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Fennell DA, Casbard AC, Porter C, Rudd R, Lester JF, Nicolson M, Morgan B, Steele JP, Darlison L, Gardner GM, Nixon LS, Kitson T, White A, Griffiths GO, Poile C, Gaba A, Busacca S, Richards CJ. A randomized phase II trial of oral vinorelbine as second-line therapy for patients with malignant pleural mesothelioma. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.8507] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
8507 Background: All patients with malignant pleural mesothelioma (MPM) eventually relapse following standard chemotherapy. However, there is no standard treatment option in this setting. Vinorelbine, exhibits useful clinical activity but has not been formally evaluated in a randomised clinical trial, despite its widespread off-label use worldwide. BRCA1 regulates spindle assembly checkpoint in MPM and predicts vinorelbine sensitivity in preclinical models [1,2], suggesting that BRCA1 negative patients may be chemoresistant. Methods: VIM, a Cancer Research UK funded, investigator-initiated randomised controlled phase 2 multi-centre UK trial, enrolled patients with MPM who had progressed after first-line chemotherapy. Pts were randomised 2:1 to either vinorelbine (60mg/m2 weekly Q21d escalating to 80mg/m2 from cycle 2) + active supportive care (ASC) versus ASC until disease progression, unacceptable toxicity or withdrawal of consent. The primary outcome was progression free survival (PFS) defined as the time from randomisation to any progression (based on Modified RECIST criteria for assessment of response in malignant pleural mesothelioma) or death. The trial had 90% power to detect a hazard ratio of 0.65 at the one-sided 20% significance level. Secondary endpoints were overall survival (OS), tolerability and safety. Results: Between May 2016 and Oct 2018, 154 patients were recruited from 10 UK sites and randomised to vinorelbine + ASC (n=98) or ASC alone (n=56). In the Intention-to-treat analysis, after 129 events, median PFS was 4.2 months (m) for vinorelbine + ASC compared to 2.8m for ASC alone (Hazard Ratio (HR) 0.59; 95% CI: 0.41 to 0.85; one-sided p = 0.0017). 108 deaths were reported. Median OS was 9.3m for vinorelbine + ASC compared to 9.1m for ASC alone (HR=0.79; 95% CI: 0.53 to 1.17; two-sided p = 0.24). Toxicity data and subgroup analyses including the impact of BRCA1 deficiency will be presented. Conclusion: The trial met its primary endpoint. Vinorelbine demonstrates useful clinical efficacy in relapsed MPM, supporting its off-label use, as a treatment option for patients with relapsed MPM.[1] Busacca et al, J Pathol 2012, 227(2), 200. [2] Busacca et al, Mol Cancer Res, 2021, 20(2) 379. Clinical trial information: NCT02139904.
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Affiliation(s)
- Dean Anthony Fennell
- University of Leicester and University Hospitals of Leicester, Leicester, United Kingdom
| | | | | | - Robin Rudd
- Department of Oncology, St Bartholomew's Hospital, London, United Kingdom
| | | | | | - Bruno Morgan
- University of Leicester, Leicester, United Kingdom
| | | | - Liz Darlison
- University of Leicester, Leicester, United Kingdom
| | | | | | | | - Ann White
- Cardiff University, Cardiff, United Kingdom
| | - Gareth Owen Griffiths
- Southampton Clinical Trials Unit, University of Southampton, Southampton, United Kingdom
| | | | - Aarti Gaba
- University of Leicester, Leicester, United Kingdom
| | - Sara Busacca
- University of Leicester, Leicester, United Kingdom
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2
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Fennell DA, Lester JF, Danson S, Blackhall FH, Nicolson M, Nixon LS, Porter C, Gardner GM, White A, Griffiths GO, Casbard AC. A randomized phase II trial of olaparib maintenance versus placebo monotherapy in patients with chemosensitive advanced non-small cell lung cancer. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e21649] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e21649 Background: Impaired DNA damage response (DDR) is a common feature of cancer, however therapeutic exploitation has been limited to cancers harbouring somatic inactivation of BRCA1/2 which causes homologous recombination deficiency (HRD). We hypothesized that patients (pts) with metastatic non-small cell lung cancer responding to platinum doublet based chemotherapy, might enrich for impaired DDR encompassing HRD, rendering these tumours more sensitive to inhibition of poly-ADP ribose polymerase (PARP) inhibition by olaparib. Methods: PIN was a multicentre double-blind placebo controlled randomised phase II screening trial (alpha and beta = 0.2). Chemonaive pts had advanced (stage IIB/IV) squamous (Sq) or non-sq (NS) NSCLC, ECOG performance status 0-1, no EGFR nor ALK mutation. Prior immunotherapy with a PD1/ PDL1 inhibitor was allowed. If tumour shrinkage was observed after 3 cycles of platinum chemotherapy, pts were randomised 1:1 to olaparib (O, 300mg po bd q21) or placebo (P), which was continued until disease progression or withdrawal. Primary end point was progression free survival (PFS), with a one-sided test for significance. Secondary endpoints were overall survival (OS), response (RECIST v1.1) and safety (CTCAE4.0). Results: 70 pts were randomised to O (32) or P (38) between Aug 2014 and Nov 2017. There was no difference in median dose intensity (% (IQR), O vs P) was 86.4 (64.3-95.7) vs 93.3 (80.2-97.6). Pts receiving O had a longer, but not statistically significant median PFS (weeks (IQR) was O 16.6 (7.1-21.7) vs P 12 (5.6-18.7)); and hazard ratio (HR) was 0.83 (80% CI 0.6-1.15, p = 0.23), using intention to treat (ITT) unadjusted analysis. However, the ITT Cox model, adjusted for smoking history and histology, showed a significantly longer PFS for pts receiving O (HR 0.73 (80% CI 0.52-1.02, p = 0.11)). Pts receiving O also had greater, but not statistically significant OS: median (weeks (IQR) was O 59.4 (38.7-67.9) vs P 31.3 (22.4-58.6)). OS HR was 0.68 (95% CI 0.37-1.26; two-sided p = 0.22). 3 patients were completely withdrawn prior to progression. No complete responses were observed and treatment was well tolerated. Conclusions: Design parameters justifying a Phase III trial (p < 0.2) were met in the adjusted, but not unadjusted PFS analysis, with a trend towards longer PFS and OS in the O arm. We speculate that this signal may be driven by a DDR deficient molecular subgroup. Translational studies are warranted to investigate these possibilities. Clinical trial information: NCT01788332.
