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Pini F, Grigoriu B, Lieveke A, Meert AP. Management and outcome of oncological patients under immune checkpoint inhibitors presenting at the emergency department. Emerg Med J 2024:emermed-2023-213605. [PMID: 38688713 DOI: 10.1136/emermed-2023-213605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 04/16/2024] [Indexed: 05/02/2024]
Abstract
INTRODUCTION With the rising use of immune checkpoint inhibitors (ICIs) in oncology, emergency physicians are increasingly confronted with their immune-related adverse events (irAEs). We described the types of irAEs presenting to the ED of a Belgian cancer centre and determined associations with the development of an irAE and other patient's characteristics. Secondary objectives describe the therapeutic management and determine 7 and 30-day mortality. METHODS A retrospective chart review of ED visits of patients on ICI from 15 December 2016 to 6 December 2020 was performed. Clinical presentation, cancer characteristics and type of ICI were extracted by a single abstractor. We recorded any suspicion of irAE in the ED and confirmation of an irAE was based on the patient's oncologist report. Outcome was based on mortality at date of last follow-up. RESULTS 227 patients on ICI presented to the ED, with a total of 451 visits. 54 (12%) of the visits resulted in a diagnosis of irAE. Four clinical features were associated with an irAE: gastrointestinal complaints (p=0.01), skin rashes (p=0.02), acute renal failure (p=0.002) and abnormal liver function (p=0.04). An irAE was also associated with three different factors: a cancer status in remission (OR=5.33, 95% CI 2.57 to 11.04), a combination of two ICIs (OR=4.43, 95% CI 2.09 to 9.42) and a medical history of irAE (OR=2.44, 95% CI 1.27 to 4.68). 30-day mortality was lower in the irAE group (0%) than in the non-irAE group (13%, 95% CI 9% to 19%). CONCLUSIONS Oncological patients under ICI presenting in the ED are more likely to have an irAE if they present with gastrointestinal and dermatological complaints, acute renal failure and abnormal liver function. This is also true for patients with any history of irAE, a concomitant use of two ICIs and with a cancer status in remission.
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Pacot L, Masliah-Planchon J, Petcu A, Terris B, Gauthier Villars M, Lespinasse J, Wolkenstein P, Vincent-Salomon A, Vidaud D, Pasmant E. Breast cancer risk in NF1-deleted patients. J Med Genet 2024; 61:428-429. [PMID: 38154814 DOI: 10.1136/jmg-2023-109682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 12/05/2023] [Indexed: 12/30/2023]
Affiliation(s)
- Laurence Pacot
- Institut Cochin, Inserm U1016, CNRS UMR8104, Université Paris Cité, CARPEM, Paris, France
- Department of genetics, Fédération de Génétique et Médecine Génomique, Hôpital Cochin, DMU BioPhyGen, AP-HP.Centre-Université Paris Cité, Paris, France
| | | | - Adina Petcu
- Department of Pathology, Centre Hospitalier Métropole Savoie, Chambery, France
| | - Benoit Terris
- Department of Pathology, Hôpital Cochin, Assistance Publique-Hopitaux de Paris, Paris, France
| | | | - James Lespinasse
- Unité de Génétique médicale, Centre Hospitalier Métropole Savoie, Chambéry, France
| | - Pierre Wolkenstein
- Department of Dermatology, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France
- Centre d'Investigation Clinique 1430, INSERM, Hôpital Henri-Mondor, Assistance Publique-Hôpitaux de Paris, Referral Center of Neurofibromatosis, Créteil, France
| | - Anne Vincent-Salomon
- Department of Pathology, Curie Institute Hospital Group, Paris, Île-de-France, France
| | - Dominique Vidaud
- Institut Cochin, Inserm U1016, CNRS UMR8104, Université Paris Cité, CARPEM, Paris, France
- Department of genetics, Fédération de Génétique et Médecine Génomique, Hôpital Cochin, DMU BioPhyGen, AP-HP.Centre-Université Paris Cité, Paris, France
| | - Eric Pasmant
- Institut Cochin, Inserm U1016, CNRS UMR8104, Université Paris Cité, CARPEM, Paris, France
- Department of genetics, Fédération de Génétique et Médecine Génomique, Hôpital Cochin, DMU BioPhyGen, AP-HP.Centre-Université Paris Cité, Paris, France
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Grewal A, Bansal B, Mittal C, Gupta H, Sasi A, Ganesan P, Dabas A, Sahi P, Ramamoorthy L, Lalthanthuami HT, Ramamoorthy J, Sindhu A, Arora S, Bhukya A, Hepzibah M, Devi K, Krishnamurthy K, Rai SK, Mehta N, Antil K, Bakhshi S, Ganguly S. Knowledge and attitude on childhood cancer survivorship among healthcare trainees: a multicentre study from India. Fam Med Community Health 2024; 12:e002618. [PMID: 38575353 PMCID: PMC11002353 DOI: 10.1136/fmch-2023-002618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND The proportion of childhood cancer survivors (CCS) in low/middle-income countries (LMICs) is rising. CCS often develop several physical and psycho-social long-term adverse effects, with unique healthcare needs. Primary healthcare providers (primary care physicians (PCPs)), especially in LMICs, are often not equipped to handle survivorship care. This study aimed to assess knowledge, and attitude among trainee healthcare providers concerning major issues of paediatric survivorship care. METHODS A multi-centre, cross-sectional, questionnaire-based study was conducted among nursing and medical undergraduate students, and postgraduate medical residents across three tertiary-care teaching hospitals in India-All India Institute of Medical Sciences, New Delhi; Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry; and Maulana Azad Medical College, New Delhi. A questionnaire with total of 24 questions (14 knowledge-based and 10 attitude-based) was finalised after validation by expert review and piloting. The major domains covered in the questionnaire included knowledge and attitude regarding long-term adverse effects and psychosocial, employment-related issues faced by the survivors. It was administered to the study participants electronically. The knowledge-based questions had true/false responses (scored as 0 or 1 if incorrect or correct, respectively). Attitude-based questions were scored as 5-point Likert scale. RESULTS Total 898 responses were collected (median age: 21 years, 64% (576/898) female). Among the respondents, 44% were undergraduate medical students, 42% were nursing students and 14% were postgraduate medical residents. The mean (SD) of knowledge score was 8.72 (2.04) (out of 14). On multivariable analysis, only discipline of training predicted knowledge scores regarding survivorship care. Postgraduate medical residents (9.08) as well as undergraduate medical students (8.85), had significantly higher mean knowledge scores than nursing students (8.47) (p=0.004).Two questions were answered incorrectly by the majority; children and siblings of CCS need additional genetic screening (79% incorrectly answered true), and CCS face intimacy issues in relation to normal sexual functioning (59% incorrectly answered false).Nearly half (48%) of respondents believed that their knowledge of cancer survivorship issues was inadequate. Majority of respondents (84%) suggested that oncologists should handle long-term survivorship care rather than PCPs. CONCLUSION Trainee healthcare providers in India reported inadequate knowledge regarding survivorship care. Improving awareness by incorporating survivorship in teaching curriculum is imperative to equip future PCPs to provide survivorship care across the country.
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Affiliation(s)
- Amritesh Grewal
- Medical Student, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Bhavik Bansal
- Medical Student, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Chetanya Mittal
- Medical Student, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Hardik Gupta
- Medical Student, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Archana Sasi
- Department of Medical Oncology, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Prasanth Ganesan
- Department of Medical Oncology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, Puducherry, India
| | - Aashima Dabas
- Department of Pediatrics, Lok Nayak Hospital, New Delhi, Delhi, India
- Department of Pediatrics, Maulana Azad Medical College, New Delhi, Delhi, India
| | - Puneet Sahi
- Department of Pediatrics, Lok Nayak Hospital, New Delhi, Delhi, India
- Department of Pediatrics, Maulana Azad Medical College, New Delhi, Delhi, India
| | - Lakshmi Ramamoorthy
- College of Nursing, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, Puducherry, India
| | - Hmar Thiak Lalthanthuami
- College of Nursing, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, Puducherry, India
| | - Jaikumar Ramamoorthy
- Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, Puducherry, India
| | - Arwachi Sindhu
- Medical Student, Maulana Azad Medical College, New Delhi, Delhi, India
| | - Suyash Arora
- Medical Student, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Anumeha Bhukya
- Medical Student, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Muthumani Hepzibah
- College of Nursing, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, Puducherry, India
| | - Kanchana Devi
- Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, Puducherry, India
| | - Karthick Krishnamurthy
- College of Nursing, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, Puducherry, India
| | - Sanjeet K Rai
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Nikhil Mehta
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Komal Antil
- College of Nursing, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Sameer Bakhshi
- Department of Medical Oncology, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Shuvadeep Ganguly
- Department of Medical Oncology, Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, Delhi, India
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Joyce CM, Wakefield C, Chen-Maxwell D, Dineen S, Kenneally C, Downey P, Duffy C, O'Donoghue K, Coulter J, Fitzgerald B. Appraisal of hydatidiform mole incidence and registration rates in Ireland following the establishment of a National Gestational Trophoblastic Disease Registry. J Clin Pathol 2024:jcp-2023-209270. [PMID: 38555103 DOI: 10.1136/jcp-2023-209270] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 01/12/2024] [Indexed: 04/02/2024]
Abstract
AIMS This study aimed to re-evaluate the incidence of hydatidiform mole (HM) and determine gestational trophoblastic disease (GTD) registration rates in Ireland following the establishment of the National GTD Registry in 2017. METHODS We performed a 3-year retrospective audit of HM cases (January 2017 to December 2019) reported in our centre. In 2019, we surveyed Irish pathology laboratories to determine the number of HMs diagnosed nationally and compared this data to that recorded in the National GTD Registry. Additionally, we compared both local and national HM incidence rates to those reported internationally. RESULTS In the 3-year local audit, we identified 87 HMs among 1856 products of conception (POCs) providing a local HM incidence rate of 3.92 per 1000 births. The 1-year pathology survey recorded 170 HMs in 6008 POCs, yielding a national incidence rate of 2.86 per 1000 births. Importantly, the local HM incidence rate exceeded the national incidence rate by 37% and the local partial HM incidence (1 in 296 births) was 64% higher than the nationally incidence rate (1 in 484 births). Notably, 42% of the HM and atypical POCs diagnosed nationally were not reported to the National GTD Registry. CONCLUSIONS Our study reveals increased HM incidence rates both locally and nationally compared with previous Irish studies. The higher local PHM incidence may reflect more limited access to ploidy analysis in other pathology laboratories nationally. Significantly, almost half of the women with diagnosed or suspected HM were not registered with the National GTD Centre.
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Affiliation(s)
- Caroline M Joyce
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland
- Department of Biochemistry and Cell Biology, University College Cork, Cork, Ireland
- INFANT Research Centre, University College Cork, Cork, Ireland
| | - Craig Wakefield
- Department of Pathology, Cork University Hospital, Cork, Ireland
| | | | - Susan Dineen
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland
- Department of Pathology, Cork University Hospital, Cork, Ireland
| | - Caitriona Kenneally
- Department of Obstetrics and Gynaecology, Cork University Maternity Hospital, Cork, Ireland
| | - Paul Downey
- Department of Pathology, National Maternity Hospital, Dublin, Ireland
| | | | - Keelin O'Donoghue
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland
- INFANT Research Centre, University College Cork, Cork, Ireland
- Department of Obstetrics and Gynaecology, Cork University Maternity Hospital, Cork, Ireland
| | - John Coulter
- Department of Obstetrics and Gynaecology, Cork University Maternity Hospital, Cork, Ireland
| | - Brendan Fitzgerald
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland
- Department of Pathology, Cork University Hospital, Cork, Ireland
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Davies E. Informed by research, transformed by research. BMJ Evid Based Med 2024; 29:62-63. [PMID: 37857459 PMCID: PMC10850663 DOI: 10.1136/bmjebm-2023-112646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/02/2023] [Indexed: 10/21/2023]
Affiliation(s)
- Elspeth Davies
- Social Anthropology, University of Cambridge, Cambridge, UK
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Jin S, Shen Z, Li J, Liu X, Zhu Q, Li F, Shi Y, Lin P, Xu X, Chen X, Geng X, Ding X, Liu H. Clinicopathological features of kidney injury in patients receiving immune checkpoint inhibitors (ICPi) combined with anti-vascular endothelial growth factor (anti-VEGF) therapy. J Clin Pathol 2024:jcp-2023-209173. [PMID: 38242556 DOI: 10.1136/jcp-2023-209173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 12/20/2023] [Indexed: 01/21/2024]
Abstract
BACKGROUND Immune checkpoint inhibitor (ICPi) combined with anti-vascular endothelial growth factor (VEGF) therapy has increasingly become a promising strategy in various malignancies. However, the combination might be associated with increased risk of nephrotoxicity. METHODS We retrospectively recruited patients who suffered kidney injury and received renal biopsy after anti-VEGF/ICPi mono- or combination therapy and divided them into three groups: anti-VEGF monotherapy, ICPi monotherapy and combination therapy. Clinical and histopathological features of three groups were analysed. All patients were followed-up for 3 months after biopsy, with or without glucocorticoid treatment, and renal outcome were compared. RESULTS A total of 46 patients were enrolled. Eighteen patients received anti-VEGF monotherapy, 12 received ICPi monotherapy and 16 received combined treatment of anti-VEGF and ICPi. Proteinuria level of anti-VEGF group, ICPi group and combination group were 4.07±3.17 g/day, 0.60±0.61 g/day and 2.05±2.50 g/day, respectively (p=0.002). The peak serum creatinine level of combination group (1.75±0.77 mg/dL) was also in between ICPi group (2.79±0.90 mg/dL) and anti-VEGF group (1.34±0.60 mg/dL) (p<0.001). Multiple histopathological patterns involving glomerulus, tubulointerstitium and vessel existed in the majority of cases in combination group (68.8%). Renal complete and partial recovery rate of combination therapy were also in between monotherapy (57.1% vs 40.0% in anti-VEGF group, 100.0% in ICPi group, respectively). CONCLUSIONS Kidney injury in patients treated with combination therapy of ICPi and anti-VEGF shows hybrid pathological patterns and intermediate clinical features compared with monotherapy. Cohorts with larger sample and better design, as well as basic research, are needed to elucidate the mechanism of 'protection' effect of combination anti-cancer therapy to renal function.
