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Blomstrand H, Olsson H, Green H, Björnsson B, Elander NO. Impact of resection margins and para-aortic lymph node metastases on recurrence patterns and prognosis in resectable pancreatic cancer - a long-term population-based cohort study. HPB (Oxford) 2023; 25:1531-1544. [PMID: 37659905 DOI: 10.1016/j.hpb.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Received: 03/10/2023] [Revised: 05/11/2023] [Accepted: 08/10/2023] [Indexed: 09/04/2023]
Abstract
BACKGROUND Pancreatic cancer remains a leading cause of cancer-related death. To individualise management and improve survival, more accurate prognostic models are needed. METHODS All patients resected for pancreatic ductal adenocarcinoma in a tertiary Swedish centre during 2009-2019 were thoroughly analysed with regards to pathological and clinical parameters including tumour grade, resection margin status, para-aortic lymph node engagement (node station 16), and systemic treatment. RESULTS The study cohort included 275 patients. Overall median survival was 21.2 months (95% CI 17.5-24.8). Year of resection, margin status (R1 subdivided into R11mm/R1ink), perineural invasion, differentiation grade, TNM stage, and adjuvant therapy were independent factors with significant impact on survival. Margin status also significantly affected recurrence-free survival and relapse patterns, with local and peritoneal relapses being associated with R1-status (p < 0.001 and p = 0.007). Presence of para-aortic lymph node metastases was associated with shorter recurrence-free survival as compared to N1 status only. CONCLUSION Survival in resected pancreatic cancer is improving over time. Resection margin status is a key factor affecting recurrence patterns and prognosis. Given the poor recurrence-free survival in node station 16 metastasised patients, the rational for resection remains in doubt, and improved treatment strategies for this patient group is necessary.
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Affiliation(s)
- Hakon Blomstrand
- Department of Clinical Pathology, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
| | - Hans Olsson
- Department of Clinical Pathology, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Henrik Green
- Division of Clinical Chemistry and Pharmacology, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden; Department of Forensic Genetics and Forensic Toxicology, National Board of Forensic Medicine, Linköping, Sweden
| | - Bergthor Björnsson
- Department of Surgery, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Nils O Elander
- Department of Biomedical and Clinical Sciences, Linköping University, Sweden; Clatterbridge Cancer Centre NHS FT, Liverpool, United Kingdom
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Asowed M, Elander NO, Pettersson L, Ekholm M, Papantoniou D. Activity and safety of KEES - an oral multi-drug chemo-hormonal metronomic combination regimen in metastatic castration-resistant prostate cancer. BMC Cancer 2023; 23:309. [PMID: 37016322 PMCID: PMC10074662 DOI: 10.1186/s12885-023-10780-y] [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: 10/30/2022] [Accepted: 03/27/2023] [Indexed: 04/06/2023] Open
Abstract
BACKGROUND Metastatic castration-resistant prostate cancer (mCRPC) remains a therapeutic challenge and evidence for late-line treatments in real-life is limited. The present study investigates the efficacy and safety of an oral metronomic chemo-hormonal regimen including cyclophosphamide, etoposide, estramustine, ketoconazole and prednisolone (KEES) administered in a consecutive biweekly schedule. METHODS A retrospective cohort study in two Swedish regions was conducted. Overall (OS) and progression-free survival (PFS), biochemical response rate (bRR) and toxicities were analyzed. RESULTS One hundred and twenty-three patients treated with KEES after initial treatment with at least a taxane or an androgen-receptor targeting agents (ARTA) were identified. Of those, 95 (77%) had received both agents and were the primary analysis population. Median (95% CI) OS and PFS in the pre-treated population were 12.3 (10.1-15.0) and 4.4 (3.8-5.5) months, respectively. Biochemical response, defined as ≥ 50% prostate-specific antigen (PSA) reduction, occurred in 26 patients (29%), and any PSA reduction in 59 (65%). PFS was independent of prior treatments used, and KEES seemed to be effective in late treatment lines. The bRR was higher compared to historical data of metronomic treatments in docetaxel and ARTA pre-treated populations. In multivariable analyses, performance status (PS) ≥ 2 and increasing alkaline phosphatase (ALP) predicted for worse OS. Nausea, fatigue, thromboembolic events and bone marrow suppression were the predominant toxicities. CONCLUSIONS KEES demonstrated meaningful efficacy in heavily pre-treated CRPC patients, especially those with PS 0-1 and lower baseline ALP, and had an acceptable toxicity profile.
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Affiliation(s)
- Mustafa Asowed
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, 581 83, Sweden
| | - Nils O Elander
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, 581 83, Sweden
| | - Linn Pettersson
- Department of Oncology, Ryhov County Hospital, Jönköping, 551 85, Sweden
| | - Maria Ekholm
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, 581 83, Sweden
- Department of Oncology, Ryhov County Hospital, Jönköping, 551 85, Sweden
| | - Dimitrios Papantoniou
- Department of Oncology, Ryhov County Hospital, Jönköping, 551 85, Sweden.
- Department of Medical Sciences, Endocrine Oncology, Uppsala University, Uppsala, 751 85, Sweden.
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Aughton K, Elander NO, Evans A, Jackson R, Campbell F, Costello E, Halloran CM, Mackey JR, Scarfe AG, Valle JW, Carter R, Cunningham D, Tebbutt NC, Goldstein D, Shannon J, Glimelius B, Hackert T, Charnley RM, Anthoney A, Lerch MM, Mayerle J, Palmer DH, Büchler MW, Ghaneh P, Neoptolemos JP, Greenhalf W. hENT1 Predicts Benefit from Gemcitabine in Pancreatic Cancer but Only with Low CDA mRNA. Cancers (Basel) 2021; 13:5758. [PMID: 34830914 PMCID: PMC8616255 DOI: 10.3390/cancers13225758] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 11/03/2021] [Accepted: 11/08/2021] [Indexed: 11/30/2022] Open
Abstract
Gemcitabine or 5-fluorouracil (5-FU) based treatments can be selected for pancreatic cancer. Equilibrative nucleoside transporter 1 (hENT1) predicts adjuvant gemcitabine treatment benefit over 5-FU. Cytidine deaminase (CDA), inside or outside of the cancer cell, will deaminate gemcitabine, altering transporter affinity. ESPAC-3(v2) was a pancreatic cancer trial comparing adjuvant gemcitabine and 5-FU. Tissue microarray sections underwent in situ hybridization and immunohistochemistry. Analysis of both CDA and hENT1 was possible with 277 patients. The transcript did not correlate with protein levels for either marker. High hENT1 protein was prognostic with gemcitabine; median overall survival was 26.0 v 16.8 months (p = 0.006). Low CDA transcript was prognostic regardless of arm; 24.8 v 21.2 months with gemcitabine (p = 0.02) and 26.4 v 14.6 months with 5-FU (p = 0.02). Patients with low hENT1 protein did better with 5-FU, but only if the CDA transcript was low (median survival of 5-FU v gemcitabine; 29.3 v 18.3 months, compared with 14.2 v 14.6 with high CDA). CDA mRNA is an independent prognostic biomarker. When added to hENT1 protein status, it may also provide treatment-specific predictive information and, within the frame of a personalized treatment strategy, guide to either gemcitabine or 5FU for the individual patient.
