PROGRESSION-FREE SURVIVAL AND OVERALL SURVIVAL FOR PATIENTS WITH METASTATIC MELANOMA TREATED WITH ANTI-PD-1 MONOCLONAL ANTIBODIES
Creator:
McIlwaine, Peter
Date of publication:
November 18, 2019
Abstract Tesim:
Purpose: Over the past 30 years, the incidence of melanoma has been climbing at a faster rate than any other malignancy. In 2019, it is projected that close to 100,000 new patients will be diagnosed with melanoma. Melanoma would then become the fifth most common type of cancer in the United States.1 With the advent of anti-PD-1 immunotherapies, such as pembrolizumab and nivolumab, an individual’s own immune system can now recognize and kill cancers, such as melanoma2. Immunotherapies bring a new and exciting approach to the treatment of melanoma and other forms of cancer. A review of the current state of clinical studies in the setting of metastatic melanoma treatment is therefore needed to understand better how progression-free survival and overall survival have been effected with the introduction of anti-PD-1 antibodies.
Materials and Methods: Five clinical research trials were selected for review based on the following criteria: use of either pembrolizumab or nivolumab as a monotherapy for patients with metastatic melanoma. The progression-free survival period and overall survival were determined and, where appropriate, compared to chemotherapy or the cytotoxic T-lymphocyte antigen-4 inhibitor, ipilimumab.
Results: Across the five clinical studies, pembrolizumab and nivolumab showed statistically significant improvement in progression-free survival and overall survival in three out of five studies. The two studies that did not find a statistical significance still showed a numerical improvement
Conclusion: Pembrolizumab and nivolumab, given as monotherapy, improve progression-free survival and overall survival when compared to chemotherapies and the immunotherapy, ipilimumab.
Diagnostic Accuracy of Transvaginal Ultrasound in Women with Endometriosis at Deeply Infiltrating, Ovarian, and Superficial Peritoneal Sites
Creator:
Turner, Rebecca
Date of publication:
November 14, 2019
Abstract Tesim:
Endometriosis is a chronic inflammatory disease marked by pelvic pain and infertility. It is caused by ectopic implantation of endometrial tissue and affects ten percent of women of child-bearing age worldwide. It is known to negatively impact many aspects of a patient's life, including income and mental health. The average time from symptom appearance to diagnosis is eight to twelve years. This delay is due, in part, to the necessity of a surgical biopsy for diagnosis. This narrative review evaluated literature comparing the accuracy of transvaginal ultrasound (TVUS) against a surgical biopsy for diagnosing endometriosis. The results show consistently high specificity values for TVUS at ovarian and deeply infiltrating implantation sites, with low to moderate sensitivity values. The findings of this review indicate a positive TVUS may be reliable enough to diagnose endometriosis at ovarian and deeply infiltrating sites. However, a negative TVUS cannot rule out endometriosis and should prompt further testing. The results were generally limited by a lack of available research. More research is needed before a conclusion may be drawn about superficial implantation sites.
Resource type:
Masters Paper
Affiliation Label Tesim:
Department of Allied Health Sciences and Department of Obstetrics and Gynecology
Degree:
Master of Health Science
Type:
http://purl.org/dc/dcmitype/Text
DOI:
https://doi.org/10.17615/btg1-hp58
Graduation Year:
2019
Language Label:
English
ORCID:
Other Affiliation:
Person:
Faurot, Keturah, Melvin, Jacquetta, and Turner, Rebecca
HPV Self-Sampling: A Novel Approach to Cervical Cancer Screening
Creator:
Orihood, Stephanie
Date of publication:
November 20, 2019
Abstract Tesim:
Background Cervical cancer is a female specific cancer and the fourth most common cancer type worldwide with incidence rates in the United States of 8.1 cases per 100,000 women. Cervical cancer mortality has decreased since the start of screening programs with the Papanicolaou test in the 1940s, but more can be done to ensure screening reaches increasing numbers of women. One of the methods that could be used in the future to reach women for screening is using self-sampling testing for high risk HPV strains that cause over 90% of cervical cancers.
Objectives This review aims to answer the question: Is hrHPV testing via self-sampling an accurate and acceptable method of screening for cervical cancer when compared with the reference of cervical cytology otherwise known as the Papanicolaou test.
Methods PubMed, Medline and Embase were searched using the terms “cervical cancer”, HPV, “human papillomavirus” “cervical HPV”, “Pap”, “Papanicolaou”, “cytology”, “HPV cotesting”, “self-sampling” and “hrhpv testing.” Three primary research studies and three systematic review were included.
