Patterns in KRAS testing and EGFRi therapy across lines of treatment for metastatic colorectal cancer in Canada: A retrospective analysis.

665 Background: Selection and sequencing of treatment regimens for individual metastatic colorectal cancer (mCRC) patients is governed by the goals of maintaining reasonable quality of life while extending survival. The timing of KRAS testing and its effect on EGFRi therapy is poorly described. The goals of this analysis wereto describe rates and timing of KRAS testing relative to EGFRi therapy for Canadian patients diagnosed with mCRC. Methods: A retrospective chart review conducted at 6 Canadian centres included patients diagnosed with mCRC from Jan 1, 2009 onwards, who commenced 1st-line systemic treatment for mCRC between Jan 1–Dec 31, 2009. Information on the proportion of patients who received 2nd, 3rd, or subsequent lines of systemic therapy for mCRC was determined and the rates and timing of KRAS testing was ascertained. Results: 200 patients commenced 1st-line therapy and the median age was 62 yr; 78% had mCRC at the time of diagnosis. The proportions of patients who started 2nd, 3rd, and 4th lines of systemic therapy were 70%, 30%, and 15%, respectively. 103 (52%) patients had KRAS testing; 6%, 18%, 57%, 16%, 2%, and 1% of patients were tested at diagnosis or before the 2nd, 3rd, 4th, 5th and 6th lines of therapy, respectively. Median time from testing to EGFRi treatment was 105 (range, 7–1192) days, and varied by site. The frequency of KRAS testing for patients ranged from 30%–70% across study sites; across provinces, the frequency of testing ranged from 46%–60%. 38/68 (56%) of patients with wt KRAS tumors received EGFRi; 31 (46%) patients received EGFRi therapy as next therapy following KRAS testing. 19 (28%) died and 4 were lost to follow-up within 120 days of KRAS testing with no other therapy. 2 additional patients with unknown KRAS status received EGFRi (1 without KRAS testing; 1 undetermined). Conclusions: KRAS testing occurred after starting 2nd line in 76% of cases and varied by site and province. About half of patients underwent KRAS testing and 56% of those patients with wt KRAS tumors received an EGFRi. The short time interval between (K)RAS testing and EGFRi therapy may point to the need for earlier testing if EGFRi therapy is to be used in earlier lines of therapy.

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A retrospective observational study to estimate the attrition of patients across lines of systemic treatment for metastatic colorectal cancer in Canada

Current Oncology ◽

10.3747/co.26.4861 ◽

2019 ◽

Vol 26 (6) ◽

Cited By ~ 1

Author(s):

H. Kennecke ◽

S. Berry ◽

J. Maroun ◽

P. Kavan ◽

N. Aucoin ◽

...

Keyword(s):

Colorectal Cancer ◽

Metastatic Colorectal Cancer ◽

Systemic Therapy ◽

Systemic Treatment ◽

Growth Factor Receptor ◽

Retrospective Chart Review ◽

First Line ◽

Treatment Regimens ◽

First Line Therapy ◽

Epidermal Growth

Background Selection and sequencing of treatment regimens for individual patients with metastatic colorectal cancer (mcrc) is driven by maintaining reasonable quality of life and extending survival, as well as by access to and cost of therapies. The objectives of the present study were to describe, for patients with mcrc, attrition across lines of systemic therapy, patterns of therapy and their timing, and KRAS status.Methods A retrospective chart review at 6 Canadian academic centres included sequential patients who were diagnosed with mcrc from 1 January 2009 onward and who initiated first-line systemic treatment for mcrc between 1 January and 31 December 2009. Death was included as a competing risk in the analysis.Results The analysis included 200 patients who started first-line therapy. The proportions of patients who started second-, third-, and fourth-line systemic therapy were 70%, 30%, and 15% respectively. Chemotherapy plus bevacizumab was the most common first-line combination (66%). The most common first-line regimen was folfiri plus bevacizumab. KRAS testing was performed in 103 patients (52%), and 38 of 68 patients (56%, 19% overall) with confirmed KRAS wild-type tumours received an epidermal growth factor receptor inhibitor (egfri), which was more common in later lines. Most KRAS testing occurred after initiation of second-line therapy.Conclusions In the modern treatment era, a high proportion of patients receive at least two lines of therapy for mcrc, but only 19% receive egfri therapy. Earlier KRAS testing and therapy with an egfri might allow a greater proportion of patients to access all 5 active treatment agents.

