1
|
Attard G, Murphy L, Clarke NW, Sachdeva A, Jones C, Hoyle A, Cross W, Jones RJ, Parker CC, Gillessen S, Cook A, Brawley C, Gilson C, Rush H, Abdel-Aty H, Amos CL, Murphy C, Chowdhury S, Malik Z, Russell JM, Parkar N, Pugh C, Diaz-Montana C, Pezaro C, Grant W, Saxby H, Pedley I, O'Sullivan JM, Birtle A, Gale J, Srihari N, Thomas C, Tanguay J, Wagstaff J, Das P, Gray E, Alzouebi M, Parikh O, Robinson A, Montazeri AH, Wylie J, Zarkar A, Cathomas R, Brown MD, Jain Y, Dearnaley DP, Mason MD, Gilbert D, Langley RE, Millman R, Matheson D, Sydes MR, Brown LC, Parmar MKB, James ND. Abiraterone acetate plus prednisolone with or without enzalutamide for patients with metastatic prostate cancer starting androgen deprivation therapy: final results from two randomised phase 3 trials of the STAMPEDE platform protocol. Lancet Oncol 2023; 24:443-456. [PMID: 37142371 DOI: 10.1016/s1470-2045(23)00148-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 03/17/2023] [Accepted: 03/23/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND Abiraterone acetate plus prednisolone (herein referred to as abiraterone) or enzalutamide added at the start of androgen deprivation therapy improves outcomes for patients with metastatic prostate cancer. Here, we aimed to evaluate long-term outcomes and test whether combining enzalutamide with abiraterone and androgen deprivation therapy improves survival. METHODS We analysed two open-label, randomised, controlled, phase 3 trials of the STAMPEDE platform protocol, with no overlapping controls, conducted at 117 sites in the UK and Switzerland. Eligible patients (no age restriction) had metastatic, histologically-confirmed prostate adenocarcinoma; a WHO performance status of 0-2; and adequate haematological, renal, and liver function. Patients were randomly assigned (1:1) using a computerised algorithm and a minimisation technique to either standard of care (androgen deprivation therapy; docetaxel 75 mg/m2 intravenously for six cycles with prednisolone 10 mg orally once per day allowed from Dec 17, 2015) or standard of care plus abiraterone acetate 1000 mg and prednisolone 5 mg (in the abiraterone trial) orally or abiraterone acetate and prednisolone plus enzalutamide 160 mg orally once a day (in the abiraterone and enzalutamide trial). Patients were stratified by centre, age, WHO performance status, type of androgen deprivation therapy, use of aspirin or non-steroidal anti-inflammatory drugs, pelvic nodal status, planned radiotherapy, and planned docetaxel use. The primary outcome was overall survival assessed in the intention-to-treat population. Safety was assessed in all patients who started treatment. A fixed-effects meta-analysis of individual patient data was used to compare differences in survival between the two trials. STAMPEDE is registered with ClinicalTrials.gov (NCT00268476) and ISRCTN (ISRCTN78818544). FINDINGS Between Nov 15, 2011, and Jan 17, 2014, 1003 patients were randomly assigned to standard of care (n=502) or standard of care plus abiraterone (n=501) in the abiraterone trial. Between July 29, 2014, and March 31, 2016, 916 patients were randomly assigned to standard of care (n=454) or standard of care plus abiraterone and enzalutamide (n=462) in the abiraterone and enzalutamide trial. Median follow-up was 96 months (IQR 86-107) in the abiraterone trial and 72 months (61-74) in the abiraterone and enzalutamide trial. In the abiraterone trial, median overall survival was 76·6 months (95% CI 67·8-86·9) in the abiraterone group versus 45·7 months (41·6-52·0) in the standard of care group (hazard ratio [HR] 0·62 [95% CI 0·53-0·73]; p<0·0001). In the abiraterone and enzalutamide trial, median overall survival was 73·1 months (61·9-81·3) in the abiraterone and enzalutamide group versus 51·8 months (45·3-59·0) in the standard of care group (HR 0·65 [0·55-0·77]; p<0·0001). We found no difference in the treatment effect between these two trials (interaction HR 1·05 [0·83-1·32]; pinteraction=0·71) or between-trial heterogeneity (I2 p=0·70). In the first 5 years of treatment, grade 3-5 toxic effects were higher when abiraterone was added to standard of care (271 [54%] of 498 vs 192 [38%] of 502 with standard of care) and the highest toxic effects were seen when abiraterone and enzalutamide were added to standard of care (302 [68%] of 445 vs 204 [45%] of 454 with standard of care). Cardiac causes were the most common cause of death due to adverse events (five [1%] with standard of care plus abiraterone and enzalutamide [two attributed to treatment] and one (<1%) with standard of care in the abiraterone trial). INTERPRETATION Enzalutamide and abiraterone should not be combined for patients with prostate cancer starting long-term androgen deprivation therapy. Clinically important improvements in survival from addition of abiraterone to androgen deprivation therapy are maintained for longer than 7 years. FUNDING Cancer Research UK, UK Medical Research Council, Swiss Group for Clinical Cancer Research, Janssen, and Astellas.
Collapse
Affiliation(s)
- Gerhardt Attard
- Cancer Institute, University College London, London, UK; University College London Hospitals, London, UK.
| | - Laura Murphy
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - Noel W Clarke
- Christie and Salford Royal NHS Foundation Trusts, Manchester, UK
| | - Ashwin Sachdeva
- Christie and Salford Royal NHS Foundation Trusts, Manchester, UK
| | - Craig Jones
- Christie and Salford Royal NHS Foundation Trusts, Manchester, UK
| | - Alex Hoyle
- Christie and Salford Royal NHS Foundation Trusts, Manchester, UK
| | | | - Robert J Jones
- Beatson West of Scotland Cancer Centre, University of Glasgow, Glasgow, UK
| | | | - Silke Gillessen
- Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; CH and Universita della Svizzera Italiana, Lugano, Switzerland
| | - Adrian Cook
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - Chris Brawley
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - Clare Gilson
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - Hannah Rush
- Medical Research Council Clinical Trials Unit, University College London, London, UK; Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Hoda Abdel-Aty
- Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London, UK
| | - Claire L Amos
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - Claire Murphy
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | | | - Zafar Malik
- Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, UK
| | - J Martin Russell
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Nazia Parkar
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - Cheryl Pugh
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - Carlos Diaz-Montana
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | | | | | - Helen Saxby
- Torbay and South Devon NHS Foundation Trust, Torbay, UK
| | - Ian Pedley
- Northern Centre for Cancer Care, Newcastle upon Tyne, UK
| | | | - Alison Birtle
- Rosemere Cancer Centre, Royal Preston Hospital, Preston, UK
| | | | | | | | | | | | | | - Emma Gray
- Yeovil District Hospital NHS Foundation Trust, Yeovil, UK
| | | | - Omi Parikh
- East Lancashire Hospitals NHS Trust, Preston, UK
| | | | | | - James Wylie
- Christie and Salford Royal NHS Foundation Trusts, Manchester, UK
| | - Anjali Zarkar
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Richard Cathomas
- Division of Oncology and Hematology, Cantonal Hospital Graubünden, Chur, Switzerland; Swiss Group for Clinical Cancer Research, Bern, Switzerland
| | - Michael D Brown
- Christie and Salford Royal NHS Foundation Trusts, Manchester, UK
| | - Yatin Jain
- Christie and Salford Royal NHS Foundation Trusts, Manchester, UK
| | - David P Dearnaley
- Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London, UK
| | | | - Duncan Gilbert
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - Ruth E Langley
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - Robin Millman
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - David Matheson
- Faculty of Education Health and Wellbeing, University of Wolverhampton, Walsall, UK
| | - Matthew R Sydes
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - Louise C Brown
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - Mahesh K B Parmar
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - Nicholas D James
- Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London, UK
| |
Collapse
|
2
|
James ND, Clarke NW, Cook A, Ali A, Hoyle AP, Attard G, Brawley CD, Chowdhury S, Cross WR, Dearnaley DP, de Bono JS, Diaz‐Montana C, Gilbert D, Gillessen S, Gilson C, Jones RJ, Langley RE, Malik ZI, Matheson DJ, Millman R, Parker CC, Pugh C, Rush H, Russell JM, Berthold DR, Buckner ML, Mason MD, Ritchie AWS, Birtle AJ, Brock SJ, Das P, Ford D, Gale J, Grant W, Gray EK, Hoskin P, Khan MM, Manetta C, McPhail NJ, O'Sullivan JM, Parikh O, Perna C, Pezaro CJ, Protheroe AS, Robinson AJ, Rudman SM, Sheehan DJ, Srihari NN, Syndikus I, Tanguay JS, Thomas CW, Vengalil S, Wagstaff J, Wylie JP, Parmar MKB, Sydes MR. Abiraterone acetate plus prednisolone for metastatic patients starting hormone therapy: 5-year follow-up results from the STAMPEDE randomised trial (NCT00268476). Int J Cancer 2022; 151:422-434. [PMID: 35411939 PMCID: PMC9321995 DOI: 10.1002/ijc.34018] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [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: 12/10/2021] [Revised: 02/15/2022] [Accepted: 02/22/2022] [Indexed: 11/17/2022]
Abstract
Abiraterone acetate plus prednisolone (AAP) previously demonstrated improved survival in STAMPEDE, a multiarm, multistage platform trial in men starting long-term hormone therapy for prostate cancer. This long-term analysis in metastatic patients was planned for 3 years after the first results. Standard-of-care (SOC) was androgen deprivation therapy. The comparison randomised patients 1:1 to SOC-alone with or without daily abiraterone acetate 1000 mg + prednisolone 5 mg (SOC + AAP), continued until disease progression. The primary outcome measure was overall survival. Metastatic disease risk group was classified retrospectively using baseline CT and bone scans by central radiological review and pathology reports. Analyses used Cox proportional hazards and flexible parametric models, accounting for baseline stratification factors. One thousand and three patients were contemporaneously randomised (November 2011 to January 2014): median age 67 years; 94% newly-diagnosed; metastatic disease risk group: 48% high, 44% low, 8% unassessable; median PSA 97 ng/mL. At 6.1 years median follow-up, 329 SOC-alone deaths (118 low-risk, 178 high-risk) and 244 SOC + AAP deaths (75 low-risk, 145 high-risk) were reported. Adjusted HR = 0.60 (95% CI: 0.50-0.71; P = 0.31 × 10-9 ) favoured SOC + AAP, with 5-years survival improved from 41% SOC-alone to 60% SOC + AAP. This was similar in low-risk (HR = 0.55; 95% CI: 0.41-0.76) and high-risk (HR = 0.54; 95% CI: 0.43-0.69) patients. Median and current maximum time on SOC + AAP was 2.4 and 8.1 years. Toxicity at 4 years postrandomisation was similar, with 16% patients in each group reporting grade 3 or higher toxicity. A sustained and substantial improvement in overall survival of all metastatic prostate cancer patients was achieved with SOC + abiraterone acetate + prednisolone, irrespective of metastatic disease risk group.
Collapse
Affiliation(s)
| | - Noel W. Clarke
- The Departments of Surgery & UrologyThe Christie & Salford Royal HospitalsManchesterUK
| | - Adrian Cook
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, UCLLondonUK
| | - Adnan Ali
- The Christie NHS Foundation TrustManchesterUK
| | | | | | - Christopher D. Brawley
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, UCLLondonUK
| | - Simon Chowdhury
- Guy's, King's, & St. Thomas' Hospitals, and Sarah Cannon Research InstituteLondonUK
| | | | - David P. Dearnaley
- The Institute of Cancer Research and Royal Marsden NHS Foundation TrustLondonUK
| | | | - Carlos Diaz‐Montana
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, UCLLondonUK
| | - Duncan Gilbert
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, UCLLondonUK
| | - Silke Gillessen
- Istituto Oncologico della Svizzera ItalianaBellinzonaSwitzerland
| | - Clare Gilson
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, UCLLondonUK
- Royal Marsden HospitalLondonUK
| | - Rob J. Jones
- Beatson West of Scotland Cancer Centre, University of GlasgowGlasgowUK
| | - Ruth E. Langley
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, UCLLondonUK
| | - Zafar I. Malik
- Radiotherapy UnitThe Clatterbridge Cancer Centre NHS Foundation TrustLiverpoolLiverpoolL7 8YAUK
| | - David J. Matheson
- School of Allied Health and Midwifery, Faculty of Education, Health and WellbeingUniversity of WolverhamptonWolverhamptonWS1 3BDUK
| | | | - Chris C. Parker
- Uro‐Oncology UnitRoyal Marsden Hospital and Institute of Cancer ResearchSuttonUK
| | - Cheryl Pugh
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, UCLLondonUK
| | - Hannah Rush
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, UCLLondonUK
- Guys and St Thomas' NHS Foundation TrustLondonUK
| | - J. Martin Russell
- Institute of Cancer Sciences, University of GlasgowGlasgowUK
- Beatson West of Scotland Cancer CentreGlasgowUK
| | | | - Michelle L. Buckner
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, UCLLondonUK
| | | | | | - Alison J. Birtle
- Rosemere Cancer Centre, Lancashire Teaching Hospitals & University of Manchester, University of Central LancashireLancashireUK
| | | | - Prantik Das
- Department of OncologyUniversity Hospitals of Derby and Burton NHS Foundation TrustDerbyUK
| | - Dan Ford
- City Hospital, Cancer Centre at Queen Elizabeth HospitalBirminghamUK
| | - Joanna Gale
- Portsmouth Hospitals University TrustPortsmouthUK
| | - Warren Grant
- Gloucestershire Oncology Centre, Cheltenham General HospitalCheltenhamUK
| | | | | | - Mohammad M. Khan
- Department of Oncology Castle Hill HospitalHullUK
- Scarborough General HospitalScarboroughUK
| | | | | | - Joe M. O'Sullivan
- Patrick G Johnston Centre for Cancer Research, Queen's University BelfastBelfastUK
| | - Omi Parikh
- Rosemere Cancer Centre, Lancashire Teaching Hospitals NHS TrustPrestonUK
| | - Carla Perna
- Royal Surrey NHS Foundation TrustGuildfordUK
| | | | | | | | | | | | | | - Isabel Syndikus
- Radiotherapy UnitThe Clatterbridge Cancer Centre NHS Foundation TrustLiverpoolLiverpoolL7 8YAUK
| | | | | | - Salil Vengalil
- University Hospital North Midlands NHS TrustStaffordshireUK
| | - John Wagstaff
- Swansea University and the South West UK Cancer CentreSwanseaUK
| | | | - Mahesh K. B. Parmar
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, UCLLondonUK
| | - Matthew R. Sydes
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, UCLLondonUK
| | | |
Collapse
|
3
|
James ND, Ingleby FC, Clarke NW, Amos CL, Attard G, Brawley CD, Chowdhury S, Cross W, Dearnaley DP, Gilbert DC, Gillessen S, Jones RJ, Langley RE, Macnair A, Malik ZI, Mason MD, Matheson DJ, Millman R, Parker CC, Rush HL, Russell JM, Au C, Ritchie AWS, Mestre RP, Ahmed I, Birtle AJ, Brock SJ, Das P, Ford VA, Gray EK, Hughes RJ, Manetta CB, McLaren DB, Nikapota AD, O'Sullivan JM, Perna C, Peedell C, Protheroe AS, Sundar S, Tanguay JS, Tolan SP, Wagstaff J, Wallace JB, Wylie JP, Zarkar A, Parmar MKB, Sydes MR. Docetaxel for Nonmetastatic Prostate Cancer: Long-Term Survival Outcomes in the STAMPEDE Randomized Controlled Trial. JNCI Cancer Spectr 2022; 6:6649740. [PMID: 35877084 PMCID: PMC9338456 DOI: 10.1093/jncics/pkac043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 12/02/2021] [Accepted: 02/24/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND STAMPEDE previously reported adding upfront docetaxel improved overall survival for prostate cancer patients starting long-term androgen deprivation therapy. We report long-term results for non-metastatic patients using, as primary outcome, metastatic progression-free survival (mPFS), an externally demonstrated surrogate for overall survival. METHODS Standard of care (SOC) was androgen deprivation therapy with or without radical prostate radiotherapy. A total of 460 SOC and 230 SOC plus docetaxel were randomly assigned 2:1. Standard survival methods and intention to treat were used. Treatment effect estimates were summarized from adjusted Cox regression models, switching to restricted mean survival time if non-proportional hazards. mPFS (new metastases, skeletal-related events, or prostate cancer death) had 70% power (α = 0.05) for a hazard ratio (HR) of 0.70. Secondary outcome measures included overall survival, failure-free survival (FFS), and progression-free survival (PFS: mPFS, locoregional progression). RESULTS Median follow-up was 6.5 years with 142 mPFS events on SOC (3 year and 54% increases over previous report). There was no good evidence of an advantage to SOC plus docetaxel on mPFS (HR = 0.89, 95% confidence interval [CI] = 0.66 to 1.19; P = .43); with 5-year mPFS 82% (95% CI = 78% to 87%) SOC plus docetaxel vs 77% (95% CI = 73% to 81%) SOC. Secondary outcomes showed evidence SOC plus docetaxel improved FFS (HR = 0.70, 95% CI = 0.55 to 0.88; P = .002) and PFS (nonproportional P = .03, restricted mean survival time difference = 5.8 months, 95% CI = 0.5 to 11.2; P = .03) but no good evidence of overall survival benefit (125 SOC deaths; HR = 0.88, 95% CI = 0.64 to 1.21; P = .44). There was no evidence SOC plus docetaxel increased late toxicity: post 1 year, 29% SOC and 30% SOC plus docetaxel grade 3-5 toxicity. CONCLUSIONS There is robust evidence that SOC plus docetaxel improved FFS and PFS (previously shown to increase quality-adjusted life-years), without excess late toxicity, which did not translate into benefit for longer-term outcomes. This may influence patient management in individual cases.
Collapse
Affiliation(s)
- Nicholas D James
- Division of Radiotherapy and Imaging, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, UK
| | - Fiona C Ingleby
- MRC Clinical Trials Unit at University College London (UCL), Institute of Clinical Trials and Methodology, UCL, London, UK
| | - Noel W Clarke
- The Christie and Salford Royal Hospitals, Manchester, UK
| | - Claire L Amos
- MRC Clinical Trials Unit at University College London (UCL), Institute of Clinical Trials and Methodology, UCL, London, UK
| | | | - Christopher D Brawley
- MRC Clinical Trials Unit at University College London (UCL), Institute of Clinical Trials and Methodology, UCL, London, UK
| | - Simon Chowdhury
- Guy's and St. Thomas' NHS Foundation Trust, London, UK.,Sarah Cannon Research Institute, London, UK
| | | | - David P Dearnaley
- Division of Radiotherapy and Imaging, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, UK
| | - Duncan C Gilbert
- MRC Clinical Trials Unit at University College London (UCL), Institute of Clinical Trials and Methodology, UCL, London, UK
| | - Silke Gillessen
- Istituto Oncologico della Svizzera Italiana, Bellinzona, Switzerland
| | - Robert J Jones
- Institute of Cancer Sciences, University of Glasgow, Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - Ruth E Langley
- MRC Clinical Trials Unit at University College London (UCL), Institute of Clinical Trials and Methodology, UCL, London, UK
| | - Archie Macnair
- MRC Clinical Trials Unit at University College London (UCL), Institute of Clinical Trials and Methodology, UCL, London, UK.,Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Zafar I Malik
- The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, UK
| | | | - David J Matheson
- Faculty of Education, Health and Wellbeing, University of Wolverhampton, Wolverhampton, UK
| | - Robin Millman
- MRC Clinical Trials Unit at University College London (UCL), Institute of Clinical Trials and Methodology, UCL, London, UK
| | - Chris C Parker
- Division of Radiotherapy and Imaging, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, UK
| | - Hannah L Rush
- MRC Clinical Trials Unit at University College London (UCL), Institute of Clinical Trials and Methodology, UCL, London, UK.,Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - J Martin Russell
- Institute of Cancer Sciences, University of Glasgow, Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - Carly Au
- MRC Clinical Trials Unit at University College London (UCL), Institute of Clinical Trials and Methodology, UCL, London, UK
| | - Alastair W S Ritchie
- Urology Department, Gloucestershire Royal NHS Foundation Trust, Gloucester, UK (retired)
| | - Ricardo Pereira Mestre
- Oncology Institute of Southern Switzerland, Bellinzona, Switzerland.,Institute of Oncology Research (IOR), Bellinzona, Switzerland
| | | | - Alison J Birtle
- Rosemere Cancer Centre Lancs Teaching Hospitals, Preston, UK.,University of Manchester, Manchester, UK.,University of Central Lancashire (UCLan), Lancaster, UK
| | | | - Prantik Das
- University Hospitals of Derby NHS Foundation Trust, Derby, UK
| | | | | | | | | | - Duncan B McLaren
- Edinburgh Cancer Centre, Western General Hospital, Edinburgh, UK
| | - Ashok D Nikapota
- Sussex Cancer Centre, University Hospitals Sussex, Brighton, UK.,Worthing and Southlands Hospital, Worthing, UK
| | - Joe M O'Sullivan
- Patrick G. Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, UK
| | - Carla Perna
- Royal Surrey NHS Foundation Trust, Guildford, UK
| | | | | | | | | | - Shaun P Tolan
- The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, UK
| | - John Wagstaff
- Swansea University College of Medicine & The South West Wales Cancer Centre, Swansea, UK
| | | | | | | | - Mahesh K B Parmar
- MRC Clinical Trials Unit at University College London (UCL), Institute of Clinical Trials and Methodology, UCL, London, UK
| | - Matthew R Sydes
- MRC Clinical Trials Unit at University College London (UCL), Institute of Clinical Trials and Methodology, UCL, London, UK
| |
Collapse
|
4
|
Rush HL, Murphy L, Morgans AK, Clarke NW, Cook AD, Attard G, Macnair A, Dearnaley DP, Parker CC, Russell JM, Gillessen S, Matheson D, Millman R, Brawley CD, Pugh C, Tanguay JS, Jones RJ, Wagstaff J, Rudman S, O'Sullivan JM, Gale J, Birtle A, Protheroe A, Gray E, Perna C, Tolan S, McPhail N, Malik ZI, Vengalil S, Fackrell D, Hoskin P, Sydes MR, Chowdhury S, Gilbert DC, Parmar MKB, James ND, Langley RE. Quality of Life in Men With Prostate Cancer Randomly Allocated to Receive Docetaxel or Abiraterone in the STAMPEDE Trial. J Clin Oncol 2022; 40:825-836. [PMID: 34757812 PMCID: PMC7612717 DOI: 10.1200/jco.21.00728] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [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: 03/22/2021] [Revised: 08/09/2021] [Accepted: 10/01/2021] [Indexed: 12/13/2022] Open
Abstract
PURPOSE Docetaxel and abiraterone acetate plus prednisone or prednisolone (AAP) both improve survival when commenced alongside standard of care (SOC) androgen deprivation therapy in locally advanced or metastatic hormone-sensitive prostate cancer. Thus, patient-reported quality of life (QOL) data may guide treatment choices. METHODS A group of patients within the STAMPEDE trial were contemporaneously enrolled with the possibility of being randomly allocated to receive either docetaxel + SOC or AAP + SOC. A mixed-model assessed QOL in those who had completed at least one QLQ-C30 + PR25 questionnaire. The primary outcome measure was difference in global-QOL (QLQ-C30 Q29&30) between patients allocated to docetaxel + SOC or AAP + SOC over the 2 years after random assignment, with a predefined criterion for clinically meaningful difference of > 4.0 points. Secondary outcome measures included longitudinal comparison of functional domains, pain, and fatigue, plus global-QOL at defined timepoints. RESULTS Five hundred fifteen patients (173 docetaxel + SOC and 342 AAP + SOC) were included. Baseline characteristics, proportion of missing data, and mean baseline global-QOL scores (docetaxel + SOC 77.8 and AAP + SOC 78.0) were similar. Over the 2 years following random assignment, the mean modeled global-QOL score was +3.9 points (95% CI, +0.5 to +7.2; P = .022) higher in patients allocated to AAP + SOC. Global-QOL was higher for patients allocated to AAP + SOC over the first year (+5.7 points, 95% CI, +3.0 to +8.5; P < .001), particularly at 12 (+7.0 points, 95% CI, +3.0 to +11.0; P = .001) and 24 weeks (+8.3 points, 95% CI, +4.0 to +12.6; P < .001). CONCLUSION Patient-reported QOL was superior for patients allocated to receive AAP + SOC, compared with docetaxel + SOC over a 2-year period, narrowly missing the predefined value for clinical significance. Patients receiving AAP + SOC reported clinically meaningful higher global-QOL scores throughout the first year following random assignment.
Collapse
Affiliation(s)
- Hannah L. Rush
- MRC Clinical Trials Units at University College London, London, United Kingdom
| | - Laura Murphy
- MRC Clinical Trials Units at University College London, London, United Kingdom
| | | | - Noel W. Clarke
- The Christie and Salford Royal NHS Foundation Trusts, Manchester, United Kingdom
| | - Adrian D. Cook
- MRC Clinical Trials Units at University College London, London, United Kingdom
| | | | - Archie Macnair
- MRC Clinical Trials Units at University College London, London, United Kingdom
- Guys and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - David P. Dearnaley
- Royal Marsden NHS Foundation Trust and the Institute of Cancer Research, London, United Kingdom
| | - Christopher C. Parker
- Royal Marsden NHS Foundation Trust and the Institute of Cancer Research, London, United Kingdom
| | - J. Martin Russell
- Institute of Cancer Sciences, University of Glasgow, Beatson West of Scotland Cancer Centre, Glasgow, Scotland
| | - Silke Gillessen
- Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - David Matheson
- University of Wolverhampton, Wolverhampton, United Kingdom
| | - Robin Millman
- MRC Clinical Trials Units at University College London, London, United Kingdom
| | | | - Cheryl Pugh
- MRC Clinical Trials Units at University College London, London, United Kingdom
| | | | - Robert J. Jones
- Institute of Cancer Sciences, University of Glasgow, Beatson West of Scotland Cancer Centre, Glasgow, Scotland
| | - John Wagstaff
- Swansea University College of Medicine, Swansea, United Kingdom
| | - Sarah Rudman
- Guys and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Joe M. O'Sullivan
- Patrick G. Johnston Centre for Cancer Research, Queen's University Belfast, United Kingdom
| | - Joanna Gale
- Portsmouth Hospital University Trust, Portsmouth, United Kingdom
| | - Alison Birtle
- Rosemere Cancer Centre, Lancs Teaching Hospitals, Preston, United Kingdom
- University of Manchester, Manchester, United Kingdom
| | - Andrew Protheroe
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Emma Gray
- Musgrove Park Hospital, Taunton, United Kingdom
| | - Carla Perna
- Royal Surrey Hospital Foundation Trust, Guildford, United Kingdom
| | - Shaun Tolan
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, United Kingdom
| | | | - Zaf I. Malik
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Salil Vengalil
- University Hospital North Midlands NHS Trust, Stoke-on-Trent, United Kingdom
| | - David Fackrell
- University Hospital Birmingham, Birmingham, United Kingdom
| | - Peter Hoskin
- University of Manchester, Manchester, United Kingdom
- Mount Vernon Cancer Centre and University of Manchester, Manchester, United Kingdom
| | - Matthew R. Sydes
- MRC Clinical Trials Units at University College London, London, United Kingdom
| | - Simon Chowdhury
- Guys and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Duncan C. Gilbert
- MRC Clinical Trials Units at University College London, London, United Kingdom
| | - Mahesh K. B. Parmar
- MRC Clinical Trials Units at University College London, London, United Kingdom
| | - Nicholas D. James
- Royal Marsden NHS Foundation Trust and the Institute of Cancer Research, London, United Kingdom
| | - Ruth E. Langley
- MRC Clinical Trials Units at University College London, London, United Kingdom
| |
Collapse
|
5
|
Attard G, Murphy L, Clarke NW, Cross W, Jones RJ, Parker CC, Gillessen S, Cook A, Brawley C, Amos CL, Atako N, Pugh C, Buckner M, Chowdhury S, Malik Z, Russell JM, Gilson C, Rush H, Bowen J, Lydon A, Pedley I, O'Sullivan JM, Birtle A, Gale J, Srihari N, Thomas C, Tanguay J, Wagstaff J, Das P, Gray E, Alzoueb M, Parikh O, Robinson A, Syndikus I, Wylie J, Zarkar A, Thalmann G, de Bono JS, Dearnaley DP, Mason MD, Gilbert D, Langley RE, Millman R, Matheson D, Sydes MR, Brown LC, Parmar MKB, James ND. Abiraterone acetate and prednisolone with or without enzalutamide for high-risk non-metastatic prostate cancer: a meta-analysis of primary results from two randomised controlled phase 3 trials of the STAMPEDE platform protocol. Lancet 2022; 399:447-460. [PMID: 34953525 PMCID: PMC8811484 DOI: 10.1016/s0140-6736(21)02437-5] [Citation(s) in RCA: 157] [Impact Index Per Article: 78.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 11/02/2021] [Accepted: 11/03/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND Men with high-risk non-metastatic prostate cancer are treated with androgen-deprivation therapy (ADT) for 3 years, often combined with radiotherapy. We analysed new data from two randomised controlled phase 3 trials done in a multiarm, multistage platform protocol to assess the efficacy of adding abiraterone and prednisolone alone or with enzalutamide to ADT in this patient population. METHODS These open-label, phase 3 trials were done at 113 sites in the UK and Switzerland. Eligible patients (no age restrictions) had high-risk (defined as node positive or, if node negative, having at least two of the following: tumour stage T3 or T4, Gleason sum score of 8-10, and prostate-specific antigen [PSA] concentration ≥40 ng/mL) or relapsing with high-risk features (≤12 months of total ADT with an interval of ≥12 months without treatment and PSA concentration ≥4 ng/mL with a doubling time of <6 months, or a PSA concentration ≥20 ng/mL, or nodal relapse) non-metastatic prostate cancer, and a WHO performance status of 0-2. Local radiotherapy (as per local guidelines, 74 Gy in 37 fractions to the prostate and seminal vesicles or the equivalent using hypofractionated schedules) was mandated for node negative and encouraged for node positive disease. In both trials, patients were randomly assigned (1:1), by use of a computerised algorithm, to ADT alone (control group), which could include surgery and luteinising-hormone-releasing hormone agonists and antagonists, or with oral abiraterone acetate (1000 mg daily) and oral prednisolone (5 mg daily; combination-therapy group). In the second trial with no overlapping controls, the combination-therapy group also received enzalutamide (160 mg daily orally). ADT was given for 3 years and combination therapy for 2 years, except if local radiotherapy was omitted when treatment could be delivered until progression. In this primary analysis, we used meta-analysis methods to pool events from both trials. The primary endpoint of this meta-analysis was metastasis-free survival. Secondary endpoints were overall survival, prostate cancer-specific survival, biochemical failure-free survival, progression-free survival, and toxicity and adverse events. For 90% power and a one-sided type 1 error rate set to 1·25% to detect a target hazard ratio for improvement in metastasis-free survival of 0·75, approximately 315 metastasis-free survival events in the control groups was required. Efficacy was assessed in the intention-to-treat population and safety according to the treatment started within randomised allocation. STAMPEDE is registered with ClinicalTrials.gov, NCT00268476, and with the ISRCTN registry, ISRCTN78818544. FINDINGS Between Nov 15, 2011, and March 31, 2016, 1974 patients were randomly assigned to treatment. The first trial allocated 455 to the control group and 459 to combination therapy, and the second trial, which included enzalutamide, allocated 533 to the control group and 527 to combination therapy. Median age across all groups was 68 years (IQR 63-73) and median PSA 34 ng/ml (14·7-47); 774 (39%) of 1974 patients were node positive, and 1684 (85%) were planned to receive radiotherapy. With median follow-up of 72 months (60-84), there were 180 metastasis-free survival events in the combination-therapy groups and 306 in the control groups. Metastasis-free survival was significantly longer in the combination-therapy groups (median not reached, IQR not evaluable [NE]-NE) than in the control groups (not reached, 97-NE; hazard ratio [HR] 0·53, 95% CI 0·44-0·64, p<0·0001). 6-year metastasis-free survival was 82% (95% CI 79-85) in the combination-therapy group and 69% (66-72) in the control group. There was no evidence of a difference in metatasis-free survival when enzalutamide and abiraterone acetate were administered concurrently compared with abiraterone acetate alone (interaction HR 1·02, 0·70-1·50, p=0·91) and no evidence of between-trial heterogeneity (I2 p=0·90). Overall survival (median not reached [IQR NE-NE] in the combination-therapy groups vs not reached [103-NE] in the control groups; HR 0·60, 95% CI 0·48-0·73, p<0·0001), prostate cancer-specific survival (not reached [NE-NE] vs not reached [NE-NE]; 0·49, 0·37-0·65, p<0·0001), biochemical failure-free-survival (not reached [NE-NE] vs 86 months [83-NE]; 0·39, 0·33-0·47, p<0·0001), and progression-free-survival (not reached [NE-NE] vs not reached [103-NE]; 0·44, 0·36-0·54, p<0·0001) were also significantly longer in the combination-therapy groups than in the control groups. Adverse events grade 3 or higher during the first 24 months were, respectively, reported in 169 (37%) of 451 patients and 130 (29%) of 455 patients in the combination-therapy and control groups of the abiraterone trial, respectively, and 298 (58%) of 513 patients and 172 (32%) of 533 patients of the combination-therapy and control groups of the abiraterone and enzalutamide trial, respectively. The two most common events more frequent in the combination-therapy groups were hypertension (abiraterone trial: 23 (5%) in the combination-therapy group and six (1%) in control group; abiraterone and enzalutamide trial: 73 (14%) and eight (2%), respectively) and alanine transaminitis (abiraterone trial: 25 (6%) in the combination-therapy group and one (<1%) in control group; abiraterone and enzalutamide trial: 69 (13%) and four (1%), respectively). Seven grade 5 adverse events were reported: none in the control groups, three in the abiraterone acetate and prednisolone group (one event each of rectal adenocarcinoma, pulmonary haemorrhage, and a respiratory disorder), and four in the abiraterone acetate and prednisolone with enzalutamide group (two events each of septic shock and sudden death). INTERPRETATION Among men with high-risk non-metastatic prostate cancer, combination therapy is associated with significantly higher rates of metastasis-free survival compared with ADT alone. Abiraterone acetate with prednisolone should be considered a new standard treatment for this population. FUNDING Cancer Research UK, UK Medical Research Council, Swiss Group for Clinical Cancer Research, Janssen, and Astellas.
Collapse
Affiliation(s)
- Gerhardt Attard
- Cancer Institute, University College London, London, UK; University College London Hospitals, London, UK.
| | - Laura Murphy
- MRC Clinical Trials Unit at University College London, London, UK
| | - Noel W Clarke
- The Christie and Salford Royal NHS Foundation Trusts, Manchester, UK
| | | | | | | | - Silke Gillessen
- Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Universita della Svizzera Italiana, Lugano, Switzerland
| | - Adrian Cook
- MRC Clinical Trials Unit at University College London, London, UK
| | - Chris Brawley
- MRC Clinical Trials Unit at University College London, London, UK
| | - Claire L Amos
- MRC Clinical Trials Unit at University College London, London, UK
| | - Nafisah Atako
- MRC Clinical Trials Unit at University College London, London, UK
| | - Cheryl Pugh
- MRC Clinical Trials Unit at University College London, London, UK
| | - Michelle Buckner
- MRC Clinical Trials Unit at University College London, London, UK
| | | | - Zafar Malik
- Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, UK
| | | | - Clare Gilson
- MRC Clinical Trials Unit at University College London, London, UK
| | - Hannah Rush
- MRC Clinical Trials Unit at University College London, London, UK
| | - Jo Bowen
- Cheltenham General Hospital, Cheltenham, UK
| | - Anna Lydon
- Torbay and South Devon NHS Foundation Trust, Torbay, UK
| | - Ian Pedley
- Northern Centre for Cancer Care, Newcastle upon Tyne, UK
| | | | | | | | | | | | | | | | | | - Emma Gray
- Yeovil District Hospital NHS Foundation Trust, Yeovil, UK; Musgrove Park Hospital, Taunton, UK
| | | | - Omi Parikh
- Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | | | - Isabel Syndikus
- Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, UK
| | - James Wylie
- The Christie and Salford Royal NHS Foundation Trusts, Manchester, UK
| | - Anjali Zarkar
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Johann S de Bono
- Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London, UK
| | - David P Dearnaley
- Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London, UK
| | | | - Duncan Gilbert
- MRC Clinical Trials Unit at University College London, London, UK
| | - Ruth E Langley
- MRC Clinical Trials Unit at University College London, London, UK
| | - Robin Millman
- MRC Clinical Trials Unit at University College London, London, UK
| | - David Matheson
- Faculty of Education Health and Wellbeing, University of Wolverhampton, Walsall, UK
| | - Matthew R Sydes
- MRC Clinical Trials Unit at University College London, London, UK
| | - Louise C Brown
- MRC Clinical Trials Unit at University College London, London, UK
| | | | - Nicholas D James
- Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London, UK
| |
Collapse
|
6
|
Clarke CS, Hunter RM, Gabrio A, Brawley CD, Ingleby FC, Dearnaley DP, Matheson D, Attard G, Rush HL, Jones RJ, Cross W, Parker C, Russell JM, Millman R, Gillessen S, Malik Z, Lester JF, Wylie J, Clarke NW, Parmar MKB, Sydes MR, James ND. Cost-utility analysis of adding abiraterone acetate plus prednisone/prednisolone to long-term hormone therapy in newly diagnosed advanced prostate cancer in England: Lifetime decision model based on STAMPEDE trial data. PLoS One 2022; 17:e0269192. [PMID: 35653395 PMCID: PMC9162346 DOI: 10.1371/journal.pone.0269192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 05/14/2022] [Indexed: 01/27/2023] Open
Abstract
Adding abiraterone acetate (AA) plus prednisolone (P) to standard of care (SOC) improves survival in newly diagnosed advanced prostate cancer (PC) patients starting hormone therapy. Our objective was to determine the value for money to the English National Health Service (NHS) of adding AAP to SOC. We used a decision analytic model to evaluate cost-effectiveness of providing AAP in the English NHS. Between 2011-2014, the STAMPEDE trial recruited 1917 men with high-risk localised, locally advanced, recurrent or metastatic PC starting first-line androgen-deprivation therapy (ADT), and they were randomised to receive SOC plus AAP, or SOC alone. Lifetime costs and quality-adjusted life-years (QALYs) were estimated using STAMPEDE trial data supplemented with literature data where necessary, adjusting for baseline patient and disease characteristics. British National Formulary (BNF) prices (£98/day) were applied for AAP. Costs and outcomes were discounted at 3.5%/year. AAP was not cost-effective. The incremental cost-effectiveness ratio (ICER) was £149,748/QALY gained in the non-metastatic (M0) subgroup, with 2.4% probability of being cost-effective at NICE's £30,000/QALY threshold; and the metastatic (M1) subgroup had an ICER of £47,503/QALY gained, with 12.0% probability of being cost-effective. Scenario analysis suggested AAP could be cost-effective in M1 patients if priced below £62/day, or below £28/day in the M0 subgroup. AAP could dominate SOC in the M0 subgroup with price below £11/day. AAP is effective for non-metastatic and metastatic disease but is not cost-effective when using the BNF price. AAP currently only has UK approval for use in a subset of M1 patients. The actual price currently paid by the English NHS for abiraterone acetate is unknown. Broadening AAP's indication and having a daily cost below the thresholds described above is recommended, given AAP improves survival in both subgroups and its cost-saving potential in M0 subgroup.
Collapse
Affiliation(s)
- Caroline S. Clarke
- Research Department of Primary Care and Population Health, University College London, London, United Kingdom
- * E-mail:
| | - Rachael M. Hunter
- Research Department of Primary Care and Population Health, University College London, London, United Kingdom
| | - Andrea Gabrio
- Department of Methodology and Statistics, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Christopher D. Brawley
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, United Kingdom
| | - Fiona C. Ingleby
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, United Kingdom
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - David P. Dearnaley
- Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - David Matheson
- Patient Representative, University of Wolverhampton, Wolverhampton, United Kingdom
| | - Gerhardt Attard
- University College London Cancer Institute, London, United Kingdom
| | - Hannah L. Rush
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, United Kingdom
- Guys and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Rob J. Jones
- Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
- Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom
| | - William Cross
- Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Chris Parker
- Royal Marsden Hospital and Institute of Cancer Research, Sutton, United Kingdom
| | - J. Martin Russell
- Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
- Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Robin Millman
- Patient Representative, MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, United Kingdom
| | - Silke Gillessen
- Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom
- Oncology Institute of Southern Switzerland, EOC, Bellinzona, Switzerland
- Università della Svizzera Italiana, Lugano, Switzerland
| | - Zafar Malik
- Clatterbridge Cancer Centre NHS Foundation Trust, Birkenhead, United Kingdom
| | - Jason F. Lester
- South West Wales Cancer Centre, Singleton Hospital, Swansea, United Kingdom
| | - James Wylie
- Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Noel W. Clarke
- Christie NHS Foundation Trust, Manchester, United Kingdom
- Salford Royal Hospital, Salford, United Kingdom
| | - Mahesh K. B. Parmar
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, United Kingdom
| | - Matthew R. Sydes
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, United Kingdom
| | - Nicholas D. James
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, United Kingdom
- Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom
| |
Collapse
|
7
|
Clarke NW, Ali A, Ingleby FC, Hoyle A, Amos CL, Attard G, Brawley CD, Calvert J, Chowdhury S, Cook A, Cross W, Dearnaley DP, Douis H, Gilbert D, Gillessen S, Jones RJ, Langley RE, MacNair A, Malik Z, Mason MD, Matheson D, Millman R, Parker CC, Ritchie AWS, Rush H, Russell JM, Brown J, Beesley S, Birtle A, Capaldi L, Gale J, Gibbs S, Lydon A, Nikapota A, Omlin A, O'Sullivan JM, Parikh O, Protheroe A, Rudman S, Srihari NN, Simms M, Tanguay JS, Tolan S, Wagstaff J, Wallace J, Wylie J, Zarkar A, Sydes MR, Parmar MKB, James ND. Corrigendum to Addition of docetaxel to hormonal therapy in low- and high-burden metastatic hormone sensitive prostate cancer: long-term survival results from the STAMPEDE trial: Ann Oncol 2019; 30: 1992-2003. Ann Oncol 2020; 31:442. [PMID: 32067690 PMCID: PMC8929236 DOI: 10.1016/j.annonc.2020.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- N W Clarke
- Department of Urology, The Christie and Salford Royal NHS Foundation Trusts, Manchester.
| | - A Ali
- Genito-Urinary Cancer Research Group, Division of Cancer Sciences, The University of Manchester, Manchester
| | - F C Ingleby
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London; London School of Hygiene and Tropical Medicine, London
| | - A Hoyle
- Department of Urology, The Christie and Salford Royal NHS Foundation Trusts, Manchester
| | - C L Amos
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | | | - C D Brawley
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | - J Calvert
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | - S Chowdhury
- Guy's and Saint Thomas' NHS Foundation Trust, London
| | - A Cook
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | - W Cross
- St James University Hospital, Leeds
| | | | - H Douis
- Department of Radiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham
| | - D Gilbert
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | - S Gillessen
- Division of Cancer Sciences, The University of Manchester, Manchester
| | - R J Jones
- Beatson West of Scotland Cancer Centre, University of Glasgow, Glasgow
| | - R E Langley
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | - A MacNair
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | - Z Malik
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool
| | | | - D Matheson
- Faculty of Education Health and Wellbeing, University of Wolverhampton, Wolverhampton
| | - R Millman
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | - C C Parker
- Institute of Cancer Research, Sutton-London; RoyalMarsden NHS Foundation Trust, London
| | - A W S Ritchie
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | - H Rush
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | - J M Russell
- Institute of Cancer Sciences, Beatson West of Scotland Cancer Centre, Glasgow
| | - J Brown
- University of Sheffield, Sheffield
| | | | - A Birtle
- Lancashire Teaching Hospitals NHS Foundation Trust, Preston
| | - L Capaldi
- Worcestershire Acute Hospitals NHS Trust, Worcester
| | - J Gale
- Portsmouth Oncology Centre, Queen Alexandra Hospital, Portsmouth
| | | | - A Lydon
- Torbay and South Devon NHS Foundation Trust, Torbay
| | | | - A Omlin
- Department of Oncology and Haematology, Kantonsspital, St Gallen, Switzerland
| | - J M O'Sullivan
- Centre for Cancer Research and Cell Biology, Queen's University Belfast, Belfast, UK
| | - O Parikh
- East Lancashire Hospitals NHS Trust, Blackburn, UK
| | - A Protheroe
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - S Rudman
- Guy's and Saint Thomas' NHS Foundation Trust, London
| | - N N Srihari
- Shrewsbury and Telford Hospital NHS Trust, Shrewsbury, UK
| | - M Simms
- Hull and East Yorkshire Hospitals NHS Trust, Hull, UK
| | | | - S Tolan
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool
| | - J Wagstaff
- Swansea University College of Medicine, Swansea, UK
| | - J Wallace
- Beatson West of Scotland Cancer Centre, University of Glasgow, Glasgow
| | - J Wylie
- The Christie NHS Foundation Trust, Manchester, UK
| | - A Zarkar
- Heartlands Hospital, Birmingham, UK
| | - M R Sydes
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | - M K B Parmar
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | - N D James
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| |
Collapse
|
8
|
Clarke NW, Ali A, Ingleby FC, Hoyle A, Amos CL, Attard G, Brawley CD, Calvert J, Chowdhury S, Cook A, Cross W, Dearnaley DP, Douis H, Gilbert D, Gillessen S, Jones RJ, Langley RE, MacNair A, Malik Z, Mason MD, Matheson D, Millman R, Parker CC, Ritchie AWS, Rush H, Russell JM, Brown J, Beesley S, Birtle A, Capaldi L, Gale J, Gibbs S, Lydon A, Nikapota A, Omlin A, O'Sullivan JM, Parikh O, Protheroe A, Rudman S, Srihari NN, Simms M, Tanguay JS, Tolan S, Wagstaff J, Wallace J, Wylie J, Zarkar A, Sydes MR, Parmar MKB, James ND. Addition of docetaxel to hormonal therapy in low- and high-burden metastatic hormone sensitive prostate cancer: long-term survival results from the STAMPEDE trial. Ann Oncol 2019; 30:1992-2003. [PMID: 31560068 PMCID: PMC6938598 DOI: 10.1093/annonc/mdz396] [Citation(s) in RCA: 222] [Impact Index Per Article: 44.4] [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] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND STAMPEDE has previously reported that the use of upfront docetaxel improved overall survival (OS) for metastatic hormone naïve prostate cancer patients starting long-term androgen deprivation therapy. We report on long-term outcomes stratified by metastatic burden for M1 patients. METHODS We randomly allocated patients in 2 : 1 ratio to standard-of-care (SOC; control group) or SOC + docetaxel. Metastatic disease burden was categorised using retrospectively-collected baseline staging scans where available. Analysis used Cox regression models, adjusted for stratification factors, with emphasis on restricted mean survival time where hazards were non-proportional. RESULTS Between 05 October 2005 and 31 March 2013, 1086 M1 patients were randomised to receive SOC (n = 724) or SOC + docetaxel (n = 362). Metastatic burden was assessable for 830/1086 (76%) patients; 362 (44%) had low and 468 (56%) high metastatic burden. Median follow-up was 78.2 months. There were 494 deaths on SOC (41% more than the previous report). There was good evidence of benefit of docetaxel over SOC on OS (HR = 0.81, 95% CI 0.69-0.95, P = 0.009) with no evidence of heterogeneity of docetaxel effect between metastatic burden sub-groups (interaction P = 0.827). Analysis of other outcomes found evidence of benefit for docetaxel over SOC in failure-free survival (HR = 0.66, 95% CI 0.57-0.76, P < 0.001) and progression-free survival (HR = 0.69, 95% CI 0.59-0.81, P < 0.001) with no evidence of heterogeneity of docetaxel effect between metastatic burden sub-groups (interaction P > 0.5 in each case). There was no evidence that docetaxel resulted in late toxicity compared with SOC: after 1 year, G3-5 toxicity was reported for 28% SOC and 27% docetaxel (in patients still on follow-up at 1 year without prior progression). CONCLUSIONS The clinically significant benefit in survival for upfront docetaxel persists at longer follow-up, with no evidence that benefit differed by metastatic burden. We advocate that upfront docetaxel is considered for metastatic hormone naïve prostate cancer patients regardless of metastatic burden.