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Affiliation(s)
- Karen Aughton
- Liverpool Experimental Cancer Medicine Centre, 2nd Floor Sherrington Building, Ashton St, University of Liverpool, Liverpool L69 3GE, UK
| | - Nils O Elander
- Liverpool Experimental Cancer Medicine Centre, 2nd Floor Sherrington Building, Ashton St, University of Liverpool, Liverpool L69 3GE, UK
- Department of Oncology, Linköping University, SE-581 83 Linköping, Sweden
| | - Anthony Evans
- Liverpool Experimental Cancer Medicine Centre, 2nd Floor Sherrington Building, Ashton St, University of Liverpool, Liverpool L69 3GE, UK
| | - Richard Jackson
- Liverpool Experimental Cancer Medicine Centre, 2nd Floor Sherrington Building, Ashton St, University of Liverpool, Liverpool L69 3GE, UK
| | - Fiona Campbell
- Liverpool Experimental Cancer Medicine Centre, 2nd Floor Sherrington Building, Ashton St, University of Liverpool, Liverpool L69 3GE, UK
| | - Eithne Costello
- Liverpool Experimental Cancer Medicine Centre, 2nd Floor Sherrington Building, Ashton St, University of Liverpool, Liverpool L69 3GE, UK
| | - Christopher M Halloran
- Liverpool Experimental Cancer Medicine Centre, 2nd Floor Sherrington Building, Ashton St, University of Liverpool, Liverpool L69 3GE, UK
| | - John R Mackey
- Cross Cancer Institute, University of Alberta, Edmonton, AB T6G 1Z2, Canada
| | - Andrew G Scarfe
- Cross Cancer Institute, University of Alberta, Edmonton, AB T6G 1Z2, Canada
| | - Juan W Valle
- The Christie NHS Foundation Trust, University of Manchester, Manchester M20 4BX, UK
| | | | - David Cunningham
- Royal Marsden National Health Service (NHS) Foundation Trust, London SW3 6JJ, UK
| | | | - David Goldstein
- Prince of Wales Hospital and Clinical School, University of New South Wales, Sydney, NSW 2052, Australia
| | - Jennifer Shannon
- Nepean Cancer Centre, University of Sydney, Sydney, NSW 2747, Australia
| | - Bengt Glimelius
- Department of Immunology, Genetics and Pathology, Uppsala University, SE-751 05 Uppsala, Sweden
| | - Thilo Hackert
- Department of Surgery, University of Heidelberg, 69047 Heidelberg, Germany
| | | | | | - Markus M Lerch
- Department of Medicine A, University Medicine Greifswald, 17489 Greifswald, Germany
| | - Julia Mayerle
- Department of Medicine A, University Medicine Greifswald, 17489 Greifswald, Germany
- Medizinische Klinik und Poliklinik II, Klinikum der LMU München-Grosshadern, 81377 München, Germany
| | - Daniel H Palmer
- Liverpool Experimental Cancer Medicine Centre, 2nd Floor Sherrington Building, Ashton St, University of Liverpool, Liverpool L69 3GE, UK
| | - Markus W Büchler
- Department of Surgery, University of Heidelberg, 69047 Heidelberg, Germany
| | - Paula Ghaneh
- Liverpool Experimental Cancer Medicine Centre, 2nd Floor Sherrington Building, Ashton St, University of Liverpool, Liverpool L69 3GE, UK
| | - John P Neoptolemos
- Department of Surgery, University of Heidelberg, 69047 Heidelberg, Germany
| | - William Greenhalf
- Liverpool Experimental Cancer Medicine Centre, 2nd Floor Sherrington Building, Ashton St, University of Liverpool, Liverpool L69 3GE, UK
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Holmberg CJ, Katsarelias D, Jespersen H, Carneiro A, Elander NO, Helgadottir H, Isaksson K, Jansson M, Wirén S, Ullenhag GJ, Ny L, Olofsson Bagge R. Surgery of metastatic melanoma after systemic therapy - the SUMMIST trial: study protocol for a randomized controlled trial. Acta Oncol 2021; 60:52-55. [PMID: 33252282 DOI: 10.1080/0284186x.2020.1846213] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Carl Jacob Holmberg
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- Department of Surgery, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
- Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Dimitrios Katsarelias
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- Department of Surgery, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
- Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Henrik Jespersen
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- Akershus University Hospital, Nordbyhagen, Norway
| | - Ana Carneiro
- Department of Oncology, Lund University Hospital, Lund, Sweden
| | - Nils O. Elander
- Department of Oncology and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Hildur Helgadottir
- Department of Oncology, Karolinska University Hospital, Stockholm, Sweden
| | - Karolin Isaksson
- Department of Clinical Sciences, Surgery, Lund University, Lund, Sweden
- Department of Surgery, Central Hospital Kristianstad, Kristianstad, Sweden
| | - Malin Jansson
- Department of Surgical and Perioperative Sciences, Umeå University and Umeå University Hospital, Umeå, Sweden
| | - Sara Wirén
- Department of Radiation Sciences, Oncology, Umeå University Hospital, Umeå, Sweden
| | - Gustav J. Ullenhag
- Department of Immunology, Genetics and Pathology, Science of Life Laboratory, Uppsala University, Uppsala, Sweden
- Department of Oncology, Uppsala University Hospital, Uppsala, Sweden
| | - Lars Ny
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- Department of Oncology, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Roger Olofsson Bagge
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- Department of Surgery, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
- Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden
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5
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Naeser Y, Helgadottir H, Brandberg Y, Hansson J, Bagge RO, Elander NO, Ingvar C, Isaksson K, Flygare P, Nilsson C, Jakobsson F, Del Val Munoz O, Valachis A, Jansson M, Sparring C, Ohlsson L, Dyrke U, Papantoniou D, Sundin A, Ullenhag GJ. TRIM study protocol - a prospective randomized multicenter Trial to assess the Role of Imaging during follow-up after radical surgery of stage IIB-C and III cutaneous malignant Melanoma. BMC Cancer 2020; 20:1197. [PMID: 33287744 PMCID: PMC7720485 DOI: 10.1186/s12885-020-07632-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 06/08/2020] [Accepted: 11/12/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The incidence of cutaneous malignant melanoma (CMM) is increasing worldwide. In Sweden, over 4600 cases were diagnosed in 2018. The prognosis after radical surgery varies considerably with tumor stage. In recent years, new treatment options have become available for metastatic CMM. Early onset of treatment seems to improve outcome, which suggests that early detection of recurrent disease should be beneficial. Consequently, in several countries imaging is a part of the routine follow-up program after surgery of high risk CMM. However, imaging has drawbacks, including resources required (costs, personnel, equipment) and