Cancer Clinical Trials_ USA Scenario and Study Designs.pdfProRelix Research
Clinical trials in oncology are vital for the advancement of cancer treatments and
care. The US is at the forefront of these clinical trials, with many different study
designs being used to assess the efficacy and safety of new treatments. This article
will explore the current state of oncology clinical trial services in the US, as well as
discuss different types of study designs that are commonly used. It will provide
insight into how these trials are conducted, what data is collected, and how this
information can be used to improve patient care.
The United States Food and Drug Administration (FDA) has released
several guidance documents over the years through the Oncology Center
of Excellence to support the development of oncologic treatments and
diagnoses. Furthermore, information on the clinical trials for the treatment
of different types of cancer or specific interventions can be found on the
National Cancer Institute (NCI) website and Clinical Trials. Currently,
ClinicalTrials.gov, a website maintained by the National Library of
Medicine (NLM) and the National Institutes of Health (NIH) contains
listings of publicly and privately sponsored trials and includes information
on 91,937 studies related to cancer indicating the high volume of
research being conducted in this field.According to the World Health Organization (WHO), cancer is the leading
cause of death worldwide, with a death rate of one in six in 2020 (1).
Aside from the high mortality rate and morbidity associated with cancer, it
also negatively impacts the quality of life and poses a significant financial
burden on patients and payers making it imperative to develop effective
treatments for the disease. According to Global Cancer Observatory
(GLOBACAN), the United States accounted for 13.3% of all estimated
new cases of cancer in 2020 (2). In 2020, the single leading type of
cancer in the United States was breast cancer (11.1%) followed by lung
cancer (10%), prostrate (9,2%), colorectum (6.8%), and melanoma of the
skin (4.2%). Despite the significant prevalence of cancer and numerous
clinical trials conducted for oncology treatments, data have shown an
almost 95% attrition rate for anticancer drugs from Phase I trials until
marketing authorization. Various factors such as inaccurate preclinical
models, lack of suitable biomarkers in clinical trials, and a disconnect
between industry, academia, and regulators are responsible for the high
attrition rate (3). Therefore, it is vital to develop suitable study designs
and protocols for candidate molecules such that they obtain regulatory
approval and can be marketed. In addition to these challenges, the
development of anti-cancer agents comes at a monumental cost of an
estimated $2.8 billion. Several factors such as the choice of relevant
endpoints, the choice of appropriate biomarkers that are guided by tumor
biology, and careful patient selection are expected to improve the overall
fate of oncologic agents in the clinical trial phase
Toward Integrated Clinical and Gene Expression Profiles for Breast Cancer Pro...CSCJournals
Breast cancer patients with the same diagnostic and clinical prognostic profile can have markedly different clinical outcome. This difference is possibly caused by the limitation of current breast cancer prognostic indices, which group molecularly distinct patients into similar clinical classes based mainly on morphological of disease. Traditional clinical based prognosis models were discovered contain some restriction to address the heterogeneity of breast cancer. The invention of microarray technology and its ability to simultaneously interrogate thousands genes has changed the paradigm of molecular classification of human cancers as well as it shifted clinical prognosis model to broader prospect. Numerous studies have revealed the potential value of gene expression signatures in examining the risk of disease recurrence. However, currently most of these studies attempted to implement genetic marker based prognostic models to replace the traditional clinical markers, yet neglecting the rich information contain in clinical information. Therefore, this research took an effort to integrate both clinical and microarray data in order to obtain accurate breast cancer prognosis, by taking into account that these data complements each other. This article presents a review of the development of breast cancer prognosis models, concentrating precisely on clinical and gene expression profiles. The literature is reviewed in an explicit machine learning framework, which include the elements of feature selection and classification techniques.
Cancer Clinical Trials_ USA Scenario and Study Designs.pdfProRelix Research
Clinical trials in oncology are vital for the advancement of cancer treatments and
care. The US is at the forefront of these clinical trials, with many different study
designs being used to assess the efficacy and safety of new treatments. This article
will explore the current state of oncology clinical trial services in the US, as well as
discuss different types of study designs that are commonly used. It will provide
insight into how these trials are conducted, what data is collected, and how this
information can be used to improve patient care.
The United States Food and Drug Administration (FDA) has released
several guidance documents over the years through the Oncology Center
of Excellence to support the development of oncologic treatments and
diagnoses. Furthermore, information on the clinical trials for the treatment
of different types of cancer or specific interventions can be found on the
National Cancer Institute (NCI) website and Clinical Trials. Currently,
ClinicalTrials.gov, a website maintained by the National Library of
Medicine (NLM) and the National Institutes of Health (NIH) contains
listings of publicly and privately sponsored trials and includes information
on 91,937 studies related to cancer indicating the high volume of
research being conducted in this field.According to the World Health Organization (WHO), cancer is the leading
cause of death worldwide, with a death rate of one in six in 2020 (1).
