Risultati per: Terapia sistemica del carcinoma epatocellulare

To the Editor Qin and colleagues conducted an important trial to compare tislelizumab with sorafenib. The study was designed within a noninferiority setting for overall survival (OS) by claiming tislelizumab would be noninferior to sorafenib if the upper bound of the 95.003% CI for the hazard ratio (HR) was less than 1.08. The observed HR was 0.85 with a 95.003% CI of 0.71 to 1.02. The objective response rates were 14.3% and 5.4% for tislelizumab and sorafenib, respectively. The corresponding median durations of response were 36.1 and 11.0 months, respectively. There are several issues that may deserve our attention for conducting future clinical studies in a similar setting.

In Reply I thank and have provided responses to Sun et al for their comments on our article that compared tislelizumab vs sorafenib in first-line treatment of unresectable hepatocellular carcinoma. The noninferiority margin of 1.08 is clearly clinically justifiable. It is based on the data from the 2 sorafenib trials in first-line hepatocellular carcinoma (HCC), namely the SHARP trial. Using the 95% CI lower limit method on log hazard ratio (HR) as described in Rothmann et al, the noninferiority margin corresponding to 60% retention of the sorafenib effect vs placebo was calculated as 1.08. Given the consistent survival improvement of sorafenib vs placebo demonstrated in the SHARP and Asia-Pacific trials, and the fact that, at the time the BGB-A317-301 study was designed, no other monotherapy treatment was able to show superiority compared with sorafenib since its approval in 2007, a margin of 1.08 derived from 2 well-conducted phase 3 pivotal trials was statistically persuasive. Notably, the same margin was used in other noninferiority monotherapy HCC trials, namely the REFLECT (lenvatinib) and HIMALAYA (durvalumab) trials.

Hepatocellular carcinoma (HCC) is a leading cause of cancer death. HCC is preventable with about 70 percent of HCC attributable to modifiable risk factors. Glucagon-like peptide-1 receptor agonists (GLP-1RAs), FDA-approved medications for treating type 2 diabetes mellitus (T2DM), have pleiotropic effects on counteracting risk factors for HCC. Here we evaluate the association of GLP-1RAs with incident HCC risk in a real-world population.

Immunoterapia più chemioterapia raddoppia il tasso a lungo termine

Immunoterapia più chemioterapia raddoppia il tasso a lungo termine

Permetterà di fermare progressione con singola somministrazione

All’Arnas Brotzu di Cagliari primo trattamento di un paziente

New England Journal of Medicine, Volume 390, Issue 15, Page 1359-1371, April 2024.

New England Journal of Medicine, Volume 390, Issue 14, Page 1339-1341, April 2024.

Download solo con prescrizione, non è alternativa ai farmaci

Objectives
To assess and compare the diagnostic value of contrast-enhanced MRI (CEMRI) and contrast-enhanced CT (CECT) for evaluating the response of hepatocellular carcinoma (HCC) after transarterial chemoembolisation (TACE).

Design
Systematic review and meta-analysis.

Data sources
PubMed, Embase, the Cochrane Library, CNKI and Wanfang databases were systematically searched from inception to 1 August 2023.

Eligibility criteria
Studies with any outcome that demonstrates the diagnostic performance of CEMRI and CECT for HCC after TACE were included.

Data extraction and synthesis
Two authors independently extracted the data and assessed the quality of included studies. Study quality was assessed using Quality Assessment of Diagnostic Accuracy Studies-2. The diagnostic performance of CEMRI and CECT for the response of HCC was investigated by collecting true and false positives, true and false negatives, or transformed-derived data from each study to calculate specificity and sensitivity. Other outcomes are the positive likelihood ratio/negative likelihood ratio (NLR), the area under the receiver operating characteristic curve (AUC) for diagnostic tests and the diagnostic OR (DOR). Findings were summarised and synthesised qualitatively according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Results
This study included 5843 HCC patients diagnosed with CEMRI or CECT and treated with TACE from 36 studies. The mean proportion of men in the total sample was 76.3%. The pool sensitivity, specificity and AUC of CEMRI in diagnosing HCC after TACE were 0.92 (95% CI: 0.86 to 0.96), 0.94 (95% CI: 0.86 to 0.98) and 0.98 (95% CI: 0.96 to 0.99). The pool sensitivity, specificity and AUC of CECT in diagnosing HCC after TACE were 0.74 (95% CI: 0.68 to 0.80), 0.98 (95% CI: 0.93 to 1.00) and 0.90 (95% CI: 0.88 to 0.93).

Conclusions
In conclusion, this study found that both CEMRI and CECT had relatively high predictive power for assessing the response of HCC after TACE. Furthermore, the diagnostic value of CEMRI may be superior to CECT in terms of sensitivity, AUC, DOR and NLR.

This randomized clinical trial examines if radiotherapy is noninferior to chemoradiotherapy after induction chemotherapy for locoregionally advanced nasopharyngeal carcinoma.

Objectives
Immune checkpoint inhibitors (ICIs) are indicated for metastatic urothelial cancer (mUC), but predictive and prognostic factors are lacking. We investigated clinical variables associated with ICI outcomes.

Methods
We performed a multicentre retrospective cohort study of 135 patients who received ICI for mUC, 2016–2021, at three Canadian centres. Clinical characteristics, body mass index (BMI), metastatic sites, neutrophil-to-lymphocyte ratio (NLR), response and survival were abstracted from chart review.

Results
We identified 135 patients and 62% had received ICI as a second-line or later treatment for mUC. A BMI ≥25 was significantly correlated to a higher overall response rate (ORR) (45.4% vs 16.3%, p value=0.020). Patients with BMI ≥30 experienced longer median overall survival (OS) of 24.8 vs 14.4 for 25≤BMI

Aifa approva la rimborsabilità della nuova formulazione in compresse di un farmaco mirato

Aiutando genitori si riduce rischio di nuovi accessi in ospedale