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Hanna D, Merrick S, Ghose A, Devlin MJ, Yang DD, Phillips E, Okines A, Chopra N, Papadimatraki E, Ross K, Macpherson I, Boh ZY, Michie CO, Swampillai A, Gupta S, Robinson T, Germain L, Twelves C, Atkinson C, Konstantis A, Riddle P, Cresti N, Naik JD, Borley A, Guppy A, Schmid P, Phillips M. Real world study of sacituzumab govitecan in metastatic triple-negative breast cancer in the United Kingdom. Br J Cancer 2024:10.1038/s41416-024-02685-9. [PMID: 38658782 DOI: 10.1038/s41416-024-02685-9] [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] [Received: 10/27/2023] [Revised: 03/28/2024] [Accepted: 04/05/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Treatment options for pre-treated patients with metastatic triple-negative breast cancer (mTNBC) remain limited. This is the first study to assess the real-world safety and efficacy of sacituzumab govitecan (SG) in the UK. METHODS Data was retrospectively collected from 16 tertiary UK cancer centres. Pts had a diagnosis of mTNBC, received at least two prior lines of treatment (with at least one being in the metastatic setting) and received at least one dose of SG. RESULTS 132 pts were included. Median age was 56 years (28-91). All patients were ECOG performance status (PS) 0-3 (PS0; 39, PS1; 76, PS2; 16, PS3;1). 75% (99/132) of pts had visceral metastases including 18% (24/132) of pts with CNS disease. Median PFS (mPFS) was 5.2 months (95% CI 4.5-6.6) with a median OS (mOS) of 8.7 months (95% CI 6.8-NA). The most common adverse events (AEs) were fatigue (all grade; 82%, G3/4; 14%), neutropenia (all grade; 55%, G3/4; 29%), diarrhoea (all grade; 58%, G3/4, 15%), and nausea (all grade; 38%, G3/4; 3%). SG dose reduction was required in 54% of pts. CONCLUSION This study supports significant anti-tumour activity in heavily pre-treated pts with mTNBC. Toxicity data aligns with clinical trial experience.
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Affiliation(s)
- Daire Hanna
- St. Bartholomew's hospital, Barts Health NHS trust, London, UK.
- Barts Cancer Institute, Queen Mary University, London, UK.
| | | | - Aruni Ghose
- St. Bartholomew's hospital, Barts Health NHS trust, London, UK
| | | | - Dorothy D Yang
- The Royal Marsden NHS foundation trust London and Sutton, London, UK
| | - Edward Phillips
- The Royal Marsden NHS foundation trust London and Sutton, London, UK
| | - Alicia Okines
- The Royal Marsden NHS foundation trust London and Sutton, London, UK
| | - Neha Chopra
- The Royal Free, London NHS foundation trust, London, UK
| | | | - Kirsty Ross
- Beatson West of Scotland Cancer Centre, Glasgow, UK
| | | | - Zhuang Y Boh
- Edinburgh Cancer Centre and University of Edinburgh, Edinburgh, UK
| | | | | | - Sunnia Gupta
- Guy's and St Thomas' NHS foundation trust, London, UK
| | - Tim Robinson
- Bristol Haematology and Oncology Centre- NHS foundation trust, Bristol, UK
| | | | | | | | - Apostolos Konstantis
- UCLH NHS foundation trust, London, UK
- Princess Alexandra Hospital NHS trust, London, UK
| | | | - Nicola Cresti
- Northern Centre for Cancer Care, Newcastle upon Tyne Hospital NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Jay D Naik
- Harrogate and District NHS foundation trust, Harrogate, UK
| | | | - Amy Guppy
- Mount Vernon Cancer Centre, London, UK
| | - Peter Schmid
- St. Bartholomew's hospital, Barts Health NHS trust, London, UK
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Copson ER, Abraham JE, Braybrooke JP, Cameron D, McIntosh SA, Michie CO, Okines AFC, Palmieri C, Raja F, Roylance R, Spensley S. Expert UK consensus on the definition of high risk of recurrence in HER2-negative early breast cancer: A modified Delphi panel. Breast 2023; 72:103582. [PMID: 37769521 PMCID: PMC10539921 DOI: 10.1016/j.breast.2023.103582] [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] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 09/14/2023] [Accepted: 09/16/2023] [Indexed: 10/02/2023] Open
Abstract
BACKGROUND There is currently no standardised definition for patients at high risk of recurrence of human epidermal growth factor receptor 2 (HER2)-negative early breast cancer (eBC; stages 1-3) after surgery. This modified Delphi panel aimed to establish expert UK consensus on this definition, separately considering hormone receptor (HR)-positive and triple-negative (TN) patients. METHODS Over three consecutive rounds, results were collected from 29, 24 and 22 UK senior breast cancer oncologists and surgeons, respectively. The first round aimed to determine key risk factors in each patient subgroup; subsequent rounds aimed to establish appropriate risk thresholds. Consensus was pre-defined as ≥70% of respondents. RESULTS Expert consensus was achieved on need to assess age, tumour size, tumour grade, number of positive lymph nodes, inflammatory breast cancer and risk prediction tools in all HER2-negative patients. There was additional agreement on use of tumour profiling tests and biomarkers in HR-positive patients, and pathologic complete response (pCR) status in TN patients. Thresholds for high recurrence risk were subsequently agreed. In HR-positive patients, these included age <35 years, tumour size >5 cm (as independent risk factors); tumour grade 3 (independently and combined with other high-risk factors); number of positive nodes ≥4 (independently) and ≥1 (combined). For TN patients, the following thresholds reached consensus, both independently and in combination with other factors: tumour size >2 cm, tumour grade 3, number of positive nodes ≥1. CONCLUSIONS The results may be a valuable reference point to guide recurrence risk assessment and decision-making after surgery in the HER2-negative eBC population.
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Affiliation(s)
- E R Copson
- Cancer Sciences Academic Unit, University of Southampton, Southampton, UK.
| | - J E Abraham
- Precision Breast Cancer Institute, Department of Oncology, University of Cambridge, Cambridge, UK; Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - J P Braybrooke
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - D Cameron
- Edinburgh Cancer Centre, Western General Hospital, Edinburgh, UK
| | - S A McIntosh
- Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, UK
| | - C O Michie
- Edinburgh Cancer Centre, Western General Hospital, Edinburgh, UK
| | - A F C Okines
- The Royal Marsden NHS Foundation Trust, London, UK
| | - C Palmieri
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, UK; Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | - F Raja
- University College London Hospitals NHS Foundation Trust, London, UK; North Middlesex University Hospital, North Middlesex University Hospital NHS Trust, London, UK
| | - R Roylance
- University College London Hospitals NHS Foundation Trust, London, UK; NIHR University College London Hospitals Biomedical Research Centre, London, UK
| | - S Spensley
- Musgrove Park Hospital, Somerset NHS Foundation Trust, Taunton, UK
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Copson ER, Abraham JE, Braybrooke JP, McIntosh SA, Michie CO, Palmieri C, Roylance R, Spensley S. Abstract P3-05-39: Expert consensus on the definition of high risk of recurrence in HER2-negative early breast cancer: a modified Delphi panel. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-p3-05-39] [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: 03/06/2023]
Abstract
Abstract
PURPOSE: There is currently no standardised definition for patients at high risk of recurrence of HER2-negative early breast cancer (eBC, stages 1–3) after surgery. Recognising that the assessment of high risk is often multifactorial, the aim of this modified Delphi panel was to establish expert UK consensus on this definition, separately considering HR-positive and triple-negative (TN) patients. METHODS: A total of 45 UK-based clinicians, including breast cancer oncologists and surgeons, were invited to participate. The number of respondents in each of three rounds was 29, 24 and 22 respectively. Statements were developed using the results from a targeted literature review and the guidance of a lead clinician, and comprised free-text, single-choice or numerical formats. The first round aimed to determine which factors are currently used in clinical practice to assess risk of recurrence in the populations of interest. In the subsequent rounds, the objective was to establish thresholds indicative of high risk in a 10-year timeframe for each of the factors retained in Round 1. Between each round, statements were refined, considering the distribution of responses and free-text notes provided by participants. Consensus for single-choice questions was set at a pre-defined threshold of ≥70% of respondents. RESULTS: Consensus was achieved on the need to assess age, tumour size, tumour grade, number of positive nodes, presence of inflammatory breast cancer and one or more risk prediction tools to define high risk of recurrence in all HER2-negative patients. In HR-positive patients, there was agreement on the use of one or more tumour profiling tests and biomarkers to define high risk of recurrence. However, there was no consensus on biomarker use in TN patients, and support for specific biomarkers (such as Ki-67) was conflicting for both sub-populations based on the analysis of free-text notes. Similarly, while there was consensus on the use of pCR status/residual disease to indicate high risk in TN patients, this factor failed to reach consensus for the HR-positive sub-population. Germline BRCA status and menopausal status were not considered to be key factors for risk of recurrence in either biological subtype. In the second and third rounds, thresholds indicative of high recurrence risk were agreed; it should be noted that the free-text responses provided by the participants frequently highlighted that many of the factors should be considered along a continuous scale when assessing the risk of individual patients. In HR-positive patients, these thresholds included: age < 35 years, tumour size >5 cm (each when considered independently from other risk factors); tumour grade 3 (independently or in combination with other factors); number of positive lymph nodes ≥4 when considered independently or ≥1 in combination with other factors. For patients with TN tumours, the following thresholds reached consensus, whether considered independently or in combination with other factors: tumour size >2 cm, tumour grade 3, number of positive lymph nodes ≥1. In several cases, however, no consensus could be reached on the appropriate threshold indicating high risk of recurrence. In the HR-positive sub-population, these included thresholds for age and tumour size, when considered in combination with other factors. In the TN sub-population, this included age, whether independently or in combination with other factors. CONCLUSIONS: The expert consensus reached in this panel highlights that an integrated model is important in assessing recurrence risk in eBC and that definitions of high risk differ according to biological subtype. The results may serve as a valuable reference point for clinicians to use in assessing risk of disease recurrence and in making treatment decisions after surgery in the HER2-negative eBC population. FUNDING: AstraZeneca UK Ltd. Writing support: Costello Medical.
