US treatment guidelines
J
NCCN Clinical Practice Guidelines in Oncology™ Table of Contents
and
Recently updated NCCN Clinical Practice Guidelines in Oncology™
http://www.nccn.org/professionals/physician_gls/recently_updated.asp
usene...@gmail.com
Are you having second thoughts now?
Mizz Marcia Ryder
<usene...@gmail.com> wrote in message
news:1158432836....@i42g2000cwa.googlegroups.com...
> This is the same guideline I posted in August with a hostile response.
> Are you having second thoughts now?
>
> http://tinyurl.com/f4o9j
It didn't look the same to me. Sorry.
Marsha
Steph
"J" <macy...@nospam.inv> wrote in message
news:450BD618...@execulink.com...
> http://www.nccn.org/professionals/physician_gls/f_guidelines.asp
> NCCN Clinical Practice Guidelines in OncologyT Table of Contents
> and
> Recently updated NCCN Clinical Practice Guidelines in OncologyT
> http://www.nccn.org/professionals/physician_gls/recently_updated.asp
>
>
Just a word of warning. Many of these guidelines are either non-evidence
based, or fly in the face of the evidence. That's not necessarily a
criticism, as most "guidelines" have those problems. Many of these really
only have validity for the US context
Just about the most evidence-based guidelines which exist, and are very
regular reviewed and updated are at
http://www.bccancer.bc.ca/HPI/CancerManagementGuidelines/default.htm
J
> "J" <macy...@nospam.inv> wrote in message
Yes, well, I was hope that PL would see that for glioblastoma they suggest RT
ą concurrent and adjuvant temozolomide
Age < 70 y Good performance status (or clinical trials), which is basically
what we've been telling him.
Now we're stuck in clinical trials.
What do you make of (or conlude from or know about) this, please?
J
FDA Expedites Approval for Novel Treatment of Glioblastoma Multiforme
http://patient.cancerconsultants.com/brain_cancer_news.aspx?id=17064
The average duration of survival following treatment for these patients was
one year, compared to 9 months for patients who did not receive RSR13.
Additionally, this treatment was well tolerated in these patients.
The significant improvement in survival of patients plus tolerability of
treatment has lead the National Cancer Institute to immediately begin the
last phase of clinical trials evaluating RSR13 plus cranial radiation for
treatment of newly diagnosed glioblastoma multiforme. If the results from
this trial prove to be positive, the FDA will expedite its usual process for
approval in order to make RSR13 more quickly available for clinical use.
http://www.jco.org/cgi/content/abstract/20/14/3149
The objectives of this phase II study were to determine survival, safety,
pharmacokinetics (PK), and pharmacodynamics (PD) of
2,4-[[(3,5-dimethylanilino)carbonyl]methyl]phenoxy]-2-methylpropionic acid
(RSR13, efaproxiral) 100 mg/kg per day administered with standard cranial
radiotherapy (RT) for the treatment of glioblastoma multiforme (GBM). RSR13,
a synthetic allosteric modifier of hemoglobin, is a radiation-enhancing agent
that noncovalently binds to hemoglobin, reduces oxygen-binding affinity, and
increases oxygen unloading to hypoxic tissue.
PATIENTS AND METHODS: Fifty patients with newly diagnosed GBM (Karnofsky
performance status >= 60) were enrolled onto this multicenter phase II study.
Patients received daily RSR13 100 mg/kg intravenously infused for 30 minutes
immediately before cranial RT (60 Gy in 30 fractions). Supplemental oxygen
was given during RSR13 infusion and continued until after the RT treatment
was completed. RT was given within 30 minutes of the end of RSR13 infusion.
PK and PD determinations were performed.
RESULTS: The median survival for the RSR13-treated patients was 12.3 months
with 1-year and 18-month survival rates of 54% and 24%, respectively.
Twenty-four percent of patients had greater than grade 2 toxicity, which was
generally transient and self-limited. A significant PD effect on
hemoglobin-oxygen binding affinity was demonstrated for most patients.
CONCLUSION: RSR13 (100 mg/kg) administered immediately before cranial RT is
well tolerated and is pharmacodynamically active. Median survival in excess
of 1 year is favorable.
usene...@gmail.com
Since imitation is the best form of flattery, I take no offense, just
question the change of heart.
