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Ladekarl M, Nøhr AK, Sønderkær M, Dahl SC, Sunde L, Vestereghem C, Mapendano CK, Haslund CA, Pagh A, Carus A, Lörincz T, Nowicka-Matus K, Poulsen LØ, Laursen RJ, Dybkær K, Poulsen BK, Frøkjær JB, Brügmann AH, Ernst A, Wanders A, Bøgsted M, Pedersen IS. Feasibility and early clinical impact of precision medicine for late-stage cancer patients in a regional public academic hospital. Acta Oncol 2023; 62:261-271. [PMID: 36905645 DOI: 10.1080/0284186x.2023.2185542] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
Abstract
AIM Our goal was to describe a precision medicine program in a regional academic hospital, characterize features of included patients and present early data on clinical impact. MATERIALS AND METHODS We prospectively included 163 eligible patients with late-stage cancer of any diagnosis from June 2020 to May 2022 in the Proseq Cancer trial. Molecular profiling of new or fresh frozen tumor biopsies was done by WES and RNAseq with parallel sequencing of non-tumoral DNA as individual reference. Cases were presented at a National Molecular Tumor Board (NMTB) for discussion of targeted treatment. Subsequently, patients were followed for at least 7 months. RESULTS 80% (N = 131) of patients had a successful analysis done, disclosing at least one pathogenic or likely pathogenic variant in 96%. A strongly or potentially druggable variant was found in 19% and 73% of patients, respectively. A germline variant was identified in 2.5%. Median time from trial inclusion to NMTB decision was one month. One third (N = 44) of patients who underwent molecularly profiling were matched with a targeted treatment, however, only 16% were either treated (N = 16) or are waiting for treatment (N = 5), deteriorating performance status being the primary cause of failure. A history of cancer among 1st degree relatives, and a diagnosis of lung or prostate cancer correlated with greater chance of targeted treatment being available. The response rate of targeted treatments was 40%, the clinical benefit rate 53%, and the median time on treatment was 3.8 months. 23% of patients presented at NMTB were recommended clinical trial participation, not dependent on biomarkers. CONCLUSIONS Precision medicine in end-stage cancer patients is feasible in a regional academic hospital but should continue within the frame of clinical protocols as few patients benefit. Close collaboration with comprehensive cancer centers ensures expert evaluations and equality in access to early clinical trials and modern treatment.
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Affiliation(s)
- Morten Ladekarl
- Department of Oncology and Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Anne Krogh Nøhr
- Center for Clinical Data Science, Aalborg University and Aalborg University Hospital, Aalborg, Denmark.,Center for Molecular Prediction of Inflammatory Bowel Disease (PREDICT), Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Mads Sønderkær
- Molecular Diagnostics and Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark
| | - Simon Christian Dahl
- Center for Clinical Data Science, Aalborg University and Aalborg University Hospital, Aalborg, Denmark
| | - Lone Sunde
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Department of Clinical Genetics, Aalborg University Hospital, Aalborg, Denmark
| | - Charles Vestereghem
- Center for Clinical Data Science, Aalborg University and Aalborg University Hospital, Aalborg, Denmark
| | - Christophe Kamungu Mapendano
- Department of Oncology and Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Genetics, Aalborg University Hospital, Aalborg, Denmark
| | - Charlotte Aaquist Haslund
- Department of Oncology and Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark
| | - Anja Pagh
- Department of Oncology and Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark
| | - Andreas Carus
- Department of Oncology and Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Tamás Lörincz
- Department of Oncology and Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark
| | - Kinga Nowicka-Matus
- Department of Oncology and Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark
| | - Laurids Ø Poulsen
- Department of Oncology and Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | | | - Karen Dybkær
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Department of Hematology, Aalborg University Hospital, Aalborg, Denmark
| | - Birgitte Klindt Poulsen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Department of Clinical Pharmacology, Aalborg University Hospital, Aalborg, Denmark
| | - Jens Brøndum Frøkjær
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Department of Radiology, Aalborg University Hospital, Aalborg, Denmark
| | - Anja Høegh Brügmann
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Department of Pathology, Aalborg University Hospital, Aalborg, Denmark
| | - Anja Ernst
- Molecular Diagnostics and Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark
| | - Alkwin Wanders
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Department of Pathology, Aalborg University Hospital, Aalborg, Denmark
| | - Martin Bøgsted
