scholarly journals Where did the Eco go in Systemic Practice?

2021 ◽  
Vol 4 (1) ◽  
pp. 1-12
Author(s):  
Hugh Palmer
Keyword(s):  
Systemic Therapy ◽  
Systemic Practice ◽  
The Impact

In this paper, I argue that, although the systemic therapy community adopted some of Gregory Bateson’s ideas, we neglected his ecological concerns, and his thinking about epistemology and ontology might have shaped our practice even more than the comparatively few concepts we took. With rising concerns about the impact of humans upon the environment in the era in which we live, described as the Anthropocene, along with the posthuman turn, perhaps now is the time for us to look both backwards and forwards to deepen our understanding of Bateson’s message; to acknowledge the continuing importance of his thinking and influence upon the posthumanities.

The impact of hypertension on response rates in patients with renal cell carcinoma.

2021 ◽  
Vol 39 (6_suppl) ◽  
pp. 287-287
Author(s):  
Diana Maslov ◽  
Karine Tawagi ◽  
Madhav KC ◽  
Richa Goel ◽  
Helen Yuan ◽  
...  
Keyword(s):  
Heart Failure ◽  
Clinical Trial ◽  
Autoimmune Disease ◽  
Real World ◽  
Targeted Therapies ◽  
Systemic Therapy ◽  
Uncontrolled Hypertension ◽  
History Of ◽  
The Impact ◽  
Metastatic Rcc

287 Background: There are many clinical trials that demonstrate the benefits of immunotherapies and targeted therapies in patients (pts) with advanced or metastatic RCC (mRCC). Most of these studies specifically exclude many real-world pts with comorbidities such as autoimmune disease, heart failure, and hypertension. Data on treatment efficacy and adverse events in patients with a history of uncontrolled hypertension is lacking, as there have been few studies analyzing more recently approved RCC drug regimens in real-world practice. Methods: We retrospectively collected data from pts with mRCC treated with immunotherapy and/or targeted therapies. Patient characteristics, performance status, treatment type, reason for treatment discontinuation, treatment response/progression per RECIST v1.1, survival, and presence of clinical trial exclusion criteria such as hypertension, heart failure, presence of autoimmune disease, renal or liver failure, and International Metastatic RCC Database Consortium (IMDC) Risk score were collected. Results: A total of 198 pts were included. The majority of patients received Tyrosine Kinase Inhibitors (TKIs) (42.42% pazopanib (n = 84), 21.71% sunitinib (n = 43), 13.64% cabozantinib (n = 27)), whereas 10.61% were on combination of axitinib + pembrolizumab (n = 21) and 11.62% received ipilimumab + nivolumab (n = 23), and. 71.72% of patients who qualified for systemic therapy had a history of uncontrolled hypertension, whereas 28.28 % of total patients had no history of uncontrolled hypertension. The median time on first-line treatment was 5.17 months. A history of hypertension did not significantly affect Overall Survival (OS), 15.90 months median OS for those with hypertension vs 27.80 median OS for those with no hypertension (p = 0.38). Median OS for all patients was 22.80 months. There was also no difference in response rate between those with a history of hypertension vs those with no history of uncontrolled hypertension (p = 0.65) or in Progression Free Survival (PFS) (p = 0.97) Data on how many patients developed exacerbations of hypertension on therapy will be available at time of presentation. Conclusions: Uncontrolled hypertension typically excludes patients from clinical trial enrollment. We found no difference in median OS in those with a history of hypertension compared to those with normal blood pressures. Further large-scale studies are needed to further determine outcomes in patients with hypertension on systemic therapy for mRCC.

