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Levit LA, Kaneshiro J, Peppercorn J, Ratain MJ. An Expanded Role for IRBs in the Oversight of Research Biopsies. Ethics Hum Res 2022; 44:32-41. [PMID: 36047275 DOI: 10.1002/eahr.500141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Research biopsies included in cancer clinical trials have the goal of advancing scientific understanding of the biological bases of cancer and its treatments, but may offer no prospect of direct benefit to participants and often pose more than minimal risk. The research community is examining the ethics of research biopsies increasingly often, especially when they are mandatory for study participation but do not support primary study objectives and thus are "nonintegral" to the study. Ethical concerns center on the limited scientific justification supporting some biopsies, risks to research participants, and the potential for coercion and therapeutic misconception during the informed consent process. There is also a lack of comprehensive oversight of research biopsies by regulatory agencies and institutions. This paper reviews these ethical concerns, discusses the scope of federal oversight, and suggests that institutional review boards (IRBs) should assume a larger role in ensuring the ethical conduct of research biopsies. It concludes with guidance to IRBs on how to weigh the risks, benefits, and acceptability of such biopsies in different contexts that is based on a framework the American Society of Clinical Oncology developed for the inclusion of research biopsies in oncology clinical trials.
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Affiliation(s)
- Laura A Levit
- Director of research analysis and publications in the Center for Research and Analytics at the American Society of Clinical Oncology
| | - Julie Kaneshiro
- Deputy director of the Office for Human Research Protections at the U.S. Department of Health and Human Services
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Campbell G, Dixon MD, Lohani M, Cook J, Hianik R, Thomson MC, Abernethy E, Lewis C, Switchenko J, Harvey RD, Pentz RD. Therapeutic Misconception about Research Procedures: Does a Simple Information Chart Improve Understanding? Ethics Hum Res 2022; 44:18-25. [PMID: 35218599 PMCID: PMC9069479 DOI: 10.1002/eahr.500120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
In phase I trials, some biospecimens are used both for research and patient care and some for research only. Some research participants have therapeutic misconception, assuming all biospecimens are for patient care. This study's aim was to test if a simple information chart would improve understanding of nontherapeutic research procedures. A two-arm study was conducted. Participants in the control group (C) were asked whether biospecimens were for their care, for research only, or for both. The experimental group (E) was asked the same questions but provided with a study-specific information chart labeling the purpose of each biospecimen. One hundred one patients were interviewed. In both arms, understanding that pretreatment blood draws were for patient care and research was moderate (49% for C and 62% for E). Understanding that posttreatment blood draws were for research only was significantly higher in the experimental arm (16% for C and 44% for E; p = 0.002). Providing a simple information chart may help alleviate this aspect of therapeutic misconception.
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Affiliation(s)
- Gavin Campbell
- Research assistant at the Winship Cancer Institute of Emory University
| | - Margie D Dixon
- Supervisor and project coordinator at the Winship Cancer Institute of Emory University
| | - Minisha Lohani
- Internal medicine resident at the Stony Brook University School of Medicine
| | - John Cook
- Medical student at the Uniformed Services University of the Health Sciences School of Medicine
| | - Rachel Hianik
- Medical student at the University of North Carolina School of Medicine
| | | | - Eli Abernethy
- Medical student at Duke University School of Medicine
| | - Colleen Lewis
- Nurse practitioner at the Winship Cancer Institute of Emory University
| | | | - R Donald Harvey
- Phase I director at the Winship Cancer Institute of Emory University
| | - Rebecca D Pentz
- Professor of research ethics at the Winship Cancer Institute of Emory University
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Kendall TJ, Robinson M, Brierley DJ, Lim SJ, O'Connor DJ, Shaaban AM, Lewis I, Chan AW, Harrison DJ. Guidelines for cellular and molecular pathology content in clinical trial protocols: the SPIRIT-Path extension. Lancet Oncol 2021; 22:e435-e445. [PMID: 34592193 DOI: 10.1016/s1470-2045(21)00344-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 06/04/2021] [Accepted: 06/07/2021] [Indexed: 01/12/2023]
Abstract
The 2013 SPIRIT (Standard Protocol Items: Recommendations for Interventional Trials) Statement provides evidence-based recommendations for the minimum content to be included in a clinical trial protocol. Assessment of biospecimens is often required for trial eligibility or as part of an outcome evaluation, and precision molecular approaches are increasingly used in trial design. However, cellular and molecular pathology practices within trials have not been codified or formalised. We developed international consensus reporting guidelines for cellular and molecular pathology content in clinical trial protocols (the SPIRIT-Path extension) using an international Delphi process, which assesses candidate items generated from a previous systematic review, followed by an expert consensus meeting. 74 individuals from five continents responded, including clinicians, statisticians, laboratory scientists, patient advocates, funders, industry representatives, journal editors, and regulators. The SPIRIT-Path guidelines recommend 14 additional items (seven extensions to the SPIRIT checklist and seven elaborations) that should be addressed in trial protocols containing pathology content, alongside the SPIRIT 2013 Statement items. SPIRIT-Path recommends that protocols should document the individuals, processes, and standards for all cellular and molecular pathology components of the trial, including all stages of the specimen pathway and any digital pathology methods, with specific consideration of the value of trial data and biological tissues for additional translational studies.
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Affiliation(s)
- Timothy J Kendall
- Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK.
| | - Max Robinson
- Department of Cellular Pathology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - Daniel J Brierley
- Unit of Oral and Maxillofacial Pathology, University of Sheffield, Sheffield, UK
| | - Shujing Jane Lim
- Department of Cellular Pathology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | | | - Abeer M Shaaban
- Queen Elizabeth Hospital Birmingham, Birmingham, UK; University of Birmingham, Birmingham, UK
| | - Ian Lewis
- National Cancer Research Institute, London, UK
| | - An-Wen Chan
- Department of Medicine, Women's College Research Institute, University of Toronto, Toronto, ON, Canada
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Lim SJ, Gurusamy K, O'Connor D, Shaaban AM, Brierley D, Lewis I, Harrison D, Kendall TJ, Robinson M. Recommendations for cellular and molecular pathology input into clinical trials: a systematic review and meta-aggregation. J Pathol Clin Res 2021; 7:191-202. [PMID: 33635586 PMCID: PMC8073003 DOI: 10.1002/cjp2.199] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 12/11/2020] [Accepted: 01/03/2021] [Indexed: 01/10/2023]
Abstract
The SPIRIT (Standard Protocol Items: Recommendations for Interventional Trials) 2013 Statement was developed to provide guidance for inclusion of key methodological components in clinical trial protocols. However, these standards do not include guidance specific to pathology input in clinical trials. This systematic review aims to synthesise existing recommendations specific to pathology practice in clinical trials for implementation in trial protocol design. Articles were identified from database searches and deemed eligible for inclusion if they contained: (1) guidance and/or a checklist, which was (2) pathology-related, with (3) content relevant to clinical trial protocols or could influence a clinical trial protocol design from a pathology perspective and (4) were published in 1996 or later. The quality of individual papers was assessed using the AGREE-GRS (Appraisal of Guidelines for REsearch & Evaluation - Global Rating Scale) tool, and the confidence in cumulative evidence was evaluated using the GRADE-CERQual (Grading of Recommendations Assessment, Development and Evaluation-Confidence in Evidence from Reviews of Qualitative research) approach. Extracted recommendations were synthesised using the best fit framework method, which includes thematic analysis followed by a meta-aggregative approach to synthesis within the framework. Of the 10 184 records screened and 199 full-text articles reviewed, only 40 guidance resources met the eligibility criteria for inclusion. Recommendations extracted from 22 guidance documents were generalisable enough for data synthesis. Seven recommendation statements were synthesised as follows: (1) multidisciplinary collaboration in trial design with early involvement of pathologists, particularly with respect to the use of biospecimens and associated biomarker/analytical assays and in the evaluation of pathology-related parameters; (2) funding and training for personnel undertaking trial work; (3) selection of an accredited laboratory with suitable facilities to undertake scheduled work; (4) quality assurance of pathology-related parameters; (5) transparent reporting of pathology-related parameters; (6) policies regarding informatics and tracking biospecimens across trial sites; and (7) informed consent for specimen collection and retention for future research.
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Affiliation(s)
- Shujing Jane Lim
- Department of Cellular PathologyNewcastle upon Tyne Hospitals NHS Foundation TrustNewcastle Upon TyneUK
- Division of Surgery and Interventional SciencesUniversity College LondonLondonUK
| | - Kurinchi Gurusamy
- Division of Surgery and Interventional SciencesUniversity College LondonLondonUK
| | - Daniel O'Connor
- The Medicines and Healthcare Products Regulatory AgencyLondonUK
| | - Abeer M Shaaban
- Department of HistopathologyQueen Elizabeth Hospital BirminghamBirminghamUK
- Institute of Cancer and Genomic SciencesUniversity of BirminghamBirminghamUK
| | - Daniel Brierley
- Unit of Oral and Maxillofacial PathologyUniversity of SheffieldSheffieldUK
| | - Ian Lewis
- National Cancer Research InstituteLondonUK
| | | | - Timothy James Kendall
- University of Edinburgh Centre for Inflammation Research, University of EdinburghEdinburghUK
| | - Max Robinson
- Department of Cellular PathologyNewcastle upon Tyne Hospitals NHS Foundation TrustNewcastle Upon TyneUK
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5
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Seah DS, Leone JP, Openshaw TH, Scott SM, Tayob N, Hu J, Lederman RI, Frank ES, Sohl JJ, Stadler ZK, Erick TK, Silverman SG, Peppercorn JM, Winer EP, Come SE, Lin NU. Perceptions of patients with early stage breast cancer toward research biopsies. Cancer 2020; 127:1208-1219. [PMID: 33320362 PMCID: PMC8247276 DOI: 10.1002/cncr.33371] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 10/28/2020] [Accepted: 11/07/2020] [Indexed: 11/24/2022]
Abstract
Background The objective of this study was to describe the perspective of patients with early breast cancer toward research biopsies. The authors hypothesized that more patients at academic sites than at community‐based sites would be willing to consider these procedures. Methods In total, 198 patients with early stage breast cancer were recruited from 3 academic centers (n = 102) and from 1 community oncology practice (n = 96). The primary objective was to compare the proportion of patients willing to consider donating excess tissue biospecimens from surgery, from a clinically indicated breast biopsy, or from a research purposes‐only biopsy (RPOB) between practice types. Results Most patients (93% at academic sites, 94% at the community oncology site) said they would consider donating excess tissue from surgery for research. One‐half of patients from academic or community sites would consider donating tissue from a clinically indicated breast biopsy. On univariate analysis, significantly fewer patients from academic sites would consider an RPOB (22% at academic sites, 42% at the community site; P = .003); however, this difference was no longer significant on multivariate analysis (P = .96). Longer transportation times and unfavorable prior experiences were associated with less willingness to consider an RPOB on multivariate analysis. Significantly fewer patients from academic sites (14%) than from the community site (35%) would consider a research biopsy in a clinical trial (P = .04). Contributing to scientific knowledge, return of results, and a personal request by their physician were the strongest factors influencing patients' willingness to undergo research biopsies. Conclusions The current results rejected the hypothesis that more patients with early breast cancer at academic sites would be willing to donate tissue biospecimens for research compared with those at community oncology sites. These findings identify modifiable factors to consider in biobanking studies and clinical trials. In this study of the willingness of patients with early stage breast cancer to consider biospecimen collection procedures for the purposes of research, most patients were willing to provide blood samples for research but were less likely to consider percutaneous breast biopsies. Longer travel time to the clinic and adverse experiences with prior biopsies, but not treatment center type (academic versus community‐based center), were associated with less willingness to consider research biopsies.
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Affiliation(s)
- Davinia S Seah
- Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Jose Pablo Leone
- Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | | | - Sarah M Scott
- Department of Medical Oncology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Nabihah Tayob
- Department of Data Science, Dana-Farber Cancer Center, Boston, Massachusetts
| | - Jiani Hu
- Department of Data Science, Dana-Farber Cancer Center, Boston, Massachusetts
| | - Ruth I Lederman
- Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Elizabeth S Frank
- Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Jessica J Sohl
- Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Zsofia K Stadler
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Timothy K Erick
- Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Stuart G Silverman
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Jeffrey M Peppercorn
- Department of Medicine, Harvard University and Massachusetts General Hospital, Boston, Massachusetts
| | - Eric P Winer
- Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Steven E Come
- Department of Medical Oncology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Nancy U Lin
- Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
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The value of interventional radiology in clinical trial teams: experience from the BATTLE lung cancer trials. Clin Radiol 2020; 76:155.e25-155.e34. [PMID: 33268083 DOI: 10.1016/j.crad.2020.09.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 09/30/2020] [Indexed: 11/22/2022]
Abstract
AIM To report on the multidisciplinary approach, focusing specifically on the role of the interventional radiologist (IR), used to support the Biomarker-integrated Approaches of Targeted Therapy for Lung Cancer Elimination (BATTLE) and BATTLE-2 trials. MATERIALS AND METHODS Patients who underwent percutaneous image-guided biopsy for the BATTLE and BATTLE-2 trials were reviewed. A radiology-based, three-point, lesion-scoring system was developed and used by two IRs. Lesions were given a score of 3 (most likely to yield sufficient material for biomarker analysis) if they met the following criteria: size >2 cm, solid mass, demonstrated imaging evidence of viability, and were technically easy to sample. Lesions not meeting all four criteria were scored 2 with the missing criteria noted as negative factors. Lesions considered to have risks that outweighed potential benefits receive a score of 1 and were not biopsied. Univariate and multivariate analyses were performed to evaluate the score's ability to predict successful yield for biomarker adequacy. RESULTS A total of 555 biopsies were performed. The overall yield for analysis of the required biomarkers was 86.1% (478/555), and 84% (268/319) and 88.9% (210/236) for BATTLE and BATTLE-2, respectively (p=0.09). Lesions receiving a score of 3 were adequate for biomarker analysis in 89% of cases. Lesions receiving a score of 2 with more than two negative factors were adequate for molecular analysis in 69.2% (IR1, p=0.03) and 74% (IR2, p=0.04) of cases. The two IRs scored 78.4% of the lesions the same indicating moderate agreement (kappa=0.55; 95% confidence interval [CI]: 0.48, 0.61). CONCLUSIONS IRs add value to clinical trial teams by optimising lesions selected for biopsy and biomarker analysis.
