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Mizrahi D, Goldstein D, Trinh T, Li T, Timmins HC, Harrison M, Marx GM, Hovey EJ, Lewis CR, Friedlander M, Park SB. Physical activity behaviors in cancer survivors treated with neurotoxic chemotherapy. Asia Pac J Clin Oncol 2023; 19:243-249. [PMID: 35879821 PMCID: PMC10947250 DOI: 10.1111/ajco.13834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 06/21/2022] [Accepted: 07/03/2022] [Indexed: 01/20/2023]
Abstract
AIM There are many barriers to physical activity among cancer survivors. Survivors treated with neurotoxic chemotherapy may develop chemotherapy-induced peripheral neuropathy (CIPN) and experience additional barriers related to sensorimotor and mobility deficits. This study examined physical activity behaviors, including physical activity predictors, among cancer survivors treated with neurotoxic chemotherapies. METHODS A cross-sectional study of 252 participants, 3-24 months after neurotoxic chemotherapy, was undertaken. Physical activity was self-reported (IPAQ). CIPN was self-reported (FACT/GOG-Ntx-13), clinically graded (NCI-CTCAE), and objectively measured using neurological grading scales and neurophysiological techniques (tibial and sural nerve conduction studies). Balance (Swaymeter) and fine motor skills (grooved pegboard) were assessed. Regression models were used to identify clinical, demographic and CIPN predictors of walking and moderate-vigorous physical activity. RESULTS Forty-four percent of participants did not meet recommended physical activity guidelines (≥150 min/week). Sixty-six percent presented with CIPN. Nineteen percent of participants with CIPN reported that symptoms interfered with their ability to be physically active. A lower proportion of survivors aged ≥60, with grade ≥1 CIPN or BMI ≥30, reported meeting physical activity guidelines (all p < .05). Regression models identified older age, higher BMI, and patient-reported CIPN associated with lower walking, while higher BMI and females were associated with lower moderate-vigorous physical activity. Neurologically assessed CIPN did not associate with walking or moderate-vigorous physical activity. CONCLUSION Cancer survivors exposed to neurotoxic chemotherapy have low physical activity levels. Further work should examine the factors causing physical activity limitations in this cohort and designing interventions to improve physical function and quality of life in survivors.
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Affiliation(s)
- David Mizrahi
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, New South Wales, Australia
- Prince of Wales Clinical School, UNSW Medicine, UNSW Sydney, Sydney, New South Wales, Australia
| | - David Goldstein
- Prince of Wales Clinical School, UNSW Medicine, UNSW Sydney, Sydney, New South Wales, Australia
- Department of Medical Oncology, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Terry Trinh
- Prince of Wales Clinical School, UNSW Medicine, UNSW Sydney, Sydney, New South Wales, Australia
| | - Tiffany Li
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Hannah C Timmins
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | | | - Gavin M Marx
- Sydney Adventist Hospital Clinical School, The University of Sydney, Sydney, New South Wales, Australia
- Department of Medical Oncology, Sydney Adventist Hospital, Sydney, New South Wales, Australia
| | - Elizabeth J Hovey
- Prince of Wales Clinical School, UNSW Medicine, UNSW Sydney, Sydney, New South Wales, Australia
- Department of Medical Oncology, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Craig R Lewis
- Prince of Wales Clinical School, UNSW Medicine, UNSW Sydney, Sydney, New South Wales, Australia
- Department of Medical Oncology, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Michael Friedlander
- Prince of Wales Clinical School, UNSW Medicine, UNSW Sydney, Sydney, New South Wales, Australia
- Department of Medical Oncology, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Susanna B Park
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
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Hooshmand K, Goldstein D, Timmins HC, Li T, Harrison M, Friedlander ML, Lewis CR, Lees JG, Moalem-Taylor G, Guennewig B, Park SB, Kwok JB. Polygenic risk of paclitaxel-induced peripheral neuropathy: a genome-wide association study. J Transl Med 2022; 20:564. [PMID: 36474270 PMCID: PMC9724416 DOI: 10.1186/s12967-022-03754-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 11/04/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Genetic risk factors for chemotherapy-induced peripheral neuropathy (CIPN), a major dose-limiting side-effect of paclitaxel, are not well understood. METHODS We performed a genome-wide association study (GWAS) in 183 paclitaxel-treated patients to identify genetic loci associated with CIPN assessed via comprehensive neuropathy phenotyping tools (patient-reported, clinical and neurological grading scales). Bioinformatic analyses including pathway enrichment and polygenic risk score analysis were used to identify mechanistic pathways of interest. RESULTS In total, 77% of the cohort were classified with CIPN (n = 139), with moderate/severe neuropathy in 36%. GWAS was undertaken separately for the three measures of CIPN. GWAS of patient-reported CIPN identified 4 chromosomal regions that exceeded genome-wide significance (rs9846958, chromosome 3; rs117158921, chromosome 18; rs4560447, chromosome 4; rs200091415, chromosome 10). rs4560447 is located within a protein-coding gene, LIMCH1, associated with actin and neural development and expressed in the dorsal root ganglia (DRG). There were additional risk loci that exceeded the statistical threshold for suggestive genome-wide association (P < 1 × 10-5) for all measures. A polygenic risk score calculated from the top 46 ranked SNPs was highly correlated with patient-reported CIPN (r2 = 0.53; P = 1.54 × 10-35). Overlap analysis was performed to identify 3338 genes which were in common between the patient-reported CIPN, neurological grading scale and clinical grading scale GWAS. The common gene set was subsequently analysed for enrichment of gene ontology (GO) and Reactome pathways, identifying a number of pathways, including the axon development pathway (GO:0061564; P = 1.78 × 10-6) and neuronal system (R-HSA-112316; adjusted P = 3.33 × 10-7). CONCLUSIONS Our findings highlight the potential role of axon development and regeneration pathways in paclitaxel-induced CIPN.
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Affiliation(s)
- Kosar Hooshmand
- grid.1013.30000 0004 1936 834XSchool of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW Australia ,grid.1013.30000 0004 1936 834XBrain and Mind Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW Australia
| | - David Goldstein
- grid.1005.40000 0004 4902 0432Prince of Wales Clinical School, University of New South Wales, Sydney, NSW Australia
| | - Hannah C. Timmins
- grid.1013.30000 0004 1936 834XSchool of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW Australia ,grid.1013.30000 0004 1936 834XBrain and Mind Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW Australia
| | - Tiffany Li
- grid.1013.30000 0004 1936 834XSchool of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW Australia ,grid.1013.30000 0004 1936 834XBrain and Mind Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW Australia
| | | | - Michael L. Friedlander
- grid.1005.40000 0004 4902 0432Prince of Wales Clinical School, University of New South Wales, Sydney, NSW Australia
| | - Craig R. Lewis
- grid.1005.40000 0004 4902 0432Prince of Wales Clinical School, University of New South Wales, Sydney, NSW Australia
| | - Justin G. Lees
- grid.1005.40000 0004 4902 0432School of Biomedical Sciences, University of New South Wales, UNSW Sydney, Sydney, NSW Australia
| | - Gila Moalem-Taylor
- grid.1005.40000 0004 4902 0432School of Biomedical Sciences, University of New South Wales, UNSW Sydney, Sydney, NSW Australia
| | - Boris Guennewig
- grid.1013.30000 0004 1936 834XSchool of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW Australia ,grid.1013.30000 0004 1936 834XBrain and Mind Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW Australia
| | - Susanna B. Park
- grid.1013.30000 0004 1936 834XSchool of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW Australia ,grid.1013.30000 0004 1936 834XBrain and Mind Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW Australia
| | - John B. Kwok
- grid.1013.30000 0004 1936 834XSchool of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW Australia ,grid.1013.30000 0004 1936 834XBrain and Mind Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW Australia
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Mizrahi D, Goldstein D, Trinh T, Li T, Timmins HC, Harrison M, Marx GM, Hovey EJ, Lewis CR, Friedlander M, Park SB. Clinical Predictors And Levels Of Physical Activity Among Cancer Survivors Treated With Neurotoxic Chemotherapy. Med Sci Sports Exerc 2022. [DOI: 10.1249/01.mss.0000879060.88938.0b] [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: 11/21/2022]
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4
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Klingberg D, Bae S, Zhou D, Sim HW, Cai R, Anazodo A, Grimison PS, Lewis CR, Lee YC. Dose intensity and outcomes of VDC/IE chemotherapy for adolescent and adult patients with Ewing’s family sarcoma. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.11570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
11570 Background: Ewing’s family sarcoma (EFS) is a rare and aggressive malignancy with peak incidence in the second decade of life. Treatment is multimodal, involving local surgery and/or radiotherapy, and chemotherapy, typically with VDC/IE (Vincristine, Doxorubicin, Cyclophosphamide alternating with Ifosfamide, Etoposide). There is paucity of data in the adult setting, with treatment protocols extrapolated mainly from the paediatric setting. We assessed chemotherapy dose intensity and outcomes across four Australian sarcoma centres (three adult and one paediatric centre). Methods: Using the Australia New Zealand Sarcoma Association national database (ACCORD) and medical records, we identified patients aged ≥10 years diagnosed with EFS between 2010-2020. Clinical characteristics, treatment and survival information were collected for those receiving Ewing protocol with VDC/IE backbone. Received Dose Intensity (RDI) of chemotherapy was calculated using planned and actual doses received and time taken. RDI ≥85% was considered acceptable, consistent with published literature. We compared survival outcomes based on RDI. Clinical predictors of achieving an acceptable RDI were explored using logistic regression. Results: Of 146 patients with EFS identified, 76 received VDC/IE (59% male). The median age was 25 years, with age distribution 24% aged 10-19, 58% aged 20-39, and 18% aged 40-59. Majority had extraskeletal Ewing’s (57%), non-extremity primary site (64%) and localised disease (stage, II 37%; III 28%; IV 28%). Treatment received included surgery (74%), radiotherapy (66%) and chemotherapy (100%). Over two-thirds (70%) completed their scheduled chemotherapy and 57% achieved an acceptable RDI (67% aged 10-19, 61% aged 20-39, 29% aged 40-59). Compared to those aged 10-19, the odds ratio (OR) of an acceptable RDI for patients aged 20-39 was 0.79 (95% CI 0.24-2.46, p = 0.70) and for patients aged 40-59 was 0.20 (95% CI 0.04-0.86, p = 0.04). The median number of chemotherapy cycles was 14 (range, 2-17). Dose reductions were mostly within 20% cumulative target dose (91%), and were predominantly for neutropenia (47%), thrombocytopenia (30%) and/or anaemia (28%), and less frequently for cardiotoxicity (7%). Median follow-up was 37.3 months. Two-year progression-free survival (PFS) rates were 56% for acceptable RDI, compared to 30% for low RDI (p = 0.001), with two-year overall survival (OS) rates respectively 88% versus 49% (p < 0.001). After adjustment for age, gender, Ewing’s type, primary site and stage, RDI remained an important prognostic factor (PFS HR 0.39, 95% CI 0.18-0.82; OS HR 0.25, 95% CI 0.10-0.63). Conclusions: Survival outcomes in EFS were contingent on achieving an acceptable RDI. It was more difficult to maintain VDC/IE chemotherapy dose intensity in adults aged over 40 years, due to myelosuppression. Optimal treatment strategy for older adults remains to be defined.
