ErbB2+ metastatic breast cancer treatment after progression on trastuzumab: a cost-effectiveness analysis for a developing country / Tratamientos para cáncer de seno metastásico ErbB2+ en progresión Post-Trastuzumab: Análisis de costo-efectividad para un país en vía de desarrollo

Objective Breast cancer (BC) and metastatic breast cancer (MBC) are significant causes of deaths amongst women worldwide, including developing countries. The cost of treatment in the latter is even more of an issue than in higher income countries. ErbB2 overexpression is a marker of poor prognosis and the goal for targeted therapy. This study was aimed at evaluating the cost-effectiveness in Colombia of ErbB2+ MBC treatment after progression on trastuzumab. Methods A decision analytic model was constructed for evaluating such treatment in a hypothetical cohort of ErbB2+MBC patients who progressed after a first scheme involving trastuzumab. The alternatives compared were lapatinib+capecitabine (L+C), and trastuzumab+a chemotherapy agent (capecitabine, vinorelbine or a taxane). Markov models were used for calculating progression-free time and the associated costs. Effectiveness estimators for such therapy were identified from primary studies; all direct medical costs based on national fees-guidelines were included. Sensitivity was analyzed and acceptability curves estimated. A 3 % discount rate and third-payer perspective were used within a 5-year horizon. Results L+C dominated its comparators. Its cost-effectiveness ratio was COP $49,725,045 per progression-free year. The factors most influencing the results were the alternatives' hazard ratios and the cost of trastuzumab. Conclusion Lapatinib was cost-effective compared to its alternatives for treating MBC after progression on trastuzumab using a Colombian decision analytic model.

Objetivo El cáncer de seno (CS) y cáncer de seno metastásico (CSM) son importantes causas de muerte entre las mujeres a nivel mundial y en países en vía de desarrollo. En estos últimos los costos de los tratamientos son aún más preocupantes que en países de alto ingreso. La sobreexpresión de ErbB2 es marcador de pobre pronóstico y objetivo de terapias dirigidas. Se evaluó la costo-efectividad de los tratamientos de CSM ErbB2+ en progresión post-trastuzumab en Colombia. Métodos Se desarrolló un modelo analístico de decisiones para evaluar los tratamientos en una cohorte hipotética de CSM ErbB2+ que progresaron después de un primer esquema con trastuzumab. Las alternativas comparadas fueron: lapatinib+capecitabina (L+C), y trastuzumab más un agente quimioterápico (capecitabina, vinorelbinao un taxano). Se usaron modelos de Markov para calcular el tiempo libre de progresión y los costos asociados. Estimaciones de efectividad fueron identificadas de estudios primarios. Se incluyeron todos los costos médicos directos basados en los manuales tarifarios nacionales. Se realizaron análisis de sensibilidad y curvas de aceptabilidad. Se descontaron costos y resultados a una tasa anual de 3 %, la perspectiva de análisis fue del tercer pagador y el horizonte de 5 años. Resultados L+C domina a sus comparadores con un razón de costo-efectividad de COP $49 725 045 por año libre de progresión. Los factores que más influencian los resultados son los hazard ratios de las alternativas y el costo de trastuzumab. Conclusión Lapatinib es costo-efectivo comparado con sus alternativas para el tratamiento del CSM después de la progresión con trastuzumab en el escenario colombiano.

Retrospective Study of Gefitinib as a Second Line Treatment in Lung Cancer.

Objective: To find out response of Gefitinib in terms of overall survival in advanced non small cell carcinoma lung progressed after primary treatment. Methods: It is a retrospective study of clinical data experienced with use of Gefitinib as a second line treatment of advanced non small cell carcinoma lung progressed after primary treatment from period of March 2007 to March 2009 in Burdwan Medical College and Hospital at Department of Radiotherapy (Oncology). Results: Among patients treated with Gefitinib (n – 37) median overall survival was 9.6 months whereas, patients treated with placebo median survival was 5.3 months. There is a significant survival advantage ( p < 0.001) in Gefitinib group. Conclusion: Gefitinib is a well tolerated drug and it has a significant survival advantage in advanced non small cell carcinoma lung progressive after primary treatment.

Vortex Keratopathy in a Patient Receiving Vandetanib for Non-Small Cell Lung Cancer

We report a case of vortex keratopathy in a patient treated with vandetanib for non-small cell lung cancer (NSCLC). A 44-year-old female who underwent two cycles of chemotherapy for NSCLC complained of visual blurring in both eyes after the initiation of vandetanib, an anti-epidermal growth factor receptor (EGFR) and anti-vascular endothelial growth factor receptor 2 protein tyrosine kinase inhibitor. On ophthalmic examination, visual acuities were 20 / 20 OU and, with the exception of diffuse vortex keratopathy in both eyes, other findings were unremarkable. Vandetanib is believed to have caused vortex keratopathy in this patient. Anti-EGFR properties affecting normal corneal epithelial cell migration and wound healing or drug associated metabolite deposition, which is the case in numerous drug-associated vortex keratopathies, may be possible underlying mechanisms in the formation of this corneal complication.

