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Philipps L, Foster S, Gardiner D, Gath J, Gillman A, Haviland J, Hill E, King D, Manning G, Stiles M, Hall E, Lewis R. Study within a trial of electronic versus paper-based Patient-Reported oUtcomes CollEction (SPRUCE): study protocol for a partially randomised patient preference study. BMJ Open 2023; 13:e073817. [PMID: 37734892 PMCID: PMC10514621 DOI: 10.1136/bmjopen-2023-073817] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 08/30/2023] [Indexed: 09/23/2023] Open
Abstract
INTRODUCTION Patient-reported outcomes (PRO) are currently collected from trial participants using paper questionnaires by the Clinical Trials and Statistics Unit at The Institute of Cancer Research (ICR-CTSU). Streamlining PRO collection using electronic questionnaires (ePRO) may improve data collection and patient experience. Here, we outline our protocol for a Study within a trial of electronic versus paper-based Patient-Reported oUtcomes CollEction (SPRUCE), which investigates the acceptability of ePRO in oncology clinical trials. METHODS AND ANALYSIS SPRUCE was developed alongside patient and public contributors. SPRUCE runs in multiple host trials with a partially randomised patient preference design, allowing participants to be randomised or choose their preference of electronic or paper questionnaires. Questionnaires are scheduled in accordance with host trial follow-up. The primary objective will assess differences in return rates (compliance) between ePRO and paper PROs at the first timepoint post-host trial intervention in the randomised group. Paper PRO compliance is expected to be 90%. 244 randomised participants are required to exclude ≤80% compliance rates with ePRO (10% non-inferiority margin, with 80% power and one-sided alpha=0.05). SPRUCE aims to assess acceptability of ePRO in oncology clinical trials, establish whether ePRO is acceptable to ICR-CTSU trial participants and can capture complete PRO data, consistent with paper PROs. ETHICS AND DISSEMINATION The SPRUCE protocol (ICR-CTSU/2021/10074) was approved by the Coventry and Warwick Central Research Ethics Committee (21/WM/0223) on 21 October 2021. Results will be disseminated via presentations, publications and lay summaries. No participant identifiable data will be included. TRIAL REGISTRATION SWAT169.
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Affiliation(s)
- Lara Philipps
- Clinical Trials and Statistics Unit (ICR-CTSU), The Institute of Cancer Research, London, UK
| | - Stephanie Foster
- Clinical Trials and Statistics Unit (ICR-CTSU), The Institute of Cancer Research, London, UK
| | - Deborah Gardiner
- Clinical Trials and Statistics Unit (ICR-CTSU), The Institute of Cancer Research, London, UK
| | - Jacqui Gath
- Independent Patient Representative, London, UK
| | - Alexa Gillman
- Clinical Trials and Statistics Unit (ICR-CTSU), The Institute of Cancer Research, London, UK
| | - Joanne Haviland
- Pragmatic Clinical Trials Unit, Queen Mary University of London, London, UK
| | - Elizabeth Hill
- Clinical Trials and Statistics Unit (ICR-CTSU), The Institute of Cancer Research, London, UK
| | - Diana King
- Independent Patient Representative, London, UK
| | - Georgina Manning
- Clinical Trials and Statistics Unit (ICR-CTSU), The Institute of Cancer Research, London, UK
| | - Morgaine Stiles
- Clinical Trials and Statistics Unit (ICR-CTSU), The Institute of Cancer Research, London, UK
| | - Emma Hall
- Clinical Trials and Statistics Unit (ICR-CTSU), The Institute of Cancer Research, London, UK
| | - Rebecca Lewis
- Clinical Trials and Statistics Unit (ICR-CTSU), The Institute of Cancer Research, London, UK
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Melin J, Cano SJ, Gillman A, Marquis S, Flöel A, Göschel L, Pendrill LR. Traceability and comparability through crosswalks with the NeuroMET Memory Metric. Sci Rep 2023; 13:5179. [PMID: 36997632 PMCID: PMC10063602 DOI: 10.1038/s41598-023-32208-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 03/24/2023] [Indexed: 04/01/2023] Open
Abstract
AbstractAccurate assessment of memory ability for persons on the continuum of Alzheimer’s disease (AD) is vital for early diagnosis, monitoring of disease progression and evaluation of new therapies. However, currently available neuropsychological tests suffer from a lack of standardization and metrological quality assurance. Improved metrics of memory can be created by carefully combining selected items from legacy short-term memory tests, whilst at the same time retaining validity, and reducing patient burden. In psychometrics, this is known as “crosswalks” to link items empirically. The aim of this paper is to link items from different types of memory tests. Memory test data were collected from the European EMPIR NeuroMET and the SmartAge studies recruited at Charité Hospital (Healthy controls n = 92; Subjective cognitive decline n = 160; Mild cognitive impairment n = 50; and AD n = 58; age range 55–87). A bank of items (n = 57) was developed based on legacy short-term memory items (i.e., Corsi Block Test, Digit Span Test, Rey’s Auditory Verbal Learning Test, Word Learning Lists from the CERAD test battery and Mini Mental State Examination; MMSE). The NeuroMET Memory Metric (NMM) is a composite metric that comprises 57 dichotomous items (right/wrong). We previously reported on a preliminary item bank to assess memory based on immediate recall, and have now demonstrated direct comparability of measurements generated from the different legacy tests. We created crosswalks between the NMM and the legacy tests and between the NMM and the full MMSE using Rasch analysis (RUMM2030) and produced two conversion tables. Measurement uncertainties for estimates of person memory ability with the NMM across the full span were smaller than all individual legacy tests, which demonstrates the added value of the NMM. Comparisons with one (MMSE) of the legacy tests showed however higher measurement uncertainties of the NMM for people with a very low memory ability (raw score ≤ 19). The conversion tables developed through crosswalks in this paper provide clinicians and researchers with a practical tool to: (i) compensate for ordinality in raw scores, (ii) ensure traceability to make reliable and valid comparisons when measuring person ability, and (iii) enable comparability between test results from different legacy tests.
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Philipps L, Foster S, Gardiner D, Gillman A, Haviland J, Hill E, Manning G, Stiles M, Hall E, Lewis R. Considerations when introducing electronic patient-reported outcome data capture in multicentre oncology randomised controlled trials. Trials 2022; 23:1004. [PMID: 36510242 PMCID: PMC9744038 DOI: 10.1186/s13063-022-06955-w] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 11/19/2022] [Indexed: 12/15/2022] Open
Affiliation(s)
- Lara Philipps
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, SM2 5NG, UK.
