Mall, Vancouver, British Columbia V6T 2A3, Canada
| | - B A Brown
- Department of Physics and Astronomy and National Superconducting Cyclotron Laboratory, Michigan State University, East Lansing, Michigan 48824-1321, USA
| | - J Menéndez
- Department of Quantum Physics and Astrophysics and Institute of Cosmos Sciences, University of Barcelona, 08028 Barcelona, Spain
| | - B Romeo
- Donostia International Physics Center, 20018 San Sebastián, Spain
| | - P Adsley
- Cyclotron Institute and Department of Physics and Astronomy, Texas A&M University, College Station, Texas 77843, USA
| | - B G Lenardo
- SLAC National Accelerator Laboratory, Menlo Park, California 94025, USA
| | - R Lindsay
- Department of Physics and Astronomy, University of the Western Cape, P/B X17, Bellville 7535, South Africa
| | - V Bildstein
- Department of Physics, University of Guelph, Guelph, Ontario N1G 2W1, Canada
| | - C Burbadge
- Department of Physics, University of Guelph, Guelph, Ontario N1G 2W1, Canada
| | - R Coleman
- Department of Physics, University of Guelph, Guelph, Ontario N1G 2W1, Canada
| | - A Diaz Varela
- Department of Physics, University of Guelph, Guelph, Ontario N1G 2W1, Canada
| | - R Dubey
- Department of Physics and Astronomy, University of the Western Cape, P/B X17, Bellville 7535, South Africa
- Institute of Physics, University of Szczecin, 70-451 Szczecin, Poland
| | - T Faestermann
- Physik Department, Technische Universität München, D-85748 Garching, Germany
| | - R Hertenberger
- Fakultät für Physik, Ludwig-Maximilians-Universität München, D-85748 Garching, Germany
| | - M Kamil
- Department of Physics and Astronomy, University of the Western Cape, P/B X17, Bellville 7535, South Africa
| | - K G Leach
- Department of Physics, Colorado School of Mines, Golden, Colorado 80401, USA
| | - C Natzke
- Department of Physics, Colorado School of Mines, Golden, Colorado 80401, USA
| | - J C Nzobadila Ondze
- Department of Physics and Astronomy, University of the Western Cape, P/B X17, Bellville 7535, South Africa
| | - A Radich
- Department of Physics, University of Guelph, Guelph, Ontario N1G 2W1, Canada
| | - E Rand
- Department of Physics, University of Guelph, Guelph, Ontario N1G 2W1, Canada
| | - H-F Wirth
- Fakultät für Physik, Ludwig-Maximilians-Universität München, D-85748 Garching, Germany
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3
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Luen SJ, Viale G, Nik-Zainal S, Savas P, Kammler R, Dell'Orto P, Biasi O, Degasperi A, Brown LC, Láng I, MacGrogan G, Tondini C, Bellet M, Villa F, Bernardo A, Ciruelos E, Karlsson P, Neven P, Climent M, Müller B, Jochum W, Bonnefoi H, Martino S, Davidson NE, Geyer C, Chia SK, Ingle JN, Coleman R, Solbach C, Thürlimann B, Colleoni M, Coates AS, Goldhirsch A, Fleming GF, Francis PA, Speed TP, Regan MM, Loi S. Genomic characterisation of hormone receptor-positive breast cancer arising in very young women. Ann Oncol 2023; 34:397-409. [PMID: 36709040 PMCID: PMC10619213 DOI: 10.1016/j.annonc.2023.01.009] [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: 08/09/2022] [Revised: 12/14/2022] [Accepted: 01/15/2023] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Very young premenopausal women diagnosed with hormone receptor-positive, human epidermal growth factor receptor 2-negative (HR+HER2-) early breast cancer (EBC) have higher rates of recurrence and death for reasons that remain largely unexplained. PATIENTS AND METHODS Genomic sequencing was applied to HR+HER2- tumours from patients enrolled in the Suppression of Ovarian Function Trial (SOFT) to determine genomic drivers that are enriched in young premenopausal women. Genomic alterations were characterised using next-generation sequencing from a subset of 1276 patients (deep targeted sequencing, n = 1258; whole-exome sequencing in a young-age, case-control subsample, n = 82). We defined copy number (CN) subgroups and assessed for features suggestive of homologous recombination deficiency (HRD). Genomic alteration frequencies were compared between young premenopausal women (<40 years) and older premenopausal women (≥40 years), and assessed for associations with distant recurrence-free interval (DRFI) and overall survival (OS). RESULTS Younger women (<40 years, n = 359) compared with older women (≥40 years, n = 917) had significantly higher frequencies of mutations in GATA3 (19% versus 16%) and CN amplifications (CNAs) (47% versus 26%), but significantly lower frequencies of mutations in PIK3CA (32% versus 47%), CDH1 (3% versus 9%), and MAP3K1 (7% versus 12%). Additionally, they had significantly higher frequencies of features suggestive of HRD (27% versus 21%) and a higher proportion of PIK3CA mutations with concurrent CNAs (23% versus 11%). Genomic features suggestive of HRD, PIK3CA mutations with CNAs, and CNAs were associated with significantly worse DRFI and OS compared with those without these features. These poor prognostic features were enriched in younger patients: present in 72% of patients aged <35 years, 54% aged 35-39 years, and 40% aged ≥40 years. Poor prognostic features [n = 584 (46%)] versus none [n = 692 (54%)] had an 8-year DRFI of 84% versus 94% and OS of 88% versus 96%. Younger women (<40 years) had the poorest outcomes: 8-year DRFI 74% versus 85% and OS 80% versus 93%, respectively. CONCLUSION These results provide insights into genomic alterations that are enriched in young women with HR+HER2- EBC, provide rationale for genomic subgrouping, and highlight priority molecular targets for future clinical trials.
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Affiliation(s)
- S J Luen
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia
| | - G Viale
- International Breast Cancer Study Group Central Pathology Office, IEO European Institute of Oncology IRCCS, University of Milan, Milan, Italy
| | - S Nik-Zainal
- Department of Medical Genetics & MRC Cancer Unit, The Clinical School, University of Cambridge, Cambridge, UK
| | - P Savas
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia
| | - R Kammler
- International Breast Cancer Study Group, Coordinating Center, Central Pathology Office, Bern, Switzerland
| | - P Dell'Orto
- International Breast Cancer Study Group Central Pathology Office, Department of Pathology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - O Biasi
- Division of Pathology and Laboratory Medicine, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - A Degasperi
- Department of Medical Genetics & MRC Cancer Unit, The Clinical School, University of Cambridge, Cambridge, UK
| | - L C Brown
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia
| | - I Láng
- Istenhegyi Health Center Oncology Clinic, National Institute of Oncology, Budapest, Hungary
| | - G MacGrogan
- Biopathology Department, Institut Bergonié Comprehensive Cancer Centre, Bordeaux, France
| | - C Tondini
- Osp. Papa Giovanni XXIII, Bergamo, Italy
| | - M Bellet
- Vall d'Hebron Institute of Oncology (VHIO) and Vall d'Hebron University Hospital, Barcelona, Spain
| | - F Villa
- Oncology Unit, Department of Oncology, Alessandro Manzoni Hospital, ASST Lecco, Lecco, Italy
| | - A Bernardo
- ICS Maugeri IRCCS, Medical Oncology Unit of Pavia Institute, Italy
| | - E Ciruelos
- University Hospital 12 de Octubre, Madrid, Spain
| | - P Karlsson
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - P Neven
- Gynecologic Oncology and Multidisciplinary Breast Center, University Hospitals UZ-Leuven, KU Leuven, Leuven, Belgium
| | - M Climent
- Instituto Valenciano de Oncologia, Valencia, Spain
| | - B Müller
- Chilean Cooperative Group for Oncologic Research (GOCCHI), Santiago, Chile
| | - W Jochum
- Institute of Pathology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland; Swiss Group for Clinical Cancer Research (SAKK), Berne, Switzerland
| | - H Bonnefoi
- Institut Bergonié Comprehensive Cancer Centre, Université de Bordeaux, INSERM U1218, Bordeaux, France; European Organization for Research and Treatment of Cancer (EORTC), Brussels, Belgium
| | - S Martino
- The Angeles Clinic and Research Institute, Santa Monica, USA
| | - N E Davidson
- Fred Hutchinson Cancer Research Center, University of Washington, Seattle, USA
| | - C Geyer
- Houston Methodist Cancer Center, NRG Oncology, Houston, USA
| | - S K Chia
- BC Cancer and Canadian Cancer Trials Group, Vancouver, Canada
| | - J N Ingle
- Mayo Clinic, Rochester, Minnesota, USA
| | - R Coleman
- National Institute for Health Research (NIHR) Cancer Research Network, University of Sheffield, Sheffield, UK
| | - C Solbach
- Breast Center, University Hospital, Goethe University Frankfurt, Frankfurt, Germany
| | - B Thürlimann
- Swiss Group for Clinical Cancer Research (SAKK), Berne, Switzerland; Breast Center, Kantonsspital, St. Gallen, Switzerland
| | - M Colleoni
- Division of Medical Senology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - A S Coates
- International Breast Cancer Study Group and University of Sydney, Sydney, Australia
| | - A Goldhirsch
- International Breast Cancer Study Group (IBCSG), Bern Switzerland and IEO European Institute of Oncology IRCCS, Milan, Italy
| | - G F Fleming
- Section of Hematology Oncology, The University of Chicago, Chicago, USA
| | - P A Francis
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia
| | - T P Speed
- Bioinformatics Division, Walter and Eliza Hall Institute, Melbourne, Australia
| | - M M Regan
- Division of Biostatistics, International Breast Cancer Study Group Statistical Center, Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | - S Loi
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia.
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4
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Rocchini M, Garrett PE, Zielińska M, Lenzi SM, Dao DD, Nowacki F, Bildstein V, MacLean AD, Olaizola B, Ahmed ZT, Andreoiu C, Babu A, Ball GC, Bhattacharjee SS, Bidaman H, Cheng C, Coleman R, Dillmann I, Garnsworthy AB, Gillespie S, Griffin CJ, Grinyer GF, Hackman G, Hanley M, Illana A, Jones S, Laffoley AT, Leach KG, Lubna RS, McAfee J, Natzke C, Pannu S, Paxman C, Porzio C, Radich AJ, Rajabali MM, Sarazin F, Schwarz K, Shadrick S, Sharma S, Suh J, Svensson CE, Yates D, Zidar T. First Evidence of Axial Shape Asymmetry and Configuration Coexistence in ^{74}Zn: Suggestion for a Northern Extension of the N=40 Island of Inversion. Phys Rev Lett 2023; 130:122502. [PMID: 37027859 DOI: 10.1103/physrevlett.130.122502] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 11/28/2022] [Accepted: 02/09/2023] [Indexed: 06/19/2023]
Abstract
The excited states of N=44 ^{74}Zn were investigated via γ-ray spectroscopy following ^{74}Cu β decay. By exploiting γ-γ angular correlation analysis, the 2_{2}^{+}, 3_{1}^{+}, 0_{2}^{+}, and 2_{3}^{+} states in ^{74}Zn were firmly established. The γ-ray branching and E2/M1 mixing ratios for transitions deexciting the 2_{2}^{+}, 3_{1}^{+}, and 2_{3}^{+} states were measured, allowing for the extraction of relative B(E2) values. In particular, the 2_{3}^{+}→0_{2}^{+} and 2_{3}^{+}→4_{1}^{+} transitions were observed for the first time. The results show excellent agreement with new microscopic large-scale shell-model calculations, and are discussed in terms of underlying shapes, as well as the role of neutron excitations across the N=40 gap. Enhanced axial shape asymmetry (triaxiality) is suggested to characterize ^{74}Zn in its ground state. Furthermore, an excited K=0 band with a significantly larger softness in its shape is identified. A shore of the N=40 "island of inversion" appears to manifest above Z=26, previously thought as its northern limit in the chart of the nuclides.
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Affiliation(s)
- M Rocchini
- Department of Physics, University of Guelph, N1G 2W1 Guelph, Canada
| | - P E Garrett
- Department of Physics, University of Guelph, N1G 2W1 Guelph, Canada
| | - M Zielińska
- IRFU, CEA, Université Paris-Saclay, F-91191 Gif-sur-Yvette, France
| | - S M Lenzi
- Dipartimento di Fisica, Università di Padova, I-35122 Padova, Italy
- INFN Sezione di Padova, I-35131 Padova, Italy
| | - D D Dao
- Université de Strasbourg, CNRS, IPHC UMR 7178, F-67000 Strasbourg, France
| | - F Nowacki
- Université de Strasbourg, CNRS, IPHC UMR 7178, F-67000 Strasbourg, France
| | - V Bildstein
- Department of Physics, University of Guelph, N1G 2W1 Guelph, Canada
| | - A D MacLean
- Department of Physics, University of Guelph, N1G 2W1 Guelph, Canada
| | | | - Z T Ahmed
- Department of Physics, University of Guelph, N1G 2W1 Guelph, Canada
| | - C Andreoiu
- Department of Chemistry, Simon Fraser University, V5A 1S6 Burnaby, Canada
| | - A Babu
- TRIUMF, V6T 2A3 Vancouver, Canada
| | - G C Ball
- TRIUMF, V6T 2A3 Vancouver, Canada
| | | | - H Bidaman
- Department of Physics, University of Guelph, N1G 2W1 Guelph, Canada
| | - C Cheng
- TRIUMF, V6T 2A3 Vancouver, Canada
| | - R Coleman
- Department of Physics, University of Guelph, N1G 2W1 Guelph, Canada
| | - I Dillmann
- TRIUMF, V6T 2A3 Vancouver, Canada
- Department of Physics and Astronomy, University of Victoria, V8P 5C2 Victoria, Canada
| | | | | | | | - G F Grinyer
- Department of Physics, University of Regina, S4S 0A2 Regina, Canada
| | | | - M Hanley
- Department of Physics, Colorado School of Mines, Golden, Colorado 80401, USA
| | - A Illana
- Accelerator Laboratory, Department of Physics, University of Jyväskylä, FI-40014 Jyväskylä, Finland
| | - S Jones
- Department of Physics and Astronomy, University of Tennessee, Knoxville, Tennessee 37996, USA
| | - A T Laffoley
- Department of Physics, University of Guelph, N1G 2W1 Guelph, Canada
| | - K G Leach
- Department of Physics, Colorado School of Mines, Golden, Colorado 80401, USA
| | | | - J McAfee
- TRIUMF, V6T 2A3 Vancouver, Canada
- Department of Physics, University of Surrey, GU2 7XH Guildford, United Kingdom
| | - C Natzke
- TRIUMF, V6T 2A3 Vancouver, Canada
- Department of Physics, Colorado School of Mines, Golden, Colorado 80401, USA
| | - S Pannu
- Department of Physics, University of Guelph, N1G 2W1 Guelph, Canada
| | - C Paxman
- TRIUMF, V6T 2A3 Vancouver, Canada
- Department of Physics, University of Surrey, GU2 7XH Guildford, United Kingdom
| | - C Porzio
- TRIUMF, V6T 2A3 Vancouver, Canada
- INFN Sezione di Milano, I-20133 Milano, Italy
- Dipartimento di Fisica, Università di Milano, I-20133 Milano, Italy
| | - A J Radich
- Department of Physics, University of Guelph, N1G 2W1 Guelph, Canada
| | - M M Rajabali
- Physics Department, Tennessee Technological University, Cookeville, Tennessee 38505, USA
| | - F Sarazin
- Department of Physics, Colorado School of Mines, Golden, Colorado 80401, USA
| | | | - S Shadrick
- Department of Physics, Colorado School of Mines, Golden, Colorado 80401, USA
| | - S Sharma
- Department of Physics, University of Regina, S4S 0A2 Regina, Canada
| | - J Suh
- Department of Physics, University of Regina, S4S 0A2 Regina, Canada
| | - C E Svensson
- Department of Physics, University of Guelph, N1G 2W1 Guelph, Canada
| | - D Yates
- TRIUMF, V6T 2A3 Vancouver, Canada
- Department of Physics and Astronomy, University of British Columbia, V6T 1Z4 Vancouver, Canada
| | - T Zidar
- Department of Physics, University of Guelph, N1G 2W1 Guelph, Canada
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5
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Van der Kolk WL, Van der Zee AGJ, Slomovitz BM, Baldwin PJW, Van Doorn HC, De Hullu JA, Van der Velden J, Gaarenstroom KN, Slangen BFM, Kjolhede P, Brännström M, Vergote I, Holland CM, Coleman R, Van Dorst EBL, Van Driel WJ, Nunns D, Widschwendter M, Nugent D, DiSilvestro PA, Mannel RS, Tjiong MY, Boll D, Cibula D, Covens A, Provencher D, Runnebaum IB, Monk BJ, Zanagnolo V, Tamussino K, Oonk MHM. Unilateral inguinofemoral lymphadenectomy in patients with early-stage vulvar squamous cell carcinoma and a unilateral metastatic sentinel lymph node is safe. Gynecol Oncol 2022; 167:3-10. [PMID: 36085090 DOI: 10.1016/j.ygyno.2022.07.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 07/18/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Optimal management of the contralateral groin in patients with early-stage vulvar squamous cell carcinoma (VSCC) and a metastatic unilateral inguinal sentinel lymph node (SN) is unclear. We analyzed patients who participated in GROINSS-V I or II to determine whether treatment of the contralateral groin can safely be omitted in patients with a unilateral metastatic SN. METHODS We selected the patients with a unilateral metastatic SN from the GROINSS-V I and II databases. We determined the incidence of contralateral additional non-SN metastases in patients with unilateral SN-metastasis who underwent bilateral inguinofemoral lymphadenectomy (IFL). In those who underwent only ipsilateral groin treatment or no further treatment, we determined the incidence of contralateral groin recurrences during follow-up. RESULTS Of 1912 patients with early-stage VSCC, 366 had a unilateral metastatic SN. Subsequently, 244 had an IFL or no treatment of the contralateral groin. In seven patients (7/244; 2.9% [95% CI: 1.4%-5.8%]) disease was diagnosed in the contralateral groin: five had contralateral non-SN metastasis at IFL and two developed an isolated contralateral groin recurrence after no further treatment. Five of them had a primary tumor ≥30 mm. Bilateral radiotherapy was administered in 122 patients, of whom one (1/122; 0.8% [95% CI: 0.1%-4.5%]) had a contralateral groin recurrence. CONCLUSION The risk of contralateral lymph node metastases in patients with early-stage VSCC and a unilateral metastatic SN is low. It appears safe to limit groin treatment to unilateral IFL or inguinofemoral radiotherapy in these cases.
