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Stathi D, Hussain S, Crawley D, Karalliedde J. Presentation of new onset type 1 diabetes with diabetic ketoacidosis and hyperosmolar hyperglycaemia after a single dose of nivolumab and ipilimumab. Endocrinol Diabetes Metab Case Rep 2023; 2023:22-0389. [PMID: 37584383 PMCID: PMC10448588 DOI: 10.1530/edm-22-0389] [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: 10/27/2022] [Accepted: 07/31/2023] [Indexed: 08/17/2023] Open
Abstract
Summary A Caucasian man in his 60s with recent diagnosis of metastatic renal cell carcinoma presented to the emergency department with a 5-day history of severe polyuria, polydipsia and fatigue and 1-day history of confusion, abdominal pain, nausea and vomiting. Investigations revealed an overlap of diabetic ketoacidosis (DKA) and hyperosmolar hyperglycaemic state (HHS). He had received the first dose of immunotherapy with nivolumab and ipilimumab 3 weeks prior to this attendance. New-onset type 1 diabetes (T1DM) was confirmed based on the clinical features at presentation, seropositivity for glutamic acid decarboxylase antibodies and significant insulin deficiency. He is currently on a multiple daily injections of insulin and uses intermittent-scanned glucose monitoring. Given the irreversible impact on beta-cell function and clinical response with insulin resulting in improved diabetes control, immunotherapy was resumed for his metastatic cancer with good radiological response. Although rare, new-onset T1DM can present with DKA and HSS overlap after a single dose of nivolumab/ipilimumab in individuals without pre-existing history of diabetes. Learning points Although rare, new onset of T1DM after immunotherapy can present with DKA and HSS overlap after a single dose of nivolumab/ipilimumab in individuals without pre-existing history of diabetes and normal glycaemic parameters. Due to the irreversible destruction of beta-cells, treatment with steroids is not indicated in contrast to other settings such as immunotherapy-induced hypophysitis. Presence of low c-peptide levels post-acute presentation is indicative of an irreversible impact on beta-cell function and supports resuming immunotherapy given the significant benefits on cancer prognosis. Clinicians must maintain a high index of suspicion in regards to diagnosis and management of new-onset type 1 diabetes and advice patients on reporting symptoms suggestive of diabetes and/or diabetes-related hyperglycaemic emergencies.
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Affiliation(s)
- Dimitra Stathi
- Department of Endocrinology and Diabetes, Guy’s and St Thomas’ NHS Trust, London, UK
- School of Cardiovascular Medicine & Sciences, King's College London, London, UK
| | - Sufyan Hussain
- Department of Endocrinology and Diabetes, Guy’s and St Thomas’ NHS Trust, London, UK
| | - Danielle Crawley
- Department of Oncology, Guy’s and St Thomas’ NHS Trust, London, UK
| | - Janaka Karalliedde
- Department of Endocrinology and Diabetes, Guy’s and St Thomas’ NHS Trust, London, UK
- School of Cardiovascular Medicine & Sciences, King's College London, London, UK
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Lin E, Garmo H, Hagström E, Van Hemelrijck M, Adolfsson J, Stattin P, Zethelius B, Crawley D. Association between atherogenic lipids and GnRH agonists for prostate cancer in men with T2DM: a nationwide, population-based cohort study in Sweden. Br J Cancer 2023; 128:814-824. [PMID: 36522475 PMCID: PMC9977763 DOI: 10.1038/s41416-022-02091-z] [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: 01/07/2022] [Revised: 11/15/2022] [Accepted: 11/24/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Gonadotropin-releasing hormone agonists (GnRH) used in prostate cancer (PCa) are associated with atherogenic dyslipidaemia. It can be assumed that GnRH need to be used with greater caution in men with type 2 diabetes mellitus (T2DM). This study investigated association of GnRH with atherogenic lipids (AL) in PCa men with T2DM. METHODS Two cohorts including 38,311 men with 11 years follow-up based on Swedish national registers were defined (PCa-Exposure cohort and GnRH-Exposure cohort). Based on European guidelines on cardiovascular diseases (CVD), primary outcomes were defined as: 1.0 mmol/L increase in AL and lipid-lowering therapy (LLT) intensification. We used Cox proportional-hazards models and Kaplan-Meier curves to assess the association. RESULTS There was an association between GnRH and increased AL (i.e., triglyceride, PCa-Exposure cohort: HR 1.77, 95% CI 1.48-2.10; GnRH-Exposure cohort: HR 1.88, 95% CI 1.38-2.57). There was also an association between PCa diagnosis and increased AL. In contrast, no association between LLT intensification and GnRH was found. CONCLUSION In this large population-based study, men with T2DM on GnRH for PCa had an increased risk of increased atherogenic lipids. These results highlight the need to closely monitor lipids and to be ready to intensify lipid-lowering therapy in men with T2DM on GnRH for PCa.
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Affiliation(s)
- E Lin
- School of Cancer and Pharmaceutical Sciences, Translational Oncology and Urology Research (TOUR), King's College London, London, UK.
| | - Hans Garmo
- School of Cancer and Pharmaceutical Sciences, Translational Oncology and Urology Research (TOUR), King's College London, London, UK.,Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Emil Hagström
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden.,Uppsala Clinical Research Centre, Uppsala, Sweden
| | - Mieke Van Hemelrijck
- School of Cancer and Pharmaceutical Sciences, Translational Oncology and Urology Research (TOUR), King's College London, London, UK
| | - Jan Adolfsson
- Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden
| | - Pär Stattin
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Björn Zethelius
- Department of Public Health/Geriatrics, Uppsala University, Uppsala, Sweden
| | - Danielle Crawley
- School of Cancer and Pharmaceutical Sciences, Translational Oncology and Urology Research (TOUR), King's College London, London, UK
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Lin E, Garmo H, Van Hemelrijck M, Zethelius B, Stattin P, Hagström E, Adolfsson J, Crawley D. Association of Gonadotropin-Releasing Hormone Agonists for Prostate Cancer With Cardiovascular Disease Risk and Hypertension in Men With Diabetes. JAMA Netw Open 2022; 5:e2225600. [PMID: 35939302 PMCID: PMC9361086 DOI: 10.1001/jamanetworkopen.2022.25600] [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] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
IMPORTANCE Men with type 2 diabetes have an increased risk of cardiovascular disease (CVD). Meanwhile, gonadotropin-releasing hormone (GnRH) agonists used in prostate cancer (PCa) are associated with increased risk of CVD. OBJECTIVE To evaluate the association between GnRH agonist use, PCa diagnosis per se, and CVD risk in men with type 2 diabetes. DESIGN, SETTING, AND PARTICIPANTS This nationwide population-based cohort study identified men with type 2 diabetes by use of data in the Prostate Cancer Data Base Sweden version 4.1 and the Swedish National Diabetes Register, with longitudinal data from 2006 to 2016. These data were used to create 2 cohorts, 1 including men with and without PCa and the other including men with PCa who received and did not receive GnRH agonists. Data analysis was conducted from January 2006 to December 2016. EXPOSURES Treatment with GnRH agonists and PCa diagnosis were the primary exposures. MAIN OUTCOMES AND MEASURES Primary outcome was a 10% increase in predicted 5-year CVD risk score. Secondary outcome was worsening hypertension as defined by the European Society of Hypertension Guidelines. Cox proportional hazards regression models were used to analyze the association. RESULTS The PCa exposure cohort included 5714 men (median [IQR] age, 72.0 [11.0]), and the non-PCa cohort included 28 445 men without PCa (median [IQR] age, 72.0 [11.0]). The GnRH agonist-exposure cohort included 692 men with PCa who received a GnRH agonist, compared with 3460 men with PCa who did not receive a GnRH agonist. Men with PCa receiving GnRH agonists had an increased estimated 5-year CVD risk score compared with men without PCa (hazard ratio [HR], 1.25; 95% CI, 1.16-1.36) and compared with men with PCa not receiving GnRH agonists (HR, 1.53; 95% CI, 1.35-1.74). Men receiving GnRH agonists had decreased blood pressure compared with men without PCa (HR, 0.70; 95% CI, 0.61-0.80) and compared with men with PCa not receiving GnRH agonists (HR, 0.68; 95% CI, 0.56-0.82). CONCLUSIONS AND RELEVANCE In this population-based cohort study, there was an increased risk of CVD in men with type 2 diabetes who received a GnRH agonist for PCa. These findings highlight the need to closely control CVD risk factors in men with type 2 diabetes treated with GnRH agonists. The association between GnRH agonist use and decreased blood pressure levels warrants further study.
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Affiliation(s)
- E. Lin
- School of Cancer and Pharmaceutical Sciences, Translational Oncology and Urology Research (TOUR), King’s College London, London, United Kingdom
| | - Hans Garmo
- School of Cancer and Pharmaceutical Sciences, Translational Oncology and Urology Research (TOUR), King’s College London, London, United Kingdom
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Mieke Van Hemelrijck
- School of Cancer and Pharmaceutical Sciences, Translational Oncology and Urology Research (TOUR), King’s College London, London, United Kingdom
| | - Björn Zethelius
- Department of Public Health/Geriatrics, Uppsala University, Uppsala, Sweden
| | - Pär Stattin
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Emil Hagström
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
- Uppsala Clinical Research Centre, Uppsala, Sweden
| | - Jan Adolfsson
- Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden
| | - Danielle Crawley
- School of Cancer and Pharmaceutical Sciences, Translational Oncology and Urology Research (TOUR), King’s College London, London, United Kingdom
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Lin E, Garmo H, Van Hemelrijck M, Adolfsson J, Stattin P, Zethelius B, Crawley D. Exploring the association between use of gonadotropin releasing hormones agonists and prostate cancer diagnosis per se and diabetes control in men with type 2 diabetes mellitus: a nationwide, population-based cohort study. BMC Cancer 2021; 21:1259. [PMID: 34809595 PMCID: PMC8607667 DOI: 10.1186/s12885-021-08941-y] [Citation(s) in RCA: 1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 10/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Gonadotropin Releasing Hormones agonists (GnRH), which are first line treatment for metastatic prostate cancer (PCa), increase risk of type 2 diabetes mellitus (T2DM). This study aims to quantify the association of use of GnRH with diabetes control in PCa men with T2DM. METHODS Nationwide population-based cohort study in the Swedish National Diabetes Register and Prostate Cancer data Base Sweden 4.1, on the association between GnRH and diabetes control in T2DM men with PCa by comparing T2DM men with PCa vs. without PCa, as well as comparing T2DM men with PCa on or not on GnRH. The primary exposure was use of GnRH. Worsening diabetes control was the primary outcome, defined as: 1) HbA1c rose to 58 mmol/mol or higher; 2) HbA1c increase by 10 mmol/mol or more; 3) Start of antidiabetic drugs or switch to insulin. We also combined all above definitions. Cox proportional hazards regression was used to analyze the association. RESULTS There were 5714 T2DM men with PCa of whom 692 were on GnRH and 28,445 PCa-free men with T2DM with similar baseline characteristics. Diabetes control was worse in men with GnRH vs. PCa-free men (HR: 1.24, 95% CI: 1.13-1.34) as well as compared with PCa men without GnRH (HR:1.58, 95% CI: 1.39-1.80), when we defined the worsening control of diabetes by combining all definitions above. CONCLUSION Use of GnRH in T2DM men with PCa was associated with worse glycemic control. The findings highlight the need to closely monitor diabetes control in men with T2DM and PCa starting GnRH.
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Affiliation(s)
- E Lin
- School of Cancer and Pharmaceutical Sciences, Translational Oncology and Urology Research (TOUR), King's College London, 3rd Floor Bermondsey Wing, Guy's Hospital, London, SE1 9RT, UK.
| | - Hans Garmo
- School of Cancer and Pharmaceutical Sciences, Translational Oncology and Urology Research (TOUR), King's College London, 3rd Floor Bermondsey Wing, Guy's Hospital, London, SE1 9RT, UK
| | - Mieke Van Hemelrijck
- School of Cancer and Pharmaceutical Sciences, Translational Oncology and Urology Research (TOUR), King's College London, 3rd Floor Bermondsey Wing, Guy's Hospital, London, SE1 9RT, UK
| | - Jan Adolfsson
- Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden
| | - Pär Stattin
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Björn Zethelius
- Department of Public Health/Geriatrics, Uppsala University, Uppsala, Sweden
| | - Danielle Crawley
- School of Cancer and Pharmaceutical Sciences, Translational Oncology and Urology Research (TOUR), King's College London, 3rd Floor Bermondsey Wing, Guy's Hospital, London, SE1 9RT, UK
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Russell B, Moss CL, Shah V, Ko TK, Palmer K, Sylva R, George G, Monroy-Iglesias MJ, Patten P, Ceesay MM, Benjamin R, Potter V, Pagliuca A, Papa S, Irshad S, Ross P, Spicer J, Kordasti S, Crawley D, Wylie H, Cahill F, Haire A, Zaki K, Sita-Lumsden A, Josephs D, Enting D, Swampillai A, Sawyer E, D'Souza A, Gomberg S, Harrison C, Fields P, Wrench D, Rigg A, Sullivan R, Kulasekararaj A, Dolly S, Van Hemelrijck M. Risk of COVID-19 death in cancer patients: an analysis from Guy's Cancer Centre and King's College Hospital in London. Br J Cancer 2021; 125:939-947. [PMID: 34400804 PMCID: PMC8366163 DOI: 10.1038/s41416-021-01500-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 05/26/2021] [Accepted: 07/14/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Using an updated dataset with more patients and extended follow-up, we further established cancer patient characteristics associated with COVID-19 death. METHODS Data on all cancer patients with a positive reverse transcription-polymerase chain reaction swab for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) at Guy's Cancer Centre and King's College Hospital between 29 February and 31 July 2020 was used. Cox proportional hazards regression was performed to identify which factors were associated with COVID-19 mortality. RESULTS Three hundred and six SARS-CoV-2-positive cancer patients were included. Seventy-one had mild/moderate and 29% had severe COVID-19. Seventy-two patients died of COVID-19 (24%), of whom 35 died <7 days. Male sex [hazard ratio (HR): 1.97 (95% confidence interval (CI): 1.15-3.38)], Asian ethnicity [3.42 (1. 59-7.35)], haematological cancer [2.03 (1.16-3.56)] and a cancer diagnosis for >2-5 years [2.81 (1.41-5.59)] or ≥5 years were associated with an increased mortality. Age >60 years and raised C-reactive protein (CRP) were also associated with COVID-19 death. Haematological cancer, a longer-established cancer diagnosis, dyspnoea at diagnosis and raised CRP were indicative of early COVID-19-related death in cancer patients (<7 days from diagnosis). CONCLUSIONS Findings further substantiate evidence for increased risk of COVID-19 mortality for male and Asian cancer patients, and those with haematological malignancies or a cancer diagnosis >2 years. These factors should be accounted for when making clinical decisions for cancer patients.
