1
|
Louie BH, Kato S, Lim JS, Kim KH, Lim HJ, Okamura R, Lee S, Kim L, Sicklick JK, Lippman SM, Kurzrock R. Molecular Tumor Board for Unicorns: Outcomes for rare and ultra-rare cancers using an N-of-One personalized treatment strategy. iScience 2024; 27:110465. [PMID: 39148716 PMCID: PMC11324991 DOI: 10.1016/j.isci.2024.110465] [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: 06/21/2023] [Revised: 05/06/2024] [Accepted: 07/02/2024] [Indexed: 08/17/2024] Open
Abstract
Treatment of rare/ultra-rare tumors is an unmet need due to a lack of standardized therapies and clinical trials. We developed the Molecular Tumor Board (MTB), a multidisciplinary team that integrates molecular profiling to generate personalized, N-of-One treatments for advanced cancers. This study evaluates 112 patients with rare/ultra-rare tumors who presented to the MTB and were evaluable for clinical therapeutic outcome. Overall, 46/112 patients (41%) received a treatment regimen with a high degree of matching between tumor molecular alterations and drugs given (reflected by a high Matching Score (≥50%)). Patients with a high versus low Matching Score experienced significantly longer progression-free survival (p = 0.005) and overall survival (p = 0.047), and higher rates of clinical benefit (stable disease ≥6 months, partial response, or complete response) (54% vs. 32% p = 0.027). The MTB facilitated personalized N-of-One matching of drugs to tumor molecular alterations, which was associated with improved clinical outcomes in patients with rare/ultra-rare cancers.
Collapse
Affiliation(s)
- Bryan H Louie
- Center for Personalized Cancer Therapy and Division of Hematology and Oncology, Department of Medicine, UC San Diego Moores Cancer Center, La Jolla, CA, USA
| | - Shumei Kato
- Center for Personalized Cancer Therapy and Division of Hematology and Oncology, Department of Medicine, UC San Diego Moores Cancer Center, La Jolla, CA, USA
| | - Jordan S Lim
- Center for Personalized Cancer Therapy and Division of Hematology and Oncology, Department of Medicine, UC San Diego Moores Cancer Center, La Jolla, CA, USA
| | - Ki Hwan Kim
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Hyo Jeong Lim
- Department of Internal Medicine, Veterans Health Service Medical Center, Seoul, Republic of Korea
| | - Ryosuke Okamura
- Department of Surgery, Kyoto University Hospital, Kyoto, Japan
| | - Suzanna Lee
- Center for Personalized Cancer Therapy and Division of Hematology and Oncology, Department of Medicine, UC San Diego Moores Cancer Center, La Jolla, CA, USA
| | - Lisa Kim
- Center for Personalized Cancer Therapy and Division of Hematology and Oncology, Department of Medicine, UC San Diego Moores Cancer Center, La Jolla, CA, USA
| | - Jason K Sicklick
- Division of Surgical Oncology, Department of Surgery, and Department of Pharmacology, UC San Diego Health Sciences, San Diego, CA, USA
| | - Scott M Lippman
- Center for Personalized Cancer Therapy and Division of Hematology and Oncology, Department of Medicine, UC San Diego Moores Cancer Center, La Jolla, CA, USA
| | - Razelle Kurzrock
- WIN Consortium for Precision Medicine, Paris, France
- Medical College of Wisconsin Cancer Center and Genomic Sciences and Precision Medicine Center, Milwaukee, WI, USA
- University of Nebraska, Omaha, NE, USA
| |
Collapse
|
2
|
Moore SF, Abel GA, Mounce LT. Challenges of diagnosing rare cancers in primary care. Br J Gen Pract 2024; 74:340-341. [PMID: 39054086 PMCID: PMC11299691 DOI: 10.3399/bjgp24x738789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024] Open
Affiliation(s)
- Sarah F Moore
- Department of Health and Community Sciences, University of Exeter, Exeter
| | - Gary A Abel
- Department of Health and Community Sciences, University of Exeter, Exeter
| | - Luke Ta Mounce
- Department of Health and Community Sciences, University of Exeter, Exeter
| |
Collapse
|
3
|
Low CE, Loke S, Pang GE, Sim B, Yang VS. Psychological outcomes in patients with rare cancers: a systematic review and meta-analysis. EClinicalMedicine 2024; 72:102631. [PMID: 38726223 PMCID: PMC11079476 DOI: 10.1016/j.eclinm.2024.102631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 04/19/2024] [Accepted: 04/19/2024] [Indexed: 05/12/2024] Open
Abstract
Background Rare cancers are those that exhibit an incidence of less than six per 100,000 in a year. On average, the five-year relative survival for patients with rare cancers is worse than those with common cancers. The traumatic experience of cancer can be further intensified in patients with rare cancers due to the limited clinical evidence and the lack of empirical evidence for informed decision-making. With rare cancers cumulatively accounting for up to 25% of all cancers, coupled with the rising burden of rare cancers on societies globally, it is necessary to determine the psychological outcomes of patients with rare cancers. Methods This PRISMA-adherent systematic review (PROSPERO: CRD42023475748) involved a systematic search of PubMed, Embase, Cochrane and PsycINFO for all peer-reviewed English language studies published since 2000 to 30th January 2024 that evaluated the prevalence, incidence and risk of depression, anxiety, suicide, and post-traumatic stress disorder (PTSD) in patients with rare cancers. Two independent reviewers appraised and extracted the summary data from published studies. Random effects meta-analyses and meta-regression were used for primary analysis. Findings We included 32 studies with 57,470 patients with rare cancers. Meta-analyses indicated a statistically significant increased risk-ratio (RR) of depression (RR = 2.61, 95% CI: 1.43-4.77, I2 = 97%) and anxiety (RR = 2.66, 95% CI: 1.27-5.55, I2 = 92%) in patients with rare cancers compared to healthy controls. We identified a high suicide incidence (315 per 100,000 person-years, 95% CI: 162-609, I2 = 95%), prevalence of depression (17%, 95% CI: 14-22, I2 = 88%), anxiety (20%, 95% CI: 15-25, I2 = 96%) and PTSD (18%, 95% CI: 9-32, I2 = 25%). When compared to patients with common cancer types, suicide incidence, and PTSD prevalence were significantly higher in patients with rare cancers. Systematic review found that having advanced disease, chemotherapy treatment, lower income, and social status were risk factors for negative psychological outcomes. Interpretation We highlight the need for early identification of psychological maladjustment in patients with rare cancers. Additionally, studies to identify effective interventions are imperative. Funding This study was supported by the National Medical Research Council Transition Award, SingHealth Duke-NUS Oncology Academic Clinical Programme, the Khoo Pilot Collaborative Award, the National Medical Research Council Clinician Scientist-Individual Research Grant-New Investigator Grant, the Terry Fox Grant and the Khoo Bridge Funding Award.
Collapse
Affiliation(s)
- Chen Ee Low
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, 117597, Singapore
| | - Sean Loke
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, 117597, Singapore
| | - Ga Eun Pang
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, 117597, Singapore
| | - Ben Sim
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, 117597, Singapore
| | - Valerie Shiwen Yang
- Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore
- Translational Precision Oncology Lab, Institute of Molecular and Cell Biology (IMCB), A∗STAR, 61 Biopolis Dr, Proteos, Singapore, 138673, Singapore
- Oncology Academic Clinical Program, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
| |
Collapse
|
4
|
Pestana RC, Lopes David BB, Pires de Camargo V, Munhoz RR, Lopes de Mello CA, González Donna ML, Haro Varas JC, Zapata ML, Cunha Martins CL, Chacon M, Schmerling R, Jesus-Garcia R. Challenges and opportunities for sarcoma care and research in Latin America: a position paper from the LACOG sarcoma group. LANCET REGIONAL HEALTH. AMERICAS 2024; 30:100671. [PMID: 38259252 PMCID: PMC10801304 DOI: 10.1016/j.lana.2023.100671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 12/21/2023] [Accepted: 12/26/2023] [Indexed: 01/24/2024]
Abstract
As a developing region, Latin America faces unique cancer control and prevention challenges, which are intensified when considering rare cancers, including sarcomas. Sarcomas are a group of malignancies that arise in the connective tissues of the body-such as muscle, fat, nerves, blood vessels, and bones-accounting for a diverse range of tumours that, although rare, require specialized attention. Sarcoma care and research in Latin America require a comprehensive approach that includes deeper epidemiologic knowledge, diagnostic capacity building, access to innovative treatments, increased patient advocacy, and strengthening of clinical research capacity. This article will review current challenges and opportunities for treating patients with sarcoma in Latin America and outline a pathway toward improvement for regional collaborative groups.
Collapse
Affiliation(s)
- Roberto Carmagnani Pestana
- Latin American Cooperative Oncology Group, Porto Alegre, Brazil
- Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Bruna Bianca Lopes David
- Latin American Cooperative Oncology Group, Porto Alegre, Brazil
- Oncoclínicas, Rio de Janeiro, Brazil
- Instituto Nacional do Câncer, Rio de Janeiro, Brazil
| | - Veridiana Pires de Camargo
- Latin American Cooperative Oncology Group, Porto Alegre, Brazil
- Hospital Beneficência Portuguesa, São Paulo, Brazil
| | - Rodrigo Ramella Munhoz
- Latin American Cooperative Oncology Group, Porto Alegre, Brazil
- Hospital Sírio Libanês, São Paulo, Brazil
| | - Celso Abdon Lopes de Mello
- Latin American Cooperative Oncology Group, Porto Alegre, Brazil
- AC Camargo Cancer Center, São Paulo, Brazil
| | - María Lucila González Donna
- Latin American Cooperative Oncology Group, Porto Alegre, Brazil
- Instituto Nacional del Cancer Paraguay, Capiata, Paraguay
| | - Juan Carlos Haro Varas
- Latin American Cooperative Oncology Group, Porto Alegre, Brazil
- Instituto Nacional de Enfermedades Neoplásicas, Lima, Perú
| | - Maycos L. Zapata
- Latin American Cooperative Oncology Group, Porto Alegre, Brazil
- Instituto de Cancerologia las Americas AUNA, Medellin, Colombia
| | - Cicero Luiz Cunha Martins
- Latin American Cooperative Oncology Group, Porto Alegre, Brazil
- Instituto Nacional do Câncer, Rio de Janeiro, Brazil
- Americas Oncologia, Rio de Janeiro, Brazil
| | - Matias Chacon
- Latin American Cooperative Oncology Group, Porto Alegre, Brazil
- Fleming Institute, Buenos Aires, Argentina
| | - Rafael Schmerling
- Latin American Cooperative Oncology Group, Porto Alegre, Brazil
- Dasa Oncologia, São Paulo, Brazil
| | - Reynaldo Jesus-Garcia
- Latin American Cooperative Oncology Group, Porto Alegre, Brazil
- Hospital Israelita Albert Einstein, São Paulo, Brazil
| |
Collapse
|
5
|
Ahmed S, Wedekind MF, Del Rivero J, Raygada M, Lockridge R, Glod JW, Flowers C, Thomas BJ, Bernstein DB, Kapustina OB, Jain A, Miettinen M, Raffeld M, Xi L, Tyagi M, Kim J, Aldape K, Malayeri AA, Kaplan RN, Allen T, Vivelo CA, Sandler AB, Widemann BC, Reilly KM. Longitudinal Natural History Study of Children and Adults with Rare Solid Tumors: Initial Results for First 200 Participants. CANCER RESEARCH COMMUNICATIONS 2023; 3:2468-2482. [PMID: 37966258 PMCID: PMC10699159 DOI: 10.1158/2767-9764.crc-23-0247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 11/03/2023] [Accepted: 11/07/2023] [Indexed: 11/16/2023]
Abstract
Understanding of tumor biology and identification of effective therapies is lacking for many rare tumors. My Pediatric and Adult Rare Tumor (MyPART) network was established to engage patients, advocates, and researchers and conduct a comprehensive longitudinal Natural History Study of Rare Solid Tumors. Through remote or in-person enrollment at the NIH Clinical Center, participants with rare solid tumors ≥4 weeks old complete standardized medical and family history forms, patient reported outcomes, and provide tumor, blood and/or saliva samples. Medical records are extracted for clinical status and treatment history, and tumors undergo genomic analysis. A total of 200 participants (65% female, 35% male, median age at diagnosis 43 years, range = 2-77) enrolled from 46 U.S. states and nine other countries (46% remote, 55% in-person). Frequent diagnoses were neuroendocrine neoplasms (NEN), adrenocortical carcinomas (ACC), medullary thyroid carcinomas (MTC), succinate dehydrogenase (SDH)-deficient gastrointestinal stromal tumors (sdGIST), and chordomas. At enrollment, median years since diagnosis was 3.5 (range = 0-36.6), 63% participants had metastatic disease and 20% had no evidence of disease. Pathogenic germline and tumor mutations included SDHA/B/C (sdGIST), RET (MTC), TP53 and CTNNB1 (ACC), MEN1 (NEN), and SMARCB1 (poorly-differentiated chordoma). Clinically significant anxiety was observed in 20%-35% of adults. Enrollment of participants and comprehensive data collection were feasible. Remote enrollment was critical during the COVID-19 pandemic. Over 30 patients were enrolled with ACC, NEN, and sdGIST, allowing for clinical/genomic analyses across tumors. Longitudinal follow-up and expansion of cohorts are ongoing to advance understanding of disease course and establish external controls for interventional trials. SIGNIFICANCE This study demonstrates that comprehensive, tumor-agnostic data and biospecimen collection is feasible to characterize different rare tumors, and speed progress in research. The findings will be foundational to developing external controls groups for single-arm interventional trials, where randomized control trials cannot be conducted because of small patient populations.
