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Value of quality of life analysis in liver cancer: A clinician's perspective

World Journal of Hepatology 2017年第20期9卷 867-883页

作者： Leung Li winnie yeo Department of Clinical Oncology Prince of Wales HospitalFaculty of Medicinethe Chinese University of Hong KongChina

Health related quality of life(HRQOL) is increasingly recognized as an important clinical parameter and research endpoint in patients with hepatocellular carcinoma(HCC). HRQOL in HCC patients is multifaceted and affected by medical factor which encompasses HCC and its complications, oncological and palliative treatment for HCC, underlying liver disease, as well as the psychological, social or spiritual reaction to the disease. Many patients presented late with advanced disease and limited survival, plagued with multiple symptoms, rendering QOL a very important aspect in their general well being. Various instruments have been developed and validated to measure and report HRQOL in HCC patients, these included general HRQOL instruments, e.g., Short form(SF)-36, SF-12, Euro Qo L-5D, World Health Organization Quality of Life Assessment 100(WHOQOL-100), World Health Organization Quality of Life Assessment abbreviated version; general cancer HRQOL instruments, e.g., the European Organisation for Research and Treatment of Cancer(EORTC) QLQ-C30, Functional Assessment of Cancer Therapy(FACT)-General, Spitzer Quality of Life Index; and liver-cancer specific HRQOL instruments, e.g., EORTC QLQ-HCC18, FACT-Hepatobiliary(FACT-Hep), FACT-Hep Symptom Index, Trial Outcome Index. Important utilization of HRQOL in HCC patients included description of symptomatology and HRQOL of patients, treatment endpoint in clinical trial, prognostication of survival, benchmarking of palliative care service and health care valuation. In this review, difficulties regarding the use of HRQOL data in research and clinical practice, including choosing a suitable instrument, problems of missing data, data interpretation, analysis and presentation are examined. Potential solutions are also discussed.

关键词： Hepatocellular carcinoma Health related quality of life Palliative care Prognosis Survival The European Organisation for Research and Treatment of Cancer QLQ-C30 QLQ-HCC18 Index score Functional Assessment of Cancer Therapy EQ-5D Spitzer Short form 36 FHSI-8 World Health Organization Quality of Life Assessment

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Development of systemic therapy for hepatocellular carcinoma at 2013:Updates and insights

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World Journal of Gastroenterology 2014年第12期20卷 3135-3145页

作者： Stephen L Chan winnie yeo Department of Clinical Oncology The Chinese University of Hong KongPrince of Wales Hospital State Key Laboratory in Oncology in South China

A growing number of multi-targeted tyrosine kinase inhibitor(TKI)has undergone testing for hepatocellular carcinoma(HCC).Unfortunately,this enthusiasm has recently been discouraged by a number of negative phaseⅢstudies on several anti-angiogenic TKIs in HCC.Several postulations have been made to account for this phenomenon,namely the plateau effects of anti-angiogenesis approach,the heterogeneity of HCC in terms of background hepatitis/cirrhosis and tumor biology,as well as the way how clinical trials are designed.Regardless of the underlying reasons,these results suggested that alternative strategies are necessary to further develop systemic therapy for HCC.Several new strategies are currently evaluated:for examples,molecular agents with activities against targets other than vascular endothelial growth factor receptor are being evaluated in on-going clinical trials.In addition,different approaches of targeted agents in combination with various treatment modalities,such as concurrently with another molecular agent,cytotoxic chemotherapy or transarterial chemoembolization,are being developed.This review aims to give a summary on the results of recently released clinical trials on TKIs,followed by discussion on some of the potential novel agents and combinational approaches.Future directions for testing innovative systemic agents for HCC will also be discussed.

