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Gately L, Mesía C, Sepúlveda JM, Del Barco S, Pineda E, Gironés R, Fuster J, Hong W, Dumas M, Gill S, Navarro LM, Herrero A, Dowling A, de Las Peñas R, Vaz MA, Alonso M, Lwin Z, Harrup R, Peralta S, Long A, Perez-Segura P, Ahern E, Garate CO, Wong M, Campbell R, Cuff K, Jennens R, Gallego O, Underhill C, Martinez-Garcia M, Covela M, Cooper A, Brown S, Rosenthal M, Torres J, Collins IM, Gibbs P, Balana C. Correction to: A combined analysis of two prospective randomised studies exploring the impact of extended post-radiation temozolomide on survival outcomes in newly diagnosed glioblastoma. J Neurooncol 2024; 166:417-418. [PMID: 38289531 DOI: 10.1007/s11060-024-04581-x] [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: 02/01/2024]
Affiliation(s)
- L Gately
- Personalised Oncology Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia.
- Department of Medical Oncology, Alfred Health, Melbourne, VIC, Australia.
| | - C Mesía
- Medical Oncology Service, Institut Català d'Oncologia, Hospitalet de Llobregat, Barcelona, Spain
| | - J M Sepúlveda
- Medical Oncology Service, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - S Del Barco
- Medical Oncology Service, Institut Català d'Oncologia Girona, Girona, Spain
| | - E Pineda
- Medical Oncology Service, Hospital Clinic de Barcelona, Barcelona, Spain
| | - R Gironés
- Medical Oncology Service, Hospital Universitario La Fe, Valencia, Spain
| | - J Fuster
- Medical Oncology Service, Hospital Son Espases, Palma de Mallorca, Spain
| | - W Hong
- Personalised Oncology Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
| | - M Dumas
- Personalised Oncology Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
| | - S Gill
- Department of Medical Oncology, Alfred Health, Melbourne, VIC, Australia
| | - L M Navarro
- Medical Oncology Service, Hospital de Salamanca, Salamanca, Spain
| | - A Herrero
- Medical Oncology Service, Hospital Miguel Servet, Zaragoza, Spain
| | - A Dowling
- Department of Medical Oncology, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
| | - R de Las Peñas
- Medical Oncology Service, Hospital Provincial de Castellón, Castellón, Spain
| | - M A Vaz
- Medical Oncology Service, Hospital Ramón y Cajal, Madrid, Spain
| | - M Alonso
- Medical Oncology Service, Hospital Virgen del Rocio, Seville, Spain
| | - Z Lwin
- Department of Medical Oncology, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - R Harrup
- Department of Medical Oncology, Royal Hobart Hospital, Hobart, TAS, Australia
| | - S Peralta
- Medical Oncology Service, Hospital Sant Joan de Reus, Reus, Spain
| | - A Long
- Department of Medical Oncology, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - P Perez-Segura
- Medical Oncology Service, Hospital Clinico San Carlos, Madrid, Spain
| | - E Ahern
- Department of Medical Oncology, Monash Health, Melbourne, VIC, Australia
| | - C O Garate
- Medical Oncology Service, Hospital Universitario Fundación Alcorcón, Alcorcón, Spain
| | - M Wong
- Department of Medical Oncology, Westmead Hospital, Westmead, NSW, Australia
| | - R Campbell
- Department of Medical Oncology, Bendigo Health, Bendigo, VIC, Australia
| | - K Cuff
- Department of Medical Oncology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - R Jennens
- Department of Medical Oncology, Epworth Health, Richmond, VIC, Australia
| | - O Gallego
- Medical Oncology Service, Hospital de La Santa Creu I Sant Pau, Barcelona, Spain
| | - C Underhill
- Department of Medical Oncology, Border Medical Oncology, East Albury, NSW, Australia
| | | | - M Covela
- Medical Oncology Service, Hospital Lucus Augusti, Lugo, Spain
| | - A Cooper
- Department of Medical Oncology, Liverpool Hospital, Liverpool, NSW, Australia
| | - S Brown
- Department of Medical Oncology, Ballarat Health Services, Ballarat, VIC, Australia
| | - M Rosenthal
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - J Torres
- Department of Medical Oncology, Goulburn Valley Health, Shepparton, VIC, Australia
| | - I M Collins
- Department of Medical Oncology, South West Regional Cancer Centre, Geelong, VIC, Australia
| | - P Gibbs
- Personalised Oncology Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
| | - C Balana
- Medical Oncology Service, Institut Català d'Oncologia, Badalona, Spain
- Badalona Applied Research Group in Oncology (B-ARGO), Institut Investigació Germans Trias I Pujol (IGTP), Badalona, Spain
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Gately L, Mesía C, Sepúlveda JM, Del Barco S, Pineda E, Gironés R, Fuster J, Hong W, Dumas M, Gill S, Navarro LM, Herrero A, Dowling A, de Las Peñas R, Vaz MA, Alonso M, Lwin Z, Harrup R, Peralta S, Long A, Perez-Segura P, Ahern E, Garate CO, Wong M, Campbell R, Cuff K, Jennens R, Gallego O, Underhill C, Martinez-Garcia M, Covela M, Cooper A, Brown S, Rosenthal M, Torres J, Collins IM, Gibbs P, Balana C. A combined analysis of two prospective randomised studies exploring the impact of extended post-radiation temozolomide on survival outcomes in newly diagnosed glioblastoma. J Neurooncol 2024; 166:407-415. [PMID: 38153582 DOI: 10.1007/s11060-023-04513-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 11/15/2023] [Indexed: 12/29/2023]
Abstract
PURPOSE The optimal duration of post-radiation temozolomide in newly diagnosed glioblastoma remains unclear, with no published phase III randomised trials. Standard-of-care stipulates 6 months. However, in routine care, it is often extended to 12 months, despite lacking robust supporting data. METHODS GEINO14-01 (Spain) and EX-TEM (Australia) studies enrolled glioblastoma patients without progression at the end of 6 months post-radiation temozolomide. Participants were randomised 1:1 to six additional months of temozolomide or observation. Primary endpoint was 6-month progression free survival from date of randomisation (6mPFS). Secondary endpoints included overall survival (OS) and toxicity. 204 patients were required to detect an improvement in 6mPFS from 50 to 60% (80% power). Neither study recruited sufficient patients. We performed a combined analysis of individual patient data. RESULTS 205 patients were recruited: 159 in GEINO14-01 (2014-2018) and 46 in EX-TEM (2019-2022). Median follow-up was 20.0 and 14.5 months. Baseline characteristics were balanced. There was no significant improvement in 6mPFS (57.2% vs 64.0%, OR0.75, p = 0.4), nor across any subgroups, including MGMT methylated; PFS (HR0.92, p = 0.59, median 7.8 vs 9.7 months); or OS (HR1.03, p = 0.87, median 20.1 vs 19.4 months). During treatment extension, 64% experienced any grade adverse event, mainly fatigue and gastrointestinal (both 54%). Only a minority required treatment changes: 4.5% dose delay, 7.5% dose reduction, 1.5% temozolomide discontinuation. CONCLUSION For glioblastoma patients, extending post-radiation temozolomide from 6 to 12 months is well tolerated but does not improve 6mPFS. We could not identify any subset that benefitted from extended treatment. Six months should remain standard-of-care.
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Affiliation(s)
- L Gately
- Personalised Oncology Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia.
- Department of Medical Oncology, Alfred Health, Melbourne, VIC, Australia.
| | - C Mesía
- Medical Oncology Service, Institut Català d'Oncologia, Hospitalet de Llobregat, Barcelona, Spain
| | - J M Sepúlveda
- Medical Oncology Service, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - S Del Barco
- Medical Oncology Service, Institut Català d'Oncologia Girona, Girona, Spain
| | - E Pineda
- Medical Oncology Service, Hospital Clinic de Barcelona, Barcelona, Spain
| | - R Gironés
- Medical Oncology Service, Hospital Universitario La Fe, Valencia, Spain
| | - J Fuster
- Medical Oncology Service, Hospital Son Espases, Palma de Mallorca, Spain
| | - W Hong
- Personalised Oncology Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
| | - M Dumas
- Personalised Oncology Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
| | - S Gill
- Department of Medical Oncology, Alfred Health, Melbourne, VIC, Australia
| | - L M Navarro
- Medical Oncology Service, Hospital de Salamanca, Salamanca, Spain
| | - A Herrero
- Medical Oncology Service, Hospital Miguel Servet, Zaragoza, Spain
| | - A Dowling
- Department of Medical Oncology, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
| | - R de Las Peñas
- Medical Oncology Service, Hospital Provincial de Castellón, Castellón, Spain
| | - M A Vaz
- Medical Oncology Service, Hospital Ramón y Cajal, Madrid, Spain
| | - M Alonso
- Medical Oncology Service, Hospital Virgen del Rocio, Seville, Spain
| | - Z Lwin
- Department of Medical Oncology, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - R Harrup
- Department of Medical Oncology, Royal Hobart Hospital, Hobart, TAS, Australia
| | - S Peralta
- Medical Oncology Service, Hospital Sant Joan de Reus, Reus, Spain
| | - A Long
- Department of Medical Oncology, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - P Perez-Segura
- Medical Oncology Service, Hospital Clinico San Carlos, Madrid, Spain
| | - E Ahern
- Department of Medical Oncology, Monash Health, Melbourne, VIC, Australia
| | - C O Garate
- Medical Oncology Service, Hospital Universitario Fundación Alcorcón, Alcorcón, Spain
| | - M Wong
- Department of Medical Oncology, Westmead Hospital, Westmead, NSW, Australia
| | - R Campbell
- Department of Medical Oncology, Bendigo Health, Bendigo, VIC, Australia
| | - K Cuff
- Department of Medical Oncology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - R Jennens
- Department of Medical Oncology, Epworth Health, Richmond, VIC, Australia
| | - O Gallego
- Medical Oncology Service, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
| | - C Underhill
- Department of Medical Oncology, Border Medical Oncology, East Albury, NSW, Australia
| | | | - M Covela
- Medical Oncology Service, Hospital Lucus Augusti, Lugo, Spain
| | - A Cooper
- Department of Medical Oncology, Liverpool Hospital, Liverpool, NSW, Australia
| | - S Brown
- Department of Medical Oncology, Ballarat Health Services, Ballarat, VIC, Australia
| | - M Rosenthal
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - J Torres
- Department of Medical Oncology, Goulburn Valley Health, Shepparton, VIC, Australia
| | - I M Collins
- Department of Medical Oncology, South West Regional Cancer Centre, Geelong, VIC, Australia
| | - P Gibbs
- Personalised Oncology Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
| | - C Balana
- Medical Oncology Service, Institut Català d'Oncologia, Badalona, Spain
- Badalona Applied Research Group in Oncology (B-ARGO), Institut Investigació Germans Trias i Pujol (IGTP), Badalona, Spain
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Ngo P, Karikios D, Goldsbury D, Wade S, Lwin Z, Hughes BGM, Fong KM, Canfell K, Weber M. Development and Validation of txSim: A Model of Advanced Lung Cancer Treatment in Australia. Pharmacoeconomics 2023; 41:1525-1537. [PMID: 37357233 PMCID: PMC10570197 DOI: 10.1007/s40273-023-01291-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/30/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND AND OBJECTIVE Since 2016, new therapies have transformed the standard of care for lung cancer, creating a need for up-to-date evidence for health economic modelling. We developed a discrete event simulation of advanced lung cancer treatment to provide estimates of survival outcomes and healthcare costs in the Australian setting that can be updated as new therapies are introduced. METHODS Treatment for advanced lung cancer was modelled under a clinician-specified treatment algorithm for Australia in 2022. Prevalence of lung cancer subpopulations was extracted from cBioPortal and the Sax Institute's 45 and Up Study, a large prospective cohort linked to cancer registrations. All costs were from the health system perspective for the year 2020. Pharmaceutical and molecular diagnostic costs were obtained from public reimbursement fees, while other healthcare costs were obtained from health system costs in the 45 and Up Study. Treatment efficacy was obtained from clinical trials and observational study data. Costs and survival were modelled over a 10-year horizon. Uncertainty intervals were generated with probabilistic sensitivity analyses. Overall survival predictions were validated against real-world studies. RESULTS Under the 2022 treatment algorithm, estimated mean survival and costs for advanced lung cancer 10 years post-diagnosis were 16.4 months (95% uncertainty interval [UI]: 14.7-18.1) and AU$116,069 (95% UI: $107,378-$124,933). Survival and costs were higher assuming optimal treatment utilisation rates (20.5 months, 95% UI: 19.1-22.5; $154,299, 95% UI: $146,499-$161,591). The model performed well in validation, with good agreement between predicted and observed survival in real-world studies. CONCLUSIONS Survival improvements for advanced lung cancer have been accompanied by growing treatment costs. The estimates reported here can be used for budget planning and economic evaluations of interventions across the spectrum of cancer control.
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Affiliation(s)
- Preston Ngo
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, 153 Dowling St, Woolloomooloo, Sydney, NSW, 2011, Australia.
| | - Deme Karikios
- Nepean Hospital, Sydney, NSW, Australia
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - David Goldsbury
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, 153 Dowling St, Woolloomooloo, Sydney, NSW, 2011, Australia
| | - Stephen Wade
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, 153 Dowling St, Woolloomooloo, Sydney, NSW, 2011, Australia
| | - Zarnie Lwin
- Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
- School of Medicine, University of Queensland, Brisbane, QLD, Australia
- The Prince Charles Hospital, Chermside, QLD, Australia
| | - Brett G M Hughes
- Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
- School of Medicine, University of Queensland, Brisbane, QLD, Australia
- The Prince Charles Hospital, Chermside, QLD, Australia
| | - Kwun M Fong
- The Prince Charles Hospital, Chermside, QLD, Australia
- The University of Queensland Thoracic Research Centre, Brisbane, QLD, Australia
| | - Karen Canfell
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, 153 Dowling St, Woolloomooloo, Sydney, NSW, 2011, Australia
| | - Marianne Weber
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, 153 Dowling St, Woolloomooloo, Sydney, NSW, 2011, Australia
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Lee CK, Soon YY, Jeffree RL, Joshi R, Koh ES, Lam WS, Le H, Lwin Z, Pinkham MB, Siva S, Ng E, John T. Management Paradigm of Central Nervous System Metastases in NSCLC: An Australian Perspective. JTO Clin Res Rep 2023; 4:100553. [PMID: 37663675 PMCID: PMC10472312 DOI: 10.1016/j.jtocrr.2023.100553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 07/05/2023] [Accepted: 07/21/2023] [Indexed: 09/05/2023] Open
Abstract
Life-prolonging central nervous system active systemic therapies for metastatic NSCLC have increased the complexity of managing brain metastases (BMs). Australian medical oncologists, radiation oncologists, and neurosurgeons discussed the evidence guiding the diverse clinical approaches to the management of BM in NSCLC. The Australian context is broadly applicable to other jurisdictions; therefore, we have documented these discussions as principles with broader applications. Patient management was stratified according to clinical and radiologic factors under two broad classifications of newly diagnosed BMs: symptomatic and asymptomatic. Other important considerations include the number and location of metastases, tumor histotypes, molecular subtype, and treatment purpose. Careful consideration of the pace and burden of symptoms, risk of worsening neurologic function at a short interval, and extracranial disease burden should determine whether central nervous system active systemic therapies are used alone or in combination with local therapies (surgery with or without radiation therapy). Most clinical trial evidence currently focuses on historical treatment options or a single treatment modality rather than the optimal sequencing of multiple modern therapies; therefore, an individualized approach is key in a rapidly changing therapeutic landscape.
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Affiliation(s)
- Chee Khoon Lee
- National Health and Medical Research Council (NHMRC) Clinical Trials Centre, University of Sydney, Camperdown, New South Wales, Australia
| | - Yu Yang Soon
- National Health and Medical Research Council (NHMRC) Clinical Trials Centre, University of Sydney, Camperdown, New South Wales, Australia
- Department of Radiation Oncology, National University Cancer Institute Singapore, National University Hospital, Singapore
| | - Rosalind L. Jeffree
- Kenneth G Jamieson Department of Neurosurgery, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, University of Queensland, St. Lucia, Queensland, Australia
| | - Rohit Joshi
- Medical Oncology, Lyell McEwin Hospital, University of Adelaide, Adelaide, South Australia, Australia
- Allied Health & Human Performance, University of South Australia, Adelaide, South Australia, Australia
- Adelaide Medical School, Faculty of Health and Medical Science, Adelaide, South Australia, Australia
| | - Eng-Siew Koh
- Liverpool and Macarthur Cancer Therapy Centres, Liverpool, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Wei-Sen Lam
- Department of Medical Oncology, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Hien Le
- Department of Radiation Oncology, Royal Adelaide Hospital, South Australia, Australia
| | - Zarnie Lwin
- Faculty of Medicine, University of Queensland, St. Lucia, Queensland, Australia
- Department of Medical Oncology, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
| | - Mark B. Pinkham
- Faculty of Medicine, University of Queensland, St. Lucia, Queensland, Australia
- The Radiation Oncology Centre, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Shankar Siva
- Sir Peter MacCallum Department of Oncology, Peter MacCallum Cancer Centre, The University of Melbourne, Melbourne, Victoria, Australia
| | - Evan Ng
- Department of Radiation Oncology, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Thomas John
- Sir Peter MacCallum Department of Oncology, Peter MacCallum Cancer Centre, The University of Melbourne, Melbourne, Victoria, Australia
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Agar MR, Nowak AK, Hovey EJ, Barnes EH, Simes J, Vardy JL, Wheeler HR, Kong BY, Leonard R, Hall M, Tim E, Spyridopoulos D, Sim HW, Lwin Z, Dowling A, Harrup R, Jennens R, Kichenadasse G, Dunlop T, Gzell C, Koh ES. Acetazolamide versus placebo for cerebral oedema requiring dexamethasone in recurrent and/or progressive high-grade glioma: phase II randomised placebo-controlled double-blind study. BMJ Support Palliat Care 2023; 13:354-362. [PMID: 36807048 DOI: 10.1136/spcare-2022-004119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 01/23/2023] [Indexed: 02/19/2023]
Abstract
OBJECTIVES Symptoms of raised intracranial pressure (ICP) in recurrent high-grade glioma (HGG) generally require corticosteroid treatment, often causing toxicity with variable effects on ICP symptoms. Acetazolamide reduces ICP when used in other clinical non-cancer settings. The aim of the study was to explore whether the addition of oral acetazolamide enables safe dexamethasone dose reduction in management of raised ICP in recurrent HGG. METHODS Participants had recurrent HGG with any of dexamethasone recommencement, dose increase or dependency; prior/current bevacizumab was an exclusion. Eligible participants were randomised 1:1 to acetazolamide or placebo for 8 weeks. Standardised protocols were used for dexamethasone dosing, with planned dose decrease from day 5 once ICP symptoms were stable. The primary endpoint was a composite of dexamethasone dose reduction and stable Karnofsky Performance Status Secondary endpoints included toxicity and feasibility. RESULTS Thirty participants (15 per group) were enrolled (mean age 58 years) from seven Australian sites. The mean baseline dexamethasone dose was 6.2 mg. Mean duration on study treatment was 38 days (placebo group) and 31 days (acetazolamide group) with nine participants (30%) completing all study treatments (six placebo, three acetazolamide). Study withdrawal was due to adverse events (n=6; one placebo, five acetazolamide) and disease progression (n=6 (three per arm)). Four participants (13%) (two per arm) were stable responders. Ten participants experienced a total of 13 serious adverse events (acetazolamide arm: five participants (33%), six events, two related). CONCLUSIONS The study closed early due to poor accrual and increasing availability of bevacizumab. The addition of acetazolamide did not facilitate dexamethasone reduction. TRIAL REGISTRATION NUMBER ACTRN12615001072505.
