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Harsha Mohan E, Madhusudan S, Baskaran R. The sea lettuce Ulva sensu lato: Future food with health-promoting bioactives. ALGAL RES 2023. [DOI: 10.1016/j.algal.2023.103069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2023]
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Arora A, Storr SJ, Reddy H, Lobo DN, Madhusudan S, Zaitoun AM. O085 CD10 expression in carcinomas of the pancreas, bile duct and ampulla. Br J Surg 2022. [DOI: 10.1093/bjs/znac242.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Introduction
Pancreatic cancer and cholangiocarcinoma including, cancer of ampulla of Vater, are very aggressive and have a dismal prognosis; hence improved methods of patient stratification are required.
Methods
We assessed the expression of CD10 in stromal and epithelial cells of two patient cohorts using immunohistochemistry on tissue microarrays. The first cohort was composed of 68 pancreatic adenocarcinomas and the second cohort was composed of 120 cancers of the bile duct and ampulla.
Results
In bile duct and ampullary carcinomas an association was observed between CD10 stromal expression and patient age (p =0.009). The CD10 stromal expression was associated with poor disease specific survival (DSS) (p =0.05). In multivariate Cox model for DSS, stromal CD10 expression (p = 0.037) was independently associated with poor outcome. In multivariate Cox model for disease free survival (DFS), CD10 stromal expression (p = 0.012), and nodal status (p = 0.025) were independently associated with poor outcome. In pancreatic cancer, no statistically significant association was observed between CD 10 stromal expression and clinicopathological variables such as tumour size (p = 0.099), T stage (p = 0.393), N stage (p = 0.860), Vascular invasion (p = 0.904), perineural invasion (p = 0.532) and grade (0.168). In multivariate Cox model for DSS, T stage (p = 0.042) was independently associated with poor outcome.
Conclusion
The results suggest that CD10 stromal expression may have prognostic significance in cholangiocarcinoma. The findings of this study warrant a larger follow-up study.
Take-home message
The results suggest that CD10 stromal expression may have prognostic significance in cholangiocarcinoma. The findings of this study warrant a larger follow-up study.
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Affiliation(s)
- A Arora
- Nottingham University Hospitals NHS Foundation Trust
| | - SJ Storr
- Nottingham University Hospitals NHS Foundation Trust
| | - H Reddy
- Nottingham University Hospitals NHS Foundation Trust
| | - DN Lobo
- Nottingham University Hospitals NHS Foundation Trust
| | - S Madhusudan
- Nottingham University Hospitals NHS Foundation Trust
| | - AM Zaitoun
- Nottingham University Hospitals NHS Foundation Trust
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Abstract
India has an enormous burden of mental illness. In spite of the recognition of this population of people living with mental illness, the treatment gap continues to be about 83%. In order to meet this vast unmet need and in the view of aligning the mental health legislation with the international standards and the UN-Convention on the Rights of Persons with Disabilities, the Mental Healthcare Act 2017 was passed and enforced recently. The provisions in the act have been controversial from its conception. Now after the enforcement of the act, all mental health professionals (MHPs) have a legal binding to follow the provisions in the law. The MHPs are accountable to the statutory bodies - the Central Mental Health Authority, State Mental Health Authority (SMHA), Mental Health Review Board, and finally, the High Court or the Supreme Court. The Mental Healthcare Act (MHCA) and relevant articles/documents obtained pertaining to MHCA and their evaluation were reviewed, the major focus being on the role of statutory/regulatory bodies. Furthermore, an attempt was made to summarize the previous experiences in inspection of mental health establishments by SMHA of Karnataka. We concluded that the MHCA will have both positive and negative aspects. Many of the provisions in the law may appear unclear and unrealistic by many practitioners. However, it becomes precautionary for the MHPs to be well equipped with the MHCA and be acquainted with the requirements of the statutory bodies for ensuring a safe practice. The outcome of the implementation of the act will become evident only with time.
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Affiliation(s)
- N R Prashanth
- Department of Psychiatry, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
| | - Shalu Elizabeth Abraham
- Department of Psychiatry, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
| | - Chandrashekar Hongally
- Department of Psychiatry, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
| | - S Madhusudan
- Department of Psychiatry, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
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Alabdullah ML, Ahmad DA, Moseley P, Madhusudan S, Chan S, Rakha E. The mTOR downstream regulator (p-4EBP1) is a novel independent prognostic marker in ovarian cancer. J OBSTET GYNAECOL 2019; 39:522-528. [PMID: 30712414 DOI: 10.1080/01443615.2018.1534091] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Ovarian cancer is associated with the highest mortality rate among gynaecologic malignancies. There is a need to refine the classification of ovarian cancer and identify novel targets. The mammalian target of rapamycin (mTOR) pathway has a crucial role in the pathogenesis and progression of ovarian cancer. This study aims to investigate the prognostic role of p-mTOR and its major downstream effectors p-4EBP1 (eukaryotic initiation factor 4E-binding protein 1) and p-P70S6K (ribosomal protein S6 kinase) in ovarian cancer. p-mTOR, p-4EBP1 and p-P70S6K protein expression was assessed on 195 consecutive ovarian epithelial cancers and correlated to clinicopathological features and survival. We found that high cytoplasmic expression of p-4EBP1 and p-P70S6K was associated with a serous type carcinoma (p = .005) and an advanced FIGO stage (p = .012), respectively. Univariate outcome analysis showed an inverse association between a high expression of p-4EBP1 expression and overall ovarian cancer survival (OS; p = .005) and progression-free survival (PFS; p = .005). p-P70S6K showed an inverse association with PFS (p = .001). Multivariate analyses indicated that p-4EBP1 was an independent predictor of both OS and PFS (p = .016 and p = .041, respectively). Therefore, we concluded that p-4EBP1 high protein expression is an independent predictor of outcome in ovarian cancer patients. Therefore, it could be used as a potential biomarker for prognostic stratification and treatment decisions. Impact statement What is already known on this subject? The mammalian target of rapamycin (mTOR) pathway has a crucial role in the pathogenesis and progression of ovarian cancer. To-date, very limited knowledge is known about the importance of mTOR major downstream effectors p-4EBP1 (eukaryotic initiation factor 4E-binding protein 1) and p-P70S6K (ribosomal protein S6 kinase) in ovarian cancer. What do the results of this study add? In this study, we have provided further evidence of the adverse prognostic behaviour associated with the positive expression of p-mTOR and its major downstream effectors. Moreover and by performing multivariate analysis, we for the first time have proved that p-4EBP1 is an independent predictor of clinical outcome in ovarian cancer. What are the implications of these findings for clinical practice and/or further research? p-4EBP1 could be used as a potential biomarker for prognostic stratification and treatment decisions in ovarian cancer management.
