1
|
Parker CC, Petersen PM, Cook AD, Clarke NW, Catton C, Cross WR, Kynaston H, Parulekar WR, Persad RA, Saad F, Bower L, Durkan GC, Logue J, Maniatis C, Noor D, Payne H, Anderson J, Bahl AK, Bashir F, Bottomley DM, Brasso K, Capaldi L, Cooke PW, Chung C, Donohue J, Eddy B, Heath CM, Henderson A, Henry A, Jaganathan R, Jakobsen H, James ND, Joseph J, Lees K, Lester J, Lindberg H, Makar A, Morris SL, Oommen N, Ostler P, Owen L, Patel P, Pope A, Popert R, Raman R, Ramani V, Røder A, Sayers I, Simms M, Srinivasan V, Sundaram S, Tarver KL, Tran A, Wells P, Wilson J, Zarkar AM, Parmar MKM, Sydes MR. Timing of Radiotherapy (RT) After Radical Prostatectomy (RP): Long-term outcomes in the RADICALS-RT trial [NCT00541047]. Ann Oncol 2024:S0923-7534(24)00105-4. [PMID: 38583574 DOI: 10.1016/j.annonc.2024.03.010] [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: 10/20/2023] [Revised: 03/25/2024] [Accepted: 03/27/2024] [Indexed: 04/09/2024] Open
Abstract
BACKGROUND The optimal timing of radiotherapy (RT) after radical prostatectomy for prostate cancer has been uncertain. RADICALS-RT compared efficacy and safety of adjuvant RT versus an observation policy with salvage RT for PSA failure. METHODS RADICALS-RT was a randomised controlled trial enrolling patients with ≥1 risk factor (pT3/4, Gleason 7-10, positive margins, pre-op PSA≥10ng/ml) for recurrence after radical prostatectomy. Patients were randomised 1:1 to adjuvant RT ("Adjuvant-RT") or an observation policy with salvage RT for PSA failure ("Salvage-RT") defined as PSA≥0.1ng/ml or 3 consecutive rises. Stratification factors were Gleason score, margin status, planned RT schedule (52.5Gy/20 fractions or 66Gy/33 fractions) and treatment centre. The primary outcome measure was freedom-from-distant metastasis, designed with 80% power to detect an improvement from 90% with Salvage-RT (control) to 95% at 10yr with Adjuvant-RT. Secondary outcome measures were bPFS, freedom-from-non-protocol hormone therapy, safety and patient-reported outcomes. Standard survival analysis methods were used; HR<1 favours Adjuvant-RT. FINDINGS Between Oct-2007 and Dec-2016, 1396 participants from UK, Denmark, Canada and Ireland were randomised: 699 Salvage-RT, 697 Adjuvant-RT. Allocated groups were balanced with median age 65yr. 93% (649/697) Adjuvant-RT reported RT within 6m after randomisation; 39% (270/699) Salvage-RT reported RT during follow-up. Median follow-up was 7.8 years. With 80 distant metastasis events, 10yr FFDM was 93% for Adjuvant-RT and 90% for Salvage-RT: HR=0.68 (95%CI 0·43-1·07, p=0·095). Of 109 deaths, 17 were due to prostate cancer. Overall survival was not improved (HR=0.980, 95%CI 0.667-1.440, p=0.917). Adjuvant-RT reported worse urinary and faecal incontinence one year after randomisation (p=0.001); faecal incontinence remained significant after ten years (p=0.017). INTERPRETATION Long-term results from RADICALS-RT confirm adjuvant RT after radical prostatectomy increases the risk of urinary and bowel morbidity, but does not meaningfully improve disease control. An observation policy with salvage RT for PSA failure should be the current standard after radical prostatectomy.
Collapse
Affiliation(s)
- C C Parker
- Institute of Cancer Research, Royal Marsden NHS Foundation Trust, Sutton, UK
| | - P M Petersen
- Dept of Oncology, Copenhagen Prostate Cancer Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - A D Cook
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London, UK
| | - N W Clarke
- Dept of Urology, The Christie and Salford Royal Hospitals, Manchester, UK; The University of Manchester, Manchester, UK
| | - C Catton
- Dept of Radiation Oncology, Princess Margaret Hospital, University Health Network, Toronto, ON, Canada
| | - W R Cross
- Dept of Urology, St James's University Hospital, Leeds, UK
| | - H Kynaston
- Division of Cancer and Genetics, Cardiff University, Cardiff, UK
| | - W R Parulekar
- Canadian Cancer Trials Group, Queen's University, Kingston, ON, Canada
| | - R A Persad
- Dept of Urology, Bristol Urological Institute, Bristol, UK
| | - F Saad
- Dept of Urology, Centre Hospitalier de l'Université de Montréal, Montreal, Canada
| | - L Bower
- Guy's and St Thomas' NHS Foundation Trust, London, UK; Institute of Cancer Research, Royal Marsden NHS Foundation Trust, London, UK
| | - G C Durkan
- Dept of Urology, University Hospital Galway, Galway, Ireland
| | - J Logue
- Dept of Oncology, The Christie Hospital NHS FT, Wilmslow Road, Manchester, UK
| | - C Maniatis
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London, UK
| | - D Noor
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London, UK
| | - H Payne
- The Prostate Centre, London, UK
| | - J Anderson
- St James's Institute of Oncology, Leeds, UK
| | - A K Bahl
- Bristol Haematology and Oncology Centre, University Hospitals Bristol & Weston NHS Trust, Bristol, UK
| | - F Bashir
- Queen's Centre for Oncology, Castle Hill Hospital, Hull University Teaching Hospitals NHS Trust, Cottingham, UK
| | | | - K Brasso
- Dept of Urology, Copenhagen Prostate Cancer Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Dept of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - L Capaldi
- Worcester Oncology Centre, Worcestershire Acute NHS Hospitals Trust, Worcester, UK
| | - P W Cooke
- Dept of Urology, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - C Chung
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London, UK
| | - J Donohue
- Dept of Urology, Maidstone and Tunbridge Wells NHS Trust, Maidstone, UK
| | - B Eddy
- East Kent University Hospitals Foundation Trust, Kent, UK
| | - C M Heath
- Dept of Clinical Oncology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - A Henderson
- Dept of Urology, Maidstone and Tunbridge Wells NHS Trust, Maidstone, UK
| | - A Henry
- Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | - R Jaganathan
- Dept of Urology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - H Jakobsen
- Dept of Urology, Herlev University Hospital, Herlev, Denmark
| | - N D James
- Institute of Cancer Research, Royal Marsden NHS Foundation Trust, London, UK
| | - J Joseph
- Leeds Teaching Hospitals, UK; York and Scarborough Teaching Hospitals, UK
| | - K Lees
- Dept of Oncology, Maidstone and Tunbridge Wells NHS Trust, Maidstone, UK
| | - J Lester
- South West Wales Cancer Centre, Singleton Hospital, Swansea, UK
| | - H Lindberg
- Dept of Oncology, Herlev University Hospital, Herlev, Denmark
| | - A Makar
- Dept of Urology, Worcestershire Acute Hospitals Trust, Worcester, UK
| | - S L Morris
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - N Oommen
- Wrexham Maelor Hospital, Wrexham, UK
| | - P Ostler
- Mount Vernon Cancer Centre, Northwood, UK
| | - L Owen
- Bradford Royal Infirmary, Bradford, UK; Leeds Cancer Centre, Leeds, UK
| | - P Patel
- Dept of Urology, University College London Hospitals, London, UK
| | - A Pope
- Mount Vernon Cancer Centre, Northwood, UK
| | - R Popert
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - R Raman
- Kent Oncology Centre, Kent & Canterbury Hospital, Canterbury, UK
| | - V Ramani
- Dept of Urology, The Christie and Salford Royal Hospitals, Manchester, UK
| | - A Røder
- Dept of Urology, Copenhagen Prostate Cancer Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - I Sayers
- Deanesly Centre, New Cross Hospital, Wolverhampton, UK
| | - M Simms
- Dept of Urology, Hull University Hospitals NHS Trust, UK
| | - V Srinivasan
- Glan Clwyd Hospital, Betsi Cadwaladr University Health Board, Rhyl, UK
| | - S Sundaram
- Dept of Urology, Mid Yorkshire Teaching Hospital, Pontefract, UK
| | - K L Tarver
- Dept of Oncology, Queen's Hospital, Romford, UK
| | - A Tran
- Dept of Oncology, The Christie Hospital NHS FT, Wilmslow Road, Manchester, UK
| | - P Wells
- St Bartholomews Hospital, London UK
| | - J Wilson
- Royal Gwent Hospital, Newport, UK
| | - A M Zarkar
- Dept of Oncology, University Hospitals Birmingham, Birmingham, UK
| | - M K M Parmar
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London, UK
| | - M R Sydes
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London, UK.
| |
Collapse
|
2
|
Gilbert DC, Nankivell M, Rush H, Clarke NW, Mangar S, Al-Hasso A, Rosen S, Kockelbergh R, Sundaram SK, Dixit S, Laniado M, McPhail N, Shaheen A, Brown S, Gale J, Deighan J, Marshall J, Duong T, Macnair A, Griffiths A, Amos CL, Sydes MR, James ND, Parmar MKB, Langley RE. A Repurposing Programme Evaluating Transdermal Oestradiol Patches for the Treatment of Prostate Cancer Within the PATCH and STAMPEDE Trials: Current Results and Adapting Trial Design. Clin Oncol (R Coll Radiol) 2024; 36:e11-e19. [PMID: 37973477 DOI: 10.1016/j.clon.2023.10.054] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 10/31/2023] [Indexed: 11/19/2023]
Abstract
AIMS Androgen deprivation therapy (ADT), usually achieved with luteinising hormone releasing hormone analogues (LHRHa), is central to prostate cancer management. LHRHa reduce both testosterone and oestrogen and are associated with significant long-term toxicity. Previous use of oral oestrogens as ADT was curtailed because of cardiovascular toxicity. Transdermal oestrogen (tE2) patches are a potential alternative ADT, supressing testosterone without the associated oestrogen-depletion toxicities (osteoporosis, hot flushes, metabolic abnormalities) and avoiding cardiovascular toxicity, and we here describe their evaluation in men with prostate cancer. MATERIALS AND METHODS The PATCH (NCT00303784) adaptive trials programme (incorporating recruitment through the STAMPEDE [NCT00268476] platform) is evaluating the safety and efficacy of tE2 patches as ADT for men with prostate cancer. An initial randomised (LHRHa versus tE2) phase II study (n = 251) with cardiovascular toxicity as the primary outcome measure has expanded into a phase III evaluation. Those with locally advanced (M0) or metastatic (M1) prostate cancer are eligible. To reflect changes in both management and prognosis, the PATCH programme is now evaluating these cohorts separately. RESULTS Recruitment is complete, with 1362 and 1128 in the M0 and M1 cohorts, respectively. Rates of androgen suppression with tE2 were equivalent to LHRHa, with improved metabolic parameters, quality of life and bone health indices (mean absolute change in lumbar spine bone mineral density of -3.0% for LHRHa and +7.9% for tE2 with an estimated difference between arms of 9.3% (95% confidence interval 5.3-13.4). Importantly, rates of cardiovascular events were not significantly different between the two arms and the time to first cardiovascular event did not differ between treatment groups (hazard ratio 1.11, 95% confidence interval 0.80-1.53; P = 0.54). Oncological outcomes are awaited. FUTURE Efficacy results for the M0 cohort (primary outcome measure metastases-free survival) are expected in the final quarter of 2023. For M1 patients (primary outcome measure - overall survival), analysis using restricted mean survival time is being explored. Allied translational work on longitudinal samples is underway.
Collapse
Affiliation(s)
- D C Gilbert
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, UK; University Hospitals Sussex NHS Foundation Trust, Royal Sussex County Hospital, Brighton, UK.
| | - M Nankivell
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, UK
| | - H Rush
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, UK
| | - N W Clarke
- The Christie and Salford Royal Hospitals, Manchester, UK
| | - S Mangar
- Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - A Al-Hasso
- Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - S Rosen
- National Heart and Lung Institute, Imperial College, London, UK
| | - R Kockelbergh
- Department of Urology, University Hospitals of Leicester, Leicester, UK
| | - S K Sundaram
- Mid-Yorkshire Teaching NHS Trust, Pinderfields Hospital, Wakefield, UK
| | - S Dixit
- Scunthorpe General Hospital, Scunthorpe, UK
| | | | | | | | - S Brown
- Airedale General Hospital, Keighley, UK
| | - J Gale
- Queen Alexandra Hospital, Portsmouth, UK
| | - J Deighan
- Patient Representative, MRC Clinical Trials Unit at UCL, London, UK
| | - J Marshall
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, UK
| | - T Duong
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, UK
| | - A Macnair
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, UK; Guys and St Thomas' NHS Foundation Trust, London, UK
| | - A Griffiths
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, UK
| | - C L Amos
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, UK
| | - M R Sydes
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, UK
| | - N D James
- Institute of Cancer Research, Sutton, UK
| | - M K B Parmar
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, UK
| | - R E Langley
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, UK
| |
Collapse
|
3
|
Parker CC, Clarke NW, Catton C, Kynaston H, Cook A, Cross W, Davidson C, Goldstein C, Logue J, Maniatis C, Petersen PM, Neville P, Payne H, Persad R, Pugh C, Stirling A, Saad F, Parulekar WR, Parmar MKB, Sydes MR. RADICALS-HD: Reflections before the Results are Known. Clin Oncol (R Coll Radiol) 2022; 34:593-597. [PMID: 35810050 DOI: 10.1016/j.clon.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 06/01/2022] [Accepted: 06/15/2022] [Indexed: 11/16/2022]
Affiliation(s)
- C C Parker
- The Institute of Cancer Research, Royal Marsden NHS Foundation Trust, Sutton, UK.