Collapse
Affiliation(s)
- N W Clarke
- Department of Urology, The Christie and Salford Royal NHS Foundation Trusts, Manchester.
| | - A Ali
- Genito-Urinary Cancer Research Group, Division of Cancer Sciences, The University of Manchester, Manchester
| | - F C Ingleby
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London; London School of Hygiene and Tropical Medicine, London
| | - A Hoyle
- Department of Urology, The Christie and Salford Royal NHS Foundation Trusts, Manchester
| | - C L Amos
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | | | - C D Brawley
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | - J Calvert
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | - S Chowdhury
- Guy's and Saint Thomas' NHS Foundation Trust, London
| | - A Cook
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | - W Cross
- St James University Hospital, Leeds
| | | | - H Douis
- Department of Radiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham
| | - D Gilbert
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | - S Gillessen
- Division of Cancer Sciences, The University of Manchester, Manchester
| | - R J Jones
- Beatson West of Scotland Cancer Centre, University of Glasgow, Glasgow
| | - R E Langley
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | - A MacNair
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | - Z Malik
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool
| | | | - D Matheson
- Faculty of Education Health and Wellbeing, University of Wolverhampton, Wolverhampton
| | - R Millman
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | - C C Parker
- Institute of Cancer Research, Sutton-London; Royal Marsden NHS Foundation Trust, London
| | - A W S Ritchie
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | - H Rush
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | - J M Russell
- Institute of Cancer Sciences, Beatson West of Scotland Cancer Centre, Glasgow
| | - J Brown
- University of Sheffield, Sheffield
| | | | - A Birtle
- Lancashire Teaching Hospitals NHS Foundation Trust, Preston
| | - L Capaldi
- Worcestershire Acute Hospitals NHS Trust, Worcester
| | - J Gale
- Portsmouth Oncology Centre, Queen Alexandra Hospital, Portsmouth
| | | | - A Lydon
- Torbay and South Devon NHS Foundation Trust, Torbay
| | | | - A Omlin
- Department of Oncology and Haematology, Kantonsspital, St Gallen, Switzerland
| | - J M O'Sullivan
- Centre for Cancer Research and Cell Biology, Queen's University Belfast, Belfast
| | - O Parikh
- East Lancashire Hospitals NHS Trust, Blackburn
| | - A Protheroe
- Oxford University Hospitals NHS Foundation Trust, Oxford
| | - S Rudman
- Guy's and Saint Thomas' NHS Foundation Trust, London
| | - N N Srihari
- Shrewsbury and Telford Hospital NHS Trust, Shrewsbury
| | - M Simms
- Hull and East Yorkshire Hospitals NHS Trust, Hull
| | | | - S Tolan
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool
| | - J Wagstaff
- Swansea University College of Medicine, Swansea
| | - J Wallace
- Beatson West of Scotland Cancer Centre, University of Glasgow, Glasgow
| | - J Wylie
- The Christie NHS Foundation Trust, Manchester
| | | | - M R Sydes
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | - M K B Parmar
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | - N D James
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham
| |
Collapse
|
9
|
Parker CC, James ND, Brawley CD, Clarke NW, Hoyle AP, Ali A, Ritchie AWS, Attard G, Chowdhury S, Cross W, Dearnaley DP, Gillessen S, Gilson C, Jones RJ, Langley RE, Malik ZI, Mason MD, Matheson D, Millman R, Russell JM, Thalmann GN, Amos CL, Alonzi R, Bahl A, Birtle A, Din O, Douis H, Eswar C, Gale J, Gannon MR, Jonnada S, Khaksar S, Lester JF, O'Sullivan JM, Parikh OA, Pedley ID, Pudney DM, Sheehan DJ, Srihari NN, Tran ATH, Parmar MKB, Sydes MR. Radiotherapy to the primary tumour for newly diagnosed, metastatic prostate cancer (STAMPEDE): a randomised controlled phase 3 trial. Lancet 2018; 392:2353-2366. [PMID: 30355464 PMCID: PMC6269599 DOI: 10.1016/s0140-6736(18)32486-3] [Citation(s) in RCA: 779] [Impact Index Per Article: 129.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 09/30/2018] [Accepted: 10/03/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND Based on previous findings, we hypothesised that radiotherapy to the prostate would improve overall survival in men with metastatic prostate cancer, and that the benefit would be greatest in patients with a low metastatic burden. We aimed to compare standard of care for metastatic prostate cancer, with and without radiotherapy. METHODS We did a randomised controlled phase 3 trial at 117 hospitals in Switzerland and the UK. Eligible patients had newly diagnosed metastatic prostate cancer. We randomly allocated patients open-label in a 1:1 ratio to standard of care (control group) or standard of care and radiotherapy (radiotherapy group). Randomisation was stratified by hospital, age at randomisation, nodal involvement, WHO performance status, planned androgen deprivation therapy, planned docetaxel use (from December, 2015), and regular aspirin or non-steroidal anti-inflammatory drug use. Standard of care was lifelong androgen deprivation therapy, with up-front docetaxel permitted from December, 2015. Men allocated radiotherapy received either a daily (55 Gy in 20 fractions over 4 weeks) or weekly (36 Gy in six fractions over 6 weeks) schedule that was nominated before randomisation. The primary outcome was overall survival, measured as the number of deaths; this analysis had 90% power with a one-sided α of 2·5% for a hazard ratio (HR) of 0·75. Secondary outcomes were failure-free survival, progression-free survival, metastatic progression-free survival, prostate cancer-specific survival, and symptomatic local event-free survival. Analyses used Cox proportional hazards and flexible parametric models, adjusted for stratification factors. The primary outcome analysis was by intention to treat. Two prespecified subgroup analyses tested the effects of prostate radiotherapy by baseline metastatic burden and radiotherapy schedule. This trial is registered with ClinicalTrials.gov, number NCT00268476. FINDINGS Between Jan 22, 2013, and Sept 2, 2016, 2061 men underwent randomisation, 1029 were allocated the control and 1032 radiotherapy. Allocated groups were balanced, with a median age of 68 years (IQR 63-73) and median amount of prostate-specific antigen of 97 ng/mL (33-315). 367 (18%) patients received early docetaxel. 1082 (52%) participants nominated the daily radiotherapy schedule before randomisation and 979 (48%) the weekly schedule. 819 (40%) men had a low metastatic burden, 1120 (54%) had a high metastatic burden, and the metastatic burden was unknown for 122 (6%). Radiotherapy improved failure-free survival (HR 0·76, 95% CI 0·68-0·84; p<0·0001) but not overall survival (0·92, 0·80-1·06; p=0·266). Radiotherapy was well tolerated, with 48 (5%) adverse events (Radiation Therapy Oncology Group grade 3-4) reported during radiotherapy and 37 (4%) after radiotherapy. The proportion reporting at least one severe adverse event (Common Terminology Criteria for Adverse Events grade 3 or worse) was similar by treatment group in the safety population (398 [38%] with control and 380 [39%] with radiotherapy). INTERPRETATION Radiotherapy to the prostate did not improve overall survival for unselected patients with newly diagnosed metastatic prostate cancer. FUNDING Cancer Research UK, UK Medical Research Council, Swiss Group for Clinical Cancer Research, Astellas, Clovis Oncology, Janssen, Novartis, Pfizer, and Sanofi-Aventis.
Collapse
Affiliation(s)
- Christopher C Parker
- Academic Urology Unit, Royal Marsden Hospital, London, UK; Institute of Cancer Research, London, UK.
| | - Nicholas D James
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Christopher D Brawley
- Medical Research Council (MRC) Clinical Trials Unit at University College London (UCL), London, UK
| | - Noel W Clarke
- Genito-Urinary Cancer Research Group, Department of Surgery, The Christie Hospital, Manchester, UK; Department of Urology, Salford Royal Hospitals, Manchester, UK
| | - Alex P Hoyle
- Genito-Urinary Cancer Research Group, Department of Surgery, The Christie Hospital, Manchester, UK; Department of Urology, Salford Royal Hospitals, Manchester, UK
| | - Adnan Ali
- Genito-Urinary Cancer Research Group, Department of Surgery, The Christie Hospital, Manchester, UK; The FASTMAN/Genito-Urinary Cancer Research Groups, Division of Cancer Sciences, and Belfast-Manchester Movember Centre of Excellence, Manchester Cancer Research Centre, University of Manchester, Manchester, UK
| | - Alastair W S Ritchie
- Medical Research Council (MRC) Clinical Trials Unit at University College London (UCL), London, UK
| | | | - Simon Chowdhury
- Department of Medical Oncology, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - William Cross
- Department of Urology, St James University Hospital, Leeds, UK
| | - David P Dearnaley
- Academic Urology Unit, Royal Marsden Hospital, London, UK; Institute of Cancer Research, London, UK
| | - Silke Gillessen
- Division of Cancer Sciences, University of Manchester and the Christie, Manchester, UK; Division of Oncology and Haematology, Kantonsspital, St Gallen, Switzerland
| | - Clare Gilson
- Medical Research Council (MRC) Clinical Trials Unit at University College London (UCL), London, UK
| | - Robert J Jones
- Beatson West of Scotland Cancer Centre, University of Glasgow, Glasgow, UK
| | - Ruth E Langley
- Medical Research Council (MRC) Clinical Trials Unit at University College London (UCL), London, UK
| | - Zafar I Malik
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, UK
| | - Malcolm D Mason
- Division of Cancer & Genetics, School of Medicine, Cardiff University, Cardiff, UK
| | - David Matheson
- Faculty of Education, Health and Wellbeing, University of Wolverhampton, Wolverhampton, UK
| | - Robin Millman
- Medical Research Council (MRC) Clinical Trials Unit at University College London (UCL), London, UK
| | - J Martin Russell
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - George N Thalmann
- Department of Urology, University Hospital, Inselspital, Bern, Switzerland
| | - Claire L Amos
- Medical Research Council (MRC) Clinical Trials Unit at University College London (UCL), London, UK
| | | | - Amit Bahl
- Bristol Haematology and Oncology Centre, Bristol, UK
| | - Alison Birtle
- Rosemere Cancer Centre, Lancashire Teaching Hospitals, Preston, UK; School of Cancer Sciences, University of Manchester, Manchester, UK
| | - Omar Din
- Department of Clinical Oncology, Weston Park Cancer Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Hassan Douis
- Department of Radiology, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - Chinnamani Eswar
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, UK
| | - Joanna Gale
- Portsmouth Oncology Centre, Queen Alexandra Hospital, Portsmouth, UK
| | - Melissa R Gannon
- Department of Health Services Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Sai Jonnada
- Department of Oncology, Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK
| | - Sara Khaksar
- St Luke's Cancer Centre, Royal Surrey County Hospital, Guildford, UK
| | | | - Joe M O'Sullivan
- Centre for Cancer Research and Cell Biology, Queen's University Belfast, Belfast, UK
| | - Omi A Parikh
- Department of Clinical Oncology, East Lancashire Hospitals NHS Trust, Blackburn, UK
| | - Ian D Pedley
- Northern Centre for Cancer Care, Freeman Hospital, Newcastle upon Tyne, UK
| | | | - Denise J Sheehan
- Exeter Oncology Centre, Royal Devon & Exeter Hospital, Exeter, UK
| | | | - Anna T H Tran
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Mahesh K B Parmar
- Medical Research Council (MRC) Clinical Trials Unit at University College London (UCL), London, UK
| | - Matthew R Sydes
- Medical Research Council (MRC) Clinical Trials Unit at University College London (UCL), London, UK.
| |
Collapse
|
10
|
Woods BS, Sideris E, Sydes MR, Gannon MR, Parmar MKB, Alzouebi M, Attard G, Birtle AJ, Brock S, Cathomas R, Chakraborti PR, Cook A, Cross WR, Dearnaley DP, Gale J, Gibbs S, Graham JD, Hughes R, Jones RJ, Laing R, Mason MD, Matheson D, McLaren DB, Millman R, O'Sullivan JM, Parikh O, Parker CC, Peedell C, Protheroe A, Ritchie AWS, Robinson A, Russell JM, Simms MS, Srihari NN, Srinivasan R, Staffurth JN, Sundar S, Thalmann GN, Tolan S, Tran ATH, Tsang D, Wagstaff J, James ND, Sculpher MJ. Addition of Docetaxel to First-line Long-term Hormone Therapy in Prostate Cancer (STAMPEDE): Modelling to Estimate Long-term Survival, Quality-adjusted Survival, and Cost-effectiveness. Eur Urol Oncol 2018; 1:449-458. [PMID: 31158087 PMCID: PMC6692495 DOI: 10.1016/j.euo.2018.06.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 05/23/2018] [Accepted: 06/12/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Results from large randomised controlled trials have shown that adding docetaxel to the standard of care (SOC) for men initiating hormone therapy for prostate cancer (PC) prolongs survival for those with metastatic disease and prolongs failure-free survival for those without. To date there has been no formal assessment of whether funding docetaxel in this setting represents an appropriate use of UK National Health Service (NHS) resources. OBJECTIVE To assess whether administering docetaxel to men with PC starting long-term hormone therapy is cost-effective in a UK setting. DESIGN, SETTING, AND PARTICIPANTS We modelled health outcomes and costs in the UK NHS using data collected within the STAMPEDE trial, which enrolled men with high-risk, locally advanced metastatic or recurrent PC starting first-line hormone therapy. INTERVENTION SOC was hormone therapy for ≥2 yr and radiotherapy in some patients. Docetaxel (75mg/m2) was administered alongside SOC for six three-weekly cycles. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The model generated lifetime predictions of costs, changes in survival duration, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs). RESULTS AND LIMITATIONS The model predicted that docetaxel would extend survival (discounted quality-adjusted survival) by 0.89 yr (0.51) for metastatic PC and 0.78 yr (0.39) for nonmetastatic PC, and would be cost-effective in metastatic PC (ICER £5514/QALY vs SOC) and nonmetastatic PC (higher QALYs, lower costs vs SOC). Docetaxel remained cost-effective in nonmetastatic PC when the assumption of no survival advantage was modelled. CONCLUSIONS Docetaxel is cost-effective among patients with nonmetastatic and metastatic PC in a UK setting. Clinicians should consider whether the evidence is now sufficiently compelling to support docetaxel use in patients with nonmetastatic PC, as the opportunity to offer docetaxel at hormone therapy initiation will be missed for some patients by the time more mature survival data are available. PATIENT SUMMARY Starting docetaxel chemotherapy alongside hormone therapy represents a good use of UK National Health Service resources for patients with prostate cancer that is high risk or has spread to other parts of the body.
Collapse
Affiliation(s)
- Beth S Woods
- Centre for Health Economics, University of York, York, UK.
| | | | - Matthew R Sydes
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Melissa R Gannon
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Mahesh K B Parmar
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK
| | | | - Gerhardt Attard
- The Institute of Cancer Research, London, UK; The Royal Marsden NHS Foundation Trust, London, UK
| | | | - Susannah Brock
- Dorset Cancer Centre, Poole Hospital NHS Foundation Trust, Poole, UK
| | - Richard Cathomas
- Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Kantonsspital Graubünden, Chur, Switzerland
| | | | - Audrey Cook
- Gloucestershire Oncology Centre, Cheltenham, UK
| | - William R Cross
- Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - David P Dearnaley
- The Institute of Cancer Research, London, UK; The Royal Marsden NHS Foundation Trust, London, UK
| | - Joanna Gale
- Portsmouth Oncology Centre, Queen Alexandra Hospital, Portsmouth, UK
| | - Stephanie Gibbs
- Barking, Havering and Redbridge University Hospitals NHS Trust, Romford, UK
| | | | - Robert Hughes
- Mount Vernon Group, Mount Vernon Hospital, Northwood, UK
| | | | - Robert Laing
- St Luke's Cancer Centre, Royal Surrey NHS Trust, Guildford, UK
| | | | | | | | - Robin Millman
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Joe M O'Sullivan
- Centre for Cancer Research and Cell Biology, Queen's University, Belfast, UK
| | - Omi Parikh
- Department of Oncology, East Lancashire Hospitals NHS Trust, Burnley, UK
| | | | | | | | | | - Angus Robinson
- Sussex Cancer Centre, Royal Sussex County Hospital, Brighton, UK
| | - J Martin Russell
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK; Forth Valley Royal Hospital, Larbert, UK
| | | | | | | | - John N Staffurth
- Velindre Cancer Centre, Cardiff and School of Medicine, Cardiff University, Cardiff, UK
| | | | | | | | | | - David Tsang
- Southend and Basildon Hospitals, Southend, UK
| | | | | | | |
Collapse
|
11
|
Sprake EF, Russell JM, Cecil JE, Cooper RJ, Grabowski P, Pourshahidi LK, Barker ME. Dietary patterns of university students in the UK: a cross-sectional study. Nutr J 2018; 17:90. [PMID: 30290816 PMCID: PMC6172790 DOI: 10.1186/s12937-018-0398-y] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 09/24/2018] [Indexed: 11/10/2022] Open
Abstract
Background University represents a key transition into adulthood for many adolescents but there are associated concerns about health and behaviours. One important aspect relates to diet and there is emerging evidence that university students may consume poor quality diets, with potential implications for body weight and long-term health. This research aimed to characterise dietary patterns of university students in the UK and their sociodemographic and lifestyle antecedents. Methods An online, cross-sectional survey was undertaken with a convenience sample of 1448 university students from five UK universities (King’s College London, Universities of St Andrews, Southampton and Sheffield, and Ulster University). The survey comprised a validated food frequency questionnaire alongside lifestyle and sociodemographic questions. Dietary patterns were generated from food frequency intake data using principal components analysis. Nutrient intakes were estimated to characterise the nutrient profile of each dietary pattern. Associations with sociodemographic variables were assessed through general linear modelling. Results Dietary analyses revealed four major dietary patterns: ‘vegetarian’; ‘snacking’; ‘health-conscious’; and ‘convenience, red meat & alcohol’. The ‘health-conscious’ pattern had the most favourable micronutrient profile. Students’ gender, age, year of study, geographical location and cooking ability were associated with differences in pattern behaviour. Female students favoured the ‘vegetarian’ pattern, whilst male students preferred the ‘convenience, red meat & alcohol’ pattern. Less healthful dietary patterns were positively associated with lifestyle risk factors such as smoking, low physical activity and take-away consumption. The health-conscious pattern had greatest nutrient density. The ‘convenience, red meat & alcohol’ pattern was associated with higher weekly food spending; this pattern was also identified most consistently across universities. Students reporting greater cooking ability tended towards the ‘vegetarian’ and ‘health-conscious’ patterns. Conclusions Food intake varied amongst university students. A substantial proportion of students followed health-promoting diets, which had good nutrient profiles obviating a need for dietary intervention. However, some students consumed poor diets, incurred greater food costs and practised unfavourable lifestyle behaviours, which may have long-term health effects. University policy to improve students’ diets should incorporate efforts to promote student engagement in cooking and food preparation, and increased availability of low cost healthier food items. Electronic supplementary material The online version of this article (10.1186/s12937-018-0398-y) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- E F Sprake
- Human Nutrition Unit, Department of Oncology & Metabolism, The Medical School, University of Sheffield, Sheffield, S10 2RX, UK
| | - J M Russell
- Corporate Information & Computing Service, University of Sheffield, Sheffield, S10 2GU, UK
| | - J E Cecil
- Medical & Biological Sciences Building, University of St Andrews, St Andrews, KY16 9TF, UK
| | - R J Cooper
- School of Health and Related Research, University of Sheffield, Sheffield, S1 4DA, UK
| | - P Grabowski
- Human Nutrition Unit, Department of Oncology & Metabolism, The Medical School, University of Sheffield, Sheffield, S10 2RX, UK
| | - L K Pourshahidi
- Nutrition Innovation Centre for Food & Health (NICHE), Ulster University, Coleraine, BT52 1SA, UK
| | - M E Barker
- Food & Nutrition Group, Business School, Sheffield Hallam University, Sheffield, S1 1WB, UK.
| |
Collapse
|
12
|
Ensaff H, Crawford R, Russell JM, Barker ME. Preparing and sharing food: a quantitative analysis of a primary school-based food intervention. J Public Health (Oxf) 2018; 39:567-573. [PMID: 27591297 DOI: 10.1093/pubmed/fdw086] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 07/16/2016] [Indexed: 11/14/2022] Open
Abstract
Background Primary schools are increasingly used as arenas for public health initiatives. The aim of this study was to assess a primary school-based food intervention. Methods The intervention comprised timetabled kitchen classroom sessions (90 min, fortnightly). Pupils prepared and cooked food, which they then ate together. Children's relationship with food, including food enjoyment, experience and food neophobia, were addressed at the intervention school (baseline n = 154; follow-up n = 164) and at a matched control school (baseline n = 171; follow-up n = 174). Results Pupils at the intervention school scored significantly higher (M = 3.90, SD = 1.81) for scores on Kitchen Equipment, compared to the control school (M = 3.06, SD = 2.12); and again scored significantly higher (M = 9.34, SD = 3.79) for the overall Cooking Experience Score compared to the control school (M = 7.98, SD = 4.57). Shifts accompanying the intervention in three outcome measures for pupils (taste description, liking for cooking and helping with cooking at home) were also revealed. No main intervention effect for food neophobia and fussiness was found; a close to significant time by intervention interaction (P = 0.053) was evident. Conclusions The study indicates limited but encouraging changes, and contributes to the growing literature regarding school-based food initiatives.
Collapse
Affiliation(s)
- H Ensaff
- Human Nutrition Unit, Department of Oncology, The Medical School, University of Sheffield, SheffieldS10 2RX, UK
| | - R Crawford
- Human Nutrition Unit, Department of Oncology, The Medical School, University of Sheffield, SheffieldS10 2RX, UK
| | - J M Russell
- Corporate Information and Computing Services, University of Sheffield, SheffieldS10 2HB, UK
| | - M E Barker
- Human Nutrition Unit, Department of Oncology, The Medical School, University of Sheffield, SheffieldS10 2RX, UK
| |
Collapse
|
13
|
Sidek N, Buchanan G, Dodds D, Russell JM, Gillen G, Lamb C, Wallace J, Jones RJ, Alhasso A, Sadozye A, Venugopal B. Radium-223 treatment for metastatic prostate cancer: One year data in a single institution experience. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e17037] [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)
- Norma Sidek
- Beatson West of Scotland Cancer Centre, Glasgow, GB
| | - Gail Buchanan
- Gibson West of Scotland Cancer Center, Glasgow, United Kingdom
| | - David Dodds
- Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | - J. Martin Russell
- Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Gerry Gillen
- Department of Nuclear Medicine, Glasgow, United Kingdom
| | - Carolynn Lamb
- Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | - Jan Wallace
- Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | - Robert J Jones
- University of Glasgow, Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | - Abdulla Alhasso
- Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | | | | |
Collapse
|
14
|
Sydes MR, Spears MR, Mason MD, Clarke NW, Dearnaley DP, de Bono JS, Attard G, Chowdhury S, Cross W, Gillessen S, Malik ZI, Jones R, Parker CC, Ritchie AWS, Russell JM, Millman R, Matheson D, Amos C, Gilson C, Birtle A, Brock S, Capaldi L, Chakraborti P, Choudhury A, Evans L, Ford D, Gale J, Gibbs S, Gilbert DC, Hughes R, McLaren D, Lester JF, Nikapota A, O'Sullivan J, Parikh O, Peedell C, Protheroe A, Rudman SM, Shaffer R, Sheehan D, Simms M, Srihari N, Strebel R, Sundar S, Tolan S, Tsang D, Varughese M, Wagstaff J, Parmar MKB, James ND. Adding abiraterone or docetaxel to long-term hormone therapy for prostate cancer: directly randomised data from the STAMPEDE multi-arm, multi-stage platform protocol. Ann Oncol 2018; 29:1235-1248. [PMID: 29529169 PMCID: PMC5961425 DOI: 10.1093/annonc/mdy072] [Citation(s) in RCA: 175] [Impact Index Per Article: 29.2] [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] [Indexed: 12/20/2022] Open
Abstract
Background Adding abiraterone acetate with prednisolone (AAP) or docetaxel with prednisolone (DocP) to standard-of-care (SOC) each improved survival in systemic therapy for advanced or metastatic prostate cancer: evaluation of drug efficacy: a multi-arm multi-stage platform randomised controlled protocol recruiting patients with high-risk locally advanced or metastatic PCa starting long-term androgen deprivation therapy (ADT). The protocol provides the only direct, randomised comparative data of SOC + AAP versus SOC + DocP. Method Recruitment to SOC + DocP and SOC + AAP overlapped November 2011 to March 2013. SOC was long-term ADT or, for most non-metastatic cases, ADT for ≥2 years and RT to the primary tumour. Stratified randomisation allocated pts 2 : 1 : 2 to SOC; SOC + docetaxel 75 mg/m2 3-weekly×6 + prednisolone 10 mg daily; or SOC + abiraterone acetate 1000 mg + prednisolone 5 mg daily. AAP duration depended on stage and intent to give radical RT. The primary outcome measure was death from any cause. Analyses used Cox proportional hazards and flexible parametric models, adjusted for stratification factors. This was not a formally powered comparison. A hazard ratio (HR) <1 favours SOC + AAP, and HR > 1 favours SOC + DocP. Results A total of 566 consenting patients were contemporaneously randomised: 189 SOC + DocP and 377 SOC + AAP. The patients, balanced by allocated treatment were: 342 (60%) M1; 429 (76%) Gleason 8-10; 449 (79%) WHO performance status 0; median age 66 years and median PSA 56 ng/ml. With median follow-up 4 years, 149 deaths were reported. For overall survival, HR = 1.16 (95% CI 0.82-1.65); failure-free survival HR = 0.51 (95% CI 0.39-0.67); progression-free survival HR = 0.65 (95% CI 0.48-0.88); metastasis-free survival HR = 0.77 (95% CI 0.57-1.03); prostate cancer-specific survival HR = 1.02 (0.70-1.49); and symptomatic skeletal events HR = 0.83 (95% CI 0.55-1.25). In the safety population, the proportion reporting ≥1 grade 3, 4 or 5 adverse events ever was 36%, 13% and 1% SOC + DocP, and 40%, 7% and 1% SOC + AAP; prevalence 11% at 1 and 2 years on both arms. Relapse treatment patterns varied by arm. Conclusions This direct, randomised comparative analysis of two new treatment standards for hormone-naïve prostate cancer showed no evidence of a difference in overall or prostate cancer-specific survival, nor in other important outcomes such as symptomatic skeletal events. Worst toxicity grade over entire time on trial was similar but comprised different toxicities in line with the known properties of the drugs. Trial registration Clinicaltrials.gov: NCT00268476.
Collapse
Affiliation(s)
- M R Sydes
- MRC Clinical Trials Unit at UCL, London.
| | | | | | - N W Clarke
- Christie and Royal Salford Hospital, Manchester
| | | | | | - G Attard
- UCL Cancer Institute, University College London, London
| | - S Chowdhury
- Guy's & St Thomas NHS, Foundation Trust, London
| | - W Cross
- St James University Hospital, Leeds, UK
| | - S Gillessen
- Division of Oncology and Hematology, Kantonsspital St. Gallen, St. Gallen; University of Bern, Bern; Swiss Group for Cancer Clinical Research (SAKK), Bern, Switzerland
| | - Z I Malik
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool
| | - R Jones
- Institute of Cancer Sciences, University of Glasgow, Glasgow; Beatson West of Scotland Cancer Centre, University of Glasgow, Glasgow
| | - C C Parker
- Institute of Cancer Research, Sutton; Royal Marsden Hospital, Sutton
| | | | - J M Russell
- Institute of Cancer Sciences, University of Glasgow, Glasgow; Beatson West of Scotland Cancer Centre, University of Glasgow, Glasgow
| | - R Millman
- MRC Clinical Trials Unit at UCL, London
| | - D Matheson
- Faculty of Education, Health and Wellbeing, University of Wolverhampton, Wolverhampton
| | - C Amos
- MRC Clinical Trials Unit at UCL, London
| | - C Gilson
- MRC Clinical Trials Unit at UCL, London
| | - A Birtle
- Rosemere Cancer Centre, Royal Preston Hospital, Preston
| | - S Brock
- Dorset Cancer Centre, Poole Hospital, Poole
| | - L Capaldi
- Worcestershire Acute Hospitals NHS Trust, Worcester
| | | | - A Choudhury
- Division of Cancer Sciences, University of Manchester, Manchester; Manchester Academic Health Science Centre, Manchester; Christie Hospital NHS Foundation Trust, Manchester
| | - L Evans
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield
| | - D Ford
- City Hospital, Cancer Centre at Queen Elizabeth Hospital, Birmingham
| | - J Gale
- Portsmouth Oncology Centre, Queen Alexandra Hospital, Portsmouth
| | | | - D C Gilbert
- Sussex Cancer Centre, Royal Sussex County Hospital, Brighton
| | - R Hughes
- Mount Vernon Group, Mount Vernon Hospital, Middlesex
| | | | | | | | - J O'Sullivan
- Centre for Cancer Research and Cell Biology, Queens University Belfast, Belfast; Belfast City Hospital, Belfast
| | - O Parikh
- Lancashire Teaching Hospitals NHS Trust, Preston
| | - C Peedell
- Department of Oncology & Radiotherapy, South Tees NHS Trust, Middlesbrough
| | - A Protheroe
- Oxford University Hospitals NHS Foundation Trust
| | - S M Rudman
- Guy's & St Thomas NHS, Foundation Trust, London
| | - R Shaffer
- Department of Oncology, Royal Surrey County Hospital, Guildford
| | - D Sheehan
- Royal Devon and Exeter Hospital, Exeter
| | - M Simms
- Hull & East Yorkshire Hospitals NHS Trust, Hull
| | - N Srihari
- Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury, UK
| | - R Strebel
- Kantonsspital Graubünden, Chur; Swiss Group for Cancer Clinical Research (SAKK), Bern, Switzerland
| | - S Sundar
- Department of Oncology, Nottingham, University Hospitals NHS Trust, Nottingham
| | - S Tolan
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool
| | - D Tsang
- Southend Hospital, Southend-on-Sea
| | - M Varughese
- Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust
| | - J Wagstaff
- Swansea University College of Medicine, Swansea
| | | | - N D James
- Institute of Cancer and Genomic Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| |
Collapse
|
15
|
Rulach RJ, McKay S, Neilson S, White L, Wallace J, Carruthers R, Lamb C, Cascales A, Marashi H, Glen H, Venugopal B, Sadoyze A, Sidek N, Russell JM, Alhasso A, Dodds D, Laskey J, Jones RJ, MacLeod N. Real-world uptake, safety profile and outcomes of docetaxel in newly diagnosed metastatic prostate cancer. BJU Int 2017; 121:268-274. [PMID: 28940952 DOI: 10.1111/bju.14025] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To investigate the uptake, safety and efficacy of docetaxel chemotherapy in hormone-naïve metastatic prostate cancer (mPC) in the first year of use outside of a clinical trial. PATIENTS AND METHODS Patients in the West of Scotland Cancer Network with newly diagnosed mPC were identified from the regional multidisciplinary team meetings and their treatment details were collected from electronic patient records. The rate of febrile neutropenia, hospitalisations, time to progression, and overall survival were compared between those patients who received docetaxel and androgen-deprivation therapy (ADT), or ADT alone using survival analysis. RESULTS Of the 270 eligible patients, 103 received docetaxel (38.1%). 35 patients (34%) were hospitalised and there were 17 episodes of febrile neutropenia (16.5%). Two patients (1.9%) died within 30 days of chemotherapy. Patients who received ADT alone had an increased risk of progression (hazard ratio [HR] 2.03, 95% confidence interval [CI] 1.27-3.25; log-rank test, P = 0.002) and had an increased risk of death (HR 5.88, 95% CI: 2.52-13.72; log-rank test, P = 0.001) compared to the docetaxel group. The risk of febrile neutropenia was nine-times greater if chemotherapy was started within 3 weeks of ADT initiation (95% CI: 1.22-77.72; P = 0.032). CONCLUSION Docetaxel chemotherapy in hormone-naïve mPC has significant toxicities, but has a similar effect on time to progression and overall survival as seen in randomised trials. Chemotherapy should be started at ≥3 weeks after ADT.
Collapse
Affiliation(s)
| | - Stephen McKay
- The Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - Sam Neilson
- The Beatson West of Scotland Cancer Centre, Glasgow, UK
| | | | - Jan Wallace
- The Beatson West of Scotland Cancer Centre, Glasgow, UK
| | | | - Carolynn Lamb
- The Beatson West of Scotland Cancer Centre, Glasgow, UK
| | | | - Husam Marashi
- The Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - Hilary Glen
- The Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - Balaji Venugopal
- The Beatson West of Scotland Cancer Centre, Glasgow, UK.,The University of Glasgow, Glasgow, UK
| | - Azmat Sadoyze
- The Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - Norma Sidek
- The Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - J Martin Russell
- The Beatson West of Scotland Cancer Centre, Glasgow, UK.,The University of Glasgow, Glasgow, UK
| | | | - David Dodds
- The Beatson West of Scotland Cancer Centre, Glasgow, UK
| | | | - Robert J Jones
- The Beatson West of Scotland Cancer Centre, Glasgow, UK.,The University of Glasgow, Glasgow, UK
| | | |
Collapse
|
16
|
James ND, de Bono JS, Spears MR, Clarke NW, Mason MD, Dearnaley DP, Ritchie AWS, Amos CL, Gilson C, Jones RJ, Matheson D, Millman R, Attard G, Chowdhury S, Cross WR, Gillessen S, Parker CC, Russell JM, Berthold DR, Brawley C, Adab F, Aung S, Birtle AJ, Bowen J, Brock S, Chakraborti P, Ferguson C, Gale J, Gray E, Hingorani M, Hoskin PJ, Lester JF, Malik ZI, McKinna F, McPhail N, Money-Kyrle J, O'Sullivan J, Parikh O, Protheroe A, Robinson A, Srihari NN, Thomas C, Wagstaff J, Wylie J, Zarkar A, Parmar MKB, Sydes MR. Abiraterone for Prostate Cancer Not Previously Treated with Hormone Therapy. N Engl J Med 2017; 377:338-351. [PMID: 28578639 PMCID: PMC5533216 DOI: 10.1056/nejmoa1702900] [Citation(s) in RCA: 1119] [Impact Index Per Article: 159.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Abiraterone acetate plus prednisolone improves survival in men with relapsed prostate cancer. We assessed the effect of this combination in men starting long-term androgen-deprivation therapy (ADT), using a multigroup, multistage trial design. METHODS We randomly assigned patients in a 1:1 ratio to receive ADT alone or ADT plus abiraterone acetate (1000 mg daily) and prednisolone (5 mg daily) (combination therapy). Local radiotherapy was mandated for patients with node-negative, nonmetastatic disease and encouraged for those with positive nodes. For patients with nonmetastatic disease with no radiotherapy planned and for patients with metastatic disease, treatment continued until radiologic, clinical, or prostate-specific antigen (PSA) progression; otherwise, treatment was to continue for 2 years or until any type of progression, whichever came first. The primary outcome measure was overall survival. The intermediate primary outcome was failure-free survival (treatment failure was defined as radiologic, clinical, or PSA progression or death from prostate cancer). RESULTS A total of 1917 patients underwent randomization from November 2011 through January 2014. The median age was 67 years, and the median PSA level was 53 ng per milliliter. A total of 52% of the patients had metastatic disease, 20% had node-positive or node-indeterminate nonmetastatic disease, and 28% had node-negative, nonmetastatic disease; 95% had newly diagnosed disease. The median follow-up was 40 months. There were 184 deaths in the combination group as compared with 262 in the ADT-alone group (hazard ratio, 0.63; 95% confidence interval [CI], 0.52 to 0.76; P<0.001); the hazard ratio was 0.75 in patients with nonmetastatic disease and 0.61 in those with metastatic disease. There were 248 treatment-failure events in the combination group as compared with 535 in the ADT-alone group (hazard ratio, 0.29; 95% CI, 0.25 to 0.34; P<0.001); the hazard ratio was 0.21 in patients with nonmetastatic disease and 0.31 in those with metastatic disease. Grade 3 to 5 adverse events occurred in 47% of the patients in the combination group (with nine grade 5 events) and in 33% of the patients in the ADT-alone group (with three grade 5 events). CONCLUSIONS Among men with locally advanced or metastatic prostate cancer, ADT plus abiraterone and prednisolone was associated with significantly higher rates of overall and failure-free survival than ADT alone. (Funded by Cancer Research U.K. and others; STAMPEDE ClinicalTrials.gov number, NCT00268476 , and Current Controlled Trials number, ISRCTN78818544 .).
