Melvin T M Chin
UNSW, Prince of Wales Clinical School, Faculty Member
- A clinical academic medical oncologist with broad research interestsedit
BACKGROUND People from ethnic minority backgrounds are more at risk of poor care and outcomes in health services, this inequity is widely recognised. We used an adapted, experience-based co-design (EBCD) process to facilitate... more
BACKGROUND People from ethnic minority backgrounds are more at risk of poor care and outcomes in health services, this inequity is widely recognised. We used an adapted, experience-based co-design (EBCD) process to facilitate collaboration between staff and ethnic minority patients to identify key safety issues and devise a tailored solution at a cancer service in New South Wales, Australia. Identifying health service contact points relevant to medication concerns between appointments or hospital admissions was a key issue identified in the workshop. The co-design process resulted in the creation of a communication tool: Making it Meaningful (MiM). This protocol presents a pilot study testing whether MiM is feasible and acceptable for use with ethnic minority consumers in cancer services in Australia. This protocol is particularly significant as co-designed interventions are increasingly valued, but rarely documented in trials. OBJECTIVE To test whether MiM is feasible and acceptable for use with ethnic minority consumers in cancer services in Australia. METHODS A single-site, controlled before and after pilot study to determine the feasibility and acceptability of ‘MiM’. Forty patients from Chinese and Russian cultural backgrounds will be recruited; 20 treatment and 20 control. These cohorts were selected as the co-design participants identified these communities are at particular risk of medication safety concerns. The intervention group will use the MiM tool during usual appointments ,while the control group will receive routine care. Telephone surveys will be conducted with patients at three time points to assess patient knowledge and self-efficacy in medication management, and the perceived usability and acceptability of the MiM. Qualitative interviews with staff will be conducted at pilot conclusion to explore practitioner perceptions of MiM feasibility and acceptability. RESULTS Using Evidence Based Codesign (EBCD) we identified communication about medication, particularly between appointments, as a key issue. Increasing consumer engagement in medication management was identified as a strategy to reduce medication safety problems in cancer care; the MiM was developed to address this issue. CONCLUSIONS This study involves implementation and evaluation of the feasibility and acceptability of the MiM, together with preliminary data on patient knowledge about prescribed medications and confidence in medication management, with a view to expanding the study to test whether the intervention is effective in improving patient outcomes. CLINICALTRIAL This protocol is registered with Australian New Zealand Clinical Trials Registry RN: ACTRN12622001260718p
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Metastasis is the major cause of cancer mortality. A strong link between invasive metastatic tumours and epithelial‐mesenchymal plasticity (EMP) has been demonstrated in human breast cancer (BC). EMP can provide carcinoma cells with the... more
Metastasis is the major cause of cancer mortality. A strong link between invasive metastatic tumours and epithelial‐mesenchymal plasticity (EMP) has been demonstrated in human breast cancer (BC). EMP can provide carcinoma cells with the invasive ability to leave the primary tumour, enter into the circulation as circulating tumour cells (CTCs), arrive at a distant organ and ultimately form a metastasis. To investigate EMP in BC CTCs, the expression profiles of forty‐three genes including EMP markers, BC stem cell markers, hormonal receptors, hypoxia and cellular metabolism genes, were characterised in pooled CTCs and in primary tumours of two human BC xenograft‐bearing mouse models, MDA‐MB‐468 and ED03, in two replicate experiments of at least 10 mice. Gene expression of CTCs was also performed at a single cell level. A human‐specific tandem nested RT‐qPCR method, which can detect as little as a single cell, was developed and used. In pooled CTCs relative to primary tumours, a significant increase in expression of mesechymal markers (SNAIL1 and VIM), and surprisingly of a prototypic epithelial marker CDH1 were observed. A decrease/loss of EpCAM was reproducibly observed in CTCs of both models, while decreased CD24 and EGFR in CTCs were only seen in the MDA‐MB‐468 model. Genes associating with hypoxia (HIF1A, BNIP3 and APLN) and cellular metabolism (PPARGC1A) were also significantly elevated in CTCs of both models (n = 1). Preliminary analysis of single CTCs revealed the general concordance with the results obtained with the pooled CTCs. In conclusion, alteration in expression of several genes observed in one model was also present in the other model. The mixed alteration in both epithelial and mesenchymal markers in CTCs across both models is suggestive of a ‘hybrid’ phenotype, and EMP. Further studies will shed more light onto the nature of the gene expression changes and the role of EMP in CTCs
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4 months later, he was admitted with a 3-day history of severe upper abdominal pain and nausea. There was no history of alcohol intake or gallstones. On examination, there was upper abdominal tenderness and guarding. His amylase was... more
4 months later, he was admitted with a 3-day history of severe upper abdominal pain and nausea. There was no history of alcohol intake or gallstones. On examination, there was upper abdominal tenderness and guarding. His amylase was raised (246 μmol/L), and liver ...
