Well.. .my idea is always that before you decide to set yourself on one of these paths do a little clinical shadowing and several lab research.

Some definitions first….

1. MD: Signifies Doctor of Medicine, a doctor’s qualification in medicine
2. PhD: Is the highest diploma obtained at a college or university, usually requiring 3 to 5 years of original study in a specific field of study.
3. MD/PhD: refers to an education consisting of both the medical training of a medical doctor (MD or DO) with the rigor of a scientific specialist (PhD)

You could also consider to get involved in some clinical research. This will likely offer you a taste of the different fields. Some MDs do clinical research, if you get interested in that, you would not need an MD/PhD.

You actually should gain some upfront exposure prior to make any decisions. Neither clinical work nor lab bench effort is just what it may appear like in theory. You need to get your hands dirty. Attempt to request information, find out about them, and have several tastes of each one.

I believe it’s more easy to find a personality niche when you are delighted by the specific work you’re doing every single day, rather than attempt to enjoy doing work you hate, even if you fit the “typical profile” of the career.

Generally a double degree is perfect for those people who are interested in both, basically. However, you will possibly not wind up doing most of the actual bench work if you are an MD/PhD. The MD/PhD who’s the P.I. of the science lab I currently work for NEVER does some of the actual experiments we currently do, he simply covers administrational stuff and discusses problems/ideas along with his henchmen.

All his time through the week is spent on clinical work. I am not sure that will be the way it always works, but that is my own experience. However , if you happen to be equally interested in both, then I would still think an MD/PhD may be worth considering.

MD/PhD will place you at some advantage in grant-writing while you’re a new researcher. (Eventually, the degree matters less because research recruiters assess you according to your actual accomplishments.)

Imagine that studying scientific research can be easier if you have been trained like a physician. This advantage isn’t definitely worth the extra 3 years, but it’s somewhat of an advantage. It provides the flexibleness to view patients if you’d prefer. A slight majority of the MD/PhD’s I have seen usually do not, but some do and in any case all of them could. It could aid in the pursuit of an academic position too.

And also you? What are your positives and negatives of choosing a MD, MD/PhD or PhD profession?

Who am I ?: S. Ochoa is writing for the clinical research training courses blog, her personal and non-commercial in nature pastime blog to produce free recommendations for clinical research training newbie’s/experts to assist them get a new profession.

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Annual congress of the European League against Rheumatism is Rome, Italy, shows that women who drink tea have an increased risk or developing Rheumatoid Arthritis (RA) compared with those who don’t drink.

Result from the longitudinal cohort study involving 76,643 women showed a positive associated of incident RA. Consuming any amount of tea carried a significant risk of developing RA in women who drank ≥4 cups of tea per day.

Professor Christopher Collins , Assistant Professor of Medicine, Georgetown University Medical center, Washington USA said that “This does make us wonder what it is in tea, or in the method of preparation of tea that causes the significant increase in risk of developing RA.”

Data on women aged 50-79 were taken from the Women’s Health Initiative Observational Study database (a major 15-year research program to address the most common causes of death, disability and poor quality of life in postmenopausal women) where participants completed a self-administered questionnaire providing information on daily consumption of coffee and tea.

The relationships between drinking tea and coffee and the risk of RA or SLE were assessed in age-adjusted models and in multivariate Cox proportional hazard models (a statistical approach to estimating survival data). At three years follow up, the diagnosis of incident RA was determined using self-reporting and respondent’s feedback on use of disease modifying anti-rheumatic drugs (DMARDS). The variables studied in the RA population were also investigated in women with SLE, but no significant associations were found.

Articles taken from :

1. http://www.eular.org

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Resveratrol is currently a topic of numerous animal and human studies into its effects.

Antioxidants are often added to foods to prevent the radical chain reactions of oxidation and they act by inhibiting the initiation and propagation step leading to the termination of the reaction and delay the oxidation process. At the present time, the most commonly used antioxidants are BHA, BHT, and propylgallate and tert-butyl hydroquinone. Besides that BHA and BHT are restricted by legislative rules because of doubts over their toxic and carcinogenic effects. Therefore, there is a growing interest on natural and safer antioxidants in food applications, and a growing trend in consumer preferences for natural antioxidants, all of which has given more impetus to explore natural sources of antioxidants. A variety of foods and beverages of vegetable origin contain several nonflavonoid classes of phenolic compounds synthesized by plants.

