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Wilson JS, Main C, Thorp N, Taylor RE, Majothi S, Kearns PR, English M, Dandapani M, Phillips R, Wheatley K, Pizer B. Correction to: The effectiveness and safety of proton beam radiation therapy in children and young adults with Central Nervous System (CNS) tumours: a systematic review. J Neurooncol 2024; 167:35-37. [PMID: 38441841 PMCID: PMC10978623 DOI: 10.1007/s11060-024-04612-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Affiliation(s)
- Jayne S Wilson
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK.
| | - Caroline Main
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Nicky Thorp
- The Clatterbridge Cancer Centre, Liverpool, UK
- The Christie Hospital Foundation Trust Proton Beam Therapy Centre, Manchester, UK
| | | | - Saimma Majothi
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Pamela R Kearns
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, UK
- National Institute for Health Research (NIHR) Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Martin English
- Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Madhumita Dandapani
- Children's Brain Tumour Research Centre, University of Nottingham, Nottingham, UK
- Queen's Medical Centre, Nottingham University Hospitals' NHS Trust, Nottingham, UK
| | - Robert Phillips
- Centre for Reviews and Dissemination (CRD), University of York, York, UK
| | - Keith Wheatley
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Barry Pizer
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
- University of Liverpool, Liverpool, UK
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Wilson JS, Main C, Thorp N, Taylor RE, Majothi S, Kearns PR, English M, Dandapani M, Phillips R, Wheatley K, Pizer B. The effectiveness and safety of proton beam radiation therapy in children and young adults with Central Nervous System (CNS) tumours: a systematic review. J Neurooncol 2024; 167:1-34. [PMID: 38294638 PMCID: PMC10978619 DOI: 10.1007/s11060-023-04510-4] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 11/14/2023] [Indexed: 02/01/2024]
Abstract
BACKGROUND Central nervous system (CNS) tumours account for around 25% of childhood neoplasms. With multi-modal therapy, 5-year survival is at around 75% in the UK. Conventional photon radiotherapy has made significant contributions to survival, but can be associated with long-term side effects. Proton beam radiotherapy (PBT) reduces the volume of irradiated tissue outside the tumour target volume which may potentially reduce toxicity. Our aim was to assess the effectiveness and safety of PBT and make recommendations for future research for this evolving treatment. METHODS A systematic review assessing the effects of PBT for treating CNS tumours in children/young adults was undertaken using methods recommended by Cochrane and reported using PRISMA guidelines. Any study design was included where clinical and toxicity outcomes were reported. Searches were to May 2021, with a narrative synthesis employed. RESULTS Thirty-one case series studies involving 1731 patients from 10 PBT centres were included. Eleven studies involved children with medulloblastoma / primitive neuroectodermal tumours (n = 712), five ependymoma (n = 398), four atypical teratoid/rhabdoid tumour (n = 72), six craniopharyngioma (n = 272), three low-grade gliomas (n = 233), one germ cell tumours (n = 22) and one pineoblastoma (n = 22). Clinical outcomes were the most frequently reported with overall survival values ranging from 100 to 28% depending on the tumour type. Endocrine outcomes were the most frequently reported toxicity outcomes with quality of life the least reported. CONCLUSIONS This review highlights areas of uncertainty in this research area. A well-defined, well-funded research agenda is needed to best maximise the potential of PBT. SYSTEMATIC REVIEW REGISTRATION PROSPERO-CRD42016036802.
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Affiliation(s)
- Jayne S Wilson
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK.
| | - Caroline Main
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Nicky Thorp
- The Clatterbridge Cancer Centre, Liverpool, UK
- The Christie Hospital Foundation Trust Proton Beam Therapy Centre, Manchester, UK
| | | | - Saimma Majothi
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Pamela R Kearns
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, UK
- National Institute for Health Research (NIHR) Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Martin English
- Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Madhumita Dandapani
- Children's Brain Tumour Research Centre, University of Nottingham, Nottingham, UK
- Queen's Medical Centre, Nottingham University Hospitals' NHS Trust, Nottingham, UK
| | - Robert Phillips
- Centre for Reviews and Dissemination (CRD), University of York, York, UK
| | - Keith Wheatley
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Barry Pizer
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
- University of Liverpool, Liverpool, UK
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O’Connor D, Joy M, Enshaei A, Kirkwood A, Kearns PR, Samarasinghe S, Moppett J, Moorman AV, Vora A. Cranial radiotherapy has minimal benefit in children with central nervous system involvement in T-ALL. Blood Adv 2023; 7:7231-7234. [PMID: 37824845 PMCID: PMC10698522 DOI: 10.1182/bloodadvances.2023011267] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 09/15/2023] [Accepted: 09/28/2023] [Indexed: 10/14/2023] Open
Affiliation(s)
- David O’Connor
- UCL Cancer Institute, University College London, London, United Kingdom
- Department of Haematology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Melvin Joy
- Wolfson Childhood Cancer Centre, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Amir Enshaei
- Wolfson Childhood Cancer Centre, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Amy Kirkwood
- Cancer Research UK & University College London Cancer Trials Centre, UCL Cancer Institute, University College London, London, United Kingdom
| | - Pamela R. Kearns
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, United Kingdom
| | - Sujith Samarasinghe
- Department of Haematology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - John Moppett
- Department of Paediatric Oncology, Bristol Royal Hospital for Children, Bristol, United Kingdom
| | - Anthony V. Moorman
- Wolfson Childhood Cancer Centre, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Ajay Vora
- Department of Haematology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
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Moreno L, DuBois SG, Glade Bender J, Mauguen A, Bird N, Buenger V, Casanova M, Doz F, Fox E, Gore L, Hawkins DS, Izraeli S, Jones DT, Kearns PR, Molenaar JJ, Nysom K, Pfister S, Reaman G, Smith M, Weigel B, Vassal G, Zwaan CM, Paoletti X, Iasonos A, Pearson AD. Combination Early-Phase Trials of Anticancer Agents in Children and Adolescents. J Clin Oncol 2023; 41:3408-3422. [PMID: 37015036 PMCID: PMC10414747 DOI: 10.1200/jco.22.02430] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 02/07/2023] [Indexed: 04/06/2023] Open
Abstract
PURPOSE There is an increasing need to evaluate innovative drugs for childhood cancer using combination strategies. Strong biological rationale and clinical experience suggest that multiple agents will be more efficacious than monotherapy for most diseases and may overcome resistance mechanisms and increase synergy. The process to evaluate these combination trials needs to maximize efficiency and should be agreed by all stakeholders. METHODS After a review of existing combination trial methodologies, regulatory requirements, and current results, a consensus among stakeholders was achieved. RESULTS Combinations of anticancer therapies should be developed on the basis of mechanism of action and robust preclinical evaluation, and may include data from adult clinical trials. The general principle for combination early-phase studies is that, when possible, clinical trials should be dose- and schedule-confirmatory rather than dose-exploratory, and every effort should be made to optimize doses early. Efficient early-phase combination trials should be seamless, including dose confirmation and randomized expansion. Dose evaluation designs for combinations depend on the extent of previous knowledge. If not previously evaluated, limited evaluation of monotherapy should be included in the same clinical trial as the combination. Randomized evaluation of a new agent plus standard therapy versus standard therapy is the most effective approach to isolate the effect and toxicity of the novel agent. Platform trials may be valuable in the evaluation of combination studies. Patient advocates and regulators should be engaged with investigators early in a proposed clinical development pathway and trial design must consider regulatory requirements. CONCLUSION An optimized, agreed approach to the design and evaluation of early-phase pediatric combination trials will accelerate drug development and benefit all stakeholders, most importantly children and adolescents with cancer.
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Affiliation(s)
- Lucas Moreno
- Hospital Universitari Vall d’Hebron, Barcelona, Spain
| | - Steven G. DuBois
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA
| | | | | | - Nick Bird
- Solving Kids' Cancer UK, London, United Kingdom
| | - Vickie Buenger
- Coalition Against Childhood Cancer (CAC2), Philadelphia, PA
| | | | - François Doz
- Université Paris Cité, Paris, France
- SIREDO Centre (Care, Innovation Research in Pediatric, Adolescent and Young Adults Oncology), Institut Curie, Paris, France
| | | | - Lia Gore
- Children's Hospital Colorado, Aurora, CO
- University of Colorado, Aurora, CO
| | | | - Shai Izraeli
- Rina Zaizov Pediatric Hematology Oncology Division, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
- Hematological Malignancies Centre of Human Molecular Genetics and Biochemistry, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David T.W. Jones
- Hopp Children’s Cancer Center Heidelberg (KiTZ), Heidelberg, Germany
- NIHR Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, United Kingdom
| | - Pamela R. Kearns
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Department of Pharmaceutical Sciences Utrecht University, Utrecht, the Netherlands
| | - Jan J. Molenaar
- Division of Pediatric Neurooncology, DKFZ, KiTZ
- Righospitalet, Copenhagen, Denmark
| | - Karsten Nysom
- Clinical Trial Unit and Childhood Brain Tumors, Heidelberg University Hospital, Heidelberg, Germany
| | - Stefan Pfister
- Hopp Children’s Cancer Center Heidelberg (KiTZ), Heidelberg, Germany
- Division of Pediatric Glioma Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom
| | | | | | | | - Gilles Vassal
- Innovative Therapies for Children with Cancer, Paris, France
- ACCELERATE, Brussels, Belgium
- Gustave Roussy Cancer Centre, Paris, France
| | - Christian Michel Zwaan
- Righospitalet, Copenhagen, Denmark
- Department of Pediatric Oncology, Hematology, Erasmus MC, Sophia Children’s Hospital, the Netherlands
| | | | | | - Andrew D.J. Pearson
- Innovative Therapies for Children with Cancer, Paris, France
- ACCELERATE, Brussels, Belgium
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Blagden SP, Yu LM, Ellis S, Hughes H, Shaaban A, Fennelly-Barnwell J, Lythgoe MP, Cooper AM, Maignen FM, Buckland SW, Kearns PR, Brown LC. Additional consensus recommendations for conducting complex innovative trials of oncology agents: a post-pandemic perspective. Br J Cancer 2023; 128:474-477. [PMID: 36434156 PMCID: PMC9702707 DOI: 10.1038/s41416-022-02051-7] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 10/23/2022] [Accepted: 10/27/2022] [Indexed: 11/27/2022] Open
Abstract
In our 2020 consensus paper, we devised ten recommendations for conducting Complex Innovative Design (CID) trials to evaluate cancer drugs. Within weeks of its publication, the UK was hit by the first wave of the SARS-CoV-2 pandemic. Large CID trials were prioritised to compare the efficacy of new and repurposed COVID-19 treatments and inform regulatory decisions. The unusual circumstances of the pandemic meant studies such as RECOVERY were opened almost immediately and recruited record numbers of participants. However, trial teams were required to make concessions and adaptations to these studies to ensure recruitment was rapid and broad. As these are relevant to cancer trials that enrol patients with similar risk factors, we have added three new recommendations to our original ten: employing pragmatism such as using focused information sheets and collection of only the most relevant data; minimising negative environmental impacts with paperless systems; and using direct-to-patient communication methods to improve uptake. These recommendations can be applied to all oncology CID trials to improve their inclusivity, uptake and efficiency. Above all, the success of CID studies during the COVID-19 pandemic underscores their efficacy as tools for rapid treatment evaluation.
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Affiliation(s)
- Sarah P Blagden
- Department of Oncology, Old Road Campus Research Building, University of Oxford, Oxford, UK.
| | - Ly-Mee Yu
- Primary Care Clinical Trials Unit, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Stephanie Ellis
- London Hampstead Research Ethics Committee, Health Research Authority, Elephant and Castle, London, UK
| | - Helen Hughes
- Cardiff and Vale University Local Health Board, University Hospital of Wales, Cardiff, UK
| | - Abeer Shaaban
- Queen Elizabeth Hospital Birmingham and the University of Birmingham, Birmingham, UK
| | | | - Mark P Lythgoe
- Imperial College London, Hammersmith Hospital, Du Cane Road, London, UK
| | - Alison M Cooper
- The Association of the British Pharmaceutical Industry, London, UK
| | | | | | - Pamela R Kearns
- Cancer Research UK Clinical Trials Unit, NIHR Birmingham Biomedical Research Centre, Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Louise C Brown
- MRC Clinical Trials Unit at University College London, 90 High Holborn, London, UK
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6
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Otth M, Brack E, Kearns PR, Kozhaeva O, Ocokoljic M, Schoot RA, Vassal G, Balduzzi A, Beck Popovic M, Beishuizen A, Bergamaschi L, Biondi A, Bourdeaut F, Braicu E, Brok J, Brugières L, Burke A, Calaminus G, Casanova M, Choucair ML, Cleirec M, Corbaciouglu S, Correa Llano MG, De Rojas T, Domínguez Pinilla N, Elmaraghi C, Ferrari A, Fossa A, Gaspar N, Herold N, Karapiperi K, Karu M, Kjærsgaar M, Knörr F, Koenig C, Kranjcec I, Krawczyk M, Lehmberg K, Lehrnbecher T, Lunesink M, Massano D, Matijasic N, Merks H, Metzler M, Michalski A, Minkov M, Morland B, Niktoreh N, Oltenau E, Orbach D, Owens C, Papachristidou S, Pasqualini C, Pavlovic M, Perez Albert P, Poyer F, Radulovic I, Reinhardt D, Rebelo J, Roser E, Russo I, Scheinemann K, Schindera C, Schrappe M, Sehested A, Sehouli J, Spreafico F, Strauss SJ, Stutterheim J, Svojgr K, Tzotzola V, Van Ewijk R, Verschuur A, Vora A, Woessmann W, Zajac-Spychala O, Zwaan M. Essential medicines for childhood cancer in Europe: a pan-European, systematic analysis by SIOPE. Lancet Oncol 2022; 23:1537-1546. [PMID: 36332647 DOI: 10.1016/s1470-2045(22)00623-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 09/21/2022] [Accepted: 09/22/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Shortages and unequal access to anticancer medicines for children and adolescents are a reality in Europe. The aim of the European Society for Paediatric Oncology (SIOPE) Essential Anticancer Medicines Project was to provide a list of anticancer medicines that are considered essential in the treatment of paediatric cancers to help ensure their continuous access to all children and adolescents with cancer across Europe. METHODS This pan-European project, done between Jan 20, 2020, and Feb 18, 2022, was designed to be a systematic collection and review of treatment protocols and strategies that are used to treat childhood cancer in Europe. We formed 16 working groups on the basis of paediatric cancer types, and which were based on the existing SIOPE Clinical Trial Groups. Workings groups consisted of representatives from the SIOPE Clinical Trial Groups, Young SIOPE members, and senior paediatric oncology experts. Each group collected existing treatment protocols that are used to treat the respective cancer types in Europe. Medicines from the standard group of each protocol were extracted. For medicines not on the WHO Essential Medicines List for children (EMLc) 2017, working groups did a literature search to determine whether the medicines should be defined as essential, promising, or neither essential nor promising. Each group provided an individual summary, and all medicines that were considered essential by at least one group were combined in a joint list. FINDINGS The working groups identified 73 treatment protocols used in Europe and defined 66 medicines as essential. For several newer medicines, such as kinase inhibitors or tisagenlecleucel, the supporting evidence was insufficient to consider them essential, so these medicines were defined as promising. 25 medicines were considered promising by at least one working group. 22 (33%) of the 66 essential and none of the promising medicines were included in the WHO EMLc 2017. The WHO EMLc 2021 included two new medicines (everolimus and vinorelbine) following applications we made as a result of this project. INTERPRETATION Medicines that were defined as essential within this project should be available for the treatment of childhood and adolescent cancer continuously and across Europe. This list can be used to support and guide stakeholders and policy makers in negotiations on a national and European level regarding shortages, accessibility, and affordability of these medicines. FUNDING None.
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Affiliation(s)
- Maria Otth
- Division of Oncology-Hematology, Department of Pediatrics, Kantonsspital Aarau, Aarau, Switzerland; Department of Oncology, Haematology, Immunology, Stem Cell Transplantation and Somatic Gene Therapy, University Children's Hospital Zurich, Zurich, Switzerland.
| | - Eva Brack
- Division of Pediatric Hematology and Oncology, University Children's Hospital Bern, Bern, Switzerland
| | - Pamela R Kearns
- Cancer Research UK Clinical Trials Unit, National Institute for Health Research Birmingham Biomedical Research Centre, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Olga Kozhaeva
- Policy Department, European Society for Paediatric Oncology, SIOP Europe, Brussels, Belgium
| | - Marko Ocokoljic
- Policy Department, European Society for Paediatric Oncology, SIOP Europe, Brussels, Belgium
| | - Reineke A Schoot
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
| | - Gilles Vassal
- Department of Children and Adolescent Oncology, Gustave Roussy Comprehensive Cancer Center, Villejuif, France
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Kelly SM, Effeney R, Gaze MN, Bernier-Chastagner V, Blondeel A, Clementel E, Corning C, Dieckmann K, Essiaf S, Gandola L, Janssens GO, Kearns PR, Lacombe D, Lassen-Ramshad Y, Merks H, Miles E, Padovani L, Scarzello G, Schwarz R, Timmermann B, van Rijn RR, Vassal G, Boterberg T, Mandeville HC. QUARTET: A SIOP Europe project for quality and excellence in radiotherapy and imaging for children and adolescents with cancer. Eur J Cancer 2022; 172:209-220. [PMID: 35780527 DOI: 10.1016/j.ejca.2022.05.037] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [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: 03/31/2022] [Revised: 05/20/2022] [Accepted: 05/26/2022] [Indexed: 12/21/2022]
Abstract
The European Society for Paediatric Oncology (SIOPE) Radiation Oncology Working Group presents the QUARTET Project: a centralised quality assurance programme designed to standardise care and improve the quality of radiotherapy and imaging for international clinical trials recruiting children and adolescents with cancer throughout Europe. QUARTET combines the paediatric radiation oncology expertise of SIOPE with the infrastructure and experience of the European Organisation for Research and Treatment of Cancer to deliver radiotherapy quality assurance programmes for large, prospective, international clinical trials. QUARTET-affiliated trials include children and adolescents with brain tumours, neuroblastoma, sarcomas including rhabdomyosarcoma, and renal tumours including Wilms' tumour. With nine prospective clinical trials and two retrospective studies within the active portfolio in March 2022, QUARTET will collect one of the largest repositories of paediatric radiotherapy and imaging data, support the clinical assessment of radiotherapy, and evaluate the role and benefit of radiotherapy quality assurance for this cohort of patients within the context of clinical trials.