Citation Format: Ellen R. Copson, Jean E. Abraham, Jeremy P. Braybrooke, Stuart A. McIntosh, Caroline O. Michie, Carlo Palmieri, Rebecca Roylance, Saiqa Spensley. Expert consensus on the definition of high risk of recurrence in HER2-negative early breast cancer: a modified Delphi panel [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P3-05-39.
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Affiliation(s)
- Ellen R. Copson
- 1University of Southampton, Southampton, England, United Kingdom
| | - Jean E. Abraham
- 2Precision Breast Cancer Institute, Department of Oncology, University of Cambridge/Cambridge University Hospitals NHS Foundation Trust
| | | | | | | | | | | | - Saiqa Spensley
- 8Somerset NHS Foundation Trust, Taunton, England, United Kingdom
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Hollis RL, Meynert AM, Michie CO, Rye T, Churchman M, Hallas-Potts A, Croy I, McCluggage WG, Williams AR, Bartos C, Iida Y, Okamoto A, Dougherty B, Barrett JC, March R, Matakidou A, Roxburgh P, Semple CA, Harkin DP, Kennedy R, Herrington CS, Gourley C. Multiomic Characterization of High-Grade Serous Ovarian Carcinoma Enables High-Resolution Patient Stratification. Clin Cancer Res 2022; 28:3546-3556. [PMID: 35696721 PMCID: PMC9662902 DOI: 10.1158/1078-0432.ccr-22-0368] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 04/13/2022] [Accepted: 06/09/2022] [Indexed: 01/07/2023]
Abstract
PURPOSE High-grade serous ovarian carcinoma (HGSOC) is the most common ovarian cancer type; most patients experience disease recurrence that accumulates chemoresistance, leading to treatment failure. Genomic and transcriptomic features have been associated with differential outcome and treatment response. However, the relationship between events at the gene sequence, copy number, and gene-expression levels remains poorly defined. EXPERIMENTAL DESIGN We perform multiomic characterization of a large HGSOC cohort (n = 362) with detailed clinical annotation to interrogate the relationship between patient subgroups defined by specific molecular events. RESULTS BRCA2-mutant (BRCA2m) and EMSY-overexpressing cases demonstrated prolonged survival [multivariable hazard ratios (HR) 0.40 and 0.51] and significantly higher first- and second-line chemotherapy response rate. CCNE1-gained (CCNE1g) cases demonstrated underrepresentation of FIGO stage IV cases, with shorter survival but no significant difference in treatment response. We demonstrate marked overlap between the TCGA- and Tothill-derived subtypes. IMR/C2 cases displayed higher BRCA1/2m frequency (25.5%, 32.5%) and significantly greater immune cell infiltration, whereas PRO/C5 cases had the highest CCNE1g rate (23.9%, 22.2%) and were uniformly low in immune cell infiltration. The survival benefit for cases with aberrations in homologous recombination repair (HRR) genes was apparent across all transcriptomic subtypes (HR range, 0.48-0.68). There was significant co-occurrence of RB loss and HRR gene aberrations; RB loss was further associated with favorable survival within HRR-aberrant cases (multivariable HR, 0.50). CONCLUSIONS These data paint a high-resolution picture of the molecular landscape in HGSOC, better defining patients who may benefit most from specific molecular therapeutics and highlighting those for whom novel treatment strategies are needed to improve outcomes.
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Affiliation(s)
- Robert L. Hollis
- Nicola Murray Centre for Ovarian Cancer Research, Cancer Research UK Scotland Centre, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
- Corresponding Author: Robb L. Hollis, Cancer Research UK Scotland Centre, Institute of Genetics and Cancer, University of Edinburgh, Crewe Road South, Edinburgh EH4 2XU, Scotland, UK. E-mail:
| | - Alison M. Meynert
- MRC Human Genetics Unit, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
| | - Caroline O. Michie
- Edinburgh Cancer Centre, Western General Hospital, NHS Lothian, Edinburgh, UK
| | - Tzyvia Rye
- Nicola Murray Centre for Ovarian Cancer Research, Cancer Research UK Scotland Centre, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
| | - Michael Churchman
- Nicola Murray Centre for Ovarian Cancer Research, Cancer Research UK Scotland Centre, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
| | - Amelia Hallas-Potts
- Nicola Murray Centre for Ovarian Cancer Research, Cancer Research UK Scotland Centre, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
| | - Ian Croy
- Nicola Murray Centre for Ovarian Cancer Research, Cancer Research UK Scotland Centre, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
| | | | | | - Clare Bartos
- Nicola Murray Centre for Ovarian Cancer Research, Cancer Research UK Scotland Centre, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
| | - Yasushi Iida
- Nicola Murray Centre for Ovarian Cancer Research, Cancer Research UK Scotland Centre, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
- The Jikei University School of Medicine, Tokyo, Japan
| | - Aikou Okamoto
- The Jikei University School of Medicine, Tokyo, Japan
| | - Brian Dougherty
- Translational Medicine, Oncology R&D, AstraZeneca, Waltham, Massachusetts
| | - J. Carl Barrett
- Translational Medicine, Oncology R&D, AstraZeneca, Waltham, Massachusetts
| | - Ruth March
- Precision Medicine and Biosamples, Oncology R&D, AstraZeneca, Cambridge, UK
| | - Athena Matakidou
- Centre for Genomics Research, Discovery Sciences, BioPharmaceuticals R&D, AstraZeneca, Cambridge, UK
| | - Patricia Roxburgh
- Institute of Cancer Sciences, Wolfson Wohl Cancer Research Centre, University of Glasgow, Belfast, UK
- Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - Colin A. Semple
- MRC Human Genetics Unit, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
| | - D. Paul Harkin
- Almac Diagnostics, Craigavon, UK
- Centre for Cancer Research and Cell Biology, Queen's University Belfast, Belfast, UK
| | - Richard Kennedy
- Almac Diagnostics, Craigavon, UK
- Centre for Cancer Research and Cell Biology, Queen's University Belfast, Belfast, UK
| | - C. Simon Herrington
- Nicola Murray Centre for Ovarian Cancer Research, Cancer Research UK Scotland Centre, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
| | - Charlie Gourley
- Nicola Murray Centre for Ovarian Cancer Research, Cancer Research UK Scotland Centre, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
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Hollis RL, Churchman M, Michie CO, Rye T, Knight L, McCavigan A, Perren T, Williams ARW, McCluggage WG, Kaplan RS, Jayson GC, Oza A, Harkin DP, Herrington CS, Kennedy R, Gourley C. High EMSY expression defines a BRCA-like subgroup of high-grade serous ovarian carcinoma with prolonged survival and hypersensitivity to platinum. Cancer 2019; 125:2772-2781. [PMID: 31154673 PMCID: PMC6771827 DOI: 10.1002/cncr.32079] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 01/11/2019] [Accepted: 01/15/2019] [Indexed: 11/14/2022]
Abstract
BACKGROUND Approximately half of high-grade serous ovarian carcinomas (HGSOCs) demonstrate homologous recombination repair (HR) pathway defects, resulting in a distinct clinical phenotype comprising hypersensitivity to platinum, superior clinical outcome, and greater sensitivity to poly(adenosine diphosphate-ribose) polymerase (PARP) inhibitors. EMSY, which is known to be amplified in breast and ovarian cancers, encodes a protein reported to bind and inactivate BRCA2. Thus, EMSY overexpression may mimic BRCA2 mutation, resulting in HR deficiency. However, to our knowledge, the phenotypic consequences of EMSY overexpression in HGSOC patients has not been explored. METHODS Here we investigate the impact of EMSY expression on clinical outcome and sensitivity to platinum-based chemotherapy using available data from transcriptomically characterized HGSOC cohorts. RESULTS High EMSY expression was associated with better clinical outcome in a cohort of 265 patients with HGSOC from Edinburgh (overall survival multivariable hazard ratio, 0.58 [95% CI, 0.38-0.88; P = .011] and progression-free survival multivariable hazard ratio, 0.62 [95% CI, 0.40-0.96; P = .030]). Superior outcome also was demonstrated in the Medical Research Council ICON7 clinical trial and multiple publicly available data sets. Patients within the Edinburgh cohort who had high EMSY expression were found to demonstrate greater rates of complete response to multiple platinum-containing chemotherapy regimens (radiological complete response rate of 44.4% vs 12.5% at second exposure; P = .035) and corresponding prolonged time to disease progression (median, 151.5 days vs 60.5 days after third platinum exposure; P = .004). CONCLUSIONS Patients with HGSOCs demonstrating high EMSY expression appear to experience prolonged survival and greater platinum sensitivity, reminiscent of BRCA-mutant cases. These data are consistent with the notion that EMSY overexpression may render HGSOCs HR deficient.
