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Kissling E, Maurel M, Emborg HD, Whitaker H, McMenamin J, Howard J, Trebbien R, Watson C, Findlay B, Pozo F, Bolt Botnen A, Harvey C, Rose A. Interim 2022/23 influenza vaccine effectiveness: six European studies, October 2022 to January 2023. Euro Surveill 2023; 28:2300116. [PMID: 37227299 PMCID: PMC10283457 DOI: 10.2807/1560-7917.es.2023.28.21.2300116] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 03/21/2023] [Indexed: 05/26/2023] Open
Abstract
BackgroundBetween October 2022 and January 2023, influenza A(H1N1)pdm09, A(H3N2) and B/Victoria viruses circulated in Europe with different influenza (sub)types dominating in different areas.AimTo provide interim 2022/23 influenza vaccine effectiveness (VE) estimates from six European studies, covering 16 countries in primary care, emergency care and hospital inpatient settings.MethodsAll studies used the test-negative design, but with differences in other study characteristics, such as data sources, patient selection, case definitions and included age groups. Overall and influenza (sub)type-specific VE was estimated for each study using logistic regression adjusted for potential confounders.ResultsThere were 20,477 influenza cases recruited across the six studies, of which 16,589 (81%) were influenza A. Among all ages and settings, VE against influenza A ranged from 27 to 44%. Against A(H1N1)pdm09 (all ages and settings), VE point estimates ranged from 28% to 46%, higher among children (< 18 years) at 49-77%. Against A(H3N2), overall VE ranged from 2% to 44%, also higher among children (62-70%). Against influenza B/Victoria, overall and age-specific VE were ≥ 50% (87-95% among children < 18 years).ConclusionsInterim results from six European studies during the 2022/23 influenza season indicate a ≥ 27% and ≥ 50% reduction in disease occurrence among all-age influenza vaccine recipients for influenza A and B, respectively, with higher reductions among children. Genetic virus characterisation results and end-of-season VE estimates will contribute to greater understanding of differences in influenza (sub)type-specific results across studies.
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Affiliation(s)
| | | | - Hanne-Dorthe Emborg
- Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark
| | | | | | | | - Ramona Trebbien
- Department of Virus and Microbiological Special diagnostics, National Influenza Center, Statens Serum Institut, Copenhagen, Denmark
| | | | | | - Francisco Pozo
- National Centre for Microbiology, National Influenza Reference Laboratory, WHO-National Influenza Centre, Institute of Health Carlos III, Madrid, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Institute of Health Carlos III, Madrid, Spain
| | - Amanda Bolt Botnen
- Department of Virus and Microbiological Special diagnostics, National Influenza Center, Statens Serum Institut, Copenhagen, Denmark
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Leslie K, Findlay B, Ryan T, Green LI, Harvey C, Whettlock AE, Bishop J, Ponce Hardy V, Went A, Wallace L, McLeod A, Weir A, Marsh K. Epidemiology of SARS-CoV-2 during the first three waves in Scotland: a national record linkage study. J Epidemiol Community Health 2022; 77:jech-2022-219367. [PMID: 36347597 PMCID: PMC9763220 DOI: 10.1136/jech-2022-219367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 10/14/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND The early COVID-19 pandemic in Scotland-defined as the era before widespread access to vaccination and monoclonal antibody treatment-can be characterised into three distinct waves: March-July 2020, July 2020-April 2021 and May-August 2021. Each wave was met with various societal restrictions in an effort to reduce disease transmission and associated morbidity and mortality. Understanding the epidemiology of infections during these waves can provide valuable insights into future pandemic planning. METHODS Scottish RT-PCR testing data reported up until 8 August 2021, the day prior to most restrictions being lifted in Scotland, were included. Demographic characteristics including age, sex and social deprivation associated with transmission, morbidity and mortality were compared across waves. A case-control analysis for each wave was then modelled to further compare risk factors associated with death over time. RESULTS Of the 349 904 reported cases, there were 18 099, 197 251 and 134 554 in waves 1, 2 and 3, respectively. Hospitalisations, intensive care unit admissions and deaths appeared highest in wave 2, though risk factors associated with COVID-19 death remained similar across the waves. Higher deprivation and certain comorbidities were associated with higher deaths in all waves. CONCLUSIONS Despite the higher number of cases reported in waves 2 and 3, case fatality rates were lower: likely a combination of improved detection of infections in younger age groups, introduction of social measures and vaccination. Higher social deprivation and comorbidities resulted in higher deaths for all waves.
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Affiliation(s)
- Kirstin Leslie
- Clinical and Protecting Health, Public Health Scotland Glasgow Office, Glasgow, UK
| | - Beth Findlay
- Clinical and Protecting Health, Public Health Scotland Glasgow Office, Glasgow, UK
| | - Theresa Ryan
- Data Driven Innovation, Public Health Scotland Glasgow Office, Glasgow, UK
| | - Leonardo I Green
- Clinical and Protecting Health, Public Health Scotland Glasgow Office, Glasgow, UK
| | - Ciaran Harvey
- Data Driven Innovation, Public Health Scotland Glasgow Office, Glasgow, UK
| | - Alice E Whettlock
- Clinical and Protecting Health, Public Health Scotland Glasgow Office, Glasgow, UK
| | - Jen Bishop
- Data Driven Innovation, Public Health Scotland Glasgow Office, Glasgow, UK
| | | | - April Went
- Data Driven Innovation, Public Health Scotland Glasgow Office, Glasgow, UK
| | - Lesley Wallace
- Clinical and Protecting Health, Public Health Scotland Glasgow Office, Glasgow, UK
| | - Allan McLeod
- Clinical and Protecting Health, Public Health Scotland Glasgow Office, Glasgow, UK
| | - Amanda Weir
- Clinical and Protecting Health, Public Health Scotland Glasgow Office, Glasgow, UK
| | - Kimberly Marsh
- Clinical and Protecting Health, Public Health Scotland Glasgow Office, Glasgow, UK
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Findlay B, Britton C, Glasgow A, Gettman M, Tyson M, Pak R, Viers B, Habermann E, Ziegelmann M. 008 Long-term Success with Diminished Opioid Prescribing After Men's Health Urologic Procedures Using Standardized Postoperative Opioid Prescribing Guidelines: An Interrupted Time-Series Analysis. J Sex Med 2021. [DOI: 10.1016/j.jsxm.2021.01.078] [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: 11/16/2022]
