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Rajagopal S, Yao X, Abadir W, Baetz TD, Easson AM, Knight G, McWhirter E, Nessim C, Rosen CF, Sun A, Wright FC, Petrella TM. An Ontario Health (Cancer Care Ontario) Clinical Practice Guideline: Surveillance Strategies in Patients with Stage I, II, III or Resectable IV Melanoma Who Were Treated with Curative Intent. Clin Oncol (R Coll Radiol) 2024; 36:243-253. [PMID: 38336503 DOI: 10.1016/j.clon.2024.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 12/20/2023] [Accepted: 01/15/2024] [Indexed: 02/12/2024]
Abstract
AIMS To make recommendations on managing the surveillance of patients with stage I, II, III or resectable IV melanoma who are clinically free of disease following treatment with curative intent. MATERIALS AND METHODS This guideline was developed by Ontario Health's (Cancer Care Ontario's) Program in Evidence-Based Care and the Melanoma Disease Site Group (including seven medical oncologists, four surgical oncologists, three dermatologists, one radiation oncologist and one patient representative). The MEDLINE, EMBASE, Cochrane Library, PROSPERO databases and the main relevant guideline websites were searched. Internal and external reviews were conducted, with final approval by the Program in Evidence-Based Care and the Melanoma Disease Site Group. The Grading of Recommendations, Assessment, Development and Evaluation approach was followed, and the Modified Delphi method was used. RESULTS Based on the current evidence (eight eligible original study papers and four relevant guidelines) and the clinical opinions of the authors of this guideline, the initial recommendations were made. To reach 75% agreement for each recommendation, the Melanoma Disease Site Group (16 members) voted twice and one recommendation was voted on three times. After a comprehensive internal and external review process (including national and international reviewers), 12 recommendations, three weak recommendations and six qualified statements were ultimately made. CONCLUSIONS After a systematic review, a comprehensive internal and external review process and a consensus process, the current guideline has been created. The guideline authors believe that this guideline will help clinicians, patients and policymakers make well-informed healthcare decisions that will guide them in clinical melanoma surveillance and ultimately assist in improving patient outcomes.
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Affiliation(s)
- S Rajagopal
- Trillium Health Partners, Credit Valley Hospital, Peel Regional Cancer Centre, Mississauga, Ontario, Canada.
| | - X Yao
- Department of Oncology, Department of Health Research Methods Evidence and Impact, McMaster University, Hamilton, Ontario, Canada; Program in Evidence-Based Care, Ontario Health (Cancer Care Ontario), Hamilton, Ontario, Canada.
| | - W Abadir
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Ontario, Canada
| | - T D Baetz
- Cancer Centre of Southeastern Ontario, Queen's Cancer Research Institute, Kingston, Ontario, Canada
| | - A M Easson
- Department of Surgery, Marvelle Koffler Breast Centre, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - G Knight
- Department of Oncology, Grand River Regional Cancer Centre, Grand River Hospital, Kitchener, Ontario, Canada
| | - E McWhirter
- Department of Medical Oncology, Juravinski Cancer Centre, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - C Nessim
- Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - C F Rosen
- Division of Dermatology, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - A Sun
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - F C Wright
- Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - T M Petrella
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
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Wright FC, Kellett S, Hong NJL, Sun AY, Hanna TP, Nessim C, Giacomantonio CA, Temple-Oberle CF, Song X, Petrella TM. Locoregional management of in-transit metastasis in melanoma: an Ontario Health (Cancer Care Ontario) clinical practice guideline. Curr Oncol 2020; 27:e318-e325. [PMID: 32669939 PMCID: PMC7339852 DOI: 10.3747/co.27.6523] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Objective The purpose of this guideline is to provide guidance on appropriate management of satellite and in-transit metastasis (itm) from melanoma. Methods The guideline was developed by the Program in Evidence-Based Care (pebc) of Ontario Health (Cancer Care Ontario) and the Melanoma Disease Site Group. Recommendations were drafted by a Working Group based on a systematic review of publications in the medline and embase databases. The document underwent patient- and caregiver-specific consultation and was circulated to the Melanoma Disease Site Group and the pebc Report Approval Panel for internal review; the revised document underwent external review. Recommendations "Minimal itm" is defined as lesions in a location with limited spread (generally 1-4 lesions); the lesions are generally superficial, often clustered together, and surgically resectable. "Moderate itm" is defined as more than 5 lesions covering a wider area, or the rapid development (within weeks) of new in-transit lesions. "Maximal itm" is defined as large-volume disease with multiple (>15-20) 2-3 cm nodules or subcutaneous or deeper lesions over a wide area.■ In patients presenting with minimal itm, complete surgical excision with negative pathologic margins is recommended. In addition to complete surgical resection, adjuvant treatment may be considered.■ In patients presenting with moderate unresectable itm, consider using this approach for localized treatment: intralesional interleukin 2 or talimogene laherparepvec as 1st choice, topical diphenylcyclopropenone as 2nd choice, or radiation therapy as 3rd choice. Evidence is insufficient to recommend intralesional bacille Calmette- Guérin or CO2 laser ablation outside of a research setting.■ In patients presenting with maximal itm confined to an extremity, isolated limb perfusion, isolated limb infusion, or systemic therapy may be considered. In extremely select cases, amputation could be considered as a final option in patients without systemic disease after discussion at a multidisciplinary case conference.■ In cases in which local, regional, or surgical treatments for itm might be ineffective or unable to be performed, or if a patient has systemic metastases at the same time, systemic therapy may be considered.
