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Pancreatic Neoplasms: HELP
Articles by Peter P. Metrakos
Based on 9 articles published since 2009
(Why 9 articles?)

Between 2009 and 2019, P. Metrakos wrote the following 9 articles about Pancreatic Neoplasms.
+ Citations + Abstracts
1 Guideline Consensus Recommendations for the Diagnosis and Management of Pancreatic Neuroendocrine Tumors: Guidelines from a Canadian National Expert Group. 2015

Singh, Simron / Dey, Chris / Kennecke, Hagen / Kocha, Walter / Maroun, Jean / Metrakos, Peter / Mukhtar, Tariq / Pasieka, Janice / Rayson, Daniel / Rowsell, Corwyn / Sideris, Lucas / Wong, Ralph / Law, Calvin. ·Department of Medicine, Odette Cancer Centre - Sunnybrook Hospital, University of Toronto, Toronto, ON, Canada, simron.singh@sunnybrook.ca. ·Ann Surg Oncol · Pubmed #25366583.

ABSTRACT: Pancreatic neuroendocrine tumors (pNETs) are rare heterogeneous tumors that have been steadily increasing in both incidence and prevalence during the past few decades. Pancreatic NETs are categorized as functional (F) or nonfunctional (NF) based on their ability to secrete hormones that elicit clinically relevant symptoms. Specialized diagnostic tests are required for diagnosis. Treatment options are diverse and include surgical resection, intraarterial hepatic therapy, and peptide receptor radionuclide therapy (PRRT). Systemic therapy options include targeted agents as well as chemotherapy when indicated. Diagnosis and management should occur through a collaborative team of health care practitioners well-experienced in managing pNETs. Recent advances in pNET treatment options have led to the development of the Canadian consensus document described in this report. The discussion includes the epidemiology, classification, pathology, clinical presentation and prognosis, imaging and laboratory testing, medical and surgical management, and recommended treatment algorithms for pancreatic neuroendocrine cancers.

2 Clinical Trial Sunitinib in pancreatic neuroendocrine tumors: updated progression-free survival and final overall survival from a phase III randomized study. 2017

Faivre, S / Niccoli, P / Castellano, D / Valle, J W / Hammel, P / Raoul, J-L / Vinik, A / Van Cutsem, E / Bang, Y-J / Lee, S-H / Borbath, I / Lombard-Bohas, C / Metrakos, P / Smith, D / Chen, J-S / Ruszniewski, P / Seitz, J-F / Patyna, S / Lu, D R / Ishak, K J / Raymond, E. ·Medical Oncology and Gastroenterology Department, Service Inter-Hospitalier de Cancérologie, Hôpital Beaujon and Paris Diderot University, Clichy. · Cancer Care, Institut Paoli-Calmettes, and RENATEN Network, Marseille, France. · Department of Medical Oncology, Hospital Universitario 12 de Octubre, Madrid, Spain. · Medical Oncology Department, The University of Manchester/The Christie NHS Foundation Trust, Manchester, UK. · Translational Medicine - Digestive Cancers, Institut Paoli-Calmettes and RENATEN Network, Marseille, France. · Eastern Virginia Medical School Streilitz Diabetes Research Center and Neuroendocrine Unit, Norfolk, USA. · Digestive Oncology Unit, University Hospitals Leuven and KU Leuven, Leuven, Belgium. · Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea. · Hepato-Gastroenterology Unit, Cliniques Universitaires Saint-Luc, Brussels, Belgium. · Medical Oncology Department, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France. · McGill University Hospital Centre, Montreal, Canada. · Oncology Department, University Hospital, Bordeaux, France. · Linkou Chang Gung Memorial Hospital and Chang Gung University, Tao-Yuan, Taiwan. · Centre Hospitalier Universitaire Timone, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille Université, and RENATEN Network, Marseille, France. · Pfizer Oncology, La Jolla, USA. · Department of Evidera, St-Laurent, Canada. ·Ann Oncol · Pubmed #27836885.