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Affiliation(s)
| | - Susie Bae
- Peter MacCallum Cancer Centre, Melbourne, NSW, Australia
| | | | - Hao-Wen Sim
- Chris O'Brien Lifehouse, Sydney, NSW, Australia
| | - Ruilin Cai
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | | | | | | | - Yeh Chen Lee
- Prince of Wales Hospital, Sydney, NSW, Australia
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5
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Klingberg D, Dalrymple J, Zaheed M, Lewis CR, John T, Lee CK. Impact of cancer susceptibility gene (CSG) mutations in advanced NSCLC (aNSCLC). J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.9131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
9131 Background: Next generation sequencing (NGS) is used widely to identify somatic oncogenic driver mutations in aNSCLC to guide treatment. Comprehensive profiling has led to identification of multiple gene mutations of unclear significance, including germline genes associated with cancer risk, termed CSG. Using data from two randomized trials comparing atezolizumab to docetaxel, we investigated the prognostic and predictive values of CSG in aNSCLC. Methods: We used publicly available data from the OAK (NCT02008227) and POPLAR (NCT01903993) trials. At baseline, plasma was analyzed for cfDNA using FoundationOne CDx NGS assay. We defined CSGs as pathogenic variants of APC, BAP1, BRCA1/2, BRIP1, CDH1, CDKN2A, CHEK2, FH, FLCN, MEN1, MET, MSH2/6, MLH1, PMS2, PALB2, PTCH1, PTEN, RAD51, RB1, SDHB, SMARCA4, STK11, TSC1/2 and VHL. Cox models with treatment covariate, CSG status (mutant [mt] vs wild-type [wt]) and their interaction was used to assess the predictive value by treatment of CSG mt for overall survival (OS) and progression free survival (PFS) using univariate and multivariate models. Similar analysis was performed for objective response rate (ORR). Results: Of 1137 patients, 853 with sufficient tumor content formed the analysis population. In total, 295 (35%) had a known/likely pathogenic CSG mt. The variant allele frequencies (vAF) of CSG mt ≥30%, 10-30%, and <10% were 8% (N=23), 25% (N=73), and 67% (N=199) respectively. Patients with CSG mt were more likely to be smokers (89% vs 81%, P=0.005), had squamous tumors (37% vs 26%, P=0.001) with higher blood-based tumor mutation burden (mean 13.8 vs 10.2 per megabase, P<0.001). CSG mt was not predictive of greater OS benefit with atezolizumab over docetaxel (Table). CSG mt was associated with 35% increase risk of death in univariable analysis (HR 1.35, 95% CI 1.15-1.59). CSG mt was associated with inferior OS in multivariable analysis adjusting for performance status, smoking status, tumor histology, age, sex and number of organ sites of metastasis (HR 1.26, 95% CI 1.07-1.48). Conclusions: Plasma CSG mt is an independent poor prognostic factor in two large aNSCLC clinical trial datasets. Majority of vAF of CSG were low, suggesting that very few were potentially germline in origin, but dedicated sequencing for confirmation will be required. If confirmed, CSG status could be used as a stratification factor in future aNSCLC trials. [Table: see text]
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Affiliation(s)
| | | | | | | | - Tom John
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
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6
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Woodford R, Zhou D, Lord SJ, Marschner I, Cooper WA, Lewis CR, John T, Yang JCH, Lee CK. PD-L1 expression as a prognostic marker in patients treated with chemotherapy for metastatic non-small-cell lung cancer. Future Oncol 2022; 18:1793-1799. [PMID: 35156837 DOI: 10.2217/fon-2021-1184] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: In metastatic non-small-cell lung cancer (mNSCLC), PD-L1 expression is associated with benefit from immune checkpoint inhibitor (ICI) therapy. However, the significance of PD-L1 expression in chemotherapy-treated patients is uncertain. Methods: Using the chemotherapy control arm of first-line randomized trials, a meta-analysis of the association between efficacy outcomes and PD-L1 status was performed, stratified by assay due to inter-assay differences. Results: Across 12 trials and 4378 patients, overall survival (OS) was superior in high PD-L1 versus negative tumors and low versus negative according to 22C3/28-8 assays. When classified by SP142 assay, no significant difference in response or survival was seen between PD-L1 groups. Conclusion: In mNSCLC, high PD-L1-expressing tumors are associated with longer OS and improved objective rate when treated with chemotherapy. Inter-assay variability impacts outcome results.
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Affiliation(s)
- Rachel Woodford
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, Australia.,Cancer Care Centre, St George Hospital, Kogarah, 2217, Australia
| | - Deborah Zhou
- Chris O'Brien Lifehouse, Royal Prince Alfred Hospital, Sydney, 2050, Australia
| | - Sarah J Lord
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, Australia
| | - Ian Marschner
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, Australia
| | - Wendy A Cooper
- Department of Tissue Pathology & Diagnostic Oncology, NSW Health Pathology, Royal Prince Alfred Hospital, Sydney, Australia; Sydney Medical School, University of Sydney, NSW, Australia; School of Medicine, Western Sydney University, Sydney, New South Wales, 2050, Australia
| | - Craig R Lewis
- Department of Medical Oncology, Prince of Wales Hospital, Sydney, 2031, Australia
| | - Thomas John
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, 3000, Australia
| | - James Chih-Hsin Yang
- Department of Oncology, National Taiwan University Hospital, Taipei City, 100, Taiwan
| | - Chee Khoon Lee
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, Australia.,Cancer Care Centre, St George Hospital, Kogarah, 2217, Australia
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Tang M, Lee CK, Lewis CR, Boyer M, Brown B, Schaffer A, Pearson SA, Simes RJ. Generalizability of Immune Checkpoint Inhibitor Trials to Real-world Patients with Advanced Non-Small Cell Lung Cancer. Lung Cancer 2022; 166:40-48. [DOI: 10.1016/j.lungcan.2022.01.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 01/09/2022] [Accepted: 01/31/2022] [Indexed: 01/07/2023]
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Tjokrowidjaja A, Lord SJ, John T, Lewis CR, Kok PS, Marschner IC, Lee CK. Pre- and on-treatment lactate dehydrogenase as a prognostic and predictive biomarker in advanced non-small cell lung cancer. Cancer 2022; 128:1574-1583. [PMID: 35090047 PMCID: PMC9306897 DOI: 10.1002/cncr.34113] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 12/26/2021] [Accepted: 01/04/2022] [Indexed: 12/22/2022]
Abstract
BACKGROUND The survival outcomes of patients with advanced non–small cell lung cancer (NSCLC) treated with immune checkpoint inhibitors (ICIs) are variable. This study investigated whether pre‐ and on‐treatment lactate dehydrogenase (LDH) could better prognosticate and select patients for ICI therapy. METHODS Using data from the POPLAR and OAK trials of atezolizumab versus docetaxel in previously treated advanced NSCLC, the authors assessed the prognostic and predictive value of pretreatment LDH (less than or equal to vs greater than the upper limit of normal). They further examined changes in on‐treatment LDH by performing landmark analyses and estimated overall survival (OS) distributions according to the LDH level stratified by the response category (complete response [CR]/partial response [PR] vs stable disease [SD]). They repeated pretreatment analyses in subgroups defined by the programmed death ligand 1 (PD‐L1) status. RESULTS This study included 1327 patients with available pretreatment LDH. Elevated pretreatment LDH was associated with an adverse prognosis regardless of treatment (hazard ratio [HR] for atezolizumab OS, 1.49; P = .0001; HR for docetaxel OS, 1.30; P = .004; P for treatment by LDH interaction = .28). Findings for elevated pretreatment LDH were similar for patients with positive PD‐L1 expression treated with atezolizumab. Persistently elevated on‐treatment LDH was associated with a 1.3‐ to 2.8‐fold increased risk of death at weeks 6, 12, 18, and 24 regardless of treatment. Elevated LDH at 6 weeks was associated with significantly shorter OS regardless of radiological response (HR for CR/PR, 2.10; P = .04; HR for SD, 1.50; P < .01), with similar findings observed at 12 weeks. CONCLUSIONS In previously treated advanced NSCLC, elevated pretreatment LDH is an independent adverse prognostic marker. There is no evidence that pretreatment LDH predicts ICI benefit. Persistently elevated on‐treatment LDH is associated with worse OS despite radiologic response. This analysis of 1327 patients with advanced non–small cell lung cancer from the POPLAR and OAK randomized controlled trials has found that lactate dehydrogenase (LDH) is a useful pre‐ and on‐treatment prognostic marker that can assist clinicians in counselling patients undergoing second‐ or later‐line atezolizumab or docetaxel. However, the findings fail to support the use of LDH as a predictive biomarker for immune checkpoint inhibitor therapy and reinforce the importance of rigorous validation of promising predictive biomarkers using randomized data.