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Affiliation(s)
- Dean A. Fennell
- University of Leicester and University Hospitals of Leicester, Leicester, United Kingdom
| | | | - Sarah Danson
- Sheffield Experimental Cancer Medicine Centre, Weston Park Hospital, Sheffield, United Kingdom
| | - Fiona Helen Blackhall
- The University of Manchester, Institute of Cancer Sciences, Manchester, United Kingdom
| | | | | | | | | | - Ann White
- Cardiff University, Cardiff, United Kingdom
| | - Gareth Owen Griffiths
- Southampton Clinical Trials Unit, University of Southampton, Southampton, United Kingdom
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3
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Castellano D, Gedye C, Fornarini G, Fay AP, Voortman J, Mego M, Bamias A, Lester JF, Huddart RA, Matouskova M, Gurney H, Mellado B, Ong M, Carneiro F, Seseke F, Milesi L, Shariat SF, Fear S, de Ducla S, Sternberg CN. Atezolizumab (atezo) therapy for locally advanced/metastatic urinary tract carcinoma (mUTC) in patients (pts) with poor performance status (PS): Analysis of the prospective global SAUL study. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.5035] [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
5035 Background: Pts with PS > 1 have a poor prognosis and are often excluded from clinical trials. The single-arm SAUL study (NCT02928406) evaluated atezo in a ‘real-world’ population. Overall, safety and efficacy were consistent with prior trials. However, ECOG PS 2 pts had worse overall survival (OS) but fewer adverse events (AEs) than ECOG PS 0/1 pts [Sternberg, 2019], likely reflecting shorter treatment duration and warranting exploration. Methods: Pts with mUTC received atezo 1200 mg q3w until loss of clinical benefit or unacceptable toxicity. The primary endpoint was safety. Post hoc analyses compared baseline factors, AEs and efficacy in pts with ECOG PS 2 vs 0/1. In this analysis, AE incidences were restricted to the first 45 days of atezo to adjust for differing treatment exposure. Results: None of the baseline factors explored was significantly associated with worse OS or disease control rate (DCR) in ECOG PS 2 pts. However, pts with visceral metastases and ECOG PS 2 had particularly poor outcomes. Safety appeared similar between subgroups. Conclusions: ECOG PS 2 pts have a dismal prognosis. The higher proportion with poor prognostic factors despite similar age in ECOG PS 2 vs 0/1 pts may suggest that poor PS was related to disease rather than comorbidities. Risk/benefit should be considered especially carefully when treating pts with ECOG PS 2 due to high-burden/visceral disease. Clinical trial information: NCT02928406 . [Table: see text]
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Affiliation(s)
| | | | - Giuseppe Fornarini
- Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale per la Ricerca sul Cancro (IST), Genoa, Italy
| | - Andre P. Fay
- Hospital São Lucas da PUCRS/Grupo Oncoclínicas, Porto Alegre, Brazil
| | - Jens Voortman
- Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Michal Mego
- Narodny Onkologicky Ustav, Bratislava, Slovakia
| | - Aristotelis Bamias
- Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | | | | | - Howard Gurney
- Macquarie University Hospital, Sydney, NSW, Australia
| | - Begona Mellado
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic i Provincial, Barcelona, Spain
| | - Michael Ong
- The Ottawa Hospital Cancer Centre, Ottawa, ON, Canada
| | | | | | | | | | - Simon Fear
- F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | | | - Cora N. Sternberg
- San Camillo and Forlanini Hospitals, Rome, Italy and Englander Institute of Precision Medicine, Weill Cornell Medicine (current affiliation), New York, NY
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Hussain SA, Lester JF, Jackson R, Gornall M, Elliott A, Crabb SJ, Huddart RA, Vasudev N, Birtle AJ, Worlding J, James ND, Parikh O, Vilarino varela M, Alonzi R, Linch MD, Powles T, Jones RJ. Phase II randomized placebo-controlled neoadjuvant trial of nintedanib or placebo with gemcitabine and cisplatin in locally advanced muscle invasive bladder cancer (NEO-BLADE). J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.6_suppl.438] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
438 Background: Neo-adjuvant chemotherapy Improves overall survival in patients with MIBC. Nintedanib is an orally available, potent, small molecule, triple kinase inhibitor with the potential to further benefit patient prognosis. Methods: NEO-BLADE was designed as a randomised, placebo controlled phase II study (n=120) to compare the addition of nintedanib (N) (150mg/200mg BD) to a combination of Gemcitabine (G) and Cisplatin (C). The study was powered (80%, alpha=15% [one sided]) to detect an improvement in the histological complete response rate of 20% (OR = 2.37). Results: 120 patients were recruited from 15 sites between 04/Dec/2014 and 03/Sep/2018 (22% Female) with 109 patients evaluable. Complete response (CR) rates ( by ITT) were 22/57 (38.6%) and 25/63 (39.7%) for patients treated with/without N. Pathological CR on ITT was 21/57 (36.8%) and 20/63 (31.74%); For pathological evaluable patients it was 21/41 (51. 22% ) and 20/45 ( 44.44%) respectively. Patients treated with N showed a benefit in terms of PFS and OS with 12 month PFS rates of 89.0% and 74.1% in the Nintedanib and Placebo group respectively. P= 0.038 and HR (CI) 0.479 (0.236, 0.976). OS at 12/24 months N 96.26%/ 88.87% while in Placebo group 82.83%,/69.36%. P=0.022, HR (CI) 0.389 (0.168, 0.902). Toxicity was reported in terms of grade 3 adverse events [12/63 (19%) Placebo, 23/57 (40%) N] and Serious Adverse Events [35/63 (56%) Placebo, 34/57 (53%) N]. In terms of thromboembolic events, this was observed in 16/57 (28%) of patients treated with N and 13/63 (21%) without N (P=0.461). Conclusions: The study failed to reach its primary endpoint in demonstrating an improvement in pathological response rate between N and Placebo when given alongside G and C. The trial met its secondary end point in improvement of progression free survival and over all survival at 12 months and 24 months. Safety data from this placebo -controlled study confirms triplets can be given safely. There are efficacy signals with improvement in PFS and OS and the regimen warrants further investigation in randomised phase III trial. Translational studies to assess bio markers of response are planned. Clinical trial information: 11977.
