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Clarke NW, Ali A, Ingleby FC, Hoyle A, Amos CL, Attard G, Brawley CD, Calvert J, Chowdhury S, Cook A, Cross W, Dearnaley DP, Douis H, Gilbert D, Gillessen S, Jones RJ, Langley RE, MacNair A, Malik Z, Mason MD, Matheson D, Millman R, Parker CC, Ritchie AWS, Rush H, Russell JM, Brown J, Beesley S, Birtle A, Capaldi L, Gale J, Gibbs S, Lydon A, Nikapota A, Omlin A, O'Sullivan JM, Parikh O, Protheroe A, Rudman S, Srihari NN, Simms M, Tanguay JS, Tolan S, Wagstaff J, Wallace J, Wylie J, Zarkar A, Sydes MR, Parmar MKB, James ND. Corrigendum to Addition of docetaxel to hormonal therapy in low- and high-burden metastatic hormone sensitive prostate cancer: long-term survival results from the STAMPEDE trial: Ann Oncol 2019; 30: 1992-2003. Ann Oncol 2020; 31:442. [PMID: 32067690 PMCID: PMC8929236 DOI: 10.1016/j.annonc.2020.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- N W Clarke
- Department of Urology, The Christie and Salford Royal NHS Foundation Trusts, Manchester.
| | - A Ali
- Genito-Urinary Cancer Research Group, Division of Cancer Sciences, The University of Manchester, Manchester
| | - F C Ingleby
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London; London School of Hygiene and Tropical Medicine, London
| | - A Hoyle
- Department of Urology, The Christie and Salford Royal NHS Foundation Trusts, Manchester
| | - C L Amos
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | | | - C D Brawley
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | - J Calvert
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | - S Chowdhury
- Guy's and Saint Thomas' NHS Foundation Trust, London
| | - A Cook
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | - W Cross
- St James University Hospital, Leeds
| | | | - H Douis
- Department of Radiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham
| | - D Gilbert
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | - S Gillessen
- Division of Cancer Sciences, The University of Manchester, Manchester
| | - R J Jones
- Beatson West of Scotland Cancer Centre, University of Glasgow, Glasgow
| | - R E Langley
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | - A MacNair
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | - Z Malik
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool
| | | | - D Matheson
- Faculty of Education Health and Wellbeing, University of Wolverhampton, Wolverhampton
| | - R Millman
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | - C C Parker
- Institute of Cancer Research, Sutton-London; RoyalMarsden NHS Foundation Trust, London
| | - A W S Ritchie
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | - H Rush
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | - J M Russell
- Institute of Cancer Sciences, Beatson West of Scotland Cancer Centre, Glasgow
| | - J Brown
- University of Sheffield, Sheffield
| | | | - A Birtle
- Lancashire Teaching Hospitals NHS Foundation Trust, Preston
| | - L Capaldi
- Worcestershire Acute Hospitals NHS Trust, Worcester
| | - J Gale
- Portsmouth Oncology Centre, Queen Alexandra Hospital, Portsmouth
| | | | - A Lydon
- Torbay and South Devon NHS Foundation Trust, Torbay
| | | | - A Omlin
- Department of Oncology and Haematology, Kantonsspital, St Gallen, Switzerland
| | - J M O'Sullivan
- Centre for Cancer Research and Cell Biology, Queen's University Belfast, Belfast, UK
| | - O Parikh
- East Lancashire Hospitals NHS Trust, Blackburn, UK
| | - A Protheroe
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - S Rudman
- Guy's and Saint Thomas' NHS Foundation Trust, London
| | - N N Srihari
- Shrewsbury and Telford Hospital NHS Trust, Shrewsbury, UK
| | - M Simms
- Hull and East Yorkshire Hospitals NHS Trust, Hull, UK
| | | | - S Tolan
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool
| | - J Wagstaff
- Swansea University College of Medicine, Swansea, UK
| | - J Wallace
- Beatson West of Scotland Cancer Centre, University of Glasgow, Glasgow
| | - J Wylie
- The Christie NHS Foundation Trust, Manchester, UK
| | - A Zarkar
- Heartlands Hospital, Birmingham, UK
| | - M R Sydes
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | - M K B Parmar
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | - N D James
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
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Clarke NW, Ali A, Ingleby FC, Hoyle A, Amos CL, Attard G, Brawley CD, Calvert J, Chowdhury S, Cook A, Cross W, Dearnaley DP, Douis H, Gilbert D, Gillessen S, Jones RJ, Langley RE, MacNair A, Malik Z, Mason MD, Matheson D, Millman R, Parker CC, Ritchie AWS, Rush H, Russell JM, Brown J, Beesley S, Birtle A, Capaldi L, Gale J, Gibbs S, Lydon A, Nikapota A, Omlin A, O'Sullivan JM, Parikh O, Protheroe A, Rudman S, Srihari NN, Simms M, Tanguay JS, Tolan S, Wagstaff J, Wallace J, Wylie J, Zarkar A, Sydes MR, Parmar MKB, James ND. Addition of docetaxel to hormonal therapy in low- and high-burden metastatic hormone sensitive prostate cancer: long-term survival results from the STAMPEDE trial. Ann Oncol 2019; 30:1992-2003. [PMID: 31560068 PMCID: PMC6938598 DOI: 10.1093/annonc/mdz396] [Citation(s) in RCA: 222] [Impact Index Per Article: 44.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND STAMPEDE has previously reported that the use of upfront docetaxel improved overall survival (OS) for metastatic hormone naïve prostate cancer patients starting long-term androgen deprivation therapy. We report on long-term outcomes stratified by metastatic burden for M1 patients. METHODS We randomly allocated patients in 2 : 1 ratio to standard-of-care (SOC; control group) or SOC + docetaxel. Metastatic disease burden was categorised using retrospectively-collected baseline staging scans where available. Analysis used Cox regression models, adjusted for stratification factors, with emphasis on restricted mean survival time where hazards were non-proportional. RESULTS Between 05 October 2005 and 31 March 2013, 1086 M1 patients were randomised to receive SOC (n = 724) or SOC + docetaxel (n = 362). Metastatic burden was assessable for 830/1086 (76%) patients; 362 (44%) had low and 468 (56%) high metastatic burden. Median follow-up was 78.2 months. There were 494 deaths on SOC (41% more than the previous report). There was good evidence of benefit of docetaxel over SOC on OS (HR = 0.81, 95% CI 0.69-0.95, P = 0.009) with no evidence of heterogeneity of docetaxel effect between metastatic burden sub-groups (interaction P = 0.827). Analysis of other outcomes found evidence of benefit for docetaxel over SOC in failure-free survival (HR = 0.66, 95% CI 0.57-0.76, P < 0.001) and progression-free survival (HR = 0.69, 95% CI 0.59-0.81, P < 0.001) with no evidence of heterogeneity of docetaxel effect between metastatic burden sub-groups (interaction P > 0.5 in each case). There was no evidence that docetaxel resulted in late toxicity compared with SOC: after 1 year, G3-5 toxicity was reported for 28% SOC and 27% docetaxel (in patients still on follow-up at 1 year without prior progression). CONCLUSIONS The clinically significant benefit in survival for upfront docetaxel persists at longer follow-up, with no evidence that benefit differed by metastatic burden. We advocate that upfront docetaxel is considered for metastatic hormone naïve prostate cancer patients regardless of metastatic burden.
