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Phillips I, Deans M, Walton A, Vallet M, Mencnarowksi J, McMillan D, Peacock C, Hall P, O'Brien F, Stares M, Mackean M, Plant T, Grecian R, Allan L, Petrie R, Blues D, Haddad S, Barrie C. Early prehabilitation reduces admissions and time in hospital in patients with newly diagnosed lung cancer. BMJ Support Palliat Care 2024:spcare-2024-004869. [PMID: 38631891 DOI: 10.1136/spcare-2024-004869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 03/12/2024] [Indexed: 04/19/2024]
Abstract
OBJECTIVES Lung cancer is the leading cause of cancer death in the UK. Prehabilitation aims to maximise patient fitness and minimise the negative impact of anticancer treatment. What constitutes prehabilitation before non-surgical anticancer treatment is not well established. We present data from a pilot project of Early prehabilitation In lung Cancer. METHODS All new patients with likely advanced lung cancer were offered prehabilitation at respiratory clinic, if fit for further investigation. Prehabilitation included assessment and appropriate intervention from a consultant in palliative medicine, registered dietitian and rehabilitation physiotherapist. Four objective endpoints were identified, namely admissions to hospital, time spent in the hospital, treatment rates and overall survival. Outcomes were to be compared with 178 prehab eligible historical controls diagnosed from 2019 to 2021. RESULTS From July 2021 to June 2023, 65 patients underwent prehabilitation and 72% of patients underwent all 3 interventions. 54 patients had a stage 3 or 4 lung cancer. In the prehab group, fewer patients attended Accident and Emergency (31.5 vs 37.4 attendances per 100 patients) and fewer were admitted (51.9 vs 67.9) when compared with historical controls. Those receiving prehab spent a lot less time in the hospital (129.7 vs 543.5 days per 100 patients) with shorter admissions (2.5 vs 8 days). Systemic anticancer treatment rates increased in the short term but were broadly similar overall. Median survival was higher in the prehabilitation group (0.73 vs 0.41 years, p=0.046). CONCLUSIONS Early prehabilitation appears to reduce time spent in the hospital. It may improve survival. Further work is required to understand its full effect on treatment rates.
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Affiliation(s)
- Iain Phillips
- Edinburgh Cancer Centre, Western General Hospital, Edinburgh, Scotland, UK
- Edinburgh University, Edinburgh, UK
| | - Maria Deans
- Cancer Information Team, Western General Hospital, Edinburgh, UK
| | - Abi Walton
- Edinburgh Cancer Centre, Western General Hospital, Edinburgh, Scotland, UK
- St Johns Hospital, Livingston, UK
| | | | | | | | | | | | | | | | - Melanie Mackean
- Edinburgh Cancer Centre, Western General Hospital, Edinburgh, Scotland, UK
| | | | | | - Lindsey Allan
- Department of Nutrition and Dietetics, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
| | - Rebecca Petrie
- Edinburgh Cancer Centre, Western General Hospital, Edinburgh, Scotland, UK
| | - Duncan Blues
- Edinburgh Cancer Centre, Western General Hospital, Edinburgh, Scotland, UK
| | - Suraiya Haddad
- Edinburgh Cancer Centre, Western General Hospital, Edinburgh, Scotland, UK
| | - Colin Barrie
- Edinburgh Cancer Centre, Western General Hospital, Edinburgh, Scotland, UK
- St Johns Hospital, Livingston, UK
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Phillips I, Petrie R, Allan L, Hall P, Walton A, McMillan D, Peacock C, Primrose L, Vallet M, Mencnarowksi J, MacDonald N, Mackean M, Barrie C. Early prehabilitation in suspected locally advanced and metastatic lung cancer. BMJ Support Palliat Care 2024; 13:e908-e911. [PMID: 37495261 DOI: 10.1136/spcare-2023-004349] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 07/03/2023] [Indexed: 07/28/2023]
Abstract
OBJECTIVES The most common treatment for locally advanced and metastatic lung cancer is best supportive care. Patients with lung cancer are often comorbid with a high symptom burden. We wanted to assess whether early prehabilitation was feasible in patients with likely lung cancer. METHODS Patients were offered prehabilitation if they were attending the new patient respiratory clinic, had a CT scan suggesting stage III or IV lung cancer and undergoing further investigations. Patients receiving palliative care were ineligible. All prehabilitation patients were referred to a palliative medicine physician, registered dietitian and rehabilitation physiotherapist. RESULTS 50 patients underwent prehabilitation between June 2021 and August 2022. The median age was 72 years (range 54-89 years). 48 patients had lung cancer. 84% of patients attended all three interventions.Half of the palliative care consultations focused on pain. Half of the patients seen had a change in medication. 25% of patients' weights were stable, 32% required a food-first strategy and 33% required oral nutritional supplements. 57% of patients discussed managing breathlessness with the physiotherapist. CONCLUSIONS Early prehabilitation is feasible alongside the investigation of locally advanced and metastatic lung cancer. Further work will aim to assess its impact on admission to the hospital, survival and treatment rates.
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Affiliation(s)
- Iain Phillips
- Edinburgh Cancer Centre, Western General Hospital, Edinburgh, UK
| | - Rebecca Petrie
- Edinburgh Cancer Centre, Western General Hospital, Edinburgh, UK
| | - Lindsey Allan
- Department of Nutrition and Dietetics, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
| | - Peter Hall
- Edinburgh Cancer Centre, Western General Hospital, Edinburgh, UK
| | - Abi Walton
- Oncology department, St Johns Hospital, Livingston, UK
| | | | | | | | - Mahéva Vallet
- Edinburgh Cancer Centre, Western General Hospital, Edinburgh, UK
| | | | | | - Melanie Mackean
- Edinburgh Cancer Centre, Western General Hospital, Edinburgh, UK
| | - Colin Barrie
- Edinburgh Cancer Centre, Western General Hospital, Edinburgh, UK
- Oncology department, St Johns Hospital, Livingston, UK
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Phillips I, Stares M, Mackean M, Barrie C. Comment on: Prehabilitation and Rehabilitation for Patients with Lung Cancer: A Review of Where We are Today. Clin Oncol (R Coll Radiol) 2023; 35:e410. [PMID: 36925346 DOI: 10.1016/j.clon.2023.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 02/22/2023] [Indexed: 03/05/2023]
Affiliation(s)
- I Phillips
- Edinburgh Cancer Centre, Western General Hospital, Edinburgh, UK.
| | - M Stares
- Edinburgh Cancer Centre, Western General Hospital, Edinburgh, UK
| | - M Mackean
- Edinburgh Cancer Centre, Western General Hospital, Edinburgh, UK
| | - C Barrie
- Edinburgh Cancer Centre, Western General Hospital, Edinburgh, UK
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Stares M, Lewis G, Vallet M, Killean A, Tramonti G, Patrizio A, Mackean M, Harrow S, Barrie C, MacLennan K, Campbell S, Evans T, Tufail A, Hall P, Phillips I. Real-World Impact of SABR on Stage I Non-Small-Cell Lung Cancer Outcomes at a Scottish Cancer Centre. Cancers (Basel) 2023; 15:cancers15051431. [PMID: 36900224 PMCID: PMC10000454 DOI: 10.3390/cancers15051431] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 12/12/2022] [Revised: 02/09/2023] [Accepted: 02/20/2023] [Indexed: 03/06/2023] Open
Abstract
INTRODUCTION Stereotactic ablative body radiotherapy (SABR) offers patients with stage I non-small-cell lung cancer (NSCLC) a safe, effective radical therapy option. The impact of introducing SABR at a Scottish regional cancer centre was studied. METHODS The Edinburgh Cancer Centre Lung Cancer Database was assessed. Treatment patterns and outcomes were compared across treatment groups (no radical therapy (NRT), conventional radical radiotherapy (CRRT), SABR and surgery) and across three time periods reflecting the availability of SABR (A, January 2012/2013 (pre-SABR); B, 2014/2016 (introduction of SABR); C, 2017/2019, (SABR established)). RESULTS 1143 patients with stage I NSCLC were identified. Treatment was NRT in 361 (32%), CRRT in 182 (16%), SABR in 132 (12%) and surgery in 468 (41%) patients. Age, performance status, and comorbidities correlated with treatment choice. The median survival increased from 32.5 months in time period A to 38.8 months in period B to 48.8 months in time period C. The greatest improvement in survival was seen in patients treated with surgery between time periods A and C (HR 0.69 (95% CI 0.56-0.86), p < 0.001). The proportion of patients receiving a radical therapy rose between time periods A and C in younger (age ≤ 65, 65-74 and 75-84 years), fitter (PS 0 and 1), and less comorbid patients (CCI 0 and 1-2), but fell in other patient groups. CONCLUSIONS The introduction and establishment of SABR for stage I NSCLC has improved survival outcomes in Southeast Scotland. Increasing SABR utilisation appears to have enhanced the selection of surgical patients and increased the proportion of patients receiving a radical therapy.
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Affiliation(s)
- Mark Stares
- Edinburgh Cancer Centre, NHS Lothian, Western General Hospital, Crewe Road South, Edinburgh EH4 2XU, UK
- Cancer Research UK Edinburgh Centre, Institute of Genetics and Cancer, Western General Hospital, University of Edinburgh, Crewe Road South, Edinburgh EH4 2XR, UK
- Correspondence: ; Tel.: +44-1315371000
| | - Georgina Lewis
- Cancer Research UK Edinburgh Centre, Institute of Genetics and Cancer, Western General Hospital, University of Edinburgh, Crewe Road South, Edinburgh EH4 2XR, UK
| | - Maheva Vallet
- Cancer Research UK Edinburgh Centre, Institute of Genetics and Cancer, Western General Hospital, University of Edinburgh, Crewe Road South, Edinburgh EH4 2XR, UK
| | - Angus Killean
- Edinburgh Cancer Centre, NHS Lothian, Western General Hospital, Crewe Road South, Edinburgh EH4 2XU, UK
- Cancer Research UK Edinburgh Centre, Institute of Genetics and Cancer, Western General Hospital, University of Edinburgh, Crewe Road South, Edinburgh EH4 2XR, UK
| | - Giovanni Tramonti
- Cancer Research UK Edinburgh Centre, Institute of Genetics and Cancer, Western General Hospital, University of Edinburgh, Crewe Road South, Edinburgh EH4 2XR, UK
| | - Ailsa Patrizio
- Edinburgh Cancer Centre, NHS Lothian, Western General Hospital, Crewe Road South, Edinburgh EH4 2XU, UK
| | - Melanie Mackean
- Edinburgh Cancer Centre, NHS Lothian, Western General Hospital, Crewe Road South, Edinburgh EH4 2XU, UK
| | - Stephen Harrow
- Edinburgh Cancer Centre, NHS Lothian, Western General Hospital, Crewe Road South, Edinburgh EH4 2XU, UK
| | - Colin Barrie
- Edinburgh Cancer Centre, NHS Lothian, Western General Hospital, Crewe Road South, Edinburgh EH4 2XU, UK
| | - Kirsty MacLennan
- Edinburgh Cancer Centre, NHS Lothian, Western General Hospital, Crewe Road South, Edinburgh EH4 2XU, UK
| | - Sorcha Campbell
- Edinburgh Cancer Centre, NHS Lothian, Western General Hospital, Crewe Road South, Edinburgh EH4 2XU, UK
| | - Tamasin Evans
- Edinburgh Cancer Centre, NHS Lothian, Western General Hospital, Crewe Road South, Edinburgh EH4 2XU, UK
| | - Aisha Tufail
- Edinburgh Cancer Centre, NHS Lothian, Western General Hospital, Crewe Road South, Edinburgh EH4 2XU, UK
| | - Edinburgh Cancer Informatics Programme
- Cancer Research UK Edinburgh Centre, Institute of Genetics and Cancer, Western General Hospital, University of Edinburgh, Crewe Road South, Edinburgh EH4 2XR, UK
| | - Peter Hall
- Edinburgh Cancer Centre, NHS Lothian, Western General Hospital, Crewe Road South, Edinburgh EH4 2XU, UK
- Cancer Research UK Edinburgh Centre, Institute of Genetics and Cancer, Western General Hospital, University of Edinburgh, Crewe Road South, Edinburgh EH4 2XR, UK
| | - Iain Phillips
- Edinburgh Cancer Centre, NHS Lothian, Western General Hospital, Crewe Road South, Edinburgh EH4 2XU, UK
- Cancer Research UK Edinburgh Centre, Institute of Genetics and Cancer, Western General Hospital, University of Edinburgh, Crewe Road South, Edinburgh EH4 2XR, UK
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Cavers D, Nelson M, Rostron J, Robb KA, Brown LR, Campbell C, Akram AR, Dickie G, Mackean M, van Beek EJR, Sullivan F, Steele RJ, Neilson AR, Weller D. Understanding patient barriers and facilitators to uptake of lung screening using low dose computed tomography: a mixed methods scoping review of the current literature. Respir Res 2022; 23:374. [PMID: 36564817 PMCID: PMC9789658 DOI: 10.1186/s12931-022-02255-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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: 07/14/2022] [Accepted: 11/17/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Targeted lung cancer screening is effective in reducing mortality by upwards of twenty percent. However, screening is not universally available and uptake is variable and socially patterned. Understanding screening behaviour is integral to designing a service that serves its population and promotes equitable uptake. We sought to review the literature to identify barriers and facilitators to screening to inform the development of a pilot lung screening study in Scotland. METHODS We used Arksey and O'Malley's scoping review methodology and PRISMA-ScR framework to identify relevant literature to meet the study aims. Qualitative, quantitative and mixed methods primary studies published between January 2000 and May 2021 were identified and reviewed by two reviewers for inclusion, using a list of search terms developed by the study team and adapted for chosen databases. RESULTS Twenty-one articles met the final inclusion criteria. Articles were published between 2003 and 2021 and came from high income countries. Following data extraction and synthesis, findings were organised into four categories: Awareness of lung screening, Enthusiasm for lung screening, Barriers to lung screening, and Facilitators or ways of promoting uptake of lung screening. Awareness of lung screening was low while enthusiasm was high. Barriers to screening included fear of a cancer diagnosis, low perceived risk of lung cancer as well as practical barriers of cost, travel and time off work. Being health conscious, provider endorsement and seeking reassurance were all identified as facilitators of screening participation. CONCLUSIONS Understanding patient reported barriers and facilitators to lung screening can help inform the implementation of future lung screening pilots and national lung screening programmes.