| | - Stephanie Foster
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, SM2 5NG, UK
| | - Deborah Gardiner
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, SM2 5NG, UK
| | - Alexa Gillman
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, SM2 5NG, UK
| | - Joanne Haviland
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, SM2 5NG, UK
| | - Elizabeth Hill
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, SM2 5NG, UK
| | - Georgina Manning
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, SM2 5NG, UK
| | - Morgaine Stiles
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, SM2 5NG, UK
| | - Emma Hall
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, SM2 5NG, UK
| | - Rebecca Lewis
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, SM2 5NG, UK
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Marquis H, Deidda D, Gillman A, Willowson KP, Gholami Y, Hioki T, Eslick E, Thielemans K, Bailey DL. Theranostic SPECT reconstruction for improved resolution: application to radionuclide therapy dosimetry. EJNMMI Phys 2021; 8:16. [PMID: 33598750 PMCID: PMC7889770 DOI: 10.1186/s40658-021-00362-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 02/02/2021] [Indexed: 12/20/2022] Open
Abstract
Background SPECT-derived dose estimates in tissues of diameter less than 3× system resolution are subject to significant losses due to the limited spatial resolution of the gamma camera. Incorporating resolution modelling (RM) into the SPECT reconstruction has been proposed as a possible solution; however, the images produced are prone to noise amplification and Gibbs artefacts. We propose a novel approach to SPECT reconstruction in a theranostic setting, which we term SPECTRE (single photon emission computed theranostic reconstruction); using a diagnostic PET image, with its superior resolution, to guide the SPECT reconstruction of the therapeutic equivalent. This report demonstrates a proof in principle of this approach. Methods We have employed the hybrid kernelised expectation maximisation (HKEM) algorithm implemented in STIR, with the aim of producing SPECT images with PET-equivalent resolution. We demonstrate its application in both a dual 68Ga/177Lu IEC phantom study and a clinical example using 64Cu/67Cu. Results SPECTRE is shown to produce images comparable in accuracy and recovery to PET with minimal introduction of artefacts and amplification of noise. Conclusion The SPECTRE approach to image reconstruction shows improved quantitative accuracy with a reduction in noise amplification. SPECTRE shows great promise as a method of improving SPECT radioactivity concentrations, directly leading to more accurate dosimetry estimates in small structures and target lesions. Further investigation and optimisation of the algorithm parameters is needed before this reconstruction method can be utilised in a clinical setting.
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Affiliation(s)
- H Marquis
- Sydney Vital Translational Cancer Research Centre, Sydney, Australia.,Institute of Medical Physics, University of Sydney, Sydney, Australia
| | - D Deidda
- National Physical Laboratory, Teddington, UK
| | - A Gillman
- Australian e-Health Research Centre, CSIRO, Brisbane, Australia
| | - K P Willowson
- Department of Nuclear Medicine, Royal North Shore Hospital, Sydney, Australia
| | - Y Gholami
- Sydney Vital Translational Cancer Research Centre, Sydney, Australia.,Institute of Medical Physics, University of Sydney, Sydney, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - T Hioki
- Institute of Medical Physics, University of Sydney, Sydney, Australia
| | - E Eslick
- Department of Nuclear Medicine, Royal North Shore Hospital, Sydney, Australia
| | - K Thielemans
- Institute of Nuclear Medicine, University College London, London, UK
| | - D L Bailey
- Sydney Vital Translational Cancer Research Centre, Sydney, Australia. .,Department of Nuclear Medicine, Royal North Shore Hospital, Sydney, Australia. .,Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
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Antoniou M, Kolamunnage-Dona R, Wason J, Bathia R, Billingham C, Bliss J, Brown L, Gillman A, Paul J, Jorgensen A. Biomarker-guided trials: Challenges in practice. Contemp Clin Trials Commun 2019; 16:100493. [PMID: 31788574 PMCID: PMC6879976 DOI: 10.1016/j.conctc.2019.100493] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 11/06/2019] [Accepted: 11/13/2019] [Indexed: 12/14/2022] Open
Abstract
Biomarker-guided trials have drawn considerable attention as they promise to lead to improvements in the benefit-risk ratio of treatments and enhanced opportunities for drug development. A variety of such designs have been proposed in the literature, many of which have been adopted in practice. Implementing such trial designs in practice can be challenging, and identifying those challenges was the main objective of a workshop organised by the MRC Hubs for Trials Methodology Research Network's Stratified Medicine Working Group in March 2017. Participants reflected on completed and ongoing biomarker-guided trials to identify the practical challenges encountered. Here, the key challenges identified during the workshop including those related to funding, ethical and regulatory issues, recruitment, monitoring of samples and laboratories, biomarker assessment, and data sharing and resources, are discussed. Despite the complexities often associated with biomarker-guided trials, the workshop concluded that they can play an important role in advancing the field of personalised medicine. Therefore, it is important that the practical challenges surrounding their implementation are acknowledged and addressed.
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Affiliation(s)
| | | | - J. Wason
- Newcastle University and MRC Biostatistics Unit, Cambridge, UK
| | | | | | - J.M. Bliss
- Institute of Cancer Research, London, UK
| | | | - A. Gillman
- Institute of Cancer Research, London, UK
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Duley L, Gillman A, Duggan M, Belson S, Knox J, McDonald A, Rawcliffe C, Simon J, Sprosen T, Watson J, Wood W. What are the main inefficiencies in trial conduct: a survey of UKCRC registered clinical trials units in the UK. Trials 2018; 19:15. [PMID: 29310685 PMCID: PMC5759880 DOI: 10.1186/s13063-017-2378-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 12/06/2017] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The UK Clinical Research Collaboration (UKCRC) registered Clinical Trials Units (CTUs) Network aims to support high-quality, efficient and sustainable clinical trials research in the UK. To better understand the challenges in efficient trial conduct, and to help prioritise tackling these challenges, we surveyed CTU staff. The aim was to identify important inefficiencies during two key stages of the trial conduct life cycle: (i) from grant award to first participant, (ii) from first participant to reporting of final results. METHODS Respondents were asked to list their top three inefficiencies from grant award to recruitment of the first participant, and from recruitment of the first participant to publication of results. Free text space allowed respondents to explain why they thought these were important. The survey was constructed using SurveyMonkey and circulated to the 45 registered CTUs in May 2013. Respondents were asked to name their unit and job title, but were otherwise anonymous. Free-text responses were coded into broad categories. RESULTS There were 43 respondents from 25 CTUs. The top inefficiency between grant award and recruitment of first participant was reported as obtaining research and development (R&D) approvals by 23 respondents (53%), contracts by 22 (51%), and other approvals by 13 (30%). The top inefficiency from recruitment of first participant to publication of results was failure to meet recruitment targets, reported by 19 (44%) respondents. A common comment was that this reflected overoptimistic or inaccurate estimates of recruitment at site. Data management, including case report form design and delays in resolving data queries with sites, was reported as an important inefficiency by 11 (26%) respondents, and preparation and submission for publication by 9 (21%). CONCLUSIONS Recommendations for improving the efficiency of trial conduct within the CTUs network include: further reducing unnecessary bureaucracy in approvals and contracting; improving training for site staff; realistic recruitment targets and appropriate feasibility; developing training across the network; improving the working relationships between chief investigators and units; encouraging funders to release sufficient funding to allow prompt recruitment of trial staff; and encouraging more research into how to improve the efficiency and quality of trial conduct.
