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Baddeley E, Retzer A, Sivell S, Seddon K, Bulbeck H, Nelson A, Adams R, Grant R, Watts C, Aiyegbusi O, Rivera S, Kearns P, Dirven L, Calvert M, Byrne A. P09.04.B The importance of treatment tolerability for people with glioma: registry review and qualitative findings from the COBra Study. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac174.162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Gliomas are the commonest form of primary brain tumour, accounting for 80% of malignant brain tumours. Gliomas represent a heterogeneous group of cancers with variable outcomes, traditionally graded from I to IV (least to most aggressive). The poor prognosis of some glioma patients and high symptom burden has led to a growing emphasis on their quality of survival. Maintaining cognitive function, physical function and other health-related quality of life aspects throughout the disease trajectory are key considerations, particularly for patients with aggressive forms of glioma. It is therefore important that glioma intervention studies collect data aligned with patient priorities that enables assessment of the net clinical benefit of treatments and facilitates informed decision-making. In particular, and of increasing recognition, is the importance of monitoring the incidence of adverse events during and after the course of an intervention, and understanding their impact upon patients, and patients’ own assessment of, tolerability.
Material and Methods
A trial registry review, a systematic review of the qualitative literature and semi-structured interviews with patients and caregivers were undertaken. Outcomes were extracted from these sources to formulate a longlist during the development of a core outcome set for glioma interventional trials (the COBra study).
Results
The registry review (n=91), systematic review (n=21) and semi-structured interviews (n=19) identified many important outcomes and concepts, one of which was tolerability. Tolerability, adverse events, toxicity or safety was reported to be collected as an outcome in 46 trials. Outcomes related to tolerability were identified from 7 articles included in the systematic review. Themes related to tolerability emerged from the qualitative interviews. These included tolerability of side effects of treatment; trade-offs of side effects versus potential benefits in deciding on, and willingness to, undertake further treatment; and self-directed strategies for coping.
Conclusion
There is a growing acknowledgement of the importance of treatment tolerability in the wider field of cancer research. In glioma research specifically, its significance is yet to be reflected in outcomes collected in trials. Our qualitative findings indicate tolerability is of high significance to patients and those close to them. Participants reported how their preconceptions and experience of tolerability influenced treatment decisions and treatment uptake. However, outcomes related to tolerability were collected in just over half of trials in our sample. Tolerability and items relating to the patients’ experience of adverse events should be collected and reported in trial findings to reflect patients’ priorities and enable informed treatment decisions.
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Affiliation(s)
- E Baddeley
- Cardiff University - Marie Curie Palliative Care Research Centre , Cardiff , United Kingdom
| | - A Retzer
- University of Birmingham - Centre for Patient Reported Outcomes Research , Birmingham , United Kingdom
| | - S Sivell
- Cardiff University - Marie Curie Palliative Care Research Centre , Cardiff , United Kingdom
| | - K Seddon
- Cardiff University - Marie Curie Palliative Care Research Centre , Cardiff , United Kingdom
| | - H Bulbeck
- Brainstrust , London , United Kingdom
| | - A Nelson
- Cardiff University - Marie Curie Palliative Care Research Centre , Cardiff , United Kingdom
| | - R Adams
- Cardiff University - Centre for Trials Research , Cardiff , United Kingdom
| | - R Grant
- University of Edinburgh , Edinburgh , United Kingdom
| | - C Watts
- University of Birmingham - Institute of Cancer and Genomic Sciences , Birmingham , United Kingdom
| | - O Aiyegbusi
- University of Birmingham - Centre for Patient Reported Outcomes Research , Birmingham , United Kingdom
| | - S Rivera
- University of Birmingham - Centre for Patient Reported Outcomes Research , Birmingham , United Kingdom
| | - P Kearns
- University of Birmingham - Cancer and Genomic Sciences , Birmingham , United Kingdom
| | - L Dirven
- Leiden University , Leiden , Netherlands
| | - M Calvert
- University of Birmingham - Centre for Patient Reported Outcomes Research , Birmingham , United Kingdom
| | - A Byrne
- Cardiff University - Marie Curie Palliative Care Research Centre , Cardiff , United Kingdom
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Vassal G, Kozhaeva O, Griskjane S, Arnold F, Nysom K, Basset L, Kameric L, Kienesberger A, Kamal S, Cherny N, Bricalli G, Latino N, Kearns P. Access to essential anticancer medicines for children and adolescents in Europe. Ann Oncol 2021; 32:560-568. [PMID: 33388384 DOI: 10.1016/j.annonc.2020.12.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 12/16/2020] [Accepted: 12/20/2020] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Essential anticancer medicines are an indispensable component of multidisciplinary treatment of paediatric malignancies. A European Society for Medical Oncology (ESMO) study reported inequalities in the availability of anticancer medicines for adult solid tumours and provided a model for the present survey. The aim of this survey was to assess the accessibility of essential medicines used in paediatric cancer patients aged 0 to 18 years across Europe from 2016 to 2018. METHODS A list of medicines was drawn with input from the European Society for Paediatric Oncology (SIOP Europe) Clinical Research Council referring to the World Health Organization Model List of Essential Medicines for Children (WHO EMLc) 2017. A survey was sent to nominated national clinician and pharmacist rapporteurs and parent associations in up to 37 countries; answers were obtained from 34 countries. RESULTS The full survey list contained 68 medicines, including 24 on the WHO EMLc 2017. Health professionals reported that 35% of all medicines were prescribed off-label in at least one country and that 44% were always available in >90% of countries. Only 63% of the EMLc 2017 medicines were reported as always available. The main determinant of unavailability was shortages, reported for 72% of medicines in at least one country. Out-of-pocket costs were reported in eight countries. Twenty-seven percent of orally administered medicines were never available in child-friendly formulations. Parents detailed individual efforts and challenges of facilitating ingestion of oral medicines as prescribed. Inequalities in access to pain control during procedures were reported by parents across Europe. CONCLUSIONS Children and adolescents with cancer in Europe experience lack of access to essential medicines. Urgent actions are needed to address shortages, financial accessibility, availability of safe age-appropriate oral formulations, and pain management across Europe.
