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Vasudev NS, Ainsworth G, Brown S, Pickering L, Waddell T, Fife K, Griffiths R, Sharma A, Katona E, Howard H, Velikova G, Maraveyas A, Brown J, Pezaro C, Tuthill M, Boleti E, Bahl A, Szabados B, Banks RE, Brown J, Venugopal B, Patel P, Jain A, Symeonides SN, Nathan P, Collinson FJ, Powles T. Standard Versus Modified Ipilimumab, in Combination With Nivolumab, in Advanced Renal Cell Carcinoma: A Randomized Phase II Trial (PRISM). J Clin Oncol 2024; 42:312-323. [PMID: 37931206 PMCID: PMC10824383 DOI: 10.1200/jco.23.00236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 07/09/2023] [Accepted: 09/09/2023] [Indexed: 11/08/2023] Open
Abstract
PURPOSE Ipilimumab (IPI), in combination with nivolumab (NIVO), is an approved frontline treatment option for patients with intermediate- or poor-risk advanced renal cell carcinoma (aRCC). We conducted a randomized phase II trial to evaluate whether administering IPI once every 12 weeks (modified), instead of once every 3 weeks (standard), in combination with NIVO, is associated with a favorable toxicity profile. METHODS Treatment-naïve patients with clear-cell aRCC were randomly assigned 2:1 to receive four doses of modified or standard IPI, 1 mg/kg, in combination with NIVO (3 mg/kg). The primary end point was the proportion of patients with a grade 3-5 treatment-related adverse event (trAE) among those who received at least one dose of therapy. The key secondary end point was 12-month progression-free survival (PFS) in the modified arm compared with historical sunitinib control. The study was not designed to formally compare arms for efficacy. RESULTS Between March 2018 and January 2020, 192 patients (69.8% intermediate/poor-risk) were randomly assigned and received at least one dose of study drug. The incidence of grade 3-5 trAEs was significantly lower among participants receiving modified versus standard IPI (32.8% v 53.1%; odds ratio, 0.43 [90% CI, 0.25 to 0.72]; P = .0075). The 12-month PFS (90% CI) using modified IPI was 46.1% (38.6 to 53.2). At a median follow-up of 21 months, the overall response rate was 45.3% versus 35.9% and the median PFS was 10.8 months versus 9.8 months in the modified and standard IPI groups, respectively. CONCLUSION Rates of grade 3-5 trAEs were significantly lower in patients receiving modified versus standard IPI. Although 12-month PFS did not meet the prespecified efficacy threshold compared with historical control, informal comparison of treatment groups did not suggest any reduction in efficacy with the modified schedule.
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Affiliation(s)
- Naveen S. Vasudev
- Leeds Institute of Medical Research at St James's, University of Leeds, St James's University Hospital, Leeds, United Kingdom
| | - Gemma Ainsworth
- Clinical Trials Research Unit, University of Leeds, Leeds, United Kingdom
| | - Sarah Brown
- Clinical Trials Research Unit, University of Leeds, Leeds, United Kingdom
| | | | - Tom Waddell
- Department of Medical Oncology, Christie Hospital, Manchester, United Kingdom
| | - Kate Fife
- Addenbrooke's Hospital, Cambridge, United Kingdom
| | | | - Anand Sharma
- Mount Vernon Cancer Centre, Middlesex, United Kingdom
| | - Eszter Katona
- Clinical Trials Research Unit, University of Leeds, Leeds, United Kingdom
| | - Helen Howard
- Clinical Trials Research Unit, University of Leeds, Leeds, United Kingdom
| | - Galina Velikova
- Leeds Institute of Medical Research at St James's, University of Leeds, St James's University Hospital, Leeds, United Kingdom
| | | | - Janet Brown
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, United Kingdom
| | - Carmel Pezaro
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Mark Tuthill
- Department of Oncology, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | | | - Amit Bahl
- Bristol Haematology and Oncology Centre, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
| | - Bernadett Szabados
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
| | - Rosamonde E. Banks
- Leeds Institute of Medical Research at St James's, University of Leeds, St James's University Hospital, Leeds, United Kingdom
| | - Joanne Brown
- Leeds Institute of Medical Research at St James's, University of Leeds, St James's University Hospital, Leeds, United Kingdom
| | - Balaji Venugopal
- Institute of Cancer Sciences, University of Glasgow, Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | - Poulam Patel
- Division of Cancer & Stem Cells, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Ankit Jain
- The Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom
| | - Stefan N. Symeonides
- Edinburgh Cancer Centre, Western General Hospital, NHS Lothian, Edinburgh, United Kingdom
| | - Paul Nathan
- Mount Vernon Cancer Centre, Middlesex, United Kingdom
| | - Fiona J. Collinson
- Clinical Trials Research Unit, University of Leeds, Leeds, United Kingdom
| | - Thomas Powles
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
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Wadsley J, Ainsworth G, Coulson AB, Garcez K, Moss L, Newbold K, Farnell K, Swain J, Howard H, Beasley M, Weaver A, Wood K, Marshall J, Griffin M, Pascoe A, Du Y, Taprogge J, Flux G, Brown S. Results of the SEL-I-METRY Phase II Trial on Resensitization of Advanced Iodine Refractory Differentiated Thyroid Cancer to Radioiodine Therapy. Thyroid 2023; 33:1119-1123. [PMID: 37565288 PMCID: PMC10516223 DOI: 10.1089/thy.2022.0707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Affiliation(s)
- Jon Wadsley
- Weston Park Hospital, Sheffield, United Kingdom
| | - Gemma Ainsworth
- Leeds Cancer Research UK Clinical Trials Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, United Kingdom
| | - Amy Beth Coulson
- Leeds Cancer Research UK Clinical Trials Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, United Kingdom
| | - Kate Garcez
- Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Laura Moss
- Velindre Cancer Centre, Cardiff, United Kingdom
| | - Kate Newbold
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Kate Farnell
- Butterfly Thyroid Cancer Trust, NCCC Freeman Hospital, Newcastle, United Kingdom
| | - Jayne Swain
- Leeds Cancer Research UK Clinical Trials Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, United Kingdom
| | - Helen Howard
- Leeds Cancer Research UK Clinical Trials Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, United Kingdom
| | - Matthew Beasley
- Bristol Haematology and Oncology Centre, Bristol, United Kingdom
| | | | - Katie Wood
- Royal Surrey County Hospital, Guildford, United Kingdom
| | | | - Matthew Griffin
- Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Abigail Pascoe
- Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Yong Du
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Jan Taprogge
- Joint Department of Physics, Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
- The Institute of Cancer Research, London, United Kingdom
| | - Glenn Flux
- Joint Department of Physics, Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
- The Institute of Cancer Research, London, United Kingdom
| | - Sarah Brown
- Leeds Cancer Research UK Clinical Trials Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, United Kingdom
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Zarkar A, Henderson D, Carver A, Heyes G, Harrop V, Tutill S, Kilkenny J, Marshall A, Elbeltagi N, Howard H. First UK patient cohort treated with stereotactic ablative radiotherapy for primary kidney cancer. BJUI Compass 2023; 4:464-472. [PMID: 37334027 PMCID: PMC10268573 DOI: 10.1002/bco2.199] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 09/16/2022] [Accepted: 10/07/2022] [Indexed: 06/20/2023] Open
Abstract
Aims Stereotactic ablative radiotherapy (SABR) for primary renal cell carcinoma (RCC) is a promising non-invasive ablative treatment option. A prospective interventional clinical trial published showed that treatment was feasible and well tolerated. We present the first single-institution UK cohort of patients with primary RCC receiving protocol-based SABR with prospective follow-up. We also present a protocol that could be used to facilitate more widespread use of the treatment. Materials and methods Nineteen biopsy-proven primary RCC patients were treated with either 42 Gy in three fractions on alternate days or 26 Gy in a single fraction based on predefined eligibility criteria using either Linear Accelerator or CyberKnife platform. Prospective toxicity data using CTCAE V4.0 and outcome data such as estimated glomerular filtration rate (eGFR) and tumour response using CT thorax, abdomen and pelvis (CT-TAP) were collected at 6 weeks, 3, 6, 12, 18 and 24 months post treatment. Results The 19 patients had a median age of 76 years (interquartile range [IQR] 64-82 years) and 47.4% were males, and they had a median tumour size of 4.5 cm (IQR 3.8-5.2 cm). Single and fractionated treatment was well tolerated and there were no significant acute side effects. The mean drop from baseline in eGFR at 6 months was 5.4 ml/min and that at 12 months was 8.7 ml/min. The overall local control rate at both 6 and 12 months was 94.4%. Overall survival at 6 and 12 months was 94.7% and 78.3%, respectively. After a median follow-up of 17 months, three patients experienced a Grade 3 toxicity, which was resolved with conservative management. Conclusion SABR for primary RCC is a safe and feasible treatment for medically unfit patients, which can be delivered in most UK cancer centres using standard Linear Accelerator as well as CyberKnife platforms.
