Lynnda Peachey

Summary This project investigated the clinical value of a human whole blood point‐of‐care (POC) triglyceride (TG) measurement device to determine equid blood TG concentrations. Equid plasma TG measurements were determined in a commercial laboratory and also using whole blood and plasma on the POC device from equid patients with TG concentrations from within the normal range to severely hypertriglyceridaemic. Results were compared between methods using the Bland‐Altman method for validation. Seventy‐four samples were collected: 35 from inappetent or starved equid patients (considered ‘at‐risk’ of developing hypertriglyceridaemia) and 39 from equids eating with a normal appetite. The POC device readable range is 0.8–6.86 mmol/l; high readings were diluted and measurements repeated and calculated. Inappetent/starved patients had a higher risk of developing raised plasma triglycerides (OR 16.8, 95% CI 4.8–58.4, P<0.0001) than the appetent ones with 34% (12/35) having mildly increased TG and 31% (11/35) having moderately to severely increased TG concentrations. In comparison, there were no severely hypertriglyceridaemic patients, one moderately increased and 3/39 (8%) mildly elevated TG patients in the appetent group. In the readable range, using whole blood, the POC device had excellent agreement with the laboratory (mean difference ‐0.59). However, accuracy varied with TG concentration and the POC instrument overestimated TG values, particularly when TG values were above the POC device's range. For a given value in the readable range of the POC device, multiplication of the POC value by a factor of 0.77 (whole blood) and 0.72 (plasma) provides an estimation of the laboratory TG value. Whole blood TG readings below the POC instrument's range were reliably low. The POC device reliably predicted TG values in a clinical setting. Use of this device provides rapid, easy to perform, reliable assessment of blood TG concentration in equids at risk of developing hypertriglyceridaemia.

6 Background: There are no randomised trials of 2 nd line chemotherapy for esophageal cancer. The phase III COG trial of gefitinib versus placebo in patients with esophageal cancer progressing after chemotherapy did not show significant overall survival (OS) benefit, however the trial incorporated patient reported outcomes (PRO) using validated tools. The PRO data are therefore critical to inform practice and the initial results are presented here. Methods: Adults with measurable/evaluable metastatic esophageal or types I/II junctional adeno or squamous cell carcinoma progressing after prior chemotherapy, with performance status 0-2 were randomised 1:1 to 500mg gefitinib (G) or placebo (P), treated until progression. Primary outcome: OS. Secondary outcomes include safety, PFS, PRO (assessed by EORTC QLQ-C30 and EORTC QLQ-OG25 at baseline 4, 8 and 12 weeks until progression) and predictive biomarkers. Pre-specified PRO domains were global quality of life, dysphagia, eating and odynophagia. Analysis by ANCOVA of change in PRO at 4 weeks adjusted for baseline. Results: 450 patients were recruited from 51 UK centres and no difference in OS was detected. There was evidence that PFS was better in the intervention arm (P 35 days, G 49 days; HR=0.795, 95%CI 0.66, 0.96, p=0.017). Questionnaire compliance rates were excellent at baseline (94%) and at 4 weeks (77%). Patients in the gefitinib arm reported significantly better social function (9.26; 95%CI 1.94 to 16.58; p=0.013) and significantly fewer problems with odynophagia (-8.61; 95%CI -14.49 to -2.73; p=0.004), constipation (-15.24; 95%CI -22.83 to -7.65; p=0.0001) and speech (-10.40; 95%CI -16.13 to -4.67; p=0.0004) than patients receiving placebo but more problems with diarrhoea (19.23; 95%CI 11.79 to 26.27; p<0.0001). All other PRO domains were similar between the two groups. Conclusions: Gefitinib did not improve overall survival in esophageal cancer patients after chemotherapy however there was significant PFS improvement and improvement in quality of life and palliation of symptoms albeit with an excess of diarrhoea. Clinical trial information: 29580179.