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Baxter MA, Spender LC, Cairns D, Walsh S, Oparka R, Porter RJ, Bray S, Skinner G, King S, Turbitt J, Collinson D, Miedzybrodzka ZH, Jellema G, Logan G, Kennedy RD, Turkington RC, McLean MH, Swinson D, Grabsch HI, Lord S, Seymour MJ, Hall PS, Petty RD. An investigation of the clinical impact and therapeutic relevance of a DNA damage immune response (DDIR) signature in patients with advanced gastroesophageal adenocarcinoma. ESMO Open 2024; 9:103450. [PMID: 38744099 DOI: 10.1016/j.esmoop.2024.103450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 04/05/2024] [Accepted: 04/05/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND An improved understanding of which gastroesophageal adenocarcinoma (GOA) patients respond to both chemotherapy and immune checkpoint inhibitors (ICI) is needed. We investigated the predictive role and underlying biology of a 44-gene DNA damage immune response (DDIR) signature in patients with advanced GOA. MATERIALS AND METHODS Transcriptional profiling was carried out on pretreatment tissue from 252 GOA patients treated with platinum-based chemotherapy (three dose levels) within the randomized phase III GO2 trial. Cross-validation was carried out in two independent GOA cohorts with transcriptional profiling, immune cell immunohistochemistry and epidermal growth factor receptor (EGFR) fluorescent in situ hybridization (FISH) (n = 430). RESULTS In the GO2 trial, DDIR-positive tumours had a greater radiological response (51.7% versus 28.5%, P = 0.022) and improved overall survival in a dose-dependent manner (P = 0.028). DDIR positivity was associated with a pretreatment inflamed tumour microenvironment (TME) and increased expression of biomarkers associated with ICI response such as CD274 (programmed death-ligand 1, PD-L1) and a microsatellite instability RNA signature. Consensus pathway analysis identified EGFR as a potential key determinant of the DDIR signature. EGFR amplification was associated with DDIR negativity and an immune cold TME. CONCLUSIONS Our results indicate the importance of the GOA TME in chemotherapy response, its relationship to DNA damage repair and EGFR as a targetable driver of an immune cold TME. Chemotherapy-sensitive inflamed GOAs could benefit from ICI delivered in combination with standard chemotherapy. Combining EGFR inhibitors and ICIs warrants further investigation in patients with EGFR-amplified tumours.
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Affiliation(s)
- M A Baxter
- Division of Molecular and Clinical Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee; Tayside Cancer Centre, Ninewells Hospital and Medical School, NHS Tayside, Dundee.
| | - L C Spender
- Division of Molecular and Clinical Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee
| | - D Cairns
- Leeds Cancer Research UK Clinical Trials Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds
| | - S Walsh
- Department of Pathology, Ninewells Hospital and Medical School, NHS Tayside, Dundee
| | - R Oparka
- Department of Pathology, Ninewells Hospital and Medical School, NHS Tayside, Dundee
| | - R J Porter
- Department of Pathology, CRUK Scotland Centre, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh
| | - S Bray
- Tayside Biorepository, University of Dundee, Dundee
| | - G Skinner
- Tayside Biorepository, University of Dundee, Dundee
| | - S King
- Tayside Biorepository, University of Dundee, Dundee
| | - J Turbitt
- Genetics and Molecular Pathology Laboratory Services, NHS Grampian, Aberdeen
| | - D Collinson
- Genetics and Molecular Pathology Laboratory Services, NHS Grampian, Aberdeen
| | - Z H Miedzybrodzka
- Genetics and Molecular Pathology Laboratory Services, NHS Grampian, Aberdeen; School of Medicine, Medical Sciences, Nutrition and Dentistry, Polwarth Building, University of Aberdeen, Aberdeen
| | - G Jellema
- Almac Diagnostic Services, Craigavon
| | - G Logan
- Almac Diagnostic Services, Craigavon
| | - R D Kennedy
- Almac Diagnostic Services, Craigavon; Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast
| | - R C Turkington
- Almac Diagnostic Services, Craigavon; Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast
| | - M H McLean
- Division of Molecular and Clinical Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee; Tayside Cancer Centre, Ninewells Hospital and Medical School, NHS Tayside, Dundee
| | - D Swinson
- St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - H I Grabsch
- Department of Pathology, GROW School for Oncology and Reproduction, Maastricht University Medical Center, Maastricht, The Netherlands; Division of Pathology and Data Analytics, Leeds Institute of Medical Research at St James's University, University of Leeds, Leeds
| | - S Lord
- Department of Oncology, University of Oxford, Oxford
| | - M J Seymour
- Leeds Cancer Research UK Clinical Trials Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds; St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - P S Hall
- Cancer Research UK Edinburgh Centre, MRC Institute of Genetics & Molecular Medicine, The University of Edinburgh, Western General Hospital, Crewe Road South, Edinburgh, UK
| | - R D Petty
- Division of Molecular and Clinical Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee; Tayside Cancer Centre, Ninewells Hospital and Medical School, NHS Tayside, Dundee.
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Robinson OC, Pini S, Flemming K, Campling N, Fallon M, Richards SH, Mayland CR, Boland E, Swinson D, Hurlow A, Hartup S, Mulvey MR. Exploration of pain assessment and management processes in oncology outpatient services with healthcare professionals: a qualitative study. BMJ Open 2023; 13:e078619. [PMID: 38151273 PMCID: PMC10753735 DOI: 10.1136/bmjopen-2023-078619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 10/17/2023] [Indexed: 12/29/2023] Open
Abstract
OBJECTIVES This study explored cancer pain management practices and clinical care pathways used by healthcare professionals (HCPs) to understand the barriers and facilitators for standardised pain management in oncology outpatient services (OS). DESIGN Data were collected using semistructured interviews that were audio-recorded and transcribed. The data were analysed using thematic analysis. SETTING Three NHS trusts with oncology OS in Northern England. PARTICIPANTS Twenty HCPs with varied roles (eg, oncologist and nurse) and experiences (eg, registrar and consultant) from different cancer site clinics (eg, breast and lung). Data were analysed using thematic analysis. RESULTS HCPs discussed cancer pain management practices during consultation and supporting continuity of care beyond consultation. Key findings included : (1) HCPs' level of clinical experience influenced pain assessments; (2) remote consulting impeded experienced HCPs to do detailed pain assessments; (3) diffusion of HCP responsibility to manage cancer pain; (4) nurses facilitated pain management support with patients and (5) continuity of care for pain management was constrained by the integration of multidisciplinary teams. CONCLUSIONS These data demonstrate HCP cancer pain management practices varied and were unstructured. Recommendations are made for a standardised cancer pain management intervention: (1) detailed evaluation of pain with a tailored self-management strategy; (2) implementation of a structured pain assessment that supports remote consultations, (3) pain assessment tool that can support both experienced and less experienced clinicians. These findings will inform the development of a cancer pain management tool to integrate within routine oncology OS.
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Affiliation(s)
| | - Simon Pini
- Psychological and Social Medicine, University of Leeds, Leeds, UK
| | | | - Natasha Campling
- School of Health Sciences, University of Southampton, Southampton, Hampshire, UK
| | - Marie Fallon
- MRC Institute of Genetics & Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | | | - Catriona R Mayland
- Department of Oncology and Metabolism, The University of Sheffield, Sheffield, UK
- Divison of Clinical Medicine, University of Sheffield, Sheffield, UK
| | - Elaine Boland
- Palliative Medicine, Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - Daniel Swinson
- St. James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Adam Hurlow
- Palliative Care Team, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Sue Hartup
- St. James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Matthew R Mulvey
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
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Pearce J, Swinson D, Cairns D, Nair S, Baxter M, Petty R, Seymour M, Hall P, Velikova G. Frailty and treatment outcome in advanced gastro-oesophageal cancer: An exploratory analysis of the GO2 trial. J Geriatr Oncol 2022; 13:287-293. [PMID: 34955446 PMCID: PMC8986151 DOI: 10.1016/j.jgo.2021.12.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 09/17/2021] [Revised: 11/12/2021] [Accepted: 12/08/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Research into the optimal management of frail patients with cancer is limited and treatment decision-making in this cohort can be difficult. A number of measures have been developed to assess frailty, but few studies explore the correlation between frailty measures and cancer treatment outcomes. METHODS This retrospective cohort study is an exploratory analysis of the GO2 randomised controlled trial. GO2 recruited both older and frail younger patients commencing first-line palliative chemotherapy for advanced gastro-oesophageal (aGO) cancer. This analysis aims to explore the correlation between baseline frailty and treatment outcome. Baseline frailty measures were derived from clinical data and included ECOG Performance Status (PS), the GO2 Frailty Score (GO2FS), Geriatric-8 (G8), Cancer and Aging Research Group (CARG) toxicity score and a 'modified' Rockwood Clinical Frailty Scale (mCFS). Novel patient-centred composite measure Overall Treatment Utility (OTU) was the primary endpoint. Ordinal logistic regression was undertaken to give odds ratios for poor vs good/intermediate OTU. Secondary endpoints were progression-free and overall survival. Models were adjusted for age, sex, histology, metastases, Trastuzumab and renal/hepatic function. RESULTS In GO2, 514 patients were randomised between three chemotherapy dose-levels; all of these patients were assessed for OTU and are included in this analysis. Worse GO2FS, mCFS and G8 scores all had a statistically significant association with poor (vs good/intermediate) OTU, progression and death, which persisted after adjustment. Adjusted odds ratios for poor OTU amongst those with the worst GO2FS and mCFS and best G8 scores were as follows: 1.85 (95% confidence interval [CI] 1.20-2.88) for GO2FS ≥3 ('severely frail'), 1.72 (1.19-2.50) for mCFS 5+ ('frail') and 0.57 (0.32-1.00) for G8 > 14 ('normal'). Worse ECOG PS and CARG scores did not have a statistically significant association with poor OTU/progression/death. CONCLUSION In this study, frailty identified via GO2FS, mCFS and G8 conveyed a statistically significant increased risk of worse treatment outcome in older and frail younger patients with aGO cancer. Frailty assessment provides information over and above PS and should be integrated alongside routine assessments in research and clinical practice. In the absence of prospective data, frailty measures can be derived retrospectively to build the evidence base around optimal care of frailer patients.
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Affiliation(s)
- Jessica Pearce
- Leeds Institute of Medical Research at St James', University of Leeds, Woodhouse, Leeds, LS2 9JT, UK; Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds LS9 7TF, UK.
| | - Daniel Swinson
- Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds LS9 7TF, UK
| | - David Cairns
- Leeds Cancer Research UK Clinical Trials Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds LS2 9JT, UK
| | - Sherena Nair
- Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds LS9 7TF, UK
| | - Mark Baxter
- Division of Molecular and Clinical Medicine, Ninewells Hospital and Medical School, University of Dundee, Nethergate, Dundee DD1 4HN, UK
| | - Russell Petty
- Tayside Cancer Centre, Ninewells Hospital and Medical School, NHS Tayside, James Arrott Dr, Dundee DD2 1SG, UK
| | - Matt Seymour
- Leeds Institute of Medical Research at St James', University of Leeds, Woodhouse, Leeds, LS2 9JT, UK; Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds LS9 7TF, UK
| | - Peter Hall
- Cancer Research UK Edinburgh Centre, MRC Institute of Genetics & Molecular Medicine, The University of Edinburgh, Western General Hospital, Crewe Road South, Edinburgh EH4 2XR, UK
| | - Galina Velikova
- Leeds Institute of Medical Research at St James', University of Leeds, Woodhouse, Leeds, LS2 9JT, UK; Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds LS9 7TF, UK
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Shah MA, Udrea AA, Bondarenko I, Mansoor W, Sánchez RG, Sarosiek T, Bozzarelli S, Schenker M, Gomez-Martin C, Morgan C, Özgüroğlu M, Pikiel J, Kalofonos HP, Wojcik E, Buchler T, Swinson D, Cicin I, Joseph M, Vynnychenko I, Luft AV, Enzinger PC, Salek T, Papandreou C, Tournigand C, Maiello E, Wei R, Ferry D, Gao L, Oliveira JM, Ajani JA. Evaluating Alternative Ramucirumab Doses as a Single Agent or with Paclitaxel in Second-Line Treatment of Locally Advanced or Metastatic Gastric/Gastroesophageal Junction Adenocarcinoma: Results from Two Randomized, Open-Label, Phase II Studies. Cancers (Basel) 2022; 14:cancers14051168. [PMID: 35267477 PMCID: PMC8909008 DOI: 10.3390/cancers14051168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 02/03/2022] [Accepted: 02/05/2022] [Indexed: 12/02/2022] Open
Abstract
Simple Summary Ramucirumab is indicated at a dosage of 8 mg/kg every 2 weeks as monotherapy or in combination with paclitaxel for second-line advanced/metastatic gastric/gastroesophageal junction (GEJ) adenocarcinoma. A post hoc analysis of the phase III trials REGARD and RAINBOW suggested a positive correlation between ramucirumab exposure and efficacy. Studies JVDB and JVCZ explored different ramucirumab dosing regimens as monotherapy and in combination with paclitaxel, respectively. Here we report results from these studies, in which JVDB evaluated the pharmacokinetics and safety of the currently registered dosing regimen for ramucirumab monotherapy and three exploratory dosing regimens, and JVCZ evaluated the efficacy and safety of a higher dosing regimen of ramucirumab in combination with paclitaxel in second-line gastric/GEJ adenocarcinoma. Overall, the safety profiles were similar between the registered dose and the exploratory dosing regimens. However, a lack of a dose/exposure-response relationship supports the standard dose of ramucirumab as second-line treatment for patients with advanced/metastatic gastric/GEJ adenocarcinoma. Abstract Studies JVDB and JVCZ examined alternative ramucirumab dosing regimens as monotherapy or combined with paclitaxel, respectively, in patients with advanced/metastatic gastric/gastroesophageal junction (GEJ) adenocarcinoma. For JVDB, randomized patients (N = 164) received ramucirumab monotherapy at four doses: 8 mg/kg every 2 weeks (Q2W) (registered dose), 12 mg/kg Q2W, 6 mg/kg weekly (QW), or 8 mg/kg on days 1 and 8 (D1D8) every 3 weeks (Q3W). The primary objectives were the safety and pharmacokinetics of ramucirumab monotherapy. For JVCZ, randomized patients (N = 245) received paclitaxel (80 mg/m2-D1D8D15) plus ramucirumab (8 mg/kg- or 12 mg/kg-Q2W). The primary objective was progression-free survival (PFS) of 12 mg/kg-Q2W arm versus placebo from RAINBOW using meta-analysis. Relative to the registered dose, exploratory dosing regimens (EDRs) led to higher ramucirumab serum concentrations in both studies. EDR safety profiles were consistent with previous studies. In JVDB, serious adverse events occurred more frequently in the 8 mg/kg-D1D8-Q3W arm versus the registered dose; 6 mg/kg-QW EDR had a higher incidence of bleeding/hemorrhage. In JVCZ, PFS was improved with the 12 mg/kg plus paclitaxel combination versus placebo in RAINBOW; however, no significant PFS improvement was observed between the 12 mg/kg and 8 mg/kg arms. The lack of a dose/exposure-response relationship in these studies supports the standard dose of ramucirumab 8 mg/kg-Q2W as monotherapy or in combination with paclitaxel as second-line treatment for advanced/metastatic gastric/GEJ adenocarcinoma.
