Nayyer Iqbal - Academia.edu (original) (raw)

Papers by Nayyer Iqbal

Reproductive System & Sexual Disorders, 2016

Breast cancer is one of the most common cancers in women. Approximately twenty five percent breas... more Breast cancer is one of the most common cancers in women. Approximately twenty five percent breast cancer occurs during the reproductive and perimenopausal years. Surgery is the primary treatment of breast cancer. In addition, based on stage and biology of the disease, chemotherapy, radiation, endocrine therapy and biologics are recommended to reduce recurrence and cancer-related mortality. Although survival rates of women with breast cancer has significantly improved, the potential late adverse effects of adjuvant treatment and their impact on quality of life of breast cancer survivors have become increasingly important. Among premenopausal women with breast cancer, management of sexual dysfunction and fertility presents a challenge. The principal mechanisms that systemic therapy affect sexual function and fertility in women with breast cancer is ovarian suppression. In addition, cancer therapy alters anatomy and causes mucosal or skin changes that result in impaired sexual and reproductive health. In this article we review the effect of surgery and adjuvant therapy on reproductive and sexual health of young breast cancer survivors and briefly discuss various treatment options.

Colorectal Cancer - From Pathogenesis to Treatment, 2016

Over the past decade, the role of surgery in stage IV colorectal cancer (CRC) has evolved, yet th... more Over the past decade, the role of surgery in stage IV colorectal cancer (CRC) has evolved, yet the optimal surgical management of the primary tumor in patients with metastatic CRC that is not amenable to curative resection is unknown. A high rate of surgical resection of the primary tumor has been reported in patients with unresectable metastatic disease. Resection of the primary tumor in patients with metastatic CRC is often performed to deal with presenting primary tumor symptoms and or to prevent future primary tumor complications. Nevertheless, with access to novel agents and their efficacy in the primary tumor as well as lack of major complications related to an intact primary tumor, surgery is less commonly performed today. Although the data regarding survival advantages of resection of the primary tumor are inconsistent, overall the evidence suggests potential survival benefit of removal of the primary tumor in patients with both symptomatic and asymptomatic primary tumors even with access to more effective combination chemotherapy. However, the published literature favoring surgery mostly comprises retrospective observational studies. Consequently, the survival benefit related to surgery has been attributed to selection bias, and in the absence of randomized controlled trial no definite conclusion can be drawn. Currently, two randomized controlled trials are enrolling patients to answer this important question in the management of metastatic CRC.

Journal of Cancer, 2016

Observational studies have suggested that patients with stage IV colorectal cancer who undergo su... more Observational studies have suggested that patients with stage IV colorectal cancer who undergo surgical resection of the primary tumor (SRPT) have better survival. Yet the results are not confirmed in the setting of a randomized controlled trial. Lack of randomization and failure to control prognostic variables such as performance status are major critiques to the findings of the observational studies. We previously have shown that SRPT, independent of chemotherapy and performance status, improves survival of stage IV CRC patients. The current study aims to validate our findings in patients with stage IV CRC who were diagnosed during the period of modern chemotherapy. A cohort of 569 patients with stage IV CRC diagnosed during 2006-2010 in the province of Saskatchewan was evaluated. Cox regression model was used for the adjustment of prognostic variables. Median age was 69 years (59-95) and M: F was 1.4:1. Fifty-seven percent received chemotherapy, 91.4% received FOLFIRI or FOLFOX &...

Clinical Oncology, 2010

AimsThe treatment of locally advanced pancreatic cancer varies enormously both within the UK and ... more AimsThe treatment of locally advanced pancreatic cancer varies enormously both within the UK and internationally. Although chemoradiation is the treatment of choice in the USA, in the UK this modality is used infrequently because of concerns regarding both its efficacy and its toxicity. We reviewed our experience with induction chemotherapy and selective chemoradiation in an attempt to show that it

Cancers

Background: Breast cancer is rare in men. This population-based study aimed to determine outcomes... more Background: Breast cancer is rare in men. This population-based study aimed to determine outcomes of male breast cancer in relation to residence and other variables. Methods: In this retrospective cohort study, men diagnosed with breast cancer in Saskatchewan during 2000–2019 were evaluated. Cox proportional multivariable regression analyses were performed to determine the correlation between survival and clinicopathological and contextual factors. Results: One hundred-eight eligible patients with a median age of 69 years were identified. Of them, 16% had WHO performance status ≥ 2 and 61% were rural residents. The stage at diagnosis was as follows: stage 0, 7%; I, 31%; II, 42%; III, 11%; IV, 8%. Ninety-eight percent had hormone receptor-positive breast cancer. The median disease-free survival of urban patients was 97 (95% CI: 50–143) vs. 64 (46–82) months of rural patients (p = 0.29). The median OS of urban patients was 127 (94–159) vs. 93 (32–153) months for rural patients (p = 0....

Cancer Research

Background: TreatER+ight is the 1st prospective observational study in Canadian HR+ HER2- advance... more Background: TreatER+ight is the 1st prospective observational study in Canadian HR+ HER2- advanced breast cancer patients currently receiving endocrine therapy (ET) alone or in combination with targeted therapy (TT) (NCT02753686). Methods: This exploratory analysis displays real-world evidence on baseline demographics, treatment patterns, sequencing, and method of access to therapy. More specifically this abstract focuses on treatment decisions around CDK4/6-based therapy at various lines of treatment. At data cut-off of April 1st 2019, 305 patients were enrolled from 24 sites since Mar'16 with 113 patients receiving CDK4/6is at baseline. 300 patients were evaluable for treatment analysis. Results: Baseline CharacteristicsOverall (n=305)CDK4/6 + ET (n=113)Median age, years (range)67 (23 - 92)67 (23-87)ECOG 0,1,2*95, 104, 1941,32, 4Post-menopausal*21468Pre/peri-menopausal*6530Therapy by disease severity at baselineVisceral (n = 196)Bone only (n = 101)CDK4/6 + ET7338ET5941mTOR + E...