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Affiliation(s)
- Sarah M Kelly
- European Society for Paediatric Oncology (SIOPE), Clos Chapelle-aux-Champs 30, Brussels, Belgium; The European Organisation for Research and Treatment of Cancer (EORTC) Headquarters, Avenue E. Mounier 83, Brussels, Belgium; Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
| | - Rachel Effeney
- European Society for Paediatric Oncology (SIOPE), Clos Chapelle-aux-Champs 30, Brussels, Belgium; The European Organisation for Research and Treatment of Cancer (EORTC) Headquarters, Avenue E. Mounier 83, Brussels, Belgium
| | - Mark N Gaze
- Department of Oncology, University College London Hospitals NHS Foundation Trust, 250 Euston Road, London, NW1 2PG, United Kingdom
| | | | - Anne Blondeel
- European Society for Paediatric Oncology (SIOPE), Clos Chapelle-aux-Champs 30, Brussels, Belgium
| | - Enrico Clementel
- The European Organisation for Research and Treatment of Cancer (EORTC) Headquarters, Avenue E. Mounier 83, Brussels, Belgium
| | - Coreen Corning
- The European Organisation for Research and Treatment of Cancer (EORTC) Headquarters, Avenue E. Mounier 83, Brussels, Belgium
| | - Karin Dieckmann
- Children's Cancer Research Institute, St Anna Kinderkrebsforschung, Medical University of Vienna, Vienna, Austria; Department of Radiation Oncology, Medical University of Vienna, Vienna, Austria
| | - Samira Essiaf
- European Society for Paediatric Oncology (SIOPE), Clos Chapelle-aux-Champs 30, Brussels, Belgium
| | - Lorenza Gandola
- Department of Radiation Oncology, Fondazione IRCCS-Istituto Nazionale Dei Tumori, Milan, Italy
| | - Geert O Janssens
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands; Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Pamela R Kearns
- European Society for Paediatric Oncology (SIOPE), Clos Chapelle-aux-Champs 30, Brussels, Belgium; Cancer Research UK Clinical Trials Unit, National Institute for Health Research Birmingham Biomedical Research Centre, Institute of Cancer and Genomic Services, University of Birmingham, United Kingdom
| | - Denis Lacombe
- The European Organisation for Research and Treatment of Cancer (EORTC) Headquarters, Avenue E. Mounier 83, Brussels, Belgium
| | | | - Hans Merks
- Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Elizabeth Miles
- National Radiotherapy Trials Quality Assurance (RTTQA) Group, Mount Vernon Cancer Centre, United Kingdom
| | - Laetitia Padovani
- Department of Radiation Oncology, Assistance Publique Hôpitaux de Marseille, France
| | - Giovanni Scarzello
- Radiation Therapy Department, Veneto Institute of Oncology IRCCS, Padua, Italy
| | - Rudolf Schwarz
- Department of Radiation Oncology, Medical Center Hamburg-Eppendorf, Hamburg, Martinistr. 52, D 20246 Hamburg Germany
| | - Beate Timmermann
- Department of Particle Therapy, University Hospital Essen, West German Proton Therapy Centre Essen (WPE), West German Cancer Center (WTZ), Germany; German Consortium for Translational Cancer Research (DKTK), Essen, Germany
| | - Rick R van Rijn
- Department of Radiology and Nuclear Medicine, Emma Children's Hospital - Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Gilles Vassal
- European Society for Paediatric Oncology (SIOPE), Clos Chapelle-aux-Champs 30, Brussels, Belgium; Department of Pediatric Oncology, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Tom Boterberg
- Department of Radiation Oncology, Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium
| | - Henry C Mandeville
- Department of Radiotherapy, The Royal Marsden Hospital and the Institute of Cancer Research, Sutton, United Kingdom
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Vassal G, Lazarov D, Rizzari C, Szczepański T, Ladenstein R, Kearns PR. The impact of the EU General Data Protection Regulation on childhood cancer research in Europe. Lancet Oncol 2022; 23:974-975. [PMID: 35901818 DOI: 10.1016/s1470-2045(22)00287-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 05/04/2022] [Accepted: 05/05/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Gilles Vassal
- Department of Paediatric Oncology, Gustave Roussy, 94805 Villejuif, France; University Paris Saclay, Gif-sur-Yvette, France.
| | - Deyan Lazarov
- European Society for Paediatric Oncology-SIOP Europe, Brussels, Belgium
| | - Carmelo Rizzari
- University of Milano-Bicocca, Haematology-Oncology Unit, MBBM Foundation, ASST Monza, Monza, Italy
| | - Tomasz Szczepański
- Paediatric Haematology and Oncology Department, Medical University of Silesia, Zabrze, Poland
| | - Ruth Ladenstein
- St Anna Children's Hospital and Children's Cancer Research Institute, Department of Studies and Statistics for Integrated Research and Projects and Department of Paediatrics, Medical University of Vienna, Vienna, Austria
| | - Pamela R Kearns
- Cancer Research UK Clinical Trials Unit, National Institute for Health Research Birmingham Biomedical Research Centre, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
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Moreira DC, Sniderman E, Mukkada S, Chantada G, Bhakta N, Foster W, Avula M, Homsi MR, Faughnan L, Happ B, Andujar A, Sonnenfelt J, Dalvi R, Frazier AL, Hessissen L, Kearns PR, Luna‐Fineman S, Moreno A, Saghir Khan M, Sullivan M, Devidas M, Santana V, Caniza M, Pritchard‐Jones K, Rodriguez‐Galindo C. The Global COVID-19 Observatory and Resource Center for Childhood Cancer: A response for the pediatric oncology community by SIOP and St. Jude Global. Pediatr Blood Cancer 2021; 68:e28962. [PMID: 33629507 PMCID: PMC7994967 DOI: 10.1002/pbc.28962] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/01/2021] [Accepted: 02/02/2021] [Indexed: 12/16/2022]
Abstract
The COVID-19 pandemic quickly led to an abundance of publications and recommendations, despite a paucity of information on how COVID-19 affects children with cancer. This created a dire need for a trusted resource with curated information and a space for the pediatric oncology community to share experiences. The Global COVID-19 Observatory and Resource Center for Childhood Cancer was developed, launched, and maintained by the International Society of Pediatric Oncology and St. Jude Children's Research Hospital. The three components (Resource Library, Global Registry, and Collaboration Space) complement each other, establishing a mechanism to generate and transfer knowledge rapidly throughout the community.
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Affiliation(s)
- Daniel C. Moreira
- Department of Global Pediatric MedicineSt. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Elizabeth Sniderman
- Department of Global Pediatric MedicineSt. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Sheena Mukkada
- Department of Global Pediatric MedicineSt. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Guillermo Chantada
- Fundacion Perez Scremini‐Hospital Pereira RossellMontevideoUruguay
- Hospital Sant Joan de DéuBarcelonaSpain
| | - Nickhill Bhakta
- Department of Global Pediatric MedicineSt. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Whitney Foster
- Department of Global Pediatric MedicineSt. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Meghana Avula
- Department of Global Pediatric MedicineSt. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Maysam R. Homsi
- Department of Global Pediatric MedicineSt. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Lane Faughnan
- Department of Global Pediatric MedicineSt. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Brooke Happ
- Department of Global Pediatric MedicineSt. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Allyson Andujar
- Department of Global Pediatric MedicineSt. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Jason Sonnenfelt
- Department of Global Pediatric MedicineSt. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Rashmi Dalvi
- Bombay Hospital Institute of Medical Sciences and SRCC Children's HospitalMumbaiIndia
| | - A. Lindsay Frazier
- Dana‐Farber/Boston Children's Hospital Cancer and Blood Disorders CenterBostonMassachusettsUSA
| | | | - Pamela R. Kearns
- NIHR Birmingham Biomedical Research CentreInstitute of Cancer and Genomic Sciences and Birmingham Children's HospitalBirminghamUK
| | | | | | | | - Michael Sullivan
- University of Melbourne and Royal Children's HospitalMelbourneAustralia
| | - Meenakshi Devidas
- Department of Global Pediatric MedicineSt. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Victor Santana
- Department of Global Pediatric MedicineSt. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Miguela Caniza
- Department of Global Pediatric MedicineSt. Jude Children's Research HospitalMemphisTennesseeUSA
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10
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Abstract
The COVID-19 pandemic has considerably changed health services for children with cancer worldwide by creating barriers throughout the care continuum. Reports available at this time suggest that asymptomatic and mild upper and lower respiratory tract syndromes are the most common presentation of COVID-19 in children with cancer. Nonetheless, severe cases of COVID-19 and deaths secondary to the infection have been reported. In addition to the direct effects of the severe acute respiratory syndrome coronavirus 2, children with cancer have suffered from the collateral consequences of the pandemic, including decreased access to diagnosis and cancer-directed therapy. The COVID-19 pandemic has presented unprecedented challenges to safe and effective care of children with cancer, including their enrollment in therapeutic clinical trials. Data from the Children's Oncology Group and Cancer Research U.K. Clinical Trials Unit show variability in the enrollment of children with cancer in clinical trials during the COVID-19 pandemic. However, the overall effects on outcomes for children with cancer undergoing care during the pandemic remain largely unknown. In this article, we review the current knowledge about the direct and collateral effects of the COVID-19 pandemic, including on clinical trial enrollment and operations.
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Affiliation(s)
| | - Gerard C Millen
- Birmingham Children's Hospital, Birmingham, United Kingdom
- Cancer Research U.K. Clinical Trials Unit, NIHR Birmingham Biomedical Research Centre, Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Stephen Sands
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Pamela R Kearns
- Birmingham Children's Hospital, Birmingham, United Kingdom
- Cancer Research U.K. Clinical Trials Unit, NIHR Birmingham Biomedical Research Centre, Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Douglas S Hawkins
- Seattle Children's Hospital Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA
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11
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Millen GC, Arnold R, Cazier JB, Curley H, Feltbower RG, Gamble A, Glaser AW, Grundy RG, Lee LYW, McCabe MG, Phillips RS, Stiller CA, Várnai C, Kearns PR. Severity of COVID-19 in children with cancer: Report from the United Kingdom Paediatric Coronavirus Cancer Monitoring Project. Br J Cancer 2021; 124:754-759. [PMID: 33299130 PMCID: PMC7884399 DOI: 10.1038/s41416-020-01181-0] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 10/31/2020] [Accepted: 11/05/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Children with cancer are frequently immunocompromised. While children are generally thought to be at less risk of severe SARS-CoV-2 infection than adults, comprehensive population-based evidence for the risk in children with cancer is unavailable. We aimed to produce evidence of the incidence and outcomes from SARS-CoV-2 in children with cancer attending all hospitals treating this population across the UK. METHODS Retrospective and prospective observational study of all children in the UK under 16 diagnosed with cancer through data collection from all hospitals providing cancer care to this population. Eligible patients tested positive for SARS-CoV-2 on reverse transcription polymerase chain reaction (RT-PCR). The primary end-point was death, discharge or end of active care for COVID-19 for those remaining in hospital. RESULTS Between 12 March 2020 and 31 July 2020, 54 cases were identified: 15 (28%) were asymptomatic, 34 (63%) had mild infections and 5 (10%) moderate, severe or critical infections. No patients died and only three patients required intensive care support due to COVID-19. Estimated incidence of hospital identified SARS-CoV-2 infection in children with cancer under 16 was 3%. CONCLUSIONS Children with cancer with SARS-CoV-2 infection do not appear at increased risk of severe infection compared to the general paediatric population. This is reassuring and supports the continued delivery of standard treatment.
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Affiliation(s)
- Gerard C Millen
- Cancer Research UK Clinical Trials Unit, Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK.
- Department of Paediatric Oncology, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, UK.
| | - Roland Arnold
- Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - Jean-Baptiste Cazier
- Centre for Computational Biology, University of Birmingham, Edgbaston, Birmingham, UK
| | - Helen Curley
- Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - Richard G Feltbower
- Leeds Institute for Data Analytics (LIDA), School of Medicine, University of Leeds, Leeds, LS2 9JT, UK
| | - Ashley Gamble
- Children's Cancer and Leukaemia Group (CCLG), Leicester, LE1 7GB, UK
| | - Adam W Glaser
- Leeds Institute for Data Analytics (LIDA), School of Medicine, University of Leeds, Leeds, LS2 9JT, UK
- Professor of Paediatric Oncology and Late Effects Medicine, Leeds Institute of Medical Research, University of Leeds, Leeds, LS2 9JT, UK
| | - Richard G Grundy
- Children's Cancer and Leukaemia Group (CCLG), Leicester, LE1 7GB, UK
- Children's Brain Tumour Research Centre, School of Medicine, The University of Nottingham, Nottingham, NG7 2UH, UK
| | - Lennard Y W Lee
- Institute of Cancer and Genomic Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - Martin G McCabe
- Division of Cancer Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, M13 9PL, UK
- National Cancer Registration and Analysis Service, Public Health England, London, SE1 8UG, UK
| | - Robert S Phillips
- Centre for Reviews and Dissemination, University of York, York, UK
- Department of Paediatric Oncology, Leeds Children's Hospital, Leeds, UK
| | - Charles A Stiller
- National Cancer Registration and Analysis Service, Public Health England, London, SE1 8UG, UK
| | - Csilla Várnai
- Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK
- Centre for Computational Biology, University of Birmingham, Birmingham, B15 2TT, UK
| | - Pamela R Kearns
- Department of Paediatric Oncology, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, UK
- Cancer Research UK Clinical Trials Unit, NIHR Birmingham Biomedical Research Centre, Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK
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12
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Perry TA, Lupino L, Vrzalikova K, Masand N, Kearns PR, Murray PG. Abstract 2657: Sphingosine-1-phosphate receptor 1 signalling modulates macrophage recruitment to diffuse large B cell lymphomas and the phagocytosis of rituximab-opsonized tumor cells. Cancer Res 2020. [DOI: 10.1158/1538-7445.am2020-2657] [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
Diffuse large B cell lymphoma (DLBCL) is the most common form of non-Hodgkin lymphoma. Currently, approximately 40% of DLBCL patients treated with standard of care therapies, which include a combination of immunotherapy (rituximab; R) and chemotherapy (CHOP), will have disease that is refractory or will relapse. Tumor-associated macrophages can phagocytose opsonised DLBCL tumor cells and are therefore centrally important in determining therapeutic outcomes for patients treated with R-CHOP. Recent data from our lab and from others suggests that the modulation of sphingosine-1-phosphate (S1P) signalling may therapeutically benefit some patients with this tumor. Here, we have investigated the effects of S1P on macrophage functions relevant to DLBCL. We show that S1P signalling through the major receptor, S1P-receptor 1 (S1PR1), suppresses the phagocytosis of rituximab-opsonized DLBCL cells. However, we also show that chemotherapy potently induces monocyte recruitment to DLBCL tumors in vivo and that S1PR1 is a primary mediator of monocyte migration both in vitro and in vivo. According to our data, S1PR1 signalling inhibitors could improve the therapeutic efficacy of rituximab-based therapies for DLBCL patients. However, our data suggests that these drugs should be given only after chemotherapy and before rituximab administration so as to maximize the S1P-mediated recruitment of therapeutic macrophages to the tumor site.
Citation Format: Tracey Adams Perry, Lauren Lupino, Katerina Vrzalikova, Navta Masand, Pamela R. Kearns, Paul G. Murray. Sphingosine-1-phosphate receptor 1 signalling modulates macrophage recruitment to diffuse large B cell lymphomas and the phagocytosis of rituximab-opsonized tumor cells [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 2657.
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Affiliation(s)
| | | | | | - Navta Masand
- University of Birmingham, Edgbaston, United Kingdom
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13
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Blagden SP, Billingham L, Brown LC, Buckland SW, Cooper AM, Ellis S, Fisher W, Hughes H, Keatley DA, Maignen FM, Morozov A, Navaie W, Pearson S, Shaaban A, Wydenbach K, Kearns PR. Effective delivery of Complex Innovative Design (CID) cancer trials-A consensus statement. Br J Cancer 2020; 122:473-482. [PMID: 31907370 PMCID: PMC7028941 DOI: 10.1038/s41416-019-0653-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [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: 06/14/2019] [Revised: 11/06/2019] [Accepted: 11/06/2019] [Indexed: 01/13/2023] Open
Abstract
The traditional cancer drug development pathway is increasingly being superseded by trials that address multiple clinical questions. These are collectively termed Complex Innovative Design (CID) trials. CID trials not only assess the safety and toxicity of novel anticancer medicines but also their efficacy in biomarker-selected patients, specific cancer cohorts or in combination with other agents. They can be adapted to include new cohorts and test additional agents within a single protocol. Whilst CID trials can speed up the traditional route to drug licencing, they can be challenging to design, conduct and interpret. The Experimental Cancer Medicine Centres (ECMC) network, funded by the National Institute for Health Research (NIHR), Cancer Research UK (CRUK) and the Health Boards of Wales, Northern Ireland and Scotland, formed a working group with relevant stakeholders from clinical trials units, the pharmaceutical industry, funding bodies, regulators and patients to identify the main challenges of CID trials. The working group generated ten consensus recommendations. These aim to improve the conduct, quality and acceptability of oncology CID trials in clinical research and, importantly, to expedite the process by which effective treatments can reach cancer patients.
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Affiliation(s)
| | - Lucinda Billingham
- Cancer Research UK Clinical Trials Unit, Institute of Cancer and Genomic Studies, University of Birmingham, Birmingham, UK
| | - Louise C Brown
- Medical Research Council (MRC) Clinical Trials Unit, University College London, London, UK
| | | | - Alison M Cooper
- The Association of the British Pharmaceutical Industry (ABPI), London, UK
| | | | | | - Helen Hughes
- Cardiff and Vale University Health Board, Cardiff, UK
| | - Debbie A Keatley
- Independent Cancer Patients' Voice, National Cancer Research Institute (NCRI), London, UK
| | | | | | | | - Sarah Pearson
- Oncology Clinical Trials Office, University of Oxford, Oxford, UK
| | - Abeer Shaaban
- Queen Elizabeth Hospital Birmingham and the University of Birmingham, Birmingham, UK
| | - Kirsty Wydenbach
- Medicines and Healthcare products Regulatory Agency (MHRA), London, UK
| | - Pamela R Kearns
- Cancer Research UK Clinical Trials Unit, Institute of Cancer and Genomic Studies, University of Birmingham, Birmingham, UK
- National Institute for Health Research (NIHR) Birmingham Biomedical Research Centre, Institute of Cancer and Genomic Studies, University of Birmingham, Birmingham, UK
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14
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Gatz SA, Aladowicz E, Casanova M, Chisholm JC, Kearns PR, Fulda S, Geoerger B, Schäfer BW, Shipley JM. A Perspective on Polo-Like Kinase-1 Inhibition for the Treatment of Rhabdomyosarcomas. Front Oncol 2019; 9:1271. [PMID: 31824851 PMCID: PMC6882953 DOI: 10.3389/fonc.2019.01271] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 08/21/2019] [Accepted: 11/04/2019] [Indexed: 12/13/2022] Open
Abstract
Rhabdomyosarcomas are the most common pediatric soft tissue sarcoma and are a major cause of death from cancer in young patients requiring new treatment options to improve outcomes. High-risk patients include those with metastatic or relapsed disease and tumors with PAX3-FOXO1 fusion genes that encode a potent transcription factor that drives tumourigenesis through transcriptional reprogramming. Polo-Like Kinase-1 (PLK1) is a serine/threonine kinase that phosphorylates a wide range of target substrates and alters their activity. PLK1 functions as a pleiotropic master regulator of mitosis and regulates DNA replication after stress. Taken together with high levels of expression that correlate with poor outcomes in many cancers, including rhabdomyosarcomas, it is an attractive therapeutic target. This is supported in rhabdomyosarcoma models by characterization of molecular and phenotypic effects of reducing and inhibiting PLK1, including changes to the PAX3-FOXO1 fusion protein. However, as tumor re-growth has been observed, combination strategies are required. Here we review preclinical evidence and consider biological rationale for PLK1 inhibition in combination with drugs that promote apoptosis, interfere with activity of PAX3-FOXO1 and are synergistic with microtubule-destabilizing drugs such as vincristine. The preclinical effects of low doses of the PLK1 inhibitor volasertib in combination with vincristine, which is widely used in rhabdomyosarcoma treatment, show particular promise in light of recent clinical data in the pediatric setting that support achievable volasertib doses predicted to be effective. Further development of novel therapeutic strategies including PLK1 inhibition may ultimately benefit young patients with rhabdomyosarcoma and other cancers.
