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Koncina E, Nurmik M, Pozdeev VI, Gilson C, Tsenkova M, Begaj R, Stang S, Gaigneaux A, Weindorfer C, Rodriguez F, Schmoetten M, Klein E, Karta J, Atanasova VS, Grzyb K, Ullmann P, Halder R, Hengstschläger M, Graas J, Augendre V, Karapetyan YE, Kerger L, Zuegel N, Skupin A, Haan S, Meiser J, Dolznig H, Letellier E. IL1R1 + cancer-associated fibroblasts drive tumor development and immunosuppression in colorectal cancer. Nat Commun 2023; 14:4251. [PMID: 37460545 DOI: 10.1038/s41467-023-39953-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 07/05/2023] [Indexed: 07/20/2023] Open
Abstract
Fibroblasts have a considerable functional and molecular heterogeneity and can play various roles in the tumor microenvironment. Here we identify a pro-tumorigenic IL1R1+, IL-1-high-signaling subtype of fibroblasts, using multiple colorectal cancer (CRC) patient single cell sequencing datasets. This subtype of fibroblasts is linked to T cell and macrophage suppression and leads to increased cancer cell growth in 3D co-culture assays. Furthermore, both a fibroblast-specific IL1R1 knockout and IL-1 receptor antagonist Anakinra administration reduce tumor growth in vivo. This is accompanied by reduced intratumoral Th17 cell infiltration. Accordingly, CRC patients who present with IL1R1-expressing cancer-associated-fibroblasts (CAFs), also display elevated levels of immune exhaustion markers, as well as an increased Th17 score and an overall worse survival. Altogether, this study underlines the therapeutic value of targeting IL1R1-expressing CAFs in the context of CRC.
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Affiliation(s)
- E Koncina
- Molecular Disease Mechanisms Group, Department of Life Sciences and Medicine, University of Luxembourg, Belval, Luxembourg
| | - M Nurmik
- Molecular Disease Mechanisms Group, Department of Life Sciences and Medicine, University of Luxembourg, Belval, Luxembourg
| | - V I Pozdeev
- Molecular Disease Mechanisms Group, Department of Life Sciences and Medicine, University of Luxembourg, Belval, Luxembourg
| | - C Gilson
- Molecular Disease Mechanisms Group, Department of Life Sciences and Medicine, University of Luxembourg, Belval, Luxembourg
| | - M Tsenkova
- Molecular Disease Mechanisms Group, Department of Life Sciences and Medicine, University of Luxembourg, Belval, Luxembourg
| | - R Begaj
- Molecular Disease Mechanisms Group, Department of Life Sciences and Medicine, University of Luxembourg, Belval, Luxembourg
| | - S Stang
- Center for Pathobiochemistry and Genetics, Institute of Medical Genetics, Medical University of Vienna, Vienna, Austria
| | - A Gaigneaux
- Molecular Disease Mechanisms Group, Department of Life Sciences and Medicine, University of Luxembourg, Belval, Luxembourg
| | - C Weindorfer
- Center for Pathobiochemistry and Genetics, Institute of Medical Genetics, Medical University of Vienna, Vienna, Austria
| | - F Rodriguez
- Molecular Disease Mechanisms Group, Department of Life Sciences and Medicine, University of Luxembourg, Belval, Luxembourg
| | - M Schmoetten
- Molecular Disease Mechanisms Group, Department of Life Sciences and Medicine, University of Luxembourg, Belval, Luxembourg
| | - E Klein
- Molecular Disease Mechanisms Group, Department of Life Sciences and Medicine, University of Luxembourg, Belval, Luxembourg
| | - J Karta
- Molecular Disease Mechanisms Group, Department of Life Sciences and Medicine, University of Luxembourg, Belval, Luxembourg
| | - V S Atanasova
- Center for Pathobiochemistry and Genetics, Institute of Medical Genetics, Medical University of Vienna, Vienna, Austria
| | - K Grzyb
- Luxembourg Centre for Systems Biomedicine, University of Luxembourg, Belval, Luxembourg
| | - P Ullmann
- Molecular Disease Mechanisms Group, Department of Life Sciences and Medicine, University of Luxembourg, Belval, Luxembourg
| | - R Halder
- Luxembourg Centre for Systems Biomedicine, University of Luxembourg, Belval, Luxembourg
| | - M Hengstschläger
- Center for Pathobiochemistry and Genetics, Institute of Medical Genetics, Medical University of Vienna, Vienna, Austria
| | - J Graas
- Clinical and Epidemiological Investigation Center, Department of Population Health, Luxembourg Institute of Health, Luxembourg, Luxembourg
| | - V Augendre
- National Center of Pathology, Laboratoire National de Santé, Dudelange, Luxembourg
| | | | - L Kerger
- Department of Surgery, Centre Hospitalier Emile Mayrisch, Esch-sur-Alzette, Luxembourg
| | - N Zuegel
- Department of Surgery, Centre Hospitalier Emile Mayrisch, Esch-sur-Alzette, Luxembourg
| | - A Skupin
- Luxembourg Centre for Systems Biomedicine, University of Luxembourg, Belval, Luxembourg
| | - S Haan
- Molecular Disease Mechanisms Group, Department of Life Sciences and Medicine, University of Luxembourg, Belval, Luxembourg
| | - J Meiser
- Cancer Metabolism Group, Department of Cancer Research, Luxembourg Institute of Health, Luxembourg, Luxembourg
| | - H Dolznig
- Center for Pathobiochemistry and Genetics, Institute of Medical Genetics, Medical University of Vienna, Vienna, Austria.
| | - E Letellier
- Molecular Disease Mechanisms Group, Department of Life Sciences and Medicine, University of Luxembourg, Belval, Luxembourg.
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Attard G, Murphy L, Clarke NW, Sachdeva A, Jones C, Hoyle A, Cross W, Jones RJ, Parker CC, Gillessen S, Cook A, Brawley C, Gilson C, Rush H, Abdel-Aty H, Amos CL, Murphy C, Chowdhury S, Malik Z, Russell JM, Parkar N, Pugh C, Diaz-Montana C, Pezaro C, Grant W, Saxby H, Pedley I, O'Sullivan JM, Birtle A, Gale J, Srihari N, Thomas C, Tanguay J, Wagstaff J, Das P, Gray E, Alzouebi M, Parikh O, Robinson A, Montazeri AH, Wylie J, Zarkar A, Cathomas R, Brown MD, Jain Y, Dearnaley DP, Mason MD, Gilbert D, Langley RE, Millman R, Matheson D, Sydes MR, Brown LC, Parmar MKB, James ND. Abiraterone acetate plus prednisolone with or without enzalutamide for patients with metastatic prostate cancer starting androgen deprivation therapy: final results from two randomised phase 3 trials of the STAMPEDE platform protocol. Lancet Oncol 2023; 24:443-456. [PMID: 37142371 DOI: 10.1016/s1470-2045(23)00148-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 03/17/2023] [Accepted: 03/23/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND Abiraterone acetate plus prednisolone (herein referred to as abiraterone) or enzalutamide added at the start of androgen deprivation therapy improves outcomes for patients with metastatic prostate cancer. Here, we aimed to evaluate long-term outcomes and test whether combining enzalutamide with abiraterone and androgen deprivation therapy improves survival. METHODS We analysed two open-label, randomised, controlled, phase 3 trials of the STAMPEDE platform protocol, with no overlapping controls, conducted at 117 sites in the UK and Switzerland. Eligible patients (no age restriction) had metastatic, histologically-confirmed prostate adenocarcinoma; a WHO performance status of 0-2; and adequate haematological, renal, and liver function. Patients were randomly assigned (1:1) using a computerised algorithm and a minimisation technique to either standard of care (androgen deprivation therapy; docetaxel 75 mg/m2 intravenously for six cycles with prednisolone 10 mg orally once per day allowed from Dec 17, 2015) or standard of care plus abiraterone acetate 1000 mg and prednisolone 5 mg (in the abiraterone trial) orally or abiraterone acetate and prednisolone plus enzalutamide 160 mg orally once a day (in the abiraterone and enzalutamide trial). Patients were stratified by centre, age, WHO performance status, type of androgen deprivation therapy, use of aspirin or non-steroidal anti-inflammatory drugs, pelvic nodal status, planned radiotherapy, and planned docetaxel use. The primary outcome was overall survival assessed in the intention-to-treat population. Safety was assessed in all patients who started treatment. A fixed-effects meta-analysis of individual patient data was used to compare differences in survival between the two trials. STAMPEDE is registered with ClinicalTrials.gov (NCT00268476) and ISRCTN (ISRCTN78818544). FINDINGS Between Nov 15, 2011, and Jan 17, 2014, 1003 patients were randomly assigned to standard of care (n=502) or standard of care plus abiraterone (n=501) in the abiraterone trial. Between July 29, 2014, and March 31, 2016, 916 patients were randomly assigned to standard of care (n=454) or standard of care plus abiraterone and enzalutamide (n=462) in the abiraterone and enzalutamide trial. Median follow-up was 96 months (IQR 86-107) in the abiraterone trial and 72 months (61-74) in the abiraterone and enzalutamide trial. In the abiraterone trial, median overall survival was 76·6 months (95% CI 67·8-86·9) in the abiraterone group versus 45·7 months (41·6-52·0) in the standard of care group (hazard ratio [HR] 0·62 [95% CI 0·53-0·73]; p<0·0001). In the abiraterone and enzalutamide trial, median overall survival was 73·1 months (61·9-81·3) in the abiraterone and enzalutamide group versus 51·8 months (45·3-59·0) in the standard of care group (HR 0·65 [0·55-0·77]; p<0·0001). We found no difference in the treatment effect between these two trials (interaction HR 1·05 [0·83-1·32]; pinteraction=0·71) or between-trial heterogeneity (I2 p=0·70). In the first 5 years of treatment, grade 3-5 toxic effects were higher when abiraterone was added to standard of care (271 [54%] of 498 vs 192 [38%] of 502 with standard of care) and the highest toxic effects were seen when abiraterone and enzalutamide were added to standard of care (302 [68%] of 445 vs 204 [45%] of 454 with standard of care). Cardiac causes were the most common cause of death due to adverse events (five [1%] with standard of care plus abiraterone and enzalutamide [two attributed to treatment] and one (<1%) with standard of care in the abiraterone trial). INTERPRETATION Enzalutamide and abiraterone should not be combined for patients with prostate cancer starting long-term androgen deprivation therapy. Clinically important improvements in survival from addition of abiraterone to androgen deprivation therapy are maintained for longer than 7 years. FUNDING Cancer Research UK, UK Medical Research Council, Swiss Group for Clinical Cancer Research, Janssen, and Astellas.
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Affiliation(s)
- Gerhardt Attard
- Cancer Institute, University College London, London, UK; University College London Hospitals, London, UK.
| | - Laura Murphy
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - Noel W Clarke
- Christie and Salford Royal NHS Foundation Trusts, Manchester, UK
| | - Ashwin Sachdeva
- Christie and Salford Royal NHS Foundation Trusts, Manchester, UK
| | - Craig Jones
- Christie and Salford Royal NHS Foundation Trusts, Manchester, UK
| | - Alex Hoyle
- Christie and Salford Royal NHS Foundation Trusts, Manchester, UK
| | | | - Robert J Jones
- Beatson West of Scotland Cancer Centre, University of Glasgow, Glasgow, UK
| | | | - Silke Gillessen
- Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; CH and Universita della Svizzera Italiana, Lugano, Switzerland
| | - Adrian Cook
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - Chris Brawley
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - Clare Gilson
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - Hannah Rush
- Medical Research Council Clinical Trials Unit, University College London, London, UK; Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Hoda Abdel-Aty
- Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London, UK
| | - Claire L Amos
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - Claire Murphy
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | | | - Zafar Malik
- Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, UK
| | - J Martin Russell
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Nazia Parkar
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - Cheryl Pugh
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - Carlos Diaz-Montana
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | | | | | - Helen Saxby
- Torbay and South Devon NHS Foundation Trust, Torbay, UK
| | - Ian Pedley
- Northern Centre for Cancer Care, Newcastle upon Tyne, UK
| | | | - Alison Birtle
- Rosemere Cancer Centre, Royal Preston Hospital, Preston, UK
| | | | | | | | | | | | | | - Emma Gray
- Yeovil District Hospital NHS Foundation Trust, Yeovil, UK
| | | | - Omi Parikh
- East Lancashire Hospitals NHS Trust, Preston, UK
| | | | | | - James Wylie
- Christie and Salford Royal NHS Foundation Trusts, Manchester, UK
| | - Anjali Zarkar
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Richard Cathomas
- Division of Oncology and Hematology, Cantonal Hospital Graubünden, Chur, Switzerland; Swiss Group for Clinical Cancer Research, Bern, Switzerland
| | - Michael D Brown
- Christie and Salford Royal NHS Foundation Trusts, Manchester, UK
| | - Yatin Jain
- Christie and Salford Royal NHS Foundation Trusts, Manchester, UK
| | - David P Dearnaley
- Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London, UK
| | | | - Duncan Gilbert
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - Ruth E Langley
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - Robin Millman
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - David Matheson
- Faculty of Education Health and Wellbeing, University of Wolverhampton, Walsall, UK
| | - Matthew R Sydes
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - Louise C Brown
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - Mahesh K B Parmar
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - Nicholas D James
- Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London, UK
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James ND, Clarke NW, Cook A, Ali A, Hoyle AP, Attard G, Brawley CD, Chowdhury S, Cross WR, Dearnaley DP, de Bono JS, Diaz‐Montana C, Gilbert D, Gillessen S, Gilson C, Jones RJ, Langley RE, Malik ZI, Matheson DJ, Millman R, Parker CC, Pugh C, Rush H, Russell JM, Berthold DR, Buckner ML, Mason MD, Ritchie AWS, Birtle AJ, Brock SJ, Das P, Ford D, Gale J, Grant W, Gray EK, Hoskin P, Khan MM, Manetta C, McPhail NJ, O'Sullivan JM, Parikh O, Perna C, Pezaro CJ, Protheroe AS, Robinson AJ, Rudman SM, Sheehan DJ, Srihari NN, Syndikus I, Tanguay JS, Thomas CW, Vengalil S, Wagstaff J, Wylie JP, Parmar MKB, Sydes MR. Abiraterone acetate plus prednisolone for metastatic patients starting hormone therapy: 5-year follow-up results from the STAMPEDE randomised trial (NCT00268476). Int J Cancer 2022; 151:422-434. [PMID: 35411939 PMCID: PMC9321995 DOI: 10.1002/ijc.34018] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [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: 12/10/2021] [Revised: 02/15/2022] [Accepted: 02/22/2022] [Indexed: 11/17/2022]
Abstract
Abiraterone acetate plus prednisolone (AAP) previously demonstrated improved survival in STAMPEDE, a multiarm, multistage platform trial in men starting long-term hormone therapy for prostate cancer. This long-term analysis in metastatic patients was planned for 3 years after the first results. Standard-of-care (SOC) was androgen deprivation therapy. The comparison randomised patients 1:1 to SOC-alone with or without daily abiraterone acetate 1000 mg + prednisolone 5 mg (SOC + AAP), continued until disease progression. The primary outcome measure was overall survival. Metastatic disease risk group was classified retrospectively using baseline CT and bone scans by central radiological review and pathology reports. Analyses used Cox proportional hazards and flexible parametric models, accounting for baseline stratification factors. One thousand and three patients were contemporaneously randomised (November 2011 to January 2014): median age 67 years; 94% newly-diagnosed; metastatic disease risk group: 48% high, 44% low, 8% unassessable; median PSA 97 ng/mL. At 6.1 years median follow-up, 329 SOC-alone deaths (118 low-risk, 178 high-risk) and 244 SOC + AAP deaths (75 low-risk, 145 high-risk) were reported. Adjusted HR = 0.60 (95% CI: 0.50-0.71; P = 0.31 × 10-9 ) favoured SOC + AAP, with 5-years survival improved from 41% SOC-alone to 60% SOC + AAP. This was similar in low-risk (HR = 0.55; 95% CI: 0.41-0.76) and high-risk (HR = 0.54; 95% CI: 0.43-0.69) patients. Median and current maximum time on SOC + AAP was 2.4 and 8.1 years. Toxicity at 4 years postrandomisation was similar, with 16% patients in each group reporting grade 3 or higher toxicity. A sustained and substantial improvement in overall survival of all metastatic prostate cancer patients was achieved with SOC + abiraterone acetate + prednisolone, irrespective of metastatic disease risk group.
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Affiliation(s)
| | - Noel W. Clarke
- The Departments of Surgery & UrologyThe Christie & Salford Royal HospitalsManchesterUK
| | - Adrian Cook
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, UCLLondonUK
| | - Adnan Ali
- The Christie NHS Foundation TrustManchesterUK
| | | | | | - Christopher D. Brawley
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, UCLLondonUK
| | - Simon Chowdhury
- Guy's, King's, & St. Thomas' Hospitals, and Sarah Cannon Research InstituteLondonUK
| | | | - David P. Dearnaley
- The Institute of Cancer Research and Royal Marsden NHS Foundation TrustLondonUK
| | | | - Carlos Diaz‐Montana
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, UCLLondonUK
| | - Duncan Gilbert
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, UCLLondonUK
| | - Silke Gillessen
- Istituto Oncologico della Svizzera ItalianaBellinzonaSwitzerland
| | - Clare Gilson
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, UCLLondonUK
- Royal Marsden HospitalLondonUK
| | - Rob J. Jones
- Beatson West of Scotland Cancer Centre, University of GlasgowGlasgowUK
| | - Ruth E. Langley
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, UCLLondonUK
| | - Zafar I. Malik
- Radiotherapy UnitThe Clatterbridge Cancer Centre NHS Foundation TrustLiverpoolLiverpoolL7 8YAUK
| | - David J. Matheson
- School of Allied Health and Midwifery, Faculty of Education, Health and WellbeingUniversity of WolverhamptonWolverhamptonWS1 3BDUK
| | | | - Chris C. Parker
- Uro‐Oncology UnitRoyal Marsden Hospital and Institute of Cancer ResearchSuttonUK
| | - Cheryl Pugh
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, UCLLondonUK
| | - Hannah Rush
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, UCLLondonUK
- Guys and St Thomas' NHS Foundation TrustLondonUK
| | - J. Martin Russell
- Institute of Cancer Sciences, University of GlasgowGlasgowUK
- Beatson West of Scotland Cancer CentreGlasgowUK
| | | | - Michelle L. Buckner
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, UCLLondonUK
| | | | | | - Alison J. Birtle
- Rosemere Cancer Centre, Lancashire Teaching Hospitals & University of Manchester, University of Central LancashireLancashireUK
| | | | - Prantik Das
- Department of OncologyUniversity Hospitals of Derby and Burton NHS Foundation TrustDerbyUK
| | - Dan Ford
- City Hospital, Cancer Centre at Queen Elizabeth HospitalBirminghamUK
| | - Joanna Gale
- Portsmouth Hospitals University TrustPortsmouthUK
| | - Warren Grant
- Gloucestershire Oncology Centre, Cheltenham General HospitalCheltenhamUK
| | | | | | - Mohammad M. Khan
- Department of Oncology Castle Hill HospitalHullUK
- Scarborough General HospitalScarboroughUK
| | | | | | - Joe M. O'Sullivan
- Patrick G Johnston Centre for Cancer Research, Queen's University BelfastBelfastUK
| | - Omi Parikh
- Rosemere Cancer Centre, Lancashire Teaching Hospitals NHS TrustPrestonUK
| | - Carla Perna
- Royal Surrey NHS Foundation TrustGuildfordUK
| | | | | | | | | | | | | | - Isabel Syndikus
- Radiotherapy UnitThe Clatterbridge Cancer Centre NHS Foundation TrustLiverpoolLiverpoolL7 8YAUK
| | | | | | - Salil Vengalil
- University Hospital North Midlands NHS TrustStaffordshireUK
| | - John Wagstaff
- Swansea University and the South West UK Cancer CentreSwanseaUK
| | | | - Mahesh K. B. Parmar
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, UCLLondonUK
| | - Matthew R. Sydes
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, UCLLondonUK
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Attard G, Murphy L, Clarke NW, Cross W, Jones RJ, Parker CC, Gillessen S, Cook A, Brawley C, Amos CL, Atako N, Pugh C, Buckner M, Chowdhury S, Malik Z, Russell JM, Gilson C, Rush H, Bowen J, Lydon A, Pedley I, O'Sullivan JM, Birtle A, Gale J, Srihari N, Thomas C, Tanguay J, Wagstaff J, Das P, Gray E, Alzoueb M, Parikh O, Robinson A, Syndikus I, Wylie J, Zarkar A, Thalmann G, de Bono JS, Dearnaley DP, Mason MD, Gilbert D, Langley RE, Millman R, Matheson D, Sydes MR, Brown LC, Parmar MKB, James ND. Abiraterone acetate and prednisolone with or without enzalutamide for high-risk non-metastatic prostate cancer: a meta-analysis of primary results from two randomised controlled phase 3 trials of the STAMPEDE platform protocol. Lancet 2022; 399:447-460. [PMID: 34953525 PMCID: PMC8811484 DOI: 10.1016/s0140-6736(21)02437-5] [Citation(s) in RCA: 157] [Impact Index Per Article: 78.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 11/02/2021] [Accepted: 11/03/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND Men with high-risk non-metastatic prostate cancer are treated with androgen-deprivation therapy (ADT) for 3 years, often combined with radiotherapy. We analysed new data from two randomised controlled phase 3 trials done in a multiarm, multistage platform protocol to assess the efficacy of adding abiraterone and prednisolone alone or with enzalutamide to ADT in this patient population. METHODS These open-label, phase 3 trials were done at 113 sites in the UK and Switzerland. Eligible patients (no age restrictions) had high-risk (defined as node positive or, if node negative, having at least two of the following: tumour stage T3 or T4, Gleason sum score of 8-10, and prostate-specific antigen [PSA] concentration ≥40 ng/mL) or relapsing with high-risk features (≤12 months of total ADT with an interval of ≥12 months without treatment and PSA concentration ≥4 ng/mL with a doubling time of <6 months, or a PSA concentration ≥20 ng/mL, or nodal relapse) non-metastatic prostate cancer, and a WHO performance status of 0-2. Local radiotherapy (as per local guidelines, 74 Gy in 37 fractions to the prostate and seminal vesicles or the equivalent using hypofractionated schedules) was mandated for node negative and encouraged for node positive disease. In both trials, patients were randomly assigned (1:1), by use of a computerised algorithm, to ADT alone (control group), which could include surgery and luteinising-hormone-releasing hormone agonists and antagonists, or with oral abiraterone acetate (1000 mg daily) and oral prednisolone (5 mg daily; combination-therapy group). In the second trial with no overlapping controls, the combination-therapy group also received enzalutamide (160 mg daily orally). ADT was given for 3 years and combination therapy for 2 years, except if local radiotherapy was omitted when treatment could be delivered until progression. In this primary analysis, we used meta-analysis methods to pool events from both trials. The primary endpoint of this meta-analysis was metastasis-free survival. Secondary endpoints were overall survival, prostate cancer-specific survival, biochemical failure-free survival, progression-free survival, and toxicity and adverse events. For 90% power and a one-sided type 1 error rate set to 1·25% to detect a target hazard ratio for improvement in metastasis-free survival of 0·75, approximately 315 metastasis-free survival events in the control groups was required. Efficacy was assessed in the intention-to-treat population and safety according to the treatment started within randomised allocation. STAMPEDE is registered with ClinicalTrials.gov, NCT00268476, and with the ISRCTN registry, ISRCTN78818544. FINDINGS Between Nov 15, 2011, and March 31, 2016, 1974 patients were randomly assigned to treatment. The first trial allocated 455 to the control group and 459 to combination therapy, and the second trial, which included enzalutamide, allocated 533 to the control group and 527 to combination therapy. Median age across all groups was 68 years (IQR 63-73) and median PSA 34 ng/ml (14·7-47); 774 (39%) of 1974 patients were node positive, and 1684 (85%) were planned to receive radiotherapy. With median follow-up of 72 months (60-84), there were 180 metastasis-free survival events in the combination-therapy groups and 306 in the control groups. Metastasis-free survival was significantly longer in the combination-therapy groups (median not reached, IQR not evaluable [NE]-NE) than in the control groups (not reached, 97-NE; hazard ratio [HR] 0·53, 95% CI 0·44-0·64, p<0·0001). 6-year metastasis-free survival was 82% (95% CI 79-85) in the combination-therapy group and 69% (66-72) in the control group. There was no evidence of a difference in metatasis-free survival when enzalutamide and abiraterone acetate were administered concurrently compared with abiraterone acetate alone (interaction HR 1·02, 0·70-1·50, p=0·91) and no evidence of between-trial heterogeneity (I2 p=0·90). Overall survival (median not reached [IQR NE-NE] in the combination-therapy groups vs not reached [103-NE] in the control groups; HR 0·60, 95% CI 0·48-0·73, p<0·0001), prostate cancer-specific survival (not reached [NE-NE] vs not reached [NE-NE]; 0·49, 0·37-0·65, p<0·0001), biochemical failure-free-survival (not reached [NE-NE] vs 86 months [83-NE]; 0·39, 0·33-0·47, p<0·0001), and progression-free-survival (not reached [NE-NE] vs not reached [103-NE]; 0·44, 0·36-0·54, p<0·0001) were also significantly longer in the combination-therapy groups than in the control groups. Adverse events grade 3 or higher during the first 24 months were, respectively, reported in 169 (37%) of 451 patients and 130 (29%) of 455 patients in the combination-therapy and control groups of the abiraterone trial, respectively, and 298 (58%) of 513 patients and 172 (32%) of 533 patients of the combination-therapy and control groups of the abiraterone and enzalutamide trial, respectively. The two most common events more frequent in the combination-therapy groups were hypertension (abiraterone trial: 23 (5%) in the combination-therapy group and six (1%) in control group; abiraterone and enzalutamide trial: 73 (14%) and eight (2%), respectively) and alanine transaminitis (abiraterone trial: 25 (6%) in the combination-therapy group and one (<1%) in control group; abiraterone and enzalutamide trial: 69 (13%) and four (1%), respectively). Seven grade 5 adverse events were reported: none in the control groups, three in the abiraterone acetate and prednisolone group (one event each of rectal adenocarcinoma, pulmonary haemorrhage, and a respiratory disorder), and four in the abiraterone acetate and prednisolone with enzalutamide group (two events each of septic shock and sudden death). INTERPRETATION Among men with high-risk non-metastatic prostate cancer, combination therapy is associated with significantly higher rates of metastasis-free survival compared with ADT alone. Abiraterone acetate with prednisolone should be considered a new standard treatment for this population. FUNDING Cancer Research UK, UK Medical Research Council, Swiss Group for Clinical Cancer Research, Janssen, and Astellas.
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Affiliation(s)
- Gerhardt Attard
- Cancer Institute, University College London, London, UK; University College London Hospitals, London, UK.
| | - Laura Murphy
- MRC Clinical Trials Unit at University College London, London, UK
| | - Noel W Clarke
- The Christie and Salford Royal NHS Foundation Trusts, Manchester, UK
| | | | | | | | - Silke Gillessen
- Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Universita della Svizzera Italiana, Lugano, Switzerland
| | - Adrian Cook
- MRC Clinical Trials Unit at University College London, London, UK
| | - Chris Brawley
- MRC Clinical Trials Unit at University College London, London, UK
| | - Claire L Amos
- MRC Clinical Trials Unit at University College London, London, UK
| | - Nafisah Atako
- MRC Clinical Trials Unit at University College London, London, UK
| | - Cheryl Pugh
- MRC Clinical Trials Unit at University College London, London, UK
| | - Michelle Buckner
- MRC Clinical Trials Unit at University College London, London, UK
| | | | - Zafar Malik
- Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, UK
| | | | - Clare Gilson
- MRC Clinical Trials Unit at University College London, London, UK
| | - Hannah Rush
- MRC Clinical Trials Unit at University College London, London, UK
| | - Jo Bowen
- Cheltenham General Hospital, Cheltenham, UK
| | - Anna Lydon
- Torbay and South Devon NHS Foundation Trust, Torbay, UK
| | - Ian Pedley
- Northern Centre for Cancer Care, Newcastle upon Tyne, UK
| | | | | | | | | | | | | | | | | | - Emma Gray
- Yeovil District Hospital NHS Foundation Trust, Yeovil, UK; Musgrove Park Hospital, Taunton, UK
| | | | - Omi Parikh
- Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | | | - Isabel Syndikus
- Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, UK
| | - James Wylie
- The Christie and Salford Royal NHS Foundation Trusts, Manchester, UK
| | - Anjali Zarkar
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Johann S de Bono
- Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London, UK
| | - David P Dearnaley
- Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London, UK
| | | | - Duncan Gilbert
- MRC Clinical Trials Unit at University College London, London, UK
| | - Ruth E Langley
- MRC Clinical Trials Unit at University College London, London, UK
| | - Robin Millman
- MRC Clinical Trials Unit at University College London, London, UK
| | - David Matheson
- Faculty of Education Health and Wellbeing, University of Wolverhampton, Walsall, UK
| | - Matthew R Sydes
- MRC Clinical Trials Unit at University College London, London, UK
| | - Louise C Brown
- MRC Clinical Trials Unit at University College London, London, UK
| | | | - Nicholas D James
- Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London, UK
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Gilson C, Ingleby F, Gilbert DC, Parry MA, Atako NB, Ali A, Hoyle A, Clarke NW, Gannon M, Wanstall C, Brawley C, Mason MD, Malik Z, Simmons A, Loehr A, Parry-Jones A, Eeles R, Kote-Jarai Z, James ND, Amos C, Parmar MKB, Langley RE, Sydes MR, Attard G, Chowdhury S. Genomic Profiles of De Novo High- and Low-Volume Metastatic Prostate Cancer: Results From a 2-Stage Feasibility and Prevalence Study in the STAMPEDE Trial. JCO Precis Oncol 2020; 4:882-897. [PMID: 35050761 DOI: 10.1200/po.19.00388] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2020] [Indexed: 02/11/2024] Open
Abstract
PURPOSE The STAMPEDE trial recruits men with newly diagnosed, high-risk, hormone-sensitive prostate cancer. To ascertain the feasibility of targeted next-generation sequencing (tNGS) and the prevalence of baseline genomic aberrations, we sequenced tumor and germline DNA from patients with metastatic prostate cancer (mPCa) starting long-term androgen-deprivation therapy (ADT). METHODS In a 2-stage approach, archival, formalin-fixed, paraffin-embedded (FFPE) prostate tumor core biopsy samples were retrospectively subjected to 2 tNGS assays. Prospective enrollment enabled validation using tNGS in tumor and germline DNA. RESULTS In stage 1, tNGS data were obtained from 185 tumors from 287 patients (65%); 98% had de novo mPCa. We observed PI3K pathway aberrations in 43%, due to PTEN copy-number loss (34%) and/or activating mutations in PIK3 genes or AKT (18%) and TP53 mutation or loss in 33%. No androgen receptor (AR) aberrations were detected; RB1 loss was observed in < 1%. In stage 2, 93 (92%) of 101 FFPE tumors (biopsy obtained within 8 months) were successfully sequenced prospectively. The prevalence of DNA damage repair (DDR) deficiency was 14% (somatic) and 5% (germline). BRCA2 mutations and mismatch repair gene mutations were exclusive to high-volume disease. Aberrant DDR (22% v 15%), Wnt pathway (16% v 4%), and chromatin remodeling (16% v 8%) were all more common in high-volume compared with low-volume disease, but the small numbers limited statistical comparisons. CONCLUSION Prospective genomic characterization is feasible using residual diagnostic tumor samples and reveals that the genomic landscapes of de novo high-volume mPCa and advanced metastatic prostate cancer have notable similarities (PI3K pathway, DDR, Wnt, chromatin remodeling) and differences (AR, RB1). These results will inform the design and conduct of biomarker-directed trials in men with metastatic hormone-sensitive prostate cancer.
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Affiliation(s)
- Clare Gilson
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, United Kingdom
| | - Fiona Ingleby
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, United Kingdom
| | - Duncan C Gilbert
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, United Kingdom
| | - Marina A Parry
- University College London Cancer Institute, London, United Kingdom
| | - Nafisah B Atako
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, United Kingdom
| | - Adnan Ali
- GU Research and FASTMAN groups, Manchester Cancer Institute, University of Manchester, Manchester, United Kingdom
| | - Alex Hoyle
- GU Research and FASTMAN groups, Manchester Cancer Institute, University of Manchester, Manchester, United Kingdom
- Department of Surgery, The Christie NHS Foundation Trust, Manchester and Salford Royal NHS Foundation Trusts, Manchester, United Kingdom
| | - Noel W Clarke
- GU Research and FASTMAN groups, Manchester Cancer Institute, University of Manchester, Manchester, United Kingdom
- Department of Surgery, The Christie NHS Foundation Trust, Manchester and Salford Royal NHS Foundation Trusts, Manchester, United Kingdom
| | - Melissa Gannon
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, United Kingdom
| | - Chris Wanstall
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, United Kingdom
| | - Christopher Brawley
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, United Kingdom
| | | | - Zafar Malik
- Clatterbridge Cancer Centre, Liverpool, United Kingdom
| | | | | | | | - Rosalind Eeles
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
- Institute of Cancer Research, London, United Kingdom
| | | | | | - Claire Amos
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, United Kingdom
| | - Mahesh K B Parmar
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, United Kingdom
| | - Ruth E Langley
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, United Kingdom
| | - Matthew R Sydes
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, United Kingdom
| | - Gerhardt Attard
- University College London Cancer Institute, London, United Kingdom
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6
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Gilson C, Sharp T, Jenkins C, Barker K. The effectiveness of hip strengthening exercises in the management of patellofemoral pain syndrome (PFPS) in females: a systematic review. Physiotherapy 2020. [DOI: 10.1016/j.physio.2020.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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7
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Hoyle AP, Ali A, James ND, Cook A, Parker CC, de Bono JS, Attard G, Chowdhury S, Cross WR, Dearnaley DP, Brawley CD, Gilson C, Ingleby F, Gillessen S, Aebersold DM, Jones RJ, Matheson D, Millman R, Mason MD, Ritchie AWS, Russell M, Douis H, Parmar MKB, Sydes MR, Clarke NW. Abiraterone in "High-" and "Low-risk" Metastatic Hormone-sensitive Prostate Cancer. Eur Urol 2019; 76:719-728. [PMID: 31447077 DOI: 10.1016/j.eururo.2019.08.006] [Citation(s) in RCA: 127] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 08/07/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Abiraterone acetate received licencing for use in only "high-risk" metastatic hormone-naïve prostate cancer (mHNPC) following the LATITUDE trial findings. However, a "risk"-related effect was not seen in the STAMPEDE trial. There remains uncertainty as to whether men with LATITUDE "low-risk" M1 disease benefit from androgen deprivation therapy (ADT) combined with abiraterone acetate and prednisolone (AAP). OBJECTIVE Evaluation of heterogeneity of effect between LATITUDE high- and low-risk M1 prostate cancer patients receiving ADT + AAP in the STAMPEDE trial. DESIGN, SETTING, AND PARTICIPANTS A post hoc subgroup analysis of the 2017 STAMPEDE "abiraterone comparison". Staging scans for M1 patients contemporaneously randomised to ADT or ADT + AAP within the STAMPEDE trial were evaluated centrally and blind to treatment assignment. Stratification was by risk according to the criteria set out in the LATITUDE trial. Exploratory subgroup stratification incorporated the CHAARTED criteria. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary outcome measure was overall survival (OS) and the secondary outcome measure was failure-free survival (FFS). Further exploratory analysis evaluated clinical skeletal-related events, progression-free survival (PFS), and prostate cancer-specific death. Standard Cox-regression and Kaplan-Meier survival estimates were employed for analysis. RESULTS AND LIMITATIONS A total of 901 M1 STAMPEDE patients were evaluated after exclusions. Of the patients, 428 (48%) were identified as having a low risk and 473 (52%) a high risk. Patients receiving ADT + AAP had significantly improved OS (low-risk hazard ratio [HR]: 0.66, 95% confidence interval or CI [0.44-0.98]) and FFS (low-risk HR: 0.24, 95% CI [0.17-0.33]) compared with ADT alone. Heterogeneity of effect was not seen between low- and high-risk groups for OS or FFS. For OS benefit in low risk, the number needed to treat was four times greater than that for high risk. However, this was not observed for the other measured endpoints. CONCLUSIONS Men with mHNPC gain treatment benefit from ADT + AAP irrespective of risk stratification for "risk" or "volume". PATIENT SUMMARY Coadministration of abiraterone acetate and prednisolone with androgen deprivation therapy (ADT) is associated with prolonged overall survival and disease control, compared with ADT alone, in all men with metastatic disease starting hormone therapy for the first time.
