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Chapman A, Bardsley E, Card H, Marshall E, Olsson-Brown A. Evaluation of an established oncology triage hotline in a model of emergency department avoidance: assessing the UKONS triage tool and call outcomes. Support Care Cancer 2023; 32:6. [PMID: 38051438 DOI: 10.1007/s00520-023-08167-7] [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: 05/12/2023] [Accepted: 11/07/2023] [Indexed: 12/07/2023]
Abstract
PURPOSE In response to a demonstrable need for 24/7, specialist oncology advice for patients undergoing systemic anti-cancer therapy, many healthcare institutions have adopted a telephone triage (TT) service. This is true of the Clatterbridge Cancer Centre which uses the UKONS framework to guide its decisions. This study aims to investigate the utilisation and outcomes of this TT service, with a focus on the most unwell call outcomes and factors leading to referrals to accident and emergency departments that could be mitigated with service development and modifications. METHODS A retrospective evaluation study was conducted of calls occurring between 1st September 2021 and 31st August 2022. A descriptive analysis of call UKONS grading, triage outcome and primary complaint was performed. RESULTS The TT hotline received 23,766 calls of which only 9066 were for clinical advice. Of the clinical calls, 45.2% were UKONS red. The majority of red calls 53.3% were directed to AED. The proportion of red calls going to AED changed drastically depending on the timing of call and the corresponding services available at those times, with 38.3% of reds being sent to AED in hours but 72.3% out of hours. The profile of complaints also showed significant differences in hours versus out of hours. CONCLUSION Significant use of the hotline supports a genuine demand for oncology TT services. In order to reduce referrals to AED, this study supports the creation of alternative destinations of emergency care, especially out of hours.
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Affiliation(s)
- A Chapman
- Medical Oncology Department, Clatterbridge Cancer Centre, Liverpool, L7 8YA, UK.
| | - E Bardsley
- Medical Oncology Department, Clatterbridge Cancer Centre, Liverpool, L7 8YA, UK
| | - H Card
- Medical Oncology Department, Clatterbridge Cancer Centre, Liverpool, L7 8YA, UK
| | - E Marshall
- Medical Oncology Department, Clatterbridge Cancer Centre, Liverpool, L7 8YA, UK
| | - A Olsson-Brown
- Medical Oncology Department, Clatterbridge Cancer Centre, Liverpool, L7 8YA, UK
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Kulkarni S, Knight T, Cooksley T, Marshall E, Patel N, Selvaratnam R, Atkin C. Provision of acute oncology services in the UK: data from the Society for Acute Medicine Benchmarking Audit 2022 (SAMBA22). Clin Med (Lond) 2023; 23:571-581. [PMID: 38065597 PMCID: PMC11046619 DOI: 10.7861/clinmed.2023-0251] [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] [Indexed: 12/18/2023]
Abstract
Acute oncology services (AOS) manage acute cancer-related presentations alongside acute medical teams. This study assessed AOS provision against national peer review measures and the burden of acute cancer-related admissions. The 2022 Society for Acute Medicine Benchmarking Audit surveyed UK hospitals, collecting hospital-level and patient-level data for all medical admissions over a 24-h period. Logistic regression models were constructed to identify differences in patient outcomes for cancer-related admissions. Most hospitals (n=120 or 91.6%) reported having an AOS. There was heterogeneity in AOS provision, with many failing to meet peer-review measures. Of the 7,116 patients, 542 (7.6%) were cancer-related admissions. Cancer-related admissions had greater clinical acuity (p<0.05), length of stay (p<0.001) and 14-day mortality (adjusted odds ratio (OR)=3.54, 95% confidence interval (CI): 2.41-5.22, p<0.001) compared with other medical admissions. Increasing availability of AOS with integration of ambulatory pathways are vital next steps to improving care for acute cancer-related admissions.
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Affiliation(s)
- Sanat Kulkarni
- Sandwell and West Birmingham NHS Trust, West Bromwich, UK
| | - Thomas Knight
- Sandwell and West Birmingham NHS Trust, West Bromwich, UK
| | - Tim Cooksley
- The Christie NHS Foundation Trust, Manchester, UK
| | - Ernie Marshall
- Clatterbridge Cancer Centre NHS Foundation Trust, Birkenhead, UK
| | - Neil Patel
- Ashford and St Peter's NHS Foundation Trust, Chertsey, UK
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Cooksley T, Klotz A, Marshall E, Weaver J, Font C, Lasserson D. The need for ambulatory emergency oncology: exemplified by the management of immune checkpoint inhibitor toxicity. Support Care Cancer 2023; 31:653. [PMID: 37878140 DOI: 10.1007/s00520-023-08132-4] [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: 07/19/2023] [Accepted: 10/19/2023] [Indexed: 10/26/2023]
Abstract
Cancer patients seeking emergency care can be vulnerable in increasingly overcrowded Emergency Departments and timely delivery of care is often aspirational rather than reality in many acute care systems. Ambulatory emergency care and its various international models are recognized as contributing to the safety and sustainability of emergency care services. This schema can logically be extended to the emergency oncology setting. The recent proliferation of immune checkpoint inhibitors (ICIs) has led to another opportunity for the management of oncologic complications in the ambulatory emergency care setting. More nuanced risk stratification of currently perceived high-risk toxicities may also afford the opportunity to personalize acute management. Virtual wards, which predominantly provide virtual monitoring only, and hospital at home services, which provide more comprehensive in-person assessment and interventions, may be well suited to supporting care for ICI toxicity alongside hospital-based assessment. Emergency management guidelines for immune-mediated toxicities will increasingly need to be both pragmatic and deliverable, especially as larger numbers of patients will present outside cancer centers. Identifying and modelling those suitable for emergency ambulatory care is integral to achieving this.
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Affiliation(s)
- Tim Cooksley
- Department of Acute Medicine, The Christie NHS Foundation Trust, Wilmslow Road, Manchester, UK.
- University of Manchester, Manchester, UK.
| | | | | | - Jamie Weaver
- Department of Acute Medicine, The Christie NHS Foundation Trust, Wilmslow Road, Manchester, UK
- University of Manchester, Manchester, UK
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Wade S, Marshall E. A pharmacist-led penicillin allergy de-labelling project within a preoperative assessment clinic: the low-hanging fruit is within reach. J Hosp Infect 2023; 139:1-5. [PMID: 37343770 DOI: 10.1016/j.jhin.2023.06.012] [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: 06/08/2022] [Revised: 05/24/2023] [Accepted: 06/05/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND Having a false penicillin-allergy label is linked to longer hospital stays and to an increased risk of Clostridioides difficile and meticillin-resistant Staphylococcus aureus infection. AIM To assess a penicillin-allergy de-labelling tool designed for use by the non-allergist. METHODS Patients attending the surgical preoperative assessment clinic (POAC) at a large UK teaching hospital, who reported a penicillin allergy, were directly de-labelled by nursing or pharmacy staff, where appropriate. A penicillin-allergy de-labelling tool designed for use by the non-allergist was adapted and applied; nursing staff were provided with supporting information and education to enable removal of spurious labels. Antimicrobial pharmacists (AMPs) provided follow-up, cross-checked prophylactic antibiotics administered, interrogated clinical notes, and telephoned patients following their surgery, for details of any adverse reactions suffered. FINDINGS A total of 163 patients reporting a penicillin allergy were identified for intervention. Twenty-nine (17.8%) patients reported a penicillin-allergy history appropriate for direct de-labelling, of whom eight (27.6%) declined to consent. The remaining 21 patients (12.8%) were directly de-labelled, with 12 (7.4%) patients consenting during their POAC appointment; the remaining nine (5.5%) patients were consented and de-labelled after their surgery by an AMP. CONCLUSION The POAC was identified as an appropriate location and time-point in the patient pathway to enable the direct removal of spurious penicillin-allergy labels prior to surgery. Results suggest that this could be undertaken by nursing staff, although support from AMPs enabled a greater number of patients to be de-labelled.
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Affiliation(s)
- S Wade
- University Hospitals Bristol & Weston NHS Foundation Trust, Marlborough Street, Bristol, UK.
| | - E Marshall
- University Hospitals Bristol & Weston NHS Foundation Trust, Marlborough Street, Bristol, UK
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Ramafikeng MC, Marshall E. Navigating language discordance in public health care in rural South Africa: a qualitative descriptive study of occupational therapists' perspectives. BMC Health Serv Res 2023; 23:867. [PMID: 37582788 PMCID: PMC10428555 DOI: 10.1186/s12913-023-09658-3] [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] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 06/06/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND Language discordance occurs in healthcare when staff and service users do not share proficiency in the same language. It is a global phenomenon impacting on the quality of health services, as person-centred practice requires communication to establish partnerships and rapport. In a country as linguistically diverse as South Africa, effective ways to navigate language discordance in health care are urgently required, yet there is limited research. This study aimed to describe how occupational therapists navigated language discordance when working in the public health sector in KwaZulu-Natal. METHODS A qualitative descriptive design involved using purposive sampling to recruit occupational therapists as participants (n = 8) for 15 semi-structured interviews. Thematic analysis was used to analyse the data, which included reflective journal entries from all participants. RESULTS The four emergent themes were: (1) concurrent use of strategies, (2) I'm doing as much I can, what more can I do? (3) Language definitely impacts that therapy process and lastly, (4) systemic oppression perpetuating language discordance. CONCLUSION Language discordance is a complex context-specific phenomenon, therefore insight into concurrent use of strategies is important to practitioners to enable them to navigate language discordance and ensure provision of quality services. These insights are significant for healthcare professionals and resource allocators as they shed light on the shortcomings of advocating for a single strategy such as providing trained interpreters. Successful navigation is characterised by determination, being kind to oneself, willingness to learn and use of pragmatic and flexible approaches. To prepare to navigate language discordance in a low-resource context, education should extend in time and scope, to include multiple strategies, culture and relevant languages.