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Affiliation(s)
- Susanne A. Gatz
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom
- Divisions of Molecular Pathology and Cancer Therapeutics, The Institute of Cancer Research, London, United Kingdom
| | - Ewa Aladowicz
- Divisions of Molecular Pathology and Cancer Therapeutics, The Institute of Cancer Research, London, United Kingdom
| | | | - Julia C. Chisholm
- Divisions of Molecular Pathology and Cancer Therapeutics, The Institute of Cancer Research, London, United Kingdom
- Children and Young People's Unit, The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Pamela R. Kearns
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Simone Fulda
- Institute for Experimental Cancer Research in Pediatrics, Goethe-University Frankfurt, Frankfurt, Germany
| | - Birgit Geoerger
- Gustave Roussy Cancer Campus, Department of Paediatric and Adolescent Oncology, Université Paris-Saclay, Villejuif, France
| | - Beat W. Schäfer
- Department of Oncology and Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Janet M. Shipley
- Divisions of Molecular Pathology and Cancer Therapeutics, The Institute of Cancer Research, London, United Kingdom
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15
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Jackson RK, Liebich M, Berry P, Errington J, Liu J, Parker C, Moppett J, Samarasinghe S, Hough R, Rowntree C, Goulden NJ, Vora A, Kearns PR, Saha V, Hempel G, Irving JAE, Veal GJ. Impact of dose and duration of therapy on dexamethasone pharmacokinetics in childhood acute lymphoblastic leukaemia-a report from the UKALL 2011 trial. Eur J Cancer 2019; 120:75-85. [PMID: 31499383 DOI: 10.1016/j.ejca.2019.07.026] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [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: 05/03/2019] [Revised: 07/01/2019] [Accepted: 07/23/2019] [Indexed: 11/21/2022]
Abstract
INTRODUCTION The use of dexamethasone in acute lymphoblastic leukaemia therapy contributes to short- and long-term toxicities. The UKALL 2011 randomised trial investigated whether a more intense dexamethasone dose (10 mg/m2/d x 14d, short vs 6 mg/m2/d x 28d, standard) would lead to a more rapid cytoreduction and reduced adverse effects associated with longer durations of steroids in induction. The impact of dose and duration on dexamethasone pharmacokinetics was investigated. METHODS Blood samples were obtained on one of the first three and last three days of induction dexamethasone dosing at time points up to 8 h after oral administration. Plasma dexamethasone levels were quantified in 1084 plasma samples obtained from 174 children and a population pharmacokinetic model developed. RESULTS Drug exposure varied significantly between patients, with a >12-fold variation in AUC0-12h values and a marked overlap in dexamethasone exposures between dose levels. Intuitively, AUC0-12h was significantly higher with short dosing (10 mg/m2/d), but cumulative exposure was significantly higher with standard dosing over 28 days, after a higher cumulative dose. Concomitant rasburicase administration was associated with a 60% higher dexamethasone clearance. Day 8 bone marrow response was comparable between dosing arms, but those with <5% blast count exhibited a greater mean dexamethasone exposure than those with >5%. No statistical differences were observed between arms in terms of steroid-related toxicity or minimal residual disease at the end of induction. CONCLUSION The potential significance of dexamethasone AUC0-12h on early response and higher cumulative exposure on the standard arm suggest that duration of therapy and exposure may be more important factors than absolute dose from a clinical pharmacology perspective.
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Affiliation(s)
- Rosanna K Jackson
- Northern Institute for Cancer Research, Newcastle University, Newcastle Upon Tyne, UK
| | - Martina Liebich
- Department of Pharmaceutical and Medical Chemistry, Clinical Pharmacy, University of Münster, Germany
| | - Philip Berry
- Northern Institute for Cancer Research, Newcastle University, Newcastle Upon Tyne, UK
| | - Julie Errington
- Northern Institute for Cancer Research, Newcastle University, Newcastle Upon Tyne, UK
| | - Jizhong Liu
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK
| | - Catriona Parker
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK
| | - John Moppett
- Department of Paediatric Haematology and Oncology, Bristol Royal Hospital for Children, UK
| | - Sujith Samarasinghe
- Department of Haematology, Great Ormond Street Hospital for Children, London, UK
| | | | | | - Nick J Goulden
- Department of Haematology, Great Ormond Street Hospital for Children, London, UK
| | - Ajay Vora
- Department of Paediatric Haematology, Great Ormond Street Hospital, UK
| | - Pamela R Kearns
- Cancer Research UK Clinical Trials Unit, National Institute for Health Research (NIHR) Birmingham Biomedical Research Centre, Institute of Cancer and Genomic Studies, University of Birmingham, UK
| | - Vaskar Saha
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK; Tata Translational Cancer Research Centre, Tata Medical Center, Kolkata, India
| | - Georg Hempel
- Department of Pharmaceutical and Medical Chemistry, Clinical Pharmacy, University of Münster, Germany
| | - Julie A E Irving
- Northern Institute for Cancer Research, Newcastle University, Newcastle Upon Tyne, UK
| | - Gareth J Veal
- Northern Institute for Cancer Research, Newcastle University, Newcastle Upon Tyne, UK.
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Kearns PR, Vassal G, Ladenstein R, Schrappe M, Biondi A, Blanc P, Eggert A, Kienesberger A, Kozhaeva O, Pieters R, Schmiegelow K. A European paediatric cancer mission: aspiration or reality? Lancet Oncol 2019; 20:1200-1202. [DOI: 10.1016/s1470-2045(19)30487-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 07/17/2019] [Accepted: 07/17/2019] [Indexed: 11/26/2022]
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17
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Pais H, Ruggero K, Zhang J, Al-Assar O, Bery N, Bhuller R, Weston V, Kearns PR, Mecucci C, Miller A, Rabbitts TH. Surfaceome interrogation using an RNA-seq approach highlights leukemia initiating cell biomarkers in an LMO2 T cell transgenic model. Sci Rep 2019; 9:5760. [PMID: 30962539 PMCID: PMC6453905 DOI: 10.1038/s41598-019-42214-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 01/14/2019] [Accepted: 03/27/2019] [Indexed: 12/27/2022] Open
Abstract
The surfaceome is critical because surface proteins provide a gateway for internal signals and transfer of molecules into cells, and surfaceome differences can influence therapy response. We have used a surfaceome analysis method, based on comparing RNA-seq data between normal and abnormal cells (Surfaceome DataBase Mining or Surfaceome DBM), to identify sets of upregulated cell surface protein mRNAs in an LMO2-mediated T-ALL mouse model and corroborated by protein detection using antibodies. In this model the leukemia initiating cells (LICs) comprise pre-leukaemic, differentiation inhibited thymocytes allowing us to provide a profile of the LIC surfaceome in which GPR56, CD53 and CD59a are co-expressed with CD25. Implementation of cell surface interaction assays demonstrates fluid interaction of surface proteins and CD25 is only internalized when co-localized with other proteins. The Surfaceome DBM approach to analyse cancer cell surfaceomes is a way to find targetable surface biomarkers for clinical conditions where RNA-seq data from normal and abnormal cell are available.
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Affiliation(s)
- Helio Pais
- Trivago GmbH, Bennigsen-Platz 1, 40474, Düsseldorf, Germany
| | - Katia Ruggero
- Catalan Institute of Oncology, Bellvitge Institute for Biomedical Research (IDIBELL), Gran Via de L'Hospitalet, 199, Barcelona, Spain
| | - Jing Zhang
- MRC Weatherall Institute of Molecular Medicine, MRC Molecular Haematology Unit, University of Oxford, Oxford, OX3 9DS, UK
| | - Osama Al-Assar
- The Wellcome Centre for Human Genetics, Roosevelt Drive, Oxford, OX3 7BN, UK
| | - Nicolas Bery
- MRC Weatherall Institute of Molecular Medicine, MRC Molecular Haematology Unit, University of Oxford, Oxford, OX3 9DS, UK
| | - Ravneet Bhuller
- MRC Weatherall Institute of Molecular Medicine, MRC Molecular Haematology Unit, University of Oxford, Oxford, OX3 9DS, UK
| | - Victoria Weston
- Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Vincent Drive, Edgbaston, B15 2TT, UK
| | - Pamela R Kearns
- Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Vincent Drive, Edgbaston, B15 2TT, UK
| | | | - Ami Miller
- MRC Weatherall Institute of Molecular Medicine, MRC Molecular Haematology Unit, University of Oxford, Oxford, OX3 9DS, UK
| | - Terence H Rabbitts
- MRC Weatherall Institute of Molecular Medicine, MRC Molecular Haematology Unit, University of Oxford, Oxford, OX3 9DS, UK.
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18
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Moreno L, Vaidya SJ, Schrey D, Pinkerton CR, Lewis IJ, Kearns PR, Machin D, Pearson ADJ. Long-term analysis of children with metastatic neuroblastoma treated in the ENSG5 randomised clinical trial. Pediatr Blood Cancer 2019; 66:e27565. [PMID: 30516328 DOI: 10.1002/pbc.27565] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 09/17/2018] [Revised: 10/24/2018] [Accepted: 10/30/2018] [Indexed: 11/11/2022]
Abstract
BACKGROUND The European Neuroblastoma Study Group 5 (ENSG5) trial showed that time-intensive "rapid" induction chemotherapy (COJEC) was superior to "standard" 3-weekly chemotherapy for children with high-risk metastatic neuroblastoma. Long-term outcomes of the ENSG5 trial were analysed. PROCEDURE Patients with metastatic neuroblastoma aged ≥12 months were randomly assigned to "standard" or "rapid" induction, receiving the same chemotherapy drugs and doses. Event-free survival (EFS) and overall survival (OS) were analysed and prognostic factors evaluated. Amongst patients surviving >5 years, a population of children with persistent metastatic disease after the end of treatment was identified and described. RESULTS Ten-year EFS was 18.2% (95% confidence interval: 12.2-25.2) for the "standard" arm and 26.8% (19.5-34.7) for the "rapid" arm (hazard ratio [HR] 0.85, P = 0.28). Ten-year OS for the "standard" arm was 19.7% (13.4-26.8) and 28.3% (20.8-36.2) for the "rapid arm" (HR 0.83, P = 0.19). There was a trend for worse EFS and OS for patients having MYCN amplification (HR 1.37 and 1.40, respectively) and those with partial and mixed response to induction (HR 1.69 and 1.75 for EFS and 1.66 and 2.00 for OS, respectively). Among 69 patients who survived >5 years, six had persistent metastatic disease after the end of treatment. CONCLUSION The benefit of the "rapid" induction regimen seems to be maintained in the long term, although the small number of survivors could justify the lack of statistical significance. MYCN amplification and poor metastatic response to induction could be associated with worse outcomes. A small group of patients with persistent metastatic disease that survived long term has been described.
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Affiliation(s)
- Lucas Moreno
- Clinical Trials Unit, Department of, Paediatric Haematology, Oncology and SCT, Hospital Infantil Universitario Niño Jesus, Madrid, Spain
- Children and Young People's Unit, The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, United Kingdom
| | - Sucheta J Vaidya
- Children and Young People's Unit, The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Dominik Schrey
- Children and Young People's Unit, The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | | | - Ian J Lewis
- Leeds Community Healthcare NHS Trust, Leeds, United Kingdom
| | - Pamela R Kearns
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, United Kingdom
| | - David Machin
- Department of Cancer Studies, Clinical Sciences Building, Leicester Royal Infirmary, University of Leicester, Leicester, United Kingdom
| | - Andrew D J Pearson
- Children and Young People's Unit, The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom (retired)
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Stevens SP, Main C, Bailey S, Pizer B, English M, Phillips B, Peet A, Avula S, Wilne S, Wheatley K, Kearns PR, Wilson JS. The utility of routine surveillance screening with magnetic resonance imaging to detect tumor recurrence/progression in children with high-grade central nervous system tumors: a systematic review. Pediatr Blood Cancer 2019; 66:e27509. [PMID: 30408313 DOI: 10.1002/pbc.27509] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 09/14/2018] [Accepted: 09/26/2018] [Indexed: 11/06/2022]
Abstract
BACKGROUND Surveillance magnetic resonance imaging (MRI) is routinely used to detect recurrence in children with high-grade central nervous system (CNS) tumors, although no consensus has been reached regarding its effectiveness and whether earlier detection is associated with improved patient outcomes. This review aimed to evaluate this practice and any associated benefits and harms. METHODS Systematic searches for relevant studies were undertaken in a number of databases, including MEDLINE and EMBASE, from 1985 to August 2018. Study selection and data extraction was undertaken independently by two reviewers. Due to heterogeneity between studies, no pooling of data was undertaken. Reporting followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS No comparative studies were identified. Three retrospective observational studies involving 306 patients were reviewed. All had high risk of bias by virtue of study design. Two studies reported outcomes by symptomatic status-both recurrence rates and overall survival for asymptomatic patients were comparable with those for clinically symptomatic patients. No quality-of-life outcomes were reported. CONCLUSION There is a paucity of evidence to guide clinical practice as to the effectiveness of MRI surveillance in pediatric patients with high-grade CNS tumors. These studies do not clearly demonstrate benefit or harm for the practice. With more research needed, there is a role for researchers to build into future trials data collection on surveillance imaging to give more information for the assessment of imaging frequency and duration in asymptomatic patients. This is an important question not only to clinicians and patients and their families but also from a health service resource perspective.
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Affiliation(s)
- Simon P Stevens
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Caroline Main
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Simon Bailey
- Sir James Spence Institute of Child Health, Royal Victoria Infirmary, Newcastle-Upon-Tyne, UK
| | - Barry Pizer
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Martin English
- Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Bob Phillips
- Centre for Reviews and Dissemination (CRD), University of York, York, UK
| | - Andrew Peet
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Shivaram Avula
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Sophie Wilne
- Queen's Medical Centre, Nottingham University Hospitals' NHS Trust, Nottingham, UK
| | - Keith Wheatley
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Pamela R Kearns
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Jayne S Wilson
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
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Stevens SP, Main C, Bailey S, Pizer B, English M, Phillips R, Peet A, Avula S, Wilne S, Wheatley K, Kearns PR, Wilson JS. The utility of routine surveillance screening with magnetic resonance imaging (MRI) to detect tumour recurrence in children with low-grade central nervous system (CNS) tumours: a systematic review. J Neurooncol 2018; 139:507-522. [PMID: 29948767 PMCID: PMC6132973 DOI: 10.1007/s11060-018-2901-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 02/16/2018] [Accepted: 05/12/2018] [Indexed: 01/13/2023]
Abstract
BACKGROUND Magnetic resonance imaging (MRI) is routinely used as a surveillance tool to detect early asymptomatic tumour recurrence with a view to improving patient outcomes. This systematic review aimed to assess its utility in children with low-grade CNS tumours. METHODS Using standard systematic review methods, twelve databases were searched up to January 2017. RESULTS Seven retrospective case series studies (n = 370 patients) were included, with average follow-up ranging from 5.6 to 7 years. No randomised controlled trials (RCTs) were identified. Due to study heterogeneity only a descriptive synthesis could be undertaken. Imaging was most frequent in the first year post-surgery (with 2-4 scans) reducing to around half this frequency in year two and annually thereafter for the duration of follow-up. Diagnostic yield ranged from 0.25 to 2%. Recurrence rates ranged from 5 to 41%, with most recurrences asymptomatic (range 65-100%). Collectively, 56% of recurrences had occurred within the first year post-treatment (46% in the first 6-months), 68% by year two and 90% by year five. Following recurrence, 90% of patients underwent treatment changes, mainly repeat surgery (72%). Five-year OS ranged from 96 to 100%, while five-year recurrence-free survival ranged from 67 to 100%. None of the studies reported quality of life measures. CONCLUSION This systematic review highlights the paucity of evidence currently available to assess the utility of MRI surveillance despite it being routine clinical practice and costly to patients, their families and healthcare systems. This needs to be evaluated within the context of an RCT.
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Affiliation(s)
- Simon P Stevens
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Caroline Main
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Simon Bailey
- Sir James Spence Institute of Child Health, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Barry Pizer
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Martin English
- Birmingham Women and Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Robert Phillips
- Centre for Reviews and Dissemination (CRD), University of York, York, UK
| | - Andrew Peet
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Shivaram Avula
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Sophie Wilne
- Queen's Medical Centre, Nottingham University Hospitals' NHS Trust, Nottingham, UK
| | - Keith Wheatley
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Pamela R Kearns
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Birmingham Women and Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Jayne S Wilson
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK.
