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Szlosarek PW, Creelan BC, Sarkodie T, Nolan L, Taylor P, Olevsky O, Grosso F, Cortinovis D, Chitnis M, Roy A, Gilligan D, Kindler H, Papadatos-Pastos D, Ceresoli GL, Mansfield AS, Tsao A, O’Byrne KJ, Nowak AK, Steele J, Sheaff M, Shiu CF, Kuo CL, Johnston A, Bomalaski J, Zauderer MG, Fennell DA. Pegargiminase Plus First-Line Chemotherapy in Patients With Nonepithelioid Pleural Mesothelioma: The ATOMIC-Meso Randomized Clinical Trial. JAMA Oncol 2024; 10:475-483. [PMID: 38358753 PMCID: PMC10870227 DOI: 10.1001/jamaoncol.2023.6789] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 09/29/2023] [Indexed: 02/16/2024]
Abstract
Importance Arginine deprivation using ADI-PEG20 (pegargiminase) combined with chemotherapy is untested in a randomized study among patients with cancer. ATOMIC-Meso (ADI-PEG20 Targeting of Malignancies Induces Cytotoxicity-Mesothelioma) is a pivotal trial comparing standard first-line chemotherapy plus pegargiminase or placebo in patients with nonepithelioid pleural mesothelioma. Objective To determine the effect of pegargiminase-based chemotherapy on survival in nonepithelioid pleural mesothelioma, an arginine-auxotrophic tumor. Design, Setting, and Participants This was a phase 2-3, double-blind randomized clinical trial conducted at 43 centers in 5 countries that included patients with chemotherapy-naive nonepithelioid pleural mesothelioma from August 1, 2017, to August 15, 2021, with at least 12 months' follow-up. Final follow-up was on August 15, 2022. Data analysis was performed from March 2018 to June 2023. Intervention Patients were randomly assigned (1:1) to receive weekly intramuscular pegargiminase (36.8 mg/m2) or placebo. All patients received intravenous pemetrexed (500 mg/m2) and platinum (75-mg/m2 cisplatin or carboplatin area under the curve 5) chemotherapy every 3 weeks up to 6 cycles. Pegargiminase or placebo was continued until progression, toxicity, or 24 months. Main Outcomes and Measures The primary end point was overall survival, and secondary end points were progression-free survival and safety. Response rate by blinded independent central review was assessed in the phase 2 portion only. Results Among 249 randomized patients (mean [SD] age, 69.5 [7.9] years; 43 female individuals [17.3%] and 206 male individuals [82.7%]), all were included in the analysis. The median overall survival was 9.3 months (95% CI, 7.9-11.8 months) with pegargiminase-chemotherapy as compared with 7.7 months (95% CI, 6.1-9.5 months) with placebo-chemotherapy (hazard ratio [HR] for death, 0.71; 95% CI, 0.55-0.93; P = .02). The median progression-free survival was 6.2 months (95% CI, 5.8-7.4 months) with pegargiminase-chemotherapy as compared with 5.6 months (95% CI, 4.1-5.9 months) with placebo-chemotherapy (HR, 0.65; 95% CI, 0.46-0.90; P = .02). Grade 3 to 4 adverse events with pegargiminase occurred in 36 patients (28.8%) and with placebo in 21 patients (16.9%); drug hypersensitivity and skin reactions occurred in the experimental arm in 3 patients (2.4%) and 2 patients (1.6%), respectively, and none in the placebo arm. Rates of poststudy treatments were comparable in both arms (57 patients [45.6%] with pegargiminase vs 58 patients [46.8%] with placebo). Conclusions and Relevance In this randomized clinical trial of arginine depletion with pegargiminase plus chemotherapy, survival was extended beyond standard chemotherapy with a favorable safety profile in patients with nonepithelioid pleural mesothelioma. Pegargiminase-based chemotherapy as a novel antimetabolite strategy for mesothelioma validates wider clinical testing in oncology. Trial Registration ClinicalTrials.gov Identifier: NCT02709512.
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Affiliation(s)
- Peter W. Szlosarek
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
- The Mid and South Essex University Hospitals Group, Chelmsford, United Kingdom
- Barts Cancer Centre, St Bartholomew’s Hospital, London, United Kingdom
| | | | - Thomas Sarkodie
- The Mid and South Essex University Hospitals Group, Chelmsford, United Kingdom
| | - Luke Nolan
- Southampton University Hospital NHS Foundation Trust, Southampton, United Kingdom
| | - Paul Taylor
- Manchester University NHS Foundation Trust, Wythenshawe Hospital, Manchester, United Kingdom
| | - Olga Olevsky
- David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Federica Grosso
- Mesothelioma Unit, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | | | - Meenali Chitnis
- Oxford Cancer and Haematology Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Amy Roy
- University Hospitals Plymouth NHS Trust, Plymouth, United Kingdom
| | - David Gilligan
- Cambridge University Hospitals NHS Foundation Trust, Addenbrooke’s Hospital, Cambridge, United Kingdom
| | - Hedy Kindler
- University of Chicago Medicine, Chicago, Illinois
| | | | | | | | - Anne Tsao
- The University of Texas MD Anderson Cancer Center, Houston
| | - Kenneth J. O’Byrne
- Princess Alexandra Hospital and Queensland University of Technology, Brisbane, Australia
| | - Anna K. Nowak
- Medical School, The University of Western Australia and Sir Charles Gairdner Hospital, Perth, Western Australia
| | - Jeremy Steele
- Barts Cancer Centre, St Bartholomew’s Hospital, London, United Kingdom
| | - Michael Sheaff
- Barts Cancer Centre, St Bartholomew’s Hospital, London, United Kingdom
| | | | | | | | | | - Marjorie G. Zauderer
- Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, New York
| | - Dean A. Fennell
- University of Leicester & University Hospitals of Leicester NHS, United Kingdom
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Evison M, Robinson SD, Sharman A, Datta S, Rammohan K, Duerden R, Montero-Fernandez MA, Gilligan D. Making an accurate diagnosis of anterior mediastinal lesions: a proposal for a new diagnostic algorithm from the BTOG Thymic Malignancies Special Interest Group. Clin Radiol 2024:S0009-9260(24)00139-9. [PMID: 38565483 DOI: 10.1016/j.crad.2024.03.003] [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] [Received: 01/04/2024] [Revised: 03/01/2024] [Accepted: 03/12/2024] [Indexed: 04/04/2024]
Abstract
Due to the rising demand in cross-sectional thoracic imaging, anterior mediastinal lesions are being identified with increasing frequency. Following iterative and multidisciplinary discussions, the BTOG Thymic Malignancies Special Interest Group have developed an algorithm to standardise the diagnostic approach for these relatively uncommon but important conditions which span from benign (thymic remnant, thymic hyperplasia and thymic cysts) to suspected localised thymomas to suspected more aggressive malignancy (thymic carcinoma, lymphoma and germ cell tumours). For each condition, we provide a brief description, an overview of the key radiological findings and a description of the proposed algorithm including the rationale behind the recommendations. We also highlight the role of magnetic resonance (MR) imaging for the characterisation of anterior mediastinal masses in specific indications when the necessary local resources and expertise exist. In addition, we hope this provides the rationale for service development in MR of the anterior mediastinum where current resource and expertise requires development. Through this standardised pathway, we hope to drive improvements in patient care by rationalising surveillance schedules, avoiding unnecessary resections of benign entities with their associated morbidity and optimising the diagnostic work-up prior to the appropriate treatment of anterior mediastinal malignancies.
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Affiliation(s)
- M Evison
- Lung Cancer & Thoracic Surgery Directorate, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK; Manchester Academic Health Science Centre (MAHSC), Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK.
| | - S D Robinson
- Sussex Cancer Centre, Royal Sussex County Hospital, University Hospitals Sussex NHS Foundation Trust, Brighton, UK; Department of Biochemistry and Biomedicine, School of Life Sciences, University of Sussex, Falmer, Brighton, UK.
| | - A Sharman
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - S Datta
- Department of Radiology, Royal Alexandra Hospital, NHS Glasgow and Clyde, Glasgow, UK
| | - K Rammohan
- Lung Cancer & Thoracic Surgery Directorate, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - R Duerden
- Department of Radiology, Stepping Hill Hospital, Stockport NHS Foundation Trust, Stockport, UK
| | - M A Montero-Fernandez
- Department of Histopathology, Royal Liverpool University Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - D Gilligan
- Department of Oncology, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Robinson SD, Gault A, Kathirgamakarthigeyan S, Gilligan D. Thymic epithelial tumour radiotherapy in the UK: A survey of current clinical practice. Radiother Oncol 2023; 189:109940. [PMID: 37813311 DOI: 10.1016/j.radonc.2023.109940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 09/26/2023] [Accepted: 10/01/2023] [Indexed: 10/11/2023]
Abstract
Significant variation in treatment centre setup and radiotherapy practice for thymic epithelial tumours (TET) was identified through a comprehensive survey of current UK Clinical (Radiation) Oncology practice. Multi-centre collaboration and wider TET specific multidisciplinary team meetings are needed and will be essential for developing expertise in TET radiotherapy.
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Affiliation(s)
- Stephen D Robinson
- Sussex Cancer Centre, University Hospitals Sussex NHS Foundation Trust, Brighton BN2 5BD, United Kingdom; Department of Biochemistry, University of Sussex, Brighton BN1 9BX, United Kingdom.
| | - Abigail Gault
- Northern Centre for Cancer Care, Newcastle NE7 7DN, United Kingdom; Translational & Clinical Research Institute, Newcastle University, Newcastle NE2 4HH, United Kingdom.
| | | | - David Gilligan
- Addenbrookes Hospital, Cambridge CB2 0QQ, United Kingdom; University of Cambridge, Cambridge CB2 0QQ, United Kingdom.
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Homicsko K, Zygoura P, Norkin M, Tissot S, Shakarishvili N, Popat S, Curioni-Fontecedro A, O'Brien M, Pope A, Shah R, Fisher P, Spicer J, Roy A, Gilligan D, Rusakiewicz S, Fortis E, Marti N, Kammler R, Finn SP, Coukos G, Dafni U, Peters S, Stahel RA. PD-1-expressing macrophages and CD8 T cells are independent predictors of clinical benefit from PD-1 inhibition in advanced mesothelioma. J Immunother Cancer 2023; 11:e007585. [PMID: 37880184 PMCID: PMC10603330 DOI: 10.1136/jitc-2023-007585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Few tissue biomarkers exist to date that could enrich patient with cancer populations to benefit from immune checkpoint blockade by programmed cell death protein 1/ligand-1 (PD-/L-1) inhibitors. PD-L1 expression has value in this context in some tumor types but is an imperfect predictor of clinical benefit. In malignant pleural mesothelioma, PD-L1 expression is not predictive of the benefit from PD-1 blockade. We aimed to identify novel markers in malignant pleural mesothelioma to select patients better. METHODS We performed a multiplex-immune histochemistry analysis of tumor samples from the phase III PROMISE-meso study, which randomized 144 pretreated patients to receive either pembrolizumab or standard second-line chemotherapy. Our panel focused on CD8+T cell, CD68+macrophages, and the expression of PD-1 and PD-L1 on these and cancer cells. We analyzed single and double positive cells within cancer tissues (infiltrating immune cells) and in the stroma. In addition, we performed cell neighborhood analysis. The cell counts were compared with clinical outcomes, including responses, progression-free and overall survivals. RESULTS We confirmed the absence of predictive value for PD-L1 in this cohort of patients. Furthermore, total CD8 T cells, CD68+macrophages, or inflammatory subtypes (desert, excluded, inflamed) did not predict outcomes. In contrast, PD-1-expressing CD8+T cells (exhausted T cells) and PD-1-expressing CD68+macrophages were both independent predictors of progression-free survival benefit from pembrolizumab. Patients with tumors simultaneously harboring PD1+T cells and PD-1+macrophages benefited the most from immune therapy. CONCLUSION We analyzed a large cohort of patients within a phase III study and found that not only PD-1+CD8 T cells but also PD-1+CD68+ macrophages are predictive. This data provides evidence for the first time for the existence of PD-1+macrophages in mesothelioma and their clinical relevance for immune checkpoint blockade.
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Affiliation(s)
- Krisztian Homicsko
- Department of Oncology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
- Ludwig Institute for Cancer Research, Lausanne branch, Lausanne, Switzerland
| | - Panagiota Zygoura
- ETOP Statistical Center, Frontier Science Foundation - Hellas, Athens, Greece
| | - Maxim Norkin
- Department of Oncology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
- Ludwig Institute for Cancer Research, Lausanne branch, Lausanne, Switzerland
| | - Stephanie Tissot
- Department of Oncology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
- Immune Landscape Laboratory, Centre Thérapies Expérimentales (CTE), Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | | | - Sanjay Popat
- Lung Unit, Royal Marsden Hospital NHS Trust, London, UK
| | - Alessandra Curioni-Fontecedro
- Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland
- Department of Oncology, Fribourg Hospitals, Fribourg, Switzerland
| | - Mary O'Brien
- Department of Oncology, Royal Marsden Hospital NHS Trust, London, UK
| | - Anthony Pope
- Department of Oncology, Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, UK
| | - Riyaz Shah
- Department of Medical Oncology, Kent Oncology Centre, Maidstone, UK
| | - Patricia Fisher
- Department of Medical Oncology, Weston Park Hospital, Sheffield, UK
| | - James Spicer
- Comprehensive Cancer Center, King's College London, London, UK
| | - Amy Roy
- Department of Medical Oncology, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - David Gilligan
- Department of Medical Oncology, Addenbrooke's Hospital, Cambridge, UK
| | - Sylvie Rusakiewicz
- Immune Landscape Laboratory, Centre Thérapies Expérimentales (CTE), Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Ekaterina Fortis
- Department of Oncology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
- Immune Landscape Laboratory, Centre Thérapies Expérimentales (CTE), Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Nesa Marti
- Translational Research Coordination, ETOP IBCSG Partners Foundation, Bern, Switzerland
| | - Roswitha Kammler
- Translational Research Coordination, ETOP IBCSG Partners Foundation, Bern, Switzerland
| | - Stephen P Finn
- Molecular Diagnostics and Histopathology, Trinity College, Dublin, Ireland
| | - Georges Coukos
- Department of Oncology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
- Ludwig Institute for Cancer Research, Lausanne branch, Lausanne, Switzerland
| | - Urania Dafni
- ETOP Statistical Center, Frontier Science Foundation - Hellas, Athens, Greece
- National and Kapodistrian University of Athens, Athens, Greece
| | - Solange Peters
- Department of Oncology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
- Agora Research Center, Swiss Cancer Center Leman, Lausanne, Switzerland
| | - Rolf A Stahel
- President, ETOP IBCSG Partners Foundation, Bern, Switzerland
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Hayat R, Ahmed S, Badiger R, Lee SH, Peryt A, Gilligan D, Khalid Z. A case of malignant mesothelioma in a young patient with childhood leukaemia who had received total body irradiation. Oxf Med Case Reports 2023; 2023:omac151. [PMID: 37260730 PMCID: PMC10228118 DOI: 10.1093/omcr/omac151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 11/08/2022] [Accepted: 11/20/2022] [Indexed: 06/02/2023] Open
Abstract
This case report explores a 34-year-old male diagnosed with mesothelioma who had no known risk factors. The patient initially was treated for empyema with antibiotics but later represented to hospital with worsening symptoms. He underwent a surgical Video-assisted thoracoscopic surgery procedure and lung biopsy, which revealed a diagnosis of mesothelioma. The young age of the patient as well as absence of significant risk factors for mesothelioma made the diagnosis unexpected. The patient had total body irradiation (TBI) therapy for leukaemia as a child, which increases the risk of developing cancer. However, there are limited studies exploring the risk of pleural mesothelioma post-TBI. Young patients who represent to hospital, with limited response to initial treatment, and suspicious radiological features should be considered for lung biopsy to reduce the risk of a missed diagnosis. Patients with a background of TBI should also be considered for follow-up to monitor for any subsequent malignancy.
