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Title: Early clinical trials in upper gastrointestinal cancer
Author: Millar, Joanne Ruth
ISNI:       0000 0001 3398 9212
Awarding Body: Queen's University of Belfast
Current Institution: Queen's University Belfast
Date of Award: 2008
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On a worldwide basis, gastric and oesophageal cancer are the third and seventh most common causes of cancer respectively. The majority of patients either present with locally advanced I inoperable or metastatic disease, or develop recurrent disease after potentially curative management. Palliative chemotherapy is therefore a consideration for the majority of patients. Standard chemotherapy in this setting using cisplatin and fluorouracil based regimens does improve survival. However, to date, no randomised trial has shown survival beyond 12 months. There has therefore been considerable early trial activity in an attempt to improve outcomes and/or reduce toxicity of treatment in this palliative setting. An audit was conducted of all new cases of gastro-oesophageal cancer referred to the Northern Ireland Cancer Centre in the year 2003. This gave a broad overview of the current referral and management patterns employed, and their resulting outcomes. Two trials were performed in this treatment setting. The first was a phase II trial of the gemcitabine / cisplatin doublet in the treatment of advanced / metastatic oesophageal cancer. This regimen, used in other settings, had not been previously assessed in this patient group. A total of 42 patients were entered. The regimen was tolerable and yielded a response rate of 45% by intention to treat analysis. The second trial was a phase I trial using a new schedule of weekly docetaxel in combination with oxaliplatin, both drugs with promising activity in the treatment of gastro-oesophageal cancer. This trial was open to patients with all tumour types, but 15 of the 25 patients entered had gastro-oesophageal primaries. The response rate in this patient group was 40%. Toxicity was predictable and manageable, and the recommended phase II dose was established. .Pharmacokinetic analysis revealed no significant interaction. A phase II study of this regimen in gastro-oesophageal cancer has recently opened.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (M.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available