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Harmer V, Harbeck N, Boyle F, Werutsky G, Ammendolea C, El Mouzain D, Marshall D, Thomas C, Heidenreich S, Lu H, Dionne PA, Gao M, Aubel D, Pathak P, Ryan M. P263 Patients’ perspectives on treatments for HR+/HER2– early breast cancer: developing a quantitative patient preference survey. Breast 2023. [DOI: 10.1016/s0960-9776(23)00381-8] [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: 03/15/2023] Open
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Conefrey C, Donovan JL, Stein RC, Paramasivan S, Marshall A, Bartlett J, Cameron D, Campbell A, Dunn J, Earl H, Hall P, Harmer V, Hughes-Davies L, Macpherson I, Makris A, Morgan A, Pinder S, Poole C, Rea D, Rooshenas L. Strategies to Improve Recruitment to a De-escalation Trial: A Mixed-Methods Study of the OPTIMA Prelim Trial in Early Breast Cancer. Clin Oncol (R Coll Radiol) 2020; 32:382-389. [PMID: 32089356 PMCID: PMC7246331 DOI: 10.1016/j.clon.2020.01.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 12/19/2019] [Accepted: 12/23/2019] [Indexed: 11/16/2022]
Abstract
AIMS De-escalation trials are challenging and sometimes may fail due to poor recruitment. The OPTIMA Prelim randomised controlled trial (ISRCTN42400492) randomised patients with early stage breast cancer to chemotherapy versus 'test-directed' chemotherapy, with a possible outcome of no chemotherapy, which could confer less treatment relative to routine practice. Despite encountering challenges, OPTIMA Prelim reached its recruitment target ahead of schedule. This study reports the root causes of recruitment challenges and the strategies used to successfully overcome them. MATERIALS AND METHODS A mixed-methods recruitment intervention (QuinteT Recruitment Intervention) was used to investigate the recruitment difficulties and feedback findings to inform interventions and optimise ongoing recruitment. Quantitative site-level recruitment data, audio-recorded recruitment appointments (n = 46), qualitative interviews (n = 22) with trialists/recruiting staff (oncologists/nurses) and patient-facing documentation were analysed using descriptive, thematic and conversation analyses. Findings were triangulated to inform a 'plan of action' to optimise recruitment. RESULTS Despite best intentions, oncologists' routine practices complicated recruitment. Discomfort about deviating from the usual practice of recommending chemotherapy according to tumour clinicopathological features meant that not all eligible patients were approached. Audio-recorded recruitment appointments revealed how routine practices undermined recruitment. A tendency to justify chemotherapy provision before presenting the randomised controlled trial and subtly indicating that chemotherapy would be more/less beneficial undermined equipoise and made it difficult for patients to engage with OPTIMA Prelim. To tackle these challenges, individual and group recruiter feedback focussed on communication issues and vignettes of eligible patients were discussed to address discomforts around approaching patients. 'Tips' documents concerning structuring discussions and conveying equipoise were disseminated across sites, together with revisions to the Patient Information Sheet. CONCLUSIONS This is the first study illuminating the tension between oncologists' routine practices and recruitment to de-escalation trials. Although time and resources are required, these challenges can be addressed through specific feedback and training as the trial is underway.
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Affiliation(s)
- C Conefrey
- Population Health Sciences, University of Bristol, Bristol, UK.
| | - J L Donovan
- Population Health Sciences, University of Bristol, Bristol, UK
| | - R C Stein
- National Institute for Health Research, University College London Hospitals Biomedical Research Centre, London, UK
| | - S Paramasivan
- Population Health Sciences, University of Bristol, Bristol, UK
| | - A Marshall
- Warwick Medical School, University of Warwick, Coventry, UK
| | - J Bartlett
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - D Cameron
- The University of Edinburgh, Cancer Research UK Edinburgh Centre, Western General Hospital, EH4 University Cancer Centre, University of Edinburgh, Edinburgh, UK
| | - A Campbell
- Warwick Medical School, University of Warwick, Coventry, UK
| | - J Dunn
- Warwick Medical School, University of Warwick, Coventry, UK
| | - H Earl
- Oncology Centre, Addenbrooke's Hospital, Cambridge, UK
| | - P Hall
- The University of Edinburgh, Cancer Research UK Edinburgh Centre, Western General Hospital, EH4 University Cancer Centre, University of Edinburgh, Edinburgh, UK
| | - V Harmer
- Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
| | | | - I Macpherson
- Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - A Makris
- Mount Vernon Cancer Centre, Mount Vernon Hospital, Northwood, UK
| | - A Morgan
- Independent Cancer Patients' Voice, London, UK
| | - S Pinder
- King's College London, Comprehensive Cancer Centre at Guy's Hospital, London, UK
| | - C Poole
- Arden Cancer Centre, University Hospitals Coventry and Warwickshire, Coventry, UK
| | - D Rea
- School of Cancer Sciences, University of Birmingham, Birmingham, UK
| | - L Rooshenas
- Population Health Sciences, University of Bristol, Bristol, UK
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Stein RC, Hughes-Davies L, Makris A, Macpherson IR, Conefrey C, Rooshenas L, Pinder SE, Thomas J, Hall PS, Cameron DA, Earl HM, Naume B, Poole CJ, Rea DW, MacIntosh SA, Harmer V, Morgan A, Hulme C, McCabe C, Stallard N, Higgins H, Donovan JL, Bartlett JM, Marshall A, Dunn JA. Abstract OT1-05-02: OPTIMA: A prospective randomized trial to validate the clinical utility and cost-effectiveness of gene expression test-directed chemotherapy decisions in high clinical risk early breast cancer. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-ot1-05-02] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background:Multi-parameter tumour gene expression assays (MPAs) are widely used to estimate individual patient residual risk and to guide chemotherapy use in hormone-sensitive, HER2-negative early breast cancer. The TAILORx trial supports MPA use in a node-negative population. Evidence for MPA use in node-positive breast cancer is limited. OPTIMA (Optimal Personalised Treatment of early breast cancer usIng Multi-parameter Analysis) (ISRCTN42400492) aims to validate MPAs as predictors of chemotherapy sensitivity in a largely node-positive breast cancer population where prospective RCT (Randomised Controlled Trial) evidence is lacking.
