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Cartwright E, Slater S, Saffery C, Tran A, Turkes F, Smith G, Aresu M, Kohoutova D, Terlizzo M, Zhitkov O, Rana I, Johnston EW, Sanna I, Smyth E, Mansoor W, Fribbens C, Rao S, Chau I, Starling N, Cunningham D. Phase II trial of domatinostat (4SC-202) in combination with avelumab in patients with previously treated advanced mismatch repair proficient oesophagogastric and colorectal adenocarcinoma: EMERGE. ESMO Open 2024; 9:102971. [PMID: 38518549 PMCID: PMC10972804 DOI: 10.1016/j.esmoop.2024.102971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 02/23/2024] [Accepted: 02/26/2024] [Indexed: 03/24/2024] Open
Abstract
BACKGROUND Most oesophagogastric adenocarcinomas (OGAs) and colorectal cancers (CRCs) are mismatch repair proficient (MMRp), responding poorly to immune checkpoint inhibition. We evaluated the safety and efficacy of domatinostat (histone deacetylase inhibitor) plus avelumab (anti-PD-L1 antibody) in patients with previously treated inoperable, advanced/metastatic MMRp OGA and CRC. PATIENTS AND METHODS Eligible patients were evaluated in a multicentre, open-label dose escalation/dose expansion phase II trial. In the escalation phase, patients received escalating doses of domatinostat [100 mg once daily (OD), 200 mg OD, 200 mg twice daily (BD)] orally for 14 days followed by continuous dosing plus avelumab 10 mg/kg administered intravenously 2-weekly (2qw) to determine the recommended phase II dose (RP2D). The trial expansion phase evaluated the best objective response rate (ORR) during 6 months by RECIST version 1.1 using a Simon two-stage optimal design with 2/9 and 1/10 responses required to proceed to stage 2 in the OGA and CRC cohorts, respectively. RESULTS Patients (n = 40) were registered between February 2019 and October 2021. Patients in the dose escalation phase (n = 12) were evaluated to confirm the RP2D of domatinostat 200 mg BD plus avelumab 10 mg/kg. No dose-limiting toxicities were observed. Twenty-one patients were treated at the RP2D, 19 (9 OGA and 10 CRC) were assessable for the best ORR; 2 patients with CRC did not receive combination treatment and were not assessable for the primary endpoint analysis. Six patients were evaluated in the dose escalation and expansion phases. In the OGA cohort, the best ORR was 22.2% (95% one-sided confidence interval lower bound 4.1) and the median duration of disease control was 11.3 months (range 9.9-12.7 months). No responses were observed in the CRC cohort. No treatment-related grade 3-4 adverse events were reported at the RP2D. CONCLUSIONS Responses in the OGA cohort met the criteria to expand to stage 2 of recruitment with an acceptable safety profile. There was insufficient signal in the CRC cohort to progress to stage 2. TRIAL REGISTRATION NCT03812796 (registered 23rd January 2019).
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Affiliation(s)
- E Cartwright
- Gastrointestinal and Lymphoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London
| | - S Slater
- Gastrointestinal and Lymphoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London
| | - C Saffery
- Gastrointestinal and Lymphoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London
| | - A Tran
- Gastrointestinal and Lymphoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London
| | - F Turkes
- Gastrointestinal and Lymphoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London
| | - G Smith
- Gastrointestinal and Lymphoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London
| | - M Aresu
- Gastrointestinal and Lymphoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London
| | - D Kohoutova
- Gastrointestinal and Lymphoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London
| | - M Terlizzo
- Gastrointestinal and Lymphoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London
| | - O Zhitkov
- Gastrointestinal and Lymphoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London
| | - I Rana
- Gastrointestinal and Lymphoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London
| | - E W Johnston
- Gastrointestinal and Lymphoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London
| | - I Sanna
- Gastrointestinal and Lymphoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London
| | - E Smyth
- Gastrointestinal and Lymphoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London
| | - W Mansoor
- Oesophago-Gastric Cancer Services, The Christie NHS Foundation Trust, Manchester, UK
| | - C Fribbens
- Gastrointestinal and Lymphoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London
| | - S Rao
- Gastrointestinal and Lymphoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London
| | - I Chau
- Gastrointestinal and Lymphoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London
| | - N Starling
- Gastrointestinal and Lymphoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London
| | - D Cunningham
- Gastrointestinal and Lymphoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London.
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Ketkar A, Willey V, Glasser L, Dobie C, Wenziger C, Teng CC, Dube C, Hirpara S, Cunningham D, Verduzco-Gutierrez M. Assessing the Burden and Cost of COVID-19 Across Variants in Commercially Insured Immunocompromised Populations in the United States: Updated Results and Trends from the Ongoing EPOCH-US Study. Adv Ther 2024; 41:1075-1102. [PMID: 38216825 PMCID: PMC10879378 DOI: 10.1007/s12325-023-02754-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 11/28/2023] [Indexed: 01/14/2024]
Abstract
INTRODUCTION/METHODS EPOCH-US is an ongoing, retrospective, observational cohort study among individuals identified in the Healthcare Integrated Research Database (HIRD®) with ≥ 12 months of continuous health plan enrollment. Data were collected for the HIRD population (containing immunocompetent and immunocompromised [IC] individuals), individual IC cohorts (non-mutually exclusive cohorts based on immunocompromising condition and/or immunosuppressive [IS] treatment), and the composite IC population (all unique IC individuals). This study updates previous results with addition of the general population cohort and data specifically for the year of 2022 (i.e., Omicron wave period). To provide healthcare decision-makers the most recent trends, this study reports incidence rates (IR) and severity of first SARS-CoV-2 infection; and relative risk, healthcare utilization, and costs related to first COVID-19 hospitalizations in the full year of 2022 and overall between April 2020 and December 2022. RESULTS These updated results showed a 2.9% prevalence of immune compromise in the population. From April 2020 through December 2022, the overall IR of COVID-19 was 115.7 per 1000 patient-years in the composite IC cohort and 77.8 per 1000 patient-years in the HIRD cohort. The composite IC cohort had a 15.4% hospitalization rate with an average cost of $42,719 for first COVID-19 hospitalization. Comparatively, the HIRD cohort had a 3.7% hospitalization rate with an average cost of $28,848 for first COVID-19 hospitalization. Compared to the general population, IC individuals had 4.3 to 23 times greater risk of hospitalization with first diagnosis of COVID-19. Between January and December 2022, hospitalizations associated with first COVID-19 diagnosis cost over $1 billion, with IC individuals (~ 3% of the population) generating $310 million (31%) of these costs. CONCLUSION While only 2.9% of the population, IC individuals had a higher risk of COVID-19 hospitalization and incurred higher healthcare costs across variants. They also disproportionately accounted for over 30% of total costs for first COVID-19 hospitalization in 2022, amounting to ~ $310 million. These data highlight the need for additional preventive measures to decrease the risk of developing severe COVID-19 outcomes in vulnerable IC populations.
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Affiliation(s)
| | | | - Lisa Glasser
- AstraZeneca, Biopharmaceuticals Medical, Wilmington, DE, USA
| | - Casey Dobie
- Xcenda, a Cencora company, Conshohocken, PA, USA
| | | | | | - Christine Dube
- AstraZeneca, Biopharmaceuticals Medical, Wilmington, DE, USA
| | - Sunny Hirpara
- AstraZeneca, Biopharmaceuticals Medical, Wilmington, DE, USA
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Ajani J, El Hajbi F, Cunningham D, Alsina M, Thuss-Patience P, Scagliotti GV, Van den Eynde M, Kim SB, Kato K, Shen L, Li L, Ding N, Shi J, Barnes G, Van Cutsem E. Tislelizumab versus chemotherapy as second-line treatment for European and North American patients with advanced or metastatic esophageal squamous cell carcinoma: a subgroup analysis of the randomized phase III RATIONALE-302 study. ESMO Open 2024; 9:102202. [PMID: 38118368 PMCID: PMC10837773 DOI: 10.1016/j.esmoop.2023.102202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 11/22/2023] [Accepted: 11/22/2023] [Indexed: 12/22/2023] Open
Abstract
BACKGROUND The phase III RATIONALE-302 study evaluated tislelizumab, an anti-programmed cell death protein 1 antibody, as second-line (2L) treatment for advanced/metastatic esophageal squamous cell carcinoma (ESCC). This prespecified exploratory analysis investigated outcomes in patients from Europe and North America (Europe/North America subgroup). PATIENTS AND METHODS Patients with tumor progression during/after first-line systemic treatment were randomized 1 : 1 to open-label tislelizumab or investigator's choice of chemotherapy (paclitaxel, docetaxel, or irinotecan). RESULTS The Europe/North America subgroup comprised 108 patients (tislelizumab: n = 55; chemotherapy: n = 53). Overall survival (OS) was prolonged with tislelizumab versus chemotherapy (median: 11.2 versus 6.3 months), with a hazard ratio (HR) of 0.55 [95% confidence interval (CI) 0.35-0.87]; HR was similar irrespective of programmed death-ligand 1 score [≥10%: 0.47 (95% CI 0.18-1.21); <10%: 0.55 (95% CI 0.30-1.01)]. Median progression-free survival was 2.3 versus 2.7 months with tislelizumab versus chemotherapy [HR: 0.97 (95% CI 0.64-1.47)]. Overall response rate was greater with tislelizumab (20.0%) versus chemotherapy (11.3%), with more durable response (median duration of response: 5.1 versus 2.1 months). Tislelizumab had a favorable safety profile versus chemotherapy, with fewer patients experiencing ≥grade 3 treatment-related adverse events (13.0% versus 51.0%). Those on tislelizumab experienced less deterioration in health-related quality of life, physical functioning, and/or disease- and treatment-related symptoms (i.e. fatigue, pain, and eating problems) as compared to those on chemotherapy, per the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (QLQ-C30) and QLQ-OES18 scores. CONCLUSIONS As a 2L therapy for advanced/metastatic ESCC, tislelizumab improved OS and had a favorable safety profile as compared to chemotherapy in European/North American ESCC patients in the randomized phase III RATIONALE-302 study.
