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DeCesaris C, Wilson T, Kim J, Burt LM, Grant JD, Harkenrider MM, Huang J, Jhingran A, Kidd EA, Konski AA, Lin LL, Small W, Suneja G, Gaffney DK. Financial Improvements from Short Course Adjuvant Vaginal Cuff Brachytherapy (VCB) in Early Endometrial Cancer Compared to Standard of Care, "SAVE" Trial. Int J Radiat Oncol Biol Phys 2023; 117:S92. [PMID: 37784606 DOI: 10.1016/j.ijrobp.2023.06.421] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Early-stage endometrial cancer is often managed with hysterectomy followed by adjuvant VCB. Financial toxicity from cancer treatment is a strong driver of adherence. The SAVE trial is a multicenter, prospective randomized trial of standard of care (SoC) VCB doses delivered in 3-5 fractions per physician discretion compared to a 2-fraction course. We report on secondary cost endpoints, quantifying the financial impacts of shorter treatment courses on institutions and participating patients. MATERIALS/METHODS Technical (TechCs), professional (PCs), and total charges (TotCs) were collected prospectively and are reported as raw and Medicare-adjusted charges per patient. Geographic variations were standardized with CMS Geographic Practice Cost Indices (GPCI), and inflation was adjusted using the Consumer Price Index (CPI): Medical Care. Distance to treatment center was calculated from the patient's zip code to the corresponding treatment center. Cost of commutes was estimated through round-trip travel distance multiplied by average gas MPG for new vehicles by treatment year and state. Median income for each patient's zip code was estimated using 5-year Household income in 2021 inflation-adjusted dollars from the US Census. Mann-Whitney U, T- and Chi-square tests were used to compare characteristics between the two groups. RESULTS One hundred eight patients were analyzed. SoC VCB was delivered in 3, 4 and 5 fractions for 27/54 (50%), 11/54 (20%), and 16/54 (30%), respectively. Median total distance traveled per patient for SoC vs. experimental arms was 213 vs 137 miles (p = .12), and median cost of commute for patients was 36.3 vs 18.0 USD (p = .11). Compared to 2-fraction treatment, 5-fraction treatment resulted in longer travel distances (median 462 vs. 137 miles, p < 0.01) and increased travel costs (median 59.3 v. 18.0 USD, p = < 0.01). Median income by zip code for SoC v. experimental arms was 79,704 vs. 79,671 USD (p = 1.0). For SoC v. experimental arms, 11 (20%) vs 7 (13%) of patients had zip codes with median income in the lowest or second lowest quintiles (p = 0.5). Adjusted raw PCs per patient did not differ between SoC vs. experimental arms (9,159$ vs. 7,532$, p = 0.19). TechCs were significantly higher on the SoC arm (35,734$ vs. 24,696$ p = < 0.01), as were TotCs (44,892$ vs. 32,228$, p < 0.01;). Medicare-adjusted PCs, TechCs, and TotCs were higher for the SoC arm (Table 1). CONCLUSION Two-fraction VCB resulted in fewer treatments per patient, reduced cost of travel compared to longer courses, and an adjusted reduction in healthcare expenditures compared to standard of care. Ongoing work will include assessment of patient-reported financial toxicities.
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Affiliation(s)
- C DeCesaris
- Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - T Wilson
- Department of Radiation Oncology, Huntsman Cancer Hospital, University of Utah, Salt Lake City, UT
| | - J Kim
- University of Utah, Economics Department, Salt Lake City, UT
| | - L M Burt
- Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - J D Grant
- Intermountain Healthcare, Salt Lake City, UT
| | | | - J Huang
- Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - A Jhingran
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - E A Kidd
- Department of Radiation Oncology, Stanford University School of Medicine, Palo Alto, CA
| | - A A Konski
- University of Pennsylvania School of Medicine, Philadelphia, PA
| | - L L Lin
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - W Small
- Department of Radiation Oncology, Stritch School of Medicine, Cardinal Bernardin Cancer Center, Loyola University Chicago, Maywood, IL
| | - G Suneja
- Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - D K Gaffney
- Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
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O’Connor T, MacKenzie L, Clarke RW, Bradburn M, Wilson TR, Lee MJ. Screening for malnutrition in emergency laparotomy patients: a comparison of three tools. Ann R Coll Surg Engl 2023; 105:413-421. [PMID: 36541125 PMCID: PMC10149256 DOI: 10.1308/rcsann.2022.0077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2022] [Indexed: 05/02/2023] Open
Abstract
INTRODUCTION Malnourished patients undergoing emergency laparotomy are at risk of significant morbidity. The optimum screening tool to identify such patients in practice and research is yet to be determined. This study aims to compare the performance of three nutrition risk tools in predicting time without enteral nutrition in this population. METHODS A prospective cohort study (NCT04696367) was conducted across two sites, recruiting patients undergoing National Emergency Laparotomy Audit eligible procedures. Data collected included demographics, diagnosis, procedure and outcomes. Nutrition risk was assessed using three tools: Malnutrition Universal Screening Tool (MUST) score, Nutritional Risk Index (NRI) and Nutritional Risk Score 2002 (NRS-2002). Complications were assessed with the Comprehensive Complication Index. Quality of life was measured at baseline and 5 days postsurgery using EQ-5D-5L. RESULTS A total of 59 patients were recruited. Median age was 69 years. Of the 59 participants, 23 were judged high risk using MUST score, 13 using NRS and 8 using NRI. Median time to restart enteral intake was 7 days (interquartile range 7-14). Time without intake was correlated with increasing score using MUST (r=0.463, p<0.001) and NRS-2002 (r=0.296, p=0.03) but not NRI (r=-0.121, p=0.38). High-risk nutritional groups also had increased length of hospital stay, but not complication scores. CONCLUSIONS Patients undergoing emergency laparotomy spend a prolonged time without enteral nutrition. Although all nutritional tools demonstrated some propensity to identify patients at higher risk of needing nutritional support, their performance was variable. Nevertheless, some may be useful in future clinical studies.
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Affiliation(s)
- T O’Connor
- Sheffield Teaching Hospitals NHS Foundation Trust, UK
| | - L MacKenzie
- Sheffield Teaching Hospitals NHS Foundation Trust, UK
| | - RW Clarke
- Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust, UK
| | - M Bradburn
- Clinical Trials Research Unit, University of Sheffield, UK
| | - TR Wilson
- Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust, UK
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Kirk S, Rashid H, Demisse E, Wilson T, Heath M, De-Kam P. NON-CLINICAL SAFETY EVALUATION OF A NOVEL THERAPEUTIC VACCINE FOR PEANUT ALLERGY. Ann Allergy Asthma Immunol 2022. [DOI: 10.1016/j.anai.2022.08.673] [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: 11/11/2022]
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Torkington J, Harries R, O'Connell S, Knight L, Islam S, Bashir N, Watkins A, Fegan G, Cornish J, Rees B, Cole H, Jarvis H, Jones S, Russell I, Bosanquet D, Cleves A, Sewell B, Farr A, Zbrzyzna N, Fiera N, Ellis-Owen R, Hilton Z, Parry C, Bradbury A, Wall P, Hill J, Winter D, Cocks K, Harris D, Hilton J, Vakis S, Hanratty D, Rajagopal R, Akbar F, Ben-Sassi A, Francis N, Jones L, Williamson M, Lindsey I, West R, Smart C, Ziprin P, Agarwal T, Faulkner G, Pinkney T, Vimalachandran D, Lawes D, Faiz O, Nisar P, Smart N, Wilson T, Myers A, Lund J, Smolarek S, Acheson A, Horwood J, Ansell J, Phillips S, Davies M, Davies L, Bird S, Palmer N, Williams M, Galanopoulos G, Rao PD, Jones D, Barnett R, Tate S, Wheat J, Patel N, Rahmani S, Toynton E, Smith L, Reeves N, Kealaher E, Williams G, Sekaran C, Evans M, Beynon J, Egan R, Qasem E, Khot U, Ather S, Mummigati P, Taylor G, Williamson J, Lim J, Powell A, Nageswaran H, Williams A, Padmanabhan J, Phillips K, Ford T, Edwards J, Varney N, Hicks L, Greenway C, Chesters K, Jones H, Blake P, Brown C, Roche L, Jones D, Feeney M, Shah P, Rutter C, McGrath C, Curtis N, Pippard L, Perry J, Allison J, Ockrim J, Dalton R, Allison A, Rendell J, Howard L, Beesley K, Dennison G, Burton J, Bowen G, Duberley S, Richards L, Giles J, Katebe J, Dalton S, Wood J, Courtney E, Hompes R, Poole A, Ward S, Wilkinson L, Hardstaff L, Bogden M, Al-Rashedy M, Fensom C, Lunt N, McCurrie M, Peacock R, Malik K, Burns H, Townley B, Hill P, Sadat M, Khan U, Wignall C, Murati D, Dhanaratne M, Quaid S, Gurram S, Smith D, Harris P, Pollard J, DiBenedetto G, Chadwick J, Hull R, Bach S, Morton D, Hollier K, Hardy V, Ghods M, Tyrrell D, Ashraf S, Glasbey J, Ashraf M, Garner S, Whitehouse A, Yeung D, Mohamed SN, Wilkin R, Suggett N, Lee C, Bagul A, McNeill C, Eardley N, Mahapatra R, Gabriel C, Datt P, Mahmud S, Daniels I, McDermott F, Nodolsk M, Park L, Scott H, Trickett J, Bearn P, Trivedi P, Frost V, Gray C, Croft M, Beral D, Osborne J, Pugh R, Herdman G, George R, Howell AM, Al-Shahaby S, Narendrakumar B, Mohsen Y, Ijaz S, Nasseri M, Herrod P, Brear T, Reilly JJ, Sohal A, Otieno C, Lai W, Coleman M, Platt E, Patrick A, Pitman C, Balasubramanya S, Dickson E, Warman R, Newton C, Tani S, Simpson J, Banerjee A, Siddika A, Campion D, Humes D, Randhawa N, Saunders J, Bharathan B, Hay O. Incisional hernia following colorectal cancer surgery according to suture technique: Hughes Abdominal Repair Randomized Trial (HART). Br J Surg 2022; 109:943-950. [PMID: 35979802 PMCID: PMC10364691 DOI: 10.1093/bjs/znac198] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 05/09/2022] [Accepted: 05/13/2022] [Indexed: 11/14/2022]
Abstract
BACKGROUND Incisional hernias cause morbidity and may require further surgery. HART (Hughes Abdominal Repair Trial) assessed the effect of an alternative suture method on the incidence of incisional hernia following colorectal cancer surgery. METHODS A pragmatic multicentre single-blind RCT allocated patients undergoing midline incision for colorectal cancer to either Hughes closure (double far-near-near-far sutures of 1 nylon suture at 2-cm intervals along the fascia combined with conventional mass closure) or the surgeon's standard closure. The primary outcome was the incidence of incisional hernia at 1 year assessed by clinical examination. An intention-to-treat analysis was performed. RESULTS Between August 2014 and February 2018, 802 patients were randomized to either Hughes closure (401) or the standard mass closure group (401). At 1 year after surgery, 672 patients (83.7 per cent) were included in the primary outcome analysis; 50 of 339 patients (14.8 per cent) in the Hughes group and 57 of 333 (17.1 per cent) in the standard closure group had incisional hernia (OR 0.84, 95 per cent c.i. 0.55 to 1.27; P = 0.402). At 2 years, 78 patients (28.7 per cent) in the Hughes repair group and 84 (31.8 per cent) in the standard closure group had incisional hernia (OR 0.86, 0.59 to 1.25; P = 0.429). Adverse events were similar in the two groups, apart from the rate of surgical-site infection, which was higher in the Hughes group (13.2 versus 7.7 per cent; OR 1.82, 1.14 to 2.91; P = 0.011). CONCLUSION The incidence of incisional hernia after colorectal cancer surgery is high. There was no statistical difference in incidence between Hughes closure and mass closure at 1 or 2 years. REGISTRATION NUMBER ISRCTN25616490 (http://www.controlled-trials.com).
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Proietti M, Romiti GF, Vitolo M, Harrison SL, Lane DA, Fauchier L, Marin F, Näbauer M, Potpara TS, Dan GA, Maggioni AP, Cesari M, Boriani G, Lip GYH, Ekmekçiu U, Paparisto V, Tase M, Gjergo H, Dragoti J, Goda A, Ciutea M, Ahadi N, el Husseini Z, Raepers M, Leroy J, Haushan P, Jourdan A, Lepiece C, Desteghe L, Vijgen J, Koopman P, Van Genechten G, Heidbuchel H, Boussy T, De Coninck M, Van Eeckhoutte H, Bouckaert N, Friart A, Boreux J, Arend C, Evrard P, Stefan L, Hoffer E, Herzet J, Massoz M, Celentano C, Sprynger M, Pierard L, Melon P, Van Hauwaert B, Kuppens C, Faes D, Van Lier D, Van Dorpe A, Gerardy A, Deceuninck O, Xhaet O, Dormal F, Ballant E, Blommaert D, Yakova D, Hristov M, Yncheva T, Stancheva N, Tisheva S, Tokmakova M, Nikolov F, Gencheva D, Shalganov T, Kunev B, Stoyanov M, Marchov D, Gelev V, Traykov V, Kisheva A, Tsvyatkov H, Shtereva R, Bakalska-Georgieva S, Slavcheva S, Yotov Y, Kubíčková M, Marni Joensen A, Gammelmark A, Hvilsted Rasmussen L, Dinesen P, Riahi S, Krogh Venø S, Sorensen B, Korsgaard A, Andersen K, Fragtrup Hellum C, Svenningsen A, Nyvad O, Wiggers P, May O, Aarup A, Graversen B, Jensen L, Andersen M, Svejgaard M, Vester S, Hansen S, Lynggaard V, Ciudad M, Vettus R, Muda P, Maestre A, Castaño S, Cheggour S, Poulard J, Mouquet V, Leparrée S, Bouet J, Taieb J, Doucy A, Duquenne H, Furber A, Dupuis J, Rautureau J, Font M, Damiano P, Lacrimini M, Abalea J, Boismal S, Menez T, Mansourati J, Range G, Gorka H, Laure C, Vassalière C, Elbaz N, Lellouche N, Djouadi K, Roubille F, Dietz D, Davy J, Granier M, Winum P, Leperchois-Jacquey C, Kassim H, Marijon E, Le Heuzey J, Fedida J, Maupain C, Himbert C, Gandjbakhch E, Hidden-Lucet F, Duthoit G, Badenco N, Chastre T, Waintraub X, Oudihat M, Lacoste J, Stephan C, Bader H, Delarche N, Giry L, Arnaud D, Lopez C, Boury F, Brunello I, Lefèvre M, Mingam R, Haissaguerre M, Le Bidan M, Pavin D, Le Moal V, Leclercq C, Piot O, Beitar T, Martel I, Schmid A, Sadki N, Romeyer-Bouchard C, Da Costa A, Arnault I, Boyer M, Piat C, Fauchier L, Lozance N, Nastevska S, Doneva A, Fortomaroska Milevska B, Sheshoski B, Petroska K, Taneska N, Bakrecheski N, Lazarovska K, Jovevska S, Ristovski V, Antovski A, Lazarova E, Kotlar I, Taleski J, Poposka L, Kedev S, Zlatanovik N, Jordanova S, Bajraktarova Proseva T, Doncovska S, Maisuradze D, Esakia A, Sagirashvili E, Lartsuliani K, Natelashvili N, Gumberidze N, Gvenetadze R, Etsadashvili K, Gotonelia N, Kuridze N, Papiashvili G, Menabde I, Glöggler S, Napp A, Lebherz C, Romero H, Schmitz K, Berger M, Zink M, Köster S, Sachse J, Vonderhagen E, Soiron G, Mischke K, Reith R, Schneider M, Rieker W, Boscher D, Taschareck A, Beer A, Oster D, Ritter O, Adamczewski J, Walter S, Frommhold A, Luckner E, Richter J, Schellner M, Landgraf S, Bartholome S, Naumann R, Schoeler J, Westermeier D, William F, Wilhelm K, Maerkl M, Oekinghaus R, Denart M, Kriete M, Tebbe U, Scheibner T, Gruber M, Gerlach A, Beckendorf C, Anneken L, Arnold M, Lengerer S, Bal Z, Uecker C, Förtsch H, Fechner S, Mages V, Martens E, Methe H, Schmidt T, Schaeffer B, Hoffmann B, Moser J, Heitmann K, Willems S, Willems S, Klaus C, Lange I, Durak M, Esen E, Mibach F, Mibach H, Utech A, Gabelmann M, Stumm R, Ländle V, Gartner C, Goerg C, Kaul N, Messer S, Burkhardt D, Sander C, Orthen R, Kaes S, Baumer A, Dodos F, Barth A, Schaeffer G, Gaertner J, Winkler J, Fahrig A, Aring J, Wenzel I, Steiner S, Kliesch A, Kratz E, Winter K, Schneider P, Haag A, Mutscher I, Bosch R, Taggeselle J, Meixner S, Schnabel A, Shamalla A, Hötz H, Korinth A, Rheinert C, Mehltretter G, Schön B, Schön N, Starflinger A, Englmann E, Baytok G, Laschinger T, Ritscher G, Gerth A, Dechering D, Eckardt L, Kuhlmann M, Proskynitopoulos N, Brunn J, Foth K, Axthelm C, Hohensee H, Eberhard K, Turbanisch S, Hassler N, Koestler A, Stenzel G, Kschiwan D, Schwefer M, Neiner S, Hettwer S, Haeussler-Schuchardt M, Degenhardt R, Sennhenn S, Steiner S, Brendel M, Stoehr A, Widjaja W, Loehndorf S, Logemann A, Hoskamp J, Grundt J, Block M, Ulrych R, Reithmeier A, Panagopoulos V, Martignani C, Bernucci D, Fantecchi E, Diemberger I, Ziacchi M, Biffi M, Cimaglia P, Frisoni J, Boriani G, Giannini I, Boni S, Fumagalli S, Pupo S, Di Chiara A, Mirone P, Fantecchi E, Boriani G, Pesce F, Zoccali C, Malavasi VL, Mussagaliyeva A, Ahyt B, Salihova Z, Koshum-Bayeva K, Kerimkulova A, Bairamukova A, Mirrakhimov E, Lurina B, Zuzans R, Jegere S, Mintale I, Kupics K, Jubele K, Erglis A, Kalejs O, Vanhear K, Burg M, Cachia M, Abela E, Warwicker S, Tabone T, Xuereb R, Asanovic D, Drakalovic D, Vukmirovic M, Pavlovic N, Music L, Bulatovic N, Boskovic A, Uiterwaal H, Bijsterveld N, De Groot J, Neefs J, van den Berg N, Piersma F, Wilde A, Hagens V, Van Es J, Van Opstal J, Van Rennes B, Verheij H, Breukers W, Tjeerdsma G, Nijmeijer R, Wegink D, Binnema R, Said S, Erküner Ö, Philippens S, van Doorn W, Crijns H, Szili-Torok T, Bhagwandien R, Janse P, Muskens A, van Eck M, Gevers R, van der Ven N, Duygun A, Rahel B, Meeder J, Vold A, Holst Hansen C, Engset I, Atar D, Dyduch-Fejklowicz B, Koba E, Cichocka M, Sokal A, Kubicius A, Pruchniewicz E, Kowalik-Sztylc A, Czapla W, Mróz I, Kozlowski M, Pawlowski T, Tendera M, Winiarska-Filipek A, Fidyk A, Slowikowski A, Haberka M, Lachor-Broda M, Biedron M, Gasior Z, Kołodziej M, Janion M, Gorczyca-Michta I, Wozakowska-Kaplon B, Stasiak M, Jakubowski P, Ciurus T, Drozdz J, Simiera M, Zajac P, Wcislo T, Zycinski P, Kasprzak J, Olejnik A, Harc-Dyl E, Miarka J, Pasieka M, Ziemińska-Łuć M, Bujak W, Śliwiński A, Grech A, Morka J, Petrykowska K, Prasał M, Hordyński G, Feusette P, Lipski P, Wester A, Streb W, Romanek J, Woźniak P, Chlebuś M, Szafarz P, Stanik W, Zakrzewski M, Kaźmierczak J, Przybylska A, Skorek E, Błaszczyk H, Stępień M, Szabowski S, Krysiak W, Szymańska M, Karasiński J, Blicharz J, Skura M, Hałas K, Michalczyk L, Orski Z, Krzyżanowski K, Skrobowski A, Zieliński L, Tomaszewska-Kiecana M, Dłużniewski M, Kiliszek M, Peller M, Budnik M, Balsam P, Opolski G, Tymińska A, Ozierański K, Wancerz A, Borowiec A, Majos E, Dabrowski R, Szwed H, Musialik-Lydka A, Leopold-Jadczyk A, Jedrzejczyk-Patej E, Koziel M, Lenarczyk R, Mazurek M, Kalarus Z, Krzemien-Wolska K, Starosta P, Nowalany-Kozielska E, Orzechowska A, Szpot M, Staszel M, Almeida S, Pereira H, Brandão Alves L, Miranda R, Ribeiro L, Costa F, Morgado F, Carmo P, Galvao Santos P, Bernardo R, Adragão P, Ferreira da Silva G, Peres M, Alves M, Leal M, Cordeiro A, Magalhães P, Fontes P, Leão S, Delgado A, Costa A, Marmelo B, Rodrigues B, Moreira D, Santos J, Santos L, Terchet A, Darabantiu D, Mercea S, Turcin Halka V, Pop Moldovan A, Gabor A, Doka B, Catanescu G, Rus H, Oboroceanu L, Bobescu E, Popescu R, Dan A, Buzea A, Daha I, Dan G, Neuhoff I, Baluta M, Ploesteanu R, Dumitrache N, Vintila M, Daraban A, Japie C, Badila E, Tewelde H, Hostiuc M, Frunza S, Tintea E, Bartos D, Ciobanu A, Popescu I, Toma N, Gherghinescu C, Cretu D, Patrascu N, Stoicescu C, Udroiu C, Bicescu G, Vintila V, Vinereanu D, Cinteza M, Rimbas R, Grecu M, Cozma A, Boros F, Ille M, Tica O, Tor R, Corina A, Jeewooth A, Maria B, Georgiana C, Natalia C, Alin D, Dinu-Andrei D, Livia M, Daniela R, Larisa R, Umaar S, Tamara T, Ioachim Popescu M, Nistor D, Sus I, Coborosanu O, Alina-Ramona N, Dan R, Petrescu L, Ionescu G, Popescu I, Vacarescu C, Goanta E, Mangea M, Ionac A, Mornos C, Cozma D, Pescariu S, Solodovnicova E, Soldatova I, Shutova J, Tjuleneva L, Zubova T, Uskov V, Obukhov D, Rusanova G, Soldatova I, Isakova N, Odinsova S, Arhipova T, Kazakevich E, Serdechnaya E, Zavyalova O, Novikova T, Riabaia I, Zhigalov S, Drozdova E, Luchkina I, Monogarova Y, Hegya D, Rodionova L, Rodionova L, Nevzorova V, Soldatova I, Lusanova O, Arandjelovic A, Toncev D, Milanov M, Sekularac N, Zdravkovic M, Hinic S, Dimkovic S, Acimovic T, Saric J, Polovina M, Potpara T, Vujisic-Tesic B, Nedeljkovic M, Zlatar M, Asanin M, Vasic V, Popovic Z, Djikic D, Sipic M, Peric V, Dejanovic B, Milosevic N, Stevanovic A, Andric A, Pencic B, Pavlovic-Kleut M, Celic V, Pavlovic M, Petrovic M, Vuleta M, Petrovic N, Simovic S, Savovic Z, Milanov S, Davidovic G, Iric-Cupic V, Simonovic D, Stojanovic M, Stojanovic S, Mitic V, Ilic V, Petrovic D, Deljanin Ilic M, Ilic S, Stoickov V, Markovic S, Kovacevic S, García Fernandez A, Perez Cabeza A, Anguita M, Tercedor Sanchez L, Mau E, Loayssa J, Ayarra M, Carpintero M, Roldán Rabadan I, Leal M, Gil Ortega M, Tello Montoliu A, Orenes Piñero E, Manzano Fernández S, Marín F, Romero Aniorte A, Veliz Martínez A, Quintana Giner M, Ballesteros G, Palacio M, Alcalde O, García-Bolao I, Bertomeu Gonzalez V, Otero-Raviña F, García Seara J, Gonzalez Juanatey J, Dayal N, Maziarski P, Gentil-Baron P, Shah D, Koç M, Onrat E, Dural IE, Yilmaz K, Özin B, Tan Kurklu S, Atmaca Y, Canpolat U, Tokgozoglu L, Dolu AK, Demirtas B, Sahin D, Ozcan Celebi O, Diker E, Gagirci G, Turk UO, Ari H, Polat N, Toprak N, Sucu M, Akin Serdar O, Taha Alper A, Kepez A, Yuksel Y, Uzunselvi A, Yuksel S, Sahin M, Kayapinar O, Ozcan T, Kaya H, Yilmaz MB, Kutlu M, Demir M, Gibbs C, Kaminskiene S, Bryce M, Skinner A, Belcher G, Hunt J, Stancombe L, Holbrook B, Peters C, Tettersell S, Shantsila A, Lane D, Senoo K, Proietti M, Russell K, Domingos P, Hussain S, Partridge J, Haynes R, Bahadur S, Brown R, McMahon S, Y H Lip G, McDonald J, Balachandran K, Singh R, Garg S, Desai H, Davies K, Goddard W, Galasko G, Rahman I, Chua Y, Payne O, Preston S, Brennan O, Pedley L, Whiteside C, Dickinson C, Brown J, Jones K, Benham L, Brady R, Buchanan L, Ashton A, Crowther H, Fairlamb H, Thornthwaite S, Relph C, McSkeane A, Poultney U, Kelsall N, Rice P, Wilson T, Wrigley M, Kaba R, Patel T, Young E, Law J, Runnett C, Thomas H, McKie H, Fuller J, Pick S, Sharp A, Hunt A, Thorpe K, Hardman C, Cusack E, Adams L, Hough M, Keenan S, Bowring A, Watts J, Zaman J, Goffin K, Nutt H, Beerachee Y, Featherstone J, Mills C, Pearson J, Stephenson L, Grant S, Wilson A, Hawksworth C, Alam I, Robinson M, Ryan S, Egdell R, Gibson E, Holland M, Leonard D, Mishra B, Ahmad S, Randall H, Hill J, Reid L, George M, McKinley S, Brockway L, Milligan W, Sobolewska J, Muir J, Tuckis L, Winstanley L, Jacob P, Kaye S, Morby L, Jan A, Sewell T, Boos C, Wadams B, Cope C, Jefferey P, Andrews N, Getty A, Suttling A, Turner C, Hudson K, Austin R, Howe S, Iqbal R, Gandhi N, Brophy K, Mirza P, Willard E, Collins S, Ndlovu N, Subkovas E, Karthikeyan V, Waggett L, Wood A, Bolger A, Stockport J, Evans L, Harman E, Starling J, Williams L, Saul V, Sinha M, Bell L, Tudgay S, Kemp S, Brown J, Frost L, Ingram T, Loughlin A, Adams C, Adams M, Hurford F, Owen C, Miller C, Donaldson D, Tivenan H, Button H, Nasser A, Jhagra O, Stidolph B, Brown C, Livingstone C, Duffy M, Madgwick P, Roberts P, Greenwood E, Fletcher L, Beveridge M, Earles S, McKenzie D, Beacock D, Dayer M, Seddon M, Greenwell D, Luxton F, Venn F, Mills H, Rewbury J, James K, Roberts K, Tonks L, Felmeden D, Taggu W, Summerhayes A, Hughes D, Sutton J, Felmeden L, Khan M, Walker E, Norris L, O’Donohoe L, Mozid A, Dymond H, Lloyd-Jones H, Saunders G, Simmons D, Coles D, Cotterill D, Beech S, Kidd S, Wrigley B, Petkar S, Smallwood A, Jones R, Radford E, Milgate S, Metherell S, Cottam V, Buckley C, Broadley A, Wood D, Allison J, Rennie K, Balian L, Howard L, Pippard L, Board S, Pitt-Kerby T. Epidemiology and impact of frailty in patients with atrial fibrillation in Europe. Age Ageing 2022; 51:6670566. [PMID: 35997262 DOI: 10.1093/ageing/afac192] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [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: 03/17/2022] [Revised: 06/08/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Frailty is a medical syndrome characterised by reduced physiological reserve and increased vulnerability to stressors. Data regarding the relationship between frailty and atrial fibrillation (AF) are still inconsistent. OBJECTIVES We aim to perform a comprehensive evaluation of frailty in a large European cohort of AF patients. METHODS A 40-item frailty index (FI) was built according to the accumulation of deficits model in the AF patients enrolled in the ESC-EHRA EORP-AF General Long-Term Registry. Association of baseline characteristics, clinical management, quality of life, healthcare resources use and risk of outcomes with frailty was examined. RESULTS Among 10,177 patients [mean age (standard deviation) 69.0 (11.4) years, 4,103 (40.3%) females], 6,066 (59.6%) were pre-frail and 2,172 (21.3%) were frail, whereas only 1,939 (19.1%) were considered robust. Baseline thromboembolic and bleeding risks were independently associated with increasing FI. Frail patients with AF were less likely to be treated with oral anticoagulants (OACs) (odds ratio 0.70, 95% confidence interval 0.55-0.89), especially with non-vitamin K antagonist OACs and managed with a rhythm control strategy, compared with robust patients. Increasing frailty was associated with a higher risk for all outcomes examined, with a non-linear exponential relationship. The use of OAC was associated with a lower risk of outcomes, except in patients with very/extremely high frailty. CONCLUSIONS In this large cohort of AF patients, there was a high burden of frailty, influencing clinical management and risk of adverse outcomes. The clinical benefit of OAC is maintained in patients with high frailty, but not in very high/extremely frail ones.
