Medscape: Bleeding Rates and Medical Costs of New Oral Anticoagulants (warfarin, dabigatran...)

Bleeding Rates and Medical Costs of New Oral Anticoagulants

April 2, 2012 (Chicago, Illinois) — Firsthand experience with the new oral anticoagulants, coupled with excitement over those yet to be widely in use, has inspired a range of studies examining real-world risk/benefits, as well as the potential costs of replacing warfarin with the new agents.

In a poster session at last week's American College of Cardiology 2012 Scientific Sessions, investigators presented two separate experiences with dabigatran from different US centers--showing very different results--while others presented new cost analyses comparing different oral agents with warfarin.

One US report of patients switched to dabigatran showed a much higher rate of major bleeding than in the RE-LY trial, but a lower rate of dyspepsia, while a second report showed a lower rate of both major and minor bleeding compared with RE-LY trial.

phase 11 - Cancer Research UK launches 'outpatients' (oral)trial of breast and ovarian cancer drug (BRCA/serous cell type - AG-014699 known as Rucaparib or CO-338 - PARP inhibitor)

" Cancer Research UK’s Drug Development Office has re-launched a trial of a promising drug to treat inherited breast and ovarian cancer – but this time taken as a tablet by outpatients."
 
"Women with advanced breast or ovarian cancer with faults in the known high-risk BRCA1 or BRCA2 genes will receive the drug called AG-014699 (Rucaparib) – which belongs to a promising class of drugs called PARP inhibitors. The trial is also open to women with advanced serous ovarian cancer but unknown BRCA status."

"Notes to editors

The drug AG-014699 (also called Rucaparib or CO-338) was recently licenced to Clovis Oncology from Pfizer."

Long-Term Doxorubicin Linked to Secondary Oral Cancers

".......Four patients who received long-term PLD for advanced-stage ovarian cancer developed malignant and/or premalignant lesions of the tongue and/or oral cavity. Dr. Cannon points out that there were only about 16 patients who received PLD for an extended period of time, "so 4 out of 16 patients is quite high."
All 4 of the patients had received maintenance therapy with PLD for at least 3 years. Of this group, 3 women were subsequently diagnosed with squamous cell carcinoma (SCC) of the tongue and/or oral cavity, and 1 patient was diagnosed with sublingual mucosa high-grade dysplasia. All 3 cases of SCCs were negative for human papillomavirus.

Of note, said Dr. Cannon, was a patient who presented with 3 separate lesions of SCC of the oral cavity.

"I don't think this is a coincidence, that 4 of 16 patients receiving this treatment developed oral cancers," he said. "If this treatment for ovarian cancer becomes more popular, then this is something that should become known. Early dental screening would need to be initiated, and the treatment may need to be stopped after a certain time period."

It is relatively uncommon for ovarian cancer patients to receive PLD for this length of time.......cont'd

also: see chart

EvidenceUpdates-Cochrane Collaboration review: Interventions for treating oral mucositis for patients with cancer receiving treatment

Note:"* Ratings pending – login to http://plus.mcmaster.ca/evidenceupdates in a few days if interested."


Abstract

Background

Treatment of cancer is increasingly effective but associated with short and long term side effects. Oral side effects, including oral mucositis (mouth ulceration), remain a major source of illness despite the use of a variety of agents to treat them.

Objectives

To assess the effectiveness of interventions for treating oral mucositis or its associated pain in patients with cancer receiving chemotherapy or radiotherapy or both.


Plain language summary:

Interventions for treating oral mucositis for patients with cancer receiving treatment
Using a low level laser may reduce the severity of ulcers caused by cancer treatment.
Treatments for cancer can cause severe ulcers (sores) in the mouth. These can be painful and slow to heal. The review found weak and unreliable evidence that using a laser may relieve or cure the ulcers. Morphine can control the pain. Although using morphine automatically on a constant drip, or self controlled use, provide similar relief, people use less morphine when they are controlling it themselves.

Feasibility study of oral cyclophosphamide salvage therapy for the treatment of heavily pretreated patients with recurrent epithelial ovarian cancer

A Study Comparing Oral Picoplatin With Intravenous Picoplatin in Subjects With Solid Tumors - Full Text View - ClinicalTrials.gov

A Study Comparing Oral Picoplatin With Intravenous Picoplatin in Subjects With Solid Tumors - Full Text View - ClinicalTrials.gov:
"This study has been completed.
First Received: April 23, 2007 Last Updated: September 23, 2009
Sponsor: Poniard Pharmaceuticals
Information provided by: Poniard Pharmaceuticals
ClinicalTrials.gov Identifier: NCT00465725"