21 results on '"Susnerwala S"'
Search Results
2. A prospective phase II study of pre-operative chemotherapy then short-course radiotherapy for high risk rectal cancer: COPERNICUS
- Author
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Gollins, S, West, N, Sebag-Montefiore, D, Susnerwala, S, Falk, S, Brown, N, Saunders, M, Quirke, P, Ray, R, Parsons, P, Griffiths, G, Maughan, T, Adams, R, Hurt, C, and McIntyre, A
- Abstract
BACKGROUND:Neoadjuvant chemotherapy (NAC) allows earlier treatment of rectal cancer micro-metastases but is not standard of care. There are currently no biomarkers predicting long-term progression-free survival (PFS) benefit from NAC. PATIENTS AND METHODS:In this single arm phase II trial, patients with non-metastatic magnetic resonance imaging (MRI)-defined operable rectal adenocarcinoma at high risk of post-operative metastatic recurrence, received 8 weeks of oxaliplatin/fluorouracil NAC then short-course preoperative radiotherapy (SCPRT) before immediate surgery. Sixteen weeks of post-operative adjuvant chemotherapy (AC) was planned. A pelvic MRI was performed at week 9 immediately post-NAC, before SCPRT. The primary end point was feasibility assessed by completion of protocol treatment up to and including surgery. Secondary endpoints included compliance, toxicity, downstaging efficacy, and PFS. RESULTS:In total 60 patients were recruited May 2012-June 2014. In total 57 patients completed protocol treatment, meeting the primary endpoint. Compliance with NAC was much better than AC: Comparing NAC vs. AC, the median percentage dose intensity for fluoropyrimidine was 100% vs. 63% and for oxaliplatin 100% vs. 45%. Treatment-related toxicity was acceptable with no treatment-related deaths. Post-NAC MRI showed 44 tumours (73%) were T-downstaged and 22 (37%) had excellent MRI tumour regression grade (mrTRG 1-2). Median follow-up was 27 months with 2-year PFS of 86.2% (10 events). On exploratory analysis, post-NAC mrTRG predicted PFS with no event among those with excellent regression. CONCLUSION:The regimen was well tolerated with effective downstaging and encouraging PFS. mrTRG response to NAC may be a new prognostic factor for long-term PFS, but needs validation in larger studies.
- Published
- 2019
3. A prospective phase II study of pre-operative chemotherapy then short-course radiotherapy for high risk rectal cancer: COPERNICUS
- Author
-
Gollins, S, West, N, Sebag-Montefiore, D, Susnerwala, S, Falk, S, Brown, N, Saunders, M, Quirke, P, Ray, R, Parsons, P, Griffiths, G, Maughan, T, Adams, R, Hurt, C, and McIntyre, A
- Subjects
Adult ,Male ,Rectal Neoplasms ,Radiotherapy Dosage ,Middle Aged ,Combined Modality Therapy ,Survival Analysis ,Drug Administration Schedule ,Neoadjuvant Therapy ,Article ,Oxaliplatin ,Treatment Outcome ,Chemotherapy, Adjuvant ,Feasibility Studies ,Humans ,Patient Compliance ,Female ,Radiotherapy, Adjuvant ,Fluorouracil ,Prospective Studies ,Rectal cancer ,Aged ,Neoplasm Staging - Abstract
Background: Neoadjuvant chemotherapy (NAC) allows earlier treatment of rectal cancer micro-metastases but is not standard of care. There are currently no biomarkers predicting long-term progression-free survival (PFS) benefit from NAC. Patients and methods: In this single arm phase II trial, patients with non-metastatic magnetic resonance imaging (MRI)-defined operable rectal adenocarcinoma at high risk of post-operative metastatic recurrence, received 8 weeks of oxaliplatin/fluorouracil NAC then short-course preoperative radiotherapy (SCPRT) before immediate surgery. Sixteen weeks of post-operative adjuvant chemotherapy (AC) was planned. A pelvic MRI was performed at week 9 immediately post-NAC, before SCPRT. The primary end point was feasibility assessed by completion of protocol treatment up to and including surgery. Secondary endpoints included compliance, toxicity, downstaging efficacy, and PFS. Results: In total 60 patients were recruited May 2012–June 2014. In total 57 patients completed protocol treatment, meeting the primary endpoint. Compliance with NAC was much better than AC: Comparing NAC vs. AC, the median percentage dose intensity for fluoropyrimidine was 100% vs. 63% and for oxaliplatin 100% vs. 45%. Treatment-related toxicity was acceptable with no treatment-related deaths. Post-NAC MRI showed 44 tumours (73%) were T-downstaged and 22 (37%) had excellent MRI tumour regression grade (mrTRG 1–2). Median follow-up was 27 months with 2-year PFS of 86.2% (10 events). On exploratory analysis, post-NAC mrTRG predicted PFS with no event among those with excellent regression. Conclusion: The regimen was well tolerated with effective downstaging and encouraging PFS. mrTRG response to NAC may be a new prognostic factor for long-term PFS, but needs validation in larger studies.
