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Vasiliadou I, Grose D, Wilson C, Thapa A, Donnelly O, Lee E, Leslie I, Karim M, Hartley A, Partridge S, Medlow K, De Boisanger J, Metcalf R, Williamson A, Haridass A, Noble D, Mactier K, Walter H, Ma N, De Winton E, Cohen J, Rayner L, Geropantas K, Jankowska P, Mason J, Moleron R, Laws K, Ulahannan D, Nallathambi C, Michaelidou A, Nallamilli S, Raouf S, Palmer K, Bienz M, Karet T, Khalique S, Paterson C, Harrington K, Bhide S, Kong A. The use of pembrolizumab monotherapy for the management of head and neck squamous cell carcinoma (HNSCC) in the UK. Int J Cancer 2024. [PMID: 38685816 DOI: 10.1002/ijc.34963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 01/01/2024] [Accepted: 01/11/2024] [Indexed: 05/02/2024]
Abstract
Pembrolizumab has received approval in the UK as first-line monotherapy for recurrent and/or metastatic HNSCC (R/M HNSCC) following the results of the KEYNOTE-048 trial, which demonstrated a longer overall survival (OS) in comparison to the EXTREME chemotherapy regimen in patients with a combined positive score (CPS) ≥1. In this article, we provide retrospective real-world data on the role of pembrolizumab monotherapy as first-line systemic therapy for HNSCC across 18 centers in the UK from March 20, 2020 to May 31, 2021. 211 patients were included, and in the efficacy analysis, the objective response rate (ORR) was 24.7%, the median progression-free survival (PFS) was 4.8 months (95% confidence interval [CI]: 3.6-6.1), and the median OS was 10.8 months (95% CI 9.0-12.5). Pembrolizumab monotherapy was well tolerated, with 18 patients having to stop treatment owing to immune-related adverse events (irAEs). 53 patients proceeded to second-line treatment with a median PFS2 of 10.2 months (95% CI: 8.8-11.5). Moreover, patients with documented irAEs had a statistically significant longer median PFS (11.3 vs. 3.3 months; log-rank p value = <.001) and median OS (18.8 vs. 8.9 months; log-rank p value <.001). The efficacy and safety of pembrolizumab first-line monotherapy for HNSCC has been validated using real-world data.
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Affiliation(s)
- Ifigenia Vasiliadou
- Guy's and St. Thomas NHS Foundation Trust, London, UK
- King's College London, London, UK
| | - Derek Grose
- Beatson West of Scotland Cancer Centre, Glasgow, UK
| | | | - Alekh Thapa
- Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - Olly Donnelly
- Portsmouth Hospitals NHS Trust, Portsmouth, Hampshire, UK
| | - Elsa Lee
- Guy's and St. Thomas NHS Foundation Trust, London, UK
- King's College London, London, UK
| | - Isla Leslie
- Royal Marsden NHS Foundation Trust, London, UK
| | | | | | - Sarah Partridge
- Imperial College Healthcare NHS Trust-Charing Cross Hospital, London, UK
| | - Katharine Medlow
- Imperial College Healthcare NHS Trust-Charing Cross Hospital, London, UK
| | - James De Boisanger
- Imperial College Healthcare NHS Trust-Charing Cross Hospital, London, UK
| | | | | | | | | | | | | | - Ning Ma
- University Hospitals of Leicester, Leicester, UK
| | - Emma De Winton
- Royal United Hospitals Bath-NHS Foundation trust, Bath, UK
| | - Jennifer Cohen
- Royal United Hospitals Bath-NHS Foundation trust, Bath, UK
| | - Lindsay Rayner
- Royal United Hospitals Bath-NHS Foundation trust, Bath, UK
| | | | - Petra Jankowska
- Musgrove Park Hospital-Taunton and Somerset NHS Foundation Trust, Taunton, UK
| | - Jessica Mason
- Musgrove Park Hospital-Taunton and Somerset NHS Foundation Trust, Taunton, UK
| | | | - Kirsten Laws
- Aberdeen Royal Infirmary-NHS Grampian, Aberdeen, UK
| | | | | | | | - Susanna Nallamilli
- Maidstone Hospital-Tunbridge Wells Hospital-NHS Trust, Tunbridge Wells, UK
| | - Sherif Raouf
- St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Kieran Palmer
- King's College London, London, UK
- St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | | | | | | | | | - Kevin Harrington
- Royal Marsden NHS Foundation Trust, London, UK
- The Institute of Cancer Research, London, UK
| | - Shreerang Bhide
- Royal Marsden NHS Foundation Trust, London, UK
- The Institute of Cancer Research, London, UK
| | - Anthony Kong
- Guy's and St. Thomas NHS Foundation Trust, London, UK
- King's College London, London, UK
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Gaffney J, Ramzan A, Dinizulu T, Maley C, Onamusi O, Motamedi-Ghahfarokhi G, Price G, Metcalf R, Garcez K, Hughes C, Lee L, Thomson D, Price J, Jain Y, McPartlin A. Association of follow-up imaging frequency with temporal incidence and patterns of distant failure following (chemo) radiotherapy for HPV related oropharyngeal cancer. Oral Oncol 2024; 148:106645. [PMID: 37992488 DOI: 10.1016/j.oraloncology.2023.106645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 11/17/2023] [Accepted: 11/19/2023] [Indexed: 11/24/2023]
Abstract
OBJECTIVES Emerging data supports radical intent therapy for oligometastatic (OM) relapsed human papilloma virus (HPV+) related oropharyngeal cancer (OPC). We assess the association of follow-up imaging frequency amongst HPV + OPC, with temporal and spatial patterns of distant relapse, to inform rationalisation of routine post-treatment imaging. MATERIALS AND METHODS A retrospective single centre cohort study was carried out of consecutive HPV + OPC patients treated with radical intent (chemo)radiotherapy ((CT)RT) between 2011 and 2019. OM state was defined as ≤ 5 metastasis, none larger than 3 cm (OMs) or, if interval from last negative surveillance imaging > 6-months, then ≤ 10 metastasis, none larger than 5 cm, (OMp). Patients not meeting OMs / OMp criteria were deemed to have incurable diffuse metastatic disease (DMdiffuse). RESULTS 793 HPV-OPC patients were identified with median follow-up 3.15years (range 0.2-8.9). 52 (6.6 %) patients had radiologically identified DM at first failure and were considered for analysis. The median time to recurrence was 15.1 months (range: 2.6-63 months). 87 % of distant metastasis (DM) occurred in the first two years after treatment. Twenty-seven (52 %) patients had OM (OMs or OMp) at time of failure, with 31 % having OMs. The median time from completion of treatment to diagnosis of DMdiffuse vs OM was 22.2 months (range: 2.6-63.1 months) vs 11.6 months (range: 3.5-32.5 months). The probability of being diagnosed with OM vs DMdiffuse increased with reducing interval from last negative surveillance scan to imaging identifying DM (≤6 months 88.9 %, 7-12 months 71.4 %, 13-24 months 35 %, > 24 months 22.2 %). CONCLUSION We demonstrate that a reduced interval between last negative imaging and subsequent radiological diagnosis of DM is associated with increased likelihood of identification of OM disease. Consideration of increased frequency of surveillance imaging during the first two years of follow up is supported, particularly for patients at high risk of distant failure.
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Affiliation(s)
- John Gaffney
- The Christie NHS Foundation Trust, Manchester, UK.
| | | | | | | | | | | | - Gareth Price
- The Christie NHS Foundation Trust, Manchester, UK; The University of Manchester, Manchester, UK
| | | | - Kate Garcez
- The Christie NHS Foundation Trust, Manchester, UK
| | | | - Lip Lee
- The Christie NHS Foundation Trust, Manchester, UK
| | | | - James Price
- The Christie NHS Foundation Trust, Manchester, UK; The University of Manchester, Manchester, UK
| | - Yatin Jain
- The Christie NHS Foundation Trust, Manchester, UK
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Patel K, Manzo M, Hapuarachi B, Rack S, Jermann P, Feeney L, Heathcote E, Betts G, Aster JC, Murone M, Bobadilla M, Lehal R, Vogl FD, Harrington K, Metcalf R. Gene expression patterns in adenoid cystic carcinoma with and without diffuse NOTCH1 intracellular domain (NICD1) immunohistochemistry staining. Oral Oncol 2023; 146:106542. [PMID: 37619521 DOI: 10.1016/j.oraloncology.2023.106542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 08/08/2023] [Indexed: 08/26/2023]
Affiliation(s)
- Karan Patel
- The Christie NHS Foundation Trust, Wilmslow Road, Manchester M20 4BX, UK
| | - Massimiliano Manzo
- Institute of Medical Genetics and Pathology, University Hospital Basel, Schönbeinstrasse 40, 4056 Basel, Switzerland
| | - Brindley Hapuarachi
- Weston Park Cancer Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Samuel Rack
- The Christie NHS Foundation Trust, Wilmslow Road, Manchester M20 4BX, UK
| | - Philip Jermann
- Institute of Medical Genetics and Pathology, University Hospital Basel, Schönbeinstrasse 40, 4056 Basel, Switzerland
| | | | - Emily Heathcote
- The Christie NHS Foundation Trust, Wilmslow Road, Manchester M20 4BX, UK
| | - Guy Betts
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Jon C Aster
- Harvard Medical School and Brigham and Women's Hospital, Boston, MA, USA
| | | | | | | | | | - Kevin Harrington
- The Royal Marsden NHS Foundation Trust, Clyde Road, Wallington, London SM6, UK
| | - Robert Metcalf
- The Christie NHS Foundation Trust, Wilmslow Road, Manchester M20 4BX, UK.
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Gogate A, Bennett B, Poonja Z, Stewart G, Medina Colmenero A, Szturz P, Carrington C, Castro C, Gemmen E, Lau A, Carral Maseda A, Winquist E, Arrazubi V, Hao D, Cook A, Martinez Galan J, Ugidos L, Fernández Garay D, Gutierrez Abad D, Metcalf R. Phase 4 Multinational Multicenter Retrospective and Prospective Real-World Study of Nivolumab in Recurrent and Metastatic Squamous Cell Carcinoma of the Head and Neck. Cancers (Basel) 2023; 15:3552. [PMID: 37509217 PMCID: PMC10377225 DOI: 10.3390/cancers15143552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 06/13/2023] [Accepted: 06/28/2023] [Indexed: 07/30/2023] Open
Abstract
This study examined the real-world use of nivolumab in patients with recurrent/metastatic squamous cell carcinoma of the head and neck (R/M SCCHN). This was a multinational retrospective study (VOLUME) assessing treatment effectiveness and safety outcomes and a prospective study (VOLUME-PRO) assessing HRQoL and patient-reported symptoms. There were 447 and 51 patients in VOLUME and VOLUME-PRO, respectively. Across both studies, the median age was 64.0 years, 80.9% were male, and 52.6% were former smokers. Clinical outcomes of interest included real-world overall survival (rwOS) and real-world progression-free survival (rwPFS). The median rwOS was 9.2 months. Among patients with at least one assessment, 21.7% reported their best response as 'partial response', with 3.9% reporting 'complete response'. The median duration of response (DoR) and median rwPFS were 11.0 months and 3.9 months, respectively. At baseline, VOLUME-PRO patients reported difficulties relating to fatigue, physical and sexual functioning, dyspnea, nausea, sticky saliva, dry mouth, pain/discomfort, mobility, and financial difficulties. There were improvements in social functioning and financial difficulties throughout the study; however, no other clinically meaningful changes were noted. No new safety concerns were identified. This real-world, multinational, multicenter, retrospective and prospective study supports the effectiveness and safety of nivolumab for R/M SCCHN patients.
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Affiliation(s)
| | | | - Zia Poonja
- BC Cancer, University of British Columbia, Victoria, BC V8R 6V5, Canada
| | - Grant Stewart
- Royal Cornwall Hospital NHS Trust, Truro TR1 3LJ, UK
| | | | - Petr Szturz
- Department of Oncology, University of Lausanne (UNIL), Lausanne University Hospital (CHUV), 1011 Lausanne, Switzerland
| | | | | | | | | | | | - Eric Winquist
- Department of Oncology, London Health Sciences Centre, Western University, London, ON N6A 5W9, Canada
| | - Virginia Arrazubi
- Oncology, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Hospital Universitario de Navarra, 31008 Pamplona, Spain
| | - Desiree Hao
- Thoracic and Head & Neck Oncology, Tom Baker Cancer Centre, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N2, Canada
| | - Audrey Cook
- Cheltenham General Hospital, Cheltenham GL53 0BG, UK
| | - Joaquina Martinez Galan
- Instituto de Investigación Biosanitaria, Hospital Universitario Virgen Nieves, 18014 Granada, Spain
| | - Lisardo Ugidos
- Oncology, Hospital Universitario HM Madrid Sanchinarro, 28050 Madrid, Spain
| | | | | | - Robert Metcalf
- The Christie NHS Foundation Trust, Manchester M20 4BX, UK
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Kinloch E, Metcalf R. 41P Addressing the unmet need for salivary gland cancers in the UK and beyond. ESMO Open 2023. [DOI: 10.1016/j.esmoop.2023.101062] [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: 04/05/2023] Open
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Pisaniello HL, Whittle SL, Lester S, Menz F, Metcalf R, McWilliams L, Hill CL, Proudman S. Using the derived 28-joint disease activity score patient-reported components (DAS28-P) index as a discriminatory measure of response to disease-modifying anti-rheumatic drug therapy in early rheumatoid arthritis. BMC Rheumatol 2022; 6:67. [PMCID: PMC9664777 DOI: 10.1186/s41927-022-00299-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 07/07/2022] [Indexed: 11/16/2022] Open
Abstract
Abstract
Background
The 28-joint disease activity score (DAS28) is a widely used measure to assess disease activity in rheumatoid arthritis (RA). The DAS28-P index, a derived proportion of the patient-reported components (joint tenderness and patient global assessment) within the DAS28, has been utilized as a discriminatory measure of non-inflammatory pain mechanisms in RA. This study aimed to evaluate the use of the DAS28-P index as a predictor of treatment response in early RA.