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Affiliation(s)
- Robert L. Hollis
- Nicola Murray Centre for Ovarian Cancer Research, Cancer Research UK Edinburgh Centre, Medical Research Council Institute of Genetics and Molecular MedicineUniversity of EdinburghEdinburghUnited Kingdom
| | - Michael Churchman
- Nicola Murray Centre for Ovarian Cancer Research, Cancer Research UK Edinburgh Centre, Medical Research Council Institute of Genetics and Molecular MedicineUniversity of EdinburghEdinburghUnited Kingdom
| | - Caroline O. Michie
- Nicola Murray Centre for Ovarian Cancer Research, Cancer Research UK Edinburgh Centre, Medical Research Council Institute of Genetics and Molecular MedicineUniversity of EdinburghEdinburghUnited Kingdom
| | - Tzyvia Rye
- Nicola Murray Centre for Ovarian Cancer Research, Cancer Research UK Edinburgh Centre, Medical Research Council Institute of Genetics and Molecular MedicineUniversity of EdinburghEdinburghUnited Kingdom
| | | | | | - Timothy Perren
- St. James's Institute of OncologySt. James's University HospitalLeedsUnited Kingdom
| | | | - W. Glenn McCluggage
- Center for Cancer Research and Cell BiologyQueen's University of BelfastBelfastUnited Kingdom
- Department of PathologyBelfast Health and Social Care TrustBelfastUnited Kingdom
| | - Richard S. Kaplan
- Medical Research Council Clinical Trials Unit at University College LondonLondonUnited Kingdom
| | - Gordon C. Jayson
- Division of Molecular and Clinical Cancer SciencesUniversity of ManchesterManchesterUnited Kingdom
| | - Amit Oza
- Cancer Clinical Research Unit, Division of Medical Oncology and Hematology, Princess Margaret Cancer CentreUniversity of TorontoTorontoOntarioCanada
| | - D. Paul Harkin
- Almac DiagnosticsCraigavonUnited Kingdom
- Center for Cancer Research and Cell BiologyQueen's University of BelfastBelfastUnited Kingdom
| | - C. Simon Herrington
- Nicola Murray Centre for Ovarian Cancer Research, Cancer Research UK Edinburgh Centre, Medical Research Council Institute of Genetics and Molecular MedicineUniversity of EdinburghEdinburghUnited Kingdom
- Department of PathologyUniversity of EdinburghEdinburghUnited Kingdom
- Division of Pathology, Centre for Comparative Pathology, Cancer Research UK Edinburgh Centre, Medical Research Council Institute of Genetics and Molecular MedicineUniversity of EdinburghEdinburghUnited Kingdom
| | - Richard Kennedy
- Almac DiagnosticsCraigavonUnited Kingdom
- Center for Cancer Research and Cell BiologyQueen's University of BelfastBelfastUnited Kingdom
| | - Charlie Gourley
- Nicola Murray Centre for Ovarian Cancer Research, Cancer Research UK Edinburgh Centre, Medical Research Council Institute of Genetics and Molecular MedicineUniversity of EdinburghEdinburghUnited Kingdom
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Helali AE, McCabe N, Steele C, Perez LD, O'Neill CL, Dickson N, McGivern N, Harkin C, McCavigan A, Medina RJ, Knight LA, McQuaid S, James JA, Michie CO, Gourley C, McCluggage WG, Harkin DP, Wilson RH, Stitt AW, Kennedy RD. Abstract 7: Platinum resistance in epithelial ovarian cancer is dependent on a PDGFR alpha-VEGF-A signalling mechanism that activates downstream angiogenesis pathways. Cancer Res 2018. [DOI: 10.1158/1538-7445.am2018-7] [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
Introduction:
40-45% of patients with High Grade Serous Ovarian Cancer (HGSOC) will eventually relapse with platinum resistant disease. Tothill et al and TCGA are two independent gene expression datasets which have demonstrated the presence of a mesenchymal molecular subgroup, characterised by upregulation of angiogenesis regulating genes. Angiogenesis is known to be an integral pathological feature of HGSOC and anti-angiogenics have dominated the field of drug development in EOC. However, despite this, anti-angiogenic agents have failed to demonstrate a significant impact on overall survival (OS) benefit. In this study, we asked if platinum resistance could be associated with an improved response to anti-angiogenic agents and what the underlying biological rationale for this could be.
Methods:
A meta-analysis of 14 phase II and III clinical trials in EOC were used to investigate the association between platinum resistance and response to anti-angiogenic agents. In addition, we analysed gene expression in 12 matched pre- and post-chemotherapy EOC samples. Novel isogenic cisplatin-resistant HGSOC cell lines were established to study the development of an angiogenic phenotype. Further studies were performed in novel ascites-derived primary cell lines from HGSOC patients with known outcomes following platinum-based chemotherapy.
Result:
In the clinical trial meta-analysis, an OS benefit for antiangiogenics was observed in platinum-resistant disease (p=0.029), whilst platinum-sensitive EOC only derived progression free survival (PFS) (p=<0.0001) benefit and not OS (p=0.125). In the 12 matched pairs of patient samples, post-platinum samples had a higher micro-vessel density (MVD) relative to their paired treatment-naïve sample (p= 0.0001). Additionally, an in vivo angiogenesis matrigel plug assay demonstrated that cisplatin-resistant EOC cell lines were associated with an increase in MVD (p=<0.0001). MVD was reduced in the platinum-resistant cells following treatment with bevacizumab (p=0.001). Ascites-derived primary cells established from platinum-resistant patients demonstrated overexpression of VEGF-A, consistent with stimulating angiogenesis. Gene expression analysis of pre- and post-platinum paired samples identified that PDGFRα (p=0.007) and PDGFRβ (p=0.005) were differentially expressed in the post-platinum therapy samples. In vitro validation in the platinum-resistant cell lines demonstrated that VEGF-A expression was regulated by PDGFRα.
