This document summarizes key findings from studies presented at the 2009 American Society of Hematology annual meeting regarding the drug MabThera for the treatment of chronic lymphocytic leukemia (CLL) and non-Hodgkin's lymphoma (NHL). Long-term follow up data from the CLL8 trial showed that the combination of MabThera and chemotherapy improved 3-year overall survival rates compared to chemotherapy alone in patients with first-line CLL. The progression-free survival benefit was also improved with longer follow up. Several studies also investigated optimizing MabThera-based therapy for NHL and demonstrated benefits for combinations with other drugs.
This document discusses the development and clinical trials of the drug bortezomib for the treatment of multiple myeloma. It summarizes that:
1) Bortezomib is a proteasome inhibitor that showed promise in preclinical studies for inhibiting multiple myeloma cell growth and inducing apoptosis.
2) Phase 1, 2 and 3 clinical trials demonstrated that bortezomib had significant anti-tumor activity and increased response rates, time to progression, and survival outcomes compared to other treatments in patients with relapsed or refractory multiple myeloma.
3) Combination trials using bortezomib with other drugs, such as dexamethasone, produced even higher response rates, suggesting
Etoposide 50 mg, 100mg capsule, soft smpc taj pharmaceuticalsTaj Pharma
ETOPOSIDE - Drug Information - Taj Pharma, ETOPOSIDE dose Taj pharmaceuticals ETOPOSIDE interactions, Taj Pharmaceutical ETOPOSIDE contraindications, ETOPOSIDE price, ETOPOSIDE Taj Pharma Cancer, oncologyEtoposide 50 mg, 100mg capsule, soft SMPC- Taj Pharma . Stay connected to all updated on ETOPOSIDE Taj Pharmaceuticals Taj pharmaceuticals Hyderabad.
Jorge E. Cortes, MD, and Stephen A. Strickland, MD, MSCI, prepared useful practice aids pertaining to acute myeloid leukemia for this CME activity titled "Novel Induction Options in AML: Assessing the Implications for HCT-Eligible Patients." For the full presentation, monograph, complete CME information, and to apply for credit, please visit us at http://bit.ly/2u4yk5p. CME credit will be available until April 3, 2019.
This document discusses cancer fatigue, which is a persistent sense of physical, emotional, and cognitive tiredness disproportionate to activity that interferes with functioning. It affects 25-99% of cancer patients and leads to poor quality of life. Risk factors include chemotherapy, radiation therapy, and immunotherapy. Fatigue is caused by genetic, immune, endocrine, and mitochondrial factors. Screening and treatment of fatigue should be provided according to NCCN guidelines. Treatment options include exercise, diet, sleep hygiene, psychotherapy, pharmacotherapy like stimulants and antidepressants, and complementary therapies.
Metronomic Chemotherapy Vs Best Supportive Care in Progressive Pediatric Tumors.Pranav Sopory
Journaal Club discussing the Randomised Clinical Trial (RCT) of metronomic chemotherapy in extra cranial, non-hematopoietic solid malignancies in paediatric population (aged 5-18 years). Courtesy Dr Atul Batra, Asst. Prof. Medical Oncology, IRCH, AIIMS.
Gemcitabine 200mg, 1g powder for solution for infusion smpc taj pharmaceuticalsTaj Pharma
GEMCITABINE Taj Pharma : Uses, Side Effects, Interactions, Pictures, Warnings, GEMCITABINE Dosage & Rx Info | GEMCITABINE Uses, Side Effects -: Indications, Side Effects, Warnings, GEMCITABINE - Drug Information - Taj Pharma, GEMCITABINE dose Taj pharmaceuticals GEMCITABINE interactions, Taj Pharmaceutical GEMCITABINE contraindications, GEMCITABINE price, GEMCITABINE Taj Pharma Cancer, oncologyGemcitabine 200mg, 1g Powder for Solution for Infusion. SMPC- Taj Pharma
botulinum toxin and appropriate modulation of spasticity giankaianieri
The aim of this study was to demonstrate high dosage and appropriate flexible intervals between infiltrations cause a significant clinical efficacy over time or a rise in adverse reactions
This document discusses the development and clinical trials of the drug bortezomib for the treatment of multiple myeloma. It summarizes that:
1) Bortezomib is a proteasome inhibitor that showed promise in preclinical studies for inhibiting multiple myeloma cell growth and inducing apoptosis.
2) Phase 1, 2 and 3 clinical trials demonstrated that bortezomib had significant anti-tumor activity and increased response rates, time to progression, and survival outcomes compared to other treatments in patients with relapsed or refractory multiple myeloma.
3) Combination trials using bortezomib with other drugs, such as dexamethasone, produced even higher response rates, suggesting
Etoposide 50 mg, 100mg capsule, soft smpc taj pharmaceuticalsTaj Pharma
ETOPOSIDE - Drug Information - Taj Pharma, ETOPOSIDE dose Taj pharmaceuticals ETOPOSIDE interactions, Taj Pharmaceutical ETOPOSIDE contraindications, ETOPOSIDE price, ETOPOSIDE Taj Pharma Cancer, oncologyEtoposide 50 mg, 100mg capsule, soft SMPC- Taj Pharma . Stay connected to all updated on ETOPOSIDE Taj Pharmaceuticals Taj pharmaceuticals Hyderabad.
Jorge E. Cortes, MD, and Stephen A. Strickland, MD, MSCI, prepared useful practice aids pertaining to acute myeloid leukemia for this CME activity titled "Novel Induction Options in AML: Assessing the Implications for HCT-Eligible Patients." For the full presentation, monograph, complete CME information, and to apply for credit, please visit us at http://bit.ly/2u4yk5p. CME credit will be available until April 3, 2019.
This document discusses cancer fatigue, which is a persistent sense of physical, emotional, and cognitive tiredness disproportionate to activity that interferes with functioning. It affects 25-99% of cancer patients and leads to poor quality of life. Risk factors include chemotherapy, radiation therapy, and immunotherapy. Fatigue is caused by genetic, immune, endocrine, and mitochondrial factors. Screening and treatment of fatigue should be provided according to NCCN guidelines. Treatment options include exercise, diet, sleep hygiene, psychotherapy, pharmacotherapy like stimulants and antidepressants, and complementary therapies.
Metronomic Chemotherapy Vs Best Supportive Care in Progressive Pediatric Tumors.Pranav Sopory
Journaal Club discussing the Randomised Clinical Trial (RCT) of metronomic chemotherapy in extra cranial, non-hematopoietic solid malignancies in paediatric population (aged 5-18 years). Courtesy Dr Atul Batra, Asst. Prof. Medical Oncology, IRCH, AIIMS.
Gemcitabine 200mg, 1g powder for solution for infusion smpc taj pharmaceuticalsTaj Pharma
GEMCITABINE Taj Pharma : Uses, Side Effects, Interactions, Pictures, Warnings, GEMCITABINE Dosage & Rx Info | GEMCITABINE Uses, Side Effects -: Indications, Side Effects, Warnings, GEMCITABINE - Drug Information - Taj Pharma, GEMCITABINE dose Taj pharmaceuticals GEMCITABINE interactions, Taj Pharmaceutical GEMCITABINE contraindications, GEMCITABINE price, GEMCITABINE Taj Pharma Cancer, oncologyGemcitabine 200mg, 1g Powder for Solution for Infusion. SMPC- Taj Pharma
botulinum toxin and appropriate modulation of spasticity giankaianieri
The aim of this study was to demonstrate high dosage and appropriate flexible intervals between infiltrations cause a significant clinical efficacy over time or a rise in adverse reactions
Perspectives on the Treatment of Melanomaflasco_org
OBJECTIVES:
To understand the mechanisms of action of BRAF and MEK targeted therapy of melanoma.
To understand the mechanisms of action of currently approved immunotherapy drugs for melanoma.
To outline the recent phase III results of immunotherapy and targeted therapy for metastatic melanoma.
