Nathan William Dana Lamond

Cost-utility of the 21-gene recurrence score assay in node-negative and node-positive breast cancer

The 21-gene recurrence score (Oncotype DX®: RS) appears to augment clinico-pathologic prognostication and is predictive of adjuvant chemotherapy benefit in node-negative (N−) and node-positive (N+), endocrine-sensitive breast cancer. RS is a costly assay that is associated with good ‘value for money’ in N− disease, while economic evaluations in N+ disease based on most recent data have not been conducted. We examined the cost-utility (CU) of a RS-guided adjuvant strategy, compared to current practice without RS in N− and N+, endocrine-sensitive, breast cancer from a Canadian health care system perspective. A generic state-transition model was developed to compute cumulative costs and quality-adjusted life years (QALYs) over a 25-year horizon. Patient outcomes with and without chemotherapy in RS-untested cohorts and in those with low, intermediate and high RS were examined based on the reported prognostic and predictive impact of RS in N− and N+ disease. Chemotherapy utilization (current vs. RS-guided), unit costs and utilities were derived from a Nova Scotia Canadian population-based cohort, local unit costs and the literature. Costs and outcomes were discounted at 3% annually, and costs were reported in 2011 Canadian dollars (

Drug-induced subacute cutaneous lupus erythematosus associated with nab-paclitaxel therapy.

). Probabilistic and one-way sensitivity analyses were conducted for key model parameters. Compared to a non-RS-guided strategy, RS-guided adjuvant therapy was associated with

Is the 21-gene recurrence score a cost-effective assay in endocrine-sensitive node-negative breast cancer?

2,585 and

Reduction of traumatic macroglossia with base of tongue corticosteroid injection

864 incremental costs, 0.27 and 0.06 QALY gains, and resultant CUs of

Cavernous sinus involvement in human papillomavirus associated oropharyngeal squamous cell carcinoma: case report of an atypical site of distant metastasis

9,591 and

Orbital mass as first presentation of metastatic p16-positive oropharyngeal squamous cell carcinoma

14,844 per QALY gained for N− and N+ disease, respectively. CU estimates were robust to key model parameters, and were most sensitive to chemo utilization proportions. RS-guided adjuvant therapy appears to be a cost-effective strategy in both N− and N+, endocrine-sensitive breast cancer with resultant CU ratios well below commonly quoted thresholds.

Cost-utility of adjuvant zoledronic acid in patients with breast cancer and low estrogen levels.

Drug-induced lupus erythematosus (dile) syndromes are documented complications of chemotherapeutic agents, including paclitaxel. Subacute cutaneous lupus erythematosus (scle) is a distinct dile syndrome presenting with characteristic annular or papulosquamous skin lesions in a photosensitive distribution with associated high anti-ssa titres. Previously, dile syndromes complicating paclitaxel therapy have been attributed to polyethoxylated castor oil (Kolliphor EL: BASF, Ludwigshafen, Germany), the biologic solvent included in the drugs original formulation (Taxol: Bristol-Myers Squibb, Montreal, QC), rather than the parent chemotherapy molecule. Here, we report a characteristic case of drug-induced scle complicating treatment with nanoparticle albumin bound (nab)-paclitaxel (Abraxane: Celgene, Summit, NJ, U.S.A.), a solvent-free taxane formulation. The pertinent English-language literature is also discussed. This case report is the first to link solvent-free paclitaxel with scle, and it suggests that the parent molecule is responsible for the reaction.

The impact of palliative care consultation on overall survival and aggressive care at the end-of-life in unresectable pancreatic cancer.

The 21-gene recurrence score (RS) is a gene expression profile assay currently endorsed for use in patients with endocrine-sensitive node-negative breast cancers. The RS has been shown to augment current ‘prognostic’ and ‘predictive’ assessments of relapse risk and chemotherapy benefits, respectively, and lead to significant change in oncologists’ recommendations for adjuvant chemotherapy, with an overall reduction in chemotherapy utilization. The RS (Oncotype DX®) is marketed by Genomic Health Inc. (CA, USA) and currently retails for approximately US

Palliative care intervention and aggressive care at end-of-life in patients with advanced pancreatic adenocarcinoma.

4290 per patient. Like all novel tests/therapies, however, these upfront costs should be examined in the context of all its clinical benefits through cost–effectiveness or cost–utility evaluations. This review highlights the clinical evidence supporting RS testing for patients with endocrine-sensitive node-negative breast cancers, and examines all published economic evaluations that examined its ‘value for money’ in this setting.

Method of diagnosis of pancreatic adenocarcinoma: A Nova Scotia experience.

A20-year-old male underwent elective urinary diversion by ileal conduit. Relevant medical history included developmental delay and Chiari II malformation, with associated hydrocephalus and lumbar myelomeningocele. His postoperative recovery was complicated by premature extubation that required reintubation. He was transferred to the Intensive Care Unit, where his condition worsened with the development of pneumothorax, sepsis, and severe macroglossia. Macroglossia was believed to be secondary to tongue-biting and traumatic reintubation. There was no history of macroglossia. The Otolaryngology–Head and Neck Surgery service was consulted to assess the patient’s macroglossia. At this time, the patient was sedated with an endotracheal tube in place. On examination, there was severe diffuse lingual swelling with 6 cm of the tongue protruding from the oral cavity. Concerns were raised with respect to the ability to secure the airway in the event of inadvertent extubation. Options for the control of macroglossia and airway protection were therefore discussed. Standard cervical tracheotomy for definitive airway management was precluded by anatomic variations that included marked flexion of the neck with a deep cleft between the mandible and the sternum. No significant extension of the neck was possible and the thyroid notch was palpated postero-inferior to the sternal notch. After consultation, the thoracic surgeons concluded that tracheotomy would require median sternotomy, which was deemed inappropriate at this time. Consequently, treatment of macroglossia itself was considered. The patient was administered 20 mg intravenous (IV) dexamethasone daily and bite blocks were used to decrease further tongue trauma. However, this management did not improve the macroglossia and was consequently discontinued after 48 hours (Fig 1). Alternate treatment was again considered as the potential for airway embarrassment continued. With this in mind, 200 mg of intramuscular (IM) triamcinolone acetonide (40 mg/cc)