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Affiliation(s)
- Lelia Duley
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - Alexa Gillman
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - Marian Duggan
- Cancer Research UK & UCL Cancer Trials Centre, London, UK
| | - Stephanie Belson
- Formally of Leicester Clinical Trials Unit, University of Leicester, Leicester, UK
| | - Jill Knox
- Barts Clinical Trials Unit, Queen Mary University of London, London, UK
| | - Alison McDonald
- Centre for Healthcare Randomised Trials, University of Aberdeen, Aberdeen, UK
| | - Charlotte Rawcliffe
- Cancer Research UK, Liverpool Cancer Trials Unit, University of Liverpool, Liverpool, UK
| | - Joanne Simon
- Formally of Bristol Randomised Trial Collaboration, University of Bristol, Bristol, UK
| | - Tim Sprosen
- Oxford Clinical Trial Service Unit & Epidemiological Studies Unit, University of Oxford, Oxford, UK
| | - Jude Watson
- York Trials Unit, University of York, York, UK
| | - Wendy Wood
- NIHR RDS South Central, University of Southampton, Southampton, UK
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Kronborg C, Pumar M, Gillman A. CGR 10: WHEN HER ITCH TURNED BLUE AND HER BLOOD A CHOCOLATE BROWN HUE: ACQUIRED METHAEMOGLOBINAEMIA SECONDARY TO OMALIZUMAB IN TREATMENT-RESISTANT CHRONIC IDIOPATHIC URTICARIA. Intern Med J 2017. [DOI: 10.1111/imj.10_13579] [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: 11/28/2022]
Affiliation(s)
| | - M Pumar
- Alfred Health; Melbourne Australia
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Pumar M, Gillman A. P21: SKIN TESTING AND ORAL CHALLENGE FOR PENICILLIN ALLERGY: A SINGLE CENTRE EXPERIENCE. Intern Med J 2017. [DOI: 10.1111/imj.21_13578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- M Pumar
- The Alfred Hospital; Melbourne Victoria Australia
| | - A Gillman
- The Alfred Hospital; Melbourne Victoria Australia
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Goodall J, Mateo J, Yuan W, Mossop H, Porta N, Miranda S, Perez-Lopez R, Dolling D, Robinson DR, Sandhu S, Fowler G, Ebbs B, Flohr P, Seed G, Rodrigues DN, Boysen G, Bertan C, Atkin M, Clarke M, Crespo M, Figueiredo I, Riisnaes R, Sumanasuriya S, Rescigno P, Zafeiriou Z, Sharp A, Tunariu N, Bianchini D, Gillman A, Lord CJ, Hall E, Chinnaiyan AM, Carreira S, de Bono JS. Circulating Cell-Free DNA to Guide Prostate Cancer Treatment with PARP Inhibition. Cancer Discov 2017; 7:1006-1017. [PMID: 28450425 PMCID: PMC6143169 DOI: 10.1158/2159-8290.cd-17-0261] [Citation(s) in RCA: 299] [Impact Index Per Article: 42.7] [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: 03/14/2017] [Revised: 04/15/2017] [Accepted: 04/26/2017] [Indexed: 12/13/2022]
Abstract
Biomarkers for more precise patient care are needed in metastatic prostate cancer. We have reported a phase II trial (TOPARP-A) of the PARP inhibitor olaparib in metastatic prostate cancer, demonstrating antitumor activity associating with homologous recombination DNA repair defects. We now report targeted and whole-exome sequencing of serial circulating cell-free DNA (cfDNA) samples collected during this trial. Decreases in cfDNA concentration independently associated with outcome in multivariable analyses (HR for overall survival at week 8: 0.19; 95% CI, 0.06-0.56; P = 0.003). All tumor tissue somatic DNA repair mutations were detectable in cfDNA; allele frequency of somatic mutations decreased selectively in responding patients (χ2P < 0.001). At disease progression, following response to olaparib, multiple subclonal aberrations reverting germline and somatic DNA repair mutations (BRCA2, PALB2) back in frame emerged as mechanisms of resistance. These data support the role of liquid biopsies as a predictive, prognostic, response, and resistance biomarker in metastatic prostate cancer.Significance: We report prospectively planned, serial, cfDNA analyses from patients with metastatic prostate cancer treated on an investigator-initiated phase II trial of olaparib. These analyses provide predictive, prognostic, response, and resistance data with "second hit" mutations first detectable at disease progression, suggesting clonal evolution from treatment-selective pressure and platinum resistance. Cancer Discov; 7(9); 1006-17. ©2017 AACR.See related commentary by Domchek, p. 937See related article by Kondrashova et al., p. 984See related article by Quigley et al., p. 999This article is highlighted in the In This Issue feature, p. 920.
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Affiliation(s)
- Jane Goodall
- The Institute of Cancer Research, London, United Kingdom
| | - Joaquin Mateo
- The Institute of Cancer Research, London, United Kingdom
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Wei Yuan
- The Institute of Cancer Research, London, United Kingdom
| | - Helen Mossop
- The Institute of Cancer Research, London, United Kingdom
| | - Nuria Porta
- The Institute of Cancer Research, London, United Kingdom
| | - Susana Miranda
- The Institute of Cancer Research, London, United Kingdom
| | - Raquel Perez-Lopez
- The Institute of Cancer Research, London, United Kingdom
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - David Dolling
- The Institute of Cancer Research, London, United Kingdom
| | | | | | - Gemma Fowler
- The Institute of Cancer Research, London, United Kingdom
| | - Berni Ebbs
- The Institute of Cancer Research, London, United Kingdom
| | - Penny Flohr
- The Institute of Cancer Research, London, United Kingdom
| | - George Seed
- The Institute of Cancer Research, London, United Kingdom
| | - Daniel Nava Rodrigues
- The Institute of Cancer Research, London, United Kingdom
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Gunther Boysen
- The Institute of Cancer Research, London, United Kingdom
| | - Claudia Bertan
- The Institute of Cancer Research, London, United Kingdom
| | - Mark Atkin
- The Institute of Cancer Research, London, United Kingdom
| | - Matthew Clarke
- The Institute of Cancer Research, London, United Kingdom
| | - Mateus Crespo
- The Institute of Cancer Research, London, United Kingdom
| | | | - Ruth Riisnaes
- The Institute of Cancer Research, London, United Kingdom
| | - Semini Sumanasuriya
- The Institute of Cancer Research, London, United Kingdom
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Pasquale Rescigno
- The Institute of Cancer Research, London, United Kingdom
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Zafeiris Zafeiriou
- The Institute of Cancer Research, London, United Kingdom
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Adam Sharp
- The Institute of Cancer Research, London, United Kingdom
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Nina Tunariu
- The Institute of Cancer Research, London, United Kingdom
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Diletta Bianchini
- The Institute of Cancer Research, London, United Kingdom
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Alexa Gillman
- The Institute of Cancer Research, London, United Kingdom
| | | | - Emma Hall
- The Institute of Cancer Research, London, United Kingdom
| | | | | | - Johann S de Bono
- The Institute of Cancer Research, London, United Kingdom.
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
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Gibson PG, Reddel H, McDonald VM, Marks G, Jenkins C, Gillman A, Upham J, Sutherland M, Rimmer J, Thien F, Katsoulotos GP, Cook M, Yang I, Katelaris C, Bowler S, Langton D, Robinson P, Wright C, Yozghatlian V, Burgess S, Sivakumaran P, Jaffe A, Bowden J, Wark PAB, Yan KY, Kritikos V, Peters M, Hew M, Aminazad A, Bint M, Guo M. Effectiveness and response predictors of omalizumab in a severe allergic asthma population with a high prevalence of comorbidities: the Australian Xolair Registry. Intern Med J 2017; 46:1054-62. [PMID: 27350385 DOI: 10.1111/imj.13166] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 06/02/2016] [Accepted: 06/21/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND Severe asthma is a high impact disease. Omalizumab targets the allergic inflammatory pathway; however, effectiveness data in a population with significant comorbidities are limited. AIMS To describe severe allergic asthma, omalizumab treatment outcomes and predictors of response among the Australian Xolair Registry participants. METHODS A web-based post-marketing surveillance registry was established to characterise the use, effectiveness and adverse effects of omalizumab (Xolair) for severe allergic asthma. RESULTS Participants (n = 192) (mean age 51 years, 118 female) with severe allergic asthma from 21 clinics in Australia were assessed, and 180 received omalizumab therapy. They had poor asthma control (Asthma Control Questionnaire, ACQ-5, mean score 3.56) and significant quality of life impairment (Asthma-related Quality of Life Questionnaire score 3.57), and 52% were using daily oral corticosteroid (OCS). Overall, 95% had one or more comorbidities (rhinitis 48%, obesity 45%, cardiovascular disease 23%). The omalizumab responder rate, assessed by an improvement of at least 0.5 in ACQ-5, was high at 83%. OCS use was significantly reduced. The response in participants with comorbid obesity and cardiovascular disease was similar to those without these conditions. Baseline ACQ-5 ≥ 2.0 (P = 0.002) and older age (P = 0.05) predicted the magnitude of change in ACQ-5 in response to omalizumab. Drug-related adverse events included anaphylactoid reactions (n = 4), headache (n = 2) and chest pains (n = 1). CONCLUSION Australian patients with severe allergic asthma report a high disease burden and have extensive comorbidity. Symptomatic response to omalizumab was high despite significant comorbid disease. Omalizumab is an effective targeted therapy for severe allergic asthma with comorbidity in a real-life setting.