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Affiliation(s)
- M L Alabdullah
- a Academic Unit of Oncology, Division of Cancer and Stem Cells, School of Medicine , University of Nottingham , Nottingham , UK.,b Paediatric Surgery Department , Birmingham Children's Hospital NHS Trust , Birmingham , UK
| | - D A Ahmad
- c Department of Histopathology, Division of Cancer and Stem cells, School of Medicine , University of Nottingham , Nottingham , UK
| | - P Moseley
- d Department of Oncology , Nottingham University Hospital , Nottingham , UK
| | - S Madhusudan
- d Department of Oncology , Nottingham University Hospital , Nottingham , UK.,e Translational Oncology, Division of Cancer and Stem Cells, School of Medicine , University of Nottingham , UK
| | - S Chan
- d Department of Oncology , Nottingham University Hospital , Nottingham , UK
| | - E Rakha
- c Department of Histopathology, Division of Cancer and Stem cells, School of Medicine , University of Nottingham , Nottingham , UK
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Alabdullah M, Ali R, Moseley P, Chan S, Rakha E, Madhusudan S. PO-236 Human ligase profiling to predict platinum sensitivity and clinical outcome in primary epithelial ovarian cancers. ESMO Open 2018. [DOI: 10.1136/esmoopen-2018-eacr25.752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Alabdullah M, Moseley P, Madhusudan S, Chan S, Rakha E. PO-110 AKT expression is associated with poor clinical outcome in ovarian cancer. ESMO Open 2018. [DOI: 10.1136/esmoopen-2018-eacr25.151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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7
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Ali R, Al-kawaz A, Toss M, Green A, Miligy I, Mesquita KA, Seedhouse C, Mirza S, Rakha E, Madhusudan S. PO-014 Targeting PARP1 in XRCC1 deficient sporadic invasive breast cancer or pre-invasive ductal carcinoma in situ for synthetic lethality and chemoprevention. ESMO Open 2018. [DOI: 10.1136/esmoopen-2018-eacr25.59] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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8
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Alabdullah M, Moseley P, Chan S, Rakha E, Madhusudan S. Clinicopathological, predictive and prognostic significance of XRCC1-Ligase III heterodimer expression in ovarian cancer. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy047.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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9
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Alabdullah M, Miligy I, Moseley P, Madhusudan S, Chan S, Rakha E. mTORC1 and its downstream effectors predict poor outcome in primary epithelial ovarian cancer. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy047.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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10
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Reece-Smith AM, Saunders JH, Soomro IN, Bowman CR, Duffy JP, Kaye PV, Welch NT, Madhusudan S, Parsons SL. Postoperative survival following perioperative MAGIC versus neoadjuvant OE02-type chemotherapy in oesophageal adenocarcinoma. Ann R Coll Surg Engl 2017; 99:378-384. [PMID: 28462649 PMCID: PMC5449699 DOI: 10.1308/rcsann.2017.0024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2016] [Indexed: 01/02/2023] Open
Abstract
The optimal management of resectable oesophageal adenocarcinoma is controversial, with many centres using neoadjuvant chemotherapy following the Medical Research Council (MRC) oesophageal working group (OE02) trial and the MRC Adjuvant Gastric Infusional Chemotherapy (MAGIC) trial. The more intensive MAGIC regimen is used primarily in gastric cancer but some also use it for oesophageal cancer. A database of cancer resections (2001-2013) provided information on survival of patients following either OE02 or MAGIC-type treatment. The data were compared using Kaplan-Meier analysis. Straight-to-surgery patients were also reviewed and divided into an 'early' cohort (2001-2006, OE02 era) and a 'late' cohort (2006-2013, MAGIC era) to estimate changes in survival over time. Subgroup analysis was performed for responders (tumour regression grade [TRG] 1-3) versus non-responders (TRG 4 and 5) and for anatomical site (gastro-oesophageal junction [GOJ] vs oesophagus). An OE02 regimen was used for 97 patients and 275 received a MAGIC regimen. Those in the MAGIC group were of a similar age to those undergoing OE02 chemotherapy but the proportion of oesophageal cancers was higher among MAGIC patients than among those receiving OE02 treatment. MAGIC patients had a significantly lower stage following chemotherapy than OE02 patients and a higher median overall survival although TRG was similar. On subgroup analysis, this survival benefit was maintained for GOJ and oesophageal cancer patients as well as non-responders. Analysis of responders showed no difference between regimens. 'Late' group straight-to-surgery patients were significantly older than those in the 'early' group. Survival, however, was not significantly different for these two cohorts. Although the original MAGIC trial comprised few oesophageal cancer cases, our patients had better survival with MAGIC than with OE02 chemotherapy in all anatomical subgroups, even though there was no significant change in operative survival over the time period in which these patients were treated. The use of the MAGIC regimen should therefore be encouraged in cases of operable oesophagogastric adenocarcinoma.
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Affiliation(s)
| | | | - I N Soomro
- Nottingham University Hospitals NHS Trust, UK
| | - C R Bowman
- Nottingham University Hospitals NHS Trust, UK
| | - J P Duffy
- Nottingham University Hospitals NHS Trust, UK
| | - P V Kaye
- Nottingham University Hospitals NHS Trust, UK
| | - N T Welch
- Nottingham University Hospitals NHS Trust, UK
| | | | - S L Parsons
- Nottingham University Hospitals NHS Trust, UK
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11
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Madhusudan S, Sarcar MMM, Bhargava NRMR. Microstructure and mechanical behavior assessment of Al–Cu composites fabricated through stir casting. Particulate Science and Technology 2016. [DOI: 10.1080/02726351.2016.1240125] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- S. Madhusudan
- Department of Mechanical Engineering, Usha Rama College of Engineering, Telaprolu, India
| | | | - N. R. M. R. Bhargava
- Department of Metallurgical Engineering, AU College of Engineering, Visakhapatnam, India
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Madhusudan S, Gupta A, Prakash M, Matta D, Suri D, Singh S. Camptodactyly-arthropathy-coxa vara-pericarditis (CACP) syndrome: a mimicker of juvenile idiopathic arthritis. Scand J Rheumatol 2015; 45:77-78. [PMID: 26508154 DOI: 10.3109/03009742.2015.1085085] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- S Madhusudan
- a Department of Paediatrics , Postgraduate Institute of Medical Education and Research , Chandigarh , India
| | - A Gupta
- a Department of Paediatrics , Postgraduate Institute of Medical Education and Research , Chandigarh , India
| | - M Prakash
- b Department of Radiodiagnosis , Postgraduate Institute of Medical Education and Research , Chandigarh , India
| | - D Matta
- c Centre for DNA Fingerprinting and Diagnostics , Hyderabad , India
| | - D Suri
- a Department of Paediatrics , Postgraduate Institute of Medical Education and Research , Chandigarh , India
| | - S Singh
- a Department of Paediatrics , Postgraduate Institute of Medical Education and Research , Chandigarh , India
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Rollins K, Tewari N, Ackner A, Awwad A, Madhusudan S, Macdonald I, Lobo D. OR003: The Impact of Sarcopenia and Myosteatosis on Outcomes of Unresectable Pancreatic Cancer and Distal Cholangiocarcinoma. Clin Nutr 2015. [DOI: 10.1016/s0261-5614(15)30121-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Perry C, Soomro I, Kaye P, Hardy E, Parsons SL, Ragunath K, Lobo DN, Martin SG, Madhusudan S. Analysis of lymphatic and blood vessel invasion biomarkers in T1 esophagogastric adenocarcinomas for improved patient prognostication. Dis Esophagus 2015; 28:262-8. [PMID: 24612464 DOI: 10.1111/dote.12190] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Lymphovascular invasion (LVI) in T1 esophagogastric adenocarcinoma may predict risk of recurrence despite definitive treatment with surgery or endoscopic resection. Podoplanin and CD34 are emerging biomarkers of lymphatic and blood vessel invasion, respectively, and could be adopted to refine LVI assessment. A consecutive series of 65 patients with T1 adenocarcinomas diagnosed at Nottingham University Hospitals were investigated. T1 tumors from 43/65 patients who received primary surgery only were suitable for LVI evaluation by hematoxylin and eosin (H&E) staining as well as by CD34 and Podoplanin immunohistochemistry. LVI was correlated to clinicopathological features and recurrence free survival. H&E staining detected LVI in 11.6% (5/43) of T1 tumors. CD34 and Podoplanin immunohistochemistry significantly improved LVI detection to 25.6% (11/43). Compared with LVI by H&E, immunohistochemical evaluation of blood vessel invasion (CD34) or lymphatic vessel invasion (Podoplanin) was significantly associated with higher grade (P = 0.005), submucosal invasion (T1b) (P = 0.018), lymph node positivity (N1) (P = 0.029) and poor recurrence free survival (P = 0.0003). Our study provides evidence that CD34 and Podoplanin immunohistochemistry could improve LVI detection and allow better prognostication of patients and optimum selection of definitive treatment. Larger multicenter studies are required for further validation that could have significant clinical implications.
