Staff Publication

Real-world Effectiveness and Safety of Pazopanib in Patients With Intermediate Prognostic Risk Advanced Renal Cell Carcinoma (2019)

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Type of publication:
Journal article

Author(s):
Procopio G.; Bamias A.; Schmidinger M.; Hawkins R.; Sanchez A.R.; Estevez S.V.; *Srihari N.; Kalofonos H.; Bono P.; Pisal C.B.; Hirschberg Y.; Dezzani L.; Ahmad Q.; Rodriguez C.S.; Jonasch E.

Citation:
Clinical Genitourinary Cancer; Jun 2019; vol. 17 (no. 3), p. e526-e533

Abstract:
Introduction: The objective of this study was to determine the effectiveness and safety of pazopanib in patients with intermediate-risk advanced/metastatic renal cell carcinoma in the PRINCIPAL study (NCT01649778).
Patients and Methods: Patients had clear-cell advanced/metastatic renal cell carcinoma and met intermediate risk International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) and Memorial Sloan Kettering Cancer Center (MSKCC) criteria. Assessments included progression-free survival, overall survival, objective response rate, and safety. We also evaluated effectiveness based on number of risk factors, age, and performance status (PS), as well as safety in older and younger patients.
Result(s): Three hundred sixty three and 343 intermediate-risk MSKCC and IMDC patients were included, respectively. The median progression-free survival was 13.8 months (95% confidence interval [CI], 10.7-18.1 months) and 7.4 months (95% CI, 6.2-10.3 months) for patients with 1 and 2 MSKCC risk factors, respectively, and 13.1 months (95% CI, 10.7-18.1 months) and 8.1 months (95% CI, 6.4-10.7 months) for patients with 1 and 2 IMDC risk factors, respectively. The median overall survival was not reached and was 15.2 months (95% CI, 12.3-26.5 months) for patients with 1 and 2 MSKCC risk factors, respectively, and 33.9 months (95% CI, 33.9 months to not estimable) and 19.4 months (95% CI, 14.3 months to not estimable) with 1 and 2 IMDC risk factors, respectively. A lower overall response rate was observed with Eastern Cooperative Oncology Group PS >= 2 (vs. PS < 2). All-grade treatment-related adverse events occurred in approximately 63% of patients, and the safety profile among older and younger patients was similar.
Conclusion(s): Outcomes with pazopanib in intermediate-risk patients suggest that patients can be further stratified by number of risk factors (1 vs. 2) and Eastern Cooperative Oncology Group PS (< 2 vs. >= 2) to more accurately predict outcomes.Patients with intermediate-risk advanced renal cell carcinoma are a heterogeneous population, having either 1 or 2 risk factors. It is unclear whether all patients in this risk category should be treated similarly. A secondary analysis of the PRINCIPAL study of pazopanib found that
patients can be stratified by number of risk factors and Eastern Cooperative Oncology Group performance status to more accurately predict outcomes.

Failure of drip and suck in postoperative ileus: A faulty non-perforated NG tube (2019)

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Type of publication:
Journal article

Author(s):
*Bristow D.; *Shaw J.

Citation:
BMJ Case Reports; Jun 2019; vol. 12 (no. 6)

Abstract:
A 55-year-old woman developed a postoperative ileus with associated nausea and vomiting following an
elective laparotomy. A wide bore nasogastric (NG) tube was inserted for gastric decompression and symptom
relief. Aspiration of the tube was unsuccessful and the patient continued to vomit. Imaging to investigate the
acute abdomen demonstrated the nasogastric tube to be correctly sited and within pooled gastric contents.
Gentle initial attempts were made to unblock the NG but to no avail and therefore it was removed. On
inspection it was discovered that the NG tube had no distal perforations to allow drainage, causing failure and
increasing the patient's risk of aspiration. The aim of this report is draw attention to the importance of
scrutinising all medical equipment prior to use to prevent avoidable and potentially serious patient harm.

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Local experience at DGH shows combination Pertuzumab and Herceptin nearly doubles PCR rate of Neo-adjuvant Chemotherapy (NAC) in HER2 positive breast cancer (2018)

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Type of publication:
Poster presentation

Author(s):
*Blossom Lake, *Donna Appleton, *Abel Zachariah, *Habib Khan, *Kerry Flemming, *Jennifer Neill, *Laura Pettit

Citation:
Presented at BASO: The Association for Cancer Surgery

Link to poster [PDF]

Respiratory workload and medical staffing in uk local neonatal units (LNUS) and special care units (SCUS)-time for a rethink (2019)

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Type of publication:
Conference abstract

Author(s):
*Tyler W.; Fox G.F.; Fenton A.C.

Citation:
Archives of Disease in Childhood; May 2019; vol. 104

Abstract:
Introduction: The majority of UK neonatal care occurs in SCUs and LNUs with a smaller volume of highly complex care delivered by NICUs. Whilst the significant shortfall in nursing numbers nationally has been highlighted, medical staffing has received little attention. Aim To determine levels of medical staffing in UK LNUs/ SCUs, days of respiratory support provided and admissions weighing <1.5 kg. Methods Questionnaire sent to every LNU and SCU requesting details of medical tier staffing. ODNs provided the number of
respiratory care days (RCD – invasive and non-invasive mechanical respiratory support) delivered 2013-15 and numbers of admissions weighing <1.5 kg. Results 78 (86.7%) LNUs and 38 (95%) SCUs responded. 11/ 90 LNUs delivered <365 RCDs annually. Of these 9 admitted <25 infants weighing <1.5 kg. 6/40 SCUs delivered >365 RCDs annually. Significant numbers of LNUs and SCUs employed nontraining grade medical staff and ANNPs to cover rotas; neonatal CST holders or equivalent support many units (Tables 1 & 2). The 8/11 low-activity LNUs who responded provided partially separate Tier 1 staffing from paediatrics, consistent with SCU staffing recommendations only. Half of the high activity LNUs and all high activity SCUs did not achieve staffing standards for NICUs or LNUs respectively. Conclusions A wide range of activity is undertaken by UK LNUs and SCUs, with moderate overlap of workload between unit types. These data should inform potential unit redesignation as part of the current national reviews. Current medical and ANNP staffing is a major barrier to implementing change. (Table Presented).

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