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Effect of geographic distance from a cancer centre on choice of systemic therapy in metastatic colorectal cancer

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.15_suppl.e17559 ◽

2009 ◽

Vol 27 (15_suppl) ◽

pp. e17559-e17559

Author(s):

M. D. Seal ◽

G. R. Pond ◽

T. Wilkieson ◽

S. J. Hotte

Keyword(s):

Colorectal Cancer ◽

Metastatic Colorectal Cancer ◽

Travel Time ◽

Systemic Therapy ◽

Statistical Significance ◽

Geographic Distance ◽

Retrospective Chart Review ◽

Full Data ◽

Cancer Centre ◽

Treatment Regimens

e17559 Background: There is little data on whether geographic distance from patient residence to a treatment facility is a predictor of systemic therapy utilization or clinical trial (CT) enrollment. Therefore a retrospective chart review was undertaken to investigate this variable. Methods: Consecutive patients with metastatic colorectal cancer (mCRC) assessed by a medical oncologist at the Juravinski Cancer Centre (JCC), Ontario during 2006 were selected. Patients with pathology other than adenocarcinoma and those with complete surgical resection of metastases were excluded. Distance and time to JCC were calculated using online mapping software. The study received full ethics approval. Results: 276 patients were included with full data available on 169 patients. Median travel time and distance to JCC were 23.0 minutes (min) and 19.2 kilometers (km), respectively. The maximum travel time was 120 min and 87% of patients lived within 60 min of JCC. Distance and time were highly correlated (p<0.0001). Overall, 43% of patients had discussed a CT with their oncologist and 20% enrolled in a CT. Patients living >50 km from JCC were less likely to discuss a CT (38%) or participate in a CT (15%) than patients who lived 25–50 km (39% and 19%) or <25 km (47% and 23%) from JCC. These trends did not attain statistical significance (odds ratio [OR] = 0.88, 95% CI = 0.66–1.17, p = 0.39 for CT discussion, OR = 0.76, 95% CI = 0.54–1.08, p = 0.13 for CT enrollment). Distance was not a statistically significant (p = 0.42) predictor of number of treatment regimens, however, 44% of patients <25 km from JCC received 3 or more lines of treatment compared with 33% of patients ≥25 km away. No association with survival was observed. Conclusions: Patients with mCRC living ≥25 km from JCC received fewer systemic regimens and were less likely to discuss or enter a CT. These trends were not statistically significant. Data collection is ongoing to increase the power of this study. No significant financial relationships to disclose.

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Comparison of Treatment, Cost, and Survival in Patients With Metastatic Colorectal Cancer in Western Washington, United States, and British Columbia, Canada

JCO Oncology Practice ◽

10.1200/jop.19.00719 ◽

2020 ◽

Vol 16 (5) ◽

pp. e425-e432 ◽

Cited By ~ 1

Author(s):

Todd A. Yezefski ◽

Dan Le ◽

Leo Chen ◽

Caroline H. Speers ◽

Shasank Chennupati ◽

...

Keyword(s):

