Survival of melanoma patients treated with novel drugs: retrospective analysis of real-world data.

PURPOSE: Recently, several new drugs have been licensed for advanced melanoma therapy, significantly changing the therapeutic landscape. Ipilimumab and vemurafenib were the first drugs that demonstrated a survival benefit over the long-standing standard therapy with dacarbazine. However, the comparative efficacy of these novel drugs has not been properly assessed yet. PATIENTS AND METHODS: We conducted a retrospective analysis of all the Polish population treated between January 2012 and October 2016 with one of the following agents: ipilimumab (IPI), vemurafenib (VEM), dabrafenib (DAB), and classic chemotherapy (CTH). The main objective was to assess the overall survival of melanoma patients treated in real-world conditions, taking into account sequences of treatment. RESULTS: We identified 3397 patients with malignant melanoma treated for the first line and the second line. Patients receiving CTH were significantly older than those treated with the novel drugs. At the same time, the population treated with immunotherapy and targeted therapy was well balanced. Overall survival was significantly better for the novel drugs compared to classic chemotherapy in both lines (for the first line, VEM vs CTH HR = 0.72, 95% CI 0.65-0.81; p < .01, and for the second line, VEM vs CTH HR = 0.78, 95% CI 0.62-0.98; p = .03; IPI vs CTH HR = 0.72, 95% CI 0.62-0.86; p < .01). There was no statistically significant difference for IPI vs VEM; however, subgroup analysis revealed superior results in the case of the CTH-IPI over BRAFi-IPI sequence. CONCLUSION: Novel drugs for melanoma provide a significant advantage in survival over classic chemotherapy. Comparative assessment of IPI and VEM indicated no difference, but only immunotherapy-treated patients achieved long-lasting results. Our data on sequential treatment indicate that immunotherapy might be a better option for the first line rather than targeted therapy, but that conclusion requires further studies of the best way to manage the treatment of melanoma patients.

[Coordinated care after myocardial infarction. The statement of the Polish Cardiac Society and the Agency for Health Technology Assessment and Tariff System]. / Opieka koordynowana po zawale serca. Stanowisko Polskiego Towarzystwa Kardiologicznego oraz Agencji Oceny Technologii Medycznych i Taryfikacji.

The in-hospital mortality following myocardial infarction has decreased substantially over the last two decades in Poland. However, according to the available evidence approximately every 10th patient discharged after myocardial infarction (MI) dies during next 12 months. We identified the most important barriers (e.g. insufficient risk factors control, insufficient and delayed cardiac rehabilitation, suboptimal pharmacotherapy, delayed complete myocardial revascularisation) and proposed a new nation-wide system of coordinated care after MI. The system should consist of four modules: complete revascularisation, education and rehabilitation programme, electrotherapy (including ICDs and BiVs when appropriate) and periodical cardiac consultations. At first stage the coordinated care programme should last 12 months. The proposal contains also the quality of care assessment based on clinical measures (e.g. risk factors control, rate of complete myocardial revascularisation, etc.) as well as on the rate of cardiovascular events. The wide implementation of the proposed system is expected to decrease one year mortality after MI and allow for better financial resources allocation in Poland.

[Evaluation of self-measurement of blood pressure im ambulatory monitoring of hypertension therapy]. / Ocena przydatnosci samopomiarów cisnienia tetniczego w ambulatoryjnym monitorowaniu terapii nadcisnienia tetniczego.

OBJECTIVES: The aim of this study was to compare the usefulness and credibility of ambulatory self-measurement of blood pressure (SMBP) by hypertensive patients to automatic ambulatory blood pressure monitoring (ABPM). METHODS: The study was performed in 51 patients with primary hypertension (19 F, 32 M), aged 25-67 y divided into 3 groups: I-without treatment (n = 13), II-receiving monotherapy (n = 17) and III-treated at least with 2 hypotensive drugs (n = 21). For three consecutive days, patients measured their systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) three times a day at 2 minute intervals during the following periods 06:00-08:00, 15:00-17:00 and 20:00-22:00. Afterwards, the process was repeated for three days using the automatic OMRON HEM-705C device. Results obtained on the second and third days were included in the calculation of SBP, DBP and HR mean values for the period 06:00-22:00. On the fourth day of the study, ABPM was performed with a Tycos Quiet Trak recorder. The parameters were measured every 20 minutes between 06:00 and 22:00. The average values for SBP, DBP and HR that were obtained with these two methods of blood pressure monitoring using the time period 06:00-22:00, were then compared. RESULTS: There was a significant correlation between SMBP and ABPM for SBP, DBP and HR in groups I, II and III (for SBP r = 0.81; 0.80; 0.82; for DBP r = 0.61; 0.62; 0.83; for HR r = 0.53; 0.69; 00.81). According to statistical tests, significant differences in the mean values of SBP, DBP and HR were found in the first (3.9 mmHg, 5.7 mmHg and 8 min-1 and second (4.9 mmHg, 6.2 mmHg and 6.2 min-1) groups. Only the HR (7.7 min-1) was statistically significant in the third group. CONCLUSIONS: Self-measurement of BP with automatic device is comparable to ABPM method of blood pressure monitoring, especially if multi-drug therapy is used for sustained hypertension. However, SMBP is not a completely alternative method for ABPM.