Results Sensitivity of HPV testing in self samples ranged between 51% and 93% for CIN2+32 and between 63% and 94% for CIN3+32. Rates of hrHPV positivity in self versus clinician collected samples were very similar (560 positive results self-collected, 554 positive results clinician collected15.) Noninferiority of HPV self-sampling was indicated by one included RCT16. 80% of women in an underserved area returned self-testing samples14 and most of these women indicated a positive experience with self-testing. Women were found to be twice as likely to be screened if they used self-sampling compared to standard of care screening (RR: 2.13, 95% CI 1.89-2.40)17. One review found that there was no consensus among women whether clinician or self-collected testing was preferred18.
Conclusions Overall, self-sampling appears to be an accurate method of testing for hrHPV in women. Most papers in this review point to the acceptability of self-testing among women. More research is most definitely needed surrounding accuracy of self-testing methods and how to encourage follow up care.
Resource type:
Masters Paper
Affiliation Label Tesim:
Physician Assistant Program
Degree:
Master of Health Science
Type:
http://purl.org/dc/dcmitype/Text
DOI:
https://doi.org/10.17615/xhzm-qw85
Graduation Year:
2019
Language Label:
English
ORCID:
Other Affiliation:
Person:
Faurot, Kim PA, MPH, PhD, Melvin, Jacquetta W. MPH, PA-C, and Orihood, Stephanie
A Narrative Overview Introducing Brexanolone as a Promising New Treatment Option for Postpartum Depression
Creator:
Izlar, Gillian
Date of publication:
November 18, 2019
Abstract Tesim:
Postpartum depression (PPD) is a serious and common public health issue that often goes undiagnosed and untreated. The treatment options for PPD, including antidepressants, are the same interventions used to treat major depressive disorder outside of the peripartum period; thus, they are not targeted to PPD. Novel studies of the pathophysiology of PPD implicate the role of neuroactive steroids in the regulation of Gamma-Aminobutyric Acid (GABA) A receptors. This new evidence led to the recent clinical trials which evaluate the efficacy of Brexanolone, a synthetic neuroactive steroid, for the treatment of PPD. Brexanolone is an intravenous synthetic version of allopregnanolone, which is a positive modulator of the GABA A receptor. The drug, which is administered as a continuous infusion over a period of 60 hours, was recently tested in both open-label and placebo- controlled randomized clinical trials. The results of these trials reveal an overall rapid diminishment of depressive symptoms in those with moderate to severe PPD. This impressive positive response to Brexanolone led to the US Food and Drug Administration approval of the drug in March of 2019. Brexanolone is the first targeted pharmacotherapy for this condition and marks an important turning-point for future research in the pathophysiology and treatment of PPD.
Regenerating Life: Exploring the Potential for Stem Cell Therapy in Traumatic Brain Injury
Creator:
Wiley, Codie
Date of publication:
2017
Abstract Tesim:
Traumatic Brain Injury is responsible for 30% of trauma related death and over 2.8 million visits
to the emergency room, hospitalizations, and deaths in 2010. Many survivors are left with
cognitive and motor deficits while others are left in a persistent vegetative state. Current
treatments have shown advancement over the past decade however TBI rates continue to rise
across the country. Recently stem cells have been tested and shown to have efficacy in many
diseases and genetic disorders. TBI clinical trials are moving into human trials and show promise
in both the acute and sub-acute time period. Research reports improvements in cognitive and
motor function after injection with Mesenchymal stem cells. These cells are harvested from bone
marrow and umbilical cord blood instead of fetal embryos. With the ability to differentiate in to
specialized cells they have the ability to repair and renew damaged tissue. Limitations in recently
published clinical trials show the need for more research in an exciting and rapidly expanding
field.
Atrial Fibrillation: A Clinical Review and Comparison of Warfarin versus Dabigatran for Anticoagulation Therapy
Creator:
Cowan, Richard
Date of publication:
2017
Abstract Tesim:
Atrial fibrillation (AF), or AFib, is the most commonly occurring type of cardiac
arrhythmia. AF is commonly referred to as an “irregularly irregular” rhythm and is defined
as a supraventricular tachyarrhythmia in which an irregular electrical impulse in the upper
chambers (atria) of the heart produces an uncoordinated depolarization and thus an inefficient
contraction of the atria. As a result, there is a reduction in cardiac output and potential for
pooling of blood in the atria which increases the risk of clot formation and mortality from a
cerebrovascular accident or pulmonary embolism. AFib is a public health concern that affects
up to 6 million people in the United States and is associated with more than 130,000 deaths
per year. It also costs the U.S. healthcare system nearly $6 billion per year. AF becomes
more prevalent with age, and with the steadily increasing elderly population worldwide,
prevention and treatment of this condition becomes more important clinically and
economically. Due to the immense burden on the healthcare system, there have been many
advances in surgical and pharmacological modalities for treatment AF, however long-term
anticoagulation therapy for prevention of thromboembolism has remained a guideline
recommended treatment for AF. The goal of this article is to review the clinical aspects of
atrial fibrillation including prevalence, pathophysiology, diagnosis, and treatment, with a
focus on comparing traditional anticoagulation therapy of Warfarin with the newer nonVitamin
K anti-coagulant Dabigatran (Pradaxa). This article will also serve to review
recently collected data from the VA Medical Center in regard to implementation of
anticoagulation guidelines in the management of non-valvular AFib.