Methods: OPTIMA is a partially blinded multi-center RCT with an adaptive two-stage design. The main eligibility criteria are women and men age 40 or older with resected ER-positive, HER2-negative invasive breast cancer and up to 9 involved axillary lymph nodes. Randomisation is to standard management (chemotherapy and endocrine therapy) or to MPA-directed treatment using the Prosigna (PAM50) test. Those with a Prosigna tumour score (ROR_PT) >60 receive standard management whilst those with a low score (≤60) are treated with endocrine therapy alone. Endocrine therapy for pre-menopausal women includes ovarian suppression. The co-primary outcomes are (1) Invasive Disease Free Survival (IDFS) and (2) cost-effectiveness of test-directed treatment. Secondary outcomes include IDFS in patients with low-score tumours and quality of life. An integrated qualitative recruitment study addresses challenges to consent and recruitment and will build on experience from the feasibility study that a multidisciplinary approach at sites is important for recruitment success. Tumour blocks will be banked to allow evaluation of additional MPA technologies. Recruitment of 4500 patients over 5 years will permit demonstration of 3% non-inferiority of test-directed treatment, assuming 5-year IDFS of 85% with standard management, equivalent to a HR of 1.22. Inclusion of patients from the feasibility study will increase the power to test for non-inferiority.
Results: The OPTIMA main trial opened in January 2017. Overall recruitment (including the feasibility study) will reach 1000 in August 2018. Recruitment in Norway will commence in July 2018. Characteristics of the OPTIMA main participants recruited to 31st May 2018 are shown in the table.
Main study patient characteristicsCharacteristic %Median age in years (range)57 (40-80) Menopause statusPre34 Post66 Male1Tumour size<30mm58 >=30mm42Node statuspN04 pN1mi(sn)7 pN1(sn)20 pN155 pN214Historic grade16 258 336
Conclusion: OPTIMA is one of two large scale prospective trials validating the use of test-guided chemotherapy decisions in node-positive early breast cancer. It is expected to have a global impact on breast cancer treatment. Experience from the preliminary study and close engagement with centres will aid trial success.
Funding: OPTIMA is funded by the UK NIHR HTA Programme (10/34/501). Views expressed are those of the authors and not those of the HTA Programme, NIHR, NHS or the DoH.
Citation Format: Stein RC, Hughes-Davies L, Makris A, Macpherson IR, Conefrey C, Rooshenas L, Pinder SE, Thomas J, Hall PS, Cameron DA, Earl HM, Naume B, Poole CJ, Rea DW, MacIntosh SA, Harmer V, Morgan A, Hulme C, McCabe C, Stallard N, Higgins H, Donovan JL, Bartlett JM, Marshall A, Dunn JA. OPTIMA: A prospective randomized trial to validate the clinical utility and cost-effectiveness of gene expression test-directed chemotherapy decisions in high clinical risk early breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr OT1-05-02.
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Affiliation(s)
- RC Stein
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Mount Vernon Cancer Centre, Northwood, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; University of Bristol, Bristol, United Kingdom; Kings College London, London, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; Oslo University Hospital HF, Radiumhospitalet, Postboks 4953 Nydalen, Oslo, Norway; University Hosptial Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; In
| | - L Hughes-Davies
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Mount Vernon Cancer Centre, Northwood, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; University of Bristol, Bristol, United Kingdom; Kings College London, London, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; Oslo University Hospital HF, Radiumhospitalet, Postboks 4953 Nydalen, Oslo, Norway; University Hosptial Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; In
| | - A Makris
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Mount Vernon Cancer Centre, Northwood, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; University of Bristol, Bristol, United Kingdom; Kings College London, London, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; Oslo University Hospital HF, Radiumhospitalet, Postboks 4953 Nydalen, Oslo, Norway; University Hosptial Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; In
| | - IR Macpherson
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Mount Vernon Cancer Centre, Northwood, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; University of Bristol, Bristol, United Kingdom; Kings College London, London, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; Oslo University Hospital HF, Radiumhospitalet, Postboks 4953 Nydalen, Oslo, Norway; University Hosptial Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; In
| | - C Conefrey
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Mount Vernon Cancer Centre, Northwood, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; University of Bristol, Bristol, United Kingdom; Kings College London, London, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; Oslo University Hospital HF, Radiumhospitalet, Postboks 4953 Nydalen, Oslo, Norway; University Hosptial Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; In
| | - L Rooshenas
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Mount Vernon Cancer Centre, Northwood, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; University of Bristol, Bristol, United Kingdom; Kings College London, London, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; Oslo University Hospital HF, Radiumhospitalet, Postboks 4953 Nydalen, Oslo, Norway; University Hosptial Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; In
| | - SE Pinder
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Mount Vernon Cancer Centre, Northwood, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; University of Bristol, Bristol, United Kingdom; Kings College London, London, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; Oslo University Hospital HF, Radiumhospitalet, Postboks 4953 Nydalen, Oslo, Norway; University Hosptial Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; In
| | - J Thomas
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Mount Vernon Cancer Centre, Northwood, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; University of Bristol, Bristol, United Kingdom; Kings College London, London, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; Oslo University Hospital HF, Radiumhospitalet, Postboks 4953 Nydalen, Oslo, Norway; University Hosptial Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; In
| | - PS Hall
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Mount Vernon Cancer Centre, Northwood, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; University of Bristol, Bristol, United Kingdom; Kings College London, London, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; Oslo University Hospital HF, Radiumhospitalet, Postboks 4953 Nydalen, Oslo, Norway; University Hosptial Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; In
| | - DA Cameron
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Mount Vernon Cancer Centre, Northwood, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; University of Bristol, Bristol, United Kingdom; Kings College London, London, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; Oslo University Hospital HF, Radiumhospitalet, Postboks 4953 Nydalen, Oslo, Norway; University Hosptial Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; In
| | - HM Earl
