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
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.
1. The study analyzed treatment patterns over time in patients receiving first-line chemotherapy for advanced or metastatic esophageal or gastric cancer based on data from 2,808 patients documented in Therapiemonitor from 2006-2013.
2. Treatment intensity increased over time, with 49.3% of patients receiving triplet chemotherapy in 2013 compared to just 10.1% in 2006. HER2 testing rates increased from 49.1% in earlier studies to 79.1% in 2012-2013, though testing was still not always performed according to guidelines.
3. Usage of fluoropyrimidine/cisplatin combinations with trastuzumab declined from 67% in 2010-2011 to 50% in 2012-2013
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 It includes individual patient data from 875 patients across 4 trials, as well as previously unpublished updated follow-up data from 261 additional patients in the ESPAC1 trial.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
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.
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 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 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.
- 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
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.
1. The study analyzed treatment patterns over time in patients receiving first-line chemotherapy for advanced or metastatic esophageal or gastric cancer based on data from 2,808 patients documented in Therapiemonitor from 2006-2013.
2. Treatment intensity increased over time, with 49.3% of patients receiving triplet chemotherapy in 2013 compared to just 10.1% in 2006. HER2 testing rates increased from 49.1% in earlier studies to 79.1% in 2012-2013, though testing was still not always performed according to guidelines.
3. Usage of fluoropyrimidine/cisplatin combinations with trastuzumab declined from 67% in 2010-2011 to 50% in 2012-2013
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
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.
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 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 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.
- 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
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.
Treatment of Ovarian Cancer First Line Chemotherapy or Targeted Therapy for R...ijtsrd
Ovarian cancer is the seventh most common gynecological cancer worldwide, ovarian cancer is the eighth leading cause of cancer death in women. In recent years, the number of ovarian cancer cases has been increasing in Japan, more than 9,000 women are diagnosed with ovarian cancer each year. The 5 year survival rate is 58 , the lowest among gynecological cancers, 4,758 ovarian cancer deaths in 2012. That is, it is reported that about one in two ovarian cancer patients has died. Because it is difficult to cure recurrent ovarian cancer, treatment is used to prolong life and improve quality of life. Because PARP inhibitors are oral targeted drugs that specifically act on cancer cells, they are expected to reduce the risk of disease progression and death while maintaining a good safety profile. In this way, the development of oral preparations has made it possible to avoid the burden on patients such as pain caused by conventional injections and the time constraints required for infusion. In this review, we discuss new treatments for ovarian cancer. Takuma Hayashi | Kaoru Abiko | Ken Yamaguchi | Junzo Hamanishi | Masaki Mandan | Ikuo Konishi "Treatment of Ovarian Cancer: First-Line Chemotherapy or Targeted Therapy for Recurrent Cases" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-4 | Issue-3 , April 2020, URL: https://www.ijtsrd.com/papers/ijtsrd30470.pdf Paper Url :https://www.ijtsrd.com/medicine/other/30470/treatment-of-ovarian-cancer-firstline-chemotherapy-or-targeted-therapy-for-recurrent-cases/takuma-hayashi
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.
A Novel Eclectic Approach for Cancer Therapy with Liquid Knife & Immuno Thera...CrimsonpublishersCancer
Recent years cancer immunological therapy is getting very popular and many new drug have been approved by FDA like PD1 and PDl-1, however, in clinical practice of cancer treatment, it looks very limited efficacy for advanced cancer, so that physician started to use comprehensive plan by combination chemotherapy with PD1 as a novel strategy with a better clinical benefit. Since chemotherapy and radiation therapy always produce the side effect like loss hair, vomit and neutropenia, and surgery is limited for many later stages of cancers, also surgery damages body shapes with functions, esophageal cancer was removed with reconstruction and put stomach into chest and stomach never has normal function; a lot of cases showed surgery can’t be performed because tumor location in special site, like tumor location in posterior vaginal wall or vaginal carnal, surgery just is not allowed to do the procedure, if remove the tumor in these location, it will make a hole to connect to the rectal. Because of the extremely toxic side effects, many cancer patients cannot be successfully completed a surgery or a complete course of chemotherapy or radiation therapy, and some cases even die from the side effects of surgery or chemotherapy or radiation therapy due to a patient’s poor tolerance.
