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Ajiboye BO, Fatoki TH, Akinola OG, Ajeigbe KO, Bamisaye AF, Domínguez-Martín EM, Rijo P, Oyinloye BE. In silico exploration of anti-prostate cancer compounds from differential expressed genes. BMC Urol 2024; 24:138. [PMID: 38956591 PMCID: PMC11221101 DOI: 10.1186/s12894-024-01521-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 06/19/2024] [Indexed: 07/04/2024] Open
Abstract
Prostate cancer (PCa) is a complex and biologically diverse disease with no curative treatment options at present. This study aims to utilize computational methods to explore potential anti-PCa compounds based on differentially expressed genes (DEGs), with the goal of identifying novel therapeutic indications or repurposing existing drugs. The methods employed in this study include DEGs-to-drug prediction, pharmacokinetics prediction, target prediction, network analysis, and molecular docking. The findings revealed a total of 79 upregulated DEGs and 110 downregulated DEGs in PCa, which were used to identify drug compounds capable of reversing the dysregulated conditions (dexverapamil, emetine, parthenolide, dobutamine, terfenadine, pimozide, mefloquine, ellipticine, and trifluoperazine) at a threshold probability of 20% on several molecular targets, such as serotonin receptors 2a/2b/2c, HERG protein, adrenergic receptors alpha-1a/2a, dopamine D3 receptor, inducible nitric oxide synthase (iNOS), epidermal growth factor receptor erbB1 (EGFR), tyrosine-protein kinases, and C-C chemokine receptor type 5 (CCR5). Molecular docking analysis revealed that terfenadine binding to inducible nitric oxide synthase (-7.833 kcal.mol-1) and pimozide binding to HERG (-7.636 kcal.mol-1). Overall, binding energy ΔGbind (Total) at 0 ns was lower than that of 100 ns for both the Terfenadine-iNOS complex (-101.707 to -103.302 kcal.mol-1) and Ellipticine-TOPIIα complex (-42.229 to -58.780 kcal.mol-1). In conclusion, this study provides insight on molecular targets that could possibly contribute to the molecular mechanisms underlying PCa. Further preclinical and clinical studies are required to validate the therapeutic effectiveness of these identified drugs in PCa disease.
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Affiliation(s)
- Basiru Olaitan Ajiboye
- Phytomedicine and Molecular Toxicology Research Laboratory, Department of Biochemistry, Federal University Oye-Ekiti, Oye-Ekiti, Ekiti State, Nigeria.
| | - Toluwase Hezekiah Fatoki
- Applied Bioinformatics Research Laboratory, Department of Biochemistry, Federal University Oye-Ekiti, Oye-Ekiti, Ekiti State, Nigeria
| | - Olamilekan Ganiu Akinola
- Phytomedicine and Molecular Toxicology Research Laboratory, Department of Biochemistry, Federal University Oye-Ekiti, Oye-Ekiti, Ekiti State, Nigeria
| | - Kazeem Olasunkanmi Ajeigbe
- Department of Physiology, Faculty of Basic Medical Sciences, Federal University Oye-Ekiti, Oye-Ekiti, Ekiti State, Nigeria
| | | | - Eva-María Domínguez-Martín
- CBIOS-Universidade Lusófona's Research Center for Biosciences & Health Technologies, Lusófona University, Campo Grande 376, Lisbon, 1749-024, Portugal
- Facultad de Farmacia, Departamento de Ciencias Biomédicas (Área de Farmacología), Universidad de Alcalá de Henares, Nuevos Agentes Antitumorales, Acción Tóxica Sobre Células Leucémicas, Ctra. Madrid-Barcelona km. 33,600, Alcalá de Henares, Madrid, 28805, España
| | - Patricia Rijo
- CBIOS-Universidade Lusófona's Research Center for Biosciences & Health Technologies, Lusófona University, Campo Grande 376, Lisbon, 1749-024, Portugal
| | - Babatunji Emmanuel Oyinloye
- Phytomedicine, Biochemical Toxicology and Biotechnology Research Laboratories, Department of Biochemistry, College of Sciences, Afe Babalola University, Ado-Ekiti, Nigeria
- Biotechnology and Structural Biology (BSB) Group, Department of Biochemistry and Microbiology, University of Zululand, KwaDlangezwa, 3886, South Africa
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2
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Pujalte‐Martin M, Belaïd A, Bost S, Kahi M, Peraldi P, Rouleau M, Mazure NM, Bost F. Targeting cancer and immune cell metabolism with the complex I inhibitors metformin and IACS-010759. Mol Oncol 2024; 18:1719-1738. [PMID: 38214418 PMCID: PMC11223609 DOI: 10.1002/1878-0261.13583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 11/15/2023] [Accepted: 12/29/2023] [Indexed: 01/13/2024] Open
Abstract
Metformin and IACS-010759 are two distinct antimetabolic agents. Metformin, an established antidiabetic drug, mildly inhibits mitochondrial complex I, while IACS-010759 is a new potent mitochondrial complex I inhibitor. Mitochondria is pivotal in the energy metabolism of cells by providing adenosine triphosphate through oxidative phosphorylation (OXPHOS). Hence, mitochondrial metabolism and OXPHOS become a vulnerability when targeted in cancer cells. Both drugs have promising antitumoral effects in diverse cancers, supported by preclinical in vitro and in vivo studies. We present evidence of their direct impact on cancer cells and their immunomodulatory effects. In clinical studies, while observational epidemiologic studies on metformin were encouraging, actual trial results were not as expected. However, IACS-01075 exhibited major adverse effects, thereby causing a metabolic shift to glycolysis and elevated lactic acid concentrations. Therefore, the future outlook for these two drugs depends on preventive clinical trials for metformin and investigations into the plausible toxic effects on normal cells for IACS-01075.
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Affiliation(s)
- Marc Pujalte‐Martin
- Inserm U1065, Centre Méditerranéen de Médecine Moléculaire (C3M)NiceFrance
- Equipe Labellisée Ligue Nationale Contre le Cancer
- Faculté de MédecineUniversité Côte d'AzurNiceFrance
| | - Amine Belaïd
- Inserm U1065, Centre Méditerranéen de Médecine Moléculaire (C3M)NiceFrance
- Equipe Labellisée Ligue Nationale Contre le Cancer
- Faculté de MédecineUniversité Côte d'AzurNiceFrance
| | - Simon Bost
- Equipe Labellisée Ligue Nationale Contre le Cancer
- Faculté de MédecineUniversité Côte d'AzurNiceFrance
| | - Michel Kahi
- Inserm U1065, Centre Méditerranéen de Médecine Moléculaire (C3M)NiceFrance
- Equipe Labellisée Ligue Nationale Contre le Cancer
- Faculté de MédecineUniversité Côte d'AzurNiceFrance
| | - Pascal Peraldi
- Inserm U1065, Centre Méditerranéen de Médecine Moléculaire (C3M)NiceFrance
- Equipe Labellisée Ligue Nationale Contre le Cancer
- Faculté de MédecineUniversité Côte d'AzurNiceFrance
| | - Matthieu Rouleau
- Equipe Labellisée Ligue Nationale Contre le Cancer
- Faculté de MédecineUniversité Côte d'AzurNiceFrance
- CNRS UMR7370, LP2MNiceFrance
| | - Nathalie M. Mazure
- Inserm U1065, Centre Méditerranéen de Médecine Moléculaire (C3M)NiceFrance
- Equipe Labellisée Ligue Nationale Contre le Cancer
- Faculté de MédecineUniversité Côte d'AzurNiceFrance
| | - Frédéric Bost
- Inserm U1065, Centre Méditerranéen de Médecine Moléculaire (C3M)NiceFrance
- Equipe Labellisée Ligue Nationale Contre le Cancer
- Faculté de MédecineUniversité Côte d'AzurNiceFrance
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3
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Zhou W, Zhang W, Yan S, Zhang K, Wu H, Chen H, Shi M, Zhou T. Novel Therapeutic Targets on the Horizon: An Analysis of Clinical Trials on Therapies for Bone Metastasis in Prostate Cancer. Cancers (Basel) 2024; 16:627. [PMID: 38339378 PMCID: PMC10854912 DOI: 10.3390/cancers16030627] [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: 10/28/2023] [Revised: 12/03/2023] [Accepted: 12/11/2023] [Indexed: 02/12/2024] Open
Abstract
In the absence of early detection and initial treatment, prostate cancer often progresses to an advanced stage, frequently spreading to the bones and significantly impacting patients' well-being and healthcare resources. Therefore, managing patients with prostate cancer that has spread to the bones often involves using bone-targeted medications like bisphosphonates and denosumab to enhance bone structure and minimize skeletal complications. Additionally, researchers are studying the tumor microenvironment and biomarkers to understand the mechanisms and potential treatment targets for bone metastases in prostate cancer. A literature search was conducted to identify clinical studies from 2013 to 2023 that focused on pain, performance status, or quality of life as primary outcomes. The analysis included details such as patient recruitment, prior palliative therapies, baseline characteristics, follow-up, and outcome reporting. The goal was to highlight the advancements and trends in bone metastasis research in prostate cancer over the past decade, with the aim of developing strategies to prevent and treat bone metastases and improve the quality of life and survival rates for prostate cancer patients.
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Affiliation(s)
- Wenhao Zhou
- Department of Urology, Shanghai Fourth People’s Hospital, School of Medicine, Tongji University, Shanghai 200434, China; (W.Z.); (S.Y.); (K.Z.); (H.W.)
| | - Wei Zhang
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai 200433, China;
| | - Shi Yan
- Department of Urology, Shanghai Fourth People’s Hospital, School of Medicine, Tongji University, Shanghai 200434, China; (W.Z.); (S.Y.); (K.Z.); (H.W.)
| | - Kaixuan Zhang
- Department of Urology, Shanghai Fourth People’s Hospital, School of Medicine, Tongji University, Shanghai 200434, China; (W.Z.); (S.Y.); (K.Z.); (H.W.)
| | - Han Wu
- Department of Urology, Shanghai Fourth People’s Hospital, School of Medicine, Tongji University, Shanghai 200434, China; (W.Z.); (S.Y.); (K.Z.); (H.W.)
| | - Hongyu Chen
- School of Medicine, Tongji University, Shanghai 200092, China;
| | - Minfeng Shi
- Reproduction Center, Changhai Hospital, Naval Medical University, Shanghai 200433, China
| | - Tie Zhou
- Department of Urology, Shanghai Fourth People’s Hospital, School of Medicine, Tongji University, Shanghai 200434, China; (W.Z.); (S.Y.); (K.Z.); (H.W.)
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4
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Romo-Perez A, Domínguez-Gómez G, Chávez-Blanco AD, González-Fierro A, Correa-Basurto J, Dueñas-González A. PaSTe. Blockade of the Lipid Phenotype of Prostate Cancer as Metabolic Therapy: A Theoretical Proposal. Curr Med Chem 2024; 31:3265-3285. [PMID: 37287286 DOI: 10.2174/0929867330666230607104441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 04/10/2023] [Accepted: 05/09/2023] [Indexed: 06/09/2023]
Abstract
BACKGROUND Prostate cancer is the most frequently diagnosed malignancy in 112 countries and is the leading cause of death in eighteen. In addition to continuing research on prevention and early diagnosis, improving treatments and making them more affordable is imperative. In this sense, the therapeutic repurposing of low-cost and widely available drugs could reduce global mortality from this disease. The malignant metabolic phenotype is becoming increasingly important due to its therapeutic implications. Cancer generally is characterized by hyperactivation of glycolysis, glutaminolysis, and fatty acid synthesis. However, prostate cancer is particularly lipidic; it exhibits increased activity in the pathways for synthesizing fatty acids, cholesterol, and fatty acid oxidation (FAO). OBJECTIVE Based on a literature review, we propose the PaSTe regimen (Pantoprazole, Simvastatin, Trimetazidine) as a metabolic therapy for prostate cancer. Pantoprazole and simvastatin inhibit the enzymes fatty acid synthase (FASN) and 3-hydroxy-3-methylglutaryl- coenzyme A reductase (HMGCR), therefore, blocking the synthesis of fatty acids and cholesterol, respectively. In contrast, trimetazidine inhibits the enzyme 3-β-Ketoacyl- CoA thiolase (3-KAT), an enzyme that catalyzes the oxidation of fatty acids (FAO). It is known that the pharmacological or genetic depletion of any of these enzymes has antitumor effects in prostatic cancer. RESULTS Based on this information, we hypothesize that the PaSTe regimen will have increased antitumor effects and may impede the metabolic reprogramming shift. Existing knowledge shows that enzyme inhibition occurs at molar concentrations achieved in plasma at standard doses of these drugs. CONCLUSION We conclude that this regimen deserves to be preclinically evaluated because of its clinical potential for the treatment of prostate cancer.
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Affiliation(s)
- Adriana Romo-Perez
- Instituto de Química, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | | | - Alma D Chávez-Blanco
- Subdirección de Investigación Básica, Instituto Nacional de Cancerologia, Mexico City, Mexico
| | - Aurora González-Fierro
- Subdirección de Investigación Básica, Instituto Nacional de Cancerologia, Mexico City, Mexico
| | - José Correa-Basurto
- Escuela Superior de Medicina, Instituto Politécnico Nacional, Mexico City, Mexico
| | - Alfonso Dueñas-González
- Subdirección de Investigación Básica, Instituto Nacional de Cancerologia, Mexico City, Mexico
- Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Mexico City, Mexico
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5
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Ye J, Cai S, Feng Y, Li J, Cai Z, Deng Y, Liu R, Zhu X, Lu J, Zhuo Y, Liang Y, Xie J, Zhang Y, He H, Han Z, Jia Z, Zhong W. Metformin escape in prostate cancer by activating the PTGR1 transcriptional program through a novel super-enhancer. Signal Transduct Target Ther 2023; 8:303. [PMID: 37582751 PMCID: PMC10427640 DOI: 10.1038/s41392-023-01516-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 05/25/2023] [Accepted: 05/30/2023] [Indexed: 08/17/2023] Open
Abstract
The therapeutic efficacy of metformin in prostate cancer (PCa) appears uncertain based on various clinical trials. Metformin treatment failure may be attributed to the high frequency of transcriptional dysregulation, which leads to drug resistance. However, the underlying mechanism is still unclear. In this study, we found evidences that metformin resistance in PCa cells may be linked to cell cycle reactivation. Super-enhancers (SEs), crucial regulatory elements, have been shown to be associated with drug resistance in various cancers. Our analysis of SEs in metformin-resistant (MetR) PCa cells revealed a correlation with Prostaglandin Reductase 1 (PTGR1) expression, which was identified as significantly increased in a cluster of cells with metformin resistance through single-cell transcriptome sequencing. Our functional experiments showed that PTGR1 overexpression accelerated cell cycle progression by promoting progression from the G0/G1 to the S and G2/M phases, resulting in reduced sensitivity to metformin. Additionally, we identified key transcription factors that significantly increase PTGR1 expression, such as SRF and RUNX3, providing potential new targets to address metformin resistance in PCa. In conclusion, our study sheds new light on the cellular mechanism underlying metformin resistance and the regulation of the SE-TFs-PTGR1 axis, offering potential avenues to enhance metformin's therapeutic efficacy in PCa.
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Affiliation(s)
- Jianheng Ye
- Department of Urology, Guangzhou First People's Hospital, South China University of Technology, 510180, Guangzhou, Guangdong, China
| | - Shanghua Cai
- Department of Urology, Guangzhou First People's Hospital, South China University of Technology, 510180, Guangzhou, Guangdong, China
- Urology Key Laboratory of Guangdong Province, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, 510230, Guangzhou, Guangdong, China
- Guangzhou National Laboratory, No. 9 XingDaoHuanBei Road, Guangzhou International Bio Island, 510005, Guangzhou, Guangdong, China
| | - Yuanfa Feng
- Department of Urology, Guangzhou First People's Hospital, South China University of Technology, 510180, Guangzhou, Guangdong, China
- Urology Key Laboratory of Guangdong Province, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, 510230, Guangzhou, Guangdong, China
| | - Jinchuang Li
- Department of Urology, Guangzhou First People's Hospital, South China University of Technology, 510180, Guangzhou, Guangdong, China
| | - Zhiduan Cai
- Department of Urology, Guangzhou First People's Hospital, South China University of Technology, 510180, Guangzhou, Guangdong, China
| | - Yulin Deng
- Urology Key Laboratory of Guangdong Province, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, 510230, Guangzhou, Guangdong, China
| | - Ren Liu
- Department of Urology, Guangzhou First People's Hospital, South China University of Technology, 510180, Guangzhou, Guangdong, China
| | - Xuejin Zhu
- Department of Urology, Guangzhou First People's Hospital, South China University of Technology, 510180, Guangzhou, Guangdong, China
| | - Jianming Lu
- Department of Urology, Guangzhou First People's Hospital, South China University of Technology, 510180, Guangzhou, Guangdong, China
| | - Yangjia Zhuo
- Department of Urology, Guangzhou First People's Hospital, South China University of Technology, 510180, Guangzhou, Guangdong, China
| | - Yingke Liang
- Department of Urology, Guangzhou First People's Hospital, South China University of Technology, 510180, Guangzhou, Guangdong, China
| | - Jianjiang Xie
- Department of Urology, Guangzhou First People's Hospital, South China University of Technology, 510180, Guangzhou, Guangdong, China
| | - Yanqiong Zhang
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, 100700, Beijing, China
| | - Huichan He
- Urology Key Laboratory of Guangdong Province, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, 510230, Guangzhou, Guangdong, China
| | - Zhaodong Han
- Department of Urology, Guangzhou First People's Hospital, South China University of Technology, 510180, Guangzhou, Guangdong, China.
| | - Zhenyu Jia
- Department of Botany and Plant Sciences, University of California, Riverside, CA, 92507, USA.
- Graduate Program in Genetics, Genomics & Bioinformatics, University of California, Riverside, CA, 92507, USA.
| | - Weide Zhong
- Department of Urology, Guangzhou First People's Hospital, South China University of Technology, 510180, Guangzhou, Guangdong, China.
- Urology Key Laboratory of Guangdong Province, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, 510230, Guangzhou, Guangdong, China.
- Guangzhou National Laboratory, No. 9 XingDaoHuanBei Road, Guangzhou International Bio Island, 510005, Guangzhou, Guangdong, China.
- State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science and Technology, Taipa, 999078, Macau, China.
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6
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Ahmed F, Samantasinghar A, Manzoor Soomro A, Kim S, Hyun Choi K. A systematic review of computational approaches to understand cancer biology for informed drug repurposing. J Biomed Inform 2023; 142:104373. [PMID: 37120047 DOI: 10.1016/j.jbi.2023.104373] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 03/25/2023] [Accepted: 04/23/2023] [Indexed: 05/01/2023]
Abstract
Cancer is the second leading cause of death globally, trailing only heart disease. In the United States alone, 1.9 million new cancer cases and 609,360 deaths were recorded for 2022. Unfortunately, the success rate for new cancer drug development remains less than 10%, making the disease particularly challenging. This low success rate is largely attributed to the complex and poorly understood nature of cancer etiology. Therefore, it is critical to find alternative approaches to understanding cancer biology and developing effective treatments. One such approach is drug repurposing, which offers a shorter drug development timeline and lower costs while increasing the likelihood of success. In this review, we provide a comprehensive analysis of computational approaches for understanding cancer biology, including systems biology, multi-omics, and pathway analysis. Additionally, we examine the use of these methods for drug repurposing in cancer, including the databases and tools that are used for cancer research. Finally, we present case studies of drug repurposing, discussing their limitations and offering recommendations for future research in this area.
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Affiliation(s)
- Faheem Ahmed
- Department of Mechatronics Engineering, Jeju National University, Republic of Korea
| | | | | | - Sejong Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea; Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
| | - Kyung Hyun Choi
- Department of Mechatronics Engineering, Jeju National University, Republic of Korea.
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7
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Penfold L, Woods A, Pollard AE, Arizanova J, Pascual-Navarro E, Muckett PJ, Dore MH, Montoya A, Whilding C, Fets L, Mokochinski J, Constantin TA, Varela-Carver A, Leach DA, Bevan CL, Nikitin AY, Hall Z, Carling D. AMPK activation protects against prostate cancer by inducing a catabolic cellular state. Cell Rep 2023; 42:112396. [PMID: 37061917 PMCID: PMC10576838 DOI: 10.1016/j.celrep.2023.112396] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 12/02/2022] [Accepted: 03/30/2023] [Indexed: 04/17/2023] Open
Abstract
Emerging evidence indicates that metabolic dysregulation drives prostate cancer (PCa) progression and metastasis. AMP-activated protein kinase (AMPK) is a master regulator of metabolism, although its role in PCa remains unclear. Here, we show that genetic and pharmacological activation of AMPK provides a protective effect on PCa progression in vivo. We show that AMPK activation induces PGC1α expression, leading to catabolic metabolic reprogramming of PCa cells. This catabolic state is characterized by increased mitochondrial gene expression, increased fatty acid oxidation, decreased lipogenic potential, decreased cell proliferation, and decreased cell invasiveness. Together, these changes inhibit PCa disease progression. Additionally, we identify a gene network involved in cell cycle regulation that is inhibited by AMPK activation. Strikingly, we show a correlation between this gene network and PGC1α gene expression in human PCa. Taken together, our findings support the use of AMPK activators for clinical treatment of PCa to improve patient outcome.
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Affiliation(s)
- Lucy Penfold
- MRC London Institute of Medical Sciences, Hammersmith Hospital Campus, Imperial College London, London W12 0NN, UK.
| | - Angela Woods
- MRC London Institute of Medical Sciences, Hammersmith Hospital Campus, Imperial College London, London W12 0NN, UK
| | - Alice E Pollard
- Institute of Clinical Sciences, Imperial College London, London, UK
| | - Julia Arizanova
- MRC London Institute of Medical Sciences, Hammersmith Hospital Campus, Imperial College London, London W12 0NN, UK
| | - Eneko Pascual-Navarro
- MRC London Institute of Medical Sciences, Hammersmith Hospital Campus, Imperial College London, London W12 0NN, UK
| | - Phillip J Muckett
- MRC London Institute of Medical Sciences, Hammersmith Hospital Campus, Imperial College London, London W12 0NN, UK
| | - Marian H Dore
- MRC London Institute of Medical Sciences, Hammersmith Hospital Campus, Imperial College London, London W12 0NN, UK
| | - Alex Montoya
- MRC London Institute of Medical Sciences, Hammersmith Hospital Campus, Imperial College London, London W12 0NN, UK
| | - Chad Whilding
- MRC London Institute of Medical Sciences, Hammersmith Hospital Campus, Imperial College London, London W12 0NN, UK
| | - Louise Fets
- MRC London Institute of Medical Sciences, Hammersmith Hospital Campus, Imperial College London, London W12 0NN, UK
| | - Joao Mokochinski
- MRC London Institute of Medical Sciences, Hammersmith Hospital Campus, Imperial College London, London W12 0NN, UK
| | - Theodora A Constantin
- Imperial Centre for Translational and Experimental Medicine, Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital Campus, London, UK
| | - Anabel Varela-Carver
- Imperial Centre for Translational and Experimental Medicine, Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital Campus, London, UK
| | - Damien A Leach
- Imperial Centre for Translational and Experimental Medicine, Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital Campus, London, UK
| | - Charlotte L Bevan
- Imperial Centre for Translational and Experimental Medicine, Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital Campus, London, UK
| | - Alexander Yu Nikitin
- Department of Biomedical Sciences and Cornell Stem Cell Program, Cornell University, Ithaca, NY, USA
| | - Zoe Hall
- Biomolecular Medicine, Division of Systems Medicine, Department of Metabolism, Digestion, and Reproduction, Imperial College London, London, UK
| | - David Carling
- MRC London Institute of Medical Sciences, Hammersmith Hospital Campus, Imperial College London, London W12 0NN, UK; Institute of Clinical Sciences, Imperial College London, London, UK.
