Cancer and other noncommunicable diseases (NCDs) arenowwidely recognized as a threat to global development.The latest United Nations high-level meeting on NCDs reaffirmed thisc observation and also highlighted the slow progress in meeting the 2011 Political Declarationon the Prevention and Control of Noncommunicable Diseases and the third Sustainable Development Goal. Lack of situational analyses, priority setting,and budgeting have been identified as major obstacles in achieving these goals. All of these have incommon that they require information on the local cancer epidemiology.
The Global Burden of Disease (GBD) study is uniquely poised to provide these crucial data.
Clinicopathologic Features and Survival Analysis of Non-metastatic Breast Can...Hugo Raul Castro Salguero
Background: Breast cancer (BC) is a leading cause of cancer related death
worldwide. Unfortunately, data concerning clinicopathologic features of this
malignancy in non-developed countries is scarce. This study aims to characterize a
cohort of Guatemalan female patients with non-metastatic BC and to determine
risk factors for overall survival (OS).
Breast conserving surgery followed by adjuvant radiotherapy is adopted in the early detected cases and mastectomy followed by radiotherapy or chemotherapy in the advanced cases are the general practices.
Analysis of Radiation Cystitis and Radiation Proctitis Cases in Patients with...Premier Publishers
Carcinoma cervix is commonly seen in India and is mostly diagnosed at an advanced stage where radiation therapy forms the basis of its treatment. Radiation cystitis and proctitis are commonly seen in these patients and contribute to increased morbidity and mortality. The aim of our study was to analyze the factors associated with radiation cystitis and proctitis in treated patients of carcinoma cervix. A retrospective observational study. All treated patients of carcinoma cervix from 2012 to 2017 with radiation induced cystitis and proctitis attending GOPD were analyzed. Descriptive statistics applied using SPSS software (Version 16). Chi square test and Fischer t test applied for calculating significance values. 100 cases were analyzed in toto. 89% belonged to radiation proctitis group and 11% to radiation cystitis group. All patients received external beam radiotherapy either in the form of conventional (90%) or IMRT technique (10%). Prevalence of radiation proctitis and cystitis in conventional radiotherapy group was 10.4% and 1.31% respectively and in IMRT group was 6.29% and 0.69% respectively. The patients were followed up after treatment for a minimum of 6 months. 100% cystitis cases were cured. But, 15.7% of proctitis cases did not get relieved of their symptoms. Radiation proctitis was seen more in patients receiving conventional radiotherapy via LINAC accelerators as compared to IMRT technique. More patient load, lack of adequate packing methods may contribute to increased incidence of RT related complications. Further evaluation of these patients is required to suggest management protocols and also to avoid them.
Cancer and other noncommunicable diseases (NCDs) arenowwidely recognized as a threat to global development.The latest United Nations high-level meeting on NCDs reaffirmed thisc observation and also highlighted the slow progress in meeting the 2011 Political Declarationon the Prevention and Control of Noncommunicable Diseases and the third Sustainable Development Goal. Lack of situational analyses, priority setting,and budgeting have been identified as major obstacles in achieving these goals. All of these have incommon that they require information on the local cancer epidemiology.
The Global Burden of Disease (GBD) study is uniquely poised to provide these crucial data.
Clinicopathologic Features and Survival Analysis of Non-metastatic Breast Can...Hugo Raul Castro Salguero
Background: Breast cancer (BC) is a leading cause of cancer related death
worldwide. Unfortunately, data concerning clinicopathologic features of this
malignancy in non-developed countries is scarce. This study aims to characterize a
cohort of Guatemalan female patients with non-metastatic BC and to determine
risk factors for overall survival (OS).
Breast conserving surgery followed by adjuvant radiotherapy is adopted in the early detected cases and mastectomy followed by radiotherapy or chemotherapy in the advanced cases are the general practices.