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Affiliation(s)
- Redwan Hayat
- Correspondence address. 22 Fossway, Dagenham RM8 1UJ, UK. Mobile: 07513081702; E-mail:
| | - Saad Ahmed
- Acute Medicine, Colchester General Hospital, Colchester, UK
| | - Rekha Badiger
- Respiratory Medicine, Colchester General Hospital, Colchester, UK
| | - Shi Han Lee
- Respiratory Medicine, Colchester General Hospital, Colchester, UK
| | - Adam Peryt
- Cardiothoracic Surgery, Royal Papworth Hospital, Cambridge, UK
| | - David Gilligan
- Clinical Oncology, Cambridge University Hospitals, Cambridge, UK
| | - Zubair Khalid
- Respiratory Medicine, Broomfield Hospital, Chelmsford, UK
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Gale D, Heider K, Ruiz-Valdepenas A, Hackinger S, Perry M, Marsico G, Rundell V, Wulff J, Sharma G, Knock H, Castedo J, Cooper W, Zhao H, Smith CG, Garg S, Anand S, Howarth K, Gilligan D, Harden SV, Rassl DM, Rintoul RC, Rosenfeld N. Residual ctDNA after treatment predicts early relapse in patients with early-stage non-small cell lung cancer. Ann Oncol 2022; 33:500-510. [PMID: 35306155 PMCID: PMC9067454 DOI: 10.1016/j.annonc.2022.02.007] [Citation(s) in RCA: 109] [Impact Index Per Article: 54.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 02/02/2022] [Accepted: 02/14/2022] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Identification of residual disease in patients with localized non-small cell lung cancer (NSCLC) following treatment with curative intent holds promise to identify patients at risk of relapse. New methods can detect circulating tumour DNA (ctDNA) in plasma to fractional concentrations as low as a few parts per million, and clinical evidence is required to inform their use. PATIENTS AND METHODS We analyzed 363 serial plasma samples from 88 patients with early-stage NSCLC (48.9%/28.4%/22.7% at stage I/II/III), predominantly adenocarcinomas (62.5%), treated with curative intent by surgery (n = 61), surgery and adjuvant chemotherapy/radiotherapy (n = 8), or chemoradiotherapy (n = 19). Tumour exome sequencing identified somatic mutations and plasma was analyzed using patient-specific RaDaR™ assays with up to 48 amplicons targeting tumour-specific variants unique to each patient. RESULTS ctDNA was detected before treatment in 24%, 77% and 87% of patients with stage I, II and III disease, respectively, and in 26% of all longitudinal samples. The median tumour fraction detected was 0.042%, with 63% of samples <0.1% and 36% of samples <0.01%. ctDNA detection had clinical specificity >98.5% and preceded clinical detection of recurrence of the primary tumour by a median of 212.5 days. ctDNA was detected after treatment in 18/28 (64.3%) of patients who had clinical recurrence of their primary tumour. Detection within the landmark timepoint 2 weeks to 4 months after treatment end occurred in 17% of patients, and was associated with shorter recurrence-free survival [hazard ratio (HR): 14.8, P <0.00001] and overall survival (HR: 5.48, P <0.0003). ctDNA was detected 1-3 days after surgery in 25% of patients yet was not associated with disease recurrence. Detection before treatment was associated with shorter overall survival and recurrence-free survival (HR: 2.97 and 3.14, P values 0.01 and 0.003, respectively). CONCLUSIONS ctDNA detection after initial treatment of patients with early-stage NSCLC using sensitive patient-specific assays has potential to identify patients who may benefit from further therapeutic intervention.
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Affiliation(s)
- D Gale
- Cancer Research UK Cambridge Institute, Li Ka Shing Centre, University of Cambridge, Cambridge, UK; Cancer Research UK Cambridge Centre - Cambridge, Cancer Research UK Cambridge Institute, Li Ka Shing Centre, Cambridge, UK
| | - K Heider
- Cancer Research UK Cambridge Institute, Li Ka Shing Centre, University of Cambridge, Cambridge, UK; Cancer Research UK Cambridge Centre - Cambridge, Cancer Research UK Cambridge Institute, Li Ka Shing Centre, Cambridge, UK
| | - A Ruiz-Valdepenas
- Cancer Research UK Cambridge Institute, Li Ka Shing Centre, University of Cambridge, Cambridge, UK; Cancer Research UK Cambridge Centre - Cambridge, Cancer Research UK Cambridge Institute, Li Ka Shing Centre, Cambridge, UK
| | - S Hackinger
- Inivata Ltd, The Glenn Berge Building, Babraham Research Park, Babraham, Cambridge, UK
| | - M Perry
- Inivata Ltd, The Glenn Berge Building, Babraham Research Park, Babraham, Cambridge, UK
| | - G Marsico
- Inivata Ltd, The Glenn Berge Building, Babraham Research Park, Babraham, Cambridge, UK
| | - V Rundell
- Cambridge Clinical Trials Unit - Cancer Theme, Cambridge, UK
| | - J Wulff
- Cambridge Clinical Trials Unit - Cancer Theme, Cambridge, UK
| | - G Sharma
- Inivata Ltd, The Glenn Berge Building, Babraham Research Park, Babraham, Cambridge, UK
| | - H Knock
- Cambridge Clinical Trials Unit - Cancer Theme, Cambridge, UK
| | - J Castedo
- Cancer Research UK Cambridge Centre - Cambridge, Cancer Research UK Cambridge Institute, Li Ka Shing Centre, Cambridge, UK; Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - W Cooper
- Cancer Research UK Cambridge Institute, Li Ka Shing Centre, University of Cambridge, Cambridge, UK; Cancer Research UK Cambridge Centre - Cambridge, Cancer Research UK Cambridge Institute, Li Ka Shing Centre, Cambridge, UK
| | - H Zhao
- Cancer Research UK Cambridge Institute, Li Ka Shing Centre, University of Cambridge, Cambridge, UK; Cancer Research UK Cambridge Centre - Cambridge, Cancer Research UK Cambridge Institute, Li Ka Shing Centre, Cambridge, UK
| | - C G Smith
- Cancer Research UK Cambridge Institute, Li Ka Shing Centre, University of Cambridge, Cambridge, UK; Cancer Research UK Cambridge Centre - Cambridge, Cancer Research UK Cambridge Institute, Li Ka Shing Centre, Cambridge, UK
| | - S Garg
- Cancer Molecular Diagnostics Laboratory, Clifford Allbutt Building, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
| | - S Anand
- Cancer Molecular Diagnostics Laboratory, Clifford Allbutt Building, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
| | - K Howarth
- Inivata Ltd, The Glenn Berge Building, Babraham Research Park, Babraham, Cambridge, UK
| | - D Gilligan
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK; Addenbrooke's Hospital, Cambridge, UK
| | | | - D M Rassl
- Cancer Research UK Cambridge Centre - Cambridge, Cancer Research UK Cambridge Institute, Li Ka Shing Centre, Cambridge, UK; Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - R C Rintoul
- Cancer Research UK Cambridge Centre - Cambridge, Cancer Research UK Cambridge Institute, Li Ka Shing Centre, Cambridge, UK; Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK; Department of Oncology, University of Cambridge Hutchison-MRC Research Centre, Cambridge Biomedical Campus, Cambridge, UK.
| | - N Rosenfeld
- Cancer Research UK Cambridge Institute, Li Ka Shing Centre, University of Cambridge, Cambridge, UK; Cancer Research UK Cambridge Centre - Cambridge, Cancer Research UK Cambridge Institute, Li Ka Shing Centre, Cambridge, UK; Inivata Ltd, The Glenn Berge Building, Babraham Research Park, Babraham, Cambridge, UK.
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7
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Luigi Banna G, Addeo A, Zygoura P, Tsourti Z, Popat S, Curioni-Fontecedro A, Nadal E, Shah R, Pope A, Fisher P, Spicer J, Roy A, Gilligan D, Gautschi O, Janthur WD, López-Castro R, Roschitzki-Voser H, Dafni U, Peters S, Stahel RA. A prognostic score for patients with malignant pleural mesothelioma (MPM) receiving second-line immunotherapy or chemotherapy in the ETOP 9–15 PROMISE-meso phase III trial. Lung Cancer 2022; 169:77-83. [DOI: 10.1016/j.lungcan.2022.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/10/2022] [Accepted: 05/26/2022] [Indexed: 10/18/2022]
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Padden-Modi M, Cheng J, Kirby R, Twyman N, Aslam S, Bulusu V, Gilligan D, Martin A, Pipalia N, Shiarli A, Yang H, Thippu Jayaprakash K. PD-0670 Minimising radical radiotherapy commencement time for lung cancer to improve clinical outcomes. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02917-6] [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: 11/26/2022]
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Kieran R, de Paula BHR, Hubank M, Barker A, Paterson AL, Gilligan D, Doherty GJ. Response of NOTCH1-Activated Tracheal Adenoid Cystic Carcinoma to the Gamma Secretase Inhibitor Nirogacestat. JCO Precis Oncol 2022; 5:1579-1583. [PMID: 34994644 DOI: 10.1200/po.21.00228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Rosalind Kieran
- Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | - Bruno H R de Paula
- Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, United Kingdom.,Early Phase Trials Unit, Department of Oncology, University of Cambridge, Cambridge, United Kingdom
| | | | - Allanah Barker
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | - Anna L Paterson
- Department of Histopathology, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | - David Gilligan
- Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, United Kingdom.,Cancer Research UK Cambridge Centre, Cambridge, United Kingdom
| | - Gary J Doherty
- Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, United Kingdom.,Cancer Research UK Cambridge Centre, Cambridge, United Kingdom
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Graham K, Gilligan D, Brown P, van Klinken RD, McColl KA, Durr PA. Use of spatio-temporal habitat suitability modelling to prioritise areas for common carp biocontrol in Australia using the virus CyHV-3. J Environ Manage 2021; 295:113061. [PMID: 34348430 DOI: 10.1016/j.jenvman.2021.113061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 05/09/2021] [Accepted: 06/08/2021] [Indexed: 06/13/2023]
Abstract
Common carp (Cyprinus carpio) are an invasive species of the rivers and waterways of south-eastern Australia, implicated in the serious decline of many native fish species. Over the past 50 years a variety of control options have been explored, all of which to date have proved either ineffective or cost prohibitive. Most recently the use of cyprinid herpesvirus 3 (CyHV-3) has been proposed as a biocontrol agent, but to assess the risks and benefits of this, as well as to develop a strategy for the release of the virus, a knowledge of the fundamental processes driving carp distribution and abundance is required. To this end, we developed a novel process-based modelling framework that integrates expert opinion with spatio-temporal datasets via the construction of a Bayesian Network. The resulting weekly networks thus enabled an estimate of the habitat suitability for carp across a range of hydrological habitats in south-eastern Australia, covering five diverse catchment areas encompassing in total a drainage area of 132,129 km2 over a period of 17-27 years. This showed that while suitability for adult and subadult carp was medium-high across most habitats throughout the period, nevertheless the majority of habitats were poorly suited for the recruitment of larvae and young-of-year (YOY). Instead, high population abundance was confirmed to depend on a small number of recruitment hotspots which occur in years of favourable inundation. Quantification of the underlying ecological drivers of carp abundance thus makes possible detailed planning by focusing on critical weaknesses in the population biology of carp. More specifically, it permits the rational planning for population reduction using the biocontrol agent, CyHV-3, targeting areas where the total population density is above a "damage threshold" of approximately 100 kg/ha.
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Affiliation(s)
- K Graham
- CSIRO Australian Centre for Disease Preparedness (ACDP), Geelong, VIC, Australia
| | - D Gilligan
- NSW Department of Primary Industries - Fisheries NSW, NSW, Australia
| | - P Brown
- Centre for Freshwater Ecosystems, School of Life Sciences, La Trobe University, Mildura, VIC, Australia; Fisheries and Wetlands Consulting, Portarlington, VIC, Australia
| | | | - K A McColl
- CSIRO Health and Biosecurity, Geelong, VIC, Australia
| | - P A Durr
- CSIRO Australian Centre for Disease Preparedness (ACDP), Geelong, VIC, Australia.
