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Szabados B, Rodriguez-Vida A, Duran I, Crabb S, van der Heijden M, Pous AF, Gravis G, Herranz UA, Protheroe A, Ravaud A, Maillet D, Mendez M, Suarez C, Linch M, Prendergast A, Tyson C, Mousa K, Castellano D, Powles T. 199O A phase II study investigating neoadjuvant atezolizumab in cisplatin-ineligible patients with muscle-invasive bladder cancer: Final analysis. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.10.211] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Tuthill M, Cappuccini F, Carter L, Pollock E, Poulton I, Verrill C, Evans T, Gillessen S, Attard G, Protheroe A, Hamdy F, Hill A, Redchenko I. 682P Results from ADVANCE: A phase I/II open-label non-randomised safety and efficacy study of the viral vectored ChAdOx1-MVA 5T4 (VTP-800) vaccine in combination with PD-1 checkpoint blockade in metastatic prostate cancer. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.2076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Sullivan M, Patel N, Brown S, Blick C, Leiblich A, Protheroe A, Cranston D, Bryant R. Active surveillance of small renal masses in an older population offers long-term oncological efficacy equivalent to partial or radical nephrectomy. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33211-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Clarke NW, Ali A, Ingleby FC, Hoyle A, Amos CL, Attard G, Brawley CD, Calvert J, Chowdhury S, Cook A, Cross W, Dearnaley DP, Douis H, Gilbert D, Gillessen S, Jones RJ, Langley RE, MacNair A, Malik Z, Mason MD, Matheson D, Millman R, Parker CC, Ritchie AWS, Rush H, Russell JM, Brown J, Beesley S, Birtle A, Capaldi L, Gale J, Gibbs S, Lydon A, Nikapota A, Omlin A, O'Sullivan JM, Parikh O, Protheroe A, Rudman S, Srihari NN, Simms M, Tanguay JS, Tolan S, Wagstaff J, Wallace J, Wylie J, Zarkar A, Sydes MR, Parmar MKB, James ND. Corrigendum to Addition of docetaxel to hormonal therapy in low- and high-burden metastatic hormone sensitive prostate cancer: long-term survival results from the STAMPEDE trial: Ann Oncol 2019; 30: 1992-2003. Ann Oncol 2020; 31:442. [PMID: 32067690 PMCID: PMC8929236 DOI: 10.1016/j.annonc.2020.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- N W Clarke
- Department of Urology, The Christie and Salford Royal NHS Foundation Trusts, Manchester.
| | - A Ali
- Genito-Urinary Cancer Research Group, Division of Cancer Sciences, The University of Manchester, Manchester
| | - F C Ingleby
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London; London School of Hygiene and Tropical Medicine, London
| | - A Hoyle
- Department of Urology, The Christie and Salford Royal NHS Foundation Trusts, Manchester
| | - C L Amos
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | | | - C D Brawley
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | - J Calvert
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | - S Chowdhury
- Guy's and Saint Thomas' NHS Foundation Trust, London
| | - A Cook
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | - W Cross
- St James University Hospital, Leeds
| | | | - H Douis
- Department of Radiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham
| | - D Gilbert
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | - S Gillessen
- Division of Cancer Sciences, The University of Manchester, Manchester
| | - R J Jones
- Beatson West of Scotland Cancer Centre, University of Glasgow, Glasgow
| | - R E Langley
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | - A MacNair
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | - Z Malik
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool
| | | | - D Matheson
- Faculty of Education Health and Wellbeing, University of Wolverhampton, Wolverhampton
| | - R Millman
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | - C C Parker
- Institute of Cancer Research, Sutton-London; RoyalMarsden NHS Foundation Trust, London
| | - A W S Ritchie
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | - H Rush
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | - J M Russell
- Institute of Cancer Sciences, Beatson West of Scotland Cancer Centre, Glasgow
| | - J Brown
- University of Sheffield, Sheffield
| | | | - A Birtle
- Lancashire Teaching Hospitals NHS Foundation Trust, Preston
| | - L Capaldi
- Worcestershire Acute Hospitals NHS Trust, Worcester
| | - J Gale
- Portsmouth Oncology Centre, Queen Alexandra Hospital, Portsmouth
| | | | - A Lydon
- Torbay and South Devon NHS Foundation Trust, Torbay
| | | | - A Omlin
- Department of Oncology and Haematology, Kantonsspital, St Gallen, Switzerland
| | - J M O'Sullivan
- Centre for Cancer Research and Cell Biology, Queen's University Belfast, Belfast, UK
| | - O Parikh
- East Lancashire Hospitals NHS Trust, Blackburn, UK
| | - A Protheroe
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - S Rudman
- Guy's and Saint Thomas' NHS Foundation Trust, London
| | - N N Srihari
- Shrewsbury and Telford Hospital NHS Trust, Shrewsbury, UK
| | - M Simms
- Hull and East Yorkshire Hospitals NHS Trust, Hull, UK
| | | | - S Tolan
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool
| | - J Wagstaff
- Swansea University College of Medicine, Swansea, UK
| | - J Wallace
- Beatson West of Scotland Cancer Centre, University of Glasgow, Glasgow
| | - J Wylie
- The Christie NHS Foundation Trust, Manchester, UK
| | - A Zarkar
- Heartlands Hospital, Birmingham, UK
| | - M R Sydes
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | - M K B Parmar
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | - N D James
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
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Clarke NW, Ali A, Ingleby FC, Hoyle A, Amos CL, Attard G, Brawley CD, Calvert J, Chowdhury S, Cook A, Cross W, Dearnaley DP, Douis H, Gilbert D, Gillessen S, Jones RJ, Langley RE, MacNair A, Malik Z, Mason MD, Matheson D, Millman R, Parker CC, Ritchie AWS, Rush H, Russell JM, Brown J, Beesley S, Birtle A, Capaldi L, Gale J, Gibbs S, Lydon A, Nikapota A, Omlin A, O'Sullivan JM, Parikh O, Protheroe A, Rudman S, Srihari NN, Simms M, Tanguay JS, Tolan S, Wagstaff J, Wallace J, Wylie J, Zarkar A, Sydes MR, Parmar MKB, James ND. Addition of docetaxel to hormonal therapy in low- and high-burden metastatic hormone sensitive prostate cancer: long-term survival results from the STAMPEDE trial. Ann Oncol 2019; 30:1992-2003. [PMID: 31560068 PMCID: PMC6938598 DOI: 10.1093/annonc/mdz396] [Citation(s) in RCA: 222] [Impact Index Per Article: 44.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND STAMPEDE has previously reported that the use of upfront docetaxel improved overall survival (OS) for metastatic hormone naïve prostate cancer patients starting long-term androgen deprivation therapy. We report on long-term outcomes stratified by metastatic burden for M1 patients. METHODS We randomly allocated patients in 2 : 1 ratio to standard-of-care (SOC; control group) or SOC + docetaxel. Metastatic disease burden was categorised using retrospectively-collected baseline staging scans where available. Analysis used Cox regression models, adjusted for stratification factors, with emphasis on restricted mean survival time where hazards were non-proportional. RESULTS Between 05 October 2005 and 31 March 2013, 1086 M1 patients were randomised to receive SOC (n = 724) or SOC + docetaxel (n = 362). Metastatic burden was assessable for 830/1086 (76%) patients; 362 (44%) had low and 468 (56%) high metastatic burden. Median follow-up was 78.2 months. There were 494 deaths on SOC (41% more than the previous report). There was good evidence of benefit of docetaxel over SOC on OS (HR = 0.81, 95% CI 0.69-0.95, P = 0.009) with no evidence of heterogeneity of docetaxel effect between metastatic burden sub-groups (interaction P = 0.827). Analysis of other outcomes found evidence of benefit for docetaxel over SOC in failure-free survival (HR = 0.66, 95% CI 0.57-0.76, P < 0.001) and progression-free survival (HR = 0.69, 95% CI 0.59-0.81, P < 0.001) with no evidence of heterogeneity of docetaxel effect between metastatic burden sub-groups (interaction P > 0.5 in each case). There was no evidence that docetaxel resulted in late toxicity compared with SOC: after 1 year, G3-5 toxicity was reported for 28% SOC and 27% docetaxel (in patients still on follow-up at 1 year without prior progression). CONCLUSIONS The clinically significant benefit in survival for upfront docetaxel persists at longer follow-up, with no evidence that benefit differed by metastatic burden. We advocate that upfront docetaxel is considered for metastatic hormone naïve prostate cancer patients regardless of metastatic burden.