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Affiliation(s)
- Debbie Cavers
- Usher Institute, University of Edinburgh, Doorway 1, Medical School, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG UK
| | - Mia Nelson
- Usher Institute, University of Edinburgh, Doorway 1, Medical School, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG UK
| | - Jasmin Rostron
- The National Institute of Economic and Social Research, 2 Dean Trench Street, London, NW1P 3HE UK
| | - Kathryn A. Robb
- Institute of Health and Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow, G12 8RZ UK
| | - Lynsey R. Brown
- School of Medicine, University of St. Andrews, North Haugh, St. Andrews, KY16 9TF UK
| | - Christine Campbell
- Usher Institute, University of Edinburgh, Doorway 1, Medical School, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG UK
| | - Ahsan R. Akram
- MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Graeme Dickie
- Usher Institute, University of Edinburgh, Doorway 1, Medical School, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG UK
| | - Melanie Mackean
- Edinburgh Cancer Centre, Western General Hospital, Crewe Road South, Edinburgh, EH4 2XU UK
| | - Edwin J. R. van Beek
- Edinburgh Imaging, Queen’s Medical Research Institute, University of Edinburgh, 49 Little France Crescent, Edinburgh, EH16 4TJ UK
| | - Frank Sullivan
- School of Medicine, University of St. Andrews, North Haugh, St. Andrews, KY16 9TF UK
| | - Robert J. Steele
- School of Medicine, University of Dundee, Ninewells Hospital, Dundee, DD1 9SY UK
| | - Aileen R. Neilson
- Usher Institute, University of Edinburgh, Doorway 1, Medical School, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG UK
| | - David Weller
- Usher Institute, University of Edinburgh, Doorway 1, Medical School, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG UK
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Cavers D, Nelson M, Rostron J, Robb KA, Brown LR, Campbell C, Akram AR, Dickie G, Mackean M, van Beek EJR, Sullivan F, Steele RJ, Neilson AR, Weller D. Optimizing the implementation of lung cancer screening in Scotland: Focus group participant perspectives in the LUNGSCOT study. Health Expect 2022; 25:3246-3258. [PMID: 36263948 PMCID: PMC9700133 DOI: 10.1111/hex.13632] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 09/15/2022] [Accepted: 10/05/2022] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Targeted lung cancer screening is effective in reducing lung cancer and all-cause mortality according to major trials in the United Kingdom and Europe. However, the best ways of implementing screening in local communities requires an understanding of the population the programme will serve. We undertook a study to explore the views of those potentially eligible for, and to identify potential barriers and facilitators to taking part in, lung screening, to inform the development of a feasibility study. METHODS Men and women aged 45-70, living in urban and rural Scotland, and either self-reported people who smoke or who recently quit, were invited to take part in the study via research agency Taylor McKenzie. Eleven men and 14 women took part in three virtual focus groups exploring their views on lung screening. Focus group transcripts were transcribed and analysed using thematic analysis, assisted by QSR NVivo. FINDINGS Three overarching themes were identified: (1) Knowledge, awareness and acceptability of lung screening, (2) Barriers and facilitators to screening and (3) Promoting screening and implementation ideas. Participants were largely supportive of lung screening in principle and described the importance of the early detection of cancer. Emotional and psychological concerns as well as system-level and practical issues were discussed as posing barriers and facilitators to lung screening. CONCLUSIONS Understanding the views of people potentially eligible for a lung health check can usefully inform the development of a further study to test the feasibility and acceptability of lung screening in Scotland. PATIENT OR PUBLIC CONTRIBUTION The LUNGSCOT study has convened a patient advisory group to advise on all aspects of study development and implementation. Patient representatives commented on the focus group study design, study materials and ethics application, and two representatives read the focus group transcripts.
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Affiliation(s)
- Debbie Cavers
- Edinburgh Clinical Trials Unit, Usher InstituteUniversity of EdinburghEdinburghUK
| | - Mia Nelson
- Edinburgh Clinical Trials Unit, Usher InstituteUniversity of EdinburghEdinburghUK
| | - Jasmin Rostron
- Edinburgh Clinical Trials Unit, Usher InstituteUniversity of EdinburghEdinburghUK
- Present address:
The National Institute of Economic and Social Research2 Dean Trench Street, London NW1P 3HEUK
| | - Kathryn A. Robb
- School of Health and WellbeingUniversity of GlasgowGlasgowUK
| | | | - Christine Campbell
- Edinburgh Clinical Trials Unit, Usher InstituteUniversity of EdinburghEdinburghUK
| | - Ahsan R. Akram
- Centre for Inflammation Research and Edinburgh Cancer Research CentreUniversity of EdinburghEdinburghUK
| | - Graeme Dickie
- Care of the Usher InstituteUniversity of Edinburgh, EdinburghEdinburghUK
| | | | - Edwin J. R. van Beek
- Edinburgh Imaging, Queen's Medical Research InstituteUniversity of EdinburghEdinburghUK
| | | | - Robert J. Steele
- School of Medicine, Ninewells HospitalUniversity of DundeeDundeeUK
| | - Aileen R. Neilson
- Edinburgh Clinical Trials Unit, Usher InstituteUniversity of EdinburghEdinburghUK
| | - David Weller
- Edinburgh Clinical Trials Unit, Usher InstituteUniversity of EdinburghEdinburghUK
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Leach J, Stares M, Langley B, Fenner F, Killean A, Barrie C, Maclennan K, Campbell S, Evans T, Tufail A, Harrow S, McMenemy M, Mackean M, Phillips I. Real-world outcomes for patients with inoperable stage III non-small cell lung cancer: a prognostic role for albumin? Lung Cancer 2022. [DOI: 10.1016/s0169-5002(22)00171-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Thomson F, Stratton C, Phillips I, Mackean M, Barrie C, Campbell S, Tufail A, Maclennan K, Evans T, Stares M. FP12.04 Obesity is Associated With Greater Overall Survival in Patients With Metastatic NSCLC Receiving First-Line Pembrolizumab. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Ding TEG, Thomson F, Stratton C, Cumming K, Barrie C, Maclennan K, Evans T, Campbell S, Tufail A, Mackean M, Phillips I, Stares M. Scottish Immunotherapy Prognostic Score: biomarker of systemic inflammation predicts response to first-line pembrolizumab for metastatic non-small cell lung cancer. Lung Cancer 2021. [DOI: 10.1016/s0169-5002(21)00301-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Ewing A, Meynert A, Churchman M, Grimes GR, Hollis RL, Herrington CS, Rye T, Bartos C, Croy I, Ferguson M, Lennie M, McGoldrick T, McPhail N, Siddiqui N, Dowson S, Glasspool R, Mackean M, Nussey F, McDade B, Ennis D, McMahon L, Matakidou A, Dougherty B, March R, Barrett JC, McNeish IA, Biankin AV, Roxburgh P, Gourley C, Semple CA. Structural Variants at the BRCA1/2 Loci are a Common Source of Homologous Repair Deficiency in High-grade Serous Ovarian Carcinoma. Clin Cancer Res 2021; 27:3201-3214. [PMID: 33741650 PMCID: PMC7610896 DOI: 10.1158/1078-0432.ccr-20-4068] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 01/29/2021] [Accepted: 03/16/2021] [Indexed: 12/27/2022]
Abstract
PURPOSE The abundance and effects of structural variation at BRCA1/2 in tumors are not well understood. In particular, the impact of these events on homologous recombination repair deficiency (HRD) has yet to be demonstrated. EXPERIMENTAL DESIGN Exploiting a large collection of whole-genome sequencing data from high-grade serous ovarian carcinoma (N = 205) together with matched RNA sequencing for the majority of tumors (N = 150), we have comprehensively characterized mutation and expression at BRCA1/2. RESULTS In addition to the known spectrum of short somatic mutations (SSM), we discovered that multi-megabase structural variants (SV) were a frequent, unappreciated source of BRCA1/2 disruption in these tumors, and we found a genome-wide enrichment for large deletions at the BRCA1/2 loci across the cohort. These SVs independently affected a substantial proportion of patients (16%) in addition to those affected by SSMs (24%), conferring HRD and impacting patient survival. We also detail compound deficiencies involving SSMs and SVs at both loci, demonstrating that the strongest risk of HRD emerges from combined SVs at both BRCA1 and BRCA2 in the absence of SSMs. Furthermore, these SVs are abundant and disruptive in other cancer types. CONCLUSIONS These results extend our understanding of the mutational landscape underlying HRD, increase the number of patients predicted to benefit from therapies exploiting HRD, and suggest there is currently untapped potential in SV detection for patient stratification.
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Affiliation(s)
- Ailith Ewing
- MRC Human Genetics Unit, MRC IGMM, University of Edinburgh, Edinburgh, Scotland, United Kingdom.
