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Corrie PG, Qian W, Basu B, Valle JW, Falk S, Lwuji C, Wasan H, Palmer D, Scott-Brown M, Wadsley J, Arif S, Bridgewater J, Propper D, Gillmore R, Gopinathan A, Skells R, Bundi P, Brais R, Dalchau K, Bax L, Chhabra A, Machin A, Dayim A, McAdam K, Cummins S, Wall L, Ellis R, Anthoney A, Evans J, Ma YT, Isherwood C, Neesse A, Tuveson D, Jodrell DI. Scheduling nab-paclitaxel combined with gemcitabine as first-line treatment for metastatic pancreatic adenocarcinoma. Br J Cancer 2020; 122:1760-1768. [PMID: 32350413 PMCID: PMC7283477 DOI: 10.1038/s41416-020-0846-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 03/19/2020] [Accepted: 04/01/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Nab-paclitaxel plus gemcitabine (nabP+gemcitabine) offers modest survival gains for patients with metastatic pancreatic ductal adenocarcinoma (PDAC). Sequential scheduling of nabP+gemcitabine in a PDAC mouse model improved efficacy; this hypothesis was tested in a clinical trial. METHODS Patients with previously untreated metastatic PDAC were randomised to receive nabP+gemcitabine administered either concomitantly on the same day, or sequentially, with gemcitabine administered 24 h after nabP. The primary outcome measure was progression-free survival (PFS). Secondary outcome measures were objective response rate (ORR), overall survival (OS), safety, quality of life (QoL) and predictive biomarkers. RESULTS In total, 71 patients received sequential (SEQ) and 75 concomitant (CON) treatment. Six-month PFS was 46% with SEQ and 32% with CON scheduling. Median PFS (5.6 versus 4.0 months, hazard ratio [HR] 0.67, 95% confidence interval [95% CI] 0.47-0.95, p = 0.022) and ORR (52% versus 31%, p = 0.023) favoured the SEQ arm; median OS was 10.2 versus 8.2 months (HR 0.93, 95% CI 0.65-1.33, p = 0.70). CTCAE Grade ≥3 neutropaenia incidence doubled with SEQ therapy but was not detrimental to QoL. Strongly positive tumour epithelial cytidine deaminase (CDA) expression favoured benefit from SEQ therapy (PFS HR 0.31, 95% CI 0.13-0.70). CONCLUSIONS SEQ delivery of nabP+gemcitabine improved PFS and ORR, with manageable toxicity, but did not significantly improve OS. CLINICAL TRIAL REGISTRATION ISRCTN71070888; ClinialTrials.gov (NCT03529175).
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Affiliation(s)
- P G Corrie
- Cambridge University Hospitals NHS Foundation Trust (Addenbrooke's Hospital), Cambridge, UK.
