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Ng K, Metcalf R, Sacco J, Kong A, Wheeler G, Forsyth S, Bhat R, Ward J, Ensell L, Lowe H, Spanswick V, Hartley J, White L, Lloyd-Dehler E, Forster M. Protocol for the EACH trial: a multicentre phase II study evaluating the safety and antitumour activity of the combination of avelumab, an anti-PD-L1 agent, and cetuximab, as any line treatment for patients with recurrent/metastatic head and neck squamous cell cancer (HNSCC) in the UK. BMJ Open 2023; 13:e070391. [PMID: 38011968 PMCID: PMC10685941 DOI: 10.1136/bmjopen-2022-070391] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 07/18/2023] [Indexed: 11/29/2023] Open
Abstract
INTRODUCTION Head and neck cancer is the eighth most common cancer in the UK. Current standard of care treatment for patients with recurrent/metastatic squamous cell head and neck carcinoma (HNSCC) is platinum-based chemotherapy combined with the anti-epidermal growth factor receptor (anti-EGFR) monoclonal antibody, cetuximab. However, most patients will have poor median overall survival (OS) of 6-9 months despite treatment. HNSCC tumours exhibit an immune landscape poised to respond to immunotherapeutic approaches, with most tumours expressing the immunosuppressive receptor programmed death-ligand 1 (PD-L1). We undertook the current study to determine the safety and efficacy of avelumab, a monoclonal antibody targeting the interaction between PD-L1 and its receptor on cytotoxic T-cells, in combination with cetuximab. METHODS AND ANALYSIS This is a multi-centre, single-arm dose de-escalation phase II safety and efficacy study of avelumab combined with cetuximab; the study was to progress to a randomised phase II trial, however, the study will now complete after the safety run-in component. Up to 16 participants with histologically/cytologically recurrent/metastatic squamous cell carcinoma (including HNSCC) who have not received cetuximab previously will be recruited. All patients will receive 10 mg/kg avelumab and cetuximab (500, 400 or 300 mg/m2 depending on the cohort open at time of registration) on days 1 and 15 of 4-week cycles for up to 1 year, (avelumab not given cycle 1 day 1). A modified continual reassessment method will be used to determine dose de-escalation. The primary objective is to establish the safety of the combination and to determine the optimum dose of cetuximab. Secondary objectives include assessing evidence of antitumour activity by evaluating response rates and disease control rates at 6 and 12 months as well as progression-free and OS. ETHICS AND DISSEMINATION Approval granted by City and East REC (18/LO/0021). Findings will be published in peer-reviewed journals and disseminated at conferences. TRIAL REGISTRATION NUMBER NCT03494322.
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Affiliation(s)
- Kenrick Ng
- Medical Oncology, University College London, London, UK
| | - Rob Metcalf
- Department of Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Joseph Sacco
- Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Anthony Kong
- Comprehensive Cancer Centre, King's College London, London, UK
| | - Graham Wheeler
- Imperial Clinical Trials Unit, Imperial College London, London, UK
| | - Sharon Forsyth
- CR UK & UCL Cancer Trials Centre, University College London, London, UK
| | - Reshma Bhat
- CR UK & UCL Cancer Trials Centre, University College London, London, UK
| | - Joseph Ward
- Department of Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Leah Ensell
- UCL ECMC GCLP Facility, UCL Cancer Institute, University College London, London, UK
| | - Helen Lowe
- UCL ECMC GCLP Facility, UCL Cancer Institute, University College London, London, UK
| | - Victoria Spanswick
- UCL ECMC GCLP Facility, UCL Cancer Institute, University College London, London, UK
| | - John Hartley
- UCL ECMC GCLP Facility, UCL Cancer Institute, University College London, London, UK
| | - Laura White
- CR UK & UCL Cancer Trials Centre, University College London, London, UK
| | | | - Martin Forster
- UCL Cancer Institute, University College London, London, UK
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Smithard DG, Swaine I, Ayis S, Gambaruto A, Stone-Ghariani A, Hansjee D, Kulnik ST, Kyberd P, Lloyd-Dehler E, Oliff W. Chin tuck against resistance exercise with feedback to improve swallowing, eating and drinking in frail older people admitted to hospital with pneumonia: protocol for a feasibility randomised controlled study. Pilot Feasibility Stud 2022; 8:105. [PMID: 35590347 PMCID: PMC9117987 DOI: 10.1186/s40814-022-01060-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 05/03/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Swallowing difficulties (dysphagia) and community-acquired pneumonia are common in frail older people and maybe addressed through targeted training of the anterior neck musculature that affects the swallow. We have developed a swallowing exercise rehabilitation intervention (CTAR-SwiFt) by adapting a previously established swallowing exercise to ensure patient safety and ease of execution in the frail elderly population. The CTAR-SwiFt intervention consists of a feedback-enabled exercise ball that can be squeezed under the chin, with real-time feedback provided via a mobile application. The aim of this study is to evaluate the feasibility of assessing the effectiveness of the CTAR-SwiFt intervention in reducing dysphagia and community-acquired pneumonia, prior to a larger-scale multi-centre randomised controlled trial. METHODS We will recruit 60 medically stable patients over the age of 75 years who have been admitted with a diagnosis of pneumonia to the acute frailty wards at two participating hospitals in the UK. Study participants will be randomised into one of three groups: standard care, low intensity (once daily) CTAR-SwiFt exercise or high intensity (twice daily) CTAR-SwiFt exercises. The intervention period will last for 12 weeks, the final follow-up assessment will be conducted at 24 weeks. We will assess the feasibility outcomes, including rates of participant recruitment and retention, compliance with the exercise regime and adverse incidents. Additionally, we will assess the usability and acceptability of the intervention device and the performance of different clinical outcome measures (e.g. chin tuck strength, Functional Oral Intake Scale, SWAL-QOL, EQ-5D and swallow speed). A sub-sample of study participants will complete videofluoroscopic assessments of swallowing function before and after the intervention to evaluate the physiological changes (e.g. bolus flow rates, laryngeal elevation, base-of-tongue retraction). CONCLUSIONS By improving the ability to swallow, using our chin tuck exercise intervention, in frail older patients admitted to hospital with pneumonia, it is anticipated that patients' oral intake will improve. It is suggested that this will further impact clinical, patient and healthcare economic outcomes, i.e. reduce the need for supplemental feeding, improve patient satisfaction with oral intake and swallowing-related quality of life, decrease the occurrence of chest infections and reduce hospital admissions and related healthcare costs. TRIAL REGISTRATION ISRCTN, ISRCTN12813363 . Registered on 20 January 2020.
