DOCSLIB.ORG

Lung Cancer Frontiers the Forum for Early Diagnosis and Treatment of Lung Cancer

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Lung Cancer Frontiers the Forum for Early Diagnosis and Treatment of Lung Cancer LungSummer 2009 | NO 37 1 Cancer FRONTIERS Lung Cancer FRONTIERS The Forum for Early Diagnosis and Treatment of Lung Cancer EGFR Testing in Lung Cancer is Ready for Prime Time By Fred R. Hirsch, MD, PhD The epidermal growth factor receptor (EGFR) protein is widely expressed in non-small cell lung cancers (NSCLC). The gene is sometimes amplified, but it is often increased in copy number and, less frequently, mutated with activating mutations. EGFR-directed therapies include the reversible specific tyrosine kinase inhibitors (TKIs) gefitinib (Iressa®) and erlotinib (Tarceva®) and the monoclonal antibody cetuximab (Erbitux®). Also, more recently, irreversible pan-Her inhibitors were introduced into clinical trials. In unselected patients treated with EGFR inhibitors, a minority will achieve an objective Fred R. Hirsch, MD, PhD, response, but many more will have symptomatic improvement with stable disease. Large, is Professor of Medicine and randomized studies failed to demonstrate any additional clinical benefit by adding an Pathology, University of Colorado EGFR TKI to chemotherapy in first line treatment. However, major breakthroughs in Denver School of Medicine, University patient selection were made by studying tumor specimens from patients in these trials. of Colorado Cancer Center, Aurora, CO. He is a member of the Lung Many objective responders had EGFR mutations occurring specifically in exons 19 and 21 1 Cancer Frontiers Editorial Board. associated with never-smoker status, Asian ethnicity and adenocarcinoma histology . Single- arm studies selecting patients for these mutations showed response rates and progression free survival times superior to those seen with chemotherapy2. These studies led to recently The purpose of Lung Cancer reported randomized phase II and III trials in chemo-naive patients with advanced NSCLC. Frontiers is to acquire and In one of the largest trials (IPASS), 1,217 NSCLC patients of Asian ethnicity, never or disseminate new knowledge light smoking status, and adenocarcinoma histology received either gefitinib or multi-agent about lung cancer and how chemotherapy3. Patients with EGFR mutations treated with gefitinib had much higher it can be most quickly and response rates and longer progression free survival than patients treated with chemotherapy. effectively diagnosed and In marked contrast, patients without EGFR mutations fared much better on chemotherapy treated. than on gefitinib, and the response rate to gefitinib was only 1%. Thus, the molecular Access current and past features (EGFR mutations) of the tumor trump the clinical features, and the therapy of issues of Lung Cancer choice for patients with EGFR mutations in this setting seems to be gefitinib. Frontiers via the Internet at Are these findings similar in Caucasians and with erlotinib? A randomized phase II trial in LungCancerFrontiers.org Caucasians randomized chemo-naive NSCLC patients to erlotinib alone or chemotherapy plus erlotinib. In patients with EGFR mutations, the response rates and progression free continued on page 2 In this issue 1-3 EGFR TESTING IN LUNG CANCER 4-7 SelectIONS FROM THE PEER REVIEWED LITERATURE 7 LUNG CANCER MEETINGS 8 CONTINUING MEDICAL EDUCATION EVENTS 2 Lung Cancer FRONTIERS EGFR Testing in Lung Cancer is Ready for Prime Time continued from page 1 survival favored erlotinib alone, whereas erlotinib alone The results of SWOG 0342 were quite compelling and led was inferior in those without these mutations4. Thus, both to the design of the SWOG 0819 study. SWOG 0819 is a gefitinib and erlotinib seem superior to chemotherapy in randomized phase III trial which will prospectively validate patients with EGFR mutations, and such testing is now EGFR FISH as a predictive biomarker in NSCLC patients ready for prime time! In most studies, direct sequencing is treated with chemotherapy and bevacizumab (if eligible), used to detect EGFR mutations. The sensitivity of these with or without cetuximab. In immunohistochemistry methods is about 10%, i.e. a mutation can be detected in based selected patients, cetuximab added to chemotherapy specimens having 10% tumor cells. Newer techniques using in the large, randomized FLEX study showed significant amplification may be more sensitive in detecting mutations in survival benefit with a Hazard Ratio (HR) = 0.87 (p = 0.04) specimens having less than 1% tumor cells. While the optimal and a difference in median survival of 10.1 months with test for mutation detection has yet to be determined, direct chemotherapy alone compared to 11.3 months with added sequencing can be recommended in routine practice. cetuximab9. In unselected patients, cetuximab is associated with minimal clinical benefit, as demonstrated in the BMS- High EGFR gene copy number determined by fluorescence 099 study10. Additional trials evaluating EGFR gene status by in situ hybridization (FISH) occurs in 30-50% of NSCLC FISH in patients considered for cetuximab is a high priority. 