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Affiliation(s)
- W L Van der Kolk
- University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - A G J Van der Zee
- University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - B M Slomovitz
- Mount Sinai Medical Center, Miami Beach, FL, United States of America
| | - P J W Baldwin
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - H C Van Doorn
- Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - J A De Hullu
- Radboud University Medical Center, Nijmegen, the Netherlands
| | | | | | - B F M Slangen
- Maastricht University Medical Center+, Maastricht, the Netherlands
| | | | - M Brännström
- Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
| | - I Vergote
- Leuven Cancer Institute, Leuven, Belgium
| | - C M Holland
- Manchester University NHS Foundation Trust-St Marys Hospital, Manchester, United Kingdom
| | - R Coleman
- The University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
| | | | - W J Van Driel
- Center of Gynecological Oncology Amsterdam, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - D Nunns
- Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - M Widschwendter
- European Translational Oncology Prevention and Screening (EUTOPS) Institute, University Innsbruck, Austria
| | - D Nugent
- Leeds Teaching Hospitals NHS Trust, St James' University Hospital, Leeds, United Kingdom
| | - P A DiSilvestro
- Women and Infants Hospital of Rhode Island, Providence, RI, United States of America
| | - R S Mannel
- Stephenson Cancer Center, University of Oklahoma, Oklahoma City, OK, United States of America
| | - M Y Tjiong
- Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - D Boll
- Catharina Ziekenhuis Eindhoven, the Netherlands
| | - D Cibula
- First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - A Covens
- University of Toronto, Toronto, Ontario, Canada
| | - D Provencher
- CHUM, Université de Montréal, Montréal, Quebec, Canada
| | - I B Runnebaum
- Jena University Hospital, Friedrich Schiller University, Jena, Germany
| | - B J Monk
- St Josephs Hospital and Medical Center, Phoenix, AZ, United States of America
| | - V Zanagnolo
- Department of Obstetrics and Gynaecology, European Cancer Institute, Milan, Italy
| | | | - M H M Oonk
- University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
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6
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Winter M, Coleman R, Kendall J, Palmieri C, Twelves C, Howell S, MacPherson I, Wilson C, Purohit K, Gath J, Taylor C, Eastell R, Murden G, Brown SR, Rathbone E, Brown J. A phase IB and randomised phase IIA trial of CApecitabine plus Radium-223 (Xofigo™) in breast cancer patients with BONe metastases: CARBON trial results. J Bone Oncol 2022; 35:100442. [PMID: 35800293 PMCID: PMC9253642 DOI: 10.1016/j.jbo.2022.100442] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 06/08/2022] [Accepted: 06/21/2022] [Indexed: 11/16/2022] Open
Abstract
Background Approximately 70% of patients with metastatic breast cancer (MBC) develop bone metastases. Despite advances in systemic treatment options and the use of bone targeted agents in the management of bone metastases to reduce skeletal morbidity, there remains an unmet need for further treatment options. Radium-223 (Ra223) is an alpha-emitting radiopharmaceutical that is preferentially taken up into bone at sites of increased osteoblastic activity where it emits high-energy, short-range alpha-particles that could provide a targeted anti-tumour effect on bone metastases. Here we evaluate the safety, feasibility and efficacy findings of the combination of Ra223 with capecitabine chemotherapy in patients with MBC with bone involvement. Methods CARBON is a multi-centre, open-label phase IB/IIA study evaluating the combination of Ra223 (55 kBq/kg day 1 given on 6 weekly schedule) and capecitabine (1000 mg/m2 bd days 4-17 every 21 days) in patients with bone metastases from MBC (± other disease sites). Other eligibility criteria included ECOG performance status 0-2, ≤2 lines of chemotherapy for MBC and current bisphosphonate or denosumab use for ≥ 6 weeks. The phase IB part of the trial (6 patients) was conducted to provide preliminary feasibility and safety of capecitabine + Ra223. Thereafter, 28 patients were randomised (2:1) to capecitabine + Ra223 or capecitabine alone to further characterise the safety profile and evaluate efficacy, the primary efficacy endpoint being the bone turnover marker (urinary n-telopeptide of type I collagen) change from baseline to end of cycle 5 and secondary endpoints of time to first symptomatic skeletal event, and disease progression at extra-skeletal and bone disease. Results In addition to bone metastases, 10/23 [44%] and 13/23 [57%] capecitabine + Ra223 and 2/11 [18%] and 9/11 [82%] capecitabine alone patients had soft tissue and visceral disease sites respectively. More capecitabine + Ra223 patients had received prior chemotherapy for MBC: 11/23 [48%] vs 2/11 [18%]. The analysis populations comprise 34 patients (23 capecitabine + Ra223, 11 capecitabine); 2 patients randomised to capecitabine + Ra223 received capecitabine alone and are included in the capecitabine arm. Median number of cycles received was 8.5 in capecitabine + Ra223 (range 3-12) and 12 in the capecitabine arm (range 1-12). 94/95 prescribed Ra223 cycles were administered. No dose limiting toxicities were seen in phase IB and no patients developed grade ≥ III diarrhoea. Gastrointestinal, haematological and palmer-planter erthyrodysesthesia adverse events were similar in both arms. Although formal statistical comparisons were not made, changes in bone turnover markers, the times to extra-skeletal progression and bone disease progression, and the frequency of symptomatic skeletal events were similar across the two treatment arms. Conclusion Capecitabine + Ra223 at the planned dose was safe and feasible in MBC patients with bone metastases. However, no efficacy signals were seen that might suggest greater efficacy of the combination over capecitabine alone clinically or biochemically.
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Affiliation(s)
- Matthew Winter
- Weston Park Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- Department of Oncology and Metabolism, The University of Sheffield, Sheffield, UK
| | - Rob Coleman
- Department of Oncology and Metabolism, The University of Sheffield, Sheffield, UK
| | - Jessica Kendall
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Carlo Palmieri
- Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, UK. University of Liverpool, Liverpool, UK
| | - Chris Twelves
- University of Leeds, St James’s University Hospital and NIHR Clinical Research Facility, Leeds, UK
| | - Sacha Howell
- The Christie NHS Foundation Trust, Manchester, UK
| | - Iain MacPherson
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Caroline Wilson
- Weston Park Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Kash Purohit
- Weston Park Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Jacqui Gath
- Consumer Research Forum, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Christine Taylor
- Consumer Research Forum, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Richard Eastell
- Department of Oncology and Metabolism, The University of Sheffield, Sheffield, UK
| | - Geraldine Murden
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Sarah R. Brown
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Emma Rathbone
- Calderdale and Huddersfield NHS Foundation Trust, Huddersfield, UK
| | - Janet Brown
- Department of Oncology and Metabolism, The University of Sheffield, Sheffield, UK
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7
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Vogt KS, Grange A, Johnson J, Marran J, Budworth L, Coleman R, Simms-Ellis R. Study protocol for the online adaptation and evaluation of the 'Reboot' (Recovery-boosting) coaching programme, to prepare critical care nurses for, and aid recovery after, stressful clinical events. Pilot Feasibility Stud 2022; 8:63. [PMID: 35300720 PMCID: PMC8927745 DOI: 10.1186/s40814-022-01014-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 02/25/2022] [Indexed: 11/24/2022] Open
Abstract
Background Critical care nurses (CCNs) are routinely exposed to highly stressful events, exacerbated during the COVID-19 pandemic. Supporting resilience and wellbeing of CCNs is therefore crucial to prevent burnout. One approach for delivering this support is by preparing critical care nurses for situations they may encounter, drawing on evidence-based techniques to strengthen relevant psychological coping strategies. As such, the current study seeks to tailor a Resilience-boosting psychological coaching programme [Reboot] for CCNs, based on cognitive behavioural therapy (CBT) principles and the Bi-Dimensional Resilience Framework (BDF), and (1) to assess the feasibility of delivering Reboot via online, remote delivery to CCNs, and (2) to provide a preliminary assessment of whether Reboot could increase resilience and confidence in coping with adverse events. Methods Eighty CCNs (n=80) will be recruited to the 8-week Reboot programme, comprised of two group workshops and two individual coaching calls. The study uses a single-arm before-after feasibility study design and will be evaluated with a mixed-methods approach, using online questionnaires (all participants) and telephone interviews (25% of participants). Primary outcomes will be confidence in coping with adverse events (the Confidence scale) and resilience (the Brief Resilience Scale) measured at four time points. Discussion Results will determine whether it is feasible to deliver and evaluate a remote version of the Reboot coaching programme to CCNs, and will indicate whether participating in the programme is associated with increases in confidence in coping with adverse events, resilience and wellbeing (as indicated by levels of depression).
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Affiliation(s)
- K S Vogt
- Bradford Institute for Health Research, Bradford Royal Infirmary, Temple Bank House, Duckworth Lane, Bradford, BD9 6RJ, UK. .,Department of Psychology, University of Leeds, Leeds, LS2 9JT, UK.
| | - A Grange
- Bradford Institute for Health Research, Bradford Royal Infirmary, Temple Bank House, Duckworth Lane, Bradford, BD9 6RJ, UK
| | - J Johnson
- Bradford Institute for Health Research, Bradford Royal Infirmary, Temple Bank House, Duckworth Lane, Bradford, BD9 6RJ, UK.,Department of Psychology, University of Leeds, Leeds, LS2 9JT, UK.,School of Public Health and Community Medicine, University of New South Wales, Sydney, 2052, Australia
| | - J Marran
- Bradford Institute for Health Research, Bradford Royal Infirmary, Temple Bank House, Duckworth Lane, Bradford, BD9 6RJ, UK
| | - L Budworth
- Bradford Institute for Health Research, Bradford Royal Infirmary, Temple Bank House, Duckworth Lane, Bradford, BD9 6RJ, UK
| | - R Coleman
- Bradford Institute for Health Research, Bradford Royal Infirmary, Temple Bank House, Duckworth Lane, Bradford, BD9 6RJ, UK
| | - R Simms-Ellis
- Bradford Institute for Health Research, Bradford Royal Infirmary, Temple Bank House, Duckworth Lane, Bradford, BD9 6RJ, UK.,Department of Psychology, University of Leeds, Leeds, LS2 9JT, UK
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8
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Zubiena L, Lewin O, Ogunfiditimi G, Coleman R, Phezulu J, Blackburn T, Joseph L. Development and testing of the Health Information Website Evaluation Tool (HIWET) – An inter-rater reliability analysis study. Physiotherapy 2022. [DOI: 10.1016/j.physio.2021.12.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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9
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Robert N, Chen L, Espirito J, Karhade M, Nwokeji E, Evangelist M, Spira A, Neubauer M, Bullock S, Coleman R. P60.11 Trends in Molecular Testing for Metastatic Non-Small Cell Lung Cancer in The US Oncology Network Community Practices. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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10
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Evangelist M, Jotte R, Spira A, Waterhouse D, Ali K, Alwardt S, Bullock S, Butrynski J, Espirito J, Fitzgerald C, Hakimian D, Larson T, Meshad M, Neubauer M, Paschold J, Robert N, Walberg J, Coleman R. P60.13 MYLUNG Consortium: Molecularly Informed Lung Cancer Treatment in a Community Cancer Network. Pragmatic Prospective RWR Study. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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11
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Winter M, Kendall J, Brown S, Rathbone E, Wilson C, Howell S, Twelves C, Palmieri C, Anand A, MacPherson I, Coleman R, Brown J. Abstract PS14-02: A randomised phase IB/IIA study of CApecitabine plus Radium-223 in breast cancer patients with BONe metastases (CARBON) - Safety and preliminary efficacy findings. Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-ps14-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Bone metastases (BMs) occur in approximately 70% of patients (pts) with metastatic breast cancer (MBC). Despite significant advances in the management of BMs with bone-targeted agents and the associated reduction in skeletal-related events, there remains an unmet need for further treatment options to improve median overall survival beyond 2-3 years. Radium-223 [R] dichloride is an alpha-emitting radiopharmaceutical that is avidly taken up, like calcium, into the bone where it emits high-energy, short-range alpha-particles resulting in a targeted anti-tumour effect on BMs. Combining R with current systemic therapy could potentially enhance efficacy in MBC with BMs. Methods: CARBON is a UK, open-label, multi-centre phase IB/IIA study evaluating the combination of capecitabine [C] (1000mg/m2 bd days 4-17, 12x21 day cycles) with R 55kBq/kg day 1 given on a 6-weekly schedule in pts with BMs from MBC (+/- other sites of disease) with ≥2 bone lesions on radionuclide bone scan and/or ≥1 lesion confirmed on plain radiographs, CT or MRI. Other eligibility criteria included ECOG PS 0-2, ≤ 2 lines of chemotherapy for MBC and current use of a bisphosphonate / denosumab for ≥6 weeks. To establish the feasibility and safety of C+R the phase IB opened in August 2016 registering 6 pts; the primary endpoint was dose-limiting toxicities (DLTs), defined as ≥grade 3 gastrointestinal toxicity lasting >48 hours or ≥grade 4 haematological toxicity lasting >7 days. Subsequently, between April 2017 and March 2019 28 pts were randomised (2:1) to C+R vs C in phase IIa to further characterise the safety profile, with frequency of CTC grade 3-4 toxicities and diarrhoea as primary endpoints. Preliminary evaluation of efficacy through assessment of bone turnover marker changes from baseline to end of cycle 5 and time to progression in bone and overall was made. Results: Baseline clinico-pathologic characteristics and prior treatments were well balanced between the arms; 13 C+R and 9 C pts had visceral metastases. There were 0 DLTs in the 6 phase IB pts, therefore the same C+R dose and schedule was studied in phase IIA. 2 pts randomised to C+R received C alone and are included in the C arm. The safety population consists of 34 pts (23 C+R, 11 C). Median number of cycles received was 8.5 (range 3-12) in C+R arm and 12 (range 1-12) in C arm. 38/307 (12%) treatment cycles were delayed (25 [13%] C+R arm, 13 [12%] C arm). 11 (48%) C+R and 6 (55%) C pts had a permanent C dose reduction. 94/95 (99%) prescribed R cycles were administered. 9 (39%) C+R and 9 (82%) C pts completed all 12 cycles. Other reasons for discontinuation were: progressive disease in 12 (52%) C+R and 0 in C pts; toxicity in 1 (4%) C+R and 1 (9%) C pt; clinician decision in 1 (9%) C pt; progressive disease and toxicity in 1 (4%) C+R pt. Only 25/575 (4%) reported AEs were grade 3-4 (n=21 in 11 [48%] C+R pts, n=4 in 4 [36%] C pts) with 0 episodes of grade 3-4 diarrhoea. Table 1 shows maximum grades of diarrhoea and haematological AEs experienced by arm. 18 SAEs occurred (n=11 in 8 C+R pts, n=7 in 2 C pts). 8 (44%) SAEs were grade 3 (C+R: 6, C: 2); none were related to diarrhoea. There were 0 SUSARs. Conclusion: In the first completed trial evaluating R with chemotherapy in MBC pts, the combination of C+R is safe and well-tolerated. Preliminary efficacy analyses including bone markers are ongoing and will be presented at the meeting. The creation of the data was supported in part by Bayer Plc and Yorkshire Cancer Research.
Table 1: Maximum CTCAE grade (G) experienced - diarrhoea and haematological AEs.C+R (n=23)C (n=11)Not experiencedG1G2G3G4Not experiencedG1G2G3G4Diarrhoea7 (30%)14 (61%)2 (9%)006 (55%)4 (36%)1 (9%)00Neutropenia18 (78%)02 (9%)3 (13%)010 (91%)01 (9%)00Thrombocytopenia21 (91%)1 (4%)1 (4%)009 (82%)1 (9%)1 (9%)00Anaemia21 (91%)2 (9%)0008 (73%)1 (9%)2 (18%)00
Citation Format: Matthew Winter, Jessica Kendall, Sarah Brown, Emma Rathbone, Caroline Wilson, Sacha Howell, Chris Twelves, Carlo Palmieri, Anjana Anand, Iain MacPherson, Rob Coleman, Janet Brown. A randomised phase IB/IIA study of CApecitabine plus Radium-223 in breast cancer patients with BONe metastases (CARBON) - Safety and preliminary efficacy findings [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS14-02.
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Affiliation(s)
- Matthew Winter
- 1Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | | | - Sarah Brown
- 2CTRU, University of Leeds, Leeds, United Kingdom
| | - Emma Rathbone
- 3Calderdale and Huddersfield NHS Foundation Trust, Huddersfield, United Kingdom
| | - Caroline Wilson
- 1Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Sacha Howell
- 4The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Chris Twelves
- 5St James’s University Hospital, Leeds, United Kingdom
| | - Carlo Palmieri
- 6Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Anjana Anand
- 7Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Iain MacPherson
- 8Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Rob Coleman
- 9The University of Sheffield, Sheffield, United Kingdom
| | - Janet Brown
- 9The University of Sheffield, Sheffield, United Kingdom
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12
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Clézardin P, Coleman R, Puppo M, Ottewell P, Bonnelye E, Paycha F, Confavreux CB, Holen I. Bone metastasis: mechanisms, therapies, and biomarkers. Physiol Rev 2020; 101:797-855. [PMID: 33356915 DOI: 10.1152/physrev.00012.2019] [Citation(s) in RCA: 130] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Skeletal metastases are frequent complications of many cancers, causing bone complications (fractures, bone pain, disability) that negatively affect the patient's quality of life. Here, we first discuss the burden of skeletal complications in cancer bone metastasis. We then describe the pathophysiology of bone metastasis. Bone metastasis is a multistage process: long before the development of clinically detectable metastases, circulating tumor cells settle and enter a dormant state in normal vascular and endosteal niches present in the bone marrow, which provide immediate attachment and shelter, and only become active years later as they proliferate and alter the functions of bone-resorbing (osteoclasts) and bone-forming (osteoblasts) cells, promoting skeletal destruction. The molecular mechanisms involved in mediating each of these steps are described, and we also explain how tumor cells interact with a myriad of interconnected cell populations in the bone marrow, including a rich vascular network, immune cells, adipocytes, and nerves. We discuss metabolic programs that tumor cells could engage with to specifically grow in bone. We also describe the progress and future directions of existing bone-targeted agents and report emerging therapies that have arisen from recent advances in our understanding of the pathophysiology of bone metastases. Finally, we discuss the value of bone turnover biomarkers in detection and monitoring of progression and therapeutic effects in patients with bone metastasis.
