An Overview of the Changing Landscape of Treatment for Advanced Melanoma.

Abstract

PMID:

28052356

DOI:

10.1002/phar.1895

Melanoma-the deadliest form of skin cancer-leads to thousands of deaths each year. Although melanoma is less common than basal cell and squamous cell skin cancers, melanoma is more dangerous because it is more likely to spread to other parts of the body, such as lymph nodes, if not diagnosed and treated early. Data from the National Cancer Institute indicate a steady rise in new cases of melanoma and, unfortunately, a steady rate in the number of deaths through 2013.

Ninety percent of melanomas are linked to inadequate sun protection from ultraviolet rays or the tanning habits of young adults. Over the past 5 years, however, there have been a variety of new pharmacologic treatments for advanced melanoma including immunotherapy, targeted agents (BRAF and MEK inhibitors), and oncolytic viral therapy. In this article, we review the current literature on the treatment of melanoma, with a focus on emerging therapies,

Placental growth factor as an aid to the assessment of women with suspected pre-eclampsia: systematic review and economic analysis.

Abstract

BACKGROUND:

Pre-eclampsia (PE) prediction based on blood pressure, presence of protein in the urine, symptoms and laboratory test abnormalities can result in false-positive diagnoses. This may lead to unnecessary antenatal admissions and preterm delivery. Blood tests that measure placental growth factor (PlGF) or the ratio of soluble fms-like tyrosine kinase 1 (sFlt-1) to PlGF could aid prediction of PE if either were added to routine clinical assessment or used as a replacement for proteinuria testing.

OBJECTIVES:

To evaluate the diagnostic accuracy and cost-effectiveness of PlGF-based tests for patients referred to secondary care with suspected PE in weeks 20-37 of pregnancy.

DESIGN:

Systematic reviews and an economic analysis.

DATA SOURCES:

Bibliographic databases including MEDLINE, EMBASE, Web of Science and The Cochrane Library and Database of Abstracts of Reviews of Effects were searched up to July 2015 for English-language references. Conferences, websites, systematic reviews and confidential company submissions were also accessed.

REVIEW METHODS:

Systematic reviews of test accuracy and economic studies were conducted to inform an economic analysis. Test accuracy studies were required to include women with suspected PE and report quantitatively the accuracy of PlGF-based tests; their risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) criteria. The economic studies review had broad eligibility criteria to capture any types of economic analysis; critical appraisal employed standard checklists consistent with National Institute for Health and Care Excellence criteria. Study selection, critical appraisal and data extraction in both reviews were performed by two reviewers.

ECONOMIC ANALYSIS:

An independent economic analysis was conducted based on a decision tree model, using the best evidence available. The model evaluates costs (2014, GBP) from a NHS and Personal Social Services perspective. Given the short analysis time horizon, no discounting was undertaken.

RESULTS:

Four studies were included in the systematic review of test accuracy: two on Alere's Triage^® PlGF test (Alere, Inc., San Diego, CA, USA) for predicting PE requiring delivery within a specified time and two on Roche Diagnostics' Elecsys^® sFlt-1 to PlGF ratio test (Roche Diagnostics GmbH, Mannheim, Germany) for predicting PE within a specified time. Three studies were included in the systematic review of economic studies, and two confidential company economic analyses were assessed separately. Study heterogeneity precluded meta-analyses of test accuracy or cost-analysis outcomes, so narrative syntheses were conducted to inform the independent economic model. The model predicts that, when supplementing routine clinical assessment for rule-out and rule-in of PE, the two tests would be cost-saving in weeks 20-35 of gestation, and marginally cost-saving in weeks 35-37, but with minuscule impact on quality of life. Length of neonatal intensive care unit stay was the most influential parameter in sensitivity analyses. All other sensitivity analyses had negligible effects on results.

LIMITATIONS:

No head-to-head comparisons of the tests were identified. No studies investigated accuracy of PlGF-based tests when used as a replacement for proteinuria testing. Test accuracy studies were found to be at high risk of clinical review bias.