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Affiliation(s)
- Alex P Hoyle
- The Christie and Royal Salford Hospitals, Manchester, UK; Genito Urinary Cancer Research Group and the FASTMAN Centre of Excellence, Division of Cancer Sciences, The University of Manchester, Manchester, UK
| | - Adnan Ali
- The Christie and Royal Salford Hospitals, Manchester, UK
| | - Nicholas D James
- Institute of Cancer and Genomic Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - Adrian Cook
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London, UK
| | | | | | | | | | | | | | - Christopher D Brawley
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London, UK
| | - Clare Gilson
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London, UK
| | | | - Silke Gillessen
- Division of Oncology and Haematology, Kantonsspital St. Gallen, St. Gallen, Switzerland; Christie Hospital, Manchester, UK; University of Manchester, Manchester, UK; Swiss Group for Cancer Clinical Research (SAKK), Bern, Switzerland
| | | | - Rob J Jones
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK; Beatson West of Scotland Cancer Centre, University of Glasgow, Glasgow, UK
| | | | | | | | | | - Martin Russell
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK; Beatson West of Scotland Cancer Centre, University of Glasgow, Glasgow, UK
| | - Hassan Douis
- Institute of Cancer and Genomic Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - Mahesh K B Parmar
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London, UK
| | - Matthew R Sydes
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London, UK
| | - Noel W Clarke
- The Christie and Royal Salford Hospitals, Manchester, UK; Genito Urinary Cancer Research Group and the FASTMAN Centre of Excellence, Division of Cancer Sciences, The University of Manchester, Manchester, UK.
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Schiavone F, Bathia R, Letchemanan K, Masters L, Amos C, Bara A, Brown L, Gilson C, Pugh C, Atako N, Hudson F, Parmar M, Langley R, Kaplan RS, Parker C, Attard G, Clarke NW, Gillessen S, James ND, Maughan T, Sydes MR. This is a platform alteration: a trial management perspective on the operational aspects of adaptive and platform and umbrella protocols. Trials 2019; 20:264. [PMID: 31138317 PMCID: PMC6540525 DOI: 10.1186/s13063-019-3216-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 01/19/2019] [Indexed: 12/25/2022] Open
Abstract
Background There are limited research and literature on the trial management challenges encountered in running adaptive platform trials. This trial design allows both (1) the seamless addition of new research comparisons when compelling clinical and scientific research questions emerge, and (2) early stopping of accrual to individual comparisons that do not show sufficient activity without affecting other active comparisons. Adaptive platform design trials also offer many potential benefits over traditional trials, from faster time to accrual to contemporaneously recruiting multiple research comparisons, added flexibility to focus on more promising research comparisons via pre-planned interim analyses and potentially shorter time to primary results. We share here our experiences from a trial management perspective, highlighting the challenges and successes. Methods We evaluated the operational aspects of making changes to these adaptive platform trials and identified both common and trial-specific challenges. The operational steps and challenges linked to both the addition of new research comparisons and stopping recruitment following pre-planned interim analysis were considered in our evaluation. Results Specific operational challenges in these adaptive platform protocols, additional to those in traditional two-arm trials, were identified. Key lessons are presented describing some of the solutions and considerations over conducting these trials. Careful consideration on the practicality of the protocol structure (modular versus single protocol), the longevity and continuity of trial oversight committees, and having clear clinical and scientific criteria for the addition of new research comparisons were identified as some of the most common challenges. Conclusions Understanding the operational complexities associated with running adaptive platform protocols is paramount for their conduct, adaptive platform trials offer an efficient model to run randomised controlled trials and we are continuing to work to reduce further the effort required from an operational perspective. Trial registration FOCUS4: ISRCTN Registry, ISRCTN90061546. Registered on 16 October 2013. STAMPEDE: ISRCTN Registry, ISRCTN78818544. Registered on 2 February 2004.
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Affiliation(s)
- Francesca Schiavone
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, 90 High Holborn, London, WC1V 6LJ, UK. .,MRC London Hub for Trials Methodology Research, London, UK.
| | - Riya Bathia
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, 90 High Holborn, London, WC1V 6LJ, UK.,MRC London Hub for Trials Methodology Research, London, UK
| | - Krishna Letchemanan
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, 90 High Holborn, London, WC1V 6LJ, UK.,MRC London Hub for Trials Methodology Research, London, UK
| | - Lindsey Masters
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, 90 High Holborn, London, WC1V 6LJ, UK.,MRC London Hub for Trials Methodology Research, London, UK
| | - Claire Amos
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, 90 High Holborn, London, WC1V 6LJ, UK.,MRC London Hub for Trials Methodology Research, London, UK
| | - Anna Bara
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, 90 High Holborn, London, WC1V 6LJ, UK.,MRC London Hub for Trials Methodology Research, London, UK
| | - Louise Brown
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, 90 High Holborn, London, WC1V 6LJ, UK.,MRC London Hub for Trials Methodology Research, London, UK
| | - Clare Gilson
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, 90 High Holborn, London, WC1V 6LJ, UK.,MRC London Hub for Trials Methodology Research, London, UK
| | - Cheryl Pugh
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, 90 High Holborn, London, WC1V 6LJ, UK.,MRC London Hub for Trials Methodology Research, London, UK
| | - Nafisah Atako
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, 90 High Holborn, London, WC1V 6LJ, UK.,MRC London Hub for Trials Methodology Research, London, UK
| | - Fleur Hudson
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, 90 High Holborn, London, WC1V 6LJ, UK.,MRC London Hub for Trials Methodology Research, London, UK
| | - Mahesh Parmar
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, 90 High Holborn, London, WC1V 6LJ, UK.,MRC London Hub for Trials Methodology Research, London, UK
| | - Ruth Langley
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, 90 High Holborn, London, WC1V 6LJ, UK.,MRC London Hub for Trials Methodology Research, London, UK
| | - Richard S Kaplan
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, 90 High Holborn, London, WC1V 6LJ, UK.,MRC London Hub for Trials Methodology Research, London, UK
| | - Chris Parker
- Institute of Cancer Research, Sutton, UK.,Royal Marsden Hospital, Sutton, UK
| | - Gert Attard
- UCL Cancer Institute, University College London, London, UK
| | | | - Silke Gillessen
- Division of Cancer Sciences, University of Manchester and the Christie, Manchester, UK.,Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Nicholas D James
- Institute of Cancer and Genomic Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - Tim Maughan
- Cancer Research UK/MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford, UK
| | - Matthew R Sydes
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, 90 High Holborn, London, WC1V 6LJ, UK.,MRC London Hub for Trials Methodology Research, London, UK
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9
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Gilson C, Ingleby F, Gilbert DC, Parry M, Atako NB, Mason MD, Malik Z, Langley RE, Simmons A, Loehr A, Clarke N, James N, Parmar MKB, Sydes MR, Attard G, Chowdhury S. Targeted next-generation sequencing (tNGS) of metastatic castrate-sensitive prostate cancer (M1 CSPC): A pilot molecular analysis in the STAMPEDE multi-center clinical trial. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.5019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
5019 Background: The STAMPEDE trial recruits men with high risk prostate cancer commencing first line systemic therapy. In a pilot study to ascertain the feasibility of tNGS and the prevalence of common genomic aberrations, we tested a commercial clinically-accredited assay on tumor blocks and present data obtained in the largest cohort of treatment-naïve M1 CSPC to date. Methods: Archival FFPE blocks were retrieved from trial participants and a single block submitted for sequencing by a Foundation Medicine. Inc. tNGS assay that includes 395 genes. Results: We successfully obtained tNGS data on 115 (62%) of 186 patients enrolled between Nov-2011 and April-2017 at 15 UK participating centers. The median age was 70 years (IQR 44-85); 97% had de novo M1 disease and 83% Gleason score ≥8. We observed PTEN deficiency (34%) due to copy-number loss (25%) or mutation (9%); TP53 mutation or loss (33%) and aberrations in PI3K signaling (16%), genes involved in DNA repair (14%), Wnt signaling (14%) and cell cycle control (6%). In total, these aberrations were observed in 76% of patients, with 35% harboring two or more. No androgen receptor ( AR) mutations were detected. Conclusions: The prevalence of PTEN deficiency is comparable with that observed in mCRPC consistent with this being a feature of metastatic disease. In contrast, AR mutations are not observed in this treatment-naïve group. The prevalence of DNA repair deficiency is less than observed in mCRPC but more than reported in prostatectomy cohorts. Although it is possible to use FFPE biopsies for tNGS, the test failure-rate poises challenges to evaluating treatments in low prevalence biomarker-defined groups. These data will inform the design and conduct of biomarker-directed trials.
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Affiliation(s)
- Clare Gilson
- MRC Clinical Trials Unit at UCL, London, United Kingdom
| | - Fiona Ingleby
- Medical Research Council Clinical Trials Unit, London, United Kingdom
| | | | | | | | | | - Zafar Malik
- Clatterbridge Cancer Centre, Merseyside, United Kingdom
| | - Ruth E Langley
- Medical Research Council Clinical Trials Unit at University College London, London, United Kingdom
| | | | | | - Noel Clarke
- The Christie and Salford Royal NHS Foundation Trusts, Manchester, United Kingdom
| | - Nicholas James
- Institute of Cancer and Genomic Sciences University Hospitals Birmingham Edgbaston, Birmingham, United Kingdom
| | - Mahesh K B Parmar
- Medical Research Center Clinical Trials Unit at University College London, London, United Kingdom
| | - Matthew Robert Sydes
- Medical Research Center Clinical Trials Unit at University College London, London, United Kingdom
| | | | - Simon Chowdhury
- Guy’s, King’s and St. Thomas’ Hospitals, and Sarah Cannon Research Institute, London, United Kingdom
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10
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Hoyle A, Ali A, James N, Parker C, Cooke A, Attard G, Chowdhury S, Cross W, Dearnaley D, De Bono J, Gilson C, Gillessen S, Jones R, Matheson D, Mason M, Ritchie A, Russell M, Douis H, Parmer M, Sydes M, Clarke N. The role of abiraterone acetate plus prednisone/prednisolone in high- and low-risk metastatic hormone sensitive prostate cancer. ACTA ACUST UNITED AC 2019. [DOI: 10.1016/s1569-9056(19)31004-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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11
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Parker CC, James ND, Brawley CD, Clarke NW, Hoyle AP, Ali A, Ritchie AWS, Attard G, Chowdhury S, Cross W, Dearnaley DP, Gillessen S, Gilson C, Jones RJ, Langley RE, Malik ZI, Mason MD, Matheson D, Millman R, Russell JM, Thalmann GN, Amos CL, Alonzi R, Bahl A, Birtle A, Din O, Douis H, Eswar C, Gale J, Gannon MR, Jonnada S, Khaksar S, Lester JF, O'Sullivan JM, Parikh OA, Pedley ID, Pudney DM, Sheehan DJ, Srihari NN, Tran ATH, Parmar MKB, Sydes MR. Radiotherapy to the primary tumour for newly diagnosed, metastatic prostate cancer (STAMPEDE): a randomised controlled phase 3 trial. Lancet 2018; 392:2353-2366. [PMID: 30355464 PMCID: PMC6269599 DOI: 10.1016/s0140-6736(18)32486-3] [Citation(s) in RCA: 779] [Impact Index Per Article: 129.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 09/30/2018] [Accepted: 10/03/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND Based on previous findings, we hypothesised that radiotherapy to the prostate would improve overall survival in men with metastatic prostate cancer, and that the benefit would be greatest in patients with a low metastatic burden. We aimed to compare standard of care for metastatic prostate cancer, with and without radiotherapy. METHODS We did a randomised controlled phase 3 trial at 117 hospitals in Switzerland and the UK. Eligible patients had newly diagnosed metastatic prostate cancer. We randomly allocated patients open-label in a 1:1 ratio to standard of care (control group) or standard of care and radiotherapy (radiotherapy group). Randomisation was stratified by hospital, age at randomisation, nodal involvement, WHO performance status, planned androgen deprivation therapy, planned docetaxel use (from December, 2015), and regular aspirin or non-steroidal anti-inflammatory drug use. Standard of care was lifelong androgen deprivation therapy, with up-front docetaxel permitted from December, 2015. Men allocated radiotherapy received either a daily (55 Gy in 20 fractions over 4 weeks) or weekly (36 Gy in six fractions over 6 weeks) schedule that was nominated before randomisation. The primary outcome was overall survival, measured as the number of deaths; this analysis had 90% power with a one-sided α of 2·5% for a hazard ratio (HR) of 0·75. Secondary outcomes were failure-free survival, progression-free survival, metastatic progression-free survival, prostate cancer-specific survival, and symptomatic local event-free survival. Analyses used Cox proportional hazards and flexible parametric models, adjusted for stratification factors. The primary outcome analysis was by intention to treat. Two prespecified subgroup analyses tested the effects of prostate radiotherapy by baseline metastatic burden and radiotherapy schedule. This trial is registered with ClinicalTrials.gov, number NCT00268476. FINDINGS Between Jan 22, 2013, and Sept 2, 2016, 2061 men underwent randomisation, 1029 were allocated the control and 1032 radiotherapy. Allocated groups were balanced, with a median age of 68 years (IQR 63-73) and median amount of prostate-specific antigen of 97 ng/mL (33-315). 367 (18%) patients received early docetaxel. 1082 (52%) participants nominated the daily radiotherapy schedule before randomisation and 979 (48%) the weekly schedule. 819 (40%) men had a low metastatic burden, 1120 (54%) had a high metastatic burden, and the metastatic burden was unknown for 122 (6%). Radiotherapy improved failure-free survival (HR 0·76, 95% CI 0·68-0·84; p<0·0001) but not overall survival (0·92, 0·80-1·06; p=0·266). Radiotherapy was well tolerated, with 48 (5%) adverse events (Radiation Therapy Oncology Group grade 3-4) reported during radiotherapy and 37 (4%) after radiotherapy. The proportion reporting at least one severe adverse event (Common Terminology Criteria for Adverse Events grade 3 or worse) was similar by treatment group in the safety population (398 [38%] with control and 380 [39%] with radiotherapy). INTERPRETATION Radiotherapy to the prostate did not improve overall survival for unselected patients with newly diagnosed metastatic prostate cancer. FUNDING Cancer Research UK, UK Medical Research Council, Swiss Group for Clinical Cancer Research, Astellas, Clovis Oncology, Janssen, Novartis, Pfizer, and Sanofi-Aventis.
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Affiliation(s)
- Christopher C Parker
- Academic Urology Unit, Royal Marsden Hospital, London, UK; Institute of Cancer Research, London, UK.
| | - Nicholas D James
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Christopher D Brawley
- Medical Research Council (MRC) Clinical Trials Unit at University College London (UCL), London, UK
| | - Noel W Clarke
- Genito-Urinary Cancer Research Group, Department of Surgery, The Christie Hospital, Manchester, UK; Department of Urology, Salford Royal Hospitals, Manchester, UK
| | - Alex P Hoyle
- Genito-Urinary Cancer Research Group, Department of Surgery, The Christie Hospital, Manchester, UK; Department of Urology, Salford Royal Hospitals, Manchester, UK
| | - Adnan Ali
- Genito-Urinary Cancer Research Group, Department of Surgery, The Christie Hospital, Manchester, UK; The FASTMAN/Genito-Urinary Cancer Research Groups, Division of Cancer Sciences, and Belfast-Manchester Movember Centre of Excellence, Manchester Cancer Research Centre, University of Manchester, Manchester, UK
| | - Alastair W S Ritchie
- Medical Research Council (MRC) Clinical Trials Unit at University College London (UCL), London, UK
| | | | - Simon Chowdhury
- Department of Medical Oncology, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - William Cross
- Department of Urology, St James University Hospital, Leeds, UK
| | - David P Dearnaley
- Academic Urology Unit, Royal Marsden Hospital, London, UK; Institute of Cancer Research, London, UK
| | - Silke Gillessen
- Division of Cancer Sciences, University of Manchester and the Christie, Manchester, UK; Division of Oncology and Haematology, Kantonsspital, St Gallen, Switzerland
| | - Clare Gilson
- Medical Research Council (MRC) Clinical Trials Unit at University College London (UCL), London, UK
| | - Robert J Jones
- Beatson West of Scotland Cancer Centre, University of Glasgow, Glasgow, UK
| | - Ruth E Langley
- Medical Research Council (MRC) Clinical Trials Unit at University College London (UCL), London, UK
| | - Zafar I Malik
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, UK
| | - Malcolm D Mason
- Division of Cancer & Genetics, School of Medicine, Cardiff University, Cardiff, UK
| | - David Matheson
- Faculty of Education, Health and Wellbeing, University of Wolverhampton, Wolverhampton, UK
| | - Robin Millman
- Medical Research Council (MRC) Clinical Trials Unit at University College London (UCL), London, UK
| | - J Martin Russell
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - George N Thalmann
- Department of Urology, University Hospital, Inselspital, Bern, Switzerland
| | - Claire L Amos
- Medical Research Council (MRC) Clinical Trials Unit at University College London (UCL), London, UK
| | | | - Amit Bahl
- Bristol Haematology and Oncology Centre, Bristol, UK
| | - Alison Birtle
- Rosemere Cancer Centre, Lancashire Teaching Hospitals, Preston, UK; School of Cancer Sciences, University of Manchester, Manchester, UK
| | - Omar Din
- Department of Clinical Oncology, Weston Park Cancer Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Hassan Douis
- Department of Radiology, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - Chinnamani Eswar
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, UK
| | - Joanna Gale
- Portsmouth Oncology Centre, Queen Alexandra Hospital, Portsmouth, UK
| | - Melissa R Gannon
- Department of Health Services Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Sai Jonnada
- Department of Oncology, Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK
| | - Sara Khaksar
- St Luke's Cancer Centre, Royal Surrey County Hospital, Guildford, UK
| | | | - Joe M O'Sullivan
- Centre for Cancer Research and Cell Biology, Queen's University Belfast, Belfast, UK
| | - Omi A Parikh
- Department of Clinical Oncology, East Lancashire Hospitals NHS Trust, Blackburn, UK
| | - Ian D Pedley
- Northern Centre for Cancer Care, Freeman Hospital, Newcastle upon Tyne, UK
| | | | - Denise J Sheehan
- Exeter Oncology Centre, Royal Devon & Exeter Hospital, Exeter, UK
| | | | - Anna T H Tran
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Mahesh K B Parmar
- Medical Research Council (MRC) Clinical Trials Unit at University College London (UCL), London, UK
| | - Matthew R Sydes
- Medical Research Council (MRC) Clinical Trials Unit at University College London (UCL), London, UK.
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Fatania G, Gilson C, Glover A, Alsafi A, Jackson JE, Patel MC, Shovlin CL. Uptake and radiological findings of screening cerebral magnetic resonance scans in patients with hereditary haemorrhagic telangiectasia. Intractable Rare Dis Res 2018; 7:236-244. [PMID: 30560015 PMCID: PMC6290842 DOI: 10.5582/irdr.2018.01103] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Hereditary haemorrhagic telangiectasia (HHT) results in arteriovenous malformations (AVMs), most commonly in the lungs, liver and brain. Discussion of cerebral vascular malformations is an important element of patient management. The current study objectives were to examine uptake and results of screening cerebral magnetic resonance (MR) scans, excluding symptomatic patients requiring neurological investigations. The remaining non-symptomatic individuals received formal pretest counselling that differed according to family history. For the 603 patients with no neurological symptoms of concern, screening scan uptake was higher after publication of the ARUBA trial. Patients with a family history of cerebral haemorrhage were 4 to 14-fold more likely to have a screening scan than patients with no such family history. For patients without neurological symptoms suggesting cerebral AVMs, none of the 59 screening scans performed at our institution demonstrated a cerebral AVM. Four scans (6.8%) demonstrated small aneurysms. The most common abnormality was cerebral infarction (20/59, 33.9%), predominantly identified in patients with pulmonary AVMs. Of 29 pulmonary AVM patients with no previous history of clinical stroke, 16 (55.2%) had between one and five silent infarcts. For HHT patients with pulmonary AVMs, the most frequently affected sites were the cerebellum (40%) and thalamus (14.3%), and the age-adjusted odds ratio for an infarct was 21.6 (95% confidence intervals 3.7, 126), p = 0.001. We concluded that for cerebral screening programmes in HHT, the findings support informed patient choice incorporating understanding that cerebral AVMs are rare in non-symptomatic HHT patients, but that screening scans commonly detect silent cerebral infarction due to pulmonary AVMs.
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Affiliation(s)
- Gavin Fatania
- Department of Imaging, Imperial College Healthcare NHS Trust, London, UK
| | - Clare Gilson
- NHLI Cardiovascular Sciences, Imperial College London, London, UK
| | - Alan Glover
- Department of Imaging, Imperial College Healthcare NHS Trust, London, UK
| | - Ali Alsafi
- Department of Imaging, Imperial College Healthcare NHS Trust, London, UK
- VASCERN HHT European Reference Centre, Imperial College Healthcare NHS Trust, London, UK
| | - James E Jackson
- Department of Imaging, Imperial College Healthcare NHS Trust, London, UK
- VASCERN HHT European Reference Centre, Imperial College Healthcare NHS Trust, London, UK
| | - Maneesh C Patel
- Department of Imaging, Imperial College Healthcare NHS Trust, London, UK
- VASCERN HHT European Reference Centre, Imperial College Healthcare NHS Trust, London, UK
| | - Claire L. Shovlin
- NHLI Cardiovascular Sciences, Imperial College London, London, UK
- VASCERN HHT European Reference Centre, Imperial College Healthcare NHS Trust, London, UK
- Address correspondence to:Claire L. Shovlin, Professor of Practice (Clinical and Molecular Medicine), NHLI Cardiovascular Sciences, Imperial College London, Hammersmith Campus, Du Cane Road, London W12 0NN, UK. E-mail:
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13
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Grist E, Parry M, Mendes L, Santos Vidal S, Kudahetti S, Gilson C, Anjum M, Atako N, Ingleby F, James N, Clarke N, Sydes M, Parmar M, Chowdhury S, Jones R, Leung H, Eeles R, Waugh D, Berney D, Attard G. Implementing molecular characterisation of prostate cancer tissue from patients recruited to the multi-centre STAMPEDE trial: The STRATOSPHERE consortium. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy318.011] [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: 11/14/2022] Open
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14
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Sydes MR, Spears MR, Mason MD, Clarke NW, Dearnaley DP, de Bono JS, Attard G, Chowdhury S, Cross W, Gillessen S, Malik ZI, Jones R, Parker CC, Ritchie AWS, Russell JM, Millman R, Matheson D, Amos C, Gilson C, Birtle A, Brock S, Capaldi L, Chakraborti P, Choudhury A, Evans L, Ford D, Gale J, Gibbs S, Gilbert DC, Hughes R, McLaren D, Lester JF, Nikapota A, O'Sullivan J, Parikh O, Peedell C, Protheroe A, Rudman SM, Shaffer R, Sheehan D, Simms M, Srihari N, Strebel R, Sundar S, Tolan S, Tsang D, Varughese M, Wagstaff J, Parmar MKB, James ND. Adding abiraterone or docetaxel to long-term hormone therapy for prostate cancer: directly randomised data from the STAMPEDE multi-arm, multi-stage platform protocol. Ann Oncol 2018; 29:1235-1248. [PMID: 29529169 PMCID: PMC5961425 DOI: 10.1093/annonc/mdy072] [Citation(s) in RCA: 175] [Impact Index Per Article: 29.2] [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] [Indexed: 12/20/2022] Open
Abstract
Background Adding abiraterone acetate with prednisolone (AAP) or docetaxel with prednisolone (DocP) to standard-of-care (SOC) each improved survival in systemic therapy for advanced or metastatic prostate cancer: evaluation of drug efficacy: a multi-arm multi-stage platform randomised controlled protocol recruiting patients with high-risk locally advanced or metastatic PCa starting long-term androgen deprivation therapy (ADT). The protocol provides the only direct, randomised comparative data of SOC + AAP versus SOC + DocP. Method Recruitment to SOC + DocP and SOC + AAP overlapped November 2011 to March 2013. SOC was long-term ADT or, for most non-metastatic cases, ADT for ≥2 years and RT to the primary tumour. Stratified randomisation allocated pts 2 : 1 : 2 to SOC; SOC + docetaxel 75 mg/m2 3-weekly×6 + prednisolone 10 mg daily; or SOC + abiraterone acetate 1000 mg + prednisolone 5 mg daily. AAP duration depended on stage and intent to give radical RT. The primary outcome measure was death from any cause. Analyses used Cox proportional hazards and flexible parametric models, adjusted for stratification factors. This was not a formally powered comparison. A hazard ratio (HR) <1 favours SOC + AAP, and HR > 1 favours SOC + DocP. Results A total of 566 consenting patients were contemporaneously randomised: 189 SOC + DocP and 377 SOC + AAP. The patients, balanced by allocated treatment were: 342 (60%) M1; 429 (76%) Gleason 8-10; 449 (79%) WHO performance status 0; median age 66 years and median PSA 56 ng/ml. With median follow-up 4 years, 149 deaths were reported. For overall survival, HR = 1.16 (95% CI 0.82-1.65); failure-free survival HR = 0.51 (95% CI 0.39-0.67); progression-free survival HR = 0.65 (95% CI 0.48-0.88); metastasis-free survival HR = 0.77 (95% CI 0.57-1.03); prostate cancer-specific survival HR = 1.02 (0.70-1.49); and symptomatic skeletal events HR = 0.83 (95% CI 0.55-1.25). In the safety population, the proportion reporting ≥1 grade 3, 4 or 5 adverse events ever was 36%, 13% and 1% SOC + DocP, and 40%, 7% and 1% SOC + AAP; prevalence 11% at 1 and 2 years on both arms. Relapse treatment patterns varied by arm. Conclusions This direct, randomised comparative analysis of two new treatment standards for hormone-naïve prostate cancer showed no evidence of a difference in overall or prostate cancer-specific survival, nor in other important outcomes such as symptomatic skeletal events. Worst toxicity grade over entire time on trial was similar but comprised different toxicities in line with the known properties of the drugs. Trial registration Clinicaltrials.gov: NCT00268476.
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Affiliation(s)
- M R Sydes
- MRC Clinical Trials Unit at UCL, London.
| | | | | | - N W Clarke
- Christie and Royal Salford Hospital, Manchester
| | | | | | - G Attard
- UCL Cancer Institute, University College London, London
| | - S Chowdhury
- Guy's & St Thomas NHS, Foundation Trust, London
| | - W Cross
- St James University Hospital, Leeds, UK
| | - S Gillessen
- Division of Oncology and Hematology, Kantonsspital St. Gallen, St. Gallen; University of Bern, Bern; Swiss Group for Cancer Clinical Research (SAKK), Bern, Switzerland
| | - Z I Malik
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool
| | - R Jones
- Institute of Cancer Sciences, University of Glasgow, Glasgow; Beatson West of Scotland Cancer Centre, University of Glasgow, Glasgow
| | - C C Parker
- Institute of Cancer Research, Sutton; Royal Marsden Hospital, Sutton
| | | | - J M Russell
- Institute of Cancer Sciences, University of Glasgow, Glasgow; Beatson West of Scotland Cancer Centre, University of Glasgow, Glasgow
| | - R Millman
- MRC Clinical Trials Unit at UCL, London
| | - D Matheson
- Faculty of Education, Health and Wellbeing, University of Wolverhampton, Wolverhampton
| | - C Amos
- MRC Clinical Trials Unit at UCL, London
| | - C Gilson
- MRC Clinical Trials Unit at UCL, London
| | - A Birtle
- Rosemere Cancer Centre, Royal Preston Hospital, Preston
| | - S Brock
- Dorset Cancer Centre, Poole Hospital, Poole
| | - L Capaldi
- Worcestershire Acute Hospitals NHS Trust, Worcester
| | | | - A Choudhury
- Division of Cancer Sciences, University of Manchester, Manchester; Manchester Academic Health Science Centre, Manchester; Christie Hospital NHS Foundation Trust, Manchester
| | - L Evans
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield
| | - D Ford
- City Hospital, Cancer Centre at Queen Elizabeth Hospital, Birmingham
| | - J Gale
- Portsmouth Oncology Centre, Queen Alexandra Hospital, Portsmouth
| | | | - D C Gilbert
- Sussex Cancer Centre, Royal Sussex County Hospital, Brighton
| | - R Hughes
- Mount Vernon Group, Mount Vernon Hospital, Middlesex
| | | | | | | | - J O'Sullivan
- Centre for Cancer Research and Cell Biology, Queens University Belfast, Belfast; Belfast City Hospital, Belfast
| | - O Parikh
- Lancashire Teaching Hospitals NHS Trust, Preston
| | - C Peedell
- Department of Oncology & Radiotherapy, South Tees NHS Trust, Middlesbrough
| | - A Protheroe
- Oxford University Hospitals NHS Foundation Trust
| | - S M Rudman
- Guy's & St Thomas NHS, Foundation Trust, London
| | - R Shaffer
- Department of Oncology, Royal Surrey County Hospital, Guildford
| | - D Sheehan
- Royal Devon and Exeter Hospital, Exeter
| | - M Simms
- Hull & East Yorkshire Hospitals NHS Trust, Hull
| | - N Srihari
- Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury, UK
| | - R Strebel
- Kantonsspital Graubünden, Chur; Swiss Group for Cancer Clinical Research (SAKK), Bern, Switzerland
| | - S Sundar
- Department of Oncology, Nottingham, University Hospitals NHS Trust, Nottingham
| | - S Tolan
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool
| | - D Tsang
- Southend Hospital, Southend-on-Sea
| | - M Varughese
- Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust
| | - J Wagstaff
- Swansea University College of Medicine, Swansea
| | | | - N D James
- Institute of Cancer and Genomic Sciences, University of Birmingham, Edgbaston, Birmingham, UK
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Gilson C, Chowdhury S, Parmar MKB, Sydes MR. Incorporating Biomarker Stratification into STAMPEDE: an Adaptive Multi-arm, Multi-stage Trial Platform. Clin Oncol (R Coll Radiol) 2017; 29:778-786. [PMID: 29079227 PMCID: PMC5710986 DOI: 10.1016/j.clon.2017.10.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Revised: 10/03/2017] [Accepted: 10/04/2017] [Indexed: 12/13/2022]
Abstract
The treatment and outcomes for advanced prostate cancer have experienced significant progress over recent years. Importantly, the additional benefits of ‘up front’ chemotherapy (docetaxel) and abiraterone, over and above conventional androgen deprivation, have been separately demonstrated in the multi-arm, multi-stage (MAMS) STAMPEDE protocol, which continues recruitment to other questions. Alongside this, insights into the underlying molecular biology and, inevitably, the molecular heterogeneity of prostate cancer are opening the door to new therapeutic approaches. Incorporating this understanding and testing these hypotheses within STAMPEDE brings new challenges to the MAMS approach, but has the potential to further improve the outlook for this disease.
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Affiliation(s)
- C Gilson
- MRC Clinical Trials Unit at UCL, London, UK.
| | - S Chowdhury
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - M R Sydes
- MRC Clinical Trials Unit at UCL, London, UK
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16
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James N, de Bono J, Spears M, Clarke N, Mason M, Dearnaley D, Ritchie A, Russell M, Gilson C, Jones R, Gillessen S, Matheson D, Aung S, Birtle A, Chowdhury S, Gale J, Malik Z, O'Sullivan J, Parmar M, Sydes M. Adding abiraterone for patients (pts) with high-risk prostate cancer (PCa) starting long-term androgen deprivation therapy (ADT): Outcomes in non-metastatic (M0) patients from STAMPEDE (NCT00268476). Ann Oncol 2017. [DOI: 10.1093/annonc/mdx440.027] [Citation(s) in RCA: 5] [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: 11/15/2022] Open
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17
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Sydes M, Mason M, Spears M, Clarke N, Dearnaley D, Ritchie A, Russell M, Gilson C, Jones R, de Bono J, Gillessen S, Millman R, Tolan S, Wagstaff J, Chowdhury S, Lester J, Sheehan D, Gale J, Parmar M, James N. Adding abiraterone acetate plus prednisolone (AAP) or docetaxel for patients (pts) with high-risk prostate cancer (PCa) starting long-term androgen deprivation therapy (ADT): Directly randomised data from STAMPEDE (NCT00268476). Ann Oncol 2017. [DOI: 10.1093/annonc/mdx440.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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18
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James ND, de Bono JS, Spears MR, Clarke NW, Mason MD, Dearnaley DP, Ritchie AWS, Amos CL, Gilson C, Jones RJ, Matheson D, Millman R, Attard G, Chowdhury S, Cross WR, Gillessen S, Parker CC, Russell JM, Berthold DR, Brawley C, Adab F, Aung S, Birtle AJ, Bowen J, Brock S, Chakraborti P, Ferguson C, Gale J, Gray E, Hingorani M, Hoskin PJ, Lester JF, Malik ZI, McKinna F, McPhail N, Money-Kyrle J, O'Sullivan J, Parikh O, Protheroe A, Robinson A, Srihari NN, Thomas C, Wagstaff J, Wylie J, Zarkar A, Parmar MKB, Sydes MR. Abiraterone for Prostate Cancer Not Previously Treated with Hormone Therapy. N Engl J Med 2017; 377:338-351. [PMID: 28578639 PMCID: PMC5533216 DOI: 10.1056/nejmoa1702900] [Citation(s) in RCA: 1119] [Impact Index Per Article: 159.9] [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: 12/23/2022]
Abstract
BACKGROUND Abiraterone acetate plus prednisolone improves survival in men with relapsed prostate cancer. We assessed the effect of this combination in men starting long-term androgen-deprivation therapy (ADT), using a multigroup, multistage trial design. METHODS We randomly assigned patients in a 1:1 ratio to receive ADT alone or ADT plus abiraterone acetate (1000 mg daily) and prednisolone (5 mg daily) (combination therapy). Local radiotherapy was mandated for patients with node-negative, nonmetastatic disease and encouraged for those with positive nodes. For patients with nonmetastatic disease with no radiotherapy planned and for patients with metastatic disease, treatment continued until radiologic, clinical, or prostate-specific antigen (PSA) progression; otherwise, treatment was to continue for 2 years or until any type of progression, whichever came first. The primary outcome measure was overall survival. The intermediate primary outcome was failure-free survival (treatment failure was defined as radiologic, clinical, or PSA progression or death from prostate cancer). RESULTS A total of 1917 patients underwent randomization from November 2011 through January 2014. The median age was 67 years, and the median PSA level was 53 ng per milliliter. A total of 52% of the patients had metastatic disease, 20% had node-positive or node-indeterminate nonmetastatic disease, and 28% had node-negative, nonmetastatic disease; 95% had newly diagnosed disease. The median follow-up was 40 months. There were 184 deaths in the combination group as compared with 262 in the ADT-alone group (hazard ratio, 0.63; 95% confidence interval [CI], 0.52 to 0.76; P<0.001); the hazard ratio was 0.75 in patients with nonmetastatic disease and 0.61 in those with metastatic disease. There were 248 treatment-failure events in the combination group as compared with 535 in the ADT-alone group (hazard ratio, 0.29; 95% CI, 0.25 to 0.34; P<0.001); the hazard ratio was 0.21 in patients with nonmetastatic disease and 0.31 in those with metastatic disease. Grade 3 to 5 adverse events occurred in 47% of the patients in the combination group (with nine grade 5 events) and in 33% of the patients in the ADT-alone group (with three grade 5 events). CONCLUSIONS Among men with locally advanced or metastatic prostate cancer, ADT plus abiraterone and prednisolone was associated with significantly higher rates of overall and failure-free survival than ADT alone. (Funded by Cancer Research U.K. and others; STAMPEDE ClinicalTrials.gov number, NCT00268476 , and Current Controlled Trials number, ISRCTN78818544 .).