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Khan K, Gonzalez-Exposito R, Cunningham D, Koh DM, Woolston A, Barber L, Griffiths B, Kouvelakis K, Calamai V, Bali M, Khan N, Bryant A, Saffery C, Dearman C, Begum R, Rao S, Starling N, Watkins D, Chau I, Braconi C, Valeri N, Gerlinger M, Fotiadis N. Diagnostic Accuracy and Safety of Coaxial System in Oncology Patients Treated in a Specialist Cancer Center With Prospective Validation Within Clinical Trial Data. Front Oncol 2020; 10:1634. [PMID: 33014822 PMCID: PMC7500492 DOI: 10.3389/fonc.2020.01634] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 07/27/2020] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Image-guided tissue biopsies are critically important in the diagnosis and management of cancer patients. High-yield samples are also vital for biomarker and resistance mechanism discovery through molecular/genomic analyses. PATIENTS AND METHODS All consecutive patients who underwent plugged image-guided biopsy at Royal Marsden from June 2013 until September 2016 were included in the analysis. In the next step, a second cohort of patients prospectively treated within two clinical trials (PROSPECT-C and PROSPECT-R) were assessed for the DNA yield from biopsies assessed for complex genomic analysis. RESULTS A total of 522 plugged core biopsies were performed in 457 patients [men, 52%; median age, 63 years (range, 17-93)]. Histological diagnosis was achieved in 501 of 522 (96%) performed biopsies. Age, gender, modality, metastatic site, and seniority of the interventionist were not found to be significant factors associated with odds of failure on a logistic regression. Seventeen (3.3%) were admitted due to biopsy-related complications; nine, three, two, one, one, and one were admitted for grade I/II pain control, sepsis, vasovagal syncope, thrombosis, hematuria, and deranged liver functions, respectively; two patients with right upper quadrant pain after liver biopsy were found to have radiologically confirmed subcapsular hematoma requiring conservative treatment. One patient (0.2%) developed grade III hemorrhage following biopsy of a gastric gastrointestinal stromal tumor (GIST). Overall molecular analysis was successful in 89% (197/222 biopsies). Prospective validation in 62 biopsies gave success rates of 92.06 and 79.03% for DNA extraction of >1 μm and tmour content of >20%, respectively. CONCLUSION The probability of diagnostic success for complex molecular analysis is increased with plugged large coaxial needle biopsy technique, which also minimizes complications and reduces hospital stay. High-yield DNA acquisition allows genomic molecular characterization for personalized medicine.
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Affiliation(s)
- Khurum Khan
- Department of Gastrointestinal Oncology, UCL Cancer Institute, University College NHS Foundation Trust, London, United Kingdom
| | | | - David Cunningham
- Department of Medicine, The Royal Marsden NHS Trust, London, United Kingdom
| | - Dow-Mu Koh
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research and Royal Marsden Hospital, London, United Kingdom
| | - Andrew Woolston
- Translational Oncogenomics Laboratory, Centre for Evolution and Cancer, The Institute of Cancer Research, London, United Kingdom
| | - Louise Barber
- Translational Oncogenomics Laboratory, Centre for Evolution and Cancer, The Institute of Cancer Research, London, United Kingdom
| | - Beatrice Griffiths
- Translational Oncogenomics Laboratory, Centre for Evolution and Cancer, The Institute of Cancer Research, London, United Kingdom
| | | | - Vanessa Calamai
- Department of Medicine, The Royal Marsden NHS Trust, London, United Kingdom
| | - Monia Bali
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research and Royal Marsden Hospital, London, United Kingdom
| | - Nasir Khan
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research and Royal Marsden Hospital, London, United Kingdom
| | - Annette Bryant
- Department of Medicine, The Royal Marsden NHS Trust, London, United Kingdom
| | - Claire Saffery
- Department of Medicine, The Royal Marsden NHS Trust, London, United Kingdom
| | - Charles Dearman
- Department of Medicine, The Royal Marsden NHS Trust, London, United Kingdom
| | - Ruwaida Begum
- Department of Medicine, The Royal Marsden NHS Trust, London, United Kingdom
| | - Sheela Rao
- Department of Medicine, The Royal Marsden NHS Trust, London, United Kingdom
| | - Naureen Starling
- Department of Medicine, The Royal Marsden NHS Trust, London, United Kingdom
| | - David Watkins
- Department of Medicine, The Royal Marsden NHS Trust, London, United Kingdom
| | - Ian Chau
- Department of Medicine, The Royal Marsden NHS Trust, London, United Kingdom
| | - Chiara Braconi
- Department of Medicine, The Royal Marsden NHS Trust, London, United Kingdom
| | - Nicola Valeri
- Department of Medicine, The Royal Marsden NHS Trust, London, United Kingdom
- Division of Molecular Pathology, The Institute of Cancer Research, London, United Kingdom
| | - Marco Gerlinger
- Department of Medicine, The Royal Marsden NHS Trust, London, United Kingdom
- Translational Oncogenomics Laboratory, Centre for Evolution and Cancer, The Institute of Cancer Research, London, United Kingdom
| | - Nicos Fotiadis
- Cancer Research UK Cancer Imaging Centre, Division of Radiotherapy and Imaging, The Institute of Cancer Research and Royal Marsden Hospital, London, United Kingdom
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Gut microbiota and human NAFLD: disentangling microbial signatures from metabolic disorders. Nat Rev Gastroenterol Hepatol 2020; 17:279-297. [PMID: 32152478 DOI: 10.1038/s41575-020-0269-9] [Citation(s) in RCA: 542] [Impact Index Per Article: 135.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/21/2020] [Indexed: 02/07/2023]
Abstract
Gut microbiota dysbiosis has been repeatedly observed in obesity and type 2 diabetes mellitus, two metabolic diseases strongly intertwined with non-alcoholic fatty liver disease (NAFLD). Animal studies have demonstrated a potential causal role of gut microbiota in NAFLD. Human studies have started to describe microbiota alterations in NAFLD and have found a few consistent microbiome signatures discriminating healthy individuals from those with NAFLD, non-alcoholic steatohepatitis or cirrhosis. However, patients with NAFLD often present with obesity and/or insulin resistance and type 2 diabetes mellitus, and these metabolic confounding factors for dysbiosis have not always been considered. Patients with different NAFLD severity stages often present with heterogeneous lesions and variable demographic characteristics (including age, sex and ethnicity), which are known to affect the gut microbiome and have been overlooked in most studies. Finally, multiple gut microbiome sequencing tools and NAFLD diagnostic methods have been used across studies that could account for discrepant microbiome signatures. This Review provides a broad insight into microbiome signatures for human NAFLD and explores issues with disentangling these signatures from underlying metabolic disorders. More advanced metagenomics and multi-omics studies using system biology approaches are needed to improve microbiome biomarkers.
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Waninger JJ, Green MD, Cheze Le Rest C, Rosen B, El Naqa I. Integrating radiomics into clinical trial design. THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING : OFFICIAL PUBLICATION OF THE ITALIAN ASSOCIATION OF NUCLEAR MEDICINE (AIMN) [AND] THE INTERNATIONAL ASSOCIATION OF RADIOPHARMACOLOGY (IAR), [AND] SECTION OF THE SOCIETY OF RADIOPHARMACEUTICAL CHEMISTRY AND BIOLOGY 2019; 63:339-346. [PMID: 31527581 DOI: 10.23736/s1824-4785.19.03217-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
In radiomics, quantitative features that describe phenotypic tumor characteristics are derived from radiographic images. Because radiomics generates information from routine medical images, it is a powerful way to non-invasively examine the spatial and temporal heterogeneity of disease, and thus has potential to significantly impact clinical trial design, execution, and ultimately patient care. The aim of this review article is to discuss how radiomics may address some of the current challenges in clinical randomized control trials, and the difficulties of integrating robust and repeatable radiomics analysis into trial design. Each step of the radiomics process, including image acquisition and reconstruction, image segmentation, feature extraction, and computational analysis, requires extensive standardization in order to be successfully incorporated into clinical trials and inform clinical decision making. By addressing these challenges, the potential of radiomics may be realized.
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Affiliation(s)
- Jessica J Waninger
- Department of Medical Education, University of Michigan School of Medicine, Ann Arbor, MI, USA.,Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Michael D Green
- Department of Radiation Oncology, University of Michigan School of Medicine, Ann Arbor, MI, USA.,University of Michigan Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA
| | | | - Benjamin Rosen
- Department of Radiation Oncology, University of Michigan School of Medicine, Ann Arbor, MI, USA
| | - Issam El Naqa
- Department of Radiation Oncology, University of Michigan School of Medicine, Ann Arbor, MI, USA -
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10
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Levit LA, Peppercorn JM, Tam AL, Marron JM, Mathews DJ, Levit K, Roach N, Ratain MJ. Ethical Framework for Including Research Biopsies in Oncology Clinical Trials: American Society of Clinical Oncology Research Statement. J Clin Oncol 2019; 37:2368-2377. [DOI: 10.1200/jco.19.01479] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
In contrast to clinical biopsies, where tissue is collected to inform patient care, research biopsies are performed for scientific purposes to potentially enhance understanding of the biologic bases of cancer and drug action, thereby improving diagnosis and treatment, but they may offer no direct benefit to participants and have known risks. The widespread use of research biopsies that do not have the potential to directly benefit participants has come under scrutiny, with critics raising ethical concerns related to the adequacy of participant protections, informed consent, and participant understanding of the risks and benefits, as well as the scientific impact of research biopsies on drug development and treatment. This manuscript presents the American Society of Clinical Oncology’s (ASCO’s) ethical framework for incorporation of research biopsies in trials. The framework provides guidance on the circumstances to include optional and mandatory biopsies, as well as provides recommendations to stakeholders on necessary steps for improving the conduct of research biopsies overall.
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Affiliation(s)
| | | | - Alda L. Tam
- University of Texas MD Anderson Cancer Center, Houston, TX
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11
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Lee K, Lee SJ, Yoon S, Ryoo BY, Kim SW, Choi SH, Lee SM, Chae EJ, Park Y, Jang SJ, Park SY, Yoon YK, Park SH, Kim TW. Feasibility, safety, and adequacy of research biopsies for cancer clinical trials at an academic medical center. PLoS One 2019; 14:e0221065. [PMID: 31404103 PMCID: PMC6690517 DOI: 10.1371/journal.pone.0221065] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 07/29/2019] [Indexed: 12/11/2022] Open
Abstract
Objective Research biopsies are an essential component of cancer clinical trials for studying drug efficacy and identifying biomarkers. Site-level clinical investigators, however, do not have access to results on the adequacy of research biopsies for histological or molecular assays, because samples are sent to central labs and the test results are seldom reported back to site-level investigators unless requested. We evaluated the feasibility, safety, and adequacy of research biopsies performed at an academic medical center. Materials and methods We retrospectively reviewed the data on 122 research biopsy sessions conducted in 99 patients via percutaneous core needle biopsy for 39 clinical trials from January 2017 to February 2018 at a single institute. We asked the sponsors of each clinical trial for the adequacy of the biopsy samples for histological or molecular assays. Results The biopsy success rate was 93.4% (113/122), with nine samples categorized as inadequate for obtaining pathologic diagnosis. Post-biopsy complications occurred in 9.8% (12/122) of biopsies, all of which were mild and completely recovered by the day after the biopsy. The sponsors of clinical trials provided feedbacks on the adequacy of 76 biopsy samples, and noted that a total of 8 biopsy samples from 7 patients were inadequate for analysis, resulting in an adequacy rate of 89.5% (68/76): the reasons for inadequacy were insufficient tumor content for immunohistochemistry (n = 3) and low RNA yield for sequencing (n = 5). Conclusion Research biopsies performed at an experienced, multidisciplinary center had acceptable safety for patients as well as practicality in terms of obtaining adequate tissue samples for molecular studies.