Collapse
Affiliation(s)
- Nicholas D James
- From the Institute of Cancer and Genomic Sciences, University of Birmingham (N.D.J.), and University Hospital Birmingham (A.Z.), Birmingham, the Institute of Cancer Research (J.S.B., D.P.D., G.A.), Medical Research Council Clinical Trials Unit at University College London (M.R. Spears, C.L.A., C.G., C.B., M.K.B.P., M.R. Sydes), King's College London and Guy's and St. Thomas' NHS Foundation Trust (S.C.), and Royal Marsden NHS Foundation Trust (C.C.P.), London, Salford Royal NHS Foundation Trust, Salford (N.W.C.), Cardiff University School of Medicine (M.D.M.) and Velindre Cancer Centre (J.F.L.), Cardiff, Gloucestershire Royal Hospital (A.W.S.R.) and Gloucestershire Hospitals NHS Foundation Trust (J.B.), Gloucester, University of Glasgow, Glasgow (R.J.J., J.M.R.), St. James's University Hospital, Leeds (W.R.C.), University Hospital of North-Midlands, Stoke-on-Trent (F.A.), Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter (S.A.), Rosemere Cancer Centre, Royal Preston Hospital, Preston (A.J.B.), Dorset Cancer Centre, Poole Hospital, Poole (S.B.), Royal Derby Hospital, Derby (P.C.), Weston Park Hospital, Sheffield (C.F.), Portsmouth Oncology Centre, Queen Alexandra Hospital, Portsmouth (J.G.), Musgrove Park Hospital, Taunton (E.G.), Hull and East Yorkshire Hospitals NHS Trust, Hull (M.H.), Mount Vernon Cancer Centre, Northwood (P.J.H.), Clatterbridge Cancer Centre, Wirral (Z.I.M.), Brighton and Sussex University Hospitals NHS Trust (F.M.) and Sussex Cancer Centre, Royal Sussex County Hospital (A.R.), Brighton, NHS Highland, Inverness (N.M.), Royal Surrey County Hospital, Guildford (J.M.-K.), Northern Ireland Cancer and Queens University, Belfast (J.O.), Lancashire Teaching Hospitals NHS Trust, Preston (O.P.), Churchill Hospital, Oxford (A.P.), Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury (N.N.S.), East Kent Hospitals NHS Trust, Canterbury (C.T.), Swansea University College of Medicine, Swansea (J. Wagstaff), and Christie NHS Foundation Trust, Manchester (J. Wylie) - all in the United Kingdom; and the Department of Medical Oncology, Kantonsspital St. Gallen, St. Gallen (S.G.), and University Hospital of Lausanne, Lausanne (D.R.B.) - both in Switzerland. Two of the authors (D.M., R.M.) were unaffiliated lay members of the STAMPEDE investigators
| | - Johann S de Bono
- From the Institute of Cancer and Genomic Sciences, University of Birmingham (N.D.J.), and University Hospital Birmingham (A.Z.), Birmingham, the Institute of Cancer Research (J.S.B., D.P.D., G.A.), Medical Research Council Clinical Trials Unit at University College London (M.R. Spears, C.L.A., C.G., C.B., M.K.B.P., M.R. Sydes), King's College London and Guy's and St. Thomas' NHS Foundation Trust (S.C.), and Royal Marsden NHS Foundation Trust (C.C.P.), London, Salford Royal NHS Foundation Trust, Salford (N.W.C.), Cardiff University School of Medicine (M.D.M.) and Velindre Cancer Centre (J.F.L.), Cardiff, Gloucestershire Royal Hospital (A.W.S.R.) and Gloucestershire Hospitals NHS Foundation Trust (J.B.), Gloucester, University of Glasgow, Glasgow (R.J.J., J.M.R.), St. James's University Hospital, Leeds (W.R.C.), University Hospital of North-Midlands, Stoke-on-Trent (F.A.), Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter (S.A.), Rosemere Cancer Centre, Royal Preston Hospital, Preston (A.J.B.), Dorset Cancer Centre, Poole Hospital, Poole (S.B.), Royal Derby Hospital, Derby (P.C.), Weston Park Hospital, Sheffield (C.F.), Portsmouth Oncology Centre, Queen Alexandra Hospital, Portsmouth (J.G.), Musgrove Park Hospital, Taunton (E.G.), Hull and East Yorkshire Hospitals NHS Trust, Hull (M.H.), Mount Vernon Cancer Centre, Northwood (P.J.H.), Clatterbridge Cancer Centre, Wirral (Z.I.M.), Brighton and Sussex University Hospitals NHS Trust (F.M.) and Sussex Cancer Centre, Royal Sussex County Hospital (A.R.), Brighton, NHS Highland, Inverness (N.M.), Royal Surrey County Hospital, Guildford (J.M.-K.), Northern Ireland Cancer and Queens University, Belfast (J.O.), Lancashire Teaching Hospitals NHS Trust, Preston (O.P.), Churchill Hospital, Oxford (A.P.), Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury (N.N.S.), East Kent Hospitals NHS Trust, Canterbury (C.T.), Swansea University College of Medicine, Swansea (J. Wagstaff), and Christie NHS Foundation Trust, Manchester (J. Wylie) - all in the United Kingdom; and the Department of Medical Oncology, Kantonsspital St. Gallen, St. Gallen (S.G.), and University Hospital of Lausanne, Lausanne (D.R.B.) - both in Switzerland. Two of the authors (D.M., R.M.) were unaffiliated lay members of the STAMPEDE investigators
| | - Melissa R Spears
- From the Institute of Cancer and Genomic Sciences, University of Birmingham (N.D.J.), and University Hospital Birmingham (A.Z.), Birmingham, the Institute of Cancer Research (J.S.B., D.P.D., G.A.), Medical Research Council Clinical Trials Unit at University College London (M.R. Spears, C.L.A., C.G., C.B., M.K.B.P., M.R. Sydes), King's College London and Guy's and St. Thomas' NHS Foundation Trust (S.C.), and Royal Marsden NHS Foundation Trust (C.C.P.), London, Salford Royal NHS Foundation Trust, Salford (N.W.C.), Cardiff University School of Medicine (M.D.M.) and Velindre Cancer Centre (J.F.L.), Cardiff, Gloucestershire Royal Hospital (A.W.S.R.) and Gloucestershire Hospitals NHS Foundation Trust (J.B.), Gloucester, University of Glasgow, Glasgow (R.J.J., J.M.R.), St. James's University Hospital, Leeds (W.R.C.), University Hospital of North-Midlands, Stoke-on-Trent (F.A.), Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter (S.A.), Rosemere Cancer Centre, Royal Preston Hospital, Preston (A.J.B.), Dorset Cancer Centre, Poole Hospital, Poole (S.B.), Royal Derby Hospital, Derby (P.C.), Weston Park Hospital, Sheffield (C.F.), Portsmouth Oncology Centre, Queen Alexandra Hospital, Portsmouth (J.G.), Musgrove Park Hospital, Taunton (E.G.), Hull and East Yorkshire Hospitals NHS Trust, Hull (M.H.), Mount Vernon Cancer Centre, Northwood (P.J.H.), Clatterbridge Cancer Centre, Wirral (Z.I.M.), Brighton and Sussex University Hospitals NHS Trust (F.M.) and Sussex Cancer Centre, Royal Sussex County Hospital (A.R.), Brighton, NHS Highland, Inverness (N.M.), Royal Surrey County Hospital, Guildford (J.M.-K.), Northern Ireland Cancer and Queens University, Belfast (J.O.), Lancashire Teaching Hospitals NHS Trust, Preston (O.P.), Churchill Hospital, Oxford (A.P.), Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury (N.N.S.), East Kent Hospitals NHS Trust, Canterbury (C.T.), Swansea University College of Medicine, Swansea (J. Wagstaff), and Christie NHS Foundation Trust, Manchester (J. Wylie) - all in the United Kingdom; and the Department of Medical Oncology, Kantonsspital St. Gallen, St. Gallen (S.G.), and University Hospital of Lausanne, Lausanne (D.R.B.) - both in Switzerland. Two of the authors (D.M., R.M.) were unaffiliated lay members of the STAMPEDE investigators
| | - Noel W Clarke
- From the Institute of Cancer and Genomic Sciences, University of Birmingham (N.D.J.), and University Hospital Birmingham (A.Z.), Birmingham, the Institute of Cancer Research (J.S.B., D.P.D., G.A.), Medical Research Council Clinical Trials Unit at University College London (M.R. Spears, C.L.A., C.G., C.B., M.K.B.P., M.R. Sydes), King's College London and Guy's and St. Thomas' NHS Foundation Trust (S.C.), and Royal Marsden NHS Foundation Trust (C.C.P.), London, Salford Royal NHS Foundation Trust, Salford (N.W.C.), Cardiff University School of Medicine (M.D.M.) and Velindre Cancer Centre (J.F.L.), Cardiff, Gloucestershire Royal Hospital (A.W.S.R.) and Gloucestershire Hospitals NHS Foundation Trust (J.B.), Gloucester, University of Glasgow, Glasgow (R.J.J., J.M.R.), St. James's University Hospital, Leeds (W.R.C.), University Hospital of North-Midlands, Stoke-on-Trent (F.A.), Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter (S.A.), Rosemere Cancer Centre, Royal Preston Hospital, Preston (A.J.B.), Dorset Cancer Centre, Poole Hospital, Poole (S.B.), Royal Derby Hospital, Derby (P.C.), Weston Park Hospital, Sheffield (C.F.), Portsmouth Oncology Centre, Queen Alexandra Hospital, Portsmouth (J.G.), Musgrove Park Hospital, Taunton (E.G.), Hull and East Yorkshire Hospitals NHS Trust, Hull (M.H.), Mount Vernon Cancer Centre, Northwood (P.J.H.), Clatterbridge Cancer Centre, Wirral (Z.I.M.), Brighton and Sussex University Hospitals NHS Trust (F.M.) and Sussex Cancer Centre, Royal Sussex County Hospital (A.R.), Brighton, NHS Highland, Inverness (N.M.), Royal Surrey County Hospital, Guildford (J.M.-K.), Northern Ireland Cancer and Queens University, Belfast (J.O.), Lancashire Teaching Hospitals NHS Trust, Preston (O.P.), Churchill Hospital, Oxford (A.P.), Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury (N.N.S.), East Kent Hospitals NHS Trust, Canterbury (C.T.), Swansea University College of Medicine, Swansea (J. Wagstaff), and Christie NHS Foundation Trust, Manchester (J. Wylie) - all in the United Kingdom; and the Department of Medical Oncology, Kantonsspital St. Gallen, St. Gallen (S.G.), and University Hospital of Lausanne, Lausanne (D.R.B.) - both in Switzerland. Two of the authors (D.M., R.M.) were unaffiliated lay members of the STAMPEDE investigators
| | - Malcolm D Mason
- From the Institute of Cancer and Genomic Sciences, University of Birmingham (N.D.J.), and University Hospital Birmingham (A.Z.), Birmingham, the Institute of Cancer Research (J.S.B., D.P.D., G.A.), Medical Research Council Clinical Trials Unit at University College London (M.R. Spears, C.L.A., C.G., C.B., M.K.B.P., M.R. Sydes), King's College London and Guy's and St. Thomas' NHS Foundation Trust (S.C.), and Royal Marsden NHS Foundation Trust (C.C.P.), London, Salford Royal NHS Foundation Trust, Salford (N.W.C.), Cardiff University School of Medicine (M.D.M.) and Velindre Cancer Centre (J.F.L.), Cardiff, Gloucestershire Royal Hospital (A.W.S.R.) and Gloucestershire Hospitals NHS Foundation Trust (J.B.), Gloucester, University of Glasgow, Glasgow (R.J.J., J.M.R.), St. James's University Hospital, Leeds (W.R.C.), University Hospital of North-Midlands, Stoke-on-Trent (F.A.), Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter (S.A.), Rosemere Cancer Centre, Royal Preston Hospital, Preston (A.J.B.), Dorset Cancer Centre, Poole Hospital, Poole (S.B.), Royal Derby Hospital, Derby (P.C.), Weston Park Hospital, Sheffield (C.F.), Portsmouth Oncology Centre, Queen Alexandra Hospital, Portsmouth (J.G.), Musgrove Park Hospital, Taunton (E.G.), Hull and East Yorkshire Hospitals NHS Trust, Hull (M.H.), Mount Vernon Cancer Centre, Northwood (P.J.H.), Clatterbridge Cancer Centre, Wirral (Z.I.M.), Brighton and Sussex University Hospitals NHS Trust (F.M.) and Sussex Cancer Centre, Royal Sussex County Hospital (A.R.), Brighton, NHS Highland, Inverness (N.M.), Royal Surrey County Hospital, Guildford (J.M.-K.), Northern Ireland Cancer and Queens University, Belfast (J.O.), Lancashire Teaching Hospitals NHS Trust, Preston (O.P.), Churchill Hospital, Oxford (A.P.), Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury (N.N.S.), East Kent Hospitals NHS Trust, Canterbury (C.T.), Swansea University College of Medicine, Swansea (J. Wagstaff), and Christie NHS Foundation Trust, Manchester (J. Wylie) - all in the United Kingdom; and the Department of Medical Oncology, Kantonsspital St. Gallen, St. Gallen (S.G.), and University Hospital of Lausanne, Lausanne (D.R.B.) - both in Switzerland. Two of the authors (D.M., R.M.) were unaffiliated lay members of the STAMPEDE investigators
| | - David P Dearnaley
- From the Institute of Cancer and Genomic Sciences, University of Birmingham (N.D.J.), and University Hospital Birmingham (A.Z.), Birmingham, the Institute of Cancer Research (J.S.B., D.P.D., G.A.), Medical Research Council Clinical Trials Unit at University College London (M.R. Spears, C.L.A., C.G., C.B., M.K.B.P., M.R. Sydes), King's College London and Guy's and St. Thomas' NHS Foundation Trust (S.C.), and Royal Marsden NHS Foundation Trust (C.C.P.), London, Salford Royal NHS Foundation Trust, Salford (N.W.C.), Cardiff University School of Medicine (M.D.M.) and Velindre Cancer Centre (J.F.L.), Cardiff, Gloucestershire Royal Hospital (A.W.S.R.) and Gloucestershire Hospitals NHS Foundation Trust (J.B.), Gloucester, University of Glasgow, Glasgow (R.J.J., J.M.R.), St. James's University Hospital, Leeds (W.R.C.), University Hospital of North-Midlands, Stoke-on-Trent (F.A.), Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter (S.A.), Rosemere Cancer Centre, Royal Preston Hospital, Preston (A.J.B.), Dorset Cancer Centre, Poole Hospital, Poole (S.B.), Royal Derby Hospital, Derby (P.C.), Weston Park Hospital, Sheffield (C.F.), Portsmouth Oncology Centre, Queen Alexandra Hospital, Portsmouth (J.G.), Musgrove Park Hospital, Taunton (E.G.), Hull and East Yorkshire Hospitals NHS Trust, Hull (M.H.), Mount Vernon Cancer Centre, Northwood (P.J.H.), Clatterbridge Cancer Centre, Wirral (Z.I.M.), Brighton and Sussex University Hospitals NHS Trust (F.M.) and Sussex Cancer Centre, Royal Sussex County Hospital (A.R.), Brighton, NHS Highland, Inverness (N.M.), Royal Surrey County Hospital, Guildford (J.M.-K.), Northern Ireland Cancer and Queens University, Belfast (J.O.), Lancashire Teaching Hospitals NHS Trust, Preston (O.P.), Churchill Hospital, Oxford (A.P.), Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury (N.N.S.), East Kent Hospitals NHS Trust, Canterbury (C.T.), Swansea University College of Medicine, Swansea (J. Wagstaff), and Christie NHS Foundation Trust, Manchester (J. Wylie) - all in the United Kingdom; and the Department of Medical Oncology, Kantonsspital St. Gallen, St. Gallen (S.G.), and University Hospital of Lausanne, Lausanne (D.R.B.) - both in Switzerland. Two of the authors (D.M., R.M.) were unaffiliated lay members of the STAMPEDE investigators
| | - Alastair W S Ritchie
- From the Institute of Cancer and Genomic Sciences, University of Birmingham (N.D.J.), and University Hospital Birmingham (A.Z.), Birmingham, the Institute of Cancer Research (J.S.B., D.P.D., G.A.), Medical Research Council Clinical Trials Unit at University College London (M.R. Spears, C.L.A., C.G., C.B., M.K.B.P., M.R. Sydes), King's College London and Guy's and St. Thomas' NHS Foundation Trust (S.C.), and Royal Marsden NHS Foundation Trust (C.C.P.), London, Salford Royal NHS Foundation Trust, Salford (N.W.C.), Cardiff University School of Medicine (M.D.M.) and Velindre Cancer Centre (J.F.L.), Cardiff, Gloucestershire Royal Hospital (A.W.S.R.) and Gloucestershire Hospitals NHS Foundation Trust (J.B.), Gloucester, University of Glasgow, Glasgow (R.J.J., J.M.R.), St. James's University Hospital, Leeds (W.R.C.), University Hospital of North-Midlands, Stoke-on-Trent (F.A.), Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter (S.A.), Rosemere Cancer Centre, Royal Preston Hospital, Preston (A.J.B.), Dorset Cancer Centre, Poole Hospital, Poole (S.B.), Royal Derby Hospital, Derby (P.C.), Weston Park Hospital, Sheffield (C.F.), Portsmouth Oncology Centre, Queen Alexandra Hospital, Portsmouth (J.G.), Musgrove Park Hospital, Taunton (E.G.), Hull and East Yorkshire Hospitals NHS Trust, Hull (M.H.), Mount Vernon Cancer Centre, Northwood (P.J.H.), Clatterbridge Cancer Centre, Wirral (Z.I.M.), Brighton and Sussex University Hospitals NHS Trust (F.M.) and Sussex Cancer Centre, Royal Sussex County Hospital (A.R.), Brighton, NHS Highland, Inverness (N.M.), Royal Surrey County Hospital, Guildford (J.M.-K.), Northern Ireland Cancer and Queens University, Belfast (J.O.), Lancashire Teaching Hospitals NHS Trust, Preston (O.P.), Churchill Hospital, Oxford (A.P.), Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury (N.N.S.), East Kent Hospitals NHS Trust, Canterbury (C.T.), Swansea University College of Medicine, Swansea (J. Wagstaff), and Christie NHS Foundation Trust, Manchester (J. Wylie) - all in the United Kingdom; and the Department of Medical Oncology, Kantonsspital St. Gallen, St. Gallen (S.G.), and University Hospital of Lausanne, Lausanne (D.R.B.) - both in Switzerland. Two of the authors (D.M., R.M.) were unaffiliated lay members of the STAMPEDE investigators
| | - Claire L Amos
- From the Institute of Cancer and Genomic Sciences, University of Birmingham (N.D.J.), and University Hospital Birmingham (A.Z.), Birmingham, the Institute of Cancer Research (J.S.B., D.P.D., G.A.), Medical Research Council Clinical Trials Unit at University College London (M.R. Spears, C.L.A., C.G., C.B., M.K.B.P., M.R. Sydes), King's College London and Guy's and St. Thomas' NHS Foundation Trust (S.C.), and Royal Marsden NHS Foundation Trust (C.C.P.), London, Salford Royal NHS Foundation Trust, Salford (N.W.C.), Cardiff University School of Medicine (M.D.M.) and Velindre Cancer Centre (J.F.L.), Cardiff, Gloucestershire Royal Hospital (A.W.S.R.) and Gloucestershire Hospitals NHS Foundation Trust (J.B.), Gloucester, University of Glasgow, Glasgow (R.J.J., J.M.R.), St. James's University Hospital, Leeds (W.R.C.), University Hospital of North-Midlands, Stoke-on-Trent (F.A.), Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter (S.A.), Rosemere Cancer Centre, Royal Preston Hospital, Preston (A.J.B.), Dorset Cancer Centre, Poole Hospital, Poole (S.B.), Royal Derby Hospital, Derby (P.C.), Weston Park Hospital, Sheffield (C.F.), Portsmouth Oncology Centre, Queen Alexandra Hospital, Portsmouth (J.G.), Musgrove Park Hospital, Taunton (E.G.), Hull and East Yorkshire Hospitals NHS Trust, Hull (M.H.), Mount Vernon Cancer Centre, Northwood (P.J.H.), Clatterbridge Cancer Centre, Wirral (Z.I.M.), Brighton and Sussex University Hospitals NHS Trust (F.M.) and Sussex Cancer Centre, Royal Sussex County Hospital (A.R.), Brighton, NHS Highland, Inverness (N.M.), Royal Surrey County Hospital, Guildford (J.M.-K.), Northern Ireland Cancer and Queens University, Belfast (J.O.), Lancashire Teaching Hospitals NHS Trust, Preston (O.P.), Churchill Hospital, Oxford (A.P.), Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury (N.N.S.), East Kent Hospitals NHS Trust, Canterbury (C.T.), Swansea University College of Medicine, Swansea (J. Wagstaff), and Christie NHS Foundation Trust, Manchester (J. Wylie) - all in the United Kingdom; and the Department of Medical Oncology, Kantonsspital St. Gallen, St. Gallen (S.G.), and University Hospital of Lausanne, Lausanne (D.R.B.) - both in Switzerland. Two of the authors (D.M., R.M.) were unaffiliated lay members of the STAMPEDE investigators
| | - Clare Gilson
- From the Institute of Cancer and Genomic Sciences, University of Birmingham (N.D.J.), and University Hospital Birmingham (A.Z.), Birmingham, the Institute of Cancer Research (J.S.B., D.P.D., G.A.), Medical Research Council Clinical Trials Unit at University College London (M.R. Spears, C.L.A., C.G., C.B., M.K.B.P., M.R. Sydes), King's College London and Guy's and St. Thomas' NHS Foundation Trust (S.C.), and Royal Marsden NHS Foundation Trust (C.C.P.), London, Salford Royal NHS Foundation Trust, Salford (N.W.C.), Cardiff University School of Medicine (M.D.M.) and Velindre Cancer Centre (J.F.L.), Cardiff, Gloucestershire Royal Hospital (A.W.S.R.) and Gloucestershire Hospitals NHS Foundation Trust (J.B.), Gloucester, University of Glasgow, Glasgow (R.J.J., J.M.R.), St. James's University Hospital, Leeds (W.R.C.), University Hospital of North-Midlands, Stoke-on-Trent (F.A.), Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter (S.A.), Rosemere Cancer Centre, Royal Preston Hospital, Preston (A.J.B.), Dorset Cancer Centre, Poole Hospital, Poole (S.B.), Royal Derby Hospital, Derby (P.C.), Weston Park Hospital, Sheffield (C.F.), Portsmouth Oncology Centre, Queen Alexandra Hospital, Portsmouth (J.G.), Musgrove Park Hospital, Taunton (E.G.), Hull and East Yorkshire Hospitals NHS Trust, Hull (M.H.), Mount Vernon Cancer Centre, Northwood (P.J.H.), Clatterbridge Cancer Centre, Wirral (Z.I.M.), Brighton and Sussex University Hospitals NHS Trust (F.M.) and Sussex Cancer Centre, Royal Sussex County Hospital (A.R.), Brighton, NHS Highland, Inverness (N.M.), Royal Surrey County Hospital, Guildford (J.M.-K.), Northern Ireland Cancer and Queens University, Belfast (J.O.), Lancashire Teaching Hospitals NHS Trust, Preston (O.P.), Churchill Hospital, Oxford (A.P.), Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury (N.N.S.), East Kent Hospitals NHS Trust, Canterbury (C.T.), Swansea University College of Medicine, Swansea (J. Wagstaff), and Christie NHS Foundation Trust, Manchester (J. Wylie) - all in the United Kingdom; and the Department of Medical Oncology, Kantonsspital St. Gallen, St. Gallen (S.G.), and University Hospital of Lausanne, Lausanne (D.R.B.) - both in Switzerland. Two of the authors (D.M., R.M.) were unaffiliated lay members of the STAMPEDE investigators
| | - Rob J Jones
- From the Institute of Cancer and Genomic Sciences, University of Birmingham (N.D.J.), and University Hospital Birmingham (A.Z.), Birmingham, the Institute of Cancer Research (J.S.B., D.P.D., G.A.), Medical Research Council Clinical Trials Unit at University College London (M.R. Spears, C.L.A., C.G., C.B., M.K.B.P., M.R. Sydes), King's College London and Guy's and St. Thomas' NHS Foundation Trust (S.C.), and Royal Marsden NHS Foundation Trust (C.C.P.), London, Salford Royal NHS Foundation Trust, Salford (N.W.C.), Cardiff University School of Medicine (M.D.M.) and Velindre Cancer Centre (J.F.L.), Cardiff, Gloucestershire Royal Hospital (A.W.S.R.) and Gloucestershire Hospitals NHS Foundation Trust (J.B.), Gloucester, University of Glasgow, Glasgow (R.J.J., J.M.R.), St. James's University Hospital, Leeds (W.R.C.), University Hospital of North-Midlands, Stoke-on-Trent (F.A.), Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter (S.A.), Rosemere Cancer Centre, Royal Preston Hospital, Preston (A.J.B.), Dorset Cancer Centre, Poole Hospital, Poole (S.B.), Royal Derby Hospital, Derby (P.C.), Weston Park Hospital, Sheffield (C.F.), Portsmouth Oncology Centre, Queen Alexandra Hospital, Portsmouth (J.G.), Musgrove Park Hospital, Taunton (E.G.), Hull and East Yorkshire Hospitals NHS Trust, Hull (M.H.), Mount Vernon Cancer Centre, Northwood (P.J.H.), Clatterbridge Cancer Centre, Wirral (Z.I.M.), Brighton and Sussex University Hospitals NHS Trust (F.M.) and Sussex Cancer Centre, Royal Sussex County Hospital (A.R.), Brighton, NHS Highland, Inverness (N.M.), Royal Surrey County Hospital, Guildford (J.M.-K.), Northern Ireland Cancer and Queens University, Belfast (J.O.), Lancashire Teaching Hospitals NHS Trust, Preston (O.P.), Churchill Hospital, Oxford (A.P.), Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury (N.N.S.), East Kent Hospitals NHS Trust, Canterbury (C.T.), Swansea University College of Medicine, Swansea (J. Wagstaff), and Christie NHS Foundation Trust, Manchester (J. Wylie) - all in the United Kingdom; and the Department of Medical Oncology, Kantonsspital St. Gallen, St. Gallen (S.G.), and University Hospital of Lausanne, Lausanne (D.R.B.) - both in Switzerland. Two of the authors (D.M., R.M.) were unaffiliated lay members of the STAMPEDE investigators
| | - David Matheson
- From the Institute of Cancer and Genomic Sciences, University of Birmingham (N.D.J.), and University Hospital Birmingham (A.Z.), Birmingham, the Institute of Cancer Research (J.S.B., D.P.D., G.A.), Medical Research Council Clinical Trials Unit at University College London (M.R. Spears, C.L.A., C.G., C.B., M.K.B.P., M.R. Sydes), King's College London and Guy's and St. Thomas' NHS Foundation Trust (S.C.), and Royal Marsden NHS Foundation Trust (C.C.P.), London, Salford Royal NHS Foundation Trust, Salford (N.W.C.), Cardiff University School of Medicine (M.D.M.) and Velindre Cancer Centre (J.F.L.), Cardiff, Gloucestershire Royal Hospital (A.W.S.R.) and Gloucestershire Hospitals NHS Foundation Trust (J.B.), Gloucester, University of Glasgow, Glasgow (R.J.J., J.M.R.), St. James's University Hospital, Leeds (W.R.C.), University Hospital of North-Midlands, Stoke-on-Trent (F.A.), Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter (S.A.), Rosemere Cancer Centre, Royal Preston Hospital, Preston (A.J.B.), Dorset Cancer Centre, Poole Hospital, Poole (S.B.), Royal Derby Hospital, Derby (P.C.), Weston Park Hospital, Sheffield (C.F.), Portsmouth Oncology Centre, Queen Alexandra Hospital, Portsmouth (J.G.), Musgrove Park Hospital, Taunton (E.G.), Hull and East Yorkshire Hospitals NHS Trust, Hull (M.H.), Mount Vernon Cancer Centre, Northwood (P.J.H.), Clatterbridge Cancer Centre, Wirral (Z.I.M.), Brighton and Sussex University Hospitals NHS Trust (F.M.) and Sussex Cancer Centre, Royal Sussex County Hospital (A.R.), Brighton, NHS Highland, Inverness (N.M.), Royal Surrey County Hospital, Guildford (J.M.-K.), Northern Ireland Cancer and Queens University, Belfast (J.O.), Lancashire Teaching Hospitals NHS Trust, Preston (O.P.), Churchill Hospital, Oxford (A.P.), Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury (N.N.S.), East Kent Hospitals NHS Trust, Canterbury (C.T.), Swansea University College of Medicine, Swansea (J. Wagstaff), and Christie NHS Foundation Trust, Manchester (J. Wylie) - all in the United Kingdom; and the Department of Medical Oncology, Kantonsspital St. Gallen, St. Gallen (S.G.), and University Hospital of Lausanne, Lausanne (D.R.B.) - both in Switzerland. Two of the authors (D.M., R.M.) were unaffiliated lay members of the STAMPEDE investigators
| | - Robin Millman
- From the Institute of Cancer and Genomic Sciences, University of Birmingham (N.D.J.), and University Hospital Birmingham (A.Z.), Birmingham, the Institute of Cancer Research (J.S.B., D.P.D., G.A.), Medical Research Council Clinical Trials Unit at University College London (M.R. Spears, C.L.A., C.G., C.B., M.K.B.P., M.R. Sydes), King's College London and Guy's and St. Thomas' NHS Foundation Trust (S.C.), and Royal Marsden NHS Foundation Trust (C.C.P.), London, Salford Royal NHS Foundation Trust, Salford (N.W.C.), Cardiff University School of Medicine (M.D.M.) and Velindre Cancer Centre (J.F.L.), Cardiff, Gloucestershire Royal Hospital (A.W.S.R.) and Gloucestershire Hospitals NHS Foundation Trust (J.B.), Gloucester, University of Glasgow, Glasgow (R.J.J., J.M.R.), St. James's University Hospital, Leeds (W.R.C.), University Hospital of North-Midlands, Stoke-on-Trent (F.A.), Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter (S.A.), Rosemere Cancer Centre, Royal Preston Hospital, Preston (A.J.B.), Dorset Cancer Centre, Poole Hospital, Poole (S.B.), Royal Derby Hospital, Derby (P.C.), Weston Park Hospital, Sheffield (C.F.), Portsmouth Oncology Centre, Queen Alexandra Hospital, Portsmouth (J.G.), Musgrove Park Hospital, Taunton (E.G.), Hull and East Yorkshire Hospitals NHS Trust, Hull (M.H.), Mount Vernon Cancer Centre, Northwood (P.J.H.), Clatterbridge Cancer Centre, Wirral (Z.I.M.), Brighton and Sussex University Hospitals NHS Trust (F.M.) and Sussex Cancer Centre, Royal Sussex County Hospital (A.R.), Brighton, NHS Highland, Inverness (N.M.), Royal Surrey County Hospital, Guildford (J.M.-K.), Northern Ireland Cancer and Queens University, Belfast (J.O.), Lancashire Teaching Hospitals NHS Trust, Preston (O.P.), Churchill Hospital, Oxford (A.P.), Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury (N.N.S.), East Kent Hospitals NHS Trust, Canterbury (C.T.), Swansea University College of Medicine, Swansea (J. Wagstaff), and Christie NHS Foundation Trust, Manchester (J. Wylie) - all in the United Kingdom; and the Department of Medical Oncology, Kantonsspital St. Gallen, St. Gallen (S.G.), and University Hospital of Lausanne, Lausanne (D.R.B.) - both in Switzerland. Two of the authors (D.M., R.M.) were unaffiliated lay members of the STAMPEDE investigators
| | - Gerhardt Attard
- From the Institute of Cancer and Genomic Sciences, University of Birmingham (N.D.J.), and University Hospital Birmingham (A.Z.), Birmingham, the Institute of Cancer Research (J.S.B., D.P.D., G.A.), Medical Research Council Clinical Trials Unit at University College London (M.R. Spears, C.L.A., C.G., C.B., M.K.B.P., M.R. Sydes), King's College London and Guy's and St. Thomas' NHS Foundation Trust (S.C.), and Royal Marsden NHS Foundation Trust (C.C.P.), London, Salford Royal NHS Foundation Trust, Salford (N.W.C.), Cardiff University School of Medicine (M.D.M.) and Velindre Cancer Centre (J.F.L.), Cardiff, Gloucestershire Royal Hospital (A.W.S.R.) and Gloucestershire Hospitals NHS Foundation Trust (J.B.), Gloucester, University of Glasgow, Glasgow (R.J.J., J.M.R.), St. James's University Hospital, Leeds (W.R.C.), University Hospital of North-Midlands, Stoke-on-Trent (F.A.), Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter (S.A.), Rosemere Cancer Centre, Royal Preston Hospital, Preston (A.J.B.), Dorset Cancer Centre, Poole Hospital, Poole (S.B.), Royal Derby Hospital, Derby (P.C.), Weston Park Hospital, Sheffield (C.F.), Portsmouth Oncology Centre, Queen Alexandra Hospital, Portsmouth (J.G.), Musgrove Park Hospital, Taunton (E.G.), Hull and East Yorkshire Hospitals NHS Trust, Hull (M.H.), Mount Vernon Cancer Centre, Northwood (P.J.H.), Clatterbridge Cancer Centre, Wirral (Z.I.M.), Brighton and Sussex University Hospitals NHS Trust (F.M.) and Sussex Cancer Centre, Royal Sussex County Hospital (A.R.), Brighton, NHS Highland, Inverness (N.M.), Royal Surrey County Hospital, Guildford (J.M.-K.), Northern Ireland Cancer and Queens University, Belfast (J.O.), Lancashire Teaching Hospitals NHS Trust, Preston (O.P.), Churchill Hospital, Oxford (A.P.), Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury (N.N.S.), East Kent Hospitals NHS Trust, Canterbury (C.T.), Swansea University College of Medicine, Swansea (J. Wagstaff), and Christie NHS Foundation Trust, Manchester (J. Wylie) - all in the United Kingdom; and the Department of Medical Oncology, Kantonsspital St. Gallen, St. Gallen (S.G.), and University Hospital of Lausanne, Lausanne (D.R.B.) - both in Switzerland. Two of the authors (D.M., R.M.) were unaffiliated lay members of the STAMPEDE investigators
| | - Simon Chowdhury
- From the Institute of Cancer and Genomic Sciences, University of Birmingham (N.D.J.), and University Hospital Birmingham (A.Z.), Birmingham, the Institute of Cancer Research (J.S.B., D.P.D., G.A.), Medical Research Council Clinical Trials Unit at University College London (M.R. Spears, C.L.A., C.G., C.B., M.K.B.P., M.R. Sydes), King's College London and Guy's and St. Thomas' NHS Foundation Trust (S.C.), and Royal Marsden NHS Foundation Trust (C.C.P.), London, Salford Royal NHS Foundation Trust, Salford (N.W.C.), Cardiff University School of Medicine (M.D.M.) and Velindre Cancer Centre (J.F.L.), Cardiff, Gloucestershire Royal Hospital (A.W.S.R.) and Gloucestershire Hospitals NHS Foundation Trust (J.B.), Gloucester, University of Glasgow, Glasgow (R.J.J., J.M.R.), St. James's University Hospital, Leeds (W.R.C.), University Hospital of North-Midlands, Stoke-on-Trent (F.A.), Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter (S.A.), Rosemere Cancer Centre, Royal Preston Hospital, Preston (A.J.B.), Dorset Cancer Centre, Poole Hospital, Poole (S.B.), Royal Derby Hospital, Derby (P.C.), Weston Park Hospital, Sheffield (C.F.), Portsmouth Oncology Centre, Queen Alexandra Hospital, Portsmouth (J.G.), Musgrove Park Hospital, Taunton (E.G.), Hull and East Yorkshire Hospitals NHS Trust, Hull (M.H.), Mount Vernon Cancer Centre, Northwood (P.J.H.), Clatterbridge Cancer Centre, Wirral (Z.I.M.), Brighton and Sussex University Hospitals NHS Trust (F.M.) and Sussex Cancer Centre, Royal Sussex County Hospital (A.R.), Brighton, NHS Highland, Inverness (N.M.), Royal Surrey County Hospital, Guildford (J.M.-K.), Northern Ireland Cancer and Queens University, Belfast (J.O.), Lancashire Teaching Hospitals NHS Trust, Preston (O.P.), Churchill Hospital, Oxford (A.P.), Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury (N.N.S.), East Kent Hospitals NHS Trust, Canterbury (C.T.), Swansea University College of Medicine, Swansea (J. Wagstaff), and Christie NHS Foundation Trust, Manchester (J. Wylie) - all in the United Kingdom; and the Department of Medical Oncology, Kantonsspital St. Gallen, St. Gallen (S.G.), and University Hospital of Lausanne, Lausanne (D.R.B.) - both in Switzerland. Two of the authors (D.M., R.M.) were unaffiliated lay members of the STAMPEDE investigators
| | - William R Cross
- From the Institute of Cancer and Genomic Sciences, University of Birmingham (N.D.J.), and University Hospital Birmingham (A.Z.), Birmingham, the Institute of Cancer Research (J.S.B., D.P.D., G.A.), Medical Research Council Clinical Trials Unit at University College London (M.R. Spears, C.L.A., C.G., C.B., M.K.B.P., M.R. Sydes), King's College London and Guy's and St. Thomas' NHS Foundation Trust (S.C.), and Royal Marsden NHS Foundation Trust (C.C.P.), London, Salford Royal NHS Foundation Trust, Salford (N.W.C.), Cardiff University School of Medicine (M.D.M.) and Velindre Cancer Centre (J.F.L.), Cardiff, Gloucestershire Royal Hospital (A.W.S.R.) and Gloucestershire Hospitals NHS Foundation Trust (J.B.), Gloucester, University of Glasgow, Glasgow (R.J.J., J.M.R.), St. James's University Hospital, Leeds (W.R.C.), University Hospital of North-Midlands, Stoke-on-Trent (F.A.), Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter (S.A.), Rosemere Cancer Centre, Royal Preston Hospital, Preston (A.J.B.), Dorset Cancer Centre, Poole Hospital, Poole (S.B.), Royal Derby Hospital, Derby (P.C.), Weston Park Hospital, Sheffield (C.F.), Portsmouth Oncology Centre, Queen Alexandra Hospital, Portsmouth (J.G.), Musgrove Park Hospital, Taunton (E.G.), Hull and East Yorkshire Hospitals NHS Trust, Hull (M.H.), Mount Vernon Cancer Centre, Northwood (P.J.H.), Clatterbridge Cancer Centre, Wirral (Z.I.M.), Brighton and Sussex University Hospitals NHS Trust (F.M.) and Sussex Cancer Centre, Royal Sussex County Hospital (A.R.), Brighton, NHS Highland, Inverness (N.M.), Royal Surrey County Hospital, Guildford (J.M.-K.), Northern Ireland Cancer and Queens University, Belfast (J.O.), Lancashire Teaching Hospitals NHS Trust, Preston (O.P.), Churchill Hospital, Oxford (A.P.), Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury (N.N.S.), East Kent Hospitals NHS Trust, Canterbury (C.T.), Swansea University College of Medicine, Swansea (J. Wagstaff), and Christie NHS Foundation Trust, Manchester (J. Wylie) - all in the United Kingdom; and the Department of Medical Oncology, Kantonsspital St. Gallen, St. Gallen (S.G.), and University Hospital of Lausanne, Lausanne (D.R.B.) - both in Switzerland. Two of the authors (D.M., R.M.) were unaffiliated lay members of the STAMPEDE investigators
| | - Silke Gillessen
- From the Institute of Cancer and Genomic Sciences, University of Birmingham (N.D.J.), and University Hospital Birmingham (A.Z.), Birmingham, the Institute of Cancer Research (J.S.B., D.P.D., G.A.), Medical Research Council Clinical Trials Unit at University College London (M.R. Spears, C.L.A., C.G., C.B., M.K.B.P., M.R. Sydes), King's College London and Guy's and St. Thomas' NHS Foundation Trust (S.C.), and Royal Marsden NHS Foundation Trust (C.C.P.), London, Salford Royal NHS Foundation Trust, Salford (N.W.C.), Cardiff University School of Medicine (M.D.M.) and Velindre Cancer Centre (J.F.L.), Cardiff, Gloucestershire Royal Hospital (A.W.S.R.) and Gloucestershire Hospitals NHS Foundation Trust (J.B.), Gloucester, University of Glasgow, Glasgow (R.J.J., J.M.R.), St. James's University Hospital, Leeds (W.R.C.), University Hospital of North-Midlands, Stoke-on-Trent (F.A.), Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter (S.A.), Rosemere Cancer Centre, Royal Preston Hospital, Preston (A.J.B.), Dorset Cancer Centre, Poole Hospital, Poole (S.B.), Royal Derby Hospital, Derby (P.C.), Weston Park Hospital, Sheffield (C.F.), Portsmouth Oncology Centre, Queen Alexandra Hospital, Portsmouth (J.G.), Musgrove Park Hospital, Taunton (E.G.), Hull and East Yorkshire Hospitals NHS Trust, Hull (M.H.), Mount Vernon Cancer Centre, Northwood (P.J.H.), Clatterbridge Cancer Centre, Wirral (Z.I.M.), Brighton and Sussex University Hospitals NHS Trust (F.M.) and Sussex Cancer Centre, Royal Sussex County Hospital (A.R.), Brighton, NHS Highland, Inverness (N.M.), Royal Surrey County Hospital, Guildford (J.M.-K.), Northern Ireland Cancer and Queens University, Belfast (J.O.), Lancashire Teaching Hospitals NHS Trust, Preston (O.P.), Churchill Hospital, Oxford (A.P.), Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury (N.N.S.), East Kent Hospitals NHS Trust, Canterbury (C.T.), Swansea University College of Medicine, Swansea (J. Wagstaff), and Christie NHS Foundation Trust, Manchester (J. Wylie) - all in the United Kingdom; and the Department of Medical Oncology, Kantonsspital St. Gallen, St. Gallen (S.G.), and University Hospital of Lausanne, Lausanne (D.R.B.) - both in Switzerland. Two of the authors (D.M., R.M.) were unaffiliated lay members of the STAMPEDE investigators
| | - Christopher C Parker
- From the Institute of Cancer and Genomic Sciences, University of Birmingham (N.D.J.), and University Hospital Birmingham (A.Z.), Birmingham, the Institute of Cancer Research (J.S.B., D.P.D., G.A.), Medical Research Council Clinical Trials Unit at University College London (M.R. Spears, C.L.A., C.G., C.B., M.K.B.P., M.R. Sydes), King's College London and Guy's and St. Thomas' NHS Foundation Trust (S.C.), and Royal Marsden NHS Foundation Trust (C.C.P.), London, Salford Royal NHS Foundation Trust, Salford (N.W.C.), Cardiff University School of Medicine (M.D.M.) and Velindre Cancer Centre (J.F.L.), Cardiff, Gloucestershire Royal Hospital (A.W.S.R.) and Gloucestershire Hospitals NHS Foundation Trust (J.B.), Gloucester, University of Glasgow, Glasgow (R.J.J., J.M.R.), St. James's University Hospital, Leeds (W.R.C.), University Hospital of North-Midlands, Stoke-on-Trent (F.A.), Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter (S.A.), Rosemere Cancer Centre, Royal Preston Hospital, Preston (A.J.B.), Dorset Cancer Centre, Poole Hospital, Poole (S.B.), Royal Derby Hospital, Derby (P.C.), Weston Park Hospital, Sheffield (C.F.), Portsmouth Oncology Centre, Queen Alexandra Hospital, Portsmouth (J.G.), Musgrove Park Hospital, Taunton (E.G.), Hull and East Yorkshire Hospitals NHS Trust, Hull (M.H.), Mount Vernon Cancer Centre, Northwood (P.J.H.), Clatterbridge Cancer Centre, Wirral (Z.I.M.), Brighton and Sussex University Hospitals NHS Trust (F.M.) and Sussex Cancer Centre, Royal Sussex County Hospital (A.R.), Brighton, NHS Highland, Inverness (N.M.), Royal Surrey County Hospital, Guildford (J.M.-K.), Northern Ireland Cancer and Queens University, Belfast (J.O.), Lancashire Teaching Hospitals NHS Trust, Preston (O.P.), Churchill Hospital, Oxford (A.P.), Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury (N.N.S.), East Kent Hospitals NHS Trust, Canterbury (C.T.), Swansea University College of Medicine, Swansea (J. Wagstaff), and Christie NHS Foundation Trust, Manchester (J. Wylie) - all in the United Kingdom; and the Department of Medical Oncology, Kantonsspital St. Gallen, St. Gallen (S.G.), and University Hospital of Lausanne, Lausanne (D.R.B.) - both in Switzerland. Two of the authors (D.M., R.M.) were unaffiliated lay members of the STAMPEDE investigators
| | - J Martin Russell
- From the Institute of Cancer and Genomic Sciences, University of Birmingham (N.D.J.), and University Hospital Birmingham (A.Z.), Birmingham, the Institute of Cancer Research (J.S.B., D.P.D., G.A.), Medical Research Council Clinical Trials Unit at University College London (M.R. Spears, C.L.A., C.G., C.B., M.K.B.P., M.R. Sydes), King's College London and Guy's and St. Thomas' NHS Foundation Trust (S.C.), and Royal Marsden NHS Foundation Trust (C.C.P.), London, Salford Royal NHS Foundation Trust, Salford (N.W.C.), Cardiff University School of Medicine (M.D.M.) and Velindre Cancer Centre (J.F.L.), Cardiff, Gloucestershire Royal Hospital (A.W.S.R.) and Gloucestershire Hospitals NHS Foundation Trust (J.B.), Gloucester, University of Glasgow, Glasgow (R.J.J., J.M.R.), St. James's University Hospital, Leeds (W.R.C.), University Hospital of North-Midlands, Stoke-on-Trent (F.A.), Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter (S.A.), Rosemere Cancer Centre, Royal Preston Hospital, Preston (A.J.B.), Dorset Cancer Centre, Poole Hospital, Poole (S.B.), Royal Derby Hospital, Derby (P.C.), Weston Park Hospital, Sheffield (C.F.), Portsmouth Oncology Centre, Queen Alexandra Hospital, Portsmouth (J.G.), Musgrove Park Hospital, Taunton (E.G.), Hull and East Yorkshire Hospitals NHS Trust, Hull (M.H.), Mount Vernon Cancer Centre, Northwood (P.J.H.), Clatterbridge Cancer Centre, Wirral (Z.I.M.), Brighton and Sussex University Hospitals NHS Trust (F.M.) and Sussex Cancer Centre, Royal Sussex County Hospital (A.R.), Brighton, NHS Highland, Inverness (N.M.), Royal Surrey County Hospital, Guildford (J.M.-K.), Northern Ireland Cancer and Queens University, Belfast (J.O.), Lancashire Teaching Hospitals NHS Trust, Preston (O.P.), Churchill Hospital, Oxford (A.P.), Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury (N.N.S.), East Kent Hospitals NHS Trust, Canterbury (C.T.), Swansea University College of Medicine, Swansea (J. Wagstaff), and Christie NHS Foundation Trust, Manchester (J. Wylie) - all in the United Kingdom; and the Department of Medical Oncology, Kantonsspital St. Gallen, St. Gallen (S.G.), and University Hospital of Lausanne, Lausanne (D.R.B.) - both in Switzerland. Two of the authors (D.M., R.M.) were unaffiliated lay members of the STAMPEDE investigators
| | - Dominik R Berthold
- From the Institute of Cancer and Genomic Sciences, University of Birmingham (N.D.J.), and University Hospital Birmingham (A.Z.), Birmingham, the Institute of Cancer Research (J.S.B., D.P.D., G.A.), Medical Research Council Clinical Trials Unit at University College London (M.R. Spears, C.L.A., C.G., C.B., M.K.B.P., M.R. Sydes), King's College London and Guy's and St. Thomas' NHS Foundation Trust (S.C.), and Royal Marsden NHS Foundation Trust (C.C.P.), London, Salford Royal NHS Foundation Trust, Salford (N.W.C.), Cardiff University School of Medicine (M.D.M.) and Velindre Cancer Centre (J.F.L.), Cardiff, Gloucestershire Royal Hospital (A.W.S.R.) and Gloucestershire Hospitals NHS Foundation Trust (J.B.), Gloucester, University of Glasgow, Glasgow (R.J.J., J.M.R.), St. James's University Hospital, Leeds (W.R.C.), University Hospital of North-Midlands, Stoke-on-Trent (F.A.), Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter (S.A.), Rosemere Cancer Centre, Royal Preston Hospital, Preston (A.J.B.), Dorset Cancer Centre, Poole Hospital, Poole (S.B.), Royal Derby Hospital, Derby (P.C.), Weston Park Hospital, Sheffield (C.F.), Portsmouth Oncology Centre, Queen Alexandra Hospital, Portsmouth (J.G.), Musgrove Park Hospital, Taunton (E.G.), Hull and East Yorkshire Hospitals NHS Trust, Hull (M.H.), Mount Vernon Cancer Centre, Northwood (P.J.H.), Clatterbridge Cancer Centre, Wirral (Z.I.M.), Brighton and Sussex University Hospitals NHS Trust (F.M.) and Sussex Cancer Centre, Royal Sussex County Hospital (A.R.), Brighton, NHS Highland, Inverness (N.M.), Royal Surrey County Hospital, Guildford (J.M.-K.), Northern Ireland Cancer and Queens University, Belfast (J.O.), Lancashire Teaching Hospitals NHS Trust, Preston (O.P.), Churchill Hospital, Oxford (A.P.), Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury (N.N.S.), East Kent Hospitals NHS Trust, Canterbury (C.T.), Swansea University College of Medicine, Swansea (J. Wagstaff), and Christie NHS Foundation Trust, Manchester (J. Wylie) - all in the United Kingdom; and the Department of Medical Oncology, Kantonsspital St. Gallen, St. Gallen (S.G.), and University Hospital of Lausanne, Lausanne (D.R.B.) - both in Switzerland. Two of the authors (D.M., R.M.) were unaffiliated lay members of the STAMPEDE investigators
| | - Chris Brawley
- From the Institute of Cancer and Genomic Sciences, University of Birmingham (N.D.J.), and University Hospital Birmingham (A.Z.), Birmingham, the Institute of Cancer Research (J.S.B., D.P.D., G.A.), Medical Research Council Clinical Trials Unit at University College London (M.R. Spears, C.L.A., C.G., C.B., M.K.B.P., M.R. Sydes), King's College London and Guy's and St. Thomas' NHS Foundation Trust (S.C.), and Royal Marsden NHS Foundation Trust (C.C.P.), London, Salford Royal NHS Foundation Trust, Salford (N.W.C.), Cardiff University School of Medicine (M.D.M.) and Velindre Cancer Centre (J.F.L.), Cardiff, Gloucestershire Royal Hospital (A.W.S.R.) and Gloucestershire Hospitals NHS Foundation Trust (J.B.), Gloucester, University of Glasgow, Glasgow (R.J.J., J.M.R.), St. James's University Hospital, Leeds (W.R.C.), University Hospital of North-Midlands, Stoke-on-Trent (F.A.), Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter (S.A.), Rosemere Cancer Centre, Royal Preston Hospital, Preston (A.J.B.), Dorset Cancer Centre, Poole Hospital, Poole (S.B.), Royal Derby Hospital, Derby (P.C.), Weston Park Hospital, Sheffield (C.F.), Portsmouth Oncology Centre, Queen Alexandra Hospital, Portsmouth (J.G.), Musgrove Park Hospital, Taunton (E.G.), Hull and East Yorkshire Hospitals NHS Trust, Hull (M.H.), Mount Vernon Cancer Centre, Northwood (P.J.H.), Clatterbridge Cancer Centre, Wirral (Z.I.M.), Brighton and Sussex University Hospitals NHS Trust (F.M.) and Sussex Cancer Centre, Royal Sussex County Hospital (A.R.), Brighton, NHS Highland, Inverness (N.M.), Royal Surrey County Hospital, Guildford (J.M.-K.), Northern Ireland Cancer and Queens University, Belfast (J.O.), Lancashire Teaching Hospitals NHS Trust, Preston (O.P.), Churchill Hospital, Oxford (A.P.), Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury (N.N.S.), East Kent Hospitals NHS Trust, Canterbury (C.T.), Swansea University College of Medicine, Swansea (J. Wagstaff), and Christie NHS Foundation Trust, Manchester (J. Wylie) - all in the United Kingdom; and the Department of Medical Oncology, Kantonsspital St. Gallen, St. Gallen (S.G.), and University Hospital of Lausanne, Lausanne (D.R.B.) - both in Switzerland. Two of the authors (D.M., R.M.) were unaffiliated lay members of the STAMPEDE investigators