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Affiliation(s)
- Angelina Tjokrowidjaja
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia.,Department of Medical Oncology, St George Hospital, Kogarah, New South Wales, Australia
| | - Sarah J Lord
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia.,School of Medicine, University of Notre Dame, Sydney, New South Wales, Australia
| | - Thomas John
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Craig R Lewis
- Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Peey-Sei Kok
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Ian C Marschner
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Chee K Lee
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia.,Department of Medical Oncology, St George Hospital, Kogarah, New South Wales, Australia
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McLean LS, Faisal W, Parakh S, Kao SC, Lewis CR, Chin MT, Voskoboynik M, Itchins MJ, Jennens RR, Broad AR, Morris TA, Solomon BJ. Standard-Dose Osimertinib in EGFR-Mutated Non-Small-Cell Lung Adenocarcinoma With Leptomeningeal Disease. JCO Precis Oncol 2022; 5:561-568. [PMID: 34994604 DOI: 10.1200/po.20.00464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
PURPOSE Leptomeningeal disease (LMD) in epidermal growth factor receptor (EGFR)-mutant lung adenocarcinoma is associated with a poor prognosis and limited treatment options. Osimertinib is a potent third-generation EGFR tyrosine kinase inhibitor with confirmed CNS penetration. This study reports on outcomes of patients with EGFR-mutated non-small-cell lung cancer who developed LMD and were subsequently treated with osimertinib. METHODS We identified patients treated with osimertinib 80 mg PO daily under a compassionate access scheme across nine tertiary Australian institutes between July 2017 and July 2020. Patient demographics, tumor characteristics, and treatment history were collected. Median overall survival, median progression-free survival, disease control rates (DCR), and overall response rates (ORR) were assessed. Kaplan-Meier analysis was performed and descriptive statistics were used. RESULTS Thirty-nine patients were analyzed of which 74% were female. Exon 19 deletions (49%) and L858R point mutations (41%) were the most common EGFR mutations. Forty-nine percentage of patients were Eastern Cooperative Oncology Group 1. The median duration of osimertinib therapy was 6 months. The extracranial DCR and ORR were 60% and 54%, and the intracranial DCR and ORR were 68% and 53%, respectively. Median overall survival was 10.5 months (95% CI, 8.17 to 15.05 months). CONCLUSION There are limited treatment options for LMD in EGFR-positive lung cancer, and osimertinib at a dose of 80 mg daily is an active therapeutic option for these patients.
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Affiliation(s)
- Luke S McLean
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Wasek Faisal
- Department of Medical Oncology, Ballarat Health Services, Ballarat, Victoria, Australia
| | - Sagun Parakh
- Department of Medical Oncology, Austin Health, Melbourne, Victoria, Australia
| | - Steven C Kao
- Department of Medical Oncology, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Craig R Lewis
- Department of Medical Oncology, Prince of Wales Hospital, Sydney, New South Wales, Australia.,Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Melvin T Chin
- Department of Medical Oncology, Prince of Wales Hospital, Sydney, New South Wales, Australia.,Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Mark Voskoboynik
- Department of Medical Oncology, Alfred Health, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Malinda J Itchins
- Department of Medical Oncology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Ross R Jennens
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Department of Medical Oncology, Epworth Health, Melbourne, Victoria, Australia
| | - Adam R Broad
- Department of Medical Oncology, Andrew Love Cancer Centre, Geelong, Victoria, Australia
| | - Tessa A Morris
- Southern Blood and Cancer Service, Dunedin, New Zealand.,Department of Medicine, University of Otago, Dunedin, New Zealand
| | - Benjamin J Solomon
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
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10
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Chiang JCB, Goldstein D, Tavakoli A, Trinh T, Klisser J, Lewis CR, Friedlander M, Naduvilath TJ, Au K, Park SB, Krishnan AV, Markoulli M. Corneal dendritic cells and the subbasal nerve plexus following neurotoxic treatment with oxaliplatin or paclitaxel. Sci Rep 2021; 11:22884. [PMID: 34819589 PMCID: PMC8613280 DOI: 10.1038/s41598-021-02439-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 11/08/2021] [Indexed: 02/08/2023] Open
Abstract
Immune cell infiltration has been implicated in neurotoxic chemotherapy for cancer treatment. However, our understanding of immune processes is still incomplete and current methods of observing immune cells are time consuming or invasive. Corneal dendritic cells are potent antigen-presenting cells and can be imaged with in-vivo corneal confocal microscopy. Corneal dendritic cell densities and nerve parameters in patients treated with neurotoxic chemotherapy were investigated. Patients treated for cancer with oxaliplatin (n = 39) or paclitaxel (n = 48), 3 to 24 months prior to assessment were recruited along with 40 healthy controls. Immature (ImDC), mature (MDC) and total dendritic cell densities (TotalDC), and corneal nerve parameters were analyzed from in-vivo corneal confocal microscopy images. ImDC was increased in the oxaliplatin group (Median, Md = 22.7 cells/mm2) compared to healthy controls (Md = 10.1 cells/mm2, p = 0.001), but not in the paclitaxel group (Md = 10.6 cells/mm2). ImDC was also associated with higher oxaliplatin cumulative dose (r = 0.33, p = 0.04) and treatment cycles (r = 0.40, p = 0.01). There was no significant difference in MDC between the three groups (p > 0.05). Corneal nerve parameters were reduced in both oxaliplatin and paclitaxel groups compared to healthy controls (p < 0.05). There is evidence of elevation of corneal ImDC in oxaliplatin-treated patients. Further investigation is required to explore this potential link through longitudinal studies and animal or laboratory-based immunohistochemical research.
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Affiliation(s)
- Jeremy Chung Bo Chiang
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia.
| | - David Goldstein
- Department of Medical Oncology, Prince of Wales Hospital, Sydney, Australia
- Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - Azadeh Tavakoli
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Terry Trinh
- Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - Jacob Klisser
- Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - Craig R Lewis
- Department of Medical Oncology, Prince of Wales Hospital, Sydney, Australia
- Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - Michael Friedlander
- Department of Medical Oncology, Prince of Wales Hospital, Sydney, Australia
- Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - Thomas J Naduvilath
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
- Brien Holden Vision Institute, Sydney, NSW, Australia
| | - Kimberley Au
- Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - Susanna B Park
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Arun V Krishnan
- Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - Maria Markoulli
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
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11
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Sullivan RP, Gaskell C, Lewis CR, Post JJ. Blood-borne virus testing in patients diagnosed with non-Hodgkin lymphoma. Intern Med J 2021; 51:301-302. [PMID: 33631849 DOI: 10.1111/imj.15178] [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] [Received: 12/01/2019] [Revised: 01/27/2020] [Accepted: 01/27/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Richard P Sullivan
- Department of Infectious Diseases, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Catriona Gaskell
- Department of Infectious Diseases, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Craig R Lewis
- Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia.,Department of Medical Oncology, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Jeffrey J Post
- Department of Infectious Diseases, Prince of Wales Hospital, Sydney, New South Wales, Australia.,Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia
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12
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Gullapalli V, Xu W, Lewis CR, Anazodo A, Gerber GK. A multi-centre case series of alectinib-related erythrocyte membrane changes and associated haemolysis. J Hematop 2021. [DOI: 10.1007/s12308-020-00427-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
AbstractAlectinib is an orally bioavailable anaplastic lymphoma kinase (ALK) inhibitor indicated for ALK mutated non-small cell lung cancer (NSCLC). This case series documents the development of significant erythrocyte membrane changes associated with alectinib use in six patients. Morphological findings found on blood film examination include moderate-marked acanthocytes, spheroacanthocytes, and one case demonstrated moderate schistocytes. Two patients in this multi-centre case series developed grade 1 anaemia, and four patients developed grade 2 anaemia. Two patients suffered significant non-immune-related haemolysis. One patient had a co-existing β thalassaemia trait and required treatment cessation due to severe haemolysis. Low-grade anaemia was seen in 22% of patients using alectinib in the ALEX trial and 5% developed ≥ grade 3 anaemia. Alterations in erythrocyte morphology and membrane structure have not been reported in the safety data and clinical trials to date. Drug-induced acanthocytosis is a rare phenomenon and has previously been reported with high-dose prostaglandin administration only. This case series highlights this important laboratory finding with alectinib use and associated clinical sequelae. Alectinib-associated acanthocytosis is likely to be more prevalent than previously recognised. We also highlight the need for vigilance in haematopathology departments for unexpected laboratory findings associated with novel therapies. These findings can be detected in the post-marketing surveillance phase and may have serious clinical implications for patients.
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13
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Cui W, Shingleton J, Byrne L, Kelly A, King L, Smith P, Lewis CR, Stein BN, Shapiro J, Karapetis C, Wong R. Dose modification for haematological toxicity: a survey of Australian medical oncologists. Intern Med J 2020; 50:1338-1343. [DOI: 10.1111/imj.14712] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 11/29/2019] [Accepted: 11/30/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Wanyuan Cui
- Department of Medical Oncology Eastern Health Melbourne Victoria Australia
| | | | - Liesel Byrne
- Cancer Institute NSW Sydney New South Wales Australia
| | - Aisling Kelly
- Cancer Institute NSW Sydney New South Wales Australia
| | - Lisa King
- Cancer Institute NSW Sydney New South Wales Australia
| | | | - Craig R. Lewis
- Prince of Wales Hospital and University of New South Wales Sydney New South Wales Australia
| | - Brian N. Stein
- Adelaide Cancer Centre Adelaide South Australia Australia
| | - Jeremy Shapiro
- Cabrini Haematology and Oncology Centre Melbourne Victoria Australia
| | - Christos Karapetis
- Department of Medical Oncology Flinders Medical Centre and Flinders University Adelaide South Australia Australia
| | - Rachel Wong
- Department of Medical Oncology Eastern Health Melbourne Victoria Australia
- Eastern Health Clinical School Monash University Melbourne Victoria Australia
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14
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Lee S, Nath CE, Balzer BWR, Lewis CR, Trahair TN, Anazodo AC, Shaw PJ. An HPLC–PDA method for determination of alectinib concentrations in the plasma of an adolescent. ACTA CHROMATOGR 2020. [DOI: 10.1556/1326.2019.00578] [Citation(s) in RCA: 2] [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: 11/19/2022]
Abstract
Alectinib is a central nervous system-active small molecule anaplastic lymphoma kinase (ALK) inhibitor that is effective in the treatment of patients with ALK positive tumors, including advanced non-small cell lung cancers and lymphomas. A simple, isocratic high-performance liquid chromatography–photo diode array detection (HPLC–PDA) assay for measurement of alectinib in human plasma is described. Alectinib is extracted from the plasma matrix by addition of methanol, followed by centrifugation and acidification with 0.1% formic acid. It elutes with a run time of 4.6 min using a 250 mm × 4.6 mm RP-C18 column with 0.1% aqueous formic acid and methanol (35:65, v/v) and a flow rate of 1 mL/min. Detection was at 339 nm. Linear calibration plots were achieved in the range of 0.1–20 μg/mL for alectinib (r2 = 0.9996). With limits of detection and quantification of 0.05 and 0.1 μg/mL, respectively, and excellent precision (%CV < 10%), accuracy (bias < ±12%), and recovery (>97%) within the 1–20 μg/mL concentration range, this assay was suitable for measuring pre-dose alectinib concentrations in an adolescent receiving 600-mg doses twice daily.
