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O'Reilly S. Pulmonary fibrosis in COVID-19: mechanisms, consequences and targets. QJM 2023; 116:750-754. [PMID: 37191984 DOI: 10.1093/qjmed/hcad092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Indexed: 05/17/2023] Open
Abstract
Pulmonary fibrosis is characterized by extracellular deposition in the lung primarily collagen but also other ECM molecules. The primary cell type responsible for this is the myofibroblast, and this can be induced by various stressors and signals. Infections be they bacterial or viral can cause pulmonary fibrosis (PF). In 2019, severe acute respiratory syndrome coronavirus 2 (SAR-CoV-2) originated in Wuhan, China, has led to a worldwide pandemic and can lead to acute respiratory distress and lung fibrosis. The virus itself can be cleared, but patients may develop long-term PF, which can be debilitating and life-limiting. There is a significantly perturbed immune response that shapes the fibrotic response leading to fibrosis. Given the importance of PF irrespective of cause, understanding the similarities and differences in pathogenesis caused by SARS-CoV-2-induced PF may yield new therapeutic targets. This review examines the pathology associated with the disease and discusses possible targets.
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Affiliation(s)
- S O'Reilly
- Department of Biosciences, Durham University, South Road, Durham DH1 3LE, UK
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Calvert AH, Newell DR, Gumbrell LA, O'Reilly S, Burnell M, Boxall FE, Siddik ZH, Judson IR, Gore ME, Wiltshaw E. Carboplatin dosage: prospective evaluation of a simple formula based on renal function. J Clin Oncol 2023; 41:4453-4454. [PMID: 37757592 DOI: 10.1200/jco.22.02768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023] Open
Abstract
A dosage formula has been derived from a retrospective analysis of carboplatin pharmacokinetics in 18 patients with pretreatment glomerular filtration rates (GFR) in the range of 33 to 136 mL/min. Carboplatin plasma clearance was linearly related to GFR (r = 0.85, P less than .00001) and rearrangements of the equation describing the correlation gave the dosage formula dose (mg) = target area under the free carboplatin plasma concentration versus time curve (AUC) x (1.2 x GFR + 20). In a prospective clinical and pharmacokinetic study the formula was used to determine the dose required to treat 31 patients (GFR range, 33 to 135 mL/min) with 40 courses of carboplatin. The target AUC was escalated from 3 to 8 mg carboplatin/mL/min. Over this AUC range the formula accurately predicted the observed AUC (observed/predicted ratio 1.24 +/- 0.11, r = 0.886) and using these additional data, the formula was refined. Dose (mg) = target AUC x (GFR + 25) is now the recommended formula. AUC values of 4 to 6 and 6 to 8 mg/mL. min gave rise to manageable hematological toxicity in previously treated and untreated patients, respectively, and hence target AUC values of 5 and 7 mg/mL min are recommended for single-agent carboplatin in these patient groups. Pharmacokinetic modeling demonstrated that the formula was reasonably accurate regardless of whether a one- or two-compartment model most accurately described carboplatin pharmacokinetics, assuming that body size did not influence nonrenal clearance. The validity of this assumption was demonstrated in 13 patients where no correlation between surface area and nonrenal clearance was found (r = .31, P = .30). Therefore, the formula provides a simple and consistent method of determining carboplatin dose in adults. Since the measure of carboplatin exposure in the formula is AUC, and not toxicity, it will not be influenced by previous or concurrent myelosuppressive therapy or supportive measures. The formula is therefore applicable to combination and high-dose studies as well as conventional single-agent therapy, although the target AUC for carboplatin will need to be redefined for combination chemotherapy.
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Hamid M, Joyce CM, Carroll HK, Kenneally C, Mulcahy S, O'Neill MK, Coulter J, O'Reilly S. Challenging gestational trophoblastic disease cases and mimics: An exemplar for the management of rare tumours. Eur J Obstet Gynecol Reprod Biol 2023; 286:76-84. [PMID: 37224702 DOI: 10.1016/j.ejogrb.2023.05.016] [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: 03/06/2023] [Revised: 05/05/2023] [Accepted: 05/12/2023] [Indexed: 05/26/2023]
Abstract
OBJECTIVE Rare tumour management is challenging for clinicians as evidence bases are limited and clinical trials are difficult to conduct. It is even more difficult for patients where self-reliance alone is insufficient to overcome the challenges of navigating care which is often poorly evidence based. In Ireland, a national Gestational Trophoblastic Disease (GTD) service was established as one of 3 initiatives for rare tumours by the National Cancer Control Programme. The service has a national clinical lead, a dedicated supportive nursing service and a clinical biochemistry liaison team. This study sought to assess the impact of a GTD centre using national clinical guidelines and integrating and networking with European and International GTD groups on the clinical management of challenging GTD cases and to consider the application of this model of care to other rare tumour management. STUDY DESIGN In this article, we analyse the impact of a national GTD service on five challenging cases, and review how the service affects patient management in this rare tumour type. These cases were selected from a cohort of patients who were voluntarily registered in the service based on the diagnostic management dilemma they posed. RESULTS Case management was impacted by the identification of GTD mimics, the provision of lifesaving treatment of metastatic choriocarcinoma with brain metastasis, networking with international colleagues, the identification of early relapse, the use of genetics to differentiate treatment pathways and prognosis, and supportive supervision of treatment courses of up to 2 years of therapy in a cohort of patients starting or completing families. CONCLUSION The National GTD service could be an exemplar for the management of rare tumours (such as cholangiocarcinoma) in our jurisdiction which could benefit from a similar constellation of supports. Our study demonstrates the importance of a nominated national clinical lead, dedicated nurse navigator support, registration of cases and networking. The impact of our service would be greater if registration was mandatory rather than voluntary. Such a measure would also ensure equity of access for patients to the service, assist in quantifying the need for resourcing and facilitate research to improve outcomes.
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Affiliation(s)
- M Hamid
- Department of Medical Oncology, Cork University Hospital, Cork, Ireland
| | - C M Joyce
- Pregnancy Loss Research Group, Department of Obstetrics & Gynaecology, University College Cork, Cork, Ireland; Department of Biochemistry and Cell Biology, University College Cork, Cork, Ireland; Department of Clinical Biochemistry, Cork University Hospital, Cork, Ireland.
| | - H K Carroll
- Department of Medical Oncology, Cork University Hospital, Cork, Ireland
| | - C Kenneally
- Department of Obstetrics and Gynaecology, Cork University Maternity Hospital, Cork, Ireland
| | - S Mulcahy
- Department of Obstetrics and Gynaecology, Cork University Maternity Hospital, Cork, Ireland
| | - Mary-Kate O'Neill
- Department of Obstetrics and Gynaecology, Cork University Maternity Hospital, Cork, Ireland
| | - J Coulter
- Department of Obstetrics and Gynaecology, Cork University Maternity Hospital, Cork, Ireland
| | - S O'Reilly
- Department of Medical Oncology, Cork University Hospital, Cork, Ireland; Cancer Research @UCC, University College Cork, Cork, Ireland
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O'Sullivan M, O'Reilly S. Unmet Psychological Needs and Support Service. Ir Med J 2023; 116:736. [PMID: 37555804] [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: 08/10/2023]
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O'Sullivan M, O'Reilly S. Unmet Psychological Needs and Support Service Uptake of Patients with Cancer. Ir Med J 2023; 116:736. [PMID: 37929704] [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: 11/07/2023]
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Murphy F, O'Reilly S, Clarke C, Kennelly S. 32 HOLISTIC PERSON-CENTRED CARE FOR PEOPLE LIVING WITH DEMENTIA AND CO EXISTING MENTAL HEALTH ILLNESSES: A CASE FOR INTEGRATION. Age Ageing 2022. [PMCID: PMC9620330 DOI: 10.1093/ageing/afac218.024] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background 65,000 people live with dementia in Ireland, many have co-existing or emerging mental health illnesses and non-cognitive symptoms. During the COVID-19 pandemic there was a need to provide innovative solutions to service provision. As Medicine for the Elderly (MEDEL) and Psychiatry of Later Life (PLL) were established stand-alone services, there was no formalised working relationship, resulting in an overlap of cases and disparity in service provision. Methods A description of three cases to illustrate the joint working interface with MEDEL and PLL. These cases highlight their complex care needs and the speciality input required by both services within a shared catchment area. The age range was 78-88 years. All presented with at least two medical co-morbidities, including vascular risk factors and delirium. Each had at least one mental health illness including new onset psychotic and mood disorders. Sharing of resources including diagnostic services, nursing, medical, occupational therapy, physiotherapy and social work facilitated cost effective holistic care. Results Given the existing structures of MEDEL and PLL, it was possible to link with community partners attached to each service, allowing domiciliary visits for crisis intervention and best use of expertise from both disciplines. This resulted in the provision of timely patient centred care, reduced polypharmacy through a unified pharmacological approach, enhanced communication, shared learning and cost effectiveness. Care that is in the right place at the right time, in line with Sláinte Care, allowed timely access to diagnostics, improved care outcomes and a cohesive response. Conclusion This cohort present with complex care needs. An integrated approach enables patients to receive holistic care without duplication of resources or disparity of treatment and care options. Going forward this should involve a fully integrated memory service, with shared governance.
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Affiliation(s)
- F Murphy
- Connolly Hospital , Dublin, Ireland
| | | | - C Clarke
- Dublin North City and County Mental Health Services , Dublin, Ireland
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Kennelly S, Loye J, O'Reilly S, Wall E. 149 A PROFILE OF THE COMMUNICATION NEEDS OF NEW PATIENTS ATTENDING A MEMORY ASSESSMENT AND SUPPORT SERVICE. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.126] [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: 11/12/2022] Open
Abstract
Abstract
Background
Communication is a key factor in maintaining quality of life and well-being. This is of core importance for people with dementia who experience changes to their communication abilities. The role of the Speech and Language Therapist working with people with dementia is well documented. Speech and Language Therapists support people with communication and swallowing disorders however in practice the focus is often on swallowing disorders with less emphasis on communication. The recommended allocation of Speech and Language Therapy (SLT) for a Memory and Support Service (MASS) is 0.5 Senior Speech and Language Therapist. A pilot SLT service was trialled in a MASS to identify the SLT service needs and the benefit of introducing SLT earlier for people with Dementia.
Methods
A retrospective caseload review was completed of ten patients seen by SLT as part of the MASS assessment. Communication profiles and SLT interventions were analysed.
Results
The majority of the ten patients reviewed self-reported communication and speech and language changes, such as word finding difficulties and difficulties understanding conversations. Patient's self-report often corresponded with formal assessment results. On formal assessment 30% of patients presented with slight cognitive-communicative changes and 30% of patients presented with slight-mild cognitive-communicative changes. 10% of patients presented with mild cognitive-communicative changes and 30% of patients presented with mild-moderate cognitive-communicative changes. SLT interventions included conversational strategies, language strategies, language tasks and conversation partner training. 50% of patients were referred to Primary Care SLT.
Conclusion
SLT interventions support patients’ cognitive-communication abilities in dementia. SLT within a MASS adds clinical value by supporting assessment and diagnosis of dementia and developing patients’ communication profiles to highlight communicative abilities. Furthermore, SLT input supports developing communication strategies for the patient and communication partner training. In summary these interventions support improved quality of life and well-being for the person with dementia and their family.
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Affiliation(s)
| | - J Loye
- Connolly Hospital , Dublin, Ireland
| | | | - E Wall
- Connolly Hospital , Dublin, Ireland
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van der pligt P, Absalom G, Zinga J, Margerison C, Abbott G, O'Reilly S. Associations of dietetic care and pregnancy outcomes in women with gestational diabetes. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac131.290] [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: 11/13/2022] Open
Abstract
Abstract
Background
Gestational diabetes mellitus (GDM) is a significant, global public health problem. Subsequent strain on healthcare systems is widespread and multidisciplinary care may be inadequate. We assessed current nutrition management of GDM in a large, metropolitan maternity hospital in Melbourne, Australia and associations between the model of dietetic care and maternal and neonatal health outcomes.
Methods
Hospital medical record data from The Women’s Hospital, Melbourne for women with GDM (n = 1,185) (July 2105-May 2017) was retrospectively analysed. Adjusted linear and logistic regression were used to assess associations between the number of dietitian consultations and maternal and neonatal health outcomes.
Results
Half of all women received two consultations with a dietitian. Nineteen percent of women received three or more consultations and of these women, almost twice as many were managed by medical nutrition therapy (MNT) and pharmacotherapy (66%) compared with MNT alone (34%). Odds of maternal complications increased with number of consultations (p = 0.008). Lower odds of infant admission to the Neonatal Intensive Care Unit were observed among women receiving one (OR = 0.38 [95% CI: 0.18, 0.78], p = 0.008), two (OR = 0.37 [95% CI: 15 0.19, 0.71], p = 0.003), or three+ dietitian consultations (OR = 0.43 [95% CI: 0.21, 0.88], p = 0.020), compared to no consultations.
Conclusions
The optimal schedule of dietitian consultations for women with GDM in Australia is unclear. Alternative delivery of nutrition education for women with GDM such as telehealth and utilisation of technology may assist in relieving public health and healthcare system pressures and ensure optimal pregnancy outcomes.
Key messages
• Delivering medical nutrition therapy through individual consultations does not deliver a linear benefit to women with GDM and their offspring.
• Alternative delivery modes are needed to optimise outcomes for healthcare services and their patients.
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Affiliation(s)
- P van der pligt
- Institute for Physical Activity and Nutrition, Deakin University , Victoria, Australia
| | - G Absalom
- School of Exercise and Nutrition Sciences, Deakin University , Victoria, Australia
| | - J Zinga
- Department of Nutrition, Royal Women’s Hospital , Victoria, Australia
| | - C Margerison
- Institute for Physical Activity and Nutrition, Deakin University , Victoria, Australia
| | - G Abbott
- Institute for Physical Activity and Nutrition, Deakin University , Victoria, Australia
| | - S O'Reilly
- School of Agriculture and Food Science, University College Dublin , Dublin, Ireland
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Carroll H, Broderick A, McCarthy O, Kennedy M, Bambury R, Power D, Collins D, Connolly R, Noonan S, Collins D, Cunningham E, O'Driscoll K, Nuzum D, Twomey K, O'Riordan A, O'Sullivan F, Roe C, O'Leary M, Lowney A, O'Reilly S. 1292P A review of in-hospital end-of-life care (EOLC) for oncology patients during the COVID-19 pandemic. Ann Oncol 2022. [PMCID: PMC9472553 DOI: 10.1016/j.annonc.2022.07.1424] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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10
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Jittla P, Graham DM, Zhou C, Halliwell J, O'Reilly S, Aruketty S, Azizi A, Germetaki T, Lowe J, Little M, Punnett G, McMahon P, Benson L, Carter L, Krebs MG, Thistlethwaite FC, Darlington E, Yorke J, Cook N. EPIC: an evaluation of the psychological impact of early-phase clinical trials in cancer patients. ESMO Open 2022; 7:100550. [PMID: 35994790 PMCID: PMC9420347 DOI: 10.1016/j.esmoop.2022.100550] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 06/17/2022] [Accepted: 06/27/2022] [Indexed: 11/30/2022] Open
Abstract
Background Anxiety and depression in patients with cancer is associated with decreased quality of life and increased morbidity and mortality. However, these are often overlooked and untreated. Early-phase clinical trials (EPCTs) recruit patients with advanced cancers who frequently lack future treatment options, which may lead to increased anxiety and depression. Despite this, EPCTs do not routinely consider psychological screening for patients. Patients and methods This prospective observational study explored levels of anxiety and depression alongside impact of trial participation in the context of EPCTs. The Hospital Anxiety and Depression Scale and the Brief Illness Perceptions Questionnaire were completed at the point of EPCT consent, the end of screening and at pre-specified time points thereafter. Results Sixty-four patients (median age 56 years; median Eastern Cooperative Oncology Group performance status 1) were recruited. At consent, 57 patients returned questionnaires; 39% reported clinically relevant levels of anxiety whilst 18% reported clinically relevant levels of depression. Sixty-three percent of patients experiencing psychological distress had never previously reported this. Males were more likely to be depressed (P = 0.037) and females were more likely to be anxious (P = 0.011). Changes in anxiety or depression were observed after trial enrolment on an individual level, but not significant on a population level. Conclusions Patients on EPCTs are at an increased risk of anxiety and depression but may not seek relevant support. Sites offering EPCTs should consider including psychological screening to encourage a more holistic approach to cancer care and consider the sex of individuals when tailoring psychological support to meet specific needs. Early-phase cancer trial patients have an increased risk of anxiety and depression. Patients at risk were not seeking support for anxiety and depression. Male patients were more likely to be depressed; female patients were more likely to be anxious. This work highlights the need to screen for psychological symptoms in patients entering early-phase trials.
