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Saturday, November 10, 2007
International Cancer Symposium at 10 November, 2007.
Molecular Targeting Therapy in Lung Cancer
Speaker: Dr. Adi Gazdar, from UT Southwestern Medical Center.
Gefinitib "Lazarus" Response
www.aacr.org/page4369.aspx
"...Dr. Tom Lynch at Massachusetts General Hospital in Boston called the “Lazarus response.” Lazarus was brought back from the dead in the Bible. In a similar manner, there was the occasional patient who came to the clinic in a wheelchair on oxygen, and after taking this pill once a day for a couple of months, will now come into the clinic walking, with clear lungs on the CT scan."
Janus of DNA repair gene.
Zhong Z, et al.
DNA Synthesis and Repair Genes RRM1 and ERCC1 in Lung Cancer
New Engl j Med 356:800-808, 2007.(Link)
Expression of RRM1 correlated with good prognosis.
Gazdar A.
DNA Repair and Survival in Lung Cancer — The Two Faces of Janus
New Engl j Med 356:771-773, 2007.(Link 1, 2)
However, expression of RRM1 preedicts
poor response to gemcitabine and platinum compounds.
Bild AH, et al. Oncogenic pathway signatures in human cancers as a guide to targeted therapies
Nature 439:353-357, 2006. (Link)
Japanese Status of "Bevacizumab (BV: Avastin)" in Advanced colorectal cancer.
Speaker: Dr. Toshihiko Doi, from National Cancer Center East Hospital.
Practical Use of Imatinib in CML Patients: Results from Shomofusa Study Group.
Speker: Dr. Hisashi Wakita, from Narita Red Cross Hospital.
Aggressive Surgery for Hilar Cholangiocarcinoma
Speaker: Dr. Peter Neuhaus, from Charité - Berlin University School of Medicine, Campus Virchow-Klinikum.
Bismuth Classification.
Neoadjuvant therapy + transplantation 5 yr survival 82%. Transplant only lower than HCC survival.
Expression of VEGF-C (lymphangiogenesis) expression correlate with poor prognosis.
Pitt HA, Nakeeb A, Abrams RA, et al. Perihilar cholangiocarcinoma. Postoperative radiotherapy does not improve survival.
Ann Surg. 221:788-97, 1995.(Link)
*Conflicting results.
Eckel F, Schmid RM. Chemotherapy in advanced biliary tract carcinoma: a pooled analysis of clinical trials.
Br J Cancer. 96:896-902, 2007. Gemcitabine + platinum compounds provisionaly standards chemotherapy.
LiMAX rather than ICG correlate well with liver function.
Pre- EPO, post-insulin+glucose
HGF/EGF increases hepatic regeneration.
Extended hepatectomy (R0) good prognosis.
Ebata T, Nagino M, Kamiya J, et al. Hepatectomy with portal vein resection for hilar cholangiocarcinoma: audit of 52 consecutive cases. Ann Surg. 238:720-7, 2003.(Link)
About lymph node status
N+ 53%,
N- 5yr 32%, #16 micrometastases 29%.
Kitagawa Y, Nagino M, Kamiya J, et al. Lymph node metastasis from hilar cholangiocarcinoma: audit
of 110 patients who underwent regional and paraaortic node dissection. Ann Surg. 233:385-92, 2001.
(Link)
Virchow's node
Lancet 03/11/2007 - 02:01
A 70-year-old man presented to his primary care physician with postprandial epigastric pain. He was prescribed antacids, which were ineffective; his weight then decreased by 11 kg in 3 months. Oesophagogastroduodenoscopy showed a mass in the antrum; histopathological analysis of a biopsy sample established that the mass was a signet-ring adenocarcinoma. Even before the biopsy was analysed, examination of the neck supported the diagnosis of cancer: the left supraclavicular lymph node was firm and enlarged (). The left supraclavicular lymph node is near the junction of the thoracic duct and the left subclavian vein, where the lymph from much of the body drains into the systemic circulation. An enlarged node can be the first sign of gastric cancer—and is often called Virchow's node, because the association between left supraclavicular lymphadenopathy and gastric cancer was first described by the German pathologist Rudolf Virchow (1821–1902). Virchow lectured and practised at the Charité Medical School of the Humboldt University of Berlin, where he discovered several facts fundamental to modern medicine.
Clinical Management of Cancer Therapy
Speaker: Dr. Richard S. Zimmerman, from Mayo clinic.
Can We deliver good practice?
Dissociation between medical research and real world.
Hawthorne effect (Link1, 2)
Evaluation of Process
Fonarow GC, Abraham WT, Albert NM, et al.Association between performance measures and clinical outcomes for patients hospitalized with heart failure. JAMA. 297:61-70, 2007. (Link1)
"Assessment of quality of care in heart failure has focused on the development and use of process-based performance measures, with the presumption that these processes are associated with improved clinical outcomes. However, this link remains largely untested."
Publication bias and so on. Is the good results can be directly translated into the clinical practice??
Ioannidis JP. Contradicted and initially stronger effects in highly cited clinical research. JAMA. 294:218-28, 2005. href="http://jama.ama-assn.org/cgi/content/full/294/2/218">(Link)
"16% contraindicated later, 16% shows stronger effect"
Pros and cons of megatrial.
Mammoscreening risk up down 0.05%, up 0.5%!
