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Desai S, Jarmi T, Ruiz J, Paghdar S, Patel P, Malkani S, Nativi J, Yip D, Lyle M, Leoni J, Goswami R. Renal Function Stabilization in Patients with Advanced Heart Failure and Chronic Kidney Disease Supported with Impella 5.5 as a Bridge to Transplantation. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.528] [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: 04/05/2023] Open
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2
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Ruiz J, Desai S, Paghdar S, Malkani S, Nativi J, Yip D, Patel P, Leoni J, Lyle M, Goswami R. The Impact of Axillary Mechanical Circulatory Support in Patients Awaiting Heart Transplantation with Pulmonary Hypertension. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.820] [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: 04/05/2023] Open
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Desai S, Soto-Arenall M, Ruiz J, Postell A, Paghdar S, Malkani S, Nativi J, Patel P, Yip D, Lyle M, Leoni J, Goswami R. Systemic Effects of Impella 5.5 Purge Solution in Patients with Heart Failure Cardiogenic Shock. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.813] [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: 04/05/2023] Open
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Goswami R, Jang J, Ruiz J, Desai S, Paghdar S, Malkani S, Yip D, Leoni J, Patel P, Lyle M, Nativi J. Artificial Intelligence to Predict Death or Transplant in ATTR Amyloidosis Cardiomyopathy. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.044] [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: 04/05/2023] Open
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Desai S, Ruiz J, Paghdar S, Malkani S, Nativi J, Juan L, Yip D, Patel P, Lyle M, Goswami R. Cardiogenic Shock in Eosinophilic Myocarditis. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.448] [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: 04/05/2023] Open
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Jang J, Ruiz J, Desai S, Sareyyupoglu B, Paghdar S, Malkani S, Landolfo K, Patel P, Nativi J, Yip D, Lyle M, Leoni J, Pham S, Goswami R. Mid-Term Survival in Patients with Advanced Heart Failure Receiving an Impella Device Intended as Bridge to Transplantation. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.047] [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: 04/05/2023] Open
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Wang M, Nair A, Smith B, Nguyen T, Kehoe N, Vyas H, Liu D, Murthy V, Yip D, Steidley D, Clavell A, Kushwaha S, Park W, Eisen H, Stegall M, Pereira N. Transcriptomic Profiling of Acute Cellular Rejection after Heart Transplantation. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1550] [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: 04/05/2023] Open
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Tie J, Cohen J, Lahouel K, Lo S, Wang Y, Wong R, Shapiro J, Harris S, Khattak A, Burge M, Horvath L, Karapetis C, Shannon J, Singh M, Yip D, Papadopoulos N, Tomasetti C, Kinzler K, Vogelstein B, Gibbs P. 318MO Circulating tumour DNA (ctDNA) dynamics, CEA and sites of recurrence for the randomised DYNAMIC study: Adjuvant chemotherapy (ACT) guided by ctDNA analysis in stage II colon cancer (CC). Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Ruiz Morales J, Nativi-Nicolau J, Jang J, Patel P, Yip D, Leoni-Moreno J, Goswami R. Artificial Intelligence 12 Lead ECG Based Heart Age Estimation and 1-year Outcomes After Heart Transplantation. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Jang J, Nativi-Nicolau J, Yip D, Patel P, Leoni-Moreno J, Goswami R. Impact of SGLT2i Use on Functional Capacity in Heart Failure. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1388] [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: 11/27/2022] Open
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Mohammed-Ali Z, Bhandarkar S, Tahir S, Handford C, Yip D, Beriault D, Hicks LK. Implementing effective test utilization via team-based evaluation and revision of a family medicine laboratory test requisition. BMJ Open Qual 2021; 10:bmjoq-2020-001219. [PMID: 33731485 PMCID: PMC7978073 DOI: 10.1136/bmjoq-2020-001219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 02/16/2021] [Accepted: 02/28/2021] [Indexed: 11/21/2022] Open
Affiliation(s)
- Zahraa Mohammed-Ali
- Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Seema Bhandarkar
- Department of Family and Community Medicine, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Shafqat Tahir
- Department of Laboratory Medicine, Unity HealthToronto, Toronto, Ontario, Canada
| | - Curtis Handford
- Department of Family and Community Medicine, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada.,Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Drake Yip
- Department of Laboratory Medicine, Unity HealthToronto, Toronto, Ontario, Canada
| | - Daniel Beriault
- Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Laboratory Medicine, Unity HealthToronto, Toronto, Ontario, Canada
| | - Lisa K Hicks
- Department of Medicine, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada .,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Bodley T, Chan M, Levi O, Clarfield L, Yip D, Smith O, Friedrich JO, Hicks LK. Patient harm associated with serial phlebotomy and blood waste in the intensive care unit: A retrospective cohort study. PLoS One 2021; 16:e0243782. [PMID: 33439871 PMCID: PMC7806151 DOI: 10.1371/journal.pone.0243782] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 11/25/2020] [Indexed: 11/23/2022] Open
Abstract
Background Intensive care unit (ICU) patients are at high risk of anemia, and phlebotomy is a potentially modifiable source of blood loss. Our objective was to quantify daily phlebotomy volume for ICU patients, including blood discarded as waste during vascular access, and evaluate the impact of phlebotomy volume on patient outcomes. Methods This was a retrospective observational cohort study between September 2014 and August 2015 at a tertiary care academic medical-surgical ICU. A prospective audit of phlebotomy practices in March 2018 was used to estimate blood waste during vascular access. Multivariable logistic regression was used to evaluate phlebotomy volume as a predictor of ICU nadir hemoglobin < 80 g/L, and red blood cell transfusion. Results There were 428 index ICU admissions, median age 64.4 yr, 41% female. Forty-four patients (10%) with major bleeding events were excluded. Mean bedside waste per blood draw (144 draws) was: 3.9 mL from arterial lines, 5.5 mL central venous lines, and 6.3 mL from peripherally inserted central catheters. Mean phlebotomy volume per patient day was 48.1 ± 22.2 mL; 33.1 ± 15.0 mL received by the lab and 15.0 ± 8.1 mL discarded as bedside waste. Multivariable regression, including age, sex, admission hemoglobin, sequential organ failure assessment score, and ICU length of stay, showed total daily phlebotomy volume was predictive of hemoglobin <80 g/L (p = 0.002), red blood cell transfusion (p<0.001), and inpatient mortality (p = 0.002). For every 5 mL increase in average daily phlebotomy the odds ratio for nadir hemoglobin <80 g/L was 1.18 (95% CI 1.07–1.31) and for red blood cell transfusion was 1.17 (95% CI 1.07–1.28). Conclusion A substantial portion of daily ICU phlebotomy is waste discarded during vascular access. Average ICU phlebotomy volume is independently associated with ICU acquired anemia and red blood cell transfusion which supports the need for phlebotomy stewardship programs.
