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St-Laurent A, Zielinski D, Qazi A, AlAwadi A, Almajed A, Adamko DJ, Alabdoulsalam T, Chiang J, Derynck M, Gerdung C, Kam K, Katz SL, MacLusky I, Mehta K, Mateos D, Nguyen TTD, Praud JP, Proulx F, Seear M, Smith MJ, Wensley D, Amin R. Chronic tracheostomy care of ventilator-dependent and -independent children: Clinical practice patterns of pediatric respirologists in a publicly funded (Canadian) healthcare system. Pediatr Pulmonol 2023; 58:140-151. [PMID: 36178281 DOI: 10.1002/ppul.26171] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 09/06/2022] [Accepted: 09/25/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVES To describe the current clinical practice patterns of Canadian pediatric respirologists at pediatric tertiary care institutions regarding chronic tracheostomy tube care and management of home invasive ventilation. METHODS A pediatric respirologist/pediatrician with expertise in tracheostomy tube care and home ventilation was identified at each Canadian pediatric tertiary care center to complete a 59-item survey of multiple choice and short answer questions. Domains assessed included tracheostomy tube care, caregiver competency and home monitoring, speaking valves, medical management of tracheostomy complications, decannulation, and long-term follow-up. RESULTS The response rate was 100% (17/17) with all Canadian tertiary care pediatric centers represented and heterogeneity of practice was observed in all domains assessed. For example, though most centers employ Bivona™ (17/17) and Shiley™ (15/17) tracheostomy tubes, variability was observed around tube change, re-use, and cleaning practices. Most centers require two trained caregivers (14/17) and recommend 24/7 eyes on care and oxygen saturation monitoring. Discharge with an emergency tracheostomy kit was universal (17/17). Considerable heterogeneity was observed in the timing and use of speaking valves and speech-language assessment. Inhaled anti-pseudomonal antibiotics are employed by most centers (16/17) though the indication, agent, and protocol varied by center. Though decannulation practices varied considerably, the requirement of upper airway patency was universally required to proceed with decannulation (17/17) independent of ongoing ventilatory support requirements. CONCLUSION Considerable variability in pediatric tracheostomy tube care practice exists across Canada. These results will serve as a starting point to standardize and evaluate tracheostomy tube care nationally.
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Affiliation(s)
- Aaron St-Laurent
- Department of Paediatrics, Division of Respiratory Medicine, Children's Hospital-London Health Sciences Centre, London, Ontario, Canada
| | - David Zielinski
- Division of Pediatric Respirology, Department of Pediatrics, Montreal Children's Hospital/McGill University, Montreal, Quebec, Canada.,Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Adam Qazi
- Department of Pediatrics, The Division of Respiratory Medicine, Toronto, The Hospital for Sick Children, Ontario, Canada
| | - Aceel AlAwadi
- Mubarak Al-Kabeer Hospital, Ministry of Health of Kuwait, Jabriya, Kuwait
| | - Athari Almajed
- Mubarak Al-Kabeer Hospital, Ministry of Health of Kuwait, Jabriya, Kuwait
| | - Darryl J Adamko
- Department of Pediatrics, Division of Respiratory Medicine, Jim Pattison's Children's Hospital, Saskatoon, Saskatchewan, Canada
| | - Tareq Alabdoulsalam
- Section of Pediatric Respirology, Department of Pediatrics and Child Health, HSC Winnipeg Children's Hospital/University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jackie Chiang
- Department of Pediatrics, The Division of Respiratory Medicine, Toronto, The Hospital for Sick Children, Ontario, Canada
| | - Michael Derynck
- Department of Pediatrics, Kingston Health Sciences Centre/Queen's University, Kingston, Ontario, Canada
| | - Chris Gerdung
- Stollery Children's Hospital, Department of Pediatrics, The Division of Respiratory Medicine, University of Alberta, Edmonton Alberta, Canada
| | - Karen Kam
- Department of Pediatrics, Section of Respiratory Medicine, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Sherri L Katz
- Department of Pediatrics, Division of Respiratory Medicine, Children's Hospital of Eastern Ontario/University of Ottawa, Ottawa, Ontario, Canada.,Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Ian MacLusky
- Department of Pediatrics, Division of Respiratory Medicine, Children's Hospital of Eastern Ontario/University of Ottawa, Ottawa, Ontario, Canada
| | - Kevan Mehta
- Department of Pediatrics, Division of Respirology, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Dimas Mateos
- Department of Pediatrics, Pediatric Respirology, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - The Thanh D Nguyen
- Department of Pediatrics, Division of Respirology, CHU Sainte-Justine, Montreal, Quebec, Canada
| | - Jean-Paul Praud
- Division of Respiratory Medicine, Department of Pediatrics, University of Sherbrooke, Quebec, Canada
| | - Frederic Proulx
- Department of Pediatrics, Division of Respirology, CHUL et Centre Mère-Enfant Soleil, Quebec, Quebec, Canada
| | - Michael Seear
- Division of Pediatric Respiratory Medicine, Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - Mary Jane Smith
- Department of Pediatrics, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Canada
| | - David Wensley
- Division of Pediatric Respiratory Medicine, Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - Reshma Amin
- Department of Pediatrics, The Division of Respiratory Medicine, Toronto, The Hospital for Sick Children, Ontario, Canada
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Gonska T, Keenan K, Au J, Dupuis A, Chilvers MA, Burgess C, Bjornson C, Fairservice L, Brusky J, Kherani T, Jober A, Kosteniuk L, Price A, Itterman J, Morgan L, Mateos-Corral D, Hughes D, Donnelly C, Smith MJ, Iqbal S, Arpin J, Reisman J, Hammel J, van Wylick R, Derynck M, Henderson N, Solomon M, Ratjen F. Outcomes of Cystic Fibrosis Screening-Positive Infants With Inconclusive Diagnosis at School Age. Pediatrics 2021; 148:183433. [PMID: 34814176 DOI: 10.1542/peds.2021-051740] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/24/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Cystic fibrosis (CF) screen-positive infants with an inconclusive diagnosis (CFSPID) are infants in whom sweat testing and genetic analysis does not resolve a CF diagnosis. Lack of knowledge about the health outcome of these children who require clinical follow-up challenges effective consultation. Early predictive biomarkers to delineate the CF risk would allow a more targeted approach to these children. METHODS Prospective, longitudinal, multicenter, Canada-wide cohort study of CF positive-screened newborns with 1 to 2 cystic fibrosis transmembrane conductance regulator gene variants, of which at least 1 is not known to be CF-causing and/or a sweat chloride between 30 and 59 mmol/L. These were monitored for conversion to a CF diagnosis, pulmonary, and nutritional outcomes. RESULTS The mean observation period was 7.7 (95% confidence interval 7.1 to 8.4) years. A CF diagnosis was established for 24 of the 115 children with CFSPID (21%) either because of reinterpretation of the cystic fibrosis transmembrane conductance regulator genotype or because of increase in sweat chloride concentration ≥60 mmol/L. An initial sweat chloride of ≥40 mmol/l predicted conversion to CF on the basis of sweat testing. The 91 remaining children with CFSPID were pancreatic sufficient and showed normal growth until school age. Pulmonary function as well as lung clearance index in a subgroup of children with CFSPID were similar to that of healthy controls. CONCLUSIONS Children with CFSPID have good nutritional and pulmonary outcomes at school age, but rates of reclassifying the diagnosis are high. The initial sweat chloride test can be used as a biomarker to predict the risk for CF in CFSPID.