| | - Alison Meynert
- MRC Human Genetics Unit, MRC IGMM, University of Edinburgh, Edinburgh, Scotland, United Kingdom
| | - Michael Churchman
- Nicola Murray Centre for Ovarian Cancer Research, Cancer Research UK Edinburgh Centre, MRC IGMM, University of Edinburgh, Edinburgh, Scotland, United Kingdom
| | - Graeme R Grimes
- MRC Human Genetics Unit, MRC IGMM, University of Edinburgh, Edinburgh, Scotland, United Kingdom
| | - Robert L Hollis
- Nicola Murray Centre for Ovarian Cancer Research, Cancer Research UK Edinburgh Centre, MRC IGMM, University of Edinburgh, Edinburgh, Scotland, United Kingdom
| | - C Simon Herrington
- Nicola Murray Centre for Ovarian Cancer Research, Cancer Research UK Edinburgh Centre, MRC IGMM, University of Edinburgh, Edinburgh, Scotland, United Kingdom
- Edinburgh Pathology, Cancer Research UK Edinburgh Centre, MRC IGMM, University of Edinburgh, Edinburgh, Scotland, United Kingdom
| | - Tzyvia Rye
- Nicola Murray Centre for Ovarian Cancer Research, Cancer Research UK Edinburgh Centre, MRC IGMM, University of Edinburgh, Edinburgh, Scotland, United Kingdom
| | - Clare Bartos
- Nicola Murray Centre for Ovarian Cancer Research, Cancer Research UK Edinburgh Centre, MRC IGMM, University of Edinburgh, Edinburgh, Scotland, United Kingdom
| | - Ian Croy
- Nicola Murray Centre for Ovarian Cancer Research, Cancer Research UK Edinburgh Centre, MRC IGMM, University of Edinburgh, Edinburgh, Scotland, United Kingdom
| | - Michelle Ferguson
- Department of Oncology, Ninewells Hospital, NHS Tayside, Dundee, Scotland, United Kingdom
- Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Dundee, Scotland, United Kingdom
| | - Mairi Lennie
- Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Dundee, Scotland, United Kingdom
| | - Trevor McGoldrick
- Department of Oncology, Aberdeen Royal Infirmary, Aberdeen, Scotland, United Kingdom
- Institute of Education for Medical and Dental Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, Scotland, United Kingdom
| | - Neil McPhail
- Department of Oncology, Raigmore Hospital, NHS Highland, Inverness, Scotland, United Kingdom
| | - Nadeem Siddiqui
- Department of Gynaecological Oncology, Glasgow Royal Infirmary, Glasgow, Scotland, United Kingdom
| | - Suzanne Dowson
- Institute of Cancer Sciences, Wolfson Wohl Cancer Research Centre, University of Glasgow, Glasgow, Scotland, United Kingdom
| | - Rosalind Glasspool
- Beatson West of Scotland Cancer Centre and University of Glasgow, Glasgow, Scotland, United Kingdom
| | - Melanie Mackean
- Edinburgh Cancer Centre, Western General Hospital, NHS Lothian, Edinburgh, Scotland, United Kingdom
| | - Fiona Nussey
- Edinburgh Cancer Centre, Western General Hospital, NHS Lothian, Edinburgh, Scotland, United Kingdom
| | - Brian McDade
- Institute of Cancer Sciences, Wolfson Wohl Cancer Research Centre, University of Glasgow, Glasgow, Scotland, United Kingdom
| | - Darren Ennis
- Institute of Cancer Sciences, Wolfson Wohl Cancer Research Centre, University of Glasgow, Glasgow, Scotland, United Kingdom
- Ovarian Cancer Action Research Centre, Department of Surgery and Cancer, Imperial College London, London, England, United Kingdom
| | - Lynn McMahon
- Precision Medicine Scotland (PMS-IC), Queen Elizabeth University Hospital, Glasgow, Scotland, United Kingdom
| | - Athena Matakidou
- Discovery Sciences, BioPharmaceuticals R&D, AstraZeneca, Cambridge, England, United Kingdom
| | - Brian Dougherty
- Translational Medicine, Oncology R&D, AstraZeneca, Waltham, Massachusetts
| | - Ruth March
- Precision Medicine, Oncology R&D, AstraZeneca, Cambridge, England, United Kingdom
| | - J Carl Barrett
- Translational Medicine, Oncology R&D, AstraZeneca, Waltham, Massachusetts
| | - Iain A McNeish
- Institute of Cancer Sciences, Wolfson Wohl Cancer Research Centre, University of Glasgow, Glasgow, Scotland, United Kingdom
- Beatson West of Scotland Cancer Centre and University of Glasgow, Glasgow, Scotland, United Kingdom
- Ovarian Cancer Action Research Centre, Department of Surgery and Cancer, Imperial College London, London, England, United Kingdom
| | - Andrew V Biankin
- Institute of Cancer Sciences, Wolfson Wohl Cancer Research Centre, University of Glasgow, Glasgow, Scotland, United Kingdom
- West of Scotland Pancreatic Unit, Glasgow Royal Infirmary, Glasgow, Scotland, United Kingdom
- South Western Sydney Clinical School, Faculty of Medicine, University of NSW, Liverpool, New South Wales, Australia
| | - Patricia Roxburgh
- Institute of Cancer Sciences, Wolfson Wohl Cancer Research Centre, University of Glasgow, Glasgow, Scotland, United Kingdom
- Beatson West of Scotland Cancer Centre and University of Glasgow, Glasgow, Scotland, United Kingdom
| | - Charlie Gourley
- Nicola Murray Centre for Ovarian Cancer Research, Cancer Research UK Edinburgh Centre, MRC IGMM, University of Edinburgh, Edinburgh, Scotland, United Kingdom
| | - Colin A Semple
- MRC Human Genetics Unit, MRC IGMM, University of Edinburgh, Edinburgh, Scotland, United Kingdom
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Torrance F, Purshouse K, Hall P, Mackean M, Phillips I. MA10.10 Lung Cancer Admission Rates During the COVID-19 Pandemic to a Tertiary Cancer Centre in South East Scotland. J Thorac Oncol 2021. [PMCID: PMC7976859 DOI: 10.1016/j.jtho.2021.01.246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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12
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Boh Z, Phillips I, Barrie C, Mackean M. P76.89 Is it Possible to Halt Cachexia in Poor Performance Patients with Metastatic EGFR Positive Lung Cancer? J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.1146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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13
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Glanville L, Phillips I, Mackean M, Reid P, Boellert F, Mencnarowski J, Borthwick D, Little F, Maclennan K, Tufail A, Evans T, Barrie C, Campbell S. P09.32 Is the New Patient Respiratory Appointment an Appropriate Time to Refer Patients With Likely Lung Cancer for Prehabilitation? J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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14
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Hollis RL, Thomson JP, Stanley B, Churchman M, Meynert AM, Rye T, Bartos C, Iida Y, Croy I, Mackean M, Nussey F, Okamoto A, Semple CA, Gourley C, Herrington CS. Molecular stratification of endometrioid ovarian carcinoma predicts clinical outcome. Nat Commun 2020; 11:4995. [PMID: 33020491 PMCID: PMC7536188 DOI: 10.1038/s41467-020-18819-5] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [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: 03/02/2020] [Accepted: 09/11/2020] [Indexed: 01/06/2023] Open
Abstract
Endometrioid ovarian carcinoma (EnOC) demonstrates substantial clinical and molecular heterogeneity. Here, we report whole exome sequencing of 112 EnOC cases following rigorous pathological assessment. We detect a high frequency of mutation in CTNNB1 (43%), PIK3CA (43%), ARID1A (36%), PTEN (29%), KRAS (26%), TP53 (26%) and SOX8 (19%), a recurrently-mutated gene previously unreported in EnOC. POLE and mismatch repair protein-encoding genes were mutated at lower frequency (6%, 18%) with significant co-occurrence. A molecular taxonomy is constructed, identifying clinically distinct EnOC subtypes: cases with TP53 mutation demonstrate greater genomic complexity, are commonly FIGO stage III/IV at diagnosis (48%), are frequently incompletely debulked (44%) and demonstrate inferior survival; conversely, cases with CTNNB1 mutation, which is mutually exclusive with TP53 mutation, demonstrate low genomic complexity and excellent clinical outcome, and are predominantly stage I/II at diagnosis (89%) and completely resected (87%). Moreover, we identify the WNT, MAPK/RAS and PI3K pathways as good candidate targets for molecular therapeutics in EnOC.
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Affiliation(s)
- Robert L Hollis
- Nicola Murray Centre for Ovarian Cancer Research, Cancer Research UK Edinburgh Centre, MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - John P Thomson
- Nicola Murray Centre for Ovarian Cancer Research, Cancer Research UK Edinburgh Centre, MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Barbara Stanley
- Nicola Murray Centre for Ovarian Cancer Research, Cancer Research UK Edinburgh Centre, MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Michael Churchman
- Nicola Murray Centre for Ovarian Cancer Research, Cancer Research UK Edinburgh Centre, MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Alison M Meynert
- MRC Human Genetics Unit, MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Tzyvia Rye
- Nicola Murray Centre for Ovarian Cancer Research, Cancer Research UK Edinburgh Centre, MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Clare Bartos
- Nicola Murray Centre for Ovarian Cancer Research, Cancer Research UK Edinburgh Centre, MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Yasushi Iida
- Nicola Murray Centre for Ovarian Cancer Research, Cancer Research UK Edinburgh Centre, MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK.,The Jikei University School of Medicine, Tokyo, Japan
| | - Ian Croy
- Nicola Murray Centre for Ovarian Cancer Research, Cancer Research UK Edinburgh Centre, MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Melanie Mackean
- Edinburgh Cancer Centre, Western General Hospital, Edinburgh, UK
| | - Fiona Nussey
- Edinburgh Cancer Centre, Western General Hospital, Edinburgh, UK
| | - Aikou Okamoto
- The Jikei University School of Medicine, Tokyo, Japan
| | - Colin A Semple
- MRC Human Genetics Unit, MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Charlie Gourley
- Nicola Murray Centre for Ovarian Cancer Research, Cancer Research UK Edinburgh Centre, MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - C Simon Herrington
- Nicola Murray Centre for Ovarian Cancer Research, Cancer Research UK Edinburgh Centre, MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK.
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15
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Middleton G, Fletcher P, Popat S, Savage J, Summers Y, Greystoke A, Gilligan D, Cave J, O'Rourke N, Brewster A, Toy E, Spicer J, Jain P, Dangoor A, Mackean M, Forster M, Farley A, Wherton D, Mehmi M, Sharpe R, Mills TC, Cerone MA, Yap TA, Watkins TBK, Lim E, Swanton C, Billingham L. Publisher Correction: The National Lung Matrix Trial of personalized therapy in lung cancer. Nature 2020; 585:E21. [PMID: 32887973 DOI: 10.1038/s41586-020-2656-3] [Citation(s) in RCA: 1] [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: 11/09/2022]
Abstract
An amendment to this paper has been published and can be accessed via a link at the top of the paper.
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Affiliation(s)
- Gary Middleton
- Institute of Immunology & Immunotherapy, University of Birmingham, Birmingham, UK. .,University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
| | - Peter Fletcher
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | | | - Joshua Savage
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | | | | | | | - Judith Cave
- Southampton University Hospitals NHS Trust, Southampton, UK
| | | | | | - Elizabeth Toy
- Royal Devon and Exeter Foundation NHS Trust, Exeter, UK
| | - James Spicer
- King's College London, Guy's Hospital, London, UK
| | - Pooja Jain
- St James's University Hospital, Leeds, UK
| | - Adam Dangoor
- Bristol Haematology and Oncology Centre, Bristol, UK
| | | | | | - Amanda Farley
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Dee Wherton
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Manita Mehmi
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Rowena Sharpe
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | | | | | - Timothy A Yap
- The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | | | | | - Charles Swanton
- The Francis Crick Institute, London, UK.,Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, University College London, London, UK
| | - Lucinda Billingham
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
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16
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Middleton G, Fletcher P, Popat S, Savage J, Summers Y, Greystoke A, Gilligan D, Cave J, O'Rourke N, Brewster A, Toy E, Spicer J, Jain P, Dangoor A, Mackean M, Forster M, Farley A, Wherton D, Mehmi M, Sharpe R, Mills TC, Cerone MA, Yap TA, Watkins TBK, Lim E, Swanton C, Billingham L. The National Lung Matrix Trial of personalized therapy in lung cancer. Nature 2020; 583:807-812. [PMID: 32669708 PMCID: PMC7116732 DOI: 10.1038/s41586-020-2481-8] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [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: 01/28/2020] [Accepted: 06/08/2020] [Indexed: 02/06/2023]
Abstract
The majority of targeted therapies for non-small-cell lung cancer (NSCLC) are directed against oncogenic drivers that are more prevalent in patients with light exposure to tobacco smoke1-3. As this group represents around 20% of all patients with lung cancer, the discovery of stratified medicine options for tobacco-associated NSCLC is a high priority. Umbrella trials seek to streamline the investigation of genotype-based treatments by screening tumours for multiple genomic alterations and triaging patients to one of several genotype-matched therapeutic agents. Here we report the current outcomes of 19 drug-biomarker cohorts from the ongoing National Lung Matrix Trial, the largest umbrella trial in NSCLC. We use next-generation sequencing to match patients to appropriate targeted therapies on the basis of their tumour genotype. The Bayesian trial design enables outcome data from open cohorts that are still recruiting to be reported alongside data from closed cohorts. Of the 5,467 patients that were screened, 2,007 were molecularly eligible for entry into the trial, and 302 entered the trial to receive genotype-matched therapy-including 14 that re-registered to the trial for a sequential trial drug. Despite pre-clinical data supporting the drug-biomarker combinations, current evidence shows that a limited number of combinations demonstrate clinically relevant benefits, which remain concentrated in patients with lung cancers that are associated with minimal exposure to tobacco smoke.
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Affiliation(s)
- Gary Middleton
- Institute of Immunology & Immunotherapy, University of Birmingham, Birmingham, UK.
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
| | - Peter Fletcher
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | | | - Joshua Savage
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | | | | | | | - Judith Cave
- Southampton University Hospitals NHS Trust, Southampton, UK
| | | | | | - Elizabeth Toy
- Royal Devon and Exeter Foundation NHS Trust, Exeter, UK
| | - James Spicer
- King's College London, Guy's Hospital, London, UK
| | - Pooja Jain
- St James's University Hospital, Leeds, UK
| | - Adam Dangoor
- Bristol Haematology and Oncology Centre, Bristol, UK
| | | | | | - Amanda Farley
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Dee Wherton
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Manita Mehmi
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Rowena Sharpe
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | | | | | - Timothy A Yap
- The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | | | | | - Charles Swanton
- The Francis Crick Institute, London, UK
- Cancer Research UK Lung Cancer Centre of Excellence, University College London Cancer Institute, University College London, London, UK
| | - Lucinda Billingham
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
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17
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Irodi A, Rye T, Herbert K, Churchman M, Bartos C, Mackean M, Nussey F, Herrington CS, Gourley C, Hollis RL. Patterns of clinicopathological features and outcome in epithelial ovarian cancer patients: 35 years of prospectively collected data. BJOG 2020; 127:1409-1420. [PMID: 32285600 DOI: 10.1111/1471-0528.16264] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Investigate the clinical landscape of ovarian carcinoma (OC) over time. DESIGN Register-based prospectively collected data. SETTING South East Scotland. SAMPLE A total of 2805 OC patients diagnosed in 1981-2015. METHODS Survival times were visualised using the Kaplan-Meier method; median survival, 5-year survival probabilities and associated restricted mean survival time analyses were used to quantify survival differences. MAIN OUTCOME MEASURES Disease-specific survival. RESULTS A significant increase in disease-specific survival (DSS) from 1981-1985 to 2011-2015 was observed (median 1.73 versus 4.23 years, P < 0.0001). Corresponding increase in progression-free survival (PFS) was not statistically significant (median 1.22 versus 1.58 years, P = 0.2568). An increase in the proportion of cases with low residual disease volume (RD) (<2 cm RD) following debulking was observed (54.0% versus 87.7%, P < 0.0001). The proportion of high grade serous (HGS) cases increased (P < 0.0001), whereas endometrioid and mucinous cases decreased (P = 0.0005 and P = 0.0002). Increases in stage IV HGS OC incidence (P = 0.0009) and stage IV HGS OC DSS (P = 0.0122) were observed. Increasing median age at diagnosis correlated with increasing Eastern Cooperative Oncology Group Performance Status (ECOG PS) over time (r = 0.86). CONCLUSIONS OC DSS has improved over the last 35 years. PFS has not significantly increased, highlighting that improvement in outcome has been limited to extending post-relapse survival. Distribution of stage at diagnosis, histological subtype and RD following debulking has changed over time, reflecting evolution in tumour classification, staging and optimal debulking definitions (from low RD to minimal or zero RD). Histology, stage, RD and ECOG PS remain reliable outcome predictors. Increasing median age at diagnosis and ECOG PS indicates demographic shifts in the clinical population. TWEETABLE ABSTRACT Significant improvement in ovarian carcinoma survival has been seen over time. Most of this improvement is due to an extension of survival following disease relapse.
