Central serous retinopathy (CSR) is a lesser-established ocular toxicity associated with BRAF/MEK inhibitors, a targeted treatment used in BRAF-mutated melanoma. This case study outlines a patient ...with metastatic cutaneous melanoma, who developed bilateral multifocal CSR secondary to dabrafenib and trametinib, two commonly used BRAF/MEK inhibitors. This report aims to improve the understanding of CSR as an adverse effect of BRAF/MEK inhibitors, including the potential for sight threatening ocular toxicity. It also aims to emphasise the importance of multi-specialty management to manage such toxicity while upholding delivery of cancer treatment in the best interests of the patient. In this case, the BRAF/MEK inhibitors were re-commenced at half dose and the CSR did not further progress, demonstrating an alternative option to halting treatment or switching to second-line therapy. Ultimately, a risk versus benefit approach is required, with decision making involving the multi-disciplinary team centred around an informed patient.
An increased mortality risk was observed in patients with cancer during the first wave of COVID-19. Here, we describe determinants of mortality in patients with solid cancer comparing the first and ...second waves of COVID-19. A retrospective analysis encompassing two waves of COVID-19 (March-May 2020; December 2020-February 2021) was performed. 207 patients with cancer were matched to 452 patients without cancer. Patient demographics and oncological variables such as cancer subtype, staging and anti-cancer treatment were evaluated for association with COVID-19 mortality. Overall mortality was lower in wave two compared to wave one, HR 0.41 (95% CI: 0.30-0.56). In patients with cancer, mortality was 43.6% in wave one and 15.9% in wave two. In hospitalized patients, after adjusting for age, ethnicity and co-morbidities, a history of cancer was associated with increased mortality in wave one but not wave two. In summary, the second UK wave of COVID-19 is associated with lower mortality in hospitalized patients. A history of solid cancer was not associated with increased mortality despite the dominance of the more transmissible B.1.1.7 SARS-CoV-2 variant. In both waves, metastatic disease and systemic anti-cancer treatment appeared to be independent risk factors for death within the combined cancer cohort.
Advanced Triple-Negative Breast Cancer Patel, Grisma; Prince, Alison; Harries, Mark
Seminars in oncology nursing,
February 2024, 2024-Feb, 2024-02-00, 20240201, Letnik:
40, Številka:
1
Journal Article
Recenzirano
Our focus within this review is to summarize key advances and new therapeutic approaches within advanced triple-negative breast cancer. In addition, we highlight the importance of multidisciplinary ...management, discussing key issues for patients and importance of the supportive role that specialist nurses provide.
Peer-reviewed literature, clinical practice guidelines, clinical trial, and government websites.
Triple-negative breast cancer is a highly heterogeneous subtype of breast cancer, often associated with a less favorable prognosis compared to other types. Significant advances in our understanding of specific mutations and signaling pathways within this subtype, coupled with expanding therapeutic options, has broadened the treatment landscape considerably. While chemotherapy traditionally formed the mainstay of treatment, new therapeutics such as immunotherapy, targeted agents, and antibody-drug conjugates in first-line and subsequent-line settings are now available. It is essential for all those who care for this patient group to be up-to-date on current practice and emerging treatments, so patients receive the support they need and deserve.
Nurses need to become familiar with new systemic anticancer therapies within advanced triple-negative breast cancer to provide patients with adequate information about new treatment options and support with potential treatment-associated toxicities. It is important for nurses to be able to recognise key issues facing patients with a diagnosis of advanced triple-negative breast cancer, to gain a deeper understanding of both the physical and psychosocial support required, signposting or referring patients to additional support services if needed.
The COVID-19 pandemic has led to a range of novel and adaptive research designs. In this perspective, we use our experience coordinating the National COVID Cancer Antibody Survey to demonstrate how a ...balance between speed and integrity can be achieved within a hyper-accelerated study design. Using the COVID-19 pandemic as an example, we show this approach is necessary in the face of uncertain and evolving situations wherein reliable information is needed in a timely fashion to guide policy. We identify streamlined participant involvement, healthcare systems integration, data architecture and real-world real-time analytics as key areas that differentiate this design from traditional cancer trials, and enable rapid results. Caution needs to be taken to avoid the exclusion of patient subgroups without digital access or literacy. We summarise the merits and defining features of hyper-accelerated cancer studies.
