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Ueno A, Yokota M, Ueno M, Kawamoto K. Colorectal cancer in adolescent and young adults: epidemiology in Japan and narrative review. J Gastrointest Oncol 2023; 14:1856-1868. [PMID: 37720434 PMCID: PMC10502560 DOI: 10.21037/jgo-23-98] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 06/26/2023] [Indexed: 09/19/2023] Open
Abstract
Background and Objective Although only a small proportion of colorectal cancer (CRC) cases develop in adolescents and young adults (AYAs), its incidence has increased recently. We aimed to conduct a narrative literature review and summarize the epidemiology, clinicopathological features, genetics, and treatments for AYA-CRCs. Methods We searched the articles published in the PubMed database until November 30, 2022, with keywords, "((adolescent and young adult) OR AYA) AND ((colorectal cancer) OR (colon cancer) OR (rectal cancer))" and "young-onset AND ((colorectal cancer) OR (colon cancer) OR (rectal cancer))". Key Content and Findings In Japan, the annual incidence of AYA-CRC was approximately 1,200 in the 1970s, but has increased to 2,000 nowadays. An increased incidence of AYA-CRC has also been reported in other countries. AYA-CRC tends to be a more advanced disease at presentation than CRC in older patients, with more adverse histological features and variability in molecular characteristics. Diagnosis of CRC is often delayed in AYAs because they are not invited to undergo cancer screening. Three to five percent of patients with AYA-CRC have hereditary cancer syndromes such as Lynch syndrome and familial adenomatous polyposis (FAP), and a family history should be obtained. Additionally, providing information on fertility preservation and social systems before starting treatment is important for sustainable treatment and life after cancer treatment. Conclusions The number of AYA-CRC cases is increasing in Japan. Before initiating treatment for AYA-CRC, we should know that these patients may have a hereditary disease and fertility preservation should be explained. More physicians should be aware of the importance of AYA-CRC.
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Affiliation(s)
- Ayako Ueno
- Department of General Surgery, Kurashiki Central Hospital, Okayama, Japan
| | - Mitsuru Yokota
- Department of General Surgery, Kurashiki Central Hospital, Okayama, Japan
| | - Masayuki Ueno
- Department of Gastroenterology and Hepatology, Kurashiki Central Hospital, Okayama, Japan
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kazuyuki Kawamoto
- Department of General Surgery, Kurashiki Central Hospital, Okayama, Japan
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Dean M, Hintz EA, Baker J, Reblin M, Quinn GP, Haskins C, Vadaparampil ST. Shared Decision-Making Experiences of Couples with Inherited Cancer Risk Regarding Family Building. JOURNAL OF HEALTH COMMUNICATION 2023:1-10. [PMID: 37078713 DOI: 10.1080/10810730.2023.2202630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Patients with hereditary cancer predisposition syndromes have a high likelihood of passing germline mutations to future offspring. Patients at risk for inherited cancer may not have started and/or completed building their families; thus, they must decide about having children and consider the possibility of passing on their germline mutation. Utilizing the Shared Decision Making (SDM) Model, this study explores family building decision-making communication processes in opposite-sex couples with inherited cancer risk (ICR). Fifteen couples completed two recorded, analogue discussions and dyadic interviews at two time points. Participants were recruited through social media and snowball sampling. The constant comparison method was utilized to thematically analyze the data. When couples discussed family building options (FBOs), several themes were identified: FBO risks, FBO considerations, genetic-related FBO logistics, and life FBOs logistics. When deliberating family building decisions, couples shared easy conversational topics (e.g. FBO options and potential child's cancer risk due to a genetic variant) and difficult/conflict-inducing topics (e.g. preparing for possibilities, parenting, emotions, finances, and timing). Last, couples self-reported primary and secondary FBOs. The findings of this study capture couples' decision-making communication process while considering their experiences. Clinicians and practitioners can utilize these findings to support couples' family building decisions considering their ICR.