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Affiliation(s)
- Marco Proietti
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy
| | - Giulio Francesco Romiti
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,Department of Translational and Precision Medicine, Sapienza - University of Rome, Italy
| | - Marco Vitolo
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy.,Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Stephanie L Harrison
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Deirdre A Lane
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Laurent Fauchier
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau, Tours, France
| | - Francisco Marin
- Department of Cardiology, Hospital Universitario Virgen de la Arrixaca, IMIB-Arrixaca, University of Murcia, CIBER-CV, Murcia, Spain
| | - Michael Näbauer
- Department of Cardiology, Ludwig-Maximilians-University, Munich, Germany
| | - Tatjana S Potpara
- School of Medicine, University of Belgrade, Belgrade, Serbia.,Clinical Center of Serbia, Belgrade, Serbia
| | - Gheorghe-Andrei Dan
- University of Medicine, 'Carol Davila', Colentina University Hospital, Bucharest, Romania
| | - Aldo P Maggioni
- ANMCO Research Center, Heart Care Foundation, Florence, Italy
| | - Matteo Cesari
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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6
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Rajivmoorthy M, Wilson TR, Eberhart ME. Neighborhoods and functionality in metals. Phys Chem Chem Phys 2022; 24:12898-12908. [PMID: 35583315 DOI: 10.1039/d1cp04787f] [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: 11/21/2022]
Abstract
The fundamental construct of organic chemistry involves understanding molecular behavior through functional groups. Much of computational chemistry focuses on this very principle, but metallic materials are rarely analyzed using these techniques owing to the assumption that they are delocalized and do not possess inherent functionality. In this paper, we propose a methodology that recovers functional groups in metallic materials from an energy perspective. We characterize neighborhoods associated with functional groups in metals by observing the evolution of Bader energy of the central cluster as a function of cluster size. This approach can be used to conceptually decompose metallic structure into meaningful chemical neighborhoods allowing for localization of energy-dependent properties. The generalizability of this approach is assessed by determining neighborhoods for crystalline materials of different structure types, and significant structural defects such as grain boundaries and dislocations. In all cases, we observe that the neighborhood size may be universal-around 2-3 atomic diameters. In its practical sense, this approach opens the door to the application of chemical concepts, e.g., orbital methods, to investigate a broad range of metallurgical phenomena, one neighborhood at a time.
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Affiliation(s)
- M Rajivmoorthy
- Molecular Theory Group, Colorado School of Mines, Golden, Colorado, USA.
| | - T R Wilson
- Molecular Theory Group, Colorado School of Mines, Golden, Colorado, USA.
| | - M E Eberhart
- Molecular Theory Group, Colorado School of Mines, Golden, Colorado, USA.
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7
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Wilson T, Nambiema A, Porro B, Descatha A, Aublet-Cuvelier A, Bradley E, Roquelaure Y. La dose d'activité physique nécessaire pour améliorer le retour au travail après cancer : revue systématique et méta-régression. Rev Epidemiol Sante Publique 2022. [DOI: 10.1016/j.respe.2022.03.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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8
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Hutten R, Parsons M, Khouri A, Tward A, Wilson T, Peterson J, Morrell G, Kokeny K, Lloyd S, Cannon D, Tward J, Sanchez A, Johnson S. The Clinical Significance of Maximum Tumor Diameter on MRI in Men Undergoing Radical Prostatectomy or Definitive Radiotherapy for Locoregional Prostate Cancer. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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9
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Westphalen CB, Krebs MG, Le Tourneau C, Sokol ES, Maund SL, Wilson TR, Jin DX, Newberg JY, Fabrizio D, Veronese L, Thomas M, de Braud F. Author Correction: Genomic context of NTRK1/2/3 fusion-positive tumours from a large real-world population. NPJ Precis Oncol 2021; 5:86. [PMID: 34535754 PMCID: PMC8448774 DOI: 10.1038/s41698-021-00222-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- C B Westphalen
- Comprehensive Cancer Center Munich & Department of Medicine III, University Hospital, LMU Munich, Munich, Germany.
| | - M G Krebs
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, The University of Manchester and The Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - C Le Tourneau
- Department of Drug Development and Innovation (D3i), Institut Curie, Paris & Saint-Cloud, France, Saint-Cloud, France.,INSERM U900 Research Unit, Saint-Cloud, France.,Paris-Saclay University, Paris, France
| | - E S Sokol
- Foundation Medicine Inc., Cambridge, MA, USA
| | - S L Maund
- Genentech Inc., South San Francisco, CA, USA
| | - T R Wilson
- Genentech Inc., South San Francisco, CA, USA
| | - D X Jin
- Foundation Medicine Inc., Cambridge, MA, USA
| | - J Y Newberg
- Foundation Medicine Inc., Cambridge, MA, USA
| | - D Fabrizio
- Foundation Medicine Inc., Cambridge, MA, USA
| | - L Veronese
- F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - M Thomas
- F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - F de Braud
- Department of Medical Oncology and Haematology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.,School of Specialisation in Medical Oncology, University of Milan, Milan, Italy
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10
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Seejore K, Alavi SA, Pearson SM, Robins JMW, Alromhain B, Sheikh A, Nix P, Wilson T, Orme SM, Tyagi A, Phillips N, Murray RD. Post-operative volumes following endoscopic surgery for non-functioning pituitary macroadenomas are predictive of further intervention, but not endocrine outcomes. BMC Endocr Disord 2021; 21:116. [PMID: 34112169 PMCID: PMC8194144 DOI: 10.1186/s12902-021-00777-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 05/04/2021] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Transsphenoidal surgery (TSS) remains the treatment of choice for non-functioning pituitary macroadenomas (NFPMA). The value of measuring tumour volumes before and after surgery, and its influence on endocrine outcomes and further treatment of the residual or recurrent tumour are unknown. METHODS Data from patients who underwent endoscopic TSS for a NFPMA (2009-2018) in a UK tertiary centre were analysed for pre- and post-operative endocrine and surgical outcomes. RESULTS Of 173 patients with NFPMA, 159 (61% male) were treatment naïve. At presentation, 76.2% (77/101) had ≥1 pituitary axis deficit. Older age (p = 0.002) was an independent predictor for multiple hormonal deficiencies. Preoperative tumour volume did not correlate with degree of hypopituitarism. Postoperative tumour volume and extent of tumour resection were not predictive of new onset hypopituitarism. Hormonal recovery was observed in 16 patients (20.8%) with impaired pituitary function, with the greatest recovery in the hypothalamic-pituitary-adrenal axis (21.2%, 7/33). A larger residual tumour volume was predictive of adjuvant radiotherapy (3.40 vs. 1.24 cm3, p = 0.005) and likelihood for repeat surgery (5.40 vs. 1.67cm3, p = 0.004). CONCLUSION Pre- and post-operative NFPMA volumes fail to predict the number of pituitary hormone deficits, however, greater post-operative residual volumes increase the likelihood of further intervention to control tumour growth.
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Affiliation(s)
- K Seejore
- Leeds Centre for Diabetes & Endocrinology, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - S A Alavi
- Department of Neurosurgery, Leeds Centre for Neurosciences, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - S M Pearson
- Leeds Centre for Diabetes & Endocrinology, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - J M W Robins
- Department of Neurosurgery, Leeds Centre for Neurosciences, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - B Alromhain
- Department of Neurosurgery, Leeds Centre for Neurosciences, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - A Sheikh
- Department of Neurosurgery, Leeds Centre for Neurosciences, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - P Nix
- Department of Ear, Nose and Throat (ENT) Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - T Wilson
- Department of Ear, Nose and Throat (ENT) Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - S M Orme
- Leeds Centre for Diabetes & Endocrinology, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - A Tyagi
- Department of Neurosurgery, Leeds Centre for Neurosciences, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - N Phillips
- Department of Neurosurgery, Leeds Centre for Neurosciences, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - R D Murray
- Leeds Centre for Diabetes & Endocrinology, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.
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11
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Iranmanesh P, Bajwa K, Snyder B, Wilson T, Chandwani K, Shah S, Wilson E. Trocar site closure with a novel anchor-based (neoClose®) system versus standard suture closure: A prospective randomized controlled trial. Br J Surg 2021. [DOI: 10.1093/bjs/znab202.035] [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]
Abstract
Abstract
Objective
Patients with obesity have a higher risk of trocar site hernia. The objective of the present study was to compare a standard suture passer versus the neoClose® device for port site fascial closure in patients with obesity undergoing laparoscopic bariatric surgery.
Methods
This is a randomized, controlled trial with two parallel arms. Thirty five patients with BMI ≥ 35 kg/m2 and undergoing laparoscopic sleeve gastrectomy or Roux-en-Y gastric bypass were randomized to each group. Port site fascial closure for trocars ≥ 10 mm was performed with the neoClose® device in the study group and the standard suture passer in the control group. Primary outcomes were time required to complete closure and intensity of postoperative pain at the fascial closure sites. Secondary outcomes were intraabdominal needle depth and incidence of trocar site hernia.
Results
The use of the neoClose® device resulted in shorter closure times (20.2 vs 30.0 s, p = 0.0002), less pain (0.3 vs 0.9, p = 0.002) at port closure sites, and decreased needle depth (3.3 cm vs 5.2 cm, p < 0.0001) compared to the standard suture passer. There was no trocar site hernia at the one-year follow-up in either group.
Conclusion
Use of the neoClose® device resulted in faster fascial closure times, decreased intraoperative needle depth, and decreased postoperative abdominal pain at 1 week as compared to the standard suture passer. These data need to be confirmed on larger cohorts of patients with longer follow-up, especially in terms of long-term hernia recurrence rates.
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Affiliation(s)
- P Iranmanesh
- Department of Surgery, Geneva University Hospital, Geneva, Switzerland
- Division of Minimally Invasive Surgery, Department of Surgery, McGovern Medical School, University of Texas Health Science Center, Houston, USA
| | - K Bajwa
- Division of Minimally Invasive Surgery, Department of Surgery, McGovern Medical School, University of Texas Health Science Center, Houston, USA
| | - B Snyder
- Division of Minimally Invasive Surgery, Department of Surgery, McGovern Medical School, University of Texas Health Science Center, Houston, USA
| | - T Wilson
- Division of Minimally Invasive Surgery, Department of Surgery, McGovern Medical School, University of Texas Health Science Center, Houston, USA
| | - K Chandwani
- Division of Minimally Invasive Surgery, Department of Surgery, McGovern Medical School, University of Texas Health Science Center, Houston, USA
| | - S Shah
- Division of Minimally Invasive Surgery, Department of Surgery, McGovern Medical School, University of Texas Health Science Center, Houston, USA
| | - E Wilson
- Division of Minimally Invasive Surgery, Department of Surgery, McGovern Medical School, University of Texas Health Science Center, Houston, USA
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12
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Wilson T, Javaheri P, Finlay J, Hazlewood G, Wilton SB, Sajobi T, Levin A, Pearson W, Connolly C, James MT. Treatment Preferences for Cardiac Procedures of Patients With Chronic Kidney Disease in Acute Coronary Syndrome: Design and Pilot Testing of a Discrete Choice Experiment. Can J Kidney Health Dis 2021; 8:2054358120985375. [PMID: 33552527 PMCID: PMC7844446 DOI: 10.1177/2054358120985375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 11/27/2020] [Indexed: 12/03/2022] Open
Abstract
Background: Chronic kidney disease is associated with a high incidence of acute coronary syndrome and related morbidity and mortality. Treatment choices for patients with chronic kidney disease involve trade-offs in the potential benefits and harms of invasive management options. Objective: The objective was to quantify preferences of patients with chronic kidney disease toward invasive heart procedures. Design: Design and pilot a discrete choice experiment. Setting: We piloted the discrete choice experiment in 2 multidisciplinary chronic kidney disease clinics in Calgary, Alberta, using an 8-question survey. Patients: Eligible patients included those aged 18 years and older, an estimated glomerular filtration rate < 45 mL/min/1.73 m2, not currently receiving dialysis, and able to communicate in English. Measurements: Quantification of the average importances of key attributes of invasive heart procedures. Methods: We identified attributes most important to patients and physicians concerning invasive versus conservative management for acute coronary syndrome, using semi-structured qualitative interviews. Levels for each attribute were derived from analysis of early invasive versus conservative acute coronary syndrome management clinical trials and cohort studies, where subgroups of patients with chronic kidney disease were reported. We designed the pilot study with patient partners with relevant lived experience and considered statistical efficiency to estimate main effects and interactions, as well as response efficiency. Hierarchical Bayesian estimation was used to quantify average importances of attributes. Results: We recruited 43 patients with chronic kidney disease, mean (SD) age 67 (14) years, 67% male, and 35% with a history of cardiovascular disease, of whom 39 completed the survey within 2 weeks of enrollment. The results of the pilot revealed acute kidney injury requiring dialysis and permanent kidney replacement therapy, as well as death within 1 year were the most important attributes. Measures of internal validity for the pilot discrete choice experiment were comparable to those for other published discrete choice experiments. Limitations: Discrete choice experiments are complex instruments and often cognitively demanding for patients. This survey included multiple risk attributes which may have been challenging for some patients to understand. Conclusions: This pilot study demonstrates the feasibility of a discrete choice experiment to quantify preferences of patients with chronic kidney disease toward the benefits and trade-offs related to invasive versus conservative management for acute coronary syndrome. These preliminary findings suggest that patients with chronic kidney disease may be on average similarly risk averse toward kidney replacement therapy and death. This pilot information will be used to inform a larger discrete choice experiment that will refine these estimates of patient preferences and characterize subgroups with distinct treatment preferences, which should provide new knowledge that can facilitate shared decision-making between patients with chronic kidney disease and their care providers in the setting of acute coronary syndrome.
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Affiliation(s)
- T Wilson
- Department of Community Health Sciences, University of Calgary, AB, Canada
| | - P Javaheri
- Department of Medicine, University of Calgary, AB, Canada
| | - J Finlay
- Department of Medicine, University of Calgary, AB, Canada
| | - G Hazlewood
- Department of Medicine, University of Calgary, AB, Canada
| | - S B Wilton
- Department of Cardiac Sciences, University of Calgary, AB, Canada
| | - T Sajobi
- Department of Community Health Sciences, University of Calgary, AB, Canada
| | - A Levin
- Division of Nephrology, The University of British Columbia, Vancouver, Canada
| | - W Pearson
- Patient and Community Engagement Research Program, O'Brien Institute of Public Health, University of Calgary, AB, Canada
| | - C Connolly
- Department of Cardiac Sciences, University of Calgary, AB, Canada
| | - M T James
- Department of Medicine, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, AB, Canada
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Wilson T, Gray R, Ellenberger K, Friedman D, Lambros J, Eggleton S, Freeman T, Mathur G, Cranney G, Yu J. Comparison of Hospital Resource Allocation Associated With CTCA for Intermediate-Risk ACS as Inpatient vs Expedited Outpatient. Heart Lung Circ 2021. [PMCID: PMC8324090 DOI: 10.1016/j.hlc.2021.06.368] [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: 11/30/2022]
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Zeng Z, Orfan N, Carneal G, Wilson T. P230 ASTHMA AND BEHAVIORAL HEALTH CONDITIONS IN THE ELDERLY. Ann Allergy Asthma Immunol 2020. [DOI: 10.1016/j.anai.2020.08.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Smith J, Gass N, Huntley M, Nanuck R, Vandendris S, Bell C, Heitz E, Wilson T. 97 Complexity In Croydon. Age Ageing 2020. [DOI: 10.1093/ageing/afz194.08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
The Complex Care Support Team (CCST) are a newly-formed, integrated service, caring for Croydon residents when existing services decide additional multidisciplinary team input is required.
There is no single definition of healthcare complexity. Most cases encountered by the team have involved many different services and professionals. The team have found that by forging relationships and co-ordinating care across organisational boundaries, some of the “complexities” can be mitigated. We aim to develop our understanding of the needs of this population and the underlying drivers for complexity in Croydon.
Methods
The records on EMIS, CERNER and ePJS were reviewed from the inaugural two months of the service, for:Rockwood Frailty ScoreNumber of medicationsNumber of long-term conditionsED attendances or admissions to hospital over the preceding year.
After team discussion on every case, underlying causes of complexity were assigned to four groups: medical, psychological, social and systems failure.
Results
Of the 57 people accepted by CCST over 2 months, 39 required reviewing in person. 5 records were not completed, so 34 cases were included for evaluation. The age range of this cohort was 49-92, with 17 male and 17 female. Results revealed significant frailty, multimorbidity and polypharmacy. 91% had two or more underlying drivers for complexity, with the largest underlying driver being systems failure, in 85% of cases.
Conclusions
This work improves our understanding of the needs of the population deemed the most “complex” in Croydon. The likelihood of multiple underlying drivers for complexity was high, highlighting how complex health issues are likely to span both professional and organisational boundaries. This can in itself be a significant underlying driver for complexity, illustrated here as “systems failure”. In developing current and future services, this work reinforces the vital benefits of multidisciplinary and cross-organisational working currently occurring in CCST.
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Affiliation(s)
- J Smith
- Croydon Health Services NHS Trust
| | - N Gass
- Croydon Health Services NHS Trust
| | | | - R Nanuck
- Croydon Health Services NHS Trust
| | | | - C Bell
- Croydon Health Services NHS Trust
| | - E Heitz
- Croydon Health Services NHS Trust
| | - T Wilson
- Croydon Health Services NHS Trust
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Chacko Y, Poon K, Incani A, Keegan W, Beevors R, Hazlewood J, Ang V, Gasperini V, Wilson T, Smith I. 812 Contemporary Radiation Doses in Uncomplicated Transcatheter Aortic Valve Implantation Procedures. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lambert N, Robertson A, Srivas R, Peterman N, Close J, Wilson T, George P, Wood H, Wong B, Tezcan A, Tezcan H. Comparison of enzymatic-and bisulfite conversion to map the plasma cell-free methylome in cancer. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz238.045] [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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Davis A, Iams W, Chan D, Oh M, Lentz R, Peterman N, Robertson A, Shah A, Srivas R, Lambert N, Wilson T, George P, Wong B, Close J, Wood H, Tezcan A, Spinosa J, Tezcan H, Chae Y. Dynamic changes in whole-genome cell-free DNA (cfDNA) to identify disease progression prior to imaging in advanced solid tumours. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz239.025] [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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Davis A, Iams W, Chan D, Oh M, Lentz R, Srivas R, Lambert N, Robertson A, Peterman N, Shah A, Wilson T, Close J, George P, Wood H, Wong B, Tezcan A, Spinosa J, Tezcan H, Chae Y. Longitudinal changes in cell-free DNA (cfDNA) methylation levels identify early non-responders to treatment in advanced solid tumours. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz239.027] [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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Wilson T, Lyons H, Winter H, Bird T, Falk S, Gangadhara S. Neo-adjuvant (NA) Imatinib for gastrointestinal stromal tumours (GISTs): What is the optimal length of treatment? Ann Oncol 2019. [DOI: 10.1093/annonc/mdz283.037] [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: 11/12/2022] Open
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Davis A, Iams W, Chan D, Oh M, Lentz R, Peterman N, Robertson A, Shah A, Srivas R, Lambert N, Wilson T, Tezcan A, Spinosa J, Tezcan H, Mohindra N, Villaflor V, Chae Y. P1.01-49 Serial Changes in Whole-Genome Cell-Free DNA (cfDNA) to Identify Disease Progression Prior to Imaging in Advanced NSCLC. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Hernandez N, Perez D, Wilson T. A Novel Technique for Atraumatic, Fiberoptic Nasal Intubation: Pilot Study and Preliminary Results. J Oral Maxillofac Surg 2019. [DOI: 10.1016/j.joms.2019.06.159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Humphry N, Wilson T, Cox M, Hewitt J. 96SARCOPENIA, FRAILTY AND NUTRITIONAL STATUS OF COLORECTAL CANCER SURGICAL PATIENTS AND URINARY BIOMARKERS: STUDY PROTOCOL. Age Ageing 2019. [DOI: 10.1093/ageing/afz063.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- N Humphry
- Cardiff and Vale University Health Board
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Lloyd AJ, Willis ND, Wilson T, Zubair H, Chambers E, Garcia-Perez I, Xie L, Tailliart K, Beckmann M, Mathers JC, Draper J. Addressing the pitfalls when designing intervention studies to discover and validate biomarkers of habitual dietary intake. Metabolomics 2019; 15:72. [PMID: 31049735 PMCID: PMC6497620 DOI: 10.1007/s11306-019-1532-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 04/19/2019] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Dietary exposure monitoring within populations is reliant on self-reported measures such as Food Frequency Questionnaires and diet diaries. These methods often contain inaccurate information due to participant misreporting, non-compliance and bias. Urinary metabolites derived from individual foods could provide additional objective indicators of dietary exposure. For biomarker approaches to have utility it is essential that they cover a wide-range of commonly consumed foods and the methodology works in a real-world environment. OBJECTIVES To test that the methodology works in a real-world environment and to consider the impact of the major sources of likely variance; particularly complex meals, different food formulations, processing and cooking methods, as well as the dynamics of biomarker duration in the body. METHODS We designed and tested a dietary exposure biomarker discovery and validation strategy based on a food intervention study involving free-living individuals preparing meals and collecting urine samples at home. Two experimental periods were built around three consecutive day menu plans where all foods and drinks were provided (n = 15 and n = 36). RESULTS The experimental design was validated by confirming known consumption biomarkers in urinary samples after the first menu plan. We tested biomarker performance with different food formulations and processing methods involving meat, wholegrain, fruits and vegetables. CONCLUSION It was demonstrated that spot urine samples, together with robust dietary biomarkers, despite major sources of variance, could be used successfully for dietary exposure monitoring in large epidemiological studies.
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Affiliation(s)
- A J Lloyd
- Institute of Biological, Environmental and Rural Sciences, Aberystwyth University, Aberystwyth, SY23 3DA, UK
| | - N D Willis
- Human Nutrition Research Centre, Institute of Cellular Medicine, Newcastle University, Newcastle-upon-Tyne, NE2 4HH, UK
| | - T Wilson
- Institute of Biological, Environmental and Rural Sciences, Aberystwyth University, Aberystwyth, SY23 3DA, UK
| | - H Zubair
- Institute of Biological, Environmental and Rural Sciences, Aberystwyth University, Aberystwyth, SY23 3DA, UK
| | - E Chambers
- Nutrition and Dietetic Research Group, Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, Hammersmith Hospital Campus, Imperial College London, London, W12 0NN, UK
| | - I Garcia-Perez
- Nutrition and Dietetic Research Group, Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, Hammersmith Hospital Campus, Imperial College London, London, W12 0NN, UK
| | - L Xie
- Human Nutrition Research Centre, Institute of Cellular Medicine, Newcastle University, Newcastle-upon-Tyne, NE2 4HH, UK
| | - K Tailliart
- Institute of Biological, Environmental and Rural Sciences, Aberystwyth University, Aberystwyth, SY23 3DA, UK
| | - M Beckmann
- Institute of Biological, Environmental and Rural Sciences, Aberystwyth University, Aberystwyth, SY23 3DA, UK
| | - J C Mathers
- Human Nutrition Research Centre, Institute of Cellular Medicine, Newcastle University, Newcastle-upon-Tyne, NE2 4HH, UK
| | - J Draper
- Institute of Biological, Environmental and Rural Sciences, Aberystwyth University, Aberystwyth, SY23 3DA, UK.
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Schmid P, Pinder S, Wheatley D, Zummit C, Macaskill EJ, Hu J, Price R, Bundred N, Hadad S, Shia A, Sarker SJ, Lim L, Mousa K, O'Brien C, Wilson TR, Lackner MR, Gendreau S, Gazinska P, Korbie D, Trau M, Mainwaring P, Thompson A, Purushotham A. Abstract P2-08-02: Interaction of PIK3CA mutation subclasses with response to preoperative treatment with the PI3K inhibitor pictilisib in patients with estrogen receptor-positive breast cancer. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p2-08-02] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: Although preclinical data suggest that combining PI3K inhibitors with endocrine therapy may overcome resistance, results from randomized clinical trials have failed to identify a subgroup of patients that derive a substantial benefit. This preoperative window study assessed whether adding the PI3K inhibitor pictilisib can increase the anti-tumor effects of anastrozole in primary breast cancer and aimed to identify the most appropriate patient population for combination therapy.
Methods: In this randomized, open-label, phase 2 study, 167 postmenopausal women with newly diagnosed, operable, ER-positive, HER2-negative breast cancers were recruited. Participants were randomly allocated (2:1, favoring the combination) to two-weeks of preoperative treatment with anastrozole 1 mg once daily or the combination of anastrozole 1mg with pictilisib 260 mg once daily. The primary endpoint was inhibition of tumor cell proliferation, as measured by change in Ki-67 protein expression between tumor samples taken before and at the end of treatment. Secondary endpoints include induction of apoptosis (Caspase3) and safety. Comprehensive biomarkers analyses included targeted NGS of a comprehensive cancer panel of >400 genes (Ampliseq Comprehensive Cancer panel), copy number variation analyses, and pre- and post-treatment reverse-phase protein arrays (RPPA) and RNA profiling (NanoString nCounter platform).
Results:There was significantly greater geometric mean Ki67 suppression of 82.5% (90% CI, 78.3%-85.8%) for the combination vs 70.7% (61.0%-78.0%) for anastrozole [geometric mean ratio (combination/ anastrozole) 0.60 (0.58-0.85);p=0.01]. Higher baseline Ki67, Luminal B status and/or negative PR status were associated with increased benefit from adding pictilisib. A significant interaction was observed between PIK3CA mutation subtypes [helical domain mutations (HD), kinase domain mutations (KD), wildtype (WT)] and mean Ki67 suppression; the combination/anastrozole geometric mean ratio of Ki67 suppression was 0.48 (0.27-0.84; p=0.02) for patients with HD mutations and 0.63 (0.39–1.0; p=0.05) for patients with PIK3Ca WT, compared to 1.17 (0.57–2.41; p=0.64) for patients with KD mutations. This was largely due to patients with HD mutations showing a particularly poor response to anastrozole alone [mean Ki67 suppression 53.9% (9.5%-76.5%)], that was reversed by the addition of pictilisib [mean Ki-67 suppression 78.1% (71.0%-83.4%)]. On the other hand, patients with KD mutations responded well to anastrozole alone [mean Ki-67 suppression 77.7% (57.0%-88.4%)] and showed no benefit from the addition of pictilisib [mean Ki-67 suppression 73.9% (59.8%-83.0%)]. There was no significant difference in induction of apoptosis between treatment groups. Comprehensive pre- and post-treatment biomarkers analyses will be presented.
Conclusions: Adding pictilisib to anastrozole significantly increases the anti-proliferative response to preoperative treatment with anastrozole. A significant interaction was observed between PIK3CA mutation subtypes, with patients with helical domain mutations showing a particularly poor response to anastrozole alone that was reversed by the addition of pictilisib.
