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Medical Forum / Diseases and Disorders / Cancer / September 2006US treatment guidelines
http://www.nccn.org/professionals/physician_gls/f_guidelines.asp NCCN Clinical Practice Guidelines in Oncology Table of Contents and Recently updated NCCN Clinical Practice Guidelines in Oncology http://www.nccn.org/professionals/physician_gls/recently_updated.asp This is the same guideline I posted in August with a hostile response. Are you having second thoughts now? http://tinyurl.com/f4o9j > This is the same guideline I posted in August with a hostile response. > Are you having second thoughts now? > > http://tinyurl.com/f4o9j It didn't look the same to me. Sorry. Marsha Sorry, I posted J link to my orginal posting, http://tinyurl.com/mufw4 Since imitation is the best form of flattery, I take no offense, just question the change of heart. Alex > > This is the same guideline I posted in August with a hostile response. > > Are you having second thoughts now? [quoted text clipped - 3 lines] > It didn't look the same to me. Sorry. > Marsha > http://www.nccn.org/professionals/physician_gls/f_guidelines.asp > NCCN Clinical Practice Guidelines in OncologyT Table of Contents > and > Recently updated NCCN Clinical Practice Guidelines in OncologyT > http://www.nccn.org/professionals/physician_gls/recently_updated.asp Just a word of warning. Many of these guidelines are either non-evidence based, or fly in the face of the evidence. That's not necessarily a criticism, as most "guidelines" have those problems. Many of these really only have validity for the US context Just about the most evidence-based guidelines which exist, and are very regular reviewed and updated are at http://www.bccancer.bc.ca/HPI/CancerManagementGuidelines/default.htm > "J" <macyinno@nospam.inv> wrote in message > > http://www.nccn.org/professionals/physician_gls/f_guidelines.asp [quoted text clipped - 11 lines] > regular reviewed and updated are at > http://www.bccancer.bc.ca/HPI/CancerManagementGuidelines/default.htm Yes, well, I was hope that PL would see that for glioblastoma they suggest RT ± concurrent and adjuvant temozolomide Age < 70 y Good performance status (or clinical trials), which is basically what we've been telling him. Now we're stuck in clinical trials. What do you make of (or conlude from or know about) this, please? J FDA Expedites Approval for Novel Treatment of Glioblastoma Multiforme http://patient.cancerconsultants.com/brain_cancer_news.aspx?id=17064 The average duration of survival following treatment for these patients was one year, compared to 9 months for patients who did not receive RSR13. Additionally, this treatment was well tolerated in these patients. The significant improvement in survival of patients plus tolerability of treatment has lead the National Cancer Institute to immediately begin the last phase of clinical trials evaluating RSR13 plus cranial radiation for treatment of newly diagnosed glioblastoma multiforme. If the results from this trial prove to be positive, the FDA will expedite its usual process for approval in order to make RSR13 more quickly available for clinical use. http://www.jco.org/cgi/content/abstract/20/14/3149 The objectives of this phase II study were to determine survival, safety, pharmacokinetics (PK), and pharmacodynamics (PD) of 2,4-[[(3,5-dimethylanilino)carbonyl]methyl]phenoxy]-2-methylpropionic acid (RSR13, efaproxiral) 100 mg/kg per day administered with standard cranial radiotherapy (RT) for the treatment of glioblastoma multiforme (GBM). RSR13, a synthetic allosteric modifier of hemoglobin, is a radiation-enhancing agent that noncovalently binds to hemoglobin, reduces oxygen-binding affinity, and increases oxygen unloading to hypoxic tissue. PATIENTS AND METHODS: Fifty patients with newly diagnosed GBM (Karnofsky performance status >= 60) were enrolled onto this multicenter phase II study. Patients received daily RSR13 100 mg/kg intravenously infused for 30 minutes immediately before cranial RT (60 Gy in 30 fractions). Supplemental oxygen was given during RSR13 infusion and continued until after the RT treatment was completed. RT was given within 30 minutes of the end of RSR13 infusion. PK and PD determinations were performed. RESULTS: The median survival for the RSR13-treated patients was 12.3 months with 1-year and 18-month survival rates of 54% and 24%, respectively. Twenty-four percent of patients had greater than grade 2 toxicity, which was generally transient and self-limited. A significant PD effect on hemoglobin-oxygen binding affinity was demonstrated for most patients. CONCLUSION: RSR13 (100 mg/kg) administered immediately before cranial RT is well tolerated and is pharmacodynamically active. Median survival in excess of 1 year is favorable. >From NCCN"The National Comprehensive Cancer