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
TriCancerVac is a new drug combination therapy for chemoimmunotherapy developed by Baofa Cancer Therapeutics Inc. It consists of a clinically approved cytotoxic drug, adjuvant, and oxidant that is injected intratumorally. This allows for sustained drug release and boosts the immune response by releasing tumor antigens. Clinical trials show it improves survival rates and reduces side effects for various cancers including liver, lung, and pancreatic cancer compared to chemotherapy alone. The simple procedure may reduce healthcare costs and help treat a broad range of cancer patients.
TriCancerVac is a new drug combination therapy for chemoimmunotherapy developed by Baofa Cancer Therapeutics Inc. It consists of a clinically approved cytotoxic drug, adjuvant, and oxidant that is injected intratumorally. This allows for sustained drug release and boosts the immune response by releasing tumor antigens. Clinical trials show it improves survival rates and reduces side effects for various cancers including liver, lung, and pancreatic cancer compared to chemotherapy alone. The simple procedure may reduce healthcare costs and help treat a broad range of cancer patients.
Nick chen ppt presentation metronomic chemotherapy 2015CNPS, LLC
Metronomic chemotherapy provides several advantages over conventional chemotherapy:
- It is associated with lower toxicity due to more frequent lower doses, allowing better treatment consistency.
- It has enhanced anti-cancer effects through anti-angiogenesis and improved immune response against tumors.
- Targeting both the tumor and tumor microenvironment makes it less likely to encounter chemo-resistance.
Impact of Multidisciplinary Discussion on Treatment Outcome For Gynecologic C...Emad Shash
Tumor conferences are multidisciplinary meetings at which the
management of cancer patients is discussed. They have been
an integral part of oncology services and are regarded
as an essential component of quality control and continuing
medical education. There are data to suggest that the tumor conference enhances patient care. Many studies of effectiveness have been conducted. Reported benefits include improved patient management and treatment. In this presentation, I'll try to assess the role of the multidisciplinary tumor conference in patient management in gynecologic oncology services.
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
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.
- The document summarizes adjuvant therapies for malignant melanoma that have been presented by Dr. v.veeranath reddy and moderated by Dr. G.Puranik at a journal club meeting.
- Traditional adjuvant therapies included wide local excision, lymph node dissection, and radiotherapy to lymph node basins. However, evidence for their impact on survival is lacking.
- Recent therapies that have shown improved survival include targeted BRAF and MEK inhibitors for BRAF mutant tumors, and immuno therapies like anti-PD-1 inhibitors for BRAF wild type tumors. These are now established as first line therapies for stage 4 disease.
- Ongoing adjuvant trials are investigating
The document discusses value assessment frameworks for cancer therapies developed by the European Society for Medical Oncology (ESMO) and the American Society of Clinical Oncology (ASCO). It describes ESMO's Magnitude of Clinical Benefit Scale (ESMO-MCBS), which provides a relative ranking of clinical benefit for new cancer drugs. Studies applying the ESMO-MCBS found that it supported treatment decisions and aligned with reimbursement decisions. While the ESMO-MCBS provides standardized benefit assessment, it only applies to comparative studies and cannot assess single-arm trials. Overall, the ESMO-MCBS provides an unbiased and standardized approach to quantify the clinical benefit of new cancer treatments.
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
Effect of differnt chemotherapy regimens on pathological response in the preo...Klinikum Lippe GmbH
Verfasser: R. Bücker, G. Jaenke, F. Hartmann, T. Hansen, U. Schäfer
A retrospective analysis. In this small patient, the kind of chemotherapy regimen appaers to have a signifcant influence on pathologic tumor regression after preoperative combined chemo radiotherapy of rectal cancer.
This memorandum discusses the management of meningeal myeloma, a lethal condition involving the membranes surrounding the brain and spinal cord. While optimal treatment is unclear, three modalities consistently appear effective: intrathecal chemotherapy administered directly into the cerebrospinal fluid (CSF), radiation therapy, and systemic chemotherapy. Intrathecal chemotherapy with cytarabine, methotrexate and dexamethasone is the preferred method and should be administered until the CSF normalizes. Radiation therapy provides a survival benefit and should be considered part of treatment. Systemic chemotherapy, such as the D(T)PACE regimen, also has a role in management.
The survey analyzed treatment patterns for multiple myeloma in Germany between 2008-2011 based on data from 478 patients. Key findings include:
- Bortezomib-chemotherapy regimens are now preferred for first-line treatment regardless of planned autologous stem cell transplantation (ASCT), which was performed in around 30% of eligible patients.