5 patients and about 10% have gene amplification . High EGFR Final biomarker analysis from the FLEX and BMS-099 gene copy number/amplification predicted superior outcome studies with cetuximab is underway. in NSCLC patients who previously received chemotherapy and were randomized to receive erlotinib versus placebo, or K-ras mutations occur in 15-20% of the tumors from gefitinib versus placebo6,7. However, EGFR FISH did not NSCLC patients and are associated with low response rates to predict a superior outcome in patients randomized to gefitinib EGFR inhibitors. In lung cancer, K-ras mutations are rarely versus chemotherapy, in part because high gene copy number present together with EGFR mutations. However, despite predicted a superior outcome in both groups. While EGFR the low response rates in patients with these mutations, the mutations might not be expected to predict outcome with presence of K-ras mutations has not been able to predict cetuximab, because the receptor is active even in the absence significantly inferior survival outcomes in NSCLC patients of the ligand, EGFR FISH predicted a superior outcome treated with erlotinib or cetuximab. Thus, the clinical after cetuximab in the SWOG 0342 trial8. This randomized relevance of K-ras testing in NSCLC is still unclear. phase II study of chemotherapy with sequential or concurrent cetuximab was conducted to determine whether one schedule A serum proteomic classifier can be used to select patients or the other was preferable for subsequent phase III testing with a good or a poor outcome after EGFR inhibitor 11 against chemotherapy alone. Two hundred and twenty-nine therapy . This classifier is today commercialized as the ® patients with advanced NSCLC were enrolled. EGFR FISH Veristrat (Biodesix, Broomfield, CO). Additional prospective was performed by using the Colorado criteria, and increased studies evaluating this method are in progress. EGFR copy number by FISH was associated with a 100% Which material is suitable for EGFR testing? Mutation prolongation in progression free survival and overall survival testing is DNA based. How can we obtain sufficient DNA for compared to the EGFR FISH negative patients. Objective this testing and how can tumor DNA be separated from non- responses were dramatically higher in FISH positive patients tumor DNA? Micro dissection of specimens is generally done, (45%) versus FISH negative patients (26%), while disease but it is labor intensive. Mutation assays for testing circulating control rate was statistically superior (81% versus 55%) in the tumor cells in blood have been developed12. EGFR mutations FISH positive group. Patients with FISH positive tumors had are detected in both circulating DNA and circulating tumor a median progression free survival of 6 months compared to 3 cells from NSCLC patients whose tumors have EGFR months for FISH negative patients (p = 0.0008). The median mutations. However, the sensitivity of EGFR mutation overall survival was 15 months for FISH positive patients versus detection in peripheral blood is only about 70%, while the 7 months for FISH negative patients (p = 0.04). specificity is near 100% when compared to tumor Lung 3 Cancer FRONTIERS EGFR Testing in Lung Cancer is Ready for Prime Time continued from page 2 tissue detection. While EGFR testing in peripheral blood is the association between the biomarker expression and the promising, it is still the focus on ongoing research and is not sensitivity to the EGFR TKIs based on a comparison of EGFR yet ready for clinical practice. expression in pretreatment specimens compared to response and outcome of EGFR TKIs given as second or third line Most cancer patients are diagnosed with advanced disease therapy. A true biological association to second line therapy based on a small biopsy or a fine needle aspiration. The requires that first line therapy does not affect the biomarker success rates for obtaining sufficient tissue for biomarker expression, which may not be true. The optimal situation assessment range from 30-80%. Factors that may affect would be to assess biomarkers in a specimen obtained just success are multiple: the requirement of tissue quality for before the relevant therapy is given, but this could be difficult the specific biomarker assay, investigational site capacity in clinical practice. Hopefully, that will be easier in the future and infrastructure, the physician-patient dialogue, and the when patients have a better understanding of the importance of understanding of importance of sufficient tissue. A strong biomarker determination