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Affiliation(s)
- Shi Jin
- Department of Nephrology, Zhongshan Hospital Fudan University, Shanghai, Shanghai, China
| | - Ziyan Shen
- Department of Nephrology, Zhongshan Hospital Fudan University, Shanghai, Shanghai, China
| | - Jie Li
- Department of Nephrology, Zhongshan Hospital Fudan University, Shanghai, Shanghai, China
| | - Xueguang Liu
- Department of Pathology, Fudan University School of Basic Medical Sciences, Shanghai, Shanghai, China
| | - Qifan Zhu
- Department of Nephrology, Zhongshan Hospital Fudan University, Shanghai, Shanghai, China
| | - Fang Li
- Department of Nephrology, Zhongshan Hospital Fudan University, Shanghai, Shanghai, China
| | - Yiqin Shi
- Department of Nephrology, Zhongshan Hospital Fudan University, Shanghai, Shanghai, China
| | - Pan Lin
- Department of Nephrology, Zhongshan Hospital Fudan University, Shanghai, Shanghai, China
| | - Xialian Xu
- Department of Nephrology, Zhongshan Hospital Fudan University, Shanghai, Shanghai, China
| | - Xiaohong Chen
- Department of Nephrology, Zhongshan Hospital Fudan University, Shanghai, Shanghai, China
| | - Xuemei Geng
- Department of Nephrology, Zhongshan Hospital Fudan University, Shanghai, Shanghai, China
| | - Xiaoqiang Ding
- Department of Nephrology, Zhongshan Hospital Fudan University, Shanghai, Shanghai, China
| | - Hong Liu
- Department of Nephrology, Zhongshan Hospital Fudan University, Shanghai, Shanghai, China
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Gosney JR, Peake MD, Kerr KM. Improving practice in PD-L1 testing of non-small cell lung cancer in the UK: current problems and potential solutions. J Clin Pathol 2024; 77:135-139. [PMID: 36604178 PMCID: PMC10850646 DOI: 10.1136/jcp-2022-208643] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 12/20/2022] [Indexed: 01/07/2023]
Abstract
AIMS Programmed cell death ligand 1 (PD-L1) expression, used universally to predict response of non-small cell lung cancer (NSCLC) to immune-modulating drugs, is a fragile biomarker due to biological heterogeneity and challenges in interpretation. The aim of this study was to assess current PD-L1 testing practices in the UK, which may help to define strategies to improve its reliability and consistency. METHODS A questionnaire covering NSCLC PD-L1 testing practice was devised and members of the Association of Pulmonary Pathologists were invited to complete this online. RESULTS Of 44 pathologists identified as involved in PD-L1 testing, 32 (73%) responded. There was good consistency in practice and approach, but there was wide variability in the distribution of PD-L1 scoring. Although the proportions of scores falling into the three groups (negative, low and high) defined by the 1% and 50% 'cut-offs' (38%, 33% and 27%, respectively) reflect the general experience, the range within each group was wide at 23-70%, 10-60% and 15-36%, respectively. CONCLUSIONS There is inconsistency in the crucial endpoint of PD-L1 testing of NSCLC, the expression score that guides management. Addressing this requires formal networking of individuals and laboratories to devise a strategy for its reduction.
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Affiliation(s)
- John R Gosney
- Cellular Pathology, Royal Liverpool and Broadgreen Hospitals NHS Trust, Liverpool, UK
| | - Michael D Peake
- Center for Cancer Outcomes, North Central and North East London Cancer Alliances, UCLH, London, UK
- Groby Road Hospital, University of Leicester, Leicester, UK
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Ali RH, Almanabri M, Ali NY, Alsaber AR, Khalifa NM, Hussein R, Alateeqi M, Mohammed EMA, Jama H, Almarzooq A, Benobaid N, Alqallaf Z, Ahmed AA, Bahzad S, Almurshed M. Clinicopathological analysis of BRAF and non-BRAF MAPK pathway-altered gliomas in paediatric and adult patients: a single-institution study of 40 patients. J Clin Pathol 2024:jcp-2023-209318. [PMID: 38195220 DOI: 10.1136/jcp-2023-209318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 12/28/2023] [Indexed: 01/11/2024]
Abstract
AIMS Mitogen-activated protein kinase (MAPK) pathway alteration is a major oncogenic driver in paediatric low-grade gliomas (LGG) and some adult gliomas, encompassing BRAF (most common) and non-BRAF alterations. The aim was to determine the frequency, molecular spectrum and clinicopathological features of MAPK-altered gliomas in paediatric and adult patients at our neuropathology site in Kuwait. METHODS We retrospectively searched the data of molecularly sequenced gliomas between 2018 and 2023 for MAPK alterations, revised the pathology in view of the 2021 WHO classification and evaluated the clinicopathological data for possible correlations. RESULTS Of 272 gliomas, 40 (15%) harboured a MAPK pathway alteration in 19 paediatric (median 9.6 years; 1.2-17.6) and 21 adult patients (median 37 years; 18.9-89.2), comprising 42% and 9% of paediatric and adult cases, respectively. Pilocytic astrocytoma and glioblastoma were the most frequent diagnoses in children (47%) and adults (43%), respectively. BRAF V600E (n=17, 43%) showed a wide distribution across age groups, locations and pathological diagnoses while KIAA1549::BRAF fusion (n=8, 20%) was spatially and histologically restricted to cerebellar paediatric LGGs. Non-V600E variants and BRAF amplifications accompanied other molecular aberrations in high-grade tumours. Non-BRAF MAPK alterations (n=8) included mutations and gene fusions involving FGFR1, NTRK2, NF1, ROS1 and MYB. Fusions included KANK1::NTRK2, GOPC::ROS1 (both infant hemispheric gliomas), FGFR1::TACC1 (diffuse LGG), MYB::QKI (angiocentric glioma) and BCR::NTRK2 (glioblastoma). Paradoxical H3 K27M/MAPK co-mutations were observed in two LGGs. CONCLUSION The study provided insights into MAPK-altered gliomas in Kuwait highlighting the differences among paediatric and adult patients and providing a framework for planning therapeutic polices.
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Affiliation(s)
- Rola H Ali
- Department of Pathology, College of Medicine, Kuwait University, Jabriya, Hawalli, Kuwait
- Department of Histopathology, Al Sabah Hospital, Shuwaikh, Al Asimah, Kuwait
| | - Mohamad Almanabri
- Department of Neurosurgery, Ibn Sina Hospital, Shuwaikh, Al Asimah, Kuwait
| | - Nawal Y Ali
- Department of Radiology, Ibn Sina Hospital, Shuwaikh, Al Asimah, Kuwait
| | - Ahmad R Alsaber
- Department of Management, College of Business and Economics, American University of Kuwait, Salmiya, Hawalli, Kuwait
| | - Nisreen M Khalifa
- Department of Pediatric Hematology/Oncology, NBK Children's Hospital, Shuwaikh, Al Asimah, Kuwait
| | - Rania Hussein
- Department of Radiation Oncology, Kuwait Cancer Control Center, Shuwaikh, Al Asimah, Kuwait
| | - Mona Alateeqi
- Molecular Genetics Laboratory, Kuwait Cancer Control Center, Shuwaikh, Al Asimah, Kuwait
| | - Eiman M A Mohammed
- Molecular Genetics Laboratory, Kuwait Cancer Control Center, Shuwaikh, Al Asimah, Kuwait
| | - Hiba Jama
- Molecular Genetics Laboratory, Kuwait Cancer Control Center, Shuwaikh, Al Asimah, Kuwait
| | - Ammar Almarzooq
- Molecular Genetics Laboratory, Kuwait Cancer Control Center, Shuwaikh, Al Asimah, Kuwait
| | - Noelle Benobaid
- Molecular Genetics Laboratory, Kuwait Cancer Control Center, Shuwaikh, Al Asimah, Kuwait
| | - Zainab Alqallaf
- Molecular Genetics Laboratory, Kuwait Cancer Control Center, Shuwaikh, Al Asimah, Kuwait
| | - Amir A Ahmed
- Molecular Genetics Laboratory, Kuwait Cancer Control Center, Shuwaikh, Al Asimah, Kuwait
| | - Shakir Bahzad
- Molecular Genetics Laboratory, Kuwait Cancer Control Center, Shuwaikh, Al Asimah, Kuwait
| | - Maryam Almurshed
- Department of Histopathology, Al Sabah Hospital, Shuwaikh, Al Asimah, Kuwait
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Mizrahi D, Lai JKL, Wareing H, Ren Y, Li T, Swain CTV, Smith DP, Adams D, Martiniuk A, David M. Effect of exercise interventions on hospital length of stay and admissions during cancer treatment: a systematic review and meta-analysis. Br J Sports Med 2024; 58:97-109. [PMID: 37989539 DOI: 10.1136/bjsports-2023-107372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2023] [Indexed: 11/23/2023]
Abstract
OBJECTIVE To assess the effect of participating in an exercise intervention compared with no exercise during cancer treatment on the duration and frequency of hospital admissions. DESIGN Systematic review and meta-analysis. DATA SOURCES MEDLINE, EMBASE, PEDro and Cochrane Central Registry of Randomized Controlled Trials. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Randomised studies published until August 2023 evaluating exercise interventions during chemotherapy, radiotherapy or stem cell transplant regimens, compared with usual care, and which assessed hospital admissions (length of stay and/or frequency of admissions). STUDY APPRAISAL AND SYNTHESIS Study quality was assessed using the Cochrane Risk-of-Bias tool and Grading of Recommendations Assessment, Development and Evaluation assessment. Meta-analyses were conducted by pooling the data using random-effects models. RESULTS Of 3918 screened abstracts, 20 studies met inclusion criteria, including 2635 participants (1383 intervention and 1252 control). Twelve studies were conducted during haematopoietic stem cell transplantation regimens. There was a small effect size in a pooled analysis that found exercise during treatment reduced hospital length of stay by 1.40 days (95% CI: -2.26 to -0.54 days; low-quality evidence) and lowered the rate of hospital admission by 8% (difference in proportions=-0.08, 95% CI: -0.13 to -0.03, low-quality evidence) compared with usual care. CONCLUSION Exercise during cancer treatment can decrease hospital length of stay and admissions, although a small effect size and high heterogeneity limits the certainty. While exercise is factored into some multidisciplinary care plans, it could be included as standard practice for patients as cancer care pathways evolve.
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Affiliation(s)
- David Mizrahi
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, New South Wales, Australia
- Discipline of Exercise and Sport Science, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Jonathan King Lam Lai
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Medical Sciences Division, The University of Oxford, Oxford, UK
| | - Hayley Wareing
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Yi Ren
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Tong Li
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, New South Wales, Australia
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Christopher T V Swain
- Department of Physiotherapy, University of Melbourne, Melbourne, Victoria, Australia
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - David P Smith
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, New South Wales, Australia
| | - Diana Adams
- Macarthur Cancer Therapy Centre, Campbelltown Hospital, Sydney, New South Wales, Australia
| | - Alexandra Martiniuk
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, New South Wales, Australia
- Office of the Chief Scientist, The George Institute for Global Health, Sydney, New South Wales, Australia
- Dalla Lana School of Public Health, The University of Toronto, Toronto, Ontario, Canada
| | - Michael David
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, New South Wales, Australia
- School of Medicine & Dentistry, Griffith University, Gold Coast, Queensland, Australia
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10
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Ifrah N, Méric JB, Bousquet PJ. [Cancers in France: 10 key messages]. Rev Prat 2024; 74:52. [PMID: 38329253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Affiliation(s)
- Norbert Ifrah
- Institut national du cancer, Boulogne-Billancourt, France
| | | | - Philippe-Jean Bousquet
- Direction de l'observation, des sciences des données et de l'évaluation, Institut national du cancer. Aix-Marseille Université, Inserm, IRD, SESSTIM (Sciences économiques et sociales de la santé Traitement de l'information médicale), ISSPAM, Marseille, France
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11
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Cedillo S, Garí C, Aceituno S, Manso L, Cercos Lleti AC, Ventayol Bosch P, Casado A, Perez Fidalgo A. Cost-effectiveness of olaparib plus bevacizumab versus bevacizumab monotherapy in the maintenance of patients with homologous recombination deficiency-positive advanced ovarian cancer after response to first-line platinum-based chemotherapy. Int J Gynecol Cancer 2023:ijgc-2023-004786. [PMID: 38054270 DOI: 10.1136/ijgc-2023-004786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023] Open
Abstract
OBJECTIVE The PAOLA-1 trial confirmed that adding olaparib to bevacizumab significantly increased clinical benefit following response to platinum-based chemotherapy in homologous recombination deficiency-positive ovarian cancer. The objective of this analysis was to determine the cost-effectiveness of olaparib plus bevacizumab compared with bevacizumab alone as maintenance treatment for patients with homologous recombination deficiency-positive advanced ovarian cancer from the Spanish National Health System perspective. METHODS A lifetime partitioned survival model with four health states (progression-free, post-progression 1, post-progression 2, and death) and monthly cycles was developed. Long-term survival, defined as 60 months, was included as a landmark to extrapolate progression-free survival from PAOLA-1. Weibull distribution was selected as the most accurate survival model for progression-free survival extrapolation. Time to second progression and overall survival were extrapolated using parametric survival models. Mortality was obtained from the overall survival and adjusted by Spanish women mortality rates. Health state utilities and utility decrements for adverse events were included. An expert panel validated data and assumptions. Direct costs (in 2021 euros (€)) were obtained from local sources and included drug acquisition and administration, subsequent therapies, monitoring costs, adverse events, and palliative care. A 3% annual discount rate was applied to costs and outcomes. The incremental cost-effectiveness ratio was calculated as cost per quality-adjusted life-years (QALYs) gained. Deterministic and probabilistic sensitivity analyses were performed. RESULTS Compared with bevacizumab alone, olaparib plus bevacizumab increased QALYs and life-years by 2.39 and 2.77, respectively, at an incremental cost of €58 295.31, resulting in an incremental cost-effectiveness ratio of €24 371/QALY. Probabilistic sensitivity analysis demonstrated that olaparib plus bevacizumab had a 49.5% and 90.3% probability of being cost-effective versus bevacizumab alone at a willingness-to-pay threshold of €25 000 and €60 000 per QALY gained, respectively. CONCLUSION For patients with homologous recombination deficiency-positive advanced ovarian cancer, olaparib plus bevacizumab is a cost-effective maintenance therapy compared with bevacizumab alone in Spain.
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Affiliation(s)
| | - Carla Garí
- Outcomes'10 SLU, Castellon de la Plana, Spain
| | | | - Luis Manso
- Hospital Universitario 12 de Octubre, Madrid, Comunidad de Madrid, Spain
| | | | | | - Antonio Casado
- Hospital Clínico Universitario San Carlos, Madrid, Comunidad de Madrid, Spain
| | - Alejandro Perez Fidalgo
- Medical Oncology, Hospital Clinico Universitario, Valencia, Spain
- Centro de Investigación Biomédica en Red de Cáncer, Madrid, Comunidad de Madrid, Spain
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12
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Hebert R, Cullinan N, Armstrong L, Blood KA, Brossard J, Brunga L, Cacciotti C, Caswell K, Cellot S, Coltin H, Deyell RJ, Felton K, Fernandez CV, Fleming AJ, Gibson P, Hammad R, Jabado N, Johnston DL, Lafay-Cousin L, Larouche V, Leblanc-Desrochers C, Michaeli O, Perrier R, Pike M, Say J, Schiller I, Toupin AK, Vairy S, van Engelen K, Waespe N, Villani A, Foulkes WD, Malkin D, Reichman L, Goudie C. Performance of the eHealth decision support tool, MIPOGG, for recognising children with Li-Fraumeni, DICER1, Constitutional mismatch repair deficiency and Gorlin syndromes. J Med Genet 2023; 60:1218-1223. [PMID: 37460202 DOI: 10.1136/jmg-2023-109376] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 06/26/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Cancer predisposition syndromes (CPSs) are responsible for at least 10% of cancer diagnoses in children and adolescents, most of which are not clinically recognised prior to cancer diagnosis. A variety of clinical screening guidelines are used in healthcare settings to help clinicians detect patients who have a higher likelihood of having a CPS. The McGill Interactive Pediatric OncoGenetic Guidelines (MIPOGG) is an electronic health decision support tool that uses algorithms to help clinicians determine if a child/adolescent diagnosed with cancer should be referred to genetics for a CPS evaluation. METHODS This study assessed MIPOGG's performance in identifying Li-Fraumeni, DICER1, Constitutional mismatch repair deficiency and Gorlin (nevoid basal cell carcinoma) syndromes in a retrospective series of 84 children diagnosed with cancer and one of these four CPSs in Canadian hospitals over an 18-year period. RESULTS MIPOGG detected 82 of 83 (98.8%) evaluable patients with any one of these four genetic conditions and demonstrated an appropriate rationale for suggesting CPS evaluation. When compared with syndrome-specific clinical screening criteria, MIPOGG's ability to correctly identify children with any of the four CPSs was equivalent to, or outperformed, existing clinical criteria respective to each CPS. CONCLUSION This study adds evidence that MIPOGG is an appropriate tool for CPS screening in clinical practice. MIPOGG's strength is that it starts with a specific cancer diagnosis and incorporates criteria relevant for associated CPSs, making MIPOGG a more universally accessible diagnostic adjunct that does not require in-depth knowledge of each CPS.
