Lomustine, vindesine and bleomycin (LVB) used in the treatment of relapsed advanced Hodgkin's disease. A prospective study on behalf of the East of Scotland and Newcastle Lymphoma Group (ESNLG)

Sixty-three patients with relapsed advanced Hodgkin's disease were treated with lomustine (CCNU), vindesine and bleomycin (LVB). Age range was 17-72 years, with 38 males and 25 females. Thirty patients achieved complete remission (CR) with a median duration of 24+ months (range 3-55). Nineteen continue in unmaintained CR. CR rates were highest for those patients who relapsed greater than 6 months after first line treatment and for those at second or subsequent relapse. CR rates were higher in those with nodal only relapse. Twenty-seven patients were non-responders and six were partial responders. These 33 patients were subsequently changed to alternative chemotherapeutic regimes and 26 failed to respond to any therapy and have since died. Only one patient is in unmaintained complete remission. The regimen was well tolerated by patients, and easy to administer. It produced no serious episodes of toxicity. We conclude that LVB is of value in the management of relapsed advanced Hodgkin's disease especially in chronic relapsing patients, and where relapse occurs greater than 6 months after the first line treatment. We are presently unsure whether it offers any advantage over reintroduction of first line treatment in the latter group.     

Pricing appraisal of anti-cancer drugs in the South East Asian,Western Pacific and East Mediterranean Region

Background

Globally, cancer is one of the leading causes of mortality. High treatment cost, partly owing to higher prices of anti-cancer drugs, presents a significant burden on patients and healthcare systems. The aim of the present study was to survey and compare retail prices of anti-cancer drugs between high, middle and low income countries in the South-East Asia, Western Pacific and Eastern Mediterranean regions.

Methods

Cross-sectional survey design was used for the present study. Pricing data from ten counties including one from South-East Asia, two from Western Pacific and seven from Eastern Mediterranean regions were used in this study. Purchasing power parity (PPP)-adjusted mean unit prices for 26 anti-cancer drug presentations (similar pharmaceutical form, strength, and pack size) were used to compare prices of anti-cancer drugs across three regions. A structured form was used to extract relevant data. Data were entered and analysed using Microsoft Excel®.

Results

Overall, Taiwan had the lowest mean unit prices while Oman had the highest prices. Six (23.1%) and nine (34.6%) drug presentations had a mean unit price below US$100 and between US$100 and US$500 respectively. Eight drug presentations (30.7%) had a mean unit price of more than US$1000 including cabazitaxel with a mean unit price of $17,304.9/vial. There was a direct relationship between income category of the countries and their mean unit price; low-income countries had lower mean unit prices. The average PPP-adjusted unit prices for countries based on their income level were as follows: low middle-income countries (LMICs): US$814.07; high middle income countries (HMICs): US$1150.63; and high income countries (HICs): US$1148.19.

Conclusions

There is a great variation in pricing of anticancer drugs in selected countires and within their respective regions. These findings will allow policy makers to compare prices of anti-cancer agents with neighbouring countries and develop policies to ensure accessibility and affordability of anti-cancer drugs.

     

Changes in the site distribution of malignant melanoma in South East Scotland (1979-2002)

Scottish Melanoma Group (SMG) data on 2790 melanoma (MM) cases in South East Scotland over a 24-year time period were analysed in four periods each of 6 years duration grouped into frequently exposed, intermittently exposed, and always covered sites. Incidence increased significantly over time with females having a higher incidence rate than males. In both sexes, the proportion of cases seen on the posterior trunk and arm increased significantly (P<0.001), but declines were seen in the proportion of leg tumours in males (P=0.09) and of head tumours in females (P=0.011). Although the proportion of cases decreased for certain sites, the actual MM incidence increased at all sites. A significant increase in incidence occurred at usually and always covered sites (P<0.001 and P<0.001, respectively) in females and at usually covered sites in males (P<0.001).     

Comparison of time trends in oesophagus cancer incidence (1973-1997) in East Asia, Europe, and the USA, from cancer incidence in five continents Vols IV VIII

Time trends of age-standardized rate (ASR) of oesophagus cancerincidence [ICD-10: oesophagus (C15)] were compared among 18selected cancer registries and ethnic/racial groups in EastAsia, Europe, and the USA. Data source was the Cancer Incidencein Five Continents Vols IV–VIII (years at diagnosis: 1973–77,     

STLV-I antibodies in feral populations of East African vervet monkeys (Cercopithecus aethiops)

Serum samples from feral populations of African green monkeys (Cercopithecus aethiops) were screened for antibodies to the simian T-lymphotropic virus, type I (STLV-I). Blood samples had been collected from 336 monkeys in 4 regions of central and southern Kenya in 1978 and 1979, from 114 monkeys in central Ethiopia in 1973, and from 85 monkeys from the Kampala region of Uganda in 1966. A total of 178/535 monkeys (33%) were seropositive (STLV-I+). Only 4/114 monkeys (4%) from Ethiopia were seropositive compared to 25/85 Ugandan monkeys (29%) and 149/336 Kenyan monkeys (44%). Epidemiological analysis of the Kenyan monkeys showed that 37% of the males and 54% of the females were STLV-I+, and that there was a progressive increase in the proportion of STLV-I+ monkeys of both sexes with age, rising from an average of 16% in infants (less than 9 months) to an average of 69% in adults (greater than 42 months). The proportion of STLV-I+ monkeys was higher among females in each age category. Seropositivity for antibodies to STLV-I had no apparent effect on the health of monkeys, and no association with the occurrence of Hepatocystis parasitemia was seen in this species. The analysis of data from infants of STLV-I+ mothers showed that seroconversion had occurred in 1 of 3 cases, suggesting that vertical transmission of the STLV-I virus is not an inevitable consequence for infants of seropositive mothers.     

