1. The cost of systemic therapy for metastatic colorectal carcinoma in Slovenia : discrepancy analysis between cost and reimbursementTanja Mesti, Biljana Mileva Boshkoska, Mitja Kos, Metka Tekavčič, Janja Ocvirk, 2015, izvirni znanstveni članek Povzetek: The aim of the study was to estimate the direct medical costs of metastatic colorectal cancer (mCRC) treated at the Institute of Oncology Ljubljana and to question the healthcare payment system in Slovenia. Methods. Using an internal patient database, the costs of mCRC patients were estimated in 2009 by examining (1) mCRC direct medical related costs, and (2) the cost difference between payment received by Slovenian health insurance and actual mCRC costs. Costs were analysed in the treatment phase of the disease by assessing the direct medical costs of hospital treatment with systemic therapy together with hospital treatment of side effects, without assessing radiotherapy or surgical treatment. Follow-up costs, indirect medical costs, and nonmedical costs were not included. Results. A total of 209 mCRC patients met all eligibility criteria. The direct medical costs of mCRC hospitalization with systemic therapy in Slovenia for 2009 were estimated as the cost of medications (cost of systemic therapy + cost of drugs for premedication) + labor cost (the cost of carrying out systemic treatment) + cost of lab tests + cost of imaging tests + KRAS testing cost + cost of hospital treatment due to side effects of mCRC treatment, and amounted to %3,914,697. The difference between the cost paid by health insurance and actual costs, estimated as direct medical costs of hospitalization of mCRC patients treated with systemic therapy at the Institute of Oncology Ljubljana in 2009, was %1,900,757.80. Conclusions. The costs paid to the Institute of Oncology Ljubljana by health insurance for treating mCRC with systemic therapy do not match the actual cost of treatment. In fact, the difference between the payment and the actual cost estimated as direct medical costs of hospitalization of mCRC patients treated with systemic therapy at the Institute of Oncology Ljubljana in 2009 was %1,900,757.80. The model Australian Refined Diagnosis Related Groups (AR-DRG) for cost assessment in oncology being currently used is probably one of the reasons for the discrepancy between pay-outs and actual costs. We propose new method for more precise cost assessment in oncology.
Ključne besede: cost of treatment, metastatic colorectal cancer, cost of targeted therapy, monitoring costs
Objavljeno v DiRROS: 17.04.2024; Ogledov: 39; Prenosov: 5
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2. Bevacizumab and irinotecan in recurrent malignant glioma, a single institution experienceTanja Mesti, Maja Ebert Moltara, Marko Boc, Martina Reberšek, Janja Ocvirk, 2015, izvirni znanstveni članek Povzetek: Treatment options of recurrent malignant gliomas are very limited and with a poor survival benefit. The results from phase II trials suggest that the combination of bevacizumab and irinotecan is beneficial. Patients and methods. The medical documentation of 19 adult patients with recurrent malignant gliomas was retrospectively reviewed. All patients received bevacizumab (10 mg/kg) and irinotecan (340 mg/m2 or 125 mg/m2) every two weeks. Patient clinical characteristics, drug toxicities, response rate, progression free survival (PFS) and overall survival (OS) were evaluated. Results. Between August 2008 and November 2011, 19 patients with recurrent malignant gliomas (median age 44.7, male 73.7%, WHO performance status 0%2) were treated with bevacizumab/irinotecan regimen. Thirteen patients had glioblastoma, 5 anaplastic astrocytoma and 1 anaplastic oligoastrocytoma. With exception of one patient, all patients had initially a standard therapy with primary resection followed by postoperative chemoradiotherapy. Radiological response was confirmed after 3 months in 9 patients (1 complete response, 8 partial responses), seven patients had stable disease and three patients have progressed. The median PFS was 6.8 months (95% confidence interval [CI]: 5.3-8.3) with six-month PFS rate 52.6%. The median OS was 7.7 months (95% CI: 6.6-8.7), while six-month and twelve-month survival rates were 68.4% and 31.6%, respectively. There were 16 cases of hematopoietic toxicity grade (G) 1-2. Non-hematopoietic toxicity was present in 14 cases, all G1-2, except for one patient with proteinuria G3. No grade 4 toxicities, no thromboembolic event and no intracranial hemorrhage were observed. Conclusions. In recurrent malignant gliomas combination of bevacizumab and irinotecan might be an active regimen with acceptable toxicity.
Ključne besede: recurrent malignant glioma, systemic therapy, bevacizumab
Objavljeno v DiRROS: 17.04.2024; Ogledov: 40; Prenosov: 5
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4. The prognostic and predictive value of human gastrointestinal microbiome and exosomal mRNA expression of PD-L1 and IFNγ for immune checkpoint inhibitors response in metastatic melanoma patients : protocol trialAna Erman, Marija Ignjatović, Katja Leskovšek, Simona Miceska, Urša Lampreht Tratar, Maša Omerzel, Veronika Kloboves-Prevodnik, Maja Čemažar, Lidija Kandolf Sekulović, Gorazd Avguštin, Janja Ocvirk, Tanja Mesti, 2023, izvirni znanstveni članek Povzetek: Background: Immunotherapy has been successful in treating advanced melanoma, but a large proportion of patients do not respond to the treatment with immune checkpoint inhibitors (ICIs). Preclinical and small cohort studies suggest gastrointestinal microbiome composition and exosomal mRNA expression of PD-L1 and IFNγ from the primary tumor, stool and body fluids as potential biomarkers for response. Methods: Patients treated with immune checkpoint inhibitors as a first line treatment for metastatic melanoma are recruted to this prospective study. Stool samples are submitted before the start of treatment, at the 12th (+/−2) week and 28th (+/−2) week, and at the occurrence of event (suspected disease progression/hyperprogression, immune-related adverse event (irAE), deterioration). Peripheral venous blood samples are taken additionally at the same time points for cytologic and molecular tests. Histological material from the tumor tissue is obtained before the start of immunotherapy treatment. Primary objectives are to determine whether the human gastrointestinal microbiome (bacterial and viral) and the exosomal mRNA expression of PD-L1 and IFNγ and its dynamics predicts the response to treatment with PD-1 and CTLA-4 inhibitors and its association with the occurrence of irAE. The response is evaluated radiologically with imaging methods in accordance with the irRECIST criteria. Conclusions: This is the first study to combine and investigate multiple potential predictive and prognostic biomarkers and their dynamics in first line ICI in metastatic melanoma patients.