Collapse
Affiliation(s)
- Shadin Ahmed
- Pediatric Oncology Branch, Center for Cancer Research, NCI, Bethesda, Maryland
| | | | - Jaydira Del Rivero
- Developmental Therapeutics Branch, Center for Cancer Research, NCI, Bethesda, Maryland
| | - Margarita Raygada
- Pediatric Oncology Branch, Center for Cancer Research, NCI, Bethesda, Maryland
| | - Robin Lockridge
- Clinical Research Directorate (CRD), Frederick National Laboratory for Cancer Research, Frederick, Maryland
| | - John W. Glod
- Pediatric Oncology Branch, Center for Cancer Research, NCI, Bethesda, Maryland
| | - Crystal Flowers
- Pediatric Oncology Branch, Center for Cancer Research, NCI, Bethesda, Maryland
| | - BJ Thomas
- Pediatric Oncology Branch, Center for Cancer Research, NCI, Bethesda, Maryland
| | - Donna B. Bernstein
- Pediatric Oncology Branch, Center for Cancer Research, NCI, Bethesda, Maryland
| | - Oxana B. Kapustina
- Pediatric Oncology Branch, Center for Cancer Research, NCI, Bethesda, Maryland
| | - Ashish Jain
- Pediatric Oncology Branch, Center for Cancer Research, NCI, Bethesda, Maryland
- Research Computing, Department of Information Technology, Boston Children's Hospital, Boston, Massachusetts
| | - Markku Miettinen
- Laboratory of Pathology, Center for Cancer Research, NCI, Bethesda, Maryland
| | - Mark Raffeld
- Laboratory of Pathology, Center for Cancer Research, NCI, Bethesda, Maryland
| | - Liqiang Xi
- Laboratory of Pathology, Center for Cancer Research, NCI, Bethesda, Maryland
| | - Manoj Tyagi
- Laboratory of Pathology, Center for Cancer Research, NCI, Bethesda, Maryland
| | - Jung Kim
- Laboratory of Pathology, Center for Cancer Research, NCI, Bethesda, Maryland
| | - Kenneth Aldape
- Laboratory of Pathology, Center for Cancer Research, NCI, Bethesda, Maryland
| | - Ashkan A. Malayeri
- Department of Radiology and Imaging Sciences, Clinical Center, NIH, Bethesda, Maryland
| | - Rosandra N. Kaplan
- Pediatric Oncology Branch, Center for Cancer Research, NCI, Bethesda, Maryland
| | - Taryn Allen
- Pediatric Oncology Branch, Center for Cancer Research, NCI, Bethesda, Maryland
- Clinical Research Directorate (CRD), Frederick National Laboratory for Cancer Research, Frederick, Maryland
| | - Christina A. Vivelo
- Pediatric Oncology Branch, Center for Cancer Research, NCI, Bethesda, Maryland
- Kelly Government Solutions, Bethesda, Maryland
| | - Abby B. Sandler
- Pediatric Oncology Branch, Center for Cancer Research, NCI, Bethesda, Maryland
| | | | - Karlyne M. Reilly
- Pediatric Oncology Branch, Center for Cancer Research, NCI, Bethesda, Maryland
| | | |
Collapse
|
6
|
Hamid M, Joyce CM, Carroll HK, Kenneally C, Mulcahy S, O'Neill MK, Coulter J, O'Reilly S. Challenging gestational trophoblastic disease cases and mimics: An exemplar for the management of rare tumours. Eur J Obstet Gynecol Reprod Biol 2023; 286:76-84. [PMID: 37224702 DOI: 10.1016/j.ejogrb.2023.05.016] [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: 03/06/2023] [Revised: 05/05/2023] [Accepted: 05/12/2023] [Indexed: 05/26/2023]
Abstract
OBJECTIVE Rare tumour management is challenging for clinicians as evidence bases are limited and clinical trials are difficult to conduct. It is even more difficult for patients where self-reliance alone is insufficient to overcome the challenges of navigating care which is often poorly evidence based. In Ireland, a national Gestational Trophoblastic Disease (GTD) service was established as one of 3 initiatives for rare tumours by the National Cancer Control Programme. The service has a national clinical lead, a dedicated supportive nursing service and a clinical biochemistry liaison team. This study sought to assess the impact of a GTD centre using national clinical guidelines and integrating and networking with European and International GTD groups on the clinical management of challenging GTD cases and to consider the application of this model of care to other rare tumour management. STUDY DESIGN In this article, we analyse the impact of a national GTD service on five challenging cases, and review how the service affects patient management in this rare tumour type. These cases were selected from a cohort of patients who were voluntarily registered in the service based on the diagnostic management dilemma they posed. RESULTS Case management was impacted by the identification of GTD mimics, the provision of lifesaving treatment of metastatic choriocarcinoma with brain metastasis, networking with international colleagues, the identification of early relapse, the use of genetics to differentiate treatment pathways and prognosis, and supportive supervision of treatment courses of up to 2 years of therapy in a cohort of patients starting or completing families. CONCLUSION The National GTD service could be an exemplar for the management of rare tumours (such as cholangiocarcinoma) in our jurisdiction which could benefit from a similar constellation of supports. Our study demonstrates the importance of a nominated national clinical lead, dedicated nurse navigator support, registration of cases and networking. The impact of our service would be greater if registration was mandatory rather than voluntary. Such a measure would also ensure equity of access for patients to the service, assist in quantifying the need for resourcing and facilitate research to improve outcomes.
Collapse
Affiliation(s)
- M Hamid
- Department of Medical Oncology, Cork University Hospital, Cork, Ireland
| | - C M Joyce
- Pregnancy Loss Research Group, Department of Obstetrics & Gynaecology, University College Cork, Cork, Ireland; Department of Biochemistry and Cell Biology, University College Cork, Cork, Ireland; Department of Clinical Biochemistry, Cork University Hospital, Cork, Ireland.
| | - H K Carroll
- Department of Medical Oncology, Cork University Hospital, Cork, Ireland
| | - C Kenneally
- Department of Obstetrics and Gynaecology, Cork University Maternity Hospital, Cork, Ireland
| | - S Mulcahy
- Department of Obstetrics and Gynaecology, Cork University Maternity Hospital, Cork, Ireland
| | - Mary-Kate O'Neill
- Department of Obstetrics and Gynaecology, Cork University Maternity Hospital, Cork, Ireland
| | - J Coulter
- Department of Obstetrics and Gynaecology, Cork University Maternity Hospital, Cork, Ireland
| | - S O'Reilly
- Department of Medical Oncology, Cork University Hospital, Cork, Ireland; Cancer Research @UCC, University College Cork, Cork, Ireland
| |
Collapse
|
7
|
Mancini S, Bucchi L, Zamagni F, Baldacchini F, Crocetti E, Giuliani O, Ravaioli A, Vattiato R, Preti M, Tumino R, Ferretti S, Biggeri A, Ballotari P, Boschetti L, Brustolin A, Caldarella A, Cavallo R, Cirilli C, Citarella A, Contrino ML, Dal Maso L, Filiberti RA, Fusco M, Galasso R, Lotti FL, Magoni M, Mangone L, Masanotti G, Mazzoleni G, Mazzucco W, Melcarne A, Michiara M, Pesce P, Pinto A, Piras D, Rizzello RV, Rognoni M, Rosso S, Rugge M, Sampietro G, Scalzi S, Scuderi T, Tagliabue G, Toffolutti F, Vitarelli S, Falcini F. Trends in Net Survival from Vulvar Squamous Cell Carcinoma in Italy (1990–2015). J Clin Med 2023; 12:jcm12062172. [PMID: 36983173 PMCID: PMC10054662 DOI: 10.3390/jcm12062172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/27/2023] [Accepted: 03/06/2023] [Indexed: 03/14/2023] Open
Abstract
(1) Objective: In many Western countries, survival from vulvar squamous cell carcinoma (VSCC) has been stagnating for decades or has increased insufficiently from a clinical perspective. In Italy, previous studies on cancer survival have not taken vulvar cancer into consideration or have pooled patients with vulvar and vaginal cancer. To bridge this knowledge gap, we report the trend in survival from vulvar cancer between 1990 and 2015. (2) Methods: Thirty-eight local cancer registries covering 49% of the national female population contributed the records of 6274 patients. Study endpoints included 1- and 2-year net survival (NS) calculated using the Pohar-Perme estimator and 5-year NS conditional on having survived two years (5|2-year CNS). The significance of survival trends was assessed with the Wald test on the coefficient of the period of diagnosis, entered as a continuous regressor in a Poisson regression model. (3) Results: The median patient age was stable at 76 years. One-year NS decreased from 83.9% in 1990–2001 to 81.9% in 2009–2015 and 2-year NS from 72.2% to 70.5%. Five|2-year CNS increased from 85.7% to 86.7%. These trends were not significant. In the age stratum 70–79 years, a weakly significant decrease in 2-year NS from 71.4% to 65.7% occurred. Multivariate analysis adjusting for age group at diagnosis and geographic area showed an excess risk of death at 5|2-years, of borderline significance, in 2003–2015 versus 1990–2002. (4) Conclusions: One- and 2-year NS and 5|2-year CNS showed no improvements. Current strategies for VSCC control need to be revised both in Italy and at the global level.
Collapse
Affiliation(s)
- Silvia Mancini
- Romagna Cancer Registry, Romagna Cancer Institute (IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori), 47014 Meldola, Italy; (S.M.); (L.B.); (F.B.); (E.C.); (O.G.); (A.R.); (R.V.); (F.F.)
| | - Lauro Bucchi
- Romagna Cancer Registry, Romagna Cancer Institute (IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori), 47014 Meldola, Italy; (S.M.); (L.B.); (F.B.); (E.C.); (O.G.); (A.R.); (R.V.); (F.F.)
| | - Federica Zamagni
- Romagna Cancer Registry, Romagna Cancer Institute (IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori), 47014 Meldola, Italy; (S.M.); (L.B.); (F.B.); (E.C.); (O.G.); (A.R.); (R.V.); (F.F.)