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Affiliation(s)
- G Vassal
- Paediatric Oncology Department, Gustave Roussy, Villejuif, France; Paris-Sud University, Orsay, France; European Society for Paediatric Oncology (SIOP Europe), Brussels, Belgium.
| | - O Kozhaeva
- Policy Department, SIOP Europe, Brussels, Belgium
| | - S Griskjane
- Children's Clinical University Hospital, Riga, Latvia; European Society of Oncology Pharmacy (ESOP), Luxembourg
| | - F Arnold
- Childhood Cancer International - Europe (CCI-E), Montpellier, France
| | - K Nysom
- Department of Paediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen, Denmark; SIOP Europe, Brussels, Belgium
| | - L Basset
- CCI-E, Madrid, Spain; Universitat Politècnica de València, Valencia, Spain
| | - L Kameric
- CCI-E, Sarajevo, Bosnia and Herzegovina
| | | | - S Kamal
- Department of Pharmaceutical Services, Children's Cancer Hospital, Cairo, Egypt; ESOP, Luxembourg
| | - N Cherny
- Cancer Pain and Palliative Medicine Service, Department of Medical Oncology, Shaare Zedek Medical Center, Jerusalem, Israel; European Society for Medical Oncology (ESMO), Lugano, Switzerland
| | - G Bricalli
- European Society for Medical Oncology (ESMO), Lugano, Switzerland
| | - N Latino
- European Society for Medical Oncology (ESMO), Lugano, Switzerland
| | - P Kearns
- Institute of Cancer and Genomic Sciences, NIHR Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK; SIOP Europe, Brussels, Belgium
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Nysom K, Leblond P, Frappaz D, Aerts I, Varlet P, Giangaspero F, Gambart M, Hargrave D, Marshall L, Kearns P, Makin G, Gallego S, Kieran M, Casanova M, Lahogue A, Wind S, Stolze B, Roy D, Uttenreuther-Fischer M, Geoerger B. Biomarker prevalence study and phase I trial of afatinib in children with malignant tumours. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx363.002] [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: 11/12/2022] Open
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Vormoor B, Veal GJ, Griffin MJ, Boddy AV, Irving J, Minto L, Case M, Banerji U, Swales KE, Tall JR, Moore AS, Toguchi M, Acton G, Dyer K, Schwab C, Harrison CJ, Grainger JD, Lancaster D, Kearns P, Hargrave D, Vormoor J. A phase I/II trial of AT9283, a selective inhibitor of aurora kinase in children with relapsed or refractory acute leukemia: challenges to run early phase clinical trials for children with leukemia. Pediatr Blood Cancer 2017; 64. [PMID: 27905678 DOI: 10.1002/pbc.26351] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 10/07/2016] [Indexed: 01/21/2023]
Abstract
Aurora kinases regulate mitosis and are commonly overexpressed in leukemia. This phase I/IIa study of AT9283, a multikinase inhibitor, was designed to identify maximal tolerated doses, safety, pharmacokinetics, and pharmacodynamic activity in children with relapsed/refractory acute leukemia. The trial suffered from poor recruitment and terminated early, therefore failing to identify its primary endpoints. AT9283 caused tolerable toxicity, but failed to show clinical responses. Future trials should be based on robust preclinical data that provide an indication of which patients may benefit from the experimental agent, and recruitment should be improved through international collaborations and early combination with established treatment strategies.