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Research Interests: Nursing, Oncology, Qualitative Research, Personalized Medicine, Medicine, and 14 moreThematic Analysis, Distress, Lung Cancer, Comprehension, Melanoma, Psychosocial, Expectations, Genomic Medicine, Public health systems and services research, Psychological Impact, Oncologists, Gefitinib, Trametinib, and Dabrafenib
Table S1. Treatment-related adverse events of {greater than or equal to} grade 2 reported in at least 5% of patients by dose (3); Table S2. Summary of plasma dabrafenib pharmacokinetic parameters after single-dose administration of... more
Table S1. Treatment-related adverse events of {greater than or equal to} grade 2 reported in at least 5% of patients by dose (3); Table S2. Summary of plasma dabrafenib pharmacokinetic parameters after single-dose administration of dabrafenib gelatin capsules under fasted conditions (dose escalation: Part 1); Table S3. Summary of plasma dabrafenib pharmacokinetic parameters after repeated dose administration of dabrafenib gelatin capsules under fasting conditions on day 8 or day 15 (dose escalation: Part 1).
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Co-design is increasingly employed as a user-centric method to create healthcare change. In healthcare co-design, small groups of consumers and healthcare workers come together to identify processes, policies or service elements that... more
Co-design is increasingly employed as a user-centric method to create healthcare change. In healthcare co-design, small groups of consumers and healthcare workers come together to identify processes, policies or service elements that require improvement and to design solutions. Multiple frameworks have emerged to guide the health work force and health researchers how to conduct co-design and support consumer members to engage in the process effectively. Frameworks have sought to address the propensity for co-design to exacerbate inequities for consumers with complex care needs or in under-served populations. Advice regarding the need to consider and ensure co-design is accessible to an increasingly diverse health workforce is, however, lacking. Drawing on our experience co-designing with diverse consumer and healthcare-worker populations, we discuss the implications of co-design for the healthcare workforce.
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Research Interests: General Practice, Education, Cancer, Medicine, General, and 9 morePractice, Care, Social and Behavioral Sciences, Follow Up, Patient, Gp, About, Views, and Oncologist
Background:Prior to the Covid-19 pandemic, telemedicine was only used to deliver health care to patients living in remote areas of Australia. However, the spread of the Covid-19 virus pushed the widespread uptake of telemedicine across... more
Background:Prior to the Covid-19 pandemic, telemedicine was only used to deliver health care to patients living in remote areas of Australia. However, the spread of the Covid-19 virus pushed the widespread uptake of telemedicine across Australia, including in metropolitan regions. This qualitative study will explore the medical oncology (MO) patient and clinician experience of telemedicine in a metropolitan setting as a result of Covid-19.Method:Participants were selected and invited to participate by theoretical sampling from MO clinicians and patients attending MO clinics at Prince of Wales Hospital. Data was collected by in-depth semi-structured interviews. Thematic analysis was performed to analyse the interview data. Transcripts were coded using the grounded theory approach to identify overarching themes.Results:Twelve participants were recruited to the study. Most participants viewed the adoption of telemedicine positively because it was considered as convenient, efficient and...