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Affiliation(s)
- Robyn Hebert
- Department of Human Genetics, McGill University, Montreal, Québec, Canada
- Genetic Counselling Services, Sudbury Regional Hospital, Sudbury, Ontario, Canada
| | - Noelle Cullinan
- Department of Paediatric Haematology-Oncology, Children's Health Ireland, Dublin, Ireland
- Department of Pediatrics, Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Linlea Armstrong
- Medical Genetics, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Katherine A Blood
- Medical Genetics, The University of British Columbia, Vancouver, British Columbia, Canada
- Hereditary Cancer Program, BC Cancer Agency, Vancouver, British Columbia, Canada
| | - Josee Brossard
- Division of Pediatric Hematology-Oncology, Centre intégré universitaire de santé et de services sociaux de l'Estrie Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Ledia Brunga
- Department of Genetics and Genome Biology, University of Toronto, Toronto, Ontario, Canada
| | - Chantel Cacciotti
- Department of Pediatric Hematology-Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Kimberly Caswell
- Department of Genetics and Genome Biology, University of Toronto, Toronto, Ontario, Canada
| | - Sonia Cellot
- Charles-Bruneau Cancer Centre, Pediatric Hematology-Oncology Division, Centre Hospitalier Universitaire Sainte-Justine Centre de Recherche, Montreal, Québec, Canada
| | - Hallie Coltin
- Charles-Bruneau Cancer Centre, Pediatric Hematology-Oncology Division, Centre Hospitalier Universitaire Sainte-Justine Centre de Recherche, Montreal, Québec, Canada
- Division of Hematology/Oncology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Rebecca J Deyell
- Division of Pediatric Hematology/Oncology/BMT, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Kathleen Felton
- Pediatric Hematology/Oncology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Conrad V Fernandez
- Division of Hematology/Oncology, Department of Pediatrics, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Adam J Fleming
- Division of Pediatric Hematology/Oncology, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Paul Gibson
- Division of Pediatric Hematology/Oncology, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Rawan Hammad
- Department of Pediatrics, Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Haematology, King Abdulaziz University, Jeddah, Makkah, Saudi Arabia
| | - Nada Jabado
- Department of Human Genetics, McGill University, Montreal, Québec, Canada
- Division of Hematology-Oncology, Department of Pediatrics, McGill University Health Centre, Montreal, Québec, Canada
| | - Donna L Johnston
- Division of Hematology/Oncology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Lucie Lafay-Cousin
- Section of Pediatric Hematology, Oncology and Bone Marrow Transplantation, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Valérie Larouche
- Department of Pediatrics, Centre mère-enfant Soleil du CHU de Québec-Université Laval, Quebec City, Quebec, Canada
| | - Cassandra Leblanc-Desrochers
- Centre de recherche du CHUS, Centre intégré universitaire de santé et de services sociaux de l'Estrie Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Orli Michaeli
- Department of Pediatrics, Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Hematology/Oncology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Renee Perrier
- Medical Genetics, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Meghan Pike
- Division of Hematology/Oncology, Department of Pediatrics, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Jemma Say
- Paediatric Haematology/Oncology Programme, Bristol Royal Hospital for Children, Bristol, UK
| | - Ian Schiller
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
| | - Annie-Kim Toupin
- Department of Medicine, University Laval, Québec, Québec, Canada
| | - Stéphanie Vairy
- Division of Pediatric Hematology-Oncology, Centre intégré universitaire de santé et de services sociaux de l'Estrie Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
- Charles-Bruneau Cancer Centre, Pediatric Hematology-Oncology Division, Centre Hospitalier Universitaire Sainte-Justine Centre de Recherche, Montreal, Québec, Canada
| | - Kalene van Engelen
- Medical Genetics Program of Southwestern Ontario, London Health Sciences Centre, London, Ontario, Canada
| | - Nicolas Waespe
- Department of Pediatrics, Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Pediatric Oncology and Hematology, University Children's Hospital Bern, University of Bern, Bern, Switzerland
| | - Anita Villani
- Department of Pediatrics, Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - William D Foulkes
- Departments of Human Genetics, Oncology and Medicine, McGill University, Montreal, Quebec, Canada
| | - David Malkin
- Department of Pediatrics, Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Lara Reichman
- Department of Human Genetics, McGill University, Montreal, Québec, Canada
- Department of Child Health and Human Development, Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
| | - Catherine Goudie
- Division of Hematology-Oncology, Department of Pediatrics, McGill University Health Centre, Montreal, Québec, Canada
- Department of Child Health and Human Development, Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
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Koll FJ, Döring C, Herwig L, Hoeh B, Wenzel M, Cano Garcia C, Banek S, Kluth L, Köllermann J, Weigert A, Chun FKH, Wild P, Reis H. Impact of consensus molecular subtypes on survival with and without adjuvant chemotherapy in muscle-invasive urothelial bladder cancer. J Clin Pathol 2023:jcp-2023-208973. [PMID: 37989554 DOI: 10.1136/jcp-2023-208973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 10/30/2023] [Indexed: 11/23/2023]
Abstract
AIMS Adjuvant chemotherapy after radical cystectomy can reduce the risk of recurrence and death in advanced muscle-invasive urothelial bladder cancer (MIBC). Molecular subtypes have been shown to be associated with survival. However, their predictive value to guide treatment decisions is controversial and data to use subtypes as guidance for adjuvant chemotherapy is sparse. We aimed to assess survival rates based on MIBC consensus molecular subtypes with and without adjuvant chemotherapy. METHODS Gene expression profiles of 143 patients with MIBC undergoing radical cystectomy were determined from formalin-fixed, paraffin-embedded specimen to assign consensus molecular subtypes. Expression of programmed cell death ligand-1 (PD-L1) and immune cell infiltration were determined using multiplex immunofluorescence. Matched-pair analysis was performed to evaluate the effect of adjuvant chemotherapy on overall survival (OS) for molecular subtypes applying Kaplan-Meier and Cox regression survival analyses. RESULTS Samples were luminal papillary: 9.1% (n=13), luminal non-specified: 6.3% (n=9), luminal unstable: 4.9% (n=7), stroma-rich: 27.9% (n=40), basal/squamous (Ba/Sq): 48.9% (n=70) and neuroendocrine-like (NE-like): 2.8% (n=4). Ba/Sq tumours had the highest concentration of PD-L1+ tumour and immune cells. Patients with luminal subtypes had better OS than those with NE-like (HR 0.2, 95% CI 0.1 to 0.7, p<0.05) and Ba/Sq (HR 0.5, 95% CI 0.2 to 0.9, p<0.05). No survival benefit with adjuvant chemotherapy was observed for luminal tumours, whereas Ba/Sq had significantly improved survival rates with adjuvant chemotherapy. Retrospective design and sample size are the main limitations. CONCLUSION Consensus molecular subtypes can be used to stratify patients with MIBC. Luminal tumours have the best prognosis and less benefit when receiving adjuvant chemotherapy compared with Ba/Sq tumours.
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Affiliation(s)
- Florestan J Koll
- Department of Urology, Hospital of the Goethe University Frankfurt, Frankfurt am Main, Hessen, Germany
- Frankfurt Cancer Institute (FCI), Hospital of the Goethe University Frankfurt, Frankfurt am Main, Hessen, Germany
- University Cancer Center (UCT) Frankfurt, Hospital of the Goethe University Frankfurt, Frankfurt am Main, Hessen, Germany
| | - Claudia Döring
- Dr. Senckenberg Institute of Pathology, Hospital of the Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Leon Herwig
- Dr. Senckenberg Institute of Pathology, Hospital of the Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Benedikt Hoeh
- Department of Urology, Hospital of the Goethe University Frankfurt, Frankfurt am Main, Hessen, Germany
| | - Mike Wenzel
- Department of Urology, Hospital of the Goethe University Frankfurt, Frankfurt am Main, Hessen, Germany
| | - Cristina Cano Garcia
- Department of Urology, Hospital of the Goethe University Frankfurt, Frankfurt am Main, Hessen, Germany
| | - Severine Banek
- Department of Urology, Hospital of the Goethe University Frankfurt, Frankfurt am Main, Hessen, Germany
| | - Luis Kluth
- Department of Urology, Hospital of the Goethe University Frankfurt, Frankfurt am Main, Hessen, Germany
| | - Jens Köllermann
- Dr. Senckenberg Institute of Pathology, Hospital of the Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Andreas Weigert
- Institute of Biochemistry I, Faculty of Medicine, Goethe University Frankfurt, Frankfurt am Main, Hessen, Germany
| | - Felix K-H Chun
- Department of Urology, Hospital of the Goethe University Frankfurt, Frankfurt am Main, Hessen, Germany
| | - Peter Wild
- Frankfurt Cancer Institute (FCI), Hospital of the Goethe University Frankfurt, Frankfurt am Main, Hessen, Germany
- Dr. Senckenberg Institute of Pathology, Hospital of the Goethe University Frankfurt, Frankfurt am Main, Germany
- Frankfurt Institute for Advanced Studies (FIAS), Frankfurt am Main, Hessen, Germany
| | - Henning Reis
- Dr. Senckenberg Institute of Pathology, Hospital of the Goethe University Frankfurt, Frankfurt am Main, Germany
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Shen W, Jing C, Tian W, Zhang W, Ren Y, Shan B, Wang H. Anlotinib in patients with recurrent platinum resistant/refractory ovarian cancer: a prospective, single arm, phase II study. Int J Gynecol Cancer 2023; 33:1764-1770. [PMID: 37775281 DOI: 10.1136/ijgc-2023-004777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/01/2023] Open
Abstract
OBJECTIVE This study aimed to prospectively evaluate the efficacy and safety of anlotinib in patients with platinum resistant/refractory ovarian cancer. METHODS In this prospective, single arm, phase II study, patients with platinum resistant/refractory ovarian cancer received anlotinib (12 mg once daily; days 1-14; 21 days per cycle) until disease progression, unacceptable toxicity, or study withdrawal. The study was conducted between May 2019 and May 2021. The primary endpoint was objective response rate. Secondary endpoints were disease control rate, progression free survival, overall survival, and safety. An exploratory biomarker analysis was performed to evaluate the correlation of baseline TP53 mutation status with outcomes. RESULTS 33 of 34 enrolled patients received at least one dose of anlotinib. The objective response rate was 31.2% (95% confidence interval (CI) 16.1% to 50.0%), with 2 (6.3%) complete and 8 (25.0%) partial responses. In total, 14 (43.8%) patients achieved stable disease, resulting in a disease control rate of 75.0% (95% CI 56.6% to 88.5%). With a median follow-up of 4.6 months (range 0.5-17.2) at data cut-off (September 16, 2022), median progression free survival was 5.3 months (95% CI 4.04 to 6.56) and median overall survival was not reached. In a subgroup analysis, patients with a TP53 mutation showed a trend towards worse progression free survival than those with the wild-type TP53 (4.4 months vs 8.4 months; hazard ratio 2.48 (95% CI 0.91 to 6.76), p=0.067). Common adverse events were hypertension (42.4%), hand-foot syndrome (27.3%), and fatigue (24.2%). Grade 3 events were reported in 3 (9.1%) patients and no grade 4-5 events or deaths were observed. CONCLUSION Anlotinib showed antitumor activity with an acceptable safety profile in patients with platinum resistant/refractory ovarian cancer, and it might be a potential treatment in this population.
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Affiliation(s)
- Wenbin Shen
- Department of Gynecologic Oncology, Department of Oncology, Fudan University Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, China
| | - Chuyu Jing
- Department of Gynecologic Oncology, Department of Oncology, Fudan University Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, China
| | - Wenjuan Tian
- Department of Gynecologic Oncology, Department of Oncology, Fudan University Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, China
| | - Wei Zhang
- Department of Gynecologic Oncology, Department of Oncology, Fudan University Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yulan Ren
- Department of Gynecologic Oncology, Department of Oncology, Fudan University Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, China
| | - Boer Shan
- Department of Gynecologic Oncology, Department of Oncology, Fudan University Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, China
| | - Huaying Wang
- Department of Gynecologic Oncology, Department of Oncology, Fudan University Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, China
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15
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Pradhan R, Yu OHY, Platt RW, Azoulay L. Dipeptidyl peptidase-4 inhibitors and the risk of skin cancer among patients with type 2 diabetes: a UK population-based cohort study. BMJ Open Diabetes Res Care 2023; 11:e003550. [PMID: 37949470 PMCID: PMC10649616 DOI: 10.1136/bmjdrc-2023-003550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 09/16/2023] [Indexed: 11/12/2023] Open
Abstract
INTRODUCTION The dipeptidyl peptidase-4 (DPP-4) enzyme significantly influences carcinogenic pathways in the skin. The objective of this study was to determine whether DPP-4 inhibitors are associated with the incidence of melanoma and nonmelanoma skin cancer, compared with sulfonylureas. RESEARCH DESIGN AND METHODS Using the United Kingdom Clinical Practice Research Datalink, we assembled two new-user active comparator cohorts for each skin cancer outcome from 2007 to 2019. For melanoma, the cohort included 96 739 DPP-4 inhibitor users and 209 341 sulfonylurea users, and 96 411 DPP-4 inhibitor users and 208 626 sulfonylurea users for non-melanoma skin cancer. Propensity score fine stratification weighted Cox proportional hazards models were used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs of melanoma and non-melanoma skin cancer, separately. RESULTS Overall, DPP-4 inhibitors were associated with a 23% decreased risk of melanoma compared with sulfonylureas (49.7 vs 65.3 per 100 000 person-years, respectively; HR 0.77, 95% CI 0.61 to 0.96). The HR progressively reduced with increasing cumulative duration of use (0-2 years HR 1.14, 95% CI 0.84 to 1.54; 2.1-5 years HR 0.44, 95% CI 0.29 to 0.66; >5 years HR 0.33, 95% CI 0.14 to 0.74). In contrast, these drugs were not associated with the incidence of non-melanoma skin cancer, compared with sulfonylureas (448.1 vs 426.1 per 100 000 person-years, respectively; HR 1.06, 95% CI 0.98 to 1.15). CONCLUSIONS In this large, population-based cohort study, DPP-4 inhibitors were associated with a reduced risk of melanoma but not non-melanoma skin cancer, compared with sulfonylureas.