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Affiliation(s)
- Marleah Dean
- Department of Communication, University of South Florida, Tampa, Florida, USA
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, USA
| | - Elizabeth A Hintz
- Department of Communication, University of Connecticut, Storrs, Connecticut, USA
| | - Jonathan Baker
- Department of Communication, University of South Florida, Tampa, Florida, USA
| | - Maija Reblin
- Department of Family Medicine, University of Vermont, Burlington, Vermont, USA
| | - Gwendolyn P Quinn
- Department of OB-GYN, Grossman School of Medicine, New York University, New York, USA
| | - Carolyn Haskins
- Department of Genetic Counseling, Moffitt Cancer Center, Tampa, Florida, USA
| | - Susan T Vadaparampil
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, USA
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3
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Fung SM, Wu RR, Myers RA, Goh J, Ginsburg GS, Matchar D, Orlando LA, Ngeow J. Clinical implementation of an oncology-specific family health history risk assessment tool. Hered Cancer Clin Pract 2021; 19:20. [PMID: 33743786 PMCID: PMC7981979 DOI: 10.1186/s13053-021-00177-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 03/10/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The presence of hereditary cancer syndromes in cancer patients can have an impact on current clinical care and post-treatment prevention and surveillance measures. Several barriers inhibit identification of hereditary cancer syndromes in routine practice. This paper describes the impact of using a patient-facing family health history risk assessment platform on the identification and referral of breast cancer patients to genetic counselling services. METHODS This was a hybrid implementation-effectiveness study completed in breast cancer clinics. English-literate patients not previously referred for genetic counselling and/or gone through genetic testing were offered enrollment. Consented participants were provided educational materials on family health history collection, entered their family health history into the platform and completed a satisfaction survey. Upon completion, participants and their clinicians were given personalized risk reports. Chart abstraction was done to identify actions taken by patients, providers and genetic counsellors. RESULTS Of 195 patients approached, 102 consented and completed the study (mean age 55.7, 100 % women). Sixty-six (65 %) met guideline criteria for genetic counseling of which 24 (36 %) were referred for genetic counseling. Of those referred, 13 (54 %) participants attended and eight (33 %) completed genetic testing. On multivariate logistic regression, referral was not associated with age, cancer stage, or race but was associated with clinical provider (p = 0.041). Most providers (71 %) had higher referral rates during the study compared to prior. The majority of participants found the experience useful (84 %), were more aware of their health risks (83 %), and were likely to recommend using a patient-facing platform to others (69 %). CONCLUSIONS 65 % of patients attending breast cancer clinics in this study are at-risk for hereditary conditions based on current guidelines. Using a patient-facing risk assessment platform enhances the ability to identify these patients systematically and with widespread acceptability and recognized value by patients. As only a third of at-risk participants received referrals for genetic counseling, further understanding barriers to referral is needed to optimize hereditary risk assessment in oncology practices. TRIAL REGISTRATION NIH Clinical Trials registry, NCT04639934 . Registered Nov 23, 2020 -- Retrospectively registered.
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Affiliation(s)
- Si Ming Fung
- Cancer Genetics Service, Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - R Ryanne Wu
- Centre for Applied Genomics and Precision Medicine, Department of Medicine, Duke University School of Medicine, 304 Research Dr. Box 90141, Office 264, North Carolina, 27708, Durham, USA.
- Department of Medicine, Duke University School of Medicine, 304 Research Dr. Box 90141, Office 264, North Carolina, 27708, Durham, USA.
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore.
| | - Rachel A Myers
- Centre for Applied Genomics and Precision Medicine, Department of Medicine, Duke University School of Medicine, 304 Research Dr. Box 90141, Office 264, North Carolina, 27708, Durham, USA
| | - Jasper Goh
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Geoffrey S Ginsburg
- Centre for Applied Genomics and Precision Medicine, Department of Medicine, Duke University School of Medicine, 304 Research Dr. Box 90141, Office 264, North Carolina, 27708, Durham, USA
- Department of Medicine, Duke University School of Medicine, 304 Research Dr. Box 90141, Office 264, North Carolina, 27708, Durham, USA
| | - David Matchar
- Department of Medicine, Duke University School of Medicine, 304 Research Dr. Box 90141, Office 264, North Carolina, 27708, Durham, USA
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Lori A Orlando
- Centre for Applied Genomics and Precision Medicine, Department of Medicine, Duke University School of Medicine, 304 Research Dr. Box 90141, Office 264, North Carolina, 27708, Durham, USA
- Department of Medicine, Duke University School of Medicine, 304 Research Dr. Box 90141, Office 264, North Carolina, 27708, Durham, USA
| | - Joanne Ngeow
- Cancer Genetics Service, Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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4
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Gałczyński K, Olcha P, Romanek-Piva K, Jóźwik M, Semczuk A. Fertility-Sparing Methods in Adolescents Affected by Endometrial Cancer: A Comprehensive Review. J Clin Med 2021; 10:jcm10051020. [PMID: 33801452 PMCID: PMC7958602 DOI: 10.3390/jcm10051020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 02/18/2021] [Accepted: 02/20/2021] [Indexed: 01/01/2023] Open
Abstract
Although in developed countries endometrial cancer (EC) is the most common gynecological malignancy, its occurrence in adolescents is exceedingly rare. The increasing rate of obesity in children and adolescents is held responsible for the increasing prevalence of EC in younger cohorts of patients. The diagnosis of this malignancy can have devastating consequences for future fertility because standard treatment protocols for EC include hysterectomy. Here, we present the first detailed review of the world literature on EC in subjects aged 21 years or younger (n = 19). The mean age at diagnosis was 16.7 ± 0.6 years. One patient (5.3%) had a Type II (high-risk) disease. No communication retrieved from the search reported on patient death; however, two (10.5%) patients were lost to follow-up. There was also a high proportion (five subjects, or 26.3%) of cases with genetic background (Cowden syndrome and Turner syndrome), therefore genetic screening or a direct genetic study should be considered in very young patients with EC. The current fertility-sparing options, limited to Type I (low-risk) disease, are presented and discussed. Such information, obtained from studies on older women, translates well to adolescent girls and very young women. Careful anatomopathological monitoring at follow-up is essential for the safety of a conservative approach. Improved survival in very young EC patients makes the preservation of fertility a central survivorship issue, therefore both patients and caregivers should undergo counseling regarding available options. Moreover, our study suggests that genetic syndromes other than Lynch syndrome may be associated with EC more frequently than previously thought.