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Affiliation(s)
- B Vormoor
- Newcastle Cancer Centre at the Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK
- Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - G J Veal
- Newcastle Cancer Centre at the Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK
| | - M J Griffin
- Newcastle Cancer Centre at the Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK
| | - A V Boddy
- Newcastle Cancer Centre at the Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK
| | - J Irving
- Newcastle Cancer Centre at the Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK
| | - L Minto
- Newcastle Cancer Centre at the Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK
| | - M Case
- Newcastle Cancer Centre at the Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK
| | - U Banerji
- Cancer Research UK Cancer Therapeutics Unit, The Institute of Cancer Research, London, U.K
- The Royal Marsden Hospital, Sutton, UK
| | - K E Swales
- Cancer Research UK Cancer Therapeutics Unit, The Institute of Cancer Research, London, U.K
| | - J R Tall
- Cancer Research UK Cancer Therapeutics Unit, The Institute of Cancer Research, London, U.K
| | - A S Moore
- Cancer Research UK Cancer Therapeutics Unit, The Institute of Cancer Research, London, U.K
- The Royal Marsden Hospital, Sutton, UK
| | - M Toguchi
- Astex Pharmaceuticals, Cambridge Science Park, Cambridge, UK
| | - G Acton
- Cancer Research UK Centre for Drug Development, London, UK
| | - K Dyer
- Cancer Research UK Centre for Drug Development, London, UK
| | - C Schwab
- Newcastle Cancer Centre at the Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK
| | - C J Harrison
- Newcastle Cancer Centre at the Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK
| | - J D Grainger
- Royal Manchester Children's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
- Faculty of Medical & Human Sciences, University of Manchester, Manchester, UK
| | | | - P Kearns
- Institute of Cancer and Genomic Medicine, University of Birmingham, Birmingham, UK
| | - D Hargrave
- Great Ormond Street Hospital for Children, London, UK
| | - J Vormoor
- Newcastle Cancer Centre at the Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK
- Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
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Vassal G, Schrappe M, Pritchard-Jones K, Arnold F, Basset L, Biondi A, Bode G, Eggert A, Hjorth L, Kamerić L, Karner S, Kearns P, Kienesberger A, Kowalczyk J, Lack P, Perilongo G, Sullivan R, Tsirou A, Kamerić N, Essiaf S, Ladenstein R. 1407 The European Strategic Plan for children and adolescents with cancer. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)30578-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Meijer L, Veal G, Grundy R, Konczalik W, Ivanov D, Garnett M, Kearns P, Walker D. P67 * DEFINING A TARGET INTRA-CEREBROSPINAL FLUID STEADY STATE ETOPOSIDE CONCENTRATION [CSF ETOPOSIDE] FOR PHASE I STUDY IN CHILDREN WITH LEPTOMENINGEAL METASTASIS (LM): INTREPID, A FIRST IN MAN STUDY. Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou249.53] [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: 11/13/2022] Open
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Tippelt S, Mikasch R, Warmuth-Metz M, Pietsch T, Hilger RA, Kwiecien R, Faldum A, Rutkowski S, Bode U, Siegler N, Fleischhack G, Dufour C, Delisle MB, Geoffray A, Laplanche A, Frappaz D, Icher C, Bertozzi AI, Leblond P, Doz F, Andre N, Schneider P, De Carli E, Berger C, Lejars O, Chastagner P, Soler C, Entz-Werle N, Valteau-Couanet D, Burzynski S, Janicki T, Burzynski G, Marszalek A, Deiss A, Korshunov A, Capper D, Witt H, van Tilburg C, von Deimling A, Kulozik AE, Pfister SM, Witt O, Milde T, Dhall G, Haley K, Finlay J, Rushing T, Sposto R, Seeger R, Lulla RR, Goldman S, Beattie C, DasGupta TK, Pollack I, Fisher PG, Wu S, Boyett JM, Fouladi M, Meijer L, Veal G, Walker D, Grundy R, Meijer L, Veal G, Grundy R, Konczalik W, Ivanov D, Garnett M, Parker T, Kearns P, Walker D, Grundy R, Garnett M, Rahman R, Smith S, Meijer L, Walker D, Kimpo M, Yan B, Ning C, Villegas M, Alcasabas AP, Juh YE, Chong QT, Lin TP, Dewire M, Fouladi M, Drissi R, Chow L, Goldman S, Pai A, Leach J, Lane A, Backus L, Grimme L, Tabares J, Kumar S, Sobo M, Hummel TR, Alharbi M, Abdullah S, Alharbi Q, Alshahrani M, Mosleh O, Balbaid A, Alkofide A, Alkhayat N, AlFar K, Banyhamdan A, Ahmed O, El-Badawy S, Bouffet E, Jiang MW, Zhou RH, Zhou Q, Yuan XJ, Ma J, Turner D, Wright K, Broniscer A, Robinson G, Qaddoumi I, Armstrong G, Gajjar A, Stewart C, Misra SN, Misra AK, Michalski A, Stiller C. CLINICAL TRIALS. Neuro Oncol 2014; 16:i10-i13. [PMCID: PMC4046282 DOI: 10.1093/neuonc/nou066] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2023] Open
