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McGowan M, O'Carrigan B, Martins FC, Haldar K, Pathiraja P. Organ-sparing central pelvic compartment resection for the treatment of vulvo-vaginal melanomas. Melanoma Manag 2023; 10:MMT66. [PMID: 38229953 PMCID: PMC10789441 DOI: 10.2217/mmt-2023-0001] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 11/29/2023] [Indexed: 01/18/2024] Open
Abstract
Vulvo-vaginal melanomas are one of the rarest gynecological oncology diseases with a poor survival compared with other malignancies. The 5-year survival varies from 13% to 32.3%. Vulvo-vaginal melanomas involving the upper 2/3rds of the vagina are usually treated with total pelvic exenteration (TPE). TPE surgery carries a 50% risk of major complications and also morbidity associated with double stomas. Central pelvic compartment resection is a novel organ-sparing surgical approach entailing radical total laparoscopic hysterectomy, bilateral salpingo-oophrectomy, laparoscopic vaginectomy and vulvectomy to reduce morbidity compared with TPE. Permanent suprapubic catheters are used if there is urethral involvement but require quality of life studies to assess their long-term outcomes.
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Affiliation(s)
- Mark McGowan
- Department of Gynaecological Oncology, Cambridge University Hospital, Cambridge, CB2 0QQ, UK
| | - Brent O'Carrigan
- Department of Gynaecological Oncology, Cambridge University Hospital, Cambridge, CB2 0QQ, UK
| | | | - Krishnayan Haldar
- Department of Gynaecological Oncology, Cambridge University Hospital, Cambridge, CB2 0QQ, UK
| | - Pubudu Pathiraja
- Department of Gynaecological Oncology, Cambridge University Hospital, Cambridge, CB2 0QQ, UK
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2
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Merrick S, Nankivell M, Quartagno M, Clarke CS, Joharatnam-Hogan N, Waddell T, O'Carrigan B, Seckl M, Ghorani E, Banks E, Edmonds K, Bray G, Woodward R, Bennett R, Badrock J, Hudson W, Langley RE, Vasudev N, Pickering L, Gilbert DC. REFINE (REduced Frequency ImmuNE checkpoint inhibition in cancers): A multi-arm phase II basket trial testing reduced intensity immunotherapy across different cancers. Contemp Clin Trials 2023; 124:107030. [PMID: 36519749 PMCID: PMC7614585 DOI: 10.1016/j.cct.2022.107030] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 10/13/2022] [Accepted: 11/22/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Immune checkpoint inhibitors (ICI) have revolutionised treating advanced cancers. ICI are administered intravenously every 2-6 weeks for up to 2 years, until cancer progression/unacceptable toxicity. Physiological efficacy is observed at lower doses than those used as standard of care (SOC). Pharmacodynamic studies indicate sustained target occupancy, despite a pharmacological half-life of 2-3 weeks. Reducing frequency of administration may be possible without compromising outcomes. The REFINE trial aims to limit individual patient exposure to ICI whilst maintaining efficacy, with potential benefits in quality of life and reduced drug treatment/attendance costs. METHODS/DESIGN REFINE is a randomised phase II, multi-arm, multi-stage (MAMS) adaptive basket trial investigating extended interval administration of ICIs. Eligible patients are those responding to conventionally dosed ICI at 12 weeks. In stage I, patients (n = 160 per tumour-specific cohort) will be randomly allocated (1:1) to receive maintenance ICI at SOC vs extended dose interval. REFINE is currently recruiting UK patients with locally advanced or metastatic renal cell carcinoma (RCC) who have tolerated and responded to initial nivolumab/ipilimumab, randomised to receive maintenance nivolumab SOC (480 mg 4 weekly) vs extended interval (480 mg 8 weekly). Additional tumour cohorts are planned. Subject to satisfactory outcomes (progression-free survival) stage II will investigate up to 5 different treatment intervals. Secondary outcome measures include overall survival, quality-of-life, treatment-related toxicity, mean incremental pathway costs and quality-adjusted life-years per patient. REFINE is funded by the Jon Moulton Charity Trust and Medical Research Council, sponsored by University College London (UCL), and coordinated by the MRC CTU at UCL. Trial Registration ISRCTN79455488. NCT04913025 EUDRACT #: 2021-002060-47. CTA 31330/0008/001-0001; MREC approval: 21/LO/0593. REFINE Protocol version 4.0.
