1) Adding hormone therapy to radiotherapy improves outcomes for prostate cancer, including disease-specific mortality and distant metastases.
2) For high-risk or locally advanced prostate cancer, short-course neoadjuvant hormone therapy of 3-6 months improves local control when combined with radiotherapy.
3) Long-term hormone therapy of at least 2 years reduces the risk of metastases and improves survival more than short-term therapy, especially for high-grade disease.
Treatment strategies in patients with statin intoleranceVishwanath Hesarur
Statins are among the most prescribed drugs in the world and are first-line therapy in the management of hyperlipidemia.
Their beneficial effects on cardiovascular morbidity and mortality have been demonstrated both in primary and in secondary prevention.
They are generally safe, but in some patients, statin therapy is stopped because of intolerance to the drug that may result in muscle aches and weakness, gastrointestinal symptoms, liver enzyme abnormalities, or other nonspecific discomforts.
The rate of reported statin-related events is about 5% to 10% in randomized, placebo controlled clinical trials.
Management of Anemia in cancer patientsAjeet Gandhi
Anemia in cancer patients are important both in terms of quality of life as well as response to therapy. Cause of anemia is multi-factorial and its management is critical in optimizing best outcomes of cancer patients
Treatment strategies in patients with statin intoleranceVishwanath Hesarur
Statins are among the most prescribed drugs in the world and are first-line therapy in the management of hyperlipidemia.
Their beneficial effects on cardiovascular morbidity and mortality have been demonstrated both in primary and in secondary prevention.
They are generally safe, but in some patients, statin therapy is stopped because of intolerance to the drug that may result in muscle aches and weakness, gastrointestinal symptoms, liver enzyme abnormalities, or other nonspecific discomforts.
The rate of reported statin-related events is about 5% to 10% in randomized, placebo controlled clinical trials.
Management of Anemia in cancer patientsAjeet Gandhi
Anemia in cancer patients are important both in terms of quality of life as well as response to therapy. Cause of anemia is multi-factorial and its management is critical in optimizing best outcomes of cancer patients
This is a getting started guide to help retailers and partners evaluate the LocalSocial In-Store Engagement platform. LocalSocial is a soup-to-nuts proximity platform that supports iBeacon (among other things).
This guide covers the basics of setting up a Merchant Account, configuring in-store welcome messages, product cards, promotions and loyalty points, and setting up your iBeacons / BLE Beacons so that they're available in your merchant account.
Videos available here: https://vimeo.com/album/3328680
the hotel industry is under going another disruption: the "collaboration economy" and its poster child Airbnb give rise to a variety of apartment rentals, offered to consumers for more affordable prices. Hotels respond to this trend by sharpening their strategy and their differentiation compared to the new competition.
Core competency is a concept in management theory introduced by, C. K. PRAHALAD and GARY HAMEL.
It can be defined as "a harmonized combination of multiple resources and skills that distinguish a firm in the marketplace“
Core competency are the skills, characteristics, and assets that set your company apart from competitors.
They are the fuel for innovation and the roots of competitive advantage.
The engine for new business development, underlying component of a company’s competitive advantage created from the coordination, integration and harmonization of diverse skills and multiple streams of technologies.
Induction chemotherapy followed by concurrent ct rt versus ct-rt in advanced ...Santam Chakraborty
Small Presentation where the benefit of addition of induction / neoadjuvant chemotherapy to concurrent chemoradiation in head neck cancers is explored.
Locally advanced Ca prostate
Courtesy : NCCN , Perez, Gunderson and Tepper
Brief outline on management
ADT, Radiotherapy, Surgery indications and Standard of care
Presentation is highlighting the integration of different modalities in the management of locally advanced and metastatic prostate cancer pointing to the proven values of adding chemotherapy. A special note has been made to oligometastatic disease.