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Affiliation(s)
- N W Clarke
- Department of Urology, The Christie and Salford Royal NHS Foundation Trusts, Manchester.
| | - A Ali
- Genito-Urinary Cancer Research Group, Division of Cancer Sciences, The University of Manchester, Manchester
| | - F C Ingleby
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London; London School of Hygiene and Tropical Medicine, London
| | - A Hoyle
- Department of Urology, The Christie and Salford Royal NHS Foundation Trusts, Manchester
| | - C L Amos
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | | | - C D Brawley
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | - J Calvert
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | - S Chowdhury
- Guy's and Saint Thomas' NHS Foundation Trust, London
| | - A Cook
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | - W Cross
- St James University Hospital, Leeds
| | | | - H Douis
- Department of Radiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham
| | - D Gilbert
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | - S Gillessen
- Division of Cancer Sciences, The University of Manchester, Manchester
| | - R J Jones
- Beatson West of Scotland Cancer Centre, University of Glasgow, Glasgow
| | - R E Langley
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | - A MacNair
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | - Z Malik
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool
| | | | - D Matheson
- Faculty of Education Health and Wellbeing, University of Wolverhampton, Wolverhampton
| | - R Millman
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | - C C Parker
- Institute of Cancer Research, Sutton-London; Royal Marsden NHS Foundation Trust, London
| | - A W S Ritchie
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | - H Rush
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | - J M Russell
- Institute of Cancer Sciences, Beatson West of Scotland Cancer Centre, Glasgow
| | - J Brown
- University of Sheffield, Sheffield
| | | | - A Birtle
- Lancashire Teaching Hospitals NHS Foundation Trust, Preston
| | - L Capaldi
- Worcestershire Acute Hospitals NHS Trust, Worcester
| | - J Gale
- Portsmouth Oncology Centre, Queen Alexandra Hospital, Portsmouth
| | | | - A Lydon
- Torbay and South Devon NHS Foundation Trust, Torbay
| | | | - A Omlin
- Department of Oncology and Haematology, Kantonsspital, St Gallen, Switzerland
| | - J M O'Sullivan
- Centre for Cancer Research and Cell Biology, Queen's University Belfast, Belfast
| | - O Parikh
- East Lancashire Hospitals NHS Trust, Blackburn
| | - A Protheroe
- Oxford University Hospitals NHS Foundation Trust, Oxford
| | - S Rudman
- Guy's and Saint Thomas' NHS Foundation Trust, London
| | - N N Srihari
- Shrewsbury and Telford Hospital NHS Trust, Shrewsbury
| | - M Simms
- Hull and East Yorkshire Hospitals NHS Trust, Hull
| | | | - S Tolan
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool
| | - J Wagstaff
- Swansea University College of Medicine, Swansea
| | - J Wallace
- Beatson West of Scotland Cancer Centre, University of Glasgow, Glasgow
| | - J Wylie
- The Christie NHS Foundation Trust, Manchester
| | | | - M R Sydes
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | - M K B Parmar
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | - N D James
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham
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Matsubara N, Chi K, Ozguroglu M, Rodriguez Antolin A, Feyerabend S, Fein L, Alekseev B, Sulur G, Protheroe A, Li S, Mundle S, De Porre P, Tran N, Fazazi K. LATITUDE study: PSA response characteristics and correlation with overall survival (OS) and radiological progression-free survival (rPFS) in patients with metastatic hormone-sensitive prostate cancer (mHSPC) receiving ADT+abiraterone acetate and prednisone (AAP) or placebo (PBO). Ann Oncol 2018. [DOI: 10.1093/annonc/mdy284.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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7
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Castellano D, Duran I, Rodríguez-Vida A, Crabb S, van der Heijden M, Font Pous A, Gravis G, Anido Herranz U, Protheroe A, Ravaud A, Maillet D, Mendez-Vidal M, Suarez C, Lorch A, Sternberg C, Linch M, Sarker SJ, Notta J, Mousa K, Powles T. A phase II study investigating the safety and efficacy of neoadjuvent atezolizumab in muscle invasive bladder cancer (ABACUS). Ann Oncol 2018. [DOI: 10.1093/annonc/mdy283.108] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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8
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Sydes MR, Spears MR, Mason MD, Clarke NW, Dearnaley DP, de Bono JS, Attard G, Chowdhury S, Cross W, Gillessen S, Malik ZI, Jones R, Parker CC, Ritchie AWS, Russell JM, Millman R, Matheson D, Amos C, Gilson C, Birtle A, Brock S, Capaldi L, Chakraborti P, Choudhury A, Evans L, Ford D, Gale J, Gibbs S, Gilbert DC, Hughes R, McLaren D, Lester JF, Nikapota A, O'Sullivan J, Parikh O, Peedell C, Protheroe A, Rudman SM, Shaffer R, Sheehan D, Simms M, Srihari N, Strebel R, Sundar S, Tolan S, Tsang D, Varughese M, Wagstaff J, Parmar MKB, James ND. Adding abiraterone or docetaxel to long-term hormone therapy for prostate cancer: directly randomised data from the STAMPEDE multi-arm, multi-stage platform protocol. Ann Oncol 2018; 29:1235-1248. [PMID: 29529169 PMCID: PMC5961425 DOI: 10.1093/annonc/mdy072] [Citation(s) in RCA: 175] [Impact Index Per Article: 29.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background Adding abiraterone acetate with prednisolone (AAP) or docetaxel with prednisolone (DocP) to standard-of-care (SOC) each improved survival in systemic therapy for advanced or metastatic prostate cancer: evaluation of drug efficacy: a multi-arm multi-stage platform randomised controlled protocol recruiting patients with high-risk locally advanced or metastatic PCa starting long-term androgen deprivation therapy (ADT). The protocol provides the only direct, randomised comparative data of SOC + AAP versus SOC + DocP. Method Recruitment to SOC + DocP and SOC + AAP overlapped November 2011 to March 2013. SOC was long-term ADT or, for most non-metastatic cases, ADT for ≥2 years and RT to the primary tumour. Stratified randomisation allocated pts 2 : 1 : 2 to SOC; SOC + docetaxel 75 mg/m2 3-weekly×6 + prednisolone 10 mg daily; or SOC + abiraterone acetate 1000 mg + prednisolone 5 mg daily. AAP duration depended on stage and intent to give radical RT. The primary outcome measure was death from any cause. Analyses used Cox proportional hazards and flexible parametric models, adjusted for stratification factors. This was not a formally powered comparison. A hazard ratio (HR) <1 favours SOC + AAP, and HR > 1 favours SOC + DocP. Results A total of 566 consenting patients were contemporaneously randomised: 189 SOC + DocP and 377 SOC + AAP. The patients, balanced by allocated treatment were: 342 (60%) M1; 429 (76%) Gleason 8-10; 449 (79%) WHO performance status 0; median age 66 years and median PSA 56 ng/ml. With median follow-up 4 years, 149 deaths were reported. For overall survival, HR = 1.16 (95% CI 0.82-1.65); failure-free survival HR = 0.51 (95% CI 0.39-0.67); progression-free survival HR = 0.65 (95% CI 0.48-0.88); metastasis-free survival HR = 0.77 (95% CI 0.57-1.03); prostate cancer-specific survival HR = 1.02 (0.70-1.49); and symptomatic skeletal events HR = 0.83 (95% CI 0.55-1.25). In the safety population, the proportion reporting ≥1 grade 3, 4 or 5 adverse events ever was 36%, 13% and 1% SOC + DocP, and 40%, 7% and 1% SOC + AAP; prevalence 11% at 1 and 2 years on both arms. Relapse treatment patterns varied by arm. Conclusions This direct, randomised comparative analysis of two new treatment standards for hormone-naïve prostate cancer showed no evidence of a difference in overall or prostate cancer-specific survival, nor in other important outcomes such as symptomatic skeletal events. Worst toxicity grade over entire time on trial was similar but comprised different toxicities in line with the known properties of the drugs. Trial registration Clinicaltrials.gov: NCT00268476.