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Affiliation(s)
- Anjali Zarkar
- University Hospitals Birmingham NHS Foundation TrustBirminghamUK
| | - Dan Henderson
- University Hospitals Birmingham NHS Foundation TrustBirminghamUK
| | - Antony Carver
- University Hospitals Birmingham NHS Foundation TrustBirminghamUK
| | - Geoff Heyes
- University Hospitals Birmingham NHS Foundation TrustBirminghamUK
| | - Victoria Harrop
- University Hospitals Birmingham NHS Foundation TrustBirminghamUK
| | - Sarah Tutill
- University Hospitals Birmingham NHS Foundation TrustBirminghamUK
| | - Julie Kilkenny
- University Hospitals Birmingham NHS Foundation TrustBirminghamUK
| | | | | | - Helen Howard
- University Hospitals Birmingham NHS Foundation TrustBirminghamUK
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Brown J, Royle KL, Ralph C, Meads D, Martin A, Howard H, Linsley C, Swain J, Powles T, Jones R, Eisen T, Maraveyas A, Griffiths R, Din O, Goh V, Wah T, Selby P, Hewison J, Brown J, Collinson F. LBA28 STAR: A randomised multi-stage phase II/III trial of standard first-line therapy (sunitinib or pazopanib) comparing temporary cessation with allowing continuation, in the treatment of locally advanced and/or metastatic renal Cancer (RCC). Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.2104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Vasudev N, Ainsworth G, Brown S, Pickering L, Waddell T, Fife K, Griffiths R, Sharma A, Katona E, Howard H, Velikova G, Maraveyas A, Brown J, Venugopal B, Patel P, Jain A, Symeonides S, Nathan P, Collinson F, Powles T. LBA29 Nivolumab in combination with alternatively scheduled ipilimumab in first-line treatment of patients with advanced renal cell carcinoma: A randomized phase II trial (PRISM). Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.2105] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Coen O, Corrie P, Marshall H, Plummer R, Ottensmeier C, Hook J, Bell S, Sagoo GS, Meads D, Bestall J, Velikova G, Gallagher FA, Smith A, Howard H, Mason E, Katona E, Silva S, Collinson M, Rodwell S, Danson S. The DANTE trial protocol: a randomised phase III trial to evaluate the Duration of ANti-PD-1 monoclonal antibody Treatment in patients with metastatic mElanoma. BMC Cancer 2021; 21:761. [PMID: 34210290 PMCID: PMC8246129 DOI: 10.1186/s12885-021-08509-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 06/14/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Immunotherapy is revolutionising the treatment of patients diagnosed with melanoma and other cancers. The first immune checkpoint inhibitor, ipilimumab (targeting cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4)), showed a survival advantage over standard chemotherapy. Subsequently the anti-programmed cell death protein 1 (PD-1) antibodies, nivolumab and pembrolizumab were shown to be more effective than ipilimumab. Ipilimumab combined with nivolumab gives an incremental gain in overall survival compared with nivolumab alone but increases the risk of severe, potentially life-threatening toxicities. In contrast to ipilimumab monotherapy, anti-PD-1 antibodies are licensed to be continued until disease progression. Follow-up of patients recruited to the first trials evaluating 2 years of pembrolizumab showed that three-quarters of responding patients continue responding after stopping treatment. Suggestive of early response, we hypothesised that continuing anti-PD-1 treatment beyond 1 year in progression-free patients may be unnecessary and so designed the DANTE trial. METHODS DANTE is a multicentre, randomised, phase III, non-inferiority trial to evaluate the duration of anti-PD-1 therapy in patients with metastatic (unresectable stage III and stage IV) melanoma. It uses a two-stage recruitment strategy, registering patients before they complete 1 year of first-line anti-PD-1 +/- CTLA-4 therapy and randomising eligible patients who have received 12 months of treatment and are progression-free at 1 year. At randomisation, 1208 patients are assigned (1:1) to either 1) continue anti-PD-1 treatment until disease progression/ unacceptable toxicity/ for at least 2 years in the absence of disease progression/ unacceptable toxicity or 2) to stop treatment. Randomisation stratifies for baseline prognostic factors. The primary outcome is progression-free survival at 3, 6, 9 and 12 months and then, 6-monthly for up to 4-years. Secondary outcomes collected at all timepoints include overall survival, response-rate and duration and safety, with quality of life and cost-effectiveness outcomes collected 3-monthly for up to 18-months. Sub-studies include a qualitative analysis of patient acceptance of randomisation and sample collection to inform future translational studies into response/ toxicity biomarkers. DISCUSSION DANTE is a unique prospective trial investigating the optimal duration of anti-PD-1 therapy in metastatic melanoma patients. Outcomes will inform future use of these high burden drugs. TRIAL REGISTRATION ISRCTN15837212 , 31 July 2018.
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Affiliation(s)
- Oliver Coen
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Pippa Corrie
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Helen Marshall
- University of Leeds, Leeds, UK
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, Leeds, UK
| | | | | | - Jane Hook
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Sue Bell
- University of Leeds, Leeds, UK
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, Leeds, UK
| | | | | | | | - Galina Velikova
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
- University of Leeds, Leeds, UK
- Leeds Institute of Medical Research at St James's University Hospital, Leeds, UK
| | - Ferdia A Gallagher
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- University of Cambridge, Cambridge, UK
| | - Alexandra Smith
- University of Leeds, Leeds, UK
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, Leeds, UK
| | - Helen Howard
- University of Leeds, Leeds, UK
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, Leeds, UK
| | - Ellen Mason
- University of Leeds, Leeds, UK
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, Leeds, UK
| | - Eszter Katona
- University of Leeds, Leeds, UK
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, Leeds, UK
| | - Shobha Silva
- Sheffield Teaching Hospitals NHS Foundation Trust , Sheffield, UK
- University of Sheffield, Sheffield, UK
| | - Michelle Collinson
- University of Leeds, Leeds, UK
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, Leeds, UK
| | - Simon Rodwell
- University of Sheffield, Sheffield, UK
- Melanoma Focus, Cambridge, UK
| | - Sarah Danson
- Sheffield Teaching Hospitals NHS Foundation Trust , Sheffield, UK.
- University of Sheffield, Sheffield, UK.
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Hall PS, Swinson D, Cairns DA, Waters JS, Petty R, Allmark C, Ruddock S, Falk S, Wadsley J, Roy R, Tillett T, Nicoll J, Cummins S, Mano J, Grumett S, Stokes Z, Kamposioras KV, Chatterjee A, Garcia A, Waddell T, Guptal K, Maisey N, Khan M, Dent J, Lord S, Crossley A, Katona E, Marshall H, Grabsch HI, Velikova G, Ow PL, Handforth C, Howard H, Seymour MT. Efficacy of Reduced-Intensity Chemotherapy With Oxaliplatin and Capecitabine on Quality of Life and Cancer Control Among Older and Frail Patients With Advanced Gastroesophageal Cancer: The GO2 Phase 3 Randomized Clinical Trial. JAMA Oncol 2021; 7:869-877. [PMID: 33983395 PMCID: PMC8120440 DOI: 10.1001/jamaoncol.2021.0848] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 03/04/2021] [Indexed: 01/10/2023]
Abstract
Importance Older and/or frail patients are underrepresented in landmark cancer trials. Tailored research is needed to address this evidence gap. Objective The GO2 randomized clinical trial sought to optimize chemotherapy dosing in older and/or frail patients with advanced gastroesophageal cancer, and explored baseline geriatric assessment (GA) as a tool for treatment decision-making. Design, Setting, and Participants This multicenter, noninferiority, open-label randomized trial took place at oncology clinics in the United Kingdom with nurse-led geriatric health assessment. Patients were recruited for whom full-dose combination chemotherapy was considered unsuitable because of advanced age and/or frailty. Interventions There were 2 randomizations that were performed: CHEMO-INTENSITY compared oxaliplatin/capecitabine at Level A (oxaliplatin 130 mg/m2 on day 1, capecitabine 625 mg/m2 twice daily on days 1-21, on a 21-day cycle), Level B (doses 0.8 times A), or Level C (doses 0.6 times A). Alternatively, if the patient and clinician agreed the indication for chemotherapy was uncertain, the patient could instead enter CHEMO-BSC, comparing Level C vs best supportive care. Main Outcomes and Measures First, broad noninferiority of the lower doses vs reference (Level A) was assessed using a permissive boundary of 34 days reduction in progression-free survival (PFS) (hazard ratio, HR = 1.34), selected as acceptable by a forum of patients and clinicians. Then, the patient experience was compared using Overall Treatment Utility (OTU), which combines efficacy, toxic effects, quality of life, and patient value/acceptability. For CHEMO-BSC, the main outcome measure was overall survival. Results A total of 514 patients entered CHEMO-INTENSITY, of whom 385 (75%) were men and 299 (58%) were severely frail, with median age 76 years. Noninferior PFS was confirmed for Levels B vs A (HR = 1.09 [95% CI, 0.89-1.32]) and C vs A (HR = 1.10 [95% CI, 0.90-1.33]). Level C produced less toxic effects and better OTU than A or B. No subgroup benefited from higher doses: Level C produced better OTU even in younger or less frail patients. A total of 45 patients entered the CHEMO-BSC randomization: overall survival was nonsignificantly longer with chemotherapy: median 6.1 vs 3.0 months (HR = 0.69 [95% CI, 0.32-1.48], P = .34). In multivariate analysis in 522 patients with all variables available, baseline frailty, quality of life, and neutrophil to lymphocyte ratio were independently associated with OTU, and can be combined in a model to estimate the probability of different outcomes. Conclusions and Relevance This phase 3 randomized clinical trial found that reduced-intensity chemotherapy provided a better patient experience without significantly compromising cancer control and should be considered for older and/or frail patients. Baseline geriatric assessment can help predict the utility of chemotherapy but did not identify a group benefiting from higher-dose treatment. Trial Registration isrctn.org Identifier: ISRCTN44687907.