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8
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Lee CS, Lam SY, Liu A, Sison C, Zhu XH. A Retrospective Study of the Effect of Metformin on Patients with Metastatic Prostate Cancer. Clin Med Insights Oncol 2023; 17:11795549231152073. [PMID: 36744171 PMCID: PMC9896090 DOI: 10.1177/11795549231152073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 01/05/2023] [Indexed: 02/04/2023] Open
Abstract
Introduction Previous studies demonstrated that metformin could lead to an inhibition of proliferation of cancer cells through a shift from anabolic to catabolic metabolism. In this study, we seek to investigate the effect of metformin in metastatic prostate cancer. Methods Patients followed at Northwell Health Zuckerberg Cancer Center during 2014-2018 were included if they were diagnosed with metastatic hormone-sensitive prostate cancer (mHSPC) or metastatic castration-resistant prostate cancer (mCRPC), with ⩾6 months follow-up with and without metformin treatment. The primary outcomes, 6-month prostate-specific antigen (PSA) response, overall survival (OS), and radiographic progression free survival (rPFS), were evaluated. Results There were 267 patients included in the final analysis; 196 patients had mHSPC (73.2%) and 71 had mCRPC (26.8%). Within the mHSPC subjects, there was a significant difference in OS between metformin vs nonmetformin groups (148.5 vs 85.6 months; P < .046) in a univariate analysis; patients who took metformin had a significantly longer OS than subjects who did not (median OS: 148.5 vs 86 months; P < .046). There was no significant difference between the 2 groups with respect to either PSA response rate at 6 months or rPFS or OS in patients with mHSPC in both univariate and multivariate analysis. Within the mCRPC subjects, there was no significant difference between metformin and nonmetformin groups with respect to OS (43.3 vs 51.5 months; P < 0.160) or PSA response at 6 months (38.5% vs 57.1%; p < 0.24); however, patients on metformin had a significantly shorter rPFS in both the univariate analysis (7.3 vs 17.4; P < .0002) and in the multivariate analysis (HR = 2.52; 95% CI: 1.24m 5.11; P < .0109). Conclusions Among patients with mHSPC, use of metformin was not significantly associated with improved OS in the multivariate analysis.
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Affiliation(s)
- Chung-Shien Lee
- Department of Clinical Health
Professions, College of Pharmacy and Health Sciences, St. John’s University, Queens,
NY, USA,Division of Medical Oncology and
Hematology, Northwell Health Cancer Institute, Donald & Barbara Zucker School of
Medicine at Hofstra/Northwell, Lake Success, NY, USA
| | - So Yi Lam
- Department of Clinical Health
Professions, College of Pharmacy and Health Sciences, St. John’s University, Queens,
NY, USA
| | - Angel Liu
- Department of Clinical Health
Professions, College of Pharmacy and Health Sciences, St. John’s University, Queens,
NY, USA
| | - Cristina Sison
- Biostatistics Unit, The Feinstein
Institutes for Medical Research, Manhasset, NY, USA,Department of Molecular Medicine,
Donald & Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell
Health, Manhasset, NY, USA
| | - Xin-Hua Zhu
- Division of Medical Oncology and
Hematology, Northwell Health Cancer Institute, Donald & Barbara Zucker School of
Medicine at Hofstra/Northwell, Lake Success, NY, USA,Xin-Hua Zhu, Division of Medical Oncology
and Hematology, Northwell Health Cancer Institute, Donald & Barbara Zucker
School of Medicine at Hofstra/Northwell, 450 Lakeville Road, Lake Success, NY
11042, USA.
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9
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Scheinberg T, Mak B, Butler L, Selth L, Horvath LG. Targeting lipid metabolism in metastatic prostate cancer. Ther Adv Med Oncol 2023; 15:17588359231152839. [PMID: 36743527 PMCID: PMC9893394 DOI: 10.1177/17588359231152839] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 01/05/2023] [Indexed: 02/04/2023] Open
Abstract
Despite key advances in the treatment of prostate cancer (PCa), a proportion of men have de novo resistance, and all will develop resistance to current therapeutics over time. Aberrant lipid metabolism has long been associated with prostate carcinogenesis and progression, but more recently there has been an explosion of preclinical and clinical data which is informing new clinical trials. This review explores the epidemiological links between obesity and metabolic syndrome and PCa, the evidence for altered circulating lipids in PCa and their potential role as biomarkers, as well as novel therapeutic strategies for targeting lipids in men with PCa, including therapies widely used in cardiovascular disease such as statins, metformin and lifestyle modification, as well as novel targeted agents such as sphingosine kinase inhibitors, DES1 inhibitors and agents targeting FASN and beta oxidation.
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Affiliation(s)
- Tahlia Scheinberg
- Medical Oncology, Chris O’Brien Lifehouse, Camperdown NSW, Australia,Advanced Prostate Cancer Group, Garvan Institute of Medical Research, Darlinghurst, NSW, Australia,University of Sydney, Camperdown, NSW, Australia
| | - Blossom Mak
- Medical Oncology, Chris O’Brien Lifehouse, Camperdown NSW, Australia,Advanced Prostate Cancer Group, Garvan Institute of Medical Research, Darlinghurst, NSW, Australia,University of Sydney, Camperdown, NSW, Australia
| | - Lisa Butler
- Prostate Cancer Research Group, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia,South Australian Immunogenomics Cancer Institute and Freemason’s Centre for Male Health and Wellbeing, University of Adelaide, South Australia, Australia
| | - Luke Selth
- South Australian Immunogenomics Cancer Institute and Freemason’s Centre for Male Health and Wellbeing, University of Adelaide, South Australia, Australia,Dame Roma Mitchell Cancer Research Labs, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia,Flinders Health and Medical Research Institute, Flinders University, College of Medicine and Public Health, Bedford Park, Australia
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10
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A Novel Biguanide Derivative, IM176, Induces Prostate Cancer Cell Death via AMPK-mTOR Pathway and Androgen Receptor Signalling Pathway. Prostate Int 2022. [DOI: 10.1016/j.prnil.2022.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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11
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Grist E, Friedrich S, Brawley C, Mendes L, Parry M, Ali A, Haran A, Hoyle A, Gilson C, Lall S, Zakka L, Bautista C, Landless A, Nowakowska K, Wingate A, Wetterskog D, Hasan AMM, Akato NB, Richmond M, Ishaq S, Matthews N, Hamid AA, Sweeney CJ, Sydes MR, Berney DM, Lise S, Parmar MKB, Clarke NW, James ND, Cremaschi P, Brown LC, Attard G. Accumulation of copy number alterations and clinical progression across advanced prostate cancer. Genome Med 2022; 14:102. [PMID: 36059000 PMCID: PMC9442998 DOI: 10.1186/s13073-022-01080-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 06/23/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Genomic copy number alterations commonly occur in prostate cancer and are one measure of genomic instability. The clinical implication of copy number change in advanced prostate cancer, which defines a wide spectrum of disease from high-risk localised to metastatic, is unknown. METHODS We performed copy number profiling on 688 tumour regions from 300 patients, who presented with advanced prostate cancer prior to the start of long-term androgen deprivation therapy (ADT), in the control arm of the prospective randomised STAMPEDE trial. Patients were categorised into metastatic states as follows; high-risk non-metastatic with or without local lymph node involvement, or metastatic low/high volume. We followed up patients for a median of 7 years. Univariable and multivariable Cox survival models were fitted to estimate the association between the burden of copy number alteration as a continuous variable and the hazard of death or disease progression. RESULTS The burden of copy number alterations positively associated with radiologically evident distant metastases at diagnosis (P=0.00006) and showed a non-linear relationship with clinical outcome on univariable and multivariable analysis, characterised by a sharp increase in the relative risk of progression (P=0.003) and death (P=0.045) for each unit increase, stabilising into more modest increases with higher copy number burdens. This association between copy number burden and outcome was similar in each metastatic state. Copy number loss occurred significantly more frequently than gain at the lowest copy number burden quartile (q=4.1 × 10-6). Loss of segments in chromosome 5q21-22 and gains at 8q21-24, respectively including CHD1 and cMYC occurred more frequently in cases with higher copy number alteration (for either region: Kolmogorov-Smirnov distance, 0.5; adjusted P<0.0001). Copy number alterations showed variability across tumour regions in the same prostate. This variance associated with increased risk of distant metastases (Kruskal-Wallis test P=0.037). CONCLUSIONS Copy number alteration in advanced prostate cancer associates with increased risk of metastases at diagnosis. Accumulation of a limited number of copy number alterations associates with most of the increased risk of disease progression and death. The increased likelihood of involvement of specific segments in high copy number alteration burden cancers may suggest an order underlying the accumulation of copy number changes. TRIAL REGISTRATION ClinicalTrials.gov NCT00268476 , registered on December 22, 2005. EudraCT 2004-000193-31 , registered on October 4, 2004.
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Affiliation(s)
- Emily Grist
- Cancer Institute, University College London, London, UK
| | | | | | | | - Marina Parry
- Cancer Institute, University College London, London, UK
| | - Adnan Ali
- GU Cancer Research/FASTMAN Group, Manchester Cancer Institute, Manchester, UK
| | - Aine Haran
- The Christie and Salford Royal NHS Foundation Trusts, Manchester, UK
| | - Alex Hoyle
- The Christie and Salford Royal NHS Foundation Trusts, Manchester, UK
| | - Claire Gilson
- MRC Clinical Trials Unit at University College London, London, UK
| | | | - Leila Zakka
- Cancer Institute, University College London, London, UK
| | | | - Alex Landless
- Cancer Institute, University College London, London, UK
| | | | - Anna Wingate
- Cancer Institute, University College London, London, UK
| | | | | | - Nafisah B Akato
- MRC Clinical Trials Unit at University College London, London, UK
| | - Malissa Richmond
- MRC Clinical Trials Unit at University College London, London, UK
| | - Sofeya Ishaq
- MRC Clinical Trials Unit at University College London, London, UK
| | - Nik Matthews
- The Institute of Cancer Research, London, UK
- Imperial College, London, UK
| | - Anis A Hamid
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | | | - Matthew R Sydes
- MRC Clinical Trials Unit at University College London, London, UK
| | - Daniel M Berney
- Barts Cancer Institute, Queen Mary University of London, London, UK
| | - Stefano Lise
- Cancer Institute, University College London, London, UK
| | | | - Noel W Clarke
- GU Cancer Research/FASTMAN Group, Manchester Cancer Institute, Manchester, UK
| | - Nicholas D James
- The Royal Marsden Hospital NHS Foundation Trust and The Institute of Cancer Research, London, UK
| | | | - Louise C Brown
- MRC Clinical Trials Unit at University College London, London, UK
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12
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Sekhoacha M, Riet K, Motloung P, Gumenku L, Adegoke A, Mashele S. Prostate Cancer Review: Genetics, Diagnosis, Treatment Options, and Alternative Approaches. Molecules 2022; 27:molecules27175730. [PMID: 36080493 PMCID: PMC9457814 DOI: 10.3390/molecules27175730] [Citation(s) in RCA: 151] [Impact Index Per Article: 75.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 08/29/2022] [Accepted: 08/30/2022] [Indexed: 01/07/2023] Open
Abstract
Simple Summary Prostate cancer affects men of all racial and ethnic groups and leads to higher rates of mortality in those belonging to a lower socioeconomic status due to late detection of the disease. There is growing evidence that suggests the contribution of an individual’s genetic profile to prostate cancer. Currently used prostate cancer treatments have serious adverse effects; therefore, new research is focusing on alternative treatment options such as the use of genetic biomarkers for targeted gene therapy, nanotechnology for controlled targeted treatment, and further exploring medicinal plants for new anticancer agents. In this review, we describe the recent advances in prostate cancer research. Abstract Prostate cancer is one of the malignancies that affects men and significantly contributes to increased mortality rates in men globally. Patients affected with prostate cancer present with either a localized or advanced disease. In this review, we aim to provide a holistic overview of prostate cancer, including the diagnosis of the disease, mutations leading to the onset and progression of the disease, and treatment options. Prostate cancer diagnoses include a digital rectal examination, prostate-specific antigen analysis, and prostate biopsies. Mutations in certain genes are linked to the onset, progression, and metastasis of the cancer. Treatment for localized prostate cancer encompasses active surveillance, ablative radiotherapy, and radical prostatectomy. Men who relapse or present metastatic prostate cancer receive androgen deprivation therapy (ADT), salvage radiotherapy, and chemotherapy. Currently, available treatment options are more effective when used as combination therapy; however, despite available treatment options, prostate cancer remains to be incurable. There has been ongoing research on finding and identifying other treatment approaches such as the use of traditional medicine, the application of nanotechnologies, and gene therapy to combat prostate cancer, drug resistance, as well as to reduce the adverse effects that come with current treatment options. In this article, we summarize the genes involved in prostate cancer, available treatment options, and current research on alternative treatment options.
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Affiliation(s)
- Mamello Sekhoacha
- Department of Pharmacology, University of the Free State, Bloemfontein 9300, South Africa
- Correspondence:
| | - Keamogetswe Riet
- Department of Health Sciences, Central University of Technology, Bloemfontein 9300, South Africa
| | - Paballo Motloung
- Department of Health Sciences, Central University of Technology, Bloemfontein 9300, South Africa
| | - Lemohang Gumenku
- Department of Health Sciences, Central University of Technology, Bloemfontein 9300, South Africa
| | - Ayodeji Adegoke
- Department of Pharmacology, University of the Free State, Bloemfontein 9300, South Africa
- Cancer Research and Molecular Biology Laboratories, Department of Biochemistry, College of Medicine, University of Ibadan, Ibadan 200005, Nigeria
| | - Samson Mashele
- Department of Health Sciences, Central University of Technology, Bloemfontein 9300, South Africa
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13
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Geng JH, Plym A, Penney KL, Pomerantz M, Mucci LA, Kibel AS. Metabolic syndrome and its pharmacologic treatment are associated with the time to castration-resistant prostate cancer. Prostate Cancer Prostatic Dis 2022; 25:320-326. [PMID: 35075214 DOI: 10.1038/s41391-022-00494-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 12/22/2021] [Accepted: 01/12/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Metabolic syndrome and its pharmacologic treatment can potentially influence the progression of prostate cancer in men receiving androgen deprivation therapy (ADT). We aimed to evaluate the association between metabolic syndrome and its pharmacologic treatment with time to castration-resistant prostate cancer (CRPC). METHODS We identified 409 men with metastatic castration-sensitive prostate cancer receiving first line ADT from 1996 to 2014 at our institution. Information concerning metabolic syndrome, statin use, aspirin use, and metformin use at initiation of ADT was collected from medical records. Time to CRPC was defined as the duration between initiating ADT and diagnosis of CRPC based on the Prostate Cancer Working Group 3 definition. Flexible parametric survival models were used to calculate hazard ratios (HR, and 95% confidence intervals, CI) of the association between metabolic conditions and time from ADT initiation to CRPC. RESULTS During a median follow-up of 59 months, 87% (N = 356) men progressed to CRPC. Median time to CRPC was 19 months. Fifty-six percent of men met the definition of metabolic syndrome. Controlling for demographic and prostate cancer-specific variables, metabolic syndrome was associated with shorter time to CRPC (HR 1.41, 95% CI 1.09-1.81). Importantly, in men with metabolic syndrome, statin use was associated with a slower progression to CRPC (HR 0.70, 95% CI 0.49-0.98). CONCLUSIONS Our study suggests that metabolic syndrome is a risk factor for earlier progression from castration-sensitive to castration-resistant prostate cancer and raises the possibility that treatment, such as statin use, may slow the time to progression.
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Affiliation(s)
- Jiun-Hung Geng
- Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. .,Department of Urology, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan. .,Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
| | - Anna Plym
- Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Kathryn L Penney
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Channing Division of Network Medicine, Harvard Medical School and Brigham & Women's Hospital, Boston, MA, USA
| | - Mark Pomerantz
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Lorelei A Mucci
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Adam S Kibel
- Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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14
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Chen CL, Lin CY, Kung HJ. Targeting Mitochondrial OXPHOS and Their Regulatory Signals in Prostate Cancers. Int J Mol Sci 2021; 22:13435. [PMID: 34948229 PMCID: PMC8708687 DOI: 10.3390/ijms222413435] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 12/13/2021] [Accepted: 12/13/2021] [Indexed: 12/26/2022] Open
Abstract
Increasing evidence suggests that tumor development requires not only oncogene/tumor suppressor mutations to drive the growth, survival, and metastasis but also metabolic adaptations to meet the increasing energy demand for rapid cellular expansion and to cope with the often nutritional and oxygen-deprived microenvironment. One well-recognized strategy is to shift the metabolic flow from oxidative phosphorylation (OXPHOS) or respiration in mitochondria to glycolysis or fermentation in cytosol, known as Warburg effects. However, not all cancer cells follow this paradigm. In the development of prostate cancer, OXPHOS actually increases as compared to normal prostate tissue. This is because normal prostate epithelial cells divert citrate in mitochondria for the TCA cycle to the cytosol for secretion into seminal fluid. The sustained level of OXPHOS in primary tumors persists in progression to an advanced stage. As such, targeting OXPHOS and mitochondrial activities in general present therapeutic opportunities. In this review, we summarize the recent findings of the key regulators of the OXPHOS pathway in prostate cancer, ranging from transcriptional regulation, metabolic regulation to genetic regulation. Moreover, we provided a comprehensive update of the current status of OXPHOS inhibitors for prostate cancer therapy. A challenge of developing OXPHOS inhibitors is to selectively target cancer mitochondria and spare normal counterparts, which is also discussed.
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Affiliation(s)
- Chia-Lin Chen
- Ph.D. Program for Cancer Biology and Drug Discovery, College of Medical Science and Technology, Taipei Medical University, Taipei 110, Taiwan; (C.-L.C.); (C.-Y.L.)
| | - Ching-Yu Lin
- Ph.D. Program for Cancer Biology and Drug Discovery, College of Medical Science and Technology, Taipei Medical University, Taipei 110, Taiwan; (C.-L.C.); (C.-Y.L.)
| | - Hsing-Jien Kung
- Ph.D. Program for Cancer Biology and Drug Discovery, College of Medical Science and Technology, Taipei Medical University, Taipei 110, Taiwan; (C.-L.C.); (C.-Y.L.)
- Research Center of Cancer Translational Medicine, Taipei Medical University, Taipei 110, Taiwan
- Institute of Molecular and Genomic Medicine, National Health Research Institutes, Zhunan, Miaoli County 350, Taiwan
- Comprehensive Cancer Center, Department of Biochemistry and Molecular Medicine, University of California at Davis, Sacramento, CA 95817, USA
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15
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Kim JO, McDonald MO, Ong A, Koul R, Dubey A, Hunter W, Ahmed S, Quon H, Yee D, Parliament M, Sivananthan G, Danielson B, Rowe L, Ghosh S, Usmani N. Gastrointestinal and genitourinary toxicity profiles of metformin versus placebo in men with prostate cancer receiving prostate radiotherapy: interim toxicity results of a double-blinded, multicenter, phase II randomized controlled trial. Radiat Oncol 2021; 16:212. [PMID: 34736499 PMCID: PMC8567697 DOI: 10.1186/s13014-021-01935-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 10/20/2021] [Indexed: 11/13/2022] Open
Abstract
Androgen deprivation therapy (ADT) used for prostate cancer (PCa) management is associated with metabolic and anthropometric toxicity. Metformin given concurrent to ADT is hypothesized to counteract these changes. This planned interim analysis reports the gastrointestinal and genitourinary toxicity profiles of PCa patients receiving ADT and prostate/pelvic radiotherapy plus metformin versus placebo as part of a phase 2 randomized controlled trial. Men with intermediate or high-risk PCa were randomized 1:1 to metformin versus placebo. Both groups were given ADT for 18–36 months with minimum 2-month neoadjuvant phase prior to radiotherapy. Acute gastrointestinal and genitourinary toxicities were quantified using CTCAE v4.0. Differences in ≥ grade 2 toxicities by treatment were assessed by chi-squared test. 83 patients were enrolled with 44 patients randomized to placebo and 39 randomized to metformin. There were no significant differences at any time point in ≥ grade 2 gastrointestinal toxicities or overall gastrointestinal toxicity. Overall ≥ grade 2 gastrointestinal toxicity was low prior to radiotherapy (7.9% (placebo) vs. 3.1% (metformin), p = 0.39) and at the end of radiotherapy (2.8% (placebo) vs 3.1% (metformin), p = 0.64). There were no differences in overall ≥ grade 2 genitourinary toxicity between treatment arms (19.0% (placebo) vs. 9.4% (metformin), p = 0.30). Metformin added to radiotherapy and ADT did not increase rates of ≥ grade 2 gastrointestinal or genitourinary toxicity and is generally safe and well-tolerated.