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Affiliation(s)
- Samiuela Lee
- 1 Department of Biochemistry, The Children’s Hospital at Westmead, Australia
| | - Christa E. Nath
- 1 Department of Biochemistry, The Children’s Hospital at Westmead, Australia
- 2 Faculty of Pharmacy, University of Sydney, Australia
| | - Ben W. R. Balzer
- 3 Sydney Children's Hospital, Randwick NSW 2031, Australia
- 4 School of Women's and Children's Health, University of New South Wales, Randwick NSW 2031, Australia
| | - Craig R. Lewis
- 5 Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Randwick NSW 2031, Australia
- 6 Prince of Wales Clinical School, University of New South Wales, Randwick NSW 2031, Australia
| | - Toby N. Trahair
- 4 School of Women's and Children's Health, University of New South Wales, Randwick NSW 2031, Australia
- 7 Kids Cancer Centre, Sydney Children's Hospital, Randwick NSW 2031, Australia
| | - Antoinette C. Anazodo
- 4 School of Women's and Children's Health, University of New South Wales, Randwick NSW 2031, Australia
- 5 Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Randwick NSW 2031, Australia
- 7 Kids Cancer Centre, Sydney Children's Hospital, Randwick NSW 2031, Australia
| | - Peter J. Shaw
- 8 Cancer Centre for Children, The Children's Hospital at Westmead, Australia
- 9 Discipline of Child and Adolescent Health, University of Sydney, Australia
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15
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McCrary JM, Goldstein D, Trinh T, Timmins HC, Li T, Menant J, Friedlander M, Lewis CR, Hertzberg M, O'Neill S, King T, Bosco A, Harrison M, Park SB. Balance Deficits and Functional Disability in Cancer Survivors Exposed to Neurotoxic Cancer Treatments. J Natl Compr Canc Netw 2020; 17:949-955. [PMID: 31390588 DOI: 10.6004/jnccn.2019.7290] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 02/25/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Chemotherapy-induced peripheral neuropathy (CIPN) persists after treatment in up to 40% of cancer survivors and has been linked with increased balance deficits, disabilities, and fall occurrences. This study aimed to comprehensively assess the links between CIPN, balance deficits, and functional disability and to inform the development of clinical screening tools for patients at risk of these events. PATIENTS AND METHODS A total of 190 cancer survivors exposed to neurotoxic chemotherapies (age, 57 ± 13 years; average time from completion of neurotoxic therapy, 12 ± 11 months) attended a neurology research clinic for a single cross-sectional assessment of patient-reported and objective CIPN, standing balance in 4 conditions of increasing difficulty, and functional disability. RESULTS Most patients (68%) reported CIPN symptoms at assessment. Symptomatic patients displayed increased functional disability (F=39.4; P<.001) and balance deficits (F=34.5; P<.001), with degree of balance impairments consistent with a healthy elderly population (age ≥65 years) reporting multiple falls over the subsequent year. Increasing CIPN severity correlated with increasing functional disability (clinically assessed R2=0.46; patient-reported R2=0.49; P<.001) and balance deficits (clinically assessed R2=0.41; patient-reported R2=0.30; P<.001). A 5-factor model of key independent correlates-patient-reported numbness/tingling, weakness, and balance deficit; age; and vibration perception-was strongly linked to balance deficits (R2=0.46; P<.001) and functional disability (R2=0.56; P<.001). CONCLUSIONS This study confirms links between increasing CIPN severity and increasing balance deficits and functional disability using comprehensive CIPN assessment methodology. The extent of balance deficits in patients with CIPN underscores the functional consequences of neurotoxicity. A 5-factor model provides a foundation for clinical screening tools to assess balance deficits and functional disability in patients exposed to neurotoxic chemotherapies.
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Affiliation(s)
- J Matt McCrary
- Prince of Wales Clinical School, University of New South Wales, Kensington
| | - David Goldstein
- Prince of Wales Clinical School, University of New South Wales, Kensington.,Prince of Wales Hospital, Randwick
| | - Terry Trinh
- Prince of Wales Clinical School, University of New South Wales, Kensington
| | | | - Tiffany Li
- Brain and Mind Centre, The University of Sydney, Camperdown
| | | | - Michael Friedlander
- Prince of Wales Clinical School, University of New South Wales, Kensington.,Prince of Wales Hospital, Randwick
| | - Craig R Lewis
- Prince of Wales Clinical School, University of New South Wales, Kensington.,Prince of Wales Hospital, Randwick
| | - Mark Hertzberg
- Prince of Wales Clinical School, University of New South Wales, Kensington.,Prince of Wales Hospital, Randwick
| | | | - Tracy King
- Royal Prince Alfred Hospital, Camperdown.,Sydney Nursing School, The University of Sydney, Camperdown
| | - Annmarie Bosco
- Prince of Wales Hospital, Randwick.,School of Medical Sciences, University of New South Wales, Kensington; and
| | - Michelle Harrison
- School of Medical Sciences, University of New South Wales, Kensington; and.,School of Medical Sciences, University of New South Wales, Kensington; and
| | - Susanna B Park
- Prince of Wales Clinical School, University of New South Wales, Kensington.,Brain and Mind Centre, The University of Sydney, Camperdown
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16
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Kasherman L, Siu DHW, Lee KWC, Lord S, Marschner I, Lewis CR, Friedlander M, Lee CK. Efficacy of immune checkpoint inhibitors in older adults with advanced stage cancers: A meta-analysis. J Geriatr Oncol 2020; 11:508-514. [DOI: 10.1016/j.jgo.2019.05.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 05/02/2019] [Accepted: 05/14/2019] [Indexed: 12/26/2022]
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17
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Sullivan R, Gaskell C, Lewis CR, Vollmer-Conna U, Post JJ. Infectious disease screening in patients prior to undergoing immunosuppressive therapy. Int J Clin Pract 2019; 73:e13406. [PMID: 31441189 DOI: 10.1111/ijcp.13406] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Affiliation(s)
- Richard Sullivan
- Department of Infectious Diseases, Prince of Wales Hospital, Randwick, NSW, Australia
- St George and Sutherland Clinical School, Department of Infectious Diseases, Immunology and Sexual Health, St George Hospital, University of New South Wales, Kogarah, NSW, Australia
| | - Catriona Gaskell
- Foundation Year 2 Doctor at Glasgow Royal Infirmary, Glasgow, UK
| | - Craig R Lewis
- Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia
- Department of Medical Oncology, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Ute Vollmer-Conna
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Jeffrey J Post
- Department of Infectious Diseases, Prince of Wales Hospital, Randwick, NSW, Australia
- Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia
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18
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Woodford R, Loh Y, Lee J, Cooper W, Marschner I, Lewis CR, Millward M, Lord S, Gralla RJ, Yang JCH, Mok T, Lee CK. Predictive value of PD-L1 and other clinical factors for chemoimmunotherapy in advanced non-small-cell lung cancer. Future Oncol 2019; 15:2371-2383. [DOI: 10.2217/fon-2019-0105] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
We investigate if PD-L1 expression and other clinical characteristics predict chemoimmunotherapy (CIT) benefits versus chemotherapy in advanced non-small-cell lung cancer. We performed a meta-analysis of randomized controlled trials of CIT versus chemotherapy identified through electronic searches. In seven randomized controlled trials (n = 4170), CIT prolonged progression-free survival over chemotherapy (hazard ratio [HR]: 0.62; 95% CI: 0.58–0.67; p < 0.00001). The treatment benefits differed between PD-L1-high (HR: 0.41; 95% CI: 0.34–0.49) and PD-L1 low (HR: 0.63; 95% CI: 0.55–0.72; interaction-p = 0.00002) and PD-L1-high and PD-L1-negative (HR: 0.72; 95% CI: 0.65–0.80; interaction-p < 0.00001). Similar benefits were observed regardless of gender, EGFR/ALK status and histological subtype. PD-L1 status is predictive of CIT benefit and may assist patient selection and design of future trials.
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Affiliation(s)
- Rachel Woodford
- Cancer Care Centre, St George Hospital, Kogarah, Sydney, New South Wales 2217, Australia
| | - Yanni Loh
- Cancer Care Centre, St George Hospital, Kogarah, Sydney, New South Wales 2217, Australia
| | - Joanna Lee
- Cancer Care Centre, St George Hospital, Kogarah, Sydney, New South Wales 2217, Australia
| | - Wendy Cooper
- Tissue Pathology & Diagnostic Oncology, Royal Prince Alfred Hospital, Camperdown, Sydney, New South Wales 2050, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales 2006, Australia
- School of Medicine, Western Sydney University, Penrith, Sydney, New South Wales 2751, Australia
| | - Ian Marschner
- National Health & Medical Research Council Clinical Trials Centre, The University of Sydney, Camperdown, Sydney, New South Wales 1450, Australia
- Department of Statistics, Macquarie University, North Ryde, Sydney, New South Wales 2109, Australia
| | - Craig R Lewis
- Prince of Wales Hospital Clinical School, University of NSW, Randwick, Sydney, New South Wales 2031, Australia
| | - Michael Millward
- School of Medicine, University of Western Australia, Perth, Western Australia 6009, Australia
- Department of Medical Oncology, Sir Charles Gairdner Hospital, Nedlands, Perth, Western Australia 6010, Australia
| | - Sally Lord
- National Health & Medical Research Council Clinical Trials Centre, The University of Sydney, Camperdown, Sydney, New South Wales 1450, Australia
- School of Medicine, University of Notre Dame, Darlinghurst, Sydney, New South Wales 2010, Australia
| | - Richard J Gralla
- Albert Einstein College of Medicine, Jacobi Medical Center, The Bronx, NY 10461, USA
| | - James C-H Yang
- Graduate Institute of Oncology, National Taiwan University & Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan 10002, Taiwan
| | - Tony Mok
- Department of Clinical Oncology, Hong Kong Cancer Institute, Chinese University of Hong Kong, Shatin NT, PR China
| | - Chee K Lee
- Cancer Care Centre, St George Hospital, Kogarah, Sydney, New South Wales 2217, Australia
- National Health & Medical Research Council Clinical Trials Centre, The University of Sydney, Camperdown, Sydney, New South Wales 1450, Australia
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19
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McCrary JM, Goldstein D, Wyld D, Henderson R, Lewis CR, Park SB. Mobility in survivors with chemotherapy-induced peripheral neuropathy and utility of the 6-min walk test. J Cancer Surviv 2019; 13:495-502. [PMID: 31172429 DOI: 10.1007/s11764-019-00769-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 03/06/2019] [Accepted: 05/17/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Chemotherapy-induced peripheral neuropathy (CIPN) is a significant and often lasting side effect of cancer treatment, with increasing CIPN severity associated with increasing deficits in balance, gait, and mobility. The 6-min walk test (6MWT) is a widely validated and utilized measure of general physical functioning and mobility, although its utility in a CIPN context is unclear. This study aimed to determine the utility of the 6MWT as an assessment of mobility deficits in a CIPN cohort and utilize the 6MWT to compare mobility data from CIPN patients to those of healthy and clinical populations. METHODS Cancer survivors exposed to neurotoxic chemotherapies (N = 100; mean 17 ± 13 months post-treatment; mean age 59 ± 13 years) completed a single cross-sectional assessment of patient-reported and objective CIPN, mobility (6MWT), and disability. RESULTS CIPN symptoms were reported in the majority of the cohort (87%). Increasing age, patient-reported and objective CIPN symptoms, and disability were associated with decreasing 6MWT distance (.48 ≤ R ≤ .63; p < .001) in bivariate models. Multiple regression models of 6MWT distance included age, sex, and patient-reported or objective CIPN severity as significant independent correlates (.62 ≤ R ≤ .64; p < .03). 6MWT distances in patients with CIPN symptom severity above the cohort mean were consistent with mean values reported in diabetic neuropathy and clinical populations. CONCLUSIONS Increased CIPN symptoms are associated with increased mobility deficits. The 6MWT demonstrates promising utility as a mobility assessment in a CIPN cohort. IMPLICATIONS FOR CANCER SURVIVORS The impact of the progression of CIPN on mobility deficits in survivors emphasizes the need for effective interventions to treat and prevent CIPN.
