This study performed a cost-effectiveness analysis of adjuvant chemoradiotherapy for resected gastric cancer based on results from the Intergroup 0116 trial. The analysis found that the incremental cost of adding chemoradiotherapy was $20,100 and provided an additional 0.53 quality-adjusted life years, resulting in an incremental cost-effectiveness ratio of $38,400 per quality-adjusted life year gained. A probabilistic sensitivity analysis predicted a 67% likelihood that the ratio would be less than $50,000 per quality-adjusted life year, which compares favorably to other widely used cancer treatments.
This phase 2 clinical trial evaluated the safety and efficacy of induction chemotherapy with gemcitabine, oxaliplatin and cetuximab followed by selective chemoradiation in patients with borderline resectable or unresectable locally advanced pancreatic cancer. The regimen was found to be well tolerated. Almost one-third of patients underwent complete surgical resection. Median progression-free survival was 10.4 months and median overall survival was 11.8 months. Survival was markedly prolonged in patients who underwent complete resection.
This meta-analysis combines data from 5 randomized controlled trials investigating adjuvant chemotherapy and chemoradiation for pancreatic cancer. It includes individual patient data from 875 patients across 4 trials, as well as previously unpublished updated follow-up data from 261 additional patients in the ESPAC1 trial. The analysis found that chemotherapy significantly reduced the risk of death, with median survival of 19 months with chemotherapy versus 13.5 months without. However, chemoradiation did not significantly reduce the risk of death compared to no adjuvant treatment, with median survivals of 15.8 months and 15.2 months respectively. Subgroup analyses suggested chemoradiation may be more effective for patients with positive resection margins, while chemotherapy was less effective for this
Chemotherapy Combined with Intraperitoneal Perfusion Chemotherapy for Gastric...Ross Finesmith M.D.
Gastric cancer is a common cancer with relatively poor survival rates. Early detection improves survivability, but clinical symptoms often do not present until late stages of the disease. Gastric resection and intravenous chemotherapy are the current accepted standard treatment. Intraperitoneal chemotherapy has been utilized in other abdominal cancers with moderate success. This systematic meta-analysis included randomized control studies that compared gastric cancer outcome data between post-operative subjects that received intravenous chemotherapy alone vs those that received intravenous plus intraperitoneal chemotherapy.
Malnutrition is common in cancer patients, affecting 40-80% during their disease course. It negatively impacts treatment outcomes, mortality, and quality of life. Early screening and nutritional interventions can help prevent weight loss and treatment interruptions. A multidisciplinary team approach is needed to address nutritional status from diagnosis onward through cancer treatment. Screening tools help identify at-risk patients who need comprehensive assessment and individualized nutritional support through diet, oral supplements, enteral feeding, or parenteral nutrition as needed. Exercise should also be encouraged to preserve muscle mass. Prioritizing nutritional care represents good clinical practice that can optimize cancer treatment.
Evidence for Cure by Adjuvant Therapy in Colon Cancer: Observations Based on ...alessandrolealmd
This document summarizes a study analyzing individual patient data from 20,898 patients in 18 randomized trials testing fluorouracil-based adjuvant therapy for stage II-III colon cancer. The key findings were:
1) Adjuvant chemotherapy provided a significant and consistent overall survival benefit over 8 years of follow-up, indicating chemotherapy cures some patients rather than just delaying recurrence.
2) Recurrence rates after 5 years were less than 1.5% per year, and after 8 years were less than 0.5% per year for patients treated in clinical trials, demonstrating low long-term recurrence risks.
3) Significant disease-free survival benefit from adjuvant chemotherapy was seen in the first 2 years
- Adjuvant therapy after surgical resection of pancreatic cancer aims to improve survival outcomes.
- Early trials showed 5-FU chemoradiation improved median survival to 20 months compared to 11 months for observation alone. However, benefit was small.
- CONKO-001 demonstrated gemcitabine alone significantly improved disease-free survival compared to observation.
- ESPAC-1 found 5-FU chemotherapy improved 5-year survival to 21% versus 8% for observation, while chemoradiation had a deleterious effect.
- Recent ESPAC-4 trial established gemcitabine-capecitabine as the new standard of care, improving median survival to 28.0 months versus 25
Premier on Medicinal Fungus as effective Adjuvant & Complementary Agents for ...Chee-Cheow Lee
This document discusses cancer and potential complementary and adjuvant treatments. It summarizes the characteristics and current treatment approaches for cancer. It then discusses various medicinal mushrooms and compounds that show promise as complementary agents, including polysaccharides from Coriolus versicolor and Phellinus linteus, and the compound Antroquinonol isolated from Antrodia camphorata. Antroquinonol in particular has shown safety and efficacy against various cancer types in both in vitro and in vivo studies. The document concludes by discussing how these natural compounds can be applied at different stages of cancer prevention and treatment.
This study compared short-course radiotherapy to long-course chemoradiation for patients with T3 rectal cancer. It found that long-course treatment resulted in a lower risk of local tumor recurrence, though the difference was not statistically significant. Both treatments had similar rates of distant tumor recurrence and overall survival. Long-course treatment seemed to provide a greater benefit for distal tumors, with fewer local recurrences, but again the difference was not statistically significant due to the small number of distal tumors.
This phase 2 clinical trial evaluated the safety and efficacy of induction chemotherapy with gemcitabine, oxaliplatin and cetuximab followed by selective chemoradiation in patients with borderline resectable or unresectable locally advanced pancreatic cancer. The regimen was found to be well tolerated. Almost one-third of patients underwent complete surgical resection. Median progression-free survival was 10.4 months and median overall survival was 11.8 months. Survival was markedly prolonged in patients who underwent complete resection.
This meta-analysis combines data from 5 randomized controlled trials investigating adjuvant chemotherapy and chemoradiation for pancreatic cancer. It includes individual patient data from 875 patients across 4 trials, as well as previously unpublished updated follow-up data from 261 additional patients in the ESPAC1 trial. The analysis found that chemotherapy significantly reduced the risk of death, with median survival of 19 months with chemotherapy versus 13.5 months without. However, chemoradiation did not significantly reduce the risk of death compared to no adjuvant treatment, with median survivals of 15.8 months and 15.2 months respectively. Subgroup analyses suggested chemoradiation may be more effective for patients with positive resection margins, while chemotherapy was less effective for this
Chemotherapy Combined with Intraperitoneal Perfusion Chemotherapy for Gastric...Ross Finesmith M.D.
Gastric cancer is a common cancer with relatively poor survival rates. Early detection improves survivability, but clinical symptoms often do not present until late stages of the disease. Gastric resection and intravenous chemotherapy are the current accepted standard treatment. Intraperitoneal chemotherapy has been utilized in other abdominal cancers with moderate success. This systematic meta-analysis included randomized control studies that compared gastric cancer outcome data between post-operative subjects that received intravenous chemotherapy alone vs those that received intravenous plus intraperitoneal chemotherapy.
Malnutrition is common in cancer patients, affecting 40-80% during their disease course. It negatively impacts treatment outcomes, mortality, and quality of life. Early screening and nutritional interventions can help prevent weight loss and treatment interruptions. A multidisciplinary team approach is needed to address nutritional status from diagnosis onward through cancer treatment. Screening tools help identify at-risk patients who need comprehensive assessment and individualized nutritional support through diet, oral supplements, enteral feeding, or parenteral nutrition as needed. Exercise should also be encouraged to preserve muscle mass. Prioritizing nutritional care represents good clinical practice that can optimize cancer treatment.
Evidence for Cure by Adjuvant Therapy in Colon Cancer: Observations Based on ...alessandrolealmd
This document summarizes a study analyzing individual patient data from 20,898 patients in 18 randomized trials testing fluorouracil-based adjuvant therapy for stage II-III colon cancer. The key findings were:
1) Adjuvant chemotherapy provided a significant and consistent overall survival benefit over 8 years of follow-up, indicating chemotherapy cures some patients rather than just delaying recurrence.