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Affiliation(s)
- P Jittla
- Experimental Cancer Medicine Team, The Christie NHS Foundation Trust, Manchester, UK
| | - D M Graham
- Experimental Cancer Medicine Team, The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - C Zhou
- CRUK Manchester Institute Cancer Biomarker Centre, University of Manchester, Manchester, UK
| | - J Halliwell
- Experimental Cancer Medicine Team, The Christie NHS Foundation Trust, Manchester, UK
| | - S O'Reilly
- Experimental Cancer Medicine Team, The Christie NHS Foundation Trust, Manchester, UK
| | - S Aruketty
- Experimental Cancer Medicine Team, The Christie NHS Foundation Trust, Manchester, UK
| | - A Azizi
- Experimental Cancer Medicine Team, The Christie NHS Foundation Trust, Manchester, UK
| | - T Germetaki
- Experimental Cancer Medicine Team, The Christie NHS Foundation Trust, Manchester, UK
| | - J Lowe
- Experimental Cancer Medicine Team, The Christie NHS Foundation Trust, Manchester, UK
| | - M Little
- Experimental Cancer Medicine Team, The Christie NHS Foundation Trust, Manchester, UK
| | - G Punnett
- Christie Patient Centred Research, The Christie NHS Foundation Trust, Manchester, UK
| | - P McMahon
- Medical Oncology, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - L Benson
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - L Carter
- Experimental Cancer Medicine Team, The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - M G Krebs
- Experimental Cancer Medicine Team, The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - F C Thistlethwaite
- Experimental Cancer Medicine Team, The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - E Darlington
- Experimental Cancer Medicine Team, The Christie NHS Foundation Trust, Manchester, UK
| | - J Yorke
- Christie Patient Centred Research, The Christie NHS Foundation Trust, Manchester, UK
| | - N Cook
- Experimental Cancer Medicine Team, The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.
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McMahon DJ, Gleeson JP, O'Reilly S, Bambury RM. Management of newly diagnosed glioblastoma multiforme: current state of the art and emerging therapeutic approaches. Med Oncol 2022; 39:129. [PMID: 35716200 DOI: 10.1007/s12032-022-01708-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 03/14/2022] [Indexed: 12/21/2022]
Abstract
Glioblastoma multiforme represent > 50% of primary gliomas and have five year survival rates of ~ 5%. Maximal safe surgical resection followed by radiotherapy with concurrent and adjuvant temozolomide remains the standard treatment since published by Stupp et al. (in N Engl J Med 352:987-996, 2005), with additional benefit for patients with MGMT-methylated tumors. We review the current treatment landscape and ongoing efforts to improve these outcomes. An extensive literature search of Pubmed and Google Scholar involving the search terms "glioblastoma," "glioblastoma multiforme," or "GBM" for papers published to July 2021 was conducted and papers evaluated for relevance. As well as current data that informs clinical practice, we review ongoing clinical research in both newly diagnosed and recurrent settings that provides hope for a breakthrough. The Stupp protocol remains standard of care in 2021. Addition of tumor treating fields improved mOS modestly, with benefit seen in MGMT-methylated and unmethylated cohorts and also improved time to cognitive decline but has not been widely adopted. The addition of lomustine to temozolomide, in MGMT-methylated patients, also showed a mOS benefit but further investigation is required. Other promising therapeutic strategies including anti-angiogenic therapy, targeted therapy, and immunotherapy have yet to show a survival advantage. Improvements in the multidisciplinary management, surgical techniques and equipment, early palliative care, carrier support, and psychological support may be responsible for improving survival over time. Despite promising preclinical rationale, immunotherapy and targeted therapy are struggling to impact survival. A number of ongoing clinical trials provide hope for a breakthrough.
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Affiliation(s)
- D J McMahon
- Cork University Hospital, Cork, Ireland, UK.
| | | | - S O'Reilly
- Cork University Hospital, Cork, Ireland, UK
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12
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Steele C, O'Reilly S. Secondary Risk Reduction Strategies in Breast Cancer Care. Ir Med J 2022; 115:541. [PMID: 35416553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Over the past three decades breast cancer survival rates have increased in Ireland. This is due to advances in cancer diagnostics and therapeutics. Cure is now anticipated for most newly diagnosed patients. Cancer survivorship however is associated with an increased risk of additional cancers and the development of other non-communicable diseases such as cardiovascular disease. At present, secondary risk reduction strategies are an integral part of cardiovascular disease management. Given the improvements in breast cancer survival, similar strategies should be implemented as part of routine early-stage breast cancer care treatment plan. Herein, we present compelling evidence to support the integration of secondary risk reduction strategies for patients as a standard of care.
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Affiliation(s)
- C Steele
- School of Medicine, University College Cork, Ireland
| | - S O'Reilly
- Department of Medical Oncology, Cork University Hospital, Ireland and Cancer Research@UCC, College of Medicine and Health, University College Cork, Ireland
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O'Sullivan HM, Conroy M, Power DG, Bambury RM, O'Mahony D, Collins DC, O'Leary MJ, O'Reilly S. Immune Checkpoint Inhibitors and Palliative Care at the End of Life: An Irish Multicentre Retrospective Study. J Palliat Care 2022:8258597221078391. [PMID: 35129002 DOI: 10.1177/08258597221078391] [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] [Indexed: 02/21/2024]
Abstract
Background and Objectives: Immune checkpoint inhibitors (ICIs) have less toxicity than standard chemotherapy and are now standard of care for many patients with advanced cancer. A manageable side effect profile and potential for durable responses may lead to aggressive care of the palliative patient. We sought to evaluate palliative care input and ICI use at the end of life at two Irish cancer centres. Methods: We identified deceased patients who received at least one dose of an ICI between first of January 2013 to 31st of December 2018. A retrospective electronic chart review was performed. Results: The electronic records of 102 patients were analysed. Fifty eight percent were male and the median age of diagnosis of advanced disease was 60 years (range 17-78). Median time from last dose of ICI to death was 57 days (range 8-574) and 20% of patients died within 30 days of last dose of ICI. Most patients, 92%, were referred to palliative care. The median time from palliative care referral to death was 64 days (range 1- 1010). In the last 30 days of life, 39% of patients attended the emergency department (ED) and 46% had at least one hospital admission. Late palliative care referrals, ≤3 months before death, were associated with hospitalisations in the last month of life (64% vs. 36%, P = .02). Timing of palliative care referral did not affect ICI prescribing at the end of life (P = 0.38). ICI use in the last 30 days of life was not associated with increased ED presentations or hospitalisations at the end of life. Patients who received ICI in the last month had a higher likelihood of in-hospital death (43% vs. 16%, P = 0.02). Conclusions: ICI within 30 days of death was associated with dying in hospital but did not lead to more hospitalisations and emergency department presentations. Early palliative care did not affect ICI use but reduced hospitalisations at the end of life.
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Affiliation(s)
- H M O'Sullivan
- Department of Medical Oncology, Cork University Hospital, Cork, Ireland
| | - M Conroy
- Department of Medical Oncology, Cork University Hospital, Cork, Ireland
| | - D G Power
- Department of Medical Oncology, Cork University Hospital, Cork, Ireland
- Department of Medical Oncology, Mercy University Hospital, Cork, Ireland
| | - R M Bambury
- Department of Medical Oncology, Cork University Hospital, Cork, Ireland
| | - D O'Mahony
- Department of Medical Oncology, Cork University Hospital, Cork, Ireland
| | - D C Collins
- Department of Medical Oncology, Cork University Hospital, Cork, Ireland
| | - M J O'Leary
- Department of Palliative Medicine, Marymount University Hospital and Hospice, Cork, Ireland
- Department of Palliative Medicine, Cork University Hospital, Cork, Ireland
| | - S O'Reilly
- Department of Medical Oncology, Cork University Hospital, Cork, Ireland
- Department of Medical Oncology, Mercy University Hospital, Cork, Ireland
- Cork Cancer Research Centre, University College Cork, Cork, Ireland
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14
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Fitzpatrick P, Mooney T, Byrne H, Healy O, Russell N, O'Reilly S. Interval cancer audit and disclosure in cervical screening programmes: An international survey. J Med Screen 2021; 29:104-109. [PMID: 34894859 DOI: 10.1177/09691413211062344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Legal cases involving the National Cervical Screening Programme in Ireland following non-disclosure of an interval cervical cancer audit prompted this first international comparative survey of interval cervical cancer audit. METHODS A survey of 22 international population-based cervical screening programmes was conducted, to determine if they undertook audit of invasive cervical cancers. Those countries/regions that perform reviews were asked (i) how the audit was undertaken, including how the reviews were performed and how they controlled for retrospective bias, (ii) how women are informed of the audit process and how their consent is obtained, and (iii) how audit results were disclosed to patients. RESULTS Seventeen countries/regions invited completed the survey (77%); 65% (11/17) have an audit process for interval cervical cancers. Five perform individual patient reviews; three perform programme-wide review, with calculation of interval cancer detection rates; one routinely performs programme-wide review with calculation of interval cancer detection rates and offers individual reviews, and one routinely performs local hospital-level reviews. In the remaining country/region, hospital laboratories audit cancers, with a national audit process for all cervical cancers. Varying methodologies for retrospective cytology review were employed; four include control samples, with a ratio varying from 1:1 to 1:2. Three conduct a blinded review. Most countries/regions do not discuss interval cancer audit with participants and 3/11 (27.3%) inform women when a cervical cancer audit takes place. Disclosure is limited and variable. CONCLUSION The responses suggest that there is no consistent approach to audit of interval cervical cancers or to disclosure of audit results.
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Affiliation(s)
- Patricia Fitzpatrick
- Programme Evaluation Unit, 155307National Screening Service, Ireland.,School of Public Health, Physiotherapy & Sports Science, University College Dublin, Ireland
| | - Therese Mooney
- Programme Evaluation Unit, 155307National Screening Service, Ireland
| | - Helen Byrne
- Programme Evaluation Unit, 155307National Screening Service, Ireland
| | | | | | - Susan O'Reilly
- 8809Trinity College Dublin, Heath Service Executive, Ireland
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Molloy U, O'Reilly S, Ryan K, Kennelly S. 129 MAKING THE CASE FOR ENHANCED INTEGRATION BETWEEN MEMORY ASSESSMENT AND SUPPORT AND COMMUNITY PALLIATIVE CARE SERVICES IN ADVANCED DEMENTIA. Age Ageing 2021. [DOI: 10.1093/ageing/afab219.129] [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: 02/25/2023] Open
Abstract
Abstract
Background
In Ireland there are an estimated 64,000 people living with dementia. There is a growing body of evidence that a palliative approach, including access to specialist palliative care in the later stages of dementia is essential for wellbeing and the promotion of holistic, person-centred care. Yet many people living with advanced dementia have limited access to specialist palliative care services and such services often feel ill equipped to meet the unique, complex needs of this cohort.
Methods
This is a case study report of the joint working interface between Memory Assessment and Support (MASS) and Specialist Community Palliative Care (SPPCT). M was a 85 year old lady, with advanced dementia and history of lung cancer. CT Brain showed a large left parietal lobe tumour, probable metastatic lesion. Family agreed that further investigations were inappropriate and care objective was to manage her needs in her home in accordance with her previously known wishes.
Results
A joint initial visit with SCPCT and MASS was carried out which included medication review, symptom management and assessment of additional service need. Regular visits from SCPCT with support from primary care services and MASS ensured that appropriate services were in situ, symptoms were regularly assessed and treatment plan adjusted as needed. M was supported to die at home in the care of her family, as per her wishes.
Conclusion
This case illustrates the value of the partnership between MASS and SCPCT. Services that are responsive to client needs can ensure that appropriate care is given in the right place at the right time in accordance with their will and preference. This is in line with Slainte Care principles and provides an alternative pathway for end of live care for people with advanced dementia away from acute care settings.
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Affiliation(s)
- U Molloy
- St Francis Hospice , Dublin, Ireland
| | | | - K Ryan
- St Francis Hospice , Dublin, Ireland
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Jittla P, Graham D, Zhou C, Halliwell J, O'Reilly S, Aruketty S, Azizi A, Germetaki T, Lowe J, Little M, Punnett G, McMahon P, Benson L, Carter L, Krebs M, Thistlethwaite F, Yorke J, Cook N. 1493P An evaluation of the psychological impact of early phase clinical trials in cancer patients. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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17
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O'Reilly S. 1629P SARS-Cov-2 and Cancer Trials Ireland: Impact, resolution, legacy. Ann Oncol 2021. [PMCID: PMC8454420 DOI: 10.1016/j.annonc.2021.08.1622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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18
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Jerusalem G, Farah S, Courtois A, Chirgwin J, Aebi S, Karlsson P, Neven P, Hitre E, Graas MP, Simoncini E, Abdi E, Kamby C, Thompson A, Loibl S, Gavilá J, Kuroi K, Marth C, Müller B, O'Reilly S, Gombos A, Ruhstaller T, Burstein HJ, Rabaglio M, Ruepp B, Ribi K, Viale G, Gelber RD, Coates AS, Loi S, Goldhirsch A, Regan MM, Colleoni M. Continuous versus intermittent extended adjuvant letrozole for breast cancer: final results of randomized phase III SOLE (Study of Letrozole Extension) and SOLE Estrogen Substudy. Ann Oncol 2021; 32:1256-1266. [PMID: 34384882 DOI: 10.1016/j.annonc.2021.07.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 07/28/2021] [Accepted: 07/29/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Late recurrences in postmenopausal women with hormone receptor-positive breast cancers remain an important challenge. Avoidance or delayed development of resistance represents the main objective in extended endocrine therapy (ET). In animal models, resistance was reversed with restoration of circulating estrogen levels during interruption of letrozole treatment. This phase III, randomized, open-label Study of Letrozole Extension (SOLE) studied the effect of extended intermittent letrozole treatment in comparison with continuous letrozole. In parallel, the SOLE estrogen substudy (SOLE-EST) analyzed the levels of estrogen during the interruption of treatment. PATIENTS AND METHODS SOLE enrolled 4884 postmenopausal women with hormone receptor-positive, lymph node-positive, operable breast cancer between December 2007 and October 2012 and among them, 104 patients were enrolled in SOLE-EST. They must have undergone local treatment and have completed 4-6 years of adjuvant ET. Patients were randomized between continuous letrozole (2.5 mg/day orally for 5 years) and intermittent letrozole treatment (2.5 mg/day for 9 months followed by a 3-month interruption in years 1-4 and then 2.5 mg/day during all of year 5). RESULTS Intention-to-treat population included 4851 women in SOLE (n = 2425 in the intermittent and n = 2426 in the continuous letrozole groups) and 103 women in SOLE-EST (n = 78 in the intermittent and n = 25 in the continuous letrozole groups). After a median follow-up of 84 months, 7-year disease-free survival (DFS) was 81.4% in the intermittent group and 81.5% in the continuous group (hazard ratio: 1.03, 95% confidence interval: 0.91-1.17). Reported adverse events were similar in both groups. Circulating estrogen recovery was demonstrated within 6 weeks after the stop of letrozole treatment. CONCLUSIONS Extended adjuvant ET by intermittent administration of letrozole did not improve DFS compared with continuous use, despite the recovery of circulating estrogen levels. The similar DFS coupled with previously reported quality-of-life advantages suggest intermittent extended treatment is a valid option for patients who require or prefer a treatment interruption.