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Affiliation(s)
- F C Wright
- Department of General Surgery, Sunnybrook Health Sciences Centre/Odette Regional Cancer Centre, Toronto, ON
| | - S Kellett
- Program in Evidence-Based Care, Ontario Health (Cancer Care Ontario), and Department of Oncology, McMaster University, Hamilton, ON
| | - N J Look Hong
- Department of General Surgery, Division of Surgical Oncology, Sunnybrook Health Sciences Centre, and Department of Surgery, University of Toronto, Toronto, ON
| | - A Y Sun
- Department of Radiation Oncology, University Health Network, Princess Margaret Cancer Centre, Toronto, ON
| | - T P Hanna
- Department of Oncology, Division of Radiation Oncology, Queen's University, Kingston, ON
| | - C Nessim
- Division of General Surgery, The Ottawa Hospital, and Department of Surgery, University of Ottawa, Ottawa, ON
| | - C A Giacomantonio
- Queen Elizabeth II Health Sciences Centre, Capital District Health, and Departments of Surgery and Pathology, Dalhousie University, Halifax, NS
| | - C F Temple-Oberle
- Departments of Oncology and Surgery, University of Calgary, Calgary, AB
| | - X Song
- Department of Internal Medicine, Division of Medical Oncology, University of Ottawa, and The Ottawa Hospital Cancer Centre, Ottawa, ON
| | - T M Petrella
- Division of Medical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, and University of Toronto, Toronto, ON
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Petrella TM, Fletcher GG, Knight G, McWhirter E, Rajagopal S, Song X, Baetz TD. Systemic adjuvant therapy for adult patients at high risk for recurrent cutaneous or mucosal melanoma: an Ontario Health (Cancer Care Ontario) clinical practice guideline. Curr Oncol 2020; 27:e43-e52. [PMID: 32218667 PMCID: PMC7096195 DOI: 10.3747/co.27.5933] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background Previous versions of the guideline from the Program in Evidence-Based Care (pebc) at Ontario Health (Cancer Care Ontario) recommended that the use of high-dose interferon alfa 2b therapy be discussed and offered to patients with resected cutaneous melanoma with a high risk of recurrence. Subsequently, several clinical trials in patients with resected or metastatic melanoma found that immune checkpoint inhibitors and targeted therapies have a benefit greater than that with interferon. It was therefore considered timely for an update to the guideline about adjuvant systemic therapy in melanoma. Methods The present guideline was developed by the pebc and the Melanoma Disease Site Group (dsg). Based on a systematic review from a literature search conducted using medline, embase, and the Evidence Based Medicine Reviews databases for the period 1996 to 28 May 2019, the Working Group drafted recommendations. The systematic review and recommendations were then circulated to the Melanoma dsg and the pebc Report Approval Panel for internal review; the revised document underwent external review. Recommendations For patients with completely resected cutaneous or mucosal melanoma with a high risk of recurrence, the recommended adjuvant therapies are nivolumab, pembrolizumab, or dabrafenib-trametinib for patients with BRAF V600E or V600K mutations; nivolumab or pembrolizumab are recommend for patients with BRAF wild-type disease. Use of ipilimumab is not recommended. Molecular testing should be conducted to help guide treatment decisions. Interferon alfa, chemotherapy regimens, vaccines, levamisole, bevacizumab, bacillus Calmette-Guérin, and isolated limb perfusion are not recommended for adjuvant treatment of cutaneous melanoma except as part of a clinical trial.
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Affiliation(s)
- T M Petrella
- University of Toronto and Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON
| | - G G Fletcher
- Program in Evidence-Based Care, Ontario Health (Cancer Care Ontario), and Department of Oncology, McMaster University, Hamilton, ON
| | - G Knight
- Department of Oncology, McMaster University, Hamilton, and Grand River Regional Cancer Centre, Kitchener, ON
| | - E McWhirter
- Department of Oncology, Division of Medical Oncology, McMaster University, and Juravinski Cancer Centre, Hamilton, ON
| | | | - X Song
- Department of Internal Medicine, Division of Medical Oncology, University of Ottawa, and The Ottawa Hospital Cancer Centre, Ottawa, ON
| | - T D Baetz
- Department of Oncology, Queen's University, and Cancer Centre of Southeastern Ontario-Kingston General Hospital, Kingston, ON
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Keech J, Beca J, Eisen A, Kennedy E, Kim J, Kouroukis CT, Darling G, Ferguson SE, Finelli A, Petrella TM, Perry JR, Chan K, Gavura S. Impact of a novel prioritization framework on clinician-led oncology drug submissions. ACTA ACUST UNITED AC 2019; 26:e155-e161. [PMID: 31043821 DOI: 10.3747/co.26.4501] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background In Canada, requests for public reimbursement of cancer drugs are predominately initiated by pharmaceutical manufacturers. Clinician-led submissions provide a mechanism to initiate the drug funding process when industry does not submit a request for funding consideration. Although such requests are resource-intensive to produce, Cancer Care Ontario (cco) has the capacity to facilitate clinician-led submissions. In 2014, cco began developing a cancer drug prioritization framework that allocates resources to systematically address a growing number of clinician-identified funding gaps with clinician-led submissions. Methods Cancer site-specific drug advisory committees established by cco consist of health care practitioners whose roles include identifying and prioritizing funding gaps. The committees submit their identified gaps to a cross-cancer-site prioritization exercise in which the requests are ranked based on a set of guiding principles derived from health technology assessment. The requests are then sequentially allocated the resources needed to meet submission requirements. Whether the funding gap is of provincial or pan-Canadian relevance determines where the submission is filed for assessment. Results Since its inception, the cco framework has identified 17 funding gaps in 9 cancer sites. In 4 prioritizations, the framework supported 6 submissions. As of June 2018, the framework had contributed to the eventual funding of more than 9 new drug-indication pairs, with more awaiting funding consideration. Conclusions The cco prioritization framework has enabled clinicians to effectively and systematically identify, prioritize, and fill funding gaps not addressed by industry. Ultimately, the framework helps to ensure that patients can access evidence-informed and cost-effective therapies. The framework will continue to evolve as it encounters new challenges, including funding requests for rare indications.
