Onkologinės ligos

Imetelstatas yra efektyvus mielofibrozės gydyme.

Nacionalinė Medikų Asociacija paskelbė 2015-09-04 03:23

Dviejų tyrimų išvadose, kurios publikuojamos žurnale New England Journal of Medicine, teigiama, kad imetelstatas yra efektyvus gydant mielofibrozę ir esencialinę trombocitemiją. Plačiau...


Vaizdas: http://www.medpagetoday.com/HematologyOncology/Myeloma/29018

Imetelstat Deemed Active in Myelofibrosis, Thrombocythemia

(HealthDay News) -- Imetelstat, a 13-mer lipid-conjugated oligonucleotide that targets the RNA template of human telomerase reverse transcriptase, is active in patients with myelofibrosis and essential thrombocythemia, according to two studies published in the Sept. 3 issue of the New England Journal of Medicine.

Ayalew Tefferi, M.D., from the Mayo Clinic in Rochester, Minn., and colleagues examined the therapeutic activity and safety of imetelstat in patients with high-risk or intermediate-risk myelofibrosis. Imetelstat was administered to 33 patients (median age, 67 years) as a two-hour intravenous infusion every one to three weeks. The researchers found that complete or partial remission occurred in 21 percent of patients. In all four patients who had a complete response, bone marrow fibrosis was reversed; a molecular response occurred in three patients. Among patients with versus without aJAK2 mutation, response rates were 27 versus 0 percent; response rates were 32 versus 0 percent for those without versus with an ASXL1 mutation.

Gabriela M. Baerlocher, M.D., from the University Hospital of Bern in Switzerland, and colleagues examined hematologic and molecular responses to imetelstat in 18 patients with essential thrombocythemia. The researchers found that in all 18 patients, imetelstat induced hematologic responses, and 89 percent of patients had a complete hematologic response. In seven of eight patients who were positive for the JAK2 V617F mutation, molecular responses were observed. There was a 15 to 66 percent reduction in CALR and MPL mutant allele burdens.

"Rapid and durable hematologic and molecular responses were observed in patients with essential thrombocythemia who received imetelstat," Baerlocher and colleagues write.

Both studies were funded by Geron, the manufacturer of imetelstat.

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H. pylori eradikacija mažina skrandžio vėžio riziką.

Nacionalinė Medikų Asociacija paskelbė 2015-07-27 04:21

Britanijos mokslininkai teigia, kad Helicobacter pylori sunaikinimas jokių simptomų nejaučiantiems asmenims mažina skrandžio vėžio riziką, rašoma internetiniame žurnale The Cochrane Library. Duomenys apibendrinti atlikus šešių tyrimų, kuriuose dalyvavo 6497 asmenys, metaanalizę. Plačiau...


Vaizdas: http://www.pyroenergen.com/articles13/stomach-cancer-pylori.htm

Review: Eradicating H. pylori Cuts Incidence of Gastric Cancer

(HealthDay News) -- Eradication of Helicobacter pylori in asymptomatic adults is associated with a reduction in the incidence of gastric cancer, according to a review published online July 22 in The Cochrane Library.

Alexander C. Ford, M.B., Ch.B., M.D., from St. James's University Hospital in Leeds, U.K., and colleagues examined the effectiveness of H. pylori eradication in healthy asymptomatic individuals in the general population in reducing the incidence of gastric cancer. Data were included from six trials (five in Asian populations) which compared at least one week of H. pylori therapy with placebo or no treatment in otherwise healthy and asymptomatic H. pylori-positive adults.

The researchers found that H. pylorieradication therapy was superior to placebo or no treatment for preventing development of subsequent gastric cancer (six trials, 6,497 participants; risk ratio, 0.66; 95 percent confidence interval, 0.46 to 0.95). Wide confidence intervals were seen on analysis of the effect of H. pylori eradication on preventing death from gastric cancer compared with placebo or no treatment (three trials, 4,475 participants; risk ratio, 0.67; 95 percent confidence interval, 0.40 to 1.11). No effect was seen on all-cause mortality (four trials; 5,253 participants; risk ratio, 1.09; 95 percent confidence interval, 0.86 to 1.38).