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Affiliation(s)
- Sophie Merrick
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, 2nd Floor 90 High Holborn, London WC1V 6LJ, UK
| | - Matthew Nankivell
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, 2nd Floor 90 High Holborn, London WC1V 6LJ, UK
| | - Matteo Quartagno
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, 2nd Floor 90 High Holborn, London WC1V 6LJ, UK
| | - Caroline S Clarke
- University College London (UCL) Research Department of Primary Care and Population Health, Upper 3rd Floor, UCL Medical School, Royal Free Campus, London NW3 2PF, UK
| | - Nalinie Joharatnam-Hogan
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, 2nd Floor 90 High Holborn, London WC1V 6LJ, UK
| | - Tom Waddell
- The Christie NHS Foundation Trust, Wilmslow Road, Manchester M20 4BX, UK
| | - Brent O'Carrigan
- Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge Biomedical Campus Hill's Road, Cambridge CB2 0QQ, UK
| | - Michael Seckl
- Imperial College London, Division of Cancer, 2nd floor U201 Hammersmith Hospital Campus, London W12 0NN, UK
| | - Ehsan Ghorani
- Imperial College London, Division of Cancer, 2nd floor U201 Hammersmith Hospital Campus, London W12 0NN, UK
| | - Emma Banks
- Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds LS9 7TF, UK
| | - Kim Edmonds
- Royal Marsden Hospital, 203 Fulham Rd, Chelsea, London SW3 6JJ, UK
| | - George Bray
- University College London (UCL) Research Department of Primary Care and Population Health, Upper 3rd Floor, UCL Medical School, Royal Free Campus, London NW3 2PF, UK
| | - Rose Woodward
- Action Kidney Cancer, 11th Floor, 3 Piccadilly Place, Manchester M1 3BN, UK
| | - Rachel Bennett
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, 2nd Floor 90 High Holborn, London WC1V 6LJ, UK
| | - Jonathan Badrock
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, 2nd Floor 90 High Holborn, London WC1V 6LJ, UK
| | - Will Hudson
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, 2nd Floor 90 High Holborn, London WC1V 6LJ, UK
| | - Ruth E Langley
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, 2nd Floor 90 High Holborn, London WC1V 6LJ, UK
| | - Naveen Vasudev
- Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds LS9 7TF, UK
| | - Lisa Pickering
- Royal Marsden Hospital, 203 Fulham Rd, Chelsea, London SW3 6JJ, UK
| | - Duncan C Gilbert
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, 2nd Floor 90 High Holborn, London WC1V 6LJ, UK.
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Serrao EM, Costa AM, Ferreira S, McMorran V, Cargill E, Hough C, Shaw AS, O'Carrigan B, Parkinson CA, Corrie PG, Sadler TJ. The different faces of metastatic melanoma in the gastrointestinal tract. Insights Imaging 2022; 13:161. [PMID: 36195726 PMCID: PMC9532488 DOI: 10.1186/s13244-022-01294-5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 09/04/2022] [Indexed: 11/10/2022] Open
Abstract
Melanoma is the most aggressive form of skin cancer, with tendency to spread to any organ of the human body, including the gastrointestinal tract (GIT). The diagnosis of metastases to the GIT can be difficult, as they may be clinically silent for somewhile and may occur years after the initial melanoma diagnosis. CT imaging remains the standard modality for staging and surveillance of melanoma patients, and in most cases, it will be the first imaging modality to identify GIT lesions. However, interpretation of CT studies in patients with melanoma can be challenging as lesions may be subtle and random in distribution, as well as sometimes mimicking other conditions. Even so, early diagnosis of GIT metastases is critical to avoid emergency hospitalisations, whilst surgical intervention can be curative in some cases. In this review, we illustrate the various imaging presentations of melanoma metastases within the GIT, discuss the clinical aspects and offer advice on investigation and management. We offer tips intended to aid radiologists in their diagnostic skills and interpretation of melanoma imaging scans.
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Affiliation(s)
- Eva Mendes Serrao
- Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK. .,Department of Radiology, University of Cambridge, Box 218, Cambridge, CB2 0QQ, UK.
| | - Ana Maria Costa
- Department of Radiology, Hospital Fernando Fonseca, Amadora, Portugal
| | - Sergio Ferreira
- Department of Radiology, Hospital Fernando Fonseca, Amadora, Portugal
| | - Victoria McMorran
- Department of Oncology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Emma Cargill
- Department of Oncology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Caroline Hough
- Department of Oncology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Ashley S Shaw
- Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Brent O'Carrigan
- Department of Oncology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Christine A Parkinson
- Department of Oncology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Pippa G Corrie
- Department of Oncology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Timothy J Sadler
- Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Mendes Serrao E, Joslin E, McMorran V, Hough C, Palmer C, McDonald S, Cargill E, Shaw AS, O'Carrigan B, Parkinson CA, Corrie PG, Sadler TJ. The forgotten appearance of metastatic melanoma in the small bowel. Cancer Imaging 2022; 22:27. [PMID: 35701818 PMCID: PMC9195247 DOI: 10.1186/s40644-022-00463-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 05/19/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Melanoma is the most aggressive form of skin cancer, with a tendency to metastasise to any organ of the human body. While the most common body organs affected include liver, lungs, brain and soft tissues, spread to the gastrointestinal tract is not uncommon. In the bowel, it can present with a multitude of imaging appearances, more rarely as an aneurysmal dilatation. This appearance is classically associated with lymphoma, but it has more rarely been associated with other forms of malignancy. CASE PRESENTATION We report a case series of three patients with aneurysmal dilatation in the small bowel (SB) confirmed to be due to metastatic melanoma (MM). All patients had non-specific symptoms; most times being attributed initially to causes other than melanoma. On CT the identified aneurysmal SB dilatations were diagnosed as presumed lymphoma in all cases. In two cases, the aneurysmal dilatation was the first presentation of metastatic disease and in two of the cases more than one site of the gastrointestinal tract was concomitantly involved. All patients underwent surgical resection with histological confirmation of MM. CONCLUSIONS Recognition of unusual SB presentation of MM, such as aneurysmal SB dilatation, is important to expedite diagnosis, provide appropriate treatment, and consequently improve quality of life and likely survival of these patients. As the most common cancer to metastasise to the SB and as a known imaging mimicker, MM should remain in any radiologist's differential diagnosis for SB lesions with aneurysmal dilatation.
