Sunnybrook Odette Cancer Center

Toronto, Canada

Sunnybrook Odette Cancer Center

Toronto, Canada
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Bjarnason G.A.,Sunnybrook Odette Cancer Center
Canadian Urological Association Journal | Year: 2016

The recommended starting dose and schedule for sunitinib is 50 mg daily for 28 days, followed by a 14-day break with significant dose reductions to 37.5 mg (75% of starting dose), and then 25 mg (50% of starting dose) on the same schedule (four/two schedule). There are several reasons why these dose and scheduling recommendations may not be optimal for most patients, as outlined below. © 2016 Canadian Urological Association.

Cortes J.,Autonomous University of Barcelona | Andre F.,Institut Universitaire de France | Verma S.,Sunnybrook Odette Cancer Center
Annals of Oncology | Year: 2012

Background: There is an unmet therapeutic need in endocrine-resistant, hormone receptor (HR)-positive, human epidermal growth factor receptor 2-negative advanced breast cancer (BC). Preclinical studies support the hypothesis that the mammalian target of rapamycin (mTOR) inhibition could potentially overcome resistance to endocrine therapy. Materials and methods: A literature review regarding BC and mTOR inhibitors was undertaken. The reference lists from retrieved manuscripts were reviewed to identify further studies. Results: Phase II studies have reported that the combination of mTOR inhibitors with endocrine therapy shows efficacy in patients with advanced disease that progressed after treatment with aromatase inhibitors. The recent findings of the phase III BOLERO-2 confirmed that everolimus in combination with exemestane significantly improved progression-free survival and response rate, with a manageable safety profile. Conclusions: The addition of everolimus to exemestane for women with HR-positive metastatic BC is now considered a new therapeutic strategy. However, a word of caution should be added regarding toxic effects, which might limit practical use and compliance. It is essential that clinicians are educated about key recommendations for toxicity management and specific guideline dose modifications. Additional research efforts with the addition of these compounds in the early-stage setting is greatly needed to improve the survival of patients with HR-positive BC. © The Author 2012. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved.

Verma S.,Sunnybrook Odette Cancer Center | Miles D.,Mount Vernon Cancer Center | Gianni L.,San Raffaele Hospital | Krop I.E.,Dana-Farber Cancer Institute | And 10 more authors.
New England Journal of Medicine | Year: 2012

BACKGROUND: Trastuzumab emtansine (T-DM1) is an antibody-drug conjugate incorporating the human epidermal growth factor receptor 2 (HER2)-targeted antitumor properties of trastuzumab with the cytotoxic activity of the microtubule-inhibitory agent DM1. The antibody and the cytotoxic agent are conjugated by means of a stable linker. METHODS: We randomly assigned patients with HER2-positive advanced breast cancer, who had previously been treated with trastuzumab and a taxane, to T-DM1 or lapatinib plus capecitabine. The primary end points were progression-free survival (as assessed by independent review), overall survival, and safety. Secondary end points included progression-free survival (investigator-assessed), the objective response rate, and the time to symptom progression. Two interim analyses of overall survival were conducted. RESULTS: Among 991 randomly assigned patients, median progression-free survival as assessed by independent review was 9.6 months with T-DM1 versus 6.4 months with lapatinib plus capecitabine (hazard ratio for progression or death from any cause, 0.65; 95% confidence interval [CI], 0.55 to 0.77; P<0.001), and median overall survival at the second interim analysis crossed the stopping boundary for efficacy (30.9 months vs. 25.1 months; hazard ratio for death from any cause, 0.68; 95% CI, 0.55 to 0.85; P<0.001). The objective response rate was higher with T-DM1 (43.6%, vs. 30.8% with lapatinib plus capecitabine; P<0.001); results for all additional secondary end points favored T-DM1. Rates of grade 3 or 4 adverse events were higher with lapatinib plus capecitabine than with T-DM1 (57% vs. 41%). The incidences of thrombocytopenia and increased serum aminotransferase levels were higher with T-DM1, whereas the incidences of diarrhea, nausea, vomiting, and palmar-plantar erythrodysesthesia were higher with lapatinib plus capecitabine. CONCLUSIONS: T-DM1 significantly prolonged progression-free and overall survival with less toxicity than lapatinib plus capecitabine in patients with HER2-positive advanced breast cancer previously treated with trastuzumab and a taxane. (Funded by F. Hoffmann-La Roche/Genentech; EMILIA number, NCT00829166.) Copyright © 2012 Massachusetts Medical Society.