Analysis of Radiation Cystitis and Radiation Proctitis Cases in Patients with...Premier Publishers
Carcinoma cervix is commonly seen in India and is mostly diagnosed at an advanced stage where radiation therapy forms the basis of its treatment. Radiation cystitis and proctitis are commonly seen in these patients and contribute to increased morbidity and mortality. The aim of our study was to analyze the factors associated with radiation cystitis and proctitis in treated patients of carcinoma cervix. A retrospective observational study. All treated patients of carcinoma cervix from 2012 to 2017 with radiation induced cystitis and proctitis attending GOPD were analyzed. Descriptive statistics applied using SPSS software (Version 16). Chi square test and Fischer t test applied for calculating significance values. 100 cases were analyzed in toto. 89% belonged to radiation proctitis group and 11% to radiation cystitis group. All patients received external beam radiotherapy either in the form of conventional (90%) or IMRT technique (10%). Prevalence of radiation proctitis and cystitis in conventional radiotherapy group was 10.4% and 1.31% respectively and in IMRT group was 6.29% and 0.69% respectively. The patients were followed up after treatment for a minimum of 6 months. 100% cystitis cases were cured. But, 15.7% of proctitis cases did not get relieved of their symptoms. Radiation proctitis was seen more in patients receiving conventional radiotherapy via LINAC accelerators as compared to IMRT technique. More patient load, lack of adequate packing methods may contribute to increased incidence of RT related complications. Further evaluation of these patients is required to suggest management protocols and also to avoid them.
Cancer is a leading cause of death in developed countries. In this webcast Dr. Andreas Scherer will explain how personalized medicine can transform our approach to fighting this disease. He will also discuss current roadblocks and diagnostic challenges, and the pivotal role of Next Gen Sequencing to overcome these challenges.
The webcast will inform about best practices to design and implement a cancer testing pipeline: from sample preparation, to sequencing, to secondary and tertiary analysis of sequencing data. The goal is to rapidly identify clinically actionable data that allows an oncologist to quickly determine the best available treatment options.
The webcast will include demonstrations of the Golden Helix VarSeq software in the context of analyzing cancer gene panels and somatic mutations.
Cancer is a leading cause of death in developed countries. In this webcast Dr. Andreas Scherer will explain how personalized medicine can transform our approach to fighting this disease. He will also discuss current roadblocks and diagnostic challenges, and the pivotal role of Next Gen Sequencing to overcome these challenges.
The webcast will inform about best practices to design and implement a cancer testing pipeline: from sample preparation, to sequencing, to secondary and tertiary analysis of sequencing data. The goal is to rapidly identify clinically actionable data that allows an oncologist to quickly determine the best available treatment options.
The webcast will include demonstrations of the Golden Helix VarSeq software in the context of analyzing cancer gene panels and somatic mutations.
DOSIMETRY ANALYSIS OF 3D CRT AND IMRT TECHNIQUES ON SMALL AND LARGE BREAST C...AM Publications
The aim of the study was to compare dosimetric parameters of planning target volume (PTV) and organs at risk (lungs) between 3D-conformal radiation therapy (3D CRT) and intensity-modulated radiation therapy (IMRT) in breast cancer, also to find correlation between volume and these parameters. A total of 60 patients with left/right breast cancer received radiotherapy, 30 by 3D CRT and 30 by IMRT, with a dose of 50 Gy in 25 sessions. Plans were compared according to dose-volume histogram (DVH) analysis in terms of PTV homogeneity (HI) and conformity (CI) indices as well as lungs dose, also integral dose (ID). IMRT had the higher CI than 3D CRT, and the lower HI than 3D CRT. But IMRT had the higher ID than 3D CRT. So, IMRT had the better HI and CI than 3D CRT in breast cancer treatment. In other hand, there are negatif correlation between volume and CI in 3D CRT. But no signifficant correlation in IMRT. And there are no correlations between volume and HI in both techniques. Also there are signifficant positif correlation between volume and ID in both techniques.
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.
Cancer is one of the modern and major causes of mortality worldwide, the incidence and mortality rates vary according to geographical distribution.
It can be controlled by using awareness and screening programs to reduce mortality rates.