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Affiliation(s)
- Eva Mendes Serrao
- Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK. .,Department of Radiology, University of Cambridge, Box 218, Cambridge, CB2 0QQ, UK.
| | - Emily Joslin
- Department of Pathology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Victoria McMorran
- Department of Oncology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Caroline Hough
- Department of Oncology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Cheryl Palmer
- Department of Oncology, Hinchingbrooke Hospital, Huntingdon, UK
| | - Sarah McDonald
- Department of Pathology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Emma Cargill
- Department of Oncology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Ashley S Shaw
- Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Brent O'Carrigan
- Department of Oncology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Christine A Parkinson
- Department of Oncology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Pippa G Corrie
- Department of Oncology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Timothy J Sadler
- Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Zhang J, O'Carrigan B, Fife K. 89P Survival and immunotoxicity profiles in younger versus elderly patients with metastatic renal cell cancer undergoing immunotherapy. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.10.107] [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] Open
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Drewett LM, Pugh SA, Kieran R, Nair B, Attia H, Sabar MI, Milne I, Saunders S, Bragg J, Whitehorn D, Lay J, Rueda OM, Harris F, Welsh SJ, Doherty G, Basu B, Abraham J, Beddowes E, Corrie PG, O'Carrigan B. The impact of COVID-19 on clinical cancer care: An individual-patient level analysis. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.1533] [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
1533 Background: At the outset of the COVID-19 pandemic, concerns for the safety of patients receiving anti-cancer treatment coupled with pressures on healthcare services prompted review of standard clinical care pathways in the UK. Revised consensus treatment guidelines were generated. Individual patient-level data regarding actual treatment modifications implemented in clinical practice are lacking. Methods: All anti-cancer treatment plans of patients with breast, lung, renal, hepatopancreatobiliary, CNS cancers and melanoma attending a single academic cancer centre in the UK between 16 March and 31 May 2020 were reviewed and any modifications to standard practice were documented. The effect of patient (age, ECOG performance status [PS], sex) and cancer (site, stage, treatment intent) characteristics on likelihood of treatment modifications were analysed using univariable and multivariable models. Results: Treatment plans for 925 patients were reviewed: median patient age was 63 (range 19-97); 66% were female; 73% were PS 0-1; 45% were on a curative pathway. Overall, 47% of all patients had one or more modifications made to their treatment plans: 53% of surgeries (primarily being delayed); 41% of radiotherapy (primarily reduced fractions delivered); 39% of systemic therapy prescriptions. 96-100% of all systemic therapy modifications resulted in treatment de-escalation, excluding endocrine therapy used as a bridge to defer primary breast cancer surgery. Biological therapy was predominantly interrupted (49%), immunotherapy was mostly omitted entirely (36%), and chemotherapy varied between interruptions (39%) or omissions (31%). Relative to the likelihood of modification to chemotherapy, surgery was significantly more likely to be modified (OR 1.69 95%CI 1.20-2.38). Chemotherapy, radiotherapy, biological therapy and immunotherapy were all modified to a similar degree. Multivariate analysis identified PS ≥2 (OR 1.79, 95% CI 1.18–2.75), but not patient age, as a predictor of treatment modification. Some tumour types were less likely to undergo any modification: stage 1-3 lung (OR 0.13, 95%CI 0.04-0.37), stage 4 lung (OR 0.26 95%CI 0.24–0.60) and stage 4 renal cancer (OR 0.22 95%CI 0.09-0.52). Conclusions: This single centre analysis demonstrated almost half of cancer patients had their treatment modified, the overwhelming majority resulting in treatment de-escalation. The impact of the treatment modifications on overall cancer patient outcomes remains to be determined.