Changing landscape in the treatment of advanced prostate cancer Alok Gupta
This presentation describes how the treatment of stage 4 prostate cancer has improved over last 100 years. This was presented at URO ONCOLOGY UPDATE meeting of Delhi Urological Society on 18th March 2017
14. Diabetes and cardiovascular disease during androgen deprivation for prostate cancerKeating JNCI 2010VA Study
15. Efsathiou JCO 2009 2792-99 No. = 945 FU 8.1 yrs CVD = 117 At 9 yrs CVD 8% vs 11% With LOWER risk in LHRHagroup
16. Osteoporosis and duration of LHRHa therapy Stage I-II Ca Prostate with PSA control Morote Eur Urol 2003 44 661 Prostatectomy controls (57) Men treated with LHRHa (53) Loss of bone mineral density particularly in first 6–12m (Daniell 2000, Mittan 2002) Osteoporotic fracture rate increased. 4% 5yr, 20% 10yr (Oefelein 2001)
17. What should we advise patients on androgen deprivation therapy? Address risk factors Diabetes , Cholesterol, Hypertension Aspirin Exercise In the adjuvant setting duration of hormone therapy should be tailored to need
23. Samson et al 2002 “Modest benefit at 5 years probable outweighed by increased side-effects”
24. Phase 3 RCT IAS vs Continuous AD –PSA progression after local Rx; NCIC PR07 Klotz abs 2011
25. MRC Trial PR05 AD vs AD +Clodronate in Metastatic Prostate Cancer Dearnaley D P et al. JNCI J Natl Cancer Inst 2003;95:1300-1311 overall survival time from randomization symptomatic bone progression-free survival time Also STAMPEDE trial recruiting—looking at AD withzoledronate, celecoxib, docetaxel and will have an abiraterone arm
26. What is the evidence that adding hormone therapy to radiotherapy improves outcome? For how long should hormone therapy be continued? Hormone deprivation or anti-androgen? Should we add RT in patients on long term hormone therapy?
27. Roach JCO 2008 26 585-591 N = 456 1987-91 T2 (bulky) -T4 N+/- MAB 4m pre and with RT vs RT alone
28. Disease specific mortality Roach JCO 2008 26 585-591 Overall survival 10yr OS 43% vs 34% p=0.12 10yr DSM 23% vs 36% p=0.01 Fatal cardiac events Distant metastases 10 yr Dist Met 35% vs 47% p=0.006 10 yr Cardiac deaths 14% vs 10%
29. Long term androgen suppression and external irradiation in patients with locally advanced prostate cancer (an EORTC study): a phase III randomised trial Bolla Lancet 2002 360 103
30.
31. All trials show improvement in cause related and overall survival
32. RTOG 85-31 shows overall survival advantage for Gleason 8-10 only and Swedish trial for node positiveBolla Lancet 2002 360 103; Pilepich IJROBP 2005 61 1285; Granfors J Urol 2006 176 544
33. Hormones + RT versus RT alone Short course hormones markedly improve local control and disease free survival For short course hormones most trials have not shown an improvement in overall survival Long term hormones have markedly improved survival in patients with locally advanced high risk cancers. Conclusions
34. What is the evidence that adding hormone therapy to radiotherapy improves outcome? For how long should hormone therapy be continued? Hormone deprivation or anti-androgen? Should we add RT in patients on long term hormone therapy?
36. 6months vs 3yrs concomitant and adjuvant hormonal treatment for locally advanced Ca Prostate EORTC 22961 Bolla et al 2009 N=970 Overall survival STAD 81% vs LTAD 84.8% P Ca deaths STAD n=46 vs LTAD 28 CVD deaths STAD n= 31 vs LTAD 25 Overall STAD Overall LTAD P Ca STAD P Ca LTAD
37. Hormone duration? Long term hormone therapy compared to short term improves progression free survival Improved overall survival probably just in high risk patients As yet unclear that intermediate risk patients gain from more than 3-6 months Conclusions
38. What is the evidence that adding hormone therapy to radiotherapy improves outcome? For how long should hormone therapy be continued? Hormone deprivation or anti-androgen? Should we add RT in patients on long term hormone therapy?
39. Bicalutamide 150mg plus standard care vs standard care alone for early prostate cancer.McleodBJU Int 2006 9 247 Dearnaley ECCO September 07
40. What is the evidence that adding hormone therapy to radiotherapy improves outcome? For how long should hormone therapy be continued? Hormone deprivation or anti-androgen? Should we add RT in patients on long term hormone therapy?
41. NCRI PR3 / MRC PR07 TrialP.Warde ASCO 2010 Randomisation: Hormone Treatment alone vs HT and RT to prostate +/- pelvis No.1205 Deaths 310 CaP deaths 140 7yr OS 66% vs 74% HR 0.77 p=0.03 NNT 12.5 7 yr CSS 79% vs 90 % HR 0.57 p=0.001 NNT 9 Same result as Widmark et al 2009
42. CONCLUSIONS: Combined Modality Treatment Neo/Adjuvant hormonal therapy should be used in all men with high risk or locally advanced prostate cancer treated with external beam radiotherapy Short course (3-6m) NAD improves local control in intermediate/high risk localised and advanced localised prostate cancer Long course androgen suppression reduces development of metastases and improves survival for men with advanced localisedand high grade prostate cancer Optimal duration of ‘long term’ hormone therapy is at least 2 years for Gl ≥8 cancer, but may be shorter for more favourable disease Comparisons of LHRHa with monotherapybicalutamide are needed Men with locally advanced disease and good health should have RT as well as hormone therapy