Browsing by Subject "treatment modalities"

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A Review of Dendritic Cell Vaccines in Cancer Treatment and a Managerial Focus on Issues Related to Subject Recruitment
(2006-12-01) McFarlin, Tory; Arredondo, LaChelle; Gwirtz, Patricia A.; Oglesby, Michael
McFarlin, Tory. A Review of Dendritic Cell Vaccines in Cancer Treatment and a Managerial Focus on Issues Related to Subject Recruitment. Master of Science (Clinical Research Management), December 2006, 97 pp., 5 tables, bibliography, 24 titles. Melanoma is form of skin cancer that can become deadly if the cancer progresses to a stage of metastasis. Five year survival rates as low as 10% may be noted in such patients. Decarbazine and Proleukin have been approved by the FDA for the treatment of metastatic melanoma; however both have response rates of approximately 20% or less. New treatment modalities including dendritic cell (DC) vaccines are currently being tested for treating metastatic melanoma with greater safety and efficacy profiles. DC vaccines are made by obtaining a subject’s DCs, priming them with melanoma antigen ex vivo and then injecting them into the patient to initiate an immune response against melanoma tumor cells in vivo. Investigational new treatments such has the DC vaccine must first be tested in clinical trials on research subjects. Subject enrollment issues regarding such a trial can cause delays in advances of the treatment. As an intern with a DC vaccine clinical trial, the author assisted in screening 45 patients and observed many hindrances involving enrollment of subjects. Such hindrances include: low rates of study personnel retention, small patient pools, and competing trials. Recommendations to improve enrollment include: more effective advertisement strategies and increased patient education.
A Study to Determine Improved Compliance of Biophosphonate Treatment in Subjects with Osteoporosis
(2005-02-01) Enard, April T.; Gwirtz, Patricia A.; Jimenez-Williams, Cynthia; Rubin, Bernard
Enard, April T. A Study to Determine Improved Compliance of Bisphosphonate Treatment in Subjects with Osteoporosis. Master of Science, February 11, 2005. The ability of patients to adhere to treatment regimens is very poor and continues to impede optimal therapy of osteoporosis. The shortcomings in treating osteoporosis are: a) noncompliance and/or lack of continued persistence of therapy, b) efficacy of therapy on bone turnover marker levels and fracture prevalence, and c) tolerability of therapy to patients. Studies have shown that interventions such as education and awareness of bone mineral density promote patient usage compliance. The slightest improvement in compliance allows further understanding of accurate efficacy of medication therapy to fractures, bone marker levels, and overall improvement of bone mass. Increased compliance/persistence allows accurate comparison of bisphosphonates to one another for effectiveness on osteoporosis patients and allows improvement opportunity in treatment modalities that can positively influence the course of osteoporosis. This phase IV study targets compliancy/persistence in bisphosphonate therapy in treatment of osteoporosis.
RENAL CELL CARCINOMA WITH INVASION INTO THE RENAL VEIN
(2013-04-12) Tollemache, Julie
Purpose: The purpose of this case presentation is to provide an example of a complex scenario involving renal cell carcinoma invasion into the renal vein. By reviewing research and guidelines surrounding diagnosis, staging and treatment of renal cell carcinoma, the probable outcomes of this case can be addressed. Methods: Medical records were reviewed in order to detail the history, physical exam, surgical intervention, pathology, histology, and staging for a patient with renal cell carcinoma. Results: A 60 year old male presented to urology for follow-up from a recent trip to the emergency department where he was evaluated for gross hematuria and urinary retention. The patient's past medical history was significant for hypertension and diabetes mellitus, type II. Family history was significant only for diabetes. One month later, the patient again presented to urology for follow-up from another visit to the emergency department where he was evaluated for the presence of blood clots in his urine, pain with urination, and chills. An abdominal CT scan revealed a 14 cm renal mass with invasion into the left renal vein to the area over the aorta. An MRI was ordered and an open radical nephrectomy was scheduled.The resected left renal mass was sent to pathology. The overall specimen dimensions were reported as 23.0 x 13.5 x 9.0 cm. Bisection of the kidney revealed a tumor mass with a variegated red-orange cut surface measuring 13.0 x 9.0 x 9.0 cm. Microscopic analysis of the tumor reveals a clear cell carcinoma with gross and microscopic invasion of the renal vein. Conclusions: Diagnosis of renal cell carcinoma is presumptively made based on radiologic imaging of a solid renal mass. Surgical resection tends to be the preferred method since this approach is both diagnostic and therapeutic. Since the 1960s, radical nephrectomy has been the procedure of choice when a study demonstrated a 5-year survival rate increase to 66% from 48% with simple nephrectomy.In the case presented, radiologic imaging revealed a single 13 cm tumor with renal vein invasion, but without lymph node involvement preoperatively classifying it as Stage III. Due to the stage and size of the tumor, absence of evidence of metastatic disease, and stable health of the patient, radical nephrectomy was chosen as the treatment modality.In the case presented, both the high stage and especially the presence of venous invasion are poor prognostic indicators. However, the apparent lack of nodal involvement is favorable.