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Affiliation(s)
- Peter S. Hall
- University of Leeds, Leeds, United Kingdom
- University of Edinburgh, Edinburgh, United Kingdom
| | - Daniel Swinson
- Leeds Teaching Hospitals National Health Service Trust, United Kingdom
| | | | - Justin S. Waters
- Maidstone and Tunbridge Wells National Health Service Trust, Maidstone, United Kingdom
| | | | | | | | - Stephen Falk
- Bristol Oncology Centre, Bristol, United Kingdom
| | | | - Rajarshi Roy
- Hull University Hospitals National Health Service Trust, Hull, United Kingdom
| | | | - Jonathan Nicoll
- North Cumbria University Hospitals National Health Service Trust, Carlisle, United Kingdom
| | - Sebastian Cummins
- Royal Surrey County Hospital National Health Service Foundation Trust, Guildford, United Kingdom
| | - Joseph Mano
- The Royal Wolverhampton National Health Service Trust, Wolverhampton, United Kingdom
| | - Simon Grumett
- The Dudley Group National Health Service Foundation Trust, Dudley, United Kingdom
| | - Zuzana Stokes
- United Lincolnshire Hospitals National Health Service Trust, Lincoln, United Kingdom
| | | | - Anirban Chatterjee
- The Shrewsbury and Telford Hospital National Health Service Trust, Shrewsbury, United Kingdom
| | - Angel Garcia
- Betsi Cadwaladr University Local Health Board, Bangor, United Kingdom
| | - Tom Waddell
- The Christie National Health Service Foundation Trust, Manchester, United Kingdom
| | - Kamalnayan Guptal
- Worcestershire Acute Hospitals National Health Service Trust, Worcester, United Kingdom
| | - Nick Maisey
- Guys and St Thomas’s National Health Service Foundation Trust, London, United Kingdom
| | - Mohammed Khan
- York Teaching Hospital National Health Service Foundation Trust, Scarborough, United Kingdom
| | - Jo Dent
- Calderdale and Huddersfield National Health Service Foundation Trust, Huddersfield, United Kingdom
| | - Simon Lord
- University of Oxford, Oxford, United Kingdom
| | - Ann Crossley
- Leeds Teaching Hospitals National Health Service Trust, United Kingdom
| | | | | | - Heike I. Grabsch
- University of Leeds, Leeds, United Kingdom
- Maastricht University Medical Center, Maastricht, the Netherlands
| | | | - Pei Loo Ow
- University of Leeds, Leeds, United Kingdom
| | | | | | - Matthew T. Seymour
- University of Leeds, Leeds, United Kingdom
- Leeds Teaching Hospitals National Health Service Trust, United Kingdom
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Craig Z, Swain J, Batman E, Wadsley J, Reed N, Faluyi O, Cave J, Sharma R, Chau I, Wall L, Lamarca A, Hubner R, Mansoor W, Sarker D, Meyer T, Cairns DA, Howard H, Valle JW, McNamara MG. NET-02 trial protocol: a multicentre, randomised, parallel group, open-label, phase II, single-stage selection trial of liposomal irinotecan (nal-IRI) and 5-fluorouracil (5-FU)/folinic acid or docetaxel as second-line therapy in patients with progressive poorly differentiated extrapulmonary neuroendocrine carcinoma (NEC). BMJ Open 2020; 10:e034527. [PMID: 32029495 PMCID: PMC7045240 DOI: 10.1136/bmjopen-2019-034527] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 12/17/2019] [Accepted: 01/20/2020] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Poorly differentiated (PD), extrapulmonary (EP), neuroendocrine carcinomas (NECs) are rare but aggressive neuroendocrine neoplasms. First-line treatment for advanced disease is an etoposide and platinum-based chemotherapy combination. There is no established second-line treatment for patients with PD-EP-NEC, and this is an area of unmet need. METHODS AND ANALYSIS NET-02 is a UK, multicentre, randomised (1:1), parallel group, open-label, phase II, single-stage selection trial of liposomal irinotecan (nal-IRI)/5-fluorouracil (5-FU)/folinic acid or docetaxel as second-line therapy in patients with progressive PD-EP-NEC. One hundred and two eligible participants will be randomised to receive either nal-IRI/5-FU/folinic acid or docetaxel. The primary objective is to determine the 6-month progression-free survival (PFS) rate. The secondary objectives of this study are to determine PFS, overall survival, objective response rate, toxicity, quality of life and whether neuron-specific enolase is predictive of treatment response. If either treatment is found to have a 6-month PFS rate of at least 25%, that treatment will be considered for a phase III trial. If both treatments meet this target, prespecified selection criteria will be applied to establish which treatment to take forward. ETHICS AND DISSEMINATION This study has ethical approval from the Greater Manchester Central Research Ethics Committee (reference no. 18/NW/0031) and clinical trial authorisation from the Medicine and Healthcare Products Regulatory Agency. Results will be published in peer-reviewed journals and uploaded to the European Union Clinical Trials Register. TRIAL REGISTRATION NUMBERS ISRCTN10996604, NCT03837977, EudraCT Number: 2017-002453-11.
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Affiliation(s)
- Zoe Craig
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, West Yorkshire, UK
| | - Jayne Swain
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, West Yorkshire, UK
| | - Emma Batman
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, West Yorkshire, UK
| | - Jonathan Wadsley
- Department of Oncology, Weston Park Hospital, Sheffield, Sheffield, UK
| | - Nicholas Reed
- Beatson West of Scotland Cancer Centre, Glasgow, Glasgow, UK
| | - Olusola Faluyi
- Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral, UK
| | - Judith Cave
- Department of Oncology, University Hospital Southampton NHS Foundation Trust, Southampton, Southampton, UK
| | - Rohini Sharma
- Department of Surgery and Cancer, Imperial College London, London, London, UK
| | - Ian Chau
- Gastrointestinal and Lymphoma Unit, Royal Marsden Hospital NHS Trust, London, London, UK
| | - Lucy Wall
- Department of Oncology, Western General Hospital, Edinburgh, UK
| | - Angela Lamarca
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK
- Division of Cancer Sciences, The University of Manchester, Manchester, UK
| | - R Hubner
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK
- Division of Cancer Sciences, The University of Manchester, Manchester, UK
| | - Wasat Mansoor
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Debashis Sarker
- Comprehensive Cancer Centre, King's College Hospital, London, UK
| | - Tim Meyer
- Department of Oncology, University College London Cancer Institute, London, UK
| | - David A Cairns
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, West Yorkshire, UK
| | - Helen Howard
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, West Yorkshire, UK
| | - Juan W Valle
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK
- Division of Cancer Sciences, The University of Manchester, Manchester, UK
| | - Mairéad G McNamara
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK
- Division of Cancer Sciences, The University of Manchester, Manchester, UK
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Collinson F, Brown S, Buckley H, Ainsworth G, Howard H, Poad H, Carr G, Banks R, Brown J, Velikova G, Larkin J, Nathan P, Powles T, Vasudev N. PRISM: A randomised phase II trial of nivolumab in combination with alternatively scheduled ipilimumab in first-line treatment of patients with advanced or metastatic renal cell carcinoma. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy283.140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Mackie M, Rüther P, Samodova D, Di Gianvincenzo F, Granzotto C, Lyon D, Peggie DA, Howard H, Harrison L, Jensen LJ, Olsen JV, Cappellini E. Palaeoproteomic Profiling of Conservation Layers on a 14th Century Italian Wall Painting. Angew Chem Int Ed Engl 2018. [DOI: 10.1002/ange.201713020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Meaghan Mackie
- Natural History Museum of Denmark; University of Copenhagen; Øster Voldgade 5-7 1350 Copenhagen Denmark
- Proteomics Program, Novo Nordisk Foundation Center for Protein Research, Faculty of Health Science; University of Copenhagen; Blegdamsvej 3b 2200 Copenhagen Denmark
| | - Patrick Rüther
- Proteomics Program, Novo Nordisk Foundation Center for Protein Research, Faculty of Health Science; University of Copenhagen; Blegdamsvej 3b 2200 Copenhagen Denmark
| | - Diana Samodova
- Proteomics Program, Novo Nordisk Foundation Center for Protein Research, Faculty of Health Science; University of Copenhagen; Blegdamsvej 3b 2200 Copenhagen Denmark
| | - Fabiana Di Gianvincenzo
- Natural History Museum of Denmark; University of Copenhagen; Øster Voldgade 5-7 1350 Copenhagen Denmark
| | - Clara Granzotto
- Natural History Museum of Denmark; University of Copenhagen; Øster Voldgade 5-7 1350 Copenhagen Denmark
| | - David Lyon
- Disease Systems Biology Program, Novo Nordisk Foundation Center for Protein Research; Faculty of Health Science; University of Copenhagen; Blegdamsvej 3b 2200 Copenhagen Denmark
| | - David A. Peggie
- Scientific Department; National Gallery London; Trafalgar Square London WC2N 5DN UK
| | - Helen Howard
- Scientific Department; National Gallery London; Trafalgar Square London WC2N 5DN UK
| | - Lynne Harrison
- Conservation Department; National Gallery London; Trafalgar Square London WC2N 5DN UK
| | - Lars Juhl Jensen
- Disease Systems Biology Program, Novo Nordisk Foundation Center for Protein Research; Faculty of Health Science; University of Copenhagen; Blegdamsvej 3b 2200 Copenhagen Denmark
| | - Jesper V. Olsen
- Proteomics Program, Novo Nordisk Foundation Center for Protein Research, Faculty of Health Science; University of Copenhagen; Blegdamsvej 3b 2200 Copenhagen Denmark
| | - Enrico Cappellini
- Natural History Museum of Denmark; University of Copenhagen; Øster Voldgade 5-7 1350 Copenhagen Denmark
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Mackie M, Rüther P, Samodova D, Di Gianvincenzo F, Granzotto C, Lyon D, Peggie DA, Howard H, Harrison L, Jensen LJ, Olsen JV, Cappellini E. Palaeoproteomic Profiling of Conservation Layers on a 14th Century Italian Wall Painting. Angew Chem Int Ed Engl 2018; 57:7369-7374. [PMID: 29603563 PMCID: PMC6032867 DOI: 10.1002/anie.201713020] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [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: 12/18/2017] [Revised: 03/08/2018] [Indexed: 01/24/2023]
Abstract
Ahead of display, a non-original layer was observed on the surface of a fragment of a wall painting by Ambrogio Lorenzetti (active 1319, died 1348/9). FTIR analysis suggested proteinaceous content. Mass spectrometry was used to better characterise this layer and revealed two protein components: sheep and cow glue and chicken and duck egg white. Analysis of post-translational modifications detected several photo-oxidation products, which suggest that the egg experienced prolonged exposure to UV light and was likely applied long before the glue layer. Additionally, glycation products detected may indicate naturally occurring glycoprotein degradation or reaction with a carbohydrate material such as starch, identified by ATR-FTIR in a cross-section of a sample taken from the painting. Palaeoproteomics is shown to provide detailed characterisation of organic layers associated with mural paintings and therefore aids reconstruction of the conservation history of these objects.