Aside from the high mortality rate and morbidity associated with cancer, it
also negatively impacts the quality of life and poses a significant financial
burden on patients and payers making it imperative to develop effective
treatments for the disease. According to Global Cancer Observatory
(GLOBACAN), the United States accounted for 13.3% of all estimated
new cases of cancer in 2020 (2). In 2020, the single leading type of
cancer in the United States was breast cancer (11.1%) followed by lung
cancer (10%), prostrate (9,2%), colorectum (6.8%), and melanoma of the
skin (4.2%). Despite the significant prevalence of cancer and numerous
clinical trials conducted for oncology treatments, data have shown an
almost 95% attrition rate for anticancer drugs from Phase I trials until
marketing authorization. Various factors such as inaccurate preclinical
models, lack of suitable biomarkers in clinical trials, and a disconnect
between industry, academia, and regulators are responsible for the high
attrition rate (3). Therefore, it is vital to develop suitable study designs
and protocols for candidate molecules such that they obtain regulatory
approval and can be marketed. In addition to these challenges, the
development of anti-cancer agents comes at a monumental cost of an
estimated $2.8 billion. Several factors such as the choice of relevant
endpoints, the choice of appropriate biomarkers that are guided by tumor
biology, and careful patient selection are expected to improve the overall
fate of oncologic agents in the clinical trial phase
Toward Integrated Clinical and Gene Expression Profiles for Breast Cancer Pro...CSCJournals
Breast cancer patients with the same diagnostic and clinical prognostic profile can have markedly different clinical outcome. This difference is possibly caused by the limitation of current breast cancer prognostic indices, which group molecularly distinct patients into similar clinical classes based mainly on morphological of disease. Traditional clinical based prognosis models were discovered contain some restriction to address the heterogeneity of breast cancer. The invention of microarray technology and its ability to simultaneously interrogate thousands genes has changed the paradigm of molecular classification of human cancers as well as it shifted clinical prognosis model to broader prospect. Numerous studies have revealed the potential value of gene expression signatures in examining the risk of disease recurrence. However, currently most of these studies attempted to implement genetic marker based prognostic models to replace the traditional clinical markers, yet neglecting the rich information contain in clinical information. Therefore, this research took an effort to integrate both clinical and microarray data in order to obtain accurate breast cancer prognosis, by taking into account that these data complements each other. This article presents a review of the development of breast cancer prognosis models, concentrating precisely on clinical and gene expression profiles. The literature is reviewed in an explicit machine learning framework, which include the elements of feature selection and classification techniques.
How general internists can participate in the continuum of care for patients with cancer. (Talk given at Internal Medicine Grand Rounds, St. Elizabeth Hospital, General Santos City, 10 Feb 2021.)
Decision makers in the healthcare field like doctors, patients and policy makers need access to clinical evidence to address issues that have bearing on the health of the population and the treatment prescribed and thereby on the financials implications of the healthcare industry.
Genetic Technologies (NASDAQ: GENE) is a diversified molecular diagnostics company embracing blockchain technologies across genomic testing platforms. GENE offers cancer predictive testing and assessment tools to help physicians proactively manage patient health. The Company’s lead product, BREVAGenplus®, is a clinically validated risk assessment test for non-hereditary breast cancer and is first in its class. For more information, please visit genetechinfo.com.
Skin Cancer Screening
IMPORTANT NOTE TO USERS OF WEBSITE & DOCUMENTS POSTED ON SLIDESHARE- Global Medical Cures™ does not offer any medical advice, diagnosis, treatment or recommendations. Only your healthcare provider/physician can offer you information and recommendations for you to decide about your healthcare choices.
www.globalmedicalcures.com
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.
I need a response for the 2 peers belowMany disorders, eskarinorchard1
I need a response for the 2 peers below:
Many disorders, especially malignancies, are asymptomatic in their early stages. Consequently, it is imperative that health care providers provide routine screenings so that diseases can be detected early on and prevention and treatment can be implemented if necessary. Screening is in no way a cure for diseases, but it provides a means to detect diseases before symptoms start. Screenings include Pap smear to detect cervical cancer, mammograms to detect breast cancer, colonoscopy to detect colorectal cancer, and low dose CT scan to detect lung cancer (Centers for Disease Control and Prevention (CDC), 2020).
Enacted in 1984, the U. S. Preventive Task Force (USPTF) is an independent group of experts from several specialties, such as pediatrics, primary care, behavioral health, and nursing, that strive to provide knowledge and advice on various interventions and preventive services for diseases based on evidence-based research (D’Andrea, Ahnen, Sussman, & Najafzadeh, 2019). The USPTF helps shape medicine by assisting health care professionals and patients to prevent and treat diseases. Patients and clinicians collectively decide what treatment is best for the patient based on the recommendation of “best practice” disseminated by the USPTF (D’ Andrea et al., 2019). The ultimate goal of USPFT is to promote and improve the health of Americans by enacting clinical preventive measures based on scientific research.
Colorectal Cancer Screening Recommendation
The USPFT has several recommendations in place regarding screening for colorectal cancer, which is a collective group of cancers that affects the large intestine (the colon) and/or the rectum. This type of cancer usually starts in the colon, preliminary as polyps in many cases, and then metastasize as cancerous cells to proximal areas of the gastrointestinal system or reproductive organs (American Cancer Society, 2020). According to the American Cancer Society, the recommendation for individuals of average risk of colorectal cancer is screening starting at age 45, with either a stool-based test that detects cancer cells in the stool or an imaging exam that visualizes the structures of the colon and rectum.
The American Cancer Society (2020) recommends that individuals who are in “good health and a life expectancy of at least 10 years” should continue to be screened for colorectal cancer until they are 75 years of age. For individuals 76 to 85 years of age, the choice to continue to be screened should be based on the preference of the patient, their life expectancy, overall health status, and outcome of prior screenings (American Cancer Society, 2020). Screening is not recommended for individuals over the age of 85 due to their decreased life expectancy with or without the disease (American Cancer Society, 2020).
The American Cancer Society (2020) reports that testing for colorectal is separated by stool-based testing or visualization of images. The ...