Discussion:
We have demonstrated that previous platinum therapy for EOC is associated with an increase in tumor PDGFα and VEGF-A expression, correlating with a response to anti-angiogenic therapies. This data suggests that platinum therapy resistance may inform the selection of EOC patients for novel antiangiogenic therapies in future clinical trials.
Citation Format: Aya El Helali, Nuala McCabe, Christopher Steele, Lara Dura Perez, Christina L. O'Neill, Naomi Dickson, Niamh McGivern, Caolan Harkin, Andrena McCavigan, Reinhold J. Medina, Laura A. Knight, Stephen McQuaid, Jacqueline A. James, Caroline O. Michie, Charlie Gourley, W Glenn McCluggage, Denis P. Harkin, Richard H. Wilson, Alan W. Stitt, Richard D. Kennedy. Platinum resistance in epithelial ovarian cancer is dependent on a PDGFR alpha-VEGF-A signalling mechanism that activates downstream angiogenesis pathways [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 7.
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Affiliation(s)
- Aya El Helali
- 1Centre for Cancer Research and Cell Biology, Belfast, United Kingdom
| | - Nuala McCabe
- 1Centre for Cancer Research and Cell Biology, Belfast, United Kingdom
| | | | | | | | | | - Niamh McGivern
- 1Centre for Cancer Research and Cell Biology, Belfast, United Kingdom
| | - Caolan Harkin
- 1Centre for Cancer Research and Cell Biology, Belfast, United Kingdom
| | | | | | | | - Stephen McQuaid
- 4Northern Ireland Molecular Pathology Laboratory, Belfast, United Kingdom
| | | | - Caroline O. Michie
- 5Nicola Murray Ovarian Cancer Research Centre, Edinburgh, United Kingdom
| | - Charlie Gourley
- 5Nicola Murray Ovarian Cancer Research Centre, Edinburgh, United Kingdom
| | - W Glenn McCluggage
- 6Department of Pathology, Royal Group of Hospitals Trust, Belfast, United Kingdom
| | | | - Richard H. Wilson
- 1Centre for Cancer Research and Cell Biology, Belfast, United Kingdom
| | - Alan W. Stitt
- 3Centre for Experimental Medicine, Belfast, United Kingdom
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Xintaropoulou C, Ward C, Wise A, Queckborner S, Turnbull A, Michie CO, Williams ARW, Rye T, Gourley C, Langdon SP. Expression of glycolytic enzymes in ovarian cancers and evaluation of the glycolytic pathway as a strategy for ovarian cancer treatment. BMC Cancer 2018; 18:636. [PMID: 29866066 PMCID: PMC5987622 DOI: 10.1186/s12885-018-4521-4] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [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: 11/10/2017] [Accepted: 05/18/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Novel therapeutic approaches are required to treat ovarian cancer and dependency on glycolysis may provide new targets for treatment. This study sought to investigate the variation of expression of molecular components (GLUT1, HKII, PKM2, LDHA) of the glycolytic pathway in ovarian cancers and the effectiveness of targeting this pathway in ovarian cancer cell lines with inhibitors. METHODS Expression of GLUT1, HKII, PKM2, LDHA were analysed by quantitative immunofluorescence in a tissue microarray (TMA) analysis of 380 ovarian cancers and associations with clinicopathological features were sought. The effect of glycolysis pathway inhibitors on the growth of a panel of ovarian cancer cell lines was assessed by use of the SRB proliferation assay. Combination studies were undertaken combining these inhibitors with cytotoxic agents. RESULTS Mean expression levels of GLUT1 and HKII were higher in high grade serous ovarian cancer (HGSOC), the most frequently occurring subtype, than in non-HGSOC. GLUT1 expression was also significantly higher in advanced stage (III/IV) ovarian cancer than early stage (I/II) disease. Growth dependency of ovarian cancer cells on glucose was demonstrated in a panel of ovarian cancer cell lines. Inhibitors of the glycolytic pathway (STF31, IOM-1190, 3PO and oxamic acid) attenuated cell proliferation in platinum-sensitive and platinum-resistant HGSOC cell line models in a concentration dependent manner. In combination with either cisplatin or paclitaxel, 3PO (a novel PFKFB3 inhibitor) enhanced the cytotoxic effect in both platinum sensitive and platinum resistant ovarian cancer cells. Furthermore, synergy was identified between STF31 (a novel GLUT1 inhibitor) or oxamic acid (an LDH inhibitor) when combined with metformin, an inhibitor of oxidative phosphorylation, resulting in marked inhibition of ovarian cancer cell growth. CONCLUSIONS The findings of this study provide further support for targeting the glycolytic pathway in ovarian cancer and several useful combinations were identified.
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Affiliation(s)
- Chrysi Xintaropoulou
- Cancer Research UK Edinburgh Centre and Division of Pathology Laboratory, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, EH4 2XU UK
| | - Carol Ward
- Cancer Research UK Edinburgh Centre and Division of Pathology Laboratory, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, EH4 2XU UK
- The Royal (Dick) School of Veterinary Studies and Roslin Institute, Easter Bush, Roslin, Midlothian, EH25 9RG UK
| | - Alan Wise
- IOmet Pharma (a wholly owned subsidiary of Merck & Co., Inc., Kenilworth, NJ USA, known as MSD outside the United States and Canada) Nine Edinburgh Bioquarter, Little France Road, Edinburgh, EH16 4UX UK
| | - Suzanna Queckborner
- Cancer Research UK Edinburgh Centre and Division of Pathology Laboratory, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, EH4 2XU UK
| | - Arran Turnbull
- Cancer Research UK Edinburgh Centre and Division of Pathology Laboratory, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, EH4 2XU UK
| | - Caroline O. Michie
- Cancer Research UK Edinburgh Centre, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, EH4 2XU UK
| | - Alistair R. W. Williams
- Division of Pathology, University of Edinburgh Medical School, 51 Little France Crescent, Edinburgh, EH16 4SA UK
| | - Tzyvia Rye
- Cancer Research UK Edinburgh Centre, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, EH4 2XU UK
| | - Charlie Gourley
- Cancer Research UK Edinburgh Centre, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, EH4 2XU UK
| | - Simon P. Langdon
- Cancer Research UK Edinburgh Centre and Division of Pathology Laboratory, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, EH4 2XU UK
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El-Helali A, McCabe N, Gourley C, McCavigan A, Michie CO, Price B, McGivern N, Churchman M, El-Helai A, O'Brien EJ, Hill L, Davison TS, Williams A, McCluggage WG, Keating KE, Harkin DP, Kennedy R. Abstract MIP-055: IDENTIFICATION OF A MOLECULAR SUBTYPE OF HIGH GRADE SEROUS OVARIAN CANCER REPRESENTING MAPK PATHWAY ACTIVATION AND PLATINUM RESISTANCE. Clin Cancer Res 2017. [DOI: 10.1158/1557-3265.ovcasymp16-mip-055] [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: We previously defined 3 molecular subgroups of High Grade Serous Ovarian Cancer (HGSOC), using gene expression data from 265 FFPE samples obtained from treatment naive patients, who received platinum based treatment following surgical resection. The 3 molecular subgroups were Angio: characterised by upregulation of angiogenesis genes; Immune: characterised by upregulation of immune genes and AngioImmune: characterised by upregulation of angiogenesis and immune genes. Patients within these 3 subgroups respond differently to standard of care treatment The Immune subgroup have the best prognosis and the Angio and AngioImmune subgroups have similar worse prognosis. A weighted gene signature to identify each of the molecular subgroups was developed. This dataset was used as a reference to investigate the effect of chemotherapy on molecular subgroup designation.
METHODS: To investigate the effect of chemotherapy on predefined molecular subgroups, we analysed 35 matched pre- and post- chemotherapy samples by gene expression. The molecular subgroup assignment for each of the paired samples was determined using the gene expression signatures for each subgroup. Novel cisplatin resistant HGSOC cell lines were generated to study the mechanisms of acquired cisplatin resistance.
RESULTS: 40% of the treatment naive samples that were aligned with the AngioImmune subgroup and this increased to 67.5% post-chemotherapy. 10/15 (67%) treatment naïve tumours that were initially assigned to the good prognostic Immune molecular subgroup shifted to the bad prognostic AngioImmune molecular subgroup post chemotherapy. Hence platinum chemotherapy selects for the AngioImmune subgroup, suggesting that this subgroup represents tumours which are innately platinum resistant but also provides a mechanism of acquired resistance. Additionally we demonstrate that the AngioImmune subgroup is driven by activation of the MAPK pathway and shows that cisplatin resistant HGSOC cell lines are specifically sensitive to MEK inhibitors.