2) Recurrence rates after 5 years were less than 1.5% per year, and after 8 years were less than 0.5% per year for patients treated in clinical trials, demonstrating low long-term recurrence risks.
3) Significant disease-free survival benefit from adjuvant chemotherapy was seen in the first 2 years
- Adjuvant therapy after surgical resection of pancreatic cancer aims to improve survival outcomes.
- Early trials showed 5-FU chemoradiation improved median survival to 20 months compared to 11 months for observation alone. However, benefit was small.
- CONKO-001 demonstrated gemcitabine alone significantly improved disease-free survival compared to observation.
- ESPAC-1 found 5-FU chemotherapy improved 5-year survival to 21% versus 8% for observation, while chemoradiation had a deleterious effect.
- Recent ESPAC-4 trial established gemcitabine-capecitabine as the new standard of care, improving median survival to 28.0 months versus 25
Premier on Medicinal Fungus as effective Adjuvant & Complementary Agents for ...Chee-Cheow Lee
This document discusses cancer and potential complementary and adjuvant treatments. It summarizes the characteristics and current treatment approaches for cancer. It then discusses various medicinal mushrooms and compounds that show promise as complementary agents, including polysaccharides from Coriolus versicolor and Phellinus linteus, and the compound Antroquinonol isolated from Antrodia camphorata. Antroquinonol in particular has shown safety and efficacy against various cancer types in both in vitro and in vivo studies. The document concludes by discussing how these natural compounds can be applied at different stages of cancer prevention and treatment.
This study compared short-course radiotherapy to long-course chemoradiation for patients with T3 rectal cancer. It found that long-course treatment resulted in a lower risk of local tumor recurrence, though the difference was not statistically significant. Both treatments had similar rates of distant tumor recurrence and overall survival. Long-course treatment seemed to provide a greater benefit for distal tumors, with fewer local recurrences, but again the difference was not statistically significant due to the small number of distal tumors.
This document summarizes the results of a survey of 115 Japanese medical facilities that treat gynecologic cancers, regarding their palliative care practices. The survey found that about 30% of facilities had a dedicated palliative care ward. Most facilities had a palliative care team but about half of physicians on the team had other duties as well. End-of-life care was typically managed in the gynecology department. The median time between a patient's last chemotherapy treatment and death was 85 days. Over 15% of patients received chemotherapy within 30 days of death and over 7% within 14 days of death. The survey identified some gaps in palliative care coordination and opportunities to improve symptom management at the end of life.
This document describes the development of a novel intratumoral drug delivery system using interstitial chemotherapy devices. The system aims to deliver chemotherapy drugs directly into solid tumors via implantable polymeric devices to achieve higher drug concentrations and more homogeneous distribution compared to systemic chemotherapy. The document outlines the design of biodegradable polymer implants loaded with cisplatin as a model drug. In vitro studies show sustained release of cisplatin from the implants over 1 month in a rate dependent on drug loading. The system has the potential for localized treatment with fewer systemic side effects.
This document discusses improving systemic chemotherapy for bladder cancer. It covers the following key points:
1) Neoadjuvant chemotherapy, particularly cisplatin-based regimens like gemcitabine and cisplatin, has become the standard of care for muscle-invasive bladder cancer based on improved survival outcomes shown in clinical trials.
2) Dose-dense regimens are being explored as a way to improve pathologic response rates without increasing toxicity.
3) While no definitive trials provide support, adjuvant chemotherapy after cystectomy may benefit select patients who did not receive neoadjuvant therapy.
This document summarizes the results of a study that evaluated the health care resource utilization and costs of patients with symptomatic multiple myeloma in the United Kingdom. The study found that the average total cost per treatment line was £34,296, with most costs attributed to anti-tumor drugs. The average cost per month of active treatment was £5,168. For patients receiving best supportive care after discontinuing active treatment, the average total cost was £1,444 if they progressed or £2,480 if they did not progress before death.
This article discusses a study of 124 patients with differentiated thyroid cancer who underwent dosimetric evaluation to determine the optimal radioactive iodine dose for treatment. Dosimetry calculations were performed using MIRD methodology to estimate radiation doses to bone marrow, lungs, and tumor metastases. The goal was to determine the maximum safe dose that would deliver less than 3 Gy to bone marrow or 30 Gy to lungs, while aiming to deliver over 100 Gy to metastases for a curative intent. No patients experienced permanent bone marrow suppression when doses were under 3 Gy. The largest administered dose was 38.5 GBq (1,040 mCi) based on bone marrow dose limitations. Dosimetry-guided treatment allows administration of the maximum possible
1. The document analyzes changes in treatment strategies for metastatic colorectal cancer in Germany between 2005-2007 based on data from large population surveys. It finds that results from clinical trials showing increased effectiveness of new drugs like oxaliplatin and irinotecan were quickly implemented in clinical practice.
2. The treatment objective of achieving secondary resection of metastases after chemotherapy increased significantly from 18% to 27% during this period, as clinical trials showed biologicals improving resectability rates. Biologicals were used more often when secondary resection was the goal compared to other objectives.
3. A multivariate analysis found that while many factors influenced treatment choices, the objective of secondary resection and patient age had the most significant impact
Сравнение эффективности препаратов Карбоплатин (Carboplatin) и Паклитаксел (P...oncoportal.net
Сравнение эффективности препаратов Карбоплатин (Carboplatin) и Паклитаксел (Paclitaxel) при добавлении препарата Бевацизумаб (Bevacizumab) и без него для лечения одной их форм рака легкого у пациентов старше 65 лет
in Older Patients With Advanced Non–Small Cell Lung Cancer
Open-label uncontrolled pilot study to evaluate complementary therapy with Ru...home
Some patients treated with Ruta graveolens 9c had a transitory improvement
in QoL, but the effectiveness of this treatment remains to be confirmed in further
studies.
1) Radiation therapy can cause xerostomia or dry mouth by damaging the salivary glands and reducing saliva production.
2) Studies show that the drug pilocarpine, given during and after radiation therapy, can significantly increase saliva production and relieve symptoms of dry mouth for many patients.
3) Pilocarpine has been shown in multiple randomized controlled trials to improve patient-reported dryness, swallowing difficulty, and quality of life when compared to placebo.
Abstract—Colorectal cancer is leading cancer-related public health problem. This study was conducted to determine the effect of High-Dose-Rate intraluminal brachytherapy (HDR-BT) with or without interstitial brachytherapy during neoadjuvant chemoradiation for locally advanced rectal cancer. This randomized contrial was conducted on 28 patients attended with locally advanced rectal cancer (T3, T4 or N+) treated initially with concurrent capecitabine (800 mg/m2 twice daily for 5 days per week) and pelvic external beam radiation therapy (45Gy in 25 Fractions) after one week MRI for all patients; received intraluminal HDR-BT with 4Gy x 2 Fractions with one week interval for those had gross residual disease within 1cm of rectal wall and receiveed intraluminal and interstitial brachytherapy with 4Gy x 2 Fractions with one week interval for those had gross residual disease far from 1cm of rectal wall. All patients underwent surgery within 4-8 week after completion of neoadjuvant therapy. In the control group which were not randomized, twenty-eight patients underwent neoadjuvant chemoradiation (45Gy in 25 Fraction with concurrent capecitabine 800mg/m2 twice daily for 5 days per week) followed by surgery. It was found that in HDR-BT group pathologic complete response (pCR), pathologic partial response (pPR) and pathologic response rates (pCR+pPR) based on AJCC TNM staging for colorectal cancer were %35.7, %35.7, and %71.4 respectively. The pCR, pPR, and pRR were %25, %17, and %42 in the control group respectively. pCR, pPR, and pRR were improved with HDR-BT. However, only response rate improvement was statistically significant (p=0.031). There was no a statistically significant difference in the complications between the two groups (p > 0.05). So it can be concluded that HDR intraluminal with or without interstitial brachytherapy may be an effective method of dose escalation technique in neoadjuvant chemoradiation therapy of locally advanced rectal cancer with higher response rate and manageable side effects.
