Posted by James
Psychologists and Prescribing Privileges
I found multiple issues to be challenged in a disappointing article by Dr. Field (”Psychologists Gain a Foothold in the Battle for Prescribing Privileges,” P&T, June 2005).
If physicians are the “guardians against inappropriate and harmful use” of pharmacotherapy, then Dr. Field has chosen to ignore the Institute of Medicine and a host of other studies. Diagnosis, which is the keystone of appropriate therapy, might be representative of the statistics in bipolar disease: 20% of patients receive the correct diagnosis, 30% are diagnosed as having unipolar depression and 50% are misdiagnosed entirely. It takes 10.4 years to diagnose Bipolar II Disorder.
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Posted by James
I am sold!
I was very skeptical about the design and construction of a multitiered, co-payment drug benefit that could link improvement in clinical outcome with a lowered out-of-pocket cost for patients. I am sure that your P&T committee has at least heard of such value-based or benefit-based co-payment schemes.
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Posted by James
Speaker: Paul Richardson, Dana-Farber Cancer Institute, Boston, Massachusetts
Lenalidomide/Dexamethasone. The combination of lenalidomide and dexamethasone is effective for newly diagnosed MM. It demonstrated a 91% overall objective response with a complete response in 6% of the patients. An ongoing study of lenalidomide and dexamethasone (at a lower dose) is in progress to establish better tolerability than that found in the previous standard dosing study. Results to date indicate that lenalidomide/dexamethasone provides high anti-cancer responses when it is used as an initial therapy.
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Posted by James
Speaker: Thomas Shea, University of North Carolina School of Medicine, Chapel Hill, North Carolina
Melphalan. High-dose chemotherapy appears to be commonly used to treat MM. Researchers compared the two most widely used conditioning regimens in a prospective, randomized trial before autologous stem-cell transplantation in patients with newly diagnosed symptomatic MM. The patients were younger than 65 years old. Those in arm A received 8 gray (Gy) of total-body irradiation (TBI) plus 140 mg/m2 of melphalan; those in arm B received 200 mg/m2 of melphalan (Alkeran®). A total of 282 evaluable patients were compared.
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Posted by James
Speaker: Stephanie A. Gregory, Rush University Medical Center, Chicago, Illinois
Clinical trials in patients with relapsed follicular lymphoma have shown that rituximab plus CHOP therapy (R-CHOP) is better than CHOP therapy alone. Rituximab maintenance therapy following initial FCM (fludarabine, cyclophosphamide, mitoxantrone) chemotherapy, with or without rituximab, resulted in a 94% overall response rate (P = .011). There was a trend toward improved overall survival following rituximab maintenance therapy after three years.
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Posted by James
Speaker: Thomas C. Shea, University of North Carolina School of Medicine, Chapel Hill, North Carolina
Salvage therapy for relapse of diffuse, large B-cell lymphoma depends on the answers to several questions:
• Which relapse is it?
• Which therapies have been used in the past?
• What was the last interval of response?
• Was the prior response complete or partial?
• What are the patient’s characteristics and profile (age, organ function, medical history, and comorbidities?)
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Posted by James
Multiple Myeloma: Oncogenomics for Targeting Tumor Cells in the Microenvironment
Speaker: Kenneth Anderson, Dana-Farber Cancer Institute, Boston, Massachusetts
Recent progress in the research on multiple myeloma (MM) demonstrates the tumor-promoting influence of the micro-environment. Growth factors promote tumor cell proliferation and survival, and cytokines and chemotactic factors promote tumor cell migration and invasion. Proteases break down the basement membrane, alter the architecture of tissue structures, and promote migration and invasion by tumor cells. The vasculature of tumor cells is composed of endothelial cells that are uniquely altered in different tumors. Tumors produce growth factors, such as vascular endothelial growth factor (VEGF) and fibroblast growth factor (FGF), which recruit endothelial cells, thus affecting the growth of the tumor vasculature.
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