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Affiliation(s)
- G Jerusalem
- International Breast Cancer Study Group, Bern, Switzerland; Medical Oncology Department, CHU Liège, Liège University, Liège, Belgium.
| | - S Farah
- International Breast Cancer Study Group Statistical Center, Division of Biostatistics, Dana-Farber Cancer Institute, Boston, USA
| | - A Courtois
- Medical Oncology Department, CHU Liège, Liège University, Liège, Belgium
| | - J Chirgwin
- Breast Cancer Trials-Australia and New Zealand, University of Newcastle, Callaghan, Australia; Box Hill and Maroondah Hospitals, Monash University, Clayton, Australia
| | - S Aebi
- Division of Medical Oncology, Cancer Center, Lucerne Cantonal Hospital, Lucerne, Switzerland; Faculty of Medicine, University of Bern, Bern, Switzerland
| | - 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
| | - E Hitre
- Department of Medical Oncology and Clinical Pharmacology "B", National Institute of Oncology, Budapest, Hungary
| | | | - E Simoncini
- ASST Spedali Civili di Brescia, Brescia, Italy
| | - E Abdi
- The Tweed Hospital, Griffith University Gold Coast, Tweed Heads, Australia
| | - C Kamby
- Danish Breast Cancer Group and Rigshospitalet, Copenhagen, Denmark
| | - A Thompson
- Scottish Cancer Trials Breast Group and Division of Surgical Oncology, Baylor College of Medicine, Houston, USA
| | - S Loibl
- German Breast Group Forschungs GmbH, Neu-Isenburg, Germany
| | - J Gavilá
- SOLTI Group and Fundación Instituto Valenciano de Oncologia, Valencia, Spain
| | - K Kuroi
- Japan Breast Cancer Research Group and Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - C Marth
- Austrian Breast & Colorectal Cancer Study Group and Department of Obstetrics and Gynecology, Medical University Innsbruck, Innsbruck, Austria
| | - B Müller
- Chilean Cooperative Group for Oncologic Research (GOCCHI), Providencia, Santiago, Chile
| | - S O'Reilly
- Cancer Trials Ireland, Dublin, Ireland; University College Cork, Cork University Hospital, Cork, Ireland
| | - A Gombos
- Université Libre de Bruxelles, Institut Jules Bordet, Brussels, Belgium
| | - T Ruhstaller
- International Breast Cancer Study Group, Bern, Switzerland; Swiss Group for Clinical Cancer Research SAKK, Bern, Switzerland; Breast Center St. Gallen, St. Gallen, Switzerland; Faculty of Medicine, University of Basel, Basel, Switzerland
| | - H J Burstein
- Medical Oncology Department, CHU Liège, Liège University, Liège, Belgium; Harvard Medical School, Boston, USA; Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA
| | - M Rabaglio
- International Breast Cancer Study Group, Bern, Switzerland; Swiss Group for Clinical Cancer Research SAKK, Bern, Switzerland; Department of Medical Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - B Ruepp
- International Breast Cancer Study Group, Bern, Switzerland
| | - K Ribi
- International Breast Cancer Study Group, Bern, Switzerland
| | - G Viale
- Department of Pathology, University of Milan, Milan, Italy; IEO European Institute of Oncology IRCCS, Milan, Italy
| | - R D Gelber
- International Breast Cancer Study Group Statistical Center, Division of Biostatistics, Dana-Farber Cancer Institute, Boston, USA; Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA; Harvard TH Chan School of Public Health, Boston, USA; Frontier Science Foundation, Boston, USA
| | - A S Coates
- International Breast Cancer Study Group, Bern, Switzerland; NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia
| | - S Loi
- International Breast Cancer Study Group, Bern, Switzerland; Peter MacCallum Cancer Center, University of Melbourne, Melbourne, Australia
| | - A Goldhirsch
- International Breast Cancer Study Group, Bern, Switzerland; IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - M M Regan
- International Breast Cancer Study Group Statistical Center, Division of Biostatistics, Dana-Farber Cancer Institute, Boston, USA; Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA
| | - M Colleoni
- International Breast Cancer Study Group, Bern, Switzerland; Division of Medical Senology, IEO, European Institute of Oncology, IRCCS, Milan, Italy
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19
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Crofton E, Meredith P, Gray P, O'Reilly S, Strong J. Response to letter to the editor: Efficacy of pressure garment on prevention and regression of scars. Burns 2021; 48:247-248. [PMID: 34857417 DOI: 10.1016/j.burns.2021.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 05/26/2021] [Indexed: 11/15/2022]
Affiliation(s)
- E Crofton
- The University of Queensland, Australia; Queensland Health, Australia.
| | - P Meredith
- Central Queensland University, Australia.
| | - P Gray
- The University of Queensland, Australia; Queensland Health, Australia.
| | - S O'Reilly
- The University of Queensland, Australia; Queensland Health, Australia.
| | - J Strong
- The University of Queensland, Australia; Queensland Health, Australia.
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20
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Kijowsjki F, Moore S, Iqbal S, Cronin J, Milewski L, Woods N, O'Reilly S. Financial resilience among doctors in training and the COVID-19 pandemic. Ir Med J 2021; 114:390. [PMID: 37929705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
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21
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Bhogal P, Makalanda H, Wong K, Keston P, Downer J, Du Plessis JC, Nania A, Simonato D, Fuschi M, Chong W, O'Reilly S, Rennie I. The Silk Vista Baby - The UK experience. Interv Neuroradiol 2021; 28:201-212. [PMID: 34078155 DOI: 10.1177/15910199211024061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The Silk Vista Baby (SVB) flow diverter (FDS) is the only FDS deliverable via a 0.017 inch microcatheter and is specifically designed for the distal vasculature. We sought to evaluate the safety and efficacy of the SVB. MATERIALS AND METHODS We performed a retrospective review to identify SVB cases at 4 tertiary neurosurgical centres within the U.K. Clinical, procedural, angiographic and follow-up data were collected. RESULTS We identified 60 patients (35 female, 58%) of average age 54 ± 10.5 (range 30-72) with 61 aneurysms, 50 (81.9%) located in the anterior circulation. The majority of the aneurysms treated were unruptured (46, 75.4%) and saccular (46, 75.4%). Dome size was 6.2 ± 6.2 mm (range 1-36mm) and parent vessel diameter was 2.3 ± 0.4 mm (range 1.2-3.3 mm).An average number of 1.07 devices were implanted. Coils or other devices were implanted in 14 aneurysms (23.3%). At last angiographic follow-up (n = 55), 7.5 ± 4.2 months post-procedure, 32 aneurysms (57.1%) were graded as RRC I, 7 (12.5%) RRC II, and 17 RRC III (30.4%).Clinical complications, excluding death, were seen in 4 patients (6.8%) including 1 delayed aneurysm rupture and 3 symptomatic ischaemic events. Only one patient had permanent morbidity (mRS 1). 3 patients died during follow-up (5.1%); 2 deaths were related to the aneurysms (3.4%) - one ruptured dissecting MCA aneurysm, and one giant partially thrombosed posterior circulation aneurysm. 93% of patients were mRS ≤ 2 at last follow-up. CONCLUSION The SVB has high rates of technical success and an acceptable safety profile. Distal aneurysms may occlude slower due to relative oversizing of the devices.
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Affiliation(s)
- P Bhogal
- The Royal London Hospital, London, UK
| | | | - K Wong
- The Royal London Hospital, London, UK
| | - P Keston
- Department of Clinical Neurosciences, Western General Hospital, Edinburgh, UK
| | - J Downer
- Department of Clinical Neurosciences, Western General Hospital, Edinburgh, UK
| | - J C Du Plessis
- Department of Clinical Neurosciences, Western General Hospital, Edinburgh, UK
| | - A Nania
- Department of Clinical Neurosciences, Western General Hospital, Edinburgh, UK
| | - D Simonato
- Department of Interventional Neuroradiology, John Radcliffe Hospital, Oxford, UK
| | - M Fuschi
- Department of Interventional Neuroradiology, John Radcliffe Hospital, Oxford, UK
| | - W Chong
- Department of Interventional Neuroradiology, University Hospitals Coventry and Warwickshire, Warwickshire, UK
| | - S O'Reilly
- Department of Interventional Neuroradiology, The Royal Victoria Hospital, Belfast, UK
| | - I Rennie
- Department of Interventional Neuroradiology, The Royal Victoria Hospital, Belfast, UK
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22
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Keogh B, Ting To W, Daly L, Hynes G, Kennelly S, Lawlor B, Timmons S, O'Reilly S, Bracken-Scally M, Ciblis A, Cole N, Drury A, Pittalis C, Kennelly B, McCarron M, Brady AM. Acute hospital staff's attitudes towards dementia and perceived dementia knowledge: a cross-sectional survey in Ireland. BMC Geriatr 2020; 20:376. [PMID: 32998718 PMCID: PMC7526250 DOI: 10.1186/s12877-020-01783-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 09/21/2020] [Indexed: 11/13/2022] Open
Abstract
Background Little is known about staff’s attitudes in Irish acute hospital settings towards people living with dementia and their perceived dementia knowledge. The aim of this study was to understand the general level of dementia knowledge and attitudes towards dementia in different types of hospital staff, as well as to explore the potential influence of previous dementia training and experience (having a family member with dementia) and the potential moderating effects of personal characteristics. This data was required to plan and deliver general and targeted educational interventions to raise awareness of dementia throughout the acute services. Methods A cross-sectional survey was carried out among a diverse range of hospital staff (n = 1795) in three urban acute general hospitals in Ireland, including doctors, nurses, healthcare attendants, allied professionals, and general support staff. Participants’ perceived dementia knowledge and attitudes were assessed as well as their previous dementia training and experience. To measure participant’s attitude towards dementia, the validated Approaches to Dementia Questionnaire (ADQ) was used. Results Hospital staff demonstrated positive attitudes towards people living with dementia, and believed they had a fair to moderate understanding of dementia. Both ‘having previous dementia training’ and ‘having a relative living with dementia’ predicted attitude towards dementia and perceived dementia knowledge. Interestingly, certain personal staff characteristics did impact dementia training in predicting attitude towards dementia and perceived dementia knowledge. Conclusion This study provides a baseline of data regarding the attitudes towards dementia and perceived dementia knowledge for hospital staff in Irish acute hospitals. The results can inform educational initiatives that target different hospital staff, in order to increase awareness and knowledge to improve quality of dementia care in Irish hospitals.
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Affiliation(s)
- Brian Keogh
- School of Nursing and Midwifery, The University of Dublin, Trinity College, 24 D'Olier Street, Dublin, D02, Ireland.
| | - Wing Ting To
- School of Nursing and Midwifery, The University of Dublin, Trinity College, 24 D'Olier Street, Dublin, D02, Ireland
| | - Louise Daly
- School of Nursing and Midwifery, The University of Dublin, Trinity College, 24 D'Olier Street, Dublin, D02, Ireland
| | - Geralyn Hynes
- School of Nursing and Midwifery, The University of Dublin, Trinity College, 24 D'Olier Street, Dublin, D02, Ireland
| | - Siobhan Kennelly
- Medicine for the Elderly, Connolly Hospital, Blanchardstown and National Clinical Integrated Care Programme, Health Services Executive, Dublin, Ireland
| | - Brian Lawlor
- Director Mercer's Memory Clinic, St James's Hospital, Dublin 8, School of Medicine and Global Brain Institute, Trinity College Dublin, Dublin, Ireland
| | - Suzanne Timmons
- Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork and Mercy University Hospital, Cork, Ireland
| | - Susan O'Reilly
- Medicine for the Elderly, Connolly Hospital, Blanchardstown, Dublin, Ireland
| | | | - Aurelia Ciblis
- School of Nursing and Midwifery, The University of Dublin, Trinity College, 24 D'Olier Street, Dublin, D02, Ireland
| | - Natalie Cole
- National Research and Development Office, Health Service Executive, Dublin, Ireland
| | - Amanda Drury
- School of Nursing and Midwifery, The University of Dublin, Trinity College, 24 D'Olier Street, Dublin, D02, Ireland
| | - Chiara Pittalis
- Department of Epidemiology and Public Health Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Brendan Kennelly
- School of Business and Economics, National University of Ireland Galway, Galway, Ireland
| | - Mary McCarron
- School of Nursing and Midwifery, The University of Dublin, Trinity College, 24 D'Olier Street, Dublin, D02, Ireland
| | - Anne-Marie Brady
- School of Nursing and Midwifery, The University of Dublin, Trinity College, 24 D'Olier Street, Dublin, D02, Ireland
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Iqbal S, Farooq A, Aziz NA, Dea P, Aherne D, O'Reilly S, Power D, Bambury R, Collins D. 1218P Real world outcome and toxicity of adjuvant chemotherapy in non-small cell lung cancer. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.1420] [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] Open
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24
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Ni Choinin A, Allen M, Milewski L, Power D, Connolly R, Collins D, O'Reilly S, Bambury R. 1751P Lessons from a pandemic: An audit of acute medical oncology admissions during SARS-CoV-2 outbreak. Ann Oncol 2020. [PMCID: PMC7506404 DOI: 10.1016/j.annonc.2020.08.1815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Conroy M, O'Sullivan H, Collins D, Bambury R, Power D, Grossman S, O'Reilly S. 123P The prognostic role of lymphocyte count for treatment response in immune checkpoint inhibitor therapy. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.244] [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] Open
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26
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Affiliation(s)
- S O'Reilly
- Department of Biosciences, Durham University, Durham, UK
| | - J van Laar
- Clinical Rheumatology Department, University Medical Centre Utrecht, Utrecht, the Netherlands
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27
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Affiliation(s)
- S O'Reilly
- Department of Biosciences, Durham University, Durham, UK
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28
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Dempsey R, O'Reilly S. Prescribing Exercise for Cancer Survivors. Ir Med J 2020; 113:89. [PMID: 32603581] [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: 06/11/2023]
Affiliation(s)
- R Dempsey
- Mercy University Hospital Cork, South Intern Network Ireland
| | - S O'Reilly
- Medical Oncology Cork University Hospital, Mercy University Hospital, South Infirmary Victoria University Hospital Cork
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29
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Lim SS, O'Reilly S, Versace V, Janus E, Skinner TC, Best JD, Dunbar J, Teede H. Recommendations for promoting healthier lifestyles in postpartum women after gestational diabetes. Diabet Med 2020; 37:706-708. [PMID: 31833086 DOI: 10.1111/dme.14208] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/10/2019] [Indexed: 11/29/2022]
Affiliation(s)
- S S Lim
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Australia
| | - S O'Reilly
- Institute of Food and Health, School of Agriculture and Food Science, University College Dublin, Dublin, Ireland
| | - V Versace
- Deakin Rural Health, School of Medicine, Deakin University, Geelong, Australia
| | - E Janus
- General Internal Medicine Unit, Western Health and Department of Medicine, Melbourne Medical School, University of Melbourne, Melbourne, Australia
| | - T C Skinner
- Institut for Psykologi, Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - J D Best
- Lee Kong Chian School of Medicine, Nanyang Technology University, Singapore
| | - J Dunbar
- Deakin Rural Health, School of Medicine, Deakin University, Geelong, Australia
| | - H Teede
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Australia
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Agostinho Hunt AM, Gibson JA, Larrivee CL, O'Reilly S, Navitskaya S, Needle DB, Abramovitch RB, Busik JV, Waters CM. A bioluminescent Pseudomonas aeruginosa wound model reveals increased mortality of type 1 diabetic mice to biofilm infection. J Wound Care 2019; 26:S24-S33. [PMID: 28704171 DOI: 10.12968/jowc.2017.26.sup7.s24] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To examine how bacterial biofilms, as contributing factors in the delayed closure of chronic wounds in patients with diabetes, affect the healing process. METHOD We used daily microscopic imaging and the IVIS Spectrum in vivo imaging system to monitor biofilm infections of bioluminescent Pseudomonas aeruginosa and evaluate healing in non-diabetic and streptozotocin-induced diabetic mice. RESULTS Our studies determined that diabetes alone did not affect the rate of healing of full-depth murine back wounds compared with non-diabetic mice. The application of mature biofilms to the wounds significantly decreased the rate of healing compared with non-infected wounds for both non-diabetic as well as diabetic mice. Diabetic mice were also more severely affected by biofilms displaying elevated pus production, higher mortality rates and statistically significant increase in wound depth, granulation/fibrosis and biofilm presence. Introduction of a mutant Pseudomonas aeruginosa capable of producing high concentrations of cyclic di-GMP did not result in increased persistence in either diabetic or non-diabetic animals compared with the wild type strain. CONCLUSION Understanding the interplay between diabetes and biofilms may lead to novel treatments and better clinical management of chronic wounds.
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Affiliation(s)
- A M Agostinho Hunt
- Postdoctoral Associate, Department of Microbiology and Molecular Genetics, Michigan State University, East Lansing, MI US
| | - J A Gibson
- Undergraduate Researcher, Department of Biochemistry and Molecular Biology, Michigan State University, East Lansing, MI US
| | - C L Larrivee
- Undergraduate Researcher, Department of Microbiology and Molecular Genetics, Michigan State University, East Lansing, MI US
| | - S O'Reilly
- Research Assistant Professor, Department of Physiology, Michigan State University, East Lansing, MI USA
| | - S Navitskaya
- Lab Manager, Department of Physiology, Michigan State University, East Lansing, MI USA
| | - D B Needle
- Senior Veterinary Pathologist, New Hampshire Veterinary Diagnostic Laboratory, University of New Hampshire, Durham, NH US
| | - R B Abramovitch
- Assistant Professor, Department of Microbiology and Molecular Genetics, Michigan State University, East Lansing, MI US
| | - J V Busik
- Professor, Department of Physiology, Michigan State University, East Lansing, MI USA
| | - C M Waters
- Associate Professor, Department of Microbiology and Molecular Genetics, Michigan State University, East Lansing, MI US
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Hall BJ, Bhojwani AA, Innes H, Ahmed E, Cliff J, Malik Z, O'Hagan JE, Tolan S, Hall A, Hayat K, Errington D, Alam F, Thorp N, Flint H, Law A, Wong H, O'Reilly S, Jackson R, Cicconi S, Palmieri C. Real-world evidence regarding the efficacy and toxicity of neoadjuvant trastuzumab and pertuzumab in the management of HER2-positive early-breast cancer. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e12108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e12108 Background: Neoadjuvant (NA) HER2 blockade with trastuzumab (T) and pertuzumab (P) results in pathological complete response (pCR) rates of 39% to 62%. Diarrhoea is reported in up to 73% of cases. No real-world studies have explored the efficacy and toxicity of this treatment. This study aimed to determine the efficacy and toxicity of NA T-P and CT within a routine NHS clinical practice in the UK. Methods: HER2+ BC patients given NA T-P (accessed via the Cancer Drug Fund) between Oct2016-Jan 2018 at Clatterbridge Cancer Centre NHS Foundation Trust were retrospectively identified. Clinico-pathological information, treatment data, nurse led toxicity and echocardiography were reviewed. Data lock: 30th January 2019. Final pathological response data is presented. Results: 78 female patients were identified with a median age of 50 years (IQR: 44.4-60.2). Diagnosis: median tumour size 30mm (IQR 23.0-47.5mm), 62% (48/78) LN+ & 71% ER+. CT regimens: 81% (63/78) given FEC-DHP; of these 19 (30%) switched to weekly paclitaxel (wP) or nab-paclitaxel; 5% (4/78) AC/EC-DHP; 9% (8/78) TCHP of which 1 (13%) switched to wP. All patients underwent definitive surgery: 50% (39/78) mastectomy & 50% (39/78) WLE. 44% (35/78) axillary node clearance (ANC) & 56% (43/78) sentinel node biopsy (4 prior to NA therapy). 91% (32/35) undergoing ANC were LN+ at diagnosis, of which 66% (21/32) were LN- at surgery. pCR rate (ypT0/is, N0) was 47% (37/78), pCR by HR: ER+ 42% (23/55) & ER- 61% (14/23). pCR for 20 cases switched to wP was 60% (12/20). 6% (5/78) achieved pCR in the breast alone (in these LN status ITCx1, micrometsx3 & macrometsx1). Median size of the 46% (36/78) with residual breast tumour was 14.5mm (1-65mm). Outcome: Median follow up 68 weeks with one local and one distant recurrence occurring but no deaths. Toxicity: Ejection fraction did not decline beyond 10% of baseline in any patients. Diarrhoea occurred in 74% of cases, and CTCAE grade 3-4 toxicity occurring in >2% of patients: diarrhoea, fatigue, and infection. Conclusions: This data confirms 1) the real world efficacy of NA T-P 2) a significant number of LN+ patients become LN- and measures to avoid ANC are needed 3) switching to NA wP is not uncommon and may be associated with a higher pCR 4) diarrhoea rates reflect the literature and measures to mitigate it are needed. Updated outcomes will be presented.