Cardiovascular Risk Associated with Male Testosterone Therapy
Creator:
Pitts, Johnny
Date of publication:
2017
Abstract Tesim:
Background:
Testosterone therapy, also known as male hormone replacement therapy has commonly
been prescribed for older men since the 1950’s. Low testosterone (low T) in men has been linked
with elevated cardiovascular risk factors, cardiovascular events, and increased cardiovascular
mortality. However, in 2014 the Food and Drug Administration (FDA) issued a warning
regarding therapeutic testosterone use for age related hypogonadism or low T regarding
increased cardiovascular related events and stroke. Although studied extensively, providers
continue to disagree as to its safety and effectiveness especially considering this recent
recommendation. Therefore, the purpose of this clinical review is to discuss diagnosis and
treatment options for men with low T while evaluating systematic reviews analyzing
cardiovascular risk.
Unlike female menopause, male hypogonadism does not universally develop in men.
Low T, also known as hypogonadism or andropause, is associated with a lower quality of life
and is currently estimated to affect as many as 38-40% of men in their lifetime. To treat men for
andropause, Testosterone therapy (TTh) is prescribed in several different forms such as
intramuscular (IM) injections, topical creams, subcutaneous (SC) pellets, oral pills, and
transdermal patches. With sales projected to reach 3.2 billion by 2022, TTh is marketed to older
men to treat multiple symptoms including: 1) fatigue, 2) mood, 3) muscle mass, 4) strength, and
5) sexual dysfunction as well as prevention of worsening heart disease. But, in multiple reviews
the conclusion is that there is little benefit that outweighs the risks associated with TTh. These
risks include cardiovascular events such as myocardial infarction (MI) and stroke as well as
prostatic hyperplasia, and cancer. With the widespread use of TTh, more definitive
determinations need to be made regarding the potential dangers of TTh.
Neoadjuvant Chemotherapy and Adjuvant Chemoradiotherapy in the Treatment of Gastric Adenocarcinomas
Creator:
Feldman, James
Date of publication:
2018
Abstract Tesim:
Purpose: Gastric cancer is the third leading cause of cancer-related death worldwide. From 1974-1975,
patients who received gastric resection only had a 5-year survival rate of 15.3%.16 With the introduction
of chemoradiotherapy, the 5-year survival rate increased to 23.2% from 1995-2001.16 One question
which can be imposed is how necessary is neoadjuvant chemotherapy in addition to surgery compared
to surgery then adjuvant chemoradiotherapy in improvement of 5-year survivability of a gastric
adenocarcinoma.
Methods and Materials: 7 random control trials using neoadjuvant chemotherapy and 2 random control
trials using adjuvant chemoradiotherapy were examined using a network meta-analysis to determine
which was the more beneficial for 3-year, 5-year, and Overall Survival. Secondary outcome was to
determine which caused more life-altering side effects
Results: There was no statistical benefit found in the use of adjuvant chemoradiotherapy over the use of
neoadjuvant chemotherapy. The 5-year and Overall mortality were consistently higher in the adjuvant
chemoradiotherapy group, but the strength of data in the network meta-analysis was inconclusive.
Conclusion: Further study the use of neoadjuvant chemotherapy plus surgery in the treatment of gastric
adenocarcinomas in order to improve quality of life for the patients is recommended as well as further
study of adjuvant chemoradiotherapy to improve survivability.
Resource type:
Masters Paper
Affiliation Label Tesim:
Physician Assistant Program
Degree:
Master of Science
Degree Granting Institution:
University of North Carolina at Chapel Hill
Deposit Record:
4f71c304-2e36-4df1-8e2e-a02d9e847439
Type:
http://purl.org/dc/dcmitype/Text
DOI:
https://doi.org/10.17615/kqy9-ty90
Graduation Year:
2018
Keyword:
gastric cancer, physician assistant, chemoradiotherapy, chemotherapy, and adenocarcinoma