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Affiliation(s)
- Meaghan Mackie
- Natural History Museum of DenmarkUniversity of CopenhagenØster Voldgade 5–71350CopenhagenDenmark
- Proteomics Program, Novo Nordisk Foundation Center for Protein Research, Faculty of Health ScienceUniversity of CopenhagenBlegdamsvej 3b2200CopenhagenDenmark
| | - Patrick Rüther
- Proteomics Program, Novo Nordisk Foundation Center for Protein Research, Faculty of Health ScienceUniversity of CopenhagenBlegdamsvej 3b2200CopenhagenDenmark
| | - Diana Samodova
- Proteomics Program, Novo Nordisk Foundation Center for Protein Research, Faculty of Health ScienceUniversity of CopenhagenBlegdamsvej 3b2200CopenhagenDenmark
| | - Fabiana Di Gianvincenzo
- Natural History Museum of DenmarkUniversity of CopenhagenØster Voldgade 5–71350CopenhagenDenmark
| | - Clara Granzotto
- Natural History Museum of DenmarkUniversity of CopenhagenØster Voldgade 5–71350CopenhagenDenmark
| | - David Lyon
- Disease Systems Biology Program, Novo Nordisk Foundation Center for Protein ResearchFaculty of Health ScienceUniversity of CopenhagenBlegdamsvej 3b2200CopenhagenDenmark
| | - David A. Peggie
- Scientific DepartmentNational Gallery LondonTrafalgar SquareLondonWC2N 5DNUK
| | - Helen Howard
- Scientific DepartmentNational Gallery LondonTrafalgar SquareLondonWC2N 5DNUK
| | - Lynne Harrison
- Conservation DepartmentNational Gallery LondonTrafalgar SquareLondonWC2N 5DNUK
| | - Lars Juhl Jensen
- Disease Systems Biology Program, Novo Nordisk Foundation Center for Protein ResearchFaculty of Health ScienceUniversity of CopenhagenBlegdamsvej 3b2200CopenhagenDenmark
| | - Jesper V. Olsen
- Proteomics Program, Novo Nordisk Foundation Center for Protein Research, Faculty of Health ScienceUniversity of CopenhagenBlegdamsvej 3b2200CopenhagenDenmark
| | - Enrico Cappellini
- Natural History Museum of DenmarkUniversity of CopenhagenØster Voldgade 5–71350CopenhagenDenmark
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Good J, Tween H, Howard H, Ma Y, Punia P, Shah T, Mehrzad H, Green S. SABR for Hepatocellular Carcinoma: Efficacy and Toxicity Analysis of a Single-centre Cohort Treated within the NHS England Commissioning through Evaluation Programme. Clin Oncol (R Coll Radiol) 2018. [DOI: 10.1016/j.clon.2018.02.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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13
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Ghafoor Q, Allos B, Stevenson R, Watkins S, Yahya S, Stange D, Howard H, Davies K, Carruthers H. Normal Tissue Dose Constraints for Multiple Lung Stereotactic Radiotherapy Treatments. Clin Oncol (R Coll Radiol) 2018; 30:455. [PMID: 29571935 DOI: 10.1016/j.clon.2018.03.003] [Citation(s) in RCA: 3] [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: 11/09/2017] [Accepted: 03/05/2018] [Indexed: 12/25/2022]
Affiliation(s)
- Q Ghafoor
- University Hospital Birmingham Cancer Centre, University Hospital Birmingham, Edgbaston, Birmingham, UK.
| | - B Allos
- University Hospital Birmingham Cancer Centre, University Hospital Birmingham, Edgbaston, Birmingham, UK
| | - R Stevenson
- University Hospital Birmingham Cancer Centre, University Hospital Birmingham, Edgbaston, Birmingham, UK
| | - S Watkins
- University Hospital Birmingham Cancer Centre, University Hospital Birmingham, Edgbaston, Birmingham, UK
| | - S Yahya
- University Hospital Birmingham Cancer Centre, University Hospital Birmingham, Edgbaston, Birmingham, UK
| | - D Stange
- University Hospital Birmingham Cancer Centre, University Hospital Birmingham, Edgbaston, Birmingham, UK
| | - H Howard
- University Hospital Birmingham Cancer Centre, University Hospital Birmingham, Edgbaston, Birmingham, UK
| | - K Davies
- University Hospital Birmingham Cancer Centre, University Hospital Birmingham, Edgbaston, Birmingham, UK
| | - H Carruthers
- University Hospital Birmingham Cancer Centre, University Hospital Birmingham, Edgbaston, Birmingham, UK
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Hall PS, Lord SR, Collinson M, Marshall H, Jones M, Lowe C, Howard H, Swinson D, Velikova G, Anthoney A, Roy R, Dent J, Cheeseman S, Last K, Seymour MT. A randomised phase II trial and feasibility study of palliative chemotherapy in frail or elderly patients with advanced gastroesophageal cancer (321GO). Br J Cancer 2017; 116:472-478. [PMID: 28095397 PMCID: PMC5318975 DOI: 10.1038/bjc.2016.442] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Revised: 11/08/2016] [Accepted: 12/05/2016] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Elderly patients are commonly under-represented in cancer clinical trials. The 321GO was undertaken in preparation for a definitive phase three trial assessing different chemotherapy regimens in a frail and/or elderly population with advanced gastroesophageal (GO) cancer. METHODS Patients with advanced GO cancer considered unfit for conventional dose chemotherapy were randomly assigned in a 1 : 1 : 1 ratio to: epirubicin, oxaliplatin and capecitabine (EOX); oxaliplatin and capecitabine (OX); and capecitabine alone (X) (all 80% of full dose and unblinded). The primary end point was patient recruitment over an 18-month period. A registration study recorded treatment choice for all patients with advanced GO cancer at trial centres. RESULTS A total of 313 patients were considered for palliative chemotherapy for GO cancer over the 18-month period: 115 received full dose treatment, 89 less than standard treatment or entered 321GO and 111 no treatment. Within 321GO, 55 patients were randomly assigned (19 to OX and X; 17 to EOX). Progression-free survival (PFS) for all patients was 4.4 months and by arm 5.4, 5.6 and 3.0 months for EOX, OX and X, respectively. The number of patients with a good overall treatment utility (OTU), a novel patient-centred endpoint, at 12 weeks was 3 (18%), 6 (32%) and 1 (6%) for EOX, OX and X, respectively. At 6 weeks, 22 patients (41%) had experienced a non-haematologic toxicity ⩾grade 3, most commonly lethargy or diarrhoea. The OTU was prognostic for overall survival in patients alive at week 12 (logrank test P=0.0001). CONCLUSIONS It is feasible to recruit elderly and/or frail patients with advanced GO cancer to a randomised clinical trial. The OX is the preferred regimen for further study. Overall treatment utility shows promise as a comparator between treatment regimens for feasibility and randomised trials in the elderly and/or frail GO cancer population.