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Affiliation(s)
- J Keech
- Cancer Care Ontario, Toronto, ON.,Canadian Centre for Applied Research in Cancer Control, Toronto, ON
| | - J Beca
- Cancer Care Ontario, Toronto, ON.,Canadian Centre for Applied Research in Cancer Control, Toronto, ON
| | - A Eisen
- Cancer Care Ontario, Toronto, ON.,Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON
| | - E Kennedy
- Cancer Care Ontario, Toronto, ON.,Mount Sinai Hospital, Toronto, ON
| | - J Kim
- Cancer Care Ontario, Toronto, ON.,Princess Margaret Cancer Centre, University Health Network, Toronto, ON
| | - C T Kouroukis
- Cancer Care Ontario, Toronto, ON.,Juravinski Cancer Centre, Hamilton Health Sciences, Hamilton, ON
| | - G Darling
- Cancer Care Ontario, Toronto, ON.,Princess Margaret Cancer Centre, University Health Network, Toronto, ON
| | - S E Ferguson
- Cancer Care Ontario, Toronto, ON.,Princess Margaret Cancer Centre, University Health Network, Toronto, ON
| | - A Finelli
- Cancer Care Ontario, Toronto, ON.,Princess Margaret Cancer Centre, University Health Network, Toronto, ON
| | - T M Petrella
- Cancer Care Ontario, Toronto, ON.,Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON
| | - J R Perry
- Cancer Care Ontario, Toronto, ON.,Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON
| | - K Chan
- Cancer Care Ontario, Toronto, ON.,Canadian Centre for Applied Research in Cancer Control, Toronto, ON.,Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON
| | - S Gavura
- Cancer Care Ontario, Toronto, ON
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Higenell V, Fajzel R, Batist G, Cheema PK, McArthur HL, Melosky B, Morris D, Petrella TM, Sangha R, Savard MF, Sridhar SS, Stagg J, Stewart DJ, Verma S. A network approach to developing immuno-oncology combinations in Canada. Curr Oncol 2019; 26:73-79. [PMID: 31043804 PMCID: PMC6476440 DOI: 10.3747/co.26.4393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Immune checkpoint inhibitors have revolutionized care for many cancer indications, with considerable effort now being focused on increasing the rate, depth, and duration of patient response. One strategy is to combine immune strategies (for example, ctla-4 and PD-1/L1-directed agents) to harness additive or synergistic efficacy while minimizing toxicity. Despite encouraging results with such combinations in multiple tumour types, numerous clinical challenges remain, including a lack of biomarkers that reliably predict outcome, the emergence of therapeutic resistance, and optimal management of immune-related toxicities. Furthermore, the selection of ideal combinations from the myriad of immune, systemic, and locoregional therapies has yet to be determined. A longitudinal network-based approach could offer advantages in addressing those critical questions, including long-term follow-up of patients beyond individual trials. The molecular cancer registry Personalize My Treatment, managed by the Networks of Centres of Excellence nonprofit organization Exactis Innovation, is uniquely positioned to accelerate Canadian immuno-oncology (io) research efforts throughout its national network of cancer sites. To gain deeper insight into how a pan-Canadian network could advance research in io combinations, Exactis invited preeminent clinical and scientific advisors from across Canada to a roundtable event in November 2017. The present white paper captures the expert advice provided: leverage longitudinal patient data collection; facilitate network collaboration and assay harmonization; synergize with existing initiatives, networks, and biobanks; and develop an io combination trial based on Canadian discoveries.
