Rustin G.J.S.,Mount Vernon Cancer Center
Annals of Oncology | Year: 2011
Background: Only one randomized trial has examined the value of performing routine CA125 measurements during follow-up of ovarian cancer. The results of this trial and implications of frequent CA125 measurements are examined. Patients and methods: The Medical Research Council OV05/European Organisation for Research and Treatment of Cancer 55955 trial enrolled 1442 patients with a CA125 level within the normal range following platinum-based chemotherapy for epithelial ovarian cancer. If CA125 levels rose to more than twice the upper limit of normal, patients were randomized to immediate or delayed chemotherapy. Results: Those randomized in the early arm started chemotherapy a median of 4.8 months earlier than those on the delayed arm. There was no difference in survival between the early and delayed arms. Conclusions: Women should be advised not to have routine CA125 measurements, providing they are well and have no symptoms suggesting relapse. In asymptomatic patients with a rising CA125 level, chemotherapy can be delayed. Earlier stopping of maintenance therapy just because of rising CA125 might deny patients continuing benefit from that therapy. Use of CA125 to define progression could result in platinum-sensitive patients being falsely classified as platinum resistant. ©The Author 2011. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved.
Maher E.J.,Mount Vernon Cancer Center
Acta Oncologica | Year: 2013
Background. In 2007 the English National Cancer Survivorship initiative was launched as a partnership between a national charity, Macmillan Cancer Support, the English Department of Health (DH) and the quality improvement agency NHS Improvement. The initiative involved a number of work streams, one of which was to improve the detection and management of the Consequences of adult cancer Treatment (COT). Material and methods. The adult COT group took evidence from a range of stakeholders and published a vision and work programme focused on awareness raising, linking self-administered questionnaires to routine activity data collection and testing new models of care with a particular focus on pelvic cancers. Results. Key outputs include national media campaigns, publications demonstrating the value of linking cancer treatment episodes to routine recording of chronic illness, identification of sensitive Patient Reported Outcome Measures (PROMs) items for use in national surveys, evidence reviews and published national guidelines, together with the development of a three level risk stratified model of care. Pilot testing with survivors treated for pelvic cancers, and adult survivors with radiation-induced brachial plexopathy has been completed. Conclusion. Early results suggest that a systematic approach to the prevention, detection and management of some treatment-related consequences can significantly improve the ability of patients to manage their conditions. As a result of these findings, new services have now been commissioned by the NHS, initially for those with complex problems. © 2013 Informa Healthcare.
Maher J.,Mount Vernon Cancer Center |
McConnell H.,Support Intelligence
British Journal of Cancer | Year: 2011
Background:Two million people in the UK had a cancer diagnosis at the end of 2008. Understanding the number of people diagnosed with cancer with and without health needs is valuable information that can be used to inform service planning, treatment provision and support for people at the right time in the right place as demand grows over time.Methods:Using available data and clinically led assumptions about patient need and outcomes, we make indicative estimates. We quantify, for three common cancers, the number of people in each of the five main identified phases of the cancer care pathway.Results:Estimates are provided for each phase of the pathway for breast, colorectal and lung cancers. We estimate that there are nearly 575 000 women a year with breast cancer in the care pathway at some point in the year, 8% are in the rehabilitation phase and 4% in the progressive illness phase. This compares to nearly 270 000 with colorectal and around 95 000 with lung cancer.Conclusion: Using readily available data, we estimate the numbers of patients with different health needs. These numbers could inform the targeting of resources for service providers. © 2011 Cancer Research UK All rights reserved.
Zweifel M.,Mount Vernon Cancer Center |
Padhani A.R.,Paul Strickland Scanner Center
European Journal of Nuclear Medicine and Molecular Imaging | Year: 2010
Introduction: Classically, the first step in the clinical development of drugs in oncology involves assessments of dose limiting toxicity (DLT) and maximum tolerated dose (MTD). New paradigms are needed for antiangiogenic drugs and vascular disrupting agents (VDAs) as they are active at doses well below the MTD and as single agents their use might not translate into anti-tumour efficacy. MRI is able to assess the antivascular effects of antivascular drugs via changes in functional kinetic parameters; however, the usefulness of MRI in decision making has been questioned by many. Objectives: Our aim is to review the experience of using dynamic contrast-enhanced MRI (DCE-MRI) in early clinical development of vascular directed anticancer therapies over the last decade. Thirty-nine phase I and II studies including data on more than 700 patients have been published as abstracts and/or papers, documenting DCE-MRI changes after the administration of antiangiogenic drugs and VDAs. Discussion: Perfusion MRI is helpful in assessing whether mechanistic goals are achieved, in assisting dose selection for phase II studies, in selecting subpopulations enriched for response and in predicting patient benefit. Imaging tools are increasingly available. Future challenges for imaging include correlation with clinical measures of efficacy and determining relationships with blood and serum biomarkers. © 2010 Springer-Verlag.
Alonzi R.,Mount Vernon Cancer Center
Clinical Oncology | Year: 2015
Various quantitative and semi-quantitative imaging biomarkers have been identified that may serve as valid surrogates for the risk of recurrence after radiotherapy. Tumour characteristics, such as hypoxia, vascularity, cellular proliferation and clonogen density, can be geographically mapped using biological imaging techniques. The potential gains in therapeutic ratio from the precision targeting of areas of intrinsic resistance makes focused dose escalation an exciting field of study. This overview will explore the issues surrounding biologically optimised radiotherapy, including its requirements, feasibility, technical considerations and potential applicability. © 2015 The Royal College of Radiologists.