| | - N W Clarke
- Genito-Urinary Cancer Research Group, Department of Surgery, The Christie Hospital, Manchester, UK; Department of Urology, Salford Royal Hospitals, Manchester, UK
| | - C Catton
- Radiation Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - H Kynaston
- Cardiff University School of Medicine, Cardiff University, Cardiff, UK
| | - A Cook
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London, UK
| | - W Cross
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - C Davidson
- Canadian Cancer Trials Group, Queen's University, Kingston, Canada
| | - C Goldstein
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London, UK
| | - J Logue
- Oncology, The Christie Hospital, Manchester, UK
| | - C Maniatis
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London, UK
| | - P M Petersen
- Department of Oncology, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - P Neville
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London, UK
| | - H Payne
- Oncology, University College London Hospitals, London, UK
| | - R Persad
- Bristol Urological Institute, North Bristol Hospitals, Bristol, UK
| | - C Pugh
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London, UK
| | - A Stirling
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London, UK
| | - F Saad
- University of Montreal Hospital Center (CHUM), Montréal, Canada
| | - W R Parulekar
- Canadian Cancer Trials Group, Queen's University, Kingston, Canada
| | - M K B Parmar
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London, UK
| | - M R Sydes
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London, UK
| |
Collapse
|
4
|
Cannistraci A, Hascoet P, Ali A, Mundra P, Clarke NW, Pavet V, Marais R. MiR-378a inhibits glucose metabolism by suppressing GLUT1 in prostate cancer. Oncogene 2022; 41:1445-1455. [PMID: 35039635 PMCID: PMC8897193 DOI: 10.1038/s41388-022-02178-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 12/07/2021] [Accepted: 01/05/2022] [Indexed: 12/24/2022]
Abstract
Prostate cancer (PCa) is the fifth leading cause of cancer related deaths worldwide, in part due to a lack of molecular stratification tools that can distinguish primary tumours that will remain indolent from those that will metastasise. Amongst potential molecular biomarkers, microRNAs (miRs) have attracted particular interest because of their high stability in body fluids and fixed tissues. These small non-coding RNAs modulate several physiological and pathological processes, including cancer progression. Herein we explore the prognostic potential and the functional role of miRs in localised PCa and their relation to nodal metastasis. We define a 7-miR signature that is associated with poor survival independently of age, Gleason score, pathological T state, N stage and surgical margin status and that is also prognostic for disease-free survival in patients with intermediate-risk localised disease. Within our 7-miR signature, we show that miR-378a-3p (hereafter miR-378a) levels are low in primary tumours compared to benign prostate tissue, and also lower in Gleason score 8-9 compared to Gleason 6-7 PCa. We demonstrate that miR-378a impairs glucose metabolism and reduces proliferation in PCa cells through independent mechanisms, and we identify glucose transporter 1 (GLUT1) messenger RNA as a direct target of miR-378a. We show that GLUT1 inhibition hampers glycolysis, leading to cell death. Our data provides a rational for a new PCa stratification strategy based on miR expression, and it reveals that miR-378a and GLUT1 are potential therapeutic targets in highly aggressive glycolytic PCa.
Collapse
Affiliation(s)
- A Cannistraci
- Molecular Oncology Group, Cancer Research UK Manchester Institute, The University of Manchester, Alderley Park, Macclesfield, Cheshire, SK10 4TG, UK
| | - P Hascoet
- Molecular Oncology Group, Cancer Research UK Manchester Institute, The University of Manchester, Alderley Park, Macclesfield, Cheshire, SK10 4TG, UK
| | - A Ali
- Genito-Urinary Cancer Research Group and the FASTMAN Prostate Cancer Centre for Excellence, Division of Cancer Sciences, Manchester Cancer Research Centre, The University of Manchester, 555 Wilmslow Road, Manchester, M20 4GJ, UK
| | - P Mundra
- Molecular Oncology Group, Cancer Research UK Manchester Institute, The University of Manchester, Alderley Park, Macclesfield, Cheshire, SK10 4TG, UK
| | - N W Clarke
- Genito-Urinary Cancer Research Group and the FASTMAN Prostate Cancer Centre for Excellence, Division of Cancer Sciences, Manchester Cancer Research Centre, The University of Manchester, 555 Wilmslow Road, Manchester, M20 4GJ, UK.,The Christie NHS Foundation Trust, Wilmslow Road, Manchester, M20 4BX, UK
| | - V Pavet
- Molecular Oncology Group, Cancer Research UK Manchester Institute, The University of Manchester, Alderley Park, Macclesfield, Cheshire, SK10 4TG, UK.
| | - R Marais
- Molecular Oncology Group, Cancer Research UK Manchester Institute, The University of Manchester, Alderley Park, Macclesfield, Cheshire, SK10 4TG, UK.
| |
Collapse
|
5
|
Parry MG, Cowling TE, Sujenthiran A, Nossiter J, Berry B, Cathcart P, Aggarwal A, Payne H, van der Meulen J, Clarke NW, Gnanapragasam VJ. Risk stratification for prostate cancer management: value of the Cambridge Prognostic Group classification for assessing treatment allocation. BMC Med 2020; 18:114. [PMID: 32460859 PMCID: PMC7254634 DOI: 10.1186/s12916-020-01588-9] [Citation(s) in RCA: 11] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 04/07/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The five-tiered Cambridge Prognostic Group (CPG) classification is a better predictor of prostate cancer-specific mortality than the traditional three-tiered classification (low, intermediate, and high risk). We investigated radical treatment rates according to CPG in men diagnosed with non-metastatic prostate cancer in England between 2014 and 2017. METHODS Patients diagnosed with non-metastatic prostate cancer were identified from the National Prostate Cancer Audit database. Men were risk stratified according to the CPG classification. Risk ratios (RR) were estimated for undergoing radical treatment according to CPG and for receiving radiotherapy for those treated radically. Funnel plots were used to display variation in radical treatment rates across hospitals. RESULTS A total of 61,999 men were included with 10,963 (17.7%) in CPG1 (lowest risk group), 13,588 (21.9%) in CPG2, 9452 (15.2%) in CPG3, 12,831 (20.7%) in CPG4, and 15,165 (24.5%) in CPG5 (highest risk group). The proportion of men receiving radical treatment increased from 11.3% in CPG1 to 78.8% in CGP4, and 73.3% in CPG5. Men in CPG3 were more likely to receive radical treatment than men in CPG2 (66.3% versus 48.4%; adjusted RR 1.44; 95% CI 1.36-1.53; P < 0.001). Radically treated men in CPG3 were also more likely to receive radiotherapy than men in CPG2 (59.2% versus 43.9%; adjusted RR, 1.18; 95% CI 1.10-1.26). Although radical treatment rates were similar in CPG4 and CPG5 (78.8% versus 73.3%; adjusted RR 1.01; 95% CI 0.98-1.04), more men in CPG5 had radiotherapy than men in CPG4 (79.9% versus 59.1%, adjusted RR 1.26; 95% CI 1.12-1.40). CONCLUSIONS The CPG classification distributes men in five risk groups that are about equal in size. It reveals differences in treatment practices in men with intermediate-risk disease (CPG2 and CPG3) and in men with high-risk disease (CPG4 and CPGP5) that are not visible when using the traditional three-tiered risk classification.
Collapse
Affiliation(s)
- M G Parry
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK. .,Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, England.
| | - T E Cowling
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - A Sujenthiran
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, England
| | - J Nossiter
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, England
| | - B Berry
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK.,Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, England
| | - P Cathcart
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - A Aggarwal
- Department of Cancer Epidemiology, Population, and Global Health, King's College London, London, UK.,Department of Radiotherapy, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - H Payne
- Department of Oncology, University College London Hospitals, London, UK
| | - J van der Meulen
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - N W Clarke
- Department of Urology, The Christie NHS Foundation Trust, Manchester, UK.,Department of Urology, Salford Royal NHS Foundation Trust, Salford, UK
| | - V J Gnanapragasam
- Academic Urology Group, Department of Surgery, University of Cambridge, Cambridge, UK.,Department of Urology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.,Cambridge Urology Translational Research and Clinical Trials Office, Cambridge Biomedical Campus, Cambridge, UK
| |
Collapse
|
6
|
Clarke NW, Ali A, Ingleby FC, Hoyle A, Amos CL, Attard G, Brawley CD, Calvert J, Chowdhury S, Cook A, Cross W, Dearnaley DP, Douis H, Gilbert D, Gillessen S, Jones RJ, Langley RE, MacNair A, Malik Z, Mason MD, Matheson D, Millman R, Parker CC, Ritchie AWS, Rush H, Russell JM, Brown J, Beesley S, Birtle A, Capaldi L, Gale J, Gibbs S, Lydon A, Nikapota A, Omlin A, O'Sullivan JM, Parikh O, Protheroe A, Rudman S, Srihari NN, Simms M, Tanguay JS, Tolan S, Wagstaff J, Wallace J, Wylie J, Zarkar A, Sydes MR, Parmar MKB, James ND. Corrigendum to Addition of docetaxel to hormonal therapy in low- and high-burden metastatic hormone sensitive prostate cancer: long-term survival results from the STAMPEDE trial: Ann Oncol 2019; 30: 1992-2003. Ann Oncol 2020; 31:442. [PMID: 32067690 PMCID: PMC8929236 DOI: 10.1016/j.annonc.2020.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- N W Clarke
- Department of Urology, The Christie and Salford Royal NHS Foundation Trusts, Manchester.
| | - A Ali
- Genito-Urinary Cancer Research Group, Division of Cancer Sciences, The University of Manchester, Manchester
| | - F C Ingleby
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London; London School of Hygiene and Tropical Medicine, London
| | - A Hoyle
- Department of Urology, The Christie and Salford Royal NHS Foundation Trusts, Manchester
| | - C L Amos
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | | | - C D Brawley
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | - J Calvert
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | - S Chowdhury
- Guy's and Saint Thomas' NHS Foundation Trust, London
| | - A Cook
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | - W Cross
- St James University Hospital, Leeds
| | | | - H Douis
- Department of Radiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham
| | - D Gilbert
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | - S Gillessen
- Division of Cancer Sciences, The University of Manchester, Manchester
| | - R J Jones
- Beatson West of Scotland Cancer Centre, University of Glasgow, Glasgow
| | - R E Langley
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | - A MacNair
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | - Z Malik
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool
| | | | - D Matheson
- Faculty of Education Health and Wellbeing, University of Wolverhampton, Wolverhampton
| | - R Millman
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | - C C Parker
- Institute of Cancer Research, Sutton-London; RoyalMarsden NHS Foundation Trust, London
| | - A W S Ritchie
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | - H Rush
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | - J M Russell
- Institute of Cancer Sciences, Beatson West of Scotland Cancer Centre, Glasgow
| | - J Brown
- University of Sheffield, Sheffield
| | | | - A Birtle
- Lancashire Teaching Hospitals NHS Foundation Trust, Preston
| | - L Capaldi
- Worcestershire Acute Hospitals NHS Trust, Worcester
| | - J Gale
- Portsmouth Oncology Centre, Queen Alexandra Hospital, Portsmouth
| | | | - A Lydon
- Torbay and South Devon NHS Foundation Trust, Torbay
| | | | - A Omlin
- Department of Oncology and Haematology, Kantonsspital, St Gallen, Switzerland
| | - J M O'Sullivan
- Centre for Cancer Research and Cell Biology, Queen's University Belfast, Belfast, UK
| | - O Parikh
- East Lancashire Hospitals NHS Trust, Blackburn, UK
| | - A Protheroe
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - S Rudman
- Guy's and Saint Thomas' NHS Foundation Trust, London
| | - N N Srihari
- Shrewsbury and Telford Hospital NHS Trust, Shrewsbury, UK
| | - M Simms
- Hull and East Yorkshire Hospitals NHS Trust, Hull, UK
| | | | - S Tolan
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool
| | - J Wagstaff
- Swansea University College of Medicine, Swansea, UK
| | - J Wallace
- Beatson West of Scotland Cancer Centre, University of Glasgow, Glasgow
| | - J Wylie
- The Christie NHS Foundation Trust, Manchester, UK
| | - A Zarkar
- Heartlands Hospital, Birmingham, UK
| | - M R Sydes
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | - M K B Parmar
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | - N D James
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| |
Collapse
|
7
|
Haran ÁM, Ali A, Clarke NW. Metastatic Burden in Hormone-Naive Prostate Cancer: A Tale of Two Subgroups. Clin Oncol (R Coll Radiol) 2019; 32:209-212. [PMID: 31882196 DOI: 10.1016/j.clon.2019.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 11/29/2019] [Accepted: 12/11/2019] [Indexed: 11/25/2022]
Affiliation(s)
- Á M Haran
- Genito-urinary Cancer Research Group and FASTMAN Centre of Excellence, Division of Cancer Sciences, The University of Manchester, Manchester, UK; Department of Surgery, The Christie NHS Foundation Trust, Manchester, UK; Department of Urology, The Salford Royal NHS Foundation Trust, Manchester, UK
| | - A Ali
- Genito-urinary Cancer Research Group and FASTMAN Centre of Excellence, Division of Cancer Sciences, The University of Manchester, Manchester, UK; Department of Surgery, The Christie NHS Foundation Trust, Manchester, UK
| | - N W Clarke
- Genito-urinary Cancer Research Group and FASTMAN Centre of Excellence, Division of Cancer Sciences, The University of Manchester, Manchester, UK; Department of Surgery, The Christie NHS Foundation Trust, Manchester, UK; Department of Urology, The Salford Royal NHS Foundation Trust, Manchester, UK.