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Affiliation(s)
- C Perry
- Division of Oncology, School of Medicine, University of Nottingham, Nottingham, UK
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Madhusudan S, Singh S, Suri D, Gupta A, Gupta A. Acute anterior uveitis as the presenting feature of Kawasaki disease. Indian J Pediatr 2014; 81:415. [PMID: 24562721 DOI: 10.1007/s12098-014-1367-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Accepted: 01/30/2014] [Indexed: 12/15/2022]
Affiliation(s)
- S Madhusudan
- Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
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16
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Khanna A, Reece-Smith AM, Cunnell M, Madhusudan S, Thomas A, Bowrey DJ, Parsons SL. Venous thromboembolism in patients receiving perioperative chemotherapy for esophagogastric cancer. Dis Esophagus 2014; 27:242-7. [PMID: 23651074 DOI: 10.1111/dote.12084] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The association between venous thromboembolism and chemotherapy for esophagogastric cancer is well known in patients treated with palliative intent. Whether this risk extends to the neoadjuvant and perioperative setting is unclear. A retrospective interrogation of databases of patients receiving perioperative chemotherapy for potentially curative intent at the Leicester (2006-2011) and Nottingham (2004-2011) esophagogastric cancer centers was performed. Thromboembolic events were diagnosed in 48 of 384 patients (12.5%), 21 (5.5%) at presentation, 12 (3%) during neoadjuvant chemotherapy, and 15 (3.9%) in the postoperative period. There were no deaths from thromboembolic disease. By site these comprised catheter-related axillary vein thrombosis in 7 patients, deep venous thrombosis in 12 patients, and pulmonary embolism in 29 patients. Twenty-five of the 29 pulmonary emboli were incidental findings on staging computed tomography imaging. Combination chemotherapy with epirubicin, cisplatin, and capecitabine appeared to carry the greatest risk for the development of thromboembolism. Seven of the 12 patients (58%) who developed thromboembolism during neoadjuvant chemotherapy did not proceed to surgery because of deterioration in performance status. Preoperative thromboembolic disease resulted in a significant increase in the interval between chemotherapy and surgery, but did not influence either length of hospital stay or survival. Venous thromboembolism will develop in 12.5% of patients treated with potentially curative intent. This adverse event can occur at any time during the patient journey. In contrast to the commonly held view, this did not translate into a poorer prognosis.
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Affiliation(s)
- A Khanna
- Department of Surgery, University Hospitals of Leicester, Leicester, UK
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Tewari N, Ackner A, Ribakovs A, Tan B, Madhusudan S, Macdonald I, Lobo D. PP079-SUN THE IMPACT OF BODY COMPOSITION ON OUTCOMES OF INOPERABLE PANCREATIC CANCER. Clin Nutr 2013. [DOI: 10.1016/s0261-5614(13)60124-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abdel-Fatah TMA, Perry C, Dickinson P, Ball G, Moseley P, Madhusudan S, Ellis IO, Chan SYT. Bcl2 is an independent prognostic marker of triple negative breast cancer (TNBC) and predicts response to anthracycline combination (ATC) chemotherapy (CT) in adjuvant and neoadjuvant settings. Ann Oncol 2013; 24:2801-7. [PMID: 23908177 DOI: 10.1093/annonc/mdt277] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND TNBC represents a heterogeneous subgroup of BC with poor prognosis and frequently resistant to CT. MATERIAL AND METHODS The relationship between Bcl2 immunohistochemical protein expression and clinico-pathological outcomes was assessed in 736 TNBC-patients: 635 patients had early primary-TNBC (EP-TNBC) and 101 had primary locally advanced (PLA)-TNBC treated with neo-adjuvant- ATC-CT. RESULTS Negative Bcl2 (Bcl2-) was observed in 70% of EP-TNBC and was significantly associated with high proliferation, high levels of P-Cadherin, E-Cadherin and HER3 (P's < 0.01), while Bcl2+ was significantly associated with high levels of p27, MDM4 and SPAG5 (P < 0.01). After controlling for chemotherapy and other prognostic factors, Bcl2- was associated with 2-fold increased risk of death (P = 0.006) and recurrence (P = 0.0004). Furthermore, the prognosis of EP-TNBC/Bcl2- patients had improved both BC-specific survival (P = 0.002) and disease-free survival (P = 0.003), if they received adjuvant-ATC-CT. Moreover, Bcl2- expression was an independent predictor of pathological complete response of primary locally advanced triple negative breast cancer (PLA-TNBC) treated with neoadjuvant-ATC-CT (P = 0.008). CONCLUSION Adding Bcl2 to the panel of markers used in current clinical practice could provide both prognostic and predictive information in TNBC. TNBC/Bcl2- patients appear to benefit from ATC-CT, whereas Bcl2+ TNBC seems to be resistant to ATC-CT and may benefit from a trial of different type of chemotherapy with/without novel-targeted agents.
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Affiliation(s)
- T M A Abdel-Fatah
- Clinical Oncology Department, Nottingham University Hospitals, Nottingham
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Sultana R, Abdel-Fatah T, Albarakati N, Abbotts R, Seedhouse C, Ball G, Chan S, Rakha E, Ellis I, Madhusudan S. 275 Targeting XRCC1 (X-ray Repair Cross-complementing Gene 1), a Key DNA Base Excision Repair Protein for Personalized Therapy in Breast and Ovarian Cancer. Eur J Cancer 2012. [DOI: 10.1016/s0959-8049(12)72073-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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20
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Reece-Smith AM, Saha S, Cunnell ML, Hameed K, Bessell EM, Duffy JP, Madhusudan S, Parsons SL. MAGIC in practice: experience of peri-operative ECF/X chemotherapy in gastro-esophageal adenocarcinomas. J Surg Oncol 2012; 106:748-52. [PMID: 22674046 DOI: 10.1002/jso.23187] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2011] [Accepted: 05/14/2012] [Indexed: 01/27/2023]
Abstract
BACKGROUND The MAGIC trial demonstrated the perioperative regimen of Epirubicin (E), Cisplatin (C) and 5-Fluorouracil (F) to have an overall survival benefit for patients with gastro-esophageal adenocarcinomas. We present our experience of the peri-operative regimen of ECF/ECX(X = Capecitabine) in operable gastro-esophageal adenocarcinoma. METHODS Analysis of retrospective data of patients treated with MAGIC style therapy between May 2006 and August 2008 with potentially operable gastro-esophageal adenocarcinoma. RESULTS One hundred patients underwent peri-operative chemotherapy according to the MAGIC protocol. Median age was 66 years, with 39% above the age of 70 years. The tumours were evenly distributed between the lower esophagus, gastro-esophageal junction and stomach. Seventy-nine percent completed all pre-operative cycles of chemotherapy and 81% proceeded to surgery, whilst 24% did not receive curative surgery. The median survival on an intention to treat analysis is 31.7 months from diagnosis. The median survival of patients who underwent resection has not yet been reached after a median follow-up of 41.4 months. CONCLUSION Our patient population is older than the patients in the MAGIC trial (age 66 years vs. 62 years) with a much higher proportion of esophageal and GEJ tumours. Overall, curative resection rate was comparable to the MAGIC trial. Overall survival is superior to that found in the MAGIC trial.