CONCLUSIONS: The MAPK pathway is a mechanism of innate and acquired platinum resistance in HGSOC. Furthermore the data suggests that original pre-treatment surgical/biopsy samples may fall within a different molecular subgroup to samples taken post-platinum therapy.
Citation Format: Aya El-Helali, Nuala McCabe, Charlie Gourley, Andrena McCavigan, Caroline O. Michie, Bethanie Price, Niamh McGivern, Michael Churchman, Aya El-Helai, Eamonn J. O'Brien, Laura Hill, Timothy S Davison, Alistair Williams, W Glenn McCluggage, Katherine E Keating, Denis P Harkin, and Richard Kennedy. IDENTIFICATION OF A MOLECULAR SUBTYPE OF HIGH GRADE SEROUS OVARIAN CANCER REPRESENTING MAPK PATHWAY ACTIVATION AND PLATINUM RESISTANCE [abstract]. In: Proceedings of the 11th Biennial Ovarian Cancer Research Symposium; Sep 12-13, 2016; Seattle, WA. Philadelphia (PA): AACR; Clin Cancer Res 2017;23(11 Suppl):Abstract nr MIP-055.
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Affiliation(s)
- Aya El-Helali
- 2Centre for Cancer Research and Cell Biology, Queens University Belfast, Northern Ireland, UK
| | - Nuala McCabe
- 1Almac Diagnostics, 19 Seagoe Industrial Estate, Craigavon, UK
- 2Centre for Cancer Research and Cell Biology, Queens University Belfast, Northern Ireland, UK
| | - Charlie Gourley
- 3University of Edinburgh Cancer Research UK Center, MRC IGMM, Edinburgh, UK
| | | | - Caroline O. Michie
- 3University of Edinburgh Cancer Research UK Center, MRC IGMM, Edinburgh, UK
| | - Bethanie Price
- 2Centre for Cancer Research and Cell Biology, Queens University Belfast, Northern Ireland, UK
| | - Niamh McGivern
- 2Centre for Cancer Research and Cell Biology, Queens University Belfast, Northern Ireland, UK
| | - Michael Churchman
- 3University of Edinburgh Cancer Research UK Center, MRC IGMM, Edinburgh, UK
| | - Aya El-Helai
- 1Almac Diagnostics, 19 Seagoe Industrial Estate, Craigavon, UK
- 2Centre for Cancer Research and Cell Biology, Queens University Belfast, Northern Ireland, UK
| | | | - Laura Hill
- 1Almac Diagnostics, 19 Seagoe Industrial Estate, Craigavon, UK
| | | | | | - W Glenn McCluggage
- 2Centre for Cancer Research and Cell Biology, Queens University Belfast, Northern Ireland, UK
- 5Department of Pathology, Belfast Health and Social Care Trust, Belfast, UK
| | | | - Denis P Harkin
- 1Almac Diagnostics, 19 Seagoe Industrial Estate, Craigavon, UK
- 2Centre for Cancer Research and Cell Biology, Queens University Belfast, Northern Ireland, UK
| | - Richard Kennedy
- 1Almac Diagnostics, 19 Seagoe Industrial Estate, Craigavon, UK
- 2Centre for Cancer Research and Cell Biology, Queens University Belfast, Northern Ireland, UK
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McCabe N, Gourley C, McGavigan A, Michie CO, McGivern N, Churchman M, O’Brien EJ, Hill L, Davison TS, Williams A, McCluggage G, Keating KE, Harkin DP, Kennedy RD. Abstract 453: MEK activation is associated with a molecular subgroup in high grade serous ovarian cancer. Cancer Res 2016. [DOI: 10.1158/1538-7445.am2016-453] [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
Introduction
We have previously defined 3 molecular subgroups of High grade serous ovarian cancer (HGSOC), ‘Angio’, ‘Immune’ and ‘Angio_immune’ subgroups using gene expression data from 265 FFPE HGSOC samples obtained from treatment naive patients and who were subsequently treated with platinum-based standard of care (SoC) chemotherapy (carboplatin +/- paclitaxel) (Gourley, et al. J Clin Oncol 32:5s, 2014). Patients within these 3 molecular subgroups respond differently to SOC treatment. The immune subgroup has the best outcome compared to the Angio and Angio_immune subgroups (HR of 0.63 and 0.66 respectively on multivariate analysis). Since it has previously been shown that the MAPK pathway is an important mediator of cisplatin resistance in ovarian cancer, we wanted to investigate if the MAPK pathway was associated with one of the poor prognosis subgroups.
Methods
A gene signature that could detect each of the subgroups Angio, Immune and Angio_immune was generated from the clinical samples. Data from the Cancer Genome Atlas (TCGA) Project was used to test for correlation between each subgroup and phospho-MEK as measured by Reverse Phase Proteomic Array (RPPA). Sensitivity to the MEK inhibitor trametinib (GSK1120212) and cisplatin was determined by 10-day colony formation assay.
Results
We found a statistically significant association between the Angio_immune subgroup signature and Phospho-MEK (serine 217/221) expression (p = 0.047) indicating activation of the MAPK pathway in this subgroup. Additionally we have demonstrated that the Angio_immune subgroup signature is suppressed by MEK inhibition (p = 0.0055) and elevated by KRAS, NRAS and MEK1 overexpression in cell line models (0.0072, 0.0004 and <0.0001). These effects were specific to the Angio_immune subgroup signature as there was no association with the Angio or immune subgroup signatures. Additionally the Angio_immune gene signature could predict resistance to cisplatin and sensitivity to MEK inhibitors in a panel of breast and ovarian cancer cell line models (p = 0.0017 and p = 0.0091). Acquired resistance to cisplatin in cell line models was also associated with MEK activation and an elevated Angio_immune gene signature score, which could be reversed by a MEK inhibitor.
Conclusion
We have identified a molecular subgroup in HGSOC that is associated with MAPK signalling. A gene signature to detect this subgroup from formalin fixed paraffin embedded samples has been developed and predicts sensitivity to MEK inhibitors in pre-clinical model systems. Further work aims to validate the signature in clinical samples from patients treated with a MEK inhibitor.
Citation Format: Nuala McCabe, Charlie Gourley, Andrena McGavigan, Caroline O. Michie, Niamh McGivern, Michael Churchman, Eamonn J. O’Brien, Laura Hill, Timothy S. Davison, Alistair Williams, Glenn McCluggage, Karen E. Keating, Denis P. Harkin, Richard D. Kennedy. MEK activation is associated with a molecular subgroup in high grade serous ovarian cancer. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 453.