Ko Y.-J.,Sunnybrook Odette Cancer Center | Canil C.M.,Ottawa Regional Cancer Center | Mukherjee S.D.,Juravinski Cancer Center | Winquist E.,London Health Sciences Center | And 5 more authors.
The Lancet Oncology | Year: 2013

Background: No standard treatment exists for patients with platinum-refractory urothelial cancer. Taxanes and vinflunine are commonly used, but response is less than 20% with no survival benefit. In this phase 2 study, we assessed efficacy and tolerability of nanoparticle albumin-bound (nab) paclitaxel in platinum-refractory urothelial cancer. Methods: We did an open-label, single-group, two-stage study at five centres in Canada. We enrolled patients aged at least 18 years with histologically confirmed, locally advanced, or metastatic measurable urothelial cancer, with documented progression on or within 12 months of treatment with one previous platinum-containing regimen. Patients received nab-paclitaxel at 260 mg/m2 intravenously every 3 weeks. Treatment continued until disease progression or occurrence of unacceptable toxic effects. The primary endpoint was objective tumour response, defined by a complete response (CR) or partial response (PR) according to Response Evaluation Criteria In Solid Tumors (version 1.0) criteria. Tumour response and safety were assessed in all patients who received at least one cycle of nab-paclitaxel. This study is registered with, number NCT00683059. Findings: We enrolled 48 patients between Oct 16, 2008, and June 23, 2010. Patients received a median of six cycles (range one to 15). 47 patients were evaluable; one (2·1%) had a CR and 12 (25·5%) had PRs, resulting in an overall response of 27·7% (95% CI 17·3-44·4). The most frequently recorded adverse events of any grade were fatigue (38 of 48; 79%), pain (37 of 48; 77%), alopecia (34 of 48; 71%), and neuropathy (30 of 48; 77%). The most frequently recorded adverse events of grade 3 or higher were pain (11 of 48; 23%), fatigue (five of 48; 23%), hypertension (three of 48; 6%), neuropathy (three of 48, 6%), and joint stiffness or pain (two of 48; 4%). Interpretation: Nab-paclitaxel was well tolerated in this population of patients with pretreated advanced urothelial cancer with an encouraging tumour response. These results warrant further study of nab-paclitaxel in second-line treatment of urothelial cancer. Funding: Abraxis Bioscience, Celgene. © 2013 Elsevier Ltd.

Fitch M.I.,Sunnybrook Odette Cancer Center
Current Opinion in Oncology | Year: 2011

Purpose of Review: Interest in screening for distress in cancer patients has escalated in recent years. Despite widespread acknowledgement that screening ought to occur in daily practice, relatively few examples of successful programs exist. Recent Findings: Evidence about the need for identifying psychosocial distress is clear and there are suitable tools available to perform the screening. However, understanding about the complexities of implementing a practically sound and relevant program is still unfolding. Concerted and consistent efforts are required to achieve success in screening for distress and realize relevant outcomes. Summary: This article outlines a review of recent literature on screening for distress and the role of oncology nursing. Significant developments in the field of screening for distress in cancer are highlighted and on-going controversies are described. Suggestions for future research and clinical practice are presented. © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins.

Bartlett J.M.S.,Ontario Cancer Institute | Nofech-Moses S.,Sunnybrook Odette Cancer Center | Rakovitch E.,Sunnybrook Odette Cancer Center
Clinical Chemistry | Year: 2014

BACKGROUND: Screening for invasive cancer has led to a marked increase in the detection of ductal carcinoma in situ (DCIS). DCIS is, if appropriately managed, a low-risk disease which has a small chance of impacting on patient life expectancy. However, despite significant advances in prognostic marker development in invasive breast cancer, there are no validated diagnostic assays to inform treatment choice for women with DCIS. Therefore we are unable to target effective treatment strategies to women at high risk and avoid overtreatment of women at low risk of progression to invasive breast cancer. Paradoxically, one effect of this uncertainty is undertreatment of some women. CONTENT: We review current practice and research in the field to identify key challenges in the management of DCIS. The impact of clinical research, particularly on the over and undertreatment of women with DCIS is assessed.Wenote slow progress toward development of diagnostic biomarkers and highlight key opportunities to accelerate advances in this area. SUMMARY: DCIS is a low-risk disease, its incidence is increasing, and current treatment is effective. However, many women are either over- or undertreated. Despite repeated calls for development of diagnostic biomarkers, progress in this area has been slow, reflecting a relative lack of investment of research effort and funding. Given the low event rate in treated patients and the lateness of recurrences, many previous studies have only limited power to identify independent prognostic and predictive biomarkers. However, the potential for such biomarkers to personalize treatment for DCIS is extremely high. © 2013 American Association for Clinical Chemistry.

