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Clamp AR, James EC, McNeish IA, Dean A, Kim JW, O'Donnell DM, Gallardo-Rincon D, Blagden S, Brenton J, Perren TJ, Sundar S, Lord R, Dark G, Hall M, Banerjee S, Glasspool RM, Hanna CL, Williams S, Scatchard KM, Nam H, Essapen S, Parkinson C, McAvan L, Swart AM, Popoola B, Schiavone F, Badrock J, Fananapazir F, Cook AD, Parmar M, Kaplan R, Ledermann JA. Weekly dose-dense chemotherapy in first-line epithelial ovarian, fallopian tube, or primary peritoneal cancer treatment (ICON8): overall survival results from an open-label, randomised, controlled, phase 3 trial. Lancet Oncol 2022; 23:919-930. [PMID: 35690073 PMCID: PMC9630160 DOI: 10.1016/s1470-2045(22)00283-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [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: 02/24/2022] [Revised: 05/05/2022] [Accepted: 05/06/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Standard-of-care first-line chemotherapy for epithelial ovarian cancer is carboplatin and paclitaxel administered once every 3 weeks. The JGOG 3016 trial reported significant improvement in progression-free and overall survival with dose-dense weekly paclitaxel and 3-weekly (ie, once every 3 weeks) carboplatin. However, this benefit was not observed in the previously reported progression-free survival results of ICON8. Here, we present the final coprimary outcomes of overall survival and updated progression-free survival analyses of ICON8. METHODS In this open-label, randomised, controlled, phase 3 trial (ICON8), women aged 18 years or older with newly diagnosed stage IC-IV epithelial ovarian, primary peritoneal, or fallopian tube carcinoma (here collectively termed ovarian cancer, as defined by International Federation of Gynecology and Obstetrics [FIGO] 1988 criteria) and an Eastern Cooperative Oncology Group performance status of 0-2 were recruited from 117 hospitals with oncology departments in the UK, Australia and New Zealand, Mexico, South Korea, and Ireland. Patients could enter the trial after immediate primary surgery (IPS) or with planned delayed primary surgery (DPS) during chemotherapy, or could have no planned surgery. Participants were randomly assigned (1:1:1), using the Medical Research Council Clinical Trials Unit at University College London randomisation line with stratification by Gynecologic Cancer Intergroup group, FIGO disease stage, and outcome and timing of surgery, to either 3-weekly carboplatin area under the curve (AUC)5 or AUC6 and 3-weekly paclitaxel 175 mg/m2 (control; group 1), 3-weekly carboplatin AUC5 or AUC6 and weekly paclitaxel 80 mg/m2 (group 2), or weekly carboplatin AUC2 and weekly paclitaxel 80 mg/m2 (group 3), all administered via intravenous infusion for a total of six 21-day cycles. Coprimary outcomes were progression-free survival and overall survival, with comparisons done between group 2 and group 1, and group 3 and group 1, in the intention-to-treat population. Safety was assessed in all patients who started at least one chemotherapy cycle. The trial is registered on ClinicalTrials.gov, NCT01654146, and ISRCTN registry, ISRCTN10356387, and is closed to accrual. FINDINGS Between June 6, 2011, and Nov 28, 2014, 1566 patients were randomly assigned to group 1 (n=522), group 2 (n=523), or group 3 (n=521). The median age was 62 years (IQR 54-68), 1073 (69%) of 1566 patients had high-grade serous carcinoma, 1119 (71%) had stage IIIC-IV disease, and 745 (48%) had IPS. As of data cutoff (March 31, 2020), with a median follow-up of 69 months (IQR 61-75), no significant difference in overall survival was observed in either comparison: median overall survival of 47·4 months (95% CI 43·1-54·8) in group 1, 54·8 months (46·6-61·6) in group 2, and 53·4 months (49·2-59·6) in group 3 (group 2 vs group 1: hazard ratio 0·87 [97·5% CI 0·73-1·05]; group 3 vs group 1: 0·91 [0·76-1·09]). No significant difference was observed for progression-free survival in either comparison and evidence of non-proportional hazards was seen (p=0·037), with restricted mean survival time of 23·9 months (97·5% CI 22·1-25·6) in group 1, 25·3 months (23·6-27·1) in group 2, and 24·8 months (23·0-26·5) in group 3. The most common grade 3-4 adverse events were reduced neutrophil count (78 [15%] of 511 patients in group 1, 183 [36%] of 514 in group 2, and 154 [30%] of 513 in group 3), reduced white blood cell count (22 [4%] in group 1, 80 [16%] in group 2, and 71 [14%] in group 3), and anaemia (26 [5%] in group 1, 66 [13%] in group 2, and 24 [5%] in group 3). No new serious adverse events were reported. Seven treatment-related deaths were reported (two in group 1, four in group 2, and one in group 3). INTERPRETATION In our cohort of predominantly European women with epithelial ovarian cancer, we found that first-line weekly dose-dense chemotherapy did not improve overall or progression-free survival compared with standard 3-weekly chemotherapy and should not be used as part of standard multimodality front-line therapy in this patient group. FUNDING Cancer Research UK, Medical Research Council, Health Research Board in Ireland, Irish Cancer Society, and Cancer Australia.
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Affiliation(s)
- Andrew R Clamp
- The Christie NHS Foundation Trust and University of Manchester, Manchester, UK
| | - Elizabeth C James
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK.
| | - Iain A McNeish
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Andrew Dean
- Oncology, St John of God Hospital, Subiaco, WA, Australia
| | - Jae-Won Kim
- Department of Obstetrics and Gynecology, Seoul National University, Seoul, South Korea
| | | | | | - Sarah Blagden
- Department of Oncology, Churchill Hospital, University of Oxford, Oxford, UK
| | - James Brenton
- Li Ka Shing Centre, Cancer Research UK Cambridge Institute, Cambridge, UK
| | - Tim J Perren
- Leeds Institute of Medical Research, St James' University Hospital, Leeds, UK
| | - Sudha Sundar
- Institute of Cancer and Genomics, University of Birmingham, Birmingham, UK
| | - Rosemary Lord
- Department of Oncology, Clatterbridge Cancer Centre, Wirral, UK
| | - Graham Dark
- Northern Centre for Cancer Care, Freeman Hospital, Newcastle, UK
| | - Marcia Hall
- Department of Medical Oncology, Mount Vernon Cancer Centre, Northwood, UK
| | - Susana Banerjee
- Gynaecological Unit, The Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London, UK
| | | | - C Louise Hanna
- Department of Oncology, Velindre Cancer Centre, Cardiff, UK
| | | | - Kate M Scatchard
- North Devon District Hospital, Barnstaple, UK; Exeter Oncology Centre, Royal Devon and Exeter Hospital, Exeter, UK
| | - Helena Nam
- Broomfield Hospital, Chelmsford, UK; Southend University Hospital, Southend, UK
| | - Sharadah Essapen
- St Luke's Cancer Centre, Royal Surrey County Hospital, Guildford, UK
| | | | - Lucy McAvan
- Department of Oncology, University Hospital Coventry and Warwickshire, Coventry, UK
| | - Ann Marie Swart
- Norwich Clinical Trials Unit, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Babasola Popoola
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Francesca Schiavone
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Jonathan Badrock
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Fuad Fananapazir
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Adrian D Cook
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Mahesh Parmar
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Richard Kaplan
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Jonathan A Ledermann
- Cancer Research UK and UCL Cancer Trials Centre, UCL Cancer Institute and UCL Hospitals, London, UK
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2
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Kieran R, Moloney C, Alken S, Corrigan L, Gallagher D, Grant C, Kelleher F, Kennedy MJ, Lowery MA, McCarthy M, O'Donnell DM, Sukor S, Cuffe S. Patient knowledge, personal experience, and impact of the first wave of the COVD-19 pandemic in an Irish oncology cohort. Ir J Med Sci 2022; 192:533-540. [PMID: 35411487 PMCID: PMC9001164 DOI: 10.1007/s11845-022-02999-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 03/30/2022] [Indexed: 11/27/2022]
Abstract
Background Oncology patients have had to make many changes to minimise their exposure to COVID-19, causing stress. Despite education, some patients still do not recognise potential COVID symptoms. Aims We assessed patient knowledge of COVID, and its impact on their behaviours, concerns, and healthcare experience. Methods A 16-page questionnaire was distributed to 120 oncology patients attending the day unit of a tertiary Irish cancer centre for systemic anti-cancer therapy (May/June 2020). The Irish 7-day COVID incidence during this period ranged from 2 to 11 cases/100,000 people. Results One hundred and one responses were received, 1% had tested positive for COVID, and 31% had undergone testing. Participant insight into their knowledge about COVID and their own behaviour was limited in some cases. Seventy-five percent reported total compliance with restrictions, but many were not fully compliant. Self-reported confidence in knowledge was high, but did not predict demonstrated knowledge. Sixty percent did not recognise two or more symptoms; 40% did not self-identify as high-risk. Patients reported more health-related worry (72%), loneliness (51%), and lower mood (42%) since the pandemic began. Financial toxicity worsened, with increased financial worry (78%), reductions in household income (40%), and increased costs due to lockdown (62%). Use of facemasks introduced new communications barriers for 67% of those with hearing loss. Conclusions Despite self-reported confidence in knowledge, some patient’s recognition of COVID symptoms and the preventative strategies they should use are not optimal, highlighting the need for further education in this regard. COVID has been a significant stressor for patients and more practical, financial, and psychological supports are needed.
Supplementary information The online version contains supplementary material available at 10.1007/s11845-022-02999-8.
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Affiliation(s)
- Ruth Kieran
- Department of Medical Oncology, St. James's Hospital, Dublin, Ireland.
| | - Carolyn Moloney
- Department of Medical Oncology, St. James's Hospital, Dublin, Ireland
| | - Scheryll Alken
- Department of Medical Oncology, St. James's Hospital, Dublin, Ireland
| | - Lynda Corrigan
- Department of Medical Oncology, St. James's Hospital, Dublin, Ireland
| | - David Gallagher
- Department of Medical Oncology, St. James's Hospital, Dublin, Ireland
| | - Cliona Grant
- Department of Medical Oncology, St. James's Hospital, Dublin, Ireland
| | - Fergal Kelleher
- Department of Medical Oncology, St. James's Hospital, Dublin, Ireland
| | - M John Kennedy
- Department of Medical Oncology, St. James's Hospital, Dublin, Ireland.,The Trinity St James's Cancer Institute, Dublin, Ireland
| | - Maeve A Lowery
- Department of Medical Oncology, St. James's Hospital, Dublin, Ireland.,The Trinity St James's Cancer Institute, Dublin, Ireland
| | - Michael McCarthy
- Department of Medical Oncology, St. James's Hospital, Dublin, Ireland
| | | | - Sue Sukor
- Department of Medical Oncology, St. James's Hospital, Dublin, Ireland
| | - Sinead Cuffe
- Department of Medical Oncology, St. James's Hospital, Dublin, Ireland
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3
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Baert T, Ferrero A, Sehouli J, O'Donnell DM, González-Martín A, Joly F, van der Velden J, Blecharz P, Tan DSP, Querleu D, Colombo N, du Bois A, Ledermann JA. The systemic treatment of recurrent ovarian cancer revisited. Ann Oncol 2021; 32:710-725. [PMID: 33675937 DOI: 10.1016/j.annonc.2021.02.015] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 02/13/2021] [Accepted: 02/16/2021] [Indexed: 12/12/2022] Open
Abstract
Treatment approaches for relapsed ovarian cancer have evolved over the past decade from a calendar-based decision tree to a patient-oriented biologically driven algorithm. Nowadays, platinum-based chemotherapy should be offered to all patients with a reasonable chance of responding to this therapy. The treatment-free interval for platinum is only one of many factors affecting patients' eligibility for platinum re-treatment. Bevacizumab increases the response to chemotherapy irrespective of the cytotoxic regimen and can be valuable in patients with an urgent need for symptom relief (e.g. pleural effusion, ascites). For patients with recurrent high-grade ovarian cancer, which responds to platinum-based treatment, maintenance therapy with a poly(ADP-ribose) polymerase inhibitor can be offered, regardless of the BRCA mutation status. Here we review contemporary decision-making processes in the systemic treatment of relapsed ovarian cancer.
