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Cartwright E, Slater S, Saffery C, Tran A, Turkes F, Smith G, Aresu M, Kohoutova D, Terlizzo M, Zhitkov O, Rana I, Johnston EW, Sanna I, Smyth E, Mansoor W, Fribbens C, Rao S, Chau I, Starling N, Cunningham D. Phase II trial of domatinostat (4SC-202) in combination with avelumab in patients with previously treated advanced mismatch repair proficient oesophagogastric and colorectal adenocarcinoma: EMERGE. ESMO Open 2024; 9:102971. [PMID: 38518549 PMCID: PMC10972804 DOI: 10.1016/j.esmoop.2024.102971] [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: 12/20/2023] [Revised: 02/23/2024] [Accepted: 02/26/2024] [Indexed: 03/24/2024] Open
Abstract
BACKGROUND Most oesophagogastric adenocarcinomas (OGAs) and colorectal cancers (CRCs) are mismatch repair proficient (MMRp), responding poorly to immune checkpoint inhibition. We evaluated the safety and efficacy of domatinostat (histone deacetylase inhibitor) plus avelumab (anti-PD-L1 antibody) in patients with previously treated inoperable, advanced/metastatic MMRp OGA and CRC. PATIENTS AND METHODS Eligible patients were evaluated in a multicentre, open-label dose escalation/dose expansion phase II trial. In the escalation phase, patients received escalating doses of domatinostat [100 mg once daily (OD), 200 mg OD, 200 mg twice daily (BD)] orally for 14 days followed by continuous dosing plus avelumab 10 mg/kg administered intravenously 2-weekly (2qw) to determine the recommended phase II dose (RP2D). The trial expansion phase evaluated the best objective response rate (ORR) during 6 months by RECIST version 1.1 using a Simon two-stage optimal design with 2/9 and 1/10 responses required to proceed to stage 2 in the OGA and CRC cohorts, respectively. RESULTS Patients (n = 40) were registered between February 2019 and October 2021. Patients in the dose escalation phase (n = 12) were evaluated to confirm the RP2D of domatinostat 200 mg BD plus avelumab 10 mg/kg. No dose-limiting toxicities were observed. Twenty-one patients were treated at the RP2D, 19 (9 OGA and 10 CRC) were assessable for the best ORR; 2 patients with CRC did not receive combination treatment and were not assessable for the primary endpoint analysis. Six patients were evaluated in the dose escalation and expansion phases. In the OGA cohort, the best ORR was 22.2% (95% one-sided confidence interval lower bound 4.1) and the median duration of disease control was 11.3 months (range 9.9-12.7 months). No responses were observed in the CRC cohort. No treatment-related grade 3-4 adverse events were reported at the RP2D. CONCLUSIONS Responses in the OGA cohort met the criteria to expand to stage 2 of recruitment with an acceptable safety profile. There was insufficient signal in the CRC cohort to progress to stage 2. TRIAL REGISTRATION NCT03812796 (registered 23rd January 2019).
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Affiliation(s)
- E Cartwright
- Gastrointestinal and Lymphoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London
| | - S Slater
- Gastrointestinal and Lymphoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London
| | - C Saffery
- Gastrointestinal and Lymphoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London
| | - A Tran
- Gastrointestinal and Lymphoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London
| | - F Turkes
- Gastrointestinal and Lymphoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London
| | - G Smith
- Gastrointestinal and Lymphoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London
| | - M Aresu
- Gastrointestinal and Lymphoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London
| | - D Kohoutova
- Gastrointestinal and Lymphoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London
| | - M Terlizzo
- Gastrointestinal and Lymphoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London
| | - O Zhitkov
- Gastrointestinal and Lymphoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London
| | - I Rana
- Gastrointestinal and Lymphoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London
| | - E W Johnston
- Gastrointestinal and Lymphoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London
| | - I Sanna
- Gastrointestinal and Lymphoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London
| | - E Smyth
- Gastrointestinal and Lymphoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London
| | - W Mansoor
- Oesophago-Gastric Cancer Services, The Christie NHS Foundation Trust, Manchester, UK
| | - C Fribbens
- Gastrointestinal and Lymphoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London
| | - S Rao
- Gastrointestinal and Lymphoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London
| | - I Chau
- Gastrointestinal and Lymphoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London
| | - N Starling
- Gastrointestinal and Lymphoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London
| | - D Cunningham
- Gastrointestinal and Lymphoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London.
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Slater S, Cartwright E, Saffery C, Tran A, Smith G, Bacason M, Zhitkov O, Rana I, Johnston E, Sanna I, Aresu M, Kohoutova D, Terlizzo M, Turkes F, Smyth E, Mansoor W, Fribbens C, Rao S, Watkins D, Starling N, Chau I, Cunningham D. PD-2 EMERGE: A multi-centre, non-randomised, single-arm phase II study investigating domatinostat plus avelumab in patients with previously treated advanced mismatch repair-proficient oesophagogastric and colorectal adenocarcinoma. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.04.080] [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: 11/01/2022] Open
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Booth G, Knight R, Harlan R, Peterson K, Jacoby C, Berklich E, Slater S, Allen B, Neumann C, Dela Cruz J, Meyers G, Cook R, Maziarz R, Newell L. Characterization of chronic GVHD after day 4 versus day 5 G-CSF mobilized HLA-matched sibling donor allogeneic hematopoietic cell transplantation. Cytotherapy 2021. [DOI: 10.1016/s1465324921003881] [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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Avolio E, Mangialardi G, Slater S, Alvino V, Heesom K, Beltrami A, Angelini G, Madeddu P. Human adventitial pericytes secrete bioactive factors exerting distinct biological effects on cardiac cells: hints for cardiac repair. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3745] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Pericytes are attracting much attention as potential candidates for successful cell therapy of myocardial ischaemia. Intramyocardially delivered adventitial pericytes (APCs) secrete paracrine factors which stimulate angiogenesis and recruitment of cardiac stromal cells, reduce fibrosis and promote cardiomyocyte proliferation and viability. However, factors responsible for these biological effects have not been elucidated yet.
Purpose
To exploit the components of APC secretome exerting a biological effect on cardiac cells with the aim to discover new druggable targets with potential therapeutic activity.