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Affiliation(s)
- Meera R Agar
- Palliative Care, Liverpool Hospital, Liverpool, New South Wales, Australia
- Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Anna K Nowak
- Medical Oncology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
- Medical School, The University of Western Australia, Crawley, Western Australia, Australia
| | - Elizabeth J Hovey
- Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Randwick, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | | | - John Simes
- NHMRC Clinical Trials Centre, Camperdown, New South Wales, Australia
- Medical Oncology, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
| | - Janette L Vardy
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Medical Oncology, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Helen R Wheeler
- Medical Oncology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Benjamin Y Kong
- NHMRC Clinical Trials Centre, Camperdown, New South Wales, Australia
- Medical Oncology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Robyn Leonard
- NHMRC Clinical Trials Centre, Camperdown, New South Wales, Australia
| | - Merryn Hall
- NHMRC Clinical Trials Centre, Camperdown, New South Wales, Australia
| | - Evonne Tim
- NHMRC Clinical Trials Centre, Camperdown, New South Wales, Australia
| | | | - Hao-Wen Sim
- NHMRC Clinical Trials Centre, Camperdown, New South Wales, Australia
- Medical Oncology, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
| | - Zarnie Lwin
- Medical Oncology, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Anthony Dowling
- Medical Oncology, St Vincent's Hospital Melbourne Pty Ltd, Fitzroy, Victoria, Australia
| | - Rosemary Harrup
- Medical Oncology, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Ross Jennens
- Medical Oncology, Epworth HealthCare, Richmond, Victoria, Australia
| | - Ganessan Kichenadasse
- Flinders Centre for Innovation in Health Care, Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - Tracey Dunlop
- Medical Oncology, St George Hospital, Kogarah, New South Wales, Australia
| | - Cecelia Gzell
- Genesis Care Pty Ltd, Darlinghurst, New South Wales, Australia
| | - Eng-Siew Koh
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Radiation Oncology, Liverpool Hospital, Liverpool, New South Wales, Australia
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Kenny K, Williams Veazey L, Broom A, Peterie M, Page A, Prainsack B, Wakefield CE, Itchins M, Khasraw M, Lwin Z. Hope in the era of precision oncology: a qualitative study of informal caregivers' experiences. BMJ Open 2023; 13:e065753. [PMID: 37130677 PMCID: PMC10163471 DOI: 10.1136/bmjopen-2022-065753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
Abstract
OBJECTIVES To explore informal caregivers' perspectives on precision medicine in cancer care. DESIGN Semi-structured interviews with the informal caregivers of people living with cancer and receiving targeted/immunotherapies. Interview transcripts were analysed thematically using a framework approach. SETTING Recruitment was facilitated by two hospitals and five Australian cancer community groups. PARTICIPANTS Informal caregivers (n=28; 16 men, 12 women; aged 18-80) of people living with cancer and receiving targeted/immunotherapies. RESULTS Thematic analysis identified three findings, centred largely on the pervasive theme of hope in relation to precision therapies including: (1) precision as a key component of caregivers' hope; (2) hope as a collective practice between patients, caregivers, clinicians and others, which entailed work and obligation for caregivers; and (3) hope as linked to expectations of further scientific progress, even if there may be no personal, immediate benefit. CONCLUSIONS Innovation and change in precision oncology are rapidly reconfiguring the parameters of hope for patients and caregivers, creating new and difficult relational moments and experiences in everyday life and in clinical encounters. In the context of a shifting therapeutic landscape, caregivers' experiences illustrate the need to understand hope as collectively produced, as emotional and moral labour, and as entangled in broader cultural expectations of medical advances. Such understandings may help clinicians as they guide patients and caregivers through the complexities of diagnosis, treatment, emerging evidence and possible futures in the precision era. Developing a better understanding of informal caregivers' experiences of caring for patients receiving precision therapies is important for improving support to patients and their caregivers.
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Affiliation(s)
- Katherine Kenny
- Sydney Centre for Healthy Societies; School of Social and Political Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Leah Williams Veazey
- Sydney Centre for Healthy Societies; School of Social and Political Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Alex Broom
- Sydney Centre for Healthy Societies; School of Social and Political Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Michelle Peterie
- Sydney Centre for Healthy Societies; School of Social and Political Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Alexander Page
- Sydney Centre for Healthy Societies; School of Social and Political Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Barbara Prainsack
- Department of Political Science, University of Vienna, Wien, Austria
| | - Claire E Wakefield
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital Randwick, Randwick, New South Wales, Australia
- School of Clinical Medicine, UNSW Medicine and Health, Randwick Clinical Campus, Discipline of Paediatrics, UNSW, Sydney, New South Wales, Australia
| | - Malinda Itchins
- Northern Clinical School, The University of Sydney, Sydney, New South Wales, Australia
- Department of Medical Oncology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Mustafa Khasraw
- Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina, USA
| | - Zarnie Lwin
- Department of Medical Oncology, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Saint Lucia, Queensland, Australia
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7
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Gan HK, Day BW, Harrup R, Johns TG, Lwin Z, Scott AM, Sim HW, Koh ES. Clinical Trials in the Brain Tumour Population: Challenges and Strategies for the Future. Curr Oncol Rep 2023; 25:589-598. [PMID: 36976462 DOI: 10.1007/s11912-023-01394-5] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2023] [Indexed: 03/29/2023]
Abstract
PURPOSE OF REVIEW This review identifies challenges and barriers to successful development of drugs in neuro-oncology trials at the preclinical, clinical and translational stages that we believe has contributed to poor outcomes for patients over the last 30 years. RECENT FINDINGS Several key strategies have been proposed by leading groups to address these and improve patient outcomes. Better preclinical testing using more sophisticated and clinically relevant models is needed. A greater focus on assessing blood-brain barrier penetrance and targeting key biological processes such as tumour heterogeneity and immune response is vital. Adopting innovative trial designs permitting faster results and addressing key issues (including molecular heterogeneity and combinatorial approaches) is highly desirable. A stronger translational focus is also clearly needed. Implementation of these strategies is already starting to occur. Maintaining and increasing these novel approaches will require coordinated efforts between clinicians, scientists, industry and funding/regulator bodies.
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Affiliation(s)
- Hui Kong Gan
- Cancer Therapies and Biology Group, Centre for Research Excellence in Brain Cancer, Olivia Newton-John Cancer Research Institute, Austin Health, 145 Studley Road, Heidelberg, Melbourne, VIC, 3084, Australia.
- La Trobe University School of Cancer Medicine, Heidelberg, VIC, Australia.
- Department of Medicine, University of Melbourne, Heidelberg, VIC, Australia.
- Australian Brain Cancer Research Alliance, Melbourne, Australia.
| | - Bryan W Day
- Sid Faithfull Brain Cancer Laboratory, Cell and Molecular Biology Department, QIMR Berghofer, 300 Herston Rd, Herston, QLD, 4006, Australia
- School of Biomedical Sciences, Queensland University of Technology, Brisbane, QLD, Australia
- Australian Brain Cancer Research Alliance, Melbourne, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Rosemary Harrup
- Cancer & Blood Services, Royal Hobart Hospital, Hobart, TAS, Australia
- Menzies Research Institute, University of Tasmania, Hobart, TAS, Australia
| | - Terrance G Johns
- Australian Brain Cancer Research Alliance, Melbourne, Australia
- Oncogenic Signalling Laboratory, Telethon Kids Institute, Nedlands, WA, Australia
| | - Zarnie Lwin
- Department of Medical Oncology, Cancer Care Services, Royal Brisbane and Women's Hospital, The University of Queensland, Brisbane, QLD, Australia
| | - Andrew Mark Scott
- Tumour Targeting Program and Centre for Research Excellence in Brain Cancer, Olivia Newton-John Cancer Research Institute, Austin Health, 145 Studley Road, Heidelberg, Melbourne, VIC, 3084, Australia
- La Trobe University School of Cancer Medicine, Heidelberg, VIC, Australia
- Department of Medicine, University of Melbourne, Heidelberg, VIC, Australia
- Australian Brain Cancer Research Alliance, Melbourne, Australia
| | - Hao-Wen Sim
- NHMRC Clinical Trials Centre, Locked Bag 77, Camperdown, NSW, 1450, Australia
- Department of Medical Oncology, Chris O'Brien Lifehouse, Camperdown, NSW, Australia
- Kinghorn Cancer Centre, St Vincent's Hospital Sydney, Darlinghurst, NSW, Australia
- School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Darlinghurst, NSW, Australia
| | - Eng-Siew Koh
- South West Clinical School, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
- Department of Radiation Oncology, Liverpool Cancer Therapy Centre, Liverpool, NSW, Australia
- Ingham Institute for Applied Medical Research, Liverpool Hospital, Locked Bag 7103, Liverpool, NSW, Australia
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8
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Sim HW, Wachsmuth L, Barnes EH, Yip S, Koh ES, Hall M, Jennens R, Ashley DM, Verhaak RG, Heimberger AB, Rosenthal MA, Hovey EJ, Ellingson BM, Tognela A, Gan HK, Wheeler H, Back M, McDonald KL, Long A, Cuff K, Begbie S, Gedye C, Mislang A, Le H, Johnson MO, Kong BY, Simes JR, Lwin Z, Khasraw M. NUTMEG: A randomized phase II study of nivolumab and temozolomide versus temozolomide alone in newly diagnosed older patients with glioblastoma. Neurooncol Adv 2023; 5:vdad124. [PMID: 37841696 PMCID: PMC10576515 DOI: 10.1093/noajnl/vdad124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2023] Open
Abstract
Background There is an immunologic rationale to evaluate immunotherapy in the older glioblastoma population, who have been underrepresented in prior trials. The NUTMEG study evaluated the combination of nivolumab and temozolomide in patients with glioblastoma aged 65 years and older. Methods NUTMEG was a multicenter 2:1 randomized phase II trial for patients with newly diagnosed glioblastoma aged 65 years and older. The experimental arm consisted of hypofractionated chemoradiation with temozolomide, then adjuvant nivolumab and temozolomide. The standard arm consisted of hypofractionated chemoradiation with temozolomide, then adjuvant temozolomide. The primary objective was to improve overall survival (OS) in the experimental arm. Results A total of 103 participants were randomized, with 69 in the experimental arm and 34 in the standard arm. The median (range) age was 73 (65-88) years. After 37 months of follow-up, the median OS was 11.6 months (95% CI, 9.7-13.4) in the experimental arm and 11.8 months (95% CI, 8.3-14.8) in the standard arm. For the experimental arm relative to the standard arm, the OS hazard ratio was 0.85 (95% CI, 0.54-1.33). In the experimental arm, there were three grade 3 immune-related adverse events which resolved, with no unexpected serious adverse events. Conclusions Due to insufficient evidence of benefit with nivolumab, the decision was made not to transition to a phase III trial. No new safety signals were identified with nivolumab. This complements the existing series of immunotherapy trials. Research is needed to identify biomarkers and new strategies including combinations.
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Affiliation(s)
- Hao-Wen Sim
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
- Department of Medical Oncology, The Kinghorn Cancer Centre, Sydney, New South Wales, Australia
- Department of Medical Oncology, Chris O’Brien Lifehouse, Sydney, New South Wales, Australia
| | - Luke Wachsmuth
- The Brain Tumor Immunotherapy Program, Duke University School of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Elizabeth H Barnes
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Sonia Yip
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Eng-Siew Koh
- Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
- Department of Radiation Oncology, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Merryn Hall
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Ross Jennens
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Epworth HealthCare Richmond, Melbourne, Victoria, Australia
| | - David M Ashley
- The Preston Robert Tisch Brain Tumor Center, Duke University School of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Roel G Verhaak
- The Jackson Laboratory for Genomic Medicine, University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Amy B Heimberger
- Department of Neurological Surgery, Malnati Brain Tumor Institute of the Lurie Comprehensive Cancer Center, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Mark A Rosenthal
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Elizabeth J Hovey
- Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
- Department of Medical Oncology, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Benjamin M Ellingson
- UCLA Brain Tumor Imaging Laboratory, University of California Los Angeles, Los Angeles, California, USA
| | - Annette Tognela
- Department of Medical Oncology, Campbelltown Hospital, Sydney, New South Wales, Australia
| | - Hui K Gan
- Department of Medical Oncology, Austin Hospital, Melbourne, Victoria, Australia
| | - Helen Wheeler
- Department of Medical Oncology, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Michael Back
- Department of Medical Oncology, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Kerrie L McDonald
- Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Anne Long
- Department of Medical Oncology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Katharine Cuff
- Department of Medical Oncology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Stephen Begbie
- Department of Medical Oncology, Port Macquarie Base Hospital, Port Macquarie, New South Wales, Australia
| | - Craig Gedye
- Department of Medical Oncology, Calvary Mater Newcastle, Newcastle, New South Wales, Australia
| | - Anna Mislang
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
- Department of Medical Oncology, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Hien Le
- Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Margaret O Johnson
- The Preston Robert Tisch Brain Tumor Center, Duke University School of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Benjamin Y Kong
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
- Department of Medical Oncology, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - John R Simes
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
- Department of Medical Oncology, Chris O’Brien Lifehouse, Sydney, New South Wales, Australia
| | - Zarnie Lwin
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia
- Department of Medical Oncology, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
| | - Mustafa Khasraw
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
- The Brain Tumor Immunotherapy Program, Duke University School of Medicine, Duke University Medical Center, Durham, North Carolina, USA
- The Preston Robert Tisch Brain Tumor Center, Duke University School of Medicine, Duke University Medical Center, Durham, North Carolina, USA
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Roberts NA, Ahern E, Pelecanos A, Gasper H, Chan B, Lwin Z. From doctors to ancillary staff: Regional and metropolitan cancer workforce perceptions and distress resulting from COVID-19 pandemic adaptations. Semin Oncol 2022; 49:490-496. [PMID: 36797193 PMCID: PMC9886723 DOI: 10.1053/j.seminoncol.2023.01.008] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 01/20/2023] [Accepted: 01/20/2023] [Indexed: 01/28/2023]
Abstract
INTRODUCTION The declaration of the COVID-19 pandemic has resulted in necessary and rapid changes to health service delivery. In the Australian context, it has been broadly identified that these impacts have been felt by health care workers (HCW) providing care. We aimed to capture oncology HCW perceptions of support, stress, personal ability to meet needs and institutional preparedness across longitudinal periods of COVID-19 response in the early stages of the pandemic. METHODS AND MATERIALS An electronic survey was developed to measure the weekly impacts and distress experienced by HCW during the early phases of the pandemic. Hospital email communications relating to pandemic directives were noted. HCW included nursing, medical, ancillary staff and allied health team members at 2 study sites, 1 metropolitan and 1 regional center in Queensland, Australia. Descriptive statistics were applied to quantitative data, and a framework analysis for qualitative data. Key themes were synthesized using mixed methods approaches. RESULTS A total of 176 HCW consented to participate. Four key themes were identified. Key theme 1 was strategies for protection, and included the subthemes of self-isolation, using personal protective equipment (PPE), protecting patients and families and each other. Key theme 2 was navigating rules and keeping up, and included the subthemes of compliance, exceptions, conflict and complex decision fatigue. Key theme 3 was tempered optimism, with subthemes including this is grief, pride in one's place and strategies for coping. Key theme 4 was framing the new normal, with subthemes including using technology, second wave and uncertainty. CONCLUSION Staff groups reported the emotional impacts of rapid change across clinical areas and centers. Distress corresponded to rapid change amid uncertainty, rather than reported infection rates. These findings give insight into the experiences of patient facing oncology HCW during periods of uncertainty, potentially informing policy in the future.
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Affiliation(s)
- Natasha A Roberts
- Cancer Care Services, Royal Brisbane and Women's Hospital, Herston, QLD Australia; University of Queensland Centre Clinical Research, Herston, QLD Australia; Metro North Health, Royal Brisbane and Women's Hospital, Herston, QLD, Australia.
| | - Elizabeth Ahern
- Cancer Care Services, Royal Brisbane and Women's Hospital, Herston, QLD Australia; Department of Oncology, Monash Health, Clayton, VIC Australia; School of Clinical Sciences, Monash University, Clayton, VIC Australia
| | - Anita Pelecanos
- Statistics Unit, QIMR Berghofer Medical Research Institute, Herston, QLD Australia
| | - Harry Gasper
- Cancer Care Services, Royal Brisbane and Women's Hospital, Herston, QLD Australia; School of Medicine, University of Queensland, Herston, QLD Australia; Department of Oncology, Toowoomba Base Hospital, Toowoomba, QLD Australia
| | - Bryan Chan
- Adem Crosby Cancer Centre, Sunshine Coast University Hospital, Birtinya, QLD Australia; School of Medicine, Griffith University, Birtinya, QLD Australia
| | - Zarnie Lwin
- Cancer Care Services, Royal Brisbane and Women's Hospital, Herston, QLD Australia; School of Medicine, University of Queensland, Herston, QLD Australia
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10
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Sim HW, Lwin Z, Barnes E, McDonald K, Koh ES, Rosenthal M, Foote M, Back M, Wheeler H, Buckland M, Walsh K, Fisher L, Leonard R, Hall M, Ashley D, Yip S, Simes J, Sulman E, Khasraw M. CTNI-42. GENOME-WIDE DNA METHYLATION PATTERNS IN VERTU: A RANDOMIZED PHASE II TRIAL OF VELIPARIB, RADIOTHERAPY AND TEMOZOLOMIDE IN PATIENTS WITH MGMT-UNMETHYLATED GLIOBLASTOMA. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac209.307] [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] Open
Abstract
Abstract
BACKGROUND
VERTU was a randomized phase II trial evaluating veliparib, a brain-penetrant PARP inhibitor, combined with radiotherapy and temozolomide, for patients with newly diagnosed MGMT-unmethylated glioblastoma. As part of planned correlative work after study completion, we assessed genome-wide DNA methylation patterns to predict methylation class, glioblastoma subtype and MGMT status.
METHODS
Patients were randomized 2:1 to experimental (60Gy/30 fractions with veliparib 200mg bid, then temozolomide 150-200mg/m2 D1-5 + veliparib 40mg bid D1-7 Q28D for 6 cycles) versus standard arm (60Gy/30 fractions with temozolomide 75mg/m2 daily, then temozolomide 150-200mg/m2 D1-5 Q28D for 6 cycles). The primary objective to improve 6-month progression-free survival (PFS-6m) was not met (doi: 10.1093/neuonc/noab111). Methylation data were generated using the Illumina Infinium Methylation EPIC bead chip array. Tumor tissues were categorized using the Heidelberg methylation-based classifier.
RESULTS
Methylation data were successfully generated for 98/125 patients (poor quality DNA [n = 12], no consent [n = 11], insufficient tissue [n = 4]). Those with classifier scores below 0.5 (n = 25), tumor microenvironment only (n = 6) and rediagnosis as pleomorphic xanthoastrocytoma (n = 1) were excluded, leaving n = 66. Methylation classes were GBM RTK II (n = 23, PFS-6m 43% [95%CI 23-62]), RTK I (n = 20, PFS-6m 50% [95%CI 27-69]), MES (n = 20, PFS-6m 40% [95%CI 19-60]), MID (n = 2) and G34 (n = 1). Glioblastoma subtypes were mesenchymal (n = 28, PFS-6m 50% [95%CI 30-66]), proneural (n = 24, PFS-6m 50% [95%CI 29-68]) and classical (n = 14, PFS-6m 36% [95%CI 13-59]). MGMT status were unmethylated (n = 58, PFS-6m 48% [95%CI 35-60]) and methylated (n = 8, PFS-6m 38% [95%CI 9-67]). There was no evidence of interaction between treatment arm and methylation class (excluding GBM MID and G34, P = 0.45), glioblastoma subtype (P = 0.68) or MGMT status (P = 0.52).