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Affiliation(s)
- Krzysztof Gałczyński
- Faculty of Medical Sciences and Health Sciences, Siedlce University of Natural Sciences and Humanities, Konarskiego Str. 2, 08-110 Siedlce, Poland
- Correspondence:
| | - Piotr Olcha
- Department of Gynecology, 1st Clinical Military Hospital in Lublin, Aleje Racławickie 23, 20-049 Lublin, Poland; (P.O.); (K.R.-P.)
- Department of Gynecology and Gynecological Endocrinology, Medical University of Lublin, Aleje Racławickie 23, 20-049 Lublin, Poland
| | - Katarzyna Romanek-Piva
- Department of Gynecology, 1st Clinical Military Hospital in Lublin, Aleje Racławickie 23, 20-049 Lublin, Poland; (P.O.); (K.R.-P.)
- 2nd Department of Gynecology, Medical University of Lublin, Jaczewskiego Str. 8, 20-954 Lublin, Poland;
| | - Maciej Jóźwik
- Department of Gynecology and Gynecologic Oncology, Medical University of Białystok, Skłodowskiej Str. 24A, 15-276 Białystok, Poland;
| | - Andrzej Semczuk
- 2nd Department of Gynecology, Medical University of Lublin, Jaczewskiego Str. 8, 20-954 Lublin, Poland;
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5
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Burgers VWG, van der Graaf WTA, van der Meer DJ, McCabe MG, Rijneveld AW, van den Bent MJ, Husson O. Adolescents and Young Adults Living With an Uncertain or Poor Cancer Prognosis: The "New" Lost Tribe. J Natl Compr Canc Netw 2021; 19:240-246. [PMID: 33668023 DOI: 10.6004/jnccn.2020.7696] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Historically, adolescent and young adult (AYA) patients with cancer, diagnosed for the first time at age 15 through 39 years, have often been identified as a "lost tribe" without a medical "home"; neither pediatric nor adult oncology services were able to provide age-appropriate care to this specific group. Internationally, AYA care programs are being established to bridge the gap between the age-defined healthcare worlds and to address the specific needs of AYAs with cancer. However, AYA care programs mostly focus on improving cure rates and addressing survivorship issues, and direct less attention to the unique needs of those living with an uncertain and/or poor cancer prognosis. Additionally, palliative care services are typically poorly equipped to address the age-specific needs of this group. Given that increasingly more AYAs with an uncertain and/or poor cancer prognosis are gaining life years because of novel treatments, and sometimes even face the prospect of long-term disease control, AYA care programs should address the unique palliative care needs of this "new" lost tribe within AYA oncology. This report provides a definition and description of the AYA population living with an uncertain and/or poor cancer prognosis in terms of epidemiologic, clinical, and psychosocial characteristics and challenges, and provides perspectives for future research and care initiatives. It also highlights the need to comprehensively examine the experience of AYAs who are living with uncertain and/or poor cancer prognosis to adjust best care practices for this unique group.
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Affiliation(s)
- Vivian W G Burgers
- 1Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute.,2Department of Medical Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, and
| | - Winette T A van der Graaf
- 2Department of Medical Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, and.,3Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Daniël J van der Meer
- 1Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute.,2Department of Medical Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, and
| | - Martin G McCabe
- 4Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom
| | | | - Martin J van den Bent
- 6Department of Neurology, Erasmus University Medical Center, Rotterdam, the Netherlands; and
| | - Olga Husson
- 1Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute.,2Department of Medical Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, and.,7Division of Clinical Studies, Institute of Cancer Research, and the Royal Marsden NHS Foundation Trust, London, United Kingdom
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6
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Telles CM. A scoping review of literature: What has been studied about adolescents and young adults (AYAs) with cancer? Cancer Treat Res Commun 2021; 27:100316. [PMID: 33545568 DOI: 10.1016/j.ctarc.2021.100316] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 01/12/2021] [Accepted: 01/14/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE To map, organize and analyze the articles published in the last five years about AYAs with cancer. METHODS CAPES database and Google Scholar were searched to identify relevant studies from 2015 to February 2020. Eligible articles included empirical or theoretical research, quantitative and/or qualitative studies, targeted AYAs with cancer, addressed different topics related to AYAs such as unmet needs, hospital challenges, interventions or tools based on evidence, as well as political and socioeconomic aspects. RESULTS Of the 161 articles analyzed, 74 (46%) discussed the health system, including hospital dynamics, treatment and interventions during treatment; 63 (39.1%) discussed aspects or interventions that influence the quality of life and mental health of AYAs with cancer; 14 (8.7%) discussed issues related to sexual health; and 10 (6.2%) addressed social, economic and demographic problems of AYAs with cancer. Three types of purposes have been identified in the articles: 118 (73.3%) investigated variables in areas related to AYAs with cancer, aiming to increase the understanding of the phenomenon and the needs of AYAs; 18 (11.2%) intervened on the needs of AYAs with cancer through pilot studies or evidence-based interventions; and 22 (13.7%) aimed to evaluate an intervention previously performed or to evaluate an intervention based on evidence. CONCLUSION There is still much to be researched within the last two categories. In the last three years, these categories have been growing gradually and on a small scale.
