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Viswanathan A, Na HY, Breckenridge L, Muller A, Butts C, Reilly E, Geng T, Sigal A, Michels R, Ong A. Hypotension in the Emergency Department and Contrast Extravasation on Computerized Tomography Predict Blood Transfusion in Low-Energy Pelvic Fractures. J Surg Res 2024; 296:310-315. [PMID: 38306936 DOI: 10.1016/j.jss.2024.01.001] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 11/29/2023] [Accepted: 01/02/2024] [Indexed: 02/04/2024]
Abstract
INTRODUCTION Although low-energy pelvic fractures seldom present with significant hemorrhage, early recognition of at-risk patients is essential. We aimed to identify predictors of transfusion requirements in this cohort. METHODS A 7-y retrospective chart review was performed. Low-energy mechanism was defined as falls of ≤5 feet. Fracture pattern was classified using the Orthopedic Trauma Association/Arbeitsgemeinschaft für Osteosynthesefragen system as A, B, or C. Primary outcome was transfusion of ≥2 units of packed red blood cells in the first 48 h. Univariable analysis and logistic regression analysis were performed. A P value ≤0.05 was considered significant. RESULTS Five hundred forty six patients were included with median (interquartile range) age of 86 (79-91) and median (interquartile range) Injury Severity Score of 5 (4-8). Five hundred forty one (99%) had type A fractures. Twenty six (5%) had the primary outcome and 17 (3%) died. Logistic regression found that systolic blood pressure <100 mmHg at any time in the Emergency Department, Injury Severity Score, and pelvic angiography were predictors of the primary outcome. Seventeen percent of those who had the primary outcome died compared with 2% who did not (P = 0.0004). Three hundred sixty four (67%) received intravenous contrast for computerized tomography scans and of these, 44 (12%) had contrast extravasation (CE). CE was associated with the primary outcome but not mortality. CONCLUSIONS Hypotension at any time in the Emergency Department and CE on computerized tomography predicted transfusion of ≥2 units packed red blood cells in the first 48 h in patients with low-energy pelvic fractures.
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Affiliation(s)
| | - Hee Yun Na
- Drexel University College of Medicine, Wyomissing, Pennsylvania
| | - Leigham Breckenridge
- Department of Surgery, Reading Hospital, Tower Health System, West Reading, Pennsylvania
| | - Alison Muller
- Department of Surgery, Reading Hospital, Tower Health System, West Reading, Pennsylvania
| | - Christopher Butts
- Department of Surgery, Reading Hospital, Tower Health System, West Reading, Pennsylvania
| | - Eugene Reilly
- Department of Surgery, Reading Hospital, Tower Health System, West Reading, Pennsylvania
| | - Thomas Geng
- Department of Surgery, Reading Hospital, Tower Health System, West Reading, Pennsylvania
| | - Adam Sigal
- Department of Emergency Medicine, Reading Hospital, Tower Health System, West Reading, Pennsylvania
| | - Ryan Michels
- Department of Surgery, Reading Hospital, Tower Health System, West Reading, Pennsylvania
| | - Adrian Ong
- Department of Surgery, Reading Hospital, Tower Health System, West Reading, Pennsylvania.
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NeMoyer R, Butts C, Beckerman W, To J. Blunt Abdominal Aortic Dissection Treated by Endovascular Stent Placement. Am Surg 2020; 87:125-127. [PMID: 32845707 DOI: 10.1177/0003134820943543] [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: 11/15/2022]
Affiliation(s)
- Rachel NeMoyer
- Division of Acute Care Surgery, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Christopher Butts
- Division of Acute Care Surgery, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - William Beckerman
- Division of Vascular Surgery, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Jennifer To
- Division of Acute Care Surgery, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
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Chavarro C, Chu Y, Holbrook C, Isleib T, Bertioli D, Hovav R, Butts C, Lamb M, Sorensen R, A Jackson S, Ozias-Akins P. Pod and Seed Trait QTL Identification To Assist Breeding for Peanut Market Preferences. G3 (Bethesda) 2020; 10:2297-2315. [PMID: 32398236 PMCID: PMC7341151 DOI: 10.1534/g3.120.401147] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 05/01/2020] [Indexed: 12/20/2022]
Abstract
Although seed and pod traits are important for peanut breeding, little is known about the inheritance of these traits. A recombinant inbred line (RIL) population of 156 lines from a cross of Tifrunner x NC 3033 was genotyped with the Axiom_Arachis1 SNP array and SSRs to generate a genetic map composed of 1524 markers in 29 linkage groups (LG). The genetic positions of markers were compared with their physical positions on the peanut genome to confirm the validity of the linkage map and explore the distribution of recombination and potential chromosomal rearrangements. This linkage map was then used to identify Quantitative Trait Loci (QTL) for seed and pod traits that were phenotyped over three consecutive years for the purpose of developing trait-associated markers for breeding. Forty-nine QTL were identified in 14 LG for seed size index, kernel percentage, seed weight, pod weight, single-kernel, double-kernel, pod area and pod density. Twenty QTL demonstrated phenotypic variance explained (PVE) greater than 10% and eight more than 20%. Of note, seven of the eight major QTL for pod area, pod weight and seed weight (PVE >20% variance) were attributed to NC 3033 and located in a single linkage group, LG B06_1. In contrast, the most consistent QTL for kernel percentage were located on A07/B07 and derived from Tifrunner.
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Affiliation(s)
- Carolina Chavarro
- Center for Applied Genetic Technologies, University of Georgia, Athens, GA 30602
| | - Ye Chu
- Department of Horticulture and Institute of Plant Breeding, Genetics & Genomics, University of Georgia, Tifton, GA 31793
| | - Corley Holbrook
- USDA- Agricultural Research Service, Crop Genetics and Breeding Research Unit, Tifton, GA 31793
| | - Thomas Isleib
- Department of Crop Science, North Carolina State University, P.O. Box 7629, Raleigh, NC 27695
| | - David Bertioli
- Center for Applied Genetic Technologies, University of Georgia, Athens, GA 30602
| | - Ran Hovav
- Department of Field and Vegetable Crops, Plant Sciences Institute, ARO (Volcani Center), Bet Dagan, Israel, and
| | - Christopher Butts
- USDA- Agricultural Research Service, National Peanut Research Laboratory, Dawson, GA 39842
| | - Marshall Lamb
- USDA- Agricultural Research Service, National Peanut Research Laboratory, Dawson, GA 39842
| | - Ronald Sorensen
- USDA- Agricultural Research Service, National Peanut Research Laboratory, Dawson, GA 39842
| | - Scott A Jackson
- Center for Applied Genetic Technologies, University of Georgia, Athens, GA 30602
| | - Peggy Ozias-Akins
- Department of Horticulture and Institute of Plant Breeding, Genetics & Genomics, University of Georgia, Tifton, GA 31793,
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Chow M, Sakorafas L, Butts C, Song C, To J. Cecal Volvulus Resulting in Closed Loop Obstruction with Concomitant Gastric Perforation: A Unique Complication of the Lap-Band. Am Surg 2020. [DOI: 10.1177/000313481908501212] [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: 11/15/2022]
Affiliation(s)
- Monica Chow
- Division of Acute Care Surgery Department of Surgery Rutgers Robert Wood Johnson Medical School New Brunswick, New Jersey
| | - Lois Sakorafas
- Division of Acute Care Surgery Department of Surgery Rutgers Robert Wood Johnson Medical School New Brunswick, New Jersey
| | - Christopher Butts
- Division of Acute Care Surgery Department of Surgery Rutgers Robert Wood Johnson Medical School New Brunswick, New Jersey
| | - Cherry Song
- Division of Acute Care Surgery Department of Surgery Rutgers Robert Wood Johnson Medical School New Brunswick, New Jersey
| | - Jennifer To
- Division of Acute Care Surgery Department of Surgery Rutgers Robert Wood Johnson Medical School New Brunswick, New Jersey
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Lind M, Gettinger S, Borghaei H, Brahmer J, Chow L, Burgio M, De Castro Carpeno J, Pluzanski A, Arrieta O, Frontera OA, Chiari R, Butts C, Wojcik-Tomaszewska J, Coudert B, Garassino M, Ready N, Felip E, Garcia MA, Waterhouse D, Domine M, Barlesi F, Antonia S, Wohlleber M, Gerber D, Czyzewicz G, Spigel D, Crino L, Eberhardt W, Li A, Marimuthu S, Vokes E. Five-year outcomes from the randomized, phase 3 trials CheckMate 017/057: nivolumab vs docetaxel in previously treated NSCLC. Lung Cancer 2020. [DOI: 10.1016/s0169-5002(20)30141-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Chow M, Sakorafas L, Butts C, Song C, To J. Cecal Volvulus Resulting in Closed Loop Obstruction with Concomitant Gastric Perforation: A Unique Complication of the Lap-Band. Am Surg 2019; 85:e604-e605. [PMID: 31908242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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Vokes EE, Ready N, Felip E, Horn L, Burgio MA, Antonia SJ, Arén Frontera O, Gettinger S, Holgado E, Spigel D, Waterhouse D, Domine M, Garassino M, Chow LQM, Blumenschein G, Barlesi F, Coudert B, Gainor J, Arrieta O, Brahmer J, Butts C, Steins M, Geese WJ, Li A, Healey D, Crinò L. Nivolumab versus docetaxel in previously treated advanced non-small-cell lung cancer (CheckMate 017 and CheckMate 057): 3-year update and outcomes in patients with liver metastases. Ann Oncol 2019; 29:959-965. [PMID: 29408986 DOI: 10.1093/annonc/mdy041] [Citation(s) in RCA: 340] [Impact Index Per Article: 68.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background Long-term data with immune checkpoint inhibitors in non-small-cell lung cancer (NSCLC) are limited. Two phase III trials demonstrated improved overall survival (OS) and a favorable safety profile with the anti-programmed death-1 antibody nivolumab versus docetaxel in patients with previously treated advanced squamous (CheckMate 017) and nonsquamous (CheckMate 057) NSCLC. We report results from ≥3 years' follow-up, including subgroup analyses of patients with liver metastases, who historically have poorer prognosis among patients with NSCLC. Patients and methods Patients were randomized 1 : 1 to nivolumab (3 mg/kg every 2 weeks) or docetaxel (75 mg/m2 every 3 weeks) until progression or discontinuation. The primary end point of each study was OS. Patients with baseline liver metastases were pooled across studies by treatment for subgroup analyses. Results After 40.3 months' minimum follow-up in CheckMate 017 and 057, nivolumab continued to show an OS benefit versus docetaxel: estimated 3-year OS rates were 17% [95% confidence interval (CI), 14% to 21%] versus 8% (95% CI, 6% to 11%) in the pooled population with squamous or nonsquamous NSCLC. Nivolumab was generally well tolerated, with no new safety concerns identified. Of 854 randomized patients across both studies, 193 had baseline liver metastases. Nivolumab resulted in improved OS compared with docetaxel in patients with liver metastases (hazard ratio, 0.68; 95% CI, 0.50-0.91), consistent with findings from the overall pooled study population (hazard ratio, 0.70; 95% CI, 0.61-0.81). Rates of treatment-related hepatic adverse events (primarily grade 1-2 liver enzyme elevations) were slightly higher in nivolumab-treated patients with liver metastases (10%) than in the overall pooled population (6%). Conclusions After 3 years' minimum follow-up, nivolumab continued to demonstrate an OS benefit versus docetaxel in patients with advanced NSCLC. Similarly, nivolumab demonstrated an OS benefit versus docetaxel in patients with liver metastases, and remained well tolerated. Clinical trial registration CheckMate 017: NCT01642004; CheckMate 057: NCT01673867.
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Affiliation(s)
- E E Vokes
- Department of Medicine, University of Chicago Medicine & Biological Sciences, Chicago, USA.
| | - N Ready
- Department of Medicine, Duke University Medical Center, Durham, USA
| | - E Felip
- Lung Cancer Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - L Horn
- Thoracic Oncology Program, Vanderbilt-Ingram Cancer Center, Nashville, USA
| | - M A Burgio
- Medical Oncology Unit, Istituto Scientifico Romagnolo Per lo Studio e la Cura dei Tumori (IRST) IRCSS, Meldola, Italy
| | - S J Antonia
- Department of Thoracic Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, USA
| | - O Arén Frontera
- Oncologia Medica, Centro Internacional de Estudios Clinicos, Santiago, Chile, USA
| | - S Gettinger
- Department of Internal Medicine, Yale Comprehensive Cancer Center, New Haven, USA
| | - E Holgado
- Department of Medicine, Hospital De Madrid, Madrid, Spain
| | - D Spigel
- Research Consortium, Sarah Cannon Research Institute, Nashville, USA; Tennessee Oncology, PLLC, Nashville, USA
| | - D Waterhouse
- Department of Medical Oncology, OHC (Oncology Hematology Care), Cincinnati, USA; US Oncology, Cincinnati, USA
| | - M Domine
- Department of Medical Oncology, Fundación Jiménez Díaz, Madrid, Spain
| | - M Garassino
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - L Q M Chow
- Department of Medicine, University of Washington, Seattle, USA
| | - G Blumenschein
- Department of Thoracic/Head and Neck Medical Oncology, MD Anderson Cancer Center, Houston, USA
| | - F Barlesi
- Multidisciplinary Oncology & Therapeutic Innovations Departmen, Aix-Marseille Université, Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - B Coudert
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France
| | - J Gainor
- Cancer Center, Massachusetts General Hospital, Boston, USA
| | - O Arrieta
- Thoracic Oncology Unit and Laboratory, Instituto Nacional de Cancerología, Mexico City, Mexico
| | - J Brahmer
- Thoracic Oncology Program, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, USA
| | - C Butts
- Department of Oncolog, Division of Medical Oncology, Cross Cancer Institute, Edmonton, Canada
| | - M Steins
- Thoraxklinik, Heidelberg University Hospital, Heidelberg, Germany
| | - W J Geese
- Immuno-Oncology, Bristol-Myers Squibb, Princeton, USA
| | - A Li
- Immuno-Oncology, Bristol-Myers Squibb, Princeton, USA
| | - D Healey
- Immuno-Oncology, Bristol-Myers Squibb, Princeton, USA
| | - L Crinò
- Medical Oncology Unit, Istituto Scientifico Romagnolo Per lo Studio e la Cura dei Tumori (IRST) IRCSS, Meldola, Italy
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Gettinger S, Borghaei H, Brahmer J, Chow L, Burgio M, De Castro Carpeno J, Pluzanski A, Arrieta O, Frontera OA, Chiari R, Butts C, Wojcik-Tomaszewska J, Coudert B, Garassino M, Ready N, Felip E, Garcia MA, Waterhouse D, Domine M, Barlesi F, Antonia S, Wohlleber M, Gerber D, Czyzewicz G, Spigel D, Crino L, Eberhardt W, Li A, Marimuthu S, Vokes E. OA14.04 Five-Year Outcomes From the Randomized, Phase 3 Trials CheckMate 017/057: Nivolumab vs Docetaxel in Previously Treated NSCLC. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.486] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Bebb DG, Agulnik J, Albadine R, Banerji S, Bigras G, Butts C, Couture C, Cutz JC, Desmeules P, Ionescu DN, Leighl NB, Melosky B, Morzycki W, Rashid-Kolvear F, Lab C, Sekhon HS, Smith AC, Stockley TL, Torlakovic E, Xu Z, Tsao MS. Crizotinib inhibition of ROS1-positive tumours in advanced non-small-cell lung cancer: a Canadian perspective. Curr Oncol 2019; 26:e551-e557. [PMID: 31548824 PMCID: PMC6726257 DOI: 10.3747/co.26.5137] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
The ros1 kinase is an oncogenic driver in non-small-cell lung cancer (nsclc). Fusion events involving the ROS1 gene are found in 1%-2% of nsclc patients and lead to deregulation of a tyrosine kinase-mediated multi-use intracellular signalling pathway, which then promotes the growth, proliferation, and progression of tumour cells. ROS1 fusion is a distinct molecular subtype of nsclc, found independently of other recognized driver mutations, and it is predominantly identified in younger patients (<50 years of age), women, never-smokers, and patients with adenocarcinoma histology. Targeted inhibition of the aberrant ros1 kinase with crizotinib is associated with increased progression-free survival (pfs) and improved quality-of-life measures. As the sole approved treatment for ROS1-rearranged nsclc, crizotinib has been demonstrated, through a variety of clinical trials and retrospective analyses, to be a safe, effective, well-tolerated, and appropriate treatment for patients having the ROS1 rearrangement. Canadian physicians endorse current guidelines which recommend that all patients with nonsquamous advanced nsclc, regardless of clinical characteristics, be tested for ROS1 rearrangement. Future integration of multigene testing panels into the standard of care could allow for efficient and cost-effective comprehensive testing of all patients with advanced nsclc. If a ROS1 rearrangement is found, treatment with crizotinib, preferably in the first-line setting, constitutes the standard of care, with other treatment options being investigated, as appropriate, should resistance to crizotinib develop.
