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With New Options for the Treatment of Cervical Cancer, Considering Individual Patient Characteristics is Essential – Pharmacy Times

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The death rate from cervical cancer has dropped by more than 50% since 1975.

Carefully considering patients’ individual needs and disease characteristics is essential when selecting a therapeutic regimen, according to an expert panel at the Society of Gynecologic Cancers 2022 Annual Meeting on Women’s Cancer.

The FDA approved 2 new agents for cervical cancer in 2021, a number that moderator Bradley Monk, MD, FACS, FACOG, said was “unprecedented.” In his 35 years working in the field, Monk said he has seen the treatment of cervical cancer progress significantly, with new data now emerging consistently.

Similar to the COVID-19 pandemic, Monk said it is essential to educate patients on the importance of prevention and testing for human papillomavirus (HPV) because it can cause cervical cancer.

“If COVID has taught us anything, it’s that if you don’t get vaccinated, you might die,” Monk said in the presentation. “And that’s the same with HPV.”

Monk noted that the death rate from cervical cancer has dropped by more than 50% since 1975. Between 2007 and 2016, in fact, the death rate decreased by about 1% each year in women 50 years of age and older but remained stable in women younger than 50 years of age.

Monk also emphasized the importance of testing for programmed death-ligand 1 (PD-L1) expression in patients with cervical cancer but said that this expression is not a single entity. To make educated decisions about treatment, it is essential to know the antibody and scoring method, as well as the threshold.

“You cannot make a statement about PD-L1 testing unless you say the method, the threshold, and the antibody,” Monk said.

Next, panelist Krishnansu Tewari, MD, discussed a case presentation of first-line therapy options. In the case, a 42-year-old Caucasian woman with 3 young children presented with pelvic discomfort and cough. Scans found right paracolic gutter disease, which Tewari said probably contributed to her discomfort, as well as hilar adenopathy and supraclavicular adenopathy. The patient had been diagnosed with stage IIIc squamous cell carcinoma of the cervix 2 years previously.

Neither stereotactic radiosurgery nor pelvic exenteration would be appropriate for this patient based on her tumor burden and the fact that she had disease outside of the pelvis. Based on this, Tewari said systemic treatment would be best, potentially including chemotherapy, anti-angiogenesis therapy, or immunotherapy.

Tewari reviewed some data around chemotherapy, including the 2009 GOG-0204 study, which established cisplatin and paclitaxel as the chemotherapy palliative standard for women with metastatic cervical cancer. The JCOG-0505 study then established non-inferiority of carboplatin among patients who were previously treated with cisplatin. Therefore, the patient received carboplatin plus paclitaxel until progression.

“Those two studies, I think, are critical in helping us determine how we’re going to treat this patient moving forward,” Tewari said.

Tewari then discussed anti-angiogenesis therapy with bevacizumab, the use of which is based on clinical, pathologic, therapeutic, and molecular rationale. The GOG-0240 study found significant improvements in overall survival (OS) and progression-free survival with the addition of bevacizumab to chemotherapy. Based on these findings, in August of 2014, bevacizumab became the first targeted agent approved in gynecologic cancer. Tewari said the patient received bevacizumab in addition to her chemotherapy regimen.

Tewari also discussed the use of immunotherapy. KEYNOTE-826 was a confirmatory trial looking at the efficacy and tolerability of a chemotherapy doublet, bevacizumab, and pembrolizumab, compared with the chemotherapy doublet with or without bevacizumab. In the intent-to-treat population, researchers found that the hazard ratio for disease progression or death was reduced by 35%, and it decreased by 38% in patients with a PD-L1 combined positive score of 1 or greater.

Notably, Tewari pointed out that pembrolizumab took just 113 days to receive FDA approval. Based on these data and the patient’s combined positive score of 20, she then received the chemotherapy double, bevacizumab, and pembrolizumab. She received 3 cycles of this quadruplet therapy.

