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Colorectal Cancer
Published in Pat Price, Karol Sikora, Treatment of Cancer, 2020
Inhibiting angiogenesis in mCRC: VEGF: Bevacizumab, a VEGF inhibitor, in combination with cytotoxic chemotherapy (but not alone) in the first- and second-line settings in patients with mCRC has significant additional activity. In a pivotal study, over 900 patients were randomized to one of three treatments with bolus 5-FU: Irinotecan+5FU/leucovorin (IFL)+placebo, IFL+bevacizumab, or FU/LV+bevacizumab. The addition of bevacizumab to IFL resulted in a significantly increased response rate, duration of response, and progression-free survival and improved overall survival by almost 5 months (20.3 vs. 15.6 months; p < 0.001). For the subgroup of patients who received second-line therapy with oxaliplatin-containing regimens, overall survival times were 25.1 and 22.2 months for the IFL/bevacizumab and IFL/placebo arms, respectively.140 There are similar second-line survival benefit data with oxaliplatin–5-FU and bevacizumab combinations. Chemotherapy with bevacizumab is generally well tolerated, with few, if any, overlapping toxicities with cytotoxics. Adverse events include bleeding, thrombosis, proteinuria, and hypertension, which are generally manageable. However, a low percentage of patients (~2%) have serious gastrointestinal events, including bowel perforation, thrombosis, or bleeding. Also, there has to be caution with respect to healing following VEGF inhibitors (and chemotherapy), especially in complex multidisciplinary pathways requiring liver, vascular, or surgical intervention.
Adjuvant Therapy of Colon Cancer
Published in Peter Sagar, Andrew G. Hill, Charles H. Knowles, Stefan Post, Willem A. Bemelman, Patricia L. Roberts, Susan Galandiuk, John R.T. Monson, Michael R.B. Keighley, Norman S. Williams, Keighley & Williams’ Surgery of the Anus, Rectum and Colon, 2019
Irinotecan-based combination therapies have been investigated in several adjuvant treatment studies (CALGB 89803, FNCLCC/FFCD, PETACC-3). The so-called IFL regimen (weekly irinotecan and bolus 5-FU) showed no survival advantage compared to 5-FU/folinic acid alone38 in the study CALGB 89803. IFL was associated with an increased rate of early deaths occurring within 60 days. These were attributable to severe gastrointestinal side effects as well as to cardiovascular events. Studies in which irinotecan was combined with infusional 5-FU (FNCLCC/FFCD and PETACC-3) showed no increased early mortality.39,40 However, the study of the French group (FNCLCC/FFCD), which included only patients with high-risk stage III colorectal cancer patients (T4 category and/or N2 category), as well as the study of the multinational European study group PETACC-3, showed no statistically significant differences in DFS.39,40 Thus, a combination consisting of irinotecan plus bolus-5-FU is considered obsolete for reasons of patient safety and lack of efficiency. Irinotecan plus infusional 5-FU, on the other hand, was safely administered in the adjuvant trials but did not improve the prognosis of patients with resected colon carcinoma versus 5-FU/folinic acid, and is therefore not indicated.
Justification of Staff Positions in a Tightening Marketplace
Published in Florence S. Cromwell, Chestina Brollier, The Occupational Therapy Manager's Survival Handbook, 2013
The occupational therapy department at Northridge Hospital Medical Center is located in the Institute for Living (IFL), a 50 bed acute rehabilitation center. Physically, the IFL is adjacent to the general hospital, which has 325 medical/surgical beds. The occupational therapy department provides services for the rehabilitation center, the medical/surgical floors, as well as outpatient programs.
Safety and efficacy review of aflibercept for the treatment of metastatic colorectal cancer
Published in Expert Opinion on Drug Safety, 2022
David K. Lau, Justin Mencel, Ian Chau
Bevacizumab is a humanized IgG monoclonal antibody targeting vascular endothelial growth factor (VEGF)-A and is the most well studied anti-angiogenic drug in mCRC. The pivotal trial by Hurwitz et al. first confirmed the efficacy of anti-angiogenic therapy in mCRC. In this phase III, placebo-controlled study, patients were randomly allocated to receive IFL (irinotecan, 5FU, leucovorin) in addition to bevacizumab or placebo. Overall survival (OS) was prolonged with bevacizumab in comparison to placebo (20.3 vs 15.6 months, HR 0.66; P < 0.001) [4]. In the NO16966 study, the addition of bevacizumab to oxaliplatin-based chemotherapy as first-line therapy resulted in an improvement in progression free survival (PFS) in comparison to placebo (median PFS 9.4 vs 8.0 months, HR 0.83 97.5% CI, 0.72 to 0.95; P = 0.0023). However, overall survival was not significantly prolonged (median OS 21.3 vs 19.9 months, HR 0.89, 97.5% CI, 0.76 to 1.03; P = 0.077) [5]. Nowadays, bevacizumab has become a standard component of first-line chemotherapy, particularly where anti-EGFR therapy is not indicated such as KRAS mutant or right-sided tumors [6].
Identifying Language for People on the Autism Spectrum: A Scoping Review
Published in Issues in Mental Health Nursing, 2019
The study by Kenny et al. (2016) has been cited in recent publications to support use of IFL often without consideration of the significant limitations (Cage, Di Monaco, & Newell, 2018; Pellicano et al., 2018). The study was also incorrectly cited by Cooper et al. (2017). Nonetheless, results highlight that IFL is preferred by a number of autistic individuals. Parsloe (2015) positioned the adoption of the term Aspie as a discursive attempt to reclaim agency, symptoms and normalcy which paralleled the reappropriation of autistic presented as a political movement by Benham (2015) in their dissertation. Language reappropriation may serve to form a base for a collective through allegiance and solidarity (Bianchi, 2014). This may be perhaps particularly relevant for a condition known to be heterogeneous in presentation. The reclamation of language may be considered a discursive attempt at social protest, centred on the idea that the group targeted by language should have control over its use (Herbert, 2015).
Update on optimal treatment for metastatic colorectal cancer from the AGITG expert meeting: ESMO congress 2019
Published in Expert Review of Anticancer Therapy, 2020
David K. Lau, Matthew Burge, Amitesh Roy, Ian Chau, Daniel G. Haller, Jeremy D. Shapiro, Marc Peeters, Nick Pavlakis, Christos S. Karapetis, Niall C. Tebbutt, Eva Segelov, Timothy J. Price
Bevacizumab improves PFS when combined with both oxaliplatin- and irinotecan-based combination chemotherapy regimens and fluoropyrimidine monotherapy regimens in first-line treatment of mCRC [16–19]. When bevacizumab was given with irinotecan-based combination chemotherapy (IFL), compared to IFL alone there was an OS benefit [16] however this has not been consistently observed in prospectively randomized studies. Meta-analyses of the addition of bevacizumab to chemotherapy have concluded there is a small PFS and OS benefit with bevacizumab [20,21]. Table 1 summarizes key randomized studies investigating bevacizumab in the first-line treatment of mCRC.