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Affiliation(s)
- M C Ramafikeng
- School of Health and Social Care, University of Essex, Wivenhoe Park, Colchester, CO4 3SQ, UK.
| | - E Marshall
- Marshall Occupational Therapy, 3rd Avenue, Kenilworth, 7708, Cape Town, South Africa
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Yu Q, Kwak D, Ungchusri E, Van Ha T, Kumari D, Patel M, Marshall E, Pillai A, Liao A, Zhang M, Hwang G, Ahmed O. Abstract No. 265 Segmental Radioembolization using Yttrium-90 Glass Microspheres Greater than 400 Gray: A Real-World Experience. J Vasc Interv Radiol 2023. [DOI: 10.1016/j.jvir.2022.12.330] [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: 02/27/2023] Open
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Lorusso L, Precone V, Hart IK, Giometto B, Pezzani R, Ngonga GK, Paolacci S, Ferrari D, Ricevuti G, Marshall E, Bertelli M. Immunophenotypical characterization of paraneoplastic neurological syndrome patients: a multicentric study. J Biosci 2021. [DOI: 10.1007/s12038-020-00128-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Lorusso L, Precone V, Hart IK, Giometto B, Pezzani R, Ngonga GK, Ngonga GKNK, Paolacci S, Ferrari D, Ricevuti G, Marshall E, Bertelli M. Immunophenotypical characterization of paraneoplastic neurological syndrome patients: a multicentric study. J Biosci 2021; 46:13. [PMID: 33709965] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Paraneoplastic neurological syndromes (PNS) are a group of rare and severe immune-mediated disorders that affect the nervous system in patients with cancer. The best way to diagnose a paraneoplastic neurological disorder is to identify anti-onconeural protein antibodies that are specifically associated with various cancers. The aim of this multicentric study was to clinically and immunologically characterize patients with PNS and study their association with cancer. Patients suspected to have PNS were enrolled from various clinical centres and were characterized immunologically. This study population consisted of 112 patients. Onset of PNS was mainly subacute (76 %). PNS patients had various neurological disorders and symptoms. PNS developed before the diagnosis of cancer in 28 definite PNS patients and in six suspected PNS patients. The most frequent autoantibodies detected in PNS patients were anti-Hu and anti-Yo. One definite PNS patient with cerebellar syndrome had anti-Tr antibody and seven patients had atypical antibodies. The literature associates these antibodies with various neurological disorders and cancers. Our observations confirm the important role of autoantibodies in PNS and their importance for the early diagnosis of cancer in PNS patients.
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Affiliation(s)
- Lorenzo Lorusso
- UOC Neurology and Stroke Unit, ASST Lecco, Merate, LC, Italy
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Qureshi H, Holt C, Mirvis R, Cross S, Hussain O, Hutchings H, Marshall E, Turner F, Wilson Jones C. Introducing PEEP: The psychiatry early experience programme. Eur Psychiatry 2020. [DOI: 10.1016/j.eurpsy.2016.01.853] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
At Guy's King's and St Thomas’ School of Medicine, a unique initiative is the Psychiatry Early Experience Programme (PEEP), which allows students to shadow psychiatry trainees at work several times a year. The students’ attitudes towards psychiatry and the scheme are regularly assessed and initial results are already available.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Ahmed O, Guajardo S, Funaki B, Marshall E, Sellers E, Leef J, Lu Z. Abstract No. 474 Quantifying radiation dose with hybrid angiography computed tomography compared with cone-beam computed tomography. J Vasc Interv Radiol 2020. [DOI: 10.1016/j.jvir.2019.12.535] [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: 10/25/2022] Open
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Cooksley T, Marshall W, Ahn S, Lasserson DS, Marshall E, Rice TW, Klotz A. Ambulatory emergency oncology: A key tenet of future emergency oncology care. Int J Clin Pract 2020; 74:e13436. [PMID: 31633264 DOI: 10.1111/ijcp.13436] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 09/16/2019] [Accepted: 10/13/2019] [Indexed: 12/19/2022] Open
Abstract
Ambulatory emergency oncology The challenges of emergency oncology alongside its increasing financial burden have led to an interest in developing optimal care models for meeting patients' needs. Ambulatory care is recognised as a key tenet in ensuring the safety and sustainability of acute care services. Increased access to ambulatory care has successfully reduced ED utilisation and improved clinical outcomes in high-risk non-oncological populations. Individualised management of acute cancer presentations is a key challenge for emergency oncology services so that it can mirror routine cancer care. There are an increasing number of acute cancer presentations, such as low-risk febrile neutropenia and incidental pulmonary embolism, that can be risk assessed for care in an emergency ambulatory setting. Modelling of ambulatory emergency oncology services will be dependent on local service deliveries and pathways, but are key for providing high quality, personalised and sustainable emergency oncology care. These services will also be at the forefront of much needed emergency oncology to define the optimal management of ambulatory-sensitive presentations.
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Affiliation(s)
- Tim Cooksley
- Department of Acute Medicine and Critical Care, The Christie, Manchester, UK
| | - Will Marshall
- Department of Acute Medicine, Manchester University Foundation Trust, Manchester, UK
| | - Shin Ahn
- Department of Emergency Medicine, Cancer Emergency Room, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Daniel S Lasserson
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Ernie Marshall
- Department of Medical Oncology, Clatterbridge Cancer Centre, Wirral, UK
| | - Terry W Rice
- Division of Internal Medicine, Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Adam Klotz
- Department of Emergency Medicine, Memorial Sloan Kettering, New York, NY, USA
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Dykens JA, Smith JS, Demment M, Marshall E, Schuh T, Peters K, Irwin T, McIntosh S, Sy A, Dye T. Evaluating the implementation of cervical cancer screening programs in low-resource settings globally: a systematized review. Cancer Causes Control 2020; 31:417-429. [PMID: 32185604 PMCID: PMC7105425 DOI: 10.1007/s10552-020-01290-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 08/26/2019] [Accepted: 02/27/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE Cervical cancer disproportionately burdens low-resource populations where access to quality screening services is limited. A greater understanding of sustainable approaches to implement cervical cancer screening services is needed. METHODS We conducted a systematized literature review of evaluations from cervical cancer screening programs implemented in resource-limited settings globally that included a formal evaluation and intention of program sustainment over time. We categorized the included studies using the continuum of implementation research framework which categorizes studies progressively from "implementation light" to more implementation intensive. RESULTS Fifty-one of 13,330 initially identified papers were reviewed with most study sites in low-resource settings of middle-income countries (94.1%) ,while 9.8% were in low-income countries. Across all studies, visual inspection of the cervix with acetic acid (58.8%) was the most prevalent screening method followed by cytology testing (39.2%). Demand-side (client and community) considerations were reported in 86.3% of the articles, while 68.6% focused scientific inquiry on the supply side (health service). Eighteen articles (35.3%) were categorized as "Informing Scale-up" along the continuum of implementation research. CONCLUSIONS The number of cervical cancer screening implementation reports is limited globally, especially in low-income countries. The 18 papers we classified as Informing Scale-up provide critical insights for developing programs relevant to implementation outcomes. We recommend that program managers report lessons learnt to build collective implementation knowledge for cervical cancer screening services, globally.