关键词： Liver neoplasms Systemic treatment Biologics Stagi

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Identification of optimal contemporary antiemetic prophylaxis for doxorubicin-cyclophosphamide chemotherapy in Chinese cancer patients: post-hoc analysis of 3 prospective studies

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Cancer Biology & Medicine 2021年第3期18卷 825-832页

作者： winnie yeo Leung Li Thomas KH Lau Kwai T Lai Vicky,TC Chan Kwan H Wong Christopher CH Yip Elizabeth Pang Maggie Cheung Vivian Chan Carol CH Kwok Joyce JS Suen Frankie KF Mo Department of Clinical Oncology Prince of Wales HospitalFaculty of MedicineHong Kong Cancer InstituteHong KongChina State Key Laboratory of Translational Oncology The Chinese University of Hong KongHong KongChina Department of Clinical Oncology Princess Margaret HospitalHong KongChina

Objective:Chemotherapy-induced nausea and vomiting(CINV)are common with doxorubicin-cyclophosphamide(AC)chemotherapy.Recommended antiemetic regimens incorporate neurokinin-1 receptor antagonist(NK1 RA),5-hydroxytryptamine type-3 receptor antagonist(5 HT3 RA),corticosteroid,and dopamine antagonists.This post-hoc analysis compared results of 3 prospective antiemetic studies conducted among Chinese breast cancer patients who received(neo)adjuvant AC,in order to identify optimal antiemetic prophylaxis.Methods:A total of 304 patients were included:Group 1,ondansetron/dexamethasone(D1);Group 2,aprepitant/ondansetron/dexamethasone(D1);Group 3,aprepitant/ondansetron/dexamethasone(D1–3);Group 4,aprepitant/ondansetron/dexamethasone(D1–3)/olanzapine;and Group 5,netupitant/palonosetron/dexamethasone(D1–3).Antiemetic efficacies of Groups 3,4,and 5 during cycle 1 of AC were individually compared with Group 1.In addition,emesis outcomes of patients in Groups 3 and 5,and those of Groups 2 and 3,were compared.Results:When comparing efficacies of a historical doublet(5 HT3 RA/dexamethasone)with triplet antiemetic regimens(NK1 RA/5 HT3 RA/dexamethasone)with/without olanzapine,complete response(CR)percentages and quality of life(QOL)in overall phase of cycle 1 AC were compared between Group 1 and the other groups:Group 1 vs.3,41.9%vs.38.3%(P=0.6849);Group 1 vs.4,41.9%vs.65.0%(P=0.0107);and Group 1 vs.5,41.9%vs.60.0%(P=0.0460).Groups 4 and 5 achieved a better QOL.When comparing netupitant-based(Group 3)with aprepitant-based(Group 5)triplet antiemetics,CR percentages were 38.3%vs.60.0%,respectively(P=0.0176);Group 5 achieved a better QOL.When comparing 1 day(Group 2)vs.3 day(Group 3)dexamethasone,CR percentages were 46.8%and 38.3%,respectively(P=0.3459);Group 3 had a worse QOL.Conclusions:Aprepitant-containing triplets were non-superior to doublet antiemetics.Netupitant-containing triplets and adding olanzapine to aprepitant-containing triplets were superior to doublets.Netupitant/palonosetron/dexamethasone was superior to aprepitant/

关键词： Netupitant palonosetron aprepitant olanzapine NEPA Asians

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International validation of the Chinese University Prognostic Index for staging of hepatocellular carcinoma: a joint United Kingdom and Hong Kong study

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Chinese Journal of Cancer 2014年第10期33卷 481-491页

作者： Stephen L.Chan Philip J.Johnson Frankie Mo Sarah Berhane Mabel Teng Anthony W.H.Chan Ming C.Poon Paul B.S.Lai Simon Yu Anthony T.C.Chan winnie yeo State Key Laboratory in Oncology in South China Sir YK Pao Center for CancerDepartment of Clinical OncologyHong Kong Cancer Institute and Prince of Wales HospitalThe Chinese University of Hong Kong School of Cancer Sciences University of Birmingham the Department of Molecular and Clinical Cancer Medicine Institute of Translational MedicineUniversity of Liverpool Department of Anatomical Cellular and PathologyThe Chinese University of Hong Kong Department of Surgery The Chinese University of Hong Kong Department of Radiology and Organ Imaging The Chinese University of Hong Kong

