Volume 2, Number 3

Jonathan Wallis BA MBBS FRCP FRCPath Consultant Haematologist, Department of Haematology, Freeman Hospital, Newcastle-upon-Tyne

Anaemia is common in patients with malignancy and has many possible causes. More easily remediable disorders such as iron deficiency, autoimmune haemolysis or B12 or folate deficiency should be diagnosed and treated. However, in many or most cases, the anaemia is one of chronic disorders related to the inflammatory response to the cancer or is secondary to chemotherapy or radiotherapy.

Robert Thomas FRCP MD FRCR Consultant Oncologist, Addenbrooke’s and Bedford Hospitals, Cambridge University NHS Foundation Trust; Brendan O’Sullivan MPharm Lead Pharmacist, Oncology Department, Addenbrooke’s Hospital, Cambridge University NHS Foundation Trust; John Glen BSc MSc PGCE Director of Economics, Cranfield University; Michael Callam MBChB FRCS ChM Consultant Surgeon, Bedford Hospital NHS Trust

Since the first trial of adjuvant chemotherapy for early breast cancer,1 there have been over 200 randomised trials demonstrating reduced annual odds of recurrence and death.2 These benefits, to a varying degree, apply regardless of age, stage, nodal status and hormone receptor status.3 More recently, trials have explored strategies to achieve incremental gain by using a variety of newer drugs, dose intensities and sequences with other chemotherapy drugs, surgery, radiotherapy and hormones.

Yasser Haba MRCP Specialist Registrar, Oncology Department, Addenbrooke’s Hospital, Cambridge; Myrddin Rees MS FRCS FRCSEd Consultant Surgeon, North Hampshire Hospital, Basingstoke; David Skipper MBBS MS FRCS Consultant Surgeon, Bedford Hospital; Robert Thomas FRCP MD FRCR Consultant Oncologist, Addenbrooke’s and Bedford Hospitals, Cambridge University NHS Foundation Trust

The recent successful development of novel therapies targeting key components of biological pathways has expanded the treatment options for patients with colorectal cancer. Cetuximab (Erbitux®, Merck, UK), one of a new breed of chimeric monoclonal antibodies, has high affinity for the epidermal growth factor receptor.

Liz Darlison RN BSc FETC Nurse Consultant, The National Macmillan Mesothelioma Resource Centre, Leicester; Anthony Whitston MA MIOSH Asbestos Project Worker, Greater Manchester Asbestos Victims Support Group

The word ‘mesothelioma’ was first written by Klemperer and Rabin in 1931 and yet a consen-sus acknowledging it as a primary neoplasm was not reached until the 1960s.1,2 Epidemiological evidence linking occupational asbestos exposure to the development of mesothelioma was first published in 1965. Today, occupations with the highest risk of mesothelioma for males include metal plate workers (including shipyard workers), vehicle body builders, plumbers, gas fitters, carpenters and electricians.3,4

Gareth Morgan PhD FRCP FRCPath Consultant in Haematology; Faith Davies MBBCh MD MRCP MRCPath Department of Health Clinician Scientist, Royal Marsden Hospital, Sutton

The last ten years have seen dramatic changes in our approach to the treatment of multiple myeloma. Initial comparisons of combination chemotherapy against standard melphalan and prednisolone did not seem to show any therapeutic advantage. However, more recently, it has been confirmed that autologous trans-plantation following high-dose melphalan offers significant advantages in terms of both progression-free and overall survival.1 Consequently, autologous stem cell trans-plantation has become the central plank of the management of younger, biologically fit patients with multiple myeloma.

Steve Williamson BPharm, MRPharmS Lead Pharmacist, Cancer Services, Northumbria Healthcare NHS Trust; Lead Pharmacist, Northern Cancer Network

Obtaining access to new and expensive cancer drugs is a topic close to the hearts of cancer patients and the clinicians treating them. In England and Wales, the National Institute for Health and Clinical Excellence (NICE) has been making decisions on the availability of cancer drugs since 1999. Much has been written about the role of NICE and its perceived shortcomings.

Graham H Jackson, Editor

Welcome to issue 2.3 and thank you for the very positive feedback on the last editorial comment. It is no surprise that many of you feel cancer chemotherapy is one area where there is no clear thinking from the government.