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Affiliation(s)
- A Irodi
- Nicola Murray Centre for Ovarian Cancer Research, Cancer Research UK Edinburgh Centre, MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - T Rye
- Nicola Murray Centre for Ovarian Cancer Research, Cancer Research UK Edinburgh Centre, MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - K Herbert
- Nicola Murray Centre for Ovarian Cancer Research, Cancer Research UK Edinburgh Centre, MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK.,Oxford Cancer Centre, Churchill Hospital, Oxford, UK
| | - M Churchman
- Nicola Murray Centre for Ovarian Cancer Research, Cancer Research UK Edinburgh Centre, MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - C Bartos
- Nicola Murray Centre for Ovarian Cancer Research, Cancer Research UK Edinburgh Centre, MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - M Mackean
- Edinburgh Cancer Centre, Western General Hospital, Edinburgh, UK
| | - F Nussey
- Edinburgh Cancer Centre, Western General Hospital, Edinburgh, UK
| | - C S Herrington
- Nicola Murray Centre for Ovarian Cancer Research, Cancer Research UK Edinburgh Centre, MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - C Gourley
- Nicola Murray Centre for Ovarian Cancer Research, Cancer Research UK Edinburgh Centre, MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - R L Hollis
- Nicola Murray Centre for Ovarian Cancer Research, Cancer Research UK Edinburgh Centre, MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
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18
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Killean A, Phillips I, Collinson C, Patrizio A, Evans T, Little F, Campbell S, Tufail A, Barrie C, Mackean M. Comparing methods of evaluating sarcopenia in stage III/IV lung cancer. Lung Cancer 2020. [DOI: 10.1016/s0169-5002(20)30224-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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19
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Collinson C, Killean A, Tufail A, Evans T, Mackean M, Maclennan K, Little F, Barrie C, Campbell S, Patrizio A, Phillips I. Detecting early weight loss in patients with advanced lung cancer. Lung Cancer 2020. [DOI: 10.1016/s0169-5002(20)30216-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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20
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Hollis RL, Stanley B, Iida Y, Thomson J, Churchman M, Rye T, Mackean M, Nussey F, Gourley C, Herrington CS. Hormone receptor expression patterns define clinically meaningful subgroups of endometrioid ovarian carcinoma. Gynecol Oncol 2019; 155:318-323. [PMID: 31495455 PMCID: PMC6854467 DOI: 10.1016/j.ygyno.2019.09.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 08/28/2019] [Accepted: 09/02/2019] [Indexed: 01/15/2023]
Abstract
Background Numerous studies have investigated the association between hormone receptor expression and clinical outcome in ovarian carcinoma (OC); however, these have largely focussed on serous OCs, with few studies reporting specifically on endometrioid OCs (EnOC). Where analyses have been stratified by histotype, expression has been assessed using the percentage of positive tumor cells, without accounting for nuclear expression intensity. Methods Here we assess the expression levels of progesterone receptor (PR), estrogen receptor alpha (ER) and androgen receptor (AR) using histoscore – a nuclear scoring method incorporating both proportion of positive cells and the intensity of nuclear staining – across a cohort of 107 WT1 negative EnOCs. Results Hierarchical clustering by PR, ER and AR histoscores identified four EnOC subgroups (PR+/ER+, PR+/ER−, PR−/ER+ and PR−/ER−). EnOC patients in the PR+/ER+ and PR+/ER− groups displayed favorable outcome (multivariable HR for disease-specific survival 0.05 [0.01–0.35] and 0.05 [0.00–0.51]) compared to the PR−/ER+ group. Ten-year survival for stage II PRhigh and PRlow cases was 94.1% and 42.4%. ERhigh EnOC patients (PR+/ER+, PR−/ER+) had higher body mass index compared to ERlow cases (P = 0.015) and high grade serous OC patients (P < 0.001). Conclusion These data demonstrate that endometrioid OC cases with high PR expression display markedly favorable outcome. Stage II EnOCs with high PR expression represent potential candidates for de-escalation of first-line therapy. Future work should seek to characterise the sensitivity of PR and ER positive EnOCs to endocrine therapy. We identify four subgroups of endometrioid ovarian carcinoma (EnOC) defined by hormone receptor expression patterns. EnOC patients in the PRhigh (PR+/ER+, PR+/ER−) groups demonstrate markedly favorable outcome. Stage II EnOC patients in the PRhigh groups display a ten-year survival of approximately 95%. ERhigh (PR+/ER+, PR−/ER+) EnOC patients had a higher body mass index vs ERlow cases and high grade serous carcinoma patients.
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Affiliation(s)
- Robert L Hollis
- Nicola Murray Centre for Ovarian Cancer Research, Cancer Research UK Edinburgh Centre, MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, UK.
| | - Barbara Stanley
- Nicola Murray Centre for Ovarian Cancer Research, Cancer Research UK Edinburgh Centre, MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, UK
| | - Yasushi Iida
- Nicola Murray Centre for Ovarian Cancer Research, Cancer Research UK Edinburgh Centre, MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, UK; Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - John Thomson
- Nicola Murray Centre for Ovarian Cancer Research, Cancer Research UK Edinburgh Centre, MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, UK
| | - Michael Churchman
- Nicola Murray Centre for Ovarian Cancer Research, Cancer Research UK Edinburgh Centre, MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, UK
| | - Tzyvia Rye
- Nicola Murray Centre for Ovarian Cancer Research, Cancer Research UK Edinburgh Centre, MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, UK
| | - Melanie Mackean
- Edinburgh Cancer Centre, Western General Hospital, Edinburgh, UK
| | - Fiona Nussey
- Edinburgh Cancer Centre, Western General Hospital, Edinburgh, UK
| | - Charlie Gourley
- Nicola Murray Centre for Ovarian Cancer Research, Cancer Research UK Edinburgh Centre, MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, UK
| | - C Simon Herrington
- Nicola Murray Centre for Ovarian Cancer Research, Cancer Research UK Edinburgh Centre, MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, UK
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21
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Gore M, Hackshaw A, Brady WE, Penson RT, Zaino R, McCluggage WG, Ganesan R, Wilkinson N, Perren T, Montes A, Summers J, Lord R, Dark G, Rustin G, Mackean M, Reed N, Kehoe S, Frumovitz M, Christensen H, Feeney A, Ledermann J, Gershenson DM. An international, phase III randomized trial in patients with mucinous epithelial ovarian cancer (mEOC/GOG 0241) with long-term follow-up: and experience of conducting a clinical trial in a rare gynecological tumor. Gynecol Oncol 2019; 153:541-548. [PMID: 31005287 PMCID: PMC6559214 DOI: 10.1016/j.ygyno.2019.03.256] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [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: 02/07/2019] [Accepted: 03/26/2019] [Indexed: 12/18/2022]
Abstract
Objectives We evaluated four different treatment regimens for advanced-stage mucinous epithelial ovarian cancer. Methods We conducted a multicenter randomized factorial trial (UK and US). Patients were diagnosed with primary mEOC: FIGO stage II–IV or recurrence after stage I disease. Treatment arms were paclitaxel-carboplatin, oxaliplatin-capecitabine, paclitaxel-carboplatin-bevacizumab, or oxaliplatin-capecitabine-bevacizumab. Chemotherapy was given 3-weekly for 6 cycles, and bevacizumab (3-weekly) was continued as maintenance (for 12 cycles). Endpoints included overall-survival (OS), progression-free survival (PFS), toxicity and quality of life (QoL). Results The trial stopped after 50 patients were recruited due to slow accrual. Median follow-up was 59 months. OS hazard ratios (HR) for the two main comparisons were: 0.78 (p = 0.48) for Oxal-Cape vs. Pac-Carbo (each with/without bevacizumab), and 1.04 (p = 0.92) for bevacizumab vs. no bevacizumab. Corresponding PFS HRs were: 0.84 and 0.80. Retrospective central pathology review revealed only 45% (18/40) cases with available material had confirmed primary mEOC. Among these, OS HR for Oxal-Cape vs. Pac-Carbo was 0.36 (p = 0.14); PFS HR = 0.62 (p = 0.40). Grade 3–4 toxicity was seen in 61% Pac-Carbo, 61% Oxal-Cape, 54% Pac-Carbo-Bev, and 85% Oxal-Cape-Bev. QoL was similar between the four arms. Conclusion mEOC/GOG0241 represents an example of a randomized rare tumor trial. Logistical challenges led to early termination, including difficulties in local histopathological diagnosis and accessing drugs outside their labelled indication. There was misalignment between central funders who support clinical trials in rare cancers and the deprioritisation of such work by those managing and funding research at a local level. Rare cancer trials should include centralised pathology review before treatment. Clinical trial registry number: ISRCTN83438782. mEOC/GOG-0241 is one of the first international rare tumor trials. Oxaliplatin/capecitabine might be worth further study. Long-term follow-up is feasible in rare tumors. Challenges were lack of local resources and funding for experimental licenced therapies.
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Affiliation(s)
- Martin Gore
- Royal Marsden NHS Foundation Trust, London, UK
| | - Allan Hackshaw
- Cancer Research UK & UCL Cancer Trials Centre, London, UK.
| | | | | | - Richard Zaino
- Penn State Health Milton S. Hershey Medical Centre, PA, USA
| | | | | | - Nafisa Wilkinson
- University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Ana Montes
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Jeffrey Summers
- Maidstone and Tunbridge Wells NHS Foundation Trust, Kent, UK
| | - Rosemary Lord
- Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, UK
| | - Graham Dark
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | | | | | | | - Sean Kehoe
- Institute of Cancer and Genomics, University of Birmingham, Birmingham, UK
| | | | | | - Amanda Feeney
- Cancer Research UK & UCL Cancer Trials Centre, London, UK
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22
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Blagden S, Bertelli G, Frangou E, Butcher C, Love S, Mackean M, Glasspool R, Cook A, Nicum S, Lord R, Ferguson M, Roux R, Martinez M, Black S, James A, Palmer H, Hughes S, Marriott C, Howells L. OVPSYCH2: A randomised study of psychological support versus standard of care following chemotherapy for ovarian cancer. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy285.149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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23
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Rust K, Spiliopoulou P, Tang CY, Bell C, Stirling D, Phang T, Davidson R, Mackean M, Nussey F, Glasspool RM, Reed NS, Sadozye A, Porteous M, McGoldrick T, Ferguson M, Miedzybrodzka Z, McNeish IA, Gourley C. Routine germline BRCA1 and BRCA2 testing in patients with ovarian carcinoma: analysis of the Scottish real-life experience. BJOG 2018; 125:1451-1458. [PMID: 29460478 DOI: 10.1111/1471-0528.15171] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [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] [Accepted: 01/26/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To determine the rates of germline BRCA1 and BRCA2 mutations in Scottish patients with ovarian cancer, before and after a change in testing policy. DESIGN Retrospective cohort study. SETTING Four cancer/genetics centres in Scotland. POPULATION Patients with ovarian cancer undergoing germline BRCA1 and BRCA2 (gBRCA1/2) sequencing before 2013 (under the 'old criteria', with selection based solely on family history), after 2013 (under the 'new criteria', with sequencing offered to newly presenting patients with non-mucinous ovarian cancer), and in the 'prevalent population' (who presented before 2013, but were not eligible for sequencing under the old criteria but were sequenced under the new criteria). METHODS Clinicopathological and sequence data were collected before and for 18 months after this change in selection criteria. MAIN OUTCOME MEASURES Frequency of germline BRCA1, BRCA2, RAD51C, and RAD51D mutations. RESULTS Of 599 patients sequenced, 205, 236, and 158 were in the 'old criteria', 'new criteria', and 'prevalent' populations, respectively. The frequency of gBRCA1/2 mutations was 30.7, 13.1, and 12.7%, respectively. The annual rate of gBRCA1/2 mutation detection was 4.2 before and 20.7 after the policy change. A total of 48% (15/31) 'new criteria' patients with gBRCA1/2 mutations had a Manchester score of <15 and would not have been offered sequencing based on family history criteria. In addition, 20 patients with gBRCA1/2 were identified in the prevalent population. The prevalence of gBRCA1/2 mutations in patients aged >70 years was 8.2%. CONCLUSIONS Sequencing all patients with non-mucinous ovarian cancer gives a much higher annual gBRCA1/2 mutation detection rate, with the frequency of positive tests still exceeding the 10% threshold upon which many family history-based models operate. TWEETABLE ABSTRACT BRCA sequencing all non-mucinous cancer patients increases mutation detection five fold.
