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Joseph PLA, Bridgewater JA, Ramsden SS, El Kabir DJ. A psychiatric clinic for the single homeless in a primary care setting in Inner London. Psychiatr bull 2018. [DOI: 10.1192/pb.14.5.270] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
It is well recognised that there is an increased psychiatric morbidity, in particular psychosis, personality disorder and substance abuse, among the single homeless (Lodge Patch et al, 1971). The reasons for this are complex. There is evidence that these people are mentally ill before becoming homeless and that their illness may be a cause of their homelessness. In a study of newly presenting patients at the DHSS Reception Centre in Camberwell, London, Tidmarsh & Wood found that 87% of those with mental illness had been staying recently with their families just before their first hospital admission, suggesting that mental illness may have led to homelessness in these patients (Tidmarsh & Wood, 1972). Although direct evidence is scant in the UK, it is felt that the closure of long-stay psychiatric hospitals could lead to some of their in-patients becoming homeless.
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Crosby T, Hurt CN, Falk S, Gollins S, Staffurth J, Ray R, Bridgewater JA, Geh JI, Cunningham D, Blazeby J, Roy R, Maughan T, Griffiths G, Mukherjee S. Long-term results and recurrence patterns from SCOPE-1: a phase II/III randomised trial of definitive chemoradiotherapy +/- cetuximab in oesophageal cancer. Br J Cancer 2017; 116:709-716. [PMID: 28196063 PMCID: PMC5355926 DOI: 10.1038/bjc.2017.21] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [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: 10/17/2016] [Revised: 01/03/2017] [Accepted: 01/16/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The SCOPE-1 study tested the role of adding cetuximab to conventional definitive chemoradiotherapy (dCRT), and demonstrated greater toxicity and worse survival outcomes. We present the long-term outcomes and patterns of recurrence. METHODS SCOPE-1 was a phase II/III trial in which patients were randomised to cisplatin 60 mg m-2 (day 1) and capecitabine 625 mg m-2 bd (days 1-21) for four cycles +/- cetuximab 400 mg m-2 day 1 then by 250 mg m-2 weekly. Radiotherapy consisted of 50 Gy/25# given concurrently with cycles 3 and 4. Recruitment was between February 2008 and February 2012, when the IDMC recommended closure on the basis of futility. RESULTS About 258 patients (dCRT=129; dCRT+cetuximab (dCRT+C)=129) were recruited from 36 centres. About 72.9% (n=188) had squamous cell histology. The median follow-up (IQR) was 46.2 (35.9-48.3) months for surviving patients. The median overall survival (OS; months; 95% CI) was 34.5 (24.7-42.3) in dCRT and 24.7 (18.6-31.3) in dCRT+C (hazard ratio (HR)=1.25, 95% CIs: 0.93-1.69, P=0.137). Median progression-free survival (PFS; months; 95% CI) was 24.1 (15.3-29.9) and 15.9 (10.7-20.8) months, respectively (HR=1.28, 95% CIs: 0.94-1.75; P=0.114). On multivariable analysis only earlier stage, full-dose RT, and higher cisplatin dose intensity were associated with improved OS. CONCLUSIONS The mature analysis demonstrates that the dCRT regimen used in the study provided useful survival outcomes despite its use in patients who were largely unfit for surgery or who had inoperable disease. Given the competing risk of systemic and local failure, future studies should continue to focus on enhancing local control as well as optimising systemic therapy.
