Management of adverse events from the treatment of encorafenib plus cetuximab for patients with BRAF V600E-mutant metastatic colorectal cancer: insights from the BEACON CRC study

Colorectal cancer is the second leading cause of cancer deaths worldwide, with a 5-year relative survival of 14% in patients with metastatic colorectal cancer (mCRC). Patients with BRAF V600E mutations, which occur in ∼10%-15% of patients with mCRC, have a poorer prognosis compared with those with wild-type BRAF tumours. The combination of the BRAF inhibitor encorafenib with the epidermal growth factor receptor inhibitor cetuximab currently represents the only chemotherapy-free targeted therapy approved in the USA and Europe for previously treated patients with BRAF V600E-mutated mCRC. As a class, BRAF inhibitors are associated with dermatologic, gastrointestinal, and renal events, as well as pyrexia and secondary skin malignancies. Adverse event (AE) profiles of specific BRAF inhibitors vary, however, and are affected by the specific agents given in combination. In patients with mCRC, commonly reported AEs of cetuximab monotherapy include infusion reactions and dermatologic toxicities. Data from the phase III BEACON CRC study indicate that the combination of encorafenib with cetuximab has a distinct safety profile. Here we review the most frequently reported AEs that occurred with this combination in BEACON CRC and best practices for managing and mitigating AEs that require more than standard supportive care.

Restricted dispersal in a sea of gene flow

How far do marine larvae disperse in the ocean? Decades of population genetic studies have revealed generally low levels of genetic structure at large spatial scales (hundreds of kilometres). Yet this result, typically based on discrete sampling designs, does not necessarily imply extensive dispersal. Here, we adopt a continuous sampling strategy along 950 km of coast in the northwestern Mediterranean Sea to address this question in four species. In line with expectations, we observe weak genetic structure at a large spatial scale. Nevertheless, our continuous sampling strategy uncovers a pattern of isolation by distance at small spatial scales (few tens of kilometres) in two species. Individual-based simulations indicate that this signal is an expected signature of restricted dispersal. At the other extreme of the connectivity spectrum, two pairs of individuals that are closely related genetically were found more than 290 km apart, indicating long-distance dispersal. Such a combination of restricted dispersal with rare long-distance dispersal events is supported by a high-resolution biophysical model of larval dispersal in the study area, and we posit that it may be common in marine species. Our results bridge population genetic studies with direct dispersal studies and have implications for the design of marine reserve networks.

Improving oral hygiene for the seriously ill patient: implementing research-based practice

A research-based policy and procedure to improve the oral hygiene care of intubated and other seriously ill patients was developed, implemented, and evaluated. The project resulted in (a) improved oral hygiene for patients, (b) standardization and simplification of nursing practice, and (c) a reduction in supply costs. The project has implications for nursing practice and evidence-based practice protocol development.

Characteristics related to poor glycemic control in NIDDM patients in community practice

OBJECTIVE

To identify clinical characteristics related to poor glycemic control in patients with NIDDM cared for by Michigan primary care physicians.

RESEARCH DESIGN AND METHODS

This study was a cross-sectional secondary analysis of data from 393 NIDDM patients (mean age, 63 +/- 11 years; 54% female; 92% white) in the 1990-1991 Michigan Diabetes in Communities II Study. We evaluated patient demographic, clinical, and physiological characteristics, attitudes toward diabetes, and self-care ability. Logistic regression was used for multivariate evaluation of the characteristics of those patients whose glycosylated hemoglobin (normal GHb 4-8%) was in the upper 25% of the study sample (GHb > 11.6%).

RESULTS

A high meal-stimulated plasma C-peptide was associated with a lower likelihood of poor control (odds ratio [OR] for highest quartile vs. all others = 0.37; 95% CI 0.23-0.58). Longer time since diagnosis (OR for each 5 years duration = 1.28; 95% CI 1.07-1.53), poor self-care ability (OR = 1.85; 95% CI 1.27-2.71), and perceived absence of dietary recommendations (OR = 2.37; 95% CI 1.11-5.08) were also independently associated with presence in the highest GHb quartile. Characteristics that were not significantly related to poor glycemic control included sex, age, obesity, educational level, exercise, self-rated health status, and pharmacological treatment.

CONCLUSIONS

1) Poor glycemic control may reflect progressive failure of islet function, although the independent relationships of C-peptide level and time since diagnosis are consistent with concepts of heterogeneous mechanisms underlying NIDDM. 2) Despite the important relationships of biological characteristics of NIDDM to glycemic control, patient attitudes and self-care ability may be useful targets for designing management strategies for certain poorly controlled patients.

Estimating cancer screening indicators in the primary care setting

The software "Profile: A Cancer Risk Profile of Your Patient Practice" was used to estimate cancer screening activities in a primary care practice. "Profile" is a public health tool that does not track the screening histories of individual patients, but rather, using a sampling strategy, provides estimates for the entire practice of the age and sex specific number of screening eligible patients, the number screened, and the number that should have been screened, based on National Cancer Institute/American Cancer Society (NCI/A CS) guidelines. This report describes "Profile," and the results it generated from a sample of medical records. Primary care providers who seek to integrate primary and secondary cancer prevention activities into their routine practices will find it useful to have an objective estimate of their current level of such activities.