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Affiliation(s)
- Tanja Gonska
- Divisions of Gastroenterology, Hepatology.,Translational Medicine, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Katherine Keenan
- Translational Medicine, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jacky Au
- Respiratory Medicine, Department of Pediatrics
| | - Annie Dupuis
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Mark A Chilvers
- Division of Respiratory Medicine, Department of Pediatrics, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Caroline Burgess
- Division of Respiratory Medicine, Department of Pediatrics, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Candice Bjornson
- Section of Respiratory Medicine, Department of Pediatrics, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Lori Fairservice
- Section of Respiratory Medicine, Department of Pediatrics, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Janna Brusky
- Department of Pediatric, Jim Pattison Children's Hospital, Saskatoon, Saskatchewan, Canada
| | - Tamizan Kherani
- Division of Respiratory Medicine, Department of Pediatrics, Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Amanda Jober
- Division of Respiratory Medicine, Department of Pediatrics, Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Lorna Kosteniuk
- Department of Pediatric, Jim Pattison Children's Hospital, Saskatoon, Saskatchewan, Canada
| | - April Price
- Division of Respiratory Medicine, Department of Pediatrics, London Health Sciences Centre, London, Ontario, Canada
| | - Jennifer Itterman
- Division of Respiratory Medicine, Department of Pediatrics, London Health Sciences Centre, London, Ontario, Canada
| | - Lenna Morgan
- Department of Pediatrics, Windsor Regional Hospital, Windsor, Ontario, Canada
| | - Dimas Mateos-Corral
- Division of Respiratory Medicine, Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Daniel Hughes
- Division of Respiratory Medicine, Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Christine Donnelly
- Division of Respiratory Medicine, Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Mary Jane Smith
- Department of Paediatrics, Memorial University of Newfoundland, St John's, Newfoundland and Labrador, Canada
| | - Shaikh Iqbal
- Department of Pediatrics, Children's Hospital of Winnipeg, Winnipeg, Manitoba, Canada
| | - Jocelyn Arpin
- Department of Pediatrics, Children's Hospital of Winnipeg, Winnipeg, Manitoba, Canada
| | - Joe Reisman
- Division of Respiratory Medicine, Department of Pediatrics, Children Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Joanne Hammel
- Division of Respiratory Medicine, Department of Pediatrics, Children Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | | | - Michael Derynck
- Department of Pediatrics, Queen's University, Kingston, Ontario, Canada
| | - Natalie Henderson
- Department of Pediatrics, Queen's University, Kingston, Ontario, Canada
| | | | - Felix Ratjen
- Respiratory Medicine, Department of Pediatrics.,Translational Medicine, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
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Gonska T, Keenan K, Au J, Dupuis A, Chilvers M, Bjornson C, Brusky J, Price A, Morgan L, Mateos-Corral D, Hughes D, Smith M, Iqbal S, Reisman J, van Wylick R, Derynck M, Ratjen F. WS06.2 Nutritional and pulmonary outcomes of cystic fibrosis screen-positive infants with an inconclusive diagnosis. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)00946-2] [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: 11/29/2022]
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Cattaruza F, Koski C, Nazeer Å, Lange Z, Henkensiefken A, Hammond M, Derynck M, Schellenberger V, Irving B. HER2-XPAT, a novel protease-activatable pro-drug T cell engager (TCE), with potent T-cell activation and efficacy in solid tumors and large predicted safety margins in non-human primate (NHP). Eur J Cancer 2020. [DOI: 10.1016/s0959-8049(20)31092-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Irving B, Nazeer A, Cattaruzza F, Lange Z, Koski C, Hammond M, Henkensiefken A, Sim BC, Derynck M, Schellenberger V. 1062P EGFR-XPAT, a novel pro-drug T-cell engager (TCEs) engineered to address on-target, off-tumour toxicity and an orthogonal approach for cancer immunotherapy in EGFR, KRAS/BRAF cancers. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.1182] [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] Open
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Pellerin-Leblanc AA, Derynck M, Dow K. IMPROVING COMMUNICATION IN THE NICU: PARENTAL PERCEPTIONS AND KNOWLEDGE ABOUT RESIDENT PHYSICIANS. Paediatr Child Health 2018. [DOI: 10.1093/pch/pxy054.121] [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: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
Residents play a pivotal role in patient care. Past research has demonstrated a lack of understanding of the roles of medical learners. It is therefore pertinent to assess patients and families’ views of the roles of residents, and how patient-resident interactions can alter their understanding. Furthermore, since patients are the ultimate stakeholders in the health care system, our goal should be to encourage their much deserved voice in the way we practice medicine, particularly in the neonatal intensive care unit (NICU) which is a challenging environment for families and learners.
OBJECTIVES
Our primary objective was to to better characterize parental knowledge and perception of resident’s roles. We also determined how medical learners can best identify themselves to family. Moreover, we explored the role of residents as effective communicators with parents. We also assessed parental satisfaction regarding their interactions with residents.
DESIGN/METHODS
Parents whose children were admitted to the NICU at our hospital for at least 24 hours were asked to complete a self-administered survey. Our cross-sectional survey, administered from January to December 2016, contained three types of questions: (1) neonatal and parental demographics; (2) parental knowledge and perceptions; and (3) parental preferences. Exclusion criteria included infant death, apprehension by child protection services and parents not fluent in French or English.
