Clinical and economic impact of drug eluting beads in transarterial chemoembolization for hepatocellular carcinoma

Summary What is known and objective Drug eluting beads (DEBs) theoretically improve the efficacy and safety of transarterial chemoembolization (TACE) in hepatocellular carcinoma (HCC). Nonetheless, their economic profile has not been assessed. Our retrospective before/after study aimed to compare efficacy, safety and economic profile of two strategies of TACE without (Period 1) or with the possibility of using DEBs (Period 2). Methods All HCC patients treated by TACE in our hospital between March 2006 and May 2013 were included. Economic analyses were performed from the French Public Health Insurance point of view according to the French Diagnosis-Related Group prospective payment system an…

Idarubicin-loaded beads for chemoembolisation of hepatocellular carcinoma: results of the IDASPHERE phase I trial

SummaryBackground A phase I dose-escalation trial of transarterial chemoembolisation (TACE) with idarubicin-loaded beads was performed in cirrhotic patients with hepatocellular carcinoma (HCC). Aim To estimate the maximum-tolerated dose (MTD) and to assess safety, efficacy, pharmacokinetics and quality of life. Methods Patients received a single TACE session with injection of 2 mL drug-eluting beads (DEBs; DC Bead 300–500 μm) loaded with idarubicin. The idarubicin dose was escalated according to a modified continuous reassessment method. MTD was defined as the dose level closest to that causing dose-limiting toxicity (DLT) in 20% of patients. Results Twenty-one patients were enrolled, inclu…

Clinical and economic impact of pharmacist interventions in an ambulatory hematology–oncology department

Objectives To evaluate clinical and financial impact of pharmacist interventions in an ambulatory adult hematology–oncology department. Methods All cancer patients receiving a first injectable immuno- and/or chemotherapy regimen were included in this prospective study over a one-year period. The clinical impact of pharmacist interventions made by two clinical pharmacists was rated using the Clinical Economic and Organizational tool. Financial impact was calculated through cost savings and cost avoidance. Main results: Five hundred and fifty-eight patients were included. A total of 1970 pharmacist interventions were performed corresponding to a mean number of 3.5 pharmacist interventions/pat…

Randomised controlled trial of lipiodol transarterial chemoembolisation with or without amiodarone for unresectable hepatocellular carcinoma.

Abstract Background There is no consensus about the most effective method for transarterial chemoembolisation of hepatocellular carcinoma. Aim The aim of this phase II trial was to compare the efficacy and toxicity of lipiodol transarterial chemoembolisation with amiodarone in association with pirarubicin or doxorubicin versus lipiodol transarterial chemoembolisation with anthracycline alone in a control group. Methods Patients with unresectable hepatocellular carcinoma and Child-Pugh A/B7 were considered eligible for the trial. transarterial chemoembolisation was repeated every 6 weeks for a maximum of 4 sessions. Results Thirteen patients were randomised in the amiodarone group, and 14 we…

sj-pdf-1-opp-10.1177_1078155220915763 - Supplemental material for Clinical and economic impact of pharmacist interventions in an ambulatory hematology–oncology department

Supplemental material, sj-pdf-1-opp-10.1177_1078155220915763 for Clinical and economic impact of pharmacist interventions in an ambulatory hematology–oncology department by Jonathan de Grégori, Pauline Pistre, Meredith Boutet, Laura Porcher, Madeline Devaux, Corinne Pernot, Marie L Chrétien, Cédric Rossi, Sylvain Manfredi, Sophie Dalac, Pauline Gueneau and Mathieu Boulin in Journal of Oncology Pharmacy Practice

Impact économique de la chimioembolisation avec microsphères chargées dans le traitement du carcinome hépatocellulaire

Resume La chimioembolisation est le traitement de premiere ligne pour les patients atteints d’un carcinome hepatocellulaire (CHC) non resecable, non metastatique. Les microspheres chargees d’anticancereux recemment commercialisees ont pour objectif d’augmenter l’efficacite de la chimioembolisation en permettant un relargage controle et prolonge de l’anticancereux au plus proche de la tumeur. Notre etude monocentrique compare selon deux methodes de valorisation, les couts medicaux hospitaliers directs d’une premiere cure de chimioembolisation conventionnelle et d’une premiere cure de chimioembolisation avec microspheres chez 30 patients atteints de CHC. Le cout moyen valorise par la comptabi…

Generic vancomycin products: Analysis of serum concentrations in patients with acute myeloid leukemia.

