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Fenwick N, Weston R, Wheatley K, Hodgson J, Marshall L, Elliott M, Makin G, Ng A, Brennan B, Lowis S, Adamski J, Kilday JP, Cox R, Gattens M, Moore A, Trahair T, Ronghe M, Campbell M, Campbell H, Williams MW, Kirby M, Van Eijkelenburg N, Keely J, Scarpa U, Stavrou V, Fultang L, Booth S, Cheng P, De Santo C, Mussai F. PARC: a phase I/II study evaluating the safety and activity of pegylated recombinant human arginase BCT-100 in relapsed/refractory cancers of children and young adults. Front Oncol 2024; 14:1296576. [PMID: 38357205 PMCID: PMC10864630 DOI: 10.3389/fonc.2024.1296576] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 01/15/2024] [Indexed: 02/16/2024] Open
Abstract
Background The survival for many children with relapsed/refractory cancers remains poor despite advances in therapies. Arginine metabolism plays a key role in the pathophysiology of a number of pediatric cancers. We report the first in child study of a recombinant human arginase, BCT-100, in children with relapsed/refractory hematological, solid or CNS cancers. Procedure PARC was a single arm, Phase I/II, international, open label study. BCT-100 was given intravenously over one hour at weekly intervals. The Phase I section utilized a modified 3 + 3 design where escalation/de-escalation was based on both the safety profile and the complete depletion of arginine (defined as adequate arginine depletion; AAD <8μM arginine in the blood after 4 doses of BCT-100). The Phase II section was designed to further evaluate the clinical activity of BCT-100 at the pediatric RP2D determined in the Phase I section, by recruitment of patients with pediatric cancers into 4 individual groups. A primary evaluation of response was conducted at eight weeks with patients continuing to receive treatment until disease progression or unacceptable toxicity. Results 49 children were recruited globally. The Phase I cohort of the trial established the Recommended Phase II Dose of 1600U/kg iv weekly in children, matching that of adults. BCT-100 was very well tolerated. No responses defined as a CR, CRi or PR were seen in any cohort within the defined 8 week primary evaluation period. However a number of these relapsed/refractory patients experienced prolonged radiological SD. Conclusion Arginine depletion is a clinically safe and achievable strategy in children with cancer. The RP2D of BCT-100 in children with relapsed/refractory cancers is established at 1600U/kg intravenously weekly and can lead to sustained disease stability in this hard to treat population. Clinical trial registration EudraCT, 2017-002762-44; ISRCTN, 21727048; and ClinicalTrials.gov, NCT03455140.
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Affiliation(s)
- Nicola Fenwick
- Children’s Cancer Trials Team, Cancer Research UK Clinical Trials Unit (CRCTU), University of Birmingham, Birmingham, United Kingdom
| | - Rebekah Weston
- Children’s Cancer Trials Team, Cancer Research UK Clinical Trials Unit (CRCTU), University of Birmingham, Birmingham, United Kingdom
| | - Keith Wheatley
- Children’s Cancer Trials Team, Cancer Research UK Clinical Trials Unit (CRCTU), University of Birmingham, Birmingham, United Kingdom
| | - Jodie Hodgson
- Children’s Cancer Trials Team, Cancer Research UK Clinical Trials Unit (CRCTU), University of Birmingham, Birmingham, United Kingdom
| | | | - Martin Elliott
- Leeds Teaching Hospital, St James University Hospital, Leeds, United Kingdom
| | - Guy Makin
- Royal Manchester Children’s Hospital, Manchester, United Kingdom
| | - Antony Ng
- Bristol Royal Hospital for Children, Bristol, United Kingdom
| | | | - Stephen Lowis
- Bristol Royal Hospital for Children, Bristol, United Kingdom
| | - Jenny Adamski
- Birmingham Children’s Hospital, Birmingham, United Kingdom
| | - John Paul Kilday
- Royal Manchester Children’s Hospital, Manchester, United Kingdom
| | - Rachel Cox
- Bristol Royal Hospital for Children, Bristol, United Kingdom
| | - Mike Gattens
- Addenbrookes Hospital, Cambridge, United Kingdom
| | - Andrew Moore
- Queensland Children’s Hospital, Brisbane, QLD, Australia
| | - Toby Trahair
- Sydney Children’s Hospital, Sydney, NSW, Australia
| | - Milind Ronghe
- Royal Hospital for Children, Glasgow, United Kingdom
| | | | - Helen Campbell
- Royal Manchester Children’s Hospital, Manchester, United Kingdom
| | | | - Maria Kirby
- Michael Rice Cancer Centre, Women’s and Children’s Hospital, North Adelaide, SA, Australia
| | | | - Jennifer Keely
- Children’s Cancer Trials Team, Cancer Research UK Clinical Trials Unit (CRCTU), University of Birmingham, Birmingham, United Kingdom
| | - Ugo Scarpa
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| | - Victoria Stavrou
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| | - Livingstone Fultang
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| | - Sarah Booth
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| | - Paul Cheng
- Bio-Cancer Treatment International, Hong Kong Science Park, Hong Kong, Hong Kong SAR, China
| | - Carmela De Santo
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| | - Francis Mussai
- Birmingham Children’s Hospital, Birmingham, United Kingdom
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Al-Jilaihawi S, Lowis S. A Molecular Update and Review of Current Trials in Paediatric Low-Grade Gliomas. Pediatr Neurosurg 2023; 58:290-298. [PMID: 37604126 DOI: 10.1159/000533703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 08/18/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND Paediatric low-grade gliomas (pLGGs) are the most common primary brain tumour in children. Though considered benign, slow-growing lesions with excellent overall survival, their long-term morbidity can be significant, both from the tumour and secondary to treatment. Vast progress has been made in recent years to better understand the molecular biology underlying pLGGs, with promising implications for new targeted therapeutic strategies. SUMMARY A multi-layered classification system of biologic subgroups, integrating distinct molecular and histological features has evolved to further our clinical understanding of these heterogeneous tumours. Though surgery and chemotherapy are the mainstays of treatment for pLGGs, many tumours are not amenable to surgery and/or progress after conventional chemotherapy. Therapies targeting common genetic aberrations in the RAS-mitogen-activated protein kinase (RAS/MAPK) pathway have been the focus of many recent studies and offer new therapeutic possibilities. Here, we summarise the updated molecular classification of pLGGs and provide a review of current treatment strategies, novel agents, and open trials. KEY MESSAGES (1) There is a need for treatment strategies in pLGG that provide lasting tumour control and better quality of survival through minimising toxicity and protecting against neurological, cognitive, and endocrine deficits. (2) The latest World Health Organisation classification of pLGG incorporates a growing wealth of molecular genetic information by grouping tumours into more biologically and molecularly defined entities that may enable better risk stratification of patients, and consideration for targeted therapies in the future. (3) Novel agents and molecular-targeted therapies offer new therapeutic possibilities in pLGG and have been the subject of many recent and currently open clinical studies. (4) Adequate molecular characterisation of pLGG is therefore imperative in today's clinical trials, and treatment responses should not only be evaluated radiologically but also using neurological, visual, and quality of life outcomes to truly understand treatment benefits.
