Senin, 22 Desember 2014


 Berikut merupakan kutipan ilmiah kedokteran yang sangat bermanfaat sehingga disusun dan digunakan sebagai referensi pribadi.

Perpustakaan Keluarga Helmut T. T. Simamora, M.Si dan dr. Olga Y.V Hutapea

The U.S. Food and Drug Administration has approved a new drug to treat advanced ovarian cancer, along with a test to identify patients eligible to receive the drug.
Lynparza (olaparib) belongs to a new class of drugs called poly ADP-ribose polymerase (PARP) inhibitors. The drug is for women who have already received extensive treatment for advanced ovarian cancer associated with defective BRCA genes, according to an FDA news release issued Friday.
"Today's approval constitutes the first of a new class of drugs for treating ovarian cancer," Dr. Richard Pazdur, director of the Office of Hematology and Oncology Products in the FDA's Center for Drug Evaluation and Research, said in the news release.
"Lynparza is approved for patients with specific abnormalities in the BRCA gene and is an example of how a greater understanding of the underlying mechanisms of disease can lead to targeted, more personalized treatment," he said.
Approval of the AstraZeneca drug was based on a clinical trial of almost 140 women with BRCA mutation-associated ovarian cancer. Thirty-four percent of the patients on the drug had partial shrinkage or complete disappearance of their tumors for an average of eight months, the FDA reported.
Nausea, fatigue, vomiting, diarrhea, headache, decreased appetite, joint and muscle pain, and cold-like symptoms were common side effects of the drug. More serious side effects included lung inflammation; the bone marrow cancer acute myeloid leukemia; and myelodysplastic syndrome, a condition where the bone marrow is unable to produce enough functioning blood cells, the FDA said.
Women must undergo a genetic test to confirm BRCA gene mutations before they can be treated with Lynparza. The test to confirm those genes was approved by the FDA in conjunction with the drug.
BRCA genes play a role in repairing damaged DNA. Normally, they work to suppress tumor growth. Women with mutations that cause defective BRCA genes have an increased risk for ovarian and breast cancer. It's believed that 10 to 15 percent of all ovarian cancer is associated with these mutations, the FDA said.
In 2014, nearly 22,000 American women will be diagnosed with ovarian cancer and more than 14,000 will die from the disease, according to the U.S. National Cancer Institute.
Tiredness happens to everyone -- it is an expected feeling after certain activities or at the end of the day. Usually, you know why you are tired and a good night's sleep solves the problem.
Fatigue, in contrast to tiredness, is a daily lack of energy, an unusual or excessive whole-body tiredness not relieved by sleep. It can be acute (lasting a month or less) or chronic (lasting from one month to six months or longer). Fatigue can prevent a person from functioning normally and impacts a person's quality of life.

What Is Cancer-Related Fatigue?

Fatigue is one of the most common side effects of cancer and its treatment. It is not predictable by tumor type, treatment, or stage of illness. Usually, it comes on suddenly, does not result from activity or exertion, and is not relieved by rest or sleep. It often is described as "paralyzing." It may continue even after treatment is complete.

What Causes Cancer-Related Fatigue?

The exact reason is unknown. Cancer-related fatigue may be related to the disease process or its treatments.
Cancer treatments commonly associated with fatigue include:
  • Chemotherapy. Any chemotherapy drug may cause fatigue. Patients frequently experience fatigue after several weeks of chemotherapy, but this varies among patients. In some patients, fatigue lasts a few days, while in others, it persists throughout and after the treatment is complete.
  • Radiation therapy. Radiation therapy can cause cumulative fatigue (fatigue that increases over time). This can occur regardless of the treatment site. Fatigue usually lasts from three to four weeks after treatment stops, but can continue for up to two to three months.
  • Bone marrow transplantation. This aggressive form of treatment can cause fatigue that lasts up to one year.
  • Biological therapy. Interferons and interleukins are cytokines, natural cell proteins that are normally released by white blood cells in response to infection. These cytokines carry messages that regulate other elements of the immune and endocrine systems. In high amounts, these cytokines can be toxic and lead to persistent fatigue.
  • Combination or sequential therapy. More than one cancer treatment at the same time or one after the other increases the chances of developing fatigue.

More people in high risk groups should have their DNA tested for breast cancer risk genes, a cancer charity says.
Mutations in BRCA genes can give women up to an 80% chance of developing breast cancer.
A trial involving 1,034 Ashkenazi Jews, who are at high risk, suggested more than half of their cases were not being picked up under the current NHS guidelines.
The Eve Appeal charity said wider testing would save lives and money.
Mutations in BRCA genes stop DNA repairing itself and increase the risk of cancer developing.
As well as breast cancer, they are also linked to ovarian and prostate cancers.
More likely
Around one in 800 people carry a BRCA mutation. But in the Ashkenazi Jewish population the figure reaches one in 40.
The research team, based at University College London and the University of Manchester, compared the effectiveness of screening all Ashkenazi Jews with just screening those who were identified as being at risk because of their family history.
They showed that 56% of those carrying a mutation would not have had a test for BRCA based on family history alone.
The findings, published in the Journal of the National Cancer Institute, show extra screening could save lives and money.

Breast cancer
Can more cases of cancer be prevented?
There are an estimated 114,400 Ashkenazi Jewish women in the UK.
A separate analysis showed screening all of them over the age of 30 would lead to "a reduction in ovarian cancer and breast cancer by 276 and 508 cases, respectively, at a discounted cost savings of £3.7m."
Prof Ian Jacobs, one of the researchers at the University of Manchester, said: "For the Ashkenazi Jewish community specifically, this suggests that population testing for BRCA1/2 mutations could save lives."
He told the BBC: "This can save lives and money, why wouldn't the NHS want to do something that could achieve both objectives.
"But the NHS does need to do its own proper evaluation."
The cost of this kind of screening, both for BRCA and other risk genes, is plummeting.
The NHS will eventually have to deal with questions about screening the whole population.
"No-one is suggesting we test the entire UK population for BRCA right now," Prof Ian Jacobs told the BBC.
He added: "Broadly I think we need to do a lot more research on the consequences, good and bad, of this sort of testing in broader populations.
The costs of course would be much higher because the prevalence of the mutations is much lower."
Athena Lamnisos, from The Eve Appeal which funded the trial, said: "Women at increased risk of cancer deserve far more than today's genetic screening process gives them.
"This study shows that broadening genetic testing beyond just family history saves more lives and more money."

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