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Affiliation(s)
- M R Sydes
- MRC Clinical Trials Unit at UCL, London.
| | | | | | - N W Clarke
- Christie and Royal Salford Hospital, Manchester
| | | | | | - G Attard
- UCL Cancer Institute, University College London, London
| | - S Chowdhury
- Guy's & St Thomas NHS, Foundation Trust, London
| | - W Cross
- St James University Hospital, Leeds, UK
| | - S Gillessen
- Division of Oncology and Hematology, Kantonsspital St. Gallen, St. Gallen; University of Bern, Bern; Swiss Group for Cancer Clinical Research (SAKK), Bern, Switzerland
| | - Z I Malik
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool
| | - R Jones
- Institute of Cancer Sciences, University of Glasgow, Glasgow; Beatson West of Scotland Cancer Centre, University of Glasgow, Glasgow
| | - C C Parker
- Institute of Cancer Research, Sutton; Royal Marsden Hospital, Sutton
| | | | - J M Russell
- Institute of Cancer Sciences, University of Glasgow, Glasgow; Beatson West of Scotland Cancer Centre, University of Glasgow, Glasgow
| | - R Millman
- MRC Clinical Trials Unit at UCL, London
| | - D Matheson
- Faculty of Education, Health and Wellbeing, University of Wolverhampton, Wolverhampton
| | - C Amos
- MRC Clinical Trials Unit at UCL, London
| | - C Gilson
- MRC Clinical Trials Unit at UCL, London
| | - A Birtle
- Rosemere Cancer Centre, Royal Preston Hospital, Preston
| | - S Brock
- Dorset Cancer Centre, Poole Hospital, Poole
| | - L Capaldi
- Worcestershire Acute Hospitals NHS Trust, Worcester
| | | | - A Choudhury
- Division of Cancer Sciences, University of Manchester, Manchester; Manchester Academic Health Science Centre, Manchester; Christie Hospital NHS Foundation Trust, Manchester
| | - L Evans
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield
| | - D Ford
- City Hospital, Cancer Centre at Queen Elizabeth Hospital, Birmingham
| | - J Gale
- Portsmouth Oncology Centre, Queen Alexandra Hospital, Portsmouth
| | | | - D C Gilbert
- Sussex Cancer Centre, Royal Sussex County Hospital, Brighton
| | - R Hughes
- Mount Vernon Group, Mount Vernon Hospital, Middlesex
| | | | | | | | - J O'Sullivan
- Centre for Cancer Research and Cell Biology, Queens University Belfast, Belfast; Belfast City Hospital, Belfast
| | - O Parikh
- Lancashire Teaching Hospitals NHS Trust, Preston
| | - C Peedell
- Department of Oncology & Radiotherapy, South Tees NHS Trust, Middlesbrough
| | - A Protheroe
- Oxford University Hospitals NHS Foundation Trust
| | - S M Rudman
- Guy's & St Thomas NHS, Foundation Trust, London
| | - R Shaffer
- Department of Oncology, Royal Surrey County Hospital, Guildford
| | - D Sheehan
- Royal Devon and Exeter Hospital, Exeter
| | - M Simms
- Hull & East Yorkshire Hospitals NHS Trust, Hull
| | - N Srihari
- Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury, UK
| | - R Strebel
- Kantonsspital Graubünden, Chur; Swiss Group for Cancer Clinical Research (SAKK), Bern, Switzerland
| | - S Sundar
- Department of Oncology, Nottingham, University Hospitals NHS Trust, Nottingham
| | - S Tolan
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool
| | - D Tsang
- Southend Hospital, Southend-on-Sea
| | - M Varughese
- Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust
| | - J Wagstaff
- Swansea University College of Medicine, Swansea
| | | | - N D James
- Institute of Cancer and Genomic Sciences, University of Birmingham, Edgbaston, Birmingham, UK
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De La Pena H, Sharma A, Glicksman C, Joseph J, Subesinghe M, Traill Z, Verrill C, Sullivan M, Redgwell J, Bataillard E, Pintus E, Dallas N, Gogbashian A, Tuthill M, Protheroe A, Hall M. No longer any role for routine follow-up chest x-rays in men with stage I germ cell cancer. Eur J Cancer 2017; 84:354-359. [DOI: 10.1016/j.ejca.2017.07.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 06/19/2017] [Accepted: 07/03/2017] [Indexed: 10/18/2022]
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Chi K, Protheroe A, Rodriguez Antolin A, Facchini G, Suttmann H, Matsubara N, Ye ZQ, Keam B, Li T, McQuarrie K, Jia B, De Porre P, Martin J, Todd M, Fizazi K. Benefits of Abiraterone Acetate Plus Prednisone (AA+P) When Added to Androgen Deprivation Therapy (ADT) in LATITUDE on Patient (Pt) Reported Outcomes (PRO). Ann Oncol 2017. [DOI: 10.1093/annonc/mdx370] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Lynch RW, Churchhouse AMD, Protheroe A, Arnott IDR. Predicting outcome in acute severe ulcerative colitis: comparison of the Travis and Ho scores using UK IBD audit data. Aliment Pharmacol Ther 2016; 43:1132-41. [PMID: 27060985 DOI: 10.1111/apt.13614] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 08/13/2015] [Accepted: 03/15/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND Acute severe ulcerative colitis is categorised using the Truelove & Witts criteria. The Travis and the Ho scores are calculated following 72 h of steroid treatment to identify patients at risk of failing steroid therapy who require colectomy or second-line medical therapy. AIM To compare the Travis and the Ho scores in a large unselected cohort to determine which might be more clinically relevant. METHODS We analysed 3049 patients with ulcerative colitis from the 2010 round of the UK IBD audit of which 984 had acute severe ulcerative colitis. 420 patients had sufficient data for analysis. Patients were allocated into either a Travis high- or low-risk group and either a Ho high-, intermediate- or low-risk group. We assessed whether further medical or surgical intervention and outcomes varied between groups. RESULTS High-risk patients in Travis and the Ho groups, when compared to lower risk groups, were more likely to fail steroid therapy: 64.5% (131/203) vs. 38.7% (84/217) (P < 0.0001) for Travis and 66.2% (96/145) vs. 46.7% (85/182) vs. 36.6% (34/93) (P < 0.0001) for Ho. They were also more likely to undergo surgery 34.0% (69/203) vs. 9.7% (21/217) for Travis and 33.1% (48/145) vs. 17.0% (31/182) vs. 11.8% (11/93) (P < 0.0001) for Ho. Travis high patients were more likely to be refractory to second-line medical therapy: 44.6% (37/83) vs. 20.0% (9/45) (P = 0.01). CONCLUSIONS Patients identified as high risk using the Travis or the Ho scoring systems are more likely to be resistant to IV steroids and require surgery. Risk of surgery in both high-risk populations is lower than previously reported.