| | - Fawzi Adab
- From the Institute of Cancer and Genomic Sciences, University of Birmingham (N.D.J.), and University Hospital Birmingham (A.Z.), Birmingham, the Institute of Cancer Research (J.S.B., D.P.D., G.A.), Medical Research Council Clinical Trials Unit at University College London (M.R. Spears, C.L.A., C.G., C.B., M.K.B.P., M.R. Sydes), King's College London and Guy's and St. Thomas' NHS Foundation Trust (S.C.), and Royal Marsden NHS Foundation Trust (C.C.P.), London, Salford Royal NHS Foundation Trust, Salford (N.W.C.), Cardiff University School of Medicine (M.D.M.) and Velindre Cancer Centre (J.F.L.), Cardiff, Gloucestershire Royal Hospital (A.W.S.R.) and Gloucestershire Hospitals NHS Foundation Trust (J.B.), Gloucester, University of Glasgow, Glasgow (R.J.J., J.M.R.), St. James's University Hospital, Leeds (W.R.C.), University Hospital of North-Midlands, Stoke-on-Trent (F.A.), Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter (S.A.), Rosemere Cancer Centre, Royal Preston Hospital, Preston (A.J.B.), Dorset Cancer Centre, Poole Hospital, Poole (S.B.), Royal Derby Hospital, Derby (P.C.), Weston Park Hospital, Sheffield (C.F.), Portsmouth Oncology Centre, Queen Alexandra Hospital, Portsmouth (J.G.), Musgrove Park Hospital, Taunton (E.G.), Hull and East Yorkshire Hospitals NHS Trust, Hull (M.H.), Mount Vernon Cancer Centre, Northwood (P.J.H.), Clatterbridge Cancer Centre, Wirral (Z.I.M.), Brighton and Sussex University Hospitals NHS Trust (F.M.) and Sussex Cancer Centre, Royal Sussex County Hospital (A.R.), Brighton, NHS Highland, Inverness (N.M.), Royal Surrey County Hospital, Guildford (J.M.-K.), Northern Ireland Cancer and Queens University, Belfast (J.O.), Lancashire Teaching Hospitals NHS Trust, Preston (O.P.), Churchill Hospital, Oxford (A.P.), Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury (N.N.S.), East Kent Hospitals NHS Trust, Canterbury (C.T.), Swansea University College of Medicine, Swansea (J. Wagstaff), and Christie NHS Foundation Trust, Manchester (J. Wylie) - all in the United Kingdom; and the Department of Medical Oncology, Kantonsspital St. Gallen, St. Gallen (S.G.), and University Hospital of Lausanne, Lausanne (D.R.B.) - both in Switzerland. Two of the authors (D.M., R.M.) were unaffiliated lay members of the STAMPEDE investigators
| | - San Aung
- From the Institute of Cancer and Genomic Sciences, University of Birmingham (N.D.J.), and University Hospital Birmingham (A.Z.), Birmingham, the Institute of Cancer Research (J.S.B., D.P.D., G.A.), Medical Research Council Clinical Trials Unit at University College London (M.R. Spears, C.L.A., C.G., C.B., M.K.B.P., M.R. Sydes), King's College London and Guy's and St. Thomas' NHS Foundation Trust (S.C.), and Royal Marsden NHS Foundation Trust (C.C.P.), London, Salford Royal NHS Foundation Trust, Salford (N.W.C.), Cardiff University School of Medicine (M.D.M.) and Velindre Cancer Centre (J.F.L.), Cardiff, Gloucestershire Royal Hospital (A.W.S.R.) and Gloucestershire Hospitals NHS Foundation Trust (J.B.), Gloucester, University of Glasgow, Glasgow (R.J.J., J.M.R.), St. James's University Hospital, Leeds (W.R.C.), University Hospital of North-Midlands, Stoke-on-Trent (F.A.), Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter (S.A.), Rosemere Cancer Centre, Royal Preston Hospital, Preston (A.J.B.), Dorset Cancer Centre, Poole Hospital, Poole (S.B.), Royal Derby Hospital, Derby (P.C.), Weston Park Hospital, Sheffield (C.F.), Portsmouth Oncology Centre, Queen Alexandra Hospital, Portsmouth (J.G.), Musgrove Park Hospital, Taunton (E.G.), Hull and East Yorkshire Hospitals NHS Trust, Hull (M.H.), Mount Vernon Cancer Centre, Northwood (P.J.H.), Clatterbridge Cancer Centre, Wirral (Z.I.M.), Brighton and Sussex University Hospitals NHS Trust (F.M.) and Sussex Cancer Centre, Royal Sussex County Hospital (A.R.), Brighton, NHS Highland, Inverness (N.M.), Royal Surrey County Hospital, Guildford (J.M.-K.), Northern Ireland Cancer and Queens University, Belfast (J.O.), Lancashire Teaching Hospitals NHS Trust, Preston (O.P.), Churchill Hospital, Oxford (A.P.), Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury (N.N.S.), East Kent Hospitals NHS Trust, Canterbury (C.T.), Swansea University College of Medicine, Swansea (J. Wagstaff), and Christie NHS Foundation Trust, Manchester (J. Wylie) - all in the United Kingdom; and the Department of Medical Oncology, Kantonsspital St. Gallen, St. Gallen (S.G.), and University Hospital of Lausanne, Lausanne (D.R.B.) - both in Switzerland. Two of the authors (D.M., R.M.) were unaffiliated lay members of the STAMPEDE investigators
| | - Alison J Birtle
- From the Institute of Cancer and Genomic Sciences, University of Birmingham (N.D.J.), and University Hospital Birmingham (A.Z.), Birmingham, the Institute of Cancer Research (J.S.B., D.P.D., G.A.), Medical Research Council Clinical Trials Unit at University College London (M.R. Spears, C.L.A., C.G., C.B., M.K.B.P., M.R. Sydes), King's College London and Guy's and St. Thomas' NHS Foundation Trust (S.C.), and Royal Marsden NHS Foundation Trust (C.C.P.), London, Salford Royal NHS Foundation Trust, Salford (N.W.C.), Cardiff University School of Medicine (M.D.M.) and Velindre Cancer Centre (J.F.L.), Cardiff, Gloucestershire Royal Hospital (A.W.S.R.) and Gloucestershire Hospitals NHS Foundation Trust (J.B.), Gloucester, University of Glasgow, Glasgow (R.J.J., J.M.R.), St. James's University Hospital, Leeds (W.R.C.), University Hospital of North-Midlands, Stoke-on-Trent (F.A.), Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter (S.A.), Rosemere Cancer Centre, Royal Preston Hospital, Preston (A.J.B.), Dorset Cancer Centre, Poole Hospital, Poole (S.B.), Royal Derby Hospital, Derby (P.C.), Weston Park Hospital, Sheffield (C.F.), Portsmouth Oncology Centre, Queen Alexandra Hospital, Portsmouth (J.G.), Musgrove Park Hospital, Taunton (E.G.), Hull and East Yorkshire Hospitals NHS Trust, Hull (M.H.), Mount Vernon Cancer Centre, Northwood (P.J.H.), Clatterbridge Cancer Centre, Wirral (Z.I.M.), Brighton and Sussex University Hospitals NHS Trust (F.M.) and Sussex Cancer Centre, Royal Sussex County Hospital (A.R.), Brighton, NHS Highland, Inverness (N.M.), Royal Surrey County Hospital, Guildford (J.M.-K.), Northern Ireland Cancer and Queens University, Belfast (J.O.), Lancashire Teaching Hospitals NHS Trust, Preston (O.P.), Churchill Hospital, Oxford (A.P.), Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury (N.N.S.), East Kent Hospitals NHS Trust, Canterbury (C.T.), Swansea University College of Medicine, Swansea (J. Wagstaff), and Christie NHS Foundation Trust, Manchester (J. Wylie) - all in the United Kingdom; and the Department of Medical Oncology, Kantonsspital St. Gallen, St. Gallen (S.G.), and University Hospital of Lausanne, Lausanne (D.R.B.) - both in Switzerland. Two of the authors (D.M., R.M.) were unaffiliated lay members of the STAMPEDE investigators
| | - Jo Bowen
- From the Institute of Cancer and Genomic Sciences, University of Birmingham (N.D.J.), and University Hospital Birmingham (A.Z.), Birmingham, the Institute of Cancer Research (J.S.B., D.P.D., G.A.), Medical Research Council Clinical Trials Unit at University College London (M.R. Spears, C.L.A., C.G., C.B., M.K.B.P., M.R. Sydes), King's College London and Guy's and St. Thomas' NHS Foundation Trust (S.C.), and Royal Marsden NHS Foundation Trust (C.C.P.), London, Salford Royal NHS Foundation Trust, Salford (N.W.C.), Cardiff University School of Medicine (M.D.M.) and Velindre Cancer Centre (J.F.L.), Cardiff, Gloucestershire Royal Hospital (A.W.S.R.) and Gloucestershire Hospitals NHS Foundation Trust (J.B.), Gloucester, University of Glasgow, Glasgow (R.J.J., J.M.R.), St. James's University Hospital, Leeds (W.R.C.), University Hospital of North-Midlands, Stoke-on-Trent (F.A.), Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter (S.A.), Rosemere Cancer Centre, Royal Preston Hospital, Preston (A.J.B.), Dorset Cancer Centre, Poole Hospital, Poole (S.B.), Royal Derby Hospital, Derby (P.C.), Weston Park Hospital, Sheffield (C.F.), Portsmouth Oncology Centre, Queen Alexandra Hospital, Portsmouth (J.G.), Musgrove Park Hospital, Taunton (E.G.), Hull and East Yorkshire Hospitals NHS Trust, Hull (M.H.), Mount Vernon Cancer Centre, Northwood (P.J.H.), Clatterbridge Cancer Centre, Wirral (Z.I.M.), Brighton and Sussex University Hospitals NHS Trust (F.M.) and Sussex Cancer Centre, Royal Sussex County Hospital (A.R.), Brighton, NHS Highland, Inverness (N.M.), Royal Surrey County Hospital, Guildford (J.M.-K.), Northern Ireland Cancer and Queens University, Belfast (J.O.), Lancashire Teaching Hospitals NHS Trust, Preston (O.P.), Churchill Hospital, Oxford (A.P.), Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury (N.N.S.), East Kent Hospitals NHS Trust, Canterbury (C.T.), Swansea University College of Medicine, Swansea (J. Wagstaff), and Christie NHS Foundation Trust, Manchester (J. Wylie) - all in the United Kingdom; and the Department of Medical Oncology, Kantonsspital St. Gallen, St. Gallen (S.G.), and University Hospital of Lausanne, Lausanne (D.R.B.) - both in Switzerland. Two of the authors (D.M., R.M.) were unaffiliated lay members of the STAMPEDE investigators
| | - Susannah Brock
- From the Institute of Cancer and Genomic Sciences, University of Birmingham (N.D.J.), and University Hospital Birmingham (A.Z.), Birmingham, the Institute of Cancer Research (J.S.B., D.P.D., G.A.), Medical Research Council Clinical Trials Unit at University College London (M.R. Spears, C.L.A., C.G., C.B., M.K.B.P., M.R. Sydes), King's College London and Guy's and St. Thomas' NHS Foundation Trust (S.C.), and Royal Marsden NHS Foundation Trust (C.C.P.), London, Salford Royal NHS Foundation Trust, Salford (N.W.C.), Cardiff University School of Medicine (M.D.M.) and Velindre Cancer Centre (J.F.L.), Cardiff, Gloucestershire Royal Hospital (A.W.S.R.) and Gloucestershire Hospitals NHS Foundation Trust (J.B.), Gloucester, University of Glasgow, Glasgow (R.J.J., J.M.R.), St. James's University Hospital, Leeds (W.R.C.), University Hospital of North-Midlands, Stoke-on-Trent (F.A.), Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter (S.A.), Rosemere Cancer Centre, Royal Preston Hospital, Preston (A.J.B.), Dorset Cancer Centre, Poole Hospital, Poole (S.B.), Royal Derby Hospital, Derby (P.C.), Weston Park Hospital, Sheffield (C.F.), Portsmouth Oncology Centre, Queen Alexandra Hospital, Portsmouth (J.G.), Musgrove Park Hospital, Taunton (E.G.), Hull and East Yorkshire Hospitals NHS Trust, Hull (M.H.), Mount Vernon Cancer Centre, Northwood (P.J.H.), Clatterbridge Cancer Centre, Wirral (Z.I.M.), Brighton and Sussex University Hospitals NHS Trust (F.M.) and Sussex Cancer Centre, Royal Sussex County Hospital (A.R.), Brighton, NHS Highland, Inverness (N.M.), Royal Surrey County Hospital, Guildford (J.M.-K.), Northern Ireland Cancer and Queens University, Belfast (J.O.), Lancashire Teaching Hospitals NHS Trust, Preston (O.P.), Churchill Hospital, Oxford (A.P.), Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury (N.N.S.), East Kent Hospitals NHS Trust, Canterbury (C.T.), Swansea University College of Medicine, Swansea (J. Wagstaff), and Christie NHS Foundation Trust, Manchester (J. Wylie) - all in the United Kingdom; and the Department of Medical Oncology, Kantonsspital St. Gallen, St. Gallen (S.G.), and University Hospital of Lausanne, Lausanne (D.R.B.) - both in Switzerland. Two of the authors (D.M., R.M.) were unaffiliated lay members of the STAMPEDE investigators
| | - Prabir Chakraborti
- From the Institute of Cancer and Genomic Sciences, University of Birmingham (N.D.J.), and University Hospital Birmingham (A.Z.), Birmingham, the Institute of Cancer Research (J.S.B., D.P.D., G.A.), Medical Research Council Clinical Trials Unit at University College London (M.R. Spears, C.L.A., C.G., C.B., M.K.B.P., M.R. Sydes), King's College London and Guy's and St. Thomas' NHS Foundation Trust (S.C.), and Royal Marsden NHS Foundation Trust (C.C.P.), London, Salford Royal NHS Foundation Trust, Salford (N.W.C.), Cardiff University School of Medicine (M.D.M.) and Velindre Cancer Centre (J.F.L.), Cardiff, Gloucestershire Royal Hospital (A.W.S.R.) and Gloucestershire Hospitals NHS Foundation Trust (J.B.), Gloucester, University of Glasgow, Glasgow (R.J.J., J.M.R.), St. James's University Hospital, Leeds (W.R.C.), University Hospital of North-Midlands, Stoke-on-Trent (F.A.), Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter (S.A.), Rosemere Cancer Centre, Royal Preston Hospital, Preston (A.J.B.), Dorset Cancer Centre, Poole Hospital, Poole (S.B.), Royal Derby Hospital, Derby (P.C.), Weston Park Hospital, Sheffield (C.F.), Portsmouth Oncology Centre, Queen Alexandra Hospital, Portsmouth (J.G.), Musgrove Park Hospital, Taunton (E.G.), Hull and East Yorkshire Hospitals NHS Trust, Hull (M.H.), Mount Vernon Cancer Centre, Northwood (P.J.H.), Clatterbridge Cancer Centre, Wirral (Z.I.M.), Brighton and Sussex University Hospitals NHS Trust (F.M.) and Sussex Cancer Centre, Royal Sussex County Hospital (A.R.), Brighton, NHS Highland, Inverness (N.M.), Royal Surrey County Hospital, Guildford (J.M.-K.), Northern Ireland Cancer and Queens University, Belfast (J.O.), Lancashire Teaching Hospitals NHS Trust, Preston (O.P.), Churchill Hospital, Oxford (A.P.), Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury (N.N.S.), East Kent Hospitals NHS Trust, Canterbury (C.T.), Swansea University College of Medicine, Swansea (J. Wagstaff), and Christie NHS Foundation Trust, Manchester (J. Wylie) - all in the United Kingdom; and the Department of Medical Oncology, Kantonsspital St. Gallen, St. Gallen (S.G.), and University Hospital of Lausanne, Lausanne (D.R.B.) - both in Switzerland. Two of the authors (D.M., R.M.) were unaffiliated lay members of the STAMPEDE investigators
| | - Catherine Ferguson
- From the Institute of Cancer and Genomic Sciences, University of Birmingham (N.D.J.), and University Hospital Birmingham (A.Z.), Birmingham, the Institute of Cancer Research (J.S.B., D.P.D., G.A.), Medical Research Council Clinical Trials Unit at University College London (M.R. Spears, C.L.A., C.G., C.B., M.K.B.P., M.R. Sydes), King's College London and Guy's and St. Thomas' NHS Foundation Trust (S.C.), and Royal Marsden NHS Foundation Trust (C.C.P.), London, Salford Royal NHS Foundation Trust, Salford (N.W.C.), Cardiff University School of Medicine (M.D.M.) and Velindre Cancer Centre (J.F.L.), Cardiff, Gloucestershire Royal Hospital (A.W.S.R.) and Gloucestershire Hospitals NHS Foundation Trust (J.B.), Gloucester, University of Glasgow, Glasgow (R.J.J., J.M.R.), St. James's University Hospital, Leeds (W.R.C.), University Hospital of North-Midlands, Stoke-on-Trent (F.A.), Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter (S.A.), Rosemere Cancer Centre, Royal Preston Hospital, Preston (A.J.B.), Dorset Cancer Centre, Poole Hospital, Poole (S.B.), Royal Derby Hospital, Derby (P.C.), Weston Park Hospital, Sheffield (C.F.), Portsmouth Oncology Centre, Queen Alexandra Hospital, Portsmouth (J.G.), Musgrove Park Hospital, Taunton (E.G.), Hull and East Yorkshire Hospitals NHS Trust, Hull (M.H.), Mount Vernon Cancer Centre, Northwood (P.J.H.), Clatterbridge Cancer Centre, Wirral (Z.I.M.), Brighton and Sussex University Hospitals NHS Trust (F.M.) and Sussex Cancer Centre, Royal Sussex County Hospital (A.R.), Brighton, NHS Highland, Inverness (N.M.), Royal Surrey County Hospital, Guildford (J.M.-K.), Northern Ireland Cancer and Queens University, Belfast (J.O.), Lancashire Teaching Hospitals NHS Trust, Preston (O.P.), Churchill Hospital, Oxford (A.P.), Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury (N.N.S.), East Kent Hospitals NHS Trust, Canterbury (C.T.), Swansea University College of Medicine, Swansea (J. Wagstaff), and Christie NHS Foundation Trust, Manchester (J. Wylie) - all in the United Kingdom; and the Department of Medical Oncology, Kantonsspital St. Gallen, St. Gallen (S.G.), and University Hospital of Lausanne, Lausanne (D.R.B.) - both in Switzerland. Two of the authors (D.M., R.M.) were unaffiliated lay members of the STAMPEDE investigators
| | - Joanna Gale
- From the Institute of Cancer and Genomic Sciences, University of Birmingham (N.D.J.), and University Hospital Birmingham (A.Z.), Birmingham, the Institute of Cancer Research (J.S.B., D.P.D., G.A.), Medical Research Council Clinical Trials Unit at University College London (M.R. Spears, C.L.A., C.G., C.B., M.K.B.P., M.R. Sydes), King's College London and Guy's and St. Thomas' NHS Foundation Trust (S.C.), and Royal Marsden NHS Foundation Trust (C.C.P.), London, Salford Royal NHS Foundation Trust, Salford (N.W.C.), Cardiff University School of Medicine (M.D.M.) and Velindre Cancer Centre (J.F.L.), Cardiff, Gloucestershire Royal Hospital (A.W.S.R.) and Gloucestershire Hospitals NHS Foundation Trust (J.B.), Gloucester, University of Glasgow, Glasgow (R.J.J., J.M.R.), St. James's University Hospital, Leeds (W.R.C.), University Hospital of North-Midlands, Stoke-on-Trent (F.A.), Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter (S.A.), Rosemere Cancer Centre, Royal Preston Hospital, Preston (A.J.B.), Dorset Cancer Centre, Poole Hospital, Poole (S.B.), Royal Derby Hospital, Derby (P.C.), Weston Park Hospital, Sheffield (C.F.), Portsmouth Oncology Centre, Queen Alexandra Hospital, Portsmouth (J.G.), Musgrove Park Hospital, Taunton (E.G.), Hull and East Yorkshire Hospitals NHS Trust, Hull (M.H.), Mount Vernon Cancer Centre, Northwood (P.J.H.), Clatterbridge Cancer Centre, Wirral (Z.I.M.), Brighton and Sussex University Hospitals NHS Trust (F.M.) and Sussex Cancer Centre, Royal Sussex County Hospital (A.R.), Brighton, NHS Highland, Inverness (N.M.), Royal Surrey County Hospital, Guildford (J.M.-K.), Northern Ireland Cancer and Queens University, Belfast (J.O.), Lancashire Teaching Hospitals NHS Trust, Preston (O.P.), Churchill Hospital, Oxford (A.P.), Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury (N.N.S.), East Kent Hospitals NHS Trust, Canterbury (C.T.), Swansea University College of Medicine, Swansea (J. Wagstaff), and Christie NHS Foundation Trust, Manchester (J. Wylie) - all in the United Kingdom; and the Department of Medical Oncology, Kantonsspital St. Gallen, St. Gallen (S.G.), and University Hospital of Lausanne, Lausanne (D.R.B.) - both in Switzerland. Two of the authors (D.M., R.M.) were unaffiliated lay members of the STAMPEDE investigators
| | - Emma Gray
- From the Institute of Cancer and Genomic Sciences, University of Birmingham (N.D.J.), and University Hospital Birmingham (A.Z.), Birmingham, the Institute of Cancer Research (J.S.B., D.P.D., G.A.), Medical Research Council Clinical Trials Unit at University College London (M.R. Spears, C.L.A., C.G., C.B., M.K.B.P., M.R. Sydes), King's College London and Guy's and St. Thomas' NHS Foundation Trust (S.C.), and Royal Marsden NHS Foundation Trust (C.C.P.), London, Salford Royal NHS Foundation Trust, Salford (N.W.C.), Cardiff University School of Medicine (M.D.M.) and Velindre Cancer Centre (J.F.L.), Cardiff, Gloucestershire Royal Hospital (A.W.S.R.) and Gloucestershire Hospitals NHS Foundation Trust (J.B.), Gloucester, University of Glasgow, Glasgow (R.J.J., J.M.R.), St. James's University Hospital, Leeds (W.R.C.), University Hospital of North-Midlands, Stoke-on-Trent (F.A.), Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter (S.A.), Rosemere Cancer Centre, Royal Preston Hospital, Preston (A.J.B.), Dorset Cancer Centre, Poole Hospital, Poole (S.B.), Royal Derby Hospital, Derby (P.C.), Weston Park Hospital, Sheffield (C.F.), Portsmouth Oncology Centre, Queen Alexandra Hospital, Portsmouth (J.G.), Musgrove Park Hospital, Taunton (E.G.), Hull and East Yorkshire Hospitals NHS Trust, Hull (M.H.), Mount Vernon Cancer Centre, Northwood (P.J.H.), Clatterbridge Cancer Centre, Wirral (Z.I.M.), Brighton and Sussex University Hospitals NHS Trust (F.M.) and Sussex Cancer Centre, Royal Sussex County Hospital (A.R.), Brighton, NHS Highland, Inverness (N.M.), Royal Surrey County Hospital, Guildford (J.M.-K.), Northern Ireland Cancer and Queens University, Belfast (J.O.), Lancashire Teaching Hospitals NHS Trust, Preston (O.P.), Churchill Hospital, Oxford (A.P.), Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury (N.N.S.), East Kent Hospitals NHS Trust, Canterbury (C.T.), Swansea University College of Medicine, Swansea (J. Wagstaff), and Christie NHS Foundation Trust, Manchester (J. Wylie) - all in the United Kingdom; and the Department of Medical Oncology, Kantonsspital St. Gallen, St. Gallen (S.G.), and University Hospital of Lausanne, Lausanne (D.R.B.) - both in Switzerland. Two of the authors (D.M., R.M.) were unaffiliated lay members of the STAMPEDE investigators
| | - Mohan Hingorani
- From the Institute of Cancer and Genomic Sciences, University of Birmingham (N.D.J.), and University Hospital Birmingham (A.Z.), Birmingham, the Institute of Cancer Research (J.S.B., D.P.D., G.A.), Medical Research Council Clinical Trials Unit at University College London (M.R. Spears, C.L.A., C.G., C.B., M.K.B.P., M.R. Sydes), King's College London and Guy's and St. Thomas' NHS Foundation Trust (S.C.), and Royal Marsden NHS Foundation Trust (C.C.P.), London, Salford Royal NHS Foundation Trust, Salford (N.W.C.), Cardiff University School of Medicine (M.D.M.) and Velindre Cancer Centre (J.F.L.), Cardiff, Gloucestershire Royal Hospital (A.W.S.R.) and Gloucestershire Hospitals NHS Foundation Trust (J.B.), Gloucester, University of Glasgow, Glasgow (R.J.J., J.M.R.), St. James's University Hospital, Leeds (W.R.C.), University Hospital of North-Midlands, Stoke-on-Trent (F.A.), Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter (S.A.), Rosemere Cancer Centre, Royal Preston Hospital, Preston (A.J.B.), Dorset Cancer Centre, Poole Hospital, Poole (S.B.), Royal Derby Hospital, Derby (P.C.), Weston Park Hospital, Sheffield (C.F.), Portsmouth Oncology Centre, Queen Alexandra Hospital, Portsmouth (J.G.), Musgrove Park Hospital, Taunton (E.G.), Hull and East Yorkshire Hospitals NHS Trust, Hull (M.H.), Mount Vernon Cancer Centre, Northwood (P.J.H.), Clatterbridge Cancer Centre, Wirral (Z.I.M.), Brighton and Sussex University Hospitals NHS Trust (F.M.) and Sussex Cancer Centre, Royal Sussex County Hospital (A.R.), Brighton, NHS Highland, Inverness (N.M.), Royal Surrey County Hospital, Guildford (J.M.-K.), Northern Ireland Cancer and Queens University, Belfast (J.O.), Lancashire Teaching Hospitals NHS Trust, Preston (O.P.), Churchill Hospital, Oxford (A.P.), Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury (N.N.S.), East Kent Hospitals NHS Trust, Canterbury (C.T.), Swansea University College of Medicine, Swansea (J. Wagstaff), and Christie NHS Foundation Trust, Manchester (J. Wylie) - all in the United Kingdom; and the Department of Medical Oncology, Kantonsspital St. Gallen, St. Gallen (S.G.), and University Hospital of Lausanne, Lausanne (D.R.B.) - both in Switzerland. Two of the authors (D.M., R.M.) were unaffiliated lay members of the STAMPEDE investigators
| | - Peter J Hoskin
- From the Institute of Cancer and Genomic Sciences, University of Birmingham (N.D.J.), and University Hospital Birmingham (A.Z.), Birmingham, the Institute of Cancer Research (J.S.B., D.P.D., G.A.), Medical Research Council Clinical Trials Unit at University College London (M.R. Spears, C.L.A., C.G., C.B., M.K.B.P., M.R. Sydes), King's College London and Guy's and St. Thomas' NHS Foundation Trust (S.C.), and Royal Marsden NHS Foundation Trust (C.C.P.), London, Salford Royal NHS Foundation Trust, Salford (N.W.C.), Cardiff University School of Medicine (M.D.M.) and Velindre Cancer Centre (J.F.L.), Cardiff, Gloucestershire Royal Hospital (A.W.S.R.) and Gloucestershire Hospitals NHS Foundation Trust (J.B.), Gloucester, University of Glasgow, Glasgow (R.J.J., J.M.R.), St. James's University Hospital, Leeds (W.R.C.), University Hospital of North-Midlands, Stoke-on-Trent (F.A.), Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter (S.A.), Rosemere Cancer Centre, Royal Preston Hospital, Preston (A.J.B.), Dorset Cancer Centre, Poole Hospital, Poole (S.B.), Royal Derby Hospital, Derby (P.C.), Weston Park Hospital, Sheffield (C.F.), Portsmouth Oncology Centre, Queen Alexandra Hospital, Portsmouth (J.G.), Musgrove Park Hospital, Taunton (E.G.), Hull and East Yorkshire Hospitals NHS Trust, Hull (M.H.), Mount Vernon Cancer Centre, Northwood (P.J.H.), Clatterbridge Cancer Centre, Wirral (Z.I.M.), Brighton and Sussex University Hospitals NHS Trust (F.M.) and Sussex Cancer Centre, Royal Sussex County Hospital (A.R.), Brighton, NHS Highland, Inverness (N.M.), Royal Surrey County Hospital, Guildford (J.M.-K.), Northern Ireland Cancer and Queens University, Belfast (J.O.), Lancashire Teaching Hospitals NHS Trust, Preston (O.P.), Churchill Hospital, Oxford (A.P.), Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury (N.N.S.), East Kent Hospitals NHS Trust, Canterbury (C.T.), Swansea University College of Medicine, Swansea (J. Wagstaff), and Christie NHS Foundation Trust, Manchester (J. Wylie) - all in the United Kingdom; and the Department of Medical Oncology, Kantonsspital St. Gallen, St. Gallen (S.G.), and University Hospital of Lausanne, Lausanne (D.R.B.) - both in Switzerland. Two of the authors (D.M., R.M.) were unaffiliated lay members of the STAMPEDE investigators
| | - Jason F Lester
- From the Institute of Cancer and Genomic Sciences, University of Birmingham (N.D.J.), and University Hospital Birmingham (A.Z.), Birmingham, the Institute of Cancer Research (J.S.B., D.P.D., G.A.), Medical Research Council Clinical Trials Unit at University College London (M.R. Spears, C.L.A., C.G., C.B., M.K.B.P., M.R. Sydes), King's College London and Guy's and St. Thomas' NHS Foundation Trust (S.C.), and Royal Marsden NHS Foundation Trust (C.C.P.), London, Salford Royal NHS Foundation Trust, Salford (N.W.C.), Cardiff University School of Medicine (M.D.M.) and Velindre Cancer Centre (J.F.L.), Cardiff, Gloucestershire Royal Hospital (A.W.S.R.) and Gloucestershire Hospitals NHS Foundation Trust (J.B.), Gloucester, University of Glasgow, Glasgow (R.J.J., J.M.R.), St. James's University Hospital, Leeds (W.R.C.), University Hospital of North-Midlands, Stoke-on-Trent (F.A.), Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter (S.A.), Rosemere Cancer Centre, Royal Preston Hospital, Preston (A.J.B.), Dorset Cancer Centre, Poole Hospital, Poole (S.B.), Royal Derby Hospital, Derby (P.C.), Weston Park Hospital, Sheffield (C.F.), Portsmouth Oncology Centre, Queen Alexandra Hospital, Portsmouth (J.G.), Musgrove Park Hospital, Taunton (E.G.), Hull and East Yorkshire Hospitals NHS Trust, Hull (M.H.), Mount Vernon Cancer Centre, Northwood (P.J.H.), Clatterbridge Cancer Centre, Wirral (Z.I.M.), Brighton and Sussex University Hospitals NHS Trust (F.M.) and Sussex Cancer Centre, Royal Sussex County Hospital (A.R.), Brighton, NHS Highland, Inverness (N.M.), Royal Surrey County Hospital, Guildford (J.M.-K.), Northern Ireland Cancer and Queens University, Belfast (J.O.), Lancashire Teaching Hospitals NHS Trust, Preston (O.P.), Churchill Hospital, Oxford (A.P.), Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury (N.N.S.), East Kent Hospitals NHS Trust, Canterbury (C.T.), Swansea University College of Medicine, Swansea (J. Wagstaff), and Christie NHS Foundation Trust, Manchester (J. Wylie) - all in the United Kingdom; and the Department of Medical Oncology, Kantonsspital St. Gallen, St. Gallen (S.G.), and University Hospital of Lausanne, Lausanne (D.R.B.) - both in Switzerland. Two of the authors (D.M., R.M.) were unaffiliated lay members of the STAMPEDE investigators
| | - Zafar I Malik
- From the Institute of Cancer and Genomic Sciences, University of Birmingham (N.D.J.), and University Hospital Birmingham (A.Z.), Birmingham, the Institute of Cancer Research (J.S.B., D.P.D., G.A.), Medical Research Council Clinical Trials Unit at University College London (M.R. Spears, C.L.A., C.G., C.B., M.K.B.P., M.R. Sydes), King's College London and Guy's and St. Thomas' NHS Foundation Trust (S.C.), and Royal Marsden NHS Foundation Trust (C.C.P.), London, Salford Royal NHS Foundation Trust, Salford (N.W.C.), Cardiff University School of Medicine (M.D.M.) and Velindre Cancer Centre (J.F.L.), Cardiff, Gloucestershire Royal Hospital (A.W.S.R.) and Gloucestershire Hospitals NHS Foundation Trust (J.B.), Gloucester, University of Glasgow, Glasgow (R.J.J., J.M.R.), St. James's University Hospital, Leeds (W.R.C.), University Hospital of North-Midlands, Stoke-on-Trent (F.A.), Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter (S.A.), Rosemere Cancer Centre, Royal Preston Hospital, Preston (A.J.B.), Dorset Cancer Centre, Poole Hospital, Poole (S.B.), Royal Derby Hospital, Derby (P.C.), Weston Park Hospital, Sheffield (C.F.), Portsmouth Oncology Centre, Queen Alexandra Hospital, Portsmouth (J.G.), Musgrove Park Hospital, Taunton (E.G.), Hull and East Yorkshire Hospitals NHS Trust, Hull (M.H.), Mount Vernon Cancer Centre, Northwood (P.J.H.), Clatterbridge Cancer Centre, Wirral (Z.I.M.), Brighton and Sussex University Hospitals NHS Trust (F.M.) and Sussex Cancer Centre, Royal Sussex County Hospital (A.R.), Brighton, NHS Highland, Inverness (N.M.), Royal Surrey County Hospital, Guildford (J.M.-K.), Northern Ireland Cancer and Queens University, Belfast (J.O.), Lancashire Teaching Hospitals NHS Trust, Preston (O.P.), Churchill Hospital, Oxford (A.P.), Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury (N.N.S.), East Kent Hospitals NHS Trust, Canterbury (C.T.), Swansea University College of Medicine, Swansea (J. Wagstaff), and Christie NHS Foundation Trust, Manchester (J. Wylie) - all in the United Kingdom; and the Department of Medical Oncology, Kantonsspital St. Gallen, St. Gallen (S.G.), and University Hospital of Lausanne, Lausanne (D.R.B.) - both in Switzerland. Two of the authors (D.M., R.M.) were unaffiliated lay members of the STAMPEDE investigators
| | - Fiona McKinna
- From the Institute of Cancer and Genomic Sciences, University of Birmingham (N.D.J.), and University Hospital Birmingham (A.Z.), Birmingham, the Institute of Cancer Research (J.S.B., D.P.D., G.A.), Medical Research Council Clinical Trials Unit at University College London (M.R. Spears, C.L.A., C.G., C.B., M.K.B.P., M.R. Sydes), King's College London and Guy's and St. Thomas' NHS Foundation Trust (S.C.), and Royal Marsden NHS Foundation Trust (C.C.P.), London, Salford Royal NHS Foundation Trust, Salford (N.W.C.), Cardiff University School of Medicine (M.D.M.) and Velindre Cancer Centre (J.F.L.), Cardiff, Gloucestershire Royal Hospital (A.W.S.R.) and Gloucestershire Hospitals NHS Foundation Trust (J.B.), Gloucester, University of Glasgow, Glasgow (R.J.J., J.M.R.), St. James's University Hospital, Leeds (W.R.C.), University Hospital of North-Midlands, Stoke-on-Trent (F.A.), Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter (S.A.), Rosemere Cancer Centre, Royal Preston Hospital, Preston (A.J.B.), Dorset Cancer Centre, Poole Hospital, Poole (S.B.), Royal Derby Hospital, Derby (P.C.), Weston Park Hospital, Sheffield (C.F.), Portsmouth Oncology Centre, Queen Alexandra Hospital, Portsmouth (J.G.), Musgrove Park Hospital, Taunton (E.G.), Hull and East Yorkshire Hospitals NHS Trust, Hull (M.H.), Mount Vernon Cancer Centre, Northwood (P.J.H.), Clatterbridge Cancer Centre, Wirral (Z.I.M.), Brighton and Sussex University Hospitals NHS Trust (F.M.) and Sussex Cancer Centre, Royal Sussex County Hospital (A.R.), Brighton, NHS Highland, Inverness (N.M.), Royal Surrey County Hospital, Guildford (J.M.-K.), Northern Ireland Cancer and Queens University, Belfast (J.O.), Lancashire Teaching Hospitals NHS Trust, Preston (O.P.), Churchill Hospital, Oxford (A.P.), Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury (N.N.S.), East Kent Hospitals NHS Trust, Canterbury (C.T.), Swansea University College of Medicine, Swansea (J. Wagstaff), and Christie NHS Foundation Trust, Manchester (J. Wylie) - all in the United Kingdom; and the Department of Medical Oncology, Kantonsspital St. Gallen, St. Gallen (S.G.), and University Hospital of Lausanne, Lausanne (D.R.B.) - both in Switzerland. Two of the authors (D.M., R.M.) were unaffiliated lay members of the STAMPEDE investigators
| | - Neil McPhail
- From the Institute of Cancer and Genomic Sciences, University of Birmingham (N.D.J.), and University Hospital Birmingham (A.Z.), Birmingham, the Institute of Cancer Research (J.S.B., D.P.D., G.A.), Medical Research Council Clinical Trials Unit at University College London (M.R. Spears, C.L.A., C.G., C.B., M.K.B.P., M.R. Sydes), King's College London and Guy's and St. Thomas' NHS Foundation Trust (S.C.), and Royal Marsden NHS Foundation Trust (C.C.P.), London, Salford Royal NHS Foundation Trust, Salford (N.W.C.), Cardiff University School of Medicine (M.D.M.) and Velindre Cancer Centre (J.F.L.), Cardiff, Gloucestershire Royal Hospital (A.W.S.R.) and Gloucestershire Hospitals NHS Foundation Trust (J.B.), Gloucester, University of Glasgow, Glasgow (R.J.J., J.M.R.), St. James's University Hospital, Leeds (W.R.C.), University Hospital of North-Midlands, Stoke-on-Trent (F.A.), Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter (S.A.), Rosemere Cancer Centre, Royal Preston Hospital, Preston (A.J.B.), Dorset Cancer Centre, Poole Hospital, Poole (S.B.), Royal Derby Hospital, Derby (P.C.), Weston Park Hospital, Sheffield (C.F.), Portsmouth Oncology Centre, Queen Alexandra Hospital, Portsmouth (J.G.), Musgrove Park Hospital, Taunton (E.G.), Hull and East Yorkshire Hospitals NHS Trust, Hull (M.H.), Mount Vernon Cancer Centre, Northwood (P.J.H.), Clatterbridge Cancer Centre, Wirral (Z.I.M.), Brighton and Sussex University Hospitals NHS Trust (F.M.) and Sussex Cancer Centre, Royal Sussex County Hospital (A.R.), Brighton, NHS Highland, Inverness (N.M.), Royal Surrey County Hospital, Guildford (J.M.-K.), Northern Ireland Cancer and Queens University, Belfast (J.O.), Lancashire Teaching Hospitals NHS Trust, Preston (O.P.), Churchill Hospital, Oxford (A.P.), Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury (N.N.S.), East Kent Hospitals NHS Trust, Canterbury (C.T.), Swansea University College of Medicine, Swansea (J. Wagstaff), and Christie NHS Foundation Trust, Manchester (J. Wylie) - all in the United Kingdom; and the Department of Medical Oncology, Kantonsspital St. Gallen, St. Gallen (S.G.), and University Hospital of Lausanne, Lausanne (D.R.B.) - both in Switzerland. Two of the authors (D.M., R.M.) were unaffiliated lay members of the STAMPEDE investigators
| | - Julian Money-Kyrle
- From the Institute of Cancer and Genomic Sciences, University of Birmingham (N.D.J.), and University Hospital Birmingham (A.Z.), Birmingham, the Institute of Cancer Research (J.S.B., D.P.D., G.A.), Medical Research Council Clinical Trials Unit at University College London (M.R. Spears, C.L.A., C.G., C.B., M.K.B.P., M.R. Sydes), King's College London and Guy's and St. Thomas' NHS Foundation Trust (S.C.), and Royal Marsden NHS Foundation Trust (C.C.P.), London, Salford Royal NHS Foundation Trust, Salford (N.W.C.), Cardiff University School of Medicine (M.D.M.) and Velindre Cancer Centre (J.F.L.), Cardiff, Gloucestershire Royal Hospital (A.W.S.R.) and Gloucestershire Hospitals NHS Foundation Trust (J.B.), Gloucester, University of Glasgow, Glasgow (R.J.J., J.M.R.), St. James's University Hospital, Leeds (W.R.C.), University Hospital of North-Midlands, Stoke-on-Trent (F.A.), Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter (S.A.), Rosemere Cancer Centre, Royal Preston Hospital, Preston (A.J.B.), Dorset Cancer Centre, Poole Hospital, Poole (S.B.), Royal Derby Hospital, Derby (P.C.), Weston Park Hospital, Sheffield (C.F.), Portsmouth Oncology Centre, Queen Alexandra Hospital, Portsmouth (J.G.), Musgrove Park Hospital, Taunton (E.G.), Hull and East Yorkshire Hospitals NHS Trust, Hull (M.H.), Mount Vernon Cancer Centre, Northwood (P.J.H.), Clatterbridge Cancer Centre, Wirral (Z.I.M.), Brighton and Sussex University Hospitals NHS Trust (F.M.) and Sussex Cancer Centre, Royal Sussex County Hospital (A.R.), Brighton, NHS Highland, Inverness (N.M.), Royal Surrey County Hospital, Guildford (J.M.-K.), Northern Ireland Cancer and Queens University, Belfast (J.O.), Lancashire Teaching Hospitals NHS Trust, Preston (O.P.), Churchill Hospital, Oxford (A.P.), Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury (N.N.S.), East Kent Hospitals NHS Trust, Canterbury (C.T.), Swansea University College of Medicine, Swansea (J. Wagstaff), and Christie NHS Foundation Trust, Manchester (J. Wylie) - all in the United Kingdom; and the Department of Medical Oncology, Kantonsspital St. Gallen, St. Gallen (S.G.), and University Hospital of Lausanne, Lausanne (D.R.B.) - both in Switzerland. Two of the authors (D.M., R.M.) were unaffiliated lay members of the STAMPEDE investigators
| | - Joe O'Sullivan
- From the Institute of Cancer and Genomic Sciences, University of Birmingham (N.D.J.), and University Hospital Birmingham (A.Z.), Birmingham, the Institute of Cancer Research (J.S.B., D.P.D., G.A.), Medical Research Council Clinical Trials Unit at University College London (M.R. Spears, C.L.A., C.G., C.B., M.K.B.P., M.R. Sydes), King's College London and Guy's and St. Thomas' NHS Foundation Trust (S.C.), and Royal Marsden NHS Foundation Trust (C.C.P.), London, Salford Royal NHS Foundation Trust, Salford (N.W.C.), Cardiff University School of Medicine (M.D.M.) and Velindre Cancer Centre (J.F.L.), Cardiff, Gloucestershire Royal Hospital (A.W.S.R.) and Gloucestershire Hospitals NHS Foundation Trust (J.B.), Gloucester, University of Glasgow, Glasgow (R.J.J., J.M.R.), St. James's University Hospital, Leeds (W.R.C.), University Hospital of North-Midlands, Stoke-on-Trent (F.A.), Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter (S.A.), Rosemere Cancer Centre, Royal Preston Hospital, Preston (A.J.B.), Dorset Cancer Centre, Poole Hospital, Poole (S.B.), Royal Derby Hospital, Derby (P.C.), Weston Park Hospital, Sheffield (C.F.), Portsmouth Oncology Centre, Queen Alexandra Hospital, Portsmouth (J.G.), Musgrove Park Hospital, Taunton (E.G.), Hull and East Yorkshire Hospitals NHS Trust, Hull (M.H.), Mount Vernon Cancer Centre, Northwood (P.J.H.), Clatterbridge Cancer Centre, Wirral (Z.I.M.), Brighton and Sussex University Hospitals NHS Trust (F.M.) and Sussex Cancer Centre, Royal Sussex County Hospital (A.R.), Brighton, NHS Highland, Inverness (N.M.), Royal Surrey County Hospital, Guildford (J.M.-K.), Northern Ireland Cancer and Queens University, Belfast (J.O.), Lancashire Teaching Hospitals NHS Trust, Preston (O.P.), Churchill Hospital, Oxford (A.P.), Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury (N.N.S.), East Kent Hospitals NHS Trust, Canterbury (C.T.), Swansea University College of Medicine, Swansea (J. Wagstaff), and Christie NHS Foundation Trust, Manchester (J. Wylie) - all in the United Kingdom; and the Department of Medical Oncology, Kantonsspital St. Gallen, St. Gallen (S.G.), and University Hospital of Lausanne, Lausanne (D.R.B.) - both in Switzerland. Two of the authors (D.M., R.M.) were unaffiliated lay members of the STAMPEDE investigators
| | - Omi Parikh
- From the Institute of Cancer and Genomic Sciences, University of Birmingham (N.D.J.), and University Hospital Birmingham (A.Z.), Birmingham, the Institute of Cancer Research (J.S.B., D.P.D., G.A.), Medical Research Council Clinical Trials Unit at University College London (M.R. Spears, C.L.A., C.G., C.B., M.K.B.P., M.R. Sydes), King's College London and Guy's and St. Thomas' NHS Foundation Trust (S.C.), and Royal Marsden NHS Foundation Trust (C.C.P.), London, Salford Royal NHS Foundation Trust, Salford (N.W.C.), Cardiff University School of Medicine (M.D.M.) and Velindre Cancer Centre (J.F.L.), Cardiff, Gloucestershire Royal Hospital (A.W.S.R.) and Gloucestershire Hospitals NHS Foundation Trust (J.B.), Gloucester, University of Glasgow, Glasgow (R.J.J., J.M.R.), St. James's University Hospital, Leeds (W.R.C.), University Hospital of North-Midlands, Stoke-on-Trent (F.A.), Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter (S.A.), Rosemere Cancer Centre, Royal Preston Hospital, Preston (A.J.B.), Dorset Cancer Centre, Poole Hospital, Poole (S.B.), Royal Derby Hospital, Derby (P.C.), Weston Park Hospital, Sheffield (C.F.), Portsmouth Oncology Centre, Queen Alexandra Hospital, Portsmouth (J.G.), Musgrove Park Hospital, Taunton (E.G.), Hull and East Yorkshire Hospitals NHS Trust, Hull (M.H.), Mount Vernon Cancer Centre, Northwood (P.J.H.), Clatterbridge Cancer Centre, Wirral (Z.I.M.), Brighton and Sussex University Hospitals NHS Trust (F.M.) and Sussex Cancer Centre, Royal Sussex County Hospital (A.R.), Brighton, NHS Highland, Inverness (N.M.), Royal Surrey County Hospital, Guildford (J.M.-K.), Northern Ireland Cancer and Queens University, Belfast (J.O.), Lancashire Teaching Hospitals NHS Trust, Preston (O.P.), Churchill Hospital, Oxford (A.P.), Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury (N.N.S.), East Kent Hospitals NHS Trust, Canterbury (C.T.), Swansea University College of Medicine, Swansea (J. Wagstaff), and Christie NHS Foundation Trust, Manchester (J. Wylie) - all in the United Kingdom; and the Department of Medical Oncology, Kantonsspital St. Gallen, St. Gallen (S.G.), and University Hospital of Lausanne, Lausanne (D.R.B.) - both in Switzerland. Two of the authors (D.M., R.M.) were unaffiliated lay members of the STAMPEDE investigators
| | - Andrew Protheroe
- From the Institute of Cancer and Genomic Sciences, University of Birmingham (N.D.J.), and University Hospital Birmingham (A.Z.), Birmingham, the Institute of Cancer Research (J.S.B., D.P.D., G.A.), Medical Research Council Clinical Trials Unit at University College London (M.R. Spears, C.L.A., C.G., C.B., M.K.B.P., M.R. Sydes), King's College London and Guy's and St. Thomas' NHS Foundation Trust (S.C.), and Royal Marsden NHS Foundation Trust (C.C.P.), London, Salford Royal NHS Foundation Trust, Salford (N.W.C.), Cardiff University School of Medicine (M.D.M.) and Velindre Cancer Centre (J.F.L.), Cardiff, Gloucestershire Royal Hospital (A.W.S.R.) and Gloucestershire Hospitals NHS Foundation Trust (J.B.), Gloucester, University of Glasgow, Glasgow (R.J.J., J.M.R.), St. James's University Hospital, Leeds (W.R.C.), University Hospital of North-Midlands, Stoke-on-Trent (F.A.), Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter (S.A.), Rosemere Cancer Centre, Royal Preston Hospital, Preston (A.J.B.), Dorset Cancer Centre, Poole Hospital, Poole (S.B.), Royal Derby Hospital, Derby (P.C.), Weston Park Hospital, Sheffield (C.F.), Portsmouth Oncology Centre, Queen Alexandra Hospital, Portsmouth (J.G.), Musgrove Park Hospital, Taunton (E.G.), Hull and East Yorkshire Hospitals NHS Trust, Hull (M.H.), Mount Vernon Cancer Centre, Northwood (P.J.H.), Clatterbridge Cancer Centre, Wirral (Z.I.M.), Brighton and Sussex University Hospitals NHS Trust (F.M.) and Sussex Cancer Centre, Royal Sussex County Hospital (A.R.), Brighton, NHS Highland, Inverness (N.M.), Royal Surrey County Hospital, Guildford (J.M.-K.), Northern Ireland Cancer and Queens University, Belfast (J.O.), Lancashire Teaching Hospitals NHS Trust, Preston (O.P.), Churchill Hospital, Oxford (A.P.), Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury (N.N.S.), East Kent Hospitals NHS Trust, Canterbury (C.T.), Swansea University College of Medicine, Swansea (J. Wagstaff), and Christie NHS Foundation Trust, Manchester (J. Wylie) - all in the United Kingdom; and the Department of Medical Oncology, Kantonsspital St. Gallen, St. Gallen (S.G.), and University Hospital of Lausanne, Lausanne (D.R.B.) - both in Switzerland. Two of the authors (D.M., R.M.) were unaffiliated lay members of the STAMPEDE investigators
| | - Angus Robinson
- From the Institute of Cancer and Genomic Sciences, University of Birmingham (N.D.J.), and University Hospital Birmingham (A.Z.), Birmingham, the Institute of Cancer Research (J.S.B., D.P.D., G.A.), Medical Research Council Clinical Trials Unit at University College London (M.R. Spears, C.L.A., C.G., C.B., M.K.B.P., M.R. Sydes), King's College London and Guy's and St. Thomas' NHS Foundation Trust (S.C.), and Royal Marsden NHS Foundation Trust (C.C.P.), London, Salford Royal NHS Foundation Trust, Salford (N.W.C.), Cardiff University School of Medicine (M.D.M.) and Velindre Cancer Centre (J.F.L.), Cardiff, Gloucestershire Royal Hospital (A.W.S.R.) and Gloucestershire Hospitals NHS Foundation Trust (J.B.), Gloucester, University of Glasgow, Glasgow (R.J.J., J.M.R.), St. James's University Hospital, Leeds (W.R.C.), University Hospital of North-Midlands, Stoke-on-Trent (F.A.), Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter (S.A.), Rosemere Cancer Centre, Royal Preston Hospital, Preston (A.J.B.), Dorset Cancer Centre, Poole Hospital, Poole (S.B.), Royal Derby Hospital, Derby (P.C.), Weston Park Hospital, Sheffield (C.F.), Portsmouth Oncology Centre, Queen Alexandra Hospital, Portsmouth (J.G.), Musgrove Park Hospital, Taunton (E.G.), Hull and East Yorkshire Hospitals NHS Trust, Hull (M.H.), Mount Vernon Cancer Centre, Northwood (P.J.H.), Clatterbridge Cancer Centre, Wirral (Z.I.M.), Brighton and Sussex University Hospitals NHS Trust (F.M.) and Sussex Cancer Centre, Royal Sussex County Hospital (A.R.), Brighton, NHS Highland, Inverness (N.M.), Royal Surrey County Hospital, Guildford (J.M.-K.), Northern Ireland Cancer and Queens University, Belfast (J.O.), Lancashire Teaching Hospitals NHS Trust, Preston (O.P.), Churchill Hospital, Oxford (A.P.), Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury (N.N.S.), East Kent Hospitals NHS Trust, Canterbury (C.T.), Swansea University College of Medicine, Swansea (J. Wagstaff), and Christie NHS Foundation Trust, Manchester (J. Wylie) - all in the United Kingdom; and the Department of Medical Oncology, Kantonsspital St. Gallen, St. Gallen (S.G.), and University Hospital of Lausanne, Lausanne (D.R.B.) - both in Switzerland. Two of the authors (D.M., R.M.) were unaffiliated lay members of the STAMPEDE investigators