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Affiliation(s)
- P S Hall
- Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh EH4 2XR, UK
| | - S R Lord
- Department of Oncology, University of Oxford, Oxford, UK
| | - M Collinson
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - H Marshall
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - M Jones
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - C Lowe
- NIHR Cancer Research Network Coordinating Centre, Leeds, UK
| | - H Howard
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - D Swinson
- Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - G Velikova
- Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - A Anthoney
- Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - R Roy
- Department of Oncology, Castle Hill Hospital, Hull, UK
| | - J Dent
- Department of Oncology, Huddersfield Royal Infirmary, Huddersfield, UK
| | - S Cheeseman
- Department of Oncology, The York Hospital, York, UK
| | - K Last
- Department of Oncology, The York Hospital, York, UK
- Department of Oncology, Bradford Royal Infirmary, Bradford, UK
| | - M T Seymour
- NIHR Cancer Research Network Coordinating Centre, Leeds, UK
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Maung Maung Myint Y, Watkins S, Howard H, Jackson T. 128: 90-day mortality after radical radiotherapy and 30-day mortality after high dose palliative radiotherapy in lung cancer patients at the University Hospitals Birmingham. Lung Cancer 2017. [DOI: 10.1016/s0169-5002(17)30178-2] [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: 11/26/2022]
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16
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Fong C, Boon C, Tiffany M, Roques T, Brammer C, Foran B, Prestwich R, Chan A, Howard H, Sanghera P, Hartley A. UK Contouring Variation in Nasopharyngeal Carcinoma. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.1620] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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17
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Chakedis J, French R, Babicky M, Jaquish D, Howard H, Mose E, Lam R, Holman P, Miyamoto J, Walterscheid Z, Lowy AM. A novel protein isoform of the RON tyrosine kinase receptor transforms human pancreatic duct epithelial cells. Oncogene 2016; 35:3249-59. [PMID: 26477314 PMCID: PMC4837108 DOI: 10.1038/onc.2015.384] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 07/27/2015] [Accepted: 08/28/2015] [Indexed: 02/04/2023]
Abstract
The MST1R gene is overexpressed in pancreatic cancer producing elevated levels of the RON tyrosine kinase receptor protein. While mutations in MST1R are rare, alternative splice variants have been previously reported in epithelial cancers. We report the discovery of a novel RON isoform discovered in human pancreatic cancer. Partial splicing of exons 5 and 6 (P5P6) produces a RON isoform that lacks the first extracellular immunoglobulin-plexin-transcription domain. The splice variant is detected in 73% of xenografts derived from pancreatic adenocarcinoma patients and 71% of pancreatic cancer cell lines. Peptides specific to RON P5P6 detected in human pancreatic cancer specimens by mass spectrometry confirm translation of the protein isoform. The P5P6 isoform is found to be constitutively phosphorylated, present in the cytoplasm, and it traffics to the plasma membrane. Expression of P5P6 in immortalized human pancreatic duct epithelial (HPDE) cells activates downstream AKT, and in human pancreatic epithelial nestin-expressing cells, activates both the AKT and MAPK pathways. Inhibiting RON P5P6 in HPDE cells using a small molecule inhibitor BMS-777607 blocked constitutive activation and decreased AKT signaling. P5P6 transforms NIH3T3 cells and induces tumorigenicity in HPDE cells. Resultant HPDE-P5P6 tumors develop a dense stromal compartment similar to that seen in pancreatic cancer. In summary, we have identified a novel and constitutively active isoform of the RON tyrosine kinase receptor that has transforming activity and is expressed in human pancreatic cancer. These findings provide additional insight into the biology of the RON receptor in pancreatic cancer and are clinically relevant to the study of RON as a potential therapeutic target.
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Affiliation(s)
- J Chakedis
- Department of Surgery, Division of Surgical Oncology, Moores Cancer Center, University of California, San Diego, La Jolla, CA, USA
| | - R French
- Department of Surgery, Division of Surgical Oncology, Moores Cancer Center, University of California, San Diego, La Jolla, CA, USA
| | - M Babicky
- Department of Surgery, Division of Surgical Oncology, Moores Cancer Center, University of California, San Diego, La Jolla, CA, USA
| | - D Jaquish
- Department of Surgery, Division of Surgical Oncology, Moores Cancer Center, University of California, San Diego, La Jolla, CA, USA
| | - H Howard
- Department of Surgery, Division of Surgical Oncology, Moores Cancer Center, University of California, San Diego, La Jolla, CA, USA
| | - E Mose
- Department of Surgery, Division of Surgical Oncology, Moores Cancer Center, University of California, San Diego, La Jolla, CA, USA
| | - R Lam
- Department of Surgery, Division of Surgical Oncology, Moores Cancer Center, University of California, San Diego, La Jolla, CA, USA
| | - P Holman
- Department of Surgery, Division of Surgical Oncology, Moores Cancer Center, University of California, San Diego, La Jolla, CA, USA
| | - J Miyamoto
- Department of Surgery, Division of Surgical Oncology, Moores Cancer Center, University of California, San Diego, La Jolla, CA, USA
| | - Z Walterscheid
- Department of Surgery, Division of Surgical Oncology, Moores Cancer Center, University of California, San Diego, La Jolla, CA, USA
| | - A M Lowy
- Department of Surgery, Division of Surgical Oncology, Moores Cancer Center, University of California, San Diego, La Jolla, CA, USA
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Howard H, Johnson-Agbakwu C, Michlig G, Sisterna N, Nizigiyimana J. 003 A Culturally Informed Educational Program to Promote Sexual Health and Well-being Among Refugee Women. J Sex Med 2016. [DOI: 10.1016/j.jsxm.2016.04.003] [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: 10/21/2022]
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Sangha V, Stevenson R, Harrop V, Heyes G, Howard H, Kapadia A, Ghafoor Q. 126 CyberKnife® for early stage non-small cell lung cancer (NSCLC) at a tertiary referral centre – results of the first two years of treatment at Birmingham. Lung Cancer 2016. [DOI: 10.1016/s0169-5002(16)30143-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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20
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Stevenson R, Harrop V, Heyes G, Howard H, Simmons R, Kapadia A, Mitchell T, Ghafoor Q. 138: Cyberknife® for early stage non-small cell lung cancer (NSCLC) at a tertiary referral centre – results of the first year of treatment at Birmingham. Lung Cancer 2015. [DOI: 10.1016/s0169-5002(15)50132-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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21
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Jackson E, Demarest K, Eckert WJ, Cates-Gatto C, Nadav T, Cates LN, Howard H, Roberts AJ. Aspen shaving versus chip bedding: effects on breeding and behavior. Lab Anim 2014; 49:46-56. [DOI: 10.1177/0023677214553320] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The choice of laboratory cage bedding material is often based on both practical and husbandry issues, whereas behavioral outcomes rarely appear to be considered. It has been noted that a breeding success difference appears to be associated with the differential use of aspen chip and aspen shaving bedding in our facility; therefore, we sought to analyze breeding records maintained over a 20-month period. In fact, in all four mouse strains analyzed, shaving bedding was associated with a significant increase in average weanlings per litter relative to chip bedding. To determine whether these bedding types also resulted in differences in behaviors associated with wellbeing, we examined nest building, anxiety-like, depressive-like (or helpless-like), and social behavior in mice housed on chip versus shaving bedding. We found differences in the nests built, but no overall effect of bedding type on the other behaviors examined. Therefore, we argue that breeding success, perhaps especially in more challenging strains, is improved on shaving bedding and this is likely due to improved nest-building potential. For standard laboratory practices, however, these bedding types appear equivalent.
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Affiliation(s)
- E Jackson
- Mouse Behavioral Assessment Core Facility, The Scripps Research Institute, LA Jolla, CA, USA
| | - K Demarest
- Department of Animal Resources, The Scripps Research Institute, La Jolla, CA, USA
| | - W J Eckert
- Department of Animal Resources, The Scripps Research Institute, La Jolla, CA, USA
| | - C Cates-Gatto
- Mouse Behavioral Assessment Core Facility, The Scripps Research Institute, LA Jolla, CA, USA
| | - T Nadav
- Mouse Behavioral Assessment Core Facility, The Scripps Research Institute, LA Jolla, CA, USA
| | - L N Cates
- Mouse Behavioral Assessment Core Facility, The Scripps Research Institute, LA Jolla, CA, USA
| | - H Howard
- Department of Animal Resources, The Scripps Research Institute, La Jolla, CA, USA
| | - A J Roberts
- Mouse Behavioral Assessment Core Facility, The Scripps Research Institute, LA Jolla, CA, USA
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Chakedis J, French R, Jaquish D, Mose E, Howard H, Lowy A. DNA Methylation Regulates Expression of the RON Tyrosine Kinase Receptor in Pancreatic Cancer. J Surg Res 2014. [DOI: 10.1016/j.jss.2013.11.163] [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: 11/29/2022]
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23
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Howard H, Stange D, Sanghera P, Hartley A, Sangha V, Cashmore J. EP-1210: Dosimetric comparison of lateralised IMRT vs. 3D-CRT for unilateral carcinomas in the head and neck region. Radiother Oncol 2013. [DOI: 10.1016/s0167-8140(15)33516-7] [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: 11/17/2022]
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24
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Collinson FJ, Gregory WM, McCabe C, Howard H, Lowe C, Potrata D, Tubeuf S, Hanlon P, McParland L, Wah T, Selby PJ, Hewison J, Brown J, Brown J. The STAR trial protocol: a randomised multi-stage phase II/III study of Sunitinib comparing temporary cessation with allowing continuation, at the time of maximal radiological response, in the first-line treatment of locally advanced/metastatic renal cancer. BMC Cancer 2012; 12:598. [PMID: 23241439 PMCID: PMC3583710 DOI: 10.1186/1471-2407-12-598] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Accepted: 11/22/2012] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Over recent years a number of novel therapies have shown promise in advanced renal cell carcinoma (RCC). Internationally the standard of care of first-line therapy is sunitinib™, after a clear survival benefit was demonstrated over interferon-α. Convention dictates that sunitinib is continued until evidence of disease progression, assuming tolerability, although there is no evidence that this approach is superior to intermittent periods of treatment. The purpose of the STAR trial is to compare the standard treatment strategy (conventional continuation strategy, CCS) with a novel drug free interval strategy (DFIS) which includes planned treatment breaks. METHODS/DESIGN The STAR trial is an NIHR HTA-funded UK pragmatic randomised phase II/III clinical trial in the first-line treatment of advanced RCC. Participants will be randomised (1:1) to either a sunitinib CCS or a DFIS. The overall aim of the trial is to determine whether a DFIS is non-inferior, in terms of 2-year overall survival (OS) and quality adjusted life years (QALY) (averaged over treatment and follow up), compared to a CCS. The QALY primary endpoint was selected to assess whether any detriment in terms of OS could be balanced with improvements in quality of life (QoL). This is a complex trial with a number of design challenges, and to address these issues a feasibility stage is incorporated into the trial design. Predetermined recruitment (stage A) and efficacy (stage B) intermediary endpoints must be met to allow continuation to the overall phase III trial (stage C). An integral qualitative patient preference and understanding study will occur alongside the feasibility stage to investigate patients' feelings regarding participation or non-participation in the trial. DISCUSSION The optimal duration of continuing sunitinib in advanced RCC is unknown. Novel targeted therapies do not always have the same constraints to treatment duration as standard chemotherapeutic agents and currently there are no randomised data comparing different treatment durations. Incorporating planned treatment breaks has the potential to improve QoL and cost effectiveness, hopefully without significant detriment on OS, as has been demonstrated in other cancer types with other treatments. TRIAL REGISTRATION Controlled-trials.com ISRCTN 06473203.