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Affiliation(s)
- R W Lynch
- GI Unit, Western General Hospital, Edinburgh, UK
| | | | - A Protheroe
- UK IBD Audit, Clinical Effectiveness and Evaluation unit, Royal College of Physicians, London, UK
| | - I D R Arnott
- GI Unit, Western General Hospital, Edinburgh, UK.,UK IBD Audit, Clinical Effectiveness and Evaluation unit, Royal College of Physicians, London, UK
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Lynch RW, Lowe D, Protheroe A, Driscoll R, Rhodes JM, Arnott IDR. Outcomes of rescue therapy in acute severe ulcerative colitis: data from the United Kingdom inflammatory bowel disease audit. Aliment Pharmacol Ther 2013; 38:935-45. [PMID: 24004000 DOI: 10.1111/apt.12473] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Revised: 06/10/2013] [Accepted: 08/15/2013] [Indexed: 02/06/2023]
Abstract
BACKGROUND Approximately one third of patients with acute severe ulcerative colitis (ASUC) fail response to steroids. Ciclosporin and anti-TNFα are proven second-line therapies, but evidence of their efficacy has come mainly from tertiary centres and/or selective clinical trial recruitment. AIM To assess ASUC outcomes in a large unselected cohort. METHODS UK-wide audits of IBD care were conducted in 2008 (209 hospital sites) and 2010 (198 hospital sites), covering >87% of admitting hospitals. Each site entered data from 20 consecutive UC admissions onto a web-based proforma. Admissions included 852 (2008) and 984 (2010) with ASUC, accounting for 35% and 39% of UC admissions, respectively. RESULTS ASUC in-hospital mortality was 1.2% in 2008; 0.7% in 2010 (P = 0.22). Response to first-line steroid therapy was 61% (2008); 58% (2010) and mortality was higher in non-responders: 2008: 2.9% (9/315) vs. 0.19% (1/537; P < 0.001); 2010: 1.8% (7/391) vs. 0.0% (0/593; P = 0.002). In 2010, more patients (56%) received second-line medical therapy than in 2008 (47%, P = 0.02). In-hospital mortality was similar to second-line medical therapy vs. surgery without further medical therapy; 2008: 2.7% vs. 2.8%, P = 0.99; 2010: 0.9% vs. 3.1%, P = 0.17. Second-line therapy response was more frequently observed with anti-TNFα than ciclosporin: (2008: 76% vs. 46%, P < 0.001; 2010: 80% vs. 58%, P < 0.001). CONCLUSIONS Mortality in acute severe ulcerative colitis was low, but higher in steroid non-responders. Patients treated with second-line medical therapies had no higher risk of in-hospital mortality than those undergoing surgery. Second-line 'rescue' medical therapy usage is increasing; however, ciclosporin response rates were relatively low.
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Affiliation(s)
- R W Lynch
- Gastrointestinal Unit, Western General Hospital, Edinburgh, UK
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Fairfax BP, Pratap S, Roberts ISD, Collier J, Kaplan R, Meade AM, Ritchie AW, Eisen T, Macaulay VM, Protheroe A. Fatal case of sorafenib-associated idiosyncratic hepatotoxicity in the adjuvant treatment of a patient with renal cell carcinoma. BMC Cancer 2012; 12:590. [PMID: 23231599 PMCID: PMC3575366 DOI: 10.1186/1471-2407-12-590] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Accepted: 11/29/2012] [Indexed: 02/19/2023] Open
Abstract
Background Sorafenib is an orally available kinase inhibitor with activity at Raf, PDGFβ and VEGF receptors that is licensed for the treatment of advanced renal cell carcinoma (RCC) and hepatocellular carcinoma (HCC). Current evidence-based post-nephrectomy management of individuals with localized RCC consists of surveillance-based follow up. The SORCE trial is designed to investigate whether treatment with adjuvant sorafenib can reduce recurrence rates in this cohort. Case presentation Here we report an idiosyncratic reaction to sorafenib resulting in fatal hepatotoxicity and associated renal failure in a 62 year-old man treated with sorafenib within the SORCE trial. Conclusion This is the first reported case of sorafenib exposure associated fatal toxicity in the adjuvant setting and highlights the unpredictable adverse effects of novel adjuvant therapies.
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Affiliation(s)
- B P Fairfax
- Department of Oncology, Cancer and Haematology Centre, Churchill Hospital, Oxford OX3 7LJ, UK
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Blick C, Hall P, Pwint T, Munro N, Crew J, Powles T, Macaulay VM, Al-Terkait F, Protheroe A, Chester JD. Accelerated MVAC as neoadjuvant chemotherapy for patients with muscle-invasive transitional cell carcinoma of the bladder. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.7_suppl.235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
235 Background: Meta-analysis data demonstrate a 5% absolute survival benefit for the use of neoadjuvant chemotherapy (NAC) using cisplatin-based combination regimens in the radical treatment of muscle-invasive bladder cancer (MIBC). However, there is currently no randomized controlled trial data on the optimum regimen for this setting. Accelerated MVAC (AMVAC) is effective in advanced disease, and has the potential advantage over other NAC regimens of minimising delays to definitive, potentially curative therapy. We present data regarding its use as NAC in MIBC patients. Methods: Retrospective analysis was performed on all 80 consecutive patients with muscle-invasive transitional cell carcinoma of the bladder, treated during a 50-month period at 2 U.K. centers. Patients received either 3 or 4 cycles of methotrexate 30mg/m2, vinblastine 3mg/m2, doxorubicin 30mg/m2 and 4-hour infusion of cisplatin 70mg/m2 at 2-week intervals, with G-CSF support, prior to definitive therapy with either radical surgery (RS) or radical radiotherapy (RT). Results: All planned cycles of chemotherapy were completed in 84% of patients. All 80 patients received their planned definitive therapy. Pathological complete response (pCR) was seen in 43% of 60 patients treated with surgery following chemotherapy. There were no chemotherapy-related deaths and grade 3 or 4 toxicities were seen in 11% of patients. Median duration of chemotherapy was 34 days. Dose reduction or delay was required in 7% and 9% of patients, respectively. Objective radiological local response was seen in 75% of patients. At a median follow-up of 27.5 months, 25 (32%) patients have relapsed and 11 (14%) died. Two-year disease-free survival was 65% overall, and was statistically significantly superior in patients who were radiologically node-negative prior to chemotherapy. Conclusions: AMVAC is a safe, well-tolerated, and easily deliverable regimen with excellent treatment outcomes and minimizes delays to definitive treatment. It is an appropriate comparator for future randomized trials. No significant financial relationships to disclose.
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Affiliation(s)
- C. Blick
- The Churchill Hospital, Oxford, United Kingdom; St. James's University Hospital, Leeds, United Kingdom; Oxford Radcliffe Hospitals, Oxford, United Kingdom; St. James's University Hospital, Harrogate, United Kingdom; St. Bartholomew's Hospital, London, United Kingdom; University of Oxford, Oxford, United Kingdom; Yorkshire Deanery, St. James's University Hospital, Leeds, United Kingdom; Medical Oncology Department, University of Oxford, Oxford, United Kingdom; St. James's Institute of Oncology, Leeds,
| | - P. Hall
- The Churchill Hospital, Oxford, United Kingdom; St. James's University Hospital, Leeds, United Kingdom; Oxford Radcliffe Hospitals, Oxford, United Kingdom; St. James's University Hospital, Harrogate, United Kingdom; St. Bartholomew's Hospital, London, United Kingdom; University of Oxford, Oxford, United Kingdom; Yorkshire Deanery, St. James's University Hospital, Leeds, United Kingdom; Medical Oncology Department, University of Oxford, Oxford, United Kingdom; St. James's Institute of Oncology, Leeds,
| | - T. Pwint
- The Churchill Hospital, Oxford, United Kingdom; St. James's University Hospital, Leeds, United Kingdom; Oxford Radcliffe Hospitals, Oxford, United Kingdom; St. James's University Hospital, Harrogate, United Kingdom; St. Bartholomew's Hospital, London, United Kingdom; University of Oxford, Oxford, United Kingdom; Yorkshire Deanery, St. James's University Hospital, Leeds, United Kingdom; Medical Oncology Department, University of Oxford, Oxford, United Kingdom; St. James's Institute of Oncology, Leeds,