The RAPIDO trial tested a new experimental treatment for locally advanced rectal cancer that involved short-course radiotherapy followed by chemotherapy before surgery, compared to the standard treatment of long-course chemoradiotherapy followed by surgery and then chemotherapy. The results showed that the experimental treatment led to a lower rate of disease-related treatment failures and distant metastases, along with a doubled rate of pathologic complete responses, without increasing toxicities or compromising survival rates. This provides evidence that the experimental approach may be a new standard of care for high-risk locally advanced rectal cancer.
Medical Conferences, Pharma Conferences, Engineering Conferences, Science Conferences, Manufacturing Conferences, Social Science Conferences, Business Conferences, Scientific Conferences Malaysia, Thailand, Singapore, Hong Kong, Dubai, Turkey 2014 2015 2016
Global Research & Development Services (GRDS) is a leading academic event organizer, publishing Open Access Journals and conducting several professionally organized international conferences all over the globe annually. GRDS aims to disseminate knowledge and innovation with the help of its International Conferences and open access publications. GRDS International conferences are world-class events which provide a meaningful platform for researchers, students, academicians, institutions, entrepreneurs, industries and practitioners to create, share and disseminate knowledge and innovation and to develop long-lasting network and collaboration.
GRDS is a blend of Open Access Publications and world-wide International Conferences and Academic events. The prime mission of GRDS is to make continuous efforts in transforming the lives of people around the world through education, application of research and innovative ideas.
Global Research & Development Services (GRDS) is also active in the field of Research Funding, Research Consultancy, Training and Workshops along with International Conferences and Open Access Publications.
International Conferences 2014 – 2015
Malaysia Conferences, Thailand Conferences, Singapore Conferences, Hong Kong Conferences, Dubai Conferences, Turkey Conferences, Conference Listing, Conference Alerts
Hypofractionation in early breast cancer is no more a research scholars topic. Multiple studies with robust data have proven its utility. It may hold an important role in many countries with constrained resources. This is a short presentation incorporating important completed and ongoing trials. Feel free to use this.
The dream of any physician and consequently every patient is to receive the right treatment in the right time with cost effectiveness. To achieve this goal, the 3 pillars: evidence based medicine, clinical research innovation & resources utilization should be integrated efficiently.
In this presentation, I'll try to comprehensively review the following:
1- How are we used to perform clinical trials in Oncology?
2- Does it fits in today’s needs?
3- Integration of biology knowledge in shaping drug development
4- New Clinical trial designs “Can they offer solution for accelerating drug development?”
5- The supporting infrastructure role in clinical trial execution
Long Term Effects of Using Medicinal Mushroom Preparations in Human Colorecta...Neven Jakopovic
52 patients with bowel cancer and 89 with breast cancer used medicinal mushroom extracts from Myko San company with standard oncological treatments. In this cohort study, lasting from 2005-2010, we analysed the long term effects of using medicinal mushroom products in cancer patients.
While medicinal mushrooms are not 'magic bullets', this study provides unquestionable evidence of the benefits of their use as supportive therapy in cancer patients, leading to significantly improved outcomes.
This work was presented by Neven Jakopovic at the 6th International Medicinal Mushroom Conference in Zagreb, Croatia, in 2011.
This document summarizes a study examining the effect of breast cancer treatment on liver enzymes in diabetic and cardiac breast cancer patients. 47 breast cancer patients were divided into two groups - 22 diabetic patients without cardiac issues, and 25 cardiac patients without diabetes. Blood samples were taken before and after treatment to analyze liver enzymes. Treatment included surgery, chemotherapy, radiotherapy, and hormonal therapy. Results showed alkaline phosphatase levels were significantly higher after all treatments compared to pretreatment. Alanine transaminase increased significantly with treatment except when tamoxifen was included. The pattern of liver enzyme variations was similar between both patient groups.
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.
Dose selection trial of metronomic oral vinorelbine monotherapy in patients w...Enrique Moreno Gonzalez
Metronomic chemotherapy is considered an anti-angiogenic therapy that involves chronic administration of low-dose chemotherapy at regular short intervals. We investigated the optimal metronomic dose of oral vinorelbine when given as monotherapy in patients with metastatic cancer.
This study aimed to determine the most accurate method for defining in vitro chemosensitivity using an ATP-based chemotherapy response assay (ATP-CRA). 48 patients with advanced gastric cancer were treated with paclitaxel and cisplatin chemotherapy after obtaining tumor samples for ATP-CRA testing. The chemosensitivity index method showed the highest accuracy of 77.8% for predicting clinical response. In vitro chemosensitive tumors had a higher response rate to chemotherapy compared to chemoresistant tumors. The ATP-CRA could predict clinical response to paclitaxel and cisplatin chemotherapy in advanced gastric cancer patients with high accuracy.
This study analyzed 264 gastric cancers for mutations in exons 9 and 20 of the PIK3CA gene. PIK3CA mutations were found in 42 cases (16%), all heterozygous missense mutations. The most common mutation was H1047R in exon 20 (62% of mutations) and the second most common was Q546K in exon 9 (9.5% of mutations). A meta-analysis of 27 publications found that the ratio of exon 20 to exon 9 mutations varied by cancer type, being highest in gastric cancer. The exon mutation selectivity is a signature of the cancer type.
Este documento discute la prevención del cáncer gástrico. Explica que el cáncer gástrico es el quinto cáncer más común y la segunda causa de muerte por cáncer en Panamá. Luego describe los factores de riesgo como la infección por H. pylori, el tabaquismo y la dieta, y propone estrategias de prevención primaria como evitar el tabaco, adoptar una dieta rica en frutas y vegetales, y erradicar H. pylori. También recomienda la dete
This document summarizes the results of a survey of 115 Japanese medical facilities that treat gynecologic cancers, regarding their palliative care practices. The survey found that about 30% of facilities had a dedicated palliative care ward. Most facilities had a palliative care team but about half of physicians on the team had other duties as well. End-of-life care was typically managed in the gynecology department. The median time between a patient's last chemotherapy treatment and death was 85 days. Over 15% of patients received chemotherapy within 30 days of death and over 7% within 14 days of death. The survey identified some gaps in palliative care coordination and opportunities to improve symptom management at the end of life.
This document describes the development of a novel intratumoral drug delivery system using interstitial chemotherapy devices. The system aims to deliver chemotherapy drugs directly into solid tumors via implantable polymeric devices to achieve higher drug concentrations and more homogeneous distribution compared to systemic chemotherapy. The document outlines the design of biodegradable polymer implants loaded with cisplatin as a model drug. In vitro studies show sustained release of cisplatin from the implants over 1 month in a rate dependent on drug loading. The system has the potential for localized treatment with fewer systemic side effects.
This document discusses improving systemic chemotherapy for bladder cancer. It covers the following key points:
1) Neoadjuvant chemotherapy, particularly cisplatin-based regimens like gemcitabine and cisplatin, has become the standard of care for muscle-invasive bladder cancer based on improved survival outcomes shown in clinical trials.
2) Dose-dense regimens are being explored as a way to improve pathologic response rates without increasing toxicity.
3) While no definitive trials provide support, adjuvant chemotherapy after cystectomy may benefit select patients who did not receive neoadjuvant therapy.