- Published
- 2018
4. Preoperative chemoradiation with capecitabine, irinotecan and cetuximab in rectal cancer: significance of pre-treatment and post-resection RAS mutations
- Author
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Gollins, S, West, N, Sebag-Montefiore, D, Myint, AS, Saunders, M, Susnerwala, S, Quirke, P, Essapen, S, Samuel, L, Sizer, B, Worlding, J, Southward, K, Hemmings, G, Tinkler-Hundal, E, Taylor, M, Bottomley, D, Chambers, P, Lawrie, E, Lopes, A, and Beare, S
- Abstract
Background: The influence of EGFR pathway mutations on cetuximab-containing rectal cancer preoperative chemoradiation (CRT) is uncertain. Methods: In a prospective phase II trial (EXCITE), patients with magnetic resonance imaging (MRI)-defined non-metastatic rectal adenocarinoma threatening/involving the surgical resection plane received pelvic radiotherapy with concurrent capecitabine, irinotecan and cetuximab. Resection was recommended 8 weeks later. The primary endpoint was histopathologically clear (R0) resection margin. Pre-planned retrospective DNA pyrosequencing (PS) and next generation sequencing (NGS) of KRAS, NRAS, PIK3CA and BRAF was performed on the pre-treatment biopsy and resected specimen. Results: Eighty-two patients were recruited and 76 underwent surgery, with R0 resection in 67 (82%, 90%CI: 73–88%) (four patients with clinical complete response declined surgery). Twenty–four patients (30%) had an excellent clinical or pathological response (ECPR). Using NGS 24 (46%) of 52 matched biopsies/resections were discrepant: ten patients (19%) gained 13 new resection mutations compared to biopsy (12 KRAS, one PIK3CA) and 18 (35%) lost 22 mutations (15 KRAS, 7 PIK3CA). Tumours only ever testing RAS wild-type had significantly greater ECPR than tumours with either biopsy or resection RAS mutations (14/29 [48%] vs 10/51 [20%], P=0.008), with a trend towards increased overall survival (HR 0.23, 95% CI 0.05–1.03, P=0.055). Conclusions: This regimen was feasible and the primary study endpoint was met. For the first time using pre-operative rectal CRT, emergence of clinically important new resection mutations is described, likely reflecting intratumoural heterogeneity manifesting either as treatment-driven selective clonal expansion or a geographical biopsy sampling miss.
- Published
- 2017
5. Prognostic Factors for Local Recurrence, Distant Metastases and Survival in Anal Carcinoma
- Author
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Kapacee, Z.A., primary, Susnerwala, S., additional, Scott, N., additional, Danwata, F.D., additional, Wise, M., additional, and Biswas, A., additional
- Published
- 2014
- Full Text
- View/download PDF
6. Relationship of Ugt1A and Abc Genetic Variants to Toxicity and Response in Preoperative Chemoradiation (Crt) with Concurrent Irinotecan for Locally Advanced Rectal Cancer (Larc)
- Author
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Gollins, S., primary, Sherman, T., additional, Byers, H., additional, Bowes, J., additional, Myint, A.S., additional, Susnerwala, S., additional, Haylock, B., additional, Wise, M., additional, Saunders, M.P., additional, Essapen, S., additional, Samuel, L., additional, Latif, M.F., additional, Azam, F., additional, Ryder, D., additional, and Newman, W., additional
- Published
- 2014
- Full Text
- View/download PDF
7. An exploratory randomised controlled trial comparing telephone and hospital follow-up after treatment for colorectal cancer
- Author
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Beaver, Kinta, Campbell, M., Williamson, Susan, Procter, D., Sheridan, J., Heath, J., Susnerwala, S., Beaver, Kinta, Campbell, M., Williamson, Susan, Procter, D., Sheridan, J., Heath, J., and Susnerwala, S.