the radiation exposure. Furthermore, many patients experience anxiety in waiting for the imaging results and investigations of irrelevant findings is another factor that also could cause worry and lead to decreased quality of life. Hence, the impact of imaging in this setting is important to address and no randomized study has previously been conducted. The Swedish national guidelines stipulate follow-up for 3 years by clinical examinations only. METHODS The TRIM study is a prospective randomized multicenter trial evaluating the potential benefit of imaging and blood tests during follow-up after radical surgery for high-risk CMM, compared to clinical examinations only. Primary endpoint is overall survival (OS) at 5 years. Secondary endpoints are survival from diagnosis of relapse and health-related quality of life (HRQoL). Eligible for inclusion are patients radically operated for CMM stage IIB-C or III with sufficient renal function for iv contrast-enhanced CT and who are expected to be fit for treatment in case of recurrence. The planned number of patients is > 1300. Patients are randomized to clinical examinations for 3 years +/- whole-body imaging with CT or FDG-PET/CT and laboratory tests including S100B protein and LDH. This academic study is supported by the Swedish Melanoma Study Group. DISCUSSION This is the first randomized prospective trial on the potential benefit of imaging as a part of the follow-up scheme after radical surgery for high-risk CMM. RESULTS The first patient was recruited in June 2017 and as of April 2020, almost 500 patients had been included at 19 centers in Sweden. TRIAL REGISTRATION ClinicalTrials.gov , NCT03116412 . Registered 17 April 2017, https://clinicaltrials.gov/ct2/show/study/NCT03116412.
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Affiliation(s)
- Ylva Naeser
- Department of Immunology, Genetics and Pathology, Uppsala University, Rudbeck laboratory, 75185, Uppsala, Sweden
- Department of Oncology, Uppsala University Hospital, entrance 101, 1tr, 75185, Uppsala, Sweden
| | - Hildur Helgadottir
- Department of Oncology, Karolinska University Hospital Solna, 17164, Solna, Sweden
| | - Yvonne Brandberg
- Department of Oncology-Pathology, Karolinska Institutet, 17177, Stockholm, Sweden
| | - Johan Hansson
- Department of Oncology, Karolinska University Hospital Solna, 17164, Solna, Sweden
| | - Roger Olofsson Bagge
- Sahlgrenska Cancer Center, Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Surgery, Sahlgrenska University Hospital, 41345, Gothenburg, Sweden
- Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Nils O Elander
- Department of Oncology and Department of Biomedical and Clinical Sciences, Linköping University, 58185, Linköping, Sweden
| | - Christian Ingvar
- Department of Surgery, Clinical Sciences, Lund University, BMC F12, 22184, Lund, Sweden
| | - Karolin Isaksson
- Department of Surgery, Central Hospital Kristianstad, 29133, Kristianstad, Sweden
- Department of Clinical Sciences, Surgery, Lund University, BMC F12, 22184, Lund, Sweden
| | - Petra Flygare
- Department of Oncology, Sundsvall County Hospital, Lasarettsgatan 21, 856 43, Sundsvall, Sweden
| | - Cecilia Nilsson
- Department of Oncology, Hospital of Västmanland Västerås, 72189, Västerås, Sweden
| | - Frida Jakobsson
- Department of Oncology, Örebro University Hospital, 70185, Örebro, Sweden
| | | | - Antonis Valachis
- Department of Oncology, Faculty of Medicine and Health, Örebro University, 70182, Örebro, Sweden
| | - Malin Jansson
- Department of Surgical and perioperative sciences, Umeå University and Umeå University Hospital, 90185, Umeå, Sweden
| | - Charlotte Sparring
- Department of Dermatology, Skaraborg County Hospital, 54185, Skövde, Sweden
| | - Lars Ohlsson
- Department of Surgery, Karlstad County Hospital, Rosenborgsgatan 9, 65230, Karlstad, Sweden
| | - Ulf Dyrke
- Department of Surgery, Falun County Hospital, 79182, Falun, Sweden
| | | | - Anders Sundin
- Department of Surgical Sciences Radiology & Molecular Imaging, Uppsala University, 75185, Uppsala, Sweden
| | - Gustav J Ullenhag
- Department of Immunology, Genetics and Pathology, Uppsala University, Rudbeck laboratory, 75185, Uppsala, Sweden.
- Department of Oncology, Uppsala University Hospital, entrance 101, 1tr, 75185, Uppsala, Sweden.
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Blomstrand H, Green H, Fredrikson M, Gränsmark E, Björnsson B, Elander NO. Clinical characteristics and blood/serum bound prognostic biomarkers in advanced pancreatic cancer treated with gemcitabine and nab-paclitaxel. BMC Cancer 2020; 20:950. [PMID: 33008332 PMCID: PMC7530950 DOI: 10.1186/s12885-020-07426-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 09/16/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND In recent years treatment options for advanced pancreatic cancer have markedly improved, and a combination regimen of gemcitabine and nab-paclitaxel is now considered standard of care in Sweden and elsewhere. Nevertheless, a majority of patients do not respond to treatment. In order to guide the individual patient to the most beneficial therapeutic strategy, simple and easily available prognostic and predictive markers are needed. METHODS The potential prognostic value of a range of blood/serum parameters, patient-, and tumour characteristics was explored in a retrospective cohort of 75 patients treated with gemcitabine/nab-paclitaxel (Gem/NabP) for advanced pancreatic ductal adenocarcinoma (PDAC) in the South Eastern Region of Sweden. Primary outcome was overall survival (OS) while progression free survival (PFS) was the key secondary outcome. RESULT Univariable Cox regression analysis revealed that high baseline serum albumin (> 37 g/L) and older age (> 65) were positive prognostic markers for OS, and in multivariable regression analysis both parameters were confirmed to be independent prognostic variables (HR 0.48, p = 0.023 and HR = 0.47, p = 0.039,). Thrombocytopenia at any time during the treatment was an independent predictor for improved progression free survival (PFS) but not for OS (HR 0.49, p = 0.029, 0.54, p = 0.073), whereas thrombocytopenia developed under cycle 1 was neither related with OS nor PFS (HR 0.87, p = 0.384, HR 1.04, p = 0.771). Other parameters assessed (gender, tumour stage, ECOG performance status, myelosuppression, baseline serum CA19-9, and baseline serum bilirubin levels) were not significantly associated with survival. CONCLUSION Serum albumin at baseline is a prognostic factor with palliative Gem/NabP in advanced PDAC, and should be further assessed as a tool for risk stratification. Older age was associated with improved survival, which encourages further studies on the use of Gem/NabP in the elderly.