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Affiliation(s)
- D G Bebb
- Alberta: Tom Baker Cancer Centre and University of Calgary, Calgary (Bebb); Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton (Bigras); Cross Cancer Institute and University of Alberta, Edmonton (Butts); Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, and Calgary Laboratory Services, Calgary (Rashid-Kolvear)
| | - J Agulnik
- Quebec: Sir Mortimer B. Davis Jewish General Hospital, McGill University, Montreal (Agulnik); Department of Pathology, Centre hospitalier de l'Université de Montréal, Montreal (Albadine); Service d'anatomopathologie et de cytologie, Institut universitaire de cardiologie et de pneumologie de Québec-Université Laval, Quebec City (Couture, Desmeules)
| | - R Albadine
- Quebec: Sir Mortimer B. Davis Jewish General Hospital, McGill University, Montreal (Agulnik); Department of Pathology, Centre hospitalier de l'Université de Montréal, Montreal (Albadine); Service d'anatomopathologie et de cytologie, Institut universitaire de cardiologie et de pneumologie de Québec-Université Laval, Quebec City (Couture, Desmeules)
| | - S Banerji
- Manitoba: Department of Medical Oncology, University of Manitoba, Winnipeg (Banerji)
| | - G Bigras
- Alberta: Tom Baker Cancer Centre and University of Calgary, Calgary (Bebb); Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton (Bigras); Cross Cancer Institute and University of Alberta, Edmonton (Butts); Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, and Calgary Laboratory Services, Calgary (Rashid-Kolvear)
| | - C Butts
- Alberta: Tom Baker Cancer Centre and University of Calgary, Calgary (Bebb); Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton (Bigras); Cross Cancer Institute and University of Alberta, Edmonton (Butts); Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, and Calgary Laboratory Services, Calgary (Rashid-Kolvear)
| | - C Couture
- Quebec: Sir Mortimer B. Davis Jewish General Hospital, McGill University, Montreal (Agulnik); Department of Pathology, Centre hospitalier de l'Université de Montréal, Montreal (Albadine); Service d'anatomopathologie et de cytologie, Institut universitaire de cardiologie et de pneumologie de Québec-Université Laval, Quebec City (Couture, Desmeules)
| | - J C Cutz
- Ontario: St. Joseph's Healthcare, Hamilton Regional Laboratory Medicine Program, Department of Pathology and Molecular Medicine, McMaster University, Hamilton (Cutz); Princess Margaret Cancer Centre, University of Toronto, Toronto (Leighl); Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa (Sekhon); Department of Clinical Laboratory Genetics, Laboratory Medicine Program, University Health Network, and Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto (Smith, Stockley); Department of Laboratory Medicine and Pathobiology, Princess Margaret Cancer Centre, Toronto (Tsao)
| | - P Desmeules
- Quebec: Sir Mortimer B. Davis Jewish General Hospital, McGill University, Montreal (Agulnik); Department of Pathology, Centre hospitalier de l'Université de Montréal, Montreal (Albadine); Service d'anatomopathologie et de cytologie, Institut universitaire de cardiologie et de pneumologie de Québec-Université Laval, Quebec City (Couture, Desmeules)
| | - D N Ionescu
- British Columbia: Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver (Ionescu); BC Cancer-Vancouver Centre, Vancouver (Melosky)
| | - N B Leighl
- Ontario: St. Joseph's Healthcare, Hamilton Regional Laboratory Medicine Program, Department of Pathology and Molecular Medicine, McMaster University, Hamilton (Cutz); Princess Margaret Cancer Centre, University of Toronto, Toronto (Leighl); Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa (Sekhon); Department of Clinical Laboratory Genetics, Laboratory Medicine Program, University Health Network, and Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto (Smith, Stockley); Department of Laboratory Medicine and Pathobiology, Princess Margaret Cancer Centre, Toronto (Tsao)
| | - B Melosky
- British Columbia: Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver (Ionescu); BC Cancer-Vancouver Centre, Vancouver (Melosky)
| | - W Morzycki
- Nova Scotia: Queen Elizabeth iiHealth Sciences Centre and Dalhousie University, Halifax (Morzycki, Xu)
| | - F Rashid-Kolvear
- Alberta: Tom Baker Cancer Centre and University of Calgary, Calgary (Bebb); Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton (Bigras); Cross Cancer Institute and University of Alberta, Edmonton (Butts); Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, and Calgary Laboratory Services, Calgary (Rashid-Kolvear)
- Quebec: Sir Mortimer B. Davis Jewish General Hospital, McGill University, Montreal (Agulnik); Department of Pathology, Centre hospitalier de l'Université de Montréal, Montreal (Albadine); Service d'anatomopathologie et de cytologie, Institut universitaire de cardiologie et de pneumologie de Québec-Université Laval, Quebec City (Couture, Desmeules)
- Manitoba: Department of Medical Oncology, University of Manitoba, Winnipeg (Banerji)
- Ontario: St. Joseph's Healthcare, Hamilton Regional Laboratory Medicine Program, Department of Pathology and Molecular Medicine, McMaster University, Hamilton (Cutz); Princess Margaret Cancer Centre, University of Toronto, Toronto (Leighl); Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa (Sekhon); Department of Clinical Laboratory Genetics, Laboratory Medicine Program, University Health Network, and Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto (Smith, Stockley); Department of Laboratory Medicine and Pathobiology, Princess Margaret Cancer Centre, Toronto (Tsao)
- British Columbia: Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver (Ionescu); BC Cancer-Vancouver Centre, Vancouver (Melosky)
- Nova Scotia: Queen Elizabeth iiHealth Sciences Centre and Dalhousie University, Halifax (Morzycki, Xu)
- Saskatchewan: Department of Pathology and Laboratory Medicine, Saskatchewan Health Authority and University of Saskatchewan, Saskatoon (Torlakovic)
| | - Clin Lab
- Alberta: Tom Baker Cancer Centre and University of Calgary, Calgary (Bebb); Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton (Bigras); Cross Cancer Institute and University of Alberta, Edmonton (Butts); Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, and Calgary Laboratory Services, Calgary (Rashid-Kolvear)
| | - H S Sekhon
- Ontario: St. Joseph's Healthcare, Hamilton Regional Laboratory Medicine Program, Department of Pathology and Molecular Medicine, McMaster University, Hamilton (Cutz); Princess Margaret Cancer Centre, University of Toronto, Toronto (Leighl); Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa (Sekhon); Department of Clinical Laboratory Genetics, Laboratory Medicine Program, University Health Network, and Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto (Smith, Stockley); Department of Laboratory Medicine and Pathobiology, Princess Margaret Cancer Centre, Toronto (Tsao)
| | - A C Smith
- Ontario: St. Joseph's Healthcare, Hamilton Regional Laboratory Medicine Program, Department of Pathology and Molecular Medicine, McMaster University, Hamilton (Cutz); Princess Margaret Cancer Centre, University of Toronto, Toronto (Leighl); Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa (Sekhon); Department of Clinical Laboratory Genetics, Laboratory Medicine Program, University Health Network, and Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto (Smith, Stockley); Department of Laboratory Medicine and Pathobiology, Princess Margaret Cancer Centre, Toronto (Tsao)
| | - T L Stockley
- Ontario: St. Joseph's Healthcare, Hamilton Regional Laboratory Medicine Program, Department of Pathology and Molecular Medicine, McMaster University, Hamilton (Cutz); Princess Margaret Cancer Centre, University of Toronto, Toronto (Leighl); Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa (Sekhon); Department of Clinical Laboratory Genetics, Laboratory Medicine Program, University Health Network, and Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto (Smith, Stockley); Department of Laboratory Medicine and Pathobiology, Princess Margaret Cancer Centre, Toronto (Tsao)
| | - E Torlakovic
- Saskatchewan: Department of Pathology and Laboratory Medicine, Saskatchewan Health Authority and University of Saskatchewan, Saskatoon (Torlakovic)
| | - Z Xu
- Nova Scotia: Queen Elizabeth iiHealth Sciences Centre and Dalhousie University, Halifax (Morzycki, Xu)
| | - M S Tsao
- Ontario: St. Joseph's Healthcare, Hamilton Regional Laboratory Medicine Program, Department of Pathology and Molecular Medicine, McMaster University, Hamilton (Cutz); Princess Margaret Cancer Centre, University of Toronto, Toronto (Leighl); Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa (Sekhon); Department of Clinical Laboratory Genetics, Laboratory Medicine Program, University Health Network, and Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto (Smith, Stockley); Department of Laboratory Medicine and Pathobiology, Princess Margaret Cancer Centre, Toronto (Tsao)
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Juergens RA, Mariano C, Jolivet J, Finn N, Rothenstein J, Reaume MN, Faghih A, Labbé C, Owen S, Shepherd FA, Villeneuve J, Romeyer F, Pettersson F, Butts C. Real-world benefit of nivolumab in a Canadian non-small-cell lung cancer cohort. ACTA ACUST UNITED AC 2018; 25:384-392. [PMID: 30607113 DOI: 10.3747/co.25.4287] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [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: 01/14/2023]
Abstract
Background Nivolumab was the first immuno-oncology agent available for the treatment of lung cancer in Canada. In the present study, we evaluated the real-world benefit of nivolumab in Canadian patients with lung cancer. Methods Patients included in the cohort were identified from a registry of patients treated through expanded access to nivolumab before and after Health Canada approval. Demographics were collected from the application forms. Outcome data for the duration of treatment and survival were collected retrospectively. Results In contrast to the randomized clinical trial populations, our study cohort included patients who were older (median age: 66 years; range: 36-92 years) and who had an Eastern Cooperative Oncology Group performance status of 2 (8.9%). Despite the poorer-prognosis cohort, median overall survival was 12.0 months, which is comparable to the survival demonstrated in the randomized phase iii trials of nivolumab in lung cancer. Median time to treatment discontinuation was 3.45 months and was similar for all patient subgroups, including poorer-prognosis groups such as those with a performance status of 2, those 75 years of age and older, and those with brain metastases. Conclusions Nivolumab given in a real-world clinical setting was associated with results similar to those reported in the phase iii clinical trial setting.
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Affiliation(s)
| | - C Mariano
- Royal Columbian Hospital, New Westminster, BC
| | - J Jolivet
- Recherche médicale Saint-Jérôme Inc., Saint-Jérôme, QC
| | - N Finn
- Centre hospitalier universitaire Dr-Georges-L.-Dumont, Moncton, NB
| | - J Rothenstein
- R.S. McLaughlin Durham Regional Cancer Centre, Oshawa, ON
| | - M N Reaume
- The Ottawa Hospital Cancer Centre, Ottawa, ON
| | - A Faghih
- Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON
| | - C Labbé
- Institut universitaire de cardiologie et de pneumologie de Québec, Quebec City, QC
| | - S Owen
- McGill University Health Centre, Montreal, QC
| | | | | | | | | | - C Butts
- Cross Cancer Institute, Edmonton, AB
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11
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Melosky B, Cheema P, Agulnik J, Albadine R, Bebb DG, Blais N, Burkes R, Butts C, Card PB, Chan AMY, Hirsh V, Ionescu DN, Juergens R, Morzycki W, Poonja Z, Sangha R, Tehfe M, Tsao MS, Vincent M, Xu Z, Liu G. Canadian perspectives: update on inhibition of ALK-positive tumours in advanced non-small-cell lung cancer. Curr Oncol 2018; 25:317-328. [PMID: 30464681 PMCID: PMC6209554 DOI: 10.3747/co.25.4379] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background Inhibition of the anaplastic lymphoma kinase (alk) oncogenic driver in advanced non-small-cell lung carcinoma (nsclc) improves survival. In 2015, Canadian thoracic oncology specialists published a consensus guideline about the identification and treatment of ALK-positive patients, recommending use of the alk inhibitor crizotinib in the first line. New scientific literature warrants a consensus update. Methods Clinical trials of alk inhibitor were reviewed to assess benefits, risks, and implications relative to current Canadian guidance in patients with ALK-positive nsclc. Results Randomized phase iii trials have demonstrated clinical benefit for single-agent alectinib and ceritinib used in treatment-naïve patients and as second-line therapy after crizotinib. Phase ii trials have demonstrated activity for single-agent brigatinib and lorlatinib in further lines of therapy. Improved responses in brain metastases were observed for all second- and next/third-generation alk tyrosine kinase inhibitors in patients progressing on crizotinib. Canadian recommendations are therefore revised as follows:■ Patients with advanced nonsquamous nsclc have to be tested for the presence of an ALK rearrangement.■ Treatment-naïve patients with ALK-positive disease should initially be offered single-agent alectinib or ceritinib, or both sequentially.■ Crizotinib-refractory patients should be treated with single-agent alectinib or ceritinib, or both sequentially.■ Further treatments could include single-agent brigatinib or lorlatinib, or both sequentially.■ Patients progressing on alk tyrosine kinase inhibitors should be considered for pemetrexed-based chemotherapy.■ Other systemic therapies should be exhausted before immunotherapy is considered. Summary Multiple lines of alk inhibition are now recommended for patients with advanced nsclc with an ALK rearrangement.