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Affiliation(s)
- Julian O Kim
- Radiation Oncology, Department of Radiology, Max Rady Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada. .,CancerCare Manitoba Research Institute, CancerCare Manitoba, 675 McDermot Ave, Winnipeg, Manitoba, R3E 0V9, Canada.
| | - Megan O McDonald
- Postgraduate Medical Education, Max Rady Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Aldrich Ong
- Radiation Oncology, Department of Radiology, Max Rady Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Rashmi Koul
- Radiation Oncology, Department of Radiology, Max Rady Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Arbind Dubey
- Radiation Oncology, Department of Radiology, Max Rady Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - William Hunter
- Radiation Oncology, Department of Radiology, Max Rady Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.,Western Manitoba Cancer Center, Brandon, Manitoba, Canada
| | - Shahida Ahmed
- Radiation Oncology, Department of Radiology, Max Rady Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Harvey Quon
- Division of Radiation Oncology, Department of Oncology, University of Calgary, Calgary, Alberta, Canada
| | - Don Yee
- Division of Radiation Oncology, Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - Matthew Parliament
- Division of Radiation Oncology, Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - Gokulan Sivananthan
- Radiation Oncology, Department of Radiology, Max Rady Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.,Western Manitoba Cancer Center, Brandon, Manitoba, Canada
| | - Brita Danielson
- Division of Radiation Oncology, Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - Lindsay Rowe
- Division of Radiation Oncology, Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - Sunita Ghosh
- Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - Nawaid Usmani
- Division of Radiation Oncology, Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
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16
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León-González AJ, Jiménez-Vacas JM, Fuentes-Fayos AC, Sarmento-Cabral A, Herrera-Martínez AD, Gahete MD, Luque RM. Role of metformin and other metabolic drugs in the prevention and therapy of endocrine-related cancers. Curr Opin Pharmacol 2021; 60:17-26. [PMID: 34311387 DOI: 10.1016/j.coph.2021.06.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 06/08/2021] [Accepted: 06/15/2021] [Indexed: 12/11/2022]
Abstract
Metabolic syndrome is associated with chronic diseases, including type 2 diabetes, cardiovascular diseases, and cancer. This review summarizes the current evidence on the antitumor effects of some relevant drugs currently used to manage metabolic-related pathologies (i.e. insulin and its analogs, metformin, statins, etc.) in endocrine-related cancers including breast cancer, prostate cancer, pituitary cancer, ovarian cancer, and neuroendocrine neoplasms. Although current evidence does not provide a clear antitumor role of several of these drugs, metformin seems to be a promising chemopreventive and adjuvant agent in cancer management, modulating tumor cell metabolism and microenvironment, through both AMP-activated protein kinase-dependent and -independent mechanisms. Moreover, its combination with statins might represent a promising therapeutic strategy to tackle the progression of endocrine-related tumors. However, further studies are needed to endorse the clinical relevance of these drugs as adjuvants for cancer chemotherapy.
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Affiliation(s)
- Antonio J León-González
- Maimonides Institute of Biomedical Research of Cordoba, 14004 Cordoba, Spain; Department of Cell Biology, Physiology and Immunology, University of Cordoba, 14014 Cordoba, Spain; Reina Sofia University Hospital, 14004 Cordoba, Spain; CIBER Physiopathology of Obesity and Nutrition, 14004 Cordoba, Spain; Department of Pharmacology, School of Pharmacy, University of Seville, 41012 Seville, Spain
| | - Juan M Jiménez-Vacas
- Maimonides Institute of Biomedical Research of Cordoba, 14004 Cordoba, Spain; Department of Cell Biology, Physiology and Immunology, University of Cordoba, 14014 Cordoba, Spain; Reina Sofia University Hospital, 14004 Cordoba, Spain; CIBER Physiopathology of Obesity and Nutrition, 14004 Cordoba, Spain
| | - Antonio C Fuentes-Fayos
- Maimonides Institute of Biomedical Research of Cordoba, 14004 Cordoba, Spain; Department of Cell Biology, Physiology and Immunology, University of Cordoba, 14014 Cordoba, Spain; Reina Sofia University Hospital, 14004 Cordoba, Spain; CIBER Physiopathology of Obesity and Nutrition, 14004 Cordoba, Spain
| | - Andre Sarmento-Cabral
- Maimonides Institute of Biomedical Research of Cordoba, 14004 Cordoba, Spain; Department of Cell Biology, Physiology and Immunology, University of Cordoba, 14014 Cordoba, Spain; Reina Sofia University Hospital, 14004 Cordoba, Spain; CIBER Physiopathology of Obesity and Nutrition, 14004 Cordoba, Spain
| | - Aura D Herrera-Martínez
- Maimonides Institute of Biomedical Research of Cordoba, 14004 Cordoba, Spain; Reina Sofia University Hospital, 14004 Cordoba, Spain; CIBER Physiopathology of Obesity and Nutrition, 14004 Cordoba, Spain; Endocrinology and Nutrition Service, Reina Sofia University Hospital, Córdoba, Spain
| | - Manuel D Gahete
- Maimonides Institute of Biomedical Research of Cordoba, 14004 Cordoba, Spain; Department of Cell Biology, Physiology and Immunology, University of Cordoba, 14014 Cordoba, Spain; Reina Sofia University Hospital, 14004 Cordoba, Spain; CIBER Physiopathology of Obesity and Nutrition, 14004 Cordoba, Spain
| | - Raúl M Luque
- Maimonides Institute of Biomedical Research of Cordoba, 14004 Cordoba, Spain; Department of Cell Biology, Physiology and Immunology, University of Cordoba, 14014 Cordoba, Spain; Reina Sofia University Hospital, 14004 Cordoba, Spain; CIBER Physiopathology of Obesity and Nutrition, 14004 Cordoba, Spain.
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17
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Alghandour R, Ebrahim MA, Elshal AM, Ghobrial F, Elzaafarany M, ELbaiomy MA. Repurposing metformin as anticancer drug: Randomized controlled trial in advanced prostate cancer (MANSMED). Urol Oncol 2021; 39:831.e1-831.e10. [PMID: 34167872 DOI: 10.1016/j.urolonc.2021.05.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 05/01/2021] [Accepted: 05/17/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND The proposal of metformin as an anticancer drug has been explored in many types of cancers. Metformin may act synergistically with standard prostate cancer therapies. However, there is still a debate about the effect of metformin on hormone sensitive prostate cancer (HSPC). PATIENTS AND METHODS randomized controlled trial. Eligible patients were high risk locally advanced or metastatic HSPC. Patients were randomly assigned to receive either metformin plus standard of care or standard of care alone. The primary endpoint was castration-resistant prostate cancer-free survival (CRPC-FS). The secondary endpoints were overall survival, PSA level and adverse events. RESULTS A total number of 124 patients underwent randomization where 62 patients were allocated in each arm. Over a median follow up of 22 months, the CRPC-FS was significantly improved with metformin (29 months, 95% CI 25-33 vs. 20 months 95% CI 16-24; P = 0.01). After subgroup analysis, the addition of metformin improved the CRPC-FS in patients with high risk localized disease (median not reached vs. 25 months, 95% CI 18-31; P = 0.02) and in patients with metastatic low tumor volume disease (median not reached vs. 15 months, 95% CI 5-25; P = 0.009). No significant difference in overall survival or PSA response in both treatment arms (P = 0.1 and 0.5, respectively). Metformin was not associated with significant adverse events apart from grade II diarrhea. CONCLUSION Metformin is a safe and low-cost drug. Combining with androgen deprivation therapy improves the outcome in locally advanced or metastatic prostate cancer. Patients with low volume metastatic prostate cancer seem to drive more benefit.
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Affiliation(s)
- Reham Alghandour
- Medical Oncology Unit, OCMU - Oncology Center - Mansoura University, Mansoura, Egypt
| | - Mohamed A Ebrahim
- Medical Oncology Unit, OCMU - Oncology Center - Mansoura University, Mansoura, Egypt
| | - Ahmed M Elshal
- Department of Urology, Urology and Nephrology center -Mansoura University, Mansoura, Egypt
| | - Fady Ghobrial
- Medical Oncology Unit, OCMU - Oncology Center - Mansoura University, Mansoura, Egypt
| | - Maha Elzaafarany
- Medical Oncology Unit, OCMU - Oncology Center - Mansoura University, Mansoura, Egypt
| | - Mohamed A ELbaiomy
- Medical Oncology Unit, OCMU - Oncology Center - Mansoura University, Mansoura, Egypt.
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18
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Knura M, Garczorz W, Borek A, Drzymała F, Rachwał K, George K, Francuz T. The Influence of Anti-Diabetic Drugs on Prostate Cancer. Cancers (Basel) 2021; 13:cancers13081827. [PMID: 33921222 PMCID: PMC8068793 DOI: 10.3390/cancers13081827] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 03/27/2021] [Accepted: 04/08/2021] [Indexed: 12/13/2022] Open
Abstract
The incidences of prostate cancer (PC) and diabetes are increasing, with a sustained trend. The occurrence of PC and type 2 diabetes mellitus (T2DM) is growing with aging. The correlation between PC occurrence and diabetes is noteworthy, as T2DM is correlated with a reduced risk of incidence of prostate cancer. Despite this reduction, diabetes mellitus increases the mortality in many cancer types, including prostate cancer. The treatment of T2DM is based on lifestyle changes and pharmacological management. Current available drugs, except insulin, are aimed at increasing insulin secretion (sulfonylureas, incretin drugs), improving insulin sensitivity (biguanides, thiazolidinediones), or increasing urinary glucose excretion (gliflozin). Comorbidities should be taken into consideration during the treatment of T2DM. This review describes currently known information about the mechanism and impact of commonly used antidiabetic drugs on the incidence and progression of PC. Outcomes of pre-clinical studies are briefly presented and their correlations with available clinical trials have also been observed. Available reports and meta-analyses demonstrate that most anti-diabetic drugs do not increase the risk during the treatment of patients with PC. However, some reports show a potential advantage of treatment of T2DM with specific drugs. Based on clinical reports, use of metformin should be considered as a therapeutic option. Moreover, anticancer properties of metformin were augmented while combined with GLP-1 analogs.
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Virgo KS, Rumble RB, de Wit R, Mendelson DS, Smith TJ, Taplin ME, Wade JL, Bennett CL, Scher HI, Nguyen PL, Gleave M, Morgan SC, Loblaw A, Sachdev S, Graham DL, Vapiwala N, Sion AM, Simons VH, Talcott J. Initial Management of Noncastrate Advanced, Recurrent, or Metastatic Prostate Cancer: ASCO Guideline Update. J Clin Oncol 2021; 39:1274-1305. [PMID: 33497248 DOI: 10.1200/jco.20.03256] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 11/23/2020] [Indexed: 01/08/2023] Open
Abstract
PURPOSE Update all preceding ASCO guidelines on initial hormonal management of noncastrate advanced, recurrent, or metastatic prostate cancer. METHODS The Expert Panel based recommendations on a systematic literature review. Recommendations were approved by the Expert Panel and the ASCO Clinical Practice Guidelines Committee. RESULTS Four clinical practice guidelines, one clinical practice guidelines endorsement, 19 systematic reviews with or without meta-analyses, 47 phase III randomized controlled trials, nine cohort studies, and two review papers informed the guideline update. RECOMMENDATIONS Docetaxel, abiraterone, enzalutamide, or apalutamide, each when administered with androgen deprivation therapy (ADT), represent four separate standards of care for noncastrate metastatic prostate cancer. Currently, the use of any of these agents in any particular combination or series cannot be recommended. ADT plus docetaxel, abiraterone, enzalutamide, or apalutamide should be offered to men with metastatic noncastrate prostate cancer, including those who received prior therapies, but have not yet progressed. The combination of ADT plus abiraterone and prednisolone should be considered for men with noncastrate locally advanced nonmetastatic prostate cancer who have undergone radiotherapy, rather than castration monotherapy. Immediate ADT may be offered to men who initially present with noncastrate locally advanced nonmetastatic disease who have not undergone previous local treatment and are unwilling or unable to undergo radiotherapy. Intermittent ADT may be offered to men with high-risk biochemically recurrent nonmetastatic prostate cancer. Active surveillance may be offered to men with low-risk biochemically recurrent nonmetastatic prostate cancer. The panel does not support use of either micronized abiraterone acetate or the 250 mg dose of abiraterone with a low-fat breakfast in the noncastrate setting at this time.Additional information is available at www.asco.org/genitourinary-cancer-guidelines.
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Affiliation(s)
| | | | | | | | | | | | - James L Wade
- Cancer Care Specialists of Illinois, Decatur, IL
| | | | - Howard I Scher
- Memorial Sloan Kettering Cancer Center & Weill Cornell Medical College, New York, NY
| | | | - Martin Gleave
- University of British Columbia, Vancouver, BC, Canada
| | | | - Andrew Loblaw
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | | | | | | | - Amy M Sion
- Medical University of South Carolina, Charleston, SC
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20
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Roy S, Malone S, Grimes S, Morgan SC. Impact of Concomitant Medications on Biochemical Outcome in Localised Prostate Cancer Treated with Radiotherapy and Androgen Deprivation Therapy. Clin Oncol (R Coll Radiol) 2020; 33:181-190. [PMID: 32994091 DOI: 10.1016/j.clon.2020.09.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 08/11/2020] [Accepted: 09/14/2020] [Indexed: 02/07/2023]
Abstract
AIMS Several classes of concomitant medications have been shown to affect oncological outcomes in patients with prostate cancer (PCa). We assessed the association between the use of commonly prescribed concomitant medications and biochemical relapse-free survival (bRFS) in patients with localised PCa treated with radiotherapy and androgen deprivation therapy (ADT). MATERIALS AND METHODS A secondary pooled analysis of two phase III randomised trials was carried out. In the first trial, patients with localised PCa with clinical stage T1b-T3, prostate-specific antigen <30 ng/ml and Gleason score ≤7 were treated with radical radiotherapy and 6 months of ADT starting 4 months before or concomitantly with radiotherapy. In the second trial, patients with high-risk PCa were treated with radical radiotherapy and 36 months of ADT with randomisation to three-dimensional conformal or intensity-modulated radiotherapy. Information on concomitant medications was collected from the medical record. Univariable and multivariable Cox regression was used to identify factors associated with bRFS. RESULTS Overall, 486 patients were evaluable. The median follow-up was 125 months; 10-year bRFS was 83.7%. On univariable analysis, receipt of metformin was significantly associated with worse bRFS. Ten-year bRFS was 73% and 85% for patients with and without concomitant metformin (adjusted hazard ratio 2.11, 95% confidence interval 1.03-4.33). Similar evidence of an association was observed with sulfonamide-based α1-receptor blockers (adjusted hazard ratio 2.72, 95% confidence interval 1.31-5.66). However, no such association was seen with receipt of quinazoline-based α1-receptor blockers (adjusted hazard ratio 1.09, 95% confidence interval 0.42-2.82). There was no significant association between bRFS and receipt of all other medication classes considered. CONCLUSIONS In this population of patients with localised PCa treated with radiotherapy and ADT, receipt of concomitant metformin and sulfonamide-based α1-receptor blockers was associated with inferior biochemical outcome. Randomised trials are required to assess the true effect of these medications on oncological outcomes in localised PCa.
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Affiliation(s)
- S Roy
- Radiation Medicine Program, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - S Malone
- Radiation Medicine Program, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; Division of Radiation Oncology, University of Ottawa, Ottawa, Ontario, Canada
| | - S Grimes
- Radiation Medicine Program, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada
| | - S C Morgan
- Radiation Medicine Program, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; Division of Radiation Oncology, University of Ottawa, Ottawa, Ontario, Canada.
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21
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Dinić J, Efferth T, García-Sosa AT, Grahovac J, Padrón JM, Pajeva I, Rizzolio F, Saponara S, Spengler G, Tsakovska I. Repurposing old drugs to fight multidrug resistant cancers. Drug Resist Updat 2020; 52:100713. [PMID: 32615525 DOI: 10.1016/j.drup.2020.100713] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 06/04/2020] [Accepted: 06/06/2020] [Indexed: 02/08/2023]
Abstract
Overcoming multidrug resistance represents a major challenge for cancer treatment. In the search for new chemotherapeutics to treat malignant diseases, drug repurposing gained a tremendous interest during the past years. Repositioning candidates have often emerged through several stages of clinical drug development, and may even be marketed, thus attracting the attention and interest of pharmaceutical companies as well as regulatory agencies. Typically, drug repositioning has been serendipitous, using undesired side effects of small molecule drugs to exploit new disease indications. As bioinformatics gain increasing popularity as an integral component of drug discovery, more rational approaches are needed. Herein, we show some practical examples of in silico approaches such as pharmacophore modelling, as well as pharmacophore- and docking-based virtual screening for a fast and cost-effective repurposing of small molecule drugs against multidrug resistant cancers. We provide a timely and comprehensive overview of compounds with considerable potential to be repositioned for cancer therapeutics. These drugs are from diverse chemotherapeutic classes. We emphasize the scope and limitations of anthelmintics, antibiotics, antifungals, antivirals, antimalarials, antihypertensives, psychopharmaceuticals and antidiabetics that have shown extensive immunomodulatory, antiproliferative, pro-apoptotic, and antimetastatic potential. These drugs, either used alone or in combination with existing anticancer chemotherapeutics, represent strong candidates to prevent or overcome drug resistance. We particularly focus on outcomes and future perspectives of drug repositioning for the treatment of multidrug resistant tumors and discuss current possibilities and limitations of preclinical and clinical investigations.
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Affiliation(s)
- Jelena Dinić
- Department of Neurobiology, Institute for Biological Research "Siniša Stanković" - National Institute of Republic of Serbia, University of Belgrade, Bulevar Despota Stefana 142, 11060 Belgrade, Serbia
| | - Thomas Efferth
- Department of Pharmaceutical Biology, Institute of Pharmaceutical and Biomedical Sciences, Johannes Gutenberg University, Staudinger Weg 5, 55128 Mainz, Germany
| | | | - Jelena Grahovac
- Department of Experimental Oncology, Institute for Oncology and Radiology of Serbia, Pasterova 14, 11000 Belgrade, Serbia
| | - José M Padrón
- BioLab, Instituto Universitario de Bio-Orgánica Antonio González (IUBO AG), Universidad de La Laguna, Avda. Astrofísico Francisco Sánchez 2, E-38071 La Laguna, Spain.
| | - Ilza Pajeva
- Institute of Biophysics and Biomedical Engineering, Bulgarian Academy of Sciences, Acad. G. Bonchev Str., Bl. 105, 1113 Sofia, Bulgaria
| | - Flavio Rizzolio
- Department of Molecular Sciences and Nanosystems, Ca' Foscari University of Venice, 301724 Venezia-Mestre, Italy; Pathology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, 33081 Aviano, Italy
| | - Simona Saponara
- Department of Life Sciences, University of Siena, Via Aldo Moro 2, 53100 Siena, Italy
| | - Gabriella Spengler
- Department of Medical Microbiology and Immunobiology, Faculty of Medicine, University of Szeged, H-6720 Szeged, Dóm tér 10, Hungary
| | - Ivanka Tsakovska
- Institute of Biophysics and Biomedical Engineering, Bulgarian Academy of Sciences, Acad. G. Bonchev Str., Bl. 105, 1113 Sofia, Bulgaria
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22
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Affiliation(s)
- Daniel Taussky
- Department of Radiation Oncology, University of Montreal Health Center, Montreal, Canada.,CRCHUM-Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, Canada
| | - Guila Delouya
- Department of Radiation Oncology, University of Montreal Health Center, Montreal, Canada.,CRCHUM-Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, Canada
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23
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Linkeviciute-Ulinskiene D, Patasius A, Kincius M, Zabuliene L, Smailyte G. Preexisting diabetes, metformin use and long-term survival in patients with prostate cancer. Scand J Urol 2020; 54:401-407. [PMID: 32748714 DOI: 10.1080/21681805.2020.1798502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To assess prostate cancer-specific and overall survival in prostate cancer patients with or without preexisting type 2 diabetes mellitus (T2DM) with regards to metformin use. METHODS Patients diagnosed with prostate cancer in the Lithuanian population between 2001 and 2005 were identified through the Lithuanian Cancer Registry and followed until 2016, date of death, loss to follow-up or whichever came first. Information regarding the diagnosis of T2DM and antihyperglycemic medications were obtained from the National Health Insurance Fund database. Prostate cancer-specific and overall survival outcomes were analysed using univariate and multivariate Cox proportional hazard models. RESULTS Out of 6689 men included, 254 (3.8%) had preexisting T2DM. There were 4807 deaths during follow-up, including 2084 from prostate cancer. No differences were found in prostate cancer-specific survival between men with or without T2DM. The risk of overall mortality was higher (HR = 1.24, 95% CI = 1.07-1.43) in diabetic men. Univariate analysis showed cancer stage at diagnosis and age to be significant predictors of survival. After adjustment for age and stage at diagnosis, there was no difference in prostate-specific survival between non-diabetic patients compared to metformin users or metformin non-users. However, overall survival was lower in T2DM patients, with a higher mortality risk for metformin non-users (HR = 1.63, 95% CI = 1.27-2.10). Prostate cancer-specific mortality risk was insignificantly lower in diabetic men on metformin (HR = 0.74, 95% CI = 0.54-1.02). CONCLUSION There was no difference in long-term prostate cancer-specific survival in patients with or without T2DM. Overall survival was lower in T2DM patients not treated with metformin.
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Affiliation(s)
- Donata Linkeviciute-Ulinskiene
- Department of Pathology, Forensic Medicine and Pharmacology, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Ausvydas Patasius
- Laboratory of Cancer Epidemiology, National Cancer Institute, Vilnius, Lithuania.,Department of Public Health, Institute of Health Sciences, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Marius Kincius
- Department of Oncourology, National Cancer Institute, Vilnius, Lithuania
| | - Lina Zabuliene
- Clinic of Rheumatology, Orthopaedics, Traumatology and Reconstructive Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Giedre Smailyte
- Laboratory of Cancer Epidemiology, National Cancer Institute, Vilnius, Lithuania.,Department of Public Health, Institute of Health Sciences, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
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24
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The Evolution of Master Protocol Clinical Trial Designs: A Systematic Literature Review. Clin Ther 2020; 42:1330-1360. [DOI: 10.1016/j.clinthera.2020.05.010] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 04/10/2020] [Accepted: 05/11/2020] [Indexed: 02/07/2023]
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25
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Shorning BY, Dass MS, Smalley MJ, Pearson HB. The PI3K-AKT-mTOR Pathway and Prostate Cancer: At the Crossroads of AR, MAPK, and WNT Signaling. Int J Mol Sci 2020; 21:E4507. [PMID: 32630372 PMCID: PMC7350257 DOI: 10.3390/ijms21124507] [Citation(s) in RCA: 287] [Impact Index Per Article: 71.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 06/22/2020] [Accepted: 06/22/2020] [Indexed: 12/13/2022] Open
Abstract
Oncogenic activation of the phosphatidylinositol-3-kinase (PI3K), protein kinase B (PKB/AKT), and mammalian target of rapamycin (mTOR) pathway is a frequent event in prostate cancer that facilitates tumor formation, disease progression and therapeutic resistance. Recent discoveries indicate that the complex crosstalk between the PI3K-AKT-mTOR pathway and multiple interacting cell signaling cascades can further promote prostate cancer progression and influence the sensitivity of prostate cancer cells to PI3K-AKT-mTOR-targeted therapies being explored in the clinic, as well as standard treatment approaches such as androgen-deprivation therapy (ADT). However, the full extent of the PI3K-AKT-mTOR signaling network during prostate tumorigenesis, invasive progression and disease recurrence remains to be determined. In this review, we outline the emerging diversity of the genetic alterations that lead to activated PI3K-AKT-mTOR signaling in prostate cancer, and discuss new mechanistic insights into the interplay between the PI3K-AKT-mTOR pathway and several key interacting oncogenic signaling cascades that can cooperate to facilitate prostate cancer growth and drug-resistance, specifically the androgen receptor (AR), mitogen-activated protein kinase (MAPK), and WNT signaling cascades. Ultimately, deepening our understanding of the broader PI3K-AKT-mTOR signaling network is crucial to aid patient stratification for PI3K-AKT-mTOR pathway-directed therapies, and to discover new therapeutic approaches for prostate cancer that improve patient outcome.