Load more

Recommended publications
  • Pulmonary Highlights
    National Jewish Health 2017 PULMONARY HIGHLIGHTS Clinical Expertise, Research and Education National Jewish Health® ® National Jewish Health acknowledges The Tuchman Family Foundation and Debra and Ken Tuchman for their generous gift to establish The Tuchman Family Division of Pulmonary, Critical Care and Sleep Medicine. For more than 20 years, Debra and Ken Tuchman and the Tuchman Family have been committed to National Jewish Health through board service and as outstanding advocates for the institution. Dear Colleague, With great pleasure, we present National Jewish Health Pulmonary Highlights 2017, our annual compilation of clinical, research and educational capabilities in pulmonary medicine. At National Jewish Health, we solve hard problems. Patients come to us from around the nation — and the world — seeking answers. They have often spent years working with their physicians and experimenting with treatment options, only to have their conditions continue and sometimes worsen. Our team of expert pulmonologists conducts intensive evaluations in collaboration with cardiologists, gastroenterologists, allergists, oncologists, rheumatologists and others. Once we develop a diagnosis and treatment plan, we work with each patient’s hometown physicians to implement the plan. We are an academic medical institution that has focused on respiratory and related diseases for more than 119 years. We have one of the largest pulmonary divisions in the nation. This year we were named the #1 respiratory hospital in the nation by U.S. News & World Report in its 2017–2018 Best Hospitals rankings. Our dedicated faculty includes recognized national leaders in their fields, who continue to pass along their knowledge by training medical students, residents and postgraduate fellows in affiliation with the University of Colorado School of Medicine and through our robust, nationwide continuing medical education program.
    [Show full text]
  • Mark Boguniewicz, MD
    Mark Boguniewicz, MD • Professor • Division of Pediatric Allergy & Clinical Immunology • Department of Pediatrics Conditions Treated: • Medication/Drug Allergy • Hives (Urticaria) • Allergic Rhinitis (Hay Fever) • Immune Deficiency Disorders • Allergic Rhinitis (Pediatric) Programs & Services: • National Jewish Health for Kids / Pediatric • Eczema Program (Pediatric) Programs • Day Program (Pediatric) • Food Allergy Program (Pediatric) • Outpatient Clinic (Pediatric) • Division of Pediatric Allergy & Clinical • Ambulatory Pediatrics Immunology • Allergy & Asthma Program (Pediatric) • Asthma Treatment Programs (Pediatric) Research Interests My research interests include the immunology of the skin, especially as it relates to atopic dermatitis (eczema) and new treatments for this illness. Board Certification Pediatrics and Allergy-Immunology Fellowship 1985 - Boston Children’s Hospital and Harvard Medical School, Immunology, Allergy and 1988 Rheumatology Teaching or Professional Positions Professor, Department of Pediatrics, National Jewish Health and University of Colorado School of Medicine Affiliations with the University of Colorado Denver Professor, Department of Pediatrics, University of Colorado Denver Professional Memberships Fellow, AAAAI Fellow, ACAAI Member, CAAS Awards & Recognition 2015: Best Doctors in America, Best Doctors, Inc. 2013: Distinguished Clinician Award, AAAAI 2006: Richard S. Farr Memorial Lectureship 2003-2014: Best Doctors in America 2002: Clinician of the Year, National Jewish Health Faculty Award 1998-1999, 2010-2011, 2011-2012, 2012-2013: Pediatric Allergy-Immunology Fellows Outstanding Teacher Award Publications Boguniewicz M, Leung DY. Targeted therapy for allergic diseases: At the intersection of cutting- edge science and clinical practice. J Allergy Clin Immunol 2015;135:354-6. Boguniewicz M. Atopic dermatitis: The updated practice parameter and beyond. Allergy Asthma Proc 2014;35:429-34. Boguniewicz M, Leung DYM. Atopic dermatitis: a disease of altered skin barrier and immune dysregulation.