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Affiliation(s)
- B Melosky
- BC Cancer-Vancouver Centre, Vancouver, BC
| | - P Cheema
- William Osler Health System, University of Toronto, Brampton, ON
| | - J Agulnik
- Sir Mortimer B. Davis Jewish General Hospital, McGill University, Montreal, QC
| | - R Albadine
- Centre hospitalier de l'Université de Montréal, Montreal, QC
| | - D G Bebb
- Tom Baker Cancer Centre and University of Calgary, Calgary, AB
| | - N Blais
- Centre hospitalier de l'Université de Montréal, Montreal, QC
| | - R Burkes
- Mount Sinai Hospital, Toronto, ON
| | - C Butts
- Cross Cancer Institute and University of Alberta, Edmonton, AB
| | - P B Card
- Kaleidoscope Strategic, Inc., Toronto, ON
| | - A M Y Chan
- Tom Baker Cancer Centre and University of Calgary, Calgary, AB
| | - V Hirsh
- Royal Victoria Hospital, McGill University Health Centre, Montreal, QC
| | | | - R Juergens
- Juravinski Cancer Centre, McMaster University, Hamilton, ON
| | - W Morzycki
- qeii Health Sciences Centre, Halifax, NS
| | - Z Poonja
- BC Cancer-Vancouver Island Center, Victoria, BC
| | - R Sangha
- Cross Cancer Institute and University of Alberta, Edmonton, AB
| | - M Tehfe
- Centre hospitalier de l'Université de Montréal, Montreal, QC
| | - M S Tsao
- University Health Network, Princess Margaret Cancer Centre, Toronto, ON
| | - M Vincent
- University of Western Ontario, London, ON
| | - Z Xu
- qeii Health Sciences Centre, Halifax, NS
| | - G Liu
- University Health Network, Princess Margaret Cancer Centre, Toronto, ON
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12
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Butts C. MS18.04 Retreatment with Platinum and Etoposide and Treatment Beyond Second Line. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.164] [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: 10/28/2022]
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13
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Felip Font E, Gettinger S, Burgio M, Antonia S, Holgado E, Spigel D, Arrieta O, Domine Gomez M, Aren Frontera O, Brahmer J, Chow L, Crinò L, Butts C, Coudert B, Horn L, Steins M, Geese W, Li A, Healey D, Vokes E. Three-year follow-up from CheckMate 017/057: Nivolumab versus docetaxel in patients with previously treated advanced non-small cell lung cancer (NSCLC). Ann Oncol 2017. [DOI: 10.1093/annonc/mdx380.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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14
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Healey G, Murphy R, Butts C, Brough L, Rosendale D, Blatchford P, Stoklosinski H, Coad J. Variability in gut microbiota response to an inulin-type fructan prebiotic within an in vitro three-stage continuous colonic model system. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.bcdf.2017.07.001] [Citation(s) in RCA: 4] [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: 01/12/2023]
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15
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Cabanero M, Sangha R, Sheffield BS, Sukhai M, Pakkal M, Kamel-Reid S, Karsan A, Ionescu D, Juergens RA, Butts C, Tsao MS. Management of EGFR-mutated non-small-cell lung cancer: practical implications from a clinical and pathology perspective. ACTA ACUST UNITED AC 2017; 24:111-119. [PMID: 28490925 DOI: 10.3747/co.24.3524] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [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: 02/07/2023]
Abstract
Starting in the early 2000s, non-small-cell lung cancer (nsclc) subtypes have evolved from being histologically described to molecularly defined. Management of lung adenocarcinomas now generally requires multiple molecular tests at baseline to define the optimal treatment strategy. More recently, second biopsies performed at progression in patients treated with tyrosine kinase inhibitors (tkis) have further defined the continued use of molecularly targeted therapy. In the present article, we focus on one molecular subtype: EGFR-mutated nsclc. For that patient population, multiple lines of tki therapy are now available either clinically or in clinical trials. Each line of treatment is guided by the specific mutations (for example, L858R, T790M, C797S) identified in EGFR. We first describe the various mechanisms of acquired resistance to EGFR tki treatment. We then focus on strategies that clinicians and pathologists can both use during tissue acquisition and handling to optimize patient results. We also discuss future directions for the molecular characterization of lung cancers with driver mutations, including liquid biopsies. Finally, we provide an algorithm to guide treating physicians managing patients with EGFR-mutated nsclc. The same framework can also be applied to other molecularly defined nsclc subgroups as resistance patterns are elucidated and additional lines of treatment are developed.
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Affiliation(s)
- M Cabanero
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON
| | - R Sangha
- Cross Cancer Institute, Edmonton, AB
| | | | - M Sukhai
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON
| | - M Pakkal
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON
| | - S Kamel-Reid
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON
| | | | | | - R A Juergens
- Juravinski Cancer Centre, McMaster University, Hamilton, ON
| | - C Butts
- Cross Cancer Institute, Edmonton, AB
| | - M S Tsao
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON
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16
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Kim JOA, Davis F, Butts C, Winget M. Waiting Time Intervals for Non-small Cell Lung Cancer Diagnosis and Treatment in Alberta: Quantification of Intervals and Identification of Risk Factors Associated with Delays. Clin Oncol (R Coll Radiol) 2016; 28:750-759. [PMID: 27357099 DOI: 10.1016/j.clon.2016.06.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [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: 12/22/2015] [Revised: 05/30/2016] [Accepted: 06/01/2016] [Indexed: 11/26/2022]
Abstract
AIMS Very little is known regarding the time required to diagnose and treat patients with non-small cell lung cancer (NSCLC) in Canada. We sought to quantify diagnostic and treatment intervals for NSCLC care in Alberta and identify risk factors for delays. MATERIALS AND METHODS The Alberta Cancer Registry identified all cases of stage I-III NSCLC diagnosed and treated in Alberta, Canada from 2004 to 2011. Diagnostic data were obtained from physician billing, inpatient/outpatient hospital data and electronic medical records to quantify the duration of diagnostic and treatment intervals and their sum (system interval). Multivariable logistic regression was carried out to identify factors associated with delays. RESULTS Of the 3009 eligible patients included, the median and 90th percentile system interval was 78 (95% confidence interval 76-80) and 185 days (95% confidence interval 178-195), respectively. The treatment interval was longer than the diagnostic interval, with medians of 51 (95% confidence interval 49-53) and 38 (95% confidence interval 36-40) days, respectively. After adjustment, age > 60 years and treatment by modalities other than supportive care (especially surgery) were associated with delays. Factors associated with prompt care included high acuity presentations and stage III disease. CONCLUSION The majority of Albertans with potentially curable NSCLC exceeded guidelines for the timeliness of their care.
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Affiliation(s)
- J O A Kim
- Department of Oncology, University of Alberta, Edmonton, Alberta, Canada.
| | - F Davis
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - C Butts
- Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - M Winget
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada; Department of Medicine, School of Medicine, Stanford University, Stanford, California, USA
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17
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Melosky B, Agulnik J, Albadine R, Banerji S, Bebb DG, Bethune D, Blais N, Butts C, Cheema P, Cheung P, Cohen V, Deschenes J, Ionescu DN, Juergens R, Kamel-Reid S, Laurie SA, Liu G, Morzycki W, Tsao MS, Xu Z, Hirsh V. Canadian consensus: inhibition of ALK-positive tumours in advanced non-small-cell lung cancer. ACTA ACUST UNITED AC 2016; 23:196-200. [PMID: 27330348 DOI: 10.3747/co.23.3120] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [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: 12/22/2022]
Abstract
Anaplastic lymphoma kinase (alk) is an oncogenic driver in non-small-cell lung cancer (nsclc). Chromosomal rearrangements involving the ALK gene occur in up to 4% of nonsquamous nsclc patients and lead to constitutive activation of the alk signalling pathway. ALK-positive nsclc is found in relatively young patients, with a median age of 50 years. Patients frequently have brain metastasis. Targeted inhibition of the alk pathway prolongs progression-free survival in patients with ALK-positive advanced nsclc. The results of several recent clinical trials confirm the efficacy and safety benefit of crizotinib and ceritinib in this population. Canadian oncologists support the following consensus statement: All patients with advanced nonsquamous nsclc (excluding pure neuroendocrine carcinoma) should be tested for the presence of an ALK rearrangement. If an ALK rearrangement is present, treatment with a targeted alk inhibitor in the first-line setting is recommended. As patients become resistant to first-generation alk inhibitors, other treatments, including second-generation alk inhibitors can be considered.
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Affiliation(s)
- B Melosky
- British Columbia: BC Cancer Agency, Vancouver Centre, Vancouver, BC (Melosky, Ionescu)
| | - J Agulnik
- Quebec: Jewish General Hospital, McGill University, Montreal, QC (Agulnik); chum -Hôpital St-Luc, Montreal, QC (Albadine); chum -Hôpital Notre-Dame, Montreal, QC (Blais); Royal Victoria Hospital, Montreal, QC (Hirsh); Segal Cancer Centre and Sir Mortimer B. Davis Jewish General Hospital, Montreal, QC (Cohen)
| | - R Albadine
- Quebec: Jewish General Hospital, McGill University, Montreal, QC (Agulnik); chum -Hôpital St-Luc, Montreal, QC (Albadine); chum -Hôpital Notre-Dame, Montreal, QC (Blais); Royal Victoria Hospital, Montreal, QC (Hirsh); Segal Cancer Centre and Sir Mortimer B. Davis Jewish General Hospital, Montreal, QC (Cohen)
| | - S Banerji
- Manitoba: CancerCare Manitoba and University of Manitoba, Winnipeg, MB (Banerji)
| | - D G Bebb
- Alberta: Tom Baker Cancer Centre, Calgary, AB (Bebb); Cross Cancer Institute and University of Alberta, Edmonton, AB (Butts, Deschenes)
| | - D Bethune
- Nova Scotia: QEII Health Sciences Centre, Halifax, NS (Bethune, Morzycki, Xu)
| | - N Blais
- Quebec: Jewish General Hospital, McGill University, Montreal, QC (Agulnik); chum -Hôpital St-Luc, Montreal, QC (Albadine); chum -Hôpital Notre-Dame, Montreal, QC (Blais); Royal Victoria Hospital, Montreal, QC (Hirsh); Segal Cancer Centre and Sir Mortimer B. Davis Jewish General Hospital, Montreal, QC (Cohen)
| | - C Butts
- Alberta: Tom Baker Cancer Centre, Calgary, AB (Bebb); Cross Cancer Institute and University of Alberta, Edmonton, AB (Butts, Deschenes)
| | - P Cheema
- Ontario: Sunnybrook Odette Cancer Centre, Toronto, ON (Cheema, Cheung); Juravinski Cancer Centre, Hamilton, ON (Juergens); University Health Network, Princess Margaret Cancer Centre, Toronto, ON (Kamel-Reid, Liu, Tsao); The Ottawa Hospital Cancer Centre, Ottawa, ON (Laurie)
| | - P Cheung
- Ontario: Sunnybrook Odette Cancer Centre, Toronto, ON (Cheema, Cheung); Juravinski Cancer Centre, Hamilton, ON (Juergens); University Health Network, Princess Margaret Cancer Centre, Toronto, ON (Kamel-Reid, Liu, Tsao); The Ottawa Hospital Cancer Centre, Ottawa, ON (Laurie)
| | - V Cohen
- Quebec: Jewish General Hospital, McGill University, Montreal, QC (Agulnik); chum -Hôpital St-Luc, Montreal, QC (Albadine); chum -Hôpital Notre-Dame, Montreal, QC (Blais); Royal Victoria Hospital, Montreal, QC (Hirsh); Segal Cancer Centre and Sir Mortimer B. Davis Jewish General Hospital, Montreal, QC (Cohen)
| | - J Deschenes
- Alberta: Tom Baker Cancer Centre, Calgary, AB (Bebb); Cross Cancer Institute and University of Alberta, Edmonton, AB (Butts, Deschenes)
| | - D N Ionescu
- British Columbia: BC Cancer Agency, Vancouver Centre, Vancouver, BC (Melosky, Ionescu)
| | - R Juergens
- Ontario: Sunnybrook Odette Cancer Centre, Toronto, ON (Cheema, Cheung); Juravinski Cancer Centre, Hamilton, ON (Juergens); University Health Network, Princess Margaret Cancer Centre, Toronto, ON (Kamel-Reid, Liu, Tsao); The Ottawa Hospital Cancer Centre, Ottawa, ON (Laurie)
| | - S Kamel-Reid
- Ontario: Sunnybrook Odette Cancer Centre, Toronto, ON (Cheema, Cheung); Juravinski Cancer Centre, Hamilton, ON (Juergens); University Health Network, Princess Margaret Cancer Centre, Toronto, ON (Kamel-Reid, Liu, Tsao); The Ottawa Hospital Cancer Centre, Ottawa, ON (Laurie)
| | - S A Laurie
- British Columbia: BC Cancer Agency, Vancouver Centre, Vancouver, BC (Melosky, Ionescu)
| | - G Liu
- British Columbia: BC Cancer Agency, Vancouver Centre, Vancouver, BC (Melosky, Ionescu)
| | - W Morzycki
- Nova Scotia: QEII Health Sciences Centre, Halifax, NS (Bethune, Morzycki, Xu)
| | - M S Tsao
- Ontario: Sunnybrook Odette Cancer Centre, Toronto, ON (Cheema, Cheung); Juravinski Cancer Centre, Hamilton, ON (Juergens); University Health Network, Princess Margaret Cancer Centre, Toronto, ON (Kamel-Reid, Liu, Tsao); The Ottawa Hospital Cancer Centre, Ottawa, ON (Laurie)
| | - Z Xu
- Nova Scotia: QEII Health Sciences Centre, Halifax, NS (Bethune, Morzycki, Xu)
| | - V Hirsh
- Quebec: Jewish General Hospital, McGill University, Montreal, QC (Agulnik); chum -Hôpital St-Luc, Montreal, QC (Albadine); chum -Hôpital Notre-Dame, Montreal, QC (Blais); Royal Victoria Hospital, Montreal, QC (Hirsh); Segal Cancer Centre and Sir Mortimer B. Davis Jewish General Hospital, Montreal, QC (Cohen)
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18
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Mitchell P, Thatcher N, Socinski MA, Wasilewska-Tesluk E, Horwood K, Szczesna A, Martín C, Ragulin Y, Zukin M, Helwig C, Falk M, Butts C, Shepherd FA. Tecemotide in unresectable stage III non-small-cell lung cancer in the phase III START study: updated overall survival and biomarker analyses. Ann Oncol 2015; 26:1134-1142. [PMID: 25722382 DOI: 10.1093/annonc/mdv104] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 02/12/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Tecemotide is a MUC1-antigen-specific cancer immunotherapy. The phase III START study did not meet its primary end point but reported notable survival benefit with tecemotide versus placebo in an exploratory analysis of the predefined patient subgroup treated with concurrent chemoradiotherapy. Here, we attempted to gain further insight into the effects of tecemotide in START. PATIENTS AND METHODS START recruited patients who did not progress following frontline chemoradiotherapy for unresectable stage III non-small-cell lung cancer. We present updated overall survival (OS) data and exploratory analyses of OS for baseline biomarkers: soluble MUC1 (sMUC1), antinuclear antibodies (ANA), neutrophil/lymphocyte ratio (NLR), lymphocyte count, and HLA type. RESULTS Updated OS data are consistent with the primary analysis: median 25.8 months (tecemotide) versus 22.4 months (placebo) (HR 0.89, 95% CI 0.77-1.03, P = 0.111), with ∼20 months additional median follow-up time compared with the primary analysis. Exploratory analysis of the predefined subgroup treated with concurrent chemoradiotherapy revealed clinically relevant prolonged OS with tecemotide versus placebo (29.4 versus 20.8 months; HR 0.81, 95% CI 0.68-0.98, P = 0.026). No improvement was seen with sequential chemoradiotherapy. High sMUC1 and ANA correlated with a possible survival benefit with tecemotide (interaction P = 0.0085 and 0.0022) and might have future value as biomarkers. Interactions between lymphocyte count, NLR, or prespecified HLA alleles and treatment effect were not observed. CONCLUSION Updated OS data support potential treatment benefit with tecemotide in patients treated with concurrent chemoradiotherapy. Exploratory biomarker analyses suggest that elevated sMUC1 or ANA levels correlate with tecemotide benefit. CLINICALTRIALSGOV NUMBER NCT00409188.