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Affiliation(s)
- Beth Russell
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, UK.
| | - Charlotte L Moss
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Vallari Shah
- Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, UK
| | - Thinzar Ko Ko
- Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, UK
| | - Kieran Palmer
- King's College Hospital NHS Foundation Trust, London, UK
| | - Rushan Sylva
- Medical Oncology, Guy's and St Thomas' NHS Foundation Trust (GSTT), London, UK
| | - Gincy George
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Maria J Monroy-Iglesias
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Piers Patten
- Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, UK
- School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | | | - Reuben Benjamin
- Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, UK
- School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Victoria Potter
- Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, UK
| | - Antonio Pagliuca
- Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, UK
- School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Sophie Papa
- Medical Oncology, Guy's and St Thomas' NHS Foundation Trust (GSTT), London, UK
- School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Sheeba Irshad
- Medical Oncology, Guy's and St Thomas' NHS Foundation Trust (GSTT), London, UK
- School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Paul Ross
- Medical Oncology, Guy's and St Thomas' NHS Foundation Trust (GSTT), London, UK
| | - James Spicer
- Medical Oncology, Guy's and St Thomas' NHS Foundation Trust (GSTT), London, UK
- School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Shahram Kordasti
- School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
- Haematology Department, Guy's and St Thomas' NHS Foundation Trust (GSTT), London, UK
| | - Danielle Crawley
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
- Medical Oncology, Guy's and St Thomas' NHS Foundation Trust (GSTT), London, UK
| | - Harriet Wylie
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Fidelma Cahill
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Anna Haire
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Kamarul Zaki
- Medical Oncology, Guy's and St Thomas' NHS Foundation Trust (GSTT), London, UK
| | - Ailsa Sita-Lumsden
- Medical Oncology, Guy's and St Thomas' NHS Foundation Trust (GSTT), London, UK
| | - Debra Josephs
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
- Medical Oncology, Guy's and St Thomas' NHS Foundation Trust (GSTT), London, UK
| | - Deborah Enting
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
- Medical Oncology, Guy's and St Thomas' NHS Foundation Trust (GSTT), London, UK
| | - Angela Swampillai
- Medical Oncology, Guy's and St Thomas' NHS Foundation Trust (GSTT), London, UK
| | - Elinor Sawyer
- School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
- Clinical Oncology, Guy's and St Thomas NHS Foundation Trust (GSTT), London, UK
| | - Andrea D'Souza
- Medical Oncology, Guy's and St Thomas' NHS Foundation Trust (GSTT), London, UK
| | - Simon Gomberg
- Medical Oncology, Guy's and St Thomas' NHS Foundation Trust (GSTT), London, UK
| | - Claire Harrison
- Haematology Department, Guy's and St Thomas' NHS Foundation Trust (GSTT), London, UK
| | - Paul Fields
- Haematology Department, Guy's and St Thomas' NHS Foundation Trust (GSTT), London, UK
| | - David Wrench
- Haematology Department, Guy's and St Thomas' NHS Foundation Trust (GSTT), London, UK
| | - Anne Rigg
- Medical Oncology, Guy's and St Thomas' NHS Foundation Trust (GSTT), London, UK
| | - Richard Sullivan
- School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Austin Kulasekararaj
- Department of Haematological Medicine, King's College Hospital NHS Foundation Trust, London, UK
- School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Saoirse Dolly
- Medical Oncology, Guy's and St Thomas' NHS Foundation Trust (GSTT), London, UK
| | - Mieke Van Hemelrijck
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
- Medical Oncology, Guy's and St Thomas' NHS Foundation Trust (GSTT), London, UK
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Russell B, Moss CL, Palmer K, Sylva R, D’Souza A, Wylie H, Haire A, Cahill F, Steel R, Hoyes A, Wilson I, Macneil A, Shifa B, Monroy-Iglesias MJ, Papa S, Irshad S, Ross P, Spicer J, Kordasti S, Crawley D, Zaki K, Sita-Lumsden A, Josephs D, Enting D, Swampillai A, Sawyer E, Fields P, Wrench D, Rigg A, Sullivan R, Van Hemelrijck M, Dolly S. COVID-19 Risk Factors for Cancer Patients: A First Report with Comparator Data from COVID-19 Negative Cancer Patients. Cancers (Basel) 2021; 13:2479. [PMID: 34069565 PMCID: PMC8161328 DOI: 10.3390/cancers13102479] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 05/13/2021] [Accepted: 05/14/2021] [Indexed: 01/11/2023] Open
Abstract
Very few studies investigating COVID-19 in cancer patients have included cancer patients as controls. We aimed to identify factors associated with the risk of testing positive for SARS CoV2 infection in a cohort of cancer patients. We analyzed data from all cancer patients swabbed for COVID-19 between 1st March and 31st July 2020 at Guy's Cancer Centre. We conducted logistic regression analyses to identify which factors were associated with a positive COVID-19 test. Results: Of the 2152 patients tested for COVID-19, 190 (9%) tested positive. Male sex, black ethnicity, and hematological cancer type were positively associated with risk of COVID-19 (OR = 1.85, 95%CI:1.37-2.51; OR = 1.93, 95%CI:1.31-2.84; OR = 2.29, 95%CI:1.45-3.62, respectively) as compared to females, white ethnicity, or solid cancer type, respectively. Male, Asian ethnicity, and hematological cancer type were associated with an increased risk of severe COVID-19 (OR = 3.12, 95%CI:1.58-6.14; OR = 2.97, 95%CI:1.00-8.93; OR = 2.43, 95%CI:1.00-5.90, respectively). This study is one of the first to compare the risk of COVID-19 incidence and severity in cancer patients when including cancer patients as controls. Results from this study have echoed those of previous reports, that patients who are male, of black or Asian ethnicity, or with a hematological malignancy are at an increased risk of COVID-19.
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Affiliation(s)
- Beth Russell
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King’s College London, London SE1 9RT, UK; (C.L.M.); (H.W.); (A.H.); (F.C.); (M.J.M.-I.); (D.C.); (D.J.); (D.E.)
| | - Charlotte L. Moss
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King’s College London, London SE1 9RT, UK; (C.L.M.); (H.W.); (A.H.); (F.C.); (M.J.M.-I.); (D.C.); (D.J.); (D.E.)
| | - Kieran Palmer
- King’s College Hospital NHS Foundation Trust, London SE5 9RS, UK;
| | - Rushan Sylva
- Medical Oncology, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London SE1 9RT, UK; (R.S.); (A.D.); (S.P.); (S.I.); (P.R.); (J.S.); (K.Z.); (A.S.-L.); (A.R.); (S.D.)
| | - Andrea D’Souza
- Medical Oncology, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London SE1 9RT, UK; (R.S.); (A.D.); (S.P.); (S.I.); (P.R.); (J.S.); (K.Z.); (A.S.-L.); (A.R.); (S.D.)
| | - Harriet Wylie
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King’s College London, London SE1 9RT, UK; (C.L.M.); (H.W.); (A.H.); (F.C.); (M.J.M.-I.); (D.C.); (D.J.); (D.E.)
| | - Anna Haire
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King’s College London, London SE1 9RT, UK; (C.L.M.); (H.W.); (A.H.); (F.C.); (M.J.M.-I.); (D.C.); (D.J.); (D.E.)
| | - Fidelma Cahill
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King’s College London, London SE1 9RT, UK; (C.L.M.); (H.W.); (A.H.); (F.C.); (M.J.M.-I.); (D.C.); (D.J.); (D.E.)
| | - Renee Steel
- Clinical Oncology, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London SE1 9RT, UK; (R.S.); (A.S.); (E.S.)
| | - Angela Hoyes
- Haematology Department, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London SE1 9RT, UK; (A.H.); (S.K.); (P.F.); (D.W.)
| | - Isabelle Wilson
- Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London SE1 9RT, UK;
| | - Alyson Macneil
- Breast Surgery, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London SE1 9RT, UK; (A.M.); (B.S.)
| | - Belul Shifa
- Breast Surgery, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London SE1 9RT, UK; (A.M.); (B.S.)
| | - Maria J Monroy-Iglesias
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King’s College London, London SE1 9RT, UK; (C.L.M.); (H.W.); (A.H.); (F.C.); (M.J.M.-I.); (D.C.); (D.J.); (D.E.)
| | - Sophie Papa
- Medical Oncology, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London SE1 9RT, UK; (R.S.); (A.D.); (S.P.); (S.I.); (P.R.); (J.S.); (K.Z.); (A.S.-L.); (A.R.); (S.D.)
- School of Cancer and Pharmaceutical Sciences, King’s College London, London SE1 9RT, UK;
| | - Sheeba Irshad
- Medical Oncology, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London SE1 9RT, UK; (R.S.); (A.D.); (S.P.); (S.I.); (P.R.); (J.S.); (K.Z.); (A.S.-L.); (A.R.); (S.D.)
- School of Cancer and Pharmaceutical Sciences, King’s College London, London SE1 9RT, UK;
| | - Paul Ross
- Medical Oncology, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London SE1 9RT, UK; (R.S.); (A.D.); (S.P.); (S.I.); (P.R.); (J.S.); (K.Z.); (A.S.-L.); (A.R.); (S.D.)
| | - James Spicer
- Medical Oncology, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London SE1 9RT, UK; (R.S.); (A.D.); (S.P.); (S.I.); (P.R.); (J.S.); (K.Z.); (A.S.-L.); (A.R.); (S.D.)
- School of Cancer and Pharmaceutical Sciences, King’s College London, London SE1 9RT, UK;
| | - Shahram Kordasti
- Haematology Department, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London SE1 9RT, UK; (A.H.); (S.K.); (P.F.); (D.W.)
- School of Cancer and Pharmaceutical Sciences, King’s College London, London SE1 9RT, UK;
| | - Danielle Crawley
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King’s College London, London SE1 9RT, UK; (C.L.M.); (H.W.); (A.H.); (F.C.); (M.J.M.-I.); (D.C.); (D.J.); (D.E.)
- Medical Oncology, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London SE1 9RT, UK; (R.S.); (A.D.); (S.P.); (S.I.); (P.R.); (J.S.); (K.Z.); (A.S.-L.); (A.R.); (S.D.)
| | - Kamarul Zaki
- Medical Oncology, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London SE1 9RT, UK; (R.S.); (A.D.); (S.P.); (S.I.); (P.R.); (J.S.); (K.Z.); (A.S.-L.); (A.R.); (S.D.)
| | - Ailsa Sita-Lumsden
- Medical Oncology, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London SE1 9RT, UK; (R.S.); (A.D.); (S.P.); (S.I.); (P.R.); (J.S.); (K.Z.); (A.S.-L.); (A.R.); (S.D.)
| | - Debra Josephs
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King’s College London, London SE1 9RT, UK; (C.L.M.); (H.W.); (A.H.); (F.C.); (M.J.M.-I.); (D.C.); (D.J.); (D.E.)
- Medical Oncology, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London SE1 9RT, UK; (R.S.); (A.D.); (S.P.); (S.I.); (P.R.); (J.S.); (K.Z.); (A.S.-L.); (A.R.); (S.D.)
| | - Deborah Enting
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King’s College London, London SE1 9RT, UK; (C.L.M.); (H.W.); (A.H.); (F.C.); (M.J.M.-I.); (D.C.); (D.J.); (D.E.)
- Medical Oncology, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London SE1 9RT, UK; (R.S.); (A.D.); (S.P.); (S.I.); (P.R.); (J.S.); (K.Z.); (A.S.-L.); (A.R.); (S.D.)
| | - Angela Swampillai
- Clinical Oncology, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London SE1 9RT, UK; (R.S.); (A.S.); (E.S.)
| | - Elinor Sawyer
- Clinical Oncology, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London SE1 9RT, UK; (R.S.); (A.S.); (E.S.)
- School of Cancer and Pharmaceutical Sciences, King’s College London, London SE1 9RT, UK;
| | - Paul Fields
- Haematology Department, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London SE1 9RT, UK; (A.H.); (S.K.); (P.F.); (D.W.)
| | - David Wrench
- Haematology Department, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London SE1 9RT, UK; (A.H.); (S.K.); (P.F.); (D.W.)
| | - Anne Rigg
- Medical Oncology, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London SE1 9RT, UK; (R.S.); (A.D.); (S.P.); (S.I.); (P.R.); (J.S.); (K.Z.); (A.S.-L.); (A.R.); (S.D.)
| | - Richard Sullivan
- School of Cancer and Pharmaceutical Sciences, King’s College London, London SE1 9RT, UK;
| | - Mieke Van Hemelrijck
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King’s College London, London SE1 9RT, UK; (C.L.M.); (H.W.); (A.H.); (F.C.); (M.J.M.-I.); (D.C.); (D.J.); (D.E.)
- Medical Oncology, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London SE1 9RT, UK; (R.S.); (A.D.); (S.P.); (S.I.); (P.R.); (J.S.); (K.Z.); (A.S.-L.); (A.R.); (S.D.)
| | - Saoirse Dolly
- Medical Oncology, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London SE1 9RT, UK; (R.S.); (A.D.); (S.P.); (S.I.); (P.R.); (J.S.); (K.Z.); (A.S.-L.); (A.R.); (S.D.)