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Affiliation(s)
- N W Clarke
- Department of Urology, The Christie and Salford Royal NHS Foundation Trusts, Manchester.
| | - A Ali
- Genito-Urinary Cancer Research Group, Division of Cancer Sciences, The University of Manchester, Manchester
| | - F C Ingleby
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London; London School of Hygiene and Tropical Medicine, London
| | - A Hoyle
- Department of Urology, The Christie and Salford Royal NHS Foundation Trusts, Manchester
| | - C L Amos
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | | | - C D Brawley
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | - J Calvert
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | - S Chowdhury
- Guy's and Saint Thomas' NHS Foundation Trust, London
| | - A Cook
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | - W Cross
- St James University Hospital, Leeds
| | | | - H Douis
- Department of Radiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham
| | - D Gilbert
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | - S Gillessen
- Division of Cancer Sciences, The University of Manchester, Manchester
| | - R J Jones
- Beatson West of Scotland Cancer Centre, University of Glasgow, Glasgow
| | - R E Langley
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | - A MacNair
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | - Z Malik
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool
| | | | - D Matheson
- Faculty of Education Health and Wellbeing, University of Wolverhampton, Wolverhampton
| | - R Millman
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | - C C Parker
- Institute of Cancer Research, Sutton-London; Royal Marsden NHS Foundation Trust, London
| | - A W S Ritchie
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | - H Rush
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | - J M Russell
- Institute of Cancer Sciences, Beatson West of Scotland Cancer Centre, Glasgow
| | - J Brown
- University of Sheffield, Sheffield
| | | | - A Birtle
- Lancashire Teaching Hospitals NHS Foundation Trust, Preston
| | - L Capaldi
- Worcestershire Acute Hospitals NHS Trust, Worcester
| | - J Gale
- Portsmouth Oncology Centre, Queen Alexandra Hospital, Portsmouth
| | | | - A Lydon
- Torbay and South Devon NHS Foundation Trust, Torbay
| | | | - A Omlin
- Department of Oncology and Haematology, Kantonsspital, St Gallen, Switzerland
| | - J M O'Sullivan
- Centre for Cancer Research and Cell Biology, Queen's University Belfast, Belfast
| | - O Parikh
- East Lancashire Hospitals NHS Trust, Blackburn
| | - A Protheroe
- Oxford University Hospitals NHS Foundation Trust, Oxford
| | - S Rudman
- Guy's and Saint Thomas' NHS Foundation Trust, London
| | - N N Srihari
- Shrewsbury and Telford Hospital NHS Trust, Shrewsbury
| | - M Simms
- Hull and East Yorkshire Hospitals NHS Trust, Hull
| | | | - S Tolan
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool
| | - J Wagstaff
- Swansea University College of Medicine, Swansea
| | - J Wallace
- Beatson West of Scotland Cancer Centre, University of Glasgow, Glasgow
| | - J Wylie
- The Christie NHS Foundation Trust, Manchester
| | | | - M R Sydes
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | - M K B Parmar
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | - N D James
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham
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Ager M, Njoku K, Serra M, Pickering L, Afshar M, Beesley S, Robinson A, Crellin P, Vyas L, Kayes O, Elmamoun M, Eardley I, Ayres B, Henry A, Tree A, Watkin N. Results of a 10 year multicentre experience of adjuvant radiotherapy for pN3 squamous cell carcinoma of the penis (SCCp). ACTA ACUST UNITED AC 2019. [DOI: 10.1016/s1569-9056(19)30479-8] [Citation(s) in RCA: 1] [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: 10/27/2022]
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Li R, Sridharan M, Clarke A, Beesley S, Taylor H, Lees K. Comparison of Toxicity and Efficacy Outcomes of Capecitabine/MMC and 5FU/MMC in Patients with Bladder Cancer Treated with Radical Chemoradiotherapy. Clin Oncol (R Coll Radiol) 2018. [DOI: 10.1016/j.clon.2017.12.016] [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: 10/18/2022]
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James N, Pirrie S, Pope A, Barton D, Andronis L, Goranitis I, Collins S, McLaren D, O'Sullivan J, Parker C, Porfiri E, Staffurth J, Stanley A, Wylie J, Beesley S, Birtle A, Brown J, Chakraborti P, Russell M, Billingham L. TRAPEZE: a randomised controlled trial of the clinical effectiveness and cost-effectiveness of chemotherapy with zoledronic acid, strontium-89, or both, in men with bony metastatic castration-refractory prostate cancer. Health Technol Assess 2018; 20:1-288. [PMID: 27434595 DOI: 10.3310/hta20530] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Bony metastatic castration-refractory prostate cancer is associated with a poor prognosis and high morbidity. TRAPEZE was a two-by-two factorial randomised controlled trial of zoledronic acid (ZA) and strontium-89 (Sr-89), each combined with docetaxel. All have palliative benefits, are used to control bone symptoms and are used with docetaxel to prolong survival. ZA, approved on the basis of reducing skeletal-related events (SREs), is commonly combined with docetaxel in practice, although evidence of efficacy and cost-effectiveness