Publications by authors named "Helena Earl"

Article Synopsis
  • Current treatment options are limited by the expectation that alternative therapies must be proven "non-inferior" to existing ones, making trials expensive and complex.
  • Non-inferiority trials often overlook important factors like variability in treatment outcomes and place excessive burdens of proof on alternatives, especially in terms of toxicity and cost.
  • The authors suggest moving away from labeling trials as superiority or non-inferiority, advocating instead for a simpler description of trials as "comparative" to promote better patient-centered treatment options.
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PARTNER is a prospective, phase II-III, randomized controlled clinical trial that recruited patients with triple-negative breast cancer, who were germline BRCA1 and BRCA2 wild type. Here we report the results of the trial. Patients (n = 559) were randomized on a 1:1 basis to receive neoadjuvant carboplatin-paclitaxel with or without 150 mg olaparib twice daily, on days 3 to 14, of each of four cycles (gap schedule olaparib, research arm) followed by three cycles of anthracycline-based chemotherapy before surgery.

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Background: Adjuvant chemotherapy for patients with early breast cancer improves outcomes but its toxicity affects patients' quality of life (QOL). The UK TACT2 trial investigated whether accelerated epirubicin improves time to recurrence and if oral capecitabine is non-inferior to cyclophosphamide, methotrexate, and fluorouracil (CMF) for efficacy with less toxicity. Results showed no benefit for accelerated epirubicin and capecitabine was non-inferior.

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Objectives: To investigate the relationship between magnetization transfer (MT) imaging and tissue macromolecules in high-grade serous ovarian cancer (HGSOC) and whether MT ratio (MTR) changes following neoadjuvant chemotherapy (NACT).

Methods: This was a prospective observational study. 12 HGSOC patients were imaged before treatment.

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Article Synopsis
  • Previous studies confirmed that the residual cancer burden (RCB) after neoadjuvant chemotherapy predicts long-term outcomes in breast cancer, leading to a pooled analysis to explore this relationship across various cancer subtypes.
  • The analysis involved data from 5161 patients across 12 institutes in Europe and the USA, focusing on their clinical characteristics and the impact of RCB on event-free survival rates.
  • Findings highlighted that RCB scores were significant across all breast cancer subtypes, with higher scores correlating to poorer event-free survival outcomes, indicating the importance of RCB in treatment prognosis.
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Breast cancers are complex ecosystems of malignant cells and the tumour microenvironment. The composition of these tumour ecosystems and interactions within them contribute to responses to cytotoxic therapy. Efforts to build response predictors have not incorporated this knowledge.

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Article Synopsis
  • The study aimed to compare the effectiveness of 6 months versus 12 months of adjuvant trastuzumab in treating HER2-positive early breast cancer, with the main goal of determining if the shorter duration was as effective in preventing disease recurrence after 4 years.
  • Conducted as a Phase III randomized controlled trial across 152 NHS hospitals, it involved 4,088 patients who were randomly assigned to receive either 6 or 12 months of trastuzumab treatment alongside chemotherapy.
  • The primary outcome measured was disease-free survival, while secondary outcomes included overall survival, cost-effectiveness, and cardiac function, with an emphasis on showing that the shorter treatment duration remains within a non-inferiority
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Background: The ICON8 study reported no significant improvement in progression-free survival (a primary endpoint) with weekly chemotherapy compared with standard 3-weekly treatment among patients with epithelial ovarian cancer. All ICON8 patients were eligible to take part in the accompanying health-related quality-of-life study, which measured the effect of treatment on self-reported wellbeing, reported here.

Methods: In this open-label, randomised, controlled, phase 3, three-arm, Gynecologic Cancer Intergroup (GCIG) trial done at 117 hospital sites in the UK, Australia, New Zealand, Mexico, South Korea, and Republic of Ireland, women (aged at least 18 years) with newly diagnosed, histologically confirmed International Federation of Gynecology and Obstetrics stage IC-IV ovarian cancer and an Eastern Cooperative Oncology Group performance status of 0-2 were randomly assigned (1:1:1) centrally using minimisation to group 1 (intravenous carboplatin area under the curve [AUC]5 or AUC6 and 175 mg/m intravenous paclitaxel every 3 weeks), group 2 (carboplatin AUC5 or AUC6 every 3 weeks and 80 mg/m paclitaxel weekly), or group 3 (carboplatin AUC2 weekly and 80 mg/m paclitaxel weekly).