Methods
Patients with early RA enrolled in a supplemental fish oil clinical trial received a combination of disease-modifying anti-rheumatic drugs (DMARDs) according to a ‘treat-to-target’ protocol. First, consecutive measures of the DAS28-P index, derived from the DAS28-erythrocyte sedimentation rate (DAS28-ESR), at each visit over a 1-year period were estimated for each patient. Then, distinct subgroups of treatment responders based on the trajectories of the DAS28-P indices were identified using bivariate k-means cluster analysis. Data on baseline predictors as well as longitudinal outcomes of disease impact and DMARD use over a 1-year period and radiographic progression over a 3-year period were collected and analyzed using a random intercept, population-averaged generalized estimating equation model.
Results
121 patients were included (74% female; mean age of 57; median of 16 weeks of active disease) and a 3-cluster model was identified—the ‘Responders’ group (n = 58; 48%), the ‘Partial Responders’ group (n = 32; 26%), and the ‘Non-Responders’ group (n = 31; 26%). The ‘Partial Responders’ group had consistently higher proportions of the DAS28-P index throughout the study period and had minimal radiographic progression over time, with the lowest joint erosion score of 0.9 [95% confidence interval (CI) 0.2, 1.6], observed at the 3-year follow-up. At 52 weeks, the methotrexate dose was higher for both ‘Partial Responders’ and ‘Non-Responders’ groups (18.5 mg [95% CI 15.5, 21.5] and 18.6 mg [95% CI 15.3, 21.8] respectively), when compared with the ‘Responders’ group (12.8 mg [95% CI 14.7, 20.9]).
Conclusions
Persistently high DAS28-P index scores are useful to distinguish poor patient global assessment and excessive treatment escalation in early RA, suggestive of underlying non-inflammatory pain contributing to higher disease activity score. Early identification of patients with discordant subjective and objective components of composite disease activity measures may allow better tailoring of treatment in RA.
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Feeney L, Hapuarachi B, Adderley H, Rack S, Morgan D, Walker R, Rauch R, Herz E, Kaye J, Harrington K, Metcalf R. Clinical disease course and survival outcomes following disease recurrence in adenoid cystic carcinoma with and without NOTCH signaling pathway activation. Oral Oncol 2022; 133:106028. [PMID: 35952580 DOI: 10.1016/j.oraloncology.2022.106028] [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: 03/01/2022] [Revised: 06/28/2022] [Accepted: 07/15/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Adenoid cystic carcinoma (ACC) is a rare salivary cancer. The highest rates of disease recurrence are in patients with NOTCH pathway activation, reported in up to 20%. Novel drugs targeting NOTCH signaling are under investigation in the recurrent/metastatic (R/M) setting. To understand their clinical utility, there is an urgent need to better characterize the disease course and outcomes following current standard of care treatment. METHODS 120 patients with R/M ACC underwent clinical review at a single UK Cancer Centre. Patients were retrospectively assessed for tumor NOTCH pathway activation using next generation sequencing (NGS) targeting NOTCH1/2/3 genes and/or NOTCH1 intra-cellular domain (NICD1) immunohistochemistry. Demographic and treatment data were extracted from the clinical notes. Kaplan-Meier survival analysis was performed using log rank test. RESULTS NOTCH pathway activation was identified in 13/120 patients (11 %). In 12/101 patients analyzed by NGS, NOTCH1/3 activating somatic mutations were identified, and a further patient was identified with NICD1 diffuse nuclear staining in whom NGS testing was not possible. Patients with NOTCH pathway activation had shorter median RFS (1.1 vs 3.4 years, p = 0.2032) and significantly reduced median OS from diagnosis (4.0 vs 16.3 years, p < 0.0001). There was significantly reduced median OS from time of disease recurrence/metastasis (1.9 vs 9.6 years, p < 0.0001). CONCLUSION This study clearly demonstrates a reduction in OS from time of first confirmed disease recurrence/metastasis for patients with NOTCH pathway activated ACC. This provides support for developing new drugs for this sub-group of patients, for whom clinical outcomes are significantly worse and effective treatments are lacking.
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Affiliation(s)
- Laura Feeney
- The Christie NHS Foundation Trust, Wilmslow Road, Manchester M20 4BX, UK
| | | | - Helen Adderley
- The Christie NHS Foundation Trust, Wilmslow Road, Manchester M20 4BX, UK
| | - Sam Rack
- The Christie NHS Foundation Trust, Wilmslow Road, Manchester M20 4BX, UK
| | - David Morgan
- The University of Manchester, Oxford Road, Manchester, M13 9PL, UK
| | - Russell Walker
- Ayala Pharmaceuticals, 4 Oppenheimer Street, Rehovot 7670104, Israel
| | - Rami Rauch
- Ayala Pharmaceuticals, 4 Oppenheimer Street, Rehovot 7670104, Israel
| | - Elad Herz
- Ayala Pharmaceuticals, 4 Oppenheimer Street, Rehovot 7670104, Israel
| | - Joel Kaye
- Ayala Pharmaceuticals, 4 Oppenheimer Street, Rehovot 7670104, Israel
| | - Kevin Harrington
- The Royal Marsden NHS Foundation Trust, Clyde Road, Wallington, London SM6, UK
| | - Robert Metcalf
- The Christie NHS Foundation Trust, Wilmslow Road, Manchester M20 4BX, UK.
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Beresford L, Murphy P, Dias S, Claxton L, Walton M, Metcalf R, Schlecht H, Ottensmeier C, Pereira M, Hodgson R. Appraising the Costs of Genomic Testing for Histology-Independent Technologies: An Illustrative Example for NTRK Fusions. Value Health 2022; 25:1133-1140. [PMID: 35779940 DOI: 10.1016/j.jval.2021.11.1359] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 11/04/2021] [Accepted: 11/14/2021] [Indexed: 06/15/2023]
Abstract
OBJECTIVES Histology-independent (HI) technologies are authorized for patients with advanced or metastatic cancer if they express a particular biomarker regardless of its position in the body. Although this represents an important advancement in cancer treatment, genomic testing to identify eligible individuals for HI technologies will require substantial investment and impact their cost-effectiveness. Estimating these costs is complicated by several issues, which affect not only the overall cost of testing but also the distribution of testing costs across tumor types. METHODS Key issues that should be considered when evaluating the cost of genomic testing to identify those eligible for HI technologies are discussed. These issues are explored in illustrative analyses where costs of genomic testing for NTRK fusions in England for recently approved HI technologies are estimated. RESULTS The prevalence of mutation, testing strategy adopted, and current testing provision affect the cost of identifying eligible patients. The illustrative analysis estimated the cost of RNA-based next-generation sequencing to identify 1 individual with an NTRK fusion ranged between £377 and £282 258. To improve cost-effectiveness, testing costs could be shared across multiple technologies. An estimated additional ∼4000 patients would need to be treated with other HI therapies for testing in patients with advanced or metastatic cancer to be cost-effective. CONCLUSIONS The cost of testing to identify individuals eligible for HI technologies affect the drug's cost-effectiveness. The cost of testing across tumor types varies owing to heterogeneity in the mutation's prevalence and current testing provision. The cost-effectiveness of HI technologies may be improved if testing costs could be shared across multiple agents.
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Affiliation(s)
- Lucy Beresford
- Centre for Reviews and Dissemination, University of York, York, England, UK.
| | - Peter Murphy
- Centre for Reviews and Dissemination, University of York, York, England, UK; Centre for Health Economics, University of York, UK
| | - Sofia Dias
- Centre for Reviews and Dissemination, University of York, York, England, UK
| | | | - Matthew Walton
- Centre for Reviews and Dissemination, University of York, York, England, UK
| | - Robert Metcalf
- Medical Oncology, The Christie Hospital, Manchester, England, UK
| | - Helene Schlecht
- Genomic Diagnostic Laboratory, Manchester Centre for Genomic Medicine, Manchester, England, UK
| | - Christian Ottensmeier
- Department of Molecular & Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | - Marta Pereira
- Genomic Diagnostic Laboratory, Manchester Centre for Genomic Medicine, Manchester, England, UK
| | - Robert Hodgson
- Centre for Reviews and Dissemination, University of York, York, England, UK
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Khera R, Feeney L, Swinton M, Rack S, Sykes A, Metcalf R. Durable complete response rates following radiotherapy and immunotherapy combination in recurrent and metastatic head and neck squamous cell carcinoma: A retrospective single centre cohort study. Clin Otolaryngol 2022; 47:606-610. [PMID: 35737806 PMCID: PMC10084086 DOI: 10.1111/coa.13954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 04/25/2022] [Accepted: 05/14/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Raj Khera
- The Christie NHS Foundation Trust, Manchester, UK.,The University of Birmingham, Birmingham, UK
| | - Laura Feeney
- The Christie NHS Foundation Trust, Manchester, UK.,Queens University Belfast, Belfast, UK
| | | | - Sam Rack
- The Christie NHS Foundation Trust, Manchester, UK
| | - Andrew Sykes
- The Christie NHS Foundation Trust, Manchester, UK
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Rack S, Feeney L, Mistry H, Betts G, Harrington KJ, Metcalf R. The prevalence and prognostic impact of mutations promoting chromatin remodelling dysregulation in non-resectable or recurrent/metastatic adenoid cystic carcinoma. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.6087] [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
6087 Background: Few effective drug therapies exist for patients with recurrent/metastatic (R/M) adenoid cystic carcinoma (ACC). Mutations in genes encoding chromatin remodelling proteins are described in almost 50% of ACC patients (pts). Novel drug therapies are being developed to target these pathways, and may have clinical utility in this sub-group. We sought to classify mutations in chromatin remodelling genes in ACC based on predicted pathogenicity and to determine the impact of chromatin remodelling dysregulation (CRD) on clinical outcomes. Methods: Matched clinical-genomic data from 269 pts with non-resectable or R/M ACC were included in this study. 130 pts were prospectively recruited to an ethically approved study. For these pts, DNA extracted from FFPE tissue was sequenced on a commercially available platform to detect point mutations, indels and copy number variation in 324 genes. In addition, clinical-genomic data from 139 ACC pts were collected from cBioPortal (MetTropism, Cell 2021) for analysis. Mutations were classified as pathogenic using COSMIC, ClinVar and OncoKB. Univariate survival analysis was performed to determine the impact of one or more mutations in chromatin remodelling genes on survival from first recurrence or metastasis. p values determined using Kaplan-Meier and log-rank. Results: In 269 pts with non-resectable or R/M ACC, mutations promoting CRD were identified in ARID1A (11%), CREBBP (5%), EP300 (5%), KMT2C (1%), KMT2D (5%), KDM6A (13%), and SETD2 (3%). CRD mutations were identified in 94/269 (35%) pts, with 27/269 (10%) having 2 or more CRD mutations. For patients in whom CRD mutations were present survival from recurrence was decreased (median OS 4.6 v 8.2 years, HR 1.65 (95% confidence interval (CI) 1.13-2.40), p = 0.01). Analysis of each individual CRD gene identified that association with decreased survival from recurrence was significant for mutations in KDM6A (n = 35; median OS 4.2 vs 6.5 years; HR 2.01 (95% CI 1.25-3.22); p = 0.004), CREBBP (n = 11; median OS 4.2 vs 5.9 years; HR 2.97 (95% CI 1.20-7.38); p = 0.019) and SETD2 (n = 7; median OS 3.7 vs 5.9; HR 2.47 (95% CI 1.002-6.09); p = 0.042). Previous studies have identified NOTCH pathway activation and TP53 loss-of-function as prognostic. In a secondary analysis of pts without NOTCH activation and/or TP53 mutations (n = 202), OS from recurrence was decreased in those with CRD mutations (n = 58 median OS 5.7 vs 9.2 years, HR 1.5 (CI 95% 0.95-2.55), p = 0.07). Conclusions: We have identified a novel prognostic group of ACC pts characterised by mutations promoting CRD, which may have potential therapeutic options. Alterations in EP300/CREBBP/ARID1A may provide a rationale for treatment with CREBBP/EP300 inhibitors currently in clinical development. Significant co-occurrence with NOTCH gain of function may provide a rationale for future combination studies.