- Center for Clinical Data Science, Aalborg University and Aalborg University Hospital, Aalborg, Denmark.,Center for Molecular Prediction of Inflammatory Bowel Disease (PREDICT), Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Inge Søkilde Pedersen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Molecular Diagnostics and Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark
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Milo M, Lörincz T, Nielsen M, Kamby C, Bechmann T, Al-Rawi S, Matthiessen L, Krause M, Schreiber A, Mjaaland I, Kasti U, Brix E, kedzierawski P, Marinko T, kirkove C, Overgaard J, Offersen B. OC-0829 Acute toxicity after loco regional breast radiation therapy in the randomized DBCG SKAGEN trial 1. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02693-7] [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]
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Milo MLH, Offersen BV, Bechmann T, Diederichsen ACP, Hansen CR, Holtved E, Josipovic M, Lörincz T, Maraldo MV, Nielsen MH, Nordsmark M, Nyström PW, Pøhl M, Rose HK, Schytte T, Yates ES, Lorenzen EL. Delineation of whole heart and substructures in thoracic radiation therapy: National guidelines and contouring atlas by the Danish Multidisciplinary Cancer Groups. Radiother Oncol 2020; 150:121-127. [PMID: 32544606 DOI: 10.1016/j.radonc.2020.06.015] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 06/10/2020] [Accepted: 06/10/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND PURPOSE This study presents Danish consensus guidelines for delineation of the heart and cardiac substructures across relevant Danish Multidisciplinary Cancer Groups. MATERIAL AND METHODS Consensus guidelines for the heart and cardiac substructures were reached among 15 observers representing the radiotherapy (RT) committees of four Danish Multidisciplinary Cancer Groups. The guidelines were validated on CT scans of 12 patients, each with five independent contour sets. The Sørensen-Dice similarity coefficient (DSC), the distance between the centers of the arteries and the mean surface distance were used to evaluate the inter-observer variation. RESULTS National guidelines for contouring the heart and cardiac substructures were achieved. The median DSC was 0.78-0.96 for the heart and the four cardiac chambers. For the four substructures of the left ventricle, the median DSC was 0.35-0.57. The coronary arteries were contoured in ten segments, with the best agreement for the left anterior descending coronary artery segments, with a median distance between the arteries ranging from 2.4-4.4 mm. The median variation was 3.7-12.8 mm for the right coronary artery segments and 3.7-6.2 mm for the left circumflex coronary artery segments, with the most pronounced inter-observer variation in the distal segment for all three coronary arteries. CONCLUSION National guidelines for contouring the heart and cardiac substructures were developed across relevant Danish Multidisciplinary Cancer Groups, where RT dose to the heart is of concern. The inter-observer contour overlap was best for the heart and chambers and decreased for smaller structures.
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Affiliation(s)
- Marie Louise Holm Milo
- Aarhus University Hospital, Department of Experimental Clinical Oncology, Aarhus, Denmark.
| | - Birgitte Vrou Offersen
- Aarhus University Hospital, Department of Experimental Clinical Oncology, Aarhus, Denmark; Aarhus University Hospital, Department of Oncology, Aarhus, Denmark; Danish Centre for Particle Therapy, Aarhus, Denmark
| | - Troels Bechmann
- Lillebaelt Hospital, University Hospital of Southern Denmark, Department of Oncology, Vejle, Denmark; Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | | | - Christian Rønn Hansen
- Danish Centre for Particle Therapy, Aarhus, Denmark; Odense University Hospital, Laboratory of Radiation Physics, Odense, Denmark; University of Southern Denmark, Institute of Clinical Research, Odense, Denmark
| | - Eva Holtved
- Odense University Hospital, Department of Oncology, Odense, Denmark
| | - Mirjana Josipovic
- Rigshospitalet, Department of Oncology, Copenhagen University Hospital, Denmark
| | - Tamás Lörincz
- Aalborg University Hospital, Department of Oncology, Aalborg, Denmark
| | - Maja Vestmø Maraldo
- Rigshospitalet, Department of Oncology, Copenhagen University Hospital, Denmark
| | | | - Marianne Nordsmark
- Aarhus University Hospital, Department of Oncology, Aarhus, Denmark; Danish Centre for Particle Therapy, Aarhus, Denmark
| | - Petra Witt Nyström
- Danish Centre for Particle Therapy, Aarhus, Denmark; Skandion Clinic, Uppsala, Sweden
| | - Mette Pøhl
- Rigshospitalet, Department of Oncology, Copenhagen University Hospital, Denmark
| | - Hanne Krogh Rose
- Aarhus University Hospital, Department of Oncology, Aarhus, Denmark
| | - Tine Schytte
- Odense University Hospital, Department of Oncology, Odense, Denmark
| | - Esben Svitzer Yates
- Danish Centre for Particle Therapy, Aarhus, Denmark; Aarhus University Hospital, Department of Medical Physics, Aarhus, Denmark
| | - Ebbe Laugaard Lorenzen
- Danish Centre for Particle Therapy, Aarhus, Denmark; Odense University Hospital, Laboratory of Radiation Physics, Odense, Denmark
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