CONCLUSIONS
Genome-wide DNA methylation patterns in VERTU identified a spectrum of methylation-defined subgroups, reflecting tumoral heterogeneity. This may have utility for future clinical trials and practice. The effect of veliparib in VERTU appeared to be consistent across subgroups. ACTRN12615000407594.
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Affiliation(s)
- Hao-Wen Sim
- NHMRC Clinical Trials Centre, University of Sydney , Sydney , Australia
| | - Zarnie Lwin
- Royal Brisbane and Women’s Hospital, University of Queensland , Brisbane , Australia
| | - Elizabeth Barnes
- NHMRC Clinical Trials Centre, University of Sydney , Sydney , Australia
| | | | - Eng-Siew Koh
- Liverpool Hospital & South Western Sydney Clinical Campus, University of New South Wales , Sydney, New South Wales , Australia
| | | | | | - Michael Back
- Royal North Shore Hospital , Sydney, New South Wales , Australia
| | | | | | - Kyle Walsh
- Duke University Medical Center , Durham , USA
| | - Lauren Fisher
- NHMRC Clinical Trials Centre, University of Sydney , Sydney , Australia
| | - Robyn Leonard
- NHMRC Clinical Trials Centre, University of Sydney , Sydney , Australia
| | - Merryn Hall
- NHMRC Clinical Trials Centre, University of Sydney , Sydney , Australia
| | - David Ashley
- The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center , Durham, NC , USA
| | - Sonia Yip
- NHMRC Clinical Trials Centre, University of Sydney , Sydney , Australia
| | - John Simes
- NHMRC Clinical Trials Centre, University of Sydney , Sydney , Australia
| | - Erik Sulman
- NYU Grossman School of Medicine, Department of Radiation Oncology , New York, NY , USA
| | - Mustafa Khasraw
- The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center , Durham , USA
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11
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Yuile A, Satgunaseelan L, Alexander KL, Thavaneswaran S, Krasovitsky M, Buckland M, Lee M, Wei G, Kastelan M, Wong M, Wilson I, Bayly A, Varikat W, Sim HW, Kong B, Lwin Z, Turner C, Back M, Miller S, Lee A, Wheeler H. CSIG-13. CLINICAL IMPACT OF CDKN2A/B DELETIONS IN IDH-MUTANT ASTROCYTOMAS. Neuro Oncol 2022. [PMCID: PMC9660930 DOI: 10.1093/neuonc/noac209.162] [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] Open
Abstract
Abstract
BACKGROUND
IDH-mutant astrocytomas with CDKN2A/B homozygous deletions (HD) are now categorized as grade 4 astrocytomas. It is unclear how these HD astrocytomas should be treated. We aimed to compare 3-year outcomes for HD versus heterozygous deleted (HeD) IDH-mutant astrocytomas, describe the prognostic impact of deletions relative to histologic grade and describe differences in outcomes based on treatment regimen.
METHODS
Molecular and clinical data concerning IDH-mutant glioma patients +/-CDKN2A/B deletions were retrieved across four neuro-oncology centers and two tumor banks from 01/2016-07/2021.
RESULTS
48 patients with HD or HeD were identified. Median follow-up time was 4.0 years, median age 33 (range 20-74) years. Sixteen astrocytomas were histologic grade 4, remainder were grade 2 (n= 9) and grade 3 (n= 23). HD were detected in 16 patients. Survival data were unavailable in n= 1 HD and n= 2 HeD patients. 3-year OS for CDKN2A/B HD and HeD groups were 47% versus 67% (log-rank p= 0.004). For grades 2, 3 and 4, 3-year OS for HD were 100% (n= 1), 57% (n= 7) and 29% (n= 7) respectively, 3-year OS for HeD were 100% (n= 7), 56% (n= 16) and 57% (n= 7) respectively. In HD patients, six were treated with concurrent temozolomide-radiotherapy (3-year OS 50%) and five with radiotherapy and sequential temozolomide only (3-year OS 80%, log-rank p= 0.38). Treatment data were unavailable in two patients and three were treated with “other” regimens. Sequential regimens were preferentially used in histologic grade 2 and 3 cases.
CONCLUSION
Preliminary data are in keeping with current literature and are one of the first to describe outcomes based on clinical regimen. There was insufficient evidence of OS differences between concurrent and sequential therapy, though conclusions are limited by sample size and data maturity. Additional follow-up data are required to further define optimal treatment for these patients.
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Affiliation(s)
| | - Laveniya Satgunaseelan
- Department of Neuropathology, Royal Prince Alfred Hospital , Sydney, NSW
- Australia Sydney Medical School, Faculty of Medicine and Health Sciences, The University of Sydney , Sydney, NSW , Australia
| | | | | | | | | | - Maggie Lee
- Royal Prince Alfred Hospital , Sydney , Australia
| | - Grace Wei
- Royal Prince Alfred Hospital , Sydney , Australia
| | | | - Mark Wong
- Westmead Hospital , Sydney , Australia
| | | | | | | | - Hao-Wen Sim
- NHMRC Clinical Trials Centre, University of Sydney , Sydney , Australia
| | - Ben Kong
- Royal North Shore Hospital , Sydney , Australia
| | - Zarnie Lwin
- Royal Brisbane and Women’s Hospital, University of Queensland , Brisbane , Australia
| | - Cassie Turner
- Royal Brisbane and Women's Hospital , Brisbane , Australia
| | - Michael Back
- Royal North Shore Hospital , Sydney, New South Wales , Australia
| | - Samuel Miller
- Royal North Shore Hospital , Sydney, New South Wales , Australia
| | - Adrian Lee
- Royal North Shore Hospital , Sydney , Australia
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Sim HW, Lwin Z, Barnes E, McDonald K, Yip S, Verhaak R, Heimberger A, Hall M, Wong M, Jennens R, Ashley D, Rosenthal M, Hovey E, Ellingson B, Tognela A, Gan H, Back M, Koh ES, Long A, Cuff K, Begbie S, Gedye C, Mislang A, Le H, Johnson M, Kong B, Simes J, Khasraw M. CTIM-24. NUTMEG: A RANDOMIZED PHASE II STUDY OF NIVOLUMAB AND TEMOZOLOMIDE VERSUS TEMOZOLOMIDE ALONE IN NEWLY DIAGNOSED ELDERLY PATIENTS WITH GLIOBLASTOMA. Neuro Oncol 2022. [PMCID: PMC9660679 DOI: 10.1093/neuonc/noac209.256] [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] Open
Abstract
Abstract
BACKGROUND
Nivolumab is a PD-1 inhibitor with known safety profile. An increase in mutations as we age is well documented in glioblastoma and other cancers. Higher mutational load is associated with increased response to nivolumab in extracranial malignancies. NUTMEG examined the activity of nivolumab added to temozolomide in glioblastoma patients aged ≥ 65 years.
METHODS
NUTMEG was an international multicenter phase II trial for newly diagnosed glioblastoma patients aged ≥ 65 years, randomized 2:1 to experimental (40Gy/15 fractions with temozolomide 75mg/m2, then 6 cycles of temozolomide 150-200mg/m2 D1-5 Q28D + nivolumab 240mg D1,15 Q28D C1-4 and 480mg D1 Q28D C5-6) versus standard arm (40Gy/15 fractions with temozolomide 75mg/m2, then 6 cycles of temozolomide alone 150-200mg/m2 D1-5 Q28D), stratified by age, ECOG status, MGMT status and resection extent.
RESULTS
103 patients were enrolled (69 in experimental arm, 34 in standard arm). Median age was 73 years, 36% ECOG 0, 57% MGMT-unmethylated and 51% gross macroscopic resection. Median follow-up is 31 months to date, with 77 deaths (surviving patients to continue follow-up and final results will be presented). Median overall survival was 11.8 months in the experimental arm versus 12.0 months in the standard arm (HR 0.95 95%CI 0.59-1.53 for experimental relative to control). Six-month progression-free survival rate using mRANO was 64% in the experimental arm versus 49% in the standard arm (HR 0.81 95%CI 0.51-1.26). Grade 3/4 adverse events were reported in 46% of experimental arm (7% lung infection, 7% thromboembolic events, 6% fatigue, 6% muscle weakness) and in 29% of control arm (9% fatigue, 6% seizure, 6% thromboembolic events).
CONCLUSIONS
There was insufficient evidence of clinical benefit with nivolumab in this population. No new safety signals were identified. Central imaging review is underway and correlative studies will characterize the immune landscape, including mutational load, neoantigen and other immune markers. NCT04195139.
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Affiliation(s)
- Hao-Wen Sim
- NHMRC Clinical Trials Centre, University of Sydney , Sydney , Australia
| | - Zarnie Lwin
- Royal Brisbane and Women’s Hospital, University of Queensland , Brisbane , Australia
| | - Elizabeth Barnes
- NHMRC Clinical Trials Centre, University of Sydney , Sydney , Australia
| | | | - Sonia Yip
- NHMRC Clinical Trials Centre, University of Sydney , Sydney , Australia
| | | | | | - Merryn Hall
- NHMRC Clinical Trials Centre, University of Sydney , Sydney , Australia
| | | | | | - David Ashley
- The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center , Durham, NC , USA
| | | | | | | | | | - Hui Gan
- Olivia Newton John Cancer Research Institute , Melbourne , Australia
| | - Michael Back
- Royal North Shore Hospital , Sydney, New South Wales , Australia
| | - Eng-Siew Koh
- Liverpool Hospital & South Western Sydney Clinical Campus, University of New South Wales , Sydney, New South Wales , Australia
| | - Anne Long
- Sir Charles Gairdner Hospital , Perth , Australia
| | | | | | - Craig Gedye
- Department of Medical Oncology, Calvary Mater Hospital , Waratah, NSW , Australia
| | | | - Hien Le
- Royal Adelaide Hospital , Adelaide , Australia
| | - Margaret Johnson
- The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center , Durham , USA
| | - Benjamin Kong
- NHMRC Clinical Trials Centre, University of Sydney , Sydney , Australia
| | - John Simes
- NHMRC Clinical Trials Centre, University of Sydney , Sydney , Australia
| | - Mustafa Khasraw
- The Preston Robert Tisch Brain Tumor Center, Duke University Medical Center , Durham , USA
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Fitzpatrick L, Lwin Z, Gericke C. Pembrolizumab-induced acute right L5 neuritis unresponsive to steroids. BMJ Case Rep 2022; 15:15/11/e250971. [DOI: 10.1136/bcr-2022-250971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
We present a case of a patient with metastatic lung adenocarcinoma who developed severe right lower limb radicular pain in a L5-S1 dermatomal distribution 5 months into treatment with carboplatin, pemetrexed and pembrolizumab. MRI of the lumbar spine demonstrated contrast enhancement of the right L5 nerve root consistent with neuritis. The patient was treated with intravenous methylprednisolone 2 mg/kg/day for 3 days, followed by oral prednisolone 1 mg/kg/day with a slow wean over 6 weeks. There was no improvement and their performance status deteriorated to an Eastern Cooperative Oncology Group (ECOG) score of 3, representing capability of only limited self-care. We commenced induction therapy with intravenous immunoglobulin 2 g/kg over 5 days, which resulted in complete resolution of pain sustained for 3 weeks before recurrence of symptoms. We continued maintenance therapy with intravenous immunoglobulin 0.4 g/kg over 2 days at 4–5 weekly intervals, which led to resolution of symptoms and ECOG score to 1.
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14
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Kong BY, Sim HW, Barnes EH, Nowak AK, Hovey EJ, Jeffree R, Harrup R, Parkinson J, Gan HK, Pinkham MB, Yip S, Hall M, Tu E, Carter C, Koh ES, Lwin Z, Dowling A, Simes JS, Gedye C. Multi-Arm GlioblastoMa Australasia (MAGMA): protocol for a multiarm randomised clinical trial for people affected by glioblastoma. BMJ Open 2022; 12:e058107. [PMID: 36104135 PMCID: PMC10441685 DOI: 10.1136/bmjopen-2021-058107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 08/12/2022] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Glioblastoma (GBM) is the most common malignant primary central nervous system cancer in adults. The objective of the Multi-Arm GlioblastoMa Australasia (MAGMA) trial is to test hypotheses in real world setting to improve survival of people with GBM. Initial experimental arms are evaluating the effectiveness of interventions in newly diagnosed GBM (ndGBM). This study will compare maximal surgical resection followed by chemoradiotherapy plus adjuvant chemotherapy for 6 months with the addition of (1) 'neoadjuvant' chemotherapy beginning as soon as possible after surgery and/or (2) adjuvant chemotherapy continued until progression within the same study platform. METHODS AND ANALYSIS MAGMA will establish a platform for open-label, multiarm, multicentre randomised controlled testing of treatments for GBM. The study began recruiting in September 2020 and recruitment to the initial two interventions in MAGMA is expected to continue until September 2023.Adults aged ≥18 years with ndGBM will be given the option of undergoing randomisation to each study intervention separately, thereby giving rise to a partial factorial design, with two separate randomisation time points, one for neoadjuvant therapy and one for extended therapy. Patients will have the option of being randomised at each time point or continuing on with standard treatment.The primary outcome for the study is overall survival from the date of initial surgery until death from any cause. Secondary outcomes include progression-free survival, time to first non-temozolomide treatment, overall survival from each treatment randomisation, clinically significant toxicity as measured by grade 3 or 4 adverse events and health-related quality-of-life measures. Tertiary outcomes are predictive/prognostic biomarkers and health utilities and incremental cost-effectiveness ratio.The primary analysis of overall survival will be performed separately for each study intervention according to the intention to treat principle on all patients randomised to each study intervention. ETHICS AND DISSEMINATION The study (Protocol version 2.0 dated 23 November 2020) was approved by a lead Human Research Ethics Committee (Sydney Local Health District: 2019/ETH13297). The study will be conducted in accordance with the principles of the Declaration of Helsinki and Good Clinical Practice. TRIAL REGISTRATION NUMBER ACTRN12620000048987.
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Affiliation(s)
- Benjamin Y Kong
- NHMRC Clinical Trials Centre, Camperdown, New South Wales, Australia
- Department of Medical Oncology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Hao-Wen Sim
- NHMRC Clinical Trials Centre, Camperdown, New South Wales, Australia
- St Vincent's Clinical School, University of New South Wales, Sydney, New South Wales, Australia
- Department of Medical Oncology, The Kinghorn Cancer Centre, Darlinghurst, NSW, Australia
- Department of Medical Oncology, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
| | | | - Anna K Nowak
- Medical School, The University of Western Australia, Crawley, Western Australia, Australia
- Department of Medical Oncology, Sir Charles Gairdner Hospital, Nedlands, Perth, Australia
| | - Elizabeth J Hovey
- Department of Medical Oncology, Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Randwick, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Rosalind Jeffree
- Department of Neurosurgery, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Rosemary Harrup
- Cancer and Blood Services, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Jonathon Parkinson
- Department of Neurosurgery, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Hui K Gan
- Olivia Newton-John Cancer Research Institute, Austin Health, Heidelberg, Victoria, Australia
- School of Cancer Medicine, La Trobe University, Melbourne, Victoria, Australia
- Department of Medicine, University of Melbourne Victorian Comprehensive Cancer Centre, Parkville, Victoria, Australia
- Department of Medical Oncology, Olivia Newton-John Cancer and Wellness Centre, Austin Health, Heidelberg, VIC, Australia
| | - Mark B Pinkham
- Department of Radiation Oncology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Sonia Yip
- NHMRC Clinical Trials Centre, Camperdown, New South Wales, Australia
| | - Merryn Hall
- NHMRC Clinical Trials Centre, Camperdown, New South Wales, Australia
| | - Emily Tu
- NHMRC Clinical Trials Centre, Camperdown, New South Wales, Australia
| | - Candace Carter
- NHMRC Clinical Trials Centre, Camperdown, New South Wales, Australia
| | - Eng-Siew Koh
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Radiation Oncology, Liverpool Cancer Therapy Centre, Liverpool, New South Wales, Australia
- Collaboration for Cancer Outcomes, Research and Evaluation, Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
| | - Zarnie Lwin
- Cancer Care Services, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Anthony Dowling
- Department of Medicine, University of Melbourne Victorian Comprehensive Cancer Centre, Parkville, Victoria, Australia
- Department of Medical Oncology, St Vincent's Hospital Melbourne Pty Ltd, Fitzroy, Victoria, Australia
| | - John S Simes
- NHMRC Clinical Trials Centre, Camperdown, New South Wales, Australia
- Department of Medical Oncology, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
| | - Craig Gedye
- Department of Medical Oncology, Calvary Mater Newcastle, Waratah, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton, New South Wales, Australia
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Kirby E, van Toorn G, Lwin Z. Routines of isolation? A qualitative study of informal caregiving in the context of glioma in Australia. Health Soc Care Community 2022; 30:1924-1932. [PMID: 34528743 DOI: 10.1111/hsc.13571] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 08/10/2021] [Accepted: 09/03/2021] [Indexed: 06/13/2023]
Abstract
Informal caregiving for a person living with glioma can be both rewarding and multidimensionally challenging, given the potential for debilitating symptoms, cognitive impairment or personality changes, as early as diagnosis. There is growing evidence that, due to the demands of care, experiences and feelings of loneliness and isolation among informal caregivers are widespread, and opportunities for quality or meaningful social connectedness are lacking. While considerable research has quantified the causes and effects of loneliness and isolation in informal care contexts, the lived experience of loneliness has received relatively little attention. The aim of this study was to better understand the everyday experiences of a group of home-based informal caregivers of people living with glioma in Queensland, Australia. Drawing on in-depth interviews with 32 informal caregivers, purposively sampled, and recruited through a tertiary hospital, in this paper, we explore how the various experiences, demands, and social and relational dynamics in/of informal care (re)produce forms of isolation and loneliness. Using the framework approach to thematic analysis, we derived four themes: (a) the 'need' to be near the care recipient, and the implications for caregiver mobility; (b) the strong sense of responsibility for care, and the virtues of 'good' caring; (c) experiences of loneliness in the company of others and (d) postponement of social connection and minimising the self. The findings, we argue, are reflective of broader social and moral norms and expectations within experiences of home-based informal care.