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Affiliation(s)
- Samuel Rack
- Christie Hospital NHS Foundation Trust, Manchester, United Kingdom
| | | | - Hitesh Mistry
- The University of Manchester, Manchester, United Kingdom
| | - Guy Betts
- Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Kevin Joseph Harrington
- The Royal Marsden//The Institute of Cancer Research NIHR Biomedical Research Centre, London, United Kingdom
| | - Robert Metcalf
- The Christie NHS Foundation Trust, Manchester, United Kingdom
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Feeney L, Rack S, Mistry H, Bola B, McPartlin A, Sykes A, Metcalf R. Nomogram to predict duration of clinical benefit from nivolumab in platinum resistant, recurrent/metastatic head and neck squamous cell carcinoma. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e18016] [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
e18016 Background: Immune checkpoint blockade of the programmed death-1 receptor (PD1) with nivolumab improves survival for patients with platinum resistant recurrent/metastatic head and neck squamous cell carcinoma (R/M HNSCC). However, response rates are only 15-20% and the majority of patients do not have prolonged clinical benefit. Established predictive biomarkers such as PDL1 are not reliable in this context and there remain no reliable predictors of response to nivolumab in R/M HNSCC. We therefore sought to evaluate a panel of clinical, haematology and biochemistry parameters to develop a nomogram to predict the duration of clinical benefit following treatment with nivolumab. Methods: Ninety-one patients treated with nivolumab for R/M HNSCC were included. Nivolumab was administered as standard of care management and tumour response was evaluated every 8-12 weeks using CT or MRI. The electronic clinical records were reviewed and all clinical and demographic data were extracted in addition to baseline haematology and clinical biochemistry values. Using Cox proportional hazard analysis these variables were used to create a predictive model for duration of clinical benefit. Patients were dichotomised based upon duration on nivolumab treatment. Backwards elimination with a p-value threshold of 0.05 was used to create a predictive nomogram. For the final model, patients were assigned to two groups (< 3 months and ≥ 3 months on therapy) calculated from the date of first nivolumab dose to the date of discontinuation. Progression free survival (PFS) and overall survival (OS) were calculated from the date of the first dose of nivolumab. Results: Of the 91 patients, 82 had stopped treatment at the time of analysis with a median time on treatment of 2.5 months (95% CI 1.8 to 3.6). Median PFS was 3 months with 1-year PFS rate of 15%. Median OS was 9 months with 1 year OS rate of 40%. Multivariable analysis identified multiple pre-treatment factors that correlate with time on treatment; age (HR 0.97; 95% CI 0.93-1.00, p = 0.029), oropharyngeal tumour location (HR 0.51; 95% CI 0.31-0.85, p = 0.01), N stage (HR 1.84; 95% CI 0.97-3.5, p = 0.061), M stage (HR 2.44; 95% CI 1.27-4.7, p = 0.007), and pre-treatment peripheral blood markers which included monocyte count (HR 2.83; 95% CI 1.05-7.6, p = 0.04), sodium (HR 0.94; 95% CI 0.88-1.00, p = 0.057) and calcium (HR 7.6; 95% CI 1.46-39.7, p = 0.016) levels. These were included in the final nomogram which had a concordance index of 0.69. Conclusions: We have developed a novel nomogram to predict the duration of clinical benefit from nivolumab in platinum resistant R/M HNSCC for subsequent independent validation. This may assist clinicians in counselling patients and clinical decision making and could also be used to identifying poor responders for whom alternative treatment options are required.
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Affiliation(s)
| | - Samuel Rack
- Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Hitesh Mistry
- The University of Manchester, Manchester, United Kingdom
| | - Becky Bola
- The Christie NHS Foundation, Manchester, United Kingdom
| | | | - Andrew Sykes
- The Christie NHS Foundation, Manchester, United Kingdom
| | - Robert Metcalf
- The Christie NHS Foundation Trust, Manchester, United Kingdom
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12
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Fennell K, Keller MA, Villa MA, Paccapelo C, Kucerakova M, Rosochova J, Clemente DosSantos C, Brackney L, Lee CJ, Metcalf R, Crovetti G, Barbieri M, Travali S, Barrotta G, Giuca G, Guerra LE, Ochoa-Garay G. New ABO intron 1 variant alleles. Immunohematology 2021; 37:178-184. [PMID: 34964317 DOI: 10.21307/immunohematology-2021-029] [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: 11/11/2022]
Abstract
Unusual and discrepant ABO phenotypes are often due to genetic variants that lead to altered levels or activity of ABO transferases and consequently to altered expression of ABO antigens. This report describes eight genetic alterations found in 15 cases with reduced or undetectable expression of ABO antigens. Forward and reverse ABO grouping was performed by standard gel or tube methods. Adsorption-heat elution and saliva testing for H and A substances followed the AABB technical manual procedures. Genomic DNA extracted from whole blood was PCR-amplified to cover the entire ABO coding sequence, splice junctions, proximal promoter, and intron 1 enhancer. Amplification products were sequenced by next-generation or Sanger dideoxy methods, either directly or after cloning into a bacterial plasmid vector. Eight unreported alleles were found in the 15 cases analyzed. Alleles ABO*A(28+1C) and ABO*A(29-5G) harbor variants that alter the consensus sequence at the intron 1 donor and acceptor splice sites, respectively. The other alleles harbor variants that alter the consensus sequence at transcription factor-binding sites in the intron 1 enhancer: specifically, ABO*A(28+5792T), ABO*A(28+5859A), and ABO*A(28+5860G) at GATA-1 sites; ABO*B(28+5877T) and ABO*B(28+5878G) at a RUNX1 site; and ABO*A(28+5843A) at or near a C/EBP site. Molecular and serologic characterization of ABO alleles can help in their future identification and in the resolution of discrepancies. Unusual and discrepant ABO phenotypes are often due to genetic variants that lead to altered levels or activity of ABO transferases and consequently to altered expression of ABO antigens. This report describes eight genetic alterations found in 15 cases with reduced or undetectable expression of ABO antigens. Forward and reverse ABO grouping was performed by standard gel or tube methods. Adsorption-heat elution and saliva testing for H and A substances followed the AABB technical manual procedures. Genomic DNA extracted from whole blood was PCR-amplified to cover the entire ABO coding sequence, splice junctions, proximal promoter, and intron 1 enhancer. Amplification products were sequenced by next-generation or Sanger dideoxy methods, either directly or after cloning into a bacterial plasmid vector. Eight unreported alleles were found in the 15 cases analyzed. Alleles ABO*A(28+1C) and ABO*A(29–5G) harbor variants that alter the consensus sequence at the intron 1 donor and acceptor splice sites, respectively. The other alleles harbor variants that alter the consensus sequence at transcription factor–binding sites in the intron 1 enhancer: specifically, ABO*A(28+5792T), ABO*A(28+5859A), and ABO*A(28+5860G) at GATA-1 sites; ABO*B(28+5877T) and ABO*B(28+5878G) at a RUNX1 site; and ABO*A(28+5843A) at or near a C/EBP site. Molecular and serologic characterization of ABO alleles can help in their future identification and in the resolution of discrepancies.
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Affiliation(s)
- K Fennell
- Laboratory Manager, Thermo Fisher Scientific , Austin, TX
| | - M A Keller
- Executive at American Red Cross Biomedical Services , Philadelphia, PA
| | - M A Villa
- Retired from Fondazione IRCCS Ca'Granda-Ospedale Maggiore Policlinico , Milan , Italy
| | - C Paccapelo
- Cinzia Paccapelo, SDc Biology, Senior Assistant in Immunohematology, Fondazione IRCCS Ca'Granda-Ospedale Maggiore Policlinico , Milan , Italy
| | - M Kucerakova
- Head, Department of Hematology and Blood Bank Narodna Transfuzna Sluzba SR , Bratislava , Slovakia
| | - J Rosochova
- Specialist in Transfusion Medicine, Narodna Transfuzna Sluzba SR , Bratislava , Slovakia
| | | | - L Brackney
- Medical Director of Blood Bank, Elmhurst Memorial Hospital , Elmhurst, IL
| | - C J Lee
- Assistant Professor of Internal Medicine, University of Utah Health , Salt Lake City , UT
| | - R Metcalf
- Medical Director of Transfusion Service, University of Utah Health , Salt Lake City, UT
| | - G Crovetti
- Medical Director, Immunoematologia e Centro Trasfusionale , ASST Valle Olona , Italy
| | - M Barbieri
- Lab Technician, Immunoematologia e Centro Trasfusionale , ASST Valle Olona , Italy
| | - S Travali
- Biologist, Laboratory Director, Servizio di Immunoematologia e Medicina Trasfusionale , Ragusa , Italy
| | - G Barrotta
- Biologist, Executive Biologist, Servizio di Immunoematologia e Medicina Trasfusionale , Ragusa , Italy
| | - G Giuca
- Biologist, Executive Biologist, Servizio di Immunoematologia e Medicina Trasfusionale , Ragusa , Italy
| | - L E Guerra
- Immunohematologist, Independent Consultant , Wimberly , TX
| | - G Ochoa-Garay
- New York Blood Center , 45-01 Vernon Boulevard, Long Island City , NY 11101
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Feeney L, Jain Y, Beasley M, Donnelly O, Kong A, Moleron R, Nallathambi C, Rolles M, Sanghera P, Tin A, Ulahannan D, Walter HS, Webster R, Metcalf R. Centralised RECIST Assessment and Clinical Outcomes with Lenvatinib Monotherapy in Recurrent and Metastatic Adenoid Cystic Carcinoma. Cancers (Basel) 2021; 13:cancers13174336. [PMID: 34503145 PMCID: PMC8431195 DOI: 10.3390/cancers13174336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 08/11/2021] [Accepted: 08/13/2021] [Indexed: 11/24/2022] Open
Abstract
Simple Summary Adenoid cystic carcinoma (ACC) is a rare cancer of the head and neck. Initial treatment may involve surgery and/or radiotherapy with the aim of removing the cancer and preventing spread to other parts of the body. In patients in whom ACC has recurred or spread, systemic therapies such as chemotherapy or immunotherapy have been shown to have minimal benefit and there are currently no recommended standard systemic treatment options. More recently, the targeted therapy lenvatinib has shown promising results in treating ACC patients. We aimed to summarise the real-world experience of lenvatinib use in ACC patients in the UK and found that although some patients obtained clinical benefit, there were no significant responses on radiological imaging by centralized assessment. Abstract Adenoid cystic carcinoma (ACC) is a rare cancer of secretory glands. Recurrent or metastatic (R/M) ACC is generally considered resistant to cytotoxic chemotherapy. Recent phase II studies have reported improved objective response rates (ORR) with the use of the multi-kinase inhibitor lenvatinib. We sought to evaluate real-world experience of R/M ACC patients treated with lenvatinib monotherapy within the UK National Health Service (NHS) to determine the response rates by Response Evaluation Criteria of Solid Tumour (RECIST) and clinical outcomes. Twenty-three R/M ACC patients from eleven cancer centres were included. All treatment assessments for clinical decision making related to drug therapy were undertaken at the local oncology centre. Central radiology review was performed by an independent clinical trial radiologist and blinded to the clinical decision making. In contrast to previously reported ORR of 12–15%, complete or partial response was not observed in any patients. Eleven patients (52.4%) had stable disease and 5 patients (23.8%) had progression of disease as the best overall response. The median time on treatment was 4 months and the median survival from discontinuation was 1 month. The median PFS and OS from treatment initiation were 4.5 months and 12 months respectively. Multicentre collaborative studies such as this are required to evaluate rare cancers with no recommended standard of care therapy and variable disease courses.
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Affiliation(s)
- Laura Feeney
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester M20 4BX, UK; (L.F.); (Y.J.)
| | - Yatin Jain
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester M20 4BX, UK; (L.F.); (Y.J.)
| | - Matthew Beasley
- Department of Oncology, University Hospitals Bristol NHS Foundation Trust, Bristol BS1 3NU, UK;
| | - Oliver Donnelly
- Department of Oncology, Portsmouth Hospitals University NHS Trust, Portsmouth PO6 3LY, UK;
| | - Anthony Kong
- Department of Oncology, Guys’ Campus, King’s College London, London SE5 9RS, UK;
- Department of Oncology, University Hospital Birmingham NHS Foundation Trust, Birmingham B15 2TH, UK;
| | - Rafael Moleron
- Department of Oncology, Aberdeen Royal Infirmary NHS Grampian, Aberdeen AB25 5ZN, UK;
| | - Chandran Nallathambi
- Department of Oncology, Leeds Teaching Hospitals NHS Trust, Leeds LS9 7TF, UK; (C.N.); (D.U.)
| | - Martin Rolles
- Department of Oncology, Swansea Bay University Health Board, Port Talbot SA12 7BR, UK;
| | - Paul Sanghera
- Department of Oncology, University Hospital Birmingham NHS Foundation Trust, Birmingham B15 2TH, UK;
| | - Aung Tin
- Department of Oncology, The James Cook Cancer Institute, The James Cook University Hospital, Middlesbrough TS4 3BW, UK;
| | - Danny Ulahannan
- Department of Oncology, Leeds Teaching Hospitals NHS Trust, Leeds LS9 7TF, UK; (C.N.); (D.U.)
| | - Harriet S. Walter
- Department of Oncology, University Hospitals of Leicester NHS Trust, Leicester LE1 5WW, UK;
| | - Richard Webster
- Department of Oncology, Velindre University NHS Trust, Cardiff CF15 7QZ, UK;
| | - Robert Metcalf
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester M20 4BX, UK; (L.F.); (Y.J.)