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Monroy-Iglesias MJ, Russell B, Moss C, George G, Palmer K, Papa S, Irshad S, Ross P, Spicer J, Kordasti S, Crawley D, Wylie H, Cahill F, Haire A, Sylva R, Zaki K, Rahman F, Sita-Lumsden A, Josephs D, Enting D, Lei M, Ghosh S, Harrison C, Swampillai A, Sawyer E, D'Souza A, Gomberg S, Fields P, Wrench D, Raj K, Gleeson M, Bailey K, Dillon R, Streetly M, Kulasekararaj A, Ko TK, Shah V, Rigg A, Sullivan R, Van Hemelrijck M, Dolly S. Abstract S12-03: Clinical and demographic characteristics associated with shorter time to COVID-19 death. Clin Cancer Res 2021. [DOI: 10.1158/1557-3265.covid-19-21-s12-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: Cancer patients have been considered a high-risk population in the COVID-19 pandemic. We previously investigated risk of COVID-19 death in COVID-19 positive cancer patients during a median follow-up of 134 days, and identified the following risk factors: male sex, age >60 years, Asian ethnicity, hematological cancer type, cancer diagnosis for >2.5 years, patients presenting with fever or dyspnea, and high levels of ferritin and C-reactive protein (CRP). Here, we further investigate which factors are associated with a COVID-19 related death within 7 days of diagnosis. Methods: Using data from Guy’s Cancer Centre and one of its partner trusts (King’s College Hospital), we included 306 cancer patients with a confirmed COVID-19 diagnosis (February 29th-July 31st 2020). 72 patients had a COVID-19 related death (24%) of whom 35 died within 7 days (50%). Cox proportional hazards regression was used to identify which factors were associated with a COVID-19 related death <7 days of diagnosis. Results: Of the 72 cancer patients who had a COVID-19 related death, the mean age was 72 years (Standard Deviation (SD) 14). A total of 53 (74%) patients were men. 37 (52%) had a hematological cancer type, 47 (65%) had stage IV cancer, and 42 (58%) had been diagnosed with cancer more than 24 months before COVID-19 related death. In the group of patients who died within 7 days of diagnosis (n= 35), mean age was 73 years (SD 13.96), 24 (68%) were men, 20 (57%) had a hematological cancer type, 26 (74%) had stage IV cancer, and 24 (68%) had been diagnosed with cancer >24 months before COVID-19 diagnosis. Factors associated with COVID-19 related death <7 days of diagnosis were: hematological cancer (Hazard Ratio (HR): 2.74 (95% Confidence Interval (CI): 1.21-6.22)), 2-5 yrs since cancer diagnosis (HR: 4.81 (95%CI: 1.47-15.69)), and >5 yrs since cancer diagnosis (HR: 4.41 (95%CI: 1.38-14.06)). Additionally, patients who presented with dyspnea had increased risk of COVID-19 related death <7 days compared to asymptomatic patients (HR: 5.25 (95%CI 2.14-12.89)). CRP levels in the third tercile (146-528 mg/L) as compared to the first were also associated with increased risk of an early death due to COVID-19. Conclusion: From all the factors identified in our previous COVID-19 related death analysis, only hematological cancer type, a longer-established cancer diagnosis (2-5 years and more than 5 years), dyspnea at time of diagnosis and high levels of CRP were indicative of an early COVID-19 related death (within 7 days of diagnosis) in cancer patients.
Citation Format: Maria J. Monroy-Iglesias, Beth Russell, Charlotte Moss, Gincy George, Kieran Palmer, Sophie Papa, Sheeba Irshad, Paul Ross, James Spicer, Sharam Kordasti, Danielle Crawley, Harriet Wylie, Fidelma Cahill, Anna Haire, Rushan Sylva, Kamarul Zaki, Fareen Rahman, Ailsa Sita-Lumsden, Debra Josephs, Deborah Enting, Mary Lei, Sharmistha Ghosh, Claire Harrison, Angela Swampillai, Elinor Sawyer, Andrea D'Souza, Simon Gomberg, Paul Fields, David Wrench, Kavita Raj, Mary Gleeson, Kate Bailey, Richard Dillon, Matthew Streetly, Austin Kulasekararaj, Thinzar Ko Ko, Vallari Shah, Anne Rigg, Richard Sullivan, Mieke Van Hemelrijck, Saoirse Dolly. Clinical and demographic characteristics associated with shorter time to COVID-19 death [abstract]. In: Proceedings of the AACR Virtual Meeting: COVID-19 and Cancer; 2021 Feb 3-5. Philadelphia (PA): AACR; Clin Cancer Res 2021;27(6_Suppl):Abstract nr S12-03.
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Affiliation(s)
- Maria J. Monroy-Iglesias
- 1Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King’s College London, London, United Kingdom,
| | - Beth Russell
- 1Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King’s College London, London, United Kingdom,
| | - Charlotte Moss
- 1Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King’s College London, London, United Kingdom,
| | - Gincy George
- 1Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King’s College London, London, United Kingdom,
| | - Kieran Palmer
- 2King’s College Hospital NHS Foundation Trust, London, United Kingdom,
| | - Sophie Papa
- 3Guy’s and St Thomas’ NHS Foundation Trust (GSTT), Medical Oncology; School of Cancer and Pharmaceutical Sciences, King’s College London, London, United Kingdom,
| | - Sheeba Irshad
- 4Guy’s and St Thomas’ NHS Foundation Trust (GSTT), Medical Oncology; School of Cancer and Pharmaceutical Sciences, King’s College London, London, United Kingdom,
| | - Paul Ross
- 5Guy’s and St Thomas’ NHS Foundation Trust (GSTT), Medical Oncology, London, United Kingdom,
| | - James Spicer
- 4Guy’s and St Thomas’ NHS Foundation Trust (GSTT), Medical Oncology; School of Cancer and Pharmaceutical Sciences, King’s College London, London, United Kingdom,
| | - Sharam Kordasti
- 6Guy’s and St Thomas’ NHS Foundation Trust (GSTT), Medical Oncology; Haematology Department, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London, United Kingdom,
| | - Danielle Crawley
- 7Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King’s College London; Guy’s and St Thomas’ NHS Foundation Trust (GSTT), Medical Oncology, London, United Kingdom,
| | - Harriet Wylie
- 1Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King’s College London, London, United Kingdom,
| | - Fidelma Cahill
- 1Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King’s College London, London, United Kingdom,
| | - Anna Haire
- 1Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King’s College London, London, United Kingdom,
| | - Rushan Sylva
- 5Guy’s and St Thomas’ NHS Foundation Trust (GSTT), Medical Oncology, London, United Kingdom,
| | - Kamarul Zaki
- 5Guy’s and St Thomas’ NHS Foundation Trust (GSTT), Medical Oncology, London, United Kingdom,
| | - Fareen Rahman
- 8Guy’s and St Thomas’ NHS Foundation Trust (GSTT), Medical Oncology, London, United Kingdom, London, United Kingdom,
| | - Ailsa Sita-Lumsden
- 5Guy’s and St Thomas’ NHS Foundation Trust (GSTT), Medical Oncology, London, United Kingdom,
| | - Debra Josephs
- 9Guy’s and St Thomas’ NHS Foundation Trust (GSTT), Medical Oncology, London, United Kingdom; Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King’s College London, London, United Kingdom,
| | - Deborah Enting
- 1Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King’s College London, London, United Kingdom,
| | - Mary Lei
- 2King’s College Hospital NHS Foundation Trust, London, United Kingdom,
| | - Sharmistha Ghosh
- 2King’s College Hospital NHS Foundation Trust, London, United Kingdom,
| | - Claire Harrison
- 10King’s College Hospital NHS Foundation Trust; School of Cancer and Pharmaceutical Sciences, King’s College London, London, United Kingdom,
| | - Angela Swampillai
- 2King’s College Hospital NHS Foundation Trust, London, United Kingdom,
| | - Elinor Sawyer
- 4Guy’s and St Thomas’ NHS Foundation Trust (GSTT), Medical Oncology; School of Cancer and Pharmaceutical Sciences, King’s College London, London, United Kingdom,
| | - Andrea D'Souza
- 5Guy’s and St Thomas’ NHS Foundation Trust (GSTT), Medical Oncology, London, United Kingdom,
| | - Simon Gomberg
- 5Guy’s and St Thomas’ NHS Foundation Trust (GSTT), Medical Oncology, London, United Kingdom,
| | - Paul Fields
- 11Haematology Department, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London, United Kingdom,
| | - David Wrench
- 11Haematology Department, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London, United Kingdom,
| | - Kavita Raj
- 11Haematology Department, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London, United Kingdom,
| | - Mary Gleeson
- 11Haematology Department, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London, United Kingdom,
| | - Kate Bailey
- 11Haematology Department, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London, United Kingdom,
| | - Richard Dillon
- 12Haematology Department, Guy’s and St Thomas’ NHS Foundation Trust (GSTT); Department of Medical and Molecular Genetics, School of Basic and Medical Biosciences, King’s College London, London, United Kingdom,
| | - Matthew Streetly
- 11Haematology Department, Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London, United Kingdom,
| | - Austin Kulasekararaj
- 13Department of Haematological Medicine, King’s College Hospital NHS Foundation Trust, London, United Kingdom,
| | - Thinzar Ko Ko
- 13Department of Haematological Medicine, King’s College Hospital NHS Foundation Trust, London, United Kingdom,
| | - Vallari Shah
- 13Department of Haematological Medicine, King’s College Hospital NHS Foundation Trust, London, United Kingdom,
| | - Anne Rigg
- 5Guy’s and St Thomas’ NHS Foundation Trust (GSTT), Medical Oncology, London, United Kingdom,
| | - Richard Sullivan
- 14School of Cancer and Pharmaceutical Sciences, King’s College London, London, United Kingdom
| | - Mieke Van Hemelrijck
- 1Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King’s College London, London, United Kingdom,
| | - Saoirse Dolly
- 5Guy’s and St Thomas’ NHS Foundation Trust (GSTT), Medical Oncology, London, United Kingdom,
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Flanders L, Russell B, Moss C, Palmer K, Sylva R, George G, Crawley D, Wylie H, Cahill F, Haire A, D'Souza A, Gomberg S, Sullivan R, Rigg A, Van Hemelrijck M, Harries M, De Francesco I, Morris S, Papa S, Dolly S. Abstract P28: COVID-19 infection and mortality in patients with skin malignancies receiving systemic anti-cancer therapy (SACT): The Guy’s Cancer Centre experience. Clin Cancer Res 2021. [DOI: 10.1158/1557-3265.covid-19-21-p28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The COVID-19 pandemic has influenced treatment decisions in cancer patients. There is increasing evidence that not all oncology patients are at increased risk of COVID-19 infection or death. This study aimed to look at rate of SARS-CoV-2 infection and mortality in patients with skin malignancies receiving systemic anti-cancer therapy (SACT) during the pandemic in Guy’s Cancer Centre. Methods: All patients with skin cancer receiving SACT at Guy’s Cancer Centre between March 1st and May 31st 2020 were included. Demographic data: sex, age, socio-economic status (SES), ethnicity, comorbidities, medications and smoking history were collected along with cancer characteristics: cancer type, stage, treatment paradigm, modality and line. COVID-19 infection was confirmed by PCR and severity defined by the World Health Organisation classification. Patients with radiological or clinical diagnoses alone were excluded. Results: Of 116 skin cancer patients on SACT over the 3-month period, 89% had Melanoma, 5% Kaposi’s Sarcoma (KS), 3% Squamous Cell, 2% Merkel Cell, 1% Basal Cell Carcinoma and 1% Angiosarcoma. 53% were male and 78% were of low SES. 62% were being treated with palliative intent and 70% of these were on first line palliative treatment. The median age was 57.6 years in COVID-19 positive patients (n=3) compared to 60.3 years in the negative group (n=113). 58.6% received immunotherapy, 28.4% targeted therapy, 7.8% chemotherapy and 4.3% combined treatment. Of the 3 patients (2.6%) with confirmed COVID-19 infection, the two patients with KS were receiving liposomal doxorubicin hydrochloride and the other paclitaxel chemotherapy and the patient with Melanoma was receiving encorafenib and binimetinib. All COVID-19 positive patients were of low SES, 2 females and 1 male. There was a low rate of co-morbidities with hypertension in 1 COVID-19 positive patient and none in the negative group. All 3 confirmed COVID-19 patients developed severe pneumonia and were diagnosed within 7 days of the onset of symptoms. There were no COVID related deaths and one disease-related death in the negative cohort. Conclusion: There was a low rate of COVID-19 infection in the 116 skin cancer patients on SACT (2.6%) with 60% of patients on immunotherapy. All 3 confirmed cases had severe pneumonia with no COVID-19 related deaths (0%); 2 were receiving chemotherapy and 1 on targeted therapy. Patients on treatment were encouraged to shield between hospital attendances during this period which may account for the reduced rate of SARS-CoV-2 infection. This data supports the emerging observations that immunotherapy does not confer an increased risk of severe COVID-19 infection in cancer patients. This observation is confounded by the relatively young age and low co-morbidity rates in the cohort which may have contributed to the low infection and mortality rate.
Citation Format: Lucy Flanders, Beth Russell, Charlotte Moss, Kieran Palmer, Rushan Sylva, Gincy George, Danielle Crawley, Harriet Wylie, Fidelma Cahill, Anna Haire, Andrea D'Souza, Simon Gomberg, Richard Sullivan, Anne Rigg, Mieke Van Hemelrijck, Mark Harries, Irene De Francesco, Stephen Morris, Sophie Papa, Saiorse Dolly. COVID-19 infection and mortality in patients with skin malignancies receiving systemic anti-cancer therapy (SACT): The Guy’s Cancer Centre experience [abstract]. In: Proceedings of the AACR Virtual Meeting: COVID-19 and Cancer; 2021 Feb 3-5. Philadelphia (PA): AACR; Clin Cancer Res 2021;27(6_Suppl):Abstract nr P28.