The impact of the 21-gene recurrence score (Oncotype DX) on concordance of adjuvant therapy decision making as measured by the Liverpool Systemic Therapy Adjuvant Decision Tool

The Breast ◽  
2019 ◽  
Vol 44 ◽  
pp. 94-100 ◽  
Author(s):  
Anna Olsson-Brown ◽  
Pavlos Piskilidis ◽  
Julie O'Hagan ◽  
Nicky Thorp ◽  
Peter Robson ◽  
...  
Keyword(s):  
Decision Making ◽  
Adjuvant Therapy ◽  
Systemic Therapy ◽  
Recurrence Score ◽  
Oncotype Dx ◽  
Decision Tool ◽  
Therapy Decision ◽  
The Impact

New Era in the Management of Melanoma Brain Metastases

2018 ◽  
pp. 741-750 ◽  
Author(s):  
Hussein A. Tawbi ◽  
Celine Boutros ◽  
David Kok ◽  
Caroline Robert ◽  
Grant McArthur
Keyword(s):  
Brain Metastases ◽  
Systemic Therapy ◽  
Single Agent ◽  
Local Treatment ◽  
New Era ◽  
Therapeutic Modalities ◽  
Melanoma Brain Metastases ◽  
Extracranial Disease ◽  
Induce Response ◽  
The Impact

The remarkable advances in the systemic therapy of metastatic melanoma have now extended the 1-year overall survival rate from 25% to nearing 85%. Systemic treatment in the form of BRAF-targeted therapy and immunotherapy is slowly but surely proving its efficacy in the treatment of metatstatic brain metastases (MBM). Single-agent BRAF inhibitors provide an intracranial response rate of 25% to 40%, whereas the combination of BRAFi/MEKi leads to responses in up to 58%. However, the durability of responses induced by BRAFi/MEKi seems to be even shorter than in extracranial disease. On the other hand, single-agent ipilimumab provides comparable clinical benefit in MBMs as it does in extracranial metastases. Single-agent PD-1 anitbodies induce response rates of approximately 20%, and those responses appear durable. Similarly the combination of CTLA-4+ PD-1 antibodies induces durable responses at an impressive rate of 55% and is safe to administer. Although the local treatment approaches with radiation and surgery remain important and are critically needed in the management of MBM, systemic therapy offers a new dimension that can augment the impact of those therapies and come at a potentially lower cost of neurocognitive impairment. Considerations for combining those modalities are direly needed, in addition to considering novel systemic combinations that target mechanisms specific to MBM. In this report, we will discuss the underlying biology of melanoma brain metastases, the clinical outcomes from recent clinical trials of targeted and immunotherapy, and their impact on clinical practice in the context of existing local therapeutic modalities.

Impact of center case volume on cardiotoxicity during adjuvant trastuzumab in breast cancer.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 6625-6625 ◽  
Author(s):  
Nicolas J. Chin-Yee ◽  
Andrew Yan ◽  
George A. Tomlinson ◽  
Craig Earle ◽  
Maureen E. Trudeau ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cardiac Imaging ◽  
Systemic Therapy ◽  
Regional Variation ◽  
Cardiac Monitoring ◽  
Administrative Databases ◽  
Case Volume ◽  
Funding Program ◽  
Number Of Patients ◽  
The Impact

6625 Background: A recent study suggested that cardiotoxicity from trastuzumab (T) was associated with regional variation and insufficient cardiac monitoring (Ng et al.SABCS 2012). Few studies have examined the impact of centre or physician (MD) case volume (vol) on outcomes in systemic therapy. Methods: All breast cancer patients who were diagnosed in 2003-2009 in Ontario and treated with adjuvant T were identified through a provincial drug funding program, and linked to administrative databases to ascertain patient demographics, hospitalizations, cardiac risk factors, cardiac imaging, comorbidities, and treating centre and MD. For each year, we calculated case vol as the number of patients treated with adjuvant T by each MD and by each centre. Cardiotoxicity was defined as receiving less than 16 out of 18 doses of T because of heart failure (HF) admission, HF diagnosis by physician claims, or discontinuation after cardiac imaging. Insufficient cardiac monitoring was defined as per recent guideline and per Ng et al. Logistic regression and mixed models were constructed to examine factors associated with cardiotoxicity. Results: Our cohort consisted of 3,777 patients, 214 MDs and 68 centres. For patients, 16.5% were over age 65; 30.3%, 9.4%, and 1.2% had previous diagnoses of hypertension, diabetes, and HF, respectively; 16.9% had cardiotoxicity. Univariate analyses found that high centre vol, but not MD vol, was associated with lower cardiotoxicity. Cardiotoxicity rates by centre vol quintiles (Q) were 23.4% (Q1-3), 18.2% (Q4), and 15.2% (Q5). Multivariable analyses found that lower cardiotoxicity was associated with higher centre vol (OR=0.85 per Q, p=0.02) and diagnosis in recent years (2008-2009 vs. before 2008; OR=0.50, p<0.001), after adjusting for age, previous HF, comorbidities, regional variation, and cardiac monitoring. Accounting for clustering within centres, there remained a strong trend of lower cardiotoxicity with higher centre vol (OR=0.77 per Q, p=0.06) and recent diagnosis (OR=0.50, p<0.001). Conclusions: Our findings suggest a reduction in cardiotoxicity with experience and over time, and support the notion of centralization of systemic therapy in high vol centres to optimize outcomes.