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Affiliation(s)
- Syed A. Hussain
- University of Sheffield, Academic Unit of Oncology, Department of Oncology and Metabolism, Sheffield, United Kingdom
| | | | | | | | | | - Simon J. Crabb
- Southampton Clinical Trials Unit, University of Southampton, Southampton, United Kingdom
| | | | | | | | - Jane Worlding
- University Hospital Coventry, Coventry, United Kingdom
| | | | - Omi Parikh
- Royal Preston Hospital, Preston, United Kingdom
| | | | | | - Mark David Linch
- Department of Oncology, UCL Cancer Institute, London, United Kingdom
| | - Thomas Powles
- Barts Cancer Institute, Queen Mary University of London, Royal Free NHS Trust, London, United Kingdom
| | - Robert J. Jones
- University of Glasgow, Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
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5
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Lester JF, Courtier N, Eswar C, Mohammed N, Fenwick J, Griffiths G, Nixon LS. Initial results of the phase ib/II, I-START trial: Isotoxic accelerated radiotherapy for the treatment of stage II-IIIb NSCLC. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e20551] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | - Nazia Mohammed
- Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | | | - Gareth Griffiths
- Southampton Clinical Trials Unit, University of Southampton, Southampton, United Kingdom
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6
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Fennell DA, Kirkpatrick EV, Cozens K, Danson S, Hanna GG, Lester JF, Lord J, Nye M, Ottensmeier CH, Szlosarek PW, Steele NL, Barnes DT, Vadher KD, Maishman T, Hill SJ, Griffiths G. CONFIRM: A phase III randomized trial to evaluate the efficacy of nivolumab versus placebo in relapsed mesothelioma. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.tps8586] [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)
| | | | - Kelly Cozens
- Southampton Clinical Trials Unit University of Southampton, Southampton, United Kingdom
| | - Sarah Danson
- Sheffield Experimental Cancer Medicine Centre, Weston Park Hospital, Sheffield, United Kingdom
| | | | - Jason Francis Lester
- University Hospital of Wales, Heath Park, Cardiff/United Kingdom, Cardiff, United Kingdom
| | - Joanne Lord
- Wessex Institute Univerity of Southampton, Southampton, United Kingdom
| | - Mavis Nye
- Southampton Clinical Trials Unit, University of Southampton, Southampton, United Kingdom
| | | | | | | | - Daniel T Barnes
- University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Karan D Vadher
- Southampton Clinical Trials Unit,University of Southampton, Southampton, United Kingdom
| | - Tom Maishman
- Southampton Clinical Trials Unit University of Southampton, Southampton, United Kingdom
| | - Stephanie J Hill
- Southampton Clinical Trials Unit University of Southampton, Southampton, United Kingdom
| | - Gareth Griffiths
- Southampton Clinical Trials Unit, University of Southampton, Southampton, United Kingdom
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7
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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.
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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
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Sanganalmath P, Lester JE, Bradshaw AG, Das T, Esler C, Roy AEF, Toy E, Lester JF, Button M, Wilson P, Comins C, Atherton P, Pickles R, Foweraker K, Walker GA, Keni M, Hatton MQ. Continuous Hyperfractionated Accelerated Radiotherapy (CHART) for Non-small Cell Lung Cancer (NSCLC): 7 Years' Experience From Nine UK Centres. Clin Oncol (R Coll Radiol) 2018; 30:144-150. [PMID: 29336865 DOI: 10.1016/j.clon.2017.12.019] [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: 08/14/2017] [Revised: 08/27/2017] [Accepted: 11/06/2017] [Indexed: 01/15/2023]
Abstract
AIM Continuous hyperfractionated accelerated radiotherapy (CHART) remains an option to treat non-small cell lung cancer (NSCLC; NICE, 2011). We have previously published treatment outcomes from 1998-2003 across five UK centres. Here we update the UK CHART experience, reporting outcomes and toxicities for patients treated between 2003 and 2009. MATERIALS AND METHODS UK CHART centres were invited to participate in a retrospective data analysis of NSCLC patients treated with CHART from 2003 to 2009. Nine (of 14) centres were able to submit their data into a standard database. The Kaplan-Meier method estimated survival and the Log-rank test analysed the significance. RESULTS In total, 849 patients had CHART treatment, with a median age of 71 years (range 31-91), 534 (63%) were men, 55% had undergone positron emission tomography-computed tomography (PET-CT) and 26% had prior chemotherapy; 839 (99%) patients received all the prescribed treatment. The median overall survival was 22 months with 2 and 3 year survival of 47% and 32%, respectively. Statistically significant differences in survival were noted for stage IA versus IB (33.2 months versus 25 months; P = 0.032) and IIIA versus IIIB (20 months versus 16 months; P = 0.018). Response at 3 months and outcomes were significantly linked; complete response showing survival of 34 months against 19 months, 15 months and 8 months for partial response, stable and progressive disease, respectively (P < 0.001). Age, gender, performance status, prior chemotherapy and PET-CT did not affect the survival outcomes. Treatment was well tolerated with <5% reporting ≥grade 3 toxicity. CONCLUSION In routine practice, CHART results for NSCLC remain encouraging and we have been able to show an improvement in survival compared with the original trial cohort. We have confirmed that CHART remains deliverable with low toxicity rates and we are taking a dose-escalated CHART regimen forward in a randomised phase II study of sequential chemoradiotherapy against other accelerated dose-escalated schedules.
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Affiliation(s)
| | | | - A G Bradshaw
- Weston Park Hospital, Sheffield, UK; Newcastle on Tyne Hospitals NHS Trust, Freeman Hospital, Newcastle, UK
| | - T Das
- Weston Park Hospital, Sheffield, UK
| | - C Esler
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | - A E F Roy
- Plymouth Hospitals NHS Trust, Plymouth, UK
| | - E Toy
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | | | - M Button
- Velindre Cancer Centre, Cardiff, UK
| | - P Wilson
- University Hospitals Bristol NHS Trust, Bristol, UK
| | - C Comins
- University Hospitals Bristol NHS Trust, Bristol, UK
| | - P Atherton
- Newcastle on Tyne Hospitals NHS Trust, Freeman Hospital, Newcastle, UK
| | - R Pickles
- Newcastle on Tyne Hospitals NHS Trust, Freeman Hospital, Newcastle, UK
| | - K Foweraker
- Nottingham University Hospitals NHS Trust, City Hospital, Nottingham, UK
| | - G A Walker
- Derby Hospitals NHS Trust, Royal Derby Hospital, UK
| | - M Keni
- Derby Hospitals NHS Trust, Royal Derby Hospital, UK
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9
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Hiley CT, Ahmad T, Jamal-Hanjani M, Abbosh C, Ngai Y, Hackshaw A, Patterson P, Baijal S, Nicolson M, Lester JF, Krebs M, Ottensmeier CH, Fennell DA, Schmid P, Ezhil M, Danson S, Steele NL, Middleton GW, Dive C, Swanton C. Deciphering antitumour response and resistance with intratumour heterogeneity (DARWIN II). J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.tps9099] [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
TPS9099 Background: The importance of intratumour heterogeneity (ITH) is increasingly recognised as a driver of cancer progression and survival outcome. However understanding how tumour clonal heterogeneity impacts upon therapeutic outcome is still an area of unmet clinical and scientific need. The TRACERx trial (NCT01888601), a prospective study of patients with radically resected primary non-small cell lung cancer (NSCLC), aims to define the evolutionary trajectories of lung cancer in both space and time through genetic analysis of multi-region and longitudinal tumour sampling. DARWIN II is an investigator initiated study for patients who are enrolled within the TRACERx trial, or who have multi-region sequencing of their primary disease, but subsequently relapse with metastatic disease. This study will examine the role of intra-tumour heterogeneity and predicted neo-antigens on the anti-tumour activity of anti-PDL1 immunotherapy. Methods: This multicentre non-randomised phase II molecularly stratified umbrella study will examine how clonal dominance and ITH influence outcomes after treatment, offering a unique opportunity to decipher mechanisms of resistance to immunotherapy with anti-PDL1. These data will help improve future study design by developing greater understanding of patient selection for immunotherapies in patients with NSCLC. The relationship between ITH and cfDNA/CTCs will also be explored in DARWIN II. The study arms: Arm 1: Patients either -1) without an actionable mutation and PDL1 positive or 2) without an actionable mutation and PDL1 negative following first line cytotoxic chemotherapy - Atezolizumab. Arm 2: BRAFV600 - Vemurafenib. Arm 3: ALK/RET gene rearrangement - Alectinib. Arm 4: Her2 Amplification - Trastuzumab Emtansine. Primary Outcome Measures: Progression free survival (PFS), defined as the period between the date of registration to the date of subsequent progression or death will be assessed according to: Neo-antigen burden, mutational burden, ITH as assessed using an ITH ratio index and genomic instability as assessed using a weighted genome instability index (wGII). Trial Sponsor: University College London. Clinical trial information: NCT02314481.