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Affiliation(s)
| | | | - Helen Innes
- Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, United Kingdom
| | - Eliyaz Ahmed
- Clatterbridge Centre for Oncology NHS Foundation Trust, Bebington, United Kingdom
| | - Joanne Cliff
- Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, United Kingdom
| | - Zaf Malik
- Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, United Kingdom
| | | | - Shaun Tolan
- Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Allison Hall
- Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, United Kingdom
| | - Khizar Hayat
- Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, United Kingdom
| | - Douglas Errington
- Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, United Kingdom
| | - Farida Alam
- Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, United Kingdom
| | - Nicky Thorp
- Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, United Kingdom
| | - Helen Flint
- Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, United Kingdom
| | - Andrea Law
- Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, United Kingdom
| | - Helen Wong
- Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, United Kingdom
| | - Susan O'Reilly
- Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, United Kingdom
| | | | | | - Carlo Palmieri
- Institute of Translational Medicine, Liverpool, United Kingdom
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Bhojwani AA, Flint H, Hall BJ, Wong H, Innes H, Cliff J, Ahmed E, Malik Z, O'Hagen J, Tolan S, Hall A, Hayat K, Errington D, Alam F, Thorp N, O'Reilly S, Law A, Cicconi S, Jackson R, Palmieri C. Real-world data regarding the efficacy of neoadjuvant carboplatin-paclitaxel followed by dose-dense adriamycin-cyclophosphamide for triple-negative early breast cancer. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e12559] [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
e12559 Background: Platinum based regimens in the neoadjuvant (NA) setting for triple negative breast cancer (TNBC) have resulted in a significant increase in the pathological response (pCR) rate but at the cost of worse hematological toxicities. Despite these data such NA regimens are not widely used as yet for TNBC. Currently, no real world evidence exist regarding the efficacy and toxicity of this treatment regimen. Methods: Patients treated with neoadjuvant carbo-pac-ddAC between December 2015 and May 2018 at Clatterbridge Cancer Centre NHS Foundation Trust were identified via pharmacy records. Clinical records were reviewed, and clinico-pathological information and toxicity data were recorded. Data lock was January 16, 2019. Results: 53 female patients were identified with a median age of 48 years (IQR: 40.0-55.5). At presentation: Median tumour size 29mm (IQR: 20.0-40.0), 45% (24/53) were LN +, 8% (4/53) were ER+. Of 30 patients tested for germ line susceptibility, 23% (7/30) were found to have a BRCA mutation (full details to be presented). Delivery of planned CT : 4% (2/53) discontinued early for progressive disease or patient choice; of the remaining patients there were a total of 36 deferrals and 8 dose reductions. Surgical details: Breast: 42% (22/53) mastectomy & 58% (31/53) WLE, Ax management: 37% (19/51) Ax clearance & 63% (32/51) sentinel node biopsy (2 patients underwent previous axillary treatment for prior BC). Of 24 patients LN+ at presentation 58% (14/24) underwent Ax clearance; of these 64% (9/14) had no Ax involvement. pCR rate (ypT0/is, N0) (cases with prior ipsilateral Ax surgery excluded) was 53% (27/51) & pCR breast alone: 60% (31/52). Radiotherapy: 90% (47/52) received radiotherapy post-surgery. Outcome: At a median follow up 42.4 wks (IQR: 34.2-54.4), 6% (3/52) patients had disease recurrence resulting in 2 deaths. Conclusions: These initial real world data confirm the efficacy of NA therapy with carbo-pac-ddAC, with pCR rates consistent with literature. These results support the use of platinum based chemotherapy in the NA management of TNBC. Updated outcomes will be presented based on pCR versus no pCR; and BRCA status.
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Affiliation(s)
| | - Helen Flint
- Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, United Kingdom
| | | | - Helen Wong
- Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, United Kingdom
| | - Helen Innes
- Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, United Kingdom
| | - Joanne Cliff
- Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, United Kingdom
| | - Eliyaz Ahmed
- Clatterbridge Centre for Oncology NHS Foundation Trust, Bebington, United Kingdom
| | - Zaf Malik
- Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, United Kingdom
| | - Julie O'Hagen
- Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, United Kingdom
| | - Shaun Tolan
- Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Allison Hall
- Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, United Kingdom
| | - Khizar Hayat
- Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, United Kingdom
| | - Douglas Errington
- Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, United Kingdom
| | - Farida Alam
- Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, United Kingdom
| | - Nicky Thorp
- Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, United Kingdom
| | - Susan O'Reilly
- Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, United Kingdom
| | - Andrea Law
- Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, United Kingdom
| | | | | | - Carlo Palmieri
- Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, United Kingdom
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Olsson-Brown A, Piskilidis P, O'Hagan J, Thorp N, Robson P, Innes H, Wong H, Cicconi S, Jackson R, Kiernan T, Holcombe C, O'Reilly S, Palmieri C. The impact of the 21-gene recurrence score (Oncotype DX) on concordance of adjuvant therapy decision making as measured by the Liverpool Systemic Therapy Adjuvant Decision Tool. Breast 2019; 44:94-100. [PMID: 30703670 DOI: 10.1016/j.breast.2019.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 01/09/2019] [Accepted: 01/17/2019] [Indexed: 01/18/2023] Open
Abstract
PURPOSE The 21-gene recurrence score (Oncotype DX) (RS) informs systemic therapy decision making in ER-positive HER2-negative early breast cancer (BC). To date no study has described the more nuanced discussions that take place regarding systemic therapy or the impact of the RS on concordance in such decision making. Here we utilized a novel decision making tool to assess the impact of the RS on decision making as well as concordance of treatment recommendations. PATIENTS AND METHODS The clinicopathological information (CPI) of 50 BCs without and with the RS were presented to a panel of breast oncologists in a simulated MDT. The Liverpool Adjuvant Systemic Therapy Decision Tool (LASTDT) was developed and used to categorize treatment recommendations. Outcome measures included the impact of the RS on decisiveness and concordance in decision making and its impact on treatment recommendations. RESULTS Availability of the RS increased definitive decision making from 8% (4/50) to 56% (28/50) [χ2 = 79.35, p < 0.001] and altered the LASTDT category in 68% (34/50) of cases (p < 0.001), 74% of which were to forgo chemotherapy. With knowledge of RS, universal concordance rose from 14% to 64% [K = 0.328: K = 0.729]. CONCLUSIONS The RS improves certainty of decision making as well as concordance amongst oncologists. This provides evidence that the availability of the RS can improve consistency of decision making amongst oncologists and thus helps to ensure patients are managed consistently. This is particularly important when patients are managed in a loco-regional, multidisciplinary team manner where heterogeneous decisions can lead to disparity in care.
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Affiliation(s)
- Anna Olsson-Brown
- The University of Liverpool, Department of Molecular and Pharmacology, Institute of Translational Medicine, Liverpool, L69 3GE, UK; The Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, CH63 4JY, UK.
| | - Pavlos Piskilidis
- The Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, CH63 4JY, UK
| | - Julie O'Hagan
- The Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, CH63 4JY, UK
| | - Nicky Thorp
- The Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, CH63 4JY, UK
| | - Peter Robson
- The Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, CH63 4JY, UK
| | - Helen Innes
- The Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, CH63 4JY, UK
| | - Helen Wong
- The Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, CH63 4JY, UK
| | - Silvia Cicconi
- The University of Liverpool, Liverpool Cancer Trials Unit, Liverpool, L69 3GE, UK
| | - Richard Jackson
- The University of Liverpool, Liverpool Cancer Trials Unit, Liverpool, L69 3GE, UK
| | - Tamara Kiernan
- St Helens and Knowsley NHS Trust, St Helens, Merseyside, WA10 1ED, UK
| | - Christopher Holcombe
- The Royal Liverpool and Broadgreen University Teaching Hospitals NHS Trust, Liverpool, L7 8XP, UK
| | - Susan O'Reilly
- The Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, CH63 4JY, UK
| | - Carlo Palmieri
- The Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, CH63 4JY, UK; The University of Liverpool, Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, Liverpool, L69 3GE, UK; Liverpool and Merseyside Academic Breast Unit, Clatterbridge Cancer Centre-The Linda McCartney Centre, Liverpool, L7 8XP, UK.
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Karmali S, Hughes N, Kinneally A, Kroes J, Cook J, Killian M, Shafiq T, O'Mahony D, Bird B, O'Connor M, O'Reilly S, Galiauskas R, Murphy CG. Abstract P4-16-08: A regional audit of 6-hour monitoring for administration related reactions during the first administration of subcutaneous trastuzumab. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p4-16-08] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction
In 2012, Subcutaneous Trastuzumab (TSC) was introduced as an alternative to Intravenous Trastuzumab (TIV) for HER2+ breast cancer. The pivotal HannaH study demonstrated that TSC was non-inferior to TIV, was preferred by patients, and serious administration related reactions (ARRs) were not reported. However, the Summary of Product Characteristics (SPC) advises that patients be observed for ARRs for 6 hours post-first administration (and 2 hours post-subsequent administrations), similar to TIV.
Aim
To assess the frequency and tolerability of ARRs during the 6-hour observation period post first administration of TSC in patients with HER2+ breast cancer.
Method:
A retrospective audit of TSC was conducted in Southwest Ireland across five centers from 2014-2016. Patient charts were reviewed to record ARRs reported on the first-administration or at subsequent visit. In addition a subset of patients were interviewed regarding their recollection of ARRs with first or subsequent injections.
Results:
The study is ongoing having identified 192 patients. These centers have administered 2111 TSC injections in total, associated with 4998 hours of observation as per SPC. From the 385 injections given over the first two TSC administrations, 13 injections (3.4%) were associated with ARRs within 24 hours. Nine patients (2.3%) experienced injection site reactions immediately post injection, one injection site pain (0.3%), and one experienced petechiae on subsequent exposure (0.3%). Three patients experienced pyrexia and dry cough 24 hours post-injection and were hospitalized for respiratory tract infection. There were no reactions experienced between 2 and 6 hours post-first injection. There were no serious ARRs. Telephone interviews are ongoing and these results will be reported.
Conclusion:
ARRs related to TSC are usually immediate, mild and self-limiting. Observing patients for 6 hours post-first injection and 2 hours post-subsequent injections represents an inefficient use of healthcare resources.
Citation Format: Karmali S, Hughes N, Kinneally A, Kroes J, Cook J, Killian M, Shafiq T, O'Mahony D, Bird B, O'Connor M, O'Reilly S, Galiauskas R, Murphy CG. A regional audit of 6-hour monitoring for administration related reactions during the first administration of subcutaneous trastuzumab [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 P4-16-08.
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Affiliation(s)
- S Karmali
- Bon Secours Hospital, Cork, Munster, Ireland; University College Cork, Cork, Munster, Ireland; Cork University Hospital, Cork, Munster, Ireland; University Hospital Waterford, Waterford, Ireland; University Hospital Kerry, Tralee, Kerry, Ireland
| | - N Hughes
- Bon Secours Hospital, Cork, Munster, Ireland; University College Cork, Cork, Munster, Ireland; Cork University Hospital, Cork, Munster, Ireland; University Hospital Waterford, Waterford, Ireland; University Hospital Kerry, Tralee, Kerry, Ireland
| | - A Kinneally
- Bon Secours Hospital, Cork, Munster, Ireland; University College Cork, Cork, Munster, Ireland; Cork University Hospital, Cork, Munster, Ireland; University Hospital Waterford, Waterford, Ireland; University Hospital Kerry, Tralee, Kerry, Ireland
| | - J Kroes
- Bon Secours Hospital, Cork, Munster, Ireland; University College Cork, Cork, Munster, Ireland; Cork University Hospital, Cork, Munster, Ireland; University Hospital Waterford, Waterford, Ireland; University Hospital Kerry, Tralee, Kerry, Ireland
| | - J Cook
- Bon Secours Hospital, Cork, Munster, Ireland; University College Cork, Cork, Munster, Ireland; Cork University Hospital, Cork, Munster, Ireland; University Hospital Waterford, Waterford, Ireland; University Hospital Kerry, Tralee, Kerry, Ireland
| | - M Killian
- Bon Secours Hospital, Cork, Munster, Ireland; University College Cork, Cork, Munster, Ireland; Cork University Hospital, Cork, Munster, Ireland; University Hospital Waterford, Waterford, Ireland; University Hospital Kerry, Tralee, Kerry, Ireland
| | - T Shafiq
- Bon Secours Hospital, Cork, Munster, Ireland; University College Cork, Cork, Munster, Ireland; Cork University Hospital, Cork, Munster, Ireland; University Hospital Waterford, Waterford, Ireland; University Hospital Kerry, Tralee, Kerry, Ireland
| | - D O'Mahony
- Bon Secours Hospital, Cork, Munster, Ireland; University College Cork, Cork, Munster, Ireland; Cork University Hospital, Cork, Munster, Ireland; University Hospital Waterford, Waterford, Ireland; University Hospital Kerry, Tralee, Kerry, Ireland
| | - B Bird
- Bon Secours Hospital, Cork, Munster, Ireland; University College Cork, Cork, Munster, Ireland; Cork University Hospital, Cork, Munster, Ireland; University Hospital Waterford, Waterford, Ireland; University Hospital Kerry, Tralee, Kerry, Ireland
| | - M O'Connor
- Bon Secours Hospital, Cork, Munster, Ireland; University College Cork, Cork, Munster, Ireland; Cork University Hospital, Cork, Munster, Ireland; University Hospital Waterford, Waterford, Ireland; University Hospital Kerry, Tralee, Kerry, Ireland
| | - S O'Reilly
- Bon Secours Hospital, Cork, Munster, Ireland; University College Cork, Cork, Munster, Ireland; Cork University Hospital, Cork, Munster, Ireland; University Hospital Waterford, Waterford, Ireland; University Hospital Kerry, Tralee, Kerry, Ireland
| | - R Galiauskas
- Bon Secours Hospital, Cork, Munster, Ireland; University College Cork, Cork, Munster, Ireland; Cork University Hospital, Cork, Munster, Ireland; University Hospital Waterford, Waterford, Ireland; University Hospital Kerry, Tralee, Kerry, Ireland
| | - CG Murphy
- Bon Secours Hospital, Cork, Munster, Ireland; University College Cork, Cork, Munster, Ireland; Cork University Hospital, Cork, Munster, Ireland; University Hospital Waterford, Waterford, Ireland; University Hospital Kerry, Tralee, Kerry, Ireland
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Bhojwani A, Flint H, Hall B, Wong H, Innes H, Cliff J, Ahmed E, Malik Z, O'Hagan J, Tolan S, Hall A, Hyatt K, Errington D, Alam F, Robson P, Thorp N, O'Reilly S, Law A, Cicconi S, Jackson R, Palmieri C. Abstract P6-18-32: Profiling the early haematological dynamics and treatment modifications with palbociclib when used as first line treatment for ER-positive, HER2-negative metastatic breast cancer. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p6-18-32] [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: Palbociclib plus endocrine therapy (ET) significantly increases progression free survival compared to ET alone. Within PALOMA2 neutropenia was the most common AE and reason for dose reductions. No real data exists regarding dose reductions (DRs), dose interruptions (DIs), toxicities and benefits of palbociclib. Objective: To describe the early haematological dynamics, DRs/DIs with 1st line palbociclib in the context of a routine UK clinical practice. Methods: A prospective record was maintained of all patients with ER-positive, HER2-negative metastatic BC registered on the Pfizer patient programme at the Clatterbridge Cancer Centre NHS Foundation Trust. The clinical records of all patients commenced on treatment between April and December 2017 were reviewed, and clinico-pathological information, haematological data & toxicity data recorded. Data lock was 31st March 2018. Results: 48 patients received at least one cycle of treatment. The median age was 58, 29% (14/48) premenopausal & 71% (34/48) postmenopausal. 43% (21/48) had bone only disease with 42% (20/48) having visceral disease. The median number of cycles delivered 8 (range 2-11). DRs: 18/48 (38%) patients had a total of 21 DRs; 14/18 (78%) had 1 DR to 100mg; 1/18 (5%) 1 DR to 75mg; & 3/18 (17%) 2 DRs to 75mg. Reasons for DRs: 13 neutropenia, 2 leukopenia, 1 thrombocytopenia, 2 fatigue, 1 poor appetite, 1 sore mouth & 1 non-specially unwell. DIs: occurred in 24/48 patients (50%). Details of DRs/DIs by cycle will be presented. 85% (41 of 48) patients remain on treatment with 59% (24/41) on 125mg; 34% (14/41) on 100mg & 7% (3/41) on 75mg. FBC were available for 41/48 (85%) cases & dynamics considered over the first 6 cycles using FBC at the time of planned treatment delivery. Hb Baseline all patients (AP):129 (121 – 138), patients; patients with no dose reductions (NDR) 127 (123 – 139) & patient dose reduction (DR): 130 (118 – 136). Hb changes to cycles 2, 4 and 6 AP: 122 (115 – 131), 121 (116 – 127) and 125 (116 – 134); NDR:122 (110 - 135), 125 (117 - 127) and 131 (116 – 135); DR: 115 (112 - 120), 120 (115 - 124) and 122 (115 – 129). WCC Baseline AP: 6.8 (5.6 – 7.7); NDR: 7.2 (6.3 – 7.7); DR: 6.7 (5.2 – 7.7). WCC changes to cycles 2, 4 and 6 AP: 3.7 (2.9 – 4.4), 3.7 (3.1 – 4.4) and 3.3 (3 – 3.9); NDR: 3.5 (2.9 – 4.1), 3.6 (3.2 – 4.3) and 3.6 (3.1 – 4.1); DR: 2.1 (1.7 – 2.5), 4.3 (3 – 4.6) and 3.3 (2.8 – 3.5). ANC Baseline AP: 4.0 (3.2 – 5.1); NDR: 4.4 (3.4 – 5.0); DR: 3.6 (2.9 – 5.2). ANC changes to cycles 2, 4 and 6 AP: 1.5 (1.2 – 2.1), 1.7 (1.3 – 2.0) and 1.4 (1.2 – 1.9) NDR: 1.5 (1.1 – 2.1), 1.7 (1.4 – 2.0) and 1.3 (1.2 – 2.0); DR: 0.8 (0.6 – 0.8), 1.7 (1.2 – 2.3) and 1.4 (1.3 – 1.6). Plts Baseline AP: 298 (226 – 339), NDR: 252 (211 – 336); DR: 299 (253 – 339). Plt changes to cycles 2, 4 and 6 AP: 252 (198 – 310), 221 (186 – 259) and 200 (169 – 243). NDR: 249 (185 – 334), 229 (171 – 267) and 205 (177 – 263);DR: 208 (199 – 210), 216 (199 – 243) and 194 (162 -210). Conclusion: These initial real world data are consistent with the PALOMA2 data. Baseline WCC & ANC show no significant difference between NDR and DR cases. Updated data will be presented as well as outcome data for first time.