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Affiliation(s)
- Kyoungmin Lee
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - So Jung Lee
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Shinkyo Yoon
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Baek-Yeol Ryoo
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang-We Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang Hyun Choi
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang Min Lee
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Eun Jin Chae
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yangsoon Park
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Se-Jin Jang
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Soo-Yeon Park
- Clinical Trial Center, Asan Institute for Life Sciences, Asan Medical Center, Seoul, Republic of Korea
| | - Young-Kwang Yoon
- Clinical Trial Center, Asan Institute for Life Sciences, Asan Medical Center, Seoul, Republic of Korea
| | - Seong Ho Park
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
- * E-mail: (TWK); (SHP)
| | - Tae Won Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
- * E-mail: (TWK); (SHP)
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Overman MJ, Ellis LM, Joffe S. Ethics and the Underreporting of Research Biopsy Findings in Clinical Trials. JAMA Oncol 2018; 4:1041-1042. [PMID: 29799989 DOI: 10.1001/jamaoncol.2018.1002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Michael J Overman
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Lee M Ellis
- Division of Surgery, Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Steven Joffe
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Division of Oncology, Children's Hospital of Philadelphia, Philadelphia
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Batten LM, Bhattacharya IS, Moretti L, Haviland JS, Emson MA, Miller SE, Jefford M, MacKenzie M, Wilcox M, Hyslop M, Todd R, Snowdon CF, Bliss JM. Patient advocate involvement in the design and conduct of breast cancer clinical trials requiring the collection of multiple biopsies. RESEARCH INVOLVEMENT AND ENGAGEMENT 2018; 4:22. [PMID: 30026963 PMCID: PMC6047125 DOI: 10.1186/s40900-018-0108-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 07/03/2018] [Indexed: 06/08/2023]
Abstract
PLAIN ENGLISH SUMMARY Breast cancer is a diverse and varied disease. Recent research has shown that the collection of multiple biopsies before surgery can help researchers determine how the cancer is responding to treatment and can predict for long-term outcomes. However biopsies can be uncomfortable, and sometimes clinicians and research teams in hospitals may be reluctant to offer clinical trials requiring several biopsies to patients who have been recently diagnosed with breast cancer. The Institute of Cancer Research Clinical Trials and Statistics Unit (ICR-CTSU) oversees a large number of breast cancer clinical trials where multiple biopsies are required. ICR-CTSU recognises that patient advocates (patients who have previously had, or cared for someone with, cancer) are key members of the trial design group and should be involved in the clinical trial throughout its lifespan. Patient advocates can provide reassurance regarding the acceptability of trial designs involving multiple biopsies from a patient perspective. This paper summarises patient advocate involvement in ICR-CTSU breast cancer trials activity and how this has benefited our research. ABSTRACT The importance of collecting tissue samples in breast cancer has become increasingly recognised, as the diversity of the disease has become better known. It has been documented in recent research that tumours may change in response to treatment prior to surgery (the neoadjuvant treatment setting). The collection of sequential biopsies over time can identify changes within tumours and potentially predict how the tumour may respond to certain treatments. However, the acceptability of multiple biopsies amongst patients, clinicians and other research staff in hospitals is variable and recruitment into clinical trials requiring multiple biopsies may be challenging.The Institute of Cancer Research Clinical Trials and Statistics Unit (ICR-CTSU) is responsible for a portfolio of breast cancer trials where multiple biopsies are key to the trial design. Patient advocate involvement has been essential in helping us to design and deliver complex and innovative cancer trials which require multiple invasive tissue biopsies, often without any direct benefit to the trial participants. The views expressed by patient advocates involved in ICR-CTSU trials supports the published evidence that patients are willing to donate additional tissue for research and that clinicians' concerns about approaching patients for trials involving multiple biopsies are often unfounded.Patient advocate involvement in ICR-CTSU trials activity takes various forms, from membership on protocol development groups and trial management groups, attendance at focus groups and forums, and presentations at trial development and launch meetings. This involvement has provided reassurance to research teams within the NHS and research ethics committees of the importance and acceptability of our trials from a patient perspective. Patient advocate involvement throughout the lifetime of our trials ensures that the patient remains central to our research considerations.
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Affiliation(s)
- Leona M. Batten
- Division of Clinical Studies, The Institute of Cancer Research Clinical Trials and Statistics Unit, Sir Richard Doll Building, 15 Cotswold Road, Sutton, London, SM2 5NG UK
| | - Indrani Subarna Bhattacharya
- Division of Clinical Studies, The Institute of Cancer Research Clinical Trials and Statistics Unit, Sir Richard Doll Building, 15 Cotswold Road, Sutton, London, SM2 5NG UK
| | - Laura Moretti
- Division of Clinical Studies, The Institute of Cancer Research Clinical Trials and Statistics Unit, Sir Richard Doll Building, 15 Cotswold Road, Sutton, London, SM2 5NG UK
| | - Joanne S. Haviland
- Division of Clinical Studies, The Institute of Cancer Research Clinical Trials and Statistics Unit, Sir Richard Doll Building, 15 Cotswold Road, Sutton, London, SM2 5NG UK
| | - Marie A. Emson
- Division of Clinical Studies, The Institute of Cancer Research Clinical Trials and Statistics Unit, Sir Richard Doll Building, 15 Cotswold Road, Sutton, London, SM2 5NG UK
| | - Sarah E. Miller
- Division of Clinical Studies, The Institute of Cancer Research Clinical Trials and Statistics Unit, Sir Richard Doll Building, 15 Cotswold Road, Sutton, London, SM2 5NG UK
| | - Monica Jefford
- National Cancer Research Institute, Angel Building, 407, St John Street, Clerkenwell, London, EC1V 4AD UK
| | - Mairead MacKenzie
- Independent Cancer Patients Voice, 17 Woodbridge St, Clerkenwell, London, EC1R 0LL UK
| | - Maggie Wilcox
- Independent Cancer Patients Voice, 17 Woodbridge St, Clerkenwell, London, EC1R 0LL UK
| | - Marie Hyslop
- Division of Clinical Studies, The Institute of Cancer Research Clinical Trials and Statistics Unit, Sir Richard Doll Building, 15 Cotswold Road, Sutton, London, SM2 5NG UK
| | - Rachel Todd
- Division of Clinical Studies, The Institute of Cancer Research Clinical Trials and Statistics Unit, Sir Richard Doll Building, 15 Cotswold Road, Sutton, London, SM2 5NG UK
| | - Claire F. Snowdon
- Division of Clinical Studies, The Institute of Cancer Research Clinical Trials and Statistics Unit, Sir Richard Doll Building, 15 Cotswold Road, Sutton, London, SM2 5NG UK
| | - Judith M. Bliss
- Division of Clinical Studies, The Institute of Cancer Research Clinical Trials and Statistics Unit, Sir Richard Doll Building, 15 Cotswold Road, Sutton, London, SM2 5NG UK
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Abraham E, Post K, Spring L, Malvarosa G, Tripp E, Peppercorn J, Bardia A, Habin K. Research Biopsies: An Integrative Review of the Experiences of Patients With Cancer. Clin J Oncol Nurs 2018; 22:E71-E77. [DOI: 10.1188/18.cjon.e71-e77] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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15
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Lohrisch C, Francl M, Sun S, Villa D, Gelmon KA. Willingness of breast cancer patients to undergo biopsy and breast cancer clinicians' practices around seeking biopsy at the time of breast cancer relapse. Breast Cancer Res Treat 2017; 168:221-228. [PMID: 29181718 DOI: 10.1007/s10549-017-4586-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 11/18/2017] [Indexed: 11/30/2022]
Abstract
PURPOSE The practice of seeking a biopsy to confirm a metastatic relapse of a prior breast cancer is individualized. Tumor samples have well-recognized importance in clinical and translational research, but also an increasing role in routine care. We sought to determine the attitudes of patients and breast cancer clinicians about biopsy at breast cancer relapses. METHODS Consenting breast cancer patients and clinicians completed questionnaires with scenarios of decreasing personal benefit and increasing discomfort or inconvenience associated with biopsy at relapse of a prior breast cancer. For each scenario, patients were asked whether they would, would not, or were unsure about agreeing to a biopsy. Clinicians provided information about their practice, research activities, and usual biopsy habits. They were asked to estimate how often patients would agree to a biopsy under each of the conditions presented to patient participants. RESULTS The majority of patients expressed a willingness to undergo a biopsy procedure of modest inconvenience and discomfort to establish an uncertain diagnosis, guide treatment, to participate in a trial, or for research purposes only. About 50% of patients indicated that they would undergo an invasive biopsy procedure requiring IV sedation or general anesthetic for purely altruistic reasons. In spite of being a largely academic group, clinician respondents underestimated patient willingness to have a biopsy in all scenarios, particularly when there was no attached personal benefit. CONCLUSION Breast cancer patients were very willing to undergo biopsy at breast cancer relapse for their routine care, clinical trials, or for research only. Clinicians act as the intermediary between patients and tumor tissue repositories, and clinician perceptions and practices should shift to match the altruistic attitudes of breast cancer patients.
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Affiliation(s)
- Caroline Lohrisch
- Department of Medicine, British Columbia Cancer Agency, Vancouver Cancer Centre, University of British Columbia, 600 West 10th Avenue, Vancouver, BC, V5Z 4E6, Canada.
| | - Mia Francl
- Department of Pediatrics British Columbia Cancer Agency, University of British Columbia, Vancouver, Canada
| | - Sophie Sun
- Department of Medicine, British Columbia Cancer Agency, Vancouver Cancer Centre, University of British Columbia, 600 West 10th Avenue, Vancouver, BC, V5Z 4E6, Canada
| | - Diego Villa
- Department of Medicine, British Columbia Cancer Agency, Vancouver Cancer Centre, University of British Columbia, 600 West 10th Avenue, Vancouver, BC, V5Z 4E6, Canada
| | - Karen A Gelmon
- Department of Medicine, British Columbia Cancer Agency, Vancouver Cancer Centre, University of British Columbia, 600 West 10th Avenue, Vancouver, BC, V5Z 4E6, Canada
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Robinson DH, Churilov L, Lin NU, Lim E, Seah D. Attitudes of patients with metastatic cancer towards research biopsies. Asia Pac J Clin Oncol 2017; 14:231-238. [PMID: 29106060 DOI: 10.1111/ajco.12783] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 08/23/2017] [Indexed: 10/18/2022]
Abstract
AIM To evaluate the attitudes of patients with different cancers towards research biopsies outside a clinical trial. METHODS Patients with metastatic cancer completed a questionnaire that assessed patients' willingness to consider research biopsies. Research biopsies were divided into two groups: biopsies performed as stand-alone procedures (research purposes only biopsy, RPOB) or performed during a clinically indicated biopsy (additional pass biopsy, APB). Factors analyzed included biopsy timing, biopsy site, sociodemographic information and information about prior trial participation. Univariate and multivariable analyses were conducted using random-effects logistic regression. RESULTS One hundred and sixty-five patients with cancer (40 melanoma, 37 colorectal, 32 breast, 30 lung, 26 prostate) completed the questionnaire. Patients with melanoma demonstrated the greatest willingness to consider a research biopsy compared to patients with other cancer types (P < 0.05). Patients' ethnicity, time since previous biopsies, time since metastatic diagnosis, and previous trial enrolment were all statistically significant for willingness to consider a research biopsy on univariate analysis. When adjusting for statistically significant variables on univariate analysis, the odds of patients considering APBs were 14.6 times greater than RPOBs (P < 0.0001). Patients were also more willing to consider having blood or skin taken for research purposes (P < 0.0001) compared to liver and bone biopsies. CONCLUSIONS Patients with cancer show a greater willingness to consider APBs compared to RPOBs, and biopsies performed at less invasive body sites. There are differences in the attitudes of patients with different cancers towards research biopsies. Further research addressing motivations and barriers to research biopsies should be considered to increase the availability of this important resource.
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Affiliation(s)
| | - Leonid Churilov
- The Florey Institute of Neuroscience and Mental Health, VIC, Australia
| | - Nancy U Lin
- Dana-Farber Cancer Institute, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Elgene Lim
- Garvan Institute of Medical Research, Darlinghurst, NSW, Australia.,University of New South Wales, Kensington, NSW, Australia.,St Vincent's Health, Darlinghurst, NSW, Australia
| | - Davinia Seah
- University of New South Wales, Kensington, NSW, Australia.,St Vincent's Health, Darlinghurst, NSW, Australia.,University of Notre Dame Australia, Darlinghurst, NSW, Australia
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Parseghian CM, Raghav K, Wolff RA, Ensor J, Yao J, Ellis LM, Tam AL, Overman MJ. Underreporting of Research Biopsies from Clinical Trials in Oncology. Clin Cancer Res 2017; 23:6450-6457. [PMID: 28754815 PMCID: PMC5668146 DOI: 10.1158/1078-0432.ccr-17-1449] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 06/27/2017] [Accepted: 07/18/2017] [Indexed: 11/16/2022]
Abstract
Purpose: Research biopsies are frequently incorporated within clinical trials in oncology and are often a mandatory requirement for trial enrollment. However, limited information is available regarding the extent and completeness of research biopsy reporting.Experimental Design: We identified a cohort of therapeutic clinical trials where research biopsies were performed between January 2005 and October 2010 from an IR database at our institution. Clinical trial protocols were compared with the highest level of corresponding publication as a manuscript or registry report.Results: A total of 866 research biopsies were performed across 46 clinical trials, with a median of 8 patients biopsied/trial and 19 biopsies collected/trial. After a median follow-up time of 4.3 years from trial completion, 36 of 46 trials (78%) reported trial results: published manuscripts (n = 35), or registry report (n = 1). A total of 635 conducted biopsies were reported in 18 of the 46 trials (39%). Six (33%) of these 18 trials underreported the number of biopsies performed. Of 33 trials with mandatory research biopsies, 13 (39%) trials reported on these biopsies. Biopsy complications occurred in 8 trials [n = 39 patients, 6 grade 3/4 adverse events (AE)] but only 1 trial reported these. Factors associated with biopsy reporting included a larger number of biopsies (P ≤ 0.001) and serial biopsies (P < 0.001). Twelve of 16 (75%) trials with >12 biopsies performed reported on these biopsies compared with only 20% (6/30) that performed ≤12 biopsies.Conclusions: Despite ethical obligations to report research biopsies, the majority (61%) of trials do not report results from research biopsies. Complications are rarely reported in these studies. Improved reporting of results and AEs from research biopsies is needed. Clin Cancer Res; 23(21); 6450-7. ©2017 AACR.
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Affiliation(s)
- Christine M Parseghian
- Department of Gastrointestinal Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kanwal Raghav
- Department of Gastrointestinal Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Robert A Wolff
- Department of Gastrointestinal Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Joe Ensor
- Houston Methodist Cancer Center, Houston Methodist Research Institute Methodist, Houston, Texas
| | - James Yao
- Department of Gastrointestinal Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Lee M Ellis
- Department of Surgical Oncology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Alda L Tam
- Department of Interventional Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Michael J Overman
- Department of Gastrointestinal Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas.