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Affiliation(s)
- J Ajani
- Department of Gastrointestinal Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, USA
| | - F El Hajbi
- Department of Gastro-intestinal Oncology, Oscar Lambert Center, Lille, France
| | - D Cunningham
- Department of Oncology, Royal Marsden NHS Foundation Trust, London, UK
| | - M Alsina
- Department of Medical Oncology, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - P Thuss-Patience
- Department of Hematology, Oncology and Tumor Immunology, Campus Virchow-Klinikum, Charité-University Medicine Berlin, Berlin, Germany
| | - G V Scagliotti
- Department of Oncology, University of Torino, Orbassano, Torino, Italy
| | - M Van den Eynde
- Department of Medical Oncology and Hepato-gastroenterology, Institut Roi Albert II, Cliniques Universitaires Saint-Luc/Université Catholique De Louvain (Uclouvain), Brussels, Belgium
| | - S-B Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - K Kato
- Department of Gastrointestinal Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - L Shen
- Department of Gastrointestinal Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, China
| | - L Li
- BeiGene, Ltd., Zhongguancun Life Science Park, Beijing, China
| | - N Ding
- BeiGene, Ltd., Zhongguancun Life Science Park, Beijing, China
| | - J Shi
- BeiGene, Ltd., Zhongguancun Life Science Park, Beijing, China
| | | | - E Van Cutsem
- Digestive Oncology, University Hospitals Gasthuisberg Leuven and KULeuven, Leuven, Belgium.
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Ketkar A, Willey V, Pollack M, Glasser L, Dobie C, Wenziger C, Teng CC, Dube C, Cunningham D, Verduzco-Gutierrez M. Assessing the risk and costs of COVID-19 in immunocompromised populations in a large United States commercial insurance health plan: the EPOCH-US Study. Curr Med Res Opin 2023; 39:1103-1118. [PMID: 37431293 DOI: 10.1080/03007995.2023.2233819] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 06/30/2023] [Accepted: 07/04/2023] [Indexed: 07/12/2023]
Abstract
OBJECTIVE To estimate the prevalence of patients with an immunocompromising condition at risk for COVID-19, estimate COVID-19 prevalence rate (PR) and incidence rate (IR) by immunocompromising condition, and describe COVID-19-related healthcare resource utilization (HCRU) and costs. METHODS Using the Healthcare Integrated Research Database (HIRD), patients with ≥1 claim for an immunocompromising condition of interest or ≥2 claims for an immunosuppressive (IS) treatment and COVID-19 diagnosis during the infection period (1 April 2020-31 March 2022) and had ≥12 months baseline data were included. Cohorts (other than the composite cohort) were not mutually exclusive and were defined by each immunocompromising condition. Analyses were descriptive in nature. RESULTS Of the 16,873,161 patients in the source population, 2.7% (n = 458,049) were immunocompromised (IC). The COVID-19 IR for the composite IC cohort during the study period was 101.3 per 1000 person-years and the PR was 13.5%. The highest IR (195.0 per 1000 person-years) and PR (20.1%) were seen in the end-stage renal disease (ESRD) cohort; the lowest IR (68.3 per 1000 person-years) and PR (9.4%) were seen in the hematologic or solid tumor malignancy cohort. Mean costs for hospitalizations associated with the first COVID-19 diagnosis were estimated at nearly $1 billion (2021 United States dollars [USD]) for 14,516 IC patients, with a mean cost of $64,029 per patient. CONCLUSIONS Immunocompromised populations appear to be at substantial risk of severe COVID-19 outcomes, leading to increased costs and HCRU. Effective prophylactic options are still needed for these high-risk populations as the COVID-19 landscape evolves.
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Affiliation(s)
| | | | | | - Lisa Glasser
- AstraZeneca Biopharmaceuticals Medical, Wilmington, DE, USA
| | | | | | - Chia-Chen Teng
- AstraZeneca Biopharmaceuticals Medical, Wilmington, DE, USA
| | - Christine Dube
- AstraZeneca Biopharmaceuticals Medical, Wilmington, DE, USA
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Saunders MP, Graham J, Cunningham D, Plummer R, Church D, Kerr R, Cook S, Zheng S, La Thangue N, Kerr D. CXD101 and nivolumab in patients with metastatic microsatellite-stable colorectal cancer (CAROSELL): a multicentre, open-label, single-arm, phase II trial. ESMO Open 2022; 7:100594. [PMID: 36327756 PMCID: PMC9808483 DOI: 10.1016/j.esmoop.2022.100594] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 08/30/2022] [Accepted: 08/30/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Patients with microsatellite stable (MSS) colorectal carcinoma (CRC) do not respond to immune checkpoint inhibitors. Preclinical models suggested synergistic anti-tumour activity combining CXD101 and anti-programmed cell death protein 1 treatment; therefore, we assessed the clinical combination of CXD101 and nivolumab in heavily pre-treated patients with MSS metastatic CRC (mCRC). PATIENTS AND METHODS This single-arm, open-label study enrolled patients aged 18 years or older with biopsy-confirmed MSS CRC; at least two lines of systemic anticancer therapies (including oxaliplatin and irinotecan); at least one measurable lesion; Eastern Cooperative Oncology Group performance status of 0, 1 or 2; predicted life expectancy above 3 months; and adequate organ and bone marrow function. Nine patients were enrolled in a safety run-in study to define a tolerable combination schedule of CXD101 and nivolumab, followed by 46 patients in the efficacy assessment phase. Patients in the efficacy assessment cohort were treated orally with 20 mg CXD101 twice daily for 5 consecutive days every 3 weeks, and intravenously with 240 mg nivolumab every 2 weeks. The primary endpoint was immune disease control rate (iDCR). RESULTS Between 2018 and 2020, 55 patients were treated with CXD101 and nivolumab. The combination therapy was well tolerated with the most frequent grade 3 or 4 adverse events being neutropenia (18%) and anaemia (7%). Immune-related adverse reactions commonly ascribed to checkpoint inhibitors were surprisingly rare although we did see single cases of pneumonitis, hypothyroidism and hypopituitarism. There were no treatment-related deaths. Of 46 patients assessable for efficacy, 4 (9%) achieved partial response and 18 (39%) achieved stable disease, translating to an immune disease control rate of 48%. The median overall survival (OS) was 7.0 months (95% confidence interval 5.13-10.22 months). CONCLUSIONS The primary endpoint was met in this phase II study, which showed that the combination of CXD101 and nivolumab, at full individual doses in the treatment of advanced or metastatic MSS CRC, was both well tolerated and efficacious.
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Affiliation(s)
- M P Saunders
- The Christie NHS Foundation Trust, Manchester, UK.
| | - J Graham
- The Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - D Cunningham
- The Royal Marsden NHS Foundation Trust, London, UK
| | - R Plummer
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - D Church
- The Churchill Hospital Oxford University Hospitals NHS Trust, Oxford, UK; NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK
| | - R Kerr
- The Churchill Hospital Oxford University Hospitals NHS Trust, Oxford, UK
| | - S Cook
- Celleron Therapeutics Limited, Oxford, UK
| | - S Zheng
- Celleron Therapeutics Limited, Oxford, UK
| | | | - D Kerr
- The Churchill Hospital Oxford University Hospitals NHS Trust, Oxford, UK; Celleron Therapeutics Limited, Oxford, UK
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Zhang S, Cartwright E, Mullings S, Ferro Lopez L, Cunningham D, Chau I, Starling N, Popat S, O'Brien M, Bhosle J, Minchom A, Davidson M, Tokaca N, Lalondrelle S, Pickering L, Furness A, Turajlic S, Larkin J, José R, Young K. 87P Infliximab use in patients with checkpoint inhibitor toxicities: A tertiary centre experience. Immuno-Oncology and Technology 2022. [DOI: 10.1016/j.iotech.2022.100191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Qualls K, Cunningham D, Brown S, Ahmed S, Laack N, Mahajan A. Modern Outcomes of Pediatric and Young Adult Patients with Parotid Gland Tumors Treated with Highly-Conformal Radiation Therapy. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Cunningham D, Qualls K, Brown S, Ruff M, Kizilbash S, Uhm J, Laack N, Mahajan A. Descriptive Statistics for Patients with Glioblastoma Associated with Germline Mismatch Repair Gene Mutation. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Li S, Sharma B, Du Y, El-Sharkawi D, Iyengar S, Nicholson E, Potter M, Ethell M, Arias C, Easdale S, Alexander E, Cunningham D, Chau I. 633P Determining the prognostic value of end of treatment (EOT) 18F-choline positron emission tomography (PET) in patients treated with primary central nervous system lymphoma (PCNSL) who respond to first-line therapy: A single centre retrospective study at the Royal Marsden Hospital (RMH). Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Hobbis L, Duncan J, Kinnaird F, Fong C, Li S, Gordon A, Chau I, Starling N, Rao S, Watkins D, Fribbens C, Cunningham D. CN45 The Gastrointestinal and Lymphoma Unit Advanced Nurse Practitioner role in clinical research at The Royal Marsden Hospital. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Turkes F, Crux R, Tran A, Cartwright E, Rana I, Johnston E, Dunlop A, Thomas J, Smith A, Smyth E, Fribbens C, Rao S, Watkins D, Chau I, Starling N, Cunningham D. 1253P Safety and efficacy of Wnt inhibition with a DKK1 inhibitor, DKN-01, in combination with atezolizumab in patients with advanced oesophagogastric adenocarcinoma: Phase IIa results of the WAKING trial. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Cordell SC, Attygalle A, Nicholson E, Wotherspoon A, Chau I, El-Sharkawi D, Iyengar S, Cunningham D, Sharma B. Extranodal risk sites for CNS lymphoma: Review, good practice guide and the new SIHMIR paradigm shift. Clin Radiol 2022. [DOI: 10.1016/j.crad.2022.08.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Bai LY, Chiu CF, Kadowaki S, Robert M, Hara H, Hong M, Bergamo F, Pernot S, Cunningham D, Lin CY, Keam B, Matsumura Y, Enya K, Waxman I, Jin L, Ngo D, Drews U, Mancao C, Le Berre MA, Kato K. 1209P A phase II study of regorafenib in combination with nivolumab in patients with recurrent or metastatic solid tumors: Results of the ESCC cohort. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Fong C, Iyer S, Potts L, Peckitt C, Cromarty S, Saffery C, Kidd S, Rana T, Ausec L, Gregorc A, Pointing D, Gombert M, von Loga K, Benjamin L, Starling N, Waddell T, Petty R, Uhlik M, Chau I, Cunningham D. 1226P Predicting benefit from maintenance durvalumab after first-line chemotherapy (1L CTx) in oesophagogastric adenocarcinoma (OGA) using a novel tumour microenvironment (TME) RNA-based assay. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Cabrit N, Faron M, Tierney J, Cheugoua-Zanetsie M, Thirion P, Cunningham D, Winter K, Fu J, Mauer M, Shapiro J, Burmeister B, Walsh T, Piessen G, Klevebro F, Ychou M, Van Der Gaast A, Law S, Stahl M, Paoletti X, Ducreux M, Michiels S. SO-5 Disease-free survival as surrogate for overall survival in neoadjuvant chemo(radio)therapy treatment of esophageal or gastro-esophageal junction carcinoma: An analysis of 4518 individual patients and 22 trials. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.04.404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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16
