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Tuesday, April 27, 2010

Management of neuroendocrine tumour (NET)

Neuroendocfine tumor are a relatively rare group of tumour .The incidence and the prevalence has been increasing over the year .This probably is due to increase awareness among the medical professionals and the pathologist .The spectrum of clinical and histological grading vary widely .The prognosis varies widely depending on number of factors
age
load of disease
site of disease liver only Vs other ares
symptom
Performance status (is patient active)etc

There are number of management option .So it should be ,managed with multidisciplinary team .
1-surgery
2-chemotherapy
Cisplatin
etoposide
streptozocin
capecitabine
Temozolamaide
5-FU
Doxorubicin etc in combination
3-Radioembolisation (blocking segment of liver with cancer with beads)
4-Lutetium and other PRRT treatment - available in Europe ,part of Australia
5-symptom control with somatostatin analogue (some evidence it has anti cancer effect)
6- clinical trial
Sunitinib
everolumus

For patients being investigated for cancer unknown primary -- please check with your doctor if this might be NET

seek opinion from centres which deals with these cancer .
Erasmus University Medical Center, Rotterdam (The Netherlands)
Uppsala University Hospital, Sweden
Bad Berka Germany

useful website
Carcinoid.org
Unicorn foundation australia


Please send you comment and criticism of the post .

Monday, April 26, 2010

Clinical trial - making sense of it

Hi everyone ,

I have started my new job in a busy tertiary hospital as clinical research fellow and I mostly deal with cancer clinical trial.Let me explain what is clinical trial .

Once the scientist come up with a new molecule which has effect on cancer in the test tubes (Cell culture ).This then goes to animal study .Most of the animal studies have human cancer transferred to an accessible site such as thigh .As the natural history of the cancer is to grow .The the new molecule is administered to the animal and the tumor is assessed for response .This not only gives us idea about efficacy also potential side effects .

Phase I Clinical trial - First in human trial
aim to find the right dose of the drug
secondary aim -efficacy and toxicity

started in a small group of patient at a low dose .This dose is double in subsequent groups ,till there is dose limiting side effects this is the maximum tolerable dose(MTL) .The cohort just below the MTL becomes the standard dose for next phase

For patient-- every one gets drug.No sugar pills
what if you start at low dose.Well if in the tumour starts to grow ,the dose is increased till you reach the standard dose .

Phase II - Pilot study for efficacy in a small group of patient
for patient -everyone gets the drug .No sugar pills(placebo)
Depending on the efficacy the drug advances to the next phase .

Phase III - Randomised clinical trial
The final stage before drug comes to market
Aim is to compare the experimental drug with standard treatment .
if there is no standard treatment ,then against placebo.

1- randomised - to avoid selecting particular group to certain arm of trial the patient are randomised .This is doen by computer.It could be 1:1 or 2:1 .Proportion of patient in each arm.

2- If the doctor ,and patient does not know what treatment he/she is on - its called Blinding,if not blinded its called open label

You can find all registered clinical trial world wide here

http://clinicaltrials.gov/

pooh thats a lot for a post .So let me know if it helped anyone .Please leave your comments or question