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Bailey S, Howman A, Wheatley K, Wherton D, Boota N, Pizer B, Fisher D, Kearns P, Picton S, Saran F, Gibson M, Glaser A, Connolly D, Hargrave D. Diffuse intrinsic pontine glioma treated with prolonged temozolomide and radiotherapy--results of a United Kingdom phase II trial (CNS 2007 04). Eur J Cancer 2013; 49:3856-62. [PMID: 24011536 PMCID: PMC3853623 DOI: 10.1016/j.ejca.2013.08.006] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Revised: 06/30/2013] [Accepted: 08/08/2013] [Indexed: 12/03/2022]
Abstract
Diffuse intrinsic pontine glioma (DIPG) has a dismal prognosis with no chemotherapy regimen so far resulting in any significant improvement over standard radiotherapy. In this trial, a prolonged regimen (21/28d) of temozolomide was studied with the aim of overcoming O(6)-methylguanine methyltransferase (MGMT) mediated resistance. Forty-three patients with a defined clinico-radiological diagnosis of DIPG received radiotherapy and concomitant temozolomide (75 mg/m(2)) after which up to 12 courses of 21d of adjuvant temozolomide (75-100mg/m(2)) were given 4 weekly. The trial used a 2-stage design and passed interim analysis. At diagnosis median age was 8 years (2-20 years), 81% had cranial nerve abnormalities, 76% ataxia and 57% long tract signs. Median Karnofsky/Lansky score was 80 (10-100). Patients received a median of three courses of adjuvant temozolomide, five received all 12 courses and seven did not start adjuvant treatment. Three patients were withdrawn from study treatment due to haematological toxicity and 10 had a dose reduction. No other significant toxicity related to temozolomide was noted. Overall survival (OS) (95% confidence interval (CI)) was 56% (40%, 69%) at 9 months, 35% (21%, 49%) at 1 year and 17% (7%, 30%) at 2 years. Median survival was 9.5 months (range 7.5-11.4 months). There were five 2-year survivors with a median age of 13.6 years at diagnosis. This trial demonstrated no survival benefit of the addition of dose dense temozolomide, to standard radiotherapy in children with classical DIPG. However, a subgroup of adolescent DIPG patients did have a prolonged survival, which needs further exploration.
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Affiliation(s)
- S. Bailey
- Great North Childrens Hospital, Newcastle upon Tyne, United Kingdom
| | - A. Howman
- CRCTU, University of Birmingham, Birmingham, United Kingdom
| | - K. Wheatley
- CRCTU, University of Birmingham, Birmingham, United Kingdom
| | - D. Wherton
- CRCTU, University of Birmingham, Birmingham, United Kingdom
| | - N. Boota
- Nottingham Clinical Trials Unit, Nottingham, United Kingdom
| | - B. Pizer
- Alder Hey Childrens Hospital, Liverpool, United Kingdom
| | - D. Fisher
- Addenbroookes Hopsital, Cambridge, United Kingdom
| | - P. Kearns
- CRCTU, University of Birmingham, Birmingham, United Kingdom
| | - S. Picton
- Leeds General Infirmary, Leeds, United Kingdom
| | - F. Saran
- Royal Marsden Hospital, Surrey, London, United Kingdom
| | - M. Gibson
- CRCTU, University of Birmingham, Birmingham, United Kingdom
| | - A. Glaser
- Leeds General Infirmary, Leeds, United Kingdom
| | | | - D. Hargrave
- Great Ormond Street Hospital For Sick Children, London, United Kingdom
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Kapatai G, Brundler MA, Jenkinson H, Kearns P, Parulekar M, Peet AC, McConville CM. Gene expression profiling identifies different sub-types of retinoblastoma. Br J Cancer 2013; 109:512-25. [PMID: 23756868 PMCID: PMC3721394 DOI: 10.1038/bjc.2013.283] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [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: 02/01/2013] [Revised: 05/16/2013] [Accepted: 05/16/2013] [Indexed: 02/06/2023] Open
Abstract
Background: Mutation of the RB1 gene is necessary but not sufficient for the development of retinoblastoma. The nature of events occurring subsequent to RB1 mutation is unclear, as is the retinal cell-of-origin of this tumour. Methods: Gene expression profiling of 21 retinoblastomas was carried out to identify genetic events that contribute to tumorigenesis and to obtain information about tumour histogenesis. Results: Expression analysis showed a clear separation of retinoblastomas into two groups. Group 1 retinoblastomas express genes associated with a range of different retinal cell types, suggesting derivation from a retinal progenitor cell type. Recurrent chromosomal alterations typical of retinoblastoma, for example, chromosome 1q and 6p gain and 16q loss were also a feature of this group, and clinically they were characterised by an invasive pattern of tumour growth. In contrast, group 2 retinoblastomas were found to retain many characteristics of cone photoreceptor cells and appear to exploit the high metabolic capacity of this cell type in order to promote tumour proliferation. Conclusion: Retinoblastoma is a heterogeneous tumour with variable biology and clinical characteristics.