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21
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Gore L, Kearns PR, de Martino ML, Lee, De Souza CA, Bertrand Y, Hijiya N, Stork LC, Chung NG, Cardos RC, Saikia T, Fagioli F, Seo JJ, Landman-Parker J, Lancaster D, Place AE, Rabin KR, Sacchi M, Swanink R, Zwaan CM. Dasatinib in Pediatric Patients With Chronic Myeloid Leukemia in Chronic Phase: Results From a Phase II Trial. J Clin Oncol 2018; 36:1330-1338. [PMID: 29498925 DOI: 10.1200/jco.2017.75.9597] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Purpose Safe, effective treatments are needed for pediatric patients with chronic myeloid leukemia in chronic phase (CML-CP). Dasatinib is approved for treatment of adults and children with CML-CP. A phase I study determined suitable dosing for children with Philadelphia chromosome-positive (Ph+) leukemias. Methods CA180-226/NCT00777036 is a phase II, open-label, nonrandomized prospective trial of patients < 18 years of age receiving dasatinib. There are three cohorts: (1) imatinib-resistant/intolerant CML-CP, (2) imatinib-resistant/intolerant CML in accelerated/blast phase or Ph+ acute lymphoblastic leukemia (n = 17), and (3) newly diagnosed CML-CP treated with tablets or powder for oral suspension. Major cytogenetic response > 30% for imatinib-resistant/intolerant patients and complete cytogenetic response (CCyR) > 55% for newly diagnosed patients were of clinical interest. Results Of 113 patients with CML-CP, 14 (48%) who were imatinib-resistant/intolerant and 61 (73%) who were newly diagnosed remained on treatment at time of analysis. Major cytogenetic response > 30% was reached by 3 months in the imatinib-resistant/intolerant group and CCyR > 55% was reached by 6 months in the newly diagnosed CML-CP group. CCyR and major molecular response by 12 months, respectively, were 76% and 41% in the imatinib-resistant/intolerant group and 92% and 52% in newly diagnosed CML-CP group. Progression-free survival by 48 months was 78% and 93% in the imatinib-resistant/intolerant and newly diagnosed CML-CP groups, respectively. No dasatinib-related pleural or pericardial effusion, pulmonary edema, or pulmonary arterial hypertension were reported. Bone growth and development events were reported in 4% of patients. Conclusion In the largest prospective trial to date in children with CML-CP, we demonstrate that dasatinib is a safe, effective treatment of pediatric CML-CP. Target responses to first- or second-line dasatinib were met early, and deep molecular responses were observed. Safety of dasatinib in pediatric patients was similar to that observed in adults; however, no cases of pleural or pericardial effusion or pulmonary arterial hypertension were reported.
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Affiliation(s)
- Lia Gore
- Lia Gore, University of Colorado School of Medicine/Children's Hospital Colorado, Aurora, CO; Pamela R. Kearns, University of Birmingham, Birmingham, West Midlands; Donna Lancaster, Royal Marsden Hospital, Sutton, Surrey, United Kingdom; Maria Lucia de Martino Lee, Support Group for Children and Adolescents with Cancer; Carmino Antonio De Souza, University of Campinas, São Paulo, Brazil; Yves Bertrand, L'Institut d'Hématologie et d'Oncologie Pédiatrique, Lyon, France; Nobuko Hijiya, Ann and Robert H. Lurie Children's Hospital of Chicago, and Northwestern University Feinberg School of Medicine, Chicago, IL; Linda C. Stork, Oregon Health & Science University, Portland, OR; Nack-Gyun Chung, The Catholic University of Korea, Seoul St. Mary's Hospital; Jong Jin Seo, University of Ulsan College of Medicine, and Asan Medical Center, Seoul, Republic of Korea; Rocio Cardenas Cardos, Instituto Nacional De Pediatria, Mexico City, Mexico; Tapan Saikia, Prince Aly Khan Hospital, Mumbai, India; Franca Fagioli, Regina Margherita Hospital, Turin, Italy; Judith Landman-Parker, Hôpital Enfants Armand-Trousseau, Paris, France; Andrew E. Place, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; Karen R. Rabin, Texas Children's Cancer Center, and Baylor College of Medicine, Houston, TX; Mariana Sacchi and Rene Swanink, Bristol-Myers Squibb, Princeton, NJ; C. Michel Zwaan, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands; Pamela R. Kearns and C. Michel Zwaan, Innovative Therapies for Children with Cancer Consortium, European Union
| | - Pamela R Kearns
- Lia Gore, University of Colorado School of Medicine/Children's Hospital Colorado, Aurora, CO; Pamela R. Kearns, University of Birmingham, Birmingham, West Midlands; Donna Lancaster, Royal Marsden Hospital, Sutton, Surrey, United Kingdom; Maria Lucia de Martino Lee, Support Group for Children and Adolescents with Cancer; Carmino Antonio De Souza, University of Campinas, São Paulo, Brazil; Yves Bertrand, L'Institut d'Hématologie et d'Oncologie Pédiatrique, Lyon, France; Nobuko Hijiya, Ann and Robert H. Lurie Children's Hospital of Chicago, and Northwestern University Feinberg School of Medicine, Chicago, IL; Linda C. Stork, Oregon Health & Science University, Portland, OR; Nack-Gyun Chung, The Catholic University of Korea, Seoul St. Mary's Hospital; Jong Jin Seo, University of Ulsan College of Medicine, and Asan Medical Center, Seoul, Republic of Korea; Rocio Cardenas Cardos, Instituto Nacional De Pediatria, Mexico City, Mexico; Tapan Saikia, Prince Aly Khan Hospital, Mumbai, India; Franca Fagioli, Regina Margherita Hospital, Turin, Italy; Judith Landman-Parker, Hôpital Enfants Armand-Trousseau, Paris, France; Andrew E. Place, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; Karen R. Rabin, Texas Children's Cancer Center, and Baylor College of Medicine, Houston, TX; Mariana Sacchi and Rene Swanink, Bristol-Myers Squibb, Princeton, NJ; C. Michel Zwaan, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands; Pamela R. Kearns and C. Michel Zwaan, Innovative Therapies for Children with Cancer Consortium, European Union
| | - Maria Lucia de Martino
- Lia Gore, University of Colorado School of Medicine/Children's Hospital Colorado, Aurora, CO; Pamela R. Kearns, University of Birmingham, Birmingham, West Midlands; Donna Lancaster, Royal Marsden Hospital, Sutton, Surrey, United Kingdom; Maria Lucia de Martino Lee, Support Group for Children and Adolescents with Cancer; Carmino Antonio De Souza, University of Campinas, São Paulo, Brazil; Yves Bertrand, L'Institut d'Hématologie et d'Oncologie Pédiatrique, Lyon, France; Nobuko Hijiya, Ann and Robert H. Lurie Children's Hospital of Chicago, and Northwestern University Feinberg School of Medicine, Chicago, IL; Linda C. Stork, Oregon Health & Science University, Portland, OR; Nack-Gyun Chung, The Catholic University of Korea, Seoul St. Mary's Hospital; Jong Jin Seo, University of Ulsan College of Medicine, and Asan Medical Center, Seoul, Republic of Korea; Rocio Cardenas Cardos, Instituto Nacional De Pediatria, Mexico City, Mexico; Tapan Saikia, Prince Aly Khan Hospital, Mumbai, India; Franca Fagioli, Regina Margherita Hospital, Turin, Italy; Judith Landman-Parker, Hôpital Enfants Armand-Trousseau, Paris, France; Andrew E. Place, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; Karen R. Rabin, Texas Children's Cancer Center, and Baylor College of Medicine, Houston, TX; Mariana Sacchi and Rene Swanink, Bristol-Myers Squibb, Princeton, NJ; C. Michel Zwaan, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands; Pamela R. Kearns and C. Michel Zwaan, Innovative Therapies for Children with Cancer Consortium, European Union
| | - Lee
- Lia Gore, University of Colorado School of Medicine/Children's Hospital Colorado, Aurora, CO; Pamela R. Kearns, University of Birmingham, Birmingham, West Midlands; Donna Lancaster, Royal Marsden Hospital, Sutton, Surrey, United Kingdom; Maria Lucia de Martino Lee, Support Group for Children and Adolescents with Cancer; Carmino Antonio De Souza, University of Campinas, São Paulo, Brazil; Yves Bertrand, L'Institut d'Hématologie et d'Oncologie Pédiatrique, Lyon, France; Nobuko Hijiya, Ann and Robert H. Lurie Children's Hospital of Chicago, and Northwestern University Feinberg School of Medicine, Chicago, IL; Linda C. Stork, Oregon Health & Science University, Portland, OR; Nack-Gyun Chung, The Catholic University of Korea, Seoul St. Mary's Hospital; Jong Jin Seo, University of Ulsan College of Medicine, and Asan Medical Center, Seoul, Republic of Korea; Rocio Cardenas Cardos, Instituto Nacional De Pediatria, Mexico City, Mexico; Tapan Saikia, Prince Aly Khan Hospital, Mumbai, India; Franca Fagioli, Regina Margherita Hospital, Turin, Italy; Judith Landman-Parker, Hôpital Enfants Armand-Trousseau, Paris, France; Andrew E. Place, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; Karen R. Rabin, Texas Children's Cancer Center, and Baylor College of Medicine, Houston, TX; Mariana Sacchi and Rene Swanink, Bristol-Myers Squibb, Princeton, NJ; C. Michel Zwaan, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands; Pamela R. Kearns and C. Michel Zwaan, Innovative Therapies for Children with Cancer Consortium, European Union
| | - Carmino Antonio De Souza
- Lia Gore, University of Colorado School of Medicine/Children's Hospital Colorado, Aurora, CO; Pamela R. Kearns, University of Birmingham, Birmingham, West Midlands; Donna Lancaster, Royal Marsden Hospital, Sutton, Surrey, United Kingdom; Maria Lucia de Martino Lee, Support Group for Children and Adolescents with Cancer; Carmino Antonio De Souza, University of Campinas, São Paulo, Brazil; Yves Bertrand, L'Institut d'Hématologie et d'Oncologie Pédiatrique, Lyon, France; Nobuko Hijiya, Ann and Robert H. Lurie Children's Hospital of Chicago, and Northwestern University Feinberg School of Medicine, Chicago, IL; Linda C. Stork, Oregon Health & Science University, Portland, OR; Nack-Gyun Chung, The Catholic University of Korea, Seoul St. Mary's Hospital; Jong Jin Seo, University of Ulsan College of Medicine, and Asan Medical Center, Seoul, Republic of Korea; Rocio Cardenas Cardos, Instituto Nacional De Pediatria, Mexico City, Mexico; Tapan Saikia, Prince Aly Khan Hospital, Mumbai, India; Franca Fagioli, Regina Margherita Hospital, Turin, Italy; Judith Landman-Parker, Hôpital Enfants Armand-Trousseau, Paris, France; Andrew E. Place, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; Karen R. Rabin, Texas Children's Cancer Center, and Baylor College of Medicine, Houston, TX; Mariana Sacchi and Rene Swanink, Bristol-Myers Squibb, Princeton, NJ; C. Michel Zwaan, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands; Pamela R. Kearns and C. Michel Zwaan, Innovative Therapies for Children with Cancer Consortium, European Union
| | - Yves Bertrand
- Lia Gore, University of Colorado School of Medicine/Children's Hospital Colorado, Aurora, CO; Pamela R. Kearns, University of Birmingham, Birmingham, West Midlands; Donna Lancaster, Royal Marsden Hospital, Sutton, Surrey, United Kingdom; Maria Lucia de Martino Lee, Support Group for Children and Adolescents with Cancer; Carmino Antonio De Souza, University of Campinas, São Paulo, Brazil; Yves Bertrand, L'Institut d'Hématologie et d'Oncologie Pédiatrique, Lyon, France; Nobuko Hijiya, Ann and Robert H. Lurie Children's Hospital of Chicago, and Northwestern University Feinberg School of Medicine, Chicago, IL; Linda C. Stork, Oregon Health & Science University, Portland, OR; Nack-Gyun Chung, The Catholic University of Korea, Seoul St. Mary's Hospital; Jong Jin Seo, University of Ulsan College of Medicine, and Asan Medical Center, Seoul, Republic of Korea; Rocio Cardenas Cardos, Instituto Nacional De Pediatria, Mexico City, Mexico; Tapan Saikia, Prince Aly Khan Hospital, Mumbai, India; Franca Fagioli, Regina Margherita Hospital, Turin, Italy; Judith Landman-Parker, Hôpital Enfants Armand-Trousseau, Paris, France; Andrew E. Place, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; Karen R. Rabin, Texas Children's Cancer Center, and Baylor College of Medicine, Houston, TX; Mariana Sacchi and Rene Swanink, Bristol-Myers Squibb, Princeton, NJ; C. Michel Zwaan, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands; Pamela R. Kearns and C. Michel Zwaan, Innovative Therapies for Children with Cancer Consortium, European Union
| | - Nobuko Hijiya
- Lia Gore, University of Colorado School of Medicine/Children's Hospital Colorado, Aurora, CO; Pamela R. Kearns, University of Birmingham, Birmingham, West Midlands; Donna Lancaster, Royal Marsden Hospital, Sutton, Surrey, United Kingdom; Maria Lucia de Martino Lee, Support Group for Children and Adolescents with Cancer; Carmino Antonio De Souza, University of Campinas, São Paulo, Brazil; Yves Bertrand, L'Institut d'Hématologie et d'Oncologie Pédiatrique, Lyon, France; Nobuko Hijiya, Ann and Robert H. Lurie Children's Hospital of Chicago, and Northwestern University Feinberg School of Medicine, Chicago, IL; Linda C. Stork, Oregon Health & Science University, Portland, OR; Nack-Gyun Chung, The Catholic University of Korea, Seoul St. Mary's Hospital; Jong Jin Seo, University of Ulsan College of Medicine, and Asan Medical Center, Seoul, Republic of Korea; Rocio Cardenas Cardos, Instituto Nacional De Pediatria, Mexico City, Mexico; Tapan Saikia, Prince Aly Khan Hospital, Mumbai, India; Franca Fagioli, Regina Margherita Hospital, Turin, Italy; Judith Landman-Parker, Hôpital Enfants Armand-Trousseau, Paris, France; Andrew E. Place, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; Karen R. Rabin, Texas Children's Cancer Center, and Baylor College of Medicine, Houston, TX; Mariana Sacchi and Rene Swanink, Bristol-Myers Squibb, Princeton, NJ; C. Michel Zwaan, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands; Pamela R. Kearns and C. Michel Zwaan, Innovative Therapies for Children with Cancer Consortium, European Union
| | - Linda C Stork
- Lia Gore, University of Colorado School of Medicine/Children's Hospital Colorado, Aurora, CO; Pamela R. Kearns, University of Birmingham, Birmingham, West Midlands; Donna Lancaster, Royal Marsden Hospital, Sutton, Surrey, United Kingdom; Maria Lucia de Martino Lee, Support Group for Children and Adolescents with Cancer; Carmino Antonio De Souza, University of Campinas, São Paulo, Brazil; Yves Bertrand, L'Institut d'Hématologie et d'Oncologie Pédiatrique, Lyon, France; Nobuko Hijiya, Ann and Robert H. Lurie Children's Hospital of Chicago, and Northwestern University Feinberg School of Medicine, Chicago, IL; Linda C. Stork, Oregon Health & Science University, Portland, OR; Nack-Gyun Chung, The Catholic University of Korea, Seoul St. Mary's Hospital; Jong Jin Seo, University of Ulsan College of Medicine, and Asan Medical Center, Seoul, Republic of Korea; Rocio Cardenas Cardos, Instituto Nacional De Pediatria, Mexico City, Mexico; Tapan Saikia, Prince Aly Khan Hospital, Mumbai, India; Franca Fagioli, Regina Margherita Hospital, Turin, Italy; Judith Landman-Parker, Hôpital Enfants Armand-Trousseau, Paris, France; Andrew E. Place, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; Karen R. Rabin, Texas Children's Cancer Center, and Baylor College of Medicine, Houston, TX; Mariana Sacchi and Rene Swanink, Bristol-Myers Squibb, Princeton, NJ; C. Michel Zwaan, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands; Pamela R. Kearns and C. Michel Zwaan, Innovative Therapies for Children with Cancer Consortium, European Union
| | - Nack-Gyun Chung
- Lia Gore, University of Colorado School of Medicine/Children's Hospital Colorado, Aurora, CO; Pamela R. Kearns, University of Birmingham, Birmingham, West Midlands; Donna Lancaster, Royal Marsden Hospital, Sutton, Surrey, United Kingdom; Maria Lucia de Martino Lee, Support Group for Children and Adolescents with Cancer; Carmino Antonio De Souza, University of Campinas, São Paulo, Brazil; Yves Bertrand, L'Institut d'Hématologie et d'Oncologie Pédiatrique, Lyon, France; Nobuko Hijiya, Ann and Robert H. Lurie Children's Hospital of Chicago, and Northwestern University Feinberg School of Medicine, Chicago, IL; Linda C. Stork, Oregon Health & Science University, Portland, OR; Nack-Gyun Chung, The Catholic University of Korea, Seoul St. Mary's Hospital; Jong Jin Seo, University of Ulsan College of Medicine, and Asan Medical Center, Seoul, Republic of Korea; Rocio Cardenas Cardos, Instituto Nacional De Pediatria, Mexico City, Mexico; Tapan Saikia, Prince Aly Khan Hospital, Mumbai, India; Franca Fagioli, Regina Margherita Hospital, Turin, Italy; Judith Landman-Parker, Hôpital Enfants Armand-Trousseau, Paris, France; Andrew E. Place, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; Karen R. Rabin, Texas Children's Cancer Center, and Baylor College of Medicine, Houston, TX; Mariana Sacchi and Rene Swanink, Bristol-Myers Squibb, Princeton, NJ; C. Michel Zwaan, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands; Pamela R. Kearns and C. Michel Zwaan, Innovative Therapies for Children with Cancer Consortium, European Union
| | - Rocio Cardenas Cardos
- Lia Gore, University of Colorado School of Medicine/Children's Hospital Colorado, Aurora, CO; Pamela R. Kearns, University of Birmingham, Birmingham, West Midlands; Donna Lancaster, Royal Marsden Hospital, Sutton, Surrey, United Kingdom; Maria Lucia de Martino Lee, Support Group for Children and Adolescents with Cancer; Carmino Antonio De Souza, University of Campinas, São Paulo, Brazil; Yves Bertrand, L'Institut d'Hématologie et d'Oncologie Pédiatrique, Lyon, France; Nobuko Hijiya, Ann and Robert H. Lurie Children's Hospital of Chicago, and Northwestern University Feinberg School of Medicine, Chicago, IL; Linda C. Stork, Oregon Health & Science University, Portland, OR; Nack-Gyun Chung, The Catholic University of Korea, Seoul St. Mary's Hospital; Jong Jin Seo, University of Ulsan College of Medicine, and Asan Medical Center, Seoul, Republic of Korea; Rocio Cardenas Cardos, Instituto Nacional De Pediatria, Mexico City, Mexico; Tapan Saikia, Prince Aly Khan Hospital, Mumbai, India; Franca Fagioli, Regina Margherita Hospital, Turin, Italy; Judith Landman-Parker, Hôpital Enfants Armand-Trousseau, Paris, France; Andrew E. Place, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; Karen R. Rabin, Texas Children's Cancer Center, and Baylor College of Medicine, Houston, TX; Mariana Sacchi and Rene Swanink, Bristol-Myers Squibb, Princeton, NJ; C. Michel Zwaan, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands; Pamela R. Kearns and C. Michel Zwaan, Innovative Therapies for Children with Cancer Consortium, European Union
| | - Tapan Saikia