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Mount Vernon Cancer Centre, Northwood, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; University of Bristol, Bristol, United Kingdom; Kings College London, London, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; Oslo University Hospital HF, Radiumhospitalet, Postboks 4953 Nydalen, Oslo, Norway; University Hosptial Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; In
| | - B Naume
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Mount Vernon Cancer Centre, Northwood, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; University of Bristol, Bristol, United Kingdom; Kings College London, London, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; Oslo University Hospital HF, Radiumhospitalet, Postboks 4953 Nydalen, Oslo, Norway; University Hosptial Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; In
| | - CJ Poole
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Mount Vernon Cancer Centre, Northwood, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; University of Bristol, Bristol, United Kingdom; Kings College London, London, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; Oslo University Hospital HF, Radiumhospitalet, Postboks 4953 Nydalen, Oslo, Norway; University Hosptial Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; In
| | - DW Rea
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Mount Vernon Cancer Centre, Northwood, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; University of Bristol, Bristol, United Kingdom; Kings College London, London, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; Oslo University Hospital HF, Radiumhospitalet, Postboks 4953 Nydalen, Oslo, Norway; University Hosptial Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; In
| | - SA MacIntosh
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Mount Vernon Cancer Centre, Northwood, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; University of Bristol, Bristol, United Kingdom; Kings College London, London, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; Oslo University Hospital HF, Radiumhospitalet, Postboks 4953 Nydalen, Oslo, Norway; University Hosptial Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; In
| | - V Harmer
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Mount Vernon Cancer Centre, Northwood, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; University of Bristol, Bristol, United Kingdom; Kings College London, London, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; Oslo University Hospital HF, Radiumhospitalet, Postboks 4953 Nydalen, Oslo, Norway; University Hosptial Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; In
| | - A Morgan
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Mount Vernon Cancer Centre, Northwood, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; University of Bristol, Bristol, United Kingdom; Kings College London, London, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; Oslo University Hospital HF, Radiumhospitalet, Postboks 4953 Nydalen, Oslo, Norway; University Hosptial Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; In
| | - C Hulme
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Mount Vernon Cancer Centre, Northwood, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; University of Bristol, Bristol, United Kingdom; Kings College London, London, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; Oslo University Hospital HF, Radiumhospitalet, Postboks 4953 Nydalen, Oslo, Norway; University Hosptial Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; In
| | - C McCabe
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Mount Vernon Cancer Centre, Northwood, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; University of Bristol, Bristol, United Kingdom; Kings College London, London, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; Oslo University Hospital HF, Radiumhospitalet, Postboks 4953 Nydalen, Oslo, Norway; University Hosptial Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; In
| | - N Stallard
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Mount Vernon Cancer Centre, Northwood, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; University of Bristol, Bristol, United Kingdom; Kings College London, London, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; Oslo University Hospital HF, Radiumhospitalet, Postboks 4953 Nydalen, Oslo, Norway; University Hosptial Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; In
| | - H Higgins
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Mount Vernon Cancer Centre, Northwood, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; University of Bristol, Bristol, United Kingdom; Kings College London, London, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; Oslo University Hospital HF, Radiumhospitalet, Postboks 4953 Nydalen, Oslo, Norway; University Hosptial Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; In
| | - JL Donovan
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Mount Vernon Cancer Centre, Northwood, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; University of Bristol, Bristol, United Kingdom; Kings College London, London, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; Oslo University Hospital HF, Radiumhospitalet, Postboks 4953 Nydalen, Oslo, Norway; University Hosptial Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; In
| | - JM Bartlett
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Mount Vernon Cancer Centre, Northwood, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; University of Bristol, Bristol, United Kingdom; Kings College London, London, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; Oslo University Hospital HF, Radiumhospitalet, Postboks 4953 Nydalen, Oslo, Norway; University Hosptial Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; In
| | - A Marshall
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Mount Vernon Cancer Centre, Northwood, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; University of Bristol, Bristol, United Kingdom; Kings College London, London, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; Oslo University Hospital HF, Radiumhospitalet, Postboks 4953 Nydalen, Oslo, Norway; University Hosptial Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; In
| | - JA Dunn
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Mount Vernon Cancer Centre, Northwood, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; University of Bristol, Bristol, United Kingdom; Kings College London, London, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; Oslo University Hospital HF, Radiumhospitalet, Postboks 4953 Nydalen, Oslo, Norway; University Hosptial Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; In
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Stein RC, Makris A, Hughes-Davies L, Macpherson IR, Hall PS, Cameron DA, Earl HM, Pinder SE, Poole CJ, Rea DW, McIntosh S, Harmer V, Morgan A, Rooshenas L, Conefrey C, Donovan JL, Hulme C, McCabe C, Stallard N, Campbell A, Higgins H, Bartlett JMS, Marshall A, Dunn JA. Abstract OT1-06-01: OPTIMA: A prospective randomized trial to validate the predictive utility and cost-effectiveness of gene expression test-directed chemotherapy decisions in early breast cancer. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-ot1-06-01] [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: Multi-parameter gene expression assays (MPAs) are widely used to estimate individual patient residual risk in hormone-sensitive HER2-negative node-negative early breast cancer, allowing patients with low risk to safely avoid chemotherapy. Evidence for MPA use in node-positive breast cancer is limited. OPTIMA (Optimal Personalised Treatment of early breast cancer usIng Multi-parameter Analysis) aims to validate MPA's as predictors of chemotherapy sensitivity in a largely node-positive breast cancer population.