Avoid casual Benchmarking.
Speaker: Dr. Adi Gazdar, from UT Southwestern Medical Center.
Gefinitib "Lazarus" Response
www.aacr.org/page4369.aspx
"...Dr. Tom Lynch at Massachusetts General Hospital in Boston called the “Lazarus response.” Lazarus was brought back from the dead in the Bible. In a similar manner, there was the occasional patient who came to the clinic in a wheelchair on oxygen, and after taking this pill once a day for a couple of months, will now come into the clinic walking, with clear lungs on the CT scan."
Janus of DNA repair gene.
Zhong Z, et al.
DNA Synthesis and Repair Genes RRM1 and ERCC1 in Lung Cancer
New Engl j Med 356:800-808, 2007.(Link)
Expression of RRM1 correlated with good prognosis.
Gazdar A.
DNA Repair and Survival in Lung Cancer — The Two Faces of Janus
New Engl j Med 356:771-773, 2007.(Link 1, 2)
However, expression of RRM1 preedicts
poor response to gemcitabine and platinum compounds.
Bild AH, et al. Oncogenic pathway signatures in human cancers as a guide to targeted therapies
Nature 439:353-357, 2006. (Link)
Japanese Status of "Bevacizumab (BV: Avastin)" in Advanced colorectal cancer.
Speaker: Dr. Toshihiko Doi, from National Cancer Center East Hospital.
Practical Use of Imatinib in CML Patients: Results from Shomofusa Study Group.
Speker: Dr. Hisashi Wakita, from Narita Red Cross Hospital.
Aggressive Surgery for Hilar Cholangiocarcinoma
Speaker: Dr. Peter Neuhaus, from Charité - Berlin University School of Medicine, Campus Virchow-Klinikum.
Bismuth Classification.
Neoadjuvant therapy + transplantation 5 yr survival 82%. Transplant only lower than HCC survival.
Expression of VEGF-C (lymphangiogenesis) expression correlate with poor prognosis.
Pitt HA, Nakeeb A, Abrams RA, et al. Perihilar cholangiocarcinoma. Postoperative radiotherapy does not improve survival.
Ann Surg. 221:788-97, 1995.(Link)
*Conflicting results.
Eckel F, Schmid RM. Chemotherapy in advanced biliary tract carcinoma: a pooled analysis of clinical trials.
Br J Cancer. 96:896-902, 2007. Gemcitabine + platinum compounds provisionaly standards chemotherapy.
LiMAX rather than ICG correlate well with liver function.
Pre- EPO, post-insulin+glucose
HGF/EGF increases hepatic regeneration.
Extended hepatectomy (R0) good prognosis.
Ebata T, Nagino M, Kamiya J, et al. Hepatectomy with portal vein resection for hilar cholangiocarcinoma: audit of 52 consecutive cases. Ann Surg. 238:720-7, 2003.(Link)
About lymph node status
N+ 53%,
N- 5yr 32%, #16 micrometastases 29%.
Kitagawa Y, Nagino M, Kamiya J, et al. Lymph node metastasis from hilar cholangiocarcinoma: audit
of 110 patients who underwent regional and paraaortic node dissection. Ann Surg. 233:385-92, 2001.
(Link)
Virchow's node
Lancet 03/11/2007 - 02:01
A 70-year-old man presented to his primary care physician with postprandial epigastric pain. He was prescribed antacids, which were ineffective; his weight then decreased by 11 kg in 3 months. Oesophagogastroduodenoscopy showed a mass in the antrum; histopathological analysis of a biopsy sample established that the mass was a signet-ring adenocarcinoma. Even before the biopsy was analysed, examination of the neck supported the diagnosis of cancer: the left supraclavicular lymph node was firm and enlarged (). The left supraclavicular lymph node is near the junction of the thoracic duct and the left subclavian vein, where the lymph from much of the body drains into the systemic circulation. An enlarged node can be the first sign of gastric cancer—and is often called Virchow's node, because the association between left supraclavicular lymphadenopathy and gastric cancer was first described by the German pathologist Rudolf Virchow (1821–1902). Virchow lectured and practised at the Charité Medical School of the Humboldt University of Berlin, where he discovered several facts fundamental to modern medicine.
Clinical Management of Cancer Therapy
Speaker: Dr. Richard S. Zimmerman, from Mayo clinic.
Can We deliver good practice?
Dissociation between medical research and real world.
Hawthorne effect (Link1, 2)
Evaluation of Process
Fonarow GC, Abraham WT, Albert NM, et al.Association between performance measures and clinical outcomes for patients hospitalized with heart failure. JAMA. 297:61-70, 2007. (Link1)
"Assessment of quality of care in heart failure has focused on the development and use of process-based performance measures, with the presumption that these processes are associated with improved clinical outcomes. However, this link remains largely untested."
Publication bias and so on. Is the good results can be directly translated into the clinical practice??
Ioannidis JP. Contradicted and initially stronger effects in highly cited clinical research. JAMA. 294:218-28, 2005. href="http://jama.ama-assn.org/cgi/content/full/294/2/218">(Link)
"16% contraindicated later, 16% shows stronger effect"
Pros and cons of megatrial.
Mammoscreening risk up down 0.05%, up 0.5%!
Avoid casual Benchmarking.
Posted by: Ds20040999 / 1:31 AM 