| | - Narayanan N Srihari
- From the Institute of Cancer and Genomic Sciences, University of Birmingham (N.D.J.), and University Hospital Birmingham (A.Z.), Birmingham, the Institute of Cancer Research (J.S.B., D.P.D., G.A.), Medical Research Council Clinical Trials Unit at University College London (M.R. Spears, C.L.A., C.G., C.B., M.K.B.P., M.R. Sydes), King's College London and Guy's and St. Thomas' NHS Foundation Trust (S.C.), and Royal Marsden NHS Foundation Trust (C.C.P.), London, Salford Royal NHS Foundation Trust, Salford (N.W.C.), Cardiff University School of Medicine (M.D.M.) and Velindre Cancer Centre (J.F.L.), Cardiff, Gloucestershire Royal Hospital (A.W.S.R.) and Gloucestershire Hospitals NHS Foundation Trust (J.B.), Gloucester, University of Glasgow, Glasgow (R.J.J., J.M.R.), St. James's University Hospital, Leeds (W.R.C.), University Hospital of North-Midlands, Stoke-on-Trent (F.A.), Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter (S.A.), Rosemere Cancer Centre, Royal Preston Hospital, Preston (A.J.B.), Dorset Cancer Centre, Poole Hospital, Poole (S.B.), Royal Derby Hospital, Derby (P.C.), Weston Park Hospital, Sheffield (C.F.), Portsmouth Oncology Centre, Queen Alexandra Hospital, Portsmouth (J.G.), Musgrove Park Hospital, Taunton (E.G.), Hull and East Yorkshire Hospitals NHS Trust, Hull (M.H.), Mount Vernon Cancer Centre, Northwood (P.J.H.), Clatterbridge Cancer Centre, Wirral (Z.I.M.), Brighton and Sussex University Hospitals NHS Trust (F.M.) and Sussex Cancer Centre, Royal Sussex County Hospital (A.R.), Brighton, NHS Highland, Inverness (N.M.), Royal Surrey County Hospital, Guildford (J.M.-K.), Northern Ireland Cancer and Queens University, Belfast (J.O.), Lancashire Teaching Hospitals NHS Trust, Preston (O.P.), Churchill Hospital, Oxford (A.P.), Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury (N.N.S.), East Kent Hospitals NHS Trust, Canterbury (C.T.), Swansea University College of Medicine, Swansea (J. Wagstaff), and Christie NHS Foundation Trust, Manchester (J. Wylie) - all in the United Kingdom; and the Department of Medical Oncology, Kantonsspital St. Gallen, St. Gallen (S.G.), and University Hospital of Lausanne, Lausanne (D.R.B.) - both in Switzerland. Two of the authors (D.M., R.M.) were unaffiliated lay members of the STAMPEDE investigators
| | - Carys Thomas
- From the Institute of Cancer and Genomic Sciences, University of Birmingham (N.D.J.), and University Hospital Birmingham (A.Z.), Birmingham, the Institute of Cancer Research (J.S.B., D.P.D., G.A.), Medical Research Council Clinical Trials Unit at University College London (M.R. Spears, C.L.A., C.G., C.B., M.K.B.P., M.R. Sydes), King's College London and Guy's and St. Thomas' NHS Foundation Trust (S.C.), and Royal Marsden NHS Foundation Trust (C.C.P.), London, Salford Royal NHS Foundation Trust, Salford (N.W.C.), Cardiff University School of Medicine (M.D.M.) and Velindre Cancer Centre (J.F.L.), Cardiff, Gloucestershire Royal Hospital (A.W.S.R.) and Gloucestershire Hospitals NHS Foundation Trust (J.B.), Gloucester, University of Glasgow, Glasgow (R.J.J., J.M.R.), St. James's University Hospital, Leeds (W.R.C.), University Hospital of North-Midlands, Stoke-on-Trent (F.A.), Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter (S.A.), Rosemere Cancer Centre, Royal Preston Hospital, Preston (A.J.B.), Dorset Cancer Centre, Poole Hospital, Poole (S.B.), Royal Derby Hospital, Derby (P.C.), Weston Park Hospital, Sheffield (C.F.), Portsmouth Oncology Centre, Queen Alexandra Hospital, Portsmouth (J.G.), Musgrove Park Hospital, Taunton (E.G.), Hull and East Yorkshire Hospitals NHS Trust, Hull (M.H.), Mount Vernon Cancer Centre, Northwood (P.J.H.), Clatterbridge Cancer Centre, Wirral (Z.I.M.), Brighton and Sussex University Hospitals NHS Trust (F.M.) and Sussex Cancer Centre, Royal Sussex County Hospital (A.R.), Brighton, NHS Highland, Inverness (N.M.), Royal Surrey County Hospital, Guildford (J.M.-K.), Northern Ireland Cancer and Queens University, Belfast (J.O.), Lancashire Teaching Hospitals NHS Trust, Preston (O.P.), Churchill Hospital, Oxford (A.P.), Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury (N.N.S.), East Kent Hospitals NHS Trust, Canterbury (C.T.), Swansea University College of Medicine, Swansea (J. Wagstaff), and Christie NHS Foundation Trust, Manchester (J. Wylie) - all in the United Kingdom; and the Department of Medical Oncology, Kantonsspital St. Gallen, St. Gallen (S.G.), and University Hospital of Lausanne, Lausanne (D.R.B.) - both in Switzerland. Two of the authors (D.M., R.M.) were unaffiliated lay members of the STAMPEDE investigators
| | - John Wagstaff
- From the Institute of Cancer and Genomic Sciences, University of Birmingham (N.D.J.), and University Hospital Birmingham (A.Z.), Birmingham, the Institute of Cancer Research (J.S.B., D.P.D., G.A.), Medical Research Council Clinical Trials Unit at University College London (M.R. Spears, C.L.A., C.G., C.B., M.K.B.P., M.R. Sydes), King's College London and Guy's and St. Thomas' NHS Foundation Trust (S.C.), and Royal Marsden NHS Foundation Trust (C.C.P.), London, Salford Royal NHS Foundation Trust, Salford (N.W.C.), Cardiff University School of Medicine (M.D.M.) and Velindre Cancer Centre (J.F.L.), Cardiff, Gloucestershire Royal Hospital (A.W.S.R.) and Gloucestershire Hospitals NHS Foundation Trust (J.B.), Gloucester, University of Glasgow, Glasgow (R.J.J., J.M.R.), St. James's University Hospital, Leeds (W.R.C.), University Hospital of North-Midlands, Stoke-on-Trent (F.A.), Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter (S.A.), Rosemere Cancer Centre, Royal Preston Hospital, Preston (A.J.B.), Dorset Cancer Centre, Poole Hospital, Poole (S.B.), Royal Derby Hospital, Derby (P.C.), Weston Park Hospital, Sheffield (C.F.), Portsmouth Oncology Centre, Queen Alexandra Hospital, Portsmouth (J.G.), Musgrove Park Hospital, Taunton (E.G.), Hull and East Yorkshire Hospitals NHS Trust, Hull (M.H.), Mount Vernon Cancer Centre, Northwood (P.J.H.), Clatterbridge Cancer Centre, Wirral (Z.I.M.), Brighton and Sussex University Hospitals NHS Trust (F.M.) and Sussex Cancer Centre, Royal Sussex County Hospital (A.R.), Brighton, NHS Highland, Inverness (N.M.), Royal Surrey County Hospital, Guildford (J.M.-K.), Northern Ireland Cancer and Queens University, Belfast (J.O.), Lancashire Teaching Hospitals NHS Trust, Preston (O.P.), Churchill Hospital, Oxford (A.P.), Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury (N.N.S.), East Kent Hospitals NHS Trust, Canterbury (C.T.), Swansea University College of Medicine, Swansea (J. Wagstaff), and Christie NHS Foundation Trust, Manchester (J. Wylie) - all in the United Kingdom; and the Department of Medical Oncology, Kantonsspital St. Gallen, St. Gallen (S.G.), and University Hospital of Lausanne, Lausanne (D.R.B.) - both in Switzerland. Two of the authors (D.M., R.M.) were unaffiliated lay members of the STAMPEDE investigators
| | - James Wylie
- From the Institute of Cancer and Genomic Sciences, University of Birmingham (N.D.J.), and University Hospital Birmingham (A.Z.), Birmingham, the Institute of Cancer Research (J.S.B., D.P.D., G.A.), Medical Research Council Clinical Trials Unit at University College London (M.R. Spears, C.L.A., C.G., C.B., M.K.B.P., M.R. Sydes), King's College London and Guy's and St. Thomas' NHS Foundation Trust (S.C.), and Royal Marsden NHS Foundation Trust (C.C.P.), London, Salford Royal NHS Foundation Trust, Salford (N.W.C.), Cardiff University School of Medicine (M.D.M.) and Velindre Cancer Centre (J.F.L.), Cardiff, Gloucestershire Royal Hospital (A.W.S.R.) and Gloucestershire Hospitals NHS Foundation Trust (J.B.), Gloucester, University of Glasgow, Glasgow (R.J.J., J.M.R.), St. James's University Hospital, Leeds (W.R.C.), University Hospital of North-Midlands, Stoke-on-Trent (F.A.), Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter (S.A.), Rosemere Cancer Centre, Royal Preston Hospital, Preston (A.J.B.), Dorset Cancer Centre, Poole Hospital, Poole (S.B.), Royal Derby Hospital, Derby (P.C.), Weston Park Hospital, Sheffield (C.F.), Portsmouth Oncology Centre, Queen Alexandra Hospital, Portsmouth (J.G.), Musgrove Park Hospital, Taunton (E.G.), Hull and East Yorkshire Hospitals NHS Trust, Hull (M.H.), Mount Vernon Cancer Centre, Northwood (P.J.H.), Clatterbridge Cancer Centre, Wirral (Z.I.M.), Brighton and Sussex University Hospitals NHS Trust (F.M.) and Sussex Cancer Centre, Royal Sussex County Hospital (A.R.), Brighton, NHS Highland, Inverness (N.M.), Royal Surrey County Hospital, Guildford (J.M.-K.), Northern Ireland Cancer and Queens University, Belfast (J.O.), Lancashire Teaching Hospitals NHS Trust, Preston (O.P.), Churchill Hospital, Oxford (A.P.), Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury (N.N.S.), East Kent Hospitals NHS Trust, Canterbury (C.T.), Swansea University College of Medicine, Swansea (J. Wagstaff), and Christie NHS Foundation Trust, Manchester (J. Wylie) - all in the United Kingdom; and the Department of Medical Oncology, Kantonsspital St. Gallen, St. Gallen (S.G.), and University Hospital of Lausanne, Lausanne (D.R.B.) - both in Switzerland. Two of the authors (D.M., R.M.) were unaffiliated lay members of the STAMPEDE investigators
| | - Anjali Zarkar
- From the Institute of Cancer and Genomic Sciences, University of Birmingham (N.D.J.), and University Hospital Birmingham (A.Z.), Birmingham, the Institute of Cancer Research (J.S.B., D.P.D., G.A.), Medical Research Council Clinical Trials Unit at University College London (M.R. Spears, C.L.A., C.G., C.B., M.K.B.P., M.R. Sydes), King's College London and Guy's and St. Thomas' NHS Foundation Trust (S.C.), and Royal Marsden NHS Foundation Trust (C.C.P.), London, Salford Royal NHS Foundation Trust, Salford (N.W.C.), Cardiff University School of Medicine (M.D.M.) and Velindre Cancer Centre (J.F.L.), Cardiff, Gloucestershire Royal Hospital (A.W.S.R.) and Gloucestershire Hospitals NHS Foundation Trust (J.B.), Gloucester, University of Glasgow, Glasgow (R.J.J., J.M.R.), St. James's University Hospital, Leeds (W.R.C.), University Hospital of North-Midlands, Stoke-on-Trent (F.A.), Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter (S.A.), Rosemere Cancer Centre, Royal Preston Hospital, Preston (A.J.B.), Dorset Cancer Centre, Poole Hospital, Poole (S.B.), Royal Derby Hospital, Derby (P.C.), Weston Park Hospital, Sheffield (C.F.), Portsmouth Oncology Centre, Queen Alexandra Hospital, Portsmouth (J.G.), Musgrove Park Hospital, Taunton (E.G.), Hull and East Yorkshire Hospitals NHS Trust, Hull (M.H.), Mount Vernon Cancer Centre, Northwood (P.J.H.), Clatterbridge Cancer Centre, Wirral (Z.I.M.), Brighton and Sussex University Hospitals NHS Trust (F.M.) and Sussex Cancer Centre, Royal Sussex County Hospital (A.R.), Brighton, NHS Highland, Inverness (N.M.), Royal Surrey County Hospital, Guildford (J.M.-K.), Northern Ireland Cancer and Queens University, Belfast (J.O.), Lancashire Teaching Hospitals NHS Trust, Preston (O.P.), Churchill Hospital, Oxford (A.P.), Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury (N.N.S.), East Kent Hospitals NHS Trust, Canterbury (C.T.), Swansea University College of Medicine, Swansea (J. Wagstaff), and Christie NHS Foundation Trust, Manchester (J. Wylie) - all in the United Kingdom; and the Department of Medical Oncology, Kantonsspital St. Gallen, St. Gallen (S.G.), and University Hospital of Lausanne, Lausanne (D.R.B.) - both in Switzerland. Two of the authors (D.M., R.M.) were unaffiliated lay members of the STAMPEDE investigators
| | - Mahesh K B Parmar
- From the Institute of Cancer and Genomic Sciences, University of Birmingham (N.D.J.), and University Hospital Birmingham (A.Z.), Birmingham, the Institute of Cancer Research (J.S.B., D.P.D., G.A.), Medical Research Council Clinical Trials Unit at University College London (M.R. Spears, C.L.A., C.G., C.B., M.K.B.P., M.R. Sydes), King's College London and Guy's and St. Thomas' NHS Foundation Trust (S.C.), and Royal Marsden NHS Foundation Trust (C.C.P.), London, Salford Royal NHS Foundation Trust, Salford (N.W.C.), Cardiff University School of Medicine (M.D.M.) and Velindre Cancer Centre (J.F.L.), Cardiff, Gloucestershire Royal Hospital (A.W.S.R.) and Gloucestershire Hospitals NHS Foundation Trust (J.B.), Gloucester, University of Glasgow, Glasgow (R.J.J., J.M.R.), St. James's University Hospital, Leeds (W.R.C.), University Hospital of North-Midlands, Stoke-on-Trent (F.A.), Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter (S.A.), Rosemere Cancer Centre, Royal Preston Hospital, Preston (A.J.B.), Dorset Cancer Centre, Poole Hospital, Poole (S.B.), Royal Derby Hospital, Derby (P.C.), Weston Park Hospital, Sheffield (C.F.), Portsmouth Oncology Centre, Queen Alexandra Hospital, Portsmouth (J.G.), Musgrove Park Hospital, Taunton (E.G.), Hull and East Yorkshire Hospitals NHS Trust, Hull (M.H.), Mount Vernon Cancer Centre, Northwood (P.J.H.), Clatterbridge Cancer Centre, Wirral (Z.I.M.), Brighton and Sussex University Hospitals NHS Trust (F.M.) and Sussex Cancer Centre, Royal Sussex County Hospital (A.R.), Brighton, NHS Highland, Inverness (N.M.), Royal Surrey County Hospital, Guildford (J.M.-K.), Northern Ireland Cancer and Queens University, Belfast (J.O.), Lancashire Teaching Hospitals NHS Trust, Preston (O.P.), Churchill Hospital, Oxford (A.P.), Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury (N.N.S.), East Kent Hospitals NHS Trust, Canterbury (C.T.), Swansea University College of Medicine, Swansea (J. Wagstaff), and Christie NHS Foundation Trust, Manchester (J. Wylie) - all in the United Kingdom; and the Department of Medical Oncology, Kantonsspital St. Gallen, St. Gallen (S.G.), and University Hospital of Lausanne, Lausanne (D.R.B.) - both in Switzerland. Two of the authors (D.M., R.M.) were unaffiliated lay members of the STAMPEDE investigators
| | - Matthew R Sydes
- From the Institute of Cancer and Genomic Sciences, University of Birmingham (N.D.J.), and University Hospital Birmingham (A.Z.), Birmingham, the Institute of Cancer Research (J.S.B., D.P.D., G.A.), Medical Research Council Clinical Trials Unit at University College London (M.R. Spears, C.L.A., C.G., C.B., M.K.B.P., M.R. Sydes), King's College London and Guy's and St. Thomas' NHS Foundation Trust (S.C.), and Royal Marsden NHS Foundation Trust (C.C.P.), London, Salford Royal NHS Foundation Trust, Salford (N.W.C.), Cardiff University School of Medicine (M.D.M.) and Velindre Cancer Centre (J.F.L.), Cardiff, Gloucestershire Royal Hospital (A.W.S.R.) and Gloucestershire Hospitals NHS Foundation Trust (J.B.), Gloucester, University of Glasgow, Glasgow (R.J.J., J.M.R.), St. James's University Hospital, Leeds (W.R.C.), University Hospital of North-Midlands, Stoke-on-Trent (F.A.), Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter (S.A.), Rosemere Cancer Centre, Royal Preston Hospital, Preston (A.J.B.), Dorset Cancer Centre, Poole Hospital, Poole (S.B.), Royal Derby Hospital, Derby (P.C.), Weston Park Hospital, Sheffield (C.F.), Portsmouth Oncology Centre, Queen Alexandra Hospital, Portsmouth (J.G.), Musgrove Park Hospital, Taunton (E.G.), Hull and East Yorkshire Hospitals NHS Trust, Hull (M.H.), Mount Vernon Cancer Centre, Northwood (P.J.H.), Clatterbridge Cancer Centre, Wirral (Z.I.M.), Brighton and Sussex University Hospitals NHS Trust (F.M.) and Sussex Cancer Centre, Royal Sussex County Hospital (A.R.), Brighton, NHS Highland, Inverness (N.M.), Royal Surrey County Hospital, Guildford (J.M.-K.), Northern Ireland Cancer and Queens University, Belfast (J.O.), Lancashire Teaching Hospitals NHS Trust, Preston (O.P.), Churchill Hospital, Oxford (A.P.), Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury (N.N.S.), East Kent Hospitals NHS Trust, Canterbury (C.T.), Swansea University College of Medicine, Swansea (J. Wagstaff), and Christie NHS Foundation Trust, Manchester (J. Wylie) - all in the United Kingdom; and the Department of Medical Oncology, Kantonsspital St. Gallen, St. Gallen (S.G.), and University Hospital of Lausanne, Lausanne (D.R.B.) - both in Switzerland. Two of the authors (D.M., R.M.) were unaffiliated lay members of the STAMPEDE investigators
| |
Collapse
|
17
|
James ND, De Bono JS, Spears MR, Clarke N, Mason MD, Dearnaley DP, Ritchie AWS, Russell JM, Gilson C, Jones RJ, Gillessen S, Matheson D, Aung S, Birtle AJ, Chowdhury S, Gale J, Malik Z, O'Sullivan JM, Parmar MKB, Sydes MR. Adding abiraterone for men with high-risk prostate cancer (PCa) starting long-term androgen deprivation therapy (ADT): Survival results from STAMPEDE (NCT00268476). J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.18_suppl.lba5003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
LBA5003 Background: Abiraterone showed a survival advantage in men with castration-refractory prostate cancer. We assessed whether abiraterone would work earlier in the disease. STAMPEDE is a randomized controlled trial using a multi-arm multi-stage platform design. It recruits patients (pts) with high-risk locally advanced or metastatic PCa starting long-term ADT. We report the first comparative survival data. Methods: The standard-of-care (SOC) was ADT for 2+yrs; radiotherapy (RT) was mandated for men with N0M0 disease & encouraged for N+M0. Stratified randomization allocated pts 1:1 to SOC or SOC+abiraterone 1000mg + prednisolone 5mg daily. Treatment duration depended on stage & intent to give radical RT: pts not having RT or M1 disease, treatment continued until PSA, radiological & clinical progression; otherwise treatment continued until the earlier of 2 years or all types of progression. The primary outcome measure was death from any cause. Comparison to control for survival had 90% power at 2.5% 1-sided alpha for hazard ratio (HR) of 0.75, requiring ~267 control arm deaths, accounting for 3 intermediate lack-of-benefit analyses on failure-free survival (FFS). Analyses used Cox proportional hazards & flexible parametric models, adjusted for stratification factors. Results: 1,917 pts were contemporaneously randomized to these arms (Nov 2011- Jan 2014). Groups were balanced: median age 67yrs; 52% metastatic, 20% N+/X M0, 28% N0M0; 95% newly-diagnosed; median PSA 53ng/ml. Median follow-up was 40m. There were 262 control arm deaths (82% PCa). The adjusted HR = 0.63 (95% CI 0.52-0.76; p=0.115x10-7; 184 deaths) for SOC+Abi vs SOC, with 3yr OS improved from 76% to 83%. There were 535 control arm FFS events; the adjusted HR = 0.29 (95% CI 0.25-0.34; p = 0.377x10-63, 248 FFS events) for SOC+Abi vs SOC. Grade 3 & 4 adverse events were seen in 29% & 3% SOC, 41% & 5% SOC+Abi; Grade 5: 3 & 9 (1 & 2 related). Conclusions: The results show a clinically & statistically significant effect on overall survival & failure-free survival from adding abiraterone at start of ADT with a manageable increase in toxicity. ADT (+/- RT) + abiraterone is a new standard of care for this group. Clinical trial information: NCT00268476.
Collapse
Affiliation(s)
| | - Johann S. De Bono
- The Institute of Cancer Research and The Royal Marsden Hospital, London, United Kingdom
| | | | - Noel Clarke
- The Christie Hospital NHS Foundation Trust, Manchester, United Kingdom
| | | | - David P. Dearnaley
- The Royal Marsden Hospital and The Institute of Cancer Research, London, United Kingdom
| | | | - J. Martin Russell
- Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Clare Gilson
- MRC Clinical Trials Unit at UCL, London, United Kingdom
| | - Robert J. Jones
- University of Glasgow, Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | | | | | - San Aung
- Royal Devon and Exeter Hospital, Exeter, United Kingdom
| | - Alison J. Birtle
- Rosemere Cancer Centre, Royal Preston Hospital, Preston, United Kingdom
| | - Simon Chowdhury
- Guy's, King's, and St Thomas' Hospitals, London, United Kingdom
| | - Joanna Gale
- Portsmouth Hospitals NHS Trust, Portsmouth, United Kingdom
| | - Zafar Malik
- Clatterbridge Cancer Centre, Bebington, United Kingdom
| | | | | | | |
Collapse
|
18
|
James ND, De Bono JS, Spears MR, Clarke N, Mason MD, Dearnaley DP, Ritchie AWS, Russell JM, Gilson C, Jones RJ, Gillessen S, Matheson D, Aung S, Birtle AJ, Chowdhury S, Gale J, Malik Z, O'Sullivan JM, Parmar MKB, Sydes MR. Adding abiraterone for men with high-risk prostate cancer (PCa) starting long-term androgen deprivation therapy (ADT): Survival results from STAMPEDE (NCT00268476). J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.lba5003] [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
LBA5003 The full, final text of this abstract will be available at abstracts.asco.org at 7:30 AM (EDT) on Saturday, June 3, 2017, and in the Annual Meeting Proceedings online supplement to the June 20, 2017, issue of the Journal of Clinical Oncology. Onsite at the Meeting, this abstract will be printed in the Saturday edition of ASCO Daily News.
Collapse
Affiliation(s)
| | - Johann S. De Bono
- The Institute of Cancer Research and The Royal Marsden Hospital, London, United Kingdom
| | | | - Noel Clarke
- The Christie Hospital NHS Foundation Trust, Manchester, United Kingdom
| | | | - David P. Dearnaley
- The Royal Marsden Hospital and The Institute of Cancer Research, London, United Kingdom
| | | | - J. Martin Russell
- Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Clare Gilson
- MRC Clinical Trials Unit at UCL, London, United Kingdom
| | - Robert J. Jones
- University of Glasgow, Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | | | | | - San Aung
- Royal Devon and Exeter Hospital, Exeter, United Kingdom
| | - Alison J. Birtle
- Rosemere Cancer Centre, Royal Preston Hospital, Preston, United Kingdom
| | - Simon Chowdhury
- Guy's, King's, and St Thomas' Hospitals, London, United Kingdom
| | - Joanna Gale
- Portsmouth Hospitals NHS Trust, Portsmouth, United Kingdom
| | - Zafar Malik
- Clatterbridge Cancer Centre, Bebington, United Kingdom
| | | | | | | |
Collapse
|
19
|
Mason MD, Clarke NW, James ND, Dearnaley DP, Spears MR, Ritchie AW, Attard G, Cross W, Jones RJ, Parker CC, Russell JM, Thalmann GN, Schiavone F, Cassoly E, Matheson D, Millman R, Rentsch CA, Barber J, Gilson C, Ibrahim A, Logue J, Lydon A, Nikapota AD, O’Sullivan JM, Porfiri E, Protheroe A, Srihari NN, Tsang D, Wagstaff J, Wallace J, Walmsley C, Parmar MK, Sydes MR. Adding Celecoxib With or Without Zoledronic Acid for Hormone-Naïve Prostate Cancer: Long-Term Survival Results From an Adaptive, Multiarm, Multistage, Platform, Randomized Controlled Trial. J Clin Oncol 2017; 35:1530-1541. [PMID: 28300506 PMCID: PMC5455701 DOI: 10.1200/jco.2016.69.0677] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Purpose Systemic Therapy for Advanced or Metastatic Prostate Cancer: Evaluation of Drug Efficacy is a randomized controlled trial using a multiarm, multistage, platform design. It recruits men with high-risk, locally advanced or metastatic prostate cancer who were initiating long-term hormone therapy. We report survival data for two celecoxib (Cel)-containing comparisons, which stopped accrual early at interim analysis on the basis of failure-free survival. Patients and Methods Standard of care (SOC) was hormone therapy continuously (metastatic) or for ≥ 2 years (nonmetastatic); prostate (± pelvic node) radiotherapy was encouraged for men without metastases. Cel 400 mg was administered twice a day for 1 year. Zoledronic acid (ZA) 4 mg was administered for six 3-weekly cycles, then 4-weekly for 2 years. Stratified random assignment allocated patients 2:1:1 to SOC (control), SOC + Cel, or SOC + ZA + Cel. The primary outcome measure was all-cause mortality. Results were analyzed with Cox proportional hazards and flexible parametric models adjusted for stratification factors. Results A total of 1,245 men were randomly assigned (Oct 2005 to April 2011). Groups were balanced: median age, 65 years; 61% metastatic, 14% N+/X M0, 25% N0M0; 94% newly diagnosed; median prostate-specific antigen, 66 ng/mL. Median follow-up was 69 months. Grade 3 to 5 adverse events were seen in 36% SOC-only, 33% SOC + Cel, and 32% SOC + ZA + Cel patients. There were 303 control arm deaths (83% prostate cancer), and median survival was 66 months. Compared with SOC, the adjusted hazard ratio was 0.98 (95% CI, 0.80 to 1.20; P = .847; median survival, 70 months) for SOC + Cel and 0.86 (95% CI, 0.70 to 1.05; P =.130; median survival, 76 months) for SOC + ZA + Cel. Preplanned subgroup analyses in men with metastatic disease showed a hazard ratio of 0.78 (95% CI, 0.62 to 0.98; P = .033) for SOC + ZA + Cel. Conclusion These data show no overall evidence of improved survival with Cel. Preplanned subgroup analyses provide hypotheses for future studies.
Collapse
Affiliation(s)
- Malcolm D. Mason
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; Jim Barber, Velindre Cancer Centre, Cardiff; Noel W. Clarke, The Christie and Salford Royal NHS Foundation Trusts; John Logue, Christie Hospital, Manchester; Nicholas D. James, Institute of Cancer and Genomic Sciences; Emilio Porfiri, The Medical School, University of Birmingham; Nicholas D. James, Queen Elizabeth Hospital; Emilio Porfiri, University Hospitals Birmingham NHS Foundation Trust, Birmingham; David P. Dearnaley, Gerhardt Attard, and Christopher C. Parker, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust; Melissa R. Spears, Alastair W.S. Ritchie, Francesca Schiavone, David Matheson, Robin Millman, Clare Gilson, Mahesh K.B. Parmar, and Matthew R. Sydes, MRC Clinical Trials Unit at UCL, London; William Cross, Leeds Teaching Hospitals NHS Trust, Leeds; Rob J. Jones and J. Martin Russell, University of Glasgow; Rob J. Jones and Jan Wallace, Beatson West of Scotland Cancer Centre, Glasgow; Azman Ibrahim, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral; Anna Lydon, Torbay District Hospital, Torquay; Ashok D. Nikapota, Sussex Cancer Centre, Brighton; Ashok D. Nikapota, Worthing Hospital, Worthing; Joe M. O’Sullivan, Centre for Cancer Research and Cell Biology, Queen's University, Belfast; Andrew Protheroe, Churchill Hospital, Oxford; Narayanan Nair Srihari, Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury; David Tsang, Southend Hospital, Southend-on-Sea; David Tsang, Basildon Hospital, Basildon; John Wagstaff, The South West Wales Cancer Institute; John Wagstaff, Swansea University College of Medicine, Swansea; Catherine Walmsley, Royal Preston Hospital, Preston, United Kingdom; George N. Thalmann, University Hospital; Estelle Cassoly, SAKK Coordinating Center, Berne; and Cyrill A. Rentsch, University Hospital Basel, Basel, Switzerland
| | - Noel W. Clarke
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; Jim Barber, Velindre Cancer Centre, Cardiff; Noel W. Clarke, The Christie and Salford Royal NHS Foundation Trusts; John Logue, Christie Hospital, Manchester; Nicholas D. James, Institute of Cancer and Genomic Sciences; Emilio Porfiri, The Medical School, University of Birmingham; Nicholas D. James, Queen Elizabeth Hospital; Emilio Porfiri, University Hospitals Birmingham NHS Foundation Trust, Birmingham; David P. Dearnaley, Gerhardt Attard, and Christopher C. Parker, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust; Melissa R. Spears, Alastair W.S. Ritchie, Francesca Schiavone, David Matheson, Robin Millman, Clare Gilson, Mahesh K.B. Parmar, and Matthew R. Sydes, MRC Clinical Trials Unit at UCL, London; William Cross, Leeds Teaching Hospitals NHS Trust, Leeds; Rob J. Jones and J. Martin Russell, University of Glasgow; Rob J. Jones and Jan Wallace, Beatson West of Scotland Cancer Centre, Glasgow; Azman Ibrahim, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral; Anna Lydon, Torbay District Hospital, Torquay; Ashok D. Nikapota, Sussex Cancer Centre, Brighton; Ashok D. Nikapota, Worthing Hospital, Worthing; Joe M. O’Sullivan, Centre for Cancer Research and Cell Biology, Queen's University, Belfast; Andrew Protheroe, Churchill Hospital, Oxford; Narayanan Nair Srihari, Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury; David Tsang, Southend Hospital, Southend-on-Sea; David Tsang, Basildon Hospital, Basildon; John Wagstaff, The South West Wales Cancer Institute; John Wagstaff, Swansea University College of Medicine, Swansea; Catherine Walmsley, Royal Preston Hospital, Preston, United Kingdom; George N. Thalmann, University Hospital; Estelle Cassoly, SAKK Coordinating Center, Berne; and Cyrill A. Rentsch, University Hospital Basel, Basel, Switzerland
| | - Nicholas D. James
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; Jim Barber, Velindre Cancer Centre, Cardiff; Noel W. Clarke, The Christie and Salford Royal NHS Foundation Trusts; John Logue, Christie Hospital, Manchester; Nicholas D. James, Institute of Cancer and Genomic Sciences; Emilio Porfiri, The Medical School, University of Birmingham; Nicholas D. James, Queen Elizabeth Hospital; Emilio Porfiri, University Hospitals Birmingham NHS Foundation Trust, Birmingham; David P. Dearnaley, Gerhardt Attard, and Christopher C. Parker, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust; Melissa R. Spears, Alastair W.S. Ritchie, Francesca Schiavone, David Matheson, Robin Millman, Clare Gilson, Mahesh K.B. Parmar, and Matthew R. Sydes, MRC Clinical Trials Unit at UCL, London; William Cross, Leeds Teaching Hospitals NHS Trust, Leeds; Rob J. Jones and J. Martin Russell, University of Glasgow; Rob J. Jones and Jan Wallace, Beatson West of Scotland Cancer Centre, Glasgow; Azman Ibrahim, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral; Anna Lydon, Torbay District Hospital, Torquay; Ashok D. Nikapota, Sussex Cancer Centre, Brighton; Ashok D. Nikapota, Worthing Hospital, Worthing; Joe M. O’Sullivan, Centre for Cancer Research and Cell Biology, Queen's University, Belfast; Andrew Protheroe, Churchill Hospital, Oxford; Narayanan Nair Srihari, Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury; David Tsang, Southend Hospital, Southend-on-Sea; David Tsang, Basildon Hospital, Basildon; John Wagstaff, The South West Wales Cancer Institute; John Wagstaff, Swansea University College of Medicine, Swansea; Catherine Walmsley, Royal Preston Hospital, Preston, United Kingdom; George N. Thalmann, University Hospital; Estelle Cassoly, SAKK Coordinating Center, Berne; and Cyrill A. Rentsch, University Hospital Basel, Basel, Switzerland
| | - David P. Dearnaley
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; Jim Barber, Velindre Cancer Centre, Cardiff; Noel W. Clarke, The Christie and Salford Royal NHS Foundation Trusts; John Logue, Christie Hospital, Manchester; Nicholas D. James, Institute of Cancer and Genomic Sciences; Emilio Porfiri, The Medical School, University of Birmingham; Nicholas D. James, Queen Elizabeth Hospital; Emilio Porfiri, University Hospitals Birmingham NHS Foundation Trust, Birmingham; David P. Dearnaley, Gerhardt Attard, and Christopher C. Parker, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust; Melissa R. Spears, Alastair W.S. Ritchie, Francesca Schiavone, David Matheson, Robin Millman, Clare Gilson, Mahesh K.B. Parmar, and Matthew R. Sydes, MRC Clinical Trials Unit at UCL, London; William Cross, Leeds Teaching Hospitals NHS Trust, Leeds; Rob J. Jones and J. Martin Russell, University of Glasgow; Rob J. Jones and Jan Wallace, Beatson West of Scotland Cancer Centre, Glasgow; Azman Ibrahim, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral; Anna Lydon, Torbay District Hospital, Torquay; Ashok D. Nikapota, Sussex Cancer Centre, Brighton; Ashok D. Nikapota, Worthing Hospital, Worthing; Joe M. O’Sullivan, Centre for Cancer Research and Cell Biology, Queen's University, Belfast; Andrew Protheroe, Churchill Hospital, Oxford; Narayanan Nair Srihari, Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury; David Tsang, Southend Hospital, Southend-on-Sea; David Tsang, Basildon Hospital, Basildon; John Wagstaff, The South West Wales Cancer Institute; John Wagstaff, Swansea University College of Medicine, Swansea; Catherine Walmsley, Royal Preston Hospital, Preston, United Kingdom; George N. Thalmann, University Hospital; Estelle Cassoly, SAKK Coordinating Center, Berne; and Cyrill A. Rentsch, University Hospital Basel, Basel, Switzerland
| | - Melissa R. Spears
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; Jim Barber, Velindre Cancer Centre, Cardiff; Noel W. Clarke, The Christie and Salford Royal NHS Foundation Trusts; John Logue, Christie Hospital, Manchester; Nicholas D. James, Institute of Cancer and Genomic Sciences; Emilio Porfiri, The Medical School, University of Birmingham; Nicholas D. James, Queen Elizabeth Hospital; Emilio Porfiri, University Hospitals Birmingham NHS Foundation Trust, Birmingham; David P. Dearnaley, Gerhardt Attard, and Christopher C. Parker, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust; Melissa R. Spears, Alastair W.S. Ritchie, Francesca Schiavone, David Matheson, Robin Millman, Clare Gilson, Mahesh K.B. Parmar, and Matthew R. Sydes, MRC Clinical Trials Unit at UCL, London; William Cross, Leeds Teaching Hospitals NHS Trust, Leeds; Rob J. Jones and J. Martin Russell, University of Glasgow; Rob J. Jones and Jan Wallace, Beatson West of Scotland Cancer Centre, Glasgow; Azman Ibrahim, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral; Anna Lydon, Torbay District Hospital, Torquay; Ashok D. Nikapota, Sussex Cancer Centre, Brighton; Ashok D. Nikapota, Worthing Hospital, Worthing; Joe M. O’Sullivan, Centre for Cancer Research and Cell Biology, Queen's University, Belfast; Andrew Protheroe, Churchill Hospital, Oxford; Narayanan Nair Srihari, Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury; David Tsang, Southend Hospital, Southend-on-Sea; David Tsang, Basildon Hospital, Basildon; John Wagstaff, The South West Wales Cancer Institute; John Wagstaff, Swansea University College of Medicine, Swansea; Catherine Walmsley, Royal Preston Hospital, Preston, United Kingdom; George N. Thalmann, University Hospital; Estelle Cassoly, SAKK Coordinating Center, Berne; and Cyrill A. Rentsch, University Hospital Basel, Basel, Switzerland
| | - Alastair W.S. Ritchie
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; Jim Barber, Velindre Cancer Centre, Cardiff; Noel W. Clarke, The Christie and Salford Royal NHS Foundation Trusts; John Logue, Christie Hospital, Manchester; Nicholas D. James, Institute of Cancer and Genomic Sciences; Emilio Porfiri, The Medical School, University of Birmingham; Nicholas D. James, Queen Elizabeth Hospital; Emilio Porfiri, University Hospitals Birmingham NHS Foundation Trust, Birmingham; David P. Dearnaley, Gerhardt Attard, and Christopher C. Parker, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust; Melissa R. Spears, Alastair W.S. Ritchie, Francesca Schiavone, David Matheson, Robin Millman, Clare Gilson, Mahesh K.B. Parmar, and Matthew R. Sydes, MRC Clinical Trials Unit at UCL, London; William Cross, Leeds Teaching Hospitals NHS Trust, Leeds; Rob J. Jones and J. Martin Russell, University of Glasgow; Rob J. Jones and Jan Wallace, Beatson West of Scotland Cancer Centre, Glasgow; Azman Ibrahim, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral; Anna Lydon, Torbay District Hospital, Torquay; Ashok D. Nikapota, Sussex Cancer Centre, Brighton; Ashok D. Nikapota, Worthing Hospital, Worthing; Joe M. O’Sullivan, Centre for Cancer Research and Cell Biology, Queen's University, Belfast; Andrew Protheroe, Churchill Hospital, Oxford; Narayanan Nair Srihari, Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury; David Tsang, Southend Hospital, Southend-on-Sea; David Tsang, Basildon Hospital, Basildon; John Wagstaff, The South West Wales Cancer Institute; John Wagstaff, Swansea University College of Medicine, Swansea; Catherine Walmsley, Royal Preston Hospital, Preston, United Kingdom; George N. Thalmann, University Hospital; Estelle Cassoly, SAKK Coordinating Center, Berne; and Cyrill A. Rentsch, University Hospital Basel, Basel, Switzerland
| | - Gerhardt Attard
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; Jim Barber, Velindre Cancer Centre, Cardiff; Noel W. Clarke, The Christie and Salford Royal NHS Foundation Trusts; John Logue, Christie Hospital, Manchester; Nicholas D. James, Institute of Cancer and Genomic Sciences; Emilio Porfiri, The Medical School, University of Birmingham; Nicholas D. James, Queen Elizabeth Hospital; Emilio Porfiri, University Hospitals Birmingham NHS Foundation Trust, Birmingham; David P. Dearnaley, Gerhardt Attard, and Christopher C. Parker, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust; Melissa R. Spears, Alastair W.S. Ritchie, Francesca Schiavone, David Matheson, Robin Millman, Clare Gilson, Mahesh K.B. Parmar, and Matthew R. Sydes, MRC Clinical Trials Unit at UCL, London; William Cross, Leeds Teaching Hospitals NHS Trust, Leeds; Rob J. Jones and J. Martin Russell, University of Glasgow; Rob J. Jones and Jan Wallace, Beatson West of Scotland Cancer Centre, Glasgow; Azman Ibrahim, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral; Anna Lydon, Torbay District Hospital, Torquay; Ashok D. Nikapota, Sussex Cancer Centre, Brighton; Ashok D. Nikapota, Worthing Hospital, Worthing; Joe M. O’Sullivan, Centre for Cancer Research and Cell Biology, Queen's University, Belfast; Andrew Protheroe, Churchill Hospital, Oxford; Narayanan Nair Srihari, Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury; David Tsang, Southend Hospital, Southend-on-Sea; David Tsang, Basildon Hospital, Basildon; John Wagstaff, The South West Wales Cancer Institute; John Wagstaff, Swansea University College of Medicine, Swansea; Catherine Walmsley, Royal Preston Hospital, Preston, United Kingdom; George N. Thalmann, University Hospital; Estelle Cassoly, SAKK Coordinating Center, Berne; and Cyrill A. Rentsch, University Hospital Basel, Basel, Switzerland
| | - William Cross
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; Jim Barber, Velindre Cancer Centre, Cardiff; Noel W. Clarke, The Christie and Salford Royal NHS Foundation Trusts; John Logue, Christie Hospital, Manchester; Nicholas D. James, Institute of Cancer and Genomic Sciences; Emilio Porfiri, The Medical School, University of Birmingham; Nicholas D. James, Queen Elizabeth Hospital; Emilio Porfiri, University Hospitals Birmingham NHS Foundation Trust, Birmingham; David P. Dearnaley, Gerhardt Attard, and Christopher C. Parker, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust; Melissa R. Spears, Alastair W.S. Ritchie, Francesca Schiavone, David Matheson, Robin Millman, Clare Gilson, Mahesh K.B. Parmar, and Matthew R. Sydes, MRC Clinical Trials Unit at UCL, London; William Cross, Leeds Teaching Hospitals NHS Trust, Leeds; Rob J. Jones and J. Martin Russell, University of Glasgow; Rob J. Jones and Jan Wallace, Beatson West of Scotland Cancer Centre, Glasgow; Azman Ibrahim, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral; Anna Lydon, Torbay District Hospital, Torquay; Ashok D. Nikapota, Sussex Cancer Centre, Brighton; Ashok D. Nikapota, Worthing Hospital, Worthing; Joe M. O’Sullivan, Centre for Cancer Research and Cell Biology, Queen's University, Belfast; Andrew Protheroe, Churchill Hospital, Oxford; Narayanan Nair Srihari, Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury; David Tsang, Southend Hospital, Southend-on-Sea; David Tsang, Basildon Hospital, Basildon; John Wagstaff, The South West Wales Cancer Institute; John Wagstaff, Swansea University College of Medicine, Swansea; Catherine Walmsley, Royal Preston Hospital, Preston, United Kingdom; George N. Thalmann, University Hospital; Estelle Cassoly, SAKK Coordinating Center, Berne; and Cyrill A. Rentsch, University Hospital Basel, Basel, Switzerland
| | - Rob J. Jones
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; Jim Barber, Velindre Cancer Centre, Cardiff; Noel W. Clarke, The Christie and Salford Royal NHS Foundation Trusts; John Logue, Christie Hospital, Manchester; Nicholas D. James, Institute of Cancer and Genomic Sciences; Emilio Porfiri, The Medical School, University of Birmingham; Nicholas D. James, Queen Elizabeth Hospital; Emilio Porfiri, University Hospitals Birmingham NHS Foundation Trust, Birmingham; David P. Dearnaley, Gerhardt Attard, and Christopher C. Parker, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust; Melissa R. Spears, Alastair W.S. Ritchie, Francesca Schiavone, David Matheson, Robin Millman, Clare Gilson, Mahesh K.B. Parmar, and Matthew R. Sydes, MRC Clinical Trials Unit at UCL, London; William Cross, Leeds Teaching Hospitals NHS Trust, Leeds; Rob J. Jones and J. Martin Russell, University of Glasgow; Rob J. Jones and Jan Wallace, Beatson West of Scotland Cancer Centre, Glasgow; Azman Ibrahim, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral; Anna Lydon, Torbay District Hospital, Torquay; Ashok D. Nikapota, Sussex Cancer Centre, Brighton; Ashok D. Nikapota, Worthing Hospital, Worthing; Joe M. O’Sullivan, Centre for Cancer Research and Cell Biology, Queen's University, Belfast; Andrew Protheroe, Churchill Hospital, Oxford; Narayanan Nair Srihari, Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury; David Tsang, Southend Hospital, Southend-on-Sea; David Tsang, Basildon Hospital, Basildon; John Wagstaff, The South West Wales Cancer Institute; John Wagstaff, Swansea University College of Medicine, Swansea; Catherine Walmsley, Royal Preston Hospital, Preston, United Kingdom; George N. Thalmann, University Hospital; Estelle Cassoly, SAKK Coordinating Center, Berne; and Cyrill A. Rentsch, University Hospital Basel, Basel, Switzerland
| | - Christopher C. Parker
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; Jim Barber, Velindre Cancer Centre, Cardiff; Noel W. Clarke, The Christie and Salford Royal NHS Foundation Trusts; John Logue, Christie Hospital, Manchester; Nicholas D. James, Institute of Cancer and Genomic Sciences; Emilio Porfiri, The Medical School, University of Birmingham; Nicholas D. James, Queen Elizabeth Hospital; Emilio Porfiri, University Hospitals Birmingham NHS Foundation Trust, Birmingham; David P. Dearnaley, Gerhardt Attard, and Christopher C. Parker, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust; Melissa R. Spears, Alastair W.S. Ritchie, Francesca Schiavone, David Matheson, Robin Millman, Clare Gilson, Mahesh K.B. Parmar, and Matthew R. Sydes, MRC Clinical Trials Unit at UCL, London; William Cross, Leeds Teaching Hospitals NHS Trust, Leeds; Rob J. Jones and J. Martin Russell, University of Glasgow; Rob J. Jones and Jan Wallace, Beatson West of Scotland Cancer Centre, Glasgow; Azman Ibrahim, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral; Anna Lydon, Torbay District Hospital, Torquay; Ashok D. Nikapota, Sussex Cancer Centre, Brighton; Ashok D. Nikapota, Worthing Hospital, Worthing; Joe M. O’Sullivan, Centre for Cancer Research and Cell Biology, Queen's University, Belfast; Andrew Protheroe, Churchill Hospital, Oxford; Narayanan Nair Srihari, Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury; David Tsang, Southend Hospital, Southend-on-Sea; David Tsang, Basildon Hospital, Basildon; John Wagstaff, The South West Wales Cancer Institute; John Wagstaff, Swansea University College of Medicine, Swansea; Catherine Walmsley, Royal Preston Hospital, Preston, United Kingdom; George N. Thalmann, University Hospital; Estelle Cassoly, SAKK Coordinating Center, Berne; and Cyrill A. Rentsch, University Hospital Basel, Basel, Switzerland
| | - J. Martin Russell
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; Jim Barber, Velindre Cancer Centre, Cardiff; Noel W. Clarke, The Christie and Salford Royal NHS Foundation Trusts; John Logue, Christie Hospital, Manchester; Nicholas D. James, Institute of Cancer and Genomic Sciences; Emilio Porfiri, The Medical School, University of Birmingham; Nicholas D. James, Queen Elizabeth Hospital; Emilio Porfiri, University Hospitals Birmingham NHS Foundation Trust, Birmingham; David P. Dearnaley, Gerhardt Attard, and Christopher C. Parker, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust; Melissa R. Spears, Alastair W.S. Ritchie, Francesca Schiavone, David Matheson, Robin Millman, Clare Gilson, Mahesh K.B. Parmar, and Matthew R. Sydes, MRC Clinical Trials Unit at UCL, London; William Cross, Leeds Teaching Hospitals NHS Trust, Leeds; Rob J. Jones and J. Martin Russell, University of Glasgow; Rob J. Jones and Jan Wallace, Beatson West of Scotland Cancer Centre, Glasgow; Azman Ibrahim, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral; Anna Lydon, Torbay District Hospital, Torquay; Ashok D. Nikapota, Sussex Cancer Centre, Brighton; Ashok D. Nikapota, Worthing Hospital, Worthing; Joe M. O’Sullivan, Centre for Cancer Research and Cell Biology, Queen's University, Belfast; Andrew Protheroe, Churchill Hospital, Oxford; Narayanan Nair Srihari, Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury; David Tsang, Southend Hospital, Southend-on-Sea; David Tsang, Basildon Hospital, Basildon; John Wagstaff, The South West Wales Cancer Institute; John Wagstaff, Swansea University College of Medicine, Swansea; Catherine Walmsley, Royal Preston Hospital, Preston, United Kingdom; George N. Thalmann, University Hospital; Estelle Cassoly, SAKK Coordinating Center, Berne; and Cyrill A. Rentsch, University Hospital Basel, Basel, Switzerland