Effect of Time of Echo on 1H-magnetic Resonance Spectroscopy Imaging of Metab...submissionclinmedima
The aim of this study is to evaluate the effect of time of echo (TE) on magnetic resonance spectroscopy imaging (MRSI) of metabolites in maxillofacial carcinoma. 1.2. Methods: Twenty maxillofacial carcinoma patients and 10 healthy volunteers were recruited to undergo 1.5-Tesla high-resolution routine MRI and multi-voxel MRSI with a TE of 35 ms and 144 ms.
Breast cancer is a disease in which the cells of the breast grow out of control, creates an
abnormality in the breast tissue. It is the second leading cause of death in women worldwide. In
Saudi Arabia, Ministry of health reported that the number of new cases of cancer is 2741 including
about 19.9% of breast cancer in women due to unawareness , it usually occurs in women at the age
of 52. It accounts for about 22% of all new cancers in women. In developing countries there are
still large numbers of breast cancers diagnosed in later stages. So the death rate is also high. To
prevent people from this disease, it should be detected at an earlier stage which reduces death rate.
Digital mammogram is used for this purpose. The suspected symptoms causing breast cancer are
age, post menopause, stress, family history, physical inactivity, obesity, hormonal imbalances and
genetically mutated abnormalities. Our work focus on detecting stage of breast cancer using image
processing techniques and data mining technique is used to classify the stage of breast cancer and
the performance of classifier is evaluated through confusion matrix.
Medicinal Mushroom Preparations against Lung CancerNeven Jakopovic
In this cohort study, 13 patients with advanced small cell lung carcinoma and 52 with non-small cell lung carcinoma used medicinal mushroom extract (Dr Myko San company) from 2004 to 2007, and their status was assessed in 2009.
Using medicinal mushroom extracts with standard oncological therapy resulted in these significant dose-depended effects:
improved cancer survival and delayed mortality
decreases in tumor size
improved quality of life scores
when compared with standard therapy alone. Significant side effects or decreases in performance status, tolerance to therapy or outcome was not observed.
This work was presented by Dr. Ivan Jakopovic at the 5th International Medicinal Mushroom Conference in Nantong, China, in 2009.
Cancer is a leading cause of death in developed countries. In this webcast Dr. Andreas Scherer will explain how personalized medicine can transform our approach to fighting this disease. He will also discuss current roadblocks and diagnostic challenges, and the pivotal role of Next Gen Sequencing to overcome these challenges.
The webcast will inform about best practices to design and implement a cancer testing pipeline: from sample preparation, to sequencing, to secondary and tertiary analysis of sequencing data. The goal is to rapidly identify clinically actionable data that allows an oncologist to quickly determine the best available treatment options.
The webcast will include demonstrations of the Golden Helix VarSeq software in the context of analyzing cancer gene panels and somatic mutations.
Cancer is a leading cause of death in developed countries. In this webcast Dr. Andreas Scherer will explain how personalized medicine can transform our approach to fighting this disease. He will also discuss current roadblocks and diagnostic challenges, and the pivotal role of Next Gen Sequencing to overcome these challenges.
The webcast will inform about best practices to design and implement a cancer testing pipeline: from sample preparation, to sequencing, to secondary and tertiary analysis of sequencing data. The goal is to rapidly identify clinically actionable data that allows an oncologist to quickly determine the best available treatment options.
The webcast will include demonstrations of the Golden Helix VarSeq software in the context of analyzing cancer gene panels and somatic mutations.
DOSIMETRY ANALYSIS OF 3D CRT AND IMRT TECHNIQUES ON SMALL AND LARGE BREAST C...AM Publications
The aim of the study was to compare dosimetric parameters of planning target volume (PTV) and organs at risk (lungs) between 3D-conformal radiation therapy (3D CRT) and intensity-modulated radiation therapy (IMRT) in breast cancer, also to find correlation between volume and these parameters. A total of 60 patients with left/right breast cancer received radiotherapy, 30 by 3D CRT and 30 by IMRT, with a dose of 50 Gy in 25 sessions. Plans were compared according to dose-volume histogram (DVH) analysis in terms of PTV homogeneity (HI) and conformity (CI) indices as well as lungs dose, also integral dose (ID). IMRT had the higher CI than 3D CRT, and the lower HI than 3D CRT. But IMRT had the higher ID than 3D CRT. So, IMRT had the better HI and CI than 3D CRT in breast cancer treatment. In other hand, there are negatif correlation between volume and CI in 3D CRT. But no signifficant correlation in IMRT. And there are no correlations between volume and HI in both techniques. Also there are signifficant positif correlation between volume and ID in both techniques.