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Affiliation(s)
- K Rust
- Edinburgh Cancer Centre, Edinburgh, UK
| | | | - C Y Tang
- Department of Oncology, Ninewells Hospital, Dundee, UK
| | - C Bell
- Department of Medical Genetics, NHS Grampian, Aberdeen, UK
| | - D Stirling
- Department of Clinical Genetics, Western General Hospital, Edinburgh, UK
| | - Thf Phang
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - R Davidson
- Department of Genetics, Queen Elizabeth University Hospital, Glasgow, UK
| | - M Mackean
- Edinburgh Cancer Centre, Edinburgh, UK
| | - F Nussey
- Edinburgh Cancer Centre, Edinburgh, UK
| | | | - N S Reed
- Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - A Sadozye
- Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - M Porteous
- Department of Clinical Genetics, Western General Hospital, Edinburgh, UK
| | - T McGoldrick
- Department of Oncology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - M Ferguson
- Department of Oncology, Ninewells Hospital, Dundee, UK
| | - Z Miedzybrodzka
- Department of Medical Genetics, NHS Grampian, Aberdeen, UK
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - I A McNeish
- Beatson West of Scotland Cancer Centre, Glasgow, UK
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - C Gourley
- Edinburgh Cancer Centre, Edinburgh, UK
- Nicola Murray Centre for Ovarian Cancer Research, University of Edinburgh Cancer Research UK Centre, MRC IGMM, Western General Hospital, Edinburgh, UK
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Hollis RL, Meynert AM, Churchman M, Rye T, Mackean M, Nussey F, Arends MJ, Sims AH, Semple CA, Herrington CS, Gourley C. Enhanced response rate to pegylated liposomal doxorubicin in high grade serous ovarian carcinomas harbouring BRCA1 and BRCA2 aberrations. BMC Cancer 2018; 18:16. [PMID: 29298688 PMCID: PMC5753521 DOI: 10.1186/s12885-017-3981-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 02/06/2017] [Accepted: 12/22/2017] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Approximately 10-15% of ovarian carcinomas (OC) are attributed to inherited susceptibility, the majority of which are due to mutations in BRCA1 or BRCA2 (BRCA1/2). These patients display superior clinical outcome, including enhanced sensitivity to platinum-based chemotherapy. Here, we seek to investigate whether BRCA1/2 status influences the response rate to single-agent pegylated liposomal doxorubicin (PLD) in high grade serous (HGS) OC. METHODS One hundred and forty-eight patients treated with single-agent PLD were identified retrospectively from the Edinburgh Ovarian Cancer Database. DNA was extracted from formalin-fixed paraffin-embedded (FFPE) archival tumour material and sequenced using the Ion Ampliseq BRCA1 and BRCA2 panel. A minimum variant allele frequency threshold was applied to correct for sequencing artefacts associated with formalin fixation. RESULTS A superior response rate to PLD was observed in patients with HGS OC who harboured variants likely to affect BRCA1 or BRCA2 function compared to the BRCA1/2 wild-type population (36%, 9 of 25 patients versus 12.1%, 7 of 58 patients; p = 0.016). An enhanced response rate was also seen in patients harbouring only the BRCA1 SNP rs1799950, predicted to be detrimental to BRCA1 function (50%, 3 of 6 patients versus 12.1%, 7 of 58 patients; p = 0.044). CONCLUSIONS These data demonstrate that HGS OC patients with BRCA1/2 variants predicted damaging to protein function experience superior sensitivity to PLD, consistent with impaired DNA repair. Further characterisation of rs1799950 is now warranted in relation to chemosensitivity and susceptibility to developing ovarian carcinoma.
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Affiliation(s)
- Robert L Hollis
- Nicola Murray Centre for Ovarian Cancer Research, Edinburgh Cancer Research UK Centre, MRC IGMM, University of Edinburgh, Western General Hospital, Crewe Road, Edinburgh, EH4 2XU, UK
| | - Alison M Meynert
- MRC Human Genetics Unit, MRC IGMM, University of Edinburgh, Edinburgh, UK
| | - Michael Churchman
- Nicola Murray Centre for Ovarian Cancer Research, Edinburgh Cancer Research UK Centre, MRC IGMM, University of Edinburgh, Western General Hospital, Crewe Road, Edinburgh, EH4 2XU, UK
| | - Tzyvia Rye
- Nicola Murray Centre for Ovarian Cancer Research, Edinburgh Cancer Research UK Centre, MRC IGMM, University of Edinburgh, Western General Hospital, Crewe Road, Edinburgh, EH4 2XU, UK
| | - Melanie Mackean
- Edinburgh Cancer Centre, Western General Hospital, Edinburgh, UK
| | - Fiona Nussey
- Edinburgh Cancer Centre, Western General Hospital, Edinburgh, UK
| | - Mark J Arends
- Division of Pathology, Centre for Comparative Pathology, Edinburgh Cancer Research Centre, MRC IGMM, University of Edinburgh, Edinburgh, UK
| | - Andrew H Sims
- Nicola Murray Centre for Ovarian Cancer Research, Edinburgh Cancer Research UK Centre, MRC IGMM, University of Edinburgh, Western General Hospital, Crewe Road, Edinburgh, EH4 2XU, UK
| | - Colin A Semple
- MRC Human Genetics Unit, MRC IGMM, University of Edinburgh, Edinburgh, UK
| | - C Simon Herrington
- Nicola Murray Centre for Ovarian Cancer Research, Edinburgh Cancer Research UK Centre, MRC IGMM, University of Edinburgh, Western General Hospital, Crewe Road, Edinburgh, EH4 2XU, UK.,Division of Pathology, Centre for Comparative Pathology, Edinburgh Cancer Research Centre, MRC IGMM, University of Edinburgh, Edinburgh, UK.,Department of Pathology, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Charlie Gourley
- Nicola Murray Centre for Ovarian Cancer Research, Edinburgh Cancer Research UK Centre, MRC IGMM, University of Edinburgh, Western General Hospital, Crewe Road, Edinburgh, EH4 2XU, UK. .,Edinburgh Cancer Centre, Western General Hospital, Edinburgh, UK.
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Szabo M, Heller N, Gallanagh M, Nussey F, Gourley C, Mackean M. Changes in cognitive impairment in ovarian cancer patients receiving chemotherapy; a pilot study. Eur J Cancer 2017. [DOI: 10.1016/s0959-8049(17)30630-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Price A, Campbell S, Erridge S, Ironside J, Little F, Evans T, Mackean M, Patrizio A. P2.02-008 How Do We Really Treat Patients with Stage III Non-Small Cell Lung Cancer (NSCLC)? J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2016.11.1155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Glasspool RM, Brown R, Gore ME, Rustin GJS, McNeish IA, Wilson RH, Pledge S, Paul J, Mackean M, Hall GD, Gabra H, Halford SER, Walker J, Appleton K, Ullah R, Kaye S. A randomised, phase II trial of the DNA-hypomethylating agent 5-aza-2'-deoxycytidine (decitabine) in combination with carboplatin vs carboplatin alone in patients with recurrent, partially platinum-sensitive ovarian cancer. Br J Cancer 2014; 110:1923-9. [PMID: 24642620 PMCID: PMC3992493 DOI: 10.1038/bjc.2014.116] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 02/05/2014] [Accepted: 02/09/2014] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Our previous laboratory and clinical data suggested that one mechanism underlying the development of platinum resistance in ovarian cancer is the acquisition of DNA methylation. We therefore tested the hypothesis that the DNA hypomethylating agent 5-aza-2'-deoxycytodine (decitabine) can reverse resistance to carboplatin in women with relapsed ovarian cancer. METHODS Patients progressing 6-12 months after previous platinum therapy were randomised to decitabine on day 1 and carboplatin (AUC 6) on day 8, every 28 days or carboplatin alone. The primary objective was response rate in patients with methylated hMLH1 tumour DNA in plasma. RESULTS After a pre-defined interim analysis, the study closed due to lack of efficacy and poor treatment deliverability in 15 patients treated with the combination. Responses by GCIG criteria were 9 out of 14 vs 3 out of 15 and by RECIST were 6 out of 13 vs 1 out of 12 for carboplatin and carboplatin/decitabine, respectively. Grade 3/4 neutropenia was more common with the combination (60% vs 15.4%) as was G2/3 carboplatin hypersensitivity (47% vs 21%). CONCLUSIONS With this schedule, the addition of decitabine appears to reduce rather than increase the efficacy of carboplatin in partially platinum-sensitive ovarian cancer and is difficult to deliver. Patient-selection strategies, different schedules and other demethylating agents should be considered in future combination studies.
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Affiliation(s)
- R M Glasspool
- The Beatson West of Scotland Cancer Centre, 1053 Great Western Road, Glasgow G12 0YN, UK
| | - R Brown
- Department Surgery and Cancer, Imperial College London, Hammersmith Hospital, London W12 0NN, UK
| | - M E Gore
- Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey SM2 5PT, UK
| | - G J S Rustin
- Mount Vernon Cancer Centre, Northwood, Middlesex HA6 2RN, UK
| | - I A McNeish
- St Bartholomew's Hospital, West Smithfield, London EC1A 7BE, UK
| | - R H Wilson
- Centre for Cancer Research and Cell Biology, Queen's University Belfast, Belfast BT9 7AB, N. Ireland, UK
| | - S Pledge
- Sheffield Weston Park Hospital, Whitham Road, Sheffield, South Yorkshire S10 2SJ, UK
| | - J Paul
- The Beatson West of Scotland Cancer Centre, 1053 Great Western Road, Glasgow G12 0YN, UK
| | - M Mackean
- Edinburgh Western General Hospital, Crewe Road S, Edinburgh EH4 2XU, UK
| | - G D Hall
- St James's Institute of Oncology, St James's University Hospital, Beckett Street, Leeds LS9 7TF, UK
| | - H Gabra
- Department Surgery and Cancer, Imperial College London, Hammersmith Hospital, London W12 0NN, UK
| | - S E R Halford
- Drug Development Office Cancer Research UK, Angel Building, 407 Street, John Street, Islington, London EC1V 4AD, UK
| | - J Walker
- Analytical Services Unit, Wolfson Wohl Cancer Research Centre, Institute of Cancer Sciences, University of Glasgow, Garscube Estate, Glasgow G61 1QH, UK
| | - K Appleton
- Analytical Services Unit, Wolfson Wohl Cancer Research Centre, Institute of Cancer Sciences, University of Glasgow, Garscube Estate, Glasgow G61 1QH, UK
| | - R Ullah
- Analytical Services Unit, Wolfson Wohl Cancer Research Centre, Institute of Cancer Sciences, University of Glasgow, Garscube Estate, Glasgow G61 1QH, UK
| | - S Kaye
- Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey SM2 5PT, UK
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McGoldrick T, Mackean M, Little F, Ironside J, Campbell S, Erridge S, Price A, Walsh K, Wallace W. 24 EGFR testing in NSCLC. The Edinburgh Cancer Centre experience of the first 100 tested. Lung Cancer 2013. [DOI: 10.1016/s0169-5002(13)70024-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Mackean M, Allen A, Price A, Ironside J, Erridge S, Campbell S, Patrizio A, Fergusson R. 180 Why do some patients with small cell lung cancer (SCLC) not get chemotherapy? Lung Cancer 2012. [DOI: 10.1016/s0169-5002(12)70181-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Helpman L, Ferguson SE, Mackean M, Rana A, Le L, Atkinson MA, Rogerson A, Mackay H. Complementary and alternative medicine use among women receiving chemotherapy for ovarian cancer in 2 patient populations. Int J Gynecol Cancer 2011; 21:587-93. [PMID: 21436708 DOI: 10.1097/igc.0b013e31820fa24a] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE The authors evaluated attitudes toward complementary and alternative medicine (CAM) use in 2 populations of women receiving chemotherapy for epithelial ovarian cancer (EOC). METHODS Women with EOC currently being treated with chemotherapy at 2 tertiary cancer centers, in Canada and the United Kingdom, completed a self-administered questionnaire on attitudes and perceptions of CAM and types of CAM used within the previous month. RESULTS One hundred ninety-two patients (94 from Canada, 98 from United Kingdom) completed the questionnaire. Overall, 85 women (44%) were identified as CAM users. Complementary and alternative medicine use was more common among Canadian women (52%) compared with women from the United Kingdom (37%), P = 0.02. Participants used 71 different types of CAM, the majority (61%) taking multiple CAM. The frequency of CAM use was the same in primary compared with recurrent disease. Eighty-nine percent of CAM users considered it important for their oncologist to be aware of CAM use. Canadian women, however, were less likely to inform their physician (Canada: 50%; United Kingdom: 81%), P = 0.02. Motivations for CAM use were the same in both populations including assist healing (60%), boost the immune system (57%), improve quality of life (48%), and relieve symptoms (45%). Thirteen percent thought CAM could cure cancer, whereas 17% thought it would prevent recurrence. CONCLUSIONS Complementary and alternative medicine use is common in women receiving chemotherapy for EOC. Increasingly, interactions between CAM and prescribed medication are being identified. Oncologists should be aware and actively inquire about CAM use. Although patterns of CAM use differed, the motivation for starting CAM was similar, highlighting the need to address supportive care in all patients.