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Affiliation(s)
- Philippe Clézardin
- INSERM, Research Unit UMR_S1033, LyOS, Faculty of Medicine Lyon-Est, University of Lyon 1, Lyon, France.,Department of Oncology and Metabolism, University of Sheffield, Sheffield, United Kingdom
| | - Rob Coleman
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, United Kingdom
| | - Margherita Puppo
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, United Kingdom
| | - Penelope Ottewell
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, United Kingdom
| | - Edith Bonnelye
- INSERM, Research Unit UMR_S1033, LyOS, Faculty of Medicine Lyon-Est, University of Lyon 1, Lyon, France
| | - Frédéric Paycha
- Service de Médecine Nucléaire, Hôpital Lariboisière, Paris, France
| | - Cyrille B Confavreux
- INSERM, Research Unit UMR_S1033, LyOS, Faculty of Medicine Lyon-Est, University of Lyon 1, Lyon, France.,Service de Rhumatologie Sud, CEMOS-Centre Expert des Métastases Osseuses, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Ingunn Holen
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, United Kingdom
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13
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Coleman R, Hadji P, Body JJ, Santini D, Chow E, Terpos E, Oudard S, Bruland Ø, Flamen P, Kurth A, Van Poznak C, Aapro M, Jordan K. Bone health in cancer: ESMO Clinical Practice Guidelines. Ann Oncol 2020; 31:1650-1663. [PMID: 32801018 DOI: 10.1016/j.annonc.2020.07.019] [Citation(s) in RCA: 200] [Impact Index Per Article: 50.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 07/26/2020] [Indexed: 12/16/2022] Open
Affiliation(s)
- R Coleman
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - P Hadji
- Frankfurt Centre of Bone Health, Frankfurt, Germany; Philipps University of Marburg, Marburg, Germany
| | - J-J Body
- CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - D Santini
- Medical Oncology Department, University Campus Bio-Medico, Rome, Italy
| | - E Chow
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - E Terpos
- National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - S Oudard
- Department of Medical Oncology, Georges Pompidou Hospital, Paris Descartes University, Paris, France
| | - Ø Bruland
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Oncology, Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - P Flamen
- Department of Nuclear Medicine, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - A Kurth
- Department of Orthopaedic and Trauma Surgery, Campus Kemperhof, Community Clinics Middle Rhine, Koblenz, Germany; Major Teaching Hospital of the University Medicine Mainz, Mainz, Germany
| | | | - M Aapro
- Genolier Cancer Centre, Genolier, Switzerland
| | - K Jordan
- Department of Medicine V, Hematology, Oncology and Rheumatology, University of Heidelberg, Heidelberg, Germany
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14
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Savage P, Winter M, Parker V, Harding V, Sita-Lumsden A, Fisher RA, Harvey R, Unsworth N, Sarwar N, Short D, Aguiar X, Tidy J, Hancock B, Coleman R, Seckl MJ. Demographics, natural history and treatment outcomes of non-molar gestational choriocarcinoma: a UK population study. BJOG 2020; 127:1102-1107. [PMID: 32146729 DOI: 10.1111/1471-0528.16202] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To investigate the demographics, natural history and treatment outcomes of non-molar gestational choriocarcinoma. DESIGN A retrospective national population-based study. SETTING UK 1995-2015. POPULATION A total of 234 women with a diagnosis of gestational choriocarcinoma, in the absence of a prior molar pregnancy, managed at the UKs two gestational trophoblast centres in London and Sheffield. METHODS Retrospective review of the patient's demographic and clinical data. Comparison with contemporary UK birth and pregnancy statistics. MAIN OUTCOMES Incidence statistics for non-molar choriocarcinoma across the maternal age groups. Cure rates for patients by FIGO prognostic score group. RESULTS Over the 21-year study period, there were 234 cases of non-molar gestational choriocarcinoma, giving an incidence of 1:66 775 relative to live births and 1:84 226 to viable pregnancies. For women aged under 20, the incidence relative to viable pregnancies was 1:223 494, for ages 30-34, 1:80 227, and for ages 40-45, 1:41 718. Treatment outcomes indicated an overall 94.4% cure rate. Divided by FIGO prognostic groups, the cure rates were low-risk group 100%, high-risk group 96% and ultra-high-risk group 80.5%. CONCLUSIONS Non-molar gestational choriocarcinoma is a very rare diagnosis with little prior detailed information on the demographics and natural history. The data in this study give age-related incidence data based on a large national population study. The results also demonstrated the widely varying natural history of this rare malignancy and the marked correlation of disease incidence with rising maternal age. TWEETABLE ABSTRACT National gestational choriocarcinoma database indicates a close association between increasing maternal age and incidence.
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Affiliation(s)
- P Savage
- Department of Medical Oncology, Trophoblastic Tumour Screening and Treatment Centre, Charing Cross Hospital, Imperial Hospitals NHS Trust, London, UK
| | - M Winter
- Sheffield Trophoblastic Disease Centre, Weston Park Cancer Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - V Parker
- Sheffield Trophoblastic Disease Centre, Weston Park Cancer Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - V Harding
- Department of Medical Oncology, Trophoblastic Tumour Screening and Treatment Centre, Charing Cross Hospital, Imperial Hospitals NHS Trust, London, UK
| | - A Sita-Lumsden
- Department of Medical Oncology, Trophoblastic Tumour Screening and Treatment Centre, Charing Cross Hospital, Imperial Hospitals NHS Trust, London, UK
| | - R A Fisher
- Department of Medical Oncology, Trophoblastic Tumour Screening and Treatment Centre, Charing Cross Hospital, Imperial Hospitals NHS Trust, London, UK
| | - R Harvey
- Department of Medical Oncology, Trophoblastic Tumour Screening and Treatment Centre, Charing Cross Hospital, Imperial Hospitals NHS Trust, London, UK
| | - N Unsworth
- Department of Medical Oncology, Trophoblastic Tumour Screening and Treatment Centre, Charing Cross Hospital, Imperial Hospitals NHS Trust, London, UK
| | - N Sarwar
- Department of Medical Oncology, Trophoblastic Tumour Screening and Treatment Centre, Charing Cross Hospital, Imperial Hospitals NHS Trust, London, UK
| | - D Short
- Department of Medical Oncology, Trophoblastic Tumour Screening and Treatment Centre, Charing Cross Hospital, Imperial Hospitals NHS Trust, London, UK
| | - X Aguiar
- Department of Medical Oncology, Trophoblastic Tumour Screening and Treatment Centre, Charing Cross Hospital, Imperial Hospitals NHS Trust, London, UK
| | - J Tidy
- Sheffield Trophoblastic Disease Centre, Weston Park Cancer Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - B Hancock
- Sheffield Trophoblastic Disease Centre, Weston Park Cancer Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - R Coleman
- Sheffield Trophoblastic Disease Centre, Weston Park Cancer Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - M J Seckl
- Department of Medical Oncology, Trophoblastic Tumour Screening and Treatment Centre, Charing Cross Hospital, Imperial Hospitals NHS Trust, London, UK
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15
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Coleman R, Brown J, Rathbone E, Flanagan L, Reid A, Kendall J, Howell S, Twelves C, Palmieri C, Anand A, MacPherson I, Brown S. CApecitabine plus Radium-223 (Xofigo™) in breast cancer patients with BONe metastases (CARBON): study protocol for a phase IB/IIA randomised controlled trial. Trials 2020; 21:89. [PMID: 31941523 PMCID: PMC6961242 DOI: 10.1186/s13063-019-3643-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 08/09/2019] [Indexed: 11/10/2022] Open
Abstract
Background A substantial proportion of breast cancer patients develop metastatic disease, with over 450,000 deaths globally per year. Bone is the most common first site of metastatic disease accounting for 40% of all first recurrence and 70% of patients with advanced disease develop skeletal involvement. Treatment of bone metastases currently focusses on symptom relief and prevention and treatment of skeletal complications. However, there remains a need for further treatment options for patients with bone metastases. Combining systemic therapy with a bone-targeted agent, such as radium-223, may provide an effective treatment with minimal additional side effects. Methods/design CARBON is a UK-based, open-label, multi-centre study which comprises an initial safety phase to establish the feasibility and safety of combining radium-223 given on a 6-weekly schedule in combination with orally administered capecitabine followed by a randomised extension phase to further characterise the safety profile and provide preliminary estimation of efficacy. Discussion The CARBON study is important as the results will be the first to assess radium-223 with chemotherapy in advanced breast cancer. If the results find acceptable rates of toxicity with a decrease in bone turnover markers, further work will be necessary in a phase II/III setting to assess the efficacy and clinical benefit. Trial registration ISRCTN, ISRCTN92755158, Registered on 17 February 2016. Electronic supplementary material The online version of this article (10.1186/s13063-019-3643-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | - Emma Rathbone
- Calderdale and Huddersfield NHS Foundation Trust, Huddersfield, UK
| | - Louise Flanagan
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Amber Reid
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Jessica Kendall
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK.
| | - Sacha Howell
- The Christie NHS Foundation Trust, Manchester, UK
| | - Chris Twelves
- St James's University Hospital, Leeds, UK.,Leeds Institute of Cancer Studies and Pathology, University of Leeds, Leeds, UK
| | - Carlo Palmieri
- Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, UK.,University of Liverpool, Liverpool, UK
| | - Anjana Anand
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Iain MacPherson
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Sarah Brown
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
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Yardley DA, Coleman R, Conte P, Cortes J, Brufsky A, Shtivelband M, Young R, Bengala C, Ali H, Eakel J, Schneeweiss A, de la Cruz-Merino L, Wilks S, O'Shaughnessy J, Glück S, Li H, Miller J, Barton D, Harbeck N. nab-Paclitaxel plus carboplatin or gemcitabine versus gemcitabine plus carboplatin as first-line treatment of patients with triple-negative metastatic breast cancer: results from the tnAcity trial. Ann Oncol 2019; 29:1763-1770. [PMID: 29878040 PMCID: PMC6096741 DOI: 10.1093/annonc/mdy201] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background Metastatic triple-negative breast cancer (mTNBC) has a poor prognosis and aggressive clinical course. tnAcity evaluated the efficacy and safety of first-line nab-paclitaxel plus carboplatin (nab-P/C), nab-paclitaxel plus gemcitabine (nab-P/G), and gemcitabine plus carboplatin (G/C) in patients with mTNBC. Patients and methods Patients with pathologically confirmed mTNBC and no prior chemotherapy for metastatic BC received (1 : 1 : 1) nab-P 125 mg/m2 plus C AUC 2, nab-P 125 mg/m2 plus G 1000 mg/m2, or G 1000 mg/m2 plus C AUC 2, all on days 1, 8 q3w. Phase II primary end point: investigator-assessed progression-free survival (PFS); secondary end points included overall response rate (ORR), overall survival (OS), percentage of patients initiating cycle 6 with doublet therapy, and safety. Results In total, 191 patients were enrolled (nab-P/C, n = 64; nab-P/G, n = 61; G/C, n = 66). PFS was significantly longer with nab-P/C versus nab-P/G [median, 8.3 versus 5.5 months; hazard ratio (HR), 0.59 [95% CI, 0.38-0.92]; P = 0.02] or G/C (median, 8.3 versus 6.0 months; HR, 0.58 [95% CI, 0.37-0.90]; P = 0.02). OS was numerically longer with nab-P/C versus nab-P/G (median, 16.8 versus 12.1 months; HR, 0.73 [95% CI, 0.47-1.13]; P = 0.16) or G/C (median, 16.8 versus 12.6 months; HR, 0.80 [95% CI, 0.52-1.22]; P = 0.29). ORR was 73%, 39%, and 44%, respectively. In the nab-P/C, nab-P/G, and G/C groups, 64%, 56%, and 50% of patients initiated cycle 6 with a doublet. Grade ≥3 adverse events were mainly hematologic. Conclusions First-line nab-P/C was active in mTNBC and resulted in a significantly longer PFS and improved risk/benefit profile versus nab-P/G or G/C.
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Affiliation(s)
- D A Yardley
- Sarah Cannon Research Institute and Tennessee Oncology PLLC, Medical Oncology, Nashville, USA.
| | - R Coleman
- Department of Oncology and Metabolism, Weston Park Hospital, University of Sheffield, Sheffield, UK
| | - P Conte
- Department of Surgery, Oncology and Gastroenterology, University of Padova and Medical Oncology 2, Istituto Oncologico Veneto, Padova, Italy
| | - J Cortes
- Medical Oncology, Ramon y Cajal University Hospital, Madrid; Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - A Brufsky
- Hematology/Oncology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, USA
| | - M Shtivelband
- Medical Oncology, Ironwood Physicians, PC, Chandler, USA
| | - R Young
- Medical Oncology, The Center for Cancer and Blood Disorders, Fort Worth, USA
| | - C Bengala
- Medical Oncology, Misericordia General Hospital, Grosseto, Italy
| | - H Ali
- Medical Oncology, Henry Ford Health System, Detroit, USA
| | - J Eakel
- Hematology and Oncology, Florida Cancer Specialists, Sarasota, USA
| | - A Schneeweiss
- Gynecology and Medical Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | | | - S Wilks
- Hematology and Medical Oncology, Texas Oncology, San Antonio, USA
| | - J O'Shaughnessy
- Hematology, Medical Oncology, Baylor Sammons Cancer Center, Texas Oncology, US Oncology, Dallas, USA
| | - S Glück
- GMA Early Assets, Celgene Corporation, Summit, USA
| | - H Li
- Department of Biostatistics, Celgene Corporation, Summit, USA
| | - J Miller
- Clinical Research and Development, Hematology/Oncology, Celgene Corporation, Summit, USA
| | - D Barton
- Clinical Research and Development, Hematology/Oncology, Celgene Corporation, Summit, USA
| | - N Harbeck
- Breast Cancer Center, University of Munich, Munich, Germany
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Brenton J, Banwell B, Bergqvist C, Lehner-Gulotta D, Leytham E, Gampper L, Goldman M, Coleman R. Application of a Modified Ketogenic Diet in Relapsing-Remitting Multiple Sclerosis Subjects. J Acad Nutr Diet 2019. [DOI: 10.1016/j.jand.2019.06.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Affiliation(s)
- R. Coleman
- Department of MathematicsImperial CollegeLondonEngland
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19
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Price E, Coleman R, Ahsmann J, Glendewar G, Hunt J, Smith T, Wormell D. Individual, social, and environmental factors affecting salivary and fecal cortisol levels in captive pied tamarins (Saguinus bicolor). Am J Primatol 2019; 81:e23033. [PMID: 31368125 DOI: 10.1002/ajp.23033] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 06/21/2019] [Accepted: 06/25/2019] [Indexed: 01/17/2023]
Abstract
Pied tamarins (Saguinus bicolor) are endangered New World primates, and in captivity appear to be very susceptible to stress. We measured cortisol in 214 saliva samples from 36 tamarins and in 227 fecal samples from 27 tamarins, and investigated the effects of age, sex, pregnancy, rearing history, social status, weight, group composition, and enclosure type using generalized linear mixed models. There was no effect of age on either fecal or salivary cortisol levels. Female pied tamarins in late pregnancy had higher fecal cortisol levels than those in early pregnancy, or nonpregnant females, but there was no effect of pregnancy on salivary cortisol. Females had higher salivary cortisol levels than males, but there was no effect of rearing history. However, for fecal cortisol, there was an interaction between sex and rearing history. Hand-reared tamarins overall had higher fecal cortisol levels, but while male parent-reared tamarins had higher levels than females who were parent-reared, the reverse was true for hand-reared individuals. There was a trend towards lower fecal cortisol levels in subordinate individuals, but no effect of status on salivary cortisol. Fecal but not salivary cortisol levels declined with increasing weight. We found little effect of group composition on cortisol levels in either saliva or feces, suggesting that as long as tamarins are housed socially, the nature of the group is of less importance. However, animals in off-show enclosures had higher salivary and fecal cortisol levels than individuals housed on-show. We suggest that large on-show enclosures with permanent access to off-exhibit areas may compensate for the effects of visitor disturbance, and a larger number of tamarins of the same species housed close together may explain the higher cortisol levels found in tamarins living in off-show accommodation, but further research is needed.
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Affiliation(s)
- Eluned Price
- Durrell Wildlife Conservation Trust, Jersey, Channel Islands
| | - Rob Coleman
- Department of Biological Sciences, University of Chester, Chester, UK
| | - Judith Ahsmann
- Durrell Wildlife Conservation Trust, Jersey, Channel Islands.,University of Applied Sciences Van Hall Larenstein, Leeuwarden, The Netherlands
| | - Gale Glendewar
- Durrell Wildlife Conservation Trust, Jersey, Channel Islands
| | - Jenna Hunt
- Durrell Wildlife Conservation Trust, Jersey, Channel Islands
| | - Tessa Smith
- Department of Biological Sciences, University of Chester, Chester, UK
| | - Dominic Wormell
- Durrell Wildlife Conservation Trust, Jersey, Channel Islands
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Strain EMA, Alexander KA, Kienker S, Morris R, Jarvis R, Coleman R, Bollard B, Firth LB, Knights AM, Grabowski JH, Airoldi L, Chan BKK, Chee SY, Cheng Z, Coutinho R, de Menezes RG, Ding M, Dong Y, Fraser CML, Gómez AG, Juanes JA, Mancuso P, Messano LVR, Naval-Xavier LPD, Scyphers S, Steinberg P, Swearer S, Valdor PF, Wong JXY, Yee J, Bishop MJ. Urban blue: A global analysis of the factors shaping people's perceptions of the marine environment and ecological engineering in harbours. Sci Total Environ 2019; 658:1293-1305. [PMID: 30677991 DOI: 10.1016/j.scitotenv.2018.12.285] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 12/17/2018] [Accepted: 12/18/2018] [Indexed: 06/09/2023]
Abstract
Marine harbours are the focus of a diverse range of activities and subject to multiple anthropogenically induced pressures. Support for environmental management options aimed at improving degraded harbours depends on understanding the factors which influence people's perceptions of harbour environments. We used an online survey, across 12 harbours, to assess sources of variation people's perceptions of harbour health and ecological engineering. We tested the hypotheses: 1) people living near impacted harbours would consider their environment to be more unhealthy and degraded, be more concerned about the environment and supportive of and willing to pay for ecological engineering relative to those living by less impacted harbours, and 2) people with greater connectedness to the harbour would be more concerned about and have greater perceived knowledge of the environment, and be more supportive of, knowledgeable about and willing to pay for ecological engineering, than those with less connectedness. Across twelve locations, the levels of degradation and modification by artificial structures were lower and the concern and knowledge about the environment and ecological engineering were greater in the six Australasian and American than the six European and Asian harbours surveyed. We found that people's perception of harbours as healthy or degraded, but not their concern for the environment, reflected the degree to which harbours were impacted. There was a positive relationship between the percentage of shoreline modified and the extent of support for and people's willingness to pay indirect costs for ecological engineering. At the individual level, measures of connectedness to the harbour environment were good predictors of concern for and perceived knowledge about the environment but not support for and perceived knowledge about ecological engineering. To make informed decisions, it is important that people are empowered with sufficient knowledge of the environmental issues facing their harbour and ecological engineering options.