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Affiliation(s)
- J. Andrew Dykens
- University of Illinois at Chicago College of Medicine, Chicago, IL USA
| | - Jennifer S. Smith
- University of North Carolina School of Public Health, Chapel Hill, NC USA
| | - Margaret Demment
- University of Rochester Department of Obstetrics and Gynecology, Rochester, NY USA
| | - E. Marshall
- University of Illinois at Chicago Institute for Health Research and Policy, Chicago, IL USA
| | - Tina Schuh
- University of Illinois at Chicago Institute for Health Research and Policy, Chicago, IL USA
| | - Karen Peters
- University of Illinois at Chicago Institute for Health Research and Policy, Chicago, IL USA
| | - Tracy Irwin
- University of Washington Department of Obstetrics and Gynecology, Seattle, WA USA
| | - Scott McIntosh
- University of Rochester Department of Public Health Sciences, Rochester, NY USA
| | - Angela Sy
- University of Hawaii John A Burns School of Medicine, Honolulu, HI USA
| | - Timothy Dye
- University of Rochester Department of Obstetrics and Gynecology, Rochester, NY USA
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Corrie PG, Marshall A, Nathan PD, Lorigan P, Gore M, Tahir S, Faust G, Kelly CG, Marples M, Danson SJ, Marshall E, Houston SJ, Board RE, Waterston AM, Nobes JP, Harries M, Kumar S, Goodman A, Dalgleish A, Martin-Clavijo A, Westwell S, Casasola R, Chao D, Maraveyas A, Patel PM, Ottensmeier CH, Farrugia D, Humphreys A, Eccles B, Young G, Barker EO, Harman C, Weiss M, Myers KA, Chhabra A, Rodwell SH, Dunn JA, Middleton MR, Nathan P, Lorigan P, Dziewulski P, Holikova S, Panwar U, Tahir S, Faust G, Thomas A, Corrie P, Sirohi B, Kelly C, Middleton M, Marples M, Danson S, Lester J, Marshall E, Ajaz M, Houston S, Board R, Eaton D, Waterston A, Nobes J, Loo S, Gray G, Stubbings H, Gore M, Harries M, Kumar S, Goodman A, Dalgleish A, Martin-Clavijo A, Marsden J, Westwell S, Casasola R, Chao D, Maraveyas A, Marshall E, Patel P, Ottensmeier C, Farrugia D, Humphreys A, Eccles B, Dega R, Herbert C, Price C, Brunt M, Scott-Brown M, Hamilton J, Hayward RL, Smyth J, Woodings P, Nayak N, Burrows L, Wolstenholme V, Wagstaff J, Nicolson M, Wilson A, Barlow C, Scrase C, Podd T, Gonzalez M, Stewart J, Highley M, Wolstenholme V, Grumett S, Goodman A, Talbot T, Nathan K, Coltart R, Gee B, Gore M, Farrugia D, Martin-Clavijo A, Marsden J, Price C, Farrugia D, Nathan K, Coltart R, Nathan K, Coltart R. Adjuvant bevacizumab for melanoma patients at high risk of recurrence: survival analysis of the AVAST-M trial. Ann Oncol 2019; 29:1843-1852. [PMID: 30010756 PMCID: PMC6096737 DOI: 10.1093/annonc/mdy229] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [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: 12/27/2022] Open
Abstract
Background Bevacizumab is a recombinant humanised monoclonal antibody to vascular endothelial growth factor shown to improve survival in advanced solid cancers. We evaluated the role of adjuvant bevacizumab in melanoma patients at high risk of recurrence. Patients and methods Patients with resected AJCC stage IIB, IIC and III cutaneous melanoma were randomised to receive either adjuvant bevacizumab (7.5 mg/kg i.v. 3 weekly for 1 year) or standard observation. The primary end point was detection of an 8% difference in 5-year overall survival (OS) rate; secondary end points included disease-free interval (DFI) and distant metastasis-free interval (DMFI). Tumour and blood were analysed for prognostic and predictive markers. Results Patients (n=1343) recruited between 2007 and 2012 were predominantly stage III (73%), with median age 56 years (range 18–88 years). With 6.4-year median follow-up, 515 (38%) patients had died [254 (38%) bevacizumab; 261 (39%) observation]; 707 (53%) patients had disease recurrence [336 (50%) bevacizumab, 371 (55%) observation]. OS at 5 years was 64% for both groups [hazard ratio (HR) 0.98; 95% confidence interval (CI) 0.82–1.16, P = 0.78). At 5 years, 51% were disease free on bevacizumab versus 45% on observation (HR 0.85; 95% CI 0.74–0.99, P = 0.03), 58% were distant metastasis free on bevacizumab versus 54% on observation (HR 0.91; 95% CI 0.78–1.07, P = 0.25). Forty four percent of 682 melanomas assessed had a BRAFV600 mutation. In the observation arm, BRAF mutant patients had a trend towards poorer OS compared with BRAF wild-type patients (P = 0.06). BRAF mutation positivity trended towards better OS with bevacizumab (P = 0.21). Conclusions Adjuvant bevacizumab after resection of high-risk melanoma improves DFI, but not OS. BRAF mutation status may predict for poorer OS untreated and potential benefit from bevacizumab. Clinical Trial Information ISRCTN 81261306; EudraCT Number: 2006-005505-64
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Affiliation(s)
- P G Corrie
- Cambridge Cancer Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
| | - A Marshall
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - P D Nathan
- Medical Oncology, Mount Vernon Hospital, Northwood, UK
| | - P Lorigan
- Department of Medical Oncology, Christie Hospital, Manchester, UK
| | - M Gore
- Royal Marsden Hospital NHS Trust, London, UK
| | - S Tahir
- Oncology Research, Broomfield Hospital, Chelmsford, UK
| | - G Faust
- Oncology Department, Leicester Royal Infirmary, Leicester, UK
| | - C G Kelly
- Sir Bobby Robson Cancer Trials Research Centre, Freeman Hospital, Newcastle upon Tyne, UK
| | - M Marples
- Leeds Cancer Centre, St James's University Hospital, Leeds, UK
| | - S J Danson
- Weston Park Hospital, Academic Unit of Clinical Oncology, Sheffield, UK
| | - E Marshall
- Cancer & Palliative Care, St. Helen's Hospital, St. Helens, UK
| | - S J Houston
- Oncology Department, Royal Surrey County Hospital, Guildford, UK
| | - R E Board
- Rosemere Cancer Centre, Royal Preston Hospital, Preston, UK
| | - A M Waterston
- Clinical Trials Unit, Beatson WOS Cancer Centre, Glasgow, UK
| | - J P Nobes
- Department of Clinical Oncology, Norfolk & Norwich University Hospital, Norwich, UK
| | - M Harries
- Guy's & St. Thomas' Hospital, Guy's Cancer Centre, London, UK
| | - S Kumar
- Velindre Cancer Centre, Cardiff, UK
| | - A Goodman
- Exeter Oncology Centre, Royal Devon and Exeter Hospital, Exeter, UK
| | - A Dalgleish
- St George's Hospital, Cancer Centre, London, UK
| | | | - S Westwell
- Sussex Cancer Centre, Royal Sussex County Hospital, Brighton, UK
| | - R Casasola
- Cancer Centre, Ninewells Hospital, Dundee, UK
| | - D Chao
- Royal Free Hospital, London, UK
| | | | - P M Patel
- Academic Unit of Clinical Oncology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - C H Ottensmeier
- CRUK and NIHR Southampton Experimental Cancer Medicine Centre, Southampton University Hospitals NHS Foundation Trust, Southampton, UK
| | - D Farrugia
- Oncology Centre, Cheltenham General Hospital, Cheltenham, UK
| | - A Humphreys
- Oncology Department, James Cook University Hospital, Middlesbrough, UK
| | - B Eccles
- Oncology Department, Poole Hospital, Dorset, UK
| | - G Young
- Cambridge Cancer Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - E O Barker
- Cambridge Cancer Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - C Harman
- Cambridge Cancer Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - M Weiss
- Cambridge Cancer Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - K A Myers
- Department of Oncology, University of Oxford, Oxford, UK; Experimental Cancer Medicine Centre, Oxford, UK
| | - A Chhabra
- Cambridge Cancer Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | - J A Dunn
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
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Corrie PG, Marshall A, Nathan PD, Lorigan P, Gore M, Tahir S, Faust G, Kelly CG, Marples M, Danson SJ, Marshall E, Houston SJ, Board RE, Waterston AM, Nobes JP, Harries M, Kumar S, Goodman A, Dalgleish A, Martin-Clavijo A, Westwell S, Casasola R, Chao D, Maraveyas A, Patel PM, Ottensmeier CH, Farrugia D, Humphreys A, Eccles B, Young G, Barker EO, Harman C, Weiss M, Myers KA, Chhabra A, Rodwell SH, Dunn JA, Middleton MR. Adjuvant bevacizumab for melanoma patients at high risk of recurrence: survival analysis of the AVAST-M trial. Ann Oncol 2019; 30:2013-2014. [PMID: 31430371 PMCID: PMC6938599 DOI: 10.1093/annonc/mdz237] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Ng K, Sage A, Marshall E, Enfield K, Lam W. MA04.11 Biological and Prognostic Implications of the Long Non-Coding Transcriptome in Tumour-Infiltrating Immune Cells. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.528] [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: 10/25/2022]
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Vucic E, Marshall E, Ng R, Lam S, Lam W. P2.03-24 Concurrent Aberrations in G2/M-Phase Transcriptional Programs and Genomic Gatekeepers Highlight Lung Cancer Predisposition in COPD Patients. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.1471] [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: 11/30/2022]
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Khoja L, Atenafu E, Suciu S, Leyvraz S, Sato T, Marshall E, Keilholz U, Zimmer L, Patel S, Piperno-Neumann S, Piulats J, Kivelä T, Pfoehler C, Bhatia S, Huppert P, Van Iersel L, De Vries I, Penel N, Vogl T, Cheng T, Fiorentini G, Mouriaux F, Tarhini A, Patel P, Carvajal R, Joshua A. Meta-analysis in metastatic uveal melanoma to determine progression free and overall survival benchmarks: an international rare cancers initiative (IRCI) ocular melanoma study. Ann Oncol 2019; 30:1370-1380. [DOI: 10.1093/annonc/mdz176] [Citation(s) in RCA: 99] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Urbonas V, Schadendorf D, Zimmer L, Danson S, Marshall E, Corrie P, Wheater M, Plummer E, Mauch C, Scudder C, Goff M, Love SB, Mohammed SB, Middleton MR. Paclitaxel with or without trametinib or pazopanib in advanced wild-type BRAF melanoma (PACMEL): a multicentre, open-label, randomised, controlled phase II trial. Ann Oncol 2019; 30:317-324. [PMID: 30428063 PMCID: PMC6386028 DOI: 10.1093/annonc/mdy500] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Advanced melanoma treatments often rely on immunotherapy or targeting mutations, with few treatment options for wild-type BRAF (BRAF-wt) melanoma. However, the mitogen-activated protein kinase pathway is activated in most melanoma, including BRAF-wt. We assessed whether inhibiting this pathway by adding kinase inhibitors trametinib or pazopanib to paclitaxel chemotherapy improved outcomes in patients with advanced BRAF-wt melanoma in a phase II, randomised and open-label trial. PATIENTS AND METHODS Patients were randomised (1 : 1 : 1) to paclitaxel alone or with trametinib or pazopanib. Paclitaxel was given for a maximum of six cycles, while 2 mg trametinib and 800 mg pazopanib were administered orally once daily until disease progression or unacceptable toxicity. Participants and investigators were unblinded. The primary end point was progression-free survival (PFS). Key secondary end points included overall survival (OS) and objective response rate (ORR). RESULTS Participants were randomised to paclitaxel alone (n = 38), paclitaxel and trametinib (n = 36), or paclitaxel and pazopanib (n = 37). Adding trametinib significantly improved 6-month PFS [time ratio (TR), 1.47; 90% confidence interval (CI) 1.08-2.01, P = 0.04] and ORR (42% versus 13%; P = 0.01) but had no effect on OS (P = 0.25). Adding pazopanib did not benefit 6-month PFS; (TR 1.36; 90% CI 0.96-1.93; P = 0.14), ORR, or OS. Toxicity increased in both combination arms. CONCLUSION In this phase II trial, adding trametinib to paclitaxel chemotherapy for BRAF-wt melanoma improved PFS and substantially increased ORR but did not impact OS.This study was registered with the EU Clinical Trials Register, EudraCT number 2011-002545-35, and with the ISRCTN registry, number 43327231.