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This position statement from the Heart Failure Association of the European Society of Cardiology Cardio-Oncology Study Group in collaboration with the International Cardio-Oncology Society presents practical, easy-to-use and evidence-based risk stratification tools for oncologists, haemato-oncologists and cardiologists to use in their clinical practice to risk stratify oncology patients prior to receiving cancer therapies known to cause heart failure or other serious cardiovascular toxicities. Baseline risk stratification proformas are presented for oncology patients prior to receiving the following cancer therapies: anthracycline chemotherapy, HER2-targeted therapies such as trastuzumab, vascular endothelial growth factor inhibitors, second and third generation multi-targeted kinase inhibitors for chronic myeloid leukaemia targeting BCR-ABL, multiple myeloma therapies (proteasome inhibitors and immunomodulatory drugs), RAF and MEK inhibitors or androgen deprivation therapies. Applying these risk stratification proformas will allow clinicians to stratify cancer patients into low, medium, high and very high risk of cardiovascular complications prior to starting treatment, with the aim of improving personalised approaches to minimise the risk of cardiovascular toxicity from cancer therapies.

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Identifying the underlying genetic drivers of the heritability of breast cancer prognosis remains elusive. We adapt a network-based approach to handle underpowered complex datasets to provide new insights into the potential function of germline variants in breast cancer prognosis. This network-based analysis studies ~7.

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Background: Carboplatin and paclitaxel administered every 3 weeks is standard-of-care first-line chemotherapy for epithelial ovarian cancer. The Japanese JGOG3016 trial showed a significant improvement in progression-free and overall survival with dose-dense weekly paclitaxel and 3-weekly carboplatin. In this study, we aimed to compare efficacy and safety of two dose-dense weekly regimens to standard 3-weekly chemotherapy in a predominantly European population with epithelial ovarian cancer.

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Important oncological management decisions rely on kidney function assessed by serum creatinine-based estimated glomerular filtration rate (eGFR). However, no large-scale multicenter comparisons of methods to determine eGFR in patients with cancer are available. To compare the performance of formulas for eGFR based on routine clinical parameters and serum creatinine not calibrated with isotope dilution mass spectrometry, we studied 3620 patients with cancer and 166 without cancer who had their glomerular filtration rate (GFR) measured with an exogenous nuclear tracer at one of seven clinical centers.

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This study assessed the feasibility of using diffusion kurtosis imaging (DKI) as a measure of tissue heterogeneity and proliferation to predict the response of high grade serous ovarian cancer (HGSOC) to neoadjuvant chemotherapy (NACT). Seventeen patients with HGSOC were imaged at 3 T and had biopsy samples taken prior to any treatment. The patients were divided into two groups: responders and non-responders based on Response Evaluation Criteria In Solid Tumours (RECIST) criteria.

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Article Synopsis
  • A study investigated whether a shorter 6-month treatment of trastuzumab for HER2-positive early breast cancer is as effective as the standard 12-month treatment in improving disease-free survival.
  • This was a large, randomized trial involving over 4,000 patients from 152 centers in the UK, comparing the two treatment durations.
  • Results showed that the 4-year disease-free survival rates were similar for both groups, with 89.4% for the 6-month treatment and 89.8% for the 12-month treatment, indicating that shorter treatment could be a viable option.
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The aim of this study was to assess the feasibility of rapid sodium MRI (Na-MRI) for the imaging of peritoneal cancer deposits in high grade serous ovarian cancer (HGSOC) and to evaluate the relationship of Na-MRI with tumour cellularity. Na-MRI was performed at 3 T on twelve HGSOC patients using a 3D-cones acquisition technique. Tumour biopsies specimens were collected after imaging and cellularity was measured from histology.

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Article Synopsis
  • A large meta-analysis examined how germline variants impact breast cancer mortality in women of European ancestry, analyzing data from around 96,661 patients.
  • The study used data from approximately 10.4 million variants and found that no variant was strongly associated with breast cancer-specific mortality, although a couple of variants on chromosome 7 showed some significance for ER-positive and ER-negative breast cancer.
  • The findings suggest that while there are specific genetic variants related to breast cancer outcomes, there is still a significant challenge in using genetic information to predict mortality in breast cancer patients.
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Background: Twelve months treatment is the current standard of care for adjuvant trastuzumab in patients with HER2 positive early breast cancer however the optimal duration is not known. Persephone is a non-inferiority randomised controlled trial comparing 6- to 12-months of trastuzumab. In this trial there will be a trade-off between a possible small decrease in disease-free survival (DFS) with 6-months and reduced cardiotoxicity and cost.

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Background: Precision medicine is heralded as offering more effective treatments to smaller targeted patient populations. In breast cancer, adjuvant chemotherapy is standard for patients considered as high-risk after surgery. Molecular tests may identify patients who can safely avoid chemotherapy.

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Background: There is increasing evidence that elevated body mass index (BMI) is associated with reduced survival for women with breast cancer. However, the underlying reasons remain unclear. We conducted a Mendelian randomization analysis to investigate a possible causal role of BMI in survival from breast cancer.

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Background: An absence of reliable molecular markers has hampered individualised breast cancer treatments, and a major limitation for translational research is the lack of fresh tissue. There are, however, abundant banks of formalin-fixed paraffin-embedded (FFPE) tissue. This study evaluated two platforms available for the analysis of DNA copy number and gene expression using FFPE samples.

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