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Affiliation(s)
- Limor Helpman
- Princess Margaret Hospital, University Health Network, University of Toronto, Ontario, Canada.
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Abstract
BACKGROUND The safety of conservative surgery and the benefit of additional interventions after surgery for borderline ovarian tumours are unknown. OBJECTIVES To evaluate the benefits and harm of different treatment modalities offered for borderline ovarian tumours. SEARCH STRATEGY We searched the Cochrane Gynaecological Cancer Group Trials Register to 2009, Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2008, Issue 4), MEDLINE and EMBASE to 2009. We also searched registers of clinical trials, abstracts of scientific meetings, reference lists of included studies. SELECTION CRITERIA Randomised controlled trials (RCTs) that compared different interventions in adult women diagnosed with borderline ovarian tumours of any histological variant. DATA COLLECTION AND ANALYSIS Two review authors independently abstracted data and assessed risk of bias. MAIN RESULTS We identified seven RCTs that enrolled 372 women. We could not pool results of trials as the treatment comparisons differed.Six RCTs (n = 340) conducted over 15 years ago, evaluated adjuvant therapy (chemotherapy, pelvic external irradiation or intra-peritoneal radioactive isotope therapy) after radical surgery; over 87% of participants had Stage I tumours. Most participants were followed up for over 10 years. Overall and recurrence-free survival were similar between both arms of these trials, except that one trial (n = 66) showed a significantly lower survival (P = 0.03) in women who received chemotherapy (thio-TEPA). Adverse effects of treatment were incompletely reported and all six trials were at high risk of bias.One further trial (n = 32) that recruited participants with bilateral serous tumours who were wishing fertility preservation, revealed a significantly increased chance of pregnancy (hazard ratio (HR) = 3.3, 95% CI 1.4 to 8.0) but non-significantly earlier disease recurrence (HR = 1.5, 95% CI 0.6 to 3.8) in the women who had ultra-conservative surgery (bilateral cystectomy) than in those who had conservative surgery (cystectomy and contralateral oophorectomy). This trial was at low risk of bias.Quality of life (QoL) was not documented in any included trial. We did not find any trials that compared radical with conservative surgery or laparoscopy with laparotomy. AUTHORS' CONCLUSIONS We did not find evidence to support the use of any specific type of adjuvant therapy for borderline ovarian tumours. RCTs evaluating the benefit of adjuvant therapy with optimally dosed chemotherapy and newer targeted drugs are necessary, particularly for advanced borderline ovarian tumours. The low mortality from borderline ovarian tumours should make recurrence-free survival, time to recurrence and morbidity important end points in such trials.Bilateral cystectomy may be offered to women with bilateral borderline ovarian tumours diagnosed intra-operatively who are wishing to preserve their fertility. Similarly, women who had RCTs comparing radical with conservative surgery and comparing laparoscopy with laparotomy are needed.
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Affiliation(s)
- Olusola Faluyi
- Western General HospitalEdinburgh Cancer CentreCrewe RoadEdinburghScotlandUKEH4 2XU
| | - Melanie Mackean
- Western General HospitalEdinburgh Cancer CentreCrewe RoadEdinburghScotlandUKEH4 2XU
| | - Charlie Gourley
- Western General HospitalEdinburgh Cancer CentreCrewe RoadEdinburghScotlandUKEH4 2XU
| | - Andrew Bryant
- Newcastle UniversityInstitute of Health & SocietyMedical School New BuildRichardson RoadNewcastle upon TyneUKNE2 4AX
| | - Heather O Dickinson
- Newcastle UniversityInstitute of Health & SocietyMedical School New BuildRichardson RoadNewcastle upon TyneUKNE2 4AX
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Gourley C, Michie CO, Roxburgh P, Yap TA, Harden S, Paul J, Ragupathy K, Todd R, Petty R, Reed N, Hayward RL, Mitchell P, Rye T, Schellens JH, Lubinski J, Carmichael J, Kaye SB, Mackean M, Ferguson M. Increased Incidence of Visceral Metastases in Scottish Patients With BRCA1/2-Defective Ovarian Cancer: An Extension of the Ovarian BRCAness Phenotype. J Clin Oncol 2010; 28:2505-11. [PMID: 20406939 DOI: 10.1200/jco.2009.25.1082] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose To compare the frequency of visceral relapse of BRCA1/2-deficient ovarian cancer to that of nonhereditary controls. Patients and Methods All patients diagnosed in Scotland with epithelial ovarian cancer (EOC) or primary peritoneal cancer (PPC) and a germline BRCA1/2 mutation were identified. Those with previous malignancy were excluded. Each remaining patient who experienced relapse was matched with two nonhereditary controls. Results Seventy-nine patients with EOC/PPC and germline BRCA1/2 mutations were identified. Fifteen had inadequate clinical data, two had carcinosarcoma, 27 had previous breast cancer, and 16 were in remission. Of the remaining 19 patients who were BRCA1/2 deficient, 14 patients (74%) developed visceral metastases compared with six (16%) of 38 patients in the control group. The percentages of liver, lung, and splenic metastases were 53%, 32%, and 32%, respectively, in the patients compared with 5%, 3%, and 5%, respectively, in the controls. When events occurring outside the matched follow-up period were omitted, the percentages of visceral, liver, lung, and splenic metastases were 58%, 42%, 16%, and 32% in the patients compared with 5%, 0%, 0%, and 3% in controls (P < .001, P < .001, P = .066, and P = .011, respectively). In an independent validation set, the corresponding percentages of visceral, liver, lung, and splenic metastases were 63%, 46%, 13%, and 17% in the patients compared with 11%, 4%, 2%, and 2% in controls (P < .001, P < .001, P = .153, and P = .052, respectively). Conclusion Although sporadic EOC commonly remains confined to the peritoneum, BRCA1/2-deficient ovarian cancer frequently metastasizes to viscera. These data extend the ovarian BRCAness phenotype, imply BRCA1/2-deficient ovarian cancer is biologically distinct, and suggest that patients with visceral metastases should be considered for BRCA1/2 sequencing.
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Affiliation(s)
- Charlie Gourley
- From the University of Edinburgh Cancer Research Centre, Institute of Genetics and Molecular Medicine, Western General Hospital, Edinburgh; Cancer Research United Kingdom Clinical Trials Unit, Beatson West of Scotland Cancer Centre Level 0, Glasgow; ANCHOR Unit and University of Aberdeen, Aberdeen Royal Infirmary, Foresterhill, Aberdeen; Cancer Medicine Research Programme, Section of Translational Medical Sciences, School of Medicine and Dentistry, University of Aberdeen, Foresterhill, Aberdeen,
| | - Caroline O. Michie
- From the University of Edinburgh Cancer Research Centre, Institute of Genetics and Molecular Medicine, Western General Hospital, Edinburgh; Cancer Research United Kingdom Clinical Trials Unit, Beatson West of Scotland Cancer Centre Level 0, Glasgow; ANCHOR Unit and University of Aberdeen, Aberdeen Royal Infirmary, Foresterhill, Aberdeen; Cancer Medicine Research Programme, Section of Translational Medical Sciences, School of Medicine and Dentistry, University of Aberdeen, Foresterhill, Aberdeen,
| | - Patricia Roxburgh
- From the University of Edinburgh Cancer Research Centre, Institute of Genetics and Molecular Medicine, Western General Hospital, Edinburgh; Cancer Research United Kingdom Clinical Trials Unit, Beatson West of Scotland Cancer Centre Level 0, Glasgow; ANCHOR Unit and University of Aberdeen, Aberdeen Royal Infirmary, Foresterhill, Aberdeen; Cancer Medicine Research Programme, Section of Translational Medical Sciences, School of Medicine and Dentistry, University of Aberdeen, Foresterhill, Aberdeen,
| | - Timothy A. Yap
- From the University of Edinburgh Cancer Research Centre, Institute of Genetics and Molecular Medicine, Western General Hospital, Edinburgh; Cancer Research United Kingdom Clinical Trials Unit, Beatson West of Scotland Cancer Centre Level 0, Glasgow; ANCHOR Unit and University of Aberdeen, Aberdeen Royal Infirmary, Foresterhill, Aberdeen; Cancer Medicine Research Programme, Section of Translational Medical Sciences, School of Medicine and Dentistry, University of Aberdeen, Foresterhill, Aberdeen,
| | - Sharon Harden
- From the University of Edinburgh Cancer Research Centre, Institute of Genetics and Molecular Medicine, Western General Hospital, Edinburgh; Cancer Research United Kingdom Clinical Trials Unit, Beatson West of Scotland Cancer Centre Level 0, Glasgow; ANCHOR Unit and University of Aberdeen, Aberdeen Royal Infirmary, Foresterhill, Aberdeen; Cancer Medicine Research Programme, Section of Translational Medical Sciences, School of Medicine and Dentistry, University of Aberdeen, Foresterhill, Aberdeen,
| | - Jim Paul
- From the University of Edinburgh Cancer Research Centre, Institute of Genetics and Molecular Medicine, Western General Hospital, Edinburgh; Cancer Research United Kingdom Clinical Trials Unit, Beatson West of Scotland Cancer Centre Level 0, Glasgow; ANCHOR Unit and University of Aberdeen, Aberdeen Royal Infirmary, Foresterhill, Aberdeen; Cancer Medicine Research Programme, Section of Translational Medical Sciences, School of Medicine and Dentistry, University of Aberdeen, Foresterhill, Aberdeen,
| | - Kalpana Ragupathy
- From the University of Edinburgh Cancer Research Centre, Institute of Genetics and Molecular Medicine, Western General Hospital, Edinburgh; Cancer Research United Kingdom Clinical Trials Unit, Beatson West of Scotland Cancer Centre Level 0, Glasgow; ANCHOR Unit and University of Aberdeen, Aberdeen Royal Infirmary, Foresterhill, Aberdeen; Cancer Medicine Research Programme, Section of Translational Medical Sciences, School of Medicine and Dentistry, University of Aberdeen, Foresterhill, Aberdeen,
| | - Radha Todd
- From the University of Edinburgh Cancer Research Centre, Institute of Genetics and Molecular Medicine, Western General Hospital, Edinburgh; Cancer Research United Kingdom Clinical Trials Unit, Beatson West of Scotland Cancer Centre Level 0, Glasgow; ANCHOR Unit and University of Aberdeen, Aberdeen Royal Infirmary, Foresterhill, Aberdeen; Cancer Medicine Research Programme, Section of Translational Medical Sciences, School of Medicine and Dentistry, University of Aberdeen, Foresterhill, Aberdeen,
| | - Russell Petty
- From the University of Edinburgh Cancer Research Centre, Institute of Genetics and Molecular Medicine, Western General Hospital, Edinburgh; Cancer Research United Kingdom Clinical Trials Unit, Beatson West of Scotland Cancer Centre Level 0, Glasgow; ANCHOR Unit and University of Aberdeen, Aberdeen Royal Infirmary, Foresterhill, Aberdeen; Cancer Medicine Research Programme, Section of Translational Medical Sciences, School of Medicine and Dentistry, University of Aberdeen, Foresterhill, Aberdeen,
| | - Nick Reed
- From the University of Edinburgh Cancer Research Centre, Institute of Genetics and Molecular Medicine, Western General Hospital, Edinburgh; Cancer Research United Kingdom Clinical Trials Unit, Beatson West of Scotland Cancer Centre Level 0, Glasgow; ANCHOR Unit and University of Aberdeen, Aberdeen Royal Infirmary, Foresterhill, Aberdeen; Cancer Medicine Research Programme, Section of Translational Medical Sciences, School of Medicine and Dentistry, University of Aberdeen, Foresterhill, Aberdeen,
| | - Richard L. Hayward
- From the University of Edinburgh Cancer Research Centre, Institute of Genetics and Molecular Medicine, Western General Hospital, Edinburgh; Cancer Research United Kingdom Clinical Trials Unit, Beatson West of Scotland Cancer Centre Level 0, Glasgow; ANCHOR Unit and University of Aberdeen, Aberdeen Royal Infirmary, Foresterhill, Aberdeen; Cancer Medicine Research Programme, Section of Translational Medical Sciences, School of Medicine and Dentistry, University of Aberdeen, Foresterhill, Aberdeen,
| | - Paul Mitchell
- From the University of Edinburgh Cancer Research Centre, Institute of Genetics and Molecular Medicine, Western General Hospital, Edinburgh; Cancer Research United Kingdom Clinical Trials Unit, Beatson West of Scotland Cancer Centre Level 0, Glasgow; ANCHOR Unit and University of Aberdeen, Aberdeen Royal Infirmary, Foresterhill, Aberdeen; Cancer Medicine Research Programme, Section of Translational Medical Sciences, School of Medicine and Dentistry, University of Aberdeen, Foresterhill, Aberdeen,
| | - Tzyvia Rye
- From the University of Edinburgh Cancer Research Centre, Institute of Genetics and Molecular Medicine, Western General Hospital, Edinburgh; Cancer Research United Kingdom Clinical Trials Unit, Beatson West of Scotland Cancer Centre Level 0, Glasgow; ANCHOR Unit and University of Aberdeen, Aberdeen Royal Infirmary, Foresterhill, Aberdeen; Cancer Medicine Research Programme, Section of Translational Medical Sciences, School of Medicine and Dentistry, University of Aberdeen, Foresterhill, Aberdeen,
| | - Jan H.M. Schellens