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Affiliation(s)
- Lucy Flanders
- 1Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London, United Kingdom,
| | | | | | | | - Rushan Sylva
- 1Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London, United Kingdom,
| | | | - Danielle Crawley
- 1Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London, United Kingdom,
| | | | | | - Anna Haire
- 2King’s College London, London, United Kingdom
| | - Andrea D'Souza
- 1Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London, United Kingdom,
| | - Simon Gomberg
- 1Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London, United Kingdom,
| | - Richard Sullivan
- 1Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London, United Kingdom,
| | - Anne Rigg
- 1Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London, United Kingdom,
| | | | - Mark Harries
- 1Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London, United Kingdom,
| | - Irene De Francesco
- 1Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London, United Kingdom,
| | - Stephen Morris
- 1Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London, United Kingdom,
| | - Sophie Papa
- 1Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London, United Kingdom,
| | - Saiorse Dolly
- 1Guy’s and St Thomas’ NHS Foundation Trust (GSTT), London, United Kingdom,
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Sylva R, Russell B, Moss C, George G, Palmer K, Shah V, Ko TK, Kalsi T, Harari D, De Michele L, Kordasti S, Crawley D, Wylie H, Cahill F, Haire A, D'Souza A, Gomberg S, Kulasekararaj A, Van Hemelrijck M, Dolly S. Abstract S11-03: The impact of COVID-19 in the cancer population stratified by age: A real-world data study from Guy’s Cancer Center. Clin Cancer Res 2021. [DOI: 10.1158/1557-3265.covid-19-21-s11-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background It is widely accepted that advancing age is associated with worse COVID-19 outcomes. However, there is insufficient data analyzing the impact of COVID-19 in the older cancer population. The aim of the study is to establish if age has an influence on severity and mortality of COVID-19 in cancer patients. Methods We reviewed 306 oncology patients with PCR-confirmed COVID-19 from Guy’s Cancer Centre and its partner Trust King’s College Hospital, between 29 February – 31 July 2020. Demographic and tumor characteristics in relation to COVID-19 severity and death were assessed with logistic and Cox proportional hazards regression models, stratified by age (≤65 and >65 years). Severity of COVID-19 was classified by World Health Organization (WHO) grading. Results A total of 135 patients were aged ≤65 years (44%) and 171 aged >65 (56%). Severe COVID-19 presentation was seen in 27% of those aged ≤65 and 30% of those aged >65. The COVID-19 mortality rate was 19% in those aged ≤65 and 27% in those aged >65. In the older cohort, there was an increased incidence of severe disease in Caucasian ethnicity compared to the younger cohort (55% vs 43%) and compared to severe disease in Black and Asian ethnicities. There were increased co-morbidities in the older cohort including hypertension (54% vs 32%), diabetes (30% vs 12%) with increased rate of poly-pharmacy (62% vs 40%) compared to the younger cohort. In terms of cancer characteristics in the older cohort, there was a higher rate of patients with cancer for more than 2 years (53% vs 32%) and performance status of 3 (22% vs 6%). In terms of severity, Asian ethnicity [OR: 3.1 (95% CI: 0.88-10.96) p=0.64] had greater association with increasing COVID-19 severity in those aged >65. Interestingly, there were no positive associations between number of co-morbidities, treatment paradigm or performance status with severity of disease in the older group. The risk of mortality was greater in the elderly cohort with hematological cancer types [HR: 2.69 (1.31-5.53) p=0.85] and having cancer for more than 2 years [2.20 (1.09-4.42) p=0.28] compared to the younger cohort. Conclusions In our study we demonstrate that severity and mortality of COVID-19 did not significantly differ between the two age cohorts except in regards to Asian ethnicity, hematological malignancies and having cancer for more than 2 years. As expected, the older population had more co-morbidities and polypharmacy. Despite this, the incidence of severe COVID-19 was similar regardless of age. Further analyses for other geriatric presentations are ongoing to understand their interaction with COVID-19 in the cancer population.
Citation Format: Rushan Sylva, Beth Russell, Charlotte Moss, Gincy George, Kieran Palmer, Vallari Shah, Thinzar Ko Ko, Tania Kalsi, Danielle Harari, Luigi De Michele, Shahram Kordasti, Danielle Crawley, Harriet Wylie, Fidelma Cahill, Anna Haire, Andrea D'Souza, Simon Gomberg, Austin Kulasekararaj, Mieke Van Hemelrijck, Saoirse Dolly. The impact of COVID-19 in the cancer population stratified by age: A real-world data study from Guy’s Cancer Center [abstract]. In: Proceedings of the AACR Virtual Meeting: COVID-19 and Cancer; 2021 Feb 3-5. Philadelphia (PA): AACR; Clin Cancer Res 2021;27(6_Suppl):Abstract nr S11-03.
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Monroy-Iglesias MJ, Russell B, Crawley D, Allen NE, Travis RC, Perez-Cornago A, Van Hemelrijck M, Beckmann K. Metabolic syndrome biomarkers and prostate cancer risk in the UK Biobank. Int J Cancer 2021; 148:825-834. [PMID: 33405276 DOI: 10.1002/ijc.33255] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [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: 05/11/2020] [Revised: 07/10/2020] [Accepted: 07/14/2020] [Indexed: 01/08/2023]
Abstract
We investigated the association between metabolic syndrome (MetS) and its components and risk of prostate cancer (PCa) in a cohort of men enrolled in the UK Biobank. Our study cohort included 220 622 PCa-free men with baseline measurements of triglycerides (TGs), HDL-cholesterol (HDL), glycated hemoglobin (HbA1c), blood pressure (BP), and waist circumference (WC). Multivariable Cox proportional hazards regression was used to analyze associations with PCa for: individual metabolic components (TG, HDL, HbA1c, BP, WC), combinations of two and three components, and MetS overall (three or more components). We conducted mediation analyses to examine potential hormonal and inflammatory pathways (total testosterone [TT], C-reactive protein [CRP], insulin-like growth factor 1 [IGF-1]) through which MetS components may influence PCa risk. A total of 5409 men in the study developed PCa during a median follow-up of 6.9 years. We found no significant association between MetS and PCa risk (hazard ratio [HR] = 0.99, 95% confidence interval [CI] = 0.92-1.06). No associations were found with PCa risk and individual measurements of TG, HDL, BP, or WC. However, an inverse association was observed with elevated HbA1c (≥42 mmol/mol) (HR = 0.89, 95% CI = 0.79-0.98). Consistent inverse associations were observed between HbA1c and risk of PCa. Mediation analysis revealed TT, CRP, and IGF-1 as potential mediating factors for this association contributing 10.2%, 7.1%, and 7.9% to the total effect, respectively. Overall MetS had no association with PCa risk. However, a consistent inverse association with PCa risk was found for HbA1c. This association may be explained in part through hormonal and inflammatory pathways.
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Affiliation(s)
- Maria J Monroy-Iglesias
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Beth Russell
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Danielle Crawley
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Naomi E Allen
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, Big Data Institute, University of Oxford, Oxford, UK
| | - Ruth C Travis
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Aurora Perez-Cornago
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Mieke Van Hemelrijck
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Kerri Beckmann
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
- Cancer Research Institute, University of South Australia, Adelaide, Australia
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Parker J, Crawley D, Garmo H, Lindahl B, Styrke J, Adolfsson J, Lambe M, Stattin P, Van Hemelrijck M, Beckmann K. Use of Warfarin or Direct Oral Anticoagulants and Risk of Prostate Cancer in PCBaSe: A Nationwide Case-Control Study. Front Oncol 2020; 10:571838. [PMID: 33134172 PMCID: PMC7578339 DOI: 10.3389/fonc.2020.571838] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 08/21/2020] [Indexed: 12/31/2022] Open
Abstract
Existing literature examining warfarin's association with prostate cancer (PCa) risk provides conflicting results, while the association with direct oral anticoagulants (DOACs) has not yet been studied. We investigated the association of warfarin and DOAC use on PCa risk among men within the population-based Prostate Cancer database Sweden (PCBaSe), using a case-control design. The study population included PCa cases diagnosed 2014–2016 and five age-matched PCa-free controls. Conditional logistic regression was used to estimate odds ratios (ORs) with 95% confidence intervals (CI) for PCa associated with warfarin and DOAC use, adjusted for marital status, education level, other drug use, and comorbidities. Among 31,591 cases and 156,802 controls, there were 18,522 (9.8%) warfarin and 4,455 (2.4%) DOAC users. Warfarin ever-use was associated with reduced risk of PCa overall (OR 0.92 95% CI 0.88–0.96) as were both past and current use. DOAC use was not associated with PCa risk. For some warfarin exposures, decreased risk was observed for unfavorable PCa (high risk/locally advanced/distant metastatic) but not with favorable PCa (low/intermediate risk). Increased risk of favorable PCa was observed for men whose initial warfarin exposure occurred in the 12 month period before diagnosis (OR 1.39; 95% CI 1.13–1.70). Our findings are consistent with previous publications reporting decreased PCa risk with warfarin exposure. Increased risk of favorable PCa suggests detection bias due to increased prostate specific antigen testing when starting on warfarin. Decreased overall PCa risk could reflect bias due to reduced biopsy rates among long-term warfarin users.
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Affiliation(s)
- Jonathan Parker
- Translational Oncology and Urology Research Group, School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom
| | - Danielle Crawley
- Translational Oncology and Urology Research Group, School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom
| | - Hans Garmo
- Translational Oncology and Urology Research Group, School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom.,Regional Cancer Centre Uppsala Orebro, Uppsala, Sweden
| | - Bertil Lindahl
- Clinical Research Centre, Uppsala University Hospital, Uppsala, Sweden
| | - Johan Styrke
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Jan Adolfsson
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Mats Lambe
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Pär Stattin
- Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden
| | - Mieke Van Hemelrijck
- Translational Oncology and Urology Research Group, School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom
| | - Kerri Beckmann
- Translational Oncology and Urology Research Group, School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom.,Cancer Research Institute, School of Health Sciences, University of South Australia, Adelaide, SA, Australia
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12
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Russell B, Moss C, Papa S, Irshad S, Ross P, Spicer J, Kordasti S, Crawley D, Wylie H, Cahill F, Haire A, Zaki K, Rahman F, Sita-Lumsden A, Josephs D, Enting D, Lei M, Ghosh S, Harrison C, Swampillai A, Sullivan R, Rigg A, Dolly S, Van Hemelrijck M. Abstract S09-03: Factors affecting COVID-19 outcomes in cancer patients: A first report from Guy’s Cancer Centre in London. Clin Cancer Res 2020. [DOI: 10.1158/1557-3265.covid-19-s09-03] [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: 11/16/2022]
Abstract
Abstract
Background: Current precautionary management decisions being made for cancer patients are based on assumptions supported by limited evidence, based on small case series from China and Italy and larger series from New York and a recent consortium of 900 patients from over 85 hospitals in the USA, Canada, and Spain. Hence, there is insufficient evidence to support clinical decision-making for cancer patients diagnosed with COVID-19 due to the lack of large studies.
Methods: We used data from a single large UK Cancer Centre to assess demographic/clinical characteristics of 156 cancer patients with a confirmed COVID-19 diagnosis between 29 February-12 May 2020. Logistic/Cox proportional hazards models were used to identify which demographic and/or clinical characteristics were associated with COVID-19 severity/death.
Results: 128 (82%) presented with mild/moderate COVID-19 and 28 (18%) with severe disease. Initial diagnosis of cancer >24m before COVID-19 (OR:1.74 (95%CI: 0.71-4.26)), presenting with fever (6.21 (1.76-21.99)), dyspnea (2.60 (1.00-6.76)), gastrointestinal symptoms (7.38 (2.71-20.16)), or higher levels of CRP (9.43 (0.73-121.12)) were linked with greater COVID-19 severity. During median follow-up of 47d, 34 patients had died of COVID-19 (22%). Asian ethnicity (3.73 (1.28-10.91), palliative treatment (5.74 (1.15-28.79), initial diagnosis of cancer >24m before (2.14 (1.04-4.44), dyspnea (4.94 (1.99-12.25), and increased CRP levels (10.35 (1.05-52.21)) were positively associated with COVID-19 death. An inverse association was observed with increased levels of albumin (0.04 (0.01-0.04).
Conclusions: Our analysis of one of the largest single-center series of COVID-19-positive cancer patients to date confirms a similar distribution of age, sex, and comorbidities as reported for other populations. With respect to cancer-specific observations, patients who have lived longer with their cancer were found to be more susceptible to a greater infection severity, possibly reflecting the effect of more advanced malignant disease, as almost half of the severe cohort were on third-line metastatic treatment, or the impact of this infection. The latter was also found to be associated with COVID-19 death in cancer patients, as were Asian ethnicity and palliative treatment. Further validation will be provided from other large case series, as well as from those including longer follow-up, to provide more definite guidance for oncologic care.
Citation Format: Beth Russell, Charlotte Moss, Sophie Papa, Sheeba Irshad, Paul Ross, James Spicer, Shahram Kordasti, Danielle Crawley, Harriet Wylie, Fidelma Cahill, Anna Haire, Kamarul Zaki, Fareen Rahman, Ailsa Sita-Lumsden, Debra Josephs, Deborah Enting, Mary Lei, Sharmista Ghosh, Claire Harrison, Angela Swampillai, Richard Sullivan, Anne Rigg, Saoirse Dolly, Mieke Van Hemelrijck, Guy's Cancer Real World Evidence Programme. Factors affecting COVID-19 outcomes in cancer patients: A first report from Guy’s Cancer Centre in London [abstract]. In: Proceedings of the AACR Virtual Meeting: COVID-19 and Cancer; 2020 Jul 20-22. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(18_Suppl):Abstract nr S09-03.
