Long-term outcome data for patients with HER2-positive early-stage breast cancer treated with adjuvant trastuzumab: benefit outside clinical trial setting

Adjuvant treatment options for HER2 positive Early-Stage Breast Cancer (EBC) have grown in recent years. The addition of adjuvant trastuzumab therapy for one-year to standard chemotherapy has been shown in several Randomized Controlled Trials (RCTs) to improve Disease-Free Survival (DFS) and Overall Survival (OS) in patients with high-risk HER2-positive EBC. This study aimed to review the long-term outcome data for patients with HER2-positive EBC who were treated with adjuvant trastuzumab therapy in a designated cancer centre. Methods: Data included all women diagnosed with HER2-positive EBC between 1st January 2001 and 31st January 2010 (N=147). Retrospective evaluation of healthcare records for clinical, demographic, and pathologic data was undertaken. Most had adjuvant trastuzumab following systemic chemotherapy (80/147; 54.4%). Kaplan-Meier estimates were used to evaluate whether one-year trastuzumab administration was associated with improved DFS and OS. Additionally, cohorts were generated by pathologic tumour size and lymph node involvement to stratify outcome measures (i.e. DFS and OS) by risk features

An optical counting technique with vertical hydrodynamic focusing for biological cells

A barrier in scaling laboratory processes into automated microfluidic devices has been the transfer of lab based assays: where engineering meets biological protocol. One basic requirement is to reliably and accurately know the distribution and number of biological cells being dispensed. In this study, a novel optical counting technique to efficiently quantify the number of cells flowing into a microtube is presented. REH, B-lymphoid precursor leukaemia, are stained with a fluorescent dye and frames of moving cells are recorded using a CCD camera. The basic principle is to calculate the total fluorescence intensity of the image and to divide it by the average intensity of a single cell. This method allows counting the number of cells with an uncertainty +/- 5%, which compares favourably to the standard biological methodology, based on the manual Trypan Blue assay, which is destructive to the cells and presents an uncertainty in the order of 20%. The use of a microdevice for vertical hydrodynamic focusing, which can reduce the background noise of out of focus cells by concentrating the cells in a thin layer, has further improved the technique. CFD simulation and Confocal Laser Scanning Microscopy images have shown an 82% reduction in the vertical displacement of the cells. For the flow rates imposed during this study, a throughput of 100-200 cells/sec is achieved

Management of staphylococcus aureus bacteraemia (SAB) in the oncology patient: further evidence supports prompt removal of central venous catheters and shorter duration of intravenous antimicrobial therapy

Background Staphylococcus aureus bacteraemia (SAB) is associated with relatively high risk of complications and high levels of mortality. Internationally, SAB management guidelines lack consensus and especially so regarding oncology patients. This is likely a reflection of insufficient randomised control trials (RCT) and the diversity of SAB patient populations. However, there are 2011 guidelines recommending a minimum of 14 days of appropriate IV antibiotic therapy for SAB. Objective We wished to determine whether our practice of shortened duration of intravenous antimicrobial therapy in favour of oral administration proved as effective as recommended guidelines in a mixed oncology patient cohort. Methods Retrospective review of patient records that included any SAB episode among oncology patients from January 2002 to December 2015. Medical chart reviews were undertaken to determine patient demographics, clinical management & antimicrobial therapy, duration of stay, presence of a central venous catheter (CVC) and outcome. Results Our CVC removal rate was just 73% in SAB where CVC was the identified source of infection, with an attributable mortality rate (<4%) far lower than would be expected. Antimicrobial therapy durations were considerably lower (10 days) than current recommendations of 14 days IV therapy. The recurrence rate of 15% was also significantly lower than has been reported previously. Conclusions Our observations contribute new insights concerning the management of SAB in oncology patients. Our findings suggest that therapeutic approaches should perhaps remain individualised and reflective of patient characteristics taking into consideration the complex nature of oncology patients