"We found limited, moderate-quality evidence that searching for and eradicating H. pylori reduces the incidence of gastric cancer in healthy asymptomatic infected Asian individuals, but we cannot necessarily extrapolate this data to other populations," the authors write.

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Didelės antibiotikų dozės mažina krešėjimą.

Nacionalinė Medikų Asociacija paskelbė 2015-07-16 01:48

Skiriant didelias dozes amoksicilino/klavulaninės rūgšties kartu su varfarinu padidėja kraujavimo rizika. Nustatyta, kad didelės dozės minėto vaistų derinio 87,5 proc. atvejų padidina INR ≥4, o normalios dozės - tik 28,9 proc., rašoma žurnale Journal of Clinical Pharmacology. Plačiau...


Vaizdas: https://www.healthtap.com/topics/period-after-lochia

High Doses of Antibiotic Ups Risk of Over-Anticoagulation

(HealthDay News) -- Among hospitalized patients, high-dose amoxicillin/clavulanate correlates with increased risk of over-anticoagulation when combined with warfarin, according to a study published online July 2 in the Journal of Clinical Pharmacology.

Mahmoud I. Abdel-Aziz, from Assiut University in Egypt, and colleagues conducted a cross-sectional observational study involving 120 hospitalized patients to examine the impact of polypharmacy and high doses of amoxicillin/clavulanate on warfarin response.

The researchers found that during hospital stay, international normalized ratio (INR) values ≥4 were seen for 87.5 percent of patients prescribed high-dose amoxicillin/clavulanate and 28.9 percent of those prescribed normal dose (P < 0.001). An elevated number of potentially interacting drugs known to increase INR significantly predicted having INR values ≥4 (odds ratio, 2.5). An elevated number of potentially interacting drugs known to increase bleeding risk was identified as a significant predictor of bleeding episodes (odds ratio, 3.1).

"High doses of amoxicillin/clavulanate were associated with a higher risk of over anticoagulation when combined with warfarin than normal doses," the authors write. "Frequent monitoring of warfarin therapy along with patient's medications is necessary to avoid complications."

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Atnaujintos rekomendacijos idiopatinės plaučių fibrozės gydymui.

Nacionalinė Medikų Asociacija paskelbė 2015-07-16 01:16

Atnaujintose rekomendacijose didžiausias griežtai pasisakoma prieš antikoaguliantų, imatinibo, endotelinių receptorių antagonistų vartojimą idiopatinės plaučių fibrozės gydyme. Rekomendacijos paskelbtos žurnale American Journal of Respiratory and Critical Care Medicine. Plačiau...


Vaizdas: https://www.youtube.com/watch?v=qF-JOcevqu4

Guidelines Updated for Idiopathic Pulmonary Fibrosis Treatment

Recommendations for idiopathic pulmonary fibrosis (IPF) treatment have been updated by an international group of respiratory societies. The updated clinical practice guideline was published in the July 15 issue of the American Journal of Respiratory and Critical Care Medicine.

Ganesh Raghu, M.D., from the University of Washington in Seattle, and colleagues conducted systematic reviews and meta-analyses to update guidelines on IPF treatment. All relevant available evidence was assessed and discussed by a multidisciplinary panel. Conflict-of-interest management strategies were applied and non-conflicted panelists formulated, wrote, and graded recommendations.

The authors developed recommendations for or against specific treatment interventions. Updated guidelines included strong treatment recommendations against the use of anticoagulation (warfarin); imatinib; combination prednisone, azathioprine, and N-acetylcysteine; and selective endothelin receptor antagonist (ambrisentan). Conditional recommendations were for the use of nintedanib and pirfenidone, and against the use of phosphodiesterase-5 inhibitor and dual endothelin receptor antagonists. Recommendations remaining unchanged from 2011 included conditional recommendations against the use of N-acetylcysteine monotherapy and for the use of anti-acid therapy.