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Affiliation(s)
- Lynsey M Drewett
- Department of Oncology, University of Cambridge and Cambridge Breast Cancer Research Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Sian Alexandra Pugh
- Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Rosalind Kieran
- Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Binu Nair
- Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Hossameldin Attia
- Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Muhammad Iftikhar Sabar
- Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Isabel Milne
- Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Sharon Saunders
- Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Jennie Bragg
- Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Deborah Whitehorn
- Cambridge Breast Cancer Research Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Jonathan Lay
- Cambridge Breast Cancer Research Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Oscar M Rueda
- MRC Biostatistics Unit, University of Cambridge, Cambridge, United Kingdom
| | - Fiona Harris
- Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Sarah Joanne Welsh
- Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Gary Doherty
- Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Bristi Basu
- Department of Oncology, University of Cambridge and Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Jean Abraham
- Department of Oncology, University of Cambridge and NIHR Cambridge Biomedical Research Centre and Cambridge Breast Cancer Research Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Emma Beddowes
- Department of Oncology, University of Cambridge and Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Philippa Gail Corrie
- Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Brent O'Carrigan
- Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
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O'Carrigan B, Lim JSJ, Jalil A, Harris SJ, Papadatos-Pastos D, Banerji U, Lopez J, de Bono JS, Yap TA. Target-based therapeutic matching of phase I trials in patients with metastatic breast cancer in a tertiary referral centre. Br J Cancer 2018; 119:922-927. [PMID: 30318518 PMCID: PMC6203714 DOI: 10.1038/s41416-018-0290-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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] [Received: 05/15/2018] [Revised: 09/07/2018] [Accepted: 09/17/2018] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Greater understanding of the molecular classification of breast cancer has permitted the development of rational drug design strategies. In a phase I clinical trial setting, molecular profiling with next-generation sequencing of individual tumour samples has been employed to guide treatment. METHODS We conducted a retrospective evaluation of clinical outcomes of patients with metastatic breast cancer (MBC) treated in phase I clinical trials at our institution to assess the benefit of molecularly matched compared to non-matched treatments. RESULTS A total of 97 consecutive patients with MBC were enrolled onto ≥1 trial between 2009 and 2015. Fourteen patients participated in multiple trials, and a total of 113 trial encounters were reviewed in this retrospective study. Eighty-three percent of patients with molecular data available were able to participate in trials matched to molecular aberrations. Patients who were treated on matched studies had improved clinical benefit (RR: 1.80, p = 0.005), progression-free (HR: 0.52, p = 0.003) and overall survival (HR: 0.54, p < 0.001). Treatment was well tolerated with low rates of treatment discontinuation for toxicity (8% overall) that did not differ between groups. No toxicity-related deaths were observed. CONCLUSIONS Molecular profiling for MBC patients in a phase I setting is feasible and aids therapeutic decisions with improved patient outcomes.
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Affiliation(s)
| | - Joline Si Jing Lim
- Drug Development Unit, Royal Marsden Hospital, London, UK
- National University Cancer Institute of Singapore, Singapore, Singapore
| | - Awais Jalil
- Drug Development Unit, Royal Marsden Hospital, London, UK
| | | | | | - Udai Banerji
- Drug Development Unit, Royal Marsden Hospital, London, UK
- Division of Clinical Studies, The Institute of Cancer Research, London, UK
| | - Juanita Lopez
- Drug Development Unit, Royal Marsden Hospital, London, UK
- Division of Clinical Studies, The Institute of Cancer Research, London, UK
| | - Johann Sebastian de Bono
- Drug Development Unit, Royal Marsden Hospital, London, UK
- Division of Clinical Studies, The Institute of Cancer Research, London, UK
| | - Timothy Anthony Yap
- Drug Development Unit, Royal Marsden Hospital, London, UK.
- Division of Clinical Studies, The Institute of Cancer Research, London, UK.
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Lomax AJ, Nielsen T, Visintin L, O'Carrigan B, Honeyball F, Shum B, Saw RPM, McNeil C. Clinical Nurse Consultant Support: Management of Patients With Melanoma Receiving Immunotherapy
and Targeted Therapy
. Clin J Oncol Nurs 2018; 21:E93-E98. [PMID: 28738040 DOI: 10.1188/17.cjon.e93-e98] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Targeted therapy and immunotherapy agents for advanced melanoma are associated with novel toxicities. Melanoma clinical nurse consultants (CNCs) provide multifaceted clinical care.
. OBJECTIVES The objective was to evaluate the type of support, excluding clinic and inpatient care, provided by CNCs for patients not enrolled in a clinical trial.
. METHODS A prospective review of CNC support provided during a 12-week period was conducted.
. FINDINGS From May to August 2015, 105 patients attended clinic, and 72 received CNC support. Initial patient encounters with CNCs were documented (n = 150), as well as additional interactions (n = 291). The most common problem identified per initial encounter was symptom/drug toxicity. The most common therapy-related concern was related to anti-programmed cell death protein 1 immunotherapy and BRAF plus MEK inhibition. CNC interventions commonly involved clinical advice and counseling and care coordination.