| | - W Qian
- Cambridge University Hospitals NHS Foundation Trust (Addenbrooke's Hospital), Cambridge, UK
| | - B Basu
- Cambridge University Hospitals NHS Foundation Trust (Addenbrooke's Hospital), Cambridge, UK
- Cancer Research UK-Cambridge Institute, University of Cambridge, Cambridge, UK
| | - J W Valle
- University of Manchester and The Christie NHS Foundation Trust, Manchester, UK
| | - S Falk
- Bristol Haematology and Oncology Centre, Bristol, UK
| | - C Lwuji
- Leicester Royal Infirmary, Leicester, UK
| | - H Wasan
- Hammersmith Hospital, Imperial College, London, UK
| | - D Palmer
- Clatterbridge Cancer Centre, Liverpool, UK
| | - M Scott-Brown
- University Hospital Coventry and Warwickshire, Coventry, UK
| | | | - S Arif
- Velindre Cancer Centre, Cardiff, UK
| | | | | | | | - A Gopinathan
- Cancer Research UK-Cambridge Institute, University of Cambridge, Cambridge, UK
| | - R Skells
- Cambridge University Hospitals NHS Foundation Trust (Addenbrooke's Hospital), Cambridge, UK
| | - P Bundi
- Cambridge University Hospitals NHS Foundation Trust (Addenbrooke's Hospital), Cambridge, UK
| | - R Brais
- Cambridge University Hospitals NHS Foundation Trust (Addenbrooke's Hospital), Cambridge, UK
| | - K Dalchau
- Cambridge University Hospitals NHS Foundation Trust (Addenbrooke's Hospital), Cambridge, UK
| | - L Bax
- Cambridge University Hospitals NHS Foundation Trust (Addenbrooke's Hospital), Cambridge, UK
| | - A Chhabra
- Cambridge University Hospitals NHS Foundation Trust (Addenbrooke's Hospital), Cambridge, UK
| | - A Machin
- Cambridge University Hospitals NHS Foundation Trust (Addenbrooke's Hospital), Cambridge, UK
| | - A Dayim
- Cambridge University Hospitals NHS Foundation Trust (Addenbrooke's Hospital), Cambridge, UK
| | - K McAdam
- Peterborough City Hospital, Peterborough, UK
| | - S Cummins
- Royal Surrey County Hospital, Guildford, UK
| | - L Wall
- Western General Hospital, Edinburgh, UK
| | - R Ellis
- Royal Cornwall Hospitals, Truro, UK
| | - A Anthoney
- St. James's University Hospitals, Leeds, UK
| | - J Evans
- Beatson West of Scotland Cancer Centre, University of Glasgow, Glasgow, UK
| | - Y T Ma
- Queen Elizabeth Hospital, Birmingham, UK
| | - C Isherwood
- Cancer Research UK-Cambridge Institute, University of Cambridge, Cambridge, UK
| | - A Neesse
- Gastroenterology and Gastrointestinal Cancer Clinic, University of Göttingen, Göttingen, Germany
| | - D Tuveson
- Cold Spring Harbor Laboratory, Cold Spring Harbor, New York, USA
| | - D I Jodrell
- Cambridge University Hospitals NHS Foundation Trust (Addenbrooke's Hospital), Cambridge, UK
- Cancer Research UK-Cambridge Institute, University of Cambridge, Cambridge, UK
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2
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Abraham JE, Vallier AL, Qian W, Machin A, Grybowicz L, Thomas S, Weiss M, Harvey C, McAdam K, Hughes-Davies L, Roberts A, Provenzano E, Pinilla K, Roylance R, Copson E, Armstrong A, McMurtry E, Tischkowitz M, Earl HM. Abstract OT3-01-02: PARTNERING / PARTNER : Phase II sub-study to establish if the addition of combinations of new agents (olaparib, cell cycle and immune checkpoint inhibitors) can improve the rate of pathological complete response (pCR) and minimal residual disease (MRD) in triple negative breast cancer (TNBC) and / or germline BRCA mutated (gBRCAm) patients with evidence of residual disease after PARTNER therapy. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-ot3-01-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background:
In patients with TNBC, following standard neoadjuvant chemotherapy, residual disease (RD) is correlated with poor prognosis and 50% relapse within 5 years [1]. PARTNER is a neoadjuvant clinical trial which randomises TNBC and gBRCAm patients to carboplatin and paclitaxel +/- olaparib followed by anthracycline-based chemotherapy. Patients with RD after neoadjuvant treatment in this trial also face poorer survival outcomes, due to the paucity of treatment options. PARTNERING, develops a new strategy using novel agent combinations as an alternative pathway for patients with RD within the PARTNER trial.