Citation Format: Bhojwani A, Flint H, Hall B, Wong H, Innes H, Cliff J, Ahmed E, Malik Z, O'Hagan J, Tolan S, Hall A, Hyatt K, Errington D, Alam F, Robson P, Thorp N, O'Reilly S, Law A, Cicconi S, Jackson R, Palmieri C. Profiling the early haematological dynamics and treatment modifications with palbociclib when used as first line treatment for ER-positive, HER2-negative metastatic breast cancer [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 P6-18-32.
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Affiliation(s)
- A Bhojwani
- Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, Merseyside, Switzerland; University of Liverpool, Liverpool, Merseyside, United Kingdom
| | - H Flint
- Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, Merseyside, Switzerland; University of Liverpool, Liverpool, Merseyside, United Kingdom
| | - B Hall
- Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, Merseyside, Switzerland; University of Liverpool, Liverpool, Merseyside, United Kingdom
| | - H Wong
- Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, Merseyside, Switzerland; University of Liverpool, Liverpool, Merseyside, United Kingdom
| | - H Innes
- Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, Merseyside, Switzerland; University of Liverpool, Liverpool, Merseyside, United Kingdom
| | - J Cliff
- Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, Merseyside, Switzerland; University of Liverpool, Liverpool, Merseyside, United Kingdom
| | - E Ahmed
- Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, Merseyside, Switzerland; University of Liverpool, Liverpool, Merseyside, United Kingdom
| | - Z Malik
- Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, Merseyside, Switzerland; University of Liverpool, Liverpool, Merseyside, United Kingdom
| | - J O'Hagan
- Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, Merseyside, Switzerland; University of Liverpool, Liverpool, Merseyside, United Kingdom
| | - S Tolan
- Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, Merseyside, Switzerland; University of Liverpool, Liverpool, Merseyside, United Kingdom
| | - A Hall
- Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, Merseyside, Switzerland; University of Liverpool, Liverpool, Merseyside, United Kingdom
| | - K Hyatt
- Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, Merseyside, Switzerland; University of Liverpool, Liverpool, Merseyside, United Kingdom
| | - D Errington
- Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, Merseyside, Switzerland; University of Liverpool, Liverpool, Merseyside, United Kingdom
| | - F Alam
- Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, Merseyside, Switzerland; University of Liverpool, Liverpool, Merseyside, United Kingdom
| | - P Robson
- Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, Merseyside, Switzerland; University of Liverpool, Liverpool, Merseyside, United Kingdom
| | - N Thorp
- Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, Merseyside, Switzerland; University of Liverpool, Liverpool, Merseyside, United Kingdom
| | - S O'Reilly
- Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, Merseyside, Switzerland; University of Liverpool, Liverpool, Merseyside, United Kingdom
| | - A Law
- Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, Merseyside, Switzerland; University of Liverpool, Liverpool, Merseyside, United Kingdom
| | - S Cicconi
- Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, Merseyside, Switzerland; University of Liverpool, Liverpool, Merseyside, United Kingdom
| | - R Jackson
- Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, Merseyside, Switzerland; University of Liverpool, Liverpool, Merseyside, United Kingdom
| | - C Palmieri
- Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, Merseyside, Switzerland; University of Liverpool, Liverpool, Merseyside, United Kingdom
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Hassan A, Gullo G, O'Reilly S, Ruiz-Borrego M, Toomey S, Grogan L, Breathnach O, Morris PG, Walshe JM, Crown J, O'Mahony D, Falcon A, Egan K, Hernando A, Teiserskiene A, Kelly CM, Coate L, Hennessy BT. Abstract OT3-06-01: Phase Ib clinical trial of co PANlisib in combination with Trastuzumab emtansine (T-DM1) in pre-treated unresectable locally advanced or metastatic HER2-positive bre Ast cancer (BC) “PANTHERA”-CTRIAL-IE 17-13. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-ot3-06-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background:The phosphoinositide 3 kinase (PI3K) pathway is important in the oncogenic function of HER2. Aberrant activation of PI3K is implicated in resistance to trastuzumab and other HER2-targeted therapies and is frequent, with up to 22% of HER2 positive breast cancer having a PIK3CA mutation. Copanlisib is a pan-class 1 PI3K inhibitor administered i.v. with low nanomolar activity against both PI3Kα and PI3Kβ. Copanlisib has been shown to re-sensitise trastuzumab resistant cell lines to trastuzumab with synergism seen in some cell lines between copanlisib and HER2 targeted therapy.
Trial design: This is a phase Ib open label, single arm adaptive, multi-centre trial of copanlisib in combination with T-DM1. Eligible patients will receive T-DM1 at 3.6mg/kg i.v. on day 1 of a 21-day cycle plus copanlisib. Copanlisib will be administered i.v. according to the dose escalation scheme (dose level 1 is 45mg on days 1 and 8, dose level 2 is 60mg on days 1 and 8, dose level 3 is 60mg on days 1, 8, and 15). Dose level -1 will be 45 mg on day 1 in case dose de-escalation is needed. We will enrol 3 to 6 patients per dose level. All patients in each level must have completed at least the first cycle of therapy before enrolment in the next dose level. Patients not completing the first cycle for a reason other than toxicity will be replaced. Dose escalation and determination of the Maximum Tolerated Dose (MTD) will be based on the occurrence of Dose Limiting Toxicities (DLT).
Eligibility criteria:Eligible patients are those with unresectable locally advanced or metastatic HER2-positive BC who previously received trastuzumab and a taxane, separately or in combination. Participants must have adequate organ function and ECOG PS ≤ 2
Objectives:The primary objective is to determine the MTD for copanlisib in combination with T-DM1 in patients with pre-treated unresectable locally advanced or metastatic HER2-positive BC. Secondary objectives include evaluating the safety, efficacy and cardiotoxicity in patients treated with this regimen. Exploratory objectives include examining for predictive biomarkers in tumour tissue and blood or plasma and to examine molecular tumour adaptation to clinical trial therapy.
Statistical methods: Patients will be accrued in cohorts of 3 patients according to a standard 3+3 algorithm, with dose escalation and determination of MTD based on the occurrence of DLT, using the usual threshold probability of 33%. The final dose level will be expanded to include a total of 6 additional patients (expansion cohort).
Present accrual and target accrual:The trial will start accrual in October 2018. Maximum of 24 patients will be enrolled.
Citation Format: Hassan A, Gullo G, O'Reilly S, Ruiz-Borrego M, Toomey S, Grogan L, Breathnach O, Morris PG, Walshe JM, Crown J, O'Mahony D, Falcon A, Egan K, Hernando A, Teiserskiene A, Kelly CM, Coate L, Hennessy BT. Phase Ib clinical trial of coPANlisib in combination with Trastuzumab emtansine (T-DM1) in pre-treated unresectable locally advanced or metastatic HER2-positive breAst cancer (BC) “PANTHERA”-CTRIAL-IE 17-13 [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr OT3-06-01.
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Affiliation(s)
- A Hassan
- RCSI, Dublin 9, Ireland; Beaumont Hospital, Dublin 9, Ireland; St Vincent's University Hospital, Dublin 4, Ireland; Cork University Hospital, Cork, Ireland; Hospital Universitario Virgen Del Rocío, Sevilla, Spain; GEICAM, Spanish Breast Cancer Group, Madrid, Spain; Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland; Cancer Trials Ireland, Dublin, Ireland; Mater Misericordiae University Hospital, Dublin, Ireland
| | - G Gullo
- RCSI, Dublin 9, Ireland; Beaumont Hospital, Dublin 9, Ireland; St Vincent's University Hospital, Dublin 4, Ireland; Cork University Hospital, Cork, Ireland; Hospital Universitario Virgen Del Rocío, Sevilla, Spain; GEICAM, Spanish Breast Cancer Group, Madrid, Spain; Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland; Cancer Trials Ireland, Dublin, Ireland; Mater Misericordiae University Hospital, Dublin, Ireland
| | - S O'Reilly
- RCSI, Dublin 9, Ireland; Beaumont Hospital, Dublin 9, Ireland; St Vincent's University Hospital, Dublin 4, Ireland; Cork University Hospital, Cork, Ireland; Hospital Universitario Virgen Del Rocío, Sevilla, Spain; GEICAM, Spanish Breast Cancer Group, Madrid, Spain; Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland; Cancer Trials Ireland, Dublin, Ireland; Mater Misericordiae University Hospital, Dublin, Ireland
| | - M Ruiz-Borrego
- RCSI, Dublin 9, Ireland; Beaumont Hospital, Dublin 9, Ireland; St Vincent's University Hospital, Dublin 4, Ireland; Cork University Hospital, Cork, Ireland; Hospital Universitario Virgen Del Rocío, Sevilla, Spain; GEICAM, Spanish Breast Cancer Group, Madrid, Spain; Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland; Cancer Trials Ireland, Dublin, Ireland; Mater Misericordiae University Hospital, Dublin, Ireland
| | - S Toomey
- RCSI, Dublin 9, Ireland; Beaumont Hospital, Dublin 9, Ireland; St Vincent's University Hospital, Dublin 4, Ireland; Cork University Hospital, Cork, Ireland; Hospital Universitario Virgen Del Rocío, Sevilla, Spain; GEICAM, Spanish Breast Cancer Group, Madrid, Spain; Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland; Cancer Trials Ireland, Dublin, Ireland; Mater Misericordiae University Hospital, Dublin, Ireland
| | - L Grogan
- RCSI, Dublin 9, Ireland; Beaumont Hospital, Dublin 9, Ireland; St Vincent's University Hospital, Dublin 4, Ireland; Cork University Hospital, Cork, Ireland; Hospital Universitario Virgen Del Rocío, Sevilla, Spain; GEICAM, Spanish Breast Cancer Group, Madrid, Spain; Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland; Cancer Trials Ireland, Dublin, Ireland; Mater Misericordiae University Hospital, Dublin, Ireland
| | - O Breathnach
- RCSI, Dublin 9, Ireland; Beaumont Hospital, Dublin 9, Ireland; St Vincent's University Hospital, Dublin 4, Ireland; Cork University Hospital, Cork, Ireland; Hospital Universitario Virgen Del Rocío, Sevilla, Spain; GEICAM, Spanish Breast Cancer Group, Madrid, Spain; Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland; Cancer Trials Ireland, Dublin, Ireland; Mater Misericordiae University Hospital, Dublin, Ireland
| | - PG Morris
- RCSI, Dublin 9, Ireland; Beaumont Hospital, Dublin 9, Ireland; St Vincent's University Hospital, Dublin 4, Ireland; Cork University Hospital, Cork, Ireland; Hospital Universitario Virgen Del Rocío, Sevilla, Spain; GEICAM, Spanish Breast Cancer Group, Madrid, Spain; Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland; Cancer Trials Ireland, Dublin, Ireland; Mater Misericordiae University Hospital, Dublin, Ireland
| | - JM Walshe
- RCSI, Dublin 9, Ireland; Beaumont Hospital, Dublin 9, Ireland; St Vincent's University Hospital, Dublin 4, Ireland; Cork University Hospital, Cork, Ireland; Hospital Universitario Virgen Del Rocío, Sevilla, Spain; GEICAM, Spanish Breast Cancer Group, Madrid, Spain; Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland; Cancer Trials Ireland, Dublin, Ireland; Mater Misericordiae University Hospital, Dublin, Ireland
| | - J Crown
- RCSI, Dublin 9, Ireland; Beaumont Hospital, Dublin 9, Ireland; St Vincent's University Hospital, Dublin 4, Ireland; Cork University Hospital, Cork, Ireland; Hospital Universitario Virgen Del Rocío, Sevilla, Spain; GEICAM, Spanish Breast Cancer Group, Madrid, Spain; Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland; Cancer Trials Ireland, Dublin, Ireland; Mater Misericordiae University Hospital, Dublin, Ireland
| | - D O'Mahony
- RCSI, Dublin 9, Ireland; Beaumont Hospital, Dublin 9, Ireland; St Vincent's University Hospital, Dublin 4, Ireland; Cork University Hospital, Cork, Ireland; Hospital Universitario Virgen Del Rocío, Sevilla, Spain; GEICAM, Spanish Breast Cancer Group, Madrid, Spain; Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland; Cancer Trials Ireland, Dublin, Ireland; Mater Misericordiae University Hospital, Dublin, Ireland
| | - A Falcon
- RCSI, Dublin 9, Ireland; Beaumont Hospital, Dublin 9, Ireland; St Vincent's University Hospital, Dublin 4, Ireland; Cork University Hospital, Cork, Ireland; Hospital Universitario Virgen Del Rocío, Sevilla, Spain; GEICAM, Spanish Breast Cancer Group, Madrid, Spain; Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland; Cancer Trials Ireland, Dublin, Ireland; Mater Misericordiae University Hospital, Dublin, Ireland
| | - K Egan
- RCSI, Dublin 9, Ireland; Beaumont Hospital, Dublin 9, Ireland; St Vincent's University Hospital, Dublin 4, Ireland; Cork University Hospital, Cork, Ireland; Hospital Universitario Virgen Del Rocío, Sevilla, Spain; GEICAM, Spanish Breast Cancer Group, Madrid, Spain; Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland; Cancer Trials Ireland, Dublin, Ireland; Mater Misericordiae University Hospital, Dublin, Ireland
| | - A Hernando
- RCSI, Dublin 9, Ireland; Beaumont Hospital, Dublin 9, Ireland; St Vincent's University Hospital, Dublin 4, Ireland; Cork University Hospital, Cork, Ireland; Hospital Universitario Virgen Del Rocío, Sevilla, Spain; GEICAM, Spanish Breast Cancer Group, Madrid, Spain; Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland; Cancer Trials Ireland, Dublin, Ireland; Mater Misericordiae University Hospital, Dublin, Ireland
| | - A Teiserskiene
- RCSI, Dublin 9, Ireland; Beaumont Hospital, Dublin 9, Ireland; St Vincent's University Hospital, Dublin 4, Ireland; Cork University Hospital, Cork, Ireland; Hospital Universitario Virgen Del Rocío, Sevilla, Spain; GEICAM, Spanish Breast Cancer Group, Madrid, Spain; Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland; Cancer Trials Ireland, Dublin, Ireland; Mater Misericordiae University Hospital, Dublin, Ireland
| | - CM Kelly
- RCSI, Dublin 9, Ireland; Beaumont Hospital, Dublin 9, Ireland; St Vincent's University Hospital, Dublin 4, Ireland; Cork University Hospital, Cork, Ireland; Hospital Universitario Virgen Del Rocío, Sevilla, Spain; GEICAM, Spanish Breast Cancer Group, Madrid, Spain; Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland; Cancer Trials Ireland, Dublin, Ireland; Mater Misericordiae University Hospital, Dublin, Ireland
| | - L Coate
- RCSI, Dublin 9, Ireland; Beaumont Hospital, Dublin 9, Ireland; St Vincent's University Hospital, Dublin 4, Ireland; Cork University Hospital, Cork, Ireland; Hospital Universitario Virgen Del Rocío, Sevilla, Spain; GEICAM, Spanish Breast Cancer Group, Madrid, Spain; Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland; Cancer Trials Ireland, Dublin, Ireland; Mater Misericordiae University Hospital, Dublin, Ireland
| | - BT Hennessy
- RCSI, Dublin 9, Ireland; Beaumont Hospital, Dublin 9, Ireland; St Vincent's University Hospital, Dublin 4, Ireland; Cork University Hospital, Cork, Ireland; Hospital Universitario Virgen Del Rocío, Sevilla, Spain; GEICAM, Spanish Breast Cancer Group, Madrid, Spain; Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland; Cancer Trials Ireland, Dublin, Ireland; Mater Misericordiae University Hospital, Dublin, Ireland
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Hall B, Bhojwani A, Innes H, Ahmed E, Cliff J, Malik Z, O'Hagan J, Tolan S, Hall A, Hayat K, Errington D, Alam F, Thorp N, Flint H, Law A, Wong H, O'Reilly S, Jackson R, Cicconi S, Palmieri C. Abstract P6-17-27: Real world experience of the medical and surgical management of HER2 positive early breast cancer treated with neoadjuvant trastuzumab and pertuzumab via the NHS England cancer drug fund. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p6-17-27] [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: Studies of neoadjuvant (NA) dual HER2 blockade with trastuzumab (T) and pertuzumab (P) in combination with chemotherapy (CT) for early breast cancer (BC) have reported pathological complete response (pCR) rates of 39 to 62%. These studies also report manageable toxicity with diarrhoea reported in up to 73% of cases. To date no real-world studies have explored the efficacy and toxicity of this treatment. The objective of this study was to describe the medical and surgical management of women treated with neoadjuvant T-P in combination with CT (NAT-P-CT). As well as to determine the efficacy toxicity of NAT-P-CT in the context of a routine UK NHS clinical practice.