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Affiliation(s)
- P G Gibson
- Centre for Healthy Lungs, Department of Respiratory and Sleep Medicine, John Hunter Hospital, Hunter Medical Research Institute, University of Newcastle, Newcastle, New South Wales, Australia.
| | - H Reddel
- Department of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,University of Sydney, Liverpool Hospital, Sydney, New South Wales, Australia
| | - V M McDonald
- Centre for Healthy Lungs, Department of Respiratory and Sleep Medicine, John Hunter Hospital, Hunter Medical Research Institute, University of Newcastle, Newcastle, New South Wales, Australia.,School of Nursing and Midwifery, University of Newcastle, Newcastle, New South Wales, Australia
| | - G Marks
- Department of Respiratory Medicine, Liverpool Hospital, Sydney, New South Wales, Australia
| | - C Jenkins
- Department of Thoracic Medicine, Concord Hospital, Sydney, New South Wales, Australia
| | - A Gillman
- Department of Allergy, Immunology and Respiratory Medicine, Alfred Hospital, Melbourne, Victoria, Australia
| | - J Upham
- Department of Respiratory Medicine, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - M Sutherland
- Department of Respiratory and Sleep Medicine, Austin Hospital, Melbourne, Victoria, Australia
| | - J Rimmer
- St Vincent's Clinic, Campbelltown Hospital, Sydney, New South Wales, Australia
| | - F Thien
- Department of Respiratory Medicine, Box Hill Hospital, Melbourne, Victoria, Australia
| | - G P Katsoulotos
- St George Specialist Centre, Campbelltown Hospital, Sydney, New South Wales, Australia
| | - M Cook
- Department of Immunology, Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - I Yang
- Department of Thoracic Medicine, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - C Katelaris
- Department of Respiratory and Sleep Medicine, Campbelltown Hospital, Sydney, New South Wales, Australia
| | - S Bowler
- Department of Respiratory and Sleep Medicine, Mater Adult Hospital, Brisbane, Queensland, Australia
| | - D Langton
- Department of Thoracic Medicine, Frankston Hospital, Melbourne, Victoria, Australia
| | - P Robinson
- Department of Respiratory Medicine, Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - C Wright
- Department of Respiratory Medicine, Nambour Hospital, Nambour, Queensland, Australia
| | - V Yozghatlian
- Department of Respiratory and Sleep Medicine, St George Hospital, Sydney, New South Wales, Australia
| | - S Burgess
- QLD Children's Lung and Sleep Specialists, Brisbane, Queensland, Australia
| | - P Sivakumaran
- Department of Respiratory Medicine, Gold Coast District Hospital, Gold Coast, Queensland, Australia
| | - A Jaffe
- Department of Respiratory Medicine, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - J Bowden
- Department of Respiratory, Allergy and Sleep Medicine, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - P A B Wark
- Centre for Healthy Lungs, Department of Respiratory and Sleep Medicine, John Hunter Hospital, Hunter Medical Research Institute, University of Newcastle, Newcastle, New South Wales, Australia
| | - K Y Yan
- Department of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - V Kritikos
- Department of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - M Peters
- Department of Thoracic Medicine, Concord Hospital, Sydney, New South Wales, Australia
| | - M Hew
- Department of Allergy, Immunology and Respiratory Medicine, Alfred Hospital, Melbourne, Victoria, Australia
| | - A Aminazad
- Department of Respiratory Medicine, Box Hill Hospital, Melbourne, Victoria, Australia
| | - M Bint
- Department of Respiratory Medicine, Nambour Hospital, Nambour, Queensland, Australia
| | - M Guo
- Clinical Management, Woolcock Institute of Medical Research, Sydney, New South Wales, Australia
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Cameron D, Morden JP, Canney P, Velikova G, Coleman R, Bartlett J, Agrawal R, Banerji J, Bertelli G, Bloomfield D, Brunt AM, Earl H, Ellis P, Gaunt C, Gillman A, Hearfield N, Laing R, Murray N, Couper N, Stein RC, Verrill M, Wardley A, Barrett-Lee P, Bliss JM. Accelerated versus standard epirubicin followed by cyclophosphamide, methotrexate, and fluorouracil or capecitabine as adjuvant therapy for breast cancer in the randomised UK TACT2 trial (CRUK/05/19): a multicentre, phase 3, open-label, randomised, controlled trial. Lancet Oncol 2017; 18:929-945. [PMID: 28600210 PMCID: PMC5489700 DOI: 10.1016/s1470-2045(17)30404-7] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 03/28/2017] [Accepted: 05/10/2017] [Indexed: 01/24/2023]
Abstract
BACKGROUND Adjuvant chemotherapy for early breast cancer has improved outcomes but causes toxicity. The UK TACT2 trial used a 2×2 factorial design to test two hypotheses: whether use of accelerated epirubicin would improve time to tumour recurrence (TTR); and whether use of oral capecitabine instead of cyclophosphamide would be non-inferior in terms of patients' outcomes and would improve toxicity, quality of life, or both. METHODS In this multicentre, phase 3, randomised, controlled trial, we enrolled patients aged 18 years or older from 129 UK centres who had histologically confirmed node-positive or high-risk node-negative operable breast cancer, had undergone complete excision, and were due to receive adjuvant chemotherapy. Patients were randomly assigned to receive four cycles of 100 mg/m2 epirubicin either every 3 weeks (standard epirubicin) or every 2 weeks with 6 mg pegfilgrastim on day 2 of each cycle (accelerated epirubicin), followed by four 4-week cycles of either classic cyclophosphamide, methotrexate, and fluorouracil (CMF; 600 mg/m2 cyclophosphamide intravenously on days 1 and 8 or 100 mg/m2 orally on days 1-14; 40 mg/m2 methotrexate intravenously on days 1 and 8; and 600 mg/m2 fluorouracil intravenously on days 1 and 8 of each cycle) or four 3-week cycles of 2500 mg/m2 capecitabine (1250 mg/m2 given twice daily on days 1-14 of each cycle). The randomisation schedule was computer generated in random permuted blocks, stratified by centre, number of nodes involved (none vs one to three vs four or more), age (≤50 years vs >50 years), and planned endocrine treatment (yes vs no). The primary endpoint was TTR, defined as time from randomisation to first invasive relapse or breast cancer death, with intention-to-treat analysis of standard versus accelerated epirubicin and per-protocol analysis of CMF versus capecitabine. This trial is registered with ISRCTN, number 68068041, and with ClinicalTrials.gov, number NCT00301925. FINDINGS From Dec 16, 2005, to Dec 5, 2008, 4391 patients (4371 women and 20 men) were recruited. At a median follow-up of 85·6 months (IQR 80·6-95·9) no significant difference was seen in the proportions of patients free from TTR events between the accelerated and standard epirubicin groups (overall hazard ratio [HR] 0·94, 95% CI 0·81-1·09; stratified p=0·42). At 5 years, 85·9% (95% CI 84·3-87·3) of patients receiving standard epirubicin and 87·1% (85·6-88·4) of those receiving accelerated epirubicin were free from TTR events. 4358 patients were included in the per-protocol analysis, and no difference was seen in the proportions of patients free from TTR events between the CMF and capecitabine groups (HR 0·98, 95% CI 0·85-1.14; stratified p=0·00092 for non-inferiority). Compared with baseline, significantly more patients taking CMF than those taking capecitabine had clinically relevant worsening of quality of life at end of treatment (255 [58%] of 441 vs 235 [50%] of 475; p=0·011) and at 12 months (114 [34%] of 334 vs 89 [22%] of 401; p<0·001 at 12 months) and had worse quality of life over time (p<0·0001). Detailed toxicity and quality-of-life data were collected from 2115 (48%) of treated patients. The most common grade 3 or higher adverse events in cycles 1-4 were neutropenia (175 [16%]) and fatigue (56 [5%]) of the 1070 patients treated with standard epirubicin, and fatigue (63 [6%]) and infection (34 [3%]) of the 1045 patients treated with accelerated epirubicin. In cycles 5-8, the most common grade 3 or higher adverse events were neutropenia (321 [31%]) and fatigue (109 [11%]) in the patients treated with CMF, and hand-foot syndrome (129 [12%]) and diarrhoea (67 [6%]) in the 1044 patients treated with capcitabine. INTERPRETATION We found no benefit from increasing the dose density of the anthracycline component of chemotherapy. However, capecitabine could be used in place of CMF without significant loss of efficacy and with improved quality of life. FUNDING Cancer Research UK, Amgen, Pfizer, and Roche.