    [Show full text]
  • Sequencing Vs MALDI-TOF- Tools for Accurate Identification of Non-Tuberculous
    Sequencing Vs MALDI-TOF- tools for accurate identification of Non-Tuberculous Mycobacteria-a Pilot study Dissertation submitted in partial fulfilment of the rules and regulations for the M.D. (Branch-IV Microbiology) examination of the Tamilnadu Dr. M.G.R. Medical University to be held in May, 2019 1 CERTIFICATE This is to certify that the dissertation entitled, ―Sequencing Vs MALDI-TOF- tools for accurate identification of Non-Tuberculous Mycobacteria-a Pilot study‖is the bonafide work of Dr. Ann Susan Sam toward the M.D (Branch – IV Microbiology) Degree examination of the Tamil Nadu Dr.M.G.R.Medical University, to be conducted in May-2019. Dr. Joy Sarojini Michael Guide, Professor and Head of department The Principal Department of Clinical Microbiology Christian Medical College Christian Medical College Vellore-632004 Vellore- 632004 2 DECLARATION I hereby declare that this M.D Dissertation entitled ―Sequencing Vs MALDI-TOF- tools for accurate identification of Non-Tuberculous Mycobacteria-a Pilot study‖is the bonafide work done by me under the guidance of Dr. Joy Sarojini Michael, Professor, Department of Clinical Microbiology, Christian Medical College, Vellore. This work has not been submitted to any other university in part or full. Dr. Ann Susan Sam Department of Clinical Microbiology Christian Medical College Vellore 3 Plagiarism certificate 4 CERTIFICATE This is to certify that this dissertation work titled ―Sequencing Vs MALDI-TOF- tools for accurate identification of Non-Tuberculous Mycobacteria-a Pilot study‖ was done by candidate- Ann Susan Sam (Registration number- 201614351) for the award of Degree of MD Microbiology (branch IV). I have personally verified the plagiarism results on urkund.com website.
    [Show full text]
  • Ronald Joseph Harbeck, Phd
    Ronald Joseph Harbeck, PhD • Professor • Director, Core and Microbiology Laboratories, ADx • Director of Immunology & Beryllium Laboratories • Department of Medicine • Division of Pathology Conditions Treated: Research Areas: • Autoimmunity/Rheumatology • Pulmonary Disease Research, Other Programs & Services: • Department of Medicine • Diagnostic Laboratories • Division of Pathology • Microbiology Laboratory Board Certification 1979: Board Certification: Diplomate, American Board of Medical Laboratory Immunology, American Academy of Microbiology. Recertification: 1998, 2001, 2004, 2007 and 2010. 1990: New York State Department of Health, Certificate as Laboratory Director 1996: New York State Department of Health, Certificate of Qualification in Cellular and Diagnostic Immunology Education 1964 University of South Dakota (Vermillion, SD), BA, Chemistry 1971 University of South Dakota (Vermillion, SD), PhD, Microbiology Fellowship 1971 - 1973 National Jewish Health, Postdoctoral Research Fellow in Immunology Affiliations with the University of Colorado Denver Professor, Department of Medicine, Division of Allergy & Clinical Immunology, University of Colorado Denver Professor, Integrated Dpartment of Immunology, University of Colorado Denver Professional Memberships American Academy of Allergy, Asthma and Immunology American Society for Microbiology American Association of Immunologists Clinical Immunology Society Association of Medical Laboratory Immunologists (Charter Member) American Association for Clinical Chemistry International Immunocompromised
    [Show full text]
  • Immunotherapy (Allergy Shots)
    Immunotherapy (Allergy Shots) Subcutanous immunotherapy (commonly called allergy shots) is a form of treatment to reduce your allergic reaction to allergens. Allergens are substances to which you are allergic. Remember, not all asthma is due to allergies. Research has shown allergy shots can reduce symptoms of: Allergic rhinitis (hay fever) grass, weed and tree pollen allergies Allergic asthma Dust mite allergy Animal dander allergy Insect sting allergy Allergy shots are less effective against molds and are not a useful method for the treatment of food allergy. Allergy shots consists of a series of injections (shots) with a solution containing the allergens that cause your symptoms. There are usually two phases: build-up and maintenance. Treatment build-up begins with a weak solution given once or twice a week. The strength of the solution is gradually increased with each dose. Once the strongest dosage is reached in a few months, the injections are slowly spaced apart until it reaches once a month. At this point, sensitivity to the allergens has been decreased, and a person has reached a maintenance level. Though not a cure for everyone, allergy sots can significantly reduce allergy symptoms in people who are unable to avoid allergens and who do not respond well to other medications. Allergy shots should always be given at your health care provider's office since there is a risk of a severe reaction. When Is immunotherapy recommended? If you are thinking of allergy shots, ask your health care provider about a referral to a board-certified allergist. A board-certified allergist will follow a number of steps to evaluate if allergy shots are right for you.