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Affiliation(s)
- T Crosby
- Velindre Cancer Centre, Velindre Hospital, Cardiff CF14 2TL, UK
| | - C N Hurt
- Wales Cancer Trials Unit, Cardiff University, Cardiff CF14 4YS, UK
| | - S Falk
- Bristol Haematology and Oncology Centre, University Hospitals Bristol NHS Foundation Trust, Bristol BS2 8ED, UK
| | - S Gollins
- North Wales Cancer Treatment Centre, Conwy and Denbighshire NHS Trust, Rhyl LL18 5UJ, UK
| | - J Staffurth
- Velindre Cancer Centre, Velindre Hospital, Cardiff CF14 2TL, UK
| | - R Ray
- Wales Cancer Trials Unit, Cardiff University, Cardiff CF14 4YS, UK
| | - J A Bridgewater
- UCL Cancer Institute, University College London, London WC1E 6BT, UK
| | - J I Geh
- Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust Birmingham B15 2GW, UK
| | - D Cunningham
- The Royal Marsden Hospital NHS Foundation Trust, London SM2 5PT, UK
| | - J Blazeby
- Centre for Surgical Research, University of Bristol, Bristol BS8 2PS, UK
| | - R Roy
- Diana Princess of Wales Hospital, Northern Lincolnshire and Goole NHS Foundation Trust, Grimsby DN33 2BA, UK
| | - T Maughan
- CRUK/MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford OX3 7DQ, UK
| | - G Griffiths
- Southampton Clinical Trials Unit, University of Southampton, Southampton SO16 6YD, UK
| | - S Mukherjee
- CRUK/MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford OX3 7DQ, UK
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Maughan TS, Meade AM, Adams RA, Richman SD, Butler R, Fisher D, Wilson RH, Jasani B, Taylor GR, Williams GT, Sampson JR, Seymour MT, Nichols LL, Kenny SL, Nelson A, Sampson CM, Hodgkinson E, Bridgewater JA, Furniss DL, Roy R, Pope MJ, Pope JK, Parmar M, Quirke P, Kaplan R. A feasibility study testing four hypotheses with phase II outcomes in advanced colorectal cancer (MRC FOCUS3): a model for randomised controlled trials in the era of personalised medicine? Br J Cancer 2014; 110:2178-86. [PMID: 24743706 PMCID: PMC4007241 DOI: 10.1038/bjc.2014.182] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [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: 11/21/2013] [Revised: 02/27/2014] [Accepted: 03/13/2014] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Molecular characteristics of cancer vary between individuals. In future, most trials will require assessment of biomarkers to allocate patients into enriched populations in which targeted therapies are more likely to be effective. The MRC FOCUS3 trial is a feasibility study to assess key elements in the planning of such studies. PATIENTS AND METHODS Patients with advanced colorectal cancer were registered from 24 centres between February 2010 and April 2011. With their consent, patients' tumour samples were analysed for KRAS/BRAF oncogene mutation status and topoisomerase 1 (topo-1) immunohistochemistry. Patients were then classified into one of four molecular strata; within each strata patients were randomised to one of two hypothesis-driven experimental therapies or a common control arm (FOLFIRI chemotherapy). A 4-stage suite of patient information sheets (PISs) was developed to avoid patient overload. RESULTS A total of 332 patients were registered, 244 randomised. Among randomised patients, biomarker results were provided within 10 working days (w.d.) in 71%, 15 w.d. in 91% and 20 w.d. in 99%. DNA mutation analysis was 100% concordant between two laboratories. Over 90% of participants reported excellent understanding of all aspects of the trial. In this randomised phase II setting, omission of irinotecan in the low topo-1 group was associated with increased response rate and addition of cetuximab in the KRAS, BRAF wild-type cohort was associated with longer progression-free survival. CONCLUSIONS Patient samples can be collected and analysed within workable time frames and with reproducible mutation results. Complex multi-arm designs are acceptable to patients with good PIS. Randomisation within each cohort provides outcome data that can inform clinical practice.