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Slater S, Cartwright E, Saffery C, Tran A, Smith G, Bacason M, Zhitkov O, Rana I, Johnston E, Sanna I, Aresu M, Kohoutova D, Terlizzo M, Turkes F, Smyth E, Mansoor W, Fribbens C, Rao S, Watkins D, Starling N, Chau I, Cunningham D. PD-2 EMERGE: A multi-centre, non-randomised, single-arm phase II study investigating domatinostat plus avelumab in patients with previously treated advanced mismatch repair-proficient oesophagogastric and colorectal adenocarcinoma. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.04.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Athauda A, Nankivell M, Pritchard S, Langer R, Langley R, Von Loga K, Starling N, Chau I, Cunningham D, Grabsch H. SO-9 Pathological primary tumour and lymph node regression following neoadjuvant chemotherapy in resectable oesophagogastric cancer: Pooled analysis of 1619 patients from two randomised trials. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.04.408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Kloft M, Nankivell M, Cunningham D, Allum W, Langley R, Magee D, Grabsch H. SO-10 The prognostic role of microarchitecture in tumour-positive lymph nodes in oesophageal cancer patients: Results from the UK MRC OE02 trial. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.04.409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Faron M, Cheugoua-Zanetsie M, Thirion P, Tierney J, Cunningham D, Winter K, Fu J, Mauer M, Shapiro J, Burmeister B, Walsh T, Piessen G, Klevebro F, Ychou M, Van Der Gaast A, Law S, Stahl M, van Sandick J, Pignon J, Ducreux M, Michiels S. SO-4 Individual participant data network meta-analysis (IPD-NMA) of neoadjuvant chemotherapy or chemoradiotherapy in esophageal or gastro-esophageal junction carcinoma. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.04.403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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20
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Din F, Mellor F, Millard T, Pace E, Khan N, Attygalle AD, Cunningham D, Zafar S, Sharma B. Radiology of Castleman disease: the pivotal role of imaging in diagnosis, staging, and response assessment of this rare entity. Clin Radiol 2022; 77:399-408. [PMID: 35177229 DOI: 10.1016/j.crad.2022.01.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 01/12/2022] [Indexed: 11/16/2022]
Abstract
Castleman Disease (CD) is a rare entity that typically presents as an enhancing nodal mass in the mediastinum or head and neck region on computed tomography (CT). It may manifest as unicentric or multicentric regions of lymph node enlargement. A key clinical issue in the context of CD is delayed diagnosis, which contributes adversely to patient outcome, given that accurate diagnosis facilitates earlier treatment of this curable disease. This article will address relevant imaging aspects, with reference to typical and atypical imaging features of CD, illustrated using examples from our specialist centre; the imaging journey for patients with CD; and will provide practical pointers to radiologists in differentiating CD from other benign and malignant causes of enhancing lymphadenopathy, including lymphoma and neoplastic adenopathy. We will also review current classification tools and staging challenges with reference to World Health Organization guidelines, International Working Group guidelines as well as the Lugano classification. Finally, we will discuss the potential role of additional imaging techniques in CD, highlighting novel imaging methods and expanded utilities from our specialist centre.
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Affiliation(s)
- F Din
- Department of Radiology, The Royal Marsden NHS Trust, London, UK
| | - F Mellor
- Department of Radiology, The Royal Marsden NHS Trust, London, UK
| | - T Millard
- Department of Radiology, The Royal Marsden NHS Trust, London, UK
| | - E Pace
- Department of Radiology, The Royal Marsden NHS Trust, London, UK
| | - N Khan
- Department of Radiology, The Royal Marsden NHS Trust, London, UK
| | - A D Attygalle
- The Lymphoma Unit, The Royal Marsden NHS Trust, London, UK
| | - D Cunningham
- The Lymphoma Unit, The Royal Marsden NHS Trust, London, UK
| | - S Zafar
- Department of Radiology, The Royal Marsden NHS Trust, London, UK
| | - B Sharma
- Department of Radiology, The Royal Marsden NHS Trust, London, UK.
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21
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Chien S, Cunningham D, Khan KS. Inguinal hernia repair: a systematic analysis of online patient information using the Modified Ensuring Quality Information for Patients tool. Ann R Coll Surg Engl 2021; 104:242-248. [PMID: 34931532 DOI: 10.1308/rcsann.2021.0174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Online resources are a fundamental source of healthcare information due to the increasing popularity of the internet. Ensuring accuracy and reliability of websites is crucial to improving patient education and enhancing patient outcomes. Inguinal hernia repair is the most commonly performed general surgical procedure worldwide. This study analyses the quality of online patient information about inguinal hernia repair using the Modified Ensuring Quality Information for Patients (EQIP) tool. METHODS A systematic review of online information on inguinal hernia repair was conducted using four search terms: 'inguinal hernia', 'groin hernia', 'inguinal hernia repair' and 'inguinoscrotal hernia'. The top 100 websites for each term identified using Google were assessed using the modified EQIP tool (score 0-36). Websites for the paediatric population or intended for medical professional use were excluded from analysis. FINDINGS A total of 142 websites were eligible for analysis, 52.8% originating from the UK. The median EQIP score for all websites was 17/36 (interquartile range 14-21). The median EQIP scores for content, identification and structure were 8/18, 2/8 and 8/12, respectively. Complications of inguinal hernia repair were included in 46.5% of websites, with only 9.2% providing complication rates and 14.1% providing information on how complications are handled. CONCLUSION This study highlights that the current quality of online patient information on inguinal hernia repair is poor, with minimal information available on complications, hindering patients' ability to make informed decisions regarding their healthcare. To improve patient education, there is an immediate need for improved quality online resources to meet international standards.
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Affiliation(s)
- S Chien
- Department of General Surgery, Glasgow Royal Infirmary, Glasgow, UK
| | - D Cunningham
- Department of General Surgery, Glasgow Royal Infirmary, Glasgow, UK
| | - K S Khan
- Department of General Surgery, Glasgow Royal Infirmary, Glasgow, UK
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22
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Cunningham D, Zaniletti I, Breen W, Leavitt T, Mahajan A, Keole S, Daniels T, Vern-Gross T, Ahmed S, DeWees T, Laack N. Lymphopenia in Pediatric Patients Following Proton Radiotherapy. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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23
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Breen W, Zaniletti I, Laack N, Cunningham D, Leavitt T, Mahajan A, Keole S, Daniels T, Vern-Gross T, Ahmed S, DeWees T. Pediatric Patient-Reported Quality of Life Before and after Radiotherapy: A Prospective Registry Study. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.631] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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24
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Mehdi AS, Bitar G, Sharma RK, Iyengar S, El-Sharkawi D, Tasoulis MK, Attygalle AD, Cunningham D, Sharma B. Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL): a good practice guide, pictorial review, and new perspectives. Clin Radiol 2021; 77:79-87. [PMID: 34579859 DOI: 10.1016/j.crad.2021.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 09/02/2021] [Indexed: 11/03/2022]
Abstract
Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rare but emerging T-cell non-Hodgkin lymphoma. It has two distinct subtypes, "effusion-only" or "mass-forming" disease, arising around implants in patients with in situ or previous history of textured-surface breast implants. The clinical, histopathological and imaging features are unique and nuanced as compared to primary breast malignancy and other lymphoma categories. Prompt recognition and diagnosis triggers referral to appropriate BIA-ALCL centres and initiation of treatment, with potential for excellent prognosis. Definitive management of both subtypes involves implant and capsule removal; systemic therapy is reserved for mass-forming disease and advanced-stage disease. There have been recent crucial advances in the diagnostic pathway, with publication of national and international guidelines: from the UK Medicines Healthcare products Regulatory Agency (MHRA) Plastic, Reconstructive and Aesthetic Surgery Expert Advisory Group (PRASEAG), and the United States National Comprehensive Cancer Network (NCCN). This review provides a practical guide to the clinical work-up of BIA-ALCL, enabling optimisation of the diagnostic imaging pathway, with representative cases.
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Affiliation(s)
- A S Mehdi
- Radiology Department, Imperial College Healthcare NHS Trust, London, UK
| | - G Bitar
- Lymphoma Unit, Royal Marsden NHS Foundation Trust, London, UK
| | - R K Sharma
- Medical School, College of Medicine and Health, University of Exeter, UK
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- Lymphoma Unit, Royal Marsden NHS Foundation Trust, London, UK; Lymphoma Unit, The Institute of Cancer Research, ICR, London, UK
| | - S Iyengar
- Lymphoma Unit, Royal Marsden NHS Foundation Trust, London, UK; Lymphoma Unit, The Institute of Cancer Research, ICR, London, UK
| | - D El-Sharkawi
- Lymphoma Unit, Royal Marsden NHS Foundation Trust, London, UK; Lymphoma Unit, The Institute of Cancer Research, ICR, London, UK
| | - M K Tasoulis
- Lymphoma Unit, Royal Marsden NHS Foundation Trust, London, UK
| | - A D Attygalle
- Lymphoma Unit, Royal Marsden NHS Foundation Trust, London, UK
| | - D Cunningham
- Lymphoma Unit, Royal Marsden NHS Foundation Trust, London, UK; Lymphoma Unit, The Institute of Cancer Research, ICR, London, UK
| | - B Sharma
- Lymphoma Unit, Royal Marsden NHS Foundation Trust, London, UK; Lymphoma Unit, The Institute of Cancer Research, ICR, London, UK.