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Stereotactic Body Radiotherapy for Oligometastasis: Opportunities for Biology to Guide Clinical Management. Cancer J 2017; 22:247-56. [PMID: 27441744 DOI: 10.1097/ppo.0000000000000202] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Oligometastasis refers to a state of limited metastatic disease burden, in which surgical or ablative treatment to all known visible metastases holds promise to extend survival or even effect cure. Stereotactic body radiotherapy is a form of radiation treatment capable of delivering a high biologically effective dose of radiation in a highly conformal manner, with a favorable toxicity profile. Enthusiasm for oligometastasis ablation, however, should be counterbalanced against the limited supporting evidence. It remains unknown to what extent (if any) ablation influences survival or quality of life. Rising clinical equipoise necessitates the completion of randomized controlled trials to assess this, several of which are underway. However, a lack of clear identification criteria or biomarkers to define the oligometastatic state hampers optimal patient selection.This narrative review explores the evolutionary origins of oligometastasis, the steps of the metastatic process at which oligometastases may arise, and the biomolecular mediators of this state. It discusses clinical outcomes with treatment of oligometastases, ongoing trials, and areas of basic and translational research that may lead to novel biomarkers. These efforts should provide a clearer, biomolecular definition of oligometastatic disease and aid in the accurate selection of patients for ablative therapies.
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19
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Attitudes of Patients With Gastrointestinal Cancers Toward Research Biopsies. Clin Colorectal Cancer 2017; 16:e181-e189. [DOI: 10.1016/j.clcc.2016.09.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 09/13/2016] [Accepted: 09/22/2016] [Indexed: 11/23/2022]
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Kuderer NM, Burton KA, Blau S, Senecal F, Gadi VK, Parker S, Mahen E, Veenstra D, Carlson JJ, Lyman GH, Blau CA. Participant Attitudes Toward an Intensive Trial of Multiple Biopsies, Multidimensional Molecular Analysis, and Reporting of Results in Metastatic Triple-Negative Breast Cancer. JCO Precis Oncol 2017; 1:PO.17.00076. [PMID: 32913975 PMCID: PMC7446457 DOI: 10.1200/po.17.00076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Multidimensional molecular analysis of tumor tissue intensively over space and time can provide insight into how cancers evolve and escape treatment. Attitudes of participants in such trials have not been assessed. We explored patient views regarding an intensive study incorporating multiple biopsies, multidimensional molecular testing, and drug response predictions that are reported to the oncologist and patient. PATIENTS AND METHODS A structured, self-administered survey was conducted among the first 15 patients enrolled in ITOMIC-001 (Intensive Trial of Omics in Cancer). Patients with metastatic triple-negative breast cancer were accrued at two sites in Washington state. Surveys containing 17 items were administered at enrollment and after the return of results. Surveys explored perceptions regarding risks, personal benefits, benefits to others, uncertainties associated with interpreting complex molecular results, concerns regarding multiple biopsies, and potential loss of confidentiality. At follow-up, three additional unique items explored patient coping. RESULTS All participants expressed a strong desire for their experiences to benefit others, and all perceived a higher likelihood of deriving benefit than described during detailed consent discussions. Loss of confidentiality ranked lowest among patient concerns. Despite acknowledging uncertainties and risks inherent in complex molecular testing for clinical reporting, participants wanted access to findings in evaluating treatment choices, even if the best available evidence was weak. Follow-up surveys demonstrated relatively little change in attitudes, although concern about study biopsies generally declined. Study participation helped several patients cope better with their disease. CONCLUSION In advanced breast cancer, these findings demonstrate the feasibility of engaging motivated patients in trials that navigate the uncertainties associated with intensive spatial and longitudinal multidimensional molecular testing for the purpose of advancing precision medicine.
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Affiliation(s)
- Nicole M. Kuderer
- All authors: University of Washington; Vijayakrishna K. Gadi and Gary H. Lyman, Fred Hutchinson Cancer Research Center, Seattle; and Sibel Blau, Francis Senecal, and Stephanie Parker, Northwest Medical Specialties, Puyallup and Tacoma, WA
| | - Kimberly A. Burton
- All authors: University of Washington; Vijayakrishna K. Gadi and Gary H. Lyman, Fred Hutchinson Cancer Research Center, Seattle; and Sibel Blau, Francis Senecal, and Stephanie Parker, Northwest Medical Specialties, Puyallup and Tacoma, WA
| | - Sibel Blau
- All authors: University of Washington; Vijayakrishna K. Gadi and Gary H. Lyman, Fred Hutchinson Cancer Research Center, Seattle; and Sibel Blau, Francis Senecal, and Stephanie Parker, Northwest Medical Specialties, Puyallup and Tacoma, WA
| | - Francis Senecal
- All authors: University of Washington; Vijayakrishna K. Gadi and Gary H. Lyman, Fred Hutchinson Cancer Research Center, Seattle; and Sibel Blau, Francis Senecal, and Stephanie Parker, Northwest Medical Specialties, Puyallup and Tacoma, WA
| | - Vijayakrishna K. Gadi
- All authors: University of Washington; Vijayakrishna K. Gadi and Gary H. Lyman, Fred Hutchinson Cancer Research Center, Seattle; and Sibel Blau, Francis Senecal, and Stephanie Parker, Northwest Medical Specialties, Puyallup and Tacoma, WA
| | - Stephanie Parker
- All authors: University of Washington; Vijayakrishna K. Gadi and Gary H. Lyman, Fred Hutchinson Cancer Research Center, Seattle; and Sibel Blau, Francis Senecal, and Stephanie Parker, Northwest Medical Specialties, Puyallup and Tacoma, WA
| | - Elisabeth Mahen
- All authors: University of Washington; Vijayakrishna K. Gadi and Gary H. Lyman, Fred Hutchinson Cancer Research Center, Seattle; and Sibel Blau, Francis Senecal, and Stephanie Parker, Northwest Medical Specialties, Puyallup and Tacoma, WA
| | - David Veenstra
- All authors: University of Washington; Vijayakrishna K. Gadi and Gary H. Lyman, Fred Hutchinson Cancer Research Center, Seattle; and Sibel Blau, Francis Senecal, and Stephanie Parker, Northwest Medical Specialties, Puyallup and Tacoma, WA
| | - Josh J. Carlson
- All authors: University of Washington; Vijayakrishna K. Gadi and Gary H. Lyman, Fred Hutchinson Cancer Research Center, Seattle; and Sibel Blau, Francis Senecal, and Stephanie Parker, Northwest Medical Specialties, Puyallup and Tacoma, WA
| | - Gary H. Lyman
- All authors: University of Washington; Vijayakrishna K. Gadi and Gary H. Lyman, Fred Hutchinson Cancer Research Center, Seattle; and Sibel Blau, Francis Senecal, and Stephanie Parker, Northwest Medical Specialties, Puyallup and Tacoma, WA
| | - C. Anthony Blau
- All authors: University of Washington; Vijayakrishna K. Gadi and Gary H. Lyman, Fred Hutchinson Cancer Research Center, Seattle; and Sibel Blau, Francis Senecal, and Stephanie Parker, Northwest Medical Specialties, Puyallup and Tacoma, WA
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21
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Kimmelman J, Resnik DB, Peppercorn J, Ratain MJ. Burdensome Research Procedures in Trials: Why Less Is More. J Natl Cancer Inst 2017; 109:3003033. [PMID: 28376159 DOI: 10.1093/jnci/djw315] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Accepted: 11/29/2016] [Indexed: 01/10/2023] Open
Abstract
A large volume of trials involve invasive, nontherapeutic research procedures, like organ biopsy or sham surgeries, that can pose risks comparable with the experimental treatment itself but that have no direct benefit for volunteers. Though such procedures can enhance the value of clinical investigations, recent studies suggest that many studies involving invasive, nontherapeutic research procedures are not well planned and reported; some studies suggest that their results are often not utilized in the planning of new investigations. This commentary offers recommendations for how investigators, sponsors, and ethics committees might improve evaluation and implementation of studies involving invasive nontherapeutic procedures. We conclude by urging more demanding scientific standards for the rationale, design, and reporting of burdensome, nontherapeutic research procedures-particularly where they involve risk of serious complications.
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Affiliation(s)
- Jonathan Kimmelman
- Studies of Translation, Ethics and Medicine (STREAM), Biomedical Ethics Unit, Social Studies of Medicine, McGill University, Montréal, Canada
| | - David B Resnik
- National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA
| | - Jeffrey Peppercorn
- MGH Cancer Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Mark J Ratain
- Department of Medicine, Comprehensive Cancer Center, and Center for Personalized Therapeutics, The University of Chicago, Chicago, IL, USA
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22
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Jamshidi N, Huang D, Abtin FG, Loh CT, Kee ST, Suh RD, Yamamoto S, Das K, Dry S, Binder S, Enzmann DR, Kuo MD. Genomic Adequacy from Solid Tumor Core Needle Biopsies of ex Vivo Tissue and in Vivo Lung Masses: Prospective Study. Radiology 2016; 282:903-912. [PMID: 27755912 DOI: 10.1148/radiol.2016132230] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Purpose To identify the variables and factors that affect the quantity and quality of nucleic acid yields from imaging-guided core needle biopsy. Materials and Methods This study was approved by the institutional review board and compliant with HIPAA. The authors prospectively obtained 232 biopsy specimens from 74 patients (177 ex vivo biopsy samples from surgically resected masses were obtained from 49 patients and 55 in vivo lung biopsy samples from computed tomographic [CT]-guided lung biopsies were obtained from 25 patients) and quantitatively measured DNA and RNA yields with respect to needle gauge, number of needle passes, and percentage of the needle core. RNA quality was also assessed. Significance of correlations among variables was assessed with analysis of variance followed by linear regression. Conditional probabilities were calculated for projected sample yields. Results The total nucleic acid yield increased with an increase in the number of needle passes or a decrease in needle gauge (two-way analysis of variance, P < .0001 for both). However, contrary to calculated differences in volume yields, the effect of needle gauge was markedly greater than the number of passes. For example, the use of an 18-gauge versus a 20-gauge biopsy needle resulted in a 4.8-5.7 times greater yield, whereas a double versus a single pass resulted in a 2.4-2.8 times greater yield for 18- versus 20-gauge needles, respectively. Ninety-eight of 184 samples (53%) had an RNA integrity number of at least 7 (out of a possible score of 10). Conclusion With regard to optimizing nucleic acid yields in CT-guided lung core needle biopsies used for genomic analysis, there should be a preference for using lower gauge needles over higher gauge needles with more passes. ©RSNA, 2016 Online supplemental material is available for this article. An earlier incorrect version of this article appeared online. This article was corrected on October 21, 2016.
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Affiliation(s)
- Neema Jamshidi
- From the Departments of Radiological Sciences (N.J., D.H., F.G.A., C.T.L., S.T.K., R.D.S., S.Y., D.R.E., M.D.K.) and Pathology (S.Y., K.D., S.D., S.B., M.D.K.), David Geffen School of Medicine at UCLA, 10833 LeConte Ave, Box 951721, CHS 17-135, Los Angeles, CA 90095-1721
| | - Danshan Huang
- From the Departments of Radiological Sciences (N.J., D.H., F.G.A., C.T.L., S.T.K., R.D.S., S.Y., D.R.E., M.D.K.) and Pathology (S.Y., K.D., S.D., S.B., M.D.K.), David Geffen School of Medicine at UCLA, 10833 LeConte Ave, Box 951721, CHS 17-135, Los Angeles, CA 90095-1721
| | - Fereidoun G Abtin
- From the Departments of Radiological Sciences (N.J., D.H., F.G.A., C.T.L., S.T.K., R.D.S., S.Y., D.R.E., M.D.K.) and Pathology (S.Y., K.D., S.D., S.B., M.D.K.), David Geffen School of Medicine at UCLA, 10833 LeConte Ave, Box 951721, CHS 17-135, Los Angeles, CA 90095-1721
| | - Christopher T Loh
- From the Departments of Radiological Sciences (N.J., D.H., F.G.A., C.T.L., S.T.K., R.D.S., S.Y., D.R.E., M.D.K.) and Pathology (S.Y., K.D., S.D., S.B., M.D.K.), David Geffen School of Medicine at UCLA, 10833 LeConte Ave, Box 951721, CHS 17-135, Los Angeles, CA 90095-1721
| | - Stephen T Kee
- From the Departments of Radiological Sciences (N.J., D.H., F.G.A., C.T.L., S.T.K., R.D.S., S.Y., D.R.E., M.D.K.) and Pathology (S.Y., K.D., S.D., S.B., M.D.K.), David Geffen School of Medicine at UCLA, 10833 LeConte Ave, Box 951721, CHS 17-135, Los Angeles, CA 90095-1721
| | - Robert D Suh
- From the Departments of Radiological Sciences (N.J., D.H., F.G.A., C.T.L., S.T.K., R.D.S., S.Y., D.R.E., M.D.K.) and Pathology (S.Y., K.D., S.D., S.B., M.D.K.), David Geffen School of Medicine at UCLA, 10833 LeConte Ave, Box 951721, CHS 17-135, Los Angeles, CA 90095-1721
| | - Shota Yamamoto
- From the Departments of Radiological Sciences (N.J., D.H., F.G.A., C.T.L., S.T.K., R.D.S., S.Y., D.R.E., M.D.K.) and Pathology (S.Y., K.D., S.D., S.B., M.D.K.), David Geffen School of Medicine at UCLA, 10833 LeConte Ave, Box 951721, CHS 17-135, Los Angeles, CA 90095-1721
| | - Kingshuk Das
- From the Departments of Radiological Sciences (N.J., D.H., F.G.A., C.T.L., S.T.K., R.D.S., S.Y., D.R.E., M.D.K.) and Pathology (S.Y., K.D., S.D., S.B., M.D.K.), David Geffen School of Medicine at UCLA, 10833 LeConte Ave, Box 951721, CHS 17-135, Los Angeles, CA 90095-1721
| | - Sarah Dry
- From the Departments of Radiological Sciences (N.J., D.H., F.G.A., C.T.L., S.T.K., R.D.S., S.Y., D.R.E., M.D.K.) and Pathology (S.Y., K.D., S.D., S.B., M.D.K.), David Geffen School of Medicine at UCLA, 10833 LeConte Ave, Box 951721, CHS 17-135, Los Angeles, CA 90095-1721
| | - Scott Binder
- From the Departments of Radiological Sciences (N.J., D.H., F.G.A., C.T.L., S.T.K., R.D.S., S.Y., D.R.E., M.D.K.) and Pathology (S.Y., K.D., S.D., S.B., M.D.K.), David Geffen School of Medicine at UCLA, 10833 LeConte Ave, Box 951721, CHS 17-135, Los Angeles, CA 90095-1721
| | - Dieter R Enzmann
- From the Departments of Radiological Sciences (N.J., D.H., F.G.A., C.T.L., S.T.K., R.D.S., S.Y., D.R.E., M.D.K.) and Pathology (S.Y., K.D., S.D., S.B., M.D.K.), David Geffen School of Medicine at UCLA, 10833 LeConte Ave, Box 951721, CHS 17-135, Los Angeles, CA 90095-1721
| | - Michael D Kuo
- From the Departments of Radiological Sciences (N.J., D.H., F.G.A., C.T.L., S.T.K., R.D.S., S.Y., D.R.E., M.D.K.) and Pathology (S.Y., K.D., S.D., S.B., M.D.K.), David Geffen School of Medicine at UCLA, 10833 LeConte Ave, Box 951721, CHS 17-135, Los Angeles, CA 90095-1721
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Maugeri-Saccà M, Barba M, Vici P, Pizzuti L, Sergi D, Catenaro T, Di Lauro L, Mottolese M, Santini D, Milella M, De Maria R. Presurgical window of opportunity trial design as a platform for testing anticancer drugs: Pros, cons and a focus on breast cancer. Crit Rev Oncol Hematol 2016; 106:132-42. [PMID: 27637358 DOI: 10.1016/j.critrevonc.2016.08.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Revised: 06/17/2016] [Accepted: 08/16/2016] [Indexed: 12/24/2022] Open
Abstract
The high attrition rate is a major issue in anticancer drug development. Among the alternative trial designs, presurgical window of opportunity trials envision a short course treatment in the time window between diagnostic biopsy and surgery in a moderately-sized patient population. This approach allows testing therapeutics when pre- and post-treatment tumor tissues are available for comprehensive molecular analyses. The emerging evidence may help define the ability of a given agent to modulate its target(s) and help obtain a broader picture of the molecular changes operated by the treatment. The resulting gain may outweigh the potential harms for patients in the early disease setting. Window of opportunity trials have been extensively applied to breast cancer. Overall, a wider use of these trial designs might lead to the identification of potential responders, ineffective drugs or combinations, and ultimately contribute to enhance the efficiency of the clinical developmental process.
