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Delay in diagnosis of head and neck cancer – pro

Diagnosis and treatmetn of head and neck cancer is complex and requires co-ordination or providers and resources. Delays in diagnosis is not uncommon. In a Canadian study, median patient, professional and total delays were 4.5 weeks, 11.8 weeks and 22.5 weeks, respectively. Significantly longer delays were found among women(p < 0.01), non-smokers (p < 0.01), patients who were not referred following initial consultation(p < 0.001) and patients

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Hyper CVAD for Burkitts – pro

Standard doxorubicin-based combination chemotherapy, such as CHOP, frequently induces remissions of short duration. The overall CR rate is 915 and induction-therapy mortality was low (6%). In one review the estimated 5-year CR rate was 38% and the estimated 5-year survival rate was 39%. These results were achieved despite broad entrance criteria (no exclusions by age, performance status, organ dysfunction, or infection status at the time of diagnosis).

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Oncotype 2018 update – pro

Oncotype is now widely accepted, but not for node+ cancer, which this is. The American Society of Clinical Oncology (ASCO) has included Oncotype DX™ into its 2007 updated clinical guidelines for the use of tumor markers in breast cancer. Most recently, NCCN has decided to include Oncotype in its 2008 guidelines and BCBS issued a supportive TEC assessment. All of these, however, was in node negative patients, but NCCN changed that as well and one

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Votrient for sarcoma – pro

Pazopanib, brand name Votrient, is an oral angiogenesis inhibitor targeting vascular endothelial growth factor receptor (VEGFR), platelet derived growth factor receptor (PDGFR), and KIT. Inhibitors of VEGFR like pazopanib (Votrient, GlaxoSmithKline), show activity against leiomyosarcoma, synovial sarcoma and other sarcomas including those of vascular origin. There is one supportive phase II study from EORTC. It concluded: “Pazopanib is well tolerated

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Zydelig for mantle cell lymphoma – pro

Brad S. Kahl, Stephen E. Spurgeon, Richard R. Furman, Ian W. Flinn, Steven E. Coutre, Jennifer R. Brown, Don M. Benson, John C. Byrd, Sissy Peterman, Yoonjin Cho, Albert Yu, Wayne R. Godfrey and Nina D. Wagner-JohnstonA phase 1 study of the PI3K inhibitor idelalisib in patients with relapsed/refractory mantle cell lymphoma (MCL). Blood 2014 123:3398-3405; Furman, Richard R.; Sharman, Jeff P.; Coutre, Steven E.; Cheson, Bruce D.; Pagel, John M.; Hillmen,

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Total Therapy for myeloma – pro

Total Therapy is the name of an approach to therapy of which  several successive versions have been tested and reported by Dr. Bart Barlogie of the University of Arakansas. He continues to refine and develop the Total Therapy multi-drug approach and is now up to using Total Therapy 6. Total Therapy 4 and Total Therapy 5, initiated in late 2008, use a risk-adapted approach based on a predictive model built from gene expression profiling data. Total

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Protonix for feeding tube – pro

Indications for PROTONIX: Short-term treatment (up to 8 weeks) and maintenance of healing of erosive esophagitis (EE). Long-term treatment of pathological hypersecretory conditions (eg, Zollinger-Ellison syndrome). Protonix is often used to prevent dyspeptic symptoms due to acid rising around the tube into the esophagus and to decrease the risk of aspiration. Wensel TM. Administration of proton pump inhibitors in patients requiring enteral nutrition.

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Transcutaneous stimulation (TENS) – pro

Transcutaneous electrical nerve stimulation (TENS) uses a battery operated device that applies electrical stimulation at the site of the pain by wired electrodes that are taped to the surface of the skin. TENS can also be delivered by a form-fitting conductive garment (i.e., a garment with conductive fibers which are separated from the patients' skin by layers of fabric) and is used when a condition exists that precludes conventional TENS electrode

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Interferon for VIPoma – pro

The VIPoma syndrome is rare and difficult to treat and for this reason, ti is not well studied. It is usually caused by a neuroendocrine tumor located in the pancreas or other organs and present primarily with diarrhea. Treatment relies on resection and octreotide but occasionally interferon or steroids can be used as adjuncts (Best Practice, Eppocrates). On the other hand, other reviews do not mention interferon or mention it in combiantion with

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Multiple Myeloma, Tandem vs Second Transplants and Total Therapy – pro

Lay Summary: I review the current status of tandem versus second transplant and Total Therapy. One needs to differentiate between tandem transplants, a planned sequence of two high dose treatments with HSCT salvage, and a second transplant, an approach of consolidating the first autologous HSCT with another HSCT ONLY if the first one appears partially effective. A tandem autologous transplant, also known as a double autologous transplant, requires

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