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Affiliation(s)
- Manish A. Shah
- Department of Medicine, Division of Hematology and Medical Oncology, Weill Cornell Medical College, New York, NY 10021, USA
- Correspondence: ; Tel.: +1-646-962-6200
| | | | - Igor Bondarenko
- Department of Oncology, Dnipropetrovsk Medical Academy, 49044 Dnipropetrovsk, Ukraine;
| | - Was Mansoor
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester M20 4BX, UK;
| | - Raquel Guardeño Sánchez
- Department of Medical Oncology, Catalan Institute of Oncology (ICO) Girona Hospital Dr Josep Trueta, 17007 Girona, Spain;
| | - Tomasz Sarosiek
- Department of Clinical Oncology and Oncological Surgery, LUXMED Onkologia, 04125 Warszawa, Poland;
| | - Silvia Bozzarelli
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, 20089 Milan, Italy;
| | - Michael Schenker
- Centrul de Oncologie Sf. Nectarie SRL, 200542 Craiova, Romania;
- Department of Medical Oncology, University of Medicine and Pharmacy Craiova, 200342 Craiova, Romania
| | - Carlos Gomez-Martin
- Medical Oncology Department, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain;
| | - Carys Morgan
- Department of Clinical Oncology, Velindre Cancer Centre, Cardiff CF14 2TL, UK;
| | - Mustafa Özgüroğlu
- Medical Oncology, Istanbul University, Cerrahpaşa, Fatih, Istanbul 34098, Turkey;
| | - Joanna Pikiel
- Department of Oncology, Copernicus Podmiot Leczniczy, 80-803 Gdańsk, Poland;
| | - Haralabos P. Kalofonos
- Department of Oncology, University General Hospital of Patras Rion, 26504 Patras, Greece;
| | | | - Tomas Buchler
- Department of Oncology, First Faculty of Medicine, Charles University and Thomayer University Hospital, 14059 Prague, Czech Republic;
| | - Daniel Swinson
- Institute of Oncology, St James’s University Hospital, Leeds LS9 7TF, UK;
| | - Irfan Cicin
- Medical Oncology, Trakya University, Edirne 22030, Turkey;
| | - Mano Joseph
- Deanesly Centre, New Cross Hospital, Wolverhamptom WV10 0QP, UK;
| | - Ihor Vynnychenko
- Sumy Regional Oncology Center, Sumy State University, 40000 Sumy, Ukraine;
| | - Alexander Valerievich Luft
- Department of Oncology No 1 (Thoracic Surgery), Leningrad Regional Clinical Hospital, 194291 St. Petersburg, Russia;
| | - Peter C. Enzinger
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA;
| | - Tomas Salek
- Department of Clinical Oncology, Narodny Onkologicky Ustav, 83310 Bratislava, Slovakia;
| | - Christos Papandreou
- Department of Medical Oncology, Faculty of Medicine, University of Thessaly, Biopolis, 41223 Larissa, Greece;
| | - Christophe Tournigand
- Department of Medical Oncology, Henri Mondor et Albert Chenevier Teaching Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris-Est Creteil, 94000 Créteil, France;
| | - Evaristo Maiello
- Oncology Unit, Foundation Casa Sollievo della Sofferenza IRCCS, Viale Cappuccini 1, 71013 San Giovanni Rotondo, Italy;
| | - Ran Wei
- Eli Lilly and Company, Indianapolis, IN 46225, USA;
| | - David Ferry
- Eli Lilly and Company, New York, NY 10016, USA; (D.F.); (L.G.); (J.M.O.)
| | - Ling Gao
- Eli Lilly and Company, New York, NY 10016, USA; (D.F.); (L.G.); (J.M.O.)
| | - Joana M. Oliveira
- Eli Lilly and Company, New York, NY 10016, USA; (D.F.); (L.G.); (J.M.O.)
| | - Jaffer A. Ajani
- Department of Gastrointestinal Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
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Ashley L, Kassim S, Kellar I, Kidd L, Mair F, Matthews M, Price M, Swinson D, Taylor J, Velikova G, Wadsley J. Identifying ways to improve diabetes management during cancer treatments (INDICATE): protocol for a qualitative interview study with patients and clinicians. BMJ Open 2022; 12:e060402. [PMID: 35193924 PMCID: PMC8867345 DOI: 10.1136/bmjopen-2021-060402] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION A large and growing number of patients with cancer have comorbid diabetes. Cancer and its treatment can adversely impact glycaemic management and control, and there is accumulating evidence that suboptimal glycaemic control during cancer treatment is a contributory driver of worse cancer-related outcomes in patients with comorbid diabetes. Little research has sought to understand, from the perspective of patients and clinicians, how and why different aspects of cancer care and diabetes care can complicate or facilitate each other, which is key to informing interventions to improve diabetes management during cancer treatments. This study aims to identify and elucidate barriers and enablers to effective diabetes management and control during cancer treatments, and potential intervention targets and strategies to address and harness these, respectively. METHODS AND ANALYSIS Qualitative interviews will be conducted with people with diabetes and comorbid cancer (n=30-40) and a range of clinicians (n=30-40) involved in caring for this patient group (eg, oncologists, diabetologists, specialist nurses, general practitioners). Semistructured interviews will examine participants' experiences of and perspectives on diabetes management and control during cancer treatments. Data will be analysed using framework analysis. Data collection and analysis will be informed by the Theoretical Domains Framework, and related Theory and Techniques Tool and Behaviour Change Wheel, to facilitate examination of a comprehensive range of barriers and enablers and support identification of pertinent and feasible intervention approaches. Study dates: January 2021-January 2023. ETHICS AND DISSEMINATION The study has approval from National Health Service (NHS) West Midlands-Edgbaston Research Ethics Committee. Findings will be presented to lay, clinical, academic and NHS and charity service-provider audiences via dissemination of written summaries and presentations, and published in peer-reviewed journals. Findings will be used to inform development and implementation of clinical, health services and patient-management intervention strategies to optimise diabetes management and control during cancer treatments.
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Affiliation(s)
- Laura Ashley
- Leeds School of Social Sciences, Leeds Beckett University, Leeds, UK
| | - Saifuddin Kassim
- Leeds Centre for Diabetes and Endocrinology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Ian Kellar
- School of Psychology, University of Leeds, Leeds, UK
| | - Lisa Kidd
- Nursing & Healthcare, School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Frances Mair
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Mike Matthews
- Patient and Public Involvement representative, Harrogate, UK
| | - Mollie Price
- Leeds School of Social Sciences, Leeds Beckett University, Leeds, UK
| | - Daniel Swinson
- Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Johanna Taylor
- Department of Health Sciences, University of York, York, UK
| | - Galina Velikova
- Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - Jonathan Wadsley
- Weston Park Cancer Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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6
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Pearce J, Swinson D, Cairns D, Nair S, Baxter M, Petty R, Seymour M, Hall P, Velikova G. Frailty and treatment outcome in advanced gastro-oesophageal cancer: an exploratory analysis of the GO2 trial. J Geriatr Oncol 2021. [DOI: 10.1016/s1879-4068(21)00394-5] [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: 11/17/2022]
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Pearce J, Hatton N, Barlow V, Lad H, Nair S, Swinson D. Leeds Oncology Frailty Initiative (LOFrI): development of a pilot service for frail patients with gastrointestinal malignancy. J Geriatr Oncol 2021. [DOI: 10.1016/s1879-4068(21)00426-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Childs A, Zakeri N, Ma YT, O’Rourke J, Ross P, Hashem E, Hubner RA, Hockenhull K, Iwuji C, Khan S, Palmer DH, Connor J, Swinson D, Darby S, Braconi C, Roques T, Yu D, Luong TV, Meyer T. Biopsy for advanced hepatocellular carcinoma: results of a multicentre UK audit. Br J Cancer 2021; 125:1350-1355. [PMID: 34526664 PMCID: PMC8575957 DOI: 10.1038/s41416-021-01535-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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: 06/11/2021] [Revised: 08/04/2021] [Accepted: 08/20/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Advanced hepatocellular carcinoma (HCC) is commonly diagnosed using non-invasive radiological criteria (NIRC) defined by the European Association for the Study of the Liver or the American Association for the Study of Liver Diseases. In 2017, The National Institute for Clinical Excellence mandated histological confirmation of disease to authorise the use of sorafenib in the UK. METHODS This was a prospective multicentre audit in which patients suitable for sorafenib were identified at multidisciplinary meetings. The primary analysis cohort (PAC) was defined by the presence of Child-Pugh class A liver disease and performance status 0-2. Clinical, radiological and histological data were reported locally and collected on a standardised case report form. RESULTS Eleven centres reported 418 cases, of which 361 comprised the PAC. Overall, 76% had chronic liver disease and 66% were cirrhotic. The diagnostic imaging was computed tomography in 71%, magnetic resonance imaging in 27% and 2% had both. Pre-existing histology was available in 45 patients and 270 underwent a new biopsy, which confirmed HCC in 93.4%. Alternative histological diagnoses included cholangiocarcinoma (CC) and combined HCC-CC. In cirrhotic patients, NIRC criteria had a sensitivity of 65.4% and a positive predictive value of 91.4% to detect HCC. Two patients (0.7%) experienced mild post-biopsy bleeding. CONCLUSION The diagnostic biopsy is safe and feasible for most patients eligible for systemic therapy.
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Affiliation(s)
- Alexa Childs
- grid.437485.90000 0001 0439 3380Department of Oncology, Royal Free London NHS Foundation Trust, London, UK
| | - Nekisa Zakeri
- grid.437485.90000 0001 0439 3380Department of Oncology, Royal Free London NHS Foundation Trust, London, UK
| | - Yuk Ting Ma
- grid.412563.70000 0004 0376 6589University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Joanne O’Rourke
- grid.412563.70000 0004 0376 6589University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Paul Ross
- grid.429705.d0000 0004 0489 4320King’s College Hospital NHS Foundation Trust, London, UK
| | - Essam Hashem
- grid.429705.d0000 0004 0489 4320King’s College Hospital NHS Foundation Trust, London, UK
| | - Richard A. Hubner
- grid.412917.80000 0004 0430 9259Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Kimberley Hockenhull
- grid.412917.80000 0004 0430 9259Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Chinenye Iwuji
- grid.269014.80000 0001 0435 9078Oncology Department, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Sam Khan
- grid.269014.80000 0001 0435 9078Oncology Department, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Daniel H. Palmer
- grid.418624.d0000 0004 0614 6369University of Liverpool and The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, UK
| | - Joanna Connor
- grid.418624.d0000 0004 0614 6369University of Liverpool and The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, UK
| | - Daniel Swinson
- grid.415967.80000 0000 9965 1030Leeds Cancer Centre, St James’s University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Suzanne Darby
- grid.31410.370000 0000 9422 8284Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Chiara Braconi
- grid.5072.00000 0001 0304 893XThe Royal Marsden NHS Foundation Trust, London, UK
| | - Tom Roques
- grid.240367.40000 0004 0445 7876Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Dominic Yu
- grid.437485.90000 0001 0439 3380Department of Radiology, Royal Free London NHS Foundation Trust, London, UK
| | - Tu Vinh Luong
- grid.437485.90000 0001 0439 3380Department of Cellular Pathology, Royal Free London NHS Foundation Trust, London, UK
| | - Tim Meyer
- grid.437485.90000 0001 0439 3380Department of Oncology, Royal Free London NHS Foundation Trust, London, UK ,grid.83440.3b0000000121901201UCL Cancer Institute, University College London, London, UK
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9
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Dearden H, Baxter MA, Martin S, Rowe M, Zucker K, Jones CM, Olsson-Brown AC, Petty RD, Swinson D. Observational study investigating Tolerance Of Anticancer Systemic Therapy In the Elderly (TOASTIE): a protocol. BMJ Open 2021; 11:e051104. [PMID: 34588257 PMCID: PMC8479949 DOI: 10.1136/bmjopen-2021-051104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION The number of older adults diagnosed with cancer is increasing. Older adults are more likely to have pre-existing frailty, which is associated with greater chemotherapy-related toxicity. Early identification of those at risk of toxicity is important to reduce patient morbidity and mortality. Current chemotherapy toxicity prediction tools including the Cancer and Ageing Research Group (CARG) tool exist but are not in routine clinical use and have not been prospectively validated in a UK population. This study is the first prospective study to investigate the CARG tool in a UK population with cancer. METHODS AND ANALYSIS Tolerance Of Anticancer Systemic Therapy In the Elderly is a prospective observational study of patients, aged ≥65 years, commencing first-line (any indication) chemotherapy for a solid-organ malignancy. Patients receiving other systemic anticancer agents or radiotherapy will be excluded. The primary objective will be to validate the ability of the CARG score to predict grade 3+ toxicity in this population. Secondary objectives include describing the feasibility of screening for frailty, as well as the prevalance of frailty in this population and assessing patient and clinician perception of chemotherapy toxicity risk. 500 patients will be recruited over a two year period. Baseline assessments will be recorded. At the end of the 6-month follow-up period, toxicity data will be retrospectively collected. A descriptive analysis of the recruited population will be performed. The validity of the CARG model will be analysed using receiver-operating characteristic curves and calculation of the area under the curve (c-statistic). ETHICS AND DISSEMINATION The study has received ethical approval from the East of Scotland Research Ethics Service 20/ES/0114. Results will be reported in peer-reviewed scientific journals and disseminated to patient organisations and media.