Pancreatic Adenocarcinoma with Isolated Venous Involvement: Is Neoadjuvant Tr...EditorSara
Neoadjuvant Treatment (NAT) is indicated in locally advanced tumors and improves the results of subsequent surgery. In borderline tumors, the place of this preoperative treatment is more controversial, probably because borderline tumors are a heterogeneous group. We focused on the tumors with venous involvement without any arterial involvement and studied the results of neoadjuvant treatment in this particular group.
Racial Differences in Accepting Pegfilgrastim Onpro Kit (On-Body Injector) Us...EditorSara
Neulasta Onpro kit eliminates need for additional clinic visit after chemotherapy. Given the racially diverse population in our institution, we investigated acceptance of Onpro kit among patients on chemotherapy.Single-institution, retrospective review conducted in patients with GI tumors who received Onpro kit within 1 hour of completion of systemic chemotherapy from Jan 2014 through Jan 2018...
APL:Retinoic Acid and Retinoid Pharmacology, a Breakthrough TodayEditorSara
Acute promyelocytic leukemia(APL),a specific characteristic of t(15;17) chromosomal translocation,molecular gene analyses are conclusive in vivo evidence that oncogenic pml/RARa fusion plays a crucial role in APL leukemogenesis [1-3]. Since the introduction of initial 13-cis retinoic acid(13-cis RA)[4],and currently all-trans RA(ATRA) [5] and tamibarotene [6],RA plus chemotherapy or RA plus As2O3 regimen is currently the standard of care [7]...
Hairy Cell Leukemia (HCL) is a rare subtype of B-cell chronic lymphoid leukemia which was first described by Bertha Bouroncle in 1958 [1]. The annual incidence of HCL is approximately 0.3 cases per 100,000 and the disease comprises 2-3% of all leukaemia?s in the Western world [2,3]...
How general internists can participate in the continuum of care for patients with cancer. (Talk given at Internal Medicine Grand Rounds, St. Elizabeth Hospital, General Santos City, 10 Feb 2021.)
Decision makers in the healthcare field like doctors, patients and policy makers need access to clinical evidence to address issues that have bearing on the health of the population and the treatment prescribed and thereby on the financials implications of the healthcare industry.
Genetic Technologies (NASDAQ: GENE) is a diversified molecular diagnostics company embracing blockchain technologies across genomic testing platforms. GENE offers cancer predictive testing and assessment tools to help physicians proactively manage patient health. The Company’s lead product, BREVAGenplus®, is a clinically validated risk assessment test for non-hereditary breast cancer and is first in its class. For more information, please visit genetechinfo.com.
Skin Cancer Screening
IMPORTANT NOTE TO USERS OF WEBSITE & DOCUMENTS POSTED ON SLIDESHARE- Global Medical Cures™ does not offer any medical advice, diagnosis, treatment or recommendations. Only your healthcare provider/physician can offer you information and recommendations for you to decide about your healthcare choices.
www.globalmedicalcures.com
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.
I need a response for the 2 peers belowMany disorders, eskarinorchard1
I need a response for the 2 peers below:
Many disorders, especially malignancies, are asymptomatic in their early stages. Consequently, it is imperative that health care providers provide routine screenings so that diseases can be detected early on and prevention and treatment can be implemented if necessary. Screening is in no way a cure for diseases, but it provides a means to detect diseases before symptoms start. Screenings include Pap smear to detect cervical cancer, mammograms to detect breast cancer, colonoscopy to detect colorectal cancer, and low dose CT scan to detect lung cancer (Centers for Disease Control and Prevention (CDC), 2020).
Enacted in 1984, the U. S. Preventive Task Force (USPTF) is an independent group of experts from several specialties, such as pediatrics, primary care, behavioral health, and nursing, that strive to provide knowledge and advice on various interventions and preventive services for diseases based on evidence-based research (D’Andrea, Ahnen, Sussman, & Najafzadeh, 2019). The USPTF helps shape medicine by assisting health care professionals and patients to prevent and treat diseases. Patients and clinicians collectively decide what treatment is best for the patient based on the recommendation of “best practice” disseminated by the USPTF (D’ Andrea et al., 2019). The ultimate goal of USPFT is to promote and improve the health of Americans by enacting clinical preventive measures based on scientific research.
Colorectal Cancer Screening Recommendation
The USPFT has several recommendations in place regarding screening for colorectal cancer, which is a collective group of cancers that affects the large intestine (the colon) and/or the rectum. This type of cancer usually starts in the colon, preliminary as polyps in many cases, and then metastasize as cancerous cells to proximal areas of the gastrointestinal system or reproductive organs (American Cancer Society, 2020). According to the American Cancer Society, the recommendation for individuals of average risk of colorectal cancer is screening starting at age 45, with either a stool-based test that detects cancer cells in the stool or an imaging exam that visualizes the structures of the colon and rectum.
The American Cancer Society (2020) recommends that individuals who are in “good health and a life expectancy of at least 10 years” should continue to be screened for colorectal cancer until they are 75 years of age. For individuals 76 to 85 years of age, the choice to continue to be screened should be based on the preference of the patient, their life expectancy, overall health status, and outcome of prior screenings (American Cancer Society, 2020). Screening is not recommended for individuals over the age of 85 due to their decreased life expectancy with or without the disease (American Cancer Society, 2020).
The American Cancer Society (2020) reports that testing for colorectal is separated by stool-based testing or visualization of images. The ...