This document summarizes the results of a study that evaluated the health care resource utilization and costs of patients with symptomatic multiple myeloma in the United Kingdom. The study found that the average total cost per treatment line was £34,296, with most costs attributed to anti-tumor drugs. The average cost per month of active treatment was £5,168. For patients receiving best supportive care after discontinuing active treatment, the average total cost was £1,444 if they progressed or £2,480 if they did not progress before death.
This article discusses a study of 124 patients with differentiated thyroid cancer who underwent dosimetric evaluation to determine the optimal radioactive iodine dose for treatment. Dosimetry calculations were performed using MIRD methodology to estimate radiation doses to bone marrow, lungs, and tumor metastases. The goal was to determine the maximum safe dose that would deliver less than 3 Gy to bone marrow or 30 Gy to lungs, while aiming to deliver over 100 Gy to metastases for a curative intent. No patients experienced permanent bone marrow suppression when doses were under 3 Gy. The largest administered dose was 38.5 GBq (1,040 mCi) based on bone marrow dose limitations. Dosimetry-guided treatment allows administration of the maximum possible
1. The document analyzes changes in treatment strategies for metastatic colorectal cancer in Germany between 2005-2007 based on data from large population surveys. It finds that results from clinical trials showing increased effectiveness of new drugs like oxaliplatin and irinotecan were quickly implemented in clinical practice.
2. The treatment objective of achieving secondary resection of metastases after chemotherapy increased significantly from 18% to 27% during this period, as clinical trials showed biologicals improving resectability rates. Biologicals were used more often when secondary resection was the goal compared to other objectives.
3. A multivariate analysis found that while many factors influenced treatment choices, the objective of secondary resection and patient age had the most significant impact
Сравнение эффективности препаратов Карбоплатин (Carboplatin) и Паклитаксел (P...oncoportal.net
Сравнение эффективности препаратов Карбоплатин (Carboplatin) и Паклитаксел (Paclitaxel) при добавлении препарата Бевацизумаб (Bevacizumab) и без него для лечения одной их форм рака легкого у пациентов старше 65 лет
in Older Patients With Advanced Non–Small Cell Lung Cancer
Open-label uncontrolled pilot study to evaluate complementary therapy with Ru...home
Some patients treated with Ruta graveolens 9c had a transitory improvement
in QoL, but the effectiveness of this treatment remains to be confirmed in further
studies.
1) Radiation therapy can cause xerostomia or dry mouth by damaging the salivary glands and reducing saliva production.
2) Studies show that the drug pilocarpine, given during and after radiation therapy, can significantly increase saliva production and relieve symptoms of dry mouth for many patients.
3) Pilocarpine has been shown in multiple randomized controlled trials to improve patient-reported dryness, swallowing difficulty, and quality of life when compared to placebo.
Abstract—Colorectal cancer is leading cancer-related public health problem. This study was conducted to determine the effect of High-Dose-Rate intraluminal brachytherapy (HDR-BT) with or without interstitial brachytherapy during neoadjuvant chemoradiation for locally advanced rectal cancer. This randomized contrial was conducted on 28 patients attended with locally advanced rectal cancer (T3, T4 or N+) treated initially with concurrent capecitabine (800 mg/m2 twice daily for 5 days per week) and pelvic external beam radiation therapy (45Gy in 25 Fractions) after one week MRI for all patients; received intraluminal HDR-BT with 4Gy x 2 Fractions with one week interval for those had gross residual disease within 1cm of rectal wall and receiveed intraluminal and interstitial brachytherapy with 4Gy x 2 Fractions with one week interval for those had gross residual disease far from 1cm of rectal wall. All patients underwent surgery within 4-8 week after completion of neoadjuvant therapy. In the control group which were not randomized, twenty-eight patients underwent neoadjuvant chemoradiation (45Gy in 25 Fraction with concurrent capecitabine 800mg/m2 twice daily for 5 days per week) followed by surgery. It was found that in HDR-BT group pathologic complete response (pCR), pathologic partial response (pPR) and pathologic response rates (pCR+pPR) based on AJCC TNM staging for colorectal cancer were %35.7, %35.7, and %71.4 respectively. The pCR, pPR, and pRR were %25, %17, and %42 in the control group respectively. pCR, pPR, and pRR were improved with HDR-BT. However, only response rate improvement was statistically significant (p=0.031). There was no a statistically significant difference in the complications between the two groups (p > 0.05). So it can be concluded that HDR intraluminal with or without interstitial brachytherapy may be an effective method of dose escalation technique in neoadjuvant chemoradiation therapy of locally advanced rectal cancer with higher response rate and manageable side effects.
The RAPIDO trial tested a new experimental treatment for locally advanced rectal cancer that involved short-course radiotherapy followed by chemotherapy before surgery, compared to the standard treatment of long-course chemoradiotherapy followed by surgery and then chemotherapy. The results showed that the experimental treatment led to a lower rate of disease-related treatment failures and distant metastases, along with a doubled rate of pathologic complete responses, without increasing toxicities or compromising survival rates. This provides evidence that the experimental approach may be a new standard of care for high-risk locally advanced rectal cancer.
Medical Conferences, Pharma Conferences, Engineering Conferences, Science Conferences, Manufacturing Conferences, Social Science Conferences, Business Conferences, Scientific Conferences Malaysia, Thailand, Singapore, Hong Kong, Dubai, Turkey 2014 2015 2016
Global Research & Development Services (GRDS) is a leading academic event organizer, publishing Open Access Journals and conducting several professionally organized international conferences all over the globe annually. GRDS aims to disseminate knowledge and innovation with the help of its International Conferences and open access publications. GRDS International conferences are world-class events which provide a meaningful platform for researchers, students, academicians, institutions, entrepreneurs, industries and practitioners to create, share and disseminate knowledge and innovation and to develop long-lasting network and collaboration.
GRDS is a blend of Open Access Publications and world-wide International Conferences and Academic events. The prime mission of GRDS is to make continuous efforts in transforming the lives of people around the world through education, application of research and innovative ideas.
Global Research & Development Services (GRDS) is also active in the field of Research Funding, Research Consultancy, Training and Workshops along with International Conferences and Open Access Publications.
International Conferences 2014 – 2015
Malaysia Conferences, Thailand Conferences, Singapore Conferences, Hong Kong Conferences, Dubai Conferences, Turkey Conferences, Conference Listing, Conference Alerts
Hypofractionation in early breast cancer is no more a research scholars topic. Multiple studies with robust data have proven its utility. It may hold an important role in many countries with constrained resources. This is a short presentation incorporating important completed and ongoing trials. Feel free to use this.
The dream of any physician and consequently every patient is to receive the right treatment in the right time with cost effectiveness. To achieve this goal, the 3 pillars: evidence based medicine, clinical research innovation & resources utilization should be integrated efficiently.
In this presentation, I'll try to comprehensively review the following:
1- How are we used to perform clinical trials in Oncology?
2- Does it fits in today’s needs?
3- Integration of biology knowledge in shaping drug development
4- New Clinical trial designs “Can they offer solution for accelerating drug development?”
5- The supporting infrastructure role in clinical trial execution
Long Term Effects of Using Medicinal Mushroom Preparations in Human Colorecta...Neven Jakopovic
52 patients with bowel cancer and 89 with breast cancer used medicinal mushroom extracts from Myko San company with standard oncological treatments. In this cohort study, lasting from 2005-2010, we analysed the long term effects of using medicinal mushroom products in cancer patients.
While medicinal mushrooms are not 'magic bullets', this study provides unquestionable evidence of the benefits of their use as supportive therapy in cancer patients, leading to significantly improved outcomes.
This work was presented by Neven Jakopovic at the 6th International Medicinal Mushroom Conference in Zagreb, Croatia, in 2011.