Citation Format: Schmid P, Pinder S, Wheatley D, Zummit C, Macaskill EJ, Hu J, Price R, Bundred N, Hadad S, Shia A, Sarker S-J, Lim L, Mousa K, O'Brien C, Wilson TR, Lackner MR, Gendreau S, Gazinska P, Korbie D, Trau M, Mainwaring P, Thompson A, Purushotham A. Interaction of PIK3CA mutation subclasses with response to preoperative treatment with the PI3K inhibitor pictilisib in patients with estrogen receptor-positive 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 P2-08-02.
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Affiliation(s)
- P Schmid
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom; Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom; Ninewells Hospital, Dundee, United Kingdom; Barts Health NHS Trust, London, United Kingdom; King's College Hospital NHS Foundation Trust, London, United Kingdom; Manchester University NHS Foundation Trust, London, United Kingdom; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; Genentech, San Francisco; Breast Cancer Now Research Unit, Cancer Centre at Guy's Hospital, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Australian Institute for Bioengineering and Nanotechnology, University of Queensland, Brisbane City, Australia; Mater Research Centre, Brisbane, Australia; The University of Texas MD Anderson Cancer Centre, Houston
| | - S Pinder
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom; Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom; Ninewells Hospital, Dundee, United Kingdom; Barts Health NHS Trust, London, United Kingdom; King's College Hospital NHS Foundation Trust, London, United Kingdom; Manchester University NHS Foundation Trust, London, United Kingdom; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; Genentech, San Francisco; Breast Cancer Now Research Unit, Cancer Centre at Guy's Hospital, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Australian Institute for Bioengineering and Nanotechnology, University of Queensland, Brisbane City, Australia; Mater Research Centre, Brisbane, Australia; The University of Texas MD Anderson Cancer Centre, Houston
| | - D Wheatley
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom; Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom; Ninewells Hospital, Dundee, United Kingdom; Barts Health NHS Trust, London, United Kingdom; King's College Hospital NHS Foundation Trust, London, United Kingdom; Manchester University NHS Foundation Trust, London, United Kingdom; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; Genentech, San Francisco; Breast Cancer Now Research Unit, Cancer Centre at Guy's Hospital, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Australian Institute for Bioengineering and Nanotechnology, University of Queensland, Brisbane City, Australia; Mater Research Centre, Brisbane, Australia; The University of Texas MD Anderson Cancer Centre, Houston
| | - C Zummit
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom; Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom; Ninewells Hospital, Dundee, United Kingdom; Barts Health NHS Trust, London, United Kingdom; King's College Hospital NHS Foundation Trust, London, United Kingdom; Manchester University NHS Foundation Trust, London, United Kingdom; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; Genentech, San Francisco; Breast Cancer Now Research Unit, Cancer Centre at Guy's Hospital, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Australian Institute for Bioengineering and Nanotechnology, University of Queensland, Brisbane City, Australia; Mater Research Centre, Brisbane, Australia; The University of Texas MD Anderson Cancer Centre, Houston
| | - EJ Macaskill
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom; Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom; Ninewells Hospital, Dundee, United Kingdom; Barts Health NHS Trust, London, United Kingdom; King's College Hospital NHS Foundation Trust, London, United Kingdom; Manchester University NHS Foundation Trust, London, United Kingdom; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; Genentech, San Francisco; Breast Cancer Now Research Unit, Cancer Centre at Guy's Hospital, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Australian Institute for Bioengineering and Nanotechnology, University of Queensland, Brisbane City, Australia; Mater Research Centre, Brisbane, Australia; The University of Texas MD Anderson Cancer Centre, Houston
| | - J Hu
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom; Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom; Ninewells Hospital, Dundee, United Kingdom; Barts Health NHS Trust, London, United Kingdom; King's College Hospital NHS Foundation Trust, London, United Kingdom; Manchester University NHS Foundation Trust, London, United Kingdom; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; Genentech, San Francisco; Breast Cancer Now Research Unit, Cancer Centre at Guy's Hospital, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Australian Institute for Bioengineering and Nanotechnology, University of Queensland, Brisbane City, Australia; Mater Research Centre, Brisbane, Australia; The University of Texas MD Anderson Cancer Centre, Houston
| | - R Price
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom; Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom; Ninewells Hospital, Dundee, United Kingdom; Barts Health NHS Trust, London, United Kingdom; King's College Hospital NHS Foundation Trust, London, United Kingdom; Manchester University NHS Foundation Trust, London, United Kingdom; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; Genentech, San Francisco; Breast Cancer Now Research Unit, Cancer Centre at Guy's Hospital, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Australian Institute for Bioengineering and Nanotechnology, University of Queensland, Brisbane City, Australia; Mater Research Centre, Brisbane, Australia; The University of Texas MD Anderson Cancer Centre, Houston
| | - N Bundred
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom; Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom; Ninewells Hospital, Dundee, United Kingdom; Barts Health NHS Trust, London, United Kingdom; King's College Hospital NHS Foundation Trust, London, United Kingdom; Manchester University NHS Foundation Trust, London, United Kingdom; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; Genentech, San Francisco; Breast Cancer Now Research Unit, Cancer Centre at Guy's Hospital, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Australian Institute for Bioengineering and Nanotechnology, University of Queensland, Brisbane City, Australia; Mater Research Centre, Brisbane, Australia; The University of Texas MD Anderson Cancer Centre, Houston
| | - S Hadad
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom; Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom; Ninewells Hospital, Dundee, United Kingdom; Barts Health NHS Trust, London, United Kingdom; King's College Hospital NHS Foundation Trust, London, United Kingdom; Manchester University NHS Foundation Trust, London, United Kingdom; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; Genentech, San Francisco; Breast Cancer Now Research Unit, Cancer Centre at Guy's Hospital, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Australian Institute for Bioengineering and Nanotechnology, University of Queensland, Brisbane City, Australia; Mater Research Centre, Brisbane, Australia; The University of Texas MD Anderson Cancer Centre, Houston
| | - A Shia
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom; Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom; Ninewells Hospital, Dundee, United Kingdom; Barts Health NHS Trust, London, United Kingdom; King's College Hospital NHS Foundation Trust, London, United Kingdom; Manchester University NHS Foundation Trust, London, United Kingdom; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; Genentech, San Francisco; Breast Cancer Now Research Unit, Cancer Centre at Guy's Hospital, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Australian Institute for Bioengineering and Nanotechnology, University of Queensland, Brisbane City, Australia; Mater Research Centre, Brisbane, Australia; The University of Texas MD Anderson Cancer Centre, Houston
| | - S-J Sarker
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom; Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom; Ninewells Hospital, Dundee, United Kingdom; Barts Health NHS Trust, London, United Kingdom; King's College Hospital NHS Foundation Trust, London, United Kingdom; Manchester University NHS Foundation Trust, London, United Kingdom; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; Genentech, San Francisco; Breast Cancer Now Research Unit, Cancer Centre at Guy's Hospital, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Australian Institute for Bioengineering and Nanotechnology, University of Queensland, Brisbane City, Australia; Mater Research Centre, Brisbane, Australia; The University of Texas MD Anderson Cancer Centre, Houston
| | - L Lim
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom; Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom; Ninewells Hospital, Dundee, United Kingdom; Barts Health NHS Trust, London, United Kingdom; King's College Hospital NHS Foundation Trust, London, United Kingdom; Manchester University NHS Foundation Trust, London, United Kingdom; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; Genentech, San Francisco; Breast Cancer Now Research Unit, Cancer Centre at Guy's Hospital, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Australian Institute for Bioengineering and Nanotechnology, University of Queensland, Brisbane City, Australia; Mater Research Centre, Brisbane, Australia; The University of Texas MD Anderson Cancer Centre, Houston
| | - K Mousa
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom; Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom; Ninewells Hospital, Dundee, United Kingdom; Barts Health NHS Trust, London, United Kingdom; King's College Hospital NHS Foundation Trust, London, United Kingdom; Manchester University NHS Foundation Trust, London, United Kingdom; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; Genentech, San Francisco; Breast Cancer Now Research Unit, Cancer Centre at Guy's Hospital, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Australian Institute for Bioengineering and Nanotechnology, University of Queensland, Brisbane City, Australia; Mater Research Centre, Brisbane, Australia; The University of Texas MD Anderson Cancer Centre, Houston
| | - C O'Brien
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom; Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom; Ninewells Hospital, Dundee, United Kingdom; Barts Health NHS Trust, London, United Kingdom; King's College Hospital NHS Foundation Trust, London, United Kingdom; Manchester University NHS Foundation Trust, London, United Kingdom; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; Genentech, San Francisco; Breast Cancer Now Research Unit, Cancer Centre at Guy's Hospital, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Australian Institute for Bioengineering and Nanotechnology, University of Queensland, Brisbane City, Australia; Mater Research Centre, Brisbane, Australia; The University of Texas MD Anderson Cancer Centre, Houston
| | - TR Wilson
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom; Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom; Ninewells Hospital, Dundee, United Kingdom; Barts Health NHS Trust, London, United Kingdom; King's College Hospital NHS Foundation Trust, London, United Kingdom; Manchester University NHS Foundation Trust, London, United Kingdom; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; Genentech, San Francisco; Breast Cancer Now Research Unit, Cancer Centre at Guy's Hospital, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Australian Institute for Bioengineering and Nanotechnology, University of Queensland, Brisbane City, Australia; Mater Research Centre, Brisbane, Australia; The University of Texas MD Anderson Cancer Centre, Houston
| | - MR Lackner
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom; Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom; Ninewells Hospital, Dundee, United Kingdom; Barts Health NHS Trust, London, United Kingdom; King's College Hospital NHS Foundation Trust, London, United Kingdom; Manchester University NHS Foundation Trust, London, United Kingdom; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; Genentech, San Francisco; Breast Cancer Now Research Unit, Cancer Centre at Guy's Hospital, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Australian Institute for Bioengineering and Nanotechnology, University of Queensland, Brisbane City, Australia; Mater Research Centre, Brisbane, Australia; The University of Texas MD Anderson Cancer Centre, Houston
| | - S Gendreau
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom; Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom; Ninewells Hospital, Dundee, United Kingdom; Barts Health NHS Trust, London, United Kingdom; King's College Hospital NHS Foundation Trust, London, United Kingdom; Manchester University NHS Foundation Trust, London, United Kingdom; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; Genentech, San Francisco; Breast Cancer Now Research Unit, Cancer Centre at Guy's Hospital, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Australian Institute for Bioengineering and Nanotechnology, University of Queensland, Brisbane City, Australia; Mater Research Centre, Brisbane, Australia; The University of Texas MD Anderson Cancer Centre, Houston
| | - P Gazinska
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom; Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom; Ninewells Hospital, Dundee, United Kingdom; Barts Health NHS Trust, London, United Kingdom; King's College Hospital NHS Foundation Trust, London, United Kingdom; Manchester University NHS Foundation Trust, London, United Kingdom; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; Genentech, San Francisco; Breast Cancer Now Research Unit, Cancer Centre at Guy's Hospital, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Australian Institute for Bioengineering and Nanotechnology, University of Queensland, Brisbane City, Australia; Mater Research Centre, Brisbane, Australia; The University of Texas MD Anderson Cancer Centre, Houston
| | - D Korbie
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom; Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom; Ninewells Hospital, Dundee, United Kingdom; Barts Health NHS Trust, London, United Kingdom; King's College Hospital NHS Foundation Trust, London, United Kingdom; Manchester University NHS Foundation Trust, London, United Kingdom; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; Genentech, San Francisco; Breast Cancer Now Research Unit, Cancer Centre at Guy's Hospital, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Australian Institute for Bioengineering and Nanotechnology, University of Queensland, Brisbane City, Australia; Mater Research Centre, Brisbane, Australia; The University of Texas MD Anderson Cancer Centre, Houston
| | - M Trau
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom; Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom; Ninewells Hospital, Dundee, United Kingdom; Barts Health NHS Trust, London, United Kingdom; King's College Hospital NHS Foundation Trust, London, United Kingdom; Manchester University NHS Foundation Trust, London, United Kingdom; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; Genentech, San Francisco; Breast Cancer Now Research Unit, Cancer Centre at Guy's Hospital, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Australian Institute for Bioengineering and Nanotechnology, University of Queensland, Brisbane City, Australia; Mater Research Centre, Brisbane, Australia; The University of Texas MD Anderson Cancer Centre, Houston
| | - P Mainwaring
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom; Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom; Ninewells Hospital, Dundee, United Kingdom; Barts Health NHS Trust, London, United Kingdom; King's College Hospital NHS Foundation Trust, London, United Kingdom; Manchester University NHS Foundation Trust, London, United Kingdom; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; Genentech, San Francisco; Breast Cancer Now Research Unit, Cancer Centre at Guy's Hospital, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Australian Institute for Bioengineering and Nanotechnology, University of Queensland, Brisbane City, Australia; Mater Research Centre, Brisbane, Australia; The University of Texas MD Anderson Cancer Centre, Houston
| | - A Thompson
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom; Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom; Ninewells Hospital, Dundee, United Kingdom; Barts Health NHS Trust, London, United Kingdom; King's College Hospital NHS Foundation Trust, London, United Kingdom; Manchester University NHS Foundation Trust, London, United Kingdom; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; Genentech, San Francisco; Breast Cancer Now Research Unit, Cancer Centre at Guy's Hospital, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Australian Institute for Bioengineering and Nanotechnology, University of Queensland, Brisbane City, Australia; Mater Research Centre, Brisbane, Australia; The University of Texas MD Anderson Cancer Centre, Houston
| | - A Purushotham
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom; Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom; Ninewells Hospital, Dundee, United Kingdom; Barts Health NHS Trust, London, United Kingdom; King's College Hospital NHS Foundation Trust, London, United Kingdom; Manchester University NHS Foundation Trust, London, United Kingdom; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; Genentech, San Francisco; Breast Cancer Now Research Unit, Cancer Centre at Guy's Hospital, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Australian Institute for Bioengineering and Nanotechnology, University of Queensland, Brisbane City, Australia; Mater Research Centre, Brisbane, Australia; The University of Texas MD Anderson Cancer Centre, Houston
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Langford T, Barry G, Sims W, Hardin K, Fiske D, Pent G, Wilson T. 429 Effects of endophyte strain on performance of beef cows grazed on summer stockpiled tall fescue pastures. J Anim Sci 2018. [DOI: 10.1093/jas/sky404.458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- T Langford
- Department of Animal and Poultry Sciences, Virginia Tech,Blacksburg, VA, United States
| | - G Barry
- Department of Animal and Poultry Sciences, Virginia Tech,Blacksburg, VA, United States
| | - W Sims
- Department of Animal and Poultry Sciences, Virginia Tech,Blacksburg, VA, United States
| | - K Hardin
- Department of Animal and Poultry Sciences, Virginia Tech,Blacksburg, VA, United States
| | - D Fiske
- Shenandoah Valley Agricultural Research and Extension Center, Virginia Tech,Raphine, Raphine, VA, United States
| | - G Pent
- Southern Piedmont Agricultural Research and Extension Center, Virginia Tech,Blackstone, Blackstone, VA, United States
| | - T Wilson
- Department of Animal and Poultry Sciences, Virginia Tech,Blacksburg, VA, United States
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Hardin K, Langford T, Barry G, Sims W, White R, Greiner S, Fiske D, Wilson T. 56 Determining the energy value of dried corn gluten feed in forage-based beef rations. J Anim Sci 2018. [DOI: 10.1093/jas/sky404.856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- K Hardin
- Department of Animal and Poultry Sciences, Virginia Tech,Blacksburg, VA, United States
| | - T Langford
- Department of Animal and Poultry Sciences, Virginia Tech,Blacksburg, VA, United States
| | - G Barry
- Department of Animal and Poultry Sciences, Virginia Tech,Blacksburg, VA, United States
| | - W Sims
- Department of Animal and Poultry Sciences, Virginia Tech,Blacksburg, VA, United States
| | - R White
- Department of Animal and Poultry Sciences, Virginia Tech,Blacksburg, VA, United States
| | - S Greiner
- Department of Animal and Poultry Sciences, Virginia Tech,Blacksburg, VA, United States
| | - D Fiske
- Shenandoah Valley Agricultural Research and Extension Center, Virginia Tech,Raphine, Raphine, VA, United States
| | - T Wilson
- Department of Animal and Poultry Sciences, Virginia Tech,Blacksburg, VA, United States
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Wilson T, Robinson T, Macfarlane C, Spencer T, Herbert C, Braybrooke J. Stereotactic radiosurgery (SRS) for brain metastases (BM) from breast cancer (BC): A single centre experience of factors influencing survival. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy272.346] [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: 11/12/2022] Open
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Lee MJ, Sayers AE, Wilson TR, Acheson AG, Anderson ID, Fearnhead NS. Current management of small bowel obstruction in the UK: results from the National Audit of Small Bowel Obstruction clinical practice survey. Colorectal Dis 2018; 20:623-630. [PMID: 29331086 DOI: 10.1111/codi.14016] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Accepted: 12/30/2017] [Indexed: 02/08/2023]
Abstract
AIM Small bowel obstruction (SBO) is associated with high rates of morbidity and mortality. The National Audit of Small Bowel Obstruction (NASBO) is a collaboration between trainees and specialty associations to improve the care of patients with SBO through national clinical audit. The aim of this study was to define current consultant practice preferences in the management of SBO in the UK. METHOD A survey was designed to assess practice preferences of consultant surgeons. The anonymous survey captured demographics, indications for surgery or conservative management, use of investigations including water-soluble contrast agents (WSCA), use of laparoscopy and nutritional support strategies. The questionnaire underwent two pilot rounds prior to dissemination via the NASBO network. RESULTS A total of 384 responses were received from 131 NASBO participating units (overall response rate 29.2%). Abdominal CT and serum urea and electrolytes were considered essential initial investigations by more than 80% of consultants. Consensus was demonstrated on indications for early surgery and conservative management. Three hundred and thirty-eight (88%) respondents would consider use of WSCA; of these, 328 (97.1%) would use it in adhesive SBO. Two hundred (52.1%) consultants considered a laparoscopic approach when operating for SBO. Oral nutritional supplements were favoured in operatively managed patients by 259 (67.4%) respondents compared with conservatively managed patients (186 respondents, 48.4%). CONCLUSION This survey demonstrates consensus on imaging requirements and indications for early surgery in the management of SBO. Significant variation exists around awareness of the need for nutritional support in patients with SBO, and on strategies to achieve this support.
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Affiliation(s)
- M J Lee
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.,South Yorkshire Surgical Research Group, Sheffield, UK
| | - A E Sayers
- South Yorkshire Surgical Research Group, Sheffield, UK.,Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust, Doncaster, UK
| | - T R Wilson
- Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust, Doncaster, UK
| | - A G Acheson
- Nottingham University Hospitals NHS Foundation Trust, Nottingham, UK
| | | | - N S Fearnhead
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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de Azambuja E, Saura C, Nuciforo P, Frantal S, Oliveira M, Zardavas D, Jallitsch-Halper A, de la Pena L, Dubsky P, Lombard JM, Vuylsteke P, Castaneda Altamirano C, Sanchez C, Ballestrero A, Colleoni M, Santos Borges G, Ciruelos E, Bardia A, Fornier M, Boer K, Wilson TR, Stout TJ, Hsu JY, Shi Y, Piccart M, Baselga J, Gnant M. Abstract PD5-04: Ki67 changes and PEPI score in the LORELEI trial: A phase II randomized, double-blind study of neoadjuvant letrozole plus taselisib versus letrozole plus placebo in postmenopausal women with ER-positive/HER2-negative early-stage breast cancer. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-pd5-04] [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: Taselisib is an oral, potent, selective inhibitor of Class I PI3-kinase (PI3K) alpha, gamma, and delta isoforms with enhanced activity against PIK3CA mutant cancer cells. LORELEI trial demonstrated a significant improvement in ORR (objective response rate) centrally assessed by MRI with neoadjuvant taselisib plus letrozole compared to letrozole plus placebo in all randomized patients as well as in the PIK3CA mutant cohort (Saura et al, ESMO 2017).
Methods: 334 postmenopausal women with newly diagnosed ER+/HER2-, untreated, Stage I-III operable breast cancer and evaluable tumor tissue for PIK3CA genotyping were randomized (1:1) to receive daily letrozole (2.5 mg) with either taselisib (4 mg on a 5 days on/ 2 days off schedule) or placebo for 16 weeks, followed by surgery. Tumor tissue collection was performed at baseline, week 3 (W3) and at surgery. Secondary objectives included, but were not restricted to, ORR assessed by MRI in patients with PIK3CA wild type (WT) tumors, ORR using alternative methods of tumor assessment (ultrasound, mammogram and clinical breast exam) in all patients and patients with PIK3CA mutant and WT tumors, central assessment of Ki67 at different timepoints (baseline, W3 and surgery), and the centrally derived PEPI score. Central Ki67 was assessed by two independent readers blinded to treatment arms and PIK3CA status (Vall D'Hebron Institute of Oncology, Barcelona).
Results: ORR by centrally assessed MRI was similar in the two treatment arms in patients with PIK3CA WT tumors (45.7 vs 40.4% for taselisib and placebo, respectively). ORR assessed by breast US was also significantly higher with taselisib compared to placebo in all randomized patients and in the PIK3CA mutant cohort. The highest concordance rate between MRI and other imaging modalities was found with breast ultrasound (53.7%). Centrally assessed Ki67 changes are reported in Table 1. Ki67 values decreased from baseline to W3 and from baseline to surgery in both treatment arms. No significant differences in the decrease of Ki67 values between treatment arms were detected. Unplanned analysis of Complete Cell Cycle Arrest (CCCA) at W3 was numerically higher with taselisib than with placebo in all randomized patients (49.6% vs 38.5%) and in the PIK3CA mutant cohort (60.9% vs 47.5%). Due to the variability in timing between the last dose of taselisib (median time 11 days; interquartile range 6-16 days) and tissue collection at surgery, considering the half-life of taselisib of approximately 40 hours, centrally derived PEPI score is not interpretable.
Ki67 proportional changes, %Taselisib + letrozolePlacebo + letrozoleBaseline to W3All patients-83.8-80.4PIK3CA mutant-84.5-79.1PIK3CA WT-82.8-81.1Baseline to surgeryAll patients-75.6-80.5PIK3CA mutant-71.9-79.9PIK3CA WT-78.2-81.2
Conclusion: Among the investigated alternative methods for assessing ORR, breast ultrasound performed similar to MRI. Decrease in the Ki67 values from baseline to W3 and to surgery were observed in both treatment arms. The time interval between taselisib cessation and tissue collection at surgery are being further investigated.
Clinical trial information: NCT02273973
Citation Format: de Azambuja E, Saura C, Nuciforo P, Frantal S, Oliveira M, Zardavas D, Jallitsch-Halper A, de la Pena L, Dubsky P, Lombard JM, Vuylsteke P, Castaneda Altamirano C, Sanchez C, Ballestrero A, Colleoni M, Santos Borges G, Ciruelos E, Bardia A, Fornier M, Boer K, Wilson TR, Stout TJ, Hsu JY, Shi Y, Piccart M, Baselga J, Gnant M. Ki67 changes and PEPI score in the LORELEI trial: A phase II randomized, double-blind study of neoadjuvant letrozole plus taselisib versus letrozole plus placebo in postmenopausal women with ER-positive/HER2-negative early-stage breast cancer [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 PD5-04.