ABSTRACT: Background: In a phase III trial in patients with advanced, well-differentiated, progressive pancreatic neuroendocrine tumors, sunitinib 37.5 mg/day improved investigator-assessed progression-free survival (PFS) versus placebo (11.4 versus 5.5 months; HR, 0.42; P < 0.001). Here, we present PFS using retrospective blinded independent central review (BICR) and final median overall survival (OS), including an assessment highlighting the impact of patient crossover from placebo to sunitinib. Patients and methods: In this randomized, double-blind, placebo-controlled study, cross-sectional imaging from patients was evaluated retrospectively by blinded third-party radiologists using a two-reader, two-time-point lock, followed by a sequential locked-read, batch-mode paradigm. OS was summarized using the Kaplan-Meier method and Cox proportional hazards model. Crossover-adjusted OS effect was derived using rank-preserving structural failure time (RPSFT) analyses. Results: Of 171 randomized patients (sunitinib, n = 86; placebo, n = 85), 160 (94%) had complete scan sets/time points. By BICR, median (95% confidence interval [CI]) PFS was 12.6 (11.1-20.6) months for sunitinib and 5.8 (3.8-7.2) months for placebo (HR, 0.32; 95% CI 0.18-0.55; P = 0.000015). Five years after study closure, median (95% CI) OS was 38.6 (25.6-56.4) months for sunitinib and 29.1 (16.4-36.8) months for placebo (HR, 0.73; 95% CI 0.50-1.06; P = 0.094), with 69% of placebo patients having crossed over to sunitinib. RPSFT analysis confirmed an OS benefit for sunitinib. Conclusions: BICR confirmed the doubling of PFS with sunitinib compared with placebo. Although the observed median OS improved by nearly 10 months, the effect estimate did not reach statistical significance, potentially due to crossover from placebo to sunitinib. Trial registration number: NCT00428597.

3 Clinical Trial Patient-Reported Outcomes and Quality of Life with Sunitinib Versus Placebo for Pancreatic Neuroendocrine Tumors: Results From an International Phase III Trial. 2016

Vinik, Aaron / Bottomley, Andrew / Korytowsky, Beata / Bang, Yung-Jue / Raoul, Jean-Luc / Valle, Juan W / Metrakos, Peter / Hörsch, Dieter / Mundayat, Rajiv / Reisman, Arlene / Wang, Zhixiao / Chao, Richard C / Raymond, Eric. ·Strelitz Diabetes Research Center and Neuroendocrine Unit, Eastern Virginia Medical School, Strelitz Diabetes Center, Norfolk, VA, USA. vinikai@evms.edu. · Quality of Life Department, European Organization for Research and Treatment of Cancer, Brussels, Belgium. · Pfizer Inc, New York, NY, USA. · Seoul National University College of Medicine, Seoul, Korea. · Paoli-Calmettes Institute, Marseille, France. · The University of Manchester/The Christie NHS Foundation Trust, Manchester, UK. · McGill University Hospital Center, Montreal, Canada. · Bad Berka Central Clinic, Bad Berka, Germany. · Pfizer Oncology, La Jolla, CA, USA. · Hôpital Beaujon, Clichy, France. ·Target Oncol · Pubmed #27924459.

ABSTRACT: OBJECTIVE: The objective of this analysis was to compare patient-reported outcomes and health-related quality of life (HRQoL) in a pivotal phase III trial of sunitinib versus placebo in patients with progressive, well-differentiated pancreatic neuroendocrine tumors (NCT00428597). PATIENTS AND METHODS: Patients received sunitinib 37.5 mg (n = 86) or placebo (n = 85) on a continuous daily-dosing schedule until disease progression, unacceptable adverse events (AEs), or death. Patients completed the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 at baseline, Day 1 of every 4-week cycle, and end of treatment or withdrawal. Changes ≥10 points on each scale or item were deemed clinically meaningful. RESULTS: Sunitinib had anti-tumor effects and improved progression-free survival (PFS) compared with placebo. The study was terminated early for this reason and because of more serious AEs and deaths with placebo. Baseline HRQoL scores were well balanced between study arms, and were generally maintained over time in both groups. In the first 10 cycles, there were no significant differences between groups in global HRQoL, cognitive, emotional, physical, role, and social functioning domains, or symptom scales, except for worsening diarrhea with sunitinib (p < 0.0001 vs. placebo). Insomnia also worsened with sunitinib (p = 0.0372 vs. placebo), but the difference was not clinically meaningful. CONCLUSION: With the exception of diarrhea (a recognized side effect), sunitinib had no impact on global HRQoL, functional domains, or symptom scales during the progression-free period. Hence, in patients with pancreatic neuroendocrine tumors, sunitinib provided a benefit in PFS without adversely affecting HRQoL.

