Showing papers by "Thomas Powles published in 2005"

A Prognostic Index for Systemic AIDS-Related Non-Hodgkin Lymphoma Treated in the Era of Highly Active Antiretroviral Therapy

Abstract: The International Prognostic Index predicts death in non-Hodgkin lymphoma, including AIDS-related lymphoma before highly active antiretroviral therapy (HAART). Since the advent of HAART, the progno...

The changing presentation of germ cell tumours of the testis between 1983 and 2002

Abstract: Authors from London looked at patients diagnosed with germ cell tumours of the testis who presented between 1983 and 2002. They found that there was an overall increase in the percentage of patients presenting with stage I seminoma, with a significant reduction in the size of the primary tumour. The authors do not feel that they can clarify the reason for these changes. There is a 20-year follow-up of patients who had tumours of the ureter and renal pelvis treated with resection and renal autotransplantation. In this fascinating series from Gothenberg, it was found that in patients with a normal contralateral kidney, resection and autotransplantation was not indicated. It was possibly beneficial in patients with solitary kidneys, but only after other treatments have been considered. OBJECTIVE To prospectively investigate the presentation of germ cell tumours (GCTs) of the testis in terms of stage or histology, as the incidence of this disease in increasing. PATIENTS AND METHODS Patients diagnosed with GCT of the testis between 1983 and 2002 were categorised into three periods depending on the date of diagnosis of the GCT, and the presentational characteristics assessed. RESULTS There was a significant increase in the proportion of patients presenting with stage I disease (59% to 78%) and seminoma (43% to 58%) over this period. There was also a significant reduction in the size of the primary tumour (5 to 4 cm). CONCLUSION A greater proportion of patients with GCT are presenting with stage I seminoma, the reasons for which are unclear, although earlier diagnosis through improved awareness of GCT may be important.

Assessing the size and stage of testicular germ cell tumours: 1984-2003.

Abstract: OBJECTIVE To assess the size and stage of testicular tumours on presentation in the period 1984–2002. PATIENTS AND METHODS Demographic details and information on staging on 550 patients treated at St. Bartholomew's and the Royal London Hospital in the period 1984–2002 were collected prospectively in the departmental database. Information on testicular size was obtained by reviewing the histopathology records, and the maximum dimension of the tumour as measured in the gross specimen was taken as the size of the testicular tumour. RESULTS The period 1984–2002 was divided into three intervals, i.e. 1984–95, 1996–98 and 1999–2002. The mean testicular tumour size in the three intervals decreased from 4 cm (162 tumours) to 3.2 cm (85) and 2.5 cm (72; P = 0.002, Student's t-test). The proportion of tumours of <2 cm on presentation also increased, from 11% to 14% and 23% in the three intervals, respectively, while the proportion of patients with stage 1 disease increased from 57%, to 63% and 77%, respectively. CONCLUSIONS The size of testicular tumours on presentation has shown a consistent decline in the last two decades, the mean size now being 2.5 cm. That 23% are now <2 cm raises the possibility of testis-preserving surgery in this young group of patients, who have an excellent prognosis, and therefore in the long-term issues such as psychological morbidity and natural fertility assume greater importance. There is a need for a randomized controlled trial to evaluate these issues.

Phase I study of TNFalpha AutoVaccIne in patients with metastatic cancer.

Abstract: We evaluated the safety and immunogencity of a novel vaccine directed against autologous TNFalpha in a Phase I fixed dose escalation trial. The vaccine consisted of two recombinant TNFalpha proteins, with specific peptides replaced by foreign immunodominant T cell epitopes from tetanus toxoid. The main objectives were to establish a safe dose and evaluate the vaccines ability to raise neutralising TNFalpha antibodies. Secondary objectives were improvements in body weight and tumour response. Thirty-three patients were vaccinated with three doses (20, 100, or 400 mug) of TNFalpha vaccine at 2-weekly intervals adjuvanted with aluminium hydroxide. Anti-TNFalpha antibody titres were measured by both a RIA, using soluble native TNFalpha as the antigen, and by an ELISA using immobilized partly denatured TNFalpha. Eleven patients (33%) had mild grade1/2 injection site reactions at the higher doses. In 10 of 20 patients, serum antibodies recognize denatured TNFalpha in the ELISA, whereas, antibody titres against native TNFalpha in the RIA were undetectable. This suggests that the production process had partly denatured the vaccine preventing the formation of cross-reacting antibodies to native TNFalpha. In conclusion, TNFalpha vaccine was able to elicit vaccine specific antibodies. However, since the antibodies were only able to cross-react with partly denatured TNFalpha, evaluation of safety and tumour responses to the TNFalpha vaccine was compromised.

A phase II study of irinotecan, paclitaxel and oxaliplatin (IPO) in patients with multiply relapsed germ cell tumours (GCT)

Abstract: 4527 Background: We have shown that many patients who have viable GCT at surgery, following chemotherapy have enhanced topoisomerase 1 staining on immuno-histochemistry. We have also found that in-vitro the combination of oxaliplatin and SN38 is highly efficacious in the treatment of cisplatin refractory GCT cell lines. Methods: Patients who had failed at least two lines of cisplatin-based therapy (one line in the case of mediastinal tumours) were treated with a novel protocol IPO (oxaliplatin 100mg/m2 on day 1, irinotecan 200mg/m2 on day 1 and paclitaxel 80mg/m2 on day 1, 8 and 15 repeated every 21 days with alternate day filgrastim) to a maximum of 4 cycles. Results: To date 21 patients have been treated of whom 20 were evaluable for response. The median age was 36 years. Eleven were cisplatin sensitive (2 had received prior HDT). Six were refractory and 4 absolutely refractory (AR) according to Beyer’s criteria. A median of 4 cycles was administered. Grade 3/4 toxicity were reported as follows:-alopeci...

Antiapoptotic effect of growth factors in leukemia.

Abstract: CSF) after allogeneic bone marrow (BM) transplantation. In this retrospective analysis, patients received bone marrow or peripheral blood stem cells (PBSC), and were administered phrophylatic G-CSF post-transplantation. An increase in GVHD and treatment-related mortality (TRM) was observed only in patients receiving G-CSF after BM transplantation. Similarly, overall and leukemia-free survival rates were significantlyreduced(relativetocontrolrisks:0.59,P.0001;0.64, P.0003, respectively). The results of this study differ from the recently published meta-analyses examining the effect of growth factors on GVHD after allogeneic transplantation. 2 In addition, as discussed in the accompanying editorial, there were significant differences between the two arms in terms of patient characteristics, GVHD prophylaxis, and disease stage. However, although the authors emphasized the possibility of center effect or bias and discussed their rationale in disregarding interpatient or interstudy variability, no clear hypotheses to explain the negative effects of G-CSF in the GVHD-sensitive cohort were mooted. There are fundamental differences in the leukocyte