Clinical Practice Patterns in Chemotherapeutic Treatment Regimens for Metastatic Colorectal Cancer

3577 Background: The rechallenge with EGFR inhibitors represents an emerging strategy for anti-EGFR pre-treated patients with RAS wild type colorectal cancer (CRC). Unfortunately definitive selection criteria for anti-EGFR rechallenge in this setting are lacking. Very recently RAS wild type status on circulating tumor DNA (ct-DNA) at the time of rechallenge along with already known clinical criteria emerged as a potential watershed for this strategy. In the present study we explored liquid biopsy-driven anti-EGFR rechallenge strategy in the clinical practice for patients with metastatic colorectal cancer. Methods: Ct-DNA from RAS and BRAF wild type metastatic CRC patients previously treated with an anti-EGFR containing therapy was analyzed for RAS/BRAF mutations with the aim to evaluate the rechallenge strategy with anti-EGFR. The ct-DNA was analyzed for RAS-BRAF mutations using pyro-sequencing (PyroMark Q24 MDx Workstation) and nucleotide sequencing (Genetic Analyzer ABI3130) assays. Real-time PCR (Idylla) and droplet digital PCR (QX200 System) were performed to confirm the RAS-BRAF mutation status. Several clinical variables including previous response to anti EGFR containing therapy, tumor sidedness and anti-EGFR free interval were evaluated in relation to outcome. Tumor response evaluation was performed according to RECIST 1.1. Differences between categorical variables were evaluated using the Fisher’s exact test. Survival probability over time was estimated by the Kaplan–Meier method. Significant differences in the probability of survival between the strata were evaluated by log-rank test. Results: Twenty patients were included in the study. All patients were tested for RAS-BRAF mutations in ct-DNA. Fourteen patients (70%) showed a RAS-BRAF WT molecular profile, six patients (30%) showed a KRAS mutation. All the patients with ct-DNA RAS-BRAF WT profile underwent rechallenge with anti-EGFR. In details 11 patients (78.6%) underwent irinotecan+ cetuximab treatment, whereas 3 patients (21.4%) underwent panitumumab monotherapy. As for the outcome results to the rechallenge strategy, the median OS was 7 months (95% CI 5.0 to 13.0), the median PFS was 3 months (95% CI 2.0 to 6.0), the ORR was 27.3% with a DCR of 54.5%. Among the clinical variables evaluated as putative predictive/prognostic factors, previous response to anti-EGFR treatment was related to a not statistically significant improved OS (12 months vs 5 months HR:0.19 p: 0.06) and to a statistically significant improved ORR (75% vs 0% p:0.03). Conclusions: The rechallenge strategy with anti-EGFR confirmed to be feasible in clinical practice. The clinical outcome resulted consistent with the literature data. In addition to the molecular selection through the analysis of ct-DNA for RAS, previous response to anti EGFR treatment is confirmed as a prospective selection criteria for this therapeutic option.

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A 2017 SURVEY OF THE CLINICAL PRACTICE PATTERNS IN THE MANAGEMENT OF RELAPSING GRAVES DISEASE

Endocrine Practice ◽

10.4158/ep-2018-0386 ◽

2019 ◽

Vol 25 (1) ◽

pp. 55-61 ◽

Cited By ~ 2

Author(s):

Shlomit Koren ◽

Miriam Shteinshnaider ◽

Karen Or ◽

Dror Cantrell ◽

Carlos A. Benbassat ◽

...

Keyword(s):

Clinical Practice ◽

Practice Patterns ◽

Graves Disease ◽

Clinical Practice Patterns

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Analysis of Clinical and Economic Implications of Esmo 2014 Clinical Practice Guidelines for Metastatic Colorectal Cancer Treatment

Value in Health ◽

10.1016/j.jval.2015.09.1111 ◽

2015 ◽

Vol 18 (7) ◽

pp. A446

Author(s):

J Suarez

Keyword(s):

Colorectal Cancer ◽

Clinical Practice ◽

Cancer Treatment ◽

Metastatic Colorectal Cancer ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Economic Implications ◽

Colorectal Cancer Treatment

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The evaluation of bulbar dysfunction in amyotrophic lateral sclerosis: survey of clinical practice patterns in the United States

Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration ◽

10.1080/21678421.2017.1313868 ◽

2017 ◽

Vol 18 (5-6) ◽

pp. 351-357 ◽

Cited By ~ 18

Author(s):

Emily K. Plowman ◽

Lauren C. Tabor ◽

James Wymer ◽

Gary Pattee

Keyword(s):

United States ◽

Amyotrophic Lateral Sclerosis ◽

Clinical Practice ◽

Practice Patterns ◽

The United States ◽

Clinical Practice Patterns ◽

Bulbar Dysfunction ◽

Lateral Sclerosis

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Clinical Practice Patterns of Hypertensive Disease in Pregnancy among Korean Obstetricians

JOURNAL OF THE KOREAN SOCIETY OF MATERNAL AND CHILD HEALTH ◽

10.21896/jksmch.2021.25.3.221 ◽

2021 ◽

Vol 25 (3) ◽

pp. 221-229

Author(s):

Tae Gyu Ahn ◽

Yeon Hee Kim ◽

Yun Sook Kim ◽

Jae Eun Shin ◽

Young-Lim Oh ◽

...