"Our systematic review of the available evidence on IPF treatments points to the need for additional research and long-term studies of their safety and efficacy," Raghu said in a statement. "The guidelines empower the clinician to make the most appropriate treatment choices for the patient confronted with IPF and encourage shared decision-making with the well-informed patient to choose the most appropriate treatment options tailored to the individual patient's needs."

Several authors disclosed financial ties to the biopharmaceutical industry.

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Prenataliniai genetiniai testai gali nustatyti motinos vėžį.

Nacionalinė Medikų Asociacija paskelbė 2015-07-15 09:05

ATliekan prenatalinius testus galima diagnozuoti ne tik apsigimimus, bet ir motinos vėžinius susirgimus, rašoma žurnale Journal of American Medical Association.
Atlikus 125426 neinvazinių prenatalinių testų, nustatyta, kad 3757 testų rezultatai buvo teigiami - nustatyta vienas ar daugiau pakitimų penkiose skirtingose chromosomose, kurios susiję su apsigimimais. Vėliau iš šių teigiamų testų dešimčiai moterų nustatytas vėžys. Plačiau...


Vaizdas: http://www.orlandofamilymagazine.com/family-resources/health-and-wellness-archive/genetic-testing-and-pregnancy-is-it-necessary/

Prenatal Genetic Tests Can Identify Maternal Cancers

(HealthDay News) -- Abnormal results on noninvasive prenatal genetic tests may indicate maternal cancers rather than a medical issue with the fetus, according to research published online July 13 in the Journal of the American Medical Association.

Diana Bianchi, M.D., executive director of the Mother Infant Research Institute at Tufts Medical Center in Boston, and colleagues looked at 125,426 samples from women who had noninvasive prenatal testing (NIPT) between 2012 and 2014. Of that number, more than 3,757 had positive results for one or more abnormalities in five different chromosomes linked with birth defects. Later, 10 of these women were diagnosed with cancer.

The more fetal abnormalities the test picked up, the greater the likelihood that the pregnant woman had cancer, Bianchi found. Normally, the test may pick up one abnormality, she told HealthDay. "But seven of the 10 women had more than one," which is unusual. "If it's just a single abnormality, it's much less likely to be cancer," she said.

The chance that the abnormal NIPT result is due to cancer is small, Roberto Romero, M.D., D.Med.Sci., chief of the perinatology research branch at the U.S. National Institute of Child Health and Human Development of the National Institutes of Health, told HealthDay. He reviewed the findings and wrote an editorial to accompany the study. For women, the bottom line is that if the results of the blood test come back abnormal, they should next have a diagnostic test, such as amniocentesis, according to Romero. "An important message is that the NIPT is not a screening test for cancer during the pregnancy," he said.

Funding for the study was provided by Illumina, a company that makes a noninvasive prenatal test. Bianchi is a member of an advisory panel for Illumina.

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Kolektomija gali būti efektyvesnė nei medikamentinis opinio kolito gydymas.

Nacionalinė Medikų Asociacija paskelbė 2015-07-15 08:50

Atlikus palyginamąją analizę nustatyta, kad po penkiarių metų po operacinio opinio kolito gydymo, mirties rizika sumažėja 33 proc., palyginus su asmenims, kuriems buvo taikytas medikamentinis gydymas. Tyrime dalyvavo 830  asmenų, kuriems buvo atlikta kolektomija ir 7541asmuo, kuriems taikytas gydymas vaistais. Plačiau...


