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Jahromi H, Reynolds A, Stoehr J, Whitney N, Ettner R. IMPROVING ACCESS TO CARE AND CONSENT FOR TRANSGENDER AND GENDER DIVERSE YOUTH IN THE UNITED STATES. Georgian Med News 2024:102-103. [PMID: 38501629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
Gender-affirming care (GAC) aims to benefit transgender and gender diverse (TGD) youth. GAC includes access to mental health, medical care, and surgical interventions. However, access to GAC and the youth's ability to consent to GAC is frequently contested. This editorial reviews access to care for TGD youth and discusses perspectives on youth consent for GAC. Pertinent challenges include the ability to provide informed consent within current medical and legal frameworks, mental health and parental concerns, and the long-term effects of GAC. Further research, advocacy, and patient education are warranted to ensure safe access to GAC for TGD youth.
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Affiliation(s)
- H Jahromi
- 1Department of Plastic and Reconstructive Surgery, Temple University Medical Center, Philadelphia, Pennsylvania, United States
| | - A Reynolds
- 2University of Chicago Medicine, Chicago, Illinois, United States
| | - J Stoehr
- 3Department of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
| | - N Whitney
- 4Rush Medical College, Rush University Medical Center, Chicago, Illinois, United States
| | - R Ettner
- 5New Health Foundation Worldwide, Evanston, Illinois, United States
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Van Cutsem E, Yoshino T, Lenz HJ, Lonardi S, Falcone A, Limón ML, Saunders M, Sobrero A, Park YS, Ferreiro R, Hong YS, Tomasek J, Taniguchi H, Ciardiello F, Stoehr J, Oum'Hamed Z, Vlassak S, Studeny M, Argiles G. Nintedanib for the treatment of patients with refractory metastatic colorectal cancer (LUME-Colon 1): a phase III, international, randomized, placebo-controlled study. Ann Oncol 2019; 29:1955-1963. [PMID: 30010751 PMCID: PMC6158765 DOI: 10.1093/annonc/mdy241] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background Angiogenesis is critical to colorectal cancer (CRC) growth and metastasis. Phase I/II studies have demonstrated the efficacy of nintedanib, a triple angiokinase inhibitor, in patients with metastatic CRC. This global, randomized, phase III study investigated the efficacy and safety of nintedanib in patients with refractory CRC after failure of standard therapies. Patients and methods Eligible patients (Eastern Cooperative Oncology Group performance status 0–1, with histologically/cytologically confirmed metastatic/locally advanced CRC adenocarcinoma unamenable to surgery and/or radiotherapy) were randomized 1 : 1 to receive nintedanib (200 mg twice daily) or placebo (twice daily), until disease progression or undue toxicity. Patients were stratified by previous regorafenib, time from onset of metastatic disease to randomization, and region. Co-primary end points were overall survival (OS) and progression-free survival (PFS) by central review. Secondary end points included objective tumor response and disease control by central review. Results From October 2014 to January 2016, 768 patients were randomized; 765 were treated (nintedanib n = 384; placebo n = 381). Median follow-up was 13.4 months (interquartile range 11.1–15.7). OS was not improved [median OS 6.4 months with nintedanib versus 6.0 months with placebo; hazard ratio (HR), 1.01; 95% confidence interval (CI), 0.86–1.19; P = 0.8659]. There was a significant but modest increase in PFS with nintedanib versus placebo (median PFS 1.5 versus 1.4 months, respectively; HR 0.58; 95% CI 0.49–0.69; P < 0.0001). There were no complete or partial responses. Adverse events (AEs) occurred in 97% of 384 nintedanib-treated patients and 93% of 381 placebo-treated patients. The most frequent grade ≥3 AEs were liver-related AEs (nintedanib 16%; placebo 8%) and fatigue (nintedanib 9%; placebo 6%). Conclusions The study failed to meet both co-primary end points. Nintedanib did not improve OS and was associated with a significant but modest increase in PFS versus placebo. Nintedanib was well tolerated. ClinicalTrials.gov number NCT02149108 (LUME-Colon 1).
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Affiliation(s)
- E Van Cutsem
- Division of Digestive Oncology, University Hospitals Gasthuisberg Leuven and KU Leuven, Leuven, Belgium.
| | - T Yoshino
- Department of Gastrointestinal Oncology, National Cancer Center Hospital East, Chiba, Japan
| | - H J Lenz
- Division of Medical Oncology, Norris Comprehensive Cancer Center, Los Angeles, USA
| | - S Lonardi
- Medical Oncology Unit 1, Department of Clinical and Experimental Oncology, Istituto Oncologico Veneto - IRCCS, Padua
| | - A Falcone
- Department of Translational Research on New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - M L Limón
- Department of Medical Oncology, Hospital Universitario Virgen del Rocio, Seville, Spain
| | - M Saunders
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - A Sobrero
- Department of Medical Oncology, Azienda Ospedaliera San Martino, Genoa, Italy
| | - Y S Park
- Department of Hematology and Oncology, Samsung Medical Center, Seoul, South Korea
| | - R Ferreiro
- Department of Clinical Oncology, Ramón y Cajal Hospital, Madrid, Spain
| | - Y S Hong
- Department of Oncology, Asan Medical Center, Seoul, South Korea
| | - J Tomasek
- Department of Complex Oncology Care, Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - H Taniguchi
- Department of Clinical Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - F Ciardiello
- Oncologia Medica, Seconda Università deli Studi di Napoli, Naples, Italy
| | - J Stoehr
- Boehringer Ingelheim, Pharma GmbH & Co. KG, Biberach, Germany
| | - Z Oum'Hamed
- Boehringer Ingelheim France S.A.S, Reims, France
| | - S Vlassak
- SCS Boehringer Ingelheim Comm.V, Brussels, Belgium
| | - M Studeny
- Division of Medicine/Clinical Development Department, Boehringer Ingelheim, Vienna, Austria
| | - G Argiles
- Medical Oncology Department, Vall d'Hebron University Hospital and Institute of Oncology (VHIO), Universitat Autònoma de Barcelona, CIBERONC, Barcelona, Spain
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