| |
Collapse
|
8
|
Clarke NW, Ali A, Ingleby FC, Hoyle A, Amos CL, Attard G, Brawley CD, Calvert J, Chowdhury S, Cook A, Cross W, Dearnaley DP, Douis H, Gilbert D, Gillessen S, Jones RJ, Langley RE, MacNair A, Malik Z, Mason MD, Matheson D, Millman R, Parker CC, Ritchie AWS, Rush H, Russell JM, Brown J, Beesley S, Birtle A, Capaldi L, Gale J, Gibbs S, Lydon A, Nikapota A, Omlin A, O'Sullivan JM, Parikh O, Protheroe A, Rudman S, Srihari NN, Simms M, Tanguay JS, Tolan S, Wagstaff J, Wallace J, Wylie J, Zarkar A, Sydes MR, Parmar MKB, James ND. Addition of docetaxel to hormonal therapy in low- and high-burden metastatic hormone sensitive prostate cancer: long-term survival results from the STAMPEDE trial. Ann Oncol 2019; 30:1992-2003. [PMID: 31560068 PMCID: PMC6938598 DOI: 10.1093/annonc/mdz396] [Citation(s) in RCA: 222] [Impact Index Per Article: 44.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND STAMPEDE has previously reported that the use of upfront docetaxel improved overall survival (OS) for metastatic hormone naïve prostate cancer patients starting long-term androgen deprivation therapy. We report on long-term outcomes stratified by metastatic burden for M1 patients. METHODS We randomly allocated patients in 2 : 1 ratio to standard-of-care (SOC; control group) or SOC + docetaxel. Metastatic disease burden was categorised using retrospectively-collected baseline staging scans where available. Analysis used Cox regression models, adjusted for stratification factors, with emphasis on restricted mean survival time where hazards were non-proportional. RESULTS Between 05 October 2005 and 31 March 2013, 1086 M1 patients were randomised to receive SOC (n = 724) or SOC + docetaxel (n = 362). Metastatic burden was assessable for 830/1086 (76%) patients; 362 (44%) had low and 468 (56%) high metastatic burden. Median follow-up was 78.2 months. There were 494 deaths on SOC (41% more than the previous report). There was good evidence of benefit of docetaxel over SOC on OS (HR = 0.81, 95% CI 0.69-0.95, P = 0.009) with no evidence of heterogeneity of docetaxel effect between metastatic burden sub-groups (interaction P = 0.827). Analysis of other outcomes found evidence of benefit for docetaxel over SOC in failure-free survival (HR = 0.66, 95% CI 0.57-0.76, P < 0.001) and progression-free survival (HR = 0.69, 95% CI 0.59-0.81, P < 0.001) with no evidence of heterogeneity of docetaxel effect between metastatic burden sub-groups (interaction P > 0.5 in each case). There was no evidence that docetaxel resulted in late toxicity compared with SOC: after 1 year, G3-5 toxicity was reported for 28% SOC and 27% docetaxel (in patients still on follow-up at 1 year without prior progression). CONCLUSIONS The clinically significant benefit in survival for upfront docetaxel persists at longer follow-up, with no evidence that benefit differed by metastatic burden. We advocate that upfront docetaxel is considered for metastatic hormone naïve prostate cancer patients regardless of metastatic burden.
Collapse
Affiliation(s)
- N W Clarke
- Department of Urology, The Christie and Salford Royal NHS Foundation Trusts, Manchester.
| | - A Ali
- Genito-Urinary Cancer Research Group, Division of Cancer Sciences, The University of Manchester, Manchester
| | - F C Ingleby
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London; London School of Hygiene and Tropical Medicine, London
| | - A Hoyle
- Department of Urology, The Christie and Salford Royal NHS Foundation Trusts, Manchester
| | - C L Amos
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | | | - C D Brawley
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | - J Calvert
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | - S Chowdhury
- Guy's and Saint Thomas' NHS Foundation Trust, London
| | - A Cook
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | - W Cross
- St James University Hospital, Leeds
| | | | - H Douis
- Department of Radiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham
| | - D Gilbert
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | - S Gillessen
- Division of Cancer Sciences, The University of Manchester, Manchester
| | - R J Jones
- Beatson West of Scotland Cancer Centre, University of Glasgow, Glasgow
| | - R E Langley
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | - A MacNair
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | - Z Malik
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool
| | | | - D Matheson
- Faculty of Education Health and Wellbeing, University of Wolverhampton, Wolverhampton
| | - R Millman
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | - C C Parker
- Institute of Cancer Research, Sutton-London; Royal Marsden NHS Foundation Trust, London
| | - A W S Ritchie
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | - H Rush
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | - J M Russell
- Institute of Cancer Sciences, Beatson West of Scotland Cancer Centre, Glasgow
| | - J Brown
- University of Sheffield, Sheffield
| | | | - A Birtle
- Lancashire Teaching Hospitals NHS Foundation Trust, Preston
| | - L Capaldi
- Worcestershire Acute Hospitals NHS Trust, Worcester
| | - J Gale
- Portsmouth Oncology Centre, Queen Alexandra Hospital, Portsmouth
| | | | - A Lydon
- Torbay and South Devon NHS Foundation Trust, Torbay
| | | | - A Omlin
- Department of Oncology and Haematology, Kantonsspital, St Gallen, Switzerland
| | - J M O'Sullivan
- Centre for Cancer Research and Cell Biology, Queen's University Belfast, Belfast
| | - O Parikh
- East Lancashire Hospitals NHS Trust, Blackburn
| | - A Protheroe
- Oxford University Hospitals NHS Foundation Trust, Oxford
| | - S Rudman
- Guy's and Saint Thomas' NHS Foundation Trust, London
| | - N N Srihari
- Shrewsbury and Telford Hospital NHS Trust, Shrewsbury
| | - M Simms
- Hull and East Yorkshire Hospitals NHS Trust, Hull
| | | | - S Tolan
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool
| | - J Wagstaff
- Swansea University College of Medicine, Swansea
| | - J Wallace
- Beatson West of Scotland Cancer Centre, University of Glasgow, Glasgow
| | - J Wylie
- The Christie NHS Foundation Trust, Manchester
| | | | - M R Sydes
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | - M K B Parmar
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London
| | - N D James
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham
| |
Collapse
|
9
|
Armstrong AJ, Antonarakis ES, Taplin ME, Kelly WK, Beltran H, Fizazi K, Dahut WL, Shore N, Slovin S, George D, Carducci MA, Corn P, Danila D, Dreicer R, Heath E, Rathkopf D, Liu G, Nanus D, Stein M, Smith MR, Sternberg C, Wilding G, Nelson PS, Halabi S, Kantoff P, Clarke NW, Evans CP, Heidenreich A, Mottet N, Gleave M, Morris MJ, Scher HI. Naming disease states for clinical utility in prostate cancer: a rose by any other name might not smell as sweet. Ann Oncol 2019; 29:23-25. [PMID: 29088323 DOI: 10.1093/annonc/mdx648] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Affiliation(s)
- A J Armstrong
- Department of Medicine, Duke Cancer Institute, Durham, New York, USA
| | - E S Antonarakis
- Department of Oncology, Johns Hopkins University, Baltimore, USA
| | - M-E Taplin
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA
| | - W K Kelly
- Department of Medical Oncology, Thomas Jefferson University, Philadelphia, USA
| | - H Beltran
- Department of Medicine, Weill Cornell Medical College, New York, USA
| | - K Fizazi
- Department of Medical Oncology, Gustave Roussy Institute, Villejuif, France
| | - W L Dahut
- Medical Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, USA
| | - N Shore
- Carolina Urologic Research Center, Myrtle Beach, USA
| | - S Slovin
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA.,Weill Cornell Medical College, New York, USA
| | - D George
- Department of Medicine, Duke Cancer Institute, Durham, New York, USA
| | - M A Carducci
- Department of Oncology, Johns Hopkins University, Baltimore, USA
| | - P Corn
- Department of Medicine, MD Anderson Cancer Center, Houston, USA
| | - D Danila
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA.,Weill Cornell Medical College, New York, USA
| | - R Dreicer
- School of Medicine, University of Virginia, Charlottesville, USA
| | - E Heath
- Division of Hematology/Oncology, Wayne State University, Detroit, USA
| | - D Rathkopf
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA.,Weill Cornell Medical College, New York, USA
| | - G Liu
- Division of Hematology/Oncology, University of Wisconsin, Madison, USA
| | - D Nanus
- Department of Medicine, Weill Cornell Medical College, New York, USA
| | - M Stein
- Department of Medicine, Rutgers Cancer Institute of New Jersey, Newark, USA
| | - M R Smith
- Massachusetts General Hospital, Cancer Center, Boston, USA
| | - C Sternberg
- Department of Medical Oncology, San Camillo-Forlanini Hospital, Rome, Italy
| | - G Wilding
- Department of Medicine, MD Anderson Cancer Center, Houston, USA
| | - P S Nelson
- Division of Human Biology, University of Washington, Seattle, USA.,Fred Hutchinson Cancer Center, Seattle, USA
| | - S Halabi
- Department of Medicine, Duke Cancer Institute, Durham, New York, USA
| | - P Kantoff
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA.,Weill Cornell Medical College, New York, USA
| | - N W Clarke
- Department of Urology, The Christie Clinic, National Health Service, Manchester, UK
| | - C P Evans
- Department of Urology, UC Davis, Sacramento, USA
| | - A Heidenreich
- Department of Oncology, University Hospital Aschen, Cologne, Germany
| | - N Mottet
- Department of Urology, University Hospital St. Etienne, Saint-Etienne, France
| | - M Gleave
- Department of Urologic Sciences, Vancouver Prostate Centre, Vancouver, Canada
| | - M J Morris
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA.,Weill Cornell Medical College, New York, USA
| | - H I Scher
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA.,Weill Cornell Medical College, New York, USA
| |
Collapse
|
10
|
Vale CL, Fisher DJ, White IR, Carpenter JR, Burdett S, Clarke NW, Fizazi K, Gravis G, James ND, Mason MD, Parmar MKB, Rydzewska LH, Sweeney CJ, Spears MR, Sydes MR, Tierney JF. What is the optimal systemic treatment of men with metastatic, hormone-naive prostate cancer? A STOPCAP systematic review and network meta-analysis. Ann Oncol 2018; 29:1249-1257. [PMID: 29788164 PMCID: PMC5961275 DOI: 10.1093/annonc/mdy071] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Background Our prior Systemic Treatment Options for Cancer of the Prostate systematic reviews showed improved survival for men with metastatic hormone-naive prostate cancer when abiraterone acetate plus prednisolone/prednisone (AAP) or docetaxel (Doc), but not zoledronic acid (ZA), were added to androgen-deprivation therapy (ADT). Trial evidence also suggests a benefit of combining celecoxib (Cel) with ZA and ADT. To establish the optimal treatments, a network meta-analysis (NMA) was carried out based on aggregate data (AD) from all available studies. Methods Overall survival (OS) and failure-free survival data from completed Systemic Treatment Options for Cancer of the Prostate reviews of Doc, ZA and AAP and from recent trials of ZA and Cel contributed to this comprehensive AD-NMA. The primary outcome was OS. Correlations between treatment comparisons within one multi-arm, multi-stage trial were estimated from control-arm event counts. Network consistency and a common heterogeneity variance were assumed. Results We identified 10 completed trials which had closed to recruitment, and one trial in which recruitment was ongoing, as eligible for inclusion. Results are based on six trials including 6204 men (97% of men randomised in all completed trials). Network estimates of effects on OS were consistent with reported comparisons with ADT alone for AAP [hazard ration (HR) = 0.61, 95% confidence interval (CI) 0.53-0.71], Doc (HR = 0.77, 95% CI 0.68-0.87), ZA + Cel (HR = 0.78, 95% CI 0.62-0.97), ZA + Doc (HR = 0.79, 95% CI 0.66-0.94), Cel (HR = 0.94 95% CI 0.75-1.17) and ZA (HR = 0.90 95% CI 0.79-1.03). The effect of ZA + Cel is consistent with the additive effects of the individual treatments. Results suggest that AAP has the highest probability of being the most effective treatment both for OS (94% probability) and failure-free survival (100% probability). Doc was the second-best treatment of OS (35% probability). Conclusions Uniquely, we have included all available results and appropriately accounted for inclusion of multi-arm, multi-stage trials in this AD-NMA. Our results support the use of AAP or Doc with ADT in men with metastatic hormone-naive prostate cancer. AAP appears to be the most effective treatment, but it is not clear to what extent and whether this is due to a true increased benefit with AAP or the variable features of the individual trials. To fully account for patient variability across trials, changes in prognosis or treatment effects over time and the potential impact of treatment on progression, a network meta-analysis based on individual participant data is in development.