Finally, presenter Shannon Westin, MD, MPH, FACOG, discussed second-line options for patients with cervical cancer. In her case study, a 52-year-old patient with stage IV grade 3 squamous cell carcinoma of the cervix had previously received 6 cycles of paclitaxel, cisplatin, and bevacizumab and had evidence of near complete response. At 6 months, she noted moderate abdominal pain and imaging found recurrent peritoneal carcinomatosis, liver lesions, and omental and diaphragmatic disease. The tumor was PD-L1 positive.

Like Tewari, Westin reviewed the rationale for pembrolizumab in the second-line setting. The KEYNOTE-028 trial investigated single-agent pembrolizumab in advanced or recurrent disease and found a positive response rate, which was subsequently confirmed in the KEYNOTE-158 study. This 14% confirmatory response rate allowed for pembrolizumab to receive FDA approval for the treatment of PD-L1 positive recurrent or metastatic cervical cancer, in addition to a subsequent approval for a 6-week dosing strategy.

The EMPOWER study investigated cemiplimab with a primary endpoint of OS and found improved OS with a median of 12 months in the treatment arm. Westin did point out that it is difficult to know whether this treatment definitively does not work in a PD-L1-negative population because approximately 40% of patients in the trial had not received this testing.

The benefit of cemiplimab was also consistent, particularly across patients with prior bevacizumab treatment. An improved response rate was seen across the board, with a 16% response rate.

Most importantly, Westin noted that patients treated with cemiplimab had improved global health score/quality of life. Patients reported improved fatigue, nausea, vomiting, pain, insomnia, appetite loss, and constipation, and all of these symptoms factored the use of cemiplimab over clinician’s choice of chemotherapy.

“Obviously we want patients to live longer, it’s about survival,” Westin said. “But this is good survival.”

Based on these data, the patient in Westin’s case study started on pembrolizumab and noted increased cough and shortness of breath at 6 months. She was diagnosed with grade 2 pneumonitis, which Westin said was treated by withholding pembrolizumab and administering low-dose corticosteroids. Considering re-dosing would be appropriate with a grade 2 immune-related adverse event.

REFERENCE

Monk B, Tewari K, Westin S. The Afternoon in Gyn Onc: The Evolution of Cervical Cancer. Presented at Society of Gynecologic Oncology 2022 Annual Meeting on Women’s Cancer. March 19, 2022.

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What’s the greatest holiday gift: lips, hair, skin? Give the gift of great skin this holiday season

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Give the gift of great skin this holiday season

Skinstitut Holiday Gift Kits take the stress out of gifting

Toronto, October 31, 2024 – Beauty gifts are at the top of holiday wish lists this year, and Laser Clinics Canada, a leader in advanced beauty treatments and skincare, is taking the pressure out of seasonal shopping. Today, Laser Clincs Canada announces the arrival of its 2024 Holiday Gift Kits, courtesy of Skinstitut, the exclusive skincare line of Laser Clinics Group.

In time for the busy shopping season, the limited-edition Holiday Gifts Kits are available in Laser Clinics locations in the GTA and Ottawa. Clinics are conveniently located in popular shopping centers, including Hillcrest Mall, Square One, CF Sherway Gardens, Scarborough Town Centre, Rideau Centre, Union Station and CF Markville. These limited-edition Kits are available on a first come, first served basis.

“These kits combine our best-selling products, bundled to address the most relevant skin concerns we’re seeing among our clients,” says Christina Ho, Senior Brand & LAM Manager at Laser Clinics Canada. “With several price points available, the kits offer excellent value and suit a variety of gift-giving needs, from those new to cosmeceuticals to those looking to level up their skincare routine. What’s more, these kits are priced with a savings of up to 33 per cent so gift givers can save during the holiday season.

There are two kits to select from, each designed to address key skin concerns and each with a unique theme — Brightening Basics and Hydration Heroes.

Brightening Basics is a mix of everyday essentials for glowing skin for all skin types. The bundle comes in a sleek pink, reusable case and includes three full-sized products: 200ml gentle cleanser, 50ml Moisture Defence (normal skin) and 30ml1% Hyaluronic Complex Serum. The Brightening Basics kit is available at $129, a saving of 33 per cent.

