The document discusses a program called Connect to Protect developed by the AGA Institute to provide information on managing gastrointestinal risks of NSAIDs. It is led by Dr. Byron Cryer who has received research funding from several pharmaceutical companies. The summary is:
1) Connect to Protect provides education on reducing NSAID-related gastrointestinal risks.
2) Dr. Byron Cryer leads the program and has received research support from multiple drug companies.
3) The program aims to help manage the risks of NSAIDs which can cause ulcers, bleeding and other issues for many users.
This document summarizes treatment options for metastatic colorectal cancer (mCRC), including chemotherapy agents and regimens. It discusses several chemotherapy drugs and combinations that are commonly used as standard first- or second-line therapies for mCRC, such as 5-FU, irinotecan, oxaliplatin, capecitabine, and combinations including FOLFIRI, FOLFOX, and XELOX. Results from major clinical trials demonstrate that these therapies provide improvements in response rates, progression-free survival, and overall survival compared to previous standard treatments for mCRC. The document also reviews toxicity profiles of different regimens.
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.
The document summarizes a supportive care session that took place on April 3, 2011 from 15:00-16:30. It discusses fatigue management, antiemetics, growth factors, and bone health. Specifically, it covers the use of granulocyte colony-stimulating factors to prevent febrile neutropenia, updated antiemetic guidelines for preventing chemotherapy-induced nausea and vomiting, and the role of bisphosphonates and denosumab in maintaining bone health for cancer patients.
This document provides an overview of renal cell carcinoma (RCC), including:
1. RCC is heterogeneous with clear cell type most common. Targeted therapies like sunitinib, sorafenib, everolimus, and temsirolimus have improved outcomes but resistance develops.
2. A phase II trial found sorafenib has limited efficacy in sunitinib-refractory RCC with a 9.6% response rate.
3. The RECORD-1 trial showed everolimus more than doubled progression-free survival compared to placebo in advanced RCC previously treated with sunitinib or sorafenib. Overall survival was also improved with everolimus
- The document discusses cardiovascular disease as the leading cause of death worldwide and elevated triglyceride levels as an independent risk factor for death.
- The REDUCE-IT trial evaluated icosapent ethyl for reducing cardiovascular risk and found it significantly reduced cardiovascular events compared to placebo in patients already taking statins.
- Icosapent ethyl is a highly purified and stable form of EPA that may reduce cardiovascular risk through multiple mechanisms including lowering triglyceride levels and anti-inflammatory effects.
4 ΣΥΜΠΟΣΙΟ ΚΛΙΝΙΚΗΣ ΟΓΚΟΛΟΓΙΑΣ: Ακτινοθεραπεία στον καρκίνο του τραχήλου της ...isrodoy isr
This document discusses gastrointestinal stromal tumors (GIST) and the use of adjuvant imatinib therapy. It provides background on GIST epidemiology and risk factors for recurrence. Studies show adjuvant imatinib for 1 year after surgery significantly reduces recurrence rates compared to placebo, especially for high-risk patients. The SSGXVIII trial found adjuvant imatinib for 3 years further reduced recurrence rates compared to 1 year of treatment, with no significant difference in overall survival yet. Adjuvant imatinib for 3 years may provide additional benefit over 1 year, especially for high-risk GIST patients.
1) The document discusses endocrine resistance in hormone receptor-positive advanced breast cancer. It summarizes results from the CONFIRM and BOLERO-2 clinical trials which evaluated treatments for overcoming resistance.
2) The CONFIRM trial found that fulvestrant 500 mg resulted in significantly longer progression-free survival compared to 250 mg. It also showed a clinically relevant improvement in overall survival.
3) The BOLERO-2 trial found that everolimus (an mTOR inhibitor) plus exemestane resulted in significantly longer progression-free survival compared to placebo plus exemestane, with a 57% reduction in risk of progression.
This document summarizes treatment options for metastatic colorectal cancer (mCRC), including chemotherapy agents and regimens. It discusses several chemotherapy drugs and combinations that are commonly used as standard first- or second-line therapies for mCRC, such as 5-FU, irinotecan, oxaliplatin, capecitabine, and combinations including FOLFIRI, FOLFOX, and XELOX. Results from major clinical trials demonstrate that these therapies provide improvements in response rates, progression-free survival, and overall survival compared to previous standard treatments for mCRC. The document also reviews toxicity profiles of different regimens.
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.
The document summarizes a supportive care session that took place on April 3, 2011 from 15:00-16:30. It discusses fatigue management, antiemetics, growth factors, and bone health. Specifically, it covers the use of granulocyte colony-stimulating factors to prevent febrile neutropenia, updated antiemetic guidelines for preventing chemotherapy-induced nausea and vomiting, and the role of bisphosphonates and denosumab in maintaining bone health for cancer patients.
This document provides an overview of renal cell carcinoma (RCC), including:
1. RCC is heterogeneous with clear cell type most common. Targeted therapies like sunitinib, sorafenib, everolimus, and temsirolimus have improved outcomes but resistance develops.
2. A phase II trial found sorafenib has limited efficacy in sunitinib-refractory RCC with a 9.6% response rate.
3. The RECORD-1 trial showed everolimus more than doubled progression-free survival compared to placebo in advanced RCC previously treated with sunitinib or sorafenib. Overall survival was also improved with everolimus
- The document discusses cardiovascular disease as the leading cause of death worldwide and elevated triglyceride levels as an independent risk factor for death.
- The REDUCE-IT trial evaluated icosapent ethyl for reducing cardiovascular risk and found it significantly reduced cardiovascular events compared to placebo in patients already taking statins.
- Icosapent ethyl is a highly purified and stable form of EPA that may reduce cardiovascular risk through multiple mechanisms including lowering triglyceride levels and anti-inflammatory effects.