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Affiliation(s)
- Richeek Pradhan
- Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Québec, Canada
- Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Montreal, Québec, Canada
| | - Oriana H Y Yu
- Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Montreal, Québec, Canada
- Division of Endocrinology, Jewish General Hospital, Montreal, Québec, Canada
| | - Robert W Platt
- Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Québec, Canada
- Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Montreal, Québec, Canada
| | - Laurent Azoulay
- Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Québec, Canada
- Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Montreal, Québec, Canada
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Onerup A, Mehlig K, Geijerstam AA, Ekblom-Bak E, Kuhn HG, Lissner L, Åberg M, Börjesson M. Associations between cardiorespiratory fitness in youth and the incidence of site-specific cancer in men: a cohort study with register linkage. Br J Sports Med 2023; 57:1248-1256. [PMID: 37582636 PMCID: PMC10579181 DOI: 10.1136/bjsports-2022-106617] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2023] [Indexed: 08/17/2023]
Abstract
OBJECTIVES To assess the associations between cardiorespiratory fitness (CRF) in young men and the incidence of site-specific cancer. METHODS A Swedish population-based cohort study with register linkage of men who underwent military conscription in 1968-2005 was undertaken. CRF was assessed by maximal aerobic workload cycle test at conscription. Cox regression models assessed linear associations and included CRF, age, year and site of conscription, body mass index and parental level of education. CRF was also categorised into low, moderate and high for facilitated interpretation and results comparing high and low CRF are reported. RESULTS Primary analyses were performed in 1 078 000 men, of whom 84 117 subsequently developed cancer in at least one site during a mean follow-up of 33 years. Higher CRF was linearly associated with a lower hazard ratio (HR) of developing cancer in the head and neck (n=2738, HR 0.81, 95% CI 0.74 to 0.90), oesophagus (n=689, HR 0.61, 95% CI 0.50 to 0.74), stomach (n=902, HR 0.79, 95% CI 0.67 to 0.94), pancreas (n=1280, HR 0.88, 95% CI 0.76 to 1.01), liver (n=1111, HR 0.60, 95% CI 0.51 to 0.71), colon (n=3222, HR 0.82, 95% CI 0.75 to 0.90), rectum (n=2337, HR 0.95, 95% CI 0.85 to 1.05), kidney (n=1753, HR 0.80, 95% CI 0.70 to 0.90) and lung (n=1635, HR 0.58, 95% CI 0.51 to 0.66). However, higher CRF predicted a higher hazard of being diagnosed with prostate cancer (n=14 232, HR 1.07, 95% CI 1.03 to 1.12) and malignant skin cancer (n=23 064, HR 1.31, 95% CI 1.27 to 1.36). CONCLUSION We report a number of protective associations between higher CRF in healthy young men and the subsequent hazard of site-specific cancers. These results have implications for public health policymaking, strengthening the incentive to promote health through improving CRF in youth.
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Affiliation(s)
- Aron Onerup
- Department of Pediatrics, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Kirsten Mehlig
- School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Agnes Af Geijerstam
- School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Elin Ekblom-Bak
- Department of Physical Activity and Health, Swedish School of Sport and Health Sciences, GIH, Stockholm, Sweden
| | - Hans Georg Kuhn
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lauren Lissner
- School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Maria Åberg
- School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Mats Börjesson
- Department of Molecular and Clinical Medicine, Center for Health and Performance, University of Gothenburg, Gothenburg, Sweden
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17
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Cartwright A, Snowden JA, Whitehouse H, Scott S, Whitby L. Implementation of the updated NICE haematological cancers (NG47) improving outcomes guidelines across Specialist Integrated Haematological Malignancy Diagnostic Services (SIHMDS) in England: a UK NEQAS LI survey. J Clin Pathol 2023; 76:618-623. [PMID: 35508367 PMCID: PMC10447389 DOI: 10.1136/jclinpath-2021-208075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 04/13/2022] [Indexed: 11/04/2022]
Abstract
AIMS Haematological malignancies represent a diverse group of diseases with complex diagnostic requirements. National Institute for Health and Care Excellence (NICE) Haematological Cancer: Improving Outcomes Guidance was published in 2003 and updated in 2016 (NG47), providing recommendations for service delivery including Specialist Integrated Haematological Malignancy Diagnostic Services (SIHMDSs). This survey assessed the implementation of NG47 guidelines, with a specific focus on implementation in relation to laboratory SIHMDS delivery. METHODS A survey was issued to the 17 SIHMDSs identified in England. The questionnaire covered laboratory configuration, information systems, integrated reporting and multidisciplinary team (MDT) working recommendations. RESULTS In the 10 responding SIHMDS, full implementation of recommendations was not achieved. Higher levels of implementation were reported in 'colocated' services compared with 'networked' SIHMDS. Increased guideline implementation was reported with longer duration since initial establishment of a SIHMDS and for laboratory based as opposed to clinical (MDT) reporting recommendations. CONCLUSIONS Our survey highlights variable implementation of NICE guidance across SIHMDS, with likely inequity of access, standardisation and quality in haemato-oncology diagnostics. Provision of a more structured framework for guideline implementation could assist in increasing compliance to meet the goals of quality and equity of access to harmonised haemato-oncology diagnostics across the NHS in England. This would provide a basis for evaluating the clinical benefits and health economic impact of the SIHMDS model on patient care and outcomes.
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Affiliation(s)
- Ashley Cartwright
- UK NEQAS for Leucocyte Immunophenotyping, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - John A Snowden
- Department of Haematology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- Department of Oncology and Metabolism, The University of Sheffield, Sheffield, UK
| | - Helen Whitehouse
- UK NEQAS for Leucocyte Immunophenotyping, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Stuart Scott
- UK NEQAS for Leucocyte Immunophenotyping, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Liam Whitby
- UK NEQAS for Leucocyte Immunophenotyping, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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18
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Finall A, Murphy K, Frazer RD. Improving care of melanoma patients through efficient, integrated cellular-molecular pathology workflows using tissue samples with low tumour nuclear content. J Clin Pathol 2023; 76:612-617. [PMID: 35428674 DOI: 10.1136/jclinpath-2022-208194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 03/28/2022] [Indexed: 11/04/2022]
Abstract
AIMS The aim of this quality improvement project was to improve the turnaround time of B-raf proto-oncogene (BRAF) mutation testing in patients with malignant melanoma to support oncologists in making timely treatment decisions. METHODS This is a prospective in-house verification of the Idylla BRAF test as compared with DNA panel next-generation sequencing (NGS) performed at an external laboratory. RESULTS The Idylla BRAF test had an overall concordance of 95% compared with NGS. This was considered sufficiently good for use in patients with a poor performance status who were at risk of rapid clinical deterioration. Reliable results can be generated using the Idylla BRAF test in tissue sections with tumour neoplastic cell content below 50%. We present a multidisciplinary clinical care algorithm to support dual testing. CONCLUSIONS The Idylla BRAF test has the potential to make a significant positive impact on progression-free survival of malignant melanoma patients due to its rapid turnaround time. The Idylla BRAF test can be used as an adjunct to NGS for timely management of patients, particularly those with a poor performance status at presentation.
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Affiliation(s)
- Alison Finall
- Cellular Pathology, Swansea Bay University Health Board, Swansea, UK
- Medical School, Swansea University, Swansea, UK
| | - Kate Murphy
- Cellular and Molecular Pathology Department, Swansea Bay University Health Board, Swansea, UK
- Institute of Life Science, Swansea University, Swansea, UK
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19
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Yaniv D, Ramondetta LM, Cohen L, Amit M. Psilocybin-assisted psychotherapy for cancer-related anxiety and depression. Int J Gynecol Cancer 2023; 33:1327-1328. [PMID: 37463745 DOI: 10.1136/ijgc-2023-004659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023] Open
Affiliation(s)
- Dan Yaniv
- Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | - Lorenzo Cohen
- Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Moran Amit
- Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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20
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Fukai K, Furuya Y, Nakazawa S, Kojimahara N, Hoshi K, Toyota A, Tatemichi M. Length of employment in workplaces handling hazardous chemicals and risk of cancer among Japanese men. Occup Environ Med 2023; 80:431-438. [PMID: 37295942 PMCID: PMC10423551 DOI: 10.1136/oemed-2022-108775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 05/24/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVES In Japan, the risk of developing cancer among workers employed in workplaces where chemical substances are handled is unclear. This study aimed to assess the association between cancer risk and employment in workplaces handling hazardous chemicals. METHODS The Inpatient Clinico-Occupational Survey of the Rosai Hospital Group data of 120 278 male patients with incident cancer and 217 605 hospital controls matched for 5-year age group, hospital (34 hospitals) and year of admission (2005-2019) were analysed. Cancer risk in relation to lifetime employment in workplaces using regulated chemicals was assessed while controlling for age, region and year of diagnosis, smoking, alcohol consumption and occupation. Further analysis stratified by smoking history was performed to examine interaction effects. RESULTS In the longest group of employment in tertiles, ORs were increased for all cancers (OR=1.13; 95% CI: 1.07 to 1.19) and lung (OR=1.82; 95% CI: 1.56 to 2.13), oesophageal (OR=1.73; 95% CI: 1.18 to 2.55), pancreatic (OR=2.03; 95% CI: 1.40 to 2.94) and bladder (OR=1.40; 95% CI: 1.12 to 1.74) cancers. Employment of 1+ years was associated with risk for lung cancer; 11+ years for pancreatic and bladder cancers; and 21+ years for all cancers and oesophageal cancer. These positive relationships were particularly obvious among patients with a history of smoking; however, no significant interaction between smoking and length of employment was observed. CONCLUSIONS There is a high risk of cancer among workers, especially smokers, employed in workplaces handling regulated chemicals in Japan. Thus, future measures for chemical management in workplaces are needed to prevent avoidable cancers.
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Affiliation(s)
- Kota Fukai
- Department of Preventive Medicine, Tokai University School of Medicine, Isehara, Japan
| | - Yuko Furuya
- Department of Preventive Medicine, Tokai University School of Medicine, Isehara, Japan
| | - Shoko Nakazawa
- Department of Preventive Medicine, Tokai University School of Medicine, Isehara, Japan
| | - Noriko Kojimahara
- Department of Public Health, Shizuoka Graduate University of Public Health, Shizuoka, Japan
| | - Keika Hoshi
- Center for Health Informatics Policy, National Institute of Public Health, Wako, Japan
- Department of Hygiene, Kitasato University School of Medicine, Sagamihara, Japan
| | - Akihiro Toyota
- Chugoku Rosai Hospital Research Center for the Promotion of Health and Employment Support, Japan Organization of Occupational Health and Safety, Hiroshima, Japan
| | - Masayuki Tatemichi
- Department of Preventive Medicine, Tokai University School of Medicine, Isehara, Japan
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21
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Guth M, Coste A, Lefevre M, Deygas F, Danjou A, Ahmadi S, Dananché B, Pérol O, Boyle H, Schüz J, Bujan L, Metzler-Guillemain C, Giscard d'Estaing S, Teletin M, Ducrocq B, Frapsauce C, Olsson A, Charbotel B, Fervers B. Testicular germ cell tumour risk by occupation and industry: a French case-control study - TESTIS. Occup Environ Med 2023; 80:407-417. [PMID: 37230752 PMCID: PMC10314033 DOI: 10.1136/oemed-2022-108601] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 05/04/2023] [Indexed: 05/27/2023]
Abstract
OBJECTIVE Testicular germ cell tumours (TGCT) are the most common cancer in men of working age and its incidence has increased notably over the past 40 years. Several occupations have been identified as potentially associated with TGCT risk. The aim of this study was to further explore the relationship between occupations, industries and TGCT risk in men aged 18-45 years. METHODS The TESTIS study is a multicenter case-control study conducted between January 2015 and April 2018 in 20 of 23 university hospital centers in metropolitan France. A total of 454 TGCT cases and 670 controls were included. Full job histories were collected. Occupations were coded according to the International Standard Classification of Occupation 1968 version (ISCO-1968) and industry according to the 1999 version of Nomenclature d'Activités Française (NAF-1999). For each job held, ORs and 95% CIs were estimated using conditional logistic regression. RESULTS A positive association was observed between TGCT and occupation as agricultural, animal husbandry worker (ISCO: 6-2; OR 1.71; 95% CI (1.02 to 2.82)), as well as salesman (ISCO: 4-51; OR 1.84; 95% CI (1.20 to 2.82)). An increased risk was further observed among electrical fitters and related, electrical and electronics workers employed for 2 years or more (ISCO: 8-5; OR≥2 years 1.83; 95% CI (1.01 to 3.32)). Analyses by industry supported these findings. CONCLUSIONS Our findings suggest that agricultural, electrical and electronics workers, and salesmen workers experience an increased risk of TGCT. Further research is needed to identify the agents or chemicals in these high-risk occupations which are relevant in the TGCT development. TRIAL REGISTRATION NUMBER NCT02109926.