Alfuzosin hydrochloride transdermal films: evaluation of physicochemical, in vitro human cadaver skin permeation and thermodynamic parameters

Purpose: The main objective of the investigation was to develop a transdermal therapeutic system for alfuzosin hydrochloride and to study the effects of polymeric system and loading dose on the in vitro skin permeation pattern. Materials and methods: Principles of experimental design have been exploited to develop the dosage form. Ratio of ethyl cellulose (EC) and polyvinyl pyrrolidone (PVP) and loading dose were selected as independent variables and their influence on the cumulative amount of alfuzosin hydrochloride permeated per cm2 of human cadaver skin at 24 h (Q24), permeation flux (J) and steady state permeability coefficient (P SS) were studied using experimental design. Various physicochemical parameters of the transdermal films were also evaluated. Activation energy for in vitro transdermal permeation has been estimated. Results: Ratio of EC and PVP was found to be the main influential factor for all the dependent variables studied. Drug loading dose was also found to influence the dependent variables but to a lesser extent. Physicochemical parameters of the prepared films were evaluated and found satisfactory. Activation energy for alfuzosin permeation has also been estimated and reported. Conclusion: The therapeutic system was found to be dermatologically non-irritant and hence, a therapeutically effective amount of alfuzosin hydrochloride can be delivered via a transdermal route.

Lapatinib for treatment of advanced or metastasized breast cancer: systematic review / Lapatinib no tratamento do câncer de mama avançado ou metastático: revisão sistemática

Context and objective: Around 16 percent to 20 percent of women with breast cancer have advanced, metastasized breast cancer. At this stage, the disease is treatable, but not curable. The objective here was to assess the effectiveness of lapatinib for treating patients with advanced or metastasized breast cancer. Design and setting: Systematic review of the literature, developed at Centro Paulista de Economia da Saúde (CPES), Universidade Federal de São Paulo (Unifesp). Method: Systematic review with searches in virtual databases (PubMed, Lilacs [Literatura Latino-Americana e do Caribe em Ciências da Saúde], Cochrane Library, Scirus and Web of Science) and manual search. Results: Only one clinical trial that met the selection criteria was found. This study showed that lapatinib in association with capecitabine reduced the risk of cancer progression by 51 percent (95 percent confidence interval, CI: 0.34-0.71; P < 0.001), compared with capecitabine alone, without any increase in severe adverse effects. Conclusion: The combination of lapatinib plus capecitabine was more effective than capecitabine alone for reducing the risk of cancer progression. Further randomized clinical trials need to be carried out with the aim of assessing the effectiveness of lapatinib as monotherapy or in association for first-line or second-line treatment of advanced breast cancer.

Contexto e objetivo: Aproximadamente 16 por cento a 20 por cento das mulheres com câncer de mama têm doença avançada com metástases. Neste estágio, a doença é tratável, porém incurável. O objetivo foi avaliar a efetividade do lapatinib no tratamento de pacientes com câncer de mama avançado ou metastático. Tipo de estudo e local: Revisão sistemática da literatura desenvolvida no Centro Paulista de Economia da Saúde (CPES), Universidade Federal de São Paulo (Unifesp). Método: Revisão sistemática com busca em bases de dados virtuais (PubMed, Lilacs [Literatura Latino-Americana e do Caribe em Ciências da Saúde], Cochrane Library, Scirus and Web of Science) e busca manual. Resultados: Foi encontrado apenas um ensaio clínico que preencheu os critérios de seleção. Este estudo mostrou que o lapatinib em associação com a capecitabina reduziu em 51 por cento o risco de progressão da doença (intervalo de confiança, IC 95 por cento: 0,34-0,71; P < 0,001) quando comparado com a capecitabina isolada, sem aumento de efeitos adversos graves. Conclusão: A combinação de lapatinib e capecitabina foi mais efetiva do que a capecitabina isolada na redução do risco de progressão da doença. Ensaios clínicos aleatórios devem ser realizados com o objetivo de avaliar a efetividade do lapatinib como monoterapia ou em associação no tratamento primário ou secundário do câncer de mama avançado.

Tratamiento médico del adenoma prostático / Medical treatment of prostatic adenoma

14 pacientes portadores de Adenoma prostático menor de 40 gramos, con edad promedio de 62 años, fueron tratados con 2 a 2.5 mg de terazosin diarios. El seguimiento a 12 meses muestra que 10 enfermos (71,4 por ciento) han mejorado su score sintomático en 12 puntos y su calidad de vida en 2 grados. Un paciente (7 por ciento) presentó mareos atribuíbles al medicamente y ninguno tuvo complicaciones derivadas del adenoma