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Thapa A, Cowell A, Peters A, Noble DJ, James A, Lamb C, Grose D, Vohra S, Schipani S, Mactier K, Mackenzie J, Srinivasan D, Laws K, Moleron R, Niblock P, Soh FY, Paterson C, Wilson C. The UK Divide: Does Having a Pembrolizumab-Chemotherapy Option in Head and Neck Cancer Matter? Real-world Experience of First-line Palliative Pembrolizumab Monotherapy and Pembrolizumab-Chemotherapy Combination in Scotland. Clin Oncol (R Coll Radiol) 2024; 36:287-299. [PMID: 38395634 DOI: 10.1016/j.clon.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 12/21/2023] [Accepted: 02/08/2024] [Indexed: 02/25/2024]
Abstract
AIMS The Scottish Medical Consortium recently approved first-line pembrolizumab monotherapy or in combination with chemotherapy for head and neck squamous cell carcinoma in the palliative setting, contrasting with the decision made by the National Institute for Health and Care Excellence, who approved monotherapy alone in England and Wales. The aim of this study was to provide real-world performance data for first-line pembrolizumab-containing treatments for head and neck squamous cell carcinoma in the palliative setting in Scotland. MATERIALS AND METHODS We analysed the electronic records of patients who started pembrolizumab-containing treatment between 1 March 2020 and 30 September 2021. Outcomes included overall survival, progression-free survival (PFS), the duration of response and the disease control rate. Data were compared with the KEYNOTE-048 study and clinical factors were evaluated for association with survival. RESULTS Our cohort included 91 patients (median follow-up 10.8 months). Patient characteristics were similar to those in the KEYNOTE-048 study, although our cohort had a higher proportion of patients with newly diagnosed, non-metastatic disease. For patients receiving monotherapy (n = 76), 12- and 24-month overall survival were 45% and 27%, respectively. For patients receiving pembrolizumab-chemotherapy (n = 15), 12-month overall survival was 60% (24-month overall survival had not yet been reached). Experiencing one or more immune-related adverse event (irAE; versus no irAEs), of any grade, was associated with favourable overall survival and PFS for patients receiving monotherapy in both univariable Log-rank analysis (median overall survival 17.4 months versus 8.6 months, respectively, P = 0.0033; median PFS 10.9 months versus 3.0 months, respectively, P < 0.0001) and multivariable analysis (Cox proportional hazards regression: overall survival hazard ratio 0.31, P = 0.0009; PFS hazard ratio 0.17, P < 0.0001). CONCLUSION Our real-world data support the KEYNOTE-048 study findings and the value of combination treatment options. Additionally, our data show that irAEs of any grade, as reported in routine clinical records, are associated with better outcomes in this patient group, adding to the growing body of evidence showing that irAEs are generally a positive marker of programmed death-ligand 1 (PD-L1) inhibitor response.
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Affiliation(s)
- A Thapa
- College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, UK
| | - A Cowell
- Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - A Peters
- Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - D J Noble
- Department of Clinical Oncology, Edinburgh Cancer Centre, Western General Hospital, Edinburgh, UK; Edinburgh Cancer Research Centre, Institute of Genetics and Cancer, The University of Edinburgh, Edinburgh, UK
| | - A James
- Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - C Lamb
- Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - D Grose
- Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - S Vohra
- Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - S Schipani
- Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - K Mactier
- Department of Clinical Oncology, Edinburgh Cancer Centre, Western General Hospital, Edinburgh, UK
| | - J Mackenzie
- Department of Clinical Oncology, Edinburgh Cancer Centre, Western General Hospital, Edinburgh, UK
| | - D Srinivasan
- Department of Clinical Oncology, Edinburgh Cancer Centre, Western General Hospital, Edinburgh, UK
| | - K Laws
- Aberdeen Royal Infirmary, Aberdeen, UK
| | - R Moleron
- Aberdeen Royal Infirmary, Aberdeen, UK
| | | | - F-Y Soh
- Raigmore Hospital, Inverness, UK
| | - C Paterson
- Beatson West of Scotland Cancer Centre, Glasgow, UK.
| | - C Wilson
- Beatson West of Scotland Cancer Centre, Glasgow, UK.
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Kamat MA, Edgar L, Niblock P, McDowell C, Kelly CB. Association between antidepressant prescribing and suicide rates in OECD countries: an ecological study. Pharmacopsychiatry 2013; 47:18-21. [PMID: 24105079 DOI: 10.1055/s-0033-1357183] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
INTRODUCTION We have conducted an ecological study to assess the association between antidepressant prescribing and suicide rates using the Organisation for Economic Co-operation and Development (OECD) health data, making this the largest ecological study in recent times. METHOD Data were derived for the years 1995-2008 from the OECD health data set. The residuals for all variables were adjusted for country and year within each country. These were then analysed to identify predictors of suicide rate. Pearson's rank correlation coefficient and linear regression model were employed to assess associations and identify significant predictors of suicide rate. RESULTS Suicide rate has significant positive correlations with antidepressant rates (p=0.031) and unemployment (p=0.028). It also has a significant negative correlation with inpatient psychiatric beds (p=0.039). The actual coefficients are less than ±0.16, indicating weak relationships. After adjusting for other variables, the only variable that is a statistically significant predictor of suicide rate is antidepressant prescribing (p=0.005, r²=0.09). DISCUSSION Our analysis using this large data set suggests a statistically significant, albeit weak positive, association between antidepressant prescribing and suicide rates.