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Affiliation(s)
- Marcello Maugeri-Saccà
- Division of Medical Oncology 2, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy; Scientific Direction, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy.
| | - Maddalena Barba
- Division of Medical Oncology 2, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy; Scientific Direction, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy.
| | - Patrizia Vici
- Division of Medical Oncology 2, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | - Laura Pizzuti
- Division of Medical Oncology 2, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | - Domenico Sergi
- Division of Medical Oncology 2, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | - Teresa Catenaro
- Division of Medical Oncology 2, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | - Luigi Di Lauro
- Division of Medical Oncology 2, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | - Marcella Mottolese
- Department of Pathology, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | - Daniele Santini
- Department of Medical Oncology, Campus Bio-Medico, University of Rome, 00128 Rome, Italy
| | - Michele Milella
- Division of Medical Oncology A, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | - Ruggero De Maria
- Scientific Direction, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
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24
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Cohen B, Roth M, Marron JM, Gray SW, Geller DS, Hoang B, Gorlick R, Janeway KA, Gill J. Pediatric Oncology Provider Views on Performing a Biopsy of Solid Tumors in Children with Relapsed or Refractory Disease for the Purpose of Genomic Profiling. Ann Surg Oncol 2016; 23:990-997. [PMID: 27459981 DOI: 10.1245/s10434-016-5453-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND Patients with relapsed and refractory solid tumors have a poor prognosis. Recent advances in genomic technology have made it feasible to screen tumors for actionable mutations, with the anticipation that this may provide benefit to patients. METHODS Pediatric oncologists were emailed an anonymous 34-question survey assessing their willingness to offer a rebiopsy to patients with relapsed disease for the purpose of tumor genomic profiling. They were presented with two scenarios evaluating morbidity and invasiveness of the procedures using the clinical examples of medulloblastoma and Ewing sarcoma. RESULTS A total of 195 pediatric oncologists responded to the questionnaire. Morbidity and invasiveness of the procedure demonstrated significant differences in provider willingness to refer their patients for rebiopsy. The pretest probability was a major variable influencing provider willingness to offer a rebiopsy. Respondents were more likely to offer a rebiopsy if the likelihood was high that the results would have an impact on clinical management than if the biopsy was for histologic confirmation alone (mean 89 vs. 56 %; p = 0.017). Compared with the rate of a rebiopsy for histologic confirmation, significantly fewer providers were willing to offer a rebiopsy if they were led to believe the likelihood of finding an actionable mutation was low (mean 45 vs. 56 %; p = 0.021). CONCLUSION The scenario showed that the pretest probability of finding an actionable mutation was influential in determining provider willingness to offer a rebiopsy for the purpose of tumor genomic profiling. Further research is warranted to evaluate the benefit of tumor genomic profiling in terms of patient outcomes.
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Affiliation(s)
- Barrie Cohen
- Division of Pediatric Hematology/Oncology and Blood & Marrow Cell Transplantation, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Michael Roth
- Division of Pediatric Hematology/Oncology and Blood & Marrow Cell Transplantation, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Jonathan M Marron
- Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA, USA
| | - Stacy W Gray
- Dana-Farber Cancer Institute, Harvard Medical School and Brigham and Women's Hospital, Boston, MA, USA
| | - David S Geller
- Department of Orthopaedic Surgery, Montefiore Medical Center and Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Bang Hoang
- Department of Orthopaedic Surgery, Montefiore Medical Center and Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Richard Gorlick
- Division of Pediatric Hematology/Oncology and Blood & Marrow Cell Transplantation, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA.,Department of Molecular Pharmacology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Katherine A Janeway
- Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA, USA
| | - Jonathan Gill
- Division of Pediatric Hematology/Oncology and Blood & Marrow Cell Transplantation, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA.
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25
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Modi PK, Farber NJ, Singer EA. Precision Oncology: Identifying Predictive Biomarkers for the Treatment of Metastatic Renal Cell Carcinoma. Transl Cancer Res 2016; 5:S76-S80. [PMID: 27540511 DOI: 10.21037/tcr.2016.06.05] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The recent FDA approval of multiple new pharmaceutical agents for metastatic renal cell carcinoma (RCC) has left physicians with several options for first- and second- line therapy. With limited head-to-head comparisons, however, there is a paucity of evidence to recommend the use of one agent over another. To address this knowledge gap, Voss et al. identified serum biomarkers from specimens collected during the RECORD-3 trial, a comparative study of first-line sunitinib versus first-line everolimus. Of the biomarkers identified, the 5 most strongly associated with first-line everolimus progression-free survival (PFS1L) were combined to form a composite biomarker score (CBS). The CBS was significantly associated with everolimus PFS1L in multivariate regression analysis. This study is an example of the additional value offered by a randomized trial with prospective biospecimen collection and a significant step towards identifying predictive biomarkers for the treatment of metastatic RCC. As further comparative trials are performed, it will be essential that biomarkers are appropriately identified and validated in order to further the goal of precision oncology.
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Affiliation(s)
- Parth K Modi
- Division of Urology, Rutgers Robert Wood Johnson Medical School, Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Nicholas J Farber
- Division of Urology, Rutgers Robert Wood Johnson Medical School, Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Eric A Singer
- Division of Urology, Rutgers Robert Wood Johnson Medical School, Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
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26
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Moorcraft SY, Marriott C, Peckitt C, Cunningham D, Chau I, Starling N, Watkins D, Rao S. Patients' willingness to participate in clinical trials and their views on aspects of cancer research: results of a prospective patient survey. Trials 2016; 17:17. [PMID: 26745891 PMCID: PMC4706669 DOI: 10.1186/s13063-015-1105-3] [Citation(s) in RCA: 133] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 12/03/2015] [Indexed: 12/20/2022] Open
Abstract
Background Recruitment to clinical trials can be challenging and slower than anticipated. This prospective patient survey aimed to investigate the proportion of patients approached about a trial who agree to participate, their motivations for trial participation and their views on aspects of cancer research. Methods Patients who had been approached about participation in any clinical trials in the Gastrointestinal and Lymphoma Unit at the Royal Marsden were invited to complete a questionnaire. The statistical analysis is mainly descriptive, with percentages being reported. Univariate logistic regression analysis was used to determine any associations between patient characteristics and patient responses. Results From August 2013–July 2014, 276 patients received 298 clinical trial patient information sheets and were asked to complete the questionnaire. The majority of patients (263 patients, 88 %) consented to a clinical trial and 249 of the 263 patients (95 %) completed the questionnaire. Multiple factors influenced decisions to participate in clinical trials, with patients stating that the most important reasons were that the trial offered the best treatment available and that the trial results could benefit others. Of the 249 questionnaire respondents, 78 % would donate their tissue for genetic research, 75 % would consider participating in studies requiring a research biopsy and 75 % felt that patients should be informed of trial results. Patients treated with palliative intent and those who had received multiple lines of treatment were more willing to consider research biopsies. Of the patients approached about a clinical trial of an investigational medicinal product, 48–50 % would have liked more information on the study drugs/procedures. Conclusion The majority of patients approached about a clinical trial consented to one or more trials. Patients’ motivations for trial participation included potential personal benefit and altruistic reasons. A high proportion of patients were willing to donate tissue for research and to consider trials involving repeat biopsies. The majority of patients feel that participants should be informed of trial results and there is a group of patients who would like more detailed trial information. Electronic supplementary material The online version of this article (doi:10.1186/s13063-015-1105-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sing Yu Moorcraft
- The Royal Marsden NHS Foundation Trust, London, UK. .,The Royal Marsden NHS Foundation Trust, Sutton, UK.
| | - Cheryl Marriott
- The Royal Marsden NHS Foundation Trust, London, UK. .,The Royal Marsden NHS Foundation Trust, Sutton, UK.
| | - Clare Peckitt
- The Royal Marsden NHS Foundation Trust, London, UK. .,The Royal Marsden NHS Foundation Trust, Sutton, UK.
| | - David Cunningham
- The Royal Marsden NHS Foundation Trust, London, UK. .,The Royal Marsden NHS Foundation Trust, Sutton, UK.
| | - Ian Chau
- The Royal Marsden NHS Foundation Trust, London, UK. .,The Royal Marsden NHS Foundation Trust, Sutton, UK.
| | - Naureen Starling
- The Royal Marsden NHS Foundation Trust, London, UK. .,The Royal Marsden NHS Foundation Trust, Sutton, UK.
| | - David Watkins
- The Royal Marsden NHS Foundation Trust, London, UK. .,The Royal Marsden NHS Foundation Trust, Sutton, UK.
| | - Sheela Rao
- The Royal Marsden NHS Foundation Trust, London, UK. .,The Royal Marsden NHS Foundation Trust, Sutton, UK.
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27
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Patients with Advanced Non–Small Cell Lung Cancer: Are Research Biopsies a Barrier to Participation in Clinical Trials? J Thorac Oncol 2016; 11:79-84. [DOI: 10.1016/j.jtho.2015.09.006] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Revised: 09/23/2015] [Accepted: 09/29/2015] [Indexed: 11/22/2022]
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Gautschi O, Mach N, Rothschild SI, Li Q, Stahel RA, Zippelius A, Cathomas R, Früh M, Betticher DC, Peters S, Rauch D, Feilchenfeldt J, Bubendorf L, Savic S, Jaggi R, Leibundgut EO, Largiadèr C, Brutsche M, Pilop C, Stalder L, Pless M, Ochsenbein AF. Bevacizumab, Pemetrexed, and Cisplatin, or Bevacizumab and Erlotinib for Patients With Advanced Non–Small-Cell Lung Cancer Stratified by Epidermal Growth Factor Receptor Mutation: Phase II Trial SAKK19/09. Clin Lung Cancer 2015; 16:358-65. [DOI: 10.1016/j.cllc.2015.02.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 02/18/2015] [Accepted: 02/26/2015] [Indexed: 01/30/2023]
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Seah DS, Scott S, Guo H, Najita J, Lederman R, Frank E, Sohl J, Stadler Z, Silverman S, Peppercorn J, Winer E, Come S, Lin NU. Variation in the Attitudes of Medical Oncologists Toward Research Biopsies in Patients With Metastatic Breast Cancer. Oncologist 2015; 20:992-1000. [PMID: 26240134 DOI: 10.1634/theoncologist.2015-0112] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 06/03/2015] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Tissue from research biopsies provides access to insights into tumor biology. We aimed to determine medical oncologists' (MOs') attitudes toward research biopsies in patients with metastatic breast cancer (MBC). MATERIALS AND METHODS A total of 309 breast MOs from National Cancer Institute (NCI)-designated cancer centers were invited to complete a self-administered survey about their attitudes toward approaching patients for research purpose-only biopsies (RPOBs), performed as a standalone procedure, or additional biopsies, performed with a clinically indicated biopsy. The MOs were asked to predict what proportion of their MBC patients would consider undergoing research biopsies. RESULTS Of the 309 MOs, 221 (72%) responded. Of these 221 MOs, 30 were ineligible, leaving 191 eligible responders. Nearly all the MOs reported they were comfortable approaching patients regarding research biopsies of blood or skin. One fifth of MOs were uncomfortable approaching patients for RPOBs of the breast. One half of MOs were uncomfortable approaching patients for RPOBs of the liver. A significant variation was found in the perceptions by MOs of their patients' willingness to undergo research biopsies. The factors associated with increased comfort in approaching patients for research biopsies included fewer years in practice, caring for patients who had undergone recent research biopsies, and the predicted willingness of patients to consent to biopsies. The risk of a biopsy and biopsy-related pain were the most common reasons for reluctance to refer patients for research biopsies. CONCLUSION Significant variation exists, even at NCI centers, in the comfort level of MOs in approaching MBC patients for research biopsies. MOs' attitudes toward research biopsies might be a modifiable factor in increasing tissue collection for research. IMPLICATIONS FOR PRACTICE Tissue-based research is critical in advancing our understanding of cancer biology, and obtaining tissue from a research biopsy provides an essential resource. This study demonstrates the variability of oncologists' attitudes toward research biopsies and elicits factors associated with increased comfort levels with approaching patients for research biopsies. Biopsy risk and biopsy-related pain were commonly cited reasons not to refer patients for research biopsies. If the risk of a research biopsy is deemed sufficiently low enough to be acceptable, oncologists' attitudes might be a potential target for education and change, which may assist in increasing the availability of tissue for cancer research.