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Affiliation(s)
- T Baert
- Department of Gynecology and Gynecological Oncology, Kliniken Essen-Mitte, Essen, Germany; Department of Oncology, KU Leuven, Leuven, Belgium.
| | - A Ferrero
- Department of Clinical and Experimental Medicine, Division of Gynecology and Obstetrics, Mauriziano Hospital, Turin, Italy
| | - J Sehouli
- Department of Gynecology with Center for Oncological Surgery, Charité-University hospital Berlin, Berlin, Germany
| | - D M O'Donnell
- Department of Oncology, St. James's Hospital, Dublin, Ireland
| | - A González-Martín
- Medical Oncology Department, Clínica Universidad de Navarra University Hospital, Madrid, Spain
| | - F Joly
- Department of Oncology, Centre Francois Baclesse, Caen, France
| | - J van der Velden
- Department of Medical Oncology, Academic Medical Center Amsterdam, Amsterdam, The Netherlands
| | - P Blecharz
- Department of Gynecologic Oncology, Center of Oncology, M. Sklodowska-Curie Institute, Krakow, Poland
| | - D S P Tan
- Department of Haematology-Oncology, National University Cancer Institute of Singapore, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - D Querleu
- Department of Surgical Oncology, Institut Bergonié, Bordeaux, France
| | - N Colombo
- Department of Medicine and Surgery, European Institute of Oncology IRCCS, Milan, Italy; University of Milan-Bicocca, Milan, Italy
| | - A du Bois
- Department of Gynecology and Gynecological Oncology, Kliniken Essen-Mitte, Essen, Germany
| | - J A Ledermann
- Cancer Research UK and UCL Cancer Trials Centre, UCL Cancer Institute, London, UK
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4
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Harrold EC, Idris AF, Keegan NM, Corrigan L, Teo MY, O'Donnell M, Lim ST, Duff E, O'Donnell DM, Kennedy MJ, Sukor S, Grant C, Gallagher DG, Collier S, Kingston T, O'Dwyer AM, Cuffe S. Prevalence of Insomnia in an Oncology Patient Population: An Irish Tertiary Referral Center Experience. J Natl Compr Canc Netw 2020; 18:1623-1630. [PMID: 33285516 DOI: 10.6004/jnccn.2020.7611] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 06/26/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND The NCCN Guidelines for Survivorship recommend dedicated sleep assessment. Reported insomnia prevalence in the general Irish population is 6% to 15%. Reported insomnia prevalence internationally among new/recently diagnosed patients with cancer varies from 30.9% to 54.3%. Insomnia prevalence has not been previously quantified in an Irish oncology cohort. METHODS A 40-item questionnaire was prospectively administered to ambulatory patients with cancer aged ≥18 years. Prespecified criteria to define insomnia syndrome combined those of the International Classification of Sleep Disorders, version 1, and the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). The Hospital Anxiety and Depression Scale-Depression/Anxiety (HADS-D/A) was used to screen for potential confounding variables. RESULTS The response rate to the questionnaire was 87% (294/337). The predominant respondent age group was 55 to 64 years (26%; 77/294), 70.7% were female (208/294), and the most common cancer subtypes were breast (37.4%), colorectal (12.9%), and lung (12.2%). A total of 62% (183/294) of patients reported sleep disturbance after diagnosis, 63% (115/183) reported moderate/severe distress related to this disturbance, and 37% (61/183) reported a significant impact on physical function. Although 33% (98/294) met insomnia syndrome criteria, only 34% (33/98) of these patients had a preexisting history of sleep disturbance. Female sex, age <65 years, cancer subtype, alcohol consumption, and HADS-D/A ≥11 were associated with statistically significant higher odds ratios (OR) of insomnia syndrome. Multivariate analysis identified breast cancer (OR, 3.17; P=.01), age <65 years (OR, 1.8; P=.03), and alcohol consumption (OR, 2.3; P=.005) as independent predictors of insomnia syndrome. CONCLUSIONS Insomnia syndrome prevalence in this cohort is comparable to that reported previously and supports dedicated sleep assessment. This study identifies potentially modifiable risk factors for insomnia and demonstrates additional utility of the HADS score in identifying patients at risk.
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Affiliation(s)
- Emily C Harrold
- 1Department of Medical Oncology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Ahmad F Idris
- 2Department of Medical Oncology, St. James's Hospital, Dublin, Ireland
| | - Niamh M Keegan
- 3Department of Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Lynda Corrigan
- 2Department of Medical Oncology, St. James's Hospital, Dublin, Ireland
| | - Min Yuen Teo
- 3Department of Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Sean Tee Lim
- 4Trinity College Medical School, Dublin, Ireland; and
| | - Eimear Duff
- 4Trinity College Medical School, Dublin, Ireland; and
| | | | - M John Kennedy
- 2Department of Medical Oncology, St. James's Hospital, Dublin, Ireland
| | - Sue Sukor
- 2Department of Medical Oncology, St. James's Hospital, Dublin, Ireland
| | - Cliona Grant
- 2Department of Medical Oncology, St. James's Hospital, Dublin, Ireland
| | - David G Gallagher
- 2Department of Medical Oncology, St. James's Hospital, Dublin, Ireland
| | - Sonya Collier
- 5Department of Psychological Oncology Medicine, St. James's University Hospital, Dublin, Ireland
| | - Tara Kingston
- 5Department of Psychological Oncology Medicine, St. James's University Hospital, Dublin, Ireland
| | - Ann Marie O'Dwyer
- 5Department of Psychological Oncology Medicine, St. James's University Hospital, Dublin, Ireland
| | - Sinead Cuffe
- 2Department of Medical Oncology, St. James's Hospital, Dublin, Ireland
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5
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Moloney C, Allen M, Power DG, M Bambury R, O'Mahony D, O'Donnell DM, O'Reilly S, Collins DC. Assessing the Quality of Care Delivered to Transgender and Gender Diverse Patients with Cancer in Ireland: A Case Series. Oncologist 2020; 26:e603-e607. [PMID: 33252154 DOI: 10.1002/onco.13618] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 11/13/2020] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION "Transgender" and "gender diverse" are umbrella terms encompassing those whose gender identities or expressions differ from those typically associated with the sex they were assigned at birth. There is scant global information on cancer incidence, outcome, and mortality for this cohort. This group may present with advanced cancer, have mistrust in health care services and report anxiety and depression at higher frequencies, a finding often seen in marginalized groups because of minority stress. MATERIALS AND METHODS Medical oncologists were contacted by secure email to identify patients who self-identify as transgender and gender diverse in three Irish hospitals. Five patients were identified. A retrospective chart review was conducted and a pseudonymized patient survey was distributed. RESULTS All patients included in our chart review (n = 5) were diagnosed with advanced disease on initial diagnosis. Two patients identified as men, two as women, and one as a transwoman. Two of five patients' health record charts reflected a name or gender change. Three patients had gender transitioning treatment postponed. Assessing comorbidities, it was seen that four patients required psychiatry input. Predominant issues noted in our patient survey by the two respondents (n = 2) were "mis-gendering," lack of a gender-neutral hospital environment, lack of inclusion in cancer groups, and barriers in changing name and/or sex on hospital records. CONCLUSION Components of care requiring revision include patient accessible pathways to change names and gender on health records, earlier access to psychological support and targeted screening and support groups. Resources for hospital staff to improve awareness of correct terminology and to provide gender neutral facilities are worthwhile. IMPLICATIONS FOR PRACTICE The implications for practice on an international level include patient-friendly pathways for changing hospital name and gender so that patients may feel comfortable using wristbands. The need for international screening guidelines for transgender patients and national transgender cancer support groups is highlighted. On a day-to-day level for providers, the correct use of pronouns makes a big difference to patients. Asking about preferred pronoun on first visit and noting on patient's file is worthwhile. It is important for providers to know that increased psychological support should be offered early on first clinic visit and engaged with as necessary when patient has a history of anxiety or depression. Providers should discuss openly that some gender transitioning treatment will be postponed because of cancer care and refer to both the physical and psychological sequelae of this. Asking transgender patients which room or bathroom they would prefer when rooms are gendered is essential.
