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Zhang M, Xu P, Cheng S, Wang L, Zhao W. DECITABINE PLUS R-CHOP IN PATIENTS WITH NEWLY DIAGNOSED DIFFUSE LARGE B-CELL LYMPHOMA: INTERIM RESULTS OF A PHASE I/II STUDY. Hematol Oncol 2019. [DOI: 10.1002/hon.212_2631] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Saluja R, Everest L, Cheng S, Cheung MC, Chan KK. Do the ASCO Value Framework and the ESMO Magnitude of Clinical Benefit Scale measure Absolute or Relative clinical benefit? J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e18378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e18378 Background: It is unclear whether the clinical benefit scores from the ASCO or ESMO valuation frameworks were intended to measure absolute or relative survival benefit. To empirically examine the measurement characteristics of these frameworks, we compared their survival efficacy components (ASCO-CBS and ESMO-PMCBGs) with established measures of absolute (median survival difference and restricted mean survival time (RMST) difference) and relative (HRs) survival benefit. Methods: FDA’s Hematology/Oncology Approvals and Safety Notifications pages were reviewed to identify phase III RCTs cited in oncology drug approvals between January 2006 and December 2017. In our primary analysis, ASCO-CBS and ESMO-PMCBGs were calculated for the included trials using the framework defined endpoint (Fr). Sensitivity analyses were conducted by calculating the scores using 1) Fr + tail-of-curve bonus points (ASCO) or long-term plateau adjustments (ESMO) (defined as Fr + TOC), 2) overall survival (OS) data only, and 3) progression-free survival (PFS) data only. For both primary and sensitivity analyses, Spearman correlation coefficients were calculated to examine the relationships between 1) ASCO-CBS/ESMO-PMCBGs and RMST difference, 2) ASCO-CBS/ESMO-PMCBGs and median survival difference, and 3) ASCO-CBS/ESMO-PMCBGs and HRs. Results: 107 RCTs were included. Compared to measures of absolute survival, ESMO-PMCBG showed low-moderate correlations with RMST difference and moderate-high correlations with median survival difference (Rho = 0.44 and 0.64, respectively). ASCO-CBS showed low-moderate correlations with both measures of absolute benefit (Rho = 0.43 and 0.44 for RMST difference and median survival, respectively). Compared to a relative measure of survival (HRs), ESMO-PMCBG revealed a moderate correlation (Rho = 0.47) while ASCO-CBS showed a higher correlation (Rho = 0.76). Conclusions: Both frameworks do not perform solely as absolute measures of survival benefit. We recommend that the frameworks consider incorporating a direct measure of absolute clinical benefit, such as RMST difference, into the survival efficacy components of their algorithms.
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Wang N, Xu PP, Wang L, Cheng S, Zhao WL, Sun HP. [Prognostic study of 229 follicular lymphoma patients treated with rituximab combined with chemotherapy]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2019; 40:46-51. [PMID: 30704228 PMCID: PMC7351707 DOI: 10.3760/cma.j.issn.0253-2727.2019.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