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11
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Punjabi A, Barrett E, Cheng A, Mulla A, Walls G, Johnston D, McAleese J, Moore K, Hicks J, Blyth K, Denholm M, Magee L, Gilligan D, Silverman S, Qureshi M, Clinch H, Hatton M, Philipps L, Brown S, O'Brien M, McDonald F, Faivre-Finn C, Hiley C, Evison M. Neutrophil-Lymphocyte Ratio and Absolute Lymphocyte Count as Prognostic Markers in Patients Treated with Curative-intent Radiotherapy for Non-small Cell Lung Cancer. Clin Oncol (R Coll Radiol) 2021; 33:e331-e338. [PMID: 33863615 DOI: 10.1016/j.clon.2021.03.019] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 02/27/2021] [Accepted: 03/24/2021] [Indexed: 12/21/2022]
Abstract
AIMS The neutrophil-lymphocyte ratio (NLR) and the absolute lymphocyte count (ALC) have been proposed as prognostic markers in non-small cell lung cancer (NSCLC). The objective of this study was to examine the association of NLR/ALC before and after curative-intent radiotherapy for NSCLC on disease recurrence and overall survival. MATERIALS AND METHODS A retrospective study of consecutive patients who underwent curative-intent radiotherapy for NSCLC across nine sites in the UK from 1 October 2014 to 1 October 2016. A multivariate analysis was carried out to assess the ability of pre-treatment NLR/ALC, post-treatment NLR/ALC and change in NLR/ALC, adjusted for confounding factors using the Cox proportional hazards model, to predict disease recurrence and overall survival within 2 years of treatment. RESULTS In total, 425 patients were identified with complete blood parameter values. None of the NLR/ALC parameters were independent predictors of disease recurrence. Higher pre-NLR, post-NLR and change in NLR plus lower post-ALC were all independent predictors of worse survival. Receiver operator curve analysis found a pre-NLR > 2.5 (odds ratio 1.71, 95% confidence interval 1.06-2.79, P < 0.05), a post-NLR > 5.5 (odds ratio 2.36, 95% confidence interval 1.49-3.76, P < 0.001), a change in NLR >3.6 (odds ratio 2.41, 95% confidence interval 1.5-3.91, P < 0.001) and a post-ALC < 0.8 (odds ratio 2.86, 95% confidence interval 1.76-4.69, P < 0.001) optimally predicted poor overall survival on both univariate and multivariate analysis when adjusted for confounding factors. Median overall survival for the high-versus low-risk groups were: pre-NLR 770 versus 1009 days (P = 0.34), post-NLR 596 versus 1287 days (P ≤ 0.001), change in NLR 553 versus 1214 days (P ≤ 0.001) and post-ALC 594 versus 1287 days (P ≤ 0.001). CONCLUSION NLR and ALC, surrogate markers for systemic inflammation, have prognostic value in NSCLC patients treated with curative-intent radiotherapy. These simple and readily available parameters may have a future role in risk stratification post-treatment to inform the intensity of surveillance protocols.
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Affiliation(s)
- A Punjabi
- Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - E Barrett
- Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - A Cheng
- Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - A Mulla
- Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - G Walls
- Queen's University Belfast, Belfast, UK
| | - D Johnston
- Northern Ireland Cancer Centre, Belfast, UK
| | - J McAleese
- Northern Ireland Cancer Centre, Belfast, UK
| | - K Moore
- NHS Greater Glasgow & Clyde, Glasgow, UK
| | - J Hicks
- NHS Greater Glasgow & Clyde, Glasgow, UK
| | - K Blyth
- NHS Greater Glasgow & Clyde, Glasgow, UK
| | - M Denholm
- Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - L Magee
- Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - D Gilligan
- Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - S Silverman
- University College London Hospital, London, UK
| | - M Qureshi
- Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - H Clinch
- The University of Sheffield Medical School, Sheffield, UK
| | - M Hatton
- Weston Park Hospital, Sheffield, UK
| | | | - S Brown
- The University of Manchester, Manchester, UK
| | | | | | - C Faivre-Finn
- The University of Manchester, Manchester, UK; The Christie NHS Foundation Trust, Manchester, UK
| | - C Hiley
- CRUK Lung Cancer Centre of Excellence, UCL Cancer Institute, London, UK
| | - M Evison
- Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK.
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12
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Hiley C, Punjabi A, Barrett E, Cheng A, Mulla A, Walls G, Johnston D, McAleese J, Moore K, Hicks J, Blyth K, Denholm M, Magee L, Gilligan D, Silverman S, Qureshi M, Clinch H, Hatton M, Philips L, Brown S, O’Brien M, Macdonald F, Faivre-Finn C, Evison M. PH-0274 NLR & ALC as prognostic markers in patients treated with curative intent radiotherapy for NSCLC. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07289-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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13
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Cheng J, Padden-Modi M, Kirby R, Twyman N, Shiarli AM, Martin A, Gilligan D, Thippu Jayaprakash K. MInimising radical RAdiotherapy Commencement time for Lung cancer to improve clinical outcomEs (MIRACLE). Lung Cancer 2021. [DOI: 10.1016/s0169-5002(21)00336-6] [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: 11/24/2022]
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14
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Gale D, Heider K, Perry M, Marsico G, Ruiz-Valdepeñas A, Rundell V, Wulff J, Sharma G, Howarth K, Gilligan D, Harden S, Rassl DM, Rintoul R, Rosenfeld N. Residual ctDNA after treatment predicts early relapse in patients with early-stage NSCLC. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.8517] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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
8517 Background: Liquid biopsies based on circulating tumor DNA (ctDNA) analysis are being investigated for detection of residual disease and recurrence. Conclusive evidence for utility of ctDNA in early-stage non-small cell lung cancer (NSCLC) is awaited. Due to low ctDNA levels in early-stage disease or post-treatment, effective methods require high analytical sensitivity to detect mutant allele fractions (MAF) below 0.01%. Methods: We analysed 363 plasma samples from 88 patients with NSCLC recruited to the LUng cancer CIrculating tumour DNA (LUCID) study, with disease stage I (49%), II (28%) and III (23%). 62% were adenocarcinomas. Plasma was collected before and after treatment, and at 3, 6 and 9 months after surgery (N = 69) or chemoradiotherapy (N = 19). Additional plasma was collected at disease relapse for 17 patients. Median follow-up was 3 years, and 40 patients progressed or died of any cause. We employed the RaDaR™ assay, a highly sensitive personalized assay using deep sequencing of up to 48 tumor-specific variants. Variants identified by tumor exome analysis were tested by deep sequencing of tumor tissue and buffy coat DNA to verify somatic mutations and exclude clonal hematopoiesis. The RaDaR assay demonstrated 90% sensitivity at 0.001% MAF in analytical validation studies. Results: ctDNA was detected in 26% of samples, at median MAF of 0.047% (range: 0.0007% to > 2%), and prior to treatment in 87%, 77% and 24% for disease stage III, II and I respectively. For 62 patients, plasma was collected at a landmark timepoint, between 2 weeks and 4 months after initial treatment. ctDNA detection at the landmark timepoint was strongly predictive of clinical disease relapse, with Hazard Ratio of 20.7 (CI: 7.7-55.5, p-value < 0.0001). All 11 cases with ctDNA detected at landmark had disease progression, a median of 121 days after detection, and these included all 8 patients that relapsed within 300 days of treatment. Across 27 patients whose disease progressed during the study, ctDNA was detected at any timepoint post-treatment in 17 cases, with a median lead time of 203 days, and up to 741 days prior to clinical progression. ctDNA was detected post-treatment, in 13 of the 15 patients that progressed and had ctDNA detected prior to treatment. Conclusions: Our results support an emerging paradigm shift, by demonstrating that liquid biopsies can reliably detect recurrence of NSCLC at a preclinical stage, many months before clinical progression, thereby offering the opportunity for earlier therapeutic intervention. Clinical trial information: NCT04153526.
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Affiliation(s)
- Davina Gale
- Cancer Research UK Cambridge Institute, Cambridge, United Kingdom
| | - Katrin Heider
- Cancer Research UK Cambridge Institute, Cambridge, United Kingdom
| | | | | | | | - Viona Rundell
- Cambridge Clinical Trials Unit-Cancer Theme, Cambridge, United Kingdom
| | - Jerome Wulff
- Cambridge Clinical Trials Unit-Cancer Theme, Cambridge, United Kingdom
| | | | | | | | - Susan Harden
- Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Doris M. Rassl
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
| | - Robert Rintoul
- Department of Oncology, University of Cambridge, Cambridge, United Kingdom
| | - Nitzan Rosenfeld
- Cancer Research UK Cambridge Institute, Cambridge, United Kingdom
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15
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Evison M, Barrett E, Cheng A, Mulla A, Walls G, Johnston D, McAleese J, Moore K, Hicks J, Blyth K, Denholm M, Magee L, Gilligan D, Silverman S, Hiley C, Qureshi M, Clinch H, Hatton M, Philipps L, Brown S, O'Brien M, McDonald F, Faivre-Finn C. Predicting the Risk of Disease Recurrence and Death Following Curative-intent Radiotherapy for Non-small Cell Lung Cancer: The Development and Validation of Two Scoring Systems From a Large Multicentre UK Cohort. Clin Oncol (R Coll Radiol) 2021; 33:145-154. [PMID: 32978027 DOI: 10.1016/j.clon.2020.09.001] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 07/30/2020] [Accepted: 09/02/2020] [Indexed: 12/26/2022]
Abstract
AIMS There is a paucity of evidence on which to produce recommendations on neither the clinical nor the imaging follow-up of lung cancer patients after curative-intent radiotherapy. In the 2019 National Institute for Health and Care Excellence lung cancer guidelines, further research into risk-stratification models to inform follow-up protocols was recommended. MATERIALS AND METHODS A retrospective study of consecutive patients undergoing curative-intent radiotherapy for non-small cell lung cancer from 1 October 2014 to 1 October 2016 across nine UK trusts was carried out. Twenty-two demographic, clinical and treatment-related variables were collected and multivariable logistic regression was used to develop and validate two risk-stratification models to determine the risk of disease recurrence and death. RESULTS In total, 898 patients were included in the study. The mean age was 72 years, 63% (562/898) had a good performance status (0-1) and 43% (388/898), 15% (134/898) and 42% (376/898) were clinical stage I, II and III, respectively. Thirty-six per cent (322/898) suffered disease recurrence and 41% (369/898) died in the first 2 years after radiotherapy. The ASSENT score (age, performance status, smoking status, staging endobronchial ultrasound, N-stage, T-stage) was developed, which stratifies the risk for disease recurrence within 2 years, with an area under the receiver operating characteristic curve (AUROC) for the total score of 0.712 (0.671-0.753) and 0.72 (0.65-0.789) in the derivation and validation sets, respectively. The STEPS score (sex, performance status, staging endobronchial ultrasound, T-stage, N-stage) was developed, which stratifies the risk of death within 2 years, with an AUROC for the total score of 0.625 (0.581-0.669) and 0.607 (0.53-0.684) in the derivation and validation sets, respectively. CONCLUSIONS These validated risk-stratification models could be used to inform follow-up protocols after curative-intent radiotherapy for lung cancer. The modest performance highlights the need for more advanced risk prediction tools.
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Affiliation(s)
- M Evison
- Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK.
| | - E Barrett
- Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - A Cheng
- Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - A Mulla
- Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - G Walls
- Northern Ireland Cancer Centre, Belfast, UK
| | - D Johnston
- Cancer Centre Belfast City Hospital, Belfast, UK
| | - J McAleese
- Cancer Centre Belfast City Hospital, Belfast, UK
| | - K Moore
- NHS Greater Glasgow & Clyde, Glasgow, UK
| | - J Hicks
- NHS Greater Glasgow & Clyde, Glasgow, UK
| | - K Blyth
- NHS Greater Glasgow & Clyde, Glasgow, UK
| | - M Denholm
- Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - L Magee
- Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - D Gilligan
- Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - S Silverman
- University College London Hospital, London, UK
| | - C Hiley
- CRUK Lung Cancer Centre of Excellence, UCL Cancer Institute, London, UK
| | | | - H Clinch
- The University of Sheffield Medical School, Sheffield, UK
| | - M Hatton
- Weston Park Hospital, Sheffield, UK
| | | | - S Brown
- The Christie NHS Foundation Trust, Manchester, UK
| | | | | | - C Faivre-Finn
- The Christie NHS Foundation Trust, Manchester, UK; The University of Manchester, Manchester, UK
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16
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Popat S, Curioni-Fontecedro A, Dafni U, Shah R, O'Brien M, Pope A, Fisher P, Spicer J, Roy A, Gilligan D, Gautschi O, Nadal E, Janthur WD, López Castro R, García Campelo R, Rusakiewicz S, Letovanec I, Polydoropoulou V, Roschitzki-Voser H, Ruepp B, Gasca-Ruchti A, Peters S, Stahel RA. A multicentre randomised phase III trial comparing pembrolizumab versus single-agent chemotherapy for advanced pre-treated malignant pleural mesothelioma: the European Thoracic Oncology Platform (ETOP 9-15) PROMISE-meso trial. Ann Oncol 2020; 31:1734-1745. [PMID: 32976938 DOI: 10.1016/j.annonc.2020.09.009] [Citation(s) in RCA: 135] [Impact Index Per Article: 33.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 08/19/2020] [Accepted: 09/13/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Malignant pleural mesothelioma (MPM) is an aggressive malignancy characterised by limited treatment options and a poor prognosis. At relapse after platinum-based chemotherapy, single-agent chemotherapy is commonly used and single-arm trials of immune-checkpoint inhibitors have demonstrated encouraging activity. PATIENTS AND METHODS PROMISE-meso is an open-label 1:1 randomised phase III trial investigating the efficacy of pembrolizumab (200 mg/Q3W) versus institutional choice single-agent chemotherapy (gemcitabine or vinorelbine) in relapsed MPM patients with progression after/on previous platinum-based chemotherapy. Patients were performance status 0-1 and unselected for programmed cell death ligand 1 (PD-L1) status. At progression, patients randomly assigned to receive chemotherapy were allowed to crossover to pembrolizumab. The primary end point was progression-free survival (PFS), assessed by blinded independent central review (BICR). Secondary end points were overall survival (OS), investigator-assessed PFS, objective response rate (ORR), and safety. Efficacy by PD-L1 status was investigated in exploratory analyses. RESULTS Between September 2017 and August 2018, 144 patients were randomly allocated (pembrolizumab: 73; chemotherapy: 71). At data cut-off [20 February 2019, median follow-up of 11.8 months (interquartile range: 9.9-14.5)], 118 BICR-PFS events were observed. No difference in BICR-PFS was detected [hazard ratio = 1.06, 95% confidence interval (CI): 0.73-1.53; P = 0.76], and median BICR-PFS (95% CI) for pembrolizumab was 2.5 (2.1-4.2), compared with 3.4 (2.2-4.3) months for chemotherapy. A difference in ORR for pembrolizumab was identified (22%, 95% CI: 13% to 33%), over chemotherapy (6%, 95% CI: 2% to 14%; P = 0.004). Forty-five patients (63%) assigned to chemotherapy received pembrolizumab at progression. With follow-up to 21 August 2019 [17.5 months: (14.8-19.7)], no difference in OS was detected between groups (HR = 1.12, 95% CI: 0.74-1.69; P = 0.59), even after adjusting for crossover. Pembrolizumab safety was consistent with previous observations. Exploratory efficacy analyses by PD-L1 status demonstrated no improvements in ORR/PFS/OS. CONCLUSION This is the first randomised trial evaluating the efficacy of pembrolizumab in MPM patients progressing after/on previous platinum-based chemotherapy. In biologically unselected patients, although associated with an improved ORR, pembrolizumab improves neither PFS nor OS over single-agent chemotherapy.
