Hamid shares a brief synopsis of his dissertation and his reflections on winning the award:
My dissertation focused on patients receiving chemotherapy or targeted therapy for stage IV breast cancer. Patients with metastatic breast cancer are often on treatment for prolonged periods, sometimes years, and there is a delicate balance between managing side effects and maintaining treatment efficacy. As a practising medical oncologist, navigating this balance is a frequent and important part of my clinical work. Traditionally, higher doses of therapy have been assumed to result in greater effectiveness. I wanted to examine whether that assumption holds true in contemporary practice.
To address this question, we conducted a systematic review and meta-analysis of all phase II and phase III randomised controlled trials in metastatic breast cancer published over the past 20 years. Within each study, we examined whether outcomes were reported for patients who required dose reductions due to toxicity compared with those who remained on full-dose therapy. We then pooled these results in a meta-analysis, ultimately combining data from over 6,000 patients.
We found that approximately 40% of patients required dose reductions because of side effects. Reassuringly, patients who needed dose-reduced therapy had similar outcomes to those who continued full-dose treatment. These findings challenge the long-standing assumption that higher doses are equated with higher efficacy.
This work is important because both patients and oncologists often worry that lowering the dose may compromise efficacy. Our findings may help guide conversations around dose adjustments in clinical practice and provide reassurance when side effects require modification. More broadly, the results may prompt the medical oncology community to rethink how doses are chosen for clinical trials in the modern era of targeted therapies.
I am deeply grateful to the team who helped screen thousands of abstracts and extract data for this review. I am especially thankful to my supervisor, Dr Clare Bankhead, whose thoughtful guidance was instrumental in shaping the methodological rigor of the project. I am also grateful to my peers and faculty at the Centre for Evidence-Based Medicine for the many informal discussions that helped refine the work.
I am truly honoured to receive the Gillian Nicholls Prize. The MSc in Evidence-Based Health Care has been an extraordinarily rewarding experience, strengthening both my ability to apply evidence-based principles in day-to-day clinical practice and my skills in conducting high-quality research. It has had a lasting impact on how I approach both patient care and academic inquiry.
The Gillian Nicholls Prize is awarded annually to a Kellogg College student for the best performance in the MSc in Evidence-Based Health Care and is endowed by John Muddiman in memory of his late wife, Dr Gillian Nicholls, who undertook the MSc at Kellogg in 2002.