scholarly journals Role of Chemotherapy in Vulvar Cancers: Time to Rethink Standard of Care?

Cancers ◽  
2021 ◽  
Vol 13 (16) ◽  
pp. 4061
Author(s):  
Marco Mazzotta ◽  
Laura Pizzuti ◽  
Eriseld Krasniqi ◽  
Francesca Sofia Di Lisa ◽  
Federico Cappuzzo ◽  
...  
Keyword(s):  
Observational Studies ◽  
Vulvar Cancer ◽  
Anal Carcinoma ◽  
Standard Of Care ◽  
Research Field ◽  
Definitive Treatment ◽  
Individual Patient Level ◽  
Low Incidence ◽  
Platinum Derivative

The actual role of chemotherapy in vulvar cancer is undeniably a niche topic. The low incidence of the disease limits the feasibility of randomized trials. Decision making is thus oriented by clinical and pathological features, whose relevance is generally weighted against evidence from observational studies and clinical practice. The therapeutic management of vulvar cancer is increasingly codified and refined at an individual patient level. It is of note that the attitude towards evidence sharing and discussion within a multidisciplinary frame is progressively consolidating. Viable options included in the therapeutic armamentarium available for vulvar cancer patients are frequently an adaption from standards used for cervical or anal carcinoma. Chemotherapy is more frequently combined with radiotherapy as neo-/adjuvant or definitive treatment. Drugs commonly used are platinum derivative, 5-fluorouracil and mitomicin C, mostly in combination with radiotherapy for radiosensitization. Exclusive chemotherapy in the neo-/adjuvant setting comprises platinum-derivative, combined with bleomicin and methotrexate, 5-fluorouracil, ifosfamide or taxanes. In advanced disease, current regimens include cisplatin-based chemoradiation, with or without 5-fluorouracil, or doublets with platinum in combination with a taxane. Our work is also enriched by a concise excursus on the biologic pathways underlying vulvar cancer. Introductory hints are also provided on targeted agents, a rapidly evolving research field.

The Role of Radiation Therapy in Vulvar Cancer: Review of the Current Literature

2016 ◽  
Vol 103 (5) ◽  
pp. 422-429 ◽  
Author(s):  
Piera Sciacero ◽  
Domenico Cante ◽  
Cristina Piva ◽  
Valeria Casanova Borca ◽  
Edoardo Petrucci ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Vulvar Cancer ◽  
Intensity Modulated Radiotherapy ◽  
Long Term Outcomes ◽  
Cancer Review ◽  
Prospective Trials ◽  
Low Incidence ◽  
Tissue Sparing

The purpose of this article is to discuss the current role of radiation therapy in vulvar cancer and especially to review the recent literature relative to the use of intensity-modulated radiotherapy (IMRT) in disease management. Owing to the low incidence of vulvar cancer, at present there are no available results of cooperative prospective trials. As evidenced in dosimetric and preliminary retrospective clinical studies, the use of IMRT has resulted in superior normal tissue sparing and lower rates of acute and chronic toxicities compared to previous studies that used conventional approaches. Data on long-term outcomes in these patients remain limited.

scholarly journals Assessing social preferences in reimbursement negotiations for new Pharmaceuticals in Oncology: an experimental design to analyse willingness to pay and willingness to accept

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Dominik J. Wettstein ◽  
Stefan Boes
Keyword(s):  
Willingness To Pay ◽  
Real World ◽  
Cognitive Biases ◽  
Social Preferences ◽  
Standard Of Care ◽  
Added Value ◽  
Amazon Mechanical Turk ◽  
Patient Organisation ◽  
Patient Benefit