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Affiliation(s)
- Thomas Bodley
- Interdepartmental Division of Critical Care, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- * E-mail:
| | - Maverick Chan
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Olga Levi
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Lauren Clarfield
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Drake Yip
- Division of Laboratory Medicine, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Orla Smith
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Jan O. Friedrich
- Interdepartmental Division of Critical Care, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Lisa K. Hicks
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
- Division of Hematology/Oncology, St. Michael’s Hospital, Toronto, Ontario, Canada
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Jain A, Sjoquist K, Yip D. ESMO localised colon cancer guidelines: ‘can we improve on our surveillance protocols?’. Ann Oncol 2020; 31:1778-1779. [DOI: 10.1016/j.annonc.2020.09.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 09/15/2020] [Indexed: 10/23/2022] Open
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Jain A, Yip D. GEP-NET: Knowledge gaps in the recent ESMO Guidelines. Ann Oncol 2020; 31:1260-1261. [DOI: 10.1016/j.annonc.2020.04.481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 04/29/2020] [Indexed: 11/27/2022] Open
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Min ST, Roohullah A, Tognela A, Jalali A, Lee M, Wong R, Shapiro J, Burge M, Yip D, Nott L, Zimet A, Lee B, Dean A, Steel S, Wong HL, Gibbs P, Lim SHS. Patient demographics and management landscape of metastatic colorectal cancer in the third-line setting: Real-world data in an Australian population. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz246.134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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16
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Mahmud A, Qu X, Yip D, Leveridge M, Mackillop W. The Patterns of Practice and Outcomes of Penile Cancer in Ontario. Clin Oncol (R Coll Radiol) 2017; 29:239-247. [PMID: 28057403 DOI: 10.1016/j.clon.2016.12.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 11/15/2016] [Accepted: 11/21/2016] [Indexed: 11/15/2022]
Abstract
AIMS Penile cancer is a rare malignancy in Western countries. The management guidelines are mainly derived from retrospective studies as there are no randomised trials. The primary objective of this study was to assess patterns of practice and outcomes of penile squamous cell carcinoma in Ontario. Secondary objectives included examining trends in incidence, pathological characteristics and prognostic factors. MATERIALS AND METHODS All patients diagnosed with penile cancer between 2000 and 2010 were identified from the Ontario Cancer Registry and all available pathology reports related to penile cancer during this period were reviewed. RESULTS Pathology reports of 419 new cases of penile squamous cell carcinoma were reviewed. There was a significant improvement in completeness of the pathology reports in recent years. The age-adjusted incidence was 0.9 per 100 000 person-years. Most patients presented with a pT1 lesion (63%). A partial penectomy (40%) was the most common surgical procedure. Over 38% of patients identified to be eligible for organ-sparing surgery had a total or partial penectomy. Only 23% of the eligible patients identified to require lymph node dissection underwent the procedure. The 5 year disease-specific survival for stage 0, I, II, III were 94%, 93%, 74% and 52%, respectively. CONCLUSIONS There is a significant variation in the patterns of practice in Ontario. A large proportion of patients in this cohort were probably overtreated for the primary malignancy and undertreated for the regional nodes.
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Affiliation(s)
- A Mahmud
- Department of Oncology, Queen's University, Cancer Centre of Southeastern Ontario at Kingston General Hospital, Kingston, Ontario, Canada.
| | - X Qu
- Department of Oncology, Queen's University, Cancer Centre of Southeastern Ontario at Kingston General Hospital, Kingston, Ontario, Canada
| | - D Yip
- Department of Oncology, Queen's University, Cancer Centre of Southeastern Ontario at Kingston General Hospital, Kingston, Ontario, Canada
| | - M Leveridge
- Department of Urology, Queen's University, Kingston General Hospital, Kingston, Ontario, Canada
| | - W Mackillop
- Department of Oncology, Queen's University, Cancer Centre of Southeastern Ontario at Kingston General Hospital, Kingston, Ontario, Canada
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Day D, Kanjanapan Y, Kwan E, Yip D, Lawrentschuk N, Davis ID, Azad AA, Wong S, Rosenthal M, Gibbs P, Tran B. Benefit from cytoreductive nephrectomy and the prognostic role of neutrophil-to-lymphocyte ratio in patients with metastatic renal cell carcinoma. Intern Med J 2016; 46:1291-1297. [DOI: 10.1111/imj.13202] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 07/26/2016] [Accepted: 07/27/2016] [Indexed: 01/02/2023]
Affiliation(s)
- D. Day
- Department of Medical Oncology; The Royal Melbourne Hospital; Melbourne Victoria Australia
| | - Y. Kanjanapan
- Department of Medical Oncology; The Canberra Hospital; Canberra Australian Capital Territory Australia
| | - E. Kwan
- Department of Medical Oncology; The Royal Melbourne Hospital; Melbourne Victoria Australia
| | - D. Yip
- Department of Medical Oncology; The Canberra Hospital; Canberra Australian Capital Territory Australia
| | - N. Lawrentschuk
- Department of Urology; Austin Health; Melbourne Victoria Australia
| | - I. D. Davis
- Monash University Eastern Health Clinical School; Melbourne Victoria Australia
| | - A. A. Azad
- Department of Medical Oncology; Olivia Newton-John Cancer and Wellness Centre, Austin Health; Melbourne Victoria Australia
- School of Clinical Sciences; Monash University; Melbourne Victoria Australia
| | - S. Wong
- Department of Medical Oncology; Western Health; Melbourne Victoria Australia
| | - M. Rosenthal
- Department of Medical Oncology; The Royal Melbourne Hospital; Melbourne Victoria Australia
| | - P. Gibbs
- Department of Medical Oncology; The Royal Melbourne Hospital; Melbourne Victoria Australia
- Department of Medical Oncology; Western Health; Melbourne Victoria Australia
- Biogrid Australia; The Royal Melbourne Hospital; Melbourne Victoria Australia
- Walter and Eliza Hall Institute; Melbourne Victoria Australia
| | - B. Tran
- Department of Medical Oncology; The Royal Melbourne Hospital; Melbourne Victoria Australia
- Department of Medical Oncology; Western Health; Melbourne Victoria Australia
- Biogrid Australia; The Royal Melbourne Hospital; Melbourne Victoria Australia
- Walter and Eliza Hall Institute; Melbourne Victoria Australia
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Thewes B, Davis E, Girgis A, Valery PC, Giam K, Hocking A, Jackson J, He VY, Yip D, Garvey G. Routine screening of Indigenous cancer patients' unmet support needs: a qualitative study of patient and clinician attitudes. Int J Equity Health 2016; 15:90. [PMID: 27286811 PMCID: PMC4902957 DOI: 10.1186/s12939-016-0380-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 06/06/2016] [Indexed: 12/18/2022] Open
Abstract
Background Indigenous Australians have poorer cancer outcomes in terms of incidence mortality and survival compared with non-Indigenous Australians. The factors contributing to this disparity are complex. Identifying and addressing the psychosocial factors and support needs of Indigenous cancer patients may help reduce this disparity. The Supportive Care Needs Assessment Tool for Indigenous People (SCNAT-IP) is a validated 26-item questionnaire developed to assess their unmet supportive care needs. This qualitative study reports on patient and clinician attitudes towards feasibility and acceptability of SCNAT-IP in routine care. Methods Forty-four in-depth semi-structured interviews were conducted with 10 clinical staff and 34 Indigenous cancer patients with heterogeneous tumours. Participants were recruited from four geographically diverse Australian cancer clinics. Transcripts were imported into qualitative analysis software (NVivo 10 Software), coded and thematic analysis performed. Results Indigenous patients (mean age 54.4 years) found the SCNAT-IP beneficial and easy to understand and they felt valued and heard. Clinical staff reported multiple benefits of using the SCNAT-IP. They particularly appreciated its comprehensive and systematic nature as well as the associated opportunities for early intervention. Some staff described improvements in team communication, while both staff and patients reported that new referrals to support services were directly triggered by completion of the SCNAT-IP. There were also inter-cultural benefits, with a positive and bi-directional exchange of information and cultural knowledge reported when using the SCNAT-IP. Although staff identified some potential barriers to using the SCNAT-IP, including the time required, the response format and comprehension difficulties amongst some participants with low English fluency, these were outweighed by the benefits. Some areas for scaled improvement were also identified by staff. Conclusions Staff and patients found the SCNAT-IP to be an acceptable tool and supported universal screening for Indigenous cancer patients. The SCNAT-IP has the potential to help reduce the inequalities in cancer care experienced by Indigenous Australians by identifying and subsequently addressing their unmet support needs. Further research is needed to explore the validity of the SCNAT-IP for Indigenous people from other nations.
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Affiliation(s)
- B Thewes
- Menzies School of Health Research, Charles Darwin University, Adelaide Street, PO Box 10639, Brisbane, QLD, 4000, Australia
| | - E Davis
- Menzies School of Health Research, Charles Darwin University, Adelaide Street, PO Box 10639, Brisbane, QLD, 4000, Australia
| | - A Girgis
- South Western Sydney Clinical School, UNSW, Sydney, Australia
| | - P C Valery
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - K Giam
- Alan Walker Cancer Care Centre, Royal Darwin Hospital, Darwin, Australia
| | - A Hocking
- Peter MacCallum Cancer Centre, Melbourne, Australia
| | - J Jackson
- Southern NSW Local Health District, New South Wales, Australia
| | - V Yf He
- Menzies School of Health Research, Charles Darwin University, Adelaide Street, PO Box 10639, Brisbane, QLD, 4000, Australia
| | - D Yip
- ANU Medical School, Australian National University, Canberra, Australia
| | - G Garvey
- Menzies School of Health Research, Charles Darwin University, Adelaide Street, PO Box 10639, Brisbane, QLD, 4000, Australia.