| | - N. Munro
- The Churchill Hospital, Oxford, United Kingdom; St. James's University Hospital, Leeds, United Kingdom; Oxford Radcliffe Hospitals, Oxford, United Kingdom; St. James's University Hospital, Harrogate, United Kingdom; St. Bartholomew's Hospital, London, United Kingdom; University of Oxford, Oxford, United Kingdom; Yorkshire Deanery, St. James's University Hospital, Leeds, United Kingdom; Medical Oncology Department, University of Oxford, Oxford, United Kingdom; St. James's Institute of Oncology, Leeds,
| | - J. Crew
- The Churchill Hospital, Oxford, United Kingdom; St. James's University Hospital, Leeds, United Kingdom; Oxford Radcliffe Hospitals, Oxford, United Kingdom; St. James's University Hospital, Harrogate, United Kingdom; St. Bartholomew's Hospital, London, United Kingdom; University of Oxford, Oxford, United Kingdom; Yorkshire Deanery, St. James's University Hospital, Leeds, United Kingdom; Medical Oncology Department, University of Oxford, Oxford, United Kingdom; St. James's Institute of Oncology, Leeds,
| | - T. Powles
- The Churchill Hospital, Oxford, United Kingdom; St. James's University Hospital, Leeds, United Kingdom; Oxford Radcliffe Hospitals, Oxford, United Kingdom; St. James's University Hospital, Harrogate, United Kingdom; St. Bartholomew's Hospital, London, United Kingdom; University of Oxford, Oxford, United Kingdom; Yorkshire Deanery, St. James's University Hospital, Leeds, United Kingdom; Medical Oncology Department, University of Oxford, Oxford, United Kingdom; St. James's Institute of Oncology, Leeds,
| | - V. M. Macaulay
- The Churchill Hospital, Oxford, United Kingdom; St. James's University Hospital, Leeds, United Kingdom; Oxford Radcliffe Hospitals, Oxford, United Kingdom; St. James's University Hospital, Harrogate, United Kingdom; St. Bartholomew's Hospital, London, United Kingdom; University of Oxford, Oxford, United Kingdom; Yorkshire Deanery, St. James's University Hospital, Leeds, United Kingdom; Medical Oncology Department, University of Oxford, Oxford, United Kingdom; St. James's Institute of Oncology, Leeds,
| | - F. Al-Terkait
- The Churchill Hospital, Oxford, United Kingdom; St. James's University Hospital, Leeds, United Kingdom; Oxford Radcliffe Hospitals, Oxford, United Kingdom; St. James's University Hospital, Harrogate, United Kingdom; St. Bartholomew's Hospital, London, United Kingdom; University of Oxford, Oxford, United Kingdom; Yorkshire Deanery, St. James's University Hospital, Leeds, United Kingdom; Medical Oncology Department, University of Oxford, Oxford, United Kingdom; St. James's Institute of Oncology, Leeds,
| | - A. Protheroe
- The Churchill Hospital, Oxford, United Kingdom; St. James's University Hospital, Leeds, United Kingdom; Oxford Radcliffe Hospitals, Oxford, United Kingdom; St. James's University Hospital, Harrogate, United Kingdom; St. Bartholomew's Hospital, London, United Kingdom; University of Oxford, Oxford, United Kingdom; Yorkshire Deanery, St. James's University Hospital, Leeds, United Kingdom; Medical Oncology Department, University of Oxford, Oxford, United Kingdom; St. James's Institute of Oncology, Leeds,
| | - J. D. Chester
- The Churchill Hospital, Oxford, United Kingdom; St. James's University Hospital, Leeds, United Kingdom; Oxford Radcliffe Hospitals, Oxford, United Kingdom; St. James's University Hospital, Harrogate, United Kingdom; St. Bartholomew's Hospital, London, United Kingdom; University of Oxford, Oxford, United Kingdom; Yorkshire Deanery, St. James's University Hospital, Leeds, United Kingdom; Medical Oncology Department, University of Oxford, Oxford, United Kingdom; St. James's Institute of Oncology, Leeds,
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Mulders P, Hawkins R, Nathan P, de Jong I, Osanto S, Porfiri E, Protheroe A, Mookerjee B, Pike L, Gore M. 49LBA Final results of a Phase II randomised study of cediranib (RECENTIN™) in patients with advanced renal cell carcinoma (RCC). EJC Suppl 2009. [DOI: 10.1016/s1359-6349(09)72084-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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16
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Rudman SM, Comins C, Mukherji D, Coffey M, Mettinger K, Protheroe A, Harrington KJ, Pandha H, Spicer JF. Results of a phase I study to evaluate the feasibility, safety, and biological effects of intravenous administration of wild-type reovirus with docetaxel to patients with advanced malignancies. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e13524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e13524 Background: Reovirus has minimal pathogenicity in humans but selectively replicates in cells with activated Ras. Wild- type reovirus serotype 3 Dearing strain (Reolysin) has selective antitumor activity in vitro, in murine models, and after systemic delivery in humans in phase 1 trials. Synergistic tumour kill has been observed combining reovirus with taxanes in a range of cancer cell lines and in vivo. Methods: Patients were treated in an open-label, dose-escalating, phase I trial and received 3- weekly 75mg/m2 docetaxel i.v. and reovirus i.v. (day 1–5 of first week inclusive). Reovirus was administered at a starting dose of 3x109 tissue culture infectious dose (TCID50) and then increased to 1 x 1010 and 3 x 1010 TCID50. Primary endpoints were to determine the maximum tolerated dose (MTD), dose limiting toxicity (DLT) and to recommend a dose and schedule for future investigation. Secondary endpoints were to evaluate pharmacokinetics, neutralizing antibody development, cell- mediated immune response and anti-tumour activity. Results: 17 patients were treated (15 males, median age 60 years). No MTD has been reached. DLT's observed were G4 neutropenia (and a recurrent perianal abcess) and G3 rise in AST. Other toxicities observed were fatigue, hypotension and neutropenic sepsis. At present, 5 patients remain on treatment. We have observed 2 partial responses (breast and gastric carcinoma) and 10 patients had stable disease as best response. Conclusions: Reovirus is well tolerated when administered in combination with intravenous docetaxel, with predictable toxicity observed. The recommended dose has been defined at 3x1010 TCID50 and phase II studies are planned. Objective radiological evidence of anticancer activity for this combination has been observed. [Table: see text]
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Affiliation(s)
- S. M. Rudman
- Guy's Hospital, London, United Kingdom; University of Surrey, Guildford, United Kingdom; Oncolytics Biotech Inc., Calgary, AB, Canada; Churchill Hospital, Oxford, United Kingdom; Institute of Cancer Research, London, United Kingdom
| | - C. Comins
- Guy's Hospital, London, United Kingdom; University of Surrey, Guildford, United Kingdom; Oncolytics Biotech Inc., Calgary, AB, Canada; Churchill Hospital, Oxford, United Kingdom; Institute of Cancer Research, London, United Kingdom
| | - D. Mukherji
- Guy's Hospital, London, United Kingdom; University of Surrey, Guildford, United Kingdom; Oncolytics Biotech Inc., Calgary, AB, Canada; Churchill Hospital, Oxford, United Kingdom; Institute of Cancer Research, London, United Kingdom
| | - M. Coffey
- Guy's Hospital, London, United Kingdom; University of Surrey, Guildford, United Kingdom; Oncolytics Biotech Inc., Calgary, AB, Canada; Churchill Hospital, Oxford, United Kingdom; Institute of Cancer Research, London, United Kingdom
| | - K. Mettinger
- Guy's Hospital, London, United Kingdom; University of Surrey, Guildford, United Kingdom; Oncolytics Biotech Inc., Calgary, AB, Canada; Churchill Hospital, Oxford, United Kingdom; Institute of Cancer Research, London, United Kingdom
| | - A. Protheroe
- Guy's Hospital, London, United Kingdom; University of Surrey, Guildford, United Kingdom; Oncolytics Biotech Inc., Calgary, AB, Canada; Churchill Hospital, Oxford, United Kingdom; Institute of Cancer Research, London, United Kingdom
| | - K. J. Harrington
- Guy's Hospital, London, United Kingdom; University of Surrey, Guildford, United Kingdom; Oncolytics Biotech Inc., Calgary, AB, Canada; Churchill Hospital, Oxford, United Kingdom; Institute of Cancer Research, London, United Kingdom
| | - H. Pandha
- Guy's Hospital, London, United Kingdom; University of Surrey, Guildford, United Kingdom; Oncolytics Biotech Inc., Calgary, AB, Canada; Churchill Hospital, Oxford, United Kingdom; Institute of Cancer Research, London, United Kingdom