Abstract Background Price negotiations for specialty pharmaceuticals take place in a complex market setting. The determination of the added value of new treatments and the related societal willingness to pay are of increasing importance in policy reform debates. From a behavioural economics perspective, potential cognitive biases and other-regarding concerns affecting outcomes of reimbursement negotiations are of interest. An experimental setting to investigate social preferences in reimbursement negotiations for novel, oncology pharmaceuticals was used. Of interest were differences in social preferences caused by incremental changes of the patient outcome. Methods An online experiment was conducted in two separate runs (n = 202, n = 404) on the Amazon Mechanical Turk (MTurk) platform. Populations were split into two (run one) and four (run two) equally sized treatment groups for hypothetical reimbursement decisions. Participants were randomly assigned to the role of a public price regulator for pharmaceuticals (buyer) or a representative of a pharmaceutical company (seller). In run two, role groups were further split into two different price magnitude framings (“real world” vs unconverted “real payoff” prices). Decisions had real monetary effects on other participants (in the role of premium payers or investors) and via charitable donations to a patient organisation (patient benefit). Results 56 (run one) and 59 (run two) percent of participants stated strictly monotone preferences for incremental patient benefit. The mean incremental cost-effectiveness ratio (ICER) against standard of care (SoC) was higher than the initial ICER of the SoC against no care. Regulators stated lower reservation prices in the “real world” prices group compared to their colleagues in the unconverted payoff group. No price group showed any reluctance to trade. Overall, regulators rated the relevance of the patient for their decision higher and the relevance of their own role lower compared to sellers. Conclusions The price magnitude of current oncology treatments affects stated preferences for incremental survival, and assigned responsibilities lead to different opinions on the relevance of affected stakeholders. The design is useful to further assess effects of reimbursement negotiations on societal outcomes like affordability (cost) or availability (access) of new pharmaceuticals and test behavioural policy interventions.

scholarly journals Update on the role of pembrolizumab in patients with unresectable or metastatic colorectal cancer

2021 ◽  
Vol 14 ◽  
pp. 175628482110244
Author(s):  
Vanessa Wookey ◽  
Axel Grothey
Keyword(s):  
Colorectal Cancer ◽  
Immune Checkpoint ◽  
Checkpoint Inhibitors ◽  
Treatment Options ◽  
Standard Of Care ◽  
Cancer Type ◽  
Cancer Therapies ◽  
Multiple Cancer ◽  
Multiple Treatment

Colorectal cancer (CRC) is the third most common cancer type in both men and women in the USA. Most patients with CRC are diagnosed as local or regional disease. However, the survival rate for those diagnosed with metastatic disease remains disappointing, despite multiple treatment options. Cancer therapies for patients with unresectable or metastatic CRC are increasingly being driven by particular biomarkers. The development of various immune checkpoint inhibitors has revolutionized cancer therapy over the last decade by harnessing the immune system in the treatment of cancer, and the role of immunotherapy continues to expand and evolve. Pembrolizumab is an anti-programmed cell death protein 1 immune checkpoint inhibitor and has become an essential part of the standard of care in the treatment regimens for multiple cancer types. This paper reviews the increasing evidence supporting and defining the role of pembrolizumab in the treatment of patients with unresectable or metastatic CRC.

scholarly journals A Study on the Integration of Resilience and Smart City Concepts in Urban Systems

2021 ◽  
Vol 6 (2) ◽  
pp. 24
Author(s):  
Anastasia Tzioutziou ◽  
Yiannis Xenidis
Keyword(s):  
Smart City ◽  
Research Field ◽  
Urban Systems ◽  
City Management ◽  
Urban Resilience ◽  
Continuous Growth ◽  
Management And Development ◽  
The Many ◽  
Development And Management

The continuous growth of cities brings out various concerns for improved development and management of the multifaceted urban systems, including those of resilience and smartness. Despite the many significant efforts in the research field, both notions remain changeable, thus retaining the lack of commonly accepted conceptual and terminological frameworks. The paper’s research goals are to designate the current direct and indirect links in the conceptualizations and research trends of the resilience and smart city frameworks and to prove the potential of the conceptual convergence between them in the context of urban systems. The application of a semi-systematic literature review, including bibliometric evidence and followed by content analysis, has led to the observation that as the resilience discourse opens up to embrace other dimensions, including technology, the smart city research turns its interest to the perspective of urban protection. Therefore, both concepts share the goal for urban sustainability realized through specific capacities and processes and operationalized with the deployment of technology. The paper’s findings suggest that the conceptual and operational foundations of these two concepts could support the emergence of an integrated framework. Such a prospect acknowledges the instrumental role of the smart city approach in the pursuit of urban resilience and unfolds a new model for sustainable city management and development.

Role of CEUS in Vascular Pathology

2021 ◽  
Author(s):  
Vito Cantisani ◽  
Nicola Di Leo ◽  
Emanuele David ◽  
Dirk-André Clevert
Keyword(s):  
Research Field ◽  
Arterial System ◽  
Qualitative Assessment ◽  
Vascular Pathology ◽  
New Horizons ◽  
Contrast Enhanced ◽  
Inflammatory Infiltrates ◽  
Time Evaluation