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Affiliation(s)
- V Urbonas
- Early Phase Clinical Trials Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK; National Cancer Institute, Vilnius, Lithuania
| | - D Schadendorf
- Department of Dermatology, University Hospital Essen, West German Cancer Centre, University Duisburg-Essen, Essen, Germany; The German Cancer Consortium, Essen, Germany
| | - L Zimmer
- Department of Dermatology, University Hospital Essen, West German Cancer Centre, University Duisburg-Essen, Essen, Germany; The German Cancer Consortium, Essen, Germany
| | - S Danson
- Department of Oncology, Sheffield Experimental Cancer Medicine Centre, Weston Park Hospital, Sheffield, UK
| | - E Marshall
- Department of Oncology, Clatterbridge Cancer Centre, Wirral, UK
| | - P Corrie
- Department of Oncology, Addenbrookes Hospital, Cambridge, UK
| | - M Wheater
- Department of Oncology, Southampton General Hospital, Southampton, UK
| | - E Plummer
- Department of Oncology, Freeman Hospital, Newcastle upon Tyne, UK
| | - C Mauch
- Köln Universitätsklinik, Köln, Germany
| | - C Scudder
- Oncology Clinical Trials Office, University of Oxford, Oxford, UK
| | - M Goff
- Oncology Clinical Trials Office, University of Oxford, Oxford, UK
| | - S B Love
- Centre for Statistics in Medicine, University of Oxford, Oxford, UK
| | - S B Mohammed
- Centre for Statistics in Medicine, University of Oxford, Oxford, UK
| | - M R Middleton
- Early Phase Clinical Trials Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK; Department of Oncology, NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK.
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Marshall E. Ambulatory management in low risk neutropenic sepsis - A plea for integrated acute cancer care. Acute Med 2019; 18:6-7. [PMID: 32608386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Neutropenic Sepsis (NS) is a well recognised treatment complication, typically occurring 7-10 days following cancer cytotoxic chemotherapy. Colleagues in acute medicine will be only too familiar with the scenario of cancer patients that present with fever in the absence of localising signs and symptoms and with a very low yield from microbiological cultures. The incidence and mortality of NS are poorly defined and historically, management guidelines have often been developed in relative isolation from the broader subject of infection and sepsis care. Despite the lack of a clear and pragmatic definition, NICE guidance CG151 (2012) identified suspected NS as a medical emergency requiring prompt empirical broad spectrum antibiotics.
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Affiliation(s)
- E Marshall
- Consultant Medical Oncologist, Clatterbridge Cancer Centre, Merseyside
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Sage A, Stewart G, Rowbotham D, Enfield K, Marshall E, Martinez V, Anderson C, Lam W. MA24.07 A Novel cis-Acting lncRNA Controls HMGA1 Expression in Lung Adenocarcinoma. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.525] [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: 10/28/2022]
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Minatel B, Martinez V, Sage A, Marshall E, Tokar T, Becker-Santos D, Robinson W, Jurisica I, Lam W. MA21.10 Large-Scale Discovery of Novel Human Oncofetal Transcripts in Lung. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.499] [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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Sage A, Ng K, Marshall E, Enfield K, Stewart G, Martin S, Minatel B, Brown C, Abraham N, Lam W. MA24.06 Long Non-Coding Rna Expression Patterns Delineate Infiltrating Immune Cells in the Lung Tumour Microenvironment. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.524] [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: 10/28/2022]
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Sage A, Stewart G, Enfield K, Marshall E, Martinez V, Lam W. MA 15.14 Long Non-Coding RNA Disruption in Lung Adenocarcinoma Reveals Novel Mechanisms of Metastasis. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.595] [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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Minatel B, Martinez V, Sage A, Marshall E, Ng K, Anderson C, Becker-Santos D, Robinson W, Jurisica I, Lam W. MA 15.12 Expanding the Lung Small RNA Transcriptome: Discovery of Unannotated microRNAs with Roles in Development and Tumorigenesis. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.593] [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: 11/16/2022]
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Sage A, Stewart G, Anderson C, Rowbotham D, Enfield K, Marshall E, Martinez V, Lam W. P2.02-022 Alternative Regulation of Cancer-Associated Genes through Modulation of Long Non-Coding RNAs. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.1199] [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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Marshall E, Ng K, Enfield K, Martin S, Milne K, Kung S, Macaulay C, Lam W. MA 10.09 Increased T Follicular Helper Cell Infiltration in Lung Adenocarcinoma Tertiary Lymphoid Organs. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.539] [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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Martinez V, Ng K, Marshall E, Sage A, Minatel B, Jurisica I, Lam W. P1.02-006 Arsenic Promotes Persistent Alterations in the Lung PiRNA Transcriptome to Target Epigenetic Pathways. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.738] [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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Keenan J, Marshall E, Heidel E. Women over 37 have superior pregnancy rates with frozen compared with fresh embryo transfers - an analysis of 43,5765 cycles from the national art surveillance system (NASS). Fertil Steril 2017. [DOI: 10.1016/j.fertnstert.2017.07.503] [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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Fanari Z, Gunasekaran P, Shaukat A, Wiley M, Dawn B, Weintraub W, Tadros P, Marshall E. P1646Paradoxical low flow low gradient severe aortic stenosis with preserved left ventricular ejection fraction. impact of medical, transcatheter and surgical management. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p1646] [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: 11/13/2022] Open
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Middleton MR, Schadendorf D, Danson S, Marshall E, Corrie P, Love SB, Mohammed SB, Scudder C, Goff M. Abstract CT123: A randomised phase 2 study of paclitaxel with or without trametinib or pazopanib in advanced wild type BRAF melanoma. Cancer Res 2017. [DOI: 10.1158/1538-7445.am2017-ct123] [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: The aim of this open label study was to assess the efficacy of paclitaxel alone compared with paclitaxel in combination with either the MEK inhibitor trametinib or the anti-angiogenic agent pazopanib in metastatic melanoma.
Methods: Eligible patients aged >=18yrs with unresectable stage 3 or 4 wild type BRAF melanoma were randomised (1:1:1) to paclitaxel alone or with either trametinib or pazopanib. Paclitaxel was given intravenously on day 1, 8 and 15 of each 28 day cycle for a maximum 6 cycles at 80 mg/m2 (single agent & trametinib arms) or 65 mg/m2 (pazopanib arm). Trametinib 2 mg and pazopanib 800 mg was administered orally once daily and both treatments were permitted until disease progression or unacceptable toxicity. Patients were stratified by prior therapy, NRAS status and baseline lactate dehydrogenase level. Neither participants nor investigators were blinded. The primary end point was progression free survival (PFS) with secondary endpoints of PFS at 6 months, overall survival (OS), objective response rate (ORR) and safety and tolerability. A one sided p-value of 0.1 was considered significant for the primary analysis and for the secondary analyses a two-sided p-value of 0.05 was used.
Results: 111 patients from 26 centres (UK and Germany) were randomised to paclitaxel alone (n=38), paclitaxel plus trametinib (n=36) or paclitaxel plus pazopanib (n=37). All patients were considered in the Intention to treat analysis. Median age was 63 years and median follow-up was 26.3 months. 36 patients (40%) had prior systemic therapy. Median PFS was 3.4, 5.2 and 5.3 months with paclitaxel alone, paclitaxel+trametinib and paclitaxel+pazopanib respectively. Efficacy results show benefit for paclitaxel+trametinib as compared to paclitaxel alone in increasing PFS (Time ratio (TR), 1.47; 90% Confidence interval (CI) 1.08 to 2.01, p=0.02) and with significant benefit in ORR (36% vs 12%, odds ratio (OR), 4.7; p=0.01) but no differences in OS (p=0.1). There was significant benefit of paclitaxel+pazopanib in increasing PFS (TR, 1.17; 90% CI 0.98 to 1.39, p=0.07) but no difference in the ORR (OR, 1.82; p=0.34) or OS (p=0.20). The frequency of ≥ Gr 3 AEs was significantly higher (p<0.01) when paclitaxel was combined with trametinib or pazopanib (75% and 78% vs 24%) and this was supported by a significantly higher (p<0.01) frequency of SAEs (47% and 68% vs 13%). 54% of patients discontinued pazopanib due to toxicity vs 18% who stopped trametinib.
Conclusions: Paclitaxel+trametinib and paclitaxel+pazopanib combination improved the efficacy of paclitaxel by increasing PFS and for the trametinib combination also significantly increasing ORR. However, the combination of paclitaxel with either trametinib or pazopanib resulted in higher incidence of AEs and SAEs with the pazopanib combination being particularly problematic.