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Affiliation(s)
- Margot Guth
- UMRESTTE, Université Claude Bernard Lyon 1, Lyon, France
| | - Astrid Coste
- Radiation: Defense, Health, Environment, INSERM UMR1296, Lyon, France
- Prevention Cancer Environnement Departement, Centre Léon Bérard, Lyon, France
| | - Marie Lefevre
- UMRESTTE, Université Claude Bernard Lyon 1, Lyon, France
| | | | - Aurélie Danjou
- Environment and Lifestyle Epidemiology Branch, International Agency for Research on Cancer/World Health Organization (IARC/WHO), Lyon, France
| | - Shukrullah Ahmadi
- Environment and Lifestyle Epidemiology Branch, International Agency for Research on Cancer/World Health Organization (IARC/WHO), Lyon, France
| | - Brigitte Dananché
- Prevention Cancer Environnement Departement, Centre Léon Bérard, Lyon, France
| | - Olivia Pérol
- Prevention Cancer Environnement Departement, Centre Léon Bérard, Lyon, France
| | - Helen Boyle
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France
| | - Joachim Schüz
- Environment and Lifestyle Epidemiology Branch, International Agency for Research on Cancer/World Health Organization (IARC/WHO), Lyon, France
| | - Louis Bujan
- DEFE (Développement Embryonnaire, Fertilité, Environnement) INSERM 1202 Universités Montpellier et Toulouse 3, CECOS Hôpital Paule de Viguier, CHU de Toulouse, Toulouse, France
- Fédération Française des CECOS, Paris, France
| | - Catherine Metzler-Guillemain
- Fédération Française des CECOS, Paris, France
- Centre Clinico-Biologique d'AMP-CECOS, AP-HM La Conception University Hospital, Marseille, France
| | - Sandrine Giscard d'Estaing
- Fédération Française des CECOS, Paris, France
- CECOS de Lyon, Service de Médecine de la Reproduction, Hôpital Femme Mère Enfant, Bron, France
| | - Marius Teletin
- Fédération Française des CECOS, Paris, France
- Department of Functional Genomics and Cancer, Institut de Génétique et de Biologie Moléculaire et Cellulaire, Illkirch-Grafenstaden, France
| | - Berengere Ducrocq
- Fédération Française des CECOS, Paris, France
- CECOS Nord Lille, Hôpital Albert Calmette, Lille, France
| | - Cynthia Frapsauce
- Fédération Française des CECOS, Paris, France
- Médecine et Biologie de la Reproduction-CECOS, CHU Bretonneau, Tours, France
| | - Ann Olsson
- Environment and Lifestyle Epidemiology Branch, International Agency for Research on Cancer/World Health Organization (IARC/WHO), Lyon, France
| | - Barbara Charbotel
- UMRESTTE, Université Claude Bernard Lyon 1, Lyon, France
- Service des Maladies Professionnelles, Hospices Civils de Lyon, Pierre Bénite, France
| | - Béatrice Fervers
- Radiation: Defense, Health, Environment, INSERM UMR1296, Lyon, France
- Prevention Cancer Environnement Departement, Centre Léon Bérard, Lyon, France
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22
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Jia X, Liang J, Ma X, Wang W, Lai C. Radiomic-based machine learning model for predicting the surgical risk in children with abdominal neuroblastoma. World J Pediatr Surg 2023; 6:e000531. [PMID: 37223779 PMCID: PMC10201264 DOI: 10.1136/wjps-2022-000531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 03/27/2023] [Indexed: 05/25/2023] Open
Abstract
Background Preoperative imaging assessment of surgical risk is very important for the prognosis of these children. To develop and validate a radiomics-based machine learning model based on the analysis of radiomics features to predict surgical risk in children with abdominal neuroblastoma (NB). Methods A retrospective study was conducted from April 2019 to March 2021 among 74 children with abdominal NB. A total of 1874 radiomic features in MR images were extracted from each patient. Support vector machines (SVMs) were used to establish the model. Eighty percent of the data were used as the training set to optimize the model, and 20% of the data were used to validate its accuracy, sensitivity, specificity and area under the curve (AUC) to verify its effectiveness. Results Among the 74 children with abdominal NB, 55 (65%) had surgical risk and 19 (35%) had no surgical risk. A t test and Lasso identified that 28 radiomic features were associated with surgical risk. After developing an SVM-based model using these features, predictions were made about whether children with abdominal NB had surgical risk. The model achieved an AUC of 0.94 (a sensitivity of 0.83 and a specificity of 0.80) with 0.890 accuracy in the training set and an AUC of 0.81 (a sensitivity of 0.73 and a specificity of 0.82) with 0.838 accuracy in the test set. Conclusions Radiomics and machine learning can be used to predict the surgical risk in children with abdominal NB. The model based on 28 radiomic features established by SVM showed good diagnostic efficiency.
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Affiliation(s)
- Xuan Jia
- Department of Radiology, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jiawei Liang
- Department of Radiology, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaohui Ma
- Department of Radiology, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Wenqi Wang
- Department of Radiology, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Can Lai
- Department of Radiology, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
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23
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Park JH, Luchini C, Nottegar A, Tizaoui K, Koyanagi A, Ogino S, Shin JI, Lim BJ, Smith L. Effect of CD274 (PD-L1) overexpression on survival outcomes in 10 specific cancers: a systematic review and meta-analysis. J Clin Pathol 2023:jcp-2023-208848. [PMID: 37130750 DOI: 10.1136/jcp-2023-208848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 04/06/2023] [Indexed: 05/04/2023]
Abstract
AIM The prognostic role of CD274 (programmed cell death ligand 1 (PD-L1)) overexpression has been examined in many studies. However, the results are controversial and conflicting. The present study aims to investigate the potential role of CD274 (PD-L1) immunohistochemical overexpression as a prognostic marker in malignant tumours. METHODS We searched PubMed, Embase and Web of Science from inception to December 2021 to identify potentially eligible studies. The pooled HRs with 95% CIs were calculated to identify the association between CD274 (PD-L1) overexpression and overall survival (OS), cancer-specific survival, disease-free survival, recurrence-free survival and progression-free survival in 10 lethal malignant tumours. Heterogeneity and publication bias were also analysed. RESULTS The study included 57 322 patients from 250 eligible studies (241 articles). The meta-analysis by tumour type using multivariate HR revealed worse OS in non-small cell lung cancer (HR 1.41, 95% CI 1.19 to 1.68), hepatocellular carcinoma (HR 1.75, 95% CI 1.11 to 2.74), pancreatic cancer (HR 1.84, 95% CI 1.12 to 3.02), renal cell carcinoma (HR 1.55, 95% CI 1.12 to 2.14) and colorectal cancer (HR 1.46, 95% CI 1.14 to 1.88). Estimated HRs showed associations between CD274 (PD-L1) overexpression and worse prognosis across different types of tumours in various survival endpoints, but no inverse correlation was identified. The heterogeneity for most of the pooled results was high. CONCLUSIONS This large meta-analysis suggests that CD274 (PD-L1) overexpression is a potential biomarker for multiple types of cancers. However, further studies are needed to reduce high heterogeneity. PROSPERO REGISTRATION NUMBER CRD42022296801.
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Affiliation(s)
- Ji Hyun Park
- Yonsei University College of Medicine, Seoul, South Korea
| | - Claudio Luchini
- Department of Diagnostics and Public Health, Section of Pathology, University of Verona, Verona, Italy
| | - Alessia Nottegar
- Department of Diagnostics and Public Health, Section of Pathology, University of Verona, Verona, Italy
| | - Kalthoum Tizaoui
- Laboratory of Biomedical Genomics and Oncogenetics, LR16IPT05, Institut Pasteur de Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), ISCIII, Madrid, Spain
- Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain
| | - Shuji Ogino
- Program in MPE Molecular Pathological Epidemiology, Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
- Cancer Immunology and Cancer Epidemiology Programs, Dana-Farber Harvard Cancer Center, Boston, Massachusetts, USA
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, South Korea
| | - Beom Jin Lim
- Department of Pathology, Yonsei University College of Medicine, Seoul, South Korea
| | - Lee Smith
- Centre for Health, Performance, and Wellbeing, Anglia Ruskin University, Cambridge, UK
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Lakeman IMM, Rodríguez-Girondo MDM, Lee A, Celosse N, Braspenning ME, van Engelen K, van de Beek I, van der Hout AH, Gómez García EB, Mensenkamp AR, Ausems MGEM, Hooning MJ, Adank MA, Hollestelle A, Schmidt MK, van Asperen CJ, Devilee P. Clinical applicability of the Polygenic Risk Score for breast cancer risk prediction in familial cases. J Med Genet 2023; 60:327-336. [PMID: 36137616 DOI: 10.1136/jmg-2022-108502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 07/19/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Common low-risk variants are presently not used to guide clinical management of familial breast cancer (BC). We explored the additive impact of a 313-variant-based Polygenic Risk Score (PRS313) relative to standard gene testing in non-BRCA1/2 Dutch BC families. METHODS We included 3918 BC cases from 3492 Dutch non-BRCA1/2 BC families and 3474 Dutch population controls. The association of the standardised PRS313 with BC was estimated using a logistic regression model, adjusted for pedigree-based family history. Family history of the controls was imputed for this analysis. SEs were corrected to account for relatedness of individuals. Using the BOADICEA (Breast and Ovarian Analysis of Disease Incidence and Carrier Estimation Algorithm) V.5 model, lifetime risks were retrospectively calculated with and without individual PRS313. For 2586 cases and 2584 controls, the carrier status of pathogenic variants (PVs) in ATM, CHEK2 and PALB2 was known. RESULTS The family history-adjusted PRS313 was significantly associated with BC (per SD OR=1.97, 95% CI 1.84 to 2.11). Including the PRS313 in BOADICEA family-based risk prediction would have changed screening recommendations in up to 27%, 36% and 34% of cases according to BC screening guidelines from the USA, UK and the Netherlands (National Comprehensive Cancer Network, National Institute for Health and Care Excellence, and Netherlands Comprehensive Cancer Organisation), respectively. For the population controls, without information on family history, this was up to 39%, 44% and 58%, respectively. Among carriers of PVs in known moderate BC susceptibility genes, the PRS313 had the largest impact for CHEK2 and ATM. CONCLUSIONS Our results support the application of the PRS313 in risk prediction for genetically uninformative BC families and families with a PV in moderate BC risk genes.
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Affiliation(s)
- Inge M M Lakeman
- Department of Human Genetics, Leiden University Medical Center, Leiden, The Netherlands
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Mar D M Rodríguez-Girondo
- Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, The Netherlands
| | - Andrew Lee
- Public Health and Primary Care, University of Cambridge Centre for Cancer Genetic Epidemiology, Cambridge, UK
| | - Nandi Celosse
- Department of Human Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Merel E Braspenning
- Department of Human Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Klaartje van Engelen
- Department of Human Genetics, Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands
| | - Irma van de Beek
- Department of Human Genetics, Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands
| | - Annemiek H van der Hout
- Department of Clinical Genetics, University Medical Centre Groningen, Groningen, The Netherlands
| | - Encarna B Gómez García
- Department of Clinical Genetics, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Arjen R Mensenkamp
- Department of Human Genetics, University Medical Center Nijmegen, Nijmegen, The Netherlands
| | - Margreet G E M Ausems
- Department of Medical Genetics, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Maartje J Hooning
- Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Muriel A Adank
- Family Cancer Clinic, Antoni van Leeuwenhoek Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Antoinette Hollestelle
- Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Marjanka K Schmidt
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
- Division of Psychosocial Research and Epidemiology, Antoni van Leeuwenhoek Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Christi J van Asperen
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Peter Devilee
- Department of Human Genetics, Leiden University Medical Center, Leiden, The Netherlands
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
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25
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Tan S, Sivakumar S, Segelov E, Nicholls SJ, Nelson AJ. Cardiovascular risk factor reporting in immune checkpoint inhibitor trials: A systematic review. Cancer Epidemiol 2023; 83:102334. [PMID: 36669376 DOI: 10.1016/j.canep.2023.102334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 01/04/2023] [Accepted: 01/14/2023] [Indexed: 01/21/2023]
Abstract
BACKGROUND Immune checkpoint inhibitors (ICI) have revolutionized the treatment of numerous cancers but are associated with increased risk of myocardial infarction. The prevalence of traditional cardiovascular risk factors (CVRF) in patients treated with ICIs is unknown. This study sought to describe the frequency of reporting of CVRFs among landmark ICI trials. METHODS A systematic review of all phase 2 or 3 cancer trials employing ICIs that led to United States Food and Drug Administration approval was conducted. RESULTS Of the 69 identified trials, only one study reported baseline rates of hypertension, diabetes mellitus, and dyslipidemia. Smoking history was reported in 27 studies (39 %) and three (4 %) reported body mass index. No study reported history of previous cardiovascular disease, although 17 (25 %), six (9 %), and 21 (30 %) studies excluded patients with recent myocardial infarction, revascularization and heart failure respectively. Similarly low rates of cardiovascular risk factor reporting were observed in studies employing concurrent vascular endothelial growth factor inhibitors and recruiting (neo)adjuvant cohorts. CONCLUSION The prevalence of CVRFs is poorly described in ICI trials despite increasingly reported risks of myocardial infarction. A systematic approach to collecting and reporting CVRFs should be considered in future trials and real world populations.
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Affiliation(s)
- Sean Tan
- Victorian Heart Institute, Melbourne, Australia; Monash Heart, Monash Health, Melbourne, Australia.
| | | | | | - Stephen J Nicholls
- Victorian Heart Institute, Melbourne, Australia; Monash Heart, Monash Health, Melbourne, Australia
| | - Adam J Nelson
- Victorian Heart Institute, Melbourne, Australia; Monash Heart, Monash Health, Melbourne, Australia
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26
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Caruso G, Tomao F, Parma G, Lapresa M, Multinu F, Palaia I, Aletti G, Colombo N. Poly (ADP-ribose) polymerase inhibitors (PARPi) in ovarian cancer: lessons learned and future directions. Int J Gynecol Cancer 2023; 33:431-443. [PMID: 36928097 DOI: 10.1136/ijgc-2022-004149] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
Poly (ADP-ribose) polymerase inhibitors (PARPi) represent a new standard of care in the upfront treatment of advanced epithelial ovarian cancer to the point that the vast majority of patients now receive a PARPi, alone or in combination with the anti-angiogenic bevacizumab, as part of their first-line maintenance therapy. The clinical benefit of PARPi is well established; however, much has changed since their introduction and several relevant questions have been raised and remain unresolved in the post-PARPi era. The decision-making process regarding the most appropriate first-line maintenance therapy could be challenging in clinical practice, especially in the homologous recombination-proficient setting, and several other factors need to be considered apart from the mutational status. Concerns regarding post-PARPi progression treatment have emerged, highlighting an unmet need to define a valid algorithm strategy. PARPi may not only compromise the response to further platinum due to cross-resistance mechanisms but the impact on subsequent non-platinum chemotherapy and surgery also remains unclear. Definitive results on the role of PARPi rechallenge are awaited, especially in the case of oligoprogression managed with locoregional treatment. Moreover, the updated overall survival data from the recurrent setting warrant caution in using PARPi as single agents for unselected patients. Several PARPi combination regimens are emerging for overcoming PARPi resistance and may become our new therapeutic armamentarium. This review discusses a set of clinically relevant issues in the PARPi era and provides a glimpse of future challenges and opportunities in ovarian cancer treatment.
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Affiliation(s)
- Giuseppe Caruso
- Department of Maternal and Child Health and Urological Sciences, University of Rome La Sapienza, Rome, Italy .,Department of Experimental Medicine, University of Rome La Sapienza, Rome, Italy
| | - Federica Tomao
- Department of Maternal and Child Health and Urological Sciences, University of Rome La Sapienza, Rome, Italy
| | - Gabriella Parma
- Gynecologic Oncology Program, European Institute of Oncology IRCCS, Milan, Italy
| | - Mariateresa Lapresa
- Gynecologic Oncology Program, European Institute of Oncology IRCCS, Milan, Italy
| | - Francesco Multinu
- Gynecologic Oncology Program, European Institute of Oncology IRCCS, Milan, Italy
| | - Innocenza Palaia
- Department of Maternal and Child Health and Urological Sciences, University of Rome La Sapienza, Rome, Italy
| | - Giovanni Aletti
- Gynecologic Oncology Program, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Nicoletta Colombo
- Gynecologic Oncology Program, European Institute of Oncology IRCCS, Milan, Italy.,Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
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Tate J, Racoviță M, Cougnard-Gregoire A, Delcourt C, Harwood C, Trakatelli M. Keratinocyte carcinoma as an occupational disease. Occup Environ Med 2023; 80:237-238. [PMID: 36922015 DOI: 10.1136/oemed-2022-108784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 02/21/2023] [Indexed: 03/17/2023]
Affiliation(s)
- Jody Tate
- Research Department, The Health Policy Partnership Ltd, London, UK
| | - Monica Racoviță
- Research Department, The Health Policy Partnership Ltd, London, UK
| | | | - Cécile Delcourt
- INSERM, Bordeaux Population Health, U1219, University of Bordeaux, Bordeaux, France
| | - Catherine Harwood
- Department of Dermatology, The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Myrto Trakatelli
- Second Department of Dermatology and Venerology, Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece
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Devlin MJ, Miller R. Genomic testing in high-grade serous ovarian cancer: current options and future development. Int J Gynecol Cancer 2023; 33:358-363. [PMID: 36878563 DOI: 10.1136/ijgc-2022-003702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023] Open
Abstract
Understanding the genomic complexity of high-grade serous ovarian cancer is now essential in guiding patient management, particularly in the first-line setting. Our knowledge in this area has expanded rapidly in recent years, with biomarkers developing in parallel to agents designed to exploit cancer-associated genetic aberrations. In this review we will take stock of the current landscape of genetic testing and look towards the future with developments that aim to refine personalized treatment paradigms and track treatment resistance in real time.