Methods: Patients with HER2+ BC treated neoadjuvantly with T-P accessed via the NHS England Cancer Drug Fund (CDF) at the Clatterbridge Cancer Centre NHS Foundation Trust between October 2016 and January 2018 were retrospectively identified. Clinico-pathological information, treatment data, nurse led toxicity review and echocardiographic were reviewed. Data lock was 19th June 2018.
Results: 78 female patients were identified with a median age of 50 years (IQR: 44.4-60.2). At diagnosis: median tumour size 30mm (23.0-47.5mm), 62% (48/78) were LN positive & 56% (44/78) ER+. CT regimens: 81% (63/78) FEC-DHP of these 30% (19/63) switched to weekly paclitaxel (wP). or nab-paclitaxel; 5% (4/78); AC/EC-DHP; 9% (8/78) TCHP with 13% (1/8) switched to wP. At time of analysis, 88% (69/78) had undergone definitive surgery. Surgical details: Breast: 52% (36/69) mastectomy & 48% (33/69) WLE, Axillary management: 51% (35/69) axillary dissection (Ax Dx) & 49% (34/69) sentinel node biopsy (4 performed prior to NA treatment). 91% (32/35) of those undergoing Ax Dx were LN+ at presentation, of these 59% (19/32) had no evidence of axillary involvement at surgery. pCR rate (ypT0/is, N0) was 46% (32/69) [pCR by HR: ER+ 43% (21/49) & ER- 55% (11/20]. pCR for 20 patients switched to wP was 60% (12/20). 7% (5/69) achieved pCR in the breast alone (in these LN status ITCx1, micrometsx3 & macrometsx1). Of the 54% (37/69) with residual breast tumour median size was 13mm (1-22mm). Toxicity Data: Ejection fraction (EF) did not decline beyond 10% of baseline in any patients. Diarrhoea (any grade) occurred in 74% of cases, and CTCAE grade 3-4 toxicity occurring in >2% of patients: diarrhoea, fatigue, and infection. Updated analysis regarding pCR rate and toxicity, as well as initial outcome data will be presented.
Conclusion: These results (1) confirm the efficacy of NA T-P in a real world population; (2) support the use of NA wP; (3) indicate significant proportion of patients axilla are downstaged & (4) reveal diarrhoea rates in keeping with the literature. Currently, NHS England rules do not allow wP to be used routinely in NA setting with T-P this should be reviewed in light of these data and those of the BERENICE study. Measures to identify patients who can avoid axillary dissection as well as to mitigate diarrhoea should be considered.
Citation Format: Hall B, Bhojwani A, Innes H, Ahmed E, Cliff J, Malik Z, O'Hagan J, Tolan S, Hall A, Hayat K, Errington D, Alam F, Thorp N, Flint H, Law A, Wong H, O'Reilly S, Jackson R, Cicconi S, Palmieri C. Real world experience of the medical and surgical management of HER2 positive early breast cancer treated with neoadjuvant trastuzumab and pertuzumab via the NHS England cancer drug fund [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 P6-17-27.
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Affiliation(s)
- B Hall
- University of Liverpool, Liverpool, Hammersmith and Fulham, United Kingdom; Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - A Bhojwani
- University of Liverpool, Liverpool, Hammersmith and Fulham, United Kingdom; Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - H Innes
- University of Liverpool, Liverpool, Hammersmith and Fulham, United Kingdom; Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - E Ahmed
- University of Liverpool, Liverpool, Hammersmith and Fulham, United Kingdom; Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - J Cliff
- University of Liverpool, Liverpool, Hammersmith and Fulham, United Kingdom; Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Z Malik
- University of Liverpool, Liverpool, Hammersmith and Fulham, United Kingdom; Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - J O'Hagan
- University of Liverpool, Liverpool, Hammersmith and Fulham, United Kingdom; Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - S Tolan
- University of Liverpool, Liverpool, Hammersmith and Fulham, United Kingdom; Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - A Hall
- University of Liverpool, Liverpool, Hammersmith and Fulham, United Kingdom; Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - K Hayat
- University of Liverpool, Liverpool, Hammersmith and Fulham, United Kingdom; Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - D Errington
- University of Liverpool, Liverpool, Hammersmith and Fulham, United Kingdom; Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - F Alam
- University of Liverpool, Liverpool, Hammersmith and Fulham, United Kingdom; Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - N Thorp
- University of Liverpool, Liverpool, Hammersmith and Fulham, United Kingdom; Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - H Flint
- University of Liverpool, Liverpool, Hammersmith and Fulham, United Kingdom; Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - A Law
- University of Liverpool, Liverpool, Hammersmith and Fulham, United Kingdom; Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - H Wong
- University of Liverpool, Liverpool, Hammersmith and Fulham, United Kingdom; Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - S O'Reilly
- University of Liverpool, Liverpool, Hammersmith and Fulham, United Kingdom; Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - R Jackson
- University of Liverpool, Liverpool, Hammersmith and Fulham, United Kingdom; Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - S Cicconi
- University of Liverpool, Liverpool, Hammersmith and Fulham, United Kingdom; Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - C Palmieri
- University of Liverpool, Liverpool, Hammersmith and Fulham, United Kingdom; Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, United Kingdom
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Abstract
Systemic sclerosis (SSc) is an idiopathic systemic autoimmune disease. It is characterized by a triad of hallmarks: immune dysfunction, fibrosis and vasculopathy. Immune dysfunction in SSc is characterized by the activation and recruitment of immune cells and the production of autoantibodies and cytokines. How immune abnormalities link the fibrosis and vasculopathy in SSc is poorly understood. A plethora of immune cell types are implicated in the immunopathogenesis of SSc, including T cells, B cells, dendritic cells, mast cells and macrophages. How these different cell types interact to contribute to SSc is complicated, and can involve cell-to-cell interactions and communication via cytokines, including transforming growth factor (TGF)-β, interleukin (IL)-6 and IL-4. We will attempt to review significant and recent research demonstrating the importance of immune cell regulation in the immunopathogenesis of SSc with a particular focus on fibrosis.
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Affiliation(s)
- M Brown
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - S O'Reilly
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
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Graham D, Jordan T, Tinsley N, Aruketty S, Vickers A, Kelly C, Kurup R, White A, Smith A, Walsh A, Thomson C, O'Reilly S, Norfolk M, Chang D, Blackhall F, Summers Y, Califano R, Taylor P, Thistlethwaite F, Cook N, Carter L, Krebs M. P1.01-26 Single-Centre Experience of Clinical Outcomes for Advanced Lung Cancer Patients in Phase I Clinical Trials. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.582] [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: 10/28/2022]
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Coleman RE, Collinson M, Gregory W, Marshall H, Bell R, Dodwell D, Keane M, Gil M, Barrett-Lee P, Ritchie D, Bowman A, Liversedge V, De Boer RH, Passos-Coelho JL, O'Reilly S, Bertelli G, Joffe J, Brown JE, Wilson C, Tercero JC, Jean-Mairet J, Gomis R, Cameron D. Benefits and risks of adjuvant treatment with zoledronic acid in stage II/III breast cancer. 10 years follow-up of the AZURE randomized clinical trial (BIG 01/04). J Bone Oncol 2018; 13:123-135. [PMID: 30591866 PMCID: PMC6303395 DOI: 10.1016/j.jbo.2018.09.008] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 09/07/2018] [Accepted: 09/16/2018] [Indexed: 12/28/2022] Open
Abstract
Adjuvant bisphosphonates improve disease outcomes in postmenopausal early breast cancer (EBC) but the long-term effects are poorly described. The AZURE trial (ISRCTN79831382) was designed to determine whether adjuvant zoledronic acid (ZOL) improves disease outcomes in EBC. Previous analyses showed no effect on overall outcomes but identified benefits in postmenopausal women. Here we present the long-term risks and benefits of adjuvant ZOL with 10-years follow-up. Patients and methods 3360 patients with stage II/III breast cancer were included in an academic, international, phase III, randomized, open label trial. Patients were followed up on a regular schedule until 10 years. Patients were randomized on a 1:1 basis to standard adjuvant systemic therapy +/− intravenous ZOL 4 mg every 3–4 weeks x6, and then at reduced frequency to complete 5 years treatment. The primary outcome was disease free survival (DFS). Secondary outcomes included invasive DFS (IDFS), overall survival (OS), sites of recurrence, skeletal morbidity and treatment outcomes according to primary tumor amplification of the transcription factor, MAF. Pre-planned subgroup analyses focused on interactions between menopausal status and treatment effects. Results With a median follow up of 117 months [IQR 70.4–120.4), DFS and IDFS were similar in both arms (HRDFS = 0.94, 95%CI = 0.84–1.06, p = 0.340; HRIDFS = 0.91, 95%CI = 0.82–1.02, p = 0.116). However, outcomes remain improved with ZOL in postmenopausal women (HRDFS = 0.82, 95%CI = 0.67–1.00; HRIDFS = 0.78, 95%CI = 0.64–0.94). In the 79% of tested women with a MAF FISH negative tumor, ZOL improved IDFS (HRIDFS = 0.75, 95%CI = 0.58–0.97) and OS HROS = 0.69, 95%CI = 0.50–0.94), irrespective of menopause. ZOL did not improve disease outcomes in MAF FISH + tumors. Bone metastases as a first DFS recurrence (BDFS) were reduced with ZOL (HRB-DFS = 0.76, 95%CI = 0.63–0.92, p = 0.005). ZOL reduced skeletal morbidity with fewer fractures and skeletal events after disease recurrence. 30 cases of osteonecrosis of the jaw in the ZOL arm (1.8%) have occurred. Conclusions Disease benefits with adjuvant ZOL in postmenopausal early breast cancer persist at 10 years of follow-up. The biomarker MAF identified a patient subgroup that derived benefit from ZOL irrespective of menopausal status.
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Affiliation(s)
- R E Coleman
- Academic Unit of Clinical Oncology and Sheffield Experimental Cancer Medicine Center, Weston Park Hospital, University of Sheffield, Sheffield S10 2SJ, UK
| | - M Collinson
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - W Gregory
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - H Marshall
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - R Bell
- Andrew Love Cancer Centre, Geelong, Australia
| | - D Dodwell
- St James Institute of Oncology, University of Leeds, UK
| | - M Keane
- University Hospital Galway, Ireland
| | - M Gil
- Institut Català d´Oncologia - IDIBELL. L'Hospitalet de Llobregat, Barcelona, Spain
| | | | - D Ritchie
- Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - A Bowman
- Edinburgh Cancer Research Centre, Western General Hospital, University of Edinburgh, UK
| | - V Liversedge
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - R H De Boer
- Royal Melbourne Hospital, Melbourne, Australia
| | | | | | | | - J Joffe
- Huddersfield Royal Infirmary, Huddersfield, UK
| | - J E Brown
- Academic Unit of Clinical Oncology and Sheffield Experimental Cancer Medicine Center, Weston Park Hospital, University of Sheffield, Sheffield S10 2SJ, UK
| | - C Wilson
- Academic Unit of Clinical Oncology and Sheffield Experimental Cancer Medicine Center, Weston Park Hospital, University of Sheffield, Sheffield S10 2SJ, UK
| | | | | | - R Gomis
- Institute for Research in Biomedicine (IRB Barcelona), Barcelona Science and Technology Institute, CIBERONC and Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain
| | - D Cameron
- Edinburgh Cancer Research Centre, Western General Hospital, University of Edinburgh, UK
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Prior L, Teo M, Greally M, Ward C, O'Leary C, Aslam R, Darwish W, Ahmed N, Watson G, Kelly D, Kiely L, Hassan A, Gleeson J, Featherstone H, Lim M, Murray H, Gallagher D, Westrup J, Hennessy B, Leonard G, Grogan L, Breathnach O, Horgan A, Coate L, O'Mahony D, Coate L, O'Reilly S, Gupta R, Keane M, Duffy K, O'Connor M, Kennedy J, McCaffrey J, Higgins M, Kelly C, Carney D, Gullo G, Crown J, Walshe J. Abstract P6-08-17: Pregnancy associated breast cancer: Evaluating maternal outcomes. A multicentre study. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p6-08-17] [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
Pregnancy associated breast cancer (PABC) is defined as breast cancer (BC) diagnosed during the gestational period (GP) or in the first year postpartum (PP). Despite its infrequent occurrence, the incidence of PABC appears to be rising due to the increasing propensity for women to delay childbirth. We have established the first combined prospective and retrospective registry study of PABC in Ireland to examine specific clinicopathological characteristics, treatments and maternal outcomes. We present the retrospective findings to date.
Methods
We performed a retrospective multicentre observational study of patients (pts) with PABC treated in the eight Irish cancer centres from August 2001 to March 2017. Data extracted included information on pt demographics, tumour biology, staging, treatment administered and maternal outcomes. Standard biostatistical methods were used for analysis.
Results
111 PABC patients were identified. Sixty pts (54%) were diagnosed during the GP and 51 (46%) within 1 year PP. Median age at diagnosis was 36 years (yrs). Table 1 illustrates baseline characteristics. Two thirds of pts were node positive and a similar proportion had grade 3 pathology. Seventy pts (63%) were estrogen receptor (ER) positive, 36 (32%) HER2 positive, 25 (22%) triple negative. Twenty-two pts (20%) were metastatic at presentation. Seven pts (6%) had a known BRCA 1/2 mutation. The median OS (overall survival) and DFS (disease free survival) for the entire cohort was 107.4 and 94.2 months respectively (resp). There was no survival difference between those diagnosed during the GP versus PP. 5 yr DFS and OS was 68.6% and 69.2% resp. This compares unfavourably to results reported by the National Cancer Registry of Ireland in a similar age-matched BC population between 2000-2012 where the 5 yr OS was 86.5%. Variables in our study associated with poorer outcomes included younger age, tumour size, node positivity and lack of estrogen expression.