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Affiliation(s)
| | | | | | - Helen B. Pearson
- The European Cancer Stem Cell Research Institute, Cardiff University, Hadyn Ellis Building, Maindy Road, Cardiff CF24 4HQ, Wales, UK; (B.Y.S.); (M.S.D.); (M.J.S.)
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26
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Chen K, Li Y, Guo Z, Zeng Y, Zhang W, Wang H. Metformin: current clinical applications in nondiabetic patients with cancer. Aging (Albany NY) 2020; 12:3993-4009. [PMID: 32074084 PMCID: PMC7066888 DOI: 10.18632/aging.102787] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 01/19/2020] [Indexed: 02/06/2023]
Abstract
Metformin is one of the most commonly used first-line oral medications for type 2 diabetes mellitus. Multiple observational studies, reviewed in numerous systematic reviews, have shown that metformin treatment may not only reduce the risk of cancer but may also improve the efficacy of cancer treatment in diabetic patients. Recent studies have been conducted to determine whether a similar protective effect can be demonstrated in nondiabetic cancer patients. However, the results are controversial. The potential optimal dose, schedule, and duration of metformin treatment and the heterogeneity of histological subtypes and genotypes among cancer patients might contribute to the different clinical benefits. In addition, as the immune property of metformin was investigated, further studies of the immunomodulatory effect of metformin on cancer cells should also be taken into account to optimize its clinical use. In this review, we present and discuss the latest findings regarding the anticancer potential of metformin in nondiabetic patients with cancer.
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Affiliation(s)
- Kailin Chen
- Key Laboratory of Translational Radiation Oncology, Hunan Province, Department of Radiation Oncology, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha 410013, Hunan, P.R. China
| | - Yajun Li
- Department of Lymphoma and Hematology, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha 410013, Hunan, P.R. China
| | - Zhen Guo
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University and Institute of Clinical Pharmacology, Central South University, Hunan Key Laboratory of Pharmacogenetics, Changsha 410008, Hunan, P.R. China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, Hunan, P.R. China
| | - Yong Zeng
- Translational Medicine Center, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha 410013, Hunan, P.R. China.,Engineering Technology Research Center for Diagnosis-Treatment and Application of Tumor Liquid Biopsy, Changsha 410013, Hunan, P.R. China
| | - Wei Zhang
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University and Institute of Clinical Pharmacology, Central South University, Hunan Key Laboratory of Pharmacogenetics, Changsha 410008, Hunan, P.R. China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, Hunan, P.R. China
| | - Hui Wang
- Key Laboratory of Translational Radiation Oncology, Hunan Province, Department of Radiation Oncology, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha 410013, Hunan, P.R. China
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27
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Yang BY, Gulinazi Y, Du Y, Ning CC, Cheng YL, Shan WW, Luo XZ, Zhang HW, Zhu Q, Ma FH, Liu J, Sun L, Yu M, Guan J, Chen XJ. Metformin plus megestrol acetate compared with megestrol acetate alone as fertility-sparing treatment in patients with atypical endometrial hyperplasia and well-differentiated endometrial cancer: a randomised controlled trial. BJOG 2020; 127:848-857. [PMID: 31961463 DOI: 10.1111/1471-0528.16108] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To assess the efficacy of metformin in megestrol acetate (MA)-based fertility-sparing treatment for patients with atypical endometrial hyperplasia (AEH) and endometrioid endometrial cancer (EEC). DESIGN A randomised, single-centre, open-label, controlled trial conducted between October 2013 and December 2017. SETTING Shanghai OBGYN Hospital of Fudan University, China. POPULATION A total of 150 patients (18-45 years old) with primary AEH or well-differentiated EEC were randomised into an MA group (n = 74) and an MA plus metformin group (n = 76). METHODS Patients with AEH or EEC were firstly stratified, then randomised to receive MA (160 mg orally, daily) or MA (160 mg orally, daily) plus metformin (500 mg orally, three times a day). MAIN OUTCOMES AND MEASURES The primary efficacy parameter was the cumulate complete response (CR) rate within 16 weeks of treatment (16w-CR rate); the secondary efficacy parameters were 30w-CR rate and adverse events. RESULTS The 16w-CR rate was higher in the metformin plus MA group than in the MA-only group (34.3 versus 20.7%, odds ratio [OR] 2.0, 95% confidence interval [CI] 0.89-4.51, P = 0.09) but the difference was more significant in 102 AEH patients (39.6 versus 20.4%, OR 2.56, 95% CI 1.06-6.21, P = 0.04). This effect of metformin was also significant in non-obese (51.4 versus 24.3%, OR 3.28, 95% CI 1.22-8.84, P = 0.02) and insulin-sensitive (54.8 versus 28.6%, OR 3.04, 95% CI 1.03-8.97, P = 0.04) subgroups of AEH women. No significant result was found in secondary endpoints. CONCLUSION As a fertility-sparing treatment, metformin plus MA was associated with a higher early CR rate compared with MA alone in AEH patients. TWEETABLE ABSTRACT For AEH patients, metformin plus MA might be a better fertility-sparing treatment to achieve a higher early CR rate compared with MA alone.
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Affiliation(s)
- B-Y Yang
- Department of Gynaecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai, China
| | - Y Gulinazi
- Department of Gynaecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai, China
| | - Y Du
- Department of Clinical Epidemiology, Obstetrics and Gynaecology Hospital, Fudan University, Shanghai, China
| | - C-C Ning
- Department of Gynaecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai, China
| | - Y-L Cheng
- Department of Gynaecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai, China
| | - W-W Shan
- Department of Gynaecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai, China
| | - X-Z Luo
- Department of Gynaecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai, China
| | - H-W Zhang
- Department of Cervical Diseases, Obstetrics and Gynaecology Hospital, Fudan University, Shanghai, China
| | - Q Zhu
- Department of Pathology, Obstetrics and Gynaecology Hospital, Fudan University, Shanghai, China
| | - F-H Ma
- Department of Radiology, Obstetrics and Gynaecology Hospital, Fudan University, Shanghai, China
| | - J Liu
- Department of Radiology, Obstetrics and Gynaecology Hospital, Fudan University, Shanghai, China
| | - L Sun
- Department of Sonography, Obstetrics and Gynaecology Hospital, Fudan University, Shanghai, China
| | - M Yu
- Shanghai JiAi Genetics and IVF Institute, Obstetrics and Gynaecology Hospital, Fudan University, Shanghai, China
| | - J Guan
- Department of Gynaecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai, China.,Department of Gynaecology, Campus Virchow Clinic, Charite Medical University of Berlin, corporate member of Free University Berlin, Humboldt-University Berlin, Berlin Institute of Health, Berlin, Germany
| | - X-J Chen
- Department of Gynaecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai, China
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Velaer KN, Leppert JT. Diabetes Medications, Prostate-Specific Antigen Values, and the Chemoprevention of Prostate Cancer. JAMA Netw Open 2019; 2:e1914644. [PMID: 31693117 DOI: 10.1001/jamanetworkopen.2019.14644] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Affiliation(s)
- Kyla N Velaer
- Department of Urology, Stanford University Medical School, Stanford, California
| | - John T Leppert
- Department of Urology, Stanford University Medical School, Stanford, California
- Department of Medicine, Stanford University Medical School, Stanford, California
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29
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Narayan VM, Dahm P. The future of clinical trials in urological oncology. Nat Rev Urol 2019; 16:722-733. [PMID: 31605037 DOI: 10.1038/s41585-019-0243-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2019] [Indexed: 12/11/2022]
Abstract
Well-designed clinical trials in urological oncology help to guide treatment decisions and aid in counselling patients, ultimately serving to improve outcomes. Since the term evidence-based medicine was first used by Gordon Guyatt in 1991, a renewed emphasis on methodology, transparent trial design and study reporting has helped to improve clinical research and in turn, the landscape of medical literature. Novel clinical trial designs (including multi-arm, multistage trials, basket and umbrella studies and research from big data sources, such as electronic health records, administrative claims databases and quality monitoring registries) are well suited to advance innovation in urological oncology. Existing urological clinical trials are often limited by small numbers, are statistically underpowered and many face difficulties with accrual. Thus, efforts to improve trial design are of considerable importance. The development and use of standard outcome sets and adherence to reporting guidelines offer researchers the opportunity to guide value-oriented care, minimize research waste and efficiently identify solutions to the unanswered questions in urology cancer care.
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Affiliation(s)
- Vikram M Narayan
- Minneapolis VA Medical Center and University of Minnesota Department of Urology, Minneapolis, MN, 55417, USA.,University of Texas MD Anderson Cancer Center, Department of Urology, Houston, TX, 77030, USA
| | - Philipp Dahm
- Minneapolis VA Medical Center and University of Minnesota Department of Urology, Minneapolis, MN, 55417, USA.
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30
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31
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Current Treatment Options for Metastatic Hormone-Sensitive Prostate Cancer. Cancers (Basel) 2019; 11:cancers11091355. [PMID: 31547436 PMCID: PMC6770296 DOI: 10.3390/cancers11091355] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 09/05/2019] [Accepted: 09/10/2019] [Indexed: 02/08/2023] Open
Abstract
The possible treatments options for metastatic hormone-sensitive prostate cancer (mHSPC) have dramatically increased during the last years. The old backbone, which androgen-deprivation therapy (ADT) is the exclusive approach for hormone-naïve patients, has been disrupted. Despite the fact that several high-quality, randomized, controlled phase 3 trials have been conducted in this setting, no direct comparison is currently available among the different strategies. Inadequate power, absence of preplanning and small sample size frequently affect the subgroup analyses according to disease volume or patient's risk. The choice between ADT alone and ADT combined with docetaxel, abiraterone acetate, enzalutamide, apalutamide or radiotherapy to the primary tumor remains challenging. Factors that are related to the tumor, patient or drug side effects, currently guide these clinical decisions. This comprehensive review aims to indirectly compare the phase 3 trials in the mHSPC setting, in order to extrapolate data useful for treatment selection, providing also perspectives on future biomarkers.
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Weiner AB, Nettey OS, Morgans AK. Management of Metastatic Hormone-Sensitive Prostate Cancer (mHSPC): an Evolving Treatment Paradigm. Curr Treat Options Oncol 2019; 20:69. [PMID: 31286275 DOI: 10.1007/s11864-019-0668-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OPINION STATEMENT Combination systemic therapy is now standard of care for all men with metastatic, hormone-sensitive prostate cancer (mHSPC). Patients with mHSPC should be treated with standard androgen deprivation therapy (ADT) and abiraterone acetate with prednisone or docetaxel (chemohormoanl therapy) unless there are contraindications to combination therapy. Based on the Chemohormonal Therapy Versus Androgen Ablation Randomized Trial for Extensive Disease in Prostate Cancer (CHAARTED) study subgroup analysis, chemohormonal therapy may be most beneficial in men with high-volume disease burden, as men with low-volume metastatic disease do not appear to experience a survival benefit with chemohormonal therapy, while abiraterone in combination with ADT appears to be beneficial across both disease volume subgroups. Decisions regarding whether to use chemohormonal therapy or abiraterone and ADT for men with mHSPC should integrate consideration of volume of disease burden, quality of life effects, duration of therapy, and patient preferences for treatment as there is no formally powered prospective head-to-head comparison of these options demonstrating superiority of one approach over the other. Treatment of the primary tumor with radiation should be considered in men with de novo low-volume metastatic disease as radiation is associated with prolonged survival and a tolerable toxicity profile. Men with de novo high-volume metastatic disease do not appear to have improved survival with radiation of the primary tumor. Numerous clinical trials are ongoing to evaluate treatment approaches that may benefit men with mHSPC. Radical prostatectomy in men with mHSPC in combination with optimal systemic therapy is currently being assessed in a clinical trial, but should not be considered outside of a clinical trial. Metastasis-directed therapy with radiotherapy directed at metastatic lesions is still investigational, but can be considered in clinical trials in men with oligometastatic disease. Multiple studies are enrolling worldwide for men with mHSPC, and these should be considered for all interested patients.
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Affiliation(s)
- Adam B Weiner
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Oluwarotimi S Nettey
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Alicia K Morgans
- Department of Medicine, Northwestern University Feinberg School of Medicine, 676 N. St. Clair, Suite 850, Chicago, IL, 60611, USA.
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Schiavone F, Bathia R, Letchemanan K, Masters L, Amos C, Bara A, Brown L, Gilson C, Pugh C, Atako N, Hudson F, Parmar M, Langley R, Kaplan RS, Parker C, Attard G, Clarke NW, Gillessen S, James ND, Maughan T, Sydes MR. This is a platform alteration: a trial management perspective on the operational aspects of adaptive and platform and umbrella protocols. Trials 2019; 20:264. [PMID: 31138317 PMCID: PMC6540525 DOI: 10.1186/s13063-019-3216-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 01/19/2019] [Indexed: 12/25/2022] Open
Abstract
Background There are limited research and literature on the trial management challenges encountered in running adaptive platform trials. This trial design allows both (1) the seamless addition of new research comparisons when compelling clinical and scientific research questions emerge, and (2) early stopping of accrual to individual comparisons that do not show sufficient activity without affecting other active comparisons. Adaptive platform design trials also offer many potential benefits over traditional trials, from faster time to accrual to contemporaneously recruiting multiple research comparisons, added flexibility to focus on more promising research comparisons via pre-planned interim analyses and potentially shorter time to primary results. We share here our experiences from a trial management perspective, highlighting the challenges and successes. Methods We evaluated the operational aspects of making changes to these adaptive platform trials and identified both common and trial-specific challenges. The operational steps and challenges linked to both the addition of new research comparisons and stopping recruitment following pre-planned interim analysis were considered in our evaluation. Results Specific operational challenges in these adaptive platform protocols, additional to those in traditional two-arm trials, were identified. Key lessons are presented describing some of the solutions and considerations over conducting these trials. Careful consideration on the practicality of the protocol structure (modular versus single protocol), the longevity and continuity of trial oversight committees, and having clear clinical and scientific criteria for the addition of new research comparisons were identified as some of the most common challenges. Conclusions Understanding the operational complexities associated with running adaptive platform protocols is paramount for their conduct, adaptive platform trials offer an efficient model to run randomised controlled trials and we are continuing to work to reduce further the effort required from an operational perspective. Trial registration FOCUS4: ISRCTN Registry, ISRCTN90061546. Registered on 16 October 2013. STAMPEDE: ISRCTN Registry, ISRCTN78818544. Registered on 2 February 2004.
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Affiliation(s)
- Francesca Schiavone
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, 90 High Holborn, London, WC1V 6LJ, UK. .,MRC London Hub for Trials Methodology Research, London, UK.
| | - Riya Bathia
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, 90 High Holborn, London, WC1V 6LJ, UK.,MRC London Hub for Trials Methodology Research, London, UK
| | - Krishna Letchemanan
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, 90 High Holborn, London, WC1V 6LJ, UK.,MRC London Hub for Trials Methodology Research, London, UK
| | - Lindsey Masters
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, 90 High Holborn, London, WC1V 6LJ, UK.,MRC London Hub for Trials Methodology Research, London, UK
| | - Claire Amos
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, 90 High Holborn, London, WC1V 6LJ, UK.,MRC London Hub for Trials Methodology Research, London, UK
| | - Anna Bara
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, 90 High Holborn, London, WC1V 6LJ, UK.,MRC London Hub for Trials Methodology Research, London, UK
| | - Louise Brown
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, 90 High Holborn, London, WC1V 6LJ, UK.,MRC London Hub for Trials Methodology Research, London, UK
| | - Clare Gilson
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, 90 High Holborn, London, WC1V 6LJ, UK.,MRC London Hub for Trials Methodology Research, London, UK
| | - Cheryl Pugh
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, 90 High Holborn, London, WC1V 6LJ, UK.,MRC London Hub for Trials Methodology Research, London, UK
| | - Nafisah Atako
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, 90 High Holborn, London, WC1V 6LJ, UK.,MRC London Hub for Trials Methodology Research, London, UK
| | - Fleur Hudson
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, 90 High Holborn, London, WC1V 6LJ, UK.,MRC London Hub for Trials Methodology Research, London, UK
| | - Mahesh Parmar
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, 90 High Holborn, London, WC1V 6LJ, UK.,MRC London Hub for Trials Methodology Research, London, UK
| | - Ruth Langley
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, 90 High Holborn, London, WC1V 6LJ, UK.,MRC London Hub for Trials Methodology Research, London, UK
| | - Richard S Kaplan
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, 90 High Holborn, London, WC1V 6LJ, UK.,MRC London Hub for Trials Methodology Research, London, UK
| | - Chris Parker
- Institute of Cancer Research, Sutton, UK.,Royal Marsden Hospital, Sutton, UK
| | - Gert Attard
- UCL Cancer Institute, University College London, London, UK
| | | | - Silke Gillessen
- Division of Cancer Sciences, University of Manchester and the Christie, Manchester, UK.,Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Nicholas D James
- Institute of Cancer and Genomic Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - Tim Maughan
- Cancer Research UK/MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford, UK
| | - Matthew R Sydes
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, 90 High Holborn, London, WC1V 6LJ, UK.,MRC London Hub for Trials Methodology Research, London, UK
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Feng L, Liu T, Yang Y, Xiao W, Shi J, Mei X, Tian S, Liu X, Huang H, Bai Y. Metformin promotes proliferation and suppresses apoptosis in Ox-LDL stimulated macrophages by regulating the miR-34a/Bcl2 axis. RSC Adv 2019; 9:14670-14676. [PMID: 35516319 PMCID: PMC9064147 DOI: 10.1039/c9ra00705a] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Accepted: 04/22/2019] [Indexed: 12/25/2022] Open
Abstract
Background: Metformin, an antidiabetic drug, has been reported to be involved in atherosclerosis (AS). In this study, the effects of metformin on oxidized low-density lipoprotein (Ox-LDL)-induced macrophage apoptosis were investigated, and the mechanisms involved in this process were examined. Methods: qRT-qPCR analysis was performed to detect the expression of miR-34a in macrophage cells. Cell proliferation was determined by MTT assays and colony formation assays. Cell apoptosis was assessed by the detection of apoptotic rate and caspase 3 activity. Western blot analysis was performed to evaluate the expression of Bcl2 protein. Results: Metformin treatment promoted proliferation and suppressed apoptosis in macrophages following the treatment of oxidized low-density lipoprotein (Ox-LDL). Metformin could inhibit miR-34a in macrophages. miR-34a overexpression could reverse the effect of metformin on proliferation and apoptosis in Ox-LDL-treated macrophages. Moreover, metformin could increase the expression of the miR-34a target gene Bcl2. Furthermore, metformin treatment exerted the pro-proliferation and anti-apoptosis effect through regulating Bcl2 expression in Ox-LDL-stimulated macrophages. Conclusion: Metformin facilitated proliferation and inhibited apoptosis of macrophages treated with Ox-LDL through the miR-34a/Bcl2 axis, indicating the potential value of metformin in AS therapy.
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Affiliation(s)
- Liuliu Feng
- Department of Cardiology, Shidong Hospital Yangpu District Shanghai 200438 China +86-021-25066666-13101
| | - Tianhua Liu
- Department of Cardiology, Shidong Hospital Yangpu District Shanghai 200438 China +86-021-25066666-13101
| | - Yuya Yang
- Department of Cardiology, Shidong Hospital Yangpu District Shanghai 200438 China +86-021-25066666-13101
| | - Wenying Xiao
- Department of Cardiology, Shidong Hospital Yangpu District Shanghai 200438 China +86-021-25066666-13101
| | - Jun Shi
- Department of Cardiology, Shidong Hospital Yangpu District Shanghai 200438 China +86-021-25066666-13101
| | - Xiang Mei
- Department of Cardiology, Shidong Hospital Yangpu District Shanghai 200438 China +86-021-25066666-13101
| | - Songmei Tian
- Department of Cardiology, Shidong Hospital Yangpu District Shanghai 200438 China +86-021-25066666-13101
| | - Xinbing Liu
- Department of Cardiology, Shidong Hospital Yangpu District Shanghai 200438 China +86-021-25066666-13101
| | - Hongman Huang
- Department of Cardiology, Shidong Hospital Yangpu District Shanghai 200438 China +86-021-25066666-13101
| | - Yanyan Bai
- Department of Cardiology, Shidong Hospital Yangpu District Shanghai 200438 China +86-021-25066666-13101
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Mark M, Klingbiel D, Mey U, Winterhalder R, Rothermundt C, Gillessen S, von Moos R, Pollak M, Manetsch G, Strebel R, Cathomas R. Impact of Addition of Metformin to Abiraterone in Metastatic Castration-Resistant Prostate Cancer Patients With Disease Progressing While Receiving Abiraterone Treatment (MetAb-Pro): Phase 2 Pilot Study. Clin Genitourin Cancer 2019; 17:e323-e328. [PMID: 30686756 DOI: 10.1016/j.clgc.2018.12.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 12/23/2018] [Accepted: 12/26/2018] [Indexed: 01/15/2023]
Abstract
BACKGROUND There is evidence linking metformin to improved prostate cancer-related outcomes. PATIENTS AND METHODS Twenty-five men with metastatic castration-resistant prostate cancer and prostate-specific antigen (PSA) progression while receiving treatment with abiraterone from 3 Swiss centers were included in this single-arm phase 2 trial between November 2013 and September 2016. Metformin was added to abiraterone continuously at 1000 mg twice daily in uninterrupted 4-week cycles. The primary end point was the absence of disease progression at 12 weeks (PFS12). The Fleming single-stage design was applied. With a 5% significance level and 80% power, 25 patients were required to test PFS12 ≤ 15% (H0) compared to ≥ 35% (H1). Secondary end points included toxicity and safety issues. The study was registered at ClinicalTrials.gov (NCT01677897). RESULTS The primary end point PFS12 was 12% (3 of 25 patients) (95% confidence interval, 3-31). Most patients had PSA progression, almost half had radiographic progression, but only 1 patient had symptomatic progression. Eleven (44%) of 25 patients had grade 1 and 2 patients each grade 2 (8%) or grade 3 (8%) gastrointestinal toxicity (nausea, diarrhea, loss of appetite). One patient discontinued treatment at week 5 because of intolerable grade 3 diarrhea. CONCLUSION The addition of metformin to abiraterone for patients with metastatic castration-resistant prostate cancer and PSA progression while receiving abiraterone therapy does not affect further progression and has no meaningful clinical benefit. A higher-than-expected gastrointestinal toxicity attributed to metformin was observed.
