The prognostic impact of consensus molecular subtypes (CMS) and its predictive effects for bevacizumab benefit in metastatic colorectal cancer: molecular analysis of the AGITG MAX clinical trial.

Background: The consensus molecular subtypes (CMS) is a transcriptome-based classification of colorectal cancer (CRC) initially described in early-stage cohorts, but the associations of CMS with treatment outcomes in the metastatic setting are yet to be established. This study aimed to evaluate the prognostic impact of CMS classification and its predictive effects for bevacizumab benefit in metastatic CRC by correlative analysis of the AGITG MAX trial. Patients and methods: The MAX trial previously reported improved progression-free survival (PFS) for the addition of bevacizumab (B) to chemotherapy [capecitabine (C)±mitomycin (M)]. Archival primary tumours from 237 patients (50% of trial population) underwent gene expression profiling and classification into CMS groups. CMS groups were correlated to PFS and overall survival (OS). The interaction of CMS with treatment was assessed by proportional hazards model. Results: The distribution of CMS in MAX were CMS1 18%, CMS2 47%, CMS3 12%, CMS4 23%. CMS1 was the predominant subtype in right-sided primary tumours, while CMS2 was the predominant subtype in left-sided. CMS was prognostic of OS (P = 0.008), with CMS2 associated with the best outcome and CMS1 the worst. CMS remained an independent prognostic factor in a multivariate analysis. There was a significant interaction between CMS and treatment (P-interaction = 0.03), for PFS, with hazard ratios (95% CI) for CB+CBM versus C arms in CMS1, 2, 3 and 4: 0.83 (0.43-1.62), 0.50 (0.33-0.76), 0.31 (0.13-0.75) and 1.24 (0.68-2.25), respectively. Conclusions: This exploratory study found that CMS stratified OS outcomes in metastatic CRC regardless of first-line treatment, with prognostic effects of CMS groups distinct from those previously reported in early-stage cohorts. In CMS associations with treatment, CMS2 and possibly CMS3 tumours may preferentially benefit from the addition of bevacizumab to first-line capecitabine-based chemotherapy, compared with other CMS groups. Validation of these findings in additional cohorts is warranted. Clinical trial number: This is a molecular sub-study of MAX clinical trial (NCT00294359).status: publishe

Telehealth Utilization in Low Resource Settings

Chapter in Sustainable Community Health Systems and Practices in Diverse Settings, edited by Elias Mpofu. Chapter Description: In response to health access barriers, telehealth and telemedicine have grown as a supplemental healthcare delivery system to mainstream medical care. For rural and remote communities, which are mostly less well resourced, telehealth and telemedicine is increasingly a major system enabling health access and availability, bridging population health disparities by geography and socioeconomic gradients. People in low resources settings have less access to health care, while commuting for health services to the cities would be costly in terms of time, effort, and money, resulting in health inequities and social injustices on them. In this chapter, we examine the role of telehealth and telemedicine as health systems for providing sustainable community health in low resource settings. In doing so, we provide a historical overview of the research and practice in telehealth and telemedicine, followed by a discussion of current leading practices in telehealth and telemedicine. We consider the cultural and legal influences on telehealth and telemedicine services across jurisdictions highlighting responsiveness to local contexts and needs. Finally, we consider the issues for research and practice in telehealth and telemedicine, including security and privacy associated with telehealth; education for sustaining telehealth delivery; engaging high-risk populations from low-resource settings in telehealth services; and use of social networks to ensure telehealth care access for poor and remote regions. Book description: Applying a trans-disciplinary approach, this book provides a comprehensive, research-based guide to understanding, implementing, and strengthening sustainable community health in diverse international settings. By examining the interdependence of environmental, economic, public health, community wellbeing, and development factors, the authors address the systemic factors impacting health disparities, inequality, and social justice issues. The book analyzes strategies based on a partnership view of health, in which communities determine their health and wellness working alongside local, state, and federal health agencies. Crucially, it demonstrates that communities are themselves health systems and their wellbeing capabilities affect the health of individuals and the collective alike. It identifies health indicators and tools that communities and policy makers can utilize to sustain truly inclusive health systems. This book offers a unique resource for researchers and practitioners working across psychology, mental health, rehabilitation, public health, epidemiology, social policy, healthcare, and allied health.https://digitalcommons.usm.maine.edu/facbooks/1554/thumbnail.jp