Resveratrol is naturally occurring in the fruits and leaves of edible plants, peanuts, mulberries, grapes and red wine. Resveratrol currently in the limelight all over the world due to their beneficial effects on the human body. Resveratrol can be used for minimizing or preventing lipid oxidation in pharmaceutical products, retarding the formation of toxic oxidation products, maintaining nutritional quality and prolonging the shelf life of food products and pharmaceuticals instead of BHA and BHT and other antioxidant compounds because of their safer usage.

Apart from antioxidant resveratrol is known as anti-aging, anti-cancer, anti-inflammatory, anti-infective, heart protective and never protection properties.

How Resveratrol work?

Resveratrol inhibited 89.1% of the lipid peroxidation of linoleic acid emulsion at 30 µg/mL concentration. On the other hand, BHA, BHT, α-tocopherol, and trolox exhibited inhibitions of 83.3, 82.1, 68.1, and 81.3% against peroxidation of linoleic acid emulsion at the same concentration, respectively. In addition, resveratrol had effective DPPH•, ABTS•+, DMPD•+, O2•− and H2O2 scavenging activities, reducing power, and Fe2+ chelating activities.

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Scientists form the University of Florida found that bacteria residing in the human intestinal tract may be associated with an individual risk of developing colon cancer.

“Our findings suggest that some bacterial signatures are more frequently detected in subjects with polyps, early lesions that can develop into cancer, while other bacterial signatures are less frequently observed in such individuals” says Tyler Culpepper, a researcher on the study.

Culpepper and his colleagues collected data on dietary habits and medical history, a fecal sample as well as multiple colon biopsy samples from 91 subjects. They analyzed microbiota composition in 30 individuals presenting with at least one polyp and 30 age- and gender- matched controls.

Several bacterial signatures were detected only in subjects with polyps, others only in subjects without polyps. Eubacterium ramulus was increased in the stools of subjects with polyps while Ruminococcus sp and a human intestine firmicute were increased in subjects without polyps. In tissue samples, Acidovorax sp. was found more frequently in subjects with polyps. Other bacterial signatures that differed between cases and controls were observed but did not match any know bacteria, suggesting unidentified and uncharacterized bacteria are also present.Colorectal cancer is the third most common cancer in the United States, where it is estimated to have caused nearly 50,000 deaths in 2009.

“The results of this work suggest the feasibility of developing non-invasive screening tests based on detecting distortions in microbiota composition and a potential for the development of diet-based prevention regimen aimed at improving gut microbiota composition and reducing CRC risk” says Culpepper.

Source   http://www.asm.org/

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Wernicke’s encephalopathy is an acute neuropsychiatric disorder caused by thiamin deficiency. It is most often observed decreased with alcohol abuse and poor nutrition, gastric carcinoma, pyloric obstruction, prolonged parenteral  feeding, hunger strike, chronic kidney disease, malignancy , anorexia nervosa and hyperemesis gravidarum.

Wernicke’s encephalopathy is recognized if there are two of the following four signs; a) dietary deficiencies, (b) oculomotor abnormalities, (c) cerebellar dysfunction, and (d) either an altered mental state or mild memory impairment.

Wernicke’s encephalopathy is diagnosed based on the clinical presentation and rapid reversal of symptoms with thiamine. Thiamine status in the body determined by the blood transketolase activity and thiamine pyrophosphate but this test is very costly; hence MRI plays an important role in the diagnosis of W.E. The periventricular regions of the diencephalon, mesencephalon, brainstem and superior vermis of cerebellum are sensitive to thiamine deficiency due to cellular dependence on oxidative metabolism that causes T2W hyperintensities in these regions. The MRI of brain has high (93%) specificity and moderate (53%) sensitivity.

Thiamine is an important cofactor for several enzymes including transketolase, pyruvate dehydrogenase and α-ketoglutarate dehydrogenase in the Kreb’s and pentose phosphate cycle. Deficiency of these enzymes results in focal acidosis, depolarization of neurons due to n-methyl-D- aspartate receptor mediated excitotoxity which ultimately result in alteration ob blood brain barrier, generation of free radical scavengers and cell death due to necrosis and apoptosis.

Thiamine requirements are increased during pregnancy and its deficiency by the impaired absorption due to hyperemesis gravidarum. Body stores of thiamin last for only 18-20 days. Depletion of thiamin due to reduced intake due to any cause or prolonged vomiting, results in thiamine deficiency and W.E.

Thiamine dependence is increased with high metabolic rate or high glucose intake and forms the basis of recommending thiamin before intravenous glucose therapy.