4 ΣΥΜΠΟΣΙΟ ΚΛΙΝΙΚΗΣ ΟΓΚΟΛΟΓΙΑΣ: Ακτινοθεραπεία στον καρκίνο του τραχήλου της ...isrodoy isr
This document discusses gastrointestinal stromal tumors (GIST) and the use of adjuvant imatinib therapy. It provides background on GIST epidemiology and risk factors for recurrence. Studies show adjuvant imatinib for 1 year after surgery significantly reduces recurrence rates compared to placebo, especially for high-risk patients. The SSGXVIII trial found adjuvant imatinib for 3 years further reduced recurrence rates compared to 1 year of treatment, with no significant difference in overall survival yet. Adjuvant imatinib for 3 years may provide additional benefit over 1 year, especially for high-risk GIST patients.
1) The document discusses endocrine resistance in hormone receptor-positive advanced breast cancer. It summarizes results from the CONFIRM and BOLERO-2 clinical trials which evaluated treatments for overcoming resistance.
2) The CONFIRM trial found that fulvestrant 500 mg resulted in significantly longer progression-free survival compared to 250 mg. It also showed a clinically relevant improvement in overall survival.
3) The BOLERO-2 trial found that everolimus (an mTOR inhibitor) plus exemestane resulted in significantly longer progression-free survival compared to placebo plus exemestane, with a 57% reduction in risk of progression.
This document discusses bone health management in breast cancer patients receiving adjuvant therapies. Key points include:
- Studies have shown that zoledronic acid and denosumab can reduce bone mineral density loss and fracture risk in premenopausal and postmenopausal breast cancer patients receiving adjuvant aromatase inhibitors or tamoxifen.
- The ABCSG-12 trial found that adding zoledronic acid to adjuvant endocrine therapy improved disease-free survival and overall survival in premenopausal breast cancer patients.
- The AZURE trial found no difference in disease-free survival or overall survival between breast cancer patients receiving standard adjuvant therapy with or without zoledronic acid, though pre/perimenopausal patients
Denosumab vs bisfosfonato en metástasis óseasMauricio Lema
This document summarizes key findings from three head-to-head clinical trials comparing denosumab to zoledronic acid for the treatment of bone metastases in solid tumors. The main points are:
1) A prespecified integrated analysis of the three trials found that denosumab was superior to zoledronic acid, reducing the risk of first skeletal-related events by 17%.
2) Denosumab provided benefits across multiple solid tumor types, reducing the risk of first skeletal-related events in breast cancer, prostate cancer, and other solid tumors compared to zoledronic acid.
3) Denosumab demonstrated efficacy in reducing both the time to first skeletal-related event and the risk of subsequent skeletal
Personalized therapy in Pediatric ALL: Allen Yeohspa718
Associate Professor Allen Yeoh is a clinician scientist in Singapore who specializes in treating and researching childhood cancers, particularly acute leukemias. His interests include using microarray studies and minimal residual disease detection to personalize therapy for childhood acute leukemias. He was the principal investigator of multi-center studies in Malaysia and Singapore on ALL and AML that successfully used minimal residual disease stratification to tailor therapy intensity, achieving excellent event-free survival rates. Yeoh's research focuses on translational clinical studies of acute leukemia in children to develop personalized treatment approaches.
1) A phase 3 trial compared nivolumab to everolimus in advanced renal cell carcinoma patients who had received 1-2 prior anti-angiogenic therapies. Nivolumab demonstrated significantly longer overall survival compared to everolimus, with median overall survival of 25 months versus 19.6 months.
2) Nivolumab had a higher objective response rate compared to everolimus (25% vs 5%) and longer median duration of response.
3) The overall survival benefit of nivolumab was consistent across patient subgroups and was independent of PD-L1 expression levels.
This document summarizes preliminary results from a study of 267 prostate cancer patients treated with high-dose intensity-modulated radiation therapy (IMRT) guided by seed markers and kV X-ray imaging. Toxicity outcomes were excellent, with only 5 patients experiencing rectal complaints and 1 developing urinary incontinence. Biochemical disease-free survival was 97% at a median follow-up of 1.5 years. Potency preservation rates were high, with 77% of initially potent non-hormonally treated patients maintaining some function. The results suggest modern image-guided IMRT may achieve low morbidity for prostate cancer treatment.
The document discusses bariatric surgery options and outcomes for patients with a BMI over 50 (super obesity). It reviews the trends in various bariatric procedures from the 1990s, including restrictive procedures like vertical banded gastroplasty and laparoscopic gastric banding, as well as malabsorptive procedures like Roux-en-Y gastric bypass. Studies presented show that while super obese patients lose more weight than morbidly obese patients after various procedures, they often do not achieve normal weight. Malabsorptive procedures tend to produce greater weight loss for super obese patients compared to restrictive options.
This document discusses the physical impairments and functional limitations that can result from breast cancer treatments such as surgery, chemotherapy, radiation therapy, and endocrine therapy. It presents a prospective surveillance model for rehabilitation to promote early detection and intervention of treatment-related issues. The model involves preoperative evaluation and education, early postoperative reassessment and exercise programming, and ongoing surveillance. The goal is to improve outcomes and quality of life for breast cancer survivors.
This study examined whether metformin use predicts prostate cancer diagnosis and prognosis. 1034 men underwent transperineal template-guided mapping biopsy and were divided into 3 groups: nondiabetic, diabetic not taking metformin, diabetic taking metformin. Metformin did not predict cancer diagnosis or severity. Univariate and multivariate analyses found only age predicted cancer diagnosis, and age, PSA velocity, and BMI predicted higher Gleason scores (≥7). While metformin may reduce cancer risk in other types based on biochemical pathways, prostate cancer cells' fast doubling time may limit metformin's effects. Larger studies in more diverse populations are needed to better understand metformin's role in prostate cancer.
This document summarizes key findings from a presentation on nutrition, lifestyle and breast cancer risk. It discusses how overweight/obesity, sedentary lifestyle, certain sex hormones and growth factors like IGF-I can increase breast cancer risk or lead to poorer prognosis. It also reports on studies finding associations between higher milk consumption and breast cancer risk in BRCA mutation carriers. Preliminary results from the COS-2 study suggest higher IGF-I levels may be linked to increased breast cancer risk in high-risk women.
Asco 2006 Update Genitourinary Cancer Selected Abstractsfondas vakalis
The document summarizes several studies on targeted therapies for kidney cancer presented at the 2006 ASCO conference. Key findings include:
- Sunitinib and temsirolimus were shown to be superior to interferon for metastatic kidney cancer in phase 3 trials, with longer progression-free and overall survival.