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Affiliation(s)
- E de Azambuja
- Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Val d'Hebron University Hospital, Institut d'Oncologia, Barcelona, Spain; Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria; Breast International Group, Brussels, Belgium; SOLTI, Barcelona, Spain; Medical University of Vienna, Vienna, Austria; ANZBCTG (Australia New Zealand Breast Cancer Trials Group) and University of Newcastle, Newcastle, Australia; EORTC BCG, CHU UCL Namur, Namur, Belgium; GECOPERU, Lima, Peru; Centro del Cancer, Pontificia Universidad Catolica de Chile, Santiago, Chile; University of Genoa-IRCCS AOU San Martino IST & GOIRC, Genova, Italy; European Institute of Oncology & International Breast Cancer Study Group, Milan, Italy; Cebtro de Novos Tratamentos Itajai, Itajai, Brazil; Hospital Universitario 12 de Octubre, Madrid, Spain; Massachusetts General Hospital & Harvard Medical School, Boston; Memorial Sloan-Kettering Cancer Center, New York; Szent Margit Hospital, Budapest, Hungary; Genentech Inc - R
| | - C Saura
- Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Val d'Hebron University Hospital, Institut d'Oncologia, Barcelona, Spain; Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria; Breast International Group, Brussels, Belgium; SOLTI, Barcelona, Spain; Medical University of Vienna, Vienna, Austria; ANZBCTG (Australia New Zealand Breast Cancer Trials Group) and University of Newcastle, Newcastle, Australia; EORTC BCG, CHU UCL Namur, Namur, Belgium; GECOPERU, Lima, Peru; Centro del Cancer, Pontificia Universidad Catolica de Chile, Santiago, Chile; University of Genoa-IRCCS AOU San Martino IST & GOIRC, Genova, Italy; European Institute of Oncology & International Breast Cancer Study Group, Milan, Italy; Cebtro de Novos Tratamentos Itajai, Itajai, Brazil; Hospital Universitario 12 de Octubre, Madrid, Spain; Massachusetts General Hospital & Harvard Medical School, Boston; Memorial Sloan-Kettering Cancer Center, New York; Szent Margit Hospital, Budapest, Hungary; Genentech Inc - R
| | - P Nuciforo
- Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Val d'Hebron University Hospital, Institut d'Oncologia, Barcelona, Spain; Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria; Breast International Group, Brussels, Belgium; SOLTI, Barcelona, Spain; Medical University of Vienna, Vienna, Austria; ANZBCTG (Australia New Zealand Breast Cancer Trials Group) and University of Newcastle, Newcastle, Australia; EORTC BCG, CHU UCL Namur, Namur, Belgium; GECOPERU, Lima, Peru; Centro del Cancer, Pontificia Universidad Catolica de Chile, Santiago, Chile; University of Genoa-IRCCS AOU San Martino IST & GOIRC, Genova, Italy; European Institute of Oncology & International Breast Cancer Study Group, Milan, Italy; Cebtro de Novos Tratamentos Itajai, Itajai, Brazil; Hospital Universitario 12 de Octubre, Madrid, Spain; Massachusetts General Hospital & Harvard Medical School, Boston; Memorial Sloan-Kettering Cancer Center, New York; Szent Margit Hospital, Budapest, Hungary; Genentech Inc - R
| | - S Frantal
- Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Val d'Hebron University Hospital, Institut d'Oncologia, Barcelona, Spain; Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria; Breast International Group, Brussels, Belgium; SOLTI, Barcelona, Spain; Medical University of Vienna, Vienna, Austria; ANZBCTG (Australia New Zealand Breast Cancer Trials Group) and University of Newcastle, Newcastle, Australia; EORTC BCG, CHU UCL Namur, Namur, Belgium; GECOPERU, Lima, Peru; Centro del Cancer, Pontificia Universidad Catolica de Chile, Santiago, Chile; University of Genoa-IRCCS AOU San Martino IST & GOIRC, Genova, Italy; European Institute of Oncology & International Breast Cancer Study Group, Milan, Italy; Cebtro de Novos Tratamentos Itajai, Itajai, Brazil; Hospital Universitario 12 de Octubre, Madrid, Spain; Massachusetts General Hospital & Harvard Medical School, Boston; Memorial Sloan-Kettering Cancer Center, New York; Szent Margit Hospital, Budapest, Hungary; Genentech Inc - R
| | - M Oliveira
- Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Val d'Hebron University Hospital, Institut d'Oncologia, Barcelona, Spain; Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria; Breast International Group, Brussels, Belgium; SOLTI, Barcelona, Spain; Medical University of Vienna, Vienna, Austria; ANZBCTG (Australia New Zealand Breast Cancer Trials Group) and University of Newcastle, Newcastle, Australia; EORTC BCG, CHU UCL Namur, Namur, Belgium; GECOPERU, Lima, Peru; Centro del Cancer, Pontificia Universidad Catolica de Chile, Santiago, Chile; University of Genoa-IRCCS AOU San Martino IST & GOIRC, Genova, Italy; European Institute of Oncology & International Breast Cancer Study Group, Milan, Italy; Cebtro de Novos Tratamentos Itajai, Itajai, Brazil; Hospital Universitario 12 de Octubre, Madrid, Spain; Massachusetts General Hospital & Harvard Medical School, Boston; Memorial Sloan-Kettering Cancer Center, New York; Szent Margit Hospital, Budapest, Hungary; Genentech Inc - R
| | - D Zardavas
- Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Val d'Hebron University Hospital, Institut d'Oncologia, Barcelona, Spain; Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria; Breast International Group, Brussels, Belgium; SOLTI, Barcelona, Spain; Medical University of Vienna, Vienna, Austria; ANZBCTG (Australia New Zealand Breast Cancer Trials Group) and University of Newcastle, Newcastle, Australia; EORTC BCG, CHU UCL Namur, Namur, Belgium; GECOPERU, Lima, Peru; Centro del Cancer, Pontificia Universidad Catolica de Chile, Santiago, Chile; University of Genoa-IRCCS AOU San Martino IST & GOIRC, Genova, Italy; European Institute of Oncology & International Breast Cancer Study Group, Milan, Italy; Cebtro de Novos Tratamentos Itajai, Itajai, Brazil; Hospital Universitario 12 de Octubre, Madrid, Spain; Massachusetts General Hospital & Harvard Medical School, Boston; Memorial Sloan-Kettering Cancer Center, New York; Szent Margit Hospital, Budapest, Hungary; Genentech Inc - R
| | - A Jallitsch-Halper
- Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Val d'Hebron University Hospital, Institut d'Oncologia, Barcelona, Spain; Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria; Breast International Group, Brussels, Belgium; SOLTI, Barcelona, Spain; Medical University of Vienna, Vienna, Austria; ANZBCTG (Australia New Zealand Breast Cancer Trials Group) and University of Newcastle, Newcastle, Australia; EORTC BCG, CHU UCL Namur, Namur, Belgium; GECOPERU, Lima, Peru; Centro del Cancer, Pontificia Universidad Catolica de Chile, Santiago, Chile; University of Genoa-IRCCS AOU San Martino IST & GOIRC, Genova, Italy; European Institute of Oncology & International Breast Cancer Study Group, Milan, Italy; Cebtro de Novos Tratamentos Itajai, Itajai, Brazil; Hospital Universitario 12 de Octubre, Madrid, Spain; Massachusetts General Hospital & Harvard Medical School, Boston; Memorial Sloan-Kettering Cancer Center, New York; Szent Margit Hospital, Budapest, Hungary; Genentech Inc - R
| | - L de la Pena
- Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Val d'Hebron University Hospital, Institut d'Oncologia, Barcelona, Spain; Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria; Breast International Group, Brussels, Belgium; SOLTI, Barcelona, Spain; Medical University of Vienna, Vienna, Austria; ANZBCTG (Australia New Zealand Breast Cancer Trials Group) and University of Newcastle, Newcastle, Australia; EORTC BCG, CHU UCL Namur, Namur, Belgium; GECOPERU, Lima, Peru; Centro del Cancer, Pontificia Universidad Catolica de Chile, Santiago, Chile; University of Genoa-IRCCS AOU San Martino IST & GOIRC, Genova, Italy; European Institute of Oncology & International Breast Cancer Study Group, Milan, Italy; Cebtro de Novos Tratamentos Itajai, Itajai, Brazil; Hospital Universitario 12 de Octubre, Madrid, Spain; Massachusetts General Hospital & Harvard Medical School, Boston; Memorial Sloan-Kettering Cancer Center, New York; Szent Margit Hospital, Budapest, Hungary; Genentech Inc - R
| | - P Dubsky
- Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Val d'Hebron University Hospital, Institut d'Oncologia, Barcelona, Spain; Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria; Breast International Group, Brussels, Belgium; SOLTI, Barcelona, Spain; Medical University of Vienna, Vienna, Austria; ANZBCTG (Australia New Zealand Breast Cancer Trials Group) and University of Newcastle, Newcastle, Australia; EORTC BCG, CHU UCL Namur, Namur, Belgium; GECOPERU, Lima, Peru; Centro del Cancer, Pontificia Universidad Catolica de Chile, Santiago, Chile; University of Genoa-IRCCS AOU San Martino IST & GOIRC, Genova, Italy; European Institute of Oncology & International Breast Cancer Study Group, Milan, Italy; Cebtro de Novos Tratamentos Itajai, Itajai, Brazil; Hospital Universitario 12 de Octubre, Madrid, Spain; Massachusetts General Hospital & Harvard Medical School, Boston; Memorial Sloan-Kettering Cancer Center, New York; Szent Margit Hospital, Budapest, Hungary; Genentech Inc - R
| | - JM Lombard
- Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Val d'Hebron University Hospital, Institut d'Oncologia, Barcelona, Spain; Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria; Breast International Group, Brussels, Belgium; SOLTI, Barcelona, Spain; Medical University of Vienna, Vienna, Austria; ANZBCTG (Australia New Zealand Breast Cancer Trials Group) and University of Newcastle, Newcastle, Australia; EORTC BCG, CHU UCL Namur, Namur, Belgium; GECOPERU, Lima, Peru; Centro del Cancer, Pontificia Universidad Catolica de Chile, Santiago, Chile; University of Genoa-IRCCS AOU San Martino IST & GOIRC, Genova, Italy; European Institute of Oncology & International Breast Cancer Study Group, Milan, Italy; Cebtro de Novos Tratamentos Itajai, Itajai, Brazil; Hospital Universitario 12 de Octubre, Madrid, Spain; Massachusetts General Hospital & Harvard Medical School, Boston; Memorial Sloan-Kettering Cancer Center, New York; Szent Margit Hospital, Budapest, Hungary; Genentech Inc - R
| | - P Vuylsteke
- Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Val d'Hebron University Hospital, Institut d'Oncologia, Barcelona, Spain; Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria; Breast International Group, Brussels, Belgium; SOLTI, Barcelona, Spain; Medical University of Vienna, Vienna, Austria; ANZBCTG (Australia New Zealand Breast Cancer Trials Group) and University of Newcastle, Newcastle, Australia; EORTC BCG, CHU UCL Namur, Namur, Belgium; GECOPERU, Lima, Peru; Centro del Cancer, Pontificia Universidad Catolica de Chile, Santiago, Chile; University of Genoa-IRCCS AOU San Martino IST & GOIRC, Genova, Italy; European Institute of Oncology & International Breast Cancer Study Group, Milan, Italy; Cebtro de Novos Tratamentos Itajai, Itajai, Brazil; Hospital Universitario 12 de Octubre, Madrid, Spain; Massachusetts General Hospital & Harvard Medical School, Boston; Memorial Sloan-Kettering Cancer Center, New York; Szent Margit Hospital, Budapest, Hungary; Genentech Inc - R
| | - C Castaneda Altamirano
- Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Val d'Hebron University Hospital, Institut d'Oncologia, Barcelona, Spain; Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria; Breast International Group, Brussels, Belgium; SOLTI, Barcelona, Spain; Medical University of Vienna, Vienna, Austria; ANZBCTG (Australia New Zealand Breast Cancer Trials Group) and University of Newcastle, Newcastle, Australia; EORTC BCG, CHU UCL Namur, Namur, Belgium; GECOPERU, Lima, Peru; Centro del Cancer, Pontificia Universidad Catolica de Chile, Santiago, Chile; University of Genoa-IRCCS AOU San Martino IST & GOIRC, Genova, Italy; European Institute of Oncology & International Breast Cancer Study Group, Milan, Italy; Cebtro de Novos Tratamentos Itajai, Itajai, Brazil; Hospital Universitario 12 de Octubre, Madrid, Spain; Massachusetts General Hospital & Harvard Medical School, Boston; Memorial Sloan-Kettering Cancer Center, New York; Szent Margit Hospital, Budapest, Hungary; Genentech Inc - R
| | - C Sanchez
- Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Val d'Hebron University Hospital, Institut d'Oncologia, Barcelona, Spain; Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria; Breast International Group, Brussels, Belgium; SOLTI, Barcelona, Spain; Medical University of Vienna, Vienna, Austria; ANZBCTG (Australia New Zealand Breast Cancer Trials Group) and University of Newcastle, Newcastle, Australia; EORTC BCG, CHU UCL Namur, Namur, Belgium; GECOPERU, Lima, Peru; Centro del Cancer, Pontificia Universidad Catolica de Chile, Santiago, Chile; University of Genoa-IRCCS AOU San Martino IST & GOIRC, Genova, Italy; European Institute of Oncology & International Breast Cancer Study Group, Milan, Italy; Cebtro de Novos Tratamentos Itajai, Itajai, Brazil; Hospital Universitario 12 de Octubre, Madrid, Spain; Massachusetts General Hospital & Harvard Medical School, Boston; Memorial Sloan-Kettering Cancer Center, New York; Szent Margit Hospital, Budapest, Hungary; Genentech Inc - R
| | - A Ballestrero
- Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Val d'Hebron University Hospital, Institut d'Oncologia, Barcelona, Spain; Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria; Breast International Group, Brussels, Belgium; SOLTI, Barcelona, Spain; Medical University of Vienna, Vienna, Austria; ANZBCTG (Australia New Zealand Breast Cancer Trials Group) and University of Newcastle, Newcastle, Australia; EORTC BCG, CHU UCL Namur, Namur, Belgium; GECOPERU, Lima, Peru; Centro del Cancer, Pontificia Universidad Catolica de Chile, Santiago, Chile; University of Genoa-IRCCS AOU San Martino IST & GOIRC, Genova, Italy; European Institute of Oncology & International Breast Cancer Study Group, Milan, Italy; Cebtro de Novos Tratamentos Itajai, Itajai, Brazil; Hospital Universitario 12 de Octubre, Madrid, Spain; Massachusetts General Hospital & Harvard Medical School, Boston; Memorial Sloan-Kettering Cancer Center, New York; Szent Margit Hospital, Budapest, Hungary; Genentech Inc - R
| | - M Colleoni
- Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Val d'Hebron University Hospital, Institut d'Oncologia, Barcelona, Spain; Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria; Breast International Group, Brussels, Belgium; SOLTI, Barcelona, Spain; Medical University of Vienna, Vienna, Austria; ANZBCTG (Australia New Zealand Breast Cancer Trials Group) and University of Newcastle, Newcastle, Australia; EORTC BCG, CHU UCL Namur, Namur, Belgium; GECOPERU, Lima, Peru; Centro del Cancer, Pontificia Universidad Catolica de Chile, Santiago, Chile; University of Genoa-IRCCS AOU San Martino IST & GOIRC, Genova, Italy; European Institute of Oncology & International Breast Cancer Study Group, Milan, Italy; Cebtro de Novos Tratamentos Itajai, Itajai, Brazil; Hospital Universitario 12 de Octubre, Madrid, Spain; Massachusetts General Hospital & Harvard Medical School, Boston; Memorial Sloan-Kettering Cancer Center, New York; Szent Margit Hospital, Budapest, Hungary; Genentech Inc - R
| | - G Santos Borges
- Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Val d'Hebron University Hospital, Institut d'Oncologia, Barcelona, Spain; Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria; Breast International Group, Brussels, Belgium; SOLTI, Barcelona, Spain; Medical University of Vienna, Vienna, Austria; ANZBCTG (Australia New Zealand Breast Cancer Trials Group) and University of Newcastle, Newcastle, Australia; EORTC BCG, CHU UCL Namur, Namur, Belgium; GECOPERU, Lima, Peru; Centro del Cancer, Pontificia Universidad Catolica de Chile, Santiago, Chile; University of Genoa-IRCCS AOU San Martino IST & GOIRC, Genova, Italy; European Institute of Oncology & International Breast Cancer Study Group, Milan, Italy; Cebtro de Novos Tratamentos Itajai, Itajai, Brazil; Hospital Universitario 12 de Octubre, Madrid, Spain; Massachusetts General Hospital & Harvard Medical School, Boston; Memorial Sloan-Kettering Cancer Center, New York; Szent Margit Hospital, Budapest, Hungary; Genentech Inc - R
| | - E Ciruelos
- Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Val d'Hebron University Hospital, Institut d'Oncologia, Barcelona, Spain; Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria; Breast International Group, Brussels, Belgium; SOLTI, Barcelona, Spain; Medical University of Vienna, Vienna, Austria; ANZBCTG (Australia New Zealand Breast Cancer Trials Group) and University of Newcastle, Newcastle, Australia; EORTC BCG, CHU UCL Namur, Namur, Belgium; GECOPERU, Lima, Peru; Centro del Cancer, Pontificia Universidad Catolica de Chile, Santiago, Chile; University of Genoa-IRCCS AOU San Martino IST & GOIRC, Genova, Italy; European Institute of Oncology & International Breast Cancer Study Group, Milan, Italy; Cebtro de Novos Tratamentos Itajai, Itajai, Brazil; Hospital Universitario 12 de Octubre, Madrid, Spain; Massachusetts General Hospital & Harvard Medical School, Boston; Memorial Sloan-Kettering Cancer Center, New York; Szent Margit Hospital, Budapest, Hungary; Genentech Inc - R
| | - A Bardia
- Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Val d'Hebron University Hospital, Institut d'Oncologia, Barcelona, Spain; Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria; Breast International Group, Brussels, Belgium; SOLTI, Barcelona, Spain; Medical University of Vienna, Vienna, Austria; ANZBCTG (Australia New Zealand Breast Cancer Trials Group) and University of Newcastle, Newcastle, Australia; EORTC BCG, CHU UCL Namur, Namur, Belgium; GECOPERU, Lima, Peru; Centro del Cancer, Pontificia Universidad Catolica de Chile, Santiago, Chile; University of Genoa-IRCCS AOU San Martino IST & GOIRC, Genova, Italy; European Institute of Oncology & International Breast Cancer Study Group, Milan, Italy; Cebtro de Novos Tratamentos Itajai, Itajai, Brazil; Hospital Universitario 12 de Octubre, Madrid, Spain; Massachusetts General Hospital & Harvard Medical School, Boston; Memorial Sloan-Kettering Cancer Center, New York; Szent Margit Hospital, Budapest, Hungary; Genentech Inc - R
| | - M Fornier
- Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Val d'Hebron University Hospital, Institut d'Oncologia, Barcelona, Spain; Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria; Breast International Group, Brussels, Belgium; SOLTI, Barcelona, Spain; Medical University of Vienna, Vienna, Austria; ANZBCTG (Australia New Zealand Breast Cancer Trials Group) and University of Newcastle, Newcastle, Australia; EORTC BCG, CHU UCL Namur, Namur, Belgium; GECOPERU, Lima, Peru; Centro del Cancer, Pontificia Universidad Catolica de Chile, Santiago, Chile; University of Genoa-IRCCS AOU San Martino IST & GOIRC, Genova, Italy; European Institute of Oncology & International Breast Cancer Study Group, Milan, Italy; Cebtro de Novos Tratamentos Itajai, Itajai, Brazil; Hospital Universitario 12 de Octubre, Madrid, Spain; Massachusetts General Hospital & Harvard Medical School, Boston; Memorial Sloan-Kettering Cancer Center, New York; Szent Margit Hospital, Budapest, Hungary; Genentech Inc - R
| | - K Boer
- Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Val d'Hebron University Hospital, Institut d'Oncologia, Barcelona, Spain; Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria; Breast International Group, Brussels, Belgium; SOLTI, Barcelona, Spain; Medical University of Vienna, Vienna, Austria; ANZBCTG (Australia New Zealand Breast Cancer Trials Group) and University of Newcastle, Newcastle, Australia; EORTC BCG, CHU UCL Namur, Namur, Belgium; GECOPERU, Lima, Peru; Centro del Cancer, Pontificia Universidad Catolica de Chile, Santiago, Chile; University of Genoa-IRCCS AOU San Martino IST & GOIRC, Genova, Italy; European Institute of Oncology & International Breast Cancer Study Group, Milan, Italy; Cebtro de Novos Tratamentos Itajai, Itajai, Brazil; Hospital Universitario 12 de Octubre, Madrid, Spain; Massachusetts General Hospital & Harvard Medical School, Boston; Memorial Sloan-Kettering Cancer Center, New York; Szent Margit Hospital, Budapest, Hungary; Genentech Inc - R
| | - TR Wilson
- Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Val d'Hebron University Hospital, Institut d'Oncologia, Barcelona, Spain; Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria; Breast International Group, Brussels, Belgium; SOLTI, Barcelona, Spain; Medical University of Vienna, Vienna, Austria; ANZBCTG (Australia New Zealand Breast Cancer Trials Group) and University of Newcastle, Newcastle, Australia; EORTC BCG, CHU UCL Namur, Namur, Belgium; GECOPERU, Lima, Peru; Centro del Cancer, Pontificia Universidad Catolica de Chile, Santiago, Chile; University of Genoa-IRCCS AOU San Martino IST & GOIRC, Genova, Italy; European Institute of Oncology & International Breast Cancer Study Group, Milan, Italy; Cebtro de Novos Tratamentos Itajai, Itajai, Brazil; Hospital Universitario 12 de Octubre, Madrid, Spain; Massachusetts General Hospital & Harvard Medical School, Boston; Memorial Sloan-Kettering Cancer Center, New York; Szent Margit Hospital, Budapest, Hungary; Genentech Inc - R
| | - TJ Stout
- Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Val d'Hebron University Hospital, Institut d'Oncologia, Barcelona, Spain; Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria; Breast International Group, Brussels, Belgium; SOLTI, Barcelona, Spain; Medical University of Vienna, Vienna, Austria; ANZBCTG (Australia New Zealand Breast Cancer Trials Group) and University of Newcastle, Newcastle, Australia; EORTC BCG, CHU UCL Namur, Namur, Belgium; GECOPERU, Lima, Peru; Centro del Cancer, Pontificia Universidad Catolica de Chile, Santiago, Chile; University of Genoa-IRCCS AOU San Martino IST & GOIRC, Genova, Italy; European Institute of Oncology & International Breast Cancer Study Group, Milan, Italy; Cebtro de Novos Tratamentos Itajai, Itajai, Brazil; Hospital Universitario 12 de Octubre, Madrid, Spain; Massachusetts General Hospital & Harvard Medical School, Boston; Memorial Sloan-Kettering Cancer Center, New York; Szent Margit Hospital, Budapest, Hungary; Genentech Inc - R
| | - JY Hsu
- Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Val d'Hebron University Hospital, Institut d'Oncologia, Barcelona, Spain; Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria; Breast International Group, Brussels, Belgium; SOLTI, Barcelona, Spain; Medical University of Vienna, Vienna, Austria; ANZBCTG (Australia New Zealand Breast Cancer Trials Group) and University of Newcastle, Newcastle, Australia; EORTC BCG, CHU UCL Namur, Namur, Belgium; GECOPERU, Lima, Peru; Centro del Cancer, Pontificia Universidad Catolica de Chile, Santiago, Chile; University of Genoa-IRCCS AOU San Martino IST & GOIRC, Genova, Italy; European Institute of Oncology & International Breast Cancer Study Group, Milan, Italy; Cebtro de Novos Tratamentos Itajai, Itajai, Brazil; Hospital Universitario 12 de Octubre, Madrid, Spain; Massachusetts General Hospital & Harvard Medical School, Boston; Memorial Sloan-Kettering Cancer Center, New York; Szent Margit Hospital, Budapest, Hungary; Genentech Inc - R
| | - Y Shi
- Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Val d'Hebron University Hospital, Institut d'Oncologia, Barcelona, Spain; Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria; Breast International Group, Brussels, Belgium; SOLTI, Barcelona, Spain; Medical University of Vienna, Vienna, Austria; ANZBCTG (Australia New Zealand Breast Cancer Trials Group) and University of Newcastle, Newcastle, Australia; EORTC BCG, CHU UCL Namur, Namur, Belgium; GECOPERU, Lima, Peru; Centro del Cancer, Pontificia Universidad Catolica de Chile, Santiago, Chile; University of Genoa-IRCCS AOU San Martino IST & GOIRC, Genova, Italy; European Institute of Oncology & International Breast Cancer Study Group, Milan, Italy; Cebtro de Novos Tratamentos Itajai, Itajai, Brazil; Hospital Universitario 12 de Octubre, Madrid, Spain; Massachusetts General Hospital & Harvard Medical School, Boston; Memorial Sloan-Kettering Cancer Center, New York; Szent Margit Hospital, Budapest, Hungary; Genentech Inc - R
| | - M Piccart
- Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Val d'Hebron University Hospital, Institut d'Oncologia, Barcelona, Spain; Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria; Breast International Group, Brussels, Belgium; SOLTI, Barcelona, Spain; Medical University of Vienna, Vienna, Austria; ANZBCTG (Australia New Zealand Breast Cancer Trials Group) and University of Newcastle, Newcastle, Australia; EORTC BCG, CHU UCL Namur, Namur, Belgium; GECOPERU, Lima, Peru; Centro del Cancer, Pontificia Universidad Catolica de Chile, Santiago, Chile; University of Genoa-IRCCS AOU San Martino IST & GOIRC, Genova, Italy; European Institute of Oncology & International Breast Cancer Study Group, Milan, Italy; Cebtro de Novos Tratamentos Itajai, Itajai, Brazil; Hospital Universitario 12 de Octubre, Madrid, Spain; Massachusetts General Hospital & Harvard Medical School, Boston; Memorial Sloan-Kettering Cancer Center, New York; Szent Margit Hospital, Budapest, Hungary; Genentech Inc - R
| | - J Baselga
- Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Val d'Hebron University Hospital, Institut d'Oncologia, Barcelona, Spain; Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria; Breast International Group, Brussels, Belgium; SOLTI, Barcelona, Spain; Medical University of Vienna, Vienna, Austria; ANZBCTG (Australia New Zealand Breast Cancer Trials Group) and University of Newcastle, Newcastle, Australia; EORTC BCG, CHU UCL Namur, Namur, Belgium; GECOPERU, Lima, Peru; Centro del Cancer, Pontificia Universidad Catolica de Chile, Santiago, Chile; University of Genoa-IRCCS AOU San Martino IST & GOIRC, Genova, Italy; European Institute of Oncology & International Breast Cancer Study Group, Milan, Italy; Cebtro de Novos Tratamentos Itajai, Itajai, Brazil; Hospital Universitario 12 de Octubre, Madrid, Spain; Massachusetts General Hospital & Harvard Medical School, Boston; Memorial Sloan-Kettering Cancer Center, New York; Szent Margit Hospital, Budapest, Hungary; Genentech Inc - R
| | - M Gnant
- Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Val d'Hebron University Hospital, Institut d'Oncologia, Barcelona, Spain; Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria; Breast International Group, Brussels, Belgium; SOLTI, Barcelona, Spain; Medical University of Vienna, Vienna, Austria; ANZBCTG (Australia New Zealand Breast Cancer Trials Group) and University of Newcastle, Newcastle, Australia; EORTC BCG, CHU UCL Namur, Namur, Belgium; GECOPERU, Lima, Peru; Centro del Cancer, Pontificia Universidad Catolica de Chile, Santiago, Chile; University of Genoa-IRCCS AOU San Martino IST & GOIRC, Genova, Italy; European Institute of Oncology & International Breast Cancer Study Group, Milan, Italy; Cebtro de Novos Tratamentos Itajai, Itajai, Brazil; Hospital Universitario 12 de Octubre, Madrid, Spain; Massachusetts General Hospital & Harvard Medical School, Boston; Memorial Sloan-Kettering Cancer Center, New York; Szent Margit Hospital, Budapest, Hungary; Genentech Inc - R
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Fumagalli D, Wilson TR, Salgado R, Lu X, Yu J, O'Brien C, Walter K, Huw LY, Criscitiello C, Laios I, Jose V, Brown DN, Rothé F, Maetens M, Zardavas D, Savas P, Larsimont D, Piccart-Gebhart MJ, Michiels S, Lackner MR, Sotiriou C, Loi S. Somatic mutation, copy number and transcriptomic profiles of primary and matched metastatic estrogen receptor-positive breast cancers. Ann Oncol 2017; 27:1860-6. [PMID: 27672107 DOI: 10.1093/annonc/mdw286] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 07/14/2016] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Estrogen receptor-positive (ER+) breast cancers (BCs) constitute the most frequent BC subtype. The molecular landscape of ER+ relapsed disease is not well characterized. In this study, we aimed to describe the genomic evolution between primary (P) and matched metastatic (M) ER+ BCs after failure of adjuvant therapy. MATERIALS AND METHODS A total of 182 ER+ metastatic BC patients with long-term follow-up were identified from a single institution. P tumor tissue was available for all patients, with 88 having matched M material. According to the availability of tumor material, samples were characterized using a 120 mutational hotspot qPCR, a 29 gene copy number aberrations (CNA) and a 400 gene expression panels. ESR1 mutations were assayed by droplet digital PCR. Molecular alterations were correlated with overall survival (OS) using the Cox proportional hazards regression models. RESULTS The median follow-up was 6.4 years (range 0.5-26.6 years). Genomic analysis of P tumors revealed somatic mutations in PIK3CA, KRAS, AKT1, FGFR3, HRAS and BRAF at frequencies of 41%, 6%, 5%, 2%, 1% and 2%, respectively, and CN amplification of CCND1, ZNF703, FGFR1, RSF1 and PAK1 at 23%, 19%, 17%, 12% and 11%, respectively. Mutations and CN amplifications were largely concordant between P and matched M (>84%). ESR1 mutations were found in 10.8% of the M but none of the P. Thirteen genes, among which ESR1, FOXA1, and HIF1A, showed significant differential expression between P and M. In P, the differential expression of 18 genes, among which IDO1, was significantly associated with OS (FDR < 0.1). CONCLUSIONS Despite the large concordance between P and matched M for the evaluated molecular alterations, potential actionable targets such as ESR1 mutations were found only in M. This supports the importance of characterizing the M disease. Other targets we identified, such as HIF1A and IDO1, warrant further investigation in this patient population.
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Affiliation(s)
- D Fumagalli
- Breast Cancer Translational Research Laboratory, Institut Jules Bordet, Free University of Bruxelles, Brussels, Belgium
| | - T R Wilson
- Oncology Biomarker Development, Genentech Inc., South San Francisco, CA, USA
| | - R Salgado
- Breast Cancer Translational Research Laboratory, Institut Jules Bordet, Free University of Bruxelles, Brussels, Belgium
| | - X Lu
- Department of Biostatistics, Genentech Inc., South San Francisco, CA, USA
| | - J Yu
- Department of Biostatistics, Genentech Inc., South San Francisco, CA, USA
| | - C O'Brien
- Oncology Biomarker Development, Genentech Inc., South San Francisco, CA, USA
| | - K Walter
- Oncology Biomarker Development, Genentech Inc., South San Francisco, CA, USA
| | - L Y Huw
- Oncology Biomarker Development, Genentech Inc., South San Francisco, CA, USA
| | - C Criscitiello
- Division of Early Drug Development for Innovative Therapies, European Institute of Oncology, Milan, Italy
| | - I Laios
- Department of Pathology, Institut Jules Bordet, Brussels, Belgium
| | - V Jose
- Breast Cancer Translational Research Laboratory, Institut Jules Bordet, Free University of Bruxelles, Brussels, Belgium
| | - D N Brown
- Breast Cancer Translational Research Laboratory, Institut Jules Bordet, Free University of Bruxelles, Brussels, Belgium
| | - F Rothé
- Breast Cancer Translational Research Laboratory, Institut Jules Bordet, Free University of Bruxelles, Brussels, Belgium
| | - M Maetens
- Breast Cancer Translational Research Laboratory, Institut Jules Bordet, Free University of Bruxelles, Brussels, Belgium
| | - D Zardavas
- Breast International Group, Brussels, Belgium
| | - P Savas
- Division of Clinical Medicine and Research, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
| | - D Larsimont
- Department of Pathology, Institut Jules Bordet, Brussels, Belgium
| | | | - S Michiels
- Division of Biostatistics and Epidemiology, Institut Gustave Roussy, Villejuif, France INSERM U1018, CESP, University of Paris, Villejuif, France
| | - M R Lackner
- Oncology Biomarker Development, Genentech Inc., South San Francisco, CA, USA
| | - C Sotiriou
- Breast Cancer Translational Research Laboratory, Institut Jules Bordet, Free University of Bruxelles, Brussels, Belgium Division of Medical Oncology, Institut Jules Bordet, Brussels, Belgium
| | - S Loi
- Division of Clinical Medicine and Research, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
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Lee M, Sayers A, Fearnhead N, Wilson T. Survey on Management of Small Bowel Obstruction in the UK. Int J Surg 2017. [DOI: 10.1016/j.ijsu.2017.08.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Kriesel JD, Bhetariya PJ, Chan BK, Wilson T, Fischer KF. Enrichment of Retroviral Sequences in Brain Tissue from Patients with Severe Demyelinating Diseases. ACTA ACUST UNITED AC 2017; 3. [PMID: 29202119 PMCID: PMC5707126 DOI: 10.16966/2473-1846.132] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Background Our group has used deep sequencing to identify viral RNA signatures in human brain specimens. We have previously used this method to detect HSV1, GBV-C, and measles virus sequence in brain tissue from deceased donors. Deep sequencing was performed on brain specimens from a cohort of patients who died with progressive forms of MS, revealing evidence of increased expression of some human endogenous retrovirus (HERV) domains. Objectives Identify RNA sequences and new antigens involved in the pathogenesis of MS Methods Deep sequencing was performed on RNA extracted from 12 progressive MS, 2 neuromyelitis optica (MS/NMO = demyelination group), 14 normal control, and 7 other neurologic disease (OND) control frozen brain specimens. The resulting single-ended 50 bp sequences (reads) were compared to a non redundant viral database representing (NRVDB) all 1.2 M viral records in GenBank. A retroviral gene catalog (RVGC) was prepared by identifying human genetic loci (GRCh37.p13) homologous to domains contained in the Gypsy 2.0 retro element database. Reads were aligned to the RVGC and human transcriptome with Bowtie2. The resulting viral hit rates (VHRs) were normalized by the number of high quality reads. The expression of human genes, including HERVs, was determined using Cufflinks. Comparisons between the groups were performed using the false discovery rate. Results Fifty to 131 million high quality reads per specimen were obtained. Comparison of the reads to the NRVDB suggested that the demyelination and OND specimens had higher VHRs against some retroviral sequences compared with the controls. This was confirmed by retroviral domain averaging. Gene expression analysis showed differential expression among some HERV sequences. Single read mapping revealed one envelope and one reverse transcriptase sequence record that were significantly enriched among the demyelination samples compared to the normal controls. Less restrictive (comprehensive) read mapping showed that 2 integrase, 2 core, 2 envelope, and 3 KRAB sequences that were overexpressed in the demyelination group. Conclusions These data demonstrate that some endogenous retroviral sequences are significantly overexpressed in these demyelination brain tissue specimens, but the magnitude of this overexpression is small. This is consistent with the concept of HERV activation as a part of the innate immune response.