- Lia Gore, University of Colorado School of Medicine/Children's Hospital Colorado, Aurora, CO; Pamela R. Kearns, University of Birmingham, Birmingham, West Midlands; Donna Lancaster, Royal Marsden Hospital, Sutton, Surrey, United Kingdom; Maria Lucia de Martino Lee, Support Group for Children and Adolescents with Cancer; Carmino Antonio De Souza, University of Campinas, São Paulo, Brazil; Yves Bertrand, L'Institut d'Hématologie et d'Oncologie Pédiatrique, Lyon, France; Nobuko Hijiya, Ann and Robert H. Lurie Children's Hospital of Chicago, and Northwestern University Feinberg School of Medicine, Chicago, IL; Linda C. Stork, Oregon Health & Science University, Portland, OR; Nack-Gyun Chung, The Catholic University of Korea, Seoul St. Mary's Hospital; Jong Jin Seo, University of Ulsan College of Medicine, and Asan Medical Center, Seoul, Republic of Korea; Rocio Cardenas Cardos, Instituto Nacional De Pediatria, Mexico City, Mexico; Tapan Saikia, Prince Aly Khan Hospital, Mumbai, India; Franca Fagioli, Regina Margherita Hospital, Turin, Italy; Judith Landman-Parker, Hôpital Enfants Armand-Trousseau, Paris, France; Andrew E. Place, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; Karen R. Rabin, Texas Children's Cancer Center, and Baylor College of Medicine, Houston, TX; Mariana Sacchi and Rene Swanink, Bristol-Myers Squibb, Princeton, NJ; C. Michel Zwaan, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands; Pamela R. Kearns and C. Michel Zwaan, Innovative Therapies for Children with Cancer Consortium, European Union
| | - Franca Fagioli
- Lia Gore, University of Colorado School of Medicine/Children's Hospital Colorado, Aurora, CO; Pamela R. Kearns, University of Birmingham, Birmingham, West Midlands; Donna Lancaster, Royal Marsden Hospital, Sutton, Surrey, United Kingdom; Maria Lucia de Martino Lee, Support Group for Children and Adolescents with Cancer; Carmino Antonio De Souza, University of Campinas, São Paulo, Brazil; Yves Bertrand, L'Institut d'Hématologie et d'Oncologie Pédiatrique, Lyon, France; Nobuko Hijiya, Ann and Robert H. Lurie Children's Hospital of Chicago, and Northwestern University Feinberg School of Medicine, Chicago, IL; Linda C. Stork, Oregon Health & Science University, Portland, OR; Nack-Gyun Chung, The Catholic University of Korea, Seoul St. Mary's Hospital; Jong Jin Seo, University of Ulsan College of Medicine, and Asan Medical Center, Seoul, Republic of Korea; Rocio Cardenas Cardos, Instituto Nacional De Pediatria, Mexico City, Mexico; Tapan Saikia, Prince Aly Khan Hospital, Mumbai, India; Franca Fagioli, Regina Margherita Hospital, Turin, Italy; Judith Landman-Parker, Hôpital Enfants Armand-Trousseau, Paris, France; Andrew E. Place, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; Karen R. Rabin, Texas Children's Cancer Center, and Baylor College of Medicine, Houston, TX; Mariana Sacchi and Rene Swanink, Bristol-Myers Squibb, Princeton, NJ; C. Michel Zwaan, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands; Pamela R. Kearns and C. Michel Zwaan, Innovative Therapies for Children with Cancer Consortium, European Union
| | - Jong Jin Seo
- Lia Gore, University of Colorado School of Medicine/Children's Hospital Colorado, Aurora, CO; Pamela R. Kearns, University of Birmingham, Birmingham, West Midlands; Donna Lancaster, Royal Marsden Hospital, Sutton, Surrey, United Kingdom; Maria Lucia de Martino Lee, Support Group for Children and Adolescents with Cancer; Carmino Antonio De Souza, University of Campinas, São Paulo, Brazil; Yves Bertrand, L'Institut d'Hématologie et d'Oncologie Pédiatrique, Lyon, France; Nobuko Hijiya, Ann and Robert H. Lurie Children's Hospital of Chicago, and Northwestern University Feinberg School of Medicine, Chicago, IL; Linda C. Stork, Oregon Health & Science University, Portland, OR; Nack-Gyun Chung, The Catholic University of Korea, Seoul St. Mary's Hospital; Jong Jin Seo, University of Ulsan College of Medicine, and Asan Medical Center, Seoul, Republic of Korea; Rocio Cardenas Cardos, Instituto Nacional De Pediatria, Mexico City, Mexico; Tapan Saikia, Prince Aly Khan Hospital, Mumbai, India; Franca Fagioli, Regina Margherita Hospital, Turin, Italy; Judith Landman-Parker, Hôpital Enfants Armand-Trousseau, Paris, France; Andrew E. Place, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; Karen R. Rabin, Texas Children's Cancer Center, and Baylor College of Medicine, Houston, TX; Mariana Sacchi and Rene Swanink, Bristol-Myers Squibb, Princeton, NJ; C. Michel Zwaan, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands; Pamela R. Kearns and C. Michel Zwaan, Innovative Therapies for Children with Cancer Consortium, European Union
| | - Judith Landman-Parker
- Lia Gore, University of Colorado School of Medicine/Children's Hospital Colorado, Aurora, CO; Pamela R. Kearns, University of Birmingham, Birmingham, West Midlands; Donna Lancaster, Royal Marsden Hospital, Sutton, Surrey, United Kingdom; Maria Lucia de Martino Lee, Support Group for Children and Adolescents with Cancer; Carmino Antonio De Souza, University of Campinas, São Paulo, Brazil; Yves Bertrand, L'Institut d'Hématologie et d'Oncologie Pédiatrique, Lyon, France; Nobuko Hijiya, Ann and Robert H. Lurie Children's Hospital of Chicago, and Northwestern University Feinberg School of Medicine, Chicago, IL; Linda C. Stork, Oregon Health & Science University, Portland, OR; Nack-Gyun Chung, The Catholic University of Korea, Seoul St. Mary's Hospital; Jong Jin Seo, University of Ulsan College of Medicine, and Asan Medical Center, Seoul, Republic of Korea; Rocio Cardenas Cardos, Instituto Nacional De Pediatria, Mexico City, Mexico; Tapan Saikia, Prince Aly Khan Hospital, Mumbai, India; Franca Fagioli, Regina Margherita Hospital, Turin, Italy; Judith Landman-Parker, Hôpital Enfants Armand-Trousseau, Paris, France; Andrew E. Place, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; Karen R. Rabin, Texas Children's Cancer Center, and Baylor College of Medicine, Houston, TX; Mariana Sacchi and Rene Swanink, Bristol-Myers Squibb, Princeton, NJ; C. Michel Zwaan, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands; Pamela R. Kearns and C. Michel Zwaan, Innovative Therapies for Children with Cancer Consortium, European Union
| | - Donna Lancaster
- Lia Gore, University of Colorado School of Medicine/Children's Hospital Colorado, Aurora, CO; Pamela R. Kearns, University of Birmingham, Birmingham, West Midlands; Donna Lancaster, Royal Marsden Hospital, Sutton, Surrey, United Kingdom; Maria Lucia de Martino Lee, Support Group for Children and Adolescents with Cancer; Carmino Antonio De Souza, University of Campinas, São Paulo, Brazil; Yves Bertrand, L'Institut d'Hématologie et d'Oncologie Pédiatrique, Lyon, France; Nobuko Hijiya, Ann and Robert H. Lurie Children's Hospital of Chicago, and Northwestern University Feinberg School of Medicine, Chicago, IL; Linda C. Stork, Oregon Health & Science University, Portland, OR; Nack-Gyun Chung, The Catholic University of Korea, Seoul St. Mary's Hospital; Jong Jin Seo, University of Ulsan College of Medicine, and Asan Medical Center, Seoul, Republic of Korea; Rocio Cardenas Cardos, Instituto Nacional De Pediatria, Mexico City, Mexico; Tapan Saikia, Prince Aly Khan Hospital, Mumbai, India; Franca Fagioli, Regina Margherita Hospital, Turin, Italy; Judith Landman-Parker, Hôpital Enfants Armand-Trousseau, Paris, France; Andrew E. Place, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; Karen R. Rabin, Texas Children's Cancer Center, and Baylor College of Medicine, Houston, TX; Mariana Sacchi and Rene Swanink, Bristol-Myers Squibb, Princeton, NJ; C. Michel Zwaan, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands; Pamela R. Kearns and C. Michel Zwaan, Innovative Therapies for Children with Cancer Consortium, European Union
| | - Andrew E Place
- Lia Gore, University of Colorado School of Medicine/Children's Hospital Colorado, Aurora, CO; Pamela R. Kearns, University of Birmingham, Birmingham, West Midlands; Donna Lancaster, Royal Marsden Hospital, Sutton, Surrey, United Kingdom; Maria Lucia de Martino Lee, Support Group for Children and Adolescents with Cancer; Carmino Antonio De Souza, University of Campinas, São Paulo, Brazil; Yves Bertrand, L'Institut d'Hématologie et d'Oncologie Pédiatrique, Lyon, France; Nobuko Hijiya, Ann and Robert H. Lurie Children's Hospital of Chicago, and Northwestern University Feinberg School of Medicine, Chicago, IL; Linda C. Stork, Oregon Health & Science University, Portland, OR; Nack-Gyun Chung, The Catholic University of Korea, Seoul St. Mary's Hospital; Jong Jin Seo, University of Ulsan College of Medicine, and Asan Medical Center, Seoul, Republic of Korea; Rocio Cardenas Cardos, Instituto Nacional De Pediatria, Mexico City, Mexico; Tapan Saikia, Prince Aly Khan Hospital, Mumbai, India; Franca Fagioli, Regina Margherita Hospital, Turin, Italy; Judith Landman-Parker, Hôpital Enfants Armand-Trousseau, Paris, France; Andrew E. Place, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; Karen R. Rabin, Texas Children's Cancer Center, and Baylor College of Medicine, Houston, TX; Mariana Sacchi and Rene Swanink, Bristol-Myers Squibb, Princeton, NJ; C. Michel Zwaan, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands; Pamela R. Kearns and C. Michel Zwaan, Innovative Therapies for Children with Cancer Consortium, European Union
| | - Karen R Rabin
- Lia Gore, University of Colorado School of Medicine/Children's Hospital Colorado, Aurora, CO; Pamela R. Kearns, University of Birmingham, Birmingham, West Midlands; Donna Lancaster, Royal Marsden Hospital, Sutton, Surrey, United Kingdom; Maria Lucia de Martino Lee, Support Group for Children and Adolescents with Cancer; Carmino Antonio De Souza, University of Campinas, São Paulo, Brazil; Yves Bertrand, L'Institut d'Hématologie et d'Oncologie Pédiatrique, Lyon, France; Nobuko Hijiya, Ann and Robert H. Lurie Children's Hospital of Chicago, and Northwestern University Feinberg School of Medicine, Chicago, IL; Linda C. Stork, Oregon Health & Science University, Portland, OR; Nack-Gyun Chung, The Catholic University of Korea, Seoul St. Mary's Hospital; Jong Jin Seo, University of Ulsan College of Medicine, and Asan Medical Center, Seoul, Republic of Korea; Rocio Cardenas Cardos, Instituto Nacional De Pediatria, Mexico City, Mexico; Tapan Saikia, Prince Aly Khan Hospital, Mumbai, India; Franca Fagioli, Regina Margherita Hospital, Turin, Italy; Judith Landman-Parker, Hôpital Enfants Armand-Trousseau, Paris, France; Andrew E. Place, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; Karen R. Rabin, Texas Children's Cancer Center, and Baylor College of Medicine, Houston, TX; Mariana Sacchi and Rene Swanink, Bristol-Myers Squibb, Princeton, NJ; C. Michel Zwaan, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands; Pamela R. Kearns and C. Michel Zwaan, Innovative Therapies for Children with Cancer Consortium, European Union
| | - Mariana Sacchi
- Lia Gore, University of Colorado School of Medicine/Children's Hospital Colorado, Aurora, CO; Pamela R. Kearns, University of Birmingham, Birmingham, West Midlands; Donna Lancaster, Royal Marsden Hospital, Sutton, Surrey, United Kingdom; Maria Lucia de Martino Lee, Support Group for Children and Adolescents with Cancer; Carmino Antonio De Souza, University of Campinas, São Paulo, Brazil; Yves Bertrand, L'Institut d'Hématologie et d'Oncologie Pédiatrique, Lyon, France; Nobuko Hijiya, Ann and Robert H. Lurie Children's Hospital of Chicago, and Northwestern University Feinberg School of Medicine, Chicago, IL; Linda C. Stork, Oregon Health & Science University, Portland, OR; Nack-Gyun Chung, The Catholic University of Korea, Seoul St. Mary's Hospital; Jong Jin Seo, University of Ulsan College of Medicine, and Asan Medical Center, Seoul, Republic of Korea; Rocio Cardenas Cardos, Instituto Nacional De Pediatria, Mexico City, Mexico; Tapan Saikia, Prince Aly Khan Hospital, Mumbai, India; Franca Fagioli, Regina Margherita Hospital, Turin, Italy; Judith Landman-Parker, Hôpital Enfants Armand-Trousseau, Paris, France; Andrew E. Place, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; Karen R. Rabin, Texas Children's Cancer Center, and Baylor College of Medicine, Houston, TX; Mariana Sacchi and Rene Swanink, Bristol-Myers Squibb, Princeton, NJ; C. Michel Zwaan, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands; Pamela R. Kearns and C. Michel Zwaan, Innovative Therapies for Children with Cancer Consortium, European Union
| | - Rene Swanink
- Lia Gore, University of Colorado School of Medicine/Children's Hospital Colorado, Aurora, CO; Pamela R. Kearns, University of Birmingham, Birmingham, West Midlands; Donna Lancaster, Royal Marsden Hospital, Sutton, Surrey, United Kingdom; Maria Lucia de Martino Lee, Support Group for Children and Adolescents with Cancer; Carmino Antonio De Souza, University of Campinas, São Paulo, Brazil; Yves Bertrand, L'Institut d'Hématologie et d'Oncologie Pédiatrique, Lyon, France; Nobuko Hijiya, Ann and Robert H. Lurie Children's Hospital of Chicago, and Northwestern University Feinberg School of Medicine, Chicago, IL; Linda C. Stork, Oregon Health & Science University, Portland, OR; Nack-Gyun Chung, The Catholic University of Korea, Seoul St. Mary's Hospital; Jong Jin Seo, University of Ulsan College of Medicine, and Asan Medical Center, Seoul, Republic of Korea; Rocio Cardenas Cardos, Instituto Nacional De Pediatria, Mexico City, Mexico; Tapan Saikia, Prince Aly Khan Hospital, Mumbai, India; Franca Fagioli, Regina Margherita Hospital, Turin, Italy; Judith Landman-Parker, Hôpital Enfants Armand-Trousseau, Paris, France; Andrew E. Place, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; Karen R. Rabin, Texas Children's Cancer Center, and Baylor College of Medicine, Houston, TX; Mariana Sacchi and Rene Swanink, Bristol-Myers Squibb, Princeton, NJ; C. Michel Zwaan, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands; Pamela R. Kearns and C. Michel Zwaan, Innovative Therapies for Children with Cancer Consortium, European Union
| | - C Michel Zwaan
- Lia Gore, University of Colorado School of Medicine/Children's Hospital Colorado, Aurora, CO; Pamela R. Kearns, University of Birmingham, Birmingham, West Midlands; Donna Lancaster, Royal Marsden Hospital, Sutton, Surrey, United Kingdom; Maria Lucia de Martino Lee, Support Group for Children and Adolescents with Cancer; Carmino Antonio De Souza, University of Campinas, São Paulo, Brazil; Yves Bertrand, L'Institut d'Hématologie et d'Oncologie Pédiatrique, Lyon, France; Nobuko Hijiya, Ann and Robert H. Lurie Children's Hospital of Chicago, and Northwestern University Feinberg School of Medicine, Chicago, IL; Linda C. Stork, Oregon Health & Science University, Portland, OR; Nack-Gyun Chung, The Catholic University of Korea, Seoul St. Mary's Hospital; Jong Jin Seo, University of Ulsan College of Medicine, and Asan Medical Center, Seoul, Republic of Korea; Rocio Cardenas Cardos, Instituto Nacional De Pediatria, Mexico City, Mexico; Tapan Saikia, Prince Aly Khan Hospital, Mumbai, India; Franca Fagioli, Regina Margherita Hospital, Turin, Italy; Judith Landman-Parker, Hôpital Enfants Armand-Trousseau, Paris, France; Andrew E. Place, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; Karen R. Rabin, Texas Children's Cancer Center, and Baylor College of Medicine, Houston, TX; Mariana Sacchi and Rene Swanink, Bristol-Myers Squibb, Princeton, NJ; C. Michel Zwaan, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands; Pamela R. Kearns and C. Michel Zwaan, Innovative Therapies for Children with Cancer Consortium, European Union
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22
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Pearson AD, Heenen D, Kearns PR, Goeres A, Marshall LV, Blanc P, Vassal G. 10-year report on the European Paediatric Regulation and its impact on new drugs for children's cancers. Lancet Oncol 2018; 19:285-287. [PMID: 29508745 DOI: 10.1016/s1470-2045(18)30105-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 01/08/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Andrew Dj Pearson
- Paediatric and Adolescent Oncology Drug Development, The Royal Marsden NHS Foundation Trust, Sutton, SM2 5PT, UK; Division of Clinical Studies and Cancer Therapeutics, The Institute of Cancer Research, Sutton, UK; Innovative Therapy for Children with Cancer, Europe.
| | | | - Pamela R Kearns
- Innovative Therapy for Children with Cancer, Europe; Cancer Research UK Clinical Trials Unit Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK; SIOPE Brussels, Belgium
| | - Anne Goeres
- Unite 2 Cure, Europe; Fondatioun Kriibskrank Kanner, Strassen, Luxembourg
| | - Lynley V Marshall
- Paediatric and Adolescent Oncology Drug Development, The Royal Marsden NHS Foundation Trust, Sutton, SM2 5PT, UK; Division of Clinical Studies and Cancer Therapeutics, The Institute of Cancer Research, Sutton, UK
| | | | - Gilles Vassal
- Innovative Therapy for Children with Cancer, Europe; SIOPE Brussels, Belgium; Department of Clinical Research, Gustave Roussy, Paris-Saclay University, Villejuif, France
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23
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Moreno L, Pearson ADJ, Paoletti X, Jimenez I, Geoerger B, Kearns PR, Zwaan CM, Doz F, Baruchel A, Vormoor J, Casanova M, Pfister SM, Morland B, Vassal G. Early phase clinical trials of anticancer agents in children and adolescents - an ITCC perspective. Nat Rev Clin Oncol 2017; 14:497-507. [PMID: 28508875 DOI: 10.1038/nrclinonc.2017.59] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
In the past decade, the landscape of drug development in oncology has evolved dramatically; however, this paradigm shift remains to be adopted in early phase clinical trial designs for studies of molecularly targeted agents and immunotherapeutic agents in paediatric malignancies. In drug development, prioritization of drugs on the basis of knowledge of tumour biology, molecular 'drivers' of disease and a drug's mechanism of action, and therapeutic unmet needs are key elements; these aspects are relevant to early phase paediatric trials, in which molecular profiling is strongly encouraged. Herein, we describe the strategy of the Innovative Therapies for Children with Cancer (ITCC) Consortium, which advocates for the adoption of trial designs that enable uninterrupted patient recruitment, the extrapolation from studies in adults when possible, and the inclusion of expansion cohorts. If a drug has neither serious dose-related toxicities nor a narrow therapeutic index, then studies should generally be started at the adult recommended phase II dose corrected for body surface area, and act as dose-confirmation studies. The use of adaptive trial designs will enable drugs with promising activity to progress rapidly to randomized studies and, therefore, will substantially accelerate drug development for children and adolescents with cancer.
