Organoid culture media formulated with growth factors of defined cellular activity.

The media formulations necessary for deriving and sustaining organoids from epithelial tissues such as prostate, colon, gastric, liver, pancreas, and others have been established. Critical components of organoid media are a set of growth factors that include R-spondins and BMP signalling antagonists such as Noggin or Gremlin 1. Currently, the practical limitations for formulating organoid media of reproducible potency and larger-scale media production that have hampered further technological applications of organoid technology include: the cost of growth factors such as R-spondins and Gremlin 1/Noggin and their production as defined specific activities free of contaminants that may affect organoid growth. Here we report the production of highly pure recombinant Gremlin 1 and R-spondin 1 from bacterial expression for use in organoid media. We detail the workflow for Gremlin 1 and R-spondin 1 expression, purification, quantification of cellular activity, quality control and use in media formulated for culturing organoids derived from a number of tissues. The development of precisely formulated, cost-effective media of defined specific activity will engender the development of novel applications for organoid technology.

White blood cell growth factor use in an outpatient oncology clinic: Lessons and opportunities learned.

The increased use and high cost associated with white blood cell growth factors at our outpatient oncology clinic has prompted this evaluation. The objectives of this study were to categorize the indication for use of pegfilgrastim and filgrastim; evaluate the administration of these white blood cell growth factors; identify opportunities for cost savings; and identify ways to increase prescriber adherence to evidence-based practice guidelines. This medication use evaluation study involved retrospective data collection from patient medical records. Adult oncology patients treated in the outpatient oncology clinic who received filgrastim or pegfilgrastim were identified and included in this study. Computerized patient records were used to collect data on patient demographics, risk factors for febrile neutropenia, prescribing patterns for filgrastim and pegfilgrastim, and chemotherapy regimens. The number of pegfilgrastim and filgrastim doses were predominately used for primary prophylaxis following chemotherapy treatment. Of the 234 total doses of pegfilgrastim used in the setting of primary prophylaxis, 28 (12%), 134 (57%), and 72 (31%) doses were given to patients receiving chemotherapy regimens associated with a high risk (>20%), intermediate risk (10-20%), and low risk (<10%) of febrile neutropenia, respectively. The total number of pegfilgrastim doses used in secondary prophylaxis was 78; 20 (26%) and 58 (74%) of these doses were given to patients receiving chemotherapy regimens associated with an intermediate risk and low risk of febrile neutropenia, respectively. This study revealed a significant portion of prescribed growth factor use that was not in accordance with clinical practice guidelines.

Medical oncologists' perceptions of financial incentives in cancer care.

PURPOSE: The cost of cancer care continues to increase at an unprecedented rate. Concerns have been raised about financial incentives associated with the chemotherapy concession in oncology practices and their impact on treatment recommendations. METHODS: The objective of this study was to measure the physician-reported effects of prescribing chemotherapy or growth factors or making referrals to other cancer specialists, hospice, or hospital admissions on medical oncologists' income. US medical oncologists involved in the care of a population-based cohort of patients with lung or colorectal cancer from the Cancer Care Outcomes Research and Surveillance (CanCORS) study were surveyed regarding their perceptions of the impact of prescribing practices or referrals on their income. RESULTS: Although most oncologists reported that their incomes would be unaffected, compared with salaried oncologists, physicians in fee-for-service practice, and those paid a salary with productivity incentives were more likely to report that their income would increase from administering chemotherapy (odds ratios [ORs], 7.05 and 7.52, respectively; both P < .001) or administering growth factors (ORs, 5.60 and 6.03, respectively; both P < .001). CONCLUSION: A substantial proportion of oncologists who are not paid a fixed salary report that their incomes increase when they administer chemotherapy and growth factors. Further research is needed to understand the impact of these financial incentives on both the quality and cost of care.