Radical penectomy, a compromise for life. Results from the PECAD study

Background: The use of organ sparing strategies to treat penile cancer (PC) is currently supported by evidence that has indicated the safety, efficacy and benefit of this surgery. However, radical penectomy still represents up to 15-20% of primary tumor treatments in PC patients. The aim of the study was to evaluate efficacy in terms of overall survival (OS) and disease-free survival (DFS) of radical penectomy in PC patients. Methods: Data from a retrospective multicenter study (PEnile Cancer ADherence study, PECAD Study) on PC patients treated at 13 European and American urological centers (Hospital “Sant'Andrea”, Sapienza University, Roma, Italy; “G.D'Annunzio” University, Chieti and ASL 2 Abruzzo, Hospital “S. Pio da Pietrelcina”, Vasto, Italy; Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL, USA; Hospital of Budapest, Hungary; Department of Emergency and Organ Transplantation, Urology and Andrology Unit II, University of Bari, Italy; Hospital “Spedali Civili”, Brescia, Italy; Istituto Europeo di Oncologia, University of Milan, Milan, Italy; University of Modena & Reggio Emilia, Modena, Italy; Hospital Universitario La Paz, Madrid, Spain; Ceara Cancer Institute, Fortaleza, Brazil; Virginia Commonwealth University, Richmond, VA, USA; Aristotle University of Thessaloniki, Thessaloniki, Greece; Maria Skłodowska-Curie Memorial Cancer Center, Warsaw, Poland) between 2010 and 2016 were used. Medical records of patients who specifically underwent radical penectomy were reviewed to identify main clinical and pathological variables. Kaplan-Meier method was used to estimate 1- and 5-year OS and DFS. Results: Of the entire cohort of 425 patients, 72 patients (16.9%) treated with radical penectomy were extracted and were considered for the analysis. The median age was 64.5 (IQR, 57.5-73.2) years. Of all, 41 (56.9%) patients had pT3/pT4 and 31 (43.1%) pT1/pT2. Moreover, 36 (50.0%) were classified as pN1-3 and 5 (6.9%) M1. Furthermore, 61 (84.7%) had a high grade (G2-G3) with 6 (8.3%) positive surgical margins. The 1- and 5-year OS rates were respectively 73.3% and 59.9%, while the 1- and 5-year DFS rates were respectively 67.3% and 35.1%. Conclusions: PC is an aggressive cancer particularly in more advanced stage. Overall, more than a third of patients do not survive at 5 years and more than 60% report a disease recurrence, despite the use of a radical treatment

Assessing the overall benefit of a medication: cumulative benefit of secukinumab over time in patients with moderate-to-severe plaque psoriasis

Background: Conventional measurements for assessing psoriasis treatment effects capture improvements at fixed, pre-specified timepoints, failing to account for cumulative clinical benefit over time. Objective: Explore the innovative concept of “cumulative clinical benefit” by examining the effect of secukinumab over 52 weeks in moderate-to-severe psoriasis patients. Methods: Cumulative clinical benefit was determined as the area-under-the-curve of the percentage of responders over 52 weeks (AUC0–52 wks), using pooled data from two phase III trials for patients receiving secukinumab (300 or 150 mg) or etanercept. Results: Normalized cumulative benefit with secukinumab 300 mg, secukinumab 150 mg, and etanercept was 74.2%, 63.2%, and 50.5%, respectively, for PASI 75; 58.0%, 42.5%, and 29.5%, respectively, for PASI 90; 32.3%, 18.8%, and 8.7%, respectively, for PASI 100; and 58.3%, 47.9%, and 38.3%, respectively, for DLQI 0/1. 52-week PASI 75 clinical benefit ratios for secukinumab 300 and 150 mg versus etanercept were 1.47 and 1.25, respectively; the ratio of the two secukinumab doses was 1.17, favoring 300 mg. Limitations: Post hoc analysis. Conclusion: Cumulative clinical benefit estimated by AUC0-52 wks is a novel measure for comparing psoriasis treatments. Secukinumab 300 mg provides greater cumulative clinical benefit than secukinumab 150 mg; both provide greater cumulative benefit than etanercept

Secukinumab provides better relief from the impact of psoriasis on daily activities and personal relationships than etanercept: results of two phase 3 placebo-controlled randomized clinical trials in moderate-to-severe psoriasis

Background: Psoriasis can greatly impact patients’ lives, influencing what clothing they wear and impairing their sexual functioning. Objective: To provide a detailed comparison of the impact of secukinumab vs. etanercept on enabling patients with psoriasis to have more normal lives with respect to daily activities (DA) (e.g. choosing clothing) and personal relationships (PR) (e.g. sexual functioning). Methods: Baseline to Week 52 ERASURE and FIXTURE data for secukinumab 300 mg and etanercept were analyzed. Treatment differences in mean scores on the DA and PR subscales and items from the Dermatology Life Quality Index were compared. The proportions of subscale and item responders (score = 0) were compared. Results: Subjects receiving secukinumab (n = 572) achieved greater mean improvement in DA and items (q3 and q4) than subjects receiving etanercept (n = 326; all p < .01 through Week 52). Subjects receiving secukinumab achieved greater mean improvement in PR and items (q8 and q9) than subjects receiving etanercept (subscale: p < .05 at Weeks 8 and 12). Response rates were significantly higher for secukinumab than for etanercept for DA (all p < .0001) and PR (all p < .05 except Weeks 4 and 36). Conclusions: Secukinumab 300 mg provides greater improvements and more effective relief from psoriasis impact on DA and PR than etanercept

Greater Efficacy With Secukinumab Treatment Is Associated With Greater Psoriasis Symptom Relief: Results from Secukinumab Clinical Trial Data

Background: Psoriasis negatively affects patients’ quality of life. Secukinumab is a human interleukin-17A antagonist indicated for the treatment of moderate-to-severe plaque psoriasis. Objectives: The current analysis evaluated the benefits of secukinumab by assessing relationships between disease severity and patient-reported symptoms. Methods: Correlations between psoriasis-related itching, pain, and scaling and disease severity scores (Psoriasis Area and Severity Index [PASI] and Investigator’s Global Assessment [IGA]) were evaluated at baseline, Week 12, and change from baseline to Week 12 using secukinumab clinical data from ERASURE and FIXTURE. Symptom responder status and PASI/IGA change were evaluated using logistic modeling. Results: Correlation coefficients ranged 0.11-0.49 for PASI and 0.19-0.52 for IGA. Greater PASI response was related to greater symptom response/complete relief. Conclusions: Results further demonstrate the relationship between traditional clinical measures of disease severity and patient-reported, psoriasisrelated itching, pain, and scaling — hence the need to consider both outcomes together to evaluate treatment effects in this disease fully