Summary Concerns have recently emerged about the quality of generic vancomycin products. Our aim is to analyze serum vancomycin concentrations measured 48 hours after the start of an empirical treatment regimen in patients with acute myeloid leukemia (AML) who received one of the two generic vancomycin products available in France. Patients and methods Seventy-nine AML patients treated with vancomycin during two study periods were included in the study. Our vancomycin dosing regimen was based on the patients’ total body weight adjusted for renal clearance. Results A total of 93 serum vancomycin concentrations were collected: 31 in period 1 and 62 in period 2. In bivariate analysis, the mean…

Impact of pharmaceutical intervention on quality of life and coping strategies in patients with haematological malignancies

Summary Objectives We conducted a prospective study approved by the local ethics committee to determine the impact of a pharmaceutical intervention (PI) on pain, fatigue, quality of life (QoL) and coping strategies in patients with HMs starting chemotherapy sessions. Material and methods Patients received either usual care (UC) + PI (PI group) or UC alone (UC group). They had to complete 2 questionnaires, QLQ-C30 and MAC 21, at 3 different time points: before starting the 1st chemotherapy session (T1), during the intercure (T2) and the day before starting the 2nd chemotherapy session (T3). To determine predictive factors of pain, fatigue, QoL and coping scores at T3, a multivariate ANOVA wa…

Predictive factors of transarterial chemoembolisation toxicity in unresectable hepatocellular carcinoma

Abstract Background Transarterial chemoembolisation (TACE) is an effective treatment for unresectable hepatocellular carcinoma (HCC), but can cause severe toxicity. Aim To identify predictive factors of severe TACE-related toxicity in patients with unresectable HCC. Methods All HCC patients who underwent TACE at the Dijon University Hospital between 2008 and 2011 were included in this retrospective study. Severe TACE-related toxicity was defined as the occurrence of any adverse event grade ≥4, or any adverse event that caused a prolongation of hospitalisation of >8 days, or any additional hospitalisation within 1 month after TACE. Factors predicting toxicity were identified using a logistic…

Résultat et coût de la chimioembolisation hépatique avec des billes chargées chez 21 patients

Resume Objectif L’objectif de notre travail est d’evaluer le resultat et le cout global d’une strategie de traitement des patients atteints d’un carcinome hepatocellulaire (CHC) non resecable non metastatique par chimioembolisation (CHE) avec billes chargees. Patients et methodes L’ensemble des patients traites par CHE avec billes chargees pour un CHC entre janvier 2009 et decembre 2010 dans notre etablissement a ete inclus dans l’etude. Tous les patients etaient traites selon une strategie « a la demande » avec evaluation apres chaque cure de CHE. Resultats Vingt et un patients ont recu en moyenne 1,3 cures. La mediane de temps jusqu’a arret du traitement et la mediane de survie sans progr…

Adherence to immunomodulatory drugs in patients with multiple myeloma

Background Immunomodulatory drugs (thalidomide, lenalidomide and pomalidomide; IMID) are widely used in the treatment of multiple myeloma patients. To date, few data are available on IMID adherence in multiple myeloma patients. The aim of our study was to evaluate IMID adherence and to compare two indirect methods to measure IMID adherence in multiple myeloma patients: a specific questionnaire and the medication possession ratio (MPR). Another aim was to explore this specific questionnaire for the assessment of IMID adherence in multiple myeloma patients. Methods All consecutive multiple myeloma patients, with at least two consecutive dispensations of thalidomide, lenalidomide or pomalidomi…

Result and cost of hepatic chemoembolisation with drug eluting beads in 21 patients.