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Toohey K, Semple S, Pumpa K, Cooke J, Arnold L, Craft P, Yip D. High-intensity interval training versus continuous moderate intensity training: Effects on health outcomes and cardiometabolic disease risk factors in cancer survivors: A pilot study. J Sci Med Sport 2015. [DOI: 10.1016/j.jsams.2015.12.359] [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: 10/22/2022]
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Garvey G, Thewes B, He VFY, Davis E, Girgis A, Valery PC, Giam K, Hocking A, Jackson J, Jones V, Yip D. Indigenous cancer patient and staff attitudes towards unmet needs screening using the SCNAT-IP. Support Care Cancer 2015; 24:215-223. [PMID: 26003424 DOI: 10.1007/s00520-015-2770-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 05/12/2015] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Indigenous Australians have a higher cancer incidence, worse mortality and are less likely to receive optimal cancer treatment compared with non-Indigenous Australians. Culturally appropriate supportive care helps ensure that Indigenous patients engage in and receive optimal care. However, many existing supportive care needs tools lack cultural relevance for Indigenous people, and their feasibility with Indigenous people has not been demonstrated. The Supportive Care Needs Assessment Tool for Indigenous People (SCNAT-IP) assesses the unmet supportive care needs of Indigenous cancer patients. PURPOSE This descriptive study evaluates the clinical implementation of the SCNAT-IP in routine care. METHODS Two large tertiary cancer treatment centres and two regional oncology clinics participated. Participants included 10 clinical staff and 36 adult Indigenous cancer patients (mean age 54 years). Patients and clinicians completed brief, purpose-designed questionnaires and interviews. RESULTS Patients reported high ratings (means >8/10) for acceptability, helpfulness and timing items. The majority (≥80%) of staff agreed that the SCNAT-IP was useful to clinical practice, should be used in routine care and was acceptable to their patients. CONCLUSIONS The study provides empirical support for the feasibility and acceptability of the SCNAT-IP in routine cancer care with Indigenous Australians. Routine screening with the SCNAT-IP has the potential to improve cancer care for Indigenous people with cancer.
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Affiliation(s)
- G Garvey
- Menzies School of Health Research, PO Box 10639, Adelaide Street, Brisbane, QLD, 4000, Australia.
| | - B Thewes
- Menzies School of Health Research, PO Box 10639, Adelaide Street, Brisbane, QLD, 4000, Australia
| | - V F Y He
- Menzies School of Health Research, PO Box 10639, Adelaide Street, Brisbane, QLD, 4000, Australia
| | - E Davis
- Menzies School of Health Research, PO Box 10639, Adelaide Street, Brisbane, QLD, 4000, Australia
| | - A Girgis
- South Western Sydney Clinical School, UNSW, Sydney, Australia
| | - P C Valery
- Menzies School of Health Research, PO Box 10639, Adelaide Street, Brisbane, QLD, 4000, Australia
| | - K Giam
- Alan Walker Cancer Care Centre, Royal Darwin Hospital, Darwin, Australia
| | - A Hocking
- Peter MacCallum Cancer Centre, Melbourne, Australia
| | - J Jackson
- Southern NSW Local Health District, Queanbeyan, NSW, Australia
| | - V Jones
- Southern NSW Local Health District, Queanbeyan, NSW, Australia
| | - D Yip
- ANU Medical School, Australian National University, Canberra, Australia
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Brulé SY, Jonker DJ, Karapetis CS, O'Callaghan CJ, Moore MJ, Wong R, Tebbutt NC, Underhill C, Yip D, Zalcberg JR, Tu D, Goodwin RA. Location of colon cancer (right-sided versus left-sided) as a prognostic factor and a predictor of benefit from cetuximab in NCIC CO.17. Eur J Cancer 2015; 51:1405-14. [PMID: 25979833 DOI: 10.1016/j.ejca.2015.03.015] [Citation(s) in RCA: 237] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Revised: 03/10/2015] [Accepted: 03/14/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND Right- and left-sided colon cancers (RC, LC) differ with respect to biology, pathology and epidemiology. Previous data suggest a mortality difference between RC and LC. We examined if primary tumour side also predicts for outcome in chemotherapy refractory, metastatic colon cancer (MCC). We also compared RC versus LC as a predictor of efficacy of epidermal growth factor receptor (EGFR) inhibition with cetuximab. METHODS Reanalyzing NCIC CO.17 trial (cetuximab versus best supportive care [BSC]), we coded the primary tumour side as RC (caecum to transverse colon) or LC (splenic flexure to rectosigmoid). The association between tumour side and baseline characteristics was assessed. Cox regression models determined factors affecting overall survival (OS) and progression free survival (PFS). RESULTS Patients with RC (150/399) had more poorly differentiated, mutant KRAS, mutated PIK3CA and wild-type BRAF tumours, fewer liver and lung metastases, and shorter interval between diagnosis and study entry. Among BSC patients, tumour side was not prognostic for PFS (hazard ratios (HR) 1.07 [0.79-1.44], p = 0.67) or OS (HR 0.96 [0.70-1.31], p = 0.78). Among wild-type KRAS patients, those with LC had significantly improved PFS when treated with cetuximab compared to BSC (median 5.4 versus 1.8 months, HR 0.28 [0.18-0.45], p < 0.0001), whereas those with RC did not (median 1.9 versus 1.9 months, HR 0.73 [0.42-1.27], p = 0.26), [interaction p = 0.002]. CONCLUSION In refractory MCC, tumour location within the colon is not prognostic, but is strongly predictive of PFS benefit from cetuximab therapy. Additional research is needed to understand the molecular differences between RC and LC and their interaction with EGFR inhibition.
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Affiliation(s)
- S Y Brulé
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada
| | - D J Jonker
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada; NCIC Clinical Trials Group, Kingston, Canada
| | - C S Karapetis
- Flinders Medical Centre and Flinders Centre for Innovation in Cancer, Flinders University, Adelaide, Australia
| | | | - M J Moore
- Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Canada
| | - R Wong
- CancerCare Manitoba, Winnipeg, MB, Canada
| | - N C Tebbutt
- Austin Health and University of Melbourne, Heidelberg, Australia
| | | | - D Yip
- Canberra and Calvary Hospitals, Canberra, Australia
| | - J R Zalcberg
- Division of Cancer Medicine, Peter McCallum Cancer Centre, Melbourne, Australia
| | - D Tu
- NCIC Clinical Trials Group, Kingston, Canada
| | - R A Goodwin
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada.
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Yip D, Liebsch N, Busse P, Kim M, Adams J, Deschler D, Lin D, Varvares M, Chan A. Proton Beam Therapy for Unresectable Adenoid Cystic Carcinoma of the Nasopharynx. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.1662] [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: 10/24/2022]
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Field K, Wong HL, Shapiro J, Kosmider S, Tie J, Bae S, Yip D, McKendrick J, Nott L, Desai J, Harold M, Lipton L, Stefanou G, Lim L, Parente P, Gibbs P. Developing a national database for metastatic colorectal cancer management: perspectives and challenges. Intern Med J 2014; 43:1224-31. [PMID: 23834128 DOI: 10.1111/imj.12230] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2013] [Accepted: 06/27/2013] [Indexed: 02/06/2023]
Abstract
BACKGROUND The changing treatment landscape for metastatic colorectal cancer creates multiple potential treatment strategies. An Australian-centric database capturing comprehensive information across a range of treatment locations would create a valuable resource enabling multiple important research questions to be addressed. AIMS To establish a collection of a consensus dataset capturing treatment and outcomes at multiple public and private hospitals across Australia. METHODS An electronic database was developed by a panel of clinicians, to capture an agreed dataset for patients with newly diagnosed metastatic colorectal cancer. Of particular interest were clinician decision-making, the impact of comorbidities and the frequency of major adverse events. RESULTS Since July 2009, data collection has been established at six public and eight private hospitals across three Australian states and territories. Successful linkage and analysis, with support from BioGrid Australia, of selected data on the initial 864 patients demonstrates that data can be captured from diverse sites, including public and private practice, that multiple factors impact on treatment delivered and outcomes achieved and that comprehensive data on rare but important adverse events can be captured. As a clinical research tool, the project has been highly successful, generating multiple presentations at national and international conferences related to a diverse range of research questions. CONCLUSIONS Multistate, project-specific data collection involving large numbers of patients is achievable. Providing invaluable insight into the routine clinical management of metastatic colorectal cancer in the era of targeted therapies, this also creates a significant resource for research, including many questions not being addressed by clinical trials.