- The TARGET trial found sorafenib increased progression-free survival compared to placebo in advanced RCC and improved overall survival after patients on placebo crossed over.
- A global phase 3 trial found temsirolimus alone or with interferon improved overall survival over interferon in poor-risk metastatic RCC patients.
This study tested the pruritic (itch-causing) effects of purified bile salts by applying them to blisters on human skin. All bile salts tested caused pruritus, but the dihydroxy bile salts (especially unconjugated chenodeoxycholate) were more effective than the trihydroxy salts. This may explain the poor correlation between total serum bile salt levels and pruritus in patients with obstructive jaundice. The dihydroxy bile salts' greater ability to cause pruritus correlates with their increased toxicity and surface activity compared to trihydroxy bile salts.
Kimberly Halla, MSN, FNP-C, Paula J. Anastasia, RN, MN, AOCN, and Nelli Zafman, MSN, CRNP, AOCNP prepared useful Practice Aids pertaining to PARP inhibitor therapy for this CNE activity titled, "Realizing the Promise of PARP Inhibitors in Solid Tumor Therapy: Guiding Oncology Nurses on the Advances and Challenges." For the full presentation, monograph, complete CNE information, and to apply for credit, please visit us at http://bit.ly/2EkO5Ij. CNE credit will be available until May 22, 2020.
This document discusses treatments for bone metastases from prostate cancer. It focuses on using external beam radiotherapy, systemic radiopharmaceuticals like strontium-89 and radium-223, and bisphosphonates to treat bone metastases and provide relief from pain. It describes how these treatments work, their effectiveness, and options for preventing bone metastases rather than just treating symptoms once they occur.
The document summarizes highlights from the 11-ICML Lugano conference in 2011, including:
1) Studies showing the impact of the tumor microenvironment in lymphoma prognosis and the predictive value of increased macrophages in Hodgkin's lymphoma biopsies.
2) High response rates to antiviral treatment in patients with indolent B-cell lymphoma associated with HCV infection.
3) A PET-based approach can effectively guide treatment for limited-stage diffuse large B-cell lymphoma.
4) R-CHOP induction followed by rituximab maintenance improves survival over R-FC induction for elderly patients with mantle cell lymphoma.
My Prostate Cancer Story by Paul SchellhammerTony Crispino
With permission of Dr. Schellhammer this slide deck should be interesting to any PCa patient. Dr. Schellhammer is a former president of the American Urological Association and a leading authority on prostate cancer. He has fought i long battle. He and his colleague, Paul Lange operated on each other and had vastly different results.
Breast Cancer - Is there a link to endocrine disrupting chemicals? Breast C...MedicineAndHealthUSA
This document summarizes evidence on potential links between endocrine disrupting chemicals (EDCs) and breast cancer risk. It discusses studies finding associations between breast cancer and exposures like diethylstilbestrol (DES), post-menopausal hormone use, organochlorines like DDT and dieldrin, polychlorinated biphenyls, and chemicals in the home and workplace like phthalates and bisphenol A. While evidence is mixed, some chemicals appear to modestly increase risk, and windows of exposure during development may be important to consider.
cinv (chemotherapy induced nausea & vomiting)Mohamed Abdulla
1) The document discusses chemotherapy-induced nausea and vomiting (CINV), outlining its negative impact on quality of life, treatment adherence, and economic costs.
2) Over the past 30 years, antiemetic regimens have improved control of CINV, particularly for highly emetogenic chemotherapy, through the addition of 5-HT3 receptor antagonists, NK1 receptor antagonists, and corticosteroids.
3) For an anthracycline-based chemotherapy regimen, the expert would recommend the triple combination of palonosetron, dexamethasone, and an NK1 receptor antagonist such as aprepitant or fosaprepitant to provide the strongest protection against CINV.
Colon cancer is the second and third most common cancer in males and females. Screening programs have led to a reduction in late-stage diagnoses and mortality. Precise identification of prognostic patient groups allows for more targeted adjuvant therapy, improving disease-free and overall survival. Molecular markers of tumor aggressiveness aid in selecting optimal treatment approaches, increasing response rates, progression-free, and overall survival. A multidisciplinary team approach is essential for managing metastatic colon cancer with the goal of surgical cure in organ-limited disease.
This document summarizes information on prostate cancer, including risk factors, diagnosis, and treatment options. It also discusses the potential role of nutrition in prostate cancer. Key points include:
- Prostate cancer is the most common non-skin cancer in men and the second leading cause of cancer death. Risk increases with age and is higher in African-American men and those with a family history.
- Diagnosis involves a digital rectal exam, PSA test, biopsy. Treatment depends on cancer severity and includes surveillance, surgery, radiation, and hormone therapy.
- Nutritional factors like a low-fat, plant-based diet high in fiber and omega-3 fatty acids may reduce prostate cancer risk and slow progression by
This document discusses bone health management in breast cancer patients receiving adjuvant therapies. Key points include:
- Studies have shown that zoledronic acid and denosumab can reduce bone mineral density loss and fracture risk in premenopausal and postmenopausal breast cancer patients receiving adjuvant aromatase inhibitors or tamoxifen.
- The ABCSG-12 trial found that adding zoledronic acid to adjuvant endocrine therapy improved disease-free survival and overall survival in premenopausal breast cancer patients.
- The AZURE trial found no difference in disease-free survival or overall survival between breast cancer patients receiving standard adjuvant therapy with or without zoledronic acid, though pre/perimenopausal patients
Denosumab vs bisfosfonato en metástasis óseasMauricio Lema
This document summarizes key findings from three head-to-head clinical trials comparing denosumab to zoledronic acid for the treatment of bone metastases in solid tumors. The main points are:
1) A prespecified integrated analysis of the three trials found that denosumab was superior to zoledronic acid, reducing the risk of first skeletal-related events by 17%.
2) Denosumab provided benefits across multiple solid tumor types, reducing the risk of first skeletal-related events in breast cancer, prostate cancer, and other solid tumors compared to zoledronic acid.