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Affiliation(s)
- Michael-John Devlin
- Barts Cancer Institute, Queen Mary University of London, London, UK.,Department of Medical Oncology, St Bartholomew's Hospital, London, UK
| | - Rowan Miller
- Department of Medical Oncology, St Bartholomew's Hospital, London, UK .,Department of Medical Oncology, University College London Hospital, London, UK
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29
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Kuick CH, Chen WW, Chen H, Chang KTE, Mok Y. Validation of long mononucleotide repeat markers for microsatellite instability testing in paediatric tumours. J Clin Pathol 2023; 76:214-216. [PMID: 36581446 DOI: 10.1136/jcp-2022-208692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 11/30/2022] [Indexed: 12/30/2022]
Affiliation(s)
- Chik Hong Kuick
- Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, Singapore
| | - Wan Wan Chen
- Department of Pathology, Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Huiyi Chen
- Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, Singapore
| | - Kenneth Tou En Chang
- Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, Singapore .,Pathology Academic Clinical Programme, SingHealth Duke-NUS Medical School, Singapore
| | - Yingting Mok
- Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, Singapore.,Department of Pathology, National University Health System, Singapore
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30
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Caruso G, Gigli F, Parma G, Lapresa M, Derio S, Palaia I, Colombo N. Myeloid neoplasms post PARP inhibitors for ovarian cancer. Int J Gynecol Cancer 2023; 33:598-606. [PMID: 36707087 DOI: 10.1136/ijgc-2022-004190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
The incidence of myeloid neoplasms following treatment with poly (ADP-ribose) polymerase inhibitors (PARPi) in patients with ovarian cancer has been gradually increasing over the last few years. The cumulative exposure to PARPi and the improved overall survival of patients with ovarian cancer may represent key underlying explanations behind such trend. Fortunately, the earlier introduction of PARPi in the frontline setting reduces the risk of developing secondary myeloid neoplasms. The etiopathogenesis is still unclear but is likely to be multifactorial. The first 2 years of PARPi exposure seem to be the critical window for the onset of myeloid neoplasms post PARPi, with persistent cytopenia recognized as an early warning sign. Despite intensive treatment strategies, the outcome remains poor. There is an unmet clinical need to learn how to minimize risk, make an early diagnosis, and manage myeloid neoplasms post PARPi. First, decision making regarding the optimal maintenance treatment should avoid a 'PARPi-for-all' strategy. PARPi should be used cautiously in cases of high baseline risk for myeloid neoplasms and/or patients who are less likely to have a benefit. Active surveillance, accurate differential diagnosis, and prompt hematological referral are key management pillars. This review discusses what is known on this emerging issue as well as unresolved questions.
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Affiliation(s)
- Giuseppe Caruso
- Department of Maternal and Child Health and Urological Sciences, University of Rome La Sapienza, Rome, Italy .,Gynecologic Oncology Division, European Institute of Oncology, Milan, Italy
| | - Federica Gigli
- Onco-Hematology Division, European Institute of Oncology, Milan, Italy
| | - Gabriella Parma
- Gynecologic Oncology Division, European Institute of Oncology, Milan, Italy
| | | | - Silvia Derio
- Gynecologic Oncology Division, European Institute of Oncology, Milan, Italy
| | - Innocenza Palaia
- Department of Maternal and Child Health and Urological Sciences, University of Rome La Sapienza, Rome, Italy
| | - Nicoletta Colombo
- Medical Gynecologic Oncology Unit, University of Milan Bicocca, European Institute of Oncology, Milan, Italy
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31
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Verleye L, Castanares-Zapatero D, Devos C, De Gendt C, Silversmit G, Van Damme N, Hulstaert F, Thiry N, Neyt M. Survival in stage IV ovarian cancer with increased use of debulking surgery and bevacizumab. Int J Gynecol Cancer 2023; 33:543-548. [PMID: 36604121 DOI: 10.1136/ijgc-2022-003813] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES Advanced ovarian cancer has a poor prognosis, with a 5 year survival probability of <30%. Attempts to improve survival have focused on debulking surgery and systemic therapy. We assessed the evolution of treatment patterns and survival of patients with advanced epithelial ovarian cancer with specific attention to changes in survival after introducing bevacizumab. METHODS Population based data from the Belgian Cancer Registry were coupled with administrative reimbursement data from the compulsory health insurance organizations and the national database where date of death is registered, based on the patient's unique national number. Patients with epithelial ovarian cancer stage IV diagnosed in 2004-17 were included. The proportion of patients who underwent debulking surgery and received bevacizumab was calculated per incidence year. Survival was compared for the three incidence periods (2004-08, 2009-13, 2014-17) and before and after the introduction of bevacizumab. RESULTS 2034 patients with stage IV epitheial ovarian cancer were included. From 2012 onwards, uptake of bevacizumab increased, with 50% of patients with stage IV ovarian cancer diagnosed in 2017 receiving bevacizumab. The proportion of stage IV patients who underwent debulking surgery also increased over time, from 21.1% in 2004-08 to 50.4% and 45.4% in 2009-13 and 2014-17, respectively. The 3 year observed survival probability fluctuated between 27% and 42% without a trend over time. The increase in debulking surgery was associated with improved survival (hazard ratio (HR) 0.88, 95% confidence interval (CI) 0.79 to 0.98) but the introduction of bevacizumab was not (HR 0.94, 95% CI 0.85 to 1.03). For patients diagnosed in 2004, the mean cost per patient treated with oncological drugs was about €12 500, which doubled to about €25 000 for patients diagnosed in 2014 or later. CONCLUSIONS Despite a rise in the use of debulking surgery and the introduction of bevacizumab into clinical practice, no improvement in 3 year survival probability was observed for patients with advanced ovarian cancer in Belgium.
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Affiliation(s)
- Leen Verleye
- Belgian Health Care Knowledge Centre, Brussel, Belgium
| | | | - Carl Devos
- Belgian Health Care Knowledge Centre, Brussel, Belgium
| | | | | | | | | | - Nancy Thiry
- Belgian Health Care Knowledge Centre, Brussel, Belgium
| | - Mattias Neyt
- Belgian Health Care Knowledge Centre, Brussel, Belgium
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32
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Härmä M, Ojajärvi A, Koskinen A, Lie JA, Hansen J. Shift work with and without night shifts and breast cancer risk in a cohort study from Finland. Occup Environ Med 2023; 80:1-6. [PMID: 35948413 PMCID: PMC9763178 DOI: 10.1136/oemed-2022-108347] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 07/22/2022] [Indexed: 01/10/2023]
Abstract
OBJECTIVES To examine the association of shift work with and without night work with breast cancer among women in the public sector. METHODS Using the Finnish Public Sector cohort study (N=33 359, mean age of 40.6 years at baseline), we investigated the associations of shift work and potential confounders with incident breast cancer. Exposure to permanent day work or shift work was defined from first two consecutive surveys from 2000, 2004, 2008 or 2012 and past information on exposure in a subcohort (n=20 786). Incident cases of breast cancer (n=1129) were retrieved from the National Cancer Register and the cohort members were followed to the end of 2016. HR and 95% CI from Cox proportional hazard regression models were calculated. RESULTS Shift work with and without night shifts was not overall associated with breast cancer. When stratified according to age, both shift work without nights (HR 2.01, 95% CI 1.12 to 3.60) and shift work with nights (OR 2.05, 95% CI 1.04 to 4.01) were associated with an increased risk after a period of 10 years or more follow-up among women aged 50 years or older, when adjusted for age, socioeconomic status, children, smoking, alcohol and body mass index. In a subgroup with past information on exposure to shift work, the increased risk by longer exposure to shift work was not significant. CONCLUSIONS This study provides support for an increased risk of breast cancer among elderly shift workers. However, insufficient information on exposure and intensity of night work may attenuate the risk estimates.
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Affiliation(s)
- Mikko Härmä
- Work Ability and Working Careers, Finnish Institute of Occupational Health, Helsinki, Finland
| | - Anneli Ojajärvi
- Work Ability and Working Careers, Finnish Institute of Occupational Health, Helsinki, Finland
| | - Aki Koskinen
- Digi and Data, Finnish Institute of Occupational Health, Helsinki, Finland
| | - Jenny-Anne Lie
- Department of Occupational Medicine and Epidemiology, National Institute of Occupational Health, Oslo, Norway
| | - Johnni Hansen
- Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark
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Satyanarayan S, Spiegel J, Hovsepian D, Markert M, Thomas R, Muffly L, Miklos D, Graber K, Scott BJ. Continuous EEG monitoring detects nonconvulsive seizure and Ictal-Interictal Continuum abnormalities in moderate to severe ICANS following systemic CAR-T therapy. Neurohospitalist 2023; 13:53-60. [PMID: 36531846 PMCID: PMC9755619 DOI: 10.1177/19418744221128852] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023] Open
Abstract
Background and Purpose Immune Cell Effector Associated Neurotoxicity Syndrome (ICANS) is common amongst patients receiving CD19 targeted Chimeric Antigen Receptor T-cell (CAR-T) therapy. The purpose of this study is to characterize the incidence of seizures and ictal-interictal continuum (IIC) abnormalities in patients with ICANS. Methods Retrospective review of consecutive patients treated with axicabtagene ciloleucel (axi-cel) for recurrent high-grade systemic lymphoma at Stanford Medical Center between 2/2016-6/2019. Electronic medical records (EMR) were reviewed for clinical features, treatment information, EEG data, CRS (cytokine release syndrome)/ICANS severity, and clinical outcomes. Results Fifty-six patients met inclusion criteria. 85.7% of patients developed CRS, and 58.9% developed ICANS. Twenty-eight patients had EEG monitoring, of whom 26 had ICANS. Median duration of EEG monitoring was 30 hours (range .5-126 hours). Four patients (7.1%) had seizures (1 patient had a clinical generalized seizure, 2 patients had clinical and nonconvulsive seizures, and 1 patient had an isolated non-convulsive seizure). Ictal-interictal continuum abnormalities were common, of which generalized periodic discharges (GPDs) with triphasic morphology and GPDs with epileptiform morphology were most frequently seen. Generalized periodic discharges with triphasic wave morphology were found across Grade 2-3 peak ICANS severity, however the majority (86%) of patients with epileptiform GPDs had Grade 3 peak ICANS severity. Conclusions Among patients receiving axi-cel, seizure occurred in 7.1% of the total cohort, representing 12% of patients with ICANS. Ictal-interictal continuum abnormalities are also seen in patients with ICANS, most commonly GPDs. 75% of patients with seizures had nonconvulsive seizures supporting the use of continuous video EEG monitoring in this population.
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Affiliation(s)
- Sammita Satyanarayan
- Department of Neurology, Mount Sinai Icahn School of Medicine, New York, NY, USA
| | - Jay Spiegel
- Department of Medicine, University of Miami Health System, Miami, FL, USA
| | - Dominic Hovsepian
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Matthew Markert
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Reena Thomas
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Lori Muffly
- Department of Medicine- Blood and Marrow Transplantation, Stanford University School of Medicine, Stanford, CA, USA
| | - David Miklos
- Department of Medicine- Blood and Marrow Transplantation, Stanford University School of Medicine, Stanford, CA, USA
| | - Kevin Graber
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Brian J. Scott
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
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Noll F, Adams T, Cohen R, Soerjomataram I, Reid F. Building opportunities to improve quality of life for women with ovarian cancer in low- and middle-income countries: the Every Woman Study. Int J Gynecol Cancer 2022; 32:1080-1081. [PMID: 35314459 DOI: 10.1136/ijgc-2022-003449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Florencia Noll
- Gynecologic Oncology, Sanatorio Allende Cerro, Córdoba, Argentina
| | - Tracey Adams
- South African Medical Research Centre, University of Cape Town, Gynaecological Cancer Research Centre (SA MRC UCT GCRC), Groote Schuur Hospital, Observatory, South Africa
| | - Robin Cohen
- Sandy Rollman Ovarian Cancer Foundation, Philadelphia, Pennsylvania, USA
| | - Isabelle Soerjomataram
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, Rhône-Alpes, France
| | - Frances Reid
- Principal Investigator and Programme Director Every Woman Study, World Ovarian Cancer Coalition, Toronto, Ontario, Canada
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35
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Madland K, Bjorge L, Småstuen MC, Dørum A, Vistad I. Symptomatic or asymptomatic recurrence of ovarian cancer: does it influence survival? Int J Gynecol Cancer 2022; 32:ijgc-2022-003361. [PMID: 35680138 DOI: 10.1136/ijgc-2022-003361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The survival benefit of monitoring CA125 in ovarian cancer patients after primary treatment is debated due to findings varying from insignificant survival differences to prolonged median overall survival in favor of asymptomatic patients. Hence we aimed to compare ovarian cancer patients with and without symptoms at the time of the first diagnosed recurrence in terms of post-recurrence survival and overall survival, and to explore time to recurrence and common symptoms at recurrence. METHODS We included 421 women with ovarian cancer from a prospective multi-institutional Norwegian study of first recurrence of gynecological cancer over the period from March 2012 to April 2016. Patients were interviewed by clinicians at participating hospitals, and patient reported and clinical variables were recorded in a standardized questionnaire. The Kaplan-Meier method and the multivariate Cox model were used to evaluate post-recurrence survival and overall survival. RESULTS Of the 406 patients included, 183 (45%) patients were diagnosed with asymptomatic recurrence, and 223 (55%) patients had symptoms at recurrence. Asymptomatic patients had their recurrence detected 2 months later than symptomatic patients (14 vs 12 months, respectively, p=0.17). Median post-recurrence survival was significantly longer in asymptomatic patients compared with patients with symptoms at recurrence (33.9 vs 26.2 months, respectively, p=0.002). The post-recurrence survival rate remained higher for symptomatic patients in the adjusted analysis (hazard ratio (HR)=1.42, p=0.001). Median overall survival was 47.8 months for asymptomatic patients versus 44.0 months for symptomatic patients in the unadjusted analyses (p=0.056). Asymptomatic patients had a significantly longer survival in the adjusted analysis (HR=1.24, p=0.046). Pain was the most common symptom at recurrence (54%). CONCLUSION Patients with asymptomatic recurrence had a better prognosis based on post-recurrence data and the multivariate Cox regression analysis of overall survival. However, a closer exploration of differences in development of recurrence is needed as these results may give rise to more individualized follow-up for ovarian cancer patients.