- Thalidomide- and lenalidomide-based therapies are commonly used in the second-line setting in 31% of patients.
- Cytogenetic testing increased from 23% in 2008 to 53% in 2011 and influences treatment decisions, though age and comorbidities remain major factors.
- Supportive care needs decreased
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
Breast cancer is the commonest cancer and leading cause of cancer death in women. Triple negative breast cancers are ER, PR and Her 2 Neu negative. These tumors have high propensity for metastatic spread. The lack of expression of ER, PR and Her 2 Neu receptors makes chemotherapy only option available to treat these aggressive tumors.
Breast Cancer is the commonest cancer and leading cause of cancer death in women. In the year 2012 approximately 1,671,149
new patients were diagnosed with breast cancer and 521,907
deaths were attributed to this menace [1]. According to SEER
Cancer Registry 95% of the patients have localized disease at
initial presentation whereas 5% of patients present with metastatic disease [2]. About 20-30% of early stage patients develop
systemic disease at some point in life [3]. In Pakistan every year
approximately 90,000 women are diagnosed with breast cancer
and most of these patients have either locally advanced or metastatic disease [4]. A study conducted by Gilani et al. [5] showed
that 25-36% of Pakistani women present with disseminated disease.
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.
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.
Treatment of Ovarian Cancer First Line Chemotherapy or Targeted Therapy for R...ijtsrd
Ovarian cancer is the seventh most common gynecological cancer worldwide, ovarian cancer is the eighth leading cause of cancer death in women. In recent years, the number of ovarian cancer cases has been increasing in Japan, more than 9,000 women are diagnosed with ovarian cancer each year. The 5 year survival rate is 58 , the lowest among gynecological cancers, 4,758 ovarian cancer deaths in 2012. That is, it is reported that about one in two ovarian cancer patients has died. Because it is difficult to cure recurrent ovarian cancer, treatment is used to prolong life and improve quality of life. Because PARP inhibitors are oral targeted drugs that specifically act on cancer cells, they are expected to reduce the risk of disease progression and death while maintaining a good safety profile. In this way, the development of oral preparations has made it possible to avoid the burden on patients such as pain caused by conventional injections and the time constraints required for infusion. In this review, we discuss new treatments for ovarian cancer. Takuma Hayashi | Kaoru Abiko | Ken Yamaguchi | Junzo Hamanishi | Masaki Mandan | Ikuo Konishi "Treatment of Ovarian Cancer: First-Line Chemotherapy or Targeted Therapy for Recurrent Cases" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-4 | Issue-3 , April 2020, URL: https://www.ijtsrd.com/papers/ijtsrd30470.pdf Paper Url :https://www.ijtsrd.com/medicine/other/30470/treatment-of-ovarian-cancer-firstline-chemotherapy-or-targeted-therapy-for-recurrent-cases/takuma-hayashi
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.
A Novel Eclectic Approach for Cancer Therapy with Liquid Knife & Immuno Thera...CrimsonpublishersCancer
Recent years cancer immunological therapy is getting very popular and many new drug have been approved by FDA like PD1 and PDl-1, however, in clinical practice of cancer treatment, it looks very limited efficacy for advanced cancer, so that physician started to use comprehensive plan by combination chemotherapy with PD1 as a novel strategy with a better clinical benefit. Since chemotherapy and radiation therapy always produce the side effect like loss hair, vomit and neutropenia, and surgery is limited for many later stages of cancers, also surgery damages body shapes with functions, esophageal cancer was removed with reconstruction and put stomach into chest and stomach never has normal function; a lot of cases showed surgery can’t be performed because tumor location in special site, like tumor location in posterior vaginal wall or vaginal carnal, surgery just is not allowed to do the procedure, if remove the tumor in these location, it will make a hole to connect to the rectal. Because of the extremely toxic side effects, many cancer patients cannot be successfully completed a surgery or a complete course of chemotherapy or radiation therapy, and some cases even die from the side effects of surgery or chemotherapy or radiation therapy due to a patient’s poor tolerance.