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Abstract
BACKGROUND Bone is the most common site of metastatic disease associated with breast cancer (BC). Bisphosphonates inhibit osteoclast-mediated bone resorption, and novel targeted therapies such as denosumab inhibit other key bone metabolism pathways. We have studied these agents in both early breast cancer and advanced breast cancer settings. This is an update of the review originally published in 2002 and subsequently updated in 2005 and 2012. OBJECTIVES To assess the effects of bisphosphonates and other bone agents in addition to anti-cancer treatment: (i) in women with early breast cancer (EBC); (ii) in women with advanced breast cancer without bone metastases (ABC); and (iii) in women with metastatic breast cancer and bone metastases (BCBM). SEARCH METHODS In this review update, we searched Cochrane Breast Cancer's Specialised Register, CENTRAL, MEDLINE, Embase, the World Health Organization's International Clinical Trials Registry Platform (WHO ICTRP) and ClinicalTrials.gov on 19 September 2016. SELECTION CRITERIA We included randomised controlled trials (RCTs) comparing: (a) one treatment with a bisphosphonate/bone-acting agent with the same treatment without a bisphosphonate/bone-acting agent; (b) treatment with one bisphosphonate versus treatment with a different bisphosphonate; (c) treatment with a bisphosphonate versus another bone-acting agent of a different mechanism of action (e.g. denosumab); and (d) immediate treatment with a bisphosphonate/bone-acting agent versus delayed treatment of the same bisphosphonate/bone-acting agent. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data, and assessed risk of bias and quality of the evidence. The primary outcome measure was bone metastases for EBC and ABC, and a skeletal-related event (SRE) for BCBM. We derived risk ratios (RRs) for dichotomous outcomes and the meta-analyses used random-effects models. Secondary outcomes included overall survival and disease-free survival for EBC; we derived hazard ratios (HRs) for these time-to-event outcomes where possible. We collected toxicity and quality-of-life information. GRADE was used to assess the quality of evidence for the most important outcomes in each treatment setting. MAIN RESULTS We included 44 RCTs involving 37,302 women.In women with EBC, bisphosphonates were associated with a reduced risk of bone metastases compared to placebo/no bisphosphonate (RR 0.86, 95% confidence interval (CI) 0.75 to 0.99; P = 0.03, 11 studies; 15,005 women; moderate-quality evidence with no significant heterogeneity). Bisphosphonates provided an overall survival benefit with time-to-event data (HR 0.91, 95% CI 0.83 to 0.99; P = 0.04; 9 studies; 13,949 women; high-quality evidence with evidence of heterogeneity). Subgroup analysis by menopausal status showed a survival benefit from bisphosphonates in postmenopausal women (HR 0.77, 95% CI 0.66 to 0.90; P = 0.001; 4 studies; 6048 women; high-quality evidence with no evidence of heterogeneity) but no survival benefit for premenopausal women (HR 1.03, 95% CI 0.86 to 1.22; P = 0.78; 2 studies; 3501 women; high-quality evidence with no heterogeneity). There was evidence of no effect of bisphosphonates on disease-free survival (HR 0.94, 95% 0.87 to 1.02; P = 0.13; 7 studies; 12,578 women; high-quality evidence with significant heterogeneity present) however subgroup analyses showed a disease-free survival benefit from bisphosphonates in postmenopausal women only (HR 0.82, 95% CI 0.74 to 0.91; P < 0.001; 7 studies; 8314 women; high-quality evidence with no heterogeneity). Bisphosphonates did not significantly reduce the incidence of fractures when compared to placebo/no bisphosphonates (RR 0.77, 95% CI 0.54 to 1.08, P = 0.13, 6 studies, 7602 women; moderate-quality evidence due to wide confidence intervals). We await mature overall survival and disease-free survival results for denosumab trials.In women with ABC without clinically evident bone metastases, there was no evidence of an effect of bisphosphonates on bone metastases (RR 0.96, 95% CI 0.65 to 1.43; P = 0.86; 3 studies; 330 women; moderate-quality evidence with no heterogeneity) or overall survival (RR 0.89, 95% CI 0.73 to 1.09; P = 0.28; 3 studies; 330 women; high-quality evidence with no heterogeneity) compared to placebo/no bisphosphonates however the confidence intervals were wide. One study reported a trend towards an extended period of time without a SRE with bisphosphonate compared to placebo (low-quality evidence). One study reported quality of life and there was no apparent difference in scores between bisphosphonate and placebo (moderate-quality evidence).In women with BCBM, bisphosphonates reduced the SRE risk by 14% (RR 0.86, 95% CI 0.78 to 0.95; P = 0.003; 9 studies; 2810 women; high-quality evidence with evidence of heterogeneity) compared with placebo/no bisphosphonates. This benefit persisted when administering either intravenous or oral bisphosphonates versus placebo. Bisphosphonates delayed the median time to a SRE with a median ratio of 1.43 (95% CI 1.29 to 1.58; P < 0.00001; 9 studies; 2891 women; high-quality evidence with no heterogeneity) and reduced bone pain (in 6 out of 11 studies; moderate-quality evidence) compared to placebo/no bisphosphonate. Treatment with bisphosphonates did not appear to affect overall survival (RR 1.01, 95% CI 0.91 to 1.11; P = 0.85; 7 studies; 1935 women; moderate-quality evidence with significant heterogeneity). Quality-of-life scores were slightly better with bisphosphonates than placebo at comparable time points (in three out of five studies; moderate-quality evidence) however scores decreased during the course of the studies. Denosumab reduced the risk of developing a SRE compared with bisphosphonates by 22% (RR 0.78, 0.72 to 0.85; P < 0.001; 3 studies, 2345 women). One study reported data on overall survival and observed no difference in survival between denosumab and bisphosphonate.Reported toxicities across all settings were generally mild. Osteonecrosis of the jaw was rare, occurring less than 0.5% in the adjuvant setting (high-quality evidence). AUTHORS' CONCLUSIONS For women with EBC, bisphosphonates reduce the risk of bone metastases and provide an overall survival benefit compared to placebo or no bisphosphonates. There is preliminary evidence suggestive that bisphosphonates provide an overall survival and disease-free survival benefit in postmenopausal women only when compared to placebo or no bisphosphonate. This was not a planned subgroup for these early trials, and we await the completion of new large clinical trials assessing benefit for postmenopausal women. For women with BCBM, bisphosphonates reduce the risk of developing SREs, delay the median time to an SRE, and appear to reduce bone pain compared to placebo or no bisphosphonate.