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Affiliation(s)
- Davinia S Seah
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA; Memorial Sloan Kettering Cancer Center, New York, New York, USA; Brigham and Women's Hospital, Boston, Massachusetts, USA; Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sarah Scott
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA; Memorial Sloan Kettering Cancer Center, New York, New York, USA; Brigham and Women's Hospital, Boston, Massachusetts, USA; Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Hao Guo
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA; Memorial Sloan Kettering Cancer Center, New York, New York, USA; Brigham and Women's Hospital, Boston, Massachusetts, USA; Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Julie Najita
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA; Memorial Sloan Kettering Cancer Center, New York, New York, USA; Brigham and Women's Hospital, Boston, Massachusetts, USA; Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Ruth Lederman
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA; Memorial Sloan Kettering Cancer Center, New York, New York, USA; Brigham and Women's Hospital, Boston, Massachusetts, USA; Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Elizabeth Frank
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA; Memorial Sloan Kettering Cancer Center, New York, New York, USA; Brigham and Women's Hospital, Boston, Massachusetts, USA; Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jessica Sohl
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA; Memorial Sloan Kettering Cancer Center, New York, New York, USA; Brigham and Women's Hospital, Boston, Massachusetts, USA; Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Zsofia Stadler
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA; Memorial Sloan Kettering Cancer Center, New York, New York, USA; Brigham and Women's Hospital, Boston, Massachusetts, USA; Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Stuart Silverman
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA; Memorial Sloan Kettering Cancer Center, New York, New York, USA; Brigham and Women's Hospital, Boston, Massachusetts, USA; Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jeffrey Peppercorn
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA; Memorial Sloan Kettering Cancer Center, New York, New York, USA; Brigham and Women's Hospital, Boston, Massachusetts, USA; Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Eric Winer
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA; Memorial Sloan Kettering Cancer Center, New York, New York, USA; Brigham and Women's Hospital, Boston, Massachusetts, USA; Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Steve Come
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA; Memorial Sloan Kettering Cancer Center, New York, New York, USA; Brigham and Women's Hospital, Boston, Massachusetts, USA; Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Nancy U Lin
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA; Memorial Sloan Kettering Cancer Center, New York, New York, USA; Brigham and Women's Hospital, Boston, Massachusetts, USA; Massachusetts General Hospital, Boston, Massachusetts, USA
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Dressler LG, Deal AM, Owzar K, Watson D, Donahue K, Friedman PN, Ratain MJ, McLeod HL. Participation in Cancer Pharmacogenomic Studies: A Study of 8456 Patients Registered to Clinical Trials in the Cancer and Leukemia Group B (Alliance). J Natl Cancer Inst 2015; 107:djv188. [PMID: 26160883 DOI: 10.1093/jnci/djv188] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 06/22/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Clinically annotated specimens from cancer clinical trial participants offer an opportunity for discovery and validation of pharmacogenomic findings. The purpose of this observational study is to better understand patient/institution factors that may contribute to participation in the pharmacogenomic component of prospective cancer clinical trials. METHODS Patient demographic information (age, sex, self-reported race) and institutional characteristics (CALGB/CTSU site, "diversity," and accrual) were evaluated for 8456 patients enrolled in seven CALGB phase III studies with a pharmacogenomic component. All statistical tests were two-sided. RESULTS The majority of patients (81%) consented to participate in the pharmacogenomic component. However, in a multivariable analysis, site (CALGB vs CTSU) and "institutional diversity" (percent minority cancer patients on national trials) were statistically significantly associated with participation. For both whites and nonwhites, patients from CALGB sites were more likely to participate compared with patients from CTSU sites (whites: odds ratio [OR] = 2.26, 95% confidence interval [CI] = 1.68 to 3.04, P < .001; nonwhites: OR = 1.79, 95% CI = 1.52 to 2.11, P < .001). However, as "institutional diversity" increased, the likelihood of participation in the pharmacogenomics component decreased for both white (OR = 0.94, 95% CI = 0.91 to 0.97, P < .001) and nonwhite patients (OR = 0.90, 95% CI = 0.81 to 1.00, P = .05). CONCLUSIONS Most clinical trial cancer patients across geographical, racial, and practice settings are willing to participate in pharmacogenomic studies. However, to promote equitable benefit to the larger cancer community, optimization of both patient and institutional participation are needed. Institutional factors may be even more compelling than patient demographics. Prospective studies are needed to identify and address barriers/incentives to participation in pharmacogenomic research at the patient, clinician, and institutional levels.
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Affiliation(s)
- Lynn G Dressler
- Personalized Medicine, Mission Cancer Care, Mission Health, Asheville, NC (LGD); Biostatistics Core, Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina, Chapel Hill, NC (AMD); Alliance Statistics and Data Center, Duke University, Durham, NC (formerly the Cancer and Leukemia Group B Statistical and Data Management Center, Duke University, Durham, NC) (KO); GlaxoSmithKline, Research Triangle Park, NC (DW); Independent contractor, Williamsville, NY (KD); Department of Medicine and Center for Personalized Therapeutics, University of Chicago, Chicago, IL (PNF, MJR); DeBartolo Family Personalized Medicine Institute, Moffitt Cancer Center, Tampa, FL (HLM).
| | - Allison M Deal
- Personalized Medicine, Mission Cancer Care, Mission Health, Asheville, NC (LGD); Biostatistics Core, Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina, Chapel Hill, NC (AMD); Alliance Statistics and Data Center, Duke University, Durham, NC (formerly the Cancer and Leukemia Group B Statistical and Data Management Center, Duke University, Durham, NC) (KO); GlaxoSmithKline, Research Triangle Park, NC (DW); Independent contractor, Williamsville, NY (KD); Department of Medicine and Center for Personalized Therapeutics, University of Chicago, Chicago, IL (PNF, MJR); DeBartolo Family Personalized Medicine Institute, Moffitt Cancer Center, Tampa, FL (HLM)
| | - Kouros Owzar
- Personalized Medicine, Mission Cancer Care, Mission Health, Asheville, NC (LGD); Biostatistics Core, Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina, Chapel Hill, NC (AMD); Alliance Statistics and Data Center, Duke University, Durham, NC (formerly the Cancer and Leukemia Group B Statistical and Data Management Center, Duke University, Durham, NC) (KO); GlaxoSmithKline, Research Triangle Park, NC (DW); Independent contractor, Williamsville, NY (KD); Department of Medicine and Center for Personalized Therapeutics, University of Chicago, Chicago, IL (PNF, MJR); DeBartolo Family Personalized Medicine Institute, Moffitt Cancer Center, Tampa, FL (HLM)
| | - Dorothy Watson
- Personalized Medicine, Mission Cancer Care, Mission Health, Asheville, NC (LGD); Biostatistics Core, Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina, Chapel Hill, NC (AMD); Alliance Statistics and Data Center, Duke University, Durham, NC (formerly the Cancer and Leukemia Group B Statistical and Data Management Center, Duke University, Durham, NC) (KO); GlaxoSmithKline, Research Triangle Park, NC (DW); Independent contractor, Williamsville, NY (KD); Department of Medicine and Center for Personalized Therapeutics, University of Chicago, Chicago, IL (PNF, MJR); DeBartolo Family Personalized Medicine Institute, Moffitt Cancer Center, Tampa, FL (HLM)
| | - Katherine Donahue
- Personalized Medicine, Mission Cancer Care, Mission Health, Asheville, NC (LGD); Biostatistics Core, Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina, Chapel Hill, NC (AMD); Alliance Statistics and Data Center, Duke University, Durham, NC (formerly the Cancer and Leukemia Group B Statistical and Data Management Center, Duke University, Durham, NC) (KO); GlaxoSmithKline, Research Triangle Park, NC (DW); Independent contractor, Williamsville, NY (KD); Department of Medicine and Center for Personalized Therapeutics, University of Chicago, Chicago, IL (PNF, MJR); DeBartolo Family Personalized Medicine Institute, Moffitt Cancer Center, Tampa, FL (HLM)
| | - Paula N Friedman
- Personalized Medicine, Mission Cancer Care, Mission Health, Asheville, NC (LGD); Biostatistics Core, Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina, Chapel Hill, NC (AMD); Alliance Statistics and Data Center, Duke University, Durham, NC (formerly the Cancer and Leukemia Group B Statistical and Data Management Center, Duke University, Durham, NC) (KO); GlaxoSmithKline, Research Triangle Park, NC (DW); Independent contractor, Williamsville, NY (KD); Department of Medicine and Center for Personalized Therapeutics, University of Chicago, Chicago, IL (PNF, MJR); DeBartolo Family Personalized Medicine Institute, Moffitt Cancer Center, Tampa, FL (HLM)
| | - Mark J Ratain
- Personalized Medicine, Mission Cancer Care, Mission Health, Asheville, NC (LGD); Biostatistics Core, Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina, Chapel Hill, NC (AMD); Alliance Statistics and Data Center, Duke University, Durham, NC (formerly the Cancer and Leukemia Group B Statistical and Data Management Center, Duke University, Durham, NC) (KO); GlaxoSmithKline, Research Triangle Park, NC (DW); Independent contractor, Williamsville, NY (KD); Department of Medicine and Center for Personalized Therapeutics, University of Chicago, Chicago, IL (PNF, MJR); DeBartolo Family Personalized Medicine Institute, Moffitt Cancer Center, Tampa, FL (HLM)
| | - Howard L McLeod
- Personalized Medicine, Mission Cancer Care, Mission Health, Asheville, NC (LGD); Biostatistics Core, Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina, Chapel Hill, NC (AMD); Alliance Statistics and Data Center, Duke University, Durham, NC (formerly the Cancer and Leukemia Group B Statistical and Data Management Center, Duke University, Durham, NC) (KO); GlaxoSmithKline, Research Triangle Park, NC (DW); Independent contractor, Williamsville, NY (KD); Department of Medicine and Center for Personalized Therapeutics, University of Chicago, Chicago, IL (PNF, MJR); DeBartolo Family Personalized Medicine Institute, Moffitt Cancer Center, Tampa, FL (HLM)
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Modi PK, Singer EA. Ethical Issues in the Management of Renal Cell Carcinoma. KIDNEY CANCER JOURNAL : OFFICIAL JOURNAL OF THE KIDNEY CANCER ASSOCIATION 2015; 13:10-17. [PMID: 26949440 PMCID: PMC4778744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
| | - Eric A. Singer
- Corresponding Author Please direct all correspondence to: Eric A. Singer, M.D., M.A., Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, New Brunswick, NJ 08901, , Telephone: (732) 235-2043
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Abstract
Translation of cancer gene transfer confronts many familiar-and some distinctive-ethical challenges. In what follows, I survey three major ethical dimensions of cancer gene transfer development. Subheading 1 centers on the ethics of planning, designing, and reporting animal studies. Subheading 2 describes basic elements of human subjects protection as pertaining to cancer gene transfer. In Subheading 3, I describe how cancer gene transfer researchers have obligations to downstream consumers of the evidence they produce.
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Affiliation(s)
- Jonathan Kimmelman
- Studies in Translation, Ethics and Medicine (STREAM), Biomedical Ethics Unit/McGill University, 3647 Peel Street, Montreal, QC, Canada, H3A 1X1,
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Interiano RB, Loh AHP, Hinkle N, Wahid FN, Malkan AD, Bahrami A, Jenkins JJ, Mao S, Wu J, Proctor K, Santana VM, Pappo AS, Gold RE, Davidoff AM. Safety and diagnostic accuracy of tumor biopsies in children with cancer. Cancer 2014; 121:1098-107. [PMID: 25524504 DOI: 10.1002/cncr.29167] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Revised: 10/09/2014] [Accepted: 11/03/2014] [Indexed: 01/24/2023]
Abstract
BACKGROUND Tumor biopsies are central to the diagnosis and management of cancer and are critical to efforts in personalized medicine and targeted therapeutics. In the current study, the authors sought to evaluate the safety and accuracy of biopsies in children with cancer. METHODS All biopsies performed in children at the study institution with a suspected or established diagnosis of cancer from 2003 through 2012 were reviewed retrospectively. Patient characteristics and disease-related and procedure-related factors were correlated with procedure-related complications and diagnostic accuracy using logistic regression analysis. RESULTS A total of 1073 biopsies were performed in 808 patients. Of 1025 biopsies with adequate follow-up, 79 (7.7%) were associated with an adverse event, 35 (3.4%) of which were minor (grade 1-2) and 32 (3.1%) of which were major (grade 3-4) (grading was performed according to the National Cancer Institute Common Terminology Criteria for Adverse Events [version 4.0]). The most common major adverse events were blood transfusion (>10 mL/kg; 24 cases) and infection requiring intravenous antibiotics (6 cases). Eleven deaths (1.4%) occurred within 30 days after the procedure, but the procedure may have contributed to the outcome in only 2 cases. A total of 926 biopsies (90.3%) provided definitive histologic diagnoses. Using multivariable analysis, biopsy site, preprocedure hematocrit level, and body mass index were found to be associated with the risk of postprocedural complications (P<.0001, P<.0001, and P =.0029, respectively). Excisional biopsy and biopsy site were found to be independently associated with obtaining a diagnostic result (P =.0002 and P =.0008, respectively). CONCLUSIONS Tumor biopsies in children with cancer are associated with a low incidence of complications and a high rate of diagnostic accuracy. The predictive factors identified for adverse outcomes may aid in risk assessment and preprocedural counseling.