Methods and results
APCs were derived from saphenous veins of adult patients (n=13, 68±11 yrs, all with coronary artery disease - CAD). The APC-conditioned medium (CM) stimulated the proliferation of human iPS-derived cardiomyocytes compared with unconditioned medium (UCM) (EdU incorporation, 1.3-fold increases, P=0.004). Stimulation with APC-CM increased the number of mitotic figures in cardiomyocytes (Aurora B, 1.5-fold increases compared to UCM, P=0.002). Furthermore, APC-CM abrogated the hypoxia-induced apoptosis in cardiomyocytes (2-fold increase in Caspase 3/7 activity in hypoxic cells exposed to UCM compared to normoxic cells, P=0.002). We also found that APC-CM stimulates the migration of human cardiac stromal cells (CSCs) obtained from healthy donors (n=6, 54±11 yrs) in both a transwell and scratch migration assays (n=6, P<0.01 and P<0.05 vs UCM respectively). Interestingly, APC-CM activated also the migration of HUVECs (n=6, P<0.01 vs UCM) but did not attract fibroblasts. Next, we aimed to identify the biologically active components of the APC-CM. Depletion of exosomes and heat and RNase treatments did not abolish the pro-migratory action of the APC-CM, while this was abrogated by Proteinase K. Fractionation of the APC-CM based on the MW indicated that the bioactive peptides have MW >30KDa. The pro-migratory fractions of the APC-CM obtained from size exclusion chromatography underwent mass spectrometry analysis (n=3 APCs). This identified 14 proteins uniquely present in the pro-migratory fractions. The two most relevant candidates were SPARC and TGFBI, both confirmed by ELISA. Intriguingly, the recombinant SPARC and TGFBI failed to reproduce the biological effect of APC-CM on CSC migration, suggesting that the secreted proteins may carry unique post-translational modifications not found in synthetic peptides. Further analyses are being carried out to reveal the biological properties of the endogenous SPARC and TGFBI.
Conclusions
This study suggests a fascinating approach based on the use of the active component of the APC-CM as a surrogate of APC therapy. If the biological properties of the cellular proteins will be successfully reproduced in synthetic peptides in vitro, this innovative approach may extend the benefits of APC therapy to all those patients with CAD for whom cell therapy is not an available option.
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): British Heart Foundation programme grant “Unravelling mechanism of stem cell depletion for the preservation of regenerative fitness in patients with diabetes”
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Affiliation(s)
- E Avolio
- University of Bristol, Bristol Medical School, Bristol, United Kingdom
| | - G Mangialardi
- University of Bristol, Bristol Medical School, Bristol, United Kingdom
| | - S Slater
- University of Bristol, Bristol Medical School, Bristol, United Kingdom
| | - V.V Alvino
- University of Bristol, Bristol Medical School, Bristol, United Kingdom
| | - K Heesom
- University of Bristol, Bristol Medical School, Bristol, United Kingdom
| | - A.P Beltrami
- University of Udine, Department of Pathology, Udine, Italy
| | - G Angelini
- University of Bristol, Bristol Medical School, Bristol, United Kingdom
| | - P Madeddu
- University of Bristol, Bristol Medical School, Bristol, United Kingdom
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Awada A, Cortés J, Slater S, Macpherson I, Csoszi T, Bertrand JB, Clermont AS, Pollard R, Chrestia-Blanchine R, Biswas-Baldwin N, Youssoufian H, El-Hariry I. TRYbeCA-2: A randomized phase II/III study of eryaspase in combination with gemcitabine and carboplatin chemotherapy versus chemotherapy alone as first-line treatment in patients with metastatic or locally recurrent triple-negative breast cancer. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz242.076] [Citation(s) in RCA: 1] [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: 11/14/2022] Open
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Kocher H, Basu B, Froeling F, Sarker D, Slater S, Carlin D, Coetzee C, de Souza N, Goulart M, Hughes C, Imrali A, Lawrence C, Mousa K, North B, Prendergast A, Roberts R, Sasieni P, Propper D. STAR-PAC: Phase I clinical trial repurposing all trans retinoic acid (ATRA) as stromal targeting agent in a novel drug combination for pancreatic cancer. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz247.027] [Citation(s) in RCA: 1] [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: 11/14/2022] Open
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Slater S, Mckay S, Pheeley A, Mcloone P, Steele N, Maclaren V, Hicks J. P3.15-005 Third Line Chemotherapy in SCLC: The West of Scotland Experience. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.1795] [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: 10/18/2022]
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Slater S, Mckay S, Pheeley A, Mcloone P, Steele N, Maclaren V, Hicks J. P3.15-003 Second Line Chemotherapy in SCLC: The West of Scotland Experience. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.1793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Alvino V, Rodriguez-Arabaloaza I, Fernandez-Jimenez R, Slater S, Mangialardi G, Avolio E, Herman A, Spencer H, Emanueli C, Angelini G, Ibanez B, Madeddu P. P2540Results of a blind, randomized, placebo-controlled trial show feasibility and efficacy of adventitial progenitor cell transplantation in a swine model of reperfused myocardial infarction. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p2540] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Hahne A, Ford J, Richards M, Surkitt L, Slater S, Taylor N. Who benefits most from individualised physiotherapy versus advice for low back disorders: Effect modifier analysis of randomised controlled trial data. J Sci Med Sport 2017. [DOI: 10.1016/j.jsams.2016.12.034] [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: 10/20/2022]
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Ford J, Hahne A, Surkitt L, Slater S, Richards M, Chan A, Hinman R, Taylor N. Individualised physiotherapy versus advice for people with low back disorders: A 2-year follow-up of a randomised controlled trial. J Sci Med Sport 2017. [DOI: 10.1016/j.jsams.2016.12.037] [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: 10/20/2022]
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12
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Spurrell E, Wilson P, Gallagher C, Slater S, Roylance R. Adjuvant Chemotherapy for Breast Cancer in Older Women. Clin Oncol (R Coll Radiol) 2016; 28:542. [DOI: 10.1016/j.clon.2016.03.007] [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] [Received: 03/08/2016] [Accepted: 03/31/2016] [Indexed: 11/26/2022]
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13
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Dalley C, Rohatiner A, Bradburn M, Lillington D, Carter M, Slater S, MacCallum P, Amess J, Lister T. Acute Myelogenous Leukaemia in Patients 60 Years and Older: A Retrospective Analysis from St Bartholomew's Hospital 1969–1999. Hematology 2016; 6:163-75. [PMID: 27420122 DOI: 10.1080/10245332.2001.11746568] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- C.D. Dalley
- I.C.R.F Medical Oncology Unit, St Bartholomew's Hospital West Smithfield, London, EC1A 7BE, UK
- Department of Haematology St Bartholomew's Hospital West Smithfield, London, EC1A 7BE, UK
| | - A.Z.S. Rohatiner
- I.C.R.F Medical Oncology Unit, St Bartholomew's Hospital West Smithfield, London, EC1A 7BE, UK
| | - M. Bradburn
- I.C.R.F Medical Statistics Group, Institute of Health Sciences, Headington, Oxford, OX3 7LF, UK
| | - D.M. Lillington
- I.C.R.F Medical Oncology Unit, St Bartholomew's Hospital West Smithfield, London, EC1A 7BE, UK
| | - M. Carter
- I.C.R.F Medical Oncology Unit, St Bartholomew's Hospital West Smithfield, London, EC1A 7BE, UK
| | - S. Slater
- I.C.R.F Medical Oncology Unit, St Bartholomew's Hospital West Smithfield, London, EC1A 7BE, UK
| | - P. MacCallum