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Affiliation(s)
- Brent O'Carrigan
- Chris O'Brien LifehouseMedical Oncology119‐143 Missenden RdCamperdownSydneyNSWUK2050
- The University of SydneyCamperdownAustralia
| | - Matthew HF Wong
- Gosford HospitalDepartment of Medical OncologyGosfordNew South WalesAustralia
| | - Melina L Willson
- NHMRC Clinical Trials Centre, The University of SydneySystematic Reviews and Health Technology AssessmentsLocked Bag 77SydneyNSWAustralia1450
| | - Martin R Stockler
- The University of SydneyNHMRC Clinical Trials Centre and Sydney Cancer CentreGH6 RPAHMissenden RoadCamperdownNSWAustralia2050
| | - Nick Pavlakis
- Royal North Shore HospitalDepartment of Medical OncologyPacific HighwaySt LeonardsNew South WalesAustralia2065
| | - Annabel Goodwin
- The University of Sydney, Concord Repatriation General HospitalConcord Clinical SchoolConcordNSWAustralia2137
- Concord Repatriation General HospitalMedical Oncology DepartmentConcordAustralia
- Sydney Local Health District and South Western Sydney Local Health DistrictCancer Genetics DepartmentSydneyAustralia
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Brown JS, O'Carrigan B, Jackson SP, Yap TA. Targeting DNA Repair in Cancer: Beyond PARP Inhibitors. Cancer Discov 2017; 7:20-37. [PMID: 28003236 PMCID: PMC5300099 DOI: 10.1158/2159-8290.cd-16-0860] [Citation(s) in RCA: 411] [Impact Index Per Article: 58.7] [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: 08/03/2016] [Revised: 11/03/2016] [Accepted: 11/07/2016] [Indexed: 01/14/2023]
Abstract
Germline aberrations in critical DNA-repair and DNA damage-response (DDR) genes cause cancer predisposition, whereas various tumors harbor somatic mutations causing defective DDR/DNA repair. The concept of synthetic lethality can be exploited in such malignancies, as exemplified by approval of poly(ADP-ribose) polymerase inhibitors for treating BRCA1/2-mutated ovarian cancers. Herein, we detail how cellular DDR processes engage various proteins that sense DNA damage, initiate signaling pathways to promote cell-cycle checkpoint activation, trigger apoptosis, and coordinate DNA repair. We focus on novel therapeutic strategies targeting promising DDR targets and discuss challenges of patient selection and the development of rational drug combinations. SIGNIFICANCE Various inhibitors of DDR components are in preclinical and clinical development. A thorough understanding of DDR pathway complexities must now be combined with strategies and lessons learned from the successful registration of PARP inhibitors in order to fully exploit the potential of DDR inhibitors and to ensure their long-term clinical success. Cancer Discov; 7(1); 20-37. ©2016 AACR.
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Affiliation(s)
| | | | - Stephen P Jackson
- The Wellcome Trust/Cancer Research UK Gurdon Institute and Department of Biochemistry, University of Cambridge, Cambridge, United Kingdom
- The Wellcome Trust Sanger Institute, Hinxton, Cambridge, United Kingdom
| | - Timothy A Yap
- Royal Marsden NHS Foundation Trust, London, United Kingdom.
- The Institute of Cancer Research, London, United Kingdom
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11
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O'Carrigan B, de Miguel Luken MJ, Papadatos-Pastos D, Brown J, Tunariu N, Perez Lopez R, Ganegoda M, Riisnaes R, Figueiredo I, Carreira S, Hare B, Yang F, McDermott K, Penney MS, Pollard J, Lopez JS, Banerji U, De Bono JS, Fields SZ, Yap TA. Phase I trial of a first-in-class ATR inhibitor VX-970 as monotherapy (mono) or in combination (combo) with carboplatin (CP) incorporating pharmacodynamics (PD) studies. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.2504] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [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)
- Brent O'Carrigan
- The Royal Marsden/Institute of Cancer Research, London, United Kingdom
| | | | | | - Jessica Brown
- Drug Development Unit, Royal Marsden Hospital and The Institute of Cancer Research, London, United Kingdom
| | - Nina Tunariu
- Drug Development Unit, Royal Marsden Hospital and The Institute of Cancer Research, London, United Kingdom
| | - Raquel Perez Lopez
- Drug Development Unit, Royal Marsden Hospital and The Institute of Cancer Research, London, United Kingdom
| | - Mahesha Ganegoda
- Drug Development Unit, Royal Marsden Hospital and The Institute of Cancer Research, London, United Kingdom
| | - Ruth Riisnaes
- Cancer Biomarkers Laboratory, The Institute of Cancer Research, London, United Kingdom
| | - Ines Figueiredo
- Cancer Biomarkers Laboratory, The Institute of Cancer Research, London, United Kingdom
| | - Suzanne Carreira
- Cancer Biomarkers Laboratory, The Institute of Cancer Research, London, United Kingdom
| | | | - Fang Yang
- Vertex Pharmaceuticals Inc., Boston, MA
| | | | | | - John Pollard
- Vertex Pharmaceuticals Ltd., Milton Park, United Kingdom
| | | | - Udai Banerji
- Cancer Biomarkers Laboratory, The Institute of Cancer Research, London, United Kingdom
| | - Johann S. De Bono
- Drug Development Unit & Cancer Biomarkers Laboratory, Royal Marsden Hospital and The Institute of Cancer Research, London, United Kingdom
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12
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O'Carrigan B, Jalil A, Papadatos-Pastos D, Harris SJ, Lopez JS, Banerji U, De Bono JS, Yap TA. Target-based therapeutic matching of phase I trials in patients with advanced breast cancer (BC pts) in the Royal Marsden Hospital Drug Development Unit (RMH DDU). J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.11508] [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)