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.
Cancer is one of the modern and major causes of mortality worldwide, the incidence and mortality rates vary according to geographical distribution.
It can be controlled by using awareness and screening programs to reduce mortality rates.
Effect of Time of Echo on 1H-magnetic Resonance Spectroscopy Imaging of Metab...submissionclinmedima
The aim of this study is to evaluate the effect of time of echo (TE) on magnetic resonance spectroscopy imaging (MRSI) of metabolites in maxillofacial carcinoma. 1.2. Methods: Twenty maxillofacial carcinoma patients and 10 healthy volunteers were recruited to undergo 1.5-Tesla high-resolution routine MRI and multi-voxel MRSI with a TE of 35 ms and 144 ms.
Breast cancer is a disease in which the cells of the breast grow out of control, creates an
abnormality in the breast tissue. It is the second leading cause of death in women worldwide. In
Saudi Arabia, Ministry of health reported that the number of new cases of cancer is 2741 including
about 19.9% of breast cancer in women due to unawareness , it usually occurs in women at the age
of 52. It accounts for about 22% of all new cancers in women. In developing countries there are
still large numbers of breast cancers diagnosed in later stages. So the death rate is also high. To
prevent people from this disease, it should be detected at an earlier stage which reduces death rate.
Digital mammogram is used for this purpose. The suspected symptoms causing breast cancer are
age, post menopause, stress, family history, physical inactivity, obesity, hormonal imbalances and
genetically mutated abnormalities. Our work focus on detecting stage of breast cancer using image
processing techniques and data mining technique is used to classify the stage of breast cancer and
the performance of classifier is evaluated through confusion matrix.
Medicinal Mushroom Preparations against Lung CancerNeven Jakopovic
In this cohort study, 13 patients with advanced small cell lung carcinoma and 52 with non-small cell lung carcinoma used medicinal mushroom extract (Dr Myko San company) from 2004 to 2007, and their status was assessed in 2009.
Using medicinal mushroom extracts with standard oncological therapy resulted in these significant dose-depended effects:
improved cancer survival and delayed mortality
decreases in tumor size
improved quality of life scores
when compared with standard therapy alone. Significant side effects or decreases in performance status, tolerance to therapy or outcome was not observed.
This work was presented by Dr. Ivan Jakopovic at the 5th International Medicinal Mushroom Conference in Nantong, China, in 2009.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
1. ESMO SUMMIT LATIN AMERICA 2023
Buenos Aires, 28-29 April 2023
Teresa Amaral, MD, PhD
Head of Interdisciplinary Skin Cancer Center, University Medical Center Tuebingen
Head of Translational Research, University Medical Center Tuebingen
Chair of the ESMO Leadership Development Committee, Member of the ESMO Faculty Melanoma and Other Skin Tumors
CURRENT MANAGEMENT OF LOCALLY
ADVANCED MELANOMA
2. Content of this presentation is copyright and responsibility of the author. Permission is required for re-use.
DECLARATION OF INTERESTS
Teresa Amaral
Teresa Amaral
Last DOI update: January 20, 2022
Financial Interests
,
BMS Invited Speaker, Personal
,
CeCaVa Writing Engagement, Personal
,
Novartis Invited Speaker, Personal
,
Pierre Fabre Invited Speaker, Personal
,
iFIT Research Grant, Institutional, Financial interest
,
Neracare Funding, Institutional, Financial interest
,
Novartis Funding, Institutional, Financial interest
,
Novartis Research Grant, Institutional, Financial interest
,
Sanofi Funding, Institutional, Financial interest
,
Skyline-Dx Funding, Institutional, Financial interest
Non-Financial Interests
,
ASCO Member
,
Portuguese Society for Medical Oncology Member
,
Portuguese Society of Medical Oncology - Young Oncologists Group Member
Other
,
INFARMED Other, Clinical expert
3. Content of this presentation is copyright and responsibility of the author. Permission is required for re-use.
SUMMARY
Teresa Amaral
ü Locally advanced operable
Ø Adjuvant therapies
Ø Neoadjuvant therapies
4. Content of this presentation is copyright and responsibility of the author. Permission is required for re-use.
The golden circle
5. Content of this presentation is copyright and responsibility of the author. Permission is required for re-use.
WHY?
