Current management strategies for peritoneal mesothelioma

Mesothelioma of the peritoneum is a distinct entity that requires multidisciplinary care to improve oncological outcomes. In this article, we review the current management strategies discussed at the PSOGI meeting in Washington DC 2016 and provide evidence based recommendations for diagnosis and management of this disease

Surgical Treatment of Peritoneal Carcinomatosis from Gastric Cancer

Peritoneal carcinomatosis from gastric cancer is considered a fatal disease with limited treatment options. Recent advances in the understanding of the disease process, systemic chemotherapy, and application of cytoreductive surgery and hyperthermic chemoperfusion have shown promising results in the management of this difficult disease. Novel therapies such as extensive intraperitoneal lavage and intraperitoneal targeted agents are being applied in the management of this disease. We review the current literature in this field and describe the rationale behind some of these advances

Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for colorectal peritoneal metastases: Where do we stand?

Plain Language Summary Patients with colorectal cancer that has spread to the lining of the abdomen (peritoneum) benefit from surgery to remove all the cancer. The addition of certain types of intra-abdominal chemotherapy during surgery improves survival for select patients.</p

Can We Continue to Ignore Gender Differences in Performance on Simulation Trainers?

Background: There are differences between the genders in their innate performances on simulation trainers, which may impair accurate assessment of psychomotor skills. Methods: The performance of fourth-year students with no exposure to the Minimally Invasive Surgical Trainer compared based on gender, and other psychomotor skills. Results: Our study included 16 male and 16 female students. After adjusting for choice of medical specialty ( P <.001), current video game use ( P =.6), and experience in the operating room ( P =.4), female sex was an independent factor for worse performance ( P =.04) in multivariate models. Women took more time than men ( P <.01) and made more errors (29 versus 25 on 3 reps, P <.01). Conclusions: Among medical students with no previous exposure to laparoscopic trainers, female students perform worse than male students after adjusting for confounding factors. This difference must be recognized by training programs while using simulators for training and evaluation

Can We Continue to Ignore Gender Differences in Performance on Simulation Trainers?

Background: There are differences between the genders in their innate performances on simulation trainers, which may impair accurate assessment of psychomotor skills. Methods: The performance of fourth-year students with no exposure to the Minimally Invasive Surgical Trainer compared based on gender, and other psychomotor skills. Results: Our study included 16 male and 16 female students. After adjusting for choice of medical specialty ( P <.001), current video game use ( P =.6), and experience in the operating room ( P =.4), female sex was an independent factor for worse performance ( P =.04) in multivariate models. Women took more time than men ( P <.01) and made more errors (29 versus 25 on 3 reps, P <.01). Conclusions: Among medical students with no previous exposure to laparoscopic trainers, female students perform worse than male students after adjusting for confounding factors. This difference must be recognized by training programs while using simulators for training and evaluation

Current management strategies for peritoneal mesothelioma

Mesothelioma of the peritoneum is a distinct entity that requires multidisciplinary care to improve oncological outcomes. In this article, we review the current management strategies discussed at the PSOGI meeting in Washington DC 2016 and provide evidence based recommendations for diagnosis and management of this disease

Immunohistochemistry - Microarray Analysis of Patients with Peritoneal Metastases of Appendiceal or Colorectal Origin

BackgroundThe value of immunohistochemistry (IHC)-microarray analysis of pathological specimens in the management of patients is controversial although preliminary data suggests potential benefit. We describe the characteristics of patients undergoing a commercially available IHC-microarray method in patients with peritoneal metastases (PM) and the feasibility of this technique in this population.MethodsWe retrospectively analyzed consecutive patients with pathologically confirmed PM from appendiceal or colorectal primary who underwent Caris Molecular IntelligenceTM testing. IHC, microarray, FISH and mutational analysis were included and stratified by PCI score, histology and treatment characteristics. Statistical analysis was performed using non-parametric tests.ResultsOur study included 5 patients with appendiceal and 11 with colorectal PM. The median age of patients was 51 (IQR 39-65) years, with 11(68%) female. The median PCI score of the patients was 17(IQR 10-25). Hyperthermic intra-peritoneal chemoperfusion (HIPEC) was performed in 4 (80%) patients with appendiceal primary tumors and 4 (36%) with colorectal primary. KRAS mutations were encountered in 40% of appendiceal vs. 30% colorectal tumors, while BRAF mutations were seen in 40% of colorectal PM and none of the patients with appendiceal PM (p=0.06). IHC biomarker expression was not significantly different between the two primaries. Sufficient tumor for microarray analysis was found in 44% (n=7) patients, which was not associated with previous use of chemotherapy (p>0.20 for 5-FU/LV, Irinotecan and Oxaliplatin).ConclusionsIn a small sample of patients with peritoneal metastases, the feasibility and results of IHC-microarray staining based on a commercially available test is reported. The apparent high incidence of the BRAF mutation in patients with PM may potentially offer opportunities for novel therapeutics and suggest that IHC-microarray is a method that can be used in this population

