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Old 10-08-2007, 01:24 PM
Dross Dross is offline
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Default Tablet is better all round for cancer patients

A drug to treat colon cancer is proving much more convenient than traditional chemotherapy, has fewer side effects - and a study of almost 2,000 patients has shown it is giving them a better chance of surviving the disease.

Standard chemotherapy can be incredibly disruptive to people"s lives, said Prof Professor Chris Twelves of the University of Leeds, who led the research. Patients visit hospital five days a week for the injections and then have three weeks off before returning to hospital for the next course and the side effects can be unpleasant.

The oral chemotherapy drug Xeloda (capecitabine) offers fewer side-effects and less time in hospital and the trial has shown that patients given the drug were at least as likely to be alive and free of their disease as those on standard chemotherapy (the Mayo Clinic regimen).

The research showed that about 71 percent of patients given Xeloda were still alive after five years, compared to 68 percent of patients treated with standard chemotherapy injections.

Prof Twelves' study followed 1,987 patients who had undergone colon cancer surgery. It found that patients treated with Xeloda spent 85 percent less time with their doctor or at the hospital, and experienced fewer side effects. The new results, showing patients five-year survival rates, confirm the effectiveness of the treatment.

We now have long-term evidence now that clearly supports Xeloda's superiority over the Mayo Clinic regimen,¯ said Prof Twelves. There is now no reason why we should ask colon cancer patients to endure the burdens associated with that older treatment.¯

Last edited by gdpawel : 05-18-2012 at 07:16 PM. Reason: post full article
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Old 10-10-2007, 04:09 PM
gdpawel gdpawel is offline
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Default A Dose of Influence?

Would a clinical trial to show when drugs are selected with and without the presence of profit differential (which would include oral-dose drugs), clinical outcomes would be the same?

Dr. Neil Love's "Patterns of Care" reported a survey of breast cancer oncologists based in academic medical centers and community based, private practice medical oncologists. The former oncologists do not derive personal profit from the administration of infusion chemotherapy, the latter oncologists do derive personal profit from infusion chemotherapy, while deriving no profit from prescribing oral-dosed chemotherapy.

The results of the survey could not have been more clear-cut. For first line chemotherapy of metastatic breast cancer, 84-88% of the academic center-based oncologists (who are motivated to keep off-protocol patients out of their chemotherapy infusion rooms to reserve these rooms for on-protocol patients) prescribed oral-dose drug Xeloda (capecitabine), while only 13% prescribed infusion drugs, and none of them prescribed the expensive, highly remunerative drug Taxotere (docetaxel).

In contrast, among the commuity-based oncologists, only 18% prescribed the non-remunerative oral-dose drug Xeloda (capecitabine), while 75% prescribed remunerative infusion drugs, and about 40% prescribed the expensive, highly remunerative drug docetaxel.

ASCOs President says that we go by the literature, which has defined which are the best regimens. Well, how does he explain why the academics prescribe oral dose Xeloda to their metastatic breast cancer patients who aren't on their protocols, which keeps them from clogging up their chemo rooms and resources, which they want to use for the patients on their clinical trials, while the community oncologists almost universally prescribe infusion therapy, with the most popular drug being the still on patent Taxotere (docetaxel), which I do surmise has one of the best "spreads" between acquisition costs and average reimbursement.

The academic center-based oncologists are not without collective guilt. They are misguided in not recognizing that they continue to try and mate a notoriously heterogeneous disease into "one-size-fits-all" treatments. They predominately devote their clinical trial resources into trying to identify the best treatment for the "average" patient, in the face of evidence that this approach is non-productive. However, such unsuccessful experiments will never be viewed as such by the people whose careers are supported by these kinds of experiments.

What was interesting about the "Patterns of Care" study was that it is contemporary, after the Medicare reform. It shows that the Medicare reforms haven't solved the problem. It's not that all oncologists are bad people. It's just an impossible conflict of interest, it's the system which is rotten. The solution is to change the system. So far, Medicare reform hasn't achieved that.