Keyword(s):

Blood Pressure ◽

Clinical Practice ◽

Practice Patterns ◽

Antihypertensive Drugs ◽

Antihypertensive Agents ◽

Delivery Method ◽

Hypertensive Disease ◽

Clinical Practice Patterns ◽

Elevated Liver Enzymes ◽

Prophylactic Aspirin

Purpose: The purpose of this study was to investigate the clinical practice patterns of Korean obstetricians and gynecologists the diagnosis and management of hypertensive disease in pregnant women. Methods: From April 2015 to October 2015, questionnaire was distributed via email to obstetricians who were members of the Society for Maternal and Fetal Medicine. The survey consisted of 37 questions in 6 categories. Responses to the questions on the management of hypertensive disorders of pregnancy, from diagnosis to treatment, were evaluated. Results: A total of 93 obstetricians and gynecologists responded to the survey. High blood pressure was allocated the highest priority as an index mainly used when deciding to hospitalize patients with hypertensive disease during pregnancy, followed by pregnancy symptoms, proteinuria, and blood test results. Calcium channel blocker (CCB) for oral administration and hydralazine for injection were preferred as antihypertensive drugs mainly used to control severe hypertension. Regarding the delivery method for hypertensive disease during pregnancy, in cases of preeclampsia, 63% of the respondents chose the delivery method according to the cervical status, and in cases of hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome and eclampsia, which increased in severity, 52% and 31% responded that the delivery method was determined according to the cervical status, respectively. In cases of mild preeclampsia, the 70% of respondents preferred 37–38 weeks of gestation for the delivery time. Regarding the use of aspirin in patient with hypertension during pregnancy, 52% of the respondents occasionally administered aspirin, and in patients with a history of hypertensive disease during pregnancy, only 43% were administered prophylactic aspirin. Conclusion: Domestic obstetricians regarded blood pressure as the most meaningful factor when treating women with hypertension during pregnancy and considered blood pressure control as important. The preferred antihypertensive agents were oral CCB and hydralazine injections, and the choice of delivery method was determined according to the condition of the cervix and severity of the disease. Even in women with high risk factors for preeclampsia, prophylactic aspirin was administered in as low as 50%, of patients, possibly may due to the absence of domestic guidelines for aspirin use during pregnancy. Korean guidelines for prophylactic aspirin administration during pregnancy is needed based on additional research on the efficacy of aspirin for domestic women in the future.

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Clinical practice patterns in indirect peroral cholangiopancreatoscopy: outcome of a European survey

Endoscopy International Open ◽

10.1055/a-1535-1458 ◽

2021 ◽

Vol 09 (11) ◽

pp. E1704-E1711

Author(s):

Pauline M.C. Stassen ◽

Pieter Jan F. de Jonge ◽

George J.M. Webster ◽

Mark Ellrichmann ◽

Arno J. Dormann ◽

...

Keyword(s):

Clinical Practice ◽

Bile Duct ◽

Online Survey ◽

Practice Patterns ◽

International Consensus ◽

Clinical Practice Patterns ◽

European Survey ◽

Standardized Protocol ◽

Pancreatic Duct Stones

Abstract Background and aims Indirect peroral cholangiopancreatoscopy (IPOC) is a relatively new diagnostic and therapeutic tool for biliopancreatic diseases. This international survey aimed to evaluate clinical practice patterns in IPOC among endoscopists in Europe. Methods An online survey was developed comprising 66 questions on the use of IPOC. Questions were grouped into four domains. The survey was sent to 369 endoscopists who perform IPOC. Results 86 respondents (23.3 %) from 21 different countries across Europe completed the survey. The main indications for cholangioscopy were determination of biliary strictures (85 [98.8 %]) and removal of common bile duct or intrahepatic duct stones (79 [91.9 %]), accounting for an estimated use of 40 % (interquartile range [IQR] 25–50) and 40 % (IQR 30–60), respectively, of all cases undergoing cholangioscopy. Pancreatoscopy was mainly used for removal of pancreatic duct stones (68/76 [89.5 %]), accounting for an estimated use of 76.5 % (IQR 50–95) of all cases undergoing pancreatoscopy. Only 13/85 respondents (15.3 %) had an institutional standardized protocol for targeted cholangioscopy-guided biopsy sampling. IPOC with lithotripsy was used as first-line treatment in selected patients with bile duct stones or pancreatic stones by 24/79 (30.4 %) and 53/68 (77.9 %) respondents, respectively. Conclusions This first European survey on the clinical practice of IPOC demonstrated wide variation in experience, indications, and techniques. These results emphasize the need for prospective studies and development of an international consensus guideline to standardize the practice and quality of IPOC.

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Biomarker testing and mutation prevalence in metastatic colorectal cancer patients in five European countries using a large oncology database

Future Oncology ◽

10.2217/fon-2020-0975 ◽

2021 ◽

Author(s):

George Kafatos ◽

Victoria Banks ◽

Peter Burdon ◽

David Neasham ◽

Caroline Anger ◽

...

Keyword(s):

Colorectal Cancer ◽

Clinical Practice ◽

Metastatic Colorectal Cancer ◽

Cancer Patients ◽

Braf Mutation ◽

European Countries ◽

High Prevalence ◽

Biomarker Testing ◽

Colorectal Cancer Patients ◽

Over Time

Background: The literature on biomarker testing for metastatic colorectal cancer (mCRC) in Europe is scarce. This study aimed to estimate the percentage of mCRC patients from five European countries tested for biomarkers over time. Materials & methods: An oncology database was retrospectively analyzed; evaluated biomarkers were RAS, BRAF and microsatellite instability (MSI). The patients were drug treated during 2018 and tested for relevant biomarkers in 2013–2018. Results: RAS testing was conducted in >90% of mCRC patients from 2014 onwards. BRAF testing increased from 31% of mCRC patients in 2013 to 67% in 2018. MSI testing increased from 10 to 41%. There was no notable trend over time for RAS and BRAF mutation or MSI-high prevalence. Conclusion: Biomarker testing among patients diagnosed with mCRC was increased over time. This study demonstrates the quick uptake of biomarker testing in clinical practice. These findings are significant as biomarker-based drugs are becoming more common.

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