- Abstract
Aim: Following treatment for colorectal cancer it is common practice for patients to attend hospital clinics at regular intervals for routine monitoring, although debate persists on the benefits of this approach. Nurse-led telephone follow-up is effective in meeting information and psycho-social needs in other patient groups. We explored the potential benefits of nurse-led telephone follow-up for colorectal cancer patients. Method: Sixty-five patients were randomised to either telephone or hospital follow-up in an exploratory randomised trial. Results: The telephone intervention was deliverable in clinical practice and acceptable to patients and health professionals. Seventy-five percent of eligible patients agreed to randomization. High levels of satisfaction were evident in both study groups. Appointments in the hospital group were shorter (median 14.0 minutes) than appointments in the telephone group (median 28.9 minutes). Patients in the telephone arm were more likely to raise concerns during consultations. Conclusion: Historical approaches to follow-up unsupported by evidence of effectiveness and efficiency are not sustainable. Telephone follow-up by specialist nurses may be a feasible option. A main trial comparing hospital and telephone follow-up is justified although consideration needs to be given to trial design and practical issues related to the availability of specialist nurses at study locations.
- Published
- 2012
8. Colorectal cancer follow-up: Patient satisfaction and amenability to telephone after care
- Author
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Beaver, Kinta, Wilson, C, Procter, D, Sheridan, J, Towers, G, Heath, J, Susnerwala, S, Luker, K, Beaver, Kinta, Wilson, C, Procter, D, Sheridan, J, Towers, G, Heath, J, Susnerwala, S, and Luker, K
- Abstract
Purpose To explore patient satisfaction on different aspects of follow-up service provision following treatment for colorectal cancer and amenability to an alternative strategy for follow-up care. Methods and sample A postal survey was administered to 297 eligible patients who had been treated for colorectal cancer at a large hospital in the North West of England. Patients were asked to indicate responses to questions comprising likert scales, including views on organisation of care, information and advice, personal experience of care, satisfaction with information and care, views on specialist nursing services and amenability to telephone follow-up. Key results One hundred and eighty-seven completed surveys were returned (62.97% response rate). Analysis of scale data indicated high levels of satisfaction on all outcome measures but sub-optimal rates of satisfaction on some items. Respondents indicated high levels of satisfaction with information related to disease and treatment but lower levels of satisfaction for items related to genetic risk, sexual attractiveness and self care. Colorectal nurse specialists were highly rated, especially in terms of information provision and personal experience of care. Patients were generally amenable to telephone follow-up, although male patients indicated higher levels of willingness to accept this approach than females. Conclusions Satisfaction with traditional medical based follow-up is generally high in this patient cohort but there is room for improvement in terms of service delivery. High levels of satisfaction with the care delivered by colorectal nurse specialists and patient acceptance of telephone follow-up suggests nurse-led telephone follow-up is a viable alternative to traditional hospital based follow-up.
- Published
- 2011
9. 4150 Is telephone follow-up by specialist nurses a cost effective approach?
- Author
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Beaver, K, Hollingworth, W., McDonald, R., Dunn, G., Tysver-Robinson, D., Thomson, L., Hindley, A., Susnerwala, S., Luker, K., Beaver, K, Hollingworth, W., McDonald, R., Dunn, G., Tysver-Robinson, D., Thomson, L., Hindley, A., Susnerwala, S., and Luker, K.