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Affiliation(s)
- Camila M Telles
- Graduating in Psychology - Senior year, Positivo University - Curitiba, Paraná, Brazil (Student); Teen Cancer America - Los Angeles, California, the United States of America (Intern Pro Cancer).
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7
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Cao J, Li J, Yang X, Li P, Yao Z, Han D, Ying L, Wang L, Tian J. Transcriptomics analysis for the identification of potential age-related genes and cells associated with three major urogenital cancers. Sci Rep 2021; 11:641. [PMID: 33436826 PMCID: PMC7803945 DOI: 10.1038/s41598-020-80065-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 12/16/2020] [Indexed: 02/08/2023] Open
Abstract
Age is one of the most important risk factors of the occurrence for tumor patients. The majority of patients with urogenital cancers are the elderly, whose clinical characteristics are greatly affected by age and ageing. Our study aimed to explore age-related genes, cells, and biological changes in three common urogenital cancers via integrative bioinformatics analysis. First, mRNA (count format) and clinical data for bladder cancer, prostate cancer and renal cell carcinoma were downloaded from the Cancer Genome Atlas (TCGA). Through the comparison of clinicopathological characteristics, genes expression and cells infiltration between the old group and the young group, it was found that the clinical characteristics, genes and cells in the tumor microenvironment of different ages were quite different. And 4 key cells, 14 hub genes and some potential pathways were identified and considered as important factors. More importantly, we analyzed the differential landscape of the genes and cells from different perspectives, and confirmed its importance. In conclusion, we identified genes and cell types associated with age-related changes in the tumour microenvironment in urogenital cancer patients. These genes and cell types may play a critical role in the age-associated differences in clinicopathological characteristics among urogenital cancers, thus providing a link between ageing and cancer occurrence. The findings of this study may pave the way for the development of age-tailored approaches to treat cancer and other age-related diseases.
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Affiliation(s)
- Jinlong Cao
- Department of Urology, The Second Hospital of Lanzhou University, Lanzhou, 730000, People's Republic of China
- Key Laboratory of Urological Diseases of Gansu Provincial, Lanzhou, 730000, People's Republic of China
| | - Jianpeng Li
- Department of Urology, The Second Hospital of Lanzhou University, Lanzhou, 730000, People's Republic of China
- Key Laboratory of Urological Diseases of Gansu Provincial, Lanzhou, 730000, People's Republic of China
| | - Xin Yang
- Reproductive Medicine Center, The Second Hospital of Lanzhou University, Lanzhou, 730000, People's Republic of China
| | - Pan Li
- Department of Urology, The Second Hospital of Lanzhou University, Lanzhou, 730000, People's Republic of China
- Key Laboratory of Urological Diseases of Gansu Provincial, Lanzhou, 730000, People's Republic of China
| | - Zhiqiang Yao
- Department of Urology, The Second Hospital of Lanzhou University, Lanzhou, 730000, People's Republic of China
- Key Laboratory of Urological Diseases of Gansu Provincial, Lanzhou, 730000, People's Republic of China
| | - Dali Han
- Department of Urology, The Second Hospital of Lanzhou University, Lanzhou, 730000, People's Republic of China
- Key Laboratory of Urological Diseases of Gansu Provincial, Lanzhou, 730000, People's Republic of China
| | - Lijun Ying
- Department of Urology, The Second Hospital of Lanzhou University, Lanzhou, 730000, People's Republic of China
- Key Laboratory of Urological Diseases of Gansu Provincial, Lanzhou, 730000, People's Republic of China
| | - Lijie Wang
- Department of Gynecology, The Second Hospital of Lanzhou University, Lanzhou, 730000, People's Republic of China
| | - Junqiang Tian
- Department of Urology, The Second Hospital of Lanzhou University, Lanzhou, 730000, People's Republic of China.
- Key Laboratory of Urological Diseases of Gansu Provincial, Lanzhou, 730000, People's Republic of China.
