Objective
The aim of this study was to translate the Palliative Performance Scale (PPSv2) into Arabic and to test the reliability and validity of the PPS Arabic translation (PPS-Arabic).
Method
The PPSv2 was translated into Modern Standard Arabic using a forward–backward method. Inter-rater and intra-rater reliabilities were tested in a pilot study that included 20 patients. The validation study included 150 cancer patients. Patients were divided according to their treatment plan into three groups (in-remission, palliative chemotherapy, and best supportive care) to perform hypothesis-testing construct validity. Validity was further evaluated by correlating PPS-Arabic with the Karnofsky Performance Scale (KPS), the Eastern Cooperative Oncology Group (ECOG) scale, and Physical Functioning (PF2) and Role Functioning (RF2) scales of the European Organization for Research and Treatment of Cancer quality of life questionnaire (EORTC QLQ-C30).
Results
The intraclass correlation coefficients for the intra-rater and inter-rater reliability were 0.935 (95% CI: 0.88–0.965; p < 0.001) and 0.965 (95% CI: 0.934–0.981; p < 0.001), respectively. The PPS-Arabic internal consistency Cronbach's alpha was 0.986. The average PPS-Arabic score differed significantly (p < 0.001) between the three groups of patients being 89 for in-remission, 58 for palliative chemotherapy, and 38 for best supportive care. The PPS-Arabic score correlated significantly (p < 0.001) with the KPS, ECOG performance scale, and the EORTC QLQ-C30 PF2 and RF2 scales.
Conclusion
The PPS-Arabic is a reliable and valid tool for the assessment of performance status of cancer patients.
Background::
Androgen receptor (AR) upstreams complex signaling pathways that
regulate cell proliferation and contribute to breast tumorignensis. Several clinical trials were initiated
to investigate the clinical relevance of targeting AR especially in hormone-receptor-negative
breast cancer.
Methods::
The search was performed in PubMed and the meeting libraries of ASCO, ESMO,
SABCS, ImpakT congresses from January 2005 to July 2017. The following key words were
used: Breast cancer, Androgen receptor, androgen agonist/antagonist, Flutamide, Abiraterone, Bicalutamide,
Enzalutamide, Enobosarm, selective androgen receptor modulator.
Results::
Screening of title/abstracts yielded a total of 20 relevant results. Of those, twelve studies
were found eligible: eleven clinical trials along with one case report. Response rates ranged from
0 to 12% while clinical benefit rates reached up to 35% in 2 studies (with enzalutamide and enobosarm).
Progression-free survival ranged from 2.8 to 4.5 months. The most widely used cutoff
for AR expression was 10%. High expression of AR was associated with more clinical benefit.
Regarding safety, anti-androgens were generally well tolerated with hot flushes, elevated transaminases
and fatigue being the most commonly reported across all agents.
Conclusion::
Androgen receptor pathway targeting in advanced breast cancer remains a valid option
with reasonable clinical benefit in non-selected patients. Future studies are needed to define
an AR addicted cohort with better responses and outcome.
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