3) Denosumab demonstrated efficacy in reducing both the time to first skeletal-related event and the risk of subsequent skeletal
Personalized therapy in Pediatric ALL: Allen Yeohspa718
Associate Professor Allen Yeoh is a clinician scientist in Singapore who specializes in treating and researching childhood cancers, particularly acute leukemias. His interests include using microarray studies and minimal residual disease detection to personalize therapy for childhood acute leukemias. He was the principal investigator of multi-center studies in Malaysia and Singapore on ALL and AML that successfully used minimal residual disease stratification to tailor therapy intensity, achieving excellent event-free survival rates. Yeoh's research focuses on translational clinical studies of acute leukemia in children to develop personalized treatment approaches.
1) A phase 3 trial compared nivolumab to everolimus in advanced renal cell carcinoma patients who had received 1-2 prior anti-angiogenic therapies. Nivolumab demonstrated significantly longer overall survival compared to everolimus, with median overall survival of 25 months versus 19.6 months.
2) Nivolumab had a higher objective response rate compared to everolimus (25% vs 5%) and longer median duration of response.
3) The overall survival benefit of nivolumab was consistent across patient subgroups and was independent of PD-L1 expression levels.
This document summarizes preliminary results from a study of 267 prostate cancer patients treated with high-dose intensity-modulated radiation therapy (IMRT) guided by seed markers and kV X-ray imaging. Toxicity outcomes were excellent, with only 5 patients experiencing rectal complaints and 1 developing urinary incontinence. Biochemical disease-free survival was 97% at a median follow-up of 1.5 years. Potency preservation rates were high, with 77% of initially potent non-hormonally treated patients maintaining some function. The results suggest modern image-guided IMRT may achieve low morbidity for prostate cancer treatment.
The document discusses bariatric surgery options and outcomes for patients with a BMI over 50 (super obesity). It reviews the trends in various bariatric procedures from the 1990s, including restrictive procedures like vertical banded gastroplasty and laparoscopic gastric banding, as well as malabsorptive procedures like Roux-en-Y gastric bypass. Studies presented show that while super obese patients lose more weight than morbidly obese patients after various procedures, they often do not achieve normal weight. Malabsorptive procedures tend to produce greater weight loss for super obese patients compared to restrictive options.
This document discusses the physical impairments and functional limitations that can result from breast cancer treatments such as surgery, chemotherapy, radiation therapy, and endocrine therapy. It presents a prospective surveillance model for rehabilitation to promote early detection and intervention of treatment-related issues. The model involves preoperative evaluation and education, early postoperative reassessment and exercise programming, and ongoing surveillance. The goal is to improve outcomes and quality of life for breast cancer survivors.
This study examined whether metformin use predicts prostate cancer diagnosis and prognosis. 1034 men underwent transperineal template-guided mapping biopsy and were divided into 3 groups: nondiabetic, diabetic not taking metformin, diabetic taking metformin. Metformin did not predict cancer diagnosis or severity. Univariate and multivariate analyses found only age predicted cancer diagnosis, and age, PSA velocity, and BMI predicted higher Gleason scores (≥7). While metformin may reduce cancer risk in other types based on biochemical pathways, prostate cancer cells' fast doubling time may limit metformin's effects. Larger studies in more diverse populations are needed to better understand metformin's role in prostate cancer.
This document summarizes key findings from a presentation on nutrition, lifestyle and breast cancer risk. It discusses how overweight/obesity, sedentary lifestyle, certain sex hormones and growth factors like IGF-I can increase breast cancer risk or lead to poorer prognosis. It also reports on studies finding associations between higher milk consumption and breast cancer risk in BRCA mutation carriers. Preliminary results from the COS-2 study suggest higher IGF-I levels may be linked to increased breast cancer risk in high-risk women.
Asco 2006 Update Genitourinary Cancer Selected Abstractsfondas vakalis
The document summarizes several studies on targeted therapies for kidney cancer presented at the 2006 ASCO conference. Key findings include:
- Sunitinib and temsirolimus were shown to be superior to interferon for metastatic kidney cancer in phase 3 trials, with longer progression-free and overall survival.
- The TARGET trial found sorafenib increased progression-free survival compared to placebo in advanced RCC and improved overall survival after patients on placebo crossed over.
- A global phase 3 trial found temsirolimus alone or with interferon improved overall survival over interferon in poor-risk metastatic RCC patients.
This study tested the pruritic (itch-causing) effects of purified bile salts by applying them to blisters on human skin. All bile salts tested caused pruritus, but the dihydroxy bile salts (especially unconjugated chenodeoxycholate) were more effective than the trihydroxy salts. This may explain the poor correlation between total serum bile salt levels and pruritus in patients with obstructive jaundice. The dihydroxy bile salts' greater ability to cause pruritus correlates with their increased toxicity and surface activity compared to trihydroxy bile salts.
Kimberly Halla, MSN, FNP-C, Paula J. Anastasia, RN, MN, AOCN, and Nelli Zafman, MSN, CRNP, AOCNP prepared useful Practice Aids pertaining to PARP inhibitor therapy for this CNE activity titled, "Realizing the Promise of PARP Inhibitors in Solid Tumor Therapy: Guiding Oncology Nurses on the Advances and Challenges." For the full presentation, monograph, complete CNE information, and to apply for credit, please visit us at http://bit.ly/2EkO5Ij. CNE credit will be available until May 22, 2020.
This document discusses treatments for bone metastases from prostate cancer. It focuses on using external beam radiotherapy, systemic radiopharmaceuticals like strontium-89 and radium-223, and bisphosphonates to treat bone metastases and provide relief from pain. It describes how these treatments work, their effectiveness, and options for preventing bone metastases rather than just treating symptoms once they occur.
The document summarizes highlights from the 11-ICML Lugano conference in 2011, including:
1) Studies showing the impact of the tumor microenvironment in lymphoma prognosis and the predictive value of increased macrophages in Hodgkin's lymphoma biopsies.
2) High response rates to antiviral treatment in patients with indolent B-cell lymphoma associated with HCV infection.
3) A PET-based approach can effectively guide treatment for limited-stage diffuse large B-cell lymphoma.