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Britton C, Findlay B, Parekh N, Patel P, Eleswaarapu S, Helo S, Ziegelmann M. 082 Evaluation of Postoperative Outcomes in Chronic Scrotal Content Pain: Early Results from a Prospective Multicenter Series. J Sex Med 2021. [DOI: 10.1016/j.jsxm.2021.01.052] [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: 10/21/2022]
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Berens ME, Kim S, Kiefer J, Dhruv H, Vuori K, Findlay B, Hauser C, Oshima R, Alza-Blanc P, Emig D. CONTEXT OF VULNERABILITY OF GBM: DESCRIPTIVE GENOMICS LEADING TO EMPIRIC THERAPEUTICS. Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou208.44] [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: 11/14/2022] Open
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Cigler T, Tu D, Yaffe MJ, Findlay B, Verma S, Johnston D, Richardson H, Hu H, Qi S, Goss PE. A randomized, placebo-controlled trial (NCIC CTG MAP1) examining the effects of letrozole on mammographic breast density and other end organs in postmenopausal women. Breast Cancer Res Treat 2009; 120:427-35. [DOI: 10.1007/s10549-009-0662-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2009] [Accepted: 11/21/2009] [Indexed: 02/03/2023]
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Sammour T, Benson S, Neuhaus SJ, Findlay B, Hill AG. GS25P�BURNOUT IN AUSTRALASIAN YOUNGER FELLOWS. ANZ J Surg 2009. [DOI: 10.1111/j.1445-2197.2009.04917_25.x] [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: 11/28/2022]
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Findlay B, Tonkin K, Crump M, Norris B, Trudeau M, Blackstein M, Burnell M, Skillings J, Bowman D, Walde D, Levine M, Pritchard KI, Palmer MJ, Tu D, Shepherd L. A dose escalation trial of adjuvant cyclophosphamide and epirubicin in combination with 5-fluorouracil using G-CSF support for premenopausal women with breast cancer involving four or more positive nodes. Ann Oncol 2007; 18:1646-51. [PMID: 17716984 DOI: 10.1093/annonc/mdm277] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [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
BACKGROUND Dose-dense and dose-intensive regimens have improved the outcome of breast cancer in high-risk women with operable disease. PATIENTS AND METHODS Sixty-three premenopausal women with Stage 2, 3 breast cancer and > or =4 positive axillary nodes were treated in three successive cohorts with 70 mg/m(2) of epirubicin, 500 mg/m(2) of 5-fluorouracil and G-CSF every 14 days for 12 cycles. Cyclophosphamide (C) was given at 700 mg/m(2), 900 mg/m(2), and 1100 mg/m(2) doses. Patients were evaluated for dose-limiting toxicities (DLTs) in the first four cycles, the primary endpoint of the trial. RESULTS No DLTs were seen at C 700 mg/m(2); at C 900 mg/m(2) two of 16 patients experienced febrile neutropenia and poor performance status; at C 1100 mg/m(2), 1 of 31 patients experienced poor performance status. Over 6 months, febrile neutropenia, grade 4 thrombocytopenia, grade 3 anemia and severe fatigue were observed. Clinical congestive heart failure occurred in three patients over 4 years. CONCLUSION A dose-intense and dose-dense regimen of cyclophosphamide, epirubicin and 5-fluorouracil was delivered with G-CSF without apparent increase in acute toxicity. Cyclophosphamide could be increased to more than twice the standard dose at the cost of more anemia and fatigue.
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Affiliation(s)
- B Findlay
- Hotel Dieu Hospital, St Catharines, Ontario, Canada.
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Arnold AM, Smylie M, Ding K, Ung Y, Findlay B, Lee CW, Djurfeldt M, Seymour L, Langmuir P, Shepherd F. Randomized phase II study of maintenance vandetanib (ZD6474) in small cell lung cancer (SCLC) patients who have a complete or partial response to induction therapy: NCIC CTG BR.20. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.7522] [Citation(s) in RCA: 2] [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
7522 Background: Vandetanib (V) is an inhibitor of vascular endothelial and epidermal growth factor receptors. This trial sought to determine whether maintenance V, given after standard chemotherapy (CT) and radiation (RT), prolonged progression-free survival (PFS) in responding patients with SCLC. Secondary endpoints: overall survival (OS) and toxicity. Methods: Phase II randomized, study of V 300 mg PO daily or placebo (P). Eligibility: complete (CR) or partial response (PR) to platinum-based CT, ECOG PS 0–2 and completion of RT (thoracic or prophylactic cranial). Statistics: 80% power to detect a 2.5 months improvement in median PFS (estimate for P of 4 months) using a 1-sided 10% level test (100 eligible patients; 77 events). Results: Between May 2003 and March 2006, 107 patients were accrued from 17 centres. Median follow up: 13.5 months. 46 had limited disease (LD); 61 extensive disease (ED). There were fewer PS 0 patients (11 vs. 20), and fewer had CR to initial CT (4 vs. 8) in the V arm. V patients were more likely to experience toxicity and require dose modification. The most frequent toxicities leading to dose modifications were gastrointestinal and rash. Clinically asymptomatic QTc prolongation was observed in 8 V patients. 83 of 107 patients developed progressive disease (43 on V; 40 on P). The median PFS for V was 2.7 months (80% C.I.: 1.1 –4.5) and 2.8 months for P (80% C.I.: 1.9 –5.6); estimated hazard ratio (HR) was 1.01 for V vs P (80% C.I.: 0.75 –1.36, 1-sided P-value = 0.51). Median OS for V was 10.6 months vs. 11.9 months for P; HR was 1.43 for V vs. P (80% C.I.: 1.00 –2.05, 1-sided P-value = 0.90). In a planned subgroup analysis, a significant interaction was noted (P-value = 0.01); with LD patients randomized to V having a longer OS (HR: 0.45, 1-sided P-value = 0.07), whereas ED patients randomized to V had a shorter OS compared to P (HR: 2.27, 1-sided P-value = 0.996). Conclusion: V failed to demonstrate efficacy as maintenance therapy for SCLC. Future targeted therapies should probably be explored concurrently with chemotherapy. This study was supported by the Canadian Cancer Society and AstraZeneca. [Table: see text]
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Affiliation(s)
- A. M. Arnold
- Juravinski Cancer Centre, Hamilton, ON, Canada; Cross Cancer Institute, Edmonton, AB, Canada; NCIC CTG, Kingston, ON, Canada; Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Oncology Clinic Niagara Health System, St Catherines, ON, Canada; BC Cancer Agency, Surrey, BC, Canada; AstraZeneca, Wilmington, DE; Princess Margaret Hospital, Toronto, ON, Canada
| | - M. Smylie