4 Clinical Trial Sunitinib malate for the treatment of pancreatic neuroendocrine tumors. 2011

Raymond, Eric / Dahan, Laetitia / Raoul, Jean-Luc / Bang, Yung-Jue / Borbath, Ivan / Lombard-Bohas, Catherine / Valle, Juan / Metrakos, Peter / Smith, Denis / Vinik, Aaron / Chen, Jen-Shi / Hörsch, Dieter / Hammel, Pascal / Wiedenmann, Bertram / Van Cutsem, Eric / Patyna, Shem / Lu, Dongrui Ray / Blanckmeister, Carolyn / Chao, Richard / Ruszniewski, Philippe. ·Service Inter-Hospitalier de Cancérologie et Service de Gastroenteropancréatologie, Hôpital Beaujon, Clichy, France. eric.raymond@bjn.aphp.fr ·N Engl J Med · Pubmed #21306237.

ABSTRACT: BACKGROUND: The multitargeted tyrosine kinase inhibitor sunitinib has shown activity against pancreatic neuroendocrine tumors in preclinical models and phase 1 and 2 trials. METHODS: We conducted a multinational, randomized, double-blind, placebo-controlled phase 3 trial of sunitinib in patients with advanced, well-differentiated pancreatic neuroendocrine tumors. All patients had Response Evaluation Criteria in Solid Tumors-defined disease progression documented within 12 months before baseline. A total of 171 patients were randomly assigned (in a 1:1 ratio) to receive best supportive care with either sunitinib at a dose of 37.5 mg per day or placebo. The primary end point was progression-free survival; secondary end points included the objective response rate, overall survival, and safety. RESULTS: The study was discontinued early, after the independent data and safety monitoring committee observed more serious adverse events and deaths in the placebo group as well as a difference in progression-free survival favoring sunitinib. Median progression-free survival was 11.4 months in the sunitinib group as compared with 5.5 months in the placebo group (hazard ratio for progression or death, 0.42; 95% confidence interval [CI], 0.26 to 0.66; P<0.001). A Cox proportional-hazards analysis of progression-free survival according to baseline characteristics favored sunitinib in all subgroups studied. The objective response rate was 9.3% in the sunitinib group versus 0% in the placebo group. At the data cutoff point, 9 deaths were reported in the sunitinib group (10%) versus 21 deaths in the placebo group (25%) (hazard ratio for death, 0.41; 95% CI, 0.19 to 0.89; P=0.02). The most frequent adverse events in the sunitinib group were diarrhea, nausea, vomiting, asthenia, and fatigue. CONCLUSIONS: Continuous daily administration of sunitinib at a dose of 37.5 mg improved progression-free survival, overall survival, and the objective response rate as compared with placebo among patients with advanced pancreatic neuroendocrine tumors. (Funded by Pfizer; ClinicalTrials.gov number, NCT00428597.).

5 Article EUS-IR-Guided Revision of Whipple Anatomy for Concomitant Afferent and Efferent Limb Obstruction. 2018

Chen, Yen-I / Miller, Corey S / Hashim, Ahmad / Valenti, David / Metrakos, Peter / Barkun, Jeffrey / Zogopoulos, George / Barkun, Alan N / Bessissow, Ali. ·Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, QC, Canada. Department of Radiology, McGill University Health Centre, Montreal, QC, Canada. Department of Surgery, McGill University Health Centre, Montreal, QC, Canada. ·Am J Gastroenterol · Pubmed #30464305.


6 Article Increased in vitro and in vivo sensitivity of BRCA2-associated pancreatic cancer to the poly(ADP-ribose) polymerase-1/2 inhibitor BMN 673. 2015

Andrei, Alexandra-Zoe / Hall, Anita / Smith, Alyssa L / Bascuñana, Claire / Malina, Abba / Connor, Ashton / Altinel-Omeroglu, Gulbeyaz / Huang, Sidong / Pelletier, Jerry / Huntsman, David / Gallinger, Steven / Omeroglu, Atilla / Metrakos, Peter / Zogopoulos, George. ·Rosalind and Morris Goodman Cancer Research Centre, McGill University, 1160 Pine Ave. West, Montreal, Quebec, Canada H3A 1A3; The Research Institute of the McGill University Health Centre, 1001 Decarie Boulevard, Montreal, Quebec, Canada H4A 3J1. · Department of Biochemistry, McGill University, 3655 Promenade Sir William Osler, Montreal, Quebec, Canada H3G 1Y6. · The Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, 600 University Avenue, Toronto, Ontario, Canada M5G 1X5. · Department of Pathology, McGill University Health Centre, 1001 Decarie Boulevard, Montreal, Quebec, Canada H4A 3J1. · Rosalind and Morris Goodman Cancer Research Centre, McGill University, 1160 Pine Ave. West, Montreal, Quebec, Canada H3A 1A3; Department of Biochemistry, McGill University, 3655 Promenade Sir William Osler, Montreal, Quebec, Canada H3G 1Y6. · Centre for the Translational and Applied Genomics, British Columbia Cancer Agency, 675 West 10th Avenue, Vancouver, British Columbia, Canada V5Z 1L4. · The Research Institute of the McGill University Health Centre, 1001 Decarie Boulevard, Montreal, Quebec, Canada H4A 3J1. · Rosalind and Morris Goodman Cancer Research Centre, McGill University, 1160 Pine Ave. West, Montreal, Quebec, Canada H3A 1A3; The Research Institute of the McGill University Health Centre, 1001 Decarie Boulevard, Montreal, Quebec, Canada H4A 3J1. Electronic address: george.zogopoulos@mcgill.ca. ·Cancer Lett · Pubmed #25864590.