Hydration Heroes is a mix of hydration essentials and active heroes that cater to a wide variety of clients. A perfect stocking stuffer, this bundle includes four deluxe products: Moisture 15 15 ml Defence for normal skin, 10 ml 1% Hyaluronic Complex Serum, 10 ml Retinol Serum and 50 ml Expert Squalane Cleansing Oil. The kit retails at $59.

In addition to the 2024 Holiday Gifts Kits, gift givers can easily add a Laser Clinic Canada gift card to the mix. Offering flexibility, recipients can choose from a wide range of treatments offered by Laser Clinics Canada, or they can expand their collection of exclusive Skinstitut products.

 

Brightening Basics 2024 Holiday Gift Kit by Skinstitut, available exclusively at Laser Clincs Canada clinics and online at skinstitut.ca.

Hydration Heroes 2024 Holiday Gift Kit by Skinstitut – available exclusively at Laser Clincs Canada clinics and online at skinstitut.ca.

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Here is how to prepare your online accounts for when you die

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LONDON (AP) — Most people have accumulated a pile of data — selfies, emails, videos and more — on their social media and digital accounts over their lifetimes. What happens to it when we die?

It’s wise to draft a will spelling out who inherits your physical assets after you’re gone, but don’t forget to take care of your digital estate too. Friends and family might treasure files and posts you’ve left behind, but they could get lost in digital purgatory after you pass away unless you take some simple steps.

Here’s how you can prepare your digital life for your survivors:

Apple

The iPhone maker lets you nominate a “ legacy contact ” who can access your Apple account’s data after you die. The company says it’s a secure way to give trusted people access to photos, files and messages. To set it up you’ll need an Apple device with a fairly recent operating system — iPhones and iPads need iOS or iPadOS 15.2 and MacBooks needs macOS Monterey 12.1.

For iPhones, go to settings, tap Sign-in & Security and then Legacy Contact. You can name one or more people, and they don’t need an Apple ID or device.

You’ll have to share an access key with your contact. It can be a digital version sent electronically, or you can print a copy or save it as a screenshot or PDF.

Take note that there are some types of files you won’t be able to pass on — including digital rights-protected music, movies and passwords stored in Apple’s password manager. Legacy contacts can only access a deceased user’s account for three years before Apple deletes the account.

Google

Google takes a different approach with its Inactive Account Manager, which allows you to share your data with someone if it notices that you’ve stopped using your account.

When setting it up, you need to decide how long Google should wait — from three to 18 months — before considering your account inactive. Once that time is up, Google can notify up to 10 people.

You can write a message informing them you’ve stopped using the account, and, optionally, include a link to download your data. You can choose what types of data they can access — including emails, photos, calendar entries and YouTube videos.

There’s also an option to automatically delete your account after three months of inactivity, so your contacts will have to download any data before that deadline.

Facebook and Instagram

Some social media platforms can preserve accounts for people who have died so that friends and family can honor their memories.

When users of Facebook or Instagram die, parent company Meta says it can memorialize the account if it gets a “valid request” from a friend or family member. Requests can be submitted through an online form.

The social media company strongly recommends Facebook users add a legacy contact to look after their memorial accounts. Legacy contacts can do things like respond to new friend requests and update pinned posts, but they can’t read private messages or remove or alter previous posts. You can only choose one person, who also has to have a Facebook account.

You can also ask Facebook or Instagram to delete a deceased user’s account if you’re a close family member or an executor. You’ll need to send in documents like a death certificate.

TikTok

The video-sharing platform says that if a user has died, people can submit a request to memorialize the account through the settings menu. Go to the Report a Problem section, then Account and profile, then Manage account, where you can report a deceased user.

Once an account has been memorialized, it will be labeled “Remembering.” No one will be able to log into the account, which prevents anyone from editing the profile or using the account to post new content or send messages.

X

It’s not possible to nominate a legacy contact on Elon Musk’s social media site. But family members or an authorized person can submit a request to deactivate a deceased user’s account.

Passwords

Besides the major online services, you’ll probably have dozens if not hundreds of other digital accounts that your survivors might need to access. You could just write all your login credentials down in a notebook and put it somewhere safe. But making a physical copy presents its own vulnerabilities. What if you lose track of it? What if someone finds it?