Citation Format: Mark R. Middleton, Dirk Schadendorf, Sarah Danson, Ernie Marshall, Pippa Corrie, Sharon B. Love, Seid B. Mohammed, Claire Scudder, Matthew Goff. A randomised phase 2 study of paclitaxel with or without trametinib or pazopanib in advanced wild type BRAF melanoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr CT123. doi:10.1158/1538-7445.AM2017-CT123
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Affiliation(s)
| | | | - Sarah Danson
- 3Weston Park Hospital, Sheffield, United Kingdom
| | | | - Pippa Corrie
- 5Addenbrookes Hospital, Cambridge, United Kingdom
| | - Sharon B. Love
- 6Center for Statistics in Medicine, University of Oxford, United Kingdom
| | - Seid B. Mohammed
- 6Center for Statistics in Medicine, University of Oxford, United Kingdom
| | - Claire Scudder
- 7Oncology Clinical Trials Office, University of Oxford, United Kingdom
| | - Matthew Goff
- 7Oncology Clinical Trials Office, University of Oxford, United Kingdom
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Affiliation(s)
- Joanne Upton
- Skin Cancer Advanced Nurse Practitioner, The Clatterbridge Cancer Centre, Wirral, Merseyside
| | - Anna Olsson-Brown
- Specialty Registrar, The Clatterbridge Cancer Centre, Wirral, Merseyside
| | - Ernie Marshall
- Consultant Medical Oncologist, The Clatterbridge Cancer Centre, Wirral, Merseyside
| | - Joseph Sacco
- Consultant Medical Oncologist, The Clatterbridge Cancer Centre, Wirral, Merseyside
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Marshall E, Gibson AM. The effect of an imagery training intervention on self-confidence and anxiety in acrobatic gymnastics. J Sci Med Sport 2017. [DOI: 10.1016/j.jsams.2017.01.060] [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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Bernal F, Whiting A, Aguilar F, Marshall E. Disruption of the linear ubiquitin chain assembly complex (LUBAC) with hydrocarbon stapled alpha helices. Eur J Cancer 2016. [DOI: 10.1016/s0959-8049(16)33013-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Gupta A, Roberts C, Tysoe F, Goff M, Nobes J, Lester J, Marshall E, Corner C, Wolstenholme V, Kelly C, Wise A, Collins L, Love S, Woodward M, Salisbury A, Middleton MR. RADVAN: a randomised phase 2 trial of WBRT plus vandetanib for melanoma brain metastases - results and lessons learnt. Br J Cancer 2016; 115:1193-1200. [PMID: 27711083 PMCID: PMC5104891 DOI: 10.1038/bjc.2016.318] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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: 05/04/2016] [Revised: 08/13/2016] [Accepted: 09/13/2016] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Brain metastases occur in up to 75% of patients with advanced melanoma. Most are treated with whole-brain radiotherapy (WBRT), with limited effectiveness. Vandetanib, an inhibitor of vascular endothelial growth factor receptor, epidermal growth factor receptor and rearranged during transfection tyrosine kinases, is a potent radiosensitiser in xenograft models. We compared WBRT with WBRT plus vandetanib in the treatment of patients with melanoma brain metastases. METHODS In this double-blind, multi-centre, phase 2 trial patients with melanoma brain metastases were randomised to receive WBRT (30 Gy in 10 fractions) plus 3 weeks of concurrent vandetanib 100 mg once daily or placebo. The primary endpoint was progression-free survival in brain (PFS brain). The main study was preceded by a safety run-in phase to confirm tolerability of the combination. A post-hoc analysis and literature review considered barriers to recruiting patients with melanoma brain metastases to clinical trials. RESULTS Twenty-four patients were recruited, six to the safety phase and 18 to the randomised phase. The study closed early due to poor recruitment. Median PFS brain was 3.3 months (90% confidence interval (CI): 1.6-5.6) in the vandetanib group and 2.5 months (90% CI: 0.2-4.8) in the placebo group (P=0.34). Median overall survival (OS) was 4.6 months (90% CI: 1.6-6.3) and 2.5 months (90% CI: 0.2-7.2), respectively (P=0.54). The most frequent adverse events were fatigue, alopecia, confusion and nausea. The most common barrier to study recruitment was availability of alternative treatments. CONCLUSIONS The combination of WBRT plus vandetanib was well tolerated. Compared with WBRT alone, there was no significant improvement in PFS brain or OS, although we are unable to provide a definitive result due to poor accrual. A review of barriers to trial accrual identified several factors that affect study recruitment in this difficult disease area.
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Affiliation(s)
- Avinash Gupta
- Department of Oncology, Oxford University Hospitals NHS Foundation Trust, Cancer and Haematology Centre, Churchill Hospital, Old Road, Oxford OX3 7LE, UK
| | - Corran Roberts
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Windmill Road, Oxford OX3 7LD, UK
| | - Finn Tysoe
- Department of Oncology, Oxford University Hospitals NHS Foundation Trust, Cancer and Haematology Centre, Churchill Hospital, Old Road, Oxford OX3 7LE, UK
| | - Matthew Goff
- Oncology Clinical Trials Office, University of Oxford, Old Road Campus Research Building, Roosevelt Drive, Oxford OX3 7DQ, UK
| | - Jenny Nobes
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Colney Lane, Norwich NR4 7UY, UK
| | - James Lester
- Sheffield Teaching Hospitals NHS Foundation Trust, Weston Park Hospital, Whitham Road, Sheffield S10 2SJ, UK
| | - Ernie Marshall
- Clatterbridge Cancer Centre NHS Foundation Trust, Clatterbridge Road, Wirral CH63 4JY, UK
| | - Carie Corner
- Mount Vernon Cancer Centre, Rickmansworth Road, Northwood, Middlesex HA6 2RN, UK
| | - Virginia Wolstenholme
- Barts Health NHS Trust, St. Bartholomew's Hospital, West Smithfield, London EC1A 7BE, UK
| | - Charles Kelly
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Freeman Road, High Heaton, Newcastle upon Tyne NE7 7DN, UK
| | - Adelyn Wise
- Oncology Clinical Trials Office, University of Oxford, Old Road Campus Research Building, Roosevelt Drive, Oxford OX3 7DQ, UK
| | - Linda Collins
- Oncology Clinical Trials Office, University of Oxford, Old Road Campus Research Building, Roosevelt Drive, Oxford OX3 7DQ, UK
| | - Sharon Love
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Windmill Road, Oxford OX3 7LD, UK
| | - Martha Woodward
- Department of Oncology, Oxford University Hospitals NHS Foundation Trust, Cancer and Haematology Centre, Churchill Hospital, Old Road, Oxford OX3 7LE, UK
| | - Amanda Salisbury
- Department of Oncology, Oxford University Hospitals NHS Foundation Trust, Cancer and Haematology Centre, Churchill Hospital, Old Road, Oxford OX3 7LE, UK
| | - Mark R Middleton
- Department of Oncology, Oxford University Hospitals NHS Foundation Trust, Cancer and Haematology Centre, Churchill Hospital, Old Road, Oxford OX3 7LE, UK
- Department of Oncology, NIHR Oxford Biomedical Research Centre, Churchill Hospital, Old Road, Oxford OX3 7LE, UK
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Neville-Webbe HL, Wong H, Marshall E. Patterns of acute oncology admissions: an exploratory analysis of over 7000 patient episodes. Postgrad Med J 2016; 92:649-652. [DOI: 10.1136/postgradmedj-2015-133805] [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: 10/20/2015] [Revised: 03/09/2016] [Accepted: 03/30/2016] [Indexed: 11/03/2022]
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Nathan PD, Gaunt P, Wheatley K, Bowden SJ, Savage J, Faust G, Nobes J, Goodman A, Ritchie D, Kumar S, Plummer ER, Lester JE, Ottensmeier CH, Potter V, Barthakur U, Lorigan P, Marshall E, Larkin JMG, Marsden J, Steven NM. UKMCC-01: A phase II study of pazopanib (PAZ) in metastatic Merkel cell carcinoma. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.9542] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Paul D. Nathan
- Mount Vernon Cancer Centre, Northwood, Middlesex, United Kingdom
| | - Piers Gaunt
- University of Birmingham, Birmingham, United Kingdom
| | | | | | - Joshua Savage
- University of Birmingham, Birmingham, United Kingdom
| | - Guy Faust
- Leicester Royal Infirmary, Leicester, United Kingdom
| | - Jenny Nobes
- Clinical Oncology, Norfolk & Norwich University Hospital, Norwich, United Kingdom
| | | | - Diana Ritchie
- Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | | | | | | | | | | | | | - Paul Lorigan
- University of Manchester and The Christie NHS FT, Manchester, United Kingdom