scholarly journals Novel Prognostic Implications of PAQR3 Expression in Breast Cancer after Curative Resection and Systemic Therapy

2021 ◽  
Author(s):  
Shiyan Zeng ◽  
Sun Lei ◽  
Yun Xiao ◽  
Qian Wang ◽  
Purong Zhang
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Systemic Therapy ◽  
Curative Resection ◽  
Tumor Grade ◽  
Breast Cancer Patients ◽  
Internal Validation ◽  
Online Databases ◽  
Predictive Role ◽  
The Impact

Abstract Background: This study aimed to explore the impact of progestin and adipoQ receptor 3 (PAQR3) on the outcomes for breast cancer patients who received curative resection and systemic therapy.Methods: The online databases consisting of 2,352 breast cancer patients were used to explore the association between PAQR3 expression and clinicopathological features. Univariate and multivariate survival analysis were performed to identify the survival predictive role of PAQR3. The internal validation strategies were applied.Results: PAQR3 expression was inversely correlated with estrogen receptor (ER) expression (P<0.0001), progesterone receptor (PR) expression (P<0.0001) and tumor grade (P<0.0001). Higher PAQR3 expression independently predicted shorter overall survival (OS) (hazard ratio (HR)=1.20, 95% confidence interval (CI)=1.06-1.37, P=0.0055) and recurrence free survival (RFS) (HR=1.28, 95%CI=1.04-1.45, P=0.0170) in breast cancer patients. In ER+ breast cancer and PR+ breast cancer, PAQR3 was associated with shorter OS (ER+: HR=1.28, 95%CI=1.11-1.48, P=0.0006; PR+: HR=1.30, 95%CI=1.09-1.56, P=0.0037) and RFS (ER+: HR=1.46, 95%CI=1.19-1.77, P=0.0002; PR+: HR=1.48, 95%CI=1.16-1.89, P=0.0016), but no such prognostic values of PAQR3 expression were found in ER- breast cancer and PR- breast cancer.Conclusions: PAQR3 serves as an independent outcomes predictor for breast cancer.

scholarly journals 143P The impact of de-escalation of adjuvant systemic therapy on the outcome of women with early ER+/HER2+ breast cancer

2021 ◽  
Vol 32 ◽  
pp. S423
Author(s):  
V. Jerič Horvat ◽  
D. Manevski ◽  
M. Pohar Perme ◽  
B. Gazić ◽  
P. Drev ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Systemic Therapy ◽  
Adjuvant Systemic Therapy ◽  
Her2 Breast Cancer ◽  
The Impact

scholarly journals Pharmacotherapy: Its impact on morphofunctional characteristics of the epidermal barrier

2019 ◽  
Vol 95 (1) ◽  
pp. 59-76 ◽  
Author(s):  
D. D. Petrunin
Keyword(s):  
Literature Review ◽  
Systemic Therapy ◽  
Skin Disease ◽  
Barrier Properties ◽  
Physiological Characteristics ◽  
Human Epidermis ◽  
Disease Treatment ◽  
Epidermal Barrier ◽  
The Impact

Various pharmaceuticals used for topical and systemic therapy are capable of exerting significant impact on morphological and physiological characteristics of human epidermis, as well as its barrier properties. This may affect the course of dermatologic diseases and the efficacy of their treatment. In this literature review, the author analyzes the impact of various pharmaceutical classes on the morphofunctional characteristics of the epidermal barrier and formulates recommendations for skin disease treatment.

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