Alex
usene...@gmail.com
20 of the world's leading cancer centers, working together to develop
treatment guidelines for most cancers, and dedicated to research that
improves the quality, effectiveness and efficiency of cancer care. NCCN
offers a number of programs to help you and your family make informed
decisions about your health"
The list of participating hospitals
The NCCN member institutions are:
City of Hope Cancer Center, Los Angeles, CA
Dana-Farber/Partners CancerCare, Boston, MA
Duke Comprehensive Cancer Center, Durham, NC
Fox Chase Cancer Center, Philadelphia, PA
Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT
Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance,
Seattle, WA
Arthur G. James Cancer Hospital and Richard J. Solove Research
Institute at The Ohio State University, Columbus, OH
The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins,
Baltimore, MD
Robert H. Lurie Comprehensive Cancer Center of Northwestern University,
Chicago, IL
Memorial Sloan-Kettering Cancer Center, New York, NY
H. Lee Moffitt Cancer Center & Research Institute at the University of
South Florida, Tampa, FL
Roswell Park Cancer Institute, Buffalo, NY
Siteman Cancer Center at Barnes-Jewish Hospital and Washington
University School of Medicine, St. Louis, MO
St. Jude Children's Research Hospital/University of Tennessee Cancer
Institute, Memphis, TN
Stanford Comprehensive Cancer Center, Stanford, CA
University of Alabama at Birmingham Comprehensive Cancer Center,
Birmingham, AL
UCSF Comprehensive Cancer Center, San Francisco, CA
University of Michigan Comprehensive Cancer Center, Ann Arbor, MI
UNMC Eppley Cancer Center at The Nebraska Medical Center, Omaha, NE
The University of Texas M. D. Anderson Cancer Center, Houston, TX.
Are you saying that these institutions do not provide evidence bases
medicine?
Steph
<usene...@gmail.com> wrote in message
news:1158450606....@i42g2000cwa.googlegroups.com...
I'm telling you:
1) Any organisation which claims to consist of "20 of the world's leading
cancer centres", and only includes US centres, has to have a rather inflated
opinion of itself
2) The guidelines they produce are based on many things. But evidence is
only one of them, and sometimes it's not very prominent.
For example, based on several large clinical trials with many thousands of
patients, it's clear to the rest of the world that the optimal management
of operable rectal cancer is five days of preop radiotherapy alone, followed
by total mesorectal excision surgery, followed IN SELECTED PATIENTS by post
op chemo. That isn't in the US guidelines. However preoperative
chemotherapy/radiotherapy which is much more complex, toxic, time-consuming
and expensive than short course RT alone, is in the guidelines, and there is
not a single good clinical trial to support that assertion.
As I said, it wasn't necessarily a criticism, as most guidelines are a mix
of fact and opinion. But don't be lulled into thinking that just because
guidelines come out of a group like the one you quoted, they are necessarily
evidence-based. They often are not.
usene...@gmail.com
leading
> cancer centres", and only includes US centres, has to have a rather inflated
> opinion of itself
I see many of these US institutions have recieved the Nobel Medicine
prize, and have Nobel Laureates, in my opinion this is one factor
making them world class. The Nobel foundation is located in Sweden and
an international prize. I only see 2 Canadian Medical winners, one
recieving the prize for his American work. The other being, 1923
Medicine Laureates:and Dr John James Richard Macleod for the discovery
of Insulin , interesting Sir Frederick Grant Banting was from England.
http://nobelprize.org/nobel_prizes/medicine/laureates/index.html
If the guidelines were titles, Cancer Treatment Guidelines or the
World's Cancer Treatment guidelines I would agree with you 100%. This
is labeled US Treatment Guidelines, my interpretation is that is
written for people seeking treatment in the US.
As far as stating World's Leading institutions, my understanding that
when a center has a large international population and sought byas
resource by international physicians the center earns that right. That
is a very measurable, X percentage of international patients, number of
hits from international origin on the web site, the requests for
information for foreign medical centers, the number of international
doctors who attend conferences, the number of international health
care team members requesting site visits. It is not excluding other non
US cancer centers but considering this is a US Guideline I don't think
this is excessive bravado but of course this is my opinion not fact.
>> 2) The guidelines they produce are based on many things. But evidence is
> only one of them, and sometimes it's not very prominent.