| | - George N. Thalmann
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; Jim Barber, Velindre Cancer Centre, Cardiff; Noel W. Clarke, The Christie and Salford Royal NHS Foundation Trusts; John Logue, Christie Hospital, Manchester; Nicholas D. James, Institute of Cancer and Genomic Sciences; Emilio Porfiri, The Medical School, University of Birmingham; Nicholas D. James, Queen Elizabeth Hospital; Emilio Porfiri, University Hospitals Birmingham NHS Foundation Trust, Birmingham; David P. Dearnaley, Gerhardt Attard, and Christopher C. Parker, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust; Melissa R. Spears, Alastair W.S. Ritchie, Francesca Schiavone, David Matheson, Robin Millman, Clare Gilson, Mahesh K.B. Parmar, and Matthew R. Sydes, MRC Clinical Trials Unit at UCL, London; William Cross, Leeds Teaching Hospitals NHS Trust, Leeds; Rob J. Jones and J. Martin Russell, University of Glasgow; Rob J. Jones and Jan Wallace, Beatson West of Scotland Cancer Centre, Glasgow; Azman Ibrahim, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral; Anna Lydon, Torbay District Hospital, Torquay; Ashok D. Nikapota, Sussex Cancer Centre, Brighton; Ashok D. Nikapota, Worthing Hospital, Worthing; Joe M. O’Sullivan, Centre for Cancer Research and Cell Biology, Queen's University, Belfast; Andrew Protheroe, Churchill Hospital, Oxford; Narayanan Nair Srihari, Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury; David Tsang, Southend Hospital, Southend-on-Sea; David Tsang, Basildon Hospital, Basildon; John Wagstaff, The South West Wales Cancer Institute; John Wagstaff, Swansea University College of Medicine, Swansea; Catherine Walmsley, Royal Preston Hospital, Preston, United Kingdom; George N. Thalmann, University Hospital; Estelle Cassoly, SAKK Coordinating Center, Berne; and Cyrill A. Rentsch, University Hospital Basel, Basel, Switzerland
| | - Francesca Schiavone
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; Jim Barber, Velindre Cancer Centre, Cardiff; Noel W. Clarke, The Christie and Salford Royal NHS Foundation Trusts; John Logue, Christie Hospital, Manchester; Nicholas D. James, Institute of Cancer and Genomic Sciences; Emilio Porfiri, The Medical School, University of Birmingham; Nicholas D. James, Queen Elizabeth Hospital; Emilio Porfiri, University Hospitals Birmingham NHS Foundation Trust, Birmingham; David P. Dearnaley, Gerhardt Attard, and Christopher C. Parker, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust; Melissa R. Spears, Alastair W.S. Ritchie, Francesca Schiavone, David Matheson, Robin Millman, Clare Gilson, Mahesh K.B. Parmar, and Matthew R. Sydes, MRC Clinical Trials Unit at UCL, London; William Cross, Leeds Teaching Hospitals NHS Trust, Leeds; Rob J. Jones and J. Martin Russell, University of Glasgow; Rob J. Jones and Jan Wallace, Beatson West of Scotland Cancer Centre, Glasgow; Azman Ibrahim, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral; Anna Lydon, Torbay District Hospital, Torquay; Ashok D. Nikapota, Sussex Cancer Centre, Brighton; Ashok D. Nikapota, Worthing Hospital, Worthing; Joe M. O’Sullivan, Centre for Cancer Research and Cell Biology, Queen's University, Belfast; Andrew Protheroe, Churchill Hospital, Oxford; Narayanan Nair Srihari, Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury; David Tsang, Southend Hospital, Southend-on-Sea; David Tsang, Basildon Hospital, Basildon; John Wagstaff, The South West Wales Cancer Institute; John Wagstaff, Swansea University College of Medicine, Swansea; Catherine Walmsley, Royal Preston Hospital, Preston, United Kingdom; George N. Thalmann, University Hospital; Estelle Cassoly, SAKK Coordinating Center, Berne; and Cyrill A. Rentsch, University Hospital Basel, Basel, Switzerland
| | - Estelle Cassoly
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; Jim Barber, Velindre Cancer Centre, Cardiff; Noel W. Clarke, The Christie and Salford Royal NHS Foundation Trusts; John Logue, Christie Hospital, Manchester; Nicholas D. James, Institute of Cancer and Genomic Sciences; Emilio Porfiri, The Medical School, University of Birmingham; Nicholas D. James, Queen Elizabeth Hospital; Emilio Porfiri, University Hospitals Birmingham NHS Foundation Trust, Birmingham; David P. Dearnaley, Gerhardt Attard, and Christopher C. Parker, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust; Melissa R. Spears, Alastair W.S. Ritchie, Francesca Schiavone, David Matheson, Robin Millman, Clare Gilson, Mahesh K.B. Parmar, and Matthew R. Sydes, MRC Clinical Trials Unit at UCL, London; William Cross, Leeds Teaching Hospitals NHS Trust, Leeds; Rob J. Jones and J. Martin Russell, University of Glasgow; Rob J. Jones and Jan Wallace, Beatson West of Scotland Cancer Centre, Glasgow; Azman Ibrahim, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral; Anna Lydon, Torbay District Hospital, Torquay; Ashok D. Nikapota, Sussex Cancer Centre, Brighton; Ashok D. Nikapota, Worthing Hospital, Worthing; Joe M. O’Sullivan, Centre for Cancer Research and Cell Biology, Queen's University, Belfast; Andrew Protheroe, Churchill Hospital, Oxford; Narayanan Nair Srihari, Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury; David Tsang, Southend Hospital, Southend-on-Sea; David Tsang, Basildon Hospital, Basildon; John Wagstaff, The South West Wales Cancer Institute; John Wagstaff, Swansea University College of Medicine, Swansea; Catherine Walmsley, Royal Preston Hospital, Preston, United Kingdom; George N. Thalmann, University Hospital; Estelle Cassoly, SAKK Coordinating Center, Berne; and Cyrill A. Rentsch, University Hospital Basel, Basel, Switzerland
| | - David Matheson
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; Jim Barber, Velindre Cancer Centre, Cardiff; Noel W. Clarke, The Christie and Salford Royal NHS Foundation Trusts; John Logue, Christie Hospital, Manchester; Nicholas D. James, Institute of Cancer and Genomic Sciences; Emilio Porfiri, The Medical School, University of Birmingham; Nicholas D. James, Queen Elizabeth Hospital; Emilio Porfiri, University Hospitals Birmingham NHS Foundation Trust, Birmingham; David P. Dearnaley, Gerhardt Attard, and Christopher C. Parker, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust; Melissa R. Spears, Alastair W.S. Ritchie, Francesca Schiavone, David Matheson, Robin Millman, Clare Gilson, Mahesh K.B. Parmar, and Matthew R. Sydes, MRC Clinical Trials Unit at UCL, London; William Cross, Leeds Teaching Hospitals NHS Trust, Leeds; Rob J. Jones and J. Martin Russell, University of Glasgow; Rob J. Jones and Jan Wallace, Beatson West of Scotland Cancer Centre, Glasgow; Azman Ibrahim, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral; Anna Lydon, Torbay District Hospital, Torquay; Ashok D. Nikapota, Sussex Cancer Centre, Brighton; Ashok D. Nikapota, Worthing Hospital, Worthing; Joe M. O’Sullivan, Centre for Cancer Research and Cell Biology, Queen's University, Belfast; Andrew Protheroe, Churchill Hospital, Oxford; Narayanan Nair Srihari, Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury; David Tsang, Southend Hospital, Southend-on-Sea; David Tsang, Basildon Hospital, Basildon; John Wagstaff, The South West Wales Cancer Institute; John Wagstaff, Swansea University College of Medicine, Swansea; Catherine Walmsley, Royal Preston Hospital, Preston, United Kingdom; George N. Thalmann, University Hospital; Estelle Cassoly, SAKK Coordinating Center, Berne; and Cyrill A. Rentsch, University Hospital Basel, Basel, Switzerland
| | - Robin Millman
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; Jim Barber, Velindre Cancer Centre, Cardiff; Noel W. Clarke, The Christie and Salford Royal NHS Foundation Trusts; John Logue, Christie Hospital, Manchester; Nicholas D. James, Institute of Cancer and Genomic Sciences; Emilio Porfiri, The Medical School, University of Birmingham; Nicholas D. James, Queen Elizabeth Hospital; Emilio Porfiri, University Hospitals Birmingham NHS Foundation Trust, Birmingham; David P. Dearnaley, Gerhardt Attard, and Christopher C. Parker, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust; Melissa R. Spears, Alastair W.S. Ritchie, Francesca Schiavone, David Matheson, Robin Millman, Clare Gilson, Mahesh K.B. Parmar, and Matthew R. Sydes, MRC Clinical Trials Unit at UCL, London; William Cross, Leeds Teaching Hospitals NHS Trust, Leeds; Rob J. Jones and J. Martin Russell, University of Glasgow; Rob J. Jones and Jan Wallace, Beatson West of Scotland Cancer Centre, Glasgow; Azman Ibrahim, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral; Anna Lydon, Torbay District Hospital, Torquay; Ashok D. Nikapota, Sussex Cancer Centre, Brighton; Ashok D. Nikapota, Worthing Hospital, Worthing; Joe M. O’Sullivan, Centre for Cancer Research and Cell Biology, Queen's University, Belfast; Andrew Protheroe, Churchill Hospital, Oxford; Narayanan Nair Srihari, Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury; David Tsang, Southend Hospital, Southend-on-Sea; David Tsang, Basildon Hospital, Basildon; John Wagstaff, The South West Wales Cancer Institute; John Wagstaff, Swansea University College of Medicine, Swansea; Catherine Walmsley, Royal Preston Hospital, Preston, United Kingdom; George N. Thalmann, University Hospital; Estelle Cassoly, SAKK Coordinating Center, Berne; and Cyrill A. Rentsch, University Hospital Basel, Basel, Switzerland
| | - Cyrill A. Rentsch
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; Jim Barber, Velindre Cancer Centre, Cardiff; Noel W. Clarke, The Christie and Salford Royal NHS Foundation Trusts; John Logue, Christie Hospital, Manchester; Nicholas D. James, Institute of Cancer and Genomic Sciences; Emilio Porfiri, The Medical School, University of Birmingham; Nicholas D. James, Queen Elizabeth Hospital; Emilio Porfiri, University Hospitals Birmingham NHS Foundation Trust, Birmingham; David P. Dearnaley, Gerhardt Attard, and Christopher C. Parker, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust; Melissa R. Spears, Alastair W.S. Ritchie, Francesca Schiavone, David Matheson, Robin Millman, Clare Gilson, Mahesh K.B. Parmar, and Matthew R. Sydes, MRC Clinical Trials Unit at UCL, London; William Cross, Leeds Teaching Hospitals NHS Trust, Leeds; Rob J. Jones and J. Martin Russell, University of Glasgow; Rob J. Jones and Jan Wallace, Beatson West of Scotland Cancer Centre, Glasgow; Azman Ibrahim, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral; Anna Lydon, Torbay District Hospital, Torquay; Ashok D. Nikapota, Sussex Cancer Centre, Brighton; Ashok D. Nikapota, Worthing Hospital, Worthing; Joe M. O’Sullivan, Centre for Cancer Research and Cell Biology, Queen's University, Belfast; Andrew Protheroe, Churchill Hospital, Oxford; Narayanan Nair Srihari, Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury; David Tsang, Southend Hospital, Southend-on-Sea; David Tsang, Basildon Hospital, Basildon; John Wagstaff, The South West Wales Cancer Institute; John Wagstaff, Swansea University College of Medicine, Swansea; Catherine Walmsley, Royal Preston Hospital, Preston, United Kingdom; George N. Thalmann, University Hospital; Estelle Cassoly, SAKK Coordinating Center, Berne; and Cyrill A. Rentsch, University Hospital Basel, Basel, Switzerland
| | - Jim Barber
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; Jim Barber, Velindre Cancer Centre, Cardiff; Noel W. Clarke, The Christie and Salford Royal NHS Foundation Trusts; John Logue, Christie Hospital, Manchester; Nicholas D. James, Institute of Cancer and Genomic Sciences; Emilio Porfiri, The Medical School, University of Birmingham; Nicholas D. James, Queen Elizabeth Hospital; Emilio Porfiri, University Hospitals Birmingham NHS Foundation Trust, Birmingham; David P. Dearnaley, Gerhardt Attard, and Christopher C. Parker, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust; Melissa R. Spears, Alastair W.S. Ritchie, Francesca Schiavone, David Matheson, Robin Millman, Clare Gilson, Mahesh K.B. Parmar, and Matthew R. Sydes, MRC Clinical Trials Unit at UCL, London; William Cross, Leeds Teaching Hospitals NHS Trust, Leeds; Rob J. Jones and J. Martin Russell, University of Glasgow; Rob J. Jones and Jan Wallace, Beatson West of Scotland Cancer Centre, Glasgow; Azman Ibrahim, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral; Anna Lydon, Torbay District Hospital, Torquay; Ashok D. Nikapota, Sussex Cancer Centre, Brighton; Ashok D. Nikapota, Worthing Hospital, Worthing; Joe M. O’Sullivan, Centre for Cancer Research and Cell Biology, Queen's University, Belfast; Andrew Protheroe, Churchill Hospital, Oxford; Narayanan Nair Srihari, Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury; David Tsang, Southend Hospital, Southend-on-Sea; David Tsang, Basildon Hospital, Basildon; John Wagstaff, The South West Wales Cancer Institute; John Wagstaff, Swansea University College of Medicine, Swansea; Catherine Walmsley, Royal Preston Hospital, Preston, United Kingdom; George N. Thalmann, University Hospital; Estelle Cassoly, SAKK Coordinating Center, Berne; and Cyrill A. Rentsch, University Hospital Basel, Basel, Switzerland
| | - Clare Gilson
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; Jim Barber, Velindre Cancer Centre, Cardiff; Noel W. Clarke, The Christie and Salford Royal NHS Foundation Trusts; John Logue, Christie Hospital, Manchester; Nicholas D. James, Institute of Cancer and Genomic Sciences; Emilio Porfiri, The Medical School, University of Birmingham; Nicholas D. James, Queen Elizabeth Hospital; Emilio Porfiri, University Hospitals Birmingham NHS Foundation Trust, Birmingham; David P. Dearnaley, Gerhardt Attard, and Christopher C. Parker, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust; Melissa R. Spears, Alastair W.S. Ritchie, Francesca Schiavone, David Matheson, Robin Millman, Clare Gilson, Mahesh K.B. Parmar, and Matthew R. Sydes, MRC Clinical Trials Unit at UCL, London; William Cross, Leeds Teaching Hospitals NHS Trust, Leeds; Rob J. Jones and J. Martin Russell, University of Glasgow; Rob J. Jones and Jan Wallace, Beatson West of Scotland Cancer Centre, Glasgow; Azman Ibrahim, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral; Anna Lydon, Torbay District Hospital, Torquay; Ashok D. Nikapota, Sussex Cancer Centre, Brighton; Ashok D. Nikapota, Worthing Hospital, Worthing; Joe M. O’Sullivan, Centre for Cancer Research and Cell Biology, Queen's University, Belfast; Andrew Protheroe, Churchill Hospital, Oxford; Narayanan Nair Srihari, Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury; David Tsang, Southend Hospital, Southend-on-Sea; David Tsang, Basildon Hospital, Basildon; John Wagstaff, The South West Wales Cancer Institute; John Wagstaff, Swansea University College of Medicine, Swansea; Catherine Walmsley, Royal Preston Hospital, Preston, United Kingdom; George N. Thalmann, University Hospital; Estelle Cassoly, SAKK Coordinating Center, Berne; and Cyrill A. Rentsch, University Hospital Basel, Basel, Switzerland
| | - Azman Ibrahim
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; Jim Barber, Velindre Cancer Centre, Cardiff; Noel W. Clarke, The Christie and Salford Royal NHS Foundation Trusts; John Logue, Christie Hospital, Manchester; Nicholas D. James, Institute of Cancer and Genomic Sciences; Emilio Porfiri, The Medical School, University of Birmingham; Nicholas D. James, Queen Elizabeth Hospital; Emilio Porfiri, University Hospitals Birmingham NHS Foundation Trust, Birmingham; David P. Dearnaley, Gerhardt Attard, and Christopher C. Parker, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust; Melissa R. Spears, Alastair W.S. Ritchie, Francesca Schiavone, David Matheson, Robin Millman, Clare Gilson, Mahesh K.B. Parmar, and Matthew R. Sydes, MRC Clinical Trials Unit at UCL, London; William Cross, Leeds Teaching Hospitals NHS Trust, Leeds; Rob J. Jones and J. Martin Russell, University of Glasgow; Rob J. Jones and Jan Wallace, Beatson West of Scotland Cancer Centre, Glasgow; Azman Ibrahim, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral; Anna Lydon, Torbay District Hospital, Torquay; Ashok D. Nikapota, Sussex Cancer Centre, Brighton; Ashok D. Nikapota, Worthing Hospital, Worthing; Joe M. O’Sullivan, Centre for Cancer Research and Cell Biology, Queen's University, Belfast; Andrew Protheroe, Churchill Hospital, Oxford; Narayanan Nair Srihari, Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury; David Tsang, Southend Hospital, Southend-on-Sea; David Tsang, Basildon Hospital, Basildon; John Wagstaff, The South West Wales Cancer Institute; John Wagstaff, Swansea University College of Medicine, Swansea; Catherine Walmsley, Royal Preston Hospital, Preston, United Kingdom; George N. Thalmann, University Hospital; Estelle Cassoly, SAKK Coordinating Center, Berne; and Cyrill A. Rentsch, University Hospital Basel, Basel, Switzerland
| | - John Logue
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; Jim Barber, Velindre Cancer Centre, Cardiff; Noel W. Clarke, The Christie and Salford Royal NHS Foundation Trusts; John Logue, Christie Hospital, Manchester; Nicholas D. James, Institute of Cancer and Genomic Sciences; Emilio Porfiri, The Medical School, University of Birmingham; Nicholas D. James, Queen Elizabeth Hospital; Emilio Porfiri, University Hospitals Birmingham NHS Foundation Trust, Birmingham; David P. Dearnaley, Gerhardt Attard, and Christopher C. Parker, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust; Melissa R. Spears, Alastair W.S. Ritchie, Francesca Schiavone, David Matheson, Robin Millman, Clare Gilson, Mahesh K.B. Parmar, and Matthew R. Sydes, MRC Clinical Trials Unit at UCL, London; William Cross, Leeds Teaching Hospitals NHS Trust, Leeds; Rob J. Jones and J. Martin Russell, University of Glasgow; Rob J. Jones and Jan Wallace, Beatson West of Scotland Cancer Centre, Glasgow; Azman Ibrahim, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral; Anna Lydon, Torbay District Hospital, Torquay; Ashok D. Nikapota, Sussex Cancer Centre, Brighton; Ashok D. Nikapota, Worthing Hospital, Worthing; Joe M. O’Sullivan, Centre for Cancer Research and Cell Biology, Queen's University, Belfast; Andrew Protheroe, Churchill Hospital, Oxford; Narayanan Nair Srihari, Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury; David Tsang, Southend Hospital, Southend-on-Sea; David Tsang, Basildon Hospital, Basildon; John Wagstaff, The South West Wales Cancer Institute; John Wagstaff, Swansea University College of Medicine, Swansea; Catherine Walmsley, Royal Preston Hospital, Preston, United Kingdom; George N. Thalmann, University Hospital; Estelle Cassoly, SAKK Coordinating Center, Berne; and Cyrill A. Rentsch, University Hospital Basel, Basel, Switzerland
| | - Anna Lydon
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; Jim Barber, Velindre Cancer Centre, Cardiff; Noel W. Clarke, The Christie and Salford Royal NHS Foundation Trusts; John Logue, Christie Hospital, Manchester; Nicholas D. James, Institute of Cancer and Genomic Sciences; Emilio Porfiri, The Medical School, University of Birmingham; Nicholas D. James, Queen Elizabeth Hospital; Emilio Porfiri, University Hospitals Birmingham NHS Foundation Trust, Birmingham; David P. Dearnaley, Gerhardt Attard, and Christopher C. Parker, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust; Melissa R. Spears, Alastair W.S. Ritchie, Francesca Schiavone, David Matheson, Robin Millman, Clare Gilson, Mahesh K.B. Parmar, and Matthew R. Sydes, MRC Clinical Trials Unit at UCL, London; William Cross, Leeds Teaching Hospitals NHS Trust, Leeds; Rob J. Jones and J. Martin Russell, University of Glasgow; Rob J. Jones and Jan Wallace, Beatson West of Scotland Cancer Centre, Glasgow; Azman Ibrahim, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral; Anna Lydon, Torbay District Hospital, Torquay; Ashok D. Nikapota, Sussex Cancer Centre, Brighton; Ashok D. Nikapota, Worthing Hospital, Worthing; Joe M. O’Sullivan, Centre for Cancer Research and Cell Biology, Queen's University, Belfast; Andrew Protheroe, Churchill Hospital, Oxford; Narayanan Nair Srihari, Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury; David Tsang, Southend Hospital, Southend-on-Sea; David Tsang, Basildon Hospital, Basildon; John Wagstaff, The South West Wales Cancer Institute; John Wagstaff, Swansea University College of Medicine, Swansea; Catherine Walmsley, Royal Preston Hospital, Preston, United Kingdom; George N. Thalmann, University Hospital; Estelle Cassoly, SAKK Coordinating Center, Berne; and Cyrill A. Rentsch, University Hospital Basel, Basel, Switzerland
| | - Ashok D. Nikapota
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; Jim Barber, Velindre Cancer Centre, Cardiff; Noel W. Clarke, The Christie and Salford Royal NHS Foundation Trusts; John Logue, Christie Hospital, Manchester; Nicholas D. James, Institute of Cancer and Genomic Sciences; Emilio Porfiri, The Medical School, University of Birmingham; Nicholas D. James, Queen Elizabeth Hospital; Emilio Porfiri, University Hospitals Birmingham NHS Foundation Trust, Birmingham; David P. Dearnaley, Gerhardt Attard, and Christopher C. Parker, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust; Melissa R. Spears, Alastair W.S. Ritchie, Francesca Schiavone, David Matheson, Robin Millman, Clare Gilson, Mahesh K.B. Parmar, and Matthew R. Sydes, MRC Clinical Trials Unit at UCL, London; William Cross, Leeds Teaching Hospitals NHS Trust, Leeds; Rob J. Jones and J. Martin Russell, University of Glasgow; Rob J. Jones and Jan Wallace, Beatson West of Scotland Cancer Centre, Glasgow; Azman Ibrahim, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral; Anna Lydon, Torbay District Hospital, Torquay; Ashok D. Nikapota, Sussex Cancer Centre, Brighton; Ashok D. Nikapota, Worthing Hospital, Worthing; Joe M. O’Sullivan, Centre for Cancer Research and Cell Biology, Queen's University, Belfast; Andrew Protheroe, Churchill Hospital, Oxford; Narayanan Nair Srihari, Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury; David Tsang, Southend Hospital, Southend-on-Sea; David Tsang, Basildon Hospital, Basildon; John Wagstaff, The South West Wales Cancer Institute; John Wagstaff, Swansea University College of Medicine, Swansea; Catherine Walmsley, Royal Preston Hospital, Preston, United Kingdom; George N. Thalmann, University Hospital; Estelle Cassoly, SAKK Coordinating Center, Berne; and Cyrill A. Rentsch, University Hospital Basel, Basel, Switzerland
| | - Joe M. O’Sullivan
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; Jim Barber, Velindre Cancer Centre, Cardiff; Noel W. Clarke, The Christie and Salford Royal NHS Foundation Trusts; John Logue, Christie Hospital, Manchester; Nicholas D. James, Institute of Cancer and Genomic Sciences; Emilio Porfiri, The Medical School, University of Birmingham; Nicholas D. James, Queen Elizabeth Hospital; Emilio Porfiri, University Hospitals Birmingham NHS Foundation Trust, Birmingham; David P. Dearnaley, Gerhardt Attard, and Christopher C. Parker, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust; Melissa R. Spears, Alastair W.S. Ritchie, Francesca Schiavone, David Matheson, Robin Millman, Clare Gilson, Mahesh K.B. Parmar, and Matthew R. Sydes, MRC Clinical Trials Unit at UCL, London; William Cross, Leeds Teaching Hospitals NHS Trust, Leeds; Rob J. Jones and J. Martin Russell, University of Glasgow; Rob J. Jones and Jan Wallace, Beatson West of Scotland Cancer Centre, Glasgow; Azman Ibrahim, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral; Anna Lydon, Torbay District Hospital, Torquay; Ashok D. Nikapota, Sussex Cancer Centre, Brighton; Ashok D. Nikapota, Worthing Hospital, Worthing; Joe M. O’Sullivan, Centre for Cancer Research and Cell Biology, Queen's University, Belfast; Andrew Protheroe, Churchill Hospital, Oxford; Narayanan Nair Srihari, Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury; David Tsang, Southend Hospital, Southend-on-Sea; David Tsang, Basildon Hospital, Basildon; John Wagstaff, The South West Wales Cancer Institute; John Wagstaff, Swansea University College of Medicine, Swansea; Catherine Walmsley, Royal Preston Hospital, Preston, United Kingdom; George N. Thalmann, University Hospital; Estelle Cassoly, SAKK Coordinating Center, Berne; and Cyrill A. Rentsch, University Hospital Basel, Basel, Switzerland
| | - Emilio Porfiri
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; Jim Barber, Velindre Cancer Centre, Cardiff; Noel W. Clarke, The Christie and Salford Royal NHS Foundation Trusts; John Logue, Christie Hospital, Manchester; Nicholas D. James, Institute of Cancer and Genomic Sciences; Emilio Porfiri, The Medical School, University of Birmingham; Nicholas D. James, Queen Elizabeth Hospital; Emilio Porfiri, University Hospitals Birmingham NHS Foundation Trust, Birmingham; David P. Dearnaley, Gerhardt Attard, and Christopher C. Parker, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust; Melissa R. Spears, Alastair W.S. Ritchie, Francesca Schiavone, David Matheson, Robin Millman, Clare Gilson, Mahesh K.B. Parmar, and Matthew R. Sydes, MRC Clinical Trials Unit at UCL, London; William Cross, Leeds Teaching Hospitals NHS Trust, Leeds; Rob J. Jones and J. Martin Russell, University of Glasgow; Rob J. Jones and Jan Wallace, Beatson West of Scotland Cancer Centre, Glasgow; Azman Ibrahim, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral; Anna Lydon, Torbay District Hospital, Torquay; Ashok D. Nikapota, Sussex Cancer Centre, Brighton; Ashok D. Nikapota, Worthing Hospital, Worthing; Joe M. O’Sullivan, Centre for Cancer Research and Cell Biology, Queen's University, Belfast; Andrew Protheroe, Churchill Hospital, Oxford; Narayanan Nair Srihari, Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury; David Tsang, Southend Hospital, Southend-on-Sea; David Tsang, Basildon Hospital, Basildon; John Wagstaff, The South West Wales Cancer Institute; John Wagstaff, Swansea University College of Medicine, Swansea; Catherine Walmsley, Royal Preston Hospital, Preston, United Kingdom; George N. Thalmann, University Hospital; Estelle Cassoly, SAKK Coordinating Center, Berne; and Cyrill A. Rentsch, University Hospital Basel, Basel, Switzerland
| | - Andrew Protheroe
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; Jim Barber, Velindre Cancer Centre, Cardiff; Noel W. Clarke, The Christie and Salford Royal NHS Foundation Trusts; John Logue, Christie Hospital, Manchester; Nicholas D. James, Institute of Cancer and Genomic Sciences; Emilio Porfiri, The Medical School, University of Birmingham; Nicholas D. James, Queen Elizabeth Hospital; Emilio Porfiri, University Hospitals Birmingham NHS Foundation Trust, Birmingham; David P. Dearnaley, Gerhardt Attard, and Christopher C. Parker, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust; Melissa R. Spears, Alastair W.S. Ritchie, Francesca Schiavone, David Matheson, Robin Millman, Clare Gilson, Mahesh K.B. Parmar, and Matthew R. Sydes, MRC Clinical Trials Unit at UCL, London; William Cross, Leeds Teaching Hospitals NHS Trust, Leeds; Rob J. Jones and J. Martin Russell, University of Glasgow; Rob J. Jones and Jan Wallace, Beatson West of Scotland Cancer Centre, Glasgow; Azman Ibrahim, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral; Anna Lydon, Torbay District Hospital, Torquay; Ashok D. Nikapota, Sussex Cancer Centre, Brighton; Ashok D. Nikapota, Worthing Hospital, Worthing; Joe M. O’Sullivan, Centre for Cancer Research and Cell Biology, Queen's University, Belfast; Andrew Protheroe, Churchill Hospital, Oxford; Narayanan Nair Srihari, Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury; David Tsang, Southend Hospital, Southend-on-Sea; David Tsang, Basildon Hospital, Basildon; John Wagstaff, The South West Wales Cancer Institute; John Wagstaff, Swansea University College of Medicine, Swansea; Catherine Walmsley, Royal Preston Hospital, Preston, United Kingdom; George N. Thalmann, University Hospital; Estelle Cassoly, SAKK Coordinating Center, Berne; and Cyrill A. Rentsch, University Hospital Basel, Basel, Switzerland
| | - Narayanan Nair Srihari
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; Jim Barber, Velindre Cancer Centre, Cardiff; Noel W. Clarke, The Christie and Salford Royal NHS Foundation Trusts; John Logue, Christie Hospital, Manchester; Nicholas D. James, Institute of Cancer and Genomic Sciences; Emilio Porfiri, The Medical School, University of Birmingham; Nicholas D. James, Queen Elizabeth Hospital; Emilio Porfiri, University Hospitals Birmingham NHS Foundation Trust, Birmingham; David P. Dearnaley, Gerhardt Attard, and Christopher C. Parker, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust; Melissa R. Spears, Alastair W.S. Ritchie, Francesca Schiavone, David Matheson, Robin Millman, Clare Gilson, Mahesh K.B. Parmar, and Matthew R. Sydes, MRC Clinical Trials Unit at UCL, London; William Cross, Leeds Teaching Hospitals NHS Trust, Leeds; Rob J. Jones and J. Martin Russell, University of Glasgow; Rob J. Jones and Jan Wallace, Beatson West of Scotland Cancer Centre, Glasgow; Azman Ibrahim, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral; Anna Lydon, Torbay District Hospital, Torquay; Ashok D. Nikapota, Sussex Cancer Centre, Brighton; Ashok D. Nikapota, Worthing Hospital, Worthing; Joe M. O’Sullivan, Centre for Cancer Research and Cell Biology, Queen's University, Belfast; Andrew Protheroe, Churchill Hospital, Oxford; Narayanan Nair Srihari, Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury; David Tsang, Southend Hospital, Southend-on-Sea; David Tsang, Basildon Hospital, Basildon; John Wagstaff, The South West Wales Cancer Institute; John Wagstaff, Swansea University College of Medicine, Swansea; Catherine Walmsley, Royal Preston Hospital, Preston, United Kingdom; George N. Thalmann, University Hospital; Estelle Cassoly, SAKK Coordinating Center, Berne; and Cyrill A. Rentsch, University Hospital Basel, Basel, Switzerland
| | - David Tsang
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; Jim Barber, Velindre Cancer Centre, Cardiff; Noel W. Clarke, The Christie and Salford Royal NHS Foundation Trusts; John Logue, Christie Hospital, Manchester; Nicholas D. James, Institute of Cancer and Genomic Sciences; Emilio Porfiri, The Medical School, University of Birmingham; Nicholas D. James, Queen Elizabeth Hospital; Emilio Porfiri, University Hospitals Birmingham NHS Foundation Trust, Birmingham; David P. Dearnaley, Gerhardt Attard, and Christopher C. Parker, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust; Melissa R. Spears, Alastair W.S. Ritchie, Francesca Schiavone, David Matheson, Robin Millman, Clare Gilson, Mahesh K.B. Parmar, and Matthew R. Sydes, MRC Clinical Trials Unit at UCL, London; William Cross, Leeds Teaching Hospitals NHS Trust, Leeds; Rob J. Jones and J. Martin Russell, University of Glasgow; Rob J. Jones and Jan Wallace, Beatson West of Scotland Cancer Centre, Glasgow; Azman Ibrahim, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral; Anna Lydon, Torbay District Hospital, Torquay; Ashok D. Nikapota, Sussex Cancer Centre, Brighton; Ashok D. Nikapota, Worthing Hospital, Worthing; Joe M. O’Sullivan, Centre for Cancer Research and Cell Biology, Queen's University, Belfast; Andrew Protheroe, Churchill Hospital, Oxford; Narayanan Nair Srihari, Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury; David Tsang, Southend Hospital, Southend-on-Sea; David Tsang, Basildon Hospital, Basildon; John Wagstaff, The South West Wales Cancer Institute; John Wagstaff, Swansea University College of Medicine, Swansea; Catherine Walmsley, Royal Preston Hospital, Preston, United Kingdom; George N. Thalmann, University Hospital; Estelle Cassoly, SAKK Coordinating Center, Berne; and Cyrill A. Rentsch, University Hospital Basel, Basel, Switzerland
| | - John Wagstaff
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; Jim Barber, Velindre Cancer Centre, Cardiff; Noel W. Clarke, The Christie and Salford Royal NHS Foundation Trusts; John Logue, Christie Hospital, Manchester; Nicholas D. James, Institute of Cancer and Genomic Sciences; Emilio Porfiri, The Medical School, University of Birmingham; Nicholas D. James, Queen Elizabeth Hospital; Emilio Porfiri, University Hospitals Birmingham NHS Foundation Trust, Birmingham; David P. Dearnaley, Gerhardt Attard, and Christopher C. Parker, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust; Melissa R. Spears, Alastair W.S. Ritchie, Francesca Schiavone, David Matheson, Robin Millman, Clare Gilson, Mahesh K.B. Parmar, and Matthew R. Sydes, MRC Clinical Trials Unit at UCL, London; William Cross, Leeds Teaching Hospitals NHS Trust, Leeds; Rob J. Jones and J. Martin Russell, University of Glasgow; Rob J. Jones and Jan Wallace, Beatson West of Scotland Cancer Centre, Glasgow; Azman Ibrahim, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral; Anna Lydon, Torbay District Hospital, Torquay; Ashok D. Nikapota, Sussex Cancer Centre, Brighton; Ashok D. Nikapota, Worthing Hospital, Worthing; Joe M. O’Sullivan, Centre for Cancer Research and Cell Biology, Queen's University, Belfast; Andrew Protheroe, Churchill Hospital, Oxford; Narayanan Nair Srihari, Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury; David Tsang, Southend Hospital, Southend-on-Sea; David Tsang, Basildon Hospital, Basildon; John Wagstaff, The South West Wales Cancer Institute; John Wagstaff, Swansea University College of Medicine, Swansea; Catherine Walmsley, Royal Preston Hospital, Preston, United Kingdom; George N. Thalmann, University Hospital; Estelle Cassoly, SAKK Coordinating Center, Berne; and Cyrill A. Rentsch, University Hospital Basel, Basel, Switzerland
| | - Jan Wallace
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; Jim Barber, Velindre Cancer Centre, Cardiff; Noel W. Clarke, The Christie and Salford Royal NHS Foundation Trusts; John Logue, Christie Hospital, Manchester; Nicholas D. James, Institute of Cancer and Genomic Sciences; Emilio Porfiri, The Medical School, University of Birmingham; Nicholas D. James, Queen Elizabeth Hospital; Emilio Porfiri, University Hospitals Birmingham NHS Foundation Trust, Birmingham; David P. Dearnaley, Gerhardt Attard, and Christopher C. Parker, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust; Melissa R. Spears, Alastair W.S. Ritchie, Francesca Schiavone, David Matheson, Robin Millman, Clare Gilson, Mahesh K.B. Parmar, and Matthew R. Sydes, MRC Clinical Trials Unit at UCL, London; William Cross, Leeds Teaching Hospitals NHS Trust, Leeds; Rob J. Jones and J. Martin Russell, University of Glasgow; Rob J. Jones and Jan Wallace, Beatson West of Scotland Cancer Centre, Glasgow; Azman Ibrahim, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral; Anna Lydon, Torbay District Hospital, Torquay; Ashok D. Nikapota, Sussex Cancer Centre, Brighton; Ashok D. Nikapota, Worthing Hospital, Worthing; Joe M. O’Sullivan, Centre for Cancer Research and Cell Biology, Queen's University, Belfast; Andrew Protheroe, Churchill Hospital, Oxford; Narayanan Nair Srihari, Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury; David Tsang, Southend Hospital, Southend-on-Sea; David Tsang, Basildon Hospital, Basildon; John Wagstaff, The South West Wales Cancer Institute; John Wagstaff, Swansea University College of Medicine, Swansea; Catherine Walmsley, Royal Preston Hospital, Preston, United Kingdom; George N. Thalmann, University Hospital; Estelle Cassoly, SAKK Coordinating Center, Berne; and Cyrill A. Rentsch, University Hospital Basel, Basel, Switzerland
| | - Catherine Walmsley
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; Jim Barber, Velindre Cancer Centre, Cardiff; Noel W. Clarke, The Christie and Salford Royal NHS Foundation Trusts; John Logue, Christie Hospital, Manchester; Nicholas D. James, Institute of Cancer and Genomic Sciences; Emilio Porfiri, The Medical School, University of Birmingham; Nicholas D. James, Queen Elizabeth Hospital; Emilio Porfiri, University Hospitals Birmingham NHS Foundation Trust, Birmingham; David P. Dearnaley, Gerhardt Attard, and Christopher C. Parker, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust; Melissa R. Spears, Alastair W.S. Ritchie, Francesca Schiavone, David Matheson, Robin Millman, Clare Gilson, Mahesh K.B. Parmar, and Matthew R. Sydes, MRC Clinical Trials Unit at UCL, London; William Cross, Leeds Teaching Hospitals NHS Trust, Leeds; Rob J. Jones and J. Martin Russell, University of Glasgow; Rob J. Jones and Jan Wallace, Beatson West of Scotland Cancer Centre, Glasgow; Azman Ibrahim, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral; Anna Lydon, Torbay District Hospital, Torquay; Ashok D. Nikapota, Sussex Cancer Centre, Brighton; Ashok D. Nikapota, Worthing Hospital, Worthing; Joe M. O’Sullivan, Centre for Cancer Research and Cell Biology, Queen's University, Belfast; Andrew Protheroe, Churchill Hospital, Oxford; Narayanan Nair Srihari, Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury; David Tsang, Southend Hospital, Southend-on-Sea; David Tsang, Basildon Hospital, Basildon; John Wagstaff, The South West Wales Cancer Institute; John Wagstaff, Swansea University College of Medicine, Swansea; Catherine Walmsley, Royal Preston Hospital, Preston, United Kingdom; George N. Thalmann, University Hospital; Estelle Cassoly, SAKK Coordinating Center, Berne; and Cyrill A. Rentsch, University Hospital Basel, Basel, Switzerland
| | - Mahesh K.B. Parmar
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; Jim Barber, Velindre Cancer Centre, Cardiff; Noel W. Clarke, The Christie and Salford Royal NHS Foundation Trusts; John Logue, Christie Hospital, Manchester; Nicholas D. James, Institute of Cancer and Genomic Sciences; Emilio Porfiri, The Medical School, University of Birmingham; Nicholas D. James, Queen Elizabeth Hospital; Emilio Porfiri, University Hospitals Birmingham NHS Foundation Trust, Birmingham; David P. Dearnaley, Gerhardt Attard, and Christopher C. Parker, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust; Melissa R. Spears, Alastair W.S. Ritchie, Francesca Schiavone, David Matheson, Robin Millman, Clare Gilson, Mahesh K.B. Parmar, and Matthew R. Sydes, MRC Clinical Trials Unit at UCL, London; William Cross, Leeds Teaching Hospitals NHS Trust, Leeds; Rob J. Jones and J. Martin Russell, University of Glasgow; Rob J. Jones and Jan Wallace, Beatson West of Scotland Cancer Centre, Glasgow; Azman Ibrahim, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral; Anna Lydon, Torbay District Hospital, Torquay; Ashok D. Nikapota, Sussex Cancer Centre, Brighton; Ashok D. Nikapota, Worthing Hospital, Worthing; Joe M. O’Sullivan, Centre for Cancer Research and Cell Biology, Queen's University, Belfast; Andrew Protheroe, Churchill Hospital, Oxford; Narayanan Nair Srihari, Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury; David Tsang, Southend Hospital, Southend-on-Sea; David Tsang, Basildon Hospital, Basildon; John Wagstaff, The South West Wales Cancer Institute; John Wagstaff, Swansea University College of Medicine, Swansea; Catherine Walmsley, Royal Preston Hospital, Preston, United Kingdom; George N. Thalmann, University Hospital; Estelle Cassoly, SAKK Coordinating Center, Berne; and Cyrill A. Rentsch, University Hospital Basel, Basel, Switzerland
| | - Matthew R. Sydes
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; Jim Barber, Velindre Cancer Centre, Cardiff; Noel W. Clarke, The Christie and Salford Royal NHS Foundation Trusts; John Logue, Christie Hospital, Manchester; Nicholas D. James, Institute of Cancer and Genomic Sciences; Emilio Porfiri, The Medical School, University of Birmingham; Nicholas D. James, Queen Elizabeth Hospital; Emilio Porfiri, University Hospitals Birmingham NHS Foundation Trust, Birmingham; David P. Dearnaley, Gerhardt Attard, and Christopher C. Parker, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust; Melissa R. Spears, Alastair W.S. Ritchie, Francesca Schiavone, David Matheson, Robin Millman, Clare Gilson, Mahesh K.B. Parmar, and Matthew R. Sydes, MRC Clinical Trials Unit at UCL, London; William Cross, Leeds Teaching Hospitals NHS Trust, Leeds; Rob J. Jones and J. Martin Russell, University of Glasgow; Rob J. Jones and Jan Wallace, Beatson West of Scotland Cancer Centre, Glasgow; Azman Ibrahim, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral; Anna Lydon, Torbay District Hospital, Torquay; Ashok D. Nikapota, Sussex Cancer Centre, Brighton; Ashok D. Nikapota, Worthing Hospital, Worthing; Joe M. O’Sullivan, Centre for Cancer Research and Cell Biology, Queen's University, Belfast; Andrew Protheroe, Churchill Hospital, Oxford; Narayanan Nair Srihari, Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury; David Tsang, Southend Hospital, Southend-on-Sea; David Tsang, Basildon Hospital, Basildon; John Wagstaff, The South West Wales Cancer Institute; John Wagstaff, Swansea University College of Medicine, Swansea; Catherine Walmsley, Royal Preston Hospital, Preston, United Kingdom; George N. Thalmann, University Hospital; Estelle Cassoly, SAKK Coordinating Center, Berne; and Cyrill A. Rentsch, University Hospital Basel, Basel, Switzerland
| | - for the STAMPEDE Investigators
- Malcolm D. Mason, Cardiff University School of Medicine, Velindre Hospital; Jim Barber, Velindre Cancer Centre, Cardiff; Noel W. Clarke, The Christie and Salford Royal NHS Foundation Trusts; John Logue, Christie Hospital, Manchester; Nicholas D. James, Institute of Cancer and Genomic Sciences; Emilio Porfiri, The Medical School, University of Birmingham; Nicholas D. James, Queen Elizabeth Hospital; Emilio Porfiri, University Hospitals Birmingham NHS Foundation Trust, Birmingham; David P. Dearnaley, Gerhardt Attard, and Christopher C. Parker, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust; Melissa R. Spears, Alastair W.S. Ritchie, Francesca Schiavone, David Matheson, Robin Millman, Clare Gilson, Mahesh K.B. Parmar, and Matthew R. Sydes, MRC Clinical Trials Unit at UCL, London; William Cross, Leeds Teaching Hospitals NHS Trust, Leeds; Rob J. Jones and J. Martin Russell, University of Glasgow; Rob J. Jones and Jan Wallace, Beatson West of Scotland Cancer Centre, Glasgow; Azman Ibrahim, The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral; Anna Lydon, Torbay District Hospital, Torquay; Ashok D. Nikapota, Sussex Cancer Centre, Brighton; Ashok D. Nikapota, Worthing Hospital, Worthing; Joe M. O’Sullivan, Centre for Cancer Research and Cell Biology, Queen's University, Belfast; Andrew Protheroe, Churchill Hospital, Oxford; Narayanan Nair Srihari, Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury; David Tsang, Southend Hospital, Southend-on-Sea; David Tsang, Basildon Hospital, Basildon; John Wagstaff, The South West Wales Cancer Institute; John Wagstaff, Swansea University College of Medicine, Swansea; Catherine Walmsley, Royal Preston Hospital, Preston, United Kingdom; George N. Thalmann, University Hospital; Estelle Cassoly, SAKK Coordinating Center, Berne; and Cyrill A. Rentsch, University Hospital Basel, Basel, Switzerland
| |
Collapse
|
20
|
Andronis L, Goranitis I, Pirrie S, Pope A, Barton D, Collins S, Daunton A, McLaren D, O'Sullivan JM, Parker C, Porfiri E, Staffurth J, Stanley A, Wylie J, Beesley S, Birtle A, Brown JE, Chakraborti P, Hussain SA, Russell JM, Billingham LJ, James ND. Cost-effectiveness of zoledronic acid and strontium-89 as bone protecting treatments in addition to chemotherapy in patients with metastatic castrate-refractory prostate cancer: results from the TRAPEZE trial (ISRCTN 12808747). BJU Int 2017; 119:522-529. [PMID: 27256016 DOI: 10.1111/bju.13549] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To evaluate the cost-effectiveness of adding zoledronic acid or strontium-89 to standard docetaxel chemotherapy for patients with castrate-refractory prostate cancer (CRPC). PATIENTS AND METHODS Data on resource use and quality of life for 707 patients collected prospectively in the TRAPEZE 2 × 2 factorial randomised trial (ISRCTN 12808747) were used to assess the cost-effectiveness of i) zoledronic acid versus no zoledronic acid (ZA vs. no ZA), and ii) strontium-89 versus no strontium-89 (Sr89 vs. no Sr89). Costs were estimated from the perspective of the National Health Service in the UK and included expenditures for trial treatments, concomitant medications, and use of related hospital and primary care services. Quality-adjusted life-years (QALYs) were calculated according to patients' responses to the generic EuroQol EQ-5D-3L instrument, which evaluates health status. Results are expressed as incremental cost-effectiveness ratios (ICERs) and cost-effectiveness acceptability curves. RESULTS The per-patient cost for ZA was £12 667, £251 higher than the equivalent cost in the no ZA group. Patients in the ZA group had on average 0.03 QALYs more than their counterparts in no ZA group. The ICER for this comparison was £8 005. Sr89 was associated with a cost of £13 230, £1365 higher than no Sr89, and a gain of 0.08 QALYs compared to no Sr89. The ICER for Sr89 was £16 884. The probabilities of ZA and Sr89 being cost-effective were 0.64 and 0.60, respectively. CONCLUSIONS The addition of bone-targeting treatments to standard chemotherapy led to a small improvement in QALYs for a modest increase in cost (or cost-savings). ZA and Sr89 resulted in ICERs below conventional willingness-to-pay per QALY thresholds, suggesting that their addition to chemotherapy may represent a cost-effective use of resources.