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Affiliation(s)
- Emma Kirby
- Centre for Social Research in Health, University of New South Wales, Sydney, New South Wales, Australia
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Georgia van Toorn
- Disability Innovation Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Zarnie Lwin
- Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
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16
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Cho BC, Goldberg SB, Kim DW, Socinski MA, Burns TF, Lwin Z, Pathan N, Ma WD, Masters JC, Cossons N, Wilner K, Nishio M, Husain H. A phase 1b/2 study of PF-06747775 as monotherapy or in combination with Palbociclib in patients with epidermal growth factor receptor mutant advanced non-small cell lung cancer. Expert Opin Investig Drugs 2022; 31:747-757. [PMID: 35657653 DOI: 10.1080/13543784.2022.2075341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION This Phase 1/2 study (NCT02349633) explored the safety and antitumor activity of PF-06747775 (oral, third-generation epidermal growth factor receptor [EGFR] tyrosine kinase inhibitor) in patients with advanced non-small cell lung cancer after progression on an EGFR inhibitor. METHODS Phase 1 was a dose-escalation study of PF-06747775 monotherapy (starting dose: 25 mg once daily [QD]). Phase 1b/2 evaluated PF-06747775 monotherapy at recommended Phase 2 dose (RP2D; Cohort 1); PF-06747775 200 mg QD plus palbociclib (starting dose: 100 mg QD orally; Cohort 2A); and PF-06747775 monotherapy at RP2D in a Japanese lead-in cohort. RESULTS Sixty-five patients were treated. Median treatment duration was 40.1 weeks. Monotherapy maximum tolerated dose was not determined. Two patients in Cohort 2A had dose-limiting toxicities. The monotherapy RP2D was estimated to be 200 mg QD. Most frequently reported adverse events (AEs) were diarrhea (69.2%), paronychia (69.2%), and rash (60.0%). Most AEs were grades 1-3. Overall, objective response rate (90% confidence interval [CI]) was 41.5% (31.2-52.5%). Median (range) duration of response was 11.09 (2.70-34.57) months. Median progression-free survival (90% CI) was 8.1 (5.4-23.3) months. CONCLUSIONS PF-06747775 had a manageable safety profile and the study design highlights important considerations for future anti-EGFR agent development.
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Affiliation(s)
- Byoung Chul Cho
- Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sarah B Goldberg
- Department of Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Dong-Wan Kim
- Cancer Research Institute, Seoul National University College of Medicine and Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Mark A Socinski
- Thoracic Oncology, Advent Health Cancer Institute, Orlando, FL, USA
| | - Timothy F Burns
- Department of Medicine, University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh, PA, USA
| | - Zarnie Lwin
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Nuzhat Pathan
- Translational Oncology, Pfizer Inc, San Diego, CA, USA
| | | | | | | | - Keith Wilner
- Translational Oncology, Pfizer Inc, San Diego, CA, USA
| | - Makoto Nishio
- Department of Thoracic Medical Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Hatim Husain
- Department of Medicine, UCSD Moores Cancer Center, La Jolla, CA, USA
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Gately L, Drummond K, Rosenthal M, Harrup R, Dowling A, Gogos A, Lwin Z, Collins I, Campbell D, Ahern E, Phillips C, Gan HK, Bennett I, Sieber OM, Gibbs P. Beyond standard data collection – the promise and potential of BRAIN (Brain tumour Registry Australia INnovation and translation registry). BMC Cancer 2022; 22:604. [PMID: 35655179 PMCID: PMC9161524 DOI: 10.1186/s12885-022-09700-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 05/25/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Real-world data (RWD) is increasingly being embraced as an invaluable source of information to address clinical and policy-relevant questions that are unlikely to ever be answered by clinical trials. However, the largely unrealised potential of RWD is the value to be gained by supporting prospective studies and translational research. Here we describe the design and implementation of an Australian brain cancer registry, BRAIN, which is pursuing these opportunities.
Methods
BRAIN was designed by a panel of clinicians in conjunction with BIOGRID to capture comprehensive clinical data on patients diagnosed with brain tumours from diagnosis through treatment to recurrence or death. Extensive internal and external testing was undertaken, followed by implementation at multiple sites across Victoria and Tasmania.
Results
Between February 2021 and December 2021, a total of 350 new patients from 10 sites, including one private and two regional, were entered into BRAIN. Additionally, BRAIN supports the world’s first registry trial in neuro-oncology, EX-TEM, addressing the optimal duration of post-radiation temozolomide; and BioBRAIN, a dedicated brain tumour translational program providing a pipeline for biospecimen collection matched with linked clinical data.
Conclusions
Here we report on the first data collection effort in brain tumours for Australia, which we believe to be unique worldwide given the number of sites and patients involved and the extent to which the registry resource is being leveraged to support clinical and translational research. Further directions such as passive data flow and data linkages, use of artificial intelligence and inclusion of patient-entered data are being explored.
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18
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You KH, Lwin Z, Ahern E, Wyld D, Roberts N. Factors that influence clinical trial participation by patients with cancer in Australia: a scoping review protocol. BMJ Open 2022; 12:e057675. [PMID: 35387827 PMCID: PMC8987761 DOI: 10.1136/bmjopen-2021-057675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Clinical trials are the backbone of research. It is well recognised that patient participation in clinical trials can be influenced by a myriad of factors such as access to a clinical trial, restrictive trial eligibility criteria and perceptions held by patients or physicians about clinical trials. Australia is a key stakeholder in the global clinical trials sphere. This scoping review protocol aims to identify and map the current literature describing factors that influence clinical trial participation of patients with cancer, in Australia. METHODS AND ANALYSES The Joanna Briggs Institute (JBI) methodology for scoping reviews will be used to conduct this review. Four electronic databases will be systematically searched for relevant published literature on this topic, as a collaborative process involving the lead investigator and a health science librarian. We will hand search of citations and reference lists of the included papers, and a grey literature search through Google scholar, Grey Literature Report, Web of Science Conference Proceedings. All published papers pertaining to patients diagnosed with solid organ or haematological malignancies will be included. Studies which did not involve patients from Australia will also be excluded. A customised data extraction tool will be pilot tested and refined, and subsequently two independent reviewers will perform data screening and extraction. Results will be collated and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews: PRISMA-Scoping Reviews. Quantitative data will be presented using descriptive statistics. Qualitative data will be synthesised using thematic analyses. This scoping review does not require ethical approval as the methodology focuses on analysing information from available published data. ETHICS AND DISSEMINATION Results will be disseminated to relevant stakeholders including consumers, clinicians, professional organisations and policy-makers through peer-reviewed publications and national and international conferences.
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Affiliation(s)
- Kyung Ha You
- Cancer Care Services, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Zarnie Lwin
- Cancer Care Services, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Elizabeth Ahern
- Department of Medical Oncology, Monash Health, Clayton, Victoria, Australia
- School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
| | - David Wyld
- Cancer Care Services, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Natasha Roberts
- Cancer Care Services, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
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19
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You KH, Ahern E, Wyld D, Lwin Z, Roberts N. Scoping to analyze oncology trial participation in Australia. Semin Oncol 2022; 49:178-181. [DOI: 10.1053/j.seminoncol.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 02/02/2022] [Accepted: 04/03/2022] [Indexed: 11/11/2022]
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20
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Kirby E, Kenny K, Broom A, Lwin Z. Chronicity in/and cancer: a qualitative interview study of health professionals, patients, and family carers. Critical Public Health 2022. [DOI: 10.1080/09581596.2022.2035319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Emma Kirby
- Centre for Social Research in Health, University of New South Wales, Sydney, Australia
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Katherine Kenny
- Sydney Centre for Healthy Societies, School of Social and Political Sciences, University of Sydney, Sydney, Australia
| | - Alex Broom
- Sydney Centre for Healthy Societies, School of Social and Political Sciences, University of Sydney, Sydney, Australia
| | - Zarnie Lwin
- Cancer Care Services, Royal Brisbane and Women’s Hospital, Brisbane, Australia
- School of Medicine, University of Queensland, Brisbane, Australia
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21
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Abstract
The SARS-CoV-2 pandemic has resulted in considerable consequences for many cancer patients, exacerbating pre-existing systemic health system limitations as well as creating new challenges. From socially distanced clinics and the widespread introduction of telehealth, to the halting of clinical trials and the reassessment of what constitutes "essential" treatment, care in oncology has abruptly changed. There is currently limited analysis of cancer patients' experiences of the pandemic and its impacts on illness, wellness, and everyday life. Through semi-structured interviews with 54 people living with cancer during the 2020 phase of the SARS-CoV-2 pandemic in Australia, we explore how patients experience illness and care in reflecting upon a range of pandemic challenges, including delay, distance, and vulnerability. We find that in some cases, these pandemic conditions redefined the meaning of essential cancer care, reconfigured expectations around clinical trials, constructed new affective distances, and amplified dread and fear for people living with cancer.
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Affiliation(s)
- Alexander Page
- Sydney Centre for Healthy Societies, School of Social and Political Sciences, 4334The University of Sydney, Sydney, NSW, Australia
| | - Alex Broom
- Sydney Centre for Healthy Societies, School of Social and Political Sciences, 4334The University of Sydney, Sydney, NSW, Australia
| | - Katherine Kenny
- Sydney Centre for Healthy Societies, School of Social and Political Sciences, 4334The University of Sydney, Sydney, NSW, Australia
| | - Zarnie Lwin
- Metro North Hospital and Health Service, 3883Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Claire E Wakefield
- Kids Cancer Centre, 63623Sydney Children's Hospital, Sydney, NSW, Australia
- Behavioural Sciences Unit, Kids Cancer Centre, 63623Sydney Children's Hospital, Sydney, NSW, Australia
| | - Malinda Itchins
- Northern Cancer Institute, 94750North Shore Private Hospital, Sydney, NSW, Australia
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22
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Kong BY, Sim HW, Nowak AK, Yip S, Barnes EH, Day BW, Buckland ME, Verhaak R, Johns T, Robinson C, Thomas MA, Giardina T, Lwin Z, Scott AM, Parkinson J, Jeffree R, Lourenco RDA, Hovey EJ, Cher LM, Kichendasse G, Khasraw M, Hall M, Tu E, Amanuel B, Koh ES, Gan HK. LUMOS - Low and Intermediate Grade Glioma Umbrella Study of Molecular Guided TherapieS at relapse: Protocol for a pilot study. BMJ Open 2021; 11:e054075. [PMID: 37185327 PMCID: PMC8719186 DOI: 10.1136/bmjopen-2021-054075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Introduction Grades 2 and 3 gliomas (G2/3 gliomas), when combined, are the second largest group of malignant brain tumours in adults. The outcomes for G2/3 gliomas at progression approach the dismal outcomes for glioblastoma (GBM), yet there is a paucity of trials for Australian patients with relapsed G2/3 gliomas compared with patients with GBM. LUMOS will be a pilot umbrella study for patients with relapsed G2/3 gliomas that aims to match patients to targeted therapies based on molecular screening with contemporaneous tumour tissue. Participants in whom no actionable or no druggable mutation is found, or in whom the matching drug is not available, will form a comparator arm and receive standard of care chemotherapy. The objective of the LUMOS trial is to assess the feasibility of this approach in a multicentre study across five sites in Australia, with a view to establishing a national molecular screening platform for patient treatment guided by the mutational analysis of contemporaneous tissue biopsies Methods and analysis This study will be a multicentre pilot study enrolling patients with recurrent grade 2/3 gliomas that have previously been treated with radiotherapy and chemotherapy at diagnosis or at first relapse. Contemporaneous tumour tissue at the time of first relapse, defined as tissue obtained within 6 months of relapse and without subsequent intervening therapy, will be obtained from patients. Molecular screening will be performed by targeted next-generation sequencing at the reference laboratory (PathWest, Perth, Australia). RNA and DNA will be extracted from representative formalin-fixed paraffin embedded tissue scrolls or microdissected from sections on glass slides tissue sections following a review of the histology by pathologists. Extracted nucleic acid will be quantified by Qubit Fluorometric Quantitation (Thermo Fisher Scientific). Library preparation and targeted capture will be performed using the TruSight Tumor 170 (TST170) kit and samples sequenced on NextSeq 550 (Illumina) using NextSeq V.2.5 hi output reagents, according to the manufacturer’s instructions. Data analysis will be performed using the Illumina BaseSpace TST170 app v1.02 and a custom tertiary pipeline, implemented within the Clinical Genomics Workspace software platform from PierianDx (also refer to section 3.2). Primary outcomes for the study will be the number of patients enrolled and the number of patients who complete molecular screening. Secondary outcomes will include the proportion of screened patients enrolled; proportion of patients who complete molecular screening; the turn-around time of molecular screening; and the value of a brain tumour specific multi-disciplinary tumour board, called the molecular tumour advisory panel as measured by the proportion of patients in whom the treatment recommendation was refined compared with the recommendations from the automated bioinformatics platform of the reference laboratory testing. Ethics and dissemination The study was approved by the lead Human Research Ethics Committee of the Sydney Local Health District: Protocol No. X19-0383. The study will be conducted in accordance with the principles of the Declaration of Helsinki 2013, guidelines for Good Clinical Practice and the National Health and Medical Research Council National Statement on Ethical Conduct in Human Research (2007, updated 2018 and as amended periodically). Results will be disseminated using a range of media channels including newsletters, social media, scientific conferences and peer-reviewed publications. Trial registration number ACTRN12620000087954; Pre-results.
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Affiliation(s)
- Benjamin Y Kong
- NHMRC Clinical Trials Centre, Camperdown, New South Wales, Australia
- Department of Medical Oncology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Hao-Wen Sim
- NHMRC Clinical Trials Centre, Camperdown, New South Wales, Australia
- Department of Medical Oncology, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
- Kinghorn Cancer Centre, St Vincent's Hospital Sydney, Darlinghurst, New South Wales, Australia
- St Vincent's Clinical School, University of New South Wales, Darlinghurst, New South Wales, Australia
| | - Anna K Nowak
- Department of Medical Oncology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
- Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - Sonia Yip
- NHMRC Clinical Trials Centre, Camperdown, New South Wales, Australia
| | | | - Bryan W Day
- School of Biomedical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
- Sid Faithfull Brain Cancer Laboratory, Cell and Molecular Biology Department, QIMR Berghofer, Herston, Queensland, Australia
| | - Michael E Buckland
- Department of Neuropathology, Brain and Mind Centre, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Roel Verhaak
- The Jackson Laboratory for Genomic Medicine, Farmington, Connecticut, USA
| | - Terrance Johns
- Oncogenic Signalling Laboratory, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Cleo Robinson
- Department of Anatomical Pathology, PathWest Laboratory Medicine, Nedlands, Western Australia, Australia
| | - Marc A Thomas
- Department of Anatomical Pathology, PathWest Laboratory Medicine, Nedlands, Western Australia, Australia
| | - Tindaro Giardina
- Department of Anatomical Pathology, PathWest Laboratory Medicine, Nedlands, Western Australia, Australia
| | - Zarnie Lwin
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
- Cancer Care Services, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Andrew M Scott
- Department of Molecular Imaging and Therapy, Austin Health, Heidelberg, Victoria, Australia
- Olivia Newton-John Cancer Research Institute, Heidelberg, Victoria, Australia
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
- School of Cancer Medicine, La Trobe University, Melbourne, Victoria, Australia
| | - Jonathon Parkinson
- Department of Neurosurgery, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Rosalind Jeffree
- Department of Neurosurgery, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- University of Queensland School of Medicine, Herston, Queensland, Australia
| | - Richard de Abreu Lourenco
- Centre for Health Economics Research and Evaluation, University of Technology, Ultimo, New South Wales, Australia
| | - Elizabeth J Hovey
- Department of Medical Oncology, Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Randwick, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Randwick, New South Wales, Australia
| | - Lawrence M Cher
- Department of Neurology, Austin Health, Heidelberg, Victoria, Australia
| | - Ganessan Kichendasse
- Department of Clinical Pharmacology, College of Medicine and Public Health, Flinders Medical Centre, Bedford Park, South Australia, Australia
- Department of Medical Oncology, Flinders Centre for Innovation in Cancer, Bedford Park, South Australia, Australia
| | - Mustafa Khasraw
- Preston Robert Tisch Brain Tumor Center at Duke, Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Merryn Hall
- NHMRC Clinical Trials Centre, Camperdown, New South Wales, Australia
| | - Emily Tu
- NHMRC Clinical Trials Centre, Camperdown, New South Wales, Australia
| | - Benhur Amanuel
- Department of Anatomical Pathology, PathWest Laboratory Medicine, Nedlands, Western Australia, Australia
| | - Eng-Siew Koh
- Faculty of Medicine, University of New South Wales, Randwick, New South Wales, Australia
- Department of Radiation Oncology, Liverpool Cancer Therapy Centre, Liverpool, New South Wales, Australia
- Collaboration for Cancer Outcomes, Research and Evaluation, Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Hui K Gan
- Olivia Newton-John Cancer Research Institute, Heidelberg, Victoria, Australia
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
- School of Cancer Medicine, La Trobe University, Melbourne, Victoria, Australia
- Department of Medical Oncology, Olivia Newton-John Cancer Centre at Austin Health, Heidelberg, Victoria, Australia
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23
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Kong B, Sim HW, Amanuel B, Day B, Buckland M, Verhaak R, Yip S, Johns T, Lwin Z, Rosenthal M, Nowak AK, Barnes EH, Scott AM, Parkinson J, Jeffree R, Lourenco RDA, Lau P, Whittle J, Hovey E, Cher L, Kichendasse G, Hall M, Robinson C, Thomas M, Giardina T, Tu E, Khasraw M, Koh ES, Gan H. INNV-08. LOW AND INTERMEDIATE GRADE GLIOMA UMBRELLA STUDY OF MOLECULAR GUIDED THERAPIES (LUMOS) STUDY. Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab196.420] [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: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
Grade 2 and 3 (G2/3) gliomas are the second largest group of brain tumors in adults. Although the prognosis for G2/3 gliomas at the time of relapse mirror those of glioblastoma, there are few trials in this space.
METHODS
LUMOS was a national multi-center pilot study for patients with relapsed G2/3 gliomas designed to match contemporaneous tissue obtained at the time of disease progression with subsequent targeted therapies. The objective was to establish the feasibility of a precision oncology, umbrella approach to obtain and type tissue within a useful timeframe. As a key feature of LUMOS, a multidisciplinary Molecular Tumor Advisory Panel (MTAP) with subspecialty neuro-oncology expertise was formed to interpret the complex genomic information and provide a simplified recommendation to the treating physician.
RESULTS
Ten patients (median age 42: range 32-62; four G2 astrocytoma, one G3 astrocytoma, three G2 oligoendroglioma, one G3 oligodendroglioma, one mixed tumor) were enrolled in the study. Eight patients had biopsies within 6 months of study entry whilst two underwent a biopsy during the study. All patients had potentially targetable alterations (10 IDH, 3 FGFR, 2 PIK3K, CCND3, NRAS, CDK4, PRPRZ1-MET fusion and MET amplification). Matched therapies were delivered for two patients via compassionate access outside the study. The median turnaround time (TAT) of MTAP reports was 6.2 weeks (range 4.2-9.7 weeks) but 4.6 weeks when lag time for shipping was removed.
CONCLUSION
LUMOS confirmed that this design was feasible with good turnaround times. The MTAP facilitated education and support for treating physicians. Thes findings support moving to a larger study using contemporaneous and longitudinal tissue samples matched with targeted therapies as part of a comprehensive umbrella study design. Delivery and interpretation of molecular data is a challenge shared across oncology which may be mitigated with a neuro-oncology specific molecular tumor board.