Abstract
Background
Fifteen percent of patients with cancer experience symptomatic sequelae, which impair post–COVID-19 outcomes. In this study, we investigated whether a proinflammatory status is ...associated with the development of COVID-19 sequelae.
Methods
OnCovid recruited 2795 consecutive patients who were diagnosed with Severe Acute Respiratory Syndrome Coronavirus 2 infection between February 27, 2020, and February 14, 2021. This analysis focused on COVID-19 survivors who underwent a clinical reassessment after the exclusion of patients with hematological malignancies. We evaluated the association of inflammatory markers collected at COVID-19 diagnosis with sequelae, considering the impact of previous systemic anticancer therapy. All statistical tests were 2-sided.
Results
Of 1339 eligible patients, 203 experienced at least 1 sequela (15.2%). Median baseline C-reactive protein (CRP; 77.5 mg/L vs 22.2 mg/L, P < .001), lactate dehydrogenase (310 UI/L vs 274 UI/L, P = .03), and the neutrophil to lymphocyte ratio (NLR; 6.0 vs 4.3, P = .001) were statistically significantly higher among patients who experienced sequelae, whereas no association was reported for the platelet to lymphocyte ratio and the OnCovid Inflammatory Score, which includes albumin and lymphocytes. The widest area under the ROC curve (AUC) was reported for baseline CRP (AUC = 0.66, 95% confidence interval CI: 0.63 to 0.69), followed by the NLR (AUC = 0.58, 95% CI: 0.55 to 0.61) and lactate dehydrogenase (AUC = 0.57, 95% CI: 0.52 to 0.61). Using a fixed categorical multivariable analysis, high CRP (odds ratio OR = 2.56, 95% CI: 1.67 to 3.91) and NLR (OR = 1.45, 95% CI: 1.01 to 2.10) were confirmed to be statistically significantly associated with an increased risk of sequelae. Exposure to chemotherapy was associated with a decreased risk of sequelae (OR = 0.57, 95% CI: 0.36 to 0.91), whereas no associations with immune checkpoint inhibitors, endocrine therapy, and other types of systemic anticancer therapy were found.
Conclusions
Although the association between inflammatory status, recent chemotherapy and sequelae warrants further investigation, our findings suggest that a deranged proinflammatory reaction at COVID-19 diagnosis may predict for sequelae development.
Patients with cancer are at increased risk of hospitalisation and mortality following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. However, the SARS-CoV-2 phenotype ...evolution in patients with cancer since 2020 has not previously been described. We therefore evaluated SARS-CoV-2 on a UK populationscale from 01/11/2020-31/08/2022, assessing case-outcome rates of hospital assessment(s), intensive care admission and mortality. We observed that the SARS-CoV-2 disease phenotype has become less severe in patients with cancer and the non-cancer population. Case-hospitalisation rates for patients with cancer dropped from 30.58% in early 2021 to 7.45% in 2022 while case-mortality rates decreased from 20.53% to 3.25%. However, the risk of hospitalisation and mortality remains 2.10x and 2.54x higher in patients with cancer, respectively. Overall, the SARS-CoV-2 disease phenotype is less severe in 2022 compared to 2020 but patients with cancer remain at higher risk than the non-cancer population. Patients with cancer must therefore be empowered to live more normal lives, to see loved ones and families, while also being safeguarded with expanded measures to reduce the risk of transmission.
Niraparib is an oral, potent, highly selective poly-ADP ribose polymerase 1 (PARP1) and PARP2 inhibitor. In most developed countries, it is approved as a maintenance treatment for epithelial ovarian, ...fallopian tube, or primary peritoneal cancer in patients with complete or partial response to platinum-based therapy. These approvals are based on results of randomised, double-blind, placebo-controlled trials, particularly the NOVA trial and more recently the PRIMA trial. In this comprehensive review, we delve into the scientific basis of PARP inhibition, discussing both preclinical and clinical data which have led to the current approval status of niraparib. We also discuss ongoing trials and biological rationale of combination treatments involving niraparib, with particular focus on antiangiogenic drugs, immune checkpoint inhibitors and cyclic GMP-AMP synthase stimulator of interferon genes (cGAS/STING) pathway. In addition, we reflect on potential strategies and challenges of utilising current biomarkers for treatment selection of patients to ensure maximal benefit.
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