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Affiliation(s)
- T S Maughan
- CRUK/MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford OX3 7DQ, UK
| | - A M Meade
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London WC2B 6NH, UK
| | - R A Adams
- Cardiff University and Velindre Cancer Centre, Cardiff, UK
| | - S D Richman
- Leeds Institute of Cancer and Pathology, University of Leeds, Leeds LS9 7TF, UK
| | - R Butler
- University Hospital of Wales, Cardiff CF14 4XW, UK
| | - D Fisher
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London WC2B 6NH, UK
| | - R H Wilson
- Centre for Cancer Research and Cell Biology, Queen's University Belfast, Belfast BT9 7AE, UK
| | - B Jasani
- Institute of Cancer and Genetics, Cardiff University, Cardiff CF14 4XN, UK
| | - G R Taylor
- Leeds Institute of Cancer and Pathology, University of Leeds, Leeds LS9 7TF, UK
| | - G T Williams
- Institute of Cancer and Genetics, Cardiff University, Cardiff CF14 4XN, UK
| | - J R Sampson
- Institute of Cancer and Genetics, Cardiff University, Cardiff CF14 4XN, UK
| | - M T Seymour
- St James's Institute of Oncology, University of Leeds, Leeds LS9 7TF, UK
| | - L L Nichols
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London WC2B 6NH, UK
| | - S L Kenny
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London WC2B 6NH, UK
| | - A Nelson
- Wales Cancer Trials Unit, Cardiff University, Cardiff CF14 4YS, UK
| | - C M Sampson
- Wales Cancer Trials Unit, Cardiff University, Cardiff CF14 4YS, UK
| | - E Hodgkinson
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S5 7AU, UK
| | | | - D L Furniss
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S5 7AU, UK
| | - R Roy
- Department of Oncology, Castle Hill Hospital, East Riding of Yorkshire HU16 5JQ, UK
| | - M J Pope
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London WC2B 6NH, UK
| | - J K Pope
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London WC2B 6NH, UK
| | - M Parmar
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London WC2B 6NH, UK
| | - P Quirke
- Leeds Institute of Cancer and Pathology, University of Leeds, Leeds LS9 7TF, UK
| | - R Kaplan
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London WC2B 6NH, UK
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Maughan T, Wilson RH, Williams GT, Seymour MT, Richman S, Quirke P, Pope M, Pope J, Parmar M, Nelson A, Meade AM, Kenny SL, Jasani B, Hodgkinson E, Fisher D, Butler R, Bridgewater JA, Adams RA, Kaplan RS. Developing a biomarker-stratified trial design in advanced colorectal cancer: The MRC FOCUS 3 feasibility study. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.tps165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Bridgewater JA, Stubbs C, Primrose JN. BILCAP: A randomized clinical trial evaluating adjuvant chemotherapy with capecitabine compared to expectant treatment alone following curative surgery for biliary tract cancer. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.4125] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- J. A. Bridgewater
- UCL, London, United Kingdom; Cancer Research UK Clinical Trials Unit (CRCTU), Birmingham, United Kingdom; Southampton General Hospital, Southampton, United Kingdom
| | - C. Stubbs
- UCL, London, United Kingdom; Cancer Research UK Clinical Trials Unit (CRCTU), Birmingham, United Kingdom; Southampton General Hospital, Southampton, United Kingdom
| | - J. N. Primrose
- UCL, London, United Kingdom; Cancer Research UK Clinical Trials Unit (CRCTU), Birmingham, United Kingdom; Southampton General Hospital, Southampton, United Kingdom
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Middleton GW, Gwyther SJ, Brown SR, Maughan T, Olivier C, Richman S, Maisey NR, Hill M, Gollins S, Myint S, Slater S, Wagstaff J, Bridgewater JA, Glynne-Jones R, Hemmings G, Marshall H, Blake D, Napp V, Quirke P, Seymour MT. Biomodulation of irinotecan using ciclosporin: Results of PICCOLO, a randomized controlled trial in advanced colorectal cancer (aCRC). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.3566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Valle JW, Bridgewater JA, Roughton M, Dive C, Hughes S, Wasan HS. ABC-03: A randomized, phase II/III study of cediranib (AZD2171) or placebo in combination with cisplatin/gemcitabine for patients with advanced biliary tract cancers. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.tps218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Mukherjee S, Hurt C, Griffiths G, Crosby T, Staffurth J, Bridges S, Bridgewater JA, Mcdonald A, Falk S, Maughan TS. A Cancer Research UK multicenter randomized phase II study of induction chemotherapy followed by gemcitabine- or capecitabine-based chemoradiotherapy for locally advanced nonmetastatic pancreatic cancer. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.tps222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Valle JW, Wasan HS, Palmer DD, Cunningham D, Anthoney DA, Maraveyas A, Hughes SK, Roughton M, Bridgewater JA. Gemcitabine with or without cisplatin in patients (pts) with advanced or metastatic biliary tract cancer (ABC): Results of a multicenter, randomized phase III trial (the UK ABC-02 trial). J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.4503] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [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