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Affiliation(s)
- Carolyn Moloney
- Cork University Hospital, Cork, Ireland, Dublin, Ireland.,Mercy University Hospital, Cork, Ireland, Dublin, Ireland.,St James's University Hospital, Dublin, Ireland
| | - Margaret Allen
- Cork University Hospital, Cork, Ireland, Dublin, Ireland
| | - Derek G Power
- Cork University Hospital, Cork, Ireland, Dublin, Ireland.,Mercy University Hospital, Cork, Ireland, Dublin, Ireland
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6
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Kieran R, moloney C, Kennedy J, Lowery MA, Grant C, Gallagher DJ, O'Donnell DM, Kelleher F, Sukor S, McCarthy MT, Cuffe S. Patient self-reported awareness of COVID: Overconfidence in knowledge, underestimation of risk. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.29_suppl.174] [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: 11/20/2022] Open
Abstract
174 Background: Oncology patients have had to adapt to minimize the risks of contracting COVID-19. We assessed patient knowledge of COVID, and the impact of the pandemic on their behaviours, concerns and healthcare experience, to identify any further education/quality improvement needs. Methods: Following ethical approval, a 16 page survey was distributed to 120 oncology patients attending the day unit of a tertiary Irish cancer center for systemic anti-cancer therapy (May/June 2020). The Irish COVID rate during this period was 33.8 new cases/day (pop. 4.9 million). Results: 101 responses were received. Cancer types included breast (19%), gastrointestinal (29%), head and neck (11%), and lung (13%). 31% had been tested for COVID; just 1 patient was positive. 100% were aware of advice to “cocoon” and reported good understanding of this. 75% reported complete compliance, but of those, 73% were not social-distancing within their homes, 22% received visitors, and 36% continued to shop in-store; of these, 42% shopped as/more often than pre-COVID. Of the 51 patients regularly shopping, many were not using risk-reduction strategies e.g. social distancing (22%), mask-wearing (20%), using “priority shopping’ hours (31%), avoiding public transport (26%). 94% felt confident/very confident in recognizing COVID symptoms, but 66% did not recognize two or more key symptoms from a list of 10, most frequently aches/pains (58%), fatigue (55%), altered smell/taste (33%) and dyspnea (14%). The number recognized did not correlate with confidence (p = 0.9) or desire for more information about COVID (p = 0.9). 40% did not feel they were at higher risk of contracting COVID, while 15% thought they were no more likely to be very sick than an average person if infected. Many did not know that chemotherapy, steroids, radiation, and immunotherapy can impact morbidity/mortality in COVID (31%, 70%, 44% and 49% respectively). 46% were somewhat/very fearful of COVID, but this did not strongly predict for either protective (e.g. mask-wearing: OR 1.1, 95% CI 0.3-4.8 p = 0.9), or risk behaviors (e.g. continuing to shop frequently: OR 0.5, 95% CI 0.1-1.4 p = 0.2). 66% would like more cancer specific information, particularly about prevention (45%) and symptoms (33%), with a preference for written information (74%). Conclusions: Despite self-reported confidence in knowledge, patient’s self-assessments of their risk category and the preventative strategies they should use may be inaccurate. Increased education about risk, cocooning and symptom recognition is necessary.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Sue Sukor
- St James's Hospital, Dublin, Ireland
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7
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Blagden SP, Cook AD, Poole C, Howells L, McNeish IA, Dean A, Kim JW, O'Donnell DM, Hook J, James EC, White IR, Perren T, Lord R, Dark G, Earl HM, Hall M, Kaplan R, Ledermann JA, Clamp AR. Weekly platinum-based chemotherapy versus 3-weekly platinum-based chemotherapy for newly diagnosed ovarian cancer (ICON8): quality-of-life results of a phase 3, randomised, controlled trial. Lancet Oncol 2020; 21:969-977. [PMID: 32615110 PMCID: PMC7327508 DOI: 10.1016/s1470-2045(20)30218-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [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: 02/18/2020] [Revised: 03/30/2020] [Accepted: 03/31/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND The ICON8 study reported no significant improvement in progression-free survival (a primary endpoint) with weekly chemotherapy compared with standard 3-weekly treatment among patients with epithelial ovarian cancer. All ICON8 patients were eligible to take part in the accompanying health-related quality-of-life study, which measured the effect of treatment on self-reported wellbeing, reported here. METHODS In this open-label, randomised, controlled, phase 3, three-arm, Gynecologic Cancer Intergroup (GCIG) trial done at 117 hospital sites in the UK, Australia, New Zealand, Mexico, South Korea, and Republic of Ireland, women (aged at least 18 years) with newly diagnosed, histologically confirmed International Federation of Gynecology and Obstetrics stage IC-IV ovarian cancer and an Eastern Cooperative Oncology Group performance status of 0-2 were randomly assigned (1:1:1) centrally using minimisation to group 1 (intravenous carboplatin area under the curve [AUC]5 or AUC6 and 175 mg/m2 intravenous paclitaxel every 3 weeks), group 2 (carboplatin AUC5 or AUC6 every 3 weeks and 80 mg/m2 paclitaxel weekly), or group 3 (carboplatin AUC2 weekly and 80 mg/m2 paclitaxel weekly). Randomisation was stratified by GCIG group, disease stage, and outcome and timing of surgery. Patients and clinicians were not masked to treatment assignment. Patients underwent immediate or delayed primary surgery according to clinicians' choice. Patients were asked to complete European Organisation for Research and Treatment of Cancer QLQ-C30 and QLQ-OV28 questionnaires at enrolment, before each chemotherapy cycle, then 6-weekly up to 9 months, 3-monthly up to 2 years, and 6-monthly up to 5 years. Quality of life was a prespecified secondary outcome of the ICON8 study. Within the quality-of-life study, the co-primary endpoints were QLQ-C30 global health score at 9 months (cross-sectional analysis) and mean QLQ-C30 global health score from randomisation to 9 months (longitudinal analysis). Data analyses were done on an intention-to-treat basis. The trial is registered on ClinicalTrials.gov, NCT01654146 and ISRCTN Registry, ISRCTN10356387, and is currently in long-term follow up. FINDINGS Between June 6, 2011, and Nov 28, 2014, 1566 patients were recruited into ICON8 (522 were included in group 1, 523 in group 2, and 521 in group 3). Baseline quality-of-life questionnaires were completed by 1438 (92%) of 1566 patients and 9-month questionnaires by 882 (69%) of 1280 patients. We observed no significant difference in global health score at 9 months (cross-sectional analysis) between study groups (group 2 vs group 1, difference in mean score 2·3, 95% CI -0·4 to 4·9, p=0·095; group 3 vs group 1, -0·8, -3·8 to 2·2, p=0·61). Using longitudinal analysis, we found lower global health scores for those receiving weekly paclitaxel than for those receiving 3-weekly chemotherapy (group 2 vs group 1, mean difference -1·8, 95% CI -3·6 to -0·1, p=0·043; group 3 vs group 1, -2·9, -4·7 to -1·1, p=0·0018). INTERPRETATION We found no evidence of a difference in global quality of life between treatment groups at 9 months; however, patients receiving weekly treatment reported lower mean quality of life across the 9-month period after randomisation. Taken together with the lack of progression-free survival benefit, these findings do not support routine use of weekly paclitaxel-containing regimens in the management of newly diagnosed ovarian cancer. FUNDING Cancer Research UK, Medical Research Council, Health Research Board Ireland, Irish Cancer Society, and Cancer Australia.
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Affiliation(s)
| | - Adrian D Cook
- Medical Research Council Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | | | - Lesley Howells
- Maggie Keswick Jencks Cancer Caring Centres Trust, London, UK
| | - Ian A McNeish
- Ovarian Cancer Action Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Andrew Dean
- Oncology Department, St John of God Subiaco Hospital, Perth, WA, Australia
| | - Jae-Weon Kim
- Department of Obstetrics and Gynaecology, Seoul National University Hospital, Seoul, South Korea
| | | | - Jane Hook
- St James's University Hospital, Leeds, UK
| | - Elizabeth C James
- Medical Research Council Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Ian R White
- Medical Research Council Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | | | - Rosemary Lord
- Department of Oncology, Clatterbridge Cancer Centre, Birkenhead, UK
| | - Graham Dark
- Department of Oncology, Newcastle University, Newcastle, UK
| | - Helena M Earl
- NIHR Cambridge Biomedical Research Centre, Cambridge, UK
| | - Marcia Hall
- Department of Medical Oncology, Mount Vernon Cancer Centre, Northwood, UK
| | - Richard Kaplan
- Medical Research Council Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Jonathan A Ledermann
- UCL Cancer Centre Institute, University College London, London, UK; University College Hospital, London, UK
| | - Andrew R Clamp
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK; University of Manchester, Manchester, UK
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Clamp AR, James EC, McNeish IA, Dean A, Kim JW, O'Donnell DM, Hook J, Coyle C, Blagden S, Brenton JD, Naik R, Perren T, Sundar S, Cook AD, Gopalakrishnan GS, Gabra H, Lord R, Dark G, Earl HM, Hall M, Banerjee S, Glasspool RM, Jones R, Williams S, Swart AM, Stenning S, Parmar M, Kaplan R, Ledermann JA. Weekly dose-dense chemotherapy in first-line epithelial ovarian, fallopian tube, or primary peritoneal carcinoma treatment (ICON8): primary progression free survival analysis results from a GCIG phase 3 randomised controlled trial. Lancet 2019; 394:2084-2095. [PMID: 31791688 PMCID: PMC6902268 DOI: 10.1016/s0140-6736(19)32259-7] [Citation(s) in RCA: 104] [Impact Index Per Article: 20.8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 09/09/2019] [Accepted: 09/19/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Carboplatin and paclitaxel administered every 3 weeks is standard-of-care first-line chemotherapy for epithelial ovarian cancer. The Japanese JGOG3016 trial showed a significant improvement in progression-free and overall survival with dose-dense weekly paclitaxel and 3-weekly carboplatin. In this study, we aimed to compare efficacy and safety of two dose-dense weekly regimens to standard 3-weekly chemotherapy in a predominantly European population with epithelial ovarian cancer. METHODS In this phase 3 trial, women with newly diagnosed International Federation of Gynecology and Obstetrics stage IC-IV epithelial ovarian cancer were randomly assigned to group 1 (carboplatin area under the curve [AUC]5 or AUC6 and 175 mg/m2 paclitaxel every 3 weeks), group 2 (carboplatin AUC5 or AUC6 every 3 weeks and 80 mg/m2 paclitaxel weekly), or group 3 (carboplatin AUC2 and 80 mg/m2 paclitaxel weekly). Written informed consent was provided by all women who entered the trial. The protocol had the appropriate national research ethics committee approval for the countries where the study was conducted. Patients entered the trial after immediate primary surgery, or before neoadjuvant chemotherapy with subsequent planned delayed primary surgery. The trial coprimary outcomes were progression-free survival and overall survival. Data analyses were done on an intention-to-treat basis, and were powered to detect a hazard ratio of 0·75 in progression-free survival. The main comparisons were between the control group (group 1) and each of the weekly research groups (groups 2 and 3). FINDINGS Between June 6, 2011, and Nov 28, 2014, 1566 women were randomly assigned to treatment. 72% (365), completed six protocol-defined treatment cycles in group 1, 60% (305) in group 2, and 63% (322) in group 3, although 90% (454), 89% (454), and 85% (437) completed six platinum-based chemotherapy cycles, respectively. Paclitaxel dose intensification was achieved with weekly treatment (median total paclitaxel dose 1010 mg/m2 in group 1; 1233 mg/m2 in group 2; 1274 mg/m2 in group 3). By February, 2017, 1018 (65%) patients had experienced disease progression. No significant progression-free survival increase was observed with either weekly regimen (restricted mean survival time 24·4 months [97·5% CI 23·0-26·0] in group 1, 24·9 months [24·0-25·9] in group 2, 25·3 months [23·9-26·9] in group 3; median progression-free survival 17·7 months [IQR 10·6-not reached] in group 1, 20·8 months [11·9-59·0] in group 2, 21·0 months [12·0-54·0] in group 3; log-rank p=0·35 for group 2 vs group 1; group 3 vs 1 p=0·51). Although grade 3 or 4 toxic effects increased with weekly treatment, these effects were predominantly uncomplicated. Febrile neutropenia and sensory neuropathy incidences were similar across groups. INTERPRETATION Weekly dose-dense chemotherapy can be delivered successfully as first-line treatment for epithelial ovarian cancer but does not significantly improve progression-free survival compared with standard 3-weekly chemotherapy in predominantly European populations. FUNDING Cancer Research UK, Medical Research Council, Health Research Board in Ireland, Irish Cancer Society, Cancer Australia.