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Affiliation(s)
- A M Reece-Smith
- Department of Surgery, Nottingham University Hospitals, City Hospital, Nottingham, UK
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Chau I, Okines AFC, Gonzalez de Castro D, Saffery C, Barbachano Y, Wotherspoon A, Puckey L, Hulkki Wilson S, Coxon FY, Middleton GW, Ferry DR, Crosby TDL, Madhusudan S, Wadsley J, Waters JS, Hall M, Swinson D, Robinson A, Smith D, Cunningham D. REAL3: A multicenter randomized phase II/III trial of epirubicin, oxaliplatin, and capecitabine (EOC) versus modified (m) EOC plus panitumumab (P) in advanced oesophagogastric (OG) cancer—Response rate (RR), toxicity, and molecular analysis from phase II. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.4131] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Mohammed MZ, Vyjayanti VN, Laughton CA, Dekker LV, Fischer PM, Wilson DM, Abbotts R, Shah S, Patel PM, Hickson ID, Madhusudan S. Development and evaluation of human AP endonuclease inhibitors in melanoma and glioma cell lines. Br J Cancer 2011; 104:653-63. [PMID: 21266972 PMCID: PMC3049581 DOI: 10.1038/sj.bjc.6606058] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Aims: Modulation of DNA base excision repair (BER) has the potential to enhance response to chemotherapy and improve outcomes in tumours such as melanoma and glioma. APE1, a critical protein in BER that processes potentially cytotoxic abasic sites (AP sites), is a promising new target in cancer. In the current study, we aimed to develop small molecule inhibitors of APE1 for cancer therapy. Methods: An industry-standard high throughput virtual screening strategy was adopted. The Sybyl8.0 (Tripos, St Louis, MO, USA) molecular modelling software suite was used to build inhibitor templates. Similarity searching strategies were then applied using ROCS 2.3 (Open Eye Scientific, Santa Fe, NM, USA) to extract pharmacophorically related subsets of compounds from a chemically diverse database of 2.6 million compounds. The compounds in these subsets were subjected to docking against the active site of the APE1 model, using the genetic algorithm-based programme GOLD2.7 (CCDC, Cambridge, UK). Predicted ligand poses were ranked on the basis of several scoring functions. The top virtual hits with promising pharmaceutical properties underwent detailed in vitro analyses using fluorescence-based APE1 cleavage assays and counter screened using endonuclease IV cleavage assays, fluorescence quenching assays and radiolabelled oligonucleotide assays. Biochemical APE1 inhibitors were then subjected to detailed cytotoxicity analyses. Results: Several specific APE1 inhibitors were isolated by this approach. The IC50 for APE1 inhibition ranged between 30 nM and 50 μM. We demonstrated that APE1 inhibitors lead to accumulation of AP sites in genomic DNA and potentiated the cytotoxicity of alkylating agents in melanoma and glioma cell lines. Conclusions: Our study provides evidence that APE1 is an emerging drug target and could have therapeutic application in patients with melanoma and glioma.
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Affiliation(s)
- M Z Mohammed
- Translational DNA Repair Group, Laboratory of Molecular Oncology, Academic Unit of Oncology, School of Molecular Medical Sciences, Nottingham University Hospitals, University of Nottingham, Nottingham, UK
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Muthuramalingam SR, Braybrooke JP, Blann AD, Madhusudan S, Wilner S, Jenkins A, Han C, Kaur K, Perren T, Ganesan TS. A prospective randomised phase II trial of thalidomide with carboplatin compared with carboplatin alone as a first-line therapy in women with ovarian cancer, with evaluation of potential surrogate markers of angiogenesis. EUR J GYNAECOL ONCOL 2011; 32:253-258. [PMID: 21797111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVES To compare the safety and efficacy of thalidomide in combination with carboplatin to carboplatin alone as a first-line therapy in women with ovarian cancer and to evaluate the anti-angiogenic effects of thalidomide by measurement of surrogate markers of angiogenesis. METHODS Forty patients with Stage IC-IV ovarian cancer were randomly assigned to receive either carboplatin (AUC 7) intravenously every four weeks for up to six doses (n = 20) or carboplatin at the same dose and schedule, plus thalidomide 100 mg orally daily for six months (n = 20). RESULTS After median follow-up of 1.95 years, there was no difference in the overall response rate (90% in carboplatin arm, 75% in combination arm; p = 0.41). Increased incidence of symptoms of constipation, dizziness, tiredness and peripheral neuropathy was observed in the combination arm. There was a significant fall in CA-125 and E-selectin in both arms after treatment and VCAM-1 in the carboplatin arm. No significant difference between the two arms was observed in any of the markers analysed. CONCLUSIONS In our trial the addition of thalidomide to carboplatin was well tolerated with no increased efficacy. The fall in some of the angiogenic markers in both groups may reflect tumour response rather than any specific anti-angiogenic effect of thalidomide.
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Affiliation(s)
- S R Muthuramalingam
- Cancer Research UK Medical Oncology Unit, University of Oxford, Churchill Hospital, Oxford
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24
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Lim S, Reece-Smith A, Madhusudan S, Parsons S. Survival analysis of oesophago-gastric cancer patients receiving either oncological palliation or supportive care. Eur J Surg Oncol 2010. [DOI: 10.1016/j.ejso.2010.08.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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25
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Naik DB, Burankar VW, Madhusudan S. Knowledge of swine flu among nursing staff of RIMS, Adilabad (AP). J Commun Dis 2010; 42:219-221. [PMID: 22471187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Dhananjay B Naik
- Dept. of Community Medicine, Rajiv Gandhi Institute of Medical Sciences (RIMS)-Adilabad-504001, AP.
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26
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Fareed KR, Al-Attar A, Soomro IN, Kaye PV, Patel J, Lobo DN, Parsons SL, Madhusudan S. Tumour regression and ERCC1 nuclear protein expression predict clinical outcome in patients with gastro-oesophageal cancer treated with neoadjuvant chemotherapy. Br J Cancer 2010; 102:1600-7. [PMID: 20461087 PMCID: PMC2883154 DOI: 10.1038/sj.bjc.6605686] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Aims: Neoadjuvant chemotherapy followed by surgery is the standard of care for patients with gastro-oesophageal adenocarcinoma. Previously, we validated the utility of the tumour regression grade (TRG) as a histopathological marker of tumour downstaging in patients receiving platinum-based neoadjuvant chemotherapy. In this study we profiled key DNA repair and damage signalling factors and correlated them with clinicopathological outcomes, including TRG response. Methods and results: Formalin-fixed human gastro-oesophageal cancers were constructed into tissue microarrays (TMAs). The first set consisted of 142 gastric/gastro-oesophageal cancer cases not exposed to neoadjuvant chemotherapy and the second set consisted of 103 gastric/gastro-oesophageal cancer cases exposed to preoperative platinum-based chemotherapy. Expressions of ERCC1, XPF, FANCD2, APE1 and p53 were investigated using immunohistochemistry. In patients who received neoadjuvant chemotherapy, favourable TRG response (TRG 1, 2 or 3) was associated with improvement in disease-specific survival (P=0.038). ERCC1 nuclear expression correlated with lack of histopathological response (TRG 4 or 5) to neoadjuvant chemotherapy (P=0.006) and was associated with poor disease-specific (P=0.020) and overall survival (P=0.040). Conclusions: We provide evidence that tumour regression and ERCC1 nuclear protein expression evaluated by immunohistochemistry are promising predictive markers in gastro-oesophageal cancer patients receiving neoadjuvant platinum-based chemotherapy.