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Affiliation(s)
- Rodrigo B Interiano
- Department of Surgery, St Jude Children's Research Hospital, Memphis, Tennessee; Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
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Vaz-Luis I, Zeghibe CA, Frank ES, Sohl J, Washington KE, Silverman SG, Fonte JM, Mayer EL, Overmoyer BA, Richardson AL, Krop IE, Winer EP, Lin NU. Prospective clinical experience with research biopsies in breast cancer patients. Breast Cancer Res Treat 2013; 142:203-9. [PMID: 24113744 PMCID: PMC3825285 DOI: 10.1007/s10549-013-2717-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Accepted: 09/28/2013] [Indexed: 01/02/2023]
Abstract
There are ethical concerns regarding the performance of biopsies in patients for research purposes. We examined our single-institution experience regarding acceptance, safety, and success rate with research biopsies in patients with breast cancer. Among patients with data from paired samples, receptor status agreement between primary and metastatic samples was examined, either on first recurrence or after progression on one or more lines of therapy. An IRB-approved prospective study at the Dana-Farber Cancer Institute collects research biopsies as additional passes at the time of a clinical biopsy (AB, additional biopsy) or as a separate procedure for banking purposes (RPOB, research purposes only biopsy). Biopsies are not linked to a specific therapeutic or correlative trial. Grade 2–5 adverse events are prospectively collected. 151 patients were included in the analytic cohort (total procedures = 161); 80.8 % underwent AB, 17.2 % underwent RPOB, and 2.0 % underwent both AB and RPOB. Most patients were white (88.7 %) with a performance status of 0–1 (94.0 %). 96.0 % of patients underwent a biopsy in the setting of known or suspected metastatic disease. Receptor status between primary cancer and recurrent research biopsies differed in 43.2 % of patients with available data (18.8 % among patients who underwent the research biopsy before any systemic treatment, 48.1 % after treatment). Tissue was successfully collected in 92.3 % of patients undergoing AB and 100 % patients undergoing RPOB. Only three (2.0 %) patients had adverse events ≥grade-2: one grade-2 pain; one grade-2 pneumothorax; and one grade-3 pain. Our experience suggests research biopsies can be performed safely with a high rate of successful tissue collection. Consistent with previous reports we found a high rate of discordance between primary and metastatic samples, which was even higher among treated patients. This supports continued efforts to study tissue samples at multiple points in a patient’s disease course.
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Affiliation(s)
- Ines Vaz-Luis
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA
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Abstract
BACKGROUND As therapy for non-small-cell lung cancer (NSCLC) patients becomes more personalized, additional tissue in the form of core-needle biopsies (CNBs) for biomarker analysis is increasingly required for determining appropriate treatment and for enrollment into clinical trials. We report our experience with small-caliber percutaneous transthoracic (PT) CNBs for the evaluation of multiple molecular biomarkers in BATTLE (biomarker-integrated approaches of targeted therapy for lung cancer elimination), a personalized, targeted therapy NSCLC clinical trial. METHODS The medical records of patients who underwent PTCNB for consideration of enrollment in BATTLE were reviewed for diagnostic yield of 11 predetermined molecular markers and procedural complications. Univariate and multivariate analyses of factors related to patient and lesion characteristics were performed to determine possible influences on diagnostic yield. RESULTS One hundred and seventy PTCNBs were performed using 20-gauge biopsy needles in 151 NSCLC patients screened for the trial. The biopsy specimens of 82.9% of the patients were found to have adequate tumor tissue for analysis of the required biomarkers. On multivariate analysis, metastatic lesions were 5.4 times more likely to yield diagnostic tissue as compared with primary tumors (p = 0.0079). Pneumothorax and chest tube insertion rates were 15.3% and 9.4%, respectively. CONCLUSIONS Image-guided 20-gauge PTCNB is safe and provides adequate tissue for analysis of multiple biomarkers in the majority of patients being considered for enrollment into a personalized, targeted therapy NSCLC clinical trial. Metastatic lesions are more likely to yield diagnostic tissue as compared with primary tumors.
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Saggese M, Dua D, Simmons E, Lemech C, Arkenau HT. Research biopsies in the context of early phase oncology studies: clinical and ethical considerations. Oncol Rev 2013; 7:e5. [PMID: 25992226 PMCID: PMC4419615 DOI: 10.4081/oncol.2013.e5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Accepted: 08/26/2013] [Indexed: 11/30/2022] Open
Abstract
The Personalized Medicine approach in oncology is a direct result of an improved understanding of complex tumor biology and advances in diagnostic technologies. In recent years, there has been an increased demand for archival and fresh tumor analysis in early clinical trials to foster proof-of-concept biomarker development, to understand resistance mechanisms, and ultimately to assess biological response. Although phase I studies are aimed at defining drug safety, pharmacokinetics, and to recommend a phase II dose for further testing, there is now increasing evidence of mandatory tumor biopsies even at the earliest dose-finding stages of drug development. The increasing demand for fresh tumor biopsies adds to the complexity of novel phase I studies and results in different challenges, ranging from logistical support to ethical concerns. This paper investigates key issues, including patients’ perceptions of research biopsies, the need for accurate informed consent, and alternative strategies that may guide the drug development process.
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Affiliation(s)
- Matilde Saggese
- Sarah Cannon Research UK , UK ; University College London , UK
| | - Divyanshu Dua
- Sarah Cannon Research UK , UK ; Guy's and St Thomas' Hospital , London, UK
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Reporting practices of pharmacodynamic studies involving invasive research procedures in cancer trials. Br J Cancer 2013; 109:897-908. [PMID: 23887602 PMCID: PMC3749582 DOI: 10.1038/bjc.2013.417] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Revised: 06/21/2013] [Accepted: 07/01/2013] [Indexed: 12/25/2022] Open
Abstract
Background: Tumour biopsy for pharmacodynamic (PD) study is increasingly common in early-phase cancer trials. As they are non-diagnostic, the ethical justification for such procedures rests on their knowledge value. On the premise that knowledge value is related to reporting practices and outcome diversity, we assessed in a sample of recent invasive PD studies within cancer trials. Methods: We assessed reporting practices and outcomes for PD studies in a convenience sample of cancer trials published from 2000 to 2010 that employed invasive, non-diagnostic tissue procurement. Extracted data were used to measure outcome reporting in individual trials. Using a reporting scale we developed for exploratory purposes, we tested whether reporting varied with study characteristics, such as funding source or drug novelty. Results: Reporting varied widely within and across studies. Some practices were sporadically reported, including results of all planned tests (78% trials reporting), use of blinded histopathological assessment (43% trials reporting), biopsy dimensions (38% trials reporting), and description of patient flow through PD analysis (62%). Pharmacodynamic analysis as a primary end point and mandatory biopsy had statistically significant positive relationships with overall quality of reporting. A preponderance of positive results (61% of the studies described positive PD results) suggests possible publication bias. Conclusion: Our results highlight the need for PD-reporting guidelines, and suggest several avenues for improving the risk/benefit for studies involving invasive, non-diagnostic tissue procurement.
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38
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Seah DS, Scott SM, Najita J, Openshaw T, Krag K, Frank E, Sohl J, Stadler ZK, Garrett M, Silverman SG, Peppercorn J, Winer EP, Come SE, Lin NU. Attitudes of patients with metastatic breast cancer toward research biopsies. Ann Oncol 2013; 24:1853-1859. [PMID: 23493137 DOI: 10.1093/annonc/mdt067] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND Research studies involving human tissue are increasingly common. However, patients' attitudes toward research biopsies are not well characterized, particularly when the biopsies are carried out outside the context of therapeutic trials. PATIENTS AND METHODS One hundred sixty patients with metastatic breast cancer (MBC) from two academic (n = 80) and two community (n = 80) hospitals completed a 29-item self-administered survey to evaluate their willingness to consider providing research purposes only biopsies (RPOBs) (as a stand-alone procedure) and additional biopsies (ABs) (additional needle passes at the time of a clinically indicated biopsy). RESULTS Eighty-two (51%) of 160 patients would consider having RPOBs, of which 42 (53%) and 40 (50%) patients were from academic and community hospitals, respectively. Patients who had more prior biopsies were less likely to consider RPOBs (RR = 0.6, 95% CI: 0.4-1.0, P = 0.03). Of 160 patients, 115 (72%) patients would consider having ABs. Of these, 64 (80%) and 51 (64%) patients from academic and community hospitals, respectively, would consider ABs (RR = 1.2, 95% CI: 1.0-1.5, P = 0.03). CONCLUSIONS Many patients with MBC in both academic and community settings report willingness to consider undergoing biopsies for research. Further research is needed to understand ethical, logistical and provider-based barriers to broader participation in such studies.
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Affiliation(s)
- D S Seah
- Deparment of Medical Oncology, Dana-Farber Cancer Institute, Boston
| | - S M Scott
- Department of Medical Oncology, Beth Israel Deaconess Medical Center, Boston
| | - J Najita
- Department of Biostatics and Computational Biology, Dana-Farber Cancer Institute, Boston
| | - T Openshaw
- Department of Medical Oncology, Cancer Care of Maine, Bangor
| | - K Krag
- Department of Medical Oncology, North Short Cancer Center, Danvers
| | - E Frank
- Deparment of Medical Oncology, Dana-Farber Cancer Institute, Boston
| | - J Sohl
- Deparment of Medical Oncology, Dana-Farber Cancer Institute, Boston
| | - Z K Stadler
- Department of Medical Oncology, Memorial Sloan-Kettering Cancer Center, New York
| | - M Garrett
- Department of Medical Oncology, Cancer Care of Maine, Bangor
| | - S G Silverman
- Department of Radiology, Brigham and Women's Hospital, Boston
| | - J Peppercorn
- Department of Medicine, Duke University Medical Center, Durham, USA
| | - E P Winer
- Deparment of Medical Oncology, Dana-Farber Cancer Institute, Boston
| | - S E Come
- Department of Medical Oncology, Beth Israel Deaconess Medical Center, Boston
| | - Nancy U Lin
- Deparment of Medical Oncology, Dana-Farber Cancer Institute, Boston.
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Abstract
The majority of samples in existing tumour biobanks are surgical specimens of primary tumours. Insights into tumour biology, such as intratumoural heterogeneity, tumour-host crosstalk, and the evolution of the disease during therapy, require biospecimens from the primary tumour and those that reflect the patient's disease in specific contexts. Next-generation 'omics' technologies facilitate deep interrogation of tumours, but the characteristics of the samples can determine the ultimate accuracy of the results. The challenge is to biopsy tumours, in some cases serially over time, ensuring that the samples are representative, viable, and adequate both in quantity and quality for subsequent molecular applications. The collection of next-generation biospecimens, tumours, and blood samples at defined time points during the disease trajectory--either for discovery research or to guide clinical decisions--presents additional challenges and opportunities. From an organizational perspective, it also requires new additions to the multidisciplinary therapeutic team, notably interventional radiologists, molecular pathologists, and bioinformaticians. In this Review, we describe the existing procedures for sample procurement and processing of next-generation biospecimens, and highlight the issues involved in this endeavour, including the ethical, logistical, scientific, informational, and financial challenges accompanying next-generation biobanking.
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40
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Zhang T, Schneider A, Hamilton EP, Patel K, Kamal AH, Lyman GH, Peppercorn JM. Prevalence and impact of correlative science in breast cancer phase II trials. Breast Cancer Res Treat 2013; 139:845-50. [PMID: 23771715 DOI: 10.1007/s10549-013-2590-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2013] [Accepted: 05/28/2013] [Indexed: 11/27/2022]
Abstract
Correlative science (CS) can potentially augment clinical trial results by identifying biomarkers of response and resistance to a novel intervention. We evaluated recently published breast cancer phase II trials (BP2T) to determine prevalence, characteristics, and outcomes of CS. Through Pubmed, we identified BP2T of systemic therapy published between June 2005 and June 2010. A study-specific abstraction tool recorded trial characteristics, CS endpoints, source of tissue, adequacy of samples, biopsy safety, and CS outcomes. BP2T authors were contacted to verify abstraction results. Results were abstracted from 298 eligible trials enrolling 18,782 patients, of which 81 (27.2 %) involved CS. Of these, 57 (70.4 %) included tissue with 16 (28 %) using optional research biopsies and 17 (30 %) requiring mandatory research biopsies. No trial addressed biopsy safety issues. Trials were more likely to include CS if they were: industry versus non-industry sponsored (33.7 % vs. 17.1 %, p = 0.0017), neoadjuvant versus metastatic setting (47 % vs. 21.2 %, p = 0.0001), or U.S. versus non-U.S. trials (37 % vs. 21 %, p = 0.005). A minority of phase II breast cancer trials include CS representing a missed opportunity to learn more from clinical research. When CS is included, consistent reporting of endpoints, feasibility, outcomes, and safety is needed.
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Affiliation(s)
- Tian Zhang
- Division of Medical Oncology, Department of Medicine, Duke University Medical Center, Box 3446, Durham, NC 27710, USA
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41
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Abstract
PURPOSE OF REVIEW The landscape of medical oncology is filled with approvals of new anticancer agents, the majority of which are targeted agents. This shift in therapies raises multiple challenges including the appearance of new toxicities, the need for biomarkers, the emergence of genomics and the evolution of cancer molecular imaging. RECENT FINDINGS Biopsy of metastatic lesions is slowly becoming a standard of care before the initiation of any therapy. These invasive procedures have been found to be generally well tolerated and are being put to use with the emergence of genomics. Gene sequencing and new imaging techniques are serving the understanding of tumor biology and the search for 'biomarkers' predicting response and resistance to treatment. New clinical trial designs incorporating the 'presumed' biomarkers are guiding patients to specific treatments and have shown outcome improvements. SUMMARY Many questions remain however unanswered and new challenges appear. Intratumor heterogeneity emerges as a brake to personalized cancer care. Relevant targets remain undruggable and costs may hinder progress. Furthermore, technical issues continue to arise. The ultimate goal remains to achieve cure by blocking the multiple pathways of cancer development and proliferation, while sparing the patients the burden of therapy.