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25
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Lau D, Fong C, Arouri F, Cortez L, Katifi H, Gonzalez-Exposito R, Razzaq M, Li S, Macklin-Doherty A, Fribbens C, Watkins D, Rao S, Chau I, Cunningham D, Starling N. 453P Routine DPYD mutation testing for patients receiving fluoropyrimidines for gastrointestinal (GI) cancers: Real world experience in a tertiary UK oncology centre. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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26
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Cartwright E, Turkes F, Saffery C, Tran A, Smith G, Moreno SE, Hatt S, Renn A, Johnston E, Kohoutova D, Begum R, Smyth E, Peckitt C, Fribbens C, Rao S, Watkins D, Chau I, Starling N, Cunningham D. 443P EMERGE: A phase II trial assessing the efficacy of domatinostat plus avelumab in patients with previously treated advanced mismatch repair proficient oesophagogastric and colorectal cancers – phase IIA dose finding. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.964] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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27
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Mencel J, Lamont H, Rao S, Watkins D, Fribbens C, Cunningham D, Chau I, Starling N. 447P The prognostic factors in early stage BRAF mutant colorectal cancer: Experience from a large volume UK tertiary centre. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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28
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Esiso F, Lai F, Cunningham D, Garcia D, Barrett B, Sakkas D. P–225 The effect of rapid and delayed insemination on reproductive outcome in conventional insemination and intracytoplasmic sperm injection invitro-fertilization cycles. Hum Reprod 2021. [DOI: 10.1093/humrep/deab130.224] [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: 11/14/2022] Open
Abstract
Abstract
Study question
Does rapid or delayed insemination after egg retrieval affect fertilization, blastocyst development and live birth rates in CI and ICSI cycles?
Summary answer
When performing CI or ICSI <1.5h and >6.5h after retrieval, detrimental effects are moderate on fertilization but do not impact blastocyst usage and birth rates.
What is known already
Several studies have shown that CIor ICSI performed between 3 to 5 h after oocyte retrieval has improved laboratory outcomes. However, some studies indicate that insemination of oocytes, by either CI or ICSI, within 2 hours or more than 8 hours after oocyte retrieval has a detrimental effect on the reproductive outcome. With some ART centres experiencing an increase in workload, respecting these exact time intervals is frequently challenging.
Study design, size, duration
A single-center retrospective cohort analysis was performed on 6559 patients (9575 retrievals and insemination cycles) between January 1st2017 to July 31st2019. The main outcome measures were live-birth rates. Secondary outcomes included analysis of fertilization per all oocytes retrieved, blastocyst utilization, clinical pregnancy, and miscarriage rates. All analyses used time of insemination categorized in both CI and ICSI cycles. Fertilization rates across categories was analyzed by ANOVA and pregnancy outcomes compared using Chi-square tests.
Participants/materials, setting, methods
As part of laboratory protocol, oocyte retrieval was performed 36 h post-trigger. Cycles involving injection with testicular/epidydimal sperm, donor or frozen oocytes were excluded. The time interval between oocyte retrieval and insemination was analyzed in eight categories: 0 (0- <0.5h), 1 (0.5-<1.5h), 2 (1.5-<2.5h), 3 (2.5-<3.5h), 4 (3.5-<4.5), 5 (4.5-<5.5), 6 (5.5-<6.5) and 7 (6.5-<8h). The number of retrievals in each group (0–7) was 586, 1594, 1644, 1796, 1836, 1351, 641 and 127 respectively.
Main results and the role of chance
This study had a mean patient age of 36.0 years and mean of 12.2 oocytes per retrieval in each category. There were 4,955 CI and 4,620 ICSI retrievals. The smallest groups were time category 7 and 0 for CI and ICSI respectively. The results showed that the mean fertilization rate per egg retrieved for CI ranged from 54.1 to 64.9% with a significant difference between time category 0 and 5 (p < 0.001) and category 1 and 5 (p < 0.0.001). Mean fertilization rate for ICSI per egg retrieved ranged from 52.8 to 67.3% with no significant difference between time categories compared to category 5. Blastocyst utilization rate for CI and ICSI were not significantly different for all time categories. In the CI and ICSI groups there were 6,540 and 6,178 total fresh and frozen transfers. The miscarriage and clinical pregnancy rate in CI and ICSI were not significantly different across time categories. The overall mean live birth rate for CI was 32.4% (range: 23.1 to 35.5%). Live-birth rates differed significantly (p = 0.04) in CI with time categories 0 and 7 the lowest. In the ICSI group, the overall mean live birth rate was 30.8% (range: 29.1 to 35.7%),with no significant differences between time categories.
Limitations, reasons for caution
As this is a retrospective study, the influence of uncontrolled variables cannot be excluded. The group spread was uneven with the early and late time categories having the lowest number of representative retrievals and this could have affected the results obtained.
Wider implications of the findings: Our results indicate that both CI and ICSI are optimal when performed between 1.5–6.5 hours after oocyte retrieval. Further prospective studies on reproductive outcomes related to time of insemination are warranted. This data indicates a minimal detrimental effect when it is untenable to follow strict insemination time intervals.
Trial registration number
2015P000122
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Affiliation(s)
- F Esiso
- BSM-University Pompeo Fabrau, Masters in Human Assisted Reproduction Technology, Barcelona, Spain
| | - F Lai
- Boston IVF, Embryology, Waltham, USA
| | | | - D Garcia
- Clínica Eugin, Department of Research and Development, Barcelona, Spain
| | - B Barrett
- Boston IVF, Embryology, Waltham, USA
| | - D Sakkas
- Boston IVF, Embryology, Waltham, USA
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Abstract
Explosive outbursts (EO) by students are an intensely distressing experience for that student as well as for all school staff and students present during the outburst. These EO are characterized by rapid escalations, usually far out of proportion to precipitating events, may include significant verbal and/or physical aggression, require intensive staff intervention, are often difficult for the student to process, and are typically recurrent. These explosions cross multiple psychiatric and educational diagnostic categories and require diverse interventions to address behavioral, emotional, impulsive, and sensory components. Interventions for each stage of an EO can be used to deescalate these events.
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Affiliation(s)
- Jeff Q Bostic
- Department of Psychiatry, MedStar Georgetown University Hospital, 2115 Wisconsin Avenue, Northwest, Suite 200, Washington, DC 20007, USA.
| | | | - D Cunningham
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
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30
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Kloft M, Samarska I, Nankivell M, Cunningham D, Allum W, Langley R, Magee D, Grabsch H. SO-6 Microarchitectural changes in regional lymph nodes after chemotherapy in oesophageal cancer: Results from the UK MRC OE02 trial. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.05.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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31
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Musanhu E, Sharma RK, Attygalle A, Wotherspoon A, Chau I, Cunningham D, Dearden C, El-Sharkawi D, Iyengar S, Sharma B. Chronic lymphocytic leukaemia and Richter's transformation: multimodal review and new imaging paradigms. Clin Radiol 2021; 76:789-800. [PMID: 34217434 DOI: 10.1016/j.crad.2021.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 06/01/2021] [Indexed: 12/15/2022]
Abstract
Chronic lymphocytic leukaemia (CLL) is the most common leukaemia in adults. It is a malignancy of CD5 B-cells characterised by small, mature-appearing lymphocytes accumulating in the blood, bone marrow, and lymphoid tissues. Richer transformation (RT) is an important adverse complication. Detection of RT is critical to allow initiation of appropriate therapy. CLL staging and response evaluation is complicated and nuanced. From our extensive tertiary centre experience of several hundred CLL cases over the last decade, we detail key computed tomography (CT) and positron-emission tomography (PET) imaging features of the natural history of CLL. The authors present an original imaging-based patient-management paradigm for the investigation of potential RT, which will inform global practice. Potential applications of whole-body diffusion weighted imaging, novel PET radiotracers, minimal residual disease, and ct-DNA are addressed.
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Affiliation(s)
- E Musanhu
- Radiology Department, Royal Marsden Hospital, London, UK
| | - R K Sharma
- University of Exeter Medical School, Exeter, UK
| | - A Attygalle
- Pathology Department, Royal Marsden Hospital, UK
| | - A Wotherspoon
- Clinical Oncology Department, Royal Marsden Hospital, UK
| | - I Chau
- Clinical Oncology Department, Royal Marsden Hospital, UK
| | - D Cunningham
- Clinical Oncology Department, Royal Marsden Hospital, UK
| | - C Dearden
- Clinical Oncology Department, Royal Marsden Hospital, UK
| | - D El-Sharkawi
- Clinical Oncology Department, Royal Marsden Hospital, UK
| | - S Iyengar
- The Institute of Cancer Research, London, UK
| | - B Sharma
- Radiology Department, Royal Marsden Hospital, London, UK.