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Affiliation(s)
- G Kapatai
- School of Cancer Sciences, Vincent Drive, University of Birmingham, Birmingham, UK
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Zaghloul M, Ahmed S, Eldebaway E, Mousa A, Amin A, Elkhateeb N, Sabry M, Ogiwara H, Morota N, Sufit A, Donson A, Birks D, Patel P, Foreman N, Handler M, Massimino M, Biassoni V, Gandola L, Schiavello E, Pecori E, Potepan P, Bach F, Janssens GO, Jansen MH, Lauwers SJ, Nowak PJ, Oldenburger FR, Bouffet E, Saran F, van Ulzen KK, van Lindert EJ, Schieving JH, Boterberg T, Kaspers GJ, Span PN, Kaanders JH, Gidding CE, Hargrave D, Bailey S, Howman A, Pizer B, Harris D, Jones D, Kearns P, Picton S, Saran F, Wheatley K, Gibson M, Glaser A, Connolly D, Hargrave D, Kawamura A, Nagashima T, Yamamoto K, Sakata J, Lober R, Freret M, Fisher P, Edwards M, Yeom K, Monje M, Jansen M, Aliaga ES, Van Der Hoeven E, Van Vuurden D, Heymans M, Gidding C, De Bont E, Reddingius R, Peeters-Scholte C, van Meeteren AS, Gooskens R, Granzen B, Paardekoper G, Janssens G, Noske D, Barkhof F, Vandertop WP, Kaspers G, Saratsis A, Yadavilli S, Nazarian J, Monje M, Freret M, Mitra S, Mallick S, Kim J, Beachy P, Nobre L, Vasconcelos F, Lima F, Mattos D, Kuiven N, Lima G, Silveira J, Sevilha M, Lima MA, Ferman S, Leblond P, Lansiaux A, Rialland X, Gentet JC, Geoerger B, Frappaz D, Aerts I, Bernier-Chastagner V, Shah R, Zaky W, Grimm J, Bluml S, Wong K, Dhall G, Caretti V, Schellen P, Lagerweij T, Bugiani M, Navis A, Wesseling P, Vandertop WP, Noske DP, Kaspers G, Wurdinger T, Lee H, Ziegler D, Schroeder K, Huang E, Berlow N, Patel R, Becher O, Taylor I, Mao XG, Hutt M, Weingart M, Kahlert U, Maciacyk J, Nikkhah G, Eberhart C, Raabe E, Barton K, Misuraca K, Misuraca K, Becher O, Zhou Z, Rotman L, Ho S, Souweidane M, Hutt M, Lim KJ, Warren K, Chang H, Eberhart C, Raabe E, Lightner D, Haque S, Souweidane M, Khakoo Y, Dunkel I, Gilheeney S, Kramer K, Lyden D, Wolden S, Greenfield J, De Braganca K, Ting-Rong H, Muh-Li L, Kai-Ping C, Tai-Tong W, Hsin-Hung C, Kebudi R, Cakir FB, Agaoglu FY, Gorgun O, Dizdar Y, Ayan I, Darendeliler E, Zapotocky M, Churackova M, Malinova B, Kodet R, Kyncl M, Tichy M, Stary J, Sumerauer D, Minturn J, Shu HK, Fisher M, Patti R, Janss A, Allen J, Phillips P, Belasco J, Taylor K, Baudis M, von Beuren A, Fouladi M, Jones C. DIFFUSE INTRINSIC PONTINE GLIOMA (DIPG). Neuro Oncol 2012. [DOI: 10.1093/neuonc/nos098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Kearns P, Graham NJ, Cummins M, Gibson B, Grainger JD, Keenan R, Lancaster D, Shenton G, Vormoor J, Webb D, Hawley I, Johnson PJ. Phase I study of clofarabine and liposomal daunorubicin in childhood acute myeloid leukemia. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.9521] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Rosenberg JA, Derreumaux D, Gore L, Kearns P, Baruchel A, Barrett T, Zwaan M. Phase II study of dasatinib in children and adolescents with newly diagnosed chronic phase chronic myelogenous leukemia (CP-CML) or Philadelphia-positive (Ph+) leukemias resistant or intolerant to imatinib. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.tps281] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Graham NJ, Johnson PJ, Cummins M, Keenan R, Gibson B, Hawley I, Kearns P. A phase I study of clofarabine and liposomal daunorubicin in childhood and adolescent acute myeloid leukemia. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.tps327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Pen R, Benner A, Kearns P, Kittai A, Browne P, Kearns W. Preimplanatation genetic screening (PGS) for aneuploidy in 93 couples undergoing donor egg in vitro fertilization (IVF) cycles. Fertil Steril 2008. [DOI: 10.1016/j.fertnstert.2008.07.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Geoerger B, Doz F, Lowis S, Kearns P, Estlin E, Gibson B, Corradini N, Lardelli P, Vassal G. Phase I-II clinical and pharmacokinetic study of plitidepsin in children with malignant tumors. On behalf of the European ITCC (Innovative Therapies for Children with Cancer) Consortium. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.10028] [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] Open
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Kearns P. 10 INVITED Targeted therapies for acute leukaemias in children. EJC Suppl 2007. [DOI: 10.1016/s1359-6349(07)70124-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Geoerger B, Doz F, Estlin E, Kearns P, Bezares S, Pico C, Vassal G. 248/249 INVITED Clinical phase I-II and pharmacokinetic study of plitidepsin in children with malignant tumors. EJC Suppl 2006. [DOI: 10.1016/s1359-6349(06)70253-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Kearns P. 243 INVITED Rational development of ombination therapies for paediatric malignancies. EJC Suppl 2006. [DOI: 10.1016/s1359-6349(06)70248-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Geoerger B, Doz F, Estlin E, Kearns P, Lopez-Martin J, Vassal G, Bezares S, Ruiz M. Preliminary data of a phase I-II clinical and pharmacokinetic study of plitidepsin in children with malignant tumors. On behalf of the European ITCC (Innovative Therapies for Children with Cancer) Consortium. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.9060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