CONCLUSIONS:

The Triage and Elecsys tests would save money if added to routine clinical assessment for PE. The magnitude of savings is uncertain, but the tests remain cost-saving under worst-case assumptions. Further research is required to clarify how the test results would be interpreted and applied in clinical practice.

Health Technol Assess. 2016 Nov;20(87):1-160
 

Scientists have been able to show for the first time that super foods like pomegranate, green tea and broccoli help fight prostate cancer.

The team performed a six-month trial at Bedford Hospital with 203 men who had prostate cancer. The researchers split the men into two groups, including those who took a specially developed superfood capsule and those who took a placebo. The doctors, patients and statisticians were not informed who was taking the capsule and who was taking the placebo.
They found that those who took a capsule containing essence of pomegranate, green tea, turmeric and broccoli had 63 percent less prostate-specific antigen (PSA) levels than those who took the placebo. The PSA is a level of the protein produced by the prostate gland which is an indicator of prostate cancer.

Researchers reported that men who experienced a lower PSA increase took a purified polyphenol rich food pill called Pomi-T, which was designed by Professor Robert Thomas, a researcher on the project from both Bedford Hospital and Addenbrooke’s Hospital.
This test is the first time scientists have firmly established an influence on markers of cancer progression using a scientifically robust evaluation.

“Healthy eating and lifestyle is the main way of helping to combat the development of cancer but men can now also turn to a whole food supplement which has been shown to work,” Thomas said. “We hope this will help millions of men to help combat the onset of prostate cancer.”
If anything, this study is able to prove that super foods definitely do not elevate the risk of prostate cancer, but fried food does. Researchers reported in the journal The Prostatein January this year about how they were able to link fried food consumption and prostate cancer. They said the increase in cancer risk could be due to the carcinogenic compounds found in fried food when oil is heated to temperatures needed for deep frying. The scientists said people who consumed fried foods once or more each week had a 30 to 37 percent increased risk of developing prostate cancer.

“The link between prostate cancer and select deep-fried foods appeared to be limited to the highest level of consumption – defined in our study as more than once a week – which suggests that regular consumption of deep-fried foods confers particular risk for developing prostate cancer,” explained the study’s author Janet L. Stanford, co-director of the Hutchinson Center’s Program in Prostate Cancer Research.

Lee Rannals for redOrbit.com – Your Universe Online

M-CSF May Act As Powerful Prognostic Factor For Multiple Myeloma

By Jessica Langholtz

A recent study published in the journal Medical Oncology determined that the cytokine M-CSF is highly predictive of survival in multiple myeloma patients. In the study, researchers evaluated a diverse set of cytokines to determine their usefulness as prognostic factors in multiple myeloma.

Cytokines are proteins secreted by immune cells to generate an immune response. They are involved with allergic responses, inflammation, blood cell development, and the development of multiple myeloma and other types of cancer.

Currently, the International Staging System predicts the stage of disease progression and median survival time for multiple myeloma based on a combination of serum beta-2 microglobulin and albumin levels. Beta-2 microglobulin is a molecule commonly found on the surface of cells; serum albumin is the most abundant protein in human blood plasma. Elevated serum levels of beta-2 microglobulin and low serum levels of albumin indicate increased disease severity and progression of myeloma (see related Beacon news).

The study published in Medical Oncology evaluated the relationship between the blood serum levels of various cytokines in 64 untreated myeloma patients and the patients’ survival rates. Patients were followed up over a period of over seven years. The serum beta-2 microglobulin level was increased in 40 percent of patients, whereas the serum albumin level was low in 45 percent of patients.

Researchers observed a relationship between the cytokine M-CSF and patient survival rates. Patients with normal M-CSF levels had a median survival time of 780 days, while patients with elevated M-CSF concentrations had a median survival time of 155 days.

Most significantly, M-CSF more accurately predicted disease severity and progression than beta-2 microglobulin, which is the established prognostic factor for myeloma.

The authors of the study concluded that M-CSF is a powerful prognostic factor for multiple myeloma and should be considered in novel therapeutic treatments.