Network is an alliance of 20 of the world's leading cancer centers, working together to develop treatment guidelines for most cancers, and dedicated to research that improves the quality, effectiveness and efficiency of cancer care. NCCN offers a number of programs to help you and your family make informed decisions about your health" The list of participating hospitals The NCCN member institutions are: City of Hope Cancer Center, Los Angeles, CA Dana-Farber/Partners CancerCare, Boston, MA Duke Comprehensive Cancer Center, Durham, NC Fox Chase Cancer Center, Philadelphia, PA Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance, Seattle, WA Arthur G. James Cancer Hospital and Richard J. Solove Research Institute at The Ohio State University, Columbus, OH The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL Memorial Sloan-Kettering Cancer Center, New York, NY H. Lee Moffitt Cancer Center & Research Institute at the University of South Florida, Tampa, FL Roswell Park Cancer Institute, Buffalo, NY Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO St. Jude Children's Research Hospital/University of Tennessee Cancer Institute, Memphis, TN Stanford Comprehensive Cancer Center, Stanford, CA University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL UCSF Comprehensive Cancer Center, San Francisco, CA University of Michigan Comprehensive Cancer Center, Ann Arbor, MI UNMC Eppley Cancer Center at The Nebraska Medical Center, Omaha, NE The University of Texas M. D. Anderson Cancer Center, Houston, TX. Are you saying that these institutions do not provide evidence bases medicine? > >From NCCN"The National Comprehensive Cancer Network is an alliance of > 20 of the world's leading cancer centers, working together to develop [quoted text clipped - 38 lines] > Are you saying that these institutions do not provide evidence bases > medicine? I'm telling you: 1) Any organisation which claims to consist of "20 of the world's leading cancer centres", and only includes US centres, has to have a rather inflated opinion of itself 2) The guidelines they produce are based on many things. But evidence is only one of them, and sometimes it's not very prominent. For example, based on several large clinical trials with many thousands of patients, it's clear to the rest of the world that the optimal management of operable rectal cancer is five days of preop radiotherapy alone, followed by total mesorectal excision surgery, followed IN SELECTED PATIENTS by post op chemo. That isn't in the US guidelines. However preoperative chemotherapy/radiotherapy which is much more complex, toxic, time-consuming and expensive than short course RT alone, is in the guidelines, and there is not a single good clinical trial to support that assertion. As I said, it wasn't necessarily a criticism, as most guidelines are a mix of fact and opinion. But don't be lulled into thinking that just because guidelines come out of a group like the one you quoted, they are necessarily evidence-based. They often are not. 1) Any organisation which claims to consist of "20 of the world's leading > cancer centres", and only includes US centres, has to have a rather inflated > opinion of itself If the guidelines were titles, Cancer Treatment Guidelines or the World's Cancer Treatment guidelines I would agree with you 100%. This is labeled US Treatment Guidelines, my interpretation is that is written for people seeking treatment in the US. As far as stating World's Leading institutions, my understanding that when a center has a large international population and sought byas resource by international physicians the center earns that right. That is a very measurable, X percentage of international patients, number of hits from international origin on the web site, the requests for information for foreign medical centers, the number of international doctors who attend conferences, the number of international health care team members requesting site visits. It is not excluding other non US cancer centers but considering this is a US Guideline I don't think this is excessive bravado but of course this is my opinion not fact. >> 2) The guidelines they produce are based on many things. But evidence is > only one of them, and sometimes it's not very prominent. Medicine is often refer as an art and science. These guidelines are not listed as evidenced based, but if you review an individual guideline they do list the evidence used to support the guidelines.Guidelines will list the level of supporting research which can be extensive to non existent. There is a table which clearly states the level of consensus which is based on the level of evidence, NCCN Categories of Consensus- NCCN Overview Categories of Consensus All recommendations are category 2A unless otherwise noted Category 1 There is uniform NCCN consensus, based on high-level