The only US Food and Drug Administration (FDA)-approved first-line systemic therapy for hepatocellular carcinoma (HCC) is sorafenib; however, resistance or intolerance to sorafenib is unfortunately common. In this review, we briefly describe systemic therapies that can be considered for patients with HCC who show resistance or intolerance to sorafenib. For all patients with HCC who need systemic therapy, we strongly advocate for participation in clinical trials. Cytotoxic chemotherapy plays a minor role in the treatment of advanced HCC, with some data supporting the use of FOLFOX (infusional fluorouracil, leucovorin, and oxaliplatin) and GEMOX (gemcitabine-oxaliplatin). Multi-target kinase inhibitors such as lenvantinib and regorafenib have recently met their primary endpoints as first- and second-line therapy, respectively, with regorafenib now representing the only FDA-approved drug for second-line treatment of HCC. Other targeted therapies remain under investigation, but results so far have not significantly changed clinical practice. Immunotherapy is an interesting area of research in the treatment of HCC with preclinical and early clinical data demonstrating exciting results; thus numerous investigational studies are currently focusing on immunotherapy in the treatment of HCC. While systemic treatment options in HCC remain a challenge for providers, in this review, we summarize the current literature and highlight areas of progress with respect to the treatment of patients with HCC and resistance or intolerance to sorafenib.
One can point to a variety of historical milestones for gender equality in STEM (science, technology, engineering, and mathematics), however, the practical effects are gradual and ongoing. It is important to quantify gender differences in subdomains of scientific work in order to detect potential biases and to monitor progress. In this work, we studied the relevance of gender in scientific collaboration patterns in the Institute for Operations Research and the Management Sciences (INFORMS), a professional organization with sixteen peer-reviewed journals. We constructed a large temporal bipartite network between authors and publications, using the organization's publication data from 1952 to 2016, and augmented the author nodes with gender labels. We characterized differences in several basic statistics of this network over time, highlighting how they change with respect to relevant historical events. We found a steady increase in participation by women (e.g., fraction of authorships by women and of new women authors) starting ∼1980. However, women still comprise less than 25% of the INFORMS society, and are additionally underrepresented among authors with many publications. Finally, we describe a methodology for quantifying differences in the role that authorships by women and men play in the overall connectivity of the network. Specifically, we propose a degree-preserving temporal and geometric null model with emergent communities. We use two measures of edge importance related to diffusion throughout the network, namely effective resistance and edge contraction importance to quantify gender differences in collaboration patterns that go beyond differences in local statistics.
Purpose Cancer patients have many medical and psychosocial needs, which may increase during the COVID-19 pandemic. We sought to (1) risk-stratify hematology/oncology patients using general medicine and cancer-specific methods to identify those at high risk for acute care utilization, (2) measure the correlation between two risk stratification methods, and (3) perform a telephone-based needs assessment with intervention for high-risk patients. Methods Patients were risk-stratified using a general medical health composite score (HCS) and a cancer-specific risk (CSR) stratification based on disease and treatment characteristics. The correlation between HCS and CSR was measured using Spearman's correlation. A multidisciplinary team developed a focused needs assessment script with recommended interventions for patients categorized as high-risk by either method. The number of patient needs identified and referrals for services made in the first month of outreach are reported. Results A total of 1697 patients were risk-stratified, with 17% high-risk using HCS and 22% high-risk using CSR. Correlation between HCS and CSR was modest (ρ = 0.41). During the first month of the pilot, 286 patients were called for outreach with 245 contacted (86%). Commonly identified needs were financial difficulties (17%), uncontrolled symptoms (15%), and interest in advance care planning (13%), resulting in referral for supportive services for 33% of patients. Conclusion There is a high burden of unmet medical and psychosocial needs in hematology/oncology patients during the COVID-19 pandemic. A telephone-based outreach program results in the identification of and intervention for these needs; however, additional cancer-specific risk models are needed to improve targeting to high-risk patients.
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