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Affiliation(s)
- David Cameron
- Cancer Research UK Edinburgh Centre, MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK.
| | - James P Morden
- ICR-CTSU, Division of Clinical Studies, Institute of Cancer Research, London, UK
| | - Peter Canney
- Department of Oncology, Beatson Hospital, Glasgow, UK
| | - Galina Velikova
- St James' Institute of Oncology, University of Leeds, Leeds, UK
| | - Robert Coleman
- Department of Oncology, Weston Park Hospital, Sheffield, UK
| | - John Bartlett
- Department of Diagnostic Development, Ontario Institute for Cancer Research, Toronto, ON, Canada
| | - Rajiv Agrawal
- Department of Oncology, Shrewsbury & Telford Hospitals NHS Trust, Shrewsbury, UK
| | - Jane Banerji
- ICR-CTSU, Division of Clinical Studies, Institute of Cancer Research, London, UK
| | | | - David Bloomfield
- Department of Oncology, Royal Sussex County Hospital, Brighton, UK
| | - A Murray Brunt
- Department of Oncology, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - Helena Earl
- Department of Oncology, Addenbrooke's Hospital, Cambridge, UK
| | - Paul Ellis
- Department of Oncology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Claire Gaunt
- Cancer Research UK Clinical Trials Unit, University of Birmingham, UK
| | - Alexa Gillman
- ICR-CTSU, Division of Clinical Studies, Institute of Cancer Research, London, UK
| | | | - Robert Laing
- Department of Oncology, Royal Surrey County Hospital, Guildford, UK
| | - Nicholas Murray
- Department of Oncology, Southampton General Hospital, Southampton, UK
| | - Niki Couper
- Cancer Clinical Trials Unit Scotland (CaCTUS), Glasgow, UK
| | - Robert C Stein
- Department of Oncology, NIHR University College London Hospitals Biomedical Research Centre, London, UK
| | - Mark Verrill
- Department of Oncology, Northern Centre for Cancer Care, Freeman Hospital, Newcastle, UK
| | - Andrew Wardley
- Department of Oncology, Christie Hospital, Manchester, UK
| | | | - Judith M Bliss
- ICR-CTSU, Division of Clinical Studies, Institute of Cancer Research, London, UK
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12
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Hew M, Gillman A, Sutherland M, Wark P, Bowden J, Guo M, Reddel HK, Jenkins C, Marks GB, Thien F, Rimmer J, Katsoulotos GP, Cook M, Yang I, Katelaris C, Bowler S, Langton D, Wright C, Bint M, Yozghatlian V, Burgess S, Sivakumaran P, Yan KY, Kritikos V, Peters M, Baraket M, Aminazad A, Robinson P, Jaffe A, Powell H, Upham JW, McDonald VM, Gibson PG. Real-life effectiveness of omalizumab in severe allergic asthma above the recommended dosing range criteria. Clin Exp Allergy 2016; 46:1407-1415. [PMID: 27377155 DOI: 10.1111/cea.12774] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 05/26/2016] [Accepted: 06/01/2016] [Indexed: 01/09/2023]
Abstract
BACKGROUND Omalizumab (Xolair) dosing in severe allergic asthma is based on serum IgE and bodyweight. In Australia, patients eligible for omalizumab but exceeding recommended ranges for IgE (30-1500 IU/mL) and bodyweight (30-150 kg) may still receive a ceiling dose of 750 mg/4 weeks. About 62% of patients receiving government-subsidized omalizumab are enrolled in the Australian Xolair Registry (AXR). OBJECTIVES To determine whether AXR participants above the recommended dosing ranges benefit from omalizumab and to compare their response to within-range participants. METHODS Data were stratified according to dose range status (above-range or within-range). Further sub-analyses were conducted according to the reason for being above the dosing range (IgE only vs. IgE and weight). RESULTS Data for 179 participants were analysed. About 55 (31%) were above recommended dosing criteria; other characteristics were similar to within-range participants. Above-range participants had higher baseline IgE [812 (IQR 632, 1747) IU/mL vs. 209 (IQR 134, 306) IU/mL] and received higher doses of omalizumab [750 (IQR 650, 750) mg] compared to within-range participants [450 (IQR, 300, 600) mg]. At 6 months, improvements in Juniper 5-item Asthma Control Questionnaire (ACQ-5, 3.61 down to 2.01 for above-range, 3.47 down to 1.93 for within-range, P < 0.0001 for both) and Asthma Quality of Life Questionnaire (AQLQ mean score (3.22 up to 4.41 for above-range, 3.71 up to 4.88 for within-range, P < 0.0001) were observed in both groups. Forced expiratory volume in one second (FEV1 ) improved among above-range participants. There was no difference in response between above-range and within-range participants. Above-range participants due to either IgE alone or IgE and weight had similar improvements in ACQ-5, AQLQ and FEV1 . CONCLUSIONS AND CLINICAL RELEVANCE Patients with severe allergic asthma above recommended dosing criteria for omalizumab have significantly improved symptom control, quality of life and lung function to a similar degree to within-range participants, achieved without dose escalation above 750 mg.