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32
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Jurczak W, Zinzani PL, Cunningham D, Yavrom S, Huang W, Gorbatchevsky I, Ribrag V. COASTAL: A PHASE 3 STUDY OF THE PI3Kδ INHIBITOR ZANDELISIB WITH RITUXIMAB (R) VERSUS IMMUNOCHEMOTHERAPY IN PATIENTS WITH RELAPSED INDOLENT NON‐HODGKIN’S LYMPHOMA (INHL). Hematol Oncol 2021. [DOI: 10.1002/hon.174_2880] [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: 11/06/2022]
Affiliation(s)
- W. Jurczak
- Maria Sklodowska‐Curie National Research Institute of Oncology Hematology Krakow Poland
| | - P. L. Zinzani
- Institute of Hematology "L. e A. Seràgnoli" Lymphoma and Chronic Lymphoproliferative Syndromes Unit Bologna Italy
| | - D. Cunningham
- Royal Marsden Hospital NHS Foundation Trust, Haematology‐Oncology London UK
| | - S. Yavrom
- MEI Pharma Inc. Clinical Development San Diego USA
| | - W. Huang
- MEI Pharma Inc. Biostats San Diego USA
| | | | - V. Ribrag
- Institut Gustave Roussy Hematology Villejuif France
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33
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Zinzani PL, Santoro A, Gritti G, Brice P, Barr PM, Kuruvilla J, Cunningham D, Kline J, Johnson NA, Mehta‐Shah N, Fanale M, Francis S, Moskowitz AJ. NIVOLUMAB PLUS BRENTUXIMAB VEDOTIN FOR RELAPSED/REFRACTORY PRIMARY MEDIASTINAL LARGE B‐CELL LYMPHOMA: EXTENDED FOLLOW‐UP FROM THE PHASE 2 CHECKMATE 436 STUDY. Hematol Oncol 2021. [DOI: 10.1002/hon.51_2879] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- P. L. Zinzani
- “Seràgnoli" Bologna University Institute of Hematology Bologna Italy
| | - A. Santoro
- IRCCS Humanitas Research Center Humanitas University Rozzano–Milano Italy
| | - G. Gritti
- Ospedale Papa Giovanni XXIII Hematology and Bone Marrow Transplant Unit Bergamo Italy
| | - P. Brice
- Hôpital Saint‐Louis Service d’Hémato‐Oncologie Paris France
| | - P. M. Barr
- University of Rochester Department of Medicine Hematology/Oncology, Rochester New York USA
| | - J. Kuruvilla
- Princess Margaret Cancer Centre Division of Medical Oncology and Hematology Toronto Canada
| | - D. Cunningham
- Royal Marsden Hospital Gastrointestinal and Lymphoma Unit London UK
| | - J. Kline
- University of Chicago Department of Medicine Section of Hematology/Oncology Chicago Illinois USA
| | - N. A. Johnson
- Jewish General Hospital Division of Hematology Montreal Canada
| | - N. Mehta‐Shah
- Washington University in St. Louis School of Medicine Division of Oncology Department of Medicine St. Louis Missouri USA
| | - M. Fanale
- Seagen Inc. Medical Affairs, Bothell Washington USA
| | - S. Francis
- Bristol Myers Squibb, Global Biometrics and Data Sciences Princeton New Jersey USA
| | - A. J. Moskowitz
- Memorial Sloan Kettering Cancer Center Lymphoma Inpatient Unit New York, New York USA
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34
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Hutchings M, Mous R, Clausen MR, Johnson P, Linton K, Lewis DJ, Chamuleau ME, Balari AS, Cunningham D, DeMarco D, Chen K, Elliott B, Lugtenburg P. SUBCUTANEOUS EPCORITAMAB IN PATIENTS WITH RELAPSED/REFRACTORY B‐CELL NON‐HODGKIN LYMPHOMA: SAFETY PROFILE AND ANTI‐TUMOR ACTIVITY. Hematol Oncol 2021. [DOI: 10.1002/hon.16_2879] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- M Hutchings
- Rigshospitalet, Copenhagen University Hospital Department of Hematology Copenhagen Denmark
| | - R Mous
- On behalf of the Lunenburg Lymphoma Phase I/II Consortium‐HOVON/LLPC Universitair Medisch Centrum Utrecht Department of Hematology Utrecht Netherlands
| | - M. R Clausen
- Vejle Hospital Department of Hematology Veile Denmark
| | - P Johnson
- Cancer Research UK, Cancer Services University of Southampton Department of Hematology Southampton UK
| | - K Linton
- Christie Hospital NHS Foundation Trust Division of Cancer Services Manchester UK
| | - D. J Lewis
- Plymouth University Medical School Department of Hematology Plymouth UK
| | - M. E.D Chamuleau
- On behalf of the Lunenburg Lymphoma Phase I/II Consortium‐HOVON/LLPC VU University Medical Center Department of Hematology Amsterdam Netherlands
| | - A. S Balari
- Institut Català d'Oncologia‐Hospital Duran i Reynals, Hospitalet del Llobregat Department of Hematology Barcelona Spain
| | - D Cunningham
- The Royal Marsden NHS Foundation Trust Department of Hematology Sutton UK
| | - D DeMarco
- Genmab Clinical Research and Development Princeton, New Jersey USA
| | - K.‐M Chen
- Genmab Clinical Research and Development Princeton, New Jersey USA
| | - B Elliott
- Genmab Clinical Research and Development Princeton, New Jersey USA
| | - P Lugtenburg
- On behalf of the Lunenburg Lymphoma Phase I/II Consortium‐HOVON/LLPC Erasmus MC Cancer Institute Department of Hematology Rotterdam Netherlands
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35
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Zafar S, Sharma RK, Cunningham J, Mahalingam P, Attygalle AD, Khan N, Cunningham D, El-Sharkawi D, Iyengar S, Sharma B. Current and future best practice in imaging, staging, and response assessment for Non-Hodgkin's lymphomas: the Specialist Integrated Haematological Malignancy Imaging Reporting (SIHMIR) paradigm shift. Clin Radiol 2021; 76:391.e1-391.e18. [PMID: 33579517 DOI: 10.1016/j.crad.2020.12.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 12/24/2020] [Indexed: 12/12/2022]
Abstract
Non-Hodgkin's lymphoma (NHL) encompasses over 40 different haematological malignancies, including low and high-grade neoplasms, such as follicular lymphoma (FL) and diffuse large B-cell lymphoma (DLBCL) respectively. A key clinical issue in the context of NHL is delayed and inaccurate diagnosis, which contributes adversely to patient morbidity and mortality. This article will address relevant imaging aspects, with particular reference to advancements in NHL imaging, including computed tomography (CT), integrated positron-emission tomography (PET)-CT, and magnetic resonance imaging (MRI). We provide multiparametric (anato-functional) imaging display items, including histological correlation. We will also introduce our original concept of "Specialist Integrated Haematological Malignancy Imaging Reporting" (SIHMIR), a paradigm shift in lymphoma radiology.
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Affiliation(s)
- S Zafar
- Department of Radiology, The Royal Marsden NHS Trust, London, UK.
| | - R K Sharma
- College of Medicine and Health, University of Exeter, UK
| | - J Cunningham
- The Lymphoma Unit, The Royal Marsden NHS Trust, London, UK
| | - P Mahalingam
- The Lymphoma Unit, The Royal Marsden NHS Trust, London, UK
| | - A D Attygalle
- The Lymphoma Unit, The Royal Marsden NHS Trust, London, UK
| | - N Khan
- Department of Radiology, The Royal Marsden NHS Trust, London, UK
| | - D Cunningham
- The Lymphoma Unit, The Royal Marsden NHS Trust, London, UK
| | - D El-Sharkawi
- The Lymphoma Unit, The Royal Marsden NHS Trust, London, UK
| | - S Iyengar
- The Lymphoma Unit, The Royal Marsden NHS Trust, London, UK; The Institute of Cancer Research, London, UK
| | - B Sharma
- Department of Radiology, The Royal Marsden NHS Trust, London, UK; The Lymphoma Unit, The Royal Marsden NHS Trust, London, UK
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36
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Cunningham D, Mullikin T, Breen W, Bradley T, Sorenson K, Johnson J, Ahmed S, Laack N, Mahajan A. Proton Whole Lung Radiation Therapy: Initial Report of Outcomes. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Simillis C, Singh HKSI, Afxentiou T, Mills S, Warren OJ, Smith JJ, Riddle P, Adamina M, Cunningham D, Tekkis PP. Postoperative chemotherapy improves survival in patients with resected high-risk Stage II colorectal cancer: results of a systematic review and meta-analysis. Colorectal Dis 2020; 22:1231-1244. [PMID: 31999888 DOI: 10.1111/codi.14994] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 01/07/2020] [Indexed: 02/08/2023]
Abstract
AIM The aim was to assess the benefit of adjuvant chemotherapy in high-risk Stage II colorectal cancer. METHOD A systematic literature review and meta-analysis was performed comparing survival in patients with resected Stage II colorectal cancer and high-risk features having postoperative chemotherapy vs no chemotherapy. RESULTS Of 1031 articles screened, 29 were included, reporting on 183 749 participants. Adjuvant chemotherapy significantly improved overall survival [hazard ratio (HR) 0.61, P < 0.0001], disease-specific survival (HR = 0.73, P = 0.05) and disease-free survival (HR = 0.59, P < 0.0001) compared to no chemotherapy. Adjuvant chemotherapy significantly increased 5-year overall survival (OR = 0.53, P = 0.0008) and 5-year disease-free survival (OR = 0.50, P = 0.001). Overall survival and disease-free survival remained significantly prolonged during subgroup analysis of studies published from 2015 onwards (HR = 0.60, P < 0.0001; HR = 0.65, P = 0.0001; respectively), in patients with two or more high-risk features (HR = 0.59, P = 0.0001; HR = 0.70, P = 0.03; respectively) and in colon cancer (HR = 0.61, P < 0.0001; HR = 0.51, P = 0.0001; respectively). Overall survival, disease-specific survival and disease-free survival during subgroup analysis of individual high-risk features were T4 tumour (HR = 0.58, P < 0.0001; HR = 0.50, P = 0.003; HR = 0.75, P = 0.05), < 12 lymph nodes harvested (HR = 0.67, P = 0.0002; HR = 0.80, P = 0.17; HR = 0.72, P = 0.02), poor differentiation (HR = 0.84, P = 0.35; HR = 0.85, P = 0.23; HR = 0.61, P = 0.41), lymphovascular or perineural invasion (HR = 0.55, P = 0.05; HR = 0.59, P = 0.11; HR = 0.76, P = 0.05) and emergency surgery (HR = 0.60, P = 0.02; HR = 0.68, P = 0.19). CONCLUSION Adjuvant chemotherapy in high-risk Stage II colorectal cancer results in a modest survival improvement and should be considered on an individual patient basis. Due to potential heterogeneity and selection bias of the included studies, and lack of separate rectal cancer data, further large randomized trials with predefined inclusion criteria and standardized chemotherapy regimens are required.
