ABSTRACT
OBJECTIVE To evaluate the cost-utility of pembrolizumab combined with chemotherapy versus chemotherapy alone in the first-line treatment of advanced or metastatic esophageal carcinoma. METHODS Cost-utility analysis of pembrolizumab combined with chemotherapy versus chemotherapy alone for advanced or metastatic esophageal carcinoma was conducted by using a three-state partitioned survival model from the perspective of health system in China. The model use d a lifetime simulation time frame with 3 weeks as a cycle. The survival data were extrapolated using KEYNOTE- 590 data；cost data were obtained from the median of 2022 public winning bid on Yaozhi network ，among which the price of pembrolizumab was obtained after discounting by a patient assistance program ；utility data were obtained from the literatures ，and a 5％ discount rate was used for both cost and utility. One-way sensitivity analysis and probabilistic sensitivity analysis were also conducted to examine model robustness. RESULTS Analysis of the base case results showed that compared to chemotherapy alone ，the incremental cost-effectiveness ratio （ICER）of pembrolizumab combined with chemotherapy regimens were 950 528.42 yuan/QALY，107 845.39 yuan/QALY and 315 754.56 yuan/QALY for esophageal squamous cell carcinoma （ESCC），programmed deathligand- 1 combined positive score （PD-L1 CPS）≥10 and intention-to-treat population （ITT），respectively. The results of sensitivity analysis verified the robustness of the basic analysis results. CONCLUSIONS Under our healthcare system ，using a threshold of willingness-to-pay of 1-3 times our GDP per capita in 2021，pembrolizumab combined with chemotherapy regimen isn ’t cost-utility compared with chemotherapy alone in the ESCC and ITT subgroups of patients ，while it is cost-utility in the PD-L 1 CPS≥10 subgroup of patients.
ABSTRACT
Objective To investigate the clinical effect and patients of docetaxel and cisplatin combined with radiotherapy for advanced esophageal carcinoma of the safety and the effect on the immune status of patients. Methods 104 cases of advanced esophageal cancer patients admitted in Dongyang People's Hospital from January 2011 to June 2014 were divided into the control group and the observation group with 52 cases in each group. The two groups of patients were treated with three-dimensional conformal radiotherapy, total dose of 55~65gy, the course of treatment was six weeks, at the same time, the control group were treated with cisplatin (20mg/m2) combined with 5-fluorouracil (400mg/m2) chemotherapy, the observation group were treated with cisplatin (20mg/m2) combined with docetaxel (120mg/m2) chemotherapy, the course of treatment was three weeks. Compared the two groups of patients with clinical treatment effect, survival rate and the average survival time, adverse reaction rate, and detection of two groups of patients before and after the treatment of immune function index CD3+, CD4+, CD8+ and CD4+/CD8+ levels. Results The total effective rate of observation group was 86.53%, the total effective rate of control group was 69.23%, the difference was statistically significant (P< 0.05), the patients in the observation group two years survival rate and mean survival time were significantly better than the control group, the difference was statistically significant (P< 0.05), the adverse reaction rate of the observation group was 59.62%, the adverse reaction rate of the control group was 65.38%, the difference was statistically significant (P< 0.05), two patients immune function indexes of CD3+, CD4+, CD8+ and CD4+/CD8+ levels had no significant difference before treatment after treatment, patients in the observation group, CD4+, CD3+, CD8+and CD4+/CD8+were significantly better than the control group, the difference was statistically significant (P< 0.05). Conclusion Three-dimensional conformal radiotherapy based on cisplatin combined with docetaxel chemotherapy is superior to cisplatin combined with 5-fluorouracil chemotherapy, and less adverse reaction, while patients with advanced esophageal carcinoma immune function less.
ABSTRACT
Objective To explore how to promote the early medical consultation of patients with advanced esophageal cancer to improve the curative rate and the survival rate. Methods With the phenomenological research method, 12 patients with advanced esophageal cancer were sampled for the research. The semi-structure interview method was conducted to collect the data for analyses. Result There were 6 factors influencing the early consultation from the patients with advanced esophageal cancer in their early medical treatment, which included 6 items: lack of knowledge of the disease, economic burden, ignorance of early symptoms, lower medical level, heavy psychological burden of the disease, ageing and delay in seeking medical care. Conclusions The promotion of early medical treatment to the patients with esophageal carcinoma is in critically emergency. The measures including reducing economic burden, corresponding nursing care and health education can improve the cure rate and life quality.