Pancreatic Adenocarcinoma with Isolated Venous Involvement: Is Neoadjuvant Tr...EditorSara
Neoadjuvant Treatment (NAT) is indicated in locally advanced tumors and improves the results of subsequent surgery. In borderline tumors, the place of this preoperative treatment is more controversial, probably because borderline tumors are a heterogeneous group. We focused on the tumors with venous involvement without any arterial involvement and studied the results of neoadjuvant treatment in this particular group.
Racial Differences in Accepting Pegfilgrastim Onpro Kit (On-Body Injector) Us...EditorSara
Neulasta Onpro kit eliminates need for additional clinic visit after chemotherapy. Given the racially diverse population in our institution, we investigated acceptance of Onpro kit among patients on chemotherapy.Single-institution, retrospective review conducted in patients with GI tumors who received Onpro kit within 1 hour of completion of systemic chemotherapy from Jan 2014 through Jan 2018...
APL:Retinoic Acid and Retinoid Pharmacology, a Breakthrough TodayEditorSara
Acute promyelocytic leukemia(APL),a specific characteristic of t(15;17) chromosomal translocation,molecular gene analyses are conclusive in vivo evidence that oncogenic pml/RARa fusion plays a crucial role in APL leukemogenesis [1-3]. Since the introduction of initial 13-cis retinoic acid(13-cis RA)[4],and currently all-trans RA(ATRA) [5] and tamibarotene [6],RA plus chemotherapy or RA plus As2O3 regimen is currently the standard of care [7]...
Hairy Cell Leukemia (HCL) is a rare subtype of B-cell chronic lymphoid leukemia which was first described by Bertha Bouroncle in 1958 [1]. The annual incidence of HCL is approximately 0.3 cases per 100,000 and the disease comprises 2-3% of all leukaemia?s in the Western world [2,3]...
STAT-6 In Hodgkin Lymphoma Pathobiology and Treatment-Review of the LiteratureEditorSara
Classical Hodgkin Lymphoma (cHL), consists of rare neoplastic Hodgkin and Reed-Sternberg cells (HRS) residing in a prominent inflammatory background. HRS show deregulated activation of multiple signaling pathways and transcription factors. The activation of these pathways and factors is partly mediated through interactions of HRS with various other types of cells in the microenvironment, but also through genetic lesions...
Lipocalin 2 as a Potential Diagnostic and/or Prognostic Biomarker in Prostate...EditorSara
Lipocalin 2 (LCN2) is a 25 kDa secreted protein, initially purified from neutrophil granules, and mainly expressed in immune cells, hepatocytes, renal cells, prostate, cells of the respiratory tract and cardiomyocytes. LCN2 belongs to the family of lipocalins known for their ability to traffic small hydrophobic molecules such as lipids and retinoids...
As an Obstetrics & Gynaecology, member of National Breast Cancer Foundation and a woman I find it very important to raise awareness about the importance of early detection of Breast Cancer. Make a difference! Spread the word about mammograms and encourage communities, organisations, your friends and family memebrs to get involved! Your help matters...
Peripheral T-Cell Lymphomas: Progress in TreatmentEditorSara
Peripheral T-Cell Lymphomas (PTCL) arises from mature T-cells and they represent an extremely heterogeneous group. They are sub-classified into three major groups based on clinical presentation and localization, namely the nodal, extra nodal and leukemic PTCL. This review focuses on nodal PTCL which are the most frequently encountered entities...
Circulatingtumordna (Ctdna) in Prostate Cancer: Current Insights and New Pers...EditorSara
Prostate Cancer (PC) is the common tumor in men, which represents one of leading cause of cancer death throughout the world. Most patients were diagnosed too late for curative treatment. So, it is necessary to develop a minimal invasive method to identify novel biomarkers. Currently, plasma DNA has attracted increasing attention as a potential tumor marker..
The Role of Immunity in Chemotherapy-Resistant Patient with Pembrolizumab: A ...EditorSara
Approaches are limited for treating advanced Non-Small-Cell Lung Cancer (NSCLC) with multidrug resistance but without ALK and EGFR mutations. Pembrolizumab (KEYTRUDA) brings on unprecedented clinical benefit in various cancer types..
Deadenylase Expression in Small Cell Lung Cancer Related To Clinical Characte...EditorSara
Lung cancer is the second common malignancy and the most aggressive cancer worldwide with late diagnosis and poor prognosis. The search for biomarkers that promote early diagnosis and improve therapeutic strategies focuses to the understanding of the mechanisms underlying cancer development and progression. The deregulation of gene expression is one of the cancer hallmarks reflected to the stability..
Stereotactic Radiation Therapy of Lung Cancers and Subsequent Parenchymal Alt...EditorSara
Stereotactic body radiation therapy (SBRT) is one of the standard radical treatments in stage I nonsmall cell lung cancer (NSCLC) and an option for lung metastases. The pulmonary parenchymal CT alterations at 3, 6 and 12 months are the object of a prospective analysis in patients submitted to SBRT, to define factors affecting the different radiological alterations...
Higher Rates of Helicobacter Pylori Infection and Gastric Intestinal Metaplas...EditorSara
The rate of Helicobacter pylori (H. pylori) infection is higher in minority patients in the United States [1]. Gastric intestinal metaplasia (IM) is associated with H. pylori infection and carries an increased risk for gastric cancer over time, in particular for patients from regions of high gastric cancer incidence [2]. We aimed to compare the rates of Helicobacter pylori infection and gastric intestinal metaplasia...
Critical Role of PET-Scan in Unravelling the Dual Pathology- Review of Litera...EditorSara
Simultaneous presentation of two lymphatic haematological malignancies is extremely rare. Adequate and optimal diagnostic steps including various imaging techniques and histopathological biopsies are required unpin the exact diagnoses to be able to deliver the best management strategies...