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Affiliation(s)
- K R Fareed
- Laboratory of Molecular Oncology, Academic Unit of Oncology, School of Molecular Medical Sciences, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
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27
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Al-Attar A, Gossage L, Fareed KR, Shehata M, Mohammed M, Zaitoun AM, Soomro I, Lobo DN, Abbotts R, Chan S, Madhusudan S. Human apurinic/apyrimidinic endonuclease (APE1) is a prognostic factor in ovarian, gastro-oesophageal and pancreatico-biliary cancers. Br J Cancer 2010; 102:704-9. [PMID: 20087352 PMCID: PMC2837561 DOI: 10.1038/sj.bjc.6605541] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2009] [Revised: 12/09/2009] [Accepted: 12/16/2009] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Altered DNA repair may be associated with aggressive tumour biology and impact upon response to chemotherapy and radiotherapy. We investigated whether expression of human AP endonuclease (APE1), a key multifunctional protein involved in DNA BER, would impact on clinicopathological outcomes in ovarian, gastro-oesophageal, and pancreatico-biliary cancer. METHODS Formalin-fixed human ovarian, gastro-oesophageal, and pancreatico-biliary cancers were constructed into TMAs. Expression of APE1 was analysed by IHC and correlated to clinicopathological variables. RESULTS In ovarian cancer, nuclear APE1 expression was seen in 71.9% (97 out of 135) of tumours and correlated with tumour type (P=0.006), optimal debulking (P=0.009), and overall survival (P=0.05). In gastro-oesophageal cancers previously exposed to neoadjuvant chemotherapy, 34.8% (16 out of 46) of tumours were positive in the nucleus and this correlated with shorter overall survival (P=0.005), whereas cytoplasmic localisation correlated with tumour dedifferentiation (P=0.034). In pancreatico-biliary cancer, nuclear staining was seen in 44% (32 out of 72) of tumours. Absence of cytoplasmic staining was associated with perineural invasion (P=0.007), vascular invasion (P=0.05), and poorly differentiated tumours (P=0.068). A trend was noticed with advanced stage (P=0.077). CONCLUSIONS Positive clinicopathological correlations of APE1 expression suggest that APE1 is a potential drug target in ovarian, gastro-oesophageal, and pancreatico-biliary cancers.
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Affiliation(s)
- A Al-Attar
- Department of Clinical Oncology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - L Gossage
- Laboratory of Molecular Oncology, Academic Unit of Oncology, School of Molecular Medical Sciences, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - K R Fareed
- Laboratory of Molecular Oncology, Academic Unit of Oncology, School of Molecular Medical Sciences, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - M Shehata
- Department of Clinical Oncology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - M Mohammed
- Laboratory of Molecular Oncology, Academic Unit of Oncology, School of Molecular Medical Sciences, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - A M Zaitoun
- Department of Pathology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - I Soomro
- Department of Pathology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - D N Lobo
- Division of Gastrointestinal Surgery, Nottingham Digestive Diseases Centre, NIHR Biomedical Research Unit Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, UK
| | - R Abbotts
- Laboratory of Molecular Oncology, Academic Unit of Oncology, School of Molecular Medical Sciences, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - S Chan
- Department of Clinical Oncology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - S Madhusudan
- Laboratory of Molecular Oncology, Academic Unit of Oncology, School of Molecular Medical Sciences, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
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Abstract
Cancer of the oesophagus, gastro-oesophageal junction (GOJ) and stomach remains a major health problem worldwide. The evidence base for the optimal management of patients with operable oesophago-gastric cancer is evolving. Accepted approaches include preoperative chemotherapy followed by surgery (oesophageal cancer), chemo-radiotherapy alone (oesophageal cancer) and perioperative chemotherapy (gastric and gastro-oesophageal adenocarcinomas). The underlying principles behind neoadjuvant therapy are to improve resectability of the tumour by tumour shrinkage/downstaging and to treat occult metastatic disease as early as possible. The response rate to cytotoxic therapy is about 40% in oesophago-gastric cancer. Available evidence suggests that a favourable histopathological response to cytotoxic therapy may be a useful positive predictive marker in oesophago-gastric cancer. However, the ability to predict tumour response in routine clinical practice is difficult and is an area of intense investigation. There is evolving evidence for the role of predictive biomarkers in cancer in general and oesophago-gastric cancer in particular. We provide an overview on the current status of radiological and biological predictive biomarkers. We have focussed on clinical translational investigations and, where appropriate, provided pre-clinical insights. Whether predictive markers will be routinely incorporated in clinical practice remains to be seen as biomarker research is expensive and the data generated from these investigations are complex. It is clear that a concerted international effort between academia and industry is critical if personalised medicine as a practical reality for our cancer patients is to be realised.
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Affiliation(s)
- K R Fareed
- Faculty of Medicine & Health Sciences, Academic Unit of Oncology, Laboratory of Molecular Oncology, School of Molecular Medical Sciences, University of Nottingham, Nottingham University Hospitals NHS Trust, Nottingham, UK
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Abstract
Cancer of the oesophagus, gastro-oesophageal junction (GOJ) and stomach remains a major health problem worldwide. The evidence base for the optimal management of patients with operable oesophago-gastric cancer is evolving. Accepted approaches include preoperative chemotherapy followed by surgery (oesophageal cancer), chemo-radiotherapy alone (oesophageal cancer) and perioperative chemotherapy (gastric and gastro-oesophageal adenocarcinomas). The underlying principles behind neoadjuvant therapy are to improve resectability of the tumour by tumour shrinkage/downstaging and to treat occult metastatic disease as early as possible. The response rate to cytotoxic therapy is about 40% in oesophago-gastric cancer. Available evidence suggests that a favourable histopathological response to cytotoxic therapy may be a useful positive predictive marker in oesophago-gastric cancer. However, the ability to predict tumour response in routine clinical practice is difficult and is an area of intense investigation. There is evolving evidence for the role of predictive biomarkers in cancer in general and oesophago-gastric cancer in particular. We provide an overview on the current status of radiological and biological predictive biomarkers. We have focussed on clinical translational investigations and, where appropriate, provided pre-clinical insights. Whether predictive markers will be routinely incorporated in clinical practice remains to be seen as biomarker research is expensive and the data generated from these investigations are complex. It is clear that a concerted international effort between academia and industry is critical if personalised medicine as a practical reality for our cancer patients is to be realised.
