Choice of first line systemic treatment in pancreatic cancer among national experts.

BACKGROUND: Treatment options for patients with metastatic pancreatic cancer depend on various factors, including performance status, tumor burden and patient preferences. Metastatic pancreatic cancer is incurable and many systemic treatment options have been investigated over the past decades. This analysis of patterns of practice was performed to identify decision criteria and their impact on the choice of first-line management of metastatic pancreatic cancer. MATERIALS AND METHODS: Members of the Swiss Group for Clinical Cancer Research (SAKK) Gastrointestinal Cancer Group were contacted and agreed to participate in this analysis. Decision trees for the first line treatment of metastatic pancreatic cancer from 9 centers in Switzerland were collected and analyzed based on the objective consensus methodology to identify consensus and discrepancies in clinical decision-making. RESULTS: The final treatment algorithms included 3 decision criteria (comorbidities, performance status and age) and 5 treatment options: FOLFIRINOX, FOLFOX, gemcitabine + nab-paclitaxel, gemcitabine mono and best supportive care. CONCLUSION: We identified multiple decision criteria relevant to all participating centers. We found consensus for the treatment of young (age below 65) patients with good performance status with FOLFIRINOX. For patients with increasing age and reducing performance status there was a decreasing trend to use gemcitabine + nab-paclitaxel. Gemcitabine monotherapy was typically offered to patients in the presence of comorbidities. For patients with ECOG 3-4, most of the experts recommended BSC.

Arthrodesis of the tarsometatarsal joints in a cat with a two hole advanced locking plate system.

This report describes the successful use of the novel fixed-angle locking plating system ALPS (advanced locking plate system) in the case of dorsal tarsometatarsal instability in a cat. Partial arthrodesis of the tarsometatarsal joint was performed with a two hole ALPS 5 and two 2.4 mm selftapping locking screws through a small dorsal approach. Five days after the surgery the cat was walking without lameness. Radiographs made after six weeks showed uneventful healing. ALPS offers an alternative to existing plating systems when selecting an implant for the stabilisation of dorsal tarsometatarsal instabilities in cats.

Tibial tuberosity conformation as a risk factor for cranial cruciate ligament rupture in the dog.

The influence of the tibial tuberosity conformation on cranial cruciate ligament (CrCl) rupture was evaluated and the size of the tibial tuberosity of healthy dogs (group H) was compared with dogs with CrCl rupture (group R) and dogs treated by tibial tuberosity advancement (TTA) (group T). The medio-lateral radiographs of 219 stifle joints were evaluated. Relative tibial tuberosity width (rTTW), proximal tibial tuberosity angle (PTTA), tibial plateau angle (TPA), tibial width (TW) and tibial plateau length (TPL) were measured on each radiograph. Body weight (BW) was measured and relative body weight (rBW) was calculated. The data from group H was compared with that of group R and group T. Group H had significantly larger rTTW, lower BW, lower rBW and smaller PTTA than group R. A comparison of groups H and T showed that dogs from group H were significantly younger, had a lower BW, a lower rBW, a greater PTTA and a smaller rTTW. In each of the comparisons, the TPA and the TW/TPL were not significantly different. The conformation of the canine tibial tuberosity has a significant influence on CrCl rupture. We hypothesized that the smaller the tibial tuberosity width, the larger the cranial tibial thrust, which results in more rapid CrCL degeneration, thus leading to rupture in a younger population of dogs. The rTTW could be a helpful measurement for breeding selection. Only dogs with a rTTW of more than 0.90 should be used for breeding.

Renal safety profiles of ibandronate 6 mg infused over 15 and 60 min: a randomized, open-label study.

BACKGROUND: Clinical data show that a single, 15-min i.v. infusion of ibandronate 6 mg does not significantly alter renal function. We evaluated the effect on renal function of repeated 15-min infusions of ibandronate 6 mg in women with breast cancer and bone metastases. PATIENTS AND METHODS: Patients were randomly assigned to i.v. ibandronate 6 mg every 3-4 weeks for < or =6 months, infusion over 15 min (n = 102) or 60 min (n = 28). The primary end point was the percentage of patients with increased serum creatinine of > or =44.2 micromol/l. Blood chemistry was assessed at each visit. RESULTS: Two per cent [2/101; 95% confidence interval (CI) 0.2-7.0] of patients in the 15-min infusion arm and no patients (0/26; 95% CI 0.0-13.2) in the 60-min infusion arm had increased serum creatinine that met the primary end point. There were no clinically relevant changes in serum creatinine, creatinine clearance, or N-acetyl-beta-d-glucosaminidase, alpha(1)-microglobulin, or microalbuminuria. Most adverse events were mild or moderate. No clinically relevant changes were observed in vital signs, hematology, blood chemistry, or urine analysis. CONCLUSIONS: Ibandronate 6 mg by 15-min infusion every 3-4 weeks appear to be consistent with those renal safety profiles of 60-min infusion.