Myelomastocytic leukemia is a very rare variant of myeloid leukemia, behaves clinically very aggressive and belongs to the group of so-called metachromatic leukemias. Metachromatic leu- kemias comprise leukemias with at least 10 to 20% tumor cells exhibiting metachromatic gran- ules: mast cell leukemia...
Analysis of Treatment Option for Synchronous Liver Metastases and Colon Recta...EditorSara
Colorectal or bowel cancer is one of the major cause of cancer worldwide. Research has shown that 15 to 20 % colorectal cancer patients are also diagnosed with synchronous liver metastases (LM) at presentation and about one third eventually develop liver lesions (Leporrier, Maurel, Chiche, Bara, Segol, and Launoy, 2006; Manfredi, Lepage, Hatem, Coatmeur, Faivre, and Bou-vier, 2006)...
An Adrenal Mass in a Patient with Lynch SyndromeEditorSara
Adrenocortical cancer (ACC) is a rare malignancy (estimated annual incidence 0.7 to 2.0 cases per million individuals worldwide) with a poor prognosis. In contrast, Lynch Syndrome (LS) is a much more commonly encountered hereditary syndrome that predisposes individuals to colon cancer and multiple other malignancies.
Linitis plastica is a diffuse form of gastric cancer and accounts for about 10% of all cases of gastric malignancy and its exact general population distribution is unknown. There are no characteristic or specific symptoms, the symptoms are similar to those of other forms of stomach cancer and can manifest as a feeling of fullness after eating, nausea and vomiting, epigastric pain, weight loss, and progressive dysphagia [1]. Plastic linitisis characterized by malignant glandular proliferation of cricoid cells in the fibrous stroma, which ultimately leads to thickening and rigidity of the stomach wall.
On February 21, 2020, at Codogno Hospital (in the Lodi?s Province, Lombardy, Italy), Italy?s Coronavirus ?patient one? was discovered. In the following week the cases within the Province of Lodi increased exponentially and it was interpreted as a disease cluster originating from the hospital.
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.
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stockrebeccabio
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TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
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
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
2. • PAP smear and HPV testing are noninvasive and reliable
screening tests.
• CC precursors are amenable to detection via cytology,
colposcopy, and tissue biopsy. Treatment of precursors
largely eliminate the risk of CC.
• Finally, a vaccine was developed (Gardasil) and was suc-
cessfully used.
CitiScreen Steps of Cancer Screening:
• Screening for risk factors (healthy individuals at risk),
e.g., BRCA gene for breast cancer.
• Screening for cancer precursors, e.g., cervical dysplasia
for cervical cancer, complex endometrial hyperplasia for
endometrial cancer.
• Screening for early stage cancers, e.g., tumor markers
like CA125 for ovarian cancer.
CitiScreen is designed to utilize the latest achievements in can-
cer prevention research and follow the general recommendations
of the ACS. However, most public policies are based on princi-
ples of cost-effectiveness, sometimes at the expense of allowing
some cancers to appear and spread. CitiScreen provides potential
patients with updated information and allows them to make their
choices of screening procedures, which may not be covered by
their insurance policies.
1. Scientific Basis for Cancer Screening
A 2003 review published by Nature addressed the scientific base
for early cancer screening [3]. The reviewers used accepted cate-
gories of evidence and consensus [4].
Categories of Evidence and Consensus
Category 1: The recommendation is based on high-level evidence
(e.g., randomized controlled trials) and there is uniform consensus.
Category 2A: The recommendation is based on lower-level evi-
dence and there is uniform consensus.
Category 2B: The recommendation is based on lower-level evi-
dence and there is nonuniform consensus (but no major disagree-
ment).
Category 3: The recommendation is based on any level of evi-
dence but reflects major disagreement.
For the overall population, shifting all cases to early detection
would have a significant impact on mortality. Tests that can detect
precursor lesions or in situ disease hold the possibility of eliminat-
ing the invasive disease. An example of this being done success-
fully is that of cervical cancer [3]. Research into cancer screening
and prevention can be divided into five steps [5].
Step 1: Step one studies that evaluated the expression of genes or
proteins. New proteomics technologies will allow discovery to be
performed directly in fluids (serum or urine), which will greatly
facilitate the process of early-detection biomarker research. The
study, which combined algorithms with computational optimiza-
tion and peaks from protein mass spectra that provided discrim-
ination between ovarian cancer cases and healthy controls, is an
example of step one research [6].
Step 2: The goals of step two studies are to develop clinical assays
that are reproducible within and between laboratories.
Step 3: Retrospective, longitudinal studies.
Step 1 and 2 studies focus on discriminating between established
cases and healthy controls [3]. Step 3 studies focus on biomarker
measurements before diagnosis. Step 3 studies provide informa-
tion on how marker levels change over time in disease cases and
in healthy individuals.
Step 4: Prospective screening studies. Step 3 studies can deter-
mine how long before clinical diagnosis a marker might be able
to detect disease. Prospective studies are necessary to determine
whether the marker is able to detect the disease while it is still
localized.
Step 5: Cancer control studies.
Steps 1-4 focus on developing tests that are feasible for wide-
spread use and evaluating their diagnostic performance. Even if a
test performs well, this does not necessarily imply that the test will
reduce the cancer mortality [3].
Step 6: Step 5 studies include randomized, controlled cancer
screening trials, case-control studies, computer modelling, and
population studies. The goal of evaluation is to document or refute
efficacy.
