Addition of Algenpantucel-L Immunotherapy to Standard Adjuvant Therapy for Pancreatic Cancer: a Phase 2 Study

Background

Despite continued investigation, limited progress has been made in the adjuvant treatment of resected pancreatic cancer. Novel or targeted therapies are needed.

Methods

Multi-institutional, open-label, dose-finding, phase 2 trial evaluating the use of algenpantucel-L (NewLink Genetics Corporation, Ames, IA) immunotherapy in addition to chemotherapy and chemoradiotherapy in the adjuvant setting for resected pancreatic cancer (ClinicalTrials.gov identifier, NCT00569387). The primary outcome was 12-month disease-free survival. Secondary outcomes included overall survival and toxicity.

Results

Seventy patients were treated with gemcitabine and 5-fluorouracil-based chemoradiotherapy as well as algenpantucel-L (mean 12 doses, range 1–14). After a median follow-up of 21 months, the 12-month disease-free survival was 62 %, and the 12-month overall survival was 86 %. The most common adverse events were injection site pain and induration.

Conclusions

The addition of algenpantucel-L to standard adjuvant therapy for resected pancreatic cancer may improve survival. A multi-institutional, phase 3 study is ongoing (ClinicalTrials.gov identifier, NCT01072981).     

COVID-19: the heart and other issues

From the time that the first cases were reported from Wuhan, China on the 31^st December 2019,¹ our knowledge of the clinical and virological associations of the novel coronavirus (COVID-19) has been evolving at a rapid pace. On 18^th May 2020, COVID-19 had caused over 4.82 million cases worldwide and resulted in 316,959 deaths.² Whilst the primary focus of management for patients with COVID-19 remains close monitoring of respiratory function, there have been high levels of cardiac dysfunction in emerging cross-sectional and observational analyses, suggesting the need for heightened awareness in patients who may require cardiac input as part of a multidisciplinary approach. We review the current data on the association of COVID-19 and the heart.Key words: ACE2, azithromycin, biomarkers, COVID-19, heart disease, hydroxychloroquine, Kawasaki disease, remdesivir     

Aggressive Angiomyolipomas: the Clandestine Epithelioid Variant

Epithelioid angiomyolipoma is a rare mesenchymal derived neoplasm of the kidney. Thought to be a variant of classical angiomyolipoma, a benign tumour, its malignant potential has been highlighted by case reports of loco-regional and distant metastasis. Given the potentially adverse clinical course associated with epithelioid angiomyolipoma compared to classical angiomyolipoma, the distinction and comprehensive histological characterisation of this rare entity is essential.Key Words: Angiomyolipoma, Computed tomography, Renal cell carcinoma     

Feasibility and Acceptability of Delivering a Postpartum Weight Loss Intervention via Facebook: A Pilot Study

Objective

To evaluate the feasibility and acceptability of a Facebook-delivered postpartum weight loss intervention.

Molecular markers in prognosis of colorectal cancer and prediction of response to treatment

Colorectal cancer is the third most common human malignancy. Direct observation and biopsy sampling by colonoscopy have provided unique opportunities to study the natural history of the disease. As a consequence, advances in the understanding of colorectal cancer pathogenesis have evolved more rapidly than with most other solid tumours. Numerous molecular events arising during the development of colorectal cancer have been sorted out over the past two decades. Despite these advances, predicting outcome and response to therapy is still a major challenge in the management of patients with colorectal cancer. Molecular and biochemical markers of colorectal cancer are greatly needed for diagnosis and prognosis as well as for the selection and monitoring of treatments. The purpose of this chapter is to provide a critical assessment of the usefulness of markers in the prognosis and prediction of response to treatment in colorectal cancer.     

Circadian variation in cardiovascular events

Prospective studies have shown not only that there is a greater incidence of acute myocardial infarction during the morning waking hours but also that transient myocardial ischemia, unstable angina, sudden cardiac death, complex ventricular arrhythmieas, and strokes have a greater incidence at a similar time. Studies of the physiologic responses that occur throughout the day have shed much light on why such a pattern in the timing of cardiovascular events is seen. It has been shown, for example, that blood pressure and heart rate surge on waking and at the start of daily activities, as does release of catecholamine. It appears that delaying the time of arising and of commencing activities simply shifts the risk of cardiovascular events rather than negating it. The most important clinical message obtained from the study of circadian variation in cardiovascular disease is that protection should be offered to cover the morning waking hours in addition to other times of the day. This need is being addressed with the increasing use of long-acting therapeutic agents.