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Affiliation(s)
- J D Kriesel
- Department of Internal Medicine, Division of Infectious Diseases, USA
| | - P J Bhetariya
- Department of Internal Medicine, Division of Infectious Diseases, USA
| | - B K Chan
- Yale University, Department of Ecology and Evolutionary Biology, New Haven, Connecticut, USA
| | - T Wilson
- Department of Pathology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - K F Fischer
- Department of Pathology, University of Utah School of Medicine, Salt Lake City, Utah, USA
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Ansite J, Balamurugan AN, Barbaro B, Battle J, Brandhorst D, Cano J, Chen X, Deng S, Feddersen D, Friberg A, Gilmore T, Goldstein JS, Holbrook E, Khan A, Kin T, Lei J, Linetsky E, Liu C, Luo X, McElvaney K, Min Z, Moreno J, O'Gorman D, Papas KK, Putz G, Ricordi C, Szot G, Templeton T, Wang L, Wilhelm JJ, Willits J, Wilson T, Zhang X, Avila J, Begley B, Cano J, Carpentier S, Holbrook E, Hutchinson J, Larsen CP, Moreno J, Sears M, Turgeon NA, Webster D, Deng S, Lei J, Markmann JF, Bridges ND, Czarniecki CW, Goldstein JS, Putz G, Templeton T, Wilson T, Eggerman TL, Al-Saden P, Battle J, Chen X, Hecyk A, Kissler H, Luo X, Molitch M, Monson N, Stuart E, Wallia A, Wang L, Wang S, Zhang X, Bigam D, Campbell P, Dinyari P, Kin T, Kneteman N, Lyon J, Malcolm A, O'Gorman D, Onderka C, Owen R, Pawlick R, Richer B, Rosichuk S, Sarman D, Schroeder A, Senior PA, Shapiro AMJ, Toth L, Toth V, Zhai W, Johnson K, McElroy J, Posselt AM, Ramos M, Rojas T, Stock PG, Szot G, Barbaro B, Martellotto J, Oberholzer J, Qi M, Wang Y, Bayman L, Chaloner K, Clarke W, Dillon JS, Diltz C, Doelle GC, Ecklund D, Feddersen D, Foster E, Hunsicker LG, Jasperson C, Lafontant DE, McElvaney K, Neill-Hudson T, Nollen D, Qidwai J, Riss H, Schwieger T, Willits J, Yankey J, Alejandro R, Corrales AC, Faradji R, Froud T, Garcia AA, Herrada E, Ichii H, Inverardi L, Kenyon N, Khan A, Linetsky E, Montelongo J, Peixoto E, Peterson K, Ricordi C, Szust J, Wang X, Abdulla MH, Ansite J, Balamurugan AN, Bellin MD, Brandenburg M, Gilmore T, Harmon JV, Hering BJ, Kandaswamy R, Loganathan G, Mueller K, Papas KK, Pedersen J, Wilhelm JJ, Witson J, Dalton-Bakes C, Fu H, Kamoun M, Kearns J, Li Y, Liu C, Luning-Prak E, Luo Y, Markmann E, Min Z, Naji A, Palanjian M, Rickels M, Shlansky-Goldberg R, Vivek K, Ziaie AS, Fernandez L, Kaufman DB, Zitur L, Brandhorst D, Friberg A, Korsgren O. Purified Human Pancreatic Islets, CIT Culture Media with Lisofylline or Exenatide. CellR4 Repair Replace Regen Reprogram 2017; 5:e2377. [PMID: 30613755 PMCID: PMC6319648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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Aydoğdu A, Frasca P, D'Apice C, Manzo R, Thornton JM, Gachomo B, Wilson T, Cheung B, Tariq U, Saidel W, Piccoli B. Modeling birds on wires. J Theor Biol 2017; 415:102-112. [PMID: 27932298 DOI: 10.1016/j.jtbi.2016.11.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 11/14/2016] [Accepted: 11/29/2016] [Indexed: 11/16/2022]
Abstract
In this paper we introduce a mathematical model to study the group dynamics of birds resting on wires. The model is agent-based and postulates attraction-repulsion forces between the interacting birds: the interactions are "topological", in the sense that they involve a given number of neighbors irrespective of their distance. The model is first mathematically analyzed and then simulated to study its main properties: we observe that the model predicts birds to be more widely spaced near the borders of each group. We compare the results from the model with experimental data, derived from the analysis of pictures of pigeons and starlings taken in New Jersey: two different image elaboration protocols allow us to establish a good agreement with the model and to quantify its main parameters. We also discuss the potential handedness of the birds, by analyzing the group organization features and the group dynamics at the arrival of new birds. Finally, we propose a more refined mathematical model that describes landing and departing birds by suitable stochastic processes.
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Affiliation(s)
- A Aydoğdu
- Center for Computational and Integrative Biology, Rutgers University - Camden, NJ, United States.
| | - P Frasca
- University of Grenoble Alpes, CNRS, Inria, GIPSA-lab, F-38000 Grenoble, France.
| | - C D'Apice
- Dipartimento di Ingegneria dell'Informazione ed Elettrica e Matematica applicata, University of Salerno, Italy.
| | - R Manzo
- Dipartimento di Ingegneria dell'Informazione ed Elettrica e Matematica applicata, University of Salerno, Italy.
| | - J M Thornton
- Center for Computational and Integrative Biology, Rutgers University - Camden, NJ, United States.
| | - B Gachomo
- Center for Computational and Integrative Biology, Rutgers University - Camden, NJ, United States.
| | - T Wilson
- Center for Computational and Integrative Biology, Rutgers University - Camden, NJ, United States.
| | - B Cheung
- Center for Computational and Integrative Biology, Rutgers University - Camden, NJ, United States.
| | - U Tariq
- Center for Computational and Integrative Biology, Rutgers University - Camden, NJ, United States.
| | - W Saidel
- Department of Biology, Rutgers University - Camden, NJ, United States; Center for Computational and Integrative Biology, Rutgers University - Camden, NJ, United States.
| | - B Piccoli
- Department of Mathematical Sciences, Rutgers University - Camden, NJ, United States; Center for Computational and Integrative Biology, Rutgers University - Camden, NJ, United States.
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Dickler MN, Saura C, Oliveira M, Richards DA, Krop IE, Cervantes A, Stout TJ, Jin H, Savage HM, Wilson TR, Baselga J. Abstract P6-12-01: Phase II study of taselisib (GDC-0032) plus fulvestrant in HER2-negative, hormone receptor-positive advanced breast cancer: Analysis by PIK3CA and ESR1 mutation status from circulating tumor DNA. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p6-12-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background:
The phosphatidylinositol 3-kinase (PI3K) pathway is frequently dysregulated in hormone receptor (HR)-positive breast cancer (BC), with activating mutations of PIK3CA detected in ~35–45% of patients (pts). Acquired mutations in the ESR1 gene, which encodes estrogen receptor α, may be associated with resistance to aromatase inhibitor (AI) therapy. Taselisib is a potent and selective PI3K inhibitor, with greater selectivity against mutant PI3Kα isoforms than wild-type (WT) via a unique mechanism. In phase I studies, taselisib plus fulvestrant had clinical activity and manageable tolerability in pts with HR-positive BC. We report exploratory analyses of PIK3CA and ESR1 from circulating tumor DNA (ctDNA).
Methods:
In this phase II, open-label, single-arm study (PMT4979g; NCT01296555), pts were postmenopausal with HER2-negative, HR-positive locally advanced or metastatic BC and progression or non-response to ≥1 prior endocrine therapy in the adjuvant or metastatic setting. Pts received taselisib (6 mg capsule orally, daily) plus fulvestrant (500 mg intramuscular on Days 1 and 15 of Cycle 1, then Day 1 of each 28-day cycle) until disease progression or unacceptable toxicity. PIK3CA-mutation testing on archival tumor tissue used the cobas® PIK3CA Mutation Test. The Sysmex Inostics' BEAMing Digital PCR platform was used for ctDNA analysis of ESR1 and PIK3CA mutations (pre-dose on Cycle 1, Day 1). Primary endpoints were objective response rate (ORR) and clinical benefit rate (CBR) in all pts and those with PIK3CA mutations. ORR was confirmed complete response (cCR) and confirmed partial response (cPR). CBR was cCR, cPR, or stable disease for ≥6 months. Secondary endpoints included safety, efficacy, pharmacokinetics, and exploratory biomarker analysis.
Results:
60 pts were enrolled. Median age was 61.5 years (range 31–82). In the metastatic setting, pts had received prior chemotherapy (21.7%) and prior hormonal therapy (50.0%). 86.7% of pts had received prior treatment with an AI. 45 pts had PIK3CA mutation status from archival tumor tissue and ctDNA testing; concordance was 86.7% (39/45). ctDNA analysis, vs archival tumor tissue testing, identified 4 pts and 9 pts with PIK3CA mutations from pts with WT and unknown PIK3CA mutation status, respectively.
Based on ctDNA analysis (N=60), 13 pts (21.7%) had mutations in both ESR1 and PIK3CA, 21 pts (35.0%) were 'mutation not detected' (MND) for both genes, 8 (13.3%) had ESR1 mutations and PIK3CA MND, and 18 (30.0%) had ESR1 MND and PIK3CA mutations.
In pts with measurable disease at baseline, confirmed responses (all partial) were: PIK3CA mutation, 38.1% (8/21); PIK3CA MND, 8.7% (2/23); all pts, 22.7% (10/44). CBRs were: PIK3CA mutation, 42.9%; PIK3CA MND, 17.4%; all pts, 29.5%. ORR and CBR from ctDNA analyses were similar to archival tumor tissue data.
Conclusions:
ctDNA analysis identified PIK3CA mutations in pts with previously unknown or WT mutation status from archival tumor tissue; ORR and CBR were similar to those from archival tumor tissue suggesting that PIK3CA mutation testing from ctDNA may be used as a surrogate when tissue is unavailable. 21.7% of pts had mutations in both ESR1 and PIK3CA.
Citation Format: Dickler MN, Saura C, Oliveira M, Richards DA, Krop IE, Cervantes A, Stout TJ, Jin H, Savage HM, Wilson TR, Baselga J. Phase II study of taselisib (GDC-0032) plus fulvestrant in HER2-negative, hormone receptor-positive advanced breast cancer: Analysis by PIK3CA and ESR1 mutation status from circulating tumor DNA [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 P6-12-01.
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Affiliation(s)
- MN Dickler
- Memorial Sloan Kettering Cancer Center, Memorial Hospital, New York, NY; Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; US Oncology Research, Woodlands, TX; Dana-Farber Cancer Institute, Boston, MA; Institute of Health Research INCLIVA, University of Valencia, Valencia, Spain; Genentech Inc., South San Francisco, CA
| | - C Saura
- Memorial Sloan Kettering Cancer Center, Memorial Hospital, New York, NY; Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; US Oncology Research, Woodlands, TX; Dana-Farber Cancer Institute, Boston, MA; Institute of Health Research INCLIVA, University of Valencia, Valencia, Spain; Genentech Inc., South San Francisco, CA
| | - M Oliveira
- Memorial Sloan Kettering Cancer Center, Memorial Hospital, New York, NY; Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; US Oncology Research, Woodlands, TX; Dana-Farber Cancer Institute, Boston, MA; Institute of Health Research INCLIVA, University of Valencia, Valencia, Spain; Genentech Inc., South San Francisco, CA
| | - DA Richards
- Memorial Sloan Kettering Cancer Center, Memorial Hospital, New York, NY; Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; US Oncology Research, Woodlands, TX; Dana-Farber Cancer Institute, Boston, MA; Institute of Health Research INCLIVA, University of Valencia, Valencia, Spain; Genentech Inc., South San Francisco, CA
| | - IE Krop
- Memorial Sloan Kettering Cancer Center, Memorial Hospital, New York, NY; Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; US Oncology Research, Woodlands, TX; Dana-Farber Cancer Institute, Boston, MA; Institute of Health Research INCLIVA, University of Valencia, Valencia, Spain; Genentech Inc., South San Francisco, CA
| | - A Cervantes
- Memorial Sloan Kettering Cancer Center, Memorial Hospital, New York, NY; Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; US Oncology Research, Woodlands, TX; Dana-Farber Cancer Institute, Boston, MA; Institute of Health Research INCLIVA, University of Valencia, Valencia, Spain; Genentech Inc., South San Francisco, CA
| | - TJ Stout
- Memorial Sloan Kettering Cancer Center, Memorial Hospital, New York, NY; Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; US Oncology Research, Woodlands, TX; Dana-Farber Cancer Institute, Boston, MA; Institute of Health Research INCLIVA, University of Valencia, Valencia, Spain; Genentech Inc., South San Francisco, CA
| | - H Jin
- Memorial Sloan Kettering Cancer Center, Memorial Hospital, New York, NY; Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; US Oncology Research, Woodlands, TX; Dana-Farber Cancer Institute, Boston, MA; Institute of Health Research INCLIVA, University of Valencia, Valencia, Spain; Genentech Inc., South San Francisco, CA
| | - HM Savage
- Memorial Sloan Kettering Cancer Center, Memorial Hospital, New York, NY; Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; US Oncology Research, Woodlands, TX; Dana-Farber Cancer Institute, Boston, MA; Institute of Health Research INCLIVA, University of Valencia, Valencia, Spain; Genentech Inc., South San Francisco, CA
| | - TR Wilson
- Memorial Sloan Kettering Cancer Center, Memorial Hospital, New York, NY; Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; US Oncology Research, Woodlands, TX; Dana-Farber Cancer Institute, Boston, MA; Institute of Health Research INCLIVA, University of Valencia, Valencia, Spain; Genentech Inc., South San Francisco, CA
| | - J Baselga
- Memorial Sloan Kettering Cancer Center, Memorial Hospital, New York, NY; Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; US Oncology Research, Woodlands, TX; Dana-Farber Cancer Institute, Boston, MA; Institute of Health Research INCLIVA, University of Valencia, Valencia, Spain; Genentech Inc., South San Francisco, CA
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Spoerke JM, Schleifman E, Clark TA, Young G, Nahas M, Kennedy M, Young L, Chmielecki J, Otto GA, Lipson D, Wilson TR, Gendreau S, Lackner MR. Abstract P6-07-08: The complete spectrum of ESR1 mutations from 7590 breast cancer tumor samples. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p6-07-08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Approximately 70% of newly diagnosed breast cancers express estrogen receptor alpha (ERα), and are treated with agents that block ER signaling. Acquired mutations in ESR1, the gene that encodes ERα, have been associated with resistance to aromatase inhibitor therapy in patients with ER positive metastatic breast cancer (ER+ mBC). The most frequently occurring ESR1 mutations are clustered between amino acids 536 to 538 within the ligand binding domain (LBD), although limited data exists characterizing the full mutation profile in a large number of breast cancer samples.
Methods: We surveyed the Foundation Medicine dataset of 7590 primary and metastatic breast cancer tumor samples for ESR1 short variants and copy number alterations. Hormone receptor status was unavailable, therefore two assumptions were made to provide an estimate of prevalence in the ER+ HER2- population: 70% of the tumor samples are from ER+ HER2- patients, and all ESR1 mutations from non-HER2 amplified metastatic sites are from ER+ HER2- patients. In a separate cohort of 48 ER+ mBC patients, circulating tumor DNA (ctDNA) was analyzed for ESR1 mutations using the BEAMing method by Sysmex and with Foundation Medicine's sequencing assay, FoundationACT (Assay for Circulating Tumor DNA).
Results: The prevalence of mutations in ER+ HER2- breast cancer was estimated to be 22% in samples from metastatic sites but less than 3% in samples from primary sites. ESR1 amplification was rare in samples from both primary and metastatic disease sites at 1.3% and 2.0% respectively. A total of 153 unique short variants of known and unknown status were identified. In addition to hotspot mutations at 537 and 538, previously undescribed rare mutations were identified throughout the entire length of the LBD, although 10 alterations at amino acids 380, 463, 536, 537, and 538 account for 86% of all ESR1 mutations in the ER+ HER2- metastatic sites. We also characterized the overlap of ESR1 alterations with commonly altered and clinically relevant genes in breast cancer, including PIK3CA mutations and HER2 amplification, and we report here a landscape of co-occurring alterations. In the cohort of patient samples where ctDNA was analyzed, BEAMing and FoundationAct assays both detected ESR1 mutations in 19 out of 48 samples, and overall concordance of mutation status (wild-type vs mutant) was 100%. A total of 51 individual mutations were detected with the BEAMing assay, 42 of which were detected with the FoundationACT assay. Seven mutations that were undetected by FoundationACT had mutant allele frequencies less than 0.1%. Ten ESR1 mutations were detected only by FoundationACT, 9 of which are not covered with the BEAMing assay. Alterations in PIK3CA, CDH1, TP53, ERBB2, and other breast cancer relevant genes were also detected with FoundationACT.
Conclusions: Understanding the mutational landscape of ESR1 and co-occurring alterations is important for diagnostic development in conjunction with the clinical development of novel anti-endocrine therapies. Our data demonstrate a large spectrum of mutations in the LBD in addition to known hotspot mutations. In addition, the FoundationACT assay offers a robust NGS-based method to screen for mutations in ctDNA that is highly concordant with digital PCR methods.
Citation Format: Spoerke JM, Schleifman E, Clark TA, Young G, Nahas M, Kennedy M, Young L, Chmielecki J, Otto GA, Lipson D, Wilson TR, Gendreau S, Lackner MR. The complete spectrum of ESR1 mutations from 7590 breast cancer tumor samples [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 P6-07-08.
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Affiliation(s)
- JM Spoerke
- Genentech, Inc, South San Francisco, CA; Foundation Medicine, Inc, Cambridge, MA
| | - E Schleifman
- Genentech, Inc, South San Francisco, CA; Foundation Medicine, Inc, Cambridge, MA
| | - TA Clark
- Genentech, Inc, South San Francisco, CA; Foundation Medicine, Inc, Cambridge, MA
| | - G Young
- Genentech, Inc, South San Francisco, CA; Foundation Medicine, Inc, Cambridge, MA
| | - M Nahas
- Genentech, Inc, South San Francisco, CA; Foundation Medicine, Inc, Cambridge, MA
| | - M Kennedy
- Genentech, Inc, South San Francisco, CA; Foundation Medicine, Inc, Cambridge, MA
| | - L Young
- Genentech, Inc, South San Francisco, CA; Foundation Medicine, Inc, Cambridge, MA
| | - J Chmielecki
- Genentech, Inc, South San Francisco, CA; Foundation Medicine, Inc, Cambridge, MA
| | - GA Otto
- Genentech, Inc, South San Francisco, CA; Foundation Medicine, Inc, Cambridge, MA
| | - D Lipson
- Genentech, Inc, South San Francisco, CA; Foundation Medicine, Inc, Cambridge, MA
| | - TR Wilson
- Genentech, Inc, South San Francisco, CA; Foundation Medicine, Inc, Cambridge, MA
| | - S Gendreau
- Genentech, Inc, South San Francisco, CA; Foundation Medicine, Inc, Cambridge, MA
| | - MR Lackner
- Genentech, Inc, South San Francisco, CA; Foundation Medicine, Inc, Cambridge, MA
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Baselga J, Cortés J, De Laurentiis M, Dent S, Diéras V, Harbeck N, Hsu J, Jin H, Schimmoller F, Wilson TR, Im YH, Jacot W, Krop IE, Verma S. Abstract OT2-01-01: SANDPIPER: Phase III study of the PI3-kinase inhibitor taselisib (GDC-0032) plus fulvestrant in patients with estrogen receptor-positive, HER2-negative locally advanced or metastatic breast cancer enriched for patients with PIK3CA-mutant tumors. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-ot2-01-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: PIK3CA mutations frequently occur in breast cancer (BC), being present in ∼40% of estrogen receptor (ER)-positive, HER2-negative breast tumors. PIK3CA mutations promote growth and proliferation of tumors and mediate resistance to endocrine therapies in BC. Taselisib is a potent and selective PI3-kinase (PI3K) inhibitor that displays greater selectivity for mutant PI3Kα than wild-type PI3Kα through a unique mechanism. In cell studies, taselisib preferentially degraded mutant compared with wild-type PI3Kα, which was not seen with alpelisib and pictilisib. Taselisib has enhanced activity against PIK3CA-mutant BC cell lines, and clinical data include confirmed partial responses in patients with PIK3CA-mutant BC treated with taselisib either as a single agent or in combination with fulvestrant.
Trial design: SANDPIPER is a double-blinded, placebo-controlled, randomized, phase III study, designed to evaluate efficacy and safety of taselisib plus fulvestrant in patients with ER-positive, HER2-negative locally advanced or metastatic BC. Patients will be randomized 2:1 to receive either taselisib (4 mg daily) or placebo plus fulvestrant (500 mg intramuscular on Days 1 and 15 of Cycle 1, and on Day 1 of each subsequent 28-day cycle). Randomization will be stratified by visceral disease, endocrine sensitivity, and geographic region. The study enriches for patients with PIK3CA-mutant tumors who will be randomized separately from those with non-mutant tumors.
Eligibility: Postmenopausal women with ER-positive, HER2-negative, locally advanced or metastatic BC are eligible if they have disease recurrence or progression during or after aromatase inhibitor treatment. A valid cobas® PIK3CA Mutation Test result via central assessment is required prior to enrollment.
Aims: The primary efficacy endpoint is investigator-assessed progression-free survival (PFS) in patients with PIK3CA-mutant tumors. Additional endpoints include overall survival (OS), objective response rate (ORR), clinical benefit rate (CBR), duration of objective response, safety, pharmacokinetics, and patient-reported outcomes.
Statistical methods: The primary efficacy analysis population will include all randomized patients with PIK3CA-mutant tumors. Patients will be grouped according to randomized treatment arm. Median PFS and OS will be estimated using Kaplan–Meier methodology. Cox proportional-hazards models, stratified by the stratification factors, will be used to estimate the hazard ratio with 95% confidence intervals (CIs). ORR, CBR, and their 95% CIs will be estimated. Duration of objective response will be estimated using Kaplan–Meier methodology. Quality of life will be analyzed and summarized. Safety will be analyzed for all treated patients according to actual treatment received.
Accrual: Target enrollment is 600 patients. The study is open for enrollment and, as at April 2016, over 200 patients have been enrolled. Clinicaltrials.gov ID: NCT02340221.
Contact information: For more information or to refer a patient, email global.rochegenentechtrials@roche.com or call 1-888-662-6728 (USA only).
Citation Format: Baselga J, Cortés J, De Laurentiis M, Dent S, Diéras V, Harbeck N, Hsu J, Jin H, Schimmoller F, Wilson TR, Im Y-H, Jacot W, Krop IE, Verma S. SANDPIPER: Phase III study of the PI3-kinase inhibitor taselisib (GDC-0032) plus fulvestrant in patients with estrogen receptor-positive, HER2-negative locally advanced or metastatic breast cancer enriched for patients with PIK3CA-mutant tumors [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 OT2-01-01.