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Affiliation(s)
- P Mitchell
- Olivia Newton-John Cancer and Wellness Centre, Austin Hospital, Melbourne, Australia.
| | - N Thatcher
- Christie Hospital NHS Trust, Manchester, UK
| | | | | | - K Horwood
- Princess Alexandra Hospital, Woolloongabba, Australia
| | - A Szczesna
- Mazowieckie Centrum Leczenia Chorób Pluc i Gruzlicy, Otwock, Poland
| | - C Martín
- Division of Clinical Oncology, Instituto Especializado Alexander Fleming, Buenos Aires, Argentina
| | - Y Ragulin
- Medical Radiological Research Center, Obninsk, Russia
| | - M Zukin
- Clinical Oncology, Instituto Nacional do Câncer-INCA, Rio de Janeiro, Brazil
| | | | - M Falk
- Merck KGaA, Darmstadt, Germany
| | - C Butts
- Cancer Care, Cross Cancer Institute, Edmonton
| | - F A Shepherd
- University Health Network, Princess Margaret Cancer Centre, Toronto, Canada
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19
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Butts C, Kamel–Reid S, Batist G, Chia S, Blanke C, Moore M, Sawyer M, Desjardins C, Dubois A, Pun J, Bonter K, Ashbury F. Benefits, issues, and recommendations for personalized medicine in oncology in Canada. Curr Oncol 2013; 20:e475-83. [PMID: 24155644 PMCID: PMC3805416 DOI: 10.3747/co.20.1253] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [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: 01/09/2023] Open
Abstract
The burden of cancer for Canadian citizens and society is large. New technologies have the potential to increase the use of genetic information in clinical decision-making, furthering prevention, surveillance, and safer, more effective drug therapies for cancer patients. Personalized medicine can have different meanings to different people. The context for personalized medicine in the present paper is genetic testing, which offers the promise of refining treatment decisions for those diagnosed with chronic and life-threatening illnesses. Personalized medicine and genetic characterization of tumours can also give direction to the development of novel drugs. Genetic testing will increasingly become an essential part of clinical decision-making. In Canada, provinces are responsible for health care, and most have unique policies and programs in place to address cancer control. The result is inconsistency in access to and delivery of therapies and other interventions, beyond the differences expected because of demographic factors and clinical education. Inconsistencies arising from differences in resources, policy, and application of evidence-informed personalized cancer medicine exacerbate patient access to appropriate testing and quality care. Geographic variations in cancer incidence and mortality rates in Canada-with the Atlantic provinces and Quebec having higher rates, and British Columbia having the lowest rates-are well documented. Our purpose here is to provide an understanding of current and future applications of personalized medicine in oncology, to highlight the benefits of personalized medicine for patients, and to describe issues and opportunities for improvement in the coordination of personalized medicine in Canada. Efficient and more rapid adoption of personalized medicine in oncology in Canada could help overcome those issues and improve cancer prevention and care. That task might benefit from the creation of a National Genetics Advisory Panel that would review research and provide recommendations on tests for funding or reimbursement, guidelines, service delivery models, laboratory quality assurance, education, and communication. More has to be known about the current state of personalized cancer medicine in Canada, and strategies have to be developed to inform and improve understanding and appropriate coordination and delivery. Our hope is that the perspectives emphasized in this paper will stimulate discussion and further research to create a more informed response.
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Affiliation(s)
- C. Butts
- Department of Oncology, University of Alberta, Cross Cancer Institute, Edmonton, AB
| | - S. Kamel–Reid
- Department of Pathology, Division of Molecular Diagnostics, The University Health Network, Toronto, ON
| | - G. Batist
- Segal Cancer Centre, Jewish General Hospital, McGill University, QC
| | - S. Chia
- Department of Medicine, University of British Columbia, BC Cancer Agency, Vancouver, BC
| | - C. Blanke
- Medical Oncology, Vancouver General Hospital and the University of British Columbia, and Systemic Therapy, BC Cancer Agency, Vancouver, BC
| | - M. Moore
- Medical Oncology and Hematology, Princess Margaret Hospital, University Health Network, and Mount Sinai Hospital, Toronto, ON
| | - M.B. Sawyer
- Department of Oncology, University of Alberta, Cross Cancer Institute, Edmonton, AB
| | - C. Desjardins
- Centre of Excellence in Personalised Medicine, Montreal, QC
| | - A. Dubois
- Centre of Excellence in Personalised Medicine, Montreal, QC
| | - J. Pun
- Intelligent Improvement Consultants, Inc., Toronto, ON
| | - K. Bonter
- Centre of Excellence in Personalised Medicine, Montreal, QC
| | - F.D. Ashbury
- lllawarra Health Medical Research Institute, University of Wollongong, NSW, Australia; Division of Preventive Oncology, University of Calgary, Calgary, AB; Department of Health Policy, Management and Evaluation, University of Toronto, and Intelligent Improvement Consultants, Inc., Toronto, ON
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20
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Li X, Scarfe A, King K, Fenton D, Butts C, Winget M. Timeliness of cancer care from diagnosis to treatment: a comparison between patients with breast, colon, rectal or lung cancer. Int J Qual Health Care 2013; 25:197-204. [DOI: 10.1093/intqhc/mzt003] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
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21
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Butts C, Murray R, Smith C, Ellis P, Jasas K, Maksymiuk A, Goss G, Falk M, Loos A, Soulières D. Long-Term Efficacy and Safety of L-BLP25 Vaccine in a Multi-Centre Open-Label Study of Patients with Unresectable Stage III NSCLC. Ann Oncol 2012. [DOI: 10.1016/s0923-7534(20)33763-7] [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: 10/25/2022] Open
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22
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Gill S, Berry S, Biagi J, Butts C, Buyse M, Chen E, Jonker D, Mărginean C, Samson B, Stewart J, Thirlwell M, Wong R, Maroun J. Progression-free survival as a primary endpoint in clinical trials of metastatic colorectal cancer. Curr Oncol 2011; 18 Suppl 2:S5-S10. [PMID: 21969810 PMCID: PMC3176908] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
In recent years, significant advances have been made in the management of metastatic colorectal cancer. Traditionally, an improvement in overall survival has been considered the "gold standard"-the most convincing measure of efficacy. However, overall survival requires larger patient numbers and longer follow-up and may often be confounded by other factors, including subsequent therapies and crossover. Given the number of active therapies for potential investigation, demand for rapid evaluation and early availability of new therapies is growing. Progression-free survival is regarded as an important measure of treatment benefit and, compared with overall survival, can be evaluated earlier, with fewer patients and no confounding by subsequent lines of therapy. The present paper reviews the advantages, limitations, and relevance of progression-free survival as a primary endpoint in randomized trials of metastatic colorectal cancer.
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Affiliation(s)
- S. Gill
- University of British Columbia, Division of Medical Oncology, and BC Cancer Agency, Vancouver, BC
| | - S. Berry
- Sunnybrook Odette Cancer Centre and University of Toronto, Toronto, ON
| | - J. Biagi
- Department of Oncology, Queen’s University, Kingston, ON
| | - C. Butts
- Cross Cancer Institute and University of Alberta, Edmonton, AB
| | - M. Buyse
- International Drug Development Institute, Louvain-la-Neuve, and I-BioStat, Hasselt University, Diepenbeek, Belgium
| | - E. Chen
- Department of Medical Oncology and Hematology, Princess Margaret Hospital, Toronto, ON
| | - D. Jonker
- Ottawa Hospital Cancer Centre, Ottawa, ON
| | | | - B. Samson
- Centre intégré de cancer de la Montérégie de l’Hôpital Charles-Lemoyne, Greenfield Park, QC
| | - J. Stewart
- University Health Network, Princess Margaret Hospital, Toronto, ON
| | - M. Thirlwell
- McGill University, McGill University Health Centre, and Montreal General Hospital, Montreal, QC
| | - R. Wong
- CancerCare Manitoba, University of Manitoba, Winnipeg, MB
| | - J.A. Maroun
- Ottawa Hospital Cancer Centre and University of Ottawa, Ottawa, ON
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23
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Gill S, Berry S, Biagi J, Butts C, Buyse M, Chen E, Jonker D, Mărginean C, Samson B, Stewart J, Thirlwell M, Wong R, Maroun J. Progression-Free Survival as a Primary Endpoint in Clinical Trials of Metastatic Colorectal Cancer. Curr Oncol 2011. [DOI: 10.3747/co.v18is2.941] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
In recent years, significant advances have been made in the management of metastatic colorectal cancer. Traditionally, an improvement in overall survival has been considered the “gold standard”—the most convincing measure of efficacy. However, overall survival requires larger patient numbers and longer follow-up and may often be confounded by other factors, including subsequent therapies and crossover. Given the number of active therapies for potential investigation, demand for rapid evaluation and early availability of new therapies is growing. Progression-free survival is regarded as an important measure of treatment benefit and, compared with overall survival, can be evaluated earlier, with fewer patients and no confounding by subsequent lines of therapy. The present paper reviews the advantages, limitations, and relevance of progression-free survival as a primary endpoint in randomized trials of metastatic colorectal cancer.
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Li X, Butts C, Fenton D, King K, Scarfe A, Winget M. Utilization of oncology services and receipt of treatment: a comparison between patients with breast, colon, rectal, or lung cancer. Ann Oncol 2011; 22:1902-9. [DOI: 10.1093/annonc/mdq692] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Yee D, Butts C, Chu Q, Fenton D, Joy A, Reiman A, Smylie M, Roa W. Phase II Trial of Consolidation Chest Radiotherapy for Extensive Stage Small Cell Lung Cancer. Int J Radiat Oncol Biol Phys 2010. [DOI: 10.1016/j.ijrobp.2010.07.1230] [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: 11/17/2022]
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Butts C, Stevens A, Hue T, Mills L. 351: Can Ultrasonography of the Optic Nerve Sheath Be Used to Predict and Monitor Changes In Intracranial Pressure? Ann Emerg Med 2010. [DOI: 10.1016/j.annemergmed.2010.06.408] [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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Yee D, Chu Q, Butts C, Joy A, Fenton D, Smylie M, Reiman A, Roa W. 77 PHASE 1 DOSE ESCALATION TRIAL OF LIMITED FIELD HYPOFRACTIONATED THORACIC RADIOTHERAPY FOR LIMITED STAGE SMALL CELL LUNG CANCER. Radiother Oncol 2009. [DOI: 10.1016/s0167-8140(12)72464-7] [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: 10/27/2022]
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Vincent MD, Butts C, Seymour L, Ding K, Graham B, Twumasi-Ankrah P, Gandara D, Schiller J, Green M, Shepherd F. Updated survival analysis of JBR.10: A randomized phase III trial of vinorelbine/cisplatin versus observation in completely resected stage IB and II non-small cell lung cancer (NSCLC). J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.7501] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [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
7501 Background: JBR.10 was one of a number of phase III trials that established adjuvant cisplatin based chemotherapy as a recommended treatment in completely resected NSCLC . Long-term follow-up of these trials is important to document persistent benefit and potential late toxicities of adjuvant therapy. We report the updated survival data for JBR.10 with more than 9 years median follow up. Methods: Patients with completely resected stage IB (T2N0) or II (T1–2N1) NSCLC were randomized to receive 4 cycles of vinorelbine/cisplatin or observation.. Kaplan-Meier curves were generated for overall (OS) and disease specific survival (DSS). Log-rank test was used to compare survival distribution and to test cause specific hazard. For the competing risk analysis, the Gray test was used to test the difference in cause specific incidences. All efficacy analyses were done on an ITT basis. Results: 482 patients were randomized. Data cut-off for this update was July 2008. Median follow-up is 9.3 years (3.2–13.8 y). 12 patients were lost to follow up, a median 4.9 years from randomization (1.5–12 years). 271 deaths have occurred, 73% due to lung cancer or its treatment. Survival analysis continues to show a benefit for chemotherapy: HR .78 (CI .61-.99, p=.04). The benefit appears to be confined to N1 patients: median OS 6.8 y versus 3.6 y, HR .68 (CI .5-.92, p=.01). N0 patients did not appear to benefit: HR 1.03 (CI .7–1.52, p=.87). Chemotherapy significantly prolonged DSS, HR.73 (CI .55-.97, p=.03) Competing risk analysis showed observation to be associated with significantly higher risk of death from lung cancer (p=.02) with no difference in incidences of death from other causes between arms (p=.62). Conclusions: Prolonged follow-up of patients in the JBR.10 trial continues to show a benefit in survival for adjuvant chemotherapy. This benefit appears to be confined to N1 patients. There was no increase in death from other causes in the chemotherapy arm. [Table: see text]
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Affiliation(s)
- M. D. Vincent
- London Regional Cancer Program, London, ON, Canada; Cross Cancer Centre, Edmonton, AB, Canada; NCIC Clinical Trials Group, Kingston, ON, Canada; UC Davis Cancer Centre, Sacremento, CA; Simmons Comprehensive Cancer Center, Dallas, TX; NMCR, Atlanta, GA; Princess Margaret Hospital, Toronto, ON, Canada
| | - C. Butts
- London Regional Cancer Program, London, ON, Canada; Cross Cancer Centre, Edmonton, AB, Canada; NCIC Clinical Trials Group, Kingston, ON, Canada; UC Davis Cancer Centre, Sacremento, CA; Simmons Comprehensive Cancer Center, Dallas, TX; NMCR, Atlanta, GA; Princess Margaret Hospital, Toronto, ON, Canada
| | - L. Seymour
- London Regional Cancer Program, London, ON, Canada; Cross Cancer Centre, Edmonton, AB, Canada; NCIC Clinical Trials Group, Kingston, ON, Canada; UC Davis Cancer Centre, Sacremento, CA; Simmons Comprehensive Cancer Center, Dallas, TX; NMCR, Atlanta, GA; Princess Margaret Hospital, Toronto, ON, Canada
| | - K. Ding
- London Regional Cancer Program, London, ON, Canada; Cross Cancer Centre, Edmonton, AB, Canada; NCIC Clinical Trials Group, Kingston, ON, Canada; UC Davis Cancer Centre, Sacremento, CA; Simmons Comprehensive Cancer Center, Dallas, TX; NMCR, Atlanta, GA; Princess Margaret Hospital, Toronto, ON, Canada
| | - B. Graham
- London Regional Cancer Program, London, ON, Canada; Cross Cancer Centre, Edmonton, AB, Canada; NCIC Clinical Trials Group, Kingston, ON, Canada; UC Davis Cancer Centre, Sacremento, CA; Simmons Comprehensive Cancer Center, Dallas, TX; NMCR, Atlanta, GA; Princess Margaret Hospital, Toronto, ON, Canada
| | - P. Twumasi-Ankrah
- London Regional Cancer Program, London, ON, Canada; Cross Cancer Centre, Edmonton, AB, Canada; NCIC Clinical Trials Group, Kingston, ON, Canada; UC Davis Cancer Centre, Sacremento, CA; Simmons Comprehensive Cancer Center, Dallas, TX; NMCR, Atlanta, GA; Princess Margaret Hospital, Toronto, ON, Canada
| | - D. Gandara
- London Regional Cancer Program, London, ON, Canada; Cross Cancer Centre, Edmonton, AB, Canada; NCIC Clinical Trials Group, Kingston, ON, Canada; UC Davis Cancer Centre, Sacremento, CA; Simmons Comprehensive Cancer Center, Dallas, TX; NMCR, Atlanta, GA; Princess Margaret Hospital, Toronto, ON, Canada
| | - J. Schiller
- London Regional Cancer Program, London, ON, Canada; Cross Cancer Centre, Edmonton, AB, Canada; NCIC Clinical Trials Group, Kingston, ON, Canada; UC Davis Cancer Centre, Sacremento, CA; Simmons Comprehensive Cancer Center, Dallas, TX; NMCR, Atlanta, GA; Princess Margaret Hospital, Toronto, ON, Canada
| | - M. Green
- London Regional Cancer Program, London, ON, Canada; Cross Cancer Centre, Edmonton, AB, Canada; NCIC Clinical Trials Group, Kingston, ON, Canada; UC Davis Cancer Centre, Sacremento, CA; Simmons Comprehensive Cancer Center, Dallas, TX; NMCR, Atlanta, GA; Princess Margaret Hospital, Toronto, ON, Canada