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Affiliation(s)
- S Popat
- Royal Marsden Hospital Fulham Road, London, UK
| | - A Curioni-Fontecedro
- University Hospital Zürich, Department of Medical Oncology and Hematology, Zürich, Switzerland
| | - U Dafni
- National and Kapodistrian University of Athens & Frontier Science Foundation-Hellas, Athens, Greece
| | - R Shah
- Kent Oncology Centre, Maidstone, UK
| | - M O'Brien
- Royal Marsden Hospital Sutton, London, UK
| | - A Pope
- Clatterbridge Cancer Centre, Liverpool, UK
| | - P Fisher
- Weston Park Hospital, Sheffield, UK
| | - J Spicer
- King's College London, Guy's Hospital, London, UK
| | - A Roy
- University Hospital Plymouth, Plymouth, UK
| | | | - O Gautschi
- University of Bern and Cantonal Hospital Luzern, Luzern Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Swiss Group for Clinical Cancer Research, Switzerland (SAKK), Bern
| | - E Nadal
- Catalan Institute of Oncology (ICO), L'Hospitalet, Barcelona, Spain
| | - W D Janthur
- Swiss Group for Clinical Cancer Research, Switzerland (SAKK), Bern; Cantonal Hospital Aarau, Aarau, Switzerland
| | - R López Castro
- Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | | | - S Rusakiewicz
- Centre Hospitalier Universitaire Vaudois CHUV, Centre of Experimental Therapies and Department of Oncology, Lausanne, Switzerland
| | - I Letovanec
- Centre Hospitalier Universitaire Vaudois CHUV, Institute of Pathology, Lausanne, Switzerland
| | | | | | - B Ruepp
- European Thoracic Oncology Platform (ETOP), Bern, Switzerland
| | - A Gasca-Ruchti
- European Thoracic Oncology Platform (ETOP), Bern, Switzerland
| | - S Peters
- Centre Hospitalier Universitaire Vaudois, Department of Oncology, Lausanne, Switzerland
| | - R A Stahel
- University Hospital Zürich, Department of Medical Oncology and Hematology, Zürich, Switzerland.
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17
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Middleton G, Fletcher P, Popat S, Savage J, Summers Y, Greystoke A, Gilligan D, Cave J, O'Rourke N, Brewster A, Toy E, Spicer J, Jain P, Dangoor A, Mackean M, Forster M, Farley A, Wherton D, Mehmi M, Sharpe R, Mills TC, Cerone MA, Yap TA, Watkins TBK, Lim E, Swanton C, Billingham L. Publisher Correction: The National Lung Matrix Trial of personalized therapy in lung cancer. Nature 2020; 585:E21. [PMID: 32887973 DOI: 10.1038/s41586-020-2656-3] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
An amendment to this paper has been published and can be accessed via a link at the top of the paper.
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Affiliation(s)
- Gary Middleton
- Institute of Immunology & Immunotherapy, University of Birmingham, Birmingham, UK. .,University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
| | - Peter Fletcher
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | | | - Joshua Savage
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | | | | | | | - Judith Cave
- Southampton University Hospitals NHS Trust, Southampton, UK
| | | | | | - Elizabeth Toy
- Royal Devon and Exeter Foundation NHS Trust, Exeter, UK
| | - James Spicer
- King's College London, Guy's Hospital, London, UK
| | - Pooja Jain
- St James's University Hospital, Leeds, UK
| | - Adam Dangoor
- Bristol Haematology and Oncology Centre, Bristol, UK
| | | | | | - Amanda Farley
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Dee Wherton
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Manita Mehmi
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Rowena Sharpe
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | | | | | - Timothy A Yap
- The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | | | | | - Charles Swanton
- The Francis Crick Institute, London, UK.,Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, University College London, London, UK
| | - Lucinda Billingham
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
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18
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Middleton G, Fletcher P, Popat S, Savage J, Summers Y, Greystoke A, Gilligan D, Cave J, O'Rourke N, Brewster A, Toy E, Spicer J, Jain P, Dangoor A, Mackean M, Forster M, Farley A, Wherton D, Mehmi M, Sharpe R, Mills TC, Cerone MA, Yap TA, Watkins TBK, Lim E, Swanton C, Billingham L. The National Lung Matrix Trial of personalized therapy in lung cancer. Nature 2020; 583:807-812. [PMID: 32669708 PMCID: PMC7116732 DOI: 10.1038/s41586-020-2481-8] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 06/08/2020] [Indexed: 02/06/2023]
Abstract
The majority of targeted therapies for non-small-cell lung cancer (NSCLC) are directed against oncogenic drivers that are more prevalent in patients with light exposure to tobacco smoke1-3. As this group represents around 20% of all patients with lung cancer, the discovery of stratified medicine options for tobacco-associated NSCLC is a high priority. Umbrella trials seek to streamline the investigation of genotype-based treatments by screening tumours for multiple genomic alterations and triaging patients to one of several genotype-matched therapeutic agents. Here we report the current outcomes of 19 drug-biomarker cohorts from the ongoing National Lung Matrix Trial, the largest umbrella trial in NSCLC. We use next-generation sequencing to match patients to appropriate targeted therapies on the basis of their tumour genotype. The Bayesian trial design enables outcome data from open cohorts that are still recruiting to be reported alongside data from closed cohorts. Of the 5,467 patients that were screened, 2,007 were molecularly eligible for entry into the trial, and 302 entered the trial to receive genotype-matched therapy-including 14 that re-registered to the trial for a sequential trial drug. Despite pre-clinical data supporting the drug-biomarker combinations, current evidence shows that a limited number of combinations demonstrate clinically relevant benefits, which remain concentrated in patients with lung cancers that are associated with minimal exposure to tobacco smoke.
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Affiliation(s)
- Gary Middleton
- Institute of Immunology & Immunotherapy, University of Birmingham, Birmingham, UK.
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
| | - Peter Fletcher
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | | | - Joshua Savage
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | | | | | | | - Judith Cave
- Southampton University Hospitals NHS Trust, Southampton, UK
| | | | | | - Elizabeth Toy
- Royal Devon and Exeter Foundation NHS Trust, Exeter, UK
| | - James Spicer
- King's College London, Guy's Hospital, London, UK
| | - Pooja Jain
- St James's University Hospital, Leeds, UK
| | - Adam Dangoor
- Bristol Haematology and Oncology Centre, Bristol, UK
| | | | | | - Amanda Farley
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Dee Wherton
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Manita Mehmi
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Rowena Sharpe
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | | | | | - Timothy A Yap
- The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | | | | | - Charles Swanton
- The Francis Crick Institute, London, UK
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, University College London, London, UK
| | - Lucinda Billingham
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
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Noorani A, Li X, Goddard M, Crawte J, Alexandrov LB, Secrier M, Eldridge MD, Bower L, Weaver J, Lao-Sirieix P, Martincorena I, Debiram-Beecham I, Grehan N, MacRae S, Malhotra S, Miremadi A, Thomas T, Galbraith S, Petersen L, Preston SD, Gilligan D, Hindmarsh A, Hardwick RH, Stratton MR, Wedge DC, Fitzgerald RC. Genomic evidence supports a clonal diaspora model for metastases of esophageal adenocarcinoma. Nat Genet 2020; 52:74-83. [PMID: 31907488 PMCID: PMC7100916 DOI: 10.1038/s41588-019-0551-3] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [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: 10/21/2018] [Accepted: 11/19/2019] [Indexed: 01/23/2023]
Abstract
The poor outcomes in esophageal adenocarcinoma (EAC) prompted us to interrogate the pattern and timing of metastatic spread. Whole-genome sequencing and phylogenetic analysis of 388 samples across 18 individuals with EAC showed, in 90% of patients, that multiple subclones from the primary tumor spread very rapidly from the primary site to form multiple metastases, including lymph nodes and distant tissues-a mode of dissemination that we term 'clonal diaspora'. Metastatic subclones at autopsy were present in tissue and blood samples from earlier time points. These findings have implications for our understanding and clinical evaluation of EAC.
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Affiliation(s)
| | - Xiaodun Li
- MRC Cancer Unit, University of Cambridge, Cambridge, UK
| | - Martin Goddard
- Department of Histopathology, Papworth Hospital NHS Trust, Cambridge, UK
| | - Jason Crawte
- MRC Cancer Unit, University of Cambridge, Cambridge, UK
| | - Ludmil B Alexandrov
- Cellular and Molecular Medicine, University of California, San Diego, San Diego, CA, USA
| | - Maria Secrier
- Cancer Research UK Cambridge Research Institute, Cambridge, UK
| | | | - Lawrence Bower
- Cancer Research UK Cambridge Research Institute, Cambridge, UK
| | - Jamie Weaver
- MRC Cancer Unit, University of Cambridge, Cambridge, UK
| | | | | | | | - Nicola Grehan
- MRC Cancer Unit, University of Cambridge, Cambridge, UK
| | - Shona MacRae
- MRC Cancer Unit, University of Cambridge, Cambridge, UK
| | - Shalini Malhotra
- Department of Histopathology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Ahmad Miremadi
- Department of Histopathology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | - Sarah Galbraith
- Department of Palliative Care, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | - Stephen D Preston
- Department of Histopathology, Papworth Hospital NHS Trust, Cambridge, UK
| | - David Gilligan
- Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Andrew Hindmarsh
- Cambridge Oesophago-Gastric Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Richard H Hardwick
- Cambridge Oesophago-Gastric Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | - David C Wedge
- Big Data Institute, University of Oxford, Oxford, UK.
- Oxford NIHR Biomedical Research Centre, Oxford, UK.