Collapse
Affiliation(s)
- C L Vale
- MRC Clinical Trials Unit at UCL, London.
| | | | - I R White
- MRC Clinical Trials Unit at UCL, London
| | | | - S Burdett
- MRC Clinical Trials Unit at UCL, London
| | - N W Clarke
- Salford Royal NHS Foundation Trust, Salford, UK
| | - K Fizazi
- Gustave-Roussy, University of Paris Sud, Villejuif
| | - G Gravis
- Department of Medical Oncology, Institut Paoli Calmettes, Marseille, France
| | - N D James
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham; Queen Elizabeth Hospital, Birmingham
| | - M D Mason
- School of Medicine, Cardiff University, Cardiff, UK
| | | | | | - C J Sweeney
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | | | - M R Sydes
- MRC Clinical Trials Unit at UCL, London
| | | |
Collapse
|
11
|
Sydes MR, Spears MR, Mason MD, Clarke NW, Dearnaley DP, de Bono JS, Attard G, Chowdhury S, Cross W, Gillessen S, Malik ZI, Jones R, Parker CC, Ritchie AWS, Russell JM, Millman R, Matheson D, Amos C, Gilson C, Birtle A, Brock S, Capaldi L, Chakraborti P, Choudhury A, Evans L, Ford D, Gale J, Gibbs S, Gilbert DC, Hughes R, McLaren D, Lester JF, Nikapota A, O'Sullivan J, Parikh O, Peedell C, Protheroe A, Rudman SM, Shaffer R, Sheehan D, Simms M, Srihari N, Strebel R, Sundar S, Tolan S, Tsang D, Varughese M, Wagstaff J, Parmar MKB, James ND. Adding abiraterone or docetaxel to long-term hormone therapy for prostate cancer: directly randomised data from the STAMPEDE multi-arm, multi-stage platform protocol. Ann Oncol 2018; 29:1235-1248. [PMID: 29529169 PMCID: PMC5961425 DOI: 10.1093/annonc/mdy072] [Citation(s) in RCA: 175] [Impact Index Per Article: 29.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background Adding abiraterone acetate with prednisolone (AAP) or docetaxel with prednisolone (DocP) to standard-of-care (SOC) each improved survival in systemic therapy for advanced or metastatic prostate cancer: evaluation of drug efficacy: a multi-arm multi-stage platform randomised controlled protocol recruiting patients with high-risk locally advanced or metastatic PCa starting long-term androgen deprivation therapy (ADT). The protocol provides the only direct, randomised comparative data of SOC + AAP versus SOC + DocP. Method Recruitment to SOC + DocP and SOC + AAP overlapped November 2011 to March 2013. SOC was long-term ADT or, for most non-metastatic cases, ADT for ≥2 years and RT to the primary tumour. Stratified randomisation allocated pts 2 : 1 : 2 to SOC; SOC + docetaxel 75 mg/m2 3-weekly×6 + prednisolone 10 mg daily; or SOC + abiraterone acetate 1000 mg + prednisolone 5 mg daily. AAP duration depended on stage and intent to give radical RT. The primary outcome measure was death from any cause. Analyses used Cox proportional hazards and flexible parametric models, adjusted for stratification factors. This was not a formally powered comparison. A hazard ratio (HR) <1 favours SOC + AAP, and HR > 1 favours SOC + DocP. Results A total of 566 consenting patients were contemporaneously randomised: 189 SOC + DocP and 377 SOC + AAP. The patients, balanced by allocated treatment were: 342 (60%) M1; 429 (76%) Gleason 8-10; 449 (79%) WHO performance status 0; median age 66 years and median PSA 56 ng/ml. With median follow-up 4 years, 149 deaths were reported. For overall survival, HR = 1.16 (95% CI 0.82-1.65); failure-free survival HR = 0.51 (95% CI 0.39-0.67); progression-free survival HR = 0.65 (95% CI 0.48-0.88); metastasis-free survival HR = 0.77 (95% CI 0.57-1.03); prostate cancer-specific survival HR = 1.02 (0.70-1.49); and symptomatic skeletal events HR = 0.83 (95% CI 0.55-1.25). In the safety population, the proportion reporting ≥1 grade 3, 4 or 5 adverse events ever was 36%, 13% and 1% SOC + DocP, and 40%, 7% and 1% SOC + AAP; prevalence 11% at 1 and 2 years on both arms. Relapse treatment patterns varied by arm. Conclusions This direct, randomised comparative analysis of two new treatment standards for hormone-naïve prostate cancer showed no evidence of a difference in overall or prostate cancer-specific survival, nor in other important outcomes such as symptomatic skeletal events. Worst toxicity grade over entire time on trial was similar but comprised different toxicities in line with the known properties of the drugs. Trial registration Clinicaltrials.gov: NCT00268476.
Collapse
Affiliation(s)
- M R Sydes
- MRC Clinical Trials Unit at UCL, London.
| | | | | | - N W Clarke
- Christie and Royal Salford Hospital, Manchester
| | | | | | - G Attard
- UCL Cancer Institute, University College London, London
| | - S Chowdhury
- Guy's & St Thomas NHS, Foundation Trust, London
| | - W Cross
- St James University Hospital, Leeds, UK
| | - S Gillessen
- Division of Oncology and Hematology, Kantonsspital St. Gallen, St. Gallen; University of Bern, Bern; Swiss Group for Cancer Clinical Research (SAKK), Bern, Switzerland
| | - Z I Malik
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool
| | - R Jones
- Institute of Cancer Sciences, University of Glasgow, Glasgow; Beatson West of Scotland Cancer Centre, University of Glasgow, Glasgow
| | - C C Parker
- Institute of Cancer Research, Sutton; Royal Marsden Hospital, Sutton
| | | | - J M Russell
- Institute of Cancer Sciences, University of Glasgow, Glasgow; Beatson West of Scotland Cancer Centre, University of Glasgow, Glasgow
| | - R Millman
- MRC Clinical Trials Unit at UCL, London
| | - D Matheson
- Faculty of Education, Health and Wellbeing, University of Wolverhampton, Wolverhampton
| | - C Amos
- MRC Clinical Trials Unit at UCL, London
| | - C Gilson
- MRC Clinical Trials Unit at UCL, London
| | - A Birtle
- Rosemere Cancer Centre, Royal Preston Hospital, Preston
| | - S Brock
- Dorset Cancer Centre, Poole Hospital, Poole
| | - L Capaldi
- Worcestershire Acute Hospitals NHS Trust, Worcester
| | | | - A Choudhury
- Division of Cancer Sciences, University of Manchester, Manchester; Manchester Academic Health Science Centre, Manchester; Christie Hospital NHS Foundation Trust, Manchester
| | - L Evans
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield
| | - D Ford
- City Hospital, Cancer Centre at Queen Elizabeth Hospital, Birmingham
| | - J Gale
- Portsmouth Oncology Centre, Queen Alexandra Hospital, Portsmouth
| | | | - D C Gilbert
- Sussex Cancer Centre, Royal Sussex County Hospital, Brighton
| | - R Hughes
- Mount Vernon Group, Mount Vernon Hospital, Middlesex
| | | | | | | | - J O'Sullivan
- Centre for Cancer Research and Cell Biology, Queens University Belfast, Belfast; Belfast City Hospital, Belfast
| | - O Parikh
- Lancashire Teaching Hospitals NHS Trust, Preston
| | - C Peedell
- Department of Oncology & Radiotherapy, South Tees NHS Trust, Middlesbrough
| | - A Protheroe
- Oxford University Hospitals NHS Foundation Trust
| | - S M Rudman
- Guy's & St Thomas NHS, Foundation Trust, London
| | - R Shaffer
- Department of Oncology, Royal Surrey County Hospital, Guildford
| | - D Sheehan
- Royal Devon and Exeter Hospital, Exeter
| | - M Simms
- Hull & East Yorkshire Hospitals NHS Trust, Hull
| | - N Srihari
- Shrewsbury and Telford Hospitals NHS Trust, Shrewsbury, UK
| | - R Strebel
- Kantonsspital Graubünden, Chur; Swiss Group for Cancer Clinical Research (SAKK), Bern, Switzerland
| | - S Sundar
- Department of Oncology, Nottingham, University Hospitals NHS Trust, Nottingham
| | - S Tolan
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool
| | - D Tsang
- Southend Hospital, Southend-on-Sea
| | - M Varughese
- Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust
| | - J Wagstaff
- Swansea University College of Medicine, Swansea
| | | | - N D James
- Institute of Cancer and Genomic Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| |
Collapse
|
12
|
Larkin SET, Johnston HE, Jackson TR, Jamieson DG, Roumeliotis TI, Mockridge CI, Michael A, Manousopoulou A, Papachristou EK, Brown MD, Clarke NW, Pandha H, Aukim-Hastie CL, Cragg MS, Garbis SD, Townsend PA. Detection of candidate biomarkers of prostate cancer progression in serum: a depletion-free 3D LC/MS quantitative proteomics pilot study. Br J Cancer 2016; 115:1078-1086. [PMID: 27685442 PMCID: PMC5117786 DOI: 10.1038/bjc.2016.291] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 07/18/2016] [Accepted: 08/16/2016] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Prostate cancer (PCa) is the most common male cancer in the United Kingdom and we aimed to identify clinically relevant biomarkers corresponding to stage progression of the disease. METHODS We used enhanced proteomic profiling of PCa progression using iTRAQ 3D LC mass spectrometry on high-quality serum samples to identify biomarkers of PCa. RESULTS We identified >1000 proteins. Following specific inclusion/exclusion criteria we targeted seven proteins of which two were validated by ELISA and six potentially interacted forming an 'interactome' with only a single protein linking each marker. This network also includes accepted cancer markers, such as TNF, STAT3, NF-κB and IL6. CONCLUSIONS Our linked and interrelated biomarker network highlights the potential utility of six of our seven markers as a panel for diagnosing PCa and, critically, in determining the stage of the disease. Our validation analysis of the MS-identified proteins found that SAA alongside KLK3 may improve categorisation of PCa than by KLK3 alone, and that TSR1, although not significant in this model, might also be a clinically relevant biomarker.
Collapse
Affiliation(s)
- S E T Larkin
- Cancer Sciences Unit, Southampton General Hospital, University of Southampton, Southampton SO16 6YD, UK
| | - H E Johnston
- Cancer Sciences Unit, Southampton General Hospital, University of Southampton, Southampton SO16 6YD, UK
| | - T R Jackson
- Institute of Cancer Sciences, Manchester Cancer Research Centre, Manchester Academic Health Science Centre, University of Manchester, Wilmslow Road, Manchester M20 4QL, UK
| | - D G Jamieson
- Biorelate, BASE, Greenhey's, Manchester Science Park, Pencroft Way, Manchester M15 6JJ, UK
| | - T I Roumeliotis
- Institute for Life Sciences, Centre for Proteomic Research, University of Southampton, Southampton SO17 1BJ, UK
| | - C I Mockridge
- Cancer Sciences Unit, Southampton General Hospital, University of Southampton, Southampton SO16 6YD, UK
| | - A Michael
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey GU2 7TE, UK
| | - A Manousopoulou
- Institute for Life Sciences, Centre for Proteomic Research, University of Southampton, Southampton SO17 1BJ, UK
| | - E K Papachristou
- Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge CB2 0RE, UK
| | - M D Brown
- Institute of Cancer Sciences, Cancer Research UK Manchester Institute, Paterson Building, Wilmslow Road, Manchester M20 4BX, UK
| | - N W Clarke
- The Christie NHS Foundation Trust, Manchester M20 4BX, UK
| | - H Pandha
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey GU2 7TE, UK
| | - C L Aukim-Hastie
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey GU2 7TE, UK
| | - M S Cragg
- Cancer Sciences Unit, Southampton General Hospital, University of Southampton, Southampton SO16 6YD, UK
| | - S D Garbis
- Cancer Sciences Unit, Southampton General Hospital, University of Southampton, Southampton SO16 6YD, UK
- Institute for Life Sciences, Centre for Proteomic Research, University of Southampton, Southampton SO17 1BJ, UK
| | - P A Townsend
- Institute of Cancer Sciences, Manchester Cancer Research Centre, Manchester Academic Health Science Centre, University of Manchester, Wilmslow Road, Manchester M20 4QL, UK
- Institute of Cancer Sciences, Cancer Research UK Manchester Institute, Paterson Building, Wilmslow Road, Manchester M20 4BX, UK
| |
Collapse
|
13
|
Robinson R, Tait CD, Somov P, Lau MW, Sangar VK, Ramani VAC, Clarke NW. Estimated glomerular filtration rate is unreliable in detecting renal function loss during follow-up after cystectomy and urinary diversion. Int Urol Nephrol 2016; 48:511-5. [DOI: 10.1007/s11255-016-1216-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 01/07/2016] [Indexed: 10/22/2022]
|
14
|
Jimenez-Hernandez M, Brown MD, Hughes C, Clarke NW, Gardner P. Characterising cytotoxic agent action as a function of the cell cycle using fourier transform infrared microspectroscopy. Analyst 2015; 140:4453-64. [DOI: 10.1039/c5an00671f] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Infrared spectral signatures of drug–cell interaction, suggest that both the stages of proliferation and the degree of apoptosis need to be taken into account to elucidate the fine biochemical details of the immediate cellular response to the drug.
Collapse
Affiliation(s)
- M. Jimenez-Hernandez
- Manchester Institute of Biotechnology
- University of Manchester
- Manchester
- M1 7DN UK
- Genito-Urinary Cancer Research Group
| | - M. D. Brown
- Genito-Urinary Cancer Research Group
- Institute of Cancer Sciences
- University of Manchester
- The Christie NHS Foundation Trust
- Manchester Academic Health Sciences Centre
| | - C. Hughes
- Manchester Institute of Biotechnology
- University of Manchester
- Manchester
- M1 7DN UK
- Genito-Urinary Cancer Research Group
| | - N. W. Clarke
- Genito-Urinary Cancer Research Group
- Institute of Cancer Sciences
- University of Manchester
- The Christie NHS Foundation Trust
- Manchester Academic Health Sciences Centre
| | - P. Gardner
- Manchester Institute of Biotechnology
- University of Manchester
- Manchester
- M1 7DN UK
| |
Collapse
|
15
|
Hughes C, Henderson A, Kansiz M, Dorling KM, Jimenez-Hernandez M, Brown MD, Clarke NW, Gardner P. Enhanced FTIR bench-top imaging of single biological cells. Analyst 2015; 140:2080-5. [DOI: 10.1039/c4an02053g] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
A new optical system has recently been developed that enables infrared images to be obtained with a pixel resolution of 1 micron on a bench-top instrument using a thermal source.