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Affiliation(s)
- M Hew
- The Alfred Hospital & Monash University, Melbourne, Vic., Australia.
| | - A Gillman
- The Alfred Hospital & Monash University, Melbourne, Vic., Australia
| | | | - P Wark
- Hunter Medical Research Institute, John Hunter Hospital, University of Newcastle, New Lambton Heights, NSW, Australia
| | - J Bowden
- Flinders Medical Centre, Bedford Park, SA, Australia
| | - M Guo
- Woolcock Institute of Medical Research, Glebe, University of Sydney NSW, Australia
| | - H K Reddel
- Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - C Jenkins
- Concord Hospital, Concord, NSW, Australia
| | - G B Marks
- Liverpool Hospital, Liverpool, NSW, Australia
| | - F Thien
- Box Hill Hospital, Box Hill, Vic., Australia
| | - J Rimmer
- St Vincent's Clinic, Darlinghurst, NSW, Australia
| | | | - M Cook
- Canberra Hospital, Woden, ACT, Australia
| | - I Yang
- The Prince Charles Hospital, Chermside, Qld, Australia
| | - C Katelaris
- Campbelltown Hospital, Campbelltown, NSW, Australia
| | - S Bowler
- Mater Adult Hospital, South Brisbane, Qld, Australia
| | - D Langton
- Frankston Hospital, Frankston, Vic., Australia
| | - C Wright
- Nambour Hospital, Nambour, Qld, Australia
| | - M Bint
- Nambour Hospital, Nambour, Qld, Australia
| | | | - S Burgess
- QLD Children's Lung and Sleep Specialists, Woolloongabba, Qld, Australia
| | - P Sivakumaran
- Gold Coast District Hospital, Southport, Qld, Australia
| | - K Y Yan
- Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - V Kritikos
- Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - M Peters
- Concord Hospital, Concord, NSW, Australia
| | - M Baraket
- Liverpool Hospital, Liverpool, NSW, Australia
| | - A Aminazad
- St Vincent's Clinic, Darlinghurst, NSW, Australia
| | - P Robinson
- Children's Hospital at Westmead, Westmead, NSW, Australia
| | - A Jaffe
- School of Women's & Children's Health, UNSW Medicine, Randwick, NSW, Australia
| | - H Powell
- Hunter Medical Research Institute, John Hunter Hospital, University of Newcastle, New Lambton Heights, NSW, Australia
| | - J W Upham
- Princess Alexandra Hospital, Woolloongabba, Qld, Australia
| | - V M McDonald
- Hunter Medical Research Institute, John Hunter Hospital, University of Newcastle, New Lambton Heights, NSW, Australia
| | - P G Gibson
- Hunter Medical Research Institute, John Hunter Hospital, University of Newcastle, New Lambton Heights, NSW, Australia
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Duley L, McDonald A, Gillman A. What are the main inefficiencies in trial conduct? A survey of staff at registered clinical trials units. Trials 2015. [PMCID: PMC4660282 DOI: 10.1186/1745-6215-16-s2-p181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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14
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Lewis R, Batten L, Friend C, Webster-Smith M, Burnett S, Morden J, Hill E, Gillman A, Ereira S, Bliss J, Hall E, Snowdon C. Design considerations when transitioning from paper case report forms (CRFS) to electronic data capture (EDC). Trials 2015. [PMCID: PMC4658778 DOI: 10.1186/1745-6215-16-s2-p35] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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15
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Malik I, Burnett S, Webster-Smith M, Morden J, Ereira S, Gillman A, Lewis R, Hall E, Bliss J, Snowdon C. Benefits and challenges of electronic data capture (EDC) systems versus paper case report forms. Trials 2015. [PMCID: PMC4659180 DOI: 10.1186/1745-6215-16-s2-p37] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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16
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Mateo J, Carreira S, Sandhu S, Miranda S, Mossop H, Perez-Lopez R, Nava Rodrigues D, Robinson D, Omlin A, Tunariu N, Boysen G, Porta N, Flohr P, Gillman A, Figueiredo I, Paulding C, Seed G, Jain S, Ralph C, Protheroe A, Hussain S, Jones R, Elliott T, McGovern U, Bianchini D, Goodall J, Zafeiriou Z, Williamson CT, Ferraldeschi R, Riisnaes R, Ebbs B, Fowler G, Roda D, Yuan W, Wu YM, Cao X, Brough R, Pemberton H, A'Hern R, Swain A, Kunju LP, Eeles R, Attard G, Lord CJ, Ashworth A, Rubin MA, Knudsen KE, Feng FY, Chinnaiyan AM, Hall E, de Bono JS. DNA-Repair Defects and Olaparib in Metastatic Prostate Cancer. N Engl J Med 2015; 373:1697-708. [PMID: 26510020 PMCID: PMC5228595 DOI: 10.1056/nejmoa1506859] [Citation(s) in RCA: 1601] [Impact Index Per Article: 177.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Prostate cancer is a heterogeneous disease, but current treatments are not based on molecular stratification. We hypothesized that metastatic, castration-resistant prostate cancers with DNA-repair defects would respond to poly(adenosine diphosphate [ADP]-ribose) polymerase (PARP) inhibition with olaparib. METHODS We conducted a phase 2 trial in which patients with metastatic, castration-resistant prostate cancer were treated with olaparib tablets at a dose of 400 mg twice a day. The primary end point was the response rate, defined either as an objective response according to Response Evaluation Criteria in Solid Tumors, version 1.1, or as a reduction of at least 50% in the prostate-specific antigen level or a confirmed reduction in the circulating tumor-cell count from 5 or more cells per 7.5 ml of blood to less than 5 cells per 7.5 ml. Targeted next-generation sequencing, exome and transcriptome analysis, and digital polymerase-chain-reaction testing were performed on samples from mandated tumor biopsies. RESULTS Overall, 50 patients were enrolled; all had received prior treatment with docetaxel, 49 (98%) had received abiraterone or enzalutamide, and 29 (58%) had received cabazitaxel. Sixteen of 49 patients who could be evaluated had a response (33%; 95% confidence interval, 20 to 48), with 12 patients receiving the study treatment for more than 6 months. Next-generation sequencing identified homozygous deletions, deleterious mutations, or both in DNA-repair genes--including BRCA1/2, ATM, Fanconi's anemia genes, and CHEK2--in 16 of 49 patients who could be evaluated (33%). Of these 16 patients, 14 (88%) had a response to olaparib, including all 7 patients with BRCA2 loss (4 with biallelic somatic loss, and 3 with germline mutations) and 4 of 5 with ATM aberrations. The specificity of the biomarker suite was 94%. Anemia (in 10 of the 50 patients [20%]) and fatigue (in 6 [12%]) were the most common grade 3 or 4 adverse events, findings that are consistent with previous studies of olaparib. CONCLUSIONS Treatment with the PARP inhibitor olaparib in patients whose prostate cancers were no longer responding to standard treatments and who had defects in DNA-repair genes led to a high response rate. (Funded by Cancer Research UK and others; ClinicalTrials.gov number, NCT01682772; Cancer Research UK number, CRUK/11/029.).
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Affiliation(s)
- Joaquin Mateo
- From the Institute of Cancer Research (J.M., S.C., S.S., S.M., H.M., R.P.-L., D.N.R., A.O., N.T., G.B., N.P., P.F., A.G., I.F., C.P., G.S., D.B., J.G., Z.Z., C.T.W., R.F., R.R., B.E., G.F., D. Roda, W.Y., R.B., H.P., R.A., A.S., R.E., G.A., C.J.L., A.A., E.H., J.S.B.), the Royal Marsden NHS Foundation Trust (J.M., S.S., R.P.-L., A.O., N.T., D.B., Z.Z., R.F., D. Roda, R.E., G.A., J.S.B.), and University College London Hospital (U.M.), London, Queen's University, Belfast (S.J.), University of Leeds, Leeds (C.R.), Churchill Hospital, Oxford (A.P.), University of Liverpool, Liverpool (S.H.), Beatson West of Scotland Cancer Centre, Glasgow (R.J.), and Christie Hospital, Manchester (T.E.) - all in the United Kingdom; the University of Michigan, Ann Arbor (D. Robinson, Y.-M.W., X.C., L.P.K., F.Y.F., A.M.C.); Weill Cornell Medical College, New York (M.A.R.); and Thomas Jefferson University, Philadelphia (K.E.K.)
