葡萄球菌肠毒素B抗肿瘤作用的实验研究

探讨了葡萄球菌肠毒素B(SEB)对动物移植性肿瘤的抑制作用。以小鼠移植性肿瘤肝癌(Heps)、L2网织细胞瘤和肉瘤180(S180)为模型,环磷酰胺为阳性对照组,生理盐水为阴性对照组,观察不同剂量(5、10和20ng·Kg-1·d-1)SEB的抗肿瘤作用。不同剂量的SEB对小鼠肝癌(Heps)有明显抑制作用,抑瘤率分别为44.6%、46.7%和51.8%(P值均<0.05),对小鼠L2网织细胞瘤也有一定的抑制作用,抑瘤率分别为17.4%、44.7%(P<0.05)和44.1%(P<0.05)。SEB对小鼠S180的抑制作用不显著。结论是葡萄球菌肠毒素B(SEB)具有抗肿瘤效应,可作为一种有前途的抗肿瘤制剂进行研究。     

甘草多糖的药理作用研究进展

甘草多糖是甘草中所含有的一类主要化学成分,本文对甘草多糖的免疫调节、抗病毒、抗肿瘤等药理作用进行了系统的综述。     

CNTs/HAp热种子复合材料的制备及表征

采用化学共沉淀结合水热处理的方法,控制一定的反应条件,制备了微波靶向热疗用碳纳米管/羟基磷灰石(CNTs/HAp)热种子材料,并对所得的复合材料进行了相应的检测。结果表明:当CNTs的质量分数为10%时,结晶状态良好的HAp均匀覆盖在CNTs的表面;CNTs/HAp复合材料为典型的电损耗型吸波材料,在0-5GHz范围内具有较好的吸波性能,CNTs在其中起到主导作用。随着CNTs含量的增加,CNTs/HAp复合材料的吸波能力逐渐增强,吸收峰向着高频移动,频宽增大。当CNTs的质量分数为8%时,复合材料的最大吸收峰在3.0GHz附近,反射率达-26dB。因此,CNTs/HAp复合材料有望作为热种子材料用于肿瘤热疗。     

Cost effectiveness of tyrosine kinase inhibitor therapy in metastatic gastrointestinal stromal tumors

Abstract

Background:

Tyrosine kinase inhibitors (TKIs) such as imatinib mesylate have revolutionized the treatment of primary unresectable and/or metastatic gastrointestinal stromal tumors (GISTs), providing durable disease control and extended survival. Although most patients eventually progress on therapy, dose escalation has been shown to benefit some patients. Sunitinib, a multitargeted kinase inhibitor is effective against imatinib-resistant or intolerant GIST patients. Although the cost of TKI therapy in GIST is high, no other effective systemic treatment options exist.

Objective:

Review pharmacoeconomic studies to determine the cost effectiveness (CE) of 1st- and 2nd-line TKI therapies in GIST.

Methods:

A literature review using Medline and PubMed databases was conducted to identify published economic analyses of TKI therapy in GIST. Key results from these studies were analyzed.

Results:

Six pharmacoeconomic studies were identified, including three analyses of 1st-line imatinib and three analyses of 2nd-line sunitinib. These studies employed various time horizons and discount rates and modeled CE from a number of different perspectives. Most of the pharmacoeconomic studies reviewed used survival as their efficacy endpoint, projecting outcomes beyond available data to model CE. Analyses of 2nd-line sunitinib using survival additionally faced the challenge of adjusting for the effect of placebo crossover to active treatment in the pivotal phase III study. Most studies used Markov techniques with a range of transition probabilities.

Conclusions:

Published pharmacoeconomic studies of 1st- and 2nd-line TKI therapy for advanced GIST employ various time horizons, discount rates, and different CE models. Consequently, these differences make comparisons between studies difficult. Studies of 1st-line imatinib concluded that imatinib was cost effective in advanced, metastatic GIST. Likewise, based on data reviewed here, 2nd-line sunitinib appears to be cost effective in patients with advanced GIST who are intolerant/resistant to imatinib. Key limitations of this review included inconsistency among the studies evaluated with regard to methodologies, countries of origination (currency and healthcare systems), and patient demographics.     

Outcomes of tumor necrosis factor inhibitor cycling versus switching to a disease-modifying anti-rheumatic drug with a new mechanism of action among patients with rheumatoid arthritis

Objectives: To examine treatment patterns, treatment effectiveness, and treatment costs for 1 year after patients with rheumatoid arthritis switched from a tumor necrosis factor inhibitor (TNFi) (adalimumab, certolizumab pegol, etanercept, golimumab, or infliximab), either cycling to another TNFi (“TNFi cyclers”) or switching to a new mechanism of action (abatacept, tocilizumab, or tofacitinib) (“new MOA switchers”).

Methods: This retrospective cohort study used administrative claims data for a national insurer. Treatment persistence (without switching again, restarting, or discontinuing), treatment effectiveness (defined below), and costs were assessed for the 12-month post-switch period. Patients were “effectively treated” if they satisfied all six criteria for a treatment effectiveness algorithm (high adherence, no dose increase, no new conventional synthetic disease-modifying anti-rheumatic drug, no subsequent switch in therapy, no new/increased oral glucocorticoids, and <2 glucocorticoid injections). Multivariable logistic models were used to adjust for baseline factors.