Instead, consider a password manager that has an emergency access feature. Password managers are digital vaults that you can use to store all your credentials. Some, like Keeper,Bitwarden and NordPass, allow users to nominate one or more trusted contacts who can access their keys in case of an emergency such as a death.

But there are a few catches: Those contacts also need to use the same password manager and you might have to pay for the service.

___

Is there a tech challenge you need help figuring out? Write to us at onetechtip@ap.org with your questions.

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Pediatric group says doctors should regularly screen kids for reading difficulties

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The Canadian Paediatric Society says doctors should regularly screen children for reading difficulties and dyslexia, calling low literacy a “serious public health concern” that can increase the risk of other problems including anxiety, low self-esteem and behavioural issues, with lifelong consequences.

New guidance issued Wednesday says family doctors, nurses, pediatricians and other medical professionals who care for school-aged kids are in a unique position to help struggling readers access educational and specialty supports, noting that identifying problems early couldhelp kids sooner — when it’s more effective — as well as reveal other possible learning or developmental issues.

The 10 recommendations include regular screening for kids aged four to seven, especially if they belong to groups at higher risk of low literacy, including newcomers to Canada, racialized Canadians and Indigenous Peoples. The society says this can be done in a two-to-three-minute office-based assessment.

Other tips encourage doctors to look for conditions often seen among poor readers such as attention-deficit hyperactivity disorder; to advocate for early literacy training for pediatric and family medicine residents; to liaise with schools on behalf of families seeking help; and to push provincial and territorial education ministries to integrate evidence-based phonics instruction into curriculums, starting in kindergarten.

Dr. Scott McLeod, one of the authors and chair of the society’s mental health and developmental disabilities committee, said a key goal is to catch kids who may be falling through the cracks and to better connect families to resources, including quicker targeted help from schools.

“Collaboration in this area is so key because we need to move away from the silos of: everything educational must exist within the educational portfolio,” McLeod said in an interview from Calgary, where he is a developmental pediatrician at Alberta Children’s Hospital.

“Reading, yes, it’s education, but it’s also health because we know that literacy impacts health. So I think that a statement like this opens the window to say: Yes, parents can come to their health-care provider to get advice, get recommendations, hopefully start a collaboration with school teachers.”

McLeod noted that pediatricians already look for signs of low literacy in young children by way of a commonly used tool known as the Rourke Baby Record, which offers a checklist of key topics, such as nutrition and developmental benchmarks, to cover in a well-child appointment.

But he said questions about reading could be “a standing item” in checkups and he hoped the society’s statement to medical professionals who care for children “enhances their confidence in being a strong advocate for the child” while spurring partnerships with others involved in a child’s life such as teachers and psychologists.

The guidance said pediatricians also play a key role in detecting and monitoring conditions that often coexist with difficulty reading such as attention-deficit hyperactivity disorder, but McLeod noted that getting such specific diagnoses typically involves a referral to a specialist, during which time a child continues to struggle.

He also acknowledged that some schools can be slow to act without a specific diagnosis from a specialist, and even then a child may end up on a wait list for school interventions.

“Evidence-based reading instruction shouldn’t have to wait for some of that access to specialized assessments to occur,” he said.

“My hope is that (by) having an existing statement or document written by the Canadian Paediatric Society … we’re able to skip a few steps or have some of the early interventions present,” he said.

McLeod added that obtaining specific assessments from medical specialists is “definitely beneficial and advantageous” to know where a child is at, “but having that sort of clear, thorough assessment shouldn’t be a barrier to intervention starting.”

McLeod said the society was partly spurred to act by 2022’s “Right to Read Inquiry Report” from the Ontario Human Rights Commission, which made 157 recommendations to address inequities related to reading instruction in that province.

He called the new guidelines “a big reminder” to pediatric providers, family doctors, school teachers and psychologists of the importance of literacy.

“Early identification of reading difficulty can truly change the trajectory of a child’s life.”

This report by The Canadian Press was first published Oct. 23, 2024.

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