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8
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Younger E, Husson O, Asare B, Benson C, Judson I, Miah A, Zaidi S, Dunlop A, Al-Muderis O, van Houdt WJ, Jones RL, van der Graaf WTA. Metastatic Soft Tissue Sarcomas in Adolescents and Young Adults: A Specialist Center Experience. J Adolesc Young Adult Oncol 2020; 9:628-638. [PMID: 32379517 PMCID: PMC7757586 DOI: 10.1089/jayao.2020.0010] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Purpose: Soft tissue sarcomas (STS) account for 8% of all cancers in adolescents and young adults (AYAs). Metastatic STS contribute significantly to disease-related mortality in this age group; however, data are limited due to under-representation in clinical trials. Methods: AYAs aged 18-39 years, diagnosed with metastatic STS between 1990 and 2012, were identified from The Royal Marsden Hospital database. Outcomes of interest were clinical characteristics, treatment patterns, overall survival (OS), and prognostic factors. Results: Overall, 455 patients were included. Median age at diagnosis of metastatic STS was 33 years (interquartile range [IQR] 27-37 years). The most common histological subtypes were leiomyosarcoma (n = 68, 15%), synovial sarcoma (n = 68, 15%), Ewing sarcoma (n = 44, 10%), and rhabdomyosarcoma (n = 35, 8%). Treatments included systemic therapy (n = 395, 87%; median 2 lines [IQR 1-3]; clinical trial n = 93, 22%), radiotherapy (n = 297, 66%), and metastasectomy (n = 191, 43%). Median duration between last chemotherapy regimen and death was 4.6 months (IQR 2-10). Median OS was 19.2 months (95% confidence interval [CI] 15.8-22.2); 5-year OS was 16%. Of common subtypes, patients with rhabdomyosarcoma had the worst OS (8.8 months; 95% CI 7.9-11.4). Adverse prognostic factors included male gender, synchronous metastases, bone or liver metastases, first-line polychemotherapy, and no metastasectomy. Conclusions: Outcomes were variable; patients with supposed chemosensitive subtypes had particularly poor survival. The diverse behavior of STS in AYAs highlights the need for subtype-specific clinical trials.
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Affiliation(s)
- Eugenie Younger
- Sarcoma Unit, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Olga Husson
- Sarcoma Unit, Royal Marsden NHS Foundation Trust, London, United Kingdom.,Division of Clinical Studies, Institute of Cancer Research, London, United Kingdom
| | - Bernice Asare
- Sarcoma Unit, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Charlotte Benson
- Sarcoma Unit, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Ian Judson
- Division of Clinical Studies, Institute of Cancer Research, London, United Kingdom
| | - Aisha Miah
- Sarcoma Unit, Royal Marsden NHS Foundation Trust, London, United Kingdom.,Division of Clinical Studies, Institute of Cancer Research, London, United Kingdom
| | - Shane Zaidi
- Sarcoma Unit, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Alison Dunlop
- Sarcoma Unit, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Omar Al-Muderis
- Sarcoma Unit, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Winan J van Houdt
- Sarcoma Unit, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Robin L Jones
- Sarcoma Unit, Royal Marsden NHS Foundation Trust, London, United Kingdom.,Division of Clinical Studies, Institute of Cancer Research, London, United Kingdom
| | - Winette T A van der Graaf
- Sarcoma Unit, Royal Marsden NHS Foundation Trust, London, United Kingdom.,Division of Clinical Studies, Institute of Cancer Research, London, United Kingdom
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9
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Genetic Testing for Cancer Predisposition Syndromes in Adolescents and Young Adults (AYAs). CURRENT GENETIC MEDICINE REPORTS 2020. [DOI: 10.1007/s40142-020-00187-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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10
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Feng H, Tong H, Yan J, He M, Chen W, Wang J. Genomic Features and Clinical Characteristics of Adolescents and Young Adults With Cholangiocarcinoma. Front Oncol 2020; 9:1439. [PMID: 32010606 PMCID: PMC6971196 DOI: 10.3389/fonc.2019.01439] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 12/03/2019] [Indexed: 02/05/2023] Open
Abstract
Background: Adolescents and young adults (AYAs) diagnosed with cancer between ages 15 and 45 years may exhibit unique biologic and genomic characteristics as well as clinical features, resulting in differences in clinical characters and drug resistance. However, compared to other solid cancers, relatively few studies have been conducted in this age group in cholangiocarcinoma (CCA). This study is performed to investigate the clinical and molecular features of AYAs with CCA. Methods: Three cohorts, including the external dataset (TCGA and MSKCC) and the perihilar CCA databank of Chinese tertiary hospitals, were contained in this study. Pathway and process enrichment analysis had been carried out with the following ontology sources: KEGG Pathway, GO Biological Processes, Reactome Gene Sets, Canonical Pathways, and CORUM. Metascape and GEPIA datasets were used for bioinformatic analysis. P < 0.05 was considered statistically significant. All statistical analyses were performed with GraphPad Prism (version 7.0; GraphPad Software, La Jolla, California) and R studio (version 3.6.1; R studio, Boston, Massachusetts). Results: Compared to older adults, AYAs with CCA presented with worse overall survival, although the difference was not significant. Specific to patients with stage IV CCAs who underwent chemotherapy, AYAs were associated with significantly poorer overall survival (OS) (p = 0.03, hazards ratio (HR) 3.01, 95% confidence interval (CI) 1.14-4.91). From the anatomical perspective, more extrahepatic CCA was detected in the AYA group. Microsatellite instability (MSI) occurred in 3% of older patients in the present study. Nevertheless, none of the AYAs had MSI status. In this study, AYAs gained an enhanced frequency of additional sex combs like 1 (ASXL1) (p = 0.02) and KMT2C (p = 0.02) mutation than their older counterparts. Besides ASXL1 and KMT2C, the genes enriched in AYAs with CCA were analyzed by pathway and process enrichment analysis. And those genes were found to be associated with poorer differentiation, deubiquitination, and WNT signal pathway. Moreover, AYAs were relevant to poor differentiation and advanced tumor stage. Conclusion: This study offered a preliminary landscape of the clinical and molecular features of early-onset biliary cancers. Further studies including more samples are essential to investigate whether ASXL1 and KMT2C could be considered as potentially targetable genomic signatures for young patients.