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Affiliation(s)
| | | | - Ulrich Mey
- Kantonsspital Graubünden, Chur, Switzerland
| | | | | | | | | | - Michael Pollak
- Lady Davis Institute for Medical Research Jewish General Hospital Montreal, Montreal, Canada
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Sarkar PL, Lee W, Williams ED, Lubik AA, Stylianou N, Shokoohmand A, Lehman ML, Hollier BG, Gunter JH, Nelson CC. Insulin Enhances Migration and Invasion in Prostate Cancer Cells by Up-Regulation of FOXC2. Front Endocrinol (Lausanne) 2019; 10:481. [PMID: 31379747 PMCID: PMC6652804 DOI: 10.3389/fendo.2019.00481] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 07/03/2019] [Indexed: 12/28/2022] Open
Abstract
Androgen deprivation therapy (ADT) is the standard treatment for advanced prostate cancer (PCa), yet many patients relapse with lethal metastatic disease. With this loss of androgens, increased cell plasticity has been observed as an adaptive response to ADT. This includes gain of invasive and migratory capabilities, which may contribute to PCa metastasis. Hyperinsulinemia, which develops as a side-effect of ADT, has been associated with increased tumor aggressiveness and faster treatment failure. We investigated the direct effects of insulin in PCa cells that may contribute to this progression. We measured cell migration and invasion induced by insulin using wound healing and transwell assays in a range of PCa cell lines of variable androgen dependency (LNCaP, 22RV1, DuCaP, and DU145 cell lines). To determine the molecular events driving insulin-induced invasion we used transcriptomics, quantitative real time-PCR, and immunoblotting in three PCa cell lines. Insulin increased invasiveness of PCa cells, upregulating Forkhead Box Protein C2 (FOXC2), and activating key PCa cell plasticity mechanisms including gene changes consistent with epithelial-to-mesenchymal transition (EMT) and a neuroendocrine phenotype. Additionally, analysis of publicly available clinical PCa tumor data showed metastatic prostate tumors demonstrate a positive correlation between insulin receptor expression and the EMT transcription factor FOXC2. The insulin receptor is not suitable to target clinically however, our data shows that actions of insulin in PCa cells may be suppressed by inhibiting downstream signaling molecules, PI3K and ERK1/2. This study identifies for the first time, a mechanism for insulin-driven cancer cell motility and supports the concept that targeting insulin signaling at the level of the PCa tumor may extend the therapeutic efficacy of ADT.
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Affiliation(s)
- Phoebe L. Sarkar
- Queensland University of Technology (QUT), Australian Prostate Cancer Research Centre-Queensland, Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Faculty of Health, Translational Research Institute, Brisbane, QLD, Australia
| | - Wendy Lee
- Queensland University of Technology (QUT), Australian Prostate Cancer Research Centre-Queensland, Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Faculty of Health, Translational Research Institute, Brisbane, QLD, Australia
| | - Elizabeth D. Williams
- Queensland University of Technology (QUT), Australian Prostate Cancer Research Centre-Queensland, Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Faculty of Health, Translational Research Institute, Brisbane, QLD, Australia
| | - Amy A. Lubik
- Vancouver Prostate Centre, Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Nataly Stylianou
- Queensland University of Technology (QUT), Australian Prostate Cancer Research Centre-Queensland, Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Faculty of Health, Translational Research Institute, Brisbane, QLD, Australia
| | - Ali Shokoohmand
- Queensland University of Technology (QUT), Australian Prostate Cancer Research Centre-Queensland, Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Faculty of Health, Translational Research Institute, Brisbane, QLD, Australia
| | - Melanie L. Lehman
- Queensland University of Technology (QUT), Australian Prostate Cancer Research Centre-Queensland, Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Faculty of Health, Translational Research Institute, Brisbane, QLD, Australia
- Vancouver Prostate Centre, Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Brett G. Hollier
- Queensland University of Technology (QUT), Australian Prostate Cancer Research Centre-Queensland, Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Faculty of Health, Translational Research Institute, Brisbane, QLD, Australia
| | - Jennifer H. Gunter
- Queensland University of Technology (QUT), Australian Prostate Cancer Research Centre-Queensland, Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Faculty of Health, Translational Research Institute, Brisbane, QLD, Australia
- *Correspondence: Jennifer H. Gunter
| | - Colleen C. Nelson
- Queensland University of Technology (QUT), Australian Prostate Cancer Research Centre-Queensland, Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Faculty of Health, Translational Research Institute, Brisbane, QLD, Australia
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Mebendazole and radiation in combination increase survival through anticancer mechanisms in an intracranial rodent model of malignant meningioma. J Neurooncol 2018; 140:529-538. [PMID: 30414098 DOI: 10.1007/s11060-018-03009-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 09/20/2018] [Indexed: 12/16/2022]
Abstract
PURPOSE Meningiomas are a frequent tumor of the central nervous system. Although mostly benign, approximately 5% present as atypical or malignant tumors. Treatments for atypical meningiomas include gross total resection and radiotherapy, but about 33% of patients have recurrent tumors, sometimes as a higher grade. Recently, the brain penetrant anthelmintic drug, mebendazole, has shown promise as an anticancer agent in rodent models of glioblastoma and medulloblastoma. METHODS The half maximal inhibitory concentration (IC50) effect on colony formation, cell proliferation, and caspase-3/7 markers of apoptosis of mebendazole with and without radiation was measured in vitro. Mice intracranially implanted with KT21MG1 human meningioma were administered mebendazole alone or in combination with radiation. Survival benefit was evaluated, while tumors were investigated by immunohistochemical staining for apoptosis, cell proliferation, and vascular density. RESULTS In vitro experiments on meningioma cell lines showed the IC50 for mebendazole in the range of 0.26-0.42 µM. Mebendazole alone induced cytotoxicity, however the combination had a greater reduction in colony formation and resulted in higher levels of cleaved caspase-3. The in vivo study showed both, mebendazole alone and the combination, to have a survival benefit with an increase in apoptosis, and decreases in tumor cell and vascular proliferation. CONCLUSION These preclinical findings indicate that mebendazole alone or in combination with radiation can be considered for the treatment of malignant meningioma. The mechanism of action for this combination may include an increase in apoptosis, a reduction in proliferation and angiogenesis, or a combination of these effects.
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Lord SR, Cheng WC, Liu D, Gaude E, Haider S, Metcalf T, Patel N, Teoh EJ, Gleeson F, Bradley K, Wigfield S, Zois C, McGowan DR, Ah-See ML, Thompson AM, Sharma A, Bidaut L, Pollak M, Roy PG, Karpe F, James T, English R, Adams RF, Campo L, Ayers L, Snell C, Roxanis I, Frezza C, Fenwick JD, Buffa FM, Harris AL. Integrated Pharmacodynamic Analysis Identifies Two Metabolic Adaption Pathways to Metformin in Breast Cancer. Cell Metab 2018; 28:679-688.e4. [PMID: 30244975 PMCID: PMC6224605 DOI: 10.1016/j.cmet.2018.08.021] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Revised: 04/21/2018] [Accepted: 08/24/2018] [Indexed: 12/13/2022]
Abstract
Late-phase clinical trials investigating metformin as a cancer therapy are underway. However, there remains controversy as to the mode of action of metformin in tumors at clinical doses. We conducted a clinical study integrating measurement of markers of systemic metabolism, dynamic FDG-PET-CT, transcriptomics, and metabolomics at paired time points to profile the bioactivity of metformin in primary breast cancer. We show metformin reduces the levels of mitochondrial metabolites, activates multiple mitochondrial metabolic pathways, and increases 18-FDG flux in tumors. Two tumor groups are identified with distinct metabolic responses, an OXPHOS transcriptional response (OTR) group for which there is an increase in OXPHOS gene transcription and an FDG response group with increased 18-FDG uptake. Increase in proliferation, as measured by a validated proliferation signature, suggested that patients in the OTR group were resistant to metformin treatment. We conclude that mitochondrial response to metformin in primary breast cancer may define anti-tumor effect.
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Affiliation(s)
- Simon R Lord
- Department of Oncology, University of Oxford, Churchill Hospital, Oxford OX3 7LE, UK; Molecular Oncology Laboratories, Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DS, UK; NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Oxford OX3 7LE, UK.
| | - Wei-Chen Cheng
- Department of Oncology, University of Oxford, Churchill Hospital, Oxford OX3 7LE, UK
| | - Dan Liu
- Department of Oncology, University of Oxford, Churchill Hospital, Oxford OX3 7LE, UK
| | - Edoardo Gaude
- MRC Cancer Unit, University of Cambridge, Hutchison/MRC Research Centre, Cambridge Biomedical Campus, Cambridge CB2 0XZ, UK
| | - Syed Haider
- Breast Cancer Now Research Centre, The Institute of Cancer Research, London SW3 6JB, UK
| | - Tom Metcalf
- Institute of Translational Medicine, University of Liverpool, Royal Liverpool University Hospital, Liverpool L69 3GA, UK
| | - Neel Patel
- Department of Nuclear Medicine, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Oxford OX3 7LE, UK
| | - Eugene J Teoh
- Department of Oncology, University of Oxford, Churchill Hospital, Oxford OX3 7LE, UK; Molecular Oncology Laboratories, Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DS, UK; Department of Nuclear Medicine, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Oxford OX3 7LE, UK
| | - Fergus Gleeson
- Department of Oncology, University of Oxford, Churchill Hospital, Oxford OX3 7LE, UK; NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Oxford OX3 7LE, UK; Department of Nuclear Medicine, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Oxford OX3 7LE, UK
| | - Kevin Bradley
- Department of Nuclear Medicine, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Oxford OX3 7LE, UK
| | - Simon Wigfield
- Molecular Oncology Laboratories, Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DS, UK
| | - Christos Zois
- Molecular Oncology Laboratories, Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DS, UK
| | - Daniel R McGowan
- Department of Oncology, University of Oxford, Churchill Hospital, Oxford OX3 7LE, UK
| | - Mei-Lin Ah-See
- Department of Oncology, Luton and Dunstable Hospital, Luton, UK
| | - Alastair M Thompson
- Department of Breast Surgical Oncology, MD Anderson Cancer Centre, Houston, TX 77030, USA
| | - Anand Sharma
- Department of Oncology, University of Oxford, Churchill Hospital, Oxford OX3 7LE, UK; Molecular Oncology Laboratories, Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DS, UK
| | - Luc Bidaut
- College of Science, University of Lincoln, Lincoln LN6 7TS, UK; Clinical Research Imaging Facility, University of Dundee, Ninewells Hospital, Dundee DD2 1SY, UK
| | - Michael Pollak
- Department of Oncology, McGill University, Montreal, QC H3T 1E2, Canada
| | - Pankaj G Roy
- Breast Surgery Unit, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Oxford OX3 7LE, UK
| | - Fredrik Karpe
- Oxford Centre for Diabetes, Endocrinology and Metabolism, Radcliffe Department of Medicine, University of Oxford, Churchill Hospital, Oxford OX3 7LE, UK
| | - Tim James
- Department of Clinical Biochemistry, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - Ruth English
- Oxford Breast Imaging Centre, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 7LE, UK
| | - Rosie F Adams
- Oxford Breast Imaging Centre, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 7LE, UK
| | - Leticia Campo
- Department of Oncology, University of Oxford, Churchill Hospital, Oxford OX3 7LE, UK
| | - Lisa Ayers
- Department of Clinical and Laboratory Immunology, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Oxford OX3 7LE, UK
| | - Cameron Snell
- Department of Anatomical Pathology, Mater Research Institute, Brisbane 4101, Australia
| | - Ioannis Roxanis
- Department of Cellular Pathology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - Christian Frezza
- MRC Cancer Unit, University of Cambridge, Hutchison/MRC Research Centre, Cambridge Biomedical Campus, Cambridge CB2 0XZ, UK
| | - John D Fenwick
- Institute of Translational Medicine, University of Liverpool, Royal Liverpool University Hospital, Liverpool L69 3GA, UK
| | - Francesca M Buffa
- Department of Oncology, University of Oxford, Churchill Hospital, Oxford OX3 7LE, UK
| | - Adrian L Harris
- Department of Oncology, University of Oxford, Churchill Hospital, Oxford OX3 7LE, UK; Molecular Oncology Laboratories, Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DS, UK; NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Oxford OX3 7LE, UK
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Naguib A, Mathew G, Reczek CR, Watrud K, Ambrico A, Herzka T, Salas IC, Lee MF, El-Amine N, Zheng W, Di Francesco ME, Marszalek JR, Pappin DJ, Chandel NS, Trotman LC. Mitochondrial Complex I Inhibitors Expose a Vulnerability for Selective Killing of Pten-Null Cells. Cell Rep 2018; 23:58-67. [PMID: 29617673 PMCID: PMC6003704 DOI: 10.1016/j.celrep.2018.03.032] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 01/08/2018] [Accepted: 03/08/2018] [Indexed: 01/21/2023] Open
Abstract
A hallmark of advanced prostate cancer (PC) is the concomitant loss of PTEN and p53 function. To selectively eliminate such cells, we screened cytotoxic compounds on Pten-/-;Trp53-/- fibroblasts and their Pten-WT reference. Highly selective killing of Pten-null cells can be achieved by deguelin, a natural insecticide. Deguelin eliminates Pten-deficient cells through inhibition of mitochondrial complex I (CI). Five hundred-fold higher drug doses are needed to obtain the same killing of Pten-WT cells, even though deguelin blocks their electron transport chain equally well. Selectivity arises because mitochondria of Pten-null cells consume ATP through complex V, instead of producing it. The resulting glucose dependency can be exploited to selectively kill Pten-null cells with clinically relevant CI inhibitors, especially if they are lipophilic. In vivo, deguelin suppressed disease in our genetically engineered mouse model for metastatic PC. Our data thus introduce a vulnerability for highly selective targeting of incurable PC with inhibitors of CI.
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Affiliation(s)
- Adam Naguib
- Cold Spring Harbor Laboratory, Cancer Biology, Cold Spring Harbor, NY, USA
| | - Grinu Mathew
- Cold Spring Harbor Laboratory, Cancer Biology, Cold Spring Harbor, NY, USA
| | - Colleen R Reczek
- Northwestern Medical School, Cell and Molecular Biology, Chicago, IL, USA
| | - Kaitlin Watrud
- Cold Spring Harbor Laboratory, Cancer Biology, Cold Spring Harbor, NY, USA
| | - Alexandra Ambrico
- Cold Spring Harbor Laboratory, Cancer Biology, Cold Spring Harbor, NY, USA
| | - Tali Herzka
- Cold Spring Harbor Laboratory, Cancer Biology, Cold Spring Harbor, NY, USA
| | | | - Matthew F Lee
- Cold Spring Harbor Laboratory, Cancer Biology, Cold Spring Harbor, NY, USA
| | - Nour El-Amine
- Cold Spring Harbor Laboratory, Cancer Biology, Cold Spring Harbor, NY, USA
| | - Wu Zheng
- Cold Spring Harbor Laboratory, Cancer Biology, Cold Spring Harbor, NY, USA
| | - M Emilia Di Francesco
- Institute for Applied Cancer Science, University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Joseph R Marszalek
- Institute for Applied Cancer Science, University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Darryl J Pappin
- Cold Spring Harbor Laboratory, Cancer Biology, Cold Spring Harbor, NY, USA
| | - Navdeep S Chandel
- Northwestern Medical School, Cell and Molecular Biology, Chicago, IL, USA
| | - Lloyd C Trotman
- Cold Spring Harbor Laboratory, Cancer Biology, Cold Spring Harbor, NY, USA.
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Huangfu N, Wang Y, Cheng J, Xu Z, Wang S. Metformin protects against oxidized low density lipoprotein-induced macrophage apoptosis and inhibits lipid uptake. Exp Ther Med 2018; 15:2485-2491. [PMID: 29456653 PMCID: PMC5795518 DOI: 10.3892/etm.2018.5704] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 12/28/2017] [Indexed: 12/31/2022] Open
Abstract
Oxidized low density lipoprotein (ox-LDL)-induced macrophage apoptosis contributes to the formation of atherosclerosis. Metformin, an antidiabetic drug, has been reported to attenuate lipid accumulation in macrophages. In this study, the effects of metformin on ox-LDL-induced macrophage apoptosis were investigated and the mechanisms involved in this process were examined. By performing flow cytometry analysis, it was demonstrated that metformin inhibited ox-LDL-induced macrophage apoptosis. Increased expression of endoplasmic reticulum (ER) stress marker proteins, including C/EBP-homologous protein, eukaryotic translation initiation factor 2A, and glucose-regulated protein 78 kDa, induced by ox-LDL was also reversed by metformin. Furthermore, ox-LDL-induced cytochrome c (cyto-c) release and mitochondrial membrane potential loss were inhibited by metformin. As lipid uptake in macrophages contributed to ER stress, cyto-c release and mitochondrial membrane potential loss, the mechanisms involved in metformin-inhibited macrophage lipid uptake were investigated. Expression of scavenger receptors, including scavenger receptor A, cluster of differentiation 36 and lectin-type oxidized LDL receptor 1 was examined in the presence or absence of metformin with ox-LDL treatment. Additionally, the upstream regulatory mechanism of scavenger receptors by metformin was also analyzed. In conclusion, metformin protects against ox-LDL-induced macrophage apoptosis and inhibits macrophage lipid uptake.
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Affiliation(s)
- Ning Huangfu
- Department of Cardiology, Ningbo First Hospital, Ningbo, Zhejiang 315010, P.R. China
| | - Yong Wang
- Department of Cardiology, Ningbo First Hospital, Ningbo, Zhejiang 315010, P.R. China
| | - Jingsong Cheng
- Department of Cardiology, Ningbo First Hospital, Ningbo, Zhejiang 315010, P.R. China
| | - Zhenyu Xu
- Department of Cardiology, Ningbo First Hospital, Ningbo, Zhejiang 315010, P.R. China
| | - Shenghuang Wang
- Department of Cardiology, Ningbo First Hospital, Ningbo, Zhejiang 315010, P.R. China
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Gilson C, Chowdhury S, Parmar MKB, Sydes MR. Incorporating Biomarker Stratification into STAMPEDE: an Adaptive Multi-arm, Multi-stage Trial Platform. Clin Oncol (R Coll Radiol) 2017; 29:778-786. [PMID: 29079227 PMCID: PMC5710986 DOI: 10.1016/j.clon.2017.10.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Revised: 10/03/2017] [Accepted: 10/04/2017] [Indexed: 12/13/2022]
Abstract
The treatment and outcomes for advanced prostate cancer have experienced significant progress over recent years. Importantly, the additional benefits of ‘up front’ chemotherapy (docetaxel) and abiraterone, over and above conventional androgen deprivation, have been separately demonstrated in the multi-arm, multi-stage (MAMS) STAMPEDE protocol, which continues recruitment to other questions. Alongside this, insights into the underlying molecular biology and, inevitably, the molecular heterogeneity of prostate cancer are opening the door to new therapeutic approaches. Incorporating this understanding and testing these hypotheses within STAMPEDE brings new challenges to the MAMS approach, but has the potential to further improve the outlook for this disease.
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Affiliation(s)
- C Gilson
- MRC Clinical Trials Unit at UCL, London, UK.
| | - S Chowdhury
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - M R Sydes
- MRC Clinical Trials Unit at UCL, London, UK
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Mason MD, Clarke NW, James ND, Dearnaley DP, Spears MR, Ritchie AW, Attard G, Cross W, Jones RJ, Parker CC, Russell JM, Thalmann GN, Schiavone F, Cassoly E, Matheson D, Millman R, Rentsch CA, Barber J, Gilson C, Ibrahim A, Logue J, Lydon A, Nikapota AD, O’Sullivan JM, Porfiri E, Protheroe A, Srihari NN, Tsang D, Wagstaff J, Wallace J, Walmsley C, Parmar MK, Sydes MR. Adding Celecoxib With or Without Zoledronic Acid for Hormone-Naïve Prostate Cancer: Long-Term Survival Results From an Adaptive, Multiarm, Multistage, Platform, Randomized Controlled Trial. J Clin Oncol 2017; 35:1530-1541. [PMID: 28300506 PMCID: PMC5455701 DOI: 10.1200/jco.2016.69.0677] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Purpose Systemic Therapy for Advanced or Metastatic Prostate Cancer: Evaluation of Drug Efficacy is a randomized controlled trial using a multiarm, multistage, platform design. It recruits men with high-risk, locally advanced or metastatic prostate cancer who were initiating long-term hormone therapy. We report survival data for two celecoxib (Cel)-containing comparisons, which stopped accrual early at interim analysis on the basis of failure-free survival. Patients and Methods Standard of care (SOC) was hormone therapy continuously (metastatic) or for ≥ 2 years (nonmetastatic); prostate (± pelvic node) radiotherapy was encouraged for men without metastases. Cel 400 mg was administered twice a day for 1 year. Zoledronic acid (ZA) 4 mg was administered for six 3-weekly cycles, then 4-weekly for 2 years. Stratified random assignment allocated patients 2:1:1 to SOC (control), SOC + Cel, or SOC + ZA + Cel. The primary outcome measure was all-cause mortality. Results were analyzed with Cox proportional hazards and flexible parametric models adjusted for stratification factors. Results A total of 1,245 men were randomly assigned (Oct 2005 to April 2011). Groups were balanced: median age, 65 years; 61% metastatic, 14% N+/X M0, 25% N0M0; 94% newly diagnosed; median prostate-specific antigen, 66 ng/mL. Median follow-up was 69 months. Grade 3 to 5 adverse events were seen in 36% SOC-only, 33% SOC + Cel, and 32% SOC + ZA + Cel patients. There were 303 control arm deaths (83% prostate cancer), and median survival was 66 months. Compared with SOC, the adjusted hazard ratio was 0.98 (95% CI, 0.80 to 1.20; P = .847; median survival, 70 months) for SOC + Cel and 0.86 (95% CI, 0.70 to 1.05; P =.130; median survival, 76 months) for SOC + ZA + Cel. Preplanned subgroup analyses in men with metastatic disease showed a hazard ratio of 0.78 (95% CI, 0.62 to 0.98; P = .033) for SOC + ZA + Cel. Conclusion These data show no overall evidence of improved survival with Cel. Preplanned subgroup analyses provide hypotheses for future studies.