This document summarizes a study examining the effect of breast cancer treatment on liver enzymes in diabetic and cardiac breast cancer patients. 47 breast cancer patients were divided into two groups - 22 diabetic patients without cardiac issues, and 25 cardiac patients without diabetes. Blood samples were taken before and after treatment to analyze liver enzymes. Treatment included surgery, chemotherapy, radiotherapy, and hormonal therapy. Results showed alkaline phosphatase levels were significantly higher after all treatments compared to pretreatment. Alanine transaminase increased significantly with treatment except when tamoxifen was included. The pattern of liver enzyme variations was similar between both patient groups.
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.
Dose selection trial of metronomic oral vinorelbine monotherapy in patients w...Enrique Moreno Gonzalez
Metronomic chemotherapy is considered an anti-angiogenic therapy that involves chronic administration of low-dose chemotherapy at regular short intervals. We investigated the optimal metronomic dose of oral vinorelbine when given as monotherapy in patients with metastatic cancer.
This study aimed to determine the most accurate method for defining in vitro chemosensitivity using an ATP-based chemotherapy response assay (ATP-CRA). 48 patients with advanced gastric cancer were treated with paclitaxel and cisplatin chemotherapy after obtaining tumor samples for ATP-CRA testing. The chemosensitivity index method showed the highest accuracy of 77.8% for predicting clinical response. In vitro chemosensitive tumors had a higher response rate to chemotherapy compared to chemoresistant tumors. The ATP-CRA could predict clinical response to paclitaxel and cisplatin chemotherapy in advanced gastric cancer patients with high accuracy.
This study analyzed 264 gastric cancers for mutations in exons 9 and 20 of the PIK3CA gene. PIK3CA mutations were found in 42 cases (16%), all heterozygous missense mutations. The most common mutation was H1047R in exon 20 (62% of mutations) and the second most common was Q546K in exon 9 (9.5% of mutations). A meta-analysis of 27 publications found that the ratio of exon 20 to exon 9 mutations varied by cancer type, being highest in gastric cancer. The exon mutation selectivity is a signature of the cancer type.
Este documento discute la prevención del cáncer gástrico. Explica que el cáncer gástrico es el quinto cáncer más común y la segunda causa de muerte por cáncer en Panamá. Luego describe los factores de riesgo como la infección por H. pylori, el tabaquismo y la dieta, y propone estrategias de prevención primaria como evitar el tabaco, adoptar una dieta rica en frutas y vegetales, y erradicar H. pylori. También recomienda la dete
This study performed a cost-effectiveness analysis of adjuvant chemoradiotherapy for resected gastric cancer based on results from the Intergroup 0116 trial. An economic model was constructed to examine costs and quality-adjusted survival benefits. Results found that adjuvant chemoradiotherapy cost $20,100 more but provided 0.53 more quality-adjusted life years, resulting in an incremental cost-effectiveness ratio of $38,400 per quality-adjusted life year gained. Sensitivity analyses suggested a 67% likelihood the ratio would be less than $50,000 per quality-adjusted life year, which compares favorably to other cancer treatments.
This clinical practice guideline summarizes key points on Helicobacter pylori infections and gastroduodenal ulcer disease. It was developed by an interdisciplinary group in accordance with German guidelines. H. pylori infection can be accurately diagnosed non-invasively or invasively. Eradication therapy is recommended for H. pylori-associated ulcers or gastric MALT lymphoma. First-line eradication therapy consists of a proton pump inhibitor combined with clarithromycin and either metronidazole or amoxicillin.
This document summarizes trends in gastrointestinal diseases at a single institution in Korea over the past two decades from 1990 to 2006. Some key findings include:
1) Admission rates for GI diseases increased between 1990 and 2006, with gastric cancer, colon cancer, and colon adenomas/polyps becoming the most prevalent.
2) While gastric cancer rates decreased, colon cancer rates doubled over the two decades.
3) Detection and treatment of early gastric cancer and colon adenomas increased noticeably.
4) New emerging diseases included inflammatory bowel disease and gastroesophageal reflux.
This case report describes a 70-year-old female diagnosed with gastric adenocarcinoma with osteoclast-like giant cells (OGCs). Histopathological examination revealed a moderately differentiated adenocarcinoma with prominent lympho-histocytic infiltration and OGCs in the stroma. Immunohistochemistry showed the tumor cells were positive for pancytokeratin and the OGCs were positive for CD68. Additionally, the tumor and lymph nodes were positive for Epstein-Barr virus. The authors conclude that gastric carcinomas with OGCs are rare tumors that must be distinguished from more aggressive anaplastic carcinomas.
This study performed a cost-effectiveness analysis of adjuvant chemoradiotherapy for resected gastric cancer based on results from the Intergroup 0116 trial. The analysis found that the incremental cost of adding chemoradiotherapy was $20,100 and provided an additional 0.53 quality-adjusted life years, resulting in an incremental cost-effectiveness ratio of $38,400 per quality-adjusted life year gained. This ratio compares favorably to other widely used cancer treatments, suggesting adjuvant chemoradiotherapy is a cost-effective option for resected gastric cancer patients.
1) The earliest reports of possible gastric cancer cases date back to ancient Egyptian and Greek civilizations in 1600 BC and the 2nd century AD, though understanding of cancer was limited.
2) The first modern medical description of gastric cancer was not until the 18th century, explaining the mystery of Napoleon Bonaparte's death from stomach cancer in 1821.
3) An autopsy of Napoleon revealed a cancerous ulcer occupying most of his stomach wall, representing one of the earliest confirmed cases of gastric cancer.
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.
Neoadjuvant chemotherapy uses chemotherapy drugs to shrink tumors before surgery. It has several advantages, including allowing previously inoperable tumors to become operable, preserving organs, and improving long-term survival. Some studies have found higher rates of pathological complete response and progression-free survival with neoadjuvant chemoradiotherapy compared to chemotherapy alone for some cancers. Neoadjuvant chemotherapy has been shown to be as effective as adjuvant chemotherapy for some cancers. However, it can also be more difficult for patients due to its cumulative toxicity and longer duration before definitive surgery. It may be recommended as an alternative to adjuvant therapy for operable breast cancers where breast conservation is desired or surgery is not immediately possible.
This document describes a study protocol for a randomized phase III clinical trial comparing neoadjuvant chemoradiation followed by surgery versus surgery alone in patients with adenocarcinoma or squamous cell carcinoma of the esophagus. The trial aims to enroll 350 patients total with 175 patients in each arm. The primary objective is to compare median survival rates and quality of life between the two treatment groups. Secondary objectives include comparing pathological responses, progression-free survival, number of complete resections, treatment toxicity, and costs. The chemoradiation regimen involves weekly paclitaxel and carboplatin chemotherapy with concurrent radiation over 5 weeks. Patients will then undergo surgery and be followed up for survival and quality of life outcomes
1) Preoperative chemotherapy or chemoradiotherapy can downstage tumors and increase resection rates for stomach cancer compared to surgery alone.
2) The MAGIC trial showed perioperative chemotherapy improved survival rates over surgery alone by reducing tumor size and stage.
3) The TOPGEAR trial is currently testing adding preoperative chemoradiotherapy to perioperative chemotherapy to further improve outcomes. Interim results found it to be safe and feasible.
This document describes a study that aimed to create a predictive nomogram to help clinicians determine which patients with resected gallbladder cancer would benefit from adjuvant chemoradiotherapy (CRT). The study used a database of 1,137 patients from the SEER-Medicare database to develop several multivariate survival models. A lognormal survival model showed the best performance. From this model, researchers built a nomogram available online to provide individualized estimates of survival benefit from adjuvant CRT. The nomogram can predict that certain high-risk patients with T2 or N1 disease would gain a survival benefit from adjuvant CRT.