Methods: PARTNERING is a phase II open label, sub-study with a two-stage Simon design with biomarker guided treatment cohorts open only to patients in the PARTNER trial. A maximum of 15 patients will be included in each cohort. Patients with RD > 10% tumour cellularity (TC) on biopsy after neoadjuvant therapy will be eligible. Patients who have no tumour cells or < 10% TC, and those with progressive disease will be excluded. Allocation of patients into the cohorts will be based on tumour infiltrating lymphocytes (TILs) expression either on diagnostic or post treatment biopsy. Patients with tumours with TILs score ≤20% are considered “non-immunogenic” They will be stratified according to HRD status and allocated to receive a cell cycle checkpoint inhibitor + olaparib. Patients with a TILs score >20% are considered “immunogenic” and will be allocated to receive an immune checkpoint inhibitor with olaparib or a cell cycle checkpoint inhibitor.
Primary outcome measure is pCR / MRD rate at surgery after the administration of 2 cycles / 8 weeks of a combination of new agents. The rate of conversion to pCR/MRD will be correlated with TC, TILs, BRCA and homologous recombination deficiency (HRD) status, Ki67% and previous olaparib treatment.
Progress: The PARTNERING pathway in the PARTNER trial will be open late 2018.
Citation Format: Abraham JE, Vallier A-L, Qian W, Machin A, Grybowicz L, Thomas S, Weiss M, Harvey C, McAdam K, Hughes-Davies L, Roberts A, Provenzano E, Pinilla K, Roylance R, Copson E, Armstrong A, McMurtry E, Tischkowitz M, Earl HM. PARTNERING / PARTNER : Phase II sub-study to establish if the addition of combinations of new agents (olaparib, cell cycle and immune checkpoint inhibitors) can improve the rate of pathological complete response (pCR) and minimal residual disease (MRD) in triple negative breast cancer (TNBC) and / or germline BRCA mutated (gBRCAm) patients with evidence of residual disease after PARTNER therapy [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr OT3-01-02.
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Affiliation(s)
- JE Abraham
- University of Cambridge, Cambridge, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; AstraZeneca, Macclesfield, United Kingdom; NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom
| | - A-L Vallier
- University of Cambridge, Cambridge, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; AstraZeneca, Macclesfield, United Kingdom; NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom
| | - W Qian
- University of Cambridge, Cambridge, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; AstraZeneca, Macclesfield, United Kingdom; NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom
| | - A Machin
- University of Cambridge, Cambridge, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; AstraZeneca, Macclesfield, United Kingdom; NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom
| | - L Grybowicz
- University of Cambridge, Cambridge, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; AstraZeneca, Macclesfield, United Kingdom; NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom
| | - S Thomas
- University of Cambridge, Cambridge, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; AstraZeneca, Macclesfield, United Kingdom; NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom
| | - M Weiss
- University of Cambridge, Cambridge, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; AstraZeneca, Macclesfield, United Kingdom; NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom
| | - C Harvey
- University of Cambridge, Cambridge, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; AstraZeneca, Macclesfield, United Kingdom; NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom
| | - K McAdam
- University of Cambridge, Cambridge, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; AstraZeneca, Macclesfield, United Kingdom; NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom
| | - L Hughes-Davies
- University of Cambridge, Cambridge, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; AstraZeneca, Macclesfield, United Kingdom; NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom
| | - A Roberts
- University of Cambridge, Cambridge, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; AstraZeneca, Macclesfield, United Kingdom; NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom
| | - E Provenzano
- University of Cambridge, Cambridge, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; AstraZeneca, Macclesfield, United Kingdom; NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom
| | - K Pinilla
- University of Cambridge, Cambridge, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; AstraZeneca, Macclesfield, United Kingdom; NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom
| | - R Roylance
- University of Cambridge, Cambridge, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; AstraZeneca, Macclesfield, United Kingdom; NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom
| | - E Copson
- University of Cambridge, Cambridge, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; AstraZeneca, Macclesfield, United Kingdom; NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom
| | - A Armstrong
- University of Cambridge, Cambridge, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; AstraZeneca, Macclesfield, United Kingdom; NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom
| | - E McMurtry
- University of Cambridge, Cambridge, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; AstraZeneca, Macclesfield, United Kingdom; NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom
| | - M Tischkowitz
- University of Cambridge, Cambridge, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; AstraZeneca, Macclesfield, United Kingdom; NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom
| | - HM Earl
- University of Cambridge, Cambridge, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; AstraZeneca, Macclesfield, United Kingdom; NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom
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3
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Abraham J, Vallier AL, Qian W, Machin A, Grybowicz L, Thomas S, Weiss M, Harvey C, McAdam K, Hughes-Davies L, Roberts A, Roylance R, Copson E, Pinilla K, Armstrong A, Provenzano E, Tischkowitz M, McMurty E, Earl H. Abstract OT3-03-03: PARTNER: Randomised, phase II/III trial to evaluate the safety and efficacy of the addition of olaparib to platinum-based neoadjuvant chemotherapy in triple negative and/or germline BRCA mutated breast cancer patients. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-ot3-03-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: No specific targeted therapies are available for Triple Negative Breast Cancers (TNBC), an aggressive and diverse subgroup. The basal TNBC sub-group share some phenotypic and molecular similarities with germline BRCA (gBRCA) tumours. In gBRCA patients, and potentially other homologous recombination deficiencies, these already compromised pathways may allow drugs called PARP inhibitors (Olaparib) to work more effectively. Aims: To establish if the addition of olaparib to neoadjuvant platinum based chemotherapy for basal TNBC and/or gBRCA breast cancer is safe and improves efficacy (pathological complete response (pCR)).
Methods: Trial design: 3-stage open label randomised phase II/III trial of neoadjuvant paclitaxel and carboplatin +/- olaparib, followed by clinicians' choice of anthracycline regimen. Stage 1 and 2: Randomisation (1:1:1) to either control (3 weekly carboplatin AUC5/weekly paclitaxel 80mg/m2 for 4 cycles) or one of two research arms with the same chemotherapy regimen but with two different schedules of olaparib 150mg BD for 12 days. Stage 3: Patients are randomised (1:1) to either control arm or to the research arm selected in stage 2. End-points: Stage 1: Safety; Stage 2: Schedule selection using pCR rate and completion rate of olaparib using a “pick-the-winner” design. Stage 3: pCR rate. Enrichment design is applied with an overall significance level 0.05(α) and 80% power. A total of 527 patients will be included to detect an absolute improvement of 15% (all patients) and 20% (gBRCA patients) by adding olaparib to platinum based chemotherapy.
Trial Progress: PARTNER has been recruiting in UK since 27th May 2016. IDSMC recommended to continue the trial without change after reviewing the Stage 1 safety data. The recruitment of stage 2 was completed in April 2018 and results to be reviewed by the IDSMC in early 2019. The trial is open and enrolling patients to national and international sites.
Citation Format: Abraham J, Vallier A-L, Qian W, Machin A, Grybowicz L, Thomas S, Weiss M, Harvey C, McAdam K, Hughes-Davies L, Roberts A, Roylance R, Copson E, Pinilla K, Armstrong A, Provenzano E, Tischkowitz M, McMurty E, Earl H. PARTNER: Randomised, phase II/III trial to evaluate the safety and efficacy of the addition of olaparib to platinum-based neoadjuvant chemotherapy in triple negative and/or germline BRCA mutated breast cancer patients [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr OT3-03-03.