- Abstract
Background: This paper will report on the findings from an economic evaluation of traditional hospital follow-up versus telephone follow-up by specialist breast care nurses for patients treated for breast cancer in the United Kingdom (UK). Materials and Methods: We conducted a cost minimisation analysis from a National Health Service (NHS) perspective using data from a randomised controlled trial that demonstrated equivalence between hospital and telephone follow-up in terms of psychological morbidity; 374 participants at low-moderate risk of recurrence were recruited to the study. The study was carried out at two hospitals in the North West of Engalnd. In a primary analysis we compared NHS resource use for routine follow-up (i.e. consultations, investigations and referrals) during a mean follow-up period of 24 months. Secondary analyses included patient and carer travel and productivity costs incurred and the NHS and personal social services costs of care in the minority of patients who developed a recurrence of their breast cancer. Results: Participants in the telephone follow-up group had approximately 20% extra consultations (634 versus 524). Telephone consultations were of longer duration and conducted by senior nurses whereas hospital clinic appointments were of shorter duration and often conducted by junior medical staff; this resulted in higher routine follow-up costs in the telephone follow-up group (mean difference £55, 95% bCI £29-£77). There were no significant differences in the costs of treating recurrence between groups. Participants receiving hospital follow-up had significantly higher travel and productivity costs (mean difference £47; 95% bCI £40-£55). Conclusions: Telephone follow-up by specialist nurses may be a useful strategy for reducing the burden on busy hospital clinics and providing a quality service. Although patients and carers will have fewer costs with telephone follow-up, this approach will not necessarily lead to cost or salary savin
- Published
- 2009
10. Economic evaluation of a randomized clinical trial of hospital versus telephone follow-up after treatment for breast cancer
- Author
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Beaver, Kinta, Hollingworth, W., McDonald, R., Dunn, G., Tysver-Robinson, D., Thomson, L., Hindley, A. C., Susnerwala, S. S., Luker, K., Beaver, Kinta, Hollingworth, W., McDonald, R., Dunn, G., Tysver-Robinson, D., Thomson, L., Hindley, A. C., Susnerwala, S. S., and Luker, K.
- Abstract
Background: This was an economic evaluation of hospital versus telephone follow-up by specialist nurses after treatment for breast cancer. Methods: A cost minimization analysis was carried out from a National Health Service (NHS) perspective using data from a trial in which 374 women were randomized to telephone or hospital follow-up. Primary analysis compared NHS resource use for routine follow-up over a mean of 24 months. Secondary analyses included patient and carer travel and productivity costs, and NHS and personal social services costs of care in patients with recurrent breast cancer. Results: Patients who had telephone follow-up had approximately 20 per cent more consultations (634 versus 524). The longer duration of telephone consultations and the frequent use of junior medical staff in hospital clinics resulted in higher routine costs for telephone follow-up (mean difference £55 (bias-corrected 95 per cent confidence interval (b.c.i.) £29 to £77)). There were no significant differences in the costs of treating recurrence, but patients who had hospital-based follow-up had significantly higher travel and productivity costs (mean difference £47 (95 per cent b.c.i. £40 to £55)). Conclusion: Telephone follow-up for breast cancer may reduce the burden on busy hospital clinics but will not necessarily lead to cost or salary savings.
- Published
- 2009
11. Comparing hospital and telephone follow-up after treatment for breast cancer: randomised equivalence trial
- Author
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Beaver, Kinta, Tysver-Robinson, D., Campbell, M., Twomey, M., Williamson, Susan, Hindley, A., Susnerwala, S., Dunn, G., Luker, K., Beaver, Kinta, Tysver-Robinson, D., Campbell, M., Twomey, M., Williamson, Susan, Hindley, A., Susnerwala, S., Dunn, G., and Luker, K.