The outcome of hepatocellular carcinoma(HCC) patients significantly differs between western and eastern population centers. Our group previously developed and validated the Chinese University Prognostic Index(CUPI) for the prognostication of HCC among the Asian HCC patient population. In the current study, we aimed to validate the CUPI using an international cohort of patients with HCC and to compare the CUPI to two widely used staging systems, the Barcelona Clinic Liver Cancer(BCLC) classification and the Cancer of the Liver Italian Program(CLIP). To accomplish this goal, two cohorts of patients were enrolled in the United Kingdom(UK; n = 567; 2006-2011) and Hong Kong(HK; n = 517; 2007-2012). The baseline clinical data were recorded. The performances of the CUPI, BCLC, and CLIP were compared in terms of a concordance index(C-index) and were evaluated in subgroups of patients according to treatment intent. The results revealed that the median follow-up durations of the UK and HK cohorts were 27.9 and 29.8 months, respectively. The median overall survival of the UK and HK cohorts were 22.9 and 8.6 months, respectively. The CUPI stratified the patients in both cohorts into three risk subgroups corresponding to distinct outcomes. The median overall survival of the CUPI low-, intermediate-, and high-risk subgroups were 3.15, 1.24, and 0.29 years, respectively, in the UK cohort and were 2.07, 0.32, and 0.10 years, respectively, in the HK cohort. For the patients who underwent curative treatment, the prognostic performance did not differ between the three staging systems, and all were suboptimal. For those who underwent palliative treatment, the CUPI displayed the highest C-index, indicating that this staging system was the most informative for both cohorts. In conclusion, the CUPI is applicable to both western and eastern HCC patient populations. The performances of the three staging systems differed according to treatment intent, and the CUPI was demonstrated to be optimal for those undergoing palliative treatment. A

关键词：香港英国预后肝癌验证国际大学中国

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Lapatinib plus capecitabine in treating HER2-positive advanced breast cancer:efficacy,safety,and biomarker results from Chinese patients

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Chinese Journal of Cancer 2011年第5期30卷 327-335页

作者： Bing-He Xu Ze-Fei Jiang Daniel Chua Zhi-Min Shao Rong-Cheng Luo Xiao-Jia Wang Dong-Geng Liu winnie yeo Shi-Ying Yu Beth Newstat Alka Preston Anne-Marie Martin Hai-Dong Chi Li wang Department of Medical Oncology Cancer Hospital Chinese Academy of Medical Sciences Beijing 100021 P. R. China Breast Cancer Department PLA 307 Hospital Beijing 100071 P. R.China Queen Mary Hospital Hong Kong P. R. China Breast Cancer Surgical Department Shanghai Cancer Hospital Shanghai 200032 P. R.China Department of Medical Oncology Nanfang Hospital GuangzhouGuangdong 510515 P. R. China Department of Medical Oncology Zhejiang Provincial Cancer Hospital Hangzhou Zhejiang 310022 P. R.China Sun Yat-sen University Cancer Center GuangzhouGuangdong 510060P.R.China Prince of Wales Hospital Shatin New TerritoryHong Kong P. R. China Tongji Hospital Huazhong University of Scienceand Technology Tongji Medical College Wuhan Hubei 430030 P. R. China GlaxoSmithKline Company Collegeville PA USA GlaxoSmithKline Company Ltd Shanghai 200001 P. R. China

Overexpression of human epidermal growth factor receptor-2(HER2) in metastatic breast cancer(MBC) is associated with poor prognosis.This single-arm open-label trial(EGF109491;NCT00508274) was designed to confirm the efficacy and safety of lapatinib in combination with capecitabine in 52 heavily pretreated Chinese patients with HER2-positive MBC.The primary endpoint was clinical benefit rate(CBR).Secondary endpoints included progression-free survival(PFS),time to response(TTR),duration of response(DoR),central nervous system(CNS) as first site of relapse,and safety.The results showed that there were 23 patients with partial responses and 7 patients with stable disease,resulting in a CBR of 57.7%.The median PFS was 6.34 months(95% confidence interval,4.93-9.82 months).The median TTR and DoR were 4.07 months(range,0.03-14.78 months) and 6.93 months(range,1.45-9.72 months),respectively.Thirteen(25.0%) patients had new lesions as disease progression.Among them,2(3.8%) patients had CNS disease reported as the first relapse.The most common toxicities were palmar-plantar erythrodysesthesia(59.6%),diarrhea(48.1%),rash(48.1%),hyperbilirubinemia(34.6%),and fatigue(30.8%).Exploratory analyses of oncogenic mutations of PIK3CA suggested that of 38 patients providing a tumor sample,baseline PIK3CA mutation status was not associated with CBR(P = 0.639) or PFS(P = 0.989).These data confirm that the lapatinib plus capecitabine combination is an effective and well-tolerated treatment option for Chinese women with heavily pretreated MBC,irrespective of PIK3CA status.