    [Show full text]
  • Sputum Smear Examination of Adult Tuberculosis Patients Admitted in National Institute of Diseases of the Chest and Hospital (NIDCH)
    Sputum smear examination of adult tuberculosis patients admitted in National Institute of Diseases of the Chest and Hospital (NIDCH) A thesis report submitted to the Department of Pharmacy, East West University, Bangladesh, in partial fulfillment of the course of Pharmaceutical Research (PHRM 404) for the degree of Bachelor of Pharmacy Submitted by Sanjida Halim Topa ID: 2008-3-70-046 Submission date: 10 July, 2012 Supervised by Dr. Sufia Islam Associate Professor, Department of Pharmacy East West University This research paper is dedicated to my beloved parents i Certificate Declaration by the Research Instructor and Department Chairperson 10 July, 2012 It is pleasure to certify that the research paper entitled “Sputum smear examination of adult tuberculosis patients admitted in National Institute of Diseases of the Chest and Hospital (NIDCH)” is prepared by Sanjida Halim Topa, a student of the Department of Pharmacy, East West University, Dhaka. She prepared the paper under my supervision. This is her original work. Dr. Sufia Islam Chairperson Department of Pharmacy East West University ii Acknowledgements All praise to the Almighty, who has made all things in my life possible. It is Him who has sustained me throughout the course of my study. I would like to extend my sincere thanks to the East West University for giving me the opportunity to conduct this study under supervision of my honorable research instructor, Dr. Sufia Islam for her scholarly guidance from the very beginning till the end of this study. I would also like to thank my research co-workers Tasnuva Tamanna and Rabita Israt whose assistance during this study aided in the process of easing my workload.
    [Show full text]
  • Njhealth.Org
    Provider Directory 2014-2015 PHYSICIANS–Call one number Physician Line 800.652.9555 fax 303.270.2153 Fast Find [email protected] Reference Online Referrals Guide njhealth.org/professionals PATIENTS 800.621.0505 or 303.398.1355 fax 303.270.2162 [email protected] MEDICAL RECORDS 303.398.1256 fax 303.398.1211 Please specify when records are needed. njhealth.org Adult Medical Care ALLERGY/ASTHMA/IMMUNOLOGY CLINICAL RESEARCH STUDIES We offer personalized testing and treatments for simple 303.398.1911, Adult Studies to complex issues with our locally and nationally [email protected] renowned specialists. COPD PROGRAM Rafeul Alam, MD, PhD Our multidisciplinary program improves quality of life and Flavia Hoyte, MD reduces hospitalizations through individual treatments and Rohit Katial, MD patient education. Anita Trikha, MD Russell Bowler, MD, PhD Tho Truong, MD James Crapo, MD Richard Weber, MD William Janssen, MD Steven Lommatzsch, MD ALPHA 1 ANTITRYPSIN DEFICIENCY PROGRAM Barry J. Make, MD 303.398.1858, fax 303.270.2178 Robert A. Sandhaus, MD, PhD, FCCP CYSTIC FIBROSIS PROGRAM [email protected] As the largest adult cystic fibrosis center in the United States, we provide ongoing treatment for hundreds AUTOIMMUNE LUNG CENTER of patients. Our center works within the framework of a premier Steven Lommatzsch, MD respiratory medical facility and is one of the best David Nichols, MD in the world to seek care for autoimmune lung diseases. Jerry Nick, MD The center provides patients with a unique, cross- Milene Saavedra, MD specialty approach to care. We bring our rheumatologists, Jennifer L. Taylor-Cousar, MD pulmonologists and other related health care providers DIABETES/NEPHROLOGY together to coordinate evaluation and management We offer a three-tiered program for Type II diabetes mellitus strategies.