W.E is managed with high doses of thiamine, 500 mg/ day 8 hourly for 2 days followed by 250 mg /day until the patient tolerates oral thiamine( 100mg/day at lest three months) during treatment ocular signs improve first followed by ataxia and confusion subsequently.

Reference: Journal of the Neurological Sciences, Volume 284, Issues 1-2, 15 September 2009, Pages 214-216.

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1. Hyperemesis gravidarum

According to Alzheimer’s and Dementia, Volume 6, Issue 1, January 2010, Pages 1-10.e1; conclude that supplementation with a medical food including Phostphatide precursors and cofactors for 12 weeks improved memory (delayed verbal recall) in mild AD patients.

Alzheimer’s disease is the leading cause of dementia characterized by accumulation of beta-amyloid plaques, neurofibrillary tangles, and synaptic loss, ultimately leading to cerebral atrophy and enlargement of ventricle leads to the clinical feature of AD likes memory impairment, language deterioration and executive and visuospatial dysfunction. Only central cholinergic or glutaminergic neurotransmission, provide only symptomatic relief.

New approaches to prevent and treat AD are needed. Because the cognitive disturbances of AD best correlate with loss of hippocampal and cortical synapses. Preclinical studies indicate that such an effect can be induced by co-administration of rate-limiting precursor for membrane Phostphatide synthesis, such as nucleotide uridine, omega-3 polyunsaturated fatty acids and choline. These nutrients synergistically increase brain levels of Phostphatide molecules that comprise the bulk of synaptic membranes and brain levels of specific synaptic proteins, suggesting that they also increase synapse formation moreover these nutrition produces major increase in hippocampal dendritic spines, the anatomical precursor of and surrogate marker of new synapse.

For this, A total of 225 drug-naïve AD patients participated in this randomized, double-blind controlled trial. Patients were randomized to active product, Souvenaid, or a control drink, taken once-daily for 12 weeks. Primary outcome measures were the delayed verbal recall task of the Wechsler Memory Scale–revised, and the 13-item modified Alzheimer’s disease Assessment Scale–cognitive subscale at week 12.

Researcher found result at 12 weeks, significant improvement in the delayed verbal recall task was noted in the active group compared with control (P = .021). Modified Alzheimer’s Disease Assessment Scale–cognitive subscale and other outcome scores (e.g., Clinician Interview Based Impression of Change plus Caregiver Input, 12-item Neuropsychiatric Inventory, Alzheimer’s disease Co-operative Study–Activities of Daily Living, Quality of Life in Alzheimer’s Disease) were unchanged. The control group neither deteriorated nor improved. Compliance was excellent (95%) and the product was well tolerated.

Source: sciencedirect.com

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According to researches at National Jewish Heath; low levels of vitamin D are associated with lower lung function and greater medication use in children with asthma.

According to study asthmatic children who had low levels of vitamin D were more prone to have allergic reaction, had poorer lung function and used more medication. According to Dr.Searing (one of the member of this study) suggest that vitamin D supplementation may help reverse steroid resistance in asthmatic children and reduce the effective dose of steroids needed for patients.

Researcher found that patients who have low vitamin D had generally had higher levels of IgE (marker of allergy). Low vitamin D also correlated with low FEV1, the amount of air a person can exhale in one second, and lower FEV1/FVC, measure of lung function. Use of inhaled steroids, oral and long-acting beta agonist were all higher in patients low in vitamin D.

It could be that lower vitamin D levels contribute to increasing asthma severity, which requires more corticosteroid therapy. Vitamin D directly affects steroid activity, and that low levels of vitamin D male the steroid less effective, thus requiring more medication for the same effect.

“Our work suggests that vitamin D enhances the anti-inflammatory function of corticosteroids, said Dr.leung. “If future studies confirm these findings vitamin D may help asthma patients achieve better control of their respiratory symptoms with less medication.

Source: National Jewish Medical and Research Center.

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According to Archives of General Psychiatry, obesity is associated with an increased risk of depress and depression is also associated with an increased risk of developing risk.

Floriana S luppino one of the researcher, Leiden University analyzed the previously published studies involving 58745 participants that examined the relationship between obesity and depression.They found bidirectional association between association and obesity, depressed person had a 58 percent increased risk of developing obesity whereas 55 persons obese developed depression.

Why there is link between obese and depression is still unknown but some theories have been proposed. Over weight is considered as the state of the inflammation and inflammation state is associated with the risk of depression and being obese may have low self esteem that places individual at risk of developing depression. In depressed patient there is interference with the endocrine system which may the risk for developing obese.