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Verghese P, Jayaprakash KT, Yip K, Screaton N, Parfrey H, Simler N, Gilligan D, Thillai M. Management of lung cancer in patients with interstitial lung disease. Lung Cancer 2020. [DOI: 10.1016/s0169-5002(20)30234-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Middleton G, Popat S, Fletcher P, Summers Y, Greystoke A, Gilligan D, Cave J, O'Rourke N, Brewster A, Toy E, Spicer J, Savage J, Sharpe R, Yap T, Swanton C, Billingham L. PL02.09 National Lung Matrix Trial (NLMT): First Results from an Umbrella Phase II Trial in Advanced Non-Small Cell Lung Cancer (NSCLC). J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Popat S, Curioni-Fontecedro A, Polydoropoulou V, Shah R, O’Brien M, Pope A, Fisher P, Spicer J, Roy A, Gilligan D, Gautschi O, Nadal E, Janthur WD, López Castro R, García Campelo R, Roschitzki-Voser H, Ruepp B, Rusakiewicz S, Peters S, Stahel R. A multicentre randomized phase III trial comparing pembrolizumab (P) vs single agent chemotherapy (CT) for advanced pre-treated malignant pleural mesothelioma (MPM): Results from the European Thoracic Oncology Platform (ETOP 9-15) PROMISE-meso trial. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz394.091] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [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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Fennell DA, Taylor P, Gilligan D, Nakano T, Scherpereel A, Pavlakis N, van Meerbeeck JP, Aerts JGJV, Nowak AK, Kindler H, Baas P. Reply to K. Masuda et al. J Clin Oncol 2019; 37:2294-2295. [PMID: 31329517 DOI: 10.1200/jco.19.01208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Dean A Fennell
- Dean A. Fennell, PhD, MD, University of Leicester and University Hospitals of Leicester National Health Service Trust, Leicester, United Kingdom; Paul Taylor, MD, Wythenshawe Hospital, Manchester, United Kingdom; David Gilligan, MD, Cambridge University Hospitals National Health Service Foundation Trust, Addenbrooke's Hospital, Cambridge, United Kingdom; Takashi Nakano, MD, PhD, Hyogo College of Medicine, Nishinomiya, Japan; Arnaud Scherpereel, MD, PhD, Calmette Hospital, Regional University Hospital of Lille, Lille, France; Nick Pavlakis, MD, PhD, Northern Cancer Institute, St Leonards, NSW, Australia; Jan P. van Meerbeeck, MD, PhD, Universitair Ziekenuis, Antwerp, Belgium; Joachim G.J.V. Aerts, MD, PhD, Erasmus Medical College, Rotterdam, the Netherlands; Anna K. Nowak, MD, PhD, University of Western Australia and Sir Charles Gairdner Hospital, Perth, WA, Australia; Hedy Kindler, MD, University of Chicago Medical Center, Chicago, IL; and Paul Baas, MD, PhD, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Paul Taylor
- Dean A. Fennell, PhD, MD, University of Leicester and University Hospitals of Leicester National Health Service Trust, Leicester, United Kingdom; Paul Taylor, MD, Wythenshawe Hospital, Manchester, United Kingdom; David Gilligan, MD, Cambridge University Hospitals National Health Service Foundation Trust, Addenbrooke's Hospital, Cambridge, United Kingdom; Takashi Nakano, MD, PhD, Hyogo College of Medicine, Nishinomiya, Japan; Arnaud Scherpereel, MD, PhD, Calmette Hospital, Regional University Hospital of Lille, Lille, France; Nick Pavlakis, MD, PhD, Northern Cancer Institute, St Leonards, NSW, Australia; Jan P. van Meerbeeck, MD, PhD, Universitair Ziekenuis, Antwerp, Belgium; Joachim G.J.V. Aerts, MD, PhD, Erasmus Medical College, Rotterdam, the Netherlands; Anna K. Nowak, MD, PhD, University of Western Australia and Sir Charles Gairdner Hospital, Perth, WA, Australia; Hedy Kindler, MD, University of Chicago Medical Center, Chicago, IL; and Paul Baas, MD, PhD, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - David Gilligan
- Dean A. Fennell, PhD, MD, University of Leicester and University Hospitals of Leicester National Health Service Trust, Leicester, United Kingdom; Paul Taylor, MD, Wythenshawe Hospital, Manchester, United Kingdom; David Gilligan, MD, Cambridge University Hospitals National Health Service Foundation Trust, Addenbrooke's Hospital, Cambridge, United Kingdom; Takashi Nakano, MD, PhD, Hyogo College of Medicine, Nishinomiya, Japan; Arnaud Scherpereel, MD, PhD, Calmette Hospital, Regional University Hospital of Lille, Lille, France; Nick Pavlakis, MD, PhD, Northern Cancer Institute, St Leonards, NSW, Australia; Jan P. van Meerbeeck, MD, PhD, Universitair Ziekenuis, Antwerp, Belgium; Joachim G.J.V. Aerts, MD, PhD, Erasmus Medical College, Rotterdam, the Netherlands; Anna K. Nowak, MD, PhD, University of Western Australia and Sir Charles Gairdner Hospital, Perth, WA, Australia; Hedy Kindler, MD, University of Chicago Medical Center, Chicago, IL; and Paul Baas, MD, PhD, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Takashi Nakano
- Dean A. Fennell, PhD, MD, University of Leicester and University Hospitals of Leicester National Health Service Trust, Leicester, United Kingdom; Paul Taylor, MD, Wythenshawe Hospital, Manchester, United Kingdom; David Gilligan, MD, Cambridge University Hospitals National Health Service Foundation Trust, Addenbrooke's Hospital, Cambridge, United Kingdom; Takashi Nakano, MD, PhD, Hyogo College of Medicine, Nishinomiya, Japan; Arnaud Scherpereel, MD, PhD, Calmette Hospital, Regional University Hospital of Lille, Lille, France; Nick Pavlakis, MD, PhD, Northern Cancer Institute, St Leonards, NSW, Australia; Jan P. van Meerbeeck, MD, PhD, Universitair Ziekenuis, Antwerp, Belgium; Joachim G.J.V. Aerts, MD, PhD, Erasmus Medical College, Rotterdam, the Netherlands; Anna K. Nowak, MD, PhD, University of Western Australia and Sir Charles Gairdner Hospital, Perth, WA, Australia; Hedy Kindler, MD, University of Chicago Medical Center, Chicago, IL; and Paul Baas, MD, PhD, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Arnaud Scherpereel
- Dean A. Fennell, PhD, MD, University of Leicester and University Hospitals of Leicester National Health Service Trust, Leicester, United Kingdom; Paul Taylor, MD, Wythenshawe Hospital, Manchester, United Kingdom; David Gilligan, MD, Cambridge University Hospitals National Health Service Foundation Trust, Addenbrooke's Hospital, Cambridge, United Kingdom; Takashi Nakano, MD, PhD, Hyogo College of Medicine, Nishinomiya, Japan; Arnaud Scherpereel, MD, PhD, Calmette Hospital, Regional University Hospital of Lille, Lille, France; Nick Pavlakis, MD, PhD, Northern Cancer Institute, St Leonards, NSW, Australia; Jan P. van Meerbeeck, MD, PhD, Universitair Ziekenuis, Antwerp, Belgium; Joachim G.J.V. Aerts, MD, PhD, Erasmus Medical College, Rotterdam, the Netherlands; Anna K. Nowak, MD, PhD, University of Western Australia and Sir Charles Gairdner Hospital, Perth, WA, Australia; Hedy Kindler, MD, University of Chicago Medical Center, Chicago, IL; and Paul Baas, MD, PhD, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Nick Pavlakis
- Dean A. Fennell, PhD, MD, University of Leicester and University Hospitals of Leicester National Health Service Trust, Leicester, United Kingdom; Paul Taylor, MD, Wythenshawe Hospital, Manchester, United Kingdom; David Gilligan, MD, Cambridge University Hospitals National Health Service Foundation Trust, Addenbrooke's Hospital, Cambridge, United Kingdom; Takashi Nakano, MD, PhD, Hyogo College of Medicine, Nishinomiya, Japan; Arnaud Scherpereel, MD, PhD, Calmette Hospital, Regional University Hospital of Lille, Lille, France; Nick Pavlakis, MD, PhD, Northern Cancer Institute, St Leonards, NSW, Australia; Jan P. van Meerbeeck, MD, PhD, Universitair Ziekenuis, Antwerp, Belgium; Joachim G.J.V. Aerts, MD, PhD, Erasmus Medical College, Rotterdam, the Netherlands; Anna K. Nowak, MD, PhD, University of Western Australia and Sir Charles Gairdner Hospital, Perth, WA, Australia; Hedy Kindler, MD, University of Chicago Medical Center, Chicago, IL; and Paul Baas, MD, PhD, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Jan P van Meerbeeck
- Dean A. Fennell, PhD, MD, University of Leicester and University Hospitals of Leicester National Health Service Trust, Leicester, United Kingdom; Paul Taylor, MD, Wythenshawe Hospital, Manchester, United Kingdom; David Gilligan, MD, Cambridge University Hospitals National Health Service Foundation Trust, Addenbrooke's Hospital, Cambridge, United Kingdom; Takashi Nakano, MD, PhD, Hyogo College of Medicine, Nishinomiya, Japan; Arnaud Scherpereel, MD, PhD, Calmette Hospital, Regional University Hospital of Lille, Lille, France; Nick Pavlakis, MD, PhD, Northern Cancer Institute, St Leonards, NSW, Australia; Jan P. van Meerbeeck, MD, PhD, Universitair Ziekenuis, Antwerp, Belgium; Joachim G.J.V. Aerts, MD, PhD, Erasmus Medical College, Rotterdam, the Netherlands; Anna K. Nowak, MD, PhD, University of Western Australia and Sir Charles Gairdner Hospital, Perth, WA, Australia; Hedy Kindler, MD, University of Chicago Medical Center, Chicago, IL; and Paul Baas, MD, PhD, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Joachim G J V Aerts
- Dean A. Fennell, PhD, MD, University of Leicester and University Hospitals of Leicester National Health Service Trust, Leicester, United Kingdom; Paul Taylor, MD, Wythenshawe Hospital, Manchester, United Kingdom; David Gilligan, MD, Cambridge University Hospitals National Health Service Foundation Trust, Addenbrooke's Hospital, Cambridge, United Kingdom; Takashi Nakano, MD, PhD, Hyogo College of Medicine, Nishinomiya, Japan; Arnaud Scherpereel, MD, PhD, Calmette Hospital, Regional University Hospital of Lille, Lille, France; Nick Pavlakis, MD, PhD, Northern Cancer Institute, St Leonards, NSW, Australia; Jan P. van Meerbeeck, MD, PhD, Universitair Ziekenuis, Antwerp, Belgium; Joachim G.J.V. Aerts, MD, PhD, Erasmus Medical College, Rotterdam, the Netherlands; Anna K. Nowak, MD, PhD, University of Western Australia and Sir Charles Gairdner Hospital, Perth, WA, Australia; Hedy Kindler, MD, University of Chicago Medical Center, Chicago, IL; and Paul Baas, MD, PhD, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Anna K Nowak
- Dean A. Fennell, PhD, MD, University of Leicester and University Hospitals of Leicester National Health Service Trust, Leicester, United Kingdom; Paul Taylor, MD, Wythenshawe Hospital, Manchester, United Kingdom; David Gilligan, MD, Cambridge University Hospitals National Health Service Foundation Trust, Addenbrooke's Hospital, Cambridge, United Kingdom; Takashi Nakano, MD, PhD, Hyogo College of Medicine, Nishinomiya, Japan; Arnaud Scherpereel, MD, PhD, Calmette Hospital, Regional University Hospital of Lille, Lille, France; Nick Pavlakis, MD, PhD, Northern Cancer Institute, St Leonards, NSW, Australia; Jan P. van Meerbeeck, MD, PhD, Universitair Ziekenuis, Antwerp, Belgium; Joachim G.J.V. Aerts, MD, PhD, Erasmus Medical College, Rotterdam, the Netherlands; Anna K. Nowak, MD, PhD, University of Western Australia and Sir Charles Gairdner Hospital, Perth, WA, Australia; Hedy Kindler, MD, University of Chicago Medical Center, Chicago, IL; and Paul Baas, MD, PhD, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Hedy Kindler
- Dean A. Fennell, PhD, MD, University of Leicester and University Hospitals of Leicester National Health Service Trust, Leicester, United Kingdom; Paul Taylor, MD, Wythenshawe Hospital, Manchester, United Kingdom; David Gilligan, MD, Cambridge University Hospitals National Health Service Foundation Trust, Addenbrooke's Hospital, Cambridge, United Kingdom; Takashi Nakano, MD, PhD, Hyogo College of Medicine, Nishinomiya, Japan; Arnaud Scherpereel, MD, PhD, Calmette Hospital, Regional University Hospital of Lille, Lille, France; Nick Pavlakis, MD, PhD, Northern Cancer Institute, St Leonards, NSW, Australia; Jan P. van Meerbeeck, MD, PhD, Universitair Ziekenuis, Antwerp, Belgium; Joachim G.J.V. Aerts, MD, PhD, Erasmus Medical College, Rotterdam, the Netherlands; Anna K. Nowak, MD, PhD, University of Western Australia and Sir Charles Gairdner Hospital, Perth, WA, Australia; Hedy Kindler, MD, University of Chicago Medical Center, Chicago, IL; and Paul Baas, MD, PhD, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Paul Baas
- Dean A. Fennell, PhD, MD, University of Leicester and University Hospitals of Leicester National Health Service Trust, Leicester, United Kingdom; Paul Taylor, MD, Wythenshawe Hospital, Manchester, United Kingdom; David Gilligan, MD, Cambridge University Hospitals National Health Service Foundation Trust, Addenbrooke's Hospital, Cambridge, United Kingdom; Takashi Nakano, MD, PhD, Hyogo College of Medicine, Nishinomiya, Japan; Arnaud Scherpereel, MD, PhD, Calmette Hospital, Regional University Hospital of Lille, Lille, France; Nick Pavlakis, MD, PhD, Northern Cancer Institute, St Leonards, NSW, Australia; Jan P. van Meerbeeck, MD, PhD, Universitair Ziekenuis, Antwerp, Belgium; Joachim G.J.V. Aerts, MD, PhD, Erasmus Medical College, Rotterdam, the Netherlands; Anna K. Nowak, MD, PhD, University of Western Australia and Sir Charles Gairdner Hospital, Perth, WA, Australia; Hedy Kindler, MD, University of Chicago Medical Center, Chicago, IL; and Paul Baas, MD, PhD, Netherlands Cancer Institute, Amsterdam, the Netherlands
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Waite MMA, Martinelli AW, Preston SD, Gudgin E, Symington E, Rintoul RC, Peryt A, Coughlin P, Hayes P, Gilligan D, Besser M. A hypercoagulable state leading to venous limb gangrene associated with occult lung adenocarcinoma. Clin Case Rep 2019; 7:888-892. [PMID: 31110709 PMCID: PMC6510014 DOI: 10.1002/ccr3.2106] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Revised: 01/29/2019] [Accepted: 02/17/2019] [Indexed: 11/12/2022] Open
Abstract
We report a case of lung adenocarcinoma-associated hypercoagulability leading to venous limb gangrene, managed successfully with argatroban and then dabigatran. Use of idarucizumab permitted diagnostic investigations, leading to targeted antineoplastic therapy with crizotinib, surgical resection with curative intent, and continued survival over 2 years after the index event.
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Affiliation(s)
- Matthew M. A. Waite
- Addenbrooke's HospitalUniversity of Cambridge School of Clinical MedicineCambridgeUK
| | | | - Stephen D. Preston
- Department of Thoracic OncologyPapworth Hospital NHS Foundation TrustCambridgeUK
| | - Emma Gudgin
- Department of HaematologyPapworth Hospital NHS Foundation TrustCambridgeUK
| | - Emily Symington
- Department of HaematologyPapworth Hospital NHS Foundation TrustCambridgeUK
| | - Robert C. Rintoul
- Department of Thoracic OncologyPapworth Hospital NHS Foundation TrustCambridgeUK
| | - Adam Peryt
- Department of Thoracic SurgeryPapworth Hospital NHS Foundation TrustCambridgeUK
| | - Patrick Coughlin
- Department of Vascular and Endovascular SurgeryAddenbrooke's HospitalCambridgeUK
| | - Paul Hayes
- Department of Vascular and Endovascular SurgeryAddenbrooke's HospitalCambridgeUK
| | - David Gilligan
- Department of Thoracic OncologyPapworth Hospital NHS Foundation TrustCambridgeUK
| | - Martin Besser
- Department of HaematologyPapworth Hospital NHS Foundation TrustCambridgeUK
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25
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Affiliation(s)
- Anand Bhopal
- 1 Health Protection and Medical Directorate, Public Health England, London SE1 8UG, UK
| | - Michael D Peake
- 2 Centre for Cancer Outcomes, University College London Hospitals Cancer Collaborative, London NW1 2BU, UK.,3 University of Leicester, Glenfield Hospital, Leicester LE3 9QP, UK.,4 National Cancer Registration and Analysis Service, Public Health England, London, UK
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Fennell DA, Baas P, Taylor P, Nowak AK, Gilligan D, Nakano T, Pachter JA, Weaver DT, Scherpereel A, Pavlakis N, van Meerbeeck JP, Cedrés S, Nolan L, Kindler H, Aerts JG. Maintenance Defactinib Versus Placebo After First-Line Chemotherapy in Patients With Merlin-Stratified Pleural Mesothelioma: COMMAND—A Double-Blind, Randomized, Phase II Study. J Clin Oncol 2019; 37:790-798. [DOI: 10.1200/jco.2018.79.0543] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Inhibition of focal adhesion kinase has been shown to selectively kill mesothelioma cells that express low levels of moesin-ezrin-radixin-like protein (merlin). On this basis, we designed a randomized, phase II trial to investigate whether defactinib as maintenance therapy after standard first-line chemotherapy could improve progression-free survival (PFS) in patients with malignant pleural mesothelioma (MPM). METHODS This global, double-blind, randomized, placebo-controlled trial was conducted in patients with advanced MPM and disease control after at least four cycles of first-line chemotherapy. Patients were stratified for merlin and then randomly assigned (in a 1:1 fashion) to receive either oral defactinib or placebo until disease progression, unacceptable toxicity, or withdrawal occurred. The coprimary end points were PFS and overall survival (OS). Quality of life (QoL) was assessed using the Lung Cancer Symptom Scale for Mesothelioma tool. RESULTS Three hundred forty-four patients were randomly assigned to receive either defactinib (n = 173) or placebo (n = 171). The median PFS was 4.1 months (95% CI, 2.9 to 5.6 months) for defactinib versus 4.0 months (95% CI, 2.9 to 4.2 months) for placebo. The median OS was 12.7 months (95% CI, 9.1 to 21 months) for defactinib versus 13.6 months (95% CI, 9.6 to 21.2 months) for placebo (hazard ratio, 1.0; 95% CI, 0.7 to 1.4). Although shorter survival for both defactinib- and placebo-treated patients was observed, in the patients who had merlin-low MPM compared with the patients who had merlin-high MPM, there were no statistical differences in response rate, PFS, OS, or QoL between the treatment groups. The most common grade 3 or worse adverse events were nausea, diarrhea, fatigue, dyspnea, and decreased appetite. CONCLUSION Neither PFS nor OS was improved by defactinib after first-line chemotherapy in patients with merlin-low MPM. Defactinib cannot be recommended as maintenance therapy for advanced MPM.