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Affiliation(s)
- J Matt McCrary
- Prince of Wales Clinical School, University of New South Wales, Kensington, Australia
| | - David Goldstein
- Prince of Wales Clinical School, University of New South Wales, Kensington, Australia.,Prince of Wales Hospital, Randwick, Australia
| | - David Wyld
- Royal Brisbane and Women's Hospital, Brisbane, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Robert Henderson
- Royal Brisbane and Women's Hospital, Brisbane, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Craig R Lewis
- Prince of Wales Clinical School, University of New South Wales, Kensington, Australia.,Prince of Wales Hospital, Randwick, Australia
| | - Susanna B Park
- Prince of Wales Clinical School, University of New South Wales, Kensington, Australia. .,Brain and Mind Centre, The University of Sydney, Camperdown, NSW, 2050, Australia.
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20
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Tjokrowidjaja A, Hovey E, Lewis CR. Let's talk about cytotoxic chemotherapy dosing: unravelling adjustments and off-protocol prescribing. Med J Aust 2019; 210:65-66. [PMID: 30712300 DOI: 10.5694/mja2.12072] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
| | - Elizabeth Hovey
- Prince of Wales Hospital and Community Health Services, Sydney, NSW.,Prince of Wales Clinical School, University of New South Wales, Sydney, NSW
| | - Craig R Lewis
- Prince of Wales Hospital and Community Health Services, Sydney, NSW.,Prince of Wales Clinical School, University of New South Wales, Sydney, NSW
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21
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Balzer BW, Loo C, Lewis CR, Trahair TN, Anazodo AC. Adenocarcinoma of the Lung in Childhood and Adolescence: A Systematic Review. J Thorac Oncol 2018; 13:1832-1841. [DOI: 10.1016/j.jtho.2018.08.2020] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 08/10/2018] [Accepted: 08/26/2018] [Indexed: 11/28/2022]
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22
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Tang M, Horsley P, Lewis CR. Emergency department presentations in early stage breast cancer patients receiving adjuvant and neoadjuvant chemotherapy. Intern Med J 2018; 48:583-587. [PMID: 29722200 DOI: 10.1111/imj.13785] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 12/18/2017] [Accepted: 12/18/2017] [Indexed: 11/28/2022]
Abstract
(Neo)adjuvant chemotherapy for early stage breast cancer is associated with side-effects, resulting in increased emergency department (ED) presentations. Treatment-related toxicity can affect quality of life, compromise chemotherapy delivery and treatment outcomes, and increase healthcare use. We performed a retrospective study of ED presentations in patients receiving curative chemotherapy for early breast cancer to identify factors contributing to ED presentations. Of 102 patients, 39 (38%) presented to ED within 30 days of chemotherapy, resulting in 63 ED presentations in total. Most common reasons were non-neutropenic fever (17 presentations/27%), neutropenic fever (15/24%), pain (9/14%), drug reaction (6/10%) and infection (4/6%). Factors significantly associated with ED presentation were adjuvant chemotherapy timing compared to neoadjuvant timing (P = 0.031), prophylactic antibiotics (P = 0.045) and docetaxel-containing regimen (P = 0.018).
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Affiliation(s)
- Monica Tang
- Department of Medical Oncology, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Patrick Horsley
- Department of Medical Oncology, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Craig R Lewis
- Department of Medical Oncology, Prince of Wales Hospital, Sydney, New South Wales, Australia.,Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia
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23
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Balzer BWR, Loo C, Wegner EA, Nath CE, Lee S, Smith C, Lewis CR, Trahair TN, Anazodo AC. Alectinib is effective, safe and tolerable in an adolescent with stage IVB ALK-rearranged adenocarcinoma of the lung. Pediatr Hematol Oncol 2018; 35:415-421. [PMID: 30526220 DOI: 10.1080/08880018.2018.1541492] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Anaplastic lymphoma kinase (ALK) inhibitors such as crizotinib and alectinib have been shown to have significant activity in ALK-rearranged non-small cell lung cancers (NSCLC). There are no data for alectinib's safety or efficacy in younger patients, though it is superior to crizotinib in adult trials. We present a 14-year old girl diagnosed with stage IV-B ALK-positive adenocarcinoma of the lung after presenting with cough and fever. She was commenced on alectinib at adult dose and has had sustained complete metabolic remission for 9 months. She is the youngest patient with lung adenocarcinoma to be treated with alectinib.
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Affiliation(s)
- Ben W R Balzer
- a Sydney Children's Hospital , Randwick , New South Wales , Australia.,b School of Women's and Children's Health , University of New South Wales , Randwick , New South Wales , Australia
| | - Christine Loo
- c Department of Anatomical Pathology , NSW Health Pathology, Prince of Wales Hospital , Randwick , New South Wales , Australia
| | - Eva A Wegner
- d Department of Nuclear Medicine and PET , Prince of Wales Hospital , Randwick , New South Wales , Australia.,e Prince of Wales Clinical School , University of New South Wales , Randwick , New South Wales , Australia
| | - Christa E Nath
- f Department of Biochemistry , The Children's Hospital at Westmead , Westmead , New South Wales , Australia.,g Faculty of Pharmacy , University of Sydney , Camperdown , New South Wales , Australia
| | - Samiuela Lee
- f Department of Biochemistry , The Children's Hospital at Westmead , Westmead , New South Wales , Australia
| | - Chantelle Smith
- h Pharmacy Department , Sydney Children's Hospital , Randwick , New South Wales , Australia
| | - Craig R Lewis
- e Prince of Wales Clinical School , University of New South Wales , Randwick , New South Wales , Australia.,i Department of Medical Oncology , Prince of Wales Hospital , Randwick , New South Wales , Australia
| | - Toby N Trahair
- a Sydney Children's Hospital , Randwick , New South Wales , Australia.,b School of Women's and Children's Health , University of New South Wales , Randwick , New South Wales , Australia.,j Sydney Children's Hospital , Kids Cancer Centre , Randwick , New South Wales , Australia
| | - Antoinette C Anazodo
- a Sydney Children's Hospital , Randwick , New South Wales , Australia.,b School of Women's and Children's Health , University of New South Wales , Randwick , New South Wales , Australia.,j Sydney Children's Hospital , Kids Cancer Centre , Randwick , New South Wales , Australia.,k Prince of Wales Hospital , Nelune Comprehensive Cancer Centre , Randwick , New South Wales , Australia
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Timmins HC, Li T, Grimison P, Murray JE, Cox KM, Horvath LG, Lewis CR, Goldstein D, Kiernan MC, Park SB. 5. Neurophysiological dysfunction in chemotherapy-treated patients: Comparison of different platinum analogues. Clin Neurophysiol 2018. [DOI: 10.1016/j.clinph.2017.12.018] [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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Barnet MB, Zielinski RR, Warby A, Lewis CR, Kao S. Pseudoprogression Associated with Clinical Deterioration and Worsening Quality of Life in Malignant Pleural Mesothelioma. J Thorac Oncol 2017; 13:e1-e2. [PMID: 28919393 DOI: 10.1016/j.jtho.2017.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Revised: 09/01/2017] [Accepted: 09/02/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Megan B Barnet
- Garvan Institute of Medical Research, Darlinghurst, New South Wales, Australia; University of New South Wales, Kensington, New South Wales, Australia.
| | - Robert R Zielinski
- Western Sydney University, Penrith, New South Wales, Australia; Central West Cancer Care Centre, Orange, New South Wales, Australia
| | - Anne Warby
- University of Sydney, Camperdown, New South Wales, Australia
| | - Craig R Lewis
- University of New South Wales, Kensington, New South Wales, Australia; Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Steven Kao
- University of Sydney, Camperdown, New South Wales, Australia; Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
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Sandler CX, Goldstein D, Horsfield S, Bennett BK, Friedlander M, Bastick PA, Lewis CR, Segelov E, Boyle FM, Chin MTM, Webber K, Barry BK, Lloyd AR. Randomized Evaluation of Cognitive-Behavioral Therapy and Graded Exercise Therapy for Post-Cancer Fatigue. J Pain Symptom Manage 2017; 54:74-84. [PMID: 28502786 DOI: 10.1016/j.jpainsymman.2017.03.015] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 02/24/2017] [Accepted: 03/22/2017] [Indexed: 12/13/2022]
Abstract
CONTEXT Cancer-related fatigue is prevalent and disabling. When persistent and unexplained, it is termed post-cancer fatigue (PCF). Cognitive behavioral therapy (CBT) and graded exercise therapy (GET) may improve symptoms and functional outcomes. OBJECTIVES To evaluate the outcomes of a randomized controlled trial, which assigned patients with post-cancer fatigue to education, or 12 weeks of integrated cognitive-behavioral therapy (CBT) and graded exercise therapy (GET). METHODS Three months after treatment for breast or colon cancer, eligible patients had clinically significant fatigue, no comorbid medical or psychiatric conditions that explained the fatigue, and no evidence of recurrence. The CBT/GET arm included individually tailored consultations at approximately two weekly intervals. The education arm included a single visit with clinicians describing the principles of CBT/GET and a booklet. The primary outcome was clinically significant improvement in self-reported fatigue (Somatic and Psychological HEalth REport 0-12), designated a priori as greater than one SD of improvement in fatigue score. The secondary outcome was associated improvement in function (role limitation due to physical health problems-36-Item Short Form Health Survey 0-100) comparing baseline, end treatment (12 weeks), and follow-up (24 weeks). RESULTS There were 46 patients enrolled, including 43 women (94%), with a mean age of 51 years. Fatigue severity improved in all subjects from a mean of 5.2 (±3.1) at baseline to 3.9 (±2.8) at 12 weeks, suggesting a natural history of improvement. Clinically significant improvement was observed in 7 of 22 subjects in the intervention group compared with 2 of 24 in the education group (P < 0.05, χ2). These subjects also had improvement in functional status compared with nonresponders (P < 0.01, t-test). CONCLUSION Combined CBT/GET improves fatigue and functional outcomes for a subset of patients with post-cancer fatigue. Further studies to improve the response rate and the magnitude of the benefit are warranted.