Collapse
Affiliation(s)
- C. Hughes
- Manchester Institute of Biotechnology
- The University of Manchester
- Manchester
- UK
- Genito Urinary Cancer Research Group
| | - A. Henderson
- Manchester Institute of Biotechnology
- The University of Manchester
- Manchester
- UK
| | - M. Kansiz
- Agilent Technologies Australia Pty Ltd
- Mulgrave
- Australia
| | | | - M. Jimenez-Hernandez
- Manchester Institute of Biotechnology
- The University of Manchester
- Manchester
- UK
- Genito Urinary Cancer Research Group
| | - M. D. Brown
- Genito Urinary Cancer Research Group
- Institute of Cancer Sciences
- Paterson Building
- The University of Manchester
- Manchester Academic Health Science Centre
| | - N. W. Clarke
- Genito Urinary Cancer Research Group
- Institute of Cancer Sciences
- Paterson Building
- The University of Manchester
- Manchester Academic Health Science Centre
| | - P. Gardner
- Manchester Institute of Biotechnology
- The University of Manchester
- Manchester
- UK
| |
Collapse
|
16
|
Brown M, Roulson JA, Hart CA, Tawadros T, Clarke NW. Arachidonic acid induction of Rho-mediated transendothelial migration in prostate cancer. Br J Cancer 2014; 110:2099-108. [PMID: 24595005 PMCID: PMC3992515 DOI: 10.1038/bjc.2014.99] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [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: 08/18/2013] [Revised: 01/23/2014] [Accepted: 01/28/2014] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Bone metastases in prostate cancer (CaP) result in CaP-related morbidity/mortality. The omega-6 polyunsaturated fatty acid (PUFA) arachidonic acid (AA) and lipophilic statins affect metastasis-like behaviour in CaP cells, regulating the critical metastatic step of CaP migration to the bone marrow stroma. METHODS Microscopic analysis and measurement of adhesion and invasion of CaP cells through bone marrow endothelial cells (BMEC) was undertaken with AA stimulation and/or simvastatin (SIM) treatment. Amoeboid characteristics of PC-3, PC3-GFP and DU-145 were analysed by western blotting and Rho assays. RESULTS The CaP cell lines PC-3, PC3-GFP and DU-145 share the ability to migrate across a BMEC layer. Specific amoeboid inhibition decreased transendothelial migration (TEM). AA stimulates amoeboid characteristics, driven by Rho signalling. Selective knock-down of components of the Rho pathway (RhoA, RhoC, Rho-associated protein kinase 1 (ROCK1) and ROCK2) showed that Rho signalling is crucial to TEM. Functions of these components were analysed, regarding adhesion to BMEC, migration in 2D and the induction of the amoeboid phenotype by AA. TEM was reduced by SIM treatment of PC3-GFP and DU-145, which inhibited Rho pathway signalling. CONCLUSIONS AA-induced TEM is mediated by the induction of a Rho-driven amoeboid phenotype. Inhibition of this cell migratory process may be an important therapeutic target in high-risk CaP.
Collapse
Affiliation(s)
- M Brown
- Genito Urinary Cancer Research Group, Institute of Cancer Sciences, Paterson Building, The University of Manchester, Manchester Academic Health Science Centre, Wilmslow Road, Manchester M20 4BX, UK
| | - J-A Roulson
- Genito Urinary Cancer Research Group, Institute of Cancer Sciences, Paterson Building, The University of Manchester, Manchester Academic Health Science Centre, Wilmslow Road, Manchester M20 4BX, UK
| | - C A Hart
- Genito Urinary Cancer Research Group, Institute of Cancer Sciences, Paterson Building, The University of Manchester, Manchester Academic Health Science Centre, Wilmslow Road, Manchester M20 4BX, UK
| | - T Tawadros
- Genito Urinary Cancer Research Group, Institute of Cancer Sciences, Paterson Building, The University of Manchester, Manchester Academic Health Science Centre, Wilmslow Road, Manchester M20 4BX, UK
| | - N W Clarke
- 1] Genito Urinary Cancer Research Group, Institute of Cancer Sciences, Paterson Building, The University of Manchester, Manchester Academic Health Science Centre, Wilmslow Road, Manchester M20 4BX, UK [2] Department of Urology, Salford Royal Hospital NHS Foundation Trust, Stott Lane, Salford M6 8HD, UK
| |
Collapse
|
17
|
Hughes C, Brown MD, Ball FJ, Monjardez G, Clarke NW, Flower KR, Gardner P. Highlighting a need to distinguish cell cycle signatures from cellular responses to chemotherapeutics in SR-FTIR spectroscopy. Analyst 2013; 137:5736-42. [PMID: 23095763 DOI: 10.1039/c2an35633c] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Previous research has seen difficulties in establishing clear discrimination by principal component analysis (PCA) between drug-treated cells analysed by single point SR-FTIR spectroscopy, relative to multisampling cell monolayers by conventional FTIR. It is suggested that the issue arises due to signal mixing between cellular-response signatures and cell cycle phase contributions in individual cells. Consequently, chemometric distinction of cell spectra treated with multiple drugs is difficult even with supervised methods. In an effort to separate cell cycle chemistry from cellular response chemistry in the spectra, renal carcinoma cells were stained with propidium iodide and fluorescent-activated cell sorted (FACS) after exposure to a number of chemotherapeutic compounds; 5-fluorouracil (5FU) and a set of novel gold-based experimental compounds. The cell spectra were analysed separately by PCA in G(1), S or G(2)/M phase. The mode of action of established drug 5FU, known to disrupt S phase, was confirmed by FACS analysis. The chemical signature of 5FU-treated cells discriminated against both the control and gold-compound (KF0101)-treated cell spectra, suggesting a different mode of action due to a difference in cellular response.
Collapse
Affiliation(s)
- C Hughes
- Manchester Interdisciplinary Biocentre, University of Manchester, 131 Princess Street, Manchester, UK M1 7DN
| | | | | | | | | | | | | |
Collapse
|
18
|
Parker CC, Sydes MR, Mason MD, Clarke NW, Aebersold D, de Bono JS, Dearnaley DP, Ritchie AWS, Russell JM, Thalmann G, Parmar MKB, James ND. Prostate radiotherapy for men with metastatic disease: a new comparison in the STAMPEDE trial. Clin Oncol (R Coll Radiol) 2013; 25:318-20. [PMID: 23489869 DOI: 10.1016/j.clon.2013.01.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Accepted: 01/22/2013] [Indexed: 12/21/2022]
|
19
|
Jimenez-Hernandez M, Hughes C, Bassan P, Ball F, Brown MD, Clarke NW, Gardner P. Exploring the spectroscopic differences of Caki-2 cells progressing through the cell cycle while proliferating in vitro. Analyst 2013; 138:3957-66. [DOI: 10.1039/c3an00507k] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
20
|
Beyer J, Albers P, Altena R, Aparicio J, Bokemeyer C, Busch J, Cathomas R, Cavallin-Stahl E, Clarke NW, Claßen J, Cohn-Cedermark G, Dahl AA, Daugaard G, De Giorgi U, De Santis M, De Wit M, De Wit R, Dieckmann KP, Fenner M, Fizazi K, Flechon A, Fossa SD, Germá Lluch JR, Gietema JA, Gillessen S, Giwercman A, Hartmann JT, Heidenreich A, Hentrich M, Honecker F, Horwich A, Huddart RA, Kliesch S, Kollmannsberger C, Krege S, Laguna MP, Looijenga LHJ, Lorch A, Lotz JP, Mayer F, Necchi A, Nicolai N, Nuver J, Oechsle K, Oldenburg J, Oosterhuis JW, Powles T, Rajpert-De Meyts E, Rick O, Rosti G, Salvioni R, Schrader M, Schweyer S, Sedlmayer F, Sohaib A, Souchon R, Tandstad T, Winter C, Wittekind C. Maintaining success, reducing treatment burden, focusing on survivorship: highlights from the third European consensus conference on diagnosis and treatment of germ-cell cancer. Ann Oncol 2012; 24:878-88. [PMID: 23152360 PMCID: PMC3603440 DOI: 10.1093/annonc/mds579] [Citation(s) in RCA: 252] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
In November 2011, the Third European Consensus Conference on Diagnosis and Treatment of Germ-Cell Cancer (GCC) was held in Berlin, Germany. This third conference followed similar meetings in 2003 (Essen, Germany) and 2006 (Amsterdam, The Netherlands) [Schmoll H-J, Souchon R, Krege S et al. European consensus on diagnosis and treatment of germ-cell cancer: a report of the European Germ-Cell Cancer Consensus Group (EGCCCG). Ann Oncol 2004; 15: 1377-1399; Krege S, Beyer J, Souchon R et al. European consensus conference on diagnosis and treatment of germ-cell cancer: a report of the second meeting of the European Germ-Cell Cancer Consensus group (EGCCCG): part I. Eur Urol 2008; 53: 478-496; Krege S, Beyer J, Souchon R et al. European consensus conference on diagnosis and treatment of germ-cell cancer: a report of the second meeting of the European Germ-Cell Cancer Consensus group (EGCCCG): part II. Eur Urol 2008; 53: 497-513]. A panel of 56 of 60 invited GCC experts from all across Europe discussed all aspects on diagnosis and treatment of GCC, with a particular focus on acute and late toxic effects as well as on survivorship issues. The panel consisted of oncologists, urologic surgeons, radiooncologists, pathologists and basic scientists, who are all actively involved in care of GCC patients. Panelists were chosen based on the publication activity in recent years. Before the meeting, panelists were asked to review the literature published since 2006 in 20 major areas concerning all aspects of diagnosis, treatment and follow-up of GCC patients, and to prepare an updated version of the previous recommendations to be discussed at the conference. In addition, ∼50 E-vote questions were drafted and presented at the conference to address the most controversial areas for a poll of expert opinions. Here, we present the main recommendations and controversies of this meeting. The votes of the panelists are added as online supplements.
Collapse
Affiliation(s)
- J Beyer
- Department of Hematology and Oncology, Vivantes Klinikum Am Urban, Berlin.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Hughes C, Brown MD, Clarke NW, Flower KR, Gardner P. Investigating cellular responses to novel chemotherapeutics in renal cell carcinoma using SR-FTIR spectroscopy. Analyst 2012; 137:4720-6. [DOI: 10.1039/c2an35632e] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
22
|
Baker MJ, Clarke C, Démoulin D, Nicholson JM, Lyng FM, Byrne HJ, Hart CA, Brown MD, Clarke NW, Gardner P. An investigation of the RWPE prostate derived family of cell lines using FTIR spectroscopy. Analyst 2010; 135:887-94. [DOI: 10.1039/b920385k] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
23
|
Harvey TJ, Gazi E, Henderson A, Snook RD, Clarke NW, Brown M, Gardner P. Factors influencing the discrimination and classification of prostate cancer cell lines by FTIR microspectroscopy. Analyst 2009; 134:1083-91. [PMID: 19475133 DOI: 10.1039/b903249e] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
In this study we obtained Fourier transform infrared (FTIR) spectra of fixed prostate cell lines of differing types as well as the primary epithelial cells from benign prostatic hyperplasia (BPH). Results showed that by using multivariate chemometric analysis it was possible to discriminate and classify these cell lines, which gave rise to sensitivity and specificity values of >94% and >98%, respectively. Following on from these results the possible influences of different factors on the discrimination and classification of the prostate cell lines were examined. Firstly, the effect of using different growth media during cell culturing was investigated, with results indicating that this did not influence chemometric discrimination. Secondly, differences in the nucleus-to-cytoplasm (N/C) ratio were examined, and it was concluded that this factor was not the main reason for the discrimination and classification of the prostate cancer (CaP) cell lines. In conclusion, given the fact that neither growth media nor N/C ratio could totally explain the classification it is likely that actual biochemical differences between the cell lines is the major contributing factor.
Collapse
Affiliation(s)
- T J Harvey
- School of Chemical Engineering and Analytical Science, Manchester Interdisciplinary Biocentre, University of Manchester, 131 Princess Street, Manchester, UK M1 7DN
| | | | | | | | | | | | | |
Collapse
|
24
|
Abstract
Over the course of the past 30 years progress in identification of risk factors, improvements in therapy regimens and advances in treatment delivery have all served to render testis cancer a treatable and survivable malignancy. Institution of specialised oncology centres in the UK to address treatment options for urological cancers has proven to be an effective approach to managing testis cancer by drawing on interdisciplinary expertise and applying insights gained from ongoing R&D. This strategy could become a model for treating other cancers as well.
Collapse
Affiliation(s)
- S B Maddineni
- Urological Oncology, The Christie Hospital NHS Foundation Trust, Wilmslow Road, M20 4BX, Manchester, England
| | | |
Collapse
|
25
|
Baker MJ, Gazi E, Brown MD, Shanks JH, Gardner P, Clarke NW. FTIR-based spectroscopic analysis in the identification of clinically aggressive prostate cancer. Br J Cancer 2008; 99:1859-66. [PMID: 18985044 PMCID: PMC2600682 DOI: 10.1038/sj.bjc.6604753] [Citation(s) in RCA: 126] [Impact Index Per Article: 7.9] [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] [Indexed: 11/28/2022] Open
Abstract
Fourier transform infrared (FTIR) spectroscopy is a vibrational spectroscopic technique that uses infrared radiation to vibrate molecular bonds within the sample that absorbs it. As different samples contain different molecular bonds or different configurations of molecular bonds, FTIR allows us to obtain chemical information on molecules within the sample. Fourier transform infrared microspectroscopy in conjunction with a principal component-discriminant function analysis (PC-DFA) algorithm was applied to the grading of prostate cancer (CaP) tissue specimens. The PC-DFA algorithm is used alongside the established diagnostic measures of Gleason grading and the tumour/node/metastasis system. Principal component-discriminant function analysis improved the sensitivity and specificity of a three-band Gleason score criterion diagnosis previously reported by attaining an overall sensitivity of 92.3% and specificity of 99.4%. For the first time, we present the use of a two-band criterion showing an association of FTIR-based spectral characteristics with clinically aggressive behaviour in CaP manifest as local and/or distal spread. This paper shows the potential for the use of spectroscopic analysis for the evaluation of the biopotential of CaP in an accurate and reproducible manner.