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Affiliation(s)
- Helen Dearden
- Leeds Cancer Centre, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, West Yorkshire, UK
| | - Mark A Baxter
- Division of Molecular and Clinical Medicine, University of Dundee School of Medicine, Dundee, UK
- Tayside Cancer Centre, Ninewells Hospital, NHS Tayside, Dundee, UK
| | - Sally Martin
- Leeds Cancer Centre, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, West Yorkshire, UK
| | - Michael Rowe
- Plymouth Oncology Centre, Derriford Hospital Cancer Services Department, Plymouth, Plymouth, UK
| | - Kieran Zucker
- Leeds Cancer Centre, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, West Yorkshire, UK
| | - Christopher Mark Jones
- Leeds Cancer Centre, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, West Yorkshire, UK
| | | | - R D Petty
- Division of Molecular and Clinical Medicine, University of Dundee School of Medicine, Dundee, UK
- Tayside Cancer Centre, Ninewells Hospital, NHS Tayside, Dundee, UK
| | - Daniel Swinson
- Leeds Cancer Centre, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, West Yorkshire, UK
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10
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Hall PS, Swinson D, Cairns DA, Waters JS, Petty R, Allmark C, Ruddock S, Falk S, Wadsley J, Roy R, Tillett T, Nicoll J, Cummins S, Mano J, Grumett S, Stokes Z, Kamposioras KV, Chatterjee A, Garcia A, Waddell T, Guptal K, Maisey N, Khan M, Dent J, Lord S, Crossley A, Katona E, Marshall H, Grabsch HI, Velikova G, Ow PL, Handforth C, Howard H, Seymour MT. Efficacy of Reduced-Intensity Chemotherapy With Oxaliplatin and Capecitabine on Quality of Life and Cancer Control Among Older and Frail Patients With Advanced Gastroesophageal Cancer: The GO2 Phase 3 Randomized Clinical Trial. JAMA Oncol 2021; 7:869-877. [PMID: 33983395 PMCID: PMC8120440 DOI: 10.1001/jamaoncol.2021.0848] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 03/04/2021] [Indexed: 01/10/2023]
Abstract
Importance Older and/or frail patients are underrepresented in landmark cancer trials. Tailored research is needed to address this evidence gap. Objective The GO2 randomized clinical trial sought to optimize chemotherapy dosing in older and/or frail patients with advanced gastroesophageal cancer, and explored baseline geriatric assessment (GA) as a tool for treatment decision-making. Design, Setting, and Participants This multicenter, noninferiority, open-label randomized trial took place at oncology clinics in the United Kingdom with nurse-led geriatric health assessment. Patients were recruited for whom full-dose combination chemotherapy was considered unsuitable because of advanced age and/or frailty. Interventions There were 2 randomizations that were performed: CHEMO-INTENSITY compared oxaliplatin/capecitabine at Level A (oxaliplatin 130 mg/m2 on day 1, capecitabine 625 mg/m2 twice daily on days 1-21, on a 21-day cycle), Level B (doses 0.8 times A), or Level C (doses 0.6 times A). Alternatively, if the patient and clinician agreed the indication for chemotherapy was uncertain, the patient could instead enter CHEMO-BSC, comparing Level C vs best supportive care. Main Outcomes and Measures First, broad noninferiority of the lower doses vs reference (Level A) was assessed using a permissive boundary of 34 days reduction in progression-free survival (PFS) (hazard ratio, HR = 1.34), selected as acceptable by a forum of patients and clinicians. Then, the patient experience was compared using Overall Treatment Utility (OTU), which combines efficacy, toxic effects, quality of life, and patient value/acceptability. For CHEMO-BSC, the main outcome measure was overall survival. Results A total of 514 patients entered CHEMO-INTENSITY, of whom 385 (75%) were men and 299 (58%) were severely frail, with median age 76 years. Noninferior PFS was confirmed for Levels B vs A (HR = 1.09 [95% CI, 0.89-1.32]) and C vs A (HR = 1.10 [95% CI, 0.90-1.33]). Level C produced less toxic effects and better OTU than A or B. No subgroup benefited from higher doses: Level C produced better OTU even in younger or less frail patients. A total of 45 patients entered the CHEMO-BSC randomization: overall survival was nonsignificantly longer with chemotherapy: median 6.1 vs 3.0 months (HR = 0.69 [95% CI, 0.32-1.48], P = .34). In multivariate analysis in 522 patients with all variables available, baseline frailty, quality of life, and neutrophil to lymphocyte ratio were independently associated with OTU, and can be combined in a model to estimate the probability of different outcomes. Conclusions and Relevance This phase 3 randomized clinical trial found that reduced-intensity chemotherapy provided a better patient experience without significantly compromising cancer control and should be considered for older and/or frail patients. Baseline geriatric assessment can help predict the utility of chemotherapy but did not identify a group benefiting from higher-dose treatment. Trial Registration isrctn.org Identifier: ISRCTN44687907.
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Affiliation(s)
- Peter S. Hall
- University of Leeds, Leeds, United Kingdom
- University of Edinburgh, Edinburgh, United Kingdom
| | - Daniel Swinson
- Leeds Teaching Hospitals National Health Service Trust, United Kingdom
| | | | - Justin S. Waters
- Maidstone and Tunbridge Wells National Health Service Trust, Maidstone, United Kingdom
| | | | | | | | - Stephen Falk
- Bristol Oncology Centre, Bristol, United Kingdom
| | | | - Rajarshi Roy
- Hull University Hospitals National Health Service Trust, Hull, United Kingdom
| | | | - Jonathan Nicoll
- North Cumbria University Hospitals National Health Service Trust, Carlisle, United Kingdom
| | - Sebastian Cummins
- Royal Surrey County Hospital National Health Service Foundation Trust, Guildford, United Kingdom
| | - Joseph Mano
- The Royal Wolverhampton National Health Service Trust, Wolverhampton, United Kingdom
| | - Simon Grumett
- The Dudley Group National Health Service Foundation Trust, Dudley, United Kingdom
| | - Zuzana Stokes
- United Lincolnshire Hospitals National Health Service Trust, Lincoln, United Kingdom
| | | | - Anirban Chatterjee
- The Shrewsbury and Telford Hospital National Health Service Trust, Shrewsbury, United Kingdom
| | - Angel Garcia
- Betsi Cadwaladr University Local Health Board, Bangor, United Kingdom
| | - Tom Waddell
- The Christie National Health Service Foundation Trust, Manchester, United Kingdom
| | - Kamalnayan Guptal
- Worcestershire Acute Hospitals National Health Service Trust, Worcester, United Kingdom
| | - Nick Maisey
- Guys and St Thomas’s National Health Service Foundation Trust, London, United Kingdom
| | - Mohammed Khan
- York Teaching Hospital National Health Service Foundation Trust, Scarborough, United Kingdom
| | - Jo Dent
- Calderdale and Huddersfield National Health Service Foundation Trust, Huddersfield, United Kingdom
| | - Simon Lord
- University of Oxford, Oxford, United Kingdom
| | - Ann Crossley
- Leeds Teaching Hospitals National Health Service Trust, United Kingdom
| | | | | | - Heike I. Grabsch
- University of Leeds, Leeds, United Kingdom
- Maastricht University Medical Center, Maastricht, the Netherlands
| | | | - Pei Loo Ow
- University of Leeds, Leeds, United Kingdom
| | | | | | - Matthew T. Seymour
- University of Leeds, Leeds, United Kingdom
- Leeds Teaching Hospitals National Health Service Trust, United Kingdom
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11
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Baxter MA, Petty RD, Swinson D, Hall PS, O'Hanlon S. Real‑world challenge for clinicians treating advanced gastroesophageal adenocarcinoma (Review). Int J Oncol 2021; 58:22. [PMID: 33760115 PMCID: PMC7979263 DOI: 10.3892/ijo.2021.5202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 03/04/2021] [Indexed: 12/15/2022] Open
Abstract
Gastroesophageal adenocarcinoma (GOA) is a disease of older people. Incidence is rising in the developed world and the majority of patients present with advanced disease. Based on clinical trial data, systemic chemotherapy in the advanced setting is associated with improvements in quality of life and survival. However, there is a recognised mismatch between trial populations and the patients encountered in clinical practice in terms of age, comorbidity and fitness. Appropriate patient selection is essential to safely deliver effective treatment. In this narrative review, we discuss the challenges faced by clinicians when assessing real‑world patients with advanced GOA for systemic therapy. We also highlight the importance of frailty screening and the current available evidence we can use to guide our management.
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Affiliation(s)
- Mark A. Baxter
- Division of Molecular and Clinical Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee DD2 1SY, Scotland
- Tayside Cancer Centre, Ninewells Hospital and Medical School, NHS Tayside, Dundee DD1 9SY, UK
| | - Russell D. Petty
- Division of Molecular and Clinical Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee DD2 1SY, Scotland
- Tayside Cancer Centre, Ninewells Hospital and Medical School, NHS Tayside, Dundee DD1 9SY, UK
| | - Daniel Swinson
- Department of Oncology, St. James's Hospital, Leeds Teaching Hospitals NHS Trust, Leeds LS9 7TF, UK
| | - Peter S. Hall
- Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh EH4 2XR, Scotland, UK
| | - Shane O'Hanlon
- Department of Geriatric Medicine, St. Vincent's University Hospital, Dublin 4, D04 N2E0, Republic of Ireland
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12
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Gomes F, Lewis A, Morris R, Parks R, Kalsi T, Babic-Illamn G, Baxter M, Colquhoun K, Rodgers L, Smith E, Greystoke A, Bayman N, Cree A, Ng C, de Liguori Carino N, Basile S, Moore J, Merchant Z, Swinson D, Parbhoo A, Jones R, Davies E, Danson SJ, Young R, Morgan J, Wyld L, Corrie PG, Doherty GJ, Crawford K, Wright J, Reed M, Ugolini F, Lind M, Cheung KL, Harari D, Simcock R. The care of older cancer patients in the United Kingdom. Ecancermedicalscience 2020; 14:1101. [PMID: 33082851 PMCID: PMC7532033 DOI: 10.3332/ecancer.2020.1101] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 04/20/2020] [Indexed: 11/30/2022] Open
Abstract
The ageing population poses new challenges globally. Cancer care for older patients is one of these challenges, and it has a significant impact on societies. In the United Kingdom (UK), as the number of older cancer patients increases, the management of this group has become part of daily practice for most oncology teams in every geographical area. Older cancer patients are at a higher risk of both under- and over-treatment. Therefore, the assessment of a patient’s biological age and effective organ functional reserve becomes paramount. This may then guide treatment decisions by better estimating a prognosis and the risk-to-benefit ratio of a given therapy to anticipate and mitigate against potential toxicities/difficulties. Moreover, older cancer patients are often affected by geriatric syndromes and other issues that impact their overall health, function and quality of life. Comprehensive geriatric assessments offer an opportunity to identify and address health problems which may then optimise one’s fitness and well-being. Whilst it is widely accepted that older cancer patients may benefit from such an approach, resources are often scarce, and access to dedicated services and research remains limited to specific centres across the UK. The aim of this project is to map the current services and projects in the UK to learn from each other and shape the future direction of care of older patients with cancer.
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Affiliation(s)
- Fabio Gomes
- The Christie NHS Foundation Trust, Manchester M20 4BX, UK
| | - Anna Lewis
- Nottingham University Hospitals NHS Trust, Nottingham NG5 1PB, UK
| | - Rob Morris
- Nottingham University Hospitals NHS Trust, Nottingham NG5 1PB, UK
| | - Ruth Parks
- School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK
| | - Tania Kalsi
- Guy's and St. Thomas' NHS Foundation Trust, London SE1 9RS, UK.,King's College London, London SE5 9RS, UK
| | | | - Mark Baxter
- Ninewells Hospital, NHS Tayside, Dundee DD2 1SG, UK
| | - Kirsty Colquhoun
- Beatson West of Scotland Cancer Centre, NHS Greater Glasgow and Clyde, Glasgow G12 0YN, UK
| | - Lisa Rodgers
- Beatson West of Scotland Cancer Centre, NHS Greater Glasgow and Clyde, Glasgow G12 0YN, UK
| | - Eleanor Smith
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE7 7DN, UK
| | - Alastair Greystoke
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE7 7DN, UK
| | - Neil Bayman
- The Christie NHS Foundation Trust, Manchester M20 4BX, UK
| | - Anthea Cree
- The Christie NHS Foundation Trust, Manchester M20 4BX, UK
| | - Cassandra Ng
- Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester M23 9LT, UK
| | | | - Simone Basile
- Royal Manchester Infirmary, Manchester University NHS Foundation Trust, Manchester M13 9WL, UK
| | - John Moore
- Royal Manchester Infirmary, Manchester University NHS Foundation Trust, Manchester M13 9WL, UK
| | - Zoe Merchant
- Greater Manchester Cancer, Manchester M20 4BX, UK
| | | | - Anita Parbhoo
- South West Wales Cancer Centre, Swansea Bay University Health Board, Swansea SA2 8QA, UK
| | - Rachel Jones
- South West Wales Cancer Centre, Swansea Bay University Health Board, Swansea SA2 8QA, UK
| | - Eleri Davies
- University Hospital of Llandough, Cardiff and Vale University Health Board, Cardiff CF64 2XX, UK
| | - Sarah J Danson
- Department of Oncology and Metabolism, The Medical School, University of Sheffield, Sheffield S10 2RX, UK
| | - Robin Young
- Department of Oncology and Metabolism, The Medical School, University of Sheffield, Sheffield S10 2RX, UK
| | - Jenna Morgan
- Department of Oncology and Metabolism, The Medical School, University of Sheffield, Sheffield S10 2RX, UK
| | - Lynda Wyld
- Department of Oncology and Metabolism, The Medical School, University of Sheffield, Sheffield S10 2RX, UK
| | - Pippa G Corrie
- Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK
| | - Gary J Doherty
- Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK
| | - Kyle Crawford
- Belfast Health and Social Care Trust, Belfast BT13 1FD, UK
| | - Juliet Wright
- Brighton and Sussex Medical School, University of Brighton, Brighton BN1 9PX, UK
| | - Malcolm Reed
- Brighton and Sussex Medical School, University of Brighton, Brighton BN1 9PX, UK
| | - Fiammetta Ugolini
- Sussex Cancer Centre, Brighton and Sussex University Hospitals NHS Trust, Sussex BN2 5BD, UK
| | - Michael Lind
- Queen's Centre for Oncology and Haematology, Hull University Teaching Hospitals NHS Trust, Hull HU16 5JQ, UK
| | - Kwok-Leung Cheung
- School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK.,Co-senior authorship
| | - Danielle Harari
- Guy's and St. Thomas' NHS Foundation Trust, London SE1 9RS, UK.,King's College London, London SE5 9RS, UK.,Co-senior authorship
| | - Richard Simcock
- Sussex Cancer Centre, Brighton and Sussex University Hospitals NHS Trust, Sussex BN2 5BD, UK.,Co-senior authorship
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13
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Taylor JC, Swinson D, Seligmann JF, Birch RJ, Dewdney A, Brown V, Dent J, Rossington HL, Quirke P, Morris EJA. Addressing the variation in adjuvant chemotherapy treatment for colorectal cancer: Can a regional intervention promote national change? Int J Cancer 2020; 148:845-856. [PMID: 32818319 DOI: 10.1002/ijc.33261] [Citation(s) in RCA: 5] [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] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 07/30/2020] [Accepted: 08/04/2020] [Indexed: 01/25/2023]
Abstract
Analysis of routine population-based data has previously shown that patterns of surgical treatment for colorectal cancer can vary widely, but there is limited evidence available to determine if such variation is also seen in the use of chemotherapy. This study quantified variation in adjuvant chemotherapy across both England using cancer registry data and in more detail across the representative Yorkshire and Humber regions. Individuals with Stages II and III colorectal cancer who underwent major resection from 2014 to 2015 were identified. Rates of chemotherapy were calculated from the Systemic Anticancer Treatment database using multilevel logistic regression. Additionally, questionnaires addressing different clinical scenarios were sent to regional oncologists to investigate the treatment preferences of clinicians. The national adjusted chemotherapy treatment rate ranged from 2% to 46% (Stage II cancers), 19% to 81% (Stage III cancers), 24% to 75% (patients aged <70 years) and 5% to 46% (patients aged ≥70 years). Regionally, the rates of treatment and the proportions of treated patients receiving combination chemotherapy varied by stage (Stage II 4%-26% and 0%-55%, Stage III 48%-71% and 40%-84%) and by age (<70 years 35%-68% and 49%-91%; ≥70 years 15%-39% and 6%-75%). Questionnaire responses showed significant variations in opinions for high-risk Stage II patients with both deficient and proficient mismatch repair tumours and Stage IIIB patients aged ≥70 years. Following a review of the evidence, open discussion in our region has enabled a consensus agreement on an algorithm for colorectal cancer that is intended to reduce variation in practice.