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PURPOSE Leptomeningeal disease (LMD) in epidermal growth factor receptor (EGFR)-mutant lung adenocarcinoma is associated with a poor prognosis and limited treatment options. Osimertinib is a potent third-generation EGFR tyrosine kinase... more
PURPOSE Leptomeningeal disease (LMD) in epidermal growth factor receptor (EGFR)-mutant lung adenocarcinoma is associated with a poor prognosis and limited treatment options. Osimertinib is a potent third-generation EGFR tyrosine kinase inhibitor with confirmed CNS penetration. This study reports on outcomes of patients with EGFR-mutated non–small-cell lung cancer who developed LMD and were subsequently treated with osimertinib. METHODS We identified patients treated with osimertinib 80 mg PO daily under a compassionate access scheme across nine tertiary Australian institutes between July 2017 and July 2020. Patient demographics, tumor characteristics, and treatment history were collected. Median overall survival, median progression-free survival, disease control rates (DCR), and overall response rates (ORR) were assessed. Kaplan-Meier analysis was performed and descriptive statistics were used. RESULTS Thirty-nine patients were analyzed of which 74% were female. Exon 19 deletions (4...
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Additional file 1: Supplementary 1. Patient scenarios. Supplementary 2. Questionnaire.
The effect of age on appropriate supplementary testing. (DOCX 27 kb)
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Use of neostigmine in capecitabine-induced
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Introduction A shared model of care between cancer services and primary health care is safe and acceptable and can address the increasing demands on cancer services for long term follow-up. This paper describes the challenges developing... more
Introduction A shared model of care between cancer services and primary health care is safe and acceptable and can address the increasing demands on cancer services for long term follow-up. This paper describes the challenges developing an interactive shared care plan for colorectal cancer follow-up care. Methods A systematic literature review identified the use, functionality, and impact of web-based shared care plans to support cancer follow-up. Workshops with key stakeholders and consultations with clinicians, consumers and information service providers were conducted to agree on a model of care and technology options to interactively share a care plan. Results Seventeen papers reported five web-based shared care plan systems for cancer follow-up. These systems supported the creation and/or access to view or share the care plans using email or by downloading and printing a copy. The challenges we found included issues with the security, privacy and sharing of patient information ...
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Research Interests: Narrative, Qualitative Research, Health Services Research, Health Policy, Medicine, and 15 moreTrajectory, Patient Experiences, Qualitative, Interactions, Melanoma, Health Economics and Medical Administration, Patient Experience, Longitudinal Study, Health Services Administration, Medicine and Health Sciences, Person Centered, Person Centred, CONTINUUM OF CARE, Metastatic Melanoma, and Referral
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Research Interests: Nursing, Family Medicine, Health Administration, Medicine, Nursing Research, and 9 moreLibrary and Information Studies, Audit, Focus Group, Psychological Intervention, Behaviour change, Lynch syndrome, Public health systems and services research, theoretical domains framework implementation, and Referral
Research Interests: Primary Care, Education, Family Medicine, Cancer, Breast Cancer, and 15 moreFamily Practice, Medicine, Colorectal cancer, General, Care, Social and Behavioral Sciences, Cancer Care, Continuity of Care, Patient, Family Health, Shared Care, Long Term, Shared, Multidisciplinary Care Team, and Oncologist
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Paralytic ileus is a recognised side effect of the oral agent capecitabine. We present this report on a patient with metastatic colorectal cancer who was treated with capecitabine and presented with persistent paralytic ileus which did... more
Paralytic ileus is a recognised side effect of the oral agent capecitabine. We present this report on a patient with metastatic colorectal cancer who was treated with capecitabine and presented with persistent paralytic ileus which did not respond to standard conservative measures. Neostigmine was administered safely, resulting in resolution of the paralytic ileus. This approach merits further investigation.
