Healthcare costs of metastatic cutaneous melanoma in the era of immunotherapeutic and targeted drugs

Immunotherapeutic and targeted drugs improved survival of patients with metastatic melanoma. There is, however, a lack of evidence regarding their healthcare costs in clinical practice. The aim of our study was to provide insight into real-world healthcare costs of patients with metastatic cutaneous melanoma. Data were obtained from the Dutch Melanoma Treatment Registry for patients who were registered between July 2012 and December 2018. Mean total/monthly costs per patient were reported for all patients, patients who did not receive systemic therapy, and patients who received systemic therapy. Furthermore, mean episode/monthly costs per line of therapy and drug were reported for patients who received systemic therapy. Mean total/monthly costs were € 89,240/€ 6809: € 7988/€ 2483 for patients who did not receive systemic therapy (n = 784) and € 105,078/€ 7652 for patients who received systemic therapy (n = 4022). Mean episode/monthly costs were the highest for nivolumab plus ipilimumab (€ 79,675/€ 16,976), ipilimumab monotherapy (€ 79,110/€ 17,252), and dabrafenib plus trametinib (€ 77,053/€ 12,015). Dacarbazine yielded the lowest mean episode/monthly costs (€ 6564/€ 2027). Our study showed that immunotherapeutic and targeted drugs had a large impact on real-world healthcare costs. As new drugs continue entering the treatment landscape for (metastatic) melanoma, it remains crucial to monitor whether the benefits of these drugs outweigh their costs

Analysis of 105.000 patients with cancer : have they been discussed in oncologic multidisciplinary team meetings? A nationwide population-based study in the Netherlands

Introduction: For optimal oncological care, it is recommended to discuss every patient with cancer in a multidisciplinary team meeting (MDTM). This is a time consuming and expensive practice, leading to a growing demand to change the current workflow. We aimed to investigate the number of patients discussed in MDTMs and to identify characteristics associated with not being discussed. Methods: Data of patients with a newly diagnosed solid malignant tumour in 2015 and 2016 were analysed through the nationwide population-based Netherlands Cancer Registry (NCR). We clustered tumour types in groups that were frequently discussed within a tumour-specific MDTM. Tumour types without information about MDTMs in the NCR were excluded. Multivariable logistic regression analyses were used to analyse factors associated with not being discussed. Results: Out of 105.305 patients with cancer, 91% were discussed in a MDTM, varying from 74% to 99% between the different tumour groups. Significantly less frequently discussed were patients aged ≥75 years (odds ratio [OR] = 0.7, 95% confidence interval [CI] = 0.6–0.7), patients diagnosed with disease stage I (OR = 0.5, 95% CI = 0.5–0.6), IV (OR = 0.4, 95% CI = 0.4–0.4) or unknown (OR = 0.2, 95% CI = 0.2–0.2) and patients who received no treatment (OR = 0.3, 95% CI = 0.3–0.3). Patients who received a multidisciplinary treatment were more likely to be discussed in contrary to a monodisciplinary treatment (OR = 4.6, 95% CI = 4.2–5.1). Conclusion: In general, most patients with cancer were actually discussed in a MDTM, although differences were observed between tumour groups. Factors associated with not being discussed may, at least partially, reflect the absence of a multidisciplinary question. These results form a starting point for debate on a more durable and efficient new MDTM strategy

Healthcare Costs of Metastatic Cutaneous Melanoma in the Era of Immunotherapeutic and Targeted Drugs

Contains fulltext : 219575.pdf (publisher's version ) (Open Access

Study protocol of the GLOW study: maximising treatment options for recurrent glioblastoma patients by whole genome sequencing-based diagnostics-a prospective multicenter cohort study