RESULTS
A total of 73 surveys were collected, for a final response rate of 38%. The majority (i.e., 81% of parents) reported having a resident involved in the care of their child. Significant findings included that level of education was shown to be directly correlated with knowledge of residents (r = 0.336, p = 0.006). Questions on parental knowledge revealed that 21% of respondents were not aware that residents are physicians. Most parents would like members of the medical team to identify their role. While 70 % of parents reported that residents effectively introduced themselves to them, 29% of desirous parents did not.
CONCLUSION
Most parents were familiar with the role of residents in this single-centre, prospective qualitative study. This survey highlights the importance of a clear introduction of the resident’s role to parents. Improved awareness of this factor may help residents improve their communication skills, and improve the family’s experience in the NICU.
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Affiliation(s)
| | | | - Kim Dow
- Kingston Health Sciences Centre
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7
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Schmid P, Pinder SE, Bundred N, Wheatley D, Macaskill J, Zammit C, Hu J, Price R, Shia A, Lim L, Parker P, Molinero L, Yu J, O'Brien C, Wilson T, Savage H, Derynck M, Lackner MR, Amler L, Purushotham A, Thompson A, Gendreau S. Abstract P5-13-01: Transcript analysis of PI3K and immune-related genes and gene signatures in the pre- and post-treatment samples from the window of opportunity study of anastrozole and anastrozole with pictilisib (GDC-0941) in patients with HR-positive early breast cancer (OPPORTUNE study). Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p5-13-01] [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: 11/16/2022]
Abstract
Abstract
Background: The OPPORTUNE Study randomized postmenopausal patients (pts) to receive 2-week preoperative treatment with anastrozole (ANA) plus pictilisib ("ANA+PIC" arm) or ANA alone. Patients had newly diagnosed, operable, ER+, HER2- invasive breast cancer of ≥1 cm size. The primary outcome at interim analysis (n=70) revealed that the addition of PIC significantly increased the anti-proliferative response to ANA as measured by reduction in Ki67 immunohistochemistry (IHC). Multivariate analyses suggested benefit of PIC for patients with luminal B disease (Schmid et al. SABCS 2014).
Methods: RNA expression analysis of ∼800 breast cancer-related genes was performed on patients analyzed at the interim analysis, including 14 (ANA) and 20 (ANA+PIC) patients with matched pre- and post- treatment paired tumour samples using the nCounter platform (NanoString). Differential expression of individual genes by arm was assessed using paired and moderated t-tests and statistical significance assessed through false discovery rate (FDR). Ingenuity Pathway Analysis (IPA) of differentially expressed transcripts identified pathways of relevance. Protein expression was analyzed by reverse protein array ( RPPA) in pre- and post-treatment samples.
Results: In an unsupervised analysis, down-regulation of genes associated with ER signaling was observed in patients who received single-agent ANA and ANA+PIC, which included genes that regulate the cell cycle, cell death, survival, growth and proliferation and known ER target genes (e.g., PGR, GREB1). In addition, transcripts related to growth factor signaling pathway appeared to be specifically modulated in the ANA+PIC arm, possibly via the upregulation of the expression of RTK ligands. There were no clear changes in PI3K-related phosphoproteins (e.g., AKT, S6, 4E-BP1) in the post-treatment samples by RPPA. However, known PI3K-regulated genes, IRS2 and PIK3IP1, were upregulated in the post-treatment samples and a composite PI3K gene expression signature score (O'Brien et al. 2010) was reduced in both study arms following treatment. This PI3K signature was associated with pre-treatment luminal B status (n=27) and, consistent with this finding, the baseline PI3K gene signature score in the ANA arm, but not the ANA+PIC arm, was inversely associated with the decrease in post treatment Ki67. The tumor immune microenvironment was analyzed though the use of composite gene sets. In our initial observations, analysis of pre- and post-treatment samples showed that 2-week treatment with ANA resulted in a modest increase in transcripts associated with multiple immune signatures, which was further enhanced by the addition of PIC.
Conclusions: Gene expression analysis of pre- and post-treatment samples in the OPPORTUNE study demonstrates on-target inhibition of ER and PI3K signaling networks. The analysis of additional paired samples is in progress to further assess if 2-weeks of treatment with a regimen containing an AI in patients with early breast cancer impacts the tumor immune microenvironment.
Citation Format: Schmid P, Pinder SE, Bundred N, Wheatley D, Macaskill J, Zammit C, Hu J, Price R, Shia A, Lim L, Parker P, Molinero L, Yu J, O'Brien C, Wilson T, Savage H, Derynck M, Lackner MR, Amler L, Purushotham A, Thompson A, Gendreau S. Transcript analysis of PI3K and immune-related genes and gene signatures in the pre- and post-treatment samples from the window of opportunity study of anastrozole and anastrozole with pictilisib (GDC-0941) in patients with HR-positive early breast cancer (OPPORTUNE study). [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P5-13-01.