目的 探究滤泡性淋巴瘤(FL)的临床特征,以及FL国际预后指数(FLIPI)、FLIPI2、IPI、修正IPI(R-IPI)、NCCN-IPI在中国FL患者的预后意义。 方法 对2008年11月至2018年4月期间以利妥昔单抗联合CHOP(环磷酰胺、多柔比星、长春新碱及泼尼松)方案治疗的229例初治FL患者资料进行回顾性分析,并对所有患者进行各项预后指数评分。对201例完成化疗且有完整随访记录的患者进行单因素及多因素生存分析。 结果 229例患者中男126例,女103例,中位年龄53(21~82)岁。①对上述预后评分系统中所含的危险因素在患者总生存(OS)和无进展生存(PFS)中的影响进行分析,单因素分析结果显示:年龄>60岁、HGB<120 g/L、血β2微球蛋白升高、骨髓浸润及C反应蛋白(CRP)升高是影响患者OS和PFS的不良因素(P值均<0.05),利妥昔单抗维持组(RM)与非维持组(non-RM)患者的5年OS率分别为93.33%、87.10%(P=0.020),5年PFS率分别为90.81%、63.47%(P=0.003),前者均优于后者;多因素分析结果显示:HGB<120 g/L(P=0.001)、骨髓浸润(P=0.050)、CRP升高(P=0.010)和non-RM(P=0.010)是影响OS的不良预后因素,HGB<120 g/L(P=0.003)、CRP升高(P=0.009)和non-RM(P=0.003)是影响PFS的不良预后因素。②对FLIPI和FLIP2评分预后模型进行比较分析,结果显示:FLIPI预后模型中,低危、中危和高危组患者的5年OS率(P=0.230)和5年PFS率(P=0.160)差异均无统计学意义。FLIP2预后模型中,5年OS率和5年PFS率差异均有统计学意义(P值均<0.001),在利妥昔单抗治疗组中进行分析,低危、中危和高危组患者的5年OS率分别为96.77%、88.89%、80.00%,差异有统计学意义(P=0.042)。 结论 利妥昔单抗时代FLIPI2可以更好地用于FL危险分层。
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Chen K, Bai J, Zhao H, Yang F, Zhang C, Wang Y, Chang L, Guan Y, Yi X, Feng L, Zhang K, Cheng S, Wang J. Comprehensive profiling of genomic and TCR repertoire in localized stage lung adenocarcinomas from a prospective cohort study. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz064.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Zhang MC, Xu PP, Zhong HJ, Zhao X, Zhao WL, Cheng S. [Prognostic significance of NCCN-International Prognostic Index (NCCN-IPI) for patients with peripheral T-cell lymphoma treated with CHOP-based chemotherapy]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2019; 38:772-777. [PMID: 29081194 PMCID: PMC7348366 DOI: 10.3760/cma.j.issn.0253-2727.2017.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
目的 明确美国国家综合癌症网络国际预后指数(NCCN-IPI)对外周T细胞淋巴瘤(PTCL)患者化疗后的预后评估价值。 方法 回顾性分析2003年1月至2013年5月接受CHOP或CHOP样方案化疗的162例初治PTCL患者的临床资料,采用国际预后指数(IPI)和NCCN-IPI进行危险分层和预后评估。 结果 ①162例患者预期5年总生存(OS)和无进展生存(PFS)率分别为33%和20%,中位OS和PFS时间分别为17.0和9.2个月。②多因素分析提示美国东部肿瘤协作组体能状态评分(ECOG评分)≥2分(PFS:HR=2.418,95%CI 1.535~3.809,P<0.001;OS:HR=2.347,95%CI 1.435~3.839,P=0.001)和存在特定的结外病变部位(PFS:HR=1.800,95%CI 1.216~2.665,P=0.003;OS:HR=1.608,95%CI 1.054~2.454,P=0.027)是影响患者PFS和OS的独立危险因素;ALK+是影响间变性大细胞淋巴瘤患者PFS(HR=0.424,95%CI 0.184~0.975,P=0.043)及OS(HR=0.276,95%CI 0.087~0.877,P=0.029)的独立预后良好因素。③NCCN-IPI低危组患者的生存率显著高于IPI低危组患者(5年OS率74%对54%,χ2=5.041,P=0.025;5年PFS率50%对38%,χ2=5.295,P=0.021),差异均有统计学意义。 结论 NCCN-IPI较IPI对低危PTCL患者具有更好的预后判断意义,可作为PTCL患者有效的预后分层工具。
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Del Paggio JC, Cheng S, Booth CM, Cheung MC, Chan KKW. Reliability of Oncology Value Framework Outputs: Concordance Between Independent Research Groups. JNCI Cancer Spectr 2018; 2:pky050. [PMID: 31360865 PMCID: PMC6650061 DOI: 10.1093/jncics/pky050] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 07/30/2018] [Accepted: 08/10/2018] [Indexed: 11/20/2022] Open
Abstract
Research groups are increasingly utilizing value frameworks, but little is known of their reliability. To assess framework concordance and interrater reliability between two major value frameworks currently in use, we identified all previously published datasets containing both scores from the American Society of Clinical Oncology Value Framework (ASCO-VF) and grades from the European Society for Medical Oncology-Magnitude of Clinical Benefit Scale (ESMO-MCBS). The intraclass correlation coefficient (ICC) was used to assess interrater reliability. Four eligible studies contained drugs evaluated by both value frameworks, resulting in a dataset of 39 grades/scores for discrete drug indications. ICC was 0.82 (95% confidence interval = 0.70 to 0.90) for ASCO-VF and 0.88 (95% confidence interval = 0.80 to 0.93) for ESMO-MCBS. Absolute concordance was found to be 5% for ASCO-VF and 44% for ESMO-MCBS, increasing to 74% and 80% when deviations within 20 points and 1 grade were considered, respectively. Interrater reliability of ASCO-VF and ESMO-MCBS is, therefore, near perfect, while absolute concordance is poor. This has implications when considering framework outputs in drug funding or treatment decision making.