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Affiliation(s)
| | | | - Sophie Papa
- 1King's College London, London, United Kingdom,
| | | | - Paul Ross
- 2Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | | | | | | | | | | | - Anna Haire
- 1King's College London, London, United Kingdom,
| | - Kamarul Zaki
- 2Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Fareen Rahman
- 2Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | | | | | | | - Mary Lei
- 2Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Sharmista Ghosh
- 2Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Claire Harrison
- 2Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | | | | | - Anne Rigg
- 2Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Saoirse Dolly
- 2Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
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13
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Tillmann J, Uljarevic M, Crawley D, Dumas G, Loth E, Murphy D, Buitelaar J, Charman T. Dissecting the phenotypic heterogeneity in sensory features in autism spectrum disorder: a factor mixture modelling approach. Mol Autism 2020; 11:67. [PMID: 32867850 PMCID: PMC7457751 DOI: 10.1186/s13229-020-00367-w] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [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: 02/27/2020] [Accepted: 07/23/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Heterogeneity in the phenotypic presentation of autism spectrum disorder (ASD) is apparent in the profile and the severity of sensory features. Here, we applied factor mixture modelling (FMM) to test a multidimensional factor model of sensory processing in ASD. We aimed to identify homogeneous sensory subgroups in ASD that differ intrinsically in their severity along continuous factor scores. We also investigated sensory subgroups in relation to clinical variables: sex, age, IQ, social-communication symptoms, restricted and repetitive behaviours, adaptive functioning and symptoms of anxiety and attention-deficit/hyperactivity disorder. METHODS Three hundred thirty-two children and adults with ASD between the ages of 6 and 30 years with IQs varying between 40 and 148 were included. First, three different confirmatory factor models were fit to the 38 items of the Short Sensory Profile (SSP). Then, latent class models (with two-to-six subgroups) were evaluated. The best performing factor model, the 7-factor structure, was subsequently used in two FMMs that varied in the number of subgroups: a two-subgroup, seven-factor model and a three-subgroup and seven-factor model. RESULTS The 'three-subgroup/seven-factor' FMM was superior to all other models based on different fit criteria. Identified subgroups differed in sensory severity from severe, moderate to low. Accounting for the potential confounding effects of age and IQ, participants in these sensory subgroups had different levels of social-communicative symptoms, restricted and repetitive behaviours, adaptive functioning skills and symptoms of inattention and anxiety. LIMITATIONS Results were derived using a single parent-report measure of sensory features, the SSP, which limits the generalisability of findings. CONCLUSION Sensory features can be best described by three homogeneous sensory subgroups that differ in sensory severity gradients along seven continuous factor scores. Identified sensory subgroups were further differentiated by the severity of core and co-occurring symptoms, and level of adaptive functioning, providing novel evidence on the associated clinical correlates of sensory subgroups. These sensory subgroups provide a platform to further interrogate the neurobiological and genetic correlates of altered sensory processing in ASD.
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Affiliation(s)
- J Tillmann
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK. .,Department of Applied Psychology: Health, Development, Enhancement, and Intervention, University of Vienna, Vienna, Austria.
| | - M Uljarevic
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford Autism Center, Stanford University, Stanford, CA, USA.,Melbourne School of Psychological Sciences, Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Melbourne, VIC, Australia.,School of Psychological Science, Olga Tennison Autism Research Centre, La Trobe University, Melbourne, VIC, 3086, Australia
| | - D Crawley
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - G Dumas
- Human Genetics and Cognitive Functions, Institut Pasteur, UMR3571 CNRS, Université de Paris, Paris, France
| | - E Loth
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Sackler Institute for Translational Neurodevelopment, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - D Murphy
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Sackler Institute for Translational Neurodevelopment, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust (SLaM), London, UK
| | - J Buitelaar
- Department of Cognitive Neuroscience, Radboud University Medical Center, Nijmegen, The Netherlands.,Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, The Netherlands.,Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, The Netherlands
| | - T Charman
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK.,South London and Maudsley NHS Foundation Trust (SLaM), London, UK
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14
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Russell B, Moss C, Papa S, Irshad S, Ross P, Spicer J, Kordasti S, Crawley D, Wylie H, Cahill F, Haire A, Zaki K, Rahman F, Sita-Lumsden A, Josephs D, Enting D, Lei M, Ghosh S, Harrison C, Swampillai A, Sawyer E, D'Souza A, Gomberg S, Fields P, Wrench D, Raj K, Gleeson M, Bailey K, Dillon R, Streetly M, Rigg A, Sullivan R, Dolly S, Van Hemelrijck M. Factors Affecting COVID-19 Outcomes in Cancer Patients: A First Report From Guy's Cancer Center in London. Front Oncol 2020; 10:1279. [PMID: 32903324 PMCID: PMC7396540 DOI: 10.3389/fonc.2020.01279] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 06/19/2020] [Indexed: 12/20/2022] Open
Abstract
Background: There is insufficient evidence to support clinical decision-making for cancer patients diagnosed with COVID-19 due to the lack of large studies. Methods: We used data from a single large UK Cancer Center to assess the demographic/clinical characteristics of 156 cancer patients with a confirmed COVID-19 diagnosis between 29 February and 12 May 2020. Logistic/Cox proportional hazards models were used to identify which demographic and/or clinical characteristics were associated with COVID-19 severity/death. Results: 128 (82%) presented with mild/moderate COVID-19 and 28 (18%) with a severe case of the disease. An initial cancer diagnosis >24 months before COVID-19 [OR: 1.74 (95% CI: 0.71-4.26)], presenting with fever [6.21 (1.76-21.99)], dyspnea [2.60 (1.00-6.76)], gastro-intestinal symptoms [7.38 (2.71-20.16)], or higher levels of C-reactive protein [9.43 (0.73-121.12)] were linked with greater COVID-19 severity. During a median follow-up of 37 days, 34 patients had died of COVID-19 (22%). Being of Asian ethnicity [3.73 (1.28-10.91)], receiving palliative treatment [5.74 (1.15-28.79)], having an initial cancer diagnosis >24 months before [2.14 (1.04-4.44)], dyspnea [4.94 (1.99-12.25)], and increased CRP levels [10.35 (1.05-52.21)] were positively associated with COVID-19 death. An inverse association was observed with increased levels of albumin [0.04 (0.01-0.04)]. Conclusions: A longer-established diagnosis of cancer was associated with increased severity of infection as well as COVID-19 death, possibly reflecting the effects a more advanced malignant disease has on this infection. Asian ethnicity and palliative treatment were also associated with COVID-19 death in cancer patients.
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Affiliation(s)
- Beth Russell
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom
| | - Charlotte Moss
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom
| | - Sophie Papa
- Guy's and St Thomas' NHS Foundation Trust (GSTT), Medical Oncology, London, United Kingdom
- School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom
| | - Sheeba Irshad
- Guy's and St Thomas' NHS Foundation Trust (GSTT), Medical Oncology, London, United Kingdom
- School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom
| | - Paul Ross
- Guy's and St Thomas' NHS Foundation Trust (GSTT), Medical Oncology, London, United Kingdom
| | - James Spicer
- Guy's and St Thomas' NHS Foundation Trust (GSTT), Medical Oncology, London, United Kingdom
- School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom
| | - Shahram Kordasti
- Guy's and St Thomas' NHS Foundation Trust (GSTT), Medical Oncology, London, United Kingdom
- Haematology Department, Guy's and St Thomas' NHS Foundation Trust (GSTT), London, United Kingdom
| | - Danielle Crawley
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom
- Guy's and St Thomas' NHS Foundation Trust (GSTT), Medical Oncology, London, United Kingdom
| | - Harriet Wylie
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom
| | - Fidelma Cahill
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom
| | - Anna Haire
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom
| | - Kamarul Zaki
- Guy's and St Thomas' NHS Foundation Trust (GSTT), Medical Oncology, London, United Kingdom
| | - Fareen Rahman
- Guy's and St Thomas' NHS Foundation Trust (GSTT), Medical Oncology, London, United Kingdom
| | - Ailsa Sita-Lumsden
- Guy's and St Thomas' NHS Foundation Trust (GSTT), Medical Oncology, London, United Kingdom
| | - Debra Josephs
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom
- Guy's and St Thomas' NHS Foundation Trust (GSTT), Medical Oncology, London, United Kingdom
| | - Deborah Enting
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom
- Guy's and St Thomas' NHS Foundation Trust (GSTT), Medical Oncology, London, United Kingdom
| | - Mary Lei
- Guy's and St Thomas' NHS Foundation Trust (GSTT), Medical Oncology, London, United Kingdom
| | - Sharmistha Ghosh
- Guy's and St Thomas' NHS Foundation Trust (GSTT), Medical Oncology, London, United Kingdom
| | - Claire Harrison
- Guy's and St Thomas' NHS Foundation Trust (GSTT), Medical Oncology, London, United Kingdom
- Haematology Department, Guy's and St Thomas' NHS Foundation Trust (GSTT), London, United Kingdom
| | - Angela Swampillai
- Guy's and St Thomas' NHS Foundation Trust (GSTT), Medical Oncology, London, United Kingdom
| | - Elinor Sawyer
- Guy's and St Thomas' NHS Foundation Trust (GSTT), Medical Oncology, London, United Kingdom
- School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom
| | - Andrea D'Souza
- Guy's and St Thomas' NHS Foundation Trust (GSTT), Medical Oncology, London, United Kingdom
| | - Simon Gomberg
- Guy's and St Thomas' NHS Foundation Trust (GSTT), Medical Oncology, London, United Kingdom
| | - Paul Fields
- Haematology Department, Guy's and St Thomas' NHS Foundation Trust (GSTT), London, United Kingdom
| | - David Wrench
- Haematology Department, Guy's and St Thomas' NHS Foundation Trust (GSTT), London, United Kingdom
| | - Kavita Raj
- Haematology Department, Guy's and St Thomas' NHS Foundation Trust (GSTT), London, United Kingdom
| | - Mary Gleeson
- Haematology Department, Guy's and St Thomas' NHS Foundation Trust (GSTT), London, United Kingdom
| | - Kate Bailey
- Haematology Department, Guy's and St Thomas' NHS Foundation Trust (GSTT), London, United Kingdom
| | - Richard Dillon
- Haematology Department, Guy's and St Thomas' NHS Foundation Trust (GSTT), London, United Kingdom
- Department of Medical and Molecular Genetics, School of Basic and Medical Biosciences, King's College London, London, United Kingdom
| | - Matthew Streetly
- Haematology Department, Guy's and St Thomas' NHS Foundation Trust (GSTT), London, United Kingdom
| | - Anne Rigg
- Guy's and St Thomas' NHS Foundation Trust (GSTT), Medical Oncology, London, United Kingdom
| | - Richard Sullivan
- School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom
| | - Saoirse Dolly
- Guy's and St Thomas' NHS Foundation Trust (GSTT), Medical Oncology, London, United Kingdom
| | - Mieke Van Hemelrijck
- Translational Oncology and Urology Research (TOUR), School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom
- Guy's and St Thomas' NHS Foundation Trust (GSTT), Medical Oncology, London, United Kingdom
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Lin E, Garmo H, Van Hemelrijck M, Adolfsson J, Stattin P, Zethelius B, Crawley D. Association of type 2 diabetes mellitus and antidiabetic medication with risk of prostate cancer: a population-based case-control study. BMC Cancer 2020; 20:551. [PMID: 32539807 PMCID: PMC7294669 DOI: 10.1186/s12885-020-07036-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 06/03/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Prostate cancer (PCa) and type 2 diabetes mellitus (T2DM) are prevalent conditions that often occur concomitantly. However, many aspects of the impact of T2DM, particularly the duration of T2DM and antidiabetic medications, on PCa risk are poorly understood. METHODS To assess the association of duration of T2DM and antidiabetic medication with PCa risk, we designed a matched case-control study, including 31,415 men with PCa and 154,812 PCa-free men in Prostate Cancer data Base Sweden (PCBaSe) 4.1. RESULTS Overall, a decreased risk of PCa was observed for men with T2DM (odds ratio (OR): 0.81, 95% confidence interval (CI): 0.78-0.84), as compared to men without T2DM. The decreased risk of PCa was consistently showed across duration of T2DM. With respect to use of antidiabetic drugs, this inverse association with duration was also found for all medications types, as compared to men without T2DM, including insulin, metformin and sulphonylurea (SU) (e.g. 3- < 5 yr insulin OR:0.69, 95%CI:0.60-0.80; 3- < 5 yr metformin OR: 0.82, 95%CI: 0.74-0.91; 3- < 5 yr SU OR: 0.72, 95%CI: 0.62-0.83). When stratifying by PCa risk categories, this decreased risk was most evident for diagnosis of low and intermediate-risk PCa (low-risk OR: 0.65, 95%CI: 0.66-0.70, intermediate-risk OR: 0.80, 95%CI: 0.75-0.85). CONCLUSIONS The study showed an inverse association between pre-existing T2DM and PCa across different durations of T2DM and all types of T2DM medication received. This inverse association was most evident for low- and intermediate-risk PCa, suggesting that whilst T2DM and its medication may protect some men from developing PCa, the relationship warrants further study.