ABSTRACT
Objective To observe the clinical effect of treating advanced esophageal carcinoma with three-dimensional conformal radiotherapy combined with chemotherapy and traditional Chinese medicine.Methods 36 cases with advanced esophageal carcinoma were randomly divided into a eontrol group and a treatment group.The control group was treated with conventional radiotherapy combined with chemotherapy,and the treatment group was treated with three-dimensional conforrnal radiotherapy combined with chemotherapy and traditional Chinese medicine.The short-term effect,toxicity and long-term effect were observed,and cause of death was analyzed.Results The complete remission rate in the treatment group was significantly higher than that of the control group(P＜0.05).The toxicity of the treatment group was markedly decreased.One and three years'survival rate between the two groups had a significant difierent(P＜0.05),but five years'survival rate between the two groups had no significant difference(P＞0.05).Local uncontrolled rate and recurrence rate in the treatment group were significantly lower than those in the control group(p＜0.05).Conclusion The treatment of three-dimensional conformal radiotherapy combined with chemotherapy and traditional Chinese medicine on advanced esophageal carcinoma was better than conventional radiotherapy combined with chemotherapy.
ABSTRACT
OBJECTIVE:To observe the efficacy and toxicity of compound glycyrrhizin(Stronger Neo-Minophagen C SNMC) plus chemoradiotherapy in treating advanced esophageal carcinoma.METHODS:A total of 88 patients with advanced esophageal carcinoma were randomly assigned to receive compound glycyrrhizin in combination with chemoradiotherapy(trial group) or chemoradiotherapy alone(control group) with 3 weeks as one course of treatment.The efficacy and toxicity of the two groups after 2 courses of treatment were evaluated.RESULTS:The response rate of the trial group vs.control group was 70.5% vs.59.1%(P
ABSTRACT
AIM:To evaluate the efficacy and safety of the regimen based on platinum compound plus docetaxel in the treatment of advanced esophageal carcinoma as first-line drug,and to further explore prognostic factors of advanced esophageal carcinoma by survival analysis.METHODS:From August 2006 to October 2008,36 patients with advanced esophageal carcinoma were enrolled in the study,and non-randomly assigned to docetaxel 75 mg/m2 in the first day every 3 weeks,combined with cisplatin 25 mg/m2 in the first day to third day or in the first day to forth day(DT,n=27),or with carboplatin AUC=5 on day 1(CT,n=9).RESULTS:The curative and toxic side effects were evaluated to the 36 patients.There were 1 complete respone,17 partial respone,11 no changes and 7 progressive disease in 36 patients with total response rate of 50.00%.The response rates of DT,CT regimen were 59.26% and 22.22%(P=0.121).The major side effects were nausea-vomiting,all side effects were reversible by symptomatic treatment.After a median follow-up of 8.70 months,the overall median survival was 10.50 months(95% CI 7.36 to 13.64 months).The COX univariate regression analysis suggested there was no correlation with sex,age and the hemoglobin of before chemotherapy with existence.But there was statistical significance between the behavior state of chemotherapy and the existence(P=0.036).CONCLUSION:The regimen based on platinum compound plus docetaxel is tolerable and more effective as a first-line treatment for advanced esophageal carcinoma.Patients with good performance status before chemotherapy indicates good prognosis and it is an independent factor affecting survival for advanced esophageal carcinoma.
ABSTRACT
Purpose: The aim of this study is to assess the anti tumor efficacy and safety of high dose folinic acid plus 5 fluorouracil bolus and continuous infusion 48 hours combined with cisplatin in treating advanced esophageal carcinoma. Methods:Thirty patients with advanced esophageal carcinoma were treated with high dose folinic acid plus 5 fluorouracil bolus and continuous infusion 48 hours combined with cisplatin.Results: There were two complete responses, fourteen partial responses, thirteen no changes and one progressive disease in this series with total response rate of 53.33%. The main side effects include nausea and vomiting, mucositis, bone marrow suppression and alopecia. Other side effects were uncommon. All side effects were tolerable and mild except for nausea vomiting. Conclusions: High dose folinic acid plus 5 fluorouracil bolus and continuous infusion 48 hours combined with cisplatin may be a safe and effective therapy for the patients with advanced esophageal carcinoma.