| | - J. F. Spicer
- Guy's Hospital, London, United Kingdom; University of Surrey, Guildford, United Kingdom; Oncolytics Biotech Inc., Calgary, AB, Canada; Churchill Hospital, Oxford, United Kingdom; Institute of Cancer Research, London, United Kingdom
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Ritchie R, Leslie T, Phillips R, Protheroe A, Cranston D. 815 EXTRACORPOREAL HIGH INTENSITY FOCUSED ULTRASOUND FOR SMALL KIDNEY TUMOURS: 3 YEAR FOLLOW-UP. ACTA ACUST UNITED AC 2009. [DOI: 10.1016/s1569-9056(09)60803-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Pandha HS, Protheroe A, Wylie J, Parker C, Chambers J, Bell S, Munzert G. An open label phase II trial of BI 2536, a novel Plk1 inhibitor, in patients with metastatic hormone refractory prostate cancer (HRPC). J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.14547] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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19
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Jafri M, Protheroe A. An update on a case of regression of lung metastases after radiotherapy for bone metastasis in renal cell carcinoma. Clin Oncol (R Coll Radiol) 2008; 20:316. [PMID: 18329259 DOI: 10.1016/j.clon.2008.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2008] [Accepted: 01/29/2008] [Indexed: 10/22/2022]
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20
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Protheroe A, Reid A, Attard G, Davies A, Spicer J, Vidal L, Bone E, Hooftman L, Harris A, De-Bono J. First in-human phase 1 trial of a novel amino-peptidase inhibitor, CHR-2797. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.3537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
3537 Background: CHR-2797 is a novel, orally bioavailable agent which displays potent, tumor cell-selective, anti-proliferative properties. It is an inhibitor of Zn++-dependent aminopeptidases and generates signs of amino acid deprivation in sensitive cells, decreased protein synthesis and an increase in the level of the pro-apoptotic protein, Noxa. CHR-79888 is an active metabolite of CHR-2797. Patients and Methods: This study was conducted according to an accelerated titration design to define the MTD, DLT, toxicity profile and PK of CHR-2797 when administered orally for 28 days or longer. Patients (ECOG PS = 2) with histologically confirmed advanced solid tumors resistant or refractory to standard therapy were eligible. Results: 37 pts (median age 61.5 years [range 22.4–80.1]; 30M/7F; median ECOG PS 1; median prior regimens 2, range 0–6) enrolled in 12 cohorts (doses between 10 and 320mg). The first four patients received a 10 mg dose for 7, 14, 21 or 28 days respectively. Subsequent cohorts received 28 days continuous dosing, with dose doubling in single patient cohorts until drug-related toxicity = Grade 2. Thereafter the study followed a 3+3 design with = 40% dose increments. Common (gr 1–2) toxicity included fatigue (47%), diarrhea (47%), dizziness (24%), constipation, vomiting, abdominal pain (all 21%), and thrombocytopenia (18%). Toxicities show dose dependency for thrombocytopenia and fatigue. MTD was declared at 320 mg after 2 DLT’s were reported: 2 patients were unable to complete 28 days of daily dosing due to syncope/anemia, and dizziness/visual disturbances/thrombocytopenia, respectively. Patients recovered fully after cessation of the drug. The dose level below (240 mg) was expanded to 13 patients. Plasma PK was determined for both CHR-2797 and -79888, on days 1 and 28, which showed dose proportional increases in AUC and Cmax. Intracellular and intratumoral levels of both the parent and metabolite were also measured. So far 4 patients continued therapy for 7–9 months: one patient (RCC [130 mg]) achieved a PR, and 3 patients (ovarian ca [40 mg], NSCLC [130 mg], and breast ca [180 mg] had confirmed SD (> 3 months). Conclusion: Once daily oral CHR-2797 can be administered safely for 28 days in doses up to 240 mg and exhibits favorable PK. No significant financial relationships to disclose.
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Affiliation(s)
- A. Protheroe
- University of Oxford Cancer Research UK, Charndon Oxfordshire, United Kingdom; Royal Marsden Hospital, Sutton, United Kingdom; Chroma Therapeutics Ltd, Abingdon, United Kingdom; Churchill Hospital, Oxford, United Kingdom
| | - A. Reid
- University of Oxford Cancer Research UK, Charndon Oxfordshire, United Kingdom; Royal Marsden Hospital, Sutton, United Kingdom; Chroma Therapeutics Ltd, Abingdon, United Kingdom; Churchill Hospital, Oxford, United Kingdom
| | - G. Attard
- University of Oxford Cancer Research UK, Charndon Oxfordshire, United Kingdom; Royal Marsden Hospital, Sutton, United Kingdom; Chroma Therapeutics Ltd, Abingdon, United Kingdom; Churchill Hospital, Oxford, United Kingdom
| | - A. Davies
- University of Oxford Cancer Research UK, Charndon Oxfordshire, United Kingdom; Royal Marsden Hospital, Sutton, United Kingdom; Chroma Therapeutics Ltd, Abingdon, United Kingdom; Churchill Hospital, Oxford, United Kingdom
| | - J. Spicer
- University of Oxford Cancer Research UK, Charndon Oxfordshire, United Kingdom; Royal Marsden Hospital, Sutton, United Kingdom; Chroma Therapeutics Ltd, Abingdon, United Kingdom; Churchill Hospital, Oxford, United Kingdom
| | - L. Vidal
- University of Oxford Cancer Research UK, Charndon Oxfordshire, United Kingdom; Royal Marsden Hospital, Sutton, United Kingdom; Chroma Therapeutics Ltd, Abingdon, United Kingdom; Churchill Hospital, Oxford, United Kingdom
| | - E. Bone
- University of Oxford Cancer Research UK, Charndon Oxfordshire, United Kingdom; Royal Marsden Hospital, Sutton, United Kingdom; Chroma Therapeutics Ltd, Abingdon, United Kingdom; Churchill Hospital, Oxford, United Kingdom
| | - L. Hooftman
- University of Oxford Cancer Research UK, Charndon Oxfordshire, United Kingdom; Royal Marsden Hospital, Sutton, United Kingdom; Chroma Therapeutics Ltd, Abingdon, United Kingdom; Churchill Hospital, Oxford, United Kingdom
| | - A. Harris
- University of Oxford Cancer Research UK, Charndon Oxfordshire, United Kingdom; Royal Marsden Hospital, Sutton, United Kingdom; Chroma Therapeutics Ltd, Abingdon, United Kingdom; Churchill Hospital, Oxford, United Kingdom
| | - J. De-Bono
- University of Oxford Cancer Research UK, Charndon Oxfordshire, United Kingdom; Royal Marsden Hospital, Sutton, United Kingdom; Chroma Therapeutics Ltd, Abingdon, United Kingdom; Churchill Hospital, Oxford, United Kingdom
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Yuen JSP, Cockman ME, Sullivan M, Protheroe A, Turner GDH, Roberts IS, Pugh CW, Werner H, Macaulay VM. The VHL tumor suppressor inhibits expression of the IGF1R and its loss induces IGF1R upregulation in human clear cell renal carcinoma. Oncogene 2007; 26:6499-508. [PMID: 17486080 DOI: 10.1038/sj.onc.1210474] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Clear cell renal cell cancer (CC-RCC) is a highly chemoresistant tumor characterized by frequent inactivation of the von Hippel-Lindau (VHL) gene. The prognosis is reportedly worse in patients whose tumors express immunoreactive type I insulin-like growth factor receptor (IGF1R), a key mediator of tumor cell survival. We aimed to investigate how IGF1R expression is regulated, and found that IGF1R protein levels were unaffected by hypoxia, but were higher in CC-RCC cells harboring mutant inactive VHL than in isogenic cells expressing wild-type (WT) VHL. IGF1R mRNA and promoter activities were significantly lower in CC-RCC cells expressing WT VHL, consistent with a transcriptional effect. In Sp1-null Drosophila Schneider cells, IGF1R promoter activity was dependent on exogenous Sp1, and was suppressed by full-length VHL protein (pVHL) but only partially by truncated VHL lacking the Sp1-binding motif. pVHL also reduced the stability of IGF1R mRNA via sequestration of HuR protein. Finally, IGF1R mRNA levels were significantly higher in CC-RCC biopsies than benign kidney, confirming the clinical relevance of these findings. Thus, we have identified a new hypoxia-independent role for VHL in suppressing IGF1R transcription and mRNA stability. VHL inactivation leads to IGF1R upregulation, contributing to renal tumorigenesis and potentially also to chemoresistance.