Vaizdas: https://www.healthtap.com/topics/colectomy-vs-colostomy

Colectomy May Beat Medical Therapy for Ulcerative Colitis

(HealthDay News) -- Colectomy may extend the lives of older adults with ulcerative colitis, new research suggests. The study was published online July 14 in the Annals of Internal Medicine.

Meenakshi Bewtra, M.D., M.P.H., Ph.D., assistant professor of medicine and epidemiology at the University of Pennsylvania Perelman School of Medicine, and colleagues used data from Medicare and Medicaid for the study. The team followed 830 patients who had elective colectomy and 7,541 who took medication to manage the condition.

Over five years, colectomy was linked with a 33 percent reduced risk of death compared to medication, Bewtra's team found. The operations were performed between 2000 and 2011. Survival benefit was greatest for those 50 and older who had advanced disease. The study suggests that colectomy should be considered earlier in the course of the disease, Bewtra told HealthDay, not viewed as a last resort.

"Too often we, as gastroenterologists, think that the yardstick, the touchstone, the criterion of success in treating patients is keeping them away from the surgeon," David B. Sachar, M.D., author of an editorial accompanying the study, toldHealthDay. Sachar is a gastroenterologist and professor of medicine at the Icahn School of Medicine at Mount Sinai in New York City. If medicines are doing the job, that's great, Sachar said. "But often the swiftest, safest, surest treatment for ulcerative colitis is an operation. The name of the game is not saving colons, but saving lives, and that includes quality of life," he said.

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Paskelbti geriausi 2014 metų moksliniai darbai, diagnozuojant ir gydant plaučių ligas.

Nacionalinė Medikų Asociacija paskelbė 2015-05-10 23:17

Žurnale Annals of Internal Medicine apibendrinti geriausi 2014 metų straipsniai, kurie pateikia naujausią mokslinę informaciją apie difuzinių plaučių ligų, astmos, lėtinės obstrukcinės ligos, plaučių vėžio, respiracinių infekcijų diagnostiką ir gydymą. Plačiau...


Vaizdas: http://www.minglebox.com/medical/courses/other-medicine/pg-md-pulmonary-medicine

High-Value Research of 2014 Presented for Pulmonary Med

(HealthDay News) -- Articles relating to diffuse parenchymal lung disease, asthma, chronic obstructive pulmonary disease (COPD), lung cancer, pulmonary diagnostics, and respiratory infections are included in a special update summary published online April 30 in the Annals of Internal Medicine.

Jess Mandel, M.D., from the University of California in San Diego, identified key studies published in 2014 that are highly relevant to the practice of pulmonary medicine.

Mandel included articles discussing beneficial therapies for idiopathic pulmonary fibrosis, which had previously eluded effective treatment. Another study described a select group of patients with severe asthma refractory to traditional therapies who may benefit from a monoclonal antibody-based therapy. For COPD, one trial demonstrated that inhaled corticosteroids may be withdrawn from treatment of some patients with stable disease, while a second trial demonstrated that azithromycin most effectively decreases acute exacerbations that necessitate antibiotics and glucocorticoids in certain subsets of patients. Low-dose computed tomography screening was reported to be cost-effective for lung cancer screening in appropriate patient groups. High sensitivity and specificity were reported in a meta-analysis of point-of-care ultrasonography for the diagnosis of acute cardiogenic pulmonary edema, when experienced operators perform the test. Finally, oseltamivir was found to be modestly effective for influenza treatment in adults, although adverse events were reported.

"This article summarizes important studies published in 2014 that have the potential to substantially influence the practice of pulmonary and internal medicine," Mandel writes.

Mandel disclosed financial ties to the medical publishing industry.

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Paskelbtos 2014 metų hematologijos naujienos.

Nacionalinė Medikų Asociacija paskelbė 2015-05-08 00:23

Žurnale Annals of Internal Medicine apibendrintos 2014 metų hematologijos naujienos nuo piktybinių kraujo ligų gydymo iki kraujavimo ir krešėjimo korekcijos naujų rekomendacijų. Transfuziologijoje naujai apibrėžta, jog kraujo perpylimas septiniams ligoniams indikuotinas esant Hb žemiau 90 g/l, o ne žemiau 70 g/l. Plačiau...