    [Show full text]
  • 42Nd Annual National Jewish Health Pulmonary and Allergy Update
    This program was supported by educational grants from AstraZeneca Pharmaceuticals, GlaxoSmithKline LLC, Insmed, Inc., Pfizer, Inc., Sanofi Genzyme and Regeneron Pharmaceuticals, and Vertex Pharmaceuticals, Inc. Executive Summary: Activity Details February 5-8, 2020 Keystone, Colorado The National Jewish Health 42nd Annual The Pulmonary and Allergy Update highlighted insights and recent advances in immunology, pulmonary medicine, asthma, and allergy presented by faculty from the leading respiratory hospital in the nation. Participants had the opportunity to network with colleagues and nationally recognized experts, and learn the latest updates on management and treatment options for patients. Features included: Workshops that complimented lectures provided great opportunities to discuss key issues and apply learning with case reviews by National Jewish Health expert faculty Interactive didactic presentations Case-based learning Automated Response System (ARS) National Jewish Health Presenting Faculty Arash Babaei, MD Rebecca C. Keith, MD Associate Professor of Medicine Assistant Professor of Medicine Division of Gastroenterology Division of Pulmonary and Critical Care & Sleep Medicine National Jewish Health Interstitial Lung Disease Program National Jewish Health Mark Boguniewicz, MD Professor of Pediatrics Todd T. Kingdom, MD Division of Pediatric Allergy and Clinical Immunology Professor of Otolaryngology & Opthamology National Jewish Health Vice Chair of Clinical Affairs University of Colorado School of Medicine Division of Specialty
    [Show full text]
  • [Document Title]
    DRAFT – National Jewish Health Community Health Needs Assessment 6/3/19 with feedback from finance and proofread [DOCUMENT TITLE] Allstetter, William NATIONAL JEWISH HEALTH [Company address] Table of Contents Executive Summary .................................................................... 2 Letter from President & CEO ...................................................... 4 2019 Community Health Needs Assessment .............................. 5 • Introduction .................................................................................................. 5 • Background and Purpose of Community Health Needs Assessment ............. 6 • Review of 2016 CHNA and Implementation Strategy .................................... 7 • Assessment Methodology ............................................................................. 9 o Community Description............................................................................ 10 ○ Geographic Community ......................................................................... 10 ○ Health Focus – Respiratory Disease ....................................................... 10 o Social Determinants of Health .................................................................. 11 o Snapshot of Community Health................................................................ 12 • Identification and Prioritization of Significant Health Needs ....................... 16 o Primary Data Collection — Community Input ........................................... 16 ○ Community Focus Groups .....................................................................
    [Show full text]
  • Download the 2020 Annual Report
    NATIONAL JEWISH HEALTH Rising to the Challenge ANNUAL REPORT National Jewish Health TABLE OF CONTENTS HIS LIFE, JANUARY – MARCH HIS CHOICE LEADERSHIP 14 7 LETTER A LONG JOURNEY 2 23 SEPTEMBER – DECEMBER 8 JULY – AUGUST 4 M AY – JUNE GIVING MARCH – APRIL 30 40 24 FINANCIAL REPORT FREEDOM TO 32 HONOR ROLL OF BREATHE PHILANTHROPY 29 FACULTY, OFFICERS 54 & LEADERS 34 Rising to the Challenge Rising to the challenge is how National Jewish Health has always approached the most difficult illnesses. Through science, education and the most comprehensive care available, we meet difficult issues head on, find solutions and improve the lives of the thousands of patients we serve. During 2020, the world has been faced with a devastating pandemic, one that continues even now. National Jewish Health works at the forefront of this pandemic, doing what we do best, rising to the challenge. LEADERSHIP LETTER In 1899, National Jewish Health opened its doors to face a devastating infectious lung disease with no known cure — tuberculosis. We rose to that challenge, caring for patients in need, innovating and trusting in science, and persevering until we found effective treatments and cures. In the many years since, we have continued meeting the challenges of respiratory, cardiac and immune-related diseases that afflict millions around the world. We provide unparalleled care for our patients. We conduct basic, translational and clinical research to treat, cure and prevent those diseases. We educate and train health care leaders of tomorrow. In 2020, National Jewish Health once again adapted in the face of another deadly infectious lung disease — COVID-19.