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Affiliation(s)
| | - Paul Baas
- Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Paul Taylor
- Wythenshawe Hospital, Manchester, United Kingdom
| | - Anna K. Nowak
- University of Western Australia and Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - David Gilligan
- Cambridge University Hospitals National Health Service Foundation Trust, Addenbrooke’s Hospital, Cambridge, United Kingdom
| | | | | | | | - Arnaud Scherpereel
- Calmette Hospital, Regional University Hospital of Lille, Lille Cedex, France
| | - Nick Pavlakis
- Northern Cancer Institute, St Leonards, NSW, Australia
| | | | | | - Luke Nolan
- University Hospital, Southampton, United Kingdom
| | - Hedy Kindler
- University of Chicago Medical Center, Chicago, IL
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Bayman N, Appel W, Ashcroft L, Baldwin DR, Bates A, Darlison L, Edwards JG, Ezhil V, Gilligan D, Hatton M, Jegannathen A, Mansy T, Peake MD, Pemberton L, Rintoul RC, Snee M, Ryder WD, Taylor P, Faivre-Finn C. Prophylactic Irradiation of Tracts in Patients With Malignant Pleural Mesothelioma: An Open-Label, Multicenter, Phase III Randomized Trial. J Clin Oncol 2019; 37:1200-1208. [PMID: 30920878 DOI: 10.1200/jco.18.01678] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
PURPOSE Prophylactic irradiation to the chest wall after diagnostic or therapeutic procedures in patients with malignant pleural mesothelioma (MPM) has been a widespread practice across Europe, although the efficacy of this treatment is uncertain. In this study, we aimed to determine the efficacy of prophylactic radiotherapy in reducing the incidence of chest wall metastases (CWM) after a procedure in MPM. METHODS After undergoing a chest wall procedure, patients with MPM were randomly assigned to receive prophylactic radiotherapy (within 42 days of the procedure) or no radiotherapy. Open thoracotomies, needle biopsies, and indwelling pleural catheters were excluded. Prophylactic radiotherapy was delivered at a dose of 21 Gy in three fractions over three consecutive working days, using a single electron field adapted to maximize coverage of the tract from skin surface to pleura. The primary outcome was the incidence of CWM within 6 months from random assignment, assessed in the intention-to-treat population. Stratification factors included epithelioid histology and intention to give chemotherapy. RESULTS Between July 30, 2012, and December 12, 2015, 375 patients were recruited from 54 centers and randomly assigned to receive prophylactic radiotherapy (n = 186) or no prophylactic radiotherapy (n = 189). Participants were well matched at baseline. No significant difference was seen in the incidence of CWM at 6 months between the prophylactic radiotherapy and no radiotherapy groups (no. [%]: 6 [3.2] v 10 [5.3], respectively; odds ratio, 0.60; 95% CI, 0.17 to 1.86; P = .44). Skin toxicity was the most common radiotherapy-related adverse event in the prophylactic radiotherapy group, with 96 patients (51.6%) receiving grade 1; 19 (10.2%), grade 2; and 1 (0.5%) grade 3 radiation dermatitis (Common Terminology Criteria for Adverse Events, version 4.0). CONCLUSION There is no role for the routine use of prophylactic irradiation to chest wall procedure sites in patients with MPM.
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Affiliation(s)
- Neil Bayman
- 1 The Christie National Health Service Foundation Trust, Manchester, United Kingdom
| | - Wiebke Appel
- 2 Lancashire Teaching Hospitals National Health Service Foundation Trust, Preston, United Kingdom
| | - Linda Ashcroft
- 1 The Christie National Health Service Foundation Trust, Manchester, United Kingdom
| | - David R Baldwin
- 3 Nottingham University Hospitals National Health Service Trust, Nottingham, United Kingdom
| | - Andrew Bates
- 4 University Hospital Southampton National Health Service Foundation Trust, Southampton, United Kingdom
| | - Liz Darlison
- 5 University Hospitals of Leicester National Health Service Trust, Leicester, United Kingdom
| | - John G Edwards
- 6 Sheffield Teaching Hospitals National Health Service Foundation Trust, Sheffield, United Kingdom
| | - Veni Ezhil
- 7 Royal Surrey County Hospital, National Health Service Foundation Trust, Guildford, United Kingdom
| | - David Gilligan
- 8 Cambridge University Hospital National Health Service Foundation Trust, Cambridge, United Kingdom
| | - Matthew Hatton
- 6 Sheffield Teaching Hospitals National Health Service Foundation Trust, Sheffield, United Kingdom
| | - Apurna Jegannathen
- 9 University Hospitals of North Midlands National Health Service Trust, Stoke-on-Trent, United Kingdom
| | - Talal Mansy
- 10 South Tees Hospitals National Health Service Foundation Trust, Middlesbrough, United Kingdom
| | - Michael D Peake
- 5 University Hospitals of Leicester National Health Service Trust, Leicester, United Kingdom
| | - Laura Pemberton
- 1 The Christie National Health Service Foundation Trust, Manchester, United Kingdom
| | - Robert C Rintoul
- 11 Cancer Research UK Cambridge Centre, Cambridge, United Kingdom
| | - Michael Snee
- 12 Leeds Teaching Hospitals National Health Service Trust, Leeds, United Kingdom
| | - W David Ryder
- 1 The Christie National Health Service Foundation Trust, Manchester, United Kingdom
| | - Paul Taylor
- 13 Manchester University National Health Service Foundation Trust, Manchester, United Kingdom
| | - Corinne Faivre-Finn
- 1 The Christie National Health Service Foundation Trust, Manchester, United Kingdom.,14 University of Manchester, Manchester, United Kingdom
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28
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Tokaca N, Gomes F, Lau S, Jackson A, Gradwell M, Gyi M, Reinius M, Valentine E, Winn E, Bhosle J, O’Brien M, Yousaf N, Blackhall F, Gilligan D, Treece S, Yip K, Geldart T, Baluch S, Gulliford T, Muthuramalingam S, Dancey G, Britten A, Brock J, Stokoe J, Jain P, Franks K, Toy E, Newsom-Davis T, Khan O, Greystoke A, Ali C, Leonard P, Summers Y, Popat S. Real-world outcomes with pembrolizumab in patients with treatment-naive advanced/metastatic NSCLC in the UK: multicentre retrospective observational study. Lung Cancer 2019. [DOI: 10.1016/s0169-5002(19)30124-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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29
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Martinelli A, Waite M, Rintoul R, Peryt A, Besser M, Gilligan D. Case report: ALK-positive NSCLC presenting as a severe prothrombotic state. Lung Cancer 2018. [DOI: 10.1016/s0169-5002(18)30043-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Harihar L, Harrington J, Gilligan D, Haslop C. Successful pregnancies in two patients following multimodality treatment for thymoma. Lung Cancer 2018. [DOI: 10.1016/s0169-5002(18)30042-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Jackson A, Fenn R, Shotton R, Williams A, Treece S, Gkogkou P, Tasigiannopoulos Z, Gilligan D, Yip K. East Anglian audit of pembrolizumab in non-small cell lung cancer. Lung Cancer 2018. [DOI: 10.1016/s0169-5002(18)30120-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Bayman N, Appel W, Ashcroft L, Baldwin D, Bates A, Darlison L, Edwards J, Ezhil V, Gilligan D, Hatton M, Mansy T, Peake M, Pemberton L, Rintoul R, Ryder D, Taylor P, Faivre-Finn C. OA 02.03 Prophylactic Irradiation of Tracts (PIT) in Patients with Pleural Mesothelioma: Results of a Multicenter Phase III Trial. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.330] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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McColl KA, Sunarto A, Slater J, Bell K, Asmus M, Fulton W, Hall K, Brown P, Gilligan D, Hoad J, Williams LM, Crane MSJ. Cyprinid herpesvirus 3 as a potential biological control agent for carp (Cyprinus carpio) in Australia: susceptibility of non-target species. J Fish Dis 2017; 40:1141-1153. [PMID: 28026008 DOI: 10.1111/jfd.12591] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 10/20/2016] [Accepted: 10/21/2016] [Indexed: 06/06/2023]
Abstract
Carp (Cyprinus carpio L.) is a pest species in Australian waterways, and cyprinid herpesvirus 3 (CyHV-3) is being considered as a potential biological control (biocontrol) agent. An important consideration for any such agent is its target specificity. In this study, the susceptibility to CyHV-3 of a range of non-target species (NTS) was tested. The NTS were as follows: 13 native Australian, and one introduced, fish species; a lamprey species; a crustacean; two native amphibian species (tadpole and mature stages); two native reptilian species; chickens; and laboratory mice. Animals were exposed to 100-1000 times the approximate minimum amount of CyHV-3 required to cause disease in carp by intraperitoneal and/or bath challenge, and then examined clinically each day over the course of 28 days post-challenge. There were no clinical signs, mortalities or histological evidence consistent with a viral infection in a wide taxonomic range of NTS. Furthermore, there was no molecular evidence of infection with CyHV-3, and, in particular, all RT-PCRs for viral mRNA were negative. As a consequence, the results encourage further investigation of CyHV-3 as a potential biocontrol agent that is specific for carp.
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Affiliation(s)
- K A McColl
- CSIRO-Australian Animal Health Laboratory, Geelong, Vic., Australia
| | - A Sunarto
- CSIRO-Australian Animal Health Laboratory, Geelong, Vic., Australia
| | - J Slater
- CSIRO-Australian Animal Health Laboratory, Geelong, Vic., Australia
| | - K Bell
- K&C Global Fisheries, Sale, Vic., Australia
| | - M Asmus
- Department of Primary Industries, Narrandera Fisheries Centre, Narrandera, NSW, Australia
| | - W Fulton
- Department of Primary Industries, Fisheries Research Branch, Queenscliff, Vic., Australia
| | - K Hall
- Department of Primary Industries, Fisheries Research Branch, Queenscliff, Vic., Australia
| | - P Brown
- The Murray-Darling Freshwater Research Centre and La Trobe University, Mildura, Vic., Australia
| | - D Gilligan
- Department of Primary Industries, Narrandera Fisheries Centre, Narrandera, NSW, Australia
| | - J Hoad
- CSIRO-Australian Animal Health Laboratory, Geelong, Vic., Australia
| | - L M Williams
- CSIRO-Australian Animal Health Laboratory, Geelong, Vic., Australia
| | - M St J Crane
- CSIRO-Australian Animal Health Laboratory, Geelong, Vic., Australia
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Szlosarek PW, Baas P, Ceresoli GL, Fennell DA, Gilligan D, Johnston A, Lee P, Mansfield AS, Nolan L, Nowak AK, Steele JPC, Taylor P, Tsao AS, Zauderer MG, Bomalaski JS. ATOMIC-Meso: A randomized phase 2/3 trial of ADI-PEG20 or placebo with pemetrexed and cisplatin in patients with argininosuccinate synthetase 1-deficient non-epithelioid mesothelioma. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.tps8582] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS8582 Background: Argininosuccinate synthetase 1 (ASS1)-deficient malignant pleural mesothelioma (MPM) is sensitive to arginine deprivation therapy with pegylated arginine deiminase (ADI-PEG20), which also enhances the cytotoxicity of pemetrexed. The TRAP Phase 1 trial (NCT02029690) of ADI-PEG 20 combined with 1st-line pemetrexed (PEM) and cisplatin (CDDP) chemotherapy revealed a 94% disease control rate in non-epithelioid (biphasic and sarcomatoid) MPM subtypes characterized by a 75% rate of ASS1 loss. Thus, we plan to assess the efficacy of ADI-PEG20 or placebo combined with PEM and CDDP in patients (pts) with poor prognosis MPM in a randomized, placebo-controlled, double-blind phase 2/3 global trial. Methods: Up to 386 good performance (ECOG 0-1) pts with non-epithelioid malignant pleural mesothelioma will be enrolled in a phase 2/3 adaptive, biomarker-driven study design. Biopsies will be required prior to randomization: ASS1-agnostic pts will be enrolled initially (phase 2 stage) with an option to restrict enrolment to ASS1-deficient MPM (phase 3 stage). Pts will be randomized to receive weekly ADI-PEG20 (36 mg/m2 IM) or placebo with standard doses of PEM and CDDP for a maximum of 18 weeks (6 cycles) of treatment. Pts who develop CDDP toxicity may be switched to carboplatin. Pts will be assessed every 6 weeks using modified RECIST (RECIST 1.1 allowed for pts with significant extrathoracic disease). The primary endpoint for the phase 2 stage will be overall response rate (ORR) with secondary endpoints of overall survival (OS), safety and toxicity. The phase 2 will test ORR proportions with the placebo triplet set at 15% vs. 35% for the ADI-PEG 20 triplet, with a 1:1 randomization, 80% power. After recruitment of 176 pts, the phase 2 will convert to a phase 3 study with the primary endpoint of OS. In summary, ATOMIC-Meso is the first triplet chemotherapy study to assess the role of targeted arginine deprivation in aggressive subtypes of mesothelioma. Pt accrual has commenced across the US and Asia, with enrolment due in Europe and Australia by 2nd quarter of 2017. [Trial sponsored by Polaris Group]. Clinical trial information: NCT02709512.