- Correspondence:
| | - Flavia Baldacchini
- Romagna Cancer Registry, Romagna Cancer Institute (IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori), 47014 Meldola, Italy; (S.M.); (L.B.); (F.B.); (E.C.); (O.G.); (A.R.); (R.V.); (F.F.)
| | - Emanuele Crocetti
- Romagna Cancer Registry, Romagna Cancer Institute (IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori), 47014 Meldola, Italy; (S.M.); (L.B.); (F.B.); (E.C.); (O.G.); (A.R.); (R.V.); (F.F.)
| | - Orietta Giuliani
- Romagna Cancer Registry, Romagna Cancer Institute (IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori), 47014 Meldola, Italy; (S.M.); (L.B.); (F.B.); (E.C.); (O.G.); (A.R.); (R.V.); (F.F.)
| | - Alessandra Ravaioli
- Romagna Cancer Registry, Romagna Cancer Institute (IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori), 47014 Meldola, Italy; (S.M.); (L.B.); (F.B.); (E.C.); (O.G.); (A.R.); (R.V.); (F.F.)
| | - Rosa Vattiato
- Romagna Cancer Registry, Romagna Cancer Institute (IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori), 47014 Meldola, Italy; (S.M.); (L.B.); (F.B.); (E.C.); (O.G.); (A.R.); (R.V.); (F.F.)
| | - Mario Preti
- Department of Obstetrics and Gynaecology, University of Torino, 10124 Torino, Italy;
| | - Rosario Tumino
- Cancer Registry and Histopathology Department, Provincial Health Authority (ASP), 97100 Ragusa, Italy;
| | - Stefano Ferretti
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Local Health Authority, 44121 Ferrara, Italy;
| | - Annibale Biggeri
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy;
| | - Paola Ballotari
- Mantova & Cremona Cancer Registry, Epidemiology Unit, Val Padana Health Protection Agency, 46100 Mantova, Italy;
| | - Lorenza Boschetti
- Pavia Cancer Registry, Public Health Agency of Pavia, 27100 Pavia, Italy;
| | - Angelita Brustolin
- Unit of Epidemiology and Cancer Registry, Local Health Authority, 01100 Viterbo, Italy
| | - Adele Caldarella
- Tuscany Cancer Registry, Clinical and Descriptive Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), 50139 Florence, Italy;
| | - Rossella Cavallo
- Cancer Registry of Local Health Authority Salerno, 84124 Salerno, Italy;
| | - Claudia Cirilli
- Modena Cancer Registry, Public Health Department, Local Health Authority, 41126 Modena, Italy;
| | - Annarita Citarella
- Cancer Registry, Department of Prevention, Unit of Epidemiology, Local Health Authority, 82100 Benevento, Italy;
| | | | - Luigino Dal Maso
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, 33081 Aviano, Italy; (L.D.M.); (F.T.)
| | - Rosa A. Filiberti
- Liguria Cancer Registry, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy;
| | - Mario Fusco
- Napoli 3 Sud Cancer Registry, 80031 Napoli, Italy;
| | - Rocco Galasso
- Unit of Regional Cancer Registry, Clinical Epidemiology and Biostatistics, IRCCS-CROB, Basilicata, 85028 Rionero in Vulture, Italy;
| | - Fernanda L. Lotti
- Brindisi Cancer Registry, Local Health Authority, 72100 Brindisi, Italy;
| | - Michele Magoni
- Cancer Registry of Brescia Province, Epidemiology Unit, Brescia Health Protection Agency, 25124 Brescia, Italy;
| | - Lucia Mangone
- Epidemiology Unit, Azienda Unità Sanitaria Locale–IRCCS di Reggio Emilia, Via Amendola 2, 42122 Reggio Emilia, Italy;
| | - Giuseppe Masanotti
- Section of Public Health and RTUP Register, Department of Experimental Medicine, University of Perugia, 06123 Perugia, Italy;
| | | | - Walter Mazzucco
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90131 Palermo, Italy;
| | | | - Maria Michiara
- Parma Cancer Registry, Medical Oncology Unit, University Hospital of Parma, 43126 Parma, Italy;
| | - Paola Pesce
- Catania, Messina and Enna Cancer Registry, 95123 Catania, Italy;
| | - Angela Pinto
- Barletta, Andria, Trani Cancer Registry, BAT Province, 76121 Barletta, Italy;
| | - Daniela Piras
- Sassari Cancer Registry, Azienda Regionale per la Tutela della Salute-ATS, 7100 Sassari, Italy;
| | - Roberto V. Rizzello
- Trento Province Cancer Registry, Unit of Clinical Epidemiology, Azienda Provinciale per i Servizi Sanitari (APSS), 38123 Trento, Italy;
| | - Magda Rognoni
- Epidemiology Unit, Cancer Registry of ATS Brianza, Health Protection Agency, 20900 Monza, Italy;
| | - Stefano Rosso
- Piedmont Cancer Registry, A.O.U. Città della Salute e della Scienza di Torino, 10123 Turin, Italy;
| | - Massimo Rugge
- Veneto Tumour Registry, Azienda Zero, University of Padova-DIMED, 35132 Padova, Italy;
| | | | - Santo Scalzi
- Catanzaro ASP Cancer Registry, 88100 Catanzaro, Italy;
| | - Tiziana Scuderi
- Trapani and Agrigento Cancer Registry, 91100 Trapani, Italy;
| | - Giovanna Tagliabue
- Lombardy Cancer Registry-Varese Province, Cancer Registry Unit, Department of Research, Fondazione IRCCS Istituto Nazionale Tumori, 20133 Milan, Italy;
| | - Federica Toffolutti
- Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, 33081 Aviano, Italy; (L.D.M.); (F.T.)
| | - Susanna Vitarelli
- Macerata Province Cancer Registry, University of Camerino, 62032 Camerino, Italy;
| | - Fabio Falcini
- Romagna Cancer Registry, Romagna Cancer Institute (IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori), 47014 Meldola, Italy; (S.M.); (L.B.); (F.B.); (E.C.); (O.G.); (A.R.); (R.V.); (F.F.)
- Cancer Prevention Unit, Local Health Authority, 47121 Forlì, Italy
| |
Collapse
|
8
|
Quality of life of patients with rare cancer: a comparison with patients with colorectal cancer and the association with disease trajectory-related factors. J Cancer Surviv 2022:10.1007/s11764-022-01324-7. [PMID: 36585575 DOI: 10.1007/s11764-022-01324-7] [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: 10/25/2022] [Accepted: 12/15/2022] [Indexed: 01/01/2023]
Abstract
PURPOSE Differences in quality of life (QoL) between patients with rare and common cancer might be explained by the specific challenges patients with rare cancer face during their disease trajectory, but research is scarce. This study aimed to (1) assess the difference in QoL between patients with rare and common cancer (i.e. colorectal cancer (CRC)) and (2) examine the association between disease trajectory-related factors and QoL in patients with rare cancer. METHODS Cross-sectional data were collected among adults with rare cancer by a nationwide online survey in the Netherlands. For comparison with patients with CRC, data from the Prospective Dutch Colorectal Cancer (PLCRC) cohort were used. Associations were assessed by linear regression analyses. RESULTS Data from 1525 patients with rare cancer and 1047 patients with CRC were analysed. Having a rare cancer was significantly associated with a lower QoL compared to having CRC (p < 0.001). Disease trajectory-related factors significantly associated with QoL in patients with rare cancer were time until diagnosis, misdiagnoses, information on best treatment options, information on late and/or long-term effects, and both satisfaction with physician and specialized nurse care (all: p < 0.05). CONCLUSION Patients with rare cancers have a lower self-reported QoL than patients with CRC, and several disease trajectory-related factors are associated with QoL in patients with rare cancer. IMPLICATIONS FOR CANCER SURVIVORS To improve QoL of patients with rare cancer, appropriate guidance and support by healthcare professionals throughout the disease trajectory are needed, as well as early diagnosis and proper referral to centres of expertise.
Collapse
|
9
|
Descriptive Epidemiology of Hospitalization of Patients with a Rare Tumor in an Italian Region. Curr Oncol 2022; 29:9711-9721. [PMID: 36547176 PMCID: PMC9776515 DOI: 10.3390/curroncol29120762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/23/2022] [Accepted: 12/06/2022] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES Rare tumors (RT) collectively account for one quarter of all malignancies in Italy. The low frequency and the large heterogeneity in natural history and outcome of individual diseases, together with a scarcity of epidemiological information make them a challenge for clinical practice, as well as for public healthcare organizations. We conducted a retrospective study to quantify the burden of hospitalization in a real-word setting in patients diagnosed with these diseases in an Italian region. METHODS RT patients were tracked along all hospital stays from 2000 to 2019 using hospital discharge records. Frequency of hospitalizations, average time spent in hospital and median timespan between consecutive admissions were considered. Re-hospitalization rates were analyzed through a multivariable negative binomial regression analysis to adjust for confounding and allowing for over-dispersion in count data. RESULTS As a whole, 57,329 patients were identified at first stay for all studied tumors. A total of 183,959 admissions were retrieved, along a median of 3 hospitalizations per patient. Median timespan between hospitalizations shortened in the course of the study years (12.5 months in 2000-2004 to 5.4 months in 2015-2019). The overall re-hospitalization rate increased from 0.92 per patient/year (95% CI = 0.81-1.04) in 2000-2004 to 2.17 (95% CI = 1.90-2.47) in 2015-2019. CONCLUSIONS Overall, the hospitalization rate of patients with a RT increased in the twenty years since the 2000 and particularly doubled starting from 2015. A higher burden of hospitalizations was found for tumors of the central nervous system, thoracic cavity, digestive tract and sarcomas. To the best of our knowledge this is the first paper related to access to Italian healthcare facilities of patients with these tumors.
Collapse
|
10
|
Marte C, George LS, Rutherford SC, Ouyang DJ, Martin P, Leonard JP, Trevino KM. Unmet mental health needs in patients with advanced B-cell lymphomas. Palliat Support Care 2022; 20:328-333. [PMID: 35713350 PMCID: PMC9843817 DOI: 10.1017/s1478951521001164] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
CONTEXT Existing research on psychological distress and mental health service utilization has focused on common types of solid tumor cancers, leaving significant gaps in our understanding of patients experiencing rare forms of hematologic cancers. OBJECTIVE To examine distress, quality of life, and mental health service utilization among patients with aggressive, refractory B-cell lymphomas. METHOD Patients (n = 26) with B-cell lymphomas that relapsed after first- or second-line treatment completed self-report measures of distress (Hospital Anxiety and Depression Scale) and quality of life (Short-Form Health Survey, SF-12). Patients also reported whether they had utilized mental health treatment since their cancer diagnosis. RESULTS Approximately 42% (n = 11) of patients reported elevated levels of psychological distress. Of patients with elevated distress, only one quarter (27.2%; n = 3) received mental health treatment, while more than half did not receive mental health treatment (54.5%; n = 6), and 18.1% (n = 2) did not want treatment. Patients with elevated distress reported lower mental quality of life than patients without elevated distress [F (1, 25) = 15.32, p = 0.001]. SIGNIFICANCE OF THE RESULTS A significant proportion of patients with advanced, progressive, B-cell lymphomas may experience elevated levels of distress. Yet, few of these distressed patients receive mental health treatment. Findings highlight the need to better identify and address barriers to mental health service utilization among patients with B-cell lymphoma, including among distressed patients who decline treatment.
Collapse
Affiliation(s)
| | | | | | | | - Peter Martin
- Weill Cornell Medicine, New York, NY
- New York Presbyterian, New York, NY
| | - John P Leonard
- Weill Cornell Medicine, New York, NY
- New York Presbyterian, New York, NY
| | | |
Collapse
|
11
|
Gong P, Xia C, Yang Y, Lei W, Yang W, Yu J, Ji Y, Ren L, Ye F. Clinicopathologic profiling and oncologic outcomes of secretory carcinoma of the breast. Sci Rep 2021; 11:14738. [PMID: 34282256 PMCID: PMC8289843 DOI: 10.1038/s41598-021-94351-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 07/08/2021] [Indexed: 11/12/2022] Open
Abstract
Secretory carcinoma of the breast (SCB) is a rather rare entity of invasive breast cancer, the clinicopathologic characteristics and survival outcomes remain to be elaborated. A retrospective review was conducted in SEER database. A total of 190 SCB patients identified in SEER were eligible for inclusion in the analysis. Median age at diagnosis was 56 years (range 2–96 years). Both sexes and bilateral breast could be affected. Intriguingly, the incidence of SCB tended towards to decreasing in recent decades. Small tumor burden was observed with a mean tumor size of 2.13 cm. In a subgroup with sufficient details, positive staining of estrogen receptor (ER) and progesterone receptor (PR) was 58% and 40%, respectively. The vast majority of patients were of well to moderate differentiation (86.86%) and negative regional lymph nodes involvement (70.71%). Nearly half of the patients took radiotherapy and chemotherapy. Seniors were inclined to have an inferior breast cancer specific survival (BCSS) than their younger counterparts (P = 0.018). Patients underwent breast conserving surgery (BCS) and radiotherapy had much better BCSS than its mastectomy counterparts (P = 0.014). Collectively, SCB is a clinical indolent invasive breast cancer with excellent prognosis. BCS in conjunction with radiotherapy would be a rational alternative for this distinct entity.