is lacking. Sr-89, approved for controlling metastatic pain and reducing need for subsequent bone treatments, is generally palliatively used in patients unfit for chemotherapy. Phase II analysis confirmed the safety and feasibility of combining these agents. TRAPEZE aimed to determine the clinical effectiveness and cost-effectiveness of each agent. METHODS Patients were randomised to receive six cycles of docetaxel plus prednisolone: alone, with ZA, with a single Sr-89 dose after cycle 6, or with both. Primary outcomes were clinical progression-free survival (CPFS: time to pain progression, SRE or death) and cost-effectiveness. Secondary outcomes were SRE-free interval (SREFI), total SREs, overall survival (OS) and quality of life (QoL). Log-rank test and Cox regression modelling were used to determine clinical effectiveness. Cost-effectiveness was assessed from the NHS perspective and expressed as cost per additional quality-adjusted life-year (QALY). An additional analysis was carried out for ZA to reflect the availability of generic ZA. RESULTS PATIENTS 757 randomised (median age 68.7 years; Eastern Cooperative Oncology Group scale score 0, 40%; 1, 52%; 2, 8%; prior radiotherapy, 45%); median prostate-specific antigen 143.78 ng/ml (interquartile range 50.8-353.9 ng/ml). Stratified log-rank analysis of CPFS was statistically non-significant for either agent (Sr-89, p = 0.11; ZA, p = 0.45). Cox regression analysis adjusted for stratification variables showed CPFS benefit for Sr-89 [hazard ratio (HR) 0.845, 95% confidence interval (CI) 0.72 to 0.99; p = 0.036] and confirmed no effect of ZA (p = 0.46). ZA showed a significant SREFI effect (HR 0.76; 95% CI 0.63 to 0.93; p = 0.008). Neither agent affected OS (Sr-89, p = 0.74; ZA, p = 0.91), but both increased total cost (vs. no ZA and no Sr-89, respectively); decreased post-trial therapies partly offset costs [net difference: Sr-89 £1341; proprietary ZA (Zometa(®), East Hanover, NJ, USA) £1319; generic ZA £251]. QoL was maintained in all trial arms; Sr-89 (0.08 additional QALYs) and ZA (0.03 additional QALYs) showed slight improvements. The resulting incremental cost-effectiveness ratio (ICER) for Sr-89 was £16,590, with £42,047 per QALY for Zometa and £8005 per QALY for generic ZA. CONCLUSION Strontium-89 improved CPFS, but not OS. ZA did not improve CPFS or OS but significantly improved SREFI, mostly post progression, suggesting a role as post-chemotherapy maintenance therapy. QoL was well maintained in all treatment arms, with differing patterns of care resulting from the effects of Sr-89 on time to progression and ZA on SREFI and total SREs. The addition of Sr-89 resulted in additional cost and a small positive increase in QALYs, with an ICER below the £20,000 ceiling per QALY. The additional costs and small positive QALY changes in favour of ZA resulted in ICERs of £42,047 (Zometa) and £8005 for the generic alternative; thus, generic ZA represents a cost-effective option. Additional analyses on the basis of data from the Hospital Episode Statistics data set would allow corroborating the findings of this study. Further research into the use of ZA (and other bone-targeting therapies) with newer prostate cancer therapies would be desirable. STUDY REGISTRATION Current Controlled Trials ISRCTN12808747. FUNDING This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 20, No. 53. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Nicholas James
- Department of Oncology, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK.,Cancer Research Unit, University of Warwick, Coventry, UK
| | - Sarah Pirrie
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Ann Pope
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Darren Barton
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | | | - Ilias Goranitis
- Health Economics Unit, University of Birmingham, Birmingham, UK
| | - Stuart Collins
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Duncan McLaren
- Edinburgh Cancer Centre, Western General Hospital, Edinburgh, UK
| | - Joe O'Sullivan
- Department of Oncology, Belfast City Hospital, Belfast, UK
| | - Chris Parker
- Department of Oncology, Royal Marsden Hospital, Sutton, UK
| | - Emilio Porfiri
- Department of Oncology, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - John Staffurth
- Institute of Cancer and Genetics, Cardiff University, Cardiff, UK.,Velindre Cancer Centre, Cardiff, UK
| | | | - James Wylie
- Department of Oncology, The Christie Hospital, Manchester, UK
| | | | - Alison Birtle
- Rosemere Cancer Centre, Royal Preston Hospital, Preston, UK
| | - Janet Brown
- Department of Oncology, St James' University Hospital, Leeds, UK
| | | | | | - Lucinda Billingham
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