| | - F. Shepherd
- London Regional Cancer Program, London, ON, Canada; Cross Cancer Centre, Edmonton, AB, Canada; NCIC Clinical Trials Group, Kingston, ON, Canada; UC Davis Cancer Centre, Sacremento, CA; Simmons Comprehensive Cancer Center, Dallas, TX; NMCR, Atlanta, GA; Princess Margaret Hospital, Toronto, ON, Canada
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Butts C, Anderson H, Maksymiuk A, Vergidis D, Soulières D, Cormier Y, Davis M, Marshall E, Falk M, Goss G. Long-term safety of BLP25 liposome vaccine (L-BLP25) in patients (pts) with stage IIIB/IV non-small cell lung cancer (NSCLC). J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.3055] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [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
3055 Background: The BLP25 liposome vaccine (L-BLP25, Stimuvax) is an investigational innovative therapeutic cancer vaccine incorporating immunoadjuvant monophosphoryl lipid A and synthetic MUC1 lipopeptide in a liposomal delivery system. In an open-label phase IIb study in 171 pts with stage IIIB/IV NSCLC randomized to best supportive care (BSC) alone (n=83) or BSC + L-BLP25 (1000 μg lipopeptide) (n=88), L-BLP25 pts received weekly vaccinations for 8 weeks (wks) and could continue maintenance vaccinations every 6 wks from wk 13. Results were encouraging (Butts et al, JCO 2005) and a remarkable number of pts received prolonged treatment (tmt). As a result a global phase III study (START) has been initiated. Methods: Safety results for 16 pts from the phase IIb study treated for ≥2 years with L-BLP25 are reported. Results: In these 16 pts (median age 57.5 years, ECOG PS: 0 in 5/16 [31%] and 1 in 11/16 [69%]), there were more females (56% vs 44% [9/16 vs 76/171]) and locoregional stage IIIB disease at entry (81% vs 38% [13/16 vs 65/171]) vs the phase IIb study population. Pts received L-BLP25 for 2.0–7.7 years and 10 pts were treated for >5 years. Compliance with tmt was good: almost all (96%) maintenance vaccinations were given every 6 wks according to the tmt schedule. L-BLP25 was well tolerated: the most common tmt-emergent adverse events (TEAEs) were cough (n=12, 75%), fatigue (n=12, 75%), and dyspnea (n=11, 69%). The pattern of TEAEs did not change significantly over time and there was no rise in the incidence of TEAEs with increasing time on tmt. Among the most common TEAEs in years 1, 2, and >2 were nausea (44, 19, and 38%), fatigue (56, 18, and 38%), chest pain (38, 31, and 31%), and cough (38, 25, and 31%). Twelve pts (75%) had tmt-related TEAEs (grade 1/2 in 11/12 pts [92%] and grade 3 in 1/12 [8%]): the most common were injection-site reactions. The occurrence of tmt-related TEAEs decreased with increasing tmt duration. There was no evidence of any TEAEs related to autoimmunity. Analysis of laboratory data did not indicate any long-term renal, liver, or other toxicity. Conclusions: Long-term use of L-BLP25 was without any identifiable safety issues. In particular, there was no evidence of autoimmune reactions with prolonged use. [Table: see text]
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Affiliation(s)
- C. Butts
- Cross Cancer Institute, Edmonton, AB, Canada; Vancouver Island Cancer Centre, Victoria, BC, Canada; Cancer Care Manitoba, Winnipeg, MB, Canada; NorthWestern Ontario Regional Cancer Centre, Thunder Bay, ON, Canada; CHUM, Montreal, QC, Canada; Université Laval, Quebec, QC, Canada; Nova Scotia Cancer Centre, Halifax, NS, Canada; Clatterbridge Centre for Oncology, Bebington, United Kingdom; Merck KGaA, Darmstadt, Germany; The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada
| | - H. Anderson
- Cross Cancer Institute, Edmonton, AB, Canada; Vancouver Island Cancer Centre, Victoria, BC, Canada; Cancer Care Manitoba, Winnipeg, MB, Canada; NorthWestern Ontario Regional Cancer Centre, Thunder Bay, ON, Canada; CHUM, Montreal, QC, Canada; Université Laval, Quebec, QC, Canada; Nova Scotia Cancer Centre, Halifax, NS, Canada; Clatterbridge Centre for Oncology, Bebington, United Kingdom; Merck KGaA, Darmstadt, Germany; The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada
| | - A. Maksymiuk
- Cross Cancer Institute, Edmonton, AB, Canada; Vancouver Island Cancer Centre, Victoria, BC, Canada; Cancer Care Manitoba, Winnipeg, MB, Canada; NorthWestern Ontario Regional Cancer Centre, Thunder Bay, ON, Canada; CHUM, Montreal, QC, Canada; Université Laval, Quebec, QC, Canada; Nova Scotia Cancer Centre, Halifax, NS, Canada; Clatterbridge Centre for Oncology, Bebington, United Kingdom; Merck KGaA, Darmstadt, Germany; The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada
| | - D. Vergidis
- Cross Cancer Institute, Edmonton, AB, Canada; Vancouver Island Cancer Centre, Victoria, BC, Canada; Cancer Care Manitoba, Winnipeg, MB, Canada; NorthWestern Ontario Regional Cancer Centre, Thunder Bay, ON, Canada; CHUM, Montreal, QC, Canada; Université Laval, Quebec, QC, Canada; Nova Scotia Cancer Centre, Halifax, NS, Canada; Clatterbridge Centre for Oncology, Bebington, United Kingdom; Merck KGaA, Darmstadt, Germany; The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada
| | - D. Soulières
- Cross Cancer Institute, Edmonton, AB, Canada; Vancouver Island Cancer Centre, Victoria, BC, Canada; Cancer Care Manitoba, Winnipeg, MB, Canada; NorthWestern Ontario Regional Cancer Centre, Thunder Bay, ON, Canada; CHUM, Montreal, QC, Canada; Université Laval, Quebec, QC, Canada; Nova Scotia Cancer Centre, Halifax, NS, Canada; Clatterbridge Centre for Oncology, Bebington, United Kingdom; Merck KGaA, Darmstadt, Germany; The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada
| | - Y. Cormier
- Cross Cancer Institute, Edmonton, AB, Canada; Vancouver Island Cancer Centre, Victoria, BC, Canada; Cancer Care Manitoba, Winnipeg, MB, Canada; NorthWestern Ontario Regional Cancer Centre, Thunder Bay, ON, Canada; CHUM, Montreal, QC, Canada; Université Laval, Quebec, QC, Canada; Nova Scotia Cancer Centre, Halifax, NS, Canada; Clatterbridge Centre for Oncology, Bebington, United Kingdom; Merck KGaA, Darmstadt, Germany; The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada
| | - M. Davis
- Cross Cancer Institute, Edmonton, AB, Canada; Vancouver Island Cancer Centre, Victoria, BC, Canada; Cancer Care Manitoba, Winnipeg, MB, Canada; NorthWestern Ontario Regional Cancer Centre, Thunder Bay, ON, Canada; CHUM, Montreal, QC, Canada; Université Laval, Quebec, QC, Canada; Nova Scotia Cancer Centre, Halifax, NS, Canada; Clatterbridge Centre for Oncology, Bebington, United Kingdom; Merck KGaA, Darmstadt, Germany; The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada
| | - E. Marshall
- Cross Cancer Institute, Edmonton, AB, Canada; Vancouver Island Cancer Centre, Victoria, BC, Canada; Cancer Care Manitoba, Winnipeg, MB, Canada; NorthWestern Ontario Regional Cancer Centre, Thunder Bay, ON, Canada; CHUM, Montreal, QC, Canada; Université Laval, Quebec, QC, Canada; Nova Scotia Cancer Centre, Halifax, NS, Canada; Clatterbridge Centre for Oncology, Bebington, United Kingdom; Merck KGaA, Darmstadt, Germany; The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada
| | - M. Falk
- Cross Cancer Institute, Edmonton, AB, Canada; Vancouver Island Cancer Centre, Victoria, BC, Canada; Cancer Care Manitoba, Winnipeg, MB, Canada; NorthWestern Ontario Regional Cancer Centre, Thunder Bay, ON, Canada; CHUM, Montreal, QC, Canada; Université Laval, Quebec, QC, Canada; Nova Scotia Cancer Centre, Halifax, NS, Canada; Clatterbridge Centre for Oncology, Bebington, United Kingdom; Merck KGaA, Darmstadt, Germany; The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada
| | - G. Goss
- Cross Cancer Institute, Edmonton, AB, Canada; Vancouver Island Cancer Centre, Victoria, BC, Canada; Cancer Care Manitoba, Winnipeg, MB, Canada; NorthWestern Ontario Regional Cancer Centre, Thunder Bay, ON, Canada; CHUM, Montreal, QC, Canada; Université Laval, Quebec, QC, Canada; Nova Scotia Cancer Centre, Halifax, NS, Canada; Clatterbridge Centre for Oncology, Bebington, United Kingdom; Merck KGaA, Darmstadt, Germany; The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada
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Zatloukal P, Heo DS, Park K, Kang J, Butts C, Bradford D, Graziano S, Huang B, Healey D. Randomized phase II clinical trial comparing tremelimumab (CP-675,206) with best supportive care (BSC) following first-line platinum-based therapy in patients (pts) with advanced non-small cell lung cancer (NSCLC). J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.8071] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
8071 Background: Pts diagnosed with advanced NSCLC with good performance status typically receive platinum-based chemotherapy; however, no approved maintenance therapy exists. Tremelimumab, a fully human anti-CTLA4 mAb, is associated with durable responses in some pts with metastatic melanoma. Methods: This open-label, randomized, multicenter, phase II clinical trial evaluating efficacy and safety of tremelimumab as maintenance therapy was conducted in pts with locally advanced or metastatic NSCLC with ECOG performance status ≤1. Pts treated with ≥4 cycles of first-line platinum-based therapy resulting in either stable disease (SD) or response per RECIST were eligible and were randomized 3–6 weeks after prior therapy. Pts received 15 mg/kg IV tremelimumab Q90D or BSC until disease progression. Primary endpoint was progression-free survival (PFS) at 3 months. Secondary endpoints included safety, objective response rate, and 1-year survival. Results: Eighty-seven pts received tremelimumab (n=44) or BSC (n=43). Nine (20.9%; 90% CI: 11.4%, 33.7%) pts receiving tremelimumab and 6 (14.3%; 90% CI: 6.4%, 26.3%) pts receiving BSC were progression free at 3 months. Among pts receiving tremelimumab, there were 2 (4.8%) partial responses and 7 (16.6%) SDs, compared with 0 and 6 (14.3%) pts receiving BSC, respectively. Treatment-related adverse events (AEs) were observed in 27 (61.4%) pts receiving tremelimumab and 3 (7.0%) receiving BSC. Nine pts (20.5%) receiving tremelimumab reported grade 3 or 4 AEs compared with 0 patients receiving BSC. The most common grade 3 or 4 AEs attributed to tremelimumab were diarrhea and colitis (n=4, 9.1%). Conclusions: In pts with advanced NSCLC and good performance status receiving platinum-based first-line therapy, single-agent tremelimumab was tolerable, with safety consistent with prior studies. Although PFS analysis did not demonstrate superiority of tremelimumab over BSC, the 4.8% objective response rate seen only in the investigational arm may support future combination studies. Analysis of 1-year survival is forthcoming. [Table: see text]
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Affiliation(s)
- P. Zatloukal
- 3rd Faculty of Medicine, Charles University, Prague, Czech Republic; Seoul National University Hospital, Seoul, Republic of Korea; Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Catholic University of Korea, Seoul, Republic of Korea; Cross Cancer Institute, Edmonton, AB, Canada; Highlands Oncology Group, Fayetteville, AR; SUNY Upstate Medical University, Syracuse, NY; Pfizer Global Research & Development, New London, CT
| | - D. S. Heo
- 3rd Faculty of Medicine, Charles University, Prague, Czech Republic; Seoul National University Hospital, Seoul, Republic of Korea; Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Catholic University of Korea, Seoul, Republic of Korea; Cross Cancer Institute, Edmonton, AB, Canada; Highlands Oncology Group, Fayetteville, AR; SUNY Upstate Medical University, Syracuse, NY; Pfizer Global Research & Development, New London, CT
| | - K. Park
- 3rd Faculty of Medicine, Charles University, Prague, Czech Republic; Seoul National University Hospital, Seoul, Republic of Korea; Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Catholic University of Korea, Seoul, Republic of Korea; Cross Cancer Institute, Edmonton, AB, Canada; Highlands Oncology Group, Fayetteville, AR; SUNY Upstate Medical University, Syracuse, NY; Pfizer Global Research & Development, New London, CT
| | - J. Kang
- 3rd Faculty of Medicine, Charles University, Prague, Czech Republic; Seoul National University Hospital, Seoul, Republic of Korea; Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Catholic University of Korea, Seoul, Republic of Korea; Cross Cancer Institute, Edmonton, AB, Canada; Highlands Oncology Group, Fayetteville, AR; SUNY Upstate Medical University, Syracuse, NY; Pfizer Global Research & Development, New London, CT
| | - C. Butts
- 3rd Faculty of Medicine, Charles University, Prague, Czech Republic; Seoul National University Hospital, Seoul, Republic of Korea; Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Catholic University of Korea, Seoul, Republic of Korea; Cross Cancer Institute, Edmonton, AB, Canada; Highlands Oncology Group, Fayetteville, AR; SUNY Upstate Medical University, Syracuse, NY; Pfizer Global Research & Development, New London, CT
| | - D. Bradford
- 3rd Faculty of Medicine, Charles University, Prague, Czech Republic; Seoul National University Hospital, Seoul, Republic of Korea; Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Catholic University of Korea, Seoul, Republic of Korea; Cross Cancer Institute, Edmonton, AB, Canada; Highlands Oncology Group, Fayetteville, AR; SUNY Upstate Medical University, Syracuse, NY; Pfizer Global Research & Development, New London, CT
| | - S. Graziano
- 3rd Faculty of Medicine, Charles University, Prague, Czech Republic; Seoul National University Hospital, Seoul, Republic of Korea; Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Catholic University of Korea, Seoul, Republic of Korea; Cross Cancer Institute, Edmonton, AB, Canada; Highlands Oncology Group, Fayetteville, AR; SUNY Upstate Medical University, Syracuse, NY; Pfizer Global Research & Development, New London, CT
| | - B. Huang
- 3rd Faculty of Medicine, Charles University, Prague, Czech Republic; Seoul National University Hospital, Seoul, Republic of Korea; Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Catholic University of Korea, Seoul, Republic of Korea; Cross Cancer Institute, Edmonton, AB, Canada; Highlands Oncology Group, Fayetteville, AR; SUNY Upstate Medical University, Syracuse, NY; Pfizer Global Research & Development, New London, CT
| | - D. Healey
- 3rd Faculty of Medicine, Charles University, Prague, Czech Republic; Seoul National University Hospital, Seoul, Republic of Korea; Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Catholic University of Korea, Seoul, Republic of Korea; Cross Cancer Institute, Edmonton, AB, Canada; Highlands Oncology Group, Fayetteville, AR; SUNY Upstate Medical University, Syracuse, NY; Pfizer Global Research & Development, New London, CT
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Nones K, Knoch B, Dommels YEM, Paturi G, Butts C, McNabb WC, Roy NC. Multidrug resistance gene deficient (mdr1a-/-) mice have an altered caecal microbiota that precedes the onset of intestinal inflammation. J Appl Microbiol 2009; 107:557-66. [PMID: 19302324 DOI: 10.1111/j.1365-2672.2009.04225.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
AIM To compare caecal microbiota from mdr1a(-/-) and wild type (FVB) mice to identify differences in the bacterial community that could influence the intestinal inflammation. METHODS AND RESULTS Caecal microbiota of mdr1a(-/-) and FVB mice were evaluated at 12 and 25 weeks of age using denaturing gradient gel electrophoresis (DGGE) and quantitative real-time PCR. DGGE fingerprints of FVB and mdr1a(-/-) mice (with no intestinal inflammation) at 12 weeks revealed differences in the presence of DNA fragments identified as Bacteroides fragilis, B. thetaiotaomicron, B. vulgatus and an uncultured alphaproteobacterium. Escherichia coli and Acinetobacter sp. were only identified in DGGE profiles of mdr1a(-/-) mice at 25 weeks (with severe intestinal inflammation), which also had a lower number of total bacteria in the caecum compared with FVB mice at same age. CONCLUSIONS Differences found in the caecal microbiota of FVB and mdr1a(-/-) mice (12 weeks) suggest that the lack of Abcb1 transporters in intestinal cells due to the disruption of the mdr1a gene might lead to changes in the caecal microbiota. The altered microbiota along with the genetic defect could contribute to the development of intestinal inflammation in mdr1a(-/-) mice. SIGNIFICANCE AND IMPACT OF THE STUDY Differences in caecal microbiota of mdr1a(-/-) and FVB mice (12 weeks) suggest genotype specific colonization. The results provide evidence that Abcb1 transporters may regulate host interactions with commensal bacteria. Future work is needed to identify the mechanisms involved in this possible cross-talk between the host intestinal cells and microbiota.