6. Content of this presentation is copyright and responsibility of the author. Permission is required for re-use.
In Denmark, their proportion until 2012e2016, grew
to 1201 new cases in women and 1034 cases in men, cor-
Simultaneously, the CM burden due to demographic
changes decreased in both countries.
In Denmark, less than 5% (4.3% in men, and 3.9% in
women) of CM diagnosed in 2012e2016 were attribut-
able to changes in the demographic age distribution,
higher was their proportion in the Saarland (8.7% in
men, and 11.1% in women).
Sensitivity analysis (Tables S3a/b, S4a/b, S5a/b),
assuming a baseline PAF for UVR of around 10% and
30%, respectively, changed the estimates only marginally.
4. Discussion
In the present study, the UVR-related CM burden was
estimated to be approximately 95% for both pop-
ulations. A similar study, published by Armstrong et al.,
in 1993, estimated the proportion of CM due to UVR
exposure in Queensland, Australia to be 97% in men and
96% in women [6].
Proportions of over 95% were also estimated for the
United States (95.1%) and Canada (98.8%) [7,8]. Lower
PAFs, but still high (over 80%), were reported for
Western Europe. Estimates of 86% and 91.2% for Ger-
many and Denmark, respectively, were published by a
study investigating the global burden of CM attribut-
able to UVR for 2012 [10,11,21].
For the UK, Parkin et al. calculated a PAF of 90%
for men and 82% for women in 2010 [10]. For France,
the overall PAF was calculated to be 83% in 2015 [9].
PAFs estimated in our study are comparable to those
computed for North America and Australia. Results
from this study also underline the predominant role of
UVR exposure in the burden of CM.
In contrast, current and future changes in the age
structure of the population have only a marginal impact
on the number of CM cases.
The population attributable fraction (PAF) provides
Fig. 2. a: Number of melanoma cases attributable to UVR
exposure and demographics in the federal state Saarland/Germany
(1943/1946e2032/2036), Males. b: Number of melanoma cases
attributable to UVR exposure and demographics in the federal
state Saarland/Germany (1943/1946e2032/2036), Females.
Abbreviation: CM: cutaneous melanoma; PAF: population
attributable fraction.
Fig. 1. a: Number of melanoma cases attributable to UVR
exposure and demographics in Denmark (1943/1946e2032/2036),
Males. b: Number of melanoma cases attributable to UVR
exposure and demographics in Denmark (1943/1946e2032/2036),
Females. Abbreviation: CM: cutaneous melanoma; PAF: popu-
lation attributable fraction.
7. Content of this presentation is copyright and responsibility of the author. Permission is required for re-use.
Prognosis of Patients With Primary
Melanoma Stage I and II According to American
Joint Committee on Cancer Version 8 Validated in
Two Independent Cohorts: Implications for
Adjuvant Treatment
Claus Garbe, MD1
; Ulrike Keim, PhD1
; Teresa Amaral, MD, PhD1
; Carola Berking, MD2
; Thomas K. Eigentler, MD3
; Lukas Flatz, MD1
;
Anja Gesierich, MD4
; Ulrike Leiter, MD1
; Rudolf Stadler, MD5
; Cord Sunderkötter, MD6
; Thomas Tüting, MD7
; Jochen Utikal, MD8,9
;
Uwe Wollina, MD10
; Lisa Zimmer, MD11,12
; Christos C. Zouboulis, MD, PhD13
; Paolo A. Ascierto, MD14
; Alexander M.M. Eggermont, MD, PhD15,16,17
;
Jean-Jacques Grob, MD18
; Axel Hauschild, MD19
; Lidija Kandolf Sekulovic, MD, PhD20
; Georgina V. Long, MD, PhD21,22
; Jason J. Luke, MD23
;
Olivier Michielin, MD24
; Ketty Peris, MD25,26
; Dirk Schadendorf, MD11,12
; John M. Kirkwood, MD27
; and Paul C. Lorigan, MD28
; on behalf of the
Central Malignant Melanoma Registry (CMMR)
HOW?