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Affiliation(s)
- Nicholas D James
- From the Institute of Cancer and Genomic Sciences, University of Birmingham (N.D.J.), and University Hospital Birmingham (A.Z.), Birmingham, the Institute of Cancer Research (J.S.B., D.P.D., G.A.), Medical Research Council Clinical Trials Unit at University College London (M.R. Spears, C.L.A., C.G., C.B., M.K.B.P., M.R. Sydes), King's College London and Guy's and St. Thomas' NHS Foundation Trust (S.C.), and Royal Marsden NHS Foundation Trust (C.C.P.), London, Salford Royal NHS Foundation Trust, Salford (N.W.C.), Cardiff University School of Medicine (M.D.M.) and Velindre Cancer Centre (J.F.L.), Cardiff, Gloucestershire Royal Hospital (A.W.S.R.) and Gloucestershire Hospitals NHS Foundation Trust (J.B.), Gloucester, University of Glasgow, Glasgow (R.J.J., J.M.R.), St. James's University Hospital, Leeds (W.R.C.), University Hospital of North-Midlands, Stoke-on-Trent (F.A.), Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter (S.A.), Rosemere Cancer Centre, Royal Preston Hospital, Preston (A.J.B.), Dorset Cancer Centre, Poole Hospital, Poole (S.B.), Royal Derby Hospital, Derby (P.C.), Weston Park Hospital, Sheffield (C.F.), Portsmouth Oncology Centre, Queen Alexandra Hospital, Portsmouth (J.G.), Musgrove Park Hospital, Taunton (E.G.), Hull and East Yorkshire Hospitals NHS Trust, Hull (M.H.), Mount Vernon Cancer Centre, Northwood (P.J.H.), Clatterbridge Cancer Centre, Wirral (Z.I.M.), Brighton and Sussex University Hospitals NHS Trust (F.M.) and Sussex Cancer Centre, Royal Sussex County Hospital (A.R.), Brighton, NHS Highland, Inverness (N.M.), Royal Surrey County Hospital, Guildford (J.M.-K.), Northern Ireland Cancer and Queens University, Belfast (J.O.), Lancashire Teaching Hospitals NHS Trust, Preston (O.P.), Churchill Hospital, Oxford (A.P.), Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury (N.N.S.), East Kent Hospitals NHS Trust, Canterbury (C.T.), Swansea University College of Medicine, Swansea (J. Wagstaff), and Christie NHS Foundation Trust, Manchester (J. Wylie) - all in the United Kingdom; and the Department of Medical Oncology, Kantonsspital St. Gallen, St. Gallen (S.G.), and University Hospital of Lausanne, Lausanne (D.R.B.) - both in Switzerland. Two of the authors (D.M., R.M.) were unaffiliated lay members of the STAMPEDE investigators
| | - Johann S de Bono
- From the Institute of Cancer and Genomic Sciences, University of Birmingham (N.D.J.), and University Hospital Birmingham (A.Z.), Birmingham, the Institute of Cancer Research (J.S.B., D.P.D., G.A.), Medical Research Council Clinical Trials Unit at University College London (M.R. Spears, C.L.A., C.G., C.B., M.K.B.P., M.R. Sydes), King's College London and Guy's and St. Thomas' NHS Foundation Trust (S.C.), and Royal Marsden NHS Foundation Trust (C.C.P.), London, Salford Royal NHS Foundation Trust, Salford (N.W.C.), Cardiff University School of Medicine (M.D.M.) and Velindre Cancer Centre (J.F.L.), Cardiff, Gloucestershire Royal Hospital (A.W.S.R.) and Gloucestershire Hospitals NHS Foundation Trust (J.B.), Gloucester, University of Glasgow, Glasgow (R.J.J., J.M.R.), St. James's University Hospital, Leeds (W.R.C.), University Hospital of North-Midlands, Stoke-on-Trent (F.A.), Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter (S.A.), Rosemere Cancer Centre, Royal Preston Hospital, Preston (A.J.B.), Dorset Cancer Centre, Poole Hospital, Poole (S.B.), Royal Derby Hospital, Derby (P.C.), Weston Park Hospital, Sheffield (C.F.), Portsmouth Oncology Centre, Queen Alexandra Hospital, Portsmouth (J.G.), Musgrove Park Hospital, Taunton (E.G.), Hull and East Yorkshire Hospitals NHS Trust, Hull (M.H.), Mount Vernon Cancer Centre, Northwood (P.J.H.), Clatterbridge Cancer Centre, Wirral (Z.I.M.), Brighton and Sussex University Hospitals NHS Trust (F.M.) and Sussex Cancer Centre, Royal Sussex County Hospital (A.R.), Brighton, NHS Highland, Inverness (N.M.), Royal Surrey County Hospital, Guildford (J.M.-K.), Northern Ireland Cancer and Queens University, Belfast (J.O.), Lancashire Teaching Hospitals NHS Trust, Preston (O.P.), Churchill Hospital, Oxford (A.P.), Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury (N.N.S.), East Kent Hospitals NHS Trust, Canterbury (C.T.), Swansea University College of Medicine, Swansea (J. Wagstaff), and Christie NHS Foundation Trust, Manchester (J. Wylie) - all in the United Kingdom; and the Department of Medical Oncology, Kantonsspital St. Gallen, St. Gallen (S.G.), and University Hospital of Lausanne, Lausanne (D.R.B.) - both in Switzerland. Two of the authors (D.M., R.M.) were unaffiliated lay members of the STAMPEDE investigators
| | - Melissa R Spears
- From the Institute of Cancer and Genomic Sciences, University of Birmingham (N.D.J.), and University Hospital Birmingham (A.Z.), Birmingham, the Institute of Cancer Research (J.S.B., D.P.D., G.A.), Medical Research Council Clinical Trials Unit at University College London (M.R. Spears, C.L.A., C.G., C.B., M.K.B.P., M.R. Sydes), King's College London and Guy's and St. Thomas' NHS Foundation Trust (S.C.), and Royal Marsden NHS Foundation Trust (C.C.P.), London, Salford Royal NHS Foundation Trust, Salford (N.W.C.), Cardiff University School of Medicine (M.D.M.) and Velindre Cancer Centre (J.F.L.), Cardiff, Gloucestershire Royal Hospital (A.W.S.R.) and Gloucestershire Hospitals NHS Foundation Trust (J.B.), Gloucester, University of Glasgow, Glasgow (R.J.J., J.M.R.), St. James's University Hospital, Leeds (W.R.C.), University Hospital of North-Midlands, Stoke-on-Trent (F.A.), Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter (S.A.), Rosemere Cancer Centre, Royal Preston Hospital, Preston (A.J.B.), Dorset Cancer Centre, Poole Hospital, Poole (S.B.), Royal Derby Hospital, Derby (P.C.), Weston Park Hospital, Sheffield (C.F.), Portsmouth Oncology Centre, Queen Alexandra Hospital, Portsmouth (J.G.), Musgrove Park Hospital, Taunton (E.G.), Hull and East Yorkshire Hospitals NHS Trust, Hull (M.H.), Mount Vernon Cancer Centre, Northwood (P.J.H.), Clatterbridge Cancer Centre, Wirral (Z.I.M.), Brighton and Sussex University Hospitals NHS Trust (F.M.) and Sussex Cancer Centre, Royal Sussex County Hospital (A.R.), Brighton, NHS Highland, Inverness (N.M.), Royal Surrey County Hospital, Guildford (J.M.-K.), Northern Ireland Cancer and Queens University, Belfast (J.O.), Lancashire Teaching Hospitals NHS Trust, Preston (O.P.), Churchill Hospital, Oxford (A.P.), Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury (N.N.S.), East Kent Hospitals NHS Trust, Canterbury (C.T.), Swansea University College of Medicine, Swansea (J. Wagstaff), and Christie NHS Foundation Trust, Manchester (J. Wylie) - all in the United Kingdom; and the Department of Medical Oncology, Kantonsspital St. Gallen, St. Gallen (S.G.), and University Hospital of Lausanne, Lausanne (D.R.B.) - both in Switzerland. Two of the authors (D.M., R.M.) were unaffiliated lay members of the STAMPEDE investigators
| | - Noel W Clarke
- From the Institute of Cancer and Genomic Sciences, University of Birmingham (N.D.J.), and University Hospital Birmingham (A.Z.), Birmingham, the Institute of Cancer Research (J.S.B., D.P.D., G.A.), Medical Research Council Clinical Trials Unit at University College London (M.R. Spears, C.L.A., C.G., C.B., M.K.B.P., M.R. Sydes), King's College London and Guy's and St. Thomas' NHS Foundation Trust (S.C.), and Royal Marsden NHS Foundation Trust (C.C.P.), London, Salford Royal NHS Foundation Trust, Salford (N.W.C.), Cardiff University School of Medicine (M.D.M.) and Velindre Cancer Centre (J.F.L.), Cardiff, Gloucestershire Royal Hospital (A.W.S.R.) and Gloucestershire Hospitals NHS Foundation Trust (J.B.), Gloucester, University of Glasgow, Glasgow (R.J.J., J.M.R.), St. James's University Hospital, Leeds (W.R.C.), University Hospital of North-Midlands, Stoke-on-Trent (F.A.), Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter (S.A.), Rosemere Cancer Centre, Royal Preston Hospital, Preston (A.J.B.), Dorset Cancer Centre, Poole Hospital, Poole (S.B.), Royal Derby Hospital, Derby (P.C.), Weston Park Hospital, Sheffield (C.F.), Portsmouth Oncology Centre, Queen Alexandra Hospital, Portsmouth (J.G.), Musgrove Park Hospital, Taunton (E.G.), Hull and East Yorkshire Hospitals NHS Trust, Hull (M.H.), Mount Vernon Cancer Centre, Northwood (P.J.H.), Clatterbridge Cancer Centre, Wirral (Z.I.M.), Brighton and Sussex University Hospitals NHS Trust (F.M.) and Sussex Cancer Centre, Royal Sussex County Hospital (A.R.), Brighton, NHS Highland, Inverness (N.M.), Royal Surrey County Hospital, Guildford (J.M.-K.), Northern Ireland Cancer and Queens University, Belfast (J.O.), Lancashire Teaching Hospitals NHS Trust, Preston (O.P.), Churchill Hospital, Oxford (A.P.), Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury (N.N.S.), East Kent Hospitals NHS Trust, Canterbury (C.T.), Swansea University College of Medicine, Swansea (J. Wagstaff), and Christie NHS Foundation Trust, Manchester (J. Wylie) - all in the United Kingdom; and the Department of Medical Oncology, Kantonsspital St. Gallen, St. Gallen (S.G.), and University Hospital of Lausanne, Lausanne (D.R.B.) - both in Switzerland. Two of the authors (D.M., R.M.) were unaffiliated lay members of the STAMPEDE investigators
| | - Malcolm D Mason
- From the Institute of Cancer and Genomic Sciences, University of Birmingham (N.D.J.), and University Hospital Birmingham (A.Z.), Birmingham, the Institute of Cancer Research (J.S.B., D.P.D., G.A.), Medical Research Council Clinical Trials Unit at University College London (M.R. Spears, C.L.A., C.G., C.B., M.K.B.P., M.R. Sydes), King's College London and Guy's and St. Thomas' NHS Foundation Trust (S.C.), and Royal Marsden NHS Foundation Trust (C.C.P.), London, Salford Royal NHS Foundation Trust, Salford (N.W.C.), Cardiff University School of Medicine (M.D.M.) and Velindre Cancer Centre (J.F.L.), Cardiff, Gloucestershire Royal Hospital (A.W.S.R.) and Gloucestershire Hospitals NHS Foundation Trust (J.B.), Gloucester, University of Glasgow, Glasgow (R.J.J., J.M.R.), St. James's University Hospital, Leeds (W.R.C.), University Hospital of North-Midlands, Stoke-on-Trent (F.A.), Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter (S.A.), Rosemere Cancer Centre, Royal Preston Hospital, Preston (A.J.B.), Dorset Cancer Centre, Poole Hospital, Poole (S.B.), Royal Derby Hospital, Derby (P.C.), Weston Park Hospital, Sheffield (C.F.), Portsmouth Oncology Centre, Queen Alexandra Hospital, Portsmouth (J.G.), Musgrove Park Hospital, Taunton (E.G.), Hull and East Yorkshire Hospitals NHS Trust, Hull (M.H.), Mount Vernon Cancer Centre, Northwood (P.J.H.), Clatterbridge Cancer Centre, Wirral (Z.I.M.), Brighton and Sussex University Hospitals NHS Trust (F.M.) and Sussex Cancer Centre, Royal Sussex County Hospital (A.R.), Brighton, NHS Highland, Inverness (N.M.), Royal Surrey County Hospital, Guildford (J.M.-K.), Northern Ireland Cancer and Queens University, Belfast (J.O.), Lancashire Teaching Hospitals NHS Trust, Preston (O.P.), Churchill Hospital, Oxford (A.P.), Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury (N.N.S.), East Kent Hospitals NHS Trust, Canterbury (C.T.), Swansea University College of Medicine, Swansea (J. Wagstaff), and Christie NHS Foundation Trust, Manchester (J. Wylie) - all in the United Kingdom; and the Department of Medical Oncology, Kantonsspital St. Gallen, St. Gallen (S.G.), and University Hospital of Lausanne, Lausanne (D.R.B.) - both in Switzerland. Two of the authors (D.M., R.M.) were unaffiliated lay members of the STAMPEDE investigators
| | - David P Dearnaley
- From the Institute of Cancer and Genomic Sciences, University of Birmingham (N.D.J.), and University Hospital Birmingham (A.Z.), Birmingham, the Institute of Cancer Research (J.S.B., D.P.D., G.A.), Medical Research Council Clinical Trials Unit at University College London (M.R. Spears, C.L.A., C.G., C.B., M.K.B.P., M.R. Sydes), King's College London and Guy's and St. Thomas' NHS Foundation Trust (S.C.), and Royal Marsden NHS Foundation Trust (C.C.P.), London, Salford Royal NHS Foundation Trust, Salford (N.W.C.), Cardiff University School of Medicine (M.D.M.) and Velindre Cancer Centre (J.F.L.), Cardiff, Gloucestershire Royal Hospital (A.W.S.R.) and Gloucestershire Hospitals NHS Foundation Trust (J.B.), Gloucester, University of Glasgow, Glasgow (R.J.J., J.M.R.), St. James's University Hospital, Leeds (W.R.C.), University Hospital of North-Midlands, Stoke-on-Trent (F.A.), Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter (S.A.), Rosemere Cancer Centre, Royal Preston Hospital, Preston (A.J.B.), Dorset Cancer Centre, Poole Hospital, Poole (S.B.), Royal Derby Hospital, Derby (P.C.), Weston Park Hospital, Sheffield (C.F.), Portsmouth Oncology Centre, Queen Alexandra Hospital, Portsmouth (J.G.), Musgrove Park Hospital, Taunton (E.G.), Hull and East Yorkshire Hospitals NHS Trust, Hull (M.H.), Mount Vernon Cancer Centre, Northwood (P.J.H.), Clatterbridge Cancer Centre, Wirral (Z.I.M.), Brighton and Sussex University Hospitals NHS Trust (F.M.) and Sussex Cancer Centre, Royal Sussex County Hospital (A.R.), Brighton, NHS Highland, Inverness (N.M.), Royal Surrey County Hospital, Guildford (J.M.-K.), Northern Ireland Cancer and Queens University, Belfast (J.O.), Lancashire Teaching Hospitals NHS Trust, Preston (O.P.), Churchill Hospital, Oxford (A.P.), Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury (N.N.S.), East Kent Hospitals NHS Trust, Canterbury (C.T.), Swansea University College of Medicine, Swansea (J. Wagstaff), and Christie NHS Foundation Trust, Manchester (J. Wylie) - all in the United Kingdom; and the Department of Medical Oncology, Kantonsspital St. Gallen, St. Gallen (S.G.), and University Hospital of Lausanne, Lausanne (D.R.B.) - both in Switzerland. Two of the authors (D.M., R.M.) were unaffiliated lay members of the STAMPEDE investigators
| | - Alastair W S Ritchie
- From the Institute of Cancer and Genomic Sciences, University of Birmingham (N.D.J.), and University Hospital Birmingham (A.Z.), Birmingham, the Institute of Cancer Research (J.S.B., D.P.D., G.A.), Medical Research Council Clinical Trials Unit at University College London (M.R. Spears, C.L.A., C.G., C.B., M.K.B.P., M.R. Sydes), King's College London and Guy's and St. Thomas' NHS Foundation Trust (S.C.), and Royal Marsden NHS Foundation Trust (C.C.P.), London, Salford Royal NHS Foundation Trust, Salford (N.W.C.), Cardiff University School of Medicine (M.D.M.) and Velindre Cancer Centre (J.F.L.), Cardiff, Gloucestershire Royal Hospital (A.W.S.R.) and Gloucestershire Hospitals NHS Foundation Trust (J.B.), Gloucester, University of Glasgow, Glasgow (R.J.J., J.M.R.), St. James's University Hospital, Leeds (W.R.C.), University Hospital of North-Midlands, Stoke-on-Trent (F.A.), Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter (S.A.), Rosemere Cancer Centre, Royal Preston Hospital, Preston (A.J.B.), Dorset Cancer Centre, Poole Hospital, Poole (S.B.), Royal Derby Hospital, Derby (P.C.), Weston Park Hospital, Sheffield (C.F.), Portsmouth Oncology Centre, Queen Alexandra Hospital, Portsmouth (J.G.), Musgrove Park Hospital, Taunton (E.G.), Hull and East Yorkshire Hospitals NHS Trust, Hull (M.H.), Mount Vernon Cancer Centre, Northwood (P.J.H.), Clatterbridge Cancer Centre, Wirral (Z.I.M.), Brighton and Sussex University Hospitals NHS Trust (F.M.) and Sussex Cancer Centre, Royal Sussex County Hospital (A.R.), Brighton, NHS Highland, Inverness (N.M.), Royal Surrey County Hospital, Guildford (J.M.-K.), Northern Ireland Cancer and Queens University, Belfast (J.O.), Lancashire Teaching Hospitals NHS Trust, Preston (O.P.), Churchill Hospital, Oxford (A.P.), Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury (N.N.S.), East Kent Hospitals NHS Trust, Canterbury (C.T.), Swansea University College of Medicine, Swansea (J. Wagstaff), and Christie NHS Foundation Trust, Manchester (J. Wylie) - all in the United Kingdom; and the Department of Medical Oncology, Kantonsspital St. Gallen, St. Gallen (S.G.), and University Hospital of Lausanne, Lausanne (D.R.B.) - both in Switzerland. Two of the authors (D.M., R.M.) were unaffiliated lay members of the STAMPEDE investigators
| | - Claire L Amos
- From the Institute of Cancer and Genomic Sciences, University of Birmingham (N.D.J.), and University Hospital Birmingham (A.Z.), Birmingham, the Institute of Cancer Research (J.S.B., D.P.D., G.A.), Medical Research Council Clinical Trials Unit at University College London (M.R. Spears, C.L.A., C.G., C.B., M.K.B.P., M.R. Sydes), King's College London and Guy's and St. Thomas' NHS Foundation Trust (S.C.), and Royal Marsden NHS Foundation Trust (C.C.P.), London, Salford Royal NHS Foundation Trust, Salford (N.W.C.), Cardiff University School of Medicine (M.D.M.) and Velindre Cancer Centre (J.F.L.), Cardiff, Gloucestershire Royal Hospital (A.W.S.R.) and Gloucestershire Hospitals NHS Foundation Trust (J.B.), Gloucester, University of Glasgow, Glasgow (R.J.J., J.M.R.), St. James's University Hospital, Leeds (W.R.C.), University Hospital of North-Midlands, Stoke-on-Trent (F.A.), Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter (S.A.), Rosemere Cancer Centre, Royal Preston Hospital, Preston (A.J.B.), Dorset Cancer Centre, Poole Hospital, Poole (S.B.), Royal Derby Hospital, Derby (P.C.), Weston Park Hospital, Sheffield (C.F.), Portsmouth Oncology Centre, Queen Alexandra Hospital, Portsmouth (J.G.), Musgrove Park Hospital, Taunton (E.G.), Hull and East Yorkshire Hospitals NHS Trust, Hull (M.H.), Mount Vernon Cancer Centre, Northwood (P.J.H.), Clatterbridge Cancer Centre, Wirral (Z.I.M.), Brighton and Sussex University Hospitals NHS Trust (F.M.) and Sussex Cancer Centre, Royal Sussex County Hospital (A.R.), Brighton, NHS Highland, Inverness (N.M.), Royal Surrey County Hospital, Guildford (J.M.-K.), Northern Ireland Cancer and Queens University, Belfast (J.O.), Lancashire Teaching Hospitals NHS Trust, Preston (O.P.), Churchill Hospital, Oxford (A.P.), Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury (N.N.S.), East Kent Hospitals NHS Trust, Canterbury (C.T.), Swansea University College of Medicine, Swansea (J. Wagstaff), and Christie NHS Foundation Trust, Manchester (J. Wylie) - all in the United Kingdom; and the Department of Medical Oncology, Kantonsspital St. Gallen, St. Gallen (S.G.), and University Hospital of Lausanne, Lausanne (D.R.B.) - both in Switzerland. Two of the authors (D.M., R.M.) were unaffiliated lay members of the STAMPEDE investigators
| | - Clare Gilson
- From the Institute of Cancer and Genomic Sciences, University of Birmingham (N.D.J.), and University Hospital Birmingham (A.Z.), Birmingham, the Institute of Cancer Research (J.S.B., D.P.D., G.A.), Medical Research Council Clinical Trials Unit at University College London (M.R. Spears, C.L.A., C.G., C.B., M.K.B.P., M.R. Sydes), King's College London and Guy's and St. Thomas' NHS Foundation Trust (S.C.), and Royal Marsden NHS Foundation Trust (C.C.P.), London, Salford Royal NHS Foundation Trust, Salford (N.W.C.), Cardiff University School of Medicine (M.D.M.) and Velindre Cancer Centre (J.F.L.), Cardiff, Gloucestershire Royal Hospital (A.W.S.R.) and Gloucestershire Hospitals NHS Foundation Trust (J.B.), Gloucester, University of Glasgow, Glasgow (R.J.J., J.M.R.), St. James's University Hospital, Leeds (W.R.C.), University Hospital of North-Midlands, Stoke-on-Trent (F.A.), Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter (S.A.), Rosemere Cancer Centre, Royal Preston Hospital, Preston (A.J.B.), Dorset Cancer Centre, Poole Hospital, Poole (S.B.), Royal Derby Hospital, Derby (P.C.), Weston Park Hospital, Sheffield (C.F.), Portsmouth Oncology Centre, Queen Alexandra Hospital, Portsmouth (J.G.), Musgrove Park Hospital, Taunton (E.G.), Hull and East Yorkshire Hospitals NHS Trust, Hull (M.H.), Mount Vernon Cancer Centre, Northwood (P.J.H.), Clatterbridge Cancer Centre, Wirral (Z.I.M.), Brighton and Sussex University Hospitals NHS Trust (F.M.) and Sussex Cancer Centre, Royal Sussex County Hospital (A.R.), Brighton, NHS Highland, Inverness (N.M.), Royal Surrey County Hospital, Guildford (J.M.-K.), Northern Ireland Cancer and Queens University, Belfast (J.O.), Lancashire Teaching Hospitals NHS Trust, Preston (O.P.), Churchill Hospital, Oxford (A.P.), Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury (N.N.S.), East Kent Hospitals NHS Trust, Canterbury (C.T.), Swansea University College of Medicine, Swansea (J. Wagstaff), and Christie NHS Foundation Trust, Manchester (J. Wylie) - all in the United Kingdom; and the Department of Medical Oncology, Kantonsspital St. Gallen, St. Gallen (S.G.), and University Hospital of Lausanne, Lausanne (D.R.B.) - both in Switzerland. Two of the authors (D.M., R.M.) were unaffiliated lay members of the STAMPEDE investigators
| | - Rob J Jones
- From the Institute of Cancer and Genomic Sciences, University of Birmingham (N.D.J.), and University Hospital Birmingham (A.Z.), Birmingham, the Institute of Cancer Research (J.S.B., D.P.D., G.A.), Medical Research Council Clinical Trials Unit at University College London (M.R. Spears, C.L.A., C.G., C.B., M.K.B.P., M.R. Sydes), King's College London and Guy's and St. Thomas' NHS Foundation Trust (S.C.), and Royal Marsden NHS Foundation Trust (C.C.P.), London, Salford Royal NHS Foundation Trust, Salford (N.W.C.), Cardiff University School of Medicine (M.D.M.) and Velindre Cancer Centre (J.F.L.), Cardiff, Gloucestershire Royal Hospital (A.W.S.R.) and Gloucestershire Hospitals NHS Foundation Trust (J.B.), Gloucester, University of Glasgow, Glasgow (R.J.J., J.M.R.), St. James's University Hospital, Leeds (W.R.C.), University Hospital of North-Midlands, Stoke-on-Trent (F.A.), Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter (S.A.), Rosemere Cancer Centre, Royal Preston Hospital, Preston (A.J.B.), Dorset Cancer Centre, Poole Hospital, Poole (S.B.), Royal Derby Hospital, Derby (P.C.), Weston Park Hospital, Sheffield (C.F.), Portsmouth Oncology Centre, Queen Alexandra Hospital, Portsmouth (J.G.), Musgrove Park Hospital, Taunton (E.G.), Hull and East Yorkshire Hospitals NHS Trust, Hull (M.H.), Mount Vernon Cancer Centre, Northwood (P.J.H.), Clatterbridge Cancer Centre, Wirral (Z.I.M.), Brighton and Sussex University Hospitals NHS Trust (F.M.) and Sussex Cancer Centre, Royal Sussex County Hospital (A.R.), Brighton, NHS Highland, Inverness (N.M.), Royal Surrey County Hospital, Guildford (J.M.-K.), Northern Ireland Cancer and Queens University, Belfast (J.O.), Lancashire Teaching Hospitals NHS Trust, Preston (O.P.), Churchill Hospital, Oxford (A.P.), Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury (N.N.S.), East Kent Hospitals NHS Trust, Canterbury (C.T.), Swansea University College of Medicine, Swansea (J. Wagstaff), and Christie NHS Foundation Trust, Manchester (J. Wylie) - all in the United Kingdom; and the Department of Medical Oncology, Kantonsspital St. Gallen, St. Gallen (S.G.), and University Hospital of Lausanne, Lausanne (D.R.B.) - both in Switzerland. Two of the authors (D.M., R.M.) were unaffiliated lay members of the STAMPEDE investigators
| | - David Matheson
- From the Institute of Cancer and Genomic Sciences, University of Birmingham (N.D.J.), and University Hospital Birmingham (A.Z.), Birmingham, the Institute of Cancer Research (J.S.B., D.P.D., G.A.), Medical Research Council Clinical Trials Unit at University College London (M.R. Spears, C.L.A., C.G., C.B., M.K.B.P., M.R. Sydes), King's College London and Guy's and St. Thomas' NHS Foundation Trust (S.C.), and Royal Marsden NHS Foundation Trust (C.C.P.), London, Salford Royal NHS Foundation Trust, Salford (N.W.C.), Cardiff University School of Medicine (M.D.M.) and Velindre Cancer Centre (J.F.L.), Cardiff, Gloucestershire Royal Hospital (A.W.S.R.) and Gloucestershire Hospitals NHS Foundation Trust (J.B.), Gloucester, University of Glasgow, Glasgow (R.J.J., J.M.R.), St. James's University Hospital, Leeds (W.R.C.), University Hospital of North-Midlands, Stoke-on-Trent (F.A.), Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter (S.A.), Rosemere Cancer Centre, Royal Preston Hospital, Preston (A.J.B.), Dorset Cancer Centre, Poole Hospital, Poole (S.B.), Royal Derby Hospital, Derby (P.C.), Weston Park Hospital, Sheffield (C.F.), Portsmouth Oncology Centre, Queen Alexandra Hospital, Portsmouth (J.G.), Musgrove Park Hospital, Taunton (E.G.), Hull and East Yorkshire Hospitals NHS Trust, Hull (M.H.), Mount Vernon Cancer Centre, Northwood (P.J.H.), Clatterbridge Cancer Centre, Wirral (Z.I.M.), Brighton and Sussex University Hospitals NHS Trust (F.M.) and Sussex Cancer Centre, Royal Sussex County Hospital (A.R.), Brighton, NHS Highland, Inverness (N.M.), Royal Surrey County Hospital, Guildford (J.M.-K.), Northern Ireland Cancer and Queens University, Belfast (J.O.), Lancashire Teaching Hospitals NHS Trust, Preston (O.P.), Churchill Hospital, Oxford (A.P.), Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury (N.N.S.), East Kent Hospitals NHS Trust, Canterbury (C.T.), Swansea University College of Medicine, Swansea (J. Wagstaff), and Christie NHS Foundation Trust, Manchester (J. Wylie) - all in the United Kingdom; and the Department of Medical Oncology, Kantonsspital St. Gallen, St. Gallen (S.G.), and University Hospital of Lausanne, Lausanne (D.R.B.) - both in Switzerland. Two of the authors (D.M., R.M.) were unaffiliated lay members of the STAMPEDE investigators
| | - Robin Millman
- From the Institute of Cancer and Genomic Sciences, University of Birmingham (N.D.J.), and University Hospital Birmingham (A.Z.), Birmingham, the Institute of Cancer Research (J.S.B., D.P.D., G.A.), Medical Research Council Clinical Trials Unit at University College London (M.R. Spears, C.L.A., C.G., C.B., M.K.B.P., M.R. Sydes), King's College London and Guy's and St. Thomas' NHS Foundation Trust (S.C.), and Royal Marsden NHS Foundation Trust (C.C.P.), London, Salford Royal NHS Foundation Trust, Salford (N.W.C.), Cardiff University School of Medicine (M.D.M.) and Velindre Cancer Centre (J.F.L.), Cardiff, Gloucestershire Royal Hospital (A.W.S.R.) and Gloucestershire Hospitals NHS Foundation Trust (J.B.), Gloucester, University of Glasgow, Glasgow (R.J.J., J.M.R.), St. James's University Hospital, Leeds (W.R.C.), University Hospital of North-Midlands, Stoke-on-Trent (F.A.), Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter (S.A.), Rosemere Cancer Centre, Royal Preston Hospital, Preston (A.J.B.), Dorset Cancer Centre, Poole Hospital, Poole (S.B.), Royal Derby Hospital, Derby (P.C.), Weston Park Hospital, Sheffield (C.F.), Portsmouth Oncology Centre, Queen Alexandra Hospital, Portsmouth (J.G.), Musgrove Park Hospital, Taunton (E.G.), Hull and East Yorkshire Hospitals NHS Trust, Hull (M.H.), Mount Vernon Cancer Centre, Northwood (P.J.H.), Clatterbridge Cancer Centre, Wirral (Z.I.M.), Brighton and Sussex University Hospitals NHS Trust (F.M.) and Sussex Cancer Centre, Royal Sussex County Hospital (A.R.), Brighton, NHS Highland, Inverness (N.M.), Royal Surrey County Hospital, Guildford (J.M.-K.), Northern Ireland Cancer and Queens University, Belfast (J.O.), Lancashire Teaching Hospitals NHS Trust, Preston (O.P.), Churchill Hospital, Oxford (A.P.), Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury (N.N.S.), East Kent Hospitals NHS Trust, Canterbury (C.T.), Swansea University College of Medicine, Swansea (J. Wagstaff), and Christie NHS Foundation Trust, Manchester (J. Wylie) - all in the United Kingdom; and the Department of Medical Oncology, Kantonsspital St. Gallen, St. Gallen (S.G.), and University Hospital of Lausanne, Lausanne (D.R.B.) - both in Switzerland. Two of the authors (D.M., R.M.) were unaffiliated lay members of the STAMPEDE investigators
| | - Gerhardt Attard
- From the Institute of Cancer and Genomic Sciences, University of Birmingham (N.D.J.), and University Hospital Birmingham (A.Z.), Birmingham, the Institute of Cancer Research (J.S.B., D.P.D., G.A.), Medical Research Council Clinical Trials Unit at University College London (M.R. Spears, C.L.A., C.G., C.B., M.K.B.P., M.R. Sydes), King's College London and Guy's and St. Thomas' NHS Foundation Trust (S.C.), and Royal Marsden NHS Foundation Trust (C.C.P.), London, Salford Royal NHS Foundation Trust, Salford (N.W.C.), Cardiff University School of Medicine (M.D.M.) and Velindre Cancer Centre (J.F.L.), Cardiff, Gloucestershire Royal Hospital (A.W.S.R.) and Gloucestershire Hospitals NHS Foundation Trust (J.B.), Gloucester, University of Glasgow, Glasgow (R.J.J., J.M.R.), St. James's University Hospital, Leeds (W.R.C.), University Hospital of North-Midlands, Stoke-on-Trent (F.A.), Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter (S.A.), Rosemere Cancer Centre, Royal Preston Hospital, Preston (A.J.B.), Dorset Cancer Centre, Poole Hospital, Poole (S.B.), Royal Derby Hospital, Derby (P.C.), Weston Park Hospital, Sheffield (C.F.), Portsmouth Oncology Centre, Queen Alexandra Hospital, Portsmouth (J.G.), Musgrove Park Hospital, Taunton (E.G.), Hull and East Yorkshire Hospitals NHS Trust, Hull (M.H.), Mount Vernon Cancer Centre, Northwood (P.J.H.), Clatterbridge Cancer Centre, Wirral (Z.I.M.), Brighton and Sussex University Hospitals NHS Trust (F.M.) and Sussex Cancer Centre, Royal Sussex County Hospital (A.R.), Brighton, NHS Highland, Inverness (N.M.), Royal Surrey County Hospital, Guildford (J.M.-K.), Northern Ireland Cancer and Queens University, Belfast (J.O.), Lancashire Teaching Hospitals NHS Trust, Preston (O.P.), Churchill Hospital, Oxford (A.P.), Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury (N.N.S.), East Kent Hospitals NHS Trust, Canterbury (C.T.), Swansea University College of Medicine, Swansea (J. Wagstaff), and Christie NHS Foundation Trust, Manchester (J. Wylie) - all in the United Kingdom; and the Department of Medical Oncology, Kantonsspital St. Gallen, St. Gallen (S.G.), and University Hospital of Lausanne, Lausanne (D.R.B.) - both in Switzerland. Two of the authors (D.M., R.M.) were unaffiliated lay members of the STAMPEDE investigators