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Affiliation(s)
- Fiona J Collinson
- Clinical Trials Research Unit, University of Leeds, Leeds, LS2 9JT, UK
| | - Walter M Gregory
- Clinical Trials Research Unit, University of Leeds, Leeds, LS2 9JT, UK
| | - Chris McCabe
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, Charles Thackrah Building, University of Leeds, 101 Clarendon Road, Leeds, LS2 9LJ, UK
| | - Helen Howard
- Clinical Trials Research Unit, University of Leeds, Leeds, LS2 9JT, UK
| | - Catherine Lowe
- Clinical Trials Research Unit, University of Leeds, Leeds, LS2 9JT, UK
| | - DrBarbara Potrata
- Charles Thackrah Building, Leeds Institute of Health Sciences, University of Leeds, Leeds, LS2 9JT, UK
| | - Sandy Tubeuf
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, Charles Thackrah Building, University of Leeds, 101 Clarendon Road, Leeds, LS2 9LJ, UK
| | - Pat Hanlon
- Patient Representative National Cancer Research Institute (NCRI) Renal Cancer Clinical Studies Group, Leeds, UK
| | - Lucy McParland
- Clinical Trials Research Unit, University of Leeds, Leeds, LS2 9JT, UK
| | - T Wah
- Department of Radiology St James’s University Hospital, Leeds, LS9 7TF, UK
| | - Peter J Selby
- Cancer Research Building, St James’s University Hospital, Leeds, LS9 7TF, UK
| | - Jenny Hewison
- Charles Thackrah Building, Leeds Institute of Health Sciences, University of Leeds, Leeds, LS2 9TF, UK
| | - Julia Brown
- Clinical Trials Research Unit, University of Leeds, Leeds, LS2 9JT, UK
| | - Janet Brown
- Cancer Research UK Experimental Centres at Leeds and Sheffield, Leeds, LS2 9TF, UK
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Howard H. Looking to the future: Developing an academic skills strategy to ensure information literacy survives in a changing higher education world. JIL 2012. [DOI: 10.11645/6.1.1677] [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: 11/13/2022] Open
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26
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Collinson FJ, Jayne DG, Pigazzi A, Tsang C, Barrie JM, Edlin R, Garbett C, Guillou P, Holloway I, Howard H, Marshall H, McCabe C, Pavitt S, Quirke P, Rivers CS, Brown JMB. An international, multicentre, prospective, randomised, controlled, unblinded, parallel-group trial of robotic-assisted versus standard laparoscopic surgery for the curative treatment of rectal cancer. Int J Colorectal Dis 2012; 27:233-41. [PMID: 21912876 DOI: 10.1007/s00384-011-1313-6] [Citation(s) in RCA: 219] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/30/2011] [Indexed: 02/06/2023]
Abstract
PURPOSE There is growing enthusiasm for robotic-assisted laparoscopic operations across many surgical specialities, including colorectal surgery, often not supported by robust clinical or cost-effectiveness data. A proper assessment of this new technology is required, prior to widespread recommendation or implementation. METHODS/DESIGN The ROLARR trial is a pan-world, prospective, randomised, controlled, unblinded, superiority trial of robotic-assisted versus standard laparoscopic surgery for the curative treatment of rectal cancer. It will investigate differences in terms of the rate of conversion to open operation, rate of pathological involvement of circumferential resection margin, 3-year local recurrence, disease-free and overall survival rates and also operative morbidity and mortality, quality of life and cost-effectiveness. The primary outcome measure is the rate of conversion to open operation. For 80% power at the 5% (two-sided) significance level, to identify a relative 50% reduction in open conversion rate (25% to 12.5%), 336 patients will be required. The target recruitment is 400 patients overall to allow loss to follow-up. Patients will be followed up at 30 days and 6 months post-operatively and then annually until 3 years after the last patient has been randomised. DISCUSSION In many centres, robotic-assisted surgery is being implemented on the basis of theoretical advantages, which have yet to be confirmed in practice. Robotic surgery is an expensive health care provision and merits robust evaluation. The ROLARR trial is a pragmatic trial aiming to provide a comprehensive evaluation of both robotic-assisted and standard laparoscopic surgery for the curative resection of rectal cancer.
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Affiliation(s)
- Fiona J Collinson
- Clinical Trials Research Unit, University of Leeds, Leeds, LS2 9JT, UK.
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Hall PS, Lord S, Collinson M, Marshall H, Jones M, Olivier C, Howard H, Seligman J, Swinson D, Roy R, Dent J, Cheeseman S, Last KW, Seymour MT. Three, two, or one drug chemotherapy for frail or elderly patients with advanced gastroesophageal cancer (321GO): A feasibility study. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.4_suppl.97] [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
97 Background: The median age of death from gastroesophageal (GO) cancer is 77 years. Palliative chemotherapy can improve survival and quality of life. Current standard combination regimens have been developed in trials involving patients of median age under 65 years with predominantly good performance status (PS). In light of audit and survey evidence of widespread use of arbitrarily modified chemotherapy schedules in frail and elderly patients, better evidence is needed to guide treatment. Based on our experience with the MRC FOCUS trial in colorectal cancer, 321GO aimed to test the feasibility of a randomised trial comparing chemotherapy in frail and elderly patients with advanced GO cancer. Methods: Patients with advanced GO cancer considered unfit for full-dose 3-drug chemotherapy, were randomly allocated (1:1:1) to 3, 2 or 1 drug chemotherapy at 80% dose of standard regimens with EOX: epirubicin 40mg/m2 d1, oxaliplatin 104mg/m2 d1, capecitabine 500mg/m2 bd x21d, OX: oxaliplatin 104mg/m2 d1, capecitabine 500mg/m2 bd x21d or X: capecitabine 1000mg/m2 bd d1-14, then 7 day rest. The primary endpoint for feasibility required 45 patients to be recruited over 18 months. Secondary endpoints included tolerability, treatment benefit and compliance with detailed health and quality of life (QoL) assessment. Results: 55 patients were recruited over an average of 18 months for each of the six recruiting centres; 17 to EOX, 19 to OX and 18 to X. The median age was 75. 37 (66%) patients were of WHO PS 0 or 1 and 18 (33%) were of PS 2. After 6-weeks, 12 (71%), 9 (47%) and 9 (50%) patients in the EOX, OX and X arms had experienced a treatment delay, dose reduction, grade 3 toxicity or stopped treatment. Treatment benefit (no radiological progression or clinical deterioration) at 12 weeks was seen in 8 (47%), 11 (58%) and 3 (16%) patients for EOX, OX and X respectively. Compliance with baseline health and QoL assessment was 98% at baseline and 69% at 12 weeks. Conclusions: A phase III trial randomising frail or elderly patients with advanced GO cancer to alternative chemotherapy regimens is feasible. EOX was associated with greater toxicity compared with OX; X offered no improvement in tolerability over OX.