- Correspondence: ; Tel.: +44-161-956-1167
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14
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Wiese MD, Hopkins AM, King C, Wechalekar MD, Lee A, Spargo L, Metcalf R, McWilliams L, Hill C, Cleland LG, Proudman SM. Precision Medicine With Leflunomide: Consideration of the DHODH Haplotype and Plasma Teriflunomide Concentration and Modification of Outcomes in Patients With Rheumatoid Arthritis. Arthritis Care Res (Hoboken) 2021; 73:983-989. [PMID: 32339392 DOI: 10.1002/acr.24236] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 04/21/2020] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Leflunomide is a commonly used disease-modifying drug in the treatment of rheumatoid arthritis (RA). Its effects are mediated via inhibition of dihydroorotate dehydrogenase (DHODH) by its active metabolite teriflunomide, and the pharmacokinetics of teriflunomide are highly variable. Our objective was to examine the association between the DHODH haplotype and plasma teriflunomide concentration with response to leflunomide in patients with RA where leflunomide was added to an existing disease-modifying drug regimen after failure to achieve an adequate response with conventional triple therapy. METHODS Patients with RA who were taking, or were about to initiate, leflunomide were included. Participant characteristics, including the DHODH haplotype, were determined. Up to 5 plasma samples were collected after leflunomide was initiated for assays of total and free teriflunomide concentration. Disease activity was determined via the 28-joint Disease Activity Score (DAS28). The association between DAS28 scores and patient covariates was determined by linear mixed-effects modeling. RESULTS A total of 67 patients were included in the study. The DAS28 score after initiation of leflunomide was associated with the baseline DAS28 score (β = 0.70, P < 0.001) and was higher in those who carried the DHODH haplotype 2 (β = 0.56. P = 0.01) and did not carry the shared epitope (β = 0.56, P = 0.013). As total and free plasma teriflunomide concentration increased, the DAS28 score was significantly lower (P < 0.001 and P = 0.001, respectively). When considering threshold concentrations, teriflunomide concentrations >16 mg/liter were associated with a DAS28 score that was 0.33 lower, and when free teriflunomide concentration was >35 µg/liter, the DAS28 score was 0.32 lower. CONCLUSION Teriflunomide concentration and carriage of the DHODH haplotype 2 are associated with response to leflunomide in patients with RA, and a total plasma teriflunomide concentration of at least 16 mg/liter is needed to maximize the likelihood of response.
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Affiliation(s)
- Michael D Wiese
- University of South Australia, Adelaide, South Australia, Australia
| | - Ashley M Hopkins
- Flinders University of South Australia, Bedford Park, South Australia, Australia
| | - Catherine King
- University of South Australia, Adelaide, South Australia, Australia
| | - Mihir D Wechalekar
- Flinders University of South Australia and Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - Anita Lee
- Royal Adelaide Hospital and The University of Adelaide, Adelaide Medical School, Adelaide, South Australia, Australia
| | | | - Robert Metcalf
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Leah McWilliams
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Catherine Hill
- Royal Adelaide Hospital and The University of Adelaide, Adelaide, and The Queen Elizabeth Hospital, Woodville, South Australia, Australia
| | | | - Susanna M Proudman
- Royal Adelaide Hospital and The University of Adelaide, Adelaide Medical School, Adelaide, South Australia, Australia
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15
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Hapuarachi BS, Feeney L, Rack S, Adderley H, Morgan D, Betts G, Walker R, Rauch R, Herz E, Harrington KJ, Metcalf R. Clinical disease course and survival outcomes following disease recurrence in adenoid cystic carcinoma (ACC) with NOTCH signaling pathway activation. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.6072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6072 Background: ACC is a rare salivary cancer for which effective drug therapies remain lacking. The highest rates of disease recurrence are in patients with NOTCH pathway activation, which is reported in 10-20% of ACC tumors. Novel drugs targeting NOTCH signaling are under investigation in the recurrent and metastatic setting. To understand their clinical utility, there is an urgent need to better characterize the disease course and outcomes following current standard of care treatment from diagnosis and following recurrence. Methods: 120 patients with ACC underwent clinical review at a single UK Cancer Centre from 2017-19. Patients were retrospectively assessed for tumor NOTCH pathway activation using next generation sequencing (NGS) targeting NOTCH1/2/3 genes (n = 98) and/or by immunohistochemistry (IHC) for the NOTCH1 intra-cellular domain (NICD1) (n = 87). To understand the disease course with NOTCH pathway activation, treatment data including surgery, radiotherapy and systemic therapies were extracted and presented as swimmer plots. Kaplan-Meier survival analysis was performed and a difference in survival with/without NOTCH activation was calculated with log rank test. Overall survival (OS) was calculated both from diagnosis and from first confirmed disease recurrence or metastasis, and recurrence free survival (RFS) calculated from diagnosis. Results: Of 120 patients, median age was 46 years (22-74 years). 114/120 patients (95%) had confirmed disease recurrence at clinical review. The primary site was major salivary gland in 58/120 (48%), the others were minor salivary. NOTCH1/3 activating somatic mutations were identified in 11% by NGS (11/98) and NICD1 diffuse nuclear staining was seen in 6% by IHC (5/87) for overall NOTCH activation in 11% (13/120). In NOTCH activated ACC, primary site was major salivary gland in 7/13 (54%), and non-pulmonary visceral/bone metastases were present in 6/13 (46%). Consistent with other reports, patients with NOTCH activation (n = 13) had shorter RFS (0.9 vs 3.6 years, p = 0.11) and significantly reduced OS from diagnosis (4.0 vs 16.3 years, p < 0.0001). Critically, as therapies targeting NOTCH signaling are being evaluated in recurrent/metastatic ACC, there was significantly reduced OS from time of first confirmed disease recurrence or metastasis (1.5 vs 9.6 years, p < 0.0001). This reduction in OS for NOTCH activation following recurrence was seen consistently whether patients were classified using NGS (1.9 vs 9.6 years, p = 0.0009) or NICD1 IHC (0.8 vs 8.5 years, p < 0.0001). Conclusions: This is the first study to report clinical outcomes for patients with NOTCH pathway activated ACC following disease recurrence. Although ACC is frequently considered an indolent disease, the short survival in this sub-group of ACC patients demonstrates the urgent need to develop effective drug therapies in this setting.
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Affiliation(s)
| | | | - Sam Rack
- Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Helen Adderley
- Christie NHS Foundation Trust, Manchester, United Kingdom
| | - David Morgan
- University of Manchester, Manchester, United Kingdom
| | - Guy Betts
- Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | | | | | - Elad Herz
- Ayala Pharmaceuticals, Inc., Wilmington, DE
| | - Kevin Joseph Harrington
- The Royal Marsden//The Institute of Cancer Research NIHR Biomedical Research Centre, London, United Kingdom
| | - Robert Metcalf
- The Christie NHS Foundation Trust, Manchester, United Kingdom
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16
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Xu A, Sun C, Metcalf R, Limaye V. Health-related quality of life and work impairment in idiopathic inflammatory myopathies in South Australia. Int J Rheum Dis 2021; 24:809-814. [PMID: 33881230 DOI: 10.1111/1756-185x.14120] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 03/18/2021] [Accepted: 04/07/2021] [Indexed: 11/29/2022]
Abstract
AIM The idiopathic inflammatory myopathies (IIM) are rare autoimmune diseases that are usually chronic and often present with skeletal muscle inflammation and weakness. We sought to examine the impact of IIM in a cohort of 50 South Australian patients on health-related quality of life (HRQOL) and work productivity (WP). We uniquely categorized patients across gender, IIM subtypes, employment status, and also whether there was extramuscular involvement from IIM. METHODS Multiple modalities were used, as recommended by the International Myositis Assessment and Clinical Studies Group (IMACS), to assess the impact of IIM, including manual muscle strength testing (MMT-8), the Physician and Patient Global Activity Assessments (PHGAA, PTGAA), Myositis Disease Activity Assessment Tool (MDAAT), and serum creatinine kinase (CK) levels. The impacts of IIM on HRQOL and WP were analyzed using the Medical Outcomes Study 36-items Short Form (SF-36) and Work Productivity and Activity Impairment (WPAI) questionnaires, respectively. RESULTS We found significantly lower HRQOL outcome scores in most of the SF-36 domains when compared to the most recent population norms (P ≤ .01). Physical health was predominantly affected with relative preservation of emotional health. There were also significant associations between MMT-8, PHGAA and PTGAA scores and HRQOL and WP. CONCLUSIONS Our findings highlight the significant impact of IIM on HRQOL and WP in a well-characterized cohort of patients with IIM within Australia, and therefore the importance of a holistic approach to the management of these patients.
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Affiliation(s)
- Alan Xu
- Department of Medicine, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Caitlyn Sun
- Department of Medicine, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Robert Metcalf
- Department of Rheumatology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Vidya Limaye
- Department of Rheumatology, Royal Adelaide Hospital, Adelaide, SA, Australia
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17
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Adderley H, Rack S, Hapuarachi B, Feeney L, Morgan D, Hussell T, Wallace AJ, Betts G, Hodgson C, Harrington K, Metcalf R. The utility of TP53 and PIK3CA mutations as prognostic biomarkers in salivary adenoid cystic carcinoma. Oral Oncol 2020; 113:105095. [PMID: 33290961 DOI: 10.1016/j.oraloncology.2020.105095] [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: 08/06/2020] [Revised: 10/16/2020] [Accepted: 11/03/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Despite wide excision and post-operative irradiation, loco-regional and/or metastatic recurrence is a significant clinical problem in salivary adenoid cystic carcinoma (SACC). Reliable biomarkers are required to tailor post-treatment surveillance to patients at highest risk of recurrence. We sought to determine the utility of TP53 and PIK3CA mutations as prognostic biomarkers in SACC. MATERIALS AND METHODS DNA was extracted from archival tumour blocks of 145 SACC patients from 66 UK referral centres and sequenced for TP53 and PIK3CA mutations. Clinical, pathological and outcome data were analysed to determine the impact of the genomic alterations on disease recurrence and overall survival (OS). RESULTS TP53 and PIK3CA mutations were identified in 8% (10/121 successful analyses) and 2% (3/121) of cases, respectively. There were too few PIK3CA mutations in this cohort for informative further analysis. TP53-mutated SACC had significantly shorter median OS (5.3 vs. 16.3 years, p = 0.019) and lower 10-year survival (48% vs. 81%) compared with TP53 wild-type ACC. Solid-pattern histopathology was more frequent in TP53-mutated SACC (50% vs. 15%, p = 0.27). CONCLUSION TP53-mutated recurrent and metastatic SACC was associated with shorter OS, which was significant when combined with published genomic data sets. Stratifying by TP53 status, in addition to established clinical, pathological and genomic biomarkers, may usefully inform follow-up strategy.
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Affiliation(s)
- Helen Adderley
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Samuel Rack
- Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | | | - Laura Feeney
- Queen's University Belfast, Belfast, United Kingdom
| | - David Morgan
- The University of Manchester, Manchester, United Kingdom
| | - Tracy Hussell
- The University of Manchester, Manchester, United Kingdom
| | - Andrew J Wallace
- NW GLH, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Guy Betts
- Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Clare Hodgson
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Kevin Harrington
- The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust National Institute of Health Research Biomedical Research Centre, London, United Kingdom
| | - Robert Metcalf
- The Christie NHS Foundation Trust, Manchester, United Kingdom.