| | - Simon Chowdhury
- From the Institute of Cancer and Genomic Sciences, University of Birmingham (N.D.J.), and University Hospital Birmingham (A.Z.), Birmingham, the Institute of Cancer Research (J.S.B., D.P.D., G.A.), Medical Research Council Clinical Trials Unit at University College London (M.R. Spears, C.L.A., C.G., C.B., M.K.B.P., M.R. Sydes), King's College London and Guy's and St. Thomas' NHS Foundation Trust (S.C.), and Royal Marsden NHS Foundation Trust (C.C.P.), London, Salford Royal NHS Foundation Trust, Salford (N.W.C.), Cardiff University School of Medicine (M.D.M.) and Velindre Cancer Centre (J.F.L.), Cardiff, Gloucestershire Royal Hospital (A.W.S.R.) and Gloucestershire Hospitals NHS Foundation Trust (J.B.), Gloucester, University of Glasgow, Glasgow (R.J.J., J.M.R.), St. James's University Hospital, Leeds (W.R.C.), University Hospital of North-Midlands, Stoke-on-Trent (F.A.), Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter (S.A.), Rosemere Cancer Centre, Royal Preston Hospital, Preston (A.J.B.), Dorset Cancer Centre, Poole Hospital, Poole (S.B.), Royal Derby Hospital, Derby (P.C.), Weston Park Hospital, Sheffield (C.F.), Portsmouth Oncology Centre, Queen Alexandra Hospital, Portsmouth (J.G.), Musgrove Park Hospital, Taunton (E.G.), Hull and East Yorkshire Hospitals NHS Trust, Hull (M.H.), Mount Vernon Cancer Centre, Northwood (P.J.H.), Clatterbridge Cancer Centre, Wirral (Z.I.M.), Brighton and Sussex University Hospitals NHS Trust (F.M.) and Sussex Cancer Centre, Royal Sussex County Hospital (A.R.), Brighton, NHS Highland, Inverness (N.M.), Royal Surrey County Hospital, Guildford (J.M.-K.), Northern Ireland Cancer and Queens University, Belfast (J.O.), Lancashire Teaching Hospitals NHS Trust, Preston (O.P.), Churchill Hospital, Oxford (A.P.), Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury (N.N.S.), East Kent Hospitals NHS Trust, Canterbury (C.T.), Swansea University College of Medicine, Swansea (J. Wagstaff), and Christie NHS Foundation Trust, Manchester (J. Wylie) - all in the United Kingdom; and the Department of Medical Oncology, Kantonsspital St. Gallen, St. Gallen (S.G.), and University Hospital of Lausanne, Lausanne (D.R.B.) - both in Switzerland. Two of the authors (D.M., R.M.) were unaffiliated lay members of the STAMPEDE investigators
| | - William R Cross
- From the Institute of Cancer and Genomic Sciences, University of Birmingham (N.D.J.), and University Hospital Birmingham (A.Z.), Birmingham, the Institute of Cancer Research (J.S.B., D.P.D., G.A.), Medical Research Council Clinical Trials Unit at University College London (M.R. Spears, C.L.A., C.G., C.B., M.K.B.P., M.R. Sydes), King's College London and Guy's and St. Thomas' NHS Foundation Trust (S.C.), and Royal Marsden NHS Foundation Trust (C.C.P.), London, Salford Royal NHS Foundation Trust, Salford (N.W.C.), Cardiff University School of Medicine (M.D.M.) and Velindre Cancer Centre (J.F.L.), Cardiff, Gloucestershire Royal Hospital (A.W.S.R.) and Gloucestershire Hospitals NHS Foundation Trust (J.B.), Gloucester, University of Glasgow, Glasgow (R.J.J., J.M.R.), St. James's University Hospital, Leeds (W.R.C.), University Hospital of North-Midlands, Stoke-on-Trent (F.A.), Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter (S.A.), Rosemere Cancer Centre, Royal Preston Hospital, Preston (A.J.B.), Dorset Cancer Centre, Poole Hospital, Poole (S.B.), Royal Derby Hospital, Derby (P.C.), Weston Park Hospital, Sheffield (C.F.), Portsmouth Oncology Centre, Queen Alexandra Hospital, Portsmouth (J.G.), Musgrove Park Hospital, Taunton (E.G.), Hull and East Yorkshire Hospitals NHS Trust, Hull (M.H.), Mount Vernon Cancer Centre, Northwood (P.J.H.), Clatterbridge Cancer Centre, Wirral (Z.I.M.), Brighton and Sussex University Hospitals NHS Trust (F.M.) and Sussex Cancer Centre, Royal Sussex County Hospital (A.R.), Brighton, NHS Highland, Inverness (N.M.), Royal Surrey County Hospital, Guildford (J.M.-K.), Northern Ireland Cancer and Queens University, Belfast (J.O.), Lancashire Teaching Hospitals NHS Trust, Preston (O.P.), Churchill Hospital, Oxford (A.P.), Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury (N.N.S.), East Kent Hospitals NHS Trust, Canterbury (C.T.), Swansea University College of Medicine, Swansea (J. Wagstaff), and Christie NHS Foundation Trust, Manchester (J. Wylie) - all in the United Kingdom; and the Department of Medical Oncology, Kantonsspital St. Gallen, St. Gallen (S.G.), and University Hospital of Lausanne, Lausanne (D.R.B.) - both in Switzerland. Two of the authors (D.M., R.M.) were unaffiliated lay members of the STAMPEDE investigators
| | - Silke Gillessen
- From the Institute of Cancer and Genomic Sciences, University of Birmingham (N.D.J.), and University Hospital Birmingham (A.Z.), Birmingham, the Institute of Cancer Research (J.S.B., D.P.D., G.A.), Medical Research Council Clinical Trials Unit at University College London (M.R. Spears, C.L.A., C.G., C.B., M.K.B.P., M.R. Sydes), King's College London and Guy's and St. Thomas' NHS Foundation Trust (S.C.), and Royal Marsden NHS Foundation Trust (C.C.P.), London, Salford Royal NHS Foundation Trust, Salford (N.W.C.), Cardiff University School of Medicine (M.D.M.) and Velindre Cancer Centre (J.F.L.), Cardiff, Gloucestershire Royal Hospital (A.W.S.R.) and Gloucestershire Hospitals NHS Foundation Trust (J.B.), Gloucester, University of Glasgow, Glasgow (R.J.J., J.M.R.), St. James's University Hospital, Leeds (W.R.C.), University Hospital of North-Midlands, Stoke-on-Trent (F.A.), Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter (S.A.), Rosemere Cancer Centre, Royal Preston Hospital, Preston (A.J.B.), Dorset Cancer Centre, Poole Hospital, Poole (S.B.), Royal Derby Hospital, Derby (P.C.), Weston Park Hospital, Sheffield (C.F.), Portsmouth Oncology Centre, Queen Alexandra Hospital, Portsmouth (J.G.), Musgrove Park Hospital, Taunton (E.G.), Hull and East Yorkshire Hospitals NHS Trust, Hull (M.H.), Mount Vernon Cancer Centre, Northwood (P.J.H.), Clatterbridge Cancer Centre, Wirral (Z.I.M.), Brighton and Sussex University Hospitals NHS Trust (F.M.) and Sussex Cancer Centre, Royal Sussex County Hospital (A.R.), Brighton, NHS Highland, Inverness (N.M.), Royal Surrey County Hospital, Guildford (J.M.-K.), Northern Ireland Cancer and Queens University, Belfast (J.O.), Lancashire Teaching Hospitals NHS Trust, Preston (O.P.), Churchill Hospital, Oxford (A.P.), Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury (N.N.S.), East Kent Hospitals NHS Trust, Canterbury (C.T.), Swansea University College of Medicine, Swansea (J. Wagstaff), and Christie NHS Foundation Trust, Manchester (J. Wylie) - all in the United Kingdom; and the Department of Medical Oncology, Kantonsspital St. Gallen, St. Gallen (S.G.), and University Hospital of Lausanne, Lausanne (D.R.B.) - both in Switzerland. Two of the authors (D.M., R.M.) were unaffiliated lay members of the STAMPEDE investigators
| | - Christopher C Parker
- From the Institute of Cancer and Genomic Sciences, University of Birmingham (N.D.J.), and University Hospital Birmingham (A.Z.), Birmingham, the Institute of Cancer Research (J.S.B., D.P.D., G.A.), Medical Research Council Clinical Trials Unit at University College London (M.R. Spears, C.L.A., C.G., C.B., M.K.B.P., M.R. Sydes), King's College London and Guy's and St. Thomas' NHS Foundation Trust (S.C.), and Royal Marsden NHS Foundation Trust (C.C.P.), London, Salford Royal NHS Foundation Trust, Salford (N.W.C.), Cardiff University School of Medicine (M.D.M.) and Velindre Cancer Centre (J.F.L.), Cardiff, Gloucestershire Royal Hospital (A.W.S.R.) and Gloucestershire Hospitals NHS Foundation Trust (J.B.), Gloucester, University of Glasgow, Glasgow (R.J.J., J.M.R.), St. James's University Hospital, Leeds (W.R.C.), University Hospital of North-Midlands, Stoke-on-Trent (F.A.), Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter (S.A.), Rosemere Cancer Centre, Royal Preston Hospital, Preston (A.J.B.), Dorset Cancer Centre, Poole Hospital, Poole (S.B.), Royal Derby Hospital, Derby (P.C.), Weston Park Hospital, Sheffield (C.F.), Portsmouth Oncology Centre, Queen Alexandra Hospital, Portsmouth (J.G.), Musgrove Park Hospital, Taunton (E.G.), Hull and East Yorkshire Hospitals NHS Trust, Hull (M.H.), Mount Vernon Cancer Centre, Northwood (P.J.H.), Clatterbridge Cancer Centre, Wirral (Z.I.M.), Brighton and Sussex University Hospitals NHS Trust (F.M.) and Sussex Cancer Centre, Royal Sussex County Hospital (A.R.), Brighton, NHS Highland, Inverness (N.M.), Royal Surrey County Hospital, Guildford (J.M.-K.), Northern Ireland Cancer and Queens University, Belfast (J.O.), Lancashire Teaching Hospitals NHS Trust, Preston (O.P.), Churchill Hospital, Oxford (A.P.), Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury (N.N.S.), East Kent Hospitals NHS Trust, Canterbury (C.T.), Swansea University College of Medicine, Swansea (J. Wagstaff), and Christie NHS Foundation Trust, Manchester (J. Wylie) - all in the United Kingdom; and the Department of Medical Oncology, Kantonsspital St. Gallen, St. Gallen (S.G.), and University Hospital of Lausanne, Lausanne (D.R.B.) - both in Switzerland. Two of the authors (D.M., R.M.) were unaffiliated lay members of the STAMPEDE investigators
| | - J Martin Russell
- From the Institute of Cancer and Genomic Sciences, University of Birmingham (N.D.J.), and University Hospital Birmingham (A.Z.), Birmingham, the Institute of Cancer Research (J.S.B., D.P.D., G.A.), Medical Research Council Clinical Trials Unit at University College London (M.R. Spears, C.L.A., C.G., C.B., M.K.B.P., M.R. Sydes), King's College London and Guy's and St. Thomas' NHS Foundation Trust (S.C.), and Royal Marsden NHS Foundation Trust (C.C.P.), London, Salford Royal NHS Foundation Trust, Salford (N.W.C.), Cardiff University School of Medicine (M.D.M.) and Velindre Cancer Centre (J.F.L.), Cardiff, Gloucestershire Royal Hospital (A.W.S.R.) and Gloucestershire Hospitals NHS Foundation Trust (J.B.), Gloucester, University of Glasgow, Glasgow (R.J.J., J.M.R.), St. James's University Hospital, Leeds (W.R.C.), University Hospital of North-Midlands, Stoke-on-Trent (F.A.), Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter (S.A.), Rosemere Cancer Centre, Royal Preston Hospital, Preston (A.J.B.), Dorset Cancer Centre, Poole Hospital, Poole (S.B.), Royal Derby Hospital, Derby (P.C.), Weston Park Hospital, Sheffield (C.F.), Portsmouth Oncology Centre, Queen Alexandra Hospital, Portsmouth (J.G.), Musgrove Park Hospital, Taunton (E.G.), Hull and East Yorkshire Hospitals NHS Trust, Hull (M.H.), Mount Vernon Cancer Centre, Northwood (P.J.H.), Clatterbridge Cancer Centre, Wirral (Z.I.M.), Brighton and Sussex University Hospitals NHS Trust (F.M.) and Sussex Cancer Centre, Royal Sussex County Hospital (A.R.), Brighton, NHS Highland, Inverness (N.M.), Royal Surrey County Hospital, Guildford (J.M.-K.), Northern Ireland Cancer and Queens University, Belfast (J.O.), Lancashire Teaching Hospitals NHS Trust, Preston (O.P.), Churchill Hospital, Oxford (A.P.), Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury (N.N.S.), East Kent Hospitals NHS Trust, Canterbury (C.T.), Swansea University College of Medicine, Swansea (J. Wagstaff), and Christie NHS Foundation Trust, Manchester (J. Wylie) - all in the United Kingdom; and the Department of Medical Oncology, Kantonsspital St. Gallen, St. Gallen (S.G.), and University Hospital of Lausanne, Lausanne (D.R.B.) - both in Switzerland. Two of the authors (D.M., R.M.) were unaffiliated lay members of the STAMPEDE investigators
| | - Dominik R Berthold
- From the Institute of Cancer and Genomic Sciences, University of Birmingham (N.D.J.), and University Hospital Birmingham (A.Z.), Birmingham, the Institute of Cancer Research (J.S.B., D.P.D., G.A.), Medical Research Council Clinical Trials Unit at University College London (M.R. Spears, C.L.A., C.G., C.B., M.K.B.P., M.R. Sydes), King's College London and Guy's and St. Thomas' NHS Foundation Trust (S.C.), and Royal Marsden NHS Foundation Trust (C.C.P.), London, Salford Royal NHS Foundation Trust, Salford (N.W.C.), Cardiff University School of Medicine (M.D.M.) and Velindre Cancer Centre (J.F.L.), Cardiff, Gloucestershire Royal Hospital (A.W.S.R.) and Gloucestershire Hospitals NHS Foundation Trust (J.B.), Gloucester, University of Glasgow, Glasgow (R.J.J., J.M.R.), St. James's University Hospital, Leeds (W.R.C.), University Hospital of North-Midlands, Stoke-on-Trent (F.A.), Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter (S.A.), Rosemere Cancer Centre, Royal Preston Hospital, Preston (A.J.B.), Dorset Cancer Centre, Poole Hospital, Poole (S.B.), Royal Derby Hospital, Derby (P.C.), Weston Park Hospital, Sheffield (C.F.), Portsmouth Oncology Centre, Queen Alexandra Hospital, Portsmouth (J.G.), Musgrove Park Hospital, Taunton (E.G.), Hull and East Yorkshire Hospitals NHS Trust, Hull (M.H.), Mount Vernon Cancer Centre, Northwood (P.J.H.), Clatterbridge Cancer Centre, Wirral (Z.I.M.), Brighton and Sussex University Hospitals NHS Trust (F.M.) and Sussex Cancer Centre, Royal Sussex County Hospital (A.R.), Brighton, NHS Highland, Inverness (N.M.), Royal Surrey County Hospital, Guildford (J.M.-K.), Northern Ireland Cancer and Queens University, Belfast (J.O.), Lancashire Teaching Hospitals NHS Trust, Preston (O.P.), Churchill Hospital, Oxford (A.P.), Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury (N.N.S.), East Kent Hospitals NHS Trust, Canterbury (C.T.), Swansea University College of Medicine, Swansea (J. Wagstaff), and Christie NHS Foundation Trust, Manchester (J. Wylie) - all in the United Kingdom; and the Department of Medical Oncology, Kantonsspital St. Gallen, St. Gallen (S.G.), and University Hospital of Lausanne, Lausanne (D.R.B.) - both in Switzerland. Two of the authors (D.M., R.M.) were unaffiliated lay members of the STAMPEDE investigators
| | - Chris Brawley
- From the Institute of Cancer and Genomic Sciences, University of Birmingham (N.D.J.), and University Hospital Birmingham (A.Z.), Birmingham, the Institute of Cancer Research (J.S.B., D.P.D., G.A.), Medical Research Council Clinical Trials Unit at University College London (M.R. Spears, C.L.A., C.G., C.B., M.K.B.P., M.R. Sydes), King's College London and Guy's and St. Thomas' NHS Foundation Trust (S.C.), and Royal Marsden NHS Foundation Trust (C.C.P.), London, Salford Royal NHS Foundation Trust, Salford (N.W.C.), Cardiff University School of Medicine (M.D.M.) and Velindre Cancer Centre (J.F.L.), Cardiff, Gloucestershire Royal Hospital (A.W.S.R.) and Gloucestershire Hospitals NHS Foundation Trust (J.B.), Gloucester, University of Glasgow, Glasgow (R.J.J., J.M.R.), St. James's University Hospital, Leeds (W.R.C.), University Hospital of North-Midlands, Stoke-on-Trent (F.A.), Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter (S.A.), Rosemere Cancer Centre, Royal Preston Hospital, Preston (A.J.B.), Dorset Cancer Centre, Poole Hospital, Poole (S.B.), Royal Derby Hospital, Derby (P.C.), Weston Park Hospital, Sheffield (C.F.), Portsmouth Oncology Centre, Queen Alexandra Hospital, Portsmouth (J.G.), Musgrove Park Hospital, Taunton (E.G.), Hull and East Yorkshire Hospitals NHS Trust, Hull (M.H.), Mount Vernon Cancer Centre, Northwood (P.J.H.), Clatterbridge Cancer Centre, Wirral (Z.I.M.), Brighton and Sussex University Hospitals NHS Trust (F.M.) and Sussex Cancer Centre, Royal Sussex County Hospital (A.R.), Brighton, NHS Highland, Inverness (N.M.), Royal Surrey County Hospital, Guildford (J.M.-K.), Northern Ireland Cancer and Queens University, Belfast (J.O.), Lancashire Teaching Hospitals NHS Trust, Preston (O.P.), Churchill Hospital, Oxford (A.P.), Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury (N.N.S.), East Kent Hospitals NHS Trust, Canterbury (C.T.), Swansea University College of Medicine, Swansea (J. Wagstaff), and Christie NHS Foundation Trust, Manchester (J. Wylie) - all in the United Kingdom; and the Department of Medical Oncology, Kantonsspital St. Gallen, St. Gallen (S.G.), and University Hospital of Lausanne, Lausanne (D.R.B.) - both in Switzerland. Two of the authors (D.M., R.M.) were unaffiliated lay members of the STAMPEDE investigators
| | - Fawzi Adab
- From the Institute of Cancer and Genomic Sciences, University of Birmingham (N.D.J.), and University Hospital Birmingham (A.Z.), Birmingham, the Institute of Cancer Research (J.S.B., D.P.D., G.A.), Medical Research Council Clinical Trials Unit at University College London (M.R. Spears, C.L.A., C.G., C.B., M.K.B.P., M.R. Sydes), King's College London and Guy's and St. Thomas' NHS Foundation Trust (S.C.), and Royal Marsden NHS Foundation Trust (C.C.P.), London, Salford Royal NHS Foundation Trust, Salford (N.W.C.), Cardiff University School of Medicine (M.D.M.) and Velindre Cancer Centre (J.F.L.), Cardiff, Gloucestershire Royal Hospital (A.W.S.R.) and Gloucestershire Hospitals NHS Foundation Trust (J.B.), Gloucester, University of Glasgow, Glasgow (R.J.J., J.M.R.), St. James's University Hospital, Leeds (W.R.C.), University Hospital of North-Midlands, Stoke-on-Trent (F.A.), Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter (S.A.), Rosemere Cancer Centre, Royal Preston Hospital, Preston (A.J.B.), Dorset Cancer Centre, Poole Hospital, Poole (S.B.), Royal Derby Hospital, Derby (P.C.), Weston Park Hospital, Sheffield (C.F.), Portsmouth Oncology Centre, Queen Alexandra Hospital, Portsmouth (J.G.), Musgrove Park Hospital, Taunton (E.G.), Hull and East Yorkshire Hospitals NHS Trust, Hull (M.H.), Mount Vernon Cancer Centre, Northwood (P.J.H.), Clatterbridge Cancer Centre, Wirral (Z.I.M.), Brighton and Sussex University Hospitals NHS Trust (F.M.) and Sussex Cancer Centre, Royal Sussex County Hospital (A.R.), Brighton, NHS Highland, Inverness (N.M.), Royal Surrey County Hospital, Guildford (J.M.-K.), Northern Ireland Cancer and Queens University, Belfast (J.O.), Lancashire Teaching Hospitals NHS Trust, Preston (O.P.), Churchill Hospital, Oxford (A.P.), Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury (N.N.S.), East Kent Hospitals NHS Trust, Canterbury (C.T.), Swansea University College of Medicine, Swansea (J. Wagstaff), and Christie NHS Foundation Trust, Manchester (J. Wylie) - all in the United Kingdom; and the Department of Medical Oncology, Kantonsspital St. Gallen, St. Gallen (S.G.), and University Hospital of Lausanne, Lausanne (D.R.B.) - both in Switzerland. Two of the authors (D.M., R.M.) were unaffiliated lay members of the STAMPEDE investigators
| | - San Aung
- From the Institute of Cancer and Genomic Sciences, University of Birmingham (N.D.J.), and University Hospital Birmingham (A.Z.), Birmingham, the Institute of Cancer Research (J.S.B., D.P.D., G.A.), Medical Research Council Clinical Trials Unit at University College London (M.R. Spears, C.L.A., C.G., C.B., M.K.B.P., M.R. Sydes), King's College London and Guy's and St. Thomas' NHS Foundation Trust (S.C.), and Royal Marsden NHS Foundation Trust (C.C.P.), London, Salford Royal NHS Foundation Trust, Salford (N.W.C.), Cardiff University School of Medicine (M.D.M.) and Velindre Cancer Centre (J.F.L.), Cardiff, Gloucestershire Royal Hospital (A.W.S.R.) and Gloucestershire Hospitals NHS Foundation Trust (J.B.), Gloucester, University of Glasgow, Glasgow (R.J.J., J.M.R.), St. James's University Hospital, Leeds (W.R.C.), University Hospital of North-Midlands, Stoke-on-Trent (F.A.), Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter (S.A.), Rosemere Cancer Centre, Royal Preston Hospital, Preston (A.J.B.), Dorset Cancer Centre, Poole Hospital, Poole (S.B.), Royal Derby Hospital, Derby (P.C.), Weston Park Hospital, Sheffield (C.F.), Portsmouth Oncology Centre, Queen Alexandra Hospital, Portsmouth (J.G.), Musgrove Park Hospital, Taunton (E.G.), Hull and East Yorkshire Hospitals NHS Trust, Hull (M.H.), Mount Vernon Cancer Centre, Northwood (P.J.H.), Clatterbridge Cancer Centre, Wirral (Z.I.M.), Brighton and Sussex University Hospitals NHS Trust (F.M.) and Sussex Cancer Centre, Royal Sussex County Hospital (A.R.), Brighton, NHS Highland, Inverness (N.M.), Royal Surrey County Hospital, Guildford (J.M.-K.), Northern Ireland Cancer and Queens University, Belfast (J.O.), Lancashire Teaching Hospitals NHS Trust, Preston (O.P.), Churchill Hospital, Oxford (A.P.), Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury (N.N.S.), East Kent Hospitals NHS Trust, Canterbury (C.T.), Swansea University College of Medicine, Swansea (J. Wagstaff), and Christie NHS Foundation Trust, Manchester (J. Wylie) - all in the United Kingdom; and the Department of Medical Oncology, Kantonsspital St. Gallen, St. Gallen (S.G.), and University Hospital of Lausanne, Lausanne (D.R.B.) - both in Switzerland. Two of the authors (D.M., R.M.) were unaffiliated lay members of the STAMPEDE investigators
| | - Alison J Birtle
- From the Institute of Cancer and Genomic Sciences, University of Birmingham (N.D.J.), and University Hospital Birmingham (A.Z.), Birmingham, the Institute of Cancer Research (J.S.B., D.P.D., G.A.), Medical Research Council Clinical Trials Unit at University College London (M.R. Spears, C.L.A., C.G., C.B., M.K.B.P., M.R. Sydes), King's College London and Guy's and St. Thomas' NHS Foundation Trust (S.C.), and Royal Marsden NHS Foundation Trust (C.C.P.), London, Salford Royal NHS Foundation Trust, Salford (N.W.C.), Cardiff University School of Medicine (M.D.M.) and Velindre Cancer Centre (J.F.L.), Cardiff, Gloucestershire Royal Hospital (A.W.S.R.) and Gloucestershire Hospitals NHS Foundation Trust (J.B.), Gloucester, University of Glasgow, Glasgow (R.J.J., J.M.R.), St. James's University Hospital, Leeds (W.R.C.), University Hospital of North-Midlands, Stoke-on-Trent (F.A.), Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter (S.A.), Rosemere Cancer Centre, Royal Preston Hospital, Preston (A.J.B.), Dorset Cancer Centre, Poole Hospital, Poole (S.B.), Royal Derby Hospital, Derby (P.C.), Weston Park Hospital, Sheffield (C.F.), Portsmouth Oncology Centre, Queen Alexandra Hospital, Portsmouth (J.G.), Musgrove Park Hospital, Taunton (E.G.), Hull and East Yorkshire Hospitals NHS Trust, Hull (M.H.), Mount Vernon Cancer Centre, Northwood (P.J.H.), Clatterbridge Cancer Centre, Wirral (Z.I.M.), Brighton and Sussex University Hospitals NHS Trust (F.M.) and Sussex Cancer Centre, Royal Sussex County Hospital (A.R.), Brighton, NHS Highland, Inverness (N.M.), Royal Surrey County Hospital, Guildford (J.M.-K.), Northern Ireland Cancer and Queens University, Belfast (J.O.), Lancashire Teaching Hospitals NHS Trust, Preston (O.P.), Churchill Hospital, Oxford (A.P.), Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury (N.N.S.), East Kent Hospitals NHS Trust, Canterbury (C.T.), Swansea University College of Medicine, Swansea (J. Wagstaff), and Christie NHS Foundation Trust, Manchester (J. Wylie) - all in the United Kingdom; and the Department of Medical Oncology, Kantonsspital St. Gallen, St. Gallen (S.G.), and University Hospital of Lausanne, Lausanne (D.R.B.) - both in Switzerland. Two of the authors (D.M., R.M.) were unaffiliated lay members of the STAMPEDE investigators
| | - Jo Bowen
- From the Institute of Cancer and Genomic Sciences, University of Birmingham (N.D.J.), and University Hospital Birmingham (A.Z.), Birmingham, the Institute of Cancer Research (J.S.B., D.P.D., G.A.), Medical Research Council Clinical Trials Unit at University College London (M.R. Spears, C.L.A., C.G., C.B., M.K.B.P., M.R. Sydes), King's College London and Guy's and St. Thomas' NHS Foundation Trust (S.C.), and Royal Marsden NHS Foundation Trust (C.C.P.), London, Salford Royal NHS Foundation Trust, Salford (N.W.C.), Cardiff University School of Medicine (M.D.M.) and Velindre Cancer Centre (J.F.L.), Cardiff, Gloucestershire Royal Hospital (A.W.S.R.) and Gloucestershire Hospitals NHS Foundation Trust (J.B.), Gloucester, University of Glasgow, Glasgow (R.J.J., J.M.R.), St. James's University Hospital, Leeds (W.R.C.), University Hospital of North-Midlands, Stoke-on-Trent (F.A.), Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter (S.A.), Rosemere Cancer Centre, Royal Preston Hospital, Preston (A.J.B.), Dorset Cancer Centre, Poole Hospital, Poole (S.B.), Royal Derby Hospital, Derby (P.C.), Weston Park Hospital, Sheffield (C.F.), Portsmouth Oncology Centre, Queen Alexandra Hospital, Portsmouth (J.G.), Musgrove Park Hospital, Taunton (E.G.), Hull and East Yorkshire Hospitals NHS Trust, Hull (M.H.), Mount Vernon Cancer Centre, Northwood (P.J.H.), Clatterbridge Cancer Centre, Wirral (Z.I.M.), Brighton and Sussex University Hospitals NHS Trust (F.M.) and Sussex Cancer Centre, Royal Sussex County Hospital (A.R.), Brighton, NHS Highland, Inverness (N.M.), Royal Surrey County Hospital, Guildford (J.M.-K.), Northern Ireland Cancer and Queens University, Belfast (J.O.), Lancashire Teaching Hospitals NHS Trust, Preston (O.P.), Churchill Hospital, Oxford (A.P.), Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury (N.N.S.), East Kent Hospitals NHS Trust, Canterbury (C.T.), Swansea University College of Medicine, Swansea (J. Wagstaff), and Christie NHS Foundation Trust, Manchester (J. Wylie) - all in the United Kingdom; and the Department of Medical Oncology, Kantonsspital St. Gallen, St. Gallen (S.G.), and University Hospital of Lausanne, Lausanne (D.R.B.) - both in Switzerland. Two of the authors (D.M., R.M.) were unaffiliated lay members of the STAMPEDE investigators
| | - Susannah Brock
- From the Institute of Cancer and Genomic Sciences, University of Birmingham (N.D.J.), and University Hospital Birmingham (A.Z.), Birmingham, the Institute of Cancer Research (J.S.B., D.P.D., G.A.), Medical Research Council Clinical Trials Unit at University College London (M.R. Spears, C.L.A., C.G., C.B., M.K.B.P., M.R. Sydes), King's College London and Guy's and St. Thomas' NHS Foundation Trust (S.C.), and Royal Marsden NHS Foundation Trust (C.C.P.), London, Salford Royal NHS Foundation Trust, Salford (N.W.C.), Cardiff University School of Medicine (M.D.M.) and Velindre Cancer Centre (J.F.L.), Cardiff, Gloucestershire Royal Hospital (A.W.S.R.) and Gloucestershire Hospitals NHS Foundation Trust (J.B.), Gloucester, University of Glasgow, Glasgow (R.J.J., J.M.R.), St. James's University Hospital, Leeds (W.R.C.), University Hospital of North-Midlands, Stoke-on-Trent (F.A.), Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter (S.A.), Rosemere Cancer Centre, Royal Preston Hospital, Preston (A.J.B.), Dorset Cancer Centre, Poole Hospital, Poole (S.B.), Royal Derby Hospital, Derby (P.C.), Weston Park Hospital, Sheffield (C.F.), Portsmouth Oncology Centre, Queen Alexandra Hospital, Portsmouth (J.G.), Musgrove Park Hospital, Taunton (E.G.), Hull and East Yorkshire Hospitals NHS Trust, Hull (M.H.), Mount Vernon Cancer Centre, Northwood (P.J.H.), Clatterbridge Cancer Centre, Wirral (Z.I.M.), Brighton and Sussex University Hospitals NHS Trust (F.M.) and Sussex Cancer Centre, Royal Sussex County Hospital (A.R.), Brighton, NHS Highland, Inverness (N.M.), Royal Surrey County Hospital, Guildford (J.M.-K.), Northern Ireland Cancer and Queens University, Belfast (J.O.), Lancashire Teaching Hospitals NHS Trust, Preston (O.P.), Churchill Hospital, Oxford (A.P.), Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury (N.N.S.), East Kent Hospitals NHS Trust, Canterbury (C.T.), Swansea University College of Medicine, Swansea (J. Wagstaff), and Christie NHS Foundation Trust, Manchester (J. Wylie) - all in the United Kingdom; and the Department of Medical Oncology, Kantonsspital St. Gallen, St. Gallen (S.G.), and University Hospital of Lausanne, Lausanne (D.R.B.) - both in Switzerland. Two of the authors (D.M., R.M.) were unaffiliated lay members of the STAMPEDE investigators
| | - Prabir Chakraborti