Collapse
Affiliation(s)
| | - Ilias Goranitis
- Health Economics Unit, University of Birmingham, Birmingham, UK
| | - Sarah Pirrie
- Cancer Research UK Clinical Trials Unit (CRCTU Birmingham), University of Birmingham, Birmingham, UK
| | - Ann Pope
- Cancer Research UK Clinical Trials Unit (CRCTU Birmingham), University of Birmingham, Birmingham, UK
| | - Darren Barton
- Cancer Research UK Clinical Trials Unit (CRCTU Birmingham), University of Birmingham, Birmingham, UK
| | - Stuart Collins
- Posthumously listed (previously CRCTU Birmingham), Birmingham, UK
| | - Adam Daunton
- University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | | | | | | | - Emilio Porfiri
- University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - John Staffurth
- Institute of Cancer and Genetics, Cardiff University, UK
| | | | | | | | - Alison Birtle
- Rosemere Cancer Centre, Royal Preston Hospital, Preston, UK
| | | | | | | | | | - Lucinda J Billingham
- Cancer Research UK Clinical Trials Unit (CRCTU Birmingham), University of Birmingham, Birmingham, UK
| | - Nicholas D James
- University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| |
Collapse
|
21
|
Dearnaley DP, Mossop H, Syndikus I, Khoo V, Bloomfield DJ, Parker CC, Logue J, Scrase CD, Birtle AJ, Staffurth J, Malik Z, Panades M, Eswar C, Graham J, Russell JM, Gao A, Wilkins A, Cruickshank C, Griffin C, Hall E. 5-year patient-reported outcomes of bowel and urinary bother in the CHHiP trial (CRUK/06/016). J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.6_suppl.23] [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
23 Background: Hypofractionated radiotherapy (hRT) has been shown to be non-inferior to conventional fractionation (cRT) in the CHHiP trial. Clinician reported toxicity was low across all fractionation schedules at 5 years (y), as were patient reported outcomes (PRO) to 2y. Here we aim to confirm these findings with PRO data at 5y. Methods: The CHHiP trial randomised patients (pts) in a 1:1:1 ratio to cRT: 74Gy/37 fractions (f) or hRT: 60Gy/20f or 57Gy/19f. Overall bowel bother (BB) and urinary bother (UB) were assessed as single items of the UCLA-PCI and EPIC-50 instruments. PRO were completed before hormone therapy and RT (pRT). Late symptoms were assessed 6 monthly from 6-24 months and yearly to 5y. Differences in the distribution of scores were assessed using a chi2 trend test. Odds of an increase in bother were modelled using ordered logistic regression. Kaplan-Meier methods were used to estimate time to “small” or worse bother, with RT schedules compared using the log-rank test. Results: Between Oct, 2002 and Nov, 2009 2100 pts were recruited into the PRO sub-study (696 74Gy, 698 60Gy and 706 57Gy). Return rates at 5y were 355 (51%), 388 (56%) and 402 (57%) for the 74, 60 and 57Gy schedules respectively. Cross-sectional analyses at 5y showed no difference between groups (Table 1). The odds of an increase in BB from pRT to 5y for hRT compared to cRT were (Odds Ratio (OR) (99% CI), p-value): 60Gy: 0.78 (0.52-1.18), 0.12; 57Gy: 0.75 (0.50-1.12), 0.06, and for UB were: 60Gy: 1.00 (0.67-1.50), 1.00; 57Gy: 1.08 (0.72-1.61), 0.62. Time to first late “small” or worse BB was also similar across groups (Hazard ratio (HR) (99% CI), p-value): 60Gy: 1.08 (0.85-1.37), 0.42; 57Gy: 0.92 (0.71-1.18), 0.36 or UB: 60Gy: 0.93 (0.73-1.20), 0.48; 57Gy: 0.91 (0.71, 1.17), 0.34. Conclusions: After 5 years follow-up, cRT and hRT showed a similar low level of patient reported BB and UB. Clinical trial information: ISRCTN97182923. [Table: see text]
Collapse
Affiliation(s)
- David P. Dearnaley
- The Royal Marsden Hospital and The Institute of Cancer Research, London, United Kingdom
| | - Helen Mossop
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, United Kingdom
| | | | - Vincent Khoo
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - DJ Bloomfield
- Brighton and Sussex University Hospitals, Hassocks, United Kingdom
| | - Chris C. Parker
- Royal Marsden NHS Foundation Trust, The Institute of Cancer Research, London, United Kingdom
| | - John Logue
- Christie Hospital, Manchester, United Kingdom
| | | | - Alison J. Birtle
- Rosemere Cancer Centre, Royal Preston Hospital, Preston, United Kingdom
| | | | - Zafar Malik
- Clatterbridge Cancer Centre, Bebington, United Kingdom
| | | | | | - John Graham
- Musgrove Park Hospital, Taunton, United Kingdom
| | | | - Annie Gao
- The Institute of Cancer Research, London, United Kingdom
| | - Anna Wilkins
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, United Kingdom
| | - Clare Cruickshank
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, United Kingdom
| | - Clare Griffin
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, United Kingdom
| | - Emma Hall
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, United Kingdom
| |
Collapse
|
22
|
Hubert D, Lambert JC, Verhoelst T, Granville J, Keppens A, Baray JL, Cortesi U, Degenstein DA, Froidevaux L, Godin-Beekmann S, Hoppel KW, Kyrölä E, Leblanc T, Lichtenberg G, McElroy CT, Murtagh D, Nakane H, Querel R, Russell JM, Salvador J, Smit HGJ, Stebel K, Steinbrecht W, Strawbridge KB, Stübi R, Swart DPJ, Taha G, Thompson AM, Urban J, van Gijsel JAE, von der Gathen P, Walker KA, Wolfram E, Zawodny JM. Ground-based assessment of the bias and long-term stability of fourteen limb and occultation ozone profile data records. Atmos Meas Tech 2016; 9:2497-2534. [PMID: 29743958 DOI: 10.5194/amt-9-2497-2016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
The ozone profile records of a large number of limb and occultation satellite instruments are widely used to address several key questions in ozone research. Further progress in some domains depends on a more detailed understanding of these data sets, especially of their long-term stability and their mutual consistency. To this end, we made a systematic assessment of fourteen limb and occultation sounders that, together, provide more than three decades of global ozone profile measurements. In particular, we considered the latest operational Level-2 records by SAGE II, SAGE III, HALOE, UARS MLS, Aura MLS, POAM II, POAM III, OSIRIS, SMR, GOMOS, MIPAS, SCIAMACHY, ACE-FTS and MAESTRO. Central to our work is a consistent and robust analysis of the comparisons against the ground-based ozonesonde and stratospheric ozone lidar networks. It allowed us to investigate, from the troposphere up to the stratopause, the following main aspects of satellite data quality: long-term stability, overall bias, and short-term variability, together with their dependence on geophysical parameters and profile representation. In addition, it permitted us to quantify the overall consistency between the ozone profilers. Generally, we found that between 20-40 km the satellite ozone measurement biases are smaller than ±5 %, the short-term variabilities are less than 5-12% and the drifts are at most ±5% decade-1 (or even ±3 % decade-1 for a few records). The agreement with ground-based data degrades somewhat towards the stratopause and especially towards the tropopause where natural variability and low ozone abundances impede a more precise analysis. In part of the stratosphere a few records deviate from the preceding general conclusions; we identified biases of 10% and more (POAM II and SCIAMACHY), markedly higher single-profile variability (SMR and SCIAMACHY), and significant long-term drifts (SCIAMACHY, OSIRIS, HALOE, and possibly GOMOS and SMR as well). Furthermore, we reflected on the repercussions of our findings for the construction, analysis and interpretation of merged data records. Most notably, the discrepancies between several recent ozone profile trend assessments can be mostly explained by instrumental drift. This clearly demonstrates the need for systematic comprehensive multi-instrument comparison analyses.
Collapse
Affiliation(s)
- D Hubert
- Royal Belgian Institute for Space Aeronomy (BIRA-IASB), Brussels, Belgium
| | - J-C Lambert
- Royal Belgian Institute for Space Aeronomy (BIRA-IASB), Brussels, Belgium
| | - T Verhoelst
- Royal Belgian Institute for Space Aeronomy (BIRA-IASB), Brussels, Belgium
| | - J Granville
- Royal Belgian Institute for Space Aeronomy (BIRA-IASB), Brussels, Belgium
| | - A Keppens
- Royal Belgian Institute for Space Aeronomy (BIRA-IASB), Brussels, Belgium
| | - J-L Baray
- Laboratoire de l'Atmosphère et des Cyclones (Université de La Réunion, CNRS, Météo-France), OSU-Réunion (Université de la Réunion, CNRS), La Réunion, France
- Laboratoire de Météorologie Physique, Observatoire de Physique du Globe de Clermont-Ferrand (Université Blaise Pascal, CNRS), Clermont-Ferrand, France
| | - U Cortesi
- Istituto di Fisica Applicata "Nello Carrara" del Consiglio Nazionale delle Ricerche, Sesto Fiorentino, Italy
| | - D A Degenstein
- Institute of Space and Atmospheric Studies, University of Saskatchewan, Saskatoon, SK, Canada
| | - L Froidevaux
- Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA, USA
| | - S Godin-Beekmann
- Laboratoire Atmosphère Milieux Observations Spatiales, Université de Versailles Saint-Quentin en Yvelines, Centre National de la Recherche Scientifique, Paris, France
| | | | - E Kyrölä
- Finnish Meteorological Institute, Helsinki, Finland
| | - T Leblanc
- Jet Propulsion Laboratory, California Institute of Technology, Wrightwood, CA, USA
| | - G Lichtenberg
- German Aerospace Center (DLR), Remote Sensing Technology Institute, Oberpfaffenhofen, Germany
| | | | - D Murtagh
- Department of Earth and Space Sciences, Chalmers University of Technology, Göteborg, Sweden
| | - H Nakane
- Kochi University of Technology, Kochi, Japan
- National Institute for Environmental Studies, Tsukuba, Ibaraki, Japan
| | - R Querel
- National Institute of Water and Atmospheric Research, Lauder, New Zealand
| | - J M Russell
- Department of Atmospheric and Planetary Science, Hampton University, VA, USA
| | - J Salvador
- CEILAP-UNIDEF (MINDEF-CONICET), UMI-IFAECI-CNRS-3351, Villa Martelli, Argentina
| | - H G J Smit
- Research Centre Jülich, Institute for Energy and Climate Research: Troposphere (IEK-8), Jülich, Germany
| | - K Stebel
- Norwegian Air Research Institute (NILU), Kjeller, Norway
| | - W Steinbrecht
- Meteorologisches Observatorium, Deutscher Wetterdienst, Hohenpeissenberg, Germany
| | - K B Strawbridge
- Air Quality Processes Research Section, Environment Canada, Toronto, ON, Canada
| | - R Stübi
- Payerne Aerological Station, MeteoSwiss, Payerne, Switzerland
| | - D P J Swart
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - G Taha
- Universities Space Research Association, Greenbelt, MD, USA
- NASA Goddard Space Flight Center, Greenbelt, MD, USA
| | - A M Thompson
- NASA Goddard Space Flight Center, Greenbelt, MD, USA
| | - J Urban
- Department of Earth and Space Sciences, Chalmers University of Technology, Göteborg, Sweden
| | - J A E van Gijsel
- Royal Netherlands Meteorological Institute (KNMI), De Bilt, the Netherlands
| | - P von der Gathen
- Alfred Wegener Institute, Helmholtz Centre for Polar and Marine Research, Potsdam, Germany
| | - K A Walker
- Department of Physics, University of Toronto, Toronto, ON, Canada
- Department of Chemistry, University of Waterloo, Waterloo, ON, Canada
| | - E Wolfram
- CEILAP-UNIDEF (MINDEF-CONICET), UMI-IFAECI-CNRS-3351, Villa Martelli, Argentina
| | - J M Zawodny
- NASA Langley Research Center, Hampton, VA, USA
| |
Collapse
|
23
|
James ND, Sydes MR, Clarke NW, Mason MD, Dearnaley DP, Spears MR, Ritchie AWS, Parker CC, Russell JM, Attard G, de Bono J, Cross W, Jones RJ, Thalmann G, Amos C, Matheson D, Millman R, Alzouebi M, Beesley S, Birtle AJ, Brock S, Cathomas R, Chakraborti P, Chowdhury S, Cook A, Elliott T, Gale J, Gibbs S, Graham JD, Hetherington J, Hughes R, Laing R, McKinna F, McLaren DB, O'Sullivan JM, Parikh O, Peedell C, Protheroe A, Robinson AJ, Srihari N, Srinivasan R, Staffurth J, Sundar S, Tolan S, Tsang D, Wagstaff J, Parmar MKB. Addition of docetaxel, zoledronic acid, or both to first-line long-term hormone therapy in prostate cancer (STAMPEDE): survival results from an adaptive, multiarm, multistage, platform randomised controlled trial. Lancet 2016; 387:1163-77. [PMID: 26719232 PMCID: PMC4800035 DOI: 10.1016/s0140-6736(15)01037-5] [Citation(s) in RCA: 1426] [Impact Index Per Article: 178.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Long-term hormone therapy has been the standard of care for advanced prostate cancer since the 1940s. STAMPEDE is a randomised controlled trial using a multiarm, multistage platform design. It recruits men with high-risk, locally advanced, metastatic or recurrent prostate cancer who are starting first-line long-term hormone therapy. We report primary survival results for three research comparisons testing the addition of zoledronic acid, docetaxel, or their combination to standard of care versus standard of care alone. METHODS Standard of care was hormone therapy for at least 2 years; radiotherapy was encouraged for men with N0M0 disease to November, 2011, then mandated; radiotherapy was optional for men with node-positive non-metastatic (N+M0) disease. Stratified randomisation (via minimisation) allocated men 2:1:1:1 to standard of care only (SOC-only; control), standard of care plus zoledronic acid (SOC + ZA), standard of care plus docetaxel (SOC + Doc), or standard of care with both zoledronic acid and docetaxel (SOC + ZA + Doc). Zoledronic acid (4 mg) was given for six 3-weekly cycles, then 4-weekly until 2 years, and docetaxel (75 mg/m(2)) for six 3-weekly cycles with prednisolone 10 mg daily. There was no blinding to treatment allocation. The primary outcome measure was overall survival. Pairwise comparisons of research versus control had 90% power at 2·5% one-sided α for hazard ratio (HR) 0·75, requiring roughly 400 control arm deaths. Statistical analyses were undertaken with standard log-rank-type methods for time-to-event data, with hazard ratios (HRs) and 95% CIs derived from adjusted Cox models. This trial is registered at ClinicalTrials.gov (NCT00268476) and ControlledTrials.com (ISRCTN78818544). FINDINGS 2962 men were randomly assigned to four groups between Oct 5, 2005, and March 31, 2013. Median age was 65 years (IQR 60-71). 1817 (61%) men had M+ disease, 448 (15%) had N+/X M0, and 697 (24%) had N0M0. 165 (6%) men were previously treated with local therapy, and median prostate-specific antigen was 65 ng/mL (IQR 23-184). Median follow-up was 43 months (IQR 30-60). There were 415 deaths in the control group (347 [84%] prostate cancer). Median overall survival was 71 months (IQR 32 to not reached) for SOC-only, not reached (32 to not reached) for SOC + ZA (HR 0·94, 95% CI 0·79-1·11; p=0·450), 81 months (41 to not reached) for SOC + Doc (0·78, 0·66-0·93; p=0·006), and 76 months (39 to not reached) for SOC + ZA + Doc (0·82, 0·69-0·97; p=0·022). There was no evidence of heterogeneity in treatment effect (for any of the treatments) across prespecified subsets. Grade 3-5 adverse events were reported for 399 (32%) patients receiving SOC, 197 (32%) receiving SOC + ZA, 288 (52%) receiving SOC + Doc, and 269 (52%) receiving SOC + ZA + Doc. INTERPRETATION Zoledronic acid showed no evidence of survival improvement and should not be part of standard of care for this population. Docetaxel chemotherapy, given at the time of long-term hormone therapy initiation, showed evidence of improved survival accompanied by an increase in adverse events. Docetaxel treatment should become part of standard of care for adequately fit men commencing long-term hormone therapy. FUNDING Cancer Research UK, Medical Research Council, Novartis, Sanofi-Aventis, Pfizer, Janssen, Astellas, NIHR Clinical Research Network, Swiss Group for Clinical Cancer Research.
Collapse
Affiliation(s)
- Nicholas D James
- Warwick Medical School, University of Warwick, Coventry, UK; University Hospitals Birmingham NHS Foundation Trust, The Medical School, University of Birmingham, Birmingham, UK
| | | | - Noel W Clarke
- Department of Urology, The Christie and Salford Royal NHS Foundation Trusts, Manchester, UK
| | - Malcolm D Mason
- Cardiff University School of Medicine, Velindre Hospital, Cardiff, UK
| | - David P Dearnaley
- The Institute of Cancer Research & Royal Marsden NHS Foundation Trust, London, UK
| | | | | | - Christopher C Parker
- The Institute of Cancer Research & Royal Marsden NHS Foundation Trust, London, UK
| | - J Martin Russell
- Institute of Cancer Sciences, University of Glasgow, Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - Gerhardt Attard
- The Institute of Cancer Research & Royal Marsden NHS Foundation Trust, London, UK
| | - Johann de Bono
- The Institute of Cancer Research & Royal Marsden NHS Foundation Trust, London, UK
| | - William Cross
- Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds
| | - Rob J Jones
- Institute of Cancer Sciences, University of Glasgow, Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - George Thalmann
- Department of Urology, University Hospital, Bern, Switzerland
| | | | - David Matheson
- Patient rep, MRC Clinical Trials Unit at UCL, London, UK
| | - Robin Millman
- Patient rep, MRC Clinical Trials Unit at UCL, London, UK
| | - Mymoona Alzouebi
- Department of Oncology, Weston Park Hospital, Sheffield & Doncaster, UK
| | | | - Alison J Birtle
- Department of Oncology, Rosemere Cancer Centre, Royal Preston Hospital, Preston, UK
| | - Susannah Brock
- Department of Oncology, Poole Hospital NHS Foundation Trust and Royal Bournemouth Hospital NHS Foundation Trust, Chur, Switzerland
| | | | - Prabir Chakraborti
- Department of Oncology, Derby Hospitals NHS Foundation Trust, Royal Derby Hospital, Derby, UK
| | | | - Audrey Cook
- Department of Oncology, Cheltenham General Hospital & Hereford County Hospital, UK
| | - Tony Elliott
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Joanna Gale
- Oncology and Haematology Clinical Trials Unit, Queen Alexandra Hospital, Portsmouth, UK
| | | | | | - John Hetherington
- Department of Urology, Hull & East Yorkshire Hospitals NHS Trust, Hull, UK
| | - Robert Hughes
- Mount Vernon Group, Mount Vernon Hospital, Middlesex, UK
| | - Robert Laing
- Department of Oncology, Royal Surrey County Hospital, Guildford, UK
| | - Fiona McKinna
- Department of Oncology, East Sussex Hospitals Trust, East Sussex, UK
| | | | - Joe M O'Sullivan
- Centre for Cancer Research and Cell Biology, Queens University Belfast/Belfast City Hospital, Belfast, UK
| | - Omi Parikh
- Department of Oncology, East Lancashire Hospitals NHS Trust, East Lancashire, UK
| | - Clive Peedell
- Department of Oncology & Radiotherapy, South Tees NHS Trust, Middlesbrough, UK
| | | | | | - Narayanan Srihari
- Department of Oncology, Shrewsbury & Telford Hospitals NHS Trust, Shrewsbury, UK
| | - Rajaguru Srinivasan
- Department of Oncology, Royal Devon & Exeter Hospital, Exeter, UK/Torbay Hospital, Torquay, UK
| | - John Staffurth
- Cardiff University School of Medicine, Velindre Hospital, Cardiff, UK
| | - Santhanam Sundar
- Department of Oncology, Nottingham University Hospitals NHS trust, Nottingham, UK
| | - Shaun Tolan
- Department of Oncology & Radiotherapy, Clatterbridge Cancer Centre, Wirral, UK
| | - David Tsang
- Department of Oncology, Southend & Basildon Hospitals, Essex, UK
| | - John Wagstaff
- The South West Wales Cancer Institute and Swansea University College of Medicine, Swansea, UK
| | | |
Collapse
|
24
|
James ND, Spears MR, Clarke NW, Dearnaley DP, Mason MD, Parker CC, Ritchie AWS, Russell JM, Schiavone F, Attard G, de Bono JS, Birtle A, Engeler DS, Elliott T, Matheson D, O'Sullivan J, Pudney D, Srihari N, Wallace J, Barber J, Syndikus I, Parmar MKB, Sydes MR. Failure-Free Survival and Radiotherapy in Patients With Newly Diagnosed Nonmetastatic Prostate Cancer: Data From Patients in the Control Arm of the STAMPEDE Trial. JAMA Oncol 2016; 2:348-57. [PMID: 26606329 PMCID: PMC4789485 DOI: 10.1001/jamaoncol.2015.4350] [Citation(s) in RCA: 120] [Impact Index Per Article: 15.0] [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] [Indexed: 11/14/2022]
Abstract
IMPORTANCE The natural history of patients with newly diagnosed high-risk nonmetastatic (M0) prostate cancer receiving hormone therapy (HT) either alone or with standard-of-care radiotherapy (RT) is not well documented. Furthermore, no clinical trial has assessed the role of RT in patients with node-positive (N+) M0 disease. The STAMPEDE Trial includes such individuals, allowing an exploratory multivariate analysis of the impact of radical RT. OBJECTIVE To describe survival and the impact on failure-free survival of RT by nodal involvement in these patients. DESIGN, SETTING, AND PARTICIPANTS Cohort study using data collected for patients allocated to the control arm (standard-of-care only) of the STAMPEDE Trial between October 5, 2005, and May 1, 2014. Outcomes are presented as hazard ratios (HRs) with 95% CIs derived from adjusted Cox models; survival estimates are reported at 2 and 5 years. Participants were high-risk, hormone-naive patients with newly diagnosed M0 prostate cancer starting long-term HT for the first time. Radiotherapy is encouraged in this group, but mandated for patients with node-negative (N0) M0 disease only since November 2011. EXPOSURES Long-term HT either alone or with RT, as per local standard. Planned RT use was recorded at entry. MAIN OUTCOMES AND MEASURES Failure-free survival (FFS) and overall survival. RESULTS A total of 721 men with newly diagnosed M0 disease were included: median age at entry, 66 (interquartile range [IQR], 61-72) years, median (IQR) prostate-specific antigen level of 43 (18-88) ng/mL. There were 40 deaths (31 owing to prostate cancer) with 17 months' median follow-up. Two-year survival was 96% (95% CI, 93%-97%) and 2-year FFS, 77% (95% CI, 73%-81%). Median (IQR) FFS was 63 (26 to not reached) months. Time to FFS was worse in patients with N+ disease (HR, 2.02 [95% CI, 1.46-2.81]) than in those with N0 disease. Failure-free survival outcomes favored planned use of RT for patients with both N0M0 (HR, 0.33 [95% CI, 0.18-0.61]) and N+M0 disease (HR, 0.48 [95% CI, 0.29-0.79]). CONCLUSIONS AND RELEVANCE Survival for men entering the cohort with high-risk M0 disease was higher than anticipated at study inception. These nonrandomized data were consistent with previous trials that support routine use of RT with HT in patients with N0M0 disease. Additionally, the data suggest that the benefits of RT extend to men with N+M0 disease. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00268476; ISRCTN78818544.
Collapse
Affiliation(s)
- Nicholas D James
- Warwick Medical School, University of Warwick, Coventry, United Kingdom2University Hospitals Birmingham NHS Foundation Trust, The Medical School, University of Birmingham, Birmingham, United Kingdom
| | - Melissa R Spears
- Medical Research Council Clinical Trials Unit, University College, London, United Kingdom
| | - Noel W Clarke
- Department of Urology, Christie NHS Foundation Trust, Manchester, United Kingdom
| | - David P Dearnaley
- Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, United Kingdom
| | | | - Christopher C Parker
- Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Alastair W S Ritchie
- Medical Research Council Clinical Trials Unit, University College, London, United Kingdom
| | - J Martin Russell
- Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Francesca Schiavone
- Medical Research Council Clinical Trials Unit, University College, London, United Kingdom
| | - Gerhardt Attard
- Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Johann S de Bono
- Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, United Kingdom
| | | | | | - Tony Elliott
- Greater Manchester Group, Manchester, United Kingdom
| | | | | | | | | | - Jan Wallace
- Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | - Jim Barber
- Velindre Hospital, Cardiff, United Kingdom
| | | | - Mahesh K B Parmar
- Medical Research Council Clinical Trials Unit, University College, London, United Kingdom
| | - Matthew R Sydes
- Medical Research Council Clinical Trials Unit, University College, London, United Kingdom
| |
Collapse
|
25
|
James ND, Sydes MR, Clarke NW, Mason MD, Dearnaley DP, Spears MR, Ritchie AWS, Russell JM, Parker CC, Rentsch CA, Wallace J, Barber J, Lydon A, Parmar MKB. Celecoxib with or without zoledronic acid for hormone-naïve prostate cancer: Survival results from STAMPEDE (NCT00268476). J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.2_suppl.162] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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
162 Background: STAMPEDE is a randomised controlled trial using a multi-arm multi-stage design. It recruits men (pts) with high-risk locally advanced or metastatic prostate cancer (PCa) starting long-term hormone therapy (HT) for the first time. The trial initially assessed adding one or two of three treatment approaches to standard-of-care (SOC). We report comparative survival data for the two original comparisons that stopped accrual early at pre-planned lack-of-activity analysis based on failure-free survival (FFS): celecoxib (Cox) and celecoxib + zoledronic acid (Cox+ZA). Methods: SOC was HT for at least 2yrs; RT was encouraged for men with M0 disease. Stratified randomisation allocated pts 2:1:1 to SOC (control), SOC+Cox or SOC+Cox+ZA. Celecoxib (400mg) was given twice daily until 1yr. Zoledronic acid (4mg) was given for six 3-weekly cycles then 4-weekly until 2yrs. The primary outcome measure was death from any cause. This pre-planned analysis is triggered by analysis of the “original comparisons” that continued accrual through all activity stages. Analyses use Cox proportional hazards model and flexible parametric models, all adjusted for stratification factors. Results: 1,245 men were contemporaneously randomised to these 3 arms (Oct2005-Apr2011). Groups were well balanced: median age 65yrs; 61% metastatic, 14% N+/X M0, 25% N0M0; 94% newly-diagnosed; median PSA 66ng/ml. Median follow-up was 62m. Grade 3-5 adverse events were seen in 35% SOC, 32% SOC+Cox, 32% SOC+Cox+ZA. There were 295 control arm deaths (82% PCa); median survival 68m. The adjusted HR was 1.00 (95% CI 0.82-1.22; p=0.99; median OS 69m) for SOC+Cox vs SOC; and 0.86 (95%CI 0.70-1.06; p=0.16; median OS 74m) for SOC+Cox+ZA vs SOC. Pre-planned analyses in men with metastatic disease showed HR 0.78 (95%CI 0.62-0.99) for SOC+Cox+ZA vs SOC. Further data will be shown. Conclusions: These data show no survival advantage for the addition of celecoxib alone for men starting long-term HT for the 1st time. However, the addition of celecoxib combined with ZA demonstrated a survival advantage for men with metastatic disease, in a pre-planned analysis, and requires further investigation. Clinical trial information: NCT00268476.
Collapse
Affiliation(s)
| | | | - Noel W. Clarke
- The Christie and Salford Royal Hospitals, Manchester, United Kingdom
| | | | - David P. Dearnaley
- The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | | | | | - J. Martin Russell
- Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Chris C. Parker
- Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, London, United Kingdom
| | | | - Jan Wallace
- Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | | | - Anna Lydon
- South Devon Healthcare NHS Foundation Trust, Torquay, United Kingdom
| | - Mahesh K B Parmar
- Medical Research Council, Clinical Trials Unit at University College London, London, United Kingdom
| |
Collapse
|
26
|
James ND, Sydes MR, Mason MD, Clarke NW, Dearnaley DP, Spears MR, Millman R, Parker C, Ritchie AWS, Russell JM, Staffurth J, Jones RJ, Tolan SP, Wagstaff J, Protheroe A, Srinivasan R, Birtle AJ, O'Sullivan JM, Cathomas R, Parmar MMK. Docetaxel and/or zoledronic acid for hormone-naïve prostate cancer: First overall survival results from STAMPEDE (NCT00268476). J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.5001] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [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)
| | | | | | - Noel W. Clarke
- The Christie and Salford Royal Hospitals, Manchester, United Kingdom
| | - David Paul Dearnaley
- Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, London, United Kingdom
| | | | | | - Chris Parker
- Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, London, United Kingdom
| | | | | | | | - Robert J. Jones
- The Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | | | - John Wagstaff
- South West Wales Cancer Institute, Swansea, United Kingdom
| | - Andrew Protheroe
- University of Oxford Medical Oncology Department, Oxford, United Kingdom
| | | | - Alison J. Birtle
- Lancashire Teaching Hospitals NHS Foundation Trust, Preston, United Kingdom
| | | | | | | | | |
Collapse
|
27
|
Attard G, Sydes MR, Mason MD, Clarke NW, Aebersold D, de Bono JS, Dearnaley DP, Parker CC, Ritchie AW, Russell JM, Thalmann G, Cassoly E, Millman R, Matheson D, Schiavone F, Spears MR, Parmar MK, James ND. Combining Enzalutamide with Abiraterone, Prednisone, and Androgen Deprivation Therapy in the STAMPEDE Trial. Eur Urol 2014; 66:799-802. [DOI: 10.1016/j.eururo.2014.05.038] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 05/29/2014] [Indexed: 10/25/2022]
|
28
|
James ND, Spears MR, Clarke NW, Dearnaley DP, De Bono JS, Gale J, Hetherington J, Hoskin PJ, Jones RJ, Laing R, Lester JF, McLaren D, Parker CC, Parmar MKB, Ritchie AWS, Russell JM, Strebel RT, Thalmann GN, Mason MD, Sydes MR. Survival with Newly Diagnosed Metastatic Prostate Cancer in the "Docetaxel Era": Data from 917 Patients in the Control Arm of the STAMPEDE Trial (MRC PR08, CRUK/06/019). Eur Urol 2014; 67:1028-1038. [PMID: 25301760 DOI: 10.1016/j.eururo.2014.09.032] [Citation(s) in RCA: 286] [Impact Index Per Article: 28.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Accepted: 09/19/2014] [Indexed: 12/21/2022]
Abstract
BACKGROUND Prostate cancer (PCa) is the second most common disease among men worldwide. It is important to know survival outcomes and prognostic factors for this disease. Recruitment for the largest therapeutic randomised controlled trial in PCa--the Systemic Therapy in Advancing or Metastatic Prostate Cancer: Evaluation of Drug Efficacy: A Multi-Stage Multi-Arm Randomised Controlled Trial (STAMPEDE)--includes men with newly diagnosed metastatic PCa who are commencing long-term androgen deprivation therapy (ADT); the control arm provides valuable data for a prospective cohort. OBJECTIVE Describe survival outcomes, along with current treatment standards and factors associated with prognosis, to inform future trial design in this patient group. DESIGN, SETTING, AND PARTICIPANTS STAMPEDE trial control arm comprising men newly diagnosed with M1 disease who were recruited between October 2005 and January 2014. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Overall survival (OS) and failure-free survival (FFS) were reported by primary disease characteristics using Kaplan-Meier methods. Hazard ratios and 95% confidence intervals (CIs) were derived from multivariate Cox models. RESULTS AND LIMITATIONS A cohort of 917 men with newly diagnosed M1 disease was recruited to the control arm in the specified interval. Median follow-up was 20 mo. Median age at randomisation was 66 yr (interquartile range [IQR]: 61-71), and median prostate-specific antigen level was 112 ng/ml (IQR: 34-373). Most men (n=574; 62%) had bone-only metastases, whereas 237 (26%) had both bone and soft tissue metastases; soft tissue metastasis was found mainly in distant lymph nodes. There were 238 deaths, 202 (85%) from PCa. Median FFS was 11 mo; 2-yr FFS was 29% (95% CI, 25-33). Median OS was 42 mo; 2-yr OS was 72% (95% CI, 68-76). Survival time was influenced by performance status, age, Gleason score, and metastases distribution. Median survival after FFS event was 22 mo. Trial eligibility criteria meant men were younger and fitter than general PCa population. CONCLUSIONS Survival remains disappointing in men presenting with M1 disease who are started on only long-term ADT, despite active treatments being available at first failure of ADT. Importantly, men with M1 disease now spend the majority of their remaining life in a state of castration-resistant relapse. PATIENT SUMMARY Results from this control arm cohort found survival is relatively short and highly influenced by patient age, fitness, and where prostate cancer has spread in the body.
Collapse
Affiliation(s)
| | - Melissa R Spears
- Medical Research Council Clinical Trials Unit at University College London, London, UK
| | - Noel W Clarke
- Department of Urology, The Christie NHS Foundation Trust, Manchester, UK
| | - David P Dearnaley
- Institute of Cancer Research, London, UK; The Royal Marsden NHS Foundation Trust, London and Sutton, UK
| | - Johann S De Bono
- Institute of Cancer Research, London, UK; The Royal Marsden NHS Foundation Trust, London and Sutton, UK
| | | | | | | | - Robert J Jones
- University of Glasgow, Beatson West of Scotland Cancer Centre, Glasgow, UK
| | | | | | | | - Christopher C Parker
- Institute of Cancer Research, London, UK; The Royal Marsden NHS Foundation Trust, London and Sutton, UK
| | - Mahesh K B Parmar
- Medical Research Council Clinical Trials Unit at University College London, London, UK
| | - Alastair W S Ritchie
- Medical Research Council Clinical Trials Unit at University College London, London, UK
| | - J Martin Russell
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | | | | | | | - Matthew R Sydes
- Medical Research Council Clinical Trials Unit at University College London, London, UK
| |
Collapse
|
29
|
Dearnaley DP, Jovic G, Syndikus I, Khoo V, Cowan RA, Graham JD, Aird EG, Bottomley D, Huddart RA, Jose CC, Matthews JHL, Millar JL, Murphy C, Russell JM, Scrase CD, Parmar MKB, Sydes MR. Escalated-dose versus control-dose conformal radiotherapy for prostate cancer: long-term results from the MRC RT01 randomised controlled trial. Lancet Oncol 2014; 15:464-73. [PMID: 24581940 DOI: 10.1016/s1470-2045(14)70040-3] [Citation(s) in RCA: 328] [Impact Index Per Article: 32.8] [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] [Indexed: 11/18/2022]
Abstract
BACKGROUND The aim of this trial was to compare dose-escalated conformal radiotherapy with control-dose conformal radiotherapy in patients with localised prostate cancer. Preliminary findings reported after 5 years of follow-up showed that escalated-dose conformal radiotherapy improved biochemical progression-free survival. Based on the sample size calculation, we planned to analyse overall survival when 190 deaths occurred; this target has now been reached, after a median 10 years of follow-up. METHODS RT01 was a phase 3, open-label, international, randomised controlled trial enrolling men with histologically confirmed T1b-T3a, N0, M0 prostate cancer with prostate specific antigen of less than 50 ng/mL. Patients were randomly assigned centrally in a 1:1 ratio, using a computer-based minimisation algorithm stratifying by risk of seminal vesicle invasion and centre to either the control group (64 Gy in 32 fractions, the standard dose at the time the trial was designed) or the escalated-dose group (74 Gy in 37 fractions). Neither patients nor investigators were masked to assignment. All patients received neoadjuvant androgen deprivation therapy for 3-6 months before the start of conformal radiotherapy, which continued until the end of conformal radiotherapy. The coprimary outcome measures were biochemical progression-free survival and overall survival. All analyses were done on an intention-to-treat basis. Treatment-related side-effects have been reported previously. This trial is registered, number ISRCTN47772397. FINDINGS Between Jan 7, 1998, and Dec 20, 2001, 862 men were registered and 843 subsequently randomly assigned: 422 to the escalated-dose group and 421 to the control group. As of Aug 2, 2011, 236 deaths had occurred: 118 in each group. Median follow-up was 10·0 years (IQR 9·1-10·8). Overall survival at 10 years was 71% (95% CI 66-75) in each group (hazard ratio [HR] 0·99, 95% CI 0·77-1·28; p=0·96). Biochemical progression or progressive disease occurred in 391 patients (221 [57%] in the control group and 170 [43%] in the escalated-dose group). At 10 years, biochemical progression-free survival was 43% (95% CI 38-48) in the control group and 55% (50-61) in the escalated-dose group (HR 0·69, 95% CI 0·56-0·84; p=0·0003). INTERPRETATION At a median follow-up of 10 years, escalated-dose conformal radiotherapy with neoadjuvant androgen deprivation therapy showed an advantage in biochemical progression-free survival, but this advantage did not translate into an improvement in overall survival. These efficacy data for escalated-dose treatment must be weighed against the increase in acute and late toxicities associated with the escalated dose and emphasise the importance of use of appropriate modern radiotherapy methods to reduce side-effects. FUNDING UK Medical Research Council.
Collapse
Affiliation(s)
- David P Dearnaley
- The Institute of Cancer Research, London, UK; The Royal Marsden NHS Foundation Trust, London and Sutton, UK
| | - Gordana Jovic
- Medical Research Council Clinical Trials Unit at University College London, London, UK
| | | | - Vincent Khoo
- The Royal Marsden NHS Foundation Trust, London and Sutton, UK
| | | | | | | | | | - Robert A Huddart
- The Institute of Cancer Research, London, UK; The Royal Marsden NHS Foundation Trust, London and Sutton, UK
| | | | | | | | - Claire Murphy
- Medical Research Council Clinical Trials Unit at University College London, London, UK
| | | | | | - Mahesh K B Parmar
- Medical Research Council Clinical Trials Unit at University College London, London, UK
| | - Matthew R Sydes
- Medical Research Council Clinical Trials Unit at University College London, London, UK.
| |
Collapse
|
30
|
Parker CC, Sydes MR, Mason MD, Clarke NW, Aebersold D, de Bono JS, Dearnaley DP, Ritchie AWS, Russell JM, Thalmann G, Parmar MKB, James ND. Prostate radiotherapy for men with metastatic disease: a new comparison in the Systemic Therapy in Advancing or Metastatic Prostate Cancer: Evaluation of Drug Efficacy (STAMPEDE) trial. BJU Int 2013; 111:697-9. [PMID: 23578233 DOI: 10.1111/bju.12087] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Christopher C Parker
- Institute of Cancer Research and Royal Marsden Hospitals Foundation Trust, Sutton, UK
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Clarke NW, James ND, Mason MD, Aebersold DM, Dearnaley DP, De Bono JS, Parker C, Parmar M, Ritchie AWS, Russell JM, Spears MR, Thalmann GN, Sydes MR. Survival with newly diagnosed metastatic prostate cancer in the “docetaxel era”: Data from >600 patients in the control arm of the STAMPEDE trial (NCT00268476). J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.5012] [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
5012 Background: STAMPEDE (www.stampedetrial.org) recruits men with newly-diagnosed or rapidly relapsing prostate cancer (PCa) that is metastatic (M1) or high-risk locally advanced, all commencing long-term androgen ablation therapy (AAT) for the first time. This is now the largest therapeutic RCT in PCa. We report survival outcomes for newly-diagnosed M1 control arm men in order to inform future trials in this setting. Methods: Newly-diagnosed men with M1 disease in the trial’s control arm (standard of care: AAT alone for at least 2yr), diagnosed up to 6 months prior to randomisation, were identified from trial records in Dec-2012. We report overall survival (OS) and failure-free survival (FFS) from randomisation by primary disease characteristics. Results: 3703 men were recruited to STAMPEDE Oct-2005 to Dec-2012, including a control arm cohort of 630 M1 men with newly-diagnosed disease. This cohort has median age at randomisation 66yr (quartiles 60-71), median PSA 105 (quartiles 34-379) IU/l; metastases to bone only (B) 393 (62%), soft tissue only (ST) 78 (13%) or bone and soft tissue (B+ST) 159 (25%). ST was mainly lymph nodes. Median time from diagnosis to randomisation is 69 days (max 180 days). Median duration of AAT prior to randomisation is 46 days (max 105 days). There were 129 deaths, of which 111 were from PCa. Median OS from randomisation is 42 months, with 2-yr OS 74% (95%CI 68, 78) in this cohort; B 77% (95%CI 71, 83), ST 85% (95%CI 70, 93), B+ST 57% (95%CI 45, 68). Median FFS is 12 months, driven by rising PSA; 2-yr FFS 32% (95%CI 27-37). Median time from FFS event to death was 22 months. Additional data on relapse therapies will be presented. Conclusions: Survival, and particularly FFS, remains relatively poor for men presenting with M1 disease starting long-term AAT, despite potential access when castration-resistant (CRPC) to docetaxel and other newer therapies. Better first-line therapy is required; STAMPEDE will report many comparisons in the future. Different M1 patterns may vary prognostically. Men with M1 disease will now spend most time in a state of CRPC, which has important implications for clinicians and trialists. Clinical trial information: NCT00268476.
Collapse
Affiliation(s)
- Noel W Clarke
- Department of Urology, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | | | | | | | | | - Johann Sebastian De Bono
- The Institute of Cancer Research, The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Chris Parker
- The Institute of Cancer Research, The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | | | | | - J. Martin Russell
- Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom
| | | | | | | | | |
Collapse
|
32
|
Abstract
BACKGROUND Homeless people in the UK and elsewhere have typically been found to consume a nutritionally inadequate diet. There is need for contemporary research to update our understanding within this field. The present study aimed to provide an insight into the nutrient intake and food choice of a sample of homeless adults. METHODS In this mixed-methods study, 24 homeless individuals accessing two charitable meal services in Sheffield, UK, participated in up to four 24-h dietary recalls between April and August 2012. Twelve individuals took part in a semi-structured interview focusing on food choice. RESULTS Energy intake was significantly lower than the estimated average requirement. Median intakes of vitamin A, zinc, magnesium, potassium and selenium were significantly lower than reference nutrient intakes. Contributions of saturated fat and nonmilk extrinsic sugars to total energy intake were significantly higher, whereas dietary fibre was significantly lower, than population average intakes. Charitable meals made an important contribution to intakes of energy and most micronutrients. Thematic analysis of interview transcripts revealed three major themes: food aspirations; constraints over food choice; and food representing survival. CONCLUSIONS The present study reveals risk of dietary inadequacies amongst homeless people alongside a lack of control over food choices. Charitable meal services are suggested as a vehicle for improving the dietary intake and nutritional health of homeless people.
Collapse
Affiliation(s)
- E F Sprake
- Human Nutrition Unit, Department of Oncology, University of Sheffield, Sheffield, UK
| | | | | |
Collapse
|
33
|
Parker CC, Sydes MR, Mason MD, Clarke NW, Aebersold D, de Bono JS, Dearnaley DP, Ritchie AWS, Russell JM, Thalmann G, Parmar MKB, James ND. Prostate radiotherapy for men with metastatic disease: a new comparison in the STAMPEDE trial. Clin Oncol (R Coll Radiol) 2013; 25:318-20. [PMID: 23489869 DOI: 10.1016/j.clon.2013.01.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Accepted: 01/22/2013] [Indexed: 12/21/2022]
|
34
|
Sydes MR, Parmar MKB, Mason MD, Clarke NW, Amos C, Anderson J, de Bono J, Dearnaley DP, Dwyer J, Green C, Jovic G, Ritchie AWS, Russell JM, Sanders K, Thalmann G, James ND. Flexible trial design in practice - stopping arms for lack-of-benefit and adding research arms mid-trial in STAMPEDE: a multi-arm multi-stage randomized controlled trial. Trials 2012; 13:168. [PMID: 22978443 PMCID: PMC3466132 DOI: 10.1186/1745-6215-13-168] [Citation(s) in RCA: 106] [Impact Index Per Article: 8.8] [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: 03/09/2012] [Accepted: 08/16/2012] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Systemic Therapy for Advanced or Metastatic Prostate cancer: Evaluation of Drug Efficacy (STAMPEDE) is a randomized controlled trial that follows a novel multi-arm, multi-stage (MAMS) design. We describe methodological and practical issues arising with (1) stopping recruitment to research arms following a pre-planned intermediate analysis and (2) adding a new research arm during the trial. METHODS STAMPEDE recruits men who have locally advanced or metastatic prostate cancer who are starting standard long-term hormone therapy. Originally there were five research and one control arms, each undergoing a pilot stage (focus: safety, feasibility), three intermediate 'activity' stages (focus: failure-free survival), and a final 'efficacy' stage (focus: overall survival). Lack-of-sufficient-activity guidelines support the pairwise interim comparisons of each research arm against the control arm; these pre-defined activity cut-off becomes increasingly stringent over the stages. Accrual of further patients continues to the control arm and to those research arms showing activity and an acceptable safety profile. The design facilitates adding new research arms should sufficiently interesting agents emerge. These new arms are compared only to contemporaneously recruited control arm patients using the same intermediate guidelines in a time-delayed manner. The addition of new research arms is subject to adequate recruitment rates to support the overall trial aims. RESULTS (1) Stopping Existing Therapy: After the second intermediate activity analysis, recruitment was discontinued to two research arms for lack-of-sufficient activity. Detailed preparations meant that changes were implemented swiftly at 100 international centers and recruitment continued seamlessly into Activity Stage III with 3 remaining research arms and the control arm. Further regulatory and ethical approvals were not required because this was already included in the initial trial design.(2) Adding New Therapy: An application to add a new research arm was approved by the funder, (who also organized peer review), industrial partner and regulatory and ethical bodies. This was all done in advance of any decision to stop current therapies. CONCLUSIONS The STAMPEDE experience shows that recruitment to a MAMS trial and mid-flow changes its design are achievable with good planning. This benefits patients and the scientific community as research treatments are evaluated in a more efficient and cost-effective manner. TRIAL REGISTRATION ISRCTN78818544, NCT00268476. First patient into trial: 17 October 2005. First patient into abiraterone comparison: 15 November 2011.
Collapse
Affiliation(s)
| | | | | | - Noel W Clarke
- The Christie and Salford Royal Hospitals Foundations Trusts, Manchester, UK
| | | | | | - Johann de Bono
- Institute of Cancer Research and Royal Marsden Hospitals Foundation Trust, Sutton, UK
| | - David P Dearnaley
- Institute of Cancer Research and Royal Marsden Hospitals Foundation Trust, Sutton, UK
| | - John Dwyer
- Prostate Cancer Support Federation, Stockport, UK
| | | | | | | | | | | | | | - Nicholas D James
- School of Cancer Sciences, University of Birmingham, Birmingham, UK
| |
Collapse
|
35
|
James ND, Sydes MR, Mason MD, Clarke NW, Anderson J, Dearnaley DP, Dwyer J, Jovic G, Ritchie AWS, Russell JM, Sanders K, Thalmann GN, Bertelli G, Birtle AJ, O'Sullivan JM, Protheroe A, Sheehan D, Srihari N, Parmar MKB. Celecoxib plus hormone therapy versus hormone therapy alone for hormone-sensitive prostate cancer: first results from the STAMPEDE multiarm, multistage, randomised controlled trial. Lancet Oncol 2012; 13:549-58. [PMID: 22452894 PMCID: PMC3398767 DOI: 10.1016/s1470-2045(12)70088-8] [Citation(s) in RCA: 88] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Background Long-term hormone therapy alone is standard care for metastatic or high-risk, non-metastatic prostate cancer. STAMPEDE—an international, open-label, randomised controlled trial—uses a novel multiarm, multistage design to assess whether the early additional use of one or two drugs (docetaxel, zoledronic acid, celecoxib, zoledronic acid and docetaxel, or zoledronic acid and celecoxib) improves survival in men starting first-line, long-term hormone therapy. Here, we report the preplanned, second intermediate analysis comparing hormone therapy plus celecoxib (arm D) with hormone therapy alone (control arm A). Methods Eligible patients were men with newly diagnosed or rapidly relapsing prostate cancer who were starting long-term hormone therapy for the first time. Hormone therapy was given as standard care in all trial arms, with local radiotherapy encouraged for newly diagnosed patients without distant metastasis. Randomisation was done using minimisation with a random element across seven stratification factors. Patients randomly allocated to arm D received celecoxib 400 mg twice daily, given orally, until 1 year or disease progression (including prostate-specific antigen [PSA] failure). The intermediate outcome was failure-free survival (FFS) in three activity stages; the primary outcome was overall survival in a subsequent efficacy stage. Research arms were compared pairwise against the control arm on an intention-to-treat basis. Accrual of further patients was discontinued in any research arm showing safety concerns or insufficient evidence of activity (lack of benefit) compared with the control arm. The minimum targeted activity at the second intermediate activity stage was a hazard ratio (HR) of 0·92. This trial is registered with ClinicalTrials.gov, number NCT00268476, and with Current Controlled Trials, number ISRCTN78818544. Findings 2043 patients were enrolled in the trial from Oct 17, 2005, to Jan 31, 2011, of whom 584 were randomly allocated to receive hormone therapy alone (control group; arm A) and 291 to receive hormone therapy plus celecoxib (arm D). At the preplanned analysis of the second intermediate activity stage, with 305 FFS events (209 in arm A, 96 in arm D), there was no evidence of an advantage for hormone therapy plus celecoxib over hormone therapy alone: HR 0·98 (95% CI 0·90–1·06). 2-year FFS was 51% (95% CI 46–56) in arm A and 51% (95% CI 43–58) in arm D. There was no evidence of differences in the incidence of adverse events between groups (events of grade 3 or higher were noted at any time in 123 [23%, 95% CI 20–27] patients in arm A and 64 [25%, 19–30] in arm D). The most common grade 3–5 events adverse effects in both groups were endocrine disorders (55 [11%] of patients in arm A vs 19 [7%] in arm D) and musculoskeletal disorders (30 [6%] of patients in arm A vs 15 [6%] in arm D). The independent data monitoring committee recommended stopping accrual to both celecoxib-containing arms on grounds of lack of benefit and discontinuing celecoxib for patients currently on treatment, which was endorsed by the trial steering committee. Interpretation Celecoxib 400 mg twice daily for up to 1 year is insufficiently active in patients starting hormone therapy for high-risk prostate cancer, and we do not recommend its use in this setting. Accrual continues seamlessly to the other research arms and follow-up of all arms will continue to assess effects on overall survival. Funding Cancer Research UK, Pfizer, Novartis, Sanofi-Aventis, Medical Research Council (London, UK).