Vaizdas: http://www.medical-tourism.com/article/used-and-reconditioned-hematology-analyzers.html

High-Value Research of 2014 Presented for Hematology

(HealthDay News) -- Articles relating to malignant hematology, transfusion medicine, and bleeding and clotting disorders are included in a special update summary published online April 30 in the Annals of Internal Medicine.

Alice D. Ma, M.D., from the University of North Carolina at Chapel Hill, summarized studies relating to benign and malignant hematologic conditions published in 2014 that are relevant to practicing internists.

Ma highlighted the use of a new agent, idelalisib, which was added to rituximab to treat frail, elderly, pretreated patients with chronic lymphocytic leukemia. A study that reported updated findings with personalized cellular therapeutics was also included for the treatment of relapsed acute lymphoblastic leukemia in children and adults. Studies in the field of transfusion medicine included one describing the superiority of a hemoglobin trigger of 70 g/L to a trigger of 90 g/L for determining when to transfuse blood to septic patients. An additional study examined the risk of hospital-acquired infections with red blood cell transfusions. Meta-analyses examined genomic-based strategies for warfarin dosing, and compared the best anticoagulant regimens for acute venous thromboembolism. A randomized trial found compression stockings to be ineffective for preventing post-thrombotic syndrome compared with sham compression hose.

"In addition to [these articles], it's also worth noting that in 2014, the American Society of Hematology published its second 'Choosing Wisely' list," Ma writes. "The Society has added five commonly used tests, treatments, and procedures in hematology that might not always be necessary."

Ma disclosed financial ties to the pharmaceutical and medical device industries.

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Mamogramos keturiasdešimtmetėms turi būti atliekamos pasirinktinai.

Nacionalinė Medikų Asociacija paskelbė 2015-04-22 06:10

Keturiasdešimtmetės moterys turi pasikonsultuot su savo gydytoju ir pačios nuspręsti, ar tikslinga atlikti mamogramą. Reguliarios mamogramos turi būti atliekamos nuo 50 metų amžiaus. Nustatyta, jog mamogramos apsaugo nuo krūties vėžio mirčių keturias iš 10000, kai jos atliekamos nuo 40 iki 49 metų, 8 - nuo 50 iki 59 metų ir 21 iš 10000 virš 60 metų amžiaus moterų. Plačiau...


Vaizdas: http://www.dailytelegraph.com.au/lifestyle/will-blood-tests-replace-mammograms/story-e6frf00i-1226557805168

Mammograms a Personal Decision for Women in Their 40s, Panel Says

(HealthDay News) -- Women in their 40s should talk with their doctors and then decide for themselves whether they need regular mammograms to screen for breast cancer before age 50, according to draft U.S. federal health guidelines.

The draft mammography guidelines issued April 20 by the U.S. Preventive Services Task Force (USPSTF) largely reiterate those that have been in place since 2009, the last time they were updated.

The guidelines still recommend mammograms to screen for breast cancer every two years for women ages 50 to 74.

However, those recommendations are still at odds with the American Cancer Society and the American College of Obstetricians and Gynecologists. Both of those groups recommend annual screening beginning at age 40.

In the proposed USPSTF update, the task force emphasized that women in their 40s should make a decision whether or not to receive mammograms every two years after talking about their individual risk factors with their doctors.

"We want to be able to empower women with the science, so they can understand the potential benefits as well as the potential harms, and make the decision that's right for them based on their own values, preferences and personal health history," said Dr. Kirsten Bibbins-Domingo, vice chair of the task force and a professor at the University of California, San Francisco School of Medicine.

