Background: Randomized clinical trials have demonstrated the benefits of chemotherapy in carefully selected non-small cell lung cancer (NSCLC) patients. How generalizable these results are to other NSCLC patients is unresolved. Methods: The outcomes of patients treated with standard chemotherapy regimens (paclitaxel/carboplatin; gemcitabine/carboplatin; pemetrexed/carboplatin; paclitaxel/carboplatin/bevacizumab) off study as first line therapy between 2002 and 2012 at our institution were compared to the reported results of trials supporting the FDA approval of these drugs and/or regimens. Results: In our population, 38.1% of the patients had hypertension, 11.9% of the patients were diabetic, 23.7% had chronic obstructive pulmonary disease (COPD), 11.9% had coronary artery disease (CAD) and 2.1% had renal or liver disease. Notably, the presence of a single or multiple comorbidities was associated with low overall survival compared to matched patients with no comorbidities (p = 0.007). Conclusion: The presence of single or multiple comorbidities is associated with inferior overall survival compared to matched groups without such pre-existing conditions.
Results: 37 patients, 29 males, 8 females, with a median age of 73 years (range, 50-86), PS¼1/2/3 in 1/28/8 (3/ 76/22%), stage IVA/IVB in 11/26 (30/70%), brain/ bone disease in 8/13 (22/35%) and a median of 3 (range, 0-5) active comorbidities were treated. Twentyfive patients had an adenocarcinoma (68%), 12 (32%) a squamous cell carcinoma; 2 patients had an active mutation of the EGFR gene and were previously treated with a TKI. Fourteen patients (38%) received the treatment as first line, 8 (22%) as second line, and 15 (41%) as third or subsequent line. The median cycle of chemotherapy administered was 2 (range, 1-8). G1/G2 toxicities were: asthenia in 20 (54%) patients, constipation in 13 (35%), nausea in 9 (26%), anemia in 5 (14%). G3 toxicities were: anemia in 2 (5%) patients, neutropenia and fatigue each in one patient (3%). None patient had G4 toxicity and required dose reduction. Out of the 36 assessable patients, DCR was 25% (in 9 patients). The median duration of treatment was 2.8 months (range, 0.3-8.4). With a median follow-up of 22.1 months, 3 patients (8%) are still alive; median OS was 5.5 months (range, 5.2-6.1) and median PFS 2.5 months (range, 2.4-2.8).Conclusion: In patients with very poor prognosis advanced NSCLC unsuitable for chemotherapy, oral metronomic vinorelbine may lead to a disease control in a quarter of patients with acceptable toxicities.
Objectives: The number of people living with osteoporosis in all parts of the world is set to greatly increase in the upcoming decades due to ageing populations. In China, the number of women aged 65+ is expected to more than double from 2020-2040. We estimated the economic and clinical fracture burden in postmenopausal women (PMW) in China by modeling expected demographic shifts and the effects of potential policy changes to increase screening and treatment rates. Methods: A microsimulation model was developed to project the annual incidence and costs of osteoporotic fractures among PMW from 2020 to 2040. Fracture risk was estimated using the simplified form of the Fracture Risk Assessment Tool (FRAX) with published data on baseline characteristics and risk factors. Fractures were estimated based on annualized FRAX risk and the impact of treatment. Published literature was used to identify direct fracture costs, productivity loss, caregiver burden, DXA screening costs, and treatment costs and efficacy. We compared China's status quo screening and treatment rates (8.8% and 2.39%, respectively), against two alternative scenarios reflecting 50% increases to these rates.
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