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Affiliation(s)
- Andrew R Clamp
- Department of Medical Oncology, The Christie National Health Service Foundation Trust, and University of Manchester, Manchester, UK
| | - Elizabeth C James
- Medical Research Council Clinical Trials Unit at University College London, Institute of Clinical Trials & Methodology, University College London, London, UK.
| | - Iain A McNeish
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Andrew Dean
- Oncology Department, St John of God Hospital, Subiaco, WA, Australia
| | - Jae-Weon Kim
- Department of Obstetrics and Gynaecology, Seoul National University, Seoul, Korea
| | | | - Jane Hook
- St James' University Hospital, Leeds, UK
| | - Christopher Coyle
- Queen Alexandra Hospital, Portsmouth Hospitals National Health Service Trust, Portsmouth, UK
| | - Sarah Blagden
- Churchill Hospital, University of Oxford, Oxford, UK
| | - James D Brenton
- Li Ka Shing Centre, Cancer Research UK Cambridge Institute, Cambridge, UK
| | - Raj Naik
- Gynaecology Oncology Centre, Queen Elizabeth Hospital, Gateshead, UK
| | - Tim Perren
- St James' University Hospital, Leeds, UK
| | - Sudha Sundar
- Institute of Cancer and Genomics, University of Birmingham, Birmingham, UK
| | - Adrian D Cook
- Medical Research Council Clinical Trials Unit at University College London, Institute of Clinical Trials & Methodology, University College London, London, UK
| | - Gosala S Gopalakrishnan
- Medical Research Council Clinical Trials Unit at University College London, Institute of Clinical Trials & Methodology, University College London, London, UK
| | - Hani Gabra
- Department of Surgery and Cancer, Imperial College London, London, UK; Early Clinical Development, AstraZeneca, Cambridge, UK
| | - Rosemary Lord
- Department of Oncology, Clatterbridge Cancer Centre, Wirral, UK
| | - Graham Dark
- Northern Centre for Cancer Care, Freeman Hospital, Newcastle, UK
| | - Helena M Earl
- Department of Medical Oncology, Addenbrooke's Hospital, Cambridge, UK
| | - Marcia Hall
- Department of Medical Oncology, Mount Vernon Cancer Centre, Northwood, UK
| | - Susana Banerjee
- Gynaecological Unit, The Royal Marsden National Health Service Foundation Trust and Institute of Cancer Research, London, UK
| | | | | | | | - Ann Marie Swart
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Sally Stenning
- Medical Research Council Clinical Trials Unit at University College London, Institute of Clinical Trials & Methodology, University College London, London, UK
| | - Mahesh Parmar
- Medical Research Council Clinical Trials Unit at University College London, Institute of Clinical Trials & Methodology, University College London, London, UK
| | - Richard Kaplan
- Medical Research Council Clinical Trials Unit at University College London, Institute of Clinical Trials & Methodology, University College London, London, UK
| | - Jonathan A Ledermann
- University College London Cancer Institute, and University College London Hospitals, London, UK
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Sheill G, Brady L, Guinan EM, Hussey JM, Hayes B, Baird AM, Stanfill B, Casey O, Murphy V, Rudman SM, Peat N, Sheils O, Cahill F, Van Hemelrijck M, McCaffrey J, O'Donnell DM, Mucci L, Grogan W, McDermott R, Finn SP. A randomized trial of exercise on quality of life in men with metastatic prostate cancer: The ExPeCT Trial. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.31_suppl.97] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
97 Background: All patients living with cancer, including those with metastatic cancer, are encouraged to be physically active. This paper examines the feasibility of an aerobic exercise intervention for men with metastatic prostate cancer. Methods: ExPeCT (Exercise, Prostate Cancer and Circulating Tumour Cells), was a multi-centre randomised control trial for men living with metastatic prostate cancer. Participants were randomized to either control or exercise arms. Participants in the exercise arm completed six- months of prescribed aerobic exercise. Quality of life assessments were completed at baseline, at 3 months and at 6 months using a standardised questionnaire derived from the Harvard Health Professionals Follow-up study. Physical activity was measured using a self-administered physical activity questionnaire. Exercise adherence data was collected via Polar heart rate monitors, worn by the patient for every exercise session undertaken. Results: A total of 61 patients were included (69.4±7.3 yr, Body Mass Index 29.2±5.8 kg/m2). The median time since diagnosis was 34 months (IQR 7-54). A total of 35 (55%) of participants had >1 region affected by metastatic disease. A total of 54 (81%) of participants completed the 3 month assessment and 52 (78%) of the participants completed the 6 month assessment. Adherence to the supervised sessions was 83% (329 out of 396 sessions attended). Participants were adherent to both the intensity (82%) and duration (83%) of the prescribed exercise programme during class sessions. No adverse events were reported by participants enrolled in this study. There was no significant difference in physical activity levels, sedentary time or quality of life between either group at baseline, 3 months or 6 months. Systolic blood pressure was significantly lower in the exercise group when compared to the control group at 3 months (p=.008) and 6 months (p=.011). Conclusions: The exercise intervention was tolerated well by a group of patients with a high burden of metastatic prostate cancer however did not lead to change in physical activity levels or quality of life. This trial provides proof of principle evidence for future exercise studies involving this patient group. Clinical trial information: NCT02453139.
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Affiliation(s)
| | - Lauren Brady
- Department of Histopathology and Morbid Anatomy, Trinity Translational Medicine Institute, Trinity College Dublin, Dublin, Ireland
| | | | | | - Brian Hayes
- Department of Histopathology and Morbid Anatomy, Trinity Translational Medicine Institute, Trinity College Dublin, Department of Histopathology, Cork University Hospital, Wilton, Cork, Ireland
| | | | | | | | | | | | - Nicola Peat
- Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Orla Sheils
- Department of Histopathology and Morbid Anatomy, Trinity Translational Medicine Institute, Trinity College Dublin, Dublin, Ireland
| | - Fidelma Cahill
- King’s College London, Division of Cancer Studies, Cancer Epidemiology Group, London, United Kingdom
| | - Mieke Van Hemelrijck
- King’s College London, Division of Cancer Studies, Cancer Epidemiology Group, London, United Kingdom
| | - John McCaffrey
- Mater Misericordiae University Hospital, Dublin, Ireland
| | | | | | - William Grogan
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
| | - Ray McDermott
- Department of Oncology, Tallaght University Hospital, Dublin, Ireland
| | - Stephen P. Finn
- St. James's Hospital and Trinity College Dublin, Cancer Molecular Diagnostics, Dublin, Ireland
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Haberlin C, Broderick J, Guinan EM, Darker C, Hussey J, O'Donnell DM. eHealth-based intervention to increase physical activity levels in people with cancer: protocol of a feasibility trial in an Irish acute hospital setting. BMJ Open 2019; 9:e024999. [PMID: 30852540 PMCID: PMC6429836 DOI: 10.1136/bmjopen-2018-024999] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Exercise and physical activity (PA) are established and effective treatment options for various side effects of cancer treatments such as surgery, chemotherapy and radiotherapy. The advent of eHealth brings new opportunities to influence healthy behaviours, using interactive and novel approaches. Influencing PA behaviours in people with cancer presents a potential application of this. The aim of this study is to evaluate the feasibility and preliminary efficacy of an intervention, using eHealth, for increasing PA in cancer survivors. METHODS AND ANALYSIS This will be a single-arm pre-post feasibility study. We aim to recruit a heterogeneous sample of 60 participants from cancer clinics in St. James's Hospital, Dublin, Ireland. Eligibility criteria will include patients who have completed chemotherapy and/or radiotherapy with curative intent between 3 and 36 months prior to enrolment. The intervention will include the delivery of a 12-week PA programme. The eHealth aspect of the intervention will involve the provision of a Fitbit activity tracker, which will be used in conjunction with specific PA goals remotely prescribed and monitored by a physiotherapist. Primary outcomes will be feasibility measures related to the study (recruitment capability, data collection procedures, adherence and compliance, evaluation of the resources to implement the study and evaluation of participant responses to the intervention). Secondary measures will evaluate preliminary efficacy of the intervention in terms of clinical outcomes (body composition, PA (objective and self-report), quality of life and aerobic capacity). Primary and secondary outcomes will be assessed at baseline (as appropriate), at conclusion of the intervention and at a 6-month follow-up. ETHICS AND DISSEMINATION Ethical approval has been granted by the St. James's Hospital/AMNCH Joint Ethics Committee (2016/05/02). Results from this study will be submitted for publication in peer-reviewed journals, as well as for presentation and dissemination at conferences in the field of oncology and survivorship. TRIAL REGISTRATION NCT03036436; Pre-results.
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Affiliation(s)
- Ciarán Haberlin
- Department of Physiotherapy, University of Dublin Trinity College, Dublin, Ireland
| | - Julie Broderick
- Department of Physiotherapy, University of Dublin Trinity College, Dublin, Ireland
| | - Emer M Guinan
- School of Medicine, University of Dublin Trinity College, Dublin, Ireland
| | - Catherine Darker
- Discipline of Public Health & Primary Care, University of Dublin Trinity College, Dublin, Ireland
| | - Juliette Hussey
- Department of Physiotherapy, University of Dublin Trinity College, Dublin, Ireland
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Baird AM, Easty D, Jarzabek M, Shiels L, Soltermann A, Klebe S, Raeppel S, MacDonagh L, Wu C, Griggs K, Kirschner MB, Stanfill B, Nonaka D, Goparaju CM, Murer B, Fennell DA, O'Donnell DM, Barr MP, Mutti L, Reid G, Finn S, Cuffe S, Pass HI, Opitz I, Byrne AT, O'Byrne KJ, Gray SG. When RON MET TAM in Mesothelioma: All Druggable for One, and One Drug for All? Front Endocrinol (Lausanne) 2019; 10:89. [PMID: 30863365 PMCID: PMC6399142 DOI: 10.3389/fendo.2019.00089] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 01/31/2019] [Indexed: 12/12/2022] Open
Abstract
Malignant pleural mesothelioma (MPM) is an aggressive inflammatory cancer with a poor survival rate. Treatment options are limited at best and drug resistance is common. Thus, there is an urgent need to identify novel therapeutic targets in this disease in order to improve patient outcomes and survival times. MST1R (RON) is a trans-membrane receptor tyrosine kinase (RTK), which is part of the c-MET proto-oncogene family. The only ligand recognized to bind MST1R (RON) is Macrophage Stimulating 1 (MST1), also known as Macrophage Stimulating Protein (MSP) or Hepatocyte Growth Factor-Like Protein (HGFL). In this study, we demonstrate that the MST1-MST1R (RON) signaling axis is active in MPM. Targeting this pathway with a small molecule inhibitor, LCRF-0004, resulted in decreased proliferation with a concomitant increase in apoptosis. Cell cycle progression was also affected. Recombinant MST1 treatment was unable to overcome the effect of LCRF-0004 in terms of either proliferation or apoptosis. Subsequently, the effect of an additional small molecular inhibitor, BMS-777607 (which targets MST1R (RON), MET, Tyro3, and Axl) also resulted in a decreased proliferative capacity of MPM cells. In a cohort of MPM patient samples, high positivity for total MST1R by IHC was an independent predictor of favorable prognosis. Additionally, elevated expression levels of MST1 also correlated with better survival. This study also determined the efficacy of LCRF-0004 and BMS-777607 in xenograft MPM models. Both LCRF-0004 and BMS-777607 demonstrated significant anti-tumor efficacy in vitro, however BMS-777607 was far superior to LCRF-0004. The in vivo and in vitro data generated by this study indicates that a multi-TKI, targeting the MST1R/MET/TAM signaling pathways, may provide a more effective therapeutic strategy for the treatment of MPM as opposed to targeting MST1R alone.