This study will conduct a randomized controlled trial to compare the efficacy of ultra-low doses of rituximab (RTX) to the standard low dose in patients with rheumatoid arthritis (RA) who are being retreated with RTX. The trial will randomize 140 RA patients who have responded well previously to RTX to receive either an ultra-low dose of 1 x 200 mg or 1 x 500 mg RTX, or the standard low dose of 1 x 1000 mg RTX. The primary outcome is whether the ultra-low doses are non-inferior to the standard dose in reducing disease activity as measured by DAS28-CRP from baseline to 6 months, using a non-inferiority margin of 0
Pharmacogenetics is the study of genetic variations that influence individual responses to drugs. It aims to provide information to help doctors prescribe better and safer drugs at appropriate doses tailored to a patient's genetics. The study examines how genetic variations can affect drug metabolism and efficacy. Understanding a patient's genetic profile could help predict drug responses and prevent adverse reactions.
12 fischer best use of 5-as_as immunomodulator agentsangel4567
1) 5-ASAs are strongly recommended for inducing remission in mild-to-moderate UC but are not recommended for Crohn's disease.
2) Immunomodulators like azathioprine and 6-MP are recommended for maintaining remission in UC and Crohn's disease but not for inducing remission.
3) Diet, probiotics, and antibiotics like rifaximin show some promise in treating IBD but require more research to determine their effectiveness. Maintaining the right balance of gut microbiota may help manage symptoms.
This document discusses tumor markers and treatments for various types of ovarian cancer. It outlines several tumor markers - BRCA1/2, CA-125, HE4, HER2/neu, and OVA1 - that are analyzed in blood and/or tumors to determine cancer type and guide treatment decisions. For stage III or IV ovarian cancer, intraperitoneal chemotherapy may be given in addition to intravenous chemotherapy. Regimens discussed include paclitaxel and cisplatin. PARP inhibitors are approved for platinum-sensitive or BRCA-mutated recurrent ovarian cancer. Hormonal therapies and carboplatin-based chemotherapy are options for elderly patients or those who cannot tolerate standard treatments.
Nick chen ppt presentation metronomic chemotherapy 2015CNPS, LLC
Metronomic chemotherapy provides several advantages over conventional chemotherapy:
- It is associated with lower toxicity due to more frequent lower doses, allowing better treatment consistency.
- It has enhanced anti-cancer effects through anti-angiogenesis and improved immune response against tumors.
- Targeting both the tumor and tumor microenvironment makes it less likely to encounter chemo-resistance.
Antibody Directed Enzyme Prodrug therapy is a technique of active drug targeting therapy which was developed to reduce cancer chemotherapy associated Toxicity
Metronomic chemotherapy involves the chronic administration of low, minimally toxic doses of chemotherapy drugs on a frequent schedule with no prolonged breaks. This contrasts with conventional chemotherapy which uses maximum tolerated doses with breaks to allow for bone marrow recovery. Metronomic chemotherapy aims to target the tumor vasculature through its anti-angiogenic effects and has shown efficacy in palliative settings with less toxicity. Several drugs have been used in metronomic chemotherapy regimens with the most common being cyclophosphamide and methotrexate. Ongoing research is focused on optimizing dosing schedules and biomarkers to evaluate treatment response and resistance.
Quality of Life, Clinical Effectiveness and Satisfaction in Patient with Beta...Sunil Vadithya
Quality of Life, Clinical Effectiveness and Satisfaction in Patient with Beta Thalassemia Major and Sickel Cell Anemia Receiver Deferasirox Chelation Therapy
This document discusses the diagnosis and treatment of drugs five years after their approval, focusing on procarbazine. It provides the following key points:
1) Procarbazine has an established role in combination chemotherapy for Hodgkin's disease since its 1969 FDA approval, but its role has not expanded beyond this and a few other applications in the past 5 years.
2) It is most effective for Hodgkin's disease when used in combination with other drugs in the MOPP regimen, achieving around an 80% complete remission rate. However, relapse remains an issue.
3) For other cancers like non-Hodgkin's lymphomas and lung cancer, procarbazine has limited effectiveness as a single
Nilotinib Capsules 50mg/150mg/200mg Taj Pharma: Uses, Side Effects, Interactions, Pictures, Warnings, Nilotinib Dosage & Rx Info | Nilotinib Uses, Side Effects Nilotinib: Indications, Side Effects, Warnings, Nilotinib -Drug Information –Taj Pharma, Nilotinib dose Taj pharmaceuticals Nilotinib interactions, Taj Pharmaceutical Nilotinib contraindications, Nilotinib price, Nilotinib Taj Pharma Nilotinib SmPC-Taj Pharma Stay connected to all updated on Nilotinib Taj Pharmaceuticals Mumbai. Patient Information Leaflets, SmPC.
Drug transport and drug targeting - rumana hameedRumana Hameed
This document discusses genetic polymorphisms in drug transporters and drug targets. It covers various methods of targeted drug delivery including first, second, and third order targeting based on the specific cells or tissues targeted. Passive and active targeting approaches are described along with examples like magnetic drug targeting using nanoparticles, liposomes, transdermal patches, and brain-targeted delivery systems. The conclusion emphasizes that targeted drug delivery can reduce dose and side effects by assisting drugs to reach the desired site.
This study compared eribulin mesylate to capecitabine in patients with locally advanced or metastatic breast cancer previously treated with anthracycline and taxane chemotherapy. The open-label, randomized, phase III study found no statistically significant differences between eribulin and capecitabine in overall survival or progression-free survival. Both drugs demonstrated similar safety profiles and effects on quality of life as expected based on their known adverse effect profiles. The study concluded that eribulin was not shown to be superior to capecitabine for overall survival or progression-free survival in this patient population.
Lusedra (Fospropofol) is a new sedative-hypnotic agent indicated for monitored anesthesia care during diagnostic or therapeutic procedures. It works by metabolizing into propofol. Standard dosing for induction is 6.5mg/kg by IV bolus, with supplemental doses of 1.6mg/kg as needed to maintain sedation. Common side effects include nausea, vomiting, headache, and hypotension. It provides moderate sedation and has more predictable pharmacokinetics than propofol.
This study evaluated 122 cases of breast cancer treated with the Di Bella Method (DBM), an alternative therapy combining melatonin, retinoids, vitamins, and other supplements.
The results showed:
- For early-stage breast cancer, 4/9 cases achieved complete remission with DBM as first-line therapy alone. As adjuvant therapy, DBM achieved a 5-year survival rate of 100%, significantly higher than standard rates.
- For metastatic breast cancer, 2/4 cases achieved remission with DBM as first-line therapy. As adjuvant therapy after surgery, 3/6 cases achieved remission.
- Overall, the DBM approach improved survival rates, response rates,
1) The document discusses endocrine therapy options for ER+ HER2- metastatic breast cancer (MBC), including first-line aromatase inhibitors versus tamoxifen, comparisons between different aromatase inhibitors, and the role of fulvestrant.
2) The FIRST trial found that fulvestrant 500 mg had significantly longer time to progression compared to anastrozole as first-line therapy for postmenopausal women.
3) For premenopausal women, combinations of luteinizing hormone-releasing hormone agonists with tamoxifen or aromatase inhibitors showed benefits, with no differences between the arms.
Deferasirox Dispersible Tablets SmPC Taj PharmaceuticalsTajPharmaQC
Deferasirox Dispersible Tablets 125mg, 250mg, 400mg, 500mg Taj Pharma: Uses, Side Effects, Interactions, Pictures, Warnings, Deferasirox Dosage & Rx Info | Deferasirox Uses, Side Effects Deferasirox: Indications, Side Effects, Warnings, Deferasirox -Drug Information –Taj Pharma, Deferasirox dose Taj pharmaceuticals Deferasirox interactions, Taj Pharmaceutical Deferasirox contraindications, Deferasirox price, Deferasirox Taj Pharma Deferasirox SmPC- Taj Pharma Stay connected to all updated on Deferasirox Taj Pharmaceuticals Mumbai. Patient Information Leaflets, SMPC.
La nouvelle tag: turismo 3.0 e il Rinascimento del retailingWebsolute
Image Lab, Centro di Ricerca sui Linguaggi visivi e sulla Moda dell'Università di Urbino, ci racconta i "touchpoint", i punti di contatto tra brand e utenti nel settore retail.