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Greenhalgh J, Bagust A, Boland A, Dwan K, Beale S, Hockenhull J, Proudlove C, Dundar Y, Richardson M, Dickson R, Mullard A, Marshall E. Erlotinib and gefitinib for treating non-small cell lung cancer that has progressed following prior chemotherapy (review of NICE technology appraisals 162 and 175): a systematic review and economic evaluation. Health Technol Assess 2016; 19:1-134. [PMID: 26134145 DOI: 10.3310/hta19470] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Lung cancer is the second most diagnosed cancer in the UK. Over 70% of lung cancers are non-small cell lung cancers (NSCLCs). Patients with stage III or IV NSCLC may be offered treatment to improve survival, disease control and quality of life. One-third of these patients receive further treatment following disease progression; these treatments are the focus of this systematic review. OBJECTIVES To appraise the clinical effectiveness and cost-effectiveness of erlotinib [Tarceva(®), Roche (UK) Ltd] and gefitinib (IRESSA(®), AstraZeneca) compared with each other, docetaxel or best supportive care (BSC) for the treatment of NSCLC after disease progression following prior chemotherapy. The effectiveness of treatment with gefitinib was considered only for patients with epidermal growth factor mutation-positive (EGFR M+) disease. DATA SOURCES Four electronic databases (EMBASE, MEDLINE, The Cochrane Library, PubMed) were searched for randomised controlled trials (RCTs) and economic evaluations. Manufacturers' evidence submissions to the National Institute for Health and Care Excellence were also considered. REVIEW METHODS Outcomes for three distinct patient groups based on EGFR mutation status [EGFR M+, epidermal growth factor mutation negative (EGFR M-) and epidermal growth factor mutation status unknown (EGFR unknown)] were considered. Heterogeneity of the data precluded statistical analysis. A de novo economic model was developed to compare treatments (incremental cost per quality-adjusted life-year gained). RESULTS Twelve trials were included in the review. The use of gefitinib was compared with chemotherapy (n = 6) or BSC (n = 1), and the use of erlotinib was compared with chemotherapy (n = 3) or BSC (n = 1). One trial compared the use of gefitinib with the use of erlotinib. No trials included solely EGFR M+ patients; all data were derived from retrospective subgroup analyses from six RCTs [Kim ST, Uhm JE, Lee J, Sun JM, Sohn I, Kim SW, et al. Randomized phase II study of gefitinib versus erlotinib in patients with advanced non-small cell lung cancer who failed previous chemotherapy. Lung Cancer 2012;75:82-8, V-15-32, Tarceva In Treatment of Advanced NSCLC (TITAN), BR.21, IRESSA Survival Evaluation in Lung cancer (ISEL) and IRESSA NSCLC Trial Evaluating REsponse and Survival versus Taxotere (INTEREST)]. These limited data precluded conclusions regarding the clinical effectiveness of any treatment for EGFR M+ patients. For EGFR M- patients, data were derived from the TArceva Italian Lung Optimization tRial (TAILOR) trial and Docetaxel and Erlotinib Lung Cancer Trial (DELTA). Retrospective data were also derived from subgroup analyses of BR.21, Kim et al., TITAN, INTEREST and ISEL. The only statistically significant reported results were for progression-free survival (PFS) for TAILOR and DELTA, and favoured docetaxel over erlotinib [TAILOR hazard ratio (HR) 1.39, 95% confidence interval (CI) 1.06 to 1.82; DELTA HR 1.44, 95% CI 1.08 to 1.92]. In EGFR unknown patients, nine trials (INTEREST, IRESSA as Second-line Therapy in Advanced NSCLC - KoreA, Li, Second-line Indication of Gefitinib in NSCLC, V-15-32, ISEL, DELTA, TITAN and BR.21) reported overall survival data and only one (BR.21) reported a statistically significant result favouring the use of erlotinib over BSC (HR 0.7, 95% CI 0.58 to 0.85). For PFS, BR.21 favoured the use of erlotinib when compared with BSC (HR 0.61, 95% CI 0.51 to 0.74) and the use of gefitinib was favoured when compared with BSC (HR 0.82, 95% CI 0.73 to 0.92) in ISEL. Limitations in the clinical data precluded assessment of cost-effectiveness of treatments for an EGFR M+ population by the Assessment Group (AG). The AG's economic model suggested that for the EGFR M- population, the use of erlotinib was not cost-effective compared with the use of docetaxel and compared with BSC. For EGFR unknown patients, the use of erlotinib was not cost-effective when compared with BSC. CONCLUSIONS/FUTURE WORK The lack of clinical data available for distinct patient populations limited the conclusions of the assessment. Future trials should distinguish between patients with EGFR M+ and EGFR M- disease. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Janette Greenhalgh
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
| | - Adrian Bagust
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
| | - Angela Boland
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
| | - Kerry Dwan
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
| | - Sophie Beale
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
| | - Juliet Hockenhull
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
| | - Christine Proudlove
- North West Medicines Information Centre, Pharmacy Practice Unit, Liverpool, UK
| | - Yenal Dundar
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
| | - Marty Richardson
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
| | - Rumona Dickson
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
| | - Anna Mullard
- The Clatterbridge Centre NHS Foundation Trust, Liverpool, UK
| | - Ernie Marshall
- The Clatterbridge Centre NHS Foundation Trust, Liverpool, UK
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Young A, Marshall E, Krzyzanowska M, Robinson B, Brown S, Collinson F, Seligmann J, Abbas A, Rees A, Swinson D, Neville-Webbe H, Selby P. Responding to Acute Care Needs of Patients With Cancer: Recent Trends Across Continents. Oncologist 2016; 21:301-7. [PMID: 26921289 PMCID: PMC4786347 DOI: 10.1634/theoncologist.2014-0341] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [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: 09/06/2014] [Accepted: 11/25/2015] [Indexed: 12/28/2022] Open
Abstract
Remarkable progress has been made over the past decade in cancer medicine. Personalized medicine, driven by biomarker predictive factors, novel biotherapy, novel imaging, and molecular targeted therapeutics, has improved outcomes. Cancer is becoming a chronic disease rather than a fatal disease for many patients. However, despite this progress, there is much work to do if patients are to receive continuous high-quality care in the appropriate place, at the appropriate time, and with the right specialized expert oversight. Unfortunately, the rapid expansion of therapeutic options has also generated an ever-increasing burden of emergency care and encroaches into end-of-life palliative care. Emergency presentation is a common consequence of cancer and of cancer treatment complications. It represents an important proportion of new presentations of previously undiagnosed malignancy. In the U.K. alone, 20%-25% of new cancer diagnoses are made following an initial presentation to the hospital emergency department, with a greater proportion in patients older than 70 years. This late presentation accounts for poor survival outcomes and is often associated with poor patient experience and poorly coordinated care. The recent development of acute oncology services in the U.K. aims to improve patient safety, quality of care, and the coordination of care for all patients with cancer who require emergency access to care, irrespective of the place of care and admission route. Furthermore, prompt management coordinated by expert teams and access to protocol-driven pathways have the potential to improve patient experience and drive efficiency when services are fully established. The challenge to leaders of acute oncology services is to develop bespoke models of care, appropriate to local services, but with an opportunity for acute oncology teams to engage cancer care strategies and influence cancer care and delivery in the future. This will aid the integration of highly specialized cancer treatment with high-quality care close to home and help avoid hospital admission.
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Affiliation(s)
- Alison Young
- St. James's Institute of Oncology, St. James's University Hospital, Leeds, United Kingdom
| | - Ernie Marshall
- Medical Oncology, Clatterbridge Cancer Centre, Merseyside, United Kingdom
| | | | | | - Sean Brown
- Medical Oncology, Clatterbridge Cancer Centre, Merseyside, United Kingdom
| | - Fiona Collinson
- St. James's Institute of Oncology, St. James's University Hospital, Leeds, United Kingdom
| | - Jennifer Seligmann
- St. James's Institute of Oncology, St. James's University Hospital, Leeds, United Kingdom
| | - Afroze Abbas
- Diabetes Center, School of Medicine, University of Leeds, Leeds, United Kingdom
| | - Adrian Rees
- NHS Leeds West Clinical Commissioning Group, Leeds, United Kingdom
| | - Daniel Swinson
- St. James's Institute of Oncology, St. James's University Hospital, Leeds, United Kingdom
| | | | - Peter Selby
- St. James's Institute of Oncology, St. James's University Hospital, Leeds, United Kingdom University of Leeds, Leeds, United Kingdom
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Baird R, Banks I, Cameron D, Chester J, Earl H, Flannagan M, Januszewski A, Kennedy R, Payne S, Samuel E, Taylor H, Agarwal R, Ahmed S, Archer C, Board R, Carser J, Copson E, Cunningham D, Coleman R, Dangoor A, Dark G, Eccles D, Gallagher C, Glaser A, Griffiths R, Hall G, Hall M, Harari D, Hawkins M, Hill M, Johnson P, Jones A, Kalsi T, Karapanagiotou E, Kemp Z, Mansi J, Marshall E, Mitchell A, Moe M, Michie C, Neal R, Newsom-Davis T, Norton A, Osborne R, Patel G, Radford J, Ring A, Shaw E, Skinner R, Stark D, Turnbull S, Velikova G, White J, Young A, Joffe J, Selby P. An Association of Cancer Physicians' strategy for improving services and outcomes for cancer patients. Ecancermedicalscience 2016; 10:608. [PMID: 26913066 PMCID: PMC4762575 DOI: 10.3332/ecancer.2016.608] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Indexed: 12/02/2022] Open
Abstract
The Association of Cancer Physicians in the United Kingdom has developed a strategy to improve outcomes for cancer patients and identified the goals and commitments of the Association and its members.