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Affiliation(s)
- K Field
- Medical Oncology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
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Kuo JC, Hawkins C, Yip D. Treatment outcomes of rapid desensitisation protocols for chemotherapeutic agents and monoclonal antibodies following hypersensitivity reactions. Intern Med J 2014; 44:442-9. [DOI: 10.1111/imj.12320] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Accepted: 10/29/2013] [Indexed: 11/30/2022]
Affiliation(s)
- J. C. Kuo
- Department of Medical Oncology; The Canberra Hospital; Canberra Australian Capital Territory Australia
| | - C. Hawkins
- Department of Immunology; The Canberra Hospital; Canberra Australian Capital Territory Australia
- ANU Medical School; Australian National University; Canberra Australian Capital Territory Australia
| | - D. Yip
- Department of Medical Oncology; The Canberra Hospital; Canberra Australian Capital Territory Australia
- ANU Medical School; Australian National University; Canberra Australian Capital Territory Australia
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Wong HL, Field K, Harol M, Tran B, Tie J, Shapiro J, Wong R, Yip D, Nott L, Richardson G, McKendrick J, Gibbs P. P0183 Resection of colorectal cancer metastases in routine practice. Eur J Cancer 2014. [DOI: 10.1016/j.ejca.2014.03.227] [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: 10/25/2022]
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Abstract
WHAT IS KNOWN AND OBJECTIVE Regorafenib improves progression-free survival as a late-line treatment for patients with metastatic gastrointestinal stromal tumour (GIST). As a multitargeted tyrosine kinase inhibitor (TKI), the expected adverse events of regorafenib are similar to those reported with imatinib, sunitinib or sorafenib. We report the first case of hyperammonemic encephalopathy related to regorafenib in a patient with metastatic GIST. CASE SUMMARY A 61-year-old man maintained on regorafenib for metastatic GIST presented with acute confusion. Discontinuation of regorafenib led to complete resolution of confusion, which later recurred with hyperammonemia on recommencing regorafenib. Cessation of regorafenib and normalization of hyperammonemia then resulted in resolution of confusion. WHAT IS NEW AND CONCLUSIONS Regorafenib withdrawal and recommencement had influenced the confusional state and hyperammonemia in this patient. There is a probable relationship between regorafenib and metabolic encephalopathy. There are case reports of similar encephalopathy thought to be induced by other multitargeted TKI, and, as such, a class effect could be postulated.
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Affiliation(s)
- J C Kuo
- Department of Medical Oncology, The Canberra Hospital, Garran, ACT, Australia
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Ransom D, Wilson K, Fournier M, Simes RJ, Gebski V, Yip D, Tebbutt N, Karapetis CS, Ferry D, Gordon S, Price TJ. Final results of Australasian Gastrointestinal Trials Group ARCTIC study: an audit of raltitrexed for patients with cardiac toxicity induced by fluoropyrimidines. Ann Oncol 2013; 25:117-21. [PMID: 24299960 DOI: 10.1093/annonc/mdt479] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Cardiac toxicity an uncommon but serious side-effect of some fluoropyrimides. Cardiac toxicity from raltitrexed is rarely reported. With this background, we initiated this study to investigate the incidence of cardiac events in patients who had switched to raltitrexed following cardiac toxicity from fluoropyrimidines (5-fluorouracil or capecitabine). PATIENTS AND METHODS Pharmacy records were used to identify patients receiving raltitrexed from January 2004 till March 2012. Medical records were then reviewed to confirm the use of raltitrexed after cardiac toxicity from 5-fluorouracil or capecitabine. The primary end point was the rate of further cardiac events after commencing raltitrexed. RESULTS Forty-two patients were identified and the majority had colorectal cancer. Prior regimens included 5-fluorouracil ± leucovorin, capecitabine alone, FOLFOX, FOLFIRI, epirubicin/cisplatin/5-fluorouracil, and capecitabine/oxaliplatin. Seven patients (17%) had bolus 5-fluorouracil regimens, 26 patients (62%) had infusion 5-fluorouracil regimens, and 9 patients (21%) had capecitabine alone or in combination. Angina was the most common cardiac toxicity from 5-fluorouracil or capecitabine and usually occurred in the first or the second cycle. Four patients after their first cardiac event continued with the same 5-fluorouracil or capecitabine regimen with the addition of nitrates and calcium antagonists but still had further cardiac events. After changing to raltitrexed, either as a single agent or a continuing combination regimen, no patients experienced further cardiac toxicity. CONCLUSION Raltitrexed is associated with no significant cardiac toxicity in patients who have experienced prior cardiac toxicity from 5-fluorouracil or capecitabine. Raltitrexed, alone or in combination with oxaliplatin or irinotecan, provides a safe option in terms of cardiac toxicity for such patients.
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Affiliation(s)
- D Ransom
- Oncology Department, St John of God and Royal Perth Hospital, Perth
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Mahmud A, Qu M, Yip D. Management of Nodes in Patients Diagnosed With Penile Cancer Based on Pathologic Indicators. Int J Radiat Oncol Biol Phys 2013. [DOI: 10.1016/j.ijrobp.2013.06.1052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Price T, Wilson K, Simes R, Yip D, Karapetis C, Tebbutt N, Gebski V, Fournier M, Ferry D, Ransom D. Final Results of Australasian Gastro-Intestinal Trials Group (AGITG) Arctic Study: AN International Audit of Raltitrexed for Patients with Cardiac Toxicity Induced by Fluoropyrimidines (FP). Ann Oncol 2012. [DOI: 10.1016/s0923-7534(20)33085-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Abstract
BACKGROUND Metastatic renal cell cancer is associated with poor prognosis and survival and is resistant to conventional chemotherapy. Therapeutic targeting of molecular pathways for tumour angiogenesis and other specific activation mechanisms offers improved tumour response and prolonged survival. AIMS To conduct a retrospective audit of metastatic renal cell carcinoma patients treated with targeted therapies. METHODS Data were extracted from clinical records of patients undergoing targeted treatment between 2005 and 2009 at two hospital sites. Data collected included pathology, systemic therapy class, toxicity and survival. Univariate and multivariate survival analyses were performed. RESULTS Sixty-one patients were treated with 102 lines of therapy with a median overall survival (OS) of 23 months, median time to failure of first-line treatment (TTF1) of 10 months and median time to failure of second-line treatment (TTF2) of 5.2 months. Time from first diagnosis to treatment >12 months was significantly associated with improved OS, longer TTF1, TTF2 and response to first-line anti-vascular endothelial growth factor receptor tyrosine kinase inhibitors (anti-VEGF TKI) therapy. Variables associated with tumour biology, natural history and the systemic inflammatory response were associated with improved OS and TTF1. Development of hypertension was predictive of anti-VEGF TKI outcome. Toxicities were as expected for each drug class. CONCLUSIONS Survival and toxicity outcomes from two Australian sites are comparable to published data. The adverse event profile differs to conventional chemotherapy. Clinicians caring for patients with metastatic renal cancer will need to become familiar with these toxicities and their management as these agents enter widespread use.
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Affiliation(s)
- K Webber
- Department of Medical Oncology, Prince of Wales Hospital, University of New South Wales, Sydney, Australia.