- Juravinski Cancer Centre, Hamilton, ON, Canada; Cross Cancer Institute, Edmonton, AB, Canada; NCIC CTG, Kingston, ON, Canada; Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Oncology Clinic Niagara Health System, St Catherines, ON, Canada; BC Cancer Agency, Surrey, BC, Canada; AstraZeneca, Wilmington, DE; Princess Margaret Hospital, Toronto, ON, Canada
| | - K. Ding
- Juravinski Cancer Centre, Hamilton, ON, Canada; Cross Cancer Institute, Edmonton, AB, Canada; NCIC CTG, Kingston, ON, Canada; Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Oncology Clinic Niagara Health System, St Catherines, ON, Canada; BC Cancer Agency, Surrey, BC, Canada; AstraZeneca, Wilmington, DE; Princess Margaret Hospital, Toronto, ON, Canada
| | - Y. Ung
- Juravinski Cancer Centre, Hamilton, ON, Canada; Cross Cancer Institute, Edmonton, AB, Canada; NCIC CTG, Kingston, ON, Canada; Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Oncology Clinic Niagara Health System, St Catherines, ON, Canada; BC Cancer Agency, Surrey, BC, Canada; AstraZeneca, Wilmington, DE; Princess Margaret Hospital, Toronto, ON, Canada
| | - B. Findlay
- Juravinski Cancer Centre, Hamilton, ON, Canada; Cross Cancer Institute, Edmonton, AB, Canada; NCIC CTG, Kingston, ON, Canada; Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Oncology Clinic Niagara Health System, St Catherines, ON, Canada; BC Cancer Agency, Surrey, BC, Canada; AstraZeneca, Wilmington, DE; Princess Margaret Hospital, Toronto, ON, Canada
| | - C. W. Lee
- Juravinski Cancer Centre, Hamilton, ON, Canada; Cross Cancer Institute, Edmonton, AB, Canada; NCIC CTG, Kingston, ON, Canada; Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Oncology Clinic Niagara Health System, St Catherines, ON, Canada; BC Cancer Agency, Surrey, BC, Canada; AstraZeneca, Wilmington, DE; Princess Margaret Hospital, Toronto, ON, Canada
| | - M. Djurfeldt
- Juravinski Cancer Centre, Hamilton, ON, Canada; Cross Cancer Institute, Edmonton, AB, Canada; NCIC CTG, Kingston, ON, Canada; Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Oncology Clinic Niagara Health System, St Catherines, ON, Canada; BC Cancer Agency, Surrey, BC, Canada; AstraZeneca, Wilmington, DE; Princess Margaret Hospital, Toronto, ON, Canada
| | - L. Seymour
- Juravinski Cancer Centre, Hamilton, ON, Canada; Cross Cancer Institute, Edmonton, AB, Canada; NCIC CTG, Kingston, ON, Canada; Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Oncology Clinic Niagara Health System, St Catherines, ON, Canada; BC Cancer Agency, Surrey, BC, Canada; AstraZeneca, Wilmington, DE; Princess Margaret Hospital, Toronto, ON, Canada
| | - P. Langmuir
- Juravinski Cancer Centre, Hamilton, ON, Canada; Cross Cancer Institute, Edmonton, AB, Canada; NCIC CTG, Kingston, ON, Canada; Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Oncology Clinic Niagara Health System, St Catherines, ON, Canada; BC Cancer Agency, Surrey, BC, Canada; AstraZeneca, Wilmington, DE; Princess Margaret Hospital, Toronto, ON, Canada
| | - F. Shepherd
- Juravinski Cancer Centre, Hamilton, ON, Canada; Cross Cancer Institute, Edmonton, AB, Canada; NCIC CTG, Kingston, ON, Canada; Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Oncology Clinic Niagara Health System, St Catherines, ON, Canada; BC Cancer Agency, Surrey, BC, Canada; AstraZeneca, Wilmington, DE; Princess Margaret Hospital, Toronto, ON, Canada
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Benson S, Truskett PG, Findlay B. SE12 THE RELATIONSHIP BETWEEN BURNOUT AND EMOTIONAL INTELLIGENCE IN AUSTRALIAN SURGEONS AND SURGICAL TRAINEES. ANZ J Surg 2007. [DOI: 10.1111/j.1445-2197.2007.04129_12.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [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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Fuchs C, Pollak M, Sargent DJ, Meyerhardt JA, Ramanathan RK, Williamson S, Findlay B, Green E, Goldberg RM. Insulin-like growth factor-I (IGF-1), IGF binding protein-3 (IGFBP-3), and outcome in metastatic colorectal cancer (CRC): Results from Intergroup Trial N9741. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.3521] [Citation(s) in RCA: 1] [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)
- C. Fuchs
- Dana-Farber Cancer Institute, Boston, MA; McGill University, Montreal, PQ, Canada; NCCTG, Rochester, MN; ECOG, Pittsburgh, PA; SWOG, Kansas City, KS; NCIC, St. Catherines, ON, Canada
| | - M. Pollak
- Dana-Farber Cancer Institute, Boston, MA; McGill University, Montreal, PQ, Canada; NCCTG, Rochester, MN; ECOG, Pittsburgh, PA; SWOG, Kansas City, KS; NCIC, St. Catherines, ON, Canada
| | - D. J. Sargent
- Dana-Farber Cancer Institute, Boston, MA; McGill University, Montreal, PQ, Canada; NCCTG, Rochester, MN; ECOG, Pittsburgh, PA; SWOG, Kansas City, KS; NCIC, St. Catherines, ON, Canada
| | - J. A. Meyerhardt
- Dana-Farber Cancer Institute, Boston, MA; McGill University, Montreal, PQ, Canada; NCCTG, Rochester, MN; ECOG, Pittsburgh, PA; SWOG, Kansas City, KS; NCIC, St. Catherines, ON, Canada
| | - R. K. Ramanathan
- Dana-Farber Cancer Institute, Boston, MA; McGill University, Montreal, PQ, Canada; NCCTG, Rochester, MN; ECOG, Pittsburgh, PA; SWOG, Kansas City, KS; NCIC, St. Catherines, ON, Canada
| | - S. Williamson
- Dana-Farber Cancer Institute, Boston, MA; McGill University, Montreal, PQ, Canada; NCCTG, Rochester, MN; ECOG, Pittsburgh, PA; SWOG, Kansas City, KS; NCIC, St. Catherines, ON, Canada
| | - B. Findlay
- Dana-Farber Cancer Institute, Boston, MA; McGill University, Montreal, PQ, Canada; NCCTG, Rochester, MN; ECOG, Pittsburgh, PA; SWOG, Kansas City, KS; NCIC, St. Catherines, ON, Canada
| | - E. Green
- Dana-Farber Cancer Institute, Boston, MA; McGill University, Montreal, PQ, Canada; NCCTG, Rochester, MN; ECOG, Pittsburgh, PA; SWOG, Kansas City, KS; NCIC, St. Catherines, ON, Canada
| | - R. M. Goldberg
- Dana-Farber Cancer Institute, Boston, MA; McGill University, Montreal, PQ, Canada; NCCTG, Rochester, MN; ECOG, Pittsburgh, PA; SWOG, Kansas City, KS; NCIC, St. Catherines, ON, Canada
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Sloan JA, McLeod H, Sargent D, Zhao X, Fuchs C, Ramanathan R, Williamson S, Findlay B, Morton R, Goldberg RM. Preliminary evidence of relationship between genetic markers and oncology patient quality of life (QOL). J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [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. A. Sloan
- Mayo Clinic, Rochester, MN; Washington University School of Medicine, St. Louis, MO; Dana-Farber Cancer Institute, Boston, MA; University of Pittsburgh Cancer Institute, Pittsburgh, PA; University of Kansas Medical Center, Kansas City, KS; National Cancer Institute of Canada, St. Catherines, ON, Canada; Iowa Oncology Research Associate CCOP, Des Moines, IA; University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - H. McLeod