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Affiliation(s)
- V Higenell
- Exactis Innovation, Sir Mortimer B. Davis Jewish General Hospital, Montreal, QC
| | - R Fajzel
- Exactis Innovation, Sir Mortimer B. Davis Jewish General Hospital, Montreal, QC
| | - G Batist
- Exactis Innovation, Sir Mortimer B. Davis Jewish General Hospital, Montreal, QC
- Segal Cancer Centre, Sir Mortimer B. Davis Jewish General Hospital, Montreal, QC
| | - P K Cheema
- William Osler Health System, University of Toronto, Toronto, ON
| | - H L McArthur
- Division of Hematology Oncology, Cedars-Sinai Samuel Oschin Comprehensive Cancer Institute, Los Angeles, CA, U.S.A
| | - B Melosky
- Medical Oncology, BC Cancer-Vancouver Centre, Vancouver, BC
| | - D Morris
- Department of Oncology, Tom Baker Cancer Centre, Calgary, AB
| | - T M Petrella
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON
| | - R Sangha
- Department of Oncology, Cross Cancer Institute, Edmonton, AB
| | - M F Savard
- Department of Oncology, Tom Baker Cancer Centre, Calgary, AB
| | - S S Sridhar
- Medical Oncology, Princess Margaret Cancer Centre, Toronto, ON
| | - J Stagg
- Faculty of Pharmacy, University of Montreal, Montreal, QC
| | - D J Stewart
- Division of Medical Oncology, The Ottawa Hospital, Ottawa, ON
| | - S Verma
- Department of Oncology, Tom Baker Cancer Centre, Calgary, AB
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6
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Guo J, Carvajal RD, Dummer R, Hauschild A, Daud A, Bastian BC, Markovic SN, Queirolo P, Arance A, Berking C, Camargo V, Herchenhorn D, Petrella TM, Schadendorf D, Sharfman W, Testori A, Novick S, Hertle S, Nourry C, Chen Q, Hodi FS. Efficacy and safety of nilotinib in patients with KIT-mutated metastatic or inoperable melanoma: final results from the global, single-arm, phase II TEAM trial. Ann Oncol 2018; 28:1380-1387. [PMID: 28327988 PMCID: PMC5452069 DOI: 10.1093/annonc/mdx079] [Citation(s) in RCA: 100] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Background The single-arm, phase II Tasigna Efficacy in Advanced Melanoma (TEAM) trial evaluated the KIT-selective tyrosine kinase inhibitor nilotinib in patients with KIT-mutated advanced melanoma without prior KIT inhibitor treatment. Patients and methods Forty-two patients with KIT-mutated advanced melanoma were enrolled and treated with nilotinib 400 mg twice daily. TEAM originally included a comparator arm of dacarbazine (DTIC)-treated patients; the design was amended to a single-arm trial due to an observed low number of KIT-mutated melanomas. Thirteen patients were randomized to DTIC before the protocol amendment removing this study arm. The primary endpoint was objective response rate (ORR), determined according to Response Evaluation Criteria In Solid Tumors. Results ORR was 26.2% (n = 11/42; 95% CI, 13.9%–42.0%), sufficient to reject the null hypothesis (ORR ≤10%). All observed responses were partial responses (PRs; median response duration, 7.1 months). Twenty patients (47.6%) had stable disease and 10 (23.8%) had progressive disease; 1 (2.4%) response was unknown. Ten of the 11 responding patients had exon 11 mutations, four with an L576P mutation. The median progression-free survival and overall survival were 4.2 and 18.0 months, respectively. Three of the 13 patients on DTIC achieved a PR, and another patient had a PR following switch to nilotinib. Conclusion Nilotinib activity in patients with advanced KIT-mutated melanoma was similar to historical data from imatinib-treated patients. DTIC treatment showed potential activity, although the low patient number limits interpretation. Similar to previously reported results with imatinib, nilotinib showed greater activity among patients with an exon 11 mutation, including L576P, suggesting that nilotinib may be an effective treatment option for patients with specific KIT mutations. Clinical Trial Registration ClinicalTrials.gov, NCT01028222.