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18
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Hanna GJ, Guenette JP, Chau NG, Sayehli CM, Wilhelm C, Metcalf R, Wong DJ, Brose M, Razaq M, Pérez-Ruiz E, Cohen EEW, Aggarwal R, Scholz C, Gualberto A, Ho AL. Tipifarnib in recurrent, metastatic HRAS-mutant salivary gland cancer. Cancer 2020; 126:3972-3981. [PMID: 32557577 PMCID: PMC8266417 DOI: 10.1002/cncr.33036] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 05/01/2020] [Accepted: 05/20/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND To the authors' knowledge, there are no approved therapies for recurrent, metastatic (R/M) salivary gland carcinoma (SGC), but molecularly targeted therapies warrant ongoing investigation. In the current study, the authors have reported on the efficacy of tipifarnib in patients with aggressive HRAS-mutant, R/M SGC. METHODS The current prospective, nonrandomized, multicenter, international cohort study involved 8 centers and was conducted from May 2015 to June 2019. The median follow-up was 22 months (range, 6-55 months). Subjects with HRAS-mutant R/M SGC (any histology) and disease progression within the last 6 months were enrolled. Tipifarnib was dosed orally twice daily. The authors determined the objective response rate using Response Evaluation Criteria in Solid Tumors (version 1.1), duration of response, and molecular predictors of response. RESULTS A total of 13 patients with R/M SGC were enrolled; all had received prior systemic therapy (1-3 regimens). One objective response was observed; an additional 7 of 12 evaluable patients (58%) had stable disease as their best response with a median duration of 9 months (range, 3-14 months). Five of 7 patients had >10% tumor regression and 6 of 7 had stable disease lasting >6 months. Q61R was the most frequent activating HRAS mutation noted (7 of 13 patients; 54%), but gene variant and allele frequency did not correlate with outcomes. The median progression-free survival was 7 months (95% confidence interval, 5.9-10.1 months), and the median overall survival was 18 months (95% confidence interval, 9.6-22.4 months) with approximately 58.6% of patients alive at 1 year. Survival was similar regardless of HRAS mutant variant or co-occurring PIK3CA alterations. No participant discontinued treatment because of toxicity. CONCLUSIONS Tipifarnib resulted in modest clinical activity with a promising disease control rate among patients with HRAS-mutant, R/M SGC who developed disease progression within the last 6 months.
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Affiliation(s)
- Glenn J. Hanna
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Jeffrey P. Guenette
- Division of Neuroradiology, Brigham & Women’s Hospital, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Nicole G. Chau
- Department of Medical Oncology, BC Cancer Vancouver Centre, Vancouver, British Columbia, Canada
| | - Cyrus M. Sayehli
- Department of Internal Medicine II, Early Clinical Trial Unit, University Hospital Wurzburg, Wurzburg, Germany
| | - Christian Wilhelm
- Department of Otorhinolaryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, Julius Maximilian University of Wuerzburg, Wuerzburg, Germany
| | - Robert Metcalf
- Medical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Deborah J. Wong
- Division of Hematology and Oncology, Department of Medicine, Ronald Reagan University of California at Los Angeles Medical Center, Los Angeles, California
| | - Marcia Brose
- Department of Otorhinolaryngology, Head and Neck Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mohammad Razaq
- Department of Hematology/Oncology, Stephenson Cancer Center, The University of Oklahoma, Oklahoma City, Oklahoma
| | - Elisabeth Pérez-Ruiz
- Department of Medical Oncology, Institute of Biomedical Research of Malaga, Costa del Sol Health Agency, Marbella, Spain
| | - Ezra E. W. Cohen
- Division of Hematology-Oncology, Moores Cancer Center, University of California at San Diego Health, San Diego, California
| | - Rahul Aggarwal
- Division of Hematology/Oncology, University of California at San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, California
| | | | | | - Alan L. Ho
- Department of Hematology/Oncology, Memorial Sloan Kettering Cancer Center, New York City, New York
- Department of Medicine, Weill Cornell Medical College, New York City, New York
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19
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Brown Z, Metcalf R, Bednarz J, Spargo L, Lee A, Hill C, Wechalekar M, Stavrou C, James M, Cleland L, Proudman S. Modifiable Lifestyle Factors Associated With Response to Treatment in Early Rheumatoid Arthritis. ACR Open Rheumatol 2020; 2:371-377. [PMID: 32453505 PMCID: PMC7301874 DOI: 10.1002/acr2.11132] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 03/13/2020] [Indexed: 01/18/2023] Open
Abstract
Objective We aimed to evaluate the associations between response to algorithm‐directed treat‐to‐target conventional synthetic disease‐modifying antirheumatic drug therapy and potentially modifiable lifestyle factors, including dietary fish oil supplementation, body mass index (BMI), and smoking history in a rheumatoid arthritis (RA) inception cohort. Methods Patients with RA with a duration of less than 12 months were reviewed every 3 to 6 weeks to adjust therapy according to disease response. All patients received advice to take fish oil supplements, and omega‐3 status was measured as plasma levels of eicosapentaenoic acid (EPA). Lifestyle factors and other variables potentially prognostic for 28‐joint Disease Activity Score (DAS28) remission and DAS28 low disease activity (LDA) at the 12‐month visit were included in multivariable logistic regression models. Results Of 300 participants, 57.7% reached DAS28 LDA, and 43.7% were in DAS28 remission at 1 year. Increase in plasma EPA was associated with an increase in the odds of being in LDA (adjusted odds ratio [OR] = 1.27; P < 0.0001) and remission (adjusted OR = 1.21; P < 0.001). There was some evidence that the effect of BMI on LDA might be modified by smoking history. An increase in BMI was associated with a decrease in the odds of being in LDA in current and former smokers but had no impact on LDA in patients who had never smoked. There were no meaningful associations between BMI or smoking history and remission. Conclusion Omega‐3 status, BMI, and smoking history are potential predictors of outcome in early RA. The possibility of an effect modification by smoking on the predictive value of BMI merits further investigation.
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Affiliation(s)
- Zoe Brown
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Robert Metcalf
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Jana Bednarz
- University of Adelaide, Adelaide, South Australia, Australia
| | | | - Anita Lee
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Catherine Hill
- Royal Adelaide Hospital and University of Adelaide, Adelaide, South Australia, Australia
| | - Mihir Wechalekar
- Flinders Medical Centre and Flinders University, Bedford Park, South Australia, Australia
| | | | - Michael James
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Les Cleland
- Royal Adelaide Hospital and University of Adelaide, Adelaide, South Australia, Australia
| | - Susanna Proudman
- Royal Adelaide Hospital and University of Adelaide, Adelaide, South Australia, Australia
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20
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Metcalf R, Mubarak K, Bola B, Rack S, Morgan D, Hussell T, Wallace A, Betts G, Harrington KJ. ELLA01-1: A study to determine the utility of TP53 mutations as a prognostic biomarker in adenoid cystic carcinoma. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.6585] [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
6585 Background: TP53 mutations are reported in 5% of patients with adenoid cystic carcinoma (ACC). Whilst TP53 mutations are associated with adverse clinical outcomes across multiple tumour types, their prognostic significance in ACC is unknown. We sought to determine the utility of TP53 mutations as a prognostic biomarker in a prospective cohort of ACC patients. Methods: From April 2017 to September 2019, 146 patients with ACC were prospectively recruited to an ethically approved study. DNA was extracted from archival FFPE samples and underwent targeted next generation sequencing (Qiagen GeneRead DNAseq Targeted Panel V2 n = 134; Foundation Medicine; n = 12). Clinical, pathological and outcome data were collected on all patients and Kaplan-Meier survival analysis was performed to test for survival differences between TP53 mutated and wild-type ACC. Results: 146 ACC patients (mean age 48 years, range 16-79) underwent DNA extraction and next generation sequencing for TP53 mutations. The primary site was major salivary gland in 47% and minor salivary gland in 48% (other 5%). Analysis was successful in 122/146 patients (84%). Recurrent or metastatic disease was present in 94% (115/122) at study entry. TP53 alterations were identified in 9% (11/122), most frequently within the DNA binding domain (9/11). Non-pulmonary visceral metastases were seen more frequently in TP53 wild-type than in TP53 mutated ACC (44% vs. 10%; p = 0.042), and other clinical parameters were balanced between groups. During follow-up from diagnosis (median follow up 6.6 years), death occurred in 45% of patients with TP53 mutation and in 23% with TP53 wild-type ACC (p = ns). In TP53 mutated ACC, median overall survival was significantly shorter (5.3 vs. 16.3 years), and 10-year survival rate significantly lower (42% vs. 82%) than TP53 wild-type ACC (log-rank p = 0.013). Conclusions: In this cohort of patients with ACC, TP53 mutations were seen with a higher frequency than previously reported. This may be explained by the high frequency of recurrent or metastatic disease at study entry. TP53 mutation was associated with a statistically significant reduction in overall survival in patients with recurrent and metastatic ACC. These findings suggest that stratifying by TP53 status may be of clinical value to inform follow-up strategy in addition to established clinical, pathological and genomic biomarkers.
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Affiliation(s)
- Robert Metcalf
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | | | - Becky Bola
- University of Manchester, Manchester, United Kingdom
| | - Samuel Rack
- Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - David Morgan
- University of Manchester, Manchester, United Kingdom
| | - Tracy Hussell
- University of Manchester, Manchester, United Kingdom
| | - Andrew Wallace
- Manchester University NHS FT, Manchester, United Kingdom
| | - Guy Betts
- Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Kevin Joseph Harrington
- The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust National Institute of Health Research Biomedical Research Centre, London, United Kingdom
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21
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Lavin V, Callipo F, Donofrio CA, Ellwood-Thompson R, Metcalf R, Djoukhadar I, Higham CE, Kearney T, Colaco R, Gnanalingham K, Roncaroli F. Primary epithelial-myoepithelial carcinoma of the pituitary gland. Neuropathology 2020; 40:261-267. [PMID: 31900996 DOI: 10.1111/neup.12628] [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: 10/29/2019] [Revised: 11/10/2019] [Accepted: 11/10/2019] [Indexed: 12/30/2022]
Abstract
Primary salivary gland-like tumors of the sella are rare and often challenging to diagnose. They reportedly derive from serous and mucinous glands that remain trapped in the infundibulum during embryogenesis. We report a 68-year-old man who presented with partial left third cranial nerve palsy, visual loss in the left eye without visual field defects, headache, weight loss and reduced muscle bulk. Neuroimaging studies demonstrated a solid and cystic, avidly enhancing lesion expanding the pituitary fossa and extending to the left cavernous sinus. The patient underwent craniotomy and the tissue removed showed features of epithelial-myoepithelial carcinoma similar to the salivary gland, skin and breast counterpart. No primary tumor was found outside the sella. The lesion behaved aggressively despite radio-chemotherapy and the patient died 22 months from the onset. The tumor showed a novel TP53 in-frame deletion (Gly154del) while no variants were found in H-RAS hotspot regions (codons 12, 13 and 61). Our report expands the spectrum of salivary gland-like tumors primarily occurring in the sella and emphasizes the need for specialist review of rare, non-neuroendocrine tumors of the pituitary and sella regions.
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Affiliation(s)
- Victoria Lavin
- Department of Clinical Oncology, Christie NHS Foundation Trust, Manchester, UK
| | - Fabio Callipo
- Division of Neuroscience and Experimental Psychology, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Carmine A Donofrio
- Division of Neuroscience and Experimental Psychology, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Rhianedd Ellwood-Thompson
- All Wales Medical Genetics Laboratory, Institute of Medical Genetics, University Hospital of Wales, Cardiff, UK
| | - Robert Metcalf
- Department of Clinical Oncology, Christie NHS Foundation Trust, Manchester, UK
| | | | - Claire E Higham
- Department of Endocrinology, Christie Hospital NHS Foundation Trust, Manchester, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Tara Kearney
- Department of Endocrinology, Salford Royal Foundation Trust, Salford, UK
| | - Rovel Colaco
- Department of Clinical Oncology, Christie NHS Foundation Trust, Manchester, UK
| | | | - Federico Roncaroli
- Division of Neuroscience and Experimental Psychology, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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22
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Rack S, Li Y, McKay C, Wallace A, Metcalf R. PROSPERO: A study to determine the utility of focused genomic profiling to guide selection of drug therapy in salivary gland cancer. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.6086] [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
6086 Background: For most patients with recurrent or metastatic salivary gland cancer (RM-SGC), there are no standard therapies. Many patients undergo genomic profiling to guide selection of targeted therapy. The MSK-IMPACT study applied a 468 gene next generation sequencing (NGS) panel, identifying actionable mutations in 34/114 patients (30%) with RM-SGC. Minimising cost will facilitate application within publically funded healthcare systems. We therefore sought to determine the utility of genomic profiling using a focused 24 gene targeted NGS panel to identify actionable mutations in RM-SGC with a sub-group analysis in adenoid cystic carcinoma (ACC) and non-ACC sub-types. Methods: From January 2017 to 2018, 125 patients with RM-SGC provided informed consent to an ethically approved study. Clinical and demographic characteristics were collected. DNA was extracted from FFPE samples and analysed using Qiagen GeneRead DNAseq Targeted Panel V2 in the Manchester Centre for Genomic Medicine Diagnostic Laboratory, an NHS clinically accredited lab. A custom bioinformatic pipeline was validated to detect single nucleotide variants and indels ( < 40bp) to 5% mutant allele frequency. Alterations were categorised following American College of Medical Genetics guidelines and Association for Molecular Pathology tiering. Results: DNA from 101 tumours (69 major, 32 minor salivary gland) was sequenced with 95% coverage at > 350x read depth over the target enrichment. 65 patients had adenoid cystic carcinoma (ACC) and 36 had non-ACC SGC. Median age was 55 years (range 18-80). 43 actionable alterations were identified in 33 patients within the following genes: TP53 (21%), PIK3CA (8%), ERBB2 (6%), PTEN (3%), BRAF (2%), EGFR (T790M) (1%), and AKT1 (1%). Targeted therapy was selected based on genomic findings in 12% of these patients. In ACC patients, actionable alterations were seen in 25% compared with 55% of non-ACC patients (9 adenocarcinoma, 5 salivary duct carcinoma, 3 carcinoma ex pleomorphic adenoma, 2 mucoepidermoid carcinoma and 1 myoepithelial carcinoma). Conclusions: This study identified actionable alterations in 33% of SGC patients using focused genomic profiling, demonstrating comparable utility to larger research panels. This focussed panel is being expanded to include emerging biomarkers such as NOTCH gene mutations, with NOTCH inhibitors currently in trials in ACC. Greater access to basket studies incorporating therapies matched to genomic alterations will maximise the clinical utility of this approach.