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Affiliation(s)
- Benjamin Kong
- NHMRC Clinical Trials Centre, Camperdown, NSW, Australia
| | - Hao-Wen Sim
- NHMRC Clinical Trials Centre, Camperdown, NSW, Australia
| | | | - Bryan Day
- Sid Faithfull Brain Cancer Laboatory, Brisbane, QLD, Australia
| | | | - Roel Verhaak
- The Jackson Laboratory For Genomic Medicine, Farmington, CT, USA
| | - Sonia Yip
- NHMRC Clinical Trials Centre, Camperdown, NSW, Australia
| | | | - Zarnie Lwin
- Cancer Care Services, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Mark Rosenthal
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Anna K Nowak
- Medical School, University of Western Australia, Perth, WA, Australia
| | - Elizabeth H Barnes
- NHMRC Clinical Trials Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Andrew M Scott
- Olivia Newton-John Cancer Research Institute, Melbourne, VIC, Australia
| | | | | | - Richard De Abreu Lourenco
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, NSW, Australia
| | - Peter Lau
- Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - James Whittle
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Elizabeth Hovey
- Nelune Comprehensive Cancer Centre, Randwick, NSW, Australia
| | | | | | - Merryn Hall
- NHMRC Clinical Trials Centre, Camperdown, NSW, Australia
| | - Cleo Robinson
- Molecular Anatomical Pathology, PathWest, Nedlands, WA, Australia
| | - Marc Thomas
- Molecular Anatomical Pathology, PathWest, Nedlands, WA, Australia
| | - Tindaro Giardina
- Molecular Anatomical Pathology, PathWest, Nedlands, WA, Australia
| | - Emily Tu
- NHMRC Clinical Trials Centre, Camperdown, NSW, Australia
| | | | | | - Hui Gan
- Olivia Newton-John Cancer Research Institute, Melbourne, VIC, Australia
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Kong B, Sim HW, Koh ES, Gan H, Barnes EH, Yip S, Nowak AK, Lau P, Cuff K, Khoo E, Lwin Z, Cooper A, Dowling A, Linton A, Harrup R, Dunlop T, Hovey E, Parkinson J, Jeffree R, Hall M, Tu E, Andrew D, Simes J, Gedye C. RTID-05. THE MULTI-ARM GLIOBLASTOMA AUSTRALASIA (MAGMA) TRIAL. Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab196.767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
Survival outcomes for patients with newly diagnosed glioblastoma have not changed significantly since the introduction of concurrent temozolomide with post-surgical radiation followed by adjuvant temozolomide.
METHODS
Multi-Arm Glioblastoma Australasia (MAGMA) is a recently initiated phase III multi-arm, multi-centre randomized trial for patients with newly diagnosed glioblastoma, led by the Australian Cooperative Trials Group for Neuro-Oncology (COGNO), that will concurrently test multiple treatment questions. Initially, a partial factorial design will be implemented to compare the current standard of care with either or both of (1) neoadjuvant temozolomide and (2) aduvant temozolomide continued beyond six months until progression. MAGMA will transition to a multi-arm multi-stage (MAMS) design as additional tratment question are introduced. Treatment allocation to each question will be balanced (1:1) using minimisation over several stratification factors, including study site, age, IDH-mutation status, surgical extent and randomization to the prior treatment question(s). The primary outcome is overall survival. Secondary outcomes include progression-free survival (measured by mRANO), time to first non-temozolomide systemic treatment, clinically significant toxicity as measured by Grade 2/4 adverse events, and health-related quality of life measures. Parsimonious data collection and a streamlined assessment schedule have been incorporated to mitigate the burden of data collection (such as low grade toxicity from temozolomide), and to encourage participation in regional and rural settings. A consortium model has been adopted to foster neuro-oncology expertise and infrastructure and share academic credit and future design opportunities.
PROGRESS
Recruitment commenced in September 2020. To date, 60 patients have been recruited from an initial sample size target of 250 patients for each of these initial two treatment questions. Of these 60 patients, 45 have been randomized in Question 1 (neoadjuvant chemotherapy) whilst 50 randomized in Question 2 (prolonged adjuvant chemotherapy). To date, 14 of the 27 intended sites are open to recruitment.
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Affiliation(s)
- Benjamin Kong
- NHMRC Clinical Trial Centre, Camperdown, NSW, Australia
| | - Hao-Wen Sim
- NHMRC Clinical Trial Centre, Camperdown, NSW, Australia
| | | | - Hui Gan
- Olivia Newton-John Cancer Research Institute, Heidelberg, Melbourne, VIC, Australia
| | - Elizabeth H Barnes
- NHMRC Clinical Trials Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Sonia Yip
- NHMRC Clinical Trial Centre, Camperdown, NSW, Australia
| | - Anna K Nowak
- Medical School, University of Western Australia, Perth, WA, Australia
| | - Peter Lau
- Sir Charles Gairdner Hospital, Nedlands, Australia
| | | | - Eric Khoo
- Icon Cancer Centre, Gold Coast Hospital, Gold Coast, Australia
| | - Zarnie Lwin
- Cancer Care Services, Royal Brisbane and Women's Hospital, Herston, Australia
| | - Adam Cooper
- Liverpool Cancer Therapy Centre, Liverpool, Australia
| | | | - Anthony Linton
- Concord Repatriation General Hospital, Concord, Australia
| | | | | | | | | | | | - Merryn Hall
- NHMRC Clinical Trial Centre, Camperdown, NSW, Australia
| | - Emily Tu
- NHMRC Clinical Trial Centre, Camperdown, NSW, Australia
| | - Diana Andrew
- NHMRC Clinical Trial Centre, Camperdown, NSW, Australia
| | - John Simes
- NHMRC Clinical Trial Centre, Camperdown, NSW, Australia
| | - Craig Gedye
- Hunter Medical Research Institute Clinical Trials, Waratah, Australia
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Kenny K, Broom A, Page A, Prainsack B, Wakefield CE, Itchins M, Lwin Z, Khasraw M. A sociology of precision-in-practice: The affective and temporal complexities of everyday clinical care. Sociol Health Illn 2021; 43:2178-2195. [PMID: 34843108 PMCID: PMC9299761 DOI: 10.1111/1467-9566.13389] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 09/27/2021] [Indexed: 05/20/2023]
Abstract
The idea of 'precision medicine', which has gained increasing traction since the early 2000s, is now ubiquitous in health and medicine. Though varied in its implementation across fields, precision medicine has raised hopes of revolutionary treatments and has spurred the proliferation of novel therapeutics, the alteration of professional trajectories and various reconfigurations of health/care. Nowhere is the promise of precision medicine more apparent, nor further institutionalised, than in the field of oncology. While the transformative potential of precision medicine is widely taken for granted, there remains scant attention to how it is being experienced at the coalface of care. Here, drawing on the perspectives of 54 cancer care professionals gleaned through eight focus group discussions in two hospitals in Australia, we explore clinicians' experiences of the day-to-day dynamics of precision-in-practice. We illustrate some of the affective and temporal complexities, analysed here under the rubrics of enchantment, acceleration and distraction that are emerging alongside the uptake of precision medicine in the field of oncology. We argue that these complexities, and their dis/continuities with earlier iterations of cancer care, demonstrate the need for sociological analyses of precision medicine as it is being implemented in practice and its varied effects on 'routine' care.
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Affiliation(s)
- Katherine Kenny
- Sydney Centre for Healthy SocietiesSchool of Social and Political SciencesThe University of SydneySydneyNew South WalesAustralia
- Department of Sociology and Social PolicyFaculty of Arts and Social SciencesThe University of SydneySydneyNew South WalesAustralia
| | - Alex Broom
- Sydney Centre for Healthy SocietiesSchool of Social and Political SciencesThe University of SydneySydneyNew South WalesAustralia
- Department of Sociology and Social PolicyFaculty of Arts and Social SciencesThe University of SydneySydneyNew South WalesAustralia
| | - Alexander Page
- Sydney Centre for Healthy SocietiesSchool of Social and Political SciencesThe University of SydneySydneyNew South WalesAustralia
- Department of Sociology and Social PolicyFaculty of Arts and Social SciencesThe University of SydneySydneyNew South WalesAustralia
| | - Barbara Prainsack
- Department of Political ScienceUniversity of ViennaViennaAustria
- Department of Global Health & Social MedicineKing’s College LondonLondonUK
| | - Claire E. Wakefield
- School of Women’s and Children’s HealthUNSW Medicine and HealthUNSWSydneyNew South WalesAustralia
- Behavioural Sciences UnitKids Cancer CentreSydney Children’s HospitalRandwickNew South WalesAustralia
| | - Malinda Itchins
- Northern Clinical SchoolUniversity of SydneySt LeonardsNew South WalesAustralia
- Northern Cancer InstituteSt LeonardsNew South WalesAustralia
- Department of Medical OncologyRoyal North Shore HospitalSt LeonardsNew South WalesAustralia
| | - Zarnie Lwin
- Department of Medical OncologyRoyal Brisbane and Women’s HospitalHerstonQueenslandAustralia
- Faculty of MedicineUniversity of QueenslandSt LuciaQueenslandAustralia
| | - Mustafa Khasraw
- The Preston Robert Tisch Brain Tumor CenterDuke Center for Cancer ImmunotherapyDuke UniversityDurhamUSA
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Gan HK, Cher L, Inglis P, Lwin Z, Lau E, Wichmann C, McDonald A, Gunjur A, Ackermann U, Remen K, Fluck K, Bolarnos G, Guo N, Lee ST, Gong S, Palmer JB, Pathmaraj K, O'Keefe GJ, Scott FE, Day BW, Boyd AW, Thomas P, Ahmed O, Chappell D, Durrant C, Scott AM. Abstract CT101: Phase I safety and bioimaging trial of ifabotuzumab in patients with glioblastoma. Cancer Res 2021. [DOI: 10.1158/1538-7445.am2021-ct101] [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
Overview Glioblastoma multiforme (GBM) is the most frequent and lethal primary brain neoplasm, with only 10% of patients surviving 5 years.1 EphA3 is a tumor restricted antigen expressed in various solid tumors and the tumor vasculature of 100% of GBM.2,3 Ifabotuzumab is a non-fucosylated IgG1κ humaneered antibody targeting the EphA3 receptor.4 A Phase I study of ifabotuzumab in haematological malignancies showed it was well tolerated and clinically active.5 Here we report on a Phase I dose escalation and biodistribution study of ifabotuzumab in recurrent GBM. Study Design The primary objective is to determine the safety and recommended Phase II dose of ifabotuzumab in GBM patients (pts). Secondary objectives are to determine the biodistribution and pharmacokinetics (PK) of 89Zr- ifabotuzumab, the frequency of EphA3 positive GBM and response rates. On day 1, eligible pts with measurable tumors received a trace (5mg) dose of zirconium labelled ifabotuzumab (89Zr-ifab) followed by sequential PET imaging over 1 week to determine its biodistribution, frequency of in situ EphA3 expression and quantitative tumor uptake. Safety assessments and PK sampling were also undertaken. On day 8, pts commenced weekly ifabotuzumab infusions over 2 hours in one of two cohorts (3.5mg/kg, 5.25 mg/kg). On day 36, pts received both 89Zr-ifab and ifabotuzumab, allowing assessment of receptor occupancy. Response rate (RANO) and survival data were collected. Pts then continued on ifabotuzumab until progression. Results In total, 12 pts have been enrolled, including 6 in the 3.5mg/kg and 6 in the 5.25 mg/kg dose cohorts. Mean age was 51.6 years (±14.24) and 7/12 pts were male. Treatment emergent adverse events included infusion reactions in 4 pts, seizures in 3 pts, cerebral oedema in 1, rash in 1, headaches in 8, eye disorder in 1. Most were considered related to study drug except seizure in 2 pts, headaches and eye disorder. Seizures and infusion reactions were readily managed with increased premedications after the first occurrence. The best response was stable disease for 23 weeks. 89Zr-ifab-PET scans showed rapid, tumor-specific targeting at all known tumor sites and in all pts, but with no normal tissue uptake. MRI scans showed predominant T2/FLAIR changes, occasionally marked, which were consistent with treatment effect of ifabotuzumab on tumor vasculature. The mean ± SD (n=12) PK parameters for first infusion 89Zr-ifab were T½α= 9.03 ± 4.45 hr, T½β = 92.50 ± 65.65 hr, V1 = 3.75 ± 0.67 L, CL= 132.11 ± 70.16 mL/hr. Conclusions: Ifabotuzumab demonstrates highly sensitive, specific and reproducible targeting of the tumor and tumor microenvironment in all patients in this study. The imaging changes suggest direct modulation of the tumor vasculature. Additional studies are planned to evaluate ifabotuzumab as part of an antibody-drug conjugate in various solid tumor types. References: 1. Stupp R, et al, Lancet Oncology 10:459-66, 2009 2. Day BW, et al. Cancer Cell 23:238-48, 2013 3. Vail ME, et al. Cancer Research 74:4470-81, 2014 4. Tomasevic N, et al. Growth Factors 32:223-35, 2014 5. Swords RT, et al. Leukemia Research 50:123-131, 2016
Citation Format: Hui K. Gan, Lawrence Cher, Po Inglis, Zarnie Lwin, Eddie Lau, Christian Wichmann, Alex McDonald, Ashray Gunjur, Uwe Ackermann, Kirsten Remen, Kate Fluck, Gel Bolarnos, Nancy Guo, Sze Ting Lee, Sylvia Gong, Jodie B. Palmer, Kunthi Pathmaraj, Graeme J. O'Keefe, Fiona E. Scott, Bryan W. Day, Andrew W. Boyd, Paul Thomas, Omar Ahmed, Dale Chappell, Cameron Durrant, Andrew M. Scott. Phase I safety and bioimaging trial of ifabotuzumab in patients with glioblastoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr CT101.
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Affiliation(s)
- Hui K. Gan
- 1Austin Health; La Trobe University School of Cancer Medicine; Olivia Newton-John Cancer Research Institute, Heidelberg, Australia
| | - Lawrence Cher
- 2Austin Health; Olivia Newton-John Cancer Research Institute, Heidelberg, Australia
| | - Po Inglis
- 3Royal Brisbane and Womens Hospital, Herston, Australia
| | - Zarnie Lwin
- 4Royal Brisbane and Women's Hospital, Herston, Australia
| | - Eddie Lau
- 5Austin Health, Heidelberg, Australia
| | - Christian Wichmann
- 6Olivia Newton-John Cancer Research Institute; La Trobe University School of Cancer Medicine, Heidelberg, Australia
| | - Alex McDonald
- 6Olivia Newton-John Cancer Research Institute; La Trobe University School of Cancer Medicine, Heidelberg, Australia
| | | | | | | | | | - Gel Bolarnos
- 4Royal Brisbane and Women's Hospital, Herston, Australia
| | - Nancy Guo
- 7Olivia Newton-John Cancer Research Institute, Heidelberg, Australia
| | - Sze Ting Lee
- 8Austin Health; La Trobe University School of Cancer Medicine, Heidelberg, Australia
| | | | - Jodie B. Palmer
- 9Olivia Newton-John Cancer Research Institute; Olivia Newton-John Cancer Research Institute; La Trobe University School of Cancer Medicine, Heidelberg, Australia
| | | | | | - Fiona E. Scott
- 6Olivia Newton-John Cancer Research Institute; La Trobe University School of Cancer Medicine, Heidelberg, Australia
| | - Bryan W. Day
- 10QIMR Berghofer Medical Research Institute, Herston, Australia
| | - Andrew W. Boyd
- 4Royal Brisbane and Women's Hospital, Herston, Australia
| | - Paul Thomas
- 4Royal Brisbane and Women's Hospital, Herston, Australia
| | | | | | | | - Andrew M. Scott
- 12Austin Health; University of Melbourne; La Trobe University School of Cancer Medicine; Olivia Newton-John Cancer Research Institute, Heidelberg, Australia
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Kong BY, Carter C, Nowak AK, Hovey E, Lwin Z, Haghighi N, Gan HK, Sim HW, Ziegler DS, Barton K, Parkinson J, Leonard R, Khasraw M, Foote M. Barriers and potential solutions to international collaboration in neuro-oncology clinical trials: Challenges from the Australian perspective. Asia Pac J Clin Oncol 2021; 18:259-266. [PMID: 34166569 PMCID: PMC9292370 DOI: 10.1111/ajco.13606] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 04/27/2021] [Indexed: 11/29/2022]
Abstract
AIM The neuro-oncology community in Australia is well positioned to collaborate internationally, with a motivated trials group, strong regulatory bodies and an attractive fiscal environment. We sought to identify gaps in the Australian neuro-oncology clinical trials landscape and describe strategies to increase international trial access in Australia. METHODS We searched clinical trial registries to identify active adult primary brain cancer trials. We compared the participation rate and phase of these trials between tumour types and countries. A survey was distributed to the Cooperative Trials Group for Neuro-Oncology membership to identify barriers and solutions to effective international collaboration. RESULTS Globally, 307 trials for adult primary brain cancers were identified. These included 50% pharmaceutical agents, 18% cellular therapies and 9% radiation therapy. Twelve adult primary brain cancer trials were actively recruiting in Australia at the time the survey was sent out. There were more early phase brain cancer trials (34%) compared with colorectal and breast cancer (21% and 24%, respectively). In Australia, 92% of brain cancer trials were involving pharmaceutical agents. The most commonly cited barrier was lack of funding for international trials (86%) and insufficient research time (75%). High ranking solutions included increasing the availability of funding for international trials and creating opportunities to develop personal relationships with collaborators. Accreditation of clinical research key performance indicators into practice (88%) and hospital accreditation (73%) also ranked highly. CONCLUSIONS Participation in international research in Australia could be improved by embedding clinical research targets into institutional funding, provision of funding for early phase studies and streamlining mutual ethics schemes.