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Affiliation(s)
- Lucas Moreno
- Paediatric Phase I-II Clinical Trials Unit, Paediatric Haematology &Oncology, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Andrew D J Pearson
- Paediatric Drug Development, Children and Young People's Unit, The Royal Marsden NHS Foundation Trust, Sutton, UK; and at the Division of Clinical Studies and Cancer Therapeutics, The Institute of Cancer Research, Sutton, UK
| | - Xavier Paoletti
- Biostatistics and Epidemiology, INSERM U1018, Gustave Roussy, Paris, France
| | - Irene Jimenez
- Department of Paediatric, Adolescents and Young Adults Oncology, Institut Curie; and at the University Paris Descartes, Paris, France
| | - Birgit Geoerger
- Department of Paediatric and Adolescent Oncology, CNRS UMR 8203 Vectorology and Anticancer Treatments, Gustave Roussy, University Paris-Sud, Villejuif, France
| | - Pamela R Kearns
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - C Michel Zwaan
- Department of Paediatric Oncology/Haematology, Erasmus MC/Sophia Children's Hospital, Rotterdam, Netherlands
| | - Francois Doz
- Department of Paediatric, Adolescents and Young Adults Oncology, Institut Curie; and at the University Paris Descartes, Paris, France
| | - Andre Baruchel
- Department of Paediatric Haematology, Hôpital Robert Debré, AP-HP; and at the University Paris Diderot, Paris, France
| | - Josef Vormoor
- Wolfson Childhood Cancer Research Centre, Northern Institute for Cancer Research, Newcastle University; and at the Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Michela Casanova
- Paediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Stefan M Pfister
- German Cancer Research Center (DKFZ); German Cancer Consortium (DKTK); and at the Heidelberg University Hospital, Heidelberg, Germany
| | - Bruce Morland
- Department of Paediatric Oncology, Birmingham Children's Hospital, Birmingham, UK
| | - Gilles Vassal
- Department of Clinical Research, Gustave Roussy, Paris-Sud University, Paris, France
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24
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Pearson ADJ, Pfister SM, Baruchel A, Bourquin JP, Casanova M, Chesler L, Doz F, Eggert A, Geoerger B, Jones DTW, Kearns PR, Molenaar JJ, Morland B, Schleiermacher G, Schulte JH, Vormoor J, Marshall LV, Zwaan CM, Vassal G. From class waivers to precision medicine in paediatric oncology. Lancet Oncol 2017; 18:e394-e404. [PMID: 28677575 DOI: 10.1016/s1470-2045(17)30442-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 05/02/2017] [Accepted: 05/04/2017] [Indexed: 10/19/2022]
Abstract
New drugs are crucially needed for children with cancer. The European Paediatric Regulation facilitates paediatric class waivers for drugs developed for diseases only occurring in adults. In this Review, we retrospectively searched oncology drugs that were class waivered between June, 2012, and June, 2015. 147 oncology class waivers were confirmed for 89 drugs. Mechanisms of action were then assessed as potential paediatric therapeutic targets by both a literature search and an expert review. 48 (54%) of the 89 class-waivered drugs had a mechanisms of action warranting paediatric development. Two (2%) class-waivered drugs were considered not relevant and 16 (18%) required further data. In light of these results, we propose five initiatives: an aggregated database of paediatric biological tumour drug targets; molecular profiling of all paediatric tumours at diagnosis and relapse; a joint academic-pharmaceutical industry preclinical platform to help analyse the activity of new drugs (Innovative Therapy for Children with Cancer Paediatric Preclinical Proof-of-Concept Platform); paediatric strategy forums; and the suppression of article 11b of the European Paediatric Regulation, which allows product-specific waivers on the grounds that the associated condition does not occur in children. These initiatives and a mechanism of action-based approach to drug development will accelerate the delivery of new therapeutic drugs for front-line therapy for those children who have unmet medical needs.
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Affiliation(s)
- Andrew D J Pearson
- Paediatric Drug Development, Children and Young People's Unit, The Royal Marsden NHS Foundation Trust, Sutton, UK; Division of Clinical Studies and Cancer Therapeutics, The Institute of Cancer Research, Sutton, UK.
| | - Stefan M Pfister
- Division of Pediatric Neuro-oncology, German Cancer Research Center, Heidelberg, Germany; German Cancer Consortium, Heidelberg, Germany; Department of Pediatric Oncology, Hematology and Immunology, Heidelberg University Hospital, Heidelberg, Germany
| | - Andre Baruchel
- Pediatric Hematology-Immunology Department, University Hospital Robert Debré and Paris Diderot University, Paris, France
| | - Jean-Pierre Bourquin
- Division of Oncology and Hematology, University Children's Hospital Zurich, Children's Research Center, Zurich, Switzerland
| | - Michela Casanova
- Paediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Louis Chesler
- Paediatric Drug Development, Children and Young People's Unit, The Royal Marsden NHS Foundation Trust, Sutton, UK; Division of Clinical Studies and Cancer Therapeutics, The Institute of Cancer Research, Sutton, UK
| | - François Doz
- Department of Paediatric, Adolescents and Young Adults Oncology and INSERM U830, Institut Curie, Paris, France
| | - Angelika Eggert
- Department of Pediatric Oncology and Hematology, Charité University Hospital, Berlin, Germany; German Cancer Consortium, Berlin, Germany; Berlin Institute of Health, Berlin, Germany
| | - Birgit Geoerger
- Department of Pediatric and Adolescent Oncology, CNRS UMR 8203 Vectorology and Anticancer Treatments, Gustave Roussy, Université Paris-Sud, Villejuif, France
| | - David T W Jones
- Division of Pediatric Neuro-oncology, German Cancer Research Center, Heidelberg, Germany; German Cancer Consortium, Heidelberg, Germany
| | - Pamela R Kearns
- Cancer Research UK Clinical Trials Unit Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Jan J Molenaar
- Princess Maxima Center for Pediatric Oncology, Utrecht, Netherlands
| | - Bruce Morland
- Department of Paediatric Oncology, Birmingham Women's and Children's Hospital, Birmingham, UK
| | - Gudrun Schleiermacher
- Department of Paediatric, Adolescents and Young Adults Oncology and INSERM U830, Institut Curie, Paris, France
| | - Johannes H Schulte
- Department of Pediatric Oncology and Hematology, Charité University Hospital, Berlin, Germany; German Cancer Consortium, Berlin, Germany; Berlin Institute of Health, Berlin, Germany
| | - Josef Vormoor
- Wolfson Childhood Cancer Research Centre, Northern Institute for Cancer Research, Newcastle University and Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Lynley V Marshall
- Paediatric Drug Development, Children and Young People's Unit, The Royal Marsden NHS Foundation Trust, Sutton, UK; Division of Clinical Studies and Cancer Therapeutics, The Institute of Cancer Research, Sutton, UK
| | - C Michel Zwaan
- Department of Pediatric Oncology/Hematology, Erasmus MC/Sophia Children's Hospital, Rotterdam, Netherlands; Princess Maxima Center for Pediatric Oncology, Utrecht, Netherlands
| | - Gilles Vassal
- Department of Clinical Research, Gustave Roussy, Paris-Sud University, Paris, France
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25
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Bautista F, Van der Lugt J, Kearns PR, Mussai FJ, Zwaan CM, Moreno L. The development of targeted new agents to improve the outcome for children with leukemia. Expert Opin Drug Discov 2016; 11:1111-1122. [PMID: 27670965 DOI: 10.1080/17460441.2016.1237939] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Survival rates in pediatric leukemia have greatly improved in the last decades but still a substantial number of patients will relapse and die. New agents are necessary to overcome the limitations of conventional chemotherapy and hematopoietic stem cell transplantation and to reduce their undesirable long-term toxicities. The identification of driving molecular alterations of leukemogenesis in subsets of patients will allow the incorporation of new-targeted therapies. Areas covered: In this article the authors present a detailed review of the most recent advances in targeted therapies for pediatric leukemias. A comprehensive description of the biological background, adult data and early clinical trials in pediatrics is provided. Expert opinion: Clinical trials are the way to evaluate new agents in pediatric cancer. The development of new drugs in pediatric leukemia must be preceded by a solid biological rationale. Agents in development exploit all possible vulnerabilities of leukemic cells. Drugs targeting cell surface antigens, intracellular signaling pathways and cell cycle inhibitors or epigenetic regulators are most prominent. Major advances have occurred thanks to new developments in engineering leading to optimized molecules such as anti-CD19 bi-specific T-cell engagers (e.g. blinatumomab) and antibody-drug conjugates. The integration of new-targeted therapies in pediatric chemotherapy-based regimens will lead to improved outcomes.
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Affiliation(s)
- Francisco Bautista
- a Department of Pediatric Oncology, Hematology and Stem Cell Transplantation , Hospital Niño Jesús , Madrid , Spain
| | - Jasper Van der Lugt
- b Department of Pediatric Oncology/Hematology , Erasmus-MC Sophia Children's Hospital , Rotterdam , The Netherlands
| | - Pamela R Kearns
- c Cancer Research UK Clinical Trials Unit, School of Cancer Sciences , University of Birmingham , Birmingham , UK
| | - Francis J Mussai
- c Cancer Research UK Clinical Trials Unit, School of Cancer Sciences , University of Birmingham , Birmingham , UK
| | - C Michel Zwaan
- b Department of Pediatric Oncology/Hematology , Erasmus-MC Sophia Children's Hospital , Rotterdam , The Netherlands
| | - Lucas Moreno
- a Department of Pediatric Oncology, Hematology and Stem Cell Transplantation , Hospital Niño Jesús , Madrid , Spain
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26
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Main C, Stevens SP, Bailey S, Phillips R, Pizer B, Wheatley K, Kearns PR, English M, Wilne S, Wilson JS. The impact of routine surveillance screening with magnetic resonance imaging (MRI) to detect tumour recurrence in children with central nervous system (CNS) tumours: protocol for a systematic review and meta-analysis. Syst Rev 2016; 5:143. [PMID: 27577246 PMCID: PMC5006428 DOI: 10.1186/s13643-016-0318-1] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 08/16/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this study is to assess the impact of routine MRI surveillance to detect tumour recurrence in children with no new neurological signs or symptoms compared with alternative follow-up practices, including periodic clinical and physical examinations and the use of non-routine imaging upon presentation with disease signs or symptoms. METHODS Standard systematic review methods aimed at minimising bias will be employed for study identification, selection and data extraction. Ten electronic databases have been searched, and further citation searching and reference checking will be employed. Randomised and non-randomised controlled trials assessing the impact of routine surveillance MRI to detect tumour recurrence in children with no new neurological signs or symptoms compared to alternative follow-up schedules including imaging upon presentation with disease signs or symptoms will be included. The primary outcome is time to change in therapeutic intervention. Secondary outcomes include overall survival, surrogate survival outcomes, response rates, diagnostic yield per set of images, adverse events, quality of survival and validated measures of family psychological functioning and anxiety. Two reviewers will independently screen and select studies for inclusion. Quality assessment will be undertaken using the Cochrane Collaboration's tools for assessing risk of bias. Where possible, data will be summarised using combined estimates of effect for time to treatment change, survival outcomes and response rates using assumption-free methods. Further sub-group analyses and meta-regression models will be specified and undertaken to explore potential sources of heterogeneity between studies within each tumour type if necessary. DISCUSSION Assessment of the impact of surveillance imaging in children with CNS tumours is methodologically complex. The evidence base is likely to be heterogeneous in terms of imaging protocols, definitions of radiological response and diagnostic accuracy of tumour recurrence due to changes in imaging technology over time. Furthermore, the delineation of tumour recurrence from either pseudo-progression or radiation necrosis after radiotherapy is potentially problematic and linked to the timing of follow-up assessments. However, given the current routine practice of MRI surveillance in the follow-up of children with CNS tumours in the UK and the resource implications, it is important to evaluate the cost-benefit profile of this practice. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42016036802.
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Affiliation(s)
- Caroline Main
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Simon P. Stevens
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Simon Bailey
- Sir James Spence Institute of Child Health, Royal Victoria Infirmary, Newcastle-Upon-Tyne, UK
| | - Robert Phillips
- Centre for Reviews and Dissemination (CRD), University of York, York, UK
| | - Barry Pizer
- Alder Hey Children’s NHS Foundation Trust, Liverpool, UK
| | - Keith Wheatley
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Pamela R. Kearns
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Birmingham Children’s Hospital NHS Foundation Trust, Birmingham, UK
| | - Martin English
- Birmingham Children’s Hospital NHS Foundation Trust, Birmingham, UK
| | - Sophie Wilne
- Queen’s Medical Centre, Nottingham University Hospitals’ NHS Trust, Nottingham, UK
| | - Jayne S. Wilson
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
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Main C, Dandapani M, Pritchard M, Dodds R, Stevens SP, Thorp N, Taylor RE, Wheatley K, Pizer B, Morrall M, Phillips R, English M, Kearns PR, Wilne S, Wilson JS. The effectiveness and safety of proton beam radiation therapy in children with malignant central nervous system (CNS) tumours: protocol for a systematic review. Syst Rev 2016; 5:124. [PMID: 27460473 PMCID: PMC4962509 DOI: 10.1186/s13643-016-0285-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 06/21/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The aim of this study is to use a systematic review framework to identify and synthesise the evidence on the use of proton beam therapy (PBT) for the treatment of children with CNS tumours and where possible compare this to the use of photon radiotherapy (RT). METHODS Standard systematic review methods aimed at minimising bias will be employed for study identification, selection and data extraction. Twelve electronic databases have been searched, and further citation, hand searching and reference checking will be employed. Studies assessing the effects of PBT used either alone or as part of a multimodality treatment regimen in children with CNS tumours will be included. Relevant economic evaluations will also be identified. The outcomes are survival (overall, progression-free, event-free, disease-free), local and regional control rates, short- and long-term adverse events, functional status measures and quality of survival. Two reviewers will independently screen and select studies for inclusion in the review. All interventional study designs will be eligible for inclusion in the review. However, initial scoping searches indicate the evidence base is likely to be limited to case series studies, with no studies of a higher quality being identified. Quality assessment will be undertaken using pre-specified criteria and tailored to study design if applicable. Studies will be combined using a narrative synthesis, with differences in results between studies highlighted and discussed in relation to the patient population, intervention and study quality. Where appropriate, if no studies of a comparative design are identified, outcomes will be compared against a range of estimates from the literature for similar populations and treatment regimens from the best available evidence from studies that include the use of advanced conventional photon therapy. DISCUSSION The evidence base for the use of PBT in children with CNS tumours is likely to be relatively sparse, highly heterogeneous and potentially of a low quality with small sample sizes. Furthermore, selection and publication biases may limit the internal and external validity of studies. However, any tentative results from the review on potential treatment effects can be used to plan better quality research studies that are of a design appropriate for outcome comparison with conventional therapy. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42015029583.
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Affiliation(s)
- Caroline Main
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Science, University of Birmingham, Birmingham, UK
| | | | | | | | - Simon P. Stevens
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Science, University of Birmingham, Birmingham, UK
| | - Nicky Thorp
- The Clatterbridge Cancer Centre, Liverpool, UK
| | | | - Keith Wheatley
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Science, University of Birmingham, Birmingham, UK
| | - Barry Pizer
- Alder Hey Children’s NHS Foundation Trust, Liverpool, UK
| | | | - Robert Phillips
- Leeds General Infirmary, Leeds, UK
- Centre for Reviews and Dissemination (CRD), University of York, York, UK
| | - Martin English
- Birmingham Children’s Hospital NHS Foundation Trust, Birmingham, UK
| | - Pamela R. Kearns
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Science, University of Birmingham, Birmingham, UK
- Birmingham Children’s Hospital NHS Foundation Trust, Birmingham, UK
| | - Sophie Wilne
- Queen’s Medical Centre, Nottingham University Hospitals’ NHS Trust, Nottingham, UK
| | - Jayne S. Wilson
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Science, University of Birmingham, Birmingham, UK
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Main C, Pizer B, Wheatley K, Cooper K, Adams M, Stevens S, English M, Phillips B, Wilne S, Kearns PR, Wilson JS. MB-55THE ROLE OF HIGH-DOSE MYELOABLATIVE CHEMOTHERAPY (HDCT) WITH AUTOLOGOUS HAEMATOPOIETIC STEM CELL TRANSPLANTATION (HSCT) IN CHILDREN WITH MEDULLOBLASTOMA: RESULTS OF A SYSTEMATIC REVIEW. Neuro Oncol 2016. [DOI: 10.1093/neuonc/now076.53] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Main C, Adams M, Cooper K, Wilne S, Phillips B, English M, Kearns PR, Pizer B, Stevens SP, Wheatley K, Wilson JS. HG-54THE ROLE OF HIGH-DOSE MYELOABLATIVE CHEMOTHERAPY (HDCT) WITH HAEMATOPOIETIC STEM CELL TRANSPLANTATION (HSCT) IN CHILDREN WITH HIGH GRADE GLIOMAS (HGG) OR DIFFUSE INTRINSIC PONTINE GLIOMA (DIPG): RESULTS OF A SYSTEMATIC REVIEW. Neuro Oncol 2016. [DOI: 10.1093/neuonc/now073.50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Main C, Cooper K, Adams M, Pizer B, English M, Kearns PR, Phillips R, Stevens SP, Wilne S, Wheatley K, Wilson JS. AT-12THE ROLE OF HIGH-DOSE MYELOABLATIVE CHEMOTHERAPY (HDCT) WITH HAEMATOPOIETIC STEM CELL TRANSPLANTATION (HSCT) IN CHILDREN WITH ATYPICAL TERATOID RHABDOID TUMOURS (AT/RT): RESULTS OF A SYSTEMATIC REVIEW. Neuro Oncol 2016. [DOI: 10.1093/neuonc/now065.11] [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: 11/14/2022] Open
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Main C, Stevens SP, Thorp N, Taylor RE, Dandapani M, Pritchard MG, Dodds R, Wheatley K, Kearns PR, Pizer B, Phillips B, Morrall MC, English M, Wilne S, Wilson JS. RO-08THE EFFECTIVENESS AND SAFETY OF PBT IN CHILDREN WITH MALIGNANT CENTRAL NERVOUS SYSTEM (CNS) TUMOURS: A SYSTEMATIC REVIEW. Neuro Oncol 2016. [DOI: 10.1093/neuonc/now082.08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Nailor A, Walker DA, Jacques TS, Warren KE, Brem H, Kearns PR, Greenwood J, Penny JI, Pilkington GJ, Carcaboso AM, Fleischhack G, Macarthur D, Slavc I, Meijer L, Gill S, Lowis S, van Vuurden DG, Pearl MS, Clifford SC, Morrissy S, Ivanov DP, Beccaria K, Gilbertson RJ, Straathof K, Green JJ, Smith S, Rahman R, Kilday JP. Highlights of Children with Cancer UK's Workshop on Drug Delivery in Paediatric Brain Tumours. Ecancermedicalscience 2016; 10:630. [PMID: 27110286 PMCID: PMC4817522 DOI: 10.3332/ecancer.2016.630] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 03/09/2016] [Indexed: 11/10/2022] Open
Abstract
The first Workshop on Drug Delivery in Paediatric Brain Tumours was hosted in London by the charity Children with Cancer UK. The goals of the workshop were to break down the barriers to treating central nervous system (CNS) tumours in children, leading to new collaborations and further innovations in this under-represented and emotive field. These barriers include the physical delivery challenges presented by the blood-brain barrier, the underpinning reasons for the intractability of CNS cancers, and the practical difficulties of delivering cancer treatment to the brains of children. Novel techniques for overcoming these problems were discussed, new models brought forth, and experiences compared.