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Affiliation(s)
- J Baselga
- Memorial Sloan Kettering Cancer Center, Memorial Hospital, New York, NY; Vall d´Hebron Institute of Oncology (VHIO) / Ramón y Cajal University Hospital, Barcelona / Madrid, Spain; Istituto Nazionale Tumori Fondazione G. Pascale, Naples, Italy; The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada; Institut Curie, Paris, France; Brustzentrum der Universität München (LMU), Munich, Germany; Genentech Inc., South San Francisco, CA; Samsung Medical Center, Seoul, Republic of Korea; Institut du Cancer de Montpellier (ICM), Montpellier, France; Dana-Farber Cancer Institute, Boston, MA; Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada
| | - J Cortés
- Memorial Sloan Kettering Cancer Center, Memorial Hospital, New York, NY; Vall d´Hebron Institute of Oncology (VHIO) / Ramón y Cajal University Hospital, Barcelona / Madrid, Spain; Istituto Nazionale Tumori Fondazione G. Pascale, Naples, Italy; The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada; Institut Curie, Paris, France; Brustzentrum der Universität München (LMU), Munich, Germany; Genentech Inc., South San Francisco, CA; Samsung Medical Center, Seoul, Republic of Korea; Institut du Cancer de Montpellier (ICM), Montpellier, France; Dana-Farber Cancer Institute, Boston, MA; Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada
| | - M De Laurentiis
- Memorial Sloan Kettering Cancer Center, Memorial Hospital, New York, NY; Vall d´Hebron Institute of Oncology (VHIO) / Ramón y Cajal University Hospital, Barcelona / Madrid, Spain; Istituto Nazionale Tumori Fondazione G. Pascale, Naples, Italy; The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada; Institut Curie, Paris, France; Brustzentrum der Universität München (LMU), Munich, Germany; Genentech Inc., South San Francisco, CA; Samsung Medical Center, Seoul, Republic of Korea; Institut du Cancer de Montpellier (ICM), Montpellier, France; Dana-Farber Cancer Institute, Boston, MA; Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada
| | - S Dent
- Memorial Sloan Kettering Cancer Center, Memorial Hospital, New York, NY; Vall d´Hebron Institute of Oncology (VHIO) / Ramón y Cajal University Hospital, Barcelona / Madrid, Spain; Istituto Nazionale Tumori Fondazione G. Pascale, Naples, Italy; The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada; Institut Curie, Paris, France; Brustzentrum der Universität München (LMU), Munich, Germany; Genentech Inc., South San Francisco, CA; Samsung Medical Center, Seoul, Republic of Korea; Institut du Cancer de Montpellier (ICM), Montpellier, France; Dana-Farber Cancer Institute, Boston, MA; Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada
| | - V Diéras
- Memorial Sloan Kettering Cancer Center, Memorial Hospital, New York, NY; Vall d´Hebron Institute of Oncology (VHIO) / Ramón y Cajal University Hospital, Barcelona / Madrid, Spain; Istituto Nazionale Tumori Fondazione G. Pascale, Naples, Italy; The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada; Institut Curie, Paris, France; Brustzentrum der Universität München (LMU), Munich, Germany; Genentech Inc., South San Francisco, CA; Samsung Medical Center, Seoul, Republic of Korea; Institut du Cancer de Montpellier (ICM), Montpellier, France; Dana-Farber Cancer Institute, Boston, MA; Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada
| | - N Harbeck
- Memorial Sloan Kettering Cancer Center, Memorial Hospital, New York, NY; Vall d´Hebron Institute of Oncology (VHIO) / Ramón y Cajal University Hospital, Barcelona / Madrid, Spain; Istituto Nazionale Tumori Fondazione G. Pascale, Naples, Italy; The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada; Institut Curie, Paris, France; Brustzentrum der Universität München (LMU), Munich, Germany; Genentech Inc., South San Francisco, CA; Samsung Medical Center, Seoul, Republic of Korea; Institut du Cancer de Montpellier (ICM), Montpellier, France; Dana-Farber Cancer Institute, Boston, MA; Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada
| | - J Hsu
- Memorial Sloan Kettering Cancer Center, Memorial Hospital, New York, NY; Vall d´Hebron Institute of Oncology (VHIO) / Ramón y Cajal University Hospital, Barcelona / Madrid, Spain; Istituto Nazionale Tumori Fondazione G. Pascale, Naples, Italy; The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada; Institut Curie, Paris, France; Brustzentrum der Universität München (LMU), Munich, Germany; Genentech Inc., South San Francisco, CA; Samsung Medical Center, Seoul, Republic of Korea; Institut du Cancer de Montpellier (ICM), Montpellier, France; Dana-Farber Cancer Institute, Boston, MA; Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada
| | - H Jin
- Memorial Sloan Kettering Cancer Center, Memorial Hospital, New York, NY; Vall d´Hebron Institute of Oncology (VHIO) / Ramón y Cajal University Hospital, Barcelona / Madrid, Spain; Istituto Nazionale Tumori Fondazione G. Pascale, Naples, Italy; The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada; Institut Curie, Paris, France; Brustzentrum der Universität München (LMU), Munich, Germany; Genentech Inc., South San Francisco, CA; Samsung Medical Center, Seoul, Republic of Korea; Institut du Cancer de Montpellier (ICM), Montpellier, France; Dana-Farber Cancer Institute, Boston, MA; Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada
| | - F Schimmoller
- Memorial Sloan Kettering Cancer Center, Memorial Hospital, New York, NY; Vall d´Hebron Institute of Oncology (VHIO) / Ramón y Cajal University Hospital, Barcelona / Madrid, Spain; Istituto Nazionale Tumori Fondazione G. Pascale, Naples, Italy; The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada; Institut Curie, Paris, France; Brustzentrum der Universität München (LMU), Munich, Germany; Genentech Inc., South San Francisco, CA; Samsung Medical Center, Seoul, Republic of Korea; Institut du Cancer de Montpellier (ICM), Montpellier, France; Dana-Farber Cancer Institute, Boston, MA; Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada
| | - TR Wilson
- Memorial Sloan Kettering Cancer Center, Memorial Hospital, New York, NY; Vall d´Hebron Institute of Oncology (VHIO) / Ramón y Cajal University Hospital, Barcelona / Madrid, Spain; Istituto Nazionale Tumori Fondazione G. Pascale, Naples, Italy; The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada; Institut Curie, Paris, France; Brustzentrum der Universität München (LMU), Munich, Germany; Genentech Inc., South San Francisco, CA; Samsung Medical Center, Seoul, Republic of Korea; Institut du Cancer de Montpellier (ICM), Montpellier, France; Dana-Farber Cancer Institute, Boston, MA; Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada
| | - Y-H Im
- Memorial Sloan Kettering Cancer Center, Memorial Hospital, New York, NY; Vall d´Hebron Institute of Oncology (VHIO) / Ramón y Cajal University Hospital, Barcelona / Madrid, Spain; Istituto Nazionale Tumori Fondazione G. Pascale, Naples, Italy; The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada; Institut Curie, Paris, France; Brustzentrum der Universität München (LMU), Munich, Germany; Genentech Inc., South San Francisco, CA; Samsung Medical Center, Seoul, Republic of Korea; Institut du Cancer de Montpellier (ICM), Montpellier, France; Dana-Farber Cancer Institute, Boston, MA; Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada
| | - W Jacot
- Memorial Sloan Kettering Cancer Center, Memorial Hospital, New York, NY; Vall d´Hebron Institute of Oncology (VHIO) / Ramón y Cajal University Hospital, Barcelona / Madrid, Spain; Istituto Nazionale Tumori Fondazione G. Pascale, Naples, Italy; The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada; Institut Curie, Paris, France; Brustzentrum der Universität München (LMU), Munich, Germany; Genentech Inc., South San Francisco, CA; Samsung Medical Center, Seoul, Republic of Korea; Institut du Cancer de Montpellier (ICM), Montpellier, France; Dana-Farber Cancer Institute, Boston, MA; Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada
| | - IE Krop
- Memorial Sloan Kettering Cancer Center, Memorial Hospital, New York, NY; Vall d´Hebron Institute of Oncology (VHIO) / Ramón y Cajal University Hospital, Barcelona / Madrid, Spain; Istituto Nazionale Tumori Fondazione G. Pascale, Naples, Italy; The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada; Institut Curie, Paris, France; Brustzentrum der Universität München (LMU), Munich, Germany; Genentech Inc., South San Francisco, CA; Samsung Medical Center, Seoul, Republic of Korea; Institut du Cancer de Montpellier (ICM), Montpellier, France; Dana-Farber Cancer Institute, Boston, MA; Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada
| | - S Verma
- Memorial Sloan Kettering Cancer Center, Memorial Hospital, New York, NY; Vall d´Hebron Institute of Oncology (VHIO) / Ramón y Cajal University Hospital, Barcelona / Madrid, Spain; Istituto Nazionale Tumori Fondazione G. Pascale, Naples, Italy; The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada; Institut Curie, Paris, France; Brustzentrum der Universität München (LMU), Munich, Germany; Genentech Inc., South San Francisco, CA; Samsung Medical Center, Seoul, Republic of Korea; Institut du Cancer de Montpellier (ICM), Montpellier, France; Dana-Farber Cancer Institute, Boston, MA; Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada
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Affiliation(s)
- C Wastell
- Surgical Unit, The Gordon Hospital and Westminster Teaching Group, London SW1
| | - T Wilson
- Surgical Unit, The Gordon Hospital and Westminster Teaching Group, London SW1
| | - H Pigott
- Surgical Unit, The Gordon Hospital and Westminster Teaching Group, London SW1
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Wong BYW, Hickman S, Richards M, Jassar P, Wilson T. Management of paediatric otogenic cerebral venous sinus thrombosis: a systematic review. Clin Otolaryngol 2016; 40:704-14. [PMID: 26769686 DOI: 10.1111/coa.12504] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2015] [Indexed: 01/08/2023]
Abstract
BACKGROUND Otogenic paediatric cerebral venous sinus thrombosis (CVST) is rare but has potential clinical sequelae. Its management has long been debated mainly concerning the role of surgery and the use of anticoagulant therapy. OBJECTIVE OF REVIEW To review the current literature and examine the medical and surgical management of paediatric otogenic CVST and its clinical and radiological outcome. TYPE OF REVIEW Systematic review. SEARCH STRATEGY The electronic databases (MEDLINE, EMBASE, Cochrane) were searched from inception to November 2014 using text words 'cerebral venous sinus thrombosis OR cerebral venous thrombosis OR lateral sinus thrombosis OR sigmoid sinus thrombosis' AND 'otogenic OR mastoiditis OR otitis media' AND 'children OR paediatric OR pediatric'. EVALUATION METHOD Inclusion criteria were applied by two reviewers and data extraction was carried out. The type of otological surgery (conservative versus extensive) and the use of anticoagulants with their clinical and radiological outcomes were tabulated. RESULTS Thirty-six studies (15 case reports and 21 case series) were included with a total of 190 patients. A total of 92.1% of patients underwent otological surgery, and 69.5% had conservative surgery and 30.5% extensive otological surgery. Anticoagulants were used in 59%. A total of 79.2% of patients were reported to have had a good clinical outcome. Within this group, 56% had conservative surgery and anticoagulants. Follow-up scans were documented in 61.6% of patients and complete recanalisation was observed in 51%. Complete recanalisation was observed in 47% of those who had been anticoagulated and 55% of those who received no anticoagulation. CONCLUSIONS Conservative otological surgery with the combination of anticoagulation was the most common treatment modality found in the group of patients with good clinical outcome. However, given the current low level of evidence, a multicentre collaborative study is needed to help establish the optimum surgical approach and the role of anticoagulation in managing paediatric otogenic CVST.
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Affiliation(s)
- B Y W Wong
- Department of ENT, Pinderfields General Hospital, Wakefield, UK
| | - S Hickman
- Department of ENT, Pinderfields General Hospital, Wakefield, UK
| | - M Richards
- Department of Paediatric Haematology, Leeds Children Hospital, Leeds, UK
| | - P Jassar
- Department of ENT, Hull and East Yorkshire Hospitals NHS Trust, Hull, UK
| | - T Wilson
- Department of ENT, Leeds General Infirmary, Leeds, UK
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Vohra RS, Pasquali S, Kirkham AJ, Marriott P, Johnstone M, Spreadborough P, Alderson D, Griffiths EA, Fenwick S, Elmasry M, Nunes Q, Kennedy D, Basit Khan R, Khan MAS, Magee CJ, Jones SM, Mason D, Parappally CP, Mathur P, Saunders M, Jamel S, Ul Haque S, Zafar S, Shiwani MH, Samuel N, Dar F, Jackson A, Lovett B, Dindyal S, Winter H, Fletcher T, Rahman S, Wheatley K, Nieto T, Ayaani S, Youssef H, Nijjar RS, Watkin H, Naumann D, Emeshi S, Sarmah PB, Lee K, Joji N, Heath J, Teasdale RL, Weerasinghe C, Needham PJ, Welbourn H, Forster L, Finch D, Blazeby JM, Robb W, McNair AGK, Hrycaiczuk A, Charalabopoulos A, Kadirkamanathan S, Tang CB, Jayanthi NVG, Noor N, Dobbins B, Cockbain AJ, Nilsen-Nunn A, Siqueira J, Pellen M, Cowley JB, Ho WM, Miu V, White TJ, Hodgkins KA, Kinghorn A, Tutton MG, Al-Abed YA, Menzies D, Ahmad A, Reed J, Khan S, Monk D, Vitone LJ, Murtaza G, Joel A, Brennan S, Shier D, Zhang C, Yoganathan T, Robinson SJ, McCallum IJD, Jones MJ, Elsayed M, Tuck L, Wayman J, Carney K, Aroori S, Hosie KB, Kimble A, Bunting DM, Fawole AS, Basheer M, Dave RV, Sarveswaran J, Jones E, Kendal C, Tilston MP, Gough M, Wallace T, Singh S, Downing J, Mockford KA, Issa E, Shah N, Chauhan N, Wilson TR, Forouzanfar A, Wild JRL, Nofal E, Bunnell C, Madbak K, Rao STV, Devoto L, Siddiqi N, Khawaja Z, Hewes JC, Gould L, Chambers A, Urriza Rodriguez D, Sen G, Robinson S, Carney K, Bartlett F, Rae DM, Stevenson TEJ, Sarvananthan K, Dwerryhouse SJ, Higgs SM, Old OJ, Hardy TJ, Shah R, Hornby ST, Keogh K, Frank L, Al-Akash M, Upchurch EA, Frame RJ, Hughes M, Jelley C, Weaver S, Roy S, Sillo TO, Galanopoulos G, Cuming T, Cunha P, Tayeh S, Kaptanis S, Heshaishi M, Eisawi A, Abayomi M, Ngu WS, Fleming K, Singh Bajwa D, Chitre V, Aryal K, Ferris P, Silva M, Lammy S, Mohamed S, Khawaja A, Hussain A, Ghazanfar MA, Bellini MI, Ebdewi H, Elshaer M, Gravante G, Drake B, Ogedegbe A, Mukherjee D, Arhi C, Giwa Nusrat Iqbal L, Watson NF, Kumar Aggarwal S, Orchard P, Villatoro E, Willson PD, Wa K, Mok J, Woodman T, Deguara J, Garcea G, Babu BI, Dennison AR, Malde D, Lloyd D, Satheesan S, Al-Taan O, Boddy A, Slavin JP, Jones RP, Ballance L, Gerakopoulos S, Jambulingam P, Mansour S, Sakai N, Acharya V, Sadat MM, Karim L, Larkin D, Amin K, Khan A, Law J, Jamdar S, Smith SR, Sampat K, M O'shea K, Manu M, Asprou FM, Malik NS, Chang J, Johnstone M, Lewis M, Roberts GP, Karavadra B, Photi E, Hewes J, Gould L, Chambers A, Rodriguez D, O'Reilly DA, Rate AJ, Sekhar H, Henderson LT, Starmer BZ, Coe PO, Tolofari S, Barrie J, Bashir G, Sloane J, Madanipour S, Halkias C, Trevatt AEJ, Borowski DW, Hornsby J, Courtney MJ, Virupaksha S, Seymour K, Robinson S, Hawkins H, Bawa S, Gallagher PV, Reid A, Wood P, Finch JG, Parmar J, Stirland E, Gardner-Thorpe J, Al-Muhktar A, Peterson M, Majeed A, Bajwa FM, Martin J, Choy A, Tsang A, Pore N, Andrew DR, Al-Khyatt W, Taylor C, Bhandari S, Chambers A, Subramanium D, Toh SKC, Carter NC, Mercer SJ, Knight B, Tate S, Pearce B, Wainwright D, Vijay V, Alagaratnam S, Sinha S, Khan S, El-Hasani SS, Hussain AA, Bhattacharya V, Kansal N, Fasih T, Jackson C, Siddiqui MN, Chishti IA, Fordham IJ, Siddiqui Z, Bausbacher H, Geogloma I, Gurung K, Tsavellas G, Basynat P, Kiran Shrestha A, Basu S, Chhabra Mohan Harilingam A, Rabie M, Akhtar M, Kumar P, Jafferbhoy SF, Hussain N, Raza S, Haque M, Alam I, Aseem R, Patel S, Asad M, Booth MI, Ball WR, Wood CPJ, Pinho-Gomes AC, Kausar A, Rami Obeidallah M, Varghase J, Lodhia J, Bradley D, Rengifo C, Lindsay D, Gopalswamy S, Finlay I, Wardle S, Bullen N, Iftikhar SY, Awan A, Ahmed J, Leeder P, Fusai G, Bond-Smith G, Psica A, Puri Y, Hou D, Noble F, Szentpali K, Broadhurst J, Date R, Hossack MR, Li Goh Y, Turner P, Shetty V, Riera M, Macano CAW, Sukha A, Preston SR, Hoban JR, Puntis DJ, Williams SV, Krysztopik R, Kynaston J, Batt J, Doe M, Goscimski A, Jones GH, Smith SR, Hall C, Carty N, Ahmed J, Panteleimonitis S, Gunasekera RT, Sheel ARG, Lennon H, Hindley C, Reddy M, Kenny R, Elkheir N, McGlone ER, Rajaganeshan R, Hancorn K, Hargreaves A, Prasad R, Longbotham DA, Vijayanand D, Wijetunga I, Ziprin P, Nicolay CR, Yeldham G, Read E, Gossage JA, Rolph RC, Ebied H, Phull M, Khan MA, Popplewell M, Kyriakidis D, Hussain A, Henley N, Packer JR, Derbyshire L, Porter J, Appleton S, Farouk M, Basra M, Jennings NA, Ali S, Kanakala V, Ali H, Lane R, Dickson-Lowe R, Zarsadias P, Mirza D, Puig S, Al Amari K, Vijayan D, Sutcliffe R, Marudanayagam R, Hamady Z, Prasad AR, Patel A, Durkin D, Kaur P, Bowen L, Byrne JP, Pearson KL, Delisle TG, Davies J, Tomlinson MA, Johnpulle MA, Slawinski C, Macdonald A, Nicholson J, Newton K, Mbuvi J, Farooq A, Sidhartha Mothe B, Zafrani Z, Brett D, Francombe J, Spreadborough P, Barnes J, Cheung M, Al-Bahrani AZ, Preziosi G, Urbonas T, Alberts J, Mallik M, Patel K, Segaran A, Doulias T, Sufi PA, Yao C, Pollock S, Manzelli A, Wajed S, Kourkulos M, Pezzuto R, Wadley M, Hamilton E, Jaunoo S, Padwick R, Sayegh M, Newton RC, Hebbar M, Farag SF, Spearman J, Hamdan MF, D'Costa C, Blane C, Giles M, Peter MB, Hirst NA, Hossain T, Pannu A, El-Dhuwaib Y, Morrison TEM, Taylor GW, Thompson RLE, McCune K, Loughlin P, Lawther R, Byrnes CK, Simpson DJ, Mawhinney A, Warren C, McKay D, McIlmunn C, Martin S, MacArtney M, Diamond T, Davey P, Jones C, Clements JM, Digney R, Chan WM, McCain S, Gull S, Janeczko A, Dorrian E, Harris A, Dawson S, Johnston D, McAree B, Ghareeb E, Thomas G, Connelly M, McKenzie S, Cieplucha K, Spence G, Campbell W, Hooks G, Bradley N, Hill ADK, Cassidy JT, Boland M, Burke P, Nally DM, Hill ADK, Khogali E, Shabo W, Iskandar E, McEntee GP, O'Neill MA, Peirce C, Lyons EM, O'Sullivan AW, Thakkar R, Carroll P, Ivanovski I, Balfe P, Lee M, Winter DC, Kelly ME, Hoti E, Maguire D, Karunakaran P, Geoghegan JG, Martin ST, McDermott F, Cross KS, Cooke F, Zeeshan S, Murphy JO, Mealy K, Mohan HM, Nedujchelyn Y, Fahad Ullah M, Ahmed I, Giovinazzo F, Milburn J, Prince S, Brooke E, Buchan J, Khalil AM, Vaughan EM, Ramage MI, Aldridge RC, Gibson S, Nicholson GA, Vass DG, Grant AJ, Holroyd DJ, Jones MA, Sutton CMLR, O'Dwyer P, Nilsson F, Weber B, Williamson TK, Lalla K, Bryant A, Carter CR, Forrest CR, Hunter DI, Nassar AH, Orizu MN, Knight K, Qandeel H, Suttie S, Belding R, McClarey A, Boyd AT, Guthrie GJK, Lim PJ, Luhmann A, Watson AJM, Richards CH, Nicol L, Madurska M, Harrison E, Boyce KM, Roebuck A, Ferguson G, Pati P, Wilson MSJ, Dalgaty F, Fothergill L, Driscoll PJ, Mozolowski KL, Banwell V, Bennett SP, Rogers PN, Skelly BL, Rutherford CL, Mirza AK, Lazim T, Lim HCC, Duke D, Ahmed T, Beasley WD, Wilkinson MD, Maharaj G, Malcolm C, Brown TH, Shingler GM, Mowbray N, Radwan R, Morcous P, Wood S, Kadhim A, Stewart DJ, Baker AL, Tanner N, Shenoy H, Hafiz S, Marchi JA, Singh-Ranger D, Hisham E, Ainley P, O'Neill S, Terrace J, Napetti S, Hopwood B, Rhys T, Downing J, Kanavati O, Coats M, Aleksandrov D, Kallaway C, Yahya S, Weber B, Templeton A, Trotter M, Lo C, Dhillon A, Heywood N, Aawsaj Y, Hamdan A, Reece-Bolton O, McGuigan A, Shahin Y, Ali A, Luther A, Nicholson JA, Rajendran I, Boal M, Ritchie J. Population-based cohort study of variation in the use of emergency cholecystectomy for benign gallbladder diseases. Br J Surg 2016; 103:1716-1726. [PMID: 27748962 DOI: 10.1002/bjs.10288] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 06/21/2016] [Accepted: 07/06/2016] [Indexed: 01/05/2023]
Abstract
Abstract
Background
The aims of this prospective population-based cohort study were to identify the patient and hospital characteristics associated with emergency cholecystectomy, and the influences of these in determining variations between hospitals.
Methods
Data were collected for consecutive patients undergoing cholecystectomy in acute UK and Irish hospitals between 1 March and 1 May 2014. Potential explanatory variables influencing the performance of emergency cholecystectomy were analysed by means of multilevel, multivariable logistic regression modelling using a two-level hierarchical structure with patients (level 1) nested within hospitals (level 2).
Results
Data were collected on 4744 cholecystectomies from 165 hospitals. Increasing age, lower ASA fitness grade, biliary colic, the need for further imaging (magnetic retrograde cholangiopancreatography), endoscopic interventions (endoscopic retrograde cholangiopancreatography) and admission to a non-biliary centre significantly reduced the likelihood of an emergency cholecystectomy being performed. The multilevel model was used to calculate the probability of receiving an emergency cholecystectomy for a woman aged 40 years or over with an ASA grade of I or II and a BMI of at least 25·0 kg/m2, who presented with acute cholecystitis with an ultrasound scan showing a thick-walled gallbladder and a normal common bile duct. The mean predicted probability of receiving an emergency cholecystectomy was 0·52 (95 per cent c.i. 0·45 to 0·57). The predicted probabilities ranged from 0·02 to 0·95 across the 165 hospitals, demonstrating significant variation between hospitals.
Conclusion
Patients with similar characteristics presenting to different hospitals with acute gallbladder pathology do not receive comparable care.