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Affiliation(s)
- Malcolm D. Mason
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; Jim Barber, Velindre Cancer Centre, Cardiff; Noel W. Clarke, The Christie and Salford Royal NHS Foundation Trusts; John Logue, Christie Hospital, Manchester; Nicholas D. James, Institute of Cancer and Genomic Sciences; Emilio Porfiri, The Medical School, University of Birmingham; Nicholas D. James, Queen Elizabeth Hospital; Emilio Porfiri, University Hospitals Birmingham NHS Foundation Trust, Birmingham; David P. Dearnaley, Gerhardt Attard, and Christopher C. Parker, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust; Melissa R. Spears, Alastair W.S. Ritchie, Francesca Schiavone, David Matheson, Robin Millman, Clare Gilson, Mahesh K.B. Parmar, and Matthew R. Sydes, MRC Clinical Trials Unit at UCL, London; William Cross, Leeds Teaching Hospitals NHS Trust, Leeds; Rob J. Jones and J. Martin Russell, University of Glasgow; Rob J. Jones and Jan Wallace, Beatson West of Scotland Cancer Centre, Glasgow; Azman Ibrahim, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral; Anna Lydon, Torbay District Hospital, Torquay; Ashok D. Nikapota, Sussex Cancer Centre, Brighton; Ashok D. Nikapota, Worthing Hospital, Worthing; Joe M. O’Sullivan, Centre for Cancer Research and Cell Biology, Queen's University, Belfast; Andrew Protheroe, Churchill Hospital, Oxford; Narayanan Nair Srihari, Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury; David Tsang, Southend Hospital, Southend-on-Sea; David Tsang, Basildon Hospital, Basildon; John Wagstaff, The South West Wales Cancer Institute; John Wagstaff, Swansea University College of Medicine, Swansea; Catherine Walmsley, Royal Preston Hospital, Preston, United Kingdom; George N. Thalmann, University Hospital; Estelle Cassoly, SAKK Coordinating Center, Berne; and Cyrill A. Rentsch, University Hospital Basel, Basel, Switzerland
| | - Noel W. Clarke
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; Jim Barber, Velindre Cancer Centre, Cardiff; Noel W. Clarke, The Christie and Salford Royal NHS Foundation Trusts; John Logue, Christie Hospital, Manchester; Nicholas D. James, Institute of Cancer and Genomic Sciences; Emilio Porfiri, The Medical School, University of Birmingham; Nicholas D. James, Queen Elizabeth Hospital; Emilio Porfiri, University Hospitals Birmingham NHS Foundation Trust, Birmingham; David P. Dearnaley, Gerhardt Attard, and Christopher C. Parker, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust; Melissa R. Spears, Alastair W.S. Ritchie, Francesca Schiavone, David Matheson, Robin Millman, Clare Gilson, Mahesh K.B. Parmar, and Matthew R. Sydes, MRC Clinical Trials Unit at UCL, London; William Cross, Leeds Teaching Hospitals NHS Trust, Leeds; Rob J. Jones and J. Martin Russell, University of Glasgow; Rob J. Jones and Jan Wallace, Beatson West of Scotland Cancer Centre, Glasgow; Azman Ibrahim, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral; Anna Lydon, Torbay District Hospital, Torquay; Ashok D. Nikapota, Sussex Cancer Centre, Brighton; Ashok D. Nikapota, Worthing Hospital, Worthing; Joe M. O’Sullivan, Centre for Cancer Research and Cell Biology, Queen's University, Belfast; Andrew Protheroe, Churchill Hospital, Oxford; Narayanan Nair Srihari, Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury; David Tsang, Southend Hospital, Southend-on-Sea; David Tsang, Basildon Hospital, Basildon; John Wagstaff, The South West Wales Cancer Institute; John Wagstaff, Swansea University College of Medicine, Swansea; Catherine Walmsley, Royal Preston Hospital, Preston, United Kingdom; George N. Thalmann, University Hospital; Estelle Cassoly, SAKK Coordinating Center, Berne; and Cyrill A. Rentsch, University Hospital Basel, Basel, Switzerland
| | - Nicholas D. James
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; Jim Barber, Velindre Cancer Centre, Cardiff; Noel W. Clarke, The Christie and Salford Royal NHS Foundation Trusts; John Logue, Christie Hospital, Manchester; Nicholas D. James, Institute of Cancer and Genomic Sciences; Emilio Porfiri, The Medical School, University of Birmingham; Nicholas D. James, Queen Elizabeth Hospital; Emilio Porfiri, University Hospitals Birmingham NHS Foundation Trust, Birmingham; David P. Dearnaley, Gerhardt Attard, and Christopher C. Parker, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust; Melissa R. Spears, Alastair W.S. Ritchie, Francesca Schiavone, David Matheson, Robin Millman, Clare Gilson, Mahesh K.B. Parmar, and Matthew R. Sydes, MRC Clinical Trials Unit at UCL, London; William Cross, Leeds Teaching Hospitals NHS Trust, Leeds; Rob J. Jones and J. Martin Russell, University of Glasgow; Rob J. Jones and Jan Wallace, Beatson West of Scotland Cancer Centre, Glasgow; Azman Ibrahim, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral; Anna Lydon, Torbay District Hospital, Torquay; Ashok D. Nikapota, Sussex Cancer Centre, Brighton; Ashok D. Nikapota, Worthing Hospital, Worthing; Joe M. O’Sullivan, Centre for Cancer Research and Cell Biology, Queen's University, Belfast; Andrew Protheroe, Churchill Hospital, Oxford; Narayanan Nair Srihari, Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury; David Tsang, Southend Hospital, Southend-on-Sea; David Tsang, Basildon Hospital, Basildon; John Wagstaff, The South West Wales Cancer Institute; John Wagstaff, Swansea University College of Medicine, Swansea; Catherine Walmsley, Royal Preston Hospital, Preston, United Kingdom; George N. Thalmann, University Hospital; Estelle Cassoly, SAKK Coordinating Center, Berne; and Cyrill A. Rentsch, University Hospital Basel, Basel, Switzerland
| | - David P. Dearnaley
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; Jim Barber, Velindre Cancer Centre, Cardiff; Noel W. Clarke, The Christie and Salford Royal NHS Foundation Trusts; John Logue, Christie Hospital, Manchester; Nicholas D. James, Institute of Cancer and Genomic Sciences; Emilio Porfiri, The Medical School, University of Birmingham; Nicholas D. James, Queen Elizabeth Hospital; Emilio Porfiri, University Hospitals Birmingham NHS Foundation Trust, Birmingham; David P. Dearnaley, Gerhardt Attard, and Christopher C. Parker, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust; Melissa R. Spears, Alastair W.S. Ritchie, Francesca Schiavone, David Matheson, Robin Millman, Clare Gilson, Mahesh K.B. Parmar, and Matthew R. Sydes, MRC Clinical Trials Unit at UCL, London; William Cross, Leeds Teaching Hospitals NHS Trust, Leeds; Rob J. Jones and J. Martin Russell, University of Glasgow; Rob J. Jones and Jan Wallace, Beatson West of Scotland Cancer Centre, Glasgow; Azman Ibrahim, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral; Anna Lydon, Torbay District Hospital, Torquay; Ashok D. Nikapota, Sussex Cancer Centre, Brighton; Ashok D. Nikapota, Worthing Hospital, Worthing; Joe M. O’Sullivan, Centre for Cancer Research and Cell Biology, Queen's University, Belfast; Andrew Protheroe, Churchill Hospital, Oxford; Narayanan Nair Srihari, Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury; David Tsang, Southend Hospital, Southend-on-Sea; David Tsang, Basildon Hospital, Basildon; John Wagstaff, The South West Wales Cancer Institute; John Wagstaff, Swansea University College of Medicine, Swansea; Catherine Walmsley, Royal Preston Hospital, Preston, United Kingdom; George N. Thalmann, University Hospital; Estelle Cassoly, SAKK Coordinating Center, Berne; and Cyrill A. Rentsch, University Hospital Basel, Basel, Switzerland
| | - Melissa R. Spears
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; Jim Barber, Velindre Cancer Centre, Cardiff; Noel W. Clarke, The Christie and Salford Royal NHS Foundation Trusts; John Logue, Christie Hospital, Manchester; Nicholas D. James, Institute of Cancer and Genomic Sciences; Emilio Porfiri, The Medical School, University of Birmingham; Nicholas D. James, Queen Elizabeth Hospital; Emilio Porfiri, University Hospitals Birmingham NHS Foundation Trust, Birmingham; David P. Dearnaley, Gerhardt Attard, and Christopher C. Parker, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust; Melissa R. Spears, Alastair W.S. Ritchie, Francesca Schiavone, David Matheson, Robin Millman, Clare Gilson, Mahesh K.B. Parmar, and Matthew R. Sydes, MRC Clinical Trials Unit at UCL, London; William Cross, Leeds Teaching Hospitals NHS Trust, Leeds; Rob J. Jones and J. Martin Russell, University of Glasgow; Rob J. Jones and Jan Wallace, Beatson West of Scotland Cancer Centre, Glasgow; Azman Ibrahim, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral; Anna Lydon, Torbay District Hospital, Torquay; Ashok D. Nikapota, Sussex Cancer Centre, Brighton; Ashok D. Nikapota, Worthing Hospital, Worthing; Joe M. O’Sullivan, Centre for Cancer Research and Cell Biology, Queen's University, Belfast; Andrew Protheroe, Churchill Hospital, Oxford; Narayanan Nair Srihari, Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury; David Tsang, Southend Hospital, Southend-on-Sea; David Tsang, Basildon Hospital, Basildon; John Wagstaff, The South West Wales Cancer Institute; John Wagstaff, Swansea University College of Medicine, Swansea; Catherine Walmsley, Royal Preston Hospital, Preston, United Kingdom; George N. Thalmann, University Hospital; Estelle Cassoly, SAKK Coordinating Center, Berne; and Cyrill A. Rentsch, University Hospital Basel, Basel, Switzerland
| | - Alastair W.S. Ritchie
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; Jim Barber, Velindre Cancer Centre, Cardiff; Noel W. Clarke, The Christie and Salford Royal NHS Foundation Trusts; John Logue, Christie Hospital, Manchester; Nicholas D. James, Institute of Cancer and Genomic Sciences; Emilio Porfiri, The Medical School, University of Birmingham; Nicholas D. James, Queen Elizabeth Hospital; Emilio Porfiri, University Hospitals Birmingham NHS Foundation Trust, Birmingham; David P. Dearnaley, Gerhardt Attard, and Christopher C. Parker, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust; Melissa R. Spears, Alastair W.S. Ritchie, Francesca Schiavone, David Matheson, Robin Millman, Clare Gilson, Mahesh K.B. Parmar, and Matthew R. Sydes, MRC Clinical Trials Unit at UCL, London; William Cross, Leeds Teaching Hospitals NHS Trust, Leeds; Rob J. Jones and J. Martin Russell, University of Glasgow; Rob J. Jones and Jan Wallace, Beatson West of Scotland Cancer Centre, Glasgow; Azman Ibrahim, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral; Anna Lydon, Torbay District Hospital, Torquay; Ashok D. Nikapota, Sussex Cancer Centre, Brighton; Ashok D. Nikapota, Worthing Hospital, Worthing; Joe M. O’Sullivan, Centre for Cancer Research and Cell Biology, Queen's University, Belfast; Andrew Protheroe, Churchill Hospital, Oxford; Narayanan Nair Srihari, Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury; David Tsang, Southend Hospital, Southend-on-Sea; David Tsang, Basildon Hospital, Basildon; John Wagstaff, The South West Wales Cancer Institute; John Wagstaff, Swansea University College of Medicine, Swansea; Catherine Walmsley, Royal Preston Hospital, Preston, United Kingdom; George N. Thalmann, University Hospital; Estelle Cassoly, SAKK Coordinating Center, Berne; and Cyrill A. Rentsch, University Hospital Basel, Basel, Switzerland
| | - Gerhardt Attard
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; Jim Barber, Velindre Cancer Centre, Cardiff; Noel W. Clarke, The Christie and Salford Royal NHS Foundation Trusts; John Logue, Christie Hospital, Manchester; Nicholas D. James, Institute of Cancer and Genomic Sciences; Emilio Porfiri, The Medical School, University of Birmingham; Nicholas D. James, Queen Elizabeth Hospital; Emilio Porfiri, University Hospitals Birmingham NHS Foundation Trust, Birmingham; David P. Dearnaley, Gerhardt Attard, and Christopher C. Parker, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust; Melissa R. Spears, Alastair W.S. Ritchie, Francesca Schiavone, David Matheson, Robin Millman, Clare Gilson, Mahesh K.B. Parmar, and Matthew R. Sydes, MRC Clinical Trials Unit at UCL, London; William Cross, Leeds Teaching Hospitals NHS Trust, Leeds; Rob J. Jones and J. Martin Russell, University of Glasgow; Rob J. Jones and Jan Wallace, Beatson West of Scotland Cancer Centre, Glasgow; Azman Ibrahim, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral; Anna Lydon, Torbay District Hospital, Torquay; Ashok D. Nikapota, Sussex Cancer Centre, Brighton; Ashok D. Nikapota, Worthing Hospital, Worthing; Joe M. O’Sullivan, Centre for Cancer Research and Cell Biology, Queen's University, Belfast; Andrew Protheroe, Churchill Hospital, Oxford; Narayanan Nair Srihari, Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury; David Tsang, Southend Hospital, Southend-on-Sea; David Tsang, Basildon Hospital, Basildon; John Wagstaff, The South West Wales Cancer Institute; John Wagstaff, Swansea University College of Medicine, Swansea; Catherine Walmsley, Royal Preston Hospital, Preston, United Kingdom; George N. Thalmann, University Hospital; Estelle Cassoly, SAKK Coordinating Center, Berne; and Cyrill A. Rentsch, University Hospital Basel, Basel, Switzerland
| | - William Cross
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; Jim Barber, Velindre Cancer Centre, Cardiff; Noel W. Clarke, The Christie and Salford Royal NHS Foundation Trusts; John Logue, Christie Hospital, Manchester; Nicholas D. James, Institute of Cancer and Genomic Sciences; Emilio Porfiri, The Medical School, University of Birmingham; Nicholas D. James, Queen Elizabeth Hospital; Emilio Porfiri, University Hospitals Birmingham NHS Foundation Trust, Birmingham; David P. Dearnaley, Gerhardt Attard, and Christopher C. Parker, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust; Melissa R. Spears, Alastair W.S. Ritchie, Francesca Schiavone, David Matheson, Robin Millman, Clare Gilson, Mahesh K.B. Parmar, and Matthew R. Sydes, MRC Clinical Trials Unit at UCL, London; William Cross, Leeds Teaching Hospitals NHS Trust, Leeds; Rob J. Jones and J. Martin Russell, University of Glasgow; Rob J. Jones and Jan Wallace, Beatson West of Scotland Cancer Centre, Glasgow; Azman Ibrahim, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral; Anna Lydon, Torbay District Hospital, Torquay; Ashok D. Nikapota, Sussex Cancer Centre, Brighton; Ashok D. Nikapota, Worthing Hospital, Worthing; Joe M. O’Sullivan, Centre for Cancer Research and Cell Biology, Queen's University, Belfast; Andrew Protheroe, Churchill Hospital, Oxford; Narayanan Nair Srihari, Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury; David Tsang, Southend Hospital, Southend-on-Sea; David Tsang, Basildon Hospital, Basildon; John Wagstaff, The South West Wales Cancer Institute; John Wagstaff, Swansea University College of Medicine, Swansea; Catherine Walmsley, Royal Preston Hospital, Preston, United Kingdom; George N. Thalmann, University Hospital; Estelle Cassoly, SAKK Coordinating Center, Berne; and Cyrill A. Rentsch, University Hospital Basel, Basel, Switzerland
| | - Rob J. Jones
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; Jim Barber, Velindre Cancer Centre, Cardiff; Noel W. Clarke, The Christie and Salford Royal NHS Foundation Trusts; John Logue, Christie Hospital, Manchester; Nicholas D. James, Institute of Cancer and Genomic Sciences; Emilio Porfiri, The Medical School, University of Birmingham; Nicholas D. James, Queen Elizabeth Hospital; Emilio Porfiri, University Hospitals Birmingham NHS Foundation Trust, Birmingham; David P. Dearnaley, Gerhardt Attard, and Christopher C. Parker, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust; Melissa R. Spears, Alastair W.S. Ritchie, Francesca Schiavone, David Matheson, Robin Millman, Clare Gilson, Mahesh K.B. Parmar, and Matthew R. Sydes, MRC Clinical Trials Unit at UCL, London; William Cross, Leeds Teaching Hospitals NHS Trust, Leeds; Rob J. Jones and J. Martin Russell, University of Glasgow; Rob J. Jones and Jan Wallace, Beatson West of Scotland Cancer Centre, Glasgow; Azman Ibrahim, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral; Anna Lydon, Torbay District Hospital, Torquay; Ashok D. Nikapota, Sussex Cancer Centre, Brighton; Ashok D. Nikapota, Worthing Hospital, Worthing; Joe M. O’Sullivan, Centre for Cancer Research and Cell Biology, Queen's University, Belfast; Andrew Protheroe, Churchill Hospital, Oxford; Narayanan Nair Srihari, Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury; David Tsang, Southend Hospital, Southend-on-Sea; David Tsang, Basildon Hospital, Basildon; John Wagstaff, The South West Wales Cancer Institute; John Wagstaff, Swansea University College of Medicine, Swansea; Catherine Walmsley, Royal Preston Hospital, Preston, United Kingdom; George N. Thalmann, University Hospital; Estelle Cassoly, SAKK Coordinating Center, Berne; and Cyrill A. Rentsch, University Hospital Basel, Basel, Switzerland
| | - Christopher C. Parker
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; Jim Barber, Velindre Cancer Centre, Cardiff; Noel W. Clarke, The Christie and Salford Royal NHS Foundation Trusts; John Logue, Christie Hospital, Manchester; Nicholas D. James, Institute of Cancer and Genomic Sciences; Emilio Porfiri, The Medical School, University of Birmingham; Nicholas D. James, Queen Elizabeth Hospital; Emilio Porfiri, University Hospitals Birmingham NHS Foundation Trust, Birmingham; David P. Dearnaley, Gerhardt Attard, and Christopher C. Parker, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust; Melissa R. Spears, Alastair W.S. Ritchie, Francesca Schiavone, David Matheson, Robin Millman, Clare Gilson, Mahesh K.B. Parmar, and Matthew R. Sydes, MRC Clinical Trials Unit at UCL, London; William Cross, Leeds Teaching Hospitals NHS Trust, Leeds; Rob J. Jones and J. Martin Russell, University of Glasgow; Rob J. Jones and Jan Wallace, Beatson West of Scotland Cancer Centre, Glasgow; Azman Ibrahim, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral; Anna Lydon, Torbay District Hospital, Torquay; Ashok D. Nikapota, Sussex Cancer Centre, Brighton; Ashok D. Nikapota, Worthing Hospital, Worthing; Joe M. O’Sullivan, Centre for Cancer Research and Cell Biology, Queen's University, Belfast; Andrew Protheroe, Churchill Hospital, Oxford; Narayanan Nair Srihari, Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury; David Tsang, Southend Hospital, Southend-on-Sea; David Tsang, Basildon Hospital, Basildon; John Wagstaff, The South West Wales Cancer Institute; John Wagstaff, Swansea University College of Medicine, Swansea; Catherine Walmsley, Royal Preston Hospital, Preston, United Kingdom; George N. Thalmann, University Hospital; Estelle Cassoly, SAKK Coordinating Center, Berne; and Cyrill A. Rentsch, University Hospital Basel, Basel, Switzerland
| | - J. Martin Russell
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; Jim Barber, Velindre Cancer Centre, Cardiff; Noel W. Clarke, The Christie and Salford Royal NHS Foundation Trusts; John Logue, Christie Hospital, Manchester; Nicholas D. James, Institute of Cancer and Genomic Sciences; Emilio Porfiri, The Medical School, University of Birmingham; Nicholas D. James, Queen Elizabeth Hospital; Emilio Porfiri, University Hospitals Birmingham NHS Foundation Trust, Birmingham; David P. Dearnaley, Gerhardt Attard, and Christopher C. Parker, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust; Melissa R. Spears, Alastair W.S. Ritchie, Francesca Schiavone, David Matheson, Robin Millman, Clare Gilson, Mahesh K.B. Parmar, and Matthew R. Sydes, MRC Clinical Trials Unit at UCL, London; William Cross, Leeds Teaching Hospitals NHS Trust, Leeds; Rob J. Jones and J. Martin Russell, University of Glasgow; Rob J. Jones and Jan Wallace, Beatson West of Scotland Cancer Centre, Glasgow; Azman Ibrahim, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral; Anna Lydon, Torbay District Hospital, Torquay; Ashok D. Nikapota, Sussex Cancer Centre, Brighton; Ashok D. Nikapota, Worthing Hospital, Worthing; Joe M. O’Sullivan, Centre for Cancer Research and Cell Biology, Queen's University, Belfast; Andrew Protheroe, Churchill Hospital, Oxford; Narayanan Nair Srihari, Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury; David Tsang, Southend Hospital, Southend-on-Sea; David Tsang, Basildon Hospital, Basildon; John Wagstaff, The South West Wales Cancer Institute; John Wagstaff, Swansea University College of Medicine, Swansea; Catherine Walmsley, Royal Preston Hospital, Preston, United Kingdom; George N. Thalmann, University Hospital; Estelle Cassoly, SAKK Coordinating Center, Berne; and Cyrill A. Rentsch, University Hospital Basel, Basel, Switzerland
| | - George N. Thalmann
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; Jim Barber, Velindre Cancer Centre, Cardiff; Noel W. Clarke, The Christie and Salford Royal NHS Foundation Trusts; John Logue, Christie Hospital, Manchester; Nicholas D. James, Institute of Cancer and Genomic Sciences; Emilio Porfiri, The Medical School, University of Birmingham; Nicholas D. James, Queen Elizabeth Hospital; Emilio Porfiri, University Hospitals Birmingham NHS Foundation Trust, Birmingham; David P. Dearnaley, Gerhardt Attard, and Christopher C. Parker, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust; Melissa R. Spears, Alastair W.S. Ritchie, Francesca Schiavone, David Matheson, Robin Millman, Clare Gilson, Mahesh K.B. Parmar, and Matthew R. Sydes, MRC Clinical Trials Unit at UCL, London; William Cross, Leeds Teaching Hospitals NHS Trust, Leeds; Rob J. Jones and J. Martin Russell, University of Glasgow; Rob J. Jones and Jan Wallace, Beatson West of Scotland Cancer Centre, Glasgow; Azman Ibrahim, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral; Anna Lydon, Torbay District Hospital, Torquay; Ashok D. Nikapota, Sussex Cancer Centre, Brighton; Ashok D. Nikapota, Worthing Hospital, Worthing; Joe M. O’Sullivan, Centre for Cancer Research and Cell Biology, Queen's University, Belfast; Andrew Protheroe, Churchill Hospital, Oxford; Narayanan Nair Srihari, Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury; David Tsang, Southend Hospital, Southend-on-Sea; David Tsang, Basildon Hospital, Basildon; John Wagstaff, The South West Wales Cancer Institute; John Wagstaff, Swansea University College of Medicine, Swansea; Catherine Walmsley, Royal Preston Hospital, Preston, United Kingdom; George N. Thalmann, University Hospital; Estelle Cassoly, SAKK Coordinating Center, Berne; and Cyrill A. Rentsch, University Hospital Basel, Basel, Switzerland