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Affiliation(s)
- John C Taylor
- Division of Pathology and Data Analytics, Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - Daniel Swinson
- St James's Institute of Oncology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Jenny F Seligmann
- St James's Institute of Oncology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Rebecca J Birch
- Division of Pathology and Data Analytics, Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - Alice Dewdney
- Weston Park Cancer Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Victoria Brown
- Queen's Centre for Oncology and Haematology, Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - Joanna Dent
- Department of Oncology, Royal Huddersfield Hospital, Calderdale and Huddersfield NHS Foundation Trust, Huddersfield, UK
| | - Hannah L Rossington
- Division of Pathology and Data Analytics, Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - Philip Quirke
- Division of Pathology and Data Analytics, Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - Eva J A Morris
- Big Data Institute, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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14
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Ilyas W, Jain P, Goody R, Swinson D, Hingorani M. The Potential Role of Radiotherapy in the Management of Hepatoid Carcinomas of the Stomach: A Case Report. Oncol Res Treat 2020; 43:170-174. [PMID: 32160618 DOI: 10.1159/000505375] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Accepted: 12/10/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Hepatoid adenocarcinoma (AC) of the stomach (HAS) represents a rare variant of conventional gastric AC characterised by poor prognosis. They are usually managed with surgery (localised disease) and chemotherapy. CASE REPORT We present the first case report of a patient with HAS who presented with weight loss, poor appetite, general clinical deterioration (performance status [PS] = 3), and active gastrointestinal bleeding who was treated with fractionated palliative radiotherapy (RT) using 30 Gy in 10 fractions. The use of RT was associated with excellent symptomatic and radiological response and facilitated surgery secondary to significant improvement in general fitness and PS. CONCLUSION RT may have a role in the multimodality management of hepatoid AC of the stomach.
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Affiliation(s)
- Waqas Ilyas
- Queen's Centre of Oncology Castle Hill Hospital, Cottingham, United Kingdom
| | - Prashant Jain
- Queen's Centre of Oncology Castle Hill Hospital, Cottingham, United Kingdom
| | - Rebecca Goody
- Bexley Wing, St James University Hospital, Leeds, United Kingdom
| | - Daniel Swinson
- Bexley Wing, St James University Hospital, Leeds, United Kingdom
| | - Mohan Hingorani
- Bexley Wing, St James University Hospital, Leeds, United Kingdom,
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15
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Joharatnam-Hogan N, Cafferty F, Hubner R, Swinson D, Sothi S, Gupta K, Falk S, Patel K, Warner N, Kunene V, Rowley S, Khabra K, Underwood T, Jankowski J, Bridgewater J, Crossley A, Henson V, Berkman L, Gilbert D, Kynaston H, Ring A, Cameron D, Din F, Graham J, Iveson T, Adams R, Thomas A, Wilson R, Pramesh CS, Langley R. Aspirin as an adjuvant treatment for cancer: feasibility results from the Add-Aspirin randomised trial. Lancet Gastroenterol Hepatol 2019; 4:854-862. [PMID: 31477558 DOI: 10.1016/s2468-1253(19)30289-4] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [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] [Received: 06/17/2019] [Revised: 07/16/2019] [Accepted: 08/01/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND Preclinical, epidemiological, and randomised data indicate that aspirin might prevent tumour development and metastasis, leading to reduced cancer mortality, particularly for gastro-oesophageal and colorectal cancer. Randomised trials evaluating aspirin use after primary radical therapy are ongoing. We present the pre-planned feasibility analysis of the run-in phase of the Add-Aspirin trial to address concerns about toxicity, particularly bleeding after radical treatment for gastro-oesophageal cancer. METHODS The Add-Aspirin protocol includes four phase 3 randomised controlled trials evaluating the effect of daily aspirin on recurrence and survival after radical cancer therapy in four tumour cohorts: gastro-oesophageal, colorectal, breast, and prostate cancer. An open-label run-in phase (aspirin 100 mg daily for 8 weeks) precedes double-blind randomisation (for participants aged under 75 years, aspirin 300 mg, aspirin 100 mg, or matched placebo in a 1:1:1 ratio; for patients aged 75 years or older, aspirin 100 mg or matched placebo in a 2:1 ratio). A preplanned analysis of feasibility, including recruitment rate, adherence, and toxicity was performed. The trial is registered with the International Standard Randomised Controlled Trials Number registry (ISRCTN74358648) and remains open to recruitment. FINDINGS After 2 years of recruitment (October, 2015, to October, 2017), 3494 participants were registered (115 in the gastro-oesophageal cancer cohort, 950 in the colorectal cancer cohort, 1675 in the breast cancer cohort, and 754 in the prostate cancer cohort); 2719 (85%) of 3194 participants who had finished the run-in period proceeded to randomisation, with rates consistent across tumour cohorts. End of run-in data were available for 2253 patients; 2148 (95%) of the participants took six or seven tablets per week. 11 (0·5%) of the 2253 participants reported grade 3 toxicity during the run-in period, with no upper gastrointestinal bleeding (any grade) in the gastro-oesophageal cancer cohort. The most frequent grade 1-2 toxicity overall was dyspepsia (246 [11%] of 2253 participants). INTERPRETATION Aspirin is well-tolerated after radical cancer therapy. Toxicity has been low and there is no evidence of a difference in adherence, acceptance of randomisation, or toxicity between the different cancer cohorts. Trial recruitment continues to determine whether aspirin could offer a potential low cost and well tolerated therapy to improve cancer outcomes. FUNDING Cancer Research UK, The National Institute for Health Research Health Technology Assessment Programme, The MRC Clinical Trials Unit at UCL.
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Affiliation(s)
| | - Fay Cafferty
- MRC Clinical Trials Unit, University College London, UK
| | | | | | | | | | - Stephen Falk
- Bristol Haematology & Oncology Centre, Bristol, UK
| | | | | | | | - Sam Rowley
- MRC Clinical Trials Unit, University College London, UK
| | - Komel Khabra
- MRC Clinical Trials Unit, University College London, UK
| | | | - Janusz Jankowski
- Gastroenterology Unit, Morecambe Bay University Hospitals NHS Trust, UK; National Institute for Health and Care Excellence, London, UK
| | | | | | | | | | | | | | | | - David Cameron
- Cancer Research UK Edinburgh Centre, MRC Institute of Genetics & Molecular Medicine, Western General Hospital, Edinburgh, UK
| | - Farhat Din
- Cancer Research UK Edinburgh Centre, MRC Institute of Genetics & Molecular Medicine, Western General Hospital, Edinburgh, UK
| | - Janet Graham
- Beatson West of Scotland Cancer Centre, Glasgow, UK
| | | | | | | | | | - C S Pramesh
- Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, India
| | - Ruth Langley
- MRC Clinical Trials Unit, University College London, UK.
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16
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Dart G, Swinson D. A single institution review of capecitabine related acute admissions and cost analysis. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz263.019] [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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17
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Hall P, Swinson D, Lord S, Handforth C, Cairns D, Marshall H, Petty R, Bennett M, Velikova G, Seymour M. Chemotherapy for frail and elderly patients (pts) with advanced gastroesophageal cancer (aGOAC): Quality of Life (QoL) results from the GO2 phase III trial. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz394.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Swinson D, Hingorani M, Stokes Z, Dent J, Guptal K, Chatterjee A, Kamposioras K, Grumett SA, Khan M, Marshall H, Ruddock S, Allmark C, Katona E, Howard HC, Velikova G, Lord S, Hall PS, Seymour MT. Best supportive care (BSC) with or without low-dose chemotherapy (chemo) in frail elderly patients with advanced gastroesophageal cancer (aGOAC): The uncertain randomization of the GO2 phase III trial. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.4051] [Citation(s) in RCA: 3] [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
4051 Background: Before 2000, trials comparing BSC +/- chemo for aGOAC showed overall survival (OS) benefit, but in predominantly fit patients (pts). We have revisited this question in a modern context, using low-dose chemo in a frail population, with comprehensive baseline health and frailty assessment. Methods: In the GO2 trial, elderly and/or frail aGOAC pts with a “certain” indication for chemo were randomised between 3 chemo doses. In this GO2 substudy, pts with an “uncertain” indication for chemo were instead randomised to BSC ± the lowest dose chemo. Pts were eligible if clinician and pt agreed the indication for chemo was uncertain. There was no PS threshold, but eGFR ≥30 and bili < 2xULN were required. Baseline assessment included global QL, symptom & functional scales, frailty and comorbidity. Randomisation was 1:1 to BSC alone, or with oxaliplatin 78 mg/m2 d1, capecitabine 375 mg/m2 bd d1-21 (modified if eGFR 30-50 ml/min or bili 1.5-2.0 xULN), q21d. QL was reassessed after 9 and 18 wks. The primary endpoint analysis was OS, adjusted for baseline factors. The sample size for this exploratory sub-study was not pre-set, but around 60 pts were anticipated. Results: 558 pts entered GO2 at 61 centres 2014-17, of whom only 45 pts (8%) at 21 centres entered this uncertain randomisation. This would provide 80% power at p = 0.05 (2-tailed) to detect an OS HR of 0.3. OS was shorter in pts with worse baseline PS (p<0.01) or distant mets (p<0.05). OS was not significantly improved with chemo; however we cannot exclude HR >0.32. QL deteriorated less with BSC+chemo than with BSC alone. Conclusions: In this frail, poor PS population, we observed a small survival benefit with chemo but this did not reach statistical significance. Clinicians should carefully consider BSC alone as a valid treatment option for aGOAC pts with poor PS and/or frailty. Clinical trial information: 44687907. [Table: see text]
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Affiliation(s)
| | | | - Zuzana Stokes
- United Lincolnshire Hospitals, Lincoln, United Kingdom
| | - Jo Dent
- Calderdale and Huddersfield Royal Infirmary, Huddersfield, United Kingdom
| | | | | | | | | | - Mohammad Khan
- York Teaching Hospital NHS Foundation Trust, York, United Kingdom
| | | | | | | | | | - Helen C Howard
- Clinical Trials Research Unit, University of Leeds, Leeds, United Kingdom
| | - Galina Velikova
- Leeds Institute of Cancer and Pathology/St James's Institute of Oncology, Leeds, United Kingdom
| | - Simon Lord
- University of Oxford, Oxford, United Kingdom
| | - Peter S Hall
- St James University Hospital, Leeds, United Kingdom
| | - Matthew T. Seymour
- National Institute for Health Research Clinical Research Network, Leeds, United Kingdom
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Hall PS, Swinson D, Waters JS, Wadsley J, Falk S, Roy R, Tillett T, Nicoll J, Cummings S, Grumett SA, Kamposioras K, Garcia A, Allmark C, Marshall H, Ruddock S, Katona E, Velikova G, Petty RD, Grabsch HI, Seymour MT. Optimizing chemotherapy for frail and elderly patients (pts) with advanced gastroesophageal cancer (aGOAC): The GO2 phase III trial. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.4006] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
4006 Background: Many pts with aGOAC are elderly and/or frail. We previously compared epirubin/ oxaliplatin/ capecitabine (EOCap) vs OCap vs Cap in a pick-the-winner study and found OCap best. GO2 was designed to find the optimum dose of OCap and to explore the use of an objective baseline geriatric assessment to individualize doses for maximum Overall Treatment Utility (OTU), a composite of clinical benefit, tolerability, QL and patient value. Methods: Pts with aGOAC were eligible if unsuitable for full-dose EOCap due to age or frailty, but fit for OCap; GFR ≥ 30, bili <2x ULN. Baseline assessment included global QL; symptoms; functional scales; comorbidity; frailty. Randomization was 1:1:1 to dose Level A (Ox 130 mg/m2d1, Cap 625 mg/m2bd d1-21, q21d), B (80% Level A doses) or C (60% Level A doses). Pts with GFR 30-50 ml/min or bili 1.5-2.0 xULN received 75% of the allocated dose of Cap. At 9 wks, pts were scored for OTU. Continuation thereafter was based on clinical judgement. Non-inferiority (vs A) was assessed using PFS censored at 12 months, with boundary HR 1.34 (based on discussion with pts and clinicians), needing 284 PFS events per 2-way comparison. Baseline fitness was assessed as predictive of OTU, overall and by interaction with dose level. Results: 514 pts were randomised, 2014-17, at 61 UK centres. Clinical trial information: 44687907. Non-inferiority of PFS is confirmed for Level B vs A (HR 1.09, CI 0.89-1.32) and for Level C vs A (HR 1.10, CI 0.90-1.33). Level C pts had less toxicity and better OTU outcomes than A or B. When analysed by baseline age, frailty and PS, Level C produced the best OTU even in younger, less frail and better PS patients; no group was identified who benefit more from the higher dose levels. Conclusions: This is the largest RCT to date specifically investigating frail and/or elderly aGOAC pts, and should guide future treatment. The lowest dose tested was non-inferior in terms of PFS and produced less toxicity and better overall treatment utility.[Table: see text]
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Affiliation(s)
- Peter S Hall
- University of Edinburgh, Edinburgh, United Kingdom
| | | | | | | | - Stephen Falk
- Bristol Haematology and Oncology Centre, Bristol, United Kingdom
| | | | | | - Jonathan Nicoll
- North Cumbria University Hospitals, Carlisle, United Kingdom
| | | | | | | | | | | | | | | | | | | | | | - Heike I. Grabsch
- Leeds Institute of Cancer Studies and Pathology, University of Leeds, Leeds, United Kingdom
| | - Matthew T. Seymour
- National Institute for Health Research Clinical Research Network, Leeds, United Kingdom
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Langley RE, Wilson RH, Cafferty FH, Joharatnam N, Graham JS, Swinson D, Iveson T, Din FVN, Steele RJ, Henson V, Crossley A, Pramesh CS, Walther A, Adams R, Dawson LK, Agarwal R, Khabra K, Parmar MKB. Aspirin as adjuvant treatment for colorectal cancer: Rationale and progress of the Add-Aspirin trial. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.tps3624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS3624 Background: There is now a body of evidence indicating a potential role for aspirin in colorectal cancer (CRC) prevention. In cardiovascular trials, effects on incidence of cancer metastases and short-term mortality suggest further possible roles in the treatment setting, supported by observational studies of aspirin use after cancer diagnosis. In the prevention setting, aspirin use has been limited by toxicity concerns, particularly of serious bleeding. In the adjuvant setting, benefits associated with reducing recurrence and subsequent treatment may outweigh these risks. The Add-Aspirin trial will investigate this, and will also consider possible mechanisms of action for aspirin effects, including the impact of PIK3CA mutations, where there are currently several theories and conflicting data. Methods: Add-Aspirin (ISRCTN74358648) is an international, phase III, double-blind, randomised, placebo-controlled trial recruiting patients who have undergone surgery and relevant adjuvant treatment for stage II or III CRC, as well as those with completely resected CRC liver metastases. Parallel randomised cohorts will address the question in breast, gastro-oesophageal and prostate cancer. Participants take aspirin 100mg daily for an 8-week run-in, to assess adherence and toxicity, and those suitable to proceed are randomised (1:1:1) to aspirin 100mg, aspirin 300mg or placebo daily for at least 5 years. A number of measures – including blood pressure control and PPI use where relevant - are in place to reduce bleeding risk. The primary outcome is disease-free survival (target hazard ratio = 0.8, n = 2600 in 5 years) with a long term analysis of survival planned across the tumour groups. Translational work includes a sub-study monitoring urinary thromboxane B2 as a marker of platelet activation in a subgroup (n = 500) to investigate mechanisms of action. Add-Aspirin opened in 2015 and recruited 1505 CRC patients during the first 3 years from 137 UK centres. 1282 (85%) proceeded to randomisation. A pre-planned feasibility analysis of run-in data (n = 2253 across all 4 tumour groups) provided reassuring data on safety, tolerability and adherence, and recruitment continues with centres in India and Republic of Ireland recently joining. Clinical trial information: 74358648.