Collapse
Affiliation(s)
- M J Baker
- Manchester Interdisciplinary Biocentre, Centre for Instrumentation and Analytical Science, School of Chemical Engineering and Analytical Science, The University of Manchester, Manchester, M1 7DN, UK.
| | | | | | | | | | | |
Collapse
|
26
|
Affiliation(s)
- N W Clarke
- Department of Urological Oncology, Christie Hospital NHS Trust, Wilmslow Road, Manchester M20 4BX, UK.
| |
Collapse
|
27
|
Gazi E, Dwyer J, Lockyer NP, Gardner P, Shanks JH, Roulson J, Hart CA, Clarke NW, Brown MD. Biomolecular profiling of metastatic prostate cancer cells in bone marrow tissue using FTIR microspectroscopy: a pilot study. Anal Bioanal Chem 2007; 387:1621-31. [PMID: 17268776 DOI: 10.1007/s00216-006-1093-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [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: 09/28/2006] [Revised: 12/09/2006] [Accepted: 12/12/2006] [Indexed: 11/28/2022]
Abstract
Prostate cancer (CaP) cells preferentially metastasise to the bone marrow, a microenvironment that plays a substantial role in the sustenance and progression of the CaP tumour. Here we use a combination of FTIR microspectroscopy and histological stains to increase molecular specificity and probe the biochemistry of metastatic CaP cells in bone marrow tissue derived from a limited source of paraffin-embedded biopsies of different patients. This provides distinction between the following dominant metabolic processes driving the proliferation of the metastatic cells in each of these biopsies: glycerophospholipid synthesis from triacylglyceride, available from surrounding adipocytes, in specimen 1, through significantly high (p < or = 0.05) carbohydrate (8.23 +/- 1.44 cm(-1)), phosphate (6.13 +/- 1.5 cm(-1)) and lipid hydrocarbon (24.14 +/- 5.9 cm(-1)) signals compared with the organ-confined CaP control (OC CaP), together with vacuolation of cell cytoplasm; glycolipid synthesis in specimen 2, through significantly high (p < or = 0.05) carbohydrate (5.51 +/- 0.04 cm(-1)) and high lipid hydrocarbon (17.91 +/- 2.3 cm(-1)) compared with OC CaP, together with positive diastase-digested periodic acid Schiff staining in the majority of metastatic CaP cells; glycolysis in specimen 3, though significantly high (p < or = 0.05) carbohydrate (8.86 +/- 1.78 cm(-1)) and significantly lower (p < or = 0.05) lipid hydrocarbon (11.67 +/- 0.4 cm(-1)) than OC CaP, together with negative diastase-digested periodic acid Schiff staining in the majority of metastatic CaP cells. Detailed understanding of the biochemistry underpinning the proliferation of tumour cells at metastatic sites may help towards refining chemotherapeutic treatment.
Collapse
Affiliation(s)
- E Gazi
- School of Chemical Engineering and Analytical Science, The University of Manchester, P.O. Box 88, Manchester, M60 1QD, UK.
| | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Brown MD, Hart CA, Gazi E, Bagley S, Clarke NW. Promotion of prostatic metastatic migration towards human bone marrow stoma by Omega 6 and its inhibition by Omega 3 PUFAs. Br J Cancer 2006; 94:842-53. [PMID: 16523199 PMCID: PMC2361380 DOI: 10.1038/sj.bjc.6603030] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Epidemiological studies have shown not only a relationship between the intake of dietary lipids and an increased risk of developing metastatic prostate cancer, but also the type of lipid intake that influences the risk of metastatic prostate cancer. The Omega-6 poly-unsaturated fatty acid, Arachidonic acid, has been shown to enhance the proliferation of malignant prostate epithelial cells and increase the risk of advanced prostate cancer. However, its role in potentiating the migration of cancer cells is unknown. Here we show that arachidonic acid at concentrations ⩽5 μM is a potent stimulator of malignant epithelial cellular invasion, which is able to restore invasion toward hydrocortisone-deprived adipocyte-free human bone marrow stroma completely. This observed invasion is mediated by the arachidonic acid metabolite prostaglandin E2 and is inhibited by the Omega-3 poly-unsaturated fatty acids eicosapentaenoic acid and docosahexaenoic acid at a ratio of 1 : 2 Omega-3 : Omega-6, and by the COX-2 inhibitor NS-398. These results identify a mechanism by which arachidonic acid may potentiate the risk of metastatic migration and secondary implantation in vivo, a risk which can be reduced with the uptake of Omega-3 poly-unsaturated fatty acids.
Collapse
Affiliation(s)
- M D Brown
- ProMPT Genito Urinary Cancer Research Group, Cancer Research UK.
| | | | | | | | | |
Collapse
|
29
|
Griffiths RW, Gilham DE, Dangoor A, Ramani V, Clarke NW, Stern PL, Hawkins RE. Expression of the 5T4 oncofoetal antigen in renal cell carcinoma: a potential target for T-cell-based immunotherapy. Br J Cancer 2005; 93:670-7. [PMID: 16222313 PMCID: PMC2361613 DOI: 10.1038/sj.bjc.6602776] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
The 5T4 oncofoetal antigen is a heavily glycosylated cell surface protein found on human placental trophoblast and on diverse types of human cancer but is not expressed at significant levels on adult human tissues in health. It therefore satisfies the criteria for a tumour-associated antigen and is an ideal target for the immunotherapy of cancer. We report here that 5T4 is strongly expressed on the majority of renal cell carcinomas and therefore this population of patients is suitable for trials of 5T4-targeted therapies. In particular, we have shown that T cells from renal cell carcinoma patients can be genetically modified to kill 5T4 expressing renal cancer cell lines by introduction of a chimeric-signalling protein. This protein consists of a single chain antibody fragment capable of binding antigen directly at the cell surface and then activating the T cell by virtue of a CD3zeta-signalling domain. This is a powerful tool that bypasses a number of mechanisms that allow tumours to escape T-cell killing and can be readily scaled up for clinical use.
Collapse
Affiliation(s)
- R W Griffiths
- Department of Medical Oncology, Paterson Institute for Cancer Research, Christie Research Centre, Manchester M20 4BX, UK
| | - D E Gilham
- Department of Medical Oncology, Paterson Institute for Cancer Research, Christie Research Centre, Manchester M20 4BX, UK
| | - A Dangoor
- Department of Immunology, Paterson Institute for Cancer Research, Manchester M20 4BX, UK
| | - V Ramani
- Department of Urological Surgery, Christie Hospital NHS Trust, Manchester M20 4BX, UK
| | - N W Clarke
- Department of Urological Surgery, Christie Hospital NHS Trust, Manchester M20 4BX, UK
| | - P L Stern
- Department of Immunology, Paterson Institute for Cancer Research, Manchester M20 4BX, UK
| | - R E Hawkins
- Department of Medical Oncology, Paterson Institute for Cancer Research, Christie Research Centre, Manchester M20 4BX, UK
- Department of Medical Oncology, Paterson Institute for Cancer Research, Christie Research Centre, Manchester M20 4BX, UK. E-mail:
| |
Collapse
|
30
|
Lee LW, Clarke NW, Ramani VAC, Cowan RA, Wylie JP, Logue JP. Adjuvant and salvage treatment after radical prostatectomy: current practice in the UK. Prostate Cancer Prostatic Dis 2005; 8:229-34. [PMID: 15999120 DOI: 10.1038/sj.pcan.4500816] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [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: 11/08/2022]
Abstract
OBJECTIVE To survey UK urologists and radiation oncologists in the evaluation and treatment of localised prostate cancer in the adjuvant and salvage setting. METHODS Postal questionnaires were mailed to 292 urologists and 98 radiation oncologists in the UK. RESULTS In all, 188 (48%) questionnaires were returned. In total, 72/128 (56%) of the urologist respondents and 58/60 (97%) of the oncologist respondents perform routine radical prostate treatment. Among 43 (60%) of the urologist, 40 (69%) recommended adjuvant treatment, which could be radiotherapy, hormonal treatment or combined hormonal and radiation treatment. There is no significant difference between the modality of treatment recommended. The poor prognostic factors that would influence the decision to offer adjuvant treatment include a detectable postoperative PSA, seminal vesicle involvement, positive margins, Gleason score>8 and pathological T3. With regard to the choice of hormonal treatment, most urologists preferred antiandrogens, whereas most oncologists prefer lutienising hormone releasing hormone (LHRH) analogue (P=0.03). Regarding salvage treatment, there is a wide variation in the PSA threshold and number of PSA rises before initiation of investigations and treatment. Significantly more urologists recommended salvage radiotherapy (P=0.02), whereas oncologists recommended combined hormonal radiation therapy (P=0.03). There is a wide variation of practice regarding the duration of hormonal treatment, the type of investigations initiated, range of radiotherapy doses and treatment volumes. CONCLUSION There is a wide variation in practice among UK clinicians.
Collapse
Affiliation(s)
- L W Lee
- Clinical Oncology, Christie Hospital, Manchester, UK
| | | | | | | | | | | |
Collapse
|
31
|
Abstract
OBJECTIVE To audit the current UK outpatient workload and compare this to the national standards as set out by the British Association of Urological Surgeons (BAUS) in A Quality Urological Service for Patients in the New Millennium published in October 2000. PARTICIPANTS 520 UK (NHS) and 21 Republic of Ireland (non-NHS) consultant urologists registered with BAUS in 2000. MAIN OUTCOME MEASURES Extent to which consultant urologists are able to comply with guidelines set out by their specialist association, the BAUS and by the Royal College of Surgeons of England. RESULTS The questionnaire return rate was 61% (318/520; regional range 42%-75%). The median "routine" clinics/week was two (1-5) with a mean of 13 (1-40) new and 26 (7-80) follow ups. Fifteen percent (49/318) of consultants worked alone in clinic; of the remainder assistance included specialist registrar 67% (212/318), staff grade/associate specialist 32% (102/318), senior house officer 53% (172/318), and pre-registration house officer 2% (7/318). Only 21% (66/318; regional range 0%-46%) of responding consultants followed the BAUS recommendations for outpatient workload/manpower. CONCLUSIONS A minority of consultants are able to adhere to the outpatient workload guidelines as set out by BAUS council in 2000. In addition, there appears to be significant variations within and between training regions. Development of this project into a regional audit tool may allow intraregional guideline formation governing hospital outpatient workload.
Collapse
Affiliation(s)
- P E Gilmore
- Department of Urology, Hope Hospital, Stott Lane, Salford, Greater Manchester M6 8HD, UK.
| | | | | | | | | |
Collapse
|
32
|
Abstract
Prostate cancer has a predilection to metastasise to the bone marrow stroma (BMS) by an as yet uncharacterised mechanism. We have defined a series of coculture models of invasion, which simulate the blood/BMS boundary and allow the elucidation of the signalling and mechanics of trans-endothelial migration within the complex bone marrow environment. Confocal microscopy shows that prostate epithelial cells bind specifically to bone marrow endothelial-to-endothelial cell junctions and initiate endothelial cell retraction. Trans-endothelial migration proceeds via an epithelial cell pseudopodial process, with complete epithelial migration occurring after 232±43 min. Stromal-derived factor-1 (SDF-1)/CXCR4 signalling induced PC-3 to invade across a basement membrane although the level of invasion was 3.5-fold less than invasion towards BMS (P=0.0007) or bone marrow endothelial cells (P=0.004). Maximal SDF-1 signalling of invasion was completely inhibited by 10 μM of the SDF-1 inhibitor T140. However, 10 μM T140 only reduced invasion towards BMS and bone marrow endothelial cells by 59% (P=0.001) and 29% (P=0.011), respectively. This study highlights the need to examine the potential roles of signalling molecules and/or inhibitors, not just in single-cell models but in coculture models that mimic the complex environment of the bone marrow.
Collapse
Affiliation(s)
- C A Hart
- PromPT Genito-Urinary Cancer Research, Cancer Research UK Paterson Institute for Cancer Research, Christie Hospital NHS Trust, Wilmslow Road, Manchester M20 4BX, UK
| | - M Brown
- PromPT Genito-Urinary Cancer Research, Cancer Research UK Paterson Institute for Cancer Research, Christie Hospital NHS Trust, Wilmslow Road, Manchester M20 4BX, UK
- PromPT Genito-Urinary Cancer Research, Cancer Research UK Paterson Institute for Cancer Research, Christie Hospital NHS Trust, Wilmslow Road, Manchester M20 4BX, UK. E-mail:
| | - S Bagley
- Advanced Imaging Facility, Cancer Research UK, Paterson Institute for Cancer Research, Christie Hospital NHS Trust, Wilmslow Road, Manchester M20 4BX, UK
| | - M Sharrard
- YCR Cancer Research Unit, Biology Department, The University of York, York YO10 5YW, UK
| | - N W Clarke
- PromPT Genito-Urinary Cancer Research, Cancer Research UK Paterson Institute for Cancer Research, Christie Hospital NHS Trust, Wilmslow Road, Manchester M20 4BX, UK
- Department of Urology, Salford Royal Hospital, Eccles Old Road, Salford, UK
- Christie Hospital NHS Trust, Wilmslow Road, Manchester, UK
| |
Collapse
|
33
|
Maddineni SB, Sangar VK, Hendry JH, Margison GP, Clarke NW. Differential radiosensitisation by ZD1839 (Iressa), a highly selective epidermal growth factor receptor tyrosine kinase inhibitor in two related bladder cancer cell lines. Br J Cancer 2005; 92:125-30. [PMID: 15611794 PMCID: PMC2361738 DOI: 10.1038/sj.bjc.6602299] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The epidermal growth factor receptor (EGFR) is expressed in a wide variety of epithelial tumours including carcinoma of the bladder. Stimulation of the EGFR pathway is blocked by ZD1839 (Iressa), a highly selective EGFR tyrosine kinase inhibitor. Radical radiotherapy is an established organ sparing treatment option for muscle invasive bladder cancer and this study has explored the possibility for the use of ZD1839 as a radiosensitiser in this scenario. The effect of combination treatment with ZD1839 (0.01 μM) and ionising radiation in the established bladder cancer cell lines MGH-U1 and its radiosensitive mutant clone S40b was measured by clonogenic assays. A highly significant radiosensitising effect was seen in both cell lines (P<0.001 for MGH-U1 and S40b cell lines). This effect was independent of the concentration of the drug and the duration of exposure prior to treatment with ionising radiation. Cell cycle kinetics of both cell lines was not significantly altered with ZD1839 (0.01 μM) as a single agent. A modest induction of apoptosis was observed with ZD1839 (0.01 μM) as a single agent, but a marked induction was observed with the combination treatment of ZD1839 and ionising radiation. These results suggest a potentially important role for ZD1839 in combination with radiotherapy in the treatment of muscle invasive bladder cancer.