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Affiliation(s)
| | - Charlie Gourley
- 2University of Edinburgh Cancer Research UK Center, Edinburgh, United Kingdom
| | | | - Caroline O. Michie
- 2University of Edinburgh Cancer Research UK Center, Edinburgh, United Kingdom
| | - Niamh McGivern
- 3Centre for Cancer Research and Cell Biology, Craigavon, United Kingdom
| | - Michael Churchman
- 2University of Edinburgh Cancer Research UK Center, Edinburgh, United Kingdom
| | | | - Laura Hill
- 1Almac Diagnostics, Craigavon, United Kingdom
| | | | - Alistair Williams
- 4Division of Pathology, University of Edinburgh, Edinburgh, UK, Edinburgh, United Kingdom
| | - Glenn McCluggage
- 5Department of Pathology, Royal Group of Hospitals Trust, Belfast, United Kingdom
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George A, Michalarea V, Rafii S, Michie CO, Wong M, Bowen R, Han LY, van Hagen T, Rallis G, Banerji U, Kristeleit RS, De Bono JS, Banerjee SN, Molife LR, Gore ME, Kaye SB, Yap TA. Clinical outcomes in advanced cervical cancer (CC) and endometrial cancer (EC) patients (pts) treated in phase I trials of novel molecularly targeted agents (MTAs). J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.5596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Angela George
- The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, London, United Kingdom
| | - Vasiliki Michalarea
- The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Saeed Rafii
- The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | | | - Mabel Wong
- National Cancer Centre, Singapore, Singapore
| | - Rebecca Bowen
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Liz Y. Han
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Tom van Hagen
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | | | - Udai Banerji
- The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | | | - Johann Sebastian De Bono
- The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | | | - L Rhoda Molife
- The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | | | - Stanley B. Kaye
- The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Timothy Anthony Yap
- The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom
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11
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Yap TA, George A, Michie CO, Wong M, Bowen R, Rafii S, Michalarea V, van Hagen T, Han LY, Rallis G, Molife LR, Banerji U, Kristeleit RS, Banerjee SN, De Bono JS, Gore ME, Kaye SB. What factors influence advanced ovarian cancer patient (AOC pt) outcomes to phase I trial treatments? J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.5560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Timothy Anthony Yap
- The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, London, United Kingdom
| | - Angela George
- The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, London, United Kingdom
| | | | - Mabel Wong
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Rebecca Bowen
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Saeed Rafii
- Drug Development Unit at The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK, London, United Kingdom
| | - Vasiliki Michalarea
- Drug Development Unit at The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK, London, United Kingdom
| | - Tom van Hagen
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Liz Y. Han
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | | | - L Rhoda Molife
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Udai Banerji
- Drug Development Unit at The Institute of Cancer Research and The Royal Marsden Foundation Trust, London, United Kingdom
| | | | | | | | | | - Stanley B. Kaye
- Drug Development Unit at The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK, London, United Kingdom
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Evans A, Rauchhaus P, Whelehan P, Thomson K, Purdie CA, Jordan LB, Michie CO, Thompson A, Vinnicombe S. Does shear wave ultrasound independently predict axillary lymph node metastasis in women with invasive breast cancer? Breast Cancer Res Treat 2013; 143:153-7. [PMID: 24305976 PMCID: PMC4363519 DOI: 10.1007/s10549-013-2747-z] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Accepted: 10/21/2013] [Indexed: 11/25/2022]
Abstract
Shear wave elastography (SWE) shows promise as an adjunct to greyscale ultrasound examination in assessing breast masses. In breast cancer, higher lesion stiffness on SWE has been shown to be associated with features of poor prognosis. The purpose of this study was to assess whether lesion stiffness at SWE is an independent predictor of lymph node involvement. Patients with invasive breast cancer treated by primary surgery, who had undergone SWE examination were eligible. Data were retrospectively analysed from 396 consecutive patients. The mean stiffness values were obtained using the Aixplorer® ultrasound machine from SuperSonic Imagine Ltd. Measurements were taken from a region of interest positioned over the stiffest part of the abnormality. The average of the mean stiffness value obtained from each of two orthogonal image planes was used for analysis. Associations between lymph node involvement and mean lesion stiffness, invasive cancer size, histologic grade, tumour type, ER expression, HER-2 status and vascular invasion were assessed using univariate and multivariate logistic regression. At univariate analysis, invasive size, histologic grade, HER-2 status, vascular invasion, tumour type and mean stiffness were significantly associated with nodal involvement. Nodal involvement rates ranged from 7 % for tumours with mean stiffness <50 kPa to 41 % for tumours with a mean stiffness of >150 kPa. At multivariate analysis, invasive size, tumour type, vascular invasion, and mean stiffness maintained independent significance. Mean stiffness at SWE is an independent predictor of lymph node metastasis and thus can confer prognostic information additional to that provided by conventional preoperative tumour assessment and staging.
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Affiliation(s)
- Andrew Evans
- Dundee Cancer Centre, Ninewells Hospital & Medical School, Mailbox 4, Dundee, DD1 9SY, UK,
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13
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Gray TA, MacLaine NJ, Michie CO, Bouchalova P, Murray E, Howie J, Hrstka R, Maslon MM, Nenutil R, Vojtesek B, Langdon S, Hayward L, Gourley C, Hupp TR. Anterior Gradient-3: a novel biomarker for ovarian cancer that mediates cisplatin resistance in xenograft models. J Immunol Methods 2012; 378:20-32. [PMID: 22361111 DOI: 10.1016/j.jim.2012.01.013] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2011] [Revised: 09/02/2011] [Accepted: 01/27/2012] [Indexed: 10/28/2022]
Abstract
The Anterior Gradient (AGR) genes AGR2 and AGR3 are part of the Protein Disulfide Isomerase (PDI) family and harbour core thioredoxin folds (CxxS motifs) that have the potential to regulate protein folding and maturation. A number of proteomics and transcriptomics screens in the fields of limb regeneration, cancer cell metastasis, pro-oncogenic oestrogen-signalling, and p53 regulation have identified AGR2 as a novel component of these signalling pathways. Curiously, despite the fact that the AGR2 and AGR3 genes are contiguous on chromosome 7p21.1-3, the AGR3 protein has rarely been identified in such OMICs screens along with AGR2 protein. Therefore there is little information on how AGR3 protein is expressed in normal and diseased states. A panel of three monoclonal antibodies was generated towards AGR3 protein for identifying novel clinical models that can be used to define whether AGR3 protein could play a positive or negative role in human cancer development. One monoclonal antibody was AGR3-specific and bound a linear epitope that could be defined using both pep-scan and phage-peptide library screening. Using this monoclonal antibody, endogenous AGR3 protein expression was shown to be cytosolic in four human ovarian cancer subtypes; serous, endometrioid, clear cell, and mucinous. Mucinous ovarian cancers produced the highest number of AGR3 positive cells. AGR3 expression is coupled to AGR2 expression only in mucinous ovarian cancers, whereas AGR3 and AGR2 expressions are uncoupled in the other three types of ovarian cancer. AGR3 expression in ovarian cancer is independent of oestrogen-receptor expression, which is distinct from the oestrogen-receptor dependent expression of AGR3 in breast cancers. Isogenic cancer cell models were created that over-express AGR3 and these demonstrated that AGR3 mediates cisplatin-resistance in mouse xenografts. These data indicate that AGR3 is over-expressed by a hormone (oestrogen-receptor α)-independent mechanism and identify a novel protein-folding associated pathway that could mediate resistance to DNA-damaging agents in human cancers.
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Affiliation(s)
- Terry A Gray
- p53 Signal Transduction Group, Edinburgh Cancer Research Centre, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, EH4 2XR, Scotland, UK
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14
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Bolton KL, Chenevix-Trench G, Goh C, Sadetzki S, Ramus SJ, Karlan BY, Lambrechts D, Despierre E, Barrowdale D, McGuffog L, Healey S, Easton DF, Sinilnikova O, Benítez J, García MJ, Neuhausen S, Gail MH, Hartge P, Peock S, Frost D, Evans DG, Eeles R, Godwin AK, Daly MB, Kwong A, Ma ESK, Lázaro C, Blanco I, Montagna M, D'Andrea E, Nicoletto MO, Johnatty SE, Kjær SK, Jensen A, Høgdall E, Goode EL, Fridley BL, Loud JT, Greene MH, Mai PL, Chetrit A, Lubin F, Hirsh-Yechezkel G, Glendon G, Andrulis IL, Toland AE, Senter L, Gore ME, Gourley C, Michie CO, Song H, Tyrer J, Whittemore AS, McGuire V, Sieh W, Kristoffersson U, Olsson H, Borg Å, Levine DA, Steele L, Beattie MS, Chan S, Nussbaum RL, Moysich KB, Gross J, Cass I, Walsh C, Li AJ, Leuchter R, Gordon O, Garcia-Closas M, Gayther SA, Chanock SJ, Antoniou AC, Pharoah PDP. Association between BRCA1 and BRCA2 mutations and survival in women with invasive epithelial ovarian cancer. JAMA 2012; 307:382-90. [PMID: 22274685 PMCID: PMC3727895 DOI: 10.1001/jama.2012.20] [Citation(s) in RCA: 465] [Impact Index Per Article: 38.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT Approximately 10% of women with invasive epithelial ovarian cancer (EOC) carry deleterious germline mutations in BRCA1 or BRCA2. A recent article suggested that BRCA2-related EOC was associated with an improved prognosis, but the effect of BRCA1 remains unclear. OBJECTIVE To characterize the survival of BRCA carriers with EOC compared with noncarriers and to determine whether BRCA1 and BRCA2 carriers show similar survival patterns. DESIGN, SETTING, AND PARTICIPANTS A pooled analysis of 26 observational studies on the survival of women with ovarian cancer, which included data from 1213 EOC cases with pathogenic germline mutations in BRCA1 (n = 909) or BRCA2 (n = 304) and from 2666 noncarriers recruited and followed up at variable times between 1987 and 2010 (the median year of diagnosis was 1998). MAIN OUTCOME MEASURE Five-year overall mortality. RESULTS The 5-year overall survival was 36% (95% CI, 34%-38%) for noncarriers, 44% (95% CI, 40%-48%) for BRCA1 carriers, and 52% (95% CI, 46%-58%) for BRCA2 carriers. After adjusting for study and year of diagnosis, BRCA1 and BRCA2 mutation carriers showed a more favorable survival than noncarriers (for BRCA1: hazard ratio [HR], 0.78; 95% CI, 0.68-0.89; P < .001; and for BRCA2: HR, 0.61; 95% CI, 0.50-0.76; P < .001). These survival differences remained after additional adjustment for stage, grade, histology, and age at diagnosis (for BRCA1: HR, 0.73; 95% CI, 0.64-0.84; P < .001; and for BRCA2: HR, 0.49; 95% CI, 0.39-0.61; P < .001). The BRCA1 HR estimate was significantly different from the HR estimated in the adjusted model (P for heterogeneity = .003). CONCLUSION Among patients with invasive EOC, having a germline mutation in BRCA1 or BRCA2 was associated with improved 5-year overall survival. BRCA2 carriers had the best prognosis.