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Affiliation(s)
- Ruth E Langley
- Medical Research Council Clinical Trials Unit at University College London, London, United Kingdom
| | | | - Fay Helen Cafferty
- Medical Research Council Clinical Trials Unit at UCL, London, United Kingdom
| | - Nalinie Joharatnam
- Medical Research Council Clinical Trials Unit at UCL, London, United Kingdom
| | | | | | - Timothy Iveson
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Farhat Vanessa Nasim Din
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom
| | - Robert J.C. Steele
- Medical Research Institute Ninewells Hospital and Medical School, Dundee, United Kingdom
| | - Verity Henson
- University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Anne Crossley
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | | | - Axel Walther
- Bristol Cancer Institute, Bristol, United Kingdom
| | | | | | - Roshan Agarwal
- Northampton General Hospital, Northampton, United Kingdom
| | - Komel Khabra
- Medical Research Council Clinical Trials Unit at UCL, London, United Kingdom
| | - Mahesh K B Parmar
- Medical Research Center Clinical Trials Unit at University College London, London, United Kingdom
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Ajani J, Udrea A, Sarosiek T, Shenker M, Morgan C, Pikiel J, Wojcik E, Swinson D, Joseph M, Luft A, Salek T, Tournigand C, Ferry D, Zhang Y, Long A, Kuo WL, Gao L, Kauh J, Mansoor W. A dose-response study of ramucirumab treatment in patients with gastric cancer/gastroesophageal junction adenocarcinoma: Primary results of 4 dosing regimens in the phase 2 trial I4T-MC-JVDB. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx369.082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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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Wasan H, van Hazel G, Heinemann V, Sharma N, Taieb J, Ricke J, Peeters M, Findlay M, Virdee PS, Love S, Moschandreas J, Dutton P, Gebski V, Gray A, Price D, Bower G, Montazeri A, Swinson D, Brown E, Wilson G, Lowndes S, Sharma RA, Gibbs P. Overall survival analysis of the FOXFIRE-SIRFLOX-FOXFIRE global prospective randomized studies of first-line selective internal radiotherapy (SIRT) in patients with liver metastases from colorectal cancer. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx262.026] [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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23
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King J, Palmer DH, Johnson P, Ross P, Hubner RA, Sumpter K, Darby S, Braconi C, Iwuji C, Swinson D, Collins P, Patel K, Nobes J, Muazzam I, Blesing C, Kirkwood A, Nash S, Meyer T. Sorafenib for the Treatment of Advanced Hepatocellular Cancer - a UK Audit. Clin Oncol (R Coll Radiol) 2017; 29:256-262. [PMID: 27964898 DOI: 10.1016/j.clon.2016.11.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [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: 09/11/2016] [Revised: 10/28/2016] [Accepted: 11/01/2016] [Indexed: 01/08/2023]
Abstract
AIMS Sorafenib is the current standard treatment for advanced hepatocellular carcinoma. We carried out a national audit of UK patients treated with sorafenib as standard-of-care and those treated with systemic therapy in first-line trials. MATERIALS AND METHODS Sorafenib-treated and trial-treated patients were identified via the Cancer Drugs Fund and local databases. Data were collected retrospectively from medical records according to a standard case report form. The primary outcome measure was overall survival, estimated by the Kaplan-Meier method. RESULTS Data were obtained for 448 sorafenib-treated patients from 15 hospitals. The median age was 68 years (range 17-89) and 75% had performance status ≤ 1. At baseline, 77% were Child-Pugh A and 16.1% Child-Pugh B; 38% were albumin-bilirubin grade 1 (ALBI-1) and 48% ALBI-2; 23% were Barcelona Clinic Liver Classification B (BCLC-B) and 72% BCLC-C. The median time on sorafenib was 3.6 months, with a mean daily dose of 590 mg. The median overall survival for 448 evaluable sorafenib-treated patients was 8.5 months. There were significant differences in overall survival comparing Child-Pugh A versus Child-Pugh B (9.5 versus 4.6 months), ALBI-1 versus ALBI-2 (12.9 versus 5.9 months) and BCLC-B versus BCLC-C (13.0 versus 8.3 months). For trial-treated patients (n=109), the median overall survival was 8.1 months and this was not significantly different from the sorafenib-treated patients. CONCLUSION For Child-Pugh A patients with good performance status, survival outcomes were similar to those reported in global randomised controlled trials. Patients with ALBI grade > 1, Child-Pugh B or poor performance status seem to derive limited benefit from sorafenib treatment.
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Affiliation(s)
- J King
- Department of Oncology, Royal Free London NHS Foundation Trust, London, UK
| | - D H Palmer
- University of Birmingham, Birmingham, UK; University of Liverpool, Liverpool, UK; Clatterbridge Cancer Centre, Wirral, UK
| | - P Johnson
- University of Birmingham, Birmingham, UK; University of Liverpool, Liverpool, UK; Clatterbridge Cancer Centre, Wirral, UK
| | - P Ross
- King's College Hospital, London, UK
| | - R A Hubner
- The Christie NHS Foundation Trust, Manchester, UK
| | - K Sumpter
- The Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK
| | - S Darby
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - C Braconi
- University of Glasgow, Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - C Iwuji
- Leicester Royal Infirmary, Leicester, UK
| | - D Swinson
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - P Collins
- University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - K Patel
- Oxford University Hospitals NHS Trust, Oxford, UK
| | - J Nobes
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - I Muazzam
- Hull and East Yorkshire Hospitals NHS Trust, Hull, UK
| | - C Blesing
- Great Western Hospital NHS Trust, Swindon, UK
| | - A Kirkwood
- Cancer Research UK & UCL Cancer Trials Centre, London, UK
| | - S Nash
- Cancer Research UK & UCL Cancer Trials Centre, London, UK
| | - T Meyer
- Department of Oncology, Royal Free London NHS Foundation Trust, London, UK; UCL Cancer Institute, London, UK.
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24
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Hall PS, Lord SR, Collinson M, Marshall H, Jones M, Lowe C, Howard H, Swinson D, Velikova G, Anthoney A, Roy R, Dent J, Cheeseman S, Last K, Seymour MT. A randomised phase II trial and feasibility study of palliative chemotherapy in frail or elderly patients with advanced gastroesophageal cancer (321GO). Br J Cancer 2017; 116:472-478. [PMID: 28095397 PMCID: PMC5318975 DOI: 10.1038/bjc.2016.442] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [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: 06/18/2016] [Revised: 11/08/2016] [Accepted: 12/05/2016] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Elderly patients are commonly under-represented in cancer clinical trials. The 321GO was undertaken in preparation for a definitive phase three trial assessing different chemotherapy regimens in a frail and/or elderly population with advanced gastroesophageal (GO) cancer. METHODS Patients with advanced GO cancer considered unfit for conventional dose chemotherapy were randomly assigned in a 1 : 1 : 1 ratio to: epirubicin, oxaliplatin and capecitabine (EOX); oxaliplatin and capecitabine (OX); and capecitabine alone (X) (all 80% of full dose and unblinded). The primary end point was patient recruitment over an 18-month period. A registration study recorded treatment choice for all patients with advanced GO cancer at trial centres. RESULTS A total of 313 patients were considered for palliative chemotherapy for GO cancer over the 18-month period: 115 received full dose treatment, 89 less than standard treatment or entered 321GO and 111 no treatment. Within 321GO, 55 patients were randomly assigned (19 to OX and X; 17 to EOX). Progression-free survival (PFS) for all patients was 4.4 months and by arm 5.4, 5.6 and 3.0 months for EOX, OX and X, respectively. The number of patients with a good overall treatment utility (OTU), a novel patient-centred endpoint, at 12 weeks was 3 (18%), 6 (32%) and 1 (6%) for EOX, OX and X, respectively. At 6 weeks, 22 patients (41%) had experienced a non-haematologic toxicity ⩾grade 3, most commonly lethargy or diarrhoea. The OTU was prognostic for overall survival in patients alive at week 12 (logrank test P=0.0001). CONCLUSIONS It is feasible to recruit elderly and/or frail patients with advanced GO cancer to a randomised clinical trial. The OX is the preferred regimen for further study. Overall treatment utility shows promise as a comparator between treatment regimens for feasibility and randomised trials in the elderly and/or frail GO cancer population.
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Affiliation(s)
- P S Hall
- Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh EH4 2XR, UK
| | - S R Lord
- Department of Oncology, University of Oxford, Oxford, UK
| | - M Collinson
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - H Marshall
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - M Jones
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - C Lowe
- NIHR Cancer Research Network Coordinating Centre, Leeds, UK
| | - H Howard
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - D Swinson
- Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - G Velikova
- Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - A Anthoney
- Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - R Roy
- Department of Oncology, Castle Hill Hospital, Hull, UK
| | - J Dent
- Department of Oncology, Huddersfield Royal Infirmary, Huddersfield, UK
| | - S Cheeseman
- Department of Oncology, The York Hospital, York, UK
| | - K Last
- Department of Oncology, The York Hospital, York, UK
- Department of Oncology, Bradford Royal Infirmary, Bradford, UK
| | - M T Seymour
- NIHR Cancer Research Network Coordinating Centre, Leeds, UK
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25
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Edeline J, Blanc JF, Johnson P, Campillo-Gimenez B, Ross P, Ma YT, King J, Hubner RA, Sumpter K, Darby S, Evans J, Iwuji C, Swinson D, Collins P, Patel K, Muazzam I, Palmer DH, Meyer T. A multicentre comparison between Child Pugh and Albumin-Bilirubin scores in patients treated with sorafenib for Hepatocellular Carcinoma. Liver Int 2016; 36:1821-1828. [PMID: 27214151 DOI: 10.1111/liv.13170] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 05/18/2016] [Indexed: 12/16/2022]
Abstract
BACKGROUND & AIMS The Albumin-Bilirubin (ALBI) grade was proposed as an objective means to evaluate liver function in patients with Hepatocellular Carcinoma (HCC). ALBI grade 1 vs 2 were proposed as stratification factors within the Child Pugh (CP) A class. However, the original publication did not provide comparison with the subclassification by points (5-15) within the CP classification. METHODS We retrospectively analysed data from patients treated with sorafenib for HCC from 17 centres in United Kingdom and France. Overall survival (OS) was analysed using the Kaplan-Meier method and a Cox regression model. Discriminatory abilities of the classifications were assessed with the log likelihood ratio, Harrell's C statistics and Akaike information criterion. RESULTS Data from 1019 patients were collected, of which 905 could be assessed for both scores. 92% of ALBI grade 1 were CP A5 while ALBI 2 included a broad range of CP scores of which 44% were CP A6. Median OS was 10.2, 7.0 and 3.6 months for CP scores A5, A6 and >A6, respectively (P < 0.001), Hazard Ratio (HR) = 1.60 (95%CI: 1.35-1.89, P < 0.001) for A6 vs A5. Median OS was 10.9, 6.6 and 3.0 months for ALBI grade 1, 2 and 3, respectively (P < 0.001), HR = 1.68 (1.43-1.97, P < 0.001) for grade 2 vs 1. Discriminatory abilities of CP and ALBI were similar in the CP A population, but better for CP in the overall population. CONCLUSIONS Our findings support the use CP class A as an inclusion criterion, and ALBI as a stratification factor in trials of systemic therapy.