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adjuvant therapy for stage IIB and IIC melanoma, and in the
first adjuvant trial of pembrolizumab versus placebo re-
cently reported, the HR for recurrence was 0.65 after
12 months and 0.61 after 18 months of follow-up, and this
agent received US Food and Drug Administration (FDA)
Tübingen with more than 6,000 patients; subsequently, a
confirmatory data set with more than 10,000 patients
originating from 11 selected German university hospitals
that had documented follow-up for more than 90% of
patients. For these two cohorts, not only MSS but also
CONTEXT
Key Objective
To reassess whether the prognosis of patients with stage I and II melanoma, particularly IB and IIA, are really as favorable as
reported in the American Joint Committee on Cancer classification version 8 (AJCCv8)?
Knowledge Generated
In two independent cohorts of patients with stage I and II disease in the German Central Malignant Melanoma Registry, we
found significantly less favorable survival probabilities than those published in the AJCCv8 classification. Melanoma-
specific 10-year survival rates were 89.7%-90.9% in stage IB, instead of 94% according to AJCCv8, and 80.7%-83.1% in
stage IIA, instead of 88% according to AJCCv8. Similar differences were found for the other substages.
Relevance
The difference shown here should be considered in clinical decision making such as the indication for adjuvant therapy and
in the design of clinical trials.
Garbe et al
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0.5
0.6
0.7
0.8
0.9
1.0
0 1 2 3 4 5 6 7 8 9 10
MSS
Time Since Diagnosis (years)
IA
IB
IIA
IIB
IIC
A
0.5
0.6
0.7
0.8
0.9
1.0
0 1 2 3 4 5 6 7 8 9 10
MSS
Time Since Diagnosis (years)
IA
IB
IIA
IIB
IIC
B
FIG 2. The MSS of patients with primary melanoma staged according to the AJCC classification version 8 was substantially lower in the CMMR in Germany
compared with the IMDDP published with the AJCC classification version 8. Patients with stage IB and above are sentinel lymph node biopsy staged.
Curves were generated using an interactive digitizing software program (DigitizeIt19
) on the basis of the originals. (A) Patients in the exploratory cohort of the
CMMR with first diagnosis in 2000-2015 (n 5 6,725). (B) Patients in the IMDDP diagnosed since 1998 (n 5 15,691). AJCC, American Joint Committee on
Cancer; CMMR, Central Malignant Melanoma Registry; IMDDP, International Melanoma Database and Discovery Platform; MSS, melanoma-specific
survival.
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Yi Que et al. J Immunother Cancer 2021;9:e002920
WHAT?
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STAGE III
BRAF wt and BRAFV600 mutated melanoma
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Table 4. Summary of stage subgroup eligibility criteria and RFS efficacy data for adjuvant trials
Stage—AJCC seventh edition (all patients NED)
Study Design IIC IIIA IIIB IIIC IV
EORTC 18071 [53] Ipilimumab 10 mg/kg versus placebo SN >1 mm
HR 0.98
HR 0.75 HR 1.00, 1–3 LNs
HR 0.48, !4 LNs
EORTC 1325 [57] Pembrolizumab versus placebo SN >1 mm
HR 0.38
HR 0.58 HR 0.58
CheckMate 238 [55, 56] Ipilimumab 10 mg/kg versus nivolumab HR 0.68 HR 0.68 HR 0.66 M1a, b
HR 0.78 M1c
BRIM8 [71] Vemurafenib versus placebo HR 0.0 NE SN >1 mm
HR 0.52
HR 0.63 HR 0.8
COMBI-AD [62] Dabrafenib/trametinib versus placebo SN >1 mm
HR 0.44
HR 0.50 HR 0.45
Note: All trials including stage IIIA patients requested a minimum SN diameter of 1 mm. All stage III patients included in these trials had radical LN
dissection.