- Mayo Clinic, Rochester, MN; Washington University School of Medicine, St. Louis, MO; Dana-Farber Cancer Institute, Boston, MA; University of Pittsburgh Cancer Institute, Pittsburgh, PA; University of Kansas Medical Center, Kansas City, KS; National Cancer Institute of Canada, St. Catherines, ON, Canada; Iowa Oncology Research Associate CCOP, Des Moines, IA; University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - D. Sargent
- Mayo Clinic, Rochester, MN; Washington University School of Medicine, St. Louis, MO; Dana-Farber Cancer Institute, Boston, MA; University of Pittsburgh Cancer Institute, Pittsburgh, PA; University of Kansas Medical Center, Kansas City, KS; National Cancer Institute of Canada, St. Catherines, ON, Canada; Iowa Oncology Research Associate CCOP, Des Moines, IA; University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - X. Zhao
- Mayo Clinic, Rochester, MN; Washington University School of Medicine, St. Louis, MO; Dana-Farber Cancer Institute, Boston, MA; University of Pittsburgh Cancer Institute, Pittsburgh, PA; University of Kansas Medical Center, Kansas City, KS; National Cancer Institute of Canada, St. Catherines, ON, Canada; Iowa Oncology Research Associate CCOP, Des Moines, IA; University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - C. Fuchs
- Mayo Clinic, Rochester, MN; Washington University School of Medicine, St. Louis, MO; Dana-Farber Cancer Institute, Boston, MA; University of Pittsburgh Cancer Institute, Pittsburgh, PA; University of Kansas Medical Center, Kansas City, KS; National Cancer Institute of Canada, St. Catherines, ON, Canada; Iowa Oncology Research Associate CCOP, Des Moines, IA; University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - R. Ramanathan
- Mayo Clinic, Rochester, MN; Washington University School of Medicine, St. Louis, MO; Dana-Farber Cancer Institute, Boston, MA; University of Pittsburgh Cancer Institute, Pittsburgh, PA; University of Kansas Medical Center, Kansas City, KS; National Cancer Institute of Canada, St. Catherines, ON, Canada; Iowa Oncology Research Associate CCOP, Des Moines, IA; University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - S. Williamson
- Mayo Clinic, Rochester, MN; Washington University School of Medicine, St. Louis, MO; Dana-Farber Cancer Institute, Boston, MA; University of Pittsburgh Cancer Institute, Pittsburgh, PA; University of Kansas Medical Center, Kansas City, KS; National Cancer Institute of Canada, St. Catherines, ON, Canada; Iowa Oncology Research Associate CCOP, Des Moines, IA; University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - B. Findlay
- Mayo Clinic, Rochester, MN; Washington University School of Medicine, St. Louis, MO; Dana-Farber Cancer Institute, Boston, MA; University of Pittsburgh Cancer Institute, Pittsburgh, PA; University of Kansas Medical Center, Kansas City, KS; National Cancer Institute of Canada, St. Catherines, ON, Canada; Iowa Oncology Research Associate CCOP, Des Moines, IA; University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - R. Morton
- Mayo Clinic, Rochester, MN; Washington University School of Medicine, St. Louis, MO; Dana-Farber Cancer Institute, Boston, MA; University of Pittsburgh Cancer Institute, Pittsburgh, PA; University of Kansas Medical Center, Kansas City, KS; National Cancer Institute of Canada, St. Catherines, ON, Canada; Iowa Oncology Research Associate CCOP, Des Moines, IA; University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - R. M. Goldberg
- Mayo Clinic, Rochester, MN; Washington University School of Medicine, St. Louis, MO; Dana-Farber Cancer Institute, Boston, MA; University of Pittsburgh Cancer Institute, Pittsburgh, PA; University of Kansas Medical Center, Kansas City, KS; National Cancer Institute of Canada, St. Catherines, ON, Canada; Iowa Oncology Research Associate CCOP, Des Moines, IA; University of North Carolina at Chapel Hill, Chapel Hill, NC
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Coates J, Findlay B. The Cull report: requiring health providers to report complaints. N Z Med J 2001; 114:363. [PMID: 11587308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
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Coates J, Findlay B, Hill J. Obtaining consent for epidural analgesia for women in labour. N Z Med J 2001; 114:72-3. [PMID: 11280431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Affiliation(s)
- J Coates
- Department of Anaesthesia, National Women's Hospital, Auckland.
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Norris B, Pritchard KI, James K, Myles J, Bennett K, Marlin S, Skillings J, Findlay B, Vandenberg T, Goss P, Latreille J, Rudinskas L, Lofters W, Trudeau M, Osoba D, Rodgers A. Phase III comparative study of vinorelbine combined with doxorubicin versus doxorubicin alone in disseminated metastatic/recurrent breast cancer: National Cancer Institute of Canada Clinical Trials Group Study MA8. J Clin Oncol 2000; 18:2385-94. [PMID: 10856098 DOI: 10.1200/jco.2000.18.12.2385] [Citation(s) in RCA: 106] [Impact Index Per Article: 4.4] [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: 11/20/2022] Open
Abstract
PURPOSE This phase III study was performed to determine the superiority of doxorubicin (DOX) and vinorelbine (VNB) (arm 1) versus DOX alone (arm 2) in metastatic breast cancer (MBC) for overall survival (OS), time to treatment failure (TTF), toxicity, and quality of life (QOL). PATIENTS AND METHODS Three hundred three patients were randomized to DOX 50 mg/m(2) intravenously (IV) on day 1 and VNB 25 mg/m(2) IV on days 1 and 8 (arm 1) or DOX 70 mg/m(2) IV on day 1 (arm 2). Both regimens were given every 3 weeks until a cumulative DOX dose of 450 mg/m(2). After 16 of the first 65 randomized patients experienced febrile neutropenia (FN), the doses were reduced to DOX 40 mg/m(2) on day 1 and VNB 20 mg/m(2) on days 1 and 8 versus DOX 60 mg/m(2) on day 1. Eligible patients were vinca alkaloid and anthracycline naive. Chemotherapy was first-line or second-line for MBC. RESULTS Three patients were ineligible. Thus, 300 patients were assessable for toxicity and to determine time to disease progression (TTP), TTF, and OS. Two hundred eighty-nine patients were assessable for response, and 99 responders were assessable for response duration (RD). The response rates, QOL, and median RD, TTP, and TTF were not significantly different between the arms. Median OS was 13.8 months for arm 1 versus 14.4 months for arm 2 (P =.4). Grade 3 or 4 granulocytopenia was equivalent in both arms but more grade 3/4 neurotoxicity, mild venous toxicity, and FN were seen on arm 1. CONCLUSION The survival with DOX and VNB is not superior to DOX alone in MBC.