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Affiliation(s)
| | | | - Philip Johnson
- University of Liverpool, Liverpool, UK.,Clatterbridge Cancer Centre, Liverpool, UK
| | | | - Paul Ross
- King's College Hospital NHS Foundation Trust, London, UK
| | - Yuk Ting Ma
- University of Birmingham, Birmingham, UK.,University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - Judy King
- Department of Oncology, Royal Free London NHS Foundation Trust, London, UK
| | | | - Kate Sumpter
- The Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Suzanne Darby
- Weston Park Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Jeff Evans
- University of Glasgow, Beatson West of Scotland Cancer Centre, Glasgow, UK
| | | | | | - Peter Collins
- University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Kinnari Patel
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Iqtedar Muazzam
- Castle Hill Hospital, Hull and East Yorkshire Hospitals NHS Trust, Hull, UK
| | - Daniel H Palmer
- University of Liverpool, Liverpool, UK.,Clatterbridge Cancer Centre, Liverpool, UK
| | - Tim Meyer
- Department of Oncology, Royal Free London NHS Foundation Trust, London, UK.,UCL Cancer Institute, London, UK
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Folprecht G, Pericay C, Saunders MP, Thomas A, Lopez Lopez R, Roh JK, Chistyakov V, Höhler T, Kim JS, Hofheinz RD, Ackland SP, Swinson D, Kopp M, Udovitsa D, Hall M, Iveson T, Vogel A, Zalcberg JR. Oxaliplatin and 5-FU/folinic acid (modified FOLFOX6) with or without aflibercept in first-line treatment of patients with metastatic colorectal cancer: the AFFIRM study. Ann Oncol 2016; 27:1273-9. [PMID: 27091810 DOI: 10.1093/annonc/mdw176] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 04/10/2016] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The combination of aflibercept with FOLFIRI has been shown to significantly prolong overall survival in patients with metastatic colorectal cancer (mCRC) after progression on oxaliplatin-based therapy. This trial evaluated the addition of aflibercept to oxaliplatin-based first-line treatment of patients with mCRC. PATIENTS AND METHODS Patients with mCRC were randomized to receive first-line therapy with mFOLFOX6 plus aflibercept (4 mg/kg) or mFOLFOX6 alone. The primary end point of this phase II study was the progression-free survival (PFS) rate at 12 months in each arm. The analysis of efficacy between the arms was a pre-planned secondary analysis. RESULTS Of 236 randomized patients, 227 and 235 patients were evaluable for the primary efficacy analysis and safety, respectively. The probabilities of being progression-free at 12 months were 25.8% [95% confidence interval (CI) 17.2-34.4] for the aflibercept/mFOLFOX6 arm and 21.2% (95% CI 12.2-30.3) for the mFOLFOX6 arm. The median PFS was 8.48 months (95% CI 7.89-9.92) for the aflibercept/mFOLFOX6 arm and 8.77 months (95% CI 7.62-9.27) for the mFOLFOX6 arm; the hazard ratio of aflibercept/mFOLFOX6 versus mFOLFOX6 was 1.00 (95% CI 0.74-1.36). The response rates were 49.1% (95% CI 39.7-58.6) and 45.9% (95% CI 36.4-55.7) for patients treated with and without aflibercept, respectively. The most frequent treatment-emergent grade 3/4 adverse events (AEs) excluding laboratory abnormalities reported for aflibercept/mFOLFOX6 versus mFOLFOX6 were neuropathy (16.8% versus 17.2%) and diarrhea (13.4% versus 5.2%). Neutropenia grade 3/4 occurred in 36.1% versus 29.3%. The most common vascular endothelial growth factor inhibition class-effect grade 3/4 AEs for aflibercept/mFOLFOX6 versus mFOLFOX6 were hypertension (35.3% versus 1.7%), proteinuria (9.2% versus 0%), deep vein thrombosis (5.9% versus 0.9%) and pulmonary embolism (5.9% versus 5.2%). CONCLUSION No difference in PFS rate was observed between treatment groups. Adding aflibercept to first-line mFOLFOX6 did not increase efficacy but was associated with higher toxicity. CLINICAL TRIAL NUMBER NCT00851084, www.clinicaltrials.gov, EudraCT 2008-004178-41.
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Affiliation(s)
- G Folprecht
- Medical Department I, University Cancer Center, University Hospital Carl Gustav Carus, Dresden, Germany
| | - C Pericay
- Hospital de Sabadell, Corporació Sanitaria Parc Taulí-Institut Universitari, Sabadell, Spain
| | - M P Saunders
- Department of Radiotherapy and Oncology, The Christie NHS Foundation Trust, Manchester
| | - A Thomas
- Department of Cancer Studies, University of Leicester, Leicester, UK
| | - R Lopez Lopez
- Department of Medical Oncology, Hospital Clinico Universitario e Instituto de Investigación, Santiago de Compostela, Spain
| | - J K Roh
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | | | - T Höhler
- Department I of Internal Medicine, Prosper Hospital, Recklinghausen, Germany
| | - J-S Kim
- Department of Oncology and Hematology, Korea University Guro Hospital, Seoul, Republic of Korea
| | - R-D Hofheinz
- Department III of Internal Medicine, University Hospital, Mannheim, Germany
| | - S P Ackland
- Department of Medical Oncology, Calvary Mater Hospital, Newcastle Hunter Medical Research Institute and University of Newcastle, Callaghan, Australia
| | - D Swinson
- Department of Oncology, St James' Hospital, Leeds, UK
| | - M Kopp
- Samara Regional Oncology Dispensary, Samara
| | - D Udovitsa
- Oncological Dispensary #2, Sochi, Russia
| | - M Hall
- Cancer Services Division, Mount Vernon Cancer Centre, Middlesex
| | - T Iveson
- Department of Medical Oncology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - A Vogel
- Clinic of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - J R Zalcberg
- School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
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Young A, Marshall E, Krzyzanowska M, Robinson B, Brown S, Collinson F, Seligmann J, Abbas A, Rees A, Swinson D, Neville-Webbe H, Selby P. Responding to Acute Care Needs of Patients With Cancer: Recent Trends Across Continents. Oncologist 2016; 21:301-7. [PMID: 26921289 PMCID: PMC4786347 DOI: 10.1634/theoncologist.2014-0341] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2014] [Accepted: 11/25/2015] [Indexed: 12/28/2022] Open
Abstract
Remarkable progress has been made over the past decade in cancer medicine. Personalized medicine, driven by biomarker predictive factors, novel biotherapy, novel imaging, and molecular targeted therapeutics, has improved outcomes. Cancer is becoming a chronic disease rather than a fatal disease for many patients. However, despite this progress, there is much work to do if patients are to receive continuous high-quality care in the appropriate place, at the appropriate time, and with the right specialized expert oversight. Unfortunately, the rapid expansion of therapeutic options has also generated an ever-increasing burden of emergency care and encroaches into end-of-life palliative care. Emergency presentation is a common consequence of cancer and of cancer treatment complications. It represents an important proportion of new presentations of previously undiagnosed malignancy. In the U.K. alone, 20%-25% of new cancer diagnoses are made following an initial presentation to the hospital emergency department, with a greater proportion in patients older than 70 years. This late presentation accounts for poor survival outcomes and is often associated with poor patient experience and poorly coordinated care. The recent development of acute oncology services in the U.K. aims to improve patient safety, quality of care, and the coordination of care for all patients with cancer who require emergency access to care, irrespective of the place of care and admission route. Furthermore, prompt management coordinated by expert teams and access to protocol-driven pathways have the potential to improve patient experience and drive efficiency when services are fully established. The challenge to leaders of acute oncology services is to develop bespoke models of care, appropriate to local services, but with an opportunity for acute oncology teams to engage cancer care strategies and influence cancer care and delivery in the future. This will aid the integration of highly specialized cancer treatment with high-quality care close to home and help avoid hospital admission.
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Affiliation(s)
- Alison Young
- St. James's Institute of Oncology, St. James's University Hospital, Leeds, United Kingdom
| | - Ernie Marshall
- Medical Oncology, Clatterbridge Cancer Centre, Merseyside, United Kingdom
| | | | | | - Sean Brown
- Medical Oncology, Clatterbridge Cancer Centre, Merseyside, United Kingdom
| | - Fiona Collinson
- St. James's Institute of Oncology, St. James's University Hospital, Leeds, United Kingdom
| | - Jennifer Seligmann
- St. James's Institute of Oncology, St. James's University Hospital, Leeds, United Kingdom
| | - Afroze Abbas
- Diabetes Center, School of Medicine, University of Leeds, Leeds, United Kingdom
| | - Adrian Rees
- NHS Leeds West Clinical Commissioning Group, Leeds, United Kingdom
| | - Daniel Swinson
- St. James's Institute of Oncology, St. James's University Hospital, Leeds, United Kingdom
| | | | - Peter Selby
- St. James's Institute of Oncology, St. James's University Hospital, Leeds, United Kingdom University of Leeds, Leeds, United Kingdom
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Corbett M, Heirs M, Rose M, Smith A, Stirk L, Richardson G, Stark D, Swinson D, Craig D, Eastwood A. The delivery of chemotherapy at home: an evidence synthesis. Health Services and Delivery Research 2015. [DOI: 10.3310/hsdr03140] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundRecent policy and guidance has focused on chemotherapy services being offered closer to home, but the clinical and economic implications of this are uncertain.ObjectivesTo compare the impact of delivering intravenous chemotherapy in different settings on a range of outcomes, including quality of life, safety and costs.DesignMultimethods approach: systematic review of clinical effectiveness, qualitative and cost-effectiveness studies; description of the patient pathway and brief survey of current provision; and development of a decision model to explore aspects of cost-effectiveness.SettingProvision of intravenous chemotherapy.ParticipantsChemotherapy patients.InterventionsSetting in which chemotherapy was administered (home, community or outpatient).Outcome measuresSafety, quality of life, preference, satisfaction, opinions/experiences, social functioning, clinical outcomes, costs and resource/organisational issues.Data sourcesSixteen electronic databases (including MEDLINE, EMBASE and The Cochrane Library) were searched from inception to October 2013 for published and unpublished studies.Review methodsTwo reviewers independently screened potentially relevant studies, extracted data and quality assessed the included studies. Study validity was evaluated using appropriate quality assessment tools. Clinical effectiveness and cost-effectiveness studies were summarised narratively, and qualitative studies were synthesised using meta-ethnography.ResultsOf the 67 eligible studies, 25 were comparative, with nine including a concurrent economic evaluation. Although some of the 10 randomised trials were designed to minimise avoidable biases, slow recruitment rates and non-participation of eligible patients for setting-related reasons meant that trial sample sizes were small and populations were inherently biased to favour the home or community settings. There was little evidence to suggest differences between settings in terms of quality of life, clinical outcomes, psychological outcomes or adverse events. All nine economic evaluations were judged as having low or uncertain quality, providing limited evidence to draw overall conclusions. Most were cost–consequence analyses, presenting cost outcomes alongside trial results but deriving no summary measure of benefit. Poor resource use reporting and use of different perspectives across settings made results difficult to compare. Seventeen qualitative studies (450 participants) were judged as moderate to good quality, although all compared new or proposed services with existing outpatient facilities and biased samples were used. The three main lines of argument were barriers to service provision, satisfaction with chemotherapy and making compromises to maintain normality. Most patients made explicit trade-offs between the time and energy required for outpatient chemotherapy, which reduced quality of life, and an increased sense of safety. A patient pathway was described, informed by expert advice and a brief survey of NHS and private providers, which identified wide variation in the ways in which home and community chemotherapy was delivered. Considering limitations of the available data and variation in provision, cost-effectiveness modelling results were not robust and were viewed as exploratory only; the results were highly unstable.ConclusionsPrimary studies comparing settings for administering intravenous chemotherapy appear difficult to conduct. Consequently, few robust conclusions can be made about the clinical effectiveness and cost-effectiveness. Qualitative studies indicate that the patient time and energy required for outpatient chemotherapy reduces quality of life. A nested randomised controlled trial within a larger observational cohort of patients is proposed to enhance recruitment and improve generalisability of results. Future economic evaluations require detailed patient characteristic, resource use, cost and quality-of-life data, although their results are likely to have limited generalisability.Study registrationThis study is registered as PROSPERO CRD42013004851.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Mark Corbett
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Morag Heirs
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Micah Rose
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Alison Smith
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Lisa Stirk
- Centre for Reviews and Dissemination, University of York, York, UK
| | | | - Daniel Stark
- Leeds Institute of Cancer & Pathology, University of Leeds, Leeds, UK
| | - Daniel Swinson
- St James’s Institute of Oncology, Leeds Teaching Hospitals Foundation NHS Trust, Leeds, UK
| | - Dawn Craig
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Alison Eastwood
- Centre for Reviews and Dissemination, University of York, York, UK
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Luvai A, Mbagaya W, Narayanan D, Degg T, Toogood G, Wyatt JI, Swinson D, Hall CJ, Barth JH. Hepatocellular carcinoma in variegate porphyria: a case report and literature review. Ann Clin Biochem 2014; 52:407-12. [PMID: 25301776 DOI: 10.1177/0004563214557568] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2014] [Indexed: 01/12/2023]
Abstract
Variegate porphyria is an autosomal dominant acute hepatic porphyria characterized by photosensitivity and acute neurovisceral attacks. Hepatocellular carcinoma has been described as a potential complication of variegate porphyria in case reports. We report a case of a 48-year-old woman who was diagnosed with hepatocellular carcinoma following a brief history of right upper quadrant pain which was preceded by a few months of blistering lesions in sun-exposed areas. She was biochemically diagnosed with variegate porphyria, and mutational analysis confirmed the presence of a heterozygous mutation in the protoporphyrinogen oxidase gene. Despite two hepatic resections, she developed pulmonary metastases. She responded remarkably well to Sorafenib and remains in remission 16 months after treatment. A review of the literature revealed that hepatocellular carcinoma in variegate porphyria has been described in at least eight cases. Retrospective and prospective cohort studies have suggested a plausible association between hepatocellular carcinoma and acute hepatic porphyrias. Hepatic porphyrias should be considered in the differential diagnoses of hepatocellular carcinoma of uncertain aetiology. Patients with known hepatic porphyrias may benefit from periodic monitoring for this complication.