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Affiliation(s)
- Sarah Al-Jilaihawi
- Department of Paediatric Oncology, Bristol Royal Hospital for Children, Bristol, UK
| | - Stephen Lowis
- Department of Paediatric Oncology, Bristol Royal Hospital for Children, Bristol, UK
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3
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Green K, Panagopoulou P, D'Arco F, O'Hare P, Bowman R, Walters B, Dahl C, Jorgensen M, Patel P, Slater O, Ahmed R, Bailey S, Carceller F, Collins R, Corley E, English M, Howells L, Kamal A, Kilday JP, Lowis S, Lumb B, Pace E, Picton S, Pizer B, Shafiq A, Uzunova L, Wayman H, Wilson S, Hargrave D, Opocher E. A Nationwide Evaluation of Bevacizumab-based Treatments in Paediatric Low-Grade Glioma in the UK: Safety. Efficacy, Visual Morbidity and Outcomes. Neuro Oncol 2022; 25:774-785. [PMID: 36239316 PMCID: PMC10076941 DOI: 10.1093/neuonc/noac223] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Bevacizumab is increasingly used in children with Paediatric Low-Grade Glioma (PLGG) despite limited evidence. A nationwide UK service evaluation was conducted to provide larger cohort 'real life' safety and efficacy data including functional visual outcomes. METHODS Children receiving Bevacizumab-based treatments (BBT) for PLGG (2009-2020) from 11 centres were included. Standardised neuro-radiological (RANO-LGG) and visual (logMAR visual acuity) criteria were used to assess clinical-radiological correlation, survival outcomes and multivariate prognostic analysis. RESULTS Eighty-eight children with PLGG received BBT either as 3 rd line with Irinotecan (85%) or alongside 1 st/2 nd line chemotherapies (15%). Toxicity was limited and minimal. Partial response (PR, 40%), stable disease (SD, 49%), and progressive disease (PD, 11%) were seen during BBT. However, 65% progressed at 8 months (median) from BBT cessation, leading to a radiology-based 3yr-progression-free survival (PFS) of 29%. Diencephalic syndrome (p= 0.03) was associated with adverse PFS. Pre-existing visual morbidity included unilateral (25%) or bilateral (11%) blindness. Improvement (29%) or stabilisation (49%) of visual acuity were achieved, more often in patients' best eyes. Vision deteriorated during BBT in 14 (22%), with 3-year visual-PFS of 53%; more often in patients' worst eyes. A superior visual outcome (p=0.023) was seen in Neurofibromatosis type 1-associated Optic Pathway Glioma (OPG). Concordance between visual and radiological responses was 36%; optimised to 48% using only best eye responses. CONCLUSIONS BBTs provide effective short-term PLGG control and delay further progression, with a better sustained visual (best >worst eye) than radiological response. Further research could optimise the role of BBTs towards a potentially sight-saving strategy in OPG.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Olga Slater
- Great Ormond Street Hospital London, United Kingdom
| | | | - Simon Bailey
- Great North Children's Hospital Newcastle, United Kingdom
| | | | | | | | | | | | - Ahmed Kamal
- Birmingham Children's Hospital, United Kingdom
| | - John-Paul Kilday
- Royal Manchester Children's Hospital, United Kingdom.,The Centre for Paediatric, Teenage and Young Adult Cancer Sciences, The University of Manchester, United Kingdom
| | | | - Blanche Lumb
- Noah's Ark Children's Hospital for Wales, United Kingdom
| | - Erika Pace
- The Royal Marsden Hospital London, United Kingdom
| | | | - Barry Pizer
- Alder Hey Children's Hospital Liverpool, United Kingdom
| | - Ayad Shafiq
- Great North Children's Hospital Newcastle, United Kingdom
| | - Lena Uzunova
- Noah's Ark Children's Hospital for Wales, United Kingdom
| | | | | | | | - Enrico Opocher
- Great Ormond Street Hospital London, United Kingdom.,Padua University Hospital, Padua, Italy
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Airdrie J, Geagan C, Davies N, Powers K, Wright I, Borrill H, Gibson F, Clifford S, Lowis S, Bailey S, Limond J, Owen R, Grundy R, Lemon J, Hayes L, Malins S, Thomas S. QOL-34. The relationship between Psychological Flexibility, Quality-of-Life and psychological health in young people who have experienced a brain tumour. Neuro Oncol 2022. [PMCID: PMC9164668 DOI: 10.1093/neuonc/noac079.517] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Despite increasing survival rates in young people who have experienced a brain tumour, this patient group have the poorest reported quality-of-life (QoL) of all cancer survivors. QoL is defined as an individual’s perception of their position in life in relation to their goals, expectations and standards. QoL can be influenced by physical functioning but one of its strongest predictors is psychological health. A concept that has a large impact on psychological health is Psychological Flexibility (PF). PF refers to the ability to recognise and adapt to situations, shift cognitive and behavioural repertoires which are impacting negatively on personal and social functioning and commit to behaviours that are in line with strongly held values. Studies have demonstrated a relationship between PF and QoL in other patient populations such as chronic pain and breast cancer survivors. In this study we explored the relationship between PF and QoL at baseline in a sample of young people enrolled in a randomised controlled trial of Acceptance and Commitment Therapy (ACT) for young people who have experienced a brain tumour. We found that higher PF was associated with higher QoL in both 11-15 year olds (R2 = .69, p < .05) and 16 – 24 year olds (R2 = .29, p < .01). We also found higher PF was associated with lower levels of mental health difficulties (R2s ≥ .24, ps < .01) which was also associated with higher levels of QoL (R2 = .49 , p < .01). The results suggest assessing and providing support to increase PF is important for young people who have experienced a brain tumour. It highlights that interventions found to increase PF, such as ACT, could be helpful in improving psychological health in this population.
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Affiliation(s)
- Jac Airdrie
- University Hospitals Bristol and Weston , Bristol , United Kingdom
| | - Chloe Geagan
- The Newcastle Upon Tyne Hospitals NHS Foundation Trust , Newcastle , United Kingdom
| | - Nicholas Davies
- Nottingham University Hospitals NHS Trust , Nottingham , United Kingdom
| | - Katie Powers
- Nottingham University Hospitals NHS Trust , Nottingham , United Kingdom
| | - Ingram Wright
- University Hospitals Bristol and Weston , Bristol , United Kingdom
- University of Bristol , Bristol , United Kingdom
| | - Heather Borrill
- The Newcastle Upon Tyne Hospitals NHS Foundation Trust , Newcastle , United Kingdom
| | - Faith Gibson
- University of Surrey , Surrey , United Kingdom
- Great Ormond Street Hospital for Children NHS Foundation Trust (GOSH) , London , United Kingdom
| | | | - Stephen Lowis
- University Hospitals Bristol and Weston , Bristol , United Kingdom
- University of Bristol , Bristol , United Kingdom
| | - Simon Bailey
- University of Newcastle , Newcastle , United Kingdom
| | | | - Ray Owen
- Wye Valley NHS Trust , Hereford , United Kingdom
| | - Richard Grundy
- Nottingham University Hospitals NHS Trust , Nottingham , United Kingdom
- Children’s Brain Tumour Research Centre, University of Nottingham , Nottingham , United Kingdom
| | - James Lemon
- NHS Dumfries and Galloway , Dumfries , United Kingdom
| | | | - Sam Malins
- Children’s Brain Tumour Research Centre, University of Nottingham , Nottingham , United Kingdom
- Nottingham University Hospitals NHS Trust , Nottingham , United Kingdom
| | - Sophie Thomas
- Nottingham University Hospitals NHS Trust , Nottingham , United Kingdom
- Children’s Brain Tumour Research Centre, University of Nottingham , Nottingham , United Kingdom
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Green K, Panagopoulou P, D’Arco F, O'Hare P, Bowman R, Walters B, Dahl C, Jorgensen M, Patel P, Slater O, Ahmed R, Bailey S, Carceller F, Collins R, Corley E, English M, Hayden J, Howells L, Kamal A, Kilday JP, Lowis S, Lumb B, Micic T, Mitra D, Pace E, Picton S, Pizer B, Shafiq A, Uzunova L, Wilson S, Wayman H, Hargrave D, Opocher E. LGG-09. A Nationwide Service Evaluation of Safety, Radiologic and Visual Outcome Refining Bevacizumab-based Treatments in Children with Progressive Low-Grade Glioma. Neuro Oncol 2022. [PMCID: PMC9164923 DOI: 10.1093/neuonc/noac079.325] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
INTRODUCTION: Bevacizumab/Irinotecan is currently 3rd-line treatment in the UK for progressive Paediatric Low-Grade Glioma (PLGG) based on limited evidence. A nationwide service evaluation was conducted to review its safety and efficacy amongst a larger cohort.
METHODS: Data from children with PLGG receiving Bevacizumab-based Treatments (BBT) from 11 UK Centres (2009-2020) were reviewed. Radiological and visual outcomes were based on standardized measurements. Clinical-radiological correlation was investigated. Time to progression from BBT stop, progression free-survival (PFS) curves and multivariate analysis of prognostic factors (p 0.05) were performed.
RESULTS: 88 children with PLGG (88% OPG, 24% NF1) had BBT for radiological (43%), visual (20%) or combined (27%) progression, after 40 months (median) from diagnosis. Amongst OPG cases, visual acuity (VA) per eye (better/worse) before BBT was logMAR 0.0-0.3 (23/7) 0.3 - 1.0 (27/20), > 1.0 (14/18) and LP/NLP (8/27), with 19/8 children respectively blind (LP/NLP) in one or both eyes. Bevacizumab 10 mg/kg every 14 days (median 24 doses) was given as 3rd line+ with Irinotecan (85%) or alongside 1st/2nd line chemo (15%) leading to remarkable radiological (88%) and visual (74%) responses (stable or improved) within 3-6 months, with limited toxicity. 12% progressed on treatment, and 8% died unrelated to BBT. After initial response 65% progressed at a median of 8 months (4 - 23) after BBT, resulting in 3-year-all-causes-PFS of 16% and 3-yr-visual-PFS of 45% from start of BBT. Visual concordance with MRI was poor (36%) but increases (47%) when better-eye determines visual outcome. Lack of NF1 and diencephalic syndrome (DS) at presentation were independent negative prognostic factors for PFS.
CONCLUSIONS: A remarkable but transient effect of BBT has been confirmed. Visual > radiological responses can be sustained after BBT. Variations in current BBT strategies justifies further research, including the potential upfront use alongside conventional first-line chemotherapy as sight-saving strategy.