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Follicular dendritic cell sarcoma is a rare tumour with clinical behaviour covering a spectrum from indolent to aggressive disease. Treatment recommendations are currently based on case reports and small series describing combinations of... more
Follicular dendritic cell sarcoma is a rare tumour with clinical behaviour covering a spectrum from indolent to aggressive disease. Treatment recommendations are currently based on case reports and small series describing combinations of surgery, chemotherapy and radiotherapy providing the best patient outcomes. Recent knowledge on molecular aberrations in this disease have not yet impacted on therapeutic decisions. We describe a case of progressive follicular dendritic cell sarcoma of the lung and pleura, treated based on knowledge of the tumour's molecular aberrations. The patient was initially treated with surgery, chemotherapy and radiotherapy and developed disease progression. Mutation testing by Caris molecular intelligence demonstrated a breast cancer 2 gene mutation and further treatment with carboplatin and veliparib achieved disease stabilisation. Understanding of the molecular profile of rare tumours is key to improve therapeutic decision making and patient outcomes.
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Dabrafenib is a selective, potent ATP-competitive inhibitor of the BRAFV600-mutant kinase that has demonstrated efficacy in clinical trials. We report the rationale for dose selection in the first-in-human study of dabrafenib, including... more
Dabrafenib is a selective, potent ATP-competitive inhibitor of the BRAFV600-mutant kinase that has demonstrated efficacy in clinical trials. We report the rationale for dose selection in the first-in-human study of dabrafenib, including pharmacokinetics, tissue pharmacodynamics, 2[18F]fluoro-2-deoxy-D-glucose-positron emission tomography (FDG-PET) pharmacodynamics, and dose-response relationship. Dabrafenib was administered orally once, twice (BID), or three times daily (TID). Selected dose cohorts were expanded to collect adequate data on safety, pharmacokinetics, or pharmacodynamics. A recommended phase II dose (RP2D) was chosen based on safety, pharmacokinetic, pharmacodynamic, and response data. One hundred and eighty-four patients were enrolled and treated with doses ranging from 12 mg once daily to 300 mg BID in 10 cohorts. Pharmacokinetic assessment of dabrafenib demonstrated a less-than-dose-proportional increase in exposure after repeat dosing above 150 mg BID. Similar to p...
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Introduction Consumer engagement is central to high-quality cancer service delivery and is a recognised strategy to minimise healthcare-associated harm. Strategies developed to enhance consumer engagement specifically in relation to... more
Introduction Consumer engagement is central to high-quality cancer service delivery and is a recognised strategy to minimise healthcare-associated harm. Strategies developed to enhance consumer engagement specifically in relation to preventing healthcare harm include questioning health professionals, raising concerns about possible mistakes or risks in care and encouraging patients and caregivers to report suspected errors. Patients from ethnic minority backgrounds are particularly vulnerable to unsafe care, but current engagement strategies have not been developed specifically for (and with) this population. Using an adapted approach to experience-based codesign (EBCD) to support the target population, the aim of the project is to codesign consumer engagement interventions to increase consumer engagement and safety in New South Wales and Victorian cancer inpatient, outpatient and day procedure services. Methods and analysis A mixed-method project will be undertaken at six study sit...
Background Shared care is the preferred model for long-term survivorship care by cancer survivors, general practitioners and specialists. However, survivorship care remains specialist-led. A risk-stratified approach has been proposed to... more
Background Shared care is the preferred model for long-term survivorship care by cancer survivors, general practitioners and specialists. However, survivorship care remains specialist-led. A risk-stratified approach has been proposed to select suitable patients for long-term shared care after survivors have completed adjuvant cancer treatment. This study aims to use patient scenarios to explore views on patient suitability for long-term colorectal cancer shared care across the risk spectrum from survivors, general practitioners and specialists. Methods Participants completed a brief questionnaire assessing demographics and clinical issues before a semi-structured in-depth interview. The interviews focused on the participant’s view on suitability for long term cancer shared care, challenges and facilitators in delivering it and resources that would be helpful. We conducted thematic analysis using an inductive approach to discover new concepts and themes. Results Interviews were condu...