Colorectal Cancer ◽

British Columbia ◽

Overall Survival ◽

Metastatic Colorectal Cancer ◽

Systemic Therapy ◽

Survival Data ◽

De Novo ◽

Tumor Resection ◽

Care Utilization ◽

Western Washington

PURPOSE: Few studies have directly compared health care utilization, costs, and outcomes between patients treated in the US multipayer health system and Canada’s single-payer system. Using cancer registry and claims data, we assessed treatment types, costs, and survival for patients with metastatic colorectal cancer (mCRC) in Western Washington State (WW) and British Columbia (BC). MATERIALS AND METHODS: Patients age ≥ 18 years diagnosed with mCRC in 2010 and later were identified from the BC Cancer database and a regional database linking WW SEER to claims from Medicare and two large commercial insurers. Demographics, treatment characteristics, costs of systemic therapy, and survival data were obtained from these databases and compared between the two regions. RESULTS: A total of 1,592 patients from BC and 901 from WW were included in the study. Median age was similar (BC, 66 years; WW, 63 years), but patients in BC were more likely to be male (57.1% v 51.2%; P ≤ .01) and to have de novo metastatic disease (61.0% v 38.3%; P ≤ .01). The use of radiation therapy was similar between regions (BC, 31.2%; WW, 33.9%; P = .18), but primary tumor resection was more common in BC (74.1% v 66.3%; P ≤ .01) as was hepatic metastasectomy (12.4% v 2.3%; P ≤ .01). Similar percentages of patients received systemic therapy (BC, 68.8%; WW, 67.1%; P = .40), but costs were significantly higher for first-line systemic therapy in WW ($6,226 v $15,792 per patient per month; P ≤ .01). Median overall survival was similar (BC, 16.9 months; WW, 18 months). CONCLUSION: Cost of systemic therapy for mCRC was significantly higher for patients in WW than in BC, but this did not translate to a difference in overall survival.

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Relation between Verbal Estimation and Reproduction of a Short Time Interval: Preliminary Study

Perceptual and Motor Skills ◽

10.2466/pms.1963.17.1.45 ◽

1963 ◽

Vol 17 (1) ◽

pp. 45-46 ◽

Cited By ~ 4

Author(s):

P. D. Du Preez

Keyword(s):

Time Interval ◽

Short Time Interval ◽

Verbal Estimation ◽

Preliminary Study ◽

Short Time

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Systemic Therapy for Metastatic Colorectal Cancer

Journal of the National Comprehensive Cancer Network ◽

10.6004/jnccn.2013.0193 ◽

2013 ◽

Vol 11 (5S) ◽

pp. 649-652 ◽

Cited By ~ 6

Author(s):

Leonard Saltz

Keyword(s):

Colorectal Cancer ◽

Metastatic Colorectal Cancer ◽

Systemic Therapy

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Estimation of Time-Dependent Turning Fractions at Signalized Intersections

Transportation Research Record Journal of the Transportation Research Board ◽

10.3141/1644-15 ◽

1998 ◽

Vol 1644 (1) ◽

pp. 142-149 ◽

Cited By ~ 6

Author(s):

Gang-Len Chang ◽

Xianding Tao

Keyword(s):

Signalized Intersections ◽

Efficient Estimation ◽

Estimation Accuracy ◽

Time Interval ◽

Short Time Interval ◽

Simulation Experiments ◽

Proposed Model ◽

Short Time ◽

Estimation Of Time ◽

Additional Constraints

An effective method for estimating time-varying turning fractions at signalized intersections is described. With the inclusion of approximate intersection delay, the proposed model can account for the impacts of signal setting on the dynamic distribution of intersection flows. To improve the estimation accuracy, the use of preestimated turning fractions from a relatively longer time interval has been proposed to serve as additional constraints for the same estimation but over a short time interval. The results of extensive simulation experiments indicated that the proposed method can yield sufficiently accurate as well as efficient estimation of dynamic turning fractions for signalized intersections.

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Micro-Expression Recognition using 3D - CNN

10.54216/fpa.010101 ◽

2020 ◽

pp. 5-13

Author(s):

Vishal Dubey ◽

◽

Bhavya Takkar ◽

...

Keyword(s):

