Feasibility of Tumor Treating Fields with Pemetrexed and Platinum-Based Chemotherapy for Unresectable Malignant Pleural Mesothelioma: Single-Center, Real-World Data

Purpose: The objectives of this study were to evaluate the implementation, device usage rates, clinical outcomes, and treatment-related toxicities associated with TTFields and pemetrexed plus platinum-based chemotherapy in patients with unresectable MPM, outside the initial trial results. Methods: Consecutive patients with unresectable MPM were enrolled onto an FDA-required HDE protocol from 2019 to 2021. All patients were treated with a protocol-defined regimen of continuous TTFields (150 kHz) and pemetrexed plus platinum-based chemotherapy. Results: Five patients with unresectable MPM were enrolled. The median number of 4-week TTFields cycles was 5 (range: 2–7 cycles). Median TTFields device usage in the first 3 months was 12.5 h per day (range: 5–16.8 h), representing 52% (21–70%) of the potential daily duration. The median follow-up was 5.4 months (range: 1.1–20.9 months). Treatment-related dermatitis was the only side effect associated with TTFields and was reported as grade 1–2 in all patients; no patient had grade 3+ device-related toxicities. Conclusions: This study represents the first results of real-world implementation of TTFields for MPM. In comparison to the initial clinical trial (STELLAR), compliance rates were lower, although skin-related toxicities appeared similar. Further initiatives and guidelines should be developed to manage treatment-related dermatitis and improve device usage

Contrast-Enhanced Mammography for Screening Women after Breast Conserving Surgery

To investigate the value of contrast-enhanced mammography (CEM) compared to full-field digital mammography (FFDM) in screening breast cancer patients after breast-conserving surgery (BCS), this Health Insurance Portability and Accountability Act-compliant, institutional review board-approved retrospective, single-institution study included 971 CEM exams in 541 asymptomatic patients treated with BCS who underwent screening CEM between January 2013 and November 2018. Histopathology, or at least a one-year follow-up, was used as the standard of reference. Twenty-one of 541 patients (3.9%) were diagnosed with ipsi- or contralateral breast cancer: six (28.6%) cancers were seen with low-energy images (equivalent to FFDM), an additional nine (42.9%) cancers were detected only on iodine (contrast-enhanced) images, and six interval cancers were identified within 365 days of a negative screening CEM. Of the 10 ipsilateral cancers detected on CEM, four were detected on low-energy images (40%). Of the five contralateral cancers detected on CEM, two were detected on low-energy images (40%). Overall, the cancer detection rate (CDR) for CEM was 15.4/1000 (15/971), and the positive predictive value (PPV3) of the biopsies performed was 42.9% (15/35). For findings seen on low-energy images, with or without contrast, the CDR was 6.2/1000 (6/971), and the PPV3 of the biopsies performed was 37.5% (6/16). In the post-BCS screening setting, CEM has a higher CDR than FFDM

Development of an E-Learning System for the Endoscopic Diagnosis of Early Gastric Cancer: an International Multicenter Randomized Controlled Trial

Background: Gastric cancer is the second highest cause of cancer deaths worldwide. Apart from Japan and Korea where screening programs are implemented, most gastric cancer patients worldwide are diagnosed at an advanced stage because of limited knowledge and experience of endoscopists. An internet-based e-learning system to teach detection of early gastric cancer using standard endoscopy has been developed and this study evaluated its effectiveness. Methods: The study was designed as a randomized controlled trial. Participants worldwide signed a consent form before first undertaking a pre-test via the internet, after which they were randomly allocated to the e-learning and non-e-learning groups. Pre-adjustment strata were the pre-test score, experience of endoscopy, being a nurse endoscopist or a medical practitioner, and medical institution and country. Only the participants in the e-learning group were allowed to access the e-learning system, which consisted of video lectures on basic knowledge and self-exercise tests to accumulate experience. A post-test in both groups was conducted 2 months after the pre-test. The pre-determined primary endpoint was the difference in the rate of improvement of the test result (post-test score/pre-test score) between groups. After completion of the post-test, the e-learning system was opened for all participants. Results: Among the 515 endoscopists from 35 countries assessed for eligibility, 322 participants who met the study’s inclusion criteria completed the pre-test and were enrolled: 166 were allocated to the e-learning group and 166 to the non-e-learning. Of these, 151 participants in the e-learning group and 144 in the non-e-learning group completed the post-test, and were included in the analysis. The mean rate of improvement (standard deviation) of the test result in the e-learning and non-elearning groups was 1.24 (0.26) and. 1.00 (0.16), respectively (P!0.001, Student’s ttest). Conclusion: This global study clearly demonstrated the efficacy of an e-learning system to improve knowledge and experience on endoscopic detection of early gastric cancer. Its effectiveness will be further evaluated in a study of improvements in the rate of early gastric cancer detection by all participants in actual clinical practice (UMIN: R000012039).Trabajo presentado en el DDW2015 Digestive Disease Week (DDW 2015), desarrolado del 16 al 19 de Mayo, 2015 en la ciudad de Washington DC, EE.U