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Affiliation(s)
- J Guo
- Department of Renal Cancer & Melanona, Peking University Cancer Hospital & Institute, Beijing, China
| | - R D Carvajal
- Division of Hematology/Oncology, Columbia University Medical Center, New York, USA
| | - R Dummer
- Skin Cancer Center, University Hospital of Zurich, Zurich, Switzerland
| | - A Hauschild
- Department of Dermatology, University Hospital Schleswig-Holstein (UKSH), Campus Kiel, Kiel, Germany
| | - A Daud
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco
| | - B C Bastian
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco
| | - S N Markovic
- Department of Hematology/Oncology, Mayo Clinic Cancer Center, Rochester, USA
| | - P Queirolo
- Department of Medical Oncology, National Research Institute for Cancer, Genova, Italy
| | - A Arance
- Department of Medical Oncology, Hospital Clinic, Barcelona, Spain
| | - C Berking
- Department of Dermatology & Allergology, University Hospital Munich (LMU), Munich, Germany
| | - V Camargo
- Department of Medical Oncology, Cancer Institute of São Paulo, São Paulo
| | - D Herchenhorn
- Department of Clinical Oncology, National Institute of Cancer, Rio de Janeiro, Brazil
| | - T M Petrella
- Department of Medical Oncology, Sunnybrook Health Sciences Center, Toronto, Canada
| | - D Schadendorf
- Department of Dermatology, Essen University Hospital, Essen, Germany
| | - W Sharfman
- Department of Oncology & Dermatology, Sidney Kimmel Comprehensive Cancer Center/Johns Hopkins Medicine, Lutherville, USA
| | - A Testori
- Melanoma and Muscle Cutaneous Sarcoma Division, European Institute of Oncology, Milano, Italy
| | - S Novick
- Oncology Business Unit, Novartis Pharmaceuticals Corporation, East Hanover, USA
| | - S Hertle
- Oncology Business Unit, Novartis Pharma AG, Basel, Switzerland
| | - C Nourry
- Oncology Business Unit, Novartis Pharma AG, Basel, Switzerland
| | - Q Chen
- Oncology Business Unit, Novartis Pharmaceuticals Corporation, East Hanover, USA
| | - F S Hodi
- Melanoma Center, Dana-Farber Cancer Institute, Boston, USA
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7
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Hanna TP, Baetz T, Xu J, Miao Q, Earle CC, Peng Y, Booth CM, Petrella TM, McKay DR, Nguyen P, Langley H, Eisenhauer E. Mental health services use by melanoma patients receiving adjuvant interferon: association of pre-treatment mental health care with early discontinuation. ACTA ACUST UNITED AC 2017; 24:e503-e512. [PMID: 29270059 DOI: 10.3747/co.24.3685] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Although high-dose interferon (hd-ifn) is the sole approved adjuvant systemic treatment for melanoma in many jurisdictions, it is toxic. We sought to assess the population-level effects of hd-ifn toxicity, particularly neuropsychiatric toxicity, hypothesizing that such toxicity would have the greatest effect on mental health services use in advanced resected melanoma. Methods This retrospective population-based registry study considered all melanoma patients receiving adjuvant hd-ifn in Ontario during 2008-2012. Toxicity was investigated through health services use compatible with hd-ifn toxicity (for example, mental health physician billings). Using stage data reported from cancer centres about a subset of patients (stages iib-iiic), a propensity-matched analysis compared such service use in patients who did and did not receive hd-ifn. Associations between early hd-ifn discontinuation and health services use were examined. Results Of 718 melanoma patients who received hd-ifn, 12% were 65 years of age and older, and 83% had few or no comorbidities. One third of the patients experienced 1 or more toxicity-associated health care utilization events within 1 year of starting hd-ifn. Of 420 utilization events, 364 (87%) were mental health-related, with 54% being family practitioner visits, and 39% being psychiatrist visits. In the propensity-matched analysis, patients receiving hd-ifn were more likely than untreated matched controls to use a mental health service (p = 0.01), with 42% of the control group and 51% of the hd-ifn group using a mental health service in the period spanning the 12 months before to the 24 months after diagnosis. In the multivariable analysis, early drug discontinuation was more likely in the presence of pre-existing mental health issues (odds ratio: 2.0; 95% confidence limits: 1.1, 3.4). Conclusions Stage iib-iiic melanoma patients carry a substantial burden of mental health services use whether or not receiving hd-ifn, highlighting an important survivorship issue for these patients. High-dose interferon is associated with more use of mental health services, and pre-treatment use of mental health services is associated with treatment discontinuation. That association should be kept in mind when hd-ifn is being considered.
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Affiliation(s)
- T P Hanna
- Division of Cancer Care and Epidemiology, Cancer Research Institute at Queen's University, Kingston.,Department of Oncology, Queen's University, Kingston.,Institute for Clinical Evaluative Sciences, Queen's University, Kingston
| | - T Baetz
- Department of Oncology, Queen's University, Kingston
| | - J Xu
- Institute for Clinical Evaluative Sciences, Queen's University, Kingston.,Johnson and Johnson, Raritan, NJ, U.S.A
| | - Q Miao
- Division of Cancer Care and Epidemiology, Cancer Research Institute at Queen's University, Kingston.,Institute for Clinical Evaluative Sciences, Queen's University, Kingston
| | - C C Earle
- Faculty of Medicine, University of Toronto, Toronto.,Institute for Clinical Evaluative Sciences, Toronto
| | - Y Peng
- Division of Cancer Care and Epidemiology, Cancer Research Institute at Queen's University, Kingston.,Department of Mathematics and Statistics, Queen's University, Kingston
| | - C M Booth
- Division of Cancer Care and Epidemiology, Cancer Research Institute at Queen's University, Kingston.,Department of Oncology, Queen's University, Kingston.,Institute for Clinical Evaluative Sciences, Queen's University, Kingston
| | - T M Petrella
- Faculty of Medicine, University of Toronto, Toronto
| | - D R McKay
- Department of Surgery, Queen's University, Kingston; and
| | - P Nguyen
- Institute for Clinical Evaluative Sciences, Queen's University, Kingston
| | - H Langley
- South East Regional Cancer Program, Kingston General Hospital, Kingston, ON
| | - E Eisenhauer
- Department of Oncology, Queen's University, Kingston
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8
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Petrella TM, Laredo S, Oh P, Marzolini S, Warner E, Dent R, Verma S, Eisen A, Pritchard K, Trudeau M, Zhang L, Bjarnason G. Abstract P2-12-03: A pilot study evaluating the benefits and feasibility of an exercise program for breast cancer patients receiving adjuvant chemotherapy. Cancer Res 2012. [DOI: 10.1158/0008-5472.sabcs12-p2-12-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
BACKGROUND: Breast cancer chemotherapy is frequently associated with a decline in general physical condition, exercise tolerance, muscle strength and quality of life (QOL). Evidence suggests that physical activity and exercise interventions during chemotherapy treatment may contribute to maintaining QOL, cardiorespiratory fitness and strength, however the results of studies conducted to date have not been consistent.