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Affiliation(s)
- P Schmid
- Barts Cancer Institute, Queen Mary University London, London, United Kingdom; Kings College London, London, United Kingdom; Guys and St Thomas NHS Trust, Kings College London, London, United Kingdom; University Hospital of South Manchester, Manchester, United Kingdom; Royal Cornwall Hospital, Truro, United Kingdom; Ninewells Hospital Dundee, Dundee, United Kingdom; Brighton and Sussex University Hospital NHS Trust, Brighton, United Kingdom; Barts Health NHS Trust, London, United Kingdom; Kings College Hospital, London, United Kingdom; MD Anderson Cancer Centre, Houston, TX; Genentech, South San Francisco, California, South San Francisco, CA
| | - SE Pinder
- Barts Cancer Institute, Queen Mary University London, London, United Kingdom; Kings College London, London, United Kingdom; Guys and St Thomas NHS Trust, Kings College London, London, United Kingdom; University Hospital of South Manchester, Manchester, United Kingdom; Royal Cornwall Hospital, Truro, United Kingdom; Ninewells Hospital Dundee, Dundee, United Kingdom; Brighton and Sussex University Hospital NHS Trust, Brighton, United Kingdom; Barts Health NHS Trust, London, United Kingdom; Kings College Hospital, London, United Kingdom; MD Anderson Cancer Centre, Houston, TX; Genentech, South San Francisco, California, South San Francisco, CA
| | - N Bundred
- Barts Cancer Institute, Queen Mary University London, London, United Kingdom; Kings College London, London, United Kingdom; Guys and St Thomas NHS Trust, Kings College London, London, United Kingdom; University Hospital of South Manchester, Manchester, United Kingdom; Royal Cornwall Hospital, Truro, United Kingdom; Ninewells Hospital Dundee, Dundee, United Kingdom; Brighton and Sussex University Hospital NHS Trust, Brighton, United Kingdom; Barts Health NHS Trust, London, United Kingdom; Kings College Hospital, London, United Kingdom; MD Anderson Cancer Centre, Houston, TX; Genentech, South San Francisco, California, South San Francisco, CA
| | - D Wheatley
- Barts Cancer Institute, Queen Mary University London, London, United Kingdom; Kings College London, London, United Kingdom; Guys and St Thomas NHS Trust, Kings College London, London, United Kingdom; University Hospital of South Manchester, Manchester, United Kingdom; Royal Cornwall Hospital, Truro, United Kingdom; Ninewells Hospital Dundee, Dundee, United Kingdom; Brighton and Sussex University Hospital NHS Trust, Brighton, United Kingdom; Barts Health NHS Trust, London, United Kingdom; Kings College Hospital, London, United Kingdom; MD Anderson Cancer Centre, Houston, TX; Genentech, South San Francisco, California, South San Francisco, CA
| | - J Macaskill
- Barts Cancer Institute, Queen Mary University London, London, United Kingdom; Kings College London, London, United Kingdom; Guys and St Thomas NHS Trust, Kings College London, London, United Kingdom; University Hospital of South Manchester, Manchester, United Kingdom; Royal Cornwall Hospital, Truro, United Kingdom; Ninewells Hospital Dundee, Dundee, United Kingdom; Brighton and Sussex University Hospital NHS Trust, Brighton, United Kingdom; Barts Health NHS Trust, London, United Kingdom; Kings College Hospital, London, United Kingdom; MD Anderson Cancer Centre, Houston, TX; Genentech, South San Francisco, California, South San Francisco, CA
| | - C Zammit
- Barts Cancer Institute, Queen Mary University London, London, United Kingdom; Kings College London, London, United Kingdom; Guys and St Thomas NHS Trust, Kings College London, London, United Kingdom; University Hospital of South Manchester, Manchester, United Kingdom; Royal Cornwall Hospital, Truro, United Kingdom; Ninewells Hospital Dundee, Dundee, United Kingdom; Brighton and Sussex University Hospital NHS Trust, Brighton, United Kingdom; Barts Health NHS Trust, London, United Kingdom; Kings College Hospital, London, United Kingdom; MD Anderson Cancer Centre, Houston, TX; Genentech, South San Francisco, California, South San Francisco, CA
| | - J Hu
- Barts Cancer Institute, Queen Mary University London, London, United Kingdom; Kings College London, London, United Kingdom; Guys and St Thomas NHS Trust, Kings College London, London, United Kingdom; University Hospital of South Manchester, Manchester, United Kingdom; Royal Cornwall Hospital, Truro, United Kingdom; Ninewells Hospital Dundee, Dundee, United Kingdom; Brighton and Sussex University Hospital NHS Trust, Brighton, United Kingdom; Barts Health NHS Trust, London, United Kingdom; Kings College Hospital, London, United Kingdom; MD Anderson Cancer Centre, Houston, TX; Genentech, South San Francisco, California, South San Francisco, CA
| | - R Price
- Barts Cancer Institute, Queen Mary University London, London, United Kingdom; Kings College London, London, United Kingdom; Guys and St Thomas NHS Trust, Kings College London, London, United Kingdom; University Hospital of South Manchester, Manchester, United Kingdom; Royal Cornwall Hospital, Truro, United Kingdom; Ninewells Hospital Dundee, Dundee, United Kingdom; Brighton and Sussex University Hospital NHS Trust, Brighton, United Kingdom; Barts Health NHS Trust, London, United Kingdom; Kings College Hospital, London, United Kingdom; MD Anderson Cancer Centre, Houston, TX; Genentech, South San Francisco, California, South San Francisco, CA
| | - A Shia
- Barts Cancer Institute, Queen Mary University London, London, United Kingdom; Kings College London, London, United Kingdom; Guys and St Thomas NHS Trust, Kings College London, London, United Kingdom; University Hospital of South Manchester, Manchester, United Kingdom; Royal Cornwall Hospital, Truro, United Kingdom; Ninewells Hospital Dundee, Dundee, United Kingdom; Brighton and Sussex University Hospital NHS Trust, Brighton, United Kingdom; Barts Health NHS Trust, London, United Kingdom; Kings College Hospital, London, United Kingdom; MD Anderson Cancer Centre, Houston, TX; Genentech, South San Francisco, California, South San Francisco, CA
| | - L Lim