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Affiliation(s)
- J Abraham
- University of Cambridge, Cambridge, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; Astra Zenecca, Macclesfield, United Kingdom; NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom
| | - A-L Vallier
- University of Cambridge, Cambridge, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; Astra Zenecca, Macclesfield, United Kingdom; NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom
| | - W Qian
- University of Cambridge, Cambridge, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; Astra Zenecca, Macclesfield, United Kingdom; NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom
| | - A Machin
- University of Cambridge, Cambridge, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; Astra Zenecca, Macclesfield, United Kingdom; NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom
| | - L Grybowicz
- University of Cambridge, Cambridge, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; Astra Zenecca, Macclesfield, United Kingdom; NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom
| | - S Thomas
- University of Cambridge, Cambridge, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; Astra Zenecca, Macclesfield, United Kingdom; NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom
| | - M Weiss
- University of Cambridge, Cambridge, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; Astra Zenecca, Macclesfield, United Kingdom; NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom
| | - C Harvey
- University of Cambridge, Cambridge, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; Astra Zenecca, Macclesfield, United Kingdom; NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom
| | - K McAdam
- University of Cambridge, Cambridge, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; Astra Zenecca, Macclesfield, United Kingdom; NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom
| | - L Hughes-Davies
- University of Cambridge, Cambridge, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; Astra Zenecca, Macclesfield, United Kingdom; NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom
| | - A Roberts
- University of Cambridge, Cambridge, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; Astra Zenecca, Macclesfield, United Kingdom; NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom
| | - R Roylance
- University of Cambridge, Cambridge, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; Astra Zenecca, Macclesfield, United Kingdom; NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom
| | - E Copson
- University of Cambridge, Cambridge, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; Astra Zenecca, Macclesfield, United Kingdom; NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom
| | - K Pinilla
- University of Cambridge, Cambridge, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; Astra Zenecca, Macclesfield, United Kingdom; NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom
| | - A Armstrong
- University of Cambridge, Cambridge, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; Astra Zenecca, Macclesfield, United Kingdom; NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom
| | - E Provenzano
- University of Cambridge, Cambridge, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; Astra Zenecca, Macclesfield, United Kingdom; NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom
| | - M Tischkowitz
- University of Cambridge, Cambridge, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; Astra Zenecca, Macclesfield, United Kingdom; NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom
| | - E McMurty
- University of Cambridge, Cambridge, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; Astra Zenecca, Macclesfield, United Kingdom; NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom
| | - H Earl
- University of Cambridge, Cambridge, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; Astra Zenecca, Macclesfield, United Kingdom; NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom
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4
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Abraham J, Vallier AL, Qian W, Grybowicz L, Thomas S, Machin A, Harvey C, Chiu E, McAdam K, Hughes-Davies L, Roylance R, Copson E, Armstrong A, Provenzano E, Tischkowitz M, McMurtry E, Earl H. Abstract OT3-04-03: PARTNER randomised, phase II/III trial to evaluate the safety and efficacy of the addition of olaparib to platinum based neoadjuvant chemotherapy in triple negative and/or germline BRCA mutated breast cancer patients. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-ot3-04-03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: No specific targeted therapies are available for Triple Negative Breast Cancers (TNBC), an aggressive and diverse subgroup. The basal TNBC subgroup show some phenotypic and molecular similarities with germline BRCA (gBRCA). In gBRCA patients, and potentially other homologous recombination deficiencies, these already compromised pathways may allow drugs called PARP inhibitors (olaparib) to work more effectively.
Aims: To establish if the addition of olaparib to neoadjuvant platinum based chemotherapy for basal TNBC and/or gBRCA breast cancer is safe and improves efficacy (pathological complete response (pCR)).
Trial design: 3 stage open label randomised phase II/III trial of neoadjuvant paclitaxel and carboplatin +/olaparib, followed by clinicians' choice of anthracycline regimen.
Stage 1 and 2: Patients are randomised (1:1:1) to either control (3 weekly carboplatin AUC5/weekly paclitaxel 80mg/m2 for 4 cycles) or one of two research arms with the same chemotherapy regimen but with two different schedules of olaparib 150mg BD for 12 days.
Stage 3: Patients are randomised (1:1) to either control arm or to the research arm selected in stage 2.
Methods:
Stage 1 Safety: both research arms combined.