Collapse
Affiliation(s)
- Nicholas D James
- School of Cancer Sciences, University of Birmingham, Birmingham, UK
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
36
|
James ND, Sydes MR, Mason MD, Clarke NW, Anderson J, Dearnaley DP, Dwyer J, Jovic G, Ritchie ASW, Russell JM, Sanders K, Thalmann G, Bertelli G, Birtle AJ, O'Sullivan JM, Protheroe A, Sheehan D, Srihari N, Parmar M. Celecoxib plus hormone therapy versus hormone therapy alone for hormone-sensitive prostate cancer: First results from STAMPEDE (MRC PR08, CRUK/06/019), a randomized controlled trial. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.5_suppl.26] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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
26 Background: Long-term hormone therapy (HT) alone is standard of care for men with metastatic or high-risk non-metastatic prostate cancer (PCa). STAMPEDE investigates whether early use of additional therapies improves overall survival. It is an international randomised controlled trial ( NCT00268476 ) using novel multi-arm, multi-stage methods to assess adding 1 or 2 of three agents (docetaxel, zoledronic acid (ZA), celecoxib) in 5 research arms in men with PCa starting long-term HT for the first time. Methods: HT was given as per standard care. Celecoxib was planned as 400mg bid until the sooner of 1 year or disease (including PSA) progression. The trial has 3 intermediate activity stages (I-III) where the outcome measure (OM) is failure-free survival (FFS) and 1 final efficacy stage (IV) with overall survival as primary OM. At the end of each stage, research arms are compared pairwise to the control arm. Accrual of further patients is discontinued early for any research arm either showing (a) safety concerns or (b) insufficient evidence of activity (lack-of-benefit) where the treatment effect on FFS is compared against a pre-defined stopping guideline. The interim activity “hurdle” becomes increasingly stringent stage-by-stage. Results: From Oct-2008 to Feb-2011, 2114 patients were consented and randomised, including 875 in this comparison. With 205 control FFS events, there was evidence of insufficient activity for HT+celecoxib over HT-alone: HR 0.98 (95%CI 0.90-1.06). The Independent Data Monitoring Committee recommended stopping accrual to this arm; stopping celecoxib was also recommended for patients currently on treatment. (Accrual was also stopped to HT+celecoxib+ZA but data are not disclosed.) There was no evidence of differences in toxicity: 25% and 23% of patients reporting grade ≥3 toxicities or adverse events with or without celecoxib. Control arm FFS was 51% at 2 years, in line with expectations. Conclusions: Celecoxib shows no evidence of activity in this setting. Accrual continues seamlessly to the other research arms. Follow-up of all arms is ongoing. Support: MRC, Cancer Research UK, Novartis, Sanofi-Aventis, Pfizer.
Collapse
Affiliation(s)
- Nicholas David James
- School of Cancer Sciences, University of Birmingham, Birmingham, United Kingdom; MRC Clinical Trials Unit, London, United Kingdom; Cardiff University, Cardiff, United Kingdom; Department of Urology, The Christie NHS Foundation Trust, Manchester, United Kingdom; The Royal Hallamshire Hospital, Sheffield, United Kingdom; Institute of Cancer Research/Royal Marsden Hospital, Sutton, United Kingdom; Prostate Cancer Support Federation, Stockport, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow,
| | - Matthew Robert Sydes
- School of Cancer Sciences, University of Birmingham, Birmingham, United Kingdom; MRC Clinical Trials Unit, London, United Kingdom; Cardiff University, Cardiff, United Kingdom; Department of Urology, The Christie NHS Foundation Trust, Manchester, United Kingdom; The Royal Hallamshire Hospital, Sheffield, United Kingdom; Institute of Cancer Research/Royal Marsden Hospital, Sutton, United Kingdom; Prostate Cancer Support Federation, Stockport, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow,
| | - Malcolm David Mason
- School of Cancer Sciences, University of Birmingham, Birmingham, United Kingdom; MRC Clinical Trials Unit, London, United Kingdom; Cardiff University, Cardiff, United Kingdom; Department of Urology, The Christie NHS Foundation Trust, Manchester, United Kingdom; The Royal Hallamshire Hospital, Sheffield, United Kingdom; Institute of Cancer Research/Royal Marsden Hospital, Sutton, United Kingdom; Prostate Cancer Support Federation, Stockport, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow,
| | - Noel W Clarke
- School of Cancer Sciences, University of Birmingham, Birmingham, United Kingdom; MRC Clinical Trials Unit, London, United Kingdom; Cardiff University, Cardiff, United Kingdom; Department of Urology, The Christie NHS Foundation Trust, Manchester, United Kingdom; The Royal Hallamshire Hospital, Sheffield, United Kingdom; Institute of Cancer Research/Royal Marsden Hospital, Sutton, United Kingdom; Prostate Cancer Support Federation, Stockport, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow,
| | - John Anderson
- School of Cancer Sciences, University of Birmingham, Birmingham, United Kingdom; MRC Clinical Trials Unit, London, United Kingdom; Cardiff University, Cardiff, United Kingdom; Department of Urology, The Christie NHS Foundation Trust, Manchester, United Kingdom; The Royal Hallamshire Hospital, Sheffield, United Kingdom; Institute of Cancer Research/Royal Marsden Hospital, Sutton, United Kingdom; Prostate Cancer Support Federation, Stockport, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow,
| | - David Paul Dearnaley
- School of Cancer Sciences, University of Birmingham, Birmingham, United Kingdom; MRC Clinical Trials Unit, London, United Kingdom; Cardiff University, Cardiff, United Kingdom; Department of Urology, The Christie NHS Foundation Trust, Manchester, United Kingdom; The Royal Hallamshire Hospital, Sheffield, United Kingdom; Institute of Cancer Research/Royal Marsden Hospital, Sutton, United Kingdom; Prostate Cancer Support Federation, Stockport, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow,
| | - John Dwyer
- School of Cancer Sciences, University of Birmingham, Birmingham, United Kingdom; MRC Clinical Trials Unit, London, United Kingdom; Cardiff University, Cardiff, United Kingdom; Department of Urology, The Christie NHS Foundation Trust, Manchester, United Kingdom; The Royal Hallamshire Hospital, Sheffield, United Kingdom; Institute of Cancer Research/Royal Marsden Hospital, Sutton, United Kingdom; Prostate Cancer Support Federation, Stockport, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow,
| | - Gordana Jovic
- School of Cancer Sciences, University of Birmingham, Birmingham, United Kingdom; MRC Clinical Trials Unit, London, United Kingdom; Cardiff University, Cardiff, United Kingdom; Department of Urology, The Christie NHS Foundation Trust, Manchester, United Kingdom; The Royal Hallamshire Hospital, Sheffield, United Kingdom; Institute of Cancer Research/Royal Marsden Hospital, Sutton, United Kingdom; Prostate Cancer Support Federation, Stockport, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow,
| | - Alastair SW Ritchie
- School of Cancer Sciences, University of Birmingham, Birmingham, United Kingdom; MRC Clinical Trials Unit, London, United Kingdom; Cardiff University, Cardiff, United Kingdom; Department of Urology, The Christie NHS Foundation Trust, Manchester, United Kingdom; The Royal Hallamshire Hospital, Sheffield, United Kingdom; Institute of Cancer Research/Royal Marsden Hospital, Sutton, United Kingdom; Prostate Cancer Support Federation, Stockport, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow,
| | - J. Martin Russell
- School of Cancer Sciences, University of Birmingham, Birmingham, United Kingdom; MRC Clinical Trials Unit, London, United Kingdom; Cardiff University, Cardiff, United Kingdom; Department of Urology, The Christie NHS Foundation Trust, Manchester, United Kingdom; The Royal Hallamshire Hospital, Sheffield, United Kingdom; Institute of Cancer Research/Royal Marsden Hospital, Sutton, United Kingdom; Prostate Cancer Support Federation, Stockport, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow,
| | - Karen Sanders
- School of Cancer Sciences, University of Birmingham, Birmingham, United Kingdom; MRC Clinical Trials Unit, London, United Kingdom; Cardiff University, Cardiff, United Kingdom; Department of Urology, The Christie NHS Foundation Trust, Manchester, United Kingdom; The Royal Hallamshire Hospital, Sheffield, United Kingdom; Institute of Cancer Research/Royal Marsden Hospital, Sutton, United Kingdom; Prostate Cancer Support Federation, Stockport, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow,
| | - George Thalmann
- School of Cancer Sciences, University of Birmingham, Birmingham, United Kingdom; MRC Clinical Trials Unit, London, United Kingdom; Cardiff University, Cardiff, United Kingdom; Department of Urology, The Christie NHS Foundation Trust, Manchester, United Kingdom; The Royal Hallamshire Hospital, Sheffield, United Kingdom; Institute of Cancer Research/Royal Marsden Hospital, Sutton, United Kingdom; Prostate Cancer Support Federation, Stockport, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow,
| | - Gianfilippo Bertelli
- School of Cancer Sciences, University of Birmingham, Birmingham, United Kingdom; MRC Clinical Trials Unit, London, United Kingdom; Cardiff University, Cardiff, United Kingdom; Department of Urology, The Christie NHS Foundation Trust, Manchester, United Kingdom; The Royal Hallamshire Hospital, Sheffield, United Kingdom; Institute of Cancer Research/Royal Marsden Hospital, Sutton, United Kingdom; Prostate Cancer Support Federation, Stockport, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow,
| | - Alison J Birtle
- School of Cancer Sciences, University of Birmingham, Birmingham, United Kingdom; MRC Clinical Trials Unit, London, United Kingdom; Cardiff University, Cardiff, United Kingdom; Department of Urology, The Christie NHS Foundation Trust, Manchester, United Kingdom; The Royal Hallamshire Hospital, Sheffield, United Kingdom; Institute of Cancer Research/Royal Marsden Hospital, Sutton, United Kingdom; Prostate Cancer Support Federation, Stockport, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow,
| | - Joe M. O'Sullivan
- School of Cancer Sciences, University of Birmingham, Birmingham, United Kingdom; MRC Clinical Trials Unit, London, United Kingdom; Cardiff University, Cardiff, United Kingdom; Department of Urology, The Christie NHS Foundation Trust, Manchester, United Kingdom; The Royal Hallamshire Hospital, Sheffield, United Kingdom; Institute of Cancer Research/Royal Marsden Hospital, Sutton, United Kingdom; Prostate Cancer Support Federation, Stockport, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow,
| | - Andrew Protheroe
- School of Cancer Sciences, University of Birmingham, Birmingham, United Kingdom; MRC Clinical Trials Unit, London, United Kingdom; Cardiff University, Cardiff, United Kingdom; Department of Urology, The Christie NHS Foundation Trust, Manchester, United Kingdom; The Royal Hallamshire Hospital, Sheffield, United Kingdom; Institute of Cancer Research/Royal Marsden Hospital, Sutton, United Kingdom; Prostate Cancer Support Federation, Stockport, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow,
| | - Denise Sheehan
- School of Cancer Sciences, University of Birmingham, Birmingham, United Kingdom; MRC Clinical Trials Unit, London, United Kingdom; Cardiff University, Cardiff, United Kingdom; Department of Urology, The Christie NHS Foundation Trust, Manchester, United Kingdom; The Royal Hallamshire Hospital, Sheffield, United Kingdom; Institute of Cancer Research/Royal Marsden Hospital, Sutton, United Kingdom; Prostate Cancer Support Federation, Stockport, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow,
| | - Narayanan Srihari
- School of Cancer Sciences, University of Birmingham, Birmingham, United Kingdom; MRC Clinical Trials Unit, London, United Kingdom; Cardiff University, Cardiff, United Kingdom; Department of Urology, The Christie NHS Foundation Trust, Manchester, United Kingdom; The Royal Hallamshire Hospital, Sheffield, United Kingdom; Institute of Cancer Research/Royal Marsden Hospital, Sutton, United Kingdom; Prostate Cancer Support Federation, Stockport, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow,
| | - Mahesh Parmar
- School of Cancer Sciences, University of Birmingham, Birmingham, United Kingdom; MRC Clinical Trials Unit, London, United Kingdom; Cardiff University, Cardiff, United Kingdom; Department of Urology, The Christie NHS Foundation Trust, Manchester, United Kingdom; The Royal Hallamshire Hospital, Sheffield, United Kingdom; Institute of Cancer Research/Royal Marsden Hospital, Sutton, United Kingdom; Prostate Cancer Support Federation, Stockport, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow,
| | | |
Collapse
|
37
|
Sydes MR, James ND, Mason MD, Clarke NW, Amos C, Anderson J, De Bono JS, Dearnaley DP, Dwyer J, Jovic G, Ritchie ASW, Russell JM, Sanders K, Thalmann G, Parmar M. Flexible trial design in practice: Dropping and adding arms in STAMPEDE (MRC PR08, CRUK/06/019)—A multiarm, multistage randomized controlled trial. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.5_suppl.27] [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
27 Background: STAMPEDE ( NCT00268476 ) is a multi-centre, RCT using novel multi‐arm, multi‐stage (MAMS) methods. We describe the methodological and practical issues arising with early stopping of recruitment to some arms following an intermediate analysis and the issues in adding new research arms during the trial. Methods: The trial recruits men with locally advanced or metastatic prostate cancer starting standard long-term hormone therapy. There are 5 research and 1 control arm assessed over 3 intermediate activity stages I-III [outcome measure: failure-free survival (FFS)] and a final efficacy stage IV [outcome measure: overall survival]. At the end of each stage, research arms are formally compared to the control arm. Accrual of further patients is discontinued early for research arms not showing sufficient evidence of activity or with adverse safety considerations; accrual continues to the other arms; this interim hurdle is increasingly stringent at each stage. The addition of new research arm(s) can be actively considered when sufficiently interesting agents emerge. New research arms are compared only to contemporaneously-recruited control arm pts using the same intermediate guidelines in a time-delayed manner. Results: (1) After the second intermediate activity analysis (Mar-2011), the IDMC recommended and the Trial Steering Committee ratified discontinuation of recruitment to two research arms for lack-of-sufficient activity. Nearly 100 recruiting centres in UK and Switzerland had to promptly implement changes. Detailed advanced preparation meant that activation was swift and recruitment continued seamlessly into Activity Stage III. (2) An application to add a new research arm, abiraterone, has been agreed by funders, industry partner and ethics committee; regulatory approval awaited. Details on methodological and practical issues and implementation of these changes will be presented. Conclusions: The STAMPEDE experiences shows that recruitment to MAMS trials is achievable and that mid-flow changes to trial design are practicable and encouraged.
Collapse
Affiliation(s)
- Matthew Robert Sydes
- MRC Clinical Trials Unit, London, United Kingdom; School of Cancer Sciences, University of Birmingham, Birmingham, United Kingdom; Cardiff University, Cardiff, United Kingdom; Department of Urology, The Christie NHS Foundation Trust, Manchester, United Kingdom; The Royal Hallamshire Hospital, Sheffield, United Kingdom; The Institute for Cancer Research and Royal Marsden Hospital, Sutton, United Kingdom; Institute of Cancer Research/Royal Marsden Hospital, Sutton, United Kingdom; Prostate Cancer Support
| | - Nicholas David James
- MRC Clinical Trials Unit, London, United Kingdom; School of Cancer Sciences, University of Birmingham, Birmingham, United Kingdom; Cardiff University, Cardiff, United Kingdom; Department of Urology, The Christie NHS Foundation Trust, Manchester, United Kingdom; The Royal Hallamshire Hospital, Sheffield, United Kingdom; The Institute for Cancer Research and Royal Marsden Hospital, Sutton, United Kingdom; Institute of Cancer Research/Royal Marsden Hospital, Sutton, United Kingdom; Prostate Cancer Support
| | - Malcolm David Mason
- MRC Clinical Trials Unit, London, United Kingdom; School of Cancer Sciences, University of Birmingham, Birmingham, United Kingdom; Cardiff University, Cardiff, United Kingdom; Department of Urology, The Christie NHS Foundation Trust, Manchester, United Kingdom; The Royal Hallamshire Hospital, Sheffield, United Kingdom; The Institute for Cancer Research and Royal Marsden Hospital, Sutton, United Kingdom; Institute of Cancer Research/Royal Marsden Hospital, Sutton, United Kingdom; Prostate Cancer Support
| | - Noel W Clarke
- MRC Clinical Trials Unit, London, United Kingdom; School of Cancer Sciences, University of Birmingham, Birmingham, United Kingdom; Cardiff University, Cardiff, United Kingdom; Department of Urology, The Christie NHS Foundation Trust, Manchester, United Kingdom; The Royal Hallamshire Hospital, Sheffield, United Kingdom; The Institute for Cancer Research and Royal Marsden Hospital, Sutton, United Kingdom; Institute of Cancer Research/Royal Marsden Hospital, Sutton, United Kingdom; Prostate Cancer Support
| | - Claire Amos
- MRC Clinical Trials Unit, London, United Kingdom; School of Cancer Sciences, University of Birmingham, Birmingham, United Kingdom; Cardiff University, Cardiff, United Kingdom; Department of Urology, The Christie NHS Foundation Trust, Manchester, United Kingdom; The Royal Hallamshire Hospital, Sheffield, United Kingdom; The Institute for Cancer Research and Royal Marsden Hospital, Sutton, United Kingdom; Institute of Cancer Research/Royal Marsden Hospital, Sutton, United Kingdom; Prostate Cancer Support
| | - John Anderson
- MRC Clinical Trials Unit, London, United Kingdom; School of Cancer Sciences, University of Birmingham, Birmingham, United Kingdom; Cardiff University, Cardiff, United Kingdom; Department of Urology, The Christie NHS Foundation Trust, Manchester, United Kingdom; The Royal Hallamshire Hospital, Sheffield, United Kingdom; The Institute for Cancer Research and Royal Marsden Hospital, Sutton, United Kingdom; Institute of Cancer Research/Royal Marsden Hospital, Sutton, United Kingdom; Prostate Cancer Support
| | - Johann Sebastian De Bono
- MRC Clinical Trials Unit, London, United Kingdom; School of Cancer Sciences, University of Birmingham, Birmingham, United Kingdom; Cardiff University, Cardiff, United Kingdom; Department of Urology, The Christie NHS Foundation Trust, Manchester, United Kingdom; The Royal Hallamshire Hospital, Sheffield, United Kingdom; The Institute for Cancer Research and Royal Marsden Hospital, Sutton, United Kingdom; Institute of Cancer Research/Royal Marsden Hospital, Sutton, United Kingdom; Prostate Cancer Support
| | - David Paul Dearnaley
- MRC Clinical Trials Unit, London, United Kingdom; School of Cancer Sciences, University of Birmingham, Birmingham, United Kingdom; Cardiff University, Cardiff, United Kingdom; Department of Urology, The Christie NHS Foundation Trust, Manchester, United Kingdom; The Royal Hallamshire Hospital, Sheffield, United Kingdom; The Institute for Cancer Research and Royal Marsden Hospital, Sutton, United Kingdom; Institute of Cancer Research/Royal Marsden Hospital, Sutton, United Kingdom; Prostate Cancer Support
| | - John Dwyer
- MRC Clinical Trials Unit, London, United Kingdom; School of Cancer Sciences, University of Birmingham, Birmingham, United Kingdom; Cardiff University, Cardiff, United Kingdom; Department of Urology, The Christie NHS Foundation Trust, Manchester, United Kingdom; The Royal Hallamshire Hospital, Sheffield, United Kingdom; The Institute for Cancer Research and Royal Marsden Hospital, Sutton, United Kingdom; Institute of Cancer Research/Royal Marsden Hospital, Sutton, United Kingdom; Prostate Cancer Support
| | - Gordana Jovic
- MRC Clinical Trials Unit, London, United Kingdom; School of Cancer Sciences, University of Birmingham, Birmingham, United Kingdom; Cardiff University, Cardiff, United Kingdom; Department of Urology, The Christie NHS Foundation Trust, Manchester, United Kingdom; The Royal Hallamshire Hospital, Sheffield, United Kingdom; The Institute for Cancer Research and Royal Marsden Hospital, Sutton, United Kingdom; Institute of Cancer Research/Royal Marsden Hospital, Sutton, United Kingdom; Prostate Cancer Support
| | - Alastair SW Ritchie
- MRC Clinical Trials Unit, London, United Kingdom; School of Cancer Sciences, University of Birmingham, Birmingham, United Kingdom; Cardiff University, Cardiff, United Kingdom; Department of Urology, The Christie NHS Foundation Trust, Manchester, United Kingdom; The Royal Hallamshire Hospital, Sheffield, United Kingdom; The Institute for Cancer Research and Royal Marsden Hospital, Sutton, United Kingdom; Institute of Cancer Research/Royal Marsden Hospital, Sutton, United Kingdom; Prostate Cancer Support
| | - J. Martin Russell
- MRC Clinical Trials Unit, London, United Kingdom; School of Cancer Sciences, University of Birmingham, Birmingham, United Kingdom; Cardiff University, Cardiff, United Kingdom; Department of Urology, The Christie NHS Foundation Trust, Manchester, United Kingdom; The Royal Hallamshire Hospital, Sheffield, United Kingdom; The Institute for Cancer Research and Royal Marsden Hospital, Sutton, United Kingdom; Institute of Cancer Research/Royal Marsden Hospital, Sutton, United Kingdom; Prostate Cancer Support
| | - Karen Sanders
- MRC Clinical Trials Unit, London, United Kingdom; School of Cancer Sciences, University of Birmingham, Birmingham, United Kingdom; Cardiff University, Cardiff, United Kingdom; Department of Urology, The Christie NHS Foundation Trust, Manchester, United Kingdom; The Royal Hallamshire Hospital, Sheffield, United Kingdom; The Institute for Cancer Research and Royal Marsden Hospital, Sutton, United Kingdom; Institute of Cancer Research/Royal Marsden Hospital, Sutton, United Kingdom; Prostate Cancer Support
| | - George Thalmann
- MRC Clinical Trials Unit, London, United Kingdom; School of Cancer Sciences, University of Birmingham, Birmingham, United Kingdom; Cardiff University, Cardiff, United Kingdom; Department of Urology, The Christie NHS Foundation Trust, Manchester, United Kingdom; The Royal Hallamshire Hospital, Sheffield, United Kingdom; The Institute for Cancer Research and Royal Marsden Hospital, Sutton, United Kingdom; Institute of Cancer Research/Royal Marsden Hospital, Sutton, United Kingdom; Prostate Cancer Support
| | - Mahesh Parmar
- MRC Clinical Trials Unit, London, United Kingdom; School of Cancer Sciences, University of Birmingham, Birmingham, United Kingdom; Cardiff University, Cardiff, United Kingdom; Department of Urology, The Christie NHS Foundation Trust, Manchester, United Kingdom; The Royal Hallamshire Hospital, Sheffield, United Kingdom; The Institute for Cancer Research and Royal Marsden Hospital, Sutton, United Kingdom; Institute of Cancer Research/Royal Marsden Hospital, Sutton, United Kingdom; Prostate Cancer Support
| | | |
Collapse
|
38
|
Rezac L, Kutepov AA, Feofilov AG, Russell JM. On limb radiance calculations and convergence of relaxation type retrieval algorithms. Appl Opt 2011; 50:5499-5502. [PMID: 22016217 DOI: 10.1364/ao.50.005499] [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] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Several approaches to the solution of the radiative transfer equation assume either Curtis-Godson average or linear change of the source function across grid segments. When such solutions are used for calculating limb radiances, the peak radiance response to the source function perturbation at tangent point i is displaced down to the tangent point i+1. This effect is explained through a geometric argument. Temperature profile retrievals performed by applying the ratio of signals at level i+1 for correcting temperature at level i demonstrate dramatic convergence acceleration of the iterative relaxation scheme.
Collapse
Affiliation(s)
- L Rezac
- Center for Atmospheric Sciences, Hampton University, Hampton, Virginia 23668, USA.
| | | | | | | |
Collapse
|
39
|
Cowan CC, Hutchison C, Cole T, Barry SJE, Paul J, Reed NS, Russell JM. A randomised double-blind placebo-controlled trial to determine the effect of cranberry juice on decreasing the incidence of urinary symptoms and urinary tract infections in patients undergoing radiotherapy for cancer of the bladder or cervix. Clin Oncol (R Coll Radiol) 2011; 24:e31-8. [PMID: 21703829 DOI: 10.1016/j.clon.2011.05.009] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2010] [Revised: 03/21/2011] [Accepted: 05/12/2011] [Indexed: 11/28/2022]
Abstract
AIMS Radical pelvic radiotherapy is one of the main treatment modalities for cancers of the bladder and cervix. The side-effects of pelvic radiotherapy include urinary symptoms, such as urinary frequency and cystitis. The therapeutic effects of cranberry juice in the prevention and treatment of urinary tract infections in general are well documented. The purpose of this study was to evaluate the effectiveness of cranberry juice on the incidence of urinary tract infections and urinary symptoms in patients undergoing pelvic radiotherapy for cancer of the bladder or cervix. MATERIALS AND METHODS The study was a placebo-controlled, double-blind design. Participants were randomised to receive cranberry juice, twice a day (morning and night) for the duration of their radiotherapy treatment and for 2 weeks after treatment (6 weeks in total) or a placebo beverage, for the same duration. RESULTS The incidence of increased urinary symptoms or urinary tract infections was 82.5% on cranberry and 89.3% on placebo (P=0.240, adjusted odds ratio [cranberry/placebo] 0.48, 95% confidence interval 0.14-1.63). CONCLUSIONS The power of the study to detect differences was limited by the below target sample size and poor compliance. Further research is recommended, taking cognisance of the factors contributing to the limitations of this study.
Collapse
Affiliation(s)
- C C Cowan
- Beatson West of Scotland Cancer Centre, Glasgow, UK.
| | | | | | | | | | | | | |
Collapse
|
40
|
Paterson C, Correa PD, Russell JM. Ductal variant of adenocarcinoma prostate responding to docetaxel--a case report. Clin Oncol (R Coll Radiol) 2010; 22:617. [PMID: 20542674 DOI: 10.1016/j.clon.2010.05.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2010] [Accepted: 05/11/2010] [Indexed: 11/16/2022]
|
41
|
Smith RN, Elcock C, Abdellatif A, Bäckman B, Russell JM, Brook AH. Enamel defects in extracted and exfoliated teeth from patients with Amelogenesis Imperfecta, measured using the extended enamel defects index and image analysis. Arch Oral Biol 2009; 54 Suppl 1:S86-92. [PMID: 18768169 PMCID: PMC2981871 DOI: 10.1016/j.archoralbio.2008.07.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2008] [Revised: 07/21/2008] [Accepted: 07/21/2008] [Indexed: 11/15/2022]
Abstract
AIMS To enhance the phenotypic description and quantification of enamel defects from a North Sweden sample of extracted and exfoliated teeth originating from families with Amelogenesis Imperfecta by use of the extended enamel defects index (EDI) and image analysis to demonstrate the comparable reliability and value of the additional measurements. METHODS AND RESULTS The sample comprised 109 deciduous and 7 permanent teeth from 32 individuals of 19 families with Amelogenesis Imperfecta in Northern Sweden. A special holder for individual teeth was designed and the whole sample was examined using the extended EDI and an image analysis system. In addition to the extended EDI definitions, the calibrated images were measured for tooth surface area, defect area and percentage of surface affected using image analysis techniques. The extended EDI was assessed using weighted and unweighted Kappa statistics. The reliability of imaging and measurement was determined using Fleiss' intra-class correlation coefficient (ICCC). Kappa values indicated good or excellent intra-operator repeatability and inter-operator reproducibility for the extended EDI. The Fleiss ICCC values indicated excellent repeatability for the image analysis measurements. Hypoplastic pits on the occlusal surfaces were the most frequent defect in this sample (82.6%). The occlusal surface displayed the most post-eruptive breakdown (39.13%) whilst the incisal portion of the buccal surfaces showed most diffuse opacities (53.4%). Image analysis methods demonstrated the largest mean hypoplastic pit areas were on the lingual surfaces. The largest mean post-eruptive breakdown areas were on the lingual surfaces of posterior teeth. The largest mean demarcated opacity areas were found on the labial surfaces. CONCLUSIONS The extended EDI and the standardised image acquisition and analysis system provided additional information to conventional measurement techniques. Additional phenotypic variables were described.
Collapse
Affiliation(s)
- R N Smith
- International Collaborating Centre in Oro-facial Genetics and Development, University of Liverpool, Liverpool L69 3GN, UK.
| | | | | | | | | | | |
Collapse
|
42
|
Brook AH, Elcock C, Aggarwal M, Lath DL, Russell JM, Patel PI, Smith RN. Tooth dimensions in hypodontia with a known PAX9 mutation. Arch Oral Biol 2009; 54 Suppl 1:S57-62. [PMID: 18653171 DOI: 10.1016/j.archoralbio.2008.05.017] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2008] [Revised: 05/08/2008] [Accepted: 05/15/2008] [Indexed: 11/18/2022]
Affiliation(s)
- A H Brook
- International Collaborating Centre in Oro-facial Genetics and Development, University of Liverpool, School of Dental Sciences, Edwards Building, Daulby Street, Pembroke Place, Merseyside, Liverpool L69 3GN, UK
| | | | | | | | | | | | | |
Collapse
|
43
|
Nicolini H, Bakish D, Duenas H, Spann M, Erickson J, Hallberg C, Ball S, Sagman D, Russell JM. Improvement of psychic and somatic symptoms in adult patients with generalized anxiety disorder: examination from a duloxetine, venlafaxine extended-release and placebo-controlled trial. Psychol Med 2009; 39:267-276. [PMID: 18485261 DOI: 10.1017/s0033291708003401] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [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: 11/07/2022]
Abstract
BACKGROUND This study examined the efficacy and tolerability of duloxetine and venlafaxine extended-release (XR) treatment for generalized anxiety disorder (GAD), with a secondary focus on psychic and somatic symptoms within GAD. METHOD The design was a 10-week, multi-center, double-blind placebo-controlled study of duloxetine (20 mg or 60-120 mg once daily) and venlafaxine XR (75-225 mg once daily) treatment. Efficacy was measured using the Hamilton Anxiety Rating Scale (HAMA), which includes psychic and somatic factor scores. Tolerability was measured by occurrence of treatment-emergent adverse events (TEAEs) and discontinuation rates. RESULTS Adult out-patients (mean age 42.8 years; 57.1% women) with DSM-IV-defined GAD were randomly assigned to placebo (n=170), duloxetine 20 mg (n=84), duloxetine 60-120 mg (n=158) or venlafaxine XR 75-225 mg (n=169) treatment. Each of the three active treatment groups had significantly greater improvements on HAMA total score from baseline to endpoint compared with placebo (p=0.01-0.001). For the HAMA psychic factor score, both duloxetine treatment arms and venlafaxine XR demonstrated significantly greater improvement compared with placebo (p=0.01-0.001). For the HAMA somatic factor score, the mean improvement in the duloxetine 60-120 mg and venlafaxine XR groups was significantly greater than placebo (p0.05 and p0.01 respectively), whose mean improvement did not differ from the duloxetine 20 mg group (p=0.07). Groups did not differ in study discontinuation rate due to adverse events. CONCLUSIONS Duloxetine and venlafaxine treatment were each efficacious for improvement of core psychic anxiety symptoms and associated somatic symptoms for adults with GAD.
Collapse
Affiliation(s)
- H Nicolini
- Grupo Medico Carracci, Mexico City, Mexico
| | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Allgulander C, Nutt D, Detke M, Erickson J, Spann M, Walker D, Ball SG, Russell JM. A non-inferiority comparison of duloxetine and venlafaxine in the treatment of adult patients with generalized anxiety disorder. J Psychopharmacol 2008; 22:417-25. [PMID: 18635722 DOI: 10.1177/0269881108091588] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [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] [Indexed: 11/17/2022]
Abstract
The present study is a non-inferiority comparison of duloxetine 60-120 mg/day and venlafaxine extended-release (XR) 75-225 mg/day for the treatment of adults with generalized anxiety disorder (GAD). The non-inferiority test was a prespecified plan to pool data from two nearly identical 10-week, multicentre, randomized, placebo-controlled, double-blind studies of duloxetine 60-120 mg/day and venlafaxine 75-225 mg/ day for the treatment of GAD. An independent expert consensus panel provided six statistical and clinical criteria for determining non-inferiority between treatments. Response was defined as > or =50% reduction in Hamilton Anxiety Rating Scale (HAMA) total score. In the pooled sample, patients were randomly assigned to duloxetine (n = 320), venlafaxine XR (n = 333) or placebo (n = 331). For the non-inferiority analysis, the per-protocol patients who were treated with duloxetine (n = 239) or venlafaxine XR (n = 262) improved significantly more (mean HAMA reductions were -15.4 and -15.2, respectively) than placebo-treated patients (n = 267; -11.6, P < or = 0.001, both comparisons). Response rates were 56%, 58% and 40%, respectively. Discontinuation rate because of AEs was significantly higher for duloxetine (13.4%, P < or = 0.001) and venlafaxine XR (11.4%, P < or = 0.01) groups compared with placebo (5.4%). Duloxetine 60-120 mg/day met all statistical and clinical criteria for non-inferiority and exhibited a similar tolerability profile compared with venlafaxine XR 75-225 mg/day for the treatment of adults with GAD.
Collapse
Affiliation(s)
- C Allgulander
- Department of Clinical Neuroscience, Section of Psychiatry, Karolinska Institutet, Stockholm, Sweden.
| | | | | | | | | | | | | | | |
Collapse
|
45
|
Dearnaley DP, Sydes MR, Graham JD, Aird EG, Bottomley D, Cowan RA, Huddart RA, Jose CC, Matthews JH, Millar J, Moore AR, Morgan RC, Russell JM, Scrase CD, Stephens RJ, Syndikus I, Parmar MKB. Escalated-dose versus standard-dose conformal radiotherapy in prostate cancer: first results from the MRC RT01 randomised controlled trial. Lancet Oncol 2007; 8:475-87. [PMID: 17482880 DOI: 10.1016/s1470-2045(07)70143-2] [Citation(s) in RCA: 750] [Impact Index Per Article: 44.1] [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] [Indexed: 11/29/2022]
Abstract
BACKGROUND In men with localised prostate cancer, conformal radiotherapy (CFRT) could deliver higher doses of radiation than does standard-dose conventional radical external-beam radiotherapy, and could improve long-term efficacy, potentially at the cost of increased toxicity. We aimed to present the first analyses of effectiveness from the MRC RT01 randomised controlled trial. METHODS The MRC RT01 trial included 843 men with localised prostate cancer who were randomly assigned to standard-dose CFRT or escalated-dose CFRT, both administered with neoadjuvant androgen suppression. Primary endpoints were biochemical-progression-free survival (bPFS), freedom from local progression, metastases-free survival, overall survival, and late toxicity scores. The toxicity scores were measured with questionnaires for physicians and patients that included the Radiation Therapy Oncology Group (RTOG), the Late Effects on Normal Tissue: Subjective/Objective/Management (LENT/SOM) scales, and the University of California, Los Angeles Prostate Cancer Index (UCLA PCI) scales. Analysis was done by intention to treat. This trial is registered at the Current Controlled Trials website http://www.controlled-trials.com/ISRCTN47772397. FINDINGS Between January, 1998, and December, 2002, 843 men were randomly assigned to escalated-dose CFRT (n=422) or standard-dose CFRT (n=421). In the escalated group, the hazard ratio (HR) for bPFS was 0.67 (95% CI 0.53-0.85, p=0.0007). We noted 71% bPFS (108 cumulative events) and 60% bPFS (149 cumulative events) by 5 years in the escalated and standard groups, respectively. HR for clinical progression-free survival was 0.69 (0.47-1.02; p=0.064); local control was 0.65 (0.36-1.18; p=0.16); freedom from salvage androgen suppression was 0.78 (0.57-1.07; p=0.12); and metastases-free survival was 0.74 (0.47-1.18; p=0.21). HR for late bowel toxicity in the escalated group was 1.47 (1.12-1.92) according to the RTOG (grade >/=2) scale; 1.44 (1.16-1.80) according to the LENT/SOM (grade >/=2) scales; and 1.28 (1.03-1.60) according to the UCLA PCI (score >/=30) scale. 33% of the escalated and 24% of the standard group reported late bowel toxicity within 5 years of starting treatment. HR for late bladder toxicity according to the RTOG (grade >/=2) scale was 1.36 (0.90-2.06), but this finding was not supported by the LENT/SOM (grade >/=2) scales (HR 1.07 [0.90-1.29]), nor the UCLA PCI (score >/=30) scale (HR 1.05 [0.81-1.36]). INTERPRETATION Escalated-dose CFRT with neoadjuvant androgen suppression seems clinically worthwhile in terms of bPFS, progression-free survival, and decreased use of salvage androgen suppression. This additional efficacy is offset by an increased incidence of longer term adverse events.
Collapse
Affiliation(s)
- David P Dearnaley
- Institute of Cancer Research and Royal Marsden Hospitals, Sutton and London, UK.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Pamenter B, De Bono JS, Brown IL, Nandini M, Kaye SB, Russell JM, Yates AJ, Kirk D. Bilateral testicular cancer: a preventable problem? Experience from a large cancer centre. BJU Int 2003; 92:43-6. [PMID: 12823381 DOI: 10.1046/j.1464-410x.2003.04285.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.5] [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: 11/20/2022]
Abstract
OBJECTIVE To report a retrospective review of patients with a testicular germ cell tumour treated in a large cancer centre who developed a second tumour, as 1.8-5% of such patients will subsequently develop a new primary tumour in the contralateral testis. PATIENTS AND METHODS From a database of 570 men treated for testicular cancer in the West of Scotland between 1989 and 1998, all those who developed bilateral testicular tumours were identified. RESULTS Nineteen men (3.3%) developed a second primary testicular malignancy; the mean age at diagnosis of the first tumour was 29.5 years, with the mean (range) interval to diagnosis of the second tumour of 76 (11-181) months (except for one man with synchronous tumours). The first tumour was teratoma in 11 and seminoma in seven; one patient had synchronous bilateral teratoma. The second primary was teratoma in 10 and seminoma in eight. Known risk factors for carcinoma in situ were present in nine patients, i.e. a small atrophic contralateral testis in five, a family history of testicular cancer in two, a history of infertility in two and unilateral undescended testis in one. Two patients had had contralateral testicular biopsies at the first diagnosis; both were negative for intratubular germ cell neoplasia (IGCN). Eight patients had chemotherapy to treat the first tumour and 14 for the second. All underwent bilateral orchidectomy. Overall, 18 of 19 men are alive and disease-free, with a median follow-up of 51 months. Pathology for 12 of the second testicular tumours was available for review; there was no IGCN in any of the slides from three patients, it was only present focally around the tumour in seven, and was diffuse in two patients. CONCLUSIONS Chemotherapy for the first testicular tumour does not eliminate the risk of developing a contralateral tumour. Despite careful follow-up, in most patients the second primary tumour was not diagnosed early enough to avoid chemotherapy. The focal nature of IGCN in the second testis in most patients questions the value of biopsy of the contralateral testis. Improved methods of detecting patients at risk of second testicular tumours are needed.
Collapse
Affiliation(s)
- B Pamenter
- The University Department of Urology, Western Infirmary, Gartnavel General, and Stobhill Hospitals, Glasgow, UK.
| | | | | | | | | | | | | | | |
Collapse
|
47
|
Abstract
Atypical antipsychotic medications are associated with different adverse effects and efficacy profiles compared with conventional antipsychotics (i.e. less extrapyramidal symptoms, improved-efficacy against negative symptoms and cognitive deficits, and most often a greater ability to improve patients' quality of life). However, the atypical antipsychotics may be associated with clinically significant bodyweight gain, increasing the risk of medical comorbidity, including diabetes mellitus, hypertension, cardiovascular disease and hyperlipidaemia. This literature review assesses the various bodyweight gain liabilities associated with atypical antipsychotics, as well as the effects of bodyweight gain on quality of life. The issue of prevention and management of this often neglected adverse effect is also examined. Most studies reviewed indicate that clozapine and olanzapine are associated with more bodyweight gain than the other atypical antipsychotics. There are potential factors that place certain patients at greater risk for bodyweight gain, including low pretreatment body mass index, young age and being of female gender. Furthermore, bodyweight gain associated with the use of atypical antipsychotics has been reported to be associated with clinical improvement, although this has not been substantiated widely. It is unclear whether increased medical comorbidity, including diabetes mellitus, coronary artery disease and/or elevated triglyceride levels, is secondary to the bodyweight gain associated with atypical antipsychotics, or the result of the agents themselves. A patient's quality of life may be greatly affected by excessive bodyweight gain; either by increased comorbid medical illness, an increased relapse rate associated with noncompliance, or the social stigma associated with being obese. However, most studies reveal that treatment with atypical antipsychotic medications is associated with improved quality of life compared with that achieved with conventional antipsychotic medications. Because bodyweight is an important health risk associated with atypical antipsychotics, prevention and effective management of bodyweight are paramount in preventing comorbid medical illness, relapse and possible noncompliance.
Collapse
Affiliation(s)
- J M Russell
- Department of Psychiatry, University of Texas Medical Branch, Galveston 77550, USA
| | | |
Collapse
|
48
|
Krieglstein CF, Cerwinka WH, Laroux FS, Salter JW, Russell JM, Schuermann G, Grisham MB, Ross CR, Granger DN. Regulation of murine intestinal inflammation by reactive metabolites of oxygen and nitrogen: divergent roles of superoxide and nitric oxide. J Exp Med 2001; 194:1207-18. [PMID: 11696587 PMCID: PMC2195977 DOI: 10.1084/jem.194.9.1207] [Citation(s) in RCA: 195] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Several reports have implicated reactive oxygen and nitrogen metabolites (RONS) in the initiation and/or progression of inflammatory bowel diseases (IBDs). We have investigated the role of three key RONS-metabolizing enzymes (inducible nitric oxide synthase [iNOS], superoxide dismutase [SOD], nicotinamide adenine dinucleotide phosphate [NADPH] oxidase) in a murine model of IBD. Mice genetically deficient ((-/-)) in either iNOS or the p47phox subunit of NADPH oxidase, transgenic (Tg) mice that overexpress SOD, and their respective wild-type (WT) littermates were fed dextran sulfate sodium (DSS) in drinking water for 7 days to induce colitis. In addition, the specific iNOS inhibitor 1400W was used in DSS-treated WT and p47phox(-/-) mice. WT mice responded to DSS feeding with progressive weight loss, bloody stools, elevated serum NO(X) and colonic mucosal injury with neutrophil infiltration. Both the onset and severity of colitis were significantly attenuated in iNOS(-/-) and 1400W-treated WT mice. While the responses to DSS did not differ between WT and p47phox(-/-) mice, enhanced protection was noted in 1400W-treated p47phox(-/-) mice. Interestingly, SOD(Tg) mice exhibited more severe colitis than their WT littermates. These findings reveal divergent roles for superoxide and iNOS-derived NO in intestinal inflammation.
Collapse
Affiliation(s)
- C F Krieglstein
- Department of Molecular and Cellular Physiology, Louisiana State University Health Sciences Center, Shreveport, LA 71130, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Russell DB, Tabrizi SN, Russell JM, Garland SM. Seroprevalence of herpes simplex virus types 1 and 2 in HIV-infected and uninfected homosexual men in a primary care setting. J Clin Virol 2001; 22:305-13. [PMID: 11564596 DOI: 10.1016/s1386-6532(01)00203-7] [Citation(s) in RCA: 48] [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] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Genital herpes is usually caused by herpes simplex virus type 2 (HSV-2), with infections often being unrecognised by patients and/or clinicians. HSV-2 infections may be a risk factor for the transmission of human immunodeficiency virus (HIV) infection. Reliable tests for type-specific HSV antibodies are now readily available. OBJECTIVES To determine the seroprevalence of HSV-1 and -2 in HIV-seronegative gay men in a primary care setting in Melbourne, Australia, and to compare it with the rate in HIV-infected gay men. To assess the utility in a clinical setting of a type-specific HSV enzyme linked immunosorbent assay (ELISA) as compared with western blot. STUDY DESIGN We recruited a total of 300 HIV-seronegative homosexual men attending for HIV antibody testing, and HIV-infected men attending for CD4 lymphocyte count and viral load estimation. The subjects completed a questionnaire, and sera were sent for total IgG HSV testing and testing by Gull type-specific HSV ELISA assay. Selected serum samples were retested by western blotting and the results analysed. RESULTS In total, 168 HIV-antibody negative men and 132 HIV-antibody positive men were recruited. Of all subjects, 73.3% had HSV-1 antibodies. This proportion did not differ between HIV-seronegative and seropositive men (P=0.48). About twenty percent of HIV-seronegative men and 61% of HIV-seropositive men had antibodies to HSV-2 (P<0.0001); 75.6% of HIV-seronegative men with antibodies to HSV-2 gave no history of genital herpes, as did 66.7% of HIV-seropositive men. Overall, in using the type-specific ELISA (Gull) assay, false negative, false positive or equivocal results were obtained in 33/300 (11%) of samples tested compared with western blot. CONCLUSIONS High rates of HSV-2 infection were found in homosexual males, with the rate for HIV-seropositive men being over twice that for HIV uninfected men. Most subjects were not aware of their infection with HSV-2. HIV-infected individuals were also older and had higher numbers of sexual partners, but we were unable to unambiguously establish that these variables contributed to the difference in HSV-2 seroprevalence rates. The Gull type-specific assay for HSV antibodies has significant problems with sensitivity and specificity at a discrepancy rate of 11%. Caution is advised in using this type-specific commercial assay for clinical purposes.
Collapse
Affiliation(s)
- D B Russell
- Prahran Market Clinic, 131 Commercial Road, South Yarra, Vic. 3141, Australia.
| | | | | | | |
Collapse
|
50
|
Abstract
Acrocephalopolysyndactyly Type II (Carpenter Syndrome) is determined by autosomal recessive inheritance. Only some 40 cases have been described. Variable clinical signs have been described including prolonged retention of primary teeth and hypodontia. This paper describes the oral and dental findings in a family containing two affected brothers. The family pedigree is informative, as the mother has had children by three partners. The two affected individuals are full brothers. The first affected brother has delayed dental development, severe hypodontia and small tooth crown size. Mesio-distal and bucco-lingual dimensions were measured on the study models and compared with population data. The younger brother also has delayed dental development but only mild hypodontia. Their half sister has severe hypodontia but no signs of Carpenter Syndrome. This family study demonstrates two affected individuals with typical clinical features and a pedigree compatible with autosomal recessive inheritance. Small tooth crown size has been shown by standardized measurement and evidence advanced that hypodontia is not part of the syndrome but a coincidental finding which segregates independently. We have also shown that the marked delay in emergence of teeth is associated more with problems of tooth eruption, possibly related to the bony abnormalities, than to a generalized delay in dental development.
Collapse
|