- Barts Cancer Institute, Queen Mary University London, London, United Kingdom; Kings College London, London, United Kingdom; Guys and St Thomas NHS Trust, Kings College London, London, United Kingdom; University Hospital of South Manchester, Manchester, United Kingdom; Royal Cornwall Hospital, Truro, United Kingdom; Ninewells Hospital Dundee, Dundee, United Kingdom; Brighton and Sussex University Hospital NHS Trust, Brighton, United Kingdom; Barts Health NHS Trust, London, United Kingdom; Kings College Hospital, London, United Kingdom; MD Anderson Cancer Centre, Houston, TX; Genentech, South San Francisco, California, South San Francisco, CA
| | - P Parker
- Barts Cancer Institute, Queen Mary University London, London, United Kingdom; Kings College London, London, United Kingdom; Guys and St Thomas NHS Trust, Kings College London, London, United Kingdom; University Hospital of South Manchester, Manchester, United Kingdom; Royal Cornwall Hospital, Truro, United Kingdom; Ninewells Hospital Dundee, Dundee, United Kingdom; Brighton and Sussex University Hospital NHS Trust, Brighton, United Kingdom; Barts Health NHS Trust, London, United Kingdom; Kings College Hospital, London, United Kingdom; MD Anderson Cancer Centre, Houston, TX; Genentech, South San Francisco, California, South San Francisco, CA
| | - L Molinero
- Barts Cancer Institute, Queen Mary University London, London, United Kingdom; Kings College London, London, United Kingdom; Guys and St Thomas NHS Trust, Kings College London, London, United Kingdom; University Hospital of South Manchester, Manchester, United Kingdom; Royal Cornwall Hospital, Truro, United Kingdom; Ninewells Hospital Dundee, Dundee, United Kingdom; Brighton and Sussex University Hospital NHS Trust, Brighton, United Kingdom; Barts Health NHS Trust, London, United Kingdom; Kings College Hospital, London, United Kingdom; MD Anderson Cancer Centre, Houston, TX; Genentech, South San Francisco, California, South San Francisco, CA
| | - J Yu
- Barts Cancer Institute, Queen Mary University London, London, United Kingdom; Kings College London, London, United Kingdom; Guys and St Thomas NHS Trust, Kings College London, London, United Kingdom; University Hospital of South Manchester, Manchester, United Kingdom; Royal Cornwall Hospital, Truro, United Kingdom; Ninewells Hospital Dundee, Dundee, United Kingdom; Brighton and Sussex University Hospital NHS Trust, Brighton, United Kingdom; Barts Health NHS Trust, London, United Kingdom; Kings College Hospital, London, United Kingdom; MD Anderson Cancer Centre, Houston, TX; Genentech, South San Francisco, California, South San Francisco, CA
| | - C O'Brien
- Barts Cancer Institute, Queen Mary University London, London, United Kingdom; Kings College London, London, United Kingdom; Guys and St Thomas NHS Trust, Kings College London, London, United Kingdom; University Hospital of South Manchester, Manchester, United Kingdom; Royal Cornwall Hospital, Truro, United Kingdom; Ninewells Hospital Dundee, Dundee, United Kingdom; Brighton and Sussex University Hospital NHS Trust, Brighton, United Kingdom; Barts Health NHS Trust, London, United Kingdom; Kings College Hospital, London, United Kingdom; MD Anderson Cancer Centre, Houston, TX; Genentech, South San Francisco, California, South San Francisco, CA
| | - T Wilson
- Barts Cancer Institute, Queen Mary University London, London, United Kingdom; Kings College London, London, United Kingdom; Guys and St Thomas NHS Trust, Kings College London, London, United Kingdom; University Hospital of South Manchester, Manchester, United Kingdom; Royal Cornwall Hospital, Truro, United Kingdom; Ninewells Hospital Dundee, Dundee, United Kingdom; Brighton and Sussex University Hospital NHS Trust, Brighton, United Kingdom; Barts Health NHS Trust, London, United Kingdom; Kings College Hospital, London, United Kingdom; MD Anderson Cancer Centre, Houston, TX; Genentech, South San Francisco, California, South San Francisco, CA
| | - H Savage
- Barts Cancer Institute, Queen Mary University London, London, United Kingdom; Kings College London, London, United Kingdom; Guys and St Thomas NHS Trust, Kings College London, London, United Kingdom; University Hospital of South Manchester, Manchester, United Kingdom; Royal Cornwall Hospital, Truro, United Kingdom; Ninewells Hospital Dundee, Dundee, United Kingdom; Brighton and Sussex University Hospital NHS Trust, Brighton, United Kingdom; Barts Health NHS Trust, London, United Kingdom; Kings College Hospital, London, United Kingdom; MD Anderson Cancer Centre, Houston, TX; Genentech, South San Francisco, California, South San Francisco, CA
| | - M Derynck
- Barts Cancer Institute, Queen Mary University London, London, United Kingdom; Kings College London, London, United Kingdom; Guys and St Thomas NHS Trust, Kings College London, London, United Kingdom; University Hospital of South Manchester, Manchester, United Kingdom; Royal Cornwall Hospital, Truro, United Kingdom; Ninewells Hospital Dundee, Dundee, United Kingdom; Brighton and Sussex University Hospital NHS Trust, Brighton, United Kingdom; Barts Health NHS Trust, London, United Kingdom; Kings College Hospital, London, United Kingdom; MD Anderson Cancer Centre, Houston, TX; Genentech, South San Francisco, California, South San Francisco, CA
| | - MR Lackner
- Barts Cancer Institute, Queen Mary University London, London, United Kingdom; Kings College London, London, United Kingdom; Guys and St Thomas NHS Trust, Kings College London, London, United Kingdom; University Hospital of South Manchester, Manchester, United Kingdom; Royal Cornwall Hospital, Truro, United Kingdom; Ninewells Hospital Dundee, Dundee, United Kingdom; Brighton and Sussex University Hospital NHS Trust, Brighton, United Kingdom; Barts Health NHS Trust, London, United Kingdom; Kings College Hospital, London, United Kingdom; MD Anderson Cancer Centre, Houston, TX; Genentech, South San Francisco, California, South San Francisco, CA
| | - L Amler
- Barts Cancer Institute, Queen Mary University London, London, United Kingdom; Kings College London, London, United Kingdom; Guys and St Thomas NHS Trust, Kings College London, London, United Kingdom; University Hospital of South Manchester, Manchester, United Kingdom; Royal Cornwall Hospital, Truro, United Kingdom; Ninewells Hospital Dundee, Dundee, United Kingdom; Brighton and Sussex University Hospital NHS Trust, Brighton, United Kingdom; Barts Health NHS Trust, London, United Kingdom; Kings College Hospital, London, United Kingdom; MD Anderson Cancer Centre, Houston, TX; Genentech, South San Francisco, California, South San Francisco, CA