Collapse
Affiliation(s)
- Piguo Gong
- Department of Thyroid Breast Surgery, Qingdao Chengyang People's Hospital, Qingdao, 266109, Shandong, China
| | - Chen Xia
- Department of Medical Oncology, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, 410013, China
| | - Yifeng Yang
- Department of Thyroid Breast Surgery, Qingdao Chengyang People's Hospital, Qingdao, 266109, Shandong, China
| | - Wang Lei
- Department of Breast Surgery, Affiliated Hospital of Jining Medical University, Jining, 27200, Shandong, China
| | - Weiping Yang
- Department of Thyroid Breast Surgery, Qingdao Chengyang People's Hospital, Qingdao, 266109, Shandong, China
| | - Junhua Yu
- Department of Thyroid Breast Surgery, Qingdao Chengyang People's Hospital, Qingdao, 266109, Shandong, China
| | - Yishun Ji
- Department of Thyroid Breast Surgery, Qingdao Chengyang People's Hospital, Qingdao, 266109, Shandong, China
| | - Lijun Ren
- Department of Thyroid Breast Surgery, Qingdao Chengyang People's Hospital, Qingdao, 266109, Shandong, China
| | - Fugui Ye
- Key Laboratory of Breast Cancer in Shanghai, Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, China.
| |
Collapse
|
12
|
Drabbe C, Grünhagen DJ, Van Houdt WJ, Braam PM, Soomers VLMN, Van der Hage JA, De Haan JJ, Keymeulen KBMI, Husson O, Van der Graaf WTA. Diagnosed with a Rare Cancer: Experiences of Adult Sarcoma Survivors with the Healthcare System-Results from the SURVSARC Study. Cancers (Basel) 2021; 13:cancers13040679. [PMID: 33567553 PMCID: PMC7914609 DOI: 10.3390/cancers13040679] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 01/29/2021] [Accepted: 02/03/2021] [Indexed: 12/20/2022] Open
Abstract
Simple Summary Patients with rare cancers face obstacles including delays in diagnosis, inadequate treatments and limited scientific evidence to guide decision making. These obstacles may have a unique impact on their experience with the healthcare system and might be different at various ages. Some aspects of care that shape the experience with the healthcare system include information needs, satisfaction with care and supportive care. Very little is known about these aspects of care, specifically for rare cancer patients. Sarcomas are prime examples of rare cancers and are diagnosed at all ages. In this study, we explored the experience of sarcoma patients (N = 1099) with the healthcare system and looked into detail at whether differences in experience existed between age groups. The results of this nationwide study showed that healthcare experiences differ per age group and we identified needs related to the rarity of these tumors, such as improvements concerning (non-)medical guidance and diagnostic intervals. Abstract The aim of this study was to explore the experience of rare cancer patients with the healthcare system and examine differences between age groups (adolescents and young adults (AYA, 18–39 years), older adults (OA, 40–69 years) and elderly (≥70 years)). Dutch sarcoma patients, 2–10 years after diagnosis, completed a questionnaire on their experience with the healthcare system, satisfaction with care, information needs, patient and diagnostic intervals (first symptom to first doctor’s visit and first doctor’s visit to diagnosis, respectively) and received supportive care. In total, 1099 patients completed the questionnaire (response rate 58%): 186 AYAs, 748 OAs and 165 elderly. Many survivors experienced insufficient medical and non-medical guidance (32% and 38%), although satisfaction with care was rated good to excellent by 94%. Both patient and diagnostic intervals were >1 month for over half of the participants and information needs were largely met (97%). AYAs had the longest patient and diagnostic intervals, experienced the greatest lack of (non-)medical guidance, had more desire for patient support groups and used supportive care most often. This nationwide study among sarcoma survivors showed that healthcare experiences differ per age group and identified needs related to the rarity of these tumors, such as improvements concerning (non-)medical guidance and diagnostic intervals.
Collapse
Affiliation(s)
- Cas Drabbe
- Department of Medical Oncology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands; (C.D.); (W.T.A.V.d.G.)
- Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Dirk J. Grünhagen
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands;
| | - Winan J. Van Houdt
- Department of Surgical Oncology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands;
| | - Pètra M. Braam
- Department of Radiation Oncology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands;
| | - Vicky L. M. N. Soomers
- Department of Medical Oncology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands;
| | - Jos A. Van der Hage
- Department of Surgical Oncology, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands;
| | - Jacco J. De Haan
- Department of Medical Oncology, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands;
| | - Kristien B. M. I. Keymeulen
- Department of Surgical Oncology, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands;
| | - Olga Husson
- Department of Medical Oncology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands; (C.D.); (W.T.A.V.d.G.)
- Division of Clinical Studies, Institute of Cancer Research, 15 Cotswold Road, Sutton, London SM2 5NG, UK
- Correspondence:
| | - Winette T. A. Van der Graaf
- Department of Medical Oncology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands; (C.D.); (W.T.A.V.d.G.)
- Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| |
Collapse
|
13
|
Khan S, Carvajal RD. Dual Immunological Checkpoint Blockade for Uveal Melanoma. J Clin Oncol 2021; 39:554-556. [PMID: 33417487 DOI: 10.1200/jco.20.03274] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Shaheer Khan
- Columbia University Irving Medical Center, New York, NY
| | | |
Collapse
|
14
|
Abstract
Globally, rare cancers as a group are commoner than any single common cancer. They represent an unmet medical need, and this issue gets further amplified in India due to various reasons, including the limited accessibility of healthcare system to the population at large. The scarce available data yet only represents the tip of the iceberg, due to poor registration and incomplete medical cover. Rare cancers, as a consequence, are driven further away from attention of the policy.makers and financial authorities. Poor research prospectives and lesser administrative support restrict the research in this field. There is an urgent need for initiating studies exclusively on rare cancers in India, considering their prevalence and deprived management, as many countries are already pursuing work in this field. All such inadequacies ultimately affect the patient outcomes. In this review, after discussing these aspects, we suggest a stepwise approach to improve the care of rare cancers in India.
Collapse
Affiliation(s)
- H S Darling
- Department of Medical Oncology and Hemato-oncology, Narayana Superspeciality Hospital, Gurugram, Haryana, India
| | - Sameer Rastogi
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
15
|
Park JH, Lee JS, Koo H, Kim JE, Ahn JH, Ryu MH, Park SR, Yoon SK, Lee JC, Hong YS, Kim SY, Kim KP, Yoo CH, Hong JY, Lee JL, Jung KH, Rhyoo BY, Kim TW. How Cancer Patients Perceive Clinical Trials (CTs) in the Era of CTs: Current Perception and Its Differences Between Common and Rare Cancers. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2020; 35:545-556. [PMID: 30820925 DOI: 10.1007/s13187-019-01494-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Perception has recently been highlighted as a critical determinant for participation in clinical trials (CTs) among cancer patients. We evaluated cancer patients' current perceptions of CTs using the PARTAKE questionnaires, focusing on differences between patients with common and rare cancers. From November 2015 to May 2017, we prospectively surveyed patients who had received anti-cancer treatment at Asan Medical Center. Among 333 respondents, 70.9% had common and 29.1% had rare cancers. In the cohort, 87.7% of patients with common cancers and 75.3% of patients with rare cancers answered that they heard of and knew about CTs. However, willingness to participate in CTs was expressed only in approximately 56% of patients, although it was significantly associated with awareness and perception. Surprisingly, patients with rare cancers when compared with patients with common cancers showed significantly lower levels of awareness and perception (64.2% vs 79.9%, p = 0.003 and 77.3% vs 91.9%, p < 0.001), and consequently less willingness to participate in CTs (47.4% vs 58.9%, p = 0.06). In addition, cancer patients still harbored fear and concerns about safety and reward of CTs, and demonstrated substantial lack of knowledge about the voluntary nature of CTs, which was more obvious in patients with rare cancers. We identified relatively modest willingness of cancer patients to participate in CTs regardless of generally favorable perception. These findings are highlighted by the more negative perception of CTs among patients with rare cancers relative to those with common cancers. Further education and encouragement by research and public entities seem essential to improve motivation of CTs in cancer patients beyond good perception, especially for patients with rare cancers.
Collapse
Affiliation(s)
- Ji Hyun Park
- Departments of Oncology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
- Department of Hemato-oncology, Konkuk Medical Center, University of Konkuk College of Medicine, Seoul, South Korea
| | - Ji Sung Lee
- Clinical Research Center, Asan Institute of Life Sciences, Asan Medical Center, Seoul, South Korea
| | - HaYeong Koo
- Clinical Research Center, Asan Institute of Life Sciences, Asan Medical Center, Seoul, South Korea
- Korea Clinical Trials Global Initiative, Seoul, South Korea
| | - Jeong Eun Kim
- Departments of Oncology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Jin-Hee Ahn
- Departments of Oncology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Min-Hee Ryu
- Departments of Oncology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Sook-Ryun Park
- Departments of Oncology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Shin-Kyo Yoon
- Departments of Oncology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Jae Cheol Lee
- Departments of Oncology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Yong-Sang Hong
- Departments of Oncology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Sun Young Kim
- Departments of Oncology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Kyo-Pyo Kim
- Departments of Oncology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Chang-Hoon Yoo
- Departments of Oncology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Jung Yong Hong
- Departments of Oncology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Jae Lyun Lee
- Departments of Oncology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Kyung Hae Jung
- Departments of Oncology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Baek-Yeol Rhyoo
- Departments of Oncology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Tae Won Kim
- Departments of Oncology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea.
| |
Collapse
|
16
|
Walker EV, Maplethorpe E, Davis FG. Rare cancers in Canada, 2006-2016: A population-based surveillance report and comparison of different methods for classifying rare cancers. Cancer Epidemiol 2020; 67:101721. [PMID: 32416499 DOI: 10.1016/j.canep.2020.101721] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 03/30/2020] [Accepted: 04/03/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND The cumulative burden from rare cancers has not been adequately explored in Canada. This analysis aims to characterize the occurrence of rare cancers among Canadians and estimate the probability of being diagnosed with a rare cancer among cancer patients with different demographic characteristics. METHODS The Canadian Cancer Registry was used for this analysis. Cancer types were classified in three ways: using the SEER site recode scheme; by histology group; and by site/histology group. The age-standardized incidence rate (ASIR) and 95 % confidence intervals (CI) for each cancer type was estimated for diagnoses from 2006 to 2016. Two ASIR thresholds were used to classify cancers as rare:6/100,000/year and 15/100,000/year. Log-binomial regression was used to estimate the adjusted probability of having a rare cancer among those with cancer by age, sex and geographic region. RESULTS Using the 6/100,000/year threshold, the incidence proportion (IP) of rare cancers ranged from 9.7 %(95 %CI:9.6,9.7 %)-17.0 %(95 %CI:16.9,17.0 %), and ranged from 19.2 %(95 %CI:19.1,19.3 %)-52.5 %(95 %CI:52.0,53.0 %) using the <15/100,000/year threshold. The adjusted probability of being diagnosed with a rare cancer was highest among those aged ≤19 years. There was higher concordance in estimates of the burden of rare cancers across methods to classify cancer types when the lower incidence rate threshold was used to define rare cancers. INTERPRETATION This analysis yielded evidence that rare cancers comprise a substantial proportion of annual cancer diagnoses among Canadians. Findings from this analysis point to using a lower incidence rate threshold, to generate estimates of the burden of rare cancers that are robust to different cancer classification schemes.
Collapse
Affiliation(s)
- E V Walker
- School of Public Health, University of Alberta, Edmonton, AB, Canada.
| | - E Maplethorpe
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - F G Davis
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| |
Collapse
|
17
|
Dehbi HM, Hackshaw A. Sample size calculation in randomised phase II selection trials using a margin of practical equivalence. Trials 2020; 21:301. [PMID: 32228674 PMCID: PMC7106856 DOI: 10.1186/s13063-020-04248-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 03/12/2020] [Indexed: 11/23/2022] Open
Abstract
Background In rare cancers or subtypes of common cancers, a comparison of multiple promising treatments may be required. The selected treatment can then be assessed against the standard of care (if it exists) or used as a backbone for combinations with new, possibly targeted, agents. There could be different experimental therapies or different doses of the same therapy, and either can be done in combination with standard treatments. A ’pick-the-winner’ design is often used, which focuses on efficacy to select the most promising treatment. However, a treatment with a slightly lower efficacy compared to another treatment may actually be preferred if it has a better toxicity or quality of life profile, is easier to administer, or cheaper. Methods By pre-defining a margin of practical equivalence in order to calculate the sample size, a more flexible assessment can be made of whether the treatments have very different effects or are sufficiently close so that other factors can be used to choose between them. Using exact binomial probabilities, we calculated the sample size for two- and three-arm randomised selection trials including a margin of practical equivalence with a variety of input parameters. Results We explain conceptually the margin of practical equivalence in this paper, and provide a free user-friendly web application to calculate the required sample size for a variety of input parameters. Conclusion The web application should help promote the randomised selection design with a margin of practical equivalence, which provides greater flexibility than the ’pick-the-winner’ approach in assessing the results of selection trials.