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Affiliation(s)
- E M A Strain
- Sydney Institute of Marine Science, 19 Chowder Bay Rd, Mosman, New South Wales 2088, Australia; Centre for Marine Bio-Innovation, School of Biological, Earth and Environmental Sciences, University of New South Wales, Sydney, New South Wales 2052, Australia,; National Centre for Coasts and Climate, School of Biosciences, The University of Melbourne, Parkville, Victoria 3010, Australia.
| | - K A Alexander
- Institute for Marine and Antarctic Studies, University of Tasmania, PO Box 49, Hobart, Tasmania 7001, Australia; Centre for Marine Socioecology, University of Tasmania, Hobart, Tasmania 7001, Australia
| | - S Kienker
- Sydney Institute of Marine Science, 19 Chowder Bay Rd, Mosman, New South Wales 2088, Australia; University of Sydney, Centre for Research on Ecological Impacts of Coastal Cities, School of Life and Environmental Sciences, NSW 2006, Australia
| | - R Morris
- National Centre for Coasts and Climate, School of Biosciences, The University of Melbourne, Parkville, Victoria 3010, Australia; University of Sydney, Centre for Research on Ecological Impacts of Coastal Cities, School of Life and Environmental Sciences, NSW 2006, Australia
| | - R Jarvis
- Sydney Institute of Marine Science, 19 Chowder Bay Rd, Mosman, New South Wales 2088, Australia; Institute for Applied Ecology New Zealand, School of Science, Auckland University of Technology, Auckland 1142, New Zealand
| | - R Coleman
- Sydney Institute of Marine Science, 19 Chowder Bay Rd, Mosman, New South Wales 2088, Australia; University of Sydney, Centre for Research on Ecological Impacts of Coastal Cities, School of Life and Environmental Sciences, NSW 2006, Australia
| | - B Bollard
- Institute for Applied Ecology New Zealand, School of Science, Auckland University of Technology, Auckland 1142, New Zealand
| | - L B Firth
- School of Biological and Marine Sciences, University of Plymouth, Plymouth PL4 8AA, Drake Circus, UK
| | - A M Knights
- School of Biological and Marine Sciences, University of Plymouth, Plymouth PL4 8AA, Drake Circus, UK
| | - J H Grabowski
- Marine Science Center, Northeastern University, 430 Nahant Road, Nahant, MA 01907, USA
| | - L Airoldi
- University of Bologna, Dipartimento di Scienze Biologiche, Geologiche ed Ambientali (BIGEA) & Centro Interdipartimentale di Ricerca per le Scienze Ambientali (CIRSA), UO CoNISMa, Via S. Alberto, 163, Ravenna I-48123, Italy
| | - B K K Chan
- Biodiversity Research Centre, Academia Sinica, Taipei 115, Taiwan
| | - S Y Chee
- Centre for Marine and Coastal Studies, Universiti Sains Malaysia, Penang 11800, Malaysia
| | - Z Cheng
- State Key Laboratory of Marine Environmental Science, College of Ocean and Earth Sciences, Xiamen University, Xiamen 361102, China
| | - R Coutinho
- Department of Marine Biotecnology, Instituto de Estudos do Mar Almirante Paulo Moreira, Brazilian Navy & Post-Graduation Program in Marine Biotechnology, IEAPM/UFF, Arraial do Cabo, Rio de Janeiro 28930-000, Brazil
| | - R G de Menezes
- Department of Marine Biotecnology, Instituto de Estudos do Mar Almirante Paulo Moreira, Brazilian Navy & Post-Graduation Program in Marine Biotechnology, IEAPM/UFF, Arraial do Cabo, Rio de Janeiro 28930-000, Brazil
| | - M Ding
- State Key Laboratory of Marine Environmental Science, College of Ocean and Earth Sciences, Xiamen University, Xiamen 361102, China
| | - Y Dong
- State Key Laboratory of Marine Environmental Science, College of Ocean and Earth Sciences, Xiamen University, Xiamen 361102, China
| | - C M L Fraser
- Biodiversity Research Centre, Academia Sinica, Taipei 115, Taiwan
| | - A G Gómez
- Environmental Hydraulics Institute, Universidad de Cantabria, Avda. Isabel Torres, 15, Parque Científico y Tecnológico de Cantabria, 39011 Santander, Spain
| | - J A Juanes
- Environmental Hydraulics Institute, Universidad de Cantabria, Avda. Isabel Torres, 15, Parque Científico y Tecnológico de Cantabria, 39011 Santander, Spain
| | - P Mancuso
- University of Bologna, Dipartimento di Scienze Biologiche, Geologiche ed Ambientali (BIGEA) & Centro Interdipartimentale di Ricerca per le Scienze Ambientali (CIRSA), UO CoNISMa, Via S. Alberto, 163, Ravenna I-48123, Italy
| | - L V R Messano
- Department of Marine Biotecnology, Instituto de Estudos do Mar Almirante Paulo Moreira, Brazilian Navy & Post-Graduation Program in Marine Biotechnology, IEAPM/UFF, Arraial do Cabo, Rio de Janeiro 28930-000, Brazil
| | - L P D Naval-Xavier
- Department of Marine Biotecnology, Instituto de Estudos do Mar Almirante Paulo Moreira, Brazilian Navy & Post-Graduation Program in Marine Biotechnology, IEAPM/UFF, Arraial do Cabo, Rio de Janeiro 28930-000, Brazil
| | - S Scyphers
- Marine Science Center, Northeastern University, 430 Nahant Road, Nahant, MA 01907, USA
| | - P Steinberg
- Sydney Institute of Marine Science, 19 Chowder Bay Rd, Mosman, New South Wales 2088, Australia; Centre for Marine Bio-Innovation, School of Biological, Earth and Environmental Sciences, University of New South Wales, Sydney, New South Wales 2052, Australia
| | - S Swearer
- National Centre for Coasts and Climate, School of Biosciences, The University of Melbourne, Parkville, Victoria 3010, Australia
| | - P F Valdor
- Environmental Hydraulics Institute, Universidad de Cantabria, Avda. Isabel Torres, 15, Parque Científico y Tecnológico de Cantabria, 39011 Santander, Spain
| | - J X Y Wong
- University of Bologna, Dipartimento di Scienze Biologiche, Geologiche ed Ambientali (BIGEA) & Centro Interdipartimentale di Ricerca per le Scienze Ambientali (CIRSA), UO CoNISMa, Via S. Alberto, 163, Ravenna I-48123, Italy
| | - J Yee
- Centre for Marine and Coastal Studies, Universiti Sains Malaysia, Penang 11800, Malaysia
| | - M J Bishop
- Sydney Institute of Marine Science, 19 Chowder Bay Rd, Mosman, New South Wales 2088, Australia; Department of Biological Sciences, Macquarie University, NSW 2109, Australia
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Coleman R, Gregory W, Jean-Mairet J, Tercero JC, Torres-Martin J, Gomis R. Abstract P1-17-01: Long term survival benefits of adjuvant zoledronic acid associated with maf status of primary tumor. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p1-17-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Meta-analysis of clinical trials has shown that adjuvant bisphosphonates reduce bone metastases and improve survival in postmenopausal (PM) breast cancer and are now recommended for routine clinical use by international guidelines1. However, evaluation of menopause is imprecise and the biological rationale for lack of benefit in premenopausal women unclear. To address this, the biomarker, transcription factor MAF on 16q23 was tested retrospectively in the prospective randomized AZURE trial of standard adjuvant therapy +/- zoledronic acid (ZOL). Initial evaluation indicated that women with MAF negative tumors treated with ZOL had a lower rate of disease relapse irrespective of menopausal status.2 Here we present the long-term findings of this predictive biomarker on 10 year overall survival.
Materials and methods: The biomarker analysis was completed on TMAs from primary tumors. Quadruplicate cores of breast tumor tissue were arrayed across replicate TMAs. MAF+ was detected using a validated (MAF/D16Z3) FISH test (Inbiomotion SL, Spain). A central laboratory (Targos, Germany) validated the assay for analytic and diagnostic performance, established acceptance criteria, included appropriate quality controls for each assay, and performed the analyses in a blinded fashion. A copy number cut-off ≥2.5 was preset for MAF+ for both prognostic and predictive testing. Interactions between MAF+ and effects of ZOL on Invasive disease free (IDFS), overall (OS) survival and time to bone metastases by menopausal status were evaluated using a Cox proportional hazards model.
Results: 1769 of the 3360 AZURE pts donated primary tumor samples. Median follow-up was 117 (interquartile range 70.4-120) months. 865 pts (49%) had 2 FISH evaluable cores and were included in the analysis. These pts had similar disease and treatment characteristics to the overall study population as well as similar IDFS and OS at 10 years. 184 (21%) had MAF+ tumors and these tumors were more likely to be of higher grade, ER-ve and HER2+. In 680 pts with MAF- tumors, ZOL was associated with improved IDFS (HR=0.75; 95%CI:0.58-0.97, [P=0.02]), reduced relapse in bone (HR=0.65; 95%CI:0.45-0.94, [P=0.022] and, most importantly, better OS (HR=0.69; 95%CI:0.50-0.94, [P=0.019]). In the 185 patients with MAF+ tumors, there was a suggestion of worse outcome (IDFS HR=1.54; 95%CI:0.96-2.47 and OS HR 1.40; 95%CI:0.83-2.33), with a strong interaction between treatment effects and menopausal status. Outcomes in ZOL treated MAF+ pts who were non-PM appeared to be much worse (IDFS HR=2.31; 95%CI:1.18-4.42] and OS HR=2.28; 95%CI:1.07-4.82) due predominantly to an excess of extra-skeletal metastases in ZOL treated patients (HR=4.47; 95%CI:1.66-12.57).
Conclusions: Adjuvant ZOL significantly improved disease outcomes in 79% of patients with MAF negative tumors, irrespective of menopausal status and other clinico-pathologic features. Conversely, more extra-skeletal metastases and breast cancer deaths were seen in women with MAF+ tumors who were not PM at the start of treatment. If validated in ongoing studies, the MAF FISH test could provide a clinically useful biomarker for selection of patients for adjuvant bisphosphonate treatment.
1EBCTCG, Lancet 2015; 2Coleman RE et al, Lancet Oncol 2017
Citation Format: Coleman R, Gregory W, Jean-Mairet J, Tercero JC, Torres-Martin J, Gomis R. Long term survival benefits of adjuvant zoledronic acid associated with maf status of primary tumor [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-17-01.
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Affiliation(s)
- R Coleman
- University of Sheffield, Sheffield, United Kingdom; University of Leeds, Leeds, United Kingdom; Inbiomotion SL, Barcelona, Spain; Syntax for Science SL, Barcelona, Spain; Institute for Research in Biomedicine and and Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain
| | - W Gregory
- University of Sheffield, Sheffield, United Kingdom; University of Leeds, Leeds, United Kingdom; Inbiomotion SL, Barcelona, Spain; Syntax for Science SL, Barcelona, Spain; Institute for Research in Biomedicine and and Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain
| | - J Jean-Mairet
- University of Sheffield, Sheffield, United Kingdom; University of Leeds, Leeds, United Kingdom; Inbiomotion SL, Barcelona, Spain; Syntax for Science SL, Barcelona, Spain; Institute for Research in Biomedicine and and Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain
| | - JC Tercero
- University of Sheffield, Sheffield, United Kingdom; University of Leeds, Leeds, United Kingdom; Inbiomotion SL, Barcelona, Spain; Syntax for Science SL, Barcelona, Spain; Institute for Research in Biomedicine and and Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain
| | - J Torres-Martin
- University of Sheffield, Sheffield, United Kingdom; University of Leeds, Leeds, United Kingdom; Inbiomotion SL, Barcelona, Spain; Syntax for Science SL, Barcelona, Spain; Institute for Research in Biomedicine and and Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain
| | - R Gomis
- University of Sheffield, Sheffield, United Kingdom; University of Leeds, Leeds, United Kingdom; Inbiomotion SL, Barcelona, Spain; Syntax for Science SL, Barcelona, Spain; Institute for Research in Biomedicine and and Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain
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Olson A, Marini F, Westin S, Coleman R, Thall P, Al Jahdami V, Qazilbash M, Rezvani K, Timmons M, Heese L, Wang R, Champlin R, Shpall E, Andreeff M. A phase I trial of mesenchymal stem cells transfected with a plasmid secreting interferon beta in advanced ovarian cancer. Cytotherapy 2018. [DOI: 10.1016/j.jcyt.2018.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Wilson C, Bell R, Hinsley S, Marshall H, Brown J, Cameron D, Dodwell D, Coleman R. Adjuvant zoledronic acid reduces fractures in breast cancer patients; an AZURE (BIG 01/04) study. Eur J Cancer 2018; 94:70-78. [PMID: 29544162 DOI: 10.1016/j.ejca.2018.02.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 02/05/2018] [Accepted: 02/07/2018] [Indexed: 11/27/2022]
Abstract
The fracture impact of adjuvant bisphosphonates in breast cancer is not defined with most trials reporting changes in bone mineral density as a surrogate. The AZURE trial (ISRCTN79831382) evaluated the impact of adjuvant zoledronic acid (ZOL) on fractures. The AZURE trial is an academic, multi-centre, randomised phase III study evaluating the addition of ZOL 4 mg to standard therapy (neo/adjuvant chemotherapy and/or endocrine therapy) for 5 years (administered by intravenous (iv) infusion every 3-4 weeks for 6 doses, then 3 monthly × 8 and 6 monthly × 5) in patients with stage II/III early breast cancer. Fracture data collected as part of skeletal-related adverse event reporting were analysed after a median of 84.2 months of follow-up and 966 disease-free survival (DFS) events. We assessed number of fractures, time-to-first fracture and the incidence of fractures before and after disease recurrence. Two hundred forty-four patients reported ≥1 fracture, 140 (8.3%) in the control arm (171 fractures) and 104 (6.2%) in the ZOL arm (120 fractures). Of the 291 fractures reported, 207 fractures occurred in the absence of recurrence (control 111, ZOL 96), 80 after recurrence (control 59, ZOL 21). The 5-year fracture rate was reduced from 5.9% (95%CI 4.8, 7.1%; control) to 3.8% (95%CI 2.9, 4.7%) with ZOL. ZOL significantly increased time-to-first fracture (HR 0.69, 95%CI 0.53-0.90; P = 0.0053) but the majority of fracture prevention benefit occurred after a DFS event (HR 0.3; 95%CI 0.17, 0.53; P < 0.001). Fracture benefits from ZOL were similar across menopausal sub-groups. In conclusion, adjuvant ZOL reduced the risk of clinical fractures, the majority of this protection occurred after disease recurrence.
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Affiliation(s)
- C Wilson
- Academic Unit of Clinical Oncology, Weston Park Hospital, University of Sheffield, Sheffield, UK.
| | - R Bell
- Deakin University, Geelong, Australia
| | - S Hinsley
- Clinical Trials Research Unit, Leeds, UK
| | - H Marshall
- Clinical Trials Research Unit, Leeds, UK
| | - J Brown
- Academic Unit of Clinical Oncology, Weston Park Hospital, University of Sheffield, Sheffield, UK
| | - D Cameron
- Cancer Research UK Edinburgh Centre, Western General Hospital, University of Edinburgh, UK
| | - D Dodwell
- Institute of Oncology, Bexley Wing, St James Hospital, Leeds, UK
| | - R Coleman
- Academic Unit of Clinical Oncology, Weston Park Hospital, University of Sheffield, Sheffield, UK
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Coombes RC, Tovey H, Kilburn L, Mansi J, Palmieri C, Bartlett J, Hicks J, Makris A, Evans A, Loibl S, Denkert C, Murray E, Grieve R, Coleman R, Schmidt M, Klare P, Rezai M, Rautenberg B, Klutinus N, Rhein U, Mousa K, Ricardo-Vitorino S, von Minckwitz G, Bliss J. Abstract GS3-03: A phase III multicentre double blind randomised trial of celecoxib versus placebo in primary breast cancer patients (REACT – Randomised EuropeAn celecoxib trial). Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-gs3-03] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background
Inhibition of COX-2 has been shown to attenuate the metastatic process in pre-clinical models of human breast cancer (BC). The primary aim of this study was to assess the effect of 2 years adjuvant therapy with the COX-2 inhibitor celecoxib compared with placebo in HER2-ve primary BC patients.
Patients & Methods
Patients were randomised in a 2:1 ratio to receive celecoxib 400mg once daily or placebo for 2 years. Patients had to have completely resected BC with prior local and systemic adjuvant treatment according to local practice. Concurrent radiotherapy was permitted and hormone receptor +ve patients received endocrine therapy according to local practice. Patients with HER2+ or node negative, T1 and grade 1 disease were excluded. Median age of patients was 55 years (IQR: 49-63). 50% of patients had tumours >2cm; 42% were grade 3; 48% had node +ve disease. According to local assessment 73% were ER/PgR +ve. Primary endpoint was Disease Free Survival (DFS); defined as time from randomisation to date of first event, with events contributing to analysis defined as recurrence (distant/local), new primary BC (ipsilateral/contralateral) and death. Secondary endpoints included Overall Survival (OS), toxicity, cardiovascular mortality and incidence of second primaries. Subgroup analysis by hormone receptor status was pre-planned. Survival endpoints are analysed using Cox-proportional hazards and log-rank tests; restricted mean survival is used where proportional hazards do not hold.
Results
Between January 2007 and November 2012, 2639 patients were randomised (1763 celecoxib; 876 placebo) from 181 centres across the UK and Germany. At 13th April 2017, median follow up was 60 months (IQR: 48-72) with 428 DFS events reported. Unadjusted survival analysis results are presented below, with hazard ratio<1 favouring celecoxib:
5 year survival estimate (95% CI)Hazard ratio (95% CI)p-valueDFS (all patients) Celecoxib83% (81, 85)1.02 (0.83 – 1.24)0.88Placebo83% (80, 86)1- DFS within ER+ Celecoxib87% (85, 89)0.89 (0.69 – 1.16)0.40Placebo86% (83, 89)1- DFS within ER- Celecoxib72% (68, 76)1.17 (0.85 – 1.61)0.33Placebo75% (69, 80)1- OS (all patients) Celecoxib90% (88, 91)0.97 (0.75 – 1.25)0.81Placebo90% (88, 92)1-
The interaction between ER status and treatment was not significant; p=0.36.