- Department of Haematology St Bartholomew's Hospital West Smithfield, London, EC1A 7BE, UK
| | - J.A.L Amess
- Department of Haematology St Bartholomew's Hospital West Smithfield, London, EC1A 7BE, UK
| | - T.A. Lister
- I.C.R.F Medical Oncology Unit, St Bartholomew's Hospital West Smithfield, London, EC1A 7BE, UK
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Milojkovic Kerklaan B, Slater S, Flynn M, Greystoke A, Witteveen PO, Megui-Roelvink M, de Vos F, Dean E, Reyderman L, Ottesen L, Ranson M, Lolkema MPJ, Plummer R, Kristeleit R, Evans TRJ, Schellens JHM. A phase I, dose escalation, pharmacodynamic, pharmacokinetic, and food-effect study of α2 integrin inhibitor E7820 in patients with advanced solid tumors. Invest New Drugs 2016; 34:329-37. [PMID: 27039386 DOI: 10.1007/s10637-016-0344-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [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: 12/17/2015] [Accepted: 03/11/2016] [Indexed: 01/13/2023]
Abstract
UNLABELLED Introduction E7820 is an orally administered sulfonamide that inhibits alfa-2-integrin mRNA expression. Pre-clinically E7820 showed tumor anti-angiogenic effects in various tumor cell lines and xenograft mouse models. Human daily dosing of 100 mg QD had previously been shown to be safe and tolerable. Methods The study consisted of two parts: Part A (food effect) and Part B (determination of maximum tolerated dose (MTD) for bi-daily (BID) dosing). E7820 dosing started at 50 mg BID with planned escalation to 60, 80 and 100 mg BID every 28 days. Results Fifteen patients were enrolled in Part A and 26 in Part B. The most frequent adverse events of all grades were constipation, diarrhea, nausea, and fatigue while anemia, neutropenia, and fatigue were most frequent grade ≥3 toxicities. At dose-level 60 mg BID, two patients experienced dose-limiting toxicities (grade 3 neutropenic sepsis and grade 4 neutropenia). Therefore the recommended dose (RD) was 50 mg BID. Food had no effect on E7820 exposure. E7820 exposure following twice daily administration was dose-proportional. Expression of platelet integrin-α2 measured as a response biomarker in Part B, generally decreased by a median 7.7 % from baseline following treatment with 50 mg BID E7820. Reduction was most pronounced within 1-week post treatment. The median duration of treatment was median 54, range 20-111 days. The best overall response in any treatment group was stable disease (SD): 23.1 % in Part A (100 mg QD); at the RD 66.7 % (12 of 18 patients) and 40 % in the 60 mg BID group in Part B. CONCLUSIONS Food had no effect on E7820 exposure. A dose of 50 mg BID was considered the MTD. Treatment with E7820 is safe and tolerable with 2/3 of patients (66.7 %) at MTD having SD as their best response.
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Affiliation(s)
- B Milojkovic Kerklaan
- Department of Clinical Pharmacology, Division of Internal Medicine, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066CX, Amsterdam, The Netherlands
| | - S Slater
- The Beatson West of Scotland Cancer Centre, University Glasgow, Glasgow, UK
| | - M Flynn
- University College London Hospital, London, United Kingdom
| | - A Greystoke
- The Christie NHS Foundation Trust / University of Manchester, Manchester, UK
| | - P O Witteveen
- Department of Medical Oncology, Cancer Center, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - M Megui-Roelvink
- Department of Clinical Pharmacology, Division of Internal Medicine, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066CX, Amsterdam, The Netherlands
| | - F de Vos
- Department of Medical Oncology, Cancer Center, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - E Dean
- The Christie NHS Foundation Trust / University of Manchester, Manchester, UK
| | | | | | - M Ranson
- The Christie NHS Foundation Trust / University of Manchester, Manchester, UK
| | - M P J Lolkema
- Department of Medical Oncology, Cancer Center, University Medical Centre Utrecht, Utrecht, The Netherlands
- Erasmus Medical Center Cancer Institute, Erasmus Medical Center, Rotterdam, The Netherlands
| | - R Plummer
- Sir Bobby Robson Cancer Trials Research Centre Newcastle, Newcastle, UK
| | - R Kristeleit
- University College London Hospital, London, United Kingdom
| | - T R J Evans
- The Beatson West of Scotland Cancer Centre, University Glasgow, Glasgow, UK
| | - J H M Schellens
- Department of Clinical Pharmacology, Division of Internal Medicine, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066CX, Amsterdam, The Netherlands.
- Utrecht Institute of Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands.
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Carrabba M, De Maria C, Oikawa A, Reni C, Rodriguez-Arabaolaza I, Spencer H, Slater S, Avolio E, Dang Z, Spinetti G, Madeddu P, Vozzi G. Design, fabrication and perivascular implantation of bioactive scaffolds engineered with human adventitial progenitor cells for stimulation of arteriogenesis in peripheral ischemia. Biofabrication 2016; 8:015020. [DOI: 10.1088/1758-5090/8/1/015020] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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16
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Parsons HA, Beaver JA, Cimino-Mathews A, Zorzi J, Slater S, Clark T, Lipson D, Ali SM, Kennedy M, Otto GA, Young LE, Jeter S, VanDenBerg DA, Rosner GL, Park BH, Stearns V. Abstract PD6-08: IMAGE: Individualized molecular analyses guide efforts in breast cancer with comprehensive genomic profiling of tissue and plasma tumor DNA. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-pd6-08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Standard treatment options for patients with metastatic triple negative breast cancer (TNBC) are limited to chemotherapy. Molecular profiling of tumors may allow for novel treatment recommendations.
Methods: We initiated a prospective study designated IMAGE. Women with newly progressing metastatic TNBC who received at least one line of prior chemotherapy were eligible. New metastatic biopsies were obtained for molecular profiling at study entry. Archived metastatic biopsy specimens were allowed if patients had not commenced new systemic therapy. The specimens were reviewed by the study pathologist and stained for ER, PR, HER2, and androgen receptor (AR) by immunohistochemistry. Specimens underwent hybrid-capture based comprehensive genomic profiling (CGP) (Foundation Medicine Inc., Cambridge, MA). Clinical data and genomic profiling reports were reviewed by the GAITWAY (Genomic Alterations in Tumors with Actionable Yields) Molecular Profile Tumor Board. Recommendations were communicated to the treating oncologist and patients were followed for treatment decision and clinical outcomes. Peripheral blood was also analyzed by an investigational assay for circulating plasma tumor DNA (ptDNA) (Foundation Medicine Inc.) at study entry, and when obtainable, from serial blood draws at time of progression. The primary objective was to assess feasibility of completing the process from consent to GAITWAY recommendations within 28 days for at least 80% of patients.
Results: From September 2013 to April 2015, we enrolled 26 eligible women. Median age was 55 (range 25-67); patients identified as white 12 (46%), black 11 (42%), or other 3 (12%); median number of prior lines of treatment was 3; and 65.4% of patients had visceral disease. Twenty (77%) eligible patients received CGP of a metastatic site biopsy. Six patients did not undergo CGP due to either absence of a metastatic site amenable for biopsy or inadequate tissue for CGP. The study met the predefined statistical endpoint for futility and was closed after 20 patients had undergone CGP. Twelve (60%) evaluable patients received treatment recommendations within 28 days of study consent. Failure to meet this time frame was due to difficulties in accessing archival tumor tissue (N=5) and need for additional tissue for molecular analysis (N=3). Preliminary results demonstrate high concordance between mutations in metastatic biopsies and ptDNA in 15/17 patients.