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Affiliation(s)
- Samuel Rack
- University of Manchester, Manchester, United Kingdom
| | - Yonghan Li
- University of Manchester, Manchester, United Kingdom
| | - Craig McKay
- The Christie NHS FT, Manchester, United Kingdom
| | - Andrew Wallace
- Manchester University NHS FT, Manchester, United Kingdom
| | - Robert Metcalf
- Cancer Research UK Manchester Institute, Manchester, United Kingdom
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23
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Rothwell DG, Ayub M, Cook N, Thistlethwaite F, Carter L, Dean E, Smith N, Villa S, Dransfield J, Clipson A, White D, Nessa K, Ferdous S, Howell M, Gupta A, Kilerci B, Mohan S, Frese K, Gulati S, Miller C, Jordan A, Eaton H, Hickson N, O'Brien C, Graham D, Kelly C, Aruketty S, Metcalf R, Chiramel J, Tinsley N, Vickers AJ, Kurup R, Frost H, Stevenson J, Southam S, Landers D, Wallace A, Marais R, Hughes AM, Brady G, Dive C, Krebs MG. Utility of ctDNA to support patient selection for early phase clinical trials: the TARGET study. Nat Med 2019; 25:738-743. [PMID: 31011204 DOI: 10.1038/s41591-019-0380-z] [Citation(s) in RCA: 174] [Impact Index Per Article: 34.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 01/30/2019] [Indexed: 02/07/2023]
Abstract
Next-generation sequencing (NGS) of circulating tumor DNA (ctDNA) supports blood-based genomic profiling but is not yet routinely implemented in the setting of a phase I trials clinic. TARGET is a molecular profiling program with the primary aim to match patients with a broad range of advanced cancers to early phase clinical trials on the basis of analysis of both somatic mutations and copy number alterations (CNA) across a 641 cancer-associated-gene panel in a single ctDNA assay. For the first 100 TARGET patients, ctDNA data showed good concordance with matched tumor and results were turned round within a clinically acceptable timeframe for Molecular Tumor Board (MTB) review. When a 2.5% variant allele frequency (VAF) threshold was applied, actionable mutations were identified in 41 of 100 patients, and 11 of these patients received a matched therapy. These data support the application of ctDNA in this early phase trial setting where broad genomic profiling of contemporaneous tumor material enhances patient stratification to novel therapies and provides a practical template for bringing routinely applied blood-based analyses to the clinic.
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Affiliation(s)
- Dominic G Rothwell
- Clinical Experimental Pharmacology Group, CRUK Manchester Institute, Manchester, UK
| | - Mahmood Ayub
- Clinical Experimental Pharmacology Group, CRUK Manchester Institute, Manchester, UK
| | - Natalie Cook
- Experimental Cancer Medicine Team, The Christie NHS Foundation Trust, Manchester, UK
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Fiona Thistlethwaite
- Experimental Cancer Medicine Team, The Christie NHS Foundation Trust, Manchester, UK
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Louise Carter
- Experimental Cancer Medicine Team, The Christie NHS Foundation Trust, Manchester, UK
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Emma Dean
- Experimental Cancer Medicine Team, The Christie NHS Foundation Trust, Manchester, UK
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Nigel Smith
- Clinical Experimental Pharmacology Group, CRUK Manchester Institute, Manchester, UK
| | - Shaun Villa
- Experimental Cancer Medicine Team, The Christie NHS Foundation Trust, Manchester, UK
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Joanne Dransfield
- Experimental Cancer Medicine Team, The Christie NHS Foundation Trust, Manchester, UK
| | - Alexandra Clipson
- Clinical Experimental Pharmacology Group, CRUK Manchester Institute, Manchester, UK
| | - Daniel White
- Clinical Experimental Pharmacology Group, CRUK Manchester Institute, Manchester, UK
| | - Kamrun Nessa
- Clinical Experimental Pharmacology Group, CRUK Manchester Institute, Manchester, UK
| | - Saba Ferdous
- Clinical Experimental Pharmacology Group, CRUK Manchester Institute, Manchester, UK
| | - Matthew Howell
- Clinical Experimental Pharmacology Group, CRUK Manchester Institute, Manchester, UK
| | - Avinash Gupta
- Experimental Cancer Medicine Team, The Christie NHS Foundation Trust, Manchester, UK
| | - Bedirhan Kilerci
- Clinical Experimental Pharmacology Group, CRUK Manchester Institute, Manchester, UK
| | - Sumitra Mohan
- Clinical Experimental Pharmacology Group, CRUK Manchester Institute, Manchester, UK
| | - Kris Frese
- Clinical Experimental Pharmacology Group, CRUK Manchester Institute, Manchester, UK
| | - Sakshi Gulati
- Clinical Experimental Pharmacology Group, CRUK Manchester Institute, Manchester, UK
| | - Crispin Miller
- Clinical Experimental Pharmacology Group, CRUK Manchester Institute, Manchester, UK
| | - Allan Jordan
- Drug Discovery Unit, CRUK Manchester Institute, Manchester, UK
| | - Helen Eaton
- North West Centre for Genomic Medicine, Manchester, UK
| | | | - Ciara O'Brien
- Experimental Cancer Medicine Team, The Christie NHS Foundation Trust, Manchester, UK
| | - Donna Graham
- Experimental Cancer Medicine Team, The Christie NHS Foundation Trust, Manchester, UK
| | - Claire Kelly
- Experimental Cancer Medicine Team, The Christie NHS Foundation Trust, Manchester, UK
| | - Sreeja Aruketty
- Experimental Cancer Medicine Team, The Christie NHS Foundation Trust, Manchester, UK
| | - Robert Metcalf
- Experimental Cancer Medicine Team, The Christie NHS Foundation Trust, Manchester, UK
| | - Jaseela Chiramel
- Experimental Cancer Medicine Team, The Christie NHS Foundation Trust, Manchester, UK
| | - Nadina Tinsley
- Experimental Cancer Medicine Team, The Christie NHS Foundation Trust, Manchester, UK
| | - Alexander J Vickers
- Experimental Cancer Medicine Team, The Christie NHS Foundation Trust, Manchester, UK
| | - Roopa Kurup
- Experimental Cancer Medicine Team, The Christie NHS Foundation Trust, Manchester, UK
| | - Hannah Frost
- Experimental Cancer Medicine Team, The Christie NHS Foundation Trust, Manchester, UK
| | - Julie Stevenson
- Clinical Experimental Pharmacology Group, CRUK Manchester Institute, Manchester, UK
| | - Siobhan Southam
- Clinical Experimental Pharmacology Group, CRUK Manchester Institute, Manchester, UK
| | - Dónal Landers
- Clinical Experimental Pharmacology Group, CRUK Manchester Institute, Manchester, UK
- Innovative Medicines Biotech Unit AstraZeneca, Cambridge, UK
| | | | - Richard Marais
- Molecular Oncology Group, CRUK Manchester Institute, Manchester, UK
| | - Andrew M Hughes
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Ged Brady
- Clinical Experimental Pharmacology Group, CRUK Manchester Institute, Manchester, UK
| | - Caroline Dive
- Clinical Experimental Pharmacology Group, CRUK Manchester Institute, Manchester, UK.
- Manchester Centre for Cancer Biomarker Sciences, University of Manchester, Manchester, UK.
| | - Matthew G Krebs
- Experimental Cancer Medicine Team, The Christie NHS Foundation Trust, Manchester, UK.
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.
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24
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Rack S, Rahman R, Carter L, McKay C, Metcalf R. Impact of tumour profiling on clinical trials in salivary gland cancer. Clin Otolaryngol 2018; 44:1-6. [PMID: 30102009 DOI: 10.1111/coa.13206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 08/02/2018] [Indexed: 01/21/2023]
Affiliation(s)
- Samuel Rack
- The University of Manchester, Manchester, UK
| | | | - Louise Carter
- The University of Manchester, Manchester, UK.,The Christie NHS Foundation Trust, Manchester, UK
| | - Craig McKay
- The Christie NHS Foundation Trust, Manchester, UK
| | - Robert Metcalf
- The Christie NHS Foundation Trust, Manchester, UK.,The Cancer Research UK Manchester Institute, Manchester, UK
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25
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Metcalf R, Bishop P, Rajaram K, Patel M, Iqbal M, Pothula V, Hobson J, Shah R, Krysiak P, Fontaine E, Booton R, Evison M, Summers Y, Califano R, Sykes A, Green M, Hodgson C, Telford N, Chaturvedi A. Molecular phenotyping of mucoepidermoid carcinoma of the major and minor salivary gland using a MAML2 break apart FISH assay. Eur J Surg Oncol 2018. [DOI: 10.1016/j.ejso.2018.01.535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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26
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Metcalf R, Bishop P, Rajaram K, Patel M, Iqbal M, Pothula V, Hobson J, Shah R, Krysiak P, Fontaine E, Booton R, Evison M, Summers Y, Califano R, Sykes A, Green M, Hodgson C, Telford N, Chaturvedi A. Molecular phenotyping of mucoepidermoid carcinoma of the major and minor salivary gland using a MAML2 break apart FISH assay. Eur J Surg Oncol 2017. [DOI: 10.1016/j.ejso.2017.10.137] [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: 11/29/2022] Open
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27
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Rack S, Darlington E, Odedra S, Owens R, Sarah D, Shah B, Cook N, Thistlethwaite F, Carter L, Hughes A, Homer J, Slevin N, Krebs M, Metcalf R. Molecular profiling of recurrent and metastatic salivary gland cancer to personalise cancer therapy. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx511.024] [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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28
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Metcalf R, Mohan S, Hilton S, Pierce J, Hudson J, Betts G, Chaturvedi A, Homer J, Leong H, Schofield P, Rothwell D, Brady G, Dive C. The application of liquid biopsies in metastatic salivary gland cancer to identify candidate therapeutic targets. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx508.016] [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: 11/14/2022] Open
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29
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Rothwell D, Ayub M, Gulati S, Brognard J, Wallace A, Miller C, Dean EJ, Cook N, Thistlethwaite F, Leong HS, Eaton H, Howard E, Hudson A, Siswick C, Dransfield J, Christodolou M, Smith N, Carter L, Metcalf R, Aruketty S, Chiramel J, Hughes A, Marais R, Dive C, Brady G, Krebs MG. The TARGET trial: Molecular profiling of circulating tumour DNA to stratify patients to early phase clinical trials. Eur J Surg Oncol 2016. [DOI: 10.1016/j.ejso.2016.07.106] [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: 11/24/2022] Open
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30
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Williamson S, Trapani F, Abbott B, Galvin M, Metcalf R, Hendrix M, Blackhall F, Frese K, Simpson K, Dive C. The role of vasculogenic mimicry in small cell lung cancer. Eur J Cancer 2016. [DOI: 10.1016/s0959-8049(16)61191-7] [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: 10/21/2022]
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31
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Wabe N, Sorich MJ, Wechalekar MD, Cleland LG, McWilliams L, Lee A, Hall C, Spargo L, Metcalf R, Proudman SM, Wiese MD. Drug-induced toxicity and patient reported outcomes in rheumatoid arthritis patients following intensive treated-to-target strategy: does ceasing therapy due to toxicity worsen outcomes in long term? Int J Clin Pract 2016; 70:340-50. [PMID: 26987888 DOI: 10.1111/ijcp.12785] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
AIM While the introduction of the treat-to-target (T2T) strategy has been an important advance in the management of rheumatoid arthritis (RA), the potential for increased toxicity due to use of concurrent drugs could adversely affect patient reported outcomes (PROs). The objective was to determine whether the cessation of therapy due to toxicity affects long-term improvement in PROs in patients treated according to T2T strategy. METHODS A total of 149 patients from an inception cohort of early RA were included. The occurrence and severity of toxicity were monitored at each visit over 3 years. PROs studied were function (measured using health assessment questionnaire); pain, fatigue and patient global assessment (PtGA) all assessed using a 100 mm visual analogue scale; helplessness and health-related quality of life (HRQoL). For each PRO, effect of drug withdrawal was measured by comparing mean change in PROs among patients with no/temporary vs. permanent withdrawal. In addition, effects of frequency of drug withdrawals, weeks to withdrawal and number of drugs withdrawn were analysed using linear regression. RESULT After 3 years, 56 (37.4%) patients ceased at least one drug permanently due to toxicity. Patients with no/temporary withdrawal (n = 93) achieved significantly greater improvement in function (mean change = -0.54 vs. -0.31, p = 0.033), pain (mean change = -39.82 vs. -5.02, p = 0.018), fatigue (mean change = -29.14 vs. -14.76, p = 0.015) and PtGA (mean change = -29.64 vs. -17.00, p = 0.018) compared with their counterparts. Higher frequency of withdrawals was associated with lesser improvements in function, pain, fatigue and PtGA, while the number of drugs withdrawn and the weeks to withdrawal had lesser effects. However, the cessation of the drugs due to their toxicity did not have a significant association with HRQoL and helplessness. CONCLUSION Improvements in function, pain, fatigue and PtGA at 3 years were diminished for patients who ceased drugs due to toxicity while broader measures of HRQoL were not affected.