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
TriCancerVac is a new drug combination therapy for chemoimmunotherapy developed by Baofa Cancer Therapeutics Inc. It consists of a clinically approved cytotoxic drug, adjuvant, and oxidant that is injected intratumorally. This allows for sustained drug release and boosts the immune response by releasing tumor antigens. Clinical trials show it improves survival rates and reduces side effects for various cancers including liver, lung, and pancreatic cancer compared to chemotherapy alone. The simple procedure may reduce healthcare costs and help treat a broad range of cancer patients.
TriCancerVac is a new drug combination therapy for chemoimmunotherapy developed by Baofa Cancer Therapeutics Inc. It consists of a clinically approved cytotoxic drug, adjuvant, and oxidant that is injected intratumorally. This allows for sustained drug release and boosts the immune response by releasing tumor antigens. Clinical trials show it improves survival rates and reduces side effects for various cancers including liver, lung, and pancreatic cancer compared to chemotherapy alone. The simple procedure may reduce healthcare costs and help treat a broad range of cancer patients.
Nick chen ppt presentation metronomic chemotherapy 2015CNPS, LLC
Metronomic chemotherapy provides several advantages over conventional chemotherapy:
- It is associated with lower toxicity due to more frequent lower doses, allowing better treatment consistency.
- It has enhanced anti-cancer effects through anti-angiogenesis and improved immune response against tumors.
- Targeting both the tumor and tumor microenvironment makes it less likely to encounter chemo-resistance.
Impact of Multidisciplinary Discussion on Treatment Outcome For Gynecologic C...Emad Shash
Tumor conferences are multidisciplinary meetings at which the
management of cancer patients is discussed. They have been
an integral part of oncology services and are regarded
as an essential component of quality control and continuing
medical education. There are data to suggest that the tumor conference enhances patient care. Many studies of effectiveness have been conducted. Reported benefits include improved patient management and treatment. In this presentation, I'll try to assess the role of the multidisciplinary tumor conference in patient management in gynecologic oncology services.
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
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.
- The document summarizes adjuvant therapies for malignant melanoma that have been presented by Dr. v.veeranath reddy and moderated by Dr. G.Puranik at a journal club meeting.
- Traditional adjuvant therapies included wide local excision, lymph node dissection, and radiotherapy to lymph node basins. However, evidence for their impact on survival is lacking.
- Recent therapies that have shown improved survival include targeted BRAF and MEK inhibitors for BRAF mutant tumors, and immuno therapies like anti-PD-1 inhibitors for BRAF wild type tumors. These are now established as first line therapies for stage 4 disease.
- Ongoing adjuvant trials are investigating
The document discusses value assessment frameworks for cancer therapies developed by the European Society for Medical Oncology (ESMO) and the American Society of Clinical Oncology (ASCO). It describes ESMO's Magnitude of Clinical Benefit Scale (ESMO-MCBS), which provides a relative ranking of clinical benefit for new cancer drugs. Studies applying the ESMO-MCBS found that it supported treatment decisions and aligned with reimbursement decisions. While the ESMO-MCBS provides standardized benefit assessment, it only applies to comparative studies and cannot assess single-arm trials. Overall, the ESMO-MCBS provides an unbiased and standardized approach to quantify the clinical benefit of new cancer treatments.
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
Effect of differnt chemotherapy regimens on pathological response in the preo...Klinikum Lippe GmbH
Verfasser: R. Bücker, G. Jaenke, F. Hartmann, T. Hansen, U. Schäfer
A retrospective analysis. In this small patient, the kind of chemotherapy regimen appaers to have a signifcant influence on pathologic tumor regression after preoperative combined chemo radiotherapy of rectal cancer.
This memorandum discusses the management of meningeal myeloma, a lethal condition involving the membranes surrounding the brain and spinal cord. While optimal treatment is unclear, three modalities consistently appear effective: intrathecal chemotherapy administered directly into the cerebrospinal fluid (CSF), radiation therapy, and systemic chemotherapy. Intrathecal chemotherapy with cytarabine, methotrexate and dexamethasone is the preferred method and should be administered until the CSF normalizes. Radiation therapy provides a survival benefit and should be considered part of treatment. Systemic chemotherapy, such as the D(T)PACE regimen, also has a role in management.
The survey analyzed treatment patterns for multiple myeloma in Germany between 2008-2011 based on data from 478 patients. Key findings include:
- Bortezomib-chemotherapy regimens are now preferred for first-line treatment regardless of planned autologous stem cell transplantation (ASCT), which was performed in around 30% of eligible patients.