4503 Background: There is no established standard chemotherapy for pts with inoperable ABC. We previously reported an improvement in progression-free survival (PFS) in a randomised phase II trial of 86 pts (ABC-01) using gemcitabine/cisplatin (GemCis) vs. gemcitabine (Gem) (Valle ASCO-GI 2006, abstr. 98). This study was extended into ABC-02, a phase III trial, to recruit a further 314 pts with overall survival (OS) as the primary end-point. Methods: Consenting pts with histologically/cytologically-confirmed ABC, aged ≥18 years, ECOG performance status 0 - 2, and adequate haematological, hepatic and renal function were randomised to receive either Cis (25 mg/m2) followed by Gem (1000 mg/m2 D1, 8 q21d) for 8 cycles, or Gem alone (1000 mg/m2 on D1, 8, 15 q28d) for 6 cycles, stratified by extent of disease, site of primary tumour, ECOG score and centre. The trial had an 80% power to detect an OS hazard ratio of 0.73. Results: From May 2005 to October 2008, 324 pts were randomised to ABC- 02 from 34 UK centres. We report the pre-planned combined analysis of ABC-01 and ABC-02 based on 410 pts (GemCis=206/Gem=204). Patient characteristics: median age 64 yrs (range 23–85); male (47%); metastatic disease (75%), locally advanced (25%); gallbladder (36%), bile duct (59%), ampulla (5%); and ECOG 0–1 (87%), 2 (12%). With a median follow-up of 6.1 months and 263 deaths, the median OS was greater with GemCis than Gem, 11.7 vs. 8.2 months (log rank p=0.002), with hazard ratio 0.68 (95%-CI 0.53, 0.86). The median PFS was greater with GemCis than Gem, 8.5 vs. 6.5 months (log rank p=0.003), with hazard ratio 0.70 (95%-CI 0.56, 0.88).Toxicity was similar between the arms (by week 12, 57% had a grade 3/4 toxicity in each arm), though there was a slight excess of neutropenia using GemCis. Conclusions: This is the largest ever study in ABC and demonstrates a clear survival advantage for GemCis without added clinically significant toxicity, setting a new international standard of care. No significant financial relationships to disclose.
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Affiliation(s)
- J. W. Valle
- Christie Hospital NHS Trust, Manchester, United Kingdom; Imperial College Healthcare Trust, London, United Kingdom; University of Birmingham, Birmingham, United Kingdom; Royal Marsden Hospital, London, United Kingdom; St. James’ University Hospital, Leeds, United Kingdom; Castle Hill Hospital, Hull, United Kingdom; University College London, London, United Kingdom
| | - H. S. Wasan
- Christie Hospital NHS Trust, Manchester, United Kingdom; Imperial College Healthcare Trust, London, United Kingdom; University of Birmingham, Birmingham, United Kingdom; Royal Marsden Hospital, London, United Kingdom; St. James’ University Hospital, Leeds, United Kingdom; Castle Hill Hospital, Hull, United Kingdom; University College London, London, United Kingdom
| | - D. D. Palmer
- Christie Hospital NHS Trust, Manchester, United Kingdom; Imperial College Healthcare Trust, London, United Kingdom; University of Birmingham, Birmingham, United Kingdom; Royal Marsden Hospital, London, United Kingdom; St. James’ University Hospital, Leeds, United Kingdom; Castle Hill Hospital, Hull, United Kingdom; University College London, London, United Kingdom
| | - D. Cunningham
- Christie Hospital NHS Trust, Manchester, United Kingdom; Imperial College Healthcare Trust, London, United Kingdom; University of Birmingham, Birmingham, United Kingdom; Royal Marsden Hospital, London, United Kingdom; St. James’ University Hospital, Leeds, United Kingdom; Castle Hill Hospital, Hull, United Kingdom; University College London, London, United Kingdom
| | - D. A. Anthoney
- Christie Hospital NHS Trust, Manchester, United Kingdom; Imperial College Healthcare Trust, London, United Kingdom; University of Birmingham, Birmingham, United Kingdom; Royal Marsden Hospital, London, United Kingdom; St. James’ University Hospital, Leeds, United Kingdom; Castle Hill Hospital, Hull, United Kingdom; University College London, London, United Kingdom
| | - A. Maraveyas