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Affiliation(s)
- Hao Feng
- Department of Biliary-Pancreatic Surgery, School of Medicine, Renji Hospital, Shanghai Jiao Tong University, Shanghai, China.,University Hospital of LMU Munich, Medical Faculty of Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Huan Tong
- Clinical and Translational Research Center, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jiayan Yan
- Department of Biliary-Pancreatic Surgery, School of Medicine, Renji Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Min He
- Department of Biliary-Pancreatic Surgery, School of Medicine, Renji Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Wei Chen
- Department of Biliary-Pancreatic Surgery, School of Medicine, Renji Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jian Wang
- Department of Biliary-Pancreatic Surgery, School of Medicine, Renji Hospital, Shanghai Jiao Tong University, Shanghai, China
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11
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Ouedraogo S, Tapsoba TW, Bere B, Ouangre E, Zida M. [Epidemiology, treatment and prognosis of colorectal cancer in young adults in sub-Saharan Africa]. Bull Cancer 2019; 106:969-974. [PMID: 31615647 DOI: 10.1016/j.bulcan.2019.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 08/18/2019] [Accepted: 08/20/2019] [Indexed: 02/07/2023]
Abstract
Colorectal cancer is the most common digestive cancer. The objectives of this study was to analyse the frequency, aetiologies, and the therapeutic and progressive aspects of colorectal cancer in young adults in Burkina Faso. This study was a 10-years descriptive study conducted in 2 regional hospitals in Burkina Faso. It included all patients aged 20 to 45 years admitted to these two hospitals for colon cancer or rectal cancer during the study period. A total of 116 patients were included, which was 39.2% of all patients admitted for colorectal cancer during the same period. The average age of the included patients was 35.4 years old. There were 70 male patients (60.3%). Seven patients had a history of chronic inflammatory bowel disease, and six had a family history of colon cancer. The average consultation time was 6.2 months. In 25 cases (19.9%), the cancer was discovered in the context of an abdominal emergency. Ninety-two patients (79.3%) were diagnosed at stage 3 or stage 4 according to the TNM Staging System. The most common histological type was adenocarcinoma (103 cases, 88.9%). Therapeutically, surgery was performed on 87 patients (75%) and chemotherapy was used in 37 cases (31.9%). Sixteen patients received radiotherapy. The intra operative mortality rate was 4.6%. The 5-year survival rate was 17%. In conclusion, colorectal cancer in young adults occurs without obvious risk factors in Burkina Faso. Mortality remains high because of the limited therapeutic arsenal.
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Affiliation(s)
- Souleymane Ouedraogo
- Centre hospitalier universitaire de Ouahigouya, chirurgie générale et digestive, Burkina Faso.
| | - Toussaint W Tapsoba
- Centre hospitalier universitaire Charles De Gaulles de Ouagadougou, chirurgie pédiatrique, Burkina Faso
| | - Bernadette Bere
- Centre hospitalier universitaire de Ouahigouya, chirurgie générale et digestive, Burkina Faso
| | - Edgar Ouangre
- Centre hospitalier universitaire de Ouahigouya, chirurgie générale et digestive, Burkina Faso
| | - Maurice Zida
- Centre hospitalier universitaire de Ouahigouya, chirurgie générale et digestive, Burkina Faso
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de Rojas T, Kasper B, Van der Graaf W, Pfister SM, Bielle F, Ribalta T, Shenjere P, Preusser M, Fröhling S, Golfinopoulos V, Morfouace M, McCabe MG. EORTC SPECTA-AYA: A unique molecular profiling platform for adolescents and young adults with cancer in Europe. Int J Cancer 2019; 147:1180-1184. [PMID: 31465545 PMCID: PMC7383917 DOI: 10.1002/ijc.32651] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 07/10/2019] [Accepted: 08/12/2019] [Indexed: 01/01/2023]
Abstract
For most adolescent and young adult (AYA) cancers, age‐specific molecular features are poorly understood. EORTC‐SPECTA, an academic translational research infrastructure for biomaterial collection, will explicitly recruit AYA patients and will therefore collect empirical data to bridge the molecular gap between pediatric and adult oncology. The initial pilot study, activated in February 2019 across Europe, will recruit 100 AYA patients (aged 12–29 years) with newly diagnosed or relapsed high‐grade gliomas and high‐grade bone and soft tissue sarcomas. The primary objective of the pilot is to determine feasibility and recruitment rates. Formalin‐fixed tumor tissue and whole blood from study participants will be prospectively collected with clinical data and stored centrally at the Integrated BioBank of Luxembourg. Whole exome sequencing of matched tumor and blood, and tumor RNA sequencing and DNA methylation profiling will be performed at the German Cancer Research Center, Heidelberg, Germany. Virtual central pathology review of scanned diagnostic slides will be undertaken by an international expert panel, and diagnostic material returned to the participating centers. A multidisciplinary molecular tumor board will release a clinically validated report to referring clinicians within 4–6 weeks after biopsy. SPECTA‐AYA constitutes a major opportunity to gain knowledge about the tumor biology of this unique age group. It incorporates notable innovative aspects: AYA specificity, pan‐European academic collaboration, centralized biobanking, comprehensive molecular profiling and virtual central pathology review, among others. SPECTA‐AYA will help untangle the tumor particularities of AYAs with cancer and aims to improve their access to novel drugs and personalized medicine. What's new? To date, age‐specific molecular features remain poorly understood for most adolescent and young adult (AYA) cancers. This paper presents how SPECTA, a pan‐European academic translational research infrastructure for biomaterial collection, will specifically recruit AYA patients to bridge the molecular gap between pediatric and adult oncology. Further notable innovative aspects include centralized biobanking, comprehensive molecular profiling, and virtual central pathology review. SPECTA‐AYA, whose initial pilot study was launched in February 2019, constitutes a major opportunity to gain knowledge about the tumor biology of this unique age group and aims to improve the access of AYAs to novel drugs and personalized medicine.