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Affiliation(s)
- Audrey Nailor
- Cancer Intelligence, 154 Cheltenham Road, Bristol, UK BS6 5RL
| | - David A Walker
- Children’s Brain Tumour Research Centre, University of Nottingham, Room EE 1833a Nottingham Children’s Hospital, Queen’s Medical Centre, Nottingham, UK NG7 2UH
| | - Thomas S Jacques
- UCL Institute of Child Health, 30 Guilford St, London, UK WC1N 1EH
| | - Kathy E Warren
- National Cancer Institute, Building 10 - Hatfield CRC, Bethesda, MD 20892–1104
| | - Henry Brem
- Johns Hopkins University, 600 N Wolfe St, Baltimore, Maryland, USA, 21287
| | - Pamela R Kearns
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Edgbaston, Birmingham, UK B15 2TT
| | - John Greenwood
- University College London, 11–43 Bath Street, London, UK EC1V 9EL
| | - Jeffrey I Penny
- University of Manchester, Stopford Building, Oxford Road, Manchester, UK M13 9PT
| | | | - Angel M Carcaboso
- Institut de Recerca Pediatrica, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Gudrun Fleischhack
- Essen University Hospital, Paediatrics III, Hufelandstraße 55, Essen, Germany 45147
| | - Donald Macarthur
- University Hospital Nottingham, Derby Road, Nottingham, UK NG7 2UH
| | - Irene Slavc
- Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
| | - Lisethe Meijer
- University Hospital Nottingham, Derby Road, Nottingham, UK NG7 2UH
- University Medical Centre Groningen, 1 Hanzeplein, Groningen, The Netherlands, 9713 GZ
| | - Steven Gill
- Bristol Royal Hospital for Children, Upper Maudlin St, Bristol, UK, BS2 8BJ
| | - Stephen Lowis
- Bristol Royal Hospital for Children, Upper Maudlin St, Bristol, UK, BS2 8BJ
| | - Dannis G van Vuurden
- VU University Medical Centre, De Boelelaan 1118, Amsterdam, Netherlands, 1081 HZ
| | - Monica S Pearl
- Johns Hopkins University School of Medicine, 1800 Orleans Street, Bloomberg Building 7218, Baltimore, Maryland, USA, 21287
| | - Steven C Clifford
- Newcastle University, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, UK, NE1 4LP
| | - Sorana Morrissy
- The Hospital for Sick Children, 555 University Ave, Toronto, Ontario, Canada, ON M5G 1X8
| | - Delyan P Ivanov
- University Hospital Nottingham, Derby Road, Nottingham, UK NG7 2UH
| | - Kévin Beccaria
- Pitié Salpetriere Hospital, Assistance Publique - Hôpitaux de Paris, 27 Rue Chaligny, Paris, France, 75012
| | - Richard J Gilbertson
- Cambridge Cancer Centre, 120 Cambridge Rd, Great Shelford, Cambridge UK, CB22 5JT
| | - Karin Straathof
- Institute of Child Health, University College London, 30 Guilford Street, London, UK WC1N 1EH
| | - Jordan J Green
- Institute for NanoBioTechnology, Translational Tissue Engineering Center, The Johns Hopkins University School of Medicine, 400 N. Broadway/Smith Building Room 5017, Baltimore, MD 21231
| | - Stuart Smith
- University Hospital Nottingham, Derby Road, Nottingham, UK NG7 2UH
| | - Ruman Rahman
- University Hospital Nottingham, Derby Road, Nottingham, UK NG7 2UH
| | - John-Paul Kilday
- Royal Manchester Children’s Hospital, Oxford Rd, Manchester M13 9WL
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Main C, Wilson JS, Stevens SP, Houlton AE, English M, Kearns PR, Phillips B, Pizer B, Wilne S, Wheatley K. The role of high-dose myeloablative chemotherapy with haematopoietic stem cell transplantation (HSCT) in children with central nervous system (CNS) tumours: protocol for a systematic review and meta-analysis. Syst Rev 2015; 4:168. [PMID: 26589619 PMCID: PMC4654793 DOI: 10.1186/s13643-015-0155-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 11/09/2015] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES The objective of the study is to conduct a systematic review to compare the effects of high-dose chemotherapy (HDCT) with autologous haematopoietic stem cell transplantation (HSCT) versus standard-dose chemotherapy (SDCT) in children with malignant central nervous system (CNS) tumours. METHODS Standard systematic review methods aimed at minimising bias will be employed for study identification, selection and data extraction. Ten electronic databases will be searched, along with citation searching and reference checking. Studies assessing the effects of HDCT with HSCT in children with CNS tumours will be included. The outcomes are survival (overall, progression-free, event-free, disease-free), response rates, short- and long-term adverse events and health-related quality of life (HRQoL). Two reviewers will independently screen and select randomised and non-randomised controlled trials and controlled and uncontrolled observational studies for inclusion. Quality assessment will be tailored to the different study designs. Where possible data will be summarised using combined estimates of effect for the hazard ratio for survival outcomes and the risk ratio for response rates. A fixed effect model will be used; sub-group analyses and meta-regression will be used to explore potential sources of heterogeneity between studies. DISCUSSION Given the poor prognosis of malignant brain tumours in children in terms of survival and quality of life, this review will help guide clinical practice by summarising the current evidence on the use of high-dose myeloblative chemotherapy with stem cell support in children with CNS tumours.
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Affiliation(s)
- Caroline Main
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK.
| | - Jayne S Wilson
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK.
| | - Simon P Stevens
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK.
| | - Aimee E Houlton
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK.
| | - Martin English
- Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK.
| | - Pamela R Kearns
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK.
| | - Bob Phillips
- Centre for Reviews and Dissemination (CRD), University of York, York, UK.
| | - Barry Pizer
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK.
| | - Sophie Wilne
- Queen's Medical Centre, Nottingham University Hospitals' NHS Trust, Nottingham, UK.
| | - Keith Wheatley
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK.
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Zwaan CM, Rizzari C, Mechinaud F, Lancaster DL, Lehrnbecher T, van der Velden VH, Beverloo BB, den Boer ML, Pieters R, Reinhardt D, Dworzak M, Rosenberg J, Manos G, Agrawal S, Strauss L, Baruchel A, Kearns PR. Dasatinib in Children and Adolescents With Relapsed or Refractory Leukemia: Results of the CA180-018 Phase I Dose-Escalation Study of the Innovative Therapies for Children With Cancer Consortium. J Clin Oncol 2013; 31:2460-8. [DOI: 10.1200/jco.2012.46.8280] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Dasatinib is a potent BCR-ABL inhibitor with proven efficacy in adults with newly diagnosed chronic myeloid leukemia (CML) in chronic phase (CP) and in imatinib-resistant/intolerant disease. This phase I study of the Innovative Therapies for Children with Cancer Consortium assessed dasatinib safety and efficacy in pediatric patients. Patients and Methods Escalating once-daily dasatinib doses (60 to 120 mg/m2) were administered to children (n = 58) with (i) imatinib-pretreated CML or Philadelphia chromosome (Ph)–positive acute lymhoblastic leukemia (ALL) and (ii) treatment-refractory Ph-negative ALL or acute myeloid leukemia (AML). Results Dasatinib safety and efficacy profiles compared favorably with those in adults. The most common drug-related nonhematologic adverse events were nausea (31%, all grades; 2%, grade 3 to 4), headache (22%, 3%), diarrhea (21%, 0%), and vomiting (17%, 2%). Of 17 patients with CML-CP, 14 (82%) achieved complete cytogenetic response (CCyR) and eight (47%) achieved major molecular response. After ≥ 24 months of follow-up, median complete hematologic response (CHR) and major cytogenetic response (MCyR) durations were not reached. Of 17 patients with advanced-phase CML or Ph-positive ALL, six (35%) achieved confirmed CHR and 11 (65%) achieved CCyR. Median MCyR duration was 4.6 months (95% CI, 2.1 to 17.4 months). No patient with Ph-negative ALL or AML responded. Dasatinib pediatric pharmacokinetic parameters were comparable with those in adult studies, showing rapid absorption (time to reach maximum concentration, 0.5 to 6.0 hours) and elimination (mean half-life, 3.0 to 4.4 hours). Conclusion Dasatinib 60 mg/m2 and 80 mg/m2 once-daily dosing were selected for phase II studies in children with Ph-positive leukemias.
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Affiliation(s)
- C. Michel Zwaan
- C. Michel Zwaan, H. Berna Beverloo, Monique L. den Boer, and Rob Pieters, Erasmus Medical Center (MC)/Sophia Children's Hospital; Vincent H.J. van der Velden, Erasmus MC, Rotterdam, the Netherlands; Carmelo Rizzari, University of Milano-Bicocca, Hospital S. Gerardo, Monza, Italy; Francoise Mechinaud, Royal Children's Hospital, Melbourne, Victoria, Australia; Donna L. Lancaster, The Royal Marsden National Health Service Foundation Trust, London; Pamela R. Kearns, School of Cancer Sciences, University of
| | - Carmelo Rizzari
- C. Michel Zwaan, H. Berna Beverloo, Monique L. den Boer, and Rob Pieters, Erasmus Medical Center (MC)/Sophia Children's Hospital; Vincent H.J. van der Velden, Erasmus MC, Rotterdam, the Netherlands; Carmelo Rizzari, University of Milano-Bicocca, Hospital S. Gerardo, Monza, Italy; Francoise Mechinaud, Royal Children's Hospital, Melbourne, Victoria, Australia; Donna L. Lancaster, The Royal Marsden National Health Service Foundation Trust, London; Pamela R. Kearns, School of Cancer Sciences, University of
| | - Francoise Mechinaud
- C. Michel Zwaan, H. Berna Beverloo, Monique L. den Boer, and Rob Pieters, Erasmus Medical Center (MC)/Sophia Children's Hospital; Vincent H.J. van der Velden, Erasmus MC, Rotterdam, the Netherlands; Carmelo Rizzari, University of Milano-Bicocca, Hospital S. Gerardo, Monza, Italy; Francoise Mechinaud, Royal Children's Hospital, Melbourne, Victoria, Australia; Donna L. Lancaster, The Royal Marsden National Health Service Foundation Trust, London; Pamela R. Kearns, School of Cancer Sciences, University of
| | - Donna L. Lancaster
- C. Michel Zwaan, H. Berna Beverloo, Monique L. den Boer, and Rob Pieters, Erasmus Medical Center (MC)/Sophia Children's Hospital; Vincent H.J. van der Velden, Erasmus MC, Rotterdam, the Netherlands; Carmelo Rizzari, University of Milano-Bicocca, Hospital S. Gerardo, Monza, Italy; Francoise Mechinaud, Royal Children's Hospital, Melbourne, Victoria, Australia; Donna L. Lancaster, The Royal Marsden National Health Service Foundation Trust, London; Pamela R. Kearns, School of Cancer Sciences, University of
| | - Thomas Lehrnbecher
- C. Michel Zwaan, H. Berna Beverloo, Monique L. den Boer, and Rob Pieters, Erasmus Medical Center (MC)/Sophia Children's Hospital; Vincent H.J. van der Velden, Erasmus MC, Rotterdam, the Netherlands; Carmelo Rizzari, University of Milano-Bicocca, Hospital S. Gerardo, Monza, Italy; Francoise Mechinaud, Royal Children's Hospital, Melbourne, Victoria, Australia; Donna L. Lancaster, The Royal Marsden National Health Service Foundation Trust, London; Pamela R. Kearns, School of Cancer Sciences, University of
| | - Vincent H.J. van der Velden
- C. Michel Zwaan, H. Berna Beverloo, Monique L. den Boer, and Rob Pieters, Erasmus Medical Center (MC)/Sophia Children's Hospital; Vincent H.J. van der Velden, Erasmus MC, Rotterdam, the Netherlands; Carmelo Rizzari, University of Milano-Bicocca, Hospital S. Gerardo, Monza, Italy; Francoise Mechinaud, Royal Children's Hospital, Melbourne, Victoria, Australia; Donna L. Lancaster, The Royal Marsden National Health Service Foundation Trust, London; Pamela R. Kearns, School of Cancer Sciences, University of
| | - B. Berna Beverloo
- C. Michel Zwaan, H. Berna Beverloo, Monique L. den Boer, and Rob Pieters, Erasmus Medical Center (MC)/Sophia Children's Hospital; Vincent H.J. van der Velden, Erasmus MC, Rotterdam, the Netherlands; Carmelo Rizzari, University of Milano-Bicocca, Hospital S. Gerardo, Monza, Italy; Francoise Mechinaud, Royal Children's Hospital, Melbourne, Victoria, Australia; Donna L. Lancaster, The Royal Marsden National Health Service Foundation Trust, London; Pamela R. Kearns, School of Cancer Sciences, University of
| | - Monique L. den Boer
- C. Michel Zwaan, H. Berna Beverloo, Monique L. den Boer, and Rob Pieters, Erasmus Medical Center (MC)/Sophia Children's Hospital; Vincent H.J. van der Velden, Erasmus MC, Rotterdam, the Netherlands; Carmelo Rizzari, University of Milano-Bicocca, Hospital S. Gerardo, Monza, Italy; Francoise Mechinaud, Royal Children's Hospital, Melbourne, Victoria, Australia; Donna L. Lancaster, The Royal Marsden National Health Service Foundation Trust, London; Pamela R. Kearns, School of Cancer Sciences, University of
| | - Rob Pieters
- C. Michel Zwaan, H. Berna Beverloo, Monique L. den Boer, and Rob Pieters, Erasmus Medical Center (MC)/Sophia Children's Hospital; Vincent H.J. van der Velden, Erasmus MC, Rotterdam, the Netherlands; Carmelo Rizzari, University of Milano-Bicocca, Hospital S. Gerardo, Monza, Italy; Francoise Mechinaud, Royal Children's Hospital, Melbourne, Victoria, Australia; Donna L. Lancaster, The Royal Marsden National Health Service Foundation Trust, London; Pamela R. Kearns, School of Cancer Sciences, University of
| | - Dirk Reinhardt
- C. Michel Zwaan, H. Berna Beverloo, Monique L. den Boer, and Rob Pieters, Erasmus Medical Center (MC)/Sophia Children's Hospital; Vincent H.J. van der Velden, Erasmus MC, Rotterdam, the Netherlands; Carmelo Rizzari, University of Milano-Bicocca, Hospital S. Gerardo, Monza, Italy; Francoise Mechinaud, Royal Children's Hospital, Melbourne, Victoria, Australia; Donna L. Lancaster, The Royal Marsden National Health Service Foundation Trust, London; Pamela R. Kearns, School of Cancer Sciences, University of
| | - Michael Dworzak
- C. Michel Zwaan, H. Berna Beverloo, Monique L. den Boer, and Rob Pieters, Erasmus Medical Center (MC)/Sophia Children's Hospital; Vincent H.J. van der Velden, Erasmus MC, Rotterdam, the Netherlands; Carmelo Rizzari, University of Milano-Bicocca, Hospital S. Gerardo, Monza, Italy; Francoise Mechinaud, Royal Children's Hospital, Melbourne, Victoria, Australia; Donna L. Lancaster, The Royal Marsden National Health Service Foundation Trust, London; Pamela R. Kearns, School of Cancer Sciences, University of
| | - Julie Rosenberg
- C. Michel Zwaan, H. Berna Beverloo, Monique L. den Boer, and Rob Pieters, Erasmus Medical Center (MC)/Sophia Children's Hospital; Vincent H.J. van der Velden, Erasmus MC, Rotterdam, the Netherlands; Carmelo Rizzari, University of Milano-Bicocca, Hospital S. Gerardo, Monza, Italy; Francoise Mechinaud, Royal Children's Hospital, Melbourne, Victoria, Australia; Donna L. Lancaster, The Royal Marsden National Health Service Foundation Trust, London; Pamela R. Kearns, School of Cancer Sciences, University of
| | - George Manos
- C. Michel Zwaan, H. Berna Beverloo, Monique L. den Boer, and Rob Pieters, Erasmus Medical Center (MC)/Sophia Children's Hospital; Vincent H.J. van der Velden, Erasmus MC, Rotterdam, the Netherlands; Carmelo Rizzari, University of Milano-Bicocca, Hospital S. Gerardo, Monza, Italy; Francoise Mechinaud, Royal Children's Hospital, Melbourne, Victoria, Australia; Donna L. Lancaster, The Royal Marsden National Health Service Foundation Trust, London; Pamela R. Kearns, School of Cancer Sciences, University of
| | - Shruti Agrawal
- C. Michel Zwaan, H. Berna Beverloo, Monique L. den Boer, and Rob Pieters, Erasmus Medical Center (MC)/Sophia Children's Hospital; Vincent H.J. van der Velden, Erasmus MC, Rotterdam, the Netherlands; Carmelo Rizzari, University of Milano-Bicocca, Hospital S. Gerardo, Monza, Italy; Francoise Mechinaud, Royal Children's Hospital, Melbourne, Victoria, Australia; Donna L. Lancaster, The Royal Marsden National Health Service Foundation Trust, London; Pamela R. Kearns, School of Cancer Sciences, University of
| | - Lewis Strauss
- C. Michel Zwaan, H. Berna Beverloo, Monique L. den Boer, and Rob Pieters, Erasmus Medical Center (MC)/Sophia Children's Hospital; Vincent H.J. van der Velden, Erasmus MC, Rotterdam, the Netherlands; Carmelo Rizzari, University of Milano-Bicocca, Hospital S. Gerardo, Monza, Italy; Francoise Mechinaud, Royal Children's Hospital, Melbourne, Victoria, Australia; Donna L. Lancaster, The Royal Marsden National Health Service Foundation Trust, London; Pamela R. Kearns, School of Cancer Sciences, University of
| | - André Baruchel
- C. Michel Zwaan, H. Berna Beverloo, Monique L. den Boer, and Rob Pieters, Erasmus Medical Center (MC)/Sophia Children's Hospital; Vincent H.J. van der Velden, Erasmus MC, Rotterdam, the Netherlands; Carmelo Rizzari, University of Milano-Bicocca, Hospital S. Gerardo, Monza, Italy; Francoise Mechinaud, Royal Children's Hospital, Melbourne, Victoria, Australia; Donna L. Lancaster, The Royal Marsden National Health Service Foundation Trust, London; Pamela R. Kearns, School of Cancer Sciences, University of
| | - Pamela R. Kearns
- C. Michel Zwaan, H. Berna Beverloo, Monique L. den Boer, and Rob Pieters, Erasmus Medical Center (MC)/Sophia Children's Hospital; Vincent H.J. van der Velden, Erasmus MC, Rotterdam, the Netherlands; Carmelo Rizzari, University of Milano-Bicocca, Hospital S. Gerardo, Monza, Italy; Francoise Mechinaud, Royal Children's Hospital, Melbourne, Victoria, Australia; Donna L. Lancaster, The Royal Marsden National Health Service Foundation Trust, London; Pamela R. Kearns, School of Cancer Sciences, University of
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Moore AS, Kearns PR, Knapper S, Pearson ADJ, Zwaan CM. Novel therapies for children with acute myeloid leukaemia. Leukemia 2013; 27:1451-60. [PMID: 23563239 DOI: 10.1038/leu.2013.106] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Revised: 03/24/2013] [Accepted: 04/04/2013] [Indexed: 12/22/2022]
Abstract
Significant improvements in survival for children with acute myeloid leukaemia (AML) have been made over the past three decades, with overall survival rates now approximately 60-70%. However, these gains can be largely attributed to more intensive use of conventional cytotoxics made possible by advances in supportive care, and although over 90% of children achieve remission with frontline therapy, approximately one third in current protocols relapse. Furthermore, late effects of therapy cause significant morbidity for many survivors. Novel therapies are therefore desperately needed. Early-phase paediatric trials of several new agents such as clofarabine, sorafenib and gemtuzumab ozogamicin have shown encouraging results in recent years. Due to the relatively low incidence of AML in childhood, the success of paediatric early-phase clinical trials is largely dependent upon collaborative clinical trial design by international cooperative study groups. Successfully incorporating novel therapies into frontline therapy remains a challenge, but the potential for significant improvement in the duration and quality of survival for children with AML is high.