- Christie Hospital NHS Trust, Manchester, United Kingdom; Imperial College Healthcare Trust, London, United Kingdom; University of Birmingham, Birmingham, United Kingdom; Royal Marsden Hospital, London, United Kingdom; St. James’ University Hospital, Leeds, United Kingdom; Castle Hill Hospital, Hull, United Kingdom; University College London, London, United Kingdom
| | - S. K. Hughes
- Christie Hospital NHS Trust, Manchester, United Kingdom; Imperial College Healthcare Trust, London, United Kingdom; University of Birmingham, Birmingham, United Kingdom; Royal Marsden Hospital, London, United Kingdom; St. James’ University Hospital, Leeds, United Kingdom; Castle Hill Hospital, Hull, United Kingdom; University College London, London, United Kingdom
| | - M. Roughton
- Christie Hospital NHS Trust, Manchester, United Kingdom; Imperial College Healthcare Trust, London, United Kingdom; University of Birmingham, Birmingham, United Kingdom; Royal Marsden Hospital, London, United Kingdom; St. James’ University Hospital, Leeds, United Kingdom; Castle Hill Hospital, Hull, United Kingdom; University College London, London, United Kingdom
| | - J. A. Bridgewater
- Christie Hospital NHS Trust, Manchester, United Kingdom; Imperial College Healthcare Trust, London, United Kingdom; University of Birmingham, Birmingham, United Kingdom; Royal Marsden Hospital, London, United Kingdom; St. James’ University Hospital, Leeds, United Kingdom; Castle Hill Hospital, Hull, United Kingdom; University College London, London, United Kingdom
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Bridgewater JA, Floore A, Warmoes MO, Veer van’t L. Can gene expression microarray (GEM) provide a diagnosis in cases of carcinoma of unknown primary? J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.20117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
20117 Patients with CUP constitute approximately 5% of all malignancies and have no primary site of malignancy despite standard investigation, a poor prognosis secondary to metastatic disease and generate despondency amongst clinicians. GEM may provide an improved diagnostic tool and improve prognosis for patients through the use of more site specific chemotherapy. CupPrint is a 1900 gene custom microarray optimized for paraffin samples which uses a compiled database of 591 cancer cases to provide a statistically proven method for the discrimination of 39 different tumor types. Few data are available on the practical application of this novel technique. We have taken paraffin samples from 21 cases of “true” CUP where standard investigation failed to determine a primary site of malignancy although there were some cases were more uncertain than others. Three 4μm sections from the paraffin blocks were analysed and reviewed in the context of the histology reports, an independent histological review and the clinical history. 2 datasets were available for 1 patient and 3 datasets for another. A case by case analysis will be given but in summary, 16/21 diagnoses confirmed the clinicians suspicion. There was a clinical/CupPrint inconsistency in 4/21 patients and a pathological/CupPrint inconsistency in 1 patient. All CupPrint diagnoses were possible clinically. There was a consistency between identical samples analysed blindly by CupPrint and a consistency between different sites of tumour metastasis in the same patient. For most patients there was a consistency within the “K-Nearest Neighbors” analysis (see http://www.agendia.com). Clinical suspicion coincides with CupPrint certainty such that in those patients for whom there was no suspected site of primary, the “K-Nearest Neighbours” analysis did not match. 11/21 patients had had palliative chemotherapy with a further 4 yet to be receive treatment thus 15/21 patients could receive palliative chemotherapy. 5 patients are still alive. CupPrint is a promising analytical tool in order to more appropriately direct systemic palliative treatment in patients with CUP. These data need to be expanded to demonstrate a survival benefit of CupPrint guided treatment in a randomized clinical study. [Table: see text]
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Affiliation(s)
- J. A. Bridgewater
- Royal Free and University College Medical School, London, United Kingdom; Agendia BV, Amsterdam, The Netherlands
| | - A. Floore
- Royal Free and University College Medical School, London, United Kingdom; Agendia BV, Amsterdam, The Netherlands
| | - M. O. Warmoes
- Royal Free and University College Medical School, London, United Kingdom; Agendia BV, Amsterdam, The Netherlands
| | - L. Veer van’t
- Royal Free and University College Medical School, London, United Kingdom; Agendia BV, Amsterdam, The Netherlands
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Raja FA, Bridgewater JA. Survival following first line fluorouracil single agent therapy for advanced colorectal cancer in a cancer unit practice in the United Kingdom (UK). J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.3613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- F. A. Raja