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Andronis L, Goranitis I, Pirrie S, Pope A, Barton D, Collins S, Daunton A, McLaren D, O'Sullivan JM, Parker C, Porfiri E, Staffurth J, Stanley A, Wylie J, Beesley S, Birtle A, Brown JE, Chakraborti P, Hussain SA, Russell JM, Billingham LJ, James ND. Cost-effectiveness of zoledronic acid and strontium-89 as bone protecting treatments in addition to chemotherapy in patients with metastatic castrate-refractory prostate cancer: results from the TRAPEZE trial (ISRCTN 12808747). BJU Int 2017; 119:522-529. [PMID: 27256016 DOI: 10.1111/bju.13549] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To evaluate the cost-effectiveness of adding zoledronic acid or strontium-89 to standard docetaxel chemotherapy for patients with castrate-refractory prostate cancer (CRPC). PATIENTS AND METHODS Data on resource use and quality of life for 707 patients collected prospectively in the TRAPEZE 2 × 2 factorial randomised trial (ISRCTN 12808747) were used to assess the cost-effectiveness of i) zoledronic acid versus no zoledronic acid (ZA vs. no ZA), and ii) strontium-89 versus no strontium-89 (Sr89 vs. no Sr89). Costs were estimated from the perspective of the National Health Service in the UK and included expenditures for trial treatments, concomitant medications, and use of related hospital and primary care services. Quality-adjusted life-years (QALYs) were calculated according to patients' responses to the generic EuroQol EQ-5D-3L instrument, which evaluates health status. Results are expressed as incremental cost-effectiveness ratios (ICERs) and cost-effectiveness acceptability curves. RESULTS The per-patient cost for ZA was £12 667, £251 higher than the equivalent cost in the no ZA group. Patients in the ZA group had on average 0.03 QALYs more than their counterparts in no ZA group. The ICER for this comparison was £8 005. Sr89 was associated with a cost of £13 230, £1365 higher than no Sr89, and a gain of 0.08 QALYs compared to no Sr89. The ICER for Sr89 was £16 884. The probabilities of ZA and Sr89 being cost-effective were 0.64 and 0.60, respectively. CONCLUSIONS The addition of bone-targeting treatments to standard chemotherapy led to a small improvement in QALYs for a modest increase in cost (or cost-savings). ZA and Sr89 resulted in ICERs below conventional willingness-to-pay per QALY thresholds, suggesting that their addition to chemotherapy may represent a cost-effective use of resources.
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Affiliation(s)
| | - Ilias Goranitis
- Health Economics Unit, University of Birmingham, Birmingham, UK
| | - Sarah Pirrie
- Cancer Research UK Clinical Trials Unit (CRCTU Birmingham), University of Birmingham, Birmingham, UK
| | - Ann Pope
- Cancer Research UK Clinical Trials Unit (CRCTU Birmingham), University of Birmingham, Birmingham, UK
| | - Darren Barton
- Cancer Research UK Clinical Trials Unit (CRCTU Birmingham), University of Birmingham, Birmingham, UK
| | - Stuart Collins
- Posthumously listed (previously CRCTU Birmingham), Birmingham, UK
| | - Adam Daunton
- University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | | | | | | | - Emilio Porfiri
- University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - John Staffurth
- Institute of Cancer and Genetics, Cardiff University, UK
| | | | | | | | - Alison Birtle
- Rosemere Cancer Centre, Royal Preston Hospital, Preston, UK
| | | | | | | | | | - Lucinda J Billingham
- Cancer Research UK Clinical Trials Unit (CRCTU Birmingham), University of Birmingham, Birmingham, UK
| | - Nicholas D James
- University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
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Gough J, Sridharan M, Li R, Raman R, Edwards A, Clarke A, Beesley S, Taylor HJH, Lees K. Kent experience of radical chemoradiotherapy for muscle invasive bladder cancer. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.6_suppl.373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
373 Background: The BC2001 trial in 2012 showed concurrent chemoradiotherapy to be the new standard of care for bladder preserving treatment of muscle invasive bladder cancer. Addition of concurrent MMC and infusional 5FU showed a relative risk reduction of 33% in locoregional recurrence (James ND, Hussain S, Hall E et al. Radiotherapy with or without chemotherapy in muscle-invasive bladder cancer. N Engl J Med. 2012;366(16):1477–88.). This audit evaluates the experience across Kent in six hospitals adopting this protocol. Methods: 116 patients treated with radical radiotherapy for bladder cancer between January 2013 and December 2015 were retrospectively reviewed. 64 patients received radiotherapy alone due to contraindications to chemotherapy, performance status and patient choice. 52 patients received concurrent chemotherapy, the majority with 5FU/MMC and a subset with oral Capecitabine in place of infusional 5FU. Kaplan Meier and Log-Rank analysis of overall survival, local recurrence free survival and metastasis free survival were performed using SPSS. Results: Local recurrence free survival in the chemoradiotherapy group was 73% (95% CI 59-87%) compared to the radiotherapy group 61% (45-77) (p=0.27). There was a trend for greater metastasis free survival at 2 years, 63% (47-79) in the chemoradiotherapy group compared to 52% (38-66) in the radiotherapy group (p=0.21). Similarly, overall 2 year survival was 74% (60-88) and 59% (43-75) respectively (p=0.21). Conclusions: Our results showed a trend towards improved local control, distant control and increased overall survival in patients treated with concurrent chemoradiotherapy compared to radiotherapy alone. The differences did not meet statistical significance; however this was a small retrospective series with a relatively short median followup of 17.5 months. Treatment was well tolerated in our patient group. Overall, our data is in keeping with the results of the BC2001 trial (James ND, Hussain S, Hall E et al. Radiotherapy with or without chemotherapy in muscle-invasive bladder cancer. N Engl J Med. 2012;366(16):1477–88.)
