Recenti progressi in medicina最新文献

For many new oncological drugs, including target therapy and immunotherapy, the treatment should be continued as long as the patient is deriving clinical benefit from therapy or until unacceptable toxicity occurs. Drug survival or Time to treatment discontinuation (Ttd) or persistence have become important intermediate efficacy endpoints, especially in real-world settings due to their strong correlation with endpoints such as Time to treatment failure (Ttf) and Progression free survival (Pfs). Our methodology is based on validated indicators and information technology tools, to develop continuous and updated oncology drug utilization reports in hospital setting which include data about enrolment curves, Ttd, adherence, dose intensity, dose changes and budget impact. We present, as real-world example, the case of anti-EGFR in first line NSCLC. We analysed data of first and second generation drugs (afatinib, gefitinib, erlotinib) and the new third generation drug (osimertinib). Median Ttd and adherence as Proportion of days covered (Pdc) were respectively 11.6 versus 23.4 months and 0.92 versus 0.95.

Netaudit is a unique, voluntary network of general practitioners in Italy dedicated to conducting audits and research on their clinical practice. Unlike traditional academic research, Netaudit is driven by the grassroots efforts of primary care physicians. The project aims to provide practical tools and support for GPs seeking to improve their clinical practice through data-driven insights. Since its start in 2001, Netaudit has fostered a collaborative community of 150 Italian GPs who share a common interest in Audit and Evidence-based medicine. Members conduct a variety of audits, from monitoring laboratory results to evaluating medication use. Research findings are disseminated through the group's website and a dedicated journal. The project has faced challenges related to data standardization due to the diversity of electronic health record systems used by participating GPs. Despite these challenges, Netaudit has successfully conducted numerous audits over the past two decades, contributing to the evidence base for primary care in Italy. Netaudit has demonstrated the value of peer-led research in improving the quality of care. By empowering GPs to conduct their own research, the project has fostered a culture of continuous learning and quality improvement. Moreover, Netaudit has played a pivotal role in advocating for the academic recognition of general practice in Italy.

IFO'S communication campaign for the Italian Lung Screening Network (RISP) study, used multiple online and offline channels to engage not only smokers but a diverse audience. Out-reach activities and lifelong learning helped to promote healthy lifestyles, research findings and precision medicine. The campaign has increased the enrollment in the screening program, which in IFO, two years after 'start-up, is 3300. The pilot study targets smokers and former smokers aged 55 to 75, for prevention and early detection of lung cancer. Funded by the Ministry of Health, it involves 19 Italian centers to enroll 10,000 people. The ultimate goal is the inclusion of lung screening in the Essential Levels of Care (LEA) that is, the services that the National Health Service is required to provide to all citizens, free of charge. Subjects involved perform multilayer low-dose CT scan of the chest and blood sampling with liquid biopsy. The success of the campaign rewards the communication strategy, multidisciplinary collaboration, and activities always in synergy with the mission of the IFOs committed to: "spreading" clinical excellence; promoting citizen empowerment; considering correct information an institutional duty because it is part of treatment and prevention.

This study explores the potential use of ChatGPT, an AI-based language model, in assessing herbal-drug interactions (HDi) to enhance clinical decision-making. HDi can pose significant health risks by reducing drug efficacy or causing unwanted side effects. Clinical pharmacists play a key role in identifying these HDIs, and currently, there are limited tools available for checking drug interactions. The research focuses on a case study of a rectal adenocarcinoma patient treated with capecitabine and 26 supplements, which contain a total of 80 herbal substances. ChatGPT 3.5 was asked three questions regarding potential HDIs: "Are there possible HDIs?", "What is the pharmacokinetic mechanism?", and "What is the bibliographic source of the interaction?". The results were reviewed by an oncology clinical pharmacist and compared to existing databases and independent bibliographic research. The findings highlight ChatGPT's advantage in processing large amounts of data quickly, with 16% of interactions classified as "unlikely", confirmed by the pharmacist. However, 73% of the suggested mechanisms were false positives, and 4% were categorized as "hallucinations". Additionally, most of the bibliographic sources provided by ChatGPT were outdated or unavailable. While ChatGPT proves useful for initial HDI screening, its limitations include outdated data (last updated in January 2022), lack of access to private databases, and occasional inaccuracies. Further applications of AI in this area are recommended, though expert validation remains essential in the clinical decision-making process.

Triple negative breast cancer (TNBC) represents 15% of invasive breast cancer cases and is an aggressive subtype. Patients with metastatic TNBC have a poor prognosis. Efforts have been made to develop new therapeutic options and identify molecular biomarkers to improve overall survival and quality of life for TNBC patients. Immunotherapy has shown promising frontline clinical activity. To determine which patients will derive the most benefit from a combination of immune checkpoint inhibitors and chemotherapy in metastatic disease, it is essential to evaluate PD-L1 expression. Approximately 15% of TNBC patients have a germline mutation in BRCA1 and/or BRCA2, and for these patients, innovative therapeutic options such as olaparib and talazoparib, which are PARP inhibitors, are available. Sacituzumab govitecan (SG) is a humanized monoclonal antibody-drug conjugate directed against the surface antigen of human trophoblastic cells (Trop-2) expressed in approximately 90% of TNBC, coupled with SN-38, the active metabolite of irinotecan, a topoisomerase I inhibitor. Here, we present the case of a woman who was initially diagnosed with localized luminal B breast cancer (ER-positive; HER2-negative) and was treated with curative therapy. However, she later experienced a recurrence with metastatic TNBC (ER-negative/HER2-negative) and received treatment with sacituzumab govitecan, which resulted in prolonged disease control.