Medicine is often refer as an art and science. These guidelines are
not listed as evidenced based, but if you review an individual
guideline they do list the evidence used to support the
guidelines.Guidelines will list the level of supporting research which
can be extensive to non existent.
There is a table which clearly states the level of consensus which is
based on the level of evidence,
NCCN Categories of Consensus-
NCCN Overview Categories of Consensus All recommendations are category
2A unless otherwise noted
Category 1 There is uniform NCCN consensus, based on high-level
evidence, that the recommendation is appropriate.
Category 2AThere is uniform NCCN consensus, based on lower level
evidence including clinical experience, that the
recommendation is appropriate
Category 2B There is nonuniform NCCN consensus (but no major
disagreement), based on lower-level evidence including clinical
experience, that the recommendation is appropriate
Category 3 There is major NCCN disagreement that the
recommendation is appropriate
Steph
<akof...@gmail.com> wrote in message
news:1158482348.2...@k70g2000cwa.googlegroups.com...
> 1) Any organisation which claims to consist of "20 of the world's
> leading
>> cancer centres", and only includes US centres, has to have a rather
>> inflated
>> opinion of itself
>
>
>
> World's Cancer Treatment guidelines I would agree with you 100%. This
> is labeled US Treatment Guidelines, my interpretation is that is
> written for people seeking treatment in the US.
Read the original post - it was the NCCN making that claim about "the
world's leading centres" - take it up with them
> As far as stating World's Leading institutions, my understanding that
> when a center has a large international population and sought byas
> resource by international physicians the center earns that right. That
> is a very measurable, X percentage of international patients, number of
> hits from international origin on the web site, the requests for
> information for foreign medical centers, the number of international
> doctors who attend conferences, the number of international health
> care team members requesting site visits. It is not excluding other non
> US cancer centers but considering this is a US Guideline I don't think
> this is excessive bravado but of course this is my opinion not fact.
>
>>> 2) The guidelines they produce are based on many things. But evidence is
>> only one of them, and sometimes it's not very prominent.
>
> Medicine is often refer as an art and science. These guidelines are
> not listed as evidenced based, but if you review an individual
> guideline they do list the evidence used to support the
> guidelines.Guidelines will list the level of supporting research which
> can be extensive to non existent.
>
> There is a table which clearly states the level of consensus which is
> based on the level of evidence,
> NCCN Categories of Consensus-
> NCCN Overview Categories of Consensus All recommendations are category
> 2A unless otherwise noted
>
>
> Category 1 There is uniform NCCN consensus, based on high-level
> evidence, that the recommendation is appropriate.
>
> Category 2AThere is uniform NCCN consensus, based on lower level
> evidence including clinical experience, that the
> recommendation is appropriate
>
> Category 2B There is nonuniform NCCN consensus (but no major
> disagreement), based on lower-level evidence including clinical
> experience, that the recommendation is appropriate
>
> Category 3 There is major NCCN disagreement that the
> recommendation is appropriate
>
The evidence supporting short-course preop RT and TME surgery for operable
rectal cancer is LEVEL 1 evidence, and about as level one as it
gets..........
Do they ignore level 1 evidence? Unless it comes out of the US, I guess.
Steph
<usene...@gmail.com> wrote in message
news:1158485078.7...@h48g2000cwc.googlegroups.com...
> 1) Any organisation which claims to consist of "20 of the world's
> leading
>
>
>> cancer centres", and only includes US centres, has to have a rather
>> inflated
>> opinion of itself
>
> I see many of these US institutions have recieved the Nobel Medicine
> prize, and have Nobel Laureates, in my opinion this is one factor
> making them world class. The Nobel foundation is located in Sweden and
> an international prize. I only see 2 Canadian Medical winners, one
> recieving the prize for his American work. The other being, 1923
> Medicine Laureates:and Dr John James Richard Macleod for the discovery
> of Insulin , interesting Sir Frederick Grant Banting was from England.
>
> http://nobelprize.org/nobel_prizes/medicine/laureates/index.html
>
>
> If the guidelines were titles, Cancer Treatment Guidelines or the
> World's Cancer Treatment guidelines I would agree with you 100%. This
> is labeled US Treatment Guidelines, my interpretation is that is
> written for people seeking treatment in the US.
You are the one who posted the quote from them about "20 of the world's
leading cancer centres."
See my reply to your post under your "other" name...........