- Brent O'Carrigan
- The Royal Marsden/Institute of Cancer Research, London, United Kingdom
| | - Awais Jalil
- The Royal Marsden/Institute of Cancer Research, London, United Kingdom
| | | | | | | | - Udai Banerji
- The Royal Marsden/Institute of Cancer Research, London, United Kingdom
| | - Johann S. De Bono
- The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, London, United Kingdom
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13
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Dean EJ, Banerji U, Girotti R, Niculescu-Duvaz I, Lopes F, Davies L, Niculescu-Duvaz D, Dhomen N, Ellis S, Ali Z, O'Carrigan B, Carter L, Chisolm L, Dive C, Lane HA, Lorigan P, Gore ME, Larkin J, Marais R, Springer C. A Phase 1 first-in-human trial to evaluate the safety and tolerability of CCT3833, an oral panRAF inhibitor, in patients with advanced solid tumours, including metastatic melanoma. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.tps9597] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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)
- Emma Jane Dean
- University of Manchester, The Christie Hospital NHS Foundation Trust, Manchester, United Kingdom
| | - Udai Banerji
- The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Sutton, United Kingdom
| | - Romina Girotti
- Cancer Research UK Manchester Institute, Manchester, United Kingdom
| | | | - Filipa Lopes
- The Institute of Cancer Research, London, United Kingdom
| | | | | | - Natalie Dhomen
- Cancer Research UK Manchester Institute, Manchester, United Kingdom
| | - Sally Ellis
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Zohra Ali
- The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, London, United Kingdom
| | - Brent O'Carrigan
- The Royal Marsden/Institute of Cancer Research, London, United Kingdom
| | - Louise Carter
- Experimental Cancer Medicine Team, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Luke Chisolm
- Cancer Research UK Manchester Institute, Manchester, United Kingdom
| | - Caroline Dive
- Cancer Research UK Manchester Institute, Manchester, United Kingdom
| | - Heidi A Lane
- Basilea Pharmaceutica International Ltd, Basel, Switzerland
| | - Paul Lorigan
- University of Manchester and The Christie NHS FT, Manchester, United Kingdom
| | | | - James Larkin
- The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, London, United Kingdom
| | - Richard Marais
- Cancer Research UK Manchester Institute, Manchester, United Kingdom
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14
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Harris SJ, O'Carrigan B, Lopez JS, Bhosle J, Banerji U, Popat S, De Bono JS, O'Brien ME, Yap TA. Clinical outcomes of advanced small cell lung cancer patients (SCLC pts) on phase I (Ph I) trials in the Drug Development Unit (DDU) at the Royal Marsden Hospital (RMH). J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e14048] [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)
| | - Brent O'Carrigan
- The Royal Marsden/Institute of Cancer Research, London, United Kingdom
| | | | | | - Udai Banerji
- The Royal Marsden/Institute of Cancer Research, London, United Kingdom
| | - Sanjay Popat
- Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Johann S. De Bono
- The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, London, United Kingdom
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15
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Yap TA, Luken MJDM, O'Carrigan B, Roda D, Papadatos-Pastos D, Lorente D, Tunariu N, Lopez RP, Gayle S, Riisnaes R, Figueiredo I, Miranda S, Carreira S, Yang F, Karan S, Penney M, Pollard J, Molife LR, Banerji U, Asmal M, Fields SZ, Bono JSD. Abstract PR14: Phase I trial of first-in-class ataxia telangiectasia-mutated and Rad3-related (ATR) inhibitor VX-970 as monotherapy (mono) or in combination with carboplatin (CP) in advanced cancer patients (pts) with preliminary evidence of target modulation and antitumor activity. Clin Trials 2016. [DOI: 10.1158/1535-7163.targ-15-pr14] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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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16
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O'Carrigan B, Fournier M, Olver IN, Stockler MR, Whitford H, Toner GC, Thomson DB, Davis ID, Hanning F, Singhal N, Underhill C, Clingan P, McDonald A, Boland A, Grimison P. Testosterone deficiency and quality of life in Australasian testicular cancer survivors: a prospective cohort study. Intern Med J 2015; 44:813-7. [PMID: 25081047 DOI: 10.1111/imj.12500] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [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: 12/23/2013] [Accepted: 05/01/2014] [Indexed: 11/29/2022]
Abstract
This is the first prospective study in a contemporary Australian/New Zealand population to determine the prevalence of testosterone deficiency in testicular cancer survivors at 12 months from treatment, and any association with poorer quality of life. Hormone assays from 54 evaluable patients in a prospective cohort study revealed biochemical hypogonadism in 18 patients (33%) and low-normal testosterone in 13 patients (24%). We found no association between testosterone levels and quality of life (all P > 0.05). Hypogonadal patients should be considered for testosterone replacement to prevent long-term morbidity.