OBJECTIVES: This study aimed to determine the effect of a structured, tailored exercise program involving both aerobic and resistance training, on QOL, physical function, and body composition in breast cancer patients undergoing adjuvant chemotherapy.
METHODS: Women who were within 4–12 weeks of surgery for stage I-III breast cancer and undergoing adjuvant chemotherapy, were randomized to either a structured exercise program (6 months) or to usual oncology care. Functional assessment of cancer therapy-breast cancer (FACT-B), and Short Form Survey (SF-36), weight, waist circumference, waist hip ratio, percent body fat, peak oxygen, strength and arm volume were performed at baseline, and 3-month intervals through 12 months. One-way analysis of variance (ANOVA) was performed at baseline, 3, 6 and 12 months for all endpoints. The Wilcoxon Rank-sum Nonparametric test was applied for all Primary and Secondary endpoints with changing scores at each follow-up visit, p-value < 0.05 was considered as statistical significance.
RESULTS: Of the recruited 62 women, 51 completed all 12 months. One patient developed metastatic disease and 10 others withdrew (4 in the exercise arm and 6 in the standard arm). Median age was 48 (24–75) years. There was a general trend of improvement from baseline for most components of the FACT-B and SF-36 for the exercise group but only the FACT-B social wellbeing was statistically significant at 3 months with a p = 0.0164. Changes in other FACT-B and SF-36 scores were not significantly different between exercise and usual care groups. There were significant improvements at 6 months in weight (p = 0.0192), % body fat (p = 0.0337), max strength (p = 0.0029), and waist circumference (0.0359) and at 12 months in weight (p = 0.0293), % body fat (p = 0.0481), max strength (p = 0.0097) and endurance (p = 0.0037) in the exercise group compared to usual care.
CONCLUSIONS: This randomized prospective study suggests benefit of exercise during chemotherapy. This benefit continued 6 months beyond the completion of the exercise program with significant improvement in physical function, body composition, strength and endurance with no decline in quality of life. Regular moderate exercise may play an important role in improving function during adjuvant chemotherapy and should be further studied in a large randomized trial.
Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P2-12-03.
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Affiliation(s)
- TM Petrella
- Odette Cancer Centre, Toronto, ON, Canada; Women's College Hospital, Toronto, ON, Canada; Toronto Rehabilitation Institute, Toronto, ON, Canada; Macrostat Inc, Toronto, ON, Canada
| | - S Laredo
- Odette Cancer Centre, Toronto, ON, Canada; Women's College Hospital, Toronto, ON, Canada; Toronto Rehabilitation Institute, Toronto, ON, Canada; Macrostat Inc, Toronto, ON, Canada
| | - P Oh
- Odette Cancer Centre, Toronto, ON, Canada; Women's College Hospital, Toronto, ON, Canada; Toronto Rehabilitation Institute, Toronto, ON, Canada; Macrostat Inc, Toronto, ON, Canada
| | - S Marzolini
- Odette Cancer Centre, Toronto, ON, Canada; Women's College Hospital, Toronto, ON, Canada; Toronto Rehabilitation Institute, Toronto, ON, Canada; Macrostat Inc, Toronto, ON, Canada
| | - E Warner
- Odette Cancer Centre, Toronto, ON, Canada; Women's College Hospital, Toronto, ON, Canada; Toronto Rehabilitation Institute, Toronto, ON, Canada; Macrostat Inc, Toronto, ON, Canada
| | - R Dent
- Odette Cancer Centre, Toronto, ON, Canada; Women's College Hospital, Toronto, ON, Canada; Toronto Rehabilitation Institute, Toronto, ON, Canada; Macrostat Inc, Toronto, ON, Canada
| | - S Verma
- Odette Cancer Centre, Toronto, ON, Canada; Women's College Hospital, Toronto, ON, Canada; Toronto Rehabilitation Institute, Toronto, ON, Canada; Macrostat Inc, Toronto, ON, Canada
| | - A Eisen
- Odette Cancer Centre, Toronto, ON, Canada; Women's College Hospital, Toronto, ON, Canada; Toronto Rehabilitation Institute, Toronto, ON, Canada; Macrostat Inc, Toronto, ON, Canada
| | - K Pritchard
- Odette Cancer Centre, Toronto, ON, Canada; Women's College Hospital, Toronto, ON, Canada; Toronto Rehabilitation Institute, Toronto, ON, Canada; Macrostat Inc, Toronto, ON, Canada
| | - M Trudeau
- Odette Cancer Centre, Toronto, ON, Canada; Women's College Hospital, Toronto, ON, Canada; Toronto Rehabilitation Institute, Toronto, ON, Canada; Macrostat Inc, Toronto, ON, Canada
| | - L Zhang
- Odette Cancer Centre, Toronto, ON, Canada; Women's College Hospital, Toronto, ON, Canada; Toronto Rehabilitation Institute, Toronto, ON, Canada; Macrostat Inc, Toronto, ON, Canada
| | - G Bjarnason
- Odette Cancer Centre, Toronto, ON, Canada; Women's College Hospital, Toronto, ON, Canada; Toronto Rehabilitation Institute, Toronto, ON, Canada; Macrostat Inc, Toronto, ON, Canada