- Royal Free and Univ Coll Medcl Sch, London, United Kingdom
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Abstract
Ovarian tumours of non-epithelial origin are less common than those of epithelial origin but must be distinguished from these as their natural history and management differ. As these tumours are rare, histological review by an expert in the field is essential. There have been no randomised trials to outline the management of these tumours and therefore this paper represents a review of descriptive data. Non-epithelial ovarian tumours, which represent approximately 50% of all ovarian tumours and approximately 25% of malignant ovarian tumours, are outlined. Lymphomas and metastatic tumours should be treated the same as when found in other sites and will not be discussed further.
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Bridgewater JA, Nelstrop AE, Rustin GJ, Gore ME, McGuire WP, Hoskins WJ. Comparison of standard and CA-125 response criteria in patients with epithelial ovarian cancer treated with platinum or paclitaxel. J Clin Oncol 1999; 17:501-8. [PMID: 10080591 DOI: 10.1200/jco.1999.17.2.501] [Citation(s) in RCA: 94] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To assess CA-125 as a measure of response in patients treated with paclitaxel. PATIENTS AND METHODS One hundred forty-four patients treated with paclitaxel derived from four different trials and 625 patients treated with platinum from two trials were analyzed using precisely defined 50% and 75% reductions in CA-125. The standard and CA-125 response rates to paclitaxel and platinum were compared. In addition, we analyzed individual patient groups in which there was a difference in response according to the two response criteria. RESULTS Patients with stable disease as determined by standard criteria who were treated with platinum and responded according to CA-125 criteria have an improved median progression-free survival compared with patients with stable disease who did not respond according to CA-125 criteria (10.6 v 4.8 months; P<.001). Standard and CA-125 response rates for patients treated with platinum (58.93% v 61.31%, respectively) and paclitaxel (30.65% v 31.67%, respectively) were very similar, as were rates of false-positive prediction of response by CA-125 (platinum 2.2% and paclitaxel 2.9%). Responders to paclitaxel had a significantly improved progression-free survival compared with non-responders by both standard criteria (median progression-free survival, 6.8 v 2.5 months; P<.001) and CA-125 criteria (median progression-free survival, 6.8 v 3.4 months; P<.001). CONCLUSION Forassessing activity of therapy for ovarian cancer, these data show that precise 50% or 75% CA-125 response criteria are as sensitive as standard response criteria. We propose that they may be used as a measure of response in lieu of or in addition to standard response criteria in clinical trials involving epithelial ovarian cancer. Sensitivity is maintained whether patients are treated with platinum or paclitaxel.
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Affiliation(s)
- J A Bridgewater
- Mount Vernon Centre for Cancer Treatment, Middlesex, United Kingdom
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Affiliation(s)
- J A Bridgewater
- Mount Vernon Centre for Cancer Treatment, Mount Vernon Hospital, Rickmansworth Road, Northwood, Middlesex, HA6 2RN, United Kingdom
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Bridgewater JA, Knox RJ, Pitts JD, Collins MK, Springer CJ. The bystander effect of the nitroreductase/CB1954 enzyme/prodrug system is due to a cell-permeable metabolite. Hum Gene Ther 1997; 8:709-17. [PMID: 9113510 DOI: 10.1089/hum.1997.8.6-709] [Citation(s) in RCA: 107] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
The bystander effect is an important part of tumor kill using gene-directed enzyme prodrug therapy (GDEPT). Recently, we have described a novel enzyme prodrug system using bacterial nitroreductase and the prodrug CB1954 (NTR/CB1954). We demonstrate here the presence of a cell-permeable cytotoxic activity in the conditioned growth medium of nitroreductase (NTR)-transduced cells treated with CB1954 and show that its appearance corresponds to the appearance of two metabolites of CB1954 previously identified (Friedlos et al., 1992). The degree of bystander effect and the degree of transferred cytotoxicity correlates with the level of NTR enzyme expression. Two other prodrugs for NTR show little bystander killing and do not produce detectable cell permeable metabolites. The elucidation of the mechanism of the bystander effect may allow the more effective use of NTR/CB1954.