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Affiliation(s)
| | - Paraskevi Panagopoulou
- Great Ormond Street Hospital , London , United Kingdom
- Aristotle University of Thessaloniki Medical School , Thessaloniki , Greece
| | | | - Patricia O'Hare
- Children's Hospital Belfast , Belfast , United Kingdom
- Great Ormond Street Hospital , London , United Kingdom
| | | | | | | | | | - Pritesh Patel
- Great Ormond Street Hospital , London , United Kingdom
| | - Olga Slater
- Great Ormond Street Hospital , London , United Kingdom
| | - Rehana Ahmed
- Nottingham Children's Hospital , Nottingham , United Kingdom
| | - Simon Bailey
- Great North Children's Hospital , Newcastle , United Kingdom
| | | | | | | | - Martin English
- Birmingham Children's Hospital , Birmingham , United Kingdom
| | - James Hayden
- Alderhey Children's Hospital , Liverpool , United Kingdom
| | - Lisa Howells
- Alderhey Children's Hospital , Liverpool , United Kingdom
| | - Ahmed Kamal
- Birmingham Children's Hospital , Birmingham , United Kingdom
| | - John Paul Kilday
- Royal Manchester Children's Hospital , Manchester , United Kingdom
| | - Stephen Lowis
- Bristol Children's Hospital , Bristol , United Kingdom
| | - Blanche Lumb
- Noah's Ark Children's Hospital Wales , Cardiff , United Kingdom
| | - Thomas Micic
- Noah's Ark Children's Hospital Wales , Cardiff , United Kingdom
| | - Dip Mitra
- Great North Children's Hospital , Newcastle , United Kingdom
| | - Erika Pace
- Royal Marsden Hospital , London , United Kingdom
| | - Susan Picton
- Leeds Children's Hospital , Leeds , United Kingdom
| | - Barry Pizer
- Alderhey Children's Hospital , Liverpool , United Kingdom
| | - Ayad Shafiq
- Great North Children's Hospit , Newcastle , United Kingdom
| | - Lena Uzunova
- Noah's Ark Children's Hospital Wales , Cardiff , United Kingdom
| | - Shaun Wilson
- John Radcliffe Hospital , Oxford , United Kingdom
| | - Harriet Wayman
- Royal Manchester Children's Hospital , Manchester , United Kingdom
| | | | - Enrico Opocher
- Great Ormond Street Hospital , London , United Kingdom
- Padua University Hospital , Padua , Italy
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6
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Heravi Shargh V, Luckett J, Bouzinab K, Paisey S, Turyanska L, Singleton WGB, Lowis S, Gershkovich P, Bradshaw TD, Stevens MFG, Bienemann A, Coyle B. Chemosensitization of Temozolomide-Resistant Pediatric Diffuse Midline Glioma Using Potent Nanoencapsulated Forms of a N(3)-Propargyl Analogue. ACS Appl Mater Interfaces 2021; 13:35266-35280. [PMID: 34310112 DOI: 10.1021/acsami.1c04164] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The lack of clinical response to the alkylating agent temozolomide (TMZ) in pediatric diffuse midline/intrinsic pontine glioma (DIPG) has been associated with O6-methylguanine-DNA-methyltransferase (MGMT) expression and mismatch repair deficiency. Hence, a potent N(3)-propargyl analogue (N3P) was derived, which not only evades MGMT but also remains effective in mismatch repair deficient cells. Due to the poor pharmacokinetic profile of N3P (t1/2 < 1 h) and to bypass the blood-brain barrier, we proposed convection enhanced delivery (CED) as a method of administration to decrease dose and systemic toxicity. Moreover, to enhance N3P solubility, stability, and sustained distribution in vivo, either it was incorporated into an apoferritin (AFt) nanocage or its sulfobutyl ether β-cyclodextrin complex was loaded into nanoliposomes (Lip). The resultant AFt-N3P and Lip-N3P nanoparticles (NPs) had hydrodynamic diameters of 14 vs 93 nm, icosahedral vs spherical morphology, negative surface charge (-17 vs -34 mV), and encapsulating ∼630 vs ∼21000 N3P molecules per NP, respectively. Both NPs showed a sustained release profile and instant uptake within 1 h incubation in vitro. In comparison to the naked drug, N3P NPs demonstrated stronger anticancer efficacy against 2D TMZ-resistant DIPG cell cultures [IC50 = 14.6 (Lip-N3P) vs 32.8 μM (N3P); DIPG-IV) and (IC50 = 101.8 (AFt-N3P) vs 111.9 μM (N3P); DIPG-VI)]. Likewise, both N3P-NPs significantly (P < 0.01) inhibited 3D spheroid growth compared to the native N3P in MGMT+ DIPG-VI (100 μM) and mismatch repair deficient DIPG-XIX (50 μM) cultures. Interestingly, the potency of TMZ was remarkably enhanced when encapsulated in AFt NPs against DIPG-IV, -VI, and -XIX spheroid cultures. Dynamic PET scans of CED-administered zirconium-89 (89Zr)-labeled AFt-NPs in rats also demonstrated substantial enhancement over free 89Zr radionuclide in terms of localized distribution kinetics and retention within the brain parenchyma. Overall, both NP formulations of N3P represent promising approaches for treatment of TMZ-resistant DIPG and merit the next phase of preclinical evaluation.
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Affiliation(s)
| | | | | | - Stephen Paisey
- Wales Research and Diagnostic PET Imaging Centre, School of Medicine, Cardiff University, Cardiff, CF14 4XN, United Kingdom
| | - Lyudmila Turyanska
- Faculty of Engineering, University of Nottingham, Nottingham, Nottinghamshire NG7 2RD, United Kingdom
| | - William G B Singleton
- Translational Health Sciences, Bristol Medical School, Faculty of Health Sciences, University of Bristol, Bristol, BS8 1TD, United Kingdom
| | | | | | | | | | - Alison Bienemann
- Translational Health Sciences, Bristol Medical School, Faculty of Health Sciences, University of Bristol, Bristol, BS8 1TD, United Kingdom
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7
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Malins S, Owen R, Wright I, Borrill H, Limond J, Gibson F, Grundy RG, Bailey S, Clifford SC, Lowis S, Lemon J, Hayes L, Thomas S. Acceptance and commitment therapy for young brain tumour survivors: study protocol for an acceptability and feasibility trial. BMJ Open 2021; 11:e051091. [PMID: 34078638 PMCID: PMC8173289 DOI: 10.1136/bmjopen-2021-051091] [Citation(s) in RCA: 1] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Survivors of childhood brain tumours have the poorest health-related quality of life of all cancer survivors due to the multiple physical and psychological sequelae of brain tumours and their treatment. Remotely delivered acceptance and commitment therapy (ACT) may be a suitable and accessible psychological intervention to support young people who have survived brain tumours. This study aims to assess the feasibility and acceptability of remotely delivered ACT to improve quality of life among these young survivors. METHODS AND ANALYSIS This study is a two-arm, parallel group, randomised controlled trial comparing ACT with waitlist control at 12-week follow-up as the primary endpoint. Seventy-two participants will be recruited, who are aged 11-24 and have completed brain tumour treatment. Participants will be randomised to receive 12 weeks of ACT either immediately or after a 12-week wait. The DNA-v model of ACT will be employed, which is a developmentally appropriate model for young people. Feasibility will be assessed using the proportion of those showing interest who consent to the trial and complete the intervention. Acceptability will be assessed using participant evaluations of the intervention, alongside qualitative interviews and treatment diaries analysed thematically. A range of clinical outcome measures will also assess physical and mental health, everyday functioning, quality of life and service usage at 12-week follow-up. The durability of treatment effects will be assessed by further follow-up assessments at 24 weeks, 36 weeks and 48 weeks. ETHICS AND DISSEMINATION Ethical approval was given by East Midlands, Nottingham 1 Research Ethics Committee (Reference: 20/EM/0237). Study results will be disseminated in peer-reviewed journals, through public events and relevant third sector organisations. TRIAL REGISTRATION ISRCTN10903290; NCT04722237.