- From the Institute of Cancer and Genomic Sciences, University of Birmingham (N.D.J.), and University Hospital Birmingham (A.Z.), Birmingham, the Institute of Cancer Research (J.S.B., D.P.D., G.A.), Medical Research Council Clinical Trials Unit at University College London (M.R. Spears, C.L.A., C.G., C.B., M.K.B.P., M.R. Sydes), King's College London and Guy's and St. Thomas' NHS Foundation Trust (S.C.), and Royal Marsden NHS Foundation Trust (C.C.P.), London, Salford Royal NHS Foundation Trust, Salford (N.W.C.), Cardiff University School of Medicine (M.D.M.) and Velindre Cancer Centre (J.F.L.), Cardiff, Gloucestershire Royal Hospital (A.W.S.R.) and Gloucestershire Hospitals NHS Foundation Trust (J.B.), Gloucester, University of Glasgow, Glasgow (R.J.J., J.M.R.), St. James's University Hospital, Leeds (W.R.C.), University Hospital of North-Midlands, Stoke-on-Trent (F.A.), Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter (S.A.), Rosemere Cancer Centre, Royal Preston Hospital, Preston (A.J.B.), Dorset Cancer Centre, Poole Hospital, Poole (S.B.), Royal Derby Hospital, Derby (P.C.), Weston Park Hospital, Sheffield (C.F.), Portsmouth Oncology Centre, Queen Alexandra Hospital, Portsmouth (J.G.), Musgrove Park Hospital, Taunton (E.G.), Hull and East Yorkshire Hospitals NHS Trust, Hull (M.H.), Mount Vernon Cancer Centre, Northwood (P.J.H.), Clatterbridge Cancer Centre, Wirral (Z.I.M.), Brighton and Sussex University Hospitals NHS Trust (F.M.) and Sussex Cancer Centre, Royal Sussex County Hospital (A.R.), Brighton, NHS Highland, Inverness (N.M.), Royal Surrey County Hospital, Guildford (J.M.-K.), Northern Ireland Cancer and Queens University, Belfast (J.O.), Lancashire Teaching Hospitals NHS Trust, Preston (O.P.), Churchill Hospital, Oxford (A.P.), Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury (N.N.S.), East Kent Hospitals NHS Trust, Canterbury (C.T.), Swansea University College of Medicine, Swansea (J. Wagstaff), and Christie NHS Foundation Trust, Manchester (J. Wylie) - all in the United Kingdom; and the Department of Medical Oncology, Kantonsspital St. Gallen, St. Gallen (S.G.), and University Hospital of Lausanne, Lausanne (D.R.B.) - both in Switzerland. Two of the authors (D.M., R.M.) were unaffiliated lay members of the STAMPEDE investigators
| | - Catherine Ferguson
- From the Institute of Cancer and Genomic Sciences, University of Birmingham (N.D.J.), and University Hospital Birmingham (A.Z.), Birmingham, the Institute of Cancer Research (J.S.B., D.P.D., G.A.), Medical Research Council Clinical Trials Unit at University College London (M.R. Spears, C.L.A., C.G., C.B., M.K.B.P., M.R. Sydes), King's College London and Guy's and St. Thomas' NHS Foundation Trust (S.C.), and Royal Marsden NHS Foundation Trust (C.C.P.), London, Salford Royal NHS Foundation Trust, Salford (N.W.C.), Cardiff University School of Medicine (M.D.M.) and Velindre Cancer Centre (J.F.L.), Cardiff, Gloucestershire Royal Hospital (A.W.S.R.) and Gloucestershire Hospitals NHS Foundation Trust (J.B.), Gloucester, University of Glasgow, Glasgow (R.J.J., J.M.R.), St. James's University Hospital, Leeds (W.R.C.), University Hospital of North-Midlands, Stoke-on-Trent (F.A.), Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter (S.A.), Rosemere Cancer Centre, Royal Preston Hospital, Preston (A.J.B.), Dorset Cancer Centre, Poole Hospital, Poole (S.B.), Royal Derby Hospital, Derby (P.C.), Weston Park Hospital, Sheffield (C.F.), Portsmouth Oncology Centre, Queen Alexandra Hospital, Portsmouth (J.G.), Musgrove Park Hospital, Taunton (E.G.), Hull and East Yorkshire Hospitals NHS Trust, Hull (M.H.), Mount Vernon Cancer Centre, Northwood (P.J.H.), Clatterbridge Cancer Centre, Wirral (Z.I.M.), Brighton and Sussex University Hospitals NHS Trust (F.M.) and Sussex Cancer Centre, Royal Sussex County Hospital (A.R.), Brighton, NHS Highland, Inverness (N.M.), Royal Surrey County Hospital, Guildford (J.M.-K.), Northern Ireland Cancer and Queens University, Belfast (J.O.), Lancashire Teaching Hospitals NHS Trust, Preston (O.P.), Churchill Hospital, Oxford (A.P.), Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury (N.N.S.), East Kent Hospitals NHS Trust, Canterbury (C.T.), Swansea University College of Medicine, Swansea (J. Wagstaff), and Christie NHS Foundation Trust, Manchester (J. Wylie) - all in the United Kingdom; and the Department of Medical Oncology, Kantonsspital St. Gallen, St. Gallen (S.G.), and University Hospital of Lausanne, Lausanne (D.R.B.) - both in Switzerland. Two of the authors (D.M., R.M.) were unaffiliated lay members of the STAMPEDE investigators
| | - Joanna Gale
- From the Institute of Cancer and Genomic Sciences, University of Birmingham (N.D.J.), and University Hospital Birmingham (A.Z.), Birmingham, the Institute of Cancer Research (J.S.B., D.P.D., G.A.), Medical Research Council Clinical Trials Unit at University College London (M.R. Spears, C.L.A., C.G., C.B., M.K.B.P., M.R. Sydes), King's College London and Guy's and St. Thomas' NHS Foundation Trust (S.C.), and Royal Marsden NHS Foundation Trust (C.C.P.), London, Salford Royal NHS Foundation Trust, Salford (N.W.C.), Cardiff University School of Medicine (M.D.M.) and Velindre Cancer Centre (J.F.L.), Cardiff, Gloucestershire Royal Hospital (A.W.S.R.) and Gloucestershire Hospitals NHS Foundation Trust (J.B.), Gloucester, University of Glasgow, Glasgow (R.J.J., J.M.R.), St. James's University Hospital, Leeds (W.R.C.), University Hospital of North-Midlands, Stoke-on-Trent (F.A.), Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter (S.A.), Rosemere Cancer Centre, Royal Preston Hospital, Preston (A.J.B.), Dorset Cancer Centre, Poole Hospital, Poole (S.B.), Royal Derby Hospital, Derby (P.C.), Weston Park Hospital, Sheffield (C.F.), Portsmouth Oncology Centre, Queen Alexandra Hospital, Portsmouth (J.G.), Musgrove Park Hospital, Taunton (E.G.), Hull and East Yorkshire Hospitals NHS Trust, Hull (M.H.), Mount Vernon Cancer Centre, Northwood (P.J.H.), Clatterbridge Cancer Centre, Wirral (Z.I.M.), Brighton and Sussex University Hospitals NHS Trust (F.M.) and Sussex Cancer Centre, Royal Sussex County Hospital (A.R.), Brighton, NHS Highland, Inverness (N.M.), Royal Surrey County Hospital, Guildford (J.M.-K.), Northern Ireland Cancer and Queens University, Belfast (J.O.), Lancashire Teaching Hospitals NHS Trust, Preston (O.P.), Churchill Hospital, Oxford (A.P.), Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury (N.N.S.), East Kent Hospitals NHS Trust, Canterbury (C.T.), Swansea University College of Medicine, Swansea (J. Wagstaff), and Christie NHS Foundation Trust, Manchester (J. Wylie) - all in the United Kingdom; and the Department of Medical Oncology, Kantonsspital St. Gallen, St. Gallen (S.G.), and University Hospital of Lausanne, Lausanne (D.R.B.) - both in Switzerland. Two of the authors (D.M., R.M.) were unaffiliated lay members of the STAMPEDE investigators
| | - Emma Gray
- From the Institute of Cancer and Genomic Sciences, University of Birmingham (N.D.J.), and University Hospital Birmingham (A.Z.), Birmingham, the Institute of Cancer Research (J.S.B., D.P.D., G.A.), Medical Research Council Clinical Trials Unit at University College London (M.R. Spears, C.L.A., C.G., C.B., M.K.B.P., M.R. Sydes), King's College London and Guy's and St. Thomas' NHS Foundation Trust (S.C.), and Royal Marsden NHS Foundation Trust (C.C.P.), London, Salford Royal NHS Foundation Trust, Salford (N.W.C.), Cardiff University School of Medicine (M.D.M.) and Velindre Cancer Centre (J.F.L.), Cardiff, Gloucestershire Royal Hospital (A.W.S.R.) and Gloucestershire Hospitals NHS Foundation Trust (J.B.), Gloucester, University of Glasgow, Glasgow (R.J.J., J.M.R.), St. James's University Hospital, Leeds (W.R.C.), University Hospital of North-Midlands, Stoke-on-Trent (F.A.), Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter (S.A.), Rosemere Cancer Centre, Royal Preston Hospital, Preston (A.J.B.), Dorset Cancer Centre, Poole Hospital, Poole (S.B.), Royal Derby Hospital, Derby (P.C.), Weston Park Hospital, Sheffield (C.F.), Portsmouth Oncology Centre, Queen Alexandra Hospital, Portsmouth (J.G.), Musgrove Park Hospital, Taunton (E.G.), Hull and East Yorkshire Hospitals NHS Trust, Hull (M.H.), Mount Vernon Cancer Centre, Northwood (P.J.H.), Clatterbridge Cancer Centre, Wirral (Z.I.M.), Brighton and Sussex University Hospitals NHS Trust (F.M.) and Sussex Cancer Centre, Royal Sussex County Hospital (A.R.), Brighton, NHS Highland, Inverness (N.M.), Royal Surrey County Hospital, Guildford (J.M.-K.), Northern Ireland Cancer and Queens University, Belfast (J.O.), Lancashire Teaching Hospitals NHS Trust, Preston (O.P.), Churchill Hospital, Oxford (A.P.), Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury (N.N.S.), East Kent Hospitals NHS Trust, Canterbury (C.T.), Swansea University College of Medicine, Swansea (J. Wagstaff), and Christie NHS Foundation Trust, Manchester (J. Wylie) - all in the United Kingdom; and the Department of Medical Oncology, Kantonsspital St. Gallen, St. Gallen (S.G.), and University Hospital of Lausanne, Lausanne (D.R.B.) - both in Switzerland. Two of the authors (D.M., R.M.) were unaffiliated lay members of the STAMPEDE investigators
| | - Mohan Hingorani
- From the Institute of Cancer and Genomic Sciences, University of Birmingham (N.D.J.), and University Hospital Birmingham (A.Z.), Birmingham, the Institute of Cancer Research (J.S.B., D.P.D., G.A.), Medical Research Council Clinical Trials Unit at University College London (M.R. Spears, C.L.A., C.G., C.B., M.K.B.P., M.R. Sydes), King's College London and Guy's and St. Thomas' NHS Foundation Trust (S.C.), and Royal Marsden NHS Foundation Trust (C.C.P.), London, Salford Royal NHS Foundation Trust, Salford (N.W.C.), Cardiff University School of Medicine (M.D.M.) and Velindre Cancer Centre (J.F.L.), Cardiff, Gloucestershire Royal Hospital (A.W.S.R.) and Gloucestershire Hospitals NHS Foundation Trust (J.B.), Gloucester, University of Glasgow, Glasgow (R.J.J., J.M.R.), St. James's University Hospital, Leeds (W.R.C.), University Hospital of North-Midlands, Stoke-on-Trent (F.A.), Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter (S.A.), Rosemere Cancer Centre, Royal Preston Hospital, Preston (A.J.B.), Dorset Cancer Centre, Poole Hospital, Poole (S.B.), Royal Derby Hospital, Derby (P.C.), Weston Park Hospital, Sheffield (C.F.), Portsmouth Oncology Centre, Queen Alexandra Hospital, Portsmouth (J.G.), Musgrove Park Hospital, Taunton (E.G.), Hull and East Yorkshire Hospitals NHS Trust, Hull (M.H.), Mount Vernon Cancer Centre, Northwood (P.J.H.), Clatterbridge Cancer Centre, Wirral (Z.I.M.), Brighton and Sussex University Hospitals NHS Trust (F.M.) and Sussex Cancer Centre, Royal Sussex County Hospital (A.R.), Brighton, NHS Highland, Inverness (N.M.), Royal Surrey County Hospital, Guildford (J.M.-K.), Northern Ireland Cancer and Queens University, Belfast (J.O.), Lancashire Teaching Hospitals NHS Trust, Preston (O.P.), Churchill Hospital, Oxford (A.P.), Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury (N.N.S.), East Kent Hospitals NHS Trust, Canterbury (C.T.), Swansea University College of Medicine, Swansea (J. Wagstaff), and Christie NHS Foundation Trust, Manchester (J. Wylie) - all in the United Kingdom; and the Department of Medical Oncology, Kantonsspital St. Gallen, St. Gallen (S.G.), and University Hospital of Lausanne, Lausanne (D.R.B.) - both in Switzerland. Two of the authors (D.M., R.M.) were unaffiliated lay members of the STAMPEDE investigators
| | - Peter J Hoskin
- From the Institute of Cancer and Genomic Sciences, University of Birmingham (N.D.J.), and University Hospital Birmingham (A.Z.), Birmingham, the Institute of Cancer Research (J.S.B., D.P.D., G.A.), Medical Research Council Clinical Trials Unit at University College London (M.R. Spears, C.L.A., C.G., C.B., M.K.B.P., M.R. Sydes), King's College London and Guy's and St. Thomas' NHS Foundation Trust (S.C.), and Royal Marsden NHS Foundation Trust (C.C.P.), London, Salford Royal NHS Foundation Trust, Salford (N.W.C.), Cardiff University School of Medicine (M.D.M.) and Velindre Cancer Centre (J.F.L.), Cardiff, Gloucestershire Royal Hospital (A.W.S.R.) and Gloucestershire Hospitals NHS Foundation Trust (J.B.), Gloucester, University of Glasgow, Glasgow (R.J.J., J.M.R.), St. James's University Hospital, Leeds (W.R.C.), University Hospital of North-Midlands, Stoke-on-Trent (F.A.), Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter (S.A.), Rosemere Cancer Centre, Royal Preston Hospital, Preston (A.J.B.), Dorset Cancer Centre, Poole Hospital, Poole (S.B.), Royal Derby Hospital, Derby (P.C.), Weston Park Hospital, Sheffield (C.F.), Portsmouth Oncology Centre, Queen Alexandra Hospital, Portsmouth (J.G.), Musgrove Park Hospital, Taunton (E.G.), Hull and East Yorkshire Hospitals NHS Trust, Hull (M.H.), Mount Vernon Cancer Centre, Northwood (P.J.H.), Clatterbridge Cancer Centre, Wirral (Z.I.M.), Brighton and Sussex University Hospitals NHS Trust (F.M.) and Sussex Cancer Centre, Royal Sussex County Hospital (A.R.), Brighton, NHS Highland, Inverness (N.M.), Royal Surrey County Hospital, Guildford (J.M.-K.), Northern Ireland Cancer and Queens University, Belfast (J.O.), Lancashire Teaching Hospitals NHS Trust, Preston (O.P.), Churchill Hospital, Oxford (A.P.), Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury (N.N.S.), East Kent Hospitals NHS Trust, Canterbury (C.T.), Swansea University College of Medicine, Swansea (J. Wagstaff), and Christie NHS Foundation Trust, Manchester (J. Wylie) - all in the United Kingdom; and the Department of Medical Oncology, Kantonsspital St. Gallen, St. Gallen (S.G.), and University Hospital of Lausanne, Lausanne (D.R.B.) - both in Switzerland. Two of the authors (D.M., R.M.) were unaffiliated lay members of the STAMPEDE investigators
| | - Jason F Lester
- From the Institute of Cancer and Genomic Sciences, University of Birmingham (N.D.J.), and University Hospital Birmingham (A.Z.), Birmingham, the Institute of Cancer Research (J.S.B., D.P.D., G.A.), Medical Research Council Clinical Trials Unit at University College London (M.R. Spears, C.L.A., C.G., C.B., M.K.B.P., M.R. Sydes), King's College London and Guy's and St. Thomas' NHS Foundation Trust (S.C.), and Royal Marsden NHS Foundation Trust (C.C.P.), London, Salford Royal NHS Foundation Trust, Salford (N.W.C.), Cardiff University School of Medicine (M.D.M.) and Velindre Cancer Centre (J.F.L.), Cardiff, Gloucestershire Royal Hospital (A.W.S.R.) and Gloucestershire Hospitals NHS Foundation Trust (J.B.), Gloucester, University of Glasgow, Glasgow (R.J.J., J.M.R.), St. James's University Hospital, Leeds (W.R.C.), University Hospital of North-Midlands, Stoke-on-Trent (F.A.), Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter (S.A.), Rosemere Cancer Centre, Royal Preston Hospital, Preston (A.J.B.), Dorset Cancer Centre, Poole Hospital, Poole (S.B.), Royal Derby Hospital, Derby (P.C.), Weston Park Hospital, Sheffield (C.F.), Portsmouth Oncology Centre, Queen Alexandra Hospital, Portsmouth (J.G.), Musgrove Park Hospital, Taunton (E.G.), Hull and East Yorkshire Hospitals NHS Trust, Hull (M.H.), Mount Vernon Cancer Centre, Northwood (P.J.H.), Clatterbridge Cancer Centre, Wirral (Z.I.M.), Brighton and Sussex University Hospitals NHS Trust (F.M.) and Sussex Cancer Centre, Royal Sussex County Hospital (A.R.), Brighton, NHS Highland, Inverness (N.M.), Royal Surrey County Hospital, Guildford (J.M.-K.), Northern Ireland Cancer and Queens University, Belfast (J.O.), Lancashire Teaching Hospitals NHS Trust, Preston (O.P.), Churchill Hospital, Oxford (A.P.), Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury (N.N.S.), East Kent Hospitals NHS Trust, Canterbury (C.T.), Swansea University College of Medicine, Swansea (J. Wagstaff), and Christie NHS Foundation Trust, Manchester (J. Wylie) - all in the United Kingdom; and the Department of Medical Oncology, Kantonsspital St. Gallen, St. Gallen (S.G.), and University Hospital of Lausanne, Lausanne (D.R.B.) - both in Switzerland. Two of the authors (D.M., R.M.) were unaffiliated lay members of the STAMPEDE investigators
| | - Zafar I Malik
- From the Institute of Cancer and Genomic Sciences, University of Birmingham (N.D.J.), and University Hospital Birmingham (A.Z.), Birmingham, the Institute of Cancer Research (J.S.B., D.P.D., G.A.), Medical Research Council Clinical Trials Unit at University College London (M.R. Spears, C.L.A., C.G., C.B., M.K.B.P., M.R. Sydes), King's College London and Guy's and St. Thomas' NHS Foundation Trust (S.C.), and Royal Marsden NHS Foundation Trust (C.C.P.), London, Salford Royal NHS Foundation Trust, Salford (N.W.C.), Cardiff University School of Medicine (M.D.M.) and Velindre Cancer Centre (J.F.L.), Cardiff, Gloucestershire Royal Hospital (A.W.S.R.) and Gloucestershire Hospitals NHS Foundation Trust (J.B.), Gloucester, University of Glasgow, Glasgow (R.J.J., J.M.R.), St. James's University Hospital, Leeds (W.R.C.), University Hospital of North-Midlands, Stoke-on-Trent (F.A.), Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter (S.A.), Rosemere Cancer Centre, Royal Preston Hospital, Preston (A.J.B.), Dorset Cancer Centre, Poole Hospital, Poole (S.B.), Royal Derby Hospital, Derby (P.C.), Weston Park Hospital, Sheffield (C.F.), Portsmouth Oncology Centre, Queen Alexandra Hospital, Portsmouth (J.G.), Musgrove Park Hospital, Taunton (E.G.), Hull and East Yorkshire Hospitals NHS Trust, Hull (M.H.), Mount Vernon Cancer Centre, Northwood (P.J.H.), Clatterbridge Cancer Centre, Wirral (Z.I.M.), Brighton and Sussex University Hospitals NHS Trust (F.M.) and Sussex Cancer Centre, Royal Sussex County Hospital (A.R.), Brighton, NHS Highland, Inverness (N.M.), Royal Surrey County Hospital, Guildford (J.M.-K.), Northern Ireland Cancer and Queens University, Belfast (J.O.), Lancashire Teaching Hospitals NHS Trust, Preston (O.P.), Churchill Hospital, Oxford (A.P.), Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury (N.N.S.), East Kent Hospitals NHS Trust, Canterbury (C.T.), Swansea University College of Medicine, Swansea (J. Wagstaff), and Christie NHS Foundation Trust, Manchester (J. Wylie) - all in the United Kingdom; and the Department of Medical Oncology, Kantonsspital St. Gallen, St. Gallen (S.G.), and University Hospital of Lausanne, Lausanne (D.R.B.) - both in Switzerland. Two of the authors (D.M., R.M.) were unaffiliated lay members of the STAMPEDE investigators
| | - Fiona McKinna
- From the Institute of Cancer and Genomic Sciences, University of Birmingham (N.D.J.), and University Hospital Birmingham (A.Z.), Birmingham, the Institute of Cancer Research (J.S.B., D.P.D., G.A.), Medical Research Council Clinical Trials Unit at University College London (M.R. Spears, C.L.A., C.G., C.B., M.K.B.P., M.R. Sydes), King's College London and Guy's and St. Thomas' NHS Foundation Trust (S.C.), and Royal Marsden NHS Foundation Trust (C.C.P.), London, Salford Royal NHS Foundation Trust, Salford (N.W.C.), Cardiff University School of Medicine (M.D.M.) and Velindre Cancer Centre (J.F.L.), Cardiff, Gloucestershire Royal Hospital (A.W.S.R.) and Gloucestershire Hospitals NHS Foundation Trust (J.B.), Gloucester, University of Glasgow, Glasgow (R.J.J., J.M.R.), St. James's University Hospital, Leeds (W.R.C.), University Hospital of North-Midlands, Stoke-on-Trent (F.A.), Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter (S.A.), Rosemere Cancer Centre, Royal Preston Hospital, Preston (A.J.B.), Dorset Cancer Centre, Poole Hospital, Poole (S.B.), Royal Derby Hospital, Derby (P.C.), Weston Park Hospital, Sheffield (C.F.), Portsmouth Oncology Centre, Queen Alexandra Hospital, Portsmouth (J.G.), Musgrove Park Hospital, Taunton (E.G.), Hull and East Yorkshire Hospitals NHS Trust, Hull (M.H.), Mount Vernon Cancer Centre, Northwood (P.J.H.), Clatterbridge Cancer Centre, Wirral (Z.I.M.), Brighton and Sussex University Hospitals NHS Trust (F.M.) and Sussex Cancer Centre, Royal Sussex County Hospital (A.R.), Brighton, NHS Highland, Inverness (N.M.), Royal Surrey County Hospital, Guildford (J.M.-K.), Northern Ireland Cancer and Queens University, Belfast (J.O.), Lancashire Teaching Hospitals NHS Trust, Preston (O.P.), Churchill Hospital, Oxford (A.P.), Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury (N.N.S.), East Kent Hospitals NHS Trust, Canterbury (C.T.), Swansea University College of Medicine, Swansea (J. Wagstaff), and Christie NHS Foundation Trust, Manchester (J. Wylie) - all in the United Kingdom; and the Department of Medical Oncology, Kantonsspital St. Gallen, St. Gallen (S.G.), and University Hospital of Lausanne, Lausanne (D.R.B.) - both in Switzerland. Two of the authors (D.M., R.M.) were unaffiliated lay members of the STAMPEDE investigators
| | - Neil McPhail
- From the Institute of Cancer and Genomic Sciences, University of Birmingham (N.D.J.), and University Hospital Birmingham (A.Z.), Birmingham, the Institute of Cancer Research (J.S.B., D.P.D., G.A.), Medical Research Council Clinical Trials Unit at University College London (M.R. Spears, C.L.A., C.G., C.B., M.K.B.P., M.R. Sydes), King's College London and Guy's and St. Thomas' NHS Foundation Trust (S.C.), and Royal Marsden NHS Foundation Trust (C.C.P.), London, Salford Royal NHS Foundation Trust, Salford (N.W.C.), Cardiff University School of Medicine (M.D.M.) and Velindre Cancer Centre (J.F.L.), Cardiff, Gloucestershire Royal Hospital (A.W.S.R.) and Gloucestershire Hospitals NHS Foundation Trust (J.B.), Gloucester, University of Glasgow, Glasgow (R.J.J., J.M.R.), St. James's University Hospital, Leeds (W.R.C.), University Hospital of North-Midlands, Stoke-on-Trent (F.A.), Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter (S.A.), Rosemere Cancer Centre, Royal Preston Hospital, Preston (A.J.B.), Dorset Cancer Centre, Poole Hospital, Poole (S.B.), Royal Derby Hospital, Derby (P.C.), Weston Park Hospital, Sheffield (C.F.), Portsmouth Oncology Centre, Queen Alexandra Hospital, Portsmouth (J.G.), Musgrove Park Hospital, Taunton (E.G.), Hull and East Yorkshire Hospitals NHS Trust, Hull (M.H.), Mount Vernon Cancer Centre, Northwood (P.J.H.), Clatterbridge Cancer Centre, Wirral (Z.I.M.), Brighton and Sussex University Hospitals NHS Trust (F.M.) and Sussex Cancer Centre, Royal Sussex County Hospital (A.R.), Brighton, NHS Highland, Inverness (N.M.), Royal Surrey County Hospital, Guildford (J.M.-K.), Northern Ireland Cancer and Queens University, Belfast (J.O.), Lancashire Teaching Hospitals NHS Trust, Preston (O.P.), Churchill Hospital, Oxford (A.P.), Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury (N.N.S.), East Kent Hospitals NHS Trust, Canterbury (C.T.), Swansea University College of Medicine, Swansea (J. Wagstaff), and Christie NHS Foundation Trust, Manchester (J. Wylie) - all in the United Kingdom; and the Department of Medical Oncology, Kantonsspital St. Gallen, St. Gallen (S.G.), and University Hospital of Lausanne, Lausanne (D.R.B.) - both in Switzerland. Two of the authors (D.M., R.M.) were unaffiliated lay members of the STAMPEDE investigators
| | - Julian Money-Kyrle
- From the Institute of Cancer and Genomic Sciences, University of Birmingham (N.D.J.), and University Hospital Birmingham (A.Z.), Birmingham, the Institute of Cancer Research (J.S.B., D.P.D., G.A.), Medical Research Council Clinical Trials Unit at University College London (M.R. Spears, C.L.A., C.G., C.B., M.K.B.P., M.R. Sydes), King's College London and Guy's and St. Thomas' NHS Foundation Trust (S.C.), and Royal Marsden NHS Foundation Trust (C.C.P.), London, Salford Royal NHS Foundation Trust, Salford (N.W.C.), Cardiff University School of Medicine (M.D.M.) and Velindre Cancer Centre (J.F.L.), Cardiff, Gloucestershire Royal Hospital (A.W.S.R.) and Gloucestershire Hospitals NHS Foundation Trust (J.B.), Gloucester, University of Glasgow, Glasgow (R.J.J., J.M.R.), St. James's University Hospital, Leeds (W.R.C.), University Hospital of North-Midlands, Stoke-on-Trent (F.A.), Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter (S.A.), Rosemere Cancer Centre, Royal Preston Hospital, Preston (A.J.B.), Dorset Cancer Centre, Poole Hospital, Poole (S.B.), Royal Derby Hospital, Derby (P.C.), Weston Park Hospital, Sheffield (C.F.), Portsmouth Oncology Centre, Queen Alexandra Hospital, Portsmouth (J.G.), Musgrove Park Hospital, Taunton (E.G.), Hull and East Yorkshire Hospitals NHS Trust, Hull (M.H.), Mount Vernon Cancer Centre, Northwood (P.J.H.), Clatterbridge Cancer Centre, Wirral (Z.I.M.), Brighton and Sussex University Hospitals NHS Trust (F.M.) and Sussex Cancer Centre, Royal Sussex County Hospital (A.R.), Brighton, NHS Highland, Inverness (N.M.), Royal Surrey County Hospital, Guildford (J.M.-K.), Northern Ireland Cancer and Queens University, Belfast (J.O.), Lancashire Teaching Hospitals NHS Trust, Preston (O.P.), Churchill Hospital, Oxford (A.P.), Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury (N.N.S.), East Kent Hospitals NHS Trust, Canterbury (C.T.), Swansea University College of Medicine, Swansea (J. Wagstaff), and Christie NHS Foundation Trust, Manchester (J. Wylie) - all in the United Kingdom; and the Department of Medical Oncology, Kantonsspital St. Gallen, St. Gallen (S.G.), and University Hospital of Lausanne, Lausanne (D.R.B.) - both in Switzerland. Two of the authors (D.M., R.M.) were unaffiliated lay members of the STAMPEDE investigators
| | - Joe O'Sullivan
- From the Institute of Cancer and Genomic Sciences, University of Birmingham (N.D.J.), and University Hospital Birmingham (A.Z.), Birmingham, the Institute of Cancer Research (J.S.B., D.P.D., G.A.), Medical Research Council Clinical Trials Unit at University College London (M.R. Spears, C.L.A., C.G., C.B., M.K.B.P., M.R. Sydes), King's College London and Guy's and St. Thomas' NHS Foundation Trust (S.C.), and Royal Marsden NHS Foundation Trust (C.C.P.), London, Salford Royal NHS Foundation Trust, Salford (N.W.C.), Cardiff University School of Medicine (M.D.M.) and Velindre Cancer Centre (J.F.L.), Cardiff, Gloucestershire Royal Hospital (A.W.S.R.) and Gloucestershire Hospitals NHS Foundation Trust (J.B.), Gloucester, University of Glasgow, Glasgow (R.J.J., J.M.R.), St. James's University Hospital, Leeds (W.R.C.), University Hospital of North-Midlands, Stoke-on-Trent (F.A.), Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter (S.A.), Rosemere Cancer Centre, Royal Preston Hospital, Preston (A.J.B.), Dorset Cancer Centre, Poole Hospital, Poole (S.B.), Royal Derby Hospital, Derby (P.C.), Weston Park Hospital, Sheffield (C.F.), Portsmouth Oncology Centre, Queen Alexandra Hospital, Portsmouth (J.G.), Musgrove Park Hospital, Taunton (E.G.), Hull and East Yorkshire Hospitals NHS Trust, Hull (M.H.), Mount Vernon Cancer Centre, Northwood (P.J.H.), Clatterbridge Cancer Centre, Wirral (Z.I.M.), Brighton and Sussex University Hospitals NHS Trust (F.M.) and Sussex Cancer Centre, Royal Sussex County Hospital (A.R.), Brighton, NHS Highland, Inverness (N.M.), Royal Surrey County Hospital, Guildford (J.M.-K.), Northern Ireland Cancer and Queens University, Belfast (J.O.), Lancashire Teaching Hospitals NHS Trust, Preston (O.P.), Churchill Hospital, Oxford (A.P.), Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury (N.N.S.), East Kent Hospitals NHS Trust, Canterbury (C.T.), Swansea University College of Medicine, Swansea (J. Wagstaff), and Christie NHS Foundation Trust, Manchester (J. Wylie) - all in the United Kingdom; and the Department of Medical Oncology, Kantonsspital St. Gallen, St. Gallen (S.G.), and University Hospital of Lausanne, Lausanne (D.R.B.) - both in Switzerland. Two of the authors (D.M., R.M.) were unaffiliated lay members of the STAMPEDE investigators
| | - Omi Parikh
- From the Institute of Cancer and Genomic Sciences, University of Birmingham (N.D.J.), and University Hospital Birmingham (A.Z.), Birmingham, the Institute of Cancer Research (J.S.B., D.P.D., G.A.), Medical Research Council Clinical Trials Unit at University College London (M.R. Spears, C.L.A., C.G., C.B., M.K.B.P., M.R. Sydes), King's College London and Guy's and St. Thomas' NHS Foundation Trust (S.C.), and Royal Marsden NHS Foundation Trust (C.C.P.), London, Salford Royal NHS Foundation Trust, Salford (N.W.C.), Cardiff University School of Medicine (M.D.M.) and Velindre Cancer Centre (J.F.L.), Cardiff, Gloucestershire Royal Hospital (A.W.S.R.) and Gloucestershire Hospitals NHS Foundation Trust (J.B.), Gloucester, University of Glasgow, Glasgow (R.J.J., J.M.R.), St. James's University Hospital, Leeds (W.R.C.), University Hospital of North-Midlands, Stoke-on-Trent (F.A.), Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter (S.A.), Rosemere Cancer Centre, Royal Preston Hospital, Preston (A.J.B.), Dorset Cancer Centre, Poole Hospital, Poole (S.B.), Royal Derby Hospital, Derby (P.C.), Weston Park Hospital, Sheffield (C.F.), Portsmouth Oncology Centre, Queen Alexandra Hospital, Portsmouth (J.G.), Musgrove Park Hospital, Taunton (E.G.), Hull and East Yorkshire Hospitals NHS Trust, Hull (M.H.), Mount Vernon Cancer Centre, Northwood (P.J.H.), Clatterbridge Cancer Centre, Wirral (Z.I.M.), Brighton and Sussex University Hospitals NHS Trust (F.M.) and Sussex Cancer Centre, Royal Sussex County Hospital (A.R.), Brighton, NHS Highland, Inverness (N.M.), Royal Surrey County Hospital, Guildford (J.M.-K.), Northern Ireland Cancer and Queens University, Belfast (J.O.), Lancashire Teaching Hospitals NHS Trust, Preston (O.P.), Churchill Hospital, Oxford (A.P.), Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury (N.N.S.), East Kent Hospitals NHS Trust, Canterbury (C.T.), Swansea University College of Medicine, Swansea (J. Wagstaff), and Christie NHS Foundation Trust, Manchester (J. Wylie) - all in the United Kingdom; and the Department of Medical Oncology, Kantonsspital St. Gallen, St. Gallen (S.G.), and University Hospital of Lausanne, Lausanne (D.R.B.) - both in Switzerland. Two of the authors (D.M., R.M.) were unaffiliated lay members of the STAMPEDE investigators
| | - Andrew Protheroe