This document lists 7 types of coral: Yellow pencil coral, Great Star coral, Orange cup coral, Flower coral, Brain coral, Bubble coral, and Lettuce Coral. The corals are numbered 1 through 7 but are not described further.
Brand Monitoring: monitoraggio del marchio in Rete Websolute
Brand Monitoring: monitoraggio del marchio in Rete. Viral marketing e web monitoring. L'importanza di un costante ed efficace monitoraggio per cogliere la percezione del Brand di prodotti e servizi sulla rete.
Perspectives on the Treatment of Melanomaflasco_org
OBJECTIVES:
To understand the mechanisms of action of BRAF and MEK targeted therapy of melanoma.
To understand the mechanisms of action of currently approved immunotherapy drugs for melanoma.
To outline the recent phase III results of immunotherapy and targeted therapy for metastatic melanoma.
This study will conduct a randomized controlled trial to compare the efficacy of ultra-low doses of rituximab (RTX) to the standard low dose in patients with rheumatoid arthritis (RA) who are being retreated with RTX. The trial will randomize 140 RA patients who have responded well previously to RTX to receive either an ultra-low dose of 1 x 200 mg or 1 x 500 mg RTX, or the standard low dose of 1 x 1000 mg RTX. The primary outcome is whether the ultra-low doses are non-inferior to the standard dose in reducing disease activity as measured by DAS28-CRP from baseline to 6 months, using a non-inferiority margin of 0
Pharmacogenetics is the study of genetic variations that influence individual responses to drugs. It aims to provide information to help doctors prescribe better and safer drugs at appropriate doses tailored to a patient's genetics. The study examines how genetic variations can affect drug metabolism and efficacy. Understanding a patient's genetic profile could help predict drug responses and prevent adverse reactions.
12 fischer best use of 5-as_as immunomodulator agentsangel4567
1) 5-ASAs are strongly recommended for inducing remission in mild-to-moderate UC but are not recommended for Crohn's disease.
2) Immunomodulators like azathioprine and 6-MP are recommended for maintaining remission in UC and Crohn's disease but not for inducing remission.
3) Diet, probiotics, and antibiotics like rifaximin show some promise in treating IBD but require more research to determine their effectiveness. Maintaining the right balance of gut microbiota may help manage symptoms.
This document discusses tumor markers and treatments for various types of ovarian cancer. It outlines several tumor markers - BRCA1/2, CA-125, HE4, HER2/neu, and OVA1 - that are analyzed in blood and/or tumors to determine cancer type and guide treatment decisions. For stage III or IV ovarian cancer, intraperitoneal chemotherapy may be given in addition to intravenous chemotherapy. Regimens discussed include paclitaxel and cisplatin. PARP inhibitors are approved for platinum-sensitive or BRCA-mutated recurrent ovarian cancer. Hormonal therapies and carboplatin-based chemotherapy are options for elderly patients or those who cannot tolerate standard treatments.
Nick chen ppt presentation metronomic chemotherapy 2015CNPS, LLC
Metronomic chemotherapy provides several advantages over conventional chemotherapy:
- It is associated with lower toxicity due to more frequent lower doses, allowing better treatment consistency.
- It has enhanced anti-cancer effects through anti-angiogenesis and improved immune response against tumors.
- Targeting both the tumor and tumor microenvironment makes it less likely to encounter chemo-resistance.
Antibody Directed Enzyme Prodrug therapy is a technique of active drug targeting therapy which was developed to reduce cancer chemotherapy associated Toxicity
Metronomic chemotherapy involves the chronic administration of low, minimally toxic doses of chemotherapy drugs on a frequent schedule with no prolonged breaks. This contrasts with conventional chemotherapy which uses maximum tolerated doses with breaks to allow for bone marrow recovery. Metronomic chemotherapy aims to target the tumor vasculature through its anti-angiogenic effects and has shown efficacy in palliative settings with less toxicity. Several drugs have been used in metronomic chemotherapy regimens with the most common being cyclophosphamide and methotrexate. Ongoing research is focused on optimizing dosing schedules and biomarkers to evaluate treatment response and resistance.
Quality of Life, Clinical Effectiveness and Satisfaction in Patient with Beta...Sunil Vadithya
Quality of Life, Clinical Effectiveness and Satisfaction in Patient with Beta Thalassemia Major and Sickel Cell Anemia Receiver Deferasirox Chelation Therapy
This document discusses the diagnosis and treatment of drugs five years after their approval, focusing on procarbazine. It provides the following key points:
1) Procarbazine has an established role in combination chemotherapy for Hodgkin's disease since its 1969 FDA approval, but its role has not expanded beyond this and a few other applications in the past 5 years.
2) It is most effective for Hodgkin's disease when used in combination with other drugs in the MOPP regimen, achieving around an 80% complete remission rate. However, relapse remains an issue.
3) For other cancers like non-Hodgkin's lymphomas and lung cancer, procarbazine has limited effectiveness as a single
Nilotinib Capsules 50mg/150mg/200mg Taj Pharma: Uses, Side Effects, Interactions, Pictures, Warnings, Nilotinib Dosage & Rx Info | Nilotinib Uses, Side Effects Nilotinib: Indications, Side Effects, Warnings, Nilotinib -Drug Information –Taj Pharma, Nilotinib dose Taj pharmaceuticals Nilotinib interactions, Taj Pharmaceutical Nilotinib contraindications, Nilotinib price, Nilotinib Taj Pharma Nilotinib SmPC-Taj Pharma Stay connected to all updated on Nilotinib Taj Pharmaceuticals Mumbai. Patient Information Leaflets, SmPC.
Drug transport and drug targeting - rumana hameedRumana Hameed
This document discusses genetic polymorphisms in drug transporters and drug targets. It covers various methods of targeted drug delivery including first, second, and third order targeting based on the specific cells or tissues targeted. Passive and active targeting approaches are described along with examples like magnetic drug targeting using nanoparticles, liposomes, transdermal patches, and brain-targeted delivery systems. The conclusion emphasizes that targeted drug delivery can reduce dose and side effects by assisting drugs to reach the desired site.
This study compared eribulin mesylate to capecitabine in patients with locally advanced or metastatic breast cancer previously treated with anthracycline and taxane chemotherapy. The open-label, randomized, phase III study found no statistically significant differences between eribulin and capecitabine in overall survival or progression-free survival. Both drugs demonstrated similar safety profiles and effects on quality of life as expected based on their known adverse effect profiles. The study concluded that eribulin was not shown to be superior to capecitabine for overall survival or progression-free survival in this patient population.
Lusedra (Fospropofol) is a new sedative-hypnotic agent indicated for monitored anesthesia care during diagnostic or therapeutic procedures. It works by metabolizing into propofol. Standard dosing for induction is 6.5mg/kg by IV bolus, with supplemental doses of 1.6mg/kg as needed to maintain sedation. Common side effects include nausea, vomiting, headache, and hypotension. It provides moderate sedation and has more predictable pharmacokinetics than propofol.
This study evaluated 122 cases of breast cancer treated with the Di Bella Method (DBM), an alternative therapy combining melatonin, retinoids, vitamins, and other supplements.
The results showed:
- For early-stage breast cancer, 4/9 cases achieved complete remission with DBM as first-line therapy alone. As adjuvant therapy, DBM achieved a 5-year survival rate of 100%, significantly higher than standard rates.
- For metastatic breast cancer, 2/4 cases achieved remission with DBM as first-line therapy. As adjuvant therapy after surgery, 3/6 cases achieved remission.
- Overall, the DBM approach improved survival rates, response rates,
1) The document discusses endocrine therapy options for ER+ HER2- metastatic breast cancer (MBC), including first-line aromatase inhibitors versus tamoxifen, comparisons between different aromatase inhibitors, and the role of fulvestrant.
2) The FIRST trial found that fulvestrant 500 mg had significantly longer time to progression compared to anastrozole as first-line therapy for postmenopausal women.