Collapse
Affiliation(s)
- S B Maddineni
- Cancer Research-UK Carcinogenesis Group, Paterson Institute for Cancer Research, Wilmslow Road, Manchester M20 4BX, UK.
| | | | | | | | | |
Collapse
|
34
|
Bryden AAG, Islam S, Freemont AJ, Shanks JH, George NJR, Clarke NW. Parathyroid hormone-related peptide: expression in prostate cancer bone metastases. Prostate Cancer Prostatic Dis 2004; 5:59-62. [PMID: 15195132 DOI: 10.1038/sj.pcan.4500553] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2001] [Revised: 09/20/2001] [Accepted: 10/10/2001] [Indexed: 11/09/2022]
Abstract
Parathyroid hormone-related peptide (PTHrP) is a regulatory protein associated with cell growth in non-osseous tissues and with osteoclast stimulation in bone. It has been implicated in the pathogenesis of bone metastases, particularly in breast carcinoma. PTHrP is widely expressed in primary prostate cancers, but there are few reports of its expression in prostatic metastases. The aim of this study was to examine the expression of PTHrP in bone metastases from patients with untreated adenocarcinoma of the prostate. Ten bone biopsies containing metastatic deposits of untreated prostatic cancer were identified. These were immunohistochemically stained for PTHrP using a murine monoclonal antibody (PTHLP[Ab1]) and the streptavidin-biotin complex technique. Intensity of staining for PTHrP was graded by two observers. In total, PTHrP expression was positive in 5/10 specimens. This was graded as moderate in four and weak in one. In those specimens with positive staining, the expression varied between cells. There was no obvious association between expression of PTHrP and tumour differentiation. PTHrP is expressed in prostatic bone metastases and may have a role in their pathogenesis and pathophysiology. However, expression is not universal.
Collapse
|
35
|
Sangar VK, Cowan R, Margison GP, Hendry JH, Clarke NW. An evaluation of gemcitabines differential radiosensitising effect in related bladder cancer cell lines. Br J Cancer 2004; 90:542-8. [PMID: 14735206 PMCID: PMC2409540 DOI: 10.1038/sj.bjc.6601538] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The aim of this study was to establish the radiosensitising properties of gemcitabine in a pair of related bladder tumour cell lines with differential radiosensitivity. The radioresistant bladder tumour cell line MGH-U1 and its radiosensitive mutant clone, S40b (both p53 mutant), had SF2 values (surviving fraction at 2 Gy) of 0.98 and 0.64, respectively (P<0.001). Colony-forming assays showed that at 0.01 μM gemcitabine radiosensitisation occurred only in the S40b cell line (dose-modifying factor (DMF)=1.4). At 0.3 μM (killing 50% of cells), both cell lines were radiosensitised; DMF=2.25 and 1.2 for MGH-U1 and S40b, respectively. These data suggest that gemcitabine is an effective radiosensitiser in bladder cancer cell lines, with greater sensitisation in the radioresistant parental line–a feature that should be useful in a clinical setting.
Collapse
Affiliation(s)
- V K Sangar
- Cancer Research UK Experimental Radiation Oncology Group, Paterson Institute for Cancer Research, Manchester M20 4BX, UK.
| | | | | | | | | |
Collapse
|
36
|
Gazi E, Dwyer J, Lockyer NP, Miyan J, Gardner P, Hart C, Brown M, Clarke NW. Fixation protocols for subcellular imaging by synchrotron-based Fourier transform infrared microspectroscopy. Biopolymers 2004; 77:18-30. [PMID: 15558657 DOI: 10.1002/bip.20167] [Citation(s) in RCA: 104] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Synchrotron-based Fourier transform infrared (SR-FTIR) microspectroscopy is a powerful bioanalytical technique for the simultaneous analysis of lipids, proteins, carbohydrates, and a variety of phosphorylated molecules within intact cells. SR-FTIR microspectroscopy can be used in the imaging mode to generate biospectroscopic maps of the distribution and intensity profiles of subcellular biomolecular domains at diffraction-limited spatial resolution. However, the acquisition of highly spatially resolved IR images of cells is not only a function of instrumental parameters (source brightness, sampling aperture size) but also the cell preparation method employed. Additionally, for the IR data to be biochemically relevant the cells must be preserved in a life-like state without introducing artefacts. In the present study we demonstrate, for the first time, the differences in biomolecular localizations observed in SR-FTIR images of cells fixed by formalin, formalin-critical point drying (CPD), and glutaraldehyde-osmium tetroxide-CPD, using the PC-3 prostate cancer cell line. We compare these SR-FTIR images of fixed cells to unfixed cells. The influence of chemical fixatives on the IR spectrum is discussed in addition to the biological significance of the observed localizations. Our experiments reveal that formalin fixation at low concentration preserves lipid, phosphate, and protein components without significantly influencing the IR spectrum of the cell.
Collapse
Affiliation(s)
- E Gazi
- School of Chemical Engineering and Analytical Science, The University of Manchester, Manchester M60 1QD, UK.
| | | | | | | | | | | | | | | |
Collapse
|
37
|
Affiliation(s)
- N W Clarke
- Christie Hospital NHS Trust and Salford Royal Hospitals NHS Trust, Manchester, UK.
| |
Collapse
|
38
|
Gazi E, Dwyer J, Gardner P, Ghanbari-Siahkali A, Wade AP, Miyan J, Lockyer NP, Vickerman JC, Clarke NW, Shanks JH, Scott LJ, Hart CA, Brown M. Applications of Fourier transform infrared microspectroscopy in studies of benign prostate and prostate cancer. A pilot study. J Pathol 2003; 201:99-108. [PMID: 12950022 DOI: 10.1002/path.1421] [Citation(s) in RCA: 133] [Impact Index Per Article: 6.3] [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: 11/07/2022]
Abstract
Fourier transform infrared (FTIR) microspectroscopy has been applied to a study of prostate cancer cell lines derived from different metastatic sites and to tissue from benign prostate and Gleason-graded malignant prostate tissue. Paraffin-embedded tissue samples were analysed by FTIR, after mounting onto a BaF(2) plate and subsequent removal of wax using Citroclear followed by acetone. Cell lines were analysed as aliquots of cell suspension held between two BaF(2) plates. It was found that the ratio of peak areas at 1030 and 1080 cm(-1), corresponding to the glycogen and phosphate vibrations respectively, suggests a potential method for the differentiation of benign from malignant cells. The use of this ratio in association with FTIR spectral imaging provides a basis for estimating areas of malignant tissue within defined regions of a specimen. Initial chemometric treatment of FTIR spectra, using the linear discriminant algorithm, demonstrates a promising method for the classification of benign and malignant tissue and the separation of Gleason-graded CaP spectra. Using the principle component analysis, this study has achieved for the first time the separation of FTIR spectra of prostate cancer cell lines derived from different metastatic sites.
Collapse
Affiliation(s)
- E Gazi
- Department of Chemistry, UMIST, PO Box 88, Manchester M60 1QD, UK
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Shackley DC, Haylett A, Whitehurst C, Betts CD, O'Flynn K, Clarke NW, Moore JV. Comparison of the cellular molecular stress responses after treatments used in bladder cancer. BJU Int 2002; 90:924-32. [PMID: 12460358 DOI: 10.1046/j.1464-410x.2002.03024.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To investigate the molecular stress responses related to the quality of recovery of normal tissue after various treatments for bladder cancer, i.e. hyperthermia, ionizing radiation, mitomycin-C and 5-aminolaevulinic acid photodynamic therapy (ALA-PDT). MATERIALS AND METHODS The study focused particularly on intracellular fibroblast levels of heat-shock protein-47 (HSP47) and HSP72, which are associated with collagen metabolism and the development of tolerance to repeated treatment, respectively. Iso-effective treatment doses (50% clonogenic cell survival) of each method were delivered to a 3T6 murine fibroblast model. Intracellular extracts were analysed at 3, 6, 9, 12 and 24 h after treatment, using Western blot analysis to compare the levels of HSP47 and HSP72. Time-matched treatment and control groups were quantified by comparison with actin and glyceraldehyde-3-phosphate dehydrogenase (GAPDH) expression using appropriate software. RESULTS There were various changes in levels of HSP expression with treatment method; HSP47 levels were significantly higher after hyperthermia and radiation but not with mitomycin-C or ALA-PDT. HSP72 levels were significantly higher with all methods except ALA-PDT. CONCLUSIONS Hyperthermia and ionizing radiation are associated with early increases in levels of HSP47 (a marker of collagen metabolism), in contrast to ALA-PDT and mitomycin-C. These findings are compatible with clinical findings where fibrosis/scarring is common with the first two but not the last two methods. In addition, all methods except ALA-PDT are associated with an increase in HSP 72 (a protein associated with cellular tolerance) and this may help to explain, at a cellular level, why resistance to repeated ALA-PDT treatments does not seem to occur.
Collapse
Affiliation(s)
- D C Shackley
- CRC Experimental Radiation Oncology Group, Paterson Institute for Cancer Research, Manchester, UK.
| | | | | | | | | | | | | |
Collapse
|
40
|
Shackley DC, Briggs C, Gilhooley A, Whitehurst C, O'Flynn KJ, Betts CD, Moore JV, Clarke NW. Photodynamic therapy for superficial bladder cancer under local anaesthetic. BJU Int 2002; 89:665-70. [PMID: 11966622 DOI: 10.1046/j.1464-410x.2002.02743.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To evaluate the use of local anaesthesia (LA) in 5-aminolaevulinic acid (ALA) photodynamic therapy (PDT) for superficial transitional cell carcinoma (TCC) of the bladder, and to provide further toxicity and tolerability data on this new method within the context of a phase 1 trial. PATIENTS AND METHODS ALA PDT was administered to 19 patients with recurrent superficial TCC (stage Ta/carcinoma in situ, grades 1-3) using escalating doses of ALA (3-6%) and 633 nm laser light (25-50 J/cm2) under various LA (lignocaine) protocols. Pain was assessed using a linear analogue scale from 0 to 10. The endpoints of tolerability and toxicity were assessed for the different LA, light and ALA doses, with lignocaine levels. RESULTS ALA PDT is painful and requires some form of anaesthesia. The discomfort was immediate, associated with bladder spasm, and was a function of the ALA concentration rather than the total light dose given. Simple passive diffusion (PD) of 2% lignocaine instilled for 40 min before PDT gave adequate anaesthesia with 3% ALA (n=8; median pain score 1, range 0-2). With 6% ALA the pain was dramatically increased using PD (n=6; median pain score 8, range 5-10) and therefore the more potent LA technique of electromotive drug administration (EMDA) of 2% lignocaine was used, with excellent results (n=3; median pain score 1, range 0-2). All patients had transient bladder irritability that typically lasted 9-12 days, with no subjective/objective change in long-term bladder function. No other toxicity was reported. Serum lignocaine levels were minimal. CONCLUSION Bladder ALA PDT is both safe and feasible under LA. At a dose of 3% ALA, the procedure was well-tolerated using PD of lignocaine. At higher doses (6% ALA) more effective anaesthesia is required and this can be obtained satisfactorily with EMDA of lignocaine. With refinement, ALA PDT may be feasible as an outpatient treatment for superficial bladder TCC.
Collapse
Affiliation(s)
- D C Shackley
- Department of Urology, Hope Hospital, Salford Royal Hospitals Trust, Salford, UK.
| | | | | | | | | | | | | | | |
Collapse
|
41
|
Hart CA, Scott LJ, Bagley S, Bryden AAG, Clarke NW, Lang SH. Role of proteolytic enzymes in human prostate bone metastasis formation: in vivo and in vitro studies. Br J Cancer 2002; 86:1136-42. [PMID: 11953862 PMCID: PMC2364179 DOI: 10.1038/sj.bjc.6600207] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2001] [Revised: 11/13/2001] [Accepted: 01/21/2002] [Indexed: 11/08/2022] Open
Abstract
Prostate cancers ability to invade and grow in bone marrow stroma is thought to be due in part to degradative enzymes. The formation of prostate skeletal metastases have been reproduced in vitro by growing co-cultures of prostatic epithelial cells in bone marrow stroma. Expression of urokinase plasminogen activator, matrix metalloproteinase 1 and 7 by prostatic epithelial cells were identified using immunocytochemistry. Also, in vivo tissue sections from human prostatic bone marrow metastases were stained. To establish the role of these enzymes on colony formation, inhibitory antibodies directed against urokinase plasminogen activator, matrix metalloproteinase 1 and matrix metalloproteinase 7 were added into primary prostatic epithelial cells and bone marrow stroma co-cultures. All prostatic epithelial cell cultures stained positively for matrix metalloproteinase 1, matrix metalloproteinase 7 and urokinase plasminogen activator. Generally prostatic epithelial cells derived from malignant tissues showed increased staining in comparison to epithelia derived from non-malignant tissue. In agreement with in vitro co-cultures, the in vivo tissue sections of prostate bone marrow metastases showed positive staining for all three enzymes. Inhibition studies demonstrated that blocking matrix metalloproteinase 1, matrix metalloproteinase 7 and urokinase plasminogen activator function reduced the median epithelial colony area significantly in bone marrow stroma co-cultures in vitro. Using a human ex-vivo model we have shown that matrix metalloproteinase 1, matrix metalloproteinase 7 and urokinase plasminogen activator play an important role in the establishment of prostatic epithelial cells within bone marrow.