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Affiliation(s)
| | | | - Ruochen Li
- Kent Oncology Centre, Maidstone, United Kingdom
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James ND, Pirrie SJ, Pope AM, Barton D, Andronis L, Goranitis I, Collins S, Daunton A, McLaren D, O’Sullivan J, Parker C, Porfiri E, Staffurth J, Stanley A, Wylie J, Beesley S, Birtle A, Brown J, Chakraborti P, Hussain S, Russell M, Billingham LJ. Clinical Outcomes and Survival Following Treatment of Metastatic Castrate-Refractory Prostate Cancer With Docetaxel Alone or With Strontium-89, Zoledronic Acid, or Both. JAMA Oncol 2016; 2:493-9. [DOI: 10.1001/jamaoncol.2015.5570] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Nicholas D. James
- University Hospital Birmingham NHS Foundation Trust, Birmingham, England
| | - Sarah J. Pirrie
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, England
| | - Ann M. Pope
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, England
| | - Darren Barton
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, England
| | | | | | - Stuart Collins
- Cancer Research UK Clinical Trials Unit, Birmingham, England
| | - Adam Daunton
- University Hospital Birmingham NHS Foundation Trust, Birmingham, England
| | - Duncan McLaren
- Department of Clinical Oncology, Western General Hospital, Edinburgh, Scotland
| | - Joe O’Sullivan
- Northern Ireland Cancer Centre, Belfast City Hospital, Belfast, Northern Ireland
| | - Christopher Parker
- The Institute of Cancer Research & Royal Marsden NHS Foundation Trust, Sutton, England
| | - Emilio Porfiri
- University Hospital Birmingham NHS Foundation Trust, Birmingham, England
| | - John Staffurth
- Institute of Cancer and Genetics, Cardiff University, Cardiff, Wales
| | - Andrew Stanley
- Department of Oncology Pharmacy, Birmingham City Hospital, Birmingham, England
| | - James Wylie
- Department of Clinical Oncology, The Christie Hospital, Manchester, England
| | - Sharon Beesley
- Department of Clinical Oncology, Kent Oncology Centre, Maidstone, England
| | - Alison Birtle
- Rosemere Cancer Centre, Royal Preston Hospital, Lancashire, England
| | - Janet Brown
- Cancer Research UK Clinical Centre at Leeds, University of Leeds, St James’ University Hospital, Leeds, England
| | | | - Syed Hussain
- Institute of Translational Medicine, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, England
| | - Martin Russell
- Beatson West of Scotland Cancer Centre, Glasgow, Scotland
| | - Lucinda J. Billingham
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, England
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James ND, Sydes MR, Clarke NW, Mason MD, Dearnaley DP, Spears MR, Ritchie AWS, Parker CC, Russell JM, Attard G, de Bono J, Cross W, Jones RJ, Thalmann G, Amos C, Matheson D, Millman R, Alzouebi M, Beesley S, Birtle AJ, Brock S, Cathomas R, Chakraborti P, Chowdhury S, Cook A, Elliott T, Gale J, Gibbs S, Graham JD, Hetherington J, Hughes R, Laing R, McKinna F, McLaren DB, O'Sullivan JM, Parikh O, Peedell C, Protheroe A, Robinson AJ, Srihari N, Srinivasan R, Staffurth J, Sundar S, Tolan S, Tsang D, Wagstaff J, Parmar MKB. Addition of docetaxel, zoledronic acid, or both to first-line long-term hormone therapy in prostate cancer (STAMPEDE): survival results from an adaptive, multiarm, multistage, platform randomised controlled trial. Lancet 2016; 387:1163-77. [PMID: 26719232 PMCID: PMC4800035 DOI: 10.1016/s0140-6736(15)01037-5] [Citation(s) in RCA: 1426] [Impact Index Per Article: 178.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Long-term hormone therapy has been the standard of care for advanced prostate cancer since the 1940s. STAMPEDE is a randomised controlled trial using a multiarm, multistage platform design. It recruits men with high-risk, locally advanced, metastatic or recurrent prostate cancer who are starting first-line long-term hormone therapy. We report primary survival results for three research comparisons testing the addition of zoledronic acid, docetaxel, or their combination to standard of care versus standard of care alone. METHODS Standard of care was hormone therapy for at least 2 years; radiotherapy was encouraged for men with N0M0 disease to November, 2011, then mandated; radiotherapy was optional for men with node-positive non-metastatic (N+M0) disease. Stratified randomisation (via minimisation) allocated men 2:1:1:1 to standard of care only (SOC-only; control), standard of care plus zoledronic acid (SOC + ZA), standard of care plus docetaxel (SOC + Doc), or standard of care with both zoledronic acid and docetaxel (SOC + ZA + Doc). Zoledronic acid (4 mg) was given for six 3-weekly cycles, then 4-weekly until 2 years, and docetaxel (75 mg/m(2)) for six 3-weekly cycles with prednisolone 10 mg daily. There was no blinding to treatment allocation. The primary outcome measure was overall survival. Pairwise comparisons of research versus control had 90% power at 2·5% one-sided α for hazard ratio (HR) 0·75, requiring roughly 400 control arm deaths. Statistical analyses were undertaken with standard log-rank-type methods for time-to-event data, with hazard ratios (HRs) and 95% CIs derived from adjusted Cox models. This trial is registered at ClinicalTrials.gov (NCT00268476) and ControlledTrials.com (ISRCTN78818544). FINDINGS 2962 men were randomly assigned to four groups between Oct 5, 2005, and March 31, 2013. Median age was 65 years (IQR 60-71). 1817 (61%) men had M+ disease, 448 (15%) had N+/X M0, and 697 (24%) had N0M0. 165 (6%) men were previously treated with local therapy, and median prostate-specific antigen was 65 ng/mL (IQR 23-184). Median follow-up was 43 months (IQR 30-60). There were 415 deaths in the control group (347 [84%] prostate cancer). Median overall survival was 71 months (IQR 32 to not reached) for SOC-only, not reached (32 to not reached) for SOC + ZA (HR 0·94, 95% CI 0·79-1·11; p=0·450), 81 months (41 to not reached) for SOC + Doc (0·78, 0·66-0·93; p=0·006), and 76 months (39 to not reached) for SOC + ZA + Doc (0·82, 0·69-0·97; p=0·022). There was no evidence of heterogeneity in treatment effect (for any of the treatments) across prespecified subsets. Grade 3-5 adverse events were reported for 399 (32%) patients receiving SOC, 197 (32%) receiving SOC + ZA, 288 (52%) receiving SOC + Doc, and 269 (52%) receiving SOC + ZA + Doc. INTERPRETATION Zoledronic acid showed no evidence of survival improvement and should not be part of standard of care for this population. Docetaxel chemotherapy, given at the time of long-term hormone therapy initiation, showed evidence of improved survival accompanied by an increase in adverse events. Docetaxel treatment should become part of standard of care for adequately fit men commencing long-term hormone therapy. FUNDING Cancer Research UK, Medical Research Council, Novartis, Sanofi-Aventis, Pfizer, Janssen, Astellas, NIHR Clinical Research Network, Swiss Group for Clinical Cancer Research.