4) R-CHOP induction followed by rituximab maintenance improves survival over R-FC induction for elderly patients with mantle cell lymphoma.
My Prostate Cancer Story by Paul SchellhammerTony Crispino
With permission of Dr. Schellhammer this slide deck should be interesting to any PCa patient. Dr. Schellhammer is a former president of the American Urological Association and a leading authority on prostate cancer. He has fought i long battle. He and his colleague, Paul Lange operated on each other and had vastly different results.
Breast Cancer - Is there a link to endocrine disrupting chemicals? Breast C...MedicineAndHealthUSA
This document summarizes evidence on potential links between endocrine disrupting chemicals (EDCs) and breast cancer risk. It discusses studies finding associations between breast cancer and exposures like diethylstilbestrol (DES), post-menopausal hormone use, organochlorines like DDT and dieldrin, polychlorinated biphenyls, and chemicals in the home and workplace like phthalates and bisphenol A. While evidence is mixed, some chemicals appear to modestly increase risk, and windows of exposure during development may be important to consider.
cinv (chemotherapy induced nausea & vomiting)Mohamed Abdulla
1) The document discusses chemotherapy-induced nausea and vomiting (CINV), outlining its negative impact on quality of life, treatment adherence, and economic costs.
2) Over the past 30 years, antiemetic regimens have improved control of CINV, particularly for highly emetogenic chemotherapy, through the addition of 5-HT3 receptor antagonists, NK1 receptor antagonists, and corticosteroids.
3) For an anthracycline-based chemotherapy regimen, the expert would recommend the triple combination of palonosetron, dexamethasone, and an NK1 receptor antagonist such as aprepitant or fosaprepitant to provide the strongest protection against CINV.
Colon cancer is the second and third most common cancer in males and females. Screening programs have led to a reduction in late-stage diagnoses and mortality. Precise identification of prognostic patient groups allows for more targeted adjuvant therapy, improving disease-free and overall survival. Molecular markers of tumor aggressiveness aid in selecting optimal treatment approaches, increasing response rates, progression-free, and overall survival. A multidisciplinary team approach is essential for managing metastatic colon cancer with the goal of surgical cure in organ-limited disease.
This document summarizes information on prostate cancer, including risk factors, diagnosis, and treatment options. It also discusses the potential role of nutrition in prostate cancer. Key points include:
- Prostate cancer is the most common non-skin cancer in men and the second leading cause of cancer death. Risk increases with age and is higher in African-American men and those with a family history.
- Diagnosis involves a digital rectal exam, PSA test, biopsy. Treatment depends on cancer severity and includes surveillance, surgery, radiation, and hormone therapy.
- Nutritional factors like a low-fat, plant-based diet high in fiber and omega-3 fatty acids may reduce prostate cancer risk and slow progression by
Antibiotics in the management of chronic periodontitis.pptmalti19
This document summarizes evidence on the use of adjunctive antibiotics for chronic periodontitis. A systematic review of 25 studies found some additional benefits of antibiotics in deep pockets, including 0.2-0.6 mm more attachment gain and 0.2-0.8 mm more probing depth reduction. However, the clinical relevance is uncertain given limitations in defining chronic periodontitis and its microbiota. Overall, current studies have not conclusively established benefits of adjunctive antibiotics, so they cannot be routinely indicated as adjuncts for chronic periodontitis.
TOPIC: “Chemical Exposures & Life-Long Reproductive Health Impacts”
We will review what we understand about reproductive biology and environmental contamination exposure. We’ll discuss the role of environmental chemicals in breast development and puberty, increased susceptibility to breast cancer and exposures during early life development of both male and female offspring and life-long impacts from chemical exposure. We’ll also discuss some of the potential health implications of energy development based on what we currently understand about exposures during early reproductive and developmental biology.
SPEAKER BIO: Suzanne Fenton, Ph.D., is Group Leader, NIH, Reproductive Endocrinology Group, Mammary Gland Development/Lactation Biology and a reproductive endocrinologist working at the National Toxicology Program Laboratory with the Division of the National Toxicology Program at National Institute of Environmental Health Sciences.
1) HER2 positive breast cancer accounts for around 15-20% of cases and has a poorer prognosis than other subtypes without HER2 targeted therapy.
2) Multiple HER2 targeted agents are available including trastuzumab, lapatinib, pertuzumab, T-DM1, neratinib, and tucatinib which inhibit HER2 signaling through different mechanisms such as antibody binding or tyrosine kinase inhibition.
3) Combining HER2 targeted therapies such as trastuzumab with chemotherapy improves outcomes for patients with metastatic HER2 positive breast cancer compared to chemotherapy alone.
1) Anti-angiogenic therapy targets tumor angiogenesis and has become an established treatment for metastatic colorectal cancer (mCRC).
2) Bevacizumab, a monoclonal antibody targeting VEGF, has shown efficacy in multiple phase III trials in combination with chemotherapy as first-line and maintenance therapy for mCRC.
3) Additional anti-angiogenic agents approved for mCRC include aflibercept, ramucirumab, and regorafinib, which have demonstrated benefits in later lines of therapy.
Osteoporosis poses a significant disease burden, with over 2 million fractures occurring annually in the United States due to low bone density or previous fractures. Bisphosphonates are the mainstay treatment for osteoporosis, approved in the 1990s, but there is ongoing research into their potential links to rare adverse events like osteonecrosis of the jaw or atypical femoral fractures. While more data is still needed, the overall benefits of bisphosphonates in reducing fracture risk are considered to outweigh the potential risks for most osteoporosis patients. Treatment duration should be individualized based on fracture history and risk level.
This document discusses the gastrointestinal (GI) and cardiovascular (CV) risks associated with nonsteroidal anti-inflammatory drug (NSAID) use. It outlines the mechanisms by which NSAIDs can cause GI adverse effects like gastric ulcers and bleeding. It also notes that NSAIDs are associated with increased CV risks. The document recommends prevention strategies for NSAID use based on assessing individual patient's GI and CV risk factors.