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Affiliation(s)
- J A Bridgewater
- CRC Centre for Cell and Molecular Biology, Chester Beatty Laboratories, Institute of Cancer Research, London, UK
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Bridgewater JA, Springer CJ, Knox RJ, Minton NP, Michael NP, Collins MK. Expression of the bacterial nitroreductase enzyme in mammalian cells renders them selectively sensitive to killing by the prodrug CB1954. Eur J Cancer 1995; 31A:2362-70. [PMID: 8652270 DOI: 10.1016/0959-8049(95)00436-x] [Citation(s) in RCA: 159] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
A recombinant retrovirus encoding E. coli nitroreductase (NTR) was used to infect mammalian cells. NIH3T3 cells expressing NTR were killed by the prodrug CB1954, which NTR converts to a bifunctional alkylating agent. Admixed, unmodified NIH3T3 cells could also be killed. In contrast to the Herpes simplex virus (HSV) thymidine kinase (TK)/ganciclovir(GCV) enzyme/prodrug system, NTR/CB1954 cell killing was effective in non-cycling cells. Co-operative killing was observed when cells expressing both NTR and TK were treated with a combination of CB1954 and GCV. NTR expression in human melanoma, ovarian carcinoma or mesothelioma cells also rendered them sensitive to CB1954 killing. These data suggest that delivery of the NTR gene to human tumours, followed by treatment with CB1954, may provide a novel tumour gene therapy approach.
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Affiliation(s)
- J A Bridgewater
- CRC Centre for Cell and Molecular Biology, Chester Beatty Laboratories, London, UK
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Salter J, MacLennan K, Bridgewater JA, Moore J, Atkinson H, Nicolson M, Riches P, Gore ME. The histological and immunohistochemical changes in the skin of patients with melanoma who develop changes in skin pigmentation following immunotherapy. Melanoma Res 1995; 5:267-71. [PMID: 7496163 DOI: 10.1097/00008390-199508000-00010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The histological and immunocytochemical appearances of skin with altered pigmentation from two patients receiving chemoimmunotherapy for melanoma were examined. In both patients, there was a clinical response to treatment coincident with depigmentation of skin and hair. Skin biopsies showed extensive infiltration with CD8+ and CD4+ lymphocytes rather than CD57+ in the depigmented areas suggestive of a specific MHC-related cytotoxic T-cell activity against melanocytes. In keeping with this, MHCII expression was markedly up-regulated. These observations suggest the development of a simultaneous anti-tumour and anti-melanocyte immune response stimulated by chemoimmunotherapy, possibly against the same or similar antigens.
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Affiliation(s)
- J Salter
- Department of Medicine, Royal Marsden Hospital, London, UK
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Bridgewater JA, Souhami RL, Allgrove J, Kendall B, Pritchard J. Intracranial germ cell tumours presenting with hypopituitarism. Successful treatment with chemotherapy alone. Eur J Cancer 1994; 30A:1401-3. [PMID: 7999435 DOI: 10.1016/0959-8049(94)90197-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Abstract
We describe a case of hypercalcaemia secondary to recurrent malignant phaeochromocytoma. Parathyroid-related protein (PTHrp 1-86) immunoreactivity was identified in plasma and PTHrp was identified by immunocytochemistry in tumour tissue.
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Affiliation(s)
- J A Bridgewater
- Department of Clinical Pharmacology, Rayne Institute, University College Hospital, London, UK
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