9060 Background: Plitidepsin (Aplidin) is a cyclic depsipeptide isolated from the tunicate Aplidium albicans, nowadays manufactured by synthesis. It is a rapid and potent inductor of apoptosis. Phase I trials in adults explored 5 different schedules. Muscle and liver toxicities were dose-limiting; hematological toxicity was not observed at the recommended dose (RD). Methods: This is a multicentre, open-label, non-randomized phase I-II study with a dose finding stage in children with solid tumors, and two expanded cohorts in leukemia and solid tumors at the RD. Plitidepsin was administered as a 3 h iv infusion every 2 weeks (=1 cycle). The initial dose level was 4 mg/m2 (80% of the RD in adults), with a classical escalation to 5 and 6 mg/m2. Results: 16 patients have been entered to date with median age 7.5 years (range 2–17). 54 cycles in 15 patients were evaluable for toxicity. 8 patients were treated at 4 mg/m2, five at 5 mg/m2 and three at 6 mg/m2. One patient presented dose-limiting G2 myalgia lasting more than 2 weeks at 4mg/m2. The Maximum Tolerated Dose (MTD) has not been reached at 6 mg/m2. Non-hematological toxicities included G1-G2 muscle side effects: (myalgia, CPK elevation, muscle weakness), G1–2 fatigue, G3 vomiting. One G3 hypersensitivity reaction was observed without prophylactic treatment. Pharmacokinetic data are similar to those reported in adult (extensive tissue distribution, a long half-life); if any, clearance was slightly higher and half-life shorter. Partial response was observed in a pancreatoblastoma and disease stabilization in a progressive medulloblastoma. Conclusions: Plitidepsin was well tolerated in children, with muscular side effects being the most relevant toxicity observed. The MTD for the pediatric population has not yet been achieved at a dose 1.2 fold above the RD in adults. [Table: see text]
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Affiliation(s)
- B. Geoerger
- Institut Gustave Roussy, Villejuif Cedex, France; Institut Curie, Paris, France; Royal Children’s Hospital, Manchester, United Kingdom; Royal Hospital for Children, Bristol, United Kingdom; PharmaMar SAU, Colmenar Viejo (Madrid), Spain
| | - F. Doz
- Institut Gustave Roussy, Villejuif Cedex, France; Institut Curie, Paris, France; Royal Children’s Hospital, Manchester, United Kingdom; Royal Hospital for Children, Bristol, United Kingdom; PharmaMar SAU, Colmenar Viejo (Madrid), Spain
| | - E. Estlin
- Institut Gustave Roussy, Villejuif Cedex, France; Institut Curie, Paris, France; Royal Children’s Hospital, Manchester, United Kingdom; Royal Hospital for Children, Bristol, United Kingdom; PharmaMar SAU, Colmenar Viejo (Madrid), Spain
| | - P. Kearns
- Institut Gustave Roussy, Villejuif Cedex, France; Institut Curie, Paris, France; Royal Children’s Hospital, Manchester, United Kingdom; Royal Hospital for Children, Bristol, United Kingdom; PharmaMar SAU, Colmenar Viejo (Madrid), Spain
| | - J. Lopez-Martin
- Institut Gustave Roussy, Villejuif Cedex, France; Institut Curie, Paris, France; Royal Children’s Hospital, Manchester, United Kingdom; Royal Hospital for Children, Bristol, United Kingdom; PharmaMar SAU, Colmenar Viejo (Madrid), Spain
| | - G. Vassal
- Institut Gustave Roussy, Villejuif Cedex, France; Institut Curie, Paris, France; Royal Children’s Hospital, Manchester, United Kingdom; Royal Hospital for Children, Bristol, United Kingdom; PharmaMar SAU, Colmenar Viejo (Madrid), Spain
| | - S. Bezares
- Institut Gustave Roussy, Villejuif Cedex, France; Institut Curie, Paris, France; Royal Children’s Hospital, Manchester, United Kingdom; Royal Hospital for Children, Bristol, United Kingdom; PharmaMar SAU, Colmenar Viejo (Madrid), Spain
| | - M. Ruiz
- Institut Gustave Roussy, Villejuif Cedex, France; Institut Curie, Paris, France; Royal Children’s Hospital, Manchester, United Kingdom; Royal Hospital for Children, Bristol, United Kingdom; PharmaMar SAU, Colmenar Viejo (Madrid), Spain
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Abstract
