Latest Articles Include:
- Swine influenza: how much of a global threat?
- Lancet 373(9674):1495 (2009)
- Emergency and comprehensive care for stroke needed
- Lancet 373(9674):1496 (2009)
- Patient selection criteria and the FLEX Study
- Lancet 373(9674):1497-1498 (2009)
- Immunisation timing: the protective layer in vaccine coverage
- Lancet 373(9674):1499-1500 (2009)
- A global fund for the health MDGs?
- Lancet 373(9674):1500-1502 (2009)
- NHS Evidence: better and faster access to information
- Lancet 373(9674):1502-1504 (2009)
- An academia–industry partnership in health care
- Lancet 373(9674):1504-1505 (2009)
- International family-planning budgets in the "new US" era
- Lancet 373(9674):1505-1507 (2009)
- The African Network for Drugs and Diagnostics Innovation
- Lancet 373(9674):1507-1508 (2009)
- Health issues sidelined in India's general election
- Lancet 373(9674):1509-1511 (2009)
- Binayak Sen and the cost of dissent in India
- Lancet 373(9674):1512 (2009)
- Twisted science, regulation, and molecules
- Lancet 373(9674):1513-1514 (2009)
- A life in the lyme light
- Lancet 373(9674):1514 (2009)
- Triage
- Lancet 373(9674):1515 (2009)
- Shannon Hader
- Lancet 373(9674):1515 (2009)
- Florence Nightingale and Elizabeth Blackwell
- Lancet 373(9674):1516-1517 (2009)
- Mark H Beers
- Lancet 373(9674):1518 (2009)
- Treatment of alcohol-use disorders
- Lancet 373(9674):1519 (2009)
- Treatment of alcohol-use disorders
- Lancet 373(9674):1519 (2009)
- Treatment of alcohol-use disorders – Authors' reply
- Lancet 373(9674):1519-1520 (2009)
- Spousal violence and spontaneous fetal loss
- Lancet 373(9674):1520 (2009)
- Spousal violence and spontaneous fetal loss – Authors' reply
- Lancet 373(9674):1520-1521 (2009)
- Medical missionaries in Africa
- Lancet 373(9674):1521 (2009)
- Medical missionaries in Africa
- Lancet 373(9674):1521-1522 (2009)
- Psychiatry: all in the mind or all in the brain?
- Lancet 373(9674):1522 (2009)
- Psychiatry: all in the mind or all in the brain? – Author's reply
- Lancet 373(9674):1522-1523 (2009)
- Tomorrow's Doctors: a global perspective
- Lancet 373(9674):1523 (2009)
- Predicting atrial fibrillation
- Lancet 373(9674):1523 (2009)
- Predicting atrial fibrillation – Authors' reply
- Lancet 373(9674):1523-1524 (2009)
- Protocols, probity, and publication
- Lancet 373(9674):1524 (2009)
- Department of Error
- Lancet 373(9674):1524 (2009)
- Department of Error
- Lancet 373(9674):1524 (2009)
- Cetuximab plus chemotherapy in patients with advanced non-small-cell lung cancer (FLEX): an open-label randomised phase III trial
- Lancet 373(9674):1525-1531 (2009)
Background Use of cetuximab, a monoclonal antibody targeting the epidermal growth factor receptor (EGFR), has the potential to increase survival in patients with advanced non-small-cell lung cancer. We therefore compared chemotherapy plus cetuximab with chemotherapy alone in patients with advanced EGFR-positive non-small-cell lung cancer. Methods In a multinational, multicentre, open-label, phase III trial, chemotherapy-naive patients (≥18 years) with advanced EGFR-expressing histologically or cytologically proven stage wet IIIB or stage IV non-small-cell lung cancer were randomly assigned in a 1:1 ratio to chemotherapy plus cetuximab or just chemotherapy. Chemotherapy was cisplatin 80 mg/m2 intravenous infusion on day 1, and vinorelbine 25 mg/m2 intravenous infusion on days 1 and 8 of every 3-week cycle) for up to six cycles. Cetuximab—at a starting dose of 400 mg/m2 intravenous infusion over 2 h on day 1, and from day 8 onwards at 250 mg/m2 over 1 h per week—was continued after the end of chemotherapy until disease progression or unacceptable toxicity had occurred. The primary endpoint was overall survival. Analysis was by intention to treat. This study is registered with ClinicalTrials.gov, number NCT00148798. Findings Between October, 2004, and January, 2006, 1125 patients were randomly assigned to chemotherapy plus cetuximab (n=557) or chemotherapy alone (n=568). Patients given chemotherapy plus cetuximab survived longer than those in the chemotherapy-alone group (median 11·3 months vs 10·1 months; hazard ratio for death 0·871 [95% CI 0·762–0·996]; p=0·044). The main cetuximab-related adverse event was acne-like rash (57 [10%] of 548, grade 3). Interpretation Addition of cetuximab to platinum-based chemotherapy represents a new treatment option for patients with advanced non-small-cell lung cancer. Funding Merck KGaA. - Recombinant human erythropoiesis-stimulating agents and mortality in patients with cancer: a meta-analysis of randomised trials
- Lancet 373(9674):1532-1542 (2009)
Background Erythropoiesis-stimulating agents reduce anaemia in patients with cancer and could improve their quality of life, but these drugs might increase mortality. We therefore did a meta-analysis of randomised controlled trials in which these drugs plus red blood cell transfusions were compared with transfusion alone for prophylaxis or treatment of anaemia in patients with cancer. Methods Data for patients treated with epoetin alfa, epoetin beta, or darbepoetin alfa were obtained and analysed by independent statisticians using fixed-effects and random-effects meta-analysis. Analyses were by intention to treat. Primary endpoints were mortality during the active study period and overall survival during the longest available follow-up, irrespective of anticancer treatment, and in patients given chemotherapy. Tests for interactions were used to identify differences in effects of erythropoiesis-stimulating agents on mortality across prespecified subgroups. Findings Data from a total of 13 933 patients with cancer in 53 trials were analysed. 