Methods: OPTIMA is a partially blinded multi-center, phase 3 randomized controlled trial with an adaptive two-stage design. The main eligibility criteria are women or men aged 40 or older with resected ER-positive, HER2-negative breast cancer and up to 9 involved axillary lymph nodes. Randomization is to standard management (chemotherapy and endocrine therapy) or to MPA-directed treatment. Those with a “high risk” tumor MPA score receive standard management whilst those at “low risk” are treated with endocrine therapy alone. The preliminary phase (OPTIMA prelim) evaluated the performance of several MPAs to select a test to be used in the main efficacy trial based on economic analysis, and assessed the feasibility and acceptability of a large UK trial. OPTIMA prelim used Oncotype DX as the primary discriminator; the main trial will use Prosigna (PAM50) with Prosigna Score ≤60 defined as “low-risk”. The co-primary outcomes are (1) Invasive Disease Free Survival (IDFS) and (2) cost-effectiveness of test-directed therapy. Secondary outcomes include IDFS in “low-risk” patients, quality of life and additional survival measures. An integrated qualitative recruitment study will identify and address challenges to recruitment and informed consent. Tumor blocks from all consenting participants will be banked allowing the performance of alternative MPA technologies to be evaluated. Recruitment of 4500 patients will permit demonstration of 3% non-inferiority of test-directed treatment, with 5% significance and 85% power, assuming 3 years follow-up and a control arm 5-year IDFS of at least 85%. The addition of patients from OPTIMA prelim will allow non-inferiority to be assessed with 2.5% significance.
Results: OPTIMA-prelim recruited 412 patients in 23 months from 35 sites with a 47% acceptance rate. The main study opened in January 2017. Early progress indicates that the recruitment target is achievable in the intended 46-month timescale through the participation of >100 sites
Conclusion: OPTIMA, as one of two large scale prospective trials validating the use of test-guided chemotherapy decisions in node-positive early breast cancer, is expected to have a global impact on breast cancer treatment. Experience from OPTIMA prelim showed that patient advocate support and close engagement with sites will aid trial success.
Funding: The project is funded in the UK by the NIHR HTA Programme (10/34/501). Views expressed are those of the authors and not those of the HTA Programme, NIHR, NHS or the DoH.
Citation Format: Stein RC, Makris A, Hughes-Davies L, Macpherson IR, Hall PS, Cameron DA, Earl HM, Pinder SE, Poole CJ, Rea DW, McIntosh S, Harmer V, Morgan A, Rooshenas L, Conefrey C, Donovan JL, Hulme C, McCabe C, Stallard N, Campbell A, Higgins H, Bartlett JMS, Marshall A, Dunn JA. OPTIMA: A prospective randomized trial to validate the predictive utility and cost-effectiveness of gene expression test-directed chemotherapy decisions in early breast cancer [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr OT1-06-01.
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Affiliation(s)
- RC Stein
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Mount Vernon Cancer Centre, East and North Hertfordshire NHS Trust, Northwood, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; King's College London, London, United Kingdom; University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; Independent Cancer Patients' Voice, United Kingdom; University of Bristol, Bristol, United K
| | - A Makris
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Mount Vernon Cancer Centre, East and North Hertfordshire NHS Trust, Northwood, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; King's College London, London, United Kingdom; University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; Independent Cancer Patients' Voice, United Kingdom; University of Bristol, Bristol, United K
| | - L Hughes-Davies
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Mount Vernon Cancer Centre, East and North Hertfordshire NHS Trust, Northwood, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; King's College London, London, United Kingdom; University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; Independent Cancer Patients' Voice, United Kingdom; University of Bristol, Bristol, United K
| | - IR Macpherson
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Mount Vernon Cancer Centre, East and North Hertfordshire NHS Trust, Northwood, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; King's College London, London, United Kingdom; University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; Independent Cancer Patients' Voice, United Kingdom; University of Bristol, Bristol, United K
| | - PS Hall
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Mount Vernon Cancer Centre, East and North Hertfordshire NHS Trust, Northwood, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; King's College London, London, United Kingdom; University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; Independent Cancer Patients' Voice, United Kingdom; University of Bristol, Bristol, United K
| | - DA Cameron
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Mount Vernon Cancer Centre, East and North Hertfordshire NHS Trust, Northwood, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; King's College London, London, United Kingdom; University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; Independent Cancer Patients' Voice, United Kingdom; University of Bristol, Bristol, United K
| | - HM Earl
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Mount Vernon Cancer Centre, East and North Hertfordshire NHS Trust, Northwood, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; King's College London, London, United Kingdom; University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; Independent Cancer Patients' Voice, United Kingdom; University of Bristol, Bristol, United K
| | - SE Pinder
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Mount Vernon Cancer Centre, East and North Hertfordshire NHS Trust, Northwood, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; King's College London, London, United Kingdom; University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; Independent Cancer Patients' Voice, United Kingdom; University of Bristol, Bristol, United K
| | - CJ Poole
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Mount Vernon Cancer Centre, East and North Hertfordshire NHS Trust, Northwood, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; King's College London, London, United Kingdom; University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; Independent Cancer Patients' Voice, United Kingdom; University of Bristol, Bristol, United K
| | - DW Rea
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Mount Vernon Cancer Centre, East and North Hertfordshire NHS Trust, Northwood, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; King's College London, London, United Kingdom; University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; Independent Cancer Patients' Voice, United Kingdom; University of Bristol, Bristol, United K
| | - S McIntosh
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Mount Vernon Cancer Centre, East and North Hertfordshire NHS Trust, Northwood, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; King's College London, London, United Kingdom; University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; Independent Cancer Patients' Voice, United Kingdom; University of Bristol, Bristol, United K
| | - V Harmer
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Mount Vernon Cancer Centre, East and North Hertfordshire NHS Trust, Northwood, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; King's College London, London, United Kingdom; University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; Independent Cancer Patients' Voice, United Kingdom; University of Bristol, Bristol, United K
| | - A Morgan
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Mount Vernon Cancer Centre, East and North Hertfordshire NHS Trust, Northwood, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; King's College London, London, United Kingdom; University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; Independent Cancer Patients' Voice, United Kingdom; University of Bristol, Bristol, United K