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Vandenberghe H, Ueng S, Yip D, Steinhart B. Turn-a-round time (TAT) for NT-PRO-BNP for an integrated emergency department research protocol. Clin Biochem 2011. [DOI: 10.1016/j.clinbiochem.2011.06.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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O'Callaghan CJ, Tu D, Karapetis CS, Au H, Moore MJ, Tebbutt NC, Trudeau MG, Price TJ, Yip D, Jonker DJ. The relationship between the development of rash and clinical and health-related quality of life outcomes by KRAS mutation status in patients with colorectal cancer treated with cetuximab in NCIC CTG CO.17. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.3588] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Van Hazel GA, Tu D, Tebbutt NC, Jonker DJ, Price TJ, O'Callaghan C, Zalcberg JR, Taylor M, Strickland AH, Tomiak AT, Yip D, Simes J, Yadav SK, Links M, Burnell MJ, Jefford M, Karapetis CS. Early change in tumor size from waterfall plot analysis and RECIST response as predictor of overall survival (OS) in advanced, chemotherapy-refractory colorectal cancer (ACRC): NCIC CTG/AGITG CO.17 study. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.3602] [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: 11/20/2022] Open
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Joshi SS, Steer CB, Yoong J, Lakhanpal R, Kirsop S, Dunlop T, Mileshkin LR, Yip D, Marx GM, Hovey EJ, Della-Fiorentina S. Geriatric assessment (GA) of older patients with cancer in Australia: A national, multicenter audit. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.9134] [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: 11/20/2022] Open
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O'Callaghan CJ, Tu D, Karapetis CS, Au H, Moore MJ, Tebbutt NC, Trudeau MG, Price TJ, Yip D, Jonker DJ. The relationship between the development of rash and clinical and quality of life outcomes by Kras mutation status in patients with colorectal cancer treated with cetuximab in NCIC CTG CO.17. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.4_suppl.481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
481 Background: The NCIC Clinical Trials Group CO.17 trial, conducted with the Australasian Gastrointestinal Trials Group, showed cetuximab monotherapy (CET vs. best supportive care [BSC]) improved overall (OS) and progression-free survival (PFS) and maintained quality of life (QoL) in patients previously treated for advanced colorectal cancer. Correlative analyses showed strong relationships between CET benefits and both rash development and Kras mutation status. Association between rash and CET benefits is now presented by Kras mutation status. Methods: Rash was graded weekly by NCI CTC 2.0 criteria. Landmark-type analyses (LTA) were performed by excluding patients who died within 28 days and then grouping by rash severity (gr 2+ vs. gr 0/1) based both on worst grade ever developed (LTA1) and worst grade on or before day 28 (LTA2). Multivariate Cox models were conducted separately for wild-type (WT) and mutated (MUT) Kras tumors. Results: More rash of severity gr 2+ was observed in WT than MUT patients treated with CET (57.3% vs. 44.4%; p = 0.08). The median OS, PFS, and HRs from LTA2 are presented for WT and MUT groups (see Table). Conclusions: Rash severity was positively correlated with PFS and OS in Kras WT patients who received CET, although only for gr 2+ rash did OS significantly exceed that of BSC patients. In Kras MUT patients, neither gr 0/1 nor gr 2+ rash was associated with either improved PFS or OS vs. BSC patients. Quality of life outcomes will also be reported by Kras mutation status. [Table: see text] [Table: see text]
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Affiliation(s)
- C. J. O'Callaghan
- National Cancer Institute of Canada Clinical Trials Group, Kingston, ON, Canada; NCIC Clinical Trials Group, Kingston, ON, Canada; Flinders Medical Centre, Adelaide, Australia; Cross Cancer Institute, Edmonton, AB, Canada; Princess Margaret Hospital, Toronto, ON, Canada; Austin Health, Heidelberg, Australia; Medicine Hat Cancer Centre, Medicine Hat, AB, Canada; Queen Elizabeth Hospital, Adelaide, Australia; The Canberra Hospital, Canberra, Australia; The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada
| | - D. Tu
- National Cancer Institute of Canada Clinical Trials Group, Kingston, ON, Canada; NCIC Clinical Trials Group, Kingston, ON, Canada; Flinders Medical Centre, Adelaide, Australia; Cross Cancer Institute, Edmonton, AB, Canada; Princess Margaret Hospital, Toronto, ON, Canada; Austin Health, Heidelberg, Australia; Medicine Hat Cancer Centre, Medicine Hat, AB, Canada; Queen Elizabeth Hospital, Adelaide, Australia; The Canberra Hospital, Canberra, Australia; The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada
| | - C. S. Karapetis
- National Cancer Institute of Canada Clinical Trials Group, Kingston, ON, Canada; NCIC Clinical Trials Group, Kingston, ON, Canada; Flinders Medical Centre, Adelaide, Australia; Cross Cancer Institute, Edmonton, AB, Canada; Princess Margaret Hospital, Toronto, ON, Canada; Austin Health, Heidelberg, Australia; Medicine Hat Cancer Centre, Medicine Hat, AB, Canada; Queen Elizabeth Hospital, Adelaide, Australia; The Canberra Hospital, Canberra, Australia; The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada
| | - H. Au
- National Cancer Institute of Canada Clinical Trials Group, Kingston, ON, Canada; NCIC Clinical Trials Group, Kingston, ON, Canada; Flinders Medical Centre, Adelaide, Australia; Cross Cancer Institute, Edmonton, AB, Canada; Princess Margaret Hospital, Toronto, ON, Canada; Austin Health, Heidelberg, Australia; Medicine Hat Cancer Centre, Medicine Hat, AB, Canada; Queen Elizabeth Hospital, Adelaide, Australia; The Canberra Hospital, Canberra, Australia; The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada
| | - M. J. Moore
- National Cancer Institute of Canada Clinical Trials Group, Kingston, ON, Canada; NCIC Clinical Trials Group, Kingston, ON, Canada; Flinders Medical Centre, Adelaide, Australia; Cross Cancer Institute, Edmonton, AB, Canada; Princess Margaret Hospital, Toronto, ON, Canada; Austin Health, Heidelberg, Australia; Medicine Hat Cancer Centre, Medicine Hat, AB, Canada; Queen Elizabeth Hospital, Adelaide, Australia; The Canberra Hospital, Canberra, Australia; The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada
| | - N. C. Tebbutt
- National Cancer Institute of Canada Clinical Trials Group, Kingston, ON, Canada; NCIC Clinical Trials Group, Kingston, ON, Canada; Flinders Medical Centre, Adelaide, Australia; Cross Cancer Institute, Edmonton, AB, Canada; Princess Margaret Hospital, Toronto, ON, Canada; Austin Health, Heidelberg, Australia; Medicine Hat Cancer Centre, Medicine Hat, AB, Canada; Queen Elizabeth Hospital, Adelaide, Australia; The Canberra Hospital, Canberra, Australia; The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada
| | - M. G. Trudeau
- National Cancer Institute of Canada Clinical Trials Group, Kingston, ON, Canada; NCIC Clinical Trials Group, Kingston, ON, Canada; Flinders Medical Centre, Adelaide, Australia; Cross Cancer Institute, Edmonton, AB, Canada; Princess Margaret Hospital, Toronto, ON, Canada; Austin Health, Heidelberg, Australia; Medicine Hat Cancer Centre, Medicine Hat, AB, Canada; Queen Elizabeth Hospital, Adelaide, Australia; The Canberra Hospital, Canberra, Australia; The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada
| | - T. J. Price
- National Cancer Institute of Canada Clinical Trials Group, Kingston, ON, Canada; NCIC Clinical Trials Group, Kingston, ON, Canada; Flinders Medical Centre, Adelaide, Australia; Cross Cancer Institute, Edmonton, AB, Canada; Princess Margaret Hospital, Toronto, ON, Canada; Austin Health, Heidelberg, Australia; Medicine Hat Cancer Centre, Medicine Hat, AB, Canada; Queen Elizabeth Hospital, Adelaide, Australia; The Canberra Hospital, Canberra, Australia; The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada