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Cheng S. A NEW ERA OF SOCIOEMOTIONAL AGING. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.1547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Lum T, Wong G, Tang J, Luo H, Liu T, Mui A, Morrow-Howell N, Cheng S. PERCEIVED LIFE EXPECTANCY PREDICTS TIME INVESTMENT IN PRODUCTIVE AGING ACTIVITIES. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Cheung P, Thompson R, Chu W, Myrehaug S, Poon I, Sahgal A, Soliman H, Tseng C, Wong S, Ung Y, Abrahao A, Berry S, Chan K, Cheng S, Earle C, Erler D, Zhang L, Ko Y, Chung H. Stereotactic Body Radiation Therapy for Metastatic Colorectal Cancer: Comprehensive Review from a Large Academic Institution. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Leung M, Cheng S. A MODERATED MEDIATION MODEL OF SELF-EFFICACY, CATASTROPHIZING AND DEPRESSIVE SYMPTOMS IN CHRONIC PAIN PATIENTS. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.2486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Mainwaring P, Small E, Uemura H, Lee J, Pang ST, Marx G, Kwon T, Satoh T, Bhaumik A, Cheng S, Londhe A, Lopez-Gitlitz A, Smith M. Efficacy and safety of apalutamide (APA) in patients (pts) with nonmetastatic castration-resistant prostate cancer (nmCRPC) from SPARTAN: Asian subpopulation. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy434.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Cheng S, Qureshi M, Arciero V, Chan KW, Emmenegger U. Quality of docetaxel toxicity reporting for castration resistant prostate cancer (CRPC): A systematic review. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy284.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Chen K, Zhao H, Bai J, Yang F, Chang L, Guan Y, Yi X, Feng L, Cheng S, Wang J. P2.03-26 A Prospective Cohort Study of TMB and Determinants of ctDNA Detection by Comprehensive Genomic Profiling in Stage I Lung Adenocarcinomas. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.1213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Garassino M, Rodríguez-Abreu D, Gadgeel S, Esteban E, Felip E, Speranza G, Domine M, Hochmair M, Powell S, Cheng S, Bischoff H, Peled N, Reck M, Hui R, Garon E, Boyer M, Yang J, Burke T, Pietanza M, Gandhi L. PD.1.01 Health-Related Quality of Life with Pembrolizumab or Placebo + Pemetrexed + Platinum in Non-Squamous NSCLC: KEYNOTE-189. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.07.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Arciero VS, Cheng S, Mason R, McDonald E, Saluja R, Chan KKW. Do older and younger patients derive similar survival benefits from novel oncology drugs? A systematic review and meta-analysis. Age Ageing 2018; 47:654-660. [PMID: 29788041 DOI: 10.1093/ageing/afy079] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 05/02/2018] [Indexed: 12/27/2022] Open
Abstract
Background older patients are commonly believed to derive less benefit from cancer drugs, even if they fulfil clinical trial eligibility [Talarico et al. (2004, J Clin Oncol, 22(22):4626-31)]. We aim to examine if novel oncology drugs provide differential age-based treatment outcomes for patients on clinical trials. Methods a systematic review of randomised control trials (RCTs) cited for clinical efficacy evidence in novel oncology drug approvals by the Food and Drug Administration, European Medicines Agency and Health Canada between 2006 and 2017 was conducted. Studies reporting age-based subgroup analyses for overall or progression-free survival (OS/PFS) were included. Hazard ratios (HRs) and confidence intervals (CIs) for age-based subgroups were extracted. Meta-analyses with random effects were conducted, examining patient subgroups <65 and ≥65 years separately and pooled HRs of studies primary endpoints (OS or PFS) compared to examine if differences existed between age-based subgroups. Sensitivity analyses were conducted for cancer type, primary endpoint and systemic treatment. Results one-hundred-two RCTs, including 65,122 patients, met the inclusion criteria. One study reported age-based toxicity and none reported age-based quality of life (QOL) results. Pooled HRs [95% CIs] for patients <65 and ≥65 years were 0.61 [0.57-0.65] and 0.65 [0.61-0.70], respectively, with no difference between them (P = 0.14). Sensitivity analyses revealed similar results. Conclusion our results suggest that older and young patients, who fulfil clinical trial eligibility, may derive similar relative survival benefits from novel oncology drugs. There is, however, a need to report age-based toxicity and QOL results to support patient discussions regarding the balance of treatment benefit and harm, to encourage informed decision-making.
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Ge GJ, Ding GQ, Zhao WP, Ma L, Cheng S, Chen YL, Li GH. [Robot-assisted partial nephrectomy for treating renal hilar tumors: a clinical study of 22 cases]. ZHONGHUA YI XUE ZA ZHI 2018; 98:2438-2440. [PMID: 30138991 DOI: 10.3760/cma.j.issn.0376-2491.2018.30.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To analyze and summarize the surgical experience of robotic-assisted laparoscopic partial nephrectomy (RAPN) for treating renal hilar tumors, and assess the efficacy and safety of this surgery. Methods: The clinical data of 22 renal hilar tumor patients who underwent RAPN in Sir Run Run Shaw Hospital, Zhejiang University School of Medicine between September 2015 and September 2017 was analyzed. The patients included 19 males and 3 females, with an average age of (55.6 ±13.0) years old and the age range was 28-75 years. In 13 cases, the tumors were in left kidney, and 9 in the right. There were 10 large tumors (>4 cm diameter), the average tumor size was (3.7±1.9) cm. Preoperative glomerular filtration rate was normal in all cases. Results: The surgery was successfully finished in all of the cases, with no conversion to open surgery. The mean duration of the surgery was 80-270 min, with an average of (134.7±44.5) min. The blood loss was 80-500 ml, with an average of (135.9±130.7) ml, and none of the cases needed intraoperative blood transfusion. The warm ischemia time was 8-25 min, with an average of (18.2±4.0) min. The postoperative length of hospitalization was 7-23 d, with an average of (11.5±4.1) d. Serious gross hematuria occurred in 1 patient, and paroxysmal atrial fibrillation occurred in 1 patient after surgery. The post-operative pathology showed renal clear cell carcinoma in 18 cases, papillary renal cell carcinoma in 2 cases, chromophobe cell carcinoma in 1 case and well differentiated neuroendocrine tumor in 1 case. The tumor resection margin was negative in all cases. Neither local recurrence nor metastasis was observed during a follow-up of 1 to 15 months. Renal function of all the patients was in normal range. Conclusion: RAPN is a safe, useful approach and a minimally invasive operation for treating renal hilar tumors and it owns crucial advantages in complete and accurate resection of the renal hilar tumors and the reconstruction of the kidney.