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Affiliation(s)
- Peter S. Hall
- University of Leeds, Leeds, United Kingdom; University of Oxford, Oxford, United Kingdom; CTRU, Leeds, United Kingdom; St. James's Hospital, Leeds, United Kingdom; Castle Hill Hospital, Hull, United Kingdom; Calderdale and Huddersfield Royal Infirmary, Huddersfield, United Kingdom; Bradford Royal Infirmary, Bradford, United Kingdom; York District Hospital, York, United Kingdom
| | - Simon Lord
- University of Leeds, Leeds, United Kingdom; University of Oxford, Oxford, United Kingdom; CTRU, Leeds, United Kingdom; St. James's Hospital, Leeds, United Kingdom; Castle Hill Hospital, Hull, United Kingdom; Calderdale and Huddersfield Royal Infirmary, Huddersfield, United Kingdom; Bradford Royal Infirmary, Bradford, United Kingdom; York District Hospital, York, United Kingdom
| | - Michelle Collinson
- University of Leeds, Leeds, United Kingdom; University of Oxford, Oxford, United Kingdom; CTRU, Leeds, United Kingdom; St. James's Hospital, Leeds, United Kingdom; Castle Hill Hospital, Hull, United Kingdom; Calderdale and Huddersfield Royal Infirmary, Huddersfield, United Kingdom; Bradford Royal Infirmary, Bradford, United Kingdom; York District Hospital, York, United Kingdom
| | - Helen Marshall
- University of Leeds, Leeds, United Kingdom; University of Oxford, Oxford, United Kingdom; CTRU, Leeds, United Kingdom; St. James's Hospital, Leeds, United Kingdom; Castle Hill Hospital, Hull, United Kingdom; Calderdale and Huddersfield Royal Infirmary, Huddersfield, United Kingdom; Bradford Royal Infirmary, Bradford, United Kingdom; York District Hospital, York, United Kingdom
| | - Marc Jones
- University of Leeds, Leeds, United Kingdom; University of Oxford, Oxford, United Kingdom; CTRU, Leeds, United Kingdom; St. James's Hospital, Leeds, United Kingdom; Castle Hill Hospital, Hull, United Kingdom; Calderdale and Huddersfield Royal Infirmary, Huddersfield, United Kingdom; Bradford Royal Infirmary, Bradford, United Kingdom; York District Hospital, York, United Kingdom
| | - Catherine Olivier
- University of Leeds, Leeds, United Kingdom; University of Oxford, Oxford, United Kingdom; CTRU, Leeds, United Kingdom; St. James's Hospital, Leeds, United Kingdom; Castle Hill Hospital, Hull, United Kingdom; Calderdale and Huddersfield Royal Infirmary, Huddersfield, United Kingdom; Bradford Royal Infirmary, Bradford, United Kingdom; York District Hospital, York, United Kingdom
| | - Helen Howard
- University of Leeds, Leeds, United Kingdom; University of Oxford, Oxford, United Kingdom; CTRU, Leeds, United Kingdom; St. James's Hospital, Leeds, United Kingdom; Castle Hill Hospital, Hull, United Kingdom; Calderdale and Huddersfield Royal Infirmary, Huddersfield, United Kingdom; Bradford Royal Infirmary, Bradford, United Kingdom; York District Hospital, York, United Kingdom
| | - Jenny Seligman
- University of Leeds, Leeds, United Kingdom; University of Oxford, Oxford, United Kingdom; CTRU, Leeds, United Kingdom; St. James's Hospital, Leeds, United Kingdom; Castle Hill Hospital, Hull, United Kingdom; Calderdale and Huddersfield Royal Infirmary, Huddersfield, United Kingdom; Bradford Royal Infirmary, Bradford, United Kingdom; York District Hospital, York, United Kingdom
| | - Daniel Swinson
- University of Leeds, Leeds, United Kingdom; University of Oxford, Oxford, United Kingdom; CTRU, Leeds, United Kingdom; St. James's Hospital, Leeds, United Kingdom; Castle Hill Hospital, Hull, United Kingdom; Calderdale and Huddersfield Royal Infirmary, Huddersfield, United Kingdom; Bradford Royal Infirmary, Bradford, United Kingdom; York District Hospital, York, United Kingdom
| | - Rajarshi Roy
- University of Leeds, Leeds, United Kingdom; University of Oxford, Oxford, United Kingdom; CTRU, Leeds, United Kingdom; St. James's Hospital, Leeds, United Kingdom; Castle Hill Hospital, Hull, United Kingdom; Calderdale and Huddersfield Royal Infirmary, Huddersfield, United Kingdom; Bradford Royal Infirmary, Bradford, United Kingdom; York District Hospital, York, United Kingdom
| | - Jo Dent
- University of Leeds, Leeds, United Kingdom; University of Oxford, Oxford, United Kingdom; CTRU, Leeds, United Kingdom; St. James's Hospital, Leeds, United Kingdom; Castle Hill Hospital, Hull, United Kingdom; Calderdale and Huddersfield Royal Infirmary, Huddersfield, United Kingdom; Bradford Royal Infirmary, Bradford, United Kingdom; York District Hospital, York, United Kingdom
| | - Sue Cheeseman
- University of Leeds, Leeds, United Kingdom; University of Oxford, Oxford, United Kingdom; CTRU, Leeds, United Kingdom; St. James's Hospital, Leeds, United Kingdom; Castle Hill Hospital, Hull, United Kingdom; Calderdale and Huddersfield Royal Infirmary, Huddersfield, United Kingdom; Bradford Royal Infirmary, Bradford, United Kingdom; York District Hospital, York, United Kingdom
| | - Kim William Last
- University of Leeds, Leeds, United Kingdom; University of Oxford, Oxford, United Kingdom; CTRU, Leeds, United Kingdom; St. James's Hospital, Leeds, United Kingdom; Castle Hill Hospital, Hull, United Kingdom; Calderdale and Huddersfield Royal Infirmary, Huddersfield, United Kingdom; Bradford Royal Infirmary, Bradford, United Kingdom; York District Hospital, York, United Kingdom
| | - Matthew T. Seymour
- University of Leeds, Leeds, United Kingdom; University of Oxford, Oxford, United Kingdom; CTRU, Leeds, United Kingdom; St. James's Hospital, Leeds, United Kingdom; Castle Hill Hospital, Hull, United Kingdom; Calderdale and Huddersfield Royal Infirmary, Huddersfield, United Kingdom; Bradford Royal Infirmary, Bradford, United Kingdom; York District Hospital, York, United Kingdom
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Collinson F, Brown J, McCabe C, Brown J, Tubeuf S, Potrata B, Hewison J, Rombach I, Selby P, Olivier C, Howard H, Gregory W. The STAR trial: can quality of life benefit offset any survival detriment? Trials 2011. [PMCID: PMC3287748 DOI: 10.1186/1745-6215-12-s1-a33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Howard H, Barandas A, Creegan L, Bauer H, Chow J, Park I, Bolan G. P5-S3.01 Developing a multi-pronged quality improvement (QI) strategy to increase Chlamydia trachomatis (CT) retesting rates: building a framework for success. Br J Vener Dis 2011. [DOI: 10.1136/sextrans-2011-050108.537] [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: 11/03/2022]
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Howard H. A fight for funding. Midwives 2011; 14:36-37. [PMID: 24888005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Howard H, Chow J, Bauer H, Wright G, Menz M, Zerne R, Bolan G. Missed opportunities for Chlamydia retesting at limited service visits in California family planning clinics. Contraception 2010. [DOI: 10.1016/j.contraception.2010.04.127] [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: 10/19/2022]
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Morris SR, Bauer HM, Chartier M, Howard H, Watson S, Yokotobi J, Taylor AF, Bolan G. Relative efficiency of chlamydia screening in non-clinical settings in two California counties. Int J STD AIDS 2010; 21:52-6. [PMID: 20029065 DOI: 10.1258/ijsa.2009.008474] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We examined the relative efficiency of non-clinical sites to screen for chlamydia in youth and young adults. Chlamydia screening targeting youth (under 30 years of age) was performed at non-clinical sites in high-morbidity neighbourhoods of two California counties. Venues were subdivided into community outreach, schools, parenting centres and drug treatment/correctional facilities. Relative efficiency was estimated with multivariate Poisson regression using incidence of chlamydia per person-hours labour adjusting for strategy and county. Among the 1514 youths screened, the overall prevalence of chlamydia was 5.5%. By venue, the highest prevalence was in drug treatment/correction facilities at 11.1% followed by parenting centres at 6.3%, community outreach at 4.9% and schools at 4.6%. Drug treatment/correctional facilities were the most labour time efficient at 9.9 person-hours per chlamydia case. Schools and parenting centres had the lowest cost per screen at 0.9 person-hours per screen. Adjusted relative labour time efficiency (chlamydia cases per paid person-hour) was significantly higher in schools, 2.0 (95% confidence interval [CI] 1.0-4.2), parenting centres, 3.2 (95% CI 1.6-6.6) and drug treatment/correctional facilities, 2.9 (95% CI 1.0-7.8), compared with community outreach. In conclusion, parenting centres and drug treatment centres and correctional facilities are the most efficient venues for chlamydia screening.
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Affiliation(s)
- S R Morris
- California Department of Public Health, Sexually Transmitted Diseases (STD) Control Branch, Richmond, USA.
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Howard H, Gill M. University of Leeds: impact of information literacy initiatives. LIR 2009. [DOI: 10.29173/lirg182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
At Leeds University Library, we decided to measure the impact of our work on Information Literacy, and in particular our IL online tutorials, with the aim of demonstrating that the
time, effort and funding invested in this area of work made a real difference to library users.
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Shrivastava V, Howard H, Gaines P. Images in vascular medicine. Aortic dissection or extra-aortic artefact? Vasc Med 2004; 8:279-80. [PMID: 15125490 DOI: 10.1191/1358863x03vm498xx] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Vivek Shrivastava
- Department of Cardiothoracic Surgery, Northern General Hospital, Sheffield, UK.
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Dawkins N, Gager J, Cornillon J, Kim Y, Howard H, Phelps O. Comparative Studies on the Physicochemical Properties and Hydration Behavior of Oat Gum and Oatrim in Meat-based Patties. J Food Sci 2001. [DOI: 10.1111/j.1365-2621.2001.tb15201.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Xie YG, Rochefort D, Brais B, Howard H, Han FY, Gou LP, Maciel P, The BT, Larsson C, Rouleau GA. Restriction map of a YAC and cosmid contig encompassing the oculopharyngeal muscular dystrophy candidate region on chromosome 14q11.2-q13. Genomics 1998; 52:201-4. [PMID: 9782086 DOI: 10.1006/geno.1998.5421] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [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: 11/22/2022]
Abstract
As part of our effort to clone positionally the oculopharyngeal muscular dystrophy (OPMD) gene, we constructed a YAC contig, a cosmid contig, and an EcoRI restriction map of the OPMD candidate region. The YAC contig spans more than 2 Mb and encompasses the loci D14S283 and D14S990 and the cardiac alpha and beta myosin heavy chain genes (MYH6 and MYH7). A 700-kb cosmid contig containing the D14S990 and the myosin genes and a long-range restriction map covering the region between D14S990 and the MYH6 and MYH7 gene cluster were established. A detailed EcoRI restriction map of the cosmid contig was determined, and five putative CpG islands were identified. Based on these data, the four loci were mapped within an approximately 600-kb region with the following centromere to telomere order: D14S283, D14S990, MYH6, and MYH7. The YAC and cosmid contigs will facilitate the identification of genes lying within the OPMD candidate interval.