Stage 2 Schedule selection criteria: pCR rate and completion rate of olaparib protocol treatment. It is a “pickthewinner” design with 53 patients in each research arm. This allows a 90% power, 5% onesided significance level to test null hypothesis of pCR ≤35% versus an alternative hypothesis of pCR ≥55% in each of the research arms.
Stage 3 Efficacy:anticipated pCR ˜55-60% for all trial patients and ˜60-65% for gBRCA patients. The trial is powered to detect an absolute improvement of 15% (all patients) and 20% (gBRCA patients) by adding olaparib to chemotherapy (enriched design). TNBC patient recruitment will be capped, to ensure required gBRCA patients are enrolled. Enrichment design is applied with overall significance level 0.05(α) = 0.025(αall)+ 0.025(αgBRCA) and 80% power.
Target accrual: 527 [gBRCA 220] Current accrual: 56 Sites activated: 15 [expected number of sites 30-50].
Citation Format: Abraham J, Vallier A-L, Qian W, Grybowicz L, Thomas S, Machin A, Harvey C, Chiu E, McAdam K, Hughes-Davies L, Roylance R, Copson E, Armstrong A, Provenzano E, Tischkowitz M, McMurtry E, Earl H. PARTNER randomised, phase II/III trial to evaluate the safety and efficacy of the addition of olaparib to platinum based neoadjuvant chemotherapy in triple negative and/or germline BRCA mutated breast cancer patients [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr OT3-04-03.
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Affiliation(s)
- J Abraham
- University of Cambridge, Cambridge, Cambridgeshire, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, Hampshire, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; AstraZeneca, Macclesfield, Cheshire, United Kingdom
| | - A-L Vallier
- University of Cambridge, Cambridge, Cambridgeshire, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, Hampshire, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; AstraZeneca, Macclesfield, Cheshire, United Kingdom
| | - W Qian
- University of Cambridge, Cambridge, Cambridgeshire, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, Hampshire, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; AstraZeneca, Macclesfield, Cheshire, United Kingdom
| | - L Grybowicz
- University of Cambridge, Cambridge, Cambridgeshire, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, Hampshire, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; AstraZeneca, Macclesfield, Cheshire, United Kingdom
| | - S Thomas
- University of Cambridge, Cambridge, Cambridgeshire, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, Hampshire, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; AstraZeneca, Macclesfield, Cheshire, United Kingdom
| | - A Machin
- University of Cambridge, Cambridge, Cambridgeshire, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, Hampshire, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; AstraZeneca, Macclesfield, Cheshire, United Kingdom
| | - C Harvey
- University of Cambridge, Cambridge, Cambridgeshire, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, Hampshire, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; AstraZeneca, Macclesfield, Cheshire, United Kingdom
| | - E Chiu
- University of Cambridge, Cambridge, Cambridgeshire, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, Hampshire, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; AstraZeneca, Macclesfield, Cheshire, United Kingdom
| | - K McAdam
- University of Cambridge, Cambridge, Cambridgeshire, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, Hampshire, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; AstraZeneca, Macclesfield, Cheshire, United Kingdom
| | - L Hughes-Davies
- University of Cambridge, Cambridge, Cambridgeshire, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, Hampshire, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; AstraZeneca, Macclesfield, Cheshire, United Kingdom
| | - R Roylance
- University of Cambridge, Cambridge, Cambridgeshire, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, Hampshire, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; AstraZeneca, Macclesfield, Cheshire, United Kingdom
| | - E Copson
- University of Cambridge, Cambridge, Cambridgeshire, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, Hampshire, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; AstraZeneca, Macclesfield, Cheshire, United Kingdom
| | - A Armstrong
- University of Cambridge, Cambridge, Cambridgeshire, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, Hampshire, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; AstraZeneca, Macclesfield, Cheshire, United Kingdom
| | - E Provenzano