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Affiliation(s)
- Carolina X Sandler
- National Centre for Cancer Survivorship, The University of New South Wales, Sydney, Australia; Fatigue Clinic, Lifestyle Clinic, School of Medical Sciences, The University of New South Wales, Sydney, Australia
| | - David Goldstein
- National Centre for Cancer Survivorship, The University of New South Wales, Sydney, Australia; The Prince of Wales Hospital, Sydney, Australia
| | - Sarah Horsfield
- Fatigue Clinic, Lifestyle Clinic, School of Medical Sciences, The University of New South Wales, Sydney, Australia
| | - Barbara K Bennett
- National Centre for Cancer Survivorship, The University of New South Wales, Sydney, Australia
| | | | | | | | - Eva Segelov
- Monash University and Monash Health, Victoria, Australia
| | - Frances M Boyle
- The University of Sydney, Australia; Mater Hospital, North Sydney, Australia
| | | | - Kate Webber
- National Centre for Cancer Survivorship, The University of New South Wales, Sydney, Australia
| | - Benjamin K Barry
- Fatigue Clinic, Lifestyle Clinic, School of Medical Sciences, The University of New South Wales, Sydney, Australia; Neuroscience Research Australia, The University of New South Wales, Sydney, Australia
| | - Andrew R Lloyd
- National Centre for Cancer Survivorship, The University of New South Wales, Sydney, Australia; Fatigue Clinic, Lifestyle Clinic, School of Medical Sciences, The University of New South Wales, Sydney, Australia; Viral Immunology Systems Program (VISP), The Kirby Institute, The University of New South Wales, Sydney, Australia.
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Loke LPY, Chen TYT, Lewis CR, Ward RL, Rushton SA, Shapiro JD. Quality and impact of eviQ Cancer Treatments Online (www.eviq.org.au): the medical oncologist's perspective. Asia Pac J Clin Oncol 2017; 14:e203-e210. [PMID: 28547805 DOI: 10.1111/ajco.12689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 03/12/2017] [Indexed: 11/29/2022]
Abstract
INTRODUCTION eviQ Cancer Treatments Online is a free, web-based resource providing access to over 600 evidence-based treatment protocols in medical oncology, radiation oncology, hematology and cancer genetics. With over 60 000 registrants from 148 countries, eviQ is widely used by cancer clinicians globally. The aim of this study was to examine the perceived quality of eviQ by Australian medical oncologists, the impact it had on their knowledge and practice, and the effect it had on their patients. METHODS A web-based survey was administered to members of the Medical Oncology Group of Australia by email. Two reminders emails were sent to encourage participation. RESULTS Of the 97 respondents (15%), all but one, were practicing in Australia, with varying years of oncology experience (<2 years: 25%, 2-10 years: 36%, >10 years: 39%). eviQ was most frequently used as a source for providing patient information sheets on chemotherapy side effects, with 57% of respondents using eviQ for this purpose. Other uses included accessing side effect information (27%), checking drug doses (26%) and guiding dose adjustments (22%). The majority of respondents rated eviQ as current, accurate and relevant with over 90% agreeing that eviQ was of a high quality. Most of the respondents reported that they provided better care with enhanced patient experiences as a result of using eviQ. CONCLUSIONS eviQ was highly regarded by Australian medical oncologists who responded to our survey. The results suggested that usage of eviQ had a positive impact on individual knowledge, practice and promoted better patient-centered care.
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Affiliation(s)
| | | | - Craig R Lewis
- Nelune Comprehensive Cancer Centre, Randwick, NSW, Australia
| | - Robyn L Ward
- Nelune Comprehensive Cancer Centre, Randwick, NSW, Australia
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Grimison PS, Stockler MR, Martin AJ, Buizen L, Lawrence NJ, Thomson DB, Gebski V, Friedlander M, Yeung A, Gurney H, Rosenthal M, Singhal N, Kichenadasse G, Wong SS, Lewis CR, Vasey PA, Toner GC. Long-term outcomes of accelerated BEP (bleomycin, etoposide, cisplatin) for advanced germ cell tumors: updated analysis of an Australian multicenter phase II trial. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e16056] [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)
| | - Martin R. Stockler
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, Australia
| | | | - Luke Buizen
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, Australia
| | | | | | - Val Gebski
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, Australia
| | | | - Annie Yeung
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, Australia
| | | | | | | | - Ganessan Kichenadasse
- Flinders Medical Centre and Flinders Centre for Innovation in Cancer, Flinders University, Bedford Park South Australia, Australia
| | | | | | - Paul Austin Vasey
- Wesley Medical Centre, Haematology and Oncology Clinics of Australasia, Brisbane, Australia
| | - Guy C. Toner
- Peter MacCallum Cancer Centre, Melbourne, Australia
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Loke LPY, Chen TYT, Lewis CR, Ward RL, Rushton SA, Shapiro JD. Quality and impact of eviQ Cancer Treatments Online: The medical oncologist's perspective. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e18214] [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)
| | - Tina YT Chen
- Cancer Institute New South Wales, Sydney, Australia
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Davidson A, Veillard AS, Tognela A, Chan MMK, Hughes BGM, Boyer M, Briscoe K, Begbie S, Abdi E, Crombie C, Long J, Boyce A, Lewis CR, Varma S, Broad A, Muljadi N, Chinchen S, Espinoza D, Coskinas X, Pavlakis N, Millward M, Stockler MR. A phase III randomized trial of adding topical nitroglycerin to first-line chemotherapy for advanced nonsmall-cell lung cancer: the Australasian lung cancer trials group NITRO trial. Ann Oncol 2015; 26:2280-6. [PMID: 26347110 DOI: 10.1093/annonc/mdv373] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Accepted: 08/29/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND We sought to determine whether the substantial benefits of topical nitroglycerin with first-line, platinum-based, doublet chemotherapy in advanced nonsmall-cell lung cancer (NSCLC) seen in a phase II trial could be corroborated in a rigorous, multicenter, phase III trial. PATIENTS AND METHODS Patients starting one of five, prespecified, platinum-based doublets as first-line chemotherapy for advanced NSCLC were randomly allocated treatment with or without nitroglycerin 25 mg patches for 2 days before, the day of, and 2 days after, each chemotherapy infusion. Progression-free survival (PFS) was the primary end point. RESULTS Accrual was stopped after the first interim analysis of 270 events. Chemotherapy was predominantly with carboplatin and gemcitabine (79%) or carboplatin and paclitaxel (18%). The final analysis included 345 events in 372 participants with a median follow-up of 33 months. Topical nitroglycerin had no demonstrable effect on PFS [median 5.0 versus 4.8 months, hazard ratio (HR) = 1.07, 95% confidence interval (CI) 0.86-1.32, P = 0.55], overall survival (median 11.0 versus 10.3 months, HR = 0.99, 95% CI 0.79-1.24, P = 0.94), or objective tumor response (31% versus 30%, relative risk = 1.03, 95% CI 0.82-1.29, P = 0.81). Headache, hypotension, syncope, diarrhea, dizziness, and anorexia were more frequent in those allocated nitroglycerin. CONCLUSION The addition of topical nitroglycerin to carboplatin-based, doublet chemotherapy in NSCLC had no demonstrable benefit and should not be used or pursued further. CLINICAL TRIALS NUMBER Australian New Zealand Clinical Trials Registry Number ACTRN12608000588392.
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Affiliation(s)
- A Davidson
- Department of Medical Oncology, Fiona Stanley Hospital, Perth
| | - A-S Veillard
- NHMRC Clinical Trials Centre, University of Sydney, Sydney
| | - A Tognela
- NHMRC Clinical Trials Centre, University of Sydney, Sydney
| | - M M K Chan
- NHMRC Clinical Trials Centre, University of Sydney, Sydney
| | - B G M Hughes
- Department of Medical Oncology, The Prince Charles Hospital, Brisbane School of Medicine, University of Queensland, Brisbane
| | - M Boyer
- Department of Medical Oncology, Chris O'Brien Lifehouse, Camperdown
| | - K Briscoe
- Department of Medical Oncology, Coffs Harbour Health Campus, Coffs Harbour
| | - S Begbie
- Department of Medical Oncology, Port Macquarie Base Hospital, Port Macquarie
| | - E Abdi
- Department of Medical Oncology, The Tweed Hospital, Tweed Heads School of Medicine & Dentistry, Griffith University, Southport
| | - C Crombie
- Department of Medical Oncology, Nepean Cancer Care Centre, Kingswood
| | - J Long
- Department of Medical Oncology, Nambour General Hospital, Nambour
| | - A Boyce
- Department of Medical Oncology, Lismore Base Hospital, Lismore
| | - C R Lewis
- Prince of Wales Hospital Clinical School, University of New South Wales, Randwick
| | - S Varma
- Department of Medical Oncology, The Townsville Hospital, Townsville
| | - A Broad
- Department of Medical Oncology, Geelong Hospital, Geelong
| | - N Muljadi
- NHMRC Clinical Trials Centre, University of Sydney, Sydney
| | - S Chinchen
- NHMRC Clinical Trials Centre, University of Sydney, Sydney
| | - D Espinoza
- NHMRC Clinical Trials Centre, University of Sydney, Sydney
| | - X Coskinas
- NHMRC Clinical Trials Centre, University of Sydney, Sydney
| | - N Pavlakis
- Department of Medical Oncology, Royal North Shore Hospital, St Leonards
| | - M Millward
- Department of Medical Oncology, Sir Charles Gardiner Hospital, Nedlands School of Medicine and Pharmacology, University of Western Australia, Crawley, Australia
| | - M R Stockler
- NHMRC Clinical Trials Centre, University of Sydney, Sydney
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Sandler C, Goldstein D, Horsfield S, Bennett BK, Friedlander M, Bastick PA, Lewis CR, Segelov E, Boyle FM, Chin MT, Barry BK, Webber K, Lloyd AR. TOPS: A randomised controlled trial of a multidisciplinary intervention for post-cancer fatigue. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.9571] [Citation(s) in RCA: 2] [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)
- Carolina Sandler
- University of New South Wales, NSW Cancer Survivors Centre, Sydney, Australia
| | - David Goldstein
- Prince of Wales Hospital, University of New South Wales, Cancer Survivors Centre, Sydney, Australia
| | - Sarah Horsfield
- University of New South Wales, NSW Cancer Survivors Centre, Sydney, Australia
| | | | | | | | | | - Eva Segelov
- St. Vincent's Clinic, University of New South Wales, Sydney, Australia
| | - Frances M. Boyle
- University of Sydney and Mater Hospital, North Sydney, Australia
| | | | - Benjamin K Barry
- University of New South Wales, Neuroscience Research Australia, Sydney, Australia
| | - Kate Webber
- Prince of Wales Hospital, University of New South Wales, NSW Cancer Survivors Centre, Sydney, Australia
| | - Andrew R. Lloyd
- University of New South Wales, NSW Cancer Survivors Centre, Sydney, Australia
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Vardy JL, Bell M, van der Ploeg H, Turner J, Kabourakis M, Spencer L, Lewis CR, Hui R, Blinman PL, Clarke SJ, Boyer MJ, Dhillon HM. The impact of physical activity on fatigue and quality of life in lung cancer patients: A randomised controlled trial (RCT). J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.9507] [Citation(s) in RCA: 2] [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)
| | | | | | | | | | | | | | - Rina Hui
- Westmead Cancer Care Ctr, Westmead, Australia
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Park SB, Kwok JB, Loy CT, Friedlander ML, Lin CSY, Krishnan AV, Lewis CR, Kiernan MC. Paclitaxel-induced neuropathy: potential association of MAPT and GSK3B genotypes. BMC Cancer 2014; 14:993. [PMID: 25535399 PMCID: PMC4364586 DOI: 10.1186/1471-2407-14-993] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 12/16/2014] [Indexed: 02/07/2023] Open
Abstract
Background Paclitaxel treatment produces dose-limiting peripheral neurotoxicity, which adversely affects treatment and long-term outcomes. In the present study, the contribution of genetic polymorphisms to paclitaxel-induced neurotoxicity were assessed in 21 patients, focusing on polymorphisms involved in the tau-microtubule pathway, an important target of paclitaxel involved in neurotoxicity development. Methods Polymorphisms in the microtubule-associated protein tau (MAPT) gene (haplotype 1 and rs242557 polymorphism) and the glycogen synthase kinase-3β (GSK3β) gene (rs6438552 polymorphism) were investigated. Neurotoxicity was assessed using neuropathy grading scales, neurophysiological studies and patient questionnaires. Results A significant relationship between the GSK-3B rs6438552 polymorphism and paclitaxel-induced neurotoxicity was evident. Conclusions Polymorphisms in tau-associated genes may contribute to the development of paclitaxel-induced neurotoxicity, although larger series will be necessary to confirm these findings.