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Sanchez-Martinez S, Cikes M, Claggett B, Duchateau N, Piella G, Cheng S, Shah A, Bijnens B, Solomon S. 1105Machine-learning analysis of myocardial deformation patterns to predict incident heart failure or death in the general population. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.1105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Li L, Cheng S, Zhao S. P4688MRI characteristics and clinical value of hypertrophic cardiomyopathy with scar-like late enhancement. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Zhao D, Sun Q, Cheng S, He M, Chen X, Hou X. Extraction of Parkinson’s Disease-Related Features from Local Field Potentials for Adaptive Deep Brain Stimulation. NEUROPHYSIOLOGY+ 2018. [DOI: 10.1007/s11062-018-9717-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Fei W, Xu S, Ma J, Zhai W, Cheng S, Chang Y, Wang X, Gao J, Tang H, Yang S, Zhang X. Fundamental supply of skin blood flow in the Chinese Han population: Measurements by a full-field laser perfusion imager. Skin Res Technol 2018; 24:656-662. [PMID: 29740880 DOI: 10.1111/srt.12581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Skin blood flow is believed to link with many diseases, and shows a significant heterogeneity. There are several papers on basal cutaneous microcirculation perfusion in different races, while the data in Chinese is vacant. OBJECTIVE The aim was to establish the database of absolute fundamental supply of skin blood flow in the Chinese Han population. METHODS With a full-field laser perfusion imager (FLPI), the skin blood flow can be quantified. Cutaneous perfusion values were determined in 17 selected skin areas in 406 healthy participants aged between 20 and 80 years (mean 35.05 ± 11.33). Essential parameters such as weight, height were also measured and values of BMI were calculated. The perfusion values were reported in Arbitrary Perfusion Units (APU). RESULTS The highest cutaneous perfusion value fell on eyelid (931.20 ± 242.59 in male and 967.83 ± 225.49 in female), and pretibial had the lowest value (89.09 ± 30.28 in male and 85.08 ± 33.59 in female). The values were higher in men than women on the bank of fingertips, nose, forehead, cheek, neck and earlobe (P < .05). Perfusion values on stretch and flexion side of forearm had negative correlation with age (P = .01 and P = 4.88 × 10-3 , respectively) in male. Abdomen was negatively correlated with BMI in both gender (P = .02, respectively). CONCLUSIONS Skin blood flow values vary with skin regions. There is a tendency to measure higher perfusion values in men than in women. And the values are irrelevant with age or BMI.
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Zhai W, Huang Y, Chang Y, Fei W, Cheng S, Zhou Y, Tang X, Gao J, Zhang X, Yang S. 1038 Evaluation of the skin microbiota in a health Chinese population. J Invest Dermatol 2018. [DOI: 10.1016/j.jid.2018.03.1050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Saluja R, Arciero VS, Cheng S, McDonald E, Wong WWL, Cheung MC, Chan KKW. Examining Trends in Cost and Clinical Benefit of Novel Anticancer Drugs Over Time. J Oncol Pract 2018; 14:e280-e294. [PMID: 29601250 DOI: 10.1200/jop.17.00058] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The purpose of this study was to determine if clinical benefits of novel anticancer drugs, measured by the ASCO Value Framework and European Society of Medical Oncology (ESMO) Magnitude of Clinical Benefit Scale, have increased over time in parallel with increasing costs. METHODS Anticancer drugs from phase III randomized controlled trials cited for clinical efficacy evidence in drug approvals between January 2006 to December 2015 were identified and scored using both frameworks. For each drug, the monthly price and incremental anticancer drug costs were calculated. Relationships between cost and year of approval were examined using generalized linear regressions models. Ordinary least square models were used to evaluate relationships between ASCO and ESMO scores and year of approval. Spearman correlation coefficients between costs and clinical benefit scores were calculated. RESULTS In total, 42 randomized controlled trials were included. Both monthly prices and incremental anticancer drug costs were significantly associated with year of approval and showed an average annual increase of 9% and 21%, respectively. The predicted mean incremental anticancer drug cost increased from $30,447 in 2006 to $161,141 in 2015 (greater than five-fold increase). Both ASCO and ESMO scores were not statistically associated with year of approval or correlated with monthly prices or incremental anticancer drug costs. CONCLUSION Over the past decade, costs of novel oncology drugs have increased, while clinical benefits of these medications have not experienced a proportional positive change. The incremental anticancer drug costs have increased at a much greater rate than monthly prices, indicating that the increase in anticancer drug costs may be higher than commonly reported.