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Affiliation(s)
- Hakon Blomstrand
- Department of Clinical Pathology and Department of Biomedical and Clinical Sciences, Linköping University, 58183, Linköping, Sweden
| | - Henrik Green
- Division of Drug Research, Department of Medical Health Sciences, Linköping University, 58183, Linköping, Sweden.,Department of Forensic Genetics and Forensic Toxicology, National Board of Forensic Medicine, 58758, Linköping, Sweden
| | - Mats Fredrikson
- Forum Östergötland, Linköping University, 58185, Linköping, Sweden
| | - Emma Gränsmark
- Department of Oncology, Kalmar County Hospital, 392 44, Kalmar, Sweden
| | - Bergthor Björnsson
- Department of Surgery and Department of Biomedical and Clinical Sciences, Linköping University, 58183, Linköping, Sweden
| | - Nils O Elander
- Department of Oncology and Department of Biomedical and Clinical Sciences, Linköping University, 58183, Linköping, Sweden.
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Wode K, Hök Nordberg J, Kienle GS, Elander NO, Bernhardson BM, Sunde B, Sharp L, Henriksson R, Fransson P. Efficacy of mistletoe extract as a complement to standard treatment in advanced pancreatic cancer: study protocol for a multicentre, parallel group, double-blind, randomised, placebo-controlled clinical trial (MISTRAL). Trials 2020; 21:783. [PMID: 32917288 PMCID: PMC7488501 DOI: 10.1186/s13063-020-04581-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 07/04/2020] [Indexed: 12/12/2022] Open
Abstract
Background Most pancreatic cancer patients present with advanced stage at diagnosis with extremely short expected survival and few treatment options. A multimodal palliative approach is necessary for symptom relief and optimisation of health-related quality of life. In a recent open-label trial of mistletoe extract for advanced pancreatic cancer patients not eligible for chemotherapy, promising results on improved overall survival and better health-related quality of life were reported. The objective of the present study is to assess the value of mistletoe extract as a complement to standard treatment (palliative chemotherapy or best supportive care) in advanced pancreatic cancer patients with regard to overall survival and health-related quality of life. Methods The trial is prospective, randomised, double-blind, multicentre, parallel group and placebo-controlled. In total, 290 participants are randomly assigned to placebo or mistletoe extract given subcutaneously in increasing dosage from 0.01 to 20 mg three times per week for 9 months. Stratification is performed for site and palliative chemotherapy. Main inclusion criteria are advanced pancreatic cancer and Eastern Cooperative Oncology Group performance status 0 to 2; main exclusion criteria are life expectancy less than 4 weeks and neuroendocrine tumour of the pancreas. Two ancillary studies on sub-sets of participants are nested in the trial: a biomarker study collecting blood samples and a cross-sectional qualitative study with semi-structured face-to-face interviews. Discussion To our knowledge, this is the first placebo-controlled randomised trial assessing the impact of mistletoe extract as a complement to standard treatment on overall survival and health-related quality of life in patients with advanced pancreatic cancer. The presented trial with its two nested ancillary studies exploring biomarkers and patient experiences is expected to give new insights into the treatment of advanced pancreatic cancer. Trial registration EU Clinical Trial Register, EudraCT Number 2014-004552-64. Registered on 19 January 2016. ClinicalTrials.gov NCT02948309. Registered on 28 October 2016.
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Affiliation(s)
- Kathrin Wode
- Department Nursing, Umeå University, Umeå, Sweden. .,Department Radiation Sciences, Umeå University, Umeå, Sweden. .,Department Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden. .,Regional Cancer Centre Stockholm Gotland, Stockholm, Sweden.
| | - Johanna Hök Nordberg
- Regional Cancer Centre Stockholm Gotland, Stockholm, Sweden.,Department Neurobiology, Caring Sciences, Society and Department Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Gunver S Kienle
- Center for Complementary Medicine; Institute for Infection Prevention and Hospital Epidemiology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Institute for Applied Epistemology and Medical Mehodology at the University Witten/Herdecke, Freiburg, Germany
| | - Nils O Elander
- Department Oncology and Department Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Britt-Marie Bernhardson
- Department Learning, Informatics, Management, and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Berit Sunde
- Department Nursing, Umeå University, Umeå, Sweden.,Department Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden.,Department Clinical Intervention and Technology, Division Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Lena Sharp
- Regional Cancer Centre Stockholm Gotland, Stockholm, Sweden.,Department Learning, Informatics, Management, and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Roger Henriksson
- Department Radiation Sciences, Umeå University, Umeå, Sweden.,Cancercentrum, Norrland University Hospital, Umeå, Sweden
| | - Per Fransson
- Department Nursing, Umeå University, Umeå, Sweden.,Cancercentrum, Norrland University Hospital, Umeå, Sweden
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Wallander M, Rolander B, Åvall-Lundqvist E, Elander NO. Real world aspects of palliative trifluridine plus tiperacil (TAS-102) in refractory metastatic colorectal cancer. J Gastrointest Oncol 2020; 11:616-625. [PMID: 32953145 DOI: 10.21037/jgo-20-43] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Background While recent randomised phase III trials show that trifluridine/tiperacil (TAS-102) may prolong life in patients with refractory metastatic colorectal cancer (rmCRC), palliative aspects on its efficacy and tolerability in real world patients need further elucidation. Methods A retrospective observational multicentre study was designed, including all patients with rmCRC who received TAS-102 under 2016-2019 in the South East Health Care region of Sweden. 48 patients were identified. Primary outcome was overall survival (OS) and secondary outcomes were progression-free survival (PFS), time to ECOG performance status deterioration (PSD), safety and dose reductions, admission to and duration of access to palliative care, and administration of TAS-102 in the last 30 days before death. Results Median OS, PFS, and time to PSD (a proxy for impaired quality of life) from start of TAS-102 were 6.4 months (95% CI: 4.4-8.4), 2.3 months (95% CI: 1.8-2.7) and 2.5 months (95% CI: 1.9-3.2), respectively. Following uni- and multivariable regression analyses, the number of previous treatment lines (≤2 vs. ≥3) was statistically independent for OS (median 7.8 vs. 5.3 months, P=0.05), PFS (median 2.4 vs. 1.8 months, P=0.03), and time to PSD (median 2.8 vs. 1.8 months, P=0.03). Thirty-four (71%) of the patients received reduced doses. The most common grade 3-4 toxicity was neutropenia (39%). Forty-three (90%) were admitted to GP or hospital-based home palliative care. Median time for access to any form of palliative care before death was 2.3 (95% CI: 0.5-3.2) months. Few patients (n=3, 7%) received their last dose of TAS-102 in their last 30 days of life. Conclusions The outcome and tolerability of TAS-102 in rmCRC appear similar in a real-world context and randomised trials. The retrospective design and limited sample size preclude firm conclusions on subgroup analyses, but it appears that the prognosis is slightly better the earlier TAS-102 is introduced. Treatment durations are generally short, and early admission to a palliative care provider is recommended.