[url]http://patternsofcare.com/2005/1/editor.htm (figure 37, volume 2, issue 1, 2005)

[url]http://www.nytimes.com/2006/03/08/health/08docs.html?ex=1152158400&en=55fd0d687b5771de&ei=5 070

[url]http://www.cancer.gov/cancertopics/pdq/treatment/breast/HealthProfessional/page8#Section297

[url]http://content.healthaffairs.org/cgi/content/abstract/25/2/437

Last edited by gdpawel : 05-18-2012 at 07:18 PM. Reason: correct url address
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  #3  
Old 05-18-2012, 07:17 PM
gdpawel gdpawel is offline
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Default Infused Chemotherapy Use in the Elderly After Patent Expiration

Infused Chemotherapy Use in the Elderly After Patent Expiration

Rena M. Conti, PhD, Meredith B. Rosenthal, PhD, Blase N. Polite, MD, Peter B. Bach, MD, MAPP and Ya-Chen Tina Shih, PhD

The University of Chicago, Chicago, IL; Harvard University School of Public Health, Boston, MA; and Memorial Sloan-Kettering Cancer Center, New York, NY

Corresponding author: Rena M. Conti, PhD, The University of Chicago, 5841 S. Maryland, MC 6086, Chicago, IL 60637; e-mail: [email]rconti@uchicago.edu

Abstract

Purpose:

The use of anticancer drugs (chemotherapies) is an important determinant of national spending trends. Recent policies have aimed to accelerate generic entry among chemotherapies to generate cost savings.

Methods:

We examined the effects of generic entry on the choice of chemotherapy for the treatment of metastatic colorectal cancer (MCRC) between 2006 and 2009 using autoregressive-moving average modeling with case control. A nationally representative sample of oncologists and patients with cancer (age ≥ 65 years) was employed to estimate the magnitude and significance of the impact of the generic entry of irinotecan in February 2008 on the number of administrations of irinotecan compared with oxaliplatin.

Results:

The generic entry of irinotecan resulted in a 17% to 19% decrease (P < .001) in use among elderly patients with MCRC compared with oxaliplatin. The results were robust to multiple sensitivity checks.

Conclusion:

This study provides novel and robust estimates of the decline in use of a chemotherapy to treat a common cancer in the elderly after patent expiration. The results suggest estimates from a previous Office of the Inspector General report of the potential savings derived from the generic entry of irinotecan for public payers are an overestimate, likely confounded by oncologists' response to financial incentives, changes in scientific evidence, and promotional activities. As calls for improving the quality and cost efficiency of oncology increase, future empirical work is needed to examine the responsiveness of oncologists' treatment decision making to incentives among patients of all ages and insurance types.

Am J Manag Care. 2012;18(5 Spec No. 2):e173-e178

[url]http://www.ajmc.com/articles/Infused-Chemotherapy-Use-in-the-Elderly-After-Patent-Expiration
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  #4  
Old 01-14-2013, 04:39 PM
gdpawel gdpawel is offline
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Default Drawbacks Of Oral Chemotherapy?

As cancer treatment in pill form transforms how care is delivered, a new Michigan State University study underscores the challenges patients face in administering their own chemotherapy outside the supervised environment of a cancer clinic.

Chemotherapy pills can target specific cancers better than some traditional intravenous drugs, said Sandra Spoelstra, the MSU assistant professor of nursing who led the study. But they also can be difficult for patients to take.

"Prescriptions for some oral pills have complex instructions," she said. "Some of them require patients to take pills several times a day or cycle their doses, taking one pill a day for three weeks, then stopping for a week before starting again. And some patients take two types of pills to treat their cancer or have multiple medications for other chronic conditions. It can be very complicated."

In addition, side effects such as severe nausea, vomiting, diarrhea, fatigue, skin reactions and pain are common. Those symptoms can lead some patients to skip doses, which may render their cancer treatment ineffective.

During the study, published in the journal Cancer Nursing, more than 40 percent of participating patients took too many pills or missed doses with poor adherence more likely among those with complex treatment regimens.

The researchers randomly assigned the patients to one of three groups. Members of the first group only had help from an automated calling system, developed at MSU, to see if they were following their prescriptions and help them monitor and manage symptoms. The second group got the automated calls and follow-up calls from nurses with strategies for sticking to their pill regimen. The rest got automated calls and nurse advice on both adhering to their regimen and managing symptoms.

Patients in all three groups reported less severe symptoms at the end of the study. The automated calls were just as effective alone as when they were coupled with nurse guidance. That suggests the automated system could be a simple and inexpensive way to help some patients take their drugs properly, Spoelstra said.

The small study will be the springboard for more comprehensive research that may yield clearer lessons for health care professionals, said University Distinguished Professor Barbara Given, who co-authored the study and leads the College of Nursing's efforts to improve oral chemotherapy.