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Affiliation(s)
| | - Bernd Kasper
- Sarcoma Unit, Mannheim University Medical Center, University of Heidelberg, Mannheim, Germany
| | - Winette Van der Graaf
- Netherlands Cancer Institute van Leeuwenhoek, Amsterdam, The Netherlands.,Department of Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Stefan M Pfister
- Hopp Children's Cancer Center Heidelberg (KiTZ), Division of Pediatric Neurooncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ) and Department of Pediatric Hematology and Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Franck Bielle
- Assistance Publique-Hôpitaux de Paris, La Pitié-Salpêtrière Hospital, Department of Neuropathology, Paris, France
| | - Teresa Ribalta
- Department of Pathology, Hospital Sant Joan de Deu, Barcelona, Spain
| | - Patrick Shenjere
- Department of Histopathology, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Matthias Preusser
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Stefan Fröhling
- Department of Translational Medical Oncology, National Center for Tumor Diseases (NCT) Heidelberg, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | | | - Martin G McCabe
- Division of Cancer Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
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Moss CA, Cojocaru E, Hanwell J, Ward S, Xu W, van Zyl M, O'Leary L, de Bono JS, Banerji U, Kaye SB, Minchom A, George AJ, Lopez J, McVeigh TP. Multidisciplinary interventions in a specialist Drug Development Unit to improve family history documentation and onward referral of patients with advanced cancer to cancer genetics services. Eur J Cancer 2019; 114:97-106. [PMID: 31078974 DOI: 10.1016/j.ejca.2019.04.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 03/26/2019] [Accepted: 04/02/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Molecular aberrations in cancer may represent therapeutic targets, and, if arising from the germline, may impact further cancer risk management in patients and their blood relatives. Annually, 600-700 patients are referred for consideration of experimental drug trials in the Drug Development Unit (DDU) in our institution. A proportion of patients may merit germline genetic testing because of suspicious personal/family history or findings of tumour-based testing. We aimed to assess the impact of different multidisciplinary interventions on family history taking and referral rates from DDU to Cancer Genetics Unit (CGU). METHODS Over 42 months, three interventions were undertaken at different intervals: (1) embedding a genetics provider in the DDU review clinic, (2) 'traffic light' system flagging cancers with a heritable component and (3) virtual multidisciplinary meeting (MDM). Comparative analyses between intervals were undertaken, including referral rates to CGU, investigations and patient outcomes. Family history taking in a sample of 20 patients managed in each interval was assessed by a retrospective chart review. RESULTS Frequency of family history taking and referral to CGU, increased with each intervention, particularly, the virtual MDM (40% vs 85%). Referral rates increased over the study period, from 0.1 referral/week (5/year, 0.36% total referrals) to 1.2/week (projected 63/year, 3.81%). Forty-four (52%) patients referred required germline testing; in three of whom, variants were identified. Non-attendance rates were low (6, 7%). CONCLUSION Patients in the DDU are unique, with long cancer histories and often short estimated life expectancy. Multidisciplinary working between CGU and DDU facilitates germline testing of those patients who may otherwise miss the opportunity.
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Affiliation(s)
- Cathryn A Moss
- Cancer Genetics Unit, Royal Marsden NHS Foundation Trust, Fulham Road, London, UK
| | - Elena Cojocaru
- Drug Development Unit, Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
| | - Janet Hanwell
- Drug Development Unit, Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
| | - Simon Ward
- Cancer Genetics Unit, Royal Marsden NHS Foundation Trust, Fulham Road, London, UK
| | - Wen Xu
- Drug Development Unit, Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
| | - Mary van Zyl
- Drug Development Unit, Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
| | - Lorraine O'Leary
- Drug Development Unit, Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
| | - Johann S de Bono
- Drug Development Unit, Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
| | - Udai Banerji
- Drug Development Unit, Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
| | - Stan B Kaye
- Drug Development Unit, Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
| | - Anna Minchom
- Drug Development Unit, Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
| | - Angela J George
- Cancer Genetics Unit, Royal Marsden NHS Foundation Trust, Fulham Road, London, UK; Gynaecological Oncology Unit, Royal Marsden NHS Foundation Trust, Fulham Road, London, UK
| | - Juanita Lopez
- Drug Development Unit, Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
| | - Terri P McVeigh
- Cancer Genetics Unit, Royal Marsden NHS Foundation Trust, Fulham Road, London, UK.