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Affiliation(s)
- E Lin
- School of Cancer and Pharmaceutical Sciences, Translational Oncology and Urology Research (TOUR), King's College London, London, UK.
| | - Hans Garmo
- School of Cancer and Pharmaceutical Sciences, Translational Oncology and Urology Research (TOUR), King's College London, London, UK
| | - Mieke Van Hemelrijck
- School of Cancer and Pharmaceutical Sciences, Translational Oncology and Urology Research (TOUR), King's College London, London, UK
| | - Jan Adolfsson
- Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden
| | - Pär Stattin
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Björn Zethelius
- Department of Public Health/Geriatrics, Uppsala University, Uppsala, Sweden
| | - Danielle Crawley
- School of Cancer and Pharmaceutical Sciences, Translational Oncology and Urology Research (TOUR), King's College London, London, UK
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Crawley D, Beckmann K, Ravindra S, Josephs DH, Spicer JF, Montes A, Karapanagiotou E, Ghosh S. Association of baseline characteristics and survival in patients with advanced non-small cell lung cancer (NSCLC) treated with immune checkpoint inhibitors (CPIs): Real-world evidence. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e21625] [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
e21625 Background: CPIs including antibodies to programmed death-1 (PD-1) and its ligand anti PD-L1 are associated with superior overall survival (OS) in NSCLC. PDL1 is an imperfect predictive biomarker. We have examined real world data to identify additional factors associated with clinical benefit. Methods: 96 consecutive NSCLC patients (pts) were treated with CPIs at our institution. Multivariate cox proportional hazard regression models were used to examine the associations between OS and baseline characteristics including age, sex, histology, PDL1 status, performance status (PS), steroid use and brain metastases. Results: 93% (89/96) of pts received pembroluzimab, 6 (6%) nivolumab, and 1 (1%) atezoluzimab. All pts had metastatic disease (68% adenocarcinoma). 15% had PS 0, and 70% PS1. 11 of the 96 pts had brain metastases prior to CPI, 4 (37%) had whole brain radiotherapy, 2 (18%) targeted radiotherapy, 2 (18%) resection with radiotherapy and 3 (27%) had no definitive treatment for brain metastases. After multivariate analysis those with PS 1-2 had an increased risk of death (PS = 1 HR 2.74, 95% CI 1.11-6.72; PS = 2 3.61, 95% CI 1.28-10.15) compared with PS 0. Outcomes for pts receiving corticosteroids at the time of initiation of CPI were also inferior (HR 2.29, 95% CI 1.10-4.74) compared to those who were not. Conversely those who had brain metastasis diagnosed prior to commencing CPI had superior OS (HR 0.29 95% CI: 0.11-0.76). No statistically significant association was seen with age, gender, histology, stage at diagnosis, smoking or mutational status. PDL < 50% compared to > 50% was associated with an increased risk of death (HR 1.53 95% CI: 0.90-2.60) though it was not statistically significant. Conclusions: Here we show, using real world data, that PS and use at baseline of oral corticosteroids are associated with inferior OS with CPI treatment for NSCLC, in line with reports from large clinical trials. We show that baseline brain metastases are associated with improved outcomes. This may be explained by survivor bias, in that those who are successfully treated for brain disease, remain PS ≤2 and are able to commence CPI represent a highly selected group.
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Affiliation(s)
| | | | | | | | | | - Ana Montes
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
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17
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Crawley D, Breen RA, Elkington PT, Karapanagiotou E. Tuberculosis associated with Triplet therapy for lung cancer. Thorax 2020; 75:609-610. [PMID: 32409610 DOI: 10.1136/thoraxjnl-2019-213913] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 02/20/2020] [Accepted: 03/18/2020] [Indexed: 11/03/2022]
Abstract
We report the first case of TB associated with triplet therapy (chemotherapy and immunotherapy concurrently) for lung cancer, developing just 44 days after treatment initiation. We feel that several important learning points arise from the discussion that are likely to be very relevant to the broad readership of Thorax, and have important clinical and scientific implications. In the three discussion paragraphs, we highlight that: 1) Triplet therapy is now standard first-line treatment for inoperable lung cancer. 2) TB reactivation is increasingly recognised as an adverse effect of immune checkpoint inhibition, but sending diagnostic samples is critical to avoid a missed diagnosis. 3) These insights from novel cancer immunotherapies are challenging the traditional views of the host-pathogen interaction in TB, with wide implications for future control strategies. We propose that the cases reported in the literature are likely to be the tip of the iceberg as most people with lung cancer managed with antiprogrammed death-1 agents who develop new lung lesions will be treated with standard antibiotics and then palliated when they do not respond.
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Affiliation(s)
| | - Ronan A Breen
- Thoracic Medicine, Guy's and St Thomas NHS Trust, London, UK
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Beckmann K, Crawley D, Nordström T, Aly M, Olsson H, Lantz A, Binti Abd Jalal N, Garmo H, Adolfsson J, Eklund M, Van Hemelrijck M. Association Between Antidiabetic Medications and Prostate-Specific Antigen Levels and Biopsy Results. JAMA Netw Open 2019; 2:e1914689. [PMID: 31693126 PMCID: PMC6865613 DOI: 10.1001/jamanetworkopen.2019.14689] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
IMPORTANCE Diabetic men appear to have a lower risk of prostate cancer. Whether antidiabetic medications are protective or potentially mask prostate cancer by lowering prostate-specific antigen (PSA) levels is unclear. OBJECTIVE To examine the associations of antidiabetic medication use with (1) PSA levels, (2) frequency of PSA testing, (3) receipt of biopsy following elevated PSA results, and (4) prostate cancer detection at biopsy. DESIGN, SETTING, AND PARTICIPANTS Population-based cohort study using data from the Stockholm PSA and Biopsy Register. Participants were all prostate cancer-free men aged 40 to 79 years residing in Stockholm County, Sweden, between January 1, 2006, and December 31, 2015. Data were analyzed from November 2018 to March 2019. EXPOSURES One or more prescription for metformin, sulfonylurea, or insulin, as recorded in Sweden's National Prescribed Drug Register. MAIN OUTCOMES AND MEASURES Levels of PSA following first exposure to antidiabetic medications were assessed using multivariable linear regression. Frequency of PSA testing was assessed via multivariable Poisson regression. Biopsy following elevated PSA (≥3.0 ng/mL) and prostate cancer detection at biopsy were assessed via multivariable logistic regression. RESULTS The cohort of 564 666 men (median [range] age, 65 [40-79] years) consisted of 4583 men initially exposed to metformin, 1104 exposed to sulfonylurea, and 978 exposed to insulin who were age matched with unexposed men (1:5). Exposed men had lower median (interquartile range) PSA levels before starting antidiabetic medications compared with unexposed men (1.2 [0.7-2.5] vs 1.6 [0.8-3.2] ng/mL). After accounting for baseline differences, PSA levels did not vary from those of unexposed men following exposure to antidiabetic medications. Frequency of PSA testing was higher for those receiving metformin (rate ratio, 1.07; 95% CI, 1.06-1.09) and sulfonylurea (rate ratio, 1.06; 95% CI, 1.03-1.08) but was lower for those receiving insulin (rate ratio, 0.79; 95% CI, 0.77- 0.81). Likelihood of biopsy after elevated PSA was lower among men receiving metformin (odds ratio, 0.87; 95% CI, 0.80-0.96) and insulin (odds ratio, 0.83; 95% CI, 0.74-0.93). There were no differences in prostate cancer detection at biopsy, regardless of PSA levels that triggered the biopsy. CONCLUSIONS AND RELEVANCE This study's findings do not support the hypothesis that the inverse association between diabetes and prostate cancer is mediated through antidiabetic medications lowering PSA levels to mask prostate cancer. They do suggest potential detection bias due to fewer biopsies among men receiving antidiabetic medications, which may explain the lower prostate cancer risk in men with diabetes.
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Affiliation(s)
- Kerri Beckmann
- Translational Oncology and Urology Research, Comprehensive Cancer Centre, King’s College London, London, United Kingdom
- University of South Australia Cancer Research Institute, University of South Australia, Adelaide, Australia
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Danielle Crawley
- Translational Oncology and Urology Research, Comprehensive Cancer Centre, King’s College London, London, United Kingdom
| | - Tobias Nordström
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Markus Aly
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Olsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Anna Lantz
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Noor Binti Abd Jalal
- Translational Oncology and Urology Research, Comprehensive Cancer Centre, King’s College London, London, United Kingdom
| | | | - Jan Adolfsson
- Department of Clinical Science, Intervention, and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Martin Eklund
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Mieke Van Hemelrijck
- Translational Oncology and Urology Research, Comprehensive Cancer Centre, King’s College London, London, United Kingdom
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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Crawley D, Garmo H, Rudman S, Stattin P, Zethelius B, Armes J, Holmberg L, Adolfsson J, Van Hemelrijck M. Does a prostate cancer diagnosis affect management of pre-existing diabetes? Results from PCBaSe Sweden: a nationwide cohort study. BMJ Open 2018; 8:e020787. [PMID: 29549214 PMCID: PMC5857670 DOI: 10.1136/bmjopen-2017-020787] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES Both prostate cancer (PCa) and type 2 diabetes mellitus (T2DM) are increasingly prevalent conditions, which frequently coexist in men. Here, we set out to specifically examine the impact of a PCa diagnosis and its treatment on T2DM treatment. SETTING This study uses observational data from Prostate Cancer database Sweden Traject. PARTICIPANTS The study was undertaken in a cohort of 16 778 men with T2DM, of whom 962 were diagnosed with PCa during mean follow-up of 2.5 years. PRIMARY AND SECONDARY OUTCOME MEASURES We investigated the association between PCa diagnosis and escalation in T2DM treatment in this cohort. A treatment escalation was defined as a new or change in anti-T2DM prescription, as recorded in the prescribed drug register (ie, change from diet to metformin or sulphonylurea or insulin). We also investigated how PCa diagnosis was associated with two treatment escalations. Multivariate Cox proportional hazards regression with age as a time scale was used while adjusting for educational level and initial T2DM treatment. RESULTS We found no association between PCa diagnosis and risk of a single treatment escalation (HR 0.99, 95% CI 0.87 to 1.13). However, PCa diagnosis was associated with an increased risk of receiving two consecutive T2DM treatment escalations (HR 1.75, 95% CI 1.38 to 2.22). This increase was strongest for men on gonadotropin-releasing hormone (GnRH) agonists (HR 3.08, 95% CI 2.14 to 4.40). The corresponding HR for men with PCa not on hormonal treatment was 1.40 (95% CI 1.03 to 1.92) and for men with PCa on antiandrogens 0.91 (95% CI 0.29 to 2.82). CONCLUSIONS Men with T2DM who are diagnosed with PCa, particularly those treated with GnRH agonists, were more likely to have two consecutive escalations in T2DM treatment. This suggests a need for closer monitoring of men with both PCa and T2DM, as coexistence of PCa and its subsequent treatments could potentially worsen T2DM control.
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Affiliation(s)
- Danielle Crawley
- School of Cancer and Pharmaceutical Sciences, Translational Oncology and Urology Research (TOUR), King’s College London, London, UK
| | - Hans Garmo
- School of Cancer and Pharmaceutical Sciences, Translational Oncology and Urology Research (TOUR), King’s College London, London, UK
| | - Sarah Rudman
- Comprehensive Biomedical Research Centre, Guy’s and St Thomas' NHS Foundation Trust and King’s College London’s, London, UK
| | - Pär Stattin
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Björn Zethelius
- Department of Public Health and Geriatric, Uppsala University, Uppsala, Sweden
- Medical Products Agency, Uppsala, Sweden
| | - Jo Armes
- Florence Nightingale Faculty of Nursing and Midwifery, King’s College London, London, UK
| | - Lars Holmberg
- School of Cancer and Pharmaceutical Sciences, Translational Oncology and Urology Research (TOUR), King’s College London, London, UK
| | - Jan Adolfsson
- Florence Nightingale Faculty of Nursing and Midwifery, King’s College London, London, UK
- Department of Clinical Science, Intervention and Technology, Karolinska Insituet, Stockholm, Sweden
| | - Mieke Van Hemelrijck
- School of Cancer and Pharmaceutical Sciences, Translational Oncology and Urology Research (TOUR), King’s College London, London, UK
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Crawley D, Williams R, Garmo H, Holmberg L, Stattin P, Malmstrom H, Lambe M, Hammar N, Walldius G, Robinson D, Jungner I, Van Hemelrijck M. Serum inflammatory markers in relation to prostate cancer severity and death. Eur J Surg Oncol 2018. [DOI: 10.1016/j.ejso.2018.01.536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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21
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Crawley D, Chamberlain F, Garmo H, Rudman S, Zethelius B, Holmberg L, Adolfsson J, Stattin P, Carroll P, Van Hemelrijck M. A systematic review of the literature exploring the interplay between prostate cancer and type two diabetes mellitus. Ecancermedicalscience 2018; 12:802. [PMID: 29456619 PMCID: PMC5813911 DOI: 10.3332/ecancer.2018.802] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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: 10/23/2017] [Indexed: 11/12/2022] Open
Abstract
Prostate cancer (PCa) and type two diabetes mellitus (T2DM) are both increasing prevalent conditions and often occur concurrently. However, the relationship between the two is more complex than just two prevalent conditions co-existing. This review systematically explores the literature around the interplay between the two conditions. It covers the impact of pre-existing T2DM on PCa incidence, grade and stage, as well as exploring the impact of T2DM on PCa outcomes and mortality and the interaction between T2DM and PCa treatments.