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Affiliation(s)
- Mikael Wallander
- Department of Oncology, Ryhov County Hospital, SE-55305 Jönköping, Sweden
| | - Bo Rolander
- Futurum - Academy for Healthcare, Region Jönköping County, Sweden.,Department of Behavioural Science and Social Work, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Elisabeth Åvall-Lundqvist
- Department of Oncology, Linköping University, SE-58185 Linköping, Sweden.,Department of Biomedical and Clinical Sciences, Linköping University, SE-58185 Linköping, Sweden
| | - Nils O Elander
- Department of Oncology, Linköping University, SE-58185 Linköping, Sweden.,Department of Biomedical and Clinical Sciences, Linköping University, SE-58185 Linköping, Sweden
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9
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Gränsmark E, Bågenholm Bylin N, Blomstrand H, Fredrikson M, Åvall-Lundqvist E, Elander NO. Real World Evidence on Second-Line Palliative Chemotherapy in Advanced Pancreatic Cancer. Front Oncol 2020; 10:1176. [PMID: 32850339 PMCID: PMC7397908 DOI: 10.3389/fonc.2020.01176] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 06/10/2020] [Indexed: 12/11/2022] Open
Abstract
Background: The outcome and tolerability of palliative second line chemotherapy for advanced pancreatic cancer (APC) in real life patients are largely unknown. Prognostic parameters for risk stratification and treatment guidance are lacking. Materials and Methods: A population based multicenter retrospective cohort study was conducted, covering all APC patients who received palliative second-line chemotherapy between 2011 and 2018 at any cancer center in the South East Region of Sweden. Primary outcome was overall survival after second-line therapy (OS2). Time to treatment failure after second-line therapy (TTF2), hematological toxicity, and unplanned hospitalizations were key secondary outcomes. A number of baseline potentially prognostic parameters were assessed. Results: A total of 509 patients received first-line palliative chemotherapy, and of these 167 (33%) received at least one dose of second-line therapy and formed the final study population. Median OS2 was 5.2 months (95% CI = 4.7–5.7) and median TTF2 was 1.9 months (1.5–2.2). OS2 and TTF2 were similar regardless regimen, including comparison of the two most common regimens (fluoropyrimidine monotherapy vs. fluoropyrimidine/oxaliplatin doublet). Multivariate analysis revealed that normal plasma albumin (≥35) and serum CA-19-9 above median (>1,550) were independent predictors for OS2 (HR = 0.21, p < 0.001 and HR = 2.03, p = 0.009) and TTF2 (HR = 0.22, p < 0.001 and HR = 2.03, p = 0.01), while ECOG performance status >1 was predictive for TTF2 (HR = 2.05, p = 0.032). Grade 3–4 hematological toxicity was registered in 17 patients (10%). 50 (30%) had at least one event of hospitalization. Conclusion: The real world outcome of second line palliative chemotherapy for refractory APC remains dismal. Baseline plasma albumin, serum CA-19-9, and performance status emerge as key prognostic factors, and should be further studied as tools for individualized treatment decisions.
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Affiliation(s)
- Emma Gränsmark
- Department of Oncology, Kalmar County Hospital, Kalmar, Sweden.,Department of Oncology, Linköping University, Linköping, Sweden.,Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Nellie Bågenholm Bylin
- Department of Oncology, Linköping University, Linköping, Sweden.,Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Hakon Blomstrand
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.,Department of Clinical Pathology, Linköping University, Linköping, Sweden
| | | | - Elisabeth Åvall-Lundqvist
- Department of Oncology, Linköping University, Linköping, Sweden.,Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Nils O Elander
- Department of Oncology, Linköping University, Linköping, Sweden.,Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
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10
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Almlöv K, Woisetschläger M, Loftås P, Hallböök O, Elander NO, Sandström P. MRI Lymph Node Evaluation for Prediction of Metastases in Rectal Cancer. Anticancer Res 2020; 40:2757-2763. [PMID: 32366421 DOI: 10.21873/anticanres.14247] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 04/09/2020] [Accepted: 04/13/2020] [Indexed: 11/10/2022]
Abstract
AIM To explore whether the size and characteristics of the largest regional lymph node in patients with rectal cancer, based on magnetic resonance imaging (MRI), following neoadjuvant therapy and before surgery, is able to identify patients at high risk of developing metachronous metastases. PATIENTS AND METHODS A retrospective case-control study with data from the Swedish Colo-Rectal Cancer Registry. Forty patients were identified with metachronous metastases (M+), and 40 patients without metastases (M0) were matched as controls. RESULTS Patients with M+ disease were more likely to have a regional lymph node measuring ≥5 mm than patients with M0. (87% vs. 65%, p=0.02). There was also a significant difference between the groups regarding the presence of an irregular border of the largest lymph node (68% vs. 40%, p=0.01). CONCLUSION Lymph nodes measuring ≥5 mm with/without displaying irregular borders at MRI performed after neoadjuvant therapy emerged as risk factors for metachronous metastases in patients with rectal cancer. Intensified follow-up programmes may be indicated in these patients.