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Sundar R, McVeigh T, Dolling D, Petruckevitch A, Diamantis N, Ang JE, Chenard-Poiriér M, Collins D, Lim J, Ameratunga M, Khan K, Kaye SB, Banerji U, Lopez J, George AJ, de Bono JS, van der Graaf WT. Clinical outcomes of adolescents and young adults with advanced solid tumours participating in phase I trials. Eur J Cancer 2018; 101:55-61. [PMID: 30025230 DOI: 10.1016/j.ejca.2018.06.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 06/12/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Adolescent and young adult (AYA) patients with advanced solid tumours are often considered for phase I clinical trials with novel agents. The outcome of AYAs in these trials have not been described before. AIM To study the outcome of AYA patients in phase I clinical trials. METHODS Clinical trial data of AYAs (defined as aged 15-39 years at diagnosis) treated at the Drug Development Unit, Royal Marsden Hospital, between 2002 and 2016, were analysed. RESULTS From a prospectively maintained database of 2631 patients treated in phase I trials, 219 AYA patients (8%) were identified. Major tumour types included gynaecological cancer (25%) and sarcoma (18%). Twenty-five (11%) had a known hereditary cancer syndrome (most commonly BRCA). Molecular characterisation of tumours (n = 45) identified mutations most commonly in TP53 (33%), PI3KCA (18%) and KRAS (9%). Therapeutic targets of trials included DNA damage repair (16%), phosphoinositide 3-kinase (PI3K) (16%) and angiogenesis (16%). Grade 3/4 toxicities were experienced in 26% of patients. Of the 214 evaluable patients, objective response rate was 12%, with clinical benefit rate at 6 months of 22%. Median overall survival (OS) was 7.5 months (95% confidence interval: 6.3-9.5), and 2-year OS was 11%. Of patients with responses, 36% were matched to phase I trials based on germline or somatic genetic aberrations. CONCLUSION We describe the outcome of the largest cohort of AYA patients treated in phase I trials. A subgroup of these patients demonstrates benefit, with several durable responses beyond 2 years. A sizeable proportion of AYA patients have cancer syndromes, significant family history or somatic molecular aberrancies which may influence novel therapeutic treatment options.
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Affiliation(s)
- Raghav Sundar
- Drug development Unit, The Royal Marsden Hospital NHS Foundation Trust, The Institute of Cancer Research, London, UK; National University Health System, Singapore
| | - Terri McVeigh
- Drug development Unit, The Royal Marsden Hospital NHS Foundation Trust, The Institute of Cancer Research, London, UK
| | - David Dolling
- Drug development Unit, The Royal Marsden Hospital NHS Foundation Trust, The Institute of Cancer Research, London, UK
| | - Ann Petruckevitch
- Drug development Unit, The Royal Marsden Hospital NHS Foundation Trust, The Institute of Cancer Research, London, UK
| | - Nikolaos Diamantis
- Drug development Unit, The Royal Marsden Hospital NHS Foundation Trust, The Institute of Cancer Research, London, UK
| | - Joo Ern Ang
- Drug development Unit, The Royal Marsden Hospital NHS Foundation Trust, The Institute of Cancer Research, London, UK
| | - Maxime Chenard-Poiriér
- Drug development Unit, The Royal Marsden Hospital NHS Foundation Trust, The Institute of Cancer Research, London, UK
| | - Dearbhaile Collins
- Drug development Unit, The Royal Marsden Hospital NHS Foundation Trust, The Institute of Cancer Research, London, UK
| | - Joline Lim
- Drug development Unit, The Royal Marsden Hospital NHS Foundation Trust, The Institute of Cancer Research, London, UK; National University Health System, Singapore
| | - Malaka Ameratunga
- Drug development Unit, The Royal Marsden Hospital NHS Foundation Trust, The Institute of Cancer Research, London, UK
| | - Khurum Khan
- Drug development Unit, The Royal Marsden Hospital NHS Foundation Trust, The Institute of Cancer Research, London, UK
| | - Stan B Kaye
- Drug development Unit, The Royal Marsden Hospital NHS Foundation Trust, The Institute of Cancer Research, London, UK
| | - Udai Banerji
- Drug development Unit, The Royal Marsden Hospital NHS Foundation Trust, The Institute of Cancer Research, London, UK
| | - Juanita Lopez
- Drug development Unit, The Royal Marsden Hospital NHS Foundation Trust, The Institute of Cancer Research, London, UK
| | - Angela J George
- Drug development Unit, The Royal Marsden Hospital NHS Foundation Trust, The Institute of Cancer Research, London, UK; Gynaecology Unit, The Royal Marsden NHS Foundation Trust, The Institute of Cancer Research, London, UK
| | - Johann S de Bono
- Drug development Unit, The Royal Marsden Hospital NHS Foundation Trust, The Institute of Cancer Research, London, UK
| | - Winette T van der Graaf
- Sarcoma Unit, The Royal Marsden NHS Foundation Trust, The Institute of Cancer Research, London, UK.
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