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Affiliation(s)
| | - Line Bjorge
- Haukeland University Hospital, Bergen, Norway
- Department of Obstetrics and Gynecology, University of Bergen Center for Cancer Biomarkers, Bergen, Norway
| | | | - Anne Dørum
- Department of Gynecologic Oncology, Oslo University Hospital, Oslo, Norway
| | - Ingvild Vistad
- Gynecologic, Sorlandet Hospital Kristiansand, Kristiansand, Norway
- Department of Clinical Science, University of Bergen Faculty of Medicine and Dentistry, Bergen, Norway
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Bobiński M, Hoptyana O, Rasoul-Pelińska K, Lyzogub M, Rychlik A, Pletnev A. War in Ukraine: the opportunities for oncogynecologic patients in Poland. Int J Gynecol Cancer 2022; 32:809-810. [PMID: 35418500 DOI: 10.1136/ijgc-2022-003604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Marcin Bobiński
- 1st Department of Gynecologic Oncology and Gynecology, Medical University of Lublin, Lublin, Poland .,Polish Society of Gynecologic Oncology, Warsaw, Poland
| | - Olha Hoptyana
- Department of Gynaecologic Oncology, National Cancer Institute, Kyiv, Ukraine.,Ukrainian Society of Gynecologic Oncology, Kyiv, Ukraine
| | - Karolina Rasoul-Pelińska
- 1st Department of Gynecologic Oncology and Gynecology, Medical University of Lublin, Lublin, Poland.,Polish Society of Gynecologic Oncology, Warsaw, Poland
| | - Margaryta Lyzogub
- No 1 Medical Faculty, National Bogomolets Medical University, Kyiv, Ukraine
| | - Agnieszka Rychlik
- Polish Society of Gynecologic Oncology, Warsaw, Poland.,Department of Gynecologic Oncology, Maria Sklodowska-Curie National Research Institute of Oncology in Warsaw, Warsaw, Poland
| | - Andrei Pletnev
- Polish Society of Gynecologic Oncology, Warsaw, Poland.,Department of Gynecology and Obstetrics, University of Zielona Gora Faculty of Medicine and Health Sciences, Zielona Gora, Poland
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Sivakumaran T, Krasovitsky M, Freimund A, Lee YC, Webber K, So J, Norris C, Friedlander M, Mileshkin L, Au-Yeung G. Treatment patterns after poly-ADP ribose polymerase (PARP) inhibitors in epithelial ovarian cancer patients. Int J Gynecol Cancer 2022; 32:906-912. [PMID: 35321889 DOI: 10.1136/ijgc-2021-003009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES The primary objective of this study was to describe treatment patterns after poly-ADP ribose polymerase (PARP) inhibitor in patients with epithelial ovarian cancer. Secondary objectives were to evaluate duration of response, time to first subsequent therapy, progression-free survival and overall survival. METHODS This was a retrospective analysis of patients with epithelial ovarian cancer treated with PARP inhibitor therapy at six Australian gynecological oncology centers. Eligible patients were identified via clinics, trial databases and pharmacy dispensing logs between January 2005 and September 2019. Information regarding clinico-pathological characteristics and treatment outcomes were collated from medical records. RESULTS A total of 85 patients with epithelial ovarian cancer were identified. Of these, 61% had germline BRCA1/2 mutations, 9% had somatic BRCA1/2 mutations, 5% had confirmed homologous recombination deficiency and 25% were BRCA1/2 wildtype mutations. A total of seventy-seven (91%) patients received chemotherapy after PARP inhibitor, with fifty-six (72.7%) of these patients receiving platinum-based chemotherapy. Four patients (5%) had a complete response, 15 (20%) a partial response, 15 (20%) stable disease and 41 (55%) progressive disease. Median duration of response to chemotherapy was 7.0 months (range 0.2-20.4). Median time to first subsequent therapy was 17.6 and 15.1 months in patients who received a PARP inhibitor as maintenance therapy and treatment, respectively. Median progression-free survival of first line treatment after PARP inhibitor was 9.6, 3.5 and 4.6 months for platinum doublet, single agent platinum and non-platinum chemotherapy, respectively. Adjusting for age and FIGO (Federation of Gynecological Oncologists classification) stage progression-free survival did not differ between treatment groups (p=0.14). Median overall survival for the cohort was 69 months, and patients with platinum sensitive ovarian cancer had improved survival compared with those with platinum refractory or resistant disease. CONCLUSION Platinum doublet chemotherapy resulted in non-significant improved progression-free survival compared with other regimens, suggesting potential independent mechanisms of resistance between PARP inhibitor and platinum compounds.
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Affiliation(s)
- Tharani Sivakumaran
- Peter MacCallum Cancer Centre and Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Michael Krasovitsky
- Department of Medical Oncology, Prince of Wales Hospital and Royal Hospital for Women, Randwick, New South Wales, Australia.,University of New South Wales Prince of Wales Clinical School, Randwick, New South Wales, Australia
| | - Alison Freimund
- Peter MacCallum Cancer Centre and Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Yeh Chen Lee
- Department of Medical Oncology, Prince of Wales Hospital and Royal Hospital for Women, Randwick, New South Wales, Australia.,University of New South Wales Prince of Wales Clinical School, Randwick, New South Wales, Australia
| | - Kate Webber
- Department of Medical Oncology, Monash Health, Clayton, Victoria, Australia.,School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
| | - Jane So
- Department of Medical Oncology, Monash Health, Clayton, Victoria, Australia
| | - Christie Norris
- Department of Medical Oncology, Prince of Wales Hospital and Royal Hospital for Women, Randwick, New South Wales, Australia
| | - Michael Friedlander
- Department of Medical Oncology, Prince of Wales Hospital and Royal Hospital for Women, Randwick, New South Wales, Australia.,University of New South Wales Prince of Wales Clinical School, Randwick, New South Wales, Australia
| | - Linda Mileshkin
- Peter MacCallum Cancer Centre and Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Gynaecological Oncology, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - George Au-Yeung
- Peter MacCallum Cancer Centre and Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia .,Oncology and Dysplasia, The Royal Women's Hospital, Parkville, Victoria, Australia
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Aemaz Ur Rehman M, Farooq H, Ebaad Ur Rehman M, Ali MM, Zafar A, Khokhar MA. Perceptions of oncology as a career choice among the early career doctors in Pakistan. BMC Med Educ 2022; 22:61. [PMID: 35081960 PMCID: PMC8790828 DOI: 10.1186/s12909-022-03123-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 01/18/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Lack of oncologists is a growing global concern. With the rise in cancer burden across the world, the supply-demand mismatch of the oncology workforce is projected to increase. Furthermore, oncology is a low-ranked field of choice among medical students, and without understanding the perceptions and concerns of early-career doctors regarding oncology, any investments made in cancer care will be futile. This study aims to determine the opinions of young doctors and the factors most affecting their preferences in order to devise focused strategies to attract more doctors into oncology. METHODS A cross-sectional study was conducted on 300 early-career doctors across various public and private hospitals in Pakistan, from March to November 2019. A close-ended, self-administered questionnaire was used to assess their opinions in terms of the workplace environment, scope, and the emotional and financial aspects of oncology. Data was analyzed using SPSS version 23 and the influence (positive or negative) of the perceptions on the choice of oncology as a career was determined by binary logistic regression analysis. RESULTS Almost three-quarters of the participants did not want a career in oncology. The top positive perceptions about oncology in descending order were: progressive field, gender-neutral, stable working hours, financially healthy, and work-family balance. Top negative perceptions were: lack of oncologic facilities in hospitals, radiation exposure, need for private practice, poor patient prognosis, high patient load, and depressing environment. Participants who attended private medical school (p < 0.10), planned to live abroad (p < 0.10), had an oncologist (p < 0.05), cancer survivor or death due to cancer in the family (p < 0.05), were more likely to adopt oncology as a career. Those who believed that poor patient prognosis can have an impact on career choice were less likely to prefer oncology (p < 0.05). CONCLUSION Despite the rising cancer burden, early career doctors are reluctant to join oncology. Curricular, infrastructural and policy changes are needed at the level of medical school, oncology training and practice to recruit more young doctors and minimize the existing paucity of the oncologic workforce.
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Affiliation(s)
- Muhammad Aemaz Ur Rehman
- Department of Medicine, King Edward Medical University, Neela Gumbad Chowk, Anarkali, Lahore, 54000 Pakistan
| | - Hareem Farooq
- Department of Medicine, King Edward Medical University, Neela Gumbad Chowk, Anarkali, Lahore, 54000 Pakistan
| | | | - Muhammad Mohsin Ali
- Department of Medicine, King Edward Medical University, Neela Gumbad Chowk, Anarkali, Lahore, 54000 Pakistan
| | - Amjad Zafar
- Department of Oncology, King Edward Medical University, Neela Gumbad Chowk, Anarkali, Lahore, 54000 Pakistan
| | - Muhammad Abbas Khokhar
- Department of Oncology, King Edward Medical University, Neela Gumbad Chowk, Anarkali, Lahore, 54000 Pakistan
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Deppenwiese N, Delpy P, Lambarki M, Lablans M. ADT2FHIR - A Tool for Converting ADT/GEKID Oncology Data to HL7 FHIR Resources. Stud Health Technol Inform 2021; 283:104-10. [PMID: 34545825 DOI: 10.3233/SHTI210547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
Abstract
Harmonized and interoperable data management is a core requirement for federated infrastructures in clinical research. Institutions participating in such infrastructures often have to invest large degrees of time and resources in implementing necessary data integration processes to convert their local data to the required target structure. If the data is already available in an alternative shared data structure, the transformation from source to the desired target structure can be implemented once and then be distributed to all participants to reduce effort and harmonize results. The HL7® FHIR® standard is used as a basis for the shared data model of several medical consortia like DKTK and GBA. It is based on so-called resources which can be represented in XML. Oncological data in German university hospitals is commonly available in the ADT/GEKID format. From this common basis we conceptualized and implemented a transformation which accepts ADT/GEKID XML files and returns FHIR resources. We identified several problems with using the general ADT/GEKID structure in federated research infrastructures, as well as some possible pitfalls relating to the FHIR need for resource ids and focus on semantic coding which differs from the approach in the ADT/GEKID standard. To facilitate participation in federated infrastructures, we propose the ADT2FHIR transformation tool for partners with oncological data in the ADT/GEKID format.
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Dondapati M, Reyes JVM, Ahmad S, Stern AS, Lieber JJ. Rare Adult Subtype of Rhabdomyosarcoma, a Common Childhood Soft Tissue Carcinoma. J Investig Med High Impact Case Rep 2021; 9:23247096211042236. [PMID: 34459267 PMCID: PMC8408890 DOI: 10.1177/23247096211042236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Rhabdomyosarcoma is a malignant soft tissue sarcoma of primitive mesenchymal cells, showing varying degrees of striated skeletal muscle cell differentiation. It is a very common cancer of childhood and adolescence, but rarely seen in the adult population. Here, we present a case of a 33-year-old male presented with a poorly differentiated desmin positive alveolar rhabdomyosarcoma in the left arm. The prognosis of alveolar rhabdomyosarcoma in adults is very poor, frequently detected at advanced stages or with metastases. The alveolar subtype in particular has been found to have a more aggressive course with a high rate of metastasis. Recent studies have shown that using pediatric treatment guidelines resulted in better survival outcomes and local control, but the survival rates are still below that of the pediatric population. Newer studies are looking into using specific molecular markers for more targeted therapy in hopes of further improving survival rates in the adult population.
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Affiliation(s)
| | | | - Saad Ahmad
- Icahn School of Medicine at Mount Sinai, Elmhurst, NY, USA
| | - Aaron S Stern
- Icahn School of Medicine at Mount Sinai, Elmhurst, NY, USA
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Porcel JM, Bagüeste G, Liesa L, Bielsa S. Research productivity during residency training in Spain: Comparison among medical specialties lasting 5 years. Rev Clin Esp 2021:S2254-8874(21)00124-7. [PMID: 34294597 DOI: 10.1016/j.rceng.2021.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 02/22/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To compare the quantity and quality of publications during the residency training period in Cardiology, Intensive Care Medicine, Internal Medicine and Medical Oncology in Spain. METHODS A retrospective cohort study of residents from 4 specialties lasting 5 years (2014-2019). The number and type of publications indexed in PubMed®, the names of the journals and their bibliometric indexes (impact factor and quartiles), and author's positions were evaluated. RESULTS The 649 residents included in the study generated 801 publications (publication/resident ratio 1.23). Cardiology residents published significantly more (ratio 2.57) and Intensive Care Medicine residents less (ratio 0.42) than the remaining specialties (Internal Medicine, ratio 1.06; Medical Oncology, ratio 0.76; p < .001). Overall, only 44.5% of residents participated in a publication, with 27.6% participating in an original article; this latter percentage increased significantly among cardiologists (47.7%; p < .001). The predominant types of publications were original articles (47.9%) and clinical reports (36.8%). The proportion of publications in first quartile journals was higher for Cardiology residents (44.6% of total). The resident was the first or last author in only one-third of the publications. Scientific productivity was related to specialty, but not to gender or the size of the hospital in which the residency training occurred. CONCLUSIONS Intensive Care Medicine, Internal Medicine and Medical Oncology residents publish insufficiently, while the scientific production from Cardiology residents could be considered acceptable.
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Paredes-Paucar C, López-Fernández T. [Role of the cardiologist in the management of oncology patients. Where are we standing, and what to expect in the future?]. Arch Peru Cardiol Cir Cardiovasc 2021; 2:103-111. [PMID: 38274562 PMCID: PMC10809777 DOI: 10.47487/apcyccv.v2i2.140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 06/16/2021] [Indexed: 01/27/2024]
Abstract
Cardiovascular and oncological diseases are the main causes of death worldwide. Cancer patients have an increased risk of cardiovascular diseases but, at the same time, cardiovascular patients experience a higher risk of cancer. This relationship goes beyond the toxicity concerning cancer treatment. Cardio-oncology goal is to facilitate cancer therapy by implementing preventive strategies that allow early diagnosis and treatment of potential cancer therapy-induced cardiovascular complications, being heart failure the most fearest one. The creation of Cardio-oncology services has the potential to impact daily clinical practice and public health, with clear implications into the future.