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Affiliation(s)
- K R Fareed
- Faculty of Medicine & Health Sciences, Academic Unit of Oncology, Laboratory of Molecular Oncology, School of Molecular Medical Sciences, University of Nottingham, Nottingham University Hospitals NHS Trust, Nottingham, UK
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30
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Kalaiselvan R, Mohanta GP, Madhusudan S, Manna PK, Manavalan R. Enhancement of bioavailability and anthelmintic efficacy of albendazole by solid dispersion and cyclodextrin complexation techniques. Pharmazie 2007; 62:604-7. [PMID: 17867556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
The objective of this study was to improve the oral bioavailability and therapeutic efficacy of albendazole (ABZ) employing solid dispersion and cyclodextrin complexation techniques. Solid dispersion (dispersion) was prepared using ABZ and polyvinylpyrrolidone (PVP) polymer (1:1 weight ratio). Ternary inclusion complex (ternary complex) was prepared using ABZ, hydroxypropyl beta-cyclodextrin (HPbetaCD) and L-tartaric acid (1:1:1 molar ratio). In rabbits with high gastric acidity (gastric pH approximately 1), ternary complex and solid dispersion showed a bioavailability enhancement of 3.2 and 2.4 fold respectively, compared to a commercial suspension (p < 0.05). The rise in gastric pH (pH > 5) caused a 62% reduction in AUC (area under the plasma level curve) for the commercial suspension, whereas the reduction in case of PVP dispersion and ternary complex was only 43% and 37% respectively. The rapid absorption of the drug from solid dispersion and ternary complex was reflected in improved anthelmintic efficacy against the systemic phases of Trichinella spiralis. The ternary complex was significantly more efficient than solid dispersion and exhibited the highest larvicidal activity (90%) at a dose of 50 mg x kg(-1) (p < 0.05). These results suggest that the bioavailability and therapeutic efficacy of the ternary complex might be high even if there is a great variation in the gastric pH.
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Affiliation(s)
- R Kalaiselvan
- Department of Pharmacy, Annamalai University, Annamalai Nagar, Tamil Nadu, India.
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31
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Madhusudan S, Ganesan TS. Intraperitoneal gene therapy. Cancer Treat Res 2007; 134:515-24. [PMID: 17633078 DOI: 10.1007/978-0-387-48993-3_35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Affiliation(s)
- S Madhusudan
- Cancer Research UK Medical Oncology Unit, The Churchill Hospital, Oxford, UK
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Abstract
H-NS inhibits transcription by forming repressing nucleoprotein complexes next to promoters. We investigated repression by binding of H-NS within the transcription unit using the bgl and proU operons. Repression of both operons requires a downstream regulatory element (DRE) in addition to an upstream element (URE). In bgl, H-NS binds to a region located between 600 to 700 bp downstream of the transcription start site, whereas in proU the DRE extends up to position +270. We show that binding of H-NS to the bgl-DRE inhibits transcription initiation at a step before open complex formation, as shown before for proU. This was shown by determining the occupancy of the bgl transcription unit by RNA polymerases, expression analysis of bgl and proU reporter constructs, and chloroacetaldehyde footprinting of RNA polymerase promoter complexes. The chloroacetaldehyde footprinting also revealed that RNA polymerase is "poised" at the osmoregulated sigma70-dependent proU promoter at low osmolarity, whereas at high osmolarity poising of RNA polymerase and repression by H-NS are reduced. Furthermore, repression by H-NS via the URE and DRE is synergistic, and the efficiency of repression by H-NS via the DRE inversely correlates with the promoter activity. Repression is high for a promoter of low activity, whereas it is low for a strong promoter. Inefficient repression of strong promoters by H-NS via a DRE may account for high induction levels of proU at high osmolarity and for bgl upon disruption of the URE.
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Affiliation(s)
- V Nagarajavel
- Institute for Genetics, University of Cologne, 50674 Cologne, Germany
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33
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Madhusudan S, Paukner A, Klingen Y, Schnetz K. Independent regulation of H-NS-mediated silencing of the bgl operon at two levels: upstream by BglJ and LeuO and downstream by DnaKJ. Microbiology (Reading) 2005; 151:3349-3359. [PMID: 16207917 DOI: 10.1099/mic.0.28080-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Silencing of the Escherichia coli bgl operon by the histone-like nucleoid-structuring protein H-NS occurs at two levels. Binding of H-NS upstream of the promoter represses transcription initiation, whilst binding within the coding region is also proposed to repress transcription elongation. The latter, downstream level of repression is counteracted by the protease Lon and, thus, silencing of the bgl operon is more effective in lon mutants. Transposon-mutagenesis screens for suppression of this lon phenotype on bgl were performed and insertion mutations disrupting rpoS and crl were obtained, as well as mutations mapping upstream of the open reading frames of bglJ, leuO and dnaK. In rpoS and crl mutants, bgl promoter activity is known to be higher. Likewise, as shown here, bgl promoter activity is increased in the bglJ and leuO mutants, which express BglJ and LeuO constitutively. However, BglJ and LeuO have no impact on downstream repression. A dnaKJ mutant was isolated for the first time in the context of the bgl operon. The mutant expresses lower levels of DnaK than the wild-type. Interestingly, in this dnaKJ : : miniTn10 mutant, downstream repression of bgl by H-NS is less effective, whilst upstream repression by H-NS remains unaffected. Together, the data show that the two levels of bgl silencing by H-NS are regulated independently.
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Affiliation(s)
- S Madhusudan
- Institute for Genetics, University of Cologne, Zülpicherstr. 47, 50674 Cologne, Germany
| | - Andreas Paukner
- Institute for Genetics, University of Cologne, Zülpicherstr. 47, 50674 Cologne, Germany
| | - Yvonne Klingen
- Institute for Genetics, University of Cologne, Zülpicherstr. 47, 50674 Cologne, Germany
| | - Karin Schnetz
- Institute for Genetics, University of Cologne, Zülpicherstr. 47, 50674 Cologne, Germany
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Levitt NC, Propper DJ, Madhusudan S, Braybrooke JP, Echeta C, te Poele R, Davies SL, Flanagan E, Hickson ID, Joel S, Ganesan TS. Pharmacokinetically guided phase I trial of topotecan and etoposide phosphate in recurrent ovarian cancer. Br J Cancer 2005; 93:60-9. [PMID: 15956976 PMCID: PMC2361471 DOI: 10.1038/sj.bjc.6602657] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
A pharmacokinetically guided phase I study of topotecan and etoposide phosphate was conducted in recurrent ovarian cancer. The scheduling of the topoisomerase I and II inhibitors was determined using in vitro activity data. All patients had recurrent disease following prior platinum-containing chemotherapy. Patients had a World Health Organisation performance status of 0–2 and adequate bone marrow, renal and hepatic function. Treatment was with topotecan intravenously for 5 days followed immediately by a 5-day intravenous infusion of etoposide phosphate (EP), with pharmacokinetically guided dose adjustment. Plasma etoposide levels were measured on days 2 and 4 of the infusion. A total of 21 patients entered the study. In all, 48% were platinum resistant and 71% had received prior paclitaxel. The main toxicities were haematological, short lived and reversible. A total of 29% of patients experienced grade 4 thrombocytopenia and 66% grade 4 neutropenia after the first cycle. Neutropenia and thrombocytopenia was dose limiting. The maximum-tolerated dose was topotecan 0.85 mg m−2 day−1 days 1–5 followed immediately by a 5-day infusion of EP at a plasma concentration of 1 μg ml−1. The response rate (RR) was 28% in 18 evaluable patients. There was marked interpatient variability in topoisomerase IIα levels measured from peripheral lymphocytes, with no observed increase following topotecan. This regimen of topotecan followed by EP demonstrated good activity in recurrent ovarian cancer and was noncrossresistant with paclitaxel. Both the toxicity and RR was higher than would be expected from the single agent data, in keeping with synergy of action.