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Affiliation(s)
- N Wabe
- School of Pharmacy and Medical Sciences and Sansom Institute for Health Research, University of South Australia, Adelaide, SA, Australia
| | - M J Sorich
- School of Pharmacy and Medical Sciences and Sansom Institute for Health Research, University of South Australia, Adelaide, SA, Australia
- School of Medicine, Flinders University, Adelaide, SA, Australia
| | - M D Wechalekar
- School of Medicine, Flinders University, Adelaide, SA, Australia
- Department of Rheumatology, Royal Adelaide Hospital, North Terrace, Adelaide, SA, Australia
| | - L G Cleland
- Department of Rheumatology, Royal Adelaide Hospital, North Terrace, Adelaide, SA, Australia
- Discipline of Medicine, University of Adelaide, Adelaide, SA, Australia
| | - L McWilliams
- Department of Rheumatology, Royal Adelaide Hospital, North Terrace, Adelaide, SA, Australia
| | - A Lee
- Department of Rheumatology, Royal Adelaide Hospital, North Terrace, Adelaide, SA, Australia
- Discipline of Medicine, University of Adelaide, Adelaide, SA, Australia
| | - C Hall
- Department of Rheumatology, Royal Adelaide Hospital, North Terrace, Adelaide, SA, Australia
| | - L Spargo
- Department of Rheumatology, Royal Adelaide Hospital, North Terrace, Adelaide, SA, Australia
| | - R Metcalf
- Department of Rheumatology, Royal Adelaide Hospital, North Terrace, Adelaide, SA, Australia
| | - S M Proudman
- Department of Rheumatology, Royal Adelaide Hospital, North Terrace, Adelaide, SA, Australia
- Discipline of Medicine, University of Adelaide, Adelaide, SA, Australia
| | - M D Wiese
- School of Pharmacy and Medical Sciences and Sansom Institute for Health Research, University of South Australia, Adelaide, SA, Australia
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32
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Wabe N, Sorich MJ, Wechalekar MD, Cleland LG, McWilliams L, Lee A, Spargo L, Metcalf R, Hall C, Proudman SM, Wiese MD. Determining the acceptable level of physician compliance with a treat-to-target strategy in early rheumatoid arthritis. Int J Rheum Dis 2015; 20:576-583. [DOI: 10.1111/1756-185x.12816] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Nasir Wabe
- School of Pharmacy and Medical Sciences and Sansom Institute for Health Research; University of South Australia; Adelaide South Australia Australia
| | - Michael J. Sorich
- School of Pharmacy and Medical Sciences and Sansom Institute for Health Research; University of South Australia; Adelaide South Australia Australia
- School of Medicine; Flinders University; Adelaide South Australia Australia
| | - Mihir D. Wechalekar
- School of Medicine; Flinders University; Adelaide South Australia Australia
- Department of Rheumatology; Royal Adelaide Hospital; Adelaide South Australia Australia
| | - Leslie G. Cleland
- Department of Rheumatology; Royal Adelaide Hospital; Adelaide South Australia Australia
| | - Leah McWilliams
- Department of Rheumatology; Royal Adelaide Hospital; Adelaide South Australia Australia
| | - Anita Lee
- Department of Rheumatology; Royal Adelaide Hospital; Adelaide South Australia Australia
- Discipline of Medicine; University of Adelaide; Adelaide South Australia Australia
| | - Llewellyn Spargo
- Department of Rheumatology; Royal Adelaide Hospital; Adelaide South Australia Australia
| | - Robert Metcalf
- Department of Rheumatology; Royal Adelaide Hospital; Adelaide South Australia Australia
| | - Cindy Hall
- Department of Rheumatology; Royal Adelaide Hospital; Adelaide South Australia Australia
| | - Susanna M. Proudman
- Department of Rheumatology; Royal Adelaide Hospital; Adelaide South Australia Australia
- Discipline of Medicine; University of Adelaide; Adelaide South Australia Australia
| | - Michael D. Wiese
- School of Pharmacy and Medical Sciences and Sansom Institute for Health Research; University of South Australia; Adelaide South Australia Australia
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Abstract
Ceramic fractures have been reported to occur in hip replacements, but the techniques used to extract a well fixed but fractured component are not commonly described. We present a case of ceramic liner fracture and validate a modification of a previously reported extraction technique that allowed us to save the acetabular cup and insert a polyethylene liner. With an increasing trend in ceramic bearing usage, it is likely that the number of ceramic liner fractures will increase and therefore knowledge of successful extraction techniques will be desirable.
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Affiliation(s)
- David Ferguson
- Corresponding author. Acre Street, Lindley HD3 3EA, UK. Tel.: +44 1484 342000.
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Morrow CJ, Hodgkinson CL, Li Y, Metcalf R, Rothwell D, Trapani F, Polanski R, Burt D, Simpson K, Morris K, Pepper S, Nonaka D, Greystole A, Kelly P, Krebs M, Antonello J, Ayub M, Faulkner S, Priest L, Carter L, Tate C, Miller CJ, Blackhall F, Brady G, Dive C. Abstract 3060: Circulating tumor cells from small cell lung cancer patients are tumorigenic. Cancer Res 2014. [DOI: 10.1158/1538-7445.am2014-3060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Small cell lung cancer (SCLC), is a highly aggressive and metastatic disease with a 5 year survival of 5%. SCLC represents 15-20% of all lung cancers and causes >160,000 deaths a year. The majority of patients present with metastatic disease and consequently resections are rare, while biopsies are small and only for diagnostic purposes thus hampering the study of SCLC. However, circulating tumour cells (CTCs) are highly prevalent in SCLC patients and may represent an avenue for the better understanding this disease. Our aim was to determine whether CTCs isolated from SCLC patients were able to form tumours in immunocompromised mice. This was accomplished by erythrocyte and leukocyte depletion and implantation of the remaining cells. Of the 6 initial patients whose CTCs were implanted, 4 gave rise to tumours in less than 5 months. Immuno-histochemical analysis of the tumours revealed them to be human in nature and express markers consistent with SCLC. Whole exome sequencing demonstrated that the tumours had mutations (e.g. TP53 and RB1) and CNV (e.g. loss of 3p and 13q) commonly observed in SCLC samples. Furthermore, single cell analysis of CTCs isolated from the corresponding patient revealed that genetic abnormalities detected in the tumour were also present in the patients CTCs. This confirmed that the tumours (termed CDX for CTC derived explant), were indeed derived from CTCs. In all 4 successful cases, analysis of parallel blood samples by CellSearch demonstrated that the patients had more than 400 CTCs/7.5 ml blood. Two of these patients were initially sensitive to platinum/etoposide therapy, while 2 were refractory. The doubling times of CDX derived from refractory and sensitive patients were 7.2 and 5.0 days compared to 14.2 and 13.4 days, consistent with refractory SCLC being more aggressive than sensitive SCLC. We have been able to successfully passage, freeze and resurrect all the CDX models and aim to report whether the patient response to therapy is mirrored in their CDX. These data demonstrate that SCLC CTCs are tumorigenic and we are investigating whether the CTC derived tumours represent a faithful model of the clinical disease.
Citation Format: Christopher J. Morrow, Cassandra L. Hodgkinson, Yaoyong Li, Robert Metcalf, Dominic Rothwell, Francesca Trapani, Radoslaw Polanski, Debbie Burt, Kathryn Simpson, Karen Morris, Stuart Pepper, Daisuke Nonaka, Alastair Greystole, Paul Kelly, Matthew Krebs, Jenny Antonello, Mahmood Ayub, Suzanne Faulkner, Lynsey Priest, Louise Carter, Catriona Tate, Crispin J. Miller, Fiona Blackhall, Ged Brady, Caroline Dive. Circulating tumor cells from small cell lung cancer patients are tumorigenic. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 3060. doi:10.1158/1538-7445.AM2014-3060
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Affiliation(s)
| | | | - Yaoyong Li
- 1Cancer Research UK Manchester Institute, Manchester, United Kingdom
| | - Robert Metcalf
- 1Cancer Research UK Manchester Institute, Manchester, United Kingdom
| | - Dominic Rothwell
- 1Cancer Research UK Manchester Institute, Manchester, United Kingdom
| | - Francesca Trapani
- 1Cancer Research UK Manchester Institute, Manchester, United Kingdom
| | - Radoslaw Polanski
- 1Cancer Research UK Manchester Institute, Manchester, United Kingdom
| | - Debbie Burt
- 1Cancer Research UK Manchester Institute, Manchester, United Kingdom
| | - Kathryn Simpson
- 1Cancer Research UK Manchester Institute, Manchester, United Kingdom
| | - Karen Morris
- 1Cancer Research UK Manchester Institute, Manchester, United Kingdom
| | - Stuart Pepper
- 1Cancer Research UK Manchester Institute, Manchester, United Kingdom
| | - Daisuke Nonaka
- 2Christie NHS Foundation Trust, Manchester, United Kingdom
| | | | - Paul Kelly
- 1Cancer Research UK Manchester Institute, Manchester, United Kingdom
| | - Matthew Krebs
- 1Cancer Research UK Manchester Institute, Manchester, United Kingdom
| | - Jenny Antonello
- 1Cancer Research UK Manchester Institute, Manchester, United Kingdom
| | - Mahmood Ayub
- 1Cancer Research UK Manchester Institute, Manchester, United Kingdom
| | - Suzanne Faulkner
- 1Cancer Research UK Manchester Institute, Manchester, United Kingdom
| | - Lynsey Priest
- 1Cancer Research UK Manchester Institute, Manchester, United Kingdom
| | - Louise Carter
- 1Cancer Research UK Manchester Institute, Manchester, United Kingdom
| | - Catriona Tate
- 1Cancer Research UK Manchester Institute, Manchester, United Kingdom
| | - Crispin J. Miller
- 1Cancer Research UK Manchester Institute, Manchester, United Kingdom
| | | | - Ged Brady
- 1Cancer Research UK Manchester Institute, Manchester, United Kingdom
| | - Caroline Dive
- 1Cancer Research UK Manchester Institute, Manchester, United Kingdom
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Dive C, Crosbie P, Shah R, Metcalf R, Blackhall F. 59: CTCs and cfDNA, will they be useful for early detection of cancer? Eur J Cancer 2014. [DOI: 10.1016/s0959-8049(14)50059-7] [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: 11/24/2022]
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Ewalt M, Metcalf R, Castellanos M, Zhao S, Natkunam Y, Luna-Feinman S. Classical Hodgkin Lymphoma in Guatemalan Children of Age Less than Six Show High pPrevalence of EBV, HGAL and CD137: Prognostic and Therapeutic Implications. Klin Padiatr 2014. [DOI: 10.1055/s-0034-1371124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Carter L, Metcalf R, Blackhall FH, Dive C, Krebs MG. Biology and clinical relevance of circulating tumour cells. J Thorac Dis 2013; 4:453-5. [PMID: 23050105 DOI: 10.3978/j.issn.2072-1439.2012.09.02] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2012] [Accepted: 09/07/2012] [Indexed: 01/01/2023]
Affiliation(s)
- Louise Carter
- Clinical and Experimental Pharmacology Group, Paterson institute for Cancer Research, Manchester, UK
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Metcalf R, Booth J, Swain R, Bagley S, Morris K, Krebs M, Hughes A, Brady G, Blackhall F, Dive C. Abstract 1468: Circulating tumor cells (CTCs) and circulating tumor microemboli (CTM) from patients with small cell lung cancer (SCLC) show heterogeneity in epithelial to mesenchymal transition (EMT) phenotype and evidence of vasculogenic mimicry (VM). Cancer Res 2013. [DOI: 10.1158/1538-7445.am2013-1468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Circulating tumour cells (CTCs) and circulating tumour microemboli (CTM) are prevalent in patients with aggressive small cell lung cancer (SCLC). Heterogeneity in epithelial and mesenchymal phenotypes in CTCs and within CTM was investigated given evidence in preclinical models of epithelial and mesenchymal cell co-operativity advantageous for hematogenous spread and the role of epithelial to mesenchymal transition (EMT) in invasion and metastasis.
Methods: Four colour immunofluorescence assays were developed and applied to tumour cells enriched by filtration from peripheral blood of extensive stage SCLC patients prior to treatment. CTCs/CTM were assessed for expression of cytokeratins (CKs, epithelial marker) and vimentin (mesenchymal marker) with DAPI stained nuclei and negative selection of leukocytes and circulating endothelial cells (CECs) by CD45 and/or vascular endothelial-cadherin (VE-cadherin, CD144) expression respectively.