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Affiliation(s)
- M A Kamat
- Department of Psychiatry, Belfast City Hospital, Belfast HSC Trust, U.K
| | - L Edgar
- Department of Psychiatry, Belfast City Hospital, Belfast HSC Trust, U.K
| | - P Niblock
- Department of Psychiatry, Belfast City Hospital, Belfast HSC Trust, U.K
| | - C McDowell
- Northern Ireland Clinical Research Support Centre, Belfast, U.K
| | - C B Kelly
- Department of Psychiatry, Belfast City Hospital, Belfast HSC Trust, U.K
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Wiseman SM, Masoudi H, Niblock P, Turbin D, Rajput A, Hay J, Filipenko D, Melck A, Gilks B, Huntsman D. Derangement of p53 and MDM2 is involved in transformation of differentiated into anaplastic thyroid cancer. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.5556] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
5556 Background: Anaplastic thyroid cancer arises as a consequence of tumor progression, or transformation, from pre-existing differentiated thyroid cancer. Mutation of the p53 tumor-suppressor gene represents a common event in thyroid tumor progression. MDM2 encodes a protein that complexes with p53, downregulates its function, and leads to its degradation via a ubiquitin-proteasome pathway. The objective of this study was to evaluate the change in p53 and MDM2 expression in the transformation of differentiated to anaplastic thyroid carcinoma. Methods: Of 94 cases of anaplastic thyroid cancer diagnosed and treated in British Columbia Canada over a 20 year period (1984–2004) 32 cases (34%) had adequate tissue available for evaluation and 12 of these cases had associated foci of differentiated thyroid carcinoma. A tissue microarray was constructed from these 12 anaplastic thyroid tumors and their associated differentiated foci. Immunohistochemistry was utilized to evaluate expression of p53 and MDM2 by these tumors. Results: There was decreased expression of p53 and MDM2 by the anaplastic tumors when compared to the differentiated thyroid tumors from which they evolved. The expression of p53 and MDM2 was 17% and 8%, respectively, by the differentiated thyroid carcinoma, and 83% and 25%, respectively, by the anaplastic tumors. Evaluating the anaplastic cancers and the differentiated foci from which they evolved, p53 overexpression developed in 8 (67%) of tumors and MDM2 overexpression developed in 3 (25%) of tumors. All the anaplastic tumors that developed MDM2 overexpression also concurrently developed p53 overexpression. Conclusions: This report is the first to demonstrate derangement of p53, and its regulator, MDM2, is involved in the transformation of a subset of differentiated into anaplastic thyroid tumors. Isolated MDM2 overexpression does not appear to play an important role in anaplastic transformation of thyroid cancer. No significant financial relationships to disclose.
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Affiliation(s)
- S. M. Wiseman
- Genetic Pathology Evaluation Center, Vancouver, BC, Canada; BC Cancer Agency, Vancouver, BC, Canada; St. Paul’s Hospital, Vancouver, BC, Canada
| | - H. Masoudi
- Genetic Pathology Evaluation Center, Vancouver, BC, Canada; BC Cancer Agency, Vancouver, BC, Canada; St. Paul’s Hospital, Vancouver, BC, Canada
| | - P. Niblock
- Genetic Pathology Evaluation Center, Vancouver, BC, Canada; BC Cancer Agency, Vancouver, BC, Canada; St. Paul’s Hospital, Vancouver, BC, Canada
| | - D. Turbin
- Genetic Pathology Evaluation Center, Vancouver, BC, Canada; BC Cancer Agency, Vancouver, BC, Canada; St. Paul’s Hospital, Vancouver, BC, Canada
| | - A. Rajput
- Genetic Pathology Evaluation Center, Vancouver, BC, Canada; BC Cancer Agency, Vancouver, BC, Canada; St. Paul’s Hospital, Vancouver, BC, Canada
| | - J. Hay
- Genetic Pathology Evaluation Center, Vancouver, BC, Canada; BC Cancer Agency, Vancouver, BC, Canada; St. Paul’s Hospital, Vancouver, BC, Canada
| | - D. Filipenko
- Genetic Pathology Evaluation Center, Vancouver, BC, Canada; BC Cancer Agency, Vancouver, BC, Canada; St. Paul’s Hospital, Vancouver, BC, Canada
| | - A. Melck
- Genetic Pathology Evaluation Center, Vancouver, BC, Canada; BC Cancer Agency, Vancouver, BC, Canada; St. Paul’s Hospital, Vancouver, BC, Canada
| | - B. Gilks
- Genetic Pathology Evaluation Center, Vancouver, BC, Canada; BC Cancer Agency, Vancouver, BC, Canada; St. Paul’s Hospital, Vancouver, BC, Canada
| | - D. Huntsman
- Genetic Pathology Evaluation Center, Vancouver, BC, Canada; BC Cancer Agency, Vancouver, BC, Canada; St. Paul’s Hospital, Vancouver, BC, Canada
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