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a Centre for Primary Health Care and Equity, UNSW Sydney, Australia b Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, South Eastern Sydney Local Health District, NSW, Australia c Prince of Wales Clinical School, Faculty of... more
a Centre for Primary Health Care and Equity, UNSW Sydney, Australia b Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, South Eastern Sydney Local Health District, NSW, Australia c Prince of Wales Clinical School, Faculty of Medicine, UNSW Sydney, Australia d Cancer Services, South Eastern Sydney Local Health District, NSW, Australia e St George Hospital Cancer Care Centre, Sydney, NSW, Australia f Translational Cancer Research Network, UNSW Sydney, Australia g School of Public Health and Community Medicine, UNSW Sydney, Australia h Central and Eastern Sydney Primary Health Network, Sydney, NSW, Australia i eHealth NSW, New South Wales Ministry of Health, Sydney, Australia j Corresponding author: J.Taggart@unsw.edu.au
Co-design is increasingly employed as a user-centric method to create healthcare change. In healthcare co-design, small groups of consumers and healthcare workers come together to identify processes, policies or service elements that... more
Co-design is increasingly employed as a user-centric method to create healthcare change. In healthcare co-design, small groups of consumers and healthcare workers come together to identify processes, policies or service elements that require improvement and to design solutions. Multiple frameworks have emerged to guide the health work force and health researchers how to conduct co-design and support consumer members to engage in the process effectively. Frameworks have sought to address the propensity for co-design to exacerbate inequities for consumers with complex care needs or in under-served populations. Advice regarding the need to consider and ensure co-design is accessible to an increasingly diverse health workforce is, however, lacking. Drawing on our experience co-designing with diverse consumer and healthcare-worker populations, we discuss the implications of co-design for the healthcare workforce.
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Cancer-related fatigue is prevalent and disabling. When persistent and unexplained, it is termed post-cancer fatigue (PCF). Cognitive behavioral therapy (CBT) and graded exercise therapy (GET) may improve symptoms and functional outcomes.... more
Cancer-related fatigue is prevalent and disabling. When persistent and unexplained, it is termed post-cancer fatigue (PCF). Cognitive behavioral therapy (CBT) and graded exercise therapy (GET) may improve symptoms and functional outcomes. To evaluate the outcomes of a randomized controlled trial, which assigned patients with post-cancer fatigue to education, or 12 weeks of integrated cognitive-behavioral therapy (CBT) and graded exercise therapy (GET). Three months after treatment for breast or colon cancer, eligible patients had clinically significant fatigue, no comorbid medical or psychiatric conditions that explained the fatigue, and no evidence of recurrence. The CBT/GET arm included individually tailored consultations at approximately two weekly intervals. The education arm included a single visit with clinicians describing the principles of CBT/GET and a booklet. The primary outcome was clinically significant improvement in self-reported fatigue (Somatic and Psychological HEa...
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Plasma cystatin C (pCysC) may be superior to serum creatinine (sCr) as a surrogate of GFR. However, the performance of pCysC for diagnosing acute kidney injury (AKI) after cisplatin-based chemotherapy is potentially affected by... more
Plasma cystatin C (pCysC) may be superior to serum creatinine (sCr) as a surrogate of GFR. However, the performance of pCysC for diagnosing acute kidney injury (AKI) after cisplatin-based chemotherapy is potentially affected by accompanying corticosteroid anti-emetic therapy and hydration. In a prospective observational study pCysC, sCr, urinary kidney injury molecule-1 (KIM-1), and urinary clusterin were measured over 2 weeks in 27 patients given first-cycle chemotherapy. The same variables were measured over 2 weeks in Sprague-Dawley rats given a single intraperitoneal injection of dexamethasone, cisplatin, or both, and in controls. In patients, pCysC increases were greater than sCr 41% vs. 16%, mean paired difference 25% (95% CI: 16-34%)], relative increases were ≥ 50% in 9 patients (35%) for pCysC compared with 2 (8%) for sCr (p = 0.04) and increases in sCr were accompanied by increased KIM-1 and clusterin excretion, but increases in pCysC alone were not. In rats, dexamethasone ...