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Affiliation(s)
- C Simillis
- Department of Colorectal Surgery, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK.,Department of Surgery and Cancer, Imperial College, London, UK
| | - H K S I Singh
- Department of Colorectal Surgery, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - T Afxentiou
- Department of Clinical Oncology, Imperial College Healthcare NHS Trust, London, UK
| | - S Mills
- Department of Colorectal Surgery, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK.,Department of Surgery and Cancer, Imperial College, London, UK
| | - O J Warren
- Department of Colorectal Surgery, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK.,Department of Surgery and Cancer, Imperial College, London, UK
| | - J J Smith
- Department of Colorectal Surgery, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK.,Department of Surgery and Cancer, Imperial College, London, UK
| | - P Riddle
- Department of Clinical Oncology, Imperial College Healthcare NHS Trust, London, UK
| | - M Adamina
- Department of Surgery, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - D Cunningham
- Gastrointestinal Unit, The Royal Marsden Hospital, London, UK
| | - P P Tekkis
- Department of Colorectal Surgery, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK.,Department of Surgery and Cancer, Imperial College, London, UK.,Gastrointestinal Unit, The Royal Marsden Hospital, London, UK
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Bott RK, Beckmann K, Zylstra J, Wilkinson MJ, Knight WRC, Baker CR, Kelly M, Maisey N, Qureshi A, Sevitt T, Van Hemelrijck M, Smyth EC, Allum WH, Lagergren J, Gossage JA, Cunningham D, Davies AR. Adjuvant therapy following oesophagectomy for adenocarcinoma in patients with a positive resection margin. Br J Surg 2020; 107:1801-1810. [PMID: 32990343 DOI: 10.1002/bjs.11864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 05/18/2020] [Accepted: 06/08/2020] [Indexed: 11/12/2022]
Abstract
BACKGROUND The role of adjuvant therapy in patients with oesophagogastric adenocarcinoma treated by neoadjuvant chemotherapy is contentious. In UK practice, surgical resection margin status is often used to classify patients for receiving adjuvant treatment. The aim of this study was to assess the survival benefit of adjuvant therapy in patients with positive (R1) resection margins. METHODS Two prospectively collected UK institutional databases were combined to identify eligible patients. Adjusted Cox regression analyses were used to compare overall and recurrence-free survival according to adjuvant treatment. Recurrence patterns were assessed as a secondary outcome. Propensity score-matched analysis was also performed. RESULTS Of 616 patients included in the combined database, 242 patients who had an R1 resection were included in the study. Of these, 112 patients (46·3 per cent) received adjuvant chemoradiotherapy, 46 (19·0 per cent) were treated with adjuvant chemotherapy and 84 (34·7 per cent) had no adjuvant treatment. In adjusted analysis, adjuvant chemoradiotherapy improved recurrence-free survival (hazard ratio (HR) 0·59, 95 per cent c.i. 0·38 to 0·94; P = 0·026), with a benefit in terms of both local (HR 0·48, 0·24 to 0·99; P = 0·047) and systemic (HR 0·56, 0·33 to 0·94; P = 0·027) recurrence. In analyses stratified by tumour response to neoadjuvant chemotherapy, non-responders (Mandard tumour regression grade 4-5) treated with adjuvant chemoradiotherapy had an overall survival benefit (HR 0·61, 0·38 to 0·97; P = 0·037). In propensity score-matched analysis, an overall survival benefit (HR 0·62, 0·39 to 0·98; P = 0·042) and recurrence-free survival benefit (HR 0·51, 0·30 to 0·87; P = 0·004) were observed for adjuvant chemoradiotherapy versus no adjuvant treatment. CONCLUSION Adjuvant therapy may improve overall survival and recurrence-free survival after margin-positive resection. This pattern seems most pronounced with adjuvant chemoradiotherapy in non-responders to neoadjuvant chemotherapy.
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Affiliation(s)
- R K Bott
- Department of Upper Gastrointestinal and General Surgery, St Thomas' Hospital.,School of Cancer and Pharmaceutical Sciences
| | - K Beckmann
- School of Cancer and Pharmaceutical Sciences, Translational Oncology and Urology Research, King's College London, London, UK.,University of South Australia Cancer Research Institute, University of South Australia, Adelaide, South Australia, Australia
| | - J Zylstra
- Department of Upper Gastrointestinal and General Surgery, St Thomas' Hospital
| | - M J Wilkinson
- Departments of Upper Gastrointestinal Surgery, London, UK
| | - W R C Knight
- Department of Upper Gastrointestinal and General Surgery, St Thomas' Hospital
| | - C R Baker
- Department of Upper Gastrointestinal and General Surgery, St Thomas' Hospital.,School of Cancer and Pharmaceutical Sciences
| | - M Kelly
- Department of Upper Gastrointestinal and General Surgery, St Thomas' Hospital.,School of Cancer and Pharmaceutical Sciences
| | - N Maisey
- Departments of Medical Oncology, London, UK
| | - A Qureshi
- Clinical Oncology, Guy's Hospital, London, UK
| | - T Sevitt
- Department of Medical Oncology, Maidstone Hospital, Maidstone, UK
| | - M Van Hemelrijck
- School of Cancer and Pharmaceutical Sciences, Translational Oncology and Urology Research, King's College London, London, UK
| | - E C Smyth
- Medical Oncology, Royal Marsden Hospital, London, UK
| | - W H Allum
- Departments of Upper Gastrointestinal Surgery, London, UK
| | - J Lagergren
- School of Cancer and Pharmaceutical Sciences.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - J A Gossage
- Department of Upper Gastrointestinal and General Surgery, St Thomas' Hospital.,School of Cancer and Pharmaceutical Sciences
| | - D Cunningham
- Medical Oncology, Royal Marsden Hospital, London, UK
| | - A R Davies
- Department of Upper Gastrointestinal and General Surgery, St Thomas' Hospital.,School of Cancer and Pharmaceutical Sciences
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Van Cutsem E, Muro K, Cunningham D, Bodoky G, Sobrero A, Cascinu S, Ajani J, Oh SC, Al-Batran SE, Wainberg ZA, Wijayawardana SR, Melemed S, Ferry D, Hozak RR, Ohtsu A. Biomarker analyses of second-line ramucirumab in patients with advanced gastric cancer from RAINBOW, a global, randomized, double-blind, phase 3 study. Eur J Cancer 2020; 127:150-157. [PMID: 32014812 DOI: 10.1016/j.ejca.2019.10.026] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 05/30/2019] [Revised: 10/21/2019] [Accepted: 10/27/2019] [Indexed: 01/11/2023]
Abstract
BACKGROUND The RAINBOW trial showed that second-line ramucirumab with paclitaxel prolongs overall survival (OS) and progression-free survival (PFS) compared with placebo plus paclitaxel for treatment of advanced gastric/gastroesophageal junction cancer. Plasma samples were collected from patients during the trial and tested to identify predictive and prognostic biomarkers. PATIENTS AND METHODS Circulating factors in plasma samples from mutually exclusive subsets of RAINBOW patients were assayed using: Intertek assays (24 markers, 380 samples, 57% of patients) and Lilly-developed assay (LDA) platform (5 markers, 257 samples, 39% of patients). Time-trend plots were generated for each marker from the Intertek assays. Baseline patient data were dichotomized into low- and high-marker subgroups. Markers were analyzed for predictive effects using interaction models and for prognostic effects using main-effects models. RESULTS The Intertek and LDA populations were representative of the full trial population. Plasma levels of VEGF-D and PlGF increased from baseline levels during treatment, then declined after treatment discontinued. Angiopoietin-2 exhibited a decrease during treatment, then increased after treatment discontinuation. No clear time trend was evident with the other markers. Analyses of baseline biomarker expression and its relationship with efficacy variables found no biomarker was predictive for efficacy outcomes, including VEGF-D. However, CRP, HGF, ICAM-3, IL-8, SAA, and VCAM-1 were identified as potential prognostic markers with low baseline levels corresponding to longer OS and PFS. CONCLUSIONS Pharmacodynamic and prognostic relationships were found from the exploratory biomarker analyses in RAINBOW; however, no predictive markers for ramucirumab in gastric cancer were identified in this trial.
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Affiliation(s)
- E Van Cutsem
- Digestive Oncology, University Hospitals Gasthuisberg, Leuven and KULeuven, Leuven, Belgium.