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Affiliation(s)
- Ahai Luvai
- Department of Clinical Biochemistry, St James University Hospital, Leeds, UK
| | - Wycliffe Mbagaya
- Department of Clinical Biochemistry, St James University Hospital, Leeds, UK
| | - Deepa Narayanan
- Department of Clinical Biochemistry, St James University Hospital, Leeds, UK
| | - Tim Degg
- Department of Clinical Biochemistry, St James University Hospital, Leeds, UK
| | - Giles Toogood
- Department of Hepatobiliary Surgery, St James University Hospital, Leeds, UK
| | - Judith I Wyatt
- Department of Histopathology, St James University Hospital, Leeds, UK
| | - Daniel Swinson
- Department of Oncology, St James University Hospital, Leeds, UK
| | - Claire J Hall
- Haematology Department, Harrogate District Hospital, Harrogate, UK
| | - Julian H Barth
- Department of Clinical Biochemistry, St James University Hospital, Leeds, UK
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Seligmann JF, Young AC, Abbas A, Newsham A, Cairns DA, Hall G, Seymour MT, Swinson D. Treating diabetic patients with chemotherapy: Single-center experience of toxicity and outcomes. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.9643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | - Afroze Abbas
- Department of Diabetes and Endocrinology, St James University Hospital, Leeds, United Kingdom
| | | | - David A. Cairns
- Clinical Trials Research Unit, University of Leeds, Leeds, United Kingdom
| | - Geoff Hall
- St. James's Institute of Oncology, Leeds, United Kingdom
| | | | - Daniel Swinson
- St. James's Institute of Oncology, Leeds, United Kingdom
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Ford HER, Marshall A, Bridgewater JA, Janowitz T, Coxon FY, Wadsley J, Mansoor W, Fyfe D, Madhusudan S, Middleton GW, Swinson D, Falk S, Chau I, Cunningham D, Kareclas P, Cook N, Blazeby JM, Dunn JA. Docetaxel versus active symptom control for refractory oesophagogastric adenocarcinoma (COUGAR-02): an open-label, phase 3 randomised controlled trial. Lancet Oncol 2014; 15:78-86. [DOI: 10.1016/s1470-2045(13)70549-7] [Citation(s) in RCA: 426] [Impact Index Per Article: 42.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Cook N, Marshall A, Blazeby JM, Bridgewater JA, Wadsley J, Coxon FY, Mansoor W, Madhusudan S, Falk S, Middleton GW, Swinson D, Chau I, Thompson J, Cunningham D, Kareclas P, Dunn JA, Ford H. Cougar-02: A randomized phase III study of docetaxel versus active symptom control in patients with relapsed esophago-gastric adenocarcinoma. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.4023] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [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
4023 Background: Survival in patients who relapse after first-line chemotherapy (CT) for advanced esophago-gastric adenocarcinoma (EGC) is poor though recently randomised trials (RCT) have suggested a small benefit for second line chemotherapy with taxanes or irinotecan. There is very little data on health related quality of life (HRQL) or overall survival (OS), particularly in patients who progress shortly after first-line therapy. Methods: COUGAR-02 was a multicentre open-label, phase III RCT for patients with locally advanced or metastatic EGC of performance status (PS) 0-2 who had progressed within 6 months of previous platinum/fluoropyrimidine CT. Patients were randomised (1:1) to receive either docetaxel 75mg/m2every 3 weeks for up to 6 cycles or active symptom control (ASC). The primary endpoint was OS. The secondary endpoint of HRQL, assessed using EORTC QLQ-C30 and QLQ-ST022, was analysed using standardised area under a curve and compared using Wilcoxon rank sum test. Sensitivity analysis adjusting for dropouts due to death were performed using quality adjusted survival. Results: 168 patients (84 patients in each arm) were recruited between April 2008 and April 2012. Median age was 65 years (range 28-84); 81% were males. PS at randomisation was 0 for 27%, 1 for 57% and 2 for 15%. 86% had metastatic disease. 43% progressed during previous CT, 28% progressed within 3 months of end of previous CT and 29% progressed between 3 and 6 months. Median number of cycles of docetaxel was 3. 23% completed 6 cycles. Docetaxel was well tolerated and resulted in a significantly improved OS over ASC alone (HR=0.67 (95% CI 0.49-0.92); p=0.01). Objective response rate was 7%. For QLQ-C30, patients on docetaxel arm reported significantly less pain (p=0.0008) and trend for less nausea and vomiting (p=0.02) and constipation (p=0.02) than those on ASC arm. Similar global HRQL seen (p=0.53).For QLQ-ST022, trend seen for less dysphagia (p=0.02) and pain symptoms (p=0.01) for patients on docetaxel arm than ASC Conclusions: Docetaxel provided a significant OS benefit over ASC with improvements in symptom scores and no loss in overall HRQL. Docetaxel can be considered a standard of care in this setting. Clinical trial information: NCT00978549.
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Affiliation(s)
- Natalie Cook
- Cambridge University Hospitals NHS Founsation Trust, Cambridge, United Kingdom
| | - Andrea Marshall
- Warwick Clinical Trials Unit, University of Warwick, Coventry, United Kingdom
| | | | | | | | - Fareeda Y. Coxon
- Northern Centre for Cancer Care, Newcastle Upon Tyne, United Kingdom
| | - Wasat Mansoor
- Christie Hospital NHS Foundation Trust, Manchester, United Kingdom
| | - Srinivasan Madhusudan
- School of Molecular Medical Sciences, Nottingham University Hospitals, Nottingham, United Kingdom
| | - Stephen Falk
- Bristol Haematology and Oncology Centre, Bristol, United Kingdom
| | | | | | - Ian Chau
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Joyce Thompson
- Birmingham Heart of England Foundation Trust, Birmingham, United Kingdom
| | - David Cunningham
- The Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom
| | - Paula Kareclas
- Cambridge Cancer Trials Centre, University of Cambridge, Cambridge, United Kingdom
| | - Janet A. Dunn
- Warwick Clinical Trials Unit, University of Warwick, Coventry, United Kingdom
| | - Hugo Ford
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
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Punia P, Anthoney DA, Khanom K, Swinson D. Predictive factors for outcome after biliary stenting in malignant obstructive jaundice. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.4_suppl.298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
298 Background: Stenting of the biliary treeis a common palliative procedure to relieve obstructive jaundice in advanced malignancy. Although effective in relief of biliary obstruction and subsequent palliation of symptoms, little information is available on predictive factors for survival post-procedure to better guide selection of patients. This retrospective study sought to assess factors influencing post-procedure survival in cancer patients after biliary stenting. Methods: Case notes of all patients from a regional academic cancer centre, who underwent biliary stenting for obstructive jaundice related to malignancy during 2008 and 2009, were reviewed. We collected epidemiological, biochemical, treatment (post-stenting) and survival data on all patients. Kaplan-Meyer analysis was used to assess median survival of patients from the day of first biliary stenting (adjusted for cancer types) and Cox proportional hazard model was used for univariate and multivariate analysis. Results: 194 patients were included in the final analysis. Most cases were related to pancreatic cancer or cholangiocarcinoma (89 and 46 cases each). Median survival (MS) for all the patients was 143 days. Median survival was similar, whether obstruction was secondary to the primary tumor (141cases) or metastatic disease (53 cases). In multivariate analysis serum albumin < 3.4 g/dL ( HR 1.770; 95% confidence interval 1.312 – 2.389, P < 0.001) and age > 75 years (HR 1.490; 95% confidence interval 1.086 – 2.043, p = 0.013) at the time of procedure were two independent prognostic factors predicting for a worse survival post-stenting. The 30 day mortality post-procedure in the 194 patients was 12%. Conclusions: This study suggests that stenting of the biliary tree in cases of malignant obstruction allows durable palliation of symptoms even in cases where further active chemotherapy treatment is not possible. However, the worse outcome observed in those > 75 yrs old or with low albumin at the time of procedure, identify groups with less certain benefit from this invasive procedure and requires confirming in future studies.
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Affiliation(s)
- Pankaj Punia
- St James Insitute of Oncology, Leeds, United Kingdom
| | | | | | - Daniel Swinson
- St. James's Institute of Oncology, Leeds, United Kingdom
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Ford H, Marshall A, Wadsley J, Coxon FY, Mansoor W, Bridgewater JA, Madhusudan S, Falk S, Middleton GW, Swinson D, Chau I, Thompson J, Blazeby JM, Cunningham D, Kareclas P, Dunn JA. COUGAR-02: A randomized phase III study of docetaxel versus active symptom control in advanced esophagogastric adenocarcinoma. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.4_suppl.lba4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [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
LBA4 Background: Survival in patients who relapse after first-line chemotherapy for advanced esophagogastric adenocarcinoma (OGC) is poor though recently randomized trials have suggested a small survival benefit for second-line chemotherapy with taxanes or irinotecan. There is very little data on quality of life or survival, particularly in patients who progress shortly after first-line therapy. Methods: COUGAR-02 was a multicenter open-label, randomized controlled phase III trial for patients with locally advanced or metastatic OGC of performance status (PS) 0-2 who had progressed within 6 months of previous platinum/fluoropyrimidine (PF) chemotherapy (CT). Patients were randomized (1:1) to receive either docetaxel 75mg/m2every 3 weeks for up to 6 cycles or active symptom control (ASC), which could include any treatment thought by the treating clinician to be appropriate for the management of symptoms including radiotherapy, steroids and supportive medications. The primary endpoint was overall survival. Secondary endpoints were response rate, toxicity, health related quality of life (HRQL) and healthcare resource use. Results: Between April 2008 and April 2012, 168 patients were recruited (84 patients in each arm). Median age was 65 years (range 28-84), 81% were male. PS at randomisation was 0 for 27%, 1 for 57% and 2 for 15%. Site of disease was stomach in 46%, esophagogastric junction in 34% and esophagus in 20%. 86% had metastatic disease. 43% progressed during previous CT, 28% progressed within 3 months of end of previous CT and 29% progressed between 3 and 6 months. 19 (23%) patients completed 6 CT cycles (median 3 cycles per patient). The main reasons for not completing treatment were progression and toxicity. Docetaxel significantly improved overall survival over ASC alone (median 5.2 months (95% CI 4.1-5.9 months) for docetaxel; 3.6 months (95% CI 3.3-4.4 months) for ASC, HR=0.67 (95% CI 0.49-0.92); p=0.01). 7% had a partial response and 46% had stable disease after CT. 21% on docetaxel had grade 4 toxicity. Conclusions: The addition of docetaxel to ASC significantly improved overall survival. Docetaxel can be considered a standard of care in this setting. Clinical trial information: 13366390.
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Affiliation(s)
- Hugo Ford
- Addenbrooke's Hospital, NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom
| | - Andrea Marshall
- Warwick Clinical Trials Unit, University of Warwick, Coventry, United Kingdom
| | - Jonathan Wadsley
- Department of Clinical Oncology, Weston Park Hospital, Sheffield, United Kingdom
| | - Fareeda Y. Coxon
- Northern Centre for Cancer Care, Newcastle upon Tyne, United Kingdom
| | - Wasat Mansoor
- Christie Hospital NHS Foundation Trust, Manchester, United Kingdom
| | | | - Srinivasan Madhusudan
- School of Molecular Medical Sciences, Nottingham University Hospitals, Nottingham, United Kingdom
| | | | | | | | - Ian Chau
- The Royal Marsden Hospital, Sutton, United Kingdom
| | - Joyce Thompson
- Birmingham Heartlands Hospital, Birmingham, United Kingdom
| | | | - David Cunningham
- The Royal Marsden Hospital NHS Foundation Trust, London and Surrey, United Kingdom
| | - Paula Kareclas
- Cambridge Cancer Trials Centre, Cambridge, United Kingdom
| | - Janet A. Dunn
- Warwick Clinical Trials Unit, University of Warwick, Coventry, United Kingdom
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Hall PS, Lord S, Collinson M, Marshall H, Jones M, Olivier C, Howard H, Seligman J, Swinson D, Roy R, Dent J, Cheeseman S, Last KW, Seymour MT. Three, two, or one drug chemotherapy for frail or elderly patients with advanced gastroesophageal cancer (321GO): A feasibility study. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.4_suppl.97] [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
97 Background: The median age of death from gastroesophageal (GO) cancer is 77 years. Palliative chemotherapy can improve survival and quality of life. Current standard combination regimens have been developed in trials involving patients of median age under 65 years with predominantly good performance status (PS). In light of audit and survey evidence of widespread use of arbitrarily modified chemotherapy schedules in frail and elderly patients, better evidence is needed to guide treatment. Based on our experience with the MRC FOCUS trial in colorectal cancer, 321GO aimed to test the feasibility of a randomised trial comparing chemotherapy in frail and elderly patients with advanced GO cancer. Methods: Patients with advanced GO cancer considered unfit for full-dose 3-drug chemotherapy, were randomly allocated (1:1:1) to 3, 2 or 1 drug chemotherapy at 80% dose of standard regimens with EOX: epirubicin 40mg/m2 d1, oxaliplatin 104mg/m2 d1, capecitabine 500mg/m2 bd x21d, OX: oxaliplatin 104mg/m2 d1, capecitabine 500mg/m2 bd x21d or X: capecitabine 1000mg/m2 bd d1-14, then 7 day rest. The primary endpoint for feasibility required 45 patients to be recruited over 18 months. Secondary endpoints included tolerability, treatment benefit and compliance with detailed health and quality of life (QoL) assessment. Results: 55 patients were recruited over an average of 18 months for each of the six recruiting centres; 17 to EOX, 19 to OX and 18 to X. The median age was 75. 37 (66%) patients were of WHO PS 0 or 1 and 18 (33%) were of PS 2. After 6-weeks, 12 (71%), 9 (47%) and 9 (50%) patients in the EOX, OX and X arms had experienced a treatment delay, dose reduction, grade 3 toxicity or stopped treatment. Treatment benefit (no radiological progression or clinical deterioration) at 12 weeks was seen in 8 (47%), 11 (58%) and 3 (16%) patients for EOX, OX and X respectively. Compliance with baseline health and QoL assessment was 98% at baseline and 69% at 12 weeks. Conclusions: A phase III trial randomising frail or elderly patients with advanced GO cancer to alternative chemotherapy regimens is feasible. EOX was associated with greater toxicity compared with OX; X offered no improvement in tolerability over OX.