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Affiliation(s)
- Kelly L Bolton
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
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15
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Michie CO, Sakala M, Rivans I, Strachan MWJ, Clive S. The frequency and severity of capecitabine-induced hypertriglyceridaemia in routine clinical practice: a prospective study. Br J Cancer 2010; 103:617-21. [PMID: 20664584 PMCID: PMC2938254 DOI: 10.1038/sj.bjc.6605807] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: Capecitabine is known to rarely cause raised serum triglycerides (TG). In our centre, several patients receiving capecitabine developed raised TG levels corresponding to the ‘very high risk’ category for potentially serious acute pancreatitis. Methods: A fasting blood lipid screening protocol was introduced into clinical practice for patients receiving capecitabine. Patients with TGs >5 mmol l−1 were treated and followed up. An 18-month prospective audit was performed to establish the incidence and severity of capecitabine-induced hypertriglyceridaemia (CIHT). Results: A total of 304 patients received capecitabine for colorectal cancer between January 2008 and June 2009. Of these, 212 patients (70%) were screened and 8 (3.7%) developed clinically significant hypertriglyceridaemia requiring lipid-lowering therapy. Two of the eight patients had diabetes and one had pre-existing dyslipidaemia. One suffered cerebral infarction during chemotherapy. There were no cases of acute pancreatitis. Follow-up showed that serum TGs safely and rapidly returned to normal with appropriate treatment without discontinuation of capecitabine. Conclusions: This is the first prospective study evaluating CIHT. These results suggest that it should be classed as a ‘common’ undesired effect of capecitabine. Despite this, the incidence does not justify routine screening in all patients. Targeted screening in those with diabetes or pre-existing hyperlipidaemia is recommended, together with adoption of a clear management policy.
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Affiliation(s)
- C O Michie
- Edinburgh Cancer Centre, Western General Hospital, Crewe Road South, Edinburgh EH4 2XU, UK.
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16
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Gourley C, Michie CO, Roxburgh P, Yap TA, Harden S, Paul J, Ragupathy K, Todd R, Petty R, Reed N, Hayward RL, Mitchell P, Rye T, Schellens JH, Lubinski J, Carmichael J, Kaye SB, Mackean M, Ferguson M. Increased Incidence of Visceral Metastases in Scottish Patients With BRCA1/2-Defective Ovarian Cancer: An Extension of the Ovarian BRCAness Phenotype. J Clin Oncol 2010; 28:2505-11. [PMID: 20406939 DOI: 10.1200/jco.2009.25.1082] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [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
Purpose To compare the frequency of visceral relapse of BRCA1/2-deficient ovarian cancer to that of nonhereditary controls. Patients and Methods All patients diagnosed in Scotland with epithelial ovarian cancer (EOC) or primary peritoneal cancer (PPC) and a germline BRCA1/2 mutation were identified. Those with previous malignancy were excluded. Each remaining patient who experienced relapse was matched with two nonhereditary controls. Results Seventy-nine patients with EOC/PPC and germline BRCA1/2 mutations were identified. Fifteen had inadequate clinical data, two had carcinosarcoma, 27 had previous breast cancer, and 16 were in remission. Of the remaining 19 patients who were BRCA1/2 deficient, 14 patients (74%) developed visceral metastases compared with six (16%) of 38 patients in the control group. The percentages of liver, lung, and splenic metastases were 53%, 32%, and 32%, respectively, in the patients compared with 5%, 3%, and 5%, respectively, in the controls. When events occurring outside the matched follow-up period were omitted, the percentages of visceral, liver, lung, and splenic metastases were 58%, 42%, 16%, and 32% in the patients compared with 5%, 0%, 0%, and 3% in controls (P < .001, P < .001, P = .066, and P = .011, respectively). In an independent validation set, the corresponding percentages of visceral, liver, lung, and splenic metastases were 63%, 46%, 13%, and 17% in the patients compared with 11%, 4%, 2%, and 2% in controls (P < .001, P < .001, P = .153, and P = .052, respectively). Conclusion Although sporadic EOC commonly remains confined to the peritoneum, BRCA1/2-deficient ovarian cancer frequently metastasizes to viscera. These data extend the ovarian BRCAness phenotype, imply BRCA1/2-deficient ovarian cancer is biologically distinct, and suggest that patients with visceral metastases should be considered for BRCA1/2 sequencing.
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Affiliation(s)
- Charlie Gourley
- From the University of Edinburgh Cancer Research Centre, Institute of Genetics and Molecular Medicine, Western General Hospital, Edinburgh; Cancer Research United Kingdom Clinical Trials Unit, Beatson West of Scotland Cancer Centre Level 0, Glasgow; ANCHOR Unit and University of Aberdeen, Aberdeen Royal Infirmary, Foresterhill, Aberdeen; Cancer Medicine Research Programme, Section of Translational Medical Sciences, School of Medicine and Dentistry, University of Aberdeen, Foresterhill, Aberdeen,
| | - Caroline O. Michie
- From the University of Edinburgh Cancer Research Centre, Institute of Genetics and Molecular Medicine, Western General Hospital, Edinburgh; Cancer Research United Kingdom Clinical Trials Unit, Beatson West of Scotland Cancer Centre Level 0, Glasgow; ANCHOR Unit and University of Aberdeen, Aberdeen Royal Infirmary, Foresterhill, Aberdeen; Cancer Medicine Research Programme, Section of Translational Medical Sciences, School of Medicine and Dentistry, University of Aberdeen, Foresterhill, Aberdeen,
| | - Patricia Roxburgh
- From the University of Edinburgh Cancer Research Centre, Institute of Genetics and Molecular Medicine, Western General Hospital, Edinburgh; Cancer Research United Kingdom Clinical Trials Unit, Beatson West of Scotland Cancer Centre Level 0, Glasgow; ANCHOR Unit and University of Aberdeen, Aberdeen Royal Infirmary, Foresterhill, Aberdeen; Cancer Medicine Research Programme, Section of Translational Medical Sciences, School of Medicine and Dentistry, University of Aberdeen, Foresterhill, Aberdeen,
| | - Timothy A. Yap
- From the University of Edinburgh Cancer Research Centre, Institute of Genetics and Molecular Medicine, Western General Hospital, Edinburgh; Cancer Research United Kingdom Clinical Trials Unit, Beatson West of Scotland Cancer Centre Level 0, Glasgow; ANCHOR Unit and University of Aberdeen, Aberdeen Royal Infirmary, Foresterhill, Aberdeen; Cancer Medicine Research Programme, Section of Translational Medical Sciences, School of Medicine and Dentistry, University of Aberdeen, Foresterhill, Aberdeen,
| | - Sharon Harden
- From the University of Edinburgh Cancer Research Centre, Institute of Genetics and Molecular Medicine, Western General Hospital, Edinburgh; Cancer Research United Kingdom Clinical Trials Unit, Beatson West of Scotland Cancer Centre Level 0, Glasgow; ANCHOR Unit and University of Aberdeen, Aberdeen Royal Infirmary, Foresterhill, Aberdeen; Cancer Medicine Research Programme, Section of Translational Medical Sciences, School of Medicine and Dentistry, University of Aberdeen, Foresterhill, Aberdeen,