The document discusses adjuvant radiation therapy for gallbladder carcinoma based on available literature. It summarizes several retrospective studies that found improved survival outcomes with adjuvant radiation or chemoradiation after surgical resection compared to surgery alone, especially for node-positive or advanced-stage disease. However, it notes the evidence is limited due to the rarity of the disease and lack of large randomized controlled trials. While adjuvant therapy appears logical, more research is still needed to better define its role and optimal use.
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To evaluate a surgeon?s experience of combination chemotherapy comprising different regimens of fluorouracil with or without irinotecan together with bevacizumab with respect to response rate for patients with recurrent or metastatic colorectal cancer.
: To evaluate a surgeon’s experience of combination chemotherapy comprising
different regimens of fluorouracil with or without irinotecan together with bevacizumab with
respect to response rate for patients with recurrent or metastatic colorectal cancer
To evaluate a surgeon’s experience of combination chemotherapy comprising
different regimens of fluorouracil with or without irinotecan together with bevacizumab with
respect to response rate for patients with recurrent or metastatic colorectal cancer.
Both XELIRI And TEGAFIRI Togetherwith Bevacizumab are Effective for Recurrent...semualkaira
To evaluate a surgeon?s experience of combination chemotherapy comprising different regimens of fluorouracil with or without irinotecan together with bevacizumab with respect to response rate for patients with recurrent or metastatic colorectal cancer.
Both XELIRI And TEGAFIRI Together with Bevacizumab are Effective for Recurren...semualkaira
To evaluate a surgeon’s experience of combination chemotherapy comprising
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respect to response rate for patients with recurrent or metastatic colorectal cancer.
Both XELIRI And TEGAFIRI Togetherwith Bevacizumab are Effective for Recurrent...NainaAnon
To evaluate a surgeon?s experience of combination chemotherapy comprising different regimens of fluorouracil with or without irinotecan together with bevacizumab with respect to response rate for patients with recurrent or metastatic colorectal cancer.
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To evaluate a surgeon’s experience of combination chemotherapy comprising
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respect to response rate for patients with recurrent or metastatic colorectal cancer
Eribulin mesylate is a microtubule inhibitor with activity in preclinical breast cancer models. Two phase III trials are evaluating eribulin in advanced breast cancer patients previously treated with anthracyclines and taxanes. Study 305 compares eribulin to physician's choice chemotherapy in late-line therapy, with the primary objective being overall survival. Study 301 compares eribulin to capecitabine as second-line therapy, with the primary objectives being overall and progression-free survival. Both open-label studies have completed enrollment of over 750 and 1100 patients respectively.
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2. S.J. Wang, et al.
to IV (M0) gastric adenocarcinoma were given for the first 4 days of radiotherapy, 0116 (surgery alone). Since cost and utility
randomized to receive postoperative chemo- and cycle 3 was given on the last 3 days of information were not available from the
radiotherapy or no additional treatment. radiotherapy. The updated results of INT- actual patients enrolled in this trial, these
The adjuvant treatment arm received five 0116 showed that the adjuvant therapy data were extrapolated from other sources
cycles of bolus intravenous 5-fluorouracil arm had improved overall survival of 35 vs. as described below. A third-party payer's
10
(5-FU)/leucovorin (LV) concurrently with 26 months for the surgery-alone arm. economic perspective was used. A 3%
45 Gy of radiation. Adjuvant 5-FU was annual discount rate for costs and utilities
dosed at 425 mg/m2/day, and leucovorin at Economic Model was assumed,21 and a lifetime time horizon
20 mg/m2/day, each for 5 days for cycles 1, To determine the cost-effectiveness of the was used. All costs were converted to 2007
4, and 5. Concurrent radiotherapy was given INT-0116 protocol, we constructed an US dollars using historical US Gross
during chemotherapy cycles 2 and 3, economic model to evaluate the costs and Domestic Product deflator indices.22
consisting of 1.8 Gy per day for 25 days utilities for patients receiving this interven-
using either two- or four-field conventional tion. The reference treatment strategy for Cost Data
techniques. Chemotherapy cycle 2 was our analysis was the control arm of INT- Cost data for radiotherapy and chemo-
Table 1. Cost data* for radiotherapy, chemotherapy, and toxicity management.
Quantity Base-case Sensitivity analysis range
Description HCPCS Unit cost or % total cost Low High Reference
Radiotherapy
Initial consultation 99245 $213.93 1 $213.93 $149.75 $342.29 24
Complex treatment plan 77263 $153.97 1 $153.97 $137.57 $183.67 23
Complex simulation 77290 $388.66 2 $777.32 $571.72 $1,144.60 23
3D simulation 77295 $1,114.21 1 $1,114.21 $805.68 $1,607.64 23
Blocks/moulds 77334 $179.60 5 $898.00 $677.75 $1,258.65 23
Basic dosimetry calculation 77300 $79.32 4 $317.28 $242.44 $440.12 23
Continuing medical physics consults 77336 $99.71 5 $498.55 $341.55 $757.65 23
Radiation treatment management 77427 $175.52 5 $877.60 $791.60 $1,038.75 23
Concurrent chemotherapy 77470 $447.16 1 $447.16 $325.75 $640.31 23
Weekly CBC count 85025 $14.68 5 $73.40 $51.38 $117.44 25
Weekly port films 77417 $21.26 5 $106.30 $72.15 $160.10 23
Radiation treatment delivery 77414 $140.84 25 $3,521.00 $2,468.75 $5,469.00 23
Total radiotherapy costs: $8,998.72 $6,636.09 $13,160.22
Chemotherapy
Initial consultation 99245 $231.10 1 $231.10 $161.77 $369.75 24
Management office visits 99213 $53.09 5 $265.46 $185.82 $424.73 24
5-Fluorouracil 500-mg vial (x2) J9190 $1.66 44 $73.04 $51.13 $116.86 28
Initial CTX administration 96409 $117.12 22 $2,576.64 $1,874.62 $3,938.66 23
Leucovorin 50-mg vial J0640 $1.03 22 $22.66 $15.86 $36.26 28
Additional CTX administration 96411 $67.48 22 $1,484.56 $1,083.72 $2,227.72 23
CBC count 85025 $14.68 17 $249.56 $174.69 $399.30 25
Complete metabolic panel 80053 $19.96 2 $39.92 $27.94 $63.87 25
Total chemotherapy costs: $4,942.94 $3,460.05 $7,908.70
Toxicity management
Neutropenia
Neutropenic hospitalizations $13,224.12 2.98% $394.08 $197.04 $1,182.24 26
Outpatient neutropenia management $1,544.01 51% $787.75 $393.88 $2,363.26 27
Filgrastim $3,978.87 51% $2,030.02 $1,015.01 $6,090.06 28
Nausea/vomiting
Management of CINV x 5 cycles $2,976.09 100% $2,976.09 $1,488.04 $8,928.27 29
Total toxicity costs: $6,187.94 $3,094.00 $18,564.00
22
* All costs converted to 2007 US dollars.
Abbreviations: HCPCS = Healthcare Common Procedure Coding System; CBC = complete blood cell; CTX = chemotherapy; CINV = chemotherapy-induced
nausea & vomiting.