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Affiliation(s)
- Benjamin Y Kong
- Cooperative Trials Group for Neuro-Oncology, National Health and Medical Research Council Clinical Trials Centre, Sydney, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Department of Medical Oncology, Royal North Shore Hospital, St Leonards, Australia
| | - Candace Carter
- Cooperative Trials Group for Neuro-Oncology, National Health and Medical Research Council Clinical Trials Centre, Sydney, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Anna K Nowak
- Cooperative Trials Group for Neuro-Oncology, National Health and Medical Research Council Clinical Trials Centre, Sydney, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Department of Medical Oncology, Sir Charles Gairdner Hospital, Perth, Australia
| | - Elizabeth Hovey
- Cooperative Trials Group for Neuro-Oncology, National Health and Medical Research Council Clinical Trials Centre, Sydney, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Nelune Comprehensive Cancer Centre, Randwick, Australia.,Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Zarnie Lwin
- Cooperative Trials Group for Neuro-Oncology, National Health and Medical Research Council Clinical Trials Centre, Sydney, Australia.,Royal Brisbane and Women's Hospital, Princess Alexandra Hospital, Brisbane, Australia
| | - Neda Haghighi
- Cooperative Trials Group for Neuro-Oncology, National Health and Medical Research Council Clinical Trials Centre, Sydney, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Department of Radiation Oncology, Peter MacCallum Cancer Centre, Parkville, Australia
| | - Hui K Gan
- Cooperative Trials Group for Neuro-Oncology, National Health and Medical Research Council Clinical Trials Centre, Sydney, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Department of Medical Oncology, Austin Hospital, Melbourne, Australia.,Cancer Therapies and Biology Group, Centre of Research Excellence in Brain Tumours, Olivia Newton-John Cancer Wellness and Research Centre, Austin Hospital, Heidelberg, Melbourne, Australia.,La Trobe University School of Cancer Medicine, Heidelberg, Victoria, Australia.,Department of Medicine, University of Melbourne, Heidelberg, Victoria, Australia
| | - Hao-Wen Sim
- Cooperative Trials Group for Neuro-Oncology, National Health and Medical Research Council Clinical Trials Centre, Sydney, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Kinghorn Cancer Centre, Darlinghurst, Australia; St Vincent's Clinical School, University of New South Wales, Sydney, Australia.,Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - David S Ziegler
- Cooperative Trials Group for Neuro-Oncology, National Health and Medical Research Council Clinical Trials Centre, Sydney, Australia.,Children's Cancer Institute, University of New South Wales, Australia and Kids Cancer Centre, Sydney Children's Hospital, Sydney, Australia.,School of Women's and Children's Health, University of New South Wales, Sydney, Australia
| | - Kirston Barton
- Cooperative Trials Group for Neuro-Oncology, National Health and Medical Research Council Clinical Trials Centre, Sydney, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Jonathon Parkinson
- Cooperative Trials Group for Neuro-Oncology, National Health and Medical Research Council Clinical Trials Centre, Sydney, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Department of Medical Oncology, Royal North Shore Hospital, St Leonards, Australia
| | - Robyn Leonard
- Cooperative Trials Group for Neuro-Oncology, National Health and Medical Research Council Clinical Trials Centre, Sydney, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Mustafa Khasraw
- Cooperative Trials Group for Neuro-Oncology, National Health and Medical Research Council Clinical Trials Centre, Sydney, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Preston Robert Tisch Brain Tumor Center, Department of Neurosurgery, Duke University, Durham, North Carolina, USA
| | - Matthew Foote
- Cooperative Trials Group for Neuro-Oncology, National Health and Medical Research Council Clinical Trials Centre, Sydney, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Royal Brisbane and Women's Hospital, Princess Alexandra Hospital, Brisbane, Australia.,School of Medicine, University of Queensland, Brisbane, Australia
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28
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Affiliation(s)
- Zarnie Lwin
- Cancer Care Services, Royal Brisbane and Women's Hospital, University of Queensland, Australia
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29
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Chung HCC, Lwin Z, Gomez-Roca CA, Longo F, Yanez E, Castanon Alvarez E, Graham DM, Doherty M, Cassier P, Lopez JS, Basu B, Hendifar AE, Maurice-Dror C, Gill SS, Ghori R, Kubiak P, Jin F, Norwood KG, Saada-Bouzid E. LEAP-005: A phase 2 multicohort study of lenvatinib plus pembrolizumab in patients with previously treated selected solid tumors—Results from the gastric cancer cohort. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.4030] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4030 Background: Lenvatinib, an anti-angiogenic multiple receptor tyrosine kinase inhibitor, in combination with the anti‒PD-1 antibody pembrolizumab, has demonstrated promising antitumor activity with manageable safety in the first- or second-line in a phase 2 trial of patients with advanced gastric cancer. LEAP-005 (NCT03797326) is a phase 2, multicohort, nonrandomized, open-label study evaluating efficacy and safety of lenvatinib plus pembrolizumab in patients with previously treated advanced solid tumors; here, we present findings from the gastric cancer cohort of LEAP-005. Methods: Eligible patients were aged ≥18 years with histologically or cytologically confirmed metastatic and/or unresectable gastric cancer, received at least 2 prior lines of therapy, had measurable disease per RECIST v1.1, ECOG PS of 0‒1, and provided a tissue sample evaluable for PD-L1 expression. Patients received lenvatinib 20 mg once daily plus pembrolizumab 200 mg Q3W for up to 35 cycles of pembrolizumab (approximately 2 years) or until confirmed disease progression, unacceptable toxicity, or withdrawal of consent. Treatment with lenvatinib could continue beyond 2 years in patients experiencing clinical benefit. Primary endpoints were ORR (per RECIST v1.1 by blinded independent central review) and safety. Secondary endpoints included disease control rate (DCR; comprising CR, PR, and SD), duration of response (DOR), PFS, and OS. Tumor imaging was performed Q9W from treatment initiation for 54 weeks, then Q12W to week 102, and Q24W thereafter. Results: 31 patients were enrolled in the gastric cancer cohort; 87% were male, 58% were aged < 65 years, and 71% had PD-L1 combined positive score (CPS) ≥1. Median time from first dose to data cutoff (April 10, 2020) was 7.0 months (range, 1.9‒11.9); 19 patients (61%) had discontinued treatment. ORR was 10% (95% CI, 2‒26); 1 patient had CR (3%), and 2 had a PR (6%). 12 patients (39%) had SD. Median DOR was not reached (range, 2.1+ to 2.3+ months). DCR was 48% (95% CI, 30‒67). Median PFS was 2.5 months (95% CI, 1.8‒4.2). Median OS was 5.9 months (95% CI, 2.6‒8.7). 28 patients (90%) had treatment-related AEs, including 13 patients (42%) with grade 3‒5 AEs. 1 patient had a treatment-related AE that led to death (hemorrhage). 8 patients (26%) had immune-mediated AEs: hypothyroidism (n = 5), hyperthyroidism (n = 2), and pneumonitis (n = 1). There were no infusion-related reactions. Conclusions: In patients with advanced gastric cancer who received 2 prior lines of therapy, lenvatinib plus pembrolizumab demonstrated promising antitumor activity and a manageable safety profile. Based on these data, enrollment in the gastric cancer cohort has been expanded to 100 patients. Clinical trial information: NCT03797326.
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Affiliation(s)
- Hyun Cheol Cheol Chung
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Zarnie Lwin
- Royal Brisbane and Women's Hospital, University of Queensland, Brisbane, QLD, Australia
| | | | - Federico Longo
- Hospital Universitario Ramón y Cajal, IRYCIS, CIBERONC, Madrid, Spain
| | - Eduardo Yanez
- Oncology-Hematology Unit, Department of Internal Medicine, School of Medicine, Universidad de la Frontera, Temuco, Chile
| | | | - Donna M. Graham
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Mark Doherty
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | | | - Juanita Suzanne Lopez
- The Royal Marsden Foundation Trust and the Institute of Cancer Research, London, United Kingdom
| | - Bristi Basu
- Department of Oncology, University of Cambridge, Cambridge, United Kingdom
| | | | | | | | | | | | - Fan Jin
- Merck & Co., Inc., Kenilworth, NJ
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30
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Ahern ES, Roberts NA, Chan BA, Gasper HM, Pelecanos A, Kennedy G, Wyld D, Lwin Z. Psychosocial impacts of COVID-19 upon a diverse Australian oncology workforce: From doctors to ancillary staff. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e23016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e23016 Background: Potential moral hazards from COVID-19 for patient-facing oncology staff include rationalizing treatment, but prior research into staff distress has not included ancillary/administrative staff or compared geographic settings. We sought to document measures of distress and perceived preparedness from diverse oncology staff during the COVID-19 pandemic response, and correlate these with unfolding events. Methods: We utilised a mixed-methods approach comprising weekly diarising of executive communications and events-by investigators, and prospective self-administered online surveys-by staff. Survey domains included perceived institutional preparedness, personal wellbeing, and perceived stress using a distress thermometer (0-10, no-extreme distress). Responses were Likert-scaled or free-text. Quantitative responses were aggregated by role/site and analysed using R. These were correlated with emergent qualitative themes using the Framework Method. The study was conducted at a metropolitan and a regional hospital in Queensland, Australia. Results: 12 surveys across 18 weeks commencing April 3, 2020 (encompassing 1st lockdown, lockdown easing, and 2nd lockdown) had 993 individual responses. 40% respondents were located regionally. Role categories included: nursing (50%), allied health (18%), medical (16%), administrative (15%), ancillary (e.g. cleaner, food service) (1%). Emergent themes were: S trategies for protection- at work and home. Up to 27% respondents reported being able to attend to critical personal needs only sometimes or less, although patients were perceived to be well supported most/all of the time (>90% responses). Navigating rules and keeping up-high levels of perceived institutional preparedness in >75% responders coexisted alongside fluctuating levels of self-reported distress, from median 5 (IQR 3-7) at 1st lockdown outset to 1 (IQR 1-4) after lockdown restriction easing. Tempered optimism-pride in one’s place was reported both as reflecting healthcare worker identity and as Australians in the context of low local infection rates. No significant differences in distress or preparedness perceptions were evident comparing geographic sites. Framing the new normal-although respondents longitudinally reported increasing familiarity with pandemic directives, distress levels increased concurrently with the announcement of 2nd lockdown. Conclusions: In the context of low local COVID-19 infection rates, oncology staff regardless of role and geographic setting reported high perceptions of institutional preparedness. Distress levels increased concurrently with lockdown phases and reports of distress and psychosocial workload fatigue were made by various workers including administrative and ancillary. These should be considered frontline staff for the purpose of workplace psychosocial support in pandemic responses.
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Affiliation(s)
| | | | | | | | - Anita Pelecanos
- Queensland Institute of Medical Research-Berghofer, Brisbane, QLD, Australia
| | - Glen Kennedy
- Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - David Wyld
- Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Zarnie Lwin
- Royal Brisbane and Women's Hospital, University of Queensland, Brisbane, QLD, Australia
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Villanueva L, Lwin Z, Chung HCC, Gomez-Roca CA, Longo F, Yanez E, Senellart H, Doherty M, Garcia-Corbacho J, Hendifar AE, Maurice-Dror C, Gill SS, Kim TW, Heudobler D, Penel N, Ghori R, Kubiak P, Jin F, Norwood KG, Graham DM. Lenvatinib plus pembrolizumab for patients with previously treated biliary tract cancers in the multicohort phase 2 LEAP-005 study. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.4080] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4080 Background: Second-line treatment options for patients with biliary tract cancers (BTC) are limited. Lenvatinib, an anti-angiogenic multikinase inhibitor, in combination with the programmed death-1 immune checkpoint inhibitor pembrolizumab, has demonstrated promising antitumor activity with a manageable safety profile in patients with select advanced solid tumors. LEAP-005 (NCT03797326) is evaluating the efficacy and safety of lenvatinib plus pembrolizumab in patients with previously treated advanced solid tumors; here we present results from the BTC cohort of LEAP-005. Methods: In this nonrandomized, open-label, phase 2 study, eligible patients were aged ≥18 years with histologically or cytologically documented advanced (metastatic and/or unresectable) BTC with disease progression after 1 prior line of therapy, measurable disease per RECIST v1.1, ECOG PS of 0‒1, and tissue sample evaluable for PD-L1 expression. Patients received lenvatinib 20 mg once daily plus pembrolizumab 200 mg Q3W for up to 35 cycles (approximately 2 years) or until confirmed disease progression, unacceptable toxicity, or withdrawal of consent. Treatment with lenvatinib could continue beyond 2 years in patients experiencing clinical benefit. Primary endpoints were ORR (per RECIST v1.1 by blinded independent central review) and safety. Secondary endpoints were the disease control rate (DCR; comprising CR, PR, and SD), duration of response (DOR), PFS, and OS. Tumor imaging was performed Q9W from treatment initiation for 54 weeks, then Q12W to week 102, and Q24W thereafter. Results: 31 patients were enrolled in the BTC cohort (ECOG PS 1, 55%; 84% ex-US). As of April 10, 2020, median time from first dose to data cutoff (DCO) was 9.5 months (range, 3.1‒11.9), with 8 patients on treatment at DCO. There were 3 (10%) PRs and 18 (58%) SDs. ORR was 10% (95% CI, 2‒26), and DCR was 68% (95% CI, 49‒83). Median DOR was 5.3 months (range, 2.1+ to 6.2). Median PFS was 6.1 months (95% CI, 2.1‒6.4). Median OS was 8.6 months (95% CI, 5.6 to NR). Treatment-related AEs occurred in 30 patients (97%), including 15 (48%) who had grade 3 AEs; there were no grade 4 or 5 treatment-related AEs. 2 (6%) discontinued treatment due to treatment-related AEs (myocarditis, pyrexia; n = 1 each). The most frequent treatment-related AEs were hypertension (42%), dysphonia (39%), diarrhea (32%), fatigue (32%), and nausea (32%). 14 patients (45%) had immune-mediated AEs and 1 patient (3%) had an infusion-related reaction. Conclusions: Lenvatinib plus pembrolizumab demonstrated encouraging efficacy and manageable toxicity in patients with advanced BTC who had received 1 line of prior therapy. Based on these data, enrollment in the BTC cohort has been expanded to 100 patients. Clinical trial information: NCT03797326.
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Affiliation(s)
| | - Zarnie Lwin
- Royal Brisbane and Women's Hospital, University of Queensland, Brisbane, QLD, Australia
| | - Hyun Cheol Cheol Chung
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | | | - Federico Longo
- Hospital Universitario Ramón y Cajal, IRYCIS, CIBERONC, Madrid, Spain
| | - Eduardo Yanez
- Oncology-Hematology Unit, Department of Internal Medicine, School of Medicine, Universidad de la Frontera, Temuco, Chile
| | - Hélène Senellart
- Institut de Cancérologie de l’Ouest, Centre René Gauducheau ICO, Saint-Herblain, France
| | - Mark Doherty
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Javier Garcia-Corbacho
- Department of Medical Oncology (Hospital Clinic)/Translational Genomics and Targeted Therapies in Solid Tumors (IDIBAPs), Barcelona, Spain
| | | | | | | | | | | | | | | | | | - Fan Jin
- Merck & Co., Inc., Kenilworth, NJ
| | | | - Donna M. Graham
- The Christie NHS Foundation Trust, Manchester, United Kingdom
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32
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Sim HW, McDonald KL, Lwin Z, Barnes EH, Rosenthal M, Foote MC, Koh ES, Back M, Wheeler H, Sulman EP, Buckland ME, Fisher L, Leonard R, Hall M, Ashley DM, Yip S, Simes J, Khasraw M. A randomized phase II trial of veliparib, radiotherapy and temozolomide in patients with unmethylated MGMT glioblastoma: the VERTU study. Neuro Oncol 2021; 23:1736-1749. [PMID: 33984151 PMCID: PMC8485443 DOI: 10.1093/neuonc/noab111] [Citation(s) in RCA: 36] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Background Temozolomide offers minimal benefit in patients with glioblastoma with unmethylated O6-methylguanine-DNA methyltransferase (MGMT) promoter status, hence, the need for novel therapies. This study evaluated whether veliparib, a brain-penetrant poly(ADP-ribose) polymerase (PARP) inhibitor, acts synergistically with radiation and temozolomide. Methods VERTU was a multicenter 2:1 randomized phase II trial in patients with newly diagnosed glioblastoma and MGMT-unmethylated promotor status. The experimental arm consisted of veliparib and radiotherapy, followed by adjuvant veliparib and temozolomide. The standard arm consisted of concurrent temozolomide and radiotherapy, followed by adjuvant temozolomide. The primary objective was to extend the progression-free survival rate at six months (PFS-6m) in the experimental arm. Results A total of 125 participants were enrolled, with 84 in the experimental arm and 41 in the standard arm. The median age was 61 years, 70% were male, 59% had Eastern Cooperative Oncology Group (ECOG) performance status of 0, and 87% underwent macroscopic resection. PFS-6m was 46% (95% confidence interval [CI]: 36%-57%) in the experimental arm and 31% (95% CI: 18%-46%) in the standard arm. Median overall survival was 12.7 months (95% CI: 11.4-14.5 months) in the experimental arm and 12.8 months (95% CI: 9.5-15.8 months) in the standard arm. The most common grade 3-4 adverse events were thrombocytopenia and neutropenia, with no new safety signals. Conclusion The veliparib-containing regimen was feasible and well tolerated. However, there was insufficient evidence of clinical benefit in this population. Further information from correlative translational work and other trials of PARP inhibitors in glioblastoma are still awaited.
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Affiliation(s)
- Hao-Wen Sim
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia.,St Vincent's Clinical School, University of New South Wales, Sydney, Australia.,Department of Medical Oncology, The Kinghorn Cancer Centre, Sydney, Australia.,Department of Medical Oncology, Chris O'Brien Lifehouse, Sydney, Australia
| | - Kerrie L McDonald
- Cure Brain Cancer Neuro-Oncology Lab, University of New South Wales, Sydney, Australia
| | - Zarnie Lwin
- School of Medicine, University of Queensland, Brisbane, Australia.,Department of Medical Oncology, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | | | - Mark Rosenthal
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia.,Department of Medical Oncology, Royal Melbourne Hospital, Melbourne, Australia
| | - Matthew C Foote
- School of Medicine, University of Queensland, Brisbane, Australia.,Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane, Australia
| | - Eng-Siew Koh
- South Western Sydney Clinical School, University of New South Wales, Sydney, Australia.,Ingham Institute for Applied Medical Research, Sydney, Australia.,Department of Radiation Oncology, Liverpool Hospital, Sydney, Australia
| | - Michael Back
- Department of Radiation Oncology, Royal North Shore Hospital, Sydney, Australia
| | - Helen Wheeler
- Department of Medical Oncology, Royal North Shore Hospital, Sydney, Australia
| | - Erik P Sulman
- Department of Radiation Oncology, NYU Grossman School of Medicine and Brain and Spine Tumors, New York, USA.,Laura and Isaac Perlmutter Cancer Center, NYU Langone Health, New York, USA
| | - Michael E Buckland
- Neuropathology Department, Royal Prince Alfred Hospital, Sydney, Australia.,Brain and Mind Centre, University of Sydney, Sydney, Australia
| | - Lauren Fisher
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia
| | - Robyn Leonard
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia
| | - Merryn Hall
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia
| | - David M Ashley
- Duke University School of Medicine, Duke University, Durham, NC, USA
| | - Sonia Yip
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia
| | - John Simes
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia.,Department of Medical Oncology, Chris O'Brien Lifehouse, Sydney, Australia
| | - Mustafa Khasraw
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia.,Duke University School of Medicine, Duke University, Durham, NC, USA
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Gasper H, Ahern E, Roberts N, Chan B, Hughes B, Kennedy G, Wyld D, Eastgate M, Lwin Z. Semiqualitative research protocol to explore cancer care workforce perceptions of the health system response to COVID-19 preparations in Southeast Queensland, Australia. BMJ Open 2021; 11:e044655. [PMID: 33958340 PMCID: PMC8103556 DOI: 10.1136/bmjopen-2020-044655] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION Sars-CoV-2 is a novel coronavirus responsible for COVID-19 officially declared pandemic in March 2020. Health systems worldwide responded with swift changes to increase workflow capacity while protecting the vulnerable, including those with cancer. This led to unprecedented and rapid restructuring of health service provision. Published data from the 2003 SARS pandemic focuses on medical and nursing staff, overlooking other departmental employees such as administration officers or food service workers. Our protocol aims to document directives and adjustments communicated to staff in two cancer care departments and correlate this with measures of distress and perceived preparedness across the spectrum of all staff involved in cancer care. METHODS AND ANALYSIS We use a semiqualitative approach comprising weekly diarising of events and simultaneous staff surveys. Principal investigators will document changes at a metropolitan quaternary cancer centre and a regional cancer centre. Communications, directives and changes will be diarised in real time in four executional domains. Simultaneously, prospective voluntary self-administered online surveys will be conducted at regular intervals by staff. The survey assesses the perceived institutional preparedness and personal well-being, with a combination of Likert scaled and open response questions. A semiquantitative self-assessment of distress adapted from National Comprehensive Cancer Network distress thermometer is incorporated. Additionally, open-text personal reflections on themes including difficult decisions will be invited. Survey participants will be drawn from various work areas of the cancer care departments: administrative staff, health professionals, for example, allied health, ancillary workers, nursing and medical. ETHICS AND DISSEMINATION The study has been reviewed and approved by the Human Research Ethics Committee (LNR/2020/QRBW/62982). Published literature on domains of distress neglects categories of healthcare worker who form an essential part of the care delivery team. Our study hopes to gather insights about psychosocial impact and adjustment which could direct responses in future emergencies.