That clarification could mean that insurance companies will have to start picking up the check for screening women in their 40s, even though it's not explicitly recommended, said Dr. Richard Wender, chief cancer control officer for the American Cancer Society.

"The task force does not make coverage decisions, and they don't comment on coverage decisions, but I think their guideline makes it clear that women should have the option to be screened starting at 40," Wender said. "They [the task force] are not going to make that comment, but the American Cancer Society certainly will."

The U.S. Preventive Services Task Force is an independent, volunteer panel of national experts who regularly review the scientific evidence and make recommendations regarding health screening procedures and preventive medicine.

The USPSTF faced stiff criticism in 2009 when it raised the recommended age for regular mammogram screenings to 50. Women 40 to 49 were encouraged to talk with their doctor about the best time to start regular, every-other-year mammography.

The task force is standing by its 2009 guideline, noting that while the evidence shows that some women in their 40s will benefit from mammography, most will not, and some will be harmed.

Bibbins-Domingo said the 2009 guideline was "widely misinterpreted" as being against mammograms for all women in their 40s.

"The new recommendation is the same grade, a C grade, recommending in favor of screening for women in their 40s, but recognizing that on balance there are benefits that outweigh the harms, but only by a smaller amount," she said. "So therefore, women should be aware of both benefits and harms so they can make the decision that's right for them."

Wender agreed that the age recommendations are essentially the same.

"What's different is the messaging, but I wouldn't underestimate the importance of the messaging," he said. "The task force was really clear and careful to say the discussion about having a mammogram between a clinician and a woman should begin at 40. I hope and anticipate that will help clarify the misperception that the task force was against screening for women 40 to 49."

The most common harm from an unnecessary mammogram is a false-positive test, indicating that there is cancer where none exists, Bibbins-Domingo said. Women who receive a false positive have to undergo additional tests and procedures, and also must endure some anxiety until cancer is ruled out.

The most serious harm, however, can occur if a mammogram reveals a type of breast cancer that would not have threatened a woman's health during her lifetime, she added. Women who are "overdiagnosed" have to undergo surgery and cancer therapy that significantly diminish their quality of life while adding no extra years to their life span.

Wender agreed that the evidence shows that mammography becomes more beneficial as a woman ages.

"Starting at around 35, the risk of breast cancer goes up year by year until you're basically around 60," he said. "So at some point after 40, the benefit of screening starts to become substantially greater than the downsides associated with screening."

The benefits of mammography also increase with age. Regular screening can prevent about four breast cancer deaths per 10,000 women in their 40s, but eight per 10,000 for women in their 50s and 21 per 10,000 for women in their 60s, according to the task force report.

In the report, the task force also showed that the harms associated with mammography steadily decrease with age. For example, there more than 1,200 false positives for every 10,000 women who undergo mammography in their 40s; by their 50s, the false positive rate declines to over 900 per 10,000 women, and even further down to just over 800 per 10,000 in their 60s.

The American Cancer Society is currently re-evaluating its mammography recommendations as part of its regular review of the current scientific evidence, Wender said.

"We're updating our guideline and it will be out later this year, and we're looking at that pivot point again with the latest data," he said.

In its updated guidelines, the USPSTF also said it was unable to make a recommendation for or against the value of 3-D mammography screening, because there is not enough evidence to show whether it will save more lives and improve women's health.

The task force also couldn't say, based on the evidence available, whether additional screening tools like ultrasound or MRI could help women with dense breasts screen for cancer. Dense breasts are difficult to screen with standard mammography, and women with dense breasts are at increased risk of breast cancer, Bibbins-Domingo said.

The task force called for more research in both areas.

The public has until May 18 to comment on the draft guidelines, Bibbins-Domingo said.

More information

For more information on mammography, visit the U.S. National Institutes of Health.

SOURCES: Kirsten Bibbins-Domingo, M.D., Ph.D., vice chair of the U.S. Preventive Services Task Force, and professor, University of California, San Francisco School of Medicine; Richard