Third-line treatment patterns in HER2-positive metastatic breast cancer: a retrospective analysis of real-world data in Canada.

There is an increasing demand for real-world data pertaining to the usage of cancer treatments, especially in settings where no standard treatment is specifically recommended. This study presents the first real-world analysis of third-line treatment patterns in HER2-positive metastatic breast cancer (mBC) patients in Canada. The purpose was to assess evolution of clinical practice and identify unmet needs in post-second-line therapy. Retrospective data from medical records of 66 patients who received third-line treatment before 31st October 2018, and data from 56 patients who received third-line treatment after this date, extracted from the Personalize My Treatment (PMT) cancer patient registry, were analyzed. In the first cohort, the study revealed heterogeneity in the third-line setting, with trastuzumab, lapatinib, and T-DM1 being the main treatment options. Even though data were collected before the wide availability of tucatinib, neratinib and trastuzumab deruxtecan in Canada, the PMT cohort revealed the emergence of new therapeutic combinations and a shift from lapatinib usage to T-DM1 choice was observed. These findings underscore the evolving nature of third-line treatment strategies in Canada, a facet that is intrinsically tied to the availability of new drugs. The absence of a consensus on post-second-line treatment highlights the pressing need for more efficient therapeutic alternatives beyond the currently available options. This study not only offers valuable insights into the present landscape of third-line treatment in Canada but validates the significance and effectiveness of the PMT registry as a tool for generating pan-Canadian real-world evidence in oncology and its capacity to provide information on evolution of therapeutic practices.

Paediatric case of gastrointestinal basidiobolomycosis mimicking appendicitis - Case report.

INTRODUCTION: Basidiobolomycosis is a rare fungal infection caused by Basidiobolus ranarum that normally leads to subcutaneous infection and, rarely, to involvement in the gastrointestinal tract. PRESENTATION OF CASE: A 6-year-old boy presented to the Emergency department (ED) complaining of abdominal pain of a few weeks' duration in the right lower quadrant, associated with fever and vomiting. A computed tomography (CT) of the abdomen was done. It showed an enlarged tubular structure in the right iliac fossa, a suspected appendicular lesion, and free fluid collection, as well as multiple enlarged mesenteric and right iliac lymph nodes. Based on these results, the decision was made to do surgical exploration on the patient. After two weeks, the patient developed tachycardia, abdominal distention, constipation, and spikes of fever. Two days later, re-exploration was performed. An ileostomy and colostomy were performed and drains inserted. Post-operative, the patient was pushed to paediatric intensive care unit (PICU), while still intubated and hemodynamically stable. However, he developed cardiac arrest on the same day and cardiopulmonary resuscitation (CPR) was performed, but he couldn't be resuscitated. DISCUSSION: The patient presented with severe abdominal pain in the right lower quadrant, as well as fever and vomiting. These complaints may have been misdiagnosed as appendicitis. The diagnosis of gastrointestinal basidiobolomycosis was confirmed by histopathology, based on a surgical specimen taken during the primary exploration. The management was a combination between surgical intervention and medical treatment.

The effect of hyoscine butylbromide on the duration and progress of labor in primigravidae: a randomized controlled trial.

OBJECTIVE: To assess the effect of hyoscine butylbromide (HBB) on duration of the first stage of labor in primigravdae. METHODS: A case-control study conducted on 120 primigravida at term admitted in active labor were divided into three equal groups. A single dose of the drug (placebo or HBB 20 mg or HBB 40 mg) was injected intravenously slowly to groups A, B, and C. The duration of the first stage was calculated from the time of cervical dilatation of three to four centimeters in active labor until a fully dilated cervix was observed. RESULTS: The duration of first stage was significantly shorter in women receiving 20 and 40 mg of HBB when controlled to control women (187.73 ± 20.92, 186.41 ± 19.40 versus 231.39 ± 33.14 min). There was no significant difference between the three study groups regarding duration of the second stage (36.76 ± 9.98, 35.72 ± 9.97 and 37.55 ± 10.57, respectively, p > .05), number of cases delivered by cesarean section (12.5%, 12.5%, and 15%, respectively, p > .05) and Apgar score of the neonates (p > .05). There was no significant difference between the three study groups regarding occurrence of side effects named dry mouth (7.5%, 12.5%, and 5%, p > .05), flushing (2.5%, 5% and 0%, p > .05), tachycardia (2.5%, 2.5%, and 2.5%, p > .05), or urinary retention (2.5%, 0%, and 0%, p > .05). CONCLUSION: Intravenous injection of HBB decreases the duration of active phase of labor in primigravidae with no side effects.