- Thalidomide- and lenalidomide-based therapies are commonly used in the second-line setting in 31% of patients.
- Cytogenetic testing increased from 23% in 2008 to 53% in 2011 and influences treatment decisions, though age and comorbidities remain major factors.
- Supportive care needs decreased
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
Breast cancer is the commonest cancer and leading cause of cancer death in women. Triple negative breast cancers are ER, PR and Her 2 Neu negative. These tumors have high propensity for metastatic spread. The lack of expression of ER, PR and Her 2 Neu receptors makes chemotherapy only option available to treat these aggressive tumors.
Breast Cancer is the commonest cancer and leading cause of cancer death in women. In the year 2012 approximately 1,671,149
new patients were diagnosed with breast cancer and 521,907
deaths were attributed to this menace [1]. According to SEER
Cancer Registry 95% of the patients have localized disease at
initial presentation whereas 5% of patients present with metastatic disease [2]. About 20-30% of early stage patients develop
systemic disease at some point in life [3]. In Pakistan every year
approximately 90,000 women are diagnosed with breast cancer
and most of these patients have either locally advanced or metastatic disease [4]. A study conducted by Gilani et al. [5] showed
that 25-36% of Pakistani women present with disseminated disease.
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This document summarizes the current state of neoadjuvant treatment options for esophageal and gastric cancer. It finds that neoadjuvant therapy prior to surgery should be considered for all patients with greater than T1 or node-positive disease. For esophageal cancer, most patients should receive neoadjuvant chemoradiation. For gastric cancer, there is strong support for adjuvant chemotherapy following surgery. Future areas of research include immunotherapy, targeted therapies, and combination approaches.
34320294 jak inhibitors more than just glucocorticoids (1)EVELIN LÁZARO
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Oligometastatic lung cancer is cancer that has spread from the primary location to one or a few other organs. In most cases, oligometastatic lung disease occurs in the brain.
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.
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2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
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7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
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2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
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Travel vaccination in Manchester offers comprehensive immunization services for individuals planning international trips. Expert healthcare providers administer vaccines tailored to your destination, ensuring you stay protected against various diseases. Conveniently located clinics and flexible appointment options make it easy to get the necessary shots before your journey. Stay healthy and travel with confidence by getting vaccinated in Manchester. Visit us: www.nxhealthcare.co.uk
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
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Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotes
Ispor Poster Ois Pcn25 Nov10
1. Did the uptake of new treatment options change the treatment strategy
in patients with colorectal cancer and primary non-resectable metastases?
The results of large population-based survey in Germany 2005-2007
Lenka Kellermann1
, Dirk Arnold2
, Salah-Eddin Al-Batran3
, Hans-Joachim Schmoll2
1
OncologyInformationService, Freiburg, Germany; 2
Department of Internal Medicine IV, Hematology & Oncology, Martin Luther University Halle-Wittenberg, Halle, Germany; 3
Department of Oncology and Hematology, Krankenhaus Nordwest Frankfurt/Main
Objectives: The survey was initiated to gain insights into the changes of treatment patterns In
treatment of metastatic colorectal cancer and the implementation of the results of clinical trials in
daily practice.
Patients and methods: A representative sample of centres (82) was selected with regard to the
distribution of treated prevalence in colorectal cancer in institutions (university hospitals, community
hospitals, office based oncologists) and regional population density. The physicians reported all pts.
with a treatment decision in colorectal cancer in the respective reporting period May 06-April 07. The
database contains 3254 pts. with a retrospective record of their entire treatment history. The treat-
ment patterns were analysed in the whole patient group and in subgroups according to resectability
of metastases, the treatment objectives (esp. secondary resectability of metastases), used systemic
treatment regimen, age, concomitant diseases and performing institution type. The statistics were
performed in SPSS by bivariate analyses with two-sided Chi-square test. In the next step the decisive
parameters for treatment choice were defined by logistic regression in multivariate analysis.
Results: The clinical trial data was taken up very soon in clinical reality. The correlation of drug effi-
cacy and resectability of metastases was transferred into the disease management of colorectal can-
cer. The patient share with treatment objective “secondary resection of metastases” increased signifi-
cantly (18% 2004 vs 27% 2006-07, p=0,000%). In this subgroup the patient share treated with tar-
geted therapy was significantly higher than in patients with other treatment objectives (34% vs.