Baseline characteristics PABC patients (n=11) %(n)Diagnosed in GP (n=60) %(n)Diagnosed 1yr PP (n=51) %(n)p valueDemographic Age at diagnosis3636(25-49)36(21-44)0.31Stage I-II54(60)55(33)53(27)0.85III23(26)23(14)23(12)1IV20(22)18(11)22(11)0.81Unknown3(3)3(2)2(1)1Pathology Grade 366(74)70(42)63(32)0.43Node positive66(73)68(41)63(32)0.55ER+/HER2-41(45)38(23)43(22)0.69ER+/HER2+23(25)28(17)16(8)0.17ER-/HER2+14(16)17(10)12(6)0.59Triple negative22(25)17(10)29(15)0.11Surgery Breast conservation23(26)25(15)21(11)0.82Mastectomy56(63)57(34)59(30)0.84Adjuavnt/Neoadjuvant treatment Chemotherapy73(81)77(46)69(35)0.39Anthracycline68(55)78(36)54(19)0.03Taxane89(72)93(43)83(29)0.16Anti HER2 agent21(23)18(11)24(12)0.63Endocrine therapy64(52)63(29)66(23)0.84Radiotherapy79(64)74(34)86(30)0.85Relapse in Stage I-III Local relapse15(13)12(6)18(7)0.55Distant relapse24(21)22(11)25(10)0.80
Conclusions
PABC patients may have a poorer outcome. Our study reported higher rates of triple negative and HER2 positive breast cancer which are associated with more aggressive biology. Prospective evaluation of clinicopathological features, pharmacokinetics of treatments selected and maternal and fetal outcomes is imperative in this distinct pt group.
Citation Format: Prior L, Teo M, Greally M, Ward C, O'Leary C, Aslam R, Darwish W, Ahmed N, Watson G, Kelly D, Kiely L, Hassan A, Gleeson J, Featherstone H, Lim M, Murray H, Gallagher D, Westrup J, Hennessy B, Leonard G, Grogan L, Breathnach O, Horgan A, Coate L, O'Mahony D, Coate L, O'Reilly S, Gupta R, Keane M, Duffy K, O'Connor M, Kennedy J, McCaffrey J, Higgins M, Kelly C, Carney D, Gullo G, Crown J, Walshe J. Pregnancy associated breast cancer: Evaluating maternal outcomes. A multicentre study [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 P6-08-17.
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Affiliation(s)
- L Prior
- Cancer Trials Ireland, Dublin, Ireland
| | - M Teo
- Cancer Trials Ireland, Dublin, Ireland
| | - M Greally
- Cancer Trials Ireland, Dublin, Ireland
| | - C Ward
- Cancer Trials Ireland, Dublin, Ireland
| | - C O'Leary
- Cancer Trials Ireland, Dublin, Ireland
| | - R Aslam
- Cancer Trials Ireland, Dublin, Ireland
| | - W Darwish
- Cancer Trials Ireland, Dublin, Ireland
| | - N Ahmed
- Cancer Trials Ireland, Dublin, Ireland
| | - G Watson
- Cancer Trials Ireland, Dublin, Ireland
| | - D Kelly
- Cancer Trials Ireland, Dublin, Ireland
| | - L Kiely
- Cancer Trials Ireland, Dublin, Ireland
| | - A Hassan
- Cancer Trials Ireland, Dublin, Ireland
| | - J Gleeson
- Cancer Trials Ireland, Dublin, Ireland
| | | | - M Lim
- Cancer Trials Ireland, Dublin, Ireland
| | - H Murray
- Cancer Trials Ireland, Dublin, Ireland
| | | | - J Westrup
- Cancer Trials Ireland, Dublin, Ireland
| | | | - G Leonard
- Cancer Trials Ireland, Dublin, Ireland
| | - L Grogan
- Cancer Trials Ireland, Dublin, Ireland
| | | | - A Horgan
- Cancer Trials Ireland, Dublin, Ireland
| | - L Coate
- Cancer Trials Ireland, Dublin, Ireland
| | | | - L Coate
- Cancer Trials Ireland, Dublin, Ireland
| | | | - R Gupta
- Cancer Trials Ireland, Dublin, Ireland
| | - M Keane
- Cancer Trials Ireland, Dublin, Ireland
| | - K Duffy
- Cancer Trials Ireland, Dublin, Ireland
| | | | - J Kennedy
- Cancer Trials Ireland, Dublin, Ireland
| | | | - M Higgins
- Cancer Trials Ireland, Dublin, Ireland
| | - C Kelly
- Cancer Trials Ireland, Dublin, Ireland
| | - D Carney
- Cancer Trials Ireland, Dublin, Ireland
| | - G Gullo
- Cancer Trials Ireland, Dublin, Ireland
| | - J Crown
- Cancer Trials Ireland, Dublin, Ireland
| | - J Walshe
- Cancer Trials Ireland, Dublin, Ireland
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Kelly C, Feighery R, McCaffrey J, Higgins M, Smith M, O'Reilly S, Murphy C, Horgan A, Walshe J, McDermott R, O'Donnell D, Morris P, Keane M, Martin M, Duffy K, Mihai A, Armstrong J, Mulroe E, Murphy V, Kelly C. Do oncology patients understand clinical trials? A nationwide study by Cancer Trials Ireland. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx440.068] [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: 11/12/2022] Open
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Kelly C, Feighery R, McCaffrey J, Higgins M, Smith M, O'Reilly S, Horgan A, Walshe J, McDermott R, O'Donnell D, Morris P, Keane M, Martin M, Murphy C, Duffy K, Mihai A, Armstrong J, Mulroe E, Murphy V, Kelly C. Decisions and supports around clinical trial participation: A national study by Cancer Trials Ireland. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx385.025] [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: 11/13/2022] Open
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Picardo S, Sui J, Greally M, Woulfe B, Prior L, Corrigan L, O'Leary C, Mullally W, Walshe J, McCaffrey J, O'Connor M, O'Mahony D, Coate L, Gupta R, O'Reilly S. Oncotype DX score, menopausal status and body mass index. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx362.043] [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: 11/12/2022] Open
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Earl HM, Hiller L, Howard HC, Dunn JA, Young J, Bowden SJ, McDermaid M, Waterhouse AK, Wilson G, Agrawal R, O'Reilly S, Bowman A, Ritchie DM, Goodman A, Hickish T, McAdam K, Cameron D, Dodwell D, Rea DW, Caldas C, Provenzano E, Abraham JE, Canney P, Crown JP, Kennedy MJ, Coleman R, Leonard RC, Carmichael JA, Wardley AM, Poole CJ. Addition of gemcitabine to paclitaxel, epirubicin, and cyclophosphamide adjuvant chemotherapy for women with early-stage breast cancer (tAnGo): final 10-year follow-up of an open-label, randomised, phase 3 trial. Lancet Oncol 2017; 18:755-769. [PMID: 28479233 DOI: 10.1016/s1470-2045(17)30319-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 02/24/2017] [Accepted: 03/01/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND The tAnGo trial was designed to investigate the potential role of gemcitabine when added to anthracycline and taxane-containing adjuvant chemotherapy for early breast cancer. When this study was developed, gemcitabine had shown significant activity in metastatic breast cancer, and there was evidence of a favourable interaction with paclitaxel. METHODS tAnGo was an international, open-label, randomised, phase 3 superiority trial that enrolled women aged 18 years or older with newly diagnosed, early-stage breast cancer who had a definite indication for chemotherapy, any nodal status, any hormone receptor status, Eastern Cooperative Oncology Group performance status of 0-1, and adequate bone marrow, hepatic, and renal function. Women were recruited from 127 clinical centres and hospitals in the UK and Ireland, and randomly assigned (1:1) to one of two treatment regimens: epirubicin, cyclophosphamide, and paclitaxel (four cycles of 90 mg/m2 intravenously administered epirubicin and 600 mg/m2 intravenously administered cyclophosphamide on day 1 every 3 weeks, followed by four cycles of 175 mg/m2 paclitaxel as a 3 h infusion on day 1 every 3 weeks) or epirubicin, cyclophosphamide, and paclitaxel plus gemcitabine (the same chemotherapy regimen as the other group, with the addition of 1250 mg/m2 gemcitabine to the paclitaxel cycles, administered intravenously as a 0·5 h infusion on days 1 and 8 every 3 weeks). Patients were randomly assigned by a central computerised deterministic minimisation procedure, with stratification by country, age, radiotherapy intent, nodal status, and oestrogen receptor and HER-2 status. The primary endpoint was disease-free survival and the trial aimed to detect 5% differences in 5-year disease-free survival between the treatment groups. Recruitment completed in 2004 and this is the final, intention-to-treat analysis. This trial is registered with EudraCT (2004-002927-41), ISRCTN (51146252), and ClinicalTrials.gov (NCT00039546). FINDINGS Between Aug 22, 2001, and Nov 26, 2004, 3152 patients were enrolled and randomly assigned to epirubicin, cyclophosphamide, paclitaxel, and gemcitabine (gemcitabine group; n=1576) or to epirubicin, cyclophosphamide, and paclitaxel (control group; n=1576). 11 patients (six in the gemcitabine group and five in the control group) were ineligible because of pre-existing metastases and were therefore excluded from the analysis. At this protocol-specified final analysis (median follow-up 10 years [IQR 10-10]), 1087 disease-free survival events and 914 deaths had occurred. Disease-free survival did not differ significantly between the treatment groups at 10 years (65% [63-68] in the gemcitabine group vs 65% [62-67] in the control group), and median disease-free survival was not reached (adjusted hazard ratio 0·97 [95% CI 0·86-1·10], p=0·64). Toxicity, dose intensity, and a detailed safety substudy showed both regimens to be safe, deliverable, and tolerable. Grade 3 and 4 toxicities were reported at expected levels in both groups. The most common were neutropenia (527 [34%] of 1565 patients in the gemcitabine group vs 412 [26%] of 1567 in the control group), myalgia and arthralgia (207 [13%] vs 186 [12%]), fatigue (207 [13%] vs 152 [10%]), infection (202 [13%] vs 141 [9%]), vomiting (143 [9%] vs 108 [7%]), and nausea (132 [8%] vs 102 [7%]). INTERPRETATION The addition of gemcitabine to anthracycline and taxane-based adjuvant chemotherapy at this dose and schedule confers no therapeutic advantage in terms of disease-free survival in early breast cancer, although it can cause increased toxicity. Therefore, gemcitabine has not been added to standard adjuvant chemotherapy in breast cancer for any subgroup. FUNDING Cancer Research UK core funding for Clinical Trials Unit at the University of Birmingham, Eli Lilly, Bristol-Myers Squibb, and Pfizer.
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Affiliation(s)
- Helena M Earl
- Department of Oncology, Addenbrooke's Hospital, University of Cambridge, Cambridge UK; NIHR Cambridge Biomedical Research Centre, Cambridge, UK; Cambridge Breast Cancer Research Unit, Cambridge, UK.
| | - Louise Hiller
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Helen C Howard
- Leeds Institute for Clinical Trials Research, University of Leeds, Leeds, UK
| | - Janet A Dunn
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Jennie Young
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Sarah J Bowden
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Michelle McDermaid
- Scottish Clinical Trials Research Unit, NHS Natio nal Services Scotland, Edinburgh, UK
| | - Anna K Waterhouse
- Leeds Institute for Clinical Trials Research, University of Leeds, Leeds, UK
| | | | - Rajiv Agrawal
- Department of Oncology, Shrewsbury & Telford Hospitals NHS Trust, Shrewsbury, UK
| | - Susan O'Reilly
- Department of Oncology, Clatterbridge Cancer Centre, Wirral, UK
| | - Angela Bowman
- Edinburgh Cancer Centre, Western General Hospital, Edinburgh, UK
| | - Diana M Ritchie
- Department of Oncology, Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - Andrew Goodman
- Exeter Oncology Centre, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Tamas Hickish
- Department of Oncology, Poole Hospital, Poole Hospital NHS Foundation Trust/Bournemouth University, Poole, Dorset, UK
| | - Karen McAdam
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK; Edith Cavell Campus, Peterborough City Hospital, Peterborough and Stamford Hospitals NHS Foundation Trust, Peterborough, UK
| | - David Cameron
- Cancer Research UK Edinburgh Centre, MRC Institute of Genetics & Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - David Dodwell
- Institute of Oncology, St James's University Hospital, Leeds Teaching Hospital NHS Trust, Leeds, UK
| | - Daniel W Rea
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Carlos Caldas
- Department of Oncology, Addenbrooke's Hospital, University of Cambridge, Cambridge UK; Cancer Research UK Cambridge Institute, Li Ka Shing Centre, University of Cambridge, Cambridge UK; NIHR Cambridge Biomedical Research Centre, Cambridge, UK; Cambridge Breast Cancer Research Unit, Cambridge, UK
| | - Elena Provenzano
- NIHR Cambridge Biomedical Research Centre, Cambridge, UK; Department of Histopathology, Cambridge, UK
| | - Jean E Abraham
- Department of Oncology, Addenbrooke's Hospital, University of Cambridge, Cambridge UK; NIHR Cambridge Biomedical Research Centre, Cambridge, UK; Cambridge Breast Cancer Research Unit, Cambridge, UK
| | - Peter Canney
- Cancer Clinical Trials Unit (CaCTUS), Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - John P Crown
- Department of Medical Oncology, St Vincent's University Hospital, Dublin, Ireland
| | | | - Robert Coleman
- Academic Unit of Clinical Oncology, Weston Park Hospital, Sheffield, UK
| | - Robert C Leonard
- Department of Surgery and Cancer, Charing Cross Hospital, Imperial College London, London, UK
| | | | | | - Christopher J Poole
- Arden Cancer Research Centre, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
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Kelly D, Brady C, Sui J, Cronin E, O'Hare D, Waldron J, O'Mahony D, Power D, Bambury RM, O'Reilly S. Cancer Care Costs and Clinical Trials. Ir Med J 2017; 110:557. [PMID: 28665096] [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: 06/07/2023]
Affiliation(s)
- D Kelly
- Department of Medical Oncology and Pharmacy, Cork University Hospital
| | - C Brady
- Department of Medical Oncology and Pharmacy, Cork University Hospital
| | - J Sui
- Department of Medical Oncology and Pharmacy, Cork University Hospital
| | - E Cronin
- Department of Medical Oncology and Pharmacy, Cork University Hospital
| | - D O'Hare
- Department of Medical Oncology and Pharmacy, Cork University Hospital
| | - J Waldron
- Department of Medical Oncology and Pharmacy, Cork University Hospital
| | - D O'Mahony
- Department of Medical Oncology and Pharmacy, Cork University Hospital
| | - D Power
- Department of Medical Oncology and Pharmacy, Cork University Hospital
| | - R M Bambury
- Department of Medical Oncology and Pharmacy, Cork University Hospital
| | - S O'Reilly
- Department of Medical Oncology and Pharmacy, Cork University Hospital
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Keegan NM, Milewski M, Kelly CM, Murphy V, Chao C, Walsh J, Kennedy MJ, O'Connor M, Murphy C, O'Reilly S, Keane M, Duffy K, Hennessy B, Morris PG. Abstract OT3-04-03: The impact of the 21 gene recurrence score (RS) on chemotherapy prescribing in estrogen receptor (ER) positive, lymph node positive early stage breast cancer in Ireland. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-ot3-04-03] [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
For Estrogen Receptor (ER) positive, early stage breast cancer, the 21 gene Recurrence Score (RS) has clinical use both as a prognostic tool and to predict chemotherapy benefit. The availability of this tool in Ireland has led to a reduction in the use of adjuvant chemotherapy for women with lymph node (LN) negative disease. However, the RS is not routinely funded for patients with LN positive (LN+) breast cancer in Ireland. In addition, there are limited international data on the use of this tool in the preoperative setting. In this prospective observational study, we are investigating whether access to the 21 gene RS leads to a reduction in the receipt of chemotherapy for patients with ER+, LN+ breast cancer, and to correlate the 21 gene RS with response to preoperative systemic therapy.
TRIAL DESIGN
This is a national, multi-site, prospective, observational study that will examine the impact of the 21 gene RS on chemotherapy recommendations in both the neoadjuvant and adjuvant setting. Prior to and following tumor testing with the 21 gene RS, Physicians will complete a questionnaire which details type and strength of systemic therapy recommendations.
ELIGIBILITY
Cohort 1 (postoperative) will include patients with ER+ tumors of any size with involvement of 1-3 lymph nodes (N1 including micrometastases). Cohort 2 (preoperative) will include patients with ER+, T2-T4 tumors with biopsy proven nodal metastases. Both cohorts will have ECOG PS 0 or 1 and be fit for consideration of chemotherapy as determined by the Investigator.
SPECIFIC AIMS
The primary endpoint is the percentage reduction in the number of patients for whom treating physicians recommend chemotherapy after testing with 21 gene RS. Secondary endpoints include the correlation between the 21 gene RS and residual cancer burden score, as well as pathological, clinical and radiological response rates. The economic impact of the 21 gene RS in ER+, LN+ will also be assessed.