In the meantime, she said nurses should be attentive when explaining oral chemo regimens to be sure patients and their families understand how to take the drugs as prescribed.

"It's cutting-edge treatment, but we don't know enough about it yet," she said. "People think if they had a life-threatening disease and their doctor recommended treatment, they'd follow the recommendations. But it's really not that simple."

Michigan State University. "The Drawbacks Of Oral Chemotherapy." Medical News Today. MediLexicon, Intl., 14 Jan. 2013
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Old 12-06-2013, 03:51 PM
gdpawel gdpawel is offline
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Default Dermatologic Adverse Events Induced by Molecularly Targeted Cancer Agents

Dr. Mario Lacouture from Memorial Sloan-Kettering Center Center in New York and his colleagues from the Northwestern University Feinberg School of Medicine in Chicago, have suggested in a new study that painful rashes and other skin-related side effects of newer targeted cancer drugs may jack up treatment costs.

The average cost of treating each cancer patient who came into a dermatology clinic with skin, hair and nail complaints was almost $2,000, the researchers reported. That included expenses related to doctors' appointments, dermatology medications and lab tests. And some patients with skin problems may have to delay or alter their treatment regimen if side effects are too severe.

According to Dr. Lacouture, dermatologic side effects including skin irritation and dry skin are the two topmost concerns that patients have that they did not expect during therapy. Patients are prepared to get hair loss, they are prepared to get some nausea and diarrhea, but they aren't expecting to get is all these skin issues.

Lacouture and his colleagues tracked costs related to skin reactions in 132 patients being treated with targeted cancer-fighting drugs at their dermatology clinic between 2005 and 2008. The majority of those patients had colon or lung cancer and the most common drug treatments included Erbitux (cetuximab) and Tarceva (erlotinib).

Patients came in with a range of dermatology-related complaints, including painful acne, lesions and blisters on the hands and feet and nail infections. Those conditions cost anywhere from $21 to almost $11,000 to treat, depending on the patient.

The average total cost of medications, clinic visits, treatment procedures and lab tests such as blood work and wound culturing for each patient was $1,920. Dermatology drugs accounted for the greatest chunk of that, costing an average of about $840 per patient, according to findings published in the Archives of Dermatology.

Lacouture said that more than half of patients may have skin, hair and nail reactions to newer drugs that treat some of the most fatal types of cancer. That's because along with their cancer-fighting action, the drugs also attack proteins on the skin.

If skin reactions are severe, especially with certain cancer drugs including Nexavar (sorafenib) for kidney cancer, doctors may have to adjust dosages or take patients off those drugs for a period of time. While most of the extra costs would be covered by patients' insurance, skin problems also mean more time and transportation for appointments and co-payments.

It adds to the out-of-pocket costs for the patient and to the already ballooning cost of cancer. Those costs should be taken into consideration when evaluating new cancer drugs. The most important thing for patients is to be aware of how common these problems are and know that the sooner they are diagnosed and treated for side effects, the less likely it will interfere with cancer treatment and the quality of life.

Source: Archives of Dermatology, December 19, 2011.

[url]http://archderm.ama-assn.org/cgi/content/abstract/147/12/1403

Skin problems are the most common adverse effects from new anti-cancer drugs. Ralf Gutzmer, from the Hannover Medical School (MHH), and co-authors now summarize the current state of knowledge in the recent edition of Deutsches Aerzteblatt International (Dtsch Arztebl Int 2012; 109(8): 133-40).

Adverse effects of the skin include rashes, nail problems, and the hand-foot syndrome. The substance class of multikinase inhibitors causes such cutaneous adverse effects in up to 34% of patients. The proportion of patients with adverse effects is even higher for the selective kinase inhibitors, such as epidermal growth factor receptor (EGFR) inhibitors and inhibitors of mutated BRAF, with up to 90% affected, and for immunotherapeutics such as the CTLA-4 antibody, with up to 68% affected.

Such adverse effects can be severe, painful, or lead to psychological discomfort due to their localization on visible areas of the body, and this can affect patients' willingness to continue treatment. However, adverse effects can also be associated with a patient's positive response to therapy, as is the case for the EGFR inhibitors.

Early recognition and treatment of cutaneous adverse effects are critical to successfully implementing anti-cancer drug therapies. Achieving this requires on the one hand the primary treating physician, and on the other, an intensive, interdisciplinary collaboration involving dermatologists.