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Naim F, Ballinger R, Rombach I, Hadjiminas DJ, Al-Mufti R, Hogben RK, McLauchlan R, Palmieri C, Cleator SJ. Patient attitudes towards undergoing additional breast biopsy for research. Breast 2013; 22:850-5. [PMID: 23664924 DOI: 10.1016/j.breast.2013.03.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Revised: 02/21/2013] [Accepted: 03/03/2013] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Acquisition of additional breast tissue has become integral to breast oncology research. This questionnaire study examines patient willingness to undergo research-dedicated breast biopsies either at time of diagnostic biopsy (T1) or after carcinoma diagnosis has been confirmed and eligibility for a specific study established (T2), and influencing factors thereof. METHODS Prior to consultation, patients attending breast clinics were recruited to complete a questionnaire examining willingness to undergo an extra fine needle aspirate (FNA) and/or core needle biopsy (CNB) for research either at T1 or T2. Descriptions of FNA and CNB procedures were supplied to those with no prior experience. Patient perspectives towards donating surplus tissue remaining from a diagnostic procedure and/or surgery for future research were also explored. FINDINGS A total of 100 patients were recruited, 42% with prior history of breast carcinoma (BC), 22% with family history of BC (FHBC) and 65%/42% with previous experience of CNB/FNA respectively. Overall, 57% were willing to undergo additional biopsy at one or both time points. Willingness to undergo additional biopsy was greater for T1 than T2, but equivalent for CNB and FNA (willingness CNB T1, 50% vs T2, 26%, willingness FNA T1 50% vs T2 29%). A statistically significant increase in willingness to undergo CNB and/or FNA at T1 and/or T2 was seen in association with prior diagnosis of BC, FHBC, previous visit to breast clinic and prior experience of breast biopsy. 83% of patients expressed a willingness to allow surplus tissue to be stored in a biobank for future research. INTERPRETATION Where possible patients should be approached to undergo baseline research biopsies at time of diagnostic process rather than subsequently. Patients do not find FNA more acceptable than core biopsy. Prior exposure to the biopsy procedure increases willingness to undergo research-dedicated biopsies.
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Affiliation(s)
- Farhan Naim
- Department of Academic Oncology, The Royal Free Hampstead NHS Trust, Pond Street, London NW3 2QG, UK
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43
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Abstract
PURPOSE OF REVIEW Research directed toward an HIV cure presents ethical as well as scientific challenges. RECENT FINDINGS International guidelines, regulations, and the medical literature provide helpful guidance on protecting research participants. SUMMARY This review presents points to consider for researchers, sponsors, oversight committees, community advisory boards, and HIV advocates to help resolve ethical challenges that are particularly complex or difficult or that are not adequately addressed by current ethical guidelines. The points to consider are: collaborative partnership among international scientists from both the private and public sectors, as well as engagement of HIV-affected communities, social value, scientific validity, fair selection of participants and study sites, a favorable and acceptable risk-benefit balance, independent scientific and ethical review, informed and voluntary consent, and respect for enrolled patients and communities. To prevent therapeutic misconception, participants' comprehension of key features of the study may need to be assessed. Participants who suffer study-related adverse events should receive appropriate medical care and compensation. If interventions are shown capable of curing HIV, sponsors and international funding agencies should plan how to make them available and affordable in resource-poor countries.
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Affiliation(s)
- Bernard Lo
- University of California, San Francisco, California, USA.
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Lee JM, Hays JL, Noonan AM, Squires J, Minasian L, Annunziata C, Wood BJ, Yu M, Calvo KR, Houston N, Azad N, Kohn EC. Feasibility and safety of sequential research-related tumor core biopsies in clinical trials. Cancer 2013; 119:1357-64. [PMID: 23280317 PMCID: PMC3604070 DOI: 10.1002/cncr.27916] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Revised: 10/05/2012] [Accepted: 11/01/2012] [Indexed: 11/07/2022]
Abstract
BACKGROUND There has been increasing interest in serial research biopsies in studies of targeted therapies. Definition of patient characteristics and optimal target tissue for safe research tumor biopsy in the era of antiangiogenic and targeted agents is needed. METHODS This institutional review board-approved, retrospective study included chart and interventional radiology case review from 6 phase 1/2 studies at the National Cancer Institute. RESULTS One hundred forty-two of 150 protocol patients who were approached gave consent for research biopsies. Patients' median age was 56 years (range, 27-78 years), their median body mass index was 25.8 kg/m(2) (range, 14.4-46.2 kg/m(2) ), they had an Eastern Cooperative Oncology Group performance status of 0 or 1, and they had normal end-organ function. Baseline biopsies were collected from 138 of 142 patients (97%), and paired specimens were collected from 96 (70%). Most patients had metastatic gynecologic cancers (85%), and 78% had target disease below the diaphragm with a median size of 2.7 cm (range, 1-14.5 cm). Protocol therapies included kinase inhibitors (35%), angiogenesis inhibitors (54%), and olaparib/carboplatin (11%); therapy was not interrupted for biopsies. All adverse events were uncomplicated and were observed in 4 patients (liver subcapsular hematoma in 1 patient, vasovagal syncope in 2 patients, and pneumothorax in 1 patient). The complication rate in obese patients was similar to that in nonobese patients (3 of 108 patients vs 1 of 34 patients, respectively). Sixty-seven patients (48%) were receiving bevacizumab at the time of subsequent biopsies. The complication rate was not different between patients who were and were not receiving bevacizumab (3 of 67 patients vs 1 of 71 patients, respectively). Ninety-five percent of biopsies yielded useable material. CONCLUSIONS Serial percutaneous core-needle biopsies can be obtained safely and yield material applicable for multiple translational applications. Obesity and/or concomitant antiangiogenic therapy and depth of disease did not increase the risk or preclude the successful acquisition of useful tissue.
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Affiliation(s)
- Jung-min Lee
- Medical Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892, USA.
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Perceptions and needs of women with metastatic breast cancer: a focus on clinical trials. Breast 2013; 22:370-3. [PMID: 23535510 DOI: 10.1016/j.breast.2013.02.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Revised: 01/05/2013] [Accepted: 02/24/2013] [Indexed: 11/20/2022] Open
Abstract
Many patients are living longer with Metastatic Breast Cancer (MBC) than ever before. However, complete responses remain uncommon, and progression of disease is often inevitable. The experience of living with MBC exposes patients to a wide variety of clinical, psychological, social and spiritual issues. Although much research effort has focused on decision-making and coping strategies among women with early breast cancer, relatively little attention has been given to the needs, experiences, and perceptions of women living with MBC. Furthermore, there are major research gaps in understanding and prioritizing the types of psycho-social interventions that would make the most difference in the lives of these patients. Fortunately, the tide is turning. This communication represents a joint effort of the Breast International Group and the National Cancer Institute (NCI)-sponsored North American Breast Cancer Group (BIG-NABCG) to highlight perceptions and needs of patients living with MBC and current obstacles facing them, and recommends strategies for better addressing some of these unmet needs.
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Thomas A, Rajan A, Lopez-Chavez A, Wang Y, Giaccone G. From targets to targeted therapies and molecular profiling in non-small cell lung carcinoma. Ann Oncol 2013; 24:577-85. [PMID: 23131389 PMCID: PMC3574546 DOI: 10.1093/annonc/mds478] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Revised: 08/13/2012] [Accepted: 08/14/2012] [Indexed: 12/22/2022] Open
Abstract
Although tumor molecular-profile-directed therapy appears promising in early clinical studies, there are many practical challenges to its successful clinical application in non-small-cell lung cancer (NSCLC). These challenges may be broadly classified as those relating to tumor (heterogeneity), tissue (acquisition and processing), testing (assays for molecular profiling) and trials (clinical evaluation of molecular markers and drugs). Strategies to overcome these challenges include (i) understanding the biological basis of tumor heterogeneity and of carcinogenesis in the large subset of patients with no currently evident driver events; (ii) technological advances in minimally invasive acquisition of tumor and next-generation sequencing (NGS) which would enable single-platform analysis of molecular alterations in limited tissue at a reasonable turnaround time (TAT); (iii) deliberation in early stages of drug development as well as clinical trial design to identify, validate and assess the clinical utility of biomarkers in conjunction with drugs and (iv) collaboration to improve understanding of and accrual to trials enrolling patients with rare molecular alterations.
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Affiliation(s)
- A. Thomas
- Medical Oncology Branch, National Cancer Institute, Bethesda
| | - A. Rajan
- Medical Oncology Branch, National Cancer Institute, Bethesda
| | - A. Lopez-Chavez
- Division of Hematology/Medical Oncology, Oregon Health and Science University, Portland, USA
| | - Y. Wang
- Medical Oncology Branch, National Cancer Institute, Bethesda
| | - G. Giaccone
- Medical Oncology Branch, National Cancer Institute, Bethesda
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Overman MJ, Modak J, Kopetz S, Murthy R, Yao JC, Hicks ME, Abbruzzese JL, Tam AL. Use of research biopsies in clinical trials: are risks and benefits adequately discussed? J Clin Oncol 2012; 31:17-22. [PMID: 23129736 DOI: 10.1200/jco.2012.43.1718] [Citation(s) in RCA: 225] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Although the incorporation of research biopsies into clinical trials is increasing, limited information is available about how study protocols and informed consents integrate and describe their use. METHODS All therapeutic clinical trials in which image-guided research biopsies were performed from January 1, 2005, to October 1, 2010, were identified from an interventional radiology database. Data from study protocols and informed consents were extracted and analyzed. Procedural complications were recorded. RESULTS A total of 57 clinical trials were identified, of which 38 (67%) contained at least one mandatory biopsy. The analysis of the research biopsy tumor tissue was a study end point in 95% of trials. The primary indication for a research biopsy was for integral biomarker analysis in 32% and for correlative science in 68% of trials. A statistical analytic plan for the correlative science research biopsy tumor tissue was mentioned in 26%, described as exploratory in 51%, and not mentioned in 23% of trials. For studies with mandatory biopsies, biopsy was an eligibility criterion in 71% of trials, and a statistical justification for the research biopsy sample size was present in 50% of trials. A total of 745 research biopsies were performed on 576 patients. Overall and major complication rates were 5.2% (39 of 745 biopsies) and 0.8% (six of 745 biopsies), respectively. Complication rates for intrathoracic and abdominal/pelvic solid organ biopsies were 17.1% (36 of 211 biopsies) and 1.6% (three of 189 biopsies), respectively. Site-stratified research biopsy-related risks were discussed in five consents. CONCLUSION A better representation of the risks and benefits of research biopsies in study protocols and informed consents is needed.
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Affiliation(s)
- Michael J Overman
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
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Peppercorn J. Toward improved understanding of the ethical and clinical issues surrounding mandatory research biopsies. J Clin Oncol 2012; 31:1-2. [PMID: 23129739 DOI: 10.1200/jco.2012.44.8589] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Reck M, Reinmuth N, Heigener DF. First- and second-line treatment of non-small-cell lung cancer patients withEGFRmutation-positive tumors. Lung Cancer Manag 2012. [DOI: 10.2217/lmt.12.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
SUMMARY EGFR is a mediator of cell proliferation and is targeted by EGFR tyrosine kinase inhibitors (TKIs) to treat non-small-cell lung cancer (NSCLC). Efficacy of EGFR TKIs (specifically erlotinib and gefitinib) is influenced by mutations in EGFR. We review the evidence for targeted use of EGFR TKIs in the first-line treatment of EGFR mutation-positive NSCLC, considering epidemiology and timing/methodology of diagnosis. First- and second-generation TKIs, and other investigational drugs, also have a role in the second-line treatment of EGFR mutation-positive NSCLC; we discuss this in the context of disease progression and drug resistance. Patients with EGFR mutation-positive tumors should be considered as a separate subpopulation within NSCLC, which is the first step towards individualized treatment of this disease.
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Affiliation(s)
- Martin Reck
- Hospital Grosshansdorf, Woehrendamm 80, 22927 Grosshansdorf, Germany
| | - Niels Reinmuth
- Hospital Grosshansdorf, Woehrendamm 80, 22927 Grosshansdorf, Germany
| | - David F Heigener
- Hospital Grosshansdorf, Woehrendamm 80, 22927 Grosshansdorf, Germany
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Freeman GA, Kimmelman J. Publication and reporting conduct for pharmacodynamic analyses of tumor tissue in early-phase oncology trials. Clin Cancer Res 2012; 18:6478-84. [PMID: 22912391 DOI: 10.1158/1078-0432.ccr-12-1384] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE In principle, nondiagnostic biopsies for pharmacodynamic (PD) studies are carried out to inform decision-making in drug development. Because such procedures have no therapeutic value, their ethical justification requires that results be published. We aimed to assess the frequency of nonpublication of PD data in early phase cancer trials and to identify factors that prevent full publication of data. METHODS We identified a sample of early-phase cancer trials containing invasive nondiagnostic tissue procurement for PD analysis from American Society of Clinical Oncology and American Association for Cancer Research meeting abstracts published between 1995 and 2005. These trials were followed to publication to determine frequency of nonpublication of PD data. Corresponding authors on early-phase cancer trials using invasive nondiagnostic research procedures were also surveyed to identify factors preventing full publication of PD data. RESULTS In a sample of 90 trials, 22.2% (20 trials) resulted in no trial publication. Of published trials expected to contain PD reports, 16 (17.8%) did not include any PD data, and 21 (23.3%) reported incomplete PD data. We surveyed 92 authors; nonpublication was regarded as a frequent occurrence, and the most commonly cited barrier to full publication of PD data was strategic considerations in publication (58.8% of responding authors). CONCLUSIONS Our results suggest ways that investigators, study planners, and reviewers can improve the burden/knowledge value balance in PD studies.
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Affiliation(s)
- Georgina A Freeman
- Biomedical Ethics Unit, Department of Experimental Medicine, Department of Social Studies of Medicine, McGill University, Montreal, Quebec, Canada
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