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Affiliation(s)
- Richard Baird
- ACP Executive Member
- ACP Strategy Drafting Group
- Supporting Chapter Author
- Addenbrooke’s Hospital, Cambridge, UK
| | - Ian Banks
- ACP Strategy Drafting Group
- Supporting Chapter Author
- University of Leeds, Leeds LS2 9JT, UK
| | - David Cameron
- ACP Executive Member
- ACP Strategy Drafting Group
- Edinburgh Cancer Research Centre, UK
| | - John Chester
- ACP Executive Member
- ACP Strategy Drafting Group
- Supporting Chapter Author
- Wales Cancer Research Centre, Cardiff, UK
| | - Helena Earl
- ACP Executive Member
- ACP Strategy Drafting Group
- Supporting Chapter Author
- Addenbrooke’s Hospital, Cambridge, UK
| | - Mark Flannagan
- ACP Strategy Drafting Group
- Supporting Chapter Author
- Beating Bowel Cancer, Harlequin House, 7 High St, Teddington, Middlesex TW11 8EE, UK
| | - Adam Januszewski
- ACP Executive Member
- ACP Strategy Drafting Group
- Supporting Chapter Author
- London Deanery, Stewart House, 32 Russell Square, London WC1B 5DN, UK
| | | | - Sarah Payne
- ACP Executive Member
- ACP Strategy Drafting Group
- Supporting Chapter Author
- Guy’s and St Thomas’s Hospital, London, UK and Medical Affairs Manager, Pfizer
| | - Emlyn Samuel
- ACP Strategy Drafting Group
- Cancer Research UK, Angel Building, 407 St John Street, London EC1V 4AD, UK
| | - Hannah Taylor
- ACP Executive Member
- ACP Strategy Drafting Group
- Supporting Chapter Author
- Severn Deanery, Vantage Office Park Old Gloucester Road, Hambrook, Avon, Bristol BS16 1GW, UK
| | - Roshan Agarwal
- ACP Executive Member
- Northampton General Hospital, Cliftonville, Northampton NN1 5BD, UK
| | - Samreen Ahmed
- ACP Executive Member
- University Hospitals of Leicester, Infirmary Square, Leicester LE1 5WW, UK
| | - Caroline Archer
- ACP Executive Member
- Queen Alexandra Hospital, Portsmouth, UK
| | - Ruth Board
- ACP Executive Member
- Lancashire Teaching Hospitals, UK
| | - Judith Carser
- ACP Executive Member
- Southern Health and Social Care Trust, Southern College of Nursing, Craigavon Area Hospital, 68 Lurgan Road, Portadown, BT63 5QQ, UK
| | - Ellen Copson
- Supporting Chapter Author
- University of Southampton, University Rd, Southampton SO17 1BJ, UK
| | - David Cunningham
- ACP Executive Member
- Supporting Chapter Author
- NIHR Biomedical Research Centre, Royal Marsden Hospital, London, UK
| | - Rob Coleman
- ACP Executive Member
- Weston Park Hospital, Sheffield, UK
| | - Adam Dangoor
- ACP Executive Member
- Supporting Chapter Author
- University Hospitals Bristol, Bristol, UK
| | - Graham Dark
- Supporting Chapter Author
- Freeman Hospital, Newcastle, UK
| | - Diana Eccles
- Supporting Chapter Author
- University of Southampton, University Rd, Southampton SO17 1BJ, UK
| | | | - Adam Glaser
- Supporting Chapter Author
- University of Leeds, Leeds LS2 9JT, UK
| | - Richard Griffiths
- ACP Executive Member
- Supporting Chapter Author
- Clatterbridge Cancer Centre, Clatterbridge Health Park, Clatterbridge Rd, Wirral, Merseyside CH63 4JY, UK
| | - Geoff Hall
- Supporting Chapter Author
- Leeds Cancer Centre, St James’s University Hospital, Leeds, UK
| | - Marcia Hall
- ACP Executive Member
- Mount Vernon Cancer Centre, Northwood, UK
| | - Danielle Harari
- Supporting Chapter Author
- Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Michael Hawkins
- Supporting Chapter Author
- University of Birmingham, Edgbaston, Birmingham, West Midlands B15 2TT, UK
| | - Mark Hill
- ACP Executive Member
- Kent Oncology Centre, Maidstone, Kent, UK
| | - Peter Johnson
- Supporting Chapter Author
- University of Southampton, University Rd, Southampton SO17 1BJ, UK
| | - Alison Jones
- ACP Executive Member
- Royal Free and University College Hospital, London, UK
| | - Tania Kalsi
- Supporting Chapter Author
- Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | | | - Zoe Kemp
- Supporting Chapter Author
- Royal Marsden Hospital, London, UK
| | - Janine Mansi
- ACP Executive Member
- Supporting Chapter Author
- Guy’s and St Thomas’ Hospitals, London, UK
| | - Ernie Marshall
- Supporting Chapter Author
- Clatterbridge Cancer Centre, Clatterbridge Health Park, Clatterbridge Rd, Wirral, Merseyside CH63 4JY, UK
| | - Alex Mitchell
- Supporting Chapter Author
- University of Leicester, University Rd, Leicester LE1 7RH, UK
| | - Maung Moe
- ACP Executive Member
- North Middlesex University Hospital, UK
| | | | - Richard Neal
- Supporting Chapter Author
- University of Bangor, Bangor, Gwynedd LL57 2DG , Wales, UK
| | - Tom Newsom-Davis
- Supporting Chapter Author
- Chelsea and Westminster Hospital, London, UK
| | | | - Richard Osborne
- Supporting Chapter Author
- Poole Hospital, Longfleet Rd, Poole, Dorset BH15 2JB, UK
| | - Gargi Patel
- ACP Executive Member
- Brighton and Sussex University Hospitals, UK
| | - John Radford
- Supporting Chapter Author
- University of Manchester, Oxford Rd, Manchester M13 9PL, UK
| | - Alistair Ring
- Supporting Chapter Author
- Royal Marsden Hospital, London, UK
| | - Emily Shaw
- Supporting Chapter Author
- Southampton General Hospital, Tremona Rd, Southampton, Hampshire SO16 6YD, UK
| | - Rod Skinner
- Supporting Chapter Author
- Royal Victoria Infirmary, Newcastle, UK
| | - Dan Stark
- Supporting Chapter Author
- Leeds Cancer Centre, St James’s University Hospital, Leeds, UK
| | - Sam Turnbull
- ACP Executive Member
- Leeds Cancer Centre, St James’s University Hospital, Leeds, UK
| | - Galina Velikova
- Supporting Chapter Author
- University of Leeds, Leeds LS2 9JT, UK
| | - Jeff White
- Supporting Chapter Author
- Beatson West of Scotland Cancer Centre, Glasgow, Scotland, UK
| | - Alison Young
- ACP Executive Member
- Supporting Chapter Author
- Leeds Cancer Centre, St James’s University Hospital, Leeds, UK
| | - Johnathan Joffe
- ACP Executive Member
- ACP Strategy Drafting Group
- Supporting Chapter Author
- Senior Author
- Huddersfield Royal Infirmary, Acre St, Huddersfield, West Yorkshire HD3 3EA, UK
| | - Peter Selby
- ACP Executive Member
- ACP Strategy Drafting Group
- Supporting Chapter Author
- Senior Author
- Leeds Cancer Centre, St James’s University Hospital, Leeds, UK
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Nathan P, Cohen V, Coupland S, Curtis K, Damato B, Evans J, Fenwick S, Kirkpatrick L, Li O, Marshall E, McGuirk K, Ottensmeier C, Pearce N, Salvi S, Stedman B, Szlosarek P, Turnbull N. Uveal Melanoma UK National Guidelines. Eur J Cancer 2015; 51:2404-12. [PMID: 26278648 DOI: 10.1016/j.ejca.2015.07.013] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [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: 07/08/2015] [Accepted: 07/10/2015] [Indexed: 01/09/2023]
Abstract
The United Kingdom (UK) uveal melanoma guideline development group used an evidence based systematic approach (Scottish Intercollegiate Guidelines Network (SIGN)) to make recommendations in key areas of uncertainty in the field including: the use and effectiveness of new technologies for prognostication, the appropriate pathway for the surveillance of patients following treatment for primary uveal melanoma, the use and effectiveness of new technologies in the treatment of hepatic recurrence and the use of systemic treatments. The guidelines were sent for international peer review and have been accredited by NICE. A summary of key recommendations is presented. The full documents are available on the Melanoma Focus website.
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Affiliation(s)
- P Nathan
- Mount Vernon Cancer Centre, Northwood, Middlesex, UK.
| | - V Cohen
- Ocular Oncology Service, St Bartholomew's and Moorfields Eye Hospital, London, UK
| | - S Coupland
- Department Molecular and Clinical Cancer Medicine, University of Liverpool, UK
| | | | - B Damato
- Royal Liverpool University Hospital, Liverpool, UK
| | - J Evans
- Royal Liverpool University Hospital, Liverpool, UK
| | - S Fenwick
- University Hospital Aintree, Liverpool, UK
| | | | - O Li
- Moorfields Eye Hospital, London, UK
| | - E Marshall
- The Clatterbridge Cancer Centre, NHS Foundation Trust, Liverpool, UK
| | | | - C Ottensmeier
- Southampton University Hospitals and University of Southampton, UK
| | - N Pearce
- University Hospital Southampton, Southampton, UK
| | - S Salvi
- Royal Hallamshire Hospital, Sheffield, UK
| | - B Stedman
- Southampton University Hospitals, NHS Trust, Southampton, UK
| | - P Szlosarek
- St Bartholomew's Hospital, UK; Barts Cancer Institute, Queen Mary University of London, London, UK
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Abstract
Radiotherapy is an effective treatment modality and an essential tool in the management of cancer. As the incidence of malignant disease rises it is inevitable that physicians will increasingly encounter patients who have presented acutely and require radiotherapy or with a complication from irradiation. This paper explores the basic principles of radiotherapy tailored to the perspective of the acute medical physician and how to manage acute complications. We also discuss the role of radiotherapy in the acutely ill patient and define the need for radiotherapy pathways to ensure that patients receive treatment in a timely manner.