In the celecoxib and placebo groups there were 17 and 8 deaths respectively in patients who had not relapsed. These were due to cardiac (n=3; 2) and other (n=14; 6) in the celecoxib and placebo groups respectively; none were GI related. In total 304 serious adverse events were observed in 265 patients (186/1763 celecoxib; 79/876 placebo). In the celecoxib and placebo groups respectively these were related to cardiac (n=12; 7), GI (n=9; 2) and other (n=193; 81). Work is ongoing to determine whether a subset of ER+ patients whose primary tumours show the characteristics of a COX-2 signature receive greater benefit from celecoxib.
Conclusions
There is no benefit of celecoxib in the ITT population. Further exploratory studies focussing on the ER+ subpopulation are ongoing. Celecoxib treatment is not associated with significant toxicity when compared to placebo in this population of BC patients.
Citation Format: Coombes RC, Tovey H, Kilburn L, Mansi J, Palmieri C, Bartlett J, Hicks J, Makris A, Evans A, Loibl S, Denkert C, Murray E, Grieve R, Coleman R, Schmidt M, Klare P, Rezai M, Rautenberg B, Klutinus N, Rhein U, Mousa K, Ricardo-Vitorino S, von Minckwitz G, Bliss J. A phase III multicentre double blind randomised trial of celecoxib versus placebo in primary breast cancer patients (REACT – Randomised EuropeAn celecoxib trial) [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr GS3-03.
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Affiliation(s)
- RC Coombes
- Imperial College London, UK; Institute of Cancer Research - Clinical Trials and Statistics Unit, UK; Guys' & St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, UK; University of Liverpool and Clatterbridge Cancer Centre, UK; Ontario Institute for Cancer Research, Toronto, Canada; NHS Lanarkshire, UK; Mount Vernon Cancer Centre, UK; Poole Hospital NHS Foundation Trust, UK; German Breast Group, Neu-Isenburg, Germany; Charité University Hospital and German Cancer Consortium (DKTK), Berlin, Germany; United Lincolnshire Hospitals NHS Foundation Trust, UK; University Hospitals Coventry and Warwickshire NHS Trust, UK; University of Sheffield. Sheffield, UK; Praxisklinik Krebsheilkunde, Berlin, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitätsklinikum Freiburg, Germany; Klinikum Pforzheim GmbH, Germany; SRH Zentralklinikum Suhl GmbH, Germany; Universitatsmedizin Mainz, Germany
| | - H Tovey
- Imperial College London, UK; Institute of Cancer Research - Clinical Trials and Statistics Unit, UK; Guys' & St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, UK; University of Liverpool and Clatterbridge Cancer Centre, UK; Ontario Institute for Cancer Research, Toronto, Canada; NHS Lanarkshire, UK; Mount Vernon Cancer Centre, UK; Poole Hospital NHS Foundation Trust, UK; German Breast Group, Neu-Isenburg, Germany; Charité University Hospital and German Cancer Consortium (DKTK), Berlin, Germany; United Lincolnshire Hospitals NHS Foundation Trust, UK; University Hospitals Coventry and Warwickshire NHS Trust, UK; University of Sheffield. Sheffield, UK; Praxisklinik Krebsheilkunde, Berlin, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitätsklinikum Freiburg, Germany; Klinikum Pforzheim GmbH, Germany; SRH Zentralklinikum Suhl GmbH, Germany; Universitatsmedizin Mainz, Germany
| | - L Kilburn
- Imperial College London, UK; Institute of Cancer Research - Clinical Trials and Statistics Unit, UK; Guys' & St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, UK; University of Liverpool and Clatterbridge Cancer Centre, UK; Ontario Institute for Cancer Research, Toronto, Canada; NHS Lanarkshire, UK; Mount Vernon Cancer Centre, UK; Poole Hospital NHS Foundation Trust, UK; German Breast Group, Neu-Isenburg, Germany; Charité University Hospital and German Cancer Consortium (DKTK), Berlin, Germany; United Lincolnshire Hospitals NHS Foundation Trust, UK; University Hospitals Coventry and Warwickshire NHS Trust, UK; University of Sheffield. Sheffield, UK; Praxisklinik Krebsheilkunde, Berlin, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitätsklinikum Freiburg, Germany; Klinikum Pforzheim GmbH, Germany; SRH Zentralklinikum Suhl GmbH, Germany; Universitatsmedizin Mainz, Germany
| | - J Mansi
- Imperial College London, UK; Institute of Cancer Research - Clinical Trials and Statistics Unit, UK; Guys' & St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, UK; University of Liverpool and Clatterbridge Cancer Centre, UK; Ontario Institute for Cancer Research, Toronto, Canada; NHS Lanarkshire, UK; Mount Vernon Cancer Centre, UK; Poole Hospital NHS Foundation Trust, UK; German Breast Group, Neu-Isenburg, Germany; Charité University Hospital and German Cancer Consortium (DKTK), Berlin, Germany; United Lincolnshire Hospitals NHS Foundation Trust, UK; University Hospitals Coventry and Warwickshire NHS Trust, UK; University of Sheffield. Sheffield, UK; Praxisklinik Krebsheilkunde, Berlin, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitätsklinikum Freiburg, Germany; Klinikum Pforzheim GmbH, Germany; SRH Zentralklinikum Suhl GmbH, Germany; Universitatsmedizin Mainz, Germany
| | - C Palmieri
- Imperial College London, UK; Institute of Cancer Research - Clinical Trials and Statistics Unit, UK; Guys' & St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, UK; University of Liverpool and Clatterbridge Cancer Centre, UK; Ontario Institute for Cancer Research, Toronto, Canada; NHS Lanarkshire, UK; Mount Vernon Cancer Centre, UK; Poole Hospital NHS Foundation Trust, UK; German Breast Group, Neu-Isenburg, Germany; Charité University Hospital and German Cancer Consortium (DKTK), Berlin, Germany; United Lincolnshire Hospitals NHS Foundation Trust, UK; University Hospitals Coventry and Warwickshire NHS Trust, UK; University of Sheffield. Sheffield, UK; Praxisklinik Krebsheilkunde, Berlin, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitätsklinikum Freiburg, Germany; Klinikum Pforzheim GmbH, Germany; SRH Zentralklinikum Suhl GmbH, Germany; Universitatsmedizin Mainz, Germany
| | - J Bartlett
- Imperial College London, UK; Institute of Cancer Research - Clinical Trials and Statistics Unit, UK; Guys' & St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, UK; University of Liverpool and Clatterbridge Cancer Centre, UK; Ontario Institute for Cancer Research, Toronto, Canada; NHS Lanarkshire, UK; Mount Vernon Cancer Centre, UK; Poole Hospital NHS Foundation Trust, UK; German Breast Group, Neu-Isenburg, Germany; Charité University Hospital and German Cancer Consortium (DKTK), Berlin, Germany; United Lincolnshire Hospitals NHS Foundation Trust, UK; University Hospitals Coventry and Warwickshire NHS Trust, UK; University of Sheffield. Sheffield, UK; Praxisklinik Krebsheilkunde, Berlin, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitätsklinikum Freiburg, Germany; Klinikum Pforzheim GmbH, Germany; SRH Zentralklinikum Suhl GmbH, Germany; Universitatsmedizin Mainz, Germany
| | - J Hicks
- Imperial College London, UK; Institute of Cancer Research - Clinical Trials and Statistics Unit, UK; Guys' & St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, UK; University of Liverpool and Clatterbridge Cancer Centre, UK; Ontario Institute for Cancer Research, Toronto, Canada; NHS Lanarkshire, UK; Mount Vernon Cancer Centre, UK; Poole Hospital NHS Foundation Trust, UK; German Breast Group, Neu-Isenburg, Germany; Charité University Hospital and German Cancer Consortium (DKTK), Berlin, Germany; United Lincolnshire Hospitals NHS Foundation Trust, UK; University Hospitals Coventry and Warwickshire NHS Trust, UK; University of Sheffield. Sheffield, UK; Praxisklinik Krebsheilkunde, Berlin, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitätsklinikum Freiburg, Germany; Klinikum Pforzheim GmbH, Germany; SRH Zentralklinikum Suhl GmbH, Germany; Universitatsmedizin Mainz, Germany
| | - A Makris
- Imperial College London, UK; Institute of Cancer Research - Clinical Trials and Statistics Unit, UK; Guys' & St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, UK; University of Liverpool and Clatterbridge Cancer Centre, UK; Ontario Institute for Cancer Research, Toronto, Canada; NHS Lanarkshire, UK; Mount Vernon Cancer Centre, UK; Poole Hospital NHS Foundation Trust, UK; German Breast Group, Neu-Isenburg, Germany; Charité University Hospital and German Cancer Consortium (DKTK), Berlin, Germany; United Lincolnshire Hospitals NHS Foundation Trust, UK; University Hospitals Coventry and Warwickshire NHS Trust, UK; University of Sheffield. Sheffield, UK; Praxisklinik Krebsheilkunde, Berlin, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitätsklinikum Freiburg, Germany; Klinikum Pforzheim GmbH, Germany; SRH Zentralklinikum Suhl GmbH, Germany; Universitatsmedizin Mainz, Germany
| | - A Evans
- Imperial College London, UK; Institute of Cancer Research - Clinical Trials and Statistics Unit, UK; Guys' & St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, UK; University of Liverpool and Clatterbridge Cancer Centre, UK; Ontario Institute for Cancer Research, Toronto, Canada; NHS Lanarkshire, UK; Mount Vernon Cancer Centre, UK; Poole Hospital NHS Foundation Trust, UK; German Breast Group, Neu-Isenburg, Germany; Charité University Hospital and German Cancer Consortium (DKTK), Berlin, Germany; United Lincolnshire Hospitals NHS Foundation Trust, UK; University Hospitals Coventry and Warwickshire NHS Trust, UK; University of Sheffield. Sheffield, UK; Praxisklinik Krebsheilkunde, Berlin, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitätsklinikum Freiburg, Germany; Klinikum Pforzheim GmbH, Germany; SRH Zentralklinikum Suhl GmbH, Germany; Universitatsmedizin Mainz, Germany
| | - S Loibl
- Imperial College London, UK; Institute of Cancer Research - Clinical Trials and Statistics Unit, UK; Guys' & St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, UK; University of Liverpool and Clatterbridge Cancer Centre, UK; Ontario Institute for Cancer Research, Toronto, Canada; NHS Lanarkshire, UK; Mount Vernon Cancer Centre, UK; Poole Hospital NHS Foundation Trust, UK; German Breast Group, Neu-Isenburg, Germany; Charité University Hospital and German Cancer Consortium (DKTK), Berlin, Germany; United Lincolnshire Hospitals NHS Foundation Trust, UK; University Hospitals Coventry and Warwickshire NHS Trust, UK; University of Sheffield. Sheffield, UK; Praxisklinik Krebsheilkunde, Berlin, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitätsklinikum Freiburg, Germany; Klinikum Pforzheim GmbH, Germany; SRH Zentralklinikum Suhl GmbH, Germany; Universitatsmedizin Mainz, Germany
| | - C Denkert
- Imperial College London, UK; Institute of Cancer Research - Clinical Trials and Statistics Unit, UK; Guys' & St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, UK; University of Liverpool and Clatterbridge Cancer Centre, UK; Ontario Institute for Cancer Research, Toronto, Canada; NHS Lanarkshire, UK; Mount Vernon Cancer Centre, UK; Poole Hospital NHS Foundation Trust, UK; German Breast Group, Neu-Isenburg, Germany; Charité University Hospital and German Cancer Consortium (DKTK), Berlin, Germany; United Lincolnshire Hospitals NHS Foundation Trust, UK; University Hospitals Coventry and Warwickshire NHS Trust, UK; University of Sheffield. Sheffield, UK; Praxisklinik Krebsheilkunde, Berlin, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitätsklinikum Freiburg, Germany; Klinikum Pforzheim GmbH, Germany; SRH Zentralklinikum Suhl GmbH, Germany; Universitatsmedizin Mainz, Germany
| | - E Murray
- Imperial College London, UK; Institute of Cancer Research - Clinical Trials and Statistics Unit, UK; Guys' & St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, UK; University of Liverpool and Clatterbridge Cancer Centre, UK; Ontario Institute for Cancer Research, Toronto, Canada; NHS Lanarkshire, UK; Mount Vernon Cancer Centre, UK; Poole Hospital NHS Foundation Trust, UK; German Breast Group, Neu-Isenburg, Germany; Charité University Hospital and German Cancer Consortium (DKTK), Berlin, Germany; United Lincolnshire Hospitals NHS Foundation Trust, UK; University Hospitals Coventry and Warwickshire NHS Trust, UK; University of Sheffield. Sheffield, UK; Praxisklinik Krebsheilkunde, Berlin, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitätsklinikum Freiburg, Germany; Klinikum Pforzheim GmbH, Germany; SRH Zentralklinikum Suhl GmbH, Germany; Universitatsmedizin Mainz, Germany
| | - R Grieve
- Imperial College London, UK; Institute of Cancer Research - Clinical Trials and Statistics Unit, UK; Guys' & St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, UK; University of Liverpool and Clatterbridge Cancer Centre, UK; Ontario Institute for Cancer Research, Toronto, Canada; NHS Lanarkshire, UK; Mount Vernon Cancer Centre, UK; Poole Hospital NHS Foundation Trust, UK; German Breast Group, Neu-Isenburg, Germany; Charité University Hospital and German Cancer Consortium (DKTK), Berlin, Germany; United Lincolnshire Hospitals NHS Foundation Trust, UK; University Hospitals Coventry and Warwickshire NHS Trust, UK; University of Sheffield. Sheffield, UK; Praxisklinik Krebsheilkunde, Berlin, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitätsklinikum Freiburg, Germany; Klinikum Pforzheim GmbH, Germany; SRH Zentralklinikum Suhl GmbH, Germany; Universitatsmedizin Mainz, Germany
| | - R Coleman
- Imperial College London, UK; Institute of Cancer Research - Clinical Trials and Statistics Unit, UK; Guys' & St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, UK; University of Liverpool and Clatterbridge Cancer Centre, UK; Ontario Institute for Cancer Research, Toronto, Canada; NHS Lanarkshire, UK; Mount Vernon Cancer Centre, UK; Poole Hospital NHS Foundation Trust, UK; German Breast Group, Neu-Isenburg, Germany; Charité University Hospital and German Cancer Consortium (DKTK), Berlin, Germany; United Lincolnshire Hospitals NHS Foundation Trust, UK; University Hospitals Coventry and Warwickshire NHS Trust, UK; University of Sheffield. Sheffield, UK; Praxisklinik Krebsheilkunde, Berlin, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitätsklinikum Freiburg, Germany; Klinikum Pforzheim GmbH, Germany; SRH Zentralklinikum Suhl GmbH, Germany; Universitatsmedizin Mainz, Germany
| | - M Schmidt
- Imperial College London, UK; Institute of Cancer Research - Clinical Trials and Statistics Unit, UK; Guys' & St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, UK; University of Liverpool and Clatterbridge Cancer Centre, UK; Ontario Institute for Cancer Research, Toronto, Canada; NHS Lanarkshire, UK; Mount Vernon Cancer Centre, UK; Poole Hospital NHS Foundation Trust, UK; German Breast Group, Neu-Isenburg, Germany; Charité University Hospital and German Cancer Consortium (DKTK), Berlin, Germany; United Lincolnshire Hospitals NHS Foundation Trust, UK; University Hospitals Coventry and Warwickshire NHS Trust, UK; University of Sheffield. Sheffield, UK; Praxisklinik Krebsheilkunde, Berlin, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitätsklinikum Freiburg, Germany; Klinikum Pforzheim GmbH, Germany; SRH Zentralklinikum Suhl GmbH, Germany; Universitatsmedizin Mainz, Germany
| | - P Klare
- Imperial College London, UK; Institute of Cancer Research - Clinical Trials and Statistics Unit, UK; Guys' & St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, UK; University of Liverpool and Clatterbridge Cancer Centre, UK; Ontario Institute for Cancer Research, Toronto, Canada; NHS Lanarkshire, UK; Mount Vernon Cancer Centre, UK; Poole Hospital NHS Foundation Trust, UK; German Breast Group, Neu-Isenburg, Germany; Charité University Hospital and German Cancer Consortium (DKTK), Berlin, Germany; United Lincolnshire Hospitals NHS Foundation Trust, UK; University Hospitals Coventry and Warwickshire NHS Trust, UK; University of Sheffield. Sheffield, UK; Praxisklinik Krebsheilkunde, Berlin, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitätsklinikum Freiburg, Germany; Klinikum Pforzheim GmbH, Germany; SRH Zentralklinikum Suhl GmbH, Germany; Universitatsmedizin Mainz, Germany
| | - M Rezai
- Imperial College London, UK; Institute of Cancer Research - Clinical Trials and Statistics Unit, UK; Guys' & St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, UK; University of Liverpool and Clatterbridge Cancer Centre, UK; Ontario Institute for Cancer Research, Toronto, Canada; NHS Lanarkshire, UK; Mount Vernon Cancer Centre, UK; Poole Hospital NHS Foundation Trust, UK; German Breast Group, Neu-Isenburg, Germany; Charité University Hospital and German Cancer Consortium (DKTK), Berlin, Germany; United Lincolnshire Hospitals NHS Foundation Trust, UK; University Hospitals Coventry and Warwickshire NHS Trust, UK; University of Sheffield. Sheffield, UK; Praxisklinik Krebsheilkunde, Berlin, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitätsklinikum Freiburg, Germany; Klinikum Pforzheim GmbH, Germany; SRH Zentralklinikum Suhl GmbH, Germany; Universitatsmedizin Mainz, Germany
| | - B Rautenberg
- Imperial College London, UK; Institute of Cancer Research - Clinical Trials and Statistics Unit, UK; Guys' & St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, UK; University of Liverpool and Clatterbridge Cancer Centre, UK; Ontario Institute for Cancer Research, Toronto, Canada; NHS Lanarkshire, UK; Mount Vernon Cancer Centre, UK; Poole Hospital NHS Foundation Trust, UK; German Breast Group, Neu-Isenburg, Germany; Charité University Hospital and German Cancer Consortium (DKTK), Berlin, Germany; United Lincolnshire Hospitals NHS Foundation Trust, UK; University Hospitals Coventry and Warwickshire NHS Trust, UK; University of Sheffield. Sheffield, UK; Praxisklinik Krebsheilkunde, Berlin, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitätsklinikum Freiburg, Germany; Klinikum Pforzheim GmbH, Germany; SRH Zentralklinikum Suhl GmbH, Germany; Universitatsmedizin Mainz, Germany