Ključne besede: gastrointestinal microbiome, mRNA expression of PD-L1 and IFNγ, immune checkpoint inhibitors, metastatic melanoma
Objavljeno v DiRROS: 21.03.2024; Ogledov: 70; Prenosov: 36
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6. Rezultati sistemskega zdravljenja bolnikov s ploščatoceličnim kožnim rakom na Onkološkem inštitutu LjubljanaBlaž Tomič, Maša Sever, Janja Ocvirk, Tanja Mesti, 2023, objavljeni znanstveni prispevek na konferenci Povzetek: Zdravljenje lokalno napredovalega skvamoznoceličnega karcinoma in metastatskega skvamoznoceličnega karcinoma je mogoče z radioterapijo, kemoterapijo na osnovi platine, tarčno terapijo z zaviralci receptorjev za epidermalni rastni faktor ali zaviralci receptorjev programirane celične smrti. Cemiplimab je PD-1 inhibitor, ki je odobren za zdravljenje lokalno napredovale in metastatske oblike bolezni, kjer zdravljenje z radioterapijo ali operativno zdravljenje ni indicirano. V študijo je bilo vključenih 28 pacientov, ki so prejemali cemiplimab v prvi liniji zdravljenja. Rezultati so pokazali, da je bilo mediano obdobje brez napredovanja bolezni 4,4 mesece in mediano celokupno preživetje ni bilo doseženo. Večja stopnja odziva je bila dosežena pri pacientih z imunsko pogojenimi neželenimi učinki - splošna stopnja odziva je bila 43 %, stopnja obvladovanja bolezni je bila 71 %.
Ključne besede: rak kože, melanom, sistemsko zdravljenje
Objavljeno v DiRROS: 18.05.2023; Ogledov: 385; Prenosov: 132
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7. Vloga biomarkerjev v sistemskem zdravljenju melanoma : zgodnji prediktivni biomarkerji za zdravljenje z zaviralci imunskih kontrolnih točk, izsledki retrospektivne analizeMićo Božić, Cvetka Grašič-Kuhar, Janja Ocvirk, Tanja Mesti, 2023, objavljeni znanstveni prispevek na konferenci Povzetek: Melanom je maligni tumor, ki ga lahko relativno učinkovito zdravimo z zaviralci imunskih kontrolnih točk (ZIKT). Kljub temu pri večini bolnikov z melanom opažamo pojav odpornosti na zdravljenje z ZIKT. Biomarker, s katerim bi lahko uspeh zdravljenja z ZIKT zanesljivo napovedali, še vedno ni bil odkrit. Pojav imunsko pogojenih neželenih učinkov (irAE) je povezan z dobrim odgovorom na zdravljenje. Slednjega določa tudi vnetje v tumorju, ki se lahko odraža s sistemskimi vnetnimi procesi. Retrospektivna analiza bolnikov z razsejanim melanomom, zdravljenih z ZIKT v 1. redu, je raziskala povezanost odgovora na zdravljenje z irAE in nekaterimi modeli, temelječimi na razmerji med količinami krvnih celic, ki sodelujejo pri vnetnih procesih. Rezultati so pokazali, da sta velika izhodiščna vrednost sistemskega imunsko vnetnega indeksa (SII) in velika vrednost razmerja med trombociti in limfociti (PLR) pred 2. ciklom zdravljenja potencialna zgodnja negativna prediktivna biomarkerja za zdravljenje z ZIKT. Ponovno je bila tudi potrjena pozitivna korelacija med irAE in dobrim odgovorom na zdravljenje z ZIKT
Ključne besede: rak kože, melanom, register raka
Objavljeno v DiRROS: 16.05.2023; Ogledov: 360; Prenosov: 136
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8. Maligni melanom in ostali kožni raki : standardi in perspektive2023, ni določena Ključne besede: dermatologija, rak (medicina), zgodnja diagnostika, benigni tumorji, maligni tumorji, klasifikacija, melanocitni nevusi, ploščatocelični karcinom, bazaliom, dermoskopija
Objavljeno v DiRROS: 25.04.2023; Ogledov: 396; Prenosov: 303
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9. Novosti na področju imunoterapije rakov zgornjih prebavilTanja Mesti, 2023, objavljeni znanstveni prispevek na konferenci Povzetek: Kljub večletnim negativnim kliničnim raziskavam in minimalnemu napredku zdravljenja z imunoterapije na področju rakov zgornjih prebavil, novi podatki novi podatki so obetavni in bodo morda pomembno spremenili pristop k zdravljenju teh malignih bolezni. Ta pregled se osredotoča na letošnje novosti v imunoterapiji rakov zgornjih prebavil in vključuje ne samo novosti, katera odzivnost izidov je pripeljala do inkorporacije določenih zdravil in shem v smernice zdravljenja, ampak tudi raziskave faze 3 in faze 2, ki veliko obetajo.
Ključne besede: imunoterapija, onkologija, onkološko zdravljenje
Objavljeno v DiRROS: 16.02.2023; Ogledov: 417; Prenosov: 160
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