Proliferative activity, measured by MIB-1, and outcome in primary breast cancer following systemic therapy

There is increasing interest in the use of systemic therapy before surgery for large but operable breast cancers. It has the theoretical advantage of giving priority to the eradication of micrometastatic disease.Studies of primary systemic therapy (PST) show that tumour regression rates are high and more conservative surgery is possible. The survival data look promising although the results of randomised trials are awaited. There is no uniform approach to the selection of PST. Combination chemotherapy is most frequently given and few researchers have used biological information from the tumour to help select therapy.The Edinburgh study is an in vivo model of response to PST, examining tumour properties such as hormone receptor concentration and grade in relation to response and survival. Recent developments permit the use of monoclonal antibodies against proliferation associated antigens such as MIB -1 in archival material. This study relates MIB -1 to response to primary systemic hormone and chemotherapy and to survival.Tissue was available for 65 patients treated between 1984 and 1988 and MIB -1 index was calculated in 61. Indices ranged from 0.01 to 0.89 and there was a significant (p <0.002) difference in mean MIB -1 between tumours classified as oestrogen receptor -rich (≥20 fmol/mg) and oestrogen receptor -poor ( <20 finol/mg). MIB- i expression correlated with increasing grade. There was a significant (p <0.0004) difference in MIB -1 between tumours which responded to primary hormone therapy and those which did not, and between those which achieved a complete pathological response following primary chemotherapy and those which did not ((p <0.01). There was a significant (p <0.005) difference in survival between patients with high MIB -1 tumours treated with primary chemotherapy and those treated with second line chemotherapy after hormone failure.Patients with ER -rich tumours which are highly proliferating may not respond to primary hormone therapy. A trial of hormone therapy may jeopardize subsequent response to chemotherapy and survival

Living and dying with severe chronic obstructive pulmonary disease: multi-perspective longitudinal qualitative study

Objectives To understand the perspectives of people with severe chronic obstructive pulmonary disease (COPD) as their illness progresses, and of their informal and professional carers, to inform provision of care for people living and dying with COPD