3) For premenopausal women, combinations of luteinizing hormone-releasing hormone agonists with tamoxifen or aromatase inhibitors showed benefits, with no differences between the arms.
Deferasirox Dispersible Tablets SmPC Taj PharmaceuticalsTajPharmaQC
Deferasirox Dispersible Tablets 125mg, 250mg, 400mg, 500mg Taj Pharma: Uses, Side Effects, Interactions, Pictures, Warnings, Deferasirox Dosage & Rx Info | Deferasirox Uses, Side Effects Deferasirox: Indications, Side Effects, Warnings, Deferasirox -Drug Information –Taj Pharma, Deferasirox dose Taj pharmaceuticals Deferasirox interactions, Taj Pharmaceutical Deferasirox contraindications, Deferasirox price, Deferasirox Taj Pharma Deferasirox SmPC- Taj Pharma Stay connected to all updated on Deferasirox Taj Pharmaceuticals Mumbai. Patient Information Leaflets, SMPC.
La nouvelle tag: turismo 3.0 e il Rinascimento del retailingWebsolute
Image Lab, Centro di Ricerca sui Linguaggi visivi e sulla Moda dell'Università di Urbino, ci racconta i "touchpoint", i punti di contatto tra brand e utenti nel settore retail.
This document lists 7 types of coral: Yellow pencil coral, Great Star coral, Orange cup coral, Flower coral, Brain coral, Bubble coral, and Lettuce Coral. The corals are numbered 1 through 7 but are not described further.
Brand Monitoring: monitoraggio del marchio in Rete Websolute
Brand Monitoring: monitoraggio del marchio in Rete. Viral marketing e web monitoring. L'importanza di un costante ed efficace monitoraggio per cogliere la percezione del Brand di prodotti e servizi sulla rete.
Scoprire le ricerche per cui essere visibiliWebsolute
Come intercettare la domanda dei turisti stranieri? A chi ci rivolgiamo e cosa possiamo offrirgli? A partire dall’analisi dei trend e dei volumi di ricerca sul tema del turismo e dell’incoming in Italia, realizzata sui mercati Olanda, Francia, Germania e Austria, vengono individuate le nicchie di mercato a cui le aziende italiane del settore turistico possono rivolgersi per soddisfare bisogni puntuali e accelerare lo sviluppo del proprio business.
Social media: 11 consigli per usarli al meglioWebsolute
Identificare target e obiettivi, proporre contenuti inerenti, leggere i commenti degli utenti e rispondere alle loro domande, coinvolgere la community e infine analizzare i dati: i passi da compiere per costruire una relazione con gli utenti tramite i social media.
This document discusses Vietnam's growing middle and affluent consumer class and increasing digital engagement. It notes that Vietnam has experienced consistent economic growth and its middle/affluent consumers are expected to grow 1.7x by 2020. These consumers are shifting spending toward comfort and lifestyle products and dispersing outside major provinces. The document also outlines Vietnam's rising internet penetration and growing e-commerce sales. It finds that online households account for nearly 70% of FMCG spending and recommends marketers adapt to the digital reality by understanding consumers' purchase paths and focusing digital efforts on valued segments.
Facebook: trend, contenuti e gestione delle criticitàWebsolute
Image Lab, Centro di Ricerca sui Linguaggi visivi e sulla Moda dell'Università di Urbino, fornisce consigli pratici alle aziende per un efficace utilizzo di Facebook e una corretta gestione delle crisi.
Conditioning regimens in NEUROBLASTOMA.pptxVIVEKANANDRAI5
Three conditioning regimens for high-risk neuroblastoma are discussed: busulfan-melphalan (BuMel), carboplatin-etoposide-melphalan (CEM), and treosulfan-melphalan (TreoMel). A randomized trial found BuMel had significantly better event-free and overall survival rates compared to CEM. TreoMel showed low toxicity in small studies but requires more research. Targeted radionuclide therapies with 131I-MIBG or anti-GD2 antibody are also being investigated.
This research report compares the pharmacodynamics of intermittent and prolonged infusions of piperacillin/tazobactam using Monte Carlo simulations and pharmacokinetic data from hospitalized patients. The authors found that prolonged infusion regimens of 3.375 g or more every 8 hours achieved excellent target attainment against common gram-negative pathogens like E. coli and Enterobacteriaceae with MICs up to 16 μg/mL, using lower daily doses than standard intermittent regimens. However, none of the regimens tested provided optimal coverage against Pseudomonas aeruginosa and Klebsiella pneumoniae.
Three case histories are summarized that provide lessons for medicinal chemists:
1) The first case illustrates the importance of understanding whether animal tumors are caused by chemical toxicity or high-dose pharmacology before killing a clinical project.
2) The second case shows the value of licensing first-of-type clinical compounds from smaller companies to improve treatment of major diseases.
3) The last case emphasizes the need to investigate pharmacokinetics, safety and other properties early in optimization to select compounds best for clinical development. Converging structure-activity relationships for multiple properties can identify optimal candidates before clinical trials.
Differentiation Therapy in Acute Promyelocytic LeukemiaYaashviny Nair
This document summarizes the usage of differentiation therapy in treating acute promyelocytic leukemia (APL). It discusses how APL develops, how differentiation therapy works to treat it using all-trans retinoic acid and arsenic trioxide, and the positive and negative impacts of this therapy. It also reviews successful case studies and challenges, as well as the future direction of differentiation therapy.
- The document summarizes adjuvant therapies for malignant melanoma that have been presented by Dr. v.veeranath reddy and moderated by Dr. G.Puranik at a journal club meeting.
- Traditional adjuvant therapies included wide local excision, lymph node dissection, and radiotherapy to lymph node basins. However, evidence for their impact on survival is lacking.
- Recent therapies that have shown improved survival include targeted BRAF and MEK inhibitors for BRAF mutant tumors, and immuno therapies like anti-PD-1 inhibitors for BRAF wild type tumors. These are now established as first line therapies for stage 4 disease.
- Ongoing adjuvant trials are investigating
1) Breast cancer is the most common malignancy among females worldwide. Survival rates vary significantly based on cancer stage, with metastatic breast cancer having only a 26% 5-year survival rate.
2) Hormonal therapy is first-line treatment for hormone receptor-positive metastatic breast cancer. Tamoxifen and aromatase inhibitors are commonly used, with aromatase inhibitors showing improved outcomes compared to tamoxifen. Fulvestrant and newer targeted agents are options for progressed disease.
3) Chemotherapy is also used to treat metastatic breast cancer. Commonly used agents include taxanes like paclitaxel and docetaxel, anthracyclines like doxorubicin, and newer options
The document summarizes several key studies presented at the 2016 American Society of Hematology (ASH) Annual Meeting. It discusses results from the GALLIUM and ALCANZA studies showing improved outcomes for obinutuzumab and brentuximab vedotin, respectively, in follicular lymphoma and cutaneous T-cell lymphoma. It also summarizes positive results from maintenance rituximab in mantle cell lymphoma and lenalidomide in high-risk chronic lymphocytic leukemia. Finally, it discusses advances in CAR T-cell therapy and results from studies of pacritinib and transplant approaches in myeloma.
This document summarizes the role of cetuximab in treating squamous cell carcinoma of the head and neck (HNSCC). It discusses clinical trials that showed cetuximab improved survival when combined with radiation for locally advanced HNSCC and improved response rates compared to chemotherapy for recurrent/metastatic HNSCC. The document also reviews the mechanisms of action of cetuximab, potential biomarkers of response, common toxicities, and need for further research to better integrate cetuximab and identify patients most likely to benefit.
Over-expression of APOBEC3B (A3B) has little to no effect on the efficacy of 5-Fluorouracil (5-FU) in killing mammary epithelial MCF10A cells. The study found that transfecting, transducing, or treating MCF10A cells with PMA to induce A3B expression did not significantly impact cell viability when treated with varying concentrations of 5-FU. Repeating the experiments in A3B-high cancer cell lines and investigating the mechanisms of how A3B and 5-FU may complement each other could provide insights for personalized cancer treatment.