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Affiliation(s)
| | - Paul Baas
- The Netherlands Cancer Institute (NKI), Amsterdam, Netherlands
| | | | | | | | | | - Phuong Lee
- Polaris Pharmaceuticals Inc., San Diego, United Kingdom
| | | | - Luke Nolan
- Southampton University Hospital, Hampshire, United Kingdom
| | | | | | - Paul Taylor
- Wythenshawe Hospital, Manchester, United Kingdom
| | - Anne S. Tsao
- The University of Texas MD Anderson Cancer Center, Houston, TX
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Ewing G, Penfold C, Benson JA, Mahadeva R, Howson S, Burkin J, Booth S, Lovick R, Gilligan D, Todd C, Farquhar M. Clinicians' Views of Educational Interventions for Carers of Patients With Breathlessness Due to Advanced Disease: Findings From an Online Survey. J Pain Symptom Manage 2017; 53:265-271. [PMID: 27725250 DOI: 10.1016/j.jpainsymman.2016.08.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 07/20/2016] [Accepted: 08/04/2016] [Indexed: 11/17/2022]
Abstract
CONTEXT Carers' needs in advanced disease, and specifically in relation to breathlessness, are well evidenced. Publications on educational interventions for carers of patients with advanced disease that focus on symptoms are scarce and absent for breathlessness. OBJECTIVES To establish current education provided by clinicians for carers of patients with breathlessness in advanced disease, views about educating carers about breathlessness, and relevant outcomes for a future randomized controlled trial of an educational intervention for carers. METHODS An online survey was completed by 365 clinicians: medical, nursing, and allied health professionals from primary care, hospital, and hospice. Descriptive statistics summarized respondent characteristics and survey responses, and the Chi-squared test was applied. Content analysis of free-text comments was conducted. RESULTS Most clinicians reported educating carers by educating patients at clinical contacts with patients. Carer involvement was largely an 'add-on'; an active carer education strategy, where all carers were invited to attend, was not currently apparent. Clinicians endorsed the importance of educating carers about breathlessness through increasing carer confidence and/or control, helping patients' better self-manage breathlessness and potentially reducing admissions. Joint education with patients, giving practical advice, and strategies for helping patients were advised. To inform a future trial, clinicians identified improvement in patient outcomes, particularly patient quality of life as very important in enhancing clinician adoption of an educational intervention for carers. CONCLUSION This survey revealed an appetite among clinicians for an educational intervention for carers of patients with breathlessness in advanced disease and provided important insights to underpin a future Phase II randomized controlled trial.
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Affiliation(s)
| | | | | | - Ravi Mahadeva
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Sophie Howson
- Cambridge and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Julie Burkin
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | | | - David Gilligan
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | - Morag Farquhar
- Department of Public Health & Primary Care, University of Cambridge Institute of Public Health, Cambridge, UK.
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Yip K, Conibear J, Woolf D, Tarver K, Willis B, Hall S, Sun F, Kuhan H, Lambourne B, Piskilidis P, Kussaibati R, Martin L, Satar NA, Gray C, Khan A, Doherty G, Prewett S, Smith M, Dancey G, Patterson D, Rimmer Y, Hollingdale A, Ingle C, Tasigiannopoulos Z, Aslam S, Waite K, Polychronis A, Ghafoor Q, Baijal S, Newsom-Davis T, Shah R, Forster M, Mulatero C, Greystoke A, Postmus P, Blackhall F, Gilligan D. 62: A retrospective multicentre audit of outcome among patients with anaplastic lymphoma kinase (ALK) gene rearrangement positive non-small cell lung cancer (NSCLC) who have been treated with crizotinib in England. Lung Cancer 2017. [DOI: 10.1016/s0169-5002(17)30112-5] [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: 11/25/2022]
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Farquhar M, Penfold C, Benson J, Lovick R, Mahadeva R, Howson S, Burkin J, Booth S, Gilligan D, Todd C, Ewing G. Six key topics informal carers of patients with breathlessness in advanced disease want to learn about and why: MRC phase I study to inform an educational intervention. PLoS One 2017; 12:e0177081. [PMID: 28475655 PMCID: PMC5419601 DOI: 10.1371/journal.pone.0177081] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [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: 06/30/2016] [Accepted: 04/21/2017] [Indexed: 01/17/2023] Open
Abstract
INTRODUCTION Breathlessness is a common symptom of advanced disease placing a huge burden on patients, health systems and informal carers (families and friends providing daily help and support). It causes distress and isolation. Carers provide complex personal, practical and emotional support yet often feel ill-prepared to care. They lack knowledge and confidence in their caring role. The need to educate carers and families about breathlessness is established, yet we lack robustly developed carer-targeted educational interventions to meet their needs. METHODS We conducted a qualitative interview study with twenty five purposively-sampled patient-carer dyads living with breathlessness in advanced disease (half living with advanced cancer and half with advanced chronic obstructive pulmonary disease (COPD). We sought to identify carers' educational needs (including what they wanted to learn about) and explore differences by diagnostic group in order to inform an educational intervention for carers of patients with breathlessness in advanced disease. RESULTS There was a strong desire among carers for an educational intervention on breathlessness. Six key topics emerged as salient for them: 1) understanding breathlessness, 2) managing anxiety, panic and breathlessness, 3) managing infections, 4) keeping active, 5) living positively and 6) knowing what to expect in the future. A cross-cutting theme was relationship management: there were tensions within dyads resulting from mismatched expectations related to most topics. Carers felt that knowledge-gains would not only help them to support the patient better, but also help them to manage their own frustrations, anxieties, and quality of life. Different drivers for education need were identified by diagnostic group, possibly related to differences in caring role duration and resulting impacts. CONCLUSION Meeting the educational needs of carers requires robustly developed and evaluated interventions. This study provides the evidence-base for the content of an educational intervention for carers of patients with breathlessness in advanced disease.
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Affiliation(s)
- Morag Farquhar
- School of Health Sciences, University of East Anglia, Norwich, United Kingdom
- * E-mail:
| | - Clarissa Penfold
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - John Benson
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | | | - Ravi Mahadeva
- Department of Respiratory Medicine, Cambridge University Hospitals NHS Trust, Cambridge, United Kingdom
| | | | - Julie Burkin
- Palliative Care Team, Cambridge University Hospitals NHS Trust, Cambridge, United Kingdom
| | - Sara Booth
- Department of Oncology, University of Cambridge, Cambridge, United Kingdom
| | - David Gilligan
- Department of Oncology, University of Cambridge, Cambridge, United Kingdom
| | - Christopher Todd
- School of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, United Kingdom
| | - Gail Ewing
- Centre for Family Research, University of Cambridge, Cambridge, United Kingdom
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Buckley H, Ralph A, Liu H, Gilligan D, Harden S. 73: Tyrosine kinase inhibitors (TKIs) as first-line treatment for advanced EGFR mutated non-small cell lung cancer (NSCLC): a single-centre experience. Lung Cancer 2017. [DOI: 10.1016/s0169-5002(17)30123-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Szlosarek PW, Steele JP, Nolan L, Gilligan D, Taylor P, Spicer J, Lind M, Mitra S, Shamash J, Phillips MM, Luong P, Payne S, Hillman P, Ellis S, Szyszko T, Dancey G, Butcher L, Beck S, Avril NE, Thomson J, Johnston A, Tomsa M, Lawrence C, Schmid P, Crook T, Wu BW, Bomalaski JS, Lemoine N, Sheaff MT, Rudd RM, Fennell D, Hackshaw A. Arginine Deprivation With Pegylated Arginine Deiminase in Patients With Argininosuccinate Synthetase 1-Deficient Malignant Pleural Mesothelioma: A Randomized Clinical Trial. JAMA Oncol 2017; 3:58-66. [PMID: 27584578 DOI: 10.1001/jamaoncol.2016.3049] [Citation(s) in RCA: 128] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2024]
Abstract
IMPORTANCE Preclinical studies show that arginine deprivation is synthetically lethal in argininosuccinate synthetase 1 (ASS1)-negative cancers, including mesothelioma. The role of the arginine-lowering agent pegylated arginine deiminase (ADI-PEG20) has not been evaluated in a randomized and biomarker-driven study among patients with cancer. OBJECTIVE To assess the clinical impact of arginine depletion in patients with ASS1-deficient malignant pleural mesothelioma. DESIGN, SETTING, AND PARTICIPANTS A multicenter phase 2 randomized clinical trial, the Arginine Deiminase and Mesothelioma (ADAM) study, was conducted between March 2, 2011, and May 21, 2013, at 8 academic cancer centers. Immunohistochemical screening of 201 patients (2011-2013) identified 68 with advanced ASS1-deficient malignant pleural mesothelioma. INTERVENTIONS Randomization 2:1 to arginine deprivation (ADI-PEG20, 36.8 mg/m2, weekly intramuscular) plus best supportive care (BSC) or BSC alone. MAIN OUTCOMES AND MEASURES The primary end point was progression-free survival (PFS) assessed by modified Response Evaluation Criteria in Solid Tumors (RECIST) (target hazard ratio, 0.60). Secondary end points were overall survival (OS), tumor response rate, safety, and quality of life, analyzed by intention to treat. We measured plasma arginine and citrulline levels, anti-ADI-PEG20 antibody titer, ASS1 methylation status, and metabolic response by 18F-fluorodeoxyglucose positron-emission tomography. RESULTS Median (range) follow-up in 68 adults (median [range] age, 66 [48-83] years; 19% female) was 38 (2.5-39) months. The PFS hazard ratio was 0.56 (95% CI, 0.33-0.96), with a median of 3.2 months in the ADI-PEG20 group vs 2.0 months in the BSC group (P = .03) (absolute risk, 18% vs 0% at 6 months). Best response at 4 months (modified RECIST) was stable disease: 12 of 23 (52%) in the ADI-PEG20 group vs 2 of 9 (22%) in the BSC group (P = .23). The OS curves crossed, so life expectancy was used: 15.7 months in the ADI-PEG20 group vs 12.1 months in the BSC group (difference of 3.6 [95% CI, -1.0 to 8.1] months; P = .13). The incidence of symptomatic adverse events of grade at least 3 was 11 of 44 (25%) in the ADI-PEG20 group vs 4 of 24 (17%) in the BSC group (P = .43), the most common being immune related, nonfebrile neutropenia, gastrointestinal events, and fatigue. Differential ASS1 gene-body methylation correlated with ASS1 immunohistochemistry, and longer arginine deprivation correlated with improved PFS. CONCLUSIONS AND RELEVANCE In this trial, arginine deprivation with ADI-PEG20 improved PFS in patients with ASS1-deficient mesothelioma. Targeting arginine is safe and warrants further clinical investigation in arginine-dependent cancers. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01279967.
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Affiliation(s)
- Peter W Szlosarek
- Center for Molecular Oncology, Barts Cancer Institute, Queen Mary University of London, John Vane Science Center, London, England2Barts Health NHS Trust, St Bartholomew's Hospital, London, England
| | - Jeremy P Steele
- Barts Health NHS Trust, St Bartholomew's Hospital, London, England
| | - Luke Nolan
- Southampton University Hospital NHS Foundation Trust, Southampton, England
| | - David Gilligan
- Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, England
| | - Paul Taylor
- University Hospital of South Manchester NHS Foundation Trust, Wythenshawe Hospital, Manchester, England
| | - James Spicer
- Division of Cancer Studies, King's College London, Guy's Hospital, London, England
| | - Michael Lind
- University of Hull, Castle Hill Hospital, Cottingham, England
| | | | - Jonathan Shamash
- Barts Health NHS Trust, St Bartholomew's Hospital, London, England
| | - Melissa M Phillips
- Center for Molecular Oncology, Barts Cancer Institute, Queen Mary University of London, John Vane Science Center, London, England2Barts Health NHS Trust, St Bartholomew's Hospital, London, England
| | - Phuong Luong
- Center for Molecular Oncology, Barts Cancer Institute, Queen Mary University of London, John Vane Science Center, London, England
| | - Sarah Payne
- Barts Health NHS Trust, St Bartholomew's Hospital, London, England
| | - Paul Hillman
- Barts Health NHS Trust, St Bartholomew's Hospital, London, England
| | - Stephen Ellis
- Barts Health NHS Trust, St Bartholomew's Hospital, London, England
| | - Teresa Szyszko
- King's College London, St Thomas' Hospital, London, England
| | - Gairin Dancey
- Southend University Hospital NHS Foundation Trust, Westcliff-on-Sea, England
| | - Lee Butcher
- University College London Cancer Institute, University College London, London, England
| | - Stephan Beck
- University College London Cancer Institute, University College London, London, England
| | | | - Jim Thomson
- Polaris Pharmaceuticals Inc, San Diego, California
| | | | - Marianne Tomsa
- Center for Experimental Cancer Medicine, Barts Cancer Institute, Queen Mary University of London, John Vane Science Center, London, England
| | - Cheryl Lawrence
- Center for Experimental Cancer Medicine, Barts Cancer Institute, Queen Mary University of London, John Vane Science Center, London, England
| | - Peter Schmid
- Barts Health NHS Trust, St Bartholomew's Hospital, London, England14Center for Experimental Cancer Medicine, Barts Cancer Institute, Queen Mary University of London, John Vane Science Center, London, England
| | - Timothy Crook
- Southend University Hospital NHS Foundation Trust, Westcliff-on-Sea, England
| | - Bor-Wen Wu
- Polaris Pharmaceuticals Inc, San Diego, California
| | | | - Nicholas Lemoine
- Center for Molecular Oncology, Barts Cancer Institute, Queen Mary University of London, John Vane Science Center, London, England
| | - Michael T Sheaff
- Barts Health NHS Trust, St Bartholomew's Hospital, London, England
| | - Robin M Rudd
- Barts Health NHS Trust, St Bartholomew's Hospital, London, England
| | - Dean Fennell
- University of Leicester, Leicester Royal Infirmary, Leicester, England
| | - Allan Hackshaw
- Cancer Research UK and UCL Cancer Trials Center, University College London, London, England
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Harrisson KA, Yen JDL, Pavlova A, Rourke ML, Gilligan D, Ingram BA, Lyon J, Tonkin Z, Sunnucks P. Identifying environmental correlates of intraspecific genetic variation. Heredity (Edinb) 2016; 117:155-64. [PMID: 27273322 PMCID: PMC4981683 DOI: 10.1038/hdy.2016.37] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 04/14/2016] [Accepted: 04/18/2016] [Indexed: 11/08/2022] Open
Abstract
Genetic variation is critical to the persistence of populations and their capacity to adapt to environmental change. The distribution of genetic variation across a species' range can reveal critical information that is not necessarily represented in species occurrence or abundance patterns. We identified environmental factors associated with the amount of intraspecific, individual-based genetic variation across the range of a widespread freshwater fish species, the Murray cod Maccullochella peelii. We used two different approaches to statistically quantify the relative importance of predictor variables, allowing for nonlinear relationships: a random forest model and a Bayesian approach. The latter also accounted for population history. Both approaches identified associations between homozygosity by locus and both disturbance to the natural flow regime and mean annual flow. Homozygosity by locus was negatively associated with disturbance to the natural flow regime, suggesting that river reaches with more disturbed flow regimes may support larger, more genetically diverse populations. Our findings are consistent with the hypothesis that artificially induced perennial flows in regulated channels may provide greater and more consistent habitat and reduce the frequency of population bottlenecks that can occur frequently under the highly variable and unpredictable natural flow regime of the system. Although extensive river regulation across eastern Australia has not had an overall positive effect on Murray cod numbers over the past century, regulation may not represent the primary threat to Murray cod survival. Instead, pressures other than flow regulation may be more critical to the persistence of Murray cod (for example, reduced frequency of large floods, overfishing and chemical pollution).