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Affiliation(s)
- Peter S. Hall
- University of Leeds, Leeds, United Kingdom; University of Oxford, Oxford, United Kingdom; CTRU, Leeds, United Kingdom; St. James's Hospital, Leeds, United Kingdom; Castle Hill Hospital, Hull, United Kingdom; Calderdale and Huddersfield Royal Infirmary, Huddersfield, United Kingdom; Bradford Royal Infirmary, Bradford, United Kingdom; York District Hospital, York, United Kingdom
| | - Simon Lord
- University of Leeds, Leeds, United Kingdom; University of Oxford, Oxford, United Kingdom; CTRU, Leeds, United Kingdom; St. James's Hospital, Leeds, United Kingdom; Castle Hill Hospital, Hull, United Kingdom; Calderdale and Huddersfield Royal Infirmary, Huddersfield, United Kingdom; Bradford Royal Infirmary, Bradford, United Kingdom; York District Hospital, York, United Kingdom
| | - Michelle Collinson
- University of Leeds, Leeds, United Kingdom; University of Oxford, Oxford, United Kingdom; CTRU, Leeds, United Kingdom; St. James's Hospital, Leeds, United Kingdom; Castle Hill Hospital, Hull, United Kingdom; Calderdale and Huddersfield Royal Infirmary, Huddersfield, United Kingdom; Bradford Royal Infirmary, Bradford, United Kingdom; York District Hospital, York, United Kingdom
| | - Helen Marshall
- University of Leeds, Leeds, United Kingdom; University of Oxford, Oxford, United Kingdom; CTRU, Leeds, United Kingdom; St. James's Hospital, Leeds, United Kingdom; Castle Hill Hospital, Hull, United Kingdom; Calderdale and Huddersfield Royal Infirmary, Huddersfield, United Kingdom; Bradford Royal Infirmary, Bradford, United Kingdom; York District Hospital, York, United Kingdom
| | - Marc Jones
- University of Leeds, Leeds, United Kingdom; University of Oxford, Oxford, United Kingdom; CTRU, Leeds, United Kingdom; St. James's Hospital, Leeds, United Kingdom; Castle Hill Hospital, Hull, United Kingdom; Calderdale and Huddersfield Royal Infirmary, Huddersfield, United Kingdom; Bradford Royal Infirmary, Bradford, United Kingdom; York District Hospital, York, United Kingdom
| | - Catherine Olivier
- University of Leeds, Leeds, United Kingdom; University of Oxford, Oxford, United Kingdom; CTRU, Leeds, United Kingdom; St. James's Hospital, Leeds, United Kingdom; Castle Hill Hospital, Hull, United Kingdom; Calderdale and Huddersfield Royal Infirmary, Huddersfield, United Kingdom; Bradford Royal Infirmary, Bradford, United Kingdom; York District Hospital, York, United Kingdom
| | - Helen Howard
- University of Leeds, Leeds, United Kingdom; University of Oxford, Oxford, United Kingdom; CTRU, Leeds, United Kingdom; St. James's Hospital, Leeds, United Kingdom; Castle Hill Hospital, Hull, United Kingdom; Calderdale and Huddersfield Royal Infirmary, Huddersfield, United Kingdom; Bradford Royal Infirmary, Bradford, United Kingdom; York District Hospital, York, United Kingdom
| | - Jenny Seligman
- University of Leeds, Leeds, United Kingdom; University of Oxford, Oxford, United Kingdom; CTRU, Leeds, United Kingdom; St. James's Hospital, Leeds, United Kingdom; Castle Hill Hospital, Hull, United Kingdom; Calderdale and Huddersfield Royal Infirmary, Huddersfield, United Kingdom; Bradford Royal Infirmary, Bradford, United Kingdom; York District Hospital, York, United Kingdom
| | - Daniel Swinson
- University of Leeds, Leeds, United Kingdom; University of Oxford, Oxford, United Kingdom; CTRU, Leeds, United Kingdom; St. James's Hospital, Leeds, United Kingdom; Castle Hill Hospital, Hull, United Kingdom; Calderdale and Huddersfield Royal Infirmary, Huddersfield, United Kingdom; Bradford Royal Infirmary, Bradford, United Kingdom; York District Hospital, York, United Kingdom
| | - Rajarshi Roy
- University of Leeds, Leeds, United Kingdom; University of Oxford, Oxford, United Kingdom; CTRU, Leeds, United Kingdom; St. James's Hospital, Leeds, United Kingdom; Castle Hill Hospital, Hull, United Kingdom; Calderdale and Huddersfield Royal Infirmary, Huddersfield, United Kingdom; Bradford Royal Infirmary, Bradford, United Kingdom; York District Hospital, York, United Kingdom
| | - Jo Dent
- University of Leeds, Leeds, United Kingdom; University of Oxford, Oxford, United Kingdom; CTRU, Leeds, United Kingdom; St. James's Hospital, Leeds, United Kingdom; Castle Hill Hospital, Hull, United Kingdom; Calderdale and Huddersfield Royal Infirmary, Huddersfield, United Kingdom; Bradford Royal Infirmary, Bradford, United Kingdom; York District Hospital, York, United Kingdom
| | - Sue Cheeseman
- University of Leeds, Leeds, United Kingdom; University of Oxford, Oxford, United Kingdom; CTRU, Leeds, United Kingdom; St. James's Hospital, Leeds, United Kingdom; Castle Hill Hospital, Hull, United Kingdom; Calderdale and Huddersfield Royal Infirmary, Huddersfield, United Kingdom; Bradford Royal Infirmary, Bradford, United Kingdom; York District Hospital, York, United Kingdom
| | - Kim William Last
- University of Leeds, Leeds, United Kingdom; University of Oxford, Oxford, United Kingdom; CTRU, Leeds, United Kingdom; St. James's Hospital, Leeds, United Kingdom; Castle Hill Hospital, Hull, United Kingdom; Calderdale and Huddersfield Royal Infirmary, Huddersfield, United Kingdom; Bradford Royal Infirmary, Bradford, United Kingdom; York District Hospital, York, United Kingdom
| | - Matthew T. Seymour
- University of Leeds, Leeds, United Kingdom; University of Oxford, Oxford, United Kingdom; CTRU, Leeds, United Kingdom; St. James's Hospital, Leeds, United Kingdom; Castle Hill Hospital, Hull, United Kingdom; Calderdale and Huddersfield Royal Infirmary, Huddersfield, United Kingdom; Bradford Royal Infirmary, Bradford, United Kingdom; York District Hospital, York, United Kingdom
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Chau I, Okines AFC, Gonzalez de Castro D, Saffery C, Barbachano Y, Wotherspoon A, Puckey L, Hulkki Wilson S, Coxon FY, Middleton GW, Ferry DR, Crosby TDL, Madhusudan S, Wadsley J, Waters JS, Hall M, Swinson D, Robinson A, Smith D, Cunningham D. REAL3: A multicenter randomized phase II/III trial of epirubicin, oxaliplatin, and capecitabine (EOC) versus modified (m) EOC plus panitumumab (P) in advanced oesophagogastric (OG) cancer—Response rate (RR), toxicity, and molecular analysis from phase II. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.4131] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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37
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Szyldergemajn SA, Gonçalves A, Metges JP, Gunzer K, Montagut C, Salazar R, Alsina M, Evans TRJ, Swinson D, Petty RD, Singer H, Kahatt CM. IMAGE, a randomized phase Ib/II study of elisidepsin in pretreated advanced gastroesophageal cancer. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.tps169] [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: 11/20/2022] Open
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38
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Donnelly O, Jones J, Carey B, Swinson D, Radhakrishna G. PO-05 Incidental pulmonary emboli in cancer patients – a single centre experience. Thromb Res 2010. [DOI: 10.1016/s0049-3848(10)70055-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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39
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Hussain S, Palmer D, Swinson D, Riley P, Wills A, Brown C, Draycott C, El-Modir A, Peake D, Rea D, Chetiyawardana A, Cullen M. A phase II clinical trial of gemcitabine and split dose cisplatin in advanced non-small cell lung cancer in an outpatient setting. Oncol Rep 2008. [DOI: 10.3892/or.20.1.233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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40
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Swinson D, Williams S, Beddard K, Price L, Reaper L, Cullen MH, Ferry DR. Phase II trial of first-line gefitinib in patients unsuitable for chemotherapy with stage III/IV non-small-cell lung cancer. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.7256] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- D. Swinson
- New Cross Hosp, Wolverhampton, United Kingdom
| | - S. Williams
- New Cross Hosp, Wolverhampton, United Kingdom
| | - K. Beddard
- New Cross Hosp, Wolverhampton, United Kingdom
| | - L. Price
- New Cross Hosp, Wolverhampton, United Kingdom
| | - L. Reaper
- New Cross Hosp, Wolverhampton, United Kingdom
| | | | - D. R. Ferry
- New Cross Hosp, Wolverhampton, United Kingdom
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41
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Martin-Ucar AE, Waller DA, Atkins JL, Swinson D, O'Byrne KJ, Peake MD. The beneficial effects of specialist thoracic surgery on the resection rate for non-small-cell lung cancer. Lung Cancer 2004; 46:227-32. [PMID: 15474671 DOI: 10.1016/j.lungcan.2004.03.010] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2003] [Revised: 03/17/2004] [Accepted: 03/23/2004] [Indexed: 11/16/2022]
Abstract
We aimed to evaluate the effect of the appointment of a dedicated specialist thoracic surgeon on surgical practice for lung cancer previously served by cardio-thoracic surgeons. Outcomes were compared for the 240 patients undergoing surgical resection for lung cancer in two distinct 3-year periods: Group A: 65 patients, 1994-1996 (pre-specialist); Group B: 175 patients, 1997-1999 (post-specialist). The changes implemented resulted in a significant increase in resection rate (from 12.2 to 23.4%, P < 0.001), operations in the elderly (over 75 years) and extended resections. There were no significant differences in stage distribution, in-hospital mortality or stage-specific survival after surgery. Lung cancer surgery provided by specialists within a multidisciplinary team resulted in increased surgical resection rates without compromising outcome. Our results strengthen the case for disease-specific specialists in the treatment of lung cancer.
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Affiliation(s)
- Antonio E Martin-Ucar
- Department of Thoracic Surgery, Glenfield Hospital, Groby Road, Leicester, LE3 9QP, UK
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42
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O'Byrne KJ, Cox G, Swinson D, Richardson D, Edwards JG, Lolljee J, Andi A, Koukourakis MI, Giatromanolaki A, Gatter K, Harris AL, Waller D, Jones JL. Towards a biological staging model for operable non-small cell lung cancer. Lung Cancer 2001; 34 Suppl 2:S83-9. [PMID: 11720747 DOI: 10.1016/s0169-5002(01)00352-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Non-small cell lung cancer is the most common cause of cancer-related death in North America and Europe. Despite improvements in the diagnosis and treatment of the disease the prognosis remains poor, the overall 5-year survival being 4-14%. An increased understanding of the molecular biology of the disease may identify novel targets for drug development. We evaluated epidermal growth factor receptor (EGFR), HER-2/neu, matrix metalloproteinase (MMP)-2, MMP-9, p53 and bcl-2 expression and microvessel density (MVD) in patients who underwent surgery with curative intent in our department between 1991 and 1996. Co-expression of EGFR/MMP-9, MVD and bcl-2 were found to be independent prognostic variables, which allowed prediction of patient outcome independent of surgical stage. Other prognostic factors identified in our series were gender, surgical stage, platelet count, extent of necrosis, the hypoxia marker carbonic anhydrase-9 and beta-catenin. In collaboration with groups in Oxford and Greece, we were also able to establish the angiogenic growth factors vascular endothelial growth factor and platelet-derived endothelial growth factor as prognostic variables. The inter-relationships between these factors are currently being examined in an expanded patient series. Through this work we hope to be able to construct an integrated biological prognostic model which can be tested in prospective studies. This work has identified several potential targets for novel therapeutic agents currently in development.
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Affiliation(s)
- K J O'Byrne
- Thoracic Oncology Research Group, Institute of Cancer Studies and Institute of Lung Health, Leicester, UK.
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43
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Swinson D, Richardson D, Edwards J, Jones J, O'Byrne K. Tumour necrosis as an independent prognostic marker in non-small cell lung cancer. Eur J Cancer 2001. [DOI: 10.1016/s0959-8049(01)80673-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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44
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Hillarby MC, McMahon MJ, Grennan DM, Cooper RG, Clarkson RW, Davies EJ, Sanders PA, Chattopadhyay C, Swinson D. HLA associations in subjects with rheumatoid arthritis and bronchiectasis but not with other pulmonary complications of rheumatoid disease. Br J Rheumatol 1993; 32:794-7. [PMID: 8369890 DOI: 10.1093/rheumatology/32.9.794] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
We have examined HLA-DR, DQA and DQB variants in 72 controls, 153 subjects with RA without extra-articular features and in subjects with the rheumatoid pulmonary complications of interstitial fibrosis (23) peripheral airways disease (13) and in 41 subjects with RA and bronchiectasis. Subjects with RA alone showed the expected association with HLA-DR4 (79%) but those with RA and co-existent pulmonary fibrosis were less likely to be DR4 positive (61%). No other HLA-DR variants were significantly increased in the different disease groups. HLA-DQB1*0501 which types serologically as DQw1 was increased in subjects with RA and peripheral airways disease as compared to rheumatoid subjects with normal lung function, but these differences were not statistically significant. DQB1*0601 was increased in subjects with bronchiectasis with or without RA (but only significantly so in RA-BR subjects) DQB1*0301, DQB1*0201 and DQA1*0501 frequencies were also increased in subjects with RA and bronchiectasis as compared to those with RA alone.
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Affiliation(s)
- M C Hillarby
- University of Manchester, Rheumatic Diseases Centre, Hope Hospital, Salford
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45
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Ansell BM, Hall MA, Loftus JK, Woo P, Neumann V, Harvey A, Sills JA, Swinson D, Insley J, Amos R. A multicentre pilot study of sulphasalazine in juvenile chronic arthritis. Clin Exp Rheumatol 1991; 9:201-3. [PMID: 1676352] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
In this multicentre pilot study of sulphasalazine in juvenile chronic arthritis, the mode of onset and course of the disease, and when available, the HLA status, was recorded on the entry form. After appropriate clinical and laboratory appraisal, sulphasalazine up to 40 mg/kg/day was given for one year with assessments at 0, 1, 3, 6, 9 and 12 months. Fifty-one patients enrolled, 8 of whom were withdrawn because of side effects. In the remainder by 12 months a good effect was noted in 12, 8 having pauci-articular onset disease commencing after the age of 9 years, of whom 6 carried HLA B27. It was relatively ineffective in the other subgroups. The frequency and severity of side effects was similar to that seen in adults. Further evaluation in controlled trials is required in older onset pauci-articular arthritis, taking due note of the patient's HLA status, and also in juvenile psoriatic arthritis and seropositive juvenile rheumatoid arthritis.
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Affiliation(s)
- B M Ansell
- Clinical Research Center, Middlesex, U.K
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46
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Lewis D, Gupta I, Torry JM, Issa BG, Swinson D. Eosinophilic fasciitis without peripheral eosinophilia presenting as pyrexia of unknown origin. Br J Rheumatol 1990; 29:147-9. [PMID: 1969758 DOI: 10.1093/rheumatology/29.2.147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Eosinophilic fasciitis is a syndrome usually characterized by limb and joint pain, a raised sedimentation rate, hypergammaglobulinaemia, subcutaneous fasciitis and peripheral as well as tissue eosinophilia. We present a case with a positive tissue diagnosis, but who presented predominantly with marked nocturnal sweating and pyrexia.
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Affiliation(s)
- D Lewis
- Leigh Infirmary, Medical Department
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47
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Swinson D. Antidepressant therapy and rheumatoid arthritis. J Rheumatol Suppl 1990; 17:277. [PMID: 2319534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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48
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Abstract
A double-blind cross-over study of 35 out-patients with rheumatoid arthritis showed that Naproxen and Indomethacin suppositories were both effective forms of treatment in rheumatoid arthritis, both being significantly superior to placebo in terms of relief of morning stiffness.
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