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Affiliation(s)
- K Nones
- Crop & Food Research, Palmerston North, New Zealand
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Ellis PM, Morzycki W, Melosky B, Butts C, Hirsh V, Krasnoshtein F, Murray N, Shepherd FA, Soulieres D, Tsao MS, Goss G. The role of the epidermal growth factor receptor tyrosine kinase inhibitors as therapy for advanced, metastatic, and recurrent non-small-cell lung cancer: a Canadian national consensus statement. Curr Oncol 2009; 16:27-48. [PMID: 19229369 PMCID: PMC2644627 DOI: 10.3747/co.v16i1.393] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
PURPOSE To provide consensus recommendations on the use of epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIS) in patients with advanced or meta-static non-small-cell lung cancer (NSCLC). METHODS Using a systematic literature search, phase II trials, randomized phase III trials, and meta-analyses were identified for inclusion. RESULTS A total of forty-six trials were included. Clear evidence is available that EGFR-TKIS should not be administered concurrently with platinum-based chemotherapy as first-line therapy in advanced or metastatic nsclc. Evidence is currently insufficient to recommend single-agent EGFR-TKIS as first-line therapy either in unselected populations or in populations selected on the basis of molecular or clinical characteristics. Following failure of platinum-based chemotherapy, the evidence suggests that second-line EGFR-TKIS or second-line chemotherapy result in similar survival. Quality of life and symptom improvement for patients treated with an EGFR-TKI appear better than they do for patients treated with second-line docetaxel. Sequence of therapy may not appear to be important, but if survival is the outcome of interest, the goal should be to optimize the number of patients receiving three lines of therapy. Based on available data, molecular markers and clinical characteristics do not appear to be predictive of a differential survival benefit from an EGFR-TKI and therefore those factors should not be used to select patients for EGFR-TKI therapy. CONCLUSIONS The EGFR-TKIS represent an additional therapy in the treatment of advanced or metastatic NSCLC. The results of ongoing clinical trials may define the optimal role for these agents and the effectiveness of combinations of these agents with other targeted agents.
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Affiliation(s)
- P M Ellis
- Juravinski Cancer Centre, Hamilton, ON.
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Rothenberg ML, Cox JV, Butts C, Navarro M, Bang YJ, Goel R, Gollins S, Siu LL, Laguerre S, Cunningham D. Capecitabine plus oxaliplatin (XELOX) versus 5-fluorouracil/folinic acid plus oxaliplatin (FOLFOX-4) as second-line therapy in metastatic colorectal cancer: a randomized phase III noninferiority study. Ann Oncol 2008; 19:1720-6. [PMID: 18550577 DOI: 10.1093/annonc/mdn370] [Citation(s) in RCA: 154] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND To demonstrate the noninferiority of capecitabine plus oxaliplatin (XELOX) versus 5-fluorouracil/folinic acid and oxaliplatin (FOLFOX-4) as second-line therapy in patients with metastatic colorectal cancer after prior irinotecan-based chemotherapy. PATIENTS AND METHODS A total of 627 patients were randomly assigned to receive XELOX (n = 313) or FOLFOX-4 (n = 314) following disease progression/recurrence or intolerance to irinotecan-based chemotherapy. The primary end point was progression-free survival (PFS). RESULTS PFS for XELOX was noninferior to FOLFOX-4 [hazard ratio (HR) = 0.97; 95% confidence interval (CI) 0.83-1.14] in the intention-to-treat (ITT) population. Median PFS was 4.7 months with XELOX versus 4.8 months with FOLFOX-4. The robustness of the primary analysis was supported by multivariate and subgroup analyses. Median overall survival in the ITT population was 11.9 months with XELOX versus 12.5 months with FOLFOX-4 (HR = 1.02; 95% CI 0.86-1.21). Treatment-related grade 3/4 adverse events occurred in 50% of XELOX- and 65% of FOLFOX-4-treated patients. Whereas grade 3/4 neutropenia (35% versus 5% with XELOX) and febrile neutropenia (4% versus < 1%) were more common with FOLFOX-4, grade 3/4 diarrhea (19% versus 5% with FOLFOX-4) and grade 3 hand-foot syndrome (4% versus < 1%) were more common with XELOX. CONCLUSION XELOX is noninferior to FOLFOX-4 when administered as second-line treatment in patients with metastatic colorectal cancer.
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Affiliation(s)
- M L Rothenberg
- Division of Hematology/Oncology, Vanderbilt-Ingram Cancer Center, Nashville, TN 37232-6307, USA.
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Lee RL, Verma S, Chung J, Wood L, Butts C, Vijayaratnam S, Berry SR. Oncologyeducation.com: The development and use of a web-based educational resource for medical oncology professionals. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.17538] [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: 11/20/2022] Open
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Murray NR, Butts C, Smith C, Ellis PM, Jasas K, Maksymiuk A, Goss G, Ely G, Soulieres D. A multicenter, open-label, phase I/II study in patients with unresectable stage III non-small cell lung cancer (NSCLC) treated with L-BLP25: 2-year survival and safety results. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.3047] [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: 11/20/2022] Open
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Soulieres D, Smith C, Ellis PM, Murray N, Jasas K, Maksymiuk A, Goss G, Falk MH, Butts C. A multi-centre, open-label study to assess the safety of Stimuvax (BLP25 liposome vaccine or L-BLP25) in non-small cell lung cancer (NSCLC) patients (pts) with unresectable stage III disease. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.3075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
3075 Background: L-BLP25 is an innovative cancer vaccine that incorporates a synthetic MUC1 lipopeptide in a liposomal delivery system. L-BLP25 is expected to elicit an immune response to cancer cells that express MUC1. Previous clinical studies have demonstrated that L-BLP25 has the potential to extend survival of pts with stage IIIB locoregional NSCLC (Butts C et al., JCO 2005; 23:6674–6681). The present ph I-II study was designed to assess the safety of the current formulation of L-BLP25 using a monophosphoryl lipid A in pts with unresectable stage IIIA and stage IIIB NSCLC. Methods: Pts with stable disease or an objective response to upfront radical therapy with chemoradiation for unresectable stage III NSCLC, plus ECOG 0–1 were eligible. All pts were vaccinated according to a previously described schedule (1). Maintenance immunizations were administered every 6-wks until disease progression. Primary and secondary endpoints were safety and survival respectively. Results: Twenty-two pts were recruited at 7 sites in Canada. 16 pts were evaluated for this interim safety analysis (8 stage IIIA, 8 stage IIIB, median age; 57, ECOG 0 56%, concurrent chemotherapy; 93.8%). Thirteen pts had a partial response and 3 had stable disease following chemoradiation. Thirteen pts experienced an adverse event (AE) during the first 4 vaccinations of which 7 pts had a L-BLP25 related adverse event. Grade 1/2 AEs related to L-BLP25 ≥10% included fatigue, dyspnea, insomnia, anorexia, headache, diarrhea, paresthesia, abdominal pain, influenza-like illness, urinary tract infection and peripheral neuropathy. No pts discontinued L-BLP25 due to an AE and no grade 3/4 AEs related to L-BLP25 were reported. Six pts (37.5%) had an injection site reaction. As of September 2006, 10 pts were still on study treatment. Conclusions: This formulation of L-BLP25 was well tolerated and the side effect profile was similar to that seen in previous studies (1). A controlled global multi-center phase III trial is underway to further evaluate L-BLP25 in this patient population. No significant financial relationships to disclose.
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Affiliation(s)
- D. Soulieres
- CHUM Hospital Notre Dame, Montreal, PQ, Canada; Tom Baker Cancer Centre, Calgary, AB, Canada; Juravinski Cancer Centre, Hamilton, ON, Canada; BC Cancer Agency, Surrey, BC, Canada; CancerCare Manitoba, Winnipeg, MB, Canada; The Ottawa Hospital Regional Cancer Centre, Ottawa, ON, Canada; Merck KGaA, Darmstadt, Germany; Cross Cancer Institute, Edmonton, AB, Canada
| | - C. Smith
- CHUM Hospital Notre Dame, Montreal, PQ, Canada; Tom Baker Cancer Centre, Calgary, AB, Canada; Juravinski Cancer Centre, Hamilton, ON, Canada; BC Cancer Agency, Surrey, BC, Canada; CancerCare Manitoba, Winnipeg, MB, Canada; The Ottawa Hospital Regional Cancer Centre, Ottawa, ON, Canada; Merck KGaA, Darmstadt, Germany; Cross Cancer Institute, Edmonton, AB, Canada
| | - P. M. Ellis
- CHUM Hospital Notre Dame, Montreal, PQ, Canada; Tom Baker Cancer Centre, Calgary, AB, Canada; Juravinski Cancer Centre, Hamilton, ON, Canada; BC Cancer Agency, Surrey, BC, Canada; CancerCare Manitoba, Winnipeg, MB, Canada; The Ottawa Hospital Regional Cancer Centre, Ottawa, ON, Canada; Merck KGaA, Darmstadt, Germany; Cross Cancer Institute, Edmonton, AB, Canada
| | - N. Murray
- CHUM Hospital Notre Dame, Montreal, PQ, Canada; Tom Baker Cancer Centre, Calgary, AB, Canada; Juravinski Cancer Centre, Hamilton, ON, Canada; BC Cancer Agency, Surrey, BC, Canada; CancerCare Manitoba, Winnipeg, MB, Canada; The Ottawa Hospital Regional Cancer Centre, Ottawa, ON, Canada; Merck KGaA, Darmstadt, Germany; Cross Cancer Institute, Edmonton, AB, Canada
| | - K. Jasas
- CHUM Hospital Notre Dame, Montreal, PQ, Canada; Tom Baker Cancer Centre, Calgary, AB, Canada; Juravinski Cancer Centre, Hamilton, ON, Canada; BC Cancer Agency, Surrey, BC, Canada; CancerCare Manitoba, Winnipeg, MB, Canada; The Ottawa Hospital Regional Cancer Centre, Ottawa, ON, Canada; Merck KGaA, Darmstadt, Germany; Cross Cancer Institute, Edmonton, AB, Canada
| | - A. Maksymiuk
- CHUM Hospital Notre Dame, Montreal, PQ, Canada; Tom Baker Cancer Centre, Calgary, AB, Canada; Juravinski Cancer Centre, Hamilton, ON, Canada; BC Cancer Agency, Surrey, BC, Canada; CancerCare Manitoba, Winnipeg, MB, Canada; The Ottawa Hospital Regional Cancer Centre, Ottawa, ON, Canada; Merck KGaA, Darmstadt, Germany; Cross Cancer Institute, Edmonton, AB, Canada
| | - G. Goss
- CHUM Hospital Notre Dame, Montreal, PQ, Canada; Tom Baker Cancer Centre, Calgary, AB, Canada; Juravinski Cancer Centre, Hamilton, ON, Canada; BC Cancer Agency, Surrey, BC, Canada; CancerCare Manitoba, Winnipeg, MB, Canada; The Ottawa Hospital Regional Cancer Centre, Ottawa, ON, Canada; Merck KGaA, Darmstadt, Germany; Cross Cancer Institute, Edmonton, AB, Canada
| | - M. H. Falk
- CHUM Hospital Notre Dame, Montreal, PQ, Canada; Tom Baker Cancer Centre, Calgary, AB, Canada; Juravinski Cancer Centre, Hamilton, ON, Canada; BC Cancer Agency, Surrey, BC, Canada; CancerCare Manitoba, Winnipeg, MB, Canada; The Ottawa Hospital Regional Cancer Centre, Ottawa, ON, Canada; Merck KGaA, Darmstadt, Germany; Cross Cancer Institute, Edmonton, AB, Canada
| | - C. Butts
- CHUM Hospital Notre Dame, Montreal, PQ, Canada; Tom Baker Cancer Centre, Calgary, AB, Canada; Juravinski Cancer Centre, Hamilton, ON, Canada; BC Cancer Agency, Surrey, BC, Canada; CancerCare Manitoba, Winnipeg, MB, Canada; The Ottawa Hospital Regional Cancer Centre, Ottawa, ON, Canada; Merck KGaA, Darmstadt, Germany; Cross Cancer Institute, Edmonton, AB, Canada
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Rothenberg ML, Navarro M, Butts C, Bang Y, Cox JV, Goel R, Gollins S, Siu LL, Cunningham D. Phase III trial of capecitabine + oxaliplatin (XELOX) vs. 5-fluorouracil (5-FU), leucovorin (LV), and oxaliplatin (FOLFOX4) as 2nd-line treatment for patients with metastatic colorectal cancer (MCRC). J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.4031] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [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
4031 Background: Capecitabine is an oral fluoropyrimidine that has demonstrated similar efficacy to 5-FU/LV in the 1st-line treatment of MCRC. Most patients now receive multi-agent chemotherapy and FOLFOX4 has become a popular regimen in this setting. We conducted a phase III study comparing XELOX with FOLFOX4 in patients who had received prior treatment with irinotecan in combination with bolus and/or infusional 5-FU/LV for MCRC. The primary endpoint of the study was time-to-tumor progression (TTP). With 610 patients, this study had 80% power to detect non-inferiority of the XELOX vs. FOLFOX, defined by a progression hazard ratio (HR) of <1.3. Methods: Patients were treated with XELOX (oxaliplatin 130mg/m2 i.v., capecitabine 1,000mg/m2 bid oral x 14 days, q3w) or FOLFOX4 (as described previously). Results: The study recruited 627 patients (the intent-to-treat - ITT - group). Baseline characteristics were well balanced. The primary objective of the study was met with a progression HR of 0.97 for the XELOX group (95% CI, 0.83–1.14). Median TTP was 4.8 months for XELOX- and 4.7 months for FOLFOX4-treated patients. Overall survival was also similar between the groups with a death HR of 1.03 for the XELOX group (95% CI, 0.87–1.23). Median survival was 11.9 months for XELOX- and 12.6 months for FOLFOX4-treated patients. Grade 3/4 toxicities occurred in 60.1% of XELOX- and 72.4% of FOLFOX4-treated patients. The most common treatment-related grade 3/4 adverse events (XELOX vs. FOLFOX4) were: diarrhea (20 vs. 5%), neutropenia (5 vs. 35%), fatigue (5 vs. 8%), paresthesia (9 vs. 8%), nausea/vomiting (6 vs. 5%). The rate of grade 3 hand-foot syndrome was 3.5% with XELOX and 0.6% with FOLFOX4. The 60-day all cause mortality was 3.9% in XELOX- and 4.2% in FOLFOX4-treated patients. Conclusions: These results demonstrate that second-line treatment with XELOX is non-inferior to FOLFOX4 in terms of PFS. Results for overall survival and response rates were also similar between the two groups. The safety profile was similar to previous studies, with no unexpected toxicities. Study supported by Hoffmann-La Roche. No significant financial relationships to disclose.