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Affiliation(s)
- Cynthia Paredes-Paucar
- Unidad coronaria, Instituto Nacional de Cardiología Ignacio Chávez, México DF, México.Unidad coronariaInstituto Nacional de Cardiología Ignacio ChávezMéxico DFMéxico
| | - Teresa López-Fernández
- Servicio de cardiología, unidad de cardio-Oncologia Hospital Universitario La Paz. Instituto de investigación La Paz-IdiPAz. Madrid, España.Servicio de cardiología, unidad de cardio-OncologiaHospital Universitario La PazInstituto de investigación La Paz-IdiPAzMadridEspaña
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Rousseau A, Ashton E, Naoun N, Cren PY, Gligorov J, Negrier S, Penel N, Spano JP. [Manual for "Junior Doctors" in medical oncology]. Bull Cancer 2021; 108:377-384. [PMID: 33745736 DOI: 10.1016/j.bulcan.2021.02.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 02/18/2021] [Accepted: 02/19/2021] [Indexed: 11/30/2022]
Abstract
The reform of medical residency introduced in 2017 established the position of Junior Doctor, for its last phase, called the consolidation phase. Its goal is the increasing and supervised autonomy of the resident, in order to better support the transition toward senior practitioner. It appears necessary to define proper guidelines on the status and the specific role of Junior Doctor in medical oncology, in order to help the implementation of the reform of the 3rd cycle. This document is the result of a collaboration between AERIO and CNEC, that respectively represent medical oncology residents and university teachers. It aims to advise and guide local practices, without being compulsory, before the arrival of the first Junior Doctors in November 2021. It explains the Junior Doctors' principal jobs: consultation, multidisciplinary meeting, day clinic, hospitalization, clinical research, quality policy and teaching.
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Affiliation(s)
- Adrien Rousseau
- Association pour l'enseignement et la recherche des internes en oncologie (AERIO), 149, avenue du Maine, 75014 Paris, France
| | - Elisabeth Ashton
- Association pour l'enseignement et la recherche des internes en oncologie (AERIO), 149, avenue du Maine, 75014 Paris, France
| | - Natacha Naoun
- Association pour l'enseignement et la recherche des internes en oncologie (AERIO), 149, avenue du Maine, 75014 Paris, France.
| | - Pierre-Yves Cren
- Association du nord des internes et des chefs de clinique d'oncologie médicale et de radiothérapie (ANICOR), 3, rue Frederic-Combemale, 59000 Lille, France
| | - Joseph Gligorov
- Hôpital Tenon, Collège national des enseignants en cancérologie (CNEC), service d'oncologie médicale, 4, rue de la Chine, 75020 Paris, France
| | - Sylvie Negrier
- Collège national des enseignants en cancérologie (CNEC), centre Léon-Bérard, service d'oncologie médicale, 28, Promenade-Léa-et-Napoléon-Bullukian, 69008 Lyon, France
| | - Nicolas Penel
- Université de Lille, centre Oscar-Lambret, service d'oncologie médicale, UNICANCER, 3, rue Frédéric-Combemale, 59000 Lille, France
| | - Jean-Philippe Spano
- Hôpital Pitié-Salpétrière, Collège national des enseignants en cancérologie (CNEC), service d'oncologie médicale, 47-83, boulevard de l'Hôpital, 75013 Paris, France
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Yu S, Mamtani R, O'Hara MH, O'Dwyer PJ, Margalit O, Giantonio BJ, Shmueli E, Reiss KA, Boursi B. Comparative Effectiveness of Total Neoadjuvant Therapy Versus Standard Adjuvant Chemotherapy for Locally Advanced Rectal Cancer. Clin Colorectal Cancer 2021; 20:121-129. [PMID: 33608161 DOI: 10.1016/j.clcc.2021.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 01/11/2021] [Accepted: 01/15/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The use of total neoadjuvant therapy (TNT) for locally advanced rectal cancer has been increasing in recent years, but the long-term overall survival characteristics of this approach is currently unknown. METHODS We performed a retrospective study of patients with clinical stage II/III rectal cancer within the National Cancer Database. Patients who received TNT (defined as chemotherapy, followed by CRT, followed by surgery) were propensity score matched to patients who received adjuvant therapy (defined as CRT, followed by surgery, followed by chemotherapy). We compared overall survival (OS) and rates of pathologic complete response (pCR) between the 2 arms. RESULTS Of the 4300 patients in our cohort, 3502 (81%) received adjuvant therapy and 798 (19%) received TNT. At baseline, patients who received TNT were more likely to have higher clinical T and N stages (P< .001). The 5-year OS was 77% for both TNT and adjuvant therapy patients (hazard ratio [HR] 1.06, 95% confidence interval [CI], 0.88-1.28, P = .57). After propensity score matching and adjusting for potential confounders, there were no significant differences in OS (HRadj 1.00, 95% CI, 0.71-1.40, P = .99). After propensity score matching, there were higher pCR rates among TNT patients (16.1%) compared to adjuvant therapy patients (12.0%) (P = .037). CONCLUSION In this observational study, we found TNT was not associated with a lower OS compared to standard adjuvant chemotherapy. This finding potentially reassures clinicians choosing TNT as an alternative to adjuvant chemotherapy. However, future prospective data are needed to confirm these findings.
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Affiliation(s)
- Shun Yu
- Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Ronac Mamtani
- Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Mark H O'Hara
- Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Peter J O'Dwyer
- Hospital of the University of Pennsylvania, Philadelphia, PA
| | | | | | | | - Kim A Reiss
- Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Ben Boursi
- Hospital of the University of Pennsylvania, Philadelphia, PA; Sheba Medical Center, Tel-Hashomer, Israel.
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Coyne ZL, Hennessy M, Duke D, Hill A, Grogan L, Breathnach O, Hennessy B, Morris PG. Patient demographics and management challenges in an Irish symptomatic breast cancer unit. Ir J Med Sci 2020; 189:1237-1241. [PMID: 32436172 DOI: 10.1007/s11845-020-02245-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 04/28/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Breast cancer is the most common cancer in women. Beaumont Hospital is a nationally designated symptomatic breast cancer unit, independent of the national screening programme, BreastCheck. AIMS We hypothesised that patients attending symptomatic breast cancer units differ from national registry data and aimed to characterise this in a retrospective study. METHODS A prospective database of patients diagnosed with breast cancer was maintained between 2014 and 2017. Multiple patient and tumour demographics were analysed retrospectively and compared with data from the National Cancer Registry. RESULTS In total, 944 patients were diagnosed with breast cancer, 379 (40%) were aged < 50, 206 (22%) 50-64, 208 (22%) 65-75 and 151 (16%) > 75 years respectively. Expectedly, older patients (≥ 65 years) had a higher proportion of oestrogen receptor-positive, HER2-negative breast cancer (72%). Triple negative breast cancer was relatively more common (17%) among younger patients. These patients received more intensive chemotherapy: 118 (64%) received combination anthracycline-taxane chemotherapy, in comparison with only 14 (21%) of older patients. Patients generally presented at a later stage compared with national registry data: stage II 491 (52%) and stage III 179 (19%) versus stage II (50%) and stage III (13%). CONCLUSION Patients attending the symptomatic breast cancer unit Beaumont Hospital have different demographics compared with the national registry data. This presents particular challenges for management.
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Affiliation(s)
- Zac L Coyne
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland.
- Department of Breast Surgery, Beaumont Hospital, Dublin, Ireland.
- Department of Radiology, Beaumont Hospital, Dublin, Ireland.
- Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland.
- Royal College of Surgeons Ireland, Dublin, Ireland.
| | - Maeve Hennessy
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
- Department of Breast Surgery, Beaumont Hospital, Dublin, Ireland
- Department of Radiology, Beaumont Hospital, Dublin, Ireland
- Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland
- Royal College of Surgeons Ireland, Dublin, Ireland
| | - Deirdre Duke
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
- Department of Breast Surgery, Beaumont Hospital, Dublin, Ireland
- Department of Radiology, Beaumont Hospital, Dublin, Ireland
- Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland
- Royal College of Surgeons Ireland, Dublin, Ireland
| | - Arnold Hill
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
- Department of Breast Surgery, Beaumont Hospital, Dublin, Ireland
- Department of Radiology, Beaumont Hospital, Dublin, Ireland
- Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland
- Royal College of Surgeons Ireland, Dublin, Ireland
| | - Liam Grogan
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
- Department of Breast Surgery, Beaumont Hospital, Dublin, Ireland
- Department of Radiology, Beaumont Hospital, Dublin, Ireland
- Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland
- Royal College of Surgeons Ireland, Dublin, Ireland
| | - Oscar Breathnach
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
- Department of Breast Surgery, Beaumont Hospital, Dublin, Ireland
- Department of Radiology, Beaumont Hospital, Dublin, Ireland
- Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland
- Royal College of Surgeons Ireland, Dublin, Ireland
| | - Bryan Hennessy
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
- Department of Breast Surgery, Beaumont Hospital, Dublin, Ireland
- Department of Radiology, Beaumont Hospital, Dublin, Ireland
- Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland
- Royal College of Surgeons Ireland, Dublin, Ireland
| | - Patrick G Morris
- Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland
- Department of Breast Surgery, Beaumont Hospital, Dublin, Ireland
- Department of Radiology, Beaumont Hospital, Dublin, Ireland
- Cancer Clinical Trials and Research Unit, Beaumont Hospital, Dublin, Ireland
- Royal College of Surgeons Ireland, Dublin, Ireland
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Salas-Vega S, Shearer E, Mossialos E. Relationship between costs and clinical benefits of new cancer medicines in Australia, France, the UK, and the US. Soc Sci Med 2020; 258:113042. [PMID: 32480184 DOI: 10.1016/j.socscimed.2020.113042] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 04/30/2020] [Accepted: 05/05/2020] [Indexed: 12/19/2022]
Abstract
As cancer drug prices rise, it remains unclear whether the cost of new interventions is related to their beneficial impact for patients at a societal-level. Using data for 2003-2015 from the IQVIA MIDAS® dataset, the relationship between cancer drug costs and drug clinical benefits was studied in four countries with different approaches to drug pricing. Summary measures of drug clinical effects on overall survival, quality of life, and safety were obtained from a review of health technology assessments. Mean total drug costs for a full course of treatment were estimated using standard posology for each medicine and in each country. Regression analysis was used to test whether, at a societal-level, the cost of recently licensed drugs is related to their beneficial impact for patients. Across all eligible medicines, average treatment costs were lowest in France and Australia and highest in the UK and US. Compared with Australia, France, and the UK, cancer medicines were on average between 1.2 and 1.9 times more expensive in the US, where the average total per patient cost for treatment was $68,255.17. Costs for new cancer medicines are high and, at best, only weakly associated with drug clinical benefits. The strength of this relationship nevertheless varied across countries. Some new cancer drugs-particularly in the US-may be neither affordable nor clinically beneficial over existing treatments. While all countries can benefit from strategies that more robustly align price with therapeutic benefit in cancer drugs, the US stands out in its opportunity to improve both affordability and value in cancer drug treatment.
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Affiliation(s)
- Sebastian Salas-Vega
- Fellow in Health Policy and Economics, London School of Economics and Political Science, Houghton Street, London, UK.
| | - Emily Shearer
- Research Associate, Department of Health Research and Policy, Stanford University, Palo Alto, CA, USA
| | - Elias Mossialos
- Brian-Abel Smith Professor of Health Policy, London School of Economics and Political Science, Houghton Street, London, UK
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Abstract
Leukemic cells are rarely present in the oral cavity, and there are very few reports regarding such cases. However, we identified some reports of leukemic cells infiltrating tissues in the oral cavity, including gingival involvement. Recurrent painful oral ulcerations and prominent generalized periodontal destruction are the most common oral features of neutrophil disorders, and they may even be the initial symptoms of the disease. The ulcers may affect any part of the oral mucosa, including the tongue and palate. The objective of this report is to describe and discuss a case of myeloid sarcoma in the oral cavity of a 48-year-old male patient.
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Affiliation(s)
| | - Felipe Paiva Fonseca
- Universidade Federal de Minas Gerais (UFMG), School of Dentistry, Department of Oral Surgery and Pathology. Belo Horizonte, MG, Brazil
| | | | | | - Luciana Tucunduva
- Hospital Sírio-Libanês, Department of Onco-Hematology and Bone Marrow Transplantation. São Paulo, SP, Brazil
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Kuliš T, Penezić L, Gamulin M, Mokos I, Marić M, Ferenčak V, Goluža E, Hudolin T, Kaštelan Ž. THE PROSTATE CENTER: MULTIDISCIPLINARITY, ORGANIZATION OF DIAGNOSTIC WORK-UP AND TREATMENT OF PROSTATE CANCER. Acta Clin Croat 2019; 58:16-20. [PMID: 34975193 PMCID: PMC8693558 DOI: 10.20471/acc.2019.58.s2.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The aim of this paper is to show the results of prostate cancer treatment in Prostate Center of Department of Urology at the University Hospital Center Zagreb. The answer to growing demands for prostate cancer treatment due to increasing incidence is the formation of specialized, multidisciplinary units/centers that deal mainly with prostate cancer. The need was recognized by European School of Oncology and European Association of Urology, who have proposed their concepts of validating such centers with the aim of promoting high-quality prostate cancer treatment. Following these trends, the Department of Urology at the University Hospital Center Zagreb has established the Prostate Center. This new unit offers specialized and individualized approach to workup, treatment and follow up for prostate cancer patients based on multidisciplinarity. The Prostate Center was also established as a platform for education and research.
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Abstract
In the field of oncology, survival analysis is one of the most important tools in terms of measuring therapy success, evaluating risk or prognostic factors. Within this work, a variety of common survival analyses were embedded into a real-time analysis platform based on a comprehensive oncological dataset. The analysis platform utilizes an in-memory database, therefore allowing spontaneous adjustments of the survival curves to selections and stratifications. In contrast to classical statistics, where individual scripts have to be formulated for every possible request, the running system allows the deduction of instantaneous results.
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Affiliation(s)
- Sophie Schneiderbauer
- Comprehensive Cancer Center Munich - LMU, Hospital of the Ludwig-Maximilians-University Munich, Bavaria, Germany
| | - Diana Schweizer
- Comprehensive Cancer Center Munich - LMU, Hospital of the Ludwig-Maximilians-University Munich, Bavaria, Germany
| | - Theres Fey
- Comprehensive Cancer Center Munich - LMU, Hospital of the Ludwig-Maximilians-University Munich, Bavaria, Germany
| | - Daniel Nasseh
- Comprehensive Cancer Center Munich - LMU, Hospital of the Ludwig-Maximilians-University Munich, Bavaria, Germany
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Castelo-Branco L, Silva IP, Canhão H, Awada A. Promising Immuno-Oncology Treatments Beyond the 2018 Nobel Prize. ACTA MEDICA PORT 2019; 32:251-257. [PMID: 31067417 DOI: 10.20344/amp.12040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Accepted: 03/20/2019] [Indexed: 11/20/2022]
Affiliation(s)
- Luís Castelo-Branco
- Serviço de Oncologia Médica. Centro Hospitalar e Universitário do Algarve. Faro. Portugal; Departamento de Epidemiologia. Escola Nacional de Saúde Pública. Universidade NOVA de Lisboa. Lisboa. Portugal
| | | | - Helena Canhão
- Departamento de Epidemiologia. Escola Nacional de Saúde Pública. Universidade NOVA de Lisboa. Lisboa. Centro de Estudos de Doenças Crónicas/ Chronic Diseases Research Center - CEDOC. Epidemiology of Chronic Diseases Unit - EpiDoC. NOVA Medical School. Universidade NOVA de Lisboa. Lisboa. Serviço de Reumatologia. Hospital Curry Cabral. Centro Hospitalar e Universitário de Lisboa Central. Lisboa. Portugal
| | - Ahmad Awada
- Medical Oncology Institut Jules Bordet. Université Libre de Bruxelles. Brussels. Belgium
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