| | - K Muro
- Department of Clinical Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | | | - G Bodoky
- Department of Oncology, St. László Hospital, Budapest, Hungary
| | - A Sobrero
- Medical Oncology, IRCCS Ospedale San Martino IST, Genova, Italy
| | - S Cascinu
- Department of Medical Oncology, Università Politecnica Delle Marche, Ancona, Italy
| | - J Ajani
- Department of Gastrointestinal Medical Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - S C Oh
- Korea University Guro Hospital, Seoul, South Korea
| | - S E Al-Batran
- Institute of Clinical Cancer Research (IKF), UCT- University Cancer Center, Frankfurt, Germany
| | - Z A Wainberg
- Medical Hematology and Oncology, University of California Los Angeles, Los Angeles, CA, USA
| | | | - S Melemed
- Eli Lilly and Company, Indianapolis, IN, USA
| | - D Ferry
- Eli Lilly and Company, Bridgewater, NJ, USA
| | - R R Hozak
- Eli Lilly and Company, Indianapolis, IN, USA
| | - A Ohtsu
- Department of Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Japan
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Lathouwers E, Wong EY, Brown K, Baugh B, Ghys A, Jezorwski J, Mohsine EG, Van Landuyt E, Opsomer M, De Meyer S, De Wit S, Florence E, Vandekerckhove L, Vandercam B, Brunetta J, Klein M, Murphy D, Rachlis A, Walmsley S, Ajana F, Cotte L, Girard PM, Katlama C, Molina JM, Poizot-Martin I, Raffi F, Rey D, Reynes J, Teicher E, Yazdanpanah Y, Arastéh K, Bickel M, Bogner J, Esser S, Faetkenheuer G, Jessen H, Kern W, Rockstroh J, Spinner C, Stellbrink HJ, Stoehr A, Antinori A, Castelli F, Chirianni A, De Luca A, Di Biagio A, Galli M, Lazzarin A, Maggiolo F, Maserati R, Mussini C, Garlicki A, Gasiorowski J, Halota W, Horban A, Parczewski M, Piekarska A, Belonosova E, Chernova O, Dushkina N, Kulagin V, Ryamova E, Shuldyakov A, Sizova N, Tsybakova O, Voronin E, Yakovlev A, Antela A, Arribas JR, Berenguer J, Casado J, Estrada V, Galindo MJ, Garcia Del Toro M, Gatell JM, Gorgolas M, Gutierrez F, Gutierrez MDM, Negredo E, Pineda JA, Podzamczer D, Portilla Sogorb J, Rivero A, Rubio R, Viciana P, De Los Santos I, Clarke A, Gazzard BG, Johnson MA, Orkin C, Reeves I, Waters L, Benson P, Bhatti L, Bredeek F, Crofoot G, Cunningham D, DeJesus E, Eron J, Felizarta F, Franco R, Gallant J, Hagins D, Henry K, Jayaweera D, Lucasti C, Martorell C, McDonald C, McGowan J, Mills A, Morales-Ramirez J, Prelutsky D, Ramgopal M, Rashbaum B, Ruane P, Slim J, Wilkin A, deVente J, De Wit S, Florence E, Moutschen M, Van Wijngaerden E, Vandekerckhove L, Vandercam B, Brunetta J, Conway B, Klein M, Murphy D, Rachlis A, Shafran S, Walmsley S, Ajana F, Cotte L, Girard PM, Katlama C, Molina JM, Poizot-Martin I, Raffi F, Rey D, Reynes J, Teicher E, Yazdanpanah Y, Gasiorowski J, Halota W, Horban A, Piekarska A, Witor A, Arribas JR, Perez-Valero I, Berenguer J, Casado J, Gatell JM, Gutierrez F, Galindo MJ, Gutierrez MDM, Iribarren JA, Knobel H, Negredo E, Pineda JA, Podzamczer D, Portilla Sogorb J, Pulido F, Ricart C, Rivero A, Santos Gil I, Blaxhult A, Flamholc L, Gisslèn M, Thalme A, Fehr J, Rauch A, Stoeckle M, Clarke A, Gazzard BG, Johnson MA, Orkin C, Post F, Ustianowski A, Waters L, Bailey J, Benson P, Bhatti L, Brar I, Bredeek UF, Brinson C, Crofoot G, Cunningham D, DeJesus E, Dietz C, Dretler R, Eron J, Felizarta F, Fichtenbaum C, Gallant J, Gathe J, Hagins D, Henn S, Henry KW, Huhn G, Jain M, Lucasti C, Martorell C, McDonald C, Mills A, Morales-Ramirez J, Mounzer K, Nahass R, Olivet H, Osiyemi O, Prelutsky D, Ramgopal M, Rashbaum B, Richmond G, Ruane P, Scarsella A, Scribner A, Shalit P, Shamblaw D, Slim J, Tashima K, Voskuhl G, Ward D, Wilkin A, de Vente J. Week 48 Resistance Analyses of the Once-Daily, Single-Tablet Regimen Darunavir/Cobicistat/Emtricitabine/Tenofovir Alafenamide (D/C/F/TAF) in Adults Living with HIV-1 from the Phase III Randomized AMBER and EMERALD Trials. AIDS Res Hum Retroviruses 2020; 36:48-57. [PMID: 31516033 PMCID: PMC6944133 DOI: 10.1089/aid.2019.0111] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Darunavir/cobicistat/emtricitabine/tenofovir alafenamide (D/C/F/TAF) 800/150/200/10 mg is being investigated in two Phase III trials, AMBER (NCT02431247; treatment-naive adults) and EMERALD (NCT02269917; treatment-experienced, virologically suppressed adults). Week 48 AMBER and EMERALD resistance analyses are presented. Postbaseline samples for genotyping/phenotyping were analyzed from protocol-defined virologic failures (PDVFs) with viral load (VL) ≥400 copies/mL at failure/later time points. Post hoc analyses were deep sequencing in AMBER, and HIV-1 proviral DNA from baseline samples (VL <50 copies/mL) in EMERALD. Through week 48 across both studies, no darunavir, primary PI, or tenofovir resistance-associated mutations (RAMs) were observed in HIV-1 viruses of 1,125 participants receiving D/C/F/TAF or 629 receiving boosted darunavir plus emtricitabine/tenofovir-disoproxil-fumarate. In AMBER, the nucleos(t)ide analog reverse transcriptase inhibitor (N(t)RTI) RAM M184I/V was identified in HIV-1 of one participant during D/C/F/TAF treatment. M184V was detected pretreatment as a minority variant (9%). In EMERALD, in participants with prior VF and genoarchive data (N = 140; 98 D/C/F/TAF and 42 control), 4% had viruses with darunavir RAMs, 38% with emtricitabine RAMs, mainly at position 184 (41% not fully susceptible to emtricitabine), 4% with tenofovir RAMs, and 21% ≥ 3 thymidine analog-associated mutations (24% not fully susceptible to tenofovir) detected at screening. All achieved VL <50 copies/mL at week 48 or prior discontinuation. D/C/F/TAF has a high genetic barrier to resistance; no darunavir, primary PI, or tenofovir RAMs were observed through 48 weeks in AMBER and EMERALD. Only one postbaseline M184I/V RAM was observed in HIV-1 of an AMBER participant. In EMERALD, baseline archived RAMs to darunavir, emtricitabine, and tenofovir in participants with prior VF did not preclude virologic response.
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Affiliation(s)
| | - Eric Y Wong
- Janssen Scientific Affairs, LLC, Titusville, New Jersey
| | | | - Bryan Baugh
- Janssen Research & Development LLC, Raritan, New Jersey
| | - Anne Ghys
- Janssen Pharmaceutica NV, Beerse, Belgium
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Maurer MJ, Habermann TM, Shi Q, Schmitz N, Cunningham D, Pfreundschuh M, Seymour JF, Jaeger U, Haioun C, Tilly H, Ghesquieres H, Merli F, Ziepert M, Herbrecht R, Flament J, Fu T, Flowers CR, Coiffier B. Progression-free survival at 24 months (PFS24) and subsequent outcome for patients with diffuse large B-cell lymphoma (DLBCL) enrolled on randomized clinical trials. Ann Oncol 2019; 29:1822-1827. [PMID: 29897404 DOI: 10.1093/annonc/mdy203] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background Patients with diffuse large B-cell lymphoma treated with first-line anthracycline-based immunochemotherapy and remaining in remission at 2 years have excellent outcomes. This study assessed overall survival (OS) stratified by progression-free survival (PFS) at 24 months (PFS24) using individual patient data from patients with DLBCL enrolled in multi-center, international randomized clinical trials as part of the Surrogate Endpoint for Aggressive Lymphoma (SEAL) Collaboration. Patients and methods PFS24 was defined as being alive and PFS24 after study entry. OS from PFS24 was defined as time from identified PFS24 status until death due to any cause. OS was compared with each patient's age-, sex-, and country-matched general population using expected survival and standardized mortality ratios (SMRs). Results A total of 5853 patients enrolled in trials in the SEAL database received rituximab as part of induction therapy and were included in this analysis. The median age was 62 years (range 18-92), and 56% were greater than 60 years of age. At a median follow-up of 4.4 years, 1337 patients (23%) had disease progression, 1489 (25%) had died, and 5101 had sufficient follow-up to evaluate PFS24. A total of 1423 assessable patients failed to achieve PFS24 with a median OS of 7.2 months (95% CI 6.8-8.1) after progression; 5-year OS after progression was 19% and SMR was 32.1 (95% CI 30.0-34.4). A total of 3678 patients achieved PFS24; SMR after achieving PFS24 was 1.22 (95% CI 1.09-1.37). The observed OS versus expected OS at 3, 5, and 7 years after achieving PFS24 was 93.1% versus 94.4%, 87.6% versus 89.5%, and 80.0% versus 83.7%, respectively. Conclusion Patients treated with rituximab containing anthracycline-based immunochemotherapy on clinical trials who are alive without progression at 24 months from the onset of initial therapy have excellent outcomes with survival that is marginally lower but clinically indistinguishable from the age-, sex-, and country-matched background population for 7 years after achieving PFS24.
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Affiliation(s)
- M J Maurer
- Department of Health Sciences Research, Mayo Clinic, Rochester, USA.
| | | | - Q Shi
- Department of Health Sciences Research, Mayo Clinic, Rochester, USA
| | - N Schmitz
- Department of Hematology, Oncology and Stem Cell Transplantation, Asklepios Hospital St. Georg, Hamburg, Germany
| | - D Cunningham
- Department of Medicine, The Royal Marsden Hospital, Surrey, UK
| | - M Pfreundschuh
- Internal Medicine I, University of the Saarland, Homberg, Germany
| | - J F Seymour
- Peter MacCallum Cancer Centre, Melbourne, Australia
| | - U Jaeger
- Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - C Haioun
- Lymphoid Malignancies Unit, AP-HP Hôpital Henri Mondor, Créteil, France
| | - H Tilly
- Henri Becquerel Centre, University of Rouen, Rouen, France
| | - H Ghesquieres
- Department of Hematology, Centre Hospitalier Lyon-Sud, Pierre-Benite, France
| | - F Merli
- Hematology, Azienda Ospedaliera Santa Maria Nuova-IRCCS, Reggio Emilia, Italy
| | - M Ziepert
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
| | - R Herbrecht
- Department of Oncology and Hematology, Hôpital de Hautepierre, Strasbourg, France
| | - J Flament
- Celgene Corporation, Boudry, Switzerland
| | - T Fu
- Celgene Corporation, Summit
| | - C R Flowers
- Department of Bone Marrow and Stem Cell Transplantation, Winship Cancer Institute of Emory University, Atlanta, USA
| | - B Coiffier
- Department of Hematology, Centre Hospitalier Lyon-Sud, Pierre-Benite, France
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42
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André T, Vernerey D, Im SA, Bodoky G, Buzzoni R, Reingold S, Rivera F, McKendrick J, Scheithauer W, Ravit G, Fountzilas G, Yong WP, Isaacs R, Österlund P, Liang JT, Creemers GJ, Rakez M, Van Cutsem E, Cunningham D, Tabernero J, de Gramont A. Bevacizumab as adjuvant treatment of colon cancer: updated results from the S-AVANT phase III study by the GERCOR Group. Ann Oncol 2019; 31:246-256. [PMID: 31959341 DOI: 10.1016/j.annonc.2019.12.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 12/03/2019] [Accepted: 12/15/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The bevacizumab-Avastin® adjuVANT (AVANT) study did not meet its primary end point of improving disease-free survival (DFS) with the addition of bevacizumab to oxaliplatin-based chemotherapy in stage III colon cancer (CC). We report here the long-term survival results (S-AVANT). PATIENTS AND METHODS Patients with curatively resected stage III CC were randomly assigned to FOLFOX4, FOLFOX4-bevacizumab, or XELOX-bevacizumab. RESULTS A total of 2867 patients were randomized: FOLFOX4: n = 955, FOLFOX4-bevacizumab: n = 960, XELOX-bevacizumab: n = 952. With a median of 6.73 years follow-up (interquartile range 5.51-10.54), 672 patients died, of whom 198 (20.7%), 250 (26.0%), and 224 (23.5%) were in the FOLFOX4, FOLFOX4-bevacizumab, and XELOX-bevacizumab arms, respectively. The 10-year overall survival (OS) rates were 74.6%, 67.2%, and 69.9%, (P = 0.003) and 5-year disease-free survival (DFS) rates were 73.2%, 68.5%, and 71.0% (P = 0.174), respectively. OS and DFS hazard ratios were 1.29 [95% confidence interval (CI) 1.07-1.55; P = 0.008] and 1.16 (95% CI 0.99-1.37; P = 0.063) for FOLFOX4-bevacizumab versus FOLFOX4 and 1.15 (95% CI 0.95-1.39; P = 0.147) and 1.1 (95% CI 0.93-1.29; P = 0.269) for XELOX-bevacizumab versus FOLFOX4, respectively. CC-related deaths (n = 542) occurred in 157 (79.3%) patients receiving FOLFOX4, 205 (82.0%) receiving FOLFOX4-bevacizumab, and 180 (80.4%) receiving XELOX-bevacizumab (P = 0.764), while non-CC-related deaths occurred in 41 (20.7%), 45 (18.0%), and 44 (19.6%) patients, respectively. Cardiovascular-related and sudden deaths during treatment or follow-up were reported in 13 (6.6%), 17 (6.8%), and 14 (6.3%) patients, in the FOLFOX4, FOLFOX4-bevacizuamb, and XELOX-bevacizumab arms, respectively (P = 0.789). Treatment arm, sex, age, histological differentiation, performance status, T/ N stages, and localization of primary tumor were independent prognostic factors of OS in stage III. CONCLUSIONS S-AVANT confirms the initial AVANT report. No benefit of the bevacizumab addition to FOLFOX4 adjuvant therapy in patients with stage III CC was observed in terms of DFS with a negative effect in OS, without increase in non-CC related deaths. CLINICAL TRIAL IDENTIFICATION NCT00112918.