Because of the difficulties in assessing early-detection interven-
tions, the standard of evidence for efficacy of a screening test is
the randomized controlled trial (RCT). Only in the context of a
randomized trial can the mortality reduction due to screening be
directly estimated [3, 6].
Other than RCT, research methods also offer important informa-
tion. Non-randomized approaches (epidemiological case-control
studies) have been adapted for assessing the efficacy of cancer
screening tests [7, 8]. Both case-control and population studies
allow for the evaluation of screening tests [9]. Case-control stud-
ies compare the screening results of ‘cases’ (individuals who died
from the disease) with ‘controls’ (individuals from the same popu-
lation who did not die from the disease) [3, 8].
2. Summary of CitiScreen Project*
The American Cancer Society (ACS) publishes guidelines for ear-
ly cancer screening based on age, gender, family history, among
other factors [9]. Cancer screening is a complex process, which
includes physical diagnosis, family history, genetic and genomic
assessments, tumor markers, and imaging techniques, among oth-
ers. In most health systems, including in the United States, cancer
clinicsofoncology.com 2
Volume 3 Issue 4 -2020 Editorial
3. screening is performed by healthcare providers of various special-
ties: general and internal medicine practitioners, gynecologists,
family physicians, and others. Although cancer screening is a part
of the residency and fellowship training for many specialties, it is
not their primary goal. Most of these health care providers spend
the majority of their time treating hypertension, flu, diarrhea, etc.
On the other hand, specialists in oncology, whose primary goal is
the treatment of cancer, are usually occupied with treating patients
with already established diagnoses of various malignancies. The
screening and early detection of the majority of tumors is import-
ant because the success of therapy and survival is better in early
stages of cancer. The goal of this manuscript is to present an algo-
rithm for cancer screening that combines imaging, genetic, tumor
markers, and other technologies.
The goal of cancer screening is to detect cancer or its precursor le-
sions at an early stage when treatment is most effective, preferably
prior to the onset of symptoms. Cancer mortality has decreased
by 25% from 1990 to 2015 for the United States with greater de-
clines in the mortality for colorectal cancer (47% among men and
44% among women) and breast cancer.1 This may be attributed to
the introduction of screening programs for colorectal and breast
cancers.1 The most successful cancer screening programs are con-
centrated on the detection of the precursor lesions (e.g., cervical
intraepithelial neoplasia (CIN) in cervical cancer screening and
colonic polyps in colorectal cancer screening programs [10, 11].
3. Screening Patterns of Individual Cancers
3.1. Breast Cancer: Risk-prediction models have been created to
identify individuals who are at higher risk for breast cancer, (i.e.,
family history, personal history) as well as hormonal exposure
(i.e., age of menarche) and genetic markers (i.e., single nucleotide
polymorphisms) in an effort to improve risk-stratification [12].
The input of genetics and genomics became important after the
identification of the germline p53 mutation: the ability to identify
individuals with a germline mutation improves risk-stratification
and helps identify those who will benefit from frequent screening
and possibly preventive procedures [13]. Women at high risk of
breast cancer (carrier of a BRCA1 or BRCA2 mutation) should
undergo extensive screening and may also consider prophylactic
mastectomy to reduce their risk.
3.2. Ovarian Cancer: It is the most lethal of all cancers of the
female reproductive system. Recent evidence suggests that high-
grade serous ovarian cancer arises from malignant cells in the
fimbriated end of the fallopian tube [14]. Much of this lethality
is due to the difficulty in diagnosis because of vague symptoms
(abdominal fullness and bloating, low abdominal dull pain, and
fatigue). This often leads to a delayed detection, with 60% of cases
diagnosed at either stage III or IV. The median age for a patient at
the time of ovarian cancer diagnosis is 63. For low-risk women,
the strategies for ovarian cancer screening have included transvag-
inal (TV) ultrasonography and Doppler studies. Serum biomarkers
(CA-125 and others) have also been used to screen for ovarian
cancer. Other serum biomarkers such as human epididymis protein
(HE4) and human chorionic gonadotropin (HCG) have been tested
in combination with CA-125 to improve the screening program’s
performance. Currently, the most promising approach for ovarian
cancer screening is a strategy combining serum CA-125, with or
without other biomarkers, and TV ultrasound.
3.3. Lung Cancer: Lung cancer escapes early detection in women
because most gynecologists, as primary care providers for wom-
en, have no training and/or experience in detection of lung cancer.
Lung cancer is the most common cancer affecting both men and
women, accounting for an estimate 228,150 new cases in 2019
[17]. Lung cancer is the leading cause of death from cancer in men
and women, accounting for an estimated 142,670 deaths in 2019,
which is approximately 25% of all cancer deaths in the United
States [18]. Trends in lung cancer incidence and mortality vary by
gender. For men, mortality rates have declined by 45% since 1990.
For women, mortality rates have declined by only 19% since 2002.