19%, p=0,000%).
Conclusion: The method used for creation of the database and for the statistic analyses has been
proven as appropriate for the objectives of this survey. The resectability of metastases is recognized
as an important treatment objective. Therefore, targeted therapy was implemented more frequently
in treatment regiments for patients deemed secondary resectable, compared to other treatment
aims.
Since the 90s treatment options in metastatic colorectal cancer have developed rapidly.
(Tab. 1)
The new anticancer agents Ironotecan and Oxaliplatin displayed impressive effectiveness in clinical
trials and led to longer median overall survival of pts with metastastic colorectal cancer when used in
combination with the “old” treatment option FU/FA i.v. or oral. (Tab. 2)Grothey JCO 2004
Liver metastases are the most frequent localisation of metastases in pts. with metastatic colorectal
cancer (75%). The majority of them (80%) are not primary resectable. 30-40% of patients with pri-
mary resection of liver metastases live >= 5 years after the diagnosis of metastatic cancer. The sec-
ondary resection enables a survival benefit comparable with the primary resection. With the availabil-
ity of new effective anticancer agents secondary resectability became the focus of clinical research in
order to increase the overall survival of patients without primary resection of liver metastases. Tab.3
Fong et al. 1999, Adam et al. 2002, Poston et al., 2005, Folprecht et al. 2005
With this background the following questions were posed:
1. Were the results of clinical trials implemented into clinical reality in Germany?
2. Did the treatment strategy of 1st line therapy of metastatic colorectal cancer change between
2005-2007?
3. Were biologicals as new treatment options implemented more frequently in patients with the new
treatment strategy in the 1st line?
TherapyMonitor as a large population based survey offered a convincing method of answering these
questions.
Since 1998 O.I.s) has consistently conducted TherapyMonitor for metastatic colorectal cancer and
many other cancer types. The analysis published here is based on data from annual TherapyMoni-
tor surveys in 2004 (698 pts.), 2005 (678 pts.) and monthly continuous surveys in 5/2006-
4/2007 (1079 pts.).(Tab.4)
The sample in all TherapyMonitor surveys is representative and based on the structural analysis
of treated prevalence in metastatic colorectal cancer in Germany regarding type of treatment
institution, specialty and regional density of population. The centres in the sample represented
~10% of treated prevalence with metastatic colorectal cancer in Germany.
Each case history was reported retrospectively based on patient records by physicians or nurse
on site. O.I.s) offered EDC (SecuTrial™) or optionally CRF on paper for patient recording in or
der to avoid a technological bias. The patient records were checked by O.I.s) monitors with r e -
gard to plausibility and completeness ensuring that the data base contained only completed a n d
plausible patient records. O.I.s) performed the analysis in SPSS. The CRF method and results
were evaluated by Prof. Arnold (University Hamburg)and Prof. Schmoll (University of Hale/Salle).
Analysis of independent variables in the collected data and comparison with pub-
lished data indicated that the TherapyMonitor sample was highly consistent and rep
resentative and supported the reliability of the reported results.
1. Were the results of clinical trials implemented into clinical reality in Germa-
ny?
Since 2002 the 1st
line therapy of metastatic colorectal cancer has changed significantly. The ex
tended overall survival following the use of all available treatment options was reported in
multiple clinical trials up to 2002.
TherapyMonitor survey in Germany (Tab.5) in 2002 demonstrated the predominant use of c l a s
sical treatment options FU/FA i.v. or mono. (59% pts. with 1st
line chemotherapy). Only a mi
nority of pts (32%) received the new agents irinotecan or oxaliplatin in the 1st
line, generally
combined with FU/FA. The treatment algorithm reversed completely from 2002 to 2004. Thera
pyMonitor 2004 demonstrated the predominant use of the new agents irinotecan or oxali
latin in the 1st line (70% pts with chemotherapy) with only 27% receiving FU/FA i.v. or oral
in a mono therapy. Use of the most innovative treatment options – the biologicals bevaci
zumab and cetuximab – was only reported in TherapyMonitor 2004 in clinical trials (4%/1% pts.)
The approval of bevacizumab for the 1st line therapy of metastatic colorectal cancer fol
lowed in January 2005. The results of clinical trials resulted in the fast uptake of pts. t re a t e d
with bevacizumab in to the treatment algorithm – up to 19% in the Therapy Monitor sample
2006-2007.