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Petrella TM, Tozer R, Belanger K, Savage KJ, Wong R, Kamel-Reid S, Tron V, Chen B, Hunder NN, Eisenhauer EA. Interleukin-21 (IL-21) activity in patients (pts) with metastatic melanoma (MM). J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.8507] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [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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Morrow PH, Divers SG, Provencher L, Luoh S, Petrella TM, Giurescu M, Fielding L, Wang Y, Hortobagyi GN, Vahdat LT. Phase II study of sagopilone (ZK-Epo) in patients with recurrent metastatic breast cancer (MBC). J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.1083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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
1083 Background: Sagopilone is a novel, fully synthetic epothilone, which represents a new class of microtubule stabilizing agents. It has shown significant pre-clinical activity in taxane resistant breast cancer cell lines and in tumor models, as well as clinical activity in both taxane naïve and pretreated MBC. Methods: MBC patients who received ≤ 3 prior anthracycline and taxane containing chemotherapies were eligible. Sagopilone was given either at 16 mg/m2 (arm A) or at 22 mg/m2 (arm B, amended additional cohort) IV over 3 hours every 21 days for up to 6 cycles. The primary end point was tumor response by RECIST. The Simon 2-Stage design required 3 responders in the first 24 evaluable patients in stage 1 and 10 responders in 65 evaluable patients to declare success. Results: Between June 2006 and June 2008, 65 patients were enrolled and treated (39 in arm A, 26 in arm B). Majority of metastases were in lymph nodes (62%), liver (55%), bone (49%), lung (37%), and cutaneous sites (19%). Median number of cycles delivered was 2 (1–17). Neither arm met Stage 1 criteria for responders. Nevertheless, 2 patients in arm A and 1 in arm B had confirmed partial response, and lasted 4, 7, and 2 months, respectively. 26% patients in arm A, and 42% in arm B had stable disease. 42 patients discontinued study prior to cycle 6 due to progressive disease/death, 14 due to adverse events, and 1 due to other reasons. All 65 patients are evaluable for safety. Adverse events documented or reported in ≥ 20% patients are: sensory neuropathy 80% (23% grade 3), nausea 57% (no grade 3), fatigue 45% (12% grade 3), vomiting 29% (no grade 3), myalgia 28% (5% grade 3), diarrhea 25% (2% grade 3), insomnia 25% (no grade 3), pain in extremity 25% (2% grade 3), headache 23% (5% grade 3), arthralgia 22% (5% grade 3), constipation 22% (2% grade 3). Conclusions: Sagopilone had limited activity in these heavily pretreated MBC patients. It appeared tolerable at both dose levels. [Table: see text]
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Affiliation(s)
- P. H. Morrow
- University of Texas M. D. Anderson Cancer Center, Houston, TX; Genesis Cancer Center, Hot Springs, AR; Centre Hospitalier Affilié Universitaire de Québec, Quebec City, QC, Canada; Oregon Health and Science University, Portland, OR; Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Bayer Schering Pharma AG, Berlin, Germany; Bayer HealthCare Pharmaceuticals, Toronto, ON, Canada; Bayer HealthCare Pharmaceuticals, Wayne, NJ; Weill Cornell Medical College, New York, NY
| | - S. G. Divers
- University of Texas M. D. Anderson Cancer Center, Houston, TX; Genesis Cancer Center, Hot Springs, AR; Centre Hospitalier Affilié Universitaire de Québec, Quebec City, QC, Canada; Oregon Health and Science University, Portland, OR; Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Bayer Schering Pharma AG, Berlin, Germany; Bayer HealthCare Pharmaceuticals, Toronto, ON, Canada; Bayer HealthCare Pharmaceuticals, Wayne, NJ; Weill Cornell Medical College, New York, NY
| | - L. Provencher
- University of Texas M. D. Anderson Cancer Center, Houston, TX; Genesis Cancer Center, Hot Springs, AR; Centre Hospitalier Affilié Universitaire de Québec, Quebec City, QC, Canada; Oregon Health and Science University, Portland, OR; Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Bayer Schering Pharma AG, Berlin, Germany; Bayer HealthCare Pharmaceuticals, Toronto, ON, Canada; Bayer HealthCare Pharmaceuticals, Wayne, NJ; Weill Cornell Medical College, New York, NY
| | - S. Luoh
- University of Texas M. D. Anderson Cancer Center, Houston, TX; Genesis Cancer Center, Hot Springs, AR; Centre Hospitalier Affilié Universitaire de Québec, Quebec City, QC, Canada; Oregon Health and Science University, Portland, OR; Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Bayer Schering Pharma AG, Berlin, Germany; Bayer HealthCare Pharmaceuticals, Toronto, ON, Canada; Bayer HealthCare Pharmaceuticals, Wayne, NJ; Weill Cornell Medical College, New York, NY