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Lorente D, Ravi P, Mehra N, Gillman A, Omlin A, Pezaro C, Miranda M, Mateo J, Rescigno P, Kolinsky M, Porta N, Jayaram A, Bianchini D, Hall E, Ijzerman M, De Bono J. 2579 Evaluation of clinical decision-making and the use of circulating tumor cells (CTCs) by physicians treating castration-resistant prostate cancer (CRPC). Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)31398-3] [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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Mateo J, Sandhu S, Miranda S, Carreira S, Jain S, Ralph C, Protheroe A, Hussain S, Jones R, Elliot T, McGovern U, Gillman A, Paulding C, Mossop H, Porta N, Bianchini D, Zafeiriou Z, Boysen G, Nava Rodrigues D, Flohr P, Seed G, Goodall J, Figueiredo I, Perez-Lopez R, Tunariu N, Omlin A, Ferraldeschi R, Kunju LP, Eeles R, Attard G, Robinson D, Chinnaiyan A, Hall E, de Bono JS. Abstract CT322: DNA repair defects and antitumor activity with PARP inhibition: TOPARP, a phase II trial of olaparib in metastatic castration resistant prostate cancer. Cancer Res 2015. [DOI: 10.1158/1538-7445.am2015-ct322] [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
Introduction: Next generation sequencing (NGS) has identified genomic aberrations causing DNA repair defects in sporadic metastatic castration resistant prostate cancer (mCRPC). We hypothesized that single agent olaparib would have antitumor activity in a sub-population of mCRPC patients (pts) and that exome and transcriptome studies would identify this population.
Methods: TOPARP is an open-label, investigator-initiated phase II trial with a novel multi-step adaptive design (CRUK/11/029). The first part of the study (TOPARP-A) has a two-stage design evaluating the antitumor activity of single agent olaparib in unselected mCRPC pts (p0 = 0.05; p1 = 0.20; α = 0.02; β = 0.10) with a preplanned analysis to identify a biomarker defined sensitive subgroup. Primary endpoint, response rate (RR), was defined as objective response by RECIST 1.1 and/or PSA fall ≥50% and/or confirmed circulating tumor cell (CTC) count falls from ≥5 to <5/7.5ml blood (VeridexTM). Secondary endpoints included safety, tolerability, progression-free survival (PFS) and overall survival (OS). Olaparib tablets (400mg bid) were administered to mCRPC pts progressing after 1-2 lines of chemotherapy. NGS and other studies from paired mandatory fresh CRPC biopsies, taken before and while on olaparib, evaluated putative predictive response biomarkers.
Results: Fifty pts were enrolled from 7 UK centers; all had had prior docetaxel, 48 (96%) prior abiraterone and 29 (58%) prior cabazitaxel. Overall, 16 of 49 evaluable pts experienced a response (RR 32.7%, 95% CI: 20.0 to 47.5), with 11 and 4 pts having been on treatment for >6 and >12 months respectively at data cut-off. NGS identified homozygous deletions and/or putatively deleterious mutations in DNA repair genes in 15/49 (30.6%) evaluable pts. While a majority of these genomic aberrations occurred in BRCA2 and ATM, biallelic loss of other relevant genes, including members of the Fanconi Anemia complementation group and CHEK2, were also observed. Among these fifteen pts, 13 (86.7%) responded to olaparib. All seven pts with BRCA2 loss (somatic [4/7] or germline [3/7]) and 4/5 pts with ATM truncating mutations responded to olaparib. The specificity of the biomarker suite was 94% in this population. Conversely, PTEN loss and ERG rearrangements were not associated with response. Finally, consistent with previous studies of olaparib, anemia (10/50, 20%) and fatigue (6/50, 12%) were the most common grade>3 adverse events, with 13 (26%) pts requiring a dose reduction.
Conclusions: Olaparib has durable antitumor activity in heavily pre-treated pts with sporadic mCRPC with a 32.7% overall response rate. Genomic defects in DNA repair genes associate with olaparib sensitivity in sporadic mCRPC, offering a possibility for the very first molecular treatment stratification of advanced prostate cancer.
Citation Format: Joaquin Mateo, Shahneen Sandhu, Susana Miranda, Suzanne Carreira, Suneil Jain, Christy Ralph, Andrew Protheroe, Syed Hussain, Robert Jones, Tony Elliot, Ursula McGovern, Alexa Gillman, Claire Paulding, Helen Mossop, Nuria Porta, Diletta Bianchini, Zafeiris Zafeiriou, Gunther Boysen, Daniel Nava Rodrigues, Penelope Flohr, George Seed, Jane Goodall, Ines Figueiredo, Raquel Perez-Lopez, Nina Tunariu, Aurelius Omlin, Roberta Ferraldeschi, Lakshmi P. Kunju, Rosalind Eeles, Gerhardt Attard, Dan Robinson, Arul Chinnaiyan, Emma Hall, Johann S. de Bono. DNA repair defects and antitumor activity with PARP inhibition: TOPARP, a phase II trial of olaparib in metastatic castration resistant prostate cancer. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr CT322. doi:10.1158/1538-7445.AM2015-CT322
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Affiliation(s)
- Joaquin Mateo
- 1The Institute of Cancer Research & The Royal Marsden NHS Trust, London, United Kingdom
| | - Shahneen Sandhu
- 1The Institute of Cancer Research & The Royal Marsden NHS Trust, London, United Kingdom
| | - Susana Miranda
- 2The Institute of Cancer Research, London, United Kingdom
| | | | - Suneil Jain
- 3Queen's University, Belfast, United Kingdom
| | | | | | - Syed Hussain
- 6University of Liverpool, Liverpool, United Kingdom
| | - Robert Jones
- 7Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | - Tony Elliot
- 8Christie Hospital, Manchester, United Kingdom
| | | | - Alexa Gillman
- 10Clinical Trials and Statistics Unit at The Institute of Cancer Research, London, United Kingdom
| | - Claire Paulding
- 10Clinical Trials and Statistics Unit at The Institute of Cancer Research, London, United Kingdom
| | - Helen Mossop
- 10Clinical Trials and Statistics Unit at The Institute of Cancer Research, London, United Kingdom
| | - Nuria Porta
- 10Clinical Trials and Statistics Unit at The Institute of Cancer Research, London, United Kingdom
| | - Diletta Bianchini
- 1The Institute of Cancer Research & The Royal Marsden NHS Trust, London, United Kingdom
| | - Zafeiris Zafeiriou
- 1The Institute of Cancer Research & The Royal Marsden NHS Trust, London, United Kingdom
| | - Gunther Boysen
- 2The Institute of Cancer Research, London, United Kingdom
| | | | - Penelope Flohr
- 2The Institute of Cancer Research, London, United Kingdom
| | - George Seed
- 2The Institute of Cancer Research, London, United Kingdom
| | - Jane Goodall
- 2The Institute of Cancer Research, London, United Kingdom
| | | | - Raquel Perez-Lopez
- 1The Institute of Cancer Research & The Royal Marsden NHS Trust, London, United Kingdom
| | - Nina Tunariu
- 1The Institute of Cancer Research & The Royal Marsden NHS Trust, London, United Kingdom
| | - Aurelius Omlin
- 1The Institute of Cancer Research & The Royal Marsden NHS Trust, London, United Kingdom
| | - Roberta Ferraldeschi
- 1The Institute of Cancer Research & The Royal Marsden NHS Trust, London, United Kingdom
| | | | - Rosalind Eeles
- 1The Institute of Cancer Research & The Royal Marsden NHS Trust, London, United Kingdom
| | - Gerhardt Attard
- 1The Institute of Cancer Research & The Royal Marsden NHS Trust, London, United Kingdom
| | | | | | - Emma Hall
- 10Clinical Trials and Statistics Unit at The Institute of Cancer Research, London, United Kingdom
| | - Johann S. de Bono
- 1The Institute of Cancer Research & The Royal Marsden NHS Trust, London, United Kingdom
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Gillman A, Amadio G, Matouš K, Jackson TL. Third-order thermo-mechanical properties for packs of Platonic solids using statistical micromechanics. Proc Math Phys Eng Sci 2015; 471:20150060. [PMID: 27547103 DOI: 10.1098/rspa.2015.0060] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Obtaining an accurate higher order statistical description of heterogeneous materials and using this information to predict effective material behaviour with high fidelity has remained an outstanding problem for many years. In a recent letter, Gillman & Matouš (2014 Phys. Lett. A 378, 3070-3073. ()) accurately evaluated the three-point microstructural parameter that arises in third-order theories and predicted with high accuracy the effective thermal conductivity of highly packed material systems. Expanding this work here, we predict for the first time effective thermo-mechanical properties of granular Platonic solid packs using third-order statistical micromechanics. Systems of impenetrable and penetrable spheres are considered to verify adaptive methods for computing n-point probability functions directly from three-dimensional microstructures, and excellent agreement is shown with simulation. Moreover, a significant shape effect is discovered for the effective thermal conductivity of highly packed composites, whereas a moderate shape effect is exhibited for the elastic constants.