ABSTRACT: BRCA2-associated pancreatic ductal adenocarcinoma (PDAC) may be sensitive to agents that target homology-directed DNA repair, such as DNA crosslinking agents (DCLs) and PARP inhibitors (PARPis). Here, we assessed the sensitivities of BRCA2-deficient (Capan-1) and BRCA2-proficient (MIA PaCa-2) PDAC cell lines to a panel of DCLs and PARPis. Compared to MIA PaCa-2, Capan-1 was significantly more sensitive to all tested DCLs and PARPis, with similar increased sensitivities to cisplatin and the PARPi BMN 673 compared to other DCLs and the PARPi veliparib. We provide further support for this observation by showing that shRNA-mediated BRCA2 knockdown in PANC-1, a BRCA2-proficient cell line, induces sensitization to cisplatin and BMN 673 but not to veliparib. These findings were validated in a PDAC murine xenograft model derived from a patient with bi-allelic BRCA2 mutations. We found 64% and 61% tumor growth inhibition of this xenograft with cisplatin and BMN 673 treatments, respectively. Cisplatin and BMN 673 treatments reduced cellular proliferation and induced apoptosis. Our findings support a personalized treatment approach for BRCA2-associated PDAC.

7 Article McGill Brisbane Symptom Score for patients with resectable pancreatic head adenocarcinoma. 2014

Jamal, Mohammed H / Doi, Suhail A R / Moser, A James / Dumitra, Sinziana / abou Khalil, Jad / Simoneau, Eve / Chaudhury, Prosanto / Onitilo, Adedayo A / Metrakos, Peter / Barkun, Jeffrey S. ·Mohammed H Jamal, Sinziana Dumitra, Jad abou Khalil, Eve Simoneau, Prosanto Chaudhury, Peter Metrakos, Jeffrey S Barkun, Hepato-biliary, Pancreatic and Liver Transplant Surgery, McGill University Health Center, Montreal QCH3A 1A1, Canada. ·World J Gastroenterol · Pubmed #25232256.

ABSTRACT: AIM: To evaluate the ability of the McGill Brisbane Symptom Score (MBSS) to predict survival in resectable pancreatic head adenocarcinoma (PHA) patients. METHODS: All PHA patients (n = 83) undergoing pancreaticoduodenectomy at the McGill University Health Center, Quebec between 1/2001-1/2010 were evaluated. Data related to patient and cancer characteristics, MBSS variables, and treatment were collected; univariable and multivariable survival analyses were performed. We obtained complete follow-up until February 2011 in all patients through the database of the provincial health insurance plan of Quebec. The unique health insurance numbers of these patients were used to retrieve information from this database which captures all billable clinical encounters, and ensures 100% actual survival data. RESULTS: Median survival was 23 mo overall: 45 mo for patients with low MBSS, 17 mo for high MBSS (P = 0.005). At twelve months survival was 83.3% (95%CI: 66.6-92.1) vs 58.1% (95%CI: 42.1-71.2) in those with low vs high MBSS, and 24 mo survival was 63.8% (95%CI: 45.9-77.1) and 34.0% (95%CI: 20.2-48.2) respectively. In the multivariate Cox model (stratified by chemotherapy), after addition of clinically meaningful covariates, MBSS was the variable with the strongest association with survival (HR = 2.63; P = 0.001). Adjuvant chemotherapy interacted with MBSS category such that only high MBSS patients accrued a benefit. In univariate analysis we found a lower mortality in high MBSS but not low MBSS patients receiving adjuvant chemotherapy. This interaction variable, on Cox model, resulted in an adjusted mortality HR for the high MBSS (compared to low MBSS) of 4.14 (95%CI: 1.48-11.64) without chemotherapy and 2.11 (95%CI: 1.06-4.17) with chemotherapy. CONCLUSION: The MBSS is a simple prognostic tool for resectable PHA. Preoperative categorization of patients according to the MBSS allows effective stratification of patients to guide therapy.