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Affiliation(s)
| | - Tanya Ahmad
- University College London, London, United Kingdom
| | | | | | - Yenting Ngai
- Cancer Research UK and UCL Cancer Trials Centre, London, United Kingdom
| | - Alan Hackshaw
- Cancer Research UK and UCL Cancer Trials Centre, London, United Kingdom
| | - Paul Patterson
- Cancer Research UK and UCL Cancer Trials Centre, London, United Kingdom
| | - Shobhit Baijal
- Heart of England NHS Foundation Trust, Birmingham, United Kingdom
| | | | | | - Matthew Krebs
- The Christie NHS Foundation Trust and The University of Manchester, Manchester, United Kingdom
| | | | | | | | - Muthuveni Ezhil
- Ashford and St. Peter's Hospitals NHS Foundation Trust, London, United Kingdom
| | - Sarah Danson
- Sheffield Experimental Cancer Medicine Centre, Weston Park Hospital, Sheffield, United Kingdom
| | | | | | - Caroline Dive
- Cancer Research UK Manchester Institute, Manchester, United Kingdom
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Davies RS, Nelmes DJ, Butler R, Lester JF. Non-small Cell Lung Cancer in South Wales: Are Exon 19 Deletions and L858R Different? Anticancer Res 2016; 36:4267-4271. [PMID: 27466542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 07/01/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND/AIM In advanced non-small cell lung cancer (NSCLC), the epidermal growth factor receptor (EGFR) mutations L858R and exon 19 deletion (del19) predict response to EGFR tyrosine kinase inhibitors (TKIs). Trials have suggested a differential response to the second-generation EGFR TKI afatinib in favour of del19. We investigated whether this differential response is observed in clinical practice. MATERIALS AND METHODS Retrospective demographic, treatment and outcome data were collected on patients with: stage III/IV NSCLC and either del19 or L858R, receiving an EGFR TKI as first-line treatment. RESULTS There was no significant difference in overall survival (OS) between del19 (648 days, 95% confidence interval (CI)=461-835) and L858R (813 days, 95%CI=387-1,238), (p=0.616), or in duration of therapy between del19 (365 days, 95% CI=192-538) and L858 (428 days, 95% CI=263-593), (p=0.928). CONCLUSION Patients with exon del19 did not have a significantly longer OS with first-generation TKIs.
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Affiliation(s)
| | | | - Rachel Butler
- Institute of Cancer Genetics, Cardiff University, Cardiff, Wales, U.K
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Davies RS, Smith C, Lester JF. Third-line Enzalutamide Following Docetaxel and Abiraterone in Metastatic Castrate-resistant Prostate Cancer. Anticancer Res 2016; 36:1799-1803. [PMID: 27069162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Accepted: 03/04/2016] [Indexed: 06/05/2023]
Abstract
BACKGROUND There are no published randomised trials on the efficacy of enzalutamide against metastatic castrate-resistant prostate cancer (mCRPC) after docetaxel and abiraterone. We evaluated the activity of third-line enzalutamide in men with mCRPC after docetaxel and abiraterone. PATIENTS AND METHODS Progression-free (PFS) and overall (OS) survival from the start of enzalutamide were compared according to response to abiraterone in men with mCRPC treated at a single cancer centre. RESULTS Median PFS and OS for the whole 34-patient cohort from starting enzalutamide were 2.7 months (95% confidence interval=1.4-4.0 months) and 10.4 months (95% confidence interval=9.0-11.7 months). There was no significant difference in PFS and OS in patients according to prostate-specific antigen response to abiraterone (≥50% vs. <50%, ≤ or >6 months). CONCLUSION In mCRPC, enzalutamide has modest activity after docetaxel and abiraterone. Response to previous abiraterone is not predictive of subsequent enzalutamide response.
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Bayman N, Ardron D, Ashcroft L, Baldwin DR, Booton R, Darlison L, Edwards JG, Lang-Lazdunski L, Lester JF, Peake M, Rintoul RC, Snee M, Taylor P, Lunt C, Faivre-Finn C. Protocol for PIT: a phase III trial of prophylactic irradiation of tracts in patients with malignant pleural mesothelioma following invasive chest wall intervention. BMJ Open 2016; 6:e010589. [PMID: 26817643 PMCID: PMC4735163 DOI: 10.1136/bmjopen-2015-010589] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 12/02/2015] [Accepted: 12/07/2015] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Histological diagnosis of malignant mesothelioma requires an invasive procedure such as CT-guided needle biopsy, thoracoscopy, video-assisted thorascopic surgery (VATs) or thoracotomy. These invasive procedures encourage tumour cell seeding at the intervention site and patients can develop tumour nodules within the chest wall. In an effort to prevent nodules developing, it has been widespread practice across Europe to irradiate intervention sites postprocedure--a practice known as prophylactic irradiation of tracts (PIT). To date there has not been a suitably powered randomised trial to determine whether PIT is effective at reducing the risk of chest wall nodule development. METHODS AND ANALYSIS In this multicentre phase III randomised controlled superiority trial, 374 patients who can receive radiotherapy within 42 days of a chest wall intervention will be randomised to receive PIT or no PIT. Patients will be randomised on a 1:1 basis. Radiotherapy in the PIT arm will be 21 Gy in three fractions. Subsequent chemotherapy is given at the clinicians' discretion. A reduction in the incidence of chest wall nodules from 15% to 5% in favour of radiotherapy 6 months after randomisation would be clinically significant. All patients will be followed up for up to 2 years with monthly telephone contact and at least four outpatient visits in the first year. ETHICS AND DISSEMINATION PIT was approved by NRES Committee North West-Greater Manchester West (REC reference 12/NW/0249) and recruitment is currently on-going, the last patient is expected to be randomised by the end of 2015. The analysis of the primary end point, incidence of chest wall nodules 6 months after randomisation, is expected to be published in 2016 in a peer reviewed journal and results will also be presented at scientific meetings and summary results published online. A follow-up analysis is expected to be published in 2018. TRIAL REGISTRATION NUMBER ISRCTN04240319; NCT01604005; Pre-results.