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Affiliation(s)
- B Norris
- Fraser Valley Cancer Centre, British Columbia Cancer Agency, Surrey, Canada
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Levine MN, Bramwell VH, Pritchard KI, Norris BD, Shepherd LE, Abu-Zahra H, Findlay B, Warr D, Bowman D, Myles J, Arnold A, Vandenberg T, MacKenzie R, Robert J, Ottaway J, Burnell M, Williams CK, Tu D. Randomized trial of intensive cyclophosphamide, epirubicin, and fluorouracil chemotherapy compared with cyclophosphamide, methotrexate, and fluorouracil in premenopausal women with node-positive breast cancer. National Cancer Institute of Canada Clinical Trials Group. J Clin Oncol 1998; 16:2651-8. [PMID: 9704715 DOI: 10.1200/jco.1998.16.8.2651] [Citation(s) in RCA: 467] [Impact Index Per Article: 18.0] [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: 11/20/2022] Open
Abstract
PURPOSE To determine the relative efficacy of an intensive cyclophosphamide, epirubicin, and fluorouracil (CEF) adjuvant chemotherapy regimen compared with cyclophosphamide, methotrexate, and fluorouracil (CMF) in node-positive breast cancer. PATIENTS AND METHODS Premenopausal women with node-positive breast cancer were randomly allocated to receive either cyclophosphamide 100 mg/m2 orally days 1 through 14; methotrexate 40 mg/m2 intravenously (i.v.) days 1 and 8; and fluorouracil 600 mg/m2 i.v. days 1 and 8 or cyclophosphomide 75 mg/m2 orally days 1 through 14; epirubicin 60 mg/m2 i.v. days 1 and 8; and fluorouracil 500 mg/m2 i.v. days 1 and 8. Each cycle was administered monthly for 6 months. Patients administered CEF received antibiotic prophylaxis with cotrimoxazole two tablets twice a day for the duration of chemotherapy. RESULTS The median follow-up was 59 months. One hundred sixty-nine of the 359 CMF patients developed recurrence compared with 132 of the 351 CEF patients. The corresponding 5-year relapse-free survival rates were 53% and 63%, respectively (P = .009). One hundred seven CMF patients died compared with 85 CEF patients. The corresponding 5-year actuarial survival rates were 70% and 77%, respectively (P = .03). The rate of hospitalization for febrile neutropenia was 1.1% in the CMF group compared with 8.5% in the CEF group. There was one case of congestive heart failure in a patient who received CMF compared with none in the CEF group. Acute leukemia occurred in five patients in the CEF group. CONCLUSION The results of this trial show the superiority of CEF over CMF in terms of both disease-free and overall survival in premenopausal women with axillary node-positive breast cancer.
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Affiliation(s)
- M N Levine
- Hamilton Regional Cancer Centre, McMaster University, ON, Canada
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Latreille J, Pater J, Johnston D, Laberge F, Stewart D, Rusthoven J, Hoskins P, Findlay B, McMurtrie E, Yelle L, Williams C, Walde D, Ernst S, Dhaliwal H, Warr D, Shepherd F, Mee D, Nishimura L, Osoba D, Zee B. Use of dexamethasone and granisetron in the control of delayed emesis for patients who receive highly emetogenic chemotherapy. National Cancer Institute of Canada Clinical Trials Group. J Clin Oncol 1998; 16:1174-8. [PMID: 9508205 DOI: 10.1200/jco.1998.16.3.1174] [Citation(s) in RCA: 91] [Impact Index Per Article: 3.5] [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: 02/06/2023] Open
Abstract
PURPOSE To evaluate the roles of granisetron and dexamethasone for emesis control on days 2 through 7 after the administration of cisplatin in doses of 50 mg/m2 or greater to patients who had not previously received chemotherapy. PATIENTS AND METHODS Four hundred thirty-five eligible and assessable patients were randomized to one of two arms in a double-blind fashion: arm A; granisetron 3 mg intravenous (i.v.) plus dexamethasone 10 mg i.v. prechemotherapy followed by granisetron 1 mg orally at 6 and 12 hours, then granisetron 1 mg orally and dexamethasone 8 mg orally twice daily on days 2 through 7 (219 patients); arm B; as in arm A but with placebo substituted for granisetron on days 2 through 7 (216 patients). All patients completed diaries in which episodes of emesis and severity of nausea were recorded. RESULTS The addition of granisetron on days 2 through 7 had no discernable impact on nausea and vomiting during this period. CONCLUSION The administration of a 5-hydroxytryptamine3, receptor (5-HT3) antagonist, in this case granisetron, after 24 hours conferred no benefit. This negative result needs to be assessed in light of conflicting literature, but at present it does not appear that the routine use of these drugs in this setting is justified.
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Affiliation(s)
- J Latreille
- Hôtel-Dieu de Montréal Hospital, Québec, Canada.
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Okawara G, Rusthoven J, Newman T, Findlay B, Evans W. Unresected stage III non-small-cell lung cancer. Provincial Lung Cancer Disease Site Group. Cancer Prev Control 1997; 1:249-59. [PMID: 9765750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
GUIDELINE QUESTIONS 1) What is the role of different schedules or doses of radiotherapy in patients with unresected, clinical or pathological, stage III non-small-cell lung cancer (NSCLC)? 2) Does chemotherapy combined with radiotherapy provide improved survival compared with radiotherapy alone in patients with unresected NSCLC? OBJECTIVE To make recommendations about the role of chemotherapy and radiotherapy in the treatment of unresected stage III NSCLC. OUTCOMES Survival is the primary outcome of interest. Quality of life is a secondary outcome. PERSPECTIVE (VALUES) Evidence was selected and reviewed by 5 members of the Provincial Lung Cancer Disease Site Group (Lung DSG) of the Ontario Cancer Treatment Practice Guidelines Initiative. The Lung DSG comprises medical and radiation oncologists, pathologists, surgeons, epidemiologists, a psychologist and a medical sociologist. No community representative participated in the development of this guideline. QUALITY OF EVIDENCE Two meta-analyses were available for review. The specific analysis of interest examined the role of combined chemotherapy plus radiotherapy v. radiotherapy alone in locally advanced disease. The first meta-analysis included combined data from 22 randomized controlled (RCTs) involving a total of 3033 patients. The second included combined data from 14 RCTs involving a total of 2589 patients. Also reviewed were 4 RCTs of radiotherapy alone, 1 trial of combined chemotherapy and radiotherapy that was not included in the meta-analysis, 4 abstracts of studies of combined chemotherapy and radiotherapy, and 4 trials examining the role of hyperfractionated radiotherapy. BENEFITS In the first meta-analysis, an overall benefit was detected at 2 years for the use of combined chemotherapy and radiotherapy. A hazard ratio of 0.90 (p = 0.006), or a 10% reduction in the risk of death, translated into an absolute benefit of 3% at 2 years and 2% at 5 years. A subgroup analysis of cisplatin-based chemotherapy plus radiotherapy versus radiotherapy alone demonstrated a 13% reduction in the risk of death in the combined treatment