ABSTRACT
OBJECTIVE: Despite an increasing number of therapeutic indications, there are no specific recommendations regarding the management of PARP inhibitors other than what is specified in the SmPC of each substance. A Delphi French consensus was conducted to establish practical guidelines to meet the needs identified by healthcare professionals and patients. METHOD: Following the Delphi method, statements to optimize PARP inhibitor management were drafted by a multidisciplinary Steering Committee made up of 17 experts. These statements were submitted to the independent and anonymous vote of clinicians involved in treating patients on PARP inhibitors. RESULTS: This article presents 52 statements on the following topics: initiation and treatment; management of adverse events (hematological effects, gastrointestinal effects, renal effects, pulmonary effects, cutaneous effects, hypertension, insomnia, fatigue, dizziness); special populations and situations; communication with the patient; adherence. Forty-nine statements obtained voter consensus after 3 voting rounds. A hematologist and a nephrologist supplemented this task by drafting an expert opinion on the risk of occurrence of secondary leukemia and nephrological toxicity. CONCLUSIONS: This paper is the first Delphi consensus on the practical management of PARP inhibitors. The pragmatic recommendations resulting from this paper should make it possible to manage the side effects of PARP inhibitors better and thus prevent early treatment discontinuation and improve patient adherence by preserving quality of life.
Subject(s)
Poly(ADP-ribose) Polymerase Inhibitors , Quality of Life , Humans , Consensus , Delphi Technique , Poly(ADP-ribose) Polymerase Inhibitors/adverse effects , Health PersonnelABSTRACT
Located across three sites in Ile-de-France, the Institut Curie combines care, research and teaching activities to fight cancer. Faced with the progression of ambulatory care, the departments have had to adapt in order to improve patient support and oversee community-hospital coordination. Nurses become involved just after the disclosure of the diagnosis by the doctor, but also coordinate the patient's pathway in ambulatory care. They anticipate the needs of the teams, the patients and their carers. Patients appreciate their availability and the fact that they have a single contact person.
Subject(s)
Day Care, Medical , Neoplasms/drug therapy , France , HumansABSTRACT
A health application is aimed at patients undergoing treatment at home, with chemotherapy or targeted therapy, administered orally. Medical safety, the collaborative approach, data protection and the respect of patients' rights form part of the ethical charter of this innovative project.
Subject(s)
Home Care Services, Hospital-Based , Mobile Applications , Neoplasms/drug therapy , Telemedicine , HumansABSTRACT
Two Rhodococcus erythropolis isolates, named A66 and A69, together with the well-characterized R. erythropolis strain IGTS8 were compared biochemically and genetically. Both isolates, like strain IGTS8, desulfurized DBT to 2-hydroxybiphenyl (2-HBP), following the 4S pathway of desulfurization. Strain IGTS8 showed the highest (81.5%) desulfurization activity in a medium containing DBT at 30 degrees C. Strain A66 showed approximately the same desulfurization activity either when incubated at 30 degrees C or at 37 degrees C, while strain A69 showed an increase of desulfurization efficiency (up to 79%) when incubated at 37 degrees C. Strains A66 and A69 were also able to grow using various organosulfur or organonitrogen-compounds as the sole sulfur or nitrogen sources. The biological responses of A66, A69 and IGTS8 strains to a series of mutagens and environmental agents were evaluated, trying to mimic actual circumstances involved in exposure/handling of microorganisms during petroleum biorefining. The results showed that strains A69 and IGTS8 were much more resistant to UVC treatment than A66. The three desulfurization genes (dszA, dszB and dszC) present in strains A66 and A69 were partially characterized. They seem to be located on a plasmid, not only in the strain IGTS8, but also in A66 and A69. PCR amplification was observed using specific primers for dsz genes in all the strains tested; however, no amplification product was observed using primers for carbazole (car) or quinoline (qor) metabolisms. All this information contributes to broaden our knowledge concerning both the desulfurization of DBT and the degradation of organonitrogen compounds within the R. erythropolis species.