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Affiliation(s)
- N Bayman
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - D Ardron
- The National Cancer Research Institute (NCRI) Consumer Liaison Group, London, UK
| | - L Ashcroft
- Manchester Academic Health Science Centre Trials Co-ordination Unit (MAHSC-CTU), The Christie NHS Foundation Trust, Manchester, UK
| | - D R Baldwin
- Respiratory Medicine Unit, David Evans Research Centre, Nottingham University Hospitals NHS Trust, Nottingham City Hospital Campus, Nottingham, UK
| | - R Booton
- Respiratory and Allergy Research Group, Institute of Inflammation & Repair, The University of Manchester North West Lung Centre, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK
| | - L Darlison
- Mesothelioma UK Charitable Trust, c/o Glenfield Hospital, Leicester, UK
- Department of Respiratory Medicine, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester, UK
| | - J G Edwards
- Department of Cardiothoracic Surgery, Chesterman Unit, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust UK, Sheffield, UK
| | | | - J F Lester
- Department of Clinical Oncology, Velindre NHS Trust UK, Cardiff, UK
| | - M Peake
- Department of Respiratory Medicine, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester, UK
- National Cancer Intelligence Network, (NCIN), Public Health England, London, UK
| | - R C Rintoul
- Department of Thoracic Oncology, Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - M Snee
- Department of Clinical Oncology, Leeds Teaching Hospital NHS Trust, St James Hospital, Leeds, UK
| | - P Taylor
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK
- Department Pulmonary Oncology, Wythenshawe Hospital Manchester, Manchester, UK
| | - C Lunt
- Manchester Academic Health Science Centre Trials Co-ordination Unit (MAHSC-CTU), The Christie NHS Foundation Trust, Manchester, UK
| | - C Faivre-Finn
- The University of Manchester, Manchester Academic Health Science Centre, Institute of Cancer Sciences, Manchester Cancer Research Centre (MCRC), Manchester, UK
- Radiotherapy Related Research, The Christie NHS Foundation Trust, Manchester, UK
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Jones RJ, Crabb SJ, Chester JD, Elliott T, Huddart RA, Birtle AJ, Evans L, Lester JF, Huang C, Casbard AC, Madden TA, Griffiths G. TOUCAN: A randomised phase II trial of carboplatin and gemcitabine +/- vandetanib in first line treatment of advanced urothelial cell cancer in patients who are not suitable to receive cisplatin. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.2_suppl.448] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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
448 Background: Whilst cisplatin combination therapy remains the standard of care for patients with advanced urothelial cancers, many patients are unsuitable for cisplatin and go on to receive carboplatin combination therapy. Although responses are frequent, overall outcomes remain poor, and there is a high unmet need for more effective first line treatment. Vandetanib is a well-tolerated, oral inhibitor of vascular and epidermal growth factor receptor tyrosine kinases, both of which are implicated in the pathogenesis of urothelial cancers. Methods: Patients with metastatic or inoperable urothelial cancer who had no prior chemotherapy and were unsuitable for cisplatin were randomly allocated to receive carboplatin (AUC 4.5, day 1) plus gemcitabine (1000mg/m2, days 1 and 8) plus either vandetanib (100mg od, days 1-21) (GCV) or matching placebo (GCP) in 21-day cycles up to a total of 6 cycles. Treatment allocation was double-blind. There was a planned safety review after the first 40 patients had received at least one cycle. The primary endpoint was progression free survival (PFS). Sample size (n=82) was calculated using a one-sided alpha of 0.2 and power 80% to detect a HR of 0.65 for PFS. We present the final efficacy results. The trial was coordinated by the Wales Cancer Trials Unit at Cardiff University and funded by Cancer Research UK (CRUK/09/024) and AstraZeneca. Results: Of 82 patients, 40 received GCV. 62 (76%) had a bladder primary, and 56 (68%) had poor renal function. The arms were well balanced except for age > 75 (13 (16%) GCV, 23 (28%) GCP). Median PFS was 8.5 months (m) (95% CI 6.0, 9.7) and 8.8 m (5.8, 9.0) for GCV and GCP respectively (adjusted hazard ratio (HR) 0.93 (0.50, 1.71), P=0.89). Overall survival was 10.8 m (8.0, 13.0) and 13.8 m (11.1, 16.6) for GCV and GCP respectively (adjusted HR 1.38 (0.77, 2.46), P=0.24). Response rates were 50% (n=20) and 55% (n=23) for GCV and GCP. All-grade adverse events were similar but there were significantly more grade 3+ events in the GCV arm. Conclusion: Vandetanib did not improve efficacy of chemotherapy but increased toxicity in advanced urothelial cancer not suitable for cisplatin. Clinical trial information: 68146831.