- University of Cambridge, Cambridge, Cambridgeshire, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, Hampshire, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; AstraZeneca, Macclesfield, Cheshire, United Kingdom
| | - M Tischkowitz
- University of Cambridge, Cambridge, Cambridgeshire, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, Hampshire, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; AstraZeneca, Macclesfield, Cheshire, United Kingdom
| | - E McMurtry
- University of Cambridge, Cambridge, Cambridgeshire, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, Hampshire, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; AstraZeneca, Macclesfield, Cheshire, United Kingdom
| | - H Earl
- University of Cambridge, Cambridge, Cambridgeshire, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, United Kingdom; University College London, London, United Kingdom; University of Southampton, Southampton, Hampshire, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; AstraZeneca, Macclesfield, Cheshire, United Kingdom
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Watts C, Jenkinson M, Ashkan K, Kurian K, Qian W, Machin A, Price S, Matys T, Doughton G. OS4.8 Improving the intra-operative diagnosis of high-grade glioma using a fluorescence biomarker - A Progress Report of The GALA-BIDD Study. Neuro Oncol 2016. [DOI: 10.1093/neuonc/now188.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Machin A, Martin Alonso JM, Dalton KP, Parra F. Functional differences between precursor and mature forms of the RNA-dependent RNA polymerase from rabbit hemorrhagic disease virus. J Gen Virol 2009; 90:2114-8. [DOI: 10.1099/vir.0.011296-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Madden BP, Kariyawasam H, Siddiqi AJ, Machin A, Pryor JA, Hodson ME. Noninvasive ventilation in cystic fibrosis patients with acute or chronic respiratory failure. Eur Respir J 2002; 19:310-3. [PMID: 11866011 DOI: 10.1183/09031936.02.00218502] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The experience of using noninvasive ventilation (NIV) in 113 adult cystic fibrosis (CF) patients with chronic respiratory failure, during episodes of acute deterioration in respiratory function is reported. The patients aged 15-44 yrs were divided into three groups. Group A consisted of 65 patients (median forced expiratory volume in one second (FEV1)/forced vital capacity (FVC) 0.7/1.4 L) who were on a lung transplant waiting list. Group B consisted of 25 patients (median FEV1/FVC 0.7/1.4 L) who were being evaluated for lung transplantation. Group C consisted of 23 patients (median FEV1/FVC 0.6/1.2 L) who were not being considered for lung transplantation. The mean duration of NIV support for groups A, B and C was 61 (range: 1-600) days, 53 (1-279) days and 45 (0.5-379) days respectively. Twenty-three patients in group A subsequently received lung transplantation and 12 of these patients had a median survival of 39 months postsurgery. Thirty-nine patients died and three awaited transplantation. Five patients in group B received a transplant four of whom survived; thirteen patients died and seven awaited transplantation. Twenty patients in group C died. Noninvasive ventilation improved hypoxia but failed to correct hypercapnia in these cystic fibrosis patients. Noninvasive ventilation is useful in the treatment of acute episodes of respiratory failure in cystic fibrosis patients with end-stage lung disease who have been accepted, or are being evaluated, for lung transplantation. For these patients, there is a possibility of prolonging life if they are successfully treated for their acute episode of respiratory failure until transplantation. In this group, treatment is not merely prolonging the process of dying.
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Affiliation(s)
- B P Madden
- Dept of Cardiothoracic Medicine, St George's Hospital, London, UK
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Abstract
The children's disability team in Cambridge provides an integrated health and social care service for children with complex learning and physical disabilities and their families. The team uses a multidisciplinary and multi-agency teamwork approach to care provision. The effectiveness of the team was evaluated using a cooperative review of its functions, in which all the 'subjects' were active participants in defining and delivering the evaluation. This was combined with individual questionnaires regarding the team's perceived strengths and weaknesses. Particular implications for training and supervision emerged from the findings. This article discusses the ways in which the team has successfully refined its practice of collaborative working in a developmental way between 1992-1998.
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