Treatment of bleeding episodes in haemophilia A complicated by a factor VIII inhibitor in patients receiving Emicizumab. Interim guidance from UKHCDO Inhibitor Working Party and Executive Committee.

Emicizumab is a bispecific antibody that activates FX to FXa in the absence of FVIII. It has been shown to reduce bleeding episodes in people with haemophilia A complicated by a FVIII inhibitor. Despite the protection against bleeds, some breakthrough bleeds are inevitable and these may require additional haemostatic treatment. Emicizumab has been associated with severe adverse events when co-administered with activated prothrombin complex concentrate. To minimize the risk of adverse events, the UK Haemophilia Centre Doctors' Organisation issues the following updated interim guidance to its Inhibitor Guidelines for managing patients receiving Emicizumab based on the limit published information available in February 2018.

Cancer incidence and mortality trends among whites in the United States, 1947-84.

Cancer incidence trends from the late 1940s to 1983-84 were assessed among white residents of five geographic areas (Atlanta, Connecticut, Detroit, Iowa, San Francisco-Oakland) by means of data derived from several National Cancer Institute surveys, the Connecticut Tumor Registry, and the Surveillance, Epidemiology, and End Results Program. Incidence trends were compared with mortality trends for the entire United States and for the same five study areas. This study documented rising incidence and mortality rates for four cancers: lung cancer, melanoma of the skin, multiple myeloma, and non-Hodgkin's lymphomas. Increases in lung cancer continued through the early 1980s, but the rate of increase has been moderating during recent years, particularly among males and at younger ages for whom recent declines are evident. Overall, lung cancer incidence rates increased more than 220 and 400% among males and females, respectively. Although much rarer than lung cancer, melanoma of the skin and multiple myeloma increased greatly until the early 1980s among both males and females. The overall rate of increase in melanoma incidence among males was greater than that for lung cancer, and the rate of increase in multiple myeloma mortality among females was exceeded only by that for lung cancer. Increases of 70-120% were observed for non-Hodgkin's lymphomas. Increases in incidence and mortality rates for pancreatic cancer were apparent during the early years but less conspicuous in recent years. Laryngeal and kidney cancer rates generally increased substantially, although the changes were not remarkable for laryngeal cancer mortality among males and kidney cancer mortality among females. The rates for cancers of the mouth and pharynx increased among females but not males. Prostate, colon, and bladder cancer incidence rates increased more than 65% among males, whereas mortality rates changed only moderately. The incidence of thyroid cancer increased more than 75% among both sexes until the late 1970s, but mortality rates have declined during the period of study. Breast cancer incidence increased 30%, whereas mortality rates remained remarkably constant. The incidence of corpus uteri cancer increased dramatically during the mid-1970s and decreased substantially thereafter; these changes were not reflected in the mortality rates, which continually declined during the entire time period. The incidence of testicular cancer increased more than 90% and that of Hodgkin's disease did not change greatly; however, mortality rates for both cancers declined more than 50% since the late 1960s and early 1970s.(ABSTRACT TRUNCATED AT 400 WORDS)

Age curves of central nervous system tumor incidence in adults: variation of shape by histologic type.

Data from nine population-based cancer registries from the National Cancer Institute's Surveillance, Epidemiology, and End Results program of the United States were used to study the incidence of individual histologic types of malignant central nervous system tumors by age and sex among adults. On a log-log scale, incidence increased linearly between the ages 35 and 64, with a slope that was not different between males and females or among registries but that varied by histologic type. The estimated slopes were 0.4 for ependymomas, 1.0 for oligodendrogliomas, 1.7 for astrocytomas, 2.8 for meningiomas, and 3.9 for glioblastomas. The rate at which incidence increased with age was significantly higher for glioblastomas than for other glial tumors. This finding suggests a different mechanism of carcinogenesis for glioblastomas than for other glial tumors.

Demographic patterns for mesothelioma in the United States.

Incidence rates for pleural and peritoneal mesotheliomas in about 10% of the U.S. population were examined by various demographic characteristics based on 1973-84 data from the Surveillance, Epidemiology, and End Results Program. Although pleural mesothelioma was more common than peritoneal mesothelioma, both are rare diseases in this country. Pleural mesothelioma incidence rates among white males increased over time and were highest in seaboard areas where shipyards have been located (Seattle, San Francisco-Oakland, Hawaii). The significant secular change was attributed to both period (date of diagnosis) and cohort (date of birth) effects. Pleural mesothelioma incidence rates among white males were nearly 50% higher in the 1980-84 period compared to those in 1975-79; the cohort effect rose to a peak for the 1905-9 birth cohort and then declined. These effects probably reflect changes in asbestos exposure patterns in the past and more recent changes in clinical awareness and coding rules for mesothelioma. Geographic analysis of U.S. death certificates for pleural cancer among white males and females dying during 1968-78 indicated that mortality rates were significantly elevated in several areas that have had asbestos-manufacturing plants or shipyards. Analyses of mortality rates must be viewed with caution, since mesothelioma is considerably underreported on death certificates.

Uterine cancers of unspecified origin--a reassessment.

Uterine cancer ranks third in cancer incidence and fifth in cancer mortality among American women. The epidemiologic characteristics of cancer of the cervix uteri and the corpus uteri are different. When only "cancer of the uterus, not otherwise specified (NOS)" is reported, problems arise in data analysis. In this study, uterine cancer deaths from the National Cancer Institute's Surveillance, Epidemiology, and End Results Program, 1977-79, are compared with those from three previous studies. Uterine cancer deaths certified only as uterus, NOS, on death certificates have decreased 34 percent in the past 30 years. However, even in the late seventies, 25 percent of the uterine cancer deaths were still not being specified as either cervix uteri or corpus uteri on death certificates. Following the deaths certified as cancer of uterus, NOS, back to the pertinent hospital records showed that in recent years 75 percent of these deaths were actually diagnosed as cancer of the corpus uteri, compared with 20 percent 30 years ago. The failure to assign these unspecified uterine cancers to corpus uteri indicates that mortality from cancer of the corpus uteri is still underreported. Although the reporting of the specific subsites of cancer of the uterus on death certificates has improved during the past 30 years, every effort should be made to achieve further improvement in accuracy.