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Affiliation(s)
- Harry Gasper
- Cancer Care Services, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- School of Medicine, The University of Queensland, Saint Lucia, Queensland, Australia
- Surgery and Cancer Care, Darling Downs Hospital and Healthcare Service, Toowoomba, Queensland, Australia
| | - Elizabeth Ahern
- Cancer Care Services, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- School of Medicine, The University of Queensland, Saint Lucia, Queensland, Australia
- Monash Health, Clayton, Victoria, Australia
- School of Clinical Sciences, Faculty of Medicine, Monash University, Clayton, Victoria, Australia
| | - Natasha Roberts
- Cancer Care Services, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Bryan Chan
- School of Medicine, The University of Queensland, Saint Lucia, Queensland, Australia
- Adem Crosby Cancer Centre, Sunshine Coast University Hospital, Sunshine Coast, Queensland, Australia
| | - Brett Hughes
- Cancer Care Services, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- School of Medicine, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Glen Kennedy
- Cancer Care Services, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- School of Medicine, The University of Queensland, Saint Lucia, Queensland, Australia
| | - David Wyld
- Cancer Care Services, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- School of Medicine, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Melissa Eastgate
- Cancer Care Services, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- School of Medicine, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Zarnie Lwin
- Cancer Care Services, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- School of Medicine, The University of Queensland, Saint Lucia, Queensland, Australia
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Ives A, Pusztai T, Keller J, Ahern E, Chan B, Gasper H, Wyld D, Kennedy G, Dickie G, Lwin Z, Roberts NA. Resilience and ongoing quality care for cancer clinical trials during COVID-19: Experience from a tertiary hospital in Australia. Asia Pac J Clin Oncol 2021; 18:e141-e147. [PMID: 33819387 PMCID: PMC8251164 DOI: 10.1111/ajco.13570] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 01/18/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND The COVID-19 pandemic has forced rapid system-wide changes to be implemented within cancer care at an alarming pace. Clinical trials are a key element of comprehensive cancer care. Ensuring the continuing safe conduct of cancer clinical trials in the context of a pandemic is challenging. METHODS We aimed to describe the COVID-19 pandemic response of a Cancer Care Clinical Research Unit (CRU) of a tertiary hospital in Queensland, Australia. We used a mixed methods approach for this case study. Emailed directives from CRU managers to all CRU staff sharing were qualitatively analysed and mapped against our unit activities over longitudinal time points. Data from patient recruitment and protocol deviations were analysed using descriptive statistics. RESULTS Mapping activity from 11 March to 30 September 2020 revealed rapid change during the first 2 weeks. Four key strategies to accommodate change were identified: supporting patients and families, introduction of telehealth, accessing investigational product, and social distancing. Early in the pandemic we recognised that our core key stakeholders were integral to our response. When compared to the previous 12 months, our recruitment numbers dropped markedly in early phases of the response but recovered over time, as we accommodated internal and external impacts. CONCLUSION Our experience of agility as a necessity, adapting to support patients, and managing both clinical research activity and sponsors during the height of the pandemic response is presented here in order to inform future disaster response planning by clinical trial organisations.
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Affiliation(s)
- Amy Ives
- Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Tricia Pusztai
- Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Jacqui Keller
- Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Elizabeth Ahern
- Department of Oncology, Monash Health, Melbourne, Victoria, Australia.,School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia
| | - Bryan Chan
- Adem Crosby Cancer Centre, Sunshine Coast University Hospital, Birtinya, Queensland, Australia.,School of Medicine, Griffith University, Sunshine Coast, Queensland, Australia
| | - Harry Gasper
- Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,Clinical School of Medicine, University of Queensland, St Lucia, Australia
| | - David Wyld
- Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,Clinical School of Medicine, University of Queensland, St Lucia, Australia
| | - Glen Kennedy
- Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,Clinical School of Medicine, University of Queensland, St Lucia, Australia
| | - Graeme Dickie
- Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Zarnie Lwin
- Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Natasha A Roberts
- Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,University of Queensland Centre for Clinical Research (UQCCR), Queensland, Australia.,School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
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Dulfikar A, Koh ES, Lwin Z, Hovey E, Dhillon H, Arundell J, Pinkham E, Pinkham MB, Holland J, Trajano G, Naumann F. Physical functional capacity of patients with glioma prior to adjuvant radiation: preliminary descriptive study. Neurooncol Pract 2021; 8:290-298. [PMID: 34055376 DOI: 10.1093/nop/npab015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background Few studies have assessed physical functioning in glioma patients with grade II, III, and IV glioma prior to undergoing adjuvant radiation with or without chemotherapy. The aim of this study was to describe the baseline physical functioning capacity of patients with glioma prior to adjuvant therapy compared to validated cutoffs required to maintain independence. Methods This study is a cross-sectional study that recruited patients with grade II, III, and IV glioma (n = 33) undergoing adjuvant radiation with or without chemotherapy. The six-minute walk, thirty-second sit-to-stand, and timed "Up & Go" assessments were used to describe baseline physical functioning. Perceived quality of life from the European Organisation for Research and Treatment of Cancer (EORTC) quality of life questionnaire (QLQ-C30) version 3.0 was used to quantify the quality of life. Results Mean distance walked in the six-minute walk test was 416.2 m (SD 137.6 m) with a mean of 12.2 stands (SD 3.4 stands) achieved during the thirty-second sit-to-stand. Median time to complete the timed "Up & Go" assessment was 7 s (interquartile range: 3 s). One-sample t tests suggest walking distance and chair stands were significantly lower than cutoff criterions to maintain independent living, t(32) = -5.96, P < .001, bias-corrected accelerated 95% CI [370.7-460.4], and t(32) = -4.60, P < .01, bias-corrected accelerated 95% CI [11.0-13.4], respectively. Wilcoxon signed-rank test identified significantly shorter median time taken to complete the timed "Up & Go" test compared to the cutoff criterion (z = -4.43, n = 33, P < .01). Conclusion This study suggests glioma patient's aerobic endurance and lower limb strength are below criterion cutoffs recommended to maintain independent living. Timed "Up & Go" scores did not exceed the criterion cutoff, indicating respectable levels of mobility.
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Affiliation(s)
- Ali Dulfikar
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Kelvin Grove, Australia
| | - Eng-Siew Koh
- Radiation oncology, Liverpool Hospital, Liverpool, Australia.,University of New South Wales, Randwick, Australia
| | - Zarnie Lwin
- Department of Medical Oncology, Royal Brisbane and Womens Hospital, Herston, Australia.,School of Medicine, University of Queensland, St Lucia, Australia
| | - Elizabeth Hovey
- Department of Medical Oncology, Nelune Comprehensive Cancer Centre, Prince of wales Hospital, Randwick, Australia.,University of New South Wales, Randwick, Australia
| | - Haryana Dhillon
- Centre for Medical Psychology & Evidence-Based Decision-Making, School of Psychology Faculty of Science, The University of Sydney, Camperdown, Australia
| | - Jesica Arundell
- Radiation oncology, Liverpool Hospital, Liverpool, Australia
| | - Elizabeth Pinkham
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Kelvin Grove, Australia.,Physiotherapy, Clinical Support Services, Princess Alexandra Hospital, Woollongabba, Australia
| | - Mark B Pinkham
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Kelvin Grove, Australia.,Radiation Oncology, Cancer Services, Princess Alexandra Hospital, Woolloongabba, Australia
| | - Justin Holland
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Kelvin Grove, Australia
| | - Gabriel Trajano
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Kelvin Grove, Australia
| | - Fiona Naumann
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Kelvin Grove, Australia
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Villanueva L, Lwin Z, Chung HC, Gomez-Roca C, Longo F, Yanez E, Senellart H, Doherty M, García-Corbacho J, Hendifar AE, Maurice-Dror C, Gill SS, Kim TW, Heudobler D, Penel N, Ghori R, Kubiak P, Jin F, Norwood KG, Graham D. Lenvatinib plus pembrolizumab for patients with previously treated biliary tract cancers in the multicohort phase II LEAP-005 study. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.3_suppl.321] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
321 Background: Second-line treatment options for patients with biliary tract cancers (BTC) are limited. Lenvatinib, an anti-angiogenic multikinase inhibitor, in combination with the programmed death-1 immune checkpoint inhibitor pembrolizumab, has demonstrated promising antitumor activity with a manageable safety profile in patients with select advanced solid tumors. LEAP-005 (NCT03797326) is evaluating the efficacy and safety of lenvatinib plus pembrolizumab in patients with previously treated advanced solid tumors; here we present results from the BTC cohort of LEAP-005. Methods: In this nonrandomized, open-label, phase II study, eligible patients were aged ≥18 years with histologically or cytologically documented advanced (metastatic and/or unresectable) BTC with disease progression after 1 prior line of therapy, measurable disease per RECIST v1.1, ECOG PS of 0‒1, and tissue sample evaluable for PD-L1 expression. Patients received lenvatinib 20 mg once daily plus pembrolizumab 200 mg Q3W for up to 35 cycles (approximately 2 years) or until confirmed disease progression, unacceptable toxicity, or withdrawal of consent. Treatment with lenvatinib could continue beyond 2 years in patients experiencing clinical benefit. Primary endpoints were ORR (per RECIST v1.1 by blinded independent central review) and safety. Secondary endpoints were the disease control rate (DCR; comprising CR, PR, and SD), duration of response (DOR), PFS, and OS. Tumor imaging was performed Q9W from treatment initiation for 54 weeks, then Q12W to week 102, and Q24W thereafter. Results: 31 patients were enrolled in the BTC cohort (ECOG PS 1, 55%; 84% ex-US). As of April 10, 2020, median time from first dose to data cutoff (DCO) was 9.5 months (range, 3.1‒11.9), with 16 patients on treatment at DCO. There were 3 (10%) PRs and 18 (58%) SDs. ORR was 10% (95% CI, 2‒26), and DCR was 68% (95% CI, 49‒83). Median DOR was 5.3 months (range, 2.1+ to 6.2). Median PFS was 6.1 months (95% CI, 2.1‒6.4). Median OS was 8.6 months (95% CI, 5.6 to NR). Treatment-related AEs occurred in 30 patients (97%), including 15 (48%) who had grade 3‒4 AEs; there were no treatment-related deaths. 2 (6%) discontinued treatment due to treatment-related AEs (myocarditis, pyrexia; n = 1 each). The most frequent treatment-related AEs were hypertension (42%), dysphonia (39%), diarrhea (32%), fatigue (32%), and nausea (32%). 14 patients (45%) had immune-mediated AEs and 1 patient (3%) had an infusion-related reaction. Conclusions: Lenvatinib plus pembrolizumab demonstrated encouraging efficacy and manageable toxicity in patients with advanced BTC who had received 1 line of prior therapy. Based on these data, enrollment in the BTC cohort has been expanded to 100 patients. Clinical trial information: NCT03797326.
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Affiliation(s)
| | - Zarnie Lwin
- Royal Brisbane and Women's Hospital, University of Queensland, Brisbane, Australia
| | - Hyun Cheol Chung
- Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | | | - Federico Longo
- Hospital Universitario Ramón y Cajal, IRYCIS, CIBERONC, Madrid, Spain
| | - Eduardo Yanez
- Oncology-Hematology Unit, Department of Internal Medicine, School of Medicine, Universidad de la Frontera, Temuco, Chile
| | - Helene Senellart
- Institut de Cancérologie de l’Ouest, Centre René Gauducheau ICO, Saint-Herblain, France
| | - Mark Doherty
- Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON, Canada
| | - Javier García-Corbacho
- Department of Medical Oncology (Hospital Clinic)/Translational Genomics and Targeted Therapies in Solid Tumors (IDIBAPs), Barcelona, Spain
| | | | | | | | | | | | | | | | | | - Fan Jin
- Merck & Co., Inc., Kenilworth, NJ
| | | | - Donna Graham
- The Christie NHS Foundation Trust, Manchester, United Kingdom
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Chung HC, Lwin Z, Gomez-Roca C, Longo F, Yanez E, Castanon Alvarez E, Graham D, Doherty M, Cassier P, Lopez JS, Basu B, Hendifar AE, Maurice-Dror C, Gill SS, Ghori R, Kubiak P, Jin F, Norwood KG, Saada-Bouzid E. LEAP-005: A phase II multicohort study of lenvatinib plus pembrolizumab in patients with previously treated selected solid tumors—Results from the gastric cancer cohort. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.3_suppl.230] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
230 Background: Lenvatinib, an anti-angiogenic multiple receptor tyrosine kinase inhibitor, in combination with the anti‒PD-1 antibody pembrolizumab, has demonstrated promising antitumor activity with manageable safety in the first- or second-line in a phase 2 trial of patients with advanced gastric cancer. LEAP-005 (NCT03797326) is a phase 2, multicohort, nonrandomized, open-label study evaluating efficacy and safety of lenvatinib plus pembrolizumab in patients with previously treated advanced solid tumors; here, we present findings from the gastric cancer cohort of LEAP-005. Methods: Eligible patients were aged ≥18 years with histologically or cytologically confirmed metastatic and/or unresectable gastric cancer, received at least 2 prior lines of therapy, had measurable disease per RECIST v1.1, ECOG PS of 0‒1, and provided a tissue sample evaluable for PD-L1 expression. Patients received lenvatinib 20 mg once daily plus pembrolizumab 200 mg Q3W for up to 35 cycles of pembrolizumab (approximately 2 years) or until confirmed disease progression, unacceptable toxicity, or withdrawal of consent. Treatment with lenvatinib could continue beyond 2 years in patients experiencing clinical benefit. Primary endpoints were ORR (per RECIST v1.1 by blinded independent central review) and safety. Secondary endpoints included disease control rate (DCR; comprising CR, PR, and SD), duration of response (DOR), PFS, and OS. Tumor imaging was performed Q9W from treatment initiation for 54 weeks, then Q12W to week 102, and Q24W thereafter. Results: 31 patients were enrolled in the gastric cancer cohort; 87% were male, 58% were aged < 65 years, and 71% had PD-L1 combined positive score (CPS) ≥1. Median time from first dose to data cutoff (April 10, 2020) was 7.0 months (range, 1.9‒11.9); 19 patients (61%) had discontinued treatment. ORR was 10% (95% CI, 2‒26); 1 patient had CR (3%), and 2 had a PR (6%). 12 patients (39%) had SD. Median DOR was not reached (range, 2.1+ to 2.3+ months). DCR was 48% (95% CI, 30‒67). Median PFS was 2.5 months (95% CI, 1.8‒4.2). Median OS was 5.9 months (95% CI, 2.6‒8.7). 28 patients (90%) had treatment-related AEs, including 13 patients (42%) with grade 3‒5 AEs. 1 patient had a treatment-related AE that led to death (hemorrhage). 8 patients (26%) had immune-mediated AEs: hypothyroidism (n = 5), hyperthyroidism (n = 2), and pneumonitis (n = 1). There were no infusion-related reactions. Conclusions: In patients with advanced gastric cancer who received 2 prior lines of therapy, lenvatinib plus pembrolizumab demonstrated promising antitumor activity and a manageable safety profile. Based on these data, enrollment in the gastric cancer cohort has been expanded to 100 patients. Clinical trial information: NCT03797326.
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Affiliation(s)
- Hyun Cheol Chung
- Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Zarnie Lwin
- Royal Brisbane and Women's Hospital, University of Queensland, Brisbane, Australia
| | | | - Federico Longo
- Hospital Universitario Ramón y Cajal, IRYCIS, CIBERONC, Madrid, Spain
| | - Eduardo Yanez
- Oncology-Hematology Unit, Department of Internal Medicine, School of Medicine, Universidad de la Frontera, Temuco, Chile
| | | | - Donna Graham
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Mark Doherty
- Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON, Canada
| | | | - Juanita Suzanne Lopez
- The Royal Marsden Foundation Trust and the Institute of Cancer Research, London, United Kingdom
| | - Bristi Basu
- Department of Oncology, University of Cambridge, Cambridge, United Kingdom
| | | | | | | | | | | | - Fan Jin
- Merck & Co., Inc., Kenilworth, NJ
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Balogun J, Haynes C, Lwin Z, Nduom E, Puduvalli V, Venere M, Zadeh G. SNO 25th anniversary history series: Providing a global platform for communication and exchange in neuro-oncology. Neuro Oncol 2020; 22:1551-1552. [PMID: 32995879 DOI: 10.1093/neuonc/noaa219] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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
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Agar M, Nowak A, Hovey E, Barnes E, Simes J, Vardy J, Wheeler H, Leonard R, Hall M, Tim E, Spyridopoulos D, Sim HW, Lwin Z, Dowling A, Harrup R, Jennens R, Kichenadasse G, Dunlop T, Gzell C, Koh ES. QOLP-23. PHASE II RANDOMISED PLACEBO-CONTROLLED DOUBLE-BLIND STUDY OF ACETAZOLAMIDE VERSUS PLACEBO FOR CEREBRAL OEDEMA IN RECURRENT AND/OR PROGRESSIVE HIGH-GRADE GLIOMA REQUIRING TREATMENT WITH DEXAMETHASONE. Neuro Oncol 2020. [DOI: 10.1093/neuonc/noaa215.748] [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
Symptoms of raised intracranial pressure (ICP) in recurrent or progressive high-grade glioma (HGG) generally require corticosteroid treatment, often causing toxicity with variable effects on reversing ICP symptoms. Acetazolamide reduces ICP in other clinical settings including case series in glioma.
AIM
To explore whether addition of oral acetazolamide enables safe dexamethasone dose reduction in management of raised ICP in recurrent and/or progressive HGG.
METHODS
Participants had recurrent, progressive and/or persistent residual HGG requiring recommencement of dexamethasone, dose increase or dexamethasone dependency; prior/current bevacizumab was an exclusion. Eligible participants were randomised 1:1 to acetazolamide 250mg twice daily or placebo for 8 weeks. Standardised protocols were used for dexamethasone dose changes in both arms, with planned dose decrease from day 5 once ICP symptoms were stable. The primary endpoint was a composite of dexamethasone dose reduction and stability of performance status. Secondary endpoints included toxicity and feasibility (accrual and compliance).
RESULTS
Thirty participants of a planned sample of 84 were enrolled (mean age 58 y (32-89)) from 7 Australian sites. The mean baseline dexamethasone dose was 6.2mg (4-16mg). Mean duration on treatment was 38 days (4-57) in placebo group and 31 days (3-60) in acetazolamide group, with 9 participants (30%) completing all study treatment (6 placebo, 3 acetazolamide). Study withdrawal was due to adverse events (n=6 (1 placebo, 5 acetazolamide)) and disease progression (n=6 (3 per arm)). Four participants (13%) (2 per arm) were stable responders meeting the primary endpoint criteria (≥50% corticosteroid dose reduction from baseline by 28 days maintained for 7 days, and no deterioration in performance status). Ten participants experienced a total of 13 serious adverse events (acetazolamide arm: 5 participants (33%), 6 events, 2 related).
DISCUSSION
The addition of acetazolamide did not facilitate dexamethasone reduction. The study closed early due to poor accrual and increasing availability of bevacizumab.