Cost-effectiveness of Maintenance Capecitabine and Bevacizumab for Metastatic Colorectal Cancer

Key Points Question For metastatic colorectal cancer, what is the incremental cost-effectiveness of adding capecitabine and bevacizumab maintenance treatment after standard induction chemotherapy? Findings This economic evaluation study finds that compared with observation, capecitabine and bevacizumab maintenance therapy adds average per-patient benefits of 0.14 quality-adjusted life-years (QALYs), with incremental costs of $105 217 and an incremental cost-effectiveness ratio of$725 601 per QALY. To reduce the cost to $59 039 per unadjusted life-year (median household income) total drug costs must be reduced from$6173 to $452 per 3-week chemotherapy cycle. Meaning High US drug prices represent the best target for improving the cost-effectiveness of capecitabine and bevacizumab maintenance therapy for metastatic colorectal cancer, which is not currently cost-effective. Go to: Abstract Importance Unregulated drug prices increase cancer therapy costs. After induction chemotherapy, patients with metastatic colon cancer can receive maintenance capecitabine and bevacizumab therapy based on improved progression-free survival, but whether this treatment’s cost justifies its benefits has not been evaluated in the United States. Objective This study sought to determine the influence of capecitabine and bevacizumab drug prices on cost-effectiveness from a Medicare payer’s perspective. Design, Setting, and Participants The incremental cost-effectiveness of capecitabine and bevacizumab maintenance therapy was determined with a Markov model using a quality-of-life penalty based on outcomes data from the CAIRO phase 3 randomized clinical trial (RCT), which included 558 adults in the Netherlands with unresectable metastatic colorectal cancer who had stable disease or better following induction chemotherapy. The outcomes were modeled using Markov chains to account for patients who had treatment complications or cancer progression. Transition probabilities between patient states were determined, and each state’s costs were determined using US Medicare data on payments for capecitabine and bevacizumab treatment. Deterministic and probabilistic sensitivity analyses identified factors affecting cost-effectiveness. Main Outcomes and Measures Life-years gained were adjusted using CAIRO3 RCT quality-of-life data to determine quality-adjusted life-years (QALYs). The primary end point was the incremental cost-effectiveness ratio, representing incremental costs per QALY gained using a capecitabine and bevacizumab maintenance regimen compared with observation alone. Results Markov model estimated survival and complication outcomes closely matched those reported in the CAIRO3 RCT, which included 558 adults (n = 197 women, n = 361 men; median age, 64 and 63 years for patients in the observation and maintenance therapy groups, respectively) in the Netherlands with unresectable metastatic colorectal cancer who had stable disease or better following induction chemotherapy. Incremental costs for a 3-week maintenance chemotherapy cycle were$6601 per patient. After 29 model iterations corresponding to 60 months of follow-up, mean per-patient costs were $105 239 for maintenance therapy and$21.10 for observation. Mean QALYs accrued were 1.34 for maintenance therapy and 1.20 for observation. The incremental cost-effectiveness ratio favored maintenance treatment, at an incremental cost of $725 601 per QALY. The unadjusted ratio was$438 394 per life-year. Sensitivity analyses revealed that cost-effectiveness varied with changes in drug costs. To achieve an incremental cost-effectiveness ratio of less than $59 039 (median US household income) per unadjusted life-year would require capecitabine and bevacizumab drug costs to be reduced from$6173 (current cost) to $452 per 3-week chemotherapy cycle. Conclusions and Relevance Antineoplastic therapy is expensive for payers and society. The price of capecitabine and bevacizumab maintenance therapy would need to be reduced by 93% to make it cost-effective, a finding useful for policy decision making and payment negotiations