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Affiliation(s)
- Danielle Crawley
- Translational Oncology and Urology Research Group, King's College London, London SE1 9RT, UK
| | - Florence Chamberlain
- Department of Medical Oncology, Guy's and St Thomas' NHS Foundation Trust, London SE1 9RT, UK
| | - Hans Garmo
- Translational Oncology and Urology Research Group, King's College London, London SE1 9RT, UK
| | - Sarah Rudman
- Department of Medical Oncology, Guy's and St Thomas' NHS Foundation Trust, London SE1 9RT, UK
| | - Björn Zethelius
- Department of Public Health and Geriatrics, Uppsala University, Uppsala 751 05, Sweden.,Medical Products Agency, Uppsala 751 03, Sweden
| | - Lars Holmberg
- Translational Oncology and Urology Research Group, King's College London, London SE1 9RT, UK.,Department of Surgical Sciences, Uppsala University, Uppsala 751 05, Sweden
| | - Jan Adolfsson
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm 171 77, Sweden
| | - Par Stattin
- Department of Surgical Sciences, Uppsala University, Uppsala 751 05, Sweden
| | - Paul Carroll
- Department of Diabetes and Endocrinology, Guy's and St Thomas' NHS Foundation Trust, London, SE1 9RT UK
| | - Mieke Van Hemelrijck
- Translational Oncology and Urology Research Group, King's College London, London SE1 9RT, UK
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22
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Crawley D, Williams R, Garmo H, Holmberg L, Stattin P, Malmstrom H, Lambe M, Hammar N, Walldius G, Robinson D, Jungner I, Van Hemelrijck M. Serum inflammatory markers in relation to prostate cancer severity and death. Eur J Surg Oncol 2017. [DOI: 10.1016/j.ejso.2017.10.138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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23
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Bosco C, Wong C, Garmo H, Crawley D, Holmberg L, Hammar N, Adolfsson J, Stattin P, Van Hemelrijck M. Drugs for metabolic conditions and prostate cancer death in men on GnRH agonists. BJU Int 2017; 121:260-267. [PMID: 28940667 DOI: 10.1111/bju.14023] [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] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To evaluate whether drugs for metabolic conditions influence prostate cancer-specific mortality in men starting gonadotrophin-releasing hormone (GnRH) agonists, as it is unclear whether metabolic syndrome and its related drugs is affecting treatment response in men with prostate cancer on GnRH agonists. PATIENTS AND METHODS We selected all men receiving GnRH agonists as primary treatment in the Prostate Cancer data Base Sweden (PCBaSe) (n = 9267). Use of drugs for metabolic conditions (i.e. anti-diabetes, anti-dyslipidaemia, and antihypertension) in relation to all-cause, cardiovascular disease (CVD), and prostate cancer-specific death were studied using multivariate Cox proportional hazard and Fine and Gray competing regression models. RESULTS In all, 6322 (68%) men used at least one drug for a metabolic condition at GnRH agonist initiation: 46% on antihypertensive drugs only, 32% on drugs for dyslipidaemia and hypertension, and ~10% on drugs for more than two metabolic conditions. Cox models indicated a weak increased risk of prostate cancer death in men who were on drugs for hypertension only (hazard ratio [HR] 1.12, 95% confidence interval [CI] 1.03-1.23) or drugs for hyperglycaemia (HR 1.19, 95% CI 1.06-1.35) at GnRH agonist initiation. However, upon taking into account competing risk from CVD death, none of the drugs for metabolic conditions were associated with an increased risk of prostate cancer death. CONCLUSION We did not find evidence for a better or worse response to GnRH agonists in men with prostate cancer who were also on drugs for hypertension, dyslipidaemia, or hyperglycaemia.
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Affiliation(s)
- Cecilia Bosco
- School of Cancer and Pharmaceutical Sciences, Translational Oncology and Urology Research, King's College London, London, UK
| | - Chloe Wong
- School of Cancer and Pharmaceutical Sciences, Translational Oncology and Urology Research, King's College London, London, UK
| | - Hans Garmo
- School of Cancer and Pharmaceutical Sciences, Translational Oncology and Urology Research, King's College London, London, UK.,Regional Cancer Centre, Uppsala University, Uppsala, Sweden
| | - Danielle Crawley
- School of Cancer and Pharmaceutical Sciences, Translational Oncology and Urology Research, King's College London, London, UK
| | - Lars Holmberg
- School of Cancer and Pharmaceutical Sciences, Translational Oncology and Urology Research, King's College London, London, UK
| | - Niklas Hammar
- Unit of Epidemiology, Institute of Environmental Medicine, Stockholm, Sweden.,Medical Evidence and Observational Research, Global Medical Affairs, AstraZeneca, Mölndal, Sweden
| | - Jan Adolfsson
- CLINTEC Department, Karolinska Institutet, Stockholm, Sweden
| | - Pär Stattin
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Mieke Van Hemelrijck
- School of Cancer and Pharmaceutical Sciences, Translational Oncology and Urology Research, King's College London, London, UK.,Unit of Epidemiology, Institute of Environmental Medicine, Stockholm, Sweden
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24
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Crawley D, Chandra A, Loda M, Gillett C, Cathcart P, Challacombe B, Cook G, Cahill D, Santa Olalla A, Cahill F, George G, Rudman S, Van Hemelrijck M. Metformin and longevity (METAL): a window of opportunity study investigating the biological effects of metformin in localised prostate cancer. BMC Cancer 2017; 17:494. [PMID: 28732480 PMCID: PMC5520293 DOI: 10.1186/s12885-017-3458-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 06/26/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Metformin is a biguanide oral hypoglycaemic agent commonly used for the treatment of type 2 diabetes mellitus. In addition to its anti-diabetic effect, metformin has also been associated with a reduced risk of cancer incidence of a number of solid tumours, including prostate cancer (PCa). However, the underlying biological mechanisms for these observations have not been fully characterised in PCa. One hypothesis is that the indirect insulin lowering effect may have an anti-neoplastic action as elevated insulin and insulin like growth factor - 1 (IGF-1) levels play a role in PCa development and progression. In addition, metformin is a potent activator of activated protein kinase (AMPK) which in turn inhibits the mammalian target of rapamycin (mTOR) and other signal transduction mechanisms. These direct effects can lead to reduced cell proliferation. Given its wide availability and tolerable side effect profile, metformin represents an attractive potential therapeutic option for men with PCa. Hence, the need for a clinical trial investigating its biological mechanisms in PCa. METHODS METAL is a randomised, placebo-controlled, double-blind, window of opportunity study investigating the biological mechanism of metformin in PCa. 100 patients with newly-diagnosed, localised PCa scheduled for radical prostatectomy will be randomised 1:1 to receive metformin (1 g b.d.) or placebo for four weeks (+/- 1 week) prior to prostatectomy. Tissue will be collected from both diagnostic biopsy and prostatectomy specimens. The primary endpoint is the difference in expression levels of markers of the Fatty acid synthase (FASN)/AMPK pathway pre and post treatment between the placebo and metformin arms. Secondary endpoints include the difference in expression levels of indicators of proliferation (ki67 and TUNEL) pre and post treatment between the placebo and metformin arms. METAL is currently open to recruitment at Guy's and St Thomas' Hospital and the Royal Marsden Hospital, London. DISCUSSION This randomised placebo-controlled double blinded trial of metformin vs. placebo in men with localised PCa due to undergo radical prostatectomy, aims to elucidate the mechanism of action of metformin in PCa cells, which should then enable further larger stratification trials to take place. TRIAL REGISTRATION EudraCT number 2014-005193-11 . Registered on September 09, 2015.
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Affiliation(s)
- Danielle Crawley
- Division of Cancer Studies, Cancer Epidemiology Group, Research Oncology, King's College London, 3rd Floor, Bermondsey Wing, Guy's Hospital, London, SE1 9RT, UK.
| | | | - Massimo Loda
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA
| | - Cheryl Gillett
- Division of Cancer Studies, King's College London, London, UK
| | - Paul Cathcart
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - Gary Cook
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
| | | | - Aida Santa Olalla
- Division of Cancer Studies, Cancer Epidemiology Group, Research Oncology, King's College London, 3rd Floor, Bermondsey Wing, Guy's Hospital, London, SE1 9RT, UK
| | - Fidelma Cahill
- Division of Cancer Studies, Cancer Epidemiology Group, Research Oncology, King's College London, 3rd Floor, Bermondsey Wing, Guy's Hospital, London, SE1 9RT, UK
| | - Gincy George
- Division of Cancer Studies, Cancer Epidemiology Group, Research Oncology, King's College London, 3rd Floor, Bermondsey Wing, Guy's Hospital, London, SE1 9RT, UK
| | - Sarah Rudman
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Mieke Van Hemelrijck
- Division of Cancer Studies, Cancer Epidemiology Group, Research Oncology, King's College London, 3rd Floor, Bermondsey Wing, Guy's Hospital, London, SE1 9RT, UK
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25
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Crawley D, Garmo H, Rudman S, Stattin P, Zethelius B, Holmberg L, Adolfsson J, Van Hemelrijck M. Association between type 2 diabetes, curative treatment and survival in men with intermediate- and high-risk localized prostate cancer. BJU Int 2017; 121:209-216. [PMID: 28418195 DOI: 10.1111/bju.13880] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To investigate whether curative prostate cancer (PCa) treatment was received less often by men with both PCa and Type 2 diabetes mellitus (T2DM) as little is known about the influence of T2DM diagnosis on the receipt of such treatment in men with localized PCa. SUBJECTS AND METHODS The Prostate Cancer database Sweden (PCBaSe) was used to obtain data on men with T2DM and PCa (n = 2210) for comparison with data on men with PCa only (n = 23 071). All men had intermediate- (T1-2, Gleason score 7 and/or prostate-specific antigen [PSA] 10-20 ng/mL) or high-risk (T3 and/or Gleason score 8-10 and/or PSA 20-50 ng/mL) localized PCa diagnosed between 1 January 2006 and 31 December 2014. Multivariate logistic regression was used to calculate the odds ratios (ORs) for receipt of curative treatment in men with and without T2DM. Overall survival, for up to 8 years of follow-up, was calculated both for men with T2DM only and for men with T2DM and PCa. RESULTS Men with T2DM were less likely to receive curative treatment for PCa than men without T2DM (OR 0.78, 95% confidence interval 0.69-0.87). The 8-year overall survival rates were 79% and 33% for men with T2DM and high-risk PCa who did and did not receive curative treatment, respectively. CONCLUSIONS Men with T2DM were less likely to receive curative treatment for localized intermediate- and high-risk PCa. Men with T2DM and high-risk PCa who received curative treatment had substantially higher survival times than those who did not. Some of the survival differences represent a selection bias, whereby the healthiest patients received curative treatment. Clinicians should interpret this data carefully and ensure that individual patients with T2DM and PCa are not under- nor overtreated.
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Affiliation(s)
- Danielle Crawley
- Division of Cancer Studies, Cancer Epidemiology Group, King's College London, London, UK
| | - Hans Garmo
- Division of Cancer Studies, Cancer Epidemiology Group, King's College London, London, UK
| | - Sarah Rudman
- Guy's and St Thomas' NHS Foundation Trust and King's College London's Comprehensive Biomedical Research Centre, London, UK
| | - Pär Stattin
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.,Department of Surgical and Peri-operative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden
| | - Björn Zethelius
- Department of Public Health and Geriatric, Uppsala University, Uppsala, Sweden.,Medical Products Agency, Uppsala, Sweden
| | - Lars Holmberg
- Division of Cancer Studies, Cancer Epidemiology Group, King's College London, London, UK
| | - Jan Adolfsson
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Mieke Van Hemelrijck
- Division of Cancer Studies, Cancer Epidemiology Group, King's College London, London, UK
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26
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Crawley D, van Hemelrijck M, Chowdhury S, James N, Gilson C, Spears M, Sydes M, Rudman S. Effect of baseline metabolic aberrations in men with locally advanced/metastatic prostate cancer treated with ADT on time to disease progression, prostate cancer specific and all cause death. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw372.46] [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: 11/13/2022] Open
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27
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Crawley D, Chandra A, Loda M, Gillett C, Cathcart P, Challacombe B, Cook G, Cahill D, Cahill F, Olalla AS, George G, Rudman S, van Hemelrijck M. Metformin and longevity (METAL): A window of opportunity study investigating the biological effects of metformin in localised prostate cancer. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw372.49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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28
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Crawley D, Garmo H, Rudman S, Stattin P, Häggström C, Zethelius B, Holmberg L, Adolfsson J, Van Hemelrijck M. Association between duration and type of androgen deprivation therapy and risk of diabetes in men with prostate cancer. Int J Cancer 2016; 139:2698-2704. [PMID: 27557616 PMCID: PMC5095878 DOI: 10.1002/ijc.30403] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 07/29/2016] [Indexed: 11/05/2022]
Abstract
Androgen deprivation therapy (ADT) for prostate cancer (PCa) increases risk of type 2 diabetes (T2DM); however the association between types and duration of ADT has not been fully elucidated. We examined how type and duration of ADT affects risk of T2DM. Using data from Prostate Cancer database Sweden (PCBaSe) we investigated risk of T2DM in a cohort of 34,031 men with PCa on ADT; i.e., anti-androgens (AA), orchiectomy, or gonadotropin-releasing hormone (GnRH) agonists compared to an age-matched, PCa-free comparison cohort (n = 167,205) using multivariate Cox proportional hazard regression. T2DM was defined as a newly filled prescription for metformin, sulphonylurea, or insulin in the Prescribed Drug Register. A total of 21,874 men with PCa received GnRH agonists, 9,143 AA and 3,014 underwent orchiectomy. Risk of T2DM was increased in men in the GnRH agonists/orchiectomy group during the first 3 years of ADT [i.e., 1 - 1.5 years HR: 1.61 (95%CI: 1.36 - 1.91)], compared to PCa-free men. The risk decreased thereafter (e.g., 3 - 4 years HR: 1.17 (95% CI: 0.98 - 1.40)). Conversely, no increased risk was seen in men on AA (HR: 0.74 (95%CI: 0.65 - 0.84). The incidence of T2DM per 1,000 person-years was 10 for PCa-free men, 8 for men on AA, and 13 for men on GnRH agonists/orchiectomy. Duration of ADT has a significant impact on risk of T2DM. With the peak after three years of treatment, our data indicates that men on ADT, even for a limited period of time, such as adjuvant to radiotherapy, are at increased risk of T2DM.