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Affiliation(s)
- N C Levitt
- Cancer Research UK Cancer Centre, Churchill Hospital, Oxford OX3 7LJ, UK
| | - D J Propper
- Cancer Research UK, Medical Oncology Unit, St Bartholomew's Hospital, West Smithfield, London EC1A 7BE, UK
| | - S Madhusudan
- Cancer Research UK Cancer Centre, Churchill Hospital, Oxford OX3 7LJ, UK
| | - J P Braybrooke
- Genome Integrity Group, Molecular Oncology Laboratories, Weatherall Institute of Molecular Medicine, John Radcliffe, Hospital, Oxford 0X3 9DS, UK
| | - C Echeta
- Cancer Research UK Cancer Centre, Churchill Hospital, Oxford OX3 7LJ, UK
| | - R te Poele
- Cancer Research UK, Medical Oncology Unit, St Bartholomew's Hospital, West Smithfield, London EC1A 7BE, UK
| | - S L Davies
- Bristol Haematology and Oncology Centre, Horfield Road, Bristol BS2 8ED, UK
| | - E Flanagan
- Cancer Research UK Cancer Centre, Churchill Hospital, Oxford OX3 7LJ, UK
| | - I D Hickson
- Bristol Haematology and Oncology Centre, Horfield Road, Bristol BS2 8ED, UK
| | - S Joel
- Cancer Research UK, Medical Oncology Unit, St Bartholomew's Hospital, West Smithfield, London EC1A 7BE, UK
| | - T S Ganesan
- Cancer Research UK Cancer Centre, Churchill Hospital, Oxford OX3 7LJ, UK
- Cancer Research UK Cancer Centre, Churchill Hospital, Oxford OX3 7LJ, UK. E-mail:
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Deplanque G, Madhusudan S, Jones PH, Wellmann S, Christodoulos K, Talbot DC, Ganesan TS, Blann A, Harris AL. Phase II trial of the antiangiogenic agent IM862 in metastatic renal cell carcinoma. Br J Cancer 2004; 91:1645-50. [PMID: 15354209 PMCID: PMC2409952 DOI: 10.1038/sj.bjc.6602126] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
IM862 is a naturally occurring dipeptide (L-glu-L-trp) with immunomodulatory and antiangiogenic properties. A significant anticancer activity has been reported recently in AIDS-related Kaposi's sarcoma, a tumour of endothelial cell origin. The high vascularity and responsiveness to immunotherapy of renal cell carcinoma (RCC) makes such a tumour a potential target for IM862. In all, 25 patients were accrued in a prospective phase II trial using a standard two-step design. The main inclusion criteria were WHO performance status ⩽2, age over 18 years, expected survival >3 months, normal marrow, kidney and liver functions. IM862 was given intranasally at a dose of 20 mg three times daily. Each cycle consisted of 8 consecutive weeks of treatment. All 25 patients were fully evaluable for response and 24 for toxicities. Median age was 62 years (range 42–76), median WHO PS was 1 (0–2). No grade 2 or 3 toxicities related to the study drug have been recorded. Eight patients had stable disease (SD) and 17 progressed while on treatment. Median survival was 7.9 months (range 2.7–20). Median time to progression was 1.9 months (range 1.2–12.6). Median duration of SD was 6 months (range 5.2–12.6+). Analysis of blood angiogenic markers showed a significant decrease of plasma vascular endothelial growth factor (VEGF) levels after 4 and 8 weeks of therapy. Treatment with IM862 has no toxicity, but does not lead to any significant objective responses in metastatic RCC. IM862 should not be further evaluated as a single agent at these doses and schedule for this population of patients. The decrease in VEGF levels warrants further investigation of IM862 as an antiangiogenic therapy.
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Affiliation(s)
- G Deplanque
- University of Oxford, Cancer Research UK Medical Oncology Unit, The Churchill, Old Road, Oxford OX3 7LJ, England
| | - S Madhusudan
- University of Oxford, Cancer Research UK Medical Oncology Unit, The Churchill, Old Road, Oxford OX3 7LJ, England
| | - P H Jones
- University of Oxford, Cancer Research UK Medical Oncology Unit, The Churchill, Old Road, Oxford OX3 7LJ, England
| | - S Wellmann
- University of Oxford, Cancer Research UK Medical Oncology Unit, The Churchill, Old Road, Oxford OX3 7LJ, England
| | - K Christodoulos
- University of Oxford, Cancer Research UK Medical Oncology Unit, The Churchill, Old Road, Oxford OX3 7LJ, England
| | - D C Talbot
- University of Oxford, Cancer Research UK Medical Oncology Unit, The Churchill, Old Road, Oxford OX3 7LJ, England
| | - T S Ganesan
- University of Oxford, Cancer Research UK Medical Oncology Unit, The Churchill, Old Road, Oxford OX3 7LJ, England
| | - A Blann
- University of Oxford, Cancer Research UK Medical Oncology Unit, The Churchill, Old Road, Oxford OX3 7LJ, England
| | - A L Harris
- University of Oxford, Cancer Research UK Medical Oncology Unit, The Churchill, Old Road, Oxford OX3 7LJ, England
- University of Oxford, Cancer Research UK Medical Oncology Unit, The Churchill, Old Road, Oxford OX3 7LJ, England. E-mail:
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Muthuramalingam SR, Braybrooke J, Madhusudan S, Blann A, Wilner S, Jenkins A, Han C, Perren T, Ganesan TS. A randomised trial of carboplatin versus carboplatin and thalidomide in ovarian cancer, with evaluation of potential surrogate markers of angiogenesis. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.5024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- S. R. Muthuramalingam
- CRUK Dept. of Medical Oncology, Churchill Hospital, Oxford, United Kingdom; Thrombosis and Vascular Biology Laboratory, Brimingham, United Kingdom; St. James Hospital, Leeds, United Kingdom
| | - J. Braybrooke
- CRUK Dept. of Medical Oncology, Churchill Hospital, Oxford, United Kingdom; Thrombosis and Vascular Biology Laboratory, Brimingham, United Kingdom; St. James Hospital, Leeds, United Kingdom
| | - S. Madhusudan
- CRUK Dept. of Medical Oncology, Churchill Hospital, Oxford, United Kingdom; Thrombosis and Vascular Biology Laboratory, Brimingham, United Kingdom; St. James Hospital, Leeds, United Kingdom
| | - A. Blann
- CRUK Dept. of Medical Oncology, Churchill Hospital, Oxford, United Kingdom; Thrombosis and Vascular Biology Laboratory, Brimingham, United Kingdom; St. James Hospital, Leeds, United Kingdom
| | - S. Wilner
- CRUK Dept. of Medical Oncology, Churchill Hospital, Oxford, United Kingdom; Thrombosis and Vascular Biology Laboratory, Brimingham, United Kingdom; St. James Hospital, Leeds, United Kingdom
| | - A. Jenkins
- CRUK Dept. of Medical Oncology, Churchill Hospital, Oxford, United Kingdom; Thrombosis and Vascular Biology Laboratory, Brimingham, United Kingdom; St. James Hospital, Leeds, United Kingdom
| | - C. Han
- CRUK Dept. of Medical Oncology, Churchill Hospital, Oxford, United Kingdom; Thrombosis and Vascular Biology Laboratory, Brimingham, United Kingdom; St. James Hospital, Leeds, United Kingdom