Fitch M.I.,Sunnybrook Odette Cancer Center
Canadian oncology nursing journal = Revue canadienne de nursing oncologique | Year: 2012

Many patients with advanced cancer have numerous medical complications and multiple sites involving metastases that cause distressing symptoms. Radiotherapy is often used for the palliative treatment of these patients, especially those with bone metastases. There is a lack of information about the types of supportive care needs these patients experience, the services that are available for them, and whether people want help with their needs. The main purpose of this cross-sectional, descriptive study was to identify the supportive care needs (physical, emotional, social, spiritual, psychological, and practical) of patients with advanced cancer who attended the Palliative Radiation Therapy Rapid Response Clinic (PRTRRC) at a comprehensive, ambulatory cancer centre. A second purpose was to determine if patients wanted assistance in meeting those needs. A total of 69 patients participated in this study by completing a self-report questionnaire. The data provided a clear indication that a range of supportive care needs remained unmet for this patient group. Lack of energy, pain, and concerns about the worries of those close to them were the most frequently reported needs. Additionally, patients expressed a range of difficulty managing needs and many of these patients desired help to manage the identified needs. However, despite this reality, significant numbers of patients indicated they did not wish to have assistance with some needs. Suggestions for practice and future research are offered to assist oncology nurses in providing supportive care to these patients.

Fitch M.I.,Sunnybrook Odette Cancer Center
Canadian oncology nursing journal = Revue canadienne de nursing oncologique | Year: 2012

The practice of routine screening for distress in cancer populations has been gaining worldwide support over the past several years with the conceptualization of distress as the sixth vital sign. Across Canada, experience with screening for distress is growing, as cancer facilities implement screening programs. Early learning from these efforts has emphasized the need for a programmatic approach and the importance of oncology nurses in screening and providing the initial response to distress. To date, little has been written from the nursing perspective about the oncology nursing role in a program screening for distress and responding to the identified patient concerns. This article describes the current thinking about distress; explores how screening for and responding to distress is integral to oncology nursing practice; and shares the early learning and experiences of cancer nurses in implementing screening for distress initiatives.

Verma S.,Sunnybrook Odette Cancer Center | Ewer M.S.,University of Texas M. D. Anderson Cancer Center
Annals of Oncology | Year: 2011

The cardiotoxicity of anthracyclines, trastuzumab and other agents is of special importance to adjuvant breast cancer patients whose life expectancy is restored to normal but who may be left with cardiac abnormalities that can present years later. We systematically reviewed the design of current trials (including adjuvant studies) on the Web site. Surprisingly few specify primary or secondary cardiac end points. Although cardiac ultrasound (echocardiography) and multiple uptake gated acquisition scintigraphy remain the most frequent techniques for estimating left ventricular ejection fraction, there is no consistency in the degree of reduction from baseline or absolute value taken as indicating cardiotoxicity. The details given do not suggest that diastolic function (which may give earlier warning of problems) is a focus of interest. There is growing interest in troponin as a marker of myocyte death and brain natriuretic peptide as a marker of myocardial stress and possible heart failure (though their clinical usefulness has still to be adequately defined). The duration of follow-up in many adjuvant studies may not be sufficient to determine the risk of late cardiac events. The findings indicate a need to study and standardize cardiac toxicity assessments inoncology trials. © The Author 2010. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved.

Gandhi S.,Sunnybrook Odette Cancer Center | Verma S.,Sunnybrook Odette Cancer Center
Oncologist | Year: 2011

Background. Women aged≥65 are generally underrepresented in early breast cancer studies. Therefore, the optimal management of this group of women remains less certain. Methods. Aliterature review of recently published trials, reviews, and practice guidelines outlining the surgical and adjuvant management of early breast cancer in older women was performed. Results. Surgery remains as the cornerstone treatment for early breast cancer in the elderly. Adjuvant radiation is generally considered if the projected lifespan is >5 years. Hormone receptor-positive disease is best treated with adjuvant endocrine treatment; aromatase inhibitors and tamoxifen are both options. Evidence for the use of adjuvant chemotherapy and trastuzumab for high-risk disease in the elderly is more limited. Polychemotherapy is still preferred in fit older women. Certain toxicities from systemic treatments can be more pronounced and should be carefully managed. Treatment with systemic agents should be individualized, with consideration of patient preference, performance status, comorbidities, and projected lifespan. Molecular tumor signatures may help better select patients for treatment in the future. Conclusions. Age in itself should not be an absolute contraindication to any breast cancer therapy. Comprehensive, multidisciplinary assessment of elderly patients is imperative in evaluating eligibility for beneficial therapies. © AlphaMed Press.

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