- From the University of Edinburgh Cancer Research Centre, Institute of Genetics and Molecular Medicine, Western General Hospital, Edinburgh; Cancer Research United Kingdom Clinical Trials Unit, Beatson West of Scotland Cancer Centre Level 0, Glasgow; ANCHOR Unit and University of Aberdeen, Aberdeen Royal Infirmary, Foresterhill, Aberdeen; Cancer Medicine Research Programme, Section of Translational Medical Sciences, School of Medicine and Dentistry, University of Aberdeen, Foresterhill, Aberdeen,
| | - Jan Lubinski
- From the University of Edinburgh Cancer Research Centre, Institute of Genetics and Molecular Medicine, Western General Hospital, Edinburgh; Cancer Research United Kingdom Clinical Trials Unit, Beatson West of Scotland Cancer Centre Level 0, Glasgow; ANCHOR Unit and University of Aberdeen, Aberdeen Royal Infirmary, Foresterhill, Aberdeen; Cancer Medicine Research Programme, Section of Translational Medical Sciences, School of Medicine and Dentistry, University of Aberdeen, Foresterhill, Aberdeen,
| | - James Carmichael
- From the University of Edinburgh Cancer Research Centre, Institute of Genetics and Molecular Medicine, Western General Hospital, Edinburgh; Cancer Research United Kingdom Clinical Trials Unit, Beatson West of Scotland Cancer Centre Level 0, Glasgow; ANCHOR Unit and University of Aberdeen, Aberdeen Royal Infirmary, Foresterhill, Aberdeen; Cancer Medicine Research Programme, Section of Translational Medical Sciences, School of Medicine and Dentistry, University of Aberdeen, Foresterhill, Aberdeen,
| | - Stan B. Kaye
- From the University of Edinburgh Cancer Research Centre, Institute of Genetics and Molecular Medicine, Western General Hospital, Edinburgh; Cancer Research United Kingdom Clinical Trials Unit, Beatson West of Scotland Cancer Centre Level 0, Glasgow; ANCHOR Unit and University of Aberdeen, Aberdeen Royal Infirmary, Foresterhill, Aberdeen; Cancer Medicine Research Programme, Section of Translational Medical Sciences, School of Medicine and Dentistry, University of Aberdeen, Foresterhill, Aberdeen,
| | - Melanie Mackean
- From the University of Edinburgh Cancer Research Centre, Institute of Genetics and Molecular Medicine, Western General Hospital, Edinburgh; Cancer Research United Kingdom Clinical Trials Unit, Beatson West of Scotland Cancer Centre Level 0, Glasgow; ANCHOR Unit and University of Aberdeen, Aberdeen Royal Infirmary, Foresterhill, Aberdeen; Cancer Medicine Research Programme, Section of Translational Medical Sciences, School of Medicine and Dentistry, University of Aberdeen, Foresterhill, Aberdeen,
| | - Michelle Ferguson
- From the University of Edinburgh Cancer Research Centre, Institute of Genetics and Molecular Medicine, Western General Hospital, Edinburgh; Cancer Research United Kingdom Clinical Trials Unit, Beatson West of Scotland Cancer Centre Level 0, Glasgow; ANCHOR Unit and University of Aberdeen, Aberdeen Royal Infirmary, Foresterhill, Aberdeen; Cancer Medicine Research Programme, Section of Translational Medical Sciences, School of Medicine and Dentistry, University of Aberdeen, Foresterhill, Aberdeen,
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Glasspool RM, Gore M, Rustin G, McNeish I, Wilson R, Pledge S, Paul J, Mackean M, Halford S, Kaye S. Randomized phase II study of decitabine in combination with carboplatin compared with carboplatin alone in patients with recurrent advanced ovarian cancer. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.5562] [Citation(s) in RCA: 8] [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
5562 Background: Experimental and clinical data (Gifford et al, Clin Cancer Res. 2004) indicate the potential importance of methylation in mediating resistance to carboplatin in ovarian cancer. A previous phase I trial (Appleton et al, J Clin Oncol. 2007) established the feasibility of combining carboplatin with the demethylating agent decitabine on a day 1 + 8 q4 weekly (w) schedule and PD data provided evidence of target cell demethylation. Methods: Patients (pt) with ovarian cancer relapsing 6–12 months following first line treatment were randomised to receive either 6 cycles of carboplatin AUC 6 q4 w (Arm A), or 90 mg/m2 decitabine as a 6 hour infusion on day 1 and carboplatin AUC 6 on day 8 q4 w (Arm B). The primary endpoint was response rate. An interim analysis was planned after 11 patients were enrolled into Arm B. Results: 29 pt were enrolled. After the first 4 pt had been treated (at 90 mg/m2 decitabine) the frequency of dose delays due to neutropenia was considered unacceptable, and therefore the starting dose of decitabine was reduced to 45 mg/m2 for the subsequent 11 pt. 7 out of 14 pt in Arm A completed 6 cycles compared with 0 of 11 in Arm B (at 45 mg/m2 decitabine). Grade 2/3 hypersensitivity reactions were more common in Arm B than Arm A (64% vs. 21%), as were prolonged treatment delays due to neutropenia (36% vs. 10%). At the interim analysis, in the 11 pt treated with 45mg/m2 (Arm B), there were no RECIST responses, while 2 pt had short-lived CA125 responses (59 and 63 days). In contrast 6 of 14 patients in Arm A had RECIST responses consistent with the expected efficacy of carboplatin in this population. Conclusions: The lack of efficacy, as well as the difficulties in treatment delivery in Arm B, led the project team to conclude that the study should be closed. With this dose and schedule, decitabine is ineffective in reversing carboplatin resistance. Further investigations are ongoing to understand (a) the apparent increased incidence of hypersensitivity and (b) the trend towards reduced efficacy in Arm B. [Table: see text]
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Affiliation(s)
- R. M. Glasspool
- Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; The Royal Marsden Hospital, London, United Kingdom; Mount Vernon Hospital, London, United Kingdom; St Bartholomew's Hospital, London, United Kingdom; Belfast City Hospital Trust, Belfast, United Kingdom; Sheffield Weston Park Hospital, Sheffield, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Edinburgh Western General Hospital, Edinburgh, United Kingdom; Drug Development Office, Cancer Research UK, London, United Kingdom
| | - M. Gore
- Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; The Royal Marsden Hospital, London, United Kingdom; Mount Vernon Hospital, London, United Kingdom; St Bartholomew's Hospital, London, United Kingdom; Belfast City Hospital Trust, Belfast, United Kingdom; Sheffield Weston Park Hospital, Sheffield, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Edinburgh Western General Hospital, Edinburgh, United Kingdom; Drug Development Office, Cancer Research UK, London, United Kingdom
| | - G. Rustin
- Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; The Royal Marsden Hospital, London, United Kingdom; Mount Vernon Hospital, London, United Kingdom; St Bartholomew's Hospital, London, United Kingdom; Belfast City Hospital Trust, Belfast, United Kingdom; Sheffield Weston Park Hospital, Sheffield, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Edinburgh Western General Hospital, Edinburgh, United Kingdom; Drug Development Office, Cancer Research UK, London, United Kingdom
| | - I. McNeish
- Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; The Royal Marsden Hospital, London, United Kingdom; Mount Vernon Hospital, London, United Kingdom; St Bartholomew's Hospital, London, United Kingdom; Belfast City Hospital Trust, Belfast, United Kingdom; Sheffield Weston Park Hospital, Sheffield, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Edinburgh Western General Hospital, Edinburgh, United Kingdom; Drug Development Office, Cancer Research UK, London, United Kingdom
| | - R. Wilson
- Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; The Royal Marsden Hospital, London, United Kingdom; Mount Vernon Hospital, London, United Kingdom; St Bartholomew's Hospital, London, United Kingdom; Belfast City Hospital Trust, Belfast, United Kingdom; Sheffield Weston Park Hospital, Sheffield, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Edinburgh Western General Hospital, Edinburgh, United Kingdom; Drug Development Office, Cancer Research UK, London, United Kingdom
| | - S. Pledge
- Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; The Royal Marsden Hospital, London, United Kingdom; Mount Vernon Hospital, London, United Kingdom; St Bartholomew's Hospital, London, United Kingdom; Belfast City Hospital Trust, Belfast, United Kingdom; Sheffield Weston Park Hospital, Sheffield, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Edinburgh Western General Hospital, Edinburgh, United Kingdom; Drug Development Office, Cancer Research UK, London, United Kingdom
| | - J. Paul
- Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; The Royal Marsden Hospital, London, United Kingdom; Mount Vernon Hospital, London, United Kingdom; St Bartholomew's Hospital, London, United Kingdom; Belfast City Hospital Trust, Belfast, United Kingdom; Sheffield Weston Park Hospital, Sheffield, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Edinburgh Western General Hospital, Edinburgh, United Kingdom; Drug Development Office, Cancer Research UK, London, United Kingdom
| | - M. Mackean
- Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; The Royal Marsden Hospital, London, United Kingdom; Mount Vernon Hospital, London, United Kingdom; St Bartholomew's Hospital, London, United Kingdom; Belfast City Hospital Trust, Belfast, United Kingdom; Sheffield Weston Park Hospital, Sheffield, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Edinburgh Western General Hospital, Edinburgh, United Kingdom; Drug Development Office, Cancer Research UK, London, United Kingdom
| | - S. Halford
- Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; The Royal Marsden Hospital, London, United Kingdom; Mount Vernon Hospital, London, United Kingdom; St Bartholomew's Hospital, London, United Kingdom; Belfast City Hospital Trust, Belfast, United Kingdom; Sheffield Weston Park Hospital, Sheffield, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Edinburgh Western General Hospital, Edinburgh, United Kingdom; Drug Development Office, Cancer Research UK, London, United Kingdom
| | - S. Kaye
- Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; The Royal Marsden Hospital, London, United Kingdom; Mount Vernon Hospital, London, United Kingdom; St Bartholomew's Hospital, London, United Kingdom; Belfast City Hospital Trust, Belfast, United Kingdom; Sheffield Weston Park Hospital, Sheffield, United Kingdom; University of Glasgow, Glasgow, United Kingdom; Edinburgh Western General Hospital, Edinburgh, United Kingdom; Drug Development Office, Cancer Research UK, London, United Kingdom
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Helpman Bek L, Ferguson SE, Mackean M, Le L, Rogerson A, Dewan A, Mackay H. Use of complementary medicine (CAM) among women receiving chemotherapy for ovarian cancer: A comparison of attitudes between two patient populations. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e20545] [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
e20545 Background: CAM use in cancer patients (pts) is common. The aim of this study was to compare patterns of CAM use and attitudes to CAM among ovarian cancer (EOC) pts in Canada and Scotland. Methods: Patients receiving chemotherapy for EOC in Princess Margaret Hospital (PMH), Toronto and the Edinburgh Cancer Centre (ECC), Scotland, completed a survey on CAM taken within the previous month as well as a questionnaire assessing patient attitudes and perceptions of CAM. A comparison between the 2 patient populations and between CAM users and non-users was made. Results: 194 pts (100 ECC: 94 PMH) were enrolled on study. The use of CAM in PMH was significantly higher than in ECC (52% vs. 36%, p=0.02). Whilst both populations thought it important for their oncologist to be aware of CAM usage (86% PMH: 93% ECC), pts from PMH were less likely to inform their compared to pts from ECC (50% vs 81%, p=0.02). Patterns of CAM use differed between the 2 populations: Multivitamins were the most common CAM in both populations (31% PMH:13% ECC). They were not considered CAM for the purpose of analysis. Most commonly used CAM in PMH were Soy products (12%), vitamin C (10%) and Green Tea (9%); in ECC pts used Omega 3 and fish oil (9%), Evening Primrose (7%) and vitamin C (6%). Although the majority of CAM users in both populations found CAM to be helpful (57% PMH: 61% ECC) only a minority thought they would cure their cancer (18% PMH: 6% ECC), prevent its spread (31% PMH: 14% ECC) or prevent a recurrence (20% PMH: 11% ECC). Users more often felt CAM relieved symptoms (45% PMH: 42% ECC), boosted the immune system (55% PMH: 56% ECC) or improved their quality of life (43% PMH: 53% ECC). ECC CAM users were more likely than PMH users to concede that CAMs have side effects (39% vs 29%) or could impact the efficacy of conventional treatment (17% vs 6%). CAM users were more likely than non-users to agree with positive statements and to disagree with negative statements about CAM. Conclusions: CAM use is common among pts receiving chemotherapy for EOC. CAM use was more prevalent among North American pts than Scottish pts. Attitudes and patterns of CAM usage differ and are culturally sensitive. Oncologists need to be aware of this when initiating discussion about CAM with their patients during cancer treatment. No significant financial relationships to disclose.