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Affiliation(s)
- Y G Xie
- Center for Research in Neuroscience, McGill University, Montreal General Hospital, 1650 Cedar Avenue, Montreal, Quebec, H3G 1A4, Canada
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Howard H, Martlew V, McFadyen I, Clarke C, Duguid J, Bromilow I, Eggington J. Consequences for fetus and neonate of maternal red cell allo-immunisation. Arch Dis Child Fetal Neonatal Ed 1998; 78:F62-6. [PMID: 9536844 PMCID: PMC1720748 DOI: 10.1136/fn.78.1.f62] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
AIMS To study the distribution of clinically important red cell antibodies in pregnancy, and the associated fetal and neonatal morbidity and mortality. METHODS The case notes of women with clinically important red cell antibodies identified in their serum during pregnancy were reviewed. RESULTS During a 12 month period 22,264 women were referred for antenatal screening. Clinically important red cell antibodies were detected in 244 (1%). Of these, 100 were anti-D and 144 were non-RhD antibodies. There were three intrauterine deaths, three fetuses required intrauterine transfusion, 10 neonates were transfused, 27 others had phototherapy, and 27 with a positive direct antiglobulin test received no treatment. Early fetal losses occurred in the presence of both high and low levels of anti-D. CONCLUSIONS Anti-D remains the most common clinically important antibody in pregnancy, and accounts for the greatest fetal and neonatal morbidity and mortality. Of the other antibodies detected, anti-c was associated with most neonatal morbidity. The production of many of the non-D antibodies detected could be avoided by the use of selected red cells when transfusing pre-menopausal women.
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Affiliation(s)
- H Howard
- National Blood Service, Mersey and North Wales Centre, Liverpool
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Prakash C, Kamel A, Anderson W, Howard H. Metabolism and excretion of the novel antipsychotic drug ziprasidone in rats after oral administration of a mixture of 14C- and 3H-labeled ziprasidone. Drug Metab Dispos 1997; 25:206-18. [PMID: 9029052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
The metabolism and excretion of ziprasidone (5-[2-[4-(1,2-benzisothiazol-3-yl)piperazin-1-yl]ethyl]-6-++ +chloroindolin-2-one hydrochloride hydrate) were studied in Long Evans rats after oral administration of a single dose of a mixture of 14C- and 3H-labeled ziprasidone. The radioactive dose was quantitatively recovered over 7 days in both male and female rats. The percentage of the dose excreted in urine, bile, and feces of rats was 21.6, 19.2, and 55.6%, respectively. The total excretion in urine and bile suggested that at least 41% of the drug was absorbed. Absorption of ziprasidone was rapid, and the mean plasma concentrations of the unchanged drug and metabolites were slightly higher in the female rats than in the males. The maximal plasma concentrations for ziprasidone and metabolites were reached at 1 hr in both male and female rats. Based on AUC (0-12 hr) values, approximately 59 and 52% of the circulating radioactivity (average of 14C and 3H) was attributable to metabolites in male and female rats, respectively. Ziprasidone was extensively metabolized in rats, and only a small amount of ziprasidone was excreted as unchanged drug. Twelve metabolites were identified by ion spray LC/MS, using a combination of parent ion and product ion scanning techniques. The structures of eight metabolites were unambiguously confirmed by coelution on HPLC with synthetic standards, and four additional metabolites were partially identified. There was a gender-related difference in the excretion of urinary metabolites in Long Evans rats. The major route of metabolism in male rats involved N-dealkylation. In female rats the major metabolites were due to oxidation at the benzisothiazole ring. Based on the structures of these metabolites, four major and two minor routes of metabolism of ziprasidone were identified. The major routes included 1) N-dealkylation of the ethyl side chain attached to the piperazinyl nitrogen, 2) oxidation at the sulfur, resulting in the formation of sulfoxide and sulfone, 3) oxidation on the benzisothiazole moiety (other than sulfur), and 4) hydration of the C==N bond and subsequent oxidation at the sulfur of the benzisothiazole moiety. The minor routes involved N-oxidation on the piperazine ring and hydrolysis of the oxindole moiety.
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Affiliation(s)
- C Prakash
- Department of Drug Metabolism, Pfizer Inc., Groton, CT 06340, USA
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Howard H. Information freedom and censorship, world report 1991 (International Centre on Censorship). EFI 1992. [DOI: 10.3233/efi-1992-10107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- H. Howard
- Graduate School of Library and Information Studies, McGill University, Montreal, Quebec, Canada
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Howard H. The Future of the Academic Library; Proceedings of the Conference Held at the University of Wisconsin in September 1989 (Eugene P. Trani, ed.). EFI 1991. [DOI: 10.3233/efi-1991-9305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- H. Howard
- Graduate School of Library & Information Studies, McGill University, Montreal, Canada
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Dunsire G, Mangla P, Howard H, Large J, Wise M. Book Reviews. EFI 1990. [DOI: 10.3233/efi-1990-8406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | - P.B. Mangla
- Department of Library and Information Science, University of Delhi, Delhi, India
| | - Helen Howard
- Graduate School of Library and Information Studies, McGill University, Montreal, Canada
| | - J.A. Large
- Graduate School of Library and Information Studies, McGill University, Montreal, Canada
| | - Michael Wise
- Department of Library Science, Bayero University, Kano, Nigeria
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Howard H. Ethics and fund raising. Mich Hosp 1989; 25:7-9, 11. [PMID: 10295665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Abstract
The role of rotavirus in diarrheal disease of rabbits was investigated, and a model for human rotavirus infection was established. Orogastric inoculation of 8- and 12-week-old New Zealand White rabbits with a rabbit strain of rotavirus (L:ALA:84) resulted in fecal shedding of virus for 6 to 8 days from 2 to 5 days after inoculation. Most rabbits exhibited diarrhea, coincident with the onset of viral shedding, which persisted for 2 to 4 days. Diarrhea was characterized by soft or fluid stools and fecal staining of the perineum. Inoculation of 3-week-old rabbits resulted in a briefer period of viral shedding and diarrhea of a milder nature. Histopathologic examination during the period of viral shedding revealed a mild, nonsuppurative enteritis. Inoculated rabbits exhibited antibodies in serum to rotavirus by enzyme-linked immunosorbent assay. Sham-inoculated or uninoculated rabbits maintained in the same cage or the same room with inoculated rabbits acquired rotavirus infection. The mild diarrheal disease which resulted with a rotavirus isolate from severe field cases suggests that cofactors were involved.
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Affiliation(s)
- M E Thouless
- Department of Pathobiology, School of Medicine, University of Washington, Seattle 98195
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Russell RG, Rosenkranz SL, Lee LA, Howard H, DiGiacomo RF, Bronsdon MA, Blakley GA, Tsai CC, Morton WR. Epidemiology and etiology of diarrhea in colony-born Macaca nemestrina. Lab Anim Sci 1987; 37:309-16. [PMID: 3613510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The epidemiology of diarrhea in colony-born M. nemestrina was studied in 205 neonates and infants in an Infant Primate Research Laboratory (IPRL), and in 248 neonates, juveniles and adolescents up to 4 years of age at a separate breeding and holding facility (Primate Field Station, PFS). Computerized medical records of individual animals over a 5-year period were analyzed to determine the incidence of diarrhea; age, duration and number of episodes; mortality and etiology. The incidence of diarrhea at the IPRL was highest in infants at less than 1 month of age (18.6 cases per 1000 animal days) and at 1-6 months olds (2.0 cases per 1000 animals days). Many infants had multiple episodes. All episodes were less than 10 days in duration. Mortality was low. At the PFS, the highest incidence occurred in infants at 6-12 months of age (1.36 cases per 1000 animal days). Multiple episodes were less common. Duration was variable. The infectious agents diagnosed at both facilities were Shigella, Campylobacter and Cryptosporidium. No pathogens were identified in many episodes. Shigella was more common at PFS than at the IPRL. Chronic diarrhea occurred in approximately 10% of animals at PFS. Intestinal amyloidosis and retroperitoneal fibromatosis were found in 13 animals with chronic diarrhea. Further studies are needed to determine the pathogenesis of chronic diarrhea, the etiologic significance of Campylobacter, and the causes of diarrhea when no pathogens are isolated.
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Menon R, Roberts FE, Barr KW, Howard H, Lord VL, Hegarty MA, Luxton DE, Lacey RW. Comparison of a slow-release trimethoprim with co-trimoxazole: efficacy and selection of resistance in the Enterobacteriaceae. J Antimicrob Chemother 1986; 18:415-20. [PMID: 3533889 DOI: 10.1093/jac/18.3.415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
One hundred and fifty one patients with symptoms of urinary tract infection were treated randomly in a double blind study with a slow release form of trimethoprim or with co-trimoxazole. Similar cure rates were seen. There was no difference between the proportions of patients in the two groups who acquired trimethoprim-resistant Enterobacteriaceae. Further clinical trials with slow release trimethoprim should be performed.
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Howard H. Arthur Suckling--pioneer dental specialist. N Z Dent J 1983; 79:117-9. [PMID: 6363998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Prasad BK, Banerjee AK, Howard H. Incidence of deep vein thrombosis and the effect of pneumatic compression of the calf in elderly hemiplegics. Age Ageing 1982; 11:42-4. [PMID: 7072559 DOI: 10.1093/ageing/11.1.42] [Citation(s) in RCA: 30] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
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