This document summarizes different chemotherapy strategies for gastric cancer, including neoadjuvant, adjuvant, and palliative chemotherapy. It discusses the goals of neoadjuvant chemotherapy and results from trials showing improved survival outcomes. For adjuvant chemotherapy, it summarizes results from the Japanese S1 trial and CLASSIC trial demonstrating improved disease-free and overall survival. For advanced disease, it discusses the benefits of chemotherapy over best supportive care alone and combination over single-agent chemotherapy. Specific regimens evaluated include CF, DCF, ECF, and REAL-2 trial comparisons of capecitabine/oxaliplatin to 5-FU/cisplatin. Second-line and targeted therapies are also summarized.
1) The document summarizes a study that developed a nanomedicine co-delivering cyclosporine A and gefitinib to overcome drug resistance in lung cancer. The nanomedicine effectively encapsulated the hydrophobic drugs and showed improved co-delivery and synergistic effects compared to free drug combinations.
2) In vitro and in vivo experiments demonstrated that the nanomedicine enhanced cancer cell apoptosis, inhibited tumor growth more than free drug combinations, and suppressed the STAT3 signaling pathway associated with drug resistance.
3) However, the study did not fully examine the toxicity of the nanomedicine or potential effects on normal cells, and could have further explored other signaling pathways and gene expression changes
Comparing outcomes of meropenem administration strategies 2010eduardo de avila
This document systematically reviews evidence comparing traditional and alternative dosing strategies for meropenem. Sixteen studies were reviewed, including 13 pharmacokinetic/dynamic assessments, 5 clinical evaluations, and 3 economic appraisals. Studies suggest alternative dosing strategies like prolonged or continuous infusion may increase achieving pharmacodynamic targets compared to traditional dosing. However, evidence linking these strategies to improved clinical outcomes is lacking. Smaller, more frequent doses appear to provide similar clinical outcomes and pharmacodynamic target attainment as traditional dosing, with potential cost savings. Overall, alternative dosing strategies seem to provide comparable outcomes to traditional dosing, but evidence is limited and largely based on healthy subjects. Larger clinical trials are needed.
This document summarizes guidelines for managing lupus nephritis from KDIGO 2023. It recommends treating active proliferative lupus nephritis classes III/IV with glucocorticoids plus mycophenolic acid, low-dose intravenous cyclophosphamide, or belimumab added to one of those. It provides guidance on induction therapy duration, preferred maintenance agents, and managing treatment failure or unsatisfactory response. Trial results are presented for therapies involving belimumab, calcineurin inhibitors, voclosporin, and different immunosuppressive regimens.
INDUCTION CHEMOTHERAPY WITH TPF IN HEAD & NECK CANCERS Paul George
Three key points about induction chemotherapy for head and neck cancer:
1) Several trials have shown that a taxane-based induction chemotherapy regimen of docetaxel, cisplatin, and fluorouracil (TPF) improves overall survival compared to cisplatin and fluorouracil (PF) alone when followed by concurrent chemoradiotherapy. TPF also decreases locoregional and distant failures.
2) A large meta-analysis found TPF significantly improved overall survival, progression-free survival, organ preservation, and reduced cancer mortality compared to PF. However, no evidence shows TPF plus radiotherapy is superior to concurrent chemoradiotherapy alone.
3) While TPF is now considered standard
ADVANCED NONSURGICAL THERAPY FOR HEAD AND NECK CANCERSNINAN THOMAS
H & N cancer has been potentially curable for decades with surgery or RT or by combination of these Both of these are only successful in early stage of disease In more advanced disease the results have been disappointing .Approximately 50%-60% of patients manifest loco-regional recurrence within two years.
20%-30% develop distant metastasis if they survive long enough.
Adjuvant therapy in pancreatic cancer.pptxSujan Shrestha
This document summarizes the evolution of adjuvant therapy trials for pancreatic cancer. It discusses several major trials including ESPAC-1 which established 5FU + leucovorin as standard adjuvant therapy, CONKO-001 which showed gemcitabine was beneficial, ESPAC-3 which found similar survival for 5FU vs gemcitabine, ESPAC-4 which found gemcitabine + capecitabine improved survival, the PRODIGE/UNICANCER trial which showed modified FOLFIRINOX significantly improved survival over gemcitabine, and the APACT trial which found nab-paclitaxel + gemcitabine did not significantly improve DFS over gemcitabine alone.
2007 Tmih Artekin Trial Malaria In Cambodiawvdamme
- The study aimed to compare the efficacy and tolerability of dihydroartemisinin–piperaquine (DHA–PQP) to a 3-day regimen of mefloquine and artesunate (MAS3) for the treatment of uncomplicated falciparum malaria in Cambodia.
- 464 patients were randomly assigned to receive either DHA–PQP or MAS3. The PCR-adjusted cure rates on day 63 were 97.5% for both treatments, demonstrating non-inferiority.
- There were no serious adverse events reported. However, significantly more episodes of vomiting, dizziness, palpitations, and sleep disorders were reported in the MAS3
BRL 17421 is a novel beta-lactam antibiotic that is highly resistant to beta-lactamases, resulting in high and prolonged serum levels in humans. It has an unusual spectrum of antibacterial activity, being exceptionally stable to beta-lactamases and active against many Enterobacteriaceae. Studies in humans found it to be well tolerated with no side effects after intramuscular or intravenous administration.
Understanding your heart health with your heloAlan Teh
To fully use your HELO you need to understand basic heart function, physiology and even some basic ECG knowlege. This presentation should help all HELO users.
The document announces a seminar on prostate cancer treatment to be held on June 13, 2015 at the Hilton Petaling Jaya Hotel in Selangor, Malaysia. Assoc. Prof. Dr. Marniza bte Saad of University Malaya Medical Centre will give a lecture on the past, present, and future of prostate cancer treatment. Dr. Adlinda bte Alip will present a case study, and there will be a Q&A session. Lunch will be provided afterwards. RSVPs are requested by June 8. The document also provides biographical information on Assoc. Prof. Dr. Marniza bte Saad, noting her medical education and positions at University Malaya
Guide to GST for Healthcare services (16 Nov)Alan Teh
This document provides a summary of the Malaysian Goods and Services Tax (GST) treatment of healthcare services. It outlines that healthcare services provided by the government are not subject to GST, while those provided by private healthcare facilities and professionals are generally exempt or zero-rated. Services provided outside of private healthcare facilities or not by employees may be standard-rated. It also discusses the GST treatment of supplies like medicines, diagnostic tests, and non-healthcare services provided by private facilities.
The Malaysian Oncological Society and the European Society for Medical Oncology will be holding a joint conference to share the highlights of the ESMO 2014 Congress with South-East Asian delegates.
The conference will be held in Penang, Malaysia from 23-25 January 2015 and the theme is "Precision Medicine in Cancer Care".
Official website: http://esmomos2015penang.com.my/
For Malaysian doctors: The Medico-Legal Society of Malaysia (MLSM) and the Kuala Lumpur Regional Centre for Arbitration (KLRCA) would like to invite you for a dialogue with Datuk Seri Gopal Sri Ram on the topic "Has the Law Forced Doctors to Practice Defensive Medicine?"
Guide to GST for Healthcare Services (Malaysia)Alan Teh
This document provides a guide on the Goods and Services Tax (GST) treatment of healthcare services in Malaysia. It outlines that healthcare services provided by the government are not subject to GST, while most services provided by private healthcare facilities are exempt from GST. Some services, such as those provided under contract by non-employee healthcare professionals at private facilities, or certain pharmaceutical services, are standard rated and subject to GST.
The document provides information about an upcoming Goods and Services Tax (GST) in Malaysia, including its implementation date of April 1, 2015 at a rate of 6%. It outlines that GST will replace existing sales and service taxes. Healthcare services are discussed, with those provided by government being outside the scope of GST and those provided by private licensed facilities being exempt from GST. The impact on doctors at government hospitals is that they will not be eligible for GST registration if only providing exempt healthcare services, and thus cannot claim GST incurred on items like clinic rental.