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Affiliation(s)
- Sam Malins
- Nottingham University Hospitals NHS Trust, Nottingham, UK
- Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK
| | - Ray Owen
- Wye Valley NHS Trust, Hereford, UK
| | - Ingram Wright
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Heather Borrill
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Jenny Limond
- College of Life and Environmental Sciences, University of Exeter, Exeter, UK
| | - Faith Gibson
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
- Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
| | - Richard G Grundy
- Children's Brain Tumour Research Centre, University of Nottingham, Nottingham, UK
| | - Simon Bailey
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Newcastle University, Newcastle upon Tyne, UK
| | - Steven C Clifford
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Newcastle University, Newcastle upon Tyne, UK
| | - Stephen Lowis
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Population Health Sciences, University of Bristol, Bristol, UK
| | | | - Louise Hayes
- DNA-v International, Melbourne, Victoria, Australia
| | - Sophie Thomas
- Nottingham University Hospitals NHS Trust, Nottingham, UK
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8
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Ajithkumar T, Mandeville H, Carceller F, Ronghe M, Foord T, Lowis S, Kwok-Williams M, Calaminus G, Murray M, Nicholson J. GCT-61. CORRELATION OF PATTERNS OF DISEASE RECURRENCE WITH RADIOTHERAPY TECHNIQUES AND DOSE IN INTRACRANIAL GERM CELL TUMOURS (icGCT): LESSONS FROM THE UK COHORT OF SIOP GCT96 STUDY. Neuro Oncol 2020. [PMCID: PMC7715078 DOI: 10.1093/neuonc/noaa222.278] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
BACKGROUND
There are global variations in radiotherapy approaches for icGCT. An understanding of patterns of disease recurrence correlated with radiation techniques and doses is important in standardising and improving the quality of radiotherapy using high-precision techniques.
METHODS AND RESULTS
Data from 20 patients with tumour recurrence after treatment within the SIOP GCT96 study in the UK were analysed. Seven (35%) patients had germinoma and 13 (65%) had non-germinoma. Twelve patients had local recurrence, 5 had metastatic and 3 had local and metastatic disease. Radiotherapy details were retrieved in only 8 patients (40%). Six patients had received focal radiotherapy and two craniospinal radiotherapy. Of the patients who received focal radiotherapy, 4 had recurrence within the radiation portal, one had periventricular recurrence and one had marker-positive recurrence with no radiological lesions. Both patients who received CSI recurred within the CSF space. The main reasons for poor retrieval of treatment details were difficulty in retrieving archived information and that the study was conducted during a period before PACS or electronic radiotherapy records.
CONCLUSION
This study highlights the importance prospective data collection and analysis to understand the patterns of recurrence in icGCT. Even within a prospective study, radiotherapy techniques varied between centres. There is therefore an urgent need for centralised radiological review and prospective radiotherapy quality assurance measures in future clinical trials.
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Affiliation(s)
| | | | | | - Milind Ronghe
- NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
| | - Tina Foord
- Churchill Hospital, Oxford, United Kingdom
| | - Stephen Lowis
- University Hospital Bristol NHS Foundation Trust, Bristol, United Kingdom
| | | | | | - Matthew Murray
- Cambridge University Hospital, Cambridge, United Kingdom
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Nemes K, Bens S, Kachanov D, Teleshova M, Hauser P, Simon T, Tippelt S, Woessmann W, Beck O, Flotho C, Grigull L, Driever PH, Schlegel PG, Khurana C, Hering K, Kolb R, Leipold A, Abbink F, Gil-Da-Costa MJ, Benesch M, Kerl K, Lowis S, Marques CH, Graf N, Nysom K, Vokuhl C, Melchior P, Kröncke T, Schneppenheim R, Kordes U, Gerss J, Siebert R, Furtwängler R, Frühwald MC. Clinical and genetic risk factors define two risk groups of extracranial malignant rhabdoid tumours (eMRT/RTK). Eur J Cancer 2020; 142:112-122. [PMID: 33249395 DOI: 10.1016/j.ejca.2020.10.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 09/29/2020] [Accepted: 10/07/2020] [Indexed: 01/02/2023]
Abstract
INTRODUCTION Extracranial rhabdoid tumours are rare, highly aggressive malignancies primarily affecting young children. The EU-RHAB registry was initiated in 2009 to prospectively collect data of rhabdoid tumour patients treated according to the EU-RHAB therapeutic framework. METHODS We evaluated 100 patients recruited within EU-RHAB (2009-2018). Tumours and matching blood samples were examined for SMARCB1 mutations by sequencing and cytogenetics. RESULTS A total of 70 patients presented with extracranial, extrarenal tumours (eMRT) and 30 with renal rhabdoid tumours (RTK). Nine patients demonstrated synchronous tumours. Distant metastases at diagnosis (M+) were present in 35% (35/100), localised disease (M0) with (LN+) and without (LN-) loco-regional lymph node involvement in 65% (65/100). SMARCB1 germline mutations (GLM) were detected in 21% (17/81 evaluable) of patients. The 5-year overall survival (OS) and event-free survival (EFS) rates were 45.8 ± 5.4% and 35.2 ± 5.1%, respectively. On univariate analyses, age at diagnosis (≥12 months), M0-stage, absence of synchronous tumours, absence of a GLM, gross total resection (GTR), radiotherapy and achieving a CR were significantly associated with favourable outcomes. In an adjusted multivariate model presence of a GLM, M+ and lack of a GTR were the strongest significant negative predictors of outcome. CONCLUSIONS We suggest to stratify patients with localised disease (M0), GTR+ and without proof of a GLM (5-year OS 72.2 ± 9.9%) as 'standard risk'. Patients presenting with one of the features M+ and/or GTR- and/or GLM+ belong to a high risk group (5-year, OS 32.5 ± 6.2%). These patients need novel therapeutic strategies such as combinations of targeted agents with conventional chemotherapy or novel experimental approaches ideally within international phase I/II trials.
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Affiliation(s)
- Karolina Nemes
- Paediatrics and Adolescent Medicine, Swabian Children's Cancer Center, University Medical Center Augsburg, Germany
| | - Susanne Bens
- Institute of Human Genetics, Ulm University & Ulm University Medical Center, Ulm, Germany
| | - Denis Kachanov
- National Scientific and Practical Center of Pediatric Hematology, Oncology and Immunology named after Dmitry Rogachev, Moscow, Russian Federation
| | - Margarita Teleshova
- National Scientific and Practical Center of Pediatric Hematology, Oncology and Immunology named after Dmitry Rogachev, Moscow, Russian Federation
| | - Peter Hauser
- Department of Pediatric Oncology, 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Thorsten Simon
- Department of Pediatric Hematology and Oncology, University Children's Hospital of Cologne, Cologne, Germany
| | - Stephan Tippelt
- Department of Pediatric Hematology and Oncology, Pediatrics III, University Hospital of Essen, Essen, Germany
| | - Wilhelm Woessmann
- Department of Pediatric Hematology and Oncology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Olaf Beck
- Department of Pediatric Hematology, Oncology & Hemostaseology, University Medical Center of the Johannes Gutenberg-University Mainz, Germany
| | - Christian Flotho
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany; German Cancer Consortium, Heidelberg, Germany
| | - Lorenz Grigull
- Department of Pediatric Hematology and Oncology, Children's Hospital of Hannover, Hannover, Germany
| | - Pablo H Driever
- Department of Pediatric Oncology and Hematology, Charité - University Hospital Berlin, Corporate Member of Free University Berlin, Humboldt-University Berlin, and Berlin Institute of Health, Berlin, Germany
| | | | - Claudia Khurana
- Department of Pediatric Hematology and Oncology, Children's Hospital of Bielefeld, Germany
| | - Kathrin Hering
- Department of Radiotherapy and Radiation Oncology, Leipzig University, Leipzig, Germany
| | - Reinhard Kolb
- Department of Pediatrics, Children's Center, Hospital of Oldenburg, Oldenburg, Germany
| | | | - Floor Abbink
- Department of Pediatric Hematology and Oncology, VU University Medical Center, Amsterdam, the Netherlands
| | - Maria J Gil-Da-Costa
- Pediatric Hemathology and Oncology Division, University Hospital S. João Alameda Hernani Monteiro, Porto, Portugal
| | - Martin Benesch
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Austria
| | - Kornelius Kerl
- Department of Pediatric Hematology and Oncology, University Children's Hospital Münster, Münster, Germany
| | - Stephen Lowis
- School of Clinical Sciences, University of Bristol, London, UK
| | - Carmen H Marques
- Pediatric Onco-hematology Unit, Niño Jesús Hospital, Madrid, Spain
| | - Norbert Graf
- Department of Pediatric Hematology and Oncology, University of Saarland, Homburg, Germany
| | - Karsten Nysom
- Department of Paediatrics and Adolescent Medicine, Neuroscience Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Christian Vokuhl
- Department of Pathology, Section of Pediatric Pathology, University Hospital Bonn, Bonn, Germany
| | - Patrick Melchior
- Department of Radiation Oncology, University of Saarland, Homburg, Germany
| | - Thomas Kröncke
- Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Augsburg, Germany
| | - Reinhard Schneppenheim
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Uwe Kordes
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Joachim Gerss
- Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany
| | - Reiner Siebert
- Institute of Human Genetics, Ulm University & Ulm University Medical Center, Ulm, Germany
| | - Rhoikos Furtwängler
- Department of Pediatric Hematology and Oncology, University of Saarland, Homburg, Germany
| | - Michael C Frühwald
- Paediatrics and Adolescent Medicine, Swabian Children's Cancer Center, University Medical Center Augsburg, Germany.