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Affiliation(s)
- Robert J. Jones
- University of Glasgow, Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | - Simon J. Crabb
- Southampton Clinical Trials Unit, University of Southampton, Southampton, United Kingdom
| | | | - Tony Elliott
- Christie Hospital NHS Foundation Trust, Manchester, United Kingdom
| | | | - Alison J. Birtle
- Lancashire Teaching Hospitals NHS Foundation Trust, Preston, United Kingdom
| | - Linda Evans
- Weston Park Hospital, Sheffield, United Kingdom
| | | | - Chao Huang
- Welsh Cancer Trials Unit, Cardiff University, Cardiff, United Kingdom
| | | | - Tracie-Ann Madden
- Welsh Cancer Trials Unit, Cardiff University, Cardiff, United Kingdom
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Davies RS, Smith C, Button MR, Tanguay J, Barber J, Palaniappan N, Staffurth J, Lester JF. What Predicts Minimal Response to Abiraterone in Metastatic Castrate-resistant Prostate Cancer? Anticancer Res 2015; 35:5615-5621. [PMID: 26408734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Several treatments have been shown to prolong survival in metastatic castrate-resistant prostate cancer (mCRPC); the optimum sequencing of these is not established. We investigated methods of identifying patients with mCRPC unlikely to respond to abiraterone. PATIENTS AND METHODS A retrospective analysis was carried-out in 47 consecutive patients with mCRPC treated sequentially with androgen deprivation (LHRHa), bicalutamide, docetaxel then abiraterone. RESULTS The median progression-free survival in patients treated with abiraterone was shorter in those with ≤18 months' response to LHRHa (118 vs. 279 days; p=0.018), bicalutamide non-responders (91 vs. 196 days; p=0.003) and patients with ≤6 months' response to docetaxel (102 vs. 294 days; p<0.001). The median overall survival was also shorter (348 vs. 815 days, p=0.016; 413 vs. 752 days, p=0.009; and 325 vs. 727 days, p<0.04, respectively). CONCLUSION A response of ≤18 months' to LHRHa, non-response to bicalutamide and ≤6 months' response to docetaxel predicted poor response to abiraterone.
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Affiliation(s)
| | | | | | | | - Jim Barber
- Velindre Cancer Centre, Cardiff, Wales, U.K
| | | | - John Staffurth
- Velindre Cancer Centre, Cardiff, Wales, U.K. Institute of Cancer Genetics, Cardiff University, Cardiff, Wales, U.K
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Schmid P, Muthukumar D, Blackhall FH, Lester JF, Khan S, Illsley M, Adams J, Garcia-Alonso A, MacDonald-Smith C, Lee SM, Jacobs C, Middleton GW, James C, Mousa K, Sarker SJ, Lim L. Addition of apatorsen, an inhibitor of Hsp27, to first-line gemcitabine/carboplatin in advanced squamous cell lung cancer: Design of the Cedar study. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.tps8111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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)
- Peter Schmid
- Queen Mary, University of London, London, United Kingdom
| | - Dakshinmoorthy Muthukumar
- Clinical Oncology Department, Colchester Hospital University Foundation Trust Essex UK, Consultant Clinical Oncologist, Colchester, United Kingdom
| | | | | | - Sarah Khan
- Nottingham City Hospital, Beeston, Nottingham, United Kingdom
| | - Marianne Illsley
- Royal Surrey County Hospital NHS Foundation Trust, Guildford, United Kingdom
| | - Joss Adams
- Royal Berkshire NHS Foundation Trust, Reading, United Kingdom
| | | | | | | | | | | | | | - Kelly Mousa
- Queen Mary University of London, London, United Kingdom
| | | | - Louise Lim
- St. Bartholomew's Hospital, London, United Kingdom
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16
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Hussain SA, Jackson R, Shields A, Dickinson L, Cornford P, Jones RJ, Lester JF, Chester JD, Birtle AJ, Powles T, Crabb SJ, Mazhar D, Huddart RA, Protheroe A, Azam F, Vasudev N, Butt M, James ND. Phase II randomised placebo controlled neoadjuvant chemotherapy study of nintedanib with gemcitabine and cisplatin in locally advanced muscle invasive bladder cancer. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.tps4574] [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)
- Syed A. Hussain
- University of Liverpool, Clatterbridge Cancer Centre, Liverpool, United Kingdom
| | | | | | | | - Philip Cornford
- Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, United Kingdom
| | - Robert J. Jones
- The Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | | | | | - Alison J. Birtle
- Lancashire Teaching Hospitals NHS Foundation Trust, Preston, United Kingdom
| | - Thomas Powles
- Barts Cancer Institute, Barts Health and the Royal Free NHS Trust, London, United Kingdom
| | | | - Danish Mazhar
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | | | - Andrew Protheroe
- University of Oxford Medical Oncology Department, Oxford, United Kingdom
| | - Faisal Azam
- Betsi Cadwaladr University Health Board, Wrexham, United Kingdom
| | | | - Mohammad Butt
- Hull and East Yorkshire Hospitals NHS Trust, Hull, United Kingdom
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17
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Davies RS, Smith C, Frazer RD, Button M, Tanguay J, Barber J, Palaniappan N, Staffurth J, Lester JF. What predicts minimal response to abiraterone in metastatic castrate resistant prostate cancer? J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.e16103] [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
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18
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Davies RS, Lester JF, Smith C, Casbard AC. Pragmatic predictors of response to abiraterone in metastatic castrate resistant-prostate cancer. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.7_suppl.286] [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
286 Background: In patients with metastatic castrate resistant prostate cancer (mCRPC) there are several treatment options that have been shown to prolong survival. These treatments have not been directly compared in randomized clinical trials. In addition, the optimum sequencing of treatments for an individual patient has not yet been established. There is early evidence there are genetic predictors of response to enzalutamide and abiraterone, but these are likely to be some way off routine clinical application. There is a more urgent need for a practical method of identifying patients who are unlikely to respond to a particular treatment so that a more appropriate therapy can be used. Methods: A retrospective analysis of 47 consecutive patients with mCRPC treated in a single cancer centre was conducted. All patients were treated according to the following treatment sequence: (1) continuous LHRH analogues (LHRHa); (2) antiandrogen therapy and subsequent withdrawal; (3) docetaxel plus prednisolone; (4) abiraterone. Data were collected on patient and disease demographics, treatment received and response. Definitions of relapse and treatment response were as per the Cou-301 trial. Results: 47 patients were identified. Median age was 76 years (range 55-86). Only 1 patient had a Gleason score ≤ 6. Median duration of response to abiraterone in responders versus non-responders of each line of treatment was compared using the unpaired t-test. The results are displayed in Table. Conclusions: Time to progression on LHRHa, no response to bicalutamide and duration of biochemical response to docetaxel were strong predictors of a poor response to abiraterone. Further statistical analysis is planned, and these observations require prospective validation. [Table: see text]
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Harrett E, Davies RS, Attanoos R, Lester JF. Lung cancer masquerading as breast cancer with carcinoma en cuirasse. BMJ Case Rep 2014; 2014:bcr-2014-206596. [PMID: 25395467 DOI: 10.1136/bcr-2014-206596] [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: 11/03/2022] Open
Abstract
Metastases to the breast from lung cancer are rare. Carcinoma en cuirasse is an unusual form of metastatic cutaneous carcinoma, almost exclusively described as deposits secondary to breast carcinoma. A 63-year-old woman presented with dyspnoea. A CT scan demonstrated a pleural effusion, large pericardial effusion, mediastinal lymphadenopathy and right basal consolidation. Pleural fluid cytology and immunohistochemistry were consistent with a diagnosis of primary lung adenocarcinoma. The patient was treated with pemetrexed and carboplatin, resulting in stable disease. A year later, she developed bilateral breast masses and multiple painful erythematous subcutaneous nodules over her torso, clinically indistinguishable from carcinoma en cuirasse. A biopsy demonstrated these were deposits from metastatic adenocarcinoma of the lung. The patient received docetaxel and carboplatin with initial good response. The painful lesions were subsequently treated with radiotherapy, which provided symptomatic relief. To the best of our knowledge, this is the only case of metastatic lung adenocarcinoma mimicking carcinoma en cuirasse.