Collapse
Affiliation(s)
- Hakim-Moulay Dehbi
- Comprehensive Clinical Trials Unit at University College London (UCL), 90 High Holborn, London, WC1V 6LJ, UK.
| | - Allan Hackshaw
- Cancer Research UK & UCL Cancer Trials Centre, 90 Tottenham Court Road, London, W1T 4TJ, UK
| |
Collapse
|
18
|
Lamarca A, Frizziero M, McNamara MG, Valle JW. Clinical and Translational Research Challenges in Biliary Tract Cancers. Curr Med Chem 2020; 27:4756-4777. [PMID: 31971102 DOI: 10.2174/0929867327666200123090153] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 11/27/2019] [Accepted: 01/13/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Biliary Tract Cancers (BTC) are rare malignancies with a poor prognosis. There are many challenges encountered in treating these patients in daily practice as well as in clinical, translational and basic research. OBJECTIVE This review summarises the most relevant challenges in clinical and translational research in BTCs and suggests potential solutions towards an improvement in quality of life and outcomes of patients diagnosed with such malignancies. FINDINGS The main challenge is the low number of patients with BTCs, complicated by the aggressive natural behaviour of cancer and the lack of funding sources for research. In addition, the clinical characteristics of these patients and the specific cancer-related complications challenge clinical research and clinical trial recruitment. It is worth highlighting that BTCs are a group of different malignancies (cholangiocarcinoma, gallbladder cancer and ampullary cancer) rather than a unique homogeneous disease. These subgroups differ not only in molecular aspects, but also in clinical and demographic characteristics. In addition, tailored imaging and quality of life assessment are required to tackle some of the issues specific to BTCs. Finally, difficulties in tissue acquisition both in terms of biopsy size and inclusion of sufficient tumour within the samples, may adversely impact translational and basic research. CONCLUSION Increasing awareness among patients and clinicians regarding BTC and the need for further research and treatment development may address some of the main challenges in BTC research. International collaboration is mandatory to progress the field.
Collapse
Affiliation(s)
- Angela Lamarca
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Melissa Frizziero
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Mairéad G McNamara
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Juan W Valle
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
| |
Collapse
|
19
|
Abbas-Aghababazadeh F, Mo Q, Fridley BL. Statistical genomics in rare cancer. Semin Cancer Biol 2019; 61:1-10. [PMID: 31437624 DOI: 10.1016/j.semcancer.2019.08.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 08/14/2019] [Accepted: 08/17/2019] [Indexed: 12/26/2022]
Abstract
Rare cancers make of more than 20% of cancer cases. Due to the rare nature, less research has been conducted on rare cancers resulting in worse outcomes for patients with rare cancers compared to common cancers. The ability to study rare cancers is impaired by the ability to collect a large enough set of patients to complete an adequately powered genomic study. In this manuscript we outline analytical approaches and public genomic datasets that have been used in genomic studies of rare cancers. These statistical analysis approaches and study designs include: gene set / pathway analyses, pedigree and consortium studies, meta-analysis or horizontal integration, and integration of multiple types of genomic information or vertical integration. We also discuss some of the publicly available resources that can be leveraged in rare cancer genomic studies.
Collapse
Affiliation(s)
| | - Qianxing Mo
- Department of Biostatistics & Bioinformatics, Moffitt Cancer Center, Tampa, FL, 33612, USA.
| | - Brooke L Fridley
- Department of Biostatistics & Bioinformatics, Moffitt Cancer Center, Tampa, FL, 33612, USA.
| |
Collapse
|
20
|
|
21
|
Gore M, Hackshaw A, Brady WE, Penson RT, Zaino R, McCluggage WG, Ganesan R, Wilkinson N, Perren T, Montes A, Summers J, Lord R, Dark G, Rustin G, Mackean M, Reed N, Kehoe S, Frumovitz M, Christensen H, Feeney A, Ledermann J, Gershenson DM. An international, phase III randomized trial in patients with mucinous epithelial ovarian cancer (mEOC/GOG 0241) with long-term follow-up: and experience of conducting a clinical trial in a rare gynecological tumor. Gynecol Oncol 2019; 153:541-548. [PMID: 31005287 PMCID: PMC6559214 DOI: 10.1016/j.ygyno.2019.03.256] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 03/26/2019] [Indexed: 12/18/2022]
Abstract
OBJECTIVES We evaluated four different treatment regimens for advanced-stage mucinous epithelial ovarian cancer. METHODS We conducted a multicenter randomized factorial trial (UK and US). Patients were diagnosed with primary mEOC: FIGO stage II-IV or recurrence after stage I disease. Treatment arms were paclitaxel-carboplatin, oxaliplatin-capecitabine, paclitaxel-carboplatin-bevacizumab, or oxaliplatin-capecitabine-bevacizumab. Chemotherapy was given 3-weekly for 6 cycles, and bevacizumab (3-weekly) was continued as maintenance (for 12 cycles). Endpoints included overall-survival (OS), progression-free survival (PFS), toxicity and quality of life (QoL). RESULTS The trial stopped after 50 patients were recruited due to slow accrual. Median follow-up was 59 months. OS hazard ratios (HR) for the two main comparisons were: 0.78 (p = 0.48) for Oxal-Cape vs. Pac-Carbo (each with/without bevacizumab), and 1.04 (p = 0.92) for bevacizumab vs. no bevacizumab. Corresponding PFS HRs were: 0.84 and 0.80. Retrospective central pathology review revealed only 45% (18/40) cases with available material had confirmed primary mEOC. Among these, OS HR for Oxal-Cape vs. Pac-Carbo was 0.36 (p = 0.14); PFS HR = 0.62 (p = 0.40). Grade 3-4 toxicity was seen in 61% Pac-Carbo, 61% Oxal-Cape, 54% Pac-Carbo-Bev, and 85% Oxal-Cape-Bev. QoL was similar between the four arms. CONCLUSION mEOC/GOG0241 represents an example of a randomized rare tumor trial. Logistical challenges led to early termination, including difficulties in local histopathological diagnosis and accessing drugs outside their labelled indication. There was misalignment between central funders who support clinical trials in rare cancers and the deprioritisation of such work by those managing and funding research at a local level. Rare cancer trials should include centralised pathology review before treatment. Clinical trial registry number: ISRCTN83438782.
Collapse
MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Bevacizumab/administration & dosage
- Capecitabine/administration & dosage
- Carboplatin/administration & dosage
- Carcinoma, Ovarian Epithelial/drug therapy
- Carcinoma, Ovarian Epithelial/secondary
- Female
- Follow-Up Studies
- Humans
- Internationality
- Middle Aged
- Neoplasm Recurrence, Local/drug therapy
- Neoplasms, Cystic, Mucinous, and Serous/drug therapy
- Neoplasms, Cystic, Mucinous, and Serous/secondary
- Ovarian Neoplasms/drug therapy
- Ovarian Neoplasms/pathology
- Oxaliplatin/administration & dosage
- Paclitaxel/administration & dosage
- Progression-Free Survival
- Quality of Life
- Response Evaluation Criteria in Solid Tumors
- Survival Rate
- Young Adult
Collapse
Affiliation(s)
- Martin Gore
- Royal Marsden NHS Foundation Trust, London, UK
| | - Allan Hackshaw
- Cancer Research UK & UCL Cancer Trials Centre, London, UK.
| | | | | | - Richard Zaino
- Penn State Health Milton S. Hershey Medical Centre, PA, USA
| | | | | | - Nafisa Wilkinson
- University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Ana Montes
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Jeffrey Summers
- Maidstone and Tunbridge Wells NHS Foundation Trust, Kent, UK
| | - Rosemary Lord
- Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, UK
| | - Graham Dark
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | | | | | | | - Sean Kehoe
- Institute of Cancer and Genomics, University of Birmingham, Birmingham, UK
| | | | | | - Amanda Feeney
- Cancer Research UK & UCL Cancer Trials Centre, London, UK
| | | | | |
Collapse
|
22
|
Bergerot CD, Bergerot PG, Philip EJ, De Domenico EBL, Manhaes MFM, Pedras RN, Salgia MM, Dizman N, Ashing KT, Li M, Dale W, Pal SK. Assessment of distress and quality of life in rare cancers. Psychooncology 2018; 27:2740-2746. [DOI: 10.1002/pon.4873] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 08/23/2018] [Accepted: 08/27/2018] [Indexed: 12/23/2022]
Affiliation(s)
- Cristiane Decat Bergerot
- Department of Medical Oncology & Experimental Therapeutics; City of Hope Comprehensive Cancer Center; Duarte CA USA
- Federal University of Sao Paulo; Sao Paulo Brazil
| | - Paulo Gustavo Bergerot
- Department of Medical Oncology & Experimental Therapeutics; City of Hope Comprehensive Cancer Center; Duarte CA USA
- Federal University of Sao Paulo; Sao Paulo Brazil
| | - Errol J. Philip
- The Notre Dame Laboratory for Psycho-Oncology Research; University of Notre Dame; Notre Dame IL USA
| | | | | | | | - Meghan M. Salgia
- Department of Medical Oncology & Experimental Therapeutics; City of Hope Comprehensive Cancer Center; Duarte CA USA
| | - Nazli Dizman
- Department of Medical Oncology & Experimental Therapeutics; City of Hope Comprehensive Cancer Center; Duarte CA USA
| | - Kimlin Tam Ashing
- Department of Population Sciences; City of Hope Comprehensive Cancer Center; Duarte CA USA
| | - Min Li
- Department of Biostatistics; City of Hope Comprehensive Cancer Center; Duarte CA USA
| | - William Dale
- Department of Supportive Care Medicine; City of Hope Comprehensive Cancer Center; Duarte CA USA
| | - Sumanta K. Pal
- Department of Medical Oncology & Experimental Therapeutics; City of Hope Comprehensive Cancer Center; Duarte CA USA
| |
Collapse
|
23
|
Abstract
Rare cancers account for about 22 per cent of all cancers diagnosed worldwide, disproportionately affecting some demographic groups, with an occurrence of less than 6 per 100,000 individuals annually. Many rare cancers in adults, adolescents and children are not curable, and patients and care providers have little option to take therapeutic decisions. The epidemiology of rare cancers is a challenging area of study but is inadequately addressed. Despite efforts mainly in some European nations, a few improvements have been observed in the management of rare cancers. Reasons for this obvious stagnation are multifactorial and are mainly inherent to logistical difficulties in carrying out clinical trials in very small patient populations, hesitation of the pharmaceutical industry to spend in small markets and complexity in creating adequate information for the development of cost-effective drugs. Rare cancers also face specific challenges that include late and incorrect diagnosis, lack of clinical expertise and lack of research interest and development of new therapies. The utilization of nationally representative study findings for the patients' evaluation may possibly offer chances to find out pathogenesis and prevalence, and this will eventually lead to control and prevention. Currently, advancing targeted therapies offer a great opportunity for the better management of rare cancers. Conducting clinical trials with small patient population, innovative clinical trial approach, prevailing controlling obstacles for international cooperation and financial support for research are the present challenges for rare cancers. The International Rare Cancers Initiative functions as a main platform for achieving new international clinical trials in rare tumours. This review delineates the current challenges and issues in the interpretation, management and research scenarios of rare cancers.