arm (pooled hazard ratio 0.87, 95% confidence interval [CI] 0.79-0.96), for an absolute benefit of 4% at 2 years. In the second meta-analysis, there was a 13% reduction in the risk of death in the combined therapy arm at 2 years (pooled relative risk [RR] 0.87, 95% CI 0.81-0.94) and a 17% reduction at 3 years (pooled RR 0.83, 95% CI 0.77-0.90). Subgroup analysis of cisplatin-based chemotherapy plus radiotherapy versus radiotherapy alone showed similar results: a 15% reduction in the risk of death in the combined therapy arm at 2 years (pooled RR 0.85, 95% CI 0.79-0.92) and a 19% reduction at 3 years (pooled RR 0.81, 95% CI 0.74-0.88). PRACTICE GUIDELINE For patients with unresected stage III NSCLC, the combination of cisplatin-based chemotherapy and radical radiotherapy provides a survival benefit compared with radiotherapy alone. This guideline is based on high-quality evidence from 2 meta-analyses of RCTs. Patients with good performance status (Eastern Cooperative Oncology Group [ECOG] 0-1) and minimal weight loss (less than 5% in the preceding 3 months) have been shown to have a survival benefit from treatment with combined chemotherapy and radiotherapy and should be considered for this type of treatment approach (see section V). For these patients, thoracic irradiation of 60 Gy in 30 fractions over 6 weeks, in combination with cisplatin-based chemotherapy, should be recommended as a treatment option. The patient and physician should discuss fully the benefits, limitations and toxic effects of therapy. Patients not meeting these criteria are not candidates for combined therapy; those experiencing symptoms amenable to treatment should receive palliative thoracic irradiation. At this time, hyperfractionated radiotherapy is not recommended outside of the context of a clinical trial. (ABSTRACT TRUNCATED)
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Affiliation(s)
- G Okawara
- Hamilton Regional Cancer Centre and McMaster University, Ont
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Hirte HW, Miller D, Tonkin K, Findlay B, Capstick V, Murphy J, Buckman R, Carmichael J, Levine M, Hill W. A randomized trial of paracentesis plus intraperitoneal tumor necrosis factor-alpha versus paracentesis alone in patients with symptomatic ascites from recurrent ovarian carcinoma. Gynecol Oncol 1997; 64:80-7. [PMID: 8995552 DOI: 10.1006/gyno.1996.4529] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [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: 02/03/2023]
Abstract
PURPOSE Previous phase I and II studies of intraperitoneal recombinant human tumor necrosis factor-alpha (rhTNF-alpha) suggested a high degree of efficacy in reducing or eliminating ascitic fluid. To more accurately determine the efficacy of this agent, the role of paracentesis versus paracentesis plus intraperitoneal rhTNF-alpha was studied in a randomized trial. PATIENTS AND METHODS Thirty-nine patients with symptomatic ascites with a volume of > 1000 ml from recurrent epithelial ovarian carcinoma or primary peritoneal carcinoma, which was refractory to standard therapy, were randomized either to receive 0.06 mg/m2 rhTNF-alpha (Knoll, Canada) (the dose determined optimal from phase I and II studies) intraperitoneally after drainage of fluid or to receive drainage alone. A maximum of three treatments were given at weekly intervals. Eighteen patients were randomized to receive rhTNF-alpha. RESULTS None of 18 evaluable rhTNF-alpha patients had either a complete response (CR) (no clinical evidence of ascites and < 400 ml of fluid on ultrasound) or a partial response (PR) (asymptomatic ascites and < or = 1000 ml of fluid ultrasound). There were no CRs or PRs in the 17 evaluable patients who received drainage alone. The intraperitoneal infusion of rhTNF-alpha was generally well tolerated. Moderate to severe toxicity consisted of pain/discomfort in 42.1%, fever/chills in 36.9%, nausea/vomiting in 10.5%, edema in 10.5%, and hypotension in 5.3% of patients receiving rhTNF-alpha. CONCLUSION rhTNF-alpha, as given in this study, was not effective in preventing recurrence of ascites in this patient population.
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Affiliation(s)
- H W Hirte
- Ontario Cancer Treatment and Research Foundation, Hamilton Regional Cancer Centre, Canada
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Johnston D, Latreille J, Laberge F, Stewart D, Rusthoven J, Findlay B, Ernst S, Williams C, Hoskins P, Yelle L, McMurtrie E, Dhahwal H, Nishimura L, Pater J, Zee B. 1204 Preventing nausea and vomiting during days 2–7 following high dose cisplatin chemotherapy (HDCP). Eur J Cancer 1995. [DOI: 10.1016/0959-8049(95)96450-r] [Citation(s) in RCA: 2] [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: 10/27/2022]
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Moore MJ, Osoba D, Murphy K, Tannock IF, Armitage A, Findlay B, Coppin C, Neville A, Venner P, Wilson J. Use of palliative end points to evaluate the effects of mitoxantrone and low-dose prednisone in patients with hormonally resistant prostate cancer. J Clin Oncol 1994; 12:689-94. [PMID: 7512127 DOI: 10.1200/jco.1994.12.4.689] [Citation(s) in RCA: 122] [Impact Index Per Article: 4.1] [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: 01/25/2023] Open
Abstract
PURPOSE This phase II study was designed to assess the effects of mitoxantrone with prednisone in patients with metastatic prostate cancer who had progressed on hormonal therapy. The methods of assessment included quality-of-life analyses, pain indices, analgesic scores, and the National Prostatic Cancer Project (NPCP) criteria. PATIENTS AND METHODS Patients received mitoxantrone 12 mg/m2 intravenously every 3 weeks plus prednisone 10 mg orally daily. All had a castrate serum testosterone and Eastern Cooperation Oncology Group (ECOG) performance status < or = 3, and had not received prior chemotherapy. Every 3 weeks, analgesic intake was scored, and a present pain intensity (PPI) record and visual analog scale (VAS) describing pain were collected. Every 6 weeks, the European Organization for Research and Treatment of Cancer (EORTC) core quality-of-life questionnaire plus a prostate-specific module were completed. A palliative response was defined as a decrease in analgesic score by > or = 50% or a decrease in PPI by > or = two integers without any increase in the other. RESULTS Twenty-seven patients were entered onto the study. Nine of 25 (36%) assessable patients achieved a palliative response maintained for > or = two cycles (range, two to eight or more). Improvements in mean PPI and VAS pain scores after each cycle of therapy (P < .05) were seen. Quality-of-life analysis showed improvements in social and emotional functioning, and in pain and anorexia. Using NPCP criteria, one patient achieved a partial response (PR) and 12 had stable disease; one of seven patients with measurable disease had a PR. No serious nonhematologic toxicity was experienced, and there were no episodes of febrile neutropenia. CONCLUSION Mitoxantrone with low-dose prednisone is a well-tolerated treatment regimen that has some beneficial effects on disease-related symptoms and quality of life for patients with advanced prostate cancer.