Clinical Cancer Research, 2020

Background: Hotspot activating mutations in AKT1 and PIK3CA represent a rare but potentially uniq... more Background: Hotspot activating mutations in AKT1 and PIK3CA represent a rare but potentially unique subset of metastatic prostate cancers (mPCa). The accompanying genomic and clinical features of these patients are currently unknown. Preclinical evidence suggests that unconstrained PI3K signaling via PTEN loss may render androgen receptor (AR)-targeted therapy less effective. Given the availability of agents that target nodes within the PI3K pathway, elucidating the genomic properties of AKT1/PIK3CA mutant patients and their response to AR-targeted therapy will be critical for therapeutic selection. Methods: We performed deep targeted sequencing on 1,381 cell-free DNA samples from 608 patients with mPCa. Analysis was restricted to patients with hotspot AKT1 or PI3KCA mutations of presumed clonal origin, requiring a variant allele frequency >25% of a sample’s ctDNA fraction. Activating AKT1 and PIK3CA mutations were defined as recurrent hotspot mutations with a cBioPortal annotati...

Annals of Oncology, 2017

Background: FX and GN are more active than gemcitabine in patients with APC. However, it is not k... more Background: FX and GN are more active than gemcitabine in patients with APC. However, it is not known if FX is superior to GN in APC. In the absence of a randomized controlled trial this population-based cohort study is undertaken to compare efficacy and safety of the two standard regimens in APC.

Journal of Clinical Oncology, 2018

849 Background: Although there is evidence that social and contextual factors such as living alon... more 849 Background: Although there is evidence that social and contextual factors such as living alone are associated with outcomes in cancer patients, little is known about their influence on the use of palliative chemotherapy in mCRC. We previously reported various patient-and tumor-related factors that correlate with the use of palliative chemotherapy in mCRC (Oncology. 2015;88:289). In this study we examine social and contextual factors including marital status, having children and distance to cancer center for their association with the use of chemotherapy in patients with mCRC. Methods: A cohort of 569 patients with mCRC diagnosed from 2006-2010 in Saskatchewan was evaluated. Logistic regression analyses were performed to assess relationship between the use of chemotherapy and various variables. Results: Median age was 69 yrs (IQR 59-77) and M:F was 59:41. 326 (57%) patients received chemotherapy. Significant differences were noted between the chemotherapy vs. no chemotherapy grou...

Journal of gastrointestinal oncology, 2018

Salvage palliative chemotherapy in metastatic colorectal cancer has been associated with signific... more Salvage palliative chemotherapy in metastatic colorectal cancer has been associated with significant improvement in survival. However, not all patients receive all available therapies. Travel burden can affect patient access and use of future therapy. The present study aims to determine relationship between travel distance (TD) and salvage palliative chemotherapy in patients with metastatic colorectal cancer. A patient cohort diagnosed with metastatic colorectal cancer during 2006-2010 in the province of Saskatchewan, Canada was studied. Logistic regression analyses were performed to assess relationship between travel distance and subsequent line therapies. The median age of 264 eligible patients was 62 years [interquartile range (IQR): 53-72]. The patients who received salvage systemic therapy had a median distance to travel of 60.0 km (IQR: 4.7-144) compared with 88.1 km (IQR: 4.8-189) if they did not receive second- or third-line therapy (P=0.06). In multivariate analysis distanc...

$Research paper thumbnail of CT-planned accelerated hypofractionated radiotherapy in the radical treatment of non-small cell lung cancer$

Lung Cancer, 2004

Surgery is the standard treatment for stage I, II and certain stage IIIA non-small cell lung canc... more Surgery is the standard treatment for stage I, II and certain stage IIIA non-small cell lung cancers (NSCLC). A proportion of patients with technically operable NSCLC do not undergo surgery because of significant co-morbidity or refusal, and radical radiotherapy may cure some of these patients. Between April 1997 and March 2000, 135 consecutive patients with stage I-IIIB NSCLC were treated with CT-planned accelerated hypofractionated radical radiotherapy to a dose of 50-55Gy in 15-20 fractions over 3-4 weeks at a single centre. The 2-year overall and cause-specific survival for all patients was 44.4% (95% CI = 36.8, 53.7) and 47.8% (95% CI = 39.9, 57.3) respectively. Overall median survival was 21 months (95% 18, 28). There were no reports of severe acute or late treatment-related toxicities. These results compare favourably with previously published studies on radical radiotherapy in NSCLC, suggesting this may be an effective and safe technique.

Journal of Clinical Oncology, 2016

724 Background: Second and third line therapies in stage IV colorectal (CRC) have been associated... more 724 Background: Second and third line therapies in stage IV colorectal (CRC) have been associated with significant improvement in survival. However, not all patients receive all available therapies. Delay in starting treatment and travel burden can affect patient access and use of future therapy. Little is known about time to first line chemotherapy (TC) and travel distance to cancer center (TD) and their relationship to future therapies in stage IV CRC. The study aims to determine relationship between TC and TD with second and subsequent line of therapies. Methods: A patients cohort diagnosed with synchronous stage IV CRC during 2006-2010 in the province of Saskatchewan, Canada was studied. Patients with ECOG performance status of > 1 or who did not receive chemotherapy were excluded. The logistic regression analyses were performed to assess relationship between TC and TD and subsequent line therapies. Results: 569 patients were diagnosed with synchronous stage IV CRC. 326 patie...