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Publications (5)18.57 Total impact

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    ABSTRACT: Mortality rates for breast cancer are improving in most countries. Life expectancy is also improving, and as age is the major risk factor for the development of breast cancer, we sought to determine whether survival of elderly women with breast cancer has improved over the past 20 years in our institution. In a retrospective study using a prospectively maintained database, we identified 950 women aged > or =70 years diagnosed with breast cancer between 1980 and 2000. Overall survival of patients was compared between two different time cohorts--those diagnosed from 1980 to 1990 and from 1991 to 2000--and between three age cohorts, 70-74, 75-79, and 80+ years. In all age groups, advanced stage, the need for mastectomy, and having chemotherapy were associated with a worse outcome on univariate analysis. Endocrine therapy (tamoxifen) was given to 60-70% of all age groups. After adjustment for clinical stage, we found no significant improvement in survival between the two time cohorts in any age groups. Compared with an age-matched group in the general population, these elderly breast cancer patients have a 62% increased risk of death. The results are likely to reflect lack of data to promote treatment guidelines. More clinical trials for older women are needed, if the benefits of recent advances in the management of this disease are to be extended to the over 70s. These data should, however, act as a benchmark for future audits.
    No preview · Article · Mar 2008 · The Breast Journal
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    ABSTRACT: Response rates in the palliative treatment of non-small cell lung cancer, with combination platinum-based chemotherapy, vary from 20% to 40%, leaving a large number with either stable or progressive disease. We examined radiographic response after two courses of platinum-based induction chemotherapy to see whether this is an early predictor of outcome. In this retrospective study, 320 patients with stage III/IV NSCLC were identified who received 4 or more courses of first-line platinum-based chemotherapy and attained partial response (PR) or stable disease (SD). After two courses, 115 patients attained PR and 205 SD. Cox regression analysis shows that response after two courses of chemotherapy remains an independent significant prognostic factor for survival. The 2-year survival for patients attaining PR after two courses (n = 115) was 23% compared with 11% (n = 205) for those with SD (p = 0.002). Patients who achieve an objective response after two courses also have a better symptomatic response (p = 0.003) and it was significantly longer (p = 0.04). Of the 205 with SD, 51 attained PR with four courses, whereas 154 (48%) remained with SD; there was no difference in survival outcome of these two groups. These data suggest that NSCLC patients who only have SD after two cycles of first-line chemotherapy have poorer survival outcome and less symptomatic benefit than those in PR. Trials looking at change in management at this point are warranted.
    Full-text · Article · Sep 2007 · Journal of thoracic oncology: official publication of the International Association for the Study of Lung Cancer
  • Anna Wilkins · Sanjay Popat · Sarah Hughes · Mary O'Brien
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    ABSTRACT: We report two cases of malignant pleural mesothelioma in first degree relatives arising within weeks of each other. The patients had a shared exposure to asbestos and age difference of over 20 years at time of presentation. In both cases, the anatomical pattern was similar and unusual for mesothelioma and initial histology was reported for both as non-small cell lung cancer. Both patients were treated with platinum-based combination chemotherapy.
    No preview · Article · Sep 2007 · Lung Cancer
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    ABSTRACT: We report the case of a Caucasian female never smoker with erlotinib sensitive metastatic non-small cell lung cancer in the brain. Having progressed after receiving whole brain radiotherapy, her brain metastases responded both initially and on re-treatment with erlotinib. However, her extra-cranial disease remained erlotinib-resistant throughout. This case demonstrates that brain metastases may be sensitive to erlotinib and also highlights the oligoclonal nature of non-small cell lung cancer reflected by differential tyrosine kinase inhibitor tumour sensitivity. On the basis of this case we suggest that erlotinib should be considered in the treatment paradigm for patients with intra-cranial disease and propose further study into the continued use of this drug in the situation where there is a differential response.
    No preview · Article · May 2007 · Lung Cancer
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    ABSTRACT: Chemotherapy induced neutropenia has been shown to be associated with improved treatment outcomes in selected solid tumours. We studied the association of chemotherapy induced neutropenia with treatment related outcomes in small cell lung cancer (SCLC). This is a retrospective analysis of patients receiving chemotherapy for SCLC at the Royal Marsden Hospital, UK over an 8 year period. The chemotherapy included Carboplatin AUC 5, IV and Etoposide 100mg/m(2) IV on day 1 and 100mg/m(2) PO, B.I.D. on day 2 and 3 every 21 days. Patients were stratified into two groups (A) those experiencing grades 0-2 neutropenia and group (B) those experiencing grades 3-4 neutropenia. The outcomes studied were response rate, time to progression (TTP) and overall survival (OS). 173 patients were studied. The median age 64 (range 39-83) and M/F ratio was 112:61. The response rates in groups A and B was 90% versus 90%, p=1.0. The median TTP in groups A and B was 30 and 38 weeks, p=0.05. The median OS in groups A and B was 47 weeks versus 60 weeks, p=0.008. The differences in TTP and OS were not significant in patients with extensive stage disease. Occurrence of chemotherapy induced grade 3 or 4 neutropenia correlated with OS in patients with SCLC receiving carboplatin and etoposide chemotherapy. Trials exploring controlled, safe intra-patient dose escalation with the intent of achieving grade 3 or 4 neutropenia in patients with SCLC are warranted.
    No preview · Article · Jan 2007 · Lung Cancer