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Affiliation(s)
- M J Moore
- Department of Medicine, Princess Margaret Hospital, Toronto, Ontario, Canada
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Levine MN, Bramwell V, Pritchard K, Perrault D, Findlay B, Abu-Zahra H, Warr D, Arnold A, Skillings J. A pilot study of intensive cyclophosphamide, epirubicin and fluorouracil in patients with axillary node positive or locally advanced breast cancer. Eur J Cancer 1993; 29A:37-43. [PMID: 1445744 DOI: 10.1016/0959-8049(93)90573-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [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: 12/27/2022]
Abstract
A multicentre pilot study has been conducted to determine an intensive regimen of cyclophosphamide, epirubicin, and fluorouracil which was tolerable and acceptable to patients with node positive breast cancer. Consecutive patients with operable axillary node positive breast cancer (T1-3, N1-2, M0), 266 patients, or locally advanced breast cancer (T4), 22 patients, were treated with cyclophosphamide post-operatively for 14 days and epirubicin and fluorouracil, both intravenously on days 1 and 8. Each cycle was repeated monthly for 6 months. Dosages were increased according to predetermined guidelines. Outcome measures were admission to hospital for febrile neutropenia and change in cardiac function as assessed by radionuclide angiography. The first 46 patients were treated at the doses of cyclophosphamide = 75 mg/m2, epirubicin = 50 mg/m2, fluorouracil = 375 mg/m2 (level 1), then 42 patients at cyclophosphamide = 75 mg/m2, epirubicin = 50 mg/m2 and fluorouracil = 500 mg/m2 (level 2), 69 patients at cyclophosphamide = 75 mg/m2, epirubicin = 60 mg/m2, and fluorouracil = 500 mg/m2 (level 3), and 42 patients at cyclophosphamide = 75 mg/m2, epirubicin = 70 mg/m2, and fluorouracil = 500 mg/m2 with concurrent antibiotics (level 4). The rates of febrile neutropenia were 8.7% (level 1), 7.1% (level 2), 18.8% (level 3), and 31% (level 4), respectively, P = 0.002. Accrual to level 4 was discontinued according to study guidelines and a further 89 patients were recruited at level 3 dosages with antibiotic prophylaxis (level 3a), resulting in a 5.6% rate of febrile neutropenia. The difference in febrile neutropenia rates between levels 3 and 3a was statistically significant. There were no toxic deaths and 2 cases of heart failure. In conclusion, through a careful dose-finding study in patients with operable or locally advanced breast cancer, an intensive epirubicin-containing adjuvant regimen has been established which is presently being compared with standard CMF (cyclophosphamide, methotrexate, 5-fluorouracil) chemotherapy in a randomised trial. In addition, this study suggests that antibiotic prophylaxis reduces the risk of febrile neutropenia in breast cancer patients receiving intensive chemotherapy.
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Latreille J, Stewart D, Laberge F, Hoskins P, Rusthoven J, McMurtrie E, Warr D, Yelle L, Walde D, Shepherd F, Dhaliwal H, Findlay B, Mee D, Pater J, Zee B, Johnston D. Dexamethasone (DEX) improves the efficacy of granisetron (GRAN) in the first 24 hours following high dose cisplatin (HDCP) chemotherapy. Eur J Cancer 1993. [DOI: 10.1016/0959-8049(93)91785-j] [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: 10/26/2022]
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Levine MN, Bramwell V, Pritchard K, Perrault D, Findlay B, Abu-Zahra H, Warr D, Arnold A, Skillings J. The Canadian experience with intensive fluorouracil, epirubicin and cyclophosphamide in patients with early stage breast cancer. Drugs 1993; 45 Suppl 2:51-9; discussion 58-9. [PMID: 7693423 DOI: 10.2165/00003495-199300452-00009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [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: 01/26/2023]
Abstract
A multicentre dose-finding pilot study was conducted to determine an intensive regimen of fluorouracil (F), epirubicin (E) plus cyclophosphamide (C) [FEC] that was tolerable and acceptable to patients with node-positive operable (n = 266) or locally advanced (n = 22) breast cancer. Consecutive patients were treated with fluorouracil and epirubicin administered intravenously on days 1 and 8, in addition to cyclophosphamide orally for 14 days. Chemotherapy cycles were repeated at monthly intervals for 6 months, and dosages were increased according to a predetermined protocol. End-points were hospital admissions due to febrile neutropenia and changes in cardiac function as assessed by radionuclide angiography. The first 46 patients were treated with doses of F = 375 mg/m2, E = 50 mg/m2 and C = 75 mg/m2 (level 1), then 42 patients received F = 500 mg/m2, E = 50 mg/m2 and C = 75 mg/m2 (level 2), 69 patients received F = 500 mg/m2, E = 60 mg/m2 and C = 75 mg/m2 (level 3), and 42 patients received F = 500 mg/m2, E = 70 mg/m2 and C = 75 mg/m2 with concurrent antibiotics (level 4). Rates of febrile neutropenia were 8.7% (level 1), 7.1% (level 2), 18.8% (level 3), and 31% (level 4) [p = 0.002]. Accrual to level 4 was discontinued according to study protocol and a further 89 patients were recruited at level 3 dosages with antibiotic prophylaxis (level 3a), resulting in a 5.6% rate of febrile neutropenia. The difference in febrile neutropenia rates between dosage levels 3 and 3a was statistically significant (p = 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- M N Levine
- Ontario Cancer Treatment and Research Foundation, Hamilton, London, Toronto-Bayview, Ottawa, Canada
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Levine MN, Bramwell V, Abu-Zahra H, Goodyear MD, Arnold A, Findlay B, Skillings J, Gent M. The effect of systemic adjuvant chemotherapy on local breast recurrence in node positive breast cancer patients treated by lumpectomy without radiation. Br J Cancer 1992; 65:130-2. [PMID: 1733435 PMCID: PMC1977351 DOI: 10.1038/bjc.1992.25] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [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: 12/28/2022] Open
Abstract
A randomised trial has previously been repeated in which 437 women with node positive breast cancer received either a 12-week chemohormonal regimen consisting of cyclophosphamide, methotrexate, fluorouracil, vincristine, prednisone, adriamycin and tamoxifen or 36 weeks of CMFVP. The present analysis concerns the local recurrence rates for the 122 lumpectomy patients who did not receive breast irradiation. The cumulative rate of local breast recurrence was greater in the 12-week than the 36-week group, P = 0.02. Similarly, in the lumpectomy patients, the cumulative rate of distant recurrence was greater in the 12-week than the 36-week group, P = 0.04. In conclusion, our results suggest that adjuvant chemotherapy impacts on local breast recurrence in a similar manner to other sites in Stage II breast cancer patients treated by lumpectomy without radiation. Despite the use of a conventional 36-week adjuvant chemotherapy regimen, the local breast recurrence rate was substantial.