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Affiliation(s)
- Nicholas D James
- Warwick Medical School, University of Warwick, Coventry, UK; University Hospitals Birmingham NHS Foundation Trust, The Medical School, University of Birmingham, Birmingham, UK
| | | | - Noel W Clarke
- Department of Urology, The Christie and Salford Royal NHS Foundation Trusts, Manchester, UK
| | - Malcolm D Mason
- Cardiff University School of Medicine, Velindre Hospital, Cardiff, UK
| | - David P Dearnaley
- The Institute of Cancer Research & Royal Marsden NHS Foundation Trust, London, UK
| | | | | | - Christopher C Parker
- The Institute of Cancer Research & Royal Marsden NHS Foundation Trust, London, UK
| | - J Martin Russell
- Institute of Cancer Sciences, University of Glasgow, Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - Gerhardt Attard
- The Institute of Cancer Research & Royal Marsden NHS Foundation Trust, London, UK
| | - Johann de Bono
- The Institute of Cancer Research & Royal Marsden NHS Foundation Trust, London, UK
| | - William Cross
- Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds
| | - Rob J Jones
- Institute of Cancer Sciences, University of Glasgow, Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - George Thalmann
- Department of Urology, University Hospital, Bern, Switzerland
| | | | - David Matheson
- Patient rep, MRC Clinical Trials Unit at UCL, London, UK
| | - Robin Millman
- Patient rep, MRC Clinical Trials Unit at UCL, London, UK
| | - Mymoona Alzouebi
- Department of Oncology, Weston Park Hospital, Sheffield & Doncaster, UK
| | | | - Alison J Birtle
- Department of Oncology, Rosemere Cancer Centre, Royal Preston Hospital, Preston, UK
| | - Susannah Brock
- Department of Oncology, Poole Hospital NHS Foundation Trust and Royal Bournemouth Hospital NHS Foundation Trust, Chur, Switzerland
| | | | - Prabir Chakraborti
- Department of Oncology, Derby Hospitals NHS Foundation Trust, Royal Derby Hospital, Derby, UK
| | | | - Audrey Cook
- Department of Oncology, Cheltenham General Hospital & Hereford County Hospital, UK
| | - Tony Elliott
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Joanna Gale
- Oncology and Haematology Clinical Trials Unit, Queen Alexandra Hospital, Portsmouth, UK
| | | | | | - John Hetherington
- Department of Urology, Hull & East Yorkshire Hospitals NHS Trust, Hull, UK
| | - Robert Hughes
- Mount Vernon Group, Mount Vernon Hospital, Middlesex, UK
| | - Robert Laing
- Department of Oncology, Royal Surrey County Hospital, Guildford, UK
| | - Fiona McKinna
- Department of Oncology, East Sussex Hospitals Trust, East Sussex, UK
| | | | - Joe M O'Sullivan
- Centre for Cancer Research and Cell Biology, Queens University Belfast/Belfast City Hospital, Belfast, UK
| | - Omi Parikh
- Department of Oncology, East Lancashire Hospitals NHS Trust, East Lancashire, UK
| | - Clive Peedell
- Department of Oncology & Radiotherapy, South Tees NHS Trust, Middlesbrough, UK
| | | | | | - Narayanan Srihari
- Department of Oncology, Shrewsbury & Telford Hospitals NHS Trust, Shrewsbury, UK
| | - Rajaguru Srinivasan
- Department of Oncology, Royal Devon & Exeter Hospital, Exeter, UK/Torbay Hospital, Torquay, UK
| | - John Staffurth
- Cardiff University School of Medicine, Velindre Hospital, Cardiff, UK
| | - Santhanam Sundar
- Department of Oncology, Nottingham University Hospitals NHS trust, Nottingham, UK
| | - Shaun Tolan
- Department of Oncology & Radiotherapy, Clatterbridge Cancer Centre, Wirral, UK
| | - David Tsang
- Department of Oncology, Southend & Basildon Hospitals, Essex, UK
| | - John Wagstaff
- The South West Wales Cancer Institute and Swansea University College of Medicine, Swansea, UK
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Thomas L, Hadaki M, Sevitt T, Shah R, Burcombe R, Hall J, Taylor H, Beesley S, Cominos M. 64 Management of EGFR tyrosine kinase inhibitor associated skin toxicity: a single centre experience. Lung Cancer 2016. [DOI: 10.1016/s0169-5002(16)30081-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Hegarty G, Turner J, Sevitt T, Burcombe R, Cominos M, Taylor H, Beesley S, Hadaki M, Shah R, Mikropoulos C, Hall J. 139 A retrospective review of lung cancer patients receiving whole brain radiotherapy treated at the Kent Oncology Centre (KOC) in 2014, audited against the QUARTZ trial. Lung Cancer 2016. [DOI: 10.1016/s0169-5002(16)30156-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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James ND, Andronis L, Goranitis I, Pirrie S, Pope A, Barton D, Daunton A, McLaren D, O'Sullivan JM, Parker C, Staffurth J, Stanley A, Wylie J, Beesley S, Birtle AJ, Brown JE, Chakraborti PR, Russell JM, Billingham L. Cost-effectiveness of zoledronic acid and strontium-89 as bone protecting treatments in addition to chemotherapy in patients with metastatic castrate-refractory prostate cancer. (ISRCTN 12808747) TRAPEZE. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.e16108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Lazaros Andronis
- Health Economics Unit, University of Birmingham, Birmingham, United Kingdom
| | - Ilias Goranitis
- Health Economics Unit, University of Birmingham, Birmingham, United Kingdom
| | - Sarah Pirrie
- Cancer Research UK Clinical Trials Unit, School of Cancer Sciences, Birmingham, United Kingdom
| | - Ann Pope
- Cancer Research Clinical Trials Unit, School of Cancer Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Darren Barton
- Cancer Research UK Clinical Trials Unit, School of Cancer Sciences, Birmingham, United Kingdom
| | - Adam Daunton
- West Midlands Strategic Health Authority, Birmingham, United Kingdom
| | - Duncan McLaren
- Department of Oncology, Edinburgh Cancer Centre, Edinburgh, United Kingdom