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Affiliation(s)
- Anne-Marie Baird
- Thoracic Oncology Research Group, Labmed Directorate, St. James's Hospital, Dublin, Ireland
- Cancer and Ageing Research Program, Queensland University of Technology, Brisbane, QLD, Australia
| | - David Easty
- Thoracic Oncology Research Group, Labmed Directorate, St. James's Hospital, Dublin, Ireland
| | - Monika Jarzabek
- Department of Physiology and Medical Physics and Centre for Systems Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Liam Shiels
- Department of Physiology and Medical Physics and Centre for Systems Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Alex Soltermann
- Department of Clinical Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Sonja Klebe
- Department of Anatomical Pathology, Flinders University of South Australia, Bedford Park, SA, Australia
| | | | - Lauren MacDonagh
- Thoracic Oncology Research Group, Labmed Directorate, St. James's Hospital, Dublin, Ireland
| | - Chengguang Wu
- Department of Clinical Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Kim Griggs
- Department of Anatomical Pathology, Flinders University of South Australia, Bedford Park, SA, Australia
| | - Michaela B. Kirschner
- Asbestos Diseases Research Institute, Sydney, NSW, Australia
- Sydney Medical School, University of Sydney, NSW, Australia
| | - Bryan Stanfill
- The Commonwealth Scientific and Industrial Research Organization, Brisbane, QLD, Australia
| | - Daisuke Nonaka
- Department of Histopathology, The Christie NHS Foundation Trust, Manchester, United Kingdom
- Department of Cardiothoracic Surgery, New York University (NYU) Langone Medical Center, New York, NY, United States
| | - Chandra M. Goparaju
- Department of Cardiothoracic Surgery, New York University (NYU) Langone Medical Center, New York, NY, United States
| | - Bruno Murer
- Department of Clinical Pathology, Ospedale dell'Angelo, Venice, Italy
| | - Dean A. Fennell
- MRC Toxicology Unit, University of Leicester and Leicester University Hospitals, Leicester, United Kingdom
| | | | - Martin P. Barr
- Thoracic Oncology Research Group, Labmed Directorate, St. James's Hospital, Dublin, Ireland
| | - Luciano Mutti
- Center for Biotechnology, Sbarro Institute for Cancer Research and Molecular Medicine, College of Science and Technology, Temple University, Philadelphia, PA, United States
| | - Glen Reid
- Asbestos Diseases Research Institute, Sydney, NSW, Australia
- Sydney Medical School, University of Sydney, NSW, Australia
| | - Stephen Finn
- Department of Histopathology and Morbid Anatomy, Trinity College Dublin, Dublin, Ireland
| | - Sinead Cuffe
- HOPE Directorate, St James's Hospital, Dublin, Ireland
| | - Harvey I. Pass
- Department of Cardiothoracic Surgery, New York University (NYU) Langone Medical Center, New York, NY, United States
| | - Isabelle Opitz
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Annette T. Byrne
- Department of Physiology and Medical Physics and Centre for Systems Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Kenneth J. O'Byrne
- Thoracic Oncology Research Group, Labmed Directorate, St. James's Hospital, Dublin, Ireland
- Cancer and Ageing Research Program, Queensland University of Technology, Brisbane, QLD, Australia
- HOPE Directorate, St James's Hospital, Dublin, Ireland
- Division of Cancer Services, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Steven G. Gray
- Thoracic Oncology Research Group, Labmed Directorate, St. James's Hospital, Dublin, Ireland
- Department of Clinical Medicine, Trinity College Dublin, Dublin, Ireland
- *Correspondence: Steven G. Gray
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Haberlin C, O'Dwyer T, Mockler D, Moran J, O'Donnell DM, Broderick J. The use of eHealth to promote physical activity in cancer survivors: a systematic review. Support Care Cancer 2018; 26:3323-3336. [PMID: 29909476 DOI: 10.1007/s00520-018-4305-z] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Accepted: 06/06/2018] [Indexed: 01/08/2023]
Abstract
PURPOSE Achieving adequate levels of physical activity (PA) and avoiding sedentary behaviour are particularly important in cancer survivors. eHealth, which includes, but is not limited to, the delivery of health information through Internet and mobile technologies, is an emerging concept in healthcare which may present opportunities to improve PA in cancer survivors. The aim of this systematic review was to explore the effects of eHealth in the promotion of PA among cancer survivors. METHODS Suitable articles were searched using PubMed, CINAHL, EMBASE, PsychInfo, Web of Science and SCOPUS databases using a combination of keywords and medical subject headings. Articles were included if they described an eHealth intervention designed to improve PA in cancer survivors. Two reviewers screened studies for inclusion. RESULTS In total, 1065 articles were considered. Ten studies met eligibility criteria. A variety of platforms designed to increase PA were described in these studies: web application (app) (n = 5), web and mobile application (n = 2), mobile app (n = 1), website only (n = 1), e-mail based (n = 1). All studies measured PA using self-report outcome measures with the exception of one study which measured steps using a Fitbit. Meta-analysis was not performed because of variations in study design and interventions. All studies reported improvements in PA, with 8/10 studies reporting statistically significant changes. CONCLUSION The use of eHealth to promote PA in cancer survivors is a relatively new concept, which is supported by the recent emergent evidence described in this review. eHealth shows promise as a means of promoting and increasing daily PA, but further high-quality, longer term studies are needed to establish the feasibility and effectiveness of eHealth platforms aimed at that goal.
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Affiliation(s)
- Ciarán Haberlin
- Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, Trinity Centre for Health Sciences, St James' Hospital, Dublin, Ireland.
| | - Tom O'Dwyer
- Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, Trinity Centre for Health Sciences, St James' Hospital, Dublin, Ireland
| | - David Mockler
- John Stearne Library, Trinity Centre for Health Sciences, St. James' Hospital, Dublin, Ireland
| | - Jonathan Moran
- Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, Trinity Centre for Health Sciences, St James' Hospital, Dublin, Ireland
| | | | - Julie Broderick
- Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, Trinity Centre for Health Sciences, St James' Hospital, Dublin, Ireland
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Abstract
107 Background: Physical activity (PA) is beneficial in reducing disease and treatment related side‐effects of cancer. However, insufficient PA levels are common among cancer survivors. eHealth may offer an innovative delivery platform to support cancer survivors to increase PA. Few qualitative studies have explored the views of cancer survivors towards eHealth based PA interventions. Our aim was to use cancer survivors’ input to inform the design of a feasibility study of eHealth for PA promotion. Methods: A ten-item scoping questionnaire-based cross-sectional study was administered to 102 cancer survivors. It evaluated their knowledge of PA guidelines, their access to smartphones and interest in eHealth interventions designed to increase PA levels. Questions were refined and evaluated in a follow-up focus group study (7 groups, n=23). Focus groups were audio recorded and transcribed. Transcripts were coded using NVivo software and themes identified by thematic content analysis. Results: In the questionnaire study, only 17.6% (n=18) of participants correctly identified PA guidelines. Sixty-two (60.8%) participants reported having access to a smartphone. Interest in participating in an eHealth intervention was expressed by 56.9% of all participants (n=58) and by 75.8% (n=47) of those with access to a smartphone. Emergent themes from the focus groups included: the physical barriers to PA, the need for PA goals, the importance of both information from healthcare professionals about PA and of a support network (e.g. peer support), the need for technological support and a motivation to improve general health. Conclusions: Very few cancer survivors were aware of the correct PA guidelines. However, over half of our sample was interested in participating in an eHealth intervention for PA, demonstrating that the cancer survivor population is responsive to a PA program delivered using technology. The focus groups have given us insights about the key elements of an effective PA intervention for cancer survivors using eHealth. We are conducting a feasibility study (The IMPETUS study; NCT03036436) of an eHealth intervention targeting PA in cancer survivors; its design was informed by those insights.
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Affiliation(s)
- Ciaran Haberlin
- Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Jonathan Moran
- Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, Dublin, Ireland
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Sheill G, Brady L, Guinan E, Hayes B, Casey O, Greene J, Vlajnic T, Cahill F, Van Hemelrijck M, Peat N, Rudman S, Hussey J, Cunningham M, Grogan L, Lynch T, Manecksha RP, McCaffrey J, Mucci L, Sheils O, O'Leary J, O'Donnell DM, McDermott R, Finn S. The ExPeCT (Examining Exercise, Prostate Cancer and Circulating Tumour Cells) trial: study protocol for a randomised controlled trial. Trials 2017; 18:456. [PMID: 28978344 PMCID: PMC5628461 DOI: 10.1186/s13063-017-2201-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 09/06/2017] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Prostate cancer (PrCa) is the second most common cancer in Ireland. Many men present with locally advanced or metastatic cancer for whom curative surgery is inappropriate. Advanced cancer patients are encouraged to remain physically active and therefore there is a need to investigate how patients with metastatic disease tolerate physical activity programmes. Physical activity reduces levels of systemic inflammatory mediators and so an aerobic exercise intervention may represent an accessible and cost-effective means of ameliorating the pro-inflammatory effects of obesity and subsequently decrease poor cancer-specific outcomes in this patient population. This study will assess the feasibility and safety of introducing a structured aerobic exercise intervention to an advanced cancer population. This study will also examine if the evasion of immune editing by circulating tumour cells (CTCs) is an exercise-modifiable mechanism in obese men with prostate cancer. METHODS This international multicentre prospective study will recruit men with metastatic prostate cancer. Participants will be recruited from centres in Dublin (Ireland) and London (UK). Participants will be divided into exposed and non-exposed groups based on body mass index (BMI) ≥ 25 kg/m2 and randomised to intervention and control groups. The exercise group will undertake a regular supervised aerobic exercise programme, whereas the control group will not. Exercise intensity will be prescribed based on a target heart rate monitored by a polar heart rate monitor. Blood samples will be taken at recruitment and at 3 and 6 months to examine the primary endpoint of platelet cloaking of CTCs. Participants will complete a detailed questionnaire to assess quality of life (QoL) and other parameters at each visit. DISCUSSION The overall aim of the ExPeCT trial is to examine the relationship between PrCa, exercise, obesity, and systemic inflammation, and to improve the overall QoL in men with advanced disease. Results will inform future work in this area examining biological markers of prognosis in advanced prostate cancer. TRIAL REGISTRATION Clinicaltrials.gov NLM identifier: NCT02453139 . Registered on 12 May 2015. This document contains excerpts from the ExPeCT trial protocol Version 1.5, 28 July 2016.