PURPOSE Non-selective non-steroidal anti-inflammatory drugs (nNSAIDs) used in combination with warfarin are associated with an approximately 3-fold increased risk of upper gastrointestinal bleeding (UGIB) compared with warfarin alone. Celecoxib, a selective inhibitor of cyclo-oxygenase 2 (COX-2), is associated with less gastric mucosal injury and platelet dysregulation than nNSAIDs. We compared rates of bleeding complications in patients taking celecoxib and warfarin with those taking warfarin alone. SUBJECTS AND METHODS We performed a retrospective analysis using data from our Protime Clinic and pharmacy databases from January 2001 to April 2004. We identified 123 patients who took celecoxib and warfarin concurrently (overlap group). We compared rates of bleeding complications in this group with 1022 control patients who were taking warfarin alone. Bleeding complications were defined as major if they resulted in hospitalization, blood transfusion or death. RESULTS During approximately 1063 months of exposure to both celecoxib and warfarin, 10 bleeding complications were identified, only one of which was considered major. No patients had UGIB. In the control group, 116 bleeding complications were identified over approximately 16 520 months of exposure to warfarin alone, with 101 minor and 15 major events, including six episodes of UGIB. The relative risk of all bleeding complications was 1.34 (95% CI: 0.70-2.57) in the overlap vs. control groups, and for major bleeds was 1.04 (95% CI: 0.14-7.85). CONCLUSIONS There is a mild but non-significant increase in bleeding complications in patients taking celecoxib and warfarin compared with those taking warfarin alone.
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Affiliation(s)
- L Chung
- Division of Immunology and Rheumatology, Department of Medicine, Stanford University Hospital and Clinics, Stanford, CA 94305, USA
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Abstract
BACKGROUND Previous research has indicated that children who have received treatment for leukaemia which includes cranial irradiation exhibit deficits in their ability to focus attention. It has been suggested that the use of cranial irradiation may have a role to play in long term sequelae. AIMS To investigate neuropsychological functioning among children treated for leukaemia without cranial irradiation. METHODS In a cross sectional study, 17 leukaemic patients and their sibling controls were assessed using a neuropsychological model of attention. All were treated on the UKALL XI protocol and none had received cranial irradiation. Participants completed the Arithmetic subtest and Digit Span subtest of the Weschler Intelligence Scale for Children-Revised to assess focus-encode elements of attention; the Coding subtest and the Speed of Information subtest of the BAS to assess focus-execute aspects of attention; the VIGIL computerised battery to assess sustain elements of attention; and the Wisconsin Card Sorting test to assess the ability to shift attention. RESULTS These children did not exhibit the deficits witnessed in previous cohorts, and were performing at comparable levels to their controls on all measures of attention CONCLUSIONS These findings suggest that children who have received treatment for leukaemia without the use of cranial irradiation do not show the neuropsychological insult found in earlier treatment groups.
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Affiliation(s)
- J Rodgers
- Doctorate in Clinical Psychology, University of Newcastle, UK.
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Abstract
The Inter-Organisation Programme for the Sound Management of Chemicals (IOMC) was established in 1995 as a mechanism to co-ordinate the efforts of Inter-governmental Organisations in promoting the sound management of chemicals. The seven participating organisations are the United Nations Environment Programme (UNEP), the International Labour Organisation (ILO), the United Nations Food and Agriculture Organisation (FAO), the World Health Organisation (WHO), the United Nations Industrial Development Organisation (UNIDO), the United Nations Institute for Training and Research (UNITAR), and the Organisation of Economic Cooperation and Development (OECD). Members consult on the planning, programming, implementation and monitoring of activities undertaken jointly or individually, and help ensure that programmes are mutually supportive, complementary and avoid duplication of efforts, thus meeting the overall needs of the users more efficiently and effectively. To deal with technical work, the IOMC established smaller thematic groups in the main programme areas of Agenda 21's Chapter 19. One such group promotes information exchange work. Within this IOMC framework, the seven organisations have developed approaches and products to help customers find chemical safety information, as well as improving modalities of access to these data. These mechanisms come in addition to and complement the extensive information products and databases developed and provided by the individual organisations. This article presents an overview of the role of each organisation, an introduction to its electronic information products and tools, and a discussion of the products of this joint effort.