Enrolled in IMAGE26Successful NGS20Potentially actionable mutation identified15GAITWAY recommended targeted therapy as possible next treatment13Received targeted therapy4
Conclusions: CGP of patients with metastatic TNBC can provide additional information that may help direct treatment. However, difficulties in obtaining adequate tumor tissue may hinder this approach. Use of a well-validated ptDNA profiling assay could be an alternative to overcome these limitations.
Citation Format: Parsons HA, Beaver JA, Cimino-Mathews A, Zorzi J, Slater S, Clark T, Lipson D, Ali SM, Kennedy M, Otto GA, Young LE, Jeter S, VanDenBerg DA, Rosner GL, Park BH, Stearns V. IMAGE: Individualized molecular analyses guide efforts in breast cancer with comprehensive genomic profiling of tissue and plasma tumor DNA. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr PD6-08.
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Affiliation(s)
- HA Parsons
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Foundation Medicine, Inc., Cambridge, MA
| | - JA Beaver
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Foundation Medicine, Inc., Cambridge, MA
| | - A Cimino-Mathews
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Foundation Medicine, Inc., Cambridge, MA
| | - J Zorzi
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Foundation Medicine, Inc., Cambridge, MA
| | - S Slater
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Foundation Medicine, Inc., Cambridge, MA
| | - T Clark
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Foundation Medicine, Inc., Cambridge, MA
| | - D Lipson
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Foundation Medicine, Inc., Cambridge, MA
| | - SM Ali
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Foundation Medicine, Inc., Cambridge, MA
| | - M Kennedy
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Foundation Medicine, Inc., Cambridge, MA
| | - GA Otto
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Foundation Medicine, Inc., Cambridge, MA
| | - LE Young
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Foundation Medicine, Inc., Cambridge, MA
| | - S Jeter
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Foundation Medicine, Inc., Cambridge, MA
| | - DA VanDenBerg
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Foundation Medicine, Inc., Cambridge, MA
| | - GL Rosner
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Foundation Medicine, Inc., Cambridge, MA
| | - BH Park
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Foundation Medicine, Inc., Cambridge, MA
| | - V Stearns
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Foundation Medicine, Inc., Cambridge, MA
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Cole P, Gornall BT, Wood MD, Whitcher R, Bannon A, Bloomer S, Fear J, Hale H, Humphries J, Hunak S, Jones C, Matthewman C, Matthews A, Slater S, Stephens C, Stewart J. Strategies for engaging with future radiation protection professionals: a public outreach case study. J Radiol Prot 2015; 35:N25-N32. [PMID: 26444019 DOI: 10.1088/0952-4746/35/4/n25] [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] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
It is evident that there is a nuclear skills shortage within the UK, and logically it can be assumed that the shortfall extends to the radiation protection arena. Plans for nuclear new-build and the decommissioning of existing nuclear sites will require many more people with radiological knowledge and practical competencies. This converts to a nuclear industry requirement in the order of 1000 new recruits per year over at least the next ten years, mainly as new apprentices and graduates. At the same time, the strong demand for persons with radiation protection know-how in the non-nuclear and health care sectors is unlikely to diminish. The task of filling this skills gap is a significant one and it will require a determined effort from many UK stakeholders. The Society for Radiological Protection (SRP) has adopted a strategy in recent years to help address this skills gap. The aim is to engage the interest of secondary school students in the science of radiation and inspire them to follow a career in radiation protection. This paper presents the reasoning behind this strategy and, in an 'outreach case study', describes the establishment of the annual SRP Schools Event. This event is becoming an important addition to the national efforts aimed at increasing the numbers of skilled UK radiation protection professionals over the forthcoming decades.
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Affiliation(s)
- P Cole
- Radiation Protection Office, University of Liverpool, Liverpool, L69 3BX, UK
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Slater S, McKay S, MacLaren V, Hicks J. 175 Second line chemotherapy for recurrent SCLC: The West of Scotland SCLC retrospective database. Lung Cancer 2014. [DOI: 10.1016/s0169-5002(14)70176-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Okines AFC, Langley RE, Thompson LC, Stenning SP, Stevenson L, Falk S, Seymour M, Coxon F, Middleton GW, Smith D, Evans L, Slater S, Waters J, Ford D, Hall M, Iveson TJ, Petty RD, Plummer C, Allum WH, Blazeby JM, Griffin M, Cunningham D. Bevacizumab with peri-operative epirubicin, cisplatin and capecitabine (ECX) in localised gastro-oesophageal adenocarcinoma: a safety report. Ann Oncol 2012; 24:702-9. [PMID: 23108952 DOI: 10.1093/annonc/mds533] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Peri-operative chemotherapy and surgery is a standard treatment of localised oesophagogastric adenocarcinoma; however, the outcomes remain poor. PATIENTS AND METHODS ST03 is a multicentre, randomised, phase II/III study comparing peri-operative ECX with or without bevacizumab (ECX-B). The primary outcome measure of phase II (n = 200) was safety, specifically gastrointestinal (GI) perforation rates and cardiotoxicity. RESULTS Two hundred patients were randomised between October 2007 and April 2010. Ninety-one/101 (90%) ECX and 86/99 (87%) ECX-B patients completed pre-operative chemotherapy; 7 ECX and 9 ECX-B patients stopped due to toxicity. Gastrointestinal perforations (3 ECX, 1 ECX-B), cardiac events (1 ECX, 4 ECX-B) and venous thromboembolic events (VTEs, 8 ECX, 7 ECX-B) were uncommon. Arterial thromboembolic events (ATEs, myocardial infarction (MI) or cerebrovascular accident) were more frequent with ECX-B (5 versus 1 with ECX). Delayed wound healing, anastomotic leaks and GI bleeding rates were similar. More asymptomatic left ventricular ejection fraction (LVEF) falls (≥15% and/or to <50%) occurred with ECX-B (21.2% versus 11.1% with ECX). Clinically significant falls (≥10% to below lower limit of normal, LLN) occurred in (15.3%) and (8.9%) respectively, with no associated cardiac failure (median 22 months follow-up). CONCLUSIONS Addition of bevacizumab to peri-operative ECX chemotherapy is feasible with acceptable toxicity and no negative impact on surgical outcomes.