This document summarizes key points about iatrogenesis and drug-related risks in the elderly. It discusses age-related changes that increase risks, such as changes in body composition and drug distribution. Examples of high-risk drug classes are provided, like anticoagulants, psychotropic drugs, and antineoplastic agents. Specific situations that increase risks, such as polypharmacy and malnutrition, are also described.
VTE and Cancer Healthcare Professional Educationvtesimplified
Cancer patients are at increased risk of developing blood clots (venous thromboembolism or VTE) due to factors such as tumour infiltration of blood vessels, immobility, and cancer treatments. VTE is a leading cause of death in cancer patients and the risk is highest in the first months after diagnosis. Guidelines recommend thromboprophylaxis for hospitalized cancer patients without bleeding risk, but evidence for routine outpatient prophylaxis is limited to certain high risk groups. Risk assessment tools can help identify those at highest risk who may benefit most from prophylaxis.
1. Prolia is indicated for treating postmenopausal women with osteoporosis at high risk for fracture, as defined by a history of osteoporotic fracture or multiple risk factors. It reduces the incidence of vertebral, nonvertebral, and hip fractures.
2. The document presents the hypothetical case of 69-year-old Nina, who is currently untreated for osteoporosis with BMD T-scores of -2.8 and -2.9 and additional risk factors of age, diabetes, and history of falling. She needs to start Prolia to help remain active with her grandchildren and prevent fractures.
3. Prolia is proven to significantly reduce vertebral,
This document discusses the approach to recurrent acute pancreatitis. It begins by defining recurrent acute pancreatitis as more than two attacks of acute pancreatitis without evidence of chronic pancreatitis, with more than three months between attacks. The document then discusses the epidemiology and various etiologies of recurrent acute pancreatitis including metabolic, mechanical, genetic, and idiopathic causes. It provides details on evaluation methods for recurrent acute pancreatitis such as bile microscopy, EUS, MRCP, and genetic testing. The document concludes that even after extensive evaluation, some cases remain undiagnosed and are termed idiopathic recurrent acute pancreatitis.
Breast cancer a focus on bone health integrityMohamed Abdulla
This document summarizes information about bone health and integrity in the context of breast cancer. It discusses how breast cancer commonly spreads to bone, causing skeletal-related events like fractures. It notes that bone-targeted therapies like bisphosphonates and denosumab can help prevent these events by inhibiting bone resorption. Clinical trials show these drugs reduce the risk of skeletal complications when used adjuvantly or for metastatic breast cancer in bone. The document thus emphasizes the importance of bone health for breast cancer patients and the role of anti-resorptive therapies.
Recent advances in endometriosis were discussed. Endometriosis is a chronic disease where endometrial tissue grows outside the uterus, affecting around 10% of women. Dienogest, a progestin, was shown to be effective in reducing endometriosis-associated pelvic pain in randomized controlled trials. Dienogest 2mg daily for 24 weeks provided pain relief similar to leuprolide acetate but with fewer side effects. Long-term use of dienogest for 65 weeks maintained pain relief with a favorable safety profile. Dienogest was as effective as goserelin in reducing postoperative recurrence of endometriosis at 24 months.
This document summarizes key information about prostate cancer including:
1. Risk factors such as age, ethnicity, family history, and diet.
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Connect to protect webinar
1. Disclosures
Connect to Protect is a program developed by the AGA Institute
whose independent medical advisor, Dr. Byron Cryer from the
University of Texas Southwestern Medical Center, is responsible for
the medical content. Funding for the program is provided through an
unrestricted grant by Horizon Therapeutics.
Dr. Cryer has received research support from PLx Pharma,
Sucampo Ph
S Pharmaceuticals, P
ti l Pozen I Inc., and Pfi
d Pfizer I
Inc. and h
d has
been a consultant to PLx Pharma, Sucampo Pharmaceuticals,
Pozen Inc., Pfizer Inc., Horizon Therapeutics, Astra-Zeneca, NiCox
Inc., McNeil, Inc.
Inc McNeil Inc and Ritter Pharmaceuticals
Pharmaceuticals.
2. Connect to Protect
Management of Gastrointestinal Risks
of Non-Steroidal Anti-Inflammatory Drugs
Byron Cryer, M.D.
.
Chairman,
Chairman Connect to Protect Program
Program,
American Gastroenterological Association Institute
University of Texas Southwestern Medical School
& Dallas VA Medical Center
3. AGENDA
• Welcome and Introduction of Dr. Cryer
• The Current Impact of NSAID Use
• Reducing the Risk
• Problems with Adherence
• Summary
• Questions
5. Prevalence of NSAID-Associated
GI Complications
• More than 60 million Americans are NSAID users1
– 1% to 2% of users have clinically significant upper GI events
• Endoscopic studies indicate that g
p gastric or duodenal ulcers develop in
p
approximately 15% to 30% of patients using NSAIDs2
• Estimates of mortality vary widely from 3200 to higher than 16 500
16,500
deaths per year in the United States1
.
1Cryer B. Am J Gastroenterol. 2005;100:1694-1695.
2Laine L. Gastroenterology. 2001;120:594-606.
6. Gastrointestinal Side Effects Induced by
Nonselective NSAIDs
Complications
1% t 2%
to
Ulcers
15% to 30%
Dyspepsia occurs in
25% to 50% of patients with
or without complications
No Lesion
70% t 85%
to
Graham DY, et al. Ann Intern Med. 1993;119:257 262.
1993;119:257-262.
Langman MJ, et al. Lancet. 1994;343:1075-1078.
Larkai EN, et al. J Clin Gastroenterol. 1989;11:158-162.
Silverstein FE, et al. Ann Intern Med. 1995;123:241-249.
7. Mortality Associated With NSAID/Aspirin Use
500
443
450
Rate per million people
400
350
300 253
250
200
153
150
100
50
0
2005 2003 1999
Spain United Kingdom United States
Lanas A, et al. Am J Gastroenterol. 2005;100:1685-1693.
8. Peptic Ulcer Disease and NSAIDs
The major cause of peptic ulcer disease in Amsterdam has changed from H. pylori
to NSAIDs
Cause of Peptic
Ulcers
1990 2005
H. pylori 70% - 80% 47%
NSAIDs 20% - 30% 53%
Ramsoekh D, et al. Clin Gastroenterol Hepatol. 2005;3:859-864.