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Affiliation(s)
- A Gillman
- Department of Aerospace and Mechanical Engineering , University of Notre Dame , Notre Dame, IN 46556, USA
| | - G Amadio
- Department of Aerospace Engineering , University of Illinois , Urbana, IL 61801, USA
| | - K Matouš
- Department of Aerospace and Mechanical Engineering , University of Notre Dame , Notre Dame, IN 46556, USA
| | - T L Jackson
- Department of Aerospace and Mechanical Engineering , University of Florida , Gainesville, FL 32611, USA
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Mateo J, Hall E, Sandhu S, Omlin A, Miranda S, Carreira S, Goodall J, Gillman A, Mossop H, Ralph C, Zafeiriou Z, Perez Lopez R, Tunariu N, Ferraldeschi R, Nava Rodrigues D, Kunju L, Robinson D, Attard G, Chinnaiyan A, de Bono J. Antitumour Activity of the Parp Inhibitor Olaparib in Unselected Sporadic Castration-Resistant Prostate Cancer (Crpc) in the Toparp Trial. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu438.20] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [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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Gillman A, Matouš K, Atkinson S. Microstructure-statistics-property relations of anisotropic polydisperse particulate composites using tomography. Phys Rev E Stat Nonlin Soft Matter Phys 2013; 87:022208. [PMID: 23496506 DOI: 10.1103/physreve.87.022208] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Indexed: 06/01/2023]
Abstract
In this paper, a systematic method is presented for developing microstructure-statistics-property relations of anisotropic polydisperse particulate composites using microcomputer tomography (micro-CT). Micro-CT is used to obtain a detailed three-dimensional representation of polydisperse microstructures, and an image processing pipeline is developed for identifying particles. In this work, particles are modeled as idealized shapes in order to guide the image processing steps and to provide a description of the discrete micro-CT data set in continuous Euclidean space. n-point probability functions used to describe the morphology of mixtures are calculated directly from real microstructures. The statistical descriptors are employed in the Hashin-Shtrikman variational principle to compute overall anisotropic bounds and self-consistent estimates of the thermal-conductivity tensor. We make no assumptions of statistical isotropy nor ellipsoidal symmetry, and the statistical description is obtained directly from micro-CT data. Various mixtures consisting of polydisperse ellipsoidal and spherical particles are prepared and studied to show how the morphology impacts the overall anisotropic thermal-conductivity tensor.
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Affiliation(s)
- A Gillman
- Department of Aerospace and Mechanical Engineering, University of Notre Dame, Notre Dame, Indiana 46556, USA
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Hess C, Louis E, Gillman A, Boschung S, Yu Q, Pullman S. High Width Variability during Spiral Drawing: Further Evidence of Cerebellar Dysfunction in Essential Tremor (P04.042). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p04.042] [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: 11/15/2022] Open
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Abstract
International studies report marked increases in the prevalence of food allergy, along with increases in hospital admissions and emergency presentations for severe allergic reactions due to foods. The prevalence of self-reported food allergy is common, but generally exceeds that which can be verified from challenge studies, although nut allergies appear to be an important exception to this rule. Studies examining food allergy deaths suggest that those who die of food allergy usually have co-existent asthma. Adolescents and young adults are at most risk, and adrenaline auto-injectors are sub-optimally used. Food chemical sensitivity is very commonly reported but not usually verified by challenge testing. However, the exception to this is sulphite sensitivity, which can elicit reproducible reactions in some. The increasing prevalence of severe food allergies and awareness of its risk in those with asthma demands an especially rigorous approach to the diagnosis and management of co-existent food allergy and asthma, especially in young people who appear to be at most risk from death from severe food allergy.
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Affiliation(s)
- A Gillman
- Department of Allergy, Immunology and Respiratory Medicine, Alfred Hospital, Monash University, Melbourne, Vic., Australia
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Abstract
BACKGROUND The incidence of sarcoidosis in Australia is unknown. The clinical features, diagnostic strategy and treatment of sarcoidosis in Australia have been poorly documented. METHODS We analysed the medical records of 122 patients with sarcoidosis presenting to a respiratory service, between 1995 and 2005, which serves a regional southeastern Australian population of approximately 200,000. RESULTS The incidence of sarcoidosis from 2000 to 2005 remained static and ranged from 4.4 to 6.3 patients per 100,000 population. The data showed that 55% were women and 28% were current smokers. Systems involved included lung parenchyma (66%), thoracic adenopathy (58%), skin (22%), ocular (18%), joint (11%), gastrointestinal tract (5%), central nervous system (3%) and hypercalcaemia (3%). Fifty-one per cent of patients had an increased serum angiotensin-converting enzyme level. The diagnosis was secured based on histological confirmation in 69%. Forty-three per cent of the patients were treated with oral corticosteroids and 10% with inhaled steroids. CONCLUSION Sarcoidosis in Australia is a multi-system disease of unknown aetiology. This is the first reported incidence of sarcoidosis in Australia. The incidence is similar to another US-based epidemiological study of a predominately white population. The development of a larger multicentre database would assist in the identification, clinical description and treatment of sarcoidosis.
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Affiliation(s)
- A Gillman
- Department of Respiratory medicine, Geelong Hospital, Geelong, Victoria, Australia.
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Cochet N, Gillman A, Lebeault JM. Some biological characteristics of the casing soil and their effect duringAgaricus bisporus fructification. ACTA ACUST UNITED AC 1992. [DOI: 10.1002/abio.370120510] [Citation(s) in RCA: 5] [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: 11/12/2022]
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Daum C, Hertzberger L, Hoogland W, Jongerius R, Peters S, Deurzen P, Chabaud V, Gonzalez-Arroyo A, Hyams B, Tiecke H, Weilhammer P, Dwurazny A, Polok G, Rozanska M, Rybicki K, Turala M, Turnau J, Ascoli G, Backer H, Blanar G, Cerrada M, Dietl H, Gallivan J, Glaubmann M, Klanner R, Lorenz E, L�tjens G, Lutz G, M�nner W, Stierlin U, Blakey I, Bowler M, Cashmore R, Loken J, Spalding W, Thompson G, Alper B, Damerell C, Gillman A, Hardwick C, Hotchkiss M, Wickens F. Study of the charge-exchange reactions $$\pi ^ - p \to (\pi ^0 ,\eta ,\eta \prime )n$$ at 63 GeV. ACTA ACUST UNITED AC 1981. [DOI: 10.1007/bf01547872] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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