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Affiliation(s)
- Gráinne Sheill
- Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, Dublin, Ireland.
| | - Lauren Brady
- Department of Histopathology and Morbid Anatomy, Trinity Translational Medicine Institute, Dublin, Ireland
| | - Emer Guinan
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Brian Hayes
- Department of Histopathology and Morbid Anatomy, Trinity Translational Medicine Institute, Dublin, Ireland.,Department of Histopathology, Cork University Hospital, Wilton, Cork, Ireland
| | | | - John Greene
- Department of Histopathology and Morbid Anatomy, Trinity Translational Medicine Institute, Dublin, Ireland
| | - Tatjana Vlajnic
- Institute of Pathology, University Hospital Basel, Basel, Switzerland
| | - Fidelma Cahill
- King's College London, School of Cancer and Pharmaceutical Sciences, Translational Oncology & Urology Research (TOUR) , London, UK
| | - Mieke Van Hemelrijck
- King's College London, School of Cancer and Pharmaceutical Sciences, Translational Oncology & Urology Research (TOUR) , London, UK
| | - Nicola Peat
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Sarah Rudman
- King's College London, School of Cancer and Pharmaceutical Sciences, Translational Oncology & Urology Research (TOUR) , London, UK.,Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Juliette Hussey
- Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Moya Cunningham
- Cancer Trials Ireland, Dublin, Ireland.,Department of Radiation Oncology, St Luke's Hospital, Dublin, Ireland
| | - Liam Grogan
- Cancer Trials Ireland, Dublin, Ireland.,Department of Oncology, Beaumont Hospital, Dublin, Ireland
| | - Thomas Lynch
- Department of Urology, St James's Hospital, Dublin, Ireland
| | | | - John McCaffrey
- Cancer Trials Ireland, Dublin, Ireland.,Department of Oncology, Mater Misericordiae, Dublin, Ireland
| | - Lorelei Mucci
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Orla Sheils
- Department of Histopathology and Morbid Anatomy, Trinity Translational Medicine Institute, Dublin, Ireland
| | - John O'Leary
- Department of Histopathology and Morbid Anatomy, Trinity Translational Medicine Institute, Dublin, Ireland.,Department of Histopathology, St James's Hospital, Dublin, Ireland
| | - Dearbhaile M O'Donnell
- Cancer Trials Ireland, Dublin, Ireland.,HOPE Directorate, St James's Hospital, Dublin, Ireland
| | - Ray McDermott
- Cancer Trials Ireland, Dublin, Ireland.,Department of Oncology, Adelaide and Meath Hospital incorporating the National Children's Hospital, Dublin, Ireland
| | - Stephen Finn
- Department of Histopathology and Morbid Anatomy, Trinity Translational Medicine Institute, Dublin, Ireland.,Cancer Trials Ireland, Dublin, Ireland.,Department of Histopathology, St James's Hospital, Dublin, Ireland
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15
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Abu Saadeh F, Langhe R, Galvin DM, O Toole SA, O'Donnell DM, Gleeson N, Norris LA. Procoagulant activity in gynaecological cancer patients; the effect of surgery and chemotherapy. Thromb Res 2016; 139:135-41. [PMID: 26916311 DOI: 10.1016/j.thromres.2016.01.027] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 12/18/2015] [Accepted: 01/31/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND Gynaecological cancers are associated with high rates of venous thromboembolism (VTE). Studies on ambulatory cancer patients do not support thromboprophylaxis during chemotherapy. Approximately 6-7% of gynaecological cancer patients suffer a postoperative VTE despite Low Molecular Weight Heparin prophylaxis (LMWH). Large cancer studies have shown that Calibrated Automated Thrombogram (CAT) and Microparticles (MP) assays may be useful in predicting VTE but data on gynaecological cancer patients is scarce. OBJECTIVE Our objective was to identify whether the CAT assay and MP functional assays have potential as biomarkers predictive of VTE in gynaecological cancer patients. PATIENTS AND METHODS Gynaecological cancer patients were investigated before surgery (n=146) and at 5, 14 and 42days post-surgery (n=78). Fourteen additional patients were investigated before chemotherapy and after 3 and 6 cycles of therapy. Thrombin generation was measured before and after addition of thrombomodulin. RESULTS Patients with clear cell cancer (CCC) of the ovary and patients with endometrial cancer had higher ETP and peak thrombin compared with patients with benign disease. Patients who developed VTE (n=8) following surgery had enhanced thrombin generation prior to surgery which persisted during the post-operative period despite LMWH prophylaxis. Both neoadjuvant and adjuvant chemotherapy showed increased thrombin generation following addition of thrombomodulin. There were no differences in MP levels during the study. CONCLUSIONS CAT assay shows potential as a promising biomarker for the prediction of VTE in gynaecological cancer patients. The identification of high risk patients combined with individualised LMWH prophylaxis might reduce VTE in this high risk group.
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Affiliation(s)
- F Abu Saadeh
- Department of Gynaecology Oncology, St James's Hospital, Dublin 8, Ireland.
| | - R Langhe
- Trinity College Department of Obstetrics and Gynaecology, Trinity Centre for Health Sciences, St. James's Hospital, Dublin 8, Ireland
| | - D M Galvin
- Department of Gynaecology Oncology, St James's Hospital, Dublin 8, Ireland
| | - S A O Toole
- Trinity College Department of Obstetrics and Gynaecology, Trinity Centre for Health Sciences, St. James's Hospital, Dublin 8, Ireland
| | - D M O'Donnell
- Department of Medical Oncology, St James's Hospital, Dublin 8, Ireland
| | - N Gleeson
- Department of Gynaecology Oncology, St James's Hospital, Dublin 8, Ireland; Trinity College Department of Obstetrics and Gynaecology, Trinity Centre for Health Sciences, St. James's Hospital, Dublin 8, Ireland
| | - L A Norris
- Trinity College Department of Obstetrics and Gynaecology, Trinity Centre for Health Sciences, St. James's Hospital, Dublin 8, Ireland
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16
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O'Callaghan DS, Rexhepaj E, Gately K, Coate L, Delaney D, O'Donnell DM, Kay E, O'Connell F, Gallagher WM, O'Byrne KJ. Tumour islet Foxp3+ T-cell infiltration predicts poor outcome in nonsmall cell lung cancer. Eur Respir J 2015; 46:1762-72. [DOI: 10.1183/13993003.00176-2014] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 07/14/2015] [Indexed: 12/29/2022]
Abstract
The impact of host immunity on outcome in nonsmall cell lung cancer (NSCLC) is controversial. We examined the relationship between lymphoid infiltration patterns in NSCLC and prognosis.Tumour- and stroma-infiltrating CD3+, CD8+ and forkhead box P3 (Foxp3)+ T-lymphocytes were identified using immunohistochemistry and a novel image analysis algorithm to assess total, cytotoxic and regulatory T-lymphocyte counts, respectively, in 196 NSCLC cases. The median cell count was selected as a cut-point to define patient subgroups and the ratio of the corresponding tumour islet:stroma (TI/S) counts was determined.There was a positive association between overall survival and increased CD8+ TI/S ratio (hazard ratio (HR) for death 0.44, p<0.001) but an inverse relationship between Foxp3+ TI/S ratio and overall survival (HR 4.86, p<0.001). Patients with high CD8+ islet (HR 0.48, p<0.001) and Foxp3+ stromal (HR 0.23, p<0.001) counts had better survival, whereas high CD3+ and CD8+ stromal counts and high Foxp3+ islet infiltration conferred a worse survival (HR 1.55, 2.19 and 3.14, respectively). By multivariate analysis, a high CD8+ TI/S ratio conferred an improved survival (HR 0.48, p=0.002) but a high Foxp3+ TI/S ratio was associated with worse survival (HR 3.91, p<0.001).Microlocalisation of infiltrating T-lymphocytes is a powerful predictor of outcome in resected NSCLC.
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17
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Langhe R, Norris L, Saadeh FA, Blackshields G, Varley R, Harrison A, Gleeson N, Spillane C, Martin C, O'Donnell DM, D'Arcy T, O'Leary J, O'Toole S. A novel serum microRNA panel to discriminate benign from malignant ovarian disease. Cancer Lett 2014; 356:628-36. [PMID: 25451316 DOI: 10.1016/j.canlet.2014.10.010] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 10/08/2014] [Accepted: 10/08/2014] [Indexed: 12/19/2022]
Abstract
Ovarian cancer is the seventh most common cancer in women and the most frequent cause of gynaecological malignancy-related mortality in women. Currently, no standardized reliable screening test exists. MicroRNA profiling has allowed the identification of signatures associated with diagnosis, prognosis and response to treatment of human tumours. The aim of this study was to determine if a microRNA signature could distinguish between malignant and benign ovarian disease. A training set of 5 serous ovarian carcinomas and 5 benign serous cystadenomas were selected for the initial experiments. The validation set included 20 serous ovarian carcinomas and 20 benign serous cystadenomas. The serum/plasma focus microRNA Exiqon panel was used for the training set. For the validation set a pick and mix Exiqon panel, which focuses on microRNAs of interest was used. A panel of 4 microRNAs (let-7i-5p, miR-122, miR-152-5p and miR-25-3p) was significantly down regulated in cancer patients. These microRNAs target WNT signalling, AKT/mTOR and TLR-4/MyD88, which have previously been found to play a role in ovarian carcinogenesis and chemoresistance. let-7i-5p, miR-122, miR-152-5p and miR-25-3p could act as diagnostic biomarkers in ovarian cancer.