| | - Francesca Schiavone
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; Jim Barber, Velindre Cancer Centre, Cardiff; Noel W. Clarke, The Christie and Salford Royal NHS Foundation Trusts; John Logue, Christie Hospital, Manchester; Nicholas D. James, Institute of Cancer and Genomic Sciences; Emilio Porfiri, The Medical School, University of Birmingham; Nicholas D. James, Queen Elizabeth Hospital; Emilio Porfiri, University Hospitals Birmingham NHS Foundation Trust, Birmingham; David P. Dearnaley, Gerhardt Attard, and Christopher C. Parker, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust; Melissa R. Spears, Alastair W.S. Ritchie, Francesca Schiavone, David Matheson, Robin Millman, Clare Gilson, Mahesh K.B. Parmar, and Matthew R. Sydes, MRC Clinical Trials Unit at UCL, London; William Cross, Leeds Teaching Hospitals NHS Trust, Leeds; Rob J. Jones and J. Martin Russell, University of Glasgow; Rob J. Jones and Jan Wallace, Beatson West of Scotland Cancer Centre, Glasgow; Azman Ibrahim, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral; Anna Lydon, Torbay District Hospital, Torquay; Ashok D. Nikapota, Sussex Cancer Centre, Brighton; Ashok D. Nikapota, Worthing Hospital, Worthing; Joe M. O’Sullivan, Centre for Cancer Research and Cell Biology, Queen's University, Belfast; Andrew Protheroe, Churchill Hospital, Oxford; Narayanan Nair Srihari, Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury; David Tsang, Southend Hospital, Southend-on-Sea; David Tsang, Basildon Hospital, Basildon; John Wagstaff, The South West Wales Cancer Institute; John Wagstaff, Swansea University College of Medicine, Swansea; Catherine Walmsley, Royal Preston Hospital, Preston, United Kingdom; George N. Thalmann, University Hospital; Estelle Cassoly, SAKK Coordinating Center, Berne; and Cyrill A. Rentsch, University Hospital Basel, Basel, Switzerland
| | - Estelle Cassoly
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; Jim Barber, Velindre Cancer Centre, Cardiff; Noel W. Clarke, The Christie and Salford Royal NHS Foundation Trusts; John Logue, Christie Hospital, Manchester; Nicholas D. James, Institute of Cancer and Genomic Sciences; Emilio Porfiri, The Medical School, University of Birmingham; Nicholas D. James, Queen Elizabeth Hospital; Emilio Porfiri, University Hospitals Birmingham NHS Foundation Trust, Birmingham; David P. Dearnaley, Gerhardt Attard, and Christopher C. Parker, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust; Melissa R. Spears, Alastair W.S. Ritchie, Francesca Schiavone, David Matheson, Robin Millman, Clare Gilson, Mahesh K.B. Parmar, and Matthew R. Sydes, MRC Clinical Trials Unit at UCL, London; William Cross, Leeds Teaching Hospitals NHS Trust, Leeds; Rob J. Jones and J. Martin Russell, University of Glasgow; Rob J. Jones and Jan Wallace, Beatson West of Scotland Cancer Centre, Glasgow; Azman Ibrahim, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral; Anna Lydon, Torbay District Hospital, Torquay; Ashok D. Nikapota, Sussex Cancer Centre, Brighton; Ashok D. Nikapota, Worthing Hospital, Worthing; Joe M. O’Sullivan, Centre for Cancer Research and Cell Biology, Queen's University, Belfast; Andrew Protheroe, Churchill Hospital, Oxford; Narayanan Nair Srihari, Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury; David Tsang, Southend Hospital, Southend-on-Sea; David Tsang, Basildon Hospital, Basildon; John Wagstaff, The South West Wales Cancer Institute; John Wagstaff, Swansea University College of Medicine, Swansea; Catherine Walmsley, Royal Preston Hospital, Preston, United Kingdom; George N. Thalmann, University Hospital; Estelle Cassoly, SAKK Coordinating Center, Berne; and Cyrill A. Rentsch, University Hospital Basel, Basel, Switzerland
| | - David Matheson
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; Jim Barber, Velindre Cancer Centre, Cardiff; Noel W. Clarke, The Christie and Salford Royal NHS Foundation Trusts; John Logue, Christie Hospital, Manchester; Nicholas D. James, Institute of Cancer and Genomic Sciences; Emilio Porfiri, The Medical School, University of Birmingham; Nicholas D. James, Queen Elizabeth Hospital; Emilio Porfiri, University Hospitals Birmingham NHS Foundation Trust, Birmingham; David P. Dearnaley, Gerhardt Attard, and Christopher C. Parker, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust; Melissa R. Spears, Alastair W.S. Ritchie, Francesca Schiavone, David Matheson, Robin Millman, Clare Gilson, Mahesh K.B. Parmar, and Matthew R. Sydes, MRC Clinical Trials Unit at UCL, London; William Cross, Leeds Teaching Hospitals NHS Trust, Leeds; Rob J. Jones and J. Martin Russell, University of Glasgow; Rob J. Jones and Jan Wallace, Beatson West of Scotland Cancer Centre, Glasgow; Azman Ibrahim, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral; Anna Lydon, Torbay District Hospital, Torquay; Ashok D. Nikapota, Sussex Cancer Centre, Brighton; Ashok D. Nikapota, Worthing Hospital, Worthing; Joe M. O’Sullivan, Centre for Cancer Research and Cell Biology, Queen's University, Belfast; Andrew Protheroe, Churchill Hospital, Oxford; Narayanan Nair Srihari, Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury; David Tsang, Southend Hospital, Southend-on-Sea; David Tsang, Basildon Hospital, Basildon; John Wagstaff, The South West Wales Cancer Institute; John Wagstaff, Swansea University College of Medicine, Swansea; Catherine Walmsley, Royal Preston Hospital, Preston, United Kingdom; George N. Thalmann, University Hospital; Estelle Cassoly, SAKK Coordinating Center, Berne; and Cyrill A. Rentsch, University Hospital Basel, Basel, Switzerland
| | - Robin Millman
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; Jim Barber, Velindre Cancer Centre, Cardiff; Noel W. Clarke, The Christie and Salford Royal NHS Foundation Trusts; John Logue, Christie Hospital, Manchester; Nicholas D. James, Institute of Cancer and Genomic Sciences; Emilio Porfiri, The Medical School, University of Birmingham; Nicholas D. James, Queen Elizabeth Hospital; Emilio Porfiri, University Hospitals Birmingham NHS Foundation Trust, Birmingham; David P. Dearnaley, Gerhardt Attard, and Christopher C. Parker, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust; Melissa R. Spears, Alastair W.S. Ritchie, Francesca Schiavone, David Matheson, Robin Millman, Clare Gilson, Mahesh K.B. Parmar, and Matthew R. Sydes, MRC Clinical Trials Unit at UCL, London; William Cross, Leeds Teaching Hospitals NHS Trust, Leeds; Rob J. Jones and J. Martin Russell, University of Glasgow; Rob J. Jones and Jan Wallace, Beatson West of Scotland Cancer Centre, Glasgow; Azman Ibrahim, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral; Anna Lydon, Torbay District Hospital, Torquay; Ashok D. Nikapota, Sussex Cancer Centre, Brighton; Ashok D. Nikapota, Worthing Hospital, Worthing; Joe M. O’Sullivan, Centre for Cancer Research and Cell Biology, Queen's University, Belfast; Andrew Protheroe, Churchill Hospital, Oxford; Narayanan Nair Srihari, Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury; David Tsang, Southend Hospital, Southend-on-Sea; David Tsang, Basildon Hospital, Basildon; John Wagstaff, The South West Wales Cancer Institute; John Wagstaff, Swansea University College of Medicine, Swansea; Catherine Walmsley, Royal Preston Hospital, Preston, United Kingdom; George N. Thalmann, University Hospital; Estelle Cassoly, SAKK Coordinating Center, Berne; and Cyrill A. Rentsch, University Hospital Basel, Basel, Switzerland
| | - Cyrill A. Rentsch
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; Jim Barber, Velindre Cancer Centre, Cardiff; Noel W. Clarke, The Christie and Salford Royal NHS Foundation Trusts; John Logue, Christie Hospital, Manchester; Nicholas D. James, Institute of Cancer and Genomic Sciences; Emilio Porfiri, The Medical School, University of Birmingham; Nicholas D. James, Queen Elizabeth Hospital; Emilio Porfiri, University Hospitals Birmingham NHS Foundation Trust, Birmingham; David P. Dearnaley, Gerhardt Attard, and Christopher C. Parker, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust; Melissa R. Spears, Alastair W.S. Ritchie, Francesca Schiavone, David Matheson, Robin Millman, Clare Gilson, Mahesh K.B. Parmar, and Matthew R. Sydes, MRC Clinical Trials Unit at UCL, London; William Cross, Leeds Teaching Hospitals NHS Trust, Leeds; Rob J. Jones and J. Martin Russell, University of Glasgow; Rob J. Jones and Jan Wallace, Beatson West of Scotland Cancer Centre, Glasgow; Azman Ibrahim, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral; Anna Lydon, Torbay District Hospital, Torquay; Ashok D. Nikapota, Sussex Cancer Centre, Brighton; Ashok D. Nikapota, Worthing Hospital, Worthing; Joe M. O’Sullivan, Centre for Cancer Research and Cell Biology, Queen's University, Belfast; Andrew Protheroe, Churchill Hospital, Oxford; Narayanan Nair Srihari, Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury; David Tsang, Southend Hospital, Southend-on-Sea; David Tsang, Basildon Hospital, Basildon; John Wagstaff, The South West Wales Cancer Institute; John Wagstaff, Swansea University College of Medicine, Swansea; Catherine Walmsley, Royal Preston Hospital, Preston, United Kingdom; George N. Thalmann, University Hospital; Estelle Cassoly, SAKK Coordinating Center, Berne; and Cyrill A. Rentsch, University Hospital Basel, Basel, Switzerland
| | - Jim Barber
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; Jim Barber, Velindre Cancer Centre, Cardiff; Noel W. Clarke, The Christie and Salford Royal NHS Foundation Trusts; John Logue, Christie Hospital, Manchester; Nicholas D. James, Institute of Cancer and Genomic Sciences; Emilio Porfiri, The Medical School, University of Birmingham; Nicholas D. James, Queen Elizabeth Hospital; Emilio Porfiri, University Hospitals Birmingham NHS Foundation Trust, Birmingham; David P. Dearnaley, Gerhardt Attard, and Christopher C. Parker, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust; Melissa R. Spears, Alastair W.S. Ritchie, Francesca Schiavone, David Matheson, Robin Millman, Clare Gilson, Mahesh K.B. Parmar, and Matthew R. Sydes, MRC Clinical Trials Unit at UCL, London; William Cross, Leeds Teaching Hospitals NHS Trust, Leeds; Rob J. Jones and J. Martin Russell, University of Glasgow; Rob J. Jones and Jan Wallace, Beatson West of Scotland Cancer Centre, Glasgow; Azman Ibrahim, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral; Anna Lydon, Torbay District Hospital, Torquay; Ashok D. Nikapota, Sussex Cancer Centre, Brighton; Ashok D. Nikapota, Worthing Hospital, Worthing; Joe M. O’Sullivan, Centre for Cancer Research and Cell Biology, Queen's University, Belfast; Andrew Protheroe, Churchill Hospital, Oxford; Narayanan Nair Srihari, Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury; David Tsang, Southend Hospital, Southend-on-Sea; David Tsang, Basildon Hospital, Basildon; John Wagstaff, The South West Wales Cancer Institute; John Wagstaff, Swansea University College of Medicine, Swansea; Catherine Walmsley, Royal Preston Hospital, Preston, United Kingdom; George N. Thalmann, University Hospital; Estelle Cassoly, SAKK Coordinating Center, Berne; and Cyrill A. Rentsch, University Hospital Basel, Basel, Switzerland
| | - Clare Gilson
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; Jim Barber, Velindre Cancer Centre, Cardiff; Noel W. Clarke, The Christie and Salford Royal NHS Foundation Trusts; John Logue, Christie Hospital, Manchester; Nicholas D. James, Institute of Cancer and Genomic Sciences; Emilio Porfiri, The Medical School, University of Birmingham; Nicholas D. James, Queen Elizabeth Hospital; Emilio Porfiri, University Hospitals Birmingham NHS Foundation Trust, Birmingham; David P. Dearnaley, Gerhardt Attard, and Christopher C. Parker, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust; Melissa R. Spears, Alastair W.S. Ritchie, Francesca Schiavone, David Matheson, Robin Millman, Clare Gilson, Mahesh K.B. Parmar, and Matthew R. Sydes, MRC Clinical Trials Unit at UCL, London; William Cross, Leeds Teaching Hospitals NHS Trust, Leeds; Rob J. Jones and J. Martin Russell, University of Glasgow; Rob J. Jones and Jan Wallace, Beatson West of Scotland Cancer Centre, Glasgow; Azman Ibrahim, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral; Anna Lydon, Torbay District Hospital, Torquay; Ashok D. Nikapota, Sussex Cancer Centre, Brighton; Ashok D. Nikapota, Worthing Hospital, Worthing; Joe M. O’Sullivan, Centre for Cancer Research and Cell Biology, Queen's University, Belfast; Andrew Protheroe, Churchill Hospital, Oxford; Narayanan Nair Srihari, Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury; David Tsang, Southend Hospital, Southend-on-Sea; David Tsang, Basildon Hospital, Basildon; John Wagstaff, The South West Wales Cancer Institute; John Wagstaff, Swansea University College of Medicine, Swansea; Catherine Walmsley, Royal Preston Hospital, Preston, United Kingdom; George N. Thalmann, University Hospital; Estelle Cassoly, SAKK Coordinating Center, Berne; and Cyrill A. Rentsch, University Hospital Basel, Basel, Switzerland
| | - Azman Ibrahim
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; Jim Barber, Velindre Cancer Centre, Cardiff; Noel W. Clarke, The Christie and Salford Royal NHS Foundation Trusts; John Logue, Christie Hospital, Manchester; Nicholas D. James, Institute of Cancer and Genomic Sciences; Emilio Porfiri, The Medical School, University of Birmingham; Nicholas D. James, Queen Elizabeth Hospital; Emilio Porfiri, University Hospitals Birmingham NHS Foundation Trust, Birmingham; David P. Dearnaley, Gerhardt Attard, and Christopher C. Parker, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust; Melissa R. Spears, Alastair W.S. Ritchie, Francesca Schiavone, David Matheson, Robin Millman, Clare Gilson, Mahesh K.B. Parmar, and Matthew R. Sydes, MRC Clinical Trials Unit at UCL, London; William Cross, Leeds Teaching Hospitals NHS Trust, Leeds; Rob J. Jones and J. Martin Russell, University of Glasgow; Rob J. Jones and Jan Wallace, Beatson West of Scotland Cancer Centre, Glasgow; Azman Ibrahim, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral; Anna Lydon, Torbay District Hospital, Torquay; Ashok D. Nikapota, Sussex Cancer Centre, Brighton; Ashok D. Nikapota, Worthing Hospital, Worthing; Joe M. O’Sullivan, Centre for Cancer Research and Cell Biology, Queen's University, Belfast; Andrew Protheroe, Churchill Hospital, Oxford; Narayanan Nair Srihari, Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury; David Tsang, Southend Hospital, Southend-on-Sea; David Tsang, Basildon Hospital, Basildon; John Wagstaff, The South West Wales Cancer Institute; John Wagstaff, Swansea University College of Medicine, Swansea; Catherine Walmsley, Royal Preston Hospital, Preston, United Kingdom; George N. Thalmann, University Hospital; Estelle Cassoly, SAKK Coordinating Center, Berne; and Cyrill A. Rentsch, University Hospital Basel, Basel, Switzerland
| | - John Logue
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; Jim Barber, Velindre Cancer Centre, Cardiff; Noel W. Clarke, The Christie and Salford Royal NHS Foundation Trusts; John Logue, Christie Hospital, Manchester; Nicholas D. James, Institute of Cancer and Genomic Sciences; Emilio Porfiri, The Medical School, University of Birmingham; Nicholas D. James, Queen Elizabeth Hospital; Emilio Porfiri, University Hospitals Birmingham NHS Foundation Trust, Birmingham; David P. Dearnaley, Gerhardt Attard, and Christopher C. Parker, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust; Melissa R. Spears, Alastair W.S. Ritchie, Francesca Schiavone, David Matheson, Robin Millman, Clare Gilson, Mahesh K.B. Parmar, and Matthew R. Sydes, MRC Clinical Trials Unit at UCL, London; William Cross, Leeds Teaching Hospitals NHS Trust, Leeds; Rob J. Jones and J. Martin Russell, University of Glasgow; Rob J. Jones and Jan Wallace, Beatson West of Scotland Cancer Centre, Glasgow; Azman Ibrahim, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral; Anna Lydon, Torbay District Hospital, Torquay; Ashok D. Nikapota, Sussex Cancer Centre, Brighton; Ashok D. Nikapota, Worthing Hospital, Worthing; Joe M. O’Sullivan, Centre for Cancer Research and Cell Biology, Queen's University, Belfast; Andrew Protheroe, Churchill Hospital, Oxford; Narayanan Nair Srihari, Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury; David Tsang, Southend Hospital, Southend-on-Sea; David Tsang, Basildon Hospital, Basildon; John Wagstaff, The South West Wales Cancer Institute; John Wagstaff, Swansea University College of Medicine, Swansea; Catherine Walmsley, Royal Preston Hospital, Preston, United Kingdom; George N. Thalmann, University Hospital; Estelle Cassoly, SAKK Coordinating Center, Berne; and Cyrill A. Rentsch, University Hospital Basel, Basel, Switzerland
| | - Anna Lydon
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; Jim Barber, Velindre Cancer Centre, Cardiff; Noel W. Clarke, The Christie and Salford Royal NHS Foundation Trusts; John Logue, Christie Hospital, Manchester; Nicholas D. James, Institute of Cancer and Genomic Sciences; Emilio Porfiri, The Medical School, University of Birmingham; Nicholas D. James, Queen Elizabeth Hospital; Emilio Porfiri, University Hospitals Birmingham NHS Foundation Trust, Birmingham; David P. Dearnaley, Gerhardt Attard, and Christopher C. Parker, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust; Melissa R. Spears, Alastair W.S. Ritchie, Francesca Schiavone, David Matheson, Robin Millman, Clare Gilson, Mahesh K.B. Parmar, and Matthew R. Sydes, MRC Clinical Trials Unit at UCL, London; William Cross, Leeds Teaching Hospitals NHS Trust, Leeds; Rob J. Jones and J. Martin Russell, University of Glasgow; Rob J. Jones and Jan Wallace, Beatson West of Scotland Cancer Centre, Glasgow; Azman Ibrahim, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral; Anna Lydon, Torbay District Hospital, Torquay; Ashok D. Nikapota, Sussex Cancer Centre, Brighton; Ashok D. Nikapota, Worthing Hospital, Worthing; Joe M. O’Sullivan, Centre for Cancer Research and Cell Biology, Queen's University, Belfast; Andrew Protheroe, Churchill Hospital, Oxford; Narayanan Nair Srihari, Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury; David Tsang, Southend Hospital, Southend-on-Sea; David Tsang, Basildon Hospital, Basildon; John Wagstaff, The South West Wales Cancer Institute; John Wagstaff, Swansea University College of Medicine, Swansea; Catherine Walmsley, Royal Preston Hospital, Preston, United Kingdom; George N. Thalmann, University Hospital; Estelle Cassoly, SAKK Coordinating Center, Berne; and Cyrill A. Rentsch, University Hospital Basel, Basel, Switzerland
| | - Ashok D. Nikapota
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; Jim Barber, Velindre Cancer Centre, Cardiff; Noel W. Clarke, The Christie and Salford Royal NHS Foundation Trusts; John Logue, Christie Hospital, Manchester; Nicholas D. James, Institute of Cancer and Genomic Sciences; Emilio Porfiri, The Medical School, University of Birmingham; Nicholas D. James, Queen Elizabeth Hospital; Emilio Porfiri, University Hospitals Birmingham NHS Foundation Trust, Birmingham; David P. Dearnaley, Gerhardt Attard, and Christopher C. Parker, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust; Melissa R. Spears, Alastair W.S. Ritchie, Francesca Schiavone, David Matheson, Robin Millman, Clare Gilson, Mahesh K.B. Parmar, and Matthew R. Sydes, MRC Clinical Trials Unit at UCL, London; William Cross, Leeds Teaching Hospitals NHS Trust, Leeds; Rob J. Jones and J. Martin Russell, University of Glasgow; Rob J. Jones and Jan Wallace, Beatson West of Scotland Cancer Centre, Glasgow; Azman Ibrahim, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral; Anna Lydon, Torbay District Hospital, Torquay; Ashok D. Nikapota, Sussex Cancer Centre, Brighton; Ashok D. Nikapota, Worthing Hospital, Worthing; Joe M. O’Sullivan, Centre for Cancer Research and Cell Biology, Queen's University, Belfast; Andrew Protheroe, Churchill Hospital, Oxford; Narayanan Nair Srihari, Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury; David Tsang, Southend Hospital, Southend-on-Sea; David Tsang, Basildon Hospital, Basildon; John Wagstaff, The South West Wales Cancer Institute; John Wagstaff, Swansea University College of Medicine, Swansea; Catherine Walmsley, Royal Preston Hospital, Preston, United Kingdom; George N. Thalmann, University Hospital; Estelle Cassoly, SAKK Coordinating Center, Berne; and Cyrill A. Rentsch, University Hospital Basel, Basel, Switzerland
| | - Joe M. O’Sullivan
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; Jim Barber, Velindre Cancer Centre, Cardiff; Noel W. Clarke, The Christie and Salford Royal NHS Foundation Trusts; John Logue, Christie Hospital, Manchester; Nicholas D. James, Institute of Cancer and Genomic Sciences; Emilio Porfiri, The Medical School, University of Birmingham; Nicholas D. James, Queen Elizabeth Hospital; Emilio Porfiri, University Hospitals Birmingham NHS Foundation Trust, Birmingham; David P. Dearnaley, Gerhardt Attard, and Christopher C. Parker, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust; Melissa R. Spears, Alastair W.S. Ritchie, Francesca Schiavone, David Matheson, Robin Millman, Clare Gilson, Mahesh K.B. Parmar, and Matthew R. Sydes, MRC Clinical Trials Unit at UCL, London; William Cross, Leeds Teaching Hospitals NHS Trust, Leeds; Rob J. Jones and J. Martin Russell, University of Glasgow; Rob J. Jones and Jan Wallace, Beatson West of Scotland Cancer Centre, Glasgow; Azman Ibrahim, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral; Anna Lydon, Torbay District Hospital, Torquay; Ashok D. Nikapota, Sussex Cancer Centre, Brighton; Ashok D. Nikapota, Worthing Hospital, Worthing; Joe M. O’Sullivan, Centre for Cancer Research and Cell Biology, Queen's University, Belfast; Andrew Protheroe, Churchill Hospital, Oxford; Narayanan Nair Srihari, Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury; David Tsang, Southend Hospital, Southend-on-Sea; David Tsang, Basildon Hospital, Basildon; John Wagstaff, The South West Wales Cancer Institute; John Wagstaff, Swansea University College of Medicine, Swansea; Catherine Walmsley, Royal Preston Hospital, Preston, United Kingdom; George N. Thalmann, University Hospital; Estelle Cassoly, SAKK Coordinating Center, Berne; and Cyrill A. Rentsch, University Hospital Basel, Basel, Switzerland