9. Risk Factors for Serious GI Adverse Events
with NSAIDs
Prior bleed
P i bl d 13.5 (10.3-17.7)
13 5 (10 3 17 7)
Anticoagulant / NSAID use 12.7 (6.3-25.7)
Corticosteroid use 4.4 (2.0-9.7)
Low-dose NSAID 2.9 (2.2-3.8)
High-dose NSAID 5.8 (4.0-8.6)
Age 70-80 5.6 (4.6-6.9)
Age 60-69 3.1 (2.5-3.7)
Age 50 59
50-59 1.6 (1.4-2.0)
1 6 (1 4 2 0)
1 5 10 15
Relative risk
. García-Rodriguez LA. Lancet. 1994;343:769-772.
Gutthann SP, et al. Epidemiology. 1997;8:18-24.
Shorr RI. Arch Intern Med. 1993;153:1665-1670.
Piper JM, et al. Ann Intern Med. 1991;114:735-740
10. Risk for GI Complications Begins at an
Earlier Age in Men
g
>84 7.4 5
80-84 5.8 5.6
75-79 6 7.8
70-74 4.5 7.7
65-69 3.1 6.9
60-64 2.2 5
55-59 1.8 4.5
50 54
50-54 1.3 4.6
45-49 1 3.5
Age 40-44 0.8 3
(years)
35-39 0.6 2.5
30-34
25-29
* Male patients had an onset of GI
complications at an earlier age
than women
0.5
05
0.4
1.8
18
1.5
* Females
0.3 1 Males
20-24
15-19 0.3 0.4
10 14
10-14 0.5 0.5
5-9 0.5 0.5
0-4 0.6 0.7
9 8 7 6 5 4 3 2 1 0 1 2 3 4 5 6 7 8 9
Patients with GI complications (%)
Adapted from
Lanas A, et al. Am J Gastroenterol. 2005;100:1685-1693.
11. High Risk of Upper GI Bleeding Is
Maintained During NSAID Use
11
Increased risk appears at start of therapy and i
I d i k f h d is
maintained during use
9
Relative risk
7
5
3
5.7 3.7 4.1 5.1
1
1
Nonuse 1-30 31-90 91-180 181-365
Days of NSAID use
Hernández-Díaz S, et al. Arch Intern Med. 2000;160:2093-2099.
12. The Risk of NSAID-Associated Upper GI
Complications Is Constant Over Time
MUCOSA Trial1 VIGOR Trial2
NSAIDs (N = 4439) 5.0 Naproxen (N = 4029)
0.012
mplication
4.5
ulative incidence (%)
4.0
0.009 3.5
Probability of UGI Com
3.0
0.006 2.5
2.0
1.5
15
y
Cumu
0.003 1.0
0.5
0 0.0
0 30 60 90 120 150 180 0 2 4 6 8 10 12
Days Months
1. Silverstein FE, et al. Ann Intern Med. 1995;123:241–249.
2. Bombardier C, et al. N Engl J Med. 2000;343:1520–1528.
13. Effect of Individual NSAIDs on
Peptic Ulcer Complications
Relative Risk: Current Use Versus Nonuse
7 NSAID risk varies 6.3
63
6
• Aspirin and ibuprofen have higher risk than
non-NSAIDs*
5 – Aspirin > Ibuprofen > Acetaminophen 4.6 4.6 4.6
elative risk
k
4.1
4 3.6 3.8 4.0
3.3 3.4 3.4
3 2.7
Re
2.2 2.2
1.9
2
1 1.3
1.1
1
García-Rodríguez LA, et al. Epidemiology. 2001;12:570-576.
Hernández-Díaz S, et al. Arch Intern Med. 2000;160:2093-2099.
de Abajo FJ, et al. BMC Clin Pharmacol. 2001;1:1.
* Statistical significance was not reported
15. Reducing the Risk of GI Complications
with NSAIDs
• Identify risk factors
y
• Use of gastroprotective drugs
g g
• Safer NSAIDs
16. Options for Patients With GI Risk
Who Need NSAIDs
• NSAID plus gastroprotective agent
– Misoprostol
– PPI
– Histamine2-receptor antagonist (H2RA) - high dose
• COX-2 inhibitor
• Non-NSAID Pharmacologic Therapy
– Acetaminophen
– Tramadol
– Narcotics
17. Relative GI Safety of Different
Anti-Inflammatory Therapies: Overview
Therapy Safety Profile
• All nonselective NSAIDs • Increased risk of serious GI events
• Different formulations • No reduction in serious
of nonselective NSAIDs GI toxicity
• Different routes of NSAID • N reduction iin serious
No d ti i
administration GI toxicity
• Gastroprotection co-therapy • Reduction in serious GI toxicity but
compliance issues
• NSAIDs that specifically inhibit • Reduction in serious GI toxicity but
COX 2
COX-2 p
possible increase in cardiovascular
adverse effects
18. Gastroprotection
• Use lowest effective NSAID dose
• Misoprostol
• Proton pump inhibitors
• H2-Receptor Antagonists (high dose)
p g ( g )
19. Gastroprotection:
Misoprostol (MUCOSA trial)
% of patients with serious upper GI complications at 6 months
p pp p
p=0.049
40% reduction in
GI complications
Placebo + NSAID Misoprostol + NSAID
(n=4439) (n=4404)
Silverstein et al. Ann Intern Med 1995;123:241–249
20. Gastroprotection:
Proton Pump Inhibitors
p
% of patients with recurrent upper GI bleeding at 6 months
p
p=0.005
76% reduction in
upper GI bleeding
H. pylori eradication Omeprazole + NSAID
+ NSAID (n=75)
(n=75)
Chan et al. N Engl J Med 2001;344:967–973
21. H2-Receptor Antagonists in the Prevention of
NSAID Ul
Ulcers
35%
30%
25%
20%
15% p = 0.003
10%
5%
0%
Placebo Fam 20 bid Fam 40 bid
High dose
Gastric ulcers Duodenal ulcers
Taha AS. N Engl J Med. 1996;334:1435–9.