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Affiliation(s)
- A F C Okines
- Department of Medicine, The Royal Marsden Hospital NHS Foundation Trust London & Surrey SM2 5PT, London
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Kaye S, Siu L, Jassem J, Medioni J, Soetekouw P, Slater S, Rudin C, Schwartz G, De Jonge M, O'Dwyer P, Baudelet C, Chen A, Ratain M. Brivanib (B) in Advanced Ovarian Cancer (OC): Subset Results of a Phase 2 Randomized Discontinuation Trial (RDT). Ann Oncol 2012. [DOI: 10.1093/annonc/mds401] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [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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Liniker E, Al-Jilaihawi S, Propper D, Slater S, Pacey S. A 46 year old man with carcinoma of unknown primary site. BMJ 2012; 345:e5144. [PMID: 22859798 DOI: 10.1136/bmj.e5144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- E Liniker
- Department of Oncology, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK
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Myers L, Burmeister J, Mater E, Murray S, Curtin P, Gajewski J, Hayes-Lattin B, Kovacsovics T, Leis J, Meyers G, Slater S, Maziarz R. An Institutional Perspective on the Efficacy of Donor Leukocyte Infusions for Patients with Post-Transplant Relapse. Biol Blood Marrow Transplant 2012. [DOI: 10.1016/j.bbmt.2011.12.384] [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: 11/17/2022]
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Perets Avraham G, Bains T, Lemieux A, Slater S, Kovacsovics T, Curtin P, Gajewski J, Meyers G, Maziarz R. Improved Outcome of Elderly Patients After Reduced Intensity Allogeneic Hematopoietic Cell Transplantation (HCT). Biol Blood Marrow Transplant 2012. [DOI: 10.1016/j.bbmt.2011.12.378] [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: 11/25/2022]
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Slater S, Nowicki S, Brown J, Steele N. 34 Adjuvant chemotherapy for resected non-small cell lung cancer (NSCLC): the West of Scotland Experience. Lung Cancer 2012. [DOI: 10.1016/s0169-5002(12)70035-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Bardia A, Blackford A, Jeter S, Tarpinian K, Fetting JF, Miller R, Slater S, Henry NL, Giles J, Stearns V. OT1-01-01: Prospective Clinical Trial Evaluating Efficacy of Zoledronic Acid (ZA) Prophylaxis for Prevention of Aromatase Inhibitor Associated Musculoskeletal Symptoms: ZAP-AIMSS Trial. Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-ot1-01-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Brief background: Aromatase inhibitor associated musculoskeletal symptoms (AIMSS) occur in approximately 50% of patients receiving AIs (Henry 08). However, interventions to prevent or treat AIMSS have not been established. In a retrospective study (Muslimani 09), patients receiving bisphosphonates along with AIs were less likely to report AIMSS compared to those not taking bisphosphonates (35% vs. 60%). However, the efficacy of bisphosphonates in reducing incidence of AIMSS has not been studied prospectively, so it cannot be recommended for routine clinical practice.
Trial design: We are conducting a single arm, phase II clinical trial of 4 mg intravenous zoledronic acid (ZA) given at baseline and at 6 months, in combination with letrozole 2.5 mg daily for one year. Development of AIMSS will be assessed using the standardized Health Assessment Questionnaire (HAQ-DI) and pain Visual Analog Scale (VAS) at baseline,1, 3, 6, and 12 months. Secondary endpoints include mammographic breast density (when intact contralateral breast), bone mineral density, bone turnover metabolites, circulating inflammatory markers, and patient reported quality of life measures. Prevalence of AIMSS will be compared to historical controls from a recently completed multi-institutional study designated Exemestane and Letrozole Pharmacogenetics (ELPh trial, ClinicalTrials.gov #NCT00228956). The current study has the same eligibility criteria, method and intervals of outcome assessment, and AI medication, as the ELPh trial, ensuring that the two cohorts are comparable.
Eligibility criteria: Postmenopausal women who have completed local therapy and chemotherapy for hormone receptor positive DCIS or stage I-III breast cancer and who are scheduled to receive adjuvant AI. Prior tamoxifen therapy is permitted.
Specific aims:
1. Percentage of women experiencing AIMSS at 1, 3, 6, and 12 months after initiation of ZA and letrozole, as compared to historical controls.
2. Change in bone mineral density and breast density between baseline and 12 months for those receiving ZA and letrozole, as compared to historical controls.
3. Change in bone turnover markers and inflammatory markers between baseline and 1, 3, 6 and 12 months for those receiving ZA and letrozole, as compared to historical controls.
Statistical methods: Allowing for a 20% dropout rate, a total sample size of 59 patients yields 80% power to detect reduction in AIMSS incidence from 50% to 30% with a two sided type I error rate of 5%. The rates of AIMSS and other endpoints at each time point and across all time points between controls and patients will be compared with a logistic regression model that adjusts for potential confounding variables and include random effects as appropriate to account for correlation between outcomes in the same patient.
Present accrual and target accrual: The Johns Hopkins Institutional Review Board approved the study and it opened to accrual in January 2011. Since that time, 12 participants have signed consent and started therapy, and 2 have completed the 3 month evaluation.
Funding: Trial supported by BCRF. ZA and letrozole kindly supplied by Novartis.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr OT1-01-01.
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Affiliation(s)
- A Bardia
- 1Johns Hopkins Kimmel Cancer Center, Baltimore, MD; University of Michigan, Ann Arbor, MI; Columbia University, New York City, NY
| | - A Blackford
- 1Johns Hopkins Kimmel Cancer Center, Baltimore, MD; University of Michigan, Ann Arbor, MI; Columbia University, New York City, NY
| | - S Jeter
- 1Johns Hopkins Kimmel Cancer Center, Baltimore, MD; University of Michigan, Ann Arbor, MI; Columbia University, New York City, NY
| | - K Tarpinian
- 1Johns Hopkins Kimmel Cancer Center, Baltimore, MD; University of Michigan, Ann Arbor, MI; Columbia University, New York City, NY
| | - JF Fetting
- 1Johns Hopkins Kimmel Cancer Center, Baltimore, MD; University of Michigan, Ann Arbor, MI; Columbia University, New York City, NY
| | - R Miller
- 1Johns Hopkins Kimmel Cancer Center, Baltimore, MD; University of Michigan, Ann Arbor, MI; Columbia University, New York City, NY
| | - S Slater
- 1Johns Hopkins Kimmel Cancer Center, Baltimore, MD; University of Michigan, Ann Arbor, MI; Columbia University, New York City, NY
| | - NL Henry
- 1Johns Hopkins Kimmel Cancer Center, Baltimore, MD; University of Michigan, Ann Arbor, MI; Columbia University, New York City, NY
| | - J Giles
- 1Johns Hopkins Kimmel Cancer Center, Baltimore, MD; University of Michigan, Ann Arbor, MI; Columbia University, New York City, NY
| | - V Stearns
- 1Johns Hopkins Kimmel Cancer Center, Baltimore, MD; University of Michigan, Ann Arbor, MI; Columbia University, New York City, NY
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Slater S. Ian Charles Woolrych English. West J Med 2011. [DOI: 10.1136/bmj.d7524] [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: 11/04/2022]
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Abstract
OBJECTIVE The aim of this study was to establish the value of indirect CT venography (CTV) in clinical practice within the UK. METHODS 804 combined CT pulmonary angiogram and CTV studies were retrospectively reviewed. CTV was performed 180 s after the injection of contrast using an incremental technique with a 5-mm collimation and a 5-cm interspace between images extending from the iliac crests to the tibial plateaus. RESULTS 12.9% of studies had isolated pulmonary emboli (PE), 3.0% had both a PE and deep vein thrombosis (DVT) and 1.1% had an isolated DVT. The proportion of positive cases diagnosed by CTV alone was 6.6%. CONCLUSION In a UK-based practice, the incidence and the proportion of isolated DVT diagnosed by CTV are lower than expected from published data. An analysis of possible causes for this is made within the paper.