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Affiliation(s)
- M. L. Rothenberg
- Vanderbilt Ingram Cancer Center, Nashville, TN; Hospital Duran I Reynals, Barcelona, Spain; Cross Cancer Institute, Edmonton, AB, Canada; Seoul National University Hospital, Seoul, Republic of Korea; Texas Oncology, PA & US Oncology Research, Dallas, TX; The Ottawa Hospital, Ottawa, ON, Canada; North Wales Cancer Treatment Centre Glan Clwyd Hos, Rhyl, United Kingdom; Princess Margaret Hospital, Toronto, ON, Canada; The Royal Marsden Hospital, Sutton, United Kingdom
| | - M. Navarro
- Vanderbilt Ingram Cancer Center, Nashville, TN; Hospital Duran I Reynals, Barcelona, Spain; Cross Cancer Institute, Edmonton, AB, Canada; Seoul National University Hospital, Seoul, Republic of Korea; Texas Oncology, PA & US Oncology Research, Dallas, TX; The Ottawa Hospital, Ottawa, ON, Canada; North Wales Cancer Treatment Centre Glan Clwyd Hos, Rhyl, United Kingdom; Princess Margaret Hospital, Toronto, ON, Canada; The Royal Marsden Hospital, Sutton, United Kingdom
| | - C. Butts
- Vanderbilt Ingram Cancer Center, Nashville, TN; Hospital Duran I Reynals, Barcelona, Spain; Cross Cancer Institute, Edmonton, AB, Canada; Seoul National University Hospital, Seoul, Republic of Korea; Texas Oncology, PA & US Oncology Research, Dallas, TX; The Ottawa Hospital, Ottawa, ON, Canada; North Wales Cancer Treatment Centre Glan Clwyd Hos, Rhyl, United Kingdom; Princess Margaret Hospital, Toronto, ON, Canada; The Royal Marsden Hospital, Sutton, United Kingdom
| | - Y. Bang
- Vanderbilt Ingram Cancer Center, Nashville, TN; Hospital Duran I Reynals, Barcelona, Spain; Cross Cancer Institute, Edmonton, AB, Canada; Seoul National University Hospital, Seoul, Republic of Korea; Texas Oncology, PA & US Oncology Research, Dallas, TX; The Ottawa Hospital, Ottawa, ON, Canada; North Wales Cancer Treatment Centre Glan Clwyd Hos, Rhyl, United Kingdom; Princess Margaret Hospital, Toronto, ON, Canada; The Royal Marsden Hospital, Sutton, United Kingdom
| | - J. V. Cox
- Vanderbilt Ingram Cancer Center, Nashville, TN; Hospital Duran I Reynals, Barcelona, Spain; Cross Cancer Institute, Edmonton, AB, Canada; Seoul National University Hospital, Seoul, Republic of Korea; Texas Oncology, PA & US Oncology Research, Dallas, TX; The Ottawa Hospital, Ottawa, ON, Canada; North Wales Cancer Treatment Centre Glan Clwyd Hos, Rhyl, United Kingdom; Princess Margaret Hospital, Toronto, ON, Canada; The Royal Marsden Hospital, Sutton, United Kingdom
| | - R. Goel
- Vanderbilt Ingram Cancer Center, Nashville, TN; Hospital Duran I Reynals, Barcelona, Spain; Cross Cancer Institute, Edmonton, AB, Canada; Seoul National University Hospital, Seoul, Republic of Korea; Texas Oncology, PA & US Oncology Research, Dallas, TX; The Ottawa Hospital, Ottawa, ON, Canada; North Wales Cancer Treatment Centre Glan Clwyd Hos, Rhyl, United Kingdom; Princess Margaret Hospital, Toronto, ON, Canada; The Royal Marsden Hospital, Sutton, United Kingdom
| | - S. Gollins
- Vanderbilt Ingram Cancer Center, Nashville, TN; Hospital Duran I Reynals, Barcelona, Spain; Cross Cancer Institute, Edmonton, AB, Canada; Seoul National University Hospital, Seoul, Republic of Korea; Texas Oncology, PA & US Oncology Research, Dallas, TX; The Ottawa Hospital, Ottawa, ON, Canada; North Wales Cancer Treatment Centre Glan Clwyd Hos, Rhyl, United Kingdom; Princess Margaret Hospital, Toronto, ON, Canada; The Royal Marsden Hospital, Sutton, United Kingdom
| | - L. L. Siu
- Vanderbilt Ingram Cancer Center, Nashville, TN; Hospital Duran I Reynals, Barcelona, Spain; Cross Cancer Institute, Edmonton, AB, Canada; Seoul National University Hospital, Seoul, Republic of Korea; Texas Oncology, PA & US Oncology Research, Dallas, TX; The Ottawa Hospital, Ottawa, ON, Canada; North Wales Cancer Treatment Centre Glan Clwyd Hos, Rhyl, United Kingdom; Princess Margaret Hospital, Toronto, ON, Canada; The Royal Marsden Hospital, Sutton, United Kingdom
| | - D. Cunningham
- Vanderbilt Ingram Cancer Center, Nashville, TN; Hospital Duran I Reynals, Barcelona, Spain; Cross Cancer Institute, Edmonton, AB, Canada; Seoul National University Hospital, Seoul, Republic of Korea; Texas Oncology, PA & US Oncology Research, Dallas, TX; The Ottawa Hospital, Ottawa, ON, Canada; North Wales Cancer Treatment Centre Glan Clwyd Hos, Rhyl, United Kingdom; Princess Margaret Hospital, Toronto, ON, Canada; The Royal Marsden Hospital, Sutton, United Kingdom
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Yee D, Danielson B, Halperin R, Hanson J, Nijjar T, Butts C, Smylie M, Reiman T, Roa W. 2594. Int J Radiat Oncol Biol Phys 2006. [DOI: 10.1016/j.ijrobp.2006.07.1008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Lian J, Pervez N, Nijjar T, Quon H, Robinson D, Murray B, Butts C, Joy A, Reiman T, Smylie M, Hanson J, Amanie J, McEwan A, Roa W. 103 An Institutional experience of PET-guided high-dose IMRT with self-respiratory gating in the treatment of non-small cell lung cancer. Radiother Oncol 2006. [DOI: 10.1016/s0167-8140(06)80844-3] [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: 11/29/2022]
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Yee D, Halperin R, Hanson J, Nijjar T, Butts C, Smylie M, Reiman T, Roa W. 215 Phase I study of hypofractionated dose-escalated thoracic radiotherapy for limited-stage small cell lung cancer. Radiother Oncol 2006. [DOI: 10.1016/s0167-8140(06)80956-4] [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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Danielson B, Yee D, Halperin R, Hanson J, Nijjar T, Butts C, Smylie M, Reiman T, Roa W. 100 Quality of life in patients undergoing dose-escalated hypofractionated thoracic radiotherapy for limited stage small cell lung cancer. Radiother Oncol 2006. [DOI: 10.1016/s0167-8140(06)80841-8] [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: 10/23/2022]
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Reiman T, Lai R, Ding K, Winton T, Butts C, Mackey J, Dabbagh L, Seymour L, Tsao M, Shepherd F, Seve P. Class III beta tubulin expression and benefit from adjuvant cisplatin/vinorelbine chemotherapy in operable non-small cell lung cancer: Analysis of the National Cancer Institute of Canada Clinical Trials Group (NCIC CTG) study JBR.10. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.7051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7051 Background: Biomarkers may be useful to select patients who will benefit from a particular chemotherapy regimen. High class III beta tubulin (bTubIII) expression in advanced NSCLC is known to correlate with reduced response rates and inferior survival with the anti-microtubule agents vinorelbine or paclitaxel. JBR.10 demonstrated a 12% and 15% improvement in 5-year recurrence-free (RFS) and overall survival (OS) respectively with the addition of cisplatin and vinorelbine following resection of stage IB-II NSCLC. We sought to determine the impact of bTubIII on patient outcome and benefit from adjuvant chemotherapy in the JBR.10 trial. Methods: We performed an immunohistochemical assay for bTubIII on primary tumor tissue available from 265 of the 482 patients in JBR.10. A validated, numerical bTubIII score was assigned by two observers based on the intensity and frequency of tumour cell staining. Tumours were classified as bTubIII “low” or “high” based on the median score. We examined the prognostic impact of bTubIII in patients treated with or without chemotherapy, and the survival benefit from chemotherapy in low versus high bTubIII subgroups. Results: High bTubIII expression was associated with poorer RFS (HR = 1.9, p = 0.01) in patients treated with surgery alone, but not in patients treated with adjuvant chemotherapy (HR = 1.1, p = .75). In the low bTubIII subgroup, the improvement in RFS with chemotherapy was non-significant (HR = 0.78, p = 0.4), while the improvement in RFS with chemotherapy was significant in the high bTubIII subgroup (HR = 0.45, p = 0.002). With Cox regression, the interaction between bTubIII status and chemotherapy treatment in predicting RFS did not reach statistical significance (p = 0.15). Results for OS were similar. Conclusions: Chemotherapy appeared to overcome the negative prognostic impact of high bTubIII expression. Greater benefit from adjuvant chemotherapy was seen in patients with high bTubIII expression. This is contrary to what has been seen in the setting of advanced disease; possible reasons for this difference are being explored. No significant financial relationships to disclose.
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Affiliation(s)
- T. Reiman
- University of Alberta, Edmonton, AB, Canada; National Cancer Institute Canada Clinical Trials Group, Kingston, ON, Canada
| | - R. Lai
- University of Alberta, Edmonton, AB, Canada; National Cancer Institute Canada Clinical Trials Group, Kingston, ON, Canada
| | - K. Ding
- University of Alberta, Edmonton, AB, Canada; National Cancer Institute Canada Clinical Trials Group, Kingston, ON, Canada
| | - T. Winton
- University of Alberta, Edmonton, AB, Canada; National Cancer Institute Canada Clinical Trials Group, Kingston, ON, Canada
| | - C. Butts
- University of Alberta, Edmonton, AB, Canada; National Cancer Institute Canada Clinical Trials Group, Kingston, ON, Canada
| | - J. Mackey
- University of Alberta, Edmonton, AB, Canada; National Cancer Institute Canada Clinical Trials Group, Kingston, ON, Canada
| | - L. Dabbagh
- University of Alberta, Edmonton, AB, Canada; National Cancer Institute Canada Clinical Trials Group, Kingston, ON, Canada
| | - L. Seymour
- University of Alberta, Edmonton, AB, Canada; National Cancer Institute Canada Clinical Trials Group, Kingston, ON, Canada
| | - M. Tsao
- University of Alberta, Edmonton, AB, Canada; National Cancer Institute Canada Clinical Trials Group, Kingston, ON, Canada
| | - F. Shepherd
- University of Alberta, Edmonton, AB, Canada; National Cancer Institute Canada Clinical Trials Group, Kingston, ON, Canada
| | - P. Seve
- University of Alberta, Edmonton, AB, Canada; National Cancer Institute Canada Clinical Trials Group, Kingston, ON, Canada
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Butts C. O-083 A multicenter phase IIB randomized study of the liposomal MUC1 vaccine L-BLP25 for immunotherapy of advanced non-small cell lung cancer (NSCLC). Lung Cancer 2005. [DOI: 10.1016/s0169-5002(05)80216-8] [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: 10/25/2022]
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Soulières D, Murray N, Maksymiuk A, Marshall E, Goss G, Butts C. A liposomal MUC1 vaccine for treatment of non-small cell lung cancer (NSCLC): Differences in QOL assessments for Stage IIIBLR and IV patients. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.7209] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- D. Soulières
- CHUM - Hôpital Notre-Dame, Montreal, PQ, Canada; British Columbia Cancer Agency, Vancouver, BC, Canada; Cancer Care Manitoba, Winnipeg, MB, Canada; Clatterbridge Ctr for Oncology, Bebington, United Kingdom; Ottawa Regional Cancer Ctr, Ottawa, ON, Canada; Cross Cancer Institute, Edmonton, AB, Canada
| | - N. Murray
- CHUM - Hôpital Notre-Dame, Montreal, PQ, Canada; British Columbia Cancer Agency, Vancouver, BC, Canada; Cancer Care Manitoba, Winnipeg, MB, Canada; Clatterbridge Ctr for Oncology, Bebington, United Kingdom; Ottawa Regional Cancer Ctr, Ottawa, ON, Canada; Cross Cancer Institute, Edmonton, AB, Canada
| | - A. Maksymiuk
- CHUM - Hôpital Notre-Dame, Montreal, PQ, Canada; British Columbia Cancer Agency, Vancouver, BC, Canada; Cancer Care Manitoba, Winnipeg, MB, Canada; Clatterbridge Ctr for Oncology, Bebington, United Kingdom; Ottawa Regional Cancer Ctr, Ottawa, ON, Canada; Cross Cancer Institute, Edmonton, AB, Canada
| | - E. Marshall
- CHUM - Hôpital Notre-Dame, Montreal, PQ, Canada; British Columbia Cancer Agency, Vancouver, BC, Canada; Cancer Care Manitoba, Winnipeg, MB, Canada; Clatterbridge Ctr for Oncology, Bebington, United Kingdom; Ottawa Regional Cancer Ctr, Ottawa, ON, Canada; Cross Cancer Institute, Edmonton, AB, Canada
| | - G. Goss
- CHUM - Hôpital Notre-Dame, Montreal, PQ, Canada; British Columbia Cancer Agency, Vancouver, BC, Canada; Cancer Care Manitoba, Winnipeg, MB, Canada; Clatterbridge Ctr for Oncology, Bebington, United Kingdom; Ottawa Regional Cancer Ctr, Ottawa, ON, Canada; Cross Cancer Institute, Edmonton, AB, Canada
| | - C. Butts
- CHUM - Hôpital Notre-Dame, Montreal, PQ, Canada; British Columbia Cancer Agency, Vancouver, BC, Canada; Cancer Care Manitoba, Winnipeg, MB, Canada; Clatterbridge Ctr for Oncology, Bebington, United Kingdom; Ottawa Regional Cancer Ctr, Ottawa, ON, Canada; Cross Cancer Institute, Edmonton, AB, Canada
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Murray N, Butts C, Maksymiuk A, Marshall E, Goss G, Soulieres D. A liposomal MUC1 vaccine for treatment of non-small cell lung cancer (NSCLC): Updated survival results from patients with stage IIIB disease. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.7037] [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)
- N. Murray
- British Columbia Cancer Agency, Vancouver, BC, Canada; Cross Cancer Ctr, Edmonton, AB, Canada; CancerCare Manitoba, Winnipeg, MB, Canada; Clatterbridge Ctr for Oncology, Wirral, United Kingdom; Ottawa Regional Cancer Ctr, Ottawa, ON, Canada; Hosp Notre-Dame du CHUM, Montreal, PQ, Canada