The findings are important for clinical practice, author said “Because weight gain appears to be a late consequence of depression care providers should be aware that within depression patient’s weight should be monitored. In overweight patient. mood should be monitored .The awareness could lead to prevention, early detection and co-treatment for the ones at risk, which could ultimately reduce the burden of both condition,” they conclude.

Source:

Archives of General Psychiatry

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Sina Zarrintan, a neurologist from the Tabriz Medical university in Iran found that masturatbating or having sex may help men relives from Nasal congestion .According to him that the nose and the genitals are both connected to the same part of the systemic nervous system that control the reflex .

Swollen and inflamed nasal vessels irritated either by pollen in the air or by infection lead to nose blocked.

Sina Zarrintan points that a right time ejaculation is due to sympathetic nervous system constricts blood vessel across the body, soothe the congested nasal blood supply.

Zarrintan doesn’t perform any clinical trails but he believes that it may benefits over decongestant drugs.  He recommends having sex or masturbating when the symptoms of congestion are bad enough to warrant another ejaculation.

“It can be done time-to-time to alleviate the congestion and the patient can adjust the number of intercourse or masturbations depending on the severity of the symptoms”’ He said.

Source:

Sciencedirect.com

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According to a journal “Tuberculosis”, a new breath test was developed to detect active pulmonary tuberculosis.

Dr. Michael Philips CEO of Menssana research and developer of this test said that this breath test was 85% accurate to detecting active pulmonary tuberculosis. Breath test detects volatile organic compounds produced by the infecting organism, mycobacterium tuberculosis.

According to Dr.Micael this test is probably a better test than blood test or skin test for pulmonary tuberculosis and another advantage is safe, painless, non-invasive He added.

Breathe test offer new and reliable technique to diagnosed TB than chest x-ray or sputum culture which is expensive and not reliable. Tuberculosis is a major cause of death in developing countries.

Dr.Philips hopes that doctors and patient will consider a breath test in the same way that we think and detect several diseases in their earliest and most treatable stages.

Currently Menssana research focused on different breath tests for several other diseases, including breast cancer, lung cancer and ischemic heart disease. The Food and Drug Administration previously approved the company’s Hearts breath test for heart transplant rejection.

Source:

Menssana Research

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Abstract

Background: Studies indicate that adjuvant 5-fluorouracil (5-FU) with folinic acid (FA) in colorectal cancer patients with completely resectable liver-limited metastases (LMCRC) offers clinical benefit over surgery alone. This phase III trial compared FOLFIRI with simplified 5-FU/FA in this setting.
Patients and methods: LMCRC patients were randomized to receive every 14 days, FA, 400 mg/m² infused over 2 h, followed by 5-FU as a 400 mg/m² i.v. bolus, followed by continuous 5-FU infusion, 2400 mg/m² over 46 h (LV5FUs) with or without irinotecan: 180 mg/m² infusion (FOLFIRI). The primary end point was disease-free survival (DFS); secondary end points included overall survival (OS) and safety.
Results: Treated patients (n = 306) were balanced for critical prognostic factors in each arm. Median DFS in patients receiving LV5FUs was 21.6 versus 24.7 months for FOLFIRI [hazard ratio (HR) 0.89, log-rank P = 0.44]. No significant differences were found in OS. A trend was observed for improved DFS in patients receiving FOLFIRI within 42 days of surgery (HR 0.75, P = 0.17). Grade 3/4 toxic effects were more common in patients treated with FOLFIRI versus LV5FUs (47% versus 30%) with neutropenia being most common (23% versus 7%).
Conclusion: FOLFIRI in the adjuvant treatment of LMCRC showed no significant improvement in DFS compared with LV5FUs.

Introduction

Colorectal cancer (CRC) is in the top four most common cancers worldwide and was responsible for over 500 000 deaths in 2002.^[1] Up to 25% of CRC patients present with metastatic disease (mCRC), with the most common site for metastases being the liver.^[2] An additional 35%–45% of patients will develop liver metastases during the course of their disease, with 20%–30% of patients having liver-limited metastases (LMCRC).^{[2, 3]} The prognosis for mCRC patients is poor with 5-year survival rates of 4% reported for untreated patients^[4] and 3-year survival rates of 5%–10% in patients treated with palliative 5-fluorouracil (5-FU) and folinic acid (FA).^[5] A proportion of LMCRC patients are eligible for surgery with curative intent, which if successful has been reported to achieve 5-year survival rates of between 25% and 40%.^[6–8] However, most treatment failures are due to local hepatic recurrences or metastases to the lungs, occurring within the first 2 years of surgery, raising the question of whether adjuvant therapy should be used in this setting.