| | - N Klutinus
- Imperial College London, UK; Institute of Cancer Research - Clinical Trials and Statistics Unit, UK; Guys' & St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, UK; University of Liverpool and Clatterbridge Cancer Centre, UK; Ontario Institute for Cancer Research, Toronto, Canada; NHS Lanarkshire, UK; Mount Vernon Cancer Centre, UK; Poole Hospital NHS Foundation Trust, UK; German Breast Group, Neu-Isenburg, Germany; Charité University Hospital and German Cancer Consortium (DKTK), Berlin, Germany; United Lincolnshire Hospitals NHS Foundation Trust, UK; University Hospitals Coventry and Warwickshire NHS Trust, UK; University of Sheffield. Sheffield, UK; Praxisklinik Krebsheilkunde, Berlin, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitätsklinikum Freiburg, Germany; Klinikum Pforzheim GmbH, Germany; SRH Zentralklinikum Suhl GmbH, Germany; Universitatsmedizin Mainz, Germany
| | - U Rhein
- Imperial College London, UK; Institute of Cancer Research - Clinical Trials and Statistics Unit, UK; Guys' & St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, UK; University of Liverpool and Clatterbridge Cancer Centre, UK; Ontario Institute for Cancer Research, Toronto, Canada; NHS Lanarkshire, UK; Mount Vernon Cancer Centre, UK; Poole Hospital NHS Foundation Trust, UK; German Breast Group, Neu-Isenburg, Germany; Charité University Hospital and German Cancer Consortium (DKTK), Berlin, Germany; United Lincolnshire Hospitals NHS Foundation Trust, UK; University Hospitals Coventry and Warwickshire NHS Trust, UK; University of Sheffield. Sheffield, UK; Praxisklinik Krebsheilkunde, Berlin, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitätsklinikum Freiburg, Germany; Klinikum Pforzheim GmbH, Germany; SRH Zentralklinikum Suhl GmbH, Germany; Universitatsmedizin Mainz, Germany
| | - K Mousa
- Imperial College London, UK; Institute of Cancer Research - Clinical Trials and Statistics Unit, UK; Guys' & St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, UK; University of Liverpool and Clatterbridge Cancer Centre, UK; Ontario Institute for Cancer Research, Toronto, Canada; NHS Lanarkshire, UK; Mount Vernon Cancer Centre, UK; Poole Hospital NHS Foundation Trust, UK; German Breast Group, Neu-Isenburg, Germany; Charité University Hospital and German Cancer Consortium (DKTK), Berlin, Germany; United Lincolnshire Hospitals NHS Foundation Trust, UK; University Hospitals Coventry and Warwickshire NHS Trust, UK; University of Sheffield. Sheffield, UK; Praxisklinik Krebsheilkunde, Berlin, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitätsklinikum Freiburg, Germany; Klinikum Pforzheim GmbH, Germany; SRH Zentralklinikum Suhl GmbH, Germany; Universitatsmedizin Mainz, Germany
| | - S Ricardo-Vitorino
- Imperial College London, UK; Institute of Cancer Research - Clinical Trials and Statistics Unit, UK; Guys' & St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, UK; University of Liverpool and Clatterbridge Cancer Centre, UK; Ontario Institute for Cancer Research, Toronto, Canada; NHS Lanarkshire, UK; Mount Vernon Cancer Centre, UK; Poole Hospital NHS Foundation Trust, UK; German Breast Group, Neu-Isenburg, Germany; Charité University Hospital and German Cancer Consortium (DKTK), Berlin, Germany; United Lincolnshire Hospitals NHS Foundation Trust, UK; University Hospitals Coventry and Warwickshire NHS Trust, UK; University of Sheffield. Sheffield, UK; Praxisklinik Krebsheilkunde, Berlin, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitätsklinikum Freiburg, Germany; Klinikum Pforzheim GmbH, Germany; SRH Zentralklinikum Suhl GmbH, Germany; Universitatsmedizin Mainz, Germany
| | - G von Minckwitz
- Imperial College London, UK; Institute of Cancer Research - Clinical Trials and Statistics Unit, UK; Guys' & St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, UK; University of Liverpool and Clatterbridge Cancer Centre, UK; Ontario Institute for Cancer Research, Toronto, Canada; NHS Lanarkshire, UK; Mount Vernon Cancer Centre, UK; Poole Hospital NHS Foundation Trust, UK; German Breast Group, Neu-Isenburg, Germany; Charité University Hospital and German Cancer Consortium (DKTK), Berlin, Germany; United Lincolnshire Hospitals NHS Foundation Trust, UK; University Hospitals Coventry and Warwickshire NHS Trust, UK; University of Sheffield. Sheffield, UK; Praxisklinik Krebsheilkunde, Berlin, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitätsklinikum Freiburg, Germany; Klinikum Pforzheim GmbH, Germany; SRH Zentralklinikum Suhl GmbH, Germany; Universitatsmedizin Mainz, Germany
| | - J Bliss
- Imperial College London, UK; Institute of Cancer Research - Clinical Trials and Statistics Unit, UK; Guys' & St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, UK; University of Liverpool and Clatterbridge Cancer Centre, UK; Ontario Institute for Cancer Research, Toronto, Canada; NHS Lanarkshire, UK; Mount Vernon Cancer Centre, UK; Poole Hospital NHS Foundation Trust, UK; German Breast Group, Neu-Isenburg, Germany; Charité University Hospital and German Cancer Consortium (DKTK), Berlin, Germany; United Lincolnshire Hospitals NHS Foundation Trust, UK; University Hospitals Coventry and Warwickshire NHS Trust, UK; University of Sheffield. Sheffield, UK; Praxisklinik Krebsheilkunde, Berlin, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitätsklinikum Freiburg, Germany; Klinikum Pforzheim GmbH, Germany; SRH Zentralklinikum Suhl GmbH, Germany; Universitatsmedizin Mainz, Germany
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Colpitts M, Malinowski M, Phillion R, Coleman R, Mitchell L, Malone A, Eberhart L, Sanders R, Langholz D. Echocardiographic imaging options in ovine research subjects. J Vet Cardiol 2017; 19:502-513. [PMID: 29097107 DOI: 10.1016/j.jvc.2017.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 09/13/2017] [Accepted: 09/21/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To determine the feasibility of acquiring quality transesophageal (TEE), epicardial (EE), and intracardiac (ICE) echocardiographic images in ovine subjects and to discuss the merits of each technique with a focus on ICE image acquisition. ANIMALS Eleven male castrated Dorset adult sheep. METHODS Transesophageal echocardiography was performed under general anesthesia. Epicardial echocardiography was performed as part of an open chest (thoracotomy or sternotomy) experiment. Subjects were recovered with permanent jugular vein indwelling catheter and ICE from this approach was described. Feasibility of each technique was qualitatively assessed based on subjective image quality from three images for each image plane in each sheep. RESULTS Transesophageal echocardiography was technically challenging and did not provide adequate image quality for consistent interpretation. Epicardial echocardiography and ICE had more favorable results with ICE demonstrating unique benefits for post-operative serial monitoring. CONCLUSIONS Epicardial echocardiography and ICE were effective imaging techniques. Epicardial echocardiography required the least specialized training but was considered to have limited feasibility due to its requirement for an open chest procedure. Even with the necessity for permanent indwelling jugular cannulation, ICE was the least invasive of the three imaging techniques and potentially the most practical approach for chronic studies by minimizing post-operative stress. Transesophageal echocardiography was not a feasible technique in this study.
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Affiliation(s)
- M Colpitts
- Division of Cardiovascular Medicine, Spectrum Health, 100 Michigan St NE, Grand Rapids, MI 49503, USA.
| | - M Malinowski
- Division of Cardiothoracic Surgery, Spectrum Health, 100 Michigan St NE, Grand Rapids, MI 49503, USA; Medical University of Silesia, Department of Cardiac Surgery, Ziolowa 47, 40-635, Katowice, Poland
| | - R Phillion
- Division of Cardiovascular Medicine, Spectrum Health, 100 Michigan St NE, Grand Rapids, MI 49503, USA
| | - R Coleman
- Division of Cardiovascular Medicine, Spectrum Health, 100 Michigan St NE, Grand Rapids, MI 49503, USA
| | - L Mitchell
- Division of Cardiovascular Medicine, Spectrum Health, 100 Michigan St NE, Grand Rapids, MI 49503, USA
| | - A Malone
- Division of Cardiovascular Medicine, Spectrum Health, 100 Michigan St NE, Grand Rapids, MI 49503, USA
| | - L Eberhart
- Division of Cardiovascular Medicine, Spectrum Health, 100 Michigan St NE, Grand Rapids, MI 49503, USA
| | - R Sanders
- Michigan State University - College of Veterinary Medicine, Department of Cardiology, 736 Wilson Road, East Lansing, MI 48823, USA
| | - D Langholz
- Division of Cardiovascular Medicine, Spectrum Health, 100 Michigan St NE, Grand Rapids, MI 49503, USA
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Fleming N, Coleman R, Westin S, Sood A. When Advanced Ovarian Cancer is not Ovarian Cancer: Characteristics and Predictors of non-Ovarian Pathology in a Systematic, Laparoscopic-Based System. Gynecol Oncol 2017. [DOI: 10.1016/j.ygyno.2017.07.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Ledermann J, Oza A, Lorusso D, Aghajanian C, Oaknin A, Dean A, Colombo N, Weberpals J, Clamp A, Scambia G, Leary A, Holloway R, O'Malley D, Cameron T, Maloney L, Goble S, Lin K, Sun J, Giordano H, Coleman R. ARIEL3: A phase 3, randomised, double-blind study of rucaparib vs placebo following response to platinum-based chemotherapy for recurrent ovarian carcinoma (OC). Ann Oncol 2017. [DOI: 10.1093/annonc/mdx440.034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Taylor J, Westin S, Sharafi S, Jazaeri A, Frumovitz M, Soliman P, Sood A, Lu K, Savelieva K, Mills G, Vergara-Silva A, Coleman R. N-DUR: Matched pair pharmacodynamics study of neoadjuvant durvalumab in combination with chemotherapy in frontline ovarian cancer. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx372.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Westin S, Litton J, Williams R, Soliman P, Frumovitz M, Schmeler K, Jazaeri A, Sood A, Lu K, Moulder S, Murthy R, Rodriguez A, Samuel C, Engerman L, Cyriac A, Rugman P, Lindemann J, McMurtry E, Mills G, Coleman R. Phase I expansion of olaparib (PARP inhibitor) and AZD5363 (AKT inhibitor) in recurrent ovarian, endometrial and triple negative breast cancer. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx367.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Chenard-Poirier M, Hong D, Coleman R, de Bono J, Mau-Sorensen M, Collins D, Lisby S, Basse L, Lassen U. A phase I/II safety study of tisotumab vedotin (HuMax®-TF-ADC) in patients with solid tumors. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx376.049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Chenard-Poirier M, Hong D, Coleman R, de Bono J, Mau-Sorensen M, Collins D, Lisby S, Basse L, Lassen U. A phase I/II safety study of tisotumab vedotin (HuMax®-TF-ADC) in patients with solid tumors. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx376.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Vergote I, Dean E, Lassen U, de Bono J, Drew Y, Machiels JP, Nielsen D, Arkenau HT, Forster M, Jones R, Slomovitz B, Spicer J, Johnson M, Cornez N, Gennigens C, Fulton B, Lisby S, Basse L, Coleman R, Hong D. A phase IIa study of tisotumab vedotin (HuMax®-TF-ADC) in patients with relapsed, recurrent and/or metastatic cervical cancer. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx372.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Coleman R, Collinson M, Bell R, Marshall H, Dodwell D, Keane M, Gil M, Gregory W, Cameron D. Abstract P6-17-01: Adjuvant treatment with zoledronic acid (ZOL) in stage II/III breast cancer. The AZURE trial (BIG 01/04) 10 year follow-up. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p6-17-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
This abstract was not presented at the symposium.
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Affiliation(s)
- R Coleman
- University of Sheffield, Sheffield, United Kingdom; University of Leeds, Leeds, United Kingdom; AZURE Investigators
| | - M Collinson
- University of Sheffield, Sheffield, United Kingdom; University of Leeds, Leeds, United Kingdom; AZURE Investigators
| | - R Bell
- University of Sheffield, Sheffield, United Kingdom; University of Leeds, Leeds, United Kingdom; AZURE Investigators
| | - H Marshall
- University of Sheffield, Sheffield, United Kingdom; University of Leeds, Leeds, United Kingdom; AZURE Investigators
| | - D Dodwell
- University of Sheffield, Sheffield, United Kingdom; University of Leeds, Leeds, United Kingdom; AZURE Investigators
| | - M Keane
- University of Sheffield, Sheffield, United Kingdom; University of Leeds, Leeds, United Kingdom; AZURE Investigators
| | - M Gil
- University of Sheffield, Sheffield, United Kingdom; University of Leeds, Leeds, United Kingdom; AZURE Investigators
| | - W Gregory
- University of Sheffield, Sheffield, United Kingdom; University of Leeds, Leeds, United Kingdom; AZURE Investigators
| | - D Cameron
- University of Sheffield, Sheffield, United Kingdom; University of Leeds, Leeds, United Kingdom; AZURE Investigators
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Coleman R, Hall A, Bell R, Cameron D, Marshall H, Jean-Mairet J, Tercero J, Rojo F, Albanell J, Gomis R. Abstract P1-09-01: Impact of MAF gene amplification on disease recurrence and effects of adjuvant zoledronic acid in early breast cancer. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p1-09-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Meta-analysis of clinical trials has shown that adjuvant bisphosphonates reduce bone metastases and improve survival in postmenopausal (PM) pts1. However, we are unable to select pts most likely to benefit. To address this, the recently identified early breast cancer bone relapse biomarker, 16q23(MAF) gain (MAF+)2, was tested retrospectively in the large prospectively randomized AZURE trial3 of standard adjuvant therapy +/- zoledronic acid (ZOL) to determine the prognostic value of MAF and its potential to predict the effects of ZOL on disease outcomes.
Materials and methods: All analyses were performed with ethics approval and consent. The biomarker analysis was completed on TMAs from primary tumors. Quadruplicate cores of breast tumor tissue were arrayed across replicate TMAs. MAF+ was detected using a validated (MAF/D16Z3) FISH test (Inbiomotion SL, Barcelona, Spain). A central laboratory (Targos, Kassel, Germany) validated the assay for analytic and diagnostic performance, established acceptance criteria, included appropriate quality controls for each assay, and performed the analyses in a blinded fashion. A copy number cut-off ≥2.5 was preset for MAF+. Invasive disease free (IDFS), overall (OS) survival and time to bone metastases multivariate analyses were performed in control and ZOL pts separately. Subsequently, interactions between MAF+ and effects of ZOL on disease outcomes by menopausal status were evaluated.
Results: 1769 of the 3360 AZURE pts donated primary tumor samples. Median follow-up was 84 months. 865 pts (49%) had 2 FISH evaluable cores and were included in the analysis of which 184 (21%) had MAF+ tumors. Tumors that were MAF+ were more likely to be of higher grade, ER-ve and Her2+.
In control pts, MAF was not prognostic for IDFS or OS although there were differences in IDFS by menopause (HR for MAF-/MAF+ in PM=0.47 [95%CI 0.25-0.88]; HR in non-PM=1.58 [0.82-3.03], test for interaction (TFI) by menopause P=0.007). In ZOL pts, MAF was prognostic for IDFS (HR=0.52 [0.36-0.75] and OS (HR=0.48 [0.31-0.75]). There were insufficient bone events (19 MAF+, 73 MAF-) in this sample set to reliably assess the impact of MAF+ on relapse in bone.
In pts with MAF- tumors, ZOL was associated with improved IDFS (HR=0.74 [0.56-0.98]) and OS (HR=0.78 [0.55-1.10]). However, the effects of ZOL in MAF+ were profoundly influenced by menopausal status with possibly better outcomes in PM women (HR for IDFS=0.74 [0.35-1.58]) but clearly worse IDFS and OS outcomes in ZOL treated MAF+ pts who were non-PM (HR for IDFS 2.46 [1.23-4.92], TFI by treatment P=0.002 and HR for OS=2.27 [1.04-4.93], TFI by treatment P=0.032). The interactions between disease outcomes, ZOL use and menopause were driven largely by an association between MAF+ and an increased risk of extra-skeletal recurrence with the use of ZOL in women who were not PM.
Conclusions: Absence of MAF amplification is associated with improved disease outcomes with adjuvant ZOL. However, the use of adjuvant ZOL in women with MAF+ tumors who are not PM at the start of treatment is associated with extraskeletal spread and worse DFS and OS.
1EBCTCG Lancet 2015;386:1353–1361; 2Pavlovic M et al JNCI 2015;107(12):djv256; 3Coleman RE et al Lancet Oncol 2014;15:997-1006.
Citation Format: Coleman R, Hall A, Bell R, Cameron D, Marshall H, Jean-Mairet J, Tercero J, Rojo F, Albanell J, Gomis R. Impact of MAF gene amplification on disease recurrence and effects of adjuvant zoledronic acid in early breast cancer [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P1-09-01.