Malaysian students' international test scores have declined in recent years, registering drops in reading ability and science scores, though mathematics scores improved. This signals an increasing deterioration in Malaysia's education system according to international benchmarks, where Malaysia now ranks 52nd out of 65 countries. The Education Minister responded that if people are unhappy with the system, they can choose to send their children overseas for schooling.
The document provides an overview of Malaysia's Personal Data Protection Act 2010. It discusses key aspects of the Act including the establishment of a Personal Data Protection Commissioner, the 7 data protection principles, and requirements around notice, consent, disclosure, security, retention, data integrity and access. It also discusses some examples of data breaches and penalties for non-compliance. The Act aims to regulate the processing of personal data and protect privacy as digital data and internet usage continues to grow significantly.
This document discusses snoring and obstructive sleep apnea (OSA). It notes that OSA is a clinical condition where the upper airway collapses intermittently during sleep. Risk factors include obesity, age, hypertension, and diabetes. Untreated OSA can lead to increased risks of hypertension, heart attack, stroke, and premature death. Diagnosis involves questionnaires, physical examination, and sleep studies. Treatment aims to reduce symptoms and health risks.
Multiple myeloma is a cancer of plasma cells that produce abnormal antibodies. It causes bone destruction and can damage the kidneys and suppress the bone marrow. While the cause is unknown, risk factors include age, family history, and exposure to radiation. Symptoms include bone pain, fatigue, recurrent infection, and kidney problems. Diagnosis involves blood and urine tests and a bone marrow biopsy. Staging uses tests such as MRI, blood tests, and bone surveys. Treatment may include chemotherapy, steroids, radiation, stem cell transplants, and newer drugs that target specific pathways in myeloma cells. While not yet curable, novel agents have improved survival rates and quality of life compared to conventional chemotherapy alone.
A survey was conducted of 57 medical professionals from various backgrounds with 5-25 years of experience. The survey found:
- 71% found it difficult to maintain medical records
- 66% had limited ways to connect with patients
- 86% had limited ways to follow up with patients
- 84% experienced scheduling inefficiencies
- 75% found missed appointments bothersome
- 82% felt revenue did not compensate for time/effort
The majority used paper-based records and phone/face-to-face consultation. Only 27% were satisfied with current systems and most felt electronic systems could save time and improve research/identification of patients. Respondents viewed healthcare IT systems as important/necessary to reduce paperwork
The document is a registration form and information for the 1st National Stem Cell Congress in Kuala Lumpur, Malaysia from October 29-30, 2012. It provides details on registration fees, how to register, instructions for submitting scientific poster presentations, and an overview of the scientific programme which will include plenary lectures, symposia, and a plenary discussion on various stem cell topics. Prof. Datuk Dr. A Rahman A Jamal invites participants to join the congress to consolidate knowledge in stem cell research and interact with international speakers.
The document provides information about the Asia-Pacific Conference on Human Genetics to be held from December 5-8, 2012 in Kuala Lumpur, Malaysia. It includes details about registration fees, invited international faculty, the scientific program schedule, accommodation options at the conference hotel, and contact information for the conference secretariat. A call for abstract submissions is also announced with a deadline of September 5, 2012.
Role of cancer genomics and next generation sequencing.pptx 2Alan Teh
Dr Jimmy Lin PhD will give an afternoon lecture at Ampang Hospital on Tuesday, September 25th from 1-2pm in the Seminar Room on the 3rd floor. Dr Lin is the founder and president of Rare Genomics Institute and is affiliated with Washington University in St Louis, USA.
The document announces a workshop on haemostasis from September 10-11, 2012 at Universiti Teknologi MARA in Selayang Campus. The workshop will feature speakers like Geoff Kershaw and Dr. Jameela Sathar discussing topics like acquired factor inhibitors, clinical approach to coagulation, pre-analytical and analytical problems, and lupus anticoagulant. It also provides information on registration fees and instructions to apply for registration by email.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
1. MabThera at ASH
2009
The Essential Solution
News and comments from the 51st Annual Meeting of the American Society of Hematology, New Orleans, Louisiana, USA
5–8 December 2009
Excellent results were also presented for the combination
of MabThera 500 mg/m2 with chlorambucil and with
bendamustine in first-line CLL, while in relapsed CLL high
doses of MabThera monotherapy were shown to be very
effective, inducing a high rate of complete responses even in
patients who were fludarabine refractory.
In NHL, MabThera-based therapy is established as standard
treatment for both indolent and aggressive histologies.
Several interesting studies were presented, investigating how
MabThera treatment might be optimised to achieve the best
outcome for patients.
• A randomised trial in patients with follicular lymphoma
and other indolent NHL suggested that the combination
Headlines...
of MabThera with bendamustine may be associated with
higher efficacy and lower toxicity than the currently more
widely used regimen of MabThera-CHOP.
The ASH 2009 meeting saw the presentation • A quality-of-life analysis of patients with FL receiving MabThera
of new data from the groundbreaking CLL8 trial maintenance therapy showed improvements in some of the
of MabThera 500 mg/m2 plus FC versus FC alone studied physical and psychological endpoints in patients
in 817 patients with first-line CLL. After 37.7 months’ receiving maintenance compared with observation.
follow-up, the improvement in overall survival is now • Ten-year follow-up of the GELA-LNH-98.5 study in
statistically significant. This is the first time that a elderly patients with diffuse large B-cell lymphoma
significant improvement in overall survival has been confirmed that patients treated with MabThera-CHOP
demonstrated for any regimen used in first-line live significantly longer than with CHOP alone
treatment of patients with CLL. (10-year overall survival 43.5% versus 28%, respectively;
p < 0.0001).
• MabThera, in combination with FC, improves 3-year overall
survival by almost 5%, from 82.5% with FC alone to 87.2% in the • A randomised study in patients with high-risk DLBCL
MabThera-FC arm. This difference was statistically significant showed that high-dose therapy with autologous stem cell
(p = 0.012), with a hazard ratio of 0.664 indicating a transplantation offers no advantage and is not needed for
33.6% reduction in risk of death over the 3-year period. patients treated with MabThera plus chemotherapy.
• The PFS benefit for MabThera-FC that was first described at
ASH last year also improved remarkably with longer follow-
up. Median PFS was 51.8 months in the MabThera-FC arm
compared with 32.8 months for FC alone (p < 0.001, hazard
ratio 0.563), representing a 19-month improvement in median
PFS and 43.7% reduction in risk of progression or death.
MabThera highlights from ASH2009 | page one
2. MabThera at ASH
2009
The Essential Solution
MabThera 500 mg/m2 plus chemotherapy:
Changing the natural course of CLL
MabThera 500 mg/m2 plus chemotherapy became the standard
of care in first-line CLL based on the results of the CLL8 trial,
first presented at ASH 2008.1 This trial randomised 817 patients
MabThera-FC 61.9 months
with newly diagnosed CLL requiring treatment to 6 cycles of
Binet A
fludarabine/cyclophosphamide (FC) chemotherapy alone FC 41.8 months
or to MabThera-FC. MabThera was administered at 500 mg/m , 2
0 20 40 60
reduced to 375 mg/m2 for the first cycle only. Professor Michael
Hallek, the chair of the German CLL Study Group (GCLLSG), who
presented the interim analysis in 2008, described the latest results
MabThera-FC 68.8 months
after 37.7 months’ follow-up (Hallek et al. Blood 2009; 114:Abstract
Binet B
535). The auditorium was full for what was described by the chair, FC 44.9 months
Professor Stephen Devreux, as an “historic session” on therapy
0 20 40 60
of CLL. As had been shown in the previous interim analysis,
patients in the MabThera-FC arm experienced significantly longer
progression-free survival (PFS) compared with FC alone (Median
MabThera-FC 56.8 months
PFS: 51.8 months versus 32.8 months, respectively; p < 0.001,
Binet C
hazard ratio [HR] 0.563) (Figure 1). FC 45.2 months
0 20 40 60
Median PFS (months)
MabThera-FC 51.8 months
Figure 2: PFS benefit of MabThera-FC over FC alone in patients with Binet
p < 0.001
stage A, B and C disease
19 months
He therefore concluded that MabThera-FC is superior to FC alone
FC alone 32.8 months
for the treatment of Binet stage C patients, as well as those with
stage A and B disease.