Results and Conclusions: CTCs were identified in all patients that expressed epithelial and/or mesenchymal markers. Individual CTM were detected comprised of tumour cells of heterogeneous EMT status and CTM were also observed containing leukocytes and/or CECs. There was substantial heterogeneity in CK and vimentin expression in CTCs and within CTM consistent with EMT plasticity and with co-operativity between epithelial and mesenchymal tumour cells. A subpopulation of CTCs co-expressed CKs and VE-cadherin that intriguingly, raises the possibility that vascular mimicry accompanies and may facilitate hematogenous spread in this aggressive tumor type. Further studies are required to explore this new hypothesis.
Citation Format: Robert Metcalf, Jessica Booth, Rajeeb Swain, Steven Bagley, Karen Morris, Matthew Krebs, Andrew Hughes, Gerard Brady, Fiona Blackhall, Caroline Dive. Circulating tumor cells (CTCs) and circulating tumor microemboli (CTM) from patients with small cell lung cancer (SCLC) show heterogeneity in epithelial to mesenchymal transition (EMT) phenotype and evidence of vasculogenic mimicry (VM). [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 1468. doi:10.1158/1538-7445.AM2013-1468
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Affiliation(s)
- Robert Metcalf
- 1Clinical and Experimental Pharmacology, Paterson Institute for Cancer Research, Manchester, United Kingdom
| | - Jessica Booth
- 1Clinical and Experimental Pharmacology, Paterson Institute for Cancer Research, Manchester, United Kingdom
| | - Rajeeb Swain
- 1Clinical and Experimental Pharmacology, Paterson Institute for Cancer Research, Manchester, United Kingdom
| | - Steven Bagley
- 2Advanced Imaging Facility, Paterson Institute for Cancer Research, Manchester, United Kingdom
| | - Karen Morris
- 1Clinical and Experimental Pharmacology, Paterson Institute for Cancer Research, Manchester, United Kingdom
| | - Matthew Krebs
- 3School of Cancer and Enabling Sciences, University of Manchester, Manchester, United Kingdom
| | | | - Gerard Brady
- 1Clinical and Experimental Pharmacology, Paterson Institute for Cancer Research, Manchester, United Kingdom
| | - Fiona Blackhall
- 5Department of Medical Oncology, Christie Hospital NHS Trust, Manchester, United Kingdom
| | - Caroline Dive
- 1Clinical and Experimental Pharmacology, Paterson Institute for Cancer Research, Manchester, United Kingdom
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Dive C, Blackhall F, Hou J, Krebs M, Brady G, Metcalf R, Carter L, Morris K, Rothwell D, Ranson M. 32 Circulating Tumour Cells, Utility Beyond Prognosis? Eur J Cancer 2012. [DOI: 10.1016/s0959-8049(12)71831-2] [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: 11/26/2022]
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Carbone A, Psaltis PJ, Nelson AJ, Metcalf R, Richardson JD, Weightman M, Thomas A, Finnie JW, Young GD, Worthley SG. Dietary omega-3 supplementation exacerbates left ventricular dysfunction in an ovine model of anthracycline-induced cardiotoxicity. J Card Fail 2012; 18:502-11. [PMID: 22633309 DOI: 10.1016/j.cardfail.2012.03.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2012] [Revised: 03/26/2012] [Accepted: 03/28/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Cumulative dose-dependent nonischemic cardiomyopathy (NICM) remains a significant risk with the use of some chemotherapeutic agents. In this context, omega-3 polyunsaturated fatty acids (PUFA) have been investigated for their cardioprotective potential in rodent and in vitro models of anthracycline toxicity, with conflicting results. This study evaluated prophylactic omega-3 PUFA supplementation in a large-animal model of anthracycline-induced NICM. METHODS AND RESULTS Merino sheep were randomized to oral drenching with omega-3 PUFA (fish oil; n = 8) or olive oil placebo (n = 9) 3 weeks before commencing repeated intracoronary infusions of doxorubicin (DOX) to induce cardiac dysfunction. Cumulative DOX dose was 3.6 mg/kg. Drenching was continued for 12 weeks after final DOX exposure. Despite significant increases in tissue omega-3 PUFA levels (P < .05 vs placebo), omega-3-treated sheep displayed greater signs of anthracycline cardiotoxicity than placebo animals, consisting of left ventricular dilatation and a greater decline in ejection fraction (P < .05), although myocardial fibrosis burden was similar in both groups. CONCLUSIONS Dietary intake of omega-3 PUFA fails to prevent and may indeed exacerbate DOX-induced cardiotoxicity. Clinical use of omega-3 supplementation during chemotherapy should be deferred until more information is available regarding the mechanisms of interaction between fatty acids and the myocardium during anthracycline exposure.
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Affiliation(s)
- Angelo Carbone
- Discipline of Medicine, Faculty of Health Sciences, University of Adelaide and Cardiovascular Research Centre, Royal Adelaide Hospital, Adelaide, Australia
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Lau DH, Carbone A, Psaltis PJ, Mackenzie L, Metcalf R, Kuklik P, Wong CX, Nelson AJ, Brooks AG, Saint DA, James MJ, Young GD, Worthley SG, Sanders P. ATRIAL PROTECTIVE EFFECTS OF N-3 POLYUNSATURATED FATTY ACIDS: A LONG TERM STUDY IN OVINE CHRONIC HEART FAILURE. J Am Coll Cardiol 2010. [DOI: 10.1016/s0735-1097(10)60132-5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Lau D, Carbone A, Psaltis P, Kelly D, Mackenzie L, Metcalf R, Kuklik P, Nelson A, Zhang Y, Wong C, Saint D, James M, Young G, Worthley S, Sanders P. Omega-3 Polyunsaturated Fatty Acids in Chronic Heart Failure: Evidence of Atrial Protective Effects in an Ovine Model. Heart Lung Circ 2010. [DOI: 10.1016/j.hlc.2010.06.880] [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: 11/30/2022]
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Carbone A, Psaltis P, Nelson A, Weightman M, Thomas T, Williams K, Metcalf R, Young G, Worthley S. The Ability of Omega-3 Fatty Acids to Prevent Non-Ischaemic Cardiac Damage in an Ovine Model of Doxorubicin-induced Cardiomyopathy. Heart Lung Circ 2010. [DOI: 10.1016/j.hlc.2010.06.858] [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: 12/01/2022]
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Noel MA, Pearce GL, Metcalf R. Front line workers in long-term care: the effect of educational interventions and stabilization of staffing ratios on turnover and absenteeism. J Am Med Dir Assoc 2000; 1:241-7. [PMID: 12812607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
OBJECTIVE Front line workers in long-term care play a crucial role in helping residents achieve their highest possible functional level. High turnover (rates in excess of 100% are common) and absenteeism threaten the ability of long-term care providers to meet this goal. The purpose of this study was to determine the effect of a formalized certified nursing assistant (CNA) education program and stabilization of staffing ratios on turnover and absenteeism. DESIGN AND SETTING This study was a 12-month prospective, nonrandomized trial involving two long-term care facilities providing traditional intermediate and skilled care serving as study sites and a similar facility serving as a control. For historical comparisons, each facility served as its own control using data from the year before the interventions. INTERVENTIONS An in-house educational program based on the State of North Carolina core curriculum for CNAs was instituted in each study site. During the study period, efforts were made to achieve stable staffing ratios of 1 CNA:8 residents for days, 1:10 for evenings, and 1:15 for nights. Traditional quality of care indicators and resident/surrogate satisfaction were tracked during the study period. RESULTS Both study facilities showed a decline in turnover, with the decline reaching statistically significant levels at Facility B (134% to 41%, P = 0.0001). Absenteeism rates did not change significantly during the study period. Resident/surrogate satisfaction with nursing care was improved significantly at Facility B (P = 0.02). CONCLUSION A formal education program in conjunction with stabilization of staffing ratios can result in lower turnover rates for CNA's and improved resident/surrogate satisfaction.
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Abstract
AbstractThis paper addresses the philosophical problems posed by shame-consciousness, specifically with respect to the question as to whether the feelings of shame signify an apprehension of truth. After reviewing several methodological problems posed by shame-consciousness, the paper takes up the theoretical treatment of shame in Freud, Scheler, Sartre, and Merleau-Ponty, in order to show how shame illuminates the constitution of subjectivity by power relations in society. This psychoanalytic and phenomenological account of shame is shown to be confirmed by material drawn from cultural studies of shame, and by contemporary feminist critique.
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Metcalf R. Targetting primary research: using an evidence-based approach. Aust Nurs J 1998; 6:43. [PMID: 10205404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Affiliation(s)
- R Metcalf
- Joanna Briggs Institute for Evidence Based Nursing and Midwifery
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Strickler HD, Burk R, Shah K, Viscidi R, Jackson A, Pizza G, Bertoni F, Schiller JT, Manns A, Metcalf R, Qu W, Goedert JJ. A multifaceted study of human papillomavirus and prostate carcinoma. Cancer 1998; 82:1118-25. [PMID: 9506358] [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: 02/06/2023]
Abstract
BACKGROUND The presence of human papillomavirus (HPV) in the prostate and its role in prostate carcinoma are in dispute. To address these issues, two laboratories with extensive HPV experience were selected to test specimens from two populations at different risk for prostate carcinoma, using three different polymerase chain reaction (PCR) assays and two serologic assays for HPV. METHODS The cases were comprised of 51 African-American (men at high risk for prostate carcinoma) and 15 Italian (men at intermediate risk for prostate carcinoma) men with prostate carcinoma. Controls were 108 African-American men and 40 Italian men with histologically proven benign prostate hypertrophy (BPH). Prostate tissue was obtained from each patient at surgery and immediately frozen in liquid nitrogen. The PCR primer sets included two (MY09/MY11 and GP5+/ GP6+) that amplify different regions of L1 and a third (WD66,67,154/WD72,76) targeted to E6. Sensitivity in the 2 L1 PCR assays was shown to be 1 HPV DNA genome per 100 cells. Serum antibodies to HPV-16 and HPV-11 virus-like particles (VLPs) were detected using enzyme-linked immunosorbent assays. RESULTS All available prostate carcinoma tissue specimens (n = 63) and BPH specimens from selected controls (n = 61) were tested by PCR. Human beta-globin DNA could be amplified from all specimens except three carcinomas, but no HPV DNA was detected in any case or control specimens by MY09/MY11 or E6 PCR. Microdissection of 27 carcinoma specimens was conducted to minimize nontumor DNA, but results remained negative by MY09/MY11 and GP5+/GP6+ PCR. In addition, serum specimens in cases (n = 63) and controls (n = 144) showed no differences in their responses against HPV-16 (P = 0.54) or HPV-11 VLPs (P = 0.64). CONCLUSIONS The findings suggest that HPV is not associated with prostate carcinoma, and that HPV DNA is not at all common in the prostate glands of older men.
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Affiliation(s)
- H D Strickler
- Viral Epidemiology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
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Strickler HD, Burk R, Shah K, Viscidi R, Jackson A, Pizza G, Bertoni F, Schiller JT, Manns A, Metcalf R, Qu W, Goedert JJ. A multifaceted study of human papillomavirus and prostate carcinoma. Cancer 1998. [DOI: 10.1002/(sici)1097-0142(19980315)82:6<1118::aid-cncr16>3.0.co;2-9] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abstract
OBJECTIVE A nutritional audit was performed to determine whether current feeding regimes were achieving nutritional goals and to evaluate the use of breastmilk (BM) in a neonatal unit (NNU). METHODS All fluid consumed or infused daily was documented with daily weight and weekly length and head circumference measurements in 90 preterm infants (gestational age 30.1 +/- 2.6 weeks) while in the NNU for 60 +/- 27 days. Daily protein and energy intakes were calculated using values for South Australian preterm BM. RESULTS Parenteral nutrition provided 85% of the daily energy in week 1 falling to 11% by week 6. Ninety per cent of infants received some of their mother's BM and 62% were discharged at least partially breastfed. Protein and energy intakes were 1.03 +/- 0.35 g and 55 +/- 10 kcal/kg/day in week 1, increasing to 2.52 +/- 0.60 g and 109 +/- 15 kcal/kg per day by week 4. Protein intake correlated with weight gain (r2 = 0.39). Weight gain was 14.0 +/- 2.0 g/kg per day and z-scores for weight declined from -0.25 on admission to -1.22 on discharge, P < 0.0001. When infants were divided into two groups comprising those who received BM or formula as their predominant enteral feed, growth and protein intake (but not energy intake) were lower in the BM-fed infants. However, enteral feeds were tolerated earlier and more quickly in those infants receiving predominantly BM. CONCLUSION Energy requirements were readily met using current feeding regimes for preterm infants but protein intakes were marginal. Mothers of preterm infants had similar breastfeeding rates to mothers of term infants in South Australia. The long-term effects of the lower growth rates of preterm infants fed predominantly BM compared with those fed predominantly formula are unknown and need be balanced against the benefits of BM.
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Affiliation(s)
- K Simmer
- Department of Paediatrics, Flinders Medical Centre, South Australia, Australia
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