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Affiliation(s)
- Danielle Crawley
- Division of Cancer Studies, Cancer Epidemiology Group, King's College London, London.
| | - Hans Garmo
- Division of Cancer Studies, Cancer Epidemiology Group, King's College London, London
| | - Sarah Rudman
- Guy's and St Thomas' NHS Foundation Trust and King's College London's Comprehensive, Biomedical Research Centre, London
| | - Pär Stattin
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden.,Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Christel Häggström
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden.,Department of Biobank Research, Umeå University, Umeå, Sweden.,Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Björn Zethelius
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Lars Holmberg
- Division of Cancer Studies, Cancer Epidemiology Group, King's College London, London
| | - Jan Adolfsson
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Mieke Van Hemelrijck
- Division of Cancer Studies, Cancer Epidemiology Group, King's College London, London
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29
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Bosco C, Crawley D, Adolfsson J, Rudman S, Van Hemelrijck M. Quantifying the evidence for the risk of metabolic syndrome and its components following androgen deprivation therapy for prostate cancer: a meta-analysis. PLoS One 2015; 10:e0117344. [PMID: 25794005 PMCID: PMC4368630 DOI: 10.1371/journal.pone.0117344] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Accepted: 12/23/2014] [Indexed: 11/18/2022] Open
Abstract
Background No meta-analysis is yet available for the risk of metabolic syndrome (MetS) following androgen deprivation therapy (ADT) for men with prostate cancer. To summarize the evidence for the link between ADT and MetS or its components quantitatively with a meta-analysis including all studies published to date. Methods PubMed and Embase were searched using predefined inclusion criteria to perform meta-analyses on the association between metabolic syndrome, hyperglycemia, diabetes, hypertension, dyslipidemia or obesity and androgen deprivation therapy in patients with prostate cancer. Random effects methods were used to estimate pooled relative risks (RRs) and 95% confidence intervals (CI). Results A total of nine studies was included. There was a positive association between ADT and risk of MetS (RR: 1.75 (95% CI: 1.27–2.41)). Diabetes was the only MetS component present in more than 3 studies, and also showed an increased risk following ADT (RR: 1.36 (95% CI: 1.17–1.58)). Conclusion This is the first quantitative summary addressing the potential risk of MetS following ADT in men with PCa. The positive RRs indicate that there is a need to further elucidate how type and duration of ADT affect these increased risks of MetS and diabetes as the number of men with PCa treated with ADT is increasing.
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Affiliation(s)
- Cecilia Bosco
- King’s College London, School of Medicine, Division of Cancer Studies, Cancer Epidemiology Group, London, United Kingdom
| | - Danielle Crawley
- King’s College London, School of Medicine, Division of Cancer Studies, Cancer Epidemiology Group, London, United Kingdom
- Department of Oncology, Guy’s & St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Jan Adolfsson
- Karolinska Institute, CLINTEC Department, Stockholm, Sweden
| | - Sarah Rudman
- Department of Oncology, Guy’s & St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Mieke Van Hemelrijck
- King’s College London, School of Medicine, Division of Cancer Studies, Cancer Epidemiology Group, London, United Kingdom
- * E-mail:
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Shanmugalingam T, Crawley D, Bosco C, Melvin J, Rohrmann S, Chowdhury S, Holmberg L, Van Hemelrijck M. Obesity and cancer: the role of vitamin D. BMC Cancer 2014; 14:712. [PMID: 25255691 PMCID: PMC4182855 DOI: 10.1186/1471-2407-14-712] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2014] [Accepted: 08/21/2014] [Indexed: 12/14/2022] Open
Abstract
Background It is estimated that 20% of all cancer cases are caused by obesity. Vitamin D is thought to be one of the mechanisms underlying this association. This review aims to summarise the evidence for the mediating effect of vitamin D on the link between obesity and cancer. Methods Three literature searches using PubMed and Embase were conducted to assess whether vitamin D plays an important role in the pathway between obesity and cancer: (1) obesity and cancer; (2) obesity and vitamin D; and (3) vitamin D and cancer. A systematic review was performed for (1) and (3), whereas a meta-analysis including random effects analyses was performed for (2). Results (1) 32 meta-analyses on obesity and cancer were identified; the majority reported a positive association between obesity and risk of cancer. (2) Our meta-analysis included 12 original studies showing a pooled relative risk of 1.52 (95% CI: 1.33-1.73) for risk of vitamin D deficiency (<50 nmol/L) in obese people (body mass index >30 kg/m2). (3) 21 meta-analyses on circulating vitamin D levels and cancer risk were identified with different results for different types of cancer. Conclusion There is consistent evidence for a link between obesity and cancer as well as obesity and low vitamin D. However, it seems like the significance of the mediating role of vitamin D in the biological pathways linking obesity and cancer is low. There is a need for a study including all three components while dealing with bias related to dietary supplements and vitamin D receptor polymorphisms. Electronic supplementary material The online version of this article (doi:10.1186/1471-2407-14-712) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Thurkaa Shanmugalingam
- King's College London, School of Medicine, Division of Cancer Studies, Cancer Epidemiology Group, London, UK.
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Rodriguez-Vida A, Bianchini D, Hughes S, Lorente D, Crawley D, Van Hemelrijck M, Voskoboynik M, Chau NM, Rudman SM, Powles T, Payne H, De Bono JS, Chowdhury S. Is there an anti-androgen withdrawal effect with enzalutamide? J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.4_suppl.200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
200 Background: The second generation anti-androgen enzalutamide has demonstrated improved survival in patients with metastatic castration-resistant prostate cancer (CRPC) progressing after docetaxel. While an anti-androgen withdrawal effect has been reported for bicalutamide, flutamide, and other non-steroidal and steroidal anti-androgens, there is no published evidence of any withdrawal effect with enzalutamide. Methods: We retrospectively identified 30 consecutive patients with advanced prostate cancer who were treated with enzalutamide post-docetaxel at three London hospitals. All patients were withdrawn from enzalutamide due to clinical (73%), PSA (87%) and/or radiological progression (47%). Post-discontinuation prostate-specific antigen (PSA) results were available for all patients and were determined two-weekly for at least six weeks until starting further anti-cancer treatment. PSA withdrawal response was defined as a 50% decline in PSA from baseline, with a confirmed decrease after 3 weeks or more. Clinical tumor and patient characteristics were evaluated in relation to the withdrawal effects using multivariate logistic regression analyses. Results: Median age was 71 (range 54 to 87). The median follow-up was 5.4 months (range: 0.5 to 16.0 months). At enzalutamide initiation, ECOG performance status was 0 and 1 in 10% and 69% of patients, respectively. The most common metastatic sites were bone (87%), lymph nodes (68%), liver (17%), and lung (6%). Most patients (70%) had been on abiraterone previously and 11 patients (37%) had also received prior cabazitaxel. The median treatment duration with enzalutamide was 3.7 months. Only one patient (3%) had a confirmed PSA response of 50% or more after enzalutamide discontinuation and two patients (7%) had a confirmed PSA response between 30% and 50%. None of the clinical variables assessed in relation to withdrawal effects were found to be statistically significantly associated. Conclusions: This preliminary case series represents the first clinical evidence that enzalutamide may have an anti-androgen withdrawal effect in a minority of patients. These results warrant further prospective and controlled validation of a potential enzalutamide withdrawal effect and its clinical relevance in prostate cancer management.
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Affiliation(s)
| | - Diletta Bianchini
- The Institue of Cancer Research, The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Simon Hughes
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - David Lorente
- The Institue of Cancer Research, The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Danielle Crawley
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Mieke Van Hemelrijck
- King’s College London, Division of Cancer Studies, Cancer Epidemiology Group, London, United Kingdom
| | - Mark Voskoboynik
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Noan Minh Chau
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | | | | | - Heather Payne
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | | | - Simon Chowdhury
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
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Pennycuick A, Simpson T, Crawley D, Lal R, Santis G, Cane P, Tobal K, Spicer J. Routine EGFR and KRAS Mutation analysis using COLD-PCR in non-small cell lung cancer. Int J Clin Pract 2012; 66:748-752. [PMID: 22805266 DOI: 10.1111/j.1742-1241.2012.02961.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Aims: Epidermal growth factor receptor (EGFR) antagonists are particularly active in non-small cell lung cancer (NSCLC) patients with tumours bearing mutations in the EFGR gene. EGFR mutation prevalence is very low in squamous histology. Response rates using these drugs in patients with KRAS mutations are low, so available KRAS mutation information may aid treatment selection in the second-line setting. Since 2009, patients presenting to this hospital with non-squamous histology have been routinely screened for mutations in both the EGFR and KRAS genes, with results used to inform treatment. We present an analysis of 215 consecutive patients for whom EGFR mutation analysis was informative. Methodology: EGFR and KRAS mutations were identified using a COLD-PCR technique confirmed with sequencing, which makes no prior assumption about location of specific mutations. Results were correlated with clinical and demographic data from hospital records, where available. Results: The prevalence of patients with EGFR mutations was 14% and for KRAS mutations it was 27%. Despite the conventional understanding that EGFR and KRAS mutations are mutually exclusive, we identified two dual mutations. Of 29 patients identified with mutated EGFR, there were 3/8/8/10 mutations in exons 18/19/20/21 respectively. Exon 20 mutations were identified in a proportion exceeding many other series because of the unbiased mutation analysis used, and clinical benefit was seen in some of these. Of 23 different EGFR mutations identified, 11 have not previously been described in the literature. Conclusions: The high prevalence of EGFR, KRAS or both mutations (40%) in this non-squamous population tested in clinical practice supports a policy of routine screening for these mutations in NSCLC.
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Affiliation(s)
- A Pennycuick
- School of Medicine, King's College London, Guy's Hospital, London, UK Guy's and St Thomas' NHS Foundation Trust, London, UK
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Basu B, Ang JE, Crawley D, Folkerd E, Sarker D, Blanco-Codesido M, Moran K, Wan S, Dobbs N, Raynaud F, Johnston SRD, Dowsett M, Tutt ANJ, Spicer JF, Swanton C, De Bono JS. Phase I study of abiraterone acetate (AA) in patients (pts) with estrogen receptor– (ER) or androgen receptor (AR) –positive advanced breast carcinoma resistant to standard endocrine therapies. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.2525] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Simpson T, Pennycuick A, Crawley D, Tobal K, Santis G. 46 Prevalence of EGFR and K-RAS mutation status in clinical practice - relationship to patient characteristics. Lung Cancer 2011. [DOI: 10.1016/s0169-5002(11)70046-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Crawley D, Ng A, Mainous AG, Majeed A, Millett C. Impact of pay for performance on quality of chronic disease management by social class group in England. J R Soc Med 2009; 102:103-7. [PMID: 19297651 DOI: 10.1258/jrsm.2009.080389] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To examine associations between social class and achievement of selected national audit targets for coronary heart disease (CHD), diabetes and hypertension in England before and after the introduction of a major pay for performance programme in 2004. DESIGN Secondary analysis of 2003 and 2006 national survey data for respondents with CHD and diabetes and hypertension. SETTING England. MAIN OUTCOME MEASURE Achievement of national audit targets for blood pressure, blood glucose and cholesterol control. RESULTS There were no significant differences in achievement of blood pressure targets in individuals from manual and non-manual occupational groups with diabetes (2003: 65.9% v 60.3%, 2006: 67.6% v 69.7%) or hypertension (2003: 66.2% v 66.2%, 2006: 72.8% v 71.9%) before or after the introduction of pay for performance. Achievement of the cholesterol target was also similar in individuals from manual and non-manual groups with diabetes (2003: 52.5% v 46.6%, 2006: 68.7% v 70.5%) or CHD (2003: 54.3% v 53.3%, 2006: 68.6% v 71.3%). Differences in achievement of the blood pressure target in CHD [75.8% v 84.5%; AOR 0.44 (0.21-0.90)] were evident between manual and non-manual occupational groups after the introduction of pay for performance. CONCLUSION The quality of chronic disease management in England was broadly equitable between socioeconomic groups before this major pay for performance programme and remained so after its introduction.
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Affiliation(s)
- Danielle Crawley
- Department of Primary Care and Social Medicine, Imperial College, Reynolds Building, St Dunstan's Road, London W6 8RP, UK
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Politou M, Naresh K, Terpos E, Crawley D, Lampert I, Apperley JF, Rahemtulla A. Anti-angiogenic effect of bortezomib in patients with multiple myeloma. Acta Haematol 2005; 114:170-3. [PMID: 16227683 DOI: 10.1159/000087894] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2005] [Accepted: 03/10/2005] [Indexed: 02/02/2023]
Affiliation(s)
- Marianna Politou
- Department of Haematology, Faculty of Medicine Imperial College London, Hammersmith Hospital, London, UK
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Storey PA, Faile G, Crawley D, van Oostayen JA, Anemana S, Polderman AM, Magnussen P. Ultrasound appearance of preclinical Oesophagostomum bifurcum induced colonic pathology. Gut 2001; 48:565-6. [PMID: 11247903 PMCID: PMC1728230 DOI: 10.1136/gut.48.4.565] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Affiliation(s)
- P A Storey
- Edinburgh University Medical School Teviot Place, Edinburgh EH8 9AG, UK
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Abstract
BACKGROUND Endogenous vasodilators such as endothelially derived relaxant factor have been shown to modulate hypoxic pulmonary vasoconstriction. Sensory peptides such as substance P (SP) and calcitonin gene related peptide (CGRP) are also potent pulmonary vasodilators in both animals and humans. Their possible role in the modulation of the normal hypoxic pressor response has been examined in an isolated, ventilated, and blood perfused rat lung preparation. METHODS Animals (n = 7) were pretreated with 50 mg/kg capsaicin administered subcutaneously to deplete nerve endings of sensory neuropeptides. A control group (n = 7) received a subcutaneous dose of capsaicin vehicle. One week later the rats were killed and the rise in pulmonary artery pressure was measured during four successive periods of hypoxic ventilation (FIO2 0.03), and after four injections of angiotensin II (1.0 microgram). RESULTS A 60% depletion of SP levels was measured in the sciatic nerves of animals treated with capsaicin. The hypoxic pressor response was not significantly altered in capsaicin treated animals compared with controls, except during the fourth hypoxic episode when it was augmented. The angiotensin II pressor response was the same in both groups during each of the injections. CONCLUSION The sensory neuropeptide SP (and possibly CGRP) does not have a major role in modulating the pulmonary vascular response to hypoxia.
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Affiliation(s)
- D G McCormack
- Department of Thoracic Medicine, National Heart and Lung Institute, London
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Crawley D, Evans TW, Barnes PJ. Endothelin-1 constricts human pulmonary resistance vessels in vitro. Br J Pharmacol 1989; 98 Suppl:839P. [PMID: 2692756] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Affiliation(s)
- D Crawley
- Department of Thoracic Medicine, National Heart & Lung Institute, London, UK
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