AbstractIn recent years, the implementation of contrast-enhanced ultrasound (CEUS) in clinical practice has opened new horizons in the arterial pathologies research field, since this technique is able to supply new sets of data that can be crucial in patient management. The main applications of CEUS in the arterial system are the detection, characterization, and follow-up of carotid plaques and endoleaks after EVAR. Other situations in which CEUS was demonstrated to be a useful tool are large vessel vasculitis, dissections, and untreated aneurysms. In carotid atherosclerosis CEUS is not only able to acquire quantitative data about stenosis but also to perform a qualitative assessment of the plaque. The most important plaque features that CEUS is able to depict are ulceration, neovascularization, and the presence of inflammatory infiltrates. All of these factors contribute to plaque vulnerability. Thus, CEUS is crucial in order to allow better risk stratification and management of patients. In follow-up after EVAR, CEUS shows sensitivity and specificity values similar to CTA while ensuring several advantages, such as lower cost and the absence of ionizing radiation and nephrotoxic agents. Moreover, CEUS is able to offer real-time evaluation of endoleaks and thus is a useful tool in cases that are ambiguous on CTA. Most limitations are patient-related and are the same as in all other ultrasound techniques, such as high BMI and meteorism.

scholarly journals PRO: Carbapenems should be used for ALL infections caused by ceftriaxone-resistant Enterobacterales

2021 ◽  
Vol 3 (1) ◽  
Author(s):  
David L Paterson ◽  
Burcu Isler ◽  
Patrick N A Harris
Keyword(s):  
Antibiotic Resistance ◽  
Observational Studies ◽  
Randomized Trials ◽  
Antibiotic Resistance Genes ◽  
Definitive Treatment ◽  
In Vitro Activity ◽  
Genes Encoding ◽  
Amoxicillin Clavulanate ◽  
Trial Outcomes

Abstract Ceftriaxone resistance in the Enterobacterales is typically the result of production of ESBLs or AmpC β-lactamases. The genes encoding these enzymes are often co-located with other antibiotic resistance genes leading to resistance to aminoglycosides, quinolones and trimethoprim/sulfamethoxazole. Carbapenems are stable to ESBLs and AmpC giving them reliable in vitro activity against producers of these β-lactamases. In contrast, piperacillin/tazobactam and amoxicillin/clavulanate are compromised by co-production of OXA-1, which is not inhibited by tazobactam or clavulanate. These in vitro findings provide an explanation for the MERINO trial outcomes, where 3.7% (7/191) randomized to meropenem died compared with 12.3% (23/187) randomized to piperacillin/tazobactam as definitive treatment of bloodstream infection due to ceftriaxone-resistant organisms. No randomized trials have yet put cefepime and carbapenems head to head, but some observational studies have shown worse outcomes with cefepime. We argue that carbapenems are the antibiotics of choice for ceftriaxone-resistant Enterobacterales.

Curriculum in Cardiology To Adjust or Not to Adjust: The Role of Different Covariates in Cardiovascular Observational Studies

2021 ◽  
Author(s):  
Mahyar Etminan ◽  
James M. Brophy ◽  
Gary Collins ◽  
Maryam Nazemipour ◽  
Mohammad Ali Mansournia
Keyword(s):  
Observational Studies

Role of 18F-FDG PET-derived parameters for predicting complete response to chemoradiotherapy in squamous cell anal carcinoma

2020 ◽  
Vol 41 (10) ◽  
pp. 1089-1094 ◽  
Author(s):  
Luca Filippi ◽  
Antonella Fontana ◽  
Gian Paolo Spinelli ◽  
Lugi Rossi ◽  
Oreste Bagni
Keyword(s):  
Squamous Cell ◽  
Fdg Pet ◽  
Anal Carcinoma ◽  
Complete Response ◽  
18F Fdg

Effect of Undernutrition During the Perinatal Period on Caries Development in the Rat: II. Caries Susceptibility in Underfed Rats Supplemented with Protein or Caloric Additions During the Suckling Period

1973 ◽  
Vol 52 (4) ◽  
pp. 680-687 ◽  
Author(s):  
Lewis Menaker ◽  
Juan M. Navia
Keyword(s):  
Dental Caries ◽  
Perinatal Period ◽  
Protein Deficiency ◽  
Specific Role ◽  
Protein Supplement ◽  
Distilled Water ◽  
Suckling Period ◽  
Rat Pups ◽  
Low Incidence

The specific role of protein deficiency in altering dental caries incidence in rat pups was investigated. A 10% protein supplement given to undernourished rats during development allowed them to overcome weight deficiencies and reversed dental caries to the low incidence found in well-nourished control rats. Caries in undernourished rats supplemented with an isocaloric, proteinfree solution, was as high as that of undernourished rats intubated with distilled water.

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