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Affiliation(s)
- David G Smithard
- Queen Elizabeth Hospital, Lewisham and Greenwich NHS Trust, Stadium Road, SE18 4QH, Woolwich, UK. .,University of Greenwich, Avery Hill Campus, Avery Hill Rd., London, SE9 2BT, UK.
| | - Ian Swaine
- University of Greenwich, Avery Hill Campus, Avery Hill Rd., London, SE9 2BT, UK
| | - Salma Ayis
- King's College London, Department of Population Health Sciences, Faculty of Life Sciences & Medicine, Guy's Campus, London, SE1 1UL, UK
| | - Alberto Gambaruto
- Department of Mechanical Engineering, University of Bristol, Bristol, BS8 1TH, UK
| | - Aoife Stone-Ghariani
- Queen Elizabeth Hospital, Lewisham and Greenwich NHS Trust, Stadium Road, SE18 4QH, Woolwich, UK
| | - Dharinee Hansjee
- University of Greenwich, Medway Campus, Central Avenue, Gillingham, ME4 4TB, UK
| | - Stefan T Kulnik
- Ludwig Boltzmann Institute for Digital Health and Prevention, Lindhofstrasse 22, 5020, Salzburg, Austria
| | - Peter Kyberd
- School of Energy and Electronic Engineering, University of Portsmouth, Anglesea Building, Anglesea Road, Portsmouth, PO1 3DJ, UK
| | | | - William Oliff
- University of Greenwich, Old Royal Naval College, Park Row, London, SE10 9LS, UK
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Sun K, Goodfellow H, Konstantara E, Hill A, Lennard D, Lloyd-Dehler E, Mughal M, Pritchard-Jones K, Robson C, Murray E. The multidisciplinary, theory-based co-design of a new digital health intervention supporting the care of oesophageal cancer patients. Digit Health 2021; 7:20552076211038410. [PMID: 34873450 PMCID: PMC8642779 DOI: 10.1177/20552076211038410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 07/19/2021] [Indexed: 11/17/2022] Open
Abstract
Objective Oesophageal cancer patients have complex care needs. Cancer clinical nurse
specialists play a key role in coordinating their care but often have heavy
workloads. Digital health interventions can improve patient care but there
are few examples for oesophageal cancer. This paper aims to describe the
multidisciplinary co-design process of a digital health intervention to
improve the experience of care and reduce unmet needs among patients with
oesophageal cancer. Methods A theory-based, multi-disciplinary, co-design approach was used to inform the
developmental process of the digital health intervention. Key user needs
were elicited using mixed methodology from systematic reviews, focus groups
and interviews and holistic need assessments. Overarching decisions were
discussed among a core team of patients, carers, health care professionals
including oncologists and cancer clinical nurse specialists, researchers and
digital health providers. A series of workshops incorporating a summary of
findings of key user needs resulted in the development of a minimum viable
product. This was further refined after a pilot study based on feedback from
end users. Results The final digital health intervention consists of a mobile app feature for
patients and carers connected to a dashboard with supporting additional
features for clinical nurse specialist. It contains a one-way messaging
function for clinical nurse specialists to communicate with patients,
functions for patients to record weight and holistic need assessment results
which could be viewed by their clinical nurse specialists as well as a
library of informative articles. Conclusions The multidisciplinary co-design of a digital health intervention providing
support for oesophageal cancer patients and health care professionals has
been described. Future studies to establish its impact on patient outcomes
are planned.
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Affiliation(s)
- Kristi Sun
- Research Department of Primary Care and Population Health, University College London, UK
| | - Henry Goodfellow
- Research Department of Primary Care and Population Health, University College London, UK
| | - Emmanouela Konstantara
- Research Department of Primary Care and Population Health, University College London, UK
| | | | - Debby Lennard
- Research Department of Primary Care and Population Health, University College London, UK
| | - Elizabeth Lloyd-Dehler
- Research Department of Primary Care and Population Health, University College London, UK
| | | | - Kathy Pritchard-Jones
- North Central and East London Cancer Alliance, University College London Hospitals NHS Foundation Trust, UK
| | - Chris Robson
- Research Department of Primary Care and Population Health, University College London, UK
| | - Elizabeth Murray
- Research Department of Primary Care and Population Health, University College London, UK
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