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Affiliation(s)
- J S P Yuen
- Cancer Research UK Laboratories, Weatherall Institute of Molecular Medicine, University of Oxford, Headington, and Department of Urology, Churchill Hospital, Oxford, UK
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22
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Leslie T, Illing R, Kennedy J, Wu F, ter Haar G, Phillips R, Protheroe A, Cranston D. PD-08.02. Urology 2006. [DOI: 10.1016/j.urology.2006.08.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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23
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Reid A, Protheroe A, Attard G, Cowsill C, Spicer J, Vidal L, Bone E, Hooftman L, Harris A, De-Bono JS. A phase 1 dose finding study of CHR-2797, an inhibitor of M1 aminopeptidases, in patients with advanced solid tumours. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.3053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
3053 Background: CHR-2797 is a novel, orally bioavailable inhibitor of the M1 family of aminopeptidases, in particular PuSA, and LTA4 hydrolase. Exposure of cancer cells to CHR-2797 results in the generation of the active metabolite CHR-79888 which is poorly membrane-permeable, resulting in intracellular accumulation. CHR-2797 has shown anti-proliferative activity in syngeneic (rat) and xenograft (mouse) cancer models, and is anti-angiogenic in vitro. Methods: Patients (pts) (ECOG PS ≤ 2) with histologically confirmed advanced solid tumors resistant or refractory to standard therapy were eligible. The accelerated titration design of the trial involved two phases for evaluation of schedule and dose: 1) fixed dose with increasing duration, and 2) dose escalation over a fixed duration (28 days). Results: 16 pts (median age: 64.5 years [range 48.8–80.1], 13M/3F)were treated with once daily doses ranging from 10mg to 130mg. The first four patients received a 10mg dose for 7, 14, 21 or 28 days respectively. Five subsequent cohorts received 28 days continuous dosing, with dose doubling in single patient cohorts until drug-related toxicity ≥ Grade 2. Thereafter dose was escalated in ≤ 40% increments in 3-patient cohorts. The most frequent adverse events were: gr 1–2 thrombocytopenia (44%), gr 1 diarrhea (25%), gr 1–2 transaminitis (19%), gr 1–2 fatigue (13%), gr 1 hot flushes (13%), and gr 1 lightheadedness (13%). There were no DLTs. Five patients continued therapy after 28 days; stable disease has been achieved in 1 pt for 6 months with granulosa cell carcinoma of ovary, who was progressing prior to study entry. CHR-2797 and CHR-79888 demonstrate dose proportional increases in AUC and Cmax. The terminal half-life for CHR-2797 is around 1–2 hours, whereas it is between 9 and 11 hours for CHR-79888. Intracellular (packed blood cells) exposure to both CHR-2797 and CHR-79888 is good, with CHR-79888 accumulating over 28 days, such that by day 28 the intracellular levels are comparable to plasma. Conclusions: CHR-2797 is well tolerated and can be safely administered at doses that reach plasma concentrations associated with activity in pre-clinical models. Accrual into the study continues. No significant financial relationships to disclose.
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Affiliation(s)
- A. Reid
- Royal Marsden Hospital, Sutton, Surrey, United Kingdom; Churchill Hospital, Oxford, United Kingdom; Chroma Therapeutics Ltd., Abingdon, United Kingdom
| | - A. Protheroe
- Royal Marsden Hospital, Sutton, Surrey, United Kingdom; Churchill Hospital, Oxford, United Kingdom; Chroma Therapeutics Ltd., Abingdon, United Kingdom
| | - G. Attard
- Royal Marsden Hospital, Sutton, Surrey, United Kingdom; Churchill Hospital, Oxford, United Kingdom; Chroma Therapeutics Ltd., Abingdon, United Kingdom
| | - C. Cowsill
- Royal Marsden Hospital, Sutton, Surrey, United Kingdom; Churchill Hospital, Oxford, United Kingdom; Chroma Therapeutics Ltd., Abingdon, United Kingdom
| | - J. Spicer
- Royal Marsden Hospital, Sutton, Surrey, United Kingdom; Churchill Hospital, Oxford, United Kingdom; Chroma Therapeutics Ltd., Abingdon, United Kingdom
| | - L. Vidal
- Royal Marsden Hospital, Sutton, Surrey, United Kingdom; Churchill Hospital, Oxford, United Kingdom; Chroma Therapeutics Ltd., Abingdon, United Kingdom
| | - E. Bone
- Royal Marsden Hospital, Sutton, Surrey, United Kingdom; Churchill Hospital, Oxford, United Kingdom; Chroma Therapeutics Ltd., Abingdon, United Kingdom
| | - L. Hooftman
- Royal Marsden Hospital, Sutton, Surrey, United Kingdom; Churchill Hospital, Oxford, United Kingdom; Chroma Therapeutics Ltd., Abingdon, United Kingdom
| | - A. Harris
- Royal Marsden Hospital, Sutton, Surrey, United Kingdom; Churchill Hospital, Oxford, United Kingdom; Chroma Therapeutics Ltd., Abingdon, United Kingdom
| | - J. S. De-Bono
- Royal Marsden Hospital, Sutton, Surrey, United Kingdom; Churchill Hospital, Oxford, United Kingdom; Chroma Therapeutics Ltd., Abingdon, United Kingdom
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Abstract
Prostate cancer is the second most common cancer in men in the UK, and the incidence of prostate cancer has increased dramatically over the past two decades. Although most men are diagnosed at early stage, more than 50% develop locally advanced or metastatic disease. Androgen ablation with luteinising hormone-releasing hormone (LHRH) agonists alone, or in combination with anti-androgens, is the standard treatment for men with metastatic prostate cancer. Unfortunately, almost all men develop progressive disease after a variable time period, despite the maximal androgen blockade. The management of hormone refractory prostate cancer (HRPC) is challenging, as there is no uniformly accepted strategy. Various treatment options, including second-line hormone therapy, are discussed. Chemotherapy is being increasingly used and, importantly, docetaxel and estramustine may play an important role in the near future. The role of radiotherapy, strontium-89, bisphosphonates, novel agents and future therapies are also outlined.