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Affiliation(s)
- K A Harrisson
- School of Biological Sciences, Monash University, Clayton, Victoria, Australia
| | - J D L Yen
- School of Physics & Astronomy, Monash University, Clayton, Victoria, Australia
| | - A Pavlova
- School of Biological Sciences, Monash University, Clayton, Victoria, Australia
| | - M L Rourke
- Department of Primary Industries, DPI Fisheries, Narrandera, New South Wales, Australia
| | - D Gilligan
- Department of Primary Industries, DPI Fisheries, Batemans Bay Fisheries Office, Batemans Bay, New South Wales, Australia
| | - B A Ingram
- Fisheries Victoria, Department of Economic Development, Jobs, Transport and Resources, Alexandra, Victoria, Australia
| | - J Lyon
- Arthur Rylah Institute, Department of Environment, Land, Water & Planning, Heidelberg, Victoria, Australia
| | - Z Tonkin
- Arthur Rylah Institute, Department of Environment, Land, Water & Planning, Heidelberg, Victoria, Australia
| | - P Sunnucks
- School of Biological Sciences, Monash University, Clayton, Victoria, Australia
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Harris C, Meek D, Gilligan D, Williams L, Solli P, Rintoul RC. Assessment and Optimisation of Lung Cancer Patients for Treatment with Curative Intent. Clin Oncol (R Coll Radiol) 2016; 28:682-694. [PMID: 27546624 DOI: 10.1016/j.clon.2016.08.002] [Citation(s) in RCA: 4] [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: 06/08/2016] [Revised: 07/13/2016] [Accepted: 07/18/2016] [Indexed: 12/25/2022]
Abstract
Over the past decade the field of lung cancer management has seen many developments. Coupled with an ageing population and increasing rates of comorbid illness, the work-up for treatments with curative intent has become more complex and detailed. As well as improvements in imaging and staging techniques, developments in both surgery and radiotherapy may now allow patients who would previously have been considered unfit or not appropriate for treatment with curative intent to undergo radical therapies. This overview will highlight published studies relating to investigation and staging techniques, together with assessments of fitness, with the aim of helping clinicians to determine the most appropriate treatments for each patient. We also highlight areas where further research may be required.
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Affiliation(s)
- C Harris
- Department of Thoracic Oncology, Papworth Hospital, Cambridge, UK
| | - D Meek
- Department of Thoracic Oncology, Papworth Hospital, Cambridge, UK
| | - D Gilligan
- Department of Thoracic Oncology, Papworth Hospital, Cambridge, UK
| | - L Williams
- Department of Cardiology, Papworth Hospital, Cambridge, UK
| | - P Solli
- Department of Cardiothoracic Surgery, Papworth Hospital, Cambridge, UK
| | - R C Rintoul
- Department of Thoracic Oncology, Papworth Hospital, Cambridge, UK.
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Sheldon R, Raj SR, Rose MS, Morillo CA, Krahn AD, Medina E, Talajic M, Kus T, Seifer CM, Lelonek M, Klingenheben T, Parkash R, Ritchie D, McRae M, Sheldon R, Rose S, Ritchie D, McCrae M, Morillo C, Malcolm V, Krahn A, Spindler B, Medina E, Talajic M, Kus T, Langlois A, Lelonek M, Raj S, Seifer C, Gardner M, Romeo M, Poirier P, Simpson C, Abdollah H, Reynolds J, Dorian P, Birnie D, Giuffre M, Gilligan D, Benditt D, Sheldon R, Raj S, Rose M, Krahn A, Morillo C, Medina E. Fludrocortisone for the Prevention of Vasovagal Syncope. J Am Coll Cardiol 2016; 68:1-9. [DOI: 10.1016/j.jacc.2016.04.030] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 03/31/2016] [Accepted: 04/05/2016] [Indexed: 10/21/2022]
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Ewing G, Ngwenya N, Benson J, Gilligan D, Bailey S, Seymour J, Farquhar M. Sharing news of a lung cancer diagnosis with adult family members and friends: a qualitative study to inform a supportive intervention. Patient Educ Couns 2016; 99:378-385. [PMID: 26519236 DOI: 10.1016/j.pec.2015.09.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 09/14/2015] [Accepted: 09/29/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Extensive research exists on breaking bad news by clinicians. This study examines perspectives of patients and those accompanying them at diagnosis-giving of subsequently sharing news of lung cancer with adult family/friends, and views of healthcare professionals, to inform development of a supportive intervention. METHODS Qualitative interviews with 20 patients, 17 accompanying persons; focus groups and interviews with 27 healthcare professionals from four Thoracic Oncology Units. Intervention development workshops with 24 healthcare professionals and six service users with experience of sharing a cancer diagnosis. Framework thematic analysis. RESULTS Patients and accompanying persons shared news of lung cancer whilst coming to terms with the diagnosis. They recalled general support from healthcare professionals but not support with sharing bad news. Six elements were identified providing a framework for a potential intervention: 1-people to be told, 2-information to be shared, 3-timing of sharing, 4-responsibility for sharing, 5-methods of telling others and 6-reactions of those told. CONCLUSION This study identifies the challenge of sharing bad news and a potential framework to guide delivery of a supportive intervention tailored to individual needs of patients. PRACTICE IMPLICATIONS The identified framework could extend the portfolio of guidance on communication in cancer and potentially in other life-limiting conditions.
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Affiliation(s)
- Gail Ewing
- Centre for Family Research, University of Cambridge, Free School Lane, Cambridge CB2 3RQ, UK.
| | - Nothando Ngwenya
- Centre for Family Research, University of Cambridge, Free School Lane, Cambridge CB2 3RQ, UK
| | - John Benson
- Primary Care Unit, Department of Public Health & Primary Care, University of Cambridge, Cambridge CB2 0SR, UK
| | - David Gilligan
- Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK
| | - Susan Bailey
- Formerly Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK
| | - Jane Seymour
- School of Health Sciences, The University of Nottingham, Nottingham NG7 2UH, UK
| | - Morag Farquhar
- Primary Care Unit, Department of Public Health & Primary Care, University of Cambridge, Cambridge CB2 0SR, UK
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Thippu Jayaprakash K, Gilligan D, Harden S. 138 Stage I non small cell lung cancer (NSCLC): single centre comparison of outcome by treatment with surgery, conventional radiotherapy and stereotactic ablative radiotherapy. Lung Cancer 2016. [DOI: 10.1016/s0169-5002(16)30155-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Tan CS, Gilligan D, Pacey S. Treatment approaches for EGFR-inhibitor-resistant patients with non-small-cell lung cancer. Lancet Oncol 2015; 16:e447-e459. [PMID: 26370354 DOI: 10.1016/s1470-2045(15)00246-6] [Citation(s) in RCA: 292] [Impact Index Per Article: 32.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 03/18/2015] [Accepted: 03/23/2015] [Indexed: 12/13/2022]
Abstract
Discovery of activating mutations in EGFR and their use as predictive biomarkers to tailor patient therapy with EGFR tyrosine kinase inhibitors (TKIs) has revolutionised treatment of patients with advanced EGFR-mutant non-small-cell lung cancer (NSCLC). At present, first-line treatment with EGFR TKIs (gefitinib, erlotinib, and afatinib) has been approved for patients harbouring exon 19 deletions or exon 21 (Leu858Arg) substitution EGFR mutations. These agents improve response rates, time to progression, and overall survival. Unfortunately, patients develop resistance, limiting patient benefit and posing a challenge to oncologists. Optimum treatment after progression is not clearly defined. A more detailed understanding of the biology of EGFR-mutant NSCLC and the mechanisms of resistance to targeted therapy mean that an era of treatment approaches based on rationally developed drugs or therapeutic strategies has begun. Combination approaches-eg, dual EGFR blockade-to overcome resistance have been trialled and seem to be promising but are potentially limited by toxicity. Third-generation EGFR-mutant-selective TKIs, such as AZD9291 or rociletininb, which target Thr790Met-mutant tumours, the most common mechanism of EGFR TKI resistance, have entered clinical trials, and exciting, albeit preliminary, efficacy data have been reported. In this Review, we summarise the scientific literature and evidence on therapy options after EGFR TKI treatment for patients with NSCLC, aiming to provide a guide to oncologists, and consider how to maximise therapeutic advances in outcomes in this rapidly advancing area.
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Affiliation(s)
- Chee-Seng Tan
- Department of Haematology-Oncology, National University Cancer Institute of Singapore, National University Health System, Singapore
| | | | - Simon Pacey
- Department of Oncology, University of Cambridge, Cambridge, UK.
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Hategan M, Cook N, Prewett S, Hindmarsh A, Qian W, Gilligan D. Trimodality therapy and definitive chemoradiotherapy for esophageal cancer: a single-center experience and review of the literature. Dis Esophagus 2015; 28:612-8. [PMID: 24863560 DOI: 10.1111/dote.12242] [Citation(s) in RCA: 16] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
In the UK, the standard of care for esophageal cancer has generally combined surgery with neoadjuvant chemotherapy, with definitive chemoradiotherapy (dCRT) being reserved for certain subgroups. Chemoradiotherapy followed by surgery (trimodality therapy) has not been widely adopted. The outcomes of patients undergoing dCRT or trimodality therapy at our cancer center between 2004 and 2012 were restrospectively analyzed. Trimodality therapy was offered to selected patients of good performance status (World Health Organisation performance status 0/1), with squamous cell carcinoma or bulky adenocarcinoma. dCRT was offered to patients of good PS but with comorbidities, upper third tumors or at patient's request. Patients received four cycles of chemotherapy with a platinum agent (mostly cisplatin) and a fluoropyrimidine (mostly 5-fluorouracil) over a total of 11 weeks. Cycles 3 and 4 were given concurrently with radiotherapy: 50 Gy in 25 fractions for dCRT and 45 Gy in 25 fractions in the trimodality group. Surgery occurred 8-10 weeks following the completion of chemoradiotherapy. The cut-off length for maximum gross tumor volume length was 10 cm. One hundred two patients were included (47 received dCRT, and 55 received trimodality treatment). The majority of tumors were stage III (80.4%), and two-thirds were located in the distal esophagus (64.7%). Median follow-up was 44 months. The 2-year overall survival (OS) was 57.3% (median OS 39.7 months) for the dCRT group and 77.8% (median not reached) for the trimodality group. The 5-year OS rates were 38% and 58%, respectively. Postoperative mortality rate was low at 1.8%, and the pathological complete response rate was 23.6%. In conclusion, trimodality treatment for patients with esophageal and junctional gastroesophageal tumors offers high rates of 2-year survival, and the potential for long-term cure. dCRT is an established alternative for patients that are not fit or suitable for surgery.
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Affiliation(s)
- M Hategan
- Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - N Cook
- Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - S Prewett
- Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - A Hindmarsh
- Oesophago-Gastric Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - W Qian
- Department of Statistics, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - D Gilligan
- Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Ewing G, Ngwenya N, Farquhar M, Benson J, Gilligan D, Seymour J, Bailey S. HOW DO PATIENTS SHARE NEWS OF A CANCER DIAGNOSIS WITH FAMILY/FRIENDS; NEW UNDERSTANDINGS OF THE PROCESS AFTER BAD NEWS HAS BEEN BROKEN. BMJ Support Palliat Care 2015. [DOI: 10.1136/bmjspcare-2014-000838.32] [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: 11/04/2022]
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Penfold C, Ewing G, Gilligan D, Mahadeva R, Booth S, Benson J, Burkin J, Howson S, Lovick R, Todd C, Farquhar M. WHAT DO INFORMAL CARERS WANT TO LEARN ABOUT BREATHLESSNESS IN ADVANCED DISEASE AND HOW DO THEY WANT TO LEARN IT? BMJ Support Palliat Care 2015. [DOI: 10.1136/bmjspcare-2014-000838.14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Szlosarek PW, Steele JP, Nolan L, Gilligan D, Taylor P, Spicer JF, Lind MJ, Bomalaski JS, Fennell DA, Hackshaw A. Randomized trial of arginine deprivation with pegylated arginine deiminase in patients with malignant pleural mesothelioma. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.7507] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | - Luke Nolan
- Southampton University Hospital NHS Foundation Trust, Southampton, United Kingdom
| | | | - Paul Taylor
- Wythenshawe Hospital, Manchester, United Kingdom
| | - James F. Spicer
- King’s College London, Guy’s Hospital, London, United Kingdom
| | - Michael J. Lind
- Cancer Biology Proteomics Group, University of Hull, Hull, United Kingdom
| | | | | | - Allan Hackshaw
- Cancer Research UK and UCL Cancer Trials Centre/UCL Cancer Institute, London, United Kingdom
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Ewing G, Ngwenya N, Farquhar M, Gilligan D, Bailey S, Benson J, Seymour J. SHARING BAD NEWS: DEVELOPMENT OF AN INTERVENTION TO SUPPORT PATIENTS WITH LUNG CANCER SHARE NEWS OF THEIR CANCER DIAGNOSIS WITH FAMILY MEMBERS AND FRIENDS. BMJ Support Palliat Care 2014. [DOI: 10.1136/bmjspcare-2014-000653.29] [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: 11/04/2022]
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