| | - L Rooshenas
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Mount Vernon Cancer Centre, East and North Hertfordshire NHS Trust, Northwood, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; King's College London, London, United Kingdom; University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; Independent Cancer Patients' Voice, United Kingdom; University of Bristol, Bristol, United K
| | - C Conefrey
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Mount Vernon Cancer Centre, East and North Hertfordshire NHS Trust, Northwood, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; King's College London, London, United Kingdom; University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; Independent Cancer Patients' Voice, United Kingdom; University of Bristol, Bristol, United K
| | - JL Donovan
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Mount Vernon Cancer Centre, East and North Hertfordshire NHS Trust, Northwood, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; King's College London, London, United Kingdom; University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; Independent Cancer Patients' Voice, United Kingdom; University of Bristol, Bristol, United K
| | - C Hulme
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Mount Vernon Cancer Centre, East and North Hertfordshire NHS Trust, Northwood, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; King's College London, London, United Kingdom; University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; Independent Cancer Patients' Voice, United Kingdom; University of Bristol, Bristol, United K
| | - C McCabe
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Mount Vernon Cancer Centre, East and North Hertfordshire NHS Trust, Northwood, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; King's College London, London, United Kingdom; University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; Independent Cancer Patients' Voice, United Kingdom; University of Bristol, Bristol, United K
| | - N Stallard
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Mount Vernon Cancer Centre, East and North Hertfordshire NHS Trust, Northwood, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; King's College London, London, United Kingdom; University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; Independent Cancer Patients' Voice, United Kingdom; University of Bristol, Bristol, United K
| | - A Campbell
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Mount Vernon Cancer Centre, East and North Hertfordshire NHS Trust, Northwood, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; King's College London, London, United Kingdom; University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; Independent Cancer Patients' Voice, United Kingdom; University of Bristol, Bristol, United K
| | - H Higgins
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Mount Vernon Cancer Centre, East and North Hertfordshire NHS Trust, Northwood, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; King's College London, London, United Kingdom; University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; Independent Cancer Patients' Voice, United Kingdom; University of Bristol, Bristol, United K
| | - JMS Bartlett
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Mount Vernon Cancer Centre, East and North Hertfordshire NHS Trust, Northwood, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; King's College London, London, United Kingdom; University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; Independent Cancer Patients' Voice, United Kingdom; University of Bristol, Bristol, United K
| | - A Marshall
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Mount Vernon Cancer Centre, East and North Hertfordshire NHS Trust, Northwood, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; King's College London, London, United Kingdom; University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; Independent Cancer Patients' Voice, United Kingdom; University of Bristol, Bristol, United K
| | - JA Dunn
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Mount Vernon Cancer Centre, East and North Hertfordshire NHS Trust, Northwood, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; King's College London, London, United Kingdom; University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; Independent Cancer Patients' Voice, United Kingdom; University of Bristol, Bristol, United K
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Stein RC, Marshall A, Hall PS, Bartlett JMS, Rooshenas L, Campbell A, Cameron DA, Rea D, Macpherson I, Earl HM, Poole CJ, Francis A, Morgan A, Harmer V, Pinder SE, Stallard N, Donovan J, Hulme C, McCabe C, Hughes-Davies L, Makris A, Dunn JA. Abstract OT3-02-12: OPTIMA (optimal personalised treatment of early breast cancer usIng multi-parameter analysis), a prospective trial to validate the predictive utility and cost-effectiveness of gene expression test-directed chemotherapy decisions. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-ot3-02-12] [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: Multi-parameter gene expression assays (MPAs) are widely used to estimate individual patient residual risk and to guide chemotherapy use in hormone-sensitive HER2-negative node-negative early breast cancer. These uses of MPAs have not yet been prospectively validated. OPTIMA aims to validate the use of MPA testing to predict chemotherapy sensitivity in a largely node-positive breast cancer population.
Methods: OPTIMA is a partially blinded multi-center, phase 3 randomized controlled trial with an adaptive two-stage design. The preliminary phase (OPTIMA prelim) evaluated the performance of MPAs to identify a suitable test(s) to be used in the main efficacy trial and assessed the feasibility and acceptability of a large UK trial. Eligible patients are men or women aged 40 years or older who have surgically resected early stage breast cancer, which is ER-positive and HER2-negative and who have either 1-9 involved axillary lymph nodes or tumors of at least 30mm diameter. Randomization is to standard management (chemotherapy followed by endocrine therapy) or to MPA-directed treatment. Those with a tumor categorized as "high-risk" by the test will be assigned to standard management whilst those at "low-risk" will be treated with endocrine therapy alone. OPTIMA prelim used Oncotype DX as the primary discriminator; the main trial will use Prosigna (PAM50). The co-primary outcomes are (1) Invasive Disease Free Survival (IDFS) and (2) cost-effectiveness of test-directed therapy compared to standard practice. Secondary outcomes include IDFS in "low-risk" patients, distant disease free survival, breast cancer specific survival, overall survival and quality of life. An integrated qualitative recruitment study will identify and address challenges to recruitment and informed consent. Tumor blocks from all consenting participants will be banked allowing the performance of alternative MPA technologies to be evaluated. Recruitment of 4500 patients over 4 years will permit demonstration of 3% non-inferiority of test-directed treatment, with 5% significance and 85% power, assuming 3 years follow-up and a control arm 5-year IDFS of at least 85%. The addition of patients from OPTIMA prelim will allow non-inferiority to be assessed with 2.5% significance.
Results: OPTIMA-prelim recruited 412 patients in 23 months from 35 sites. It confirmed the acceptability of randomization to patients with a 47% acceptance rate, and to clinicians and hence the feasibility of a large prospective trial of test-directed treatment running in 100-plus UK sites. It showed that investment into research on test-directed therapy, especially with Prosigna, should be of substantial value to the NHS.
Conclusion: OPTIMA, as one of two large scale prospective trials validating the use of test-guided chemotherapy in node-positive hormone-sensitive early breast cancer will have a global impact on patient treatment. Recruitment into the main efficacy trial will commence in October 2015.