| | - A Purushotham
- Barts Cancer Institute, Queen Mary University London, London, United Kingdom; Kings College London, London, United Kingdom; Guys and St Thomas NHS Trust, Kings College London, London, United Kingdom; University Hospital of South Manchester, Manchester, United Kingdom; Royal Cornwall Hospital, Truro, United Kingdom; Ninewells Hospital Dundee, Dundee, United Kingdom; Brighton and Sussex University Hospital NHS Trust, Brighton, United Kingdom; Barts Health NHS Trust, London, United Kingdom; Kings College Hospital, London, United Kingdom; MD Anderson Cancer Centre, Houston, TX; Genentech, South San Francisco, California, South San Francisco, CA
| | - A Thompson
- Barts Cancer Institute, Queen Mary University London, London, United Kingdom; Kings College London, London, United Kingdom; Guys and St Thomas NHS Trust, Kings College London, London, United Kingdom; University Hospital of South Manchester, Manchester, United Kingdom; Royal Cornwall Hospital, Truro, United Kingdom; Ninewells Hospital Dundee, Dundee, United Kingdom; Brighton and Sussex University Hospital NHS Trust, Brighton, United Kingdom; Barts Health NHS Trust, London, United Kingdom; Kings College Hospital, London, United Kingdom; MD Anderson Cancer Centre, Houston, TX; Genentech, South San Francisco, California, South San Francisco, CA
| | - S Gendreau
- Barts Cancer Institute, Queen Mary University London, London, United Kingdom; Kings College London, London, United Kingdom; Guys and St Thomas NHS Trust, Kings College London, London, United Kingdom; University Hospital of South Manchester, Manchester, United Kingdom; Royal Cornwall Hospital, Truro, United Kingdom; Ninewells Hospital Dundee, Dundee, United Kingdom; Brighton and Sussex University Hospital NHS Trust, Brighton, United Kingdom; Barts Health NHS Trust, London, United Kingdom; Kings College Hospital, London, United Kingdom; MD Anderson Cancer Centre, Houston, TX; Genentech, South San Francisco, California, South San Francisco, CA
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8
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Spoerke J, Gendreau S, Johnston S, Schmid P, Krop I, Qui J, Derynck M, Chan I, Walter K, Amler L, Hampton G, Lackner M. Abstract PD6-03: High prevalence and clonal heterogeneity of ESR1 mutations (mt) in circulating tumor DNA (ctDNA) from patients (pts) enrolled in FERGI, a randomized phase II study testing pictilisib (GDC-0941) in combination with fulvestrant (F) in pts that failed a prior aromatase inhibitor (AI). Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-pd6-03] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Mutations in the ligand binding domain of the estrogen receptor gene (ESR1) have been associated with resistance to AI therapy in pts with ER+ breast cancer. To assess if ESR1 status has prognostic or predictive significance in the post-AI metastatic setting ESR1 mutation status was analyzed in circulating tumor DNA (ctDNA) from 168 pts enrolled on the FERGI study (NCT01437566; Krop et al., SABCS 2014).
Methods: Baseline and longitudinal mutational analysis for hotspot mutations in ESR1 (E380Q, S463P, V534E, P535H, L536R/H/P, L536Q, Y537N/S/C, D538G) and PIK3CA (C420R, E542K, E545K/G, Q546K, M1043I, H1047Y/R/L) was performed using droplet digital PCR (ddPCR) on ctDNA derived from plasma. Archival tissue was analyzed via RT-PCR and ddPCR.
Results: Baseline ctDNA analysis demonstrated a total of 62/156 (40%) and 57/153 (37%) pts with PIK3CA and ESR1 mutations, respectively. The most common ESR1 mutations are D538G, Y537S, and E380Q, representing 54%, 33% and 26% of the pts with a detectable ESR1 mutation at baseline, respectively. There was a numeric increase of ESR1 mutations in patients with LumA (41/99, 41%) vs LumB disease (14/44, 31%). PIK3CA mutations in asynchronously collected archival tissue were 85% concordant with plasma ctDNA mutations (sensitivity 78%, specificity 91%). PIK3CA mutations in baseline ctDNA showed a higher median allele frequency (AF) than ESR1 mutations (3.6% vs 0.46%), consistent with PIK3CA being an early event and ESR1 mutations occurring later in pts with recurrent disease. Of the pts with a detectable ESR1 mutation at baseline (n=57), 23 (40%) pts had multiple ESR1 mutations and 10 (18%) had ≥3 ESR1 mutations. The PFS outcomes for patients with and without ESR1 mutations detected at baseline are summarized below, indicating no obvious prognostic or predictive effect for combination of F with pictilisib compared with F in these underpowered subsets.
ArmESR1 MT - mPFS (mo)ESR1 WT - mPFS (mo)HR (95% CI)F + placebo5.4 (30 pts, 24 events)3.7 (40 pts, 31 events)1.06 (0.62, 1.81)F+pictilisib5.8 (27 pts, 20 events)6.7 (56 pts, 34 events)1.36 (0.78, 2.38)
PIK3CA and ESR1 ctDNA analysis on serial plasma samples from 40 pts and the assessment of ESR1 mutation status in the patient's tumor sample by ddPCR is currently in progress and will be reported.
Conclusions: Mutations in ESR1 detected by ddPCR in patient plasma samples occur in nearly 40% of pts that failed a prior AI. The polyclonal nature of ESR1 mutations is consistent with the convergent evolution of multiple AI resistant subclones. While these conclusions should be interpreted with caution due to the relatively small sample size and post hoc nature of the analysis, this data does not support a prognostic or predictive PFS hypothesis for ESR1 mutations with F or in combination with pictilisib.
Citation Format: Spoerke J, Gendreau S, Johnston S, Schmid P, Krop I, Qui J, Derynck M, Chan I, Walter K, Amler L, Hampton G, Lackner M. High prevalence and clonal heterogeneity of ESR1 mutations (mt) in circulating tumor DNA (ctDNA) from patients (pts) enrolled in FERGI, a randomized phase II study testing pictilisib (GDC-0941) in combination with fulvestrant (F) in pts that failed a prior aromatase inhibitor (AI). [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr PD6-03.