Collapse
Affiliation(s)
- Raveendran K Pillai
- Division of Clinical Laboratory, Regional Cancer Centre, Thiruvananthapuram, India
| | - K Jayasree
- Division of Pathology, Regional Cancer Centre, Thiruvananthapuram, India
| |
Collapse
|
24
|
Mathoulin-Pélissier S, Pritchard-Jones K. Evidence-based data and rare cancers: The need for a new methodological approach in research and investigation. Eur J Surg Oncol 2018. [PMID: 29526369 DOI: 10.1016/j.ejso.2018.02.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Rare cancers are not so rare, their incidence is increasing and, as a group, they have worse survival than the common cancers. These factors emphasise the societal need to ensure sufficient focus on research into their biological basis, aetiological factors, new more effective therapies and organisation of healthcare to improve access to best practice and innovation. Accuracy of diagnosis is one of the first hurdles to be overcome, with around one third of tumours being reclassified - by type or risk group - when subject to a centralised pathology review process. Timely access to appropriate expert knowledge is a second challenge for patients - in Europe this is being addressed by the establishment of European Reference Networks (ERNs) as part of the EU cross border healthcare initiative. There are ERNs for adult solid and haematological cancers and childhood cancers, all of which are individually rare. These ERNs will facilitate creation of large databases of rare tumours that will incorporate knowledge of their molecular features and build an evidence base for the effectiveness of innovative, biology-directed therapies. With an increasing focus on 'real world' outcome data, research methodologies are evolving, to include randomised registry trials and data linkage approaches that exploit the ever-richer information held on patients in routine health care data. The inclusion of genomic analysis into cancer diagnosis, treatment and risk prediction raises many issues for the conduct of clinical research and cohort studies and personal data sharing. Sophisticated means of pseudonymisation, together with full involvement of affected and 'at risk' patients, are supporting novel research designs and access to data that will continue to build the evidence base to improve outcomes for patients with rare cancers.
Collapse
Affiliation(s)
- S Mathoulin-Pélissier
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Epicene Team, UMR 1219, F-33000 Bordeaux, France; Clinical and Epidemiological Research Unit, INSERM CIC1401, Institut Bergonie, Comprehensive Cancer Centre, F-33000 Bordeaux, France.
| | - K Pritchard-Jones
- University College London, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK
| |
Collapse
|
25
|
McDonnell A, Rex JH, Goossens H, Bonten M, Fowler VG, Dane A. Efficient Delivery of Investigational Antibacterial Agents via Sustainable Clinical Trial Networks. Clin Infect Dis 2017; 63 Suppl 2:S57-9. [PMID: 27481955 PMCID: PMC4967592 DOI: 10.1093/cid/ciw244] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
The economics of antibiotics can be improved by infectious diseases–specific clinical trial networks. While developers would still need to implement an independent phase 1 program as well as studies focused on highly resistant pathogens, standardized procedures in a network focused on usual drug resistance phenotype isolates would permit sharing of controls and would predictably generate high-quality pivotal data for product registration while creating cost and time savings in the range of 30%–40%. This would reduce economic barriers to antibiotic development and contribute to public health.
Collapse
Affiliation(s)
| | - John H Rex
- AstraZeneca Pharmaceuticals, Waltham, Massachusetts University of Texas Medical School-Houston
| | - Herman Goossens
- Laboratory of Medical Microbiology, VAXINFECTIO, University Hospital of Antwerp, Belgium
| | - Marc Bonten
- Department of Medical Microbiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands
| | - Vance G Fowler
- Division of Infectious Diseases and Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
| | - Aaron Dane
- AstraZeneca Pharmaceuticals, Alderley Park, United Kingdom
| |
Collapse
|
26
|
Chandrasegaram MD, Gill AJ, Samra J, Price T, Chen J, Fawcett J, Merrett ND. Ampullary cancer of intestinal origin and duodenal cancer - A logical clinical and therapeutic subgroup in periampullary cancer. World J Gastrointest Oncol 2017; 9:407-415. [PMID: 29085567 PMCID: PMC5648984 DOI: 10.4251/wjgo.v9.i10.407] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 06/26/2017] [Accepted: 08/16/2017] [Indexed: 02/05/2023] Open
Abstract
Periampullary cancers include pancreatic, ampullary, biliary and duodenal cancers. At presentation, the majority of periampullary tumours have grown to involve the pancreas, bile duct, ampulla and duodenum. This can result in difficulty in defining the primary site of origin in all but the smallest tumors due to anatomical proximity and architectural distortion. This has led to variation in the reported proportions of resected periampullary cancers. Pancreatic cancer is the most common cancer resected with a pancreaticoduodenectomy followed by ampullary (16%-50%), bile duct (5%-39%), and duodenal cancer (3%-17%). Patients with resected duodenal and ampullary cancers have a better reported median survival (29-47 mo and 22-54 mo) compared to pancreatic cancer (13-19 mo). The poorer survival with pancreatic cancer relates to differences in tumour characteristics such as a higher incidence of nodal, neural and vascular invasion. While small ampullary cancers can present early with biliary obstruction, pancreatic cancers need to reach a certain size before biliary obstruction ensues. This larger size at presentation contributes to a higher incidence of resection margin involvement in pancreatic cancer. Ampullary cancers can be subdivided into intestinal or pancreatobiliary subtype cancers with histomolecular staining. This avoids relying on histomorphology alone, as even some poorly differentiated cancers preserve the histomolecular profile of their mucosa of origin. Histomolecular profiling is superior to anatomic location in prognosticating survival. Ampullary cancers of intestinal subtype and duodenal cancers are similar in their intestinal origin and form a logical clinical and therapeutic subgroup of periampullary cancers. They respond to 5-FU based chemotherapeutic regimens such as capecitabine-oxaliplatin. Unlike pancreatic cancers, KRAS mutation occurs in only approximately a third of ampullary and duodenal cancers. Future clinical trials should group ampullary cancers of intestinal origin and duodenal cancers together given their similarities and their response to fluoropyrimidine therapy in combination with oxaliplatin. The addition of anti-epidermal growth factor receptor therapy in this group warrants study.
Collapse
Affiliation(s)
- Manju D Chandrasegaram
- the Prince Charles Hospital, Brisbane, Queensland 4032, Australia
- School of Medicine, University of Queensland, Queensland 4006, Australia
| | - Anthony J Gill
- Sydney Medical School, University of Sydney, New South Wales 2006, Australia
- Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, New South Wales 2065, Australia
| | - Jas Samra
- Sydney Medical School, University of Sydney, New South Wales 2006, Australia
- Department of Surgery, Royal North Shore Hospital, Sydney, New South Wales 2065, Australia
| | - Tim Price
- Queen Elizabeth Hospital, Adelaide, South Australia 5011, Australia
- University of Adelaide, South Australia 5005, Australia
| | - John Chen
- Flinders Medical Centre, Adelaide, South Australia 5042, Australia
- Royal Adelaide Hospital, Adelaide, South Australia 5000, Australia
| | - Jonathan Fawcett
- School of Medicine, University of Queensland, Queensland 4006, Australia
- Princess Alexandra Hospital, Brisbane, Queensland 4102, Australia
| | - Neil D Merrett
- Department of Upper GI Surgery, Bankstown Hospital, Sydney, New South Wales 2200, Australia
- Discipline of Surgery, Western Sydney University, Sydney, New South Wales 2560, Australia
| |
Collapse
|
27
|
Abstract
There are limited published data on the burden of rare cancers in the United States. By using data from the North American Association of Central Cancer Registries and the Surveillance, Epidemiology, and End Results program, the authors provide information on incidence rates, stage at diagnosis, and survival for more than 100 rare cancers (defined as an incidence of fewer than 6 cases per 100,000 individuals per year) in the United States. Overall, approximately 20% of patients with cancer in the United States are diagnosed with a rare cancer. Rare cancers make up a larger proportion of cancers diagnosed in Hispanic (24%) and Asian/Pacific Islander (22%) patients compared with non-Hispanic blacks (20%) and non-Hispanic whites (19%). More than two-thirds (71%) of cancers occurring in children and adolescents are rare cancers compared with less than 20% of cancers diagnosed in patients aged 65 years and older. Among solid tumors, 59% of rare cancers are diagnosed at regional or distant stages compared with 45% of common cancers. In part because of this stage distribution, 5-year relative survival is poorer for patients with a rare cancer compared with those diagnosed with a common cancer among both males (55% vs 75%) and females (60% vs 74%). However, 5-year relative survival is substantially higher for children and adolescents diagnosed with a rare cancer (82%) than for adults (46% for ages 65-79 years). Continued efforts are needed to develop interventions for prevention, early detection, and treatment to reduce the burden of rare cancers. Such discoveries can often advance knowledge for all cancers. CA Cancer J Clin 2017. © 2017 American Cancer Society. CA Cancer J Clin 2017;67:261-272. © 2017 American Cancer Society.
Collapse
Affiliation(s)
- Carol E DeSantis
- Director, Breast and Gynecological Cancer Surveillance, Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
| | - Joan L Kramer
- Assistant Professor of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA
| | - Ahmedin Jemal
- Vice President, Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
| |
Collapse
|
28
|
Garg MK, Zhao F, Sparano JA, Palefsky J, Whittington R, Mitchell EP, Mulcahy MF, Armstrong KI, Nabbout NH, Kalnicki S, El-Rayes BF, Onitilo AA, Moriarty DJ, Fitzgerald TJ, Benson AB. Cetuximab Plus Chemoradiotherapy in Immunocompetent Patients With Anal Carcinoma: A Phase II Eastern Cooperative Oncology Group-American College of Radiology Imaging Network Cancer Research Group Trial (E3205). J Clin Oncol 2017; 35:718-726. [PMID: 28068178 DOI: 10.1200/jco.2016.69.1667] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Purpose Squamous cell carcinoma of the anal canal (SCCAC) is characterized by high locoregional failure (LRF) rates after sphincter-preserving definitive chemoradiation (CRT) and is typically associated with anogenital human papilloma virus infection. Because cetuximab enhances the effect of radiation therapy in human papilloma virus-associated oropharyngeal squamous cell carcinoma, we hypothesized that adding cetuximab to CRT would reduce LRF in SCCAC. Methods Sixty-one patients with stage I to III SCCAC received CRT including cisplatin, fluorouracil, and radiation therapy to the primary tumor and regional lymph nodes (45 to 54 Gy) plus eight once-weekly doses of concurrent cetuximab. The study was designed to detect at least a 50% reduction in 3-year LRF rate (one-sided α, 0.10; power 90%), assuming a 35% LRF rate from historical data. Results Poor risk features included stage III disease in 64% and male sex in 20%. The 3-year LRF rate was 23% (95% CI, 13% to 36%; one-sided P = .03) by binomial proportional estimate using the prespecified end point and 21% (95% CI, 7% to 26%) by Kaplan-Meier estimate in a post hoc analysis using methods consistent with historical data. Three-year rates were 68% (95% CI, 55% to 79%) for progression-free survival and 83% (95% CI, 71% to 91%) for overall survival. Grade 4 toxicity occurred in 32%, and 5% had treatment-associated deaths. Conclusion Although the addition of cetuximab to chemoradiation for SCCAC was associated with lower LRF rates than historical data with CRT alone, toxicity was substantial, and LRF still occurs in approximately 20%, indicating the continued need for more effective and less toxic therapies.