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Affiliation(s)
- S Slater
- Department of Radiology, Leeds Teaching Hospital NHS Trust, Leeds, UK
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Higgins MJ, Jelovac D, Barnathan E, Blair B, Slater S, Powers P, Zorzi J, Jeter SC, Oliver GR, Diehl F, Angenendt P, Huang P, Argani P, Murphy K, Wolff AC, Park BH. Improving detection methods for PIK3CA mutations in breast cancer using peripheral blood from patients with metastastic breast cancer (MBC). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.10512] [Citation(s) in RCA: 3] [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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30
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Okines AFC, Langley RE, Thompson LC, Stenning SP, Stevenson L, Falk S, Seymour MT, Coxon FY, Middleton GW, Smith D, Evans L, Slater S, Waters JS, Ford D, Hall M, Iveson T, Petty RD, Plummer C, Allum W, Cunningham D. Safety results from a randomized trial of perioperative epirubicin, cisplatin plus capecitabine (ECX) with or without bevacizumab (B) in patients (pts) with gastric or type II/III oesophagogastric junction (OGJ) adenocarcinoma. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.4092] [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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31
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McCarthy FM, Tookman L, Phillips M, Wilson P, Propper D, Steele JPC, Sarwar N, Hagemann T, Slater S. A retrospective single-study analysis of survival outcomes in metastatic colorectal cancer. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e14137] [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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32
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Middleton GW, Gwyther SJ, Brown SR, Maughan T, Olivier C, Richman S, Maisey NR, Hill M, Gollins S, Myint S, Slater S, Wagstaff J, Bridgewater JA, Glynne-Jones R, Hemmings G, Marshall H, Blake D, Napp V, Quirke P, Seymour MT. Biomodulation of irinotecan using ciclosporin: Results of PICCOLO, a randomized controlled trial in advanced colorectal cancer (aCRC). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.3566] [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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Abstract
OBJECTIVE Ideally, fine needle aspiration (FNA) cytology should be performed with near-patient assessment of the adequacy of the specimen by a cytopathologist. However, this is often not feasible. A cruder alternative is for the FNA practitioner to examine the gross appearances of the specimen and to try to predict the its quality. This study set out to determine the value of this approach. METHODS The study was conducted in tertiary public hospitals in New Zealand and the UK. FNA gross material grading was performed by a variety of pathologists on FNA samples taken using manual guidance and image guidance. The FNA gross material grade was compared with the findings on microscopic examination. RESULTS Nine out of 123 FNA samples were assessed as Grade 1 (unlikely to contain diagnostic material). All were subsequently reported as having insufficient diagnostic tissue on microscopic examination. Forty-two of the FNA samples were assessed as Grade 2 (possibly contains diagnostic material) and 46 as Grade 3 (probably contains diagnostic material). None from either of these grades was reported as showing insufficient diagnostic material on microscopic examination. Twenty-six cases were reported as Grade 4 (material suggesting a specific diagnosis). None of these was reported as showing insufficient diagnostic material on microscopic examination. The most common Grade 4 provisional diagnosis was that of a colloid cyst or colloid nodule of the thyroid (seven cases). Only two cases had misleading Grade 4 provisional diagnoses. Both were thought to be pus on gross examination but showed necrotic carcinoma on microscopic examination. CONCLUSIONS The gross appearances of FNA samples can usually predict the adequacy of the samples and sometimes predict the final microscopic diagnosis. However, near-patient microscopic assessment of FNA specimens is preferable if available.
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Affiliation(s)
- F Mayall
- The Department of Histopathology, Musgrove Park Hospital, Taunton, Somerset, UK.
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Abstract
Abstract
Continuity of patient care after discharge from hospital relies on effective discharge communication between the hospital doctors and the patient's general practitioner. The aim of this study was to investigate the effectiveness of discharge communication, in terms of its content and timing. The study involved analysing all discharge correspondence received by two city-based group practice medical centres over a period of one month. Three hundred and one pieces of discharge correspondence were scrutinised. These comprised 164 initial discharge summaries and 137 follow-up discharge letters. In general, information was more thoroughly and more accurately recorded in the follow-up letters than in the discharge summaries; however, there were significant delays in the receipt of the letters by the GPs. Results showed that there are many aspects of the correspondence between secondary and primary care which need improving. These include: improvement in the design of discharge correspondence forms; improvement in completing the forms; and improvement to the administrative systems for dispatching discharge correspondence. Although not specifically looked at in this study, we also believe that it would be useful for a mechanism to be set up for hospital pharmacists to establish links with their community colleagues in advance of a patient's discharge in order that the patient's pharmaceutical needs may be readily met in the community.
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Affiliation(s)
- D R Mottram
- School of Pharmacy, Liverpool John Moores University, Byrom Street, Liverpool, England L3 3AF
| | - S Slater
- School of Pharmacy, Liverpool John Moores University, Byrom Street, Liverpool, England L3 3AF
| | - P West
- Liverpool Family Health Services Authority
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Higgins MJ, Prowell TM, Blackford A, Slater S, Argani P, Green H, Khouri N, Blumenthal R, Garber JE, Stearns V. A short-term biomarker modulation prevention study of simvastatin in women at increased risk for breast cancer. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.1505] [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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37
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Stearns V, Jacobs LK, Tsangaris TN, Cheng Z, Slater S, Fackler MJ, Chao C, Bugarini R, Gabrielson E, Davidson NE. Association of vorinostat with decrease in gene expression of proliferation-related genes in tumors from women with newly diagnosed breast cancer. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.3097] [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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Saha A, Nguyen T, Watson C, Mills S, Madhani M, MacCallum P, Slater S. PO-62 The implementation of a simple step-wise intervention which dramatically improved the thromboprophylaxis rate in medical cancer patients. Thromb Res 2010. [DOI: 10.1016/s0049-3848(10)70112-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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39
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Meyers G, Subbiah N, Palmbach G, Dunn A, Abar F, Hayes-Lattin B, Gajewski J, Kovacsovics T, Slater S, Jacoby C, Allen B, Maziarz R. Addition Of Busulfan To Fludarabine And Total Body Irradiation Conditioned Allogeneic Hematopoietic Stem Cell Transplantation Enhances Donor T-Cell Engraftment And Optimizes Disease Control. Biol Blood Marrow Transplant 2010. [DOI: 10.1016/j.bbmt.2009.12.399] [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: 10/19/2022]
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Slater S, Crawford MJ, Kabbouche MA, LeCates SL, Cherney S, Vaughan P, Segers A, Manning P, Burdine D, Powers SW, Hershey AD. Effects of Gender and Age on Paediatric Headache. Cephalalgia 2009; 29:969-73. [DOI: 10.1111/j.1468-2982.2008.01827.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The aim of this study was to evaluate the impact of gender and age on headache characteristics and disability. Headache characteristics were assessed at an initial visit to a paediatric specialty care centre and five follow-up visits. A total number of 4121 patients were evaluated. Fifty-eight per cent of the sample was female. Boys were younger at their first headache and initial visit. They more frequently described headache pain as squeezing and location as top of the head. Girls reported more frequent and longer headaches. Girls more often described headache pain as sharp and location as back of the head. Age accounted for more variance than gender in headache severity, duration, frequency and disability. Gender differences exist in headache characteristics. Age is also an important factor in the variability in characteristics and disability. Longitudinal studies are needed to describe further the natural history of headaches in childhood and compare outcome between genders.