Funding: Project funded by the UK NIHR HTA Programme (10/34/501). Views expressed are those of the authors and not those of the HTA Programme, NIHR, NHS or the DoH.
Citation Format: Stein RC, Marshall A, Hall PS, Bartlett JMS, Rooshenas L, Campbell A, Cameron DA, Rea D, Macpherson I, Earl HM, Poole CJ, Francis A, Morgan A, Harmer V, Pinder SE, Stallard N, Donovan J, Hulme C, McCabe C, Hughes-Davies L, Makris A, Dunn JA. OPTIMA (optimal personalised treatment of early breast cancer usIng multi-parameter analysis), a prospective trial to validate the predictive utility and cost-effectiveness of gene expression test-directed chemotherapy decisions. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr OT3-02-12.
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Affiliation(s)
- RC Stein
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; University of Warwick, Coventry, United Kingdom; University of Edinburgh, Edinburgh, United Kingdom; Ontario Institute for Cancer Research, Toronto, ON, Canada; University of Bristol, Bristol, United Kingdom; Cancer Research UK Institute for Cancer Studies, University of Birmingham, Birmingham, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; University of Cambridge, Cambridge, United Kingdom; University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Independent Cancer Patients' Voice, London, United Kingdom; Imperial College Healthcare Trust, London, United Kingdom; King's College London, London, United Kingdom; Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom; University of Alberta, Edmonton, AB, Canada; Addenbrooke's Hospital, Cambridge University Hospitals NHS
| | - A Marshall
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; University of Warwick, Coventry, United Kingdom; University of Edinburgh, Edinburgh, United Kingdom; Ontario Institute for Cancer Research, Toronto, ON, Canada; University of Bristol, Bristol, United Kingdom; Cancer Research UK Institute for Cancer Studies, University of Birmingham, Birmingham, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; University of Cambridge, Cambridge, United Kingdom; University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Independent Cancer Patients' Voice, London, United Kingdom; Imperial College Healthcare Trust, London, United Kingdom; King's College London, London, United Kingdom; Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom; University of Alberta, Edmonton, AB, Canada; Addenbrooke's Hospital, Cambridge University Hospitals NHS
| | - PS Hall
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; University of Warwick, Coventry, United Kingdom; University of Edinburgh, Edinburgh, United Kingdom; Ontario Institute for Cancer Research, Toronto, ON, Canada; University of Bristol, Bristol, United Kingdom; Cancer Research UK Institute for Cancer Studies, University of Birmingham, Birmingham, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; University of Cambridge, Cambridge, United Kingdom; University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Independent Cancer Patients' Voice, London, United Kingdom; Imperial College Healthcare Trust, London, United Kingdom; King's College London, London, United Kingdom; Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom; University of Alberta, Edmonton, AB, Canada; Addenbrooke's Hospital, Cambridge University Hospitals NHS
| | - JMS Bartlett
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; University of Warwick, Coventry, United Kingdom; University of Edinburgh, Edinburgh, United Kingdom; Ontario Institute for Cancer Research, Toronto, ON, Canada; University of Bristol, Bristol, United Kingdom; Cancer Research UK Institute for Cancer Studies, University of Birmingham, Birmingham, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; University of Cambridge, Cambridge, United Kingdom; University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Independent Cancer Patients' Voice, London, United Kingdom; Imperial College Healthcare Trust, London, United Kingdom; King's College London, London, United Kingdom; Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom; University of Alberta, Edmonton, AB, Canada; Addenbrooke's Hospital, Cambridge University Hospitals NHS
| | - L Rooshenas
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; University of Warwick, Coventry, United Kingdom; University of Edinburgh, Edinburgh, United Kingdom; Ontario Institute for Cancer Research, Toronto, ON, Canada; University of Bristol, Bristol, United Kingdom; Cancer Research UK Institute for Cancer Studies, University of Birmingham, Birmingham, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; University of Cambridge, Cambridge, United Kingdom; University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Independent Cancer Patients' Voice, London, United Kingdom; Imperial College Healthcare Trust, London, United Kingdom; King's College London, London, United Kingdom; Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom; University of Alberta, Edmonton, AB, Canada; Addenbrooke's Hospital, Cambridge University Hospitals NHS
| | - A Campbell
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; University of Warwick, Coventry, United Kingdom; University of Edinburgh, Edinburgh, United Kingdom; Ontario Institute for Cancer Research, Toronto, ON, Canada; University of Bristol, Bristol, United Kingdom; Cancer Research UK Institute for Cancer Studies, University of Birmingham, Birmingham, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; University of Cambridge, Cambridge, United Kingdom; University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Independent Cancer Patients' Voice, London, United Kingdom; Imperial College Healthcare Trust, London, United Kingdom; King's College London, London, United Kingdom; Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom; University of Alberta, Edmonton, AB, Canada; Addenbrooke's Hospital, Cambridge University Hospitals NHS
| | - DA Cameron
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; University of Warwick, Coventry, United Kingdom; University of Edinburgh, Edinburgh, United Kingdom; Ontario Institute for Cancer Research, Toronto, ON, Canada; University of Bristol, Bristol, United Kingdom; Cancer Research UK Institute for Cancer Studies, University of Birmingham, Birmingham, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; University of Cambridge, Cambridge, United Kingdom; University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Independent Cancer Patients' Voice, London, United Kingdom; Imperial College Healthcare Trust, London, United Kingdom; King's College London, London, United Kingdom; Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom; University of Alberta, Edmonton, AB, Canada; Addenbrooke's Hospital, Cambridge University Hospitals NHS
| | - D Rea
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; University of Warwick, Coventry, United Kingdom; University of Edinburgh, Edinburgh, United Kingdom; Ontario Institute for Cancer Research, Toronto, ON, Canada; University of Bristol, Bristol, United Kingdom; Cancer Research UK Institute for Cancer Studies, University of Birmingham, Birmingham, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; University of Cambridge, Cambridge, United Kingdom; University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Independent Cancer Patients' Voice, London, United Kingdom; Imperial College Healthcare Trust, London, United Kingdom; King's College London, London, United Kingdom; Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom; University of Alberta, Edmonton, AB, Canada; Addenbrooke's Hospital, Cambridge University Hospitals NHS