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Affiliation(s)
- Meera Agar
- Liverpool Hospital, Liverpool, NSW, Australia
| | - Anna Nowak
- Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | | | - Elizabeth Barnes
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia
| | - John Simes
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia
| | | | - Helen Wheeler
- Department of Medical Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Robyn Leonard
- COGNO NHMRC Clinical Trials Centre, Camperdown, NSW, Australia
| | - Merryn Hall
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, Australia
| | - Evonne Tim
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, Australia
| | - Desma Spyridopoulos
- COGNO NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Hao-Wen Sim
- NHMRC Clinical Trials Centre, University of Sydney and Chris O’Brien Lifehouse, Camperdown, Australia
| | - Zarnie Lwin
- Royal Brisbane and Women’s Hospital, Brisbane, Australia
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Roberts NA, Chan B, Ahern ES, Gasper HM, Kennedy G, Hughes BGM, Wyld D, Eastgate MA, Lwin Z. Emotional impact of COVID-19 preparations on metro and regional cancer workforces in Queensland Australia: "We are all in this together ". J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.29_suppl.44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
44 Background: Australia has achieved a “flattening of the curve” with a sustained COVID-19 roadmap to recovery in place. We explored the emotional impact of COVID-19 on our cancer workforce, during the preparation phase of the pandemic. Methods: We developed and pilot-tested an online survey to capture the emotional impact on cancer care staff during the COVID-19 health system response. Two large cancer centres were identified for study sample, one metropolitan and one regional, in Queensland, Australia. All cancer care staff with patient-facing roles were invited via all-staff email to participate on a weekly basis, uniquely also including ancillary and administrative workers. The final survey questionnaire included qualitative domains with open text responses for reflections on difficult decisions and subsequent emotional impacts. At the same time, a prospective diary of organizational developments was independently maintained by two investigators in order to contextualize changing survey responses over time. Qualitative data analyses by four investigators included independent, multiple cross-coding, memos, dataset review and member-checking to ensure methodological rigour. Data were synthesised into key themes utilising the Framework Method (Gale, 2013). Results: 117 metropolitan and 59 regional staff were surveyed over a 6-week period. Participants were medical, nursing, allied health, administrative and ancillary staff, working across inpatient and outpatient oncology services. Four key themes were emergent across the trajectory of the COVID preparation phase; ‘Strategies for protection’ (self-isolation, using PPE, protecting patients, families and each other), ‘Navigating rules and keeping up’ (compliance, exceptions, conflict and complex decision fatigue), ‘Tempered optimism’ (this is grief, strategies for coping, pride in one’s place), and ‘Framing the new normal’ (using new technology, second wave, uncertainty). At different time points, one theme dominated more than others. Conclusions: Despite rapid adaptations to system changes, staff responses highlight that it was their sense of connectedness that had the greatest influence on their reflections during the COVID-19 pandemic, but also underpinned the humanistic aspects of their responses. Staff perceptions of feeling supported and prepared, permeated through the duration of the survey. Results from the recovery phase are awaited.
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Affiliation(s)
| | - Bryan Chan
- Sunshine Coast University Hospital, Birtinya, Australia
| | | | | | - Glen Kennedy
- Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | | | - David Wyld
- Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | | | - Zarnie Lwin
- Royal Brisbane and Women's Hospital, Herston, QLD, Australia
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41
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Ahern ES, Gasper HM, Chan B, Roberts NA, Hughes BGM, Wyld D, Kennedy G, Eastgate MA, Lwin Z. Psychosocial impacts of COVID-19 on oncology workforces: Metro versus regional Australia. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.29_suppl.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
111 Background: The COVID-19 pandemic poses psychosocial challenges to the oncology workforce. We postulate that these impacts may affect the entire patient-facing workforce. Whether distress is different in varying settings (metro vs regional hospitals) is unknown. Methods: Cancer Care staff were approached via all-staff email for a weekly online survey administered at two hospital sites, Royal Brisbane and Women’s Hospital (RBWH) (metro) and Sunshine Coast Hospital and Health System (SCHHS) (regional). Surveys included Likert-scale items exploring perceptions of departmental preparation, COVID-19 related query burden and staff well-being, and distress thermometer derived from NCCN. Mean and 95% confidence interval were calculated, with non-parametric t-tests adjusted for multiple comparisons (Holm-Sidak); significance was deemed p < 0.05. Results: 117 participants at RBWH and 59 at SCHHS consented. The survey opened April 3, 2020. Data is presented for the initial 6 weeks (COVID-19 preparation phase). Highest survey response was noted in week 1 (87%) and lowest at week 6 (36%). 65% unique responses were from RBWH. 60% participants worked in an outpatient setting, while 37% had inpatient care role. The remainder worked in either community-based or mixed settings. Significant heterogeneity was detected between sites (RBWH vs SCHHS) for some occupational roles: RBWH had more representation of administrative (19% vs 8%, p < 0.001) and ancillary staff (2% vs 0%, p = 0.005) but SCHHS had more allied health (28% vs 17%, p = 0.005). Nursing and medical staff proportions at SCHHS and RBWH were similar (50% vs 45%, and 14% vs 18% respectively). Higher levels of distress were noted early; mean (95% CI) distress thermometer result (0-10) during week 1 was 4.7 (4.3-5.2) at RBWH and 4.9 (4.2-5.5) at SCHHS. Mean distress scores significantly reduced over time: correlative scores during week 6 were 3.2 (2.3-4.1) at RBWH and 2.5 (1.6-3.4) at SCHHS. Distress levels comparing RBWH with SCHHS were similar (p = 0.22-0.76). No significant difference was noted in staff perception of self-support comparing RBWH with SCHHS, and over 80% responders felt well-supported at work most, or all of the time. Concurrently, participants perceived that the Cancer Care department of their site was either “well” or “very well” prepared for COVID-19 over 85% of the time, with no difference between sites. Conclusions: High perceptions of support and preparedness were evident, with no regional difference. Distress scores reduced over time during the COVID-19 preparation phase, in the context of low COVID-19 rates.
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Affiliation(s)
| | | | - Bryan Chan
- Sunshine Coast University Hospital, Birtinya, Australia
| | | | | | - David Wyld
- Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Glen Kennedy
- Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | | | - Zarnie Lwin
- Royal Brisbane and Women's Hospital, Herston, QLD, Australia
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42
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Broom A, Parker R, Raymond S, Kirby E, Lewis S, Kokanović R, Adams J, de Souza P, Woodland L, Wyld D, Lwin Z, Koh ES. The (Co)Production of Difference in the Care of Patients With Cancer From Migrant Backgrounds. Qual Health Res 2020; 30:1619-1631. [PMID: 32564713 DOI: 10.1177/1049732320930699] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
An extensive body of scholarship focuses on cultural diversity in health care, and this has resulted in a plethora of strategies to "manage" cultural difference. This work has often been patient-oriented (i.e., focused on the differences of the person being cared for), rather than relational in character. In this study, we aimed to explore how the difference was relational and coproduced in the accounts of cancer care professionals and patients with cancer who were from migrant backgrounds. Drawing on eight focus groups with 57 cancer care professionals and one-on-one interviews with 43 cancer patients from migrant backgrounds, we explore social relations, including intrusion and feelings of discomfort, moral logics of rights and obligation, and the practice of defaulting to difference. We argue, on the basis of these accounts, for the importance of approaching difference as relational and that this could lead to a more reflexive means for overcoming "differences" in therapeutic settings.
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Affiliation(s)
- Alex Broom
- The University of Sydney, Sydney, New South Wales, Australia
| | - Rhiannon Parker
- The University of Sydney, Sydney, New South Wales, Australia
| | | | - Emma Kirby
- The University of New South Wales, Sydney, New South Wales, Australia
| | - Sophie Lewis
- The University of New South Wales, Sydney, New South Wales, Australia
| | - Renata Kokanović
- RMIT University, Melbourne, Victoria, Australia
- Monash University, Melbourne, Victoria, Australia
| | - Jonathan Adams
- University of Technology Sydney, Sydney, New South Wales, Australia
| | - Paul de Souza
- Liverpool Hospital, Sydney, New South Wales, Australia
| | - Lisa Woodland
- South Eastern Sydney Local Health District, Sydney, New South Wales, Australia
| | - David Wyld
- Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
- University of Queensland, Brisbane, Queensland, Australia
| | - Zarnie Lwin
- Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
- University of Queensland, Brisbane, Queensland, Australia
| | - Eng-Siew Koh
- The University of New South Wales, Sydney, New South Wales, Australia
- Liverpool Hospital, Sydney, New South Wales, Australia
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43
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Abstract
The COVID-19 pandemic poses daily challenges to the entire oncology workforce. Staff members must absorb multiple executive briefings, adapt to escalating scenario modelling, and seamlessly execute ever-changing operational modes in real-time. The unique threat of looming re-deployment and rationing care add to the uncertainty. We highlight the need for qualitative research to understand the psychosocial impact of these challenges. We posit that the perspective of all team members should be explored: from doctors to ancillary staff.
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Affiliation(s)
- Harry Gasper
- Department of Medical Oncology, Royal Brisbane and Women's Hospital, Herston, Australia; School of Medicine, University of Queensland, Herston, Queensland, Australia.
| | - Elizabeth Ahern
- Department of Medical Oncology, Royal Brisbane and Women's Hospital, Herston, Australia; School of Medicine, University of Queensland, Herston, Queensland, Australia
| | - Natasha Roberts
- Department of Medical Oncology, Royal Brisbane and Women's Hospital, Herston, Australia
| | - Bryan Chan
- School of Medicine, University of Queensland, Herston, Queensland, Australia; Adem Crosby Cancer Centre, Sunshine Coast University Hospital, Birtinya, Australia
| | - Zarnie Lwin
- Department of Medical Oncology, Royal Brisbane and Women's Hospital, Herston, Australia; School of Medicine, University of Queensland, Herston, Queensland, Australia
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44
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Ahern E, Allen MJ, Schmidt A, Lwin Z, Hughes BGM. Retrospective analysis of hospital admissions due to immune checkpoint inhibitor-induced immune-related adverse events (irAE). Asia Pac J Clin Oncol 2020; 17:e109-e116. [PMID: 32519444 DOI: 10.1111/ajco.13350] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 04/01/2020] [Indexed: 01/22/2023]
Abstract
AIM Hospital admissions secondary to immune-related adverse events (irAE) arising from immune checkpoint inhibitors (ICI) are likely to increase with increasing use of this class of drug. We sought to determine the characteristics and outcomes of hospital admissions due to irAE. METHODS A retrospective analysis of patients treated with ICI at two tertiary hospitals in Queensland (Australia) was performed. Patients who received at least one dose of ICI for a nonhaematological malignancy between the 1st January 2016 and 1st January 2017 were included. All subsequent hospital admissions were analyzed. RESULTS A total of 140 patients were included, with the most common malignancies being non-small-cell-cell lung cancer (41%) and melanoma (18%), and most patients received anti-PD1 treatment (78%). A sum of 76 patients accounted for 116 admissions. Comparing admissions due to irAE and non-irAE, those admitted for irAE had a significantly longer duration on ICI prior to admission (173 vs 105 days, P = 0.04) but durations of admissions were similar (9.0 vs 8.5 days, P = 0.85). Fifteen patients (11% overall cohort) accounted for 18 admissions attributable to 16 separate irAE. irAE was not considered as a differential diagnosis on admission in 7 patients (38%). In those patients, commencement of corticosteroids was delayed (1.5 days, P = 0.01) but this did not translate into adverse outcomes such as prolonged admissions, prolonged steroid use or long-term complications. All patients with irAE were managed with high-dose corticosteroids. One death resulted from irAE (pneumonitis). CONCLUSIONS A sum of 11% patients receiving ICI required hospital admission for irAE. The relatively high rate of irAE as a missed differential diagnosis on admission suggests a need for improved cross-discipline awareness, education, and institutional management guidelines.
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Affiliation(s)
- Elizabeth Ahern
- Department of Medical Oncology, Royal Brisbane & Women's Hospital, Brisbane, Queensland, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Immunology in Cancer and Infection, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Michael J Allen
- Department of Medical Oncology, Royal Brisbane & Women's Hospital, Brisbane, Queensland, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Department of Medical Oncology, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Andrew Schmidt
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Department of Medical Oncology, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Zarnie Lwin
- Department of Medical Oncology, Royal Brisbane & Women's Hospital, Brisbane, Queensland, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Department of Medical Oncology, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Brett G M Hughes
- Department of Medical Oncology, Royal Brisbane & Women's Hospital, Brisbane, Queensland, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Department of Medical Oncology, The Prince Charles Hospital, Brisbane, Queensland, Australia
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45
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Tan JY, Senko C, Hughes B, Lwin Z, Bennett R, Power J, Thomson L. Weighted activity unit effect: evaluating the cost of diagnosis‐related group coding. Intern Med J 2020; 50:440-444. [DOI: 10.1111/imj.14373] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 05/09/2019] [Accepted: 05/13/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Joanne Y.‐A. Tan
- Cancer Care ServicesThe Prince Charles Hospital (TPCH) Victoria Australia
| | - Clare Senko
- Olivia Newton John Cancer CenterMelbourne Victoria Australia
| | - Brett Hughes
- Cancer Care ServicesThe Prince Charles Hospital (TPCH) Victoria Australia
- Cancer Care ServicesRoyal Brisbane and Women's Hospital (RBWH) Brisbane Queensland Australia
- School of MedicineUniversity of Queensland Brisbane Queensland Australia
| | - Zarnie Lwin
- Cancer Care ServicesThe Prince Charles Hospital (TPCH) Victoria Australia
- Cancer Care ServicesRoyal Brisbane and Women's Hospital (RBWH) Brisbane Queensland Australia
- School of MedicineUniversity of Queensland Brisbane Queensland Australia
| | - Richard Bennett
- Health Information ServicesThe Prince Charles Hospital Brisbane Queensland Australia
| | - John Power
- Health Information ServicesThe Prince Charles Hospital Brisbane Queensland Australia
| | - Leah Thomson
- Internal Medicine ServicesThe Prince Charles Hospital Brisbane Queensland Australia
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46
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Kenny K, Broom A, Kirby E, Oliffe JL, Wyld D, Lwin Z. Reciprocity, Autonomy, and Vulnerability in Men's Experiences of Informal Cancer Care. Qual Health Res 2020; 30:491-503. [PMID: 31216932 DOI: 10.1177/1049732319855962] [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] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Men are increasingly participating, and acknowledging their roles, as informal carers. Yet, there has been comparatively little exploration of their experiences therein, especially within the context of cancer care. Here, drawing on semi-structured qualitative interviews with 16 Australian male carers for a relative with cancer, and using constructivist grounded theory, we explore their experiences of informal caring. Our analysis highlights a series of tensions, including the following: the meanings and practicalities of care provision including notions of reciprocity, duty, autonomy, and interdependence; the discomforts of dependency and vulnerability; and the complicated moralities that inflect "caring well." Given the shifting dynamics around informal care, we argue for increased attention to the affective tensions that arise at the nexus of moralities and masculinities in informal caring relations, especially as they are articulated in the context of illness, affliction, and dependency.
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Affiliation(s)
- Katherine Kenny
- University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Alex Broom
- University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Emma Kirby
- University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - John L Oliffe
- The University of British Columbia, Vancouver, British Columbia, Canada
| | - David Wyld
- Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
- The University of Queensland, Brisbane, Queensland, Australia
| | - Zarnie Lwin
- Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
- The University of Queensland, Brisbane, Queensland, Australia
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47
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Sim HW, Nowak AK, Lwin Z, Khasraw M. Management of glioblastoma: an Australian perspective. Chin Clin Oncol 2020; 10:42. [PMID: 32075395 DOI: 10.21037/cco.2020.02.05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 02/03/2020] [Indexed: 11/06/2022]
Affiliation(s)
- Hao-Wen Sim
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia; St Vincent's Clinical School, University of New South Wales, Sydney, NSW, Australia; Department of Medical Oncology, The Kinghorn Cancer Centre, Sydney, NSW, Australia; Department of Medical Oncology, Chris O'Brien Lifehouse, Sydney, NSW, Australia
| | - Anna K Nowak
- Medical School, University of Western Australia, Perth, WA, Australia; ; Department of Medical Oncology, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Zarnie Lwin
- School of Medicine, University of Queensland, Brisbane, QLD, Australia; Department of Medical Oncology, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Mustafa Khasraw
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia; The Preston Robert Tisch Brain Tumor Center and Duke Center for Cancer Immunotherapy, Duke University, Durham, NC, USA
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48
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Fong KM, Hughes BGM, Lwin Z, Yang IA. EGFR mutations in lung cancer: not all equal in the eyes of the immune system? Ann Transl Med 2020; 7:S326. [PMID: 32016044 DOI: 10.21037/atm.2019.09.132] [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] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Kwun M Fong
- Thoracic Medicine, The Prince Charles Hospital, Queensland, Australia.,University of Queensland Thoracic Research Centre, Faculty of Medicine, The University of Queensland, Queensland, Australia
| | - Brett G M Hughes
- University of Queensland Thoracic Research Centre, Faculty of Medicine, The University of Queensland, Queensland, Australia.,Department of Cancer Care Services, The Prince Charles Hospital, Queensland, Australia.,Department of Cancer Care Services, Royal Brisbane and Women's Hospital, Queensland, Australia
| | - Zarnie Lwin
- University of Queensland Thoracic Research Centre, Faculty of Medicine, The University of Queensland, Queensland, Australia.,Department of Cancer Care Services, The Prince Charles Hospital, Queensland, Australia.,Department of Cancer Care Services, Royal Brisbane and Women's Hospital, Queensland, Australia
| | - Ian A Yang
- Thoracic Medicine, The Prince Charles Hospital, Queensland, Australia.,University of Queensland Thoracic Research Centre, Faculty of Medicine, The University of Queensland, Queensland, Australia
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49
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Tani D, Ladwa R, Xu W, Lwin Z, Steinke K, M Hughes B. Outcomes of incidental pulmonary nodules in head-and-neck squamous cell cancer patients treated with curative intent. J Head Neck Physicians Surg 2020. [DOI: 10.4103/jhnps.jhnps_39_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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50
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Broom J, Broom A, Good P, Lwin Z. Why is optimisation of antimicrobial use difficult at the end of life? Intern Med J 2019; 49:269-271. [PMID: 30754080 DOI: 10.1111/imj.14200] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Revised: 11/14/2018] [Accepted: 11/14/2018] [Indexed: 11/30/2022]
Abstract
The antibiotic optimisation imperative is now ubiquitous, with national policy frameworks in Organisation for Economic Co-operation and Development (OECD) countries incorporating the requirement for antimicrobial stewardship within healthcare services. Yet in practice, the optimisation agenda often raises complex ethical- and practice-based dilemmas. Antibiotic use at the end of life is multidimensional. It includes balancing complex issues, such as accuracy of prognostic estimates, benevolence to the individual versus the broader public health, personalised value judgement of time and quality of life and the right to treatment versus the right to die. It also occurs in an emotional context where the clinician and patient (and their family) collectively confront mortality. This provides a scenario where amplification of the already strong social and behavioural forces that drive overuse of antibiotics in many other clinical settings may occur. It therefore offers an important case for illustrating how antibiotic optimisation may be limited by social, value-based and ethical dilemmas.
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Affiliation(s)
- Jennifer Broom
- Department of Medicine, Sunshine Coast Hospital and Health Service and The University of Queensland, Brisbane, Queensland, Australia
| | - Alex Broom
- School of Social Sciences, The University of New South Wales, Sydney, New South Wales, Australia
| | - Phillip Good
- Department of Palliative Care, St Vincent's Private Hospital Brisbane, Mater Research Institute, The University of Queensland, Mater Health Services, Brisbane, Queensland, Australia
| | - Zarnie Lwin
- Department of Medical Oncology, Cancer Care Services, Royal Brisbane and Women's Hospital, and The University of Queensland, Brisbane, Queensland, Australia
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