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Affiliation(s)
| | | | | | | | | | | | | | - Matthew C Kiernan
- Brain and Mind Research Institute, University of Sydney, Sydney, Australia.
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Grimison PS, Stockler MR, Chatfield M, Thomson DB, Gebski V, Friedlander M, Boland AL, Houghton B, Gurney H, Rosenthal M, Singhal N, Kichenadasse G, Wong SS, Lewis CR, Vasey PA, Toner GC. Accelerated BEP for metastatic germ cell tumours: a multicenter phase II trial by the Australian and New Zealand Urogenital and Prostate Cancer Trials Group (ANZUP). Ann Oncol 2014; 25:143-8. [PMID: 24356625 DOI: 10.1093/annonc/mdt369] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND This Australian single-arm, multicenter, phase II trial evaluated feasibility, tolerability and activity of accelerated bleomycin, etoposide and cisplatin (BEP) as first-line chemotherapy for metastatic germ cell tumours. PATIENTS AND METHODS Patients were planned to receive cisplatin 20 mg/m(2) and etoposide 100 mg/m(2) days 1-5, and pegfilgrastim 6 mg day 6, all repeated every 2 weeks for four cycles (three cycles for good prognosis). Bleomycin was given at 30 000 IU weekly to a total of 12 doses (9 doses for good prognosis). Primary end point was feasibility, defined as the proportion of patients able to complete the etoposide and cisplatin components of BEP and be eligible to receive a fourth cycle of BEP by day 50. RESULTS Twelve poor, 16 intermediate and 15 good prognosis (n = 43) eligible patients were enrolled. Two patients aged >40 years were ineligible and excluded from analyses. The regimen was feasible in 86%, not feasible in 7% and not assessable in 7% of patients. Most common grade 3/4 adverse events were non-neutropenic infection (16%) and febrile neutropenia (12%). Complete response (CR) to chemotherapy and surgery was achieved in 33% poor-prognosis, 81% intermediate-prognosis and 100% good-prognosis patients. At median follow-up of 27 months (range 6-42), the 2-year progression-free survival was 50% for poor-prognosis, 94% for intermediate-prognosis and 92% for good-prognosis patients. CONCLUSION Accelerated BEP is feasible and tolerable. Efficacy data appear to be promising. This trial and a similar UK study provide the rationale for a randomised trial comparing accelerated versus standard BEP. Australian New Zealand Clinical Trials Registry Registration number. ACTRN 12607000294459.
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Affiliation(s)
- P S Grimison
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia
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Aidukaitis, CNA L, Allensworth JL, Andallu B, Aqil F, Arora V, Aziz, MD K, Baba Y, Bae YJ, Baveja A, Bisoffi M, Burky R, Bynum D, Calaf GM, Canuto, MD RA, Catalano, MD MG, Chakraborty K, Chen YC, Chen RJ, Chi CW, Chopra K, Coccia R, Cohen J, Cruz A, Das S, Datta P, Del Bo’ C, Devi GR, Evans, MD MK, Fadda M, Fajardo AM, Farias-Eisner R, Finocchiaro C, Foppoli C, Georgakilas AG, Gilaberte Y, Gonzalez S, Goya L, Gupta RC, Hamilton C, Hatzi VI, Hayashi S, Hummel C, Jeyabalan J, Joshi T, Joshua Loke WS, Juarranz A, Kang D, Khuda-Bukhsh AR, Krishnan K, Kuhad A, Lee SA, Lewis CR, Lim MY, Liu P, Maggiora M, Martin OA, Martín MA, Mehrotra S, Munagala R, Muzio G, Naito S, Nakajo M, Nishizawa T, Nowsheen S, O’Neill K, Olas B, Parrado C, Perluigi M, Philips N, Pramanik KC, Rajeshwari C, Ramos S, Ramsauer VP, Riso P, Robison R, Sachdeva AK, Saha SK, Sauer SJ, Schena M, Shiota M, Shobha R, Singh IP, Singh P, Siomyk H, Siva S, Sonoda S, Srivastava SK, Stone W, Sung MK, Sung MT, Suzuki H, Thomas PS, Tosuji N, Vendrame S, Wang YJ, White M, Yokomizo A. List of Contributors. Cancer 2014. [DOI: 10.1016/b978-0-12-405205-5.01002-3] [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: 11/16/2022]
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Young MA, Herlihy A, Mitchell G, Thomas DM, Ballinger M, Tucker K, Lewis CR, Neuhaus S, Halliday J. The attitudes of people with sarcoma and their family towards genomics and incidental information arising from genetic research. Clin Sarcoma Res 2013; 3:11. [PMID: 23898988 PMCID: PMC3751730 DOI: 10.1186/2045-3329-3-11] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Accepted: 07/16/2013] [Indexed: 01/24/2023] Open
Abstract
Purpose The study aimed to examine attitudes of individuals diagnosed with sarcoma and their family members towards genetics, genomic research and incidental information arising as a result of participating in genetic research. Methods A questionnaire was administered to 1200 individuals from the International Sarcoma Kindred Study (ISKS). Respondents were divided into three groups: individuals affected with sarcoma (probands), their spouses and family members. Results Approximately half of all research participants felt positively towards new discoveries in human genetics. Overall, more were positive in their attitudes towards genetic testing for inherited conditions (60%) but family members were less so. Older participants reported more highly positive attitudes more often than younger participants. Males were less likely to feel positive about new genetic discoveries and more likely to believe they could modify genetic risk by altering lifestyle factors. Almost all ISKS participants believed participants would like to be given ancillary information arising as a result of participating in genetic research. Conclusions The only difference between the study groups was the decreased likelihood of family members being highly positive about genetic testing. This may be important if predictive testing for sarcoma becomes available. Generally ISKS research participants supported the notion of returning incidental genetic information to research participants.
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Affiliation(s)
- Mary-Anne Young
- Department of Oncology, University of Melbourne, Peter MacCallum Cancer Centre, Locked Bag 1, A'Beckett Street, Victoria 8006, Australia.
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Lewis CR, Smith R, Matthews A, Choo E, Lee C. Abstract PD04-03: Is breast conservation therapy an option for young women with operable breast cancer? Local recurrence rates in young women following surgery: a single centre experience. Cancer Res 2012. [DOI: 10.1158/0008-5472.sabcs12-pd04-03] [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: 11/16/2022]
Abstract
Abstract
Background: Breast cancer (BC) is less common in young women (defined here as ≤ 40 years age), but is associated with more aggressive biological features, higher risk of local recurrence (LR) and poorer overall survival. This study examines and compares the incidence of LR following breast conservation therapy (BCT) versus mastectomy in women with operable BC treated at our centre.
Methods: The POWCC breast cancer database was retrospectively reviewed for the period January 1995 to December 2008. 2250 eligible women with BC undergoing primary breast surgery were identified. LR rate was compared between young women and older women (age > 40 years), and according to type of surgery. Data were analysed using a competing risk Cox model to account for distant recurrence and death as competing events for local recurrence.
Results: Median follow-up was 70 months. Of 2250 women, 246 (11%) were young women, and the mastectomy rate was 49.2%. In older women (89%), mastectomy rate was 41.7%. LR occurred in 17 (6.9%) and 57 (2.8%) in young and older women respectively (p = 0.001). Amongst the young women, 12 (9.6%) and 5 (4.1%) patients recurred locally in BCT and mastectomy respectively (p = 0.09). Amongst the older women, 43 (3.7%) and 14 (1.7%) patients recurred locally in BCT and mastectomy respectively (p = 0.008). In univariate Cox analysis, significant risk factors for LR were BCT (p = 0.003), positive surgical margins (p = 0.03), age ≤ 40 years (p = 0.001), premenopausal status (p = 0.003) and no adjuvant systemic therapy (0.02). Age remains a significant predictor of LR in multivariate Cox analysis (Table). There was no significant interaction between age and type of surgery on LR (p = 0.72).