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Munster PN, Park J, Desai P, Garcia E, Cheng S, Greier S, Pawlowska N, Chaudhuri AR, Thomas S. Abstract P5-14-04: A novel implant to deliver localized hormonal therapy to prevent and treat breast cancer. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p5-14-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Most cancer treatment and prevention strategies include removal of the respective organ or systemic therapy. Early interception and cancer prevention is fraught with uncertainties in individual risk assessment and the absence of early surrogate markers to monitor efficacy. Hence, cancer prevention studies typically require large patient numbers. They are performed in unselected populations without clearly defined risk and benefits are often small or diluted. Hence, even successful strategies with documented benefit such as tamoxifen, have found only poor uptake in the at-risk population. Many women and providers are deterred by the low benefits to risk ratio of systemic tamoxifen exposure. The opportunity to selectively treat with an effective agent would limit the need for surgery and circumvent systemic exposure.
We propose a less toxic and less debilitating approach to prevent and treat early stage breast cancer by utilizing the slow release of anti-estrogens from silastic tubing as a local drug delivery device to the breast. Our in vitro and in vivo data demonstrate consistent release of active fulvestrant through at least 52 weeks. Extrapolating from the amount of residual drug left in the tubing after 52 weeks suggests that drug release could be maintained sufficiently to and beyond 5 years. Silastic tubing released fulvestrant at clinically relevant concentrations and associated with inhibition of ER signaling and cell proliferation in vitro. In vivo anti-tumor activity was comparable to systemic administration of the anti-estrogen. The silastic tubing preferentially delivered the anti-estrogen to mammary tissue with minimal accumulation in major organs and 20-fold lower concentrations in adjacent (abdominal) and distant fat (thoracic) pads. Consistent with fulvestrant penetrance through tumors, local delivery was more effective in reducing Ki-67 immediately adjacent to the tubing but maintained concentrations comparable to systemic therapy throughout the entire tumors. We further demonstrated that human fat cells readily take up fulvestrant and then transfer the drug to breast cancer cells. These findings support the use of local drug delivery through the human breast tissue and surrounding fatty tissue. Mammary tissues are rapidly cleared of fulvestrant upon removal of the drug-loaded tubing. This would allow the long term implantation of a drug delivery device designed to be emptied or refilled.
Local drug delivery is ideally suited in a setting of local disease or recurrence with minimal risk for systemic metastases with the goal of producing high concentrations without systemic application of the drug. Our data support the concept of a local silastic tubing device as a means to locally deliver an anti-estrogen in three major applications: early interventions for localized tumors, such as ductal carcinoma in situ (DCIS) or early stage breast cancer with low metastatic potential, prevention of breast cancer in women at higher risk due genetic predisposition, or used in concert with systemic therapy to provide a localized therapeutic boost. Overall, the use of implantable silastic tubing for local drug delivery represents a promising approach and introduces a potential paradigm shift in prevention and treatment of breast cancer.
Citation Format: Munster PN, Park J, Desai P, Garcia E, Cheng S, Greier S, Pawlowska N, Chaudhuri AR, Thomas S. A novel implant to deliver localized hormonal therapy to prevent and treat breast cancer [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P5-14-04.
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Kourmatzis A, Cheng S, Chan HK. Airway geometry, airway flow, and particle measurement methods: implications on pulmonary drug delivery. Expert Opin Drug Deliv 2017; 15:271-282. [DOI: 10.1080/17425247.2018.1406917] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Ng W, Cheng S, Llyod A, Mahroof S. Modelling Alternative Fracture Clinic Pathways to Improve Patient Experience and Outcome. Int J Surg 2017. [DOI: 10.1016/j.ijsu.2017.08.430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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