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Inflammatory Bowel Disease
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Only 20–30% of patients with CD will have a non-progressive course [3]. The majority of pregnant women will need ongoing therapy to control bowel inflammation. Management is best guided by a multidisciplinary team that includes a gastroenterologist, obstetrician and maternal-fetal medicine specialist [3, 28]. Treatment of CD during pregnancy is similar to therapy in a non-pregnant patient. Management decisions are guided by disease activity, IBD related complications, medication risk and disease prognosis. Medical therapy is used to either induce or maintain remission. Patients who achieve remission should be considered candidates for maintenance therapy.
Non-Melanoma Skin Cancer
Published in Pat Price, Karol Sikora, Treatment of Cancer, 2020
Irene De Francesco, Sean Whittaker, Stephen L. Morris
The use of extracorporeal photophoresis (ECP) was first reported in 1987 by Edelson and colleagues, who showed a 73% RR in patients with erythrodermic CTCL.259 Response rates were lower in earlier stages of disease (38%). In this procedure, peripheral blood leukocytes are harvested, mixed with 8-MOP, exposed to UV radiation, and then returned to the patient.261 This is usually performed on two successive days every 4 weeks.262 The schedule is generally continued for up to 6 months in order to assess response: maintenance therapy is tailored according to disease course. In general, ECP is well-tolerated, although patients with a history of heart disease require careful monitoring due to changing fluid volumes.261 ECP is considered a first-line option for Stage III erythrodermic disease and SS.
High-Dose Chemotherapy with Haematopoietic Stem Cell Transplantation in Primary Systemic Vasculitis, Behcet’s Disease and Sjogren’s Syndrome
Published in Richard K. Burt, Alberto M. Marmont, Stem Cell Therapy for Autoimmune Disease, 2019
Christoph Fiehn, Manfred Hensel
The first step of treatment either in PSV, Behcet’s disease or in severe organ involvement of Sjogren’s syndrome should be effective and result in rapid remission induction, in order to limit organ damage. Induction therapy is followed by mild, long-term maintenance therapy for prevention or relapse. This maintenance therapy may lead to chronic and severe drug toxicity. The National Institutes of Health experience with Wegener’s granulomatosis reported the contribution of treatment toxicity to permanent damage in over 50% of their patients.25 In a large, international randomized trial in patients with ANCA-positive systemic vasculitis, severe or life-threatening adverse effects have been observed in 26% of patients (maintenance therapy with oral cyclophosphamide or azathioprine).26
Bridging to transplant and post-transplant maintenance therapy with FLT3 inhibitors in patients with relapsed or refractory FLT3 mutated acute myeloid leukemia
Published in Hematology, 2023
Natsuki Hirose, Takayoshi Tachibana, Akihiko Izumi, Shuku Sato, Noriyuki Tadera, Yotaro Tamai, Heiwa Kanamori, Masatsugu Tanaka, Hideaki Nakajima
Significant findings were obtained regarding the safety of maintenance therapy. According to the previous reports, the continuation rate due to adverse events of an FLT3 inhibitor has been a clinical issue. In the SORMAIN trial, 48.8% of patients required dose reduction and 22% required discontinuation of FLT3 inhibitors due to adverse events [13]. Similarly, 63% of patients required dose reduction in the Radius trial [9]. This profile is similar to the results of a meta-analysis of post-transplant FLT3 inhibitor maintenance therapy [20,21]. Unlike chemotherapy, allografted patients have reduced organ capacity and performance. For safety reasons, most patients used reduced doses of FLT3 inhibitors, and only a few used the standard dose. Although high-grade AEs may have been reasonably avoided, even with a reduced dose, several adverse events including organ disorders and hematological toxicity occurred. Therefore, several patients required further dose reduction or discontinuation of FLT3 inhibitors. Nevertheless, long-term administration of the FLT3 inhibitors, with dose reduction and drug withdrawal, may ensure safety and efficacy.
PARP inhibitors: clinical relevance and the role of multidisciplinary cancer teams on drug safety
Published in Expert Opinion on Drug Safety, 2022
Mafalda Jesus, Manuel Morgado, Ana Paula Duarte
As a result, FDA and EMA have already approved four PARPi with several clinical indications, namely: olaparib, rucaparib, niraparib and talazoparib [5–8]. Within the approved clinical indications, it is important to differentiate between two groups: PARPi that are prescribed for treatment and PARPi that are prescribed for maintenance. PARPi prescribed for treatment are understood as the drugs initially used in an attempt to shrink the current tumor. Otherwise, maintenance therapy is understood as the continuation of treatment after the completion of the use of the medication considered standard for the treatment of a particular tumor. As already mentioned, other PARPi are under investigation, such as veliparib and pamiparib, but have not yet been approved by drug regulatory agencies.
Maintenance therapy and drug holiday in sarcoma patients: systematic review
Published in Acta Oncologica, 2020
Loïc Lebellec, Anne-Sophie Defachelles, Pierre-Yves Cren, Nicolas Penel
Traditionally, at advanced stage, not amenable to curative-intent strategy, systemic treatment could be administered until severe toxicity, disease progression, or cumulative dose have been reached (e.g., as in the case of doxorubicin). After the administration of classical chemotherapy and in the absence of disease progression (including complete or partial response or stable disease), maintenance therapy could be discussed. Maintenance therapy aims to maintain response, prevent or delay progressive disease, and improve quality of life. In this setting, there is no consensus on maintenance therapy duration. In this setting, the key-difference between maintenance therapy and further line is that maintenance therapy is given in patients experiencing non-progressive disease and further line is given in those experiencing progressive disease.