Smith I.E.; Johnson L.; Dowsett M.; R. Robertson J.F.; Robison L.E.; Kokan J.S. et al; Journal of Clinical Oncology

Trial of perioperative endocrine therapy: Individualizing care (POETIC) – conference abstract

Citation: Journal of Clinical Oncology, May 2011, vol./is. 29/15 SUPPL. 1, 0732-183X (20 May 2011)

Author(s): Smith I.E.; Johnson L.; Dowsett M.; R. Robertson J.F.; Robison L.E.; Kokan J.S. et al
Language: English

Abstract: Background: The neoadjuvant IMPACT trial suggested Ki67 levels after 2 weeks endocrine therapy predicts long-term outcome. Major changes in gene expression have also been seen in ER+ breast cancer after aromatase inhibitor (AI) treatment. POETIC evaluates whether changes in Ki67 level after 2 weeks treatment predicts for relapse-free survival (RFS) more effectively than the baseline value. It also tests whether gene expression profile at this timepoint provides more accurate prognostic and predictive information than the pre-treatment profile. Experimental evidence suggests peri-operative endocrine therapy may improve disease outcome. This hypothesis is also addressed in POETIC. (ISRCTN63882543 ) With a sample size of 4000, an improvement in 5 year relapse from 10% to 7% could be detected with 91% power (two sided alpha of 5%), as would a 1.3 fold difference in the ability of Ki67 to predict RFS (90% power, two sided 5% significance level). Target recruitment is 4000 patients from 100 UK hospitals over 3-4 years.

Methods: Patients are randomised in the ratio of 2:1 to perioperative AI (letrozole 2.5mg or anastrozole 1mg daily) starting 2 weeks before planned surgery until 2 weeks after surgery. FFPE and RNA-later samples are taken prior to trial entry (baseline) and at surgery. Eligible patients are postmenopausal with ER+ invasive breast cancer. Consent to take additional research tissue is sought from patients undergoing diagnostic biopsy. Consenting patients donate tumour tissue in RNA-later and/or a FFPE research sample and enter POETIC following diagnosis of ER+ breast cancer. Matching tumour tissue is taken at surgery. Where an RNA-later sample at baseline is unavailable, consenting patients may undergo a further biopsy for research tissue immediately before study entry. Where consent procedures at diagnosis present logistical challenges, sites may provide FFPE tissue left over from diagnosis only. The 1st patient was entered in September 2008, and by January 2011 102 UK hospitals open and 1200 patients were entered. 182 optional RNA-later samples at both time points are available. Current success is due to a flexible approach to tissue sample collection and overcoming local and national logistical challenges.

Conference Information: ASCO Annual Meeting 2011 Chicago, IL United States.

Conference Start: 20110603 Conference End: 20110607

Publisher: American Society of Clinical Oncology

Publication Type: Journal: Conference Abstract

Map of Medicine News

Local news spotlight:  North Mersey

North Mersey have localised over 80 care maps, carefully designed to tackle clinical or commissioning issues in their area as part of their QIPP scheme.

The North Mersey view covers all primary and secondary care Trusts within Liverpool, Sefton and Knowsley, and each area has its own view on the Map.
Dave Lawless, Project Manager for Map of Medicine in North Mersey, says: ‘In North Mersey we market Map of Medicine as the Yellow Pages for clinicians. All localised pathways contain specific information to add weight to the pathways, such as patient information leaflets and local clinic contact details. Pathways are accessed on all GPs’ PCs across the region and benefits are monitored by accessing Map of Medicine usage and referral rates.’

Athens users: can visit the Map here and select ‘International’ / ‘England’ or your local view.

Coming soon: Next month’s publication will include new care maps on Knee injuries and Perinatal mental health. In the meantime, 23-29 April is Orchid Male Cancer Awareness Week, so take a look at Prostate cancer and Testicular cancer care maps, both updated in February with the latest evidence.

King’s Fund: Palliative care articles

School for Social Care Research, London School of Economics and Political Science

End of life care: methods review
This review provides an overview of the range of research methods that have been commonly used in end of life care research and their relevance for social care. It provides a policy and service context for understanding end of life care research in social care and, using examples from relevant research, considers the advantages and disadvantages of different research methods and tools. The particular ethical challenges and practical issues that may arise are discussed along with some strategies and sources of support to address them.

Helen & Douglas House

A review of palliative care for children and young adults in the Thames Valley
Helen & Douglas House has commissioned and authored a collaborative review of palliative care need and provision in the region for patients up to the age of 40 years. The findings of the review are presented as a consultative report, with provisional recommendations at national, regional and organisational levels. It highlights a number of key findings, including that there is a lack of palliative care studies relating to young adults.

The King’s Fund: Inpatient Survey Results 2011

Inpatient survey 2011
This survey looked at the experiences of over 70,000 people who were admitted to NHS hospitals around England. The results of the survey will be used by NHS trusts to improve their performance and to understand their patients’ experiences, and the results will be used to support the CQC’s regulatory, compliance and monitoring activities.

East Cheshire’s results showed they remained ‘about the same’ compared to other Trusts.

Wellcome backs proposal – to share academic journals freely online

One of the world’s largest funders of science is to throw its weight behind a growing campaign to break the stranglehold of academic journals and allow all research papers to be shared online.

Nearly 9,000 researchers have already signed up to a boycott of journals that restrict free sharing as part of a campaign dubbed the “academic spring” by supporters due to its potential for revolutionising the spread of knowledge. But the intervention of the Wellcome Trust, the largest non-governmental funder of medical research after the Bill & Melinda Gates Foundation, is likely to galvanise the movement by forcing academics it funds to publish in open online journals. Continue reading

Risk of skin and soft tissue infections (including shingles) in patients exposed to anti-tumour necrosis factor therapy:

Risk of skin and soft tissue infections (including shingles) in patients exposed to anti-tumour necrosis factor therapy: results from the British Society for Rheumatology …

JB Galloway, LK Mercer, A Moseley, WG Dixon… – Annals of the Rheumatic …, 2012
Hope Hospital, Salford (Dr Romela Benitha); King’s College Hospital, London, Macclesfield District General Hospital, Macclesfield (Dr Susan Knight)
Dr Knight was one of a number of consultants  acknowledged in this publication for their ‘enthusiastic collaboration’.