| | | | - Chris Parker
- The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Sutton, United Kingdom
| | | | | | - James Wylie
- The Christie Hospital NHS Foundation Trust, Manchester, United Kingdom
| | | | - Alison J. Birtle
- Lancashire Teaching Hospitals NHS Foundation Trust, Preston, United Kingdom
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Wood S, Li R, Beesley S, Brown J, Cominos M, Hall J, Sevitt T, Shah R, Taylor H, Burcombe R. 66: Adjuvant chemotherapy dose delivery for completely resected NSCLC in a regional cancer centre: analysis of outcomes by age and comorbidity. Lung Cancer 2015. [DOI: 10.1016/s0169-5002(15)50065-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ghosh-Dastidar M, Wilson H, Wakelin S, Beesley S, Pilling J, Routledge T, Harrison-Phipps K. 17: Surgery for lung cancer in nonagenarians: a new dawn approaches. Lung Cancer 2015. [DOI: 10.1016/s0169-5002(15)50017-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Sevitt T, Shiarli A, Burcombe R, Taylor H, Cominos M, Beesley S, Visioli A, Shah R, Bird T. 180 A review of treatment of limited stage small cell lung carcinoma at the Kent Oncology Centre. Lung Cancer 2014. [DOI: 10.1016/s0169-5002(14)70181-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Brown CO, Young S, Cominos M, Sevitt T, Visioli A, Burcombe R, Taylor H, Beesley S, Shah R. 83 Lung cancer diagnosis and management in patients over 80 years – An audit of practice in Kent for 2011/2012. Lung Cancer 2014. [DOI: 10.1016/s0169-5002(14)70083-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Bird T, Shiarli A, Burcombe R, Taylor H, Cominos M, Beesley S, Visioli A, Shah R, Sevitt T. 183 Treating extensive stage small cell lung carcinoma in poor performance status patients – is a high 30 day mortality rate justifiable? Lung Cancer 2014. [DOI: 10.1016/s0169-5002(14)70184-9] [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: 10/25/2022]
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Shiarli A, Georgiou A, Sevitt T, Taylor H, Cominos M, Beesley S, Visioli A, Burcombe R. 94 A review of the management of mesothelioma patients who received second line chemotherapy within the Kent Oncology Centre Network. Lung Cancer 2013. [DOI: 10.1016/s0169-5002(13)70094-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Biondo A, Beesley S, Burcombe R, Cominos M, Sevitt T, Taylor H, Shah R. 14 Audit of the management of epithelial growth factor receptor (EGFR) mutant non-small cell lung cancer (NSCLC) patients within the Kent Oncology Centre and its associated units. Lung Cancer 2012. [DOI: 10.1016/s0169-5002(12)70015-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Brulinski P, Lo A, Cominos M, Burcombe R, Beesley S, Shah R, Sevitt T, Taylor H. Radial radiotherapy versus high dose palliative radiotherapy with or without chemotherapy in non small cell lung carcinoma (NSCLC): Retrospective analysis of overall survival. Lung Cancer 2010. [DOI: 10.1016/s0169-5002(10)70101-x] [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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Mikropoulos C, Nawrocka M, Cominos M, Burcombe R, Beesley S, Shah R, Sevitt T, Taylor H. Mesothelioma in the Kent and Medway Cancer Network: A comprehensive review of 2 years of pemetrexed-based chemotherapy. Lung Cancer 2010. [DOI: 10.1016/s0169-5002(10)70053-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Cafferkey C, Jamal-Hanjani M, Beesley S, Cominos M, Sevitt T, Taylor H, Burcombe R, Shah R. A Kent and Medway Cancer Network (KMCN) audit of second-line treatment for non-small cell lung cancer. Lung Cancer 2010. [DOI: 10.1016/s0169-5002(10)70022-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Gilbert DC, VanAs NJ, Beesley S, Bloomfield D, Money-Kyrle J, Norman A, Dearnaley D, Horwich A, Huddart RA. Treating IIA/B Seminoma With Combination Carboplatin and Radiotherapy. J Clin Oncol 2009; 27:2101-2; author reply 2102-3. [DOI: 10.1200/jco.2008.21.5269] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Duncan C. Gilbert
- Royal Marsden Hospital and The Institute of Cancer Research, Sutton, United Kingdom
| | - Nicholas J. VanAs
- Royal Marsden Hospital and The Institute of Cancer Research, Sutton, United Kingdom
| | | | | | | | - Andy Norman
- Royal Marsden Hospital and The Institute of Cancer Research, Sutton, United Kingdom
| | - David Dearnaley
- Royal Marsden Hospital and The Institute of Cancer Research, Sutton, United Kingdom
| | - Alan Horwich
- Royal Marsden Hospital and The Institute of Cancer Research, Sutton, United Kingdom
| | - Robert A. Huddart
- Royal Marsden Hospital and The Institute of Cancer Research, Sutton, United Kingdom
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Abstract
In addition to the core circadian oscillator, located within the suprachiasmatic nucleus, numerous peripheral tissues possess self-sustaining circadian timers. In vivo these are entrained and temporally synchronized by signals conveyed from the core oscillator. In the present study, we examine circadian timing in the lung, determine the cellular localization of core clock proteins in both mouse and human lung tissue, and establish the effects of glucocorticoids (widely used in the treatment of asthma) on the pulmonary clock. Using organotypic lung slices prepared from transgenic mPER2::Luc mice, luciferase levels, which report PER2 expression, were measured over a number of days. We demonstrate a robust circadian rhythm in the mouse lung that is responsive to glucocorticoids. Immunohistochemical techniques were used to localize specific expression of core clock proteins, and the glucocorticoid receptor, to the epithelial cells lining the bronchioles in both mouse and human lung. In the mouse, these were established to be Clara cells. Murine Clara cells retained circadian rhythmicity when grown as a pure population in culture. Furthermore, selective ablation of Clara cells resulted in the loss of circadian rhythm in lung slices, demonstrating the importance of this cell type in maintaining overall pulmonary circadian rhythmicity. In summary, we demonstrate that Clara cells are critical for maintaining coherent circadian oscillations in lung tissue. Their coexpression of the glucocorticoid receptor and core clock components establishes them as a likely interface between humoral suprachiasmatic nucleus output and circadian lung physiology.