Adjuvant 5-FU-based chemotherapy following surgery in patients suffering stage III CRC provides significant improvements in disease-free survival (DFS) and overall survival (OS) compared with surgery alone,^[9–11] providing a rationale for its use in the adjuvant treatment of LMCRC patients following complete resection of metastases. A number of small studies indicate that significant patient benefit may be obtained from such an approach.^[12–15] In a study in which LMCRC patients were randomized to receive postoperative local hepatic arterial infusion (HAI) of floxuridine in combination with i.v. continuous 5-FU or surgery alone, a significant improvement in 4-year recurrence-free rate (46% versus 25%) was reported in patients receiving adjuvant therapy.^[15] However, in a comparable larger study, adjuvant treatment was stopped due to toxicity associated with HIA.^[16] More recently, Portier et al.^[17] demonstrated in a multicenter randomized study, a significant improvement in 5-year DFS rate (33.5% versus 26.7%) in LMCRC following complete resection receiving systemic adjuvant 5-FU/FA compared with patients receiving surgery alone.

The combination of 5-FU/FA with irinotecan (FOLFIRI) has been reported to provide a significant improvement in the palliative treatment of mCRC patients compared with 5-FU/FA alone, with median survival times in excess of 20 months reported.^[18–21] A small phase II study reported tolerability of single-agent irinotecan in CRC patients previously treated with 5-FU following complete resection of colorectal hepatic metastasis.^[22] However, there are currently no published randomized studies on the use of FOLFIRI in the adjuvant treatment of completely resectable LMCRC patients. In the present study, we report the results from a multicenter, randomized, phase III trial comparing FOLFIRI versus simplified 5-FU with leucovorin (LV, also known as FA) (LV5FUs) as adjuvant treatment in LMCRC patients following complete resection of metastases.

Article taken from sciencedirect.com

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With the recent development of double-balloon endoscopy (DBE) and capsule endoscopy (CE), it has become possible to observe the entire small bowel endoscopically. DBE enables us to make detailed observations and at the same time takes biopsy samples. Single-balloon endoscopy (SBE), which has a balloon only at the tip of the overtube, has also been introduced. Since DBE and SBE are similar in the concept of insertion method, a general term ‘balloon-assisted endoscopy’ (BAE) is used when referring to these methods. Characteristic small bowel lesions observed with BAE in Crohn’s disease are aphthoid ulcers, round ulcers, irregular ulcers and longitudinal ulcers. These ulcers tend to be located on the mesenteric side of the small bowel. Since BAE can determine the location (mesenteric or antimesenteric side) of the ulceration, it is useful in distinguishing Crohn’s disease from other diseases that have ulcers in the small bowel. Strictures are a major clinical problem in the course of Crohn’s disease. Traditionally, surgery was the main choice for small bowel strictures. In some cases, strictures located in distal ileum or proximal jejunum have been dilated using standard enteroscopes. DBE now enables balloon dilatation to be performed endoscopically even in the deep small bowel.

Introduction

Crohn’s disease was first reported by Crohn et al. in 1932 as ‘regional ileitis’ with chronic granulomatous inflammation of the terminal ileum [Chron et al. 2000]. Today, Crohn’s disease is known to be a chronic inflammatory disease of unknown origin that can occur not only in the terminal ileum but anywhere in the gastrointestinal tract [Feagans et al. 2008].

Small bowel lesions occur frequently in Crohn’s disease. Traditionally, diagnosis and assessment of the small bowel lesions in Crohn’s disease has depended on X-ray tests, such as small bowel follow-through (SBFT) and computed tomography (CT). In recent years, however, new endoscopic modalities such as capsule endoscopy (CE) [Iddan et al. 2000] and balloon-assisted endoscopy (BAE) including both double-balloon endoscopy (DBE) [Monkemuller et al. 2007; Zhong et al. 2007; Heine et al. 2006; May and Ell, 2006; Yamamoto et al., 2001] and single-balloon endoscopy (SBE) have been developed. These instruments have enabled us to obtain clear endoscopic images of the small bowel which are useful in making more accurate diagnosis and evaluation of the small bowel lesions in Crohn’s disease [Oshitani et al. 2006]. Endoscopic-balloon dilation (EBD) for intestinal strictures has also become possible in a broader area of the small intestine with DBE [Fukumoto et al. 2007; Pohl et al. 2007]. In this report, we will discuss the diagnosis and treatment of small bowel lesions in Crohn’s disease, focusing on DBE, which was developed mainly in our hospital.