58 Gastrointestinal Cancer Research Volume 2 • Issue 2
3. Cost-Effectiveness of Adjuvant CRT for Gastric Cancer
therapy were based on median Medicare- for stomach cancer, based on actual hospi- estimated to be 0.81, based on a study by
allowed charges from the 2007 Medicare tal discharge databases from seven states. Gockel,30 who evaluated patients after
Physician Fee Schedule.23 We assumed We assumed that the remainder of the pa- subtotal resection and gastrectomy with a
that all chemoradiotherapy was given in tients experiencing grade 3 or 4 neutro- gastrointestinal quality-of-life index. This
accordance with the INT-0116 trial protocol. penia could be treated as outpatients and utility was estimated by taking the
Radiotherapy was planned using computed used data from Bennett,27 who found that percentage of the gastrointestinal quality-
tomography (CT)-based simulation and the cost of outpatient treatment of neutro- of-life index score for postgastrectomy
was delivered in 25 daily fractions with a 2- penia for several cancer types was $1,329 patients (116/144). The utility for nausea/
or 4-field conventional setup. For radio- (in 2001 US dollars). We also included the vomiting was estimated to be 0.27, based
therapy, the model included costs for the costs of filgrastim,28 which was assumed to on a study by Grunberg,31 who evaluated
initial physician consultation,24 simulation have been given to all patients with neutro- quality of life of patients experiencing
and treatment planning, dosimetry, blocks, penia. chemotherapy-induced nausea and
weekly on-treatment visits, weekly labora- Cost estimates for managing chemo- vomiting. The utility for leukopenia was
tory tests,25 and daily radiotherapy delivery therapy-induced nausea and vomiting estimated to be 0.71, based on a study by
(Table 1). For chemotherapy, the model (CINV) are based on a study by Stewart,29 Fortner,32 who evaluated the effects of
included the costs of the initial physician who calculated the total costs (outpatient and neutropenia on quality of life.
consult and management visits,24 chemo- hospitalization) for prevention and manage- The overall net utility during chemora-
therapy drugs, chemotherapy administra- ment of CINV after the introduction of diotherapy administration was estimated to
tion, and laboratory analyses25 performed ondansetron. When converted to 2007 US be 0.59, calculated as a weighted average
according to the SWOG 9008 protocol dollars,22 this was calculated to be $2,976 of the fraction of patients experiencing the
schedule (Table 1). per patient (Table 1). The 2004 update of specified toxicities in INT-0116.9 Quality-
Chemoradiotherapy toxicity manage- INT-0116 confirmed that there were no adjusted life-years (QALYs) were calcu-
ment costs (Table 1) were based on the significant late toxicities in the chemora- lated by multiplying the utilities by the time
type, frequency, and grade of the most com- diotherapy arm.10 the patient spent in that state.
Base-Case and Sensitivity
Table 2. Patient health state utility values.*
Analyses
Utility Range Reference Baseline values for the costs, utilities, and
expected survival benefit from adjuvant
Postgastrectomy 0.81 0.4 –1.0 27
chemoradiotherapy were used for the
Nausea/vomiting 0.27 0.14 –1.0 28
base-case analysis. The primary outcome
Leukopenia 0.70 0.35 –1.0 29 measure for this analysis was the incre-
Net utility during chemoradiation† 0.59 mental cost-effectiveness ratio (ICER),
*Utilities were estimated based on quality-of-life data in the indicated references. defined as the incremental cost divided by
†Calculated as a weighted average based on percentage of patients experiencing these toxicities in the number of QALYs saved. The incre-
INT-0116.
mental cost was the difference in cost
between the chemoradiotherapy arm and
mon toxicities reported in the Intergroup Costs for surgery were assumed equiv- the control arm.
trial.9 We included costs for toxicity prophy- alent in both groups and were not tabulated One-way and probabilistic sensitivity
laxis and for the management of acute in this analysis, as all patients in the series analyses were performed. For the one-way
toxicities, including downstream hospital- underwent surgery prior to trial enrollment. sensitivity analyses, the upper and lower
ization costs for patients experiencing the bounds for chemotherapy and radio-
most severe toxicities. The most common Patient Utilities therapy costs were derived from the range
toxicity reported in the trial was hemato- Patient health state utility values were used in Medicare geographic practice cost
logic, primarily neutropenia (54%). to adjust survival for the decrease in indices, which ranged from 70% to 160%
We contacted the SWOG Statistical health-related quality of life from the of the median. Because of the greater
Center (www.swogstat.org) to determine if various treatment interventions. Utilities uncertainty regarding toxicity costs, a
actual hospitalization rates were recorded were estimated based on published litera- wider range of 50% to 300% of the base-
for patients in the SWOG 9008 trial experi- ture from patients who had similar health case estimate was assigned. The upper
encing toxicities, but found that this infor- states to those enrolled in INT-0116. bound for hospitalization rate was set at
mation was not recorded. Because the actual Patients in both arms of the study were 29%, to reflect the percentage of patients
hospitalization rate was not recorded, we given a baseline utility of the postgastrec- (79/273) experiencing grade 4 hematopoi-
used data from Caggiano,26 who calculated tomy state, while those in the intervention etic toxicities in the INT-0116 trial. For
the rate (2.98%) and cost ($10,900 in 1999 group had a further reduction of their utility patient utilities, we allowed values to vary
US dollars) of hospitalization for neutro- during chemoradiotherapy (Table 2). The from 50% of baseline to a maximum value
penic patients who receive chemotherapy utility for the postgastrectomy state was of unity (representing no decrease in
March/April 2008 www.myGCRonline.org 59
4. S.J. Wang, et al.
was also modeled with a normal distribu- $50,000 and $100,000 thresholds. Trial
Table 3. Quality-adjusted life-years.
tion with SD = 3.5 months to approximate points that fall to the right and below these
Survival (mo) QALYs the 95% confidence intervals for the diagonal lines indicate a cost-effectiveness
Chemoradiation 35 2.25 hazard ratio in the Intergroup trial.10 below the given threshold level. This
Surgery alone 26 1.72 analysis indicates a 67% probability that
Net survival gain 9 0.53
RESULTS the ICER would be less than $50,000/QALY,
Abbreviation: QALY = quality-adjusted life-year. When the baseline survival for patients in and a 91% probability of the ICER being
the adjuvant chemoradiotherapy arm (35 less than $100,000/QALY. The accept-
months) was adjusted for quality of life ability curve in Figure 3 can be used to
Table 4. Base case results.
using the patient utilities, this resulted in a interpret the cost-effectiveness of this
Incremental cost quality-adjusted survival of 27.01 months, intervention for any given threshold level.
of chemoradiation $20,100 or 2.25 QALYs. Similarly, for patients in the For example, at a threshold level (“willing-
QALYs gained 0.53 surgery alone arm, the baseline survival of ness to pay”) of $30,000, there would be a
Incremental cost- 26 months was adjusted to 20.68 months, 25% likelihood that this intervention would
effectiveness ratio $38,400/QALY or 1.72 QALYs (Table 3). The 9-month net be considered cost-effective. However, at a
Abbreviation: QALY = quality-adjusted life-year. survival gain with chemoradiotherapy was threshold of $100,000, there would be a
adjusted to 6.32 months (0.53 QALYs). For 91% probability that the intervention would
be considered cost-effective.
Table 5. Inputs for one-way sensitivity analysis.
DISCUSSION
Input Base case Low High
As health care costs inexorably rise, inter-
Cost of radiotherapy $9,000 $6,600 $13,200 est in assessing the economic burden of
Cost of chemotherapy $5,000 $3,500 $7,900
cancer treatments continues to increase;
Cost of toxicity management $6,200 $3,100 $18,600
Utility for postgastrectomy 0.81 0.40 1.00
this is particularly true when it comes to
Utility for nausea/vomiting 0.27 0.14 1.00 the treatment of aggressive malignancies,
Utility for leukopenia 0.70 0.35 1.00 where incremental progress in therapeutic
Hospitalization rate 2.98% 1.5% 29% advances is often measured by survival
Survival benefit (months) 9 2.8 16.8
improvement in months rather than years.