- Abstract
Objective To compare traditional hospital follow-up with telephone follow-up by specialist nurses after treatment for breast cancer. Design A two centre randomised equivalence trial in which women remained in the study for a mean of 24 months. Setting Outpatient clinics in two NHS hospital trusts in the north west of England Participants 374 women treated for breast cancer who were at low to moderate risk of recurrence. Interventions Participants were randomised to traditional hospital follow-up (consultation, clinical examination, and mammography as per hospital policy) or telephone follow-up by specialist nurses (consultation with structured intervention and mammography according to hospital policy). Main outcome measures Psychological morbidity (state-trait anxiety inventory, general health questionnaire (GHQ-12)), participants’ needs for information, participants’ satisfaction, clinical investigations ordered, and time to detection of recurrent disease. Results The 95% confidence interval for difference in mean state-trait scores adjusted for treatment received (−3.33 to 2.07) was within the predefined equivalence region (−3.5 to 3.5). The women in the telephone group were no more anxious as a result of foregoing clinic examinations and face-to-face consultations and reported higher levels of satisfaction than those attending hospital clinics (intention to treat P<0.001). The numbers of clinical investigations ordered did not differ between groups. Recurrences were few (4.5%), with no differences between groups for time to detection (median 60.5 (range 37-131) days in hospital group v 39.0 (10-152) days in telephone group; P=0.228). Conclusions Telephone follow-up was well received by participants, with no physical or psychological disadvantage. It is suitable for women at low to moderate risk of recurrence and those with long travelling distances or mobility problems and decreases the burden on busy hospital clinics.
- Published
- 2009
12. Excite: A Phase II Trial of Preoperative Cetuximab, Irinotecan and Capecitabine Plus Radiotherapy (RT) In Mri-Defined Locally Advanced Rectal Cancer (LARC)
- Author
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Gollins, S., primary, Myint, A.S., additional, Saunders, M.P., additional, Susnerwala, S., additional, Sebag-Montefiori, D., additional, Beare, S., additional, Williams, E., additional, West, N., additional, and Jitlal, M., additional
- Published
- 2012
- Full Text
- View/download PDF
13. Preoperative downstaging chemoradiation with concurrent irinotecan and capecitabine in MRI-defined locally advanced rectal cancer: a phase I trial (NWCOG-2)
- Author
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Gollins, S W, primary, Myint, S, additional, Susnerwala, S, additional, Haylock, B, additional, Wise, M, additional, Topham, C, additional, Samuel, L, additional, Swindell, R, additional, Morris, J, additional, Mason, L, additional, and Levine, E, additional
- Published
- 2009
- Full Text
- View/download PDF
14. Comparing hospital and telephone follow-up after treatment for breast cancer: randomised equivalence trial
- Author
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Beaver, K., primary, Tysver-Robinson, D., additional, Campbell, M., additional, Twomey, M., additional, Williamson, S., additional, Hindley, A., additional, Susnerwala, S., additional, Dunn, G., additional, and Luker, K., additional
- Published
- 2009
- Full Text
- View/download PDF
15. Irinotecan+5-fluorouracil with concomitant pre-operative radiotherapy in locally advanced non-resectable rectal cancer: a phase I/II study
- Author
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Iles, S M, primary, Gollins, S W, additional, Susnerwala, S, additional, Haylock, B, additional, Myint, S, additional, Biswas, A, additional, Swindell, R, additional, and Levine, E, additional
- Published
- 2008
- Full Text
- View/download PDF
16. 740P - Prognostic Factors for Local Recurrence, Distant Metastases and Survival in Anal Carcinoma
- Author
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Kapacee, Z.A., Susnerwala, S., Scott, N., Danwata, F.D., Wise, M., and Biswas, A.
- Published
- 2014
- Full Text
- View/download PDF
17. 592P - Relationship of Ugt1A and Abc Genetic Variants to Toxicity and Response in Preoperative Chemoradiation (Crt) with Concurrent Irinotecan for Locally Advanced Rectal Cancer (Larc)
- Author
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Gollins, S., Sherman, T., Byers, H., Bowes, J., Myint, A.S., Susnerwala, S., Haylock, B., Wise, M., Saunders, M.P., Essapen, S., Samuel, L., Latif, M.F., Azam, F., Ryder, D., and Newman, W.
