Sudha’s research programme investigates clinical challenges in patients with gynaecological cancer with a combined clinical trials/studies and translational research approach. Broadly, the programme encompasses 4 overlapping themes of research interest.
Obesity and cancer
Obesity contributes to the development of several cancers. We are currently investigating the use of Metformin, a well-tolerated anti-diabetic drug in serous ovarian cancer and endometrial cancer. With collaborators, we are setting out trials of Metformin, with clinical and translational endpoints to identify biomarkers of response, incorporating both a clinical and laboratory based programme. We are also currently setting up clinical trials in endometrial cancer survivors evaluating weight loss strategies. This is in collaboration with behavioural psychologists and primary care.
Poor prognostic groups of endometrial cancer
Poor prognostic histotypes of uterine cancer contribute to 10% of the incidence of endometrial cancer but up to 50% of mortality from endometrial cancer. We showed, for the first time that the increase in incidence in endometrial cancer (up by 40% over the last decade) was confined to oestrogen driven low risk endometrial cancer, whereas mortality from Type 2 non oestrogen driven cancer had increased in that time. We are now exploring novel treatments for uterine serous cancer with collaborators. This research theme combines clinical and laboratory based programmes, involving molecular pathology and genetics.
Systematic reviews and diagnostic test evaluations
Another research strand focuses on the evaluation of diagnostic tests in gynaecological cancer in collaboration with teams of systematic reviewers and health economic experts. This work has received substantial funding from NIHR
Surgery in Ovarian cancer
Extensive surgical techniques have been shown to significantly improve survival in ovarian cancer. Our studies evaluate the short term and long term outcomes, including quality of life from such surgery.
Sudha Sundar, co-PI. FOAM trial. Folic acid for hot flushes in menopausal patients with breast and ovarian cancer. Approximately 250,000£. RfPB. July 2012.
Sudha Sundar, (co PI), collaborating with Prof Andrea Rockall, Imaging at Barts (CI) for the MAPPING study. Diagnostic accuracy of MRI, diffusion-weighted MRI, FDG-PET/CT and Fluoro-ethyl-choline PET/CT in the detection of lymph node metastases in surgically staged endometrial and cervical carcinoma. BIDD grant from Cancer Research UK. £ 225,698, Nov 2010.
Sudha Sundar. ( co PI), Key collaborators – Prof Tracy Roberts, Health economics, Birmingham and Prof Khalid Khan, now at Barts, CI. Sentinel lymph node status in vulval cancer: Systematic quantitative reviews and decision analytic model based economic evaluation. HTA £229,000 June 2010.
Sudha Sundar (co-PI). Key collaborators – Prof Tracy Roberts, Health economics, Birmingham and Prof Khalid Khan, now at Barts, CI Clinical effectiveness of PET-CT imaging in restaging recurrent cervical cancer: Systematic review of evidence and economic modelling. HTA £332,000, Jan 2010.
Sudha Sundar, PI. Evaluation of autotaxin and lipid metabolites in ovarian cancer. Sandwell and West Birmingham Hospitals Research and Development Award – January 2009 £24,000 Jan 2009.
Collaboration with Prof Roy Bicknell. Cobalt Appeal Fund Fellowship – May 2007. £84,450. To investigate antiangiogenic and epidermal growth factor receptor antagonists as novel therapies in poor prognostic endometrial cancer.
PET-CT imaging in detecting and managing recurrent cervical cancer: Systematic review of evidence, elicitation of subjective probabilities and economic modelling. Authors: Catherine Meads, Peter Auguste, Clare Davenport, Sylwia Małysiak, Sudha Sundar, Monika Kowalska, Anna Zapalska, Peter Guest, Shakila Thangaratinam, Pierre Martin-Hirsch, Ewa Borowiack, Pelham Barton, Tracy Roberts, Khalid Khan. Peer reviewed HTA report, in press.
Sentinel lymph node (SLN) status in vulval cancer: Systematic reviews of test accuracy and decision analytic model-based economic evaluation. Catherine Meads, Andrew Sutton, Sylwia Małysiak, Monika Kowalska, Anna Zapalska, Ewelina Rogozińska, Peter Baldwin, Adam Rosenthal, Raji Ganesan, Ewa Borowiack, Pelham Barton, Tracy Roberts, Sudha Sundar, Khalid Khan. Peer reviewed HTA report, in press.
Sundar S, Wu J, Hillaby K, Yap J, Lilford R. A systematic review evaluating the relationship between progression free survival and post progression survival in advanced ovarian cancer. Gynecol Oncol. 2011 Dec 8. [Epub ahead of print]
C. Connolly, K. K. Chan, K. Singh, S. Sundar, D. Luesley, M. S. Anwar, I. N. Fernando;
Outcomes following interval debulking surgery in primary peritoneal carcinoma. J Clin Oncol 29: June 9; 2011 (suppl; abstr e15515)
Evans T, Sany O, Pearmain P, Ganesan R, Blann A, Sundar S. Differential trends in the rising incidence of endometrial cancer by type: data from a UK population-based registry from 1994 to 2006. Br J Cancer. 2011 Apr 26;104(9):1505-10.
Voss MA, Gordon N, Maloney S, Ganesan R, Ludeman L, McCarthy K, Gornall R, Schaller G, Wei W, Berditchevski F, Sundar S. Tetraspanin CD151 is a novel prognostic marker in poor outcome endometrial cancer. Br J Cancer. 2011 May 10;104(10):1611-8.
Voss MA, Gordon N, Maloney S, Ganesan R, Ludeman L, McCarthy K, Gornall R, Schaller G, Wei W, Sundar S. Should grade 3 endometrioid carcinoma be considered a type 2 cancer - a clinical and pathological evaluation. Available online August 2011 doi:10.1016/j.ygyno.2011.07.030
Nevin J, Luesley D, Chan KK, Singh K, Balega J, Sundar S. Meeting the challenge of developing and maintaining radical hysterectomy skills. BJOG. 2010 Jan;117(1):1-4.
Maloney SL, Sullivan DC, Suchting S, Herbert JM, Rabai EM, Nagy Z, Barker J, Sundar S, Bicknell R. Induction of thrombospondin-1 partially mediates the anti-angiogenic activity of dexrazoxane. Br J Cancer. 2009 Sep 15;101(6):957-66.
Jadoon BA, Kehoe S, Romain K, Clelland C, Sundar SS. Analysis of outcome in women with borderline glandular change on cervical cytology. Eur J Obstet Gynecol Reprod Biol. 2009 Nov;147(1):83-5
Sundar SS, Ganesan TS. Role of lymphangiogenesis in cancer. J Clin Oncol. 2007 Sep 20;25(27):4298-307.
Royal College of Obstetricians and Gynaecologists – Specialist advisory committee commissioned opinion paper. Optimum Surgery in Advanced Ovarian Cancer. Naik, McIndoe, Mould and Sundar. http://www.rcog.org.uk/womens-health/clinical-guidance/ovarian-cancer-optimum-surgery-advanced-stage-sac-opinion-paper-25.