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Murray MJ, Ruffle A, Lowis S, Howell L, Shanmugavadivel D, Dommett R, Gamble A, Shenton G, Nicholson J. Delphi method to identify expert opinion to support children's cancer referral guidelines. Arch Dis Child 2020; 105:241-246. [PMID: 31420330 DOI: 10.1136/archdischild-2019-317235] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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] [Received: 03/15/2019] [Revised: 05/16/2019] [Accepted: 08/02/2019] [Indexed: 11/03/2022]
Abstract
BACKGROUND The National Institute for Health and Care Excellence (NICE) guidance for referral of children with suspected cancer was first published in 2005 and updated in 2015. The updated version relied on sparse primary care evidence and published without input from key stakeholders, for example, acute general paediatricians and paediatric haematologists/oncologists. This led to a document that fell short as a practical guide for referring physicians managing children with potentially life-threatening conditions. Following discussions between the Children's Cancer and Leukaemia Group (CCLG, the UK multidisciplinary professional body for healthcare professionals caring for children with cancer) and NICE, it was agreed that a practical supplement should be produced for the 2015 guidance. A prerequisite was evidence gathering from tertiary care to balance the existing primary care evidence, and a Delphi consensus method was therefore convened. METHODS A CCLG NICE Guidance Committee formulated 25 draft statements for review. The CCLG emailed its paediatric haematologist/oncologist membership (n=179) and 88 responded (49%). To achieve consensus, statements required ≥70% agreement from ≥60% of actual respondents, from the denominator (n=88). RESULTS Fifteen of 25 original statements were accepted at the first round of voting. Three of 25 statements where >50% did not support were rejected outright. One statement could not be revised without replicating a previously accepted statement. The six remaining statements were revised and a second round of voting undertaken; all six revised statements were accepted. Overall, 21 of 25 statements (84%) met consensus criteria. CONCLUSIONS This expert opinion should help streamline suspected cancer referral in children and help optimise subsequent outcomes.
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Affiliation(s)
- Matthew J Murray
- Department of Paediatric Haematology and Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Amy Ruffle
- Department of Paediatric Haematology and Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Stephen Lowis
- Department of Paediatric Haematology and Oncology, Bristol Royal Hospital for Children, Bristol, Bristol, UK
| | - Lisa Howell
- Department of Paediatric Haematology and Oncology, Alder Hey Children's NHS Foundation Trust, Liverpool, Liverpool, UK
| | | | - Rachel Dommett
- Department of Paediatric Haematology and Oncology, Bristol Royal Hospital for Children, Bristol, Bristol, UK
| | - Ashley Gamble
- Children's Cancer and Leukaemia Group, Leicester, UK
| | - Geoff Shenton
- Paediatric Haematology, Great North Children's Hospital, Newcastle-upon-Tyne, UK
| | - James Nicholson
- Department of Paediatric Haematology and Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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11
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Bate J, Baker S, Breuer J, Chisholm JC, Gray J, Hambleton S, Houlton A, Jit M, Lowis S, Makin G, O'Sullivan C, Patel SR, Phillips R, Ransinghe N, Ramsay ME, Skinner R, Wheatley K, Heath PT. PEPtalk2: results of a pilot randomised controlled trial to compare VZIG and aciclovir as postexposure prophylaxis (PEP) against chickenpox in children with cancer. Arch Dis Child 2019; 104:25-29. [PMID: 29730641 DOI: 10.1136/archdischild-2017-314212] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 02/16/2018] [Accepted: 04/17/2018] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To determine the likely rate of patient randomisation and to facilitate sample size calculation for a full-scale phase III trial of varicella zoster immunoglobulin (VZIG) and aciclovir as postexposure prophylaxis against chickenpox in children with cancer. DESIGN Multicentre pilot randomised controlled trial of VZIG and oral aciclovir. SETTING England, UK. PATIENTS Children under 16 years of age with a diagnosis of cancer: currently or within 6 months of receiving cancer treatment and with negative varicella zoster virus (VZV) serostatus at diagnosis or within the last 3 months. INTERVENTIONS Study participants who have a significant VZV exposure were randomised to receive PEP in the form of VZIG or aciclovir after the exposure. MAIN OUTCOME MEASURES Number of patients registered and randomised within 12 months of the trial opening to recruitment and incidence of breakthrough varicella. RESULTS The study opened in six sites over a 13-month period. 482 patients were screened for eligibility, 32 patients were registered and 3 patients were randomised following VZV exposure. All three were randomised to receive aciclovir and there were no cases of breakthrough varicella. CONCLUSIONS Given the limited recruitment to the PEPtalk2 pilot, it is unlikely that the necessary sample size would be achievable using this strategy in a full-scale trial. The study identified factors that could be used to modify the design of a definitive trial but other options for defining the best means to protect such children against VZV should be explored. TRIAL REGISTRATION NUMBER ISRCTN48257441, EudraCT number: 2013-001332-22, sponsor: University of Birmingham.
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Affiliation(s)
- Jessica Bate
- Department of Paediatric Oncology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Stephen Baker
- Cancer Research UK Clinical Trials Unit (CRCTU), School of Cancer Sciences, University of Birmingham, Birmingham, UK
| | - Judith Breuer
- Division of Infection and Immunity, University College London, London, UK
| | - Julia C Chisholm
- Children and Young People's Unit, Royal Marsden NHS Foundation Trust, Sutton, UK
| | - Juliet Gray
- Department of Paediatric Oncology, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,Cancer Sciences Academic Unit, University of Southampton, Southampton, UK
| | - Sophie Hambleton
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK.,Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Aimee Houlton
- Cancer Research UK Clinical Trials Unit (CRCTU), School of Cancer Sciences, University of Birmingham, Birmingham, UK
| | - Mark Jit
- Modelling and Economics Unit, Public Health England, London, UK.,Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Stephen Lowis
- School of Clinical Sciences, University of Bristol, London, UK
| | - Guy Makin
- Division of Cancer Sciences, University of Manchester, Manchester, UK
| | - Catherine O'Sullivan
- Paediatric Infectious Diseases Research Group and Vaccine Institute, Institute of Infection and Immunity, St. Georges, University of London, London, UK
| | - Soonie R Patel
- Department of Paediatrics, Croydon Health Services NHS Trust, London, UK
| | | | - Neil Ransinghe
- Parent representative, Paediatric Oncology Reference Team, UK
| | | | - Roderick Skinner
- Great North Children's Hospital, Department of Paediatric and Adolescent Haematology/Oncology, Newcastle upon Tyne, UK
| | - Keith Wheatley
- Cancer Research UK Clinical Trials Unit (CRCTU), School of Cancer Sciences, University of Birmingham, Birmingham, UK
| | - Paul T Heath
- Paediatric Infectious Diseases Research Group and Vaccine Institute, Institute of Infection and Immunity, St. Georges, University of London, London, UK
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Finetti MA, Selby MP, Pons ADC, Batting S, Wood JA, Barker JM, Smith A, Crosier S, Bashton M, Pickles JC, Fairchild AR, Avery A, O’Hare P, Pizer B, Brennan B, Lowis S, Hargrave D, Jacques TS, Bailey S, Clifford SC, Williamson D. ATRT-23. SMARCB1-DEPENDENCIES IN ATYPICAL TERATOID/RHABDOID TUMOURS: A STRATEGY FOR PRE-CLINICAL THERAPEUTIC TARGET IDENTIFICATION IN THE ABSENCE OF ACTIONABLE MUTATIONS. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy059.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Martina Anna Finetti
- Wolfson Childhood Cancer Research Centre, Northern Institute for Cancer Research, Newcastle University, Newcastle Upon Tyne, UK
| | - Matthew p Selby
- Wolfson Childhood Cancer Research Centre, Northern Institute for Cancer Research, Newcastle University, Newcastle Upon Tyne, UK
| | - Alicia del-Carpio Pons
- Wolfson Childhood Cancer Research Centre, Northern Institute for Cancer Research, Newcastle University, Newcastle Upon Tyne, UK
| | - Sarah Batting
- Wolfson Childhood Cancer Research Centre, Northern Institute for Cancer Research, Newcastle University, Newcastle Upon Tyne, UK
| | - James A Wood
- Wolfson Childhood Cancer Research Centre, Northern Institute for Cancer Research, Newcastle University, Newcastle Upon Tyne, UK
| | - James M Barker
- Wolfson Childhood Cancer Research Centre, Northern Institute for Cancer Research, Newcastle University, Newcastle Upon Tyne, UK
| | - Amanda Smith
- Wolfson Childhood Cancer Research Centre, Northern Institute for Cancer Research, Newcastle University, Newcastle Upon Tyne, UK
| | - Stephen Crosier