Abstract Purpose The aim of our study was to assess the results and cost of a treatment strategy involving transarterial chemoembolisation with drug eluting beads (DEB-TACE) in patients with unresectable non-metastatic hepatocellular carcinoma (HCC). Patients and methods This study included all patients treated with DEB-TACE in our hospital between January 2009 and December 2010. All patients received DEB-TACE on demand and were evaluated after each session. Results Twenty-one patients received an average of 1.3 sessions. The median time to treatment discontinuation and median progression-free survival was 181 days and 295 days, respectively. Toxicity caused treatment discontinuation in thr…

Editorial: IDASPHERE phase I trial for chemoembolisation for HCC - authors' reply: a necessary step for treatment optimisation and standardisation

An explorative study to assess the association between health-related quality of life and the recommended phase II dose in a phase I trial: idarubicin-loaded beads for chemoembolisation of hepatocellular carcinoma

Objectives The objective of this study was to explore the association between health-related quality of life (HRQoL) and the recommended phase 2 dose in a phase I clinical trial according to the Time to HRQoL deterioration approach (TTD). Setting This is a phase I dose-escalation trial of transarterial chemoembolisation (TACE) with idarubicin-loaded beads performed in cirrhotic patients with hepatocellular carcinoma. Patients had to complete the EORTC QLQ-C30 HRQoL questionnaire at baseline and at days 15, 30 and 60 after TACE. Participants Patients aged ≥18 years with HCC unsuitable for curative treatments were evaluated for the study (N=21). Primary and secondary outcome measurements The …

Intra-arterial idarubicin_lipiodol without embolization can provide prolonged complete response in hepatocellular carcinoma: A case report.

International audience; Hepatocellular carcinoma is the fourth leading cause of cancer death. For unresectable intermediate-stage hepatocellular carcinoma, the standard treatment is transarterial chemoembolization. To date, the overall survival at three years remains low, and there is currently no consensus about the best anticancer agent and optimal treatment regimen. We report the case of a hepatocellular carcinoma patient with a vascular contraindication to embolization who achieved a complete response after four intra-arterial infusions of idarubicin emulsified with lipiodol. The patient maintained his response over a three-year period without any hepatocellular carcinoma treatment, dem…

Étude coût-utilité de l’association de la metformine aux différentes classes d’antidiabétiques chez le sujet âgé de plus de 80 ans

Resume Introduction La prevalence du diabete chez le sujet âge est superieure a 20 %. La prevention de l’hypoglycemie medicamenteuse est le point cle de la prise en charge therapeutique du diabete chez cette population de patients. A ce jour, il n’existe pas d’agent de choix a ajouter a la metformine en cas de diabete non controle chez le sujet âge de plus de 80 ans. Materiels et methodes Une revue de la litterature a ete menee afin d’etablir les types d’evenements hypoglycemiques et leur probabilite de survenue. Suite a une determination du cout des differents actes necessaires dans la prise en charge des evenements hypoglycemiques et des traitements associes, il a ete possible de calculer…

Self‐management of immunomodulatory drug treatment in multiple myeloma patients

Objective Immunomodulatory drugs (IMIDs: thalidomide, lenalidomide and pomalidomide) are widely used in patients with multiple myeloma (MM). The aim of our study was to validate a questionnaire to evaluate the self-capacity of MM patients to manage IMID treatment including side effects. Methods We used a method adapted from the recommendations of the European Organisation for Research and Treatment of Cancer (EORTC) to validate a French questionnaire for patients with MM treated with IMIDs. Results The face validity was evaluated in 15 patients and the construct validity in 56 patients. For discriminant validity, two groups were constituted by gender and depending on whether they had a prev…

Safety of ninety-minute daratumumab infusion.

Purpose Daratumumab is the first anti-CD38 monoclonal antibody of the class approved for recurrent and refractory multiple myeloma. Grade 3 and 4 Infusion-Related Reactions (IRRs) are frequent during the first and second infusions. Due to the risks associated with severe IRRs, daratumumab is systematically administered over a period of 3.5 hours. The main objective of this study was to evaluate the safety of a 90-minute daratumumab infusion from the third infusion. Patients and methods All patients who had received two or more doses of daratumumab in monotherapy or in combination with standard infusion rates were included. We excluded patients enrolled in clinical trials. For the rapid infu…

Stratégies thérapeutiques dans la maladie de Parkinson

La prise en charge du patient parkinsonien est pluridisciplinaire. Le traitement, indique des l’apparition d’une gene fonctionnelle, repose sur sept classes medicamenteuses et une strategie chirurgicale. Un accompagnement et une gestion de la pharmacie clinique de qualite conditionnent la maitrise des symptomes de la maladie et des effets iatrogenes. Le pharmacien est un acteur important pour la conduite et le suivi de la therapeutique.