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Affiliation(s)
- Emma Harrett
- Department of Clinical Oncology, Velindre Cancer Centre, Cardiff, UK
| | - Rhian Sian Davies
- Department of Clinical Oncology, ABM University Health Board, Swansea, UK
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Hudson E, Lester JF. Gemcitabine and carboplatin in the treatment of transitional cell carcinoma of the urothelium: a single centre experience and review of the literature. Eur J Cancer Care (Engl) 2009; 19:324-8. [PMID: 19912300 DOI: 10.1111/j.1365-2354.2008.01050.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The objectives of this study are to evaluate patient outcomes in clinical practice using gemcitabine and carboplatin (GCarbo) as first-line treatment in metastatic transitional cell carcinoma (TCC) of the urothelium, and to review the published evidence on the use of GCarbo in this setting. From July 2003, all cases of metastatic TCC of the urothelium referred to a single consultant were treated using 3-weekly gemcitabine 1200 mg/m(2) i.v. days 1 and 8 plus carboplatin AUC 5-6 i.v. day 1 to a maximum of six cycles. Fifteen patients (median age 67 years) were treated. Grade 3 or 4 toxicity included neutropenia (47%), anaemia (27%) and thrombocytopenia (20%). No patients required admission for neutropenic pyrexia/sepsis, and there were no treatment-related deaths. The overall response rate was 67%. The median survival was 9 months (95% CI 7.4-10.6), and 1-year survival 42%. Gemcitabine and carboplatin is well tolerated, and has activity as first-line treatment in metastatic TCC of the urothelium. However, there is now evidence suggesting that gemcitabine and cisplatin may be more efficacious, and until the appropriate randomized phase 3 trials have been carried out, gemcitabine and cisplatin should probably remain the preferred first-line therapy. Gemcitabine and carboplatin is an effective alternative in those patients not deemed fit enough for cisplatin.
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Affiliation(s)
- E Hudson
- Velindre Hospital, Whitchurch, Cardiff, CF14 2TL, UK
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Abstract
Malignant tumours arising from the basal cells of the prostate gland are extremely rare, and the majority of reports in the literature suggest a relatively indolent clinical course. We report a case of infiltrative basaloid carcinoma of the prostate in a 68-year old man that did not respond to systemic chemotherapy. It is essential that this aggressive disease is differentiated from more indolent basaloid proliferations, as metastatic spread can occur and outcome may be poor.
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Affiliation(s)
- E Hudson
- Velindre Hospital, Whitchurch, Cardiff, UK.
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Hudson E, Powell J, Mukherjee S, Crosby TDL, Brewster AE, Maughan TS, Bailey H, Lester JF. Small cell oesophageal carcinoma: an institutional experience and review of the literature. Br J Cancer 2007; 96:708-11. [PMID: 17299393 PMCID: PMC2360086 DOI: 10.1038/sj.bjc.6603611] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Primary small cell oesophageal carcinoma (SCOC) is rare, prognosis is poor and there is no established optimum treatment strategy. It shares many clinicopathologic features with small cell carcinoma of the lung; therefore, a similar staging and treatment strategy was adopted. Sixteen cases referred to Velindre hospital between 1998 and 2005 were identified. Patients received platinum-based combination chemotherapy if appropriate. Those with limited disease (LD) received radical radiotherapy (RT) to all sites of disease on completion of chemotherapy. Median survival of all patients was 13.2 months. Median survival of patients with LD was significantly longer than those with extensive disease (24.4 vs 9.1 months, P=0.034). This is one of the largest single institution series in the world literature. Combined modality therapy using platinum-based combination chemotherapy and radical RT may allow a nonsurgical approach to management, avoiding the morbidity of oesophagectomy. Prophylactic cranial irradiation is controversial, and should be discussed on an individual basis.
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Affiliation(s)
- E Hudson
- Velindre Hospital, Velindre Road, Whitchurch, Cardiff, UK.
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Lester JF, Hudson E, Barber JB. Bladder preservation in small cell carcinoma of the urinary bladder: an institutional experience and review of the literature. Clin Oncol (R Coll Radiol) 2007; 18:608-11. [PMID: 17051951 DOI: 10.1016/j.clon.2006.06.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS Primary small cell carcinoma (SCC) of the urinary bladder is rare, accounting for less than 1% of all primary bladder malignancies. Metastases are often present at the time of diagnosis, prognosis is poor and there is no established optimum treatment strategy. Small cell carcinoma of the lung (SCLC) shares many clinicopathological features with SCC of the bladder, and there is good evidence supporting the use of combination chemotherapy in SCLC. In addition, consolidation thoracic irradiation and prophylactic cranial irradiation (PCI) both increase 3-year absolute survival by 5.4% in SCLC patients with limited disease and a complete response to chemotherapy. Therefore, we adopted a similar staging and treatment strategy for SCC of the bladder. We report our clinical experience using this strategy, and review published studies. MATERIALS AND METHODS All cases of SCC of the bladder referred to Velindre Hospital between 1998 and 2005 were identified and data collected retrospectively on demographic details, stage, performance status, treatment and response to treatment. For the review, the electronic databases MEDLINE, EMBASE and Cancerlit were searched, along with hand searching of journals, relevant books and review papers. RESULTS Seven patients were identified. In total, six out of seven had platinum-based chemotherapy. Four patients received consolidation radiotherapy (CRT) to the bladder after a complete response to chemotherapy, and none have locally relapsed to date. The three patients with limited disease remain alive and disease free 14, 30 and 36 months after diagnosis. CONCLUSIONS Combined modality therapy using platinum-based combination chemotherapy and consolidation radiotherapy may provide effective local control and allow a bladder-preserving approach to the management of SCC of the bladder. The role of PCI is controversial, and should be discussed with patients on an individual basis.
