Extensive-disease small-cell lung cancer (ED-SCLC) is characterized by rapid progression and relapse, despite high initial response rates to chemotherapy. The primary objective of this trial was to demonstrate the non-inferiority of amrubicin and cisplatin (AP) combination therapy compared with the standard first-line regimen of etoposide and cisplatin (EP) for previously untreated ED-SCLC in a Chinese population. When non-inferiority was verified, the objective was switched from non-inferiority to superiority.
From June 2008 to July 2010, 300 patients were enrolled and randomly assigned at a 1:1 ratio to AP and EP groups. AP-treated patients received cisplatin (60 mg/m(2), day 1) and amrubicin (40 mg/m(2), days 1-3) once every 21 days. EP-treated patients received cisplatin (80 mg/m(2), day 1) and etoposide (100 mg/m(2), days 1-3) once every 21 days. Treatment was continued for four to six cycles, except in cases of progressive disease or toxicity, and patient refusal.
Median overall survival (OS) for AP vs. EP treatment was 11.8 vs. 10.3 months (p = 0.08), respectively, demonstrating non-inferiority of AP to EP (AP group: 95 % confidence interval for hazard ratio 0.63-1.03 months). Median progression-free survival and overall response rates for AP vs. EP groups were 6.8 vs. 5.7 months (p = 0.35) and 69.8 % vs. 57.3 %, respectively. Drug-related adverse events in both groups were similar, with neutropenia being the most frequent (AP 54.4 %; EP 44.0 %). Leukopenia, pyrexia, and fatigue were more prevalent in the AP group, but all were clinically reversible and manageable.
AP therapy demonstrated non-inferiority to EP therapy, prolonging OS for 1.5 months, but this difference was not statistically significant; thus we propose AP as a promising treatment option for ED-SCLC in China.
This trial was registered on 10 April 2008 (ClinicalTrials.gov NCT00660504 ).

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On April 13, 2016 Cancer Research UK reported that rising levels of obesity among UK women have helped fuel a 54 per cent increase in womb cancer rates over the last two decades, according to Cancer Research UK’s latest statistics published today (Press release, Cancer Research UK, APR 12, 2016, View Source [SID:1234510752]).

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"Obesity is linked to 10 different types of cancer, including womb cancer, and is the single biggest preventable cause of the disease after smoking." – Dr Julie Sharp, Cancer Research UK
In the early 1990s, around 19 women in every 100,000 developed the disease. That figure has now climbed to 29 women in every 100,000 – with obesity being the most likely culprit.*

Around 9,000 women are diagnosed with womb (uterine) cancer every year in the UK, and around 2,000 women die from the disease. Twenty years ago, there were around 4,800 new cases of womb cancer each year with around 1,500 deaths.**

Professor Jonathan Ledermann, director of the Cancer Research UK and UCL Cancer Trials Centre, said: "It’s worrying that womb cancer cases are going up so sharply. We don’t know all the reasons why. But we do know that about a third of cases are linked to being overweight so it’s no surprise to see the increases in womb cancer cases echo rising obesity levels.

"The good news is that thanks to research and improved treatments survival has improved. In the 1970s, almost six in 10 women diagnosed with the disease survived for at least 10 years. Now almost eight in 10 women survive. But we need more research to understand the biology of the disease better and to know more about how it is caused so that we can improve the treatment of these women as well as preventing more cases."

The science behind how extra weight can cause cancer is not completely clear. But there is evidence that extra fat in the body can raise cancer risk by producing hormones and growth factors that encourage cells to divide.***

A lack of exercise and taking HRT (hormone replacement therapy) are also risk factors – but are linked to fewer cases of womb cancer than obesity****. A woman’s age and genetic make-up can also affect her risk.

Symptoms of womb cancer include abnormal vaginal bleeding – particularly in post-menopausal women – blood in your pee and abdominal pain. The disease is usually diagnosed early, and most women can be cured by surgery.

Kath Bebbington, aged 56 from Stoneclough, Greater Manchester, was diagnosed with womb cancer at the end of 2013 after going to the doctor because she was bleeding between periods. She had a hysterectomy in March 2014.

Kath kick-started her healthy lifestyle after she finished treatment – since then she’s lost three stone. She said: "My cancer diagnosis was a wake-up call for me. It was a shock because I don’t smoke, I don’t drink and I walk a lot. And we don’t know what caused the cancer but I had to admit to myself that I needed to make some life-style changes to lose some extra pounds I had been carrying and stack the odds in my favour for a healthy future.

"So I began eating more healthy food and exercising to feel better and to be a role model for my daughters. I also trained to take part in Race for Life events which I’ve done with my daughters by my side."