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Affiliation(s)
- Karin Almlöv
- Department of Biomedical and Clinical Sciences, Division of Surgery, Linköping University, Norrköping, Sweden
| | - Mischa Woisetschläger
- Department of Radiology, Department of Medical and Health Sciences, and Center for Medical Image Science and Visualization, Linköping University, Linköping, Sweden
| | - Per Loftås
- Department of Biomedical and Clinical Sciences, Division of Surgery, Linköping University, Linköping, Sweden
| | - Olof Hallböök
- Department of Biomedical and Clinical Sciences, Division of Surgery, Linköping University, Linköping, Sweden
| | - Nils O Elander
- Department of Biomedical and Clinical Sciences, Division of Oncology, Linköping University, Linköping, Sweden
| | - Per Sandström
- Department of Biomedical and Clinical Sciences, Division of Surgery, Linköping University, Linköping, Sweden
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11
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Elander NO, Hussain SA. Mutation Analysis of the FGFR3-encoding gene Does Not Predict Response to Checkpoint Inhibitor Treatment in Metastatic Bladder Cancer. Eur Urol 2019; 76:604-606. [DOI: 10.1016/j.eururo.2019.07.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Accepted: 07/15/2019] [Indexed: 12/24/2022]
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12
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Ellegård S, Veenstra C, Pérez-Tenorio G, Fagerström V, Gårsjö J, Gert K, Sundquist M, Malmström A, Wingren S, Elander NO, Hallbeck AL, Stål O. ERBB2 and PTPN2 gene copy numbers as prognostic factors in HER2-positive metastatic breast cancer treated with trastuzumab. Oncol Lett 2019; 17:3371-3381. [PMID: 30867772 PMCID: PMC6396168 DOI: 10.3892/ol.2019.9998] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 12/20/2018] [Indexed: 12/25/2022] Open
Abstract
Trastuzumab has markedly improved the treatment and long-term prognosis of patients with HER2-positive breast cancer. A frequent clinical challenge in patients with relapsing and/or metastatic disease is de novo or acquired trastuzumab resistance, and to date no predictive biomarkers for palliative trastuzumab have been established. In the present study, the prognostic values of factors involved in the HER2-associated PI3K/Akt signalling pathway were explored. The first 46 consecutive patients treated at the Department of Oncology, Linköping University Hospital between 2000 and 2007 with trastuzumab for HER2-positive metastatic breast cancer were retrospectively included. The gene copy number variation and protein expression of several components of the PI3K/Akt pathway were assessed in the tumour tissue and biopsy samples using droplet digital polymerase chain reaction and immunohistochemistry. Patients with tumours displaying a high-grade ERBB2 (HER2) amplification level of ≥6 copies had a significantly improved overall survival hazard ratio [(HR)=0.4; 95%, confidence interval (CI): 0.2–0.9] and progression-free survival (HR=0.3; 95% CI: 0.1–0.7) compared with patients with tumours harbouring fewer ERBB2 copies. High-grade ERBB2 amplification was significantly associated with the development of central nervous system metastases during palliative treatment. Copy gain (≥3 copies) of the gene encoding the tyrosine phosphatase PTPN2 was associated with a shorter overall survival (HR=2.0; 95% CI: 1.0–4.0) and shorter progression-free survival (HR=2.1; 95% CI: 1.0–4.1). In conclusion, high ERBB2 amplification level is a potential positive prognostic factor in trastuzumab-treated HER2-positive metastatic breast cancer, whereas PTPN2 gain is a potential negative prognostic factor. Further studies are warranted on the role of PTPN2 in HER2 signalling.
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Affiliation(s)
- Sander Ellegård
- Department of Clinical and Experimental Medicine and Department of Oncology, Linköping University, SE-581 85 Linköping, Sweden
| | - Cynthia Veenstra
- Department of Clinical and Experimental Medicine and Department of Oncology, Linköping University, SE-581 85 Linköping, Sweden
| | - Gizeh Pérez-Tenorio
- Department of Clinical and Experimental Medicine and Department of Oncology, Linköping University, SE-581 85 Linköping, Sweden
| | - Victor Fagerström
- Department of Clinical and Experimental Medicine and Department of Oncology, Linköping University, SE-581 85 Linköping, Sweden.,Department of Surgery, Kalmar Hospital, SE-392 44 Kalmar, Sweden
| | - Jon Gårsjö
- Department of Clinical and Experimental Medicine and Department of Oncology, Linköping University, SE-581 85 Linköping, Sweden
| | - Krista Gert
- Department of Clinical and Experimental Medicine and Department of Oncology, Linköping University, SE-581 85 Linköping, Sweden
| | - Marie Sundquist
- Department of Surgery, Kalmar Hospital, SE-392 44 Kalmar, Sweden
| | - Annika Malmström
- Department of Clinical and Experimental Medicine and Department of Oncology, Linköping University, SE-581 85 Linköping, Sweden
| | - Sten Wingren
- Department of Clinical Medicine, School of Health and Medical Sciences, Örebro University, SE-701 82 Örebro, Sweden
| | - Nils O Elander
- Department of Clinical and Experimental Medicine and Department of Oncology, Linköping University, SE-581 85 Linköping, Sweden
| | - Anna-Lotta Hallbeck
- Department of Clinical and Experimental Medicine and Department of Oncology, Linköping University, SE-581 85 Linköping, Sweden
| | - Olle Stål
- Department of Clinical and Experimental Medicine and Department of Oncology, Linköping University, SE-581 85 Linköping, Sweden
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13
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Blomstrand H, Scheibling U, Bratthäll C, Green H, Elander NO. Real world evidence on gemcitabine and nab-paclitaxel combination chemotherapy in advanced pancreatic cancer. BMC Cancer 2019; 19:40. [PMID: 30621618 PMCID: PMC6325739 DOI: 10.1186/s12885-018-5244-2] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 12/21/2018] [Indexed: 12/18/2022] Open
Abstract
Background In the recent phase III trial MPACT the combination of gemcitabine and nab-paclitaxel (Gem/NabP) showed increased overall survival compared to gemcitabine alone in the treatment of advanced pancreatic ductal adenocarcinoma (aPDA). Until now there has been limited information on the clinical benefit and toxicity of the combination regimen in a real world setting. In addition the value for patients with locally advanced rather than metastatic aPDA has been unclear, since the former category of patients was not included in the MPACT trial. Methods A multicentre retrospective observational study in the South Eastern Region of Sweden was performed, with the first 75 consecutive patients diagnosed with aPDA (both locally advanced and metastatic disease) who received first-line treatment with Gem/NabP. Results In the overall population median progression free survival (PFS) and overall survival (OS) were 5.2 (3.4–7.0 95% CI) and 10.9 (7.8–14.0 95% CI) months, respectively. Patients with metastatic disease displayed a median OS of 9.4 (4.9–13.9) and a median PFS of 4.5 (3.3–5.7) months whereas the same parameters in the locally advanced subgroup were 17.1 (7.6–26.6) and 6.8 (5.2–8.4) months, respectively. Grade 3–4 hematologic toxicity was recorded: Neutropenia, leukopenia, thrombocytopenia, and anaemia were observed in 23, 20, 5, and 4% of patients, respectively. Dose reductions were performed in 80% of the patients. Conclusion This study confirms the effectiveness and safety of first-line Gem/NabP in both locally advanced and metastatic PDA in a real world setting. Electronic supplementary material The online version of this article (10.1186/s12885-018-5244-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hakon Blomstrand
- Department of Oncology, Ryhov County Hospital, 55305, Jönköping, Sweden.,Division of Oncology, Department of clinical and experimental medicine, Faculty of medicine and health sciences, Linköping University, 58183, Linköping, Sweden
| | - Ursula Scheibling
- Department of Oncology, Ryhov County Hospital, 55305, Jönköping, Sweden
| | | | - Henrik Green
- Division of Drug Research, Department of Medical Health Sciences, Linköping University, 58183, Linköping, Sweden.,Department of Forensic Genetics and Forensic Toxicology, National Board of Forensic Medicine, 58758, Linköping, Sweden
| | - Nils O Elander
- Division of Oncology, Department of clinical and experimental medicine, Faculty of medicine and health sciences, Linköping University, 58183, Linköping, Sweden.