8 Article Pancreatic cancer and predictors of survival: comparing the CA 19-9/bilirubin ratio with the McGill Brisbane Symptom Score. 2013

Dumitra, Sinziana / Jamal, Mohammad H / Aboukhalil, Jad / Doi, Suhail A / Chaudhury, Prosanto / Hassanain, Mazen / Metrakos, Peter P / Barkun, Jeffrey S. ·Department of Surgery, McGill University Health Center, Montreal, QC, Canada. ·HPB (Oxford) · Pubmed #23521164.

ABSTRACT: INTRODUCTION: Few tools predict survival from pancreatic cancer (PAC). The McGill Brisbane Symptom Score (MBSS) based on symptoms at presentation (weight loss, pain, jaundice and smoking) was recently validated. The present study compares the ability of four strategies to predict 9-month survival: MBSS, carbohydrate antigen 19-9 (CA 19-9) alone, CA19-9-to-bilirubin ratio and a combination of MBSS and the CA19-9-to-bilirubin ratio. METHODOLOGY: A retrospective review of 133 patients diagnosed with PAC between 2005 and 2011 was performed. Survival was determined from the Quebec civil registry. Blood CA 19-9 and bilirubin values were collected (n = 52) at the time of diagnosis. Receiver-operating characteristic (ROC) curves were used to determine a cutoff for optimal test characteristics of CA 19-9 and CA19-9-to-total bilirubin ratio in predicting survival at 9 months. Predictive characteristics were then calculated for the four strategies. RESULTS: Of the four strategies, the one with the greatest negative predictive value was the MBSS: negative predictive value (NPV) was 90.2% (76.9-97.3%) and the positive likelihood ratio (LR) was the greatest. The ability of CA 19-9 levels alone, at baseline, to predict survival was low. For the CA19-9-to-bilirubin ratio, the test characteristics improved but remained non-significant. The best performing strategy according to likelihood ratios was the combined MBSS and CA19-9 to the bilirubin ratio. CONCLUSION: CA19-9 levels and the CA19-9-to-bilirubin ratio are poor predictors of survival for PAC, whereas the MBSS is a far better predictor, confirming its clinical value. By adding the CA19-9-to-bilirubin ratio to the MBSS the predictive characteristics improved.

9 Article Unresectable pancreatic adenocarcinoma: do we know who survives? 2010

Jamal, Mohammad H / Doi, Suhail A / Simoneau, Eve / Abou Khalil, Jad / Hassanain, Mazen / Chaudhury, Prosanto / Tchervenkov, Jean / Metrakos, Peter / Barkun, Jeffrey S. ·Department of Surgery, McGill University Health Center, Montreal, QC, Canada. ·HPB (Oxford) · Pubmed #20887324.

ABSTRACT: BACKGROUND: This study attempts to define clinical predictors of survival in patients with unresectable pancreatic adenocarcinoma (UPA). METHODS: A retrospective study of 94 consecutive patients diagnosed with UPA from 2001 to 2006 was performed. Using data for these patients, a symptom score was devised through a forward stepwise Cox proportional hazards model based on four weighted criteria: weight loss of >10% of body weight; pain; jaundice, and smoking. The symptom score was subsequently validated in a distinct cohort of 32 patients diagnosed with UPA in 2007. RESULTS: In the original cohort, the overall median survival was 9.0 months (95% confidence interval [CI] 7.6-10.4). This altered to 10.3 months (95% CI 6.1-14.5) in patients with locally advanced disease, and 6.6 months (95% CI 4.2-9.0) in patients with distant metastasis. Median survival was 14.6 months (95% CI 13.1-16.1) in patients with a low symptom (LS) score and 6.3 months (95% CI 4.1-8.5) in patients with a high symptom (HS) score. A total of 73% of LS score patients survived beyond 9 months, compared with only 38% of HS score patients (P<0.001). The discrimination of the LS score was greater than that of any conventional method, including imaging. The validation cohort confirmed the discriminative ability of the symptom score for survival. CONCLUSIONS: A simple and clinically meaningful point-based symptom score can successfully predict survival in patients with UPA.