Emotional Response ◽

High Speed ◽

Actual State ◽

Time Interval ◽

Short Time Interval ◽

Expression Recognition ◽

Specific Emotion ◽

3D Cnn ◽

Short Time ◽

Micro Expression

Micro-expression comes under nonverbal communication, and for a matter of fact, it appears for minute fractions of a second. One cannot control micro-expression as it tells about our actual state emotionally, even if we try to hide or conceal our genuine emotions. As we know that micro-expressions are very rapid due to which it becomes challenging for any human being to detect it with bare eyes. This subtle-expression is spontaneous, and involuntary gives the emotional response. It happens when a person wants to conceal the specific emotion, but the brain is reacting appropriately to what that person is feeling then. Due to which the person displays their true feelings very briefly and later tries to make a false emotional response. Human emotions tend to last about 0.5 - 4.0 seconds, whereas micro-expression can last less than 1/2 of a second. On comparing micro-expression with regular facial expressions, it is found that for micro-expression, it is complicated to hide responses of a particular situation. Micro-expressions cannot be controlled because of the short time interval, but with a high-speed camera, we can capture one's expressions and replay them at a slow speed. Over the last ten years, researchers from all over the globe are researching automatic micro-expression recognition in the fields of computer science, security, psychology, and many more. The objective of this paper is to provide insight regarding micro-expression analysis using 3D CNN. A lot of datasets of micro-expression have been released in the last decade, we have performed this experiment on SMIC micro-expression dataset and compared the results after applying two different activation functions.

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Inter-rater and inter-device reliability of mechanical thresholds measurement with the Electronic von Frey Anaesthesiometer and the SMALGO in healthy cats

Journal of Feline Medicine and Surgery ◽

10.1177/1098612x18813426 ◽

2018 ◽

Vol 21 (10) ◽

pp. 979-984 ◽

Cited By ~ 2

Author(s):

Chiara Adami ◽

Elena Lardone ◽

Paolo Monticelli

Keyword(s):

Small Animal ◽

Time Interval ◽

Short Time Interval ◽

Sensory Thresholds ◽

Additional Tool ◽

Bland Altman Method ◽

Device Reliability ◽

Short Time ◽

Mechanical Thresholds ◽

Level Of Agreement

Objectives The aim of this study was to compare the Electronic von Frey Anaesthesiometer (EVF) and the Small Animal ALGOmeter (SMALGO), used to measure sensory thresholds in 13 healthy cats at both the stifle and the lumbosacral joint, in terms of inter-rater and inter-device reliability. Methods Two independent observers carried out the sets of measurements in a randomised order, with a 45 min interval between them, in each cat. The inter-rater and inter-device reliability were evaluated by calculating the inter-rater correlation coefficient (ICC) for each pair of measurements. The Bland–Altman method was used as an additional tool to assess the level of agreement between the two algometers. Results The mean ± SD sensory thresholds measured with the EVF were 311 ± 116 g and 378 ± 178 g for the stifle and for the lumbosacral junction, respectively, whereas those measured with the SMALGO were 391 ±172 g and 476 ± 172 g. The inter-rater reliability was fair (ICC >0.4) for each pair of measurements except those taken at the level of the stifle with the SMALGO, for which the level of agreement between observers A and B was poor (ICC = 0.01). The inter-device reliability was good (ICC = 0.73; P = 0.001). The repetition of the measurements affected reliability, as the thresholds obtained after the 45 min break were consistently lower than those measured during the first part of the trial ( P = 0.02). Conclusions and relevance The EVF and the SMALGO may be used interchangeably in cats, especially when the area to be tested is the lumbosacral joint. However, when the thresholds are measured at the stifle, the inter-observer reliability is better with the EVF than with the SMALGO. The reliability decreases when the measurements are repeated within a short time interval, suggesting a limited clinical applicability of quantitative sensory testing with both algometers in cats.

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Approximate exit probabilities for a Brownian bridge on a short time interval, and applications

Advances in Applied Probability ◽

10.2307/1427195 ◽

1989 ◽

Vol 21 (1) ◽

pp. 1-19 ◽

Cited By ~ 7

Author(s):

H. R. Lerche ◽

D. Siegmund

Keyword(s):

Virial Coefficient ◽

Large Deviation ◽

Brownian Bridge ◽

Exit Time ◽

Second Virial Coefficient ◽

Dimensional Euclidean Space ◽

Time Interval ◽

Short Time Interval ◽

First Exit Time ◽

Short Time

Let T be the first exit time of Brownian motion W(t) from a region ℛ in d-dimensional Euclidean space having a smooth boundary. Given points ξ0 and ξ1 in ℛ, ordinary and large-deviation approximations are given for Pr{T < ε |W(0) = ξ0, W(ε) = ξ 1} as ε → 0. Applications are given to hearing the shape of a drum and approximating the second virial coefficient.

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