Dr Julie Sharp, head of health information at Cancer Research UK, said: "It’s concerning that more women are developing womb cancer, but it’s important that they are informed about ways to reduce their risk of the disease. Obesity is linked to 10 different types of cancer, including womb cancer, and is the single biggest preventable cause of the disease after smoking. While there are no guarantees against cancer, keeping a healthy weight can help you stack the odds in your favour and has lots of other benefits too."

Clostridium difficile infection (CDI) represents a significant economic healthcare burden, especially the cost of recurrent disease. Fidaxomicin produced significantly lower recurrence rates and higher sustained cure rates in clinical trials. We evaluated the cost-effectiveness and budget impact of fidaxomicin compared with vancomycin in Germany in the first-line treatment of patient subgroups with CDI at increased risk of recurrence.
A semi-Markov model was used to compare the cost-effectiveness and budget impact of fidaxomicin vs. vancomycin from a payer perspective in Germany. The model cycle length was 10 days. The time horizon was 1 year. Model inputs were probability of clinical cure, 30-day probability of recurrence, and 30-day attributable mortality based on evidence from two randomized controlled trials comparing fidaxomicin and vancomycin in patients with CDI. Cost-effectiveness outcomes were cost per quality-adjusted life year gained, cost per bed-day saved, and cost per recurrence avoided.
Despite higher drug acquisition costs, fidaxomicin was dominant in the cancer subgroup (less costly and more effective) and cost-effective in the other subgroups, with incremental cost-effectiveness ratios vs. vancomycin ranging from €26,900 to €44,500. Hospitalization costs of the first-line treatment of CDI with fidaxomicin vs. vancomycin were lower in every patient subgroup, resulting in budget impacts ranging from -€1325 (in patients ≥65 years) to -€2438 (in cancer patients). Reductions in the cost of treating recurrence with fidaxomicin ranged from -€574.32 per patient in those receiving concomitant antibiotics to -€1500.68 per patient in renally impaired patients.
In patient subgroups with CDI at increased recurrence risk, fidaxomicin was cost-effective vs. vancomycin, and less costly and more effective in patients with cancer.

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The availability of tyrosine kinase inhibitors has extended therapeutic options for chronic myeloid leukaemia (CML) patients. Monitoring recommendations and clinical response goals have recently been updated. The objective of this study was to describe the profile of CML patients in chronic phase currently receiving first-line therapy, including treatment, monitoring and response kinetics. A multicentre, cross-sectional, epidemiological survey in unselected chronic phase CML patients in France attending consultations during a one-month period was performed. 438 of 697 (62·8%) reported patients were currently receiving first-line treatment and were analysed. Imatinib was the most frequently received treatment (72·4% of patients). Retrospective cytogenetic and molecular assessments at 3, 6, 12 or 18 months were available in 88·4% of patients. At the 12-month assessment, 32·2% were not in major molecular response (MMR). At last assessment, among 355 patients with duration of treatment ≥ 12 months, 91·5% had achieved MMR and 66·5% were in deep molecular response. This study, performed in everyday practice population of CML patients, suggests that monitoring of molecular responses in real-life practice is aligned with European LeukaemiaNet recommendations. The majority of patients still receiving first-line treatment are in optimal response, with a few being classified as in the warning area or responding to failure.
© 2016 John Wiley & Sons Ltd.

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Evaluation of patient characteristics and mitotane use in the treatment of adrenocortical carcinoma (ACC) over a 4-year period in Belgium.
This was a multicentre retrospective review of the outcome of 34 patients treated with mitotane for ACC during the period [01/2008-12/2011] (12 diagnosed before and 22 diagnosed during the study period) and evaluated up to 06/2013.
Patient and tumour characteristics were consistent with those generally described for ACC. Mean age at diagnosis was 46.5 years, most patients were female (62%), had functioning ACC (65%) and advanced tumours (ENSAT stages III or IV: 82%). Therapeutic mitotane plasma levels (14-20 mg/L) were achieved at least once in 70% of the cohort, after a median of 4 months, and were maintained for more than 2 months in 61% of evaluable patients. Mitotane-related adverse effects were observed in 66% of patients, were never serious, and included gastrointestinal, neurological, neuropsychological, hormonal, dermatologic and metabolic effects. Most patients (88%) discontinued mitotane, mainly due to tumour progression. Multivariate analysis showed that ENSAT stage was a prognostic factor for overall (OS) and disease-free survival (DFS); OS was also influenced independently by achievement of therapeutic mitotane plasma levels for at least two consecutive months.
Patient and tumour characteristics were consistent with previously published data. OS and DFS were mostly influenced by ENSAT stage at diagnosis. Achieving therapeutic levels of mitotane for at least two consecutive months seemed to positively influence OS, but such levels were not reached or sustained in some patients.
Copyright © 2016 Elsevier Masson SAS. All rights reserved.

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