AJCC, American Joint Committee on Cancer; EORTC, European Organisation for Research and Treatment of Cancer; HR, hazard ratio; LN, lymph node; NE,
not established; NED, no evidence of disease; RFS, recurrence-free survival; SN, sentinel node.
Annals of Oncology Special article
ESMO MCBS score A
ESMO MCBS score A
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(...) current evidence suggests that patients with BRAF-
mutated melanoma can derive an RFS benefit from either
adjuvant BRAF/MEK inhibition or adjuvant PD-1 blockade,
in the absence of a direct efficacy comparison (...)
individual treatment decisions should be made with the
patient, factoring in the toxicity profiles for the different
adjuvant treatment...
ESMO Consensus, locoregional: Michielin & al., Ann Oncol 2020
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19. Anti-PD-1 +/- anti-Lag 3
A Study to Assess Adjuvant Immunotherapy With Nivolumab Plus Relatlimab Versus Nivolumab Alone
After Complete Resection of Stage III-IV Melanoma (RELATIVITY-098)
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STAGE IIIA
ESMO Consensus, locoregional: Michielin & al., Ann Oncol 2020
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(...) a lymph node in which any metastatic tumor cells have been
identified, irrespective of how small the tumor deposit or whether it
has been identified on hematoxylin and eosin-stained or
immunostained sections, should be designated as a tumor-involved
lymph node.
CA Cancer J Clin. 2017 Nov; 67(6): 472–492.
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Recommendation 8.2. (...) insufficient evidence to support
the routine use of adjuvant therapy in AJCC8 stage IIIA
melanoma.
Level of evidence: I
Strength of recommendation: D
Level of consensus: 97% (29) yes, 3% (1) no (30 voters)
ESMO Consensus, locoregional: Michielin & al., Ann Oncol 2020
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Recommendation 8.3. (...) may be some subsets of stage IIIA
patients with a higher risk of relapse (e.g. tumour burden in
sentinel node >1 mm). In these patients, a balanced
discussion of risk reduction and long-term side-effects of
adjuvant therapy can be considered.
Level of evidence: II
Strength of recommendation: C
Level of consensus: 97% (29) yes, 3% (1) no (30 voters)
ESMO Consensus, locoregional: Michielin & al., Ann Oncol 2020
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NEOADJUVANT
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Neoadjuvant superior to adjuvant immunotherapy
Paolo A. Ascierto
Versluis, Long, and Blank, Nat Med 2020
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scans scans
scans
1:1 randomization
S1801 Study Schema
Resectable
stage IIIB-IV
clinically
assessable
melanoma
Adjuvant Arm
Neoadjuvant
Arm
Surgery
Surgery
18 cycles pembrolizumab
200 mg IV q3 wk
3 cycles
pembrolizumab
200 mg IV q3 wk
15 cycles
pembrolizumab 200
mg IV q3 wk
Primary endpoint: Event-free survival
Additional criteria: strata included AJCC 8th ed. stage and LDH, adjuvant radiation allowed, concomitant radiation &
pembrolizumab was not allowed, brain metastasis excluded, uveal melanoma excluded
Surgery type and extent was required to be pre-specified and carried out regardless of radiologic response to therapy
radiographic assessment
(scans)
scans
scans
Sapna P. Patel, MD
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S1801 primary endpoint: Event-free survival
Landmark 2-year EFS: 72% v. 49%
72%
49%
Sapna P. Patel, MD
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Overall survival
Sapna P. Patel, MD
30. Take home messages
Stage III
Ø BRAF/MEK vs anti-PD1 vs anti-PD1+anti-Lag3
Ø Stage IIIA – cautious recommendation
Neoadjuvant and peri-operative
Ø New kids on the block
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Thank you all very much for your attention
teresa.amaral@med.uni-tuebingen.de
@TeresaSAmaral