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Affiliation(s)
- S Slater
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center
| | - MJ Crawford
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center
| | - MA Kabbouche
- Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, OH, USA
- Division of Neurology, Cincinnati Children's Hospital Medical Center
| | - SL LeCates
- Division of Neurology, Cincinnati Children's Hospital Medical Center
| | - S Cherney
- Division of Neurology, Cincinnati Children's Hospital Medical Center
| | - P Vaughan
- Division of Neurology, Cincinnati Children's Hospital Medical Center
| | - A Segers
- Division of Neurology, Cincinnati Children's Hospital Medical Center
| | - P Manning
- Division of Neurology, Cincinnati Children's Hospital Medical Center
| | - D Burdine
- Division of Neurology, Cincinnati Children's Hospital Medical Center
| | - SW Powers
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center
- Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, OH, USA
| | - AD Hershey
- Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, OH, USA
- Division of Neurology, Cincinnati Children's Hospital Medical Center
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Stearns V, Jacobs LK, Tsangaris TN, Briest S, Lange JR, Slater S, Fackler M, Sugar E, Gabrielson E, Davidson NE. A pilot study evaluating surrogates of response to short-term vorinostat in women with newly diagnosed breast cancer. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e14508] [Citation(s) in RCA: 2] [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
e14508 Background: Epigenetic modifications contribute to breast cancer initiation and progression and may be reversible, thus representing an attractive area for new drug investigation. In preclinical breast cancer models, the histone deacetylase (HDAC) inhibitor suberoylanilide hydroxamic acid (SAHA, vorinostat) induces cell cycle arrest, apoptosis and differentiation. Methods: We evaluated the safety and tolerability of short term vorinostat in women with a primary clinical stage I-III histologically confirmed carcinoma of the breast on a core needle biopsy. Participants received vorinostat 300 mg PO bid for a total of 6 doses, the last dose 2 hours prior to surgery or biopsy. Peripheral blood mononuclear cells were collected at baseline and following the last vorinostat dose to determine histone acetylation. Baseline and post-treatment tumor specimens were collected for analysis of histone acetylation, candidate gene methylation and expression. Tissues were also collected from untreated controls. Paired t-tests and Fisher's exact tests were used to evaluate changes from baseline for continuous and categorical data, respectively. Results: From March 2006 to October 2008, 25 women signed an informed consent and initiated study drug. Median age was 55 and 80% had hormone receptor positive tumors. Twenty-two women took all 6 prescribed doses. One participant took 4 and one 5 doses due to insurance clearance delay; one received a single dose due to fatigue and abdominal pain. Study-related surgical delays did not occur. Grade 1 toxicities included diarrhea (28%), low white blood cell count (24%), and fatigue, taste alterations and nausea (16% each). Tissue and blood samples were successfully collected. Tissue was also collected from 25 untreated controls. No significant change was observed in the proliferation marker Ki67 following 3 days of agent administration. Modulation of apoptosis, histone acetylation and gene methylation will be presented. Conclusions: Short-term administration of vorinostat is feasible, safe, and allows for studies of biomarker modulation. The results will be used to design future studies in which vorinostat will be administered in combination with other targeted therapies or with other epigenetic modifiers. [Table: see text]
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Affiliation(s)
- V. Stearns
- Johns Hopkins School of Medicine, Baltimore, MD
| | | | | | - S. Briest
- Johns Hopkins School of Medicine, Baltimore, MD
| | - J. R. Lange
- Johns Hopkins School of Medicine, Baltimore, MD
| | - S. Slater
- Johns Hopkins School of Medicine, Baltimore, MD
| | - M. Fackler
- Johns Hopkins School of Medicine, Baltimore, MD
| | - E. Sugar
- Johns Hopkins School of Medicine, Baltimore, MD
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Hanson M, Connolly S, Slater S. The subdermal etonogestrel implant is a safe and acceptable post-abortal method of long-term contraception. Contraception 2008. [DOI: 10.1016/j.contraception.2008.04.030] [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]
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Anderson E, Berg J, Black R, Bradshaw N, Campbell J, Carnaghan H, Cetnarkyj R, Drummond S, Davidson R, Dunlop J, Fordyce A, Gibbons B, Goudie D, Gregory H, Holloway S, Longmuir M, McLeish L, Murday V, Miedzybrodska Z, Nicholson D, Pearson P, Porteous M, Reis M, Slater S, Smith K, Smyth E, Snadden L, Steel M, Stirling D, Watt C, Whyte C, Young D. Prospective surveillance of women with a family history of breast cancer: auditing the risk threshold. Br J Cancer 2008; 98:840-4. [PMID: 18283300 PMCID: PMC2259176 DOI: 10.1038/sj.bjc.6604155] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
To evaluate current guidelines criteria for inclusion of women in special ‘breast cancer family history’ surveillance programmes, records were reviewed of women referred to Scottish breast cancer family clinics between January 1994 and December 2003 but discharged as at ‘less than ‘moderate’ familial risk’. The Scottish Cancer Registry was then interrogated to determine subsequent age-specific incidence of breast cancer in this cohort and corresponding Scottish population figures. Among 2074 women, with an average follow-up of 4.0 years, 28 invasive breast cancers were recorded up to December 2003, where 14.4 were expected, a relative risk (RR) of 1.94. Eleven further breast cancers were recorded between January 2004 and February 2006 (ascertainment incomplete for this period). The overall RR for women in the study cohort exceeded the accepted ‘cutoff’ level (RR=1.7) for provision of special counselling and surveillance. The highest RR was found for the age group 45–59 years and this group also generated the majority of breast cancers. The National Institute for Clinical Excellence (‘NICE’) guidelines appear to be more accurate than those of the Scottish Intercollegiate Guidelines Network (‘SIGN’) in defining ‘moderate’ familial risk, and longer follow-up of this cohort could generate an evidence base for further modification of familial breast cancer services.