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Abstract
BACKGROUND Palliative radiotherapy to the chest is often used in patients with lung cancer, but radiotherapy regimens are more often based on tradition than research results. OBJECTIVES To discover the most effective and least toxic regimens of palliative radiotherapy for non-small cell lung cancer, and whether higher doses increase survival. SEARCH STRATEGY The electronic databases MEDLINE, EMBASE, Cancerlit and the Cochrane Central Register of Controlled Trials, reference lists, handsearching of journals and conference proceedings, and discussion with experts were used to identify potentially eligible trials, published and unpublished. SELECTION CRITERIA Randomised controlled clinical trials comparing different regimens of palliative radiotherapy in patients with non-small cell lung cancer. DATA COLLECTION AND ANALYSIS Fourteen randomised trials were reviewed. There were important differences in the doses of radiotherapy investigated, the patient characteristics and the outcome measures. Because of this heterogeneity no meta-analysis was attempted. MAIN RESULTS There is no strong evidence that any regimen gives greater palliation. Higher dose regimens give more acute toxicity, especially oesophagitis. There is evidence for a modest increase in survival (5% at 1 year and 3% at 2 years) in patients with better performance status (PS) given higher dose radiotherapy. Some regimens are associated with an increased risk of radiation myelitis. AUTHORS' CONCLUSIONS The majority of patients should be treated with short courses of palliative radiotherapy, of 1 or 2 fractions. Care should be taken with the dose to the spinal cord. The use of high dose palliative regimens should be considered for and discussed with selected patients with good performance status. More research is needed into reducing the acute toxicity of large fraction regimens and into the role of radical compared to high dose palliative radiotherapy. In the future, large trials comparing different RT regimens may be difficult to set up because of the increasing use of systemic chemotherapy. Trials looking at how best to integrate these two modalities, particularly in good PS patients, need to be carried out.
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Affiliation(s)
- J F Lester
- Velindre Hospital NHS Trust, Oncology, Velindre Road, Cardiff, South Glamorgan, UK.
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Lester JF, Hudson E, Flubacher M, Macbeth F, Baker J, Wade R, Morrey D, Hanna L, Brewster A, Linnane SJ. Small Cell Lung Cancer Treated in Southeast Wales. Clin Oncol (R Coll Radiol) 2006; 18:378-82. [PMID: 16817328 DOI: 10.1016/j.clon.2006.03.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIMS In small cell lung cancer (SCLC), consolidation thoracic irradiation (CTI) increases 3-year absolute survival by 5.4% in patients with limited disease and a complete response to chemotherapy. Early concurrent thoracic radiotherapy has been shown to improve local control and prolong survival compared with CTI in some trials. The standard management of patients with SCLC in southeast Wales is CTI in individuals with limited disease and a complete response to chemotherapy. A review of patients with SCLC was carried out to establish whether survival locally is comparable with that reported in published studies, and if patients given CTI have survival comparable with that reported in studies where early concurrent thoracic radiotherapy was used. MATERIALS AND METHODS Between January 2000 and December 2002, 303 patients were registered with SCLC in southeast Wales. One hundred and fifteen (47%) patients had limited disease and 60/115 (52%) received CTI. RESULTS Patients with limited disease receiving CTI had a median survival of 17.7 months (95% confidence interval: 15-27.9 months). The 2- and 5-year survivals were 38 and 13%, respectively. CONCLUSIONS These results compare favourably with previously published studies on SCLC. There are no plans to change our current treatment policy for SCLC in southeast Wales.
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Affiliation(s)
- J F Lester
- Department of Oncology, Velindre Hospital, Cardiff, UK.
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Lester JF, MacBeth FR, Coles B. Prophylactic cranial irradiation for preventing brain metastases in patients undergoing radical treatment for non–small-cell lung cancer: A Cochrane Review. Int J Radiat Oncol Biol Phys 2005; 63:690-4. [PMID: 15913909 DOI: 10.1016/j.ijrobp.2005.03.030] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2005] [Revised: 03/10/2005] [Accepted: 03/11/2005] [Indexed: 11/19/2022]
Abstract
PURPOSE To investigate whether prophylactic cranial irradiation (PCI) has a role in the management of patients with non-small-cell lung cancer (NSCLC) treated with curative intent. METHODS AND MATERIALS A search strategy was designed to identify randomized controlled trials (RCTs) comparing PCI with no PCI in NSCLC patients treated with curative intent. The electronic databases MEDLINE, EMBASE, LILACS, and Cancerlit were searched, along with relevant journals, books, and review articles to identify potentially eligible trials. Four RCTs were identified and reviewed. A total of 951 patients were randomized in these RCTs, of whom 833 were evaluable and reported. Forty-two patients with small-cell lung cancer were excluded, leaving 791 patients in total. Because of the small patient numbers and trial heterogeneity, no meta-analysis was attempted. RESULTS Prophylactic cranial irradiation did significantly reduce the incidence of brain metastases in three trials. No trial reported a survival advantage with PCI over observation. Toxicity data were poorly collected and no quality of life assessments were carried out in any trial. CONCLUSION Prophylactic cranial irradiation may reduce the incidence of brain metastases, but there is no evidence of a survival benefit. It was not possible to evaluate whether any radiotherapy regimen is superior, and the effect of PCI on quality of life is not known. There is insufficient evidence to support the use of PCI in clinical practice. Where possible, patients should be offered entry into a clinical trial.
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Affiliation(s)
- Jason Francis Lester
- Department of Oncology, Velindre Hospital, Whitchurch, Cardiff, Wales, United Kingdom.
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Lester JF, Coles B, Macbeth FR. Prophylactic cranial irradiation for preventing brain metastases in patients undergoing radical treatment for non-small cell lung cancer. Cochrane Database Syst Rev 2005; 2005:CD005221. [PMID: 15846743 PMCID: PMC9020164 DOI: 10.1002/14651858.cd005221] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND In non-small cell lung cancer (NSCLC), there is a relatively high incidence of brain metastases following radical treatment. At present, the role of prophylactic cranial irradiation (PCI) in this group of patients is not clear. OBJECTIVES To investigate whether PCI has a role in the management of patients with NSCLC treated with radical intent. SEARCH STRATEGY The electronic databases MEDLINE, EMBASE and Cancerlit, along with handsearching of journals, relevant books, and review articles used to identify potentially eligible trials. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing PCI with no PCI in NSCLC patients treated with radical intent. DATA COLLECTION AND ANALYSIS Four RCTs were reviewed. Due to the small patient numbers, and variations in radiotherapy (RT) dose, no meta-analysis was attempted. MAIN RESULTS PCI may reduce the incidence of brain metastases, but there is no evidence of a survival benefit. There is no evidence that any regimen is superior, and the effect of PCI on quality of life (QOL) is not known. AUTHORS' CONCLUSIONS There is insufficient evidence to support the use of PCI in clinical practice. Where possible, patients should be offered entry into a clinical trial.
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Affiliation(s)
- J F Lester
- Radiotherapy Department, Velindre Hospital, Whitchurch, Cardiff, Wales, UK, CF14 7XL.
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