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Affiliation(s)
- Sean Brown
- Clinical Oncology, Clatterbridge Cancer Centre, Bebington, UK
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Escriu C, Wong H, Marshall E. Outcomes Over a Decade in Stage IV Non-Small Cell Lung Cancer (NSCLC): the Clatterbridge Cancer Centre Experience. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv050.30] [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] Open
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Qureshi H, Holt C, Cross S, Hutchings H, Marshall E, Mirvis R, Wilson Jones C. The Psychiatry Early Experience Programme: Stigma, Attitudes and Recruitment. Eur Psychiatry 2015. [DOI: 10.1016/s0924-9338(15)31975-1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Abstract
During eukaryotic cellular protein synthesis, ribosomal translation is made more efficient through interaction between the two ends of the messenger RNA (mRNA). Ribosomes reaching the 3′ end of the mRNA can thus recycle and begin translation again on the same mRNA, the so-called ‘closed-loop’ model. Using a driven diffusion lattice model of translation, we study the effects of ribosome recycling on the dynamics of ribosome flow and density on the mRNA. We show that ribosome recycling induces a substantial increase in ribosome current. Furthermore, for sufficiently large values of the recycling rate, the lattice does not transition directly from low to high ribosome density, as seen in lattice models without recycling. Instead, a maximal current phase becomes accessible for much lower values of the initiation rate, and multiple phase transitions occur over a wide region of the phase plane. Crucially, we show that in the presence of ribosome recycling, mRNAs can exhibit a peak in protein production at low values of the initiation rate, beyond which translation rate decreases. This has important implications for translation of certain mRNAs, suggesting that there is an optimal concentration of ribosomes at which protein synthesis is maximal, and beyond which translational efficiency is impaired.
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Affiliation(s)
- E Marshall
- Institute of Medical Sciences, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZD, UK SUPA, Institute for Complex Systems and Mathematical Biology, King's College, University of Aberdeen, Aberdeen AB24 3UE, UK
| | - I Stansfield
- Institute of Medical Sciences, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZD, UK
| | - M C Romano
- Institute of Medical Sciences, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZD, UK SUPA, Institute for Complex Systems and Mathematical Biology, King's College, University of Aberdeen, Aberdeen AB24 3UE, UK
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De Boo D, Erskine B, Marshall E, kavnoudias H, Koukounaras J, Thomson K. Evaluation of a radiographer-led PICC insertion service. J Vasc Interv Radiol 2015. [DOI: 10.1016/j.jvir.2014.12.395] [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: 11/27/2022] Open
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Bogaerts J, Sydes MR, Keat N, McConnell A, Benson A, Ho A, Roth A, Fortpied C, Eng C, Peckitt C, Coens C, Pettaway C, Arnold D, Hall E, Marshall E, Sclafani F, Hatcher H, Earl H, Ray-Coquard I, Paul J, Blay JY, Whelan J, Panageas K, Wheatley K, Harrington K, Licitra L, Billingham L, Hensley M, McCabe M, Patel PM, Carvajal R, Wilson R, Glynne-Jones R, McWilliams R, Leyvraz S, Rao S, Nicholson S, Filiaci V, Negrouk A, Lacombe D, Dupont E, Pauporté I, Welch JJ, Law K, Trimble T, Seymour M. Clinical trial designs for rare diseases: studies developed and discussed by the International Rare Cancers Initiative. Eur J Cancer 2015; 51:271-81. [PMID: 25542058 PMCID: PMC4639696 DOI: 10.1016/j.ejca.2014.10.027] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 10/28/2014] [Indexed: 12/31/2022]
Abstract
BACKGROUND The past three decades have seen rapid improvements in the diagnosis and treatment of most cancers and the most important contributor has been research. Progress in rare cancers has been slower, not least because of the challenges of undertaking research. SETTINGS The International Rare Cancers Initiative (IRCI) is a partnership which aims to stimulate and facilitate the development of international clinical trials for patients with rare cancers. It is focused on interventional--usually randomized--clinical trials with the clear goal of improving outcomes for patients. The key challenges are organisational and methodological. A multi-disciplinary workshop to review the methods used in ICRI portfolio trials was held in Amsterdam in September 2013. Other as-yet unrealised methods were also discussed. RESULTS The IRCI trials are each presented to exemplify possible approaches to designing credible trials in rare cancers. Researchers may consider these for use in future trials and understand the choices made for each design. INTERPRETATION Trials can be designed using a wide array of possibilities. There is no 'one size fits all' solution. In order to make progress in the rare diseases, decisions to change practice will have to be based on less direct evidence from clinical trials than in more common diseases.
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Affiliation(s)
- Jan Bogaerts
- European Organisation for Research and Treatment of Cancer, Belgium
| | - Matthew R Sydes
- Medical Research Council Clinical Trial Unit at University College London, United Kingdom
| | | | | | - Al Benson
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University, United States
| | - Alan Ho
- Memorial Sloan Kettering Cancer Center, United States
| | - Arnaud Roth
- Geneva University Hospital, Medical Oncology, Switzerland
| | | | - Cathy Eng
- The University of Texas M.D. Anderson Cancer Center, United States
| | | | - Corneel Coens
- European Organisation for Research and Treatment of Cancer, Belgium
| | - Curtis Pettaway
- The University of Texas M.D. Anderson Cancer Center, United States
| | - Dirk Arnold
- Hubertus Wald Tumorzentrum - University Cancer Centre Hamburg, Germany
| | - Emma Hall
- The Institute of Cancer Research, London, United Kingdom
| | | | | | - Helen Hatcher
- The University of Cambridge Department of Oncology and NIHR Cambridge Biomedical Research Centre, United Kingdom
| | - Helena Earl
- The University of Cambridge Department of Oncology and NIHR Cambridge Biomedical Research Centre, United Kingdom
| | | | - James Paul
- Cancer Research UK Clinical Trials Unit, Institute of Cancer Sciences, University of Glasgow, United Kingdom
| | | | - Jeremy Whelan
- NIHR University College London Hospitals Biomedical Research Centre, United Kingdom
| | | | | | | | | | - Lucinda Billingham
- Cancer Research UK Clinical Trials Unit and MRC Midland Hub for Trials Methodology Research, University of Birmingham, United Kingdom
| | | | | | | | | | | | | | | | - Serge Leyvraz
- Centre hospitalier universitaire vaudois, Switzerland
| | | | | | | | | | - Denis Lacombe
- European Organisation for Research and Treatment of Cancer, Belgium
| | - Elisabeth Dupont
- Center for Global Health, US National Cancer Institute, United States
| | | | - John J Welch
- Center for Global Health, US National Cancer Institute, United States
| | - Kate Law
- Cancer Research UK, United Kingdom
| | - Ted Trimble
- Center for Global Health, US National Cancer Institute, United States
| | - Matthew Seymour
- National Institute for Health Research Clinical Research Network/Cancer, United Kingdom
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47
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Affiliation(s)
- Amy Ford
- Clatterbridge Cancer Centre, Bebington, UK
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Azam F, Chatterjee M, Kelly S, Pinto M, Aurangabadkar A, Latif MF, Marshall E. Multifocal calcifying fibrous tumor at six sites in one patient: a case report. World J Surg Oncol 2014; 12:235. [PMID: 25070647 PMCID: PMC4127171 DOI: 10.1186/1477-7819-12-235] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Accepted: 07/20/2014] [Indexed: 10/28/2022] Open
Abstract
Calcifying fibrous tumors (CFT) are rare benign tumors. They usually affect children and young adults and the incidence is equal in males and females. The usual clinical presentation is that of a painless mass. A computed tomography scan typically reveals a well-demarcated calcified lesion. CFT usually presents as a solitary mass and the commonest sites of occurrence are in soft tissues, the pleura, or the peritoneum. Multifocal occurrences at the same site have also been reported. The first case of CFT was reported in 1988. We present a rare case of multiple calcifying fibrous tumors at multiple sites in the same patient. To the best of our knowledge, this is the first ever reported case of multifocal CFT atsix different anatomical sites in one patient.
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Affiliation(s)
- Faisal Azam
- Department of Medical Oncology, North Wales Cancer Treatment Centre, Glan Clwyd Hospital, Rhyl LL18 5UJ, United Kingdom.
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O' Reilly S, Sinclair L, Maynard M, Rajon D, Wayson M, Marshall E, Bolch W. WE-E-BRE-01: An Image-Based Skeletal Dosimetry Model for the ICRP Reference Adult Female - Internal Electron Sources. Med Phys 2014. [DOI: 10.1118/1.4889430] [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: 11/07/2022] Open
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Gomez D, Wetherill C, Cheong J, Jones L, Marshall E, Damato B, Coupland SE, Ghaneh P, Poston GJ, Malik HZ, Fenwick SW. The Liverpool uveal melanoma liver metastases pathway: outcome following liver resection. J Surg Oncol 2014; 109:542-7. [PMID: 24357463 DOI: 10.1002/jso.23535] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [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: 09/12/2013] [Accepted: 11/27/2013] [Indexed: 01/19/2023]
Abstract
AIM To determine the outcome of patients that underwent liver resection for metastases from uveal melanoma. METHODS Over a 9-year period, patients referred with uveal melanoma metastases were included. Following treatment of primary uveal melanoma, high-risk patients were offered to be enrolled into a 6-monthly non-contrast liver magnetic resonance imaging (MRI) surveillance. Following detection of liver metastases, patients were staged with a contrast-enhanced (Primovist(®)) liver MRI, computer tomography (CT) of the thorax and staging laparoscopy. RESULTS 155 patients were referred with uveal melanoma liver metastases, of which 17 (11.0%) patients had liver resection and one patient was treated with percutaneous radio-frequency ablation. The majority of patients undergoing liver resection were treated with multiple metastectomies (n = 8) and three patients had major liver resections. The overall median survival for patients treated with surgery/ablation was 27 (14-90) months, and this was significantly better compared to patients treated palliatively [median = 8(1-30) months, P < 0.001]. Following surgery, 11 patients had recurrent disease [median = 13(6-36) months]. Patients who had undergone a major liver resection had a significantly poorer disease-free survival (P = 0.037). CONCLUSIONS Patients who can undergo surgical resection for metastatic uveal melanoma have a more favorable survival compared to those who do not.
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Affiliation(s)
- D Gomez
- North Western Hepatobiliary Unit, Aintree University Hospital NHS Foundation Trust, Liverpool, UK
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