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14
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Elander NO, Aughton K, Ghaneh P, Neoptolemos JP, Palmer DH, Cox TF, Campbell F, Costello E, Halloran CM, Mackey JR, Scarfe AG, Valle JW, McDonald AC, Carter R, Tebbutt NC, Goldstein D, Shannon J, Dervenis C, Glimelius B, Deakin M, Charnley RM, Anthoney A, Lerch MM, Mayerle J, Oláh A, Büchler MW, Greenhalf W. Intratumoural expression of deoxycytidylate deaminase or ribonuceotide reductase subunit M1 expression are not related to survival in patients with resected pancreatic cancer given adjuvant chemotherapy. Br J Cancer 2018; 118:1084-1088. [PMID: 29523831 PMCID: PMC5931097 DOI: 10.1038/s41416-018-0005-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 01/04/2018] [Accepted: 01/04/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Deoxycytidylate deaminase (DCTD) and ribonucleotide reductase subunit M1 (RRM1) are potential prognostic and predictive biomarkers for pyrimidine-based chemotherapy in pancreatic adenocarcinoma. METHODS Immunohistochemical staining of DCTD and RRM1 was performed on tissue microarrays representing tumour samples from 303 patients in European Study Group for Pancreatic Cancer (ESPAC)-randomised adjuvant trials following pancreatic resection, 272 of whom had received gemcitabine or 5-fluorouracil with folinic acid in ESPAC-3(v2), and 31 patients from the combined ESPAC-3(v1) and ESPAC-1 post-operative pure observational groups. RESULTS Neither log-rank testing on dichotomised strata or Cox proportional hazard regression showed any relationship of DCTD or RRM1 expression levels to survival overall or by treatment group. CONCLUSIONS Expression of either DCTD or RRM1 was not prognostic or predictive in patients with pancreatic adenocarcinoma who had had post-operative chemotherapy with either gemcitabine or 5-fluorouracil with folinic acid.
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Affiliation(s)
- N O Elander
- Cancer Research U.K. Liverpool Cancer Trials Unit, University of Liverpool, Liverpool, UK
| | - K Aughton
- Cancer Research U.K. Liverpool Cancer Trials Unit, University of Liverpool, Liverpool, UK
| | - P Ghaneh
- Cancer Research U.K. Liverpool Cancer Trials Unit, University of Liverpool, Liverpool, UK
| | - J P Neoptolemos
- Cancer Research U.K. Liverpool Cancer Trials Unit, University of Liverpool, Liverpool, UK
| | - D H Palmer
- Cancer Research U.K. Liverpool Cancer Trials Unit, University of Liverpool, Liverpool, UK
| | - T F Cox
- Cancer Research U.K. Liverpool Cancer Trials Unit, University of Liverpool, Liverpool, UK
| | - F Campbell
- Cancer Research U.K. Liverpool Cancer Trials Unit, University of Liverpool, Liverpool, UK
| | - E Costello
- Cancer Research U.K. Liverpool Cancer Trials Unit, University of Liverpool, Liverpool, UK
| | - C M Halloran
- Cancer Research U.K. Liverpool Cancer Trials Unit, University of Liverpool, Liverpool, UK
| | - J R Mackey
- Cross Cancer Institute and University of Alberta, Edmonton, Canada
| | - A G Scarfe
- Cross Cancer Institute and University of Alberta, Edmonton, Canada
| | - J W Valle
- University of Manchester/The Christie NHS Foundation Trust, Manchester, UK
| | - A C McDonald
- The Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - R Carter
- Glasgow Royal Infirmary, Glasgow, UK
| | | | - D Goldstein
- Prince of Wales hospital and Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - J Shannon
- Nepean Cancer Centre and University of Sydney, Camperdown, NSW, Australia
| | | | - B Glimelius
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - M Deakin
- University Hospital, North Staffordshire, Staffordshire, UK
| | | | - A Anthoney
- St James's University Hospital, Leeds, UK
| | - M M Lerch
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
| | - J Mayerle
- Department of Medicine II, University Hospital of the Ludwig-Maximilians-University Munich, Munich, Germany
| | - A Oláh
- The Petz Aladar Hospital, Gyor, Hungary
| | - M W Büchler
- Department of Surgery, University of Heidelberg, Heidelberg, Germany
| | - W Greenhalf
- Cancer Research U.K. Liverpool Cancer Trials Unit, University of Liverpool, Liverpool, UK.
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15
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Elander NO, Aughton K, Ghaneh P, Neoptolemos JP, Palmer DH, Cox TF, Campbell F, Costello E, Halloran CM, Mackey JR, Scarfe AG, Valle JW, McDonald AC, Carter R, Tebbutt NC, Goldstein D, Shannon J, Dervenis C, Glimelius B, Deakin M, Charnley RM, Anthoney A, Lerch MM, Mayerle J, Oláh A, Büchler MW, Greenhalf W. Expression of dihydropyrimidine dehydrogenase (DPD) and hENT1 predicts survival in pancreatic cancer. Br J Cancer 2018; 118:947-954. [PMID: 29515256 PMCID: PMC5931115 DOI: 10.1038/s41416-018-0004-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [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: 08/07/2017] [Revised: 12/21/2017] [Accepted: 01/04/2018] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Dihydropyrimidine dehydrogenase (DPD) tumour expression may provide added value to human equilibrative nucleoside transporter-1 (hENT1) tumour expression in predicting survival following pyrimidine-based adjuvant chemotherapy. METHODS DPD and hENT1 immunohistochemistry and scoring was completed on tumour cores from 238 patients with pancreatic cancer in the ESPAC-3(v2) trial, randomised to either postoperative gemcitabine or 5-fluorouracil/folinic acid (5FU/FA). RESULTS DPD tumour expression was associated with reduced overall survival (hazard ratio, HR = 1.73 [95% confidence interval, CI = 1.21-2.49], p = 0.003). This was significant in the 5FU/FA arm (HR = 2.07 [95% CI = 1.22-3.53], p = 0.007), but not in the gemcitabine arm (HR = 1.47 [0.91-3.37], p = 0.119). High hENT1 tumour expression was associated with increased survival in gemcitabine treated (HR = 0.56 [0.38-0.82], p = 0.003) but not in 5FU/FA treated patients (HR = 1.19 [0.80-1.78], p = 0.390). In patients with low hENT1 tumour expression, high DPD tumour expression was associated with a worse median [95% CI] survival in the 5FU/FA arm (9.7 [5.3-30.4] vs 29.2 [19.5-41.9] months, p = 0.002) but not in the gemcitabine arm (14.0 [9.1-15.7] vs. 18.0 [7.6-15.3] months, p = 1.000). The interaction of treatment arm and DPD expression was not significant (p = 0.303), but the interaction of treatment arm and hENT1 expression was (p = 0.009). CONCLUSION DPD tumour expression was a negative prognostic biomarker. Together with tumour expression of hENT1, DPD tumour expression defined patient subgroups that might benefit from either postoperative 5FU/FA or gemcitabine.