| | - Jim Paul
- From the University of Edinburgh Cancer Research Centre, Institute of Genetics and Molecular Medicine, Western General Hospital, Edinburgh; Cancer Research United Kingdom Clinical Trials Unit, Beatson West of Scotland Cancer Centre Level 0, Glasgow; ANCHOR Unit and University of Aberdeen, Aberdeen Royal Infirmary, Foresterhill, Aberdeen; Cancer Medicine Research Programme, Section of Translational Medical Sciences, School of Medicine and Dentistry, University of Aberdeen, Foresterhill, Aberdeen,
| | - Kalpana Ragupathy
- From the University of Edinburgh Cancer Research Centre, Institute of Genetics and Molecular Medicine, Western General Hospital, Edinburgh; Cancer Research United Kingdom Clinical Trials Unit, Beatson West of Scotland Cancer Centre Level 0, Glasgow; ANCHOR Unit and University of Aberdeen, Aberdeen Royal Infirmary, Foresterhill, Aberdeen; Cancer Medicine Research Programme, Section of Translational Medical Sciences, School of Medicine and Dentistry, University of Aberdeen, Foresterhill, Aberdeen,
| | - Radha Todd
- From the University of Edinburgh Cancer Research Centre, Institute of Genetics and Molecular Medicine, Western General Hospital, Edinburgh; Cancer Research United Kingdom Clinical Trials Unit, Beatson West of Scotland Cancer Centre Level 0, Glasgow; ANCHOR Unit and University of Aberdeen, Aberdeen Royal Infirmary, Foresterhill, Aberdeen; Cancer Medicine Research Programme, Section of Translational Medical Sciences, School of Medicine and Dentistry, University of Aberdeen, Foresterhill, Aberdeen,
| | - Russell Petty
- From the University of Edinburgh Cancer Research Centre, Institute of Genetics and Molecular Medicine, Western General Hospital, Edinburgh; Cancer Research United Kingdom Clinical Trials Unit, Beatson West of Scotland Cancer Centre Level 0, Glasgow; ANCHOR Unit and University of Aberdeen, Aberdeen Royal Infirmary, Foresterhill, Aberdeen; Cancer Medicine Research Programme, Section of Translational Medical Sciences, School of Medicine and Dentistry, University of Aberdeen, Foresterhill, Aberdeen,
| | - Nick Reed
- From the University of Edinburgh Cancer Research Centre, Institute of Genetics and Molecular Medicine, Western General Hospital, Edinburgh; Cancer Research United Kingdom Clinical Trials Unit, Beatson West of Scotland Cancer Centre Level 0, Glasgow; ANCHOR Unit and University of Aberdeen, Aberdeen Royal Infirmary, Foresterhill, Aberdeen; Cancer Medicine Research Programme, Section of Translational Medical Sciences, School of Medicine and Dentistry, University of Aberdeen, Foresterhill, Aberdeen,
| | - Richard L. Hayward
- From the University of Edinburgh Cancer Research Centre, Institute of Genetics and Molecular Medicine, Western General Hospital, Edinburgh; Cancer Research United Kingdom Clinical Trials Unit, Beatson West of Scotland Cancer Centre Level 0, Glasgow; ANCHOR Unit and University of Aberdeen, Aberdeen Royal Infirmary, Foresterhill, Aberdeen; Cancer Medicine Research Programme, Section of Translational Medical Sciences, School of Medicine and Dentistry, University of Aberdeen, Foresterhill, Aberdeen,
| | - Paul Mitchell
- From the University of Edinburgh Cancer Research Centre, Institute of Genetics and Molecular Medicine, Western General Hospital, Edinburgh; Cancer Research United Kingdom Clinical Trials Unit, Beatson West of Scotland Cancer Centre Level 0, Glasgow; ANCHOR Unit and University of Aberdeen, Aberdeen Royal Infirmary, Foresterhill, Aberdeen; Cancer Medicine Research Programme, Section of Translational Medical Sciences, School of Medicine and Dentistry, University of Aberdeen, Foresterhill, Aberdeen,
| | - Tzyvia Rye
- From the University of Edinburgh Cancer Research Centre, Institute of Genetics and Molecular Medicine, Western General Hospital, Edinburgh; Cancer Research United Kingdom Clinical Trials Unit, Beatson West of Scotland Cancer Centre Level 0, Glasgow; ANCHOR Unit and University of Aberdeen, Aberdeen Royal Infirmary, Foresterhill, Aberdeen; Cancer Medicine Research Programme, Section of Translational Medical Sciences, School of Medicine and Dentistry, University of Aberdeen, Foresterhill, Aberdeen,
| | - Jan H.M. Schellens
- From the University of Edinburgh Cancer Research Centre, Institute of Genetics and Molecular Medicine, Western General Hospital, Edinburgh; Cancer Research United Kingdom Clinical Trials Unit, Beatson West of Scotland Cancer Centre Level 0, Glasgow; ANCHOR Unit and University of Aberdeen, Aberdeen Royal Infirmary, Foresterhill, Aberdeen; Cancer Medicine Research Programme, Section of Translational Medical Sciences, School of Medicine and Dentistry, University of Aberdeen, Foresterhill, Aberdeen,
| | - Jan Lubinski
- From the University of Edinburgh Cancer Research Centre, Institute of Genetics and Molecular Medicine, Western General Hospital, Edinburgh; Cancer Research United Kingdom Clinical Trials Unit, Beatson West of Scotland Cancer Centre Level 0, Glasgow; ANCHOR Unit and University of Aberdeen, Aberdeen Royal Infirmary, Foresterhill, Aberdeen; Cancer Medicine Research Programme, Section of Translational Medical Sciences, School of Medicine and Dentistry, University of Aberdeen, Foresterhill, Aberdeen,
| | - James Carmichael
- From the University of Edinburgh Cancer Research Centre, Institute of Genetics and Molecular Medicine, Western General Hospital, Edinburgh; Cancer Research United Kingdom Clinical Trials Unit, Beatson West of Scotland Cancer Centre Level 0, Glasgow; ANCHOR Unit and University of Aberdeen, Aberdeen Royal Infirmary, Foresterhill, Aberdeen; Cancer Medicine Research Programme, Section of Translational Medical Sciences, School of Medicine and Dentistry, University of Aberdeen, Foresterhill, Aberdeen,
| | - Stan B. Kaye
- From the University of Edinburgh Cancer Research Centre, Institute of Genetics and Molecular Medicine, Western General Hospital, Edinburgh; Cancer Research United Kingdom Clinical Trials Unit, Beatson West of Scotland Cancer Centre Level 0, Glasgow; ANCHOR Unit and University of Aberdeen, Aberdeen Royal Infirmary, Foresterhill, Aberdeen; Cancer Medicine Research Programme, Section of Translational Medical Sciences, School of Medicine and Dentistry, University of Aberdeen, Foresterhill, Aberdeen,
| | - Melanie Mackean
- From the University of Edinburgh Cancer Research Centre, Institute of Genetics and Molecular Medicine, Western General Hospital, Edinburgh; Cancer Research United Kingdom Clinical Trials Unit, Beatson West of Scotland Cancer Centre Level 0, Glasgow; ANCHOR Unit and University of Aberdeen, Aberdeen Royal Infirmary, Foresterhill, Aberdeen; Cancer Medicine Research Programme, Section of Translational Medical Sciences, School of Medicine and Dentistry, University of Aberdeen, Foresterhill, Aberdeen,
| | - Michelle Ferguson
- From the University of Edinburgh Cancer Research Centre, Institute of Genetics and Molecular Medicine, Western General Hospital, Edinburgh; Cancer Research United Kingdom Clinical Trials Unit, Beatson West of Scotland Cancer Centre Level 0, Glasgow; ANCHOR Unit and University of Aberdeen, Aberdeen Royal Infirmary, Foresterhill, Aberdeen; Cancer Medicine Research Programme, Section of Translational Medical Sciences, School of Medicine and Dentistry, University of Aberdeen, Foresterhill, Aberdeen,
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