0 20 40 60
Median PFS (months) “In Binet stage C patients…we can
now see PFS curves start to separate.”
Figure 1: PFS in the CLL8 study (37.7 months’ follow-up)
Having explained the 19-month improvement in PFS and efficacy
In the interim analysis in 2008, the PFS benefit of MabThera-FC
1 in different patient subgroups achieved with MabThera-FC in this
was maintained in the subgroups of patients with Binet stage A analysis, Professor Hallek then went on to describe the most
and B disease but not, with the initial short follow-up, in those with exciting part of the data, the improvement in overall survival.
Binet stage C disease. Professor Hallek explained that a clinical
At 3 years, as would be expected for a first-line CLL population,
benefit for MabThera-FC in Binet stage C patients is now becoming
median overall survival had not been reached in either arm.
apparent in the latest analysis. Although the difference in PFS
Three-year overall survival was 87.2% in the MabThera-FC arm
in this subgroup of 239 patients still did not reach statistical
and 82.5% in the FC arm. This remarkable difference of almost 5%
significance (p = 0.081) (Figure 2), Professor Hallek described
in deaths between the two arms after a relatively short time was
how, with longer follow-up in Binet C patients, “we can now see
significant to a level of p = 0.012, and the HR of 0.664 indicates that
PFS curves start to separate”.
patients in the MabThera-FC arm had a 33.6% reduction in the risk
Professor Hallek also pointed out that other efficacy measures, of death – i.e. they were a third less likely to die during the 3-year
including complete response rate and eradication of minimal follow-up period.
residual disease, were markedly and significantly improved by
MabThera-FC compared with FC alone in Binet C patients.
MabThera highlights from ASH2009 | page two
3. MabThera at ASH
2009
The Essential Solution
“This is the first time that a randomised
trial has been able to show that a 100 ORR 90.9% ORR 89.5%
ORR 90.5% ORR 88.9%
treatment can improve the natural 80
course of CLL”
Patients (%)
60
ORR 42.9%
Professor Hallek emphasised the important and historic nature of 40
the overall survival finding, in that it demonstrates that the most
20
CR CR CR CR
effective treatment should be used in first-line CLL for the best 32.7% CR 15.8% 42.9% 0% 39.7%
long-term outcome. ”This is the first time that a randomised trial 0
All patients Trisomy 12 11q- 17p- Unmutated
has been able to show that a treatment can improve the natural (n = 110) (n = 19) (n = 21) (n = 7) IgVH
course of CLL”, he concluded. (n = 63)
Effective options for patients Figure 3: MabThera-bendamustine in first-line CLL: response rates
with CLL who are ineligible Phase II trial in 100 patients with untreated CLL considered
ineligible to receive fludarabine. The median age of patients in the
for fludarabine trial was 70.5 years. The results of an interim analysis of the first
50 patients were presented and compared with a cohort of
The progression-free and overall survival benefits of MabThera-FC
case-matched patients from a previous study of chlorambucil alone.
are achieved with an acceptable increase in toxicity compared with
The median age of patients in this study was 70.1 years. The ORR
FC alone, and physically fit patients, regardless of age, can be
of 84% compared favourably with the 66.7% response rate ob-
treated with this regimen without excessive toxicity. However,
tained with chlorambucil alone (Figure 4). CR rates could not be
some patients with comorbidities may not be physically fit enough
compared between trials because of different criteria for response
to tolerate FC chemotherapy and so other effective treatments
evaluation. Nevertheless, the 17% improvement in ORR indicates
are required. MabThera is approved in combination with any
that MabThera-chlorambucil is a safe and effective regimen.
chemotherapy for the treatment of CLL and two presentations
highlighted the efficacy of MabThera-chemotherapy combinations
other than MabThera-FC in first-line CLL.
Fischer et al. (Blood 2009; 114:Abstract 205) described the PR
100
results of a Phase II study of MabThera plus bendamustine in ORR 84% nPR
80 CR
117 patients with previously untreated CLL. In 110 evaluable ORR 66.7%
Patients (%)
patients, an overall response rate (ORR) of 90.9% was obtained, 60
with 32.7% CRs. The response rate was largely maintained across 40
different subgroups of patients with adverse genetics (Figure 3). 20
As expected, patients with 17p deletion had a lower response rate.
0
This combination was well tolerated, with grade 3/4 haematological MabThera - Chlorambucil
toxicity, including neutropenia, in only around 20% of patients. chlorambucil alone
Dr Fischer concluded that MabThera-bendamustine appeared
to have comparable efficacy to MabThera-FC in first-line CLL,
with a lower incidence of haematological toxicity in this analysis. Figure 4: Response rates to MabThera-chlorambucil or chlorambucil alone
(case-matched controls) in first-line CLL
This combination may offer the opportunity to treat more patients
with CLL with an effective regimen with improved tolerability.
The two combinations are now being compared in a randomised
study (CLL10) by the GCLLSG.
The other MabThera-chemotherapy combination studied in
first-line CLL was MabThera 500 mg/m2 plus chlorambucil
(Hillmen et al., Blood 2009; 114:Abstract 3428). This was a
MabThera highlights from ASH2009 | page three
4. MabThera at ASH
2009
The Essential Solution
MabThera-based treatment Optimising MabThera-based
options in later lines of therapy therapy in indolent NHL
For patients who experience PFS in excess of 1–2 years following While MabThera plus chemotherapy is standard treatment in
first-line therapy, re-treatment with the same or similar therapy is both first-line and relapsed follicular lymphoma (FL), a variety
often the most appropriate option at relapse, and MabThera 2
of MabThera-chemotherapy regimens have been evaluated and
500 mg/m2 plus chemotherapy is approved for treatment of CLL it is not yet established if any particular chemotherapy has an
in both the first-line and relapsed settings. However, some patients advantage over another as a combination partner for MabThera.
become refractory to standard treatment regimens and, particularly Rummel et al. (Blood 2009; 114:Abstract 405) presented data
for patients who are refractory to fludarabine, treatment options from one of the first randomised studies directly comparing two
may be limited. MabThera-chemotherapy regimens in first-line treatment of
indolent NHL. A total of 513 patients with previously untreated
Previous studies have shown that the activity of MabThera
indolent NHL including FL, mantle cell lymphoma (MCL), small
monotherapy is dose-dependent in CLL3,4 and Adiga and Wiernik
lymphocytic lymphoma, marginal zone lymphoma (MZL) and
et al. (Blood 2009; 114:Abstract 2380) presented a case series
Waldenström’s macroglobulinaemia (WM) were randomised
demonstrating activity of high-dose MabThera in patients
to treatment with MabThera-CHOP (n = 253) or MabThera-
with CLL, including relapsed and fludarabine-refractory disease.
bendamustine (n = 260). More than half of the patients (54%)
Twenty two patients with varying treatment histories were
had a diagnosis of FL.
analysed and the MabThera treatment schedule could be
dose-escalated at the treating physician’s discretion. The maximum The ORRs were above 90% and did not differ significantly between
dose given to any patient was 3000 mg/m (three patients).
2
the two regimens, but the CR rate was significantly superior for
patients in the MabThera-bendamustine arm (39.6% versus
An impressive ORR of 90.9% with 54.5% CR was obtained.
30.0%, p = 0.0262). After 34 months’ follow-up, PFS was also
Moreover, even in fludarabine-refractory patients the ORR
superior for MabThera-bendamustine (54.9 months versus
was 75% with 37.5% CR (Figure 5). Such a high CR rate in
34.8 months; p = 0.00012). PFS was also significantly longer for
fludarabine-refractory patients is uncommon, and the authors
MabThera-bendamustine in the subgroups of patients with FL,
noted that “Single-agent rituximab is at least as efficacious as
MCL and WM (Table 1).
other regimens available for treatment of fludarabine-refractory
patients, with a superior toxicity profile”.