Tab. 5: TherapyMonitor: 1st line Therapy mCRC in Germany
TherapyMonitor thus verified that the results of clinical trials were quick to be introduced into
clinical reality in the treatment of metastatic colorectal cancer in Germany. The majority of pa
tients in the 1st
line treatment of metastastic colorectal cancer had access to the effective new
agents promising the benefit of extended overall survival.
2. Did the treatment strategy of 1st line therapy of metastatic colorectal cancer
change between 2005-2007?
The TherapyMonitor 2006-07 sample contained 25% of pts with primary resectable liver metasta
ses – this proportion corresponds with the published data, i.w. van Velde, ESMO 2005 .
Secondary resection of liver metastases as a treatment objective was defined and focused on fol-
lowing approval of the new effective anticancer agents in the 1st
line treatment of metastatic co-
lorectal cancer. Clinical trials of biologicals with treatment endpoint „resectability of liver metasta
ses“ verified the effectiveness with an impressively increased R0-Rate. The results of clinical trials
had an immediate impact, in clinical reality, on the development of treatment strategy in 1st line
treatment of patients without primary resection of liver metastases in 2005-2007. Oncologists
accept that secondary resection is an important treatment objective.
According to TherapyMonitor 2005 there were only 18% of pts. with secondary resection of liver
metastases in Germany. Only 1 year later the rate of patients with secondary resection increased
significantly to 27%. (p=0,00, Fisher’s Exact Test). (Tab 6)
3. Were biologicals as new treatment options implemented more frequently in pa-
tients with the new treatment strategy in the 1st line?
The results of clinical trials regarding the effectiveness of bevacizumab or cetuximab in non prima-
ry resectable liver metastases had not yet been published in 2005. Both biologicals were used in
12% of pts. with non resectable liver metastases (7% bevacizumab, 5% cetuximalb) in 1st
line
treatment without any significant difference regarding treatment objectives.
The publication of CRYSTAL and NO 16966 results had an immediate impact, not only on the treat-
ment strategy, but on the choice of the anticancer agents too. In TherapyMonitor 2006-07 27% of
patients were treated with the treatment objective “secondary resectability of liver metastases”and
34% of them were treated with biologicals (24% bevacizumab, 8% cetuximab, 2 % others). The use
of biologicals in pts. with non resectable liver metastases and other treatment objectives was sig nificantly
lower at 19% (16% bevacizumab, 3% cetuximab). (p=0,00%, % Chi-Square Test, Fish er´s Exact Test)
Tab 6: Therapy Monitor mCRC: 1st line Therapy in pts without primary resection of liver
metastases: Use of Biologicals by Treatment Objective (2005 vs.´06-´07)
TherapyMonitor dealt with all individual, diagnostic and clinical variables available which could have an im-
pact on the treatment choice in the 1st
line treatment of metastatic colorectal cancer. Therefore, it was decided
to check the treatment objective “resectability of liver metastases” and other variables with respect to
their impact on the use of biologicals.
TherapyMonitor data allowed the building of profiles for patients with different treatment options in1sline
therapy regarding individual characteristics and treatment management factors, (Tab. 7) including the
treatment objective “resectability of liver metastases”. The analysis was based on 690 pts. with 1st
line
systemic treatment without primary resection of metastases.
The established profiles differed significantly in characteristics and variables and should therefore
be considered as parameters for the choice of treatment. In order to find out the variable with
the highest impact on the choice of biologicals a bivariate analysis was performed and significant
parameters were identified. (Tab.8)
We considered multiple factors to have a simultaneous impact on treatment choice. From all the significant
factors (detected in bivariate analysis) it was demonstrated in a simultaneous multi variate analysis (logistic
regression) that only the factors „age“ (median 65 y.,p=0,1%) and „treatment objective resectability of
metastases“ (p=2,7%) had a significant impact on the treat ment choice of biological. The patients with
the treatment objective „resectability of liver metas- tases“ were treated signifycantly more frequently with
the new biologicals than patients with other treatment objectives. This treatment strategy was based on the
results of clinical trials.
On the other hand, patients older than 65 had significantly limited access to the new biologicals – without
any evidence in clinical trials. In clinical reality the age >=65 y. (=median age) seemed to be a threshold
for the use of biologicals in 1st
line treatment of metastatic colorectal cancer in Germany.