reff:

Ther Adv Gastroenterol. 2009;2(6) © 2009 Sage Publications, Inc

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Pre- and peri-operative strategies are becoming standard for the management of Localized gastro-esophageal cancer. For localized gastric/gastro-esophageal junction (GEJ) cancer there are conflicting data that a peri-operative approach with cisplatin-based chemotherapy improves survival, with the benefits seen in esophageal cancer likely less than a 5—10% incremental improvement. Further trends toward improvement in local control and survival, when combined chemotherapy and radiation therapy are given pre-operatively, are suggested by recent phase III trials. In fit patients, a significant survival benefit with pre-operative chemoradiation is seen in those patients who achieve a pathologic complete response. In esophageal/GEJ cancer, definitive chemoradiation is now considered in medically inoperable patients. In squamous cell carcinoma of the esophagus, surgery after primary chemoradiation is not clearly associated with an improved overall survival, however, local control may be better. In localized gastric/GEJ cancer, the integration of bevacizumab with pre-operative chemotherapy is being explored in large randomized studies, and with chemoradiotherapy in pilot trials. The addition of anti-epidermal growth factor receptor and anti-human epidermal growth factor receptor-2 antibody treatment to pre-operative chemoradiation continues to be explored. Early results show the integration of targeted therapy is feasible. Metabolic imaging can predict early response to pre-operative chemotherapy and biomarkers may further predict response to pre-operative chemo-targeted therapy. A multimodality approach to localized gastro-esophageal cancer has resulted in better outcomes. For T3 or node-positive disease, surgery alone is no longer considered appropriate and neo-adjuvant therapy is recommended. The future of neo-adjuvant strategies in this disease will involve the individualization of therapy with the integration of molecular signatures, targeted therapy, metabolic imaging and predictive biomarkers.

Introduction

Globally both gastric and esophageal cancers are significant health problems and account for approximately 1.4 million new cases per year with 1.1 million cancer-related deaths [Parkin et al. 2005]. This annual mortality is higher than that for both breast and colorectal cancers combined. In the United States, in 2008, an esti­mated 16,470 patients will be diagnosed with esophageal cancer resulting in 14,280 deaths, making this disease the seventh leading cause of cancer death in men, and 21,500 cases of gastric cancer will be diagnosed resulting in 10,880 deaths [Jemal et al. 2008].

The last three decades have seen a dramatic epi-demiologic shift in the location of both gastric and esophageal cancers as well as the histologic sub­type of esophageal cancers. Tumors of the lower esophagus and proximal stomach are classified as gastro-esophageal junction (GEJ) cancers and this cancer has been increasing in incidence by 5—10% per year since the mid 1970s and is the most rap­idly increasing cancer in many Western countries [Kamangar et al. 2006]. Distal esophageal and GEJ adenocarcinoma is now the predominant esophageal cancer subtype, and the majority of gastric cancers are now located in the proximal stomach [Pera et al. 1993].

The 5-year survival of patients with gastro-esophageal cancers (distal esophagus, GEJ, and proximal stomach making up the majority of cases) has not changed significantly over the last 25—30 years. Approximately 50—60% of patients present with distant metastatic disease and median overall survival (OS) with systemic chemotherapy has remained at less than one year [Van Cutsem et al. 2008]. However, progress has been made in the treatment of localized disease. Combinations of pre-operative (neo-adjuvant) chemotherapy, peri-operative chemotherapy or pre-operative (neo-adjuvant) chemoradiotherapy with surgery have resulted in R0 resection rates between 40 and 80% and 5-year survival rates from 20 to 40%.

A variety of combination chemotherapeutic agents have been used in the treatment of gastro-esophageal cancers over the last 30 years. These include fluoropyrimidines, anthracyclines, platinums, taxanes and campothecins. Combining different classes of drug exploits the different modes of action in the cancer cell and may allow lower doses of each individual drug to be given in the combination regimen thus reducing side effects. Work over the last decade has identified distinct molecular pathways lead­ing to tumorigenesis, angiogenesis and metasta­sis. Drug development has led to direct treatment at specific molecular targets. This review will focus on the integration of targeted therapy into the neo-adjuvant treatment of gastro-esophageal cancers.

reference:-

Ther Adv Med Oncol. 2009;1(3):145-165. © 2009

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