Median PFS (months)
MabThera MabThera- p- value HR 95% CI
-benda- CHOP
100 ORR 90.9%
ORR 84.6% mustine
80 ORR 75.0% FL
NR 46.7 0.0281 0.63 0.42-0.95
(n = 279)
Patients (%)
60
MCL
32.5 22.3 0.0146 0.52 0.28-0.87
(n = 93)
40
WM
NR 34.8 0.0024 0.21 0.06-0.56
20 CR CR CR (n = 41)
54.5% 53.8% 37.5% NR = not reached
0
All patients Previously treated Fludarabine Table 1: MabThera-bendamustine versus MabThera-CHOP: PFS in
(n = 22) (n = 13) refractory subgroups
(n = 8)
Figure 5: Response to high-dose MabThera-monotherapy in a case series of “For the first time, a first-line regimen
22 patients with CLL
has been shown to improve overall
Overall, the ASH 2009 meeting was a landmark event in CLL. survival”
For the first time, a first-line regimen has been shown to improve
overall survival, while the combination of MabThera with different
chemotherapies offers additional effective treatment options.
MabThera highlights from ASH2009 | page four
5. MabThera at ASH
2009
The Essential Solution
MabThera maintenance therapy: A further study (the MAXIMA study) reported ongoing experience
with MabThera maintenance therapy after 8 cycles of MabThera-
Efficacy, safety and quality of life containing induction therapy in 545 patients with first-line or
MabThera maintenance therapy prolongs progression-free and relapsed FL (Witzens-Harig et al., Blood 2009; 114:Abstract 3756).
overall survival in patients with relapsed FL5,6 and is currently being MabThera maintenance therapy was administered every 2 months
evaluated in the first-line setting. A presentation by Walker for 2 years. A total of 1,367 of 5,367 infusions were delivered
et al. (Blood 2009; 114:Abstract 2498) considered the effects of by rapid protocol (90 minutes) without significant side effects
first-line MabThera maintenance therapy on patient quality of life, The authors reported that “there were no notable safety issues
including symptom burden and psychological symptoms. associated with rituximab maintenance therapy”.
This retrospective study compared health-related quality of life in
53 patients who received MabThera maintenance therapy with “[MabThera] maintenance treatment
84 observation patients, after any first-line treatment. All patients delivered via a rapid infusion protocol
had completed Patient Care Monitor (PCM) questionnaires during was safe and well tolerated”
induction and maintenance/observation. The PCM is a 38-item
self-report measure with six major components:
• General physical symptoms Eight cycles of MabThera-
• Treatment side effects chemotherapy remains gold-
• Acute distress
• Despair and depression
standard first-line treatment for
• Impaired ambulation DLBCL
• Impaired performance
Eight cycles of MabThera-CHOP became gold-standard treatment
The investigators found that scores for all six components were for patients with diffuse large B-cell lymphoma (DLBCL) based on
either similar or superior for patients receiving MabThera the GELA-LNH-98.5 trial in 399 elderly patients, first published
maintenance therapy versus observation, with significantly greater in 2002.7 At the ASH 2009 meeting, Professor Bertrand Coiffier
improvements in general physical symptoms (p = 0.019) and a (Blood 2009; 114:Abstract 3741) presented updated data from this
greater improvement in impaired performance. Overall there were trial with 10-year follow-up. The data showed that the benefit of
no detrimental effects of MabThera maintenance on health-related MabThera-CHOP persisted over time with continued, highly
quality of life, and the authors concluded that, “considering the significant superiority of MabThera-CHOP over CHOP alone in
clinical benefit of rituximab maintenance, these findings provide all efficacy endpoints including event-free survival (34% versus
further support for use of rituximab maintenance in patients with 19.0%), PFS (36.5% versus 20.0%), disease-free survival in
follicular lymphoma.” CR patients (64.0% versus 43.0%) and overall survival (43.5% versus
28%) (p < 0.0001 for each). The overall survival curves show
“Considering the clinical benefit of clear separation, even after 10 years’ follow-up in this elderly
patient population (Figure 6).
rituximab maintenance, these findings
provide further support for use of 1.0
rituximab maintenance in patients
0.8
with follicular lymphoma.”
Patients (%)
0.6 MabThera-CHOP 43.5%
0.4
0.2 CHOP 28.0%
p < 0.0001
0
0 2 4 6 8 10
Overall Survival (Years)
Figure 6: Overall Survival after 10 years’ follow-up in the GELA LNH-
98.5 study
MabThera highlights from ASH2009 | page five
6. MabThera at ASH
2009
The Essential Solution
While the use of MabThera-CHOP has dramatically increased MabThera- MabThera-
the cure rate in DLBCL over the last decade, efforts continue to CHOEP-14 megaCHOEP
further improve outcome, particularly in high-risk patients. One
EFS (%) 71.0 56.7
approach that has been considered is the use of high-dose therapy
with autologous stem cell transplantation (HDT/ASCT) first line.
PFS (%) 76.0 64.6
The German High-Grade Lymphoma Study Group (DSHNHL) has
conducted a randomised study to determine whether MabThera in Overall survival (%) 83.8 75.3
combination with HDT/ASCT provides any advantage over standard
MabThera-chemotherapy for young, high-risk patients, and interim Table 2: MabThera-CHOEP-14 versus MabThera-megaCHOEP:
survival endpoints
results of this study were presented by Professor Norbert Schmitz
(Blood 2009; 114:Abstract 404).
“These represent the best treatment
Patients (n = 185) aged 18–60 years with high-risk DLBCL were
randomised to treatment with MabThera in combination with
results ever reported for young,
CHOEP-14 (a modification of the standard CHOP regimen high-risk patients with aggressive
involving the addition of etoposide and 2-weekly rather than CD20-positive B-cell lymphoma”
3-weekly cycles) or a high-dose regimen (MabThera plus
megaCHOEP) with ASCT (Figure 7).
“These represent the best treatment results ever reported for
young, high-risk patients with aggressive CD20-positive B-cell
lymphoma”, said Professor Schmitz, who also suggested that, in the
MabThera 375 mg/m2 ASCT ASCT ASCT
era of MabThera-chemotherapy as standard treatment, there is no
place for HDT/ASCT in first-line treatment for DLBCL.
MegaCHOEP
MegaCHOEP
MegaCHOEP
MegaCHOEP
Young
patients
with References
1 14 22 36 43 56 64 77 96
untreated, Days
high-risk 1 15 29 43 57 71 83 99 1. Hallek M, et al. Blood 2008; 112:Abstract 325.
DLBCL
2. Eichhorst B, et al. Ann Oncol 2009; 20 (suppl 4):102–104.
CHOEP-14
CHOEP-14
CHOEP-14
CHOEP-14
CHOEP-14
CHOEP-14
CHOEP-14
CHOEP-14
3. Byrd J, et al. J Clin Oncol 2001; 19:2153–2164.
MegaCHOEP = cyclophosphamide 1500–6000 mg/m2, doxorubicin 70 mg/m2, vincristine 2 mg,
4. O’Brien S, et al. J Clin Oncol 2001; 19:2165–2170.
etoposide 600–1480 mg/m2, prednisone 500 mg
CHOEP-14 = cyclophosphamide 750 mg/2, doxorubicin 50 mg/m2, vincristine 2 mg, etoposide 5. van Oers MHJ, et al. Blood 2008; 112:Abstract 836.
300 mg/m2, prednisone 500 mg
6. Vidal L, et al. J Natl Cancer Inst 2009; 101:248–255.
Figure 7: MabThera-CHOEP-14 versus MabThera-megaCHOEP: study 7. Coiffier B, et al. New Engl J Med 2002; 346:235–242.
design
Professor Schmitz explained that 3-year event-free survival was
significantly superior for patients in the MabThera-CHOEP-14 arm
(71% versus 56.7%; p = 0.05). PFS and overall survival were also
superior for MabThera-CHOEP-14, but the differences were not
statistically significant (Table 2).
MabThera highlights from ASH2009 || page two
MabThera highlights from ASH2009 page six
7. MabThera at ASH
2009
The Essential Solution
MabThera highlights from ASH2009 | page seven