- From the Institute of Cancer and Genomic Sciences, University of Birmingham (N.D.J.), and University Hospital Birmingham (A.Z.), Birmingham, the Institute of Cancer Research (J.S.B., D.P.D., G.A.), Medical Research Council Clinical Trials Unit at University College London (M.R. Spears, C.L.A., C.G., C.B., M.K.B.P., M.R. Sydes), King's College London and Guy's and St. Thomas' NHS Foundation Trust (S.C.), and Royal Marsden NHS Foundation Trust (C.C.P.), London, Salford Royal NHS Foundation Trust, Salford (N.W.C.), Cardiff University School of Medicine (M.D.M.) and Velindre Cancer Centre (J.F.L.), Cardiff, Gloucestershire Royal Hospital (A.W.S.R.) and Gloucestershire Hospitals NHS Foundation Trust (J.B.), Gloucester, University of Glasgow, Glasgow (R.J.J., J.M.R.), St. James's University Hospital, Leeds (W.R.C.), University Hospital of North-Midlands, Stoke-on-Trent (F.A.), Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter (S.A.), Rosemere Cancer Centre, Royal Preston Hospital, Preston (A.J.B.), Dorset Cancer Centre, Poole Hospital, Poole (S.B.), Royal Derby Hospital, Derby (P.C.), Weston Park Hospital, Sheffield (C.F.), Portsmouth Oncology Centre, Queen Alexandra Hospital, Portsmouth (J.G.), Musgrove Park Hospital, Taunton (E.G.), Hull and East Yorkshire Hospitals NHS Trust, Hull (M.H.), Mount Vernon Cancer Centre, Northwood (P.J.H.), Clatterbridge Cancer Centre, Wirral (Z.I.M.), Brighton and Sussex University Hospitals NHS Trust (F.M.) and Sussex Cancer Centre, Royal Sussex County Hospital (A.R.), Brighton, NHS Highland, Inverness (N.M.), Royal Surrey County Hospital, Guildford (J.M.-K.), Northern Ireland Cancer and Queens University, Belfast (J.O.), Lancashire Teaching Hospitals NHS Trust, Preston (O.P.), Churchill Hospital, Oxford (A.P.), Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury (N.N.S.), East Kent Hospitals NHS Trust, Canterbury (C.T.), Swansea University College of Medicine, Swansea (J. Wagstaff), and Christie NHS Foundation Trust, Manchester (J. Wylie) - all in the United Kingdom; and the Department of Medical Oncology, Kantonsspital St. Gallen, St. Gallen (S.G.), and University Hospital of Lausanne, Lausanne (D.R.B.) - both in Switzerland. Two of the authors (D.M., R.M.) were unaffiliated lay members of the STAMPEDE investigators
| | - Angus Robinson
- From the Institute of Cancer and Genomic Sciences, University of Birmingham (N.D.J.), and University Hospital Birmingham (A.Z.), Birmingham, the Institute of Cancer Research (J.S.B., D.P.D., G.A.), Medical Research Council Clinical Trials Unit at University College London (M.R. Spears, C.L.A., C.G., C.B., M.K.B.P., M.R. Sydes), King's College London and Guy's and St. Thomas' NHS Foundation Trust (S.C.), and Royal Marsden NHS Foundation Trust (C.C.P.), London, Salford Royal NHS Foundation Trust, Salford (N.W.C.), Cardiff University School of Medicine (M.D.M.) and Velindre Cancer Centre (J.F.L.), Cardiff, Gloucestershire Royal Hospital (A.W.S.R.) and Gloucestershire Hospitals NHS Foundation Trust (J.B.), Gloucester, University of Glasgow, Glasgow (R.J.J., J.M.R.), St. James's University Hospital, Leeds (W.R.C.), University Hospital of North-Midlands, Stoke-on-Trent (F.A.), Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter (S.A.), Rosemere Cancer Centre, Royal Preston Hospital, Preston (A.J.B.), Dorset Cancer Centre, Poole Hospital, Poole (S.B.), Royal Derby Hospital, Derby (P.C.), Weston Park Hospital, Sheffield (C.F.), Portsmouth Oncology Centre, Queen Alexandra Hospital, Portsmouth (J.G.), Musgrove Park Hospital, Taunton (E.G.), Hull and East Yorkshire Hospitals NHS Trust, Hull (M.H.), Mount Vernon Cancer Centre, Northwood (P.J.H.), Clatterbridge Cancer Centre, Wirral (Z.I.M.), Brighton and Sussex University Hospitals NHS Trust (F.M.) and Sussex Cancer Centre, Royal Sussex County Hospital (A.R.), Brighton, NHS Highland, Inverness (N.M.), Royal Surrey County Hospital, Guildford (J.M.-K.), Northern Ireland Cancer and Queens University, Belfast (J.O.), Lancashire Teaching Hospitals NHS Trust, Preston (O.P.), Churchill Hospital, Oxford (A.P.), Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury (N.N.S.), East Kent Hospitals NHS Trust, Canterbury (C.T.), Swansea University College of Medicine, Swansea (J. Wagstaff), and Christie NHS Foundation Trust, Manchester (J. Wylie) - all in the United Kingdom; and the Department of Medical Oncology, Kantonsspital St. Gallen, St. Gallen (S.G.), and University Hospital of Lausanne, Lausanne (D.R.B.) - both in Switzerland. Two of the authors (D.M., R.M.) were unaffiliated lay members of the STAMPEDE investigators
| | - Narayanan N Srihari
- From the Institute of Cancer and Genomic Sciences, University of Birmingham (N.D.J.), and University Hospital Birmingham (A.Z.), Birmingham, the Institute of Cancer Research (J.S.B., D.P.D., G.A.), Medical Research Council Clinical Trials Unit at University College London (M.R. Spears, C.L.A., C.G., C.B., M.K.B.P., M.R. Sydes), King's College London and Guy's and St. Thomas' NHS Foundation Trust (S.C.), and Royal Marsden NHS Foundation Trust (C.C.P.), London, Salford Royal NHS Foundation Trust, Salford (N.W.C.), Cardiff University School of Medicine (M.D.M.) and Velindre Cancer Centre (J.F.L.), Cardiff, Gloucestershire Royal Hospital (A.W.S.R.) and Gloucestershire Hospitals NHS Foundation Trust (J.B.), Gloucester, University of Glasgow, Glasgow (R.J.J., J.M.R.), St. James's University Hospital, Leeds (W.R.C.), University Hospital of North-Midlands, Stoke-on-Trent (F.A.), Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter (S.A.), Rosemere Cancer Centre, Royal Preston Hospital, Preston (A.J.B.), Dorset Cancer Centre, Poole Hospital, Poole (S.B.), Royal Derby Hospital, Derby (P.C.), Weston Park Hospital, Sheffield (C.F.), Portsmouth Oncology Centre, Queen Alexandra Hospital, Portsmouth (J.G.), Musgrove Park Hospital, Taunton (E.G.), Hull and East Yorkshire Hospitals NHS Trust, Hull (M.H.), Mount Vernon Cancer Centre, Northwood (P.J.H.), Clatterbridge Cancer Centre, Wirral (Z.I.M.), Brighton and Sussex University Hospitals NHS Trust (F.M.) and Sussex Cancer Centre, Royal Sussex County Hospital (A.R.), Brighton, NHS Highland, Inverness (N.M.), Royal Surrey County Hospital, Guildford (J.M.-K.), Northern Ireland Cancer and Queens University, Belfast (J.O.), Lancashire Teaching Hospitals NHS Trust, Preston (O.P.), Churchill Hospital, Oxford (A.P.), Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury (N.N.S.), East Kent Hospitals NHS Trust, Canterbury (C.T.), Swansea University College of Medicine, Swansea (J. Wagstaff), and Christie NHS Foundation Trust, Manchester (J. Wylie) - all in the United Kingdom; and the Department of Medical Oncology, Kantonsspital St. Gallen, St. Gallen (S.G.), and University Hospital of Lausanne, Lausanne (D.R.B.) - both in Switzerland. Two of the authors (D.M., R.M.) were unaffiliated lay members of the STAMPEDE investigators
| | - Carys Thomas
- From the Institute of Cancer and Genomic Sciences, University of Birmingham (N.D.J.), and University Hospital Birmingham (A.Z.), Birmingham, the Institute of Cancer Research (J.S.B., D.P.D., G.A.), Medical Research Council Clinical Trials Unit at University College London (M.R. Spears, C.L.A., C.G., C.B., M.K.B.P., M.R. Sydes), King's College London and Guy's and St. Thomas' NHS Foundation Trust (S.C.), and Royal Marsden NHS Foundation Trust (C.C.P.), London, Salford Royal NHS Foundation Trust, Salford (N.W.C.), Cardiff University School of Medicine (M.D.M.) and Velindre Cancer Centre (J.F.L.), Cardiff, Gloucestershire Royal Hospital (A.W.S.R.) and Gloucestershire Hospitals NHS Foundation Trust (J.B.), Gloucester, University of Glasgow, Glasgow (R.J.J., J.M.R.), St. James's University Hospital, Leeds (W.R.C.), University Hospital of North-Midlands, Stoke-on-Trent (F.A.), Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter (S.A.), Rosemere Cancer Centre, Royal Preston Hospital, Preston (A.J.B.), Dorset Cancer Centre, Poole Hospital, Poole (S.B.), Royal Derby Hospital, Derby (P.C.), Weston Park Hospital, Sheffield (C.F.), Portsmouth Oncology Centre, Queen Alexandra Hospital, Portsmouth (J.G.), Musgrove Park Hospital, Taunton (E.G.), Hull and East Yorkshire Hospitals NHS Trust, Hull (M.H.), Mount Vernon Cancer Centre, Northwood (P.J.H.), Clatterbridge Cancer Centre, Wirral (Z.I.M.), Brighton and Sussex University Hospitals NHS Trust (F.M.) and Sussex Cancer Centre, Royal Sussex County Hospital (A.R.), Brighton, NHS Highland, Inverness (N.M.), Royal Surrey County Hospital, Guildford (J.M.-K.), Northern Ireland Cancer and Queens University, Belfast (J.O.), Lancashire Teaching Hospitals NHS Trust, Preston (O.P.), Churchill Hospital, Oxford (A.P.), Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury (N.N.S.), East Kent Hospitals NHS Trust, Canterbury (C.T.), Swansea University College of Medicine, Swansea (J. Wagstaff), and Christie NHS Foundation Trust, Manchester (J. Wylie) - all in the United Kingdom; and the Department of Medical Oncology, Kantonsspital St. Gallen, St. Gallen (S.G.), and University Hospital of Lausanne, Lausanne (D.R.B.) - both in Switzerland. Two of the authors (D.M., R.M.) were unaffiliated lay members of the STAMPEDE investigators
| | - John Wagstaff
- From the Institute of Cancer and Genomic Sciences, University of Birmingham (N.D.J.), and University Hospital Birmingham (A.Z.), Birmingham, the Institute of Cancer Research (J.S.B., D.P.D., G.A.), Medical Research Council Clinical Trials Unit at University College London (M.R. Spears, C.L.A., C.G., C.B., M.K.B.P., M.R. Sydes), King's College London and Guy's and St. Thomas' NHS Foundation Trust (S.C.), and Royal Marsden NHS Foundation Trust (C.C.P.), London, Salford Royal NHS Foundation Trust, Salford (N.W.C.), Cardiff University School of Medicine (M.D.M.) and Velindre Cancer Centre (J.F.L.), Cardiff, Gloucestershire Royal Hospital (A.W.S.R.) and Gloucestershire Hospitals NHS Foundation Trust (J.B.), Gloucester, University of Glasgow, Glasgow (R.J.J., J.M.R.), St. James's University Hospital, Leeds (W.R.C.), University Hospital of North-Midlands, Stoke-on-Trent (F.A.), Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter (S.A.), Rosemere Cancer Centre, Royal Preston Hospital, Preston (A.J.B.), Dorset Cancer Centre, Poole Hospital, Poole (S.B.), Royal Derby Hospital, Derby (P.C.), Weston Park Hospital, Sheffield (C.F.), Portsmouth Oncology Centre, Queen Alexandra Hospital, Portsmouth (J.G.), Musgrove Park Hospital, Taunton (E.G.), Hull and East Yorkshire Hospitals NHS Trust, Hull (M.H.), Mount Vernon Cancer Centre, Northwood (P.J.H.), Clatterbridge Cancer Centre, Wirral (Z.I.M.), Brighton and Sussex University Hospitals NHS Trust (F.M.) and Sussex Cancer Centre, Royal Sussex County Hospital (A.R.), Brighton, NHS Highland, Inverness (N.M.), Royal Surrey County Hospital, Guildford (J.M.-K.), Northern Ireland Cancer and Queens University, Belfast (J.O.), Lancashire Teaching Hospitals NHS Trust, Preston (O.P.), Churchill Hospital, Oxford (A.P.), Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury (N.N.S.), East Kent Hospitals NHS Trust, Canterbury (C.T.), Swansea University College of Medicine, Swansea (J. Wagstaff), and Christie NHS Foundation Trust, Manchester (J. Wylie) - all in the United Kingdom; and the Department of Medical Oncology, Kantonsspital St. Gallen, St. Gallen (S.G.), and University Hospital of Lausanne, Lausanne (D.R.B.) - both in Switzerland. Two of the authors (D.M., R.M.) were unaffiliated lay members of the STAMPEDE investigators
| | - James Wylie
- From the Institute of Cancer and Genomic Sciences, University of Birmingham (N.D.J.), and University Hospital Birmingham (A.Z.), Birmingham, the Institute of Cancer Research (J.S.B., D.P.D., G.A.), Medical Research Council Clinical Trials Unit at University College London (M.R. Spears, C.L.A., C.G., C.B., M.K.B.P., M.R. Sydes), King's College London and Guy's and St. Thomas' NHS Foundation Trust (S.C.), and Royal Marsden NHS Foundation Trust (C.C.P.), London, Salford Royal NHS Foundation Trust, Salford (N.W.C.), Cardiff University School of Medicine (M.D.M.) and Velindre Cancer Centre (J.F.L.), Cardiff, Gloucestershire Royal Hospital (A.W.S.R.) and Gloucestershire Hospitals NHS Foundation Trust (J.B.), Gloucester, University of Glasgow, Glasgow (R.J.J., J.M.R.), St. James's University Hospital, Leeds (W.R.C.), University Hospital of North-Midlands, Stoke-on-Trent (F.A.), Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter (S.A.), Rosemere Cancer Centre, Royal Preston Hospital, Preston (A.J.B.), Dorset Cancer Centre, Poole Hospital, Poole (S.B.), Royal Derby Hospital, Derby (P.C.), Weston Park Hospital, Sheffield (C.F.), Portsmouth Oncology Centre, Queen Alexandra Hospital, Portsmouth (J.G.), Musgrove Park Hospital, Taunton (E.G.), Hull and East Yorkshire Hospitals NHS Trust, Hull (M.H.), Mount Vernon Cancer Centre, Northwood (P.J.H.), Clatterbridge Cancer Centre, Wirral (Z.I.M.), Brighton and Sussex University Hospitals NHS Trust (F.M.) and Sussex Cancer Centre, Royal Sussex County Hospital (A.R.), Brighton, NHS Highland, Inverness (N.M.), Royal Surrey County Hospital, Guildford (J.M.-K.), Northern Ireland Cancer and Queens University, Belfast (J.O.), Lancashire Teaching Hospitals NHS Trust, Preston (O.P.), Churchill Hospital, Oxford (A.P.), Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury (N.N.S.), East Kent Hospitals NHS Trust, Canterbury (C.T.), Swansea University College of Medicine, Swansea (J. Wagstaff), and Christie NHS Foundation Trust, Manchester (J. Wylie) - all in the United Kingdom; and the Department of Medical Oncology, Kantonsspital St. Gallen, St. Gallen (S.G.), and University Hospital of Lausanne, Lausanne (D.R.B.) - both in Switzerland. Two of the authors (D.M., R.M.) were unaffiliated lay members of the STAMPEDE investigators
| | - Anjali Zarkar
- From the Institute of Cancer and Genomic Sciences, University of Birmingham (N.D.J.), and University Hospital Birmingham (A.Z.), Birmingham, the Institute of Cancer Research (J.S.B., D.P.D., G.A.), Medical Research Council Clinical Trials Unit at University College London (M.R. Spears, C.L.A., C.G., C.B., M.K.B.P., M.R. Sydes), King's College London and Guy's and St. Thomas' NHS Foundation Trust (S.C.), and Royal Marsden NHS Foundation Trust (C.C.P.), London, Salford Royal NHS Foundation Trust, Salford (N.W.C.), Cardiff University School of Medicine (M.D.M.) and Velindre Cancer Centre (J.F.L.), Cardiff, Gloucestershire Royal Hospital (A.W.S.R.) and Gloucestershire Hospitals NHS Foundation Trust (J.B.), Gloucester, University of Glasgow, Glasgow (R.J.J., J.M.R.), St. James's University Hospital, Leeds (W.R.C.), University Hospital of North-Midlands, Stoke-on-Trent (F.A.), Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter (S.A.), Rosemere Cancer Centre, Royal Preston Hospital, Preston (A.J.B.), Dorset Cancer Centre, Poole Hospital, Poole (S.B.), Royal Derby Hospital, Derby (P.C.), Weston Park Hospital, Sheffield (C.F.), Portsmouth Oncology Centre, Queen Alexandra Hospital, Portsmouth (J.G.), Musgrove Park Hospital, Taunton (E.G.), Hull and East Yorkshire Hospitals NHS Trust, Hull (M.H.), Mount Vernon Cancer Centre, Northwood (P.J.H.), Clatterbridge Cancer Centre, Wirral (Z.I.M.), Brighton and Sussex University Hospitals NHS Trust (F.M.) and Sussex Cancer Centre, Royal Sussex County Hospital (A.R.), Brighton, NHS Highland, Inverness (N.M.), Royal Surrey County Hospital, Guildford (J.M.-K.), Northern Ireland Cancer and Queens University, Belfast (J.O.), Lancashire Teaching Hospitals NHS Trust, Preston (O.P.), Churchill Hospital, Oxford (A.P.), Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury (N.N.S.), East Kent Hospitals NHS Trust, Canterbury (C.T.), Swansea University College of Medicine, Swansea (J. Wagstaff), and Christie NHS Foundation Trust, Manchester (J. Wylie) - all in the United Kingdom; and the Department of Medical Oncology, Kantonsspital St. Gallen, St. Gallen (S.G.), and University Hospital of Lausanne, Lausanne (D.R.B.) - both in Switzerland. Two of the authors (D.M., R.M.) were unaffiliated lay members of the STAMPEDE investigators
| | - Mahesh K B Parmar
- From the Institute of Cancer and Genomic Sciences, University of Birmingham (N.D.J.), and University Hospital Birmingham (A.Z.), Birmingham, the Institute of Cancer Research (J.S.B., D.P.D., G.A.), Medical Research Council Clinical Trials Unit at University College London (M.R. Spears, C.L.A., C.G., C.B., M.K.B.P., M.R. Sydes), King's College London and Guy's and St. Thomas' NHS Foundation Trust (S.C.), and Royal Marsden NHS Foundation Trust (C.C.P.), London, Salford Royal NHS Foundation Trust, Salford (N.W.C.), Cardiff University School of Medicine (M.D.M.) and Velindre Cancer Centre (J.F.L.), Cardiff, Gloucestershire Royal Hospital (A.W.S.R.) and Gloucestershire Hospitals NHS Foundation Trust (J.B.), Gloucester, University of Glasgow, Glasgow (R.J.J., J.M.R.), St. James's University Hospital, Leeds (W.R.C.), University Hospital of North-Midlands, Stoke-on-Trent (F.A.), Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter (S.A.), Rosemere Cancer Centre, Royal Preston Hospital, Preston (A.J.B.), Dorset Cancer Centre, Poole Hospital, Poole (S.B.), Royal Derby Hospital, Derby (P.C.), Weston Park Hospital, Sheffield (C.F.), Portsmouth Oncology Centre, Queen Alexandra Hospital, Portsmouth (J.G.), Musgrove Park Hospital, Taunton (E.G.), Hull and East Yorkshire Hospitals NHS Trust, Hull (M.H.), Mount Vernon Cancer Centre, Northwood (P.J.H.), Clatterbridge Cancer Centre, Wirral (Z.I.M.), Brighton and Sussex University Hospitals NHS Trust (F.M.) and Sussex Cancer Centre, Royal Sussex County Hospital (A.R.), Brighton, NHS Highland, Inverness (N.M.), Royal Surrey County Hospital, Guildford (J.M.-K.), Northern Ireland Cancer and Queens University, Belfast (J.O.), Lancashire Teaching Hospitals NHS Trust, Preston (O.P.), Churchill Hospital, Oxford (A.P.), Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury (N.N.S.), East Kent Hospitals NHS Trust, Canterbury (C.T.), Swansea University College of Medicine, Swansea (J. Wagstaff), and Christie NHS Foundation Trust, Manchester (J. Wylie) - all in the United Kingdom; and the Department of Medical Oncology, Kantonsspital St. Gallen, St. Gallen (S.G.), and University Hospital of Lausanne, Lausanne (D.R.B.) - both in Switzerland. Two of the authors (D.M., R.M.) were unaffiliated lay members of the STAMPEDE investigators
| | - Matthew R Sydes
- From the Institute of Cancer and Genomic Sciences, University of Birmingham (N.D.J.), and University Hospital Birmingham (A.Z.), Birmingham, the Institute of Cancer Research (J.S.B., D.P.D., G.A.), Medical Research Council Clinical Trials Unit at University College London (M.R. Spears, C.L.A., C.G., C.B., M.K.B.P., M.R. Sydes), King's College London and Guy's and St. Thomas' NHS Foundation Trust (S.C.), and Royal Marsden NHS Foundation Trust (C.C.P.), London, Salford Royal NHS Foundation Trust, Salford (N.W.C.), Cardiff University School of Medicine (M.D.M.) and Velindre Cancer Centre (J.F.L.), Cardiff, Gloucestershire Royal Hospital (A.W.S.R.) and Gloucestershire Hospitals NHS Foundation Trust (J.B.), Gloucester, University of Glasgow, Glasgow (R.J.J., J.M.R.), St. James's University Hospital, Leeds (W.R.C.), University Hospital of North-Midlands, Stoke-on-Trent (F.A.), Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter (S.A.), Rosemere Cancer Centre, Royal Preston Hospital, Preston (A.J.B.), Dorset Cancer Centre, Poole Hospital, Poole (S.B.), Royal Derby Hospital, Derby (P.C.), Weston Park Hospital, Sheffield (C.F.), Portsmouth Oncology Centre, Queen Alexandra Hospital, Portsmouth (J.G.), Musgrove Park Hospital, Taunton (E.G.), Hull and East Yorkshire Hospitals NHS Trust, Hull (M.H.), Mount Vernon Cancer Centre, Northwood (P.J.H.), Clatterbridge Cancer Centre, Wirral (Z.I.M.), Brighton and Sussex University Hospitals NHS Trust (F.M.) and Sussex Cancer Centre, Royal Sussex County Hospital (A.R.), Brighton, NHS Highland, Inverness (N.M.), Royal Surrey County Hospital, Guildford (J.M.-K.), Northern Ireland Cancer and Queens University, Belfast (J.O.), Lancashire Teaching Hospitals NHS Trust, Preston (O.P.), Churchill Hospital, Oxford (A.P.), Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury (N.N.S.), East Kent Hospitals NHS Trust, Canterbury (C.T.), Swansea University College of Medicine, Swansea (J. Wagstaff), and Christie NHS Foundation Trust, Manchester (J. Wylie) - all in the United Kingdom; and the Department of Medical Oncology, Kantonsspital St. Gallen, St. Gallen (S.G.), and University Hospital of Lausanne, Lausanne (D.R.B.) - both in Switzerland. Two of the authors (D.M., R.M.) were unaffiliated lay members of the STAMPEDE investigators
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James ND, De Bono JS, Spears MR, Clarke N, Mason MD, Dearnaley DP, Ritchie AWS, Russell JM, Gilson C, Jones RJ, Gillessen S, Matheson D, Aung S, Birtle AJ, Chowdhury S, Gale J, Malik Z, O'Sullivan JM, Parmar MKB, Sydes MR. Adding abiraterone for men with high-risk prostate cancer (PCa) starting long-term androgen deprivation therapy (ADT): Survival results from STAMPEDE (NCT00268476). J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.18_suppl.lba5003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
LBA5003 Background: Abiraterone showed a survival advantage in men with castration-refractory prostate cancer. We assessed whether abiraterone would work earlier in the disease. STAMPEDE is a randomized controlled trial using a multi-arm multi-stage platform design. It recruits patients (pts) with high-risk locally advanced or metastatic PCa starting long-term ADT. We report the first comparative survival data. Methods: The standard-of-care (SOC) was ADT for 2+yrs; radiotherapy (RT) was mandated for men with N0M0 disease & encouraged for N+M0. Stratified randomization allocated pts 1:1 to SOC or SOC+abiraterone 1000mg + prednisolone 5mg daily. Treatment duration depended on stage & intent to give radical RT: pts not having RT or M1 disease, treatment continued until PSA, radiological & clinical progression; otherwise treatment continued until the earlier of 2 years or all types of progression. The primary outcome measure was death from any cause. Comparison to control for survival had 90% power at 2.5% 1-sided alpha for hazard ratio (HR) of 0.75, requiring ~267 control arm deaths, accounting for 3 intermediate lack-of-benefit analyses on failure-free survival (FFS). Analyses used Cox proportional hazards & flexible parametric models, adjusted for stratification factors. Results: 1,917 pts were contemporaneously randomized to these arms (Nov 2011- Jan 2014). Groups were balanced: median age 67yrs; 52% metastatic, 20% N+/X M0, 28% N0M0; 95% newly-diagnosed; median PSA 53ng/ml. Median follow-up was 40m. There were 262 control arm deaths (82% PCa). The adjusted HR = 0.63 (95% CI 0.52-0.76; p=0.115x10-7; 184 deaths) for SOC+Abi vs SOC, with 3yr OS improved from 76% to 83%. There were 535 control arm FFS events; the adjusted HR = 0.29 (95% CI 0.25-0.34; p = 0.377x10-63, 248 FFS events) for SOC+Abi vs SOC. Grade 3 & 4 adverse events were seen in 29% & 3% SOC, 41% & 5% SOC+Abi; Grade 5: 3 & 9 (1 & 2 related). Conclusions: The results show a clinically & statistically significant effect on overall survival & failure-free survival from adding abiraterone at start of ADT with a manageable increase in toxicity. ADT (+/- RT) + abiraterone is a new standard of care for this group. Clinical trial information: NCT00268476.
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Affiliation(s)
| | - Johann S. De Bono
- The Institute of Cancer Research and The Royal Marsden Hospital, London, United Kingdom
| | | | - Noel Clarke
- The Christie Hospital NHS Foundation Trust, Manchester, United Kingdom
| | | | - David P. Dearnaley
- The Royal Marsden Hospital and The Institute of Cancer Research, London, United Kingdom
| | | | - J. Martin Russell
- Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Clare Gilson
- MRC Clinical Trials Unit at UCL, London, United Kingdom
| | - Robert J. Jones
- University of Glasgow, Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | | | | | - San Aung
- Royal Devon and Exeter Hospital, Exeter, United Kingdom
| | - Alison J. Birtle
- Rosemere Cancer Centre, Royal Preston Hospital, Preston, United Kingdom
| | - Simon Chowdhury
- Guy's, King's, and St Thomas' Hospitals, London, United Kingdom
| | - Joanna Gale
- Portsmouth Hospitals NHS Trust, Portsmouth, United Kingdom
| | - Zafar Malik
- Clatterbridge Cancer Centre, Bebington, United Kingdom
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James ND, De Bono JS, Spears MR, Clarke N, Mason MD, Dearnaley DP, Ritchie AWS, Russell JM, Gilson C, Jones RJ, Gillessen S, Matheson D, Aung S, Birtle AJ, Chowdhury S, Gale J, Malik Z, O'Sullivan JM, Parmar MKB, Sydes MR. Adding abiraterone for men with high-risk prostate cancer (PCa) starting long-term androgen deprivation therapy (ADT): Survival results from STAMPEDE (NCT00268476). J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.lba5003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
LBA5003 The full, final text of this abstract will be available at abstracts.asco.org at 7:30 AM (EDT) on Saturday, June 3, 2017, and in the Annual Meeting Proceedings online supplement to the June 20, 2017, issue of the Journal of Clinical Oncology. Onsite at the Meeting, this abstract will be printed in the Saturday edition of ASCO Daily News.
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Affiliation(s)
| | - Johann S. De Bono
- The Institute of Cancer Research and The Royal Marsden Hospital, London, United Kingdom
| | | | - Noel Clarke
- The Christie Hospital NHS Foundation Trust, Manchester, United Kingdom
| | | | - David P. Dearnaley
- The Royal Marsden Hospital and The Institute of Cancer Research, London, United Kingdom
| | | | - J. Martin Russell
- Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Clare Gilson
- MRC Clinical Trials Unit at UCL, London, United Kingdom
| | - Robert J. Jones
- University of Glasgow, Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | | | | | - San Aung
- Royal Devon and Exeter Hospital, Exeter, United Kingdom
| | - Alison J. Birtle
- Rosemere Cancer Centre, Royal Preston Hospital, Preston, United Kingdom
| | - Simon Chowdhury
- Guy's, King's, and St Thomas' Hospitals, London, United Kingdom
| | - Joanna Gale
- Portsmouth Hospitals NHS Trust, Portsmouth, United Kingdom
| | - Zafar Malik
- Clatterbridge Cancer Centre, Bebington, United Kingdom
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Mason MD, Clarke NW, James ND, Dearnaley DP, Spears MR, Ritchie AW, Attard G, Cross W, Jones RJ, Parker CC, Russell JM, Thalmann GN, Schiavone F, Cassoly E, Matheson D, Millman R, Rentsch CA, Barber J, Gilson C, Ibrahim A, Logue J, Lydon A, Nikapota AD, O’Sullivan JM, Porfiri E, Protheroe A, Srihari NN, Tsang D, Wagstaff J, Wallace J, Walmsley C, Parmar MK, Sydes MR. Adding Celecoxib With or Without Zoledronic Acid for Hormone-Naïve Prostate Cancer: Long-Term Survival Results From an Adaptive, Multiarm, Multistage, Platform, Randomized Controlled Trial. J Clin Oncol 2017; 35:1530-1541. [PMID: 28300506 PMCID: PMC5455701 DOI: 10.1200/jco.2016.69.0677] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Purpose Systemic Therapy for Advanced or Metastatic Prostate Cancer: Evaluation of Drug Efficacy is a randomized controlled trial using a multiarm, multistage, platform design. It recruits men with high-risk, locally advanced or metastatic prostate cancer who were initiating long-term hormone therapy. We report survival data for two celecoxib (Cel)-containing comparisons, which stopped accrual early at interim analysis on the basis of failure-free survival. Patients and Methods Standard of care (SOC) was hormone therapy continuously (metastatic) or for ≥ 2 years (nonmetastatic); prostate (± pelvic node) radiotherapy was encouraged for men without metastases. Cel 400 mg was administered twice a day for 1 year. Zoledronic acid (ZA) 4 mg was administered for six 3-weekly cycles, then 4-weekly for 2 years. Stratified random assignment allocated patients 2:1:1 to SOC (control), SOC + Cel, or SOC + ZA + Cel. The primary outcome measure was all-cause mortality. Results were analyzed with Cox proportional hazards and flexible parametric models adjusted for stratification factors. Results A total of 1,245 men were randomly assigned (Oct 2005 to April 2011). Groups were balanced: median age, 65 years; 61% metastatic, 14% N+/X M0, 25% N0M0; 94% newly diagnosed; median prostate-specific antigen, 66 ng/mL. Median follow-up was 69 months. Grade 3 to 5 adverse events were seen in 36% SOC-only, 33% SOC + Cel, and 32% SOC + ZA + Cel patients. There were 303 control arm deaths (83% prostate cancer), and median survival was 66 months. Compared with SOC, the adjusted hazard ratio was 0.98 (95% CI, 0.80 to 1.20; P = .847; median survival, 70 months) for SOC + Cel and 0.86 (95% CI, 0.70 to 1.05; P =.130; median survival, 76 months) for SOC + ZA + Cel. Preplanned subgroup analyses in men with metastatic disease showed a hazard ratio of 0.78 (95% CI, 0.62 to 0.98; P = .033) for SOC + ZA + Cel. Conclusion These data show no overall evidence of improved survival with Cel. Preplanned subgroup analyses provide hypotheses for future studies.