- Published
- 2014
- Full Text
- View/download PDF
18. Extramedullary plasmacytoma of the head and neck region: clinicopathological correlation in 25 cases.
- Author
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Susnerwala, SS, Shanks, JH, Banerjee, SS, Scarffe, JH, Farrington, WT, Slevin, NJ, Susnerwala, S S, Shanks, J H, Banerjee, S S, Scarffe, J H, Farrington, W T, and Slevin, N J
- Published
- 1997
- Full Text
- View/download PDF
19. A prospective phase II study of pre-operative chemotherapy then short-course radiotherapy for high risk rectal cancer: COPERNICUS.
- Author
-
Gollins S, West N, Sebag-Montefiore D, Susnerwala S, Falk S, Brown N, Saunders M, Quirke P, Ray R, Parsons P, Griffiths G, Maughan T, Adams R, and Hurt C
- Subjects
- Adult, Aged, Chemotherapy, Adjuvant, Combined Modality Therapy, Drug Administration Schedule, Feasibility Studies, Female, Fluorouracil adverse effects, Humans, Male, Middle Aged, Neoplasm Staging, Oxaliplatin adverse effects, Patient Compliance statistics & numerical data, Prospective Studies, Radiotherapy Dosage, Radiotherapy, Adjuvant adverse effects, Rectal Neoplasms pathology, Survival Analysis, Treatment Outcome, Fluorouracil administration & dosage, Neoadjuvant Therapy methods, Oxaliplatin administration & dosage, Rectal Neoplasms therapy
- Abstract
Background: Neoadjuvant chemotherapy (NAC) allows earlier treatment of rectal cancer micro-metastases but is not standard of care. There are currently no biomarkers predicting long-term progression-free survival (PFS) benefit from NAC., Patients and Methods: In this single arm phase II trial, patients with non-metastatic magnetic resonance imaging (MRI)-defined operable rectal adenocarcinoma at high risk of post-operative metastatic recurrence, received 8 weeks of oxaliplatin/fluorouracil NAC then short-course preoperative radiotherapy (SCPRT) before immediate surgery. Sixteen weeks of post-operative adjuvant chemotherapy (AC) was planned. A pelvic MRI was performed at week 9 immediately post-NAC, before SCPRT. The primary end point was feasibility assessed by completion of protocol treatment up to and including surgery. Secondary endpoints included compliance, toxicity, downstaging efficacy, and PFS., Results: In total 60 patients were recruited May 2012-June 2014. In total 57 patients completed protocol treatment, meeting the primary endpoint. Compliance with NAC was much better than AC: Comparing NAC vs. AC, the median percentage dose intensity for fluoropyrimidine was 100% vs. 63% and for oxaliplatin 100% vs. 45%. Treatment-related toxicity was acceptable with no treatment-related deaths. Post-NAC MRI showed 44 tumours (73%) were T-downstaged and 22 (37%) had excellent MRI tumour regression grade (mrTRG 1-2). Median follow-up was 27 months with 2-year PFS of 86.2% (10 events). On exploratory analysis, post-NAC mrTRG predicted PFS with no event among those with excellent regression., Conclusion: The regimen was well tolerated with effective downstaging and encouraging PFS. mrTRG response to NAC may be a new prognostic factor for long-term PFS, but needs validation in larger studies.
- Published
- 2018
- Full Text
- View/download PDF
20. Preoperative chemoradiation with capecitabine, irinotecan and cetuximab in rectal cancer: significance of pre-treatment and post-resection RAS mutations.