- Wolfson Childhood Cancer Research Centre, Northern Institute for Cancer Research, Newcastle University, Newcastle Upon Tyne, UK
| | - Matthew Bashton
- Wolfson Childhood Cancer Research Centre, Northern Institute for Cancer Research, Newcastle University, Newcastle Upon Tyne, UK
| | - Jessica C Pickles
- Developmental Biology and Cancer Programme, University College London Great Ormond Street Institute of Child Health, London, UK
- Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Amy R Fairchild
- Developmental Biology and Cancer Programme, University College London Great Ormond Street Institute of Child Health, London, UK
- Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Aimee Avery
- Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Patricia O’Hare
- Department of Paediatric oncology, Great Ormond Street Hospital NHS trust, London, UK
| | - Barry Pizer
- Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Bernadette Brennan
- Royal Manchester Children’s Hospital and University of Manchester, Manchester, UK
| | - Stephen Lowis
- Royal Hospital for Children and Bristol Medical School, University of Bristol, Bristol, UK
| | - Darren Hargrave
- Developmental Biology and Cancer Programme, University College London Great Ormond Street Institute of Child Health, London, UK
| | - Thomas S Jacques
- Developmental Biology and Cancer Programme, University College London Great Ormond Street Institute of Child Health, London, UK
- Department of Histopathology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Simon Bailey
- Wolfson Childhood Cancer Research Centre, Northern Institute for Cancer Research, Newcastle University, Newcastle Upon Tyne, UK
| | - Steven C Clifford
- Wolfson Childhood Cancer Research Centre, Northern Institute for Cancer Research, Newcastle University, Newcastle Upon Tyne, UK
| | - Daniel Williamson
- Wolfson Childhood Cancer Research Centre, Northern Institute for Cancer Research, Newcastle University, Newcastle Upon Tyne, UK
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Clarke MT, Jones DTW, Mackay A, Carvalho D, Izquierdo E, Hiddingh L, Temelso S, Burford A, Molinari V, Boult JKR, Virasami A, Carceller F, Marshall LV, Zebian B, Chandler C, Al-Sarraj S, Lowis S, Knipstein J, Bailey S, Crosier S, Mastronuzzi A, Carai A, Ellison DW, Baker SJ, Capper D, Maybury M, Moore AS, Vinci M, Hargrave D, Popov S, Jacques TS, Jones C. HGG-25. INFANT GLIOMAS COMPRISE MULTIPLE BIOLOGICAL AND CLINICOPATHOLOGICAL SUBGROUPS. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy059.297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - David TW Jones
- German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Alan Mackay
- The Institute of Cancer Research, London, UK
| | | | | | - Lotte Hiddingh
- German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | | | | | | | - Alex Virasami
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - Fernando Carceller
- The Royal Marsden NHS Foundation Trust, London, UK
- The Institute of Cancer Research, London, UK
| | - Lynley V Marshall
- The Royal Marsden NHS Foundation Trust, London, UK
- The Institute of Cancer Research, London, UK
| | - Bassel Zebian
- King’s College Hospital NHS Foundation Trust, London, UK
| | - Chris Chandler
- King’s College Hospital NHS Foundation Trust, London, UK
| | - Safa Al-Sarraj
- King’s College Hospital NHS Foundation Trust, London, UK
| | - Stephen Lowis
- University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | | | - Simon Bailey
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - Stephen Crosier
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | | | | | | | | | | | | | | | - Maria Vinci
- Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - Darren Hargrave
- UCL Great Ormond Street Institute of Child Health, London, UK
| | | | | | - Chris Jones
- The Institute of Cancer Research, London, UK
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Rahman R, Grundy R, Campbell E, Brem H, Pearl M, Green J, Janowski M, Cohen K, Walczak P, Warren K, Lowis S, Mullen A, Boyd M, Veal G, Hargrave D, van Vuurden D, Powell S, Walker D. EAPH-07. CHILDREN’S BRAIN TUMOUR DRUG DELIVERY CONSORTIUM. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy059.176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ruman Rahman
- Children’s Brain Tumour Research Centre, The University of Nottingham, Nottingham, UK
| | - Richard Grundy
- Children’s Brain Tumour Research Centre, The University of Nottingham, Nottingham, UK
| | - Emma Campbell
- Children’s Brain Tumour Research Centre, The University of Nottingham, Nottingham, UK
| | - Henry Brem
- Johns Hopkins University, Baltimore, USA
| | | | | | | | | | | | | | | | | | | | | | - Darren Hargrave
- University College London, Institute of Child Health, London, UK
| | | | | | - David Walker
- Children’s Brain Tumour Research Centre, The University of Nottingham, Nottingham, UK
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Rahman R, Grundy R, Campbell E, Brem H, Pearl M, Green J, Janowski M, Cohen K, Walczak P, Warren K, Lowis S, Mullen A, Boyd M, Veal G, Hargrave D, van Vuurden D, Powell S, Walker D. SCDT-27. CHILDREN’S BRAIN TUMOUR DRUG DELIVERY CONSORTIUM. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox168.1110] [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: 11/13/2022] Open
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Chisholm JC, Merks JH, Casanova M, Bisogno G, Orbach D, Gentet JC, Thomassin-Defachelles AS, Chastagner P, Lowis S, Ronghe M, McHugh K, van Rijn RR, Hilton M, Bachir J, Fürst-Recktenwald S, Geoerger B, Oberlin O. Open-label, multicentre, randomised, phase II study of the EpSSG and the ITCC evaluating the addition of bevacizumab to chemotherapy in childhood and adolescent patients with metastatic soft tissue sarcoma (the BERNIE study). Eur J Cancer 2017; 83:177-184. [DOI: 10.1016/j.ejca.2017.06.015] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 06/14/2017] [Accepted: 06/15/2017] [Indexed: 10/19/2022]
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Rahman R, Grundy R, Campbell E, Brem H, Pearl M, Green J, Janowski M, Cohen K, Walczak P, Warren K, Lowis S, Mullen A, Boyd M, Veal G, Hargrave D, van Vuurden D, Powell S, Walker D. TRTH-06. CHILDREN’S BRAIN TUMOUR DRUG DELIVERY CONSORTIUM. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox083.218] [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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Affiliation(s)
| | | | - Andrew Peet
- University of Birmingham, Edgbaston, Birmingham, UK
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Wibroe M, Avula S, Cappelen J, Castor C, Clausen N, Devenney I, Fellows G, Grillner P, Gupta R, Gustavsson B, Heyman M, Holm S, Karppinen A, Kiudeliene R, Klausen C, Lähteenmäki P, Lönnqvist T, Lowis S, Mallucci C, Mathiasen R, Mattson M, Nilsson P, Nordfors K, Nyman P, Nysom K, Persson K, Pesola J, Pizer B, Rask O, Sabel M, Schmiegelow K, Sehested A, Tonning-Olsson I, Torsvik IK, van Baarsen K, Walker D, Westerholm-Ormio M, Zetterqvist B, Juhler M. CMS-06THE NOPHO-EUROPEAN STUDY ON CEREBELLAR MUTISM SYNDROME (CMS). Neuro Oncol 2016. [DOI: 10.1093/neuonc/now066.05] [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: 11/13/2022] Open
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20
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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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Faulkner C, Shaw A, Wragg C, Greenslade M, Haynes H, Williams H, Lowis S, Williams M, Kurian KM. OP32 * A COMBINED STRATEGY FOR THE DETECTION OF BRAF FUSIONS IN PILOCYTIC ASTROCYTOMA USING RT-PCR AND FISH. Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou251.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Murray MJ, Horan G, Lowis S, Nicholson JC. Highlights from the Third International Central Nervous System Germ Cell Tumour symposium: laying the foundations for future consensus. Ecancermedicalscience 2013; 7:333. [PMID: 23861728 PMCID: PMC3709531 DOI: 10.3332/ecancer.2013.333] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Indexed: 11/06/2022] Open
Abstract
The Third International Central Nervous System (CNS) Germ Cell Tumour (GCT) Symposium brought together over 100 delegates from all over the world to learn about the latest developments in these tumours and discuss future strategies for their management. Some areas of consensus were agreed upon, and controversies were discussed. Among these, the classification of GCTs and the surgical approach to their management were among the greatest areas of difference between different parts of the world. The need for radiotherapy (RT) as a part of standard first-line management for all malignant CNS GCTs was agreed, as well as the need for additional chemotherapy to maximise the cure in nongerminomatous malignant GCTs; the benefit of the addition of chemotherapy in localised germinoma to reduce the RT burden was also accepted as a good practice. The potential of biological parameters to assist the future diagnosis, treatment stratification, and disease monitoring for CNS GCTs was discussed. Such biological parameters may also represent targets for the development of novel therapies. The need for further collaboration between groups engaged in biological studies was agreed. The merits of proton beam RT were debated, and the importance of mitigating the long-term side effects of the treatment was underlined by a session on late effects.