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Affiliation(s)
- R Coleman
- University of Sheffield, Sheffield, United Kingdom; University of Leeds, Leeds, United Kingdom; Andrew Love Cancer Centre, Geelong, Australia; University of Edinburgh, Edinburgh, United Kingdom; Inbiomotion SL, Barcelona, Spain; Fundación Jiménez Díaz, Madrid, Spain; Hospital del Mar, Barcelona, Spain; Institute for Research in Biomedicine (IRB Barcelona) and Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain
| | - A Hall
- University of Sheffield, Sheffield, United Kingdom; University of Leeds, Leeds, United Kingdom; Andrew Love Cancer Centre, Geelong, Australia; University of Edinburgh, Edinburgh, United Kingdom; Inbiomotion SL, Barcelona, Spain; Fundación Jiménez Díaz, Madrid, Spain; Hospital del Mar, Barcelona, Spain; Institute for Research in Biomedicine (IRB Barcelona) and Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain
| | - R Bell
- University of Sheffield, Sheffield, United Kingdom; University of Leeds, Leeds, United Kingdom; Andrew Love Cancer Centre, Geelong, Australia; University of Edinburgh, Edinburgh, United Kingdom; Inbiomotion SL, Barcelona, Spain; Fundación Jiménez Díaz, Madrid, Spain; Hospital del Mar, Barcelona, Spain; Institute for Research in Biomedicine (IRB Barcelona) and Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain
| | - D Cameron
- University of Sheffield, Sheffield, United Kingdom; University of Leeds, Leeds, United Kingdom; Andrew Love Cancer Centre, Geelong, Australia; University of Edinburgh, Edinburgh, United Kingdom; Inbiomotion SL, Barcelona, Spain; Fundación Jiménez Díaz, Madrid, Spain; Hospital del Mar, Barcelona, Spain; Institute for Research in Biomedicine (IRB Barcelona) and Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain
| | - H Marshall
- University of Sheffield, Sheffield, United Kingdom; University of Leeds, Leeds, United Kingdom; Andrew Love Cancer Centre, Geelong, Australia; University of Edinburgh, Edinburgh, United Kingdom; Inbiomotion SL, Barcelona, Spain; Fundación Jiménez Díaz, Madrid, Spain; Hospital del Mar, Barcelona, Spain; Institute for Research in Biomedicine (IRB Barcelona) and Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain
| | - J Jean-Mairet
- University of Sheffield, Sheffield, United Kingdom; University of Leeds, Leeds, United Kingdom; Andrew Love Cancer Centre, Geelong, Australia; University of Edinburgh, Edinburgh, United Kingdom; Inbiomotion SL, Barcelona, Spain; Fundación Jiménez Díaz, Madrid, Spain; Hospital del Mar, Barcelona, Spain; Institute for Research in Biomedicine (IRB Barcelona) and Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain
| | - J Tercero
- University of Sheffield, Sheffield, United Kingdom; University of Leeds, Leeds, United Kingdom; Andrew Love Cancer Centre, Geelong, Australia; University of Edinburgh, Edinburgh, United Kingdom; Inbiomotion SL, Barcelona, Spain; Fundación Jiménez Díaz, Madrid, Spain; Hospital del Mar, Barcelona, Spain; Institute for Research in Biomedicine (IRB Barcelona) and Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain
| | - F Rojo
- University of Sheffield, Sheffield, United Kingdom; University of Leeds, Leeds, United Kingdom; Andrew Love Cancer Centre, Geelong, Australia; University of Edinburgh, Edinburgh, United Kingdom; Inbiomotion SL, Barcelona, Spain; Fundación Jiménez Díaz, Madrid, Spain; Hospital del Mar, Barcelona, Spain; Institute for Research in Biomedicine (IRB Barcelona) and Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain
| | - J Albanell
- University of Sheffield, Sheffield, United Kingdom; University of Leeds, Leeds, United Kingdom; Andrew Love Cancer Centre, Geelong, Australia; University of Edinburgh, Edinburgh, United Kingdom; Inbiomotion SL, Barcelona, Spain; Fundación Jiménez Díaz, Madrid, Spain; Hospital del Mar, Barcelona, Spain; Institute for Research in Biomedicine (IRB Barcelona) and Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain
| | - R Gomis
- University of Sheffield, Sheffield, United Kingdom; University of Leeds, Leeds, United Kingdom; Andrew Love Cancer Centre, Geelong, Australia; University of Edinburgh, Edinburgh, United Kingdom; Inbiomotion SL, Barcelona, Spain; Fundación Jiménez Díaz, Madrid, Spain; Hospital del Mar, Barcelona, Spain; Institute for Research in Biomedicine (IRB Barcelona) and Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain
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Oaknin A, Oza A, Tinker A, Ray-Coquard I, Coleman R, O’Malley D, Shapira-Frommer R, Leary A, Chen L, Provencher D, Ma L, Brenton J, Balmaña J, Giordano H, Maloney L, Goble S, Rolfe L, McNeish I, Swisher E, Kristeleit R. Integrated efficacy and safety analysis of the poly(ADP-ribose) polymerase (PARP) inhibitor rucaparib in patients (pts) with high-grade ovarian carcinoma (HGOC). Eur J Cancer 2017. [DOI: 10.1016/s0959-8049(17)30395-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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McCarthy DT, Jovanovic D, Lintern A, Teakle I, Barnes M, Deletic A, Coleman R, Rooney G, Prosser T, Coutts S, Hipsey MR, Bruce LC, Henry R. Source tracking using microbial community fingerprints: Method comparison with hydrodynamic modelling. Water Res 2017; 109:253-265. [PMID: 27912100 DOI: 10.1016/j.watres.2016.11.043] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 11/02/2016] [Accepted: 11/14/2016] [Indexed: 05/22/2023]
Abstract
Urban estuaries around the world are experiencing contamination from diffuse and point sources, which increases risks to public health. To mitigate and manage risks posed by elevated levels of contamination in urban waterways, it is critical to identify the primary water sources of contamination within catchments. Source tracking using microbial community fingerprints is one tool that can be used to identify sources. However, results derived from this approach have not yet been evaluated using independent datasets. As such, the key objectives of this investigation were: (1) to identify the major sources of water responsible for bacterial loadings within an urban estuary using microbial source tracking (MST) using microbial communities; and (2) to evaluate this method using a 3-dimensional hydrodynamic model. The Yarra River estuary, which flows through the city of Melbourne in South-East Australia was the focus of this study. We found that the water sources contributing to the bacterial community in the Yarra River estuary varied temporally depending on the estuary's hydrodynamic conditions. The water source apportionment determined using microbial community MST correlated to those determined using a 3-dimensional hydrodynamic model of the transport and mixing of a tracer in the estuary. While there were some discrepancies between the two methods, this investigation demonstrated that MST using bacterial community fingerprints can identify the primary water sources of microorganisms in an estuarine environment. As such, with further optimization and improvements, microbial community MST has the potential to become a powerful tool that could be practically applied in the mitigation of contaminated aquatic systems.
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Affiliation(s)
- D T McCarthy
- Environmental and Public Health Microbiology Laboratory (EPHM Lab), Civil Engineering Department, Monash University, VIC, Australia.
| | - D Jovanovic
- Environmental and Public Health Microbiology Laboratory (EPHM Lab), Civil Engineering Department, Monash University, VIC, Australia
| | - A Lintern
- Environmental and Public Health Microbiology Laboratory (EPHM Lab), Civil Engineering Department, Monash University, VIC, Australia.
| | - I Teakle
- Water and Environment Group, BMT WBM Pty Ltd, Spring Hill, QLD, Australia
| | - M Barnes
- Water and Environment Group, BMT WBM Pty Ltd, Spring Hill, QLD, Australia
| | - A Deletic
- Environmental and Public Health Microbiology Laboratory (EPHM Lab), Civil Engineering Department, Monash University, VIC, Australia
| | - R Coleman
- Melbourne Water Corporation, VIC, Australia
| | - G Rooney
- Melbourne Water Corporation, VIC, Australia
| | - T Prosser
- Melbourne Water Corporation, VIC, Australia
| | - S Coutts
- Micromon, Department of Microbiology, Monash University, Australia
| | - M R Hipsey
- School of Earth & Environment, The University of Western Australia, Crawley, WA, Australia; The Oceans Institute, The University of Western Australia, Crawley, WA, Australia
| | - L C Bruce
- School of Earth & Environment, The University of Western Australia, Crawley, WA, Australia; The Oceans Institute, The University of Western Australia, Crawley, WA, Australia
| | - R Henry
- Environmental and Public Health Microbiology Laboratory (EPHM Lab), Civil Engineering Department, Monash University, VIC, Australia
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Body J, Terpos E, Tombal B, Hadji P, Arif A, Young A, Aapro M, Coleman R. Bone health in the elderly cancer patient: A SIOG position paper. Cancer Treat Rev 2016; 51:46-53. [DOI: 10.1016/j.ctrv.2016.10.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 10/19/2016] [Indexed: 01/13/2023]
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Abstract
One area of science in which probabilistic models are beginning to play a role is in neuron firing. The firing process may be thought of in terms of electrical potentials: there is a potential difference across the membrane surrounding a neuron; this potential difference is determined by the concentrations of sodium, potassium, and chlorine ions on the two sides of the membrane. When electrical impulses arrive along the many input fibers, the potential difference changes; when it crosses a certain threshold, the neuron “fires”, that is, an impulse is discharged along the axon. Arriving impulses are of two types, those which raise and those which lower the potential inside the neuron; these are called stimuli and inhibitors, respectively. The mechanism by which stimuli and inhibitors interact in changing the neuron potential is not well understood; however, it appears that some of the stimuli cause the neuron to respond, or fire, and the inhibitors play a role in preventing the other stimuli from causing a response. The ability of stimuli to cause responses is further weakened by the decay, in the absence of arriving impulses, of the transmembrane potential toward a “resting level”, the level to which the potential is reset after a firing. While several models for the firing process have been proposed ([3], [4], [5], [6], [7], [11]), the present paper is devoted to introducing some modifications into a model proposed by Ten Hoopen and Reuver ([9], [10]). In particular, we place a time limit on the ability of inhibitors to prevent a stimulus from producing a response. Hopefully, these modifications bring their model closer to physiological reality.
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Crotti T, Coleman R, Dharmapatni A, Weedon H, Haynes D, Smith M, Wechalekar M. THU0023 Expression of OSCAR in The Synovium of Early RA Patients. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.2109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Baird R, Banks I, Cameron D, Chester J, Earl H, Flannagan M, Januszewski A, Kennedy R, Payne S, Samuel E, Taylor H, Agarwal R, Ahmed S, Archer C, Board R, Carser J, Copson E, Cunningham D, Coleman R, Dangoor A, Dark G, Eccles D, Gallagher C, Glaser A, Griffiths R, Hall G, Hall M, Harari D, Hawkins M, Hill M, Johnson P, Jones A, Kalsi T, Karapanagiotou E, Kemp Z, Mansi J, Marshall E, Mitchell A, Moe M, Michie C, Neal R, Newsom-Davis T, Norton A, Osborne R, Patel G, Radford J, Ring A, Shaw E, Skinner R, Stark D, Turnbull S, Velikova G, White J, Young A, Joffe J, Selby P. An Association of Cancer Physicians' strategy for improving services and outcomes for cancer patients. Ecancermedicalscience 2016; 10:608. [PMID: 26913066 PMCID: PMC4762575 DOI: 10.3332/ecancer.2016.608] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Indexed: 12/02/2022] Open
Abstract
The Association of Cancer Physicians in the United Kingdom has developed a strategy to improve outcomes for cancer patients and identified the goals and commitments of the Association and its members.
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Affiliation(s)
- Richard Baird
- ACP Executive Member
- ACP Strategy Drafting Group
- Supporting Chapter Author
- Addenbrooke’s Hospital, Cambridge, UK
| | - Ian Banks
- ACP Strategy Drafting Group
- Supporting Chapter Author
- University of Leeds, Leeds LS2 9JT, UK
| | - David Cameron
- ACP Executive Member
- ACP Strategy Drafting Group
- Edinburgh Cancer Research Centre, UK
| | - John Chester
- ACP Executive Member
- ACP Strategy Drafting Group
- Supporting Chapter Author
- Wales Cancer Research Centre, Cardiff, UK
| | - Helena Earl
- ACP Executive Member
- ACP Strategy Drafting Group
- Supporting Chapter Author
- Addenbrooke’s Hospital, Cambridge, UK
| | - Mark Flannagan
- ACP Strategy Drafting Group
- Supporting Chapter Author
- Beating Bowel Cancer, Harlequin House, 7 High St, Teddington, Middlesex TW11 8EE, UK
| | - Adam Januszewski
- ACP Executive Member
- ACP Strategy Drafting Group
- Supporting Chapter Author
- London Deanery, Stewart House, 32 Russell Square, London WC1B 5DN, UK
| | | | - Sarah Payne
- ACP Executive Member
- ACP Strategy Drafting Group
- Supporting Chapter Author
- Guy’s and St Thomas’s Hospital, London, UK and Medical Affairs Manager, Pfizer
| | - Emlyn Samuel
- ACP Strategy Drafting Group
- Cancer Research UK, Angel Building, 407 St John Street, London EC1V 4AD, UK
| | - Hannah Taylor
- ACP Executive Member
- ACP Strategy Drafting Group
- Supporting Chapter Author
- Severn Deanery, Vantage Office Park Old Gloucester Road, Hambrook, Avon, Bristol BS16 1GW, UK
| | - Roshan Agarwal
- ACP Executive Member
- Northampton General Hospital, Cliftonville, Northampton NN1 5BD, UK
| | - Samreen Ahmed
- ACP Executive Member
- University Hospitals of Leicester, Infirmary Square, Leicester LE1 5WW, UK
| | - Caroline Archer
- ACP Executive Member
- Queen Alexandra Hospital, Portsmouth, UK
| | - Ruth Board
- ACP Executive Member
- Lancashire Teaching Hospitals, UK
| | - Judith Carser
- ACP Executive Member
- Southern Health and Social Care Trust, Southern College of Nursing, Craigavon Area Hospital, 68 Lurgan Road, Portadown, BT63 5QQ, UK
| | - Ellen Copson
- Supporting Chapter Author
- University of Southampton, University Rd, Southampton SO17 1BJ, UK
| | - David Cunningham
- ACP Executive Member
- Supporting Chapter Author
- NIHR Biomedical Research Centre, Royal Marsden Hospital, London, UK
| | - Rob Coleman
- ACP Executive Member
- Weston Park Hospital, Sheffield, UK
| | - Adam Dangoor
- ACP Executive Member
- Supporting Chapter Author
- University Hospitals Bristol, Bristol, UK
| | - Graham Dark
- Supporting Chapter Author
- Freeman Hospital, Newcastle, UK
| | - Diana Eccles
- Supporting Chapter Author
- University of Southampton, University Rd, Southampton SO17 1BJ, UK
| | | | - Adam Glaser
- Supporting Chapter Author
- University of Leeds, Leeds LS2 9JT, UK
| | - Richard Griffiths
- ACP Executive Member
- Supporting Chapter Author
- Clatterbridge Cancer Centre, Clatterbridge Health Park, Clatterbridge Rd, Wirral, Merseyside CH63 4JY, UK
| | - Geoff Hall
- Supporting Chapter Author
- Leeds Cancer Centre, St James’s University Hospital, Leeds, UK
| | - Marcia Hall
- ACP Executive Member
- Mount Vernon Cancer Centre, Northwood, UK
| | - Danielle Harari
- Supporting Chapter Author
- Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Michael Hawkins
- Supporting Chapter Author
- University of Birmingham, Edgbaston, Birmingham, West Midlands B15 2TT, UK
| | - Mark Hill
- ACP Executive Member
- Kent Oncology Centre, Maidstone, Kent, UK
| | - Peter Johnson
- Supporting Chapter Author
- University of Southampton, University Rd, Southampton SO17 1BJ, UK
| | - Alison Jones
- ACP Executive Member
- Royal Free and University College Hospital, London, UK
| | - Tania Kalsi
- Supporting Chapter Author
- Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | | | - Zoe Kemp
- Supporting Chapter Author
- Royal Marsden Hospital, London, UK
| | - Janine Mansi
- ACP Executive Member
- Supporting Chapter Author
- Guy’s and St Thomas’ Hospitals, London, UK
| | - Ernie Marshall
- Supporting Chapter Author
- Clatterbridge Cancer Centre, Clatterbridge Health Park, Clatterbridge Rd, Wirral, Merseyside CH63 4JY, UK
| | - Alex Mitchell
- Supporting Chapter Author
- University of Leicester, University Rd, Leicester LE1 7RH, UK
| | - Maung Moe
- ACP Executive Member
- North Middlesex University Hospital, UK
| | | | - Richard Neal
- Supporting Chapter Author
- University of Bangor, Bangor, Gwynedd LL57 2DG , Wales, UK
| | - Tom Newsom-Davis
- Supporting Chapter Author
- Chelsea and Westminster Hospital, London, UK
| | | | - Richard Osborne
- Supporting Chapter Author
- Poole Hospital, Longfleet Rd, Poole, Dorset BH15 2JB, UK
| | - Gargi Patel
- ACP Executive Member
- Brighton and Sussex University Hospitals, UK
| | - John Radford
- Supporting Chapter Author
- University of Manchester, Oxford Rd, Manchester M13 9PL, UK
| | - Alistair Ring
- Supporting Chapter Author
- Royal Marsden Hospital, London, UK
| | - Emily Shaw
- Supporting Chapter Author
- Southampton General Hospital, Tremona Rd, Southampton, Hampshire SO16 6YD, UK
| | - Rod Skinner
- Supporting Chapter Author
- Royal Victoria Infirmary, Newcastle, UK
| | - Dan Stark
- Supporting Chapter Author
- Leeds Cancer Centre, St James’s University Hospital, Leeds, UK
| | - Sam Turnbull
- ACP Executive Member
- Leeds Cancer Centre, St James’s University Hospital, Leeds, UK
| | - Galina Velikova
- Supporting Chapter Author
- University of Leeds, Leeds LS2 9JT, UK
| | - Jeff White
- Supporting Chapter Author
- Beatson West of Scotland Cancer Centre, Glasgow, Scotland, UK
| | - Alison Young
- ACP Executive Member
- Supporting Chapter Author
- Leeds Cancer Centre, St James’s University Hospital, Leeds, UK
| | - Johnathan Joffe
- ACP Executive Member
- ACP Strategy Drafting Group
- Supporting Chapter Author
- Senior Author
- Huddersfield Royal Infirmary, Acre St, Huddersfield, West Yorkshire HD3 3EA, UK
| | - Peter Selby
- ACP Executive Member
- ACP Strategy Drafting Group
- Supporting Chapter Author
- Senior Author
- Leeds Cancer Centre, St James’s University Hospital, Leeds, UK
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Gourgou-Bourgade S, Cameron D, Poortmans P, Asselain B, Azria D, Cardoso F, A'Hern R, Bliss J, Bogaerts J, Bonnefoi H, Brain E, Cardoso MJ, Chibaudel B, Coleman R, Cufer T, Dal Lago L, Dalenc F, De Azambuja E, Debled M, Delaloge S, Filleron T, Gligorov J, Gutowski M, Jacot W, Kirkove C, MacGrogan G, Michiels S, Negreiros I, Offersen BV, Penault Llorca F, Pruneri G, Roche H, Russell NS, Schmitt F, Servent V, Thürlimann B, Untch M, van der Hage JA, van Tienhoven G, Wildiers H, Yarnold J, Bonnetain F, Mathoulin-Pélissier S, Bellera C, Dabakuyo-Yonli TS. Guidelines for time-to-event end point definitions in breast cancer trials: results of the DATECAN initiative (Definition for the Assessment of Time-to-event Endpoints in CANcer trials). Ann Oncol 2015; 26:2505-6. [PMID: 26467471 DOI: 10.1093/annonc/mdv478] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Coleman R, King T, Nicoara CD, Bader M, McCarthy L, Chandran H, Parashar K. Nadir creatinine in posterior urethral valves: How high is low enough? J Pediatr Urol 2015; 11:356.e1-5. [PMID: 26292912 DOI: 10.1016/j.jpurol.2015.06.008] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2015] [Accepted: 06/18/2015] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Large retrospective studies of people with posterior urethral valves (PUV) have reported chronic renal insufficiency (CRI) in up to one third of the participants and end-stage renal failure in up to one quarter of them. Nadir creatinine (lowest creatinine during the first year following diagnosis) is the recognised prognostic indicator for renal outcome in PUV, the most commonly used cut-off being 1 mg/dl (88.4 umol/l). OBJECTIVE To conduct a statistical analysis of nadir creatinine in PUV patients in order to identify the optimal cut-off level as a prognostic indicator for CRI. STUDY DESIGN Patients treated by endoscopic valve ablation at the present institution between 1993 and 2004 were reviewed. Chronic renal insufficiency was defined as CKD2 or higher. Statistical methods included receiver operating characteristic (ROC) curve analysis, Fisher exact test and diagnostic utility tests. Statistical significance was defined as P < 0.05. RESULTS AND DISCUSSION Nadir creatinine was identified in 96 patients. The median follow-up was 9.4 (IQR 7.0, 13.4) years. A total of 29 (30.2%) patients developed CRI, with nine (9.4%) reaching end-stage renal failure. On ROC analysis, Nadir creatinine was highly prognostic for future CRI, with an Area Under the Curve of 0.887 (P < 0.001). Renal insufficiency occurred in all 10 (100%) patients with nadir creatinine >88.4 umol/l compared with 19 of 86 (22.2%) patients with lower nadir creatinine (P < 0.001). As a test for future CRI, a nadir creatinine cut-off of 88.4 umol/l gave a specificity of 100%, but poor sensitivity of 34.5%. Lowering the cut-off to 75 umol/l resulted in improvement in all diagnostic utility tests (Table). All 14 (100%) patients with nadir creatinine >75 umol/l developed CRI, compared with 15 of 82 (18.3%) patients with lower nadir creatinine (P < 0.001). Sensitivity only approached 95% at 35 umol/l, at which level specificity was low (Table). Two out of 36 (5.6%) patients with nadir creatinine <35 umol/l developed CRI. Multivariate analysis found recurrent UTI (OR 4.733; CI 1.297-17.280) and nadir creatinine >75 umol/l (OR 48.988; CI 4.9-490.11) to be independent risk factors for progression to CRI. Using cut-off values of 35 umol/l and 75 umol/l, patients can be stratified into low-, intermediate- and high-risk groups, with development of CRI in 5.3%, 28.3% and 100%, respectively (P <0.001). The stage of CKD was higher in higher risk groups. CONCLUSION Patients with nadir creatinine >75 umol/l (0.85 mg/dl) should be considered at high risk for CRI, while patients with nadir creatinine ≤35 umol/l (0.4 mg/dl) should be considered low risk. Patients with nadir creatinine between these two values have an intermediate risk of CRI.