Collapse
Affiliation(s)
- Madhur K Garg
- Madhur K. Garg, Joseph A. Sparano, and Shalom Kalnicki, Montefiore Medical Center, Albert Einstein College of Medicine, Montefiore-Einstein Center for Cancer Care, Bronx, NY; Fengmin Zhao, Dana Farber Cancer Institute, Boston, MA; Joel Palefsky, University of California, San Francisco, CA; Richard Whittington, Philadelphia VA Medical Center; Edith P. Mitchell, Thomas Jefferson University, Philadelphia, PA; Mary F. Mulcahy and Al B. Benson III, Northwestern University, Chicago, IL; Karin I. Armstrong, United Hospital, Woodbury, MN; Nassim H. Nabbout, Cancer Center of Kansas, Wichita, KS; Bassel F. El-Rayes, Emory University, Atlanta, GA; Adedayo A. Onitilo, Marshfield Clinic, Marshfield, WI; Daniel J. Moriarty, Overlook Medical Center, Summit, NJ; and Thomas J. Fitzgerald, Imaging and Radiation Oncology Core, Quality Assurance Review Center, Providence, RI
| | - Fengmin Zhao
- Madhur K. Garg, Joseph A. Sparano, and Shalom Kalnicki, Montefiore Medical Center, Albert Einstein College of Medicine, Montefiore-Einstein Center for Cancer Care, Bronx, NY; Fengmin Zhao, Dana Farber Cancer Institute, Boston, MA; Joel Palefsky, University of California, San Francisco, CA; Richard Whittington, Philadelphia VA Medical Center; Edith P. Mitchell, Thomas Jefferson University, Philadelphia, PA; Mary F. Mulcahy and Al B. Benson III, Northwestern University, Chicago, IL; Karin I. Armstrong, United Hospital, Woodbury, MN; Nassim H. Nabbout, Cancer Center of Kansas, Wichita, KS; Bassel F. El-Rayes, Emory University, Atlanta, GA; Adedayo A. Onitilo, Marshfield Clinic, Marshfield, WI; Daniel J. Moriarty, Overlook Medical Center, Summit, NJ; and Thomas J. Fitzgerald, Imaging and Radiation Oncology Core, Quality Assurance Review Center, Providence, RI
| | - Joseph A Sparano
- Madhur K. Garg, Joseph A. Sparano, and Shalom Kalnicki, Montefiore Medical Center, Albert Einstein College of Medicine, Montefiore-Einstein Center for Cancer Care, Bronx, NY; Fengmin Zhao, Dana Farber Cancer Institute, Boston, MA; Joel Palefsky, University of California, San Francisco, CA; Richard Whittington, Philadelphia VA Medical Center; Edith P. Mitchell, Thomas Jefferson University, Philadelphia, PA; Mary F. Mulcahy and Al B. Benson III, Northwestern University, Chicago, IL; Karin I. Armstrong, United Hospital, Woodbury, MN; Nassim H. Nabbout, Cancer Center of Kansas, Wichita, KS; Bassel F. El-Rayes, Emory University, Atlanta, GA; Adedayo A. Onitilo, Marshfield Clinic, Marshfield, WI; Daniel J. Moriarty, Overlook Medical Center, Summit, NJ; and Thomas J. Fitzgerald, Imaging and Radiation Oncology Core, Quality Assurance Review Center, Providence, RI
| | - Joel Palefsky
- Madhur K. Garg, Joseph A. Sparano, and Shalom Kalnicki, Montefiore Medical Center, Albert Einstein College of Medicine, Montefiore-Einstein Center for Cancer Care, Bronx, NY; Fengmin Zhao, Dana Farber Cancer Institute, Boston, MA; Joel Palefsky, University of California, San Francisco, CA; Richard Whittington, Philadelphia VA Medical Center; Edith P. Mitchell, Thomas Jefferson University, Philadelphia, PA; Mary F. Mulcahy and Al B. Benson III, Northwestern University, Chicago, IL; Karin I. Armstrong, United Hospital, Woodbury, MN; Nassim H. Nabbout, Cancer Center of Kansas, Wichita, KS; Bassel F. El-Rayes, Emory University, Atlanta, GA; Adedayo A. Onitilo, Marshfield Clinic, Marshfield, WI; Daniel J. Moriarty, Overlook Medical Center, Summit, NJ; and Thomas J. Fitzgerald, Imaging and Radiation Oncology Core, Quality Assurance Review Center, Providence, RI
| | - Richard Whittington
- Madhur K. Garg, Joseph A. Sparano, and Shalom Kalnicki, Montefiore Medical Center, Albert Einstein College of Medicine, Montefiore-Einstein Center for Cancer Care, Bronx, NY; Fengmin Zhao, Dana Farber Cancer Institute, Boston, MA; Joel Palefsky, University of California, San Francisco, CA; Richard Whittington, Philadelphia VA Medical Center; Edith P. Mitchell, Thomas Jefferson University, Philadelphia, PA; Mary F. Mulcahy and Al B. Benson III, Northwestern University, Chicago, IL; Karin I. Armstrong, United Hospital, Woodbury, MN; Nassim H. Nabbout, Cancer Center of Kansas, Wichita, KS; Bassel F. El-Rayes, Emory University, Atlanta, GA; Adedayo A. Onitilo, Marshfield Clinic, Marshfield, WI; Daniel J. Moriarty, Overlook Medical Center, Summit, NJ; and Thomas J. Fitzgerald, Imaging and Radiation Oncology Core, Quality Assurance Review Center, Providence, RI
| | - Edith P Mitchell
- Madhur K. Garg, Joseph A. Sparano, and Shalom Kalnicki, Montefiore Medical Center, Albert Einstein College of Medicine, Montefiore-Einstein Center for Cancer Care, Bronx, NY; Fengmin Zhao, Dana Farber Cancer Institute, Boston, MA; Joel Palefsky, University of California, San Francisco, CA; Richard Whittington, Philadelphia VA Medical Center; Edith P. Mitchell, Thomas Jefferson University, Philadelphia, PA; Mary F. Mulcahy and Al B. Benson III, Northwestern University, Chicago, IL; Karin I. Armstrong, United Hospital, Woodbury, MN; Nassim H. Nabbout, Cancer Center of Kansas, Wichita, KS; Bassel F. El-Rayes, Emory University, Atlanta, GA; Adedayo A. Onitilo, Marshfield Clinic, Marshfield, WI; Daniel J. Moriarty, Overlook Medical Center, Summit, NJ; and Thomas J. Fitzgerald, Imaging and Radiation Oncology Core, Quality Assurance Review Center, Providence, RI
| | - Mary F Mulcahy
- Madhur K. Garg, Joseph A. Sparano, and Shalom Kalnicki, Montefiore Medical Center, Albert Einstein College of Medicine, Montefiore-Einstein Center for Cancer Care, Bronx, NY; Fengmin Zhao, Dana Farber Cancer Institute, Boston, MA; Joel Palefsky, University of California, San Francisco, CA; Richard Whittington, Philadelphia VA Medical Center; Edith P. Mitchell, Thomas Jefferson University, Philadelphia, PA; Mary F. Mulcahy and Al B. Benson III, Northwestern University, Chicago, IL; Karin I. Armstrong, United Hospital, Woodbury, MN; Nassim H. Nabbout, Cancer Center of Kansas, Wichita, KS; Bassel F. El-Rayes, Emory University, Atlanta, GA; Adedayo A. Onitilo, Marshfield Clinic, Marshfield, WI; Daniel J. Moriarty, Overlook Medical Center, Summit, NJ; and Thomas J. Fitzgerald, Imaging and Radiation Oncology Core, Quality Assurance Review Center, Providence, RI
| | - Karin I Armstrong
- Madhur K. Garg, Joseph A. Sparano, and Shalom Kalnicki, Montefiore Medical Center, Albert Einstein College of Medicine, Montefiore-Einstein Center for Cancer Care, Bronx, NY; Fengmin Zhao, Dana Farber Cancer Institute, Boston, MA; Joel Palefsky, University of California, San Francisco, CA; Richard Whittington, Philadelphia VA Medical Center; Edith P. Mitchell, Thomas Jefferson University, Philadelphia, PA; Mary F. Mulcahy and Al B. Benson III, Northwestern University, Chicago, IL; Karin I. Armstrong, United Hospital, Woodbury, MN; Nassim H. Nabbout, Cancer Center of Kansas, Wichita, KS; Bassel F. El-Rayes, Emory University, Atlanta, GA; Adedayo A. Onitilo, Marshfield Clinic, Marshfield, WI; Daniel J. Moriarty, Overlook Medical Center, Summit, NJ; and Thomas J. Fitzgerald, Imaging and Radiation Oncology Core, Quality Assurance Review Center, Providence, RI
| | - Nassim H Nabbout
- Madhur K. Garg, Joseph A. Sparano, and Shalom Kalnicki, Montefiore Medical Center, Albert Einstein College of Medicine, Montefiore-Einstein Center for Cancer Care, Bronx, NY; Fengmin Zhao, Dana Farber Cancer Institute, Boston, MA; Joel Palefsky, University of California, San Francisco, CA; Richard Whittington, Philadelphia VA Medical Center; Edith P. Mitchell, Thomas Jefferson University, Philadelphia, PA; Mary F. Mulcahy and Al B. Benson III, Northwestern University, Chicago, IL; Karin I. Armstrong, United Hospital, Woodbury, MN; Nassim H. Nabbout, Cancer Center of Kansas, Wichita, KS; Bassel F. El-Rayes, Emory University, Atlanta, GA; Adedayo A. Onitilo, Marshfield Clinic, Marshfield, WI; Daniel J. Moriarty, Overlook Medical Center, Summit, NJ; and Thomas J. Fitzgerald, Imaging and Radiation Oncology Core, Quality Assurance Review Center, Providence, RI
| | - Shalom Kalnicki
- Madhur K. Garg, Joseph A. Sparano, and Shalom Kalnicki, Montefiore Medical Center, Albert Einstein College of Medicine, Montefiore-Einstein Center for Cancer Care, Bronx, NY; Fengmin Zhao, Dana Farber Cancer Institute, Boston, MA; Joel Palefsky, University of California, San Francisco, CA; Richard Whittington, Philadelphia VA Medical Center; Edith P. Mitchell, Thomas Jefferson University, Philadelphia, PA; Mary F. Mulcahy and Al B. Benson III, Northwestern University, Chicago, IL; Karin I. Armstrong, United Hospital, Woodbury, MN; Nassim H. Nabbout, Cancer Center of Kansas, Wichita, KS; Bassel F. El-Rayes, Emory University, Atlanta, GA; Adedayo A. Onitilo, Marshfield Clinic, Marshfield, WI; Daniel J. Moriarty, Overlook Medical Center, Summit, NJ; and Thomas J. Fitzgerald, Imaging and Radiation Oncology Core, Quality Assurance Review Center, Providence, RI
| | - Bassel F El-Rayes
- Madhur K. Garg, Joseph A. Sparano, and Shalom Kalnicki, Montefiore Medical Center, Albert Einstein College of Medicine, Montefiore-Einstein Center for Cancer Care, Bronx, NY; Fengmin Zhao, Dana Farber Cancer Institute, Boston, MA; Joel Palefsky, University of California, San Francisco, CA; Richard Whittington, Philadelphia VA Medical Center; Edith P. Mitchell, Thomas Jefferson University, Philadelphia, PA; Mary F. Mulcahy and Al B. Benson III, Northwestern University, Chicago, IL; Karin I. Armstrong, United Hospital, Woodbury, MN; Nassim H. Nabbout, Cancer Center of Kansas, Wichita, KS; Bassel F. El-Rayes, Emory University, Atlanta, GA; Adedayo A. Onitilo, Marshfield Clinic, Marshfield, WI; Daniel J. Moriarty, Overlook Medical Center, Summit, NJ; and Thomas J. Fitzgerald, Imaging and Radiation Oncology Core, Quality Assurance Review Center, Providence, RI
| | - Adedayo A Onitilo
- Madhur K. Garg, Joseph A. Sparano, and Shalom Kalnicki, Montefiore Medical Center, Albert Einstein College of Medicine, Montefiore-Einstein Center for Cancer Care, Bronx, NY; Fengmin Zhao, Dana Farber Cancer Institute, Boston, MA; Joel Palefsky, University of California, San Francisco, CA; Richard Whittington, Philadelphia VA Medical Center; Edith P. Mitchell, Thomas Jefferson University, Philadelphia, PA; Mary F. Mulcahy and Al B. Benson III, Northwestern University, Chicago, IL; Karin I. Armstrong, United Hospital, Woodbury, MN; Nassim H. Nabbout, Cancer Center of Kansas, Wichita, KS; Bassel F. El-Rayes, Emory University, Atlanta, GA; Adedayo A. Onitilo, Marshfield Clinic, Marshfield, WI; Daniel J. Moriarty, Overlook Medical Center, Summit, NJ; and Thomas J. Fitzgerald, Imaging and Radiation Oncology Core, Quality Assurance Review Center, Providence, RI
| | - Daniel J Moriarty
- Madhur K. Garg, Joseph A. Sparano, and Shalom Kalnicki, Montefiore Medical Center, Albert Einstein College of Medicine, Montefiore-Einstein Center for Cancer Care, Bronx, NY; Fengmin Zhao, Dana Farber Cancer Institute, Boston, MA; Joel Palefsky, University of California, San Francisco, CA; Richard Whittington, Philadelphia VA Medical Center; Edith P. Mitchell, Thomas Jefferson University, Philadelphia, PA; Mary F. Mulcahy and Al B. Benson III, Northwestern University, Chicago, IL; Karin I. Armstrong, United Hospital, Woodbury, MN; Nassim H. Nabbout, Cancer Center of Kansas, Wichita, KS; Bassel F. El-Rayes, Emory University, Atlanta, GA; Adedayo A. Onitilo, Marshfield Clinic, Marshfield, WI; Daniel J. Moriarty, Overlook Medical Center, Summit, NJ; and Thomas J. Fitzgerald, Imaging and Radiation Oncology Core, Quality Assurance Review Center, Providence, RI
| | - Thomas J Fitzgerald
- Madhur K. Garg, Joseph A. Sparano, and Shalom Kalnicki, Montefiore Medical Center, Albert Einstein College of Medicine, Montefiore-Einstein Center for Cancer Care, Bronx, NY; Fengmin Zhao, Dana Farber Cancer Institute, Boston, MA; Joel Palefsky, University of California, San Francisco, CA; Richard Whittington, Philadelphia VA Medical Center; Edith P. Mitchell, Thomas Jefferson University, Philadelphia, PA; Mary F. Mulcahy and Al B. Benson III, Northwestern University, Chicago, IL; Karin I. Armstrong, United Hospital, Woodbury, MN; Nassim H. Nabbout, Cancer Center of Kansas, Wichita, KS; Bassel F. El-Rayes, Emory University, Atlanta, GA; Adedayo A. Onitilo, Marshfield Clinic, Marshfield, WI; Daniel J. Moriarty, Overlook Medical Center, Summit, NJ; and Thomas J. Fitzgerald, Imaging and Radiation Oncology Core, Quality Assurance Review Center, Providence, RI
| | - Al B Benson
- Madhur K. Garg, Joseph A. Sparano, and Shalom Kalnicki, Montefiore Medical Center, Albert Einstein College of Medicine, Montefiore-Einstein Center for Cancer Care, Bronx, NY; Fengmin Zhao, Dana Farber Cancer Institute, Boston, MA; Joel Palefsky, University of California, San Francisco, CA; Richard Whittington, Philadelphia VA Medical Center; Edith P. Mitchell, Thomas Jefferson University, Philadelphia, PA; Mary F. Mulcahy and Al B. Benson III, Northwestern University, Chicago, IL; Karin I. Armstrong, United Hospital, Woodbury, MN; Nassim H. Nabbout, Cancer Center of Kansas, Wichita, KS; Bassel F. El-Rayes, Emory University, Atlanta, GA; Adedayo A. Onitilo, Marshfield Clinic, Marshfield, WI; Daniel J. Moriarty, Overlook Medical Center, Summit, NJ; and Thomas J. Fitzgerald, Imaging and Radiation Oncology Core, Quality Assurance Review Center, Providence, RI
| |
Collapse
|
29
|
Ravi P, Pagliaro LC. Multimodal Therapy in the Management of Advanced Penile Cancer. Urol Clin North Am 2016; 43:469-479. [PMID: 27717433 DOI: 10.1016/j.ucl.2016.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A multimodal approach to therapy is increasingly used in treating men with advanced penile cancer. Adjuvant chemotherapy improves outcomes in chemotherapy-naïve men with node-positive positive disease, and neoadjuvant chemotherapy can downstage bulky nodal disease sufficiently to permit surgery and has the potential to offer durable long-term survival. However, there remain several unanswered questions in this field, and international collaboration in the form of clinical trials is required to optimize treatment and improve survival in men with advanced penile cancer.