Background Glioblastoma (GBM), the most common glial primary brain tumour, is without exception lethal. Every year approximately 600 patients are diagnosed with this heterogeneous disease in The Netherlands. Despite neurosurgery, chemo -and radiation therapy, these tumours inevitably recur. Currently, there is no gold standard at time of recurrence and treatment options are limited. Unfortunately, the results of dedicated trials with new drugs have been very disappointing. The goal of the project is to obtain the evidence for changing standard of care (SOC) procedures to include whole genome sequencing (WGS) and consequently adapt care guidelines for this specific patient group with very poor prognosis by offering optimal and timely benefit from novel therapies, even in the absence of traditional registration trials for this small volume cancer indication. Methods The GLOW study is a prospective diagnostic cohort study executed through collaboration of the Hartwig Medical Foundation (Hartwig, a non-profit organisation) and twelve Dutch centers that perform neurosurgery and/or treat GBM patients. A total of 200 patients with a first recurrence of a glioblastoma will be included. Dual primary endpoint is the percentage of patients who receive targeted therapy based on the WGS report and overall survival. Secondary endpoints include WGS report success rate and number of targeted treatments available based on WGS reports and number of patients starting a treatment in presence of an actionable variant. At recurrence, study participants will undergo SOC neurosurgical resection. Tumour material will then, together with a blood sample, be sent to Hartwig where it will be analysed by WGS. A diagnostic report with therapy guidance, including potential matching off-label drugs and available clinical trials will then be sent back to the treating physician for discussing of the results in molecular tumour boards and targeted treatment decision making. Discussion The GLOW study aims to provide the scientific evidence for changing the SOC diagnostics for patients with a recurrent glioblastoma by investigating complete genome diagnostics to maximize treatment options for this patient group. Trial registration: ClinicalTrials.gov Identifier: NCT05186064.Neurolog

Outcomes of anti-PD1 antibodies for advanced melanoma in real-world population

Experimentele farmacotherapi

Development of a community of practice in computer music in schools : design, itinerary and modeling

Cette thèse est l’étude d’une expérience en situation de composition électroacoustique collective sous l’angle du développement d’une communauté de pratique. Elle a été réalisée en France, sur l’année scolaire 2013/2014, dans deux classes de l’école élémentaire publique Pasquier de la ville d’Antony située en région parisienne. Nous parlons donc d’un enseignement collectif de la musique à de jeunes enfants sur le temps scolaire réalisé dans un co-enseignement professeur des écoles et professeur de musique. La « théorie des communautés de pratique » d’Étienne Wenger sera utilisée comme une grille de lecture et un prisme à travers lesquels nous analyserons les interactions des participants au sein d’une expérience de pédagogie musicale de groupe menée en milieu scolaire. Nous étudierons les situations d’apprentissage via les interactions inter et intra-communautaires qui sont pour partie médiatisées par des artefacts informatiques (fichiers audio des pièces musicales, photographies numériques, publications et mises à disposition sur internet, communication par mails, etc.). À ce titre, nous nous sommes intéressés à l’usage et au rôle joué par les technologies de l’informatique et de la communication (TIC) dans les échanges de la communauté ainsi qu’aux théories relatives aux sciences documentaires.Enfin, dans la troisième partie de ce mémoire nous proposons la construction d’un modèle d’action pédagogique privilégiant les interactions que nous considérons comme transposables à l’enseignement universitaire de la composition musicale en environnement Max et Pure Data au département Musique de l’Université Paris 8.This dissertation is the study of an experiment in a situation of collective electroacoustic composition from the point of view of the development of a community of practice. It was carried out in France, during the school year 2013/2014, in two classes of public elementary school Pasquier of the city of Antony located in Paris suburbs. We are therefore talking about a collective teaching of music to young children on school time realized in a co-teaching school between a teacher and a music teacher.Étienne Wenger's "theory of community of practice" will be used as a grid of reading and a prism through which we analyze the interactions of participants in an experiment of group music pedagogy conducted in school. We will study learning situations in this situation via inter-community and intra-community interactions, which are partly mediated by computer artifacts (audio files of musical selections, digital photos, publications and Internet availability, e-mail communication, etc.). As such, we have been interested in the use and the role played by information and communication technologies (ICT) in the exchanges of the community and in the theories of documentary sciences.Finally, we propose the construction of a pedagogical action model focusing on the interactions that we consider to be transposable to the university teaching of music composition in the Max and Pure Data environment in the Music Department of Paris 8 University