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Affiliation(s)
- Matthew J Murray
- Department of Paediatric Haematology and Oncology, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK
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Stapleton S, Flanary J, Hamblin F, Steinbrueck S, Rodriguez L, Tuite G, Carey C, Storrs B, Lavey R, Fangusaro J, Jakacki R, Kaste S, Goldman S, Pollack I, Boyett J, Kun L, Gururangan S, Jakacki R, Dombi E, Steinberg S, Goldman S, Kieran M, Ullrich N, Widemann B, Goldman S, Fangusaro J, Lulla R, Reinholdt N, Newmark M, Urban M, Chi S, Manley P, Robison N, Kroon HA, Kieran M, Stancokova T, Husakova K, Deak L, Fangusaro J, Gururangan S, Onar-Thomas A, Packer R, Goldman S, Kaste S, Friedman H, Poussaint TY, Kun L, Boyett J, Gudrun F, Tippelt S, Zimmermann M, Rutkowski S, Warmuth-Metz M, Pietsch T, Faldum A, Bode U, Slavc I, Peyrl A, Chocholous M, Kieran M, Azizi A, Czech T, Dieckmann K, Haberler C, Macy M, Kieran M, Chi S, Cohen K, MacDonald T, Smith A, Etzl M, Naranderan A, Gore L, DiRenzo J, Trippett T, Foreman N, Dunkel I, Fisher MJ, Meyer J, Roberts T, Belasco JB, Phillips PC, Lustig R, Cahill AM, Laureano A, Huls H, Somanchi S, Denman C, Liadi I, Khatua S, Varadarajan N, Champlin R, Lee D, Cooper L, Silla L, Gopalakrishnan V, Legault G, Hagiwara M, Ballas M, Brown K, Vega E, Nusbaum A, Bloom M, Hochman T, Goldberg J, Golfinos J, Roland JT, Allen J, Karajannis M, Karajannis M, Bergner A, Giovannini M, Welling DB, Niparko J, Slattery W, Roland JT, Golfinos J, Allen J, Blakeley J, Owens C, Sung L, Lowis S, Rutkowski S, Gentet JC, Bouffet E, Henry J, Bala A, Freeman S, King A, Rutherford S, Mills S, Huson S, McBain C, Lloyd S, Evans G, McCabe M, Lee Y, Bartels U, Tabori U, Jansen L, Mabbott D, Bouffet E, Huang A, Aguilera D, Mazewski C, Fangusaro J, MacDonald T, McNall R, Hayes L, Liu Y, Castellino R, Cole D, Lester-McCully C, Widemann B, Warren K, Robison N, Campigotto F, Chi S, Manley P, Turner C, Zimmerman MA, Chordas C, Allen J, Goldman S, Rubin J, Isakoff M, Pan W, Khatib Z, Comito M, Bendel A, Pietrantonio J, Kondrat L, Hubbs S, Neuberg D, Kieran M, Wetmore C, Broniscer A, Wright K, Armstrong G, Baker J, Pai-Panandiker A, Kun L, Patay Z, Onar-Thomas A, Ramachandran A, Turner D, Gajjar A, Stewart C. CLINICAL TRIALS. Neuro Oncol 2012; 14:i16-i21. [PMCID: PMC3483342 DOI: 10.1093/neuonc/nos096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2024] Open
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Affiliation(s)
- Stephen Lowis
- Department of Paediatric and Adolescent Oncology, Bristol Royal Hospital for Children, Bristol, UK.
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Geoerger B, Doz F, Lowis S, Kearns P, Estlin E, Gibson B, Corradini N, Lardelli P, Vassal G. Phase I-II clinical and pharmacokinetic study of plitidepsin in children with malignant tumors. On behalf of the European ITCC (Innovative Therapies for Children with Cancer) Consortium. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.10028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Grill J, Lowis S, Frappaz D, Michalski A, Picton S, Jouvet A, Robson K, Jaspan T, Couanet D, Le Deley M. Phase II study of the combination of cisplatin + temozolomide in malignant glial tumours in children and adolescents at diagnosis or in relapse (cistem2/nct00147160). J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.9543] [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: 11/20/2022] Open
Abstract
9543 Background: Temozolomide has been shown moderately effective in pediatric high-grade glioma (HGG). By decreasing the activity of MGMT, principal mechanism of resistance to temozolomide, cisplatin may increase the activity of this alkylating agent. Methods: Patients aged 4 to 21y with HGG outside the brainstem were treated at diagnosis or at relapse every 28 days with a combination of cisplatin 80 mg/m2 intravenously on day-1 and temozolomide 200 mg/m2 orally on days 2–6, according to the pediatric phase I recommendations. Patients treated at diagnosis had to proceed to involved field radiotherapy after the chemotherapy window. According to initial response, patients were offered additional courses, up to seven. We considered that this combination would be of interest if the response rate was superior or equal to 20%, using a two-stage Simon design in 3 cohorts: evaluable non measurable (infiltrative) at diagnosis (cohort A1); measurable disease (nodular) at diagnosis (A2); recurrent disease (B). The primary endpoint was complete or partial response after two courses, confirmed by central review. Up to 29 evaluable pts were to be entered in each cohort. If fewer than 4/29 responses were observed, it would be concluded that the combination is ineffective. Results: 56 pts were entered from 10/2003 through 07/2006 in 25 centers. One was excluded after central pathology review and 3 due to insufficient radiology work-out. 42 had grade III and 13 grade IV gliomas, including 21 tumors with oligodendroglial features. No response was observed in the first 11 pts in cohort A1 and in the first 12 pts in cohort B. Two partial and 4 minor responses were confirmed in 29 pts of cohort A2 leading to a 7% response rate (95% CI, 1–23%). Median time to progression was 1.7, 7.1 and 6.9 months in cohorts A1, A2 and B, respectively. Toxicity was manageable except in pts with large infiltrative lesions who did not tolerate hydration. Conclusion: CISTEM combination has insufficient efficacy in pediatric compared to adult HGG despite efficient down-regulation of MGMT activity. To overcome resistance to temozolomide in children and adolescents, one may need to target other known resistance mechanisms such as mismatch-repair deficiency. [Table: see text]
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Affiliation(s)
- J. Grill
- Institute Gustave Roussy, Villejuif, France; University Hospital, Bristol, United Kingdom; Centre Leon Berard, Lyon, France; GOSH, London, United Kingdom; University Hospital, Leeds, United Kingdom; Centre Hospitalier, Lyon, France; University Hospital, Nottingham, United Kingdom
| | - S. Lowis
- Institute Gustave Roussy, Villejuif, France; University Hospital, Bristol, United Kingdom; Centre Leon Berard, Lyon, France; GOSH, London, United Kingdom; University Hospital, Leeds, United Kingdom; Centre Hospitalier, Lyon, France; University Hospital, Nottingham, United Kingdom
| | - D. Frappaz
- Institute Gustave Roussy, Villejuif, France; University Hospital, Bristol, United Kingdom; Centre Leon Berard, Lyon, France; GOSH, London, United Kingdom; University Hospital, Leeds, United Kingdom; Centre Hospitalier, Lyon, France; University Hospital, Nottingham, United Kingdom
| | - A. Michalski
- Institute Gustave Roussy, Villejuif, France; University Hospital, Bristol, United Kingdom; Centre Leon Berard, Lyon, France; GOSH, London, United Kingdom; University Hospital, Leeds, United Kingdom; Centre Hospitalier, Lyon, France; University Hospital, Nottingham, United Kingdom
| | - S. Picton
- Institute Gustave Roussy, Villejuif, France; University Hospital, Bristol, United Kingdom; Centre Leon Berard, Lyon, France; GOSH, London, United Kingdom; University Hospital, Leeds, United Kingdom; Centre Hospitalier, Lyon, France; University Hospital, Nottingham, United Kingdom
| | - A. Jouvet
- Institute Gustave Roussy, Villejuif, France; University Hospital, Bristol, United Kingdom; Centre Leon Berard, Lyon, France; GOSH, London, United Kingdom; University Hospital, Leeds, United Kingdom; Centre Hospitalier, Lyon, France; University Hospital, Nottingham, United Kingdom
| | - K. Robson
- Institute Gustave Roussy, Villejuif, France; University Hospital, Bristol, United Kingdom; Centre Leon Berard, Lyon, France; GOSH, London, United Kingdom; University Hospital, Leeds, United Kingdom; Centre Hospitalier, Lyon, France; University Hospital, Nottingham, United Kingdom
| | - T. Jaspan
- Institute Gustave Roussy, Villejuif, France; University Hospital, Bristol, United Kingdom; Centre Leon Berard, Lyon, France; GOSH, London, United Kingdom; University Hospital, Leeds, United Kingdom; Centre Hospitalier, Lyon, France; University Hospital, Nottingham, United Kingdom
| | - D. Couanet
- Institute Gustave Roussy, Villejuif, France; University Hospital, Bristol, United Kingdom; Centre Leon Berard, Lyon, France; GOSH, London, United Kingdom; University Hospital, Leeds, United Kingdom; Centre Hospitalier, Lyon, France; University Hospital, Nottingham, United Kingdom
| | - M. Le Deley
- Institute Gustave Roussy, Villejuif, France; University Hospital, Bristol, United Kingdom; Centre Leon Berard, Lyon, France; GOSH, London, United Kingdom; University Hospital, Leeds, United Kingdom; Centre Hospitalier, Lyon, France; University Hospital, Nottingham, United Kingdom
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Lowis S, Lewis I, Elsworth A, Weston C, Doz F, Vassal G, Bellott R, Robert J, Pein F, Ablett S, Pinkerton R, Frappaz D. A phase I study of intravenous liposomal daunorubicin (DaunoXome) in paediatric patients with relapsed or resistant solid tumours. Br J Cancer 2006; 95:571-80. [PMID: 16880787 PMCID: PMC2360691 DOI: 10.1038/sj.bjc.6603288] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Anthracyclines are widely used in paediatric oncology, but their use is limited by the risk of cumulative cardiac toxicity. Encapsulating anthracyclines in liposomes may reduce cardiac toxicity and possibly increase drug availability to tumours. A phase I study in paediatric patients was designed to establish the dose limiting toxicity (DLT) and maximum tolerated dose (MTD) after a single course of liposomal daunorubicin, ‘DaunoXome’, as a 1 h infusion on day 1 of a 21 day cycle. Patients were stratified into two groups according to prior treatment: Group A (conventional) and group B (heavily pretreated patients). Dose limiting toxicity was expected to be haematological, and a two-step escalation was planned, with and without G-CSF support. Pharmacokinetic studies were carried out in parallel. In all, 48 patients aged from 1 to 18 years were treated. Dose limiting toxicity was neutropenia for both groups. Maximum tolerated dose was defined as 155 mg m−2 for Group A and 100 mg m−2 for Group B. The second phase with G-CSF was interrupted because of evidence of cumulative cardiac toxicity. Cardiac toxicity was reported in a total of 15 patients in this study. DaunoXome shares the early cardiotoxicity of conventional anthracyclines in paediatric oncology. This study has successfully defined a haematological MTD for DaunoXome, but the significance of this is limited given the concerns of delayed cardiac toxicity. The importance of longer-term follow-up in patients enrolled into phase I studies has been underestimated previously, and may lead to an under-recognition of important adverse events.