| | - D. Yip
- National Cancer Institute of Canada Clinical Trials Group, Kingston, ON, Canada; NCIC Clinical Trials Group, Kingston, ON, Canada; Flinders Medical Centre, Adelaide, Australia; Cross Cancer Institute, Edmonton, AB, Canada; Princess Margaret Hospital, Toronto, ON, Canada; Austin Health, Heidelberg, Australia; Medicine Hat Cancer Centre, Medicine Hat, AB, Canada; Queen Elizabeth Hospital, Adelaide, Australia; The Canberra Hospital, Canberra, Australia; The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada
| | - D. J. Jonker
- National Cancer Institute of Canada Clinical Trials Group, Kingston, ON, Canada; NCIC Clinical Trials Group, Kingston, ON, Canada; Flinders Medical Centre, Adelaide, Australia; Cross Cancer Institute, Edmonton, AB, Canada; Princess Margaret Hospital, Toronto, ON, Canada; Austin Health, Heidelberg, Australia; Medicine Hat Cancer Centre, Medicine Hat, AB, Canada; Queen Elizabeth Hospital, Adelaide, Australia; The Canberra Hospital, Canberra, Australia; The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada
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Goldstein D, Lee C, Hui Y, Shah B, Yip D, McArthur GA. Development of a nomogram to predict overall survival in patients with locally advanced or metastatic gastrointestinal stromal tumor receiving first-line treatment with imatinib. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.10054] [Citation(s) in RCA: 5] [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: 11/20/2022] Open
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Flynn CJ, Danjoux C, Wong J, Christakis M, Rubenstein J, Yee A, Yip D, Chow E. Two cases of acrometastasis to the hands and review of the literature. ACTA ACUST UNITED AC 2010; 15:51-8. [PMID: 19008991 PMCID: PMC2582515 DOI: 10.3747/co.v15i5.189] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
This paper reports two cases of acrometastasis to the hands. The first case involved a 78-year-old woman with a permeative osteolytic lesion in her proximal second metacarpal. A biopsy of this lesion suggested a diagnosis of non-small-cell lung carcinoma with secondary osseous metastasis. This was the first presentation of the woman’s primary diagnosis. A single 8-Gy fraction of palliative radiotherapy was delivered to the patient’s left hand. The treatment proved successful: the woman soon experienced pain relief and regained the use of her hand. The second case involved a 69-year-old woman with extensive lytic destruction involving the proximal two thirds of her third metacarpal. This patient had been diagnosed with carcinoma of the breast in 1990. She also received a single 8-Gy fraction of radiation, which improved both her pain and her hand mobility. An extensive review of the literature uncovered 257 previously reported cases of acrometastasis. Articles were analyzed based on age and sex of the patient, site of the primary carcinoma, metastatic locations within the hand and affected appendage or appendages, the treatment given, and the patient’s length of survival. Men were almost twice as likely to experience acrometastasis as women, and the median age of the patients overall was 58 years (range: 18 months–91 years). Lung, kidney, and breast carcinoma were the three most prevalent primary diagnoses reported in the literature. Cancers of the colon, stomach, liver, prostate, and rectum affected the remainder of the population. Overall, the right hand was more often host to the metastatic lesions. In addition, almost 10% of the patients experienced lesions in both hands. The third finger was the digit most affected by osseous metastases reported in the literature. Lesions of the thumb, fourth finger, second finger, and fifth finger were less commonly reported. The region of the digit most often affected within the patient population was the distal phalanx. The metacarpal bones, proximal phalanges, and middle phalanges comprised the remainder of the four most frequent acrometastatic sites. In the literature, single lesions were more prevalent than multiple bony lesions. Based on the reported cases, amputation appeared to be the preferred method of treatment. Radiation, excision, and systemic therapy were the next most frequently used treatments. Patient survival was not well documented within the literature. However, the median survival of patients in the reported cases was 6 months. Thus, our review suggested that a diagnosis of hand metastasis is an indication of poor prognosis. This report serves to emphasize the importance of properly diagnosing acrometastases. Identifying and effectively treating these metastases in a timely manner can lead to a dramatic improvement in a patient’s quality of life.
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Affiliation(s)
- C J Flynn
- Rapid Response Radiotherapy Program, Department of Radiation Oncology, Toronto-Sunnybrook Regional Cancer Centre, Toronto, ON
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Hird A, Chow E, Yip D, Ross M, Hadi S, Flynn C, Sinclair E, Ko Y. After radiotherapy, do bone metastases from gastrointestinal cancers show response rates similar to those of bone metastases from other primary cancers? Curr Oncol 2008; 15:219-25. [PMID: 19008996 PMCID: PMC2582509] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
PURPOSE Reports investigating whether the response rates to palliative radiation therapy (RT) for painful bone metastases from gastrointestinal (GI) cancers are similar to rates for bone metastases from other primary cancer sites have been limited. The present study evaluated response rates for symptomatic bone metastases from gi cancers after palliative outpatient rt in the Rapid Response Radiotherapy Program (RRRP). PATIENTS AND METHODS We identified 69 patients with bone metastases from gi primaries who received palliative rt in the RRRP clinic during 1999-2006. We extracted records for 31 of these patients during 1999-2003 from an RRRP database that used the Edmonton Symptom Assessment Scale (ESAS). Record for the remaining 38 patients during 2003-2006 were extracted from an RRRP database that used the Brief Pain Inventory (BPI). Eligibility criteria for encryption in the two RRRP databases and for collection of patient demographic information (age, sex, primary cancer site, and Karnofsky performance status) were identical. Response rates for this cohort of metastatic gi patients were then compared to rates for 479 patients receiving palliative RT for bone metastases from other primary cancer sites. Pain scores from the ESAS and BPI and data on analgesic consumption were collected at baseline and by telephone follow-up at 4, 8, and 12 weeks after RT for all patients. Complete (CR), partial (PR), and overall (CR+PR) responses were evaluated according to International Consensus Endpoints. RESULTS Assessment of the 69 patients with metastatic GI cancers revealed CR, PR, and CR+PR rates of 18%, 42%, and 61% at 4 weeks; 22%, 35%, and 57% at 8 weeks; and 50%, 21%, and 71% at 12 weeks for evaluable patients. The 479 evaluable patients with metastatic cancer from other primary cancer sites had CR, PR, and CR+PR rates of 25%, 27%, and 51% at 4 weeks; 26%, 22%, and 48% at 8 weeks; and 22%, 29%, and 51% at 12 weeks. No statistically significant differences were observed in RT response rates for bone metastases from GI cancers than from other primary cancer sites. CONCLUSIONS After palliative RT, bone metastases from gi cancers demonstrate response rates that are similar to rates for metastases from other primary cancer sites. Patients with symptomatic bone metastases from GI malignancies should be referred for palliative RT as readily as patients with osseous metastases from other primary cancer sites.