| | - Emilio Porfiri
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; Jim Barber, Velindre Cancer Centre, Cardiff; Noel W. Clarke, The Christie and Salford Royal NHS Foundation Trusts; John Logue, Christie Hospital, Manchester; Nicholas D. James, Institute of Cancer and Genomic Sciences; Emilio Porfiri, The Medical School, University of Birmingham; Nicholas D. James, Queen Elizabeth Hospital; Emilio Porfiri, University Hospitals Birmingham NHS Foundation Trust, Birmingham; David P. Dearnaley, Gerhardt Attard, and Christopher C. Parker, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust; Melissa R. Spears, Alastair W.S. Ritchie, Francesca Schiavone, David Matheson, Robin Millman, Clare Gilson, Mahesh K.B. Parmar, and Matthew R. Sydes, MRC Clinical Trials Unit at UCL, London; William Cross, Leeds Teaching Hospitals NHS Trust, Leeds; Rob J. Jones and J. Martin Russell, University of Glasgow; Rob J. Jones and Jan Wallace, Beatson West of Scotland Cancer Centre, Glasgow; Azman Ibrahim, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral; Anna Lydon, Torbay District Hospital, Torquay; Ashok D. Nikapota, Sussex Cancer Centre, Brighton; Ashok D. Nikapota, Worthing Hospital, Worthing; Joe M. O’Sullivan, Centre for Cancer Research and Cell Biology, Queen's University, Belfast; Andrew Protheroe, Churchill Hospital, Oxford; Narayanan Nair Srihari, Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury; David Tsang, Southend Hospital, Southend-on-Sea; David Tsang, Basildon Hospital, Basildon; John Wagstaff, The South West Wales Cancer Institute; John Wagstaff, Swansea University College of Medicine, Swansea; Catherine Walmsley, Royal Preston Hospital, Preston, United Kingdom; George N. Thalmann, University Hospital; Estelle Cassoly, SAKK Coordinating Center, Berne; and Cyrill A. Rentsch, University Hospital Basel, Basel, Switzerland
| | - Andrew Protheroe
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; Jim Barber, Velindre Cancer Centre, Cardiff; Noel W. Clarke, The Christie and Salford Royal NHS Foundation Trusts; John Logue, Christie Hospital, Manchester; Nicholas D. James, Institute of Cancer and Genomic Sciences; Emilio Porfiri, The Medical School, University of Birmingham; Nicholas D. James, Queen Elizabeth Hospital; Emilio Porfiri, University Hospitals Birmingham NHS Foundation Trust, Birmingham; David P. Dearnaley, Gerhardt Attard, and Christopher C. Parker, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust; Melissa R. Spears, Alastair W.S. Ritchie, Francesca Schiavone, David Matheson, Robin Millman, Clare Gilson, Mahesh K.B. Parmar, and Matthew R. Sydes, MRC Clinical Trials Unit at UCL, London; William Cross, Leeds Teaching Hospitals NHS Trust, Leeds; Rob J. Jones and J. Martin Russell, University of Glasgow; Rob J. Jones and Jan Wallace, Beatson West of Scotland Cancer Centre, Glasgow; Azman Ibrahim, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral; Anna Lydon, Torbay District Hospital, Torquay; Ashok D. Nikapota, Sussex Cancer Centre, Brighton; Ashok D. Nikapota, Worthing Hospital, Worthing; Joe M. O’Sullivan, Centre for Cancer Research and Cell Biology, Queen's University, Belfast; Andrew Protheroe, Churchill Hospital, Oxford; Narayanan Nair Srihari, Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury; David Tsang, Southend Hospital, Southend-on-Sea; David Tsang, Basildon Hospital, Basildon; John Wagstaff, The South West Wales Cancer Institute; John Wagstaff, Swansea University College of Medicine, Swansea; Catherine Walmsley, Royal Preston Hospital, Preston, United Kingdom; George N. Thalmann, University Hospital; Estelle Cassoly, SAKK Coordinating Center, Berne; and Cyrill A. Rentsch, University Hospital Basel, Basel, Switzerland
| | - Narayanan Nair Srihari
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; Jim Barber, Velindre Cancer Centre, Cardiff; Noel W. Clarke, The Christie and Salford Royal NHS Foundation Trusts; John Logue, Christie Hospital, Manchester; Nicholas D. James, Institute of Cancer and Genomic Sciences; Emilio Porfiri, The Medical School, University of Birmingham; Nicholas D. James, Queen Elizabeth Hospital; Emilio Porfiri, University Hospitals Birmingham NHS Foundation Trust, Birmingham; David P. Dearnaley, Gerhardt Attard, and Christopher C. Parker, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust; Melissa R. Spears, Alastair W.S. Ritchie, Francesca Schiavone, David Matheson, Robin Millman, Clare Gilson, Mahesh K.B. Parmar, and Matthew R. Sydes, MRC Clinical Trials Unit at UCL, London; William Cross, Leeds Teaching Hospitals NHS Trust, Leeds; Rob J. Jones and J. Martin Russell, University of Glasgow; Rob J. Jones and Jan Wallace, Beatson West of Scotland Cancer Centre, Glasgow; Azman Ibrahim, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral; Anna Lydon, Torbay District Hospital, Torquay; Ashok D. Nikapota, Sussex Cancer Centre, Brighton; Ashok D. Nikapota, Worthing Hospital, Worthing; Joe M. O’Sullivan, Centre for Cancer Research and Cell Biology, Queen's University, Belfast; Andrew Protheroe, Churchill Hospital, Oxford; Narayanan Nair Srihari, Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury; David Tsang, Southend Hospital, Southend-on-Sea; David Tsang, Basildon Hospital, Basildon; John Wagstaff, The South West Wales Cancer Institute; John Wagstaff, Swansea University College of Medicine, Swansea; Catherine Walmsley, Royal Preston Hospital, Preston, United Kingdom; George N. Thalmann, University Hospital; Estelle Cassoly, SAKK Coordinating Center, Berne; and Cyrill A. Rentsch, University Hospital Basel, Basel, Switzerland
| | - David Tsang
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; Jim Barber, Velindre Cancer Centre, Cardiff; Noel W. Clarke, The Christie and Salford Royal NHS Foundation Trusts; John Logue, Christie Hospital, Manchester; Nicholas D. James, Institute of Cancer and Genomic Sciences; Emilio Porfiri, The Medical School, University of Birmingham; Nicholas D. James, Queen Elizabeth Hospital; Emilio Porfiri, University Hospitals Birmingham NHS Foundation Trust, Birmingham; David P. Dearnaley, Gerhardt Attard, and Christopher C. Parker, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust; Melissa R. Spears, Alastair W.S. Ritchie, Francesca Schiavone, David Matheson, Robin Millman, Clare Gilson, Mahesh K.B. Parmar, and Matthew R. Sydes, MRC Clinical Trials Unit at UCL, London; William Cross, Leeds Teaching Hospitals NHS Trust, Leeds; Rob J. Jones and J. Martin Russell, University of Glasgow; Rob J. Jones and Jan Wallace, Beatson West of Scotland Cancer Centre, Glasgow; Azman Ibrahim, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral; Anna Lydon, Torbay District Hospital, Torquay; Ashok D. Nikapota, Sussex Cancer Centre, Brighton; Ashok D. Nikapota, Worthing Hospital, Worthing; Joe M. O’Sullivan, Centre for Cancer Research and Cell Biology, Queen's University, Belfast; Andrew Protheroe, Churchill Hospital, Oxford; Narayanan Nair Srihari, Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury; David Tsang, Southend Hospital, Southend-on-Sea; David Tsang, Basildon Hospital, Basildon; John Wagstaff, The South West Wales Cancer Institute; John Wagstaff, Swansea University College of Medicine, Swansea; Catherine Walmsley, Royal Preston Hospital, Preston, United Kingdom; George N. Thalmann, University Hospital; Estelle Cassoly, SAKK Coordinating Center, Berne; and Cyrill A. Rentsch, University Hospital Basel, Basel, Switzerland
| | - John Wagstaff
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; Jim Barber, Velindre Cancer Centre, Cardiff; Noel W. Clarke, The Christie and Salford Royal NHS Foundation Trusts; John Logue, Christie Hospital, Manchester; Nicholas D. James, Institute of Cancer and Genomic Sciences; Emilio Porfiri, The Medical School, University of Birmingham; Nicholas D. James, Queen Elizabeth Hospital; Emilio Porfiri, University Hospitals Birmingham NHS Foundation Trust, Birmingham; David P. Dearnaley, Gerhardt Attard, and Christopher C. Parker, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust; Melissa R. Spears, Alastair W.S. Ritchie, Francesca Schiavone, David Matheson, Robin Millman, Clare Gilson, Mahesh K.B. Parmar, and Matthew R. Sydes, MRC Clinical Trials Unit at UCL, London; William Cross, Leeds Teaching Hospitals NHS Trust, Leeds; Rob J. Jones and J. Martin Russell, University of Glasgow; Rob J. Jones and Jan Wallace, Beatson West of Scotland Cancer Centre, Glasgow; Azman Ibrahim, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral; Anna Lydon, Torbay District Hospital, Torquay; Ashok D. Nikapota, Sussex Cancer Centre, Brighton; Ashok D. Nikapota, Worthing Hospital, Worthing; Joe M. O’Sullivan, Centre for Cancer Research and Cell Biology, Queen's University, Belfast; Andrew Protheroe, Churchill Hospital, Oxford; Narayanan Nair Srihari, Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury; David Tsang, Southend Hospital, Southend-on-Sea; David Tsang, Basildon Hospital, Basildon; John Wagstaff, The South West Wales Cancer Institute; John Wagstaff, Swansea University College of Medicine, Swansea; Catherine Walmsley, Royal Preston Hospital, Preston, United Kingdom; George N. Thalmann, University Hospital; Estelle Cassoly, SAKK Coordinating Center, Berne; and Cyrill A. Rentsch, University Hospital Basel, Basel, Switzerland
| | - Jan Wallace
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; Jim Barber, Velindre Cancer Centre, Cardiff; Noel W. Clarke, The Christie and Salford Royal NHS Foundation Trusts; John Logue, Christie Hospital, Manchester; Nicholas D. James, Institute of Cancer and Genomic Sciences; Emilio Porfiri, The Medical School, University of Birmingham; Nicholas D. James, Queen Elizabeth Hospital; Emilio Porfiri, University Hospitals Birmingham NHS Foundation Trust, Birmingham; David P. Dearnaley, Gerhardt Attard, and Christopher C. Parker, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust; Melissa R. Spears, Alastair W.S. Ritchie, Francesca Schiavone, David Matheson, Robin Millman, Clare Gilson, Mahesh K.B. Parmar, and Matthew R. Sydes, MRC Clinical Trials Unit at UCL, London; William Cross, Leeds Teaching Hospitals NHS Trust, Leeds; Rob J. Jones and J. Martin Russell, University of Glasgow; Rob J. Jones and Jan Wallace, Beatson West of Scotland Cancer Centre, Glasgow; Azman Ibrahim, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral; Anna Lydon, Torbay District Hospital, Torquay; Ashok D. Nikapota, Sussex Cancer Centre, Brighton; Ashok D. Nikapota, Worthing Hospital, Worthing; Joe M. O’Sullivan, Centre for Cancer Research and Cell Biology, Queen's University, Belfast; Andrew Protheroe, Churchill Hospital, Oxford; Narayanan Nair Srihari, Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury; David Tsang, Southend Hospital, Southend-on-Sea; David Tsang, Basildon Hospital, Basildon; John Wagstaff, The South West Wales Cancer Institute; John Wagstaff, Swansea University College of Medicine, Swansea; Catherine Walmsley, Royal Preston Hospital, Preston, United Kingdom; George N. Thalmann, University Hospital; Estelle Cassoly, SAKK Coordinating Center, Berne; and Cyrill A. Rentsch, University Hospital Basel, Basel, Switzerland
| | - Catherine Walmsley
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; Jim Barber, Velindre Cancer Centre, Cardiff; Noel W. Clarke, The Christie and Salford Royal NHS Foundation Trusts; John Logue, Christie Hospital, Manchester; Nicholas D. James, Institute of Cancer and Genomic Sciences; Emilio Porfiri, The Medical School, University of Birmingham; Nicholas D. James, Queen Elizabeth Hospital; Emilio Porfiri, University Hospitals Birmingham NHS Foundation Trust, Birmingham; David P. Dearnaley, Gerhardt Attard, and Christopher C. Parker, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust; Melissa R. Spears, Alastair W.S. Ritchie, Francesca Schiavone, David Matheson, Robin Millman, Clare Gilson, Mahesh K.B. Parmar, and Matthew R. Sydes, MRC Clinical Trials Unit at UCL, London; William Cross, Leeds Teaching Hospitals NHS Trust, Leeds; Rob J. Jones and J. Martin Russell, University of Glasgow; Rob J. Jones and Jan Wallace, Beatson West of Scotland Cancer Centre, Glasgow; Azman Ibrahim, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral; Anna Lydon, Torbay District Hospital, Torquay; Ashok D. Nikapota, Sussex Cancer Centre, Brighton; Ashok D. Nikapota, Worthing Hospital, Worthing; Joe M. O’Sullivan, Centre for Cancer Research and Cell Biology, Queen's University, Belfast; Andrew Protheroe, Churchill Hospital, Oxford; Narayanan Nair Srihari, Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury; David Tsang, Southend Hospital, Southend-on-Sea; David Tsang, Basildon Hospital, Basildon; John Wagstaff, The South West Wales Cancer Institute; John Wagstaff, Swansea University College of Medicine, Swansea; Catherine Walmsley, Royal Preston Hospital, Preston, United Kingdom; George N. Thalmann, University Hospital; Estelle Cassoly, SAKK Coordinating Center, Berne; and Cyrill A. Rentsch, University Hospital Basel, Basel, Switzerland
| | - Mahesh K.B. Parmar
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; Jim Barber, Velindre Cancer Centre, Cardiff; Noel W. Clarke, The Christie and Salford Royal NHS Foundation Trusts; John Logue, Christie Hospital, Manchester; Nicholas D. James, Institute of Cancer and Genomic Sciences; Emilio Porfiri, The Medical School, University of Birmingham; Nicholas D. James, Queen Elizabeth Hospital; Emilio Porfiri, University Hospitals Birmingham NHS Foundation Trust, Birmingham; David P. Dearnaley, Gerhardt Attard, and Christopher C. Parker, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust; Melissa R. Spears, Alastair W.S. Ritchie, Francesca Schiavone, David Matheson, Robin Millman, Clare Gilson, Mahesh K.B. Parmar, and Matthew R. Sydes, MRC Clinical Trials Unit at UCL, London; William Cross, Leeds Teaching Hospitals NHS Trust, Leeds; Rob J. Jones and J. Martin Russell, University of Glasgow; Rob J. Jones and Jan Wallace, Beatson West of Scotland Cancer Centre, Glasgow; Azman Ibrahim, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral; Anna Lydon, Torbay District Hospital, Torquay; Ashok D. Nikapota, Sussex Cancer Centre, Brighton; Ashok D. Nikapota, Worthing Hospital, Worthing; Joe M. O’Sullivan, Centre for Cancer Research and Cell Biology, Queen's University, Belfast; Andrew Protheroe, Churchill Hospital, Oxford; Narayanan Nair Srihari, Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury; David Tsang, Southend Hospital, Southend-on-Sea; David Tsang, Basildon Hospital, Basildon; John Wagstaff, The South West Wales Cancer Institute; John Wagstaff, Swansea University College of Medicine, Swansea; Catherine Walmsley, Royal Preston Hospital, Preston, United Kingdom; George N. Thalmann, University Hospital; Estelle Cassoly, SAKK Coordinating Center, Berne; and Cyrill A. Rentsch, University Hospital Basel, Basel, Switzerland
| | - Matthew R. Sydes
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; Jim Barber, Velindre Cancer Centre, Cardiff; Noel W. Clarke, The Christie and Salford Royal NHS Foundation Trusts; John Logue, Christie Hospital, Manchester; Nicholas D. James, Institute of Cancer and Genomic Sciences; Emilio Porfiri, The Medical School, University of Birmingham; Nicholas D. James, Queen Elizabeth Hospital; Emilio Porfiri, University Hospitals Birmingham NHS Foundation Trust, Birmingham; David P. Dearnaley, Gerhardt Attard, and Christopher C. Parker, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust; Melissa R. Spears, Alastair W.S. Ritchie, Francesca Schiavone, David Matheson, Robin Millman, Clare Gilson, Mahesh K.B. Parmar, and Matthew R. Sydes, MRC Clinical Trials Unit at UCL, London; William Cross, Leeds Teaching Hospitals NHS Trust, Leeds; Rob J. Jones and J. Martin Russell, University of Glasgow; Rob J. Jones and Jan Wallace, Beatson West of Scotland Cancer Centre, Glasgow; Azman Ibrahim, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral; Anna Lydon, Torbay District Hospital, Torquay; Ashok D. Nikapota, Sussex Cancer Centre, Brighton; Ashok D. Nikapota, Worthing Hospital, Worthing; Joe M. O’Sullivan, Centre for Cancer Research and Cell Biology, Queen's University, Belfast; Andrew Protheroe, Churchill Hospital, Oxford; Narayanan Nair Srihari, Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury; David Tsang, Southend Hospital, Southend-on-Sea; David Tsang, Basildon Hospital, Basildon; John Wagstaff, The South West Wales Cancer Institute; John Wagstaff, Swansea University College of Medicine, Swansea; Catherine Walmsley, Royal Preston Hospital, Preston, United Kingdom; George N. Thalmann, University Hospital; Estelle Cassoly, SAKK Coordinating Center, Berne; and Cyrill A. Rentsch, University Hospital Basel, Basel, Switzerland
| | - for the STAMPEDE Investigators
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; Jim Barber, Velindre Cancer Centre, Cardiff; Noel W. Clarke, The Christie and Salford Royal NHS Foundation Trusts; John Logue, Christie Hospital, Manchester; Nicholas D. James, Institute of Cancer and Genomic Sciences; Emilio Porfiri, The Medical School, University of Birmingham; Nicholas D. James, Queen Elizabeth Hospital; Emilio Porfiri, University Hospitals Birmingham NHS Foundation Trust, Birmingham; David P. Dearnaley, Gerhardt Attard, and Christopher C. Parker, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust; Melissa R. Spears, Alastair W.S. Ritchie, Francesca Schiavone, David Matheson, Robin Millman, Clare Gilson, Mahesh K.B. Parmar, and Matthew R. Sydes, MRC Clinical Trials Unit at UCL, London; William Cross, Leeds Teaching Hospitals NHS Trust, Leeds; Rob J. Jones and J. Martin Russell, University of Glasgow; Rob J. Jones and Jan Wallace, Beatson West of Scotland Cancer Centre, Glasgow; Azman Ibrahim, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral; Anna Lydon, Torbay District Hospital, Torquay; Ashok D. Nikapota, Sussex Cancer Centre, Brighton; Ashok D. Nikapota, Worthing Hospital, Worthing; Joe M. O’Sullivan, Centre for Cancer Research and Cell Biology, Queen's University, Belfast; Andrew Protheroe, Churchill Hospital, Oxford; Narayanan Nair Srihari, Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury; David Tsang, Southend Hospital, Southend-on-Sea; David Tsang, Basildon Hospital, Basildon; John Wagstaff, The South West Wales Cancer Institute; John Wagstaff, Swansea University College of Medicine, Swansea; Catherine Walmsley, Royal Preston Hospital, Preston, United Kingdom; George N. Thalmann, University Hospital; Estelle Cassoly, SAKK Coordinating Center, Berne; and Cyrill A. Rentsch, University Hospital Basel, Basel, Switzerland
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Miszczyk L, Namysł Kaletka A, Napieralska A, Woźniak G, Stąpór Fudzińska M, Głowacki G, Tukiendorf A. Cyberknife Radioablation of Prostate Cancer – Preliminary Results for 400 Patients. Asian Pac J Cancer Prev 2017; 18:1007-1013. [PMID: 28545199 PMCID: PMC5494208 DOI: 10.22034/apjcp.2017.18.4.1007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Objectives: To evaluate the tolerance and effectiveness of stereotactic ablative radiotherapy (SABR) applied in
the treatment of low and intermediate risk (LR & IR) prostate cancer patients (PCP) and provide an evaluation of the
level of risk group impact on treatment results. In addition, androgen deprivation therapy (ADT) usage and prostatic
specific antigen (PSA) decline after SABR were assessed. Material and Methods: A total of 400 PCP (213 LR and
187 IR, including T2c) were irradiated with a CyberKnife using fd 7.25 Gy to TD 36.25 Gy. At the start of treatment,
60.3% of patients were undergoing ADT and this gradually decreased to 0% after 38 months. Follow-up was for a
median of 15.0 months. Patients were monitored on SABR completion and 1, 4, 8 months later and then subsequently
every 6 months. GI (Gastro-Intestinal) and GU (Genito-Urinary) acute and late adverse effects, PSA and ADT usage
were evaluated. Results: Failure was noted in 9 patients (2.25%) (5 in LR and 4 in IR groups) - 4 relapses and 5 nodal
metastases. No G3/4 late adverse effects (EORTC/RTOG) were observed. Some 0.5% of G3 GU and 0.3% of G3 GI
acute reactions were noted respectively on the SABR completion day and one month later. The median of PSA declined
1.5 ng/ml during the first month and 0.6 ng/ml during the next three months. No impact of risk groups on treatment
results was found. An impact of ADT on PSA decline was only confirmed for time point interactions. Conclusions:
SABR for LR and IR PCP is a safe and effective treatment. The inclusion of T2c patients and the low percentage of
IR patient failure permit us the assumption that this procedure could be utilized in the treatment of more advanced
cases. The results do not allow clear definition of the impact of ADT on radioablation results in LR and IR+ T2c cases.
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Affiliation(s)
- Leszek Miszczyk
- Radiotherapy Department, M. Sklodowska-Curie Memorial
Cancer Center and Institute of Oncology, Gliwice Branch, Poland.
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