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Affiliation(s)
- L. Helpman Bek
- University of Toronto, Toronto, ON, Canada; Princess Margaret Hospital, Toronto, ON, Canada; Edinburgh Cancer Centre, Edinburgh, United Kingdom; University of Edinburgh, Edinburgh, United Kingdom
| | - S. E. Ferguson
- University of Toronto, Toronto, ON, Canada; Princess Margaret Hospital, Toronto, ON, Canada; Edinburgh Cancer Centre, Edinburgh, United Kingdom; University of Edinburgh, Edinburgh, United Kingdom
| | - M. Mackean
- University of Toronto, Toronto, ON, Canada; Princess Margaret Hospital, Toronto, ON, Canada; Edinburgh Cancer Centre, Edinburgh, United Kingdom; University of Edinburgh, Edinburgh, United Kingdom
| | - L. Le
- University of Toronto, Toronto, ON, Canada; Princess Margaret Hospital, Toronto, ON, Canada; Edinburgh Cancer Centre, Edinburgh, United Kingdom; University of Edinburgh, Edinburgh, United Kingdom
| | - A. Rogerson
- University of Toronto, Toronto, ON, Canada; Princess Margaret Hospital, Toronto, ON, Canada; Edinburgh Cancer Centre, Edinburgh, United Kingdom; University of Edinburgh, Edinburgh, United Kingdom
| | - A. Dewan
- University of Toronto, Toronto, ON, Canada; Princess Margaret Hospital, Toronto, ON, Canada; Edinburgh Cancer Centre, Edinburgh, United Kingdom; University of Edinburgh, Edinburgh, United Kingdom
| | - H. Mackay
- University of Toronto, Toronto, ON, Canada; Princess Margaret Hospital, Toronto, ON, Canada; Edinburgh Cancer Centre, Edinburgh, United Kingdom; University of Edinburgh, Edinburgh, United Kingdom
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English J, Mackean M, Price A, Little F, Erridge S, Ironside J. First two years experience of erlotinib in routine practice in Edinburgh. Lung Cancer 2008. [DOI: 10.1016/s0169-5002(08)70078-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
The carcinoembryonic antigen (CEA) blood test is included in most colorectal cancer follow up protocols, despite little clear evidence for its cost-effectiveness and survival benefit. In this study, patients' views were sought on the use of the CEA blood test in their follow up. Strong associations were found between the age of a patient's children and their concern about cancer recurrence and between concern about recurrence and anxiety about CEA test results (p<0.0001). Many patients expressed a desire for prognostic information, however uncertain or poor. Patients' views should be sought when designing colorectal cancer follow up protocols to ensure their needs are adequately addressed.
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Affiliation(s)
- Nicola Steele
- The Beatson West of Scotland Cancer Centre, Glasgow, UK.
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Pollock R, Mackean M, Price A, Little F, Erridge S, Ironside J. 20 Labour pains in the birth of adjuvant chemotherapy. Lung Cancer 2007. [DOI: 10.1016/s0169-5002(07)70346-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Gourley C, Smyth JF, Mackean M, Stevenson A, Williams A, Rye T, Reed N, Vasey P, Gabra H, Langdon S. Phase II study of letrozole in estrogen receptor (ER) positive relapsed epithelial ovarian cancer (EOC). J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.5025] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [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
5025 Background: Letrozole is a potent oral aromatase inhibitor which rapidly suppresses circulating estrogen levels by 99% in postmenopausal women. By comparison with cytotoxic agents it is very well tolerated. We previously demonstrated an ‘endocrine sensitive’ subgroup of ovarian cancer patients with ER histoscore cutoff of ≥150 (Bowman et al, Clin Can Res 2002). Methods: This was a phase II study with a planned sample size of 33 patients. Eligible patients had relapsed EOC or primary peritoneal cancer with an ER histoscore of ≥150 and a rising CA125 that had progressed according to Rustin’s criteria. Patients were treated with letrozole 2.5mg daily until clinical or marker evidence of disease progression. The primary endpoint was response according to CA125 and RECIST criteria. Biomarker analysis by tissue microarray is also being performed. Results: 46 patients were accrued, 45 of whom were eligible. The median age was 61 (range 39–81). 24, 10 and 10 patients had received 1,2 and >2 previous lines of chemotherapy respectively. Of 43 patients evaluable for CA125 response, 7 (16%) had a response (decrease of >50%) and 16 (37%) patients had not progressed (doubling of CA125) following 12 weeks on treatment. In the CA125 responders, the nadir CA125 ranged from 0.7–49% of baseline (actual % of baseline: 0.7, 2.6, 11.1, 17.6, 23.6, 42.6, 49). Of the 7 responding patients, 5 had received only one previous line of chemotherapy. The time taken to achieve the nadir CA125 value ranged from 10 to 36 weeks, with a median of 13 weeks. Of 33 patients evaluable for radiological response, 3 (9%) had a PR and 14 (42%) had stable disease at 12 weeks. Overall, 11 patients (26%) had a PFS of >6 months and 2 patients (5%) had a PFS of ≥2 years. Conclusions: To our knowledge this is the first study of a hormonal agent in a selected ER +ve population of ovarian cancer patients. Promising efficacy of the agent is demonstrated in this population of pre-treated patients, many with a considerable bulk of disease. Given the median time of 13 weeks to response, we suggest that this strategy should be tested in ER+ve ovarian cancer patients in the adjuvant setting following first line chemotherapy No significant financial relationships to disclose.
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Affiliation(s)
- C. Gourley
- University of Edinburgh, Edinburgh, United Kingdom; Western General Hospital, Edinburgh, United Kingdom; Beatson Oncology Centre, Glasgow, United Kingdom
| | - J. F. Smyth
- University of Edinburgh, Edinburgh, United Kingdom; Western General Hospital, Edinburgh, United Kingdom; Beatson Oncology Centre, Glasgow, United Kingdom
| | - M. Mackean
- University of Edinburgh, Edinburgh, United Kingdom; Western General Hospital, Edinburgh, United Kingdom; Beatson Oncology Centre, Glasgow, United Kingdom
| | - A. Stevenson
- University of Edinburgh, Edinburgh, United Kingdom; Western General Hospital, Edinburgh, United Kingdom; Beatson Oncology Centre, Glasgow, United Kingdom
| | - A. Williams
- University of Edinburgh, Edinburgh, United Kingdom; Western General Hospital, Edinburgh, United Kingdom; Beatson Oncology Centre, Glasgow, United Kingdom
| | - T. Rye
- University of Edinburgh, Edinburgh, United Kingdom; Western General Hospital, Edinburgh, United Kingdom; Beatson Oncology Centre, Glasgow, United Kingdom
| | - N. Reed
- University of Edinburgh, Edinburgh, United Kingdom; Western General Hospital, Edinburgh, United Kingdom; Beatson Oncology Centre, Glasgow, United Kingdom
| | - P. Vasey
- University of Edinburgh, Edinburgh, United Kingdom; Western General Hospital, Edinburgh, United Kingdom; Beatson Oncology Centre, Glasgow, United Kingdom
| | - H. Gabra
- University of Edinburgh, Edinburgh, United Kingdom; Western General Hospital, Edinburgh, United Kingdom; Beatson Oncology Centre, Glasgow, United Kingdom
| | - S. Langdon
- University of Edinburgh, Edinburgh, United Kingdom; Western General Hospital, Edinburgh, United Kingdom; Beatson Oncology Centre, Glasgow, United Kingdom
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Law A, Kerr G, Mackean M, Erridge S, Little F, Ironside J, Price A. P-780 Improving outcomes for limited stage small cell lung cancer(LS-SCLC) patients in Scotland with concomitant chemoradiation. Lung Cancer 2005. [DOI: 10.1016/s0169-5002(05)81273-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Waters JS, Norman A, Cunningham D, Scarffe JH, Webb A, Harper P, Joffe JK, Mackean M, Mansi J, Leahy M, Hill A, Oates J, Rao S, Nicolson M, Hickish T. Long-term survival after epirubicin, cisplatin and fluorouracil for gastric cancer: results of a randomized trial. Br J Cancer 1999; 80:269-72. [PMID: 10390007 PMCID: PMC2363002 DOI: 10.1038/sj.bjc.6690350] [Citation(s) in RCA: 217] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
We report the final results of a prospectively randomized study that compared the combination of epirubicin, cisplatin and protracted venous infusion fluorouracil (5-FU) (ECF regimen) with the standard combination of 5-FU, doxorubicin and methotrexate (FAMTX) in previously untreated patients with advanced oesophagogastric cancer. Between 1992 and 1995, 274 patients with adenocarcinoma or undifferentiated carcinoma were randomized from eight oncology centres in the UK and analysed for response and survival. The overall response rate was 46% (95% confidence interval (CI), 37-55%) with ECF, and 21% (95% CI, 13-28%) with FAMTX (P = 0.00003). The median survival was 8.7 months with ECF and 6.1 months with FAMTX (P = 0.0005). The 2-year survival rates were 14% (95% CI, 8-20%) for the ECF arm, and 5% (95% CI, 2-10%) for the FAMTX arm (P = 0.03). Histologically complete surgical resection following chemotherapy was achieved in ten patients in the ECF arm (three pathological complete responses to chemotherapy) and three patients in the FAMTX arm (no pathological complete responses). The ECF regimen resulted in a response and survival advantage compared with FAMTX chemotherapy. The probability of long-term survival following surgical resection of residual disease is increased by this treatment. The high response rates seen with ECF support its use in the neoadjuvant setting.
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Affiliation(s)
- J S Waters
- Cancer Research Campaign, Section of Medicine and Gastrointestinal Unit, Royal Marsden Hospital and Institute of Cancer Research, Sutton, Surrey, UK
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Mackean M, Planting A, Twelves C, Schellens J, Allman D, Osterwalder B, Reigner B, Griffin T, Kaye S, Verweij J. Phase I and pharmacologic study of intermittent twice-daily oral therapy with capecitabine in patients with advanced and/or metastatic cancer. J Clin Oncol 1998; 16:2977-85. [PMID: 9738566 DOI: 10.1200/jco.1998.16.9.2977] [Citation(s) in RCA: 197] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Capecitabine is an orally administered fluoropyrimidine carbamate selectively activated to fluorouracil (5-FU) in tumors. It passes through the intestinal mucosal membrane intact and is subsequently activated by a cascade of three enzymes that results in the preferential release of 5-FU at the tumor site. PATIENTS AND METHODS In this phase I study, capecitabine was administered twice daily as outpatient therapy, each cycle administered for 2 weeks followed by 1 week of rest. Thirty-four patients with solid tumors, all of whom except three patients were pretreated, were treated at dose levels from 502 to 3,514 mg/m2 daily. RESULTS The median treatment duration was four cycles (85 days; range, 14 to 833+ days). Two patients continue on treatment at 686 and 833+ days. Capecitabine 3,000 mg/m2 daily was not tolerable, with dose-limiting toxicities of diarrhea with hypotension, abdominal pain, and leukopenia. Palmar-plantar erythrodysesthesia (PPE) became evident at higher dose levels after prolonged treatment. Evidence of objective tumor response was reported in four patients at 2,510 mg/m2 daily and greater (one complete response [CR] and three partial responses [PRs]) with subjective minor tumor responses in a further seven patients. Pharmacokinetic studies showed rapid gastrointestinal absorption of capecitabine, followed by extensive conversion into 5'-deoxy-5-fluorouridine (5'-DFUR), with only low systemic 5-FU levels. CONCLUSION Capecitabine is a tolerable oral outpatient therapy that shows promising clinical activity in a variety of cancers. The recommended phase II dose is 2,510 mg/m2 daily administered by this intermittent schedule.
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Affiliation(s)
- M Mackean
- Department of Medical Oncology, Beatson Oncology Centre, Glasgow, UK.
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