| | - T. M. Petrella
- University of Texas M. D. Anderson Cancer Center, Houston, TX; Genesis Cancer Center, Hot Springs, AR; Centre Hospitalier Affilié Universitaire de Québec, Quebec City, QC, Canada; Oregon Health and Science University, Portland, OR; Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Bayer Schering Pharma AG, Berlin, Germany; Bayer HealthCare Pharmaceuticals, Toronto, ON, Canada; Bayer HealthCare Pharmaceuticals, Wayne, NJ; Weill Cornell Medical College, New York, NY
| | - M. Giurescu
- University of Texas M. D. Anderson Cancer Center, Houston, TX; Genesis Cancer Center, Hot Springs, AR; Centre Hospitalier Affilié Universitaire de Québec, Quebec City, QC, Canada; Oregon Health and Science University, Portland, OR; Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Bayer Schering Pharma AG, Berlin, Germany; Bayer HealthCare Pharmaceuticals, Toronto, ON, Canada; Bayer HealthCare Pharmaceuticals, Wayne, NJ; Weill Cornell Medical College, New York, NY
| | - L. Fielding
- University of Texas M. D. Anderson Cancer Center, Houston, TX; Genesis Cancer Center, Hot Springs, AR; Centre Hospitalier Affilié Universitaire de Québec, Quebec City, QC, Canada; Oregon Health and Science University, Portland, OR; Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Bayer Schering Pharma AG, Berlin, Germany; Bayer HealthCare Pharmaceuticals, Toronto, ON, Canada; Bayer HealthCare Pharmaceuticals, Wayne, NJ; Weill Cornell Medical College, New York, NY
| | - Y. Wang
- University of Texas M. D. Anderson Cancer Center, Houston, TX; Genesis Cancer Center, Hot Springs, AR; Centre Hospitalier Affilié Universitaire de Québec, Quebec City, QC, Canada; Oregon Health and Science University, Portland, OR; Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Bayer Schering Pharma AG, Berlin, Germany; Bayer HealthCare Pharmaceuticals, Toronto, ON, Canada; Bayer HealthCare Pharmaceuticals, Wayne, NJ; Weill Cornell Medical College, New York, NY
| | - G. N. Hortobagyi
- University of Texas M. D. Anderson Cancer Center, Houston, TX; Genesis Cancer Center, Hot Springs, AR; Centre Hospitalier Affilié Universitaire de Québec, Quebec City, QC, Canada; Oregon Health and Science University, Portland, OR; Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Bayer Schering Pharma AG, Berlin, Germany; Bayer HealthCare Pharmaceuticals, Toronto, ON, Canada; Bayer HealthCare Pharmaceuticals, Wayne, NJ; Weill Cornell Medical College, New York, NY
| | - L. T. Vahdat
- University of Texas M. D. Anderson Cancer Center, Houston, TX; Genesis Cancer Center, Hot Springs, AR; Centre Hospitalier Affilié Universitaire de Québec, Quebec City, QC, Canada; Oregon Health and Science University, Portland, OR; Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Bayer Schering Pharma AG, Berlin, Germany; Bayer HealthCare Pharmaceuticals, Toronto, ON, Canada; Bayer HealthCare Pharmaceuticals, Wayne, NJ; Weill Cornell Medical College, New York, NY
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Petrella TM, Dranitsaris G, Trudeau M, Rezmovitz J, Charbonneau F, Giotis A, Clemons M. The development of a prediciton index for patients at high risk of severe chemotherapy induced nausea and vomiting. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.8156] [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: 11/20/2022] Open
Affiliation(s)
- T. M. Petrella
- Toronto Sunnybrook Regional Cancer Ctr, Toronto, ON, Canada
| | - G. Dranitsaris
- Toronto Sunnybrook Regional Cancer Ctr, Toronto, ON, Canada
| | - M. Trudeau
- Toronto Sunnybrook Regional Cancer Ctr, Toronto, ON, Canada
| | - J. Rezmovitz
- Toronto Sunnybrook Regional Cancer Ctr, Toronto, ON, Canada
| | - F. Charbonneau
- Toronto Sunnybrook Regional Cancer Ctr, Toronto, ON, Canada
| | - A. Giotis
- Toronto Sunnybrook Regional Cancer Ctr, Toronto, ON, Canada
| | - M. Clemons
- Toronto Sunnybrook Regional Cancer Ctr, Toronto, ON, Canada
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Abstract
Lymphomatoid granulomatosis (LG) is an uncommon but potentially fatal disease. The disease primarily involves the lungs; however, skin, renal, and central nervous system (CNS) are seen in varying proportions. Neurological involvement occurs in one third of the patients, and confers a worse prognosis. The use of radiotherapy to treat CNS involvement in LG has not been well studied. We report a case of a 33-year-old man with multiple CNS lesions treated successfully with radiotherapy and review 6 other cases in the literature using similar treatment. These cases support the use of radiotherapy for CNS involvement in LG.
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Affiliation(s)
- T M Petrella
- Department of Medicine, McMaster University and Hamilton Health Sciences Corporation, Ontario, Canada
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