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Affiliation(s)
- E Anderson
- Edinburgh Breast Cancer Family Service, Department of Clinical Genetics and Edinburgh Breast Unit, Western General Hospital, Edinburgh EH4 2XU, UK
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Barnetson RA, Devlin L, Miller J, Farrington SM, Slater S, Drake AC, Campbell H, Dunlop MG, Porteous ME. Germline mutation prevalence in the base excision repair gene, MYH, in patients with endometrial cancer. Clin Genet 2007; 72:551-5. [PMID: 17956577 DOI: 10.1111/j.1399-0004.2007.00900.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Germline mutations in the base excision repair gene, MutY human homolog (MYH), have recently been associated with a recessively inherited multiple adenoma polyposis syndrome and colorectal cancer. The spectrum of extracolonic lesions is still being characterized, although preliminary reports suggest that bi-allelic mutation carriers may share some of the clinical features of other hereditary colon cancer syndromes. Of 225 endometrial cancer patients, we identified one individual as a compound heterozygote, carrying mutations Y165C and G382D of MYH, and five individuals with heterozygous defects (three G382D and two Y165C). The patient with the bi-allelic Y165C/G382D mutation also had a sebaceous carcinoma, a feature of Muir-Torre syndrome. Although several intronic polymorphisms were detected in the heterozygous carriers, no other pathogenic variants were identified. While not conclusive, this novel and interesting finding provides evidence that bi-allelic germline mutations in MYH may increase susceptibility to endometrial cancer.
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Affiliation(s)
- R A Barnetson
- Colon Cancer Genetics Group, University of Edinburgh Cancer Research Centre and MRC Human Genetics Unit, Western General Hospital, Edinburgh, UK.
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Hurst D, Moss M, Slater S, Sanders C. Can Healthcare Associated Infection (HAI) Rates Related to Clostridium difficile Be Reduced to Zero by Applying the Lessons Learned from the SENIC Project? Am J Infect Control 2007. [DOI: 10.1016/j.ajic.2007.04.217] [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: 10/23/2022]
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Slater S. Cervical screening: striving for outcome beyond expectation. Cytopathology 2006; 17:107-9. [PMID: 16719851 DOI: 10.1111/j.1365-2303.2006.00369.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
We have investigated the contaminating bacteria in primary hip arthroplasty and their sensitivity to the prophylactic antibiotics currently in use. Impressions (627) of the gloved hands of the surgical team in 50 total hip arthroplasties were obtained on blood agar. The gloves were changed after draping, at intervals of 20 minutes thereafter, and before using cement. Changes were also undertaken whenever a visible puncture was detected. The culture plates were incubated at 37°C for 48 hours. Isolates were identified and tested for sensitivity to flucloxacillin, which is a recognised indicator of sensitivity to cefuroxime. They were also tested against other agents depending upon their appearance on Gram staining. We found contamination in 57 (9%) impressions and 106 bacterial isolates. Coagulase-negative staphylococci were seen most frequently (68.9%), but we also isolated Micrococcus (12.3%), diphtheroids (9.4%), Staphylococcus aureus (6.6%) and Escherichia coli (0.9%). Of the coagulase-negative staphylococci, only 52.1% were sensitive to flucloxacillin and therefore to cefuroxime. We believe that it is now appropriate to review the relevance of prophylaxis with cefuroxime and to consider the use of other agents.
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Affiliation(s)
- M Al-Maiyah
- James Cook University Hospital, Middlesbrough, TS4 3BW, England, UK.
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Howarth D, Slater S, Lau P, Booker J, Clark D, Sillar R. Complementary role of adjunctive breast magnetic resonance imaging and scintimammography in patients of all ages undergoing breast cancer surgery. ACTA ACUST UNITED AC 2005; 49:289-97. [PMID: 16026435 DOI: 10.1111/j.1440-1673.2005.01438.x] [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] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The aims of this study were to assess breast MRI and scintimammography (SMM) for the detection of breast cancer, and to determine any complementary role of these tests to each other and conventional imaging. Seventy-two patients (age 35-81 years) with a suspicious breast mass were investigated by mammography, breast ultrasound, breast MRI and SMM before undergoing surgical excision of the breast mass. Sensitivity, specificity and area under receiver operator characteristic curves were calculated for each test. Of the 72 patients, there were 66 proven malignant tumours, including two patients with bilateral breast cancer. When comparing the diagnostic sensitivity of breast MRI and SMM for lesion size, both tests showed higher sensitivities for lesions >25 mm in size, particularly for SMM. When these tests were compared for patient age, patients less than 51 years showed higher sensitivities for both tests. This was statistically significant for breast MRI. The overall respective diagnostic sensitivities for mammography, mammography with breast ultrasound, breast MRI and SMM were 56, 67, 86 and 85%. The differences were significant between mammography, mammography/ultrasound and both breast MRI and SMM. Breast MRI and SMM offer incremental diagnostic advantage in the diagnosis of breast cancer. Although improved diagnostic accuracy is seen in patients of all ages, those patients less than 51 years of age receive the greatest diagnostic benefit.
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Affiliation(s)
- D Howarth
- Hunter Imaging Group, Pacific Medical Imaging, Newcastle, New South Wales, Australia.
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Abstract
AIMS To evaluate barriers to following dietary recommendations in patients with Type 2 diabetes. METHODS We conducted focus groups and surveys in urban and suburban VA and academic medical centres. For the written survey, a self-administered questionnaire was mailed to a random sample of 446 patients with diabetes. For the focus groups, six groups of patients with diabetes (three urban, three suburban) were conducted, with 6-12 participants in each group. The focus groups explored barriers across various types of diabetes self-management; we extracted all comments relevant to barriers that limited patients' ability to follow a recommended diet. RESULTS The written survey measured the burden of diabetes therapies (on a seven-point rating scale). Moderate diet was seen as a greater burden than oral agents (median 1 vs. 0, P = 0.001), but less of a burden than insulin (median 1 vs. 4, P < 0.001). A strict diet aimed at weight loss was rated as being similarly burdensome to insulin (median 4 vs. 4, P = NS). Despite this, self-reported adherence was much higher for both pills and insulin than it was for a moderate diet. In the focus groups, the most commonly identified barrier was the cost (14/14 reviews), followed by small portion sizes (13/14 reviews), support and family issues (13/14 reviews), and quality of life and lifestyle issues (12/14 reviews). Patients in the urban site, who were predominantly African-American, noted greater difficulties communicating with their provider about diet and social circumstances, and also that the rigid schedule of a diabetes diet was problematic. CONCLUSIONS Barriers to adherence to dietary therapies are numerous, but some, such as cost, and in the urban setting, communication with providers, are potentially remediable. Interventions aimed at improving patients' ability to modify their diet need to specifically address these areas. Furthermore, treatment guidelines need to consider patients' preferences and barriers when setting goals for treatment.
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Affiliation(s)
- S Vijan
- Veterans Affairs Center for Practice Management & Outcomes Research, Ann Arbor, MI, USA.
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