Comparison of time trends in ovary cancer incidence (1973-1997) in East Asia, Europe, and the USA, from Cancer Incidence in Five Continents Vols IV VIII

Time trends of age-standardized rate (ASR) of ovary cancer incidence[ICD-10: ovary (C56)] were compared among 18 selected cancerregistries and ethnic/racial groups in East Asia, Europe, andthe USA. Data source was the Cancer Incidence     

Comparison of time trends in gallbladder cancer incidence (1973-1997) in East Asia, Europe and the USA, from Cancer Incidence in Five Continents Vols IV-VIII

Time trends of age-standardized rate (ASR) of gallbladder cancerincidence (ICD-10: C23–C24) were compared among 18 selectedcancer registries and ethnic/racial groups in East Asia, Europeand the USA. Data source was the Cancer Incidence in Five ContinentsVols IV–VIII (years at diagnosis: 1973–77, 1978–82,1983–87, 1988–92 and 1993–97, respectively).World population was used for age-standardization. Figure 1 shows time trends of ASR of gallbladder cancerincidence for males. When all the areas including Asia, Europeand the USA were compared, age-adjusted incidence rates (ASRs)of gallbladder cancer were comparatively higher in three Japaneseregistries (Miyagi,     

Variations in incidence of childhood leukaemia in South East Scotland (1970-1984)

Concern has been expressed recently about apparent increases in the incidence of leukaemia amongst young people living in certain geographical areas. We analysed the incidence of childhood leukaemia in South-East Scotland (excluding North-East Fife) from 1970 to 1984. There was a significant geographical variation in incidence of ALL with an excess in Fife concentrated in a small area of one district partly balanced by a relative decrease in Edinburgh. We feel that the variation is unlikely to be an artefact of geographically biased mis-diagnosis.     

Comparison of time trends in uterine cancer incidence (1973 1997) in East Asia, Europe and USA, from Cancer Incidence in Five Continents, Vols IV VIII

Time trends of age-standardized rate (ASR) of uterine cancerincidence (ICD-10: cervix uteri (C53), corpus uteri (C54)) werecompared among 18 selected cancer registries and ethnic/racialgroups in East Asia, Europe and the USA. The data source wasthe Cancer Incidence in Five Continents, Vols IV–VIII(years at diagnosis: 1973–1977, 1978–1982, 1983–1987,1988–1992 and 1993–1997, respectively). World populationwas used for age-standardization. Figure 1 shows the time trends of ASR of cervix uteri cancerincidence. In East Asia,     

Comparison of time trends in larynx cancer incidence (1973-97) in East Asia, Europe and USA, from Cancer Incidence in Five Continents, Vols. IV-VIII

Time trends of age-standardized rate (ASR) of larynx cancerincidence (ICD-10: C32) were compared among 18 selected cancerregistries and ethnic/racial groups in East Asia, Europe andUSA. Data source was the Cancer Incidence in Five ContinentsVol. IV–VIII (years at diagnosis: 1973–77, 1978–82,1983–87, 1988–92 and 1993–97, respectively).World population was used for age-standardization. Figure      

Comparison of time trends in female breast cancer incidence (1973 1997) in East Asia, Europe and USA, from Cancer Incidence in Five Continents, Vols IV VIII

Time trends of age-standardized rate (ASR) of female breastcancer incidence (ICD-10: C50) were compared among 18 selectedcancer registries and ethnic/racial groups in East Asia, Europeand the United States. The data source was the Cancer Incidencein Five Continents, Vols IV–VIII (years at diagnosis 1973–1977,1978–1982, 1983–1987,     

Comparison of Time Trends in Cancer Incidence (1973 1997) in East Asia, Europe and USA, from Cancer Incidence in Five Continents Vol. IV VIII

The above article appeared in Japanese Journal of Clinical Oncology37(2): 157–159     

Comparison of time trends in cancer incidence (1973-1997) in East Asia, Europe and USA, from Cancer Incidence in Five Continents Vol. IV-VIII

Time trends of age-standardized rate (ASR) of cancer incidence(ICD-10: C00-C96) were compared among 18 selected cancer registriesand ethnic/racial groups in Asia, Europe, and USA. Backgroundinformation of selected cancer registries was shown in Table 1.Data source was the Cancer Incidence in Five Continents Vol.IV–VIII (year at diagnosis: 1973–77, 78–82,83–87, 88–92, and 93–97, respectively). Worldpopulation was used for age-standardization. View this table:   Table 1. Background information of