22. Endoscopic Ulcers and Ulcer Complications
Celecoxib vs NSAIDS
Ulcer Complications
Endoscopic Ulcers
CLASS Study at 1 year
at 6 months
(Patient not taking aspirin)
20 Celecoxib
P < 0.001 1.5 NSAIDS
P = 0.04
s)
15
Inciden (events 100 pt-yrs
dence (%)
1.0
10
Ulcer incid
s/
0.5
5 nce
0 0
Emery et al. Lancet 1999;354:2106-11. P value by log-rank test
Silverstein et al. JAMA. 2000;284:1247-55.
23. PPI Co-therapy Reduces
Ulcer Development in
High-Risk
Hi h Ri k NSAID and COX-2 U
d COX 2 Users*
*
1,429 H. pylori-negative subjects
Age >60 years or ulcer history
% Ulcers at 6 months
s
†p<0.01 vs. placebo
‡p<0.001 vs. placebo
‡
‡ †
‡
* P ti t t k t diti
Patients took traditional NSAID or COX
l COX- Scheiman JM, et al. Am J
2-selective inhibitor + ASA Gastroenterology. 2006:1
01:701–710.
24. Prevention of Recurrent Ulcer Bleeding in
High-Risk
High Risk Patients**
Initial Study Group1
I iti l St d G Follow-Up St d G
F ll U Study Group2
Celecoxib 200 mg bid + placebo P = NS
Diclofenac 75 mg BID +
Omeprazole 20 mg QD
P = NS
n = 143 n = 144 n = 116 n = 106
*Patients with prior ulcer bleed on NSAID; ulcer healed and H pylori-negative or eradicated prior to randomization. NS, not significant.
1. Chan FK, et al. N Engl J Med. 2002;347:2104–2110.
2. Chan FK, et al. Gastroenterology. 2004;127:1038–1043.
25. Prevention of NSAID-induced Ulcers
Systematic Review of Randomized
Controlled Trials:
Randomized Controlled Trials (n=40)
for the Prevention of NSAID-Induced Ulcers
Prevention of NSAID-induced Ulcers Relative Risk vs. Placebo (95% Confidence
Interval)
Misoprostol 800 µg 0.17 (0.11-0.24)
0.42 (0.28-0.67)
Misoprostol 400 µg
0.40 (0.32-0.51)
PPI
H2RA (standard dose) 0.73 (0.50-1.09)
H2RA (double dose) 0.44 (0.26-0.74)
0.0 0.25 0.50 0.75 1.0 1.25
Favors Co-Therapy Favors Placebo
Rostom A, et al. Cochrane Database Systematic Review. 2002;4.
27. Adherence to Evidence-Based Guidelines for
Safe Prescription of NSAIDs in
High-Risk* Patients
rence (%)
Adher
N = 303,787 veterans prescribed NSAIDs in 2002.
*Included age ≥65 years, concurrent corticosteroid or anticoagulant use, history of peptic ulcer, and high average daily dose of NSAIDs.
Abraham NS, et al. Gastroenterology. 2005;129:1171–1178.
28. Utilization of Gastroprotective Strategies
Among New NSAID Users
1 GI Risk Factor ≥ 2 GI Risk Factors
0.1% 2.5% 10.8% 0.2% 4% 14.7%
86.6% 81.2%
COX-2 Inhibitor alone NSAID + GPA Cox-2 Inhibitor + GPA No gastroprotection
GPA = gastroprotective agent
Sturkenboom MC, et al. Rheumatology. 2003;42(Suppl 3):iii23-iii31.
29. Non-adherence is associated with
decreased relative effectiveness
Annualized 0.4
04
rates of upper
GI events per
patient-year 0.3
R2 = 0.3088
0.2
0.1
0.0
00
0 20 40 60 80 100
Adherence (%)
Goldstein JL et al. Clin Gastroenterol Hepatol 2006. 4 (11): 1337-45
30. Gastric Ulcers After Six Months
(Percentage and 95% CI)
72% RR
29.4%
Gastric ulcers, cumulative %
(22.9%-37.3%)
c e
8.3%*
(5.1%-13.5%)
PPI/Naproxen (n=206) Naproxen (n=203)
Goldstein J L et al. Gastroenterology 2008, vol 134, A-19
31. Gastroduodenal Ulcers After Six Months*
(
(Percentage and 95% CI)
g % )
29.1%
23.0%- 36.5%
p=0.0002
Ulcers, cumulativ %
ve
14.7%
11.4%- 18.8%
Ibuprofen 800 mg/ Famotidine 26.6 mg TID Ibuprofen 800 mg TID
(n=550) (n=262)
*40 to 80 year old patients expected to need NSAIDs ≥ 6 months (O t
t ld ti t t dt d NSAID th (Osteoarthritis,
th iti
rheumatoid arthritis, chronic low back pain, chronic regional pain syndrome, and/or
chronic soft tissue pain)
Laine L et al., Oral abstract presented at DDW 2009_____
33. Managing NSAID-Associated GI Conditions
• Treating symptoms
– Manage dyspepsia with acid suppression
• Healing ulcers
– Heal ulcer with a PPI: More effective than H2RA
• Preventing ulcers
– Discontinue NSAID whenever possible and consider alternative
analgesic (e.g, acetaminophen)
– Lower the dose of NSAID
– Switch to COX-2 selective inhibitor or co-therapy with misoprostol, PPI
py p ,
or high-dose H2RA
– Compliance issues with a separately administered co-therapy may
reduce effectiveness
Wolfe MM, et al. N Engl J Med 1999;340:1888–1899.
34. Key Takeaways
• PPIs, high-dose H2RA, misoprostol and COX-2 selective inhibitors
decrease upper GI ulcers due to traditional, nonselective NSAIDs
traditional
(RCT evidence)
• Fixed-dose combination therapy may increase patient compliance
with GI risk reduction strategies
• Patients with the highest GI risk may require more than one risk-
reducing strategy such as COX-2 selective inhibitor plus a PPI
• Clinicians must balance GI and CV issues when choosing NSAID
therapy
RCT, randomized controlled trial.