evidence, that the recommendation is appropriate. Category 2AThere is uniform NCCN consensus, based on lower level evidence including clinical experience, that the recommendation is appropriate Category 2B There is nonuniform NCCN consensus (but no major disagreement), based on lower-level evidence including clinical experience, that the recommendation is appropriate Category 3 There is major NCCN disagreement that the recommendation is appropriate > 1) Any organisation which claims to consist of "20 of the world's > leading [quoted text clipped - 6 lines] > is labeled US Treatment Guidelines, my interpretation is that is > written for people seeking treatment in the US. Read the original post - it was the NCCN making that claim about "the world's leading centres" - take it up with them > As far as stating World's Leading institutions, my understanding that > when a center has a large international population and sought byas [quoted text clipped - 35 lines] > Category 3 There is major NCCN disagreement that the > recommendation is appropriate The evidence supporting short-course preop RT and TME surgery for operable rectal cancer is LEVEL 1 evidence, and about as level one as it gets.......... Do they ignore level 1 evidence? Unless it comes out of the US, I guess. 1) Any organisation which claims to consist of "20 of the world's leading > cancer centres", and only includes US centres, has to have a rather inflated > opinion of itself I see many of these US institutions have recieved the Nobel Medicine prize, and have Nobel Laureates, in my opinion this is one factor making them world class. The Nobel foundation is located in Sweden and an international prize. I only see 2 Canadian Medical winners, one recieving the prize for his American work. The other being, 1923 Medicine Laureates:and Dr John James Richard Macleod for the discovery of Insulin , interesting Sir Frederick Grant Banting was from England. http://nobelprize.org/nobel_prizes/medicine/laureates/index.html If the guidelines were titles, Cancer Treatment Guidelines or the World's Cancer Treatment guidelines I would agree with you 100%. This is labeled US Treatment Guidelines, my interpretation is that is written for people seeking treatment in the US. As far as stating World's Leading institutions, my understanding that when a center has a large international population and sought byas resource by international physicians the center earns that right. That is a very measurable, X percentage of international patients, number of hits from international origin on the web site, the requests for information for foreign medical centers, the number of international doctors who attend conferences, the number of international health care team members requesting site visits. It is not excluding other non US cancer centers but considering this is a US Guideline I don't think this is excessive bravado but of course this is my opinion not fact. >> 2) The guidelines they produce are based on many things. But evidence is > only one of them, and sometimes it's not very prominent. Medicine is often refer as an art and science. These guidelines are not listed as evidenced based, but if you review an individual guideline they do list the evidence used to support the guidelines.Guidelines will list the level of supporting research which can be extensive to non existent. There is a table which clearly states the level of consensus which is based on the level of evidence, NCCN Categories of Consensus- NCCN Overview Categories of Consensus All recommendations are category 2A unless otherwise noted Category 1 There is uniform NCCN consensus, based on high-level evidence, that the recommendation is appropriate. Category 2AThere is uniform NCCN consensus, based on lower level evidence including clinical experience, that the recommendation is appropriate Category 2B There is nonuniform NCCN consensus (but no major disagreement), based on lower-level evidence including clinical experience, that the recommendation is appropriate Category 3 There is major NCCN disagreement that the recommendation is appropriate > > >From NCCN"The National Comprehensive Cancer Network is an alliance of > > 20 of the world's leading cancer centers, working together to develop [quoted text clipped - 58 lines] > guidelines come out of a group like the one you quoted, they are necessarily > evidence-based. They often are not. > 1) Any organisation which claims to consist of "20 of the world's > leading [quoted text clipped - 17 lines] > is labeled US Treatment Guidelines, my interpretation is that is > written for people seeking treatment in the US. You are the one who posted the quote from them about "20 of the world's leading cancer centres." See my reply to your post under your "other" name........... |
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