- Author
-
Gollins S, West N, Sebag-Montefiore D, Myint AS, Saunders M, Susnerwala S, Quirke P, Essapen S, Samuel L, Sizer B, Worlding J, Southward K, Hemmings G, Tinkler-Hundal E, Taylor M, Bottomley D, Chambers P, Lawrie E, Lopes A, and Beare S
- Subjects
- Adenocarcinoma pathology, Adenocarcinoma surgery, Adult, Aged, Biomarkers, Tumor genetics, Camptothecin administration & dosage, Camptothecin analogs & derivatives, Capecitabine administration & dosage, Cetuximab administration & dosage, Class I Phosphatidylinositol 3-Kinases genetics, Combined Modality Therapy, Female, Follow-Up Studies, Humans, Irinotecan, Male, Middle Aged, Neoplasm Staging, Postoperative Care, Prognosis, Prospective Studies, Proto-Oncogene Proteins B-raf genetics, Rectal Neoplasms pathology, Rectal Neoplasms surgery, Retrospective Studies, Survival Rate, Adenocarcinoma therapy, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Chemoradiotherapy, GTP Phosphohydrolases genetics, Membrane Proteins genetics, Mutation, Proto-Oncogene Proteins p21(ras) genetics, Rectal Neoplasms therapy
- Abstract
Background: The influence of EGFR pathway mutations on cetuximab-containing rectal cancer preoperative chemoradiation (CRT) is uncertain., Methods: In a prospective phase II trial (EXCITE), patients with magnetic resonance imaging (MRI)-defined non-metastatic rectal adenocarinoma threatening/involving the surgical resection plane received pelvic radiotherapy with concurrent capecitabine, irinotecan and cetuximab. Resection was recommended 8 weeks later. The primary endpoint was histopathologically clear (R0) resection margin. Pre-planned retrospective DNA pyrosequencing (PS) and next generation sequencing (NGS) of KRAS, NRAS, PIK3CA and BRAF was performed on the pre-treatment biopsy and resected specimen., Results: Eighty-two patients were recruited and 76 underwent surgery, with R0 resection in 67 (82%, 90%CI: 73-88%) (four patients with clinical complete response declined surgery). Twenty-four patients (30%) had an excellent clinical or pathological response (ECPR). Using NGS 24 (46%) of 52 matched biopsies/resections were discrepant: ten patients (19%) gained 13 new resection mutations compared to biopsy (12 KRAS, one PIK3CA) and 18 (35%) lost 22 mutations (15 KRAS, 7 PIK3CA). Tumours only ever testing RAS wild-type had significantly greater ECPR than tumours with either biopsy or resection RAS mutations (14/29 [48%] vs 10/51 [20%], P=0.008), with a trend towards increased overall survival (HR 0.23, 95% CI 0.05-1.03, P=0.055)., Conclusions: This regimen was feasible and the primary study endpoint was met. For the first time using pre-operative rectal CRT, emergence of clinically important new resection mutations is described, likely reflecting intratumoural heterogeneity manifesting either as treatment-driven selective clonal expansion or a geographical biopsy sampling miss.
- Published
- 2017
- Full Text
- View/download PDF
21. Exploring the decision-making preferences of people with colorectal cancer.
- Author
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Beaver K, Jones D, Susnerwala S, Craven O, Tomlinson M, Witham G, and Luker KA
- Subjects
- Adult, Aged, Aged, 80 and over, Colorectal Neoplasms psychology, Female, Humans, Interviews as Topic, Male, Middle Aged, State Medicine, United Kingdom, Colorectal Neoplasms therapy, Decision Making, Patient Participation, Patient Satisfaction
- Abstract
Objectives: To explore patient views on participation in treatment, physical care and psychological care decisions and factors that facilitate and hinder patients from making decisions., Design: Qualitative study using semi-structured interviews with patients., Setting and Participants: Three NHS Trusts in the north-west of England. Theoretical sampling including 41 patients who had been treated for colorectal cancer., Results: For patients, participation in the decision-making process was about being informed and feeling involved in the consultation process, whether patients actually made decisions or not. The perceived availability of treatment choices (surgery, radiotherapy, chemotherapy) was related to type of treatment. Factors that impacted on whether patients wanted to make decisions included a lack of information, a lack of medical knowledge and trust in medical expertise. Patients perceived that they could have a more participatory role in decisions related to physical and psychological care., Conclusion: This study has implications for health professionals aiming to implement policy guidelines that promote patient participation and shared partnerships. Patients in this study wanted to be well informed and involved in the consultation process but did not necessarily want to use the information they received to make decisions. The presentation of choices and preferences for participation may be context specific and it cannot be assumed that patients who do not want to make decisions about one aspect of their care and treatment do not want to make decisions about other aspects of their care and treatment.
- Published
- 2005
- Full Text
- View/download PDF
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