The recent data indicates that 79% of lung cancers are diagnosed
as distant disease, for which a 5-year survival is very poor (30%
for regional disease, and 5% for distant disease) [17]. ACS recom-
mends annual screening for lung cancer with low-dose CT (LDCT)
in the high-risk group (past and/or current history of active or
passive smoking). The National Comprehensive Cancer Network
(NCCN) recommends annual lung cancer screening for adults who
do not have additional risk factors. The NCCN does not specify
a specific age for ending screenings, stating that they should be
continued until individuals are no longer candidates for defini-
tive treatments [9]. The NCCN recommends that adults who have
additional risk factors for lung cancer, such as a personal history
of other cancers or lung disease (chronic obstructive pulmonary
disease and diffuse pulmonary fibrosis), a family history of lung
cancer, radon exposure, or occupational exposure to carcinogens
that elevate their 5-year risk above 1.3%, should begin screening
at age 50. The Lung Screening Trial Research Team (LSTRT) re-
ported a reduced lung cancer mortality after the initiation of low
dose CT screening [19]. Molecular markers in blood, sputum, and
bronchial brushings have been studied but are currently unsuitable
for clinical applications [20]. Advances in multidetector Comput-
ed Tomography (CT) have made high-resolution volumetric imag-
ing possible in a single breath hold at acceptable levels of radia-
tion exposure [21]. Several observational studies have shown that
low-dose helical CT of the lung detects early-stage cancers more
effectively than chest radiography [20]. Scanners that are currently
used are technologically more advanced than those that were used
in the past. This difference may mean that screening with today’s
scanners will result in a further reduction in the rate of death from
clinicsofoncology.com 3
Volume 3 Issue 4 -2020 Editorial
4. lung cancer.
3.4 Colorectal Cancer (CRC) Screening: In 2019, the ACS es-
timated that 145,600 new cases of CRC will be diagnosed in men
and women, and 51,020 men and women will die from this dis-
ease [9]. CRC mortality has been declining for the past 2 decades
among adults aged 50 years and older, which is largely attributable
to the increase in screening and early detection. Among individu-
als aged ≥50 years, CRC incidence declined by 32% between 2000
and 2013 [22, 23]. The ACS recommends that: 1) average-risk
adults with a life expectancy of greater than 10 years continue
CRC screening until the age of 75; and 2) clinicians individualize
CRC screening decisions for individuals aged 76 through 85 years,
based on patient preferences, life expectancy, health status, and
prior screening history. The options for CRC screening are: fe-
cal immunochemical test (FIT) annually, high-sensitivity guaiac-
based fecal occult blood test (gFOBT) annually, multitarget stool
DNA test every 3 years, colonoscopy every 5 years, or flexible
sigmoidoscopy every 5 years [24]. The ACS updated its guidelines
for CRC screening in 2018. The ACS recommends that adults aged
45 years and older with an average risk of CRC undergo regu-
lar screening with either a high-sensitivity, stool-based test or a
structural (visual) examination. As part of the screening process,
all positive results from non-colonoscopy screening tests should
be followed with colonoscopy.
3.5. Recommendations for High-Risk Adults: The ACS recom-
mends more intensive surveillance for individuals at higher risk
for CRC [25-27]. Those at higher risk for CRC include individu-
als with: 1) a history of adenomatous polyps [28]; 2) a history of
resection of CRC; 3) a family history of either CRC or advanced
adenomas diagnosed in a first-degree relative [29]; 4) the presence
of hereditary syndromes (e.g., Lynch syndrome or familial ade-
nomatous polyposis); 5) a history of inflammatory bowel disease;
6) a history of abdominal or pelvic radiation [30]; and 7) patients
with cystic fibrosis [31]. Adenomatous polyposis account for 2%
of all colon cancers. We incorporated a myriad genetic program
into CitiScreen, including COLARIS, which detects mutations in
the APC and MYH genes. [They gauge] adenomatous polyposis
related colon cancer syndromes, including familial adenomatous
polyposis (FAP), attenuated FAP (AFAP) and MYH-associated
polyposis (MAP). COLARIS uses blood or oral rinse sample to
detect APC or MYH mutation.
3.6. Benefits of COLARIS AP Testing: The result of the CO-
LARIS AP test enable patients to develop an individualized medi-
cal management plan to:
• Personalize patient care to individuals with APC or MYH
gene mutation(s);
• Improve outcomes through early diagnosis of cancer;
• Counsel patients on the underlying cause of the cancer or
adenomas;
• Avoid unnecessary interventions involving family mem-
bers who do not test positive for the mutation(s);
• Differentiate between AFAP, MAP, and Lynch syndrome.
3.7. Endometrial Cancer (EC): EC is the most common type of
gynecologic cancer in the United States. In 2007, 61,380 new cases
of EC were diagnosed, and 10,920 deaths occurred [32]. In 2008,
theAmerican College of Obstetricians and Gynecologists (ACOG)
put together a special committee to develop recommendations on
the role of transvaginal sonography to evaluate the endometrium in
postmenopausal women [33]. An endometrial thickness of 4mm or
less has a greater than 99% negative predictive value for EC [33].
In women of reproductive age, in the absence of ovulation, the
endometrium is exposed to continuous estrogen, which can lead to
endometrial hyperplasia (EH) [34]. If identified in a timely fash-
ion, EH can be treated. Complex EH can progress to EC in up to
one-fourth of women [35, 36]. Complex EH with atypia can lead
to EC in up to one-half of women [37]. The leading risk factors for
EH and EC include age, nulliparity, diabetes, and obesity [38, 39].
Among women found to have endometrial polyps, the prevalence
of premalignant or malignant polyps was 5.42% in postmenopaus-
al women compared with 1.7% in reproductive-aged women. The
prevalence of endometrial neoplasia within polyps in women with
symptomatic bleeding was 4.15% compared with 2.16% for those
without bleeding. Among symptomatic postmenopausal women
with endometrial polyps, 4.47% had malignant polyps in com-
parison to 1.51% of asymptomatic postmenopausal women [40,
41]. In these cases, an office hysteroscopy can be utilized for EC
screening [41]. In 2000, we presented our preliminary results us-
ing menstrual blood content to screen for endometrial cancer in
menstruating younger women [42]. We concluded that menstrual
smears do have diagnostic potential for EC screening in a high-risk
population. Although endometrial histology remains the gold stan-
dard, cytology may also be helpful for screening purposes [43].