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Affiliation(s)
- A. Hird
- Rapid Response Radiotherapy Program, Radiation Oncology, Odette Cancer Centre, University of Toronto, Toronto, ON
| | - E. Chow
- Rapid Response Radiotherapy Program, Radiation Oncology, Odette Cancer Centre, University of Toronto, Toronto, ON,Correspondence to: Edward Chow, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5. E-mail:
| | - D. Yip
- Rapid Response Radiotherapy Program, Radiation Oncology, Odette Cancer Centre, University of Toronto, Toronto, ON
| | - M. Ross
- Rapid Response Radiotherapy Program, Radiation Oncology, Odette Cancer Centre, University of Toronto, Toronto, ON
| | - S. Hadi
- Rapid Response Radiotherapy Program, Radiation Oncology, Odette Cancer Centre, University of Toronto, Toronto, ON
| | - C. Flynn
- Rapid Response Radiotherapy Program, Radiation Oncology, Odette Cancer Centre, University of Toronto, Toronto, ON
| | - E. Sinclair
- Rapid Response Radiotherapy Program, Radiation Oncology, Odette Cancer Centre, University of Toronto, Toronto, ON
| | - Y.J. Ko
- Medical Oncology, Odette Cancer Centre, University of Toronto, Toronto, ON
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O’Callaghan CJ, Tu D, Karapetis CS, Au HJ, Moore MJ, Zalcberg JR, Trudeau M, Yip D, Vachan B, Jonker DJ. The relationship between the development of rash and clinical and quality of life outcomes in colorectal cancer patients treated with cetuximab in NCIC CTG CO.17. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.4130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Tan TH, Kosmider S, Yip D, Gibbs P. Clinical experience of selective internal radiation therapy in combination with systemic chemotherapy as first-line therapy in patients with unresectable hepatic metastases from colorectal cancer. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.15080] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Abstract
BACKGROUND Pancreatic cancer has a poor prognosis. The benefit of chemotherapy, radiotherapy or both as a palliative treatment of advanced or relapsed disease is uncertain. OBJECTIVES To assess the effects of chemotherapy and/or radiotherapy in the management of pancreatic adenocarcinoma in people with inoperable advanced disease. SEARCH STRATEGY We searched the Cochrane Central Register of Controlled Trials (CENTRAL), which includes the Cochrane Upper Gastrointestinal and Pancreatic Diseases (UGPD) Group Trials Register (The Cochrane Library 2005, Issue 1); CANCERLIT (1975-2002); MEDLINE (1966 to January 2005); and EMBASE (1980 to January 2005). We handsearched reference lists from trials revealed by electronic searches to identify further relevant trials. We searched published abstracts from relevant conference proceedings. We contacted colleagues and experts in the field, and asked them to provide details of outstanding clinical trials and any relevant unpublished materials. SELECTION CRITERIA Randomised controlled trials (single- or double-blind) in patients with advanced inoperable pancreatic cancer, in which one of the intervention types (chemotherapy or radiotherapy) was contrasted with either placebo or another type of intervention. Studies comparing non-chemotherapy agents such as biological agents, hormones, immunostimulants, vaccines and cytokines were excluded. DATA COLLECTION AND ANALYSIS Studies were assessed for eligibility and quality. Data were extracted by groups of two independent reviewers, with conflicts resolved by a third reviewer. Study authors were contacted for more information. MAIN RESULTS Fifty trials (7043 participants) were included. Chemotherapy significantly reduced the one-year mortality (odds ratio (OR) 0.37, 95% confidence interval (CI) 0.25 to 0.57, P value < 0.00001) when compared to best supportive care. Also, chemoradiation improved one year survival (0% versus 58%, P value 0.001) when compared to best supportive care. There was no significant difference in one-year mortality for 5FU alone versus 5FU combinations (OR 0.90, 95% CI 0.62 to 1.30); single-agent chemotherapy versus gemcitabine (OR 1.34, 95% CI 0.88 to 2.02, P value 0.17); or gemcitabine alone versus gemcitabine combinations (OR 0.88, 95% CI 0.74 to 1.05). However, subgroup analysis showed that platinum-gemcitabine combinations reduced six-month mortality compared to gemcitabine alone (OR 0.59, 95% CI 0.43 to 0.81, P value 0.001). A qualitative overview suggested that chemoradiation produced better survivals than either best supportive care or radiotherapy. Chemoradiation treatment was associated with more toxicity. AUTHORS' CONCLUSIONS Chemotherapy appears to prolong survival in people with advanced pancreatic cancer and can confer clinical benefits and improve quality of life. Combination chemotherapy did not improve overall survival compared to single-agent chemotherapy. Gemcitabine is an acceptable control arm for future trials investigating scheduling and combinations with novel agents. There is insufficient evidence to recommend chemoradiation in patients with locally advanced inoperable pancreatic cancer as a superior alternative to chemotherapy alone.
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Affiliation(s)
- D Yip
- Canberra Hospital, Medical Oncology Unit, Yamba Drive, Garran, ACT, Australia 2605.
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Steer CB, Chrystal K, Cheong KA, Galani E, Marx GM, Strickland AH, Yip D, Lofts F, Gallagher C, Thomas H, Harper PG. Gemcitabine and oxaliplatin followed by paclitaxel and carboplatin as first line therapy for patients with suboptimally debulked, advanced epithelial ovarian cancer. A phase II trial of sequential doublets. The GO-First Study. Gynecol Oncol 2006; 103:439-45. [PMID: 16643993 DOI: 10.1016/j.ygyno.2006.03.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2005] [Revised: 02/24/2006] [Accepted: 03/13/2006] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Gemcitabine and oxaliplatin are active in epithelial ovarian cancer with minimal overlapping toxicity. We studied the efficacy and toxicity of this combination in patients with advanced ovarian cancer when given prior to carboplatin and paclitaxel. METHODS Chemonaive patients with epithelial ovarian cancer and measurable disease were eligible for the study. Treatment consisted of gemcitabine 1250 mg/m2 on days 1 and 8 and oxaliplatin 130 mg/m2 on day 8 every 21 days (GO) for 4 cycles. This was followed by carboplatin AUC = 6 and paclitaxel 175 mg/m2 on day 1 every 21 days (CP) for 4 cycles. RESULTS Twenty patients, median age 62 years (range 39-78), FIGO stages III (16) and IV (4) received treatment. The response rate (RR) after 4 cycles of GO was 80% (95%CI 61-99%) (4 complete responses (CR), 12 partial responses (PR)). Interval debulking surgery was performed in 7 patients (35%). After CP chemotherapy, RR increased to 85% (95%CI 68-100%) (CR = 13, PR = 4). Median time to progression was 14.5 months. Estimated median overall survival was 31.5 months. Toxicities of GO were mild; grade 3/4 nausea in 3 patients (15%) and vomiting in 2 patients (10%), grade 3/4 neutropenia in 5 patients (25%). Grade 2/3 peripheral neuropathy occurred in 5 patients (25%). After sequential administration of CP, grade 2/3 neuropathy occurred in 13 patients (72%). CONCLUSION The sequential doublet regimen of GO followed by CP resulted in unacceptable neurotoxicity and is not recommended for further study; however, the doublet gemcitabine and oxaliplatin has significant activity in the first line treatment of patients with ovarian cancer.
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Affiliation(s)
- C B Steer
- Department Medical Oncology, Guys and St Thomas's NHS Trust, London, UK.
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Lim L, Gibbs P, Yip D, Shapiro JD, Dowling R, Smith D, Little A, Bailey W, Liechtenstein M. A prospective evaluation of treatment with Selective Internal Radiation Therapy (SIR-spheres) in patients with unresectable liver metastases from colorectal cancer previously treated with 5-FU based chemotherapy. BMC Cancer 2005; 5:132. [PMID: 16225697 PMCID: PMC1274303 DOI: 10.1186/1471-2407-5-132] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2005] [Accepted: 10/15/2005] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND To prospectively evaluate the efficacy and safety of Selective Internal Radiation (SIR) spheres in patients with inoperable liver metastases from colorectal cancer who have failed 5FU based chemotherapy. METHODS Patients were prospectively enrolled at three Australian centres. All patients had previously received 5-FU based chemotherapy for metastatic colorectal cancer. Patients were ECOG 0-2 and had liver dominant or liver only disease. Concurrent 5-FU was given at investigator discretion. RESULTS Thirty patients were treated between January 2002 and March 2004. As of July 2004 the median follow-up is 18.3 months. Median patient age was 61.7 years (range 36-77). Twenty-nine patients are evaluable for toxicity and response. There were 10 partial responses (33%), with the median duration of response being 8.3 months (range 2-18) and median time to progression of 5.3 mths. Response rates were lower (21%) and progression free survival shorter (3.9 mths) in patients that had received all standard chemotherapy options (n = 14). No responses were seen in patients with a poor performance status (n = 3) or extrahepatic disease (n = 6). Overall treatment related toxicity was acceptable, however significant late toxicity included 4 cases of gastric ulceration. CONCLUSION In patients with metastatic colorectal cancer that have previously received treatment with 5-FU based chemotherapy, treatment with SIR-spheres has demonstrated encouraging activity. Further studies are required to better define the subsets of patients most likely to respond.
