Expected survival with and without second-line palliative chemotherapy: who wants to know?

Background According to surveys, many patients with advancedcancer wish to receive survival information.Objective This study invest igated information preferences by offer-ing patients a decision aid (DA) with infor mation on expected sur-vival for two treatment options: supportive care with or withoutsecond-line palliative chemotherapy. Predicto rs of accepting sur-vival information were explored.Design Eligible patients in this multicentre prospective study wereoffered secon d-line chemotherapy for advanced breast or colorectalcancer. A nurse presented a DA on second-line treatment andasked patients whether they desired information on (i) adverseevents, (ii) tumour response and (iii) survival. Data on 50 clinicaland psychosocial patient characteristics were collected from inclu-sion forms and patient questionnaires.Results Seventy-seven patients received a DA; median age62 years (range 32–80), 61% female, 77% colorectal cancer. Fifty-seven patients (74%; 95% CI 64–84) desired survival information.Four psychosocial characteristics (e.g . deliberative decision style)independently predicted information desire. However, the use ofthese characteristics to predict information desire hardly outper-formed a simple prediction rule.Conclusions Many patients desired information on expected sur-vival when deciding about second-line treatment. However, ourexploratory analysis indicated that patients desiring this informa-tion could not be identified based on their clinical or psychosocialcharacteristics. These findings can help encourage candid discus-sions about expected survival. Health professionals should be care-ful not to make implicit assumptions of information desire based on patient characteristics, but to explicitly ask patients if survivalinformation is desired, and act accordingly

Primaire biliaire cirrhose met sclerodermie en hypothyreoidie

Contains fulltext : 4297.pdf (publisher's version ) (Open Access

Quantification of the endogenous growth hormone and prolactin lowering effects of a somatostatin-dopamine chimera using population PK/PD modeling

A phase 1 clinical trial in healthy male volunteers was conducted with a somatostatin-dopamine chimera (BIM23B065), from which information could be obtained on the concentration-effect relationship of the inhibition of pulsatile endogenous growth hormone and prolactin secretion. Endogenous growth hormone profiles were analyzed using a two-step deconvolution-analysis-informed population pharmacodynamic modeling approach, which was developed for the analyses of pulsatile profiles. Prolactin concentrations were modelled using a population pool model with a circadian component on the prolactin release. During treatment with BIM23B065, growth hormone secretion was significantly reduced (maximal effect [E-MAX] = - 64.8%) with significant reductions in the pulse frequency in two out of three multiple ascending dose cohorts. A circadian component in prolactin secretion was identified, modelled using a combination of two cosine functions with 24 h and 12 h periods. Dosing of BIM23B065 strongly inhibited (E-MAX = - 91%) the prolactin release and demonstrated further reduction of prolactin secretion after multiple days of dosing. This study quantified the concentration-effect relationship of BIM23B065 on the release of two pituitary hormones, providing proof of pharmacology of the chimeric actions of BIM23B065