1530 patients died during the active study period and 4993 overall. Erythropoiesis-stimulating agents increased mortality during the active study period (combined hazard ratio [cHR] 1·17, 95% CI 1·06–1·30) and worsened overall survival (1·06, 1·00–1·12), with little heterogeneity between trials (I2 0%, p=0·87 for mortality during the active study period, and I2 7·1%, p=0·33 for overall survival). 10 441 patients on chemotherapy were enrolled in 38 trials. The cHR for mortality during the active study period was 1·10 (0·98–1·24), and 1·04 (0·97–1·11) for overall survival. There was little evidence for a difference between trials of patients given different anticancer treatments (p for interaction=0·42). Interpretation Treatment with erythropoiesis-stimulating agents in patients with cancer increased mortality during active study periods and worsened overall survival. The increased risk of death associated with treatment with these drugs should be balanced against their benefits. Funding German Federal Ministry of Education and Research, Medical Faculty of University of Cologne, and Oncosuisse (Switzerland). - Timing of children's vaccinations in 45 low-income and middle-income countries: an analysis of survey data
- Lancet 373(9674):1543-1549 (2009)
Background Vaccinations are often delayed until well after the recommended ages, leaving many children exposed for longer than they should be. We estimated vaccination coverage at different ages, and delays in administration, in 45 low-income and middle-income countries. Methods We used data for 217 706 children from Demographic and Health Surveys between 1996 and 2005 (median 2002), which provided data for vaccination of children on the basis of events recorded on vaccination cards and interviews with mothers, with imputation of missing values and survival analysis. We devised an index combining coverage and delay. Findings For vaccinated children, the median of the median delays in the 45 countries was 2·3 weeks (IQR 1·4–4·6) for bacille Calmette-Guérin (BCG); 2·4 weeks (1·2–3·3) for diphtheria, tetanus, and pertussis (DTP1); 2·7 weeks (1·7–3·1) for measles-containing vaccine (MCV1); and 6·2 weeks (3·5–8·5) for DTP3. However, in the 12 countries with the longest delays for each vaccination, at least 25% of the children vaccinated were more than 10 weeks late for BCG, 8 weeks for DTP1, 11 weeks for MCV1, and 19 weeks for DTP3. Variation within countries was substantial: the median of the IQRs in the 45 countries for delay in DTP3 was 10·9 weeks, 7·9 weeks for MCV1, 5·4 weeks for BCG, and 5·3 weeks for DTP1. The median of the national coverage rates for DTP1 increased from 57% in children aged 12 weeks to 88% at 12 months, and for DTP3 from 65% at 12 months to 76% at 3 years. Interpretation The timeliness of children's vaccination varies widely between and particularly within countries, and published yearly estimates of national coverage do not capture these variations. Delayed vaccination could have important implications for the effect of new and established vaccines on the burden of disease. Funding WHO's Initiative for Vaccine Research. - Graft-versus-host disease
- Lancet 373(9674):1550-1561 (2009)
Haemopoietic-cell transplantation (HCT) is an intensive therapy used to treat high-risk haematological malignant disorders and other life-threatening haematological and genetic diseases. The main complication of HCT is graft-versus-host disease (GVHD), an immunological disorder that affects many organ systems, including the gastrointestinal tract, liver, skin, and lungs. The number of patients with this complication continues to grow, and many return home from transplant centres after HCT requiring continued treatment with immunosuppressive drugs that increases their risks for serious infections and other complications. In this Seminar, we review our understanding of the risk factors and causes of GHVD, the cellular and cytokine networks implicated in its pathophysiology, and current strategies to prevent and treat the disease. We also summarise supportive-care measures that are essential for management of this medically fragile population. - New-generation drugs that stimulate platelet production in chronic immune thrombocytopenic purpura
- Lancet 373(9674):1562-1569 (2009)
Idiopathic thrombocytopenic purpura is an acquired disease characterised by a low platelet count. Development of autoantibodies is a main cause of the disease. Although many patients have few symptoms, life-threatening bleeding can arise and hence, when platelet counts fall to unacceptable values treatment should be initiated. However, conventional immunosuppressive approaches can fail, perhaps because of the heterogeneous nature of the disease. Newly developed agents that increase platelet production by stimulating megakaryocytes—such as drugs that bind to the thrombopoietin receptor c-MPL—offer an alternative treatment strategy. Although initial thrombopoietin analogues caused adverse immune reactions, second-generation thrombopoietin-receptor agonists that are in late-stage clinical development seem promising. In particular, eltrombopag and romiplostim safely increase and maintain platelet production in patients with refractory disease. However, long-term side-e! ffects are being assessed and the exact role of these agents in the overall treatment strategy of chronic idiopathic thrombocytopenic purpura remains to be established. - Rescuing the bottom billion through control of neglected tropical diseases
- Lancet 373(9674):1570-1575 (2009)
- Fever, rash, and crusting ulcers
- Lancet 373(9674):1576 (2009)