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Affiliation(s)
- T André
- Sorbonne Université and, Department of Medical Oncology, Saint-Antoine Hospital, Paris, France.
| | - D Vernerey
- Methodology and Quality of Life Unit in Oncology, University Hospital of Besançon, INSERM UMR 1098, Besançon, France
| | - S A Im
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - G Bodoky
- Department of Medical Oncology, Combined Szent István and Szent László Hospitals, Budapest, Hungary
| | - R Buzzoni
- Department of Medical Oncology, Istituto Nazionale dei Tumori di Milano - Fondazione IRCCS, Milan, Italy
| | - S Reingold
- Department of Medical Oncology, William Osler Health Centre Brampton Civic Hospital, Brampton, Canada
| | - F Rivera
- Department of Medical Oncology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - J McKendrick
- Department of Medical Oncology, Eastern Health, Box Hill Hospital, Melbourne, Australia
| | - W Scheithauer
- Department of Medical Oncology, Vienna General Hospital (AKH), Medizinische Universität Wien, Vienna, Austria
| | - G Ravit
- Division of Oncology, Tel Aviv Sourasky Medical Center, Tel-Aviv University, Tel Aviv, Israel
| | - G Fountzilas
- Department of Medical Oncology, Papageorgiou Hospital Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - W P Yong
- Department of Hematology-Oncology, National University of Singapore, Singapore, Singapore
| | - R Isaacs
- Department of Medical Oncology, Palmerston North & Crest Hospitals, Palmerston North, New Zealand
| | - P Österlund
- Department of Oncology, Helsinki and Tampere University Hospitals, University of Helsinki, Helsinki/Tampere, Finland
| | - J T Liang
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - G J Creemers
- Department of Medical Oncology, Catharina Hospital, Eindhoven, The Netherlands
| | - M Rakez
- Statistical Unit, ARCAD Foundation, Levallois-Perret, France
| | - E Van Cutsem
- Department of Internal Medicine, University Hospitals Gasthuisberg Leuven and KU Leuven, Leuven, Belgium
| | - D Cunningham
- Department of Medicine, The Institute of Cancer Research/Royal Marsden NHS Foundation Trust, Sutton, UK
| | - J Tabernero
- Department of Medical Oncology, Vall d'Hebron University Hospital and Institute of Oncology (VHIO), UVic, IOB-Quiron, CIBERONC, TTD Group, Barcelona, Spain
| | - A de Gramont
- Statistical Unit, ARCAD Foundation, Levallois-Perret, France; Department of Medical Oncology, Franco-British Institute, Levallois-Perret, France
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Desai K, Ragulan C, Lawrence P, Wullschleger S, Tichet M, Box G, Fontana E, Young K, Larkin J, Hanahan D, Cunningham D, Starling N, Sadanandam A. A personalised approach for anti-GITR-based immunotherapy in pre-clinical models of pancreatic ductal adenocarcinoma. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz452.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Sclafani F, Kalaitzaki E, Cunningham D, Tait D, Brown G, Chau I. Neoadjuvant rectal score: run with the hare and hunt with the hounds. Ann Oncol 2019; 29:2261-2262. [PMID: 30204839 DOI: 10.1093/annonc/mdy403] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- F Sclafani
- Department of Medicine, The Royal Marsden NHS Foundation Trust, London and Surrey
| | - E Kalaitzaki
- Clinical Research & Development, The Royal Marsden NHS Foundation Trust, London and Surrey
| | - D Cunningham
- Department of Medicine, The Royal Marsden NHS Foundation Trust, London and Surrey.
| | - D Tait
- Department of Radiotherapy, The Royal Marsden NHS Foundation Trust, London and Surrey
| | - G Brown
- Department of Radiology, The Royal Marsden NHS Foundation Trust, London and Surrey, UK
| | - I Chau
- Department of Medicine, The Royal Marsden NHS Foundation Trust, London and Surrey
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Aggelis V, Cunningham D, Lordick F, Smyth EC. Peri-operative therapy for operable gastroesophageal adenocarcinoma: past, present and future. Ann Oncol 2019; 29:1377-1385. [PMID: 29771279 DOI: 10.1093/annonc/mdy183] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Surgery represents the only chance of cure for patients with gastroesophageal adenocarcinoma; however, surgery alone does not cure most patients. Over the past decade, several multimodality adjunctive treatments have improved survival for patients with operable gastroesophageal adenocarcinoma who are undergoing surgical resection; these include peri-operative chemotherapy, neoadjuvant chemoradiotherapy, adjuvant chemotherapy and adjuvant chemoradiotherapy. More recently, the results of several large randomised trials are leading to a shift in the peri-operative treatment of gastroesophageal cancer, away from anthracycline-based and towards taxane-based chemotherapy regimens. Emerging data support an increased focus on patients who are at high risk for poor operative outcomes such as R1 resection, and on patients who are at high risk for relapse following surgery such as those with lymph node metastases (N1+). Future developments may include use of fluorodeoxyglucose-positron emission tomography to inform a switch to non-cross resistant chemotherapy pre-operatively and substitution of alternative treatments for chemotherapy in high risk post-operative node positive patients. Conversely, in molecularly selected subgroups such as microsatellite unstable gastroesophageal cancer, peri-operative or adjuvant chemotherapy may not be helpful, and treatments such as immunotherapy may be considered. In this review, the most up-to-date clinical trials and translational research in the field of operable gastroesophageal cancer are discussed; with a focus on how best to risk stratify patients with operable disease for peri-operative treatment plus surgery, and how novel therapies might be integrated into standard treatments in order to improve survival outcomes in this patient group.
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Affiliation(s)
- V Aggelis
- Department of Gastrointestinal Oncology & Lymphoma, Royal Marsden Hospital, London & Surrey, UK
| | - D Cunningham
- Department of Gastrointestinal Oncology & Lymphoma, Royal Marsden Hospital, London & Surrey, UK
| | - F Lordick
- University Cancer Center Leipzig (UCCL), University Medicine Leipzig, Leipzig, Germany
| | - E C Smyth
- Department of Gastrointestinal Oncology & Lymphoma, Royal Marsden Hospital, London & Surrey, UK.
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Hedayat S, Lampis A, Vlachogiannis G, Khan K, Cunningham D, Marchetti S, Fassan M, Begum R, Schirripa M, Loupakis F, Valeri N. Circulating miR-652-3p as a biomarker of drug resistance in metastatic colorectal cancer patients. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz413.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Lampis A, Carotenuto P, Hedayat S, Previdi M, Zito D, Sclafani F, Parisi C, Hahne J, Hallsworth A, Kirkin V, Young K, Kouvelakis K, Azevedo S, Vasiliki M, Scarpa A, Cunningham D, Chau I, Valeri N, Fassan M, Braconi C. Modulation of pancreatic cancer cell sensitivity to FOLFIRINOX through microRNA-mediated regulation of response to DNA damage. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz413.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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André T, Vernerey D, Im SA, Bodoky G, Buzzoni R, Reingold S, Rivera F, McKendrick J, Scheithauer W, Geva R, Fountzilas G, Yong W, Isaacs R, Österlund P, Liang JT, Creemers GJ, Van Cutsem E, Cunningham D, Tabernero J, De Gramont A. Bevacizumab as adjuvant treatment for colon cancer: Updated results from the AVANT phase III study by the GERCOR group. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz246.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Cunningham D, Salazar R, Sobrero A, Ducreux M, Van Cutsem E, Scheithauer W, Tournigand C, Molnar V, Starke M, Baumann M, Wiegert E, Schmidt M, Arnold D. Lefitolimod vs standard of care (SOC) for patients with metastatic colorectal cancer (mCRC) responding to first-line standard treatment: Results from the randomized phase III IMPALA trial. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz394.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Cartwright E, Turkes F, Saffery C, Kalaitzaki E, Powell R, Wotherspoon A, De Paepe K, von Loga K, Hubank M, Rao S, Watkins D, Chau I, Starling N, Cunningham D. EMERGE: Epigenetic modulation of the immune response in gastrointestinal cancers. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz246.147] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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