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Affiliation(s)
- J Spoerke
- Genentech, South San Francisco, CA; Royal Marsden Hospital, London, United Kingdom; Barts Cancer Institute, Queen Mary University London, London, United Kingdom; Dana-Farber Cancer Institute, Boston, MA
| | - S Gendreau
- Genentech, South San Francisco, CA; Royal Marsden Hospital, London, United Kingdom; Barts Cancer Institute, Queen Mary University London, London, United Kingdom; Dana-Farber Cancer Institute, Boston, MA
| | - S Johnston
- Genentech, South San Francisco, CA; Royal Marsden Hospital, London, United Kingdom; Barts Cancer Institute, Queen Mary University London, London, United Kingdom; Dana-Farber Cancer Institute, Boston, MA
| | - P Schmid
- Genentech, South San Francisco, CA; Royal Marsden Hospital, London, United Kingdom; Barts Cancer Institute, Queen Mary University London, London, United Kingdom; Dana-Farber Cancer Institute, Boston, MA
| | - I Krop
- Genentech, South San Francisco, CA; Royal Marsden Hospital, London, United Kingdom; Barts Cancer Institute, Queen Mary University London, London, United Kingdom; Dana-Farber Cancer Institute, Boston, MA
| | - J Qui
- Genentech, South San Francisco, CA; Royal Marsden Hospital, London, United Kingdom; Barts Cancer Institute, Queen Mary University London, London, United Kingdom; Dana-Farber Cancer Institute, Boston, MA
| | - M Derynck
- Genentech, South San Francisco, CA; Royal Marsden Hospital, London, United Kingdom; Barts Cancer Institute, Queen Mary University London, London, United Kingdom; Dana-Farber Cancer Institute, Boston, MA
| | - I Chan
- Genentech, South San Francisco, CA; Royal Marsden Hospital, London, United Kingdom; Barts Cancer Institute, Queen Mary University London, London, United Kingdom; Dana-Farber Cancer Institute, Boston, MA
| | - K Walter
- Genentech, South San Francisco, CA; Royal Marsden Hospital, London, United Kingdom; Barts Cancer Institute, Queen Mary University London, London, United Kingdom; Dana-Farber Cancer Institute, Boston, MA
| | - L Amler
- Genentech, South San Francisco, CA; Royal Marsden Hospital, London, United Kingdom; Barts Cancer Institute, Queen Mary University London, London, United Kingdom; Dana-Farber Cancer Institute, Boston, MA
| | - G Hampton
- Genentech, South San Francisco, CA; Royal Marsden Hospital, London, United Kingdom; Barts Cancer Institute, Queen Mary University London, London, United Kingdom; Dana-Farber Cancer Institute, Boston, MA
| | - M Lackner
- Genentech, South San Francisco, CA; Royal Marsden Hospital, London, United Kingdom; Barts Cancer Institute, Queen Mary University London, London, United Kingdom; Dana-Farber Cancer Institute, Boston, MA
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Derynck M, Dow K, Synnes A, Church P, Kelly E, Levenbach J, Shah V. 60: Short-Term and Long-Term Outcomes of Neonatal Gram-Negative Sepsis in Canadian NICUs. Paediatr Child Health 2015. [DOI: 10.1093/pch/20.5.e55] [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] Open
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Yan Y, Spoerke J, Wu J, Desai R, Koeppen H, Hampton G, Fredrickson J, Derynck M, Lauchle J, Lackner M. 495 The PI3K/mTOR Inhibitor GDC-0980 Demonstrates Target Engagement and Pathway Modulation in Tumor Tissue at Tolerated Doses. Eur J Cancer 2012. [DOI: 10.1016/s0959-8049(12)72293-1] [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: 10/27/2022]
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Makhija S, Glenn D, Ueland F, Gold M, Dizon D, Paton V, Birkner M, Lin C, Derynck M, Matulonis U. Results from a phase II randomized, placebo-controlled, double-blind trial suggest improved PFS with the addition of pertuzumab to gemcitabine in patients with platinum-resistant ovarian, fallopian tube, or primary peritoneal cancer. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.5507] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [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
5507 Background: Pertuzumab (P) is a humanized monoclonal antibody that blocks the ability of HER2 to heterodimerize with other HER/ErbB receptors. As a single agent, P has demonstrated clinical activity in relapsed/refractory epithelial ovarian cancer (EOC). Since platinum-resistant (CDDP-R) EOC remains a difficult disease to treat, this phase II study was conducted to determine if addition of P to gemcitabine (G) would improve results. Methods: Patients with CDDP-R EOC (including ovarian, fallopian tube, or primary peritoneal cancer) who had received up to one prior treatment for CDDP-R disease were randomized to Gem 800 mg/m2 on D1, 8 of a 21-day cycle ± P or placebo (pl). P was given as an 840 mg initial dose followed by 420mg IV every 3 weeks. Tumor response was assessed by RECIST every 6 weeks using GOG criteria. The primary endpoint was progression free survival (PFS). Results: One hundred thirty patients (n = 65 each treatment cohort) were treated. Clinical characteristics were balanced between the treatment groups. Pts received a median of 2 prior regimens (range 1–6) for EOC. Based on 83 events, the adjusted hazard ratio for PFS was 0.67 (95% CI: 0.43–1.02), p =0.06 in favor of P+Gem. The median PFS was 3.0 months (0–8.7 months) vs. 2.6 months (0–9+ months), and the PFS rate at 4 months was 49% vs. 34% in the P+Gem and Gem/pl arms, respectively. The most common AEs increased in the P-treated pts were fatigue, nausea, diarrhea, back pain, Gr 3–4 neutropenia, rash, headache, stomatitis, epistaxis, and rhinorrhea. Clinically significant CHF was reported in one patient in the pertuzumab cohort. There was no imbalance in the LVEF results between treatment arms. One patient who received pertuzumab + gemcitabine experienced an adverse event that resulted in death (hemolytic-uremic syndrome). Conclusions: These data suggest that pertuzumab may add activity to gemcitabine as reflected by improvements in PFS in patients with CDDP-R ovarian, primary peritoneal, or fallopian tube cancer. Survival data will be presented at ASCO. No significant financial relationships to disclose.