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Affiliation(s)
- Ream Langhe
- Department of Obstetrics and Gynaecology, Trinity College Dublin, St. James's Hospital, Dublin 8, Ireland; Department of Histopathology, Trinity College Dublin, St. James's Hospital, Dublin 8, Ireland.
| | - Lucy Norris
- Department of Obstetrics and Gynaecology, Trinity College Dublin, St. James's Hospital, Dublin 8, Ireland
| | - Feras Abu Saadeh
- Department of Gynaecological-Oncology, St. James's Hospital, Dublin 8, Ireland
| | - Gordon Blackshields
- Department of Histopathology, Trinity College Dublin, St. James's Hospital, Dublin 8, Ireland
| | - Rachel Varley
- Department of Obstetrics and Gynaecology, Trinity College Dublin, St. James's Hospital, Dublin 8, Ireland
| | - Ashling Harrison
- Department of Obstetrics and Gynaecology, Trinity College Dublin, St. James's Hospital, Dublin 8, Ireland
| | - Noreen Gleeson
- Department of Gynaecological-Oncology, St. James's Hospital, Dublin 8, Ireland
| | - Cathy Spillane
- Department of Histopathology, Trinity College Dublin, Coombe Women's and Infants University Hospital, Dublin 8, Ireland
| | - Cara Martin
- Department of Histopathology, Trinity College Dublin, Coombe Women's and Infants University Hospital, Dublin 8, Ireland
| | | | - Tom D'Arcy
- Department of Gynaecological-Oncology, St. James's Hospital, Dublin 8, Ireland
| | - John O'Leary
- Department of Histopathology, Trinity College Dublin, St. James's Hospital, Dublin 8, Ireland; Department of Histopathology, Trinity College Dublin, Coombe Women's and Infants University Hospital, Dublin 8, Ireland
| | - Sharon O'Toole
- Department of Obstetrics and Gynaecology, Trinity College Dublin, St. James's Hospital, Dublin 8, Ireland; Department of Histopathology, Trinity College Dublin, St. James's Hospital, Dublin 8, Ireland
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18
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Jayaram A, Teo M, Deady S, Comber H, O'Donnell DM, McDermott R. Smoking status (SS) and influence on the clinical behavior of transitional cell carcinoma (TCC): An epidemiologic perspective. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.e15512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - MinYuen Teo
- Department of Medical Oncology, Adelaide and Meath Hospital, incorporating the National Children's Hospital, Dublin, Ireland
| | - Sandra Deady
- National Cancer Registry of Ireland, Cork, Ireland
| | | | | | - Raymond McDermott
- Department of Medical Oncology, Adelaide and Meath Hospital, Dublin, Ireland
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19
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Hook J, Stenning SP, Brenton J, Kaye SB, McNeish IA, Naik R, Perren T, Petrie J, Farrelly L, Dean AP, O'Donnell DM, Gallardo Rincon D, Kim JW, Ledermann JA, Clamp AR. ICON8: An international randomized trial comparing two dose-dense regimens, 3-weekly carboplatin plus weekly paclitaxel (CwT), and weekly carboplatin-paclitaxel (wCwT), to standard 3-weekly treatment in women with newly diagnosed ovarian, fallopian tube, and primary peritoneal cancer. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.tps5611] [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)
- Jane Hook
- Medical Research Council Clinical Trials Unit at University College London, London, United Kingdom
| | - Sally Patricia Stenning
- Medical Research Council Clinical Trials Unit at University College London, London, United Kingdom
| | - James Brenton
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, United Kingdom
| | - Stan B Kaye
- The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, London, United Kingdom
| | - Iain A. McNeish
- Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Raj Naik
- Northern Gynaecological Oncology Centre, Gateshead, United Kingdom
| | - Timothy Perren
- St James's Institute of Oncology, St. James's University Hospital, Leeds, United Kingdom
| | - Jennifer Petrie
- Medical Research Council Clinical Trials Unit at University College London, London, United Kingdom
| | - Laura Farrelly
- Medical Research Council Clinical Trials Unit at University College London, London, United Kingdom
| | | | | | | | - Jae Weon Kim
- Seoul National University, College of Medicine, Seoul, South Korea
| | | | - Andrew R. Clamp
- The Christie Hospital NHS Foundation Trust, Manchester, United Kingdom
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20
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Broderick JM, Hussey J, O'Donnell DM. Comment on 'Interventions to improve exercise behaviour in sedentary people living with and beyond cancer: a systematic review'. Br J Cancer 2014; 111:2377-8. [PMID: 24809781 PMCID: PMC4264423 DOI: 10.1038/bjc.2014.248] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- J M Broderick
- Department of Physiotherapy, School of Medicine, Trinity Centre for Health Science, St James's Hospital, St James's Street, Dublin 8, Ireland
| | - J Hussey
- Department of Physiotherapy, School of Medicine, Trinity Centre for Health Science, St James's Hospital, St James's Street, Dublin 8, Ireland
| | - D M O'Donnell
- Academic Unit of Clinical and Medical Oncology, St James's Hospital, St James's Street, Dublin 8, Ireland
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21
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22
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Gray SG, Easty D, Nonaka D, Soltermann A, Murer B, Kennedy MJ, O'Donnell DM, Mutti L, Pass HI, O'Byrne KJ. Abstract 702: RON receptor tyrosine kinase: A potential therapeutic target in malignant pleural mesothelioma. Cancer Res 2010. [DOI: 10.1158/1538-7445.am10-702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
BACKGROUND: Expression of receptor tyrosine kinases (RTK) and their cognate ligands has been described in mesothelioma, leading to the hypothesis that autocrine growth pathways could be therapeutic targets of tyrosine kinase inhibitors (TKIs).
METHODS: Phospho-RTK arrays were used to evaluate phosphorylation of 42 RTKs in 4 mesothelioma cell lines and 11 mesothelioma surgical specimens. Western Blot analysis, IHC, cellular migration and invasion assays were performed.
RESULTS: Tumours contained 14 phospho-RTKs. RON emerged as a frequently identifed kinase which has not been previously reported in mesothelioma. An extended panel of sixteen mesothelioma tumour and five benign pleural tissue samples were characterised by western blot analysis. The presence of RON message was confirmed by RT-PCR with specific primers in mesothelioma cell lines Western blot analysis detected RON in 16 tumours and 4 cell lines but not in the SV-40 transformed normal mesothelial MET-5A cells. Mesothelioma expressed different isoforms of RON compared to benign pleural plaques: both benign pleural plaques and mesotheliomas expressed the shortform of RON (sf-RON), whereas, the larger RON variants, Δ160 and Δ165, were seen in mesothelioma samples.
IHC was subsequently carried out on a large series of FFPE samples (n>400), with clinical followup to determine if RON expression correlates with prognosis or response to therapy. Scratch assays using antibodies directed against RON prevented MPM cell line migration
CONCLUSIONS: Mesothelioma contains multiple activated RTKs including RON. Previously, RON was shown to mediate epithelial mesenchymal transition (EMT). This may be significant given the epithelioid to sarcomatoid spectrum of mesothelioma. Expression of Δ160 and Δ165 was previously reported in gastric and colorectal cancers and may be associated with oncogenesis. RON has been identified as a therapeutic target in pancreatic cancer and this may also apply in mesothelioma. Functional studies on targeting RON in mesothelioma are ongoing.
Note: This abstract was not presented at the AACR 101st Annual Meeting 2010 because the presenter was unable to attend.
Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 702.
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Affiliation(s)
| | - David Easty
- 1Institute of Molecular Medicine, Dublin, Ireland
| | | | | | | | | | | | - Lucciano Mutti
- 6Department of Medicine, Local Health Unit 11, Borgosesia Vercelli, Italy
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23
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Morris PG, Swords R, Sukor S, Fortune A, O'Donnell DM, Conneally E. Autoimmune hemolytic anemia associated with ovarian cancer. J Clin Oncol 2008; 26:4993-5. [PMID: 18809611 DOI: 10.1200/jco.2008.17.1231] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Patrick G Morris
- Department of Medical Oncology, HOPE Directorate, St James's Hospital, Dublin, Ireland
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24
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Hill KS, Errington F, Steele LP, Merrick A, Morgan R, Selby PJ, Georgopoulos NT, O'Donnell DM, Melcher AA. OK432-Activated Human Dendritic Cells Kill Tumor Cells via CD40/CD40 Ligand Interactions. J Immunol 2008; 181:3108-15. [DOI: 10.4049/jimmunol.181.5.3108] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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25
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O'Donnell DM. Pulmonary complications in neuromuscular disease. Adolesc Med 2000; 11:633-45. [PMID: 11060559] [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] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Pulmonary compromise can result from primarily peripheral or central neuropathic disease (including neurodegenerative diseases) or diseases of the muscle or neuromuscular junction. Some diseases present with a combination of nervous system and muscle tissue involvement (due to secondary changes like atrophy or primary pathology, as in mitochondrial diseases). While clinically different in pathophysiology, these diseases may progress to produce and ìshareî common pulmonary pathology by the time the patient reaches the adolescent years. This article presents a review of the categories of neurologic disease that may lead to respiratory compromise, followed by thorough description of the pulmonary complications that can result from these types of diseases. Finally, a review of currently accepted treatment options that may aid in improving the quality of life of these patients is offered.
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Affiliation(s)
- D M O'Donnell
- Department of Pediatrics, Michigan State University, Kalamazoo Center for Medical Studies, Kalamazoo, MI 49008-1284, USA
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26
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Abstract
BACKGROUND Though it is well known that cardiogenic and noncardiogenic pulmonary edema can cause changes in lung mechanics, actual alterations in tracheal diameter have not been described. OBJECTIVE To evaluate the effects of pulmonary edema induced by increased left atrial pressure (cardiogenic) and Perilla ketone (PK; noncardiogenic) on tracheal diameter in chronically instrumented awake sheep. METHODS We investigated the effects of two mechanistically distinct types of pulmonary edema on tracheal diameter in chronically instrumented awake sheep. Cardiogenic pulmonary edema (analogous to congestive heart failure in humans) was induced by increasing left atrial pressure ( upward arrowP(LA)) by inflating the balloon on a Foley catheter positioned in the mitral valve annulus to cause partial obstruction to flow across the valve (n = 18). Noncardiogenic pulmonary edema (increased pulmonary microvascular permeability pulmonary edema analogous to the acute respiratory distress syndrome in humans) was produced by the intravenous administration of PK (n = 11). Lateral chest radiographs (CXRs) were scored by a standardized 5-point scoring system for the severity of pulmonary edema, and tracheal diameter was measured at a fixed location in the carina. Three radiologists, blinded to sheep identification number and experimental protocol, evaluated the radiographs independently at different points in time for edema severity and tracheal diameter. The sheep were sacrificed immediately after the final CXR, and wet/dry lung weight ratio (W/D ratio) was determined. RESULTS Both upward arrowP(LA) and PK were associated with statistically significant tracheal narrowing ( upward arrowP(LA): 20.3 +/- 0.6 to 15.1 +/- 0.9 mm; PK: 20.2 +/- 0.6 to 14.1 +/- 1.4 mm). Tracheal narrowing correlated with the severity of the pulmonary edema determined radiographically ( upward arrowP(LA): r = -0.69, p < 0.01; PK: r = -0.62, p < 0.01) and by W/D ratio ( upward arrowP(LA): r = -0.64, p < 0.05; PK: r = -0.54, p < 0. 05). CONCLUSIONS We conclude that tracheal narrowing occurs in sheep models of both cardiogenic and noncardiogenic pulmonary edema and that the degree of narrowing correlates with the severity of the edema.
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Affiliation(s)
- J R Snapper
- The Center for Lung Research, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
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27
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Abstract
Incontinence disorders are an important group of problems that clinicians manage in children and adolescents. This paper reviews the physiology of micturition, the epidemiology of enuresis, etiologic concepts of incontinence disorders, a general clinical approach to enuretic patients, laboratory evaluation and general principles of management. Neurological and nephrological concepts of enuresis are emphasized in this discussion.