1. The 1st line treatment of metastatic colorectal cancer has changed fundamentally since 2000. Clinical
trials demonstrated the increased effectiveness of new anticancer agents leading to extended overall sur-
vival. The new agents were included into the treatment algorithm from the be ginning in the 1st line.
The majority of patients in Germany benefited from these innovations immediately.
2. The next stage demonstrated that the new agents and especially the biologicals were effective in non-
resectable liver metastases. The new therapy strategy for secondary resection of liver metastases was deve-
loped and was adopted in clinical reality following impressive data from clinical trials. TherapieMonitor surveys
in 2005 and 2006-07 in Germany demonstrated the fast uptake of results from clinical trials regarding
new agents and a new treatment strategy, “secondary resec tions of liver metastases”, in clinical reality.
3. TherapyMonitor, furthermore, showed that the choice of 1st line therapy resulted from multiple factors
acting simultaneously. Following the results of clinical trials the biologicals were used significantly more frequently
in patients with the treatment objective, “secondary resectability of metastases”, than in patients with other
treatment objectives in 1st
line treatment. In addition to the results of clinical trials and the established effective-
ness of a new treatment approach, there are individual characteristics, such as the age of a patient, that were
demonstrated to have a significant impact on the treatment choice. In order to avoid limited access to the inno-
vative treatment approach for the majority of cancer patients, the median age of cancer patients should be con-
sidered as an important factor in clinical trial design.
The survey was supported by grants of Merck-Serono, Pfizer, Roche and Sanofi-Aventis, Germany.
Correspondence
Lenka Kellermann
OncologyInformationService
Goethe Str. 5a
79100 Freiburg, Germany
Phone: + 49-761-2025115
Fax.: + 49-761-2025117
e-mail: kellermann@oncologyinformationservice.com
year Development of Treatment Objective
„Secondary Resectability of Metastases“
1999
5-yr survival in pts. with primary resectability 30-40%
2002
Comparable survival in pts. with secondary resectability reported
2004-5
Definition of secondary resection as Therapy Objective (i.e.
„Oncosurge“)
2005
Retrospective analysis shows the correlation of effectiveness (Response
Rate, RR) und resectability (R0-Rate)
2005-6
Clinical Trials Phase II- III : increased RR-Rate with Cetuximab und
Bevacizumab
Year Available effective drugs
< 1995 5FU/FA
> 1995 5FU/FA iv or oral
> 2000
5FU/FA iv or oral,
Oxaliplatin, Irinotecan
> 2005
5FU/FA iv or oral, Oxaliplatin, Irinotecan
Bevacizumab, Cetuximab
AbstractAbstractAbstract
BackgroundBackgroundBackground
Therapy
Monitor
2004 2005 5/2006-4/2007
Sample Pts Centres Pts Centres Pts Centres
UICC 0-III (M0) 493 46 1775
82
UICC IV (M1) 698 48 678 73 1476
Total 1191 95 678 73 3254 82
ResultsResultsResults
MethodMethodMethod
Variable Significant impact on the choice of bio-
logicals in the 1st line therapy p-value
Age (on 31.12.2006) 0,0%
Concomitant diseases reported 2,7%
> 1 metastases 2,0%
CHD 0,1%
COPD 1,7%
Metastases in lymph nodes
reported
1,0%
Treatment objective „Resectability
of metastases“ 0,0%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2005 (437 pts.) 5/06-4/07 (1.158 pts.)
other treatment objectives
secondary resection of liver metastases
Parameter TM 2004 TM 2005 TM 2006-2007
Age Median (years) 65 65 65
Metastases %
Liver
Lung
68 78 74
23 22 24
18% 27%
ConclusionsConclusionsConclusions
PCN 25
ISPOR Europ. Conference
Prague Nov. 2010
Variable Bevacizumab
(n=218)
Cetuximab
(n=30)
Oxaliplatin +FU/FA
(n=480)
Capecitabine
(n=48)
Age (Median) 65 58 67 78
KI% (Median) 90 90 90 70
Concomitant disease
reported %
55 37 60 79
CHD reported % 11 13 17 50
Th. objective: Resecta-
bility of M.%
37 53 25 8
1 localisation of M. % 55 53 43 48
Th. initiated in non-univ.
cancer centres %
65 85 85 56
Th. initiated by office
based oncologists %
31 0 13 20