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Affiliation(s)
- B O'Carrigan
- Chris O'Brien Lifehouse, Sydney, New South Wales, Australia; Sydney Medical School, Sydney, New South Wales, Australia
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17
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O'Carrigan B, Grimison P. Editorial Comment from Dr O'Carrigan and Dr Grimison to Identification of a subgroup with worse prognosis among patients with poor-risk testicular germ cell tumor. Int J Urol 2015; 22:928-9. [PMID: 26173657 DOI: 10.1111/iju.12872] [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: 11/30/2022]
Affiliation(s)
- Brent O'Carrigan
- Chris O'Brien Lifehouse, Camperdown, NSW, Australia. .,Sydney Medical School, The University of Sydney, Camperdown, NSW, Australia.
| | - Peter Grimison
- Chris O'Brien Lifehouse, Camperdown, NSW, Australia.,Sydney Medical School, The University of Sydney, Camperdown, NSW, Australia
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18
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Chan A, O'Carrigan B, McGregor S, Beith J. Abstract P6-11-10: Central nervous system metastases in breast cancer: Impact of tumour sub-type and outcome from current treatments. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-p6-11-10] [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: 11/16/2022]
Abstract
Abstract
Background: The use of more effective systemic therapies in the management of metastatic breast cancer has led to increased response rates, progression-free survival and overall survival. The incidence of central nervous system (CNS) metastases has become an increasingly important area of unmet need. It is important to identify tumour-related factors which may predict for CNS occurrence and assess the efficacy of treatments in current use.
Methods: Consecutive patients (pts) with breast cancer (BC) seen at 2 institutions following establishment of breast cancer databases were included: January 2000 (institution A) and January 2003 (institution B) to December 2012. Patient demographic data, tumour pathology and systemic treatment given were reviewed in those patients who developed CNS metastases. Multivariate analysis of factors impacting on overall survival in this patient population will be performed.
Results: Over the study period, 4751 pts with a median age of 52.7 yrs were seen, where 86.4% and 13.6% of pts presented with early and metastatic disease, respectively. In the entire population, 77% of tumours were hormone receptor positive, 21% HER2 positive, and 15% triple negative. Overall, 228 (4.8%) pts had CNS metastases with a median age of 48.9 yrs. CNS involvement was present at the time of first metastatic recurrence in 27% of pts who had CNS metastases. The proportion of pts developing CNS metastases according to tumour subtypes were: 48% hormone receptor positive, 36% Her2 positive, and 20% triple negative. Median time from diagnosis to development of CNS metastases (excluding pts with CNS involvement at the time of first metastatic disease) was 48.9 (4.7-248 months, m). The median time to development of CNS recurrence was 61m, 43m, 23m respectively, according to tumour subtype. CNS disease was parenchymal only, leptomeningeal only or both in 78%, 9%, 13% respectively. Pts who died from BC, had a median overall survival from initial BC diagnosis of 53.6m, whereas median overall survival from CNS metastases was 4.8 m. The impact of whole brain radiation with or without stereotactic therapy, surgical resection of brain metastases and type of systemic therapy administered following development of CNS disease on overall survival will be presented.
Discussion: CNS metastases occurred in up to 5% of breast cancer pts seen at two large cancer centres. Despite improvements in overall survival of metastatic BC pts with the use of more effective systemic treatments, the prognosis following CNS involvement remains extremely poor. Until specific interventions are available to manage CNS metastases in pts with breast cancer, it remains important to assess outcomes from current standard treatment in these pts.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P6-11-10.
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Affiliation(s)
- A Chan
- Breast Cancer Research Centre-WA and Curtin University, Perth, Western Australia, Australia; Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - B O'Carrigan
- Breast Cancer Research Centre-WA and Curtin University, Perth, Western Australia, Australia; Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - S McGregor
- Breast Cancer Research Centre-WA and Curtin University, Perth, Western Australia, Australia; Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - J Beith
- Breast Cancer Research Centre-WA and Curtin University, Perth, Western Australia, Australia; Royal Prince Alfred Hospital, Sydney, NSW, Australia
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O'Carrigan B, Cheong JY. Patient with a rash, abdominal pain, and weight loss. JAMA 2012; 307:843-4. [PMID: 22357835 DOI: 10.1001/jama.2012.198] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Brent O'Carrigan
- Central Clinical School, University of Sydney, Level 4, Bldg 63, Royal Prince Alfred Hospital, Missenden Road, Camperdown, NSW, 2050, Australia.
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