Discussion: Our results demonstrate that young women who undergo BCT have the highest risk of early LR. Adjuvant systemic therapy is protective of early LR. This study is hypothesis-generating and a definitive prospective clinical trial is required to better determine the optimal type of breast surgery in young women.
Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr PD04-03.
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Affiliation(s)
- CR Lewis
- Prince of Wales Cancer Centre (POWCC), Randwick, NSW, Australia; Prince of Wales Hospital, Randwick, NSW, Australia; NHMRC Clinical Trials Unit, University of Sydney, NSW, Australia
| | - R Smith
- Prince of Wales Cancer Centre (POWCC), Randwick, NSW, Australia; Prince of Wales Hospital, Randwick, NSW, Australia; NHMRC Clinical Trials Unit, University of Sydney, NSW, Australia
| | - A Matthews
- Prince of Wales Cancer Centre (POWCC), Randwick, NSW, Australia; Prince of Wales Hospital, Randwick, NSW, Australia; NHMRC Clinical Trials Unit, University of Sydney, NSW, Australia
| | - E Choo
- Prince of Wales Cancer Centre (POWCC), Randwick, NSW, Australia; Prince of Wales Hospital, Randwick, NSW, Australia; NHMRC Clinical Trials Unit, University of Sydney, NSW, Australia
| | - C Lee
- Prince of Wales Cancer Centre (POWCC), Randwick, NSW, Australia; Prince of Wales Hospital, Randwick, NSW, Australia; NHMRC Clinical Trials Unit, University of Sydney, NSW, Australia
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Chan E, Sivagnanam T, Zhang Q, Lewis CR, Thomas PS. Tumour Necrosis Factor Alpha and Oxidative Stress in the Breath Condensate of Those with Non-Small Cell Lung Cancer. ACTA ACUST UNITED AC 2012. [DOI: 10.4236/jct.2012.324059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Cheng Z, Lewis CR, Thomas PS, Raftery MJ. Comparative Proteomics Analysis of Exhaled Breath Condensate in Lung Cancer Patients. ACTA ACUST UNITED AC 2011. [DOI: 10.4236/jct.2011.21001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Park SB, Lin CSY, Krishnan AV, Friedlander ML, Lewis CR, Kiernan MC. Early, progressive, and sustained dysfunction of sensory axons underlies paclitaxel-induced neuropathy. Muscle Nerve 2010; 43:367-74. [PMID: 21321953 DOI: 10.1002/mus.21874] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2010] [Indexed: 11/09/2022]
Abstract
Paclitaxel is used in the adjuvant treatment of breast cancer. It induces disabling and potentially long-lasting sensory neuropathy. This study systematically and prospectively investigated sensory function, using clinical grading scales, quantitative sensory testing, and neurophysiological and nerve excitability studies in 28 patients with early-stage breast cancer. After administration of 529 ± 41 mg/m(2) paclitaxel, 71% of patients developed neuropathic symptoms by 6 weeks of treatment. Early and progressive increases in stimulus threshold (P < 0.05) and reduction in sensory amplitudes from 47.0 ± 3.3 μV to 42.4 ± 3.4 μV (P < 0.05) occurred by 4 weeks, with a further reduction by final treatment (33.7 ± 3.0 μV, P < 0.001). The majority of patients (63%) did not experience recovery of neuropathic symptoms at follow-up. Axonal disruption did not relate to membrane conductance dysfunction. We found that paclitaxel produces early sensory dysfunction and leads to persistent neuropathy. Importantly, significant axonal dysfunction within the first month of treatment predated symptom onset, suggesting a window for neuroprotective therapies.
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Affiliation(s)
- Susanna B Park
- Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia
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Grimison PS, Stockler MR, Thomson DB, Olver IN, Harvey VJ, Gebski VJ, Lewis CR, Levi JA, Boyer MJ, Gurney H, Craft P, Boland AL, Simes RJ, Toner GC. Comparison of Two Standard Chemotherapy Regimens for Good-Prognosis Germ Cell Tumors: Updated Analysis of a Randomized Trial. ACTA ACUST UNITED AC 2010; 102:1253-62. [DOI: 10.1093/jnci/djq245] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
Amyloid involvement of the breast is infrequently reported and may have clinical and radiological features suspicious for a primary breast malignancy. We describe a case of amyloid of the breast in which asymptomatic mammographic findings were suspicious for locally recurrent disease in a patient with previously treated breast cancer.
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Affiliation(s)
- J M Toohey
- Department of Radiation Oncology, Prince of Wales Hospital, Sydney, New South Wales, Australia.
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Mai GT, Choo E, Yang JL, Cooke B, Dumitru D, Lonergan D, Lewis CR. Regional radiotherapy may improve outcomes in patients with early stage breast cancer undergoing breast conservation therapy. Anticancer Res 2007; 27:647-52. [PMID: 17348455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
BACKGROUND Breast conservation therapy (BCT) is recommended as standard management of early breast cancer. The aim of this study was to retrospectively evaluate the results of BCT to identify prognostic factors predictive of treatment outcomes. PATIENTS AND METHODS Four hundred and ninety-eight eligible women with unilateral stage I-II breast cancer who had undergone BCT were analyzed. RESULTS The cumulative incidence of local recurrence (LR) was 1.9% and 3.7% at 3- and 5-years respectively. The 5-year disease-free, cancer-specific, and overall survival (DFS, CSS, OS) were 80.0%, 87.3% and 85.4% respectively. Significant independent predictors for LR included young age and absence of chemotherapy. Regional nodal radiotherapy was significantly associated with improved DFS and OS. CONCLUSION Our results confirmed the efficacy of BCT in the treatment of early breast cancer and indicated that inclusion of regional nodal areas within the radiotherapy field might be beneficial in the BCT setting, particularly for patients with adverse risk features.
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Affiliation(s)
- G T Mai
- Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane, QLD 4102
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Grulich AE, Wan X, Law MG, Milliken ST, Lewis CR, Garsia RJ, Gold J, Finlayson RJ, Cooper DA, Kaldor JM. B-cell stimulation and prolonged immune deficiency are risk factors for non-Hodgkin's lymphoma in people with AIDS. AIDS 2000; 14:133-40. [PMID: 10708283 DOI: 10.1097/00002030-200001280-00008] [Citation(s) in RCA: 114] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To identify risk factors for non-Hodgkin's lymphoma (NHL) in people with HIV infection. DESIGN AND SETTING Case-control study in Sydney, Australia. PARTICIPANTS AND METHODS Two hundred and nineteen patients with AIDS-related NHL were compared with 219 HIV-infected controls without NHL, matched for CD4 positive cell count and date of specimen collection. Data on demographic, infectious, treatment-related and immunological factors were abstracted by medical record review. The association between demographic factors, sexually transmissible diseases, HIV-related opportunistic infections, anti-viral therapy, duration of immune deficiency and indices of immune stimulation and risk of NHL were derived for these groups. RESULTS In a multivariate model, there were two independent groups of predictors of NHL risk. The first was duration of immunodeficiency, as measured by longer time since seroconversion (P for trend 0.008), and lower CD4 positive cell count 1 year prior to the time of NHL diagnosis (P for trend 0.009). The second predictor was B-cell stimulation, as indicated by higher serum globulin (a surrogate marker for serum immunoglobulin, P for trend 0.044) and HIV p24 antigenaemia [odds ratio (OR) for p24 positivity, 1.82; 95% confidence interval (CI), 1.15-2.88]. Indices of B-cell stimulation preceded the diagnosis of NHL by several years. Factors not related to NHL risk included clinical indices of Epstein-Barr virus infection and receipt of individual nucleoside analogue antiretroviral agents. Combination therapy with these agents was associated with a non-significant reduction in NHL risk (OR, 0.68; 95% CI, 0.39-1.18). CONCLUSIONS Markers of long-standing immune deficiency and B-cell stimulation were associated with an increased risk of developing NHL. Unless the strongest risk factor for NHL, immune deficiency, can be reversed, NHL is likely to become proportionately more important as a cause of morbidity and mortality in people with HIV infection.
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Affiliation(s)
- A E Grulich
- National Centre in HIV Epidemiology and Clinical Research, Sydney, New South Wales, Australia.
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Lewis CR, Wheatley SE. The beginnings of middle class suburbanization in a small town: a case study of Aberystwyth, c. 1870-1930. Cylchgrawn Llyfrgell Genedlaethol Cymru 1999; 31:45-64. [PMID: 22103012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Lewis CR, Russell RR. Chromosomal deletions in Streptococcus mutans. Adv Exp Med Biol 1997; 418:677-9. [PMID: 9331742 DOI: 10.1007/978-1-4899-1825-3_158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- C R Lewis
- University of Newcastle upon Tyne, United Kingdom
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Kaye SB, Paul J, Cassidy J, Lewis CR, Duncan ID, Gordon HK, Kitchener HC, Cruickshank DJ, Atkinson RJ, Soukop M, Rankin EM, Davis JA, Reed NS, Crawford SM, MacLean A, Parkin D, Sarkar TK, Kennedy J, Symonds RP. Mature results of a randomized trial of two doses of cisplatin for the treatment of ovarian cancer. Scottish Gynecology Cancer Trials Group. J Clin Oncol 1996; 14:2113-9. [PMID: 8683244 DOI: 10.1200/jco.1996.14.7.2113] [Citation(s) in RCA: 106] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
PURPOSE In 1992, we reported the first results of a randomized study in ovarian cancer, comprising two doses of cisplatin and indicated a significant difference (P = .0008) in median survival. Four years later, we now describe the results of this trial. PATIENTS AND METHODS After a median follow-up of 4 years and 9 months, 115 of 159 cases of advanced ovarian cancer, originally randomized to receive six cycles of cyclophosphamide 750 mg/m2 and either a high dose (HD) of 100 mg/m2 cisplatin or a low dose (LD) of 50 mg/m2 (LD) cisplatin, have now died. RESULTS The overall survival for HD and LD patients is 32.4% and 26.6%, respectively, and the overall relative death rate is 0.68 (P = .043). This represents a reduction in overall benefit with longer follow-up compared with the first 2 years (relative death rate of 0.52). Toxicity, particularly neurotoxicity, is still evident in the fourth year (10/31 on HD compared with 1/24 on LD). CONCLUSION Our recommended dose of cisplatin in combination schedule is therefore 75 mg/m2, representing the optimal balance between efficacy and toxicity.
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Affiliation(s)
- S B Kaye
- Department of Medical Oncology, Beatson Oncology Centre, Western Infirmary, Glasgow, United Kingdom
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Affiliation(s)
- C R Lewis
- Department of Medical Oncology, Prince of Wales Hospital, Sydney, Randwick, Australia
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