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Affiliation(s)
| | - R S Vohra
- Trent Oesophago-Gastric Unit, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - S Pasquali
- Surgical Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy
| | - A J Kirkham
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - P Marriott
- West Midlands Research Collaborative, Academic Department of Surgery, University of Birmingham, Birmingham, UK
| | - M Johnstone
- West Midlands Research Collaborative, Academic Department of Surgery, University of Birmingham, Birmingham, UK
| | - P Spreadborough
- West Midlands Research Collaborative, Academic Department of Surgery, University of Birmingham, Birmingham, UK
| | - D Alderson
- Academic Department of Surgery, University of Birmingham, Birmingham, UK
| | - E A Griffiths
- Department of Upper Gastrointestinal Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - S Fenwick
- Aintree University Hospital NHS Foundation Trust
| | - M Elmasry
- Aintree University Hospital NHS Foundation Trust
| | - Q Nunes
- Aintree University Hospital NHS Foundation Trust
| | - D Kennedy
- Aintree University Hospital NHS Foundation Trust
| | | | | | | | | | - D Mason
- Wirral University Teaching Hospital
| | | | | | | | - S Jamel
- Barnet and Chase Farm Hospital
| | | | - S Zafar
- Barnet and Chase Farm Hospital
| | | | - N Samuel
- Barnsley District General Hospital
| | - F Dar
- Barnsley District General Hospital
| | | | | | | | | | | | | | - K Wheatley
- Sandwell and West Birmingham Hospitals NHS Trust
| | - T Nieto
- Sandwell and West Birmingham Hospitals NHS Trust
| | - S Ayaani
- Sandwell and West Birmingham Hospitals NHS Trust
| | - H Youssef
- Heart of England Foundation NHS Trust
| | | | - H Watkin
- Heart of England Foundation NHS Trust
| | - D Naumann
- Heart of England Foundation NHS Trust
| | - S Emeshi
- Heart of England Foundation NHS Trust
| | | | - K Lee
- Heart of England Foundation NHS Trust
| | - N Joji
- Heart of England Foundation NHS Trust
| | - J Heath
- Blackpool Teaching Hospitals NHS Foundation Trust
| | - R L Teasdale
- Blackpool Teaching Hospitals NHS Foundation Trust
| | | | - P J Needham
- Bradford Teaching Hospitals NHS Foundation Trust
| | - H Welbourn
- Bradford Teaching Hospitals NHS Foundation Trust
| | - L Forster
- Bradford Teaching Hospitals NHS Foundation Trust
| | - D Finch
- Bradford Teaching Hospitals NHS Foundation Trust
| | | | - W Robb
- University Hospitals Bristol NHS Trust
| | | | | | | | | | | | | | | | - B Dobbins
- Calderdale and Huddersfield NHS Trust
| | | | | | | | - M Pellen
- Hull and East Yorkshire NHS Trust
| | | | - W-M Ho
- Hull and East Yorkshire NHS Trust
| | - V Miu
- Hull and East Yorkshire NHS Trust
| | - T J White
- Chesterfield Royal Hospital NHS Foundation Trust
| | - K A Hodgkins
- Chesterfield Royal Hospital NHS Foundation Trust
| | - A Kinghorn
- Chesterfield Royal Hospital NHS Foundation Trust
| | - M G Tutton
- Colchester Hospital University NHS Foundation Trust
| | - Y A Al-Abed
- Colchester Hospital University NHS Foundation Trust
| | - D Menzies
- Colchester Hospital University NHS Foundation Trust
| | - A Ahmad
- Colchester Hospital University NHS Foundation Trust
| | - J Reed
- Colchester Hospital University NHS Foundation Trust
| | - S Khan
- Colchester Hospital University NHS Foundation Trust
| | - D Monk
- Countess of Chester NHS Foundation Trust
| | - L J Vitone
- Countess of Chester NHS Foundation Trust
| | - G Murtaza
- Countess of Chester NHS Foundation Trust
| | - A Joel
- Countess of Chester NHS Foundation Trust
| | | | - D Shier
- Croydon Health Services NHS Trust
| | - C Zhang
- Croydon Health Services NHS Trust
| | | | | | | | - M J Jones
- North Cumbria University Hospitals Trust
| | - M Elsayed
- North Cumbria University Hospitals Trust
| | - L Tuck
- North Cumbria University Hospitals Trust
| | - J Wayman
- North Cumbria University Hospitals Trust
| | - K Carney
- North Cumbria University Hospitals Trust
| | | | | | | | | | | | | | | | | | | | | | - M P Tilston
- Northern Lincolnshire and Goole NHS Foundation Trust
| | - M Gough
- Northern Lincolnshire and Goole NHS Foundation Trust
| | - T Wallace
- Northern Lincolnshire and Goole NHS Foundation Trust
| | - S Singh
- Northern Lincolnshire and Goole NHS Foundation Trust
| | - J Downing
- Northern Lincolnshire and Goole NHS Foundation Trust
| | - K A Mockford
- Northern Lincolnshire and Goole NHS Foundation Trust
| | - E Issa
- Northern Lincolnshire and Goole NHS Foundation Trust
| | - N Shah
- Northern Lincolnshire and Goole NHS Foundation Trust
| | - N Chauhan
- Northern Lincolnshire and Goole NHS Foundation Trust
| | - T R Wilson
- Doncaster and Bassetlaw Hospitals NHS Foundation Trust
| | - A Forouzanfar
- Doncaster and Bassetlaw Hospitals NHS Foundation Trust
| | - J R L Wild
- Doncaster and Bassetlaw Hospitals NHS Foundation Trust
| | - E Nofal
- Doncaster and Bassetlaw Hospitals NHS Foundation Trust
| | - C Bunnell
- Doncaster and Bassetlaw Hospitals NHS Foundation Trust
| | - K Madbak
- Doncaster and Bassetlaw Hospitals NHS Foundation Trust
| | - S T V Rao
- Dorset County Hospital NHS Foundation Trust
| | - L Devoto
- Dorset County Hospital NHS Foundation Trust
| | - N Siddiqi
- Dorset County Hospital NHS Foundation Trust
| | - Z Khawaja
- Dorset County Hospital NHS Foundation Trust
| | | | | | | | | | | | | | | | | | - D M Rae
- Frimley Park Hospital NHS Trust
| | | | | | | | | | - O J Old
- Gloucestershire Hospitals NHS Trust
| | | | - R Shah
- Gloucestershire Hospitals NHS Trust
| | | | - K Keogh
- Gloucestershire Hospitals NHS Trust
| | - L Frank
- Gloucestershire Hospitals NHS Trust
| | - M Al-Akash
- Great Western Hospitals NHS Foundation Trust
| | | | - R J Frame
- Harrogate and District NHS Foundation Trust
| | - M Hughes
- Harrogate and District NHS Foundation Trust
| | - C Jelley
- Harrogate and District NHS Foundation Trust
| | | | | | | | | | - T Cuming
- Homerton University Hospital NHS Trust
| | - P Cunha
- Homerton University Hospital NHS Trust
| | - S Tayeh
- Homerton University Hospital NHS Trust
| | | | | | - A Eisawi
- Tees Hospitals NHS Foundation Trust
| | | | - W S Ngu
- Tees Hospitals NHS Foundation Trust
| | | | | | - V Chitre
- Paget University Hospitals NHS Foundation Trust
| | - K Aryal
- Paget University Hospitals NHS Foundation Trust
| | - P Ferris
- Paget University Hospitals NHS Foundation Trust
| | | | | | | | | | | | | | | | - H Ebdewi
- Kettering General Hospital NHS Foundation Trust
| | - M Elshaer
- Kettering General Hospital NHS Foundation Trust
| | - G Gravante
- Kettering General Hospital NHS Foundation Trust
| | - B Drake
- Kettering General Hospital NHS Foundation Trust
| | - A Ogedegbe
- Barking, Havering and Redbridge University Hospitals NHS Trust
| | - D Mukherjee
- Barking, Havering and Redbridge University Hospitals NHS Trust
| | - C Arhi
- Barking, Havering and Redbridge University Hospitals NHS Trust
| | | | | | | | | | | | | | - K Wa
- Kingston Hospital NHS Foundation Trust
| | - J Mok
- Kingston Hospital NHS Foundation Trust
| | - T Woodman
- Kingston Hospital NHS Foundation Trust
| | - J Deguara
- Kingston Hospital NHS Foundation Trust
| | - G Garcea
- University Hospitals of Leicester NHS Trust
| | - B I Babu
- University Hospitals of Leicester NHS Trust
| | | | - D Malde
- University Hospitals of Leicester NHS Trust
| | - D Lloyd
- University Hospitals of Leicester NHS Trust
| | | | - O Al-Taan
- University Hospitals of Leicester NHS Trust
| | - A Boddy
- University Hospitals of Leicester NHS Trust
| | - J P Slavin
- Leighton Hospital, Mid Cheshire Hospitals NHS Foundation Trust
| | - R P Jones
- Leighton Hospital, Mid Cheshire Hospitals NHS Foundation Trust
| | - L Ballance
- Leighton Hospital, Mid Cheshire Hospitals NHS Foundation Trust
| | - S Gerakopoulos
- Leighton Hospital, Mid Cheshire Hospitals NHS Foundation Trust
| | - P Jambulingam
- Luton and Dunstable University Hospital NHS Foundation Trust
| | - S Mansour
- Luton and Dunstable University Hospital NHS Foundation Trust
| | - N Sakai
- Luton and Dunstable University Hospital NHS Foundation Trust
| | - V Acharya
- Luton and Dunstable University Hospital NHS Foundation Trust
| | - M M Sadat
- Macclesfield District General Hospital
| | - L Karim
- Macclesfield District General Hospital
| | - D Larkin
- Macclesfield District General Hospital
| | - K Amin
- Macclesfield District General Hospital
| | - A Khan
- Central Manchester NHS Foundation Trust
| | - J Law
- Central Manchester NHS Foundation Trust
| | - S Jamdar
- Central Manchester NHS Foundation Trust
| | - S R Smith
- Central Manchester NHS Foundation Trust
| | - K Sampat
- Central Manchester NHS Foundation Trust
| | | | - M Manu
- Royal Wolverhampton Hospitals NHS Trust
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- Royal Wolverhampton Hospitals NHS Trust
| | - J Chang
- Royal Wolverhampton Hospitals NHS Trust
| | | | - M Lewis
- Norfolk and Norwich University Hospitals NHS Foundation Trust
| | - G P Roberts
- Norfolk and Norwich University Hospitals NHS Foundation Trust
| | - B Karavadra
- Norfolk and Norwich University Hospitals NHS Foundation Trust
| | - E Photi
- Norfolk and Norwich University Hospitals NHS Foundation Trust
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- North Tees and Hartlepool NHS Foundation Trust
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- Northumbria Healthcare NHS Foundation Trust
| | - S Robinson
- Northumbria Healthcare NHS Foundation Trust
| | - H Hawkins
- Northumbria Healthcare NHS Foundation Trust
| | - S Bawa
- Northumbria Healthcare NHS Foundation Trust
| | | | - A Reid
- Northumbria Healthcare NHS Foundation Trust
| | - P Wood
- Northumbria Healthcare NHS Foundation Trust
| | - J G Finch
- Northampton General Hospital NHS Trust
| | - J Parmar
- Northampton General Hospital NHS Trust
| | | | | | - A Al-Muhktar
- Sheffield Teaching Hospitals NHS Foundation Trust
| | - M Peterson
- Sheffield Teaching Hospitals NHS Foundation Trust
| | - A Majeed
- Sheffield Teaching Hospitals NHS Foundation Trust
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- Peterborough City Hospital
| | | | - N Pore
- United Lincolnshire Hospitals NHS Trust
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- United Lincolnshire Hospitals NHS Trust
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- Portsmouth Hospitals NHS Trust
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- The Princess Alexandra Hospital NHS Trust
| | | | - S Sinha
- The Princess Alexandra Hospital NHS Trust
| | - S Khan
- The Princess Alexandra Hospital NHS Trust
| | | | - A A Hussain
- King's College Hospital NHS Foundation Trust
| | | | - N Kansal
- Gateshead Health NHS Foundation Trust
| | - T Fasih
- Gateshead Health NHS Foundation Trust
| | - C Jackson
- Gateshead Health NHS Foundation Trust
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- Queen Elizabeth Hospital NHS Trust
| | - G Tsavellas
- East Kent Hospitals University NHS Foundation Trust
| | - P Basynat
- East Kent Hospitals University NHS Foundation Trust
| | | | - S Basu
- East Kent Hospitals University NHS Foundation Trust
| | | | - M Rabie
- East Kent Hospitals University NHS Foundation Trust
| | - M Akhtar
- East Kent Hospitals University NHS Foundation Trust
| | - P Kumar
- Burton Hospitals NHS Foundation Trust
| | | | - N Hussain
- Burton Hospitals NHS Foundation Trust
| | - S Raza
- Burton Hospitals NHS Foundation Trust
| | - M Haque
- Royal Albert Edward Infirmary, Wigan Wrightington and Leigh NHS Trust
| | - I Alam
- Royal Albert Edward Infirmary, Wigan Wrightington and Leigh NHS Trust
| | - R Aseem
- Royal Albert Edward Infirmary, Wigan Wrightington and Leigh NHS Trust
| | - S Patel
- Royal Albert Edward Infirmary, Wigan Wrightington and Leigh NHS Trust
| | - M Asad
- Royal Albert Edward Infirmary, Wigan Wrightington and Leigh NHS Trust
| | - M I Booth
- Royal Berkshire NHS Foundation Trust
| | - W R Ball
- Royal Berkshire NHS Foundation Trust
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- Royal Bolton Hospital NHS Foundation Trust
| | - J Lodhia
- Royal Bolton Hospital NHS Foundation Trust
| | - D Bradley
- Royal Bolton Hospital NHS Foundation Trust
| | - C Rengifo
- Royal Bolton Hospital NHS Foundation Trust
| | - D Lindsay
- Royal Bolton Hospital NHS Foundation Trust
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- Royal Derby NHS Foundation Trust
| | - J Ahmed
- Royal Derby NHS Foundation Trust
| | - P Leeder
- Royal Derby NHS Foundation Trust
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- Hampshire Hospital NHS Foundation Trust
| | - F Noble
- Hampshire Hospital NHS Foundation Trust
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- Lancashire Teaching Hospitals NHS Foundation Trust
| | - M R Hossack
- Lancashire Teaching Hospitals NHS Foundation Trust
| | - Y Li Goh
- Lancashire Teaching Hospitals NHS Foundation Trust
| | - P Turner
- Lancashire Teaching Hospitals NHS Foundation Trust
| | - V Shetty
- Lancashire Teaching Hospitals NHS Foundation Trust
| | | | | | | | - S R Preston
- Royal Surrey County Hospital NHS Foundation Trust
| | - J R Hoban
- Royal Surrey County Hospital NHS Foundation Trust
| | - D J Puntis
- Royal Surrey County Hospital NHS Foundation Trust
| | - S V Williams
- Royal Surrey County Hospital NHS Foundation Trust
| | | | | | - J Batt
- Royal United Hospital Bath NHS Trust
| | - M Doe
- Royal United Hospital Bath NHS Trust
| | | | | | | | - C Hall
- Salford Royal NHS Foundation Trust
| | - N Carty
- Salisbury Hospital Foundation Trust
| | - J Ahmed
- Salisbury Hospital Foundation Trust
| | | | | | | | - H Lennon
- Southport and Ormskirk Hospital NHS Trust
| | - C Hindley
- Southport and Ormskirk Hospital NHS Trust
| | - M Reddy
- St George's Healthcare NHS Trust
| | - R Kenny
- St George's Healthcare NHS Trust
| | | | | | | | - K Hancorn
- St Helens and Knowsley Teaching Hospitals NHS Trust
| | - A Hargreaves
- St Helens and Knowsley Teaching Hospitals NHS Trust
| | | | | | | | | | - P Ziprin
- Imperial College Healthcare NHS Trust
| | | | - G Yeldham
- Imperial College Healthcare NHS Trust
| | - E Read
- Imperial College Healthcare NHS Trust
| | | | | | | | | | - M A Khan
- Mid Staffordshire NHS Foundation Trust
| | | | | | - A Hussain
- Mid Staffordshire NHS Foundation Trust
| | | | | | | | | | | | | | | | | | - S Ali
- City Hospitals Sunderland NHS Foundation Trust
| | - V Kanakala
- City Hospitals Sunderland NHS Foundation Trust
| | - H Ali
- Tunbridge Wells and Maidstone NHS Trust
| | - R Lane
- Tunbridge Wells and Maidstone NHS Trust
| | | | | | - D Mirza
- University Hospital Birmingham NHS Foundation Trust
| | - S Puig
- University Hospital Birmingham NHS Foundation Trust
| | - K Al Amari
- University Hospital Birmingham NHS Foundation Trust
| | - D Vijayan
- University Hospital Birmingham NHS Foundation Trust
| | - R Sutcliffe
- University Hospital Birmingham NHS Foundation Trust
| | | | - Z Hamady
- University Hospital Coventry and Warwickshire NHS Trust
| | - A R Prasad
- University Hospital Coventry and Warwickshire NHS Trust
| | - A Patel
- University Hospital Coventry and Warwickshire NHS Trust
| | - D Durkin
- University Hospital of North Staffordshire NHS Trust
| | - P Kaur
- University Hospital of North Staffordshire NHS Trust
| | - L Bowen
- University Hospital of North Staffordshire NHS Trust
| | - J P Byrne
- University Hospital Southampton NHS Foundation Trust
| | - K L Pearson
- University Hospital Southampton NHS Foundation Trust
| | - T G Delisle
- University Hospital Southampton NHS Foundation Trust
| | - J Davies
- University Hospital Southampton NHS Foundation Trust
| | | | | | | | - A Macdonald
- University Hospital South Manchester NHS Foundation Trust
| | - J Nicholson
- University Hospital South Manchester NHS Foundation Trust
| | - K Newton
- University Hospital South Manchester NHS Foundation Trust
| | - J Mbuvi
- University Hospital South Manchester NHS Foundation Trust
| | - A Farooq
- Warrington and Halton Hospitals NHS Trust
| | | | - Z Zafrani
- Warrington and Halton Hospitals NHS Trust
| | - D Brett
- Warrington and Halton Hospitals NHS Trust
| | | | | | - J Barnes
- South Warwickshire NHS Foundation Trust
| | - M Cheung
- South Warwickshire NHS Foundation Trust
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - M Wadley
- Worcestershire Acute Hospitals NHS Trust
| | - E Hamilton
- Worcestershire Acute Hospitals NHS Trust
| | - S Jaunoo
- Worcestershire Acute Hospitals NHS Trust
| | - R Padwick
- Worcestershire Acute Hospitals NHS Trust
| | - M Sayegh
- Western Sussex Hospitals NHS Foundation Trust
| | - R C Newton
- Western Sussex Hospitals NHS Foundation Trust
| | - M Hebbar
- Western Sussex Hospitals NHS Foundation Trust
| | - S F Farag
- Western Sussex Hospitals NHS Foundation Trust
| | | | | | | | - C Blane
- Yeovil District Hospital NHS Trust
| | - M Giles
- York Teaching Hospital NHS Foundation Trust
| | - M B Peter
- York Teaching Hospital NHS Foundation Trust
| | - N A Hirst
- York Teaching Hospital NHS Foundation Trust
| | - T Hossain
- York Teaching Hospital NHS Foundation Trust
| | - A Pannu
- York Teaching Hospital NHS Foundation Trust
| | | | | | - G W Taylor
- York Teaching Hospital NHS Foundation Trust
| | | | | | | | | | | | | | | | | | | | | | | | | | - T Diamond
- Belfast City Hospital, Mater Infirmorum Hospital Belfast and Royal Victoria Hospital
| | - P Davey
- Belfast City Hospital, Mater Infirmorum Hospital Belfast and Royal Victoria Hospital
| | - C Jones
- Belfast City Hospital, Mater Infirmorum Hospital Belfast and Royal Victoria Hospital
| | - J M Clements
- Belfast City Hospital, Mater Infirmorum Hospital Belfast and Royal Victoria Hospital
| | - R Digney
- Belfast City Hospital, Mater Infirmorum Hospital Belfast and Royal Victoria Hospital
| | - W M Chan
- Belfast City Hospital, Mater Infirmorum Hospital Belfast and Royal Victoria Hospital
| | - S McCain
- Belfast City Hospital, Mater Infirmorum Hospital Belfast and Royal Victoria Hospital
| | - S Gull
- Belfast City Hospital, Mater Infirmorum Hospital Belfast and Royal Victoria Hospital
| | - A Janeczko
- Belfast City Hospital, Mater Infirmorum Hospital Belfast and Royal Victoria Hospital
| | - E Dorrian
- Belfast City Hospital, Mater Infirmorum Hospital Belfast and Royal Victoria Hospital
| | - A Harris
- Belfast City Hospital, Mater Infirmorum Hospital Belfast and Royal Victoria Hospital
| | - S Dawson
- Belfast City Hospital, Mater Infirmorum Hospital Belfast and Royal Victoria Hospital
| | - D Johnston
- Belfast City Hospital, Mater Infirmorum Hospital Belfast and Royal Victoria Hospital
| | - B McAree
- Belfast City Hospital, Mater Infirmorum Hospital Belfast and Royal Victoria Hospital
| | | | | | | | | | | | | | | | | | | | | | | | | | - P Burke
- University Hospital Limerick
| | | | - A D K Hill
- Louth County Hospital and Our Lady of Lourdes Hospital
| | - E Khogali
- Louth County Hospital and Our Lady of Lourdes Hospital
| | - W Shabo
- Louth County Hospital and Our Lady of Lourdes Hospital
| | - E Iskandar
- Louth County Hospital and Our Lady of Lourdes Hospital
| | | | | | | | | | | | | | | | | | - P Balfe
- St Luke's General Hospital Kilkenny
| | - M Lee
- St Luke's General Hospital Kilkenny
| | - D C Winter
- St Vincent's University and Private Hospitals, Dublin
| | - M E Kelly
- St Vincent's University and Private Hospitals, Dublin
| | - E Hoti
- St Vincent's University and Private Hospitals, Dublin
| | - D Maguire
- St Vincent's University and Private Hospitals, Dublin
| | - P Karunakaran
- St Vincent's University and Private Hospitals, Dublin
| | - J G Geoghegan
- St Vincent's University and Private Hospitals, Dublin
| | - S T Martin
- St Vincent's University and Private Hospitals, Dublin
| | - F McDermott
- St Vincent's University and Private Hospitals, Dublin
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - S Gibson
- Crosshouse Hospital, Ayrshire and Arran
| | | | - D G Vass
- Crosshouse Hospital, Ayrshire and Arran
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - H C C Lim
- Glangwili General and Prince Philip Hospital
| | - D Duke
- Glangwili General and Prince Philip Hospital
| | - T Ahmed
- Glangwili General and Prince Philip Hospital
| | - W D Beasley
- Glangwili General and Prince Philip Hospital
| | | | - G Maharaj
- Glangwili General and Prince Philip Hospital
| | - C Malcolm
- Glangwili General and Prince Philip Hospital
| | | | | | | | - R Radwan
- Morriston and Singleton Hospitals
| | | | - S Wood
- Princess of Wales Hospital
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Taylor J, Semchuk W, Deschamps M, Sulz L, Tsuyuki RT, Duffy P, Wilson T. Pharmacist Intervention in Risk Reduction Study in High-Risk Cardiac Patients: The Effect of 2 Methods of Pharmacist Training. Can Pharm J (Ott) 2016. [DOI: 10.1177/171516350714000227] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Objective: To assess the effect of intensive vs conventional training on pharmacist-suggested implementation of cardiac risk reduction efforts in community practice. Methods: Sixty-one volunteer pharmacists from 40 pharmacies were randomized to 1 of 2 educational groups: intensive or conventional training in cardiac risk reduction. With training complete, pharmacists identified and approached patients at high risk for coronary artery disease (CAD) at their practice sites to participate in the program. After a patient interview, pharmacists documented the relevant CAD risk factors and medication history, and then faxed this information, along with risk reduction recommendations, to the primary care physician. Patients were then encouraged to book a medical appointment for further assessment and treatment, if warranted. Follow-up occurred at 4, 16, and 24 weeks to determine if any pharmacist-suggested risk reduction measures had been implemented. Pharmacists were reimbursed $30 per patient accrued. Results: A total of 217 patients were enrolled in the study, and of those, 216 had follow-up data available for analysis. No significant differences were observed between the groups with respect to mean number of patients enrolled per pharmacist (4.3 vs 2.7) and the proportion of pharmacists completing at least 1 patient (17/27 vs 14/34). Feedback from pharmacists on program delivery indicated no significant difference in satisfaction with the training provided. The recommendations forwarded by pharmacists of the intensive group (35.8%) received greater acceptance by physicians than those in the conventional group (23.8%). Conclusion: Although results are preliminary, intensive training for pharmacists was more likely to result in improvements in cardiovascular risk reduction therapy than when conventional training was used.
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Semchuk W, Taylor J, Sulz L, Deschamps M, Tsuyuki RT, Duffy P, Wilson T. Pharmacist Intervention in Risk Reduction Study: High-Risk Cardiac Patients. Can Pharm J (Ott) 2016. [DOI: 10.1177/171516350714000123] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: Although there are guidelines for managing patients at high vascular risk, many people remain undertreated. This community-based study was designed to 1) measure the ability of the pharmacist—physician collaboration to affect a broad array of drug-related endpoints and 2) to compare 2 methods of training community pharmacists to collaborate with physicians on cardiac patient care. This paper focuses on the first outcome, and a companion paper will address the second outcome. Methods: We used a before-and-after design to assess pharmacists' ability to affect drug-related endpoints. We identified patients by various methods, one of which was medication profiles. Those providing consent were educated on risk factor modification and encouraged to consult their physicians. Pharmacists subsequently faxed the details of their assessments to the primary care physician, along with suggestions for therapy changes. Our outcome measure was the proportion of patients who achieved a composite of either a dose increase or a new target medication as a result of pharmacist recommendations during the study. Results: A total of 61 pharmacists recruited 217 patients, and of these, follow-up was completed on 216. Of the patients for whom a pharmacist made a suggestion, pharmacologic risk reduction therapy was initiated or enhanced in 53.7%. Conclusion: This community pharmacist—based program improved utilization of the therapies known to decrease vascular risk in patients considered high risk.
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Reid JA, Wilson T, Ganapathipillai A. Studies on Filariasis in Malaya: The Mosquito Vectors of PeriodicBrugia Malayiin North-West Malaya. Annals of Tropical Medicine & Parasitology 2016. [DOI: 10.1080/00034983.1962.11686127] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Abstract
Dental patients generally recall more pain than they originally report, with ratings of pain related to state anxiety and dental fear, but the role of depression in recall of dental pain remains uncertain. This study examined the relative contributions of different variables in explaining dental pain recalled after tooth extraction. Patients presenting for tooth extraction, prior to extraction, rated their current dental pain and state anxiety, prediction of pain and state anxiety during extraction, depression, and dental fear. Immediately postprocedure and then 1 mo later, patients rated their pain and state anxiety during extraction. Hierarchical linear regression equations were used to explain variance in recalled pain and state anxiety. In addition, patients were divided into high and low dental fear and depression groups and compared on ratings of pain and state anxiety across time. In a final sample of 157 patients, the most important predictors of recalled pain were pain reported during extraction (β = .53) and recalled state anxiety (β = .52). Dental fear and depression had a significant interaction: only when patients reported less depression did those patients who reported more dental fear also report more pain than patients who reported less dental fear (P < 0.05, ω(2) = .07). Patients who reported more depression entered the dental operatory reporting more pain, but all patients generally reported less pain during extraction than they predicted or recalled. Memory of state anxiety and pain reported during tooth extraction, not depression or state anxiety at the time of extraction, were critical factors in memory of the pain associated with the procedure. At higher levels of depression, patients higher and lower in dental fear did not differ in report of pain. Future studies are needed to further clarify interactions of depression and dental fear over time.
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Affiliation(s)
- B N Kyle
- Department of Psychiatry and Behavioral Medicine, East Carolina University, Greenville, NC, USA
| | - D W McNeil
- Department of Psychology, West Virginia University, Morgantown, WV, USA Department of Dental Practice and Rural Health, West Virginia University, Morgantown, WV, USA
| | - B Weaver
- Department of Oral and Maxillofacial Surgery, West Virginia University, Morgantown, WV, USA
| | - T Wilson
- Department of Biobehavioral Health, Pennsylvania State University, University Park, PA, USA
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48
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Schmid P, Pinder SE, Bundred N, Wheatley D, Macaskill J, Zammit C, Hu J, Price R, Shia A, Lim L, Parker P, Molinero L, Yu J, O'Brien C, Wilson T, Savage H, Derynck M, Lackner MR, Amler L, Purushotham A, Thompson A, Gendreau S. Abstract P5-13-01: Transcript analysis of PI3K and immune-related genes and gene signatures in the pre- and post-treatment samples from the window of opportunity study of anastrozole and anastrozole with pictilisib (GDC-0941) in patients with HR-positive early breast cancer (OPPORTUNE study). Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p5-13-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The OPPORTUNE Study randomized postmenopausal patients (pts) to receive 2-week preoperative treatment with anastrozole (ANA) plus pictilisib ("ANA+PIC" arm) or ANA alone. Patients had newly diagnosed, operable, ER+, HER2- invasive breast cancer of ≥1 cm size. The primary outcome at interim analysis (n=70) revealed that the addition of PIC significantly increased the anti-proliferative response to ANA as measured by reduction in Ki67 immunohistochemistry (IHC). Multivariate analyses suggested benefit of PIC for patients with luminal B disease (Schmid et al. SABCS 2014).
Methods: RNA expression analysis of ∼800 breast cancer-related genes was performed on patients analyzed at the interim analysis, including 14 (ANA) and 20 (ANA+PIC) patients with matched pre- and post- treatment paired tumour samples using the nCounter platform (NanoString). Differential expression of individual genes by arm was assessed using paired and moderated t-tests and statistical significance assessed through false discovery rate (FDR). Ingenuity Pathway Analysis (IPA) of differentially expressed transcripts identified pathways of relevance. Protein expression was analyzed by reverse protein array ( RPPA) in pre- and post-treatment samples.
Results: In an unsupervised analysis, down-regulation of genes associated with ER signaling was observed in patients who received single-agent ANA and ANA+PIC, which included genes that regulate the cell cycle, cell death, survival, growth and proliferation and known ER target genes (e.g., PGR, GREB1). In addition, transcripts related to growth factor signaling pathway appeared to be specifically modulated in the ANA+PIC arm, possibly via the upregulation of the expression of RTK ligands. There were no clear changes in PI3K-related phosphoproteins (e.g., AKT, S6, 4E-BP1) in the post-treatment samples by RPPA. However, known PI3K-regulated genes, IRS2 and PIK3IP1, were upregulated in the post-treatment samples and a composite PI3K gene expression signature score (O'Brien et al. 2010) was reduced in both study arms following treatment. This PI3K signature was associated with pre-treatment luminal B status (n=27) and, consistent with this finding, the baseline PI3K gene signature score in the ANA arm, but not the ANA+PIC arm, was inversely associated with the decrease in post treatment Ki67. The tumor immune microenvironment was analyzed though the use of composite gene sets. In our initial observations, analysis of pre- and post-treatment samples showed that 2-week treatment with ANA resulted in a modest increase in transcripts associated with multiple immune signatures, which was further enhanced by the addition of PIC.
Conclusions: Gene expression analysis of pre- and post-treatment samples in the OPPORTUNE study demonstrates on-target inhibition of ER and PI3K signaling networks. The analysis of additional paired samples is in progress to further assess if 2-weeks of treatment with a regimen containing an AI in patients with early breast cancer impacts the tumor immune microenvironment.
Citation Format: Schmid P, Pinder SE, Bundred N, Wheatley D, Macaskill J, Zammit C, Hu J, Price R, Shia A, Lim L, Parker P, Molinero L, Yu J, O'Brien C, Wilson T, Savage H, Derynck M, Lackner MR, Amler L, Purushotham A, Thompson A, Gendreau S. Transcript analysis of PI3K and immune-related genes and gene signatures in the pre- and post-treatment samples from the window of opportunity study of anastrozole and anastrozole with pictilisib (GDC-0941) in patients with HR-positive early breast cancer (OPPORTUNE study). [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P5-13-01.