关键词：治疗方案安全性乳腺癌生物标志物患者中国疗效阳性

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Risk factors and natural history of breast cancer in younger Chinese women

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World Journal of Clinical Oncology 2014年第5期5卷 1097-1106页

作者： winnie yeo Hang-Mei Lee Amy Chan Emily YY Chan Miranda CM Chan Keeng-Wai Chan Sharon WW Chan Foon-Yiu Cheung Polly SY Cheung Peter HK Choi Josette SY Chor William WL Foo Wing-Hong Kwan Stephen CK Law Lawrence PK Li Janice WH Tsang Yuk Tung Lorna LS Wong Ting-Ting Wong Chun-Chung Yau Tsz-Kok Yau Benny CY Zee Department of Clinical Oncology Chinese University of Hong Kong Prince of Wales Hospital Hong Kong Breast Cancer Foundation Jockey Club School of Public Health and Primary Care Chinese University of Hong Kong Department of Surgery Kwong Wah Hospital Diagnostix Pathology Laboratories Ltd Canossa Hospital Kowloon East Cluster Breast Centre Department of Surgery United Christian Hospital Department of Clinical Oncology Pamela Youde Nethersole Eastern Hospital Private Clinical Oncologist Radiotherapy and Oncology Centre Hong Kong Baptist Hospital Comprehensive Oncology Centre Hong Kong Sanatorium and Hospital Hong Kong Adventist Oncology Center Hong Kong Adventist Hospital Department of Clinical Oncology University of Hong Kong Department of Clinical Oncology Tuen Mun Hospital Private Surgeon Department of Clinical Oncology Princess Margaret Hospital

AIM: To investigate the age differences in the risk factors, clinicopathological characteristics and patterns of treatment of female breast cancer patients. METHODS: Seven thousand one hundred and fiftytwo women with primary breast cancer from the Hong Kong Breast Cancer Registry were recruited after receiving patients' consent, they were asked to complete standardized questionnaires which captured their sociodemographic characteristics and risk factors associated with breast cancer development. Among them, clinicopathological data and patterns of treatment were further collected from medical records of 5523 patients with invasive breast cancers. Patients were divided into two groups according to the age at diagnosis: younger(< 40 years old) vs older patients(≥ 40 years old) for subsequent analyses.RESULTS: Analysis on the sociodemographic characteristics and exposure to risk factors were performed on 7152 women with primary breast cancer and the results revealed that younger patients were more likely to have unhealthy lifestyles; these include a lack of exercise(85.4% vs 73.2%, P < 0.001), having high stress in life(46.1% vs 35.5%, P < 0.001), having dairy/meat-rich diets(20.2% vs 12.9%, P < 0.001),having alcohol drinking habit(7.7% vs 5.2%, P = 0.002). Younger patients were also more likely to have hormone-related risk factors including nulliparity(43.3% vs 17.8%, P < 0.001) and an early age at menarche(20.7% vs 13.2%, P < 0.001). Analyses on clinicopathological characteristics and patterns of treatment were performed on 5523 women diagnosed with invasive breast cancer. The invasive tumours in younger patients showed more aggressive pathological features such as having a higher percentage of grade 3 histology(45.7% vs 36.5%, P < 0.001), having a higher proportion of tumours with lymphovascular invasion(39.6% vs 33.2%, P = 0.003), and having multifocal disease(15.7% vs 10.3%, P < 0.001); they received different patterns of treatment than their older counterparts.CONCLUSION: Younger patients in Hong Kong are more

关键词： Hong Kong Breast Cancer Registry Breast cancer Younger Chinese women Sociodemographic characteristics Risk factors Clinicopathological characteristics Breast cancer treatment

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