Collapse
Affiliation(s)
- Praful Ravi
- Department of Internal Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Lance C Pagliaro
- Department of Oncology, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
| |
Collapse
|
30
|
Conley BA, Sorg BS, Tricoli JV. Implications and opportunities of precision medicine in rare malignancies. Expert Opin Orphan Drugs 2016. [DOI: 10.1080/21678707.2016.1214071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Barbara A. Conley
- Cancer Diagnosis Program, Division of Cancer Diagnosis and Treatment, National Cancer Institute, Bethesda, MD, USA
| | - Brian S. Sorg
- Cancer Diagnosis Program, Division of Cancer Diagnosis and Treatment, National Cancer Institute, Bethesda, MD, USA
| | - James V. Tricoli
- Cancer Diagnosis Program, Division of Cancer Diagnosis and Treatment, National Cancer Institute, Bethesda, MD, USA
| |
Collapse
|
31
|
Mendonca SC, Abel GA, Lyratzopoulos G. Pre-referral GP consultations in patients subsequently diagnosed with rarer cancers: a study of patient-reported data. Br J Gen Pract 2016; 66:e171-81. [PMID: 26917657 PMCID: PMC4758496 DOI: 10.3399/bjgp16x683977] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 11/11/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Some patients with cancer experience multiple pre-diagnostic consultations in primary care, leading to longer time intervals to specialist investigations and diagnosis. Patients with rarer cancers are thought to be at higher risk of such events, but concrete evidence of this is lacking. AIM To examine the frequency and predictors of repeat consultations with GPs in patients with rarer cancers. DESIGN AND SETTING Patient-reported data on pre-referral consultations from three English national surveys of patients with cancer (2010, 2013, and 2014), pooled to maximise the sample size of rarer cancers. METHOD The authors examined the frequency and crude and adjusted odds ratios for ≥3 (versus 1-2) pre-referral consultations by age, sex, ethnicity, level of deprivation, and cancer diagnosis (38 diagnosis groups, including 12 rarer cancers without prior relevant evidence). RESULTS Among 7838 patients with 12 rarer cancers, crude proportions of patients with ≥3 pre-referral consultations ranged from >30.0% to 60.0% for patients with small intestine, bone sarcoma, liver, gallbladder, cancer of unknown primary, soft-tissue sarcoma, and ureteric cancer. The range was 15.0-30.0% for patients with oropharyngeal, anal, parotid, penile, and oral cancer. The overall proportion of responders with any cancer who had ≥3 consultations was 23.4%. Multivariable logistic regression indicated concordant patterns, with strong evidence for variation between rarer cancers (P <0.001). CONCLUSION Patients with rarer cancers experience pre-referral consultations at frequencies suggestive of middle-to-high diagnostic difficulty. The findings can guide the development of new diagnostic interventions and 'safety-netting' approaches for symptomatic presentations encountered in patients with rarer cancers.
Collapse
Affiliation(s)
- Silvia C Mendonca
- Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge, Cambridge
| | - Gary A Abel
- Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge, Cambridge
| | - Georgios Lyratzopoulos
- Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London
| |
Collapse
|
32
|
Billingham L, Malottki K, Steven N. Research methods to change clinical practice for patients with rare cancers. Lancet Oncol 2016; 17:e70-e80. [PMID: 26868356 DOI: 10.1016/s1470-2045(15)00396-4] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 09/30/2015] [Accepted: 10/05/2015] [Indexed: 12/11/2022]
Abstract
Rare cancers are a growing group as a result of reclassification of common cancers by molecular markers. There is therefore an increasing need to identify methods to assess interventions that are sufficiently robust to potentially affect clinical practice in this setting. Methods advocated for clinical trials in rare diseases are not necessarily applicable in rare cancers. This Series paper describes research methods that are relevant for rare cancers in relation to the range of incidence levels. Strategies that maximise recruitment, minimise sample size, or maximise the usefulness of the evidence could enable the application of conventional clinical trial design to rare cancer populations. Alternative designs that address specific challenges for rare cancers with the aim of potentially changing clinical practice include Bayesian designs, uncontrolled n-of-1 trials, and umbrella and basket trials. Pragmatic solutions must be sought to enable some level of evidence-based health care for patients with rare cancers.
Collapse
Affiliation(s)
- Lucinda Billingham
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK.
| | - Kinga Malottki
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Neil Steven
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK; University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| |
Collapse
|
33
|
Abstract
The term rare cancers is relatively new in oncology, with significant presence in cancer literature occurring only since the early 2000s. Epidemiologic studies in Europe and the United States show that rare cancers account for about 25% of adult cancers (Eslick, 2012). However, rare cancer types have been traditionally understudied, with an associated lack of progress in survival and challenges in decision making for patients, physicians, and policy makers (Greenlee et al., 2010). Initiatives led within the European Union and with the United States are intended to boost progress in treatment for rare cancers through collective research and shared databases (Keat et al., 2013). Nurses see patients with rare cancers struggle for access to quality, evidence-based care, as well as the isolation they endure as they seek the information and support needed to cope with the diagnosis of a life-threatening illness..
Collapse
|
34
|
Schott AF, Welch JJ, Verschraegen CF, Kurzrock R. The National Clinical Trials Network: Conducting Successful Clinical Trials of New Therapies for Rare Cancers. Semin Oncol 2015; 42:731-9. [PMID: 26433554 DOI: 10.1053/j.seminoncol.2015.07.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Rare cancers account for 27% of neoplasms diagnosed each year, and 25% of cancer-related deaths in the United States. However, rare cancers show some of the highest response rates to targeted therapies, probably due to identification of oncogenic drivers with little interpatient variability. Although the low incidence of rare cancers makes large-scale randomized trials involving single histologies difficult to perform, drugs have been successfully developed in rare cancers using clinical trial designs that combine microscopic histologies. Such trials are being pursued within the National Clinical Trials Network (NCTN), which possesses unique qualifications to perform widespread molecular screening of tumors for patient enrollment onto therapeutic clinical trials. When larger clinical trials are needed to determine optimum treatment strategies in rare cancers, the NCTN's broad reach in North America and internationally, and their ability to partner with both United States-based and international research organizations, can make these challenging studies feasible.
Collapse
Affiliation(s)
- Anne F Schott
- Department of Medicine, Division of Hematology-Oncology, University of Michigan, Ann Arbor, MI.
| | - John J Welch
- National Cancer Institute Center for Global Health , Bethesda, MD
| | | | - Razelle Kurzrock
- Division of Hematology and Oncology, Center for Personalized Therapy and Clinical Trials Office UC San Diego-Moores Cancer Center, San Diego, CA
| |
Collapse
|
35
|
|
36
|
Ledermann JA, Ray-Coquard I. Novel approaches to improve the treatment of rare gynecologic cancers: research opportunities and challenges. Am Soc Clin Oncol Educ Book 2014:e282-e286. [PMID: 24857114 DOI: 10.14694/edbook_am.2014.34.e282] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
More than 50% of all gynecologic cancers can be classified as rare tumors (defined as an incidence of fewer than six per 100,000). Improved understanding of the molecular pathogenesis of tumors increases the proportion of rare tumors and creates challenges in optimizing the design of clinical trials. Novel trial designs are needed to take forward the development of new treatments in rare tumors. This requires international partnerships, harmonization of treatment, and collaboration to overcome the regulatory barriers to conducting international trials. Although randomized trials can be done in many tumor types, there are some for which conducting even single-arm studies may be challenging. For these tumors, robust collection of data through national and/or international registries could lead through audit to improvements in the treatment of rare tumors.
Collapse
Affiliation(s)
- Jonathan A Ledermann
- From the UCL Cancer Institute, London, United Kingdom; Department of Adult Medical Oncology, Centre Leon Berard, Lyon, France
| | - Isabelle Ray-Coquard
- From the UCL Cancer Institute, London, United Kingdom; Department of Adult Medical Oncology, Centre Leon Berard, Lyon, France
| |
Collapse
|
37
|
Abstract
Small bowel cancers account for 3% of all gastrointestinal malignancies and small bowel adenocarcinomas represent a third of all small bowel cancers. Rarity of small bowel adenocarcinomas restricts molecular understanding and presents unique diagnostic and therapeutic challenges. Better cross-sectional imaging techniques and development of enteroscopy and capsule endoscopy have facilitated earlier and more-accurate diagnosis. Surgical resection remains the mainstay of therapy for locoregional disease. In the metastatic setting, fluoropyrimidine and oxaliplatin-based chemotherapy has shown clinical benefit in prospective non-randomized trials. Although frequently grouped under the same therapeutic umbrella as large bowel adenocarcinomas, small bowel adenocarcinomas are distinct clinical and molecular entities. Recent progress in molecular characterization has aided our understanding of the pathogenesis of these tumours and holds potential for prospective development of novel targeted therapies. Multi-institutional collaborative efforts directed towards cogent understanding of tumour biology and designing sensible clinical trials are essential for developing improved therapeutic strategies. In this Review, we endeavour to outline an evidence-based approach to present-day management of small bowel adenocarcinoma, describe contemporary challenges and uncover evolving paradigms in the management of these rare 'orphan' neoplasias.
Collapse
Affiliation(s)
- Kanwal Raghav
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Centre, Unit #426, 1515 Holcombe Boulevard, Houston, TX 77030, USA
| | | |
Collapse
|