| | - T. Perren
- CRUK Dept. of Medical Oncology, Churchill Hospital, Oxford, United Kingdom; Thrombosis and Vascular Biology Laboratory, Brimingham, United Kingdom; St. James Hospital, Leeds, United Kingdom
| | - T. S. Ganesan
- CRUK Dept. of Medical Oncology, Churchill Hospital, Oxford, United Kingdom; Thrombosis and Vascular Biology Laboratory, Brimingham, United Kingdom; St. James Hospital, Leeds, United Kingdom
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Madhusudan S, Protheroe A, Vasey P, Patel P, Selby P, Altman D, Christodoulos K, Harris AL. A randomised phase II study of interferon alpha alone or in combination with thalidomide in metastatic renal cancer. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.4742] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- S. Madhusudan
- CRUK Dept of Medical Oncology, Churchill Hospital, oxford, United Kingdom; Beatson Oncology Centre, Western Infirmary, Glasgow, United Kingdom; CRUK Clinical Cancer Centre, St. James Univ. Hosp, Leeds, United Kingdom; Centre for Statistics Medicine, Churchill Hospital, Oxford, United Kingdom
| | - A. Protheroe
- CRUK Dept of Medical Oncology, Churchill Hospital, oxford, United Kingdom; Beatson Oncology Centre, Western Infirmary, Glasgow, United Kingdom; CRUK Clinical Cancer Centre, St. James Univ. Hosp, Leeds, United Kingdom; Centre for Statistics Medicine, Churchill Hospital, Oxford, United Kingdom
| | - P. Vasey
- CRUK Dept of Medical Oncology, Churchill Hospital, oxford, United Kingdom; Beatson Oncology Centre, Western Infirmary, Glasgow, United Kingdom; CRUK Clinical Cancer Centre, St. James Univ. Hosp, Leeds, United Kingdom; Centre for Statistics Medicine, Churchill Hospital, Oxford, United Kingdom
| | - P. Patel
- CRUK Dept of Medical Oncology, Churchill Hospital, oxford, United Kingdom; Beatson Oncology Centre, Western Infirmary, Glasgow, United Kingdom; CRUK Clinical Cancer Centre, St. James Univ. Hosp, Leeds, United Kingdom; Centre for Statistics Medicine, Churchill Hospital, Oxford, United Kingdom
| | - P. Selby
- CRUK Dept of Medical Oncology, Churchill Hospital, oxford, United Kingdom; Beatson Oncology Centre, Western Infirmary, Glasgow, United Kingdom; CRUK Clinical Cancer Centre, St. James Univ. Hosp, Leeds, United Kingdom; Centre for Statistics Medicine, Churchill Hospital, Oxford, United Kingdom
| | - D. Altman
- CRUK Dept of Medical Oncology, Churchill Hospital, oxford, United Kingdom; Beatson Oncology Centre, Western Infirmary, Glasgow, United Kingdom; CRUK Clinical Cancer Centre, St. James Univ. Hosp, Leeds, United Kingdom; Centre for Statistics Medicine, Churchill Hospital, Oxford, United Kingdom
| | - K. Christodoulos
- CRUK Dept of Medical Oncology, Churchill Hospital, oxford, United Kingdom; Beatson Oncology Centre, Western Infirmary, Glasgow, United Kingdom; CRUK Clinical Cancer Centre, St. James Univ. Hosp, Leeds, United Kingdom; Centre for Statistics Medicine, Churchill Hospital, Oxford, United Kingdom
| | - A. L. Harris
- CRUK Dept of Medical Oncology, Churchill Hospital, oxford, United Kingdom; Beatson Oncology Centre, Western Infirmary, Glasgow, United Kingdom; CRUK Clinical Cancer Centre, St. James Univ. Hosp, Leeds, United Kingdom; Centre for Statistics Medicine, Churchill Hospital, Oxford, United Kingdom
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Madhusudan S, Protheroe A, Propper D, Han C, Corrie P, Earl H, Hancock B, Vasey P, Turner A, Balkwill F, Hoare S, Harris AL. A multicentre phase II trial of bryostatin-1 in patients with advanced renal cancer. Br J Cancer 2003; 89:1418-22. [PMID: 14562010 PMCID: PMC2394342 DOI: 10.1038/sj.bjc.6601321] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Protein kinase C (PKC) has a critical role in several signal transduction pathways, and is involved in renal cancer pathogenesis. Bryostatin-1 modulates PKC activity and has antitumour effects in preclinical studies. We conducted a multicentre phase II clinical trial in patients with advanced renal cancer to determine the response rate, immunomodulatory activity and toxicity of bryostatin-1 given as a continuous 24 h infusion weekly for 3 out of 4 weeks at a dose of 25 μg m−2. In all, 16 patients were recruited (11 males and five females). The median age was 59 years (range 44–68). Patients had been treated previously with nephrectomy (8) and/or interferon therapy (9) and/or hormone therapy (4) and/or radiotherapy (6). Eight, five and three patients had performance statuses of 0, 1 and 2, respectively. A total of 181 infusions were administered with a median of 12 infusions per patient (range 1–29). Disease response was evaluable in 13 patients. Three patients achieved stable disease lasting for 10.5, 8 and 5.5 months, respectively. No complete responses or partial responses were seen. Myalgia, fatigue, nausea, headache, vomiting, anorexia, anaemia and lymphopenia were the commonly reported side effects. Assessment of biological activity of bryostatin-1 was carried out using the whole–blood cytokine release assay in six patients, two of whom had a rise in IL-6 levels 24 h after initiating bryostatin-1 therapy compared to pretreatment values. However, the IL-6 level was found to be significantly lower at day 28 compared to the pretreatment level in all six patients analysed.
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Affiliation(s)
- S Madhusudan
- Cancer Research UK Medical Oncology Unit, Churchill Hospital, Oxford, UK
| | - A Protheroe
- Cancer Research UK Medical Oncology Unit, Churchill Hospital, Oxford, UK
| | - D Propper
- Cancer Research UK Medical Oncology Unit, Churchill Hospital, Oxford, UK
| | - C Han
- Cancer Research UK Medical Oncology Unit, Churchill Hospital, Oxford, UK
| | - P Corrie
- Department of Oncology, Addenbrooke's Hospital, Cambridge UK
| | - H Earl
- Department of Oncology, Addenbrooke's Hospital, Cambridge UK
| | - B Hancock
- Department of Clinical Oncology, Weston Park Hospital, Sheffield, UK
| | - P Vasey
- Beatson Oncology Centre, Western Infirmary, Glasgow, UK
| | - A Turner
- Drug Development Office, Cancer Research UK, 61 Lincoln's Inn Fields, London, UK
| | - F Balkwill
- Cancer Research UK Translational Oncology Laboratory, Barts & The London, Queen Mary's Medical School, Charterhouse Square, London UK
| | - S Hoare
- Cancer Research UK Translational Oncology Laboratory, Barts & The London, Queen Mary's Medical School, Charterhouse Square, London UK
| | - A L Harris
- Cancer Research UK Medical Oncology Unit, Churchill Hospital, Oxford, UK
- Cancer Research UK Medical Oncology Unit, University of Oxford, Churchill Hospital, Oxford OX3 7LJ, UK. E-mail:
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