| | - I Macpherson
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; University of Warwick, Coventry, United Kingdom; University of Edinburgh, Edinburgh, United Kingdom; Ontario Institute for Cancer Research, Toronto, ON, Canada; University of Bristol, Bristol, United Kingdom; Cancer Research UK Institute for Cancer Studies, University of Birmingham, Birmingham, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; University of Cambridge, Cambridge, United Kingdom; University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Independent Cancer Patients' Voice, London, United Kingdom; Imperial College Healthcare Trust, London, United Kingdom; King's College London, London, United Kingdom; Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom; University of Alberta, Edmonton, AB, Canada; Addenbrooke's Hospital, Cambridge University Hospitals NHS
| | - HM Earl
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; University of Warwick, Coventry, United Kingdom; University of Edinburgh, Edinburgh, United Kingdom; Ontario Institute for Cancer Research, Toronto, ON, Canada; University of Bristol, Bristol, United Kingdom; Cancer Research UK Institute for Cancer Studies, University of Birmingham, Birmingham, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; University of Cambridge, Cambridge, United Kingdom; University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Independent Cancer Patients' Voice, London, United Kingdom; Imperial College Healthcare Trust, London, United Kingdom; King's College London, London, United Kingdom; Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom; University of Alberta, Edmonton, AB, Canada; Addenbrooke's Hospital, Cambridge University Hospitals NHS
| | - CJ Poole
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; University of Warwick, Coventry, United Kingdom; University of Edinburgh, Edinburgh, United Kingdom; Ontario Institute for Cancer Research, Toronto, ON, Canada; University of Bristol, Bristol, United Kingdom; Cancer Research UK Institute for Cancer Studies, University of Birmingham, Birmingham, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; University of Cambridge, Cambridge, United Kingdom; University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Independent Cancer Patients' Voice, London, United Kingdom; Imperial College Healthcare Trust, London, United Kingdom; King's College London, London, United Kingdom; Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom; University of Alberta, Edmonton, AB, Canada; Addenbrooke's Hospital, Cambridge University Hospitals NHS
| | - A Francis
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; University of Warwick, Coventry, United Kingdom; University of Edinburgh, Edinburgh, United Kingdom; Ontario Institute for Cancer Research, Toronto, ON, Canada; University of Bristol, Bristol, United Kingdom; Cancer Research UK Institute for Cancer Studies, University of Birmingham, Birmingham, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; University of Cambridge, Cambridge, United Kingdom; University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Independent Cancer Patients' Voice, London, United Kingdom; Imperial College Healthcare Trust, London, United Kingdom; King's College London, London, United Kingdom; Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom; University of Alberta, Edmonton, AB, Canada; Addenbrooke's Hospital, Cambridge University Hospitals NHS
| | - A Morgan
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; University of Warwick, Coventry, United Kingdom; University of Edinburgh, Edinburgh, United Kingdom; Ontario Institute for Cancer Research, Toronto, ON, Canada; University of Bristol, Bristol, United Kingdom; Cancer Research UK Institute for Cancer Studies, University of Birmingham, Birmingham, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; University of Cambridge, Cambridge, United Kingdom; University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Independent Cancer Patients' Voice, London, United Kingdom; Imperial College Healthcare Trust, London, United Kingdom; King's College London, London, United Kingdom; Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom; University of Alberta, Edmonton, AB, Canada; Addenbrooke's Hospital, Cambridge University Hospitals NHS
| | - V Harmer
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; University of Warwick, Coventry, United Kingdom; University of Edinburgh, Edinburgh, United Kingdom; Ontario Institute for Cancer Research, Toronto, ON, Canada; University of Bristol, Bristol, United Kingdom; Cancer Research UK Institute for Cancer Studies, University of Birmingham, Birmingham, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; University of Cambridge, Cambridge, United Kingdom; University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Independent Cancer Patients' Voice, London, United Kingdom; Imperial College Healthcare Trust, London, United Kingdom; King's College London, London, United Kingdom; Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom; University of Alberta, Edmonton, AB, Canada; Addenbrooke's Hospital, Cambridge University Hospitals NHS
| | - SE Pinder
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; University of Warwick, Coventry, United Kingdom; University of Edinburgh, Edinburgh, United Kingdom; Ontario Institute for Cancer Research, Toronto, ON, Canada; University of Bristol, Bristol, United Kingdom; Cancer Research UK Institute for Cancer Studies, University of Birmingham, Birmingham, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; University of Cambridge, Cambridge, United Kingdom; University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Independent Cancer Patients' Voice, London, United Kingdom; Imperial College Healthcare Trust, London, United Kingdom; King's College London, London, United Kingdom; Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom; University of Alberta, Edmonton, AB, Canada; Addenbrooke's Hospital, Cambridge University Hospitals NHS
| | - N Stallard
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; University of Warwick, Coventry, United Kingdom; University of Edinburgh, Edinburgh, United Kingdom; Ontario Institute for Cancer Research, Toronto, ON, Canada; University of Bristol, Bristol, United Kingdom; Cancer Research UK Institute for Cancer Studies, University of Birmingham, Birmingham, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; University of Cambridge, Cambridge, United Kingdom; University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Independent Cancer Patients' Voice, London, United Kingdom; Imperial College Healthcare Trust, London, United Kingdom; King's College London, London, United Kingdom; Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom; University of Alberta, Edmonton, AB, Canada; Addenbrooke's Hospital, Cambridge University Hospitals NHS
| | - J Donovan
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; University of Warwick, Coventry, United Kingdom; University of Edinburgh, Edinburgh, United Kingdom; Ontario Institute for Cancer Research, Toronto, ON, Canada; University of Bristol, Bristol, United Kingdom; Cancer Research UK Institute for Cancer Studies, University of Birmingham, Birmingham, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; University of Cambridge, Cambridge, United Kingdom; University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Independent Cancer Patients' Voice, London, United Kingdom; Imperial College Healthcare Trust, London, United Kingdom; King's College London, London, United Kingdom; Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom; University of Alberta, Edmonton, AB, Canada; Addenbrooke's Hospital, Cambridge University Hospitals NHS