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Testing for mismatch repair (MMR) status in colorectal cancer (CRC) may provide useful prognostic and predictive information. We evaluated the impact of such testing on real-world practice regarding adjuvant chemotherapy for patients with... more
Testing for mismatch repair (MMR) status in colorectal cancer (CRC) may provide useful prognostic and predictive information. We evaluated the impact of such testing on real-world practice regarding adjuvant chemotherapy for patients with resected CRC. A total of 175 patients with stage II and III mismatch repair-deficient (MMRD) CRC were identified from an Australian population-based study of incident CRCs. Their treatment decisions were compared with those for a cohort of 773 stage-matched patients with mismatch repair-proficient (MMRP) CRCs. The effect of MMR status, age, and pathologic characteristics on treatment decisions was determined using multiple regression analysis. Overall, 32% of patients in stage II and 71% of patients in stage III received adjuvant chemotherapy. Among the stage II patients, those with MMRD cancer were less likely to receive chemotherapy than were MMRP cases (15% vs. 38%; p < .0001). In this group, the treatment decision was influenced by age, tumo...
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ABSTRACT
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The rising incidence of cancer and increasing number of cancer survivors place competing demands on specialist oncology clinics. This has led to a need to consider collaborative care between primary and secondary care for the long-term... more
The rising incidence of cancer and increasing number of cancer survivors place competing demands on specialist oncology clinics. This has led to a need to consider collaborative care between primary and secondary care for the long-term post-treatment care of cancer survivors. Objective. To explore the views of breast and colorectal cancer survivors, their oncologist and GP about GPs taking a more active role in long-term cancer follow-up care. Methods. Semi-structured interviews using a thematic analysis framework. Respondents were asked their views on the specialist hospital-based model for cancer follow-up care and their views on their GP taking a greater or leading role in follow-up care. Researcher triangulation was used to refine the coding framework and emergent themes; source triangulation and participant validation were used to increase credibility. Results. Fifty-six interviews were conducted (22 patients, 16 oncologists, 18 GPs). Respondents highlighted the importance of GPs needing specialist cancer knowledge; the need for GPs to have an interest in and time for cancer follow-up care; the GPs role in providing psychosocial care; and the reassurance that was provided from a specialist overseeing care. A staged, shared care team arrangement with both GPs and specialists flexibly providing continuing care was found to be acceptable for most. Conclusion. Collaborative care of cancer survivors may lessen the load on specialist oncology clinics. The findings suggest that building this model will require early and ongoing shared care processes.
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In this article we present a narrative approach to conceptualizing and representing patients' experiences of healthcare across a trajectory of care. We empirically investigate, analyze and represent the diagnostic and care trajectories of... more
In this article we present a narrative approach to conceptualizing and representing patients' experiences of healthcare across a trajectory of care. We empirically investigate, analyze and represent the diagnostic and care trajectories of people with the aggressive skin cancer melanoma, conceiving a model of lived narratives in which the patients are the central characters moving through a longitudinal series of events. Melanoma is a malignant form of skin cancer that makes heavy, long-term demands on patients and healthcare resources. The perspectives of people with melanoma are under-represented in studies of melanoma patient experience. In our study, we make that missing perspective visible. From data collected on the pre-symptom ordinary world of the patient through phases of medical care and into resolution of the initial disease presentation, we identify the thick plot of patients' care experiences in an archetypal narrative form of patient journey. Our findings identify the potential of this analytic framework as a flexible methodology for the reflection of outset-to-outcome melanoma care experiences in healthcare policy and practice.