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Affiliation(s)
- N O Elander
- From the Cancer Research U.K. Liverpool Cancer Trials Unit, University of Liverpool, Liverpool, UK
| | - K Aughton
- From the Cancer Research U.K. Liverpool Cancer Trials Unit, University of Liverpool, Liverpool, UK
| | - P Ghaneh
- From the Cancer Research U.K. Liverpool Cancer Trials Unit, University of Liverpool, Liverpool, UK
| | - J P Neoptolemos
- The Department of Surgery, University of Heidelberg, Heidelberg, Germany
| | - D H Palmer
- From the Cancer Research U.K. Liverpool Cancer Trials Unit, University of Liverpool, Liverpool, UK
| | - T F Cox
- From the Cancer Research U.K. Liverpool Cancer Trials Unit, University of Liverpool, Liverpool, UK
| | - F Campbell
- From the Cancer Research U.K. Liverpool Cancer Trials Unit, University of Liverpool, Liverpool, UK
| | - E Costello
- From the Cancer Research U.K. Liverpool Cancer Trials Unit, University of Liverpool, Liverpool, UK
| | - C M Halloran
- From the Cancer Research U.K. Liverpool Cancer Trials Unit, University of Liverpool, Liverpool, UK
| | - J R Mackey
- Cross Cancer Institute and University of Alberta, Alberta, Canada
| | - A G Scarfe
- Cross Cancer Institute and University of Alberta, Alberta, Canada
| | - J W Valle
- University of Manchester/The Christie NHS Foundation Trust, Manchester, UK
| | - A C McDonald
- The Beatson West of Scotland Cancer Centre, Glasgow, Scotland, UK
| | - R Carter
- Glasgow Royal Infirmary, Glasgow, Scotland, UK
| | | | - D Goldstein
- Prince of Wales hospital and Clinical School University of New South Wales, New South Wales, Australia
| | - J Shannon
- Nepean Cancer Centre and University of Sydney, Sydney, Australia
| | | | - B Glimelius
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - M Deakin
- University Hospital, North Staffordshire, UK
| | | | | | - M M Lerch
- Department of Medicine A, University Medicine Greifswald, Greifswald, Germany
| | - J Mayerle
- Department of Medicine II, University Hospital of the Ludwig-Maximilians-University, Munich, Germany
| | - A Oláh
- The Petz Aladar Hospital, Gyor, Hungary
| | - M W Büchler
- The Department of Surgery, University of Heidelberg, Heidelberg, Germany
| | - W Greenhalf
- From the Cancer Research U.K. Liverpool Cancer Trials Unit, University of Liverpool, Liverpool, UK.
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16
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Hussain SA, Ansari J, Huddart R, Power DG, Lyons J, Wylie J, Vilarino-Varlela M, Elander NO, McMenemin R, Pickering LM, Faust G, Chauhan S, Jackson RJ. VICTOR: Vinflunine in advanced metastatic transitional cell carcinoma of the urothelium: A retrospective analysis of the use of vinflunine in multi-centre real life setting as second line chemotherapy through Free of Charge Programme for patients in the UK and Ireland. Int J Oncol 2017; 50:768-772. [PMID: 28098864 PMCID: PMC5358710 DOI: 10.3892/ijo.2017.3847] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [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] [Received: 09/23/2016] [Accepted: 11/14/2016] [Indexed: 11/05/2022] Open
Abstract
There is no standard of care in the UK or Ireland for second-line chemotherapy for patients with advanced transitional cell carcinoma (TCCU). Vinflunine is approved for TCCU patients who have failed a platinum-based regimen, and is standard of care in Europe but is not routinely available in the UK. Data were collected retrospectively on patients who received vinfluine as a second-line treatment. The aims were to document the toxicity and efficacy in a real life setting. Data were collected on 49 patients from 9 sites across the UK and Ireland [median age, 64 (IQR, 57-70) years, 33 males]. All patients had advanced metastatic TCCU. Thirteen patients had bone or liver metastases, 4 patients had PS 2 and 11 patients had HB <10. Median vinflunine administration was 3.5 cycles (range 1-18). Most common grade 3-4 toxicities were constipation (4 patients) and fatigue (3 patients). Partial response rate was 29% (14 PR, 11 SD, 19 PD, 4 NE, 1 not available). Median OS was 9.1 (6.0, 12.7) months. Results are consistent with real life data from Europe. Toxicity is further reduced with prophylactic laxative and oral antibiotics. Vinflunine is an efficient and tolerable second line treatment in advanced TCCU.
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Affiliation(s)
- Syed A. Hussain
- University of Liverpool, Liverpool L69 3GA
- The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral CH63 4JY
| | | | - Robert Huddart
- Institute of Cancer Research and Royal Marsden Hospital, Sutton, Surrey SM2 5NG, UK
| | - Derek G. Power
- The Mercy University Hospital, Wilton, Cork T12 WE28, Republic of Ireland
| | | | - James Wylie
- The Christie NHS Foundation Trust, Manchester M20 4BX
| | | | - Nils O. Elander
- University of Liverpool, Liverpool L69 3GA
- The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral CH63 4JY
| | - Rhona McMenemin
- Northern Centre for Cancer Care, Freeman Hospital, High Heaton, Newcastle upon Tyne NE7 7DN
| | | | - Guy Faust
- Northampton General Hospital Trust, Cliftonville, Northampton NN1 5BD, UK
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Elander NO, Hussain SA. PARP Inhibition in Prostate Cancer: A Promising Approach. Oncology (Williston Park) 2016; 30:393-485. [PMID: 27188669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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