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Affiliation(s)
- S Lowis
- Department of Oncology, Royal Hospital for Children, Maudlin Street, Bristol BS2 8BJ, UK.
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Veal GJ, Errington J, Thomas HD, Boddy AV, Lowis S. Biliary excretion of etoposide in children with cancer. Cancer Chemother Pharmacol 2006; 58:415-7. [PMID: 16418874 DOI: 10.1007/s00280-005-0180-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2005] [Accepted: 12/21/2005] [Indexed: 11/29/2022]
Abstract
PURPOSE Two children with soft tissue sarcomas receiving etoposide as part of their standard clinical treatment had external biliary drainage due to obstruction of the bile duct. These unusual cases provided an opportunity to investigate the biliary clearance of etoposide by determining etoposide concentrations in bile and plasma samples obtained during chemotherapy. PATIENTS AND METHODS Etoposide was administered to patient 1 at a dose of 150 mg/m(2), as a 4 h infusion, on each of three days of treatment. Patient 2 received a daily etoposide dose of 800 mg/m(2) as a 24 h continuous infusion, also over a 3-day treatment period. Bile and plasma samples were obtained at regular intervals from both patients and etoposide levels quantified by LC/MS analysis. RESULTS AND DISCUSSION Biliary etoposide clearance was approximately equal to the flow of bile, with an average clearance of 0.32 ml/min determined in patient 1. Less than 2% of the etoposide dose administered was excreted in the bile in either patient studied, indicating that biliary clearance of etoposide is relatively minor. These results suggest that etoposide dose adjustment is unnecessary in patients with biliary obstruction.
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Affiliation(s)
- Gareth J Veal
- Northern Institute for Cancer Research, Paul O'Gorman Building, Medical School, University of Newcastle upon Tyne, UK.
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Van Hee R, Lowis S. David van mauden (+/- 1538 +/- 1597), "sworn medical doctor and surgical prelector of antwerp", and his book on anatomy. Acta Chir Belg 2006; 106:130-5. [PMID: 16612937 DOI: 10.1080/00015458.2006.11679856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- R Van Hee
- Institute for the History of Medicine and Natural Sciences, University of Antwerp.
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Lowis S. Malignant disease and the adolescent. J R Coll Physicians Lond 2000; 34:27-31. [PMID: 10717877 PMCID: PMC9665625] [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] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Affiliation(s)
- S Lowis
- Bristol Royal Hospital for Sick Children.
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Davidson A, Gowing R, Lowis S, Newell D, Lewis I, Dicks-Mireaux C, Pinkerton CR. Phase II study of 21 day schedule oral etoposide in children. New Agents Group of the United Kingdom Children's Cancer Study Group (UKCCSG). Eur J Cancer 1997; 33:1816-22. [PMID: 9470839 DOI: 10.1016/s0959-8049(97)00201-3] [Citation(s) in RCA: 38] [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: 02/06/2023]
Abstract
We report a multicentre phase II study of orally administered prolonged schedule etoposide in children with refractory or relapsed malignancy. 83 children were entered into the study. The largest diagnostic groups were neuroblastoma (n = 20), rhabdomyosarcoma/soft tissue sarcoma (n = 16) and brain tumours (n = 16). Etoposide was administered twice daily at a dose of 50 mg/m2/day for 21 days using the intravenous preparation given orally. Disease reassessment was performed after the second course. Etoposide plasma concentrations were measured by HPLC, 2 and 6 h after administration of therapy on days 7 and 14 in 15 patients. 61 patients completed two courses and were evaluable for response. There was 1 complete response (CR), 5 partial responses (PR) 22 stable disease (SD) and 33 progressive disease (PD). Of the 6 with responses, 3 had a diagnosis of medulloblastoma/cerebral primitive neuroectodermal tumour. 24 of 26 patients with SD/PR/CR received further courses with excellent palliative effect. The main toxicity observed was myelosuppression, with 8% and 7% of evaluable courses complicated by grade III-IV neutropenia and thrombocytopenia, respectively. Severe infection (grade III-IV) was rare, complicating only 2/94 evaluable courses. Plasma etoposide median concentrations at 2 h after administration on day 7 of course 1 were 1.5 (range 0.6-2.4) micrograms/ml. Total course 1 area under the etoposide plasma concentration versus time curve (AUC) values were estimated using a limited sampling model. Grade > or = 2 leucopenia was only observed in patients with a day 72 h etoposide concentration of > 2 micrograms/ml or a course 1 AUC of > 35 mg/ml.min. It is concluded that given at a dose of 50 mg/m2/day in two doses for 21 day courses, oral etoposide is well tolerated in children. A correlation between drug concentrations and toxicity was observed. Overall, a low response rate was seen (approximately 10%), but disease stabilisation appears to occur, and useful palliative effect was frequently noted. The response in brain tumours was more encouraging (3/14 PR) and this group requires further evaluation.
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Affiliation(s)
- A Davidson
- Paediatric Department, Royal Marsden NHS Trust, Sutton, U.K
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Davidson A, Gowing R, Lowis S, Newell H, Pinkerton R. Phase II study of 21 day schedule oral etoposide in children. Clin Oncol (R Coll Radiol) 1996. [DOI: 10.1016/s0936-6555(96)80058-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lowis S, Eastwood MA, Brydon WG. The influence of creatinine, lecithin and choline feeding on aliphatic amine production and excretion in the rat. Br J Nutr 1985; 54:43-51. [PMID: 4063314 DOI: 10.1079/bjn19850091] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The excretion of aliphatic amines, methylamine, dimethylamine and trimethylamine in the urine and faeces of rats fed on a control diet and diets supplemented with creatinine, lecithin or choline were measured over a 14 d feeding period. The rats were then killed and concentrations of amines in small and large intestinal contents measured. Adding creatinine to the diet resulted in a significant increase of methylamine excretion in the faeces and urine. The amount of methylamine found in all parts of the intestine increased, especially in the caecum. Adding lecithin to the diet resulted in an increase in the methylamine excretion only, and no change in the concentrations of amines found in the intestine, except for trimethylamine which was significantly increased in the caecum and colon. Adding choline to the diet resulted in a significant increase in excretion of trimethylamine and, to a lesser extent, methylamine. The levels of amines found in the gut increased, dimethylamine being increased in the small bowel, and methylamine and trimethylamine in the caecum.
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Lowis S, Eastwood MA, Brydon WG. The measurement of methylamines in biological material using a gas chromatographic head space gas technique. J Chromatogr 1983; 278:139-43. [PMID: 6662871 DOI: 10.1016/s0378-4347(00)84764-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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