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Affiliation(s)
- D E Greydanus
- Michigan State University College of Human Medicine, MSU/Kalamazoo Centre Medical Studies 49008-1284, USA
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28
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Abstract
OBJECTIVE The goal of this study was to determine the significance of excessive rhythmic alpha and/or theta frequency activity in neonatal EEGs. METHODS The EEGs of 963 neonates, 26-44 weeks conceptional age (CA), performed during the years 1992-1994 at the Texas Children's Hospital, Houston, Texas, were reviewed for the presence of excessive rhythmic alpha and/or theta frequency activity. Cases in which such activity was identified were further characterized by the presence or absence of other EEG abnormalities. The medical records of these patients and a group of control infants with normal EEGs were reviewed to identify associated pathological conditions. RESULTS Forty patients were identified whose EEGs revealed such activity. The CA of these patients ranged from 37 to 44 weeks. A variety of pathological conditions were seen in these patients, most commonly congenital heart disease, congenital brain anomalies and hypoxia. These conditions were not seen in the control group of infants. Twenty patients had received CNS-active drugs. The EEGs of 32 patients revealed additional abnormalities, most commonly multifocal sharp waves and episodes of voltage attenuation during slow-wave sleep. CONCLUSIONS The results indicate that excessive rhythmic alpha and/or theta frequency activity is an abnormal finding in the newborn's EEG.
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Affiliation(s)
- R A Hrachovy
- Department of Neurology, Baylor College of Medicine, Veteran's Administration Medical Center, Houston, Texas 77030, USA
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29
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O'Donnell DM, Moynihan J, Finlay GA, Keatings VM, O'Connor CM, McLoughlin P, Fitzgerald MX. Exhaled nitric oxide and bronchoalveolar lavage nitrite/nitrate in active pulmonary sarcoidosis. Am J Respir Crit Care Med 1997; 156:1892-6. [PMID: 9412571 DOI: 10.1164/ajrccm.156.6.9705013] [Citation(s) in RCA: 24] [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] [Indexed: 02/05/2023] Open
Abstract
Increased exhaled nitric oxide (NO) may reflect respiratory tract inflammation in untreated asthmatics. We compared exhaled NO and bronchoalveolar lavage (BAL) nitrate/nitrite (NO3-/NO2-) in 10 patients who had untreated, active pulmonary sarcoidosis with those of normal control subjects. Exhaled NO concentrations, determined by chemiluminescence, were similar in patients and control subjects (peak NO concentration of patients [mean +/- SD]: 13.6 +/- 5.9 parts per billion [ppb], peak NO concentration of control subjects: 11.2 +/- 5.7 ppb, p = 0.32; mean alveolar NO concentration of patients: 7.8 +/- 4.4 ppb, mean alveolar NO concentration of control subjects: 7.1 +/- 4.2 ppb, p = 0.70; end-tidal NO concentration of patients: 6.9 +/- 4.5 ppb, end-tidal NO concentration of control subjects: 6.6 +/- 4.0 ppb, p = 0.60). BAL NO2- was assayed using a modified Griess reaction after reduction of NO3- to NO2-. There was no significant difference in mean BAL NO2- concentrations, expressed as nanomoles per milliliter of epithelial lining fluid (patients: 544 nmol/ml, control subjects: 579 nmol/ml, p = 0.81) or as nanomoles per milliliter of BAL fluid (patients: 6.7 nmol/ml, control subjects: 5.7 nmol/ml, p = 0.41). These data suggest that excess NO generation does not accompany the respiratory tract inflammation of pulmonary sarcoidosis.
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Affiliation(s)
- D M O'Donnell
- Department of Medicine and Therapeutics, University College Dublin, St. Vincent's Hospital, Ireland
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Abstract
The relationship between the expansion of trinucleotide repeat sequences and human disease hs been the subject of a significant volume of study since the identification of a CGG repeat sequence in the mutated gene responsible for the fragile X syndrome. Six other neurologic diseases are now known to result from a triplet repeat expansion of either CTG or CAG nucleotides. Of particular interest to the pediatrician or pediatric subspecialist is the phenomenon of "anticipation," now clarified by mechanisms inherent to trinucleotide repeat expansions. The progressive enlargement of repeat sequences in successive generations of affected kindreds correlates inversely with the age of onset and, in some cases, the severity of the disease. The presentation of a young patient with symptoms ranging from developmental delay to movement disorders and ataxia requires that the physician involved in the child's care be aware of these diseases, their phenotypic variability, and their effects in previous generations. In this manner, pertinent history, including family history, may be obtained, relevant diagnostic testing initiated, and appropriate referrals facilitated.
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Affiliation(s)
- D M O'Donnell
- Baylor College of Medicine, Houston, Texas 77030, USA
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Vansant JP, Johnson DH, O'Donnell DM, Stewart JR, Sonin AH, McCook BM, Powers TA, Salk DJ, Frist WH, Sandler MP. Staging lung carcinoma with a Tc-99m labeled monoclonal antibody. Clin Nucl Med 1992; 17:431-8. [PMID: 1319860 DOI: 10.1097/00003072-199206000-00001] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Thirty-three patients with biopsy-proven lung cancer and a total of 150 lesions diagnosed by conventional staging procedures were imaged using a Tc-99m labeled monoclonal Fab fragment of an IgG2B murine monoclonal antibody (MoAb) (NR-LU-10, NeoRx Corporation). Immunoscintigraphy demonstrated 100% of primary and 78% of metastatic lesions. MoAb imaging detected 88% of lesions in 12 small cell lung cancer (SCLC) patients and 77% of lesions in 21 non-small cell lung cancer (NSCLC) patients. Based on initial evaluation by other methods, 29 sites of MoAb activity were not associated with evidence of disease. Eleven of these were subsequently shown to represent sites of metastases; 18 remain unconfirmed. Four of ten patients studied with limited NSCLC had eight unsuspected lesions on MoAb imaging. Confirmation of unsuspected lesions in two patients altered initial clinical staging, and surgical therapy was abandoned. This study demonstrates that Tc-99m labeled NR-LU-10 can accurately stage patients with lung cancer.
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Affiliation(s)
- J P Vansant
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee 37232-2675
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Worrell JA, Brunner JP, O'Donnell DM, Carroll FE. Chest case of the day. Pulmonary edema associated with tocolytic therapy. AJR Am J Roentgenol 1992; 158:1356-7. [PMID: 1590140 DOI: 10.2214/ajr.158.6.1590140] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Cikrit DF, O'Donnell DM, Dalsing MC, Sawchuk AP, Lalka SG. Clinical implications of combined hypogastric and profunda femoral artery occlusion. Am J Surg 1991; 162:137-40; discussion 140-1. [PMID: 1862834 DOI: 10.1016/0002-9610(91)90175-d] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
From 1983 to 1990, nine patients with combined hypogastric (HA) and profunda femoral arterial (PFA) occlusive disease presented with five nonhealing hip disarticulations, three nonhealing above-the-knee amputations, perineal necrosis in six patients, buttock necrosis in four patients, visceral ischemia in two patients, and lumbosacral spinal ischemia in one patient. Obviously some patients had more than one regional complication. Five patients died from complications of HA/PFA ischemia. Survivors included two patients who required a hemipelvectomy, one patient who required an axillary-to-hypogastric artery bypass graft for stump salvage, and one patient who survived despite lumbosacral paralysis and complete cystectomy. The 56% mortality and 100% morbidity emphasize the critical significance of combined hypogastric/profunda femoral artery circulatory compromise. Efforts should be made to preserve or re-establish the HA and/or PFA circulation whenever possible. A hemipelvectomy may be required to allow the wounds to finally heal. Furthermore, the certainty of an above-the-knee amputation healing is not present in these patients; therefore, a hemodynamic assessment of the healing potential of an above-the-knee amputation is required.
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Affiliation(s)
- D F Cikrit
- Department of Surgery, Indiana University Medical Center, Indianapolis 46202
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Prisant LM, Carr AA, Desnoyers M, Westcott RJ, Zinny MA, O'Donnell DM, Bryzinski B, McKee B, Nelson BR. Multicenter evaluation of the hemodynamic effects of bisoprolol in patients with mild to moderate hypertension. J Clin Pharmacol 1990; 30:1096-101. [PMID: 1980278 DOI: 10.1002/j.1552-4604.1990.tb01851.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Twenty-six patients with mild-to-moderate essential hypertension participated in a 6-week outpatient, multicenter, randomized, double-blind, placebo-controlled two-way crossover study to assess the hemodynamic effects of bisoprolol (20 mg QD) at steady state. Hemodynamic assessments included sitting blood pressure, heart rate, and left-ventricular ejection fraction by radionuclide ventriculography after 7 days of bisoprolol or placebo at trough (24 h post-dose) and peak (3 h post-dose) values. The group adjusted mean ejection fraction was not significantly different in patients receiving bisoprolol compared with the placebo group at either peak or trough measurements; in fact, means in patients taking bisoprolol were slightly higher than in the placebo group. No symptomatic hypotension was documented. Blood pressure, measured 24 hours after dosing, was significantly lower in those receiving bisoprolol when compared with the placebo group, by 7.7 mm Hg and 9 mm Hg for diastolic and systolic blood pressure, respectively. Similarly, mean values of heart rate were 10 beats/min lower in the bisoprolol patients than in the placebo group. Only headache and insomnia occurred as adverse events. Bisoprolol (20 mg QD) effectively lowered blood pressure over a 24-hour period without significantly reducing ejection fraction or causing adverse clinical or biochemical events.
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Affiliation(s)
- L M Prisant
- Section of Hypertension, Medical College of Georgia, Augusta 30912-3150
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Baum NH, O'Donnell DM. Evaluation and treatment of erectile dysfunction. J La State Med Soc 1983; 135:12-3, 15-6. [PMID: 6558107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
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O'Donnell DM, Kraman SS. Vesicular lung sound amplitude mapping by automated flow-gated phonopneumography. J Appl Physiol Respir Environ Exerc Physiol 1982; 53:603-9. [PMID: 7129980 DOI: 10.1152/jappl.1982.53.3.603] [Citation(s) in RCA: 35] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
A recently developed automated apparatus capable of determining vesicular lung sound amplitude rapidly and accurately was used to construct detailed inspiratory vesicular sound amplitude maps in eight healthy male subjects to determine the normal amplitude patterns on the chest wall. The sounds were recorded in 2-cm steps along the following lines bilaterally: A, vertically, clavicle to abdomen, 6 cm from the sternal border; B, vertically, from the level of T1 to the lung bases, 6 cm from the spine; and C, horizontally, from the sternal border to the spine at the level of the nipple. Sound amplitude was measured at an airflow rate of 1.3 l/s. The resulting amplitude maps revealed considerable intra- and intersubject variation with frequent amplitude heterophony. Th patterns for the subjects as a group were as follows: series A, amplitude decreasing with distance from the clavicle; series B, amplitude increasing with distance from T1 with a peak at the bases; and series C, approximately equal amplitude at all positions. The findings in series B and C are, in general, consistent with an explanation of ventilation following hydrostatic gradients. The series A pattern and the intersubject variability in amplitude are inconsistent with this explanation and suggest that the inspiratory vesicular sound amplitude is not simply a result of ventilation distribution but involves other as yet undefined factors.
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