Collapse
Affiliation(s)
- C A Hart
- Cancer Research UK - Group of Experimental Haematology, Paterson Institute for Cancer Research, Christie Hospital NHS Trust, Wilmslow Road, Manchester M20 4BX, UK.
| | | | | | | | | | | |
Collapse
|
42
|
Abstract
OBJECTIVE To determine the E-cadherin and beta-catenin expression phenotype in untreated primary prostate cancer and corresponding bone metastases. MATERIALS AND METHODS Paired bone metastasis and primary prostate specimens were obtained from 14 men with untreated metastatic prostate carcinoma. The tumours were histologically graded by an independent pathologist. Expression of mRNA for E-cadherin and beta-catenin was detected within the tumour cells using in-situ hybridization with a 35S-labelled cDNA probe. The expression of E-cadherin and beta-catenin were graded as uniform, heterogeneous or negative. RESULTS The mRNA for E-cadherin was expressed in 13 of 14 primary carcinomas and 11 bone metastases; beta-catenin was expressed by 13 and nine, respectively. Of the primary tumours, nine expressed E-cadherin and beta-catenin uniformly; in contrast, all metastases had down-regulated E-cadherin and/or beta-catenin. CONCLUSIONS The down-regulation of E-cadherin and beta-catenin are a feature of the metastatic phenotype, which may be a significant factor in the genesis of bone metastases. However, this does not appear to be reflected in the expression of these molecules in the primary tumours.
Collapse
Affiliation(s)
- A A G Bryden
- Christie and Hope Hospital, University of Manchester, UK
| | | | | | | | | | | |
Collapse
|
43
|
Bryden AAG, Hoyland JA, Freemont AJ, Clarke NW, George NJR. Parathyroid hormone related peptide and receptor expression in paired primary prostate cancer and bone metastases. Br J Cancer 2002; 86:322-5. [PMID: 11875691 PMCID: PMC2375222 DOI: 10.1038/sj.bjc.6600115] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2001] [Revised: 11/26/2001] [Accepted: 12/05/2001] [Indexed: 12/03/2022] Open
Abstract
Parathyroid hormone-related peptide is a regulatory protein implicated in the pathogenesis of bone metastases, particularly in breast carcinoma. Parathyroid hormone-related peptide is widely expressed in primary prostate cancers but there are few reports of its expression in prostatic metastases. The aim of this study was to examine the expression of parathyroid hormone-related peptide and its receptor in matched primary and in bone metastatic tissue from patients with untreated adenocarcinoma of the prostate. Eight-millimetre trephine iliac crest bone biopsies containing metastatic prostate cancer were obtained from 14 patients from whom matched primary tumour tissue was also available. Histological grading was performed by an independent pathologist. The cellular location of mRNA for parathyroid hormone-related peptide and parathyroid hormone-related peptide receptor was identified using in situ hybridization with (35)S-labelled probe. Expression of parathyroid hormone-related peptide and its receptor was described as uniform, heterogenous or negative within the tumour cell population. Parathyroid hormone-related peptide expression was positive in 13 out of 14 primary tumours and in all 14 metastases. Receptor expression was evident in all 14 primaries and 12 out of 14 metastases. Co-expression of parathyroid hormone-related peptide and parathyroid hormone-related peptide receptor was common (13 primary tumours, 12 metastases). The co-expression of parathyroid hormone-related peptide and its receptor suggest that autocrine parathyroid hormone-related peptide mediated stimulation may be a mechanism of escape from normal growth regulatory pathways. The high frequency of parathyroid hormone-related peptide expression in metastases is consistent with a role in the pathogenesis of bone metastases.
Collapse
Affiliation(s)
- A A G Bryden
- Christie Hospital, Wilmslow Road, Manchester M20 4BX, UK.
| | | | | | | | | |
Collapse
|
44
|
Collis SJ, Sangar VK, Tighe A, Roberts SA, Clarke NW, Hendry JH, Margison GP. Development of a novel rapid assay to assess the fidelity of DNA double-strand-break repair in human tumour cells. Nucleic Acids Res 2002; 30:E1. [PMID: 11788727 PMCID: PMC99840 DOI: 10.1093/nar/30.2.e1] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Cellular survival following ionising radiation-mediated damage is primarily a function of the ability to successfully detect and repair DNA double-strand breaks (DSBs). Previous studies have demonstrated that radiosensitivity, determined as a reduction in colony forming ability in vitro, may be related to the incorrect repair (misrepair) of DSBs. The novel rapid dual fluorescence (RDF) assay is a plasmid-based reporter system that rapidly assesses the correct rejoining of a restriction-enzyme produced DSBs within transfected cells. We have utilised this novel assay to determine the fidelity of DSB repair in the prostate tumour cell line LNCaP, the bladder tumour cell line MGH-U1 and a radiosensitive subclone S40b. The two bladder cell lines have been shown in previous studies to differ in their ability to correctly repair plasmids containing a single DSB. Using the RDF assay we found that a substantial portion of LNCaP cells [80.4 +/- 5.3(standard error)%] failed to reconstitute reporter gene expression; however, there was little difference in this measure of DSB repair fidelity between the two bladder cell lines (48.3 +/- 3.5% for MGH-U1; 39.9 +/- 8.2% for S40b). The RDF assay has potential to be developed to study the relationship between DSB repair fidelity and radiosensitivity as well as the mechanisms associated with this type of repair defect.
Collapse
Affiliation(s)
- S J Collis
- CRC Experimental Radiation Oncology Group, Paterson Institute for Cancer Research, Christie Hospital NHS Trust, Wilmslow Road, Manchester M20 4BX, UK
| | | | | | | | | | | | | |
Collapse
|
45
|
Denton AS, Clarke NW, Maher EJ. Non-surgical interventions for late radiation cystitis in patients who have received radical radiotherapy to the pelvis. Cochrane Database Syst Rev 2002; 2002:CD001773. [PMID: 12137633 PMCID: PMC7025765 DOI: 10.1002/14651858.cd001773] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Chronic radiation cystitis occurs a minimum of three months after completion of pelvic radiotherapy and represents a range of clinical symptoms for which there is as yet no recommended standard management. OBJECTIVES The aim of this review was to identify the various non-surgical treatment options for the management of late chronic radiation cystitis and evaluate the evidence. SEARCH STRATEGY Synonyms for radiation therapy and for the spectrum of radiation toxicity to the bladder in both text and MeSH terms were combined and applied to a range of databases without restriction of year of publication, methodology or language. SELECTION CRITERIA The inclusion criteria included studies of interventions for the non-surgical management of all grades of late radiation cystitis. DATA COLLECTION AND ANALYSIS Out of 80 relevant studies, there were no RCTs that met the inclusion criteria, but there were three prospective case series and two non-randomised studies which assessed different interventions and were not comparable. MAIN RESULTS Sixty-three reports met the stated inclusion criteria. The majority were predominantly retrospective case series with the exception of two trials which were unrandomised and unblinded studies with a control group for comparison of effect. Although these two trials, Micic 1988, (intravesical placental extract) and Milani 1988, (flavoxate) provided the strongest evidence they were not randomised and were essentially isolated controlled studies. REVIEWER'S CONCLUSIONS In such a relatively rare condition there are obvious difficulties in identifying sufficient patients to participate in a randomised controlled trial. The number of published reports is a reflection of the degree of medical interest that exists in providing therapeutic solutions for late radiation cystitis. However, in spite of the two studies of level IIA evidence, the absence of randomised controlled trials makes it impossible to draw any firm conclusions.
Collapse
Affiliation(s)
- A S Denton
- Centre for Cancer Treatment, Mount Vernon Hospital, Rickmansworth Rd, Northwood, Middlesex, UK, HA6 2RN.
| | | | | |
Collapse
|
46
|
Abstract
OBJECTIVE Prostate cancer in bone is generally thought to progress more rapidly than in its primary site, a supposition that is supported by studies of prostate-specific antigen velocity. However, descriptions of proliferative rates in metastases have relied on inferred data from in vitro studies of cell lines derived from metastases. The aim of this study was to determine directly the proliferative rate within bone metastases arising from prostate cancer. PATIENTS AND METHODS 10 bone biopsies containing metastatic deposits of untreated prostatic cancer were obtained. These were immunohistochemically stained for the Ki-67 protein with the monoclonal antibody MIB-1, using the streptavidin-biotin complex technique. Benign prostatic tissue was used as the control. Using an image analyser, the Ki-67 index (% of cells staining positively) in each specimen was determined. RESULTS In the 10 specimens the Ki-67 index ranged from 0.15 to 7.82%. Wide overlap was seen between groups of differing tumour differentiation. CONCLUSION The proliferative rate as determined by the Ki-67 index in bone metastases of prostate cancer is similar to that reported in primary tumours. There does not appear to be a relationship between tumour grade and proliferative index in these specimens.
Collapse
Affiliation(s)
- A A Bryden
- Department of Urology, Hope and Christie Hospitals, Manchester, UK.
| | | | | | | |
Collapse
|
47
|
Abstract
In photodynamic therapy, a photosensitizing drug is activated by visible light and in the presence of oxygen, results in local cell death. This evolving modality is now being used to treat and palliate a very wide variety of human solid tumors and carcinoma-in-situ lesions. With regard to bladder cancer, advances in drug development and modern light delivery techniques mean that photodynamic therapy shows promise in the treatment of superficial bladder cancer resistant to conventional treatments.
Collapse
Affiliation(s)
- D C Shackley
- Department of Urology, Hope Hospital, Salford, Manchester, M60 8HD, UK
| | | | | | | | | | | | | |
Collapse
|
48
|
Abstract
OBJECTIVES To report our results with the use of reverse transcriptase-polymerase chain reaction (RT-PCR) as a potential predictor of prostate cancer (CaP) progression in patients managed with watchful waiting. There has been much recent debate about the safety of treating older patients with localized CaP with watchful waiting. The RT-PCR is an assay that can detect small numbers of prostate cells in circulating blood. METHODS Blood samples were taken from male and female control patients and from patients with advanced, hormone-treated and untreated localized (watchful-waiting) CaP. Sensitive nested RT-PCR assays were carried out on these samples using primers for both prostate-specific antigen (PSA) and prostate-specific membrane antigen mRNA. RESULTS Fifty-one blood samples were taken from patients managed with watchful waiting. Fourteen of these had positive RT-PCR results. These patients had a significantly higher PSA velocity than did the patients with negative RT-PCR results. Circulating prostate cells were detected in 18 of 24 patients with advanced CaP, 2 of 34 patients with stable, hormone-treated CaP, and in none of the negative controls. The assay was able to detect 20 LNCaP cells reliably when added to a 5-mL volunteer blood sample. CONCLUSIONS A significant minority (27%) of patients with untreated localized CaP had detectable circulating prostate cells, and these patients tended to have a progressively rising serum PSA level. Despite low-grade disease and sometimes low serum PSA values, these patients may be at risk of early metastatic progression. RT-PCR, in conjunction with existing prognostic tests, may be of use in predicting which "watchful-waiting" patients are at risk of early progression.
Collapse
Affiliation(s)
- I G McIntyre
- Department of Urology, University Hospital of South Manchester, Withington Hospital, Manchester, United Kingdom
| | | | | | | | | |
Collapse
|
49
|
Scott LJ, Clarke NW, George NJ, Shanks JH, Testa NG, Lang SH. Interactions of human prostatic epithelial cells with bone marrow endothelium: binding and invasion. Br J Cancer 2001; 84:1417-23. [PMID: 11355957 PMCID: PMC2363632 DOI: 10.1054/bjoc.2001.1804] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Prostate cancer shows a propensity to form secondary tumours within the bone marrow. Such tumours are the major cause of mortality in this disease. We have developed an in vitro system to study the binding of prostate epithelial cells to bone marrow endothelium (BME) and stroma (BMS). The metastatic prostate cancer cell line, PC3 (derived from a bone metastasis), was seeded onto confluent layers of BME and its binding characteristics compared to human umbilical vein endothelial cells (HUVEC), lung endothelium (Hs888Lu) and BMS. The PC3 cell line showed significantly increased binding to BME (P< 0.05) compared to endothelium derived from HUVEC and lung or BMS with maximal binding occurring at 1 h. Following pre-incubation with a β1 integrin antibody PC3 binding to BME was inhibited by 64% (P< 0.001). Antibodies directed against the integrins β4, α2, α4, α5 and the cellular adhesion molecules P-selectin, CD31, VCAM-1 and sialy Lewis X showed no effect on blocking PC3 binding. Primary prostatic epithelial cells from both malignant (n = 11) and non-malignant tissue (n = 11) also demonstrated equivalent levels of increased adhesion to BME and BMS compared to HUVEC, peaking at 24 h. Further studies examined the invasive ability of prostate epithelial cells in response to bone marrow endothelium using Matrigel invasion chamber assays. In contrast to the previous results, malignant cells showed an increase (1000 fold) in invasive ability, whilst non-malignant prostate epithelia did not respond. We have shown that both malignant and non-malignant prostate epithelial cells can bind at equivalent levels and preferentially to primary human bone marrow endothelium in comparison to controls. However, only malignant prostate epithelia show increased invasive ability in response to BME. © 2001 Cancer Research Campaign www.bjcancer.com
Collapse
Affiliation(s)
- L J Scott
- CRC Experimental Haematology Group, Paterson Institute for Cancer Research, Christie Hospital NHS Trust, Wilmslow Road, Manchester, M20 4BX, UK
| | | | | | | | | | | |
Collapse
|
50
|
Clarke NW. Renal Cell Carcinoma, Molecular Biology, Immunology, and Clinical Management. BJU Int 2001. [DOI: 10.1046/j.1464-410x.2001.02053.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: 11/20/2022]
|