    [Show full text]
  • Nce. Nfidence
    Evidence. Experience. Confi dence. bij • Invasieve candidiasis1 Supplement bij twintigste jaargang, april 2012 • Invasieve aspergillose2 Voorjaarsvergadering van de Nederlandse Vereniging voor Medische Microbiologie (NVMM) • Empirische antifungale therapie3 en de Koninklijke Nederlandse Vereniging voor Microbiologie (KNVM) C. albicans C. rugosaC. glabrataC. parapsilosisC. tropicalisC. kruseiC. guilliermondiiC. lipolyticaC. dubliniensisC. kefyrC. lusitaniaeA. fl avusA. fumigatusA. terreusA. nigerA. nidulans CANDIDA ALBICANS CANDIDA NON-ALBICANS ASPERGILLUS • Bewezen effectiviteit1 4 • Gunstig veiligheidsprofi el Papendal, 17 & 18 april 2012 Programma-overzicht 5,6 • Bij volwassenen en kinderen Abstracts Auteursindex Referenties: 1. Mora-Duarte J.: Comparison of caspofungin and amphotericin B for invasive candidiasis. N Eng J Med 347;2020-9, 2002. 2. Maertens J.: Effi cacy and safety of caspofungin for treatment of invasive aspergillosis in patients refractory to or intolerant for conventional antifungal therapy. CID 2004;39:000-000. 3. Walsh T.J.: Caspofungin versus Liposomal Amphotericin B for empirical antifungal therapy in patients with persistent fever and neutropenia. N Eng J Med 2004; 351:1391-402.4. David W. Denning: Echinocandin antifungal drugs. The Lancet 362: 1142-51, 2003.5. Walsh TJ: Pharmacokinetics, safety and tolerability of caspofungin in children and adolescents. AAC 49: 4536-4545, 2005. 6. Zaoutis TE: A prospective, multicenter study of caspofungin for treatment of documented candida or aspergillus infections in pediatric patients. Pediatrics 123:877-884, 2009. 20e jaargang . april 2012 . Supplement Raadpleeg eerst de volledige productinformatie alvorens CANCIDAS voor te schrijven M Merck Sharp & Dohme BV, Postbus 581, 2003 PC Haarlem Tel. 0800-9999000, email [email protected] 1110CAN09NL539J1109 www.msd.nl, www.univadis.nl Evidence. Experience. Confi dence.
    [Show full text]
  • TB Infection Control in Healthcare Settings
    TB InfectionPresenter Control in of HealthcareReproduction Settings for Wendi K. DrummondProperty DO, MPH Medical Director,Not Infection Prevention Assistant Professor of Medicine National Jewish Health April 6, 2018 Presenter of Reproduction for Property Not Objectives Understand the epidemiology of TB in health care settings and risk factorsPresenter for transmission of Review the elements of a TB infection control program Understand the implementationReproduction of different aspects of for environmentalProperty and respiratory controls Not How contagious is tuberculosis? Factors in influencing TB transmission Source case (*AFB smear status, treatment status, frequency of cough) Presenter The environment of Among household contacts of smear-positive cases, the rates of tuberculinReproduction positivity are 30-50% above those among age-matched community controls for Duration andProperty intensity of exposure The contactNot The tubercle bacillus Sepkowitz, KA, 1996 How contagious is tuberculosis? Smear positive cases expectorate 108-1010 bacilli daily (or about 106-107 AFB/ml sputum) Smear negative sputumPresenter contains < 103 bacilli/ml of sputum of Treatment decreasesReproduction contagiousness, regardless of smear and culturefor status by decreasing the number of bacilli expectoratedProperty + introduces antibiotic into the Not infectious droplet nuclei TB Transmission Person-to-person transmission of TB occurs via inhalation of droplet nuclei (airborne particles 1-2 microns in diameter – approximately 1/100th the width
    [Show full text]