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Affiliation(s)
- L Lim
- The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - P Gibbs
- The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - D Yip
- The Canberra Hospital, Canberra, ACT, Australia
| | - JD Shapiro
- Cabrini Hospital Malvern, Victoria, Australia
| | - R Dowling
- The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - D Smith
- The Canberra Hospital, Canberra, ACT, Australia
| | - A Little
- Cabrini Hospital Malvern, Victoria, Australia
| | - W Bailey
- Cabrini Hospital Malvern, Victoria, Australia
| | - M Liechtenstein
- The Royal Melbourne Hospital, Parkville, Victoria, Australia
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Lim L, Gibbs P, Yip D, Shapiro JD, Dowling R, Smith D, Little A, Bailey W, Liechtenstein M. Prospective study of treatment with selective internal radiation therapy spheres in patients with unresectable primary or secondary hepatic malignancies. Intern Med J 2005; 35:222-7. [PMID: 15836500 DOI: 10.1111/j.1445-5994.2005.00789.x] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
AIM To prospectively evaluate the efficacy and safety of Selective Internal Radiation (SIR) Spheres (Sirtex Medical, Sydney, NSW, Australia) in patients with unresectable primary or secondary hepatic malignancies. METHODS We report our experience of SIR sphere therapy at three Australian centres. Patients with previously untreated colorectal cancer (CRC) received concurrent 5FU, other patients with CRC received 5-FU at investigator discretion and all other patients received SIR spheres alone. RESULTS Forty-six patients were enrolled between January 2002 and June 2003. The majority (32 patients) had metastatic colorectal cancer and five patients had hepatocellular carcinoma. The median age of patients was 64 years (range 46-78 years). Forty-three patients were evaluable for response. There were 12 partial responses, of which 10 were in patients with CRC. The median duration of response for all patients was 8.6 months (range 2-21 months). Overall treatment related toxicity was acceptable. Significant late toxicity included four cases of severe gastric ulceration, despite standard work-up and treatment by experienced interventional radiologists. CONCLUSION In this series of patients, treatment with SIR-spheres has demonstrated modest activity, mostly observed in patients with CRC. Toxicity was substantial in a small number of patients.
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Affiliation(s)
- L Lim
- The Royal Melbourne Hospital, Parkville, Victoria 3050, Australia.
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Underhill C, Hui R, Links M, Hawson G, Chern B, Yip D, Blackwell T, Crombie C, Boyer M. P-586 Phase II study of docetaxel and celecoxib as first or second linetherapy in patients with advanced NSCLC. Lung Cancer 2005. [DOI: 10.1016/s0169-5002(05)81079-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Karapetis CS, Strickland AH, Yip D, Steer C, Harper PG. Use of fluorodeoxyglucose positron emission tomography scans in patients with advanced germ cell tumour following chemotherapy: single-centre experience with long-term follow up*. Intern Med J 2003; 33:427-35. [PMID: 14511195 DOI: 10.1046/j.1445-5994.2003.00456.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIMS Fluorodeoxyglucose positron emission tomography (FDG-PET) may detect residual or recurrent malignancy in patients with germ cell tumours (GCT) following chemotherapy. The objective of the present study was to evaluate the use of FDG-PET in the setting of advanced GCT, and to determine the influence of FDG-PET on subsequent patient management. METHODS A computerized search of the patient database of the Department of Medical Oncology, Guy's Hospital, London, United Kingdom, and a manual search of medical records, were conducted. All male patients with metastatic or extragonadal GCT treated with chemotherapy between July 1996 and June 1999 inclusive were identified. Data from patients that had a PET scan following chemotherapy were analysed. Reported PET scan findings were compared with subsequent clinical management and patient outcome. RESULTS A total of 30 patients with metastatic testicular GCT and three patients with extragonadal GCT were treated with chemotherapy. Of these, 15 patients (12 testicular; three extragonadal; 10 non-seminoma; and five seminoma) were investigated following chemo-therapy with at least one FDG-PET scan. Seven patients had two or more PET scans, and a total of 26 FDG-PET scans was performed. The most frequent indication for PET scan was evaluation of a residual mass (11 patients). Three patients had an FDG-PET to evaluate thymic prominence. Minimum follow up from first PET scan was 18 months. Three of 26 PET scans had false positive findings. Four PET scans yielded findings of equivocal significance with repeat PET scan recommended. Relapse of disease occurred in three patients; two of whom had normal previous PET scans and one had a previous equivocal result. PET had an impact on patient management in only one case where it 'prompted' surgical excision of a residual mass. Normal PET scans provided reassurance in patients with residual small masses but did not alter their subsequent -management. CONCLUSIONS A residual mass was the most common indication for PET. For the majority of patients PET did not have a discernible influence on clinical management. Oncologists should exercise caution in their interpretation of PET scan findings and guidelines for the appropriate use of PET in testicular cancer management need to be developed. Prospective trials are required to define the clinical role of PET in this setting.
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Affiliation(s)
- C S Karapetis
- Department of Medical Oncology, Guy's Hospital, London, United Kingdom.
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Yip D, Karapetis C, Strickland AH, Steer C, Holford C, Knight S, Harper P. A dose-escalating study of oral eniluracil/5-fluorouracil plus oxaliplatin in patients with advanced gastrointestinal malignancies. Ann Oncol 2003; 14:864-6. [PMID: 12796023 DOI: 10.1093/annonc/mdg254] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Oral eniluracil/5-fluorouracil (5-FU) was shown in early clinical studies to have promising activity against gastrointestinal malignancies. Oxaliplatin in combination with 5-FU also has activity against these tumour types. The primary objective of this study was to determine a tolerable dose for oral eniluracil/5-FU in combination with oxaliplatin. PATIENTS AND METHODS Twenty-three patients with advanced gastrointestinal malignancies were recruited into this open-label study. Patients received a fixed dose of oxaliplatin (130 mg/m(2) on the first day of a 21-day cycle), and the dose intensity of oral eniluracil/5-FU was gradually increased by escalating the number of days of treatment per course. RESULTS The maximum tolerated dose intensity was eniluracil/5-FU 10.0/1.0 mg/m(2) twice daily for 16 days in combination with oxaliplatin 130 mg/m(2) on the first day of a 21-day cycle. Dose-limiting toxicities included vomiting and diarrhoea. The objective tumour response rate was 26% with a median duration of response of 15.3 weeks (95% confidence interval 8.5-22.1). Twenty-two patients (96%) experienced neurotoxicity (sensory neuropathy or cold-related dysaesthesia), although only two events were severe (grade 3). CONCLUSIONS The recommended dose for future study in patients with advanced gastrointestinal cancer is 10.0/1.0 mg/m(2) oral eniluracil/5-FU twice daily for 14 days in combination with oxaliplatin 130 mg/m(2) on the first day of each treatment cycle.
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Affiliation(s)
- D Yip
- Department of Medical Oncology, Guys Hospital, London, UK
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Abstract
PURPOSE To review image-guided chest port insertion using the right internal jugular vein as the access site of choice. MATERIAL AND METHODS One hundred and eighteen subcutaneous chest ports were placed via the internal jugular vein in 117 patients with malignancies using both fluoroscopic and US guidance in interventional radiology suites. RESULTS The technical success rate was 100% with no procedural complications. Follow-up was obtained in all patients with total access days of 40,450 days (mean, 342.8 days). Premature catheter removal was required in 8 patients (6.8%, 0.20 per 1,000 access days) due to non-treatable complications: 2 catheter occlusions/malfunctions (1.7%, 0.05 per 1,000 access days), 1 catheter-related skin erosion (0.85%, 0.024 per 1,000 access days), and 5 infections (4.2%, 0.15 per 1,000 access days). Two symptomatic right upper extremity venous thromboses also occurred (1.7%, 0.05 per 1,000 access days) that were treated successfully with anticoagulation. CONCLUSION Image-guided placement of internal jugular vein chest ports has a high success rate and low complication rate compared with reported series of unguided subclavian vein port insertion. The internal jugular vein should be used as the preferred venous access site compared to the subclavian vein.
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Affiliation(s)
- D Yip
- Department of Radiology, University of Chicago Hospitals, Chicago, IL 60637, USA
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