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Affiliation(s)
- J E Gibbs
- Faculty of Life Sciences, University of Manchester, Manchester M13 9PT, United Kingdom
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Swannie H, Beesley S, Shah R, Lowe S, Taylor H. Routine day 8 blood tests are not necessary for patients with non-small cell lung cancer treated with oral vinorelbine-carboplatin chemotherapy. Lung Cancer 2008. [DOI: 10.1016/s0169-5002(08)70062-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Raman R, Burcombe R, Beesley S, Shah R, Taylor H. 15 Oral vinorelbine in combination with carboplatin for the treatment of inoperable non-small cell lung cancer (NSCLC) —the Kent Experience. Lung Cancer 2007. [DOI: 10.1016/s0169-5002(07)70341-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
OBJECTIVE To compare laparoscopic, gross, and fluorescent assessment of laparoscopic pelvic injuries. DESIGN Experimental prospective study. SETTING Cleveland Clinic Foundation Animal Research Laboratory, Cleveland, Ohio. ANIMAL(S) Nonpregnant adult female pigs. INTERVENTION(S) Pelvic organs injured with laparoscopic energy sources were assessed laparoscopically, grossly, and with a fluorescent indicator and Wood's lamp. MAIN OUTCOME MEASURE(S) Three different measurements of each laparoscopic injury. RESULT(S) Assessment of injuries by laparoscopy did not differ significantly from gross assessment of injuries. In the segments of bowel and bladder that were injured with monopolar cautery, the Wood's lamp assessment of the injuries was significantly longer than the laparoscopic assessment of the injuries. CONCLUSION(S) Laparoscopic assessment of injured ureters, bowel, and bladder appear to be similar to gross assessment of these tissues. In tissue where the serosal surface is intact, the use of a fluorescent dye and a Wood's lamp provides a clear margin of the injured tissue.
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Affiliation(s)
- P K Tulikangas
- Minimally Invasive Surgery Center, The Cleveland Clinic Foundation, Ohio 44195, USA.
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Abstract
Providing the best possible care for the child and family is paramount to health professionals working in paediatric palliative care. However, there is little research which enables practitioners to question their current practice. There are concerns about conducting research on children receiving palliative care at such a sensitive time for the child and his/her family. These concerns must be considered against the growing demand for clear standards and guidelines for practice within health care. According to the Department of Health (DoH) there is no place within the modern healthcare system for the adoption of unproven theories or outdated care (DoH, 1998). While no-one would question the dedication and care being delivered to children and their families by well-trained staff, the lack of research is a cause for concern. A group of students undertaking a degree module in paediatric palliative care identified the lack of literature and research in this area and have undertaken a review of the available literature.
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Beesley S, Maurice J. Weighty matters. STEP Perspect 1998; 98:13-5. [PMID: 11365824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
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Beesley S, Maurice J. Muscle madness. STEP Perspect 1998; 98:3-4. [PMID: 11365542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
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Abstract
It is known that there is an association between cannabis use and psychosis. Clinically we had thought that there were increasing numbers of patients admitted to hospital who were using cannabis and that this was affecting their illness. A study was therefore undertaken to determine the extent of cannabis use and its relationships over a one month period. The findings and their implications for junior doctors on-call are also discussed.
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Affiliation(s)
- S Beesley
- Department of Psychological Medicine, Gartnaval Royal Hospital, Glasgow
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33
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Beesley S. A patient who changed my practice: The question that made all the difference. West J Med 1997. [DOI: 10.1136/bmj.314.7076.0i] [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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Maurice J, Beesley S. Protease inhibitors and food: how to maximize absorption into the blood. STEP Perspect 1997; 9:11-2. [PMID: 11364925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Affiliation(s)
- J Maurice
- University of Washington, Madison Clinic, Seattle, WA
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35
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Beesley S, Maurice J. Food, fitness and HIV: the connection. STEP Perspect 1997; 9:6, 8. [PMID: 11364272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
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