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Affiliation(s)
- R Coleman
- Department of Paediatric Surgery and Urology, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, United Kingdom.
| | - T King
- Department of Paediatric Surgery and Urology, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, United Kingdom.
| | - C-D Nicoara
- Department of Paediatric Surgery and Urology, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, United Kingdom.
| | - M Bader
- Department of Paediatric Surgery and Urology, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, United Kingdom.
| | - L McCarthy
- Department of Paediatric Surgery and Urology, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, United Kingdom.
| | - H Chandran
- Department of Paediatric Surgery and Urology, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, United Kingdom.
| | - K Parashar
- Department of Paediatric Surgery and Urology, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, United Kingdom.
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Coleman R, Lisk C, Munroe-Birt J. P-030: Provision of ambulatory emergency care for the very elderly population in Barnet, London, October 2013 – March 2015. Eur Geriatr Med 2015. [DOI: 10.1016/s1878-7649(15)30133-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Gourgou-Bourgade S, Cameron D, Poortmans P, Asselain B, Azria D, Cardoso F, A'Hern R, Bliss J, Bogaerts J, Bonnefoi H, Brain E, Cardoso MJ, Chibaudel B, Coleman R, Cufer T, Dal Lago L, Dalenc F, De Azambuja E, Debled M, Delaloge S, Filleron T, Gligorov J, Gutowski M, Jacot W, Kirkove C, MacGrogan G, Michiels S, Negreiros I, Offersen BV, Penault Llorca F, Pruneri G, Roche H, Russell NS, Schmitt F, Servent V, Thürlimann B, Untch M, van der Hage JA, van Tienhoven G, Wildiers H, Yarnold J, Bonnetain F, Mathoulin-Pélissier S, Bellera C, Dabakuyo-Yonli TS. Guidelines for time-to-event end point definitions in breast cancer trials: results of the DATECAN initiative (Definition for the Assessment of Time-to-event Endpoints in CANcer trials)†. Ann Oncol 2015; 26:873-879. [PMID: 25725046 DOI: 10.1093/annonc/mdv106] [Citation(s) in RCA: 116] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 02/16/2015] [Indexed: 02/11/2024] Open
Abstract
BACKGROUND Using surrogate end points for overall survival, such as disease-free survival, is increasingly common in randomized controlled trials. However, the definitions of several of these time-to-event (TTE) end points are imprecisely which limits interpretation and cross-trial comparisons. The estimation of treatment effects may be directly affected by the definitions of end points. The DATECAN initiative (Definition for the Assessment of Time-to-event Endpoints in CANcer trials) aims to provide recommendations for definitions of TTE end points. We report guidelines for randomized cancer clinical trials (RCTs) in breast cancer. PATIENTS AND METHODS A literature review was carried out to identify TTE end points (primary or secondary) reported in publications of randomized trials or guidelines. An international multidisciplinary panel of experts proposed recommendations for the definitions of these end points based on a validated consensus method that formalize the degree of agreement among experts. RESULTS Recommended guidelines for the definitions of TTE end points commonly used in RCTs for breast cancer are provided for non-metastatic and metastatic settings. CONCLUSION The use of standardized definitions should facilitate comparisons of trial results and improve the quality of trial design and reporting. These guidelines could be of particular interest to those involved in the design, conducting, reporting, or assessment of RCT.
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Affiliation(s)
- S Gourgou-Bourgade
- Biostatistic Unit, Montpellier Cancer Institute, Montpellier; Data Center for Cancer Clinical Trials, CTD-INCa, Montpellier, France.
| | - D Cameron
- Edinburgh Cancer Research Centre, University of Edinburgh, Western General Hospital, Edinburgh, UK
| | - P Poortmans
- Department of Radiation Oncology, Institute Verbeeten, Tilburg, The Netherlands
| | - B Asselain
- Department of Biostatistics, Institut Curie, Paris
| | - D Azria
- Department of Radiation Oncology, Montpellier Cancer Institute, Montpellier, France
| | - F Cardoso
- Breast Cancer Unit, Champalimaud Cancer Center, Lisbon, Portugal
| | - R A'Hern
- Institute of Cancer Research, London, UK
| | - J Bliss
- Institute of Cancer Research, London, UK
| | - J Bogaerts
- EORTC Data Center (European Organization of Research and Treatment of Cancer - Statistics Department), Brussels, Belgium
| | - H Bonnefoi
- Institut Bergonié, Comprehensive Cancer Centre, Bordeaux
| | - E Brain
- Departments of Clinical Research and Medical Oncology, Institut Curie - Hôpital René Huguenin, Saint-Cloud
| | - M J Cardoso
- Breast Cancer Unit, Champalimaud Cancer Center, Lisbon, Portugal
| | - B Chibaudel
- Department of Medical Oncology, Hôpital Saint-Antoine, Paris, France
| | - R Coleman
- FRCP, FRCPE YCR National Institute for Health Research Cancer Research Network (NCRN), Academic Unit of Clinical Oncology, Weston Park Hospital, Sheffield Cancer Research Centre, Sheffield, UK
| | - T Cufer
- University Clinic Golnik, Golnik, Slovenia
| | - L Dal Lago
- Institut Jules Bordet, University 'Libre' of Brussels, Brussels, Belgium
| | - F Dalenc
- Institut Claudius Régaud, Toulouse
| | - E De Azambuja
- Institut Jules Bordet, University 'Libre' of Brussels, Brussels, Belgium
| | - M Debled
- Institut Bergonié, Comprehensive Cancer Centre, Bordeaux
| | - S Delaloge
- Breast Cancer Group, Gustave Roussy Institute, Villejuif
| | | | - J Gligorov
- APHP Tenon - University Cancer Institute - Pierre & Marie Curie, Sorbonne University, Paris
| | | | - W Jacot
- Department of Medical Oncology, Montpellier Cancer Institute, Montpellier, France
| | - C Kirkove
- Université catholique Louvain, Louvain-la-Neuve, Belgium
| | - G MacGrogan
- Institut Bergonié, Comprehensive Cancer Centre, Bordeaux
| | - S Michiels
- Biostatistic and Epidemiology Unit, Gustave Roussy, Villejuif; University of Paris-Sud, Villejuif, France
| | - I Negreiros
- Breast Unit, Hospital CUF Descobertas, Lisbon, Portugal
| | - B V Offersen
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - F Penault Llorca
- Centre Jean Perrin, Clermont-Ferrand; ERTICA EA4677, UFR Medicine, University of Clermont-Ferrand 1, Clermont-Ferrand, France
| | - G Pruneri
- European Institute of Oncology, Milan; University of Milan, School of Medicine, Milan, Italy
| | - H Roche
- Institut Claudius Régaud, Toulouse
| | - N S Russell
- Department of Radiotherapy, The Netherlands Cancer Institute - Antoni van Leeuwnhoek Hospital, Amsterdam, The Netherlands
| | - F Schmitt
- IPATIMUP (Institute of Molecular Pathology and Immunology of the University of Porto), Porto; Medical Faculty of Porto University, Porto, Portugal
| | - V Servent
- Oscar Lambret Comprehensive Cancer Center, Lille, France
| | - B Thürlimann
- Kantonsspital St Gallen, Breast Center, St Gallen, Switzerland
| | - M Untch
- Clinic for Gynecology, Gynecologic Oncology and Obstetrics-Interdisciplinary Breast Cancer Center, HELIOS Klinikum Berlin-Buch, Berlin, Germany
| | - J A van der Hage
- Department of Surgical Oncology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam
| | - G van Tienhoven
- Academic Medical Center Amsterdam, Amsterdam, The Netherlands
| | - H Wildiers
- Department of General Medical Oncology, University Hospitals Leuven, Leuven Cancer Institute, Leuven; Laboratory of Experimental Oncology (LEO), Department of Oncology, KU Leuven, Leuven, Belgium
| | - J Yarnold
- The Institute of Cancer Research, Royal Cancer Hospital, London, UK
| | - F Bonnetain
- Methodological and Quality of Life Unit in Oncology (EA3181), CHU Besançon, Besançon
| | - S Mathoulin-Pélissier
- Clinical and Epidemiological Research Unit, Institut Bergonié, Comprehensive Cancer Centre, Bordeaux; Clinical Epidemiology Unit, INSERM CIC 14.01 (Clinical Epidemiology), Bordeaux
| | - C Bellera
- Clinical and Epidemiological Research Unit, Institut Bergonié, Comprehensive Cancer Centre, Bordeaux; Clinical Epidemiology Unit, INSERM CIC 14.01 (Clinical Epidemiology), Bordeaux
| | - T S Dabakuyo-Yonli
- Biostatistics and Quality of Life Unit (EA4184), Centre Georges François Leclerc Comprehensive Cancer Centre, Dijon, France
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Sestak I, Singh S, Cuzick J, Blake GM, Patel R, Gossiel F, Coleman R, Dowsett M, Forbes JF, Howell A, Eastell R. Changes in bone mineral density at 3 years in postmenopausal women receiving anastrozole and risedronate in the IBIS-II bone substudy: an international, double-blind, randomised, placebo-controlled trial. Lancet Oncol 2014; 15:1460-1468. [PMID: 25456365 DOI: 10.1016/s1470-2045(14)71035-6] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [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: 12/27/2022]
Abstract
BACKGROUND Aromatase inhibitors prevent breast cancer in postmenopausal women at high risk of the disease but are associated with accelerated bone loss. We assessed effectiveness of oral risedronate for prevention of reduction in bone mineral density (BMD) after 3 years of follow-up in a subset of patients in the IBIS-II trial. METHODS The double-blind IBIS-II trial recruited 3864 healthy, postmenopausal women at increased risk of breast cancer and randomly allocated them oral anastrozole (1 mg/day) or matched placebo. 1410 (36%) postmenopausal women were then enrolled in a bone substudy and stratified at baseline according to their lowest baseline T score at spine or femoral neck (stratum I: T score at least -1·0; stratum II: T score at least -2·5 but less than -1·0; stratum III: T score less than -2·5 but greater than -4·0). Women in stratum I were monitored only; women in stratum III were all given risedronate (35 mg/week). Women in stratum II were randomly assigned (1:1) to risedronate (35 mg/week) or matched placebo by use of a block randomisation schedule via a web-based programme. The primary outcome of this per-protocol analysis (done with all women with a baseline and 3 year DXA assessment) was the effect of risedronate versus placebo for osteopenic women in stratum II randomly allocated to anastrozole (1 mg/day). Secondary outcomes included effect of anastrozole (1 mg/day) on BMD in women not receiving risedronate (strata I and II) and in osteoporotic women who were all treated with risedronate (stratum III). The trial is ongoing, but no longer recruiting. This trial is registered, number ISRCTN31488319. FINDINGS Between Feb 2, 2003, and Sept 30, 2010, 150 (58%) of 260 women in stratum II who had been randomly allocated to anastrozole and either risedronate or placebo had baseline and 3 year assessments. At the lumbar spine, 3 year mean BMD change for the 77 women receiving anastrozole/risedronate was 1·1% (95% CI 0·2 to 2·1) versus -2·6% (-4·0 to -1·3) for the 73 women receiving anastrozole/placebo (p<0·0001). For the total hip, 3 year mean BMD change for women receiving anastrozole/risedronate was -0·7% (-1·6 to 0·2) versus -3·5% (-4·6 to -2·3) for women receiving anastrozole/placebo (p=0·0001). 652 (65%) of 1008 women in strata I and II who were not randomly allocated to risedronate had both baseline and 3 year assessments. Women not receiving risedronate in stratum I and II who received anastrozole (310 women) had a significant BMD decrease after 3 years of follow-up compared with women who received placebo (342 women) at the lumbar spine (-4·0% [-4·5 to -3·4] vs -1·2% [-1·7 to -0·7], p<0·0001) and total hip (-4·0% [-4·4 to -3·6] vs -1·8% [-2·1 to -1·4], p<0·0001). 106 (79%) of 149 women in stratum III had a baseline and a 3 year assessment. The 46 women allocated to anastrozole had a modest BMD increase of 1·2% (-0·1 to 2·6) at the spine compared with a 3·9% (2·6 to 5·2) increase for the 60 women allocated to placebo (p=0·006). For the total hip, a small 0·3% (-0·9 to 1·5) increase was noted for women allocated anastrozole compared with a 1·5% (0·5 to 2·5) increase for women allocated placebo, but the difference was not significant (p=0·12). The most common adverse event reported was arthralgia (stratum I: 94 placebo and 114 anastrozole; stratum II: 39 placebo/placebo, 25 placebo/risedronate, 34 anastrozole/placebo, and 34 anastrozole/risedronate; stratum III: 21 placebo/risedronate, 17 anastrozole/risedronate). Other adverse events included hot flushes, alopecia, abdominal pain, and back pain. INTERPRETATION Risedronate counterbalances the effect of anastrozole-induced bone loss in osteopenic and osteoporotic women and might be offered in combination with anastrozole treatment to provide an improved risk-benefit profile. FUNDING Cancer Research UK (C569/A5032), National Health and Medical Research Council Australia (GNT300755, GNT569213), Sanofi-Aventis, and AstraZeneca.
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Affiliation(s)
- Ivana Sestak
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University London, London, UK.
| | - Shalini Singh
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University London, London, UK
| | - Jack Cuzick
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University London, London, UK
| | - Glen M Blake
- Biomedical Engineering Department, King's College London, London, UK
| | | | - Fatma Gossiel
- Department of Human Metabolism, University of Sheffield, Sheffield, UK
| | - Rob Coleman
- Department of Oncology, University of Sheffield, Sheffield, UK
| | - Mitch Dowsett
- Academic Department of Biochemistry, Royal Marsden Hospital, London, UK
| | - John F Forbes
- University of Newcastle, Calvary Mater Hospital, Australia New Zealand Breast Cancer Trials Group Newcastle, Newcastle, NSW, Australia
| | | | - Richard Eastell
- Department of Human Metabolism, University of Sheffield, Sheffield, UK
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Coleman R, Roszak A, Behbakht K, Ray-Coquard I, Matulonis U, Liu H, Schusterbauer C, Ullmann CD. Randomized Phase 2 Study of Investigational, Selective Aurora a Kinase Inhibitor Alisertib (Mln8237) with Weekly Paclitaxel Vs Paclitaxel Alone in Patients (Pts) with Recurrent Ovarian Cancer (Oc). Ann Oncol 2014. [DOI: 10.1093/annonc/mdu338.2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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McNeish I, Coleman R, Oza A, Konecny G, O'Malley D, Kichenadasse G, Scott C, Oaknin A, Floquet A, Park D, Brenton J, Lin K, Shetty S, Giordano H, Raponi M, Rolfe L, Swisher E. Preliminary Results of Ariel2, a Phase 2 Open-Label Study to Identify Ovarian Cancer Patients Likely to Respond to Rucaparib. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu338.9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Schisler J, Grevengoed T, Ellis J, Paul D, Willis M, Patterson C, Coleman R. P663Cardiac energy dependence on glucose increases metabolites related to glutathione and activates metabolic genes controlled by mTOR. Cardiovasc Res 2014. [DOI: 10.1093/cvr/cvu098.88] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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