STATISTICAL METHODS
The sample size is based on similar decision impact studies conducted in other countries. Physician recommendations for chemotherapy pre 21-gene RS and recommendations post 21-gene RS testing will be compared and percentage change estimated with 95% confidence intervals. For secondary endpoints, the Pearson correlation coefficient (rho) will be used to examine the strength of the correlation between the 21 gene RS category and response. A budget impact model will be used to estimate the cost reduction in adjuvant chemotherapy as a result of 21-gene RS testing.
PRESENT ACCRUAL AND TARGET ACCRUAL
Target accrual is 75 in each of the neoadjuvant and adjuvant cohorts to total 150 patients.
Supported by Genomic Health.
Citation Format: Keegan NM, Milewski M, Kelly CM, Murphy V, Chao C, Walsh J, Kennedy MJ, O'Connor M, Murphy C, O'Reilly S, Keane M, Duffy K, Hennessy B, Morris PG. The impact of the 21 gene recurrence score (RS) on chemotherapy prescribing in estrogen receptor (ER) positive, lymph node positive early stage breast cancer in Ireland [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 OT3-04-03.
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Affiliation(s)
- NM Keegan
- Beaumont Hospital, Dublin 9, Ireland; Mater Misericordiae University Hospital, Dublin 7, Ireland; Cancer Trials Ireland, Dublin 2, Ireland; Genomic Health, Ireland; St James's Hospital, Dublin 8, Ireland; University Hospital Waterford, Waterford, Ireland; Bon Secours, Cork, Ireland; Cork University Hospital, Ireland; University College Hospital Galway, Ireland; Letterkenny General Hospital, Ireland; AMNCH and St Vincent's University Hospital, Dublin, Ireland
| | - M Milewski
- Beaumont Hospital, Dublin 9, Ireland; Mater Misericordiae University Hospital, Dublin 7, Ireland; Cancer Trials Ireland, Dublin 2, Ireland; Genomic Health, Ireland; St James's Hospital, Dublin 8, Ireland; University Hospital Waterford, Waterford, Ireland; Bon Secours, Cork, Ireland; Cork University Hospital, Ireland; University College Hospital Galway, Ireland; Letterkenny General Hospital, Ireland; AMNCH and St Vincent's University Hospital, Dublin, Ireland
| | - CM Kelly
- Beaumont Hospital, Dublin 9, Ireland; Mater Misericordiae University Hospital, Dublin 7, Ireland; Cancer Trials Ireland, Dublin 2, Ireland; Genomic Health, Ireland; St James's Hospital, Dublin 8, Ireland; University Hospital Waterford, Waterford, Ireland; Bon Secours, Cork, Ireland; Cork University Hospital, Ireland; University College Hospital Galway, Ireland; Letterkenny General Hospital, Ireland; AMNCH and St Vincent's University Hospital, Dublin, Ireland
| | - V Murphy
- Beaumont Hospital, Dublin 9, Ireland; Mater Misericordiae University Hospital, Dublin 7, Ireland; Cancer Trials Ireland, Dublin 2, Ireland; Genomic Health, Ireland; St James's Hospital, Dublin 8, Ireland; University Hospital Waterford, Waterford, Ireland; Bon Secours, Cork, Ireland; Cork University Hospital, Ireland; University College Hospital Galway, Ireland; Letterkenny General Hospital, Ireland; AMNCH and St Vincent's University Hospital, Dublin, Ireland
| | - C Chao
- Beaumont Hospital, Dublin 9, Ireland; Mater Misericordiae University Hospital, Dublin 7, Ireland; Cancer Trials Ireland, Dublin 2, Ireland; Genomic Health, Ireland; St James's Hospital, Dublin 8, Ireland; University Hospital Waterford, Waterford, Ireland; Bon Secours, Cork, Ireland; Cork University Hospital, Ireland; University College Hospital Galway, Ireland; Letterkenny General Hospital, Ireland; AMNCH and St Vincent's University Hospital, Dublin, Ireland
| | - J Walsh
- Beaumont Hospital, Dublin 9, Ireland; Mater Misericordiae University Hospital, Dublin 7, Ireland; Cancer Trials Ireland, Dublin 2, Ireland; Genomic Health, Ireland; St James's Hospital, Dublin 8, Ireland; University Hospital Waterford, Waterford, Ireland; Bon Secours, Cork, Ireland; Cork University Hospital, Ireland; University College Hospital Galway, Ireland; Letterkenny General Hospital, Ireland; AMNCH and St Vincent's University Hospital, Dublin, Ireland
| | - MJ Kennedy
- Beaumont Hospital, Dublin 9, Ireland; Mater Misericordiae University Hospital, Dublin 7, Ireland; Cancer Trials Ireland, Dublin 2, Ireland; Genomic Health, Ireland; St James's Hospital, Dublin 8, Ireland; University Hospital Waterford, Waterford, Ireland; Bon Secours, Cork, Ireland; Cork University Hospital, Ireland; University College Hospital Galway, Ireland; Letterkenny General Hospital, Ireland; AMNCH and St Vincent's University Hospital, Dublin, Ireland
| | - M O'Connor
- Beaumont Hospital, Dublin 9, Ireland; Mater Misericordiae University Hospital, Dublin 7, Ireland; Cancer Trials Ireland, Dublin 2, Ireland; Genomic Health, Ireland; St James's Hospital, Dublin 8, Ireland; University Hospital Waterford, Waterford, Ireland; Bon Secours, Cork, Ireland; Cork University Hospital, Ireland; University College Hospital Galway, Ireland; Letterkenny General Hospital, Ireland; AMNCH and St Vincent's University Hospital, Dublin, Ireland
| | - C Murphy
- Beaumont Hospital, Dublin 9, Ireland; Mater Misericordiae University Hospital, Dublin 7, Ireland; Cancer Trials Ireland, Dublin 2, Ireland; Genomic Health, Ireland; St James's Hospital, Dublin 8, Ireland; University Hospital Waterford, Waterford, Ireland; Bon Secours, Cork, Ireland; Cork University Hospital, Ireland; University College Hospital Galway, Ireland; Letterkenny General Hospital, Ireland; AMNCH and St Vincent's University Hospital, Dublin, Ireland
| | - S O'Reilly
- Beaumont Hospital, Dublin 9, Ireland; Mater Misericordiae University Hospital, Dublin 7, Ireland; Cancer Trials Ireland, Dublin 2, Ireland; Genomic Health, Ireland; St James's Hospital, Dublin 8, Ireland; University Hospital Waterford, Waterford, Ireland; Bon Secours, Cork, Ireland; Cork University Hospital, Ireland; University College Hospital Galway, Ireland; Letterkenny General Hospital, Ireland; AMNCH and St Vincent's University Hospital, Dublin, Ireland
| | - M Keane
- Beaumont Hospital, Dublin 9, Ireland; Mater Misericordiae University Hospital, Dublin 7, Ireland; Cancer Trials Ireland, Dublin 2, Ireland; Genomic Health, Ireland; St James's Hospital, Dublin 8, Ireland; University Hospital Waterford, Waterford, Ireland; Bon Secours, Cork, Ireland; Cork University Hospital, Ireland; University College Hospital Galway, Ireland; Letterkenny General Hospital, Ireland; AMNCH and St Vincent's University Hospital, Dublin, Ireland
| | - K Duffy
- Beaumont Hospital, Dublin 9, Ireland; Mater Misericordiae University Hospital, Dublin 7, Ireland; Cancer Trials Ireland, Dublin 2, Ireland; Genomic Health, Ireland; St James's Hospital, Dublin 8, Ireland; University Hospital Waterford, Waterford, Ireland; Bon Secours, Cork, Ireland; Cork University Hospital, Ireland; University College Hospital Galway, Ireland; Letterkenny General Hospital, Ireland; AMNCH and St Vincent's University Hospital, Dublin, Ireland
| | - B Hennessy
- Beaumont Hospital, Dublin 9, Ireland; Mater Misericordiae University Hospital, Dublin 7, Ireland; Cancer Trials Ireland, Dublin 2, Ireland; Genomic Health, Ireland; St James's Hospital, Dublin 8, Ireland; University Hospital Waterford, Waterford, Ireland; Bon Secours, Cork, Ireland; Cork University Hospital, Ireland; University College Hospital Galway, Ireland; Letterkenny General Hospital, Ireland; AMNCH and St Vincent's University Hospital, Dublin, Ireland
| | - PG Morris
- Beaumont Hospital, Dublin 9, Ireland; Mater Misericordiae University Hospital, Dublin 7, Ireland; Cancer Trials Ireland, Dublin 2, Ireland; Genomic Health, Ireland; St James's Hospital, Dublin 8, Ireland; University Hospital Waterford, Waterford, Ireland; Bon Secours, Cork, Ireland; Cork University Hospital, Ireland; University College Hospital Galway, Ireland; Letterkenny General Hospital, Ireland; AMNCH and St Vincent's University Hospital, Dublin, Ireland
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Kelly D, Mc Sorley L, O'Shea E, Mc Carthy E, Bowe S, Brady C, Sui J, Dawod MA, O'Brien O, Graham D, McCarthy J, Burke L, Power D, O'Reilly S, Bambury RM, Mahony DO. A regional analysis of epidermal growth factor receptor (EGFR) mutated lung cancer for HSE South. Ir J Med Sci 2017; 186:855-857. [PMID: 28185061 DOI: 10.1007/s11845-017-1579-y] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Accepted: 02/05/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND EGFR mutated lung cancer represents a subgroup with distinct clinical presentations, prognosis, and management requirements. We investigated the survival, prognostic factors, and real-world treatment of NSCLC patients with EGFR mutation in clinical practice. METHODS A retrospective review of all specimens sent for EGFR analysis from December 2009 to September 2015 was performed. Patient demographics, specimen type, EGFR mutation status/type, stage at diagnosis, treatment, response rate, and survival data were recorded. RESULTS 27/334 (8%) patient specimens sent for EGFR testing tested positive for a sensitising EGFR mutation. The median age was 65 years (40-85 years). Exon 19 deletion represented the most commonly detected alteration, accounting for 39% (n = 11). First-line treatment for those with Exon 18, 19, or 21 alterations (n = 24) was with an EGFR tyrosine kinase inhibitor (TKI) in 79% (n = 19). Objective response rate among these patients was 74% and median duration of response was 13 months (range 7-35 months). CONCLUSION The incidence of EGFR mutation in our cohort of NSCLC is 9% which is consistent with mutation incidence reported in other countries. The rate of EGFR mutation in our population is slightly below that reported internationally, but treatment outcomes are consistent with published data. Real-world patient data have important contributions to make with regard to quality measurement, incorporating patient experience into guidelines and identifying safety signals.
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Affiliation(s)
- D Kelly
- Department of Medical Oncology, Cork University Hospital, Mercy University Hospital Cork, University Hospital Kerry, Tralee, County Kerry, Ireland.
| | - L Mc Sorley
- Department of Medical Oncology, Cork University Hospital, Mercy University Hospital Cork, University Hospital Kerry, Tralee, County Kerry, Ireland
| | - E O'Shea
- Department of Medical Oncology, Cork University Hospital, Mercy University Hospital Cork, University Hospital Kerry, Tralee, County Kerry, Ireland
| | - E Mc Carthy
- Department of Medical Oncology, Cork University Hospital, Mercy University Hospital Cork, University Hospital Kerry, Tralee, County Kerry, Ireland
| | - S Bowe
- Department of Medical Oncology, Cork University Hospital, Mercy University Hospital Cork, University Hospital Kerry, Tralee, County Kerry, Ireland
| | - C Brady
- Department of Medical Oncology, Cork University Hospital, Mercy University Hospital Cork, University Hospital Kerry, Tralee, County Kerry, Ireland
| | - J Sui
- Department of Medical Oncology, Cork University Hospital, Mercy University Hospital Cork, University Hospital Kerry, Tralee, County Kerry, Ireland
| | - M A Dawod
- Department of Medical Oncology, Cork University Hospital, Mercy University Hospital Cork, University Hospital Kerry, Tralee, County Kerry, Ireland
| | - O O'Brien
- Department of Pathology, Cork University Hospital, Cork, Ireland
| | - D Graham
- Department of Respiratory Medicine, Cork University Hospital, Cork, Ireland
| | - J McCarthy
- Department of Pathology, Cork University Hospital, Cork, Ireland
| | - L Burke
- Department of Pathology, Cork University Hospital, Cork, Ireland
| | - D Power
- Department of Medical Oncology, Cork University Hospital, Mercy University Hospital Cork, University Hospital Kerry, Tralee, County Kerry, Ireland
| | - S O'Reilly
- Department of Medical Oncology, Cork University Hospital, Mercy University Hospital Cork, University Hospital Kerry, Tralee, County Kerry, Ireland
| | - R M Bambury
- Department of Medical Oncology, Cork University Hospital, Mercy University Hospital Cork, University Hospital Kerry, Tralee, County Kerry, Ireland
| | - D O Mahony
- Department of Medical Oncology, Cork University Hospital, Mercy University Hospital Cork, University Hospital Kerry, Tralee, County Kerry, Ireland
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Hartery K, O'Reilly S, Houlihan D, Doherty G, Mulcahy H, Cullen G, Sheridan J. Letter: vedolizumab for the management of inflammatory bowel disease in patients after liver transplantation for primary sclerosing cholangitis. Aliment Pharmacol Ther 2017; 45:376-378. [PMID: 27933688 DOI: 10.1111/apt.13861] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- K Hartery
- Department of Gastroenterology, Centre for Colorectal Disease, St. Vincent's University Hospital, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland
| | - S O'Reilly
- Department of Gastroenterology, Centre for Colorectal Disease, St. Vincent's University Hospital, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland
| | - D Houlihan
- School of Medicine, University College Dublin, Dublin, Ireland.,National Liver Unit, St. Vincent's University Hospital, Dublin, Ireland
| | - G Doherty
- Department of Gastroenterology, Centre for Colorectal Disease, St. Vincent's University Hospital, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland
| | - H Mulcahy
- Department of Gastroenterology, Centre for Colorectal Disease, St. Vincent's University Hospital, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland
| | - G Cullen
- Department of Gastroenterology, Centre for Colorectal Disease, St. Vincent's University Hospital, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland
| | - J Sheridan
- Department of Gastroenterology, Centre for Colorectal Disease, St. Vincent's University Hospital, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland
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Mullally WJ, O'Súilleabháin CB, Brady C, O'Reilly S. Vinorelbine induced perforation of a metastatic gastric lesion. Ir J Med Sci 2016; 186:571-575. [PMID: 28039597 PMCID: PMC5550518 DOI: 10.1007/s11845-016-1536-1] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 12/21/2016] [Indexed: 12/30/2022]
Abstract
Background Breast carcinoma metastasis to the gastrointestinal tract is rare and more frequently associated with lobular than ductal carcinoma (Borst and Ingold, Surg 114(4):637–641 [1]). The purpose of this article is to present a case based review of a unique gastrointestinal metastasis and literature review. Methods A 46 year old lady with metastatic invasive ductal breast cancer was admitted to A&E with sudden onset of epigastric and left shoulder pain. She completed the first cycle of capecitabine/vinorelbine 1 week previously. Clinical examination revealed a tender epigastrium with rigidity in the upper abdomen. Free air under the diaphragm and a positive Rigler’s sign was radiologically identified. A laparoscopy demonstrated a fibrinous exudate in the left upper quadrant consistent with a walled off lesser curvature gastric perforation. A subsequent oesophagogastroduodenoscopy (OGD) demonstrated a healed gastric ulcer of benign appearance; however the pathology confirmed metastatic breast carcinoma. Results Literature review confirmed no previously reported cases of vinorelbine induced gastric perforation. Four cases of metastatic breast cancer with gastric metastasis presenting with perforation were identified; three of these cases (Fra et al., Presse Med 25(26):1215 (1996) [2], Solis-Caxaj et al., Gastroenterol Clin Biol 28(1):91–92 (2004) [3], Ghosn et al., Bull Cancer 78(11):1071–1073 (1991) [4]), were in the French medical literature, including one male patient (Fra et al., Presse Med 25(26):1215 (1996) [2]) and at least one ductal breast carcinoma (Solis-Caxaj et al., Gastroenterol Clin Biol 28(1):91–92 (2004) [3]). The fourth case (van Geel et al., Ned Tijdschr Geneeskd 144(37):1761–1763 (2000) [5]), was in the Dutch medical literature and a lobular breast carcinoma. Conclusion This case represents a rare complication of breast cancer chemotherapy, the subsequent significant benefit the patient received from treatment is consistent with the chemosensitivity to therapy that also resulted in gastric perforation. Five years after gastric perforation she resumed palliative chemotherapy after progression on sequential hormonal therapies.
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Affiliation(s)
- W J Mullally
- Department of Medical Oncology, Cork University Hospital, Wilton Rd, Cork, Ireland. .,, Kells, Bishopstown Avenue West, Model Farm Rd, Cork, Ireland.
| | - C B O'Súilleabháin
- Hepatobiliary Pancreas Unit, Mercy University Hospital, Grenville Place, Cork, Ireland
| | - C Brady
- Department of Medical Oncology, Cork University Hospital, Wilton Rd, Cork, Ireland
| | - S O'Reilly
- Department of Medical Oncology, Cork University Hospital, Wilton Rd, Cork, Ireland
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