| | - C. Butts
- British Columbia Cancer Agency, Vancouver, BC, Canada; Cross Cancer Ctr, Edmonton, AB, Canada; CancerCare Manitoba, Winnipeg, MB, Canada; Clatterbridge Ctr for Oncology, Wirral, United Kingdom; Ottawa Regional Cancer Ctr, Ottawa, ON, Canada; Hosp Notre-Dame du CHUM, Montreal, PQ, Canada
| | - A. Maksymiuk
- British Columbia Cancer Agency, Vancouver, BC, Canada; Cross Cancer Ctr, Edmonton, AB, Canada; CancerCare Manitoba, Winnipeg, MB, Canada; Clatterbridge Ctr for Oncology, Wirral, United Kingdom; Ottawa Regional Cancer Ctr, Ottawa, ON, Canada; Hosp Notre-Dame du CHUM, Montreal, PQ, Canada
| | - E. Marshall
- British Columbia Cancer Agency, Vancouver, BC, Canada; Cross Cancer Ctr, Edmonton, AB, Canada; CancerCare Manitoba, Winnipeg, MB, Canada; Clatterbridge Ctr for Oncology, Wirral, United Kingdom; Ottawa Regional Cancer Ctr, Ottawa, ON, Canada; Hosp Notre-Dame du CHUM, Montreal, PQ, Canada
| | - G. Goss
- British Columbia Cancer Agency, Vancouver, BC, Canada; Cross Cancer Ctr, Edmonton, AB, Canada; CancerCare Manitoba, Winnipeg, MB, Canada; Clatterbridge Ctr for Oncology, Wirral, United Kingdom; Ottawa Regional Cancer Ctr, Ottawa, ON, Canada; Hosp Notre-Dame du CHUM, Montreal, PQ, Canada
| | - D. Soulieres
- British Columbia Cancer Agency, Vancouver, BC, Canada; Cross Cancer Ctr, Edmonton, AB, Canada; CancerCare Manitoba, Winnipeg, MB, Canada; Clatterbridge Ctr for Oncology, Wirral, United Kingdom; Ottawa Regional Cancer Ctr, Ottawa, ON, Canada; Hosp Notre-Dame du CHUM, Montreal, PQ, Canada
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Bathe OF, Ernst S, Sutherland F, Dixon E, Koppel J, Butts C, Bigam D, Ruether D, Walley B, Dowden S. A phase II study of neoadjuvant irinotecan (CPT-11), 5-fluorouracil (5-FU) and leucovorin (LV) for resectable liver metastases from colorectal cancer. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.3662] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- O. F. Bathe
- Univ of Calgary, Calgary, AB, Canada; London Regional Cancer Ctr, London, ON, Canada; Univ of Alberta, Edmonton, AB, Canada
| | - S. Ernst
- Univ of Calgary, Calgary, AB, Canada; London Regional Cancer Ctr, London, ON, Canada; Univ of Alberta, Edmonton, AB, Canada
| | - F. Sutherland
- Univ of Calgary, Calgary, AB, Canada; London Regional Cancer Ctr, London, ON, Canada; Univ of Alberta, Edmonton, AB, Canada
| | - E. Dixon
- Univ of Calgary, Calgary, AB, Canada; London Regional Cancer Ctr, London, ON, Canada; Univ of Alberta, Edmonton, AB, Canada
| | - J. Koppel
- Univ of Calgary, Calgary, AB, Canada; London Regional Cancer Ctr, London, ON, Canada; Univ of Alberta, Edmonton, AB, Canada
| | - C. Butts
- Univ of Calgary, Calgary, AB, Canada; London Regional Cancer Ctr, London, ON, Canada; Univ of Alberta, Edmonton, AB, Canada
| | - D. Bigam
- Univ of Calgary, Calgary, AB, Canada; London Regional Cancer Ctr, London, ON, Canada; Univ of Alberta, Edmonton, AB, Canada
| | - D. Ruether
- Univ of Calgary, Calgary, AB, Canada; London Regional Cancer Ctr, London, ON, Canada; Univ of Alberta, Edmonton, AB, Canada
| | - B. Walley
- Univ of Calgary, Calgary, AB, Canada; London Regional Cancer Ctr, London, ON, Canada; Univ of Alberta, Edmonton, AB, Canada
| | - S. Dowden
- Univ of Calgary, Calgary, AB, Canada; London Regional Cancer Ctr, London, ON, Canada; Univ of Alberta, Edmonton, AB, Canada
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47
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Abstract
Rheumatic autoimmune diseases are characterized by dysregulation of the immune response that leads to inflammation, pain, disease and stiffness and have been shown to have differences in disease pattern, depending on the gender and age of an individual. The majority of these conditions predominantly affect females of all species and also show increased severity of disease in female animal models. In addition to the gender differences in disease development, persons are often more susceptible at specific stages of life. This review will discuss some of the data indicating age and gender differences in development of these diseases and will review hormonal and other factors that may contribute to disease expression and severity.
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Affiliation(s)
- C Butts
- National Institute of Mental Health, National Institutes of Health, 36/1A23, 36 Convent Drive, Bethesda, MD 20892-1284 , USA
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48
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Winton TL, Livingston R, Johnson D, Rigas J, Cormier Y, Butts C, Ding K, Seymour L, Magoski N, Shepherd F. A prospective randomised trial of adjuvant vinorelbine (VIN) and cisplatin (CIS) in completely resected stage 1B and II non small cell lung cancer (NSCLC) Intergroup JBR.10. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.7018] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [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)
- T. L. Winton
- National Cancer Institute of Canada, CTG, Kingston, ON, Canada; National Cancer Institute of Canada CTG, Kingston, ON, Canada
| | - R. Livingston
- National Cancer Institute of Canada, CTG, Kingston, ON, Canada; National Cancer Institute of Canada CTG, Kingston, ON, Canada
| | - D. Johnson
- National Cancer Institute of Canada, CTG, Kingston, ON, Canada; National Cancer Institute of Canada CTG, Kingston, ON, Canada
| | - J. Rigas
- National Cancer Institute of Canada, CTG, Kingston, ON, Canada; National Cancer Institute of Canada CTG, Kingston, ON, Canada
| | - Y. Cormier
- National Cancer Institute of Canada, CTG, Kingston, ON, Canada; National Cancer Institute of Canada CTG, Kingston, ON, Canada
| | - C. Butts
- National Cancer Institute of Canada, CTG, Kingston, ON, Canada; National Cancer Institute of Canada CTG, Kingston, ON, Canada
| | - K. Ding
- National Cancer Institute of Canada, CTG, Kingston, ON, Canada; National Cancer Institute of Canada CTG, Kingston, ON, Canada
| | - L. Seymour
- National Cancer Institute of Canada, CTG, Kingston, ON, Canada; National Cancer Institute of Canada CTG, Kingston, ON, Canada
| | - N. Magoski
- National Cancer Institute of Canada, CTG, Kingston, ON, Canada; National Cancer Institute of Canada CTG, Kingston, ON, Canada
| | - F. Shepherd
- National Cancer Institute of Canada, CTG, Kingston, ON, Canada; National Cancer Institute of Canada CTG, Kingston, ON, Canada
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49
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Twelves C, Butts C, Cassidy J, Conroy T, De Braud F, Díaz-Rubio E, Tabernero J, Schöffski P, Figer A, Van Cutsem E. XELOX (capecitabine plus oxaliplatin), a safe and active first-line regimen for elderly patients with metastatic colorectal cancer (MCRC): Post-hoc analysis of a large phase II study. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.3555] [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)
- C. Twelves
- Tom Connors Cancer Centre, University of Bradford, Bradford, United Kingdom; Cross Cancer Institute, Edmonton, AB, Canada; Glasgow University, Glasgow, United Kingdom; Centre Alexis Vautrin, Vandoeuvre Les Nancy, France; European Institute of Oncology, Milan, Italy; Hospital Clínico Universitario San Carlos, Madrid, Spain; Hospital General d'Hebrón, Barcelona, Spain; Medizinische Hochschule Hannover, Hannover, Germany; Tel-Aviv Medical Center, Tel-Aviv, Israel; University Hospital Gasthuisberg, Leuven,
| | - C. Butts
- Tom Connors Cancer Centre, University of Bradford, Bradford, United Kingdom; Cross Cancer Institute, Edmonton, AB, Canada; Glasgow University, Glasgow, United Kingdom; Centre Alexis Vautrin, Vandoeuvre Les Nancy, France; European Institute of Oncology, Milan, Italy; Hospital Clínico Universitario San Carlos, Madrid, Spain; Hospital General d'Hebrón, Barcelona, Spain; Medizinische Hochschule Hannover, Hannover, Germany; Tel-Aviv Medical Center, Tel-Aviv, Israel; University Hospital Gasthuisberg, Leuven,
| | - J. Cassidy
- Tom Connors Cancer Centre, University of Bradford, Bradford, United Kingdom; Cross Cancer Institute, Edmonton, AB, Canada; Glasgow University, Glasgow, United Kingdom; Centre Alexis Vautrin, Vandoeuvre Les Nancy, France; European Institute of Oncology, Milan, Italy; Hospital Clínico Universitario San Carlos, Madrid, Spain; Hospital General d'Hebrón, Barcelona, Spain; Medizinische Hochschule Hannover, Hannover, Germany; Tel-Aviv Medical Center, Tel-Aviv, Israel; University Hospital Gasthuisberg, Leuven,
| | - T. Conroy
- Tom Connors Cancer Centre, University of Bradford, Bradford, United Kingdom; Cross Cancer Institute, Edmonton, AB, Canada; Glasgow University, Glasgow, United Kingdom; Centre Alexis Vautrin, Vandoeuvre Les Nancy, France; European Institute of Oncology, Milan, Italy; Hospital Clínico Universitario San Carlos, Madrid, Spain; Hospital General d'Hebrón, Barcelona, Spain; Medizinische Hochschule Hannover, Hannover, Germany; Tel-Aviv Medical Center, Tel-Aviv, Israel; University Hospital Gasthuisberg, Leuven,
| | - F. De Braud
- Tom Connors Cancer Centre, University of Bradford, Bradford, United Kingdom; Cross Cancer Institute, Edmonton, AB, Canada; Glasgow University, Glasgow, United Kingdom; Centre Alexis Vautrin, Vandoeuvre Les Nancy, France; European Institute of Oncology, Milan, Italy; Hospital Clínico Universitario San Carlos, Madrid, Spain; Hospital General d'Hebrón, Barcelona, Spain; Medizinische Hochschule Hannover, Hannover, Germany; Tel-Aviv Medical Center, Tel-Aviv, Israel; University Hospital Gasthuisberg, Leuven,
| | - E. Díaz-Rubio
- Tom Connors Cancer Centre, University of Bradford, Bradford, United Kingdom; Cross Cancer Institute, Edmonton, AB, Canada; Glasgow University, Glasgow, United Kingdom; Centre Alexis Vautrin, Vandoeuvre Les Nancy, France; European Institute of Oncology, Milan, Italy; Hospital Clínico Universitario San Carlos, Madrid, Spain; Hospital General d'Hebrón, Barcelona, Spain; Medizinische Hochschule Hannover, Hannover, Germany; Tel-Aviv Medical Center, Tel-Aviv, Israel; University Hospital Gasthuisberg, Leuven,
| | - J. Tabernero
- Tom Connors Cancer Centre, University of Bradford, Bradford, United Kingdom; Cross Cancer Institute, Edmonton, AB, Canada; Glasgow University, Glasgow, United Kingdom; Centre Alexis Vautrin, Vandoeuvre Les Nancy, France; European Institute of Oncology, Milan, Italy; Hospital Clínico Universitario San Carlos, Madrid, Spain; Hospital General d'Hebrón, Barcelona, Spain; Medizinische Hochschule Hannover, Hannover, Germany; Tel-Aviv Medical Center, Tel-Aviv, Israel; University Hospital Gasthuisberg, Leuven,
| | - P. Schöffski
- Tom Connors Cancer Centre, University of Bradford, Bradford, United Kingdom; Cross Cancer Institute, Edmonton, AB, Canada; Glasgow University, Glasgow, United Kingdom; Centre Alexis Vautrin, Vandoeuvre Les Nancy, France; European Institute of Oncology, Milan, Italy; Hospital Clínico Universitario San Carlos, Madrid, Spain; Hospital General d'Hebrón, Barcelona, Spain; Medizinische Hochschule Hannover, Hannover, Germany; Tel-Aviv Medical Center, Tel-Aviv, Israel; University Hospital Gasthuisberg, Leuven,
| | - A. Figer
- Tom Connors Cancer Centre, University of Bradford, Bradford, United Kingdom; Cross Cancer Institute, Edmonton, AB, Canada; Glasgow University, Glasgow, United Kingdom; Centre Alexis Vautrin, Vandoeuvre Les Nancy, France; European Institute of Oncology, Milan, Italy; Hospital Clínico Universitario San Carlos, Madrid, Spain; Hospital General d'Hebrón, Barcelona, Spain; Medizinische Hochschule Hannover, Hannover, Germany; Tel-Aviv Medical Center, Tel-Aviv, Israel; University Hospital Gasthuisberg, Leuven,
| | - E. Van Cutsem
- Tom Connors Cancer Centre, University of Bradford, Bradford, United Kingdom; Cross Cancer Institute, Edmonton, AB, Canada; Glasgow University, Glasgow, United Kingdom; Centre Alexis Vautrin, Vandoeuvre Les Nancy, France; European Institute of Oncology, Milan, Italy; Hospital Clínico Universitario San Carlos, Madrid, Spain; Hospital General d'Hebrón, Barcelona, Spain; Medizinische Hochschule Hannover, Hannover, Germany; Tel-Aviv Medical Center, Tel-Aviv, Israel; University Hospital Gasthuisberg, Leuven,
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50
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Mulder K, Scarfe AG, Koski S, Au HJ, Butts C, Fields A, Razavy H, Graham K, Cass CE, Sawyer MB. A prospective pharmacogenetic study of 5FU/LV in high-risk stage II and III colon cancer patients. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.2067] [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)
- K. Mulder
- Cross Cancer Institute, Edmonton, AB, Canada
| | | | - S. Koski
- Cross Cancer Institute, Edmonton, AB, Canada
| | - H. J. Au
- Cross Cancer Institute, Edmonton, AB, Canada
| | - C. Butts
- Cross Cancer Institute, Edmonton, AB, Canada
| | - A. Fields
- Cross Cancer Institute, Edmonton, AB, Canada
| | - H. Razavy
- Cross Cancer Institute, Edmonton, AB, Canada
| | - K. Graham
- Cross Cancer Institute, Edmonton, AB, Canada
| | - C. E. Cass
- Cross Cancer Institute, Edmonton, AB, Canada
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