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Affiliation(s)
- S R Muthuramalingam
- Cancer Research UK Oncology Unit, Churchill Hospital, Headington, Oxford, UK
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25
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Shamash J, Barlow C, Heath E, Wilson P, Ansell W, Somasundram U, Oliver R, Protheroe A. Interaction between glucocorticoids and estrogens in androgen independent prostate cancer - a randomised phase 2 study. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.4755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- J. Shamash
- St Bartholomew's Hospital, London, United Kingdom; Churchill Hospital, Oxford, United Kingdom
| | - C. Barlow
- St Bartholomew's Hospital, London, United Kingdom; Churchill Hospital, Oxford, United Kingdom
| | - E. Heath
- St Bartholomew's Hospital, London, United Kingdom; Churchill Hospital, Oxford, United Kingdom
| | - P. Wilson
- St Bartholomew's Hospital, London, United Kingdom; Churchill Hospital, Oxford, United Kingdom
| | - W. Ansell
- St Bartholomew's Hospital, London, United Kingdom; Churchill Hospital, Oxford, United Kingdom
| | - U. Somasundram
- St Bartholomew's Hospital, London, United Kingdom; Churchill Hospital, Oxford, United Kingdom
| | - R. Oliver
- St Bartholomew's Hospital, London, United Kingdom; Churchill Hospital, Oxford, United Kingdom
| | - A. Protheroe
- St Bartholomew's Hospital, London, United Kingdom; Churchill Hospital, Oxford, United Kingdom
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26
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Madhusudan S, Protheroe A, Vasey P, Patel P, Selby P, Altman D, Christodoulos K, Harris AL. A randomised phase II study of interferon alpha alone or in combination with thalidomide in metastatic renal cancer. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.4742] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- S. Madhusudan
- CRUK Dept of Medical Oncology, Churchill Hospital, oxford, United Kingdom; Beatson Oncology Centre, Western Infirmary, Glasgow, United Kingdom; CRUK Clinical Cancer Centre, St. James Univ. Hosp, Leeds, United Kingdom; Centre for Statistics Medicine, Churchill Hospital, Oxford, United Kingdom
| | - A. Protheroe
- CRUK Dept of Medical Oncology, Churchill Hospital, oxford, United Kingdom; Beatson Oncology Centre, Western Infirmary, Glasgow, United Kingdom; CRUK Clinical Cancer Centre, St. James Univ. Hosp, Leeds, United Kingdom; Centre for Statistics Medicine, Churchill Hospital, Oxford, United Kingdom
| | - P. Vasey
- CRUK Dept of Medical Oncology, Churchill Hospital, oxford, United Kingdom; Beatson Oncology Centre, Western Infirmary, Glasgow, United Kingdom; CRUK Clinical Cancer Centre, St. James Univ. Hosp, Leeds, United Kingdom; Centre for Statistics Medicine, Churchill Hospital, Oxford, United Kingdom
| | - P. Patel
- CRUK Dept of Medical Oncology, Churchill Hospital, oxford, United Kingdom; Beatson Oncology Centre, Western Infirmary, Glasgow, United Kingdom; CRUK Clinical Cancer Centre, St. James Univ. Hosp, Leeds, United Kingdom; Centre for Statistics Medicine, Churchill Hospital, Oxford, United Kingdom
| | - P. Selby
- CRUK Dept of Medical Oncology, Churchill Hospital, oxford, United Kingdom; Beatson Oncology Centre, Western Infirmary, Glasgow, United Kingdom; CRUK Clinical Cancer Centre, St. James Univ. Hosp, Leeds, United Kingdom; Centre for Statistics Medicine, Churchill Hospital, Oxford, United Kingdom
| | - D. Altman
- CRUK Dept of Medical Oncology, Churchill Hospital, oxford, United Kingdom; Beatson Oncology Centre, Western Infirmary, Glasgow, United Kingdom; CRUK Clinical Cancer Centre, St. James Univ. Hosp, Leeds, United Kingdom; Centre for Statistics Medicine, Churchill Hospital, Oxford, United Kingdom
| | - K. Christodoulos
- CRUK Dept of Medical Oncology, Churchill Hospital, oxford, United Kingdom; Beatson Oncology Centre, Western Infirmary, Glasgow, United Kingdom; CRUK Clinical Cancer Centre, St. James Univ. Hosp, Leeds, United Kingdom; Centre for Statistics Medicine, Churchill Hospital, Oxford, United Kingdom
| | - A. L. Harris
- CRUK Dept of Medical Oncology, Churchill Hospital, oxford, United Kingdom; Beatson Oncology Centre, Western Infirmary, Glasgow, United Kingdom; CRUK Clinical Cancer Centre, St. James Univ. Hosp, Leeds, United Kingdom; Centre for Statistics Medicine, Churchill Hospital, Oxford, United Kingdom
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27
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Madhusudan S, Protheroe A, Propper D, Han C, Corrie P, Earl H, Hancock B, Vasey P, Turner A, Balkwill F, Hoare S, Harris AL. A multicentre phase II trial of bryostatin-1 in patients with advanced renal cancer. Br J Cancer 2003; 89:1418-22. [PMID: 14562010 PMCID: PMC2394342 DOI: 10.1038/sj.bjc.6601321] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Protein kinase C (PKC) has a critical role in several signal transduction pathways, and is involved in renal cancer pathogenesis. Bryostatin-1 modulates PKC activity and has antitumour effects in preclinical studies. We conducted a multicentre phase II clinical trial in patients with advanced renal cancer to determine the response rate, immunomodulatory activity and toxicity of bryostatin-1 given as a continuous 24 h infusion weekly for 3 out of 4 weeks at a dose of 25 μg m−2. In all, 16 patients were recruited (11 males and five females). The median age was 59 years (range 44–68). Patients had been treated previously with nephrectomy (8) and/or interferon therapy (9) and/or hormone therapy (4) and/or radiotherapy (6). Eight, five and three patients had performance statuses of 0, 1 and 2, respectively. A total of 181 infusions were administered with a median of 12 infusions per patient (range 1–29). Disease response was evaluable in 13 patients. Three patients achieved stable disease lasting for 10.5, 8 and 5.5 months, respectively. No complete responses or partial responses were seen. Myalgia, fatigue, nausea, headache, vomiting, anorexia, anaemia and lymphopenia were the commonly reported side effects. Assessment of biological activity of bryostatin-1 was carried out using the whole–blood cytokine release assay in six patients, two of whom had a rise in IL-6 levels 24 h after initiating bryostatin-1 therapy compared to pretreatment values. However, the IL-6 level was found to be significantly lower at day 28 compared to the pretreatment level in all six patients analysed.
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Affiliation(s)
- S Madhusudan
- Cancer Research UK Medical Oncology Unit, Churchill Hospital, Oxford, UK
| | - A Protheroe
- Cancer Research UK Medical Oncology Unit, Churchill Hospital, Oxford, UK
| | - D Propper
- Cancer Research UK Medical Oncology Unit, Churchill Hospital, Oxford, UK
| | - C Han
- Cancer Research UK Medical Oncology Unit, Churchill Hospital, Oxford, UK
| | - P Corrie
- Department of Oncology, Addenbrooke's Hospital, Cambridge UK
| | - H Earl
- Department of Oncology, Addenbrooke's Hospital, Cambridge UK
| | - B Hancock
- Department of Clinical Oncology, Weston Park Hospital, Sheffield, UK
| | - P Vasey
- Beatson Oncology Centre, Western Infirmary, Glasgow, UK
| | - A Turner
- Drug Development Office, Cancer Research UK, 61 Lincoln's Inn Fields, London, UK
| | - F Balkwill
- Cancer Research UK Translational Oncology Laboratory, Barts & The London, Queen Mary's Medical School, Charterhouse Square, London UK
| | - S Hoare
- Cancer Research UK Translational Oncology Laboratory, Barts & The London, Queen Mary's Medical School, Charterhouse Square, London UK
| | - A L Harris
- Cancer Research UK Medical Oncology Unit, Churchill Hospital, Oxford, UK
- Cancer Research UK Medical Oncology Unit, University of Oxford, Churchill Hospital, Oxford OX3 7LJ, UK. E-mail:
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28
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Protheroe A. Renal and Adrenal Tumours. Br J Cancer 2003. [PMCID: PMC2394361 DOI: 10.1038/sj.bjc.6701274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Protheroe A, Edwards JC, Simmons A, Maclennan K, Selby P. Remission of inflammatory arthropathy in association with anti-CD20 therapy for non-Hodgkin's lymphoma. Rheumatology (Oxford) 1999; 38:1150-2. [PMID: 10556272 DOI: 10.1093/rheumatology/38.11.1150] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We describe a case involving a 53-yr-old male with a marginal zone B-cell lymphoma, associated with an IgM paraprotein and a rheumatoid factor-negative inflammatory polyarthropathy, treated with monoclonal anti-CD20 antibody. During the subsequent 12 weeks, evidence of synovitis reduced to a negligible level, despite no significant change in lymphoma bulk or paraprotein level. The relationship between the lymphoma and the arthropathy, and the likely mechanism of remission of the arthropathy, are discussed in the context of the potential value of anti-CD20 therapy in rheumatoid arthritis.
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Affiliation(s)
- A Protheroe
- ICRF Cancer Medicine Research Unit, St James' University Hospital, Leeds, UK
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Affiliation(s)
- C G Eden
- Department of Urology, King's College Hospital, London, UK
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31
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Abstract
Four of five patients with AIDS and pulmonary infection had syncopal reactions as a result of fine-needle aspiration of the lung; in one patient the reaction was fatal. Subsequently, in one of these patients and four further patients with AIDS or human immunodeficiency virus (HIV) infection, the autonomic nervous system proved to be abnormal. This preliminary evidence suggests HIV infection may be associated with an autonomic neuropathy, which may expose these patients to particular risk after invasive procedures.
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32
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Protheroe A. Television medicine. West J Med 1978. [DOI: 10.1136/bmj.1.6117.918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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