Independent Studies Find DynaMed Fastest at Including New Evidence DynaMed Weekly Update - Volume 6, Issue 38 Evidence-based clinical references must be regularly updated to provide the best current evidence available, but the approaches used to maintain currency differ among reference databases. A new study prospectively evaluated the rates at which new evidence is added to several of these databases. They identified systematic reviews selected by leading evidence-based collections to represent the most important new evidence and monitored the databases starting two months after publication to see when these reviews would appear in clinical reference content. The median time to inclusion of evidence was 7.
Next Section Abstract Myeloid growth factors MGFs are given as supportive care to patients receiving myelosuppressive chemotherapy to reduce the incidence of neutropenia.
Based upon high-level evidence, there is uniform NCCN consensus that the intervention is appropriate.
Based upon lower-level evidence, there is uniform NCCN consensus that the intervention is appropriate. Based upon lower-level evidence, there is NCCN consensus that the intervention is appropriate. Based upon any level of evidence, there is major NCCN disagreement that the intervention is appropriate.
All recommendations are category 2A unless otherwise noted. NCCN believes that the best management Weekly journal dyspnea any cancer patient is in a clinical trial.
Participation in clinical trials is especially encouraged. Previous Section Next Section Overview Myeloid growth factors MGFs are a class of biologic agents that regulate the proliferation, differentiation, survival, and activation of cells in the myeloid lineage.
In patients with cancer receiving myelosuppressive chemotherapy, MGFs are primarily used to reduce the incidence of neutropenia.
Development of FN increases diagnostic and treatment costs and often leads to longer hospital stays. In addition, correlations have been reported between changes in neutrophil counts and quality of life, as measured by physical functioning, vitality, and mental health. Thus, differences in the reported rates of myelotoxicity may be attributed to intrinsic variation in the patient population as well as differences in the delivered dose intensities.
Myeloid Growth Factors, Version 2.
In a new window Myeloid Growth Factors, Version 2. NCCN believes that the best management of any patient with cancer is in a clinical trial. All recommendations are category 2A unless otherwise indicated. Studies have demonstrated that prophylactic use of MGFs can reduce the risk, severity, and duration of FN, but the cost has prevented its routine use in all patients receiving myelosuppressive chemotherapy.
Selective use of MGFs in patients at increased risk for neutropenic complications may enhance the cost-effectiveness. Filgrastim, filgrastim-sndz, tbo-filgrastim, and pegfilgrastim are G-CSFs currently approved by the FDA for the prevention of chemotherapy-induced neutropenia.
Both tbo-filgrastim and pegfilgrastim are restricted in their FDA approval for use in patients with nonmyeloid malignancies receiving myelosuppressive anticancer drugs. Tbo-filgrastim was approved by the FDA in an original biologic license application in August56 and therefore has a more restricted indication.
A biosimilar is a biological product that is highly similar to the FDA-approved reference product with the exception of minor differences in clinically inactive components, and no differences regarding efficacy, safety, and purity between the biosimilar and the reference product.
Additional indications for filgrastim and filgrastim-sndz include treatment for patients with acute myeloid leukemia AML receiving induction or consolidation chemotherapy, patients with cancer receiving bone marrow transplant, patients undergoing peripheral blood progenitor cell PBPC collection and therapy, and patients with severe chronic neutropenia.
Filgrastim is also approved by the FDA for the treatment of patients acutely exposed to myelosuppressive doses of radiation.
Sargramostim is limited to use following induction therapy for AML and in various hematopoietic cell transplantation settings. The NCCN Panel convenes annually to update their recommendations for the use of MGFs, which are based on a review of recently published clinical trials that have led to significant improvements in treatment or have yielded new information regarding biologic factors that may have prognostic importance.
This portion of the NCCN Guidelines discusses recommendations outlined for the evaluation of regimen- and patient-specific risk factors for the development of FN, the prophylactic use of MGFs for the prevention of chemotherapy-induced FN, and assessing the risks and benefits of MGF use in clinical practice.
Risk assessment includes disease type, chemotherapy regimen, patient risk factors, and treatment intent. The panel also recommends that patients receiving cytotoxic chemotherapy as part of a clinical trial be evaluated for prophylactic use of MGFs based on both regimen-specific and patient-specific risk factors, unless precluded by trial specifications.
Chemotherapy Regimens and Risk for FN FN is a common dose-limiting toxicity of many single-agent and combination chemotherapy regimens that is directly related to the intensity of the regimen. It should be noted that the addition of monoclonal antibodies to chemotherapy regimens has the potential to increase FN risk.
It has been associated with prolonged, delayed-onset neutropenia both with or without chemotherapy. The algorithm lists common chemotherapy regimens associated with a high risk or intermediate risk of developing FN based on published data. These lists are not comprehensive and are meant to serve as examples only, as the exact risk will depend on the agent, dose, and treatment setting.
Patient Risk Factors for Developing FN Patient risk factors are an important consideration in estimating the overall risk of FN, particularly when chemotherapy regimens are considered an intermediate risk. For example, many regimens for breast and lung cancer are associated with an intermediate risk of neutropenic complications, and it is important to identify which patients would be considered high risk.
Even a low-risk regimen does not necessarily preclude the use of MGFs in a patient with high-risk factors. Most of these have been confirmed as independent risk factors for neutropenic complications in a risk model developed by Lyman et al 19 that was validated in a study population of 3, patients with cancer beginning chemotherapy treatment.A year-old woman presented to an urgent care clinic with a 1-week history of fatigue, dyspnea on exertion, and daily fevers of up to °C.
Eagle's Eye View: Your Weekly CV Update From lausannecongress2018.com (Week of June 4). The CDC has expanded its recommendations for short-course combination therapy for latent tuberculosis infection.
Previously, the agency recommended once-weekly isoniazid and rifapentine for 12 weeks by directly observed therapy for adults with latent TB, including those with HIV who weren't taking.
November 16, (Vancouver, British Columbia) — Daily singing exercises reduce dyspnea in patients with chronic obstructive pulmonary disease (COPD), according to research presented here at.
To address some of the shortcomings to providing timely and convenient education and support to patients with COPD, especially in the management of dyspnea, the Internet was considered a viable medium to deliver a previously tested program at a distance to reach more patients.
Interactive Medical Case from The New England Journal of Medicine — A Crazy Cause of Dyspnea.
participants in the NEJM Weekly CME Program should be able to affirm or demonstrate an increase.