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Patients undergoing surgery for bowel cancer now have a routine screening test to assess their genetic predisposition to this and other cancers (Lynch syndrome). A result indicating a high risk should trigger referral to a genetic clinic... more
Patients undergoing surgery for bowel cancer now have a routine screening test to assess their genetic predisposition to this and other cancers (Lynch syndrome). A result indicating a high risk should trigger referral to a genetic clinic for diagnostic testing, information, and management. Appropriate management of Lynch syndrome lowers morbidity and mortality from cancer for patients and their family, but referral rates are low. The aim of this project was to increase referral rates for patients at high risk of Lynch syndrome at two Australian hospitals, using the Theoretical Domains Framework (TDF) Implementation approach.
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Advanced and metastatic cancer has a complex diagnostic and management profile that places a heavy long-term burden on patients and healthcare systems. Little attention has been given to patients’ experiences across their entire clinical... more
Advanced and metastatic cancer has a complex diagnostic and management profile that places a heavy long-term burden on patients and healthcare systems. Little attention has been given to patients’ experiences across their entire clinical journey. Using a qualitative, longitudinal methodology over a ten-month period, we examined the symptom-to-outcome trajectories of seven people attending a medical oncology clinic at a large, public tertiary referral center in Sydney, Australia. Rather than care being experienced as a largely linear progression through diagnosis, treatment and onto surveillance in which life may return to ‘normal’, participants are embedded in a cyclical clinical pathway. Recurrence or metastases are not a matter of ‘if’ but ‘when’. This model of the patient journey points to a need for longitudinal, person-centered services to support the growing population of people with melanoma.
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Background: Follicular dendritic cell sarcoma is a rare tumour with clinical behaviour covering a spectrum from indolent to aggressive disease. Treatment recommendations are currently based on case reports and small series describing... more
Background: Follicular dendritic cell sarcoma is a rare tumour with clinical behaviour covering a spectrum from indolent to aggressive disease. Treatment recommendations are currently based on case reports and small series describing combinations of surgery, chemotherapy and radiotherapy providing the best patient outcomes. Recent knowledge on molecular aberrations in this disease have not yet impacted on therapeutic decisions. Case presentation: We describe a case of progressive follicular dendritic cell sarcoma of the lung and pleura, treated based on knowledge of the tumour's molecular aberrations. The patient was initially treated with surgery, chemo-therapy and radiotherapy and developed disease progression. Mutation testing by Caris molecular intelligence demonstrated a breast cancer 2 gene mutation and further treatment with carboplatin and veliparib achieved disease stabilisation. Conclusion: Understanding of the molecular profile of rare tumours is key to improve therapeutic decision making and patient outcomes.
Introduction To investigate the factors that affect the choice of 5-fluorouracil (5-FU) or its oral alternative, capecitabine, as first-line treatment in patients with colorectal cancer (CRC). Methods Patients treated with 5-FU or... more
Introduction
To investigate the factors that affect the choice of 5-fluorouracil (5-FU) or its oral alternative, capecitabine, as first-line treatment in patients with colorectal cancer (CRC).
Methods
Patients treated with 5-FU or capecitabine for CRC between January 1, 2011 and December 31, 2013 in a teaching hospital in the Sydney metropolitan area, Australia were identified using the hospital’s database MOSAIQ®. The electronic medical record of each patient was manually reviewed to extract factors potentially affecting treatment choice. Logistic regression was used to assess which patient and/or treatment factors could explain the choice between 5-FU or capecitabine. Where it was available in the medical correspondence, the explicit reason for the choice made was extracted.
Results
170 CRC patients were included; 119 on 5-FU, and 51 on capecitabine. The odds of receiving capecitabine as a first-line treatment were positively associated with giving patients a choice in the decision (OR = 17.51, 95% CI: 5.37–57.08). Qualitative data suggest treatment choices were motivated by convenience (oral administration) and tolerability. Time from diagnosis to treatment commencement (OR = 1.02 per month, 95% CI 1.00–1.04) was also found to be positively associated with the choice of capecitabine. The odds of being treated with capecitabine were lower for patients who lived further from the treating hospital (OR = 0.22, 95% CI 0.05–0.94).