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Affiliation(s)
- S. Makhija
- Univ of Alabama Birmingham, Birmingham, AL; Sharp Rees-Stealy Medical Group, San Diego, CA; UK HeathCare Markey Cancer Center, Lexington, KY; The University of Oklahoma Health Sciences Center, Oklahoma City, OK; Women and Infants Hospital, Providence, RI; Genentech, Inc., South San Francisco, CA; Dana-Farber Cancer Institute, Boston, MA
| | - D. Glenn
- Univ of Alabama Birmingham, Birmingham, AL; Sharp Rees-Stealy Medical Group, San Diego, CA; UK HeathCare Markey Cancer Center, Lexington, KY; The University of Oklahoma Health Sciences Center, Oklahoma City, OK; Women and Infants Hospital, Providence, RI; Genentech, Inc., South San Francisco, CA; Dana-Farber Cancer Institute, Boston, MA
| | - F. Ueland
- Univ of Alabama Birmingham, Birmingham, AL; Sharp Rees-Stealy Medical Group, San Diego, CA; UK HeathCare Markey Cancer Center, Lexington, KY; The University of Oklahoma Health Sciences Center, Oklahoma City, OK; Women and Infants Hospital, Providence, RI; Genentech, Inc., South San Francisco, CA; Dana-Farber Cancer Institute, Boston, MA
| | - M. Gold
- Univ of Alabama Birmingham, Birmingham, AL; Sharp Rees-Stealy Medical Group, San Diego, CA; UK HeathCare Markey Cancer Center, Lexington, KY; The University of Oklahoma Health Sciences Center, Oklahoma City, OK; Women and Infants Hospital, Providence, RI; Genentech, Inc., South San Francisco, CA; Dana-Farber Cancer Institute, Boston, MA
| | - D. Dizon
- Univ of Alabama Birmingham, Birmingham, AL; Sharp Rees-Stealy Medical Group, San Diego, CA; UK HeathCare Markey Cancer Center, Lexington, KY; The University of Oklahoma Health Sciences Center, Oklahoma City, OK; Women and Infants Hospital, Providence, RI; Genentech, Inc., South San Francisco, CA; Dana-Farber Cancer Institute, Boston, MA
| | - V. Paton
- Univ of Alabama Birmingham, Birmingham, AL; Sharp Rees-Stealy Medical Group, San Diego, CA; UK HeathCare Markey Cancer Center, Lexington, KY; The University of Oklahoma Health Sciences Center, Oklahoma City, OK; Women and Infants Hospital, Providence, RI; Genentech, Inc., South San Francisco, CA; Dana-Farber Cancer Institute, Boston, MA
| | - M. Birkner
- Univ of Alabama Birmingham, Birmingham, AL; Sharp Rees-Stealy Medical Group, San Diego, CA; UK HeathCare Markey Cancer Center, Lexington, KY; The University of Oklahoma Health Sciences Center, Oklahoma City, OK; Women and Infants Hospital, Providence, RI; Genentech, Inc., South San Francisco, CA; Dana-Farber Cancer Institute, Boston, MA
| | - C. Lin
- Univ of Alabama Birmingham, Birmingham, AL; Sharp Rees-Stealy Medical Group, San Diego, CA; UK HeathCare Markey Cancer Center, Lexington, KY; The University of Oklahoma Health Sciences Center, Oklahoma City, OK; Women and Infants Hospital, Providence, RI; Genentech, Inc., South San Francisco, CA; Dana-Farber Cancer Institute, Boston, MA
| | - M. Derynck
- Univ of Alabama Birmingham, Birmingham, AL; Sharp Rees-Stealy Medical Group, San Diego, CA; UK HeathCare Markey Cancer Center, Lexington, KY; The University of Oklahoma Health Sciences Center, Oklahoma City, OK; Women and Infants Hospital, Providence, RI; Genentech, Inc., South San Francisco, CA; Dana-Farber Cancer Institute, Boston, MA
| | - U. Matulonis
- Univ of Alabama Birmingham, Birmingham, AL; Sharp Rees-Stealy Medical Group, San Diego, CA; UK HeathCare Markey Cancer Center, Lexington, KY; The University of Oklahoma Health Sciences Center, Oklahoma City, OK; Women and Infants Hospital, Providence, RI; Genentech, Inc., South San Francisco, CA; Dana-Farber Cancer Institute, Boston, MA
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Beaumont J, Yount S, Lalla D, Lubeck D, Derynck M, Karlan B, Cella D. Validation of the Functional Assessment of Cancer Therapy-Ovarian (FACT-O) Symptom Index (FOSI) in a phase II clinical trial of pertuzumab in patients with advanced ovarian cancer. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.16021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
16021 Background: The FOSI is a very brief(8-item) index derived from the FACT-O to measure symptom response to treatment for ovarian cancer(OC). We evaluated its performance in a single arm Phase II clinical trial. Methods: The FOSI was administered to patients with advanced OC participating in a single arm Ph II clinical trial of pertuzumab(Gordon et al, JCO (2006) v24:4324;2006)). Pertuzumab, a humanized HER2 antibody is the first in a new class of investigational agents known as HER dimerization inhibitors(HDIs). Patients completed the FOSI at D1 of each 3 week cycle, up to 17 cycles. Validation analyses focused on data from the first 4 cycles and included Cronbach's alpha coefficients plus cross-sectional and longitudinal comparisons of groups defined by ECOG performance status (PS). Results: 62 patients completed the FOSI at baseline (B), 54 at cycle 2, 44 at cycle 3 and 27 at cycle 4. The FOSI showed acceptable internal consistency reliability with alphas of 0.73 to 0.80. The FOSI differentiated patients with PS 0 from those with PS =1 at each cycle (Table). There was a difference in FOSI scores in patients with worsened PS from those whose PS improved or was unchanged at cycle 2 only (p<0.001). The ES (mean change/ SD of change scores) for the group with worsened PS was -0.77. The minimally important difference was estimated to be 2–3 points. Conclusions: The FOSI is a valid symptom measure in this population of OC patients, demonstrating acceptable reliability, validity and responsiveness to clinical change. [Table: see text] No significant financial relationships to disclose.
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Affiliation(s)
- J. Beaumont
- Evanston Northwestern Healthcare, Evanston, IL; Genentech, Inc., South San Francisco, CA; Cedars-Sinai Medical Center, Los Angeles, CA
| | - S. Yount
- Evanston Northwestern Healthcare, Evanston, IL; Genentech, Inc., South San Francisco, CA; Cedars-Sinai Medical Center, Los Angeles, CA
| | - D. Lalla
- Evanston Northwestern Healthcare, Evanston, IL; Genentech, Inc., South San Francisco, CA; Cedars-Sinai Medical Center, Los Angeles, CA
| | - D. Lubeck
- Evanston Northwestern Healthcare, Evanston, IL; Genentech, Inc., South San Francisco, CA; Cedars-Sinai Medical Center, Los Angeles, CA
| | - M. Derynck
- Evanston Northwestern Healthcare, Evanston, IL; Genentech, Inc., South San Francisco, CA; Cedars-Sinai Medical Center, Los Angeles, CA
| | - B. Karlan
- Evanston Northwestern Healthcare, Evanston, IL; Genentech, Inc., South San Francisco, CA; Cedars-Sinai Medical Center, Los Angeles, CA
| | - D. Cella
- Evanston Northwestern Healthcare, Evanston, IL; Genentech, Inc., South San Francisco, CA; Cedars-Sinai Medical Center, Los Angeles, CA
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