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Affiliation(s)
- M N Levine
- Ontario Cancer Treatment and Research Foundation, Hamilton, London, Canada
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28
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Rusthoven J, Pater J, Kaizer L, Wilson K, Osoba D, Latreille J, Findlay B, Lofters WS, Warr D, Laberge F. A randomized, double-blinded study comparing six doses of batanopride (BMY-25801) with methylprednisolone in patients receiving moderately emetogenic chemotherapy. Ann Oncol 1991; 2:681-6. [PMID: 1742224 DOI: 10.1093/oxfordjournals.annonc.a058049] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [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: 12/28/2022] Open
Abstract
Several agents in a new class of antiemetic compounds, 5-hydroxytryptamine (5-HT3) antagonists, have shown promise as effective antiemetics with fewer side effects than metoclopramide. One of these agents, batanopride, produced no severe toxicity at doses that prevented emesis due to chemotherapy in early Phase I trials. We conducted a randomized, double-blinded, 7 arm clinical trial to: (1) identify the presence of a dose-response for complete protection from emesis, and (2) compare batanopride with a standard antiemetic, methylprednisolone if a dose-response was found not to exist. Prior to chemotherapy, six patient groups each received a single intravenous dose of batanopride ranging from 0.2 to 6.0 mg/kg whereas a seventh group received methylprednisolone 250 mg intravenously. Chemotherapy-naïve cancer patients scheduled to receive moderately emetogenic chemotherapy were eligible. Primary treatment outcomes that were recorded and analyzed included the number of episodes of emesis, the time to the first episode of emesis as well as the frequency and severity of nausea. Two hundred and eight patients accrued between April 1989 and February 1990 were evaluable for response. A significant dose-response effect for complete protection from emesis was not seen over the first 24 hours after chemotherapy (p = 0.102). However, a linear dose-response effect for time to first emesis was evident in a multivariate analysis (p = 0.029). While the highest batanopride dose group was associated with a higher complete protection rate (CPR) than the control group, this group also exhibited a higher incidence of diarrhea (p = 0.013), hypotension, and electrocardiographic abnormalities.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- J Rusthoven
- Department of Medicine, McMaster University, Hamilton Regional Cancer Centre, Canada
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29
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Levine MN, Gent M, Hryniuk WM, Bramwell V, Abu-Zahra H, DePauw S, Arnold A, Findlay B, Levin L, Skillings J. A randomized trial comparing 12 weeks versus 36 weeks of adjuvant chemotherapy in stage II breast cancer. J Clin Oncol 1990; 8:1217-25. [PMID: 2193119 DOI: 10.1200/jco.1990.8.7.1217] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.1] [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: 12/30/2022] Open
Abstract
A randomized trial has been performed in which women with axillary node-positive breast cancer were allocated to either a short intensive 12-week chemohormonal treatment consisting of cyclophosphamide, methotrexate, fluorouracil, vincristine, prednisone, Adriamycin (doxorubicin; Adria Laboratories, Columbus, OH), and tamoxifen (CMFVP plus AT) or 36 weeks of CMFVP. The median follow-up is 37 months. Of the 222 women randomized to the 12-week treatment, 113 (50.9%) have experienced either recurrence or death as compared with 90 patients (41.9%) in the 36-week treatment group. The corresponding 3-year relapse-free survivals are 55% and 64%, respectively, P = .003. Fifty-nine (26.6%) of the patients in the 12-week group have died compared with 46 (21.4%) of the 36-week group. The corresponding 3-year survival rates are 78% and 85%, respectively, P = .04. A Cox regression analysis showed an associated increased risk ratio for recurrence or death of 1.7, P = .003, and for death of 1.8, P = .017 in the 12-week treatment group compared with the 36-week group. Thus, this 12-week regimen of adjuvant chemohormonal therapy is inadequate treatment for women with axillary node-positive breast cancer; possible explanations for this inferiority are its shorter duration and/or a negative interaction of tamoxifen on the chemotherapy.
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Affiliation(s)
- M N Levine
- Ontario Cancer Treatment and Research Foundation, Hamilton, Canada
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30
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Abstract
Based on experimental observations that verapamil and tamoxifen reverse multiple drug resistance, the authors investigated the feasibility of combining both agents with the initial chemotherapy of extensive small cell lung cancer. Overall, in a consecutive series of 58 patients the most important toxicity was myelosuppression, and there was a 24% rate of severe infections. Therapeutic results included 24% complete and 34% partial response rates, median time to disease progression of 32 weeks, and median survival of 46 weeks. In three consecutive cohorts of patients the dose of either tamoxifen or verapamil were escalated by 25% and 33%, respectively. The cohort of patients receiving verapamil 360 mg/day and tamoxifen 100 mg/day (level 2) had slightly more toxicity but also more responses than the other groups. Therefore, the authors recommend that these doses be used in controlled trials to confirm the promising results of their study.
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Affiliation(s)
- A Figueredo
- Ontario Cancer Treatment and Research Foundation Hamilton Regional Cancer Centre, Canada
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Levine MN, Guyatt GH, Gent M, De Pauw S, Goodyear MD, Hryniuk WM, Arnold A, Findlay B, Skillings JR, Bramwell VH. Quality of life in stage II breast cancer: an instrument for clinical trials. J Clin Oncol 1988; 6:1798-810. [PMID: 3058874 DOI: 10.1200/jco.1988.6.12.1798] [Citation(s) in RCA: 157] [Impact Index Per Article: 4.4] [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: 01/03/2023] Open
Abstract
A questionnaire has been developed for use as an outcome measure in clinical trials of adjuvant chemotherapy in women with stage II breast cancer. The selection of items for this Breast Cancer Chemotherapy Questionnaire (BCQ) was based on the problems and experiences felt to be most important by women undergoing adjuvant chemotherapy. The BCQ consists of 30 questions that focus on loss of attractiveness, fatigue, physical symptoms, inconvenience, emotional distress, and feelings of hope and support from others. The BCQ, other instruments that evaluate quality-of-life (Spitzer, Karnofsky, and Rand), and patient and physician global assessments were administered serially to 418 patients taking part in a randomized trial comparing a 12-week regimen and a 36-week regimen of adjuvant chemotherapy. The validity of the BCQ is supported by its correlation with the Rand Emotional (r = .58), Rand Physical (r = .60), and Spitzer (r = .62) questionnaires. The BCQ correlated more strongly with global ratings of both physical and emotional function by the patients and their physicians than the other instruments. A comparison of the quality-of-life outcomes of patients in the two treatment groups in the period beyond 3 months after initiation of treatment, when one group had completed the treatment course and the other was still on treatment, revealed that the BCQ and Karnofsky were the only instruments able to demonstrate differences between the groups (P less than .0001). Hence, the BCQ is a valid and responsive method of assessing treatment-related morbidity in patients receiving adjuvant chemotherapy for stage II breast cancer.
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Affiliation(s)
- M N Levine
- Ontario Cancer Treatment and Research Foundation, Hamilton Regional Cancer Centre, Canada
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