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Affiliation(s)
- P Schmid
- Barts Cancer Institute, Queen Mary University London, London, United Kingdom; Kings College London, London, United Kingdom; Guys and St Thomas NHS Trust, Kings College London, London, United Kingdom; University Hospital of South Manchester, Manchester, United Kingdom; Royal Cornwall Hospital, Truro, United Kingdom; Ninewells Hospital Dundee, Dundee, United Kingdom; Brighton and Sussex University Hospital NHS Trust, Brighton, United Kingdom; Barts Health NHS Trust, London, United Kingdom; Kings College Hospital, London, United Kingdom; MD Anderson Cancer Centre, Houston, TX; Genentech, South San Francisco, California, South San Francisco, CA
| | - SE Pinder
- Barts Cancer Institute, Queen Mary University London, London, United Kingdom; Kings College London, London, United Kingdom; Guys and St Thomas NHS Trust, Kings College London, London, United Kingdom; University Hospital of South Manchester, Manchester, United Kingdom; Royal Cornwall Hospital, Truro, United Kingdom; Ninewells Hospital Dundee, Dundee, United Kingdom; Brighton and Sussex University Hospital NHS Trust, Brighton, United Kingdom; Barts Health NHS Trust, London, United Kingdom; Kings College Hospital, London, United Kingdom; MD Anderson Cancer Centre, Houston, TX; Genentech, South San Francisco, California, South San Francisco, CA
| | - N Bundred
- Barts Cancer Institute, Queen Mary University London, London, United Kingdom; Kings College London, London, United Kingdom; Guys and St Thomas NHS Trust, Kings College London, London, United Kingdom; University Hospital of South Manchester, Manchester, United Kingdom; Royal Cornwall Hospital, Truro, United Kingdom; Ninewells Hospital Dundee, Dundee, United Kingdom; Brighton and Sussex University Hospital NHS Trust, Brighton, United Kingdom; Barts Health NHS Trust, London, United Kingdom; Kings College Hospital, London, United Kingdom; MD Anderson Cancer Centre, Houston, TX; Genentech, South San Francisco, California, South San Francisco, CA
| | - D Wheatley
- Barts Cancer Institute, Queen Mary University London, London, United Kingdom; Kings College London, London, United Kingdom; Guys and St Thomas NHS Trust, Kings College London, London, United Kingdom; University Hospital of South Manchester, Manchester, United Kingdom; Royal Cornwall Hospital, Truro, United Kingdom; Ninewells Hospital Dundee, Dundee, United Kingdom; Brighton and Sussex University Hospital NHS Trust, Brighton, United Kingdom; Barts Health NHS Trust, London, United Kingdom; Kings College Hospital, London, United Kingdom; MD Anderson Cancer Centre, Houston, TX; Genentech, South San Francisco, California, South San Francisco, CA
| | - J Macaskill
- Barts Cancer Institute, Queen Mary University London, London, United Kingdom; Kings College London, London, United Kingdom; Guys and St Thomas NHS Trust, Kings College London, London, United Kingdom; University Hospital of South Manchester, Manchester, United Kingdom; Royal Cornwall Hospital, Truro, United Kingdom; Ninewells Hospital Dundee, Dundee, United Kingdom; Brighton and Sussex University Hospital NHS Trust, Brighton, United Kingdom; Barts Health NHS Trust, London, United Kingdom; Kings College Hospital, London, United Kingdom; MD Anderson Cancer Centre, Houston, TX; Genentech, South San Francisco, California, South San Francisco, CA
| | - C Zammit
- Barts Cancer Institute, Queen Mary University London, London, United Kingdom; Kings College London, London, United Kingdom; Guys and St Thomas NHS Trust, Kings College London, London, United Kingdom; University Hospital of South Manchester, Manchester, United Kingdom; Royal Cornwall Hospital, Truro, United Kingdom; Ninewells Hospital Dundee, Dundee, United Kingdom; Brighton and Sussex University Hospital NHS Trust, Brighton, United Kingdom; Barts Health NHS Trust, London, United Kingdom; Kings College Hospital, London, United Kingdom; MD Anderson Cancer Centre, Houston, TX; Genentech, South San Francisco, California, South San Francisco, CA
| | - J Hu
- Barts Cancer Institute, Queen Mary University London, London, United Kingdom; Kings College London, London, United Kingdom; Guys and St Thomas NHS Trust, Kings College London, London, United Kingdom; University Hospital of South Manchester, Manchester, United Kingdom; Royal Cornwall Hospital, Truro, United Kingdom; Ninewells Hospital Dundee, Dundee, United Kingdom; Brighton and Sussex University Hospital NHS Trust, Brighton, United Kingdom; Barts Health NHS Trust, London, United Kingdom; Kings College Hospital, London, United Kingdom; MD Anderson Cancer Centre, Houston, TX; Genentech, South San Francisco, California, South San Francisco, CA
| | - R Price
- Barts Cancer Institute, Queen Mary University London, London, United Kingdom; Kings College London, London, United Kingdom; Guys and St Thomas NHS Trust, Kings College London, London, United Kingdom; University Hospital of South Manchester, Manchester, United Kingdom; Royal Cornwall Hospital, Truro, United Kingdom; Ninewells Hospital Dundee, Dundee, United Kingdom; Brighton and Sussex University Hospital NHS Trust, Brighton, United Kingdom; Barts Health NHS Trust, London, United Kingdom; Kings College Hospital, London, United Kingdom; MD Anderson Cancer Centre, Houston, TX; Genentech, South San Francisco, California, South San Francisco, CA
| | - A Shia
- Barts Cancer Institute, Queen Mary University London, London, United Kingdom; Kings College London, London, United Kingdom; Guys and St Thomas NHS Trust, Kings College London, London, United Kingdom; University Hospital of South Manchester, Manchester, United Kingdom; Royal Cornwall Hospital, Truro, United Kingdom; Ninewells Hospital Dundee, Dundee, United Kingdom; Brighton and Sussex University Hospital NHS Trust, Brighton, United Kingdom; Barts Health NHS Trust, London, United Kingdom; Kings College Hospital, London, United Kingdom; MD Anderson Cancer Centre, Houston, TX; Genentech, South San Francisco, California, South San Francisco, CA
| | - L Lim
- Barts Cancer Institute, Queen Mary University London, London, United Kingdom; Kings College London, London, United Kingdom; Guys and St Thomas NHS Trust, Kings College London, London, United Kingdom; University Hospital of South Manchester, Manchester, United Kingdom; Royal Cornwall Hospital, Truro, United Kingdom; Ninewells Hospital Dundee, Dundee, United Kingdom; Brighton and Sussex University Hospital NHS Trust, Brighton, United Kingdom; Barts Health NHS Trust, London, United Kingdom; Kings College Hospital, London, United Kingdom; MD Anderson Cancer Centre, Houston, TX; Genentech, South San Francisco, California, South San Francisco, CA
| | - P Parker
- Barts Cancer Institute, Queen Mary University London, London, United Kingdom; Kings College London, London, United Kingdom; Guys and St Thomas NHS Trust, Kings College London, London, United Kingdom; University Hospital of South Manchester, Manchester, United Kingdom; Royal Cornwall Hospital, Truro, United Kingdom; Ninewells Hospital Dundee, Dundee, United Kingdom; Brighton and Sussex University Hospital NHS Trust, Brighton, United Kingdom; Barts Health NHS Trust, London, United Kingdom; Kings College Hospital, London, United Kingdom; MD Anderson Cancer Centre, Houston, TX; Genentech, South San Francisco, California, South San Francisco, CA
| | - L Molinero
- Barts Cancer Institute, Queen Mary University London, London, United Kingdom; Kings College London, London, United Kingdom; Guys and St Thomas NHS Trust, Kings College London, London, United Kingdom; University Hospital of South Manchester, Manchester, United Kingdom; Royal Cornwall Hospital, Truro, United Kingdom; Ninewells Hospital Dundee, Dundee, United Kingdom; Brighton and Sussex University Hospital NHS Trust, Brighton, United Kingdom; Barts Health NHS Trust, London, United Kingdom; Kings College Hospital, London, United Kingdom; MD Anderson Cancer Centre, Houston, TX; Genentech, South San Francisco, California, South San Francisco, CA
| | - J Yu
- Barts Cancer Institute, Queen Mary University London, London, United Kingdom; Kings College London, London, United Kingdom; Guys and St Thomas NHS Trust, Kings College London, London, United Kingdom; University Hospital of South Manchester, Manchester, United Kingdom; Royal Cornwall Hospital, Truro, United Kingdom; Ninewells Hospital Dundee, Dundee, United Kingdom; Brighton and Sussex University Hospital NHS Trust, Brighton, United Kingdom; Barts Health NHS Trust, London, United Kingdom; Kings College Hospital, London, United Kingdom; MD Anderson Cancer Centre, Houston, TX; Genentech, South San Francisco, California, South San Francisco, CA
| | - C O'Brien
- Barts Cancer Institute, Queen Mary University London, London, United Kingdom; Kings College London, London, United Kingdom; Guys and St Thomas NHS Trust, Kings College London, London, United Kingdom; University Hospital of South Manchester, Manchester, United Kingdom; Royal Cornwall Hospital, Truro, United Kingdom; Ninewells Hospital Dundee, Dundee, United Kingdom; Brighton and Sussex University Hospital NHS Trust, Brighton, United Kingdom; Barts Health NHS Trust, London, United Kingdom; Kings College Hospital, London, United Kingdom; MD Anderson Cancer Centre, Houston, TX; Genentech, South San Francisco, California, South San Francisco, CA
| | - T Wilson
- Barts Cancer Institute, Queen Mary University London, London, United Kingdom; Kings College London, London, United Kingdom; Guys and St Thomas NHS Trust, Kings College London, London, United Kingdom; University Hospital of South Manchester, Manchester, United Kingdom; Royal Cornwall Hospital, Truro, United Kingdom; Ninewells Hospital Dundee, Dundee, United Kingdom; Brighton and Sussex University Hospital NHS Trust, Brighton, United Kingdom; Barts Health NHS Trust, London, United Kingdom; Kings College Hospital, London, United Kingdom; MD Anderson Cancer Centre, Houston, TX; Genentech, South San Francisco, California, South San Francisco, CA
| | - H Savage
- Barts Cancer Institute, Queen Mary University London, London, United Kingdom; Kings College London, London, United Kingdom; Guys and St Thomas NHS Trust, Kings College London, London, United Kingdom; University Hospital of South Manchester, Manchester, United Kingdom; Royal Cornwall Hospital, Truro, United Kingdom; Ninewells Hospital Dundee, Dundee, United Kingdom; Brighton and Sussex University Hospital NHS Trust, Brighton, United Kingdom; Barts Health NHS Trust, London, United Kingdom; Kings College Hospital, London, United Kingdom; MD Anderson Cancer Centre, Houston, TX; Genentech, South San Francisco, California, South San Francisco, CA
| | - M Derynck
- Barts Cancer Institute, Queen Mary University London, London, United Kingdom; Kings College London, London, United Kingdom; Guys and St Thomas NHS Trust, Kings College London, London, United Kingdom; University Hospital of South Manchester, Manchester, United Kingdom; Royal Cornwall Hospital, Truro, United Kingdom; Ninewells Hospital Dundee, Dundee, United Kingdom; Brighton and Sussex University Hospital NHS Trust, Brighton, United Kingdom; Barts Health NHS Trust, London, United Kingdom; Kings College Hospital, London, United Kingdom; MD Anderson Cancer Centre, Houston, TX; Genentech, South San Francisco, California, South San Francisco, CA
| | - MR Lackner
- Barts Cancer Institute, Queen Mary University London, London, United Kingdom; Kings College London, London, United Kingdom; Guys and St Thomas NHS Trust, Kings College London, London, United Kingdom; University Hospital of South Manchester, Manchester, United Kingdom; Royal Cornwall Hospital, Truro, United Kingdom; Ninewells Hospital Dundee, Dundee, United Kingdom; Brighton and Sussex University Hospital NHS Trust, Brighton, United Kingdom; Barts Health NHS Trust, London, United Kingdom; Kings College Hospital, London, United Kingdom; MD Anderson Cancer Centre, Houston, TX; Genentech, South San Francisco, California, South San Francisco, CA
| | - L Amler
- Barts Cancer Institute, Queen Mary University London, London, United Kingdom; Kings College London, London, United Kingdom; Guys and St Thomas NHS Trust, Kings College London, London, United Kingdom; University Hospital of South Manchester, Manchester, United Kingdom; Royal Cornwall Hospital, Truro, United Kingdom; Ninewells Hospital Dundee, Dundee, United Kingdom; Brighton and Sussex University Hospital NHS Trust, Brighton, United Kingdom; Barts Health NHS Trust, London, United Kingdom; Kings College Hospital, London, United Kingdom; MD Anderson Cancer Centre, Houston, TX; Genentech, South San Francisco, California, South San Francisco, CA
| | - A Purushotham
- Barts Cancer Institute, Queen Mary University London, London, United Kingdom; Kings College London, London, United Kingdom; Guys and St Thomas NHS Trust, Kings College London, London, United Kingdom; University Hospital of South Manchester, Manchester, United Kingdom; Royal Cornwall Hospital, Truro, United Kingdom; Ninewells Hospital Dundee, Dundee, United Kingdom; Brighton and Sussex University Hospital NHS Trust, Brighton, United Kingdom; Barts Health NHS Trust, London, United Kingdom; Kings College Hospital, London, United Kingdom; MD Anderson Cancer Centre, Houston, TX; Genentech, South San Francisco, California, South San Francisco, CA
| | - A Thompson
- Barts Cancer Institute, Queen Mary University London, London, United Kingdom; Kings College London, London, United Kingdom; Guys and St Thomas NHS Trust, Kings College London, London, United Kingdom; University Hospital of South Manchester, Manchester, United Kingdom; Royal Cornwall Hospital, Truro, United Kingdom; Ninewells Hospital Dundee, Dundee, United Kingdom; Brighton and Sussex University Hospital NHS Trust, Brighton, United Kingdom; Barts Health NHS Trust, London, United Kingdom; Kings College Hospital, London, United Kingdom; MD Anderson Cancer Centre, Houston, TX; Genentech, South San Francisco, California, South San Francisco, CA
| | - S Gendreau
- Barts Cancer Institute, Queen Mary University London, London, United Kingdom; Kings College London, London, United Kingdom; Guys and St Thomas NHS Trust, Kings College London, London, United Kingdom; University Hospital of South Manchester, Manchester, United Kingdom; Royal Cornwall Hospital, Truro, United Kingdom; Ninewells Hospital Dundee, Dundee, United Kingdom; Brighton and Sussex University Hospital NHS Trust, Brighton, United Kingdom; Barts Health NHS Trust, London, United Kingdom; Kings College Hospital, London, United Kingdom; MD Anderson Cancer Centre, Houston, TX; Genentech, South San Francisco, California, South San Francisco, CA
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Baselga J, Cortés J, De Laurentiis M, Diéras V, Harbeck N, Hsu J, Jin H, Schimmoller F, Wilson TR, Im YH, Jacot W, Krop IE, Verma S. Abstract OT1-03-14: SANDPIPER: Phase III study of the PI3-kinase inhibitor taselisib (GDC-0032) plus fulvestrant in patients with estrogen receptor-positive, HER2-negative locally advanced or metastatic breast cancer enriched for patients with PIK3CA-mutant tumors. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-ot1-03-14] [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: PIK3CA mutations are one of the most frequent genomic alterations in breast cancer (BC), being present in ∼40% of estrogen receptor (ER)-positive, HER2-negative breast tumors. PIK3CA mutations promote growth and proliferation of tumors and mediate resistance to endocrine therapies in BC. Taselisib is a potent and selective PI3-kinase (PI3K) inhibitor that displays greater selectivity for mutant PI3Kα than wild-type PI3Kα. Taselisib has enhanced activity against PIK3CA-mutant BC cell lines, and clinical data include confirmed partial responses in patients with PIK3CA-mutant BC treated with taselisib either as a single agent or in combination with fulvestrant.
Trial design: SANDPIPER is a double-blind, placebo-controlled, randomized, phase III study, designed to evaluate efficacy and safety of taselisib plus fulvestrant in patients with ER-positive, HER2-negative locally advanced or metastatic BC. Patients will be randomized 2:1 to receive either taselisib (4 mg daily) or placebo in combination with fulvestrant (500 mg intramuscular on Days 1 and 15 of Cycle 1, and on Day 1 of each subsequent 28-day cycle). Randomization will be stratified by visceral disease, endocrine sensitivity, and geographical region. The study enriches for patients with PIK3CA-mutant tumors who will be randomized separately from patients with non-mutant tumors.
Eligibility: Postmenopausal women with ER-positive, HER2-negative, locally advanced or metastatic BC are eligible if they have disease recurrence or progression during or after aromatase inhibitor treatment. A valid PIK3CA-mutation result via central assessment is required prior to enrollment.
Aims: The primary efficacy endpoint is investigator-assessed progression-free survival (PFS) in patients with PIK3CA-mutant tumors. Other endpoints include overall survival (OS), objective response rate (ORR), clinical benefit rate (CBR), duration of objective response, safety, pharmacokinetics, and patient-reported outcomes. Efficacy in patients without PIK3CA-mutant tumors will be an exploratory endpoint.
Statistical methods: The primary efficacy analysis population will include all randomized patients with PIK3CA-mutant tumors. Patients will be grouped according to treatment arm assigned at randomization. Median PFS and OS will be estimated using Kaplan-Meier methodology in each treatment arm. Cox proportional-hazards models will be used to estimate the hazard ratio with 95% confidence intervals (CIs). ORR, CBR, and their 95% CIs will be estimated by treatment arms. Duration of objective response will be estimated by treatment arms using the Kaplan-Meier methodology. Quality of life will be analyzed and summarized by treatment arms. Safety will be analyzed for all treated patients according to actual treatment received.
Accrual: Target enrollment is 600 pts from ∼165 sites and ∼23 countries. The study is open for enrollment and 11 patients have been enrolled as of May 31, 2015. Clinicaltrials.gov ID: NCT02340221.
Contact information: For more information or to refer a patient, email global.rochegenentechtrials@roche.com or call 1-888-662-6728 (USA only).
Citation Format: Baselga J, Cortés J, De Laurentiis M, Diéras V, Harbeck N, Hsu J, Jin H, Schimmoller F, Wilson TR, Im Y-H, Jacot W, Krop IE, Verma S. SANDPIPER: Phase III study of the PI3-kinase inhibitor taselisib (GDC-0032) plus fulvestrant in patients with estrogen receptor-positive, HER2-negative locally advanced or metastatic breast cancer enriched for patients with PIK3CA-mutant tumors. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr OT1-03-14.
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Affiliation(s)
- J Baselga
- Memorial Sloan-Kettering Cancer Center, Memorial Hospital, NY, NY; Vall d'Hebron University Hospital, Barcelona, Spain; Istituto Nazionale Tumori Fondazione G. Pascale, Naples, Italy; Institut Curie, Paris, France; Brustzentrum der Universität München, Munich, Germany; Genentech Inc., South San Francisco, CA; Samsung Medical Center, Seoul, Korea; Institut du Cancer de Montpellier, Montpellier, France; Dana-Farber Cancer Institute, Boston, MA; Division of Medical Oncology, Sunnybrook Odette Cancer Centre, Toronto, ON, Canada
| | - J Cortés
- Memorial Sloan-Kettering Cancer Center, Memorial Hospital, NY, NY; Vall d'Hebron University Hospital, Barcelona, Spain; Istituto Nazionale Tumori Fondazione G. Pascale, Naples, Italy; Institut Curie, Paris, France; Brustzentrum der Universität München, Munich, Germany; Genentech Inc., South San Francisco, CA; Samsung Medical Center, Seoul, Korea; Institut du Cancer de Montpellier, Montpellier, France; Dana-Farber Cancer Institute, Boston, MA; Division of Medical Oncology, Sunnybrook Odette Cancer Centre, Toronto, ON, Canada
| | - M De Laurentiis
- Memorial Sloan-Kettering Cancer Center, Memorial Hospital, NY, NY; Vall d'Hebron University Hospital, Barcelona, Spain; Istituto Nazionale Tumori Fondazione G. Pascale, Naples, Italy; Institut Curie, Paris, France; Brustzentrum der Universität München, Munich, Germany; Genentech Inc., South San Francisco, CA; Samsung Medical Center, Seoul, Korea; Institut du Cancer de Montpellier, Montpellier, France; Dana-Farber Cancer Institute, Boston, MA; Division of Medical Oncology, Sunnybrook Odette Cancer Centre, Toronto, ON, Canada
| | - V Diéras
- Memorial Sloan-Kettering Cancer Center, Memorial Hospital, NY, NY; Vall d'Hebron University Hospital, Barcelona, Spain; Istituto Nazionale Tumori Fondazione G. Pascale, Naples, Italy; Institut Curie, Paris, France; Brustzentrum der Universität München, Munich, Germany; Genentech Inc., South San Francisco, CA; Samsung Medical Center, Seoul, Korea; Institut du Cancer de Montpellier, Montpellier, France; Dana-Farber Cancer Institute, Boston, MA; Division of Medical Oncology, Sunnybrook Odette Cancer Centre, Toronto, ON, Canada
| | - N Harbeck
- Memorial Sloan-Kettering Cancer Center, Memorial Hospital, NY, NY; Vall d'Hebron University Hospital, Barcelona, Spain; Istituto Nazionale Tumori Fondazione G. Pascale, Naples, Italy; Institut Curie, Paris, France; Brustzentrum der Universität München, Munich, Germany; Genentech Inc., South San Francisco, CA; Samsung Medical Center, Seoul, Korea; Institut du Cancer de Montpellier, Montpellier, France; Dana-Farber Cancer Institute, Boston, MA; Division of Medical Oncology, Sunnybrook Odette Cancer Centre, Toronto, ON, Canada
| | - J Hsu
- Memorial Sloan-Kettering Cancer Center, Memorial Hospital, NY, NY; Vall d'Hebron University Hospital, Barcelona, Spain; Istituto Nazionale Tumori Fondazione G. Pascale, Naples, Italy; Institut Curie, Paris, France; Brustzentrum der Universität München, Munich, Germany; Genentech Inc., South San Francisco, CA; Samsung Medical Center, Seoul, Korea; Institut du Cancer de Montpellier, Montpellier, France; Dana-Farber Cancer Institute, Boston, MA; Division of Medical Oncology, Sunnybrook Odette Cancer Centre, Toronto, ON, Canada
| | - H Jin
- Memorial Sloan-Kettering Cancer Center, Memorial Hospital, NY, NY; Vall d'Hebron University Hospital, Barcelona, Spain; Istituto Nazionale Tumori Fondazione G. Pascale, Naples, Italy; Institut Curie, Paris, France; Brustzentrum der Universität München, Munich, Germany; Genentech Inc., South San Francisco, CA; Samsung Medical Center, Seoul, Korea; Institut du Cancer de Montpellier, Montpellier, France; Dana-Farber Cancer Institute, Boston, MA; Division of Medical Oncology, Sunnybrook Odette Cancer Centre, Toronto, ON, Canada
| | - F Schimmoller
- Memorial Sloan-Kettering Cancer Center, Memorial Hospital, NY, NY; Vall d'Hebron University Hospital, Barcelona, Spain; Istituto Nazionale Tumori Fondazione G. Pascale, Naples, Italy; Institut Curie, Paris, France; Brustzentrum der Universität München, Munich, Germany; Genentech Inc., South San Francisco, CA; Samsung Medical Center, Seoul, Korea; Institut du Cancer de Montpellier, Montpellier, France; Dana-Farber Cancer Institute, Boston, MA; Division of Medical Oncology, Sunnybrook Odette Cancer Centre, Toronto, ON, Canada
| | - TR Wilson
- Memorial Sloan-Kettering Cancer Center, Memorial Hospital, NY, NY; Vall d'Hebron University Hospital, Barcelona, Spain; Istituto Nazionale Tumori Fondazione G. Pascale, Naples, Italy; Institut Curie, Paris, France; Brustzentrum der Universität München, Munich, Germany; Genentech Inc., South San Francisco, CA; Samsung Medical Center, Seoul, Korea; Institut du Cancer de Montpellier, Montpellier, France; Dana-Farber Cancer Institute, Boston, MA; Division of Medical Oncology, Sunnybrook Odette Cancer Centre, Toronto, ON, Canada
| | - Y-H Im
- Memorial Sloan-Kettering Cancer Center, Memorial Hospital, NY, NY; Vall d'Hebron University Hospital, Barcelona, Spain; Istituto Nazionale Tumori Fondazione G. Pascale, Naples, Italy; Institut Curie, Paris, France; Brustzentrum der Universität München, Munich, Germany; Genentech Inc., South San Francisco, CA; Samsung Medical Center, Seoul, Korea; Institut du Cancer de Montpellier, Montpellier, France; Dana-Farber Cancer Institute, Boston, MA; Division of Medical Oncology, Sunnybrook Odette Cancer Centre, Toronto, ON, Canada
| | - W Jacot
- Memorial Sloan-Kettering Cancer Center, Memorial Hospital, NY, NY; Vall d'Hebron University Hospital, Barcelona, Spain; Istituto Nazionale Tumori Fondazione G. Pascale, Naples, Italy; Institut Curie, Paris, France; Brustzentrum der Universität München, Munich, Germany; Genentech Inc., South San Francisco, CA; Samsung Medical Center, Seoul, Korea; Institut du Cancer de Montpellier, Montpellier, France; Dana-Farber Cancer Institute, Boston, MA; Division of Medical Oncology, Sunnybrook Odette Cancer Centre, Toronto, ON, Canada
| | - IE Krop
- Memorial Sloan-Kettering Cancer Center, Memorial Hospital, NY, NY; Vall d'Hebron University Hospital, Barcelona, Spain; Istituto Nazionale Tumori Fondazione G. Pascale, Naples, Italy; Institut Curie, Paris, France; Brustzentrum der Universität München, Munich, Germany; Genentech Inc., South San Francisco, CA; Samsung Medical Center, Seoul, Korea; Institut du Cancer de Montpellier, Montpellier, France; Dana-Farber Cancer Institute, Boston, MA; Division of Medical Oncology, Sunnybrook Odette Cancer Centre, Toronto, ON, Canada
| | - S Verma
- Memorial Sloan-Kettering Cancer Center, Memorial Hospital, NY, NY; Vall d'Hebron University Hospital, Barcelona, Spain; Istituto Nazionale Tumori Fondazione G. Pascale, Naples, Italy; Institut Curie, Paris, France; Brustzentrum der Universität München, Munich, Germany; Genentech Inc., South San Francisco, CA; Samsung Medical Center, Seoul, Korea; Institut du Cancer de Montpellier, Montpellier, France; Dana-Farber Cancer Institute, Boston, MA; Division of Medical Oncology, Sunnybrook Odette Cancer Centre, Toronto, ON, Canada
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Ong CC, Blackwood E, Jakubiak D, Daemen A, Ramaswamy S, Heise C, Schmidt M, Sanders L, Wilson TR, Huw L, Ndubaku C, Rudolph J, Hoeflich KP, Friedman L, O'Brien T. Abstract PD3-04: PAK-1 amplified breast cancer cell lines are preferentially sensitive to PAK inhibition with G-5555. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-pd3-04] [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
The small GTP-binding proteins Rac1 and Cdc42 stimulate activity of the serine/threonine kinase p21-activated kinase-1 (PAK-1) to drive growth factor signaling networks and Ras-driven tumorigenesis. Genomic amplification and over-expression of PAK1 are prevalent in luminal breast cancer and correlate with poor clinical outcome. Here we use a novel and selective small molecule inhibitor, G-5555, of the group I PAKs (PAK1, 2, and 3) to evaluate the importance of PAK1 in promoting growth of PAK1 amplified breast cancer cells. Cell lines with amplification of PAK1 were found to be more sensitive to PAK1 inhibition than non-amplified cell lines. Additionally, reverse phase protein array (RPPA) was used to assess the effects of PAK1 inhibition on a wide range of signaling pathways in both amplified and non-amplified cell lines. Reduced levels of phosphorylation of MEK S298 was observed in all cell lines exposed to G-5555 irrespective of amplification status, consistent with PAK1 inhibition in these cell lines. However, modulation of this downstream PAK1 substrate did not correlate with inhibition of cell proliferation or induction of cell death. Cell lines that showed inhibition of proliferation in response to G-5555 also showed enhanced levels of cell death along with apoptosis. Moreover, G-5555 reduced tumor growth in the PAK1 amplified MDA-MB-175 xenograft tumor model. Finally, we compared the in vitro activity of G-5555 with palbociclib, a recently approved inhibitor of the cyclin-dependent kinases CDK4 and CDK6, in PAK1 amplified luminal breast cancer cell lines. Our data supports PAK1 as an attractive target in PAK1 amplified cells and tumors and suggests that inhibiting PAK1 rather than CDK4/6 in this context may be a more attractive therapeutic strategy.
Citation Format: Ong CC, Blackwood E, Jakubiak D, Daemen A, Ramaswamy S, Heise C, Schmidt M, Sanders L, Wilson TR, Huw L, Ndubaku C, Rudolph J, Hoeflich KP, Friedman L, O'Brien T. PAK-1 amplified breast cancer cell lines are preferentially sensitive to PAK inhibition with G-5555. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr PD3-04.
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Affiliation(s)
- CC Ong
- Genentech, Inc, South San Francisco, CA; Blueprint Medicines, Cambridge, MA
| | - E Blackwood
- Genentech, Inc, South San Francisco, CA; Blueprint Medicines, Cambridge, MA
| | - D Jakubiak
- Genentech, Inc, South San Francisco, CA; Blueprint Medicines, Cambridge, MA
| | - A Daemen
- Genentech, Inc, South San Francisco, CA; Blueprint Medicines, Cambridge, MA
| | - S Ramaswamy
- Genentech, Inc, South San Francisco, CA; Blueprint Medicines, Cambridge, MA
| | - C Heise
- Genentech, Inc, South San Francisco, CA; Blueprint Medicines, Cambridge, MA
| | - M Schmidt
- Genentech, Inc, South San Francisco, CA; Blueprint Medicines, Cambridge, MA
| | - L Sanders
- Genentech, Inc, South San Francisco, CA; Blueprint Medicines, Cambridge, MA
| | - TR Wilson
- Genentech, Inc, South San Francisco, CA; Blueprint Medicines, Cambridge, MA
| | - L Huw
- Genentech, Inc, South San Francisco, CA; Blueprint Medicines, Cambridge, MA
| | - C Ndubaku
- Genentech, Inc, South San Francisco, CA; Blueprint Medicines, Cambridge, MA
| | - J Rudolph
- Genentech, Inc, South San Francisco, CA; Blueprint Medicines, Cambridge, MA
| | - KP Hoeflich
- Genentech, Inc, South San Francisco, CA; Blueprint Medicines, Cambridge, MA
| | - L Friedman
- Genentech, Inc, South San Francisco, CA; Blueprint Medicines, Cambridge, MA
| | - T O'Brien
- Genentech, Inc, South San Francisco, CA; Blueprint Medicines, Cambridge, MA
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