While prospective collection of cost and
quality of life). We also allowed the the base-case analysis, the incremental utility information concurrently during a
expected survival gain to vary from 2.8 to cost of adjuvant chemoradiotherapy was clinical trial would be ideal,17 this goal is still
16.8 months, which corresponds to the $20,100 (Table 4). This resulted in an ICER not commonly achieved because of time
95% confidence interval for the hazard of $38,400 per QALY. and resource constraints. When actual
ratio reported in INT-0116. For the one-way sensitivity analysis, the cost data from trial participants are either
The probabilistic sensitivity analysis inputs to the model were allowed to vary not collected or not available, an economic
was performed using a second-order across their specified ranges (Table 5). modeling approach34 based on costs and
Monte Carlo simulation using TreeAge Pro The results of the one-way sensitivity utilities estimates from other sources can
software.33 For this analysis, 1,000 simu- analysis are shown in the tornado diagram be used to simulate the cost-effectiveness
35-37
lated trials were run, where each input was in Figure 1, which depicts graphically how of phase III clinical trials. Our study is
sampled at random from probability distri- variations in each input affect the an example of an economic model that can
bution functions assigned to each variable. outcome. The tornado diagram is stacked be used to perform a cost-effectiveness
The cost input variables were modeled in order of decreasing width, indicating analysis of a recommended treatment regi-
with normal distributions. A standard that variations in inputs near the top men based on a major phase III clinical trial.
deviation (SD) of 25% of the baseline value (expected survival benefit) have the The recently published MAGIC trial11
was used for the chemotherapy and radio- greatest effect on the outcome, while varia- employed an alternative adjuvant treatment
therapy costs since this most closely corre- tions in inputs near the bottom (hospital- regimen for gastric cancer. The results of
sponded to the Medicare geographic ization rate and utilities) have relatively this trial demonstrated that a perioperative
practice cost index range. For toxicity costs, small effects on the outcome. chemotherapy regimen (without radio-
a larger SD of 50% was used to reflect For the probabilistic sensitivity analysis, therapy), consisting of three preoperative
greater uncertainty in these estimates. the results of the second-order Monte and three postoperative cycles of epiru-
Utilities were modeled using beta distribu- Carlo simulations are shown in the scatter bicin, cisplatin, and 5-FU, also resulted in
tions with SD = 0.1. Hospitalization rate plot in Figure 2. Each point represents one an improvement in overall and progres-
was modeled with a log-normal distribution of the 1,000 trials run where each input sion-free survival. To determine how the
(mode 3%) with a large right-sided tail to was assigned a random value according to cost-effectiveness of the MAGIC regimen
reflect the potential for higher hospitaliza- its probability density function. The solid compares with INT-0116, a complete
tion rates. The expected survival benefit and dashed diagonal lines indicate the economic analysis of the MAGIC regimen
60 Gastrointestinal Cancer Research Volume 2 • Issue 2
5. Cost-Effectiveness of Adjuvant CRT for Gastric Cancer
combination of both regimens, with both
One-Way Sensitivity Analysis preoperative chemotherapy and postoper-
$20,082 $152,373
{16.8} {2.8} Survival Benefit (months) ative chemoradiotherapy.12
$31,784 $67,360 Utility for Gastrectomy
Markov modeling is often used in other
{1.00} {0.40}
economic analyses, as this technique effec-
$32,485 $61,984 Cost of Toxicity Management
{$3,094} {$18,564} tively models disease processes that
$33,879 $46,320 Cost of Radiotherapy involve ongoing risk over extended periods.
{$6,636} {$13,160}
$35,557 $44,040 Cost of Chemotherapy
Markov modeling is useful when
{$3,460} {$7,909} attempting to extrapolate results beyond
$38,000 $44,946 Hospitalization Rate
{1.49%} {29.00%} the follow-up period of a clinical trial. Since
$35,032 $39,076 Utility for Nausea/Vomiting the median survival in both arms was well
{1.00} {0.14}
within the follow-up period of the trial (> 6
$36,742 $40,496 Utility for Leukopenia
{1.00} {0.35} years), we used the direct assessment of
$0 $20,000 $40,000 $60,000 $80,000 $100,000 $120,000 $140,000 $160,000 median survival from the clinical trial data
as an approximation for mean survival
Figure 1. Tornado diagram of the one-way sensitivity analysis indicates that the outcome is most sensitive to
variation in the expected survival benefit, and least sensitive to variation in the utilities for nausea/vomiting time, allowing us to forgo Markov modeling
and leukopenia. Dollar amounts indicate the incremental cost per quality-adjusted life year; brackets contain for this analysis.
the upper and lower values for each input.
This study has several limitations. As dis-
cussed above, since we did not have access
00
to actual cost data from patients enrolled in
0
0,0
0
this Intergroup trial, chemoradiotherapy
,0
$10
0
$5
$40K costs were obtained from Medicare fee
schedules. While other insurers may reim-
burse at greater or less than Medicare
$35K
rates, Medicare — as the largest single
domestic payer — represents a reasonable
$30K
approximation of national norms.
Incremental Cost
Since actual hospitalization rates for
$25K patients experiencing acute toxicities from
adjuvant chemoradiotherapy were not
$20K recorded in INT-0116, we used data from
26
a study by Caggiano. This study meas-
$15K ured the rates and costs of hospitalization
for neutropenic patients with gastric cancer
$10K
using data drawn from hospital discharge
databases in seven states. Interestingly,
while the costs per hospitalization for
$5K
gastric cancer patients were among the
highest among all solid tumors ($10,900 in
$0K 1999 US dollars), the rates of hospitaliza-
0.00 QALYs 0.30 QALYs 0.60 QALYs 0.90 QALYs 1.20 QALYs
tion (2.98%) were rather modest when
Incremental Effectiveness compared to other solid tumor types, such
Figure 2. Scatter plot showing results of Monte Carlo probabilistic sensitivity analysis. Each point represents as pancreatic cancer (11.1%) and lung
the outcome of 1,000 simulated trials in which each input was assigned a random value according to its pro- cancer (5.2%). We speculate that this may
bability density function. The solid and dashed diagonal lines indicate the $50,000 and $100,000 thresholds,
respectively. The percentage of points that fall to the right of these lines (67% and 91%) indicate the likelihood
be due to a combination of factors, including
that this intervention would be cost-effective at that threshold level. the tumor site and the chemotherapy
Abbreviation: QALY = quality-adjusted life-year. regimens used. Nevertheless, if the actual
hospitalization rates turn out to be higher
would need to be performed. However, a might be lower, because no costs were than in the Caggiano study, the total costs
few preliminary observations can be made. incurred for radiotherapy. Both regimens of this adjuvant treatment regimen would
The costs of the MAGIC chemotherapy demonstrated an improvement in overall increase.
regimen would likely be higher than the survival, but a full analysis would be In this study, we assumed that patients
Intergroup 5-FU/LV regimen, because of needed to determine how the improvement experiencing CINV would be managed with
the higher cost of epirubicin and contin- in QALYs in the MAGIC trial compares to ondansetron, with costs based on a study
uous infusion 5-FU. On the other hand, that in INT-0116. Future adjuvant treat- by Stewart.29 With the recent introduction
total expenses for the MAGIC regimen ment for gastric cancer may involve some of more expensive antiemetic agents, such
March/April 2008 www.myGCRonline.org 61
6. S.J. Wang, et al.
clinical trial. Our analysis suggests that the
1.0
ICER of administering adjuvant chemo-
0.9 radiotherapy after gastric cancer resection
is comparable to those of other widely
0.8
Proportion Cost-Effective
accepted cancer treatments.
0.7
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Disclosures of Potential Conflicts of Interest
Dr. Wang received support from a Resident Research Grant from the Radiological Society of North America Research & Education
Foundation to conduct this study.
Acknowledgments:
The authors would like to thank Todd J. Scarbrough, MD, and Lisa A. Kachnic, MD, for their assistance in obtaining cost and billing data.
Portions of this work were published as an abstract in the 2005 Proceedings of the 47th Annual Meeting of the American Society for
Therapeutic Radiology and Oncology, in Denver, CO.
March/April 2008 www.myGCRonline.org 63