| | - C Hulme
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; University of Warwick, Coventry, United Kingdom; University of Edinburgh, Edinburgh, United Kingdom; Ontario Institute for Cancer Research, Toronto, ON, Canada; University of Bristol, Bristol, United Kingdom; Cancer Research UK Institute for Cancer Studies, University of Birmingham, Birmingham, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; University of Cambridge, Cambridge, United Kingdom; University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Independent Cancer Patients' Voice, London, United Kingdom; Imperial College Healthcare Trust, London, United Kingdom; King's College London, London, United Kingdom; Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom; University of Alberta, Edmonton, AB, Canada; Addenbrooke's Hospital, Cambridge University Hospitals NHS
| | - C McCabe
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; University of Warwick, Coventry, United Kingdom; University of Edinburgh, Edinburgh, United Kingdom; Ontario Institute for Cancer Research, Toronto, ON, Canada; University of Bristol, Bristol, United Kingdom; Cancer Research UK Institute for Cancer Studies, University of Birmingham, Birmingham, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; University of Cambridge, Cambridge, United Kingdom; University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Independent Cancer Patients' Voice, London, United Kingdom; Imperial College Healthcare Trust, London, United Kingdom; King's College London, London, United Kingdom; Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom; University of Alberta, Edmonton, AB, Canada; Addenbrooke's Hospital, Cambridge University Hospitals NHS
| | - L Hughes-Davies
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; University of Warwick, Coventry, United Kingdom; University of Edinburgh, Edinburgh, United Kingdom; Ontario Institute for Cancer Research, Toronto, ON, Canada; University of Bristol, Bristol, United Kingdom; Cancer Research UK Institute for Cancer Studies, University of Birmingham, Birmingham, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; University of Cambridge, Cambridge, United Kingdom; University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Independent Cancer Patients' Voice, London, United Kingdom; Imperial College Healthcare Trust, London, United Kingdom; King's College London, London, United Kingdom; Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom; University of Alberta, Edmonton, AB, Canada; Addenbrooke's Hospital, Cambridge University Hospitals NHS
| | - A Makris
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; University of Warwick, Coventry, United Kingdom; University of Edinburgh, Edinburgh, United Kingdom; Ontario Institute for Cancer Research, Toronto, ON, Canada; University of Bristol, Bristol, United Kingdom; Cancer Research UK Institute for Cancer Studies, University of Birmingham, Birmingham, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; University of Cambridge, Cambridge, United Kingdom; University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Independent Cancer Patients' Voice, London, United Kingdom; Imperial College Healthcare Trust, London, United Kingdom; King's College London, London, United Kingdom; Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom; University of Alberta, Edmonton, AB, Canada; Addenbrooke's Hospital, Cambridge University Hospitals NHS
| | - JA Dunn
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; University of Warwick, Coventry, United Kingdom; University of Edinburgh, Edinburgh, United Kingdom; Ontario Institute for Cancer Research, Toronto, ON, Canada; University of Bristol, Bristol, United Kingdom; Cancer Research UK Institute for Cancer Studies, University of Birmingham, Birmingham, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; University of Cambridge, Cambridge, United Kingdom; University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Independent Cancer Patients' Voice, London, United Kingdom; Imperial College Healthcare Trust, London, United Kingdom; King's College London, London, United Kingdom; Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom; University of Alberta, Edmonton, AB, Canada; Addenbrooke's Hospital, Cambridge University Hospitals NHS
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Bartlett J, Canney P, Campbell A, Cameron D, Donovan J, Dunn J, Earl H, Francis A, Hall P, Harmer V, Higgins H, Hillier L, Hulme C, Hughes-Davies L, Makris A, Morgan A, McCabe C, Pinder S, Poole C, Rea D, Stallard N, Stein R. Selecting breast cancer patients for chemotherapy: the opening of the UK OPTIMA trial. Clin Oncol (R Coll Radiol) 2012; 25:109-16. [PMID: 23267818 DOI: 10.1016/j.clon.2012.10.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Revised: 09/19/2012] [Accepted: 10/19/2012] [Indexed: 11/26/2022]
Abstract
The mortality from breast cancer has improved steadily over the past two decades, in part because of the increased use of more effective adjuvant therapies. Thousands of women are routinely treated with intensive chemotherapy, which can be unpleasant, is expensive and is occasionally hazardous. Oncologists have long known that some of these women may not need treatment, either because they have a low risk of relapse or because they have tumour biology that makes them less sensitive to chemotherapy and more suitable for early adjuvant endocrine therapy. There is an urgent need to improve patient selection so that chemotherapy is restricted to those patients who will benefit from it. Here we review the emerging technologies that are available for improving patient selection for chemotherapy. We describe the OPTIMA trial, which has just opened to recruitment in the UK, is the latest addition to trials in this area, and is the first to focus on the relative cost-effectiveness of alternate predictive assays.
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Affiliation(s)
- J Bartlett
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada
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Harmer V. Benign breast disease. Nurs Times 2001; 97:32-3. [PMID: 11966260] [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: 02/24/2023]
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Harmer V. Symptom control for breast cancer. Nurs Times 2000; 96:38-9. [PMID: 11965805] [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: 02/24/2023]
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Harmer V. Adjuvant treatment for breast cancer patients. Nurs Times 2000; 96:34-5. [PMID: 11965956] [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: 02/24/2023]
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Harmer V. The surgical management of breast cancer. Nurs Times 2000; 96:34-5. [PMID: 11965994] [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: 02/24/2023]
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Harmer V. Breast cancer: an overview. Nurs Times 2000; 96:34-5. [PMID: 11965766] [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: 02/24/2023]
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