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Affiliation(s)
- Malcolm D. Mason
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; Jim Barber, Velindre Cancer Centre, Cardiff; Noel W. Clarke, The Christie and Salford Royal NHS Foundation Trusts; John Logue, Christie Hospital, Manchester; Nicholas D. James, Institute of Cancer and Genomic Sciences; Emilio Porfiri, The Medical School, University of Birmingham; Nicholas D. James, Queen Elizabeth Hospital; Emilio Porfiri, University Hospitals Birmingham NHS Foundation Trust, Birmingham; David P. Dearnaley, Gerhardt Attard, and Christopher C. Parker, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust; Melissa R. Spears, Alastair W.S. Ritchie, Francesca Schiavone, David Matheson, Robin Millman, Clare Gilson, Mahesh K.B. Parmar, and Matthew R. Sydes, MRC Clinical Trials Unit at UCL, London; William Cross, Leeds Teaching Hospitals NHS Trust, Leeds; Rob J. Jones and J. Martin Russell, University of Glasgow; Rob J. Jones and Jan Wallace, Beatson West of Scotland Cancer Centre, Glasgow; Azman Ibrahim, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral; Anna Lydon, Torbay District Hospital, Torquay; Ashok D. Nikapota, Sussex Cancer Centre, Brighton; Ashok D. Nikapota, Worthing Hospital, Worthing; Joe M. O’Sullivan, Centre for Cancer Research and Cell Biology, Queen's University, Belfast; Andrew Protheroe, Churchill Hospital, Oxford; Narayanan Nair Srihari, Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury; David Tsang, Southend Hospital, Southend-on-Sea; David Tsang, Basildon Hospital, Basildon; John Wagstaff, The South West Wales Cancer Institute; John Wagstaff, Swansea University College of Medicine, Swansea; Catherine Walmsley, Royal Preston Hospital, Preston, United Kingdom; George N. Thalmann, University Hospital; Estelle Cassoly, SAKK Coordinating Center, Berne; and Cyrill A. Rentsch, University Hospital Basel, Basel, Switzerland
| | - Noel W. Clarke
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; Jim Barber, Velindre Cancer Centre, Cardiff; Noel W. Clarke, The Christie and Salford Royal NHS Foundation Trusts; John Logue, Christie Hospital, Manchester; Nicholas D. James, Institute of Cancer and Genomic Sciences; Emilio Porfiri, The Medical School, University of Birmingham; Nicholas D. James, Queen Elizabeth Hospital; Emilio Porfiri, University Hospitals Birmingham NHS Foundation Trust, Birmingham; David P. Dearnaley, Gerhardt Attard, and Christopher C. Parker, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust; Melissa R. Spears, Alastair W.S. Ritchie, Francesca Schiavone, David Matheson, Robin Millman, Clare Gilson, Mahesh K.B. Parmar, and Matthew R. Sydes, MRC Clinical Trials Unit at UCL, London; William Cross, Leeds Teaching Hospitals NHS Trust, Leeds; Rob J. Jones and J. Martin Russell, University of Glasgow; Rob J. Jones and Jan Wallace, Beatson West of Scotland Cancer Centre, Glasgow; Azman Ibrahim, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral; Anna Lydon, Torbay District Hospital, Torquay; Ashok D. Nikapota, Sussex Cancer Centre, Brighton; Ashok D. Nikapota, Worthing Hospital, Worthing; Joe M. O’Sullivan, Centre for Cancer Research and Cell Biology, Queen's University, Belfast; Andrew Protheroe, Churchill Hospital, Oxford; Narayanan Nair Srihari, Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury; David Tsang, Southend Hospital, Southend-on-Sea; David Tsang, Basildon Hospital, Basildon; John Wagstaff, The South West Wales Cancer Institute; John Wagstaff, Swansea University College of Medicine, Swansea; Catherine Walmsley, Royal Preston Hospital, Preston, United Kingdom; George N. Thalmann, University Hospital; Estelle Cassoly, SAKK Coordinating Center, Berne; and Cyrill A. Rentsch, University Hospital Basel, Basel, Switzerland
| | - Nicholas D. James
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; Jim Barber, Velindre Cancer Centre, Cardiff; Noel W. Clarke, The Christie and Salford Royal NHS Foundation Trusts; John Logue, Christie Hospital, Manchester; Nicholas D. James, Institute of Cancer and Genomic Sciences; Emilio Porfiri, The Medical School, University of Birmingham; Nicholas D. James, Queen Elizabeth Hospital; Emilio Porfiri, University Hospitals Birmingham NHS Foundation Trust, Birmingham; David P. Dearnaley, Gerhardt Attard, and Christopher C. Parker, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust; Melissa R. Spears, Alastair W.S. Ritchie, Francesca Schiavone, David Matheson, Robin Millman, Clare Gilson, Mahesh K.B. Parmar, and Matthew R. Sydes, MRC Clinical Trials Unit at UCL, London; William Cross, Leeds Teaching Hospitals NHS Trust, Leeds; Rob J. Jones and J. Martin Russell, University of Glasgow; Rob J. Jones and Jan Wallace, Beatson West of Scotland Cancer Centre, Glasgow; Azman Ibrahim, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral; Anna Lydon, Torbay District Hospital, Torquay; Ashok D. Nikapota, Sussex Cancer Centre, Brighton; Ashok D. Nikapota, Worthing Hospital, Worthing; Joe M. O’Sullivan, Centre for Cancer Research and Cell Biology, Queen's University, Belfast; Andrew Protheroe, Churchill Hospital, Oxford; Narayanan Nair Srihari, Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury; David Tsang, Southend Hospital, Southend-on-Sea; David Tsang, Basildon Hospital, Basildon; John Wagstaff, The South West Wales Cancer Institute; John Wagstaff, Swansea University College of Medicine, Swansea; Catherine Walmsley, Royal Preston Hospital, Preston, United Kingdom; George N. Thalmann, University Hospital; Estelle Cassoly, SAKK Coordinating Center, Berne; and Cyrill A. Rentsch, University Hospital Basel, Basel, Switzerland
| | - David P. Dearnaley
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; Jim Barber, Velindre Cancer Centre, Cardiff; Noel W. Clarke, The Christie and Salford Royal NHS Foundation Trusts; John Logue, Christie Hospital, Manchester; Nicholas D. James, Institute of Cancer and Genomic Sciences; Emilio Porfiri, The Medical School, University of Birmingham; Nicholas D. James, Queen Elizabeth Hospital; Emilio Porfiri, University Hospitals Birmingham NHS Foundation Trust, Birmingham; David P. Dearnaley, Gerhardt Attard, and Christopher C. Parker, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust; Melissa R. Spears, Alastair W.S. Ritchie, Francesca Schiavone, David Matheson, Robin Millman, Clare Gilson, Mahesh K.B. Parmar, and Matthew R. Sydes, MRC Clinical Trials Unit at UCL, London; William Cross, Leeds Teaching Hospitals NHS Trust, Leeds; Rob J. Jones and J. Martin Russell, University of Glasgow; Rob J. Jones and Jan Wallace, Beatson West of Scotland Cancer Centre, Glasgow; Azman Ibrahim, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral; Anna Lydon, Torbay District Hospital, Torquay; Ashok D. Nikapota, Sussex Cancer Centre, Brighton; Ashok D. Nikapota, Worthing Hospital, Worthing; Joe M. O’Sullivan, Centre for Cancer Research and Cell Biology, Queen's University, Belfast; Andrew Protheroe, Churchill Hospital, Oxford; Narayanan Nair Srihari, Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury; David Tsang, Southend Hospital, Southend-on-Sea; David Tsang, Basildon Hospital, Basildon; John Wagstaff, The South West Wales Cancer Institute; John Wagstaff, Swansea University College of Medicine, Swansea; Catherine Walmsley, Royal Preston Hospital, Preston, United Kingdom; George N. Thalmann, University Hospital; Estelle Cassoly, SAKK Coordinating Center, Berne; and Cyrill A. Rentsch, University Hospital Basel, Basel, Switzerland
| | - Melissa R. Spears
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; Jim Barber, Velindre Cancer Centre, Cardiff; Noel W. Clarke, The Christie and Salford Royal NHS Foundation Trusts; John Logue, Christie Hospital, Manchester; Nicholas D. James, Institute of Cancer and Genomic Sciences; Emilio Porfiri, The Medical School, University of Birmingham; Nicholas D. James, Queen Elizabeth Hospital; Emilio Porfiri, University Hospitals Birmingham NHS Foundation Trust, Birmingham; David P. Dearnaley, Gerhardt Attard, and Christopher C. Parker, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust; Melissa R. Spears, Alastair W.S. Ritchie, Francesca Schiavone, David Matheson, Robin Millman, Clare Gilson, Mahesh K.B. Parmar, and Matthew R. Sydes, MRC Clinical Trials Unit at UCL, London; William Cross, Leeds Teaching Hospitals NHS Trust, Leeds; Rob J. Jones and J. Martin Russell, University of Glasgow; Rob J. Jones and Jan Wallace, Beatson West of Scotland Cancer Centre, Glasgow; Azman Ibrahim, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral; Anna Lydon, Torbay District Hospital, Torquay; Ashok D. Nikapota, Sussex Cancer Centre, Brighton; Ashok D. Nikapota, Worthing Hospital, Worthing; Joe M. O’Sullivan, Centre for Cancer Research and Cell Biology, Queen's University, Belfast; Andrew Protheroe, Churchill Hospital, Oxford; Narayanan Nair Srihari, Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury; David Tsang, Southend Hospital, Southend-on-Sea; David Tsang, Basildon Hospital, Basildon; John Wagstaff, The South West Wales Cancer Institute; John Wagstaff, Swansea University College of Medicine, Swansea; Catherine Walmsley, Royal Preston Hospital, Preston, United Kingdom; George N. Thalmann, University Hospital; Estelle Cassoly, SAKK Coordinating Center, Berne; and Cyrill A. Rentsch, University Hospital Basel, Basel, Switzerland
| | - Alastair W.S. Ritchie
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; Jim Barber, Velindre Cancer Centre, Cardiff; Noel W. Clarke, The Christie and Salford Royal NHS Foundation Trusts; John Logue, Christie Hospital, Manchester; Nicholas D. James, Institute of Cancer and Genomic Sciences; Emilio Porfiri, The Medical School, University of Birmingham; Nicholas D. James, Queen Elizabeth Hospital; Emilio Porfiri, University Hospitals Birmingham NHS Foundation Trust, Birmingham; David P. Dearnaley, Gerhardt Attard, and Christopher C. Parker, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust; Melissa R. Spears, Alastair W.S. Ritchie, Francesca Schiavone, David Matheson, Robin Millman, Clare Gilson, Mahesh K.B. Parmar, and Matthew R. Sydes, MRC Clinical Trials Unit at UCL, London; William Cross, Leeds Teaching Hospitals NHS Trust, Leeds; Rob J. Jones and J. Martin Russell, University of Glasgow; Rob J. Jones and Jan Wallace, Beatson West of Scotland Cancer Centre, Glasgow; Azman Ibrahim, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral; Anna Lydon, Torbay District Hospital, Torquay; Ashok D. Nikapota, Sussex Cancer Centre, Brighton; Ashok D. Nikapota, Worthing Hospital, Worthing; Joe M. O’Sullivan, Centre for Cancer Research and Cell Biology, Queen's University, Belfast; Andrew Protheroe, Churchill Hospital, Oxford; Narayanan Nair Srihari, Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury; David Tsang, Southend Hospital, Southend-on-Sea; David Tsang, Basildon Hospital, Basildon; John Wagstaff, The South West Wales Cancer Institute; John Wagstaff, Swansea University College of Medicine, Swansea; Catherine Walmsley, Royal Preston Hospital, Preston, United Kingdom; George N. Thalmann, University Hospital; Estelle Cassoly, SAKK Coordinating Center, Berne; and Cyrill A. Rentsch, University Hospital Basel, Basel, Switzerland
| | - Gerhardt Attard
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; Jim Barber, Velindre Cancer Centre, Cardiff; Noel W. Clarke, The Christie and Salford Royal NHS Foundation Trusts; John Logue, Christie Hospital, Manchester; Nicholas D. James, Institute of Cancer and Genomic Sciences; Emilio Porfiri, The Medical School, University of Birmingham; Nicholas D. James, Queen Elizabeth Hospital; Emilio Porfiri, University Hospitals Birmingham NHS Foundation Trust, Birmingham; David P. Dearnaley, Gerhardt Attard, and Christopher C. Parker, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust; Melissa R. Spears, Alastair W.S. Ritchie, Francesca Schiavone, David Matheson, Robin Millman, Clare Gilson, Mahesh K.B. Parmar, and Matthew R. Sydes, MRC Clinical Trials Unit at UCL, London; William Cross, Leeds Teaching Hospitals NHS Trust, Leeds; Rob J. Jones and J. Martin Russell, University of Glasgow; Rob J. Jones and Jan Wallace, Beatson West of Scotland Cancer Centre, Glasgow; Azman Ibrahim, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral; Anna Lydon, Torbay District Hospital, Torquay; Ashok D. Nikapota, Sussex Cancer Centre, Brighton; Ashok D. Nikapota, Worthing Hospital, Worthing; Joe M. O’Sullivan, Centre for Cancer Research and Cell Biology, Queen's University, Belfast; Andrew Protheroe, Churchill Hospital, Oxford; Narayanan Nair Srihari, Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury; David Tsang, Southend Hospital, Southend-on-Sea; David Tsang, Basildon Hospital, Basildon; John Wagstaff, The South West Wales Cancer Institute; John Wagstaff, Swansea University College of Medicine, Swansea; Catherine Walmsley, Royal Preston Hospital, Preston, United Kingdom; George N. Thalmann, University Hospital; Estelle Cassoly, SAKK Coordinating Center, Berne; and Cyrill A. Rentsch, University Hospital Basel, Basel, Switzerland
| | - William Cross
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; Jim Barber, Velindre Cancer Centre, Cardiff; Noel W. Clarke, The Christie and Salford Royal NHS Foundation Trusts; John Logue, Christie Hospital, Manchester; Nicholas D. James, Institute of Cancer and Genomic Sciences; Emilio Porfiri, The Medical School, University of Birmingham; Nicholas D. James, Queen Elizabeth Hospital; Emilio Porfiri, University Hospitals Birmingham NHS Foundation Trust, Birmingham; David P. Dearnaley, Gerhardt Attard, and Christopher C. Parker, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust; Melissa R. Spears, Alastair W.S. Ritchie, Francesca Schiavone, David Matheson, Robin Millman, Clare Gilson, Mahesh K.B. Parmar, and Matthew R. Sydes, MRC Clinical Trials Unit at UCL, London; William Cross, Leeds Teaching Hospitals NHS Trust, Leeds; Rob J. Jones and J. Martin Russell, University of Glasgow; Rob J. Jones and Jan Wallace, Beatson West of Scotland Cancer Centre, Glasgow; Azman Ibrahim, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral; Anna Lydon, Torbay District Hospital, Torquay; Ashok D. Nikapota, Sussex Cancer Centre, Brighton; Ashok D. Nikapota, Worthing Hospital, Worthing; Joe M. O’Sullivan, Centre for Cancer Research and Cell Biology, Queen's University, Belfast; Andrew Protheroe, Churchill Hospital, Oxford; Narayanan Nair Srihari, Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury; David Tsang, Southend Hospital, Southend-on-Sea; David Tsang, Basildon Hospital, Basildon; John Wagstaff, The South West Wales Cancer Institute; John Wagstaff, Swansea University College of Medicine, Swansea; Catherine Walmsley, Royal Preston Hospital, Preston, United Kingdom; George N. Thalmann, University Hospital; Estelle Cassoly, SAKK Coordinating Center, Berne; and Cyrill A. Rentsch, University Hospital Basel, Basel, Switzerland
| | - Rob J. Jones
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; Jim Barber, Velindre Cancer Centre, Cardiff; Noel W. Clarke, The Christie and Salford Royal NHS Foundation Trusts; John Logue, Christie Hospital, Manchester; Nicholas D. James, Institute of Cancer and Genomic Sciences; Emilio Porfiri, The Medical School, University of Birmingham; Nicholas D. James, Queen Elizabeth Hospital; Emilio Porfiri, University Hospitals Birmingham NHS Foundation Trust, Birmingham; David P. Dearnaley, Gerhardt Attard, and Christopher C. Parker, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust; Melissa R. Spears, Alastair W.S. Ritchie, Francesca Schiavone, David Matheson, Robin Millman, Clare Gilson, Mahesh K.B. Parmar, and Matthew R. Sydes, MRC Clinical Trials Unit at UCL, London; William Cross, Leeds Teaching Hospitals NHS Trust, Leeds; Rob J. Jones and J. Martin Russell, University of Glasgow; Rob J. Jones and Jan Wallace, Beatson West of Scotland Cancer Centre, Glasgow; Azman Ibrahim, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral; Anna Lydon, Torbay District Hospital, Torquay; Ashok D. Nikapota, Sussex Cancer Centre, Brighton; Ashok D. Nikapota, Worthing Hospital, Worthing; Joe M. O’Sullivan, Centre for Cancer Research and Cell Biology, Queen's University, Belfast; Andrew Protheroe, Churchill Hospital, Oxford; Narayanan Nair Srihari, Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury; David Tsang, Southend Hospital, Southend-on-Sea; David Tsang, Basildon Hospital, Basildon; John Wagstaff, The South West Wales Cancer Institute; John Wagstaff, Swansea University College of Medicine, Swansea; Catherine Walmsley, Royal Preston Hospital, Preston, United Kingdom; George N. Thalmann, University Hospital; Estelle Cassoly, SAKK Coordinating Center, Berne; and Cyrill A. Rentsch, University Hospital Basel, Basel, Switzerland
| | - Christopher C. Parker
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; Jim Barber, Velindre Cancer Centre, Cardiff; Noel W. Clarke, The Christie and Salford Royal NHS Foundation Trusts; John Logue, Christie Hospital, Manchester; Nicholas D. James, Institute of Cancer and Genomic Sciences; Emilio Porfiri, The Medical School, University of Birmingham; Nicholas D. James, Queen Elizabeth Hospital; Emilio Porfiri, University Hospitals Birmingham NHS Foundation Trust, Birmingham; David P. Dearnaley, Gerhardt Attard, and Christopher C. Parker, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust; Melissa R. Spears, Alastair W.S. Ritchie, Francesca Schiavone, David Matheson, Robin Millman, Clare Gilson, Mahesh K.B. Parmar, and Matthew R. Sydes, MRC Clinical Trials Unit at UCL, London; William Cross, Leeds Teaching Hospitals NHS Trust, Leeds; Rob J. Jones and J. Martin Russell, University of Glasgow; Rob J. Jones and Jan Wallace, Beatson West of Scotland Cancer Centre, Glasgow; Azman Ibrahim, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral; Anna Lydon, Torbay District Hospital, Torquay; Ashok D. Nikapota, Sussex Cancer Centre, Brighton; Ashok D. Nikapota, Worthing Hospital, Worthing; Joe M. O’Sullivan, Centre for Cancer Research and Cell Biology, Queen's University, Belfast; Andrew Protheroe, Churchill Hospital, Oxford; Narayanan Nair Srihari, Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury; David Tsang, Southend Hospital, Southend-on-Sea; David Tsang, Basildon Hospital, Basildon; John Wagstaff, The South West Wales Cancer Institute; John Wagstaff, Swansea University College of Medicine, Swansea; Catherine Walmsley, Royal Preston Hospital, Preston, United Kingdom; George N. Thalmann, University Hospital; Estelle Cassoly, SAKK Coordinating Center, Berne; and Cyrill A. Rentsch, University Hospital Basel, Basel, Switzerland
| | - J. Martin Russell
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; Jim Barber, Velindre Cancer Centre, Cardiff; Noel W. Clarke, The Christie and Salford Royal NHS Foundation Trusts; John Logue, Christie Hospital, Manchester; Nicholas D. James, Institute of Cancer and Genomic Sciences; Emilio Porfiri, The Medical School, University of Birmingham; Nicholas D. James, Queen Elizabeth Hospital; Emilio Porfiri, University Hospitals Birmingham NHS Foundation Trust, Birmingham; David P. Dearnaley, Gerhardt Attard, and Christopher C. Parker, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust; Melissa R. Spears, Alastair W.S. Ritchie, Francesca Schiavone, David Matheson, Robin Millman, Clare Gilson, Mahesh K.B. Parmar, and Matthew R. Sydes, MRC Clinical Trials Unit at UCL, London; William Cross, Leeds Teaching Hospitals NHS Trust, Leeds; Rob J. Jones and J. Martin Russell, University of Glasgow; Rob J. Jones and Jan Wallace, Beatson West of Scotland Cancer Centre, Glasgow; Azman Ibrahim, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral; Anna Lydon, Torbay District Hospital, Torquay; Ashok D. Nikapota, Sussex Cancer Centre, Brighton; Ashok D. Nikapota, Worthing Hospital, Worthing; Joe M. O’Sullivan, Centre for Cancer Research and Cell Biology, Queen's University, Belfast; Andrew Protheroe, Churchill Hospital, Oxford; Narayanan Nair Srihari, Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury; David Tsang, Southend Hospital, Southend-on-Sea; David Tsang, Basildon Hospital, Basildon; John Wagstaff, The South West Wales Cancer Institute; John Wagstaff, Swansea University College of Medicine, Swansea; Catherine Walmsley, Royal Preston Hospital, Preston, United Kingdom; George N. Thalmann, University Hospital; Estelle Cassoly, SAKK Coordinating Center, Berne; and Cyrill A. Rentsch, University Hospital Basel, Basel, Switzerland
| | - George N. Thalmann
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; Jim Barber, Velindre Cancer Centre, Cardiff; Noel W. Clarke, The Christie and Salford Royal NHS Foundation Trusts; John Logue, Christie Hospital, Manchester; Nicholas D. James, Institute of Cancer and Genomic Sciences; Emilio Porfiri, The Medical School, University of Birmingham; Nicholas D. James, Queen Elizabeth Hospital; Emilio Porfiri, University Hospitals Birmingham NHS Foundation Trust, Birmingham; David P. Dearnaley, Gerhardt Attard, and Christopher C. Parker, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust; Melissa R. Spears, Alastair W.S. Ritchie, Francesca Schiavone, David Matheson, Robin Millman, Clare Gilson, Mahesh K.B. Parmar, and Matthew R. Sydes, MRC Clinical Trials Unit at UCL, London; William Cross, Leeds Teaching Hospitals NHS Trust, Leeds; Rob J. Jones and J. Martin Russell, University of Glasgow; Rob J. Jones and Jan Wallace, Beatson West of Scotland Cancer Centre, Glasgow; Azman Ibrahim, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral; Anna Lydon, Torbay District Hospital, Torquay; Ashok D. Nikapota, Sussex Cancer Centre, Brighton; Ashok D. Nikapota, Worthing Hospital, Worthing; Joe M. O’Sullivan, Centre for Cancer Research and Cell Biology, Queen's University, Belfast; Andrew Protheroe, Churchill Hospital, Oxford; Narayanan Nair Srihari, Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury; David Tsang, Southend Hospital, Southend-on-Sea; David Tsang, Basildon Hospital, Basildon; John Wagstaff, The South West Wales Cancer Institute; John Wagstaff, Swansea University College of Medicine, Swansea; Catherine Walmsley, Royal Preston Hospital, Preston, United Kingdom; George N. Thalmann, University Hospital; Estelle Cassoly, SAKK Coordinating Center, Berne; and Cyrill A. Rentsch, University Hospital Basel, Basel, Switzerland
| | - Francesca Schiavone
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; Jim Barber, Velindre Cancer Centre, Cardiff; Noel W. Clarke, The Christie and Salford Royal NHS Foundation Trusts; John Logue, Christie Hospital, Manchester; Nicholas D. James, Institute of Cancer and Genomic Sciences; Emilio Porfiri, The Medical School, University of Birmingham; Nicholas D. James, Queen Elizabeth Hospital; Emilio Porfiri, University Hospitals Birmingham NHS Foundation Trust, Birmingham; David P. Dearnaley, Gerhardt Attard, and Christopher C. Parker, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust; Melissa R. Spears, Alastair W.S. Ritchie, Francesca Schiavone, David Matheson, Robin Millman, Clare Gilson, Mahesh K.B. Parmar, and Matthew R. Sydes, MRC Clinical Trials Unit at UCL, London; William Cross, Leeds Teaching Hospitals NHS Trust, Leeds; Rob J. Jones and J. Martin Russell, University of Glasgow; Rob J. Jones and Jan Wallace, Beatson West of Scotland Cancer Centre, Glasgow; Azman Ibrahim, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral; Anna Lydon, Torbay District Hospital, Torquay; Ashok D. Nikapota, Sussex Cancer Centre, Brighton; Ashok D. Nikapota, Worthing Hospital, Worthing; Joe M. O’Sullivan, Centre for Cancer Research and Cell Biology, Queen's University, Belfast; Andrew Protheroe, Churchill Hospital, Oxford; Narayanan Nair Srihari, Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury; David Tsang, Southend Hospital, Southend-on-Sea; David Tsang, Basildon Hospital, Basildon; John Wagstaff, The South West Wales Cancer Institute; John Wagstaff, Swansea University College of Medicine, Swansea; Catherine Walmsley, Royal Preston Hospital, Preston, United Kingdom; George N. Thalmann, University Hospital; Estelle Cassoly, SAKK Coordinating Center, Berne; and Cyrill A. Rentsch, University Hospital Basel, Basel, Switzerland
| | - Estelle Cassoly
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; Jim Barber, Velindre Cancer Centre, Cardiff; Noel W. Clarke, The Christie and Salford Royal NHS Foundation Trusts; John Logue, Christie Hospital, Manchester; Nicholas D. James, Institute of Cancer and Genomic Sciences; Emilio Porfiri, The Medical School, University of Birmingham; Nicholas D. James, Queen Elizabeth Hospital; Emilio Porfiri, University Hospitals Birmingham NHS Foundation Trust, Birmingham; David P. Dearnaley, Gerhardt Attard, and Christopher C. Parker, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust; Melissa R. Spears, Alastair W.S. Ritchie, Francesca Schiavone, David Matheson, Robin Millman, Clare Gilson, Mahesh K.B. Parmar, and Matthew R. Sydes, MRC Clinical Trials Unit at UCL, London; William Cross, Leeds Teaching Hospitals NHS Trust, Leeds; Rob J. Jones and J. Martin Russell, University of Glasgow; Rob J. Jones and Jan Wallace, Beatson West of Scotland Cancer Centre, Glasgow; Azman Ibrahim, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral; Anna Lydon, Torbay District Hospital, Torquay; Ashok D. Nikapota, Sussex Cancer Centre, Brighton; Ashok D. Nikapota, Worthing Hospital, Worthing; Joe M. O’Sullivan, Centre for Cancer Research and Cell Biology, Queen's University, Belfast; Andrew Protheroe, Churchill Hospital, Oxford; Narayanan Nair Srihari, Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury; David Tsang, Southend Hospital, Southend-on-Sea; David Tsang, Basildon Hospital, Basildon; John Wagstaff, The South West Wales Cancer Institute; John Wagstaff, Swansea University College of Medicine, Swansea; Catherine Walmsley, Royal Preston Hospital, Preston, United Kingdom; George N. Thalmann, University Hospital; Estelle Cassoly, SAKK Coordinating Center, Berne; and Cyrill A. Rentsch, University Hospital Basel, Basel, Switzerland
| | - David Matheson
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; Jim Barber, Velindre Cancer Centre, Cardiff; Noel W. Clarke, The Christie and Salford Royal NHS Foundation Trusts; John Logue, Christie Hospital, Manchester; Nicholas D. James, Institute of Cancer and Genomic Sciences; Emilio Porfiri, The Medical School, University of Birmingham; Nicholas D. James, Queen Elizabeth Hospital; Emilio Porfiri, University Hospitals Birmingham NHS Foundation Trust, Birmingham; David P. Dearnaley, Gerhardt Attard, and Christopher C. Parker, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust; Melissa R. Spears, Alastair W.S. Ritchie, Francesca Schiavone, David Matheson, Robin Millman, Clare Gilson, Mahesh K.B. Parmar, and Matthew R. Sydes, MRC Clinical Trials Unit at UCL, London; William Cross, Leeds Teaching Hospitals NHS Trust, Leeds; Rob J. Jones and J. Martin Russell, University of Glasgow; Rob J. Jones and Jan Wallace, Beatson West of Scotland Cancer Centre, Glasgow; Azman Ibrahim, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral; Anna Lydon, Torbay District Hospital, Torquay; Ashok D. Nikapota, Sussex Cancer Centre, Brighton; Ashok D. Nikapota, Worthing Hospital, Worthing; Joe M. O’Sullivan, Centre for Cancer Research and Cell Biology, Queen's University, Belfast; Andrew Protheroe, Churchill Hospital, Oxford; Narayanan Nair Srihari, Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury; David Tsang, Southend Hospital, Southend-on-Sea; David Tsang, Basildon Hospital, Basildon; John Wagstaff, The South West Wales Cancer Institute; John Wagstaff, Swansea University College of Medicine, Swansea; Catherine Walmsley, Royal Preston Hospital, Preston, United Kingdom; George N. Thalmann, University Hospital; Estelle Cassoly, SAKK Coordinating Center, Berne; and Cyrill A. Rentsch, University Hospital Basel, Basel, Switzerland
| | - Robin Millman
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; Jim Barber, Velindre Cancer Centre, Cardiff; Noel W. Clarke, The Christie and Salford Royal NHS Foundation Trusts; John Logue, Christie Hospital, Manchester; Nicholas D. James, Institute of Cancer and Genomic Sciences; Emilio Porfiri, The Medical School, University of Birmingham; Nicholas D. James, Queen Elizabeth Hospital; Emilio Porfiri, University Hospitals Birmingham NHS Foundation Trust, Birmingham; David P. Dearnaley, Gerhardt Attard, and Christopher C. Parker, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust; Melissa R. Spears, Alastair W.S. Ritchie, Francesca Schiavone, David Matheson, Robin Millman, Clare Gilson, Mahesh K.B. Parmar, and Matthew R. Sydes, MRC Clinical Trials Unit at UCL, London; William Cross, Leeds Teaching Hospitals NHS Trust, Leeds; Rob J. Jones and J. Martin Russell, University of Glasgow; Rob J. Jones and Jan Wallace, Beatson West of Scotland Cancer Centre, Glasgow; Azman Ibrahim, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral; Anna Lydon, Torbay District Hospital, Torquay; Ashok D. Nikapota, Sussex Cancer Centre, Brighton; Ashok D. Nikapota, Worthing Hospital, Worthing; Joe M. O’Sullivan, Centre for Cancer Research and Cell Biology, Queen's University, Belfast; Andrew Protheroe, Churchill Hospital, Oxford; Narayanan Nair Srihari, Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury; David Tsang, Southend Hospital, Southend-on-Sea; David Tsang, Basildon Hospital, Basildon; John Wagstaff, The South West Wales Cancer Institute; John Wagstaff, Swansea University College of Medicine, Swansea; Catherine Walmsley, Royal Preston Hospital, Preston, United Kingdom; George N. Thalmann, University Hospital; Estelle Cassoly, SAKK Coordinating Center, Berne; and Cyrill A. Rentsch, University Hospital Basel, Basel, Switzerland
| | - Cyrill A. Rentsch
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; Jim Barber, Velindre Cancer Centre, Cardiff; Noel W. Clarke, The Christie and Salford Royal NHS Foundation Trusts; John Logue, Christie Hospital, Manchester; Nicholas D. James, Institute of Cancer and Genomic Sciences; Emilio Porfiri, The Medical School, University of Birmingham; Nicholas D. James, Queen Elizabeth Hospital; Emilio Porfiri, University Hospitals Birmingham NHS Foundation Trust, Birmingham; David P. Dearnaley, Gerhardt Attard, and Christopher C. Parker, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust; Melissa R. Spears, Alastair W.S. Ritchie, Francesca Schiavone, David Matheson, Robin Millman, Clare Gilson, Mahesh K.B. Parmar, and Matthew R. Sydes, MRC Clinical Trials Unit at UCL, London; William Cross, Leeds Teaching Hospitals NHS Trust, Leeds; Rob J. Jones and J. Martin Russell, University of Glasgow; Rob J. Jones and Jan Wallace, Beatson West of Scotland Cancer Centre, Glasgow; Azman Ibrahim, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral; Anna Lydon, Torbay District Hospital, Torquay; Ashok D. Nikapota, Sussex Cancer Centre, Brighton; Ashok D. Nikapota, Worthing Hospital, Worthing; Joe M. O’Sullivan, Centre for Cancer Research and Cell Biology, Queen's University, Belfast; Andrew Protheroe, Churchill Hospital, Oxford; Narayanan Nair Srihari, Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury; David Tsang, Southend Hospital, Southend-on-Sea; David Tsang, Basildon Hospital, Basildon; John Wagstaff, The South West Wales Cancer Institute; John Wagstaff, Swansea University College of Medicine, Swansea; Catherine Walmsley, Royal Preston Hospital, Preston, United Kingdom; George N. Thalmann, University Hospital; Estelle Cassoly, SAKK Coordinating Center, Berne; and Cyrill A. Rentsch, University Hospital Basel, Basel, Switzerland
| | - Jim Barber
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; Jim Barber, Velindre Cancer Centre, Cardiff; Noel W. Clarke, The Christie and Salford Royal NHS Foundation Trusts; John Logue, Christie Hospital, Manchester; Nicholas D. James, Institute of Cancer and Genomic Sciences; Emilio Porfiri, The Medical School, University of Birmingham; Nicholas D. James, Queen Elizabeth Hospital; Emilio Porfiri, University Hospitals Birmingham NHS Foundation Trust, Birmingham; David P. Dearnaley, Gerhardt Attard, and Christopher C. Parker, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust; Melissa R. Spears, Alastair W.S. Ritchie, Francesca Schiavone, David Matheson, Robin Millman, Clare Gilson, Mahesh K.B. Parmar, and Matthew R. Sydes, MRC Clinical Trials Unit at UCL, London; William Cross, Leeds Teaching Hospitals NHS Trust, Leeds; Rob J. Jones and J. Martin Russell, University of Glasgow; Rob J. Jones and Jan Wallace, Beatson West of Scotland Cancer Centre, Glasgow; Azman Ibrahim, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral; Anna Lydon, Torbay District Hospital, Torquay; Ashok D. Nikapota, Sussex Cancer Centre, Brighton; Ashok D. Nikapota, Worthing Hospital, Worthing; Joe M. O’Sullivan, Centre for Cancer Research and Cell Biology, Queen's University, Belfast; Andrew Protheroe, Churchill Hospital, Oxford; Narayanan Nair Srihari, Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury; David Tsang, Southend Hospital, Southend-on-Sea; David Tsang, Basildon Hospital, Basildon; John Wagstaff, The South West Wales Cancer Institute; John Wagstaff, Swansea University College of Medicine, Swansea; Catherine Walmsley, Royal Preston Hospital, Preston, United Kingdom; George N. Thalmann, University Hospital; Estelle Cassoly, SAKK Coordinating Center, Berne; and Cyrill A. Rentsch, University Hospital Basel, Basel, Switzerland
| | - Clare Gilson
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; Jim Barber, Velindre Cancer Centre, Cardiff; Noel W. Clarke, The Christie and Salford Royal NHS Foundation Trusts; John Logue, Christie Hospital, Manchester; Nicholas D. James, Institute of Cancer and Genomic Sciences; Emilio Porfiri, The Medical School, University of Birmingham; Nicholas D. James, Queen Elizabeth Hospital; Emilio Porfiri, University Hospitals Birmingham NHS Foundation Trust, Birmingham; David P. Dearnaley, Gerhardt Attard, and Christopher C. Parker, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust; Melissa R. Spears, Alastair W.S. Ritchie, Francesca Schiavone, David Matheson, Robin Millman, Clare Gilson, Mahesh K.B. Parmar, and Matthew R. Sydes, MRC Clinical Trials Unit at UCL, London; William Cross, Leeds Teaching Hospitals NHS Trust, Leeds; Rob J. Jones and J. Martin Russell, University of Glasgow; Rob J. Jones and Jan Wallace, Beatson West of Scotland Cancer Centre, Glasgow; Azman Ibrahim, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral; Anna Lydon, Torbay District Hospital, Torquay; Ashok D. Nikapota, Sussex Cancer Centre, Brighton; Ashok D. Nikapota, Worthing Hospital, Worthing; Joe M. O’Sullivan, Centre for Cancer Research and Cell Biology, Queen's University, Belfast; Andrew Protheroe, Churchill Hospital, Oxford; Narayanan Nair Srihari, Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury; David Tsang, Southend Hospital, Southend-on-Sea; David Tsang, Basildon Hospital, Basildon; John Wagstaff, The South West Wales Cancer Institute; John Wagstaff, Swansea University College of Medicine, Swansea; Catherine Walmsley, Royal Preston Hospital, Preston, United Kingdom; George N. Thalmann, University Hospital; Estelle Cassoly, SAKK Coordinating Center, Berne; and Cyrill A. Rentsch, University Hospital Basel, Basel, Switzerland
| | - Azman Ibrahim
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; Jim Barber, Velindre Cancer Centre, Cardiff; Noel W. Clarke, The Christie and Salford Royal NHS Foundation Trusts; John Logue, Christie Hospital, Manchester; Nicholas D. James, Institute of Cancer and Genomic Sciences; Emilio Porfiri, The Medical School, University of Birmingham; Nicholas D. James, Queen Elizabeth Hospital; Emilio Porfiri, University Hospitals Birmingham NHS Foundation Trust, Birmingham; David P. Dearnaley, Gerhardt Attard, and Christopher C. Parker, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust; Melissa R. Spears, Alastair W.S. Ritchie, Francesca Schiavone, David Matheson, Robin Millman, Clare Gilson, Mahesh K.B. Parmar, and Matthew R. Sydes, MRC Clinical Trials Unit at UCL, London; William Cross, Leeds Teaching Hospitals NHS Trust, Leeds; Rob J. Jones and J. Martin Russell, University of Glasgow; Rob J. Jones and Jan Wallace, Beatson West of Scotland Cancer Centre, Glasgow; Azman Ibrahim, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral; Anna Lydon, Torbay District Hospital, Torquay; Ashok D. Nikapota, Sussex Cancer Centre, Brighton; Ashok D. Nikapota, Worthing Hospital, Worthing; Joe M. O’Sullivan, Centre for Cancer Research and Cell Biology, Queen's University, Belfast; Andrew Protheroe, Churchill Hospital, Oxford; Narayanan Nair Srihari, Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury; David Tsang, Southend Hospital, Southend-on-Sea; David Tsang, Basildon Hospital, Basildon; John Wagstaff, The South West Wales Cancer Institute; John Wagstaff, Swansea University College of Medicine, Swansea; Catherine Walmsley, Royal Preston Hospital, Preston, United Kingdom; George N. Thalmann, University Hospital; Estelle Cassoly, SAKK Coordinating Center, Berne; and Cyrill A. Rentsch, University Hospital Basel, Basel, Switzerland