The sensitivity of the endometrial cytology for detecting hyper-
plasia/carcinoma was 57% and the specificity was 98%. Although
the accuracy of our approach has yet to be established, it may be
similar to the guaiac method for colorectal screening [44].
4. CitiScreen Tumor Markers (TM) Program
The topic of TM in cancer screening is confusing and controver-
sial. It is known that the presence of a number of malignancies
is associated with the appearance of TM in body fluids (blood,
urine, saliva, etc.). The main problem with TM is that they have
low specificity and may be abnormal in numerous conditions un-
related to cancer. Many of the TM appear late in the course of the
disease and are used to monitor progress in treatment. CitiScreen
incorporates TM into the screening protocols according to the rec-
ommendations of the National Cancer Institute (NCI).
clinicsofoncology.com 4
Volume 3 Issue 4 -2020 Editorial
5. Several of the TM applicable for cancer detection in women with ovarian cysts/tumors are reflected in table 1.
Cancer antigen (ovarian cancer)
Carcinoembryonic antigen
Inhibit (granulosa cell tumor)
Anti-Müllerian hormone (granulosa cell tumor)
Estradiol (granulosa cell tumor)
Testosterone (Sertoli-Leydig tumor)
Androstenedione (Sertoli-Leydig tumor)
Dihydroepiandrosterone (Sertoli-Leydig tumor)
Alfa-fetoprotein (yolk sac tumor, immature teratoma, mixed germ cell tumor)
HCG (choriocarcinoma, embryonal, polyembonal, mixed germ cell tumor)
Lactate dehydrogenase (dysgerminoma, yolk sac tumor, immature teratoma, mixed germ cell tumor
TM for cancer screening are presented in table 2.
Type of Malignancy What is Analyzed TM
Breast Cancer Blood
BRCA 1 CA 15-3
BRCA 2 CA 27-29
Ovarian Cancer Blood
CA 125
HEY
Brain Cancer Blood Glial fibrillary acidic protein (GFAP)
Leukemia Blood BCR-ABL fusion gene
Thyroid Cancer Blood
Thyroid transcription factor 1
Calcitonin
Thyroglobulin
Colorectal Cancer Blood
CEA
Tumor M2-PK
Small cell Lung Cancer Blood Neuronspecific enolase (NSE)
Neuroblastoma Urine
Catecholamines:
WMA 2 HVA
Colon Cancer, Lung Cancer, Urinary Tract Cancer Blood Carcinoembryonic antigen
Recently, a new multi-analyte blood test named CancerSEEK has
been introduced to the field of oncology screening [46]. For many
adult cancers, it takes 20 to 30 years for incipient neoplastic le-
sions to progress to a late-stage disease [46]. CancerSEEK uses
combined assays for genetic alterations and protein biomarkers. It
has the capacity to not only to identify early cancers, but also to
localize the organ of origin of these cancers [45]. On the basis of
this DNA analysis, the predicted maximum detection capability
of circulating tumor DNA (ctDNA) varied by tumor type, rang-
ing from 60% for liver cancer to 100% for ovarian cancer [45].
CancerSEEK’s algorithm includes a ctDNA mutation followed by
elevations of cancer antigen 125 (CA-125), carcinoembryonic an-
tigen (CEA), cancer antigen 19-9 (CA-19-9), prolactin (PRL), he-
patocyte growth factor (HGF), osteopontin (OPN), myeloperoxi-
dase (MPO), and tissue inhibitor of metalloproteinases 1 (TIMP-1)
[45, 46]. The advantage of the combination of protein and genetic
biomarkers is the increased sensitivity.
The major problem with TM is that they are products of tumor
metabolic pathways while the goal of screening is to detect can-
cer precursors. The new DETECT test represents a combination
of TM with diagnostic PET-CT imaging [47, 49]. The DETECT-A
blood test incorporates baseline and confirmation test components
that have the potential to detect cancer in many organs. Diagnostic
PET-CT is an FDA cleared test that is routinely used to detect tu-
mors. A large body of clinical evidence supports its high sensitiv-
ity for early-stage cancers [46, 47]. The most commonly elevated
protein biomarkers in participants with cancer were CA15-3 and
CEA, followed by CA19-9, CA125, and HGF. Elevated levels of
some proteins were sometimes found in patients with cancers not
usually associated with those markers, (e.g., CEA in a lung cancer
clinicsofoncology.com 5
Volume 3 Issue 4 -2020 Editorial
6. and CA19-9 in an ovarian cancer) [50].
The analysis of cfDNA has the advantage of identifying alterations
that are specific to the tumor [51]. The application of sequencing
has allowed ctDNA-based tumor genotyping, which are present
in a variety of cancers [50]. TEC-Seq program assessed the plas-
ma specimen in “healthy” individuals (not known to have cancer).
Samples were processed within two hours to ensure the collection
of cells and cellular debris [51]. TEC-Seq analyses have signifi-
cantly reduced the sequencing error rate to fewer than one false
positive per 3 million bases pairs. Given the different tumors that
could be detected, other diagnostic tests will be needed to comple-
ment any positive ctDNA mutations analysis to identify the source
of occult lesions [57, 58].
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Volume 3 Issue 4 -2020 Editorial