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Affiliation(s)
- A S Moore
- Queensland Children's Medical Research Institute, The University of Queensland, Brisbane, Australia.
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36
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Bate J, Chisholm J, Heath PT, Breuer J, Skinner R, Manley S, Patel S, Wheatley K, Ramsay M, Kearns PR, Hambleton S. PEPtalk: postexposure prophylaxis against varicella in children with cancer. Arch Dis Child 2011; 96:841-5. [PMID: 21715391 DOI: 10.1136/adc.2010.209650] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [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: 11/03/2022]
Abstract
OBJECTIVES To describe postexposure prophylaxis (PEP) against varicella zoster virus (VZV) in children being treated for malignancy in the UK and Ireland: the population at risk, frequency of exposure, clinical practice and attitudes among healthcare providers. DESIGN An observational study in three parts: (1) a retrospective survey of serostatus at diagnosis of malignancy, (2) collation of varicella zoster immune globulin (VZIG) dispensing data over a 3-year period and (3) an online survey of paediatric oncologists' clinical practice and beliefs in relation to VZV disease and its prevention. SETTING UK and Ireland. PARTICIPANTS Children diagnosed with malignancy in 2009 (serostatus survey) or receiving VZIG between April 2006 and March 2009 (VZIG dispensing study). Paediatric oncologists and haematologists working in tertiary paediatric oncology centres and related shared care units in the UK and Ireland (physician survey). RESULTS Of 1500 children diagnosed with malignancy each year, at least 24% are VZV seronegative. Few centres make efforts to prevent household exposure by vaccinating VZV-susceptible family members. Exposures to VZV result in the administration of PEP to approximately 250 children with cancer annually: half receive an intramuscular injection of VZIG while the remainder receive a course of oral aciclovir. The choice of PEP is made by doctors. There is no consensus among paediatric oncologists as to which is the better option, reflecting the lack of a secure evidence base. CONCLUSIONS A randomised controlled trial to compare the effectiveness and acceptability of VZIG and aciclovir as PEP against varicella is both desirable and feasible.
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Affiliation(s)
- Jessica Bate
- Division of Clinical Sciences, St George's, University of London, London, UK
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37
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O'Connor D, Sibson K, Caswell M, Connor P, Cummins M, Mitchell C, Motwani J, Taj M, Vora A, Wynn R, Kearns PR. Early UK experience in the use of clofarabine in the treatment of relapsed and refractory paediatric acute lymphoblastic leukaemia. Br J Haematol 2011; 154:482-5. [PMID: 21689087 DOI: 10.1111/j.1365-2141.2011.08752.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Clofarabine is a second-generation purine nucleoside analogue, which has shown promising activity in relapsed and refractory paediatric acute lymphoblastic leukaemia (ALL). This report summarizes the early United Kingdom experience of clofarabine for the treatment of paediatric ALL in 23 patients, outside of the context of a clinical trial. Our results demonstrated that clofarabine-based chemotherapy regimes were effective and well-tolerated in this heavily pre-treated group, with an overall response rate of 67% when used in combination regimes. Responses were seen in both B and T cell disease and in patients with adverse cytogenetics.
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Affiliation(s)
- David O'Connor
- Department of Haematology, Birmingham Children's Hospital, Birmingham, UK.
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38
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Horton TM, Sposto R, Brown P, Reynolds CP, Hunger SP, Winick NJ, Raetz EA, Carroll WL, Arceci RJ, Borowitz MJ, Gaynon PS, Gore L, Jeha S, Maurer BJ, Siegel SE, Biondi A, Kearns PR, Narendran A, Silverman LB, Smith MA, Zwaan CM, Whitlock JA. Toxicity assessment of molecularly targeted drugs incorporated into multiagent chemotherapy regimens for pediatric acute lymphocytic leukemia (ALL): review from an international consensus conference. Pediatr Blood Cancer 2010; 54:872-8. [PMID: 20127846 PMCID: PMC2857540 DOI: 10.1002/pbc.22414] [Citation(s) in RCA: 18] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
One of the challenges of incorporating molecularly targeted drugs into multi-agent chemotherapy (backbone) regimens is defining dose-limiting toxicities (DLTs) of the targeted agent against the background of toxicities of the backbone regimen. An international panel of 22 pediatric acute lymphocytic leukemia (ALL) experts addressed this issue (www.ALLNA.org). Two major questions surrounding DLT assessment were explored: (1) how toxicities can be best defined, assessed, and attributed; and (2) how effective dosing of new agents incorporated into multi-agent ALL clinical trials can be safely established in the face of disease- and therapy-related systemic toxicities. The consensus DLT definition incorporates tolerance of resolving Grade 3 and some resolving Grade 4 toxicities with stringent safety monitoring. This functional DLT definition is being tested in two Children's Oncology Group (COG) ALL clinical trials.
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Affiliation(s)
- Terzah M. Horton
- Texas Children’s Cancer Center/Baylor College of Medicine, Houston, TX
| | - Richard Sposto
- USC-CHLA Institute for Pediatric Clinical Research, Children’s Hospital Los Angeles, Los Angeles, CA
| | - Patrick Brown
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | - C. Patrick Reynolds
- Cancer Center, School of Medicine Texas Tech University Health Sciences Center, Lubbock, TX
| | - Stephen P. Hunger
- The University of Colorado Denver School of Medicine and The Children’s Hospital, Aurora, CO
| | - Naomi J. Winick
- Pediatric Oncology, University of Texas Southwestern Medical Center, Dallas, TX
| | | | | | - Robert J. Arceci
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | | | - Paul S. Gaynon
- USC-CHLA Institute for Pediatric Clinical Research, Children’s Hospital Los Angeles, Los Angeles, CA
| | - Lia Gore
- The University of Colorado Denver School of Medicine and The Children’s Hospital, Aurora, CO
| | - Sima Jeha
- St. Jude Children’s Research Hospital, Memphis, TN
| | - Barry J. Maurer
- Cancer Center, School of Medicine Texas Tech University Health Sciences Center, Lubbock, TX
| | - Stuart E. Siegel
- USC-CHLA Institute for Pediatric Clinical Research, Children’s Hospital Los Angeles, Los Angeles, CA
| | - Andrea Biondi
- Centro M. Tettamanti, Clinica Pediatrica Università, Milano-Bicocca Hospital, S. Gerardo, Monza, Italy
| | - Pamela R. Kearns
- Innovative Therapies for Children with Cancer (ITCC), and Institute for Cancer Studies, University of Birmingham, UK
| | - Aru Narendran
- Southern Alberta Children’s Cancer Program, Calgary, Alberta, Canada
| | | | - Malcolm A. Smith
- Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD
| | - C. Michel Zwaan
- Erasmus Medical Center/Sophia Children’s Hospital, Netherlands, and I-BFM SG New Agents Working Group
| | - James A. Whitlock
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, Vanderbilt University, Nashville, TN
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39
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Cox CV, Martin HM, Kearns PR, Virgo P, Evely RS, Blair A. Characterization of a progenitor cell population in childhood T-cell acute lymphoblastic leukemia. Blood 2006; 109:674-82. [PMID: 17003368 DOI: 10.1182/blood-2006-06-030445] [Citation(s) in RCA: 114] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
A significant proportion of children with T-cell acute lymphoblastic leukemia (T-ALL) continue to fail therapy. Consequently, characterization of the cells that proliferate to maintain the disease should provide valuable information on the most relevant therapeutic targets. We have used in vitro suspension culture (SC) and nonobese diabetic-severe combined immune deficient (NOD/SCID) mouse assays to phenotypically characterize and purify T-ALL progenitor cells. Cells from 13 pediatric cases were maintained in vitro for at least 4 weeks and expanded in 8 cases. To characterize the progenitors, cells were sorted for expression of CD34 and CD4 or CD7 and the subfractions were evaluated in vitro and in vivo. The majority of cells capable of long-term proliferation in vitro were derived from the CD34+/CD4- and CD34+/CD7- subfractions. Moreover, the CD34+/CD4- or CD7- cells were the only subfractions capable of NOD/SCID engraftment. These T-ALL cells successfully repopulated secondary and tertiary recipients with equivalent levels of engraftment, demonstrating self-renewal ability. The immunophenotype and genotype of the original leukemia cells were preserved with serial passage in the NOD/SCID mice. These data demonstrate the long-term repopulating ability of the CD34+/CD4- and CD34+/CD7- subfractions in T-ALL and suggest that a cell with a more primitive phenotype was the target for leukemic transformation in these cases.
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Affiliation(s)
- Charlotte V Cox
- Bristol Institute for Transfusion Sciences, University of Bristol, BS10 5ND, United Kingdom
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40
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Kearns PR, Chrzanowska-Lightowlers ZMA, Pieters R, Veerman A, Hall AG. Mu class glutathione S-transferase mRNA isoform expression in acute lymphoblastic leukaemia. Br J Haematol 2003; 120:80-8. [PMID: 12492580 DOI: 10.1046/j.1365-2141.2003.04039.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Glutathione S-transferases (GSTs) are implicated in cytotoxic drug resistance in leukaemia. In a previous study, expression of mu class GST (GSTM) was associated with poor prognosis in childhood acute lymphoblastic leukaemia (ALL), however, that study did not differentiate between individual GSTM isoforms. This study, therefore, investigated individual GSTM isoform expression in ALL blasts at the mRNA level. Leukaemic blasts from 21 children with ALL were studied. Interindividual variation in the pattern of GSTM mRNA isoform expression was demonstrated. GSTM2 transcript was expressed in all patients in contradistinction to GSTM5, which was not detected in any sample. GSTM3 and GSTM4 expression varied between individuals, with GSTM3 expressed in 62% and GSTM4 in 24% of patients. Lymphoblast expression of GSTM3 was positively related to good prognosis whereas expression of GSTM4 was not related to clinical outcome in this small cohort. No relationship was demonstrated with established indicators of prognosis, including sex, age, immunophenotype and presenting white cell count. The results suggest that expression of GSTM3 may play a role in determining prognosis in childhood ALL and could provide more information for accurate stratification of treatment. Further studies are required to determine whether there is a causal relationship between GSTM3 expression and clinical outcome.
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Affiliation(s)
- Pamela R Kearns
- Department of Paediatric Oncology, University of Bristol, UK.
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41
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Kearns PR, Pieters R, Rottier MM, Pearson AD, Hall AG. Raised blast glutathione levels are associated with an increased risk of relapse in childhood acute lymphocytic leukemia. Blood 2001; 97:393-8. [PMID: 11154214 DOI: 10.1182/blood.v97.2.393] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A preliminary study has linked raised blast glutathione levels with chemoresistance in acute myeloid and lymphoblastic leukemia in adults and children. In this study, therefore, the relationship between leukemic blast glutathione levels and prognosis in childhood acute lymphoblastic leukemia (ALL) was investigated. A total of 77 childhood ALL samples were analyzed, 62 at initial presentation and 15 at relapse. A 20-fold interindividual variation in glutathione levels at presentation (median, 6.54 nmol/mg protein; range, 1.37 to 27.9) was demonstrated. The median level in T-lineage ALL was 2. 3-fold higher than in B-lineage ALL (Mann-Whitney test, P <.0001). There was a significant correlation between presenting white cell count (WBC) and glutathione level (Spearman rank correlation coefficient, rho = 0.45, P =.001). A high DNA index correlated with low glutathione levels (Mann-Whitney test, P =.013). There was no significant relationship between glutathione levels and in vitro drug sensitivity. Patients with glutathione levels above the median had a significantly greater risk of relapse (log-rank test statistic, 5.55; P =.018), and the overall survival rate was significantly reduced (log-rank test statistic, 4.38; P =.04). Multivariate analysis demonstrated that glutathione concentration was of independent prognostic value when assessed in conjunction with age, gender, WBC, and immunophenotype. The association of elevated blast glutathione levels with an increased risk of relapse suggests that glutathione-depleting agents may be of therapeutic value in patients who present with a high WBC.
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Affiliation(s)
- P R Kearns
- Department of Paediatric Oncology, University of Newcastle, and the Medical School, Newcastle Upon Tyne, United Kingdom
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42
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Den Boer ML, Pieters R, Kazemier KM, Janka-Schaub GE, Henze G, Creutzig U, Kaspers GJ, Kearns PR, Hall AG, Pearson AD, Veerman AJ. Different expression of glutathione S-transferase alpha, mu and pi in childhood acute lymphoblastic and myeloid leukaemia. Br J Haematol 1999; 104:321-7. [PMID: 10050715 DOI: 10.1046/j.1365-2141.1999.01189.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Expression of three major classes of glutathione S-transferases (GSTs), i.e. alpha, mu and pi class, P-glycoprotein (P-gp) and multidrug resistance-associated protein (MRP) were studied in childhood acute lymphoblastic leukaemia (ALL), acute myeloid leukaemia (AML) and normal peripheral blood lymphocytes by flow cytometry. In vitro cytotoxicity of 4-hydroxy-ifosfamide (IFOS), daunorubicin (DNR) and prednisolone (PRED) was assessed by the MTT assay. Expression of alpha, mu and pi class GST did not significantly differ between leukaemic cells from 100 initial and 14 unrelated relapse ALL patients (GSTalpha P=026; GSTmu P=O009; GSTpi P=0.13). The expression of GSTalpha (1.4-fold, P=0.0004), GSTpi (13-fold, P = 0001) and to a lesser extent also GSTmu (1.1-fold, P=0.03) was higher in ALL compared with normal peripheral blood lymphocytes. Expression of GSTmu and GST7pi was significantly higher in 18 AML compared with 100 ALL patients at initial diagnosis (respectively 1.3-fold, P=0.0005 and 2-fold, P<0.0001). In contrast, GSTalpha was median 2-fold lower expressed in the AML samples (P< 0.0001). Expression levels of alpha, mu and pi class GSTs were not related to the degree of resistance to IFOS, DNR and PRED nor to immunophenotype, white blood cell count or age at presentation of childhood ALL. One exception was a remarkably low expression of GSTalpha in IFOS-sensitive samples compared with a heterogenous expression in IFOS-resistant samples (P= 0.02). Expression of GSTpi, but not of GSTalpha or GSTmu, weakly correlated with the expression of MRP (Rs 0.36, P = 0.002, n = 74) but not with P-gp. However, a high expression of both GSTpi and MRP was not associated with in vitro resistance to IFOS, DNR or PRED. The present data suggest that expression of GSTs is not linked to the degree of resistance to IFOS, DNR and PRED or clinical risk factors in childhood ALL. Whether the high expression of GSTmu and GSTpi in AML cells contributes to the relative resistance to IFOS, DNR and PRED compared with ALL samples (P < or = 0.0001) warrants further study.
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Affiliation(s)
- M L Den Boer
- Department of Paediatric Haematology/Oncology, University Hospital Vrije Universiteit, Amsterdam, The Netherlands
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44
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Kearns PR, Stewart RH, Mendel EB. Atrophic vaginitis treated with nitrofurazone-estrogen vaginal suppositories. J La State Med Soc 1968; 120:457-60. [PMID: 5727825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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