| | - John Logue
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; Jim Barber, Velindre Cancer Centre, Cardiff; Noel W. Clarke, The Christie and Salford Royal NHS Foundation Trusts; John Logue, Christie Hospital, Manchester; Nicholas D. James, Institute of Cancer and Genomic Sciences; Emilio Porfiri, The Medical School, University of Birmingham; Nicholas D. James, Queen Elizabeth Hospital; Emilio Porfiri, University Hospitals Birmingham NHS Foundation Trust, Birmingham; David P. Dearnaley, Gerhardt Attard, and Christopher C. Parker, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust; Melissa R. Spears, Alastair W.S. Ritchie, Francesca Schiavone, David Matheson, Robin Millman, Clare Gilson, Mahesh K.B. Parmar, and Matthew R. Sydes, MRC Clinical Trials Unit at UCL, London; William Cross, Leeds Teaching Hospitals NHS Trust, Leeds; Rob J. Jones and J. Martin Russell, University of Glasgow; Rob J. Jones and Jan Wallace, Beatson West of Scotland Cancer Centre, Glasgow; Azman Ibrahim, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral; Anna Lydon, Torbay District Hospital, Torquay; Ashok D. Nikapota, Sussex Cancer Centre, Brighton; Ashok D. Nikapota, Worthing Hospital, Worthing; Joe M. O’Sullivan, Centre for Cancer Research and Cell Biology, Queen's University, Belfast; Andrew Protheroe, Churchill Hospital, Oxford; Narayanan Nair Srihari, Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury; David Tsang, Southend Hospital, Southend-on-Sea; David Tsang, Basildon Hospital, Basildon; John Wagstaff, The South West Wales Cancer Institute; John Wagstaff, Swansea University College of Medicine, Swansea; Catherine Walmsley, Royal Preston Hospital, Preston, United Kingdom; George N. Thalmann, University Hospital; Estelle Cassoly, SAKK Coordinating Center, Berne; and Cyrill A. Rentsch, University Hospital Basel, Basel, Switzerland
| | - Anna Lydon
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; Jim Barber, Velindre Cancer Centre, Cardiff; Noel W. Clarke, The Christie and Salford Royal NHS Foundation Trusts; John Logue, Christie Hospital, Manchester; Nicholas D. James, Institute of Cancer and Genomic Sciences; Emilio Porfiri, The Medical School, University of Birmingham; Nicholas D. James, Queen Elizabeth Hospital; Emilio Porfiri, University Hospitals Birmingham NHS Foundation Trust, Birmingham; David P. Dearnaley, Gerhardt Attard, and Christopher C. Parker, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust; Melissa R. Spears, Alastair W.S. Ritchie, Francesca Schiavone, David Matheson, Robin Millman, Clare Gilson, Mahesh K.B. Parmar, and Matthew R. Sydes, MRC Clinical Trials Unit at UCL, London; William Cross, Leeds Teaching Hospitals NHS Trust, Leeds; Rob J. Jones and J. Martin Russell, University of Glasgow; Rob J. Jones and Jan Wallace, Beatson West of Scotland Cancer Centre, Glasgow; Azman Ibrahim, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral; Anna Lydon, Torbay District Hospital, Torquay; Ashok D. Nikapota, Sussex Cancer Centre, Brighton; Ashok D. Nikapota, Worthing Hospital, Worthing; Joe M. O’Sullivan, Centre for Cancer Research and Cell Biology, Queen's University, Belfast; Andrew Protheroe, Churchill Hospital, Oxford; Narayanan Nair Srihari, Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury; David Tsang, Southend Hospital, Southend-on-Sea; David Tsang, Basildon Hospital, Basildon; John Wagstaff, The South West Wales Cancer Institute; John Wagstaff, Swansea University College of Medicine, Swansea; Catherine Walmsley, Royal Preston Hospital, Preston, United Kingdom; George N. Thalmann, University Hospital; Estelle Cassoly, SAKK Coordinating Center, Berne; and Cyrill A. Rentsch, University Hospital Basel, Basel, Switzerland
| | - Ashok D. Nikapota
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; Jim Barber, Velindre Cancer Centre, Cardiff; Noel W. Clarke, The Christie and Salford Royal NHS Foundation Trusts; John Logue, Christie Hospital, Manchester; Nicholas D. James, Institute of Cancer and Genomic Sciences; Emilio Porfiri, The Medical School, University of Birmingham; Nicholas D. James, Queen Elizabeth Hospital; Emilio Porfiri, University Hospitals Birmingham NHS Foundation Trust, Birmingham; David P. Dearnaley, Gerhardt Attard, and Christopher C. Parker, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust; Melissa R. Spears, Alastair W.S. Ritchie, Francesca Schiavone, David Matheson, Robin Millman, Clare Gilson, Mahesh K.B. Parmar, and Matthew R. Sydes, MRC Clinical Trials Unit at UCL, London; William Cross, Leeds Teaching Hospitals NHS Trust, Leeds; Rob J. Jones and J. Martin Russell, University of Glasgow; Rob J. Jones and Jan Wallace, Beatson West of Scotland Cancer Centre, Glasgow; Azman Ibrahim, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral; Anna Lydon, Torbay District Hospital, Torquay; Ashok D. Nikapota, Sussex Cancer Centre, Brighton; Ashok D. Nikapota, Worthing Hospital, Worthing; Joe M. O’Sullivan, Centre for Cancer Research and Cell Biology, Queen's University, Belfast; Andrew Protheroe, Churchill Hospital, Oxford; Narayanan Nair Srihari, Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury; David Tsang, Southend Hospital, Southend-on-Sea; David Tsang, Basildon Hospital, Basildon; John Wagstaff, The South West Wales Cancer Institute; John Wagstaff, Swansea University College of Medicine, Swansea; Catherine Walmsley, Royal Preston Hospital, Preston, United Kingdom; George N. Thalmann, University Hospital; Estelle Cassoly, SAKK Coordinating Center, Berne; and Cyrill A. Rentsch, University Hospital Basel, Basel, Switzerland
| | - Joe M. O’Sullivan
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; Jim Barber, Velindre Cancer Centre, Cardiff; Noel W. Clarke, The Christie and Salford Royal NHS Foundation Trusts; John Logue, Christie Hospital, Manchester; Nicholas D. James, Institute of Cancer and Genomic Sciences; Emilio Porfiri, The Medical School, University of Birmingham; Nicholas D. James, Queen Elizabeth Hospital; Emilio Porfiri, University Hospitals Birmingham NHS Foundation Trust, Birmingham; David P. Dearnaley, Gerhardt Attard, and Christopher C. Parker, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust; Melissa R. Spears, Alastair W.S. Ritchie, Francesca Schiavone, David Matheson, Robin Millman, Clare Gilson, Mahesh K.B. Parmar, and Matthew R. Sydes, MRC Clinical Trials Unit at UCL, London; William Cross, Leeds Teaching Hospitals NHS Trust, Leeds; Rob J. Jones and J. Martin Russell, University of Glasgow; Rob J. Jones and Jan Wallace, Beatson West of Scotland Cancer Centre, Glasgow; Azman Ibrahim, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral; Anna Lydon, Torbay District Hospital, Torquay; Ashok D. Nikapota, Sussex Cancer Centre, Brighton; Ashok D. Nikapota, Worthing Hospital, Worthing; Joe M. O’Sullivan, Centre for Cancer Research and Cell Biology, Queen's University, Belfast; Andrew Protheroe, Churchill Hospital, Oxford; Narayanan Nair Srihari, Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury; David Tsang, Southend Hospital, Southend-on-Sea; David Tsang, Basildon Hospital, Basildon; John Wagstaff, The South West Wales Cancer Institute; John Wagstaff, Swansea University College of Medicine, Swansea; Catherine Walmsley, Royal Preston Hospital, Preston, United Kingdom; George N. Thalmann, University Hospital; Estelle Cassoly, SAKK Coordinating Center, Berne; and Cyrill A. Rentsch, University Hospital Basel, Basel, Switzerland
| | - Emilio Porfiri
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; Jim Barber, Velindre Cancer Centre, Cardiff; Noel W. Clarke, The Christie and Salford Royal NHS Foundation Trusts; John Logue, Christie Hospital, Manchester; Nicholas D. James, Institute of Cancer and Genomic Sciences; Emilio Porfiri, The Medical School, University of Birmingham; Nicholas D. James, Queen Elizabeth Hospital; Emilio Porfiri, University Hospitals Birmingham NHS Foundation Trust, Birmingham; David P. Dearnaley, Gerhardt Attard, and Christopher C. Parker, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust; Melissa R. Spears, Alastair W.S. Ritchie, Francesca Schiavone, David Matheson, Robin Millman, Clare Gilson, Mahesh K.B. Parmar, and Matthew R. Sydes, MRC Clinical Trials Unit at UCL, London; William Cross, Leeds Teaching Hospitals NHS Trust, Leeds; Rob J. Jones and J. Martin Russell, University of Glasgow; Rob J. Jones and Jan Wallace, Beatson West of Scotland Cancer Centre, Glasgow; Azman Ibrahim, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral; Anna Lydon, Torbay District Hospital, Torquay; Ashok D. Nikapota, Sussex Cancer Centre, Brighton; Ashok D. Nikapota, Worthing Hospital, Worthing; Joe M. O’Sullivan, Centre for Cancer Research and Cell Biology, Queen's University, Belfast; Andrew Protheroe, Churchill Hospital, Oxford; Narayanan Nair Srihari, Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury; David Tsang, Southend Hospital, Southend-on-Sea; David Tsang, Basildon Hospital, Basildon; John Wagstaff, The South West Wales Cancer Institute; John Wagstaff, Swansea University College of Medicine, Swansea; Catherine Walmsley, Royal Preston Hospital, Preston, United Kingdom; George N. Thalmann, University Hospital; Estelle Cassoly, SAKK Coordinating Center, Berne; and Cyrill A. Rentsch, University Hospital Basel, Basel, Switzerland
| | - Andrew Protheroe
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; Jim Barber, Velindre Cancer Centre, Cardiff; Noel W. Clarke, The Christie and Salford Royal NHS Foundation Trusts; John Logue, Christie Hospital, Manchester; Nicholas D. James, Institute of Cancer and Genomic Sciences; Emilio Porfiri, The Medical School, University of Birmingham; Nicholas D. James, Queen Elizabeth Hospital; Emilio Porfiri, University Hospitals Birmingham NHS Foundation Trust, Birmingham; David P. Dearnaley, Gerhardt Attard, and Christopher C. Parker, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust; Melissa R. Spears, Alastair W.S. Ritchie, Francesca Schiavone, David Matheson, Robin Millman, Clare Gilson, Mahesh K.B. Parmar, and Matthew R. Sydes, MRC Clinical Trials Unit at UCL, London; William Cross, Leeds Teaching Hospitals NHS Trust, Leeds; Rob J. Jones and J. Martin Russell, University of Glasgow; Rob J. Jones and Jan Wallace, Beatson West of Scotland Cancer Centre, Glasgow; Azman Ibrahim, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral; Anna Lydon, Torbay District Hospital, Torquay; Ashok D. Nikapota, Sussex Cancer Centre, Brighton; Ashok D. Nikapota, Worthing Hospital, Worthing; Joe M. O’Sullivan, Centre for Cancer Research and Cell Biology, Queen's University, Belfast; Andrew Protheroe, Churchill Hospital, Oxford; Narayanan Nair Srihari, Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury; David Tsang, Southend Hospital, Southend-on-Sea; David Tsang, Basildon Hospital, Basildon; John Wagstaff, The South West Wales Cancer Institute; John Wagstaff, Swansea University College of Medicine, Swansea; Catherine Walmsley, Royal Preston Hospital, Preston, United Kingdom; George N. Thalmann, University Hospital; Estelle Cassoly, SAKK Coordinating Center, Berne; and Cyrill A. Rentsch, University Hospital Basel, Basel, Switzerland
| | - Narayanan Nair Srihari
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; Jim Barber, Velindre Cancer Centre, Cardiff; Noel W. Clarke, The Christie and Salford Royal NHS Foundation Trusts; John Logue, Christie Hospital, Manchester; Nicholas D. James, Institute of Cancer and Genomic Sciences; Emilio Porfiri, The Medical School, University of Birmingham; Nicholas D. James, Queen Elizabeth Hospital; Emilio Porfiri, University Hospitals Birmingham NHS Foundation Trust, Birmingham; David P. Dearnaley, Gerhardt Attard, and Christopher C. Parker, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust; Melissa R. Spears, Alastair W.S. Ritchie, Francesca Schiavone, David Matheson, Robin Millman, Clare Gilson, Mahesh K.B. Parmar, and Matthew R. Sydes, MRC Clinical Trials Unit at UCL, London; William Cross, Leeds Teaching Hospitals NHS Trust, Leeds; Rob J. Jones and J. Martin Russell, University of Glasgow; Rob J. Jones and Jan Wallace, Beatson West of Scotland Cancer Centre, Glasgow; Azman Ibrahim, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral; Anna Lydon, Torbay District Hospital, Torquay; Ashok D. Nikapota, Sussex Cancer Centre, Brighton; Ashok D. Nikapota, Worthing Hospital, Worthing; Joe M. O’Sullivan, Centre for Cancer Research and Cell Biology, Queen's University, Belfast; Andrew Protheroe, Churchill Hospital, Oxford; Narayanan Nair Srihari, Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury; David Tsang, Southend Hospital, Southend-on-Sea; David Tsang, Basildon Hospital, Basildon; John Wagstaff, The South West Wales Cancer Institute; John Wagstaff, Swansea University College of Medicine, Swansea; Catherine Walmsley, Royal Preston Hospital, Preston, United Kingdom; George N. Thalmann, University Hospital; Estelle Cassoly, SAKK Coordinating Center, Berne; and Cyrill A. Rentsch, University Hospital Basel, Basel, Switzerland
| | - David Tsang
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; Jim Barber, Velindre Cancer Centre, Cardiff; Noel W. Clarke, The Christie and Salford Royal NHS Foundation Trusts; John Logue, Christie Hospital, Manchester; Nicholas D. James, Institute of Cancer and Genomic Sciences; Emilio Porfiri, The Medical School, University of Birmingham; Nicholas D. James, Queen Elizabeth Hospital; Emilio Porfiri, University Hospitals Birmingham NHS Foundation Trust, Birmingham; David P. Dearnaley, Gerhardt Attard, and Christopher C. Parker, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust; Melissa R. Spears, Alastair W.S. Ritchie, Francesca Schiavone, David Matheson, Robin Millman, Clare Gilson, Mahesh K.B. Parmar, and Matthew R. Sydes, MRC Clinical Trials Unit at UCL, London; William Cross, Leeds Teaching Hospitals NHS Trust, Leeds; Rob J. Jones and J. Martin Russell, University of Glasgow; Rob J. Jones and Jan Wallace, Beatson West of Scotland Cancer Centre, Glasgow; Azman Ibrahim, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral; Anna Lydon, Torbay District Hospital, Torquay; Ashok D. Nikapota, Sussex Cancer Centre, Brighton; Ashok D. Nikapota, Worthing Hospital, Worthing; Joe M. O’Sullivan, Centre for Cancer Research and Cell Biology, Queen's University, Belfast; Andrew Protheroe, Churchill Hospital, Oxford; Narayanan Nair Srihari, Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury; David Tsang, Southend Hospital, Southend-on-Sea; David Tsang, Basildon Hospital, Basildon; John Wagstaff, The South West Wales Cancer Institute; John Wagstaff, Swansea University College of Medicine, Swansea; Catherine Walmsley, Royal Preston Hospital, Preston, United Kingdom; George N. Thalmann, University Hospital; Estelle Cassoly, SAKK Coordinating Center, Berne; and Cyrill A. Rentsch, University Hospital Basel, Basel, Switzerland
| | - John Wagstaff
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; Jim Barber, Velindre Cancer Centre, Cardiff; Noel W. Clarke, The Christie and Salford Royal NHS Foundation Trusts; John Logue, Christie Hospital, Manchester; Nicholas D. James, Institute of Cancer and Genomic Sciences; Emilio Porfiri, The Medical School, University of Birmingham; Nicholas D. James, Queen Elizabeth Hospital; Emilio Porfiri, University Hospitals Birmingham NHS Foundation Trust, Birmingham; David P. Dearnaley, Gerhardt Attard, and Christopher C. Parker, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust; Melissa R. Spears, Alastair W.S. Ritchie, Francesca Schiavone, David Matheson, Robin Millman, Clare Gilson, Mahesh K.B. Parmar, and Matthew R. Sydes, MRC Clinical Trials Unit at UCL, London; William Cross, Leeds Teaching Hospitals NHS Trust, Leeds; Rob J. Jones and J. Martin Russell, University of Glasgow; Rob J. Jones and Jan Wallace, Beatson West of Scotland Cancer Centre, Glasgow; Azman Ibrahim, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral; Anna Lydon, Torbay District Hospital, Torquay; Ashok D. Nikapota, Sussex Cancer Centre, Brighton; Ashok D. Nikapota, Worthing Hospital, Worthing; Joe M. O’Sullivan, Centre for Cancer Research and Cell Biology, Queen's University, Belfast; Andrew Protheroe, Churchill Hospital, Oxford; Narayanan Nair Srihari, Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury; David Tsang, Southend Hospital, Southend-on-Sea; David Tsang, Basildon Hospital, Basildon; John Wagstaff, The South West Wales Cancer Institute; John Wagstaff, Swansea University College of Medicine, Swansea; Catherine Walmsley, Royal Preston Hospital, Preston, United Kingdom; George N. Thalmann, University Hospital; Estelle Cassoly, SAKK Coordinating Center, Berne; and Cyrill A. Rentsch, University Hospital Basel, Basel, Switzerland
| | - Jan Wallace
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; Jim Barber, Velindre Cancer Centre, Cardiff; Noel W. Clarke, The Christie and Salford Royal NHS Foundation Trusts; John Logue, Christie Hospital, Manchester; Nicholas D. James, Institute of Cancer and Genomic Sciences; Emilio Porfiri, The Medical School, University of Birmingham; Nicholas D. James, Queen Elizabeth Hospital; Emilio Porfiri, University Hospitals Birmingham NHS Foundation Trust, Birmingham; David P. Dearnaley, Gerhardt Attard, and Christopher C. Parker, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust; Melissa R. Spears, Alastair W.S. Ritchie, Francesca Schiavone, David Matheson, Robin Millman, Clare Gilson, Mahesh K.B. Parmar, and Matthew R. Sydes, MRC Clinical Trials Unit at UCL, London; William Cross, Leeds Teaching Hospitals NHS Trust, Leeds; Rob J. Jones and J. Martin Russell, University of Glasgow; Rob J. Jones and Jan Wallace, Beatson West of Scotland Cancer Centre, Glasgow; Azman Ibrahim, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral; Anna Lydon, Torbay District Hospital, Torquay; Ashok D. Nikapota, Sussex Cancer Centre, Brighton; Ashok D. Nikapota, Worthing Hospital, Worthing; Joe M. O’Sullivan, Centre for Cancer Research and Cell Biology, Queen's University, Belfast; Andrew Protheroe, Churchill Hospital, Oxford; Narayanan Nair Srihari, Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury; David Tsang, Southend Hospital, Southend-on-Sea; David Tsang, Basildon Hospital, Basildon; John Wagstaff, The South West Wales Cancer Institute; John Wagstaff, Swansea University College of Medicine, Swansea; Catherine Walmsley, Royal Preston Hospital, Preston, United Kingdom; George N. Thalmann, University Hospital; Estelle Cassoly, SAKK Coordinating Center, Berne; and Cyrill A. Rentsch, University Hospital Basel, Basel, Switzerland
| | - Catherine Walmsley
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; Jim Barber, Velindre Cancer Centre, Cardiff; Noel W. Clarke, The Christie and Salford Royal NHS Foundation Trusts; John Logue, Christie Hospital, Manchester; Nicholas D. James, Institute of Cancer and Genomic Sciences; Emilio Porfiri, The Medical School, University of Birmingham; Nicholas D. James, Queen Elizabeth Hospital; Emilio Porfiri, University Hospitals Birmingham NHS Foundation Trust, Birmingham; David P. Dearnaley, Gerhardt Attard, and Christopher C. Parker, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust; Melissa R. Spears, Alastair W.S. Ritchie, Francesca Schiavone, David Matheson, Robin Millman, Clare Gilson, Mahesh K.B. Parmar, and Matthew R. Sydes, MRC Clinical Trials Unit at UCL, London; William Cross, Leeds Teaching Hospitals NHS Trust, Leeds; Rob J. Jones and J. Martin Russell, University of Glasgow; Rob J. Jones and Jan Wallace, Beatson West of Scotland Cancer Centre, Glasgow; Azman Ibrahim, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral; Anna Lydon, Torbay District Hospital, Torquay; Ashok D. Nikapota, Sussex Cancer Centre, Brighton; Ashok D. Nikapota, Worthing Hospital, Worthing; Joe M. O’Sullivan, Centre for Cancer Research and Cell Biology, Queen's University, Belfast; Andrew Protheroe, Churchill Hospital, Oxford; Narayanan Nair Srihari, Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury; David Tsang, Southend Hospital, Southend-on-Sea; David Tsang, Basildon Hospital, Basildon; John Wagstaff, The South West Wales Cancer Institute; John Wagstaff, Swansea University College of Medicine, Swansea; Catherine Walmsley, Royal Preston Hospital, Preston, United Kingdom; George N. Thalmann, University Hospital; Estelle Cassoly, SAKK Coordinating Center, Berne; and Cyrill A. Rentsch, University Hospital Basel, Basel, Switzerland
| | - Mahesh K.B. Parmar
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; Jim Barber, Velindre Cancer Centre, Cardiff; Noel W. Clarke, The Christie and Salford Royal NHS Foundation Trusts; John Logue, Christie Hospital, Manchester; Nicholas D. James, Institute of Cancer and Genomic Sciences; Emilio Porfiri, The Medical School, University of Birmingham; Nicholas D. James, Queen Elizabeth Hospital; Emilio Porfiri, University Hospitals Birmingham NHS Foundation Trust, Birmingham; David P. Dearnaley, Gerhardt Attard, and Christopher C. Parker, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust; Melissa R. Spears, Alastair W.S. Ritchie, Francesca Schiavone, David Matheson, Robin Millman, Clare Gilson, Mahesh K.B. Parmar, and Matthew R. Sydes, MRC Clinical Trials Unit at UCL, London; William Cross, Leeds Teaching Hospitals NHS Trust, Leeds; Rob J. Jones and J. Martin Russell, University of Glasgow; Rob J. Jones and Jan Wallace, Beatson West of Scotland Cancer Centre, Glasgow; Azman Ibrahim, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral; Anna Lydon, Torbay District Hospital, Torquay; Ashok D. Nikapota, Sussex Cancer Centre, Brighton; Ashok D. Nikapota, Worthing Hospital, Worthing; Joe M. O’Sullivan, Centre for Cancer Research and Cell Biology, Queen's University, Belfast; Andrew Protheroe, Churchill Hospital, Oxford; Narayanan Nair Srihari, Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury; David Tsang, Southend Hospital, Southend-on-Sea; David Tsang, Basildon Hospital, Basildon; John Wagstaff, The South West Wales Cancer Institute; John Wagstaff, Swansea University College of Medicine, Swansea; Catherine Walmsley, Royal Preston Hospital, Preston, United Kingdom; George N. Thalmann, University Hospital; Estelle Cassoly, SAKK Coordinating Center, Berne; and Cyrill A. Rentsch, University Hospital Basel, Basel, Switzerland
| | - Matthew R. Sydes
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; Jim Barber, Velindre Cancer Centre, Cardiff; Noel W. Clarke, The Christie and Salford Royal NHS Foundation Trusts; John Logue, Christie Hospital, Manchester; Nicholas D. James, Institute of Cancer and Genomic Sciences; Emilio Porfiri, The Medical School, University of Birmingham; Nicholas D. James, Queen Elizabeth Hospital; Emilio Porfiri, University Hospitals Birmingham NHS Foundation Trust, Birmingham; David P. Dearnaley, Gerhardt Attard, and Christopher C. Parker, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust; Melissa R. Spears, Alastair W.S. Ritchie, Francesca Schiavone, David Matheson, Robin Millman, Clare Gilson, Mahesh K.B. Parmar, and Matthew R. Sydes, MRC Clinical Trials Unit at UCL, London; William Cross, Leeds Teaching Hospitals NHS Trust, Leeds; Rob J. Jones and J. Martin Russell, University of Glasgow; Rob J. Jones and Jan Wallace, Beatson West of Scotland Cancer Centre, Glasgow; Azman Ibrahim, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral; Anna Lydon, Torbay District Hospital, Torquay; Ashok D. Nikapota, Sussex Cancer Centre, Brighton; Ashok D. Nikapota, Worthing Hospital, Worthing; Joe M. O’Sullivan, Centre for Cancer Research and Cell Biology, Queen's University, Belfast; Andrew Protheroe, Churchill Hospital, Oxford; Narayanan Nair Srihari, Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury; David Tsang, Southend Hospital, Southend-on-Sea; David Tsang, Basildon Hospital, Basildon; John Wagstaff, The South West Wales Cancer Institute; John Wagstaff, Swansea University College of Medicine, Swansea; Catherine Walmsley, Royal Preston Hospital, Preston, United Kingdom; George N. Thalmann, University Hospital; Estelle Cassoly, SAKK Coordinating Center, Berne; and Cyrill A. Rentsch, University Hospital Basel, Basel, Switzerland
| | - for the STAMPEDE Investigators
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; Jim Barber, Velindre Cancer Centre, Cardiff; Noel W. Clarke, The Christie and Salford Royal NHS Foundation Trusts; John Logue, Christie Hospital, Manchester; Nicholas D. James, Institute of Cancer and Genomic Sciences; Emilio Porfiri, The Medical School, University of Birmingham; Nicholas D. James, Queen Elizabeth Hospital; Emilio Porfiri, University Hospitals Birmingham NHS Foundation Trust, Birmingham; David P. Dearnaley, Gerhardt Attard, and Christopher C. Parker, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust; Melissa R. Spears, Alastair W.S. Ritchie, Francesca Schiavone, David Matheson, Robin Millman, Clare Gilson, Mahesh K.B. Parmar, and Matthew R. Sydes, MRC Clinical Trials Unit at UCL, London; William Cross, Leeds Teaching Hospitals NHS Trust, Leeds; Rob J. Jones and J. Martin Russell, University of Glasgow; Rob J. Jones and Jan Wallace, Beatson West of Scotland Cancer Centre, Glasgow; Azman Ibrahim, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral; Anna Lydon, Torbay District Hospital, Torquay; Ashok D. Nikapota, Sussex Cancer Centre, Brighton; Ashok D. Nikapota, Worthing Hospital, Worthing; Joe M. O’Sullivan, Centre for Cancer Research and Cell Biology, Queen's University, Belfast; Andrew Protheroe, Churchill Hospital, Oxford; Narayanan Nair Srihari, Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury; David Tsang, Southend Hospital, Southend-on-Sea; David Tsang, Basildon Hospital, Basildon; John Wagstaff, The South West Wales Cancer Institute; John Wagstaff, Swansea University College of Medicine, Swansea; Catherine Walmsley, Royal Preston Hospital, Preston, United Kingdom; George N. Thalmann, University Hospital; Estelle Cassoly, SAKK Coordinating Center, Berne; and Cyrill A. Rentsch, University Hospital Basel, Basel, Switzerland
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Affiliation(s)
- Anita Lavery
- a Clinical Research Fellow in Medical Oncology , Guy's Hospital , London
| | - Clare Gilson
- b MRC Clinical Trials Unit , University College London , London , UK
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Crawley D, van Hemelrijck M, Chowdhury S, James N, Gilson C, Spears M, Sydes M, Rudman S. Effect of baseline metabolic aberrations in men with locally advanced/metastatic prostate cancer treated with ADT on time to disease progression, prostate cancer specific and all cause death. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw372.46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Gillessen S, Gilson C, James N, Adler A, Sydes MR, Clarke N. Repurposing Metformin as Therapy for Prostate Cancer within the STAMPEDE Trial Platform. Eur Urol 2016; 70:906-908. [PMID: 27450106 DOI: 10.1016/j.eururo.2016.07.015] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 07/11/2016] [Indexed: 01/18/2023]
Abstract
Metformin is a safe, well-tolerated, inexpensive treatment that can be given in addition to current standard-of-care therapies for prostate cancer. Its use might mitigate the deleterious side effects of castration and exert an additional anticancer effect. It will be incorporated in the STAMPEDE trial platform in summer 2016. This will test its true utility as a repurposed treatment for men with high-risk locally advanced or metastatic prostate cancer at first presentation.
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Affiliation(s)
- Silke Gillessen
- Department of Oncology/Haematology, Kantonsspital, St. Gallen, Switzerland
| | - Clare Gilson
- MRC Clinical Trials Unit, University College London, London, UK
| | - Nick James
- Warwick Medical School, University of Warwick, Coventry, UK; University Hospitals Birmingham NHS Foundation Trust, The Medical School, University of Birmingham, Birmingham, UK
| | - Amanda Adler
- Diabetes Service, Addenbrooke's Hospital, Cambridge, UK
| | - Matthew R Sydes
- MRC Clinical Trials Unit, University College London, London, UK
| | - Noel Clarke
- Department of Urology, The Christie and Salford Royal NHS Foundation Trusts, Manchester, UK.
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Shovlin CL, Gilson C, Busbridge M, Patel D, Shi C, Dina R, Abdulla FN, Awan I. Can Iron Treatments Aggravate Epistaxis in Some Patients With Hereditary Hemorrhagic Telangiectasia? Laryngoscope 2016; 126:2468-2474. [PMID: 27107394 PMCID: PMC5095791 DOI: 10.1002/lary.25959] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 01/31/2016] [Accepted: 02/10/2016] [Indexed: 01/04/2023]
Abstract
Objectives/Hypothesis To examine whether there is a rationale for iron treatments precipitating nosebleeds (epistaxis) in a subgroup of patients with hereditary hemorrhagic telangiectasia (HHT). Study Design Survey evaluation of HHT patients, and a randomized control trial in healthy volunteers. Methods Nosebleed severity in response to iron treatments and standard investigations were evaluated by unbiased surveys in patients with HHT. Serial blood samples from a randomized controlled trial of 18 healthy volunteers were used to examine responses to a single iron tablet (ferrous sulfate, 200 mg). Results Iron tablet users were more likely to have daily nosebleeds than non–iron‐users as adults, but there was no difference in the proportions reporting childhood or trauma‐induced nosebleeds. Although iron and blood transfusions were commonly reported to improve nosebleeds, 35 of 732 (4.8%) iron tablet users, in addition to 17 of 261 (6.5%) iron infusion users, reported that their nosebleeds were exacerbated by the respective treatments. These rates were significantly higher than those reported for control investigations. Serum iron rose sharply in four of the volunteers ingesting ferrous sulfate (by 19.3–33.1 μmol/L in 2 hours), but not in 12 dietary controls (2‐hour iron increment ranged from −2.2 to +5.0 μmol/L). High iron absorbers demonstrated greater increments in serum ferritin at 48 hours, but transient rises in circulating endothelial cells, an accepted marker of endothelial damage. Conclusions Iron supplementation is essential to treat or prevent iron deficiency, particularly in patients with pathological hemorrhagic iron losses. However, in a small subgroup of individuals, rapid changes in serum iron may provoke endothelial changes and hemorrhage. Level of Evidence 4. Laryngoscope, 126:2468–2474, 2016
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Affiliation(s)
- Claire L Shovlin
- Cardiovascular Sciences, National Heart and Lung Institute, Imperial College London, London, United Kingdom. .,Respiratory Medicine, Imperial College Healthcare National Health Service Trust, London, United Kingdom.
| | - Clare Gilson
- Respiratory Medicine, Imperial College Healthcare National Health Service Trust, London, United Kingdom
| | - Mark Busbridge
- Clinical Chemistry, Imperial College Healthcare National Health Service Trust, London, United Kingdom
| | - Dilip Patel
- Cardiovascular Sciences, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Chenyang Shi
- Cardiovascular Sciences, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Roberto Dina
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - F Naziya Abdulla
- Cardiovascular Sciences, National Heart and Lung Institute, Imperial College London, London, United Kingdom.,Imperial College London School of Medicine, London, United Kingdom
| | - Iman Awan
- Cardiovascular Sciences, National Heart and Lung Institute, Imperial College London, London, United Kingdom.,Imperial College London School of Medicine, London, United Kingdom
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Affiliation(s)
- Clare Gilson
- Medical Research Council Clinical Trials Unit, Guy's Hospital, London, UK.,Department of Medical Oncology, Guy's Hospital, London, UK
| | - Matthew R Sydes
- Medical Research Council Clinical Trials Unit, Guy's Hospital, London, UK
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Manickavasagar T, Gilson C, Chowdhury S, Kirby R. New developments in metastatic prostate cancer therapy. Practitioner 2015; 259:21-3. [PMID: 26529826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Metastatic prostate cancer is still commonly a lethal condition. The concept that 'men with prostate cancer die with rather than of their cancer' has been shown to be false. It is estimated that 10-20% of men in the UK present with locally advanced disease. Median overall survival remains only 3.5 years for men presenting with metastatic disease. The use of LHRH analogues to achieve medical castration has become the gold standard for both locally advanced prostate cancer, combined with radiotherapy, and metastatic disease. Androgen deprivation therapy (ADT) is the standard first-line treatment for advanced disease resulting in improvements in symptoms, radiological findings and PSA levels. Ultimately the majority of men with advanced prostate cancer will develop resistance to ADT Docetaxel is the standard first-line therapy recommended by international guidelines for patients with symptomatic metastatic castrate refractory prostate cancer who are suitable candidates for chemotherapy. More than 90% of patients with castrate refractory prostate cancer have bone metastases. Radium-223 dichloride is a novel alpha-emitting radiopharmaceutical agent, which mimics calcium and therefore targets bone metastases. It is indicated in patients with metastatic castrate refractory prostate cancer who have symptomatic bone metastases without visceral metastases.
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Gilson C, Hietarinta J, Nimmo J, Ohta Y. Sasa-Satsuma higher-order nonlinear Schrödinger equation and its bilinearization and multisoliton solutions. Phys Rev E Stat Nonlin Soft Matter Phys 2003; 68:016614. [PMID: 12935277 DOI: 10.1103/physreve.68.016614] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2003] [Indexed: 05/24/2023]
Abstract
Higher-order and multicomponent generalizations of the nonlinear Schrödinger equation are important in various applications, e.g., in optics. One of these equations, the integrable Sasa-Satsuma equation, has particularly interesting soliton solutions. Unfortunately, the construction of multisoliton solutions to this equation presents difficulties due to its complicated bilinearization. We discuss briefly some previous attempts and then give the correct bilinearization based on the interpretation of the Sasa-Satsuma equation as a reduction of the three-component Kadomtsev-Petviashvili hierarchy. In the process, we also get bilinearizations and multisoliton formulas for a two-component generalization of the Sasa-Satsuma equation (the Yajima-Oikawa-Tasgal-Potasek model), and for a (2+1)-dimensional generalization.
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Affiliation(s)
- C Gilson
- Department of Mathematics, University of Glasgow, Glasgow G12 8QW, United Kingdom.
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Gilson C, Pickering A. Factorization and Painleve analysis of a class of nonlinear third-order partial differential equations. ACTA ACUST UNITED AC 1999. [DOI: 10.1088/0305-4470/28/10/017] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Bates P, Gilson C, Morris A, Humphries P. Teaching audiovisual methods to overseas medical laboratory tutors. J Audiov Media Med 1986; 9:56-9. [PMID: 2427562 DOI: 10.3109/17453058609156025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Gilson C. The design and construction of an inexpensive intervalometer. J Audiov Media Med 1983; 6:64-5. [PMID: 6875207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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McHardy N, Gilson C. An electron microscope study of diagnostic antigens prepared from Anaplasma marginale. Tropenmed Parasitol 1974; 25:11-21. [PMID: 4838997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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