Conclusion
This study suggests that patient choice, favoring oral capecitabine over i.v. 5-FU, was a key factor influencing first-line treatment for CRC in this cohort. To respect their autonomy, patients should be involved in the clinical decision making process.
To investigate the factors that affect the choice of 5-fluorouracil (5-FU) or its oral alternative, capecitabine, as first-line treatment in patients with colorectal cancer (CRC).
Methods
Patients treated with 5-FU or capecitabine for CRC between January 1, 2011 and December 31, 2013 in a teaching hospital in the Sydney metropolitan area, Australia were identified using the hospital’s database MOSAIQ®. The electronic medical record of each patient was manually reviewed to extract factors potentially affecting treatment choice. Logistic regression was used to assess which patient and/or treatment factors could explain the choice between 5-FU or capecitabine. Where it was available in the medical correspondence, the explicit reason for the choice made was extracted.
Results
170 CRC patients were included; 119 on 5-FU, and 51 on capecitabine. The odds of receiving capecitabine as a first-line treatment were positively associated with giving patients a choice in the decision (OR = 17.51, 95% CI: 5.37–57.08). Qualitative data suggest treatment choices were motivated by convenience (oral administration) and tolerability. Time from diagnosis to treatment commencement (OR = 1.02 per month, 95% CI 1.00–1.04) was also found to be positively associated with the choice of capecitabine. The odds of being treated with capecitabine were lower for patients who lived further from the treating hospital (OR = 0.22, 95% CI 0.05–0.94).
Conclusion
This study suggests that patient choice, favoring oral capecitabine over i.v. 5-FU, was a key factor influencing first-line treatment for CRC in this cohort. To respect their autonomy, patients should be involved in the clinical decision making process.
Dabrafenib is a selective, potent ATP-competitive inhibitor of the BRAFV600-mutant kinase that has demonstrated efficacy in clinical trials. We report the rationale for dose selection in the first-in-human study of dabrafenib, including... more
Dabrafenib is a selective, potent ATP-competitive inhibitor of the BRAFV600-mutant kinase that has demonstrated efficacy in clinical trials. We report the rationale for dose selection in the first-in-human study of dabrafenib, including pharmacokinetics, tissue pharmacodynamics, 2[18F]fluoro-2-deoxy-D-glucose-positron emission tomography (FDG-PET) pharmacodynamics, and dose-response relationship. Dabrafenib was administered orally once, twice (BID), or three times daily (TID). Selected dose cohorts were expanded to collect adequate data on safety, pharmacokinetics, or pharmacodynamics. A recommended phase II dose (RP2D) was chosen based on safety, pharmacokinetic, pharmacodynamic, and response data. One hundred and eighty-four patients were enrolled and treated with doses ranging from 12 mg once daily to 300 mg BID in 10 cohorts. Pharmacokinetic assessment of dabrafenib demonstrated a less-than-dose-proportional increase in exposure after repeat dosing above 150 mg BID. Similar to p...
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Lynch syndrome is an inherited disorder associated with a range of cancers, and found in 2-5 % of colorectal cancers. Lynch syndrome is diagnosed through a combination of significant family and clinical history and pathology. The... more
Lynch syndrome is an inherited disorder associated with a range of cancers, and found in 2-5 % of colorectal cancers. Lynch syndrome is diagnosed through a combination of significant family and clinical history and pathology. The definitive diagnostic germline test requires formal patient consent after genetic counselling. If diagnosed early, carriers of Lynch syndrome can undergo increased surveillance for cancers, which in turn can prevent late stage cancers, optimise treatment and decrease mortality for themselves and their relatives. However, over the past decade, international studies have reported that only a small proportion of individuals with suspected Lynch syndrome were referred for genetic consultation and possible genetic testing. The aim of this project is to use behaviour change theory and implementation science approaches to increase the number and speed of healthcare professional referrals of colorectal cancer patients with a high-likelihood risk of Lynch syndrome t...