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Affiliation(s)
- F Keita-Ouane
- UNEP Chemicals, 11-13, Chemin des Anémones, CH-1219 Châtelaine, Geneva, Switzerland.
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Abstract
In order to test the hypothesis that glutathione (GSH) is an important determinant of treatment response in childhood acute leukaemia, blast cell GSH levels were studied in a cohort of children with acute lymphoblastic (ALL) and acute myeloid (AML) leukaemia. In both ALL and AML, several indicators of poor prognosis are well established but the underlying molecular mechanisms leading to resistant disease are still poorly understood. GSH is an intracellular thiol implicated in the development of cytotoxic drug resistance and appears to be involved in the control of cell proliferation and apoptosis. In this study, total GSH was measured in cryopreserved blasts from 62 childhood ALL and 13 AML patients. In ALL, high GSH levels were associated with a relatively poor prognosis. A positive correlation was demonstrated between the GSH level and presenting white cell count (WCC). GSH levels were significantly higher in T lineage ALL compared with B lineage and in AML blasts compared with ALL. These results are supportive of GSH as prognostic indicator in childhood leukaemia and may suggest one mechanism of treatment failure. They imply that it may be possible to improve chemosensitivity by the use of known modulators of GSH synthesis.
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MESH Headings
- Adolescent
- Antineoplastic Agents/toxicity
- Blast Crisis/blood
- Blast Crisis/metabolism
- Blast Crisis/pathology
- Bone Marrow Cells/metabolism
- Bone Marrow Cells/pathology
- Cell Survival/drug effects
- Child
- Child, Preschool
- Female
- Glutathione/analysis
- Glutathione/metabolism
- Humans
- Infant
- Leukemia, Myeloid, Acute/blood
- Leukemia, Myeloid, Acute/metabolism
- Leukemia, Myeloid, Acute/mortality
- Leukemia, Myeloid, Acute/pathology
- Male
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/blood
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/metabolism
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/mortality
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/pathology
- Prognosis
- Survival Analysis
- Tumor Cells, Cultured
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Affiliation(s)
- P Kearns
- Department of Paediatric Haematology and Oncology, Free University Hospital, Amsterdam, The Netherlands
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Partridge F, Richardson W, Kearns P, Wilcox R, Majumdar G. Marked bone marrow eosinophilia at the time of relapse of acute myeloblastic leukaemia in association with the appearance of translocation t(12;20)(q24;q11). Leuk Lymphoma 1996; 22:181-2. [PMID: 8724547 DOI: 10.3109/10428199609051747] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [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: 02/01/2023]
Abstract
We report a case of acute myeloblastic leukaemia (AML), FAB type M2, with karyotype t(8;21)(q22;q22), who at the time of relapse showed marked eosinophilia of the bone marrow. Karyotype analysis showed the appearance of an additional clone t(8;21)(q22;q22),t(12;20)(q24;q11). To the best of our knowledge, marked eosinophilia has not been reported in association with this particular chromosomal translocation.
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MESH Headings
- Adult
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Bone Marrow/pathology
- Chromosomes, Human, Pair 12/ultrastructure
- Chromosomes, Human, Pair 20/ultrastructure
- Chromosomes, Human, Pair 21/ultrastructure
- Chromosomes, Human, Pair 8/ultrastructure
- Cytarabine/administration & dosage
- Daunorubicin/administration & dosage
- Eosinophilia/etiology
- Eosinophilia/genetics
- Eosinophilia/pathology
- Etoposide/administration & dosage
- Humans
- Idarubicin/administration & dosage
- Leukemia, Myeloid, Acute/complications
- Leukemia, Myeloid, Acute/drug therapy
- Leukemia, Myeloid, Acute/genetics
- Leukemia, Myeloid, Acute/pathology
- Male
- Neoplasm Recurrence, Local
- Remission Induction
- Translocation, Genetic
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Affiliation(s)
- F Partridge
- Haematology Department, George Eliot Hospital, Nuneaton, England
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Abstract
A retrospective study was made of 314 consecutive cases of traumatic hyphaema in a mixed urban and rural Scottish population. Secondary haemorrhage occurred in 4.1% of cases and was not associated with a worsening of final visual acuity. There were no identifiable risk factors for secondary haemorrhage. Poor visual outcome was in most cases attributable to retinal pathology. The use of antifibrinolytic agents does not appear to be necessary in such a population, and the importance of detecting associated retinal detachment is emphasised.
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Affiliation(s)
- P Kearns
- Princess Alexandra Eye Pavilion, Edinburgh
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Kay G, Kearns P. [Central venous pressure monitoring]. Infirm Can 1976; 18:10-3. [PMID: 1047037] [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: 12/25/2022]
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