Results: The database included 581 new MOA switchers and 935 TNFi cyclers. New MOA switchers were 39% more likely than TNFi cyclers to persist after the switch (odds ratio [OR]?=?1.39; 95% confidence interval [CI]?=?1.12–1.74; p?=?.003) and 36% less likely to switch therapy again (OR?=?0.64; 95% CI?=?0.51–0.81; p?p?=?.006). New MOA switchers had 16% lower drug costs than TNFi cyclers (cost ratio?=?0.84; 95% CI?=?0.79–0.88; p?p?Limitations: Claims payments may not reflect rebates or other cost offsets. Medical and pharmacy claims do not include clinical end-points or reasons that lead to new MOA switching vs TNFi cycling.

Conclusions: These results support switching to a new MOA after a patient fails treatment with a TNFi, which is consistent with recent guidelines for the pharmacologic management of established rheumatoid arthritis.     

Indirect cost-effectiveness analyses of abatacept and rituximab in patients with moderate-to-severe rheumatoid arthritis in the United States

Abstract

Objective: To estimate the incremental cost per quality-adjusted life-years (QALYs) for abatacept and rituximab, in combination with methotrexate, relative to methotrexate alone in patients with active rheumatoid arthritis (RA).

Methods: A patient-level simulation model was used to depict the progression of functional disability over the lifetimes of women aged 55–64 years with active RA and inadequate response to a tumor necrosis factor (TNF)-α antagonist therapy. Future health-state utilities and medical care costs were based on projected values of the Health Assessment Questionnaire Disability Index (HAQ-DI). Patients were assumed to receive abatacept or rituximab in combination with methotrexate until death or therapy discontinuation due to lack of efficacy or adverse events. HAQ-DI improvement at month 6, after adjustments for control drug (methotrexate) response, was derived from two clinical trials. Costs of medical care and biologic drugs, discounted at 3% annually, were from the perspective of a US third-party payer and expressed in 2007 US dollars.

Results: Relative to methotrexate alone, abatacept/methotrexate and rituximab/methotrexate therapies were estimated to yield an average of 1.25 and 1.10 additional QALYs per patient, at mean incremental costs of $58,989 and $60,380, respectively. The incremental cost-utility ratio relative to methotrexate was $47,191 (95% CI $44,810–49,920) per QALY gained for abatacept/methotrexate and $54,891 (95% CI $52,274–58,073) per QALY gained for rituximab/methotrexate. At an acceptability threshold of $50,000 per QALY, the probability of cost effectiveness was 90% for abatacept and 0.0% for rituximab.

Conclusion: Abatacept was estimated to be more cost effective than rituximab for use in RA from a US third-party payer perspective. However, head-to-head clinical trials and long-term observational data are needed to confirm these findings.     

肿瘤靶向药物不良反应发生率的Meta分析

目的 探讨肿瘤患者使用靶向药物治疗后引发的不良反应发生率.方法 从建库至2020年7月1日检索中国期刊全文数据库、中文期刊全文数据库、万方数据知识服务平台等数据库,获取现有的不同类型肿瘤靶向药物及不良反应发生率的相关文献,根据纳入和排除标准选取临床研究文献,采用ReviewManager 5.3软件对肿瘤靶向药物不良反...     

数字减影/血管造影在骨盆肿瘤诊断及治疗中的应用研究

文章选取97例骨盆肿瘤行介入治疗，治疗前均行髂内动脉、髂外动脉造影，研究了血管造影在骨盆肿瘤诊疗上的应用。结果显示：①提示造影中恶性骨盆肿瘤的染色程度大于良性肿瘤。②造影中染色明显的肿瘤往往术中出血较多（〉3000mL），而无或轻度染色的肿瘤出血比较少。结论：骨盆肿瘤血管造影可显示肿瘤血供、侵犯范围和程度，有助于良恶性的判断，为随后肿瘤栓塞、灌注化疗、手术切除及术后疗效评价等提供客观依据，对骨盆肿瘤的临床诊断和治疗具有重要的指导意义。     

The impact of economic factors on treatment results for tumor inpatients in the under-developed Western region of China

Objective:

To discuss the influences of economic factors on the treatment outcomes of cancer patients and the relaxation effects of medical insurance policies on the influences of economic factors.

Method:

The concentration index (CI) and horizontal inequality (HI) of treatment outcomes of cancer patients were calculated and the role of the economy, disease, and other factors to HI was analyzed by describing the influence of treatment expense on the treatment outcomes of different cancer patients.

Results:

The study showed that the equity of the death rate and the effective rate of six types of cancer patients was good. The HI of the cure rate was 0.225, indicating a strong, pro-rich inequity of the cancer inpatient cure rate, while the contribution of the economic factors to HI was 0.158. The uncured rate in the low-cost group represented the rate of patients who discontinued the treatment; the HI was ?0.324, indicating a strong, pro-poor inequity. The relaxation effect on the HI of the cured rate by medical insurance was 14.9%, while the effect on the HI of the uncured rate was 18.7%.

Conclusion:

At present, medical insurance has demonstrated relaxation effects on the fairness of treatment outcomes to some extent. The main reason for this inequity comes from the payment of the items at present. To relieve such inequity to a greater extent, the payment system should be changed and diagnosis-related groups should be implemented.