Deutsches Aerzteblatt International

[url]http://www.aerzteblatt.de/pdf.asp?id=122847
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Old 12-06-2013, 03:52 PM
gdpawel gdpawel is offline
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Default Capecitabine (Xeloda) Linked to Potentially Fatal Skin Reactions

Capecitabine (Xeloda), an oral drug used to treat breast and colorectal cancers, has been associated with potentially fatal cutaneous reactions.

The drug's manufacturer, Hoffmann-La Roche, reported in an advisory from Health Canada that severe skin reactions have been observed in patients using capecitabine.

In a letter to healthcare professionals, Health Canada noted that "very rare cases of severe cutaneous reactions such as Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), in some cases with fatal outcome, have been reported during treatment with [capecitabine]."

Associated signs and symptoms of severe skin reactions can include flu-like symptoms, fever, skin itching, and a painful red or purplish skin rash that spreads and blisters and eventually causes the skin to shed. Other possible symptoms include mouth sores, eye burning, itching, and discharge.

The manufacturer emphasized that patients using this drug who develop any of these symptoms should contact their healthcare professional immediately.

Capecitabine is approved in the United States for the treatment of metastatic colorectal and breast cancer. A generic capecitabine product (Teva Pharmaceuticals) received approval from the US Food and Drug Administration (FDA) in September.

That product currently carries a boxed warning about a potential drug interaction; levels of warfarin in the blood can increase, leading to serious adverse effects.

Adverse effects reported with capecitabine include diarrhea, vomiting, nausea, mouth sores, hand–foot syndrome, fever, and infection, according to the FDA.

Citation: Capecitabine Linked to Potentially Fatal Skin Reactions. Medscape. Dec 03, 2013.
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Old 12-06-2013, 03:57 PM
gdpawel gdpawel is offline
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Default Side effects of treatment a reality

By analyzing non-cancer deaths among cancer patients, it becomes clear that orthodox therapies often do more harm than good. For example, cancer treatment can damage the heart and cause deaths from heart failure. This means fewer deaths from cancer. Analysis of the records of 1.2 million cancer cases in the Surveilance, Evaluation and End Results (SEER) database showed that non-cancer deaths accounted for 21 - 37% of all deaths. The authors attributed this effect to the damage caused by cancer treatment (mainly radiotherapy and chemotherapy).

Some common chemotherapeutic agents (paclitaxel, doxorubicin, and trastuzumab) can trigger hypertension or problems with the heart, such as arrhythmias, congestive heart failure, or bradycardia. Such drugs like doxorubicin and daunorubicin can damage the heart and produce dilated cardiomyopathy. There are some, like 5-FU [fluorouracil] and Xeloda [capecitabine], that can cause chest pains, resulting from spasms of the arteries that go to the heart. Many patients on chemotherapy become anemic, and that can trigger further cardiac complications. Other agents affect the kidneys, sometimes to the point of requiring dialysis. In addition, because many patients on chemotherapy are immunocompromised, pulmonary infections are quite common.

It's interesting. Results from clinical trials indicated that most "targeted" therapies of today do not cause the usual side effects associated with cancer treatment, such as hair loss and fatigue. However, other side effects may occur with these drugs, including rash, hand/foot syndrome (sores on the hands and feet) and an increased risk of heart attack and stroke. Exchanging one set of side effects with another set of side effects?

Bacterial infections (with pseudomonas being a very common offender) have been a recognized risk of chemotherapy since the 1940's. In fact, the number one cause of chemotherapy-related mortality (save for the likely probability that it induces mutations in genetically unstable cancer cells to produce a more aggressive cancer cell) is infection, resulting from immunosupression. There are several mechanisms of immunosuppression, the most obvious being the predictable reduction in the white blood cell count following most forms of chemotherapy. The main justification of having medical oncology be a medical specialty unto itself is the expertise it requires to push the envelop with toxic drugs to kill the tumor without killing the patient. The second mechanism of immunosuppression is a reduction in lymphocytes and plasma cells, which also assist in fighting infections.

It's analogous to the old medical specialty of syphilology. There was a big medical specialty called syphilology which existed because of the expertise it took to give toxic cocktails of the various (mostly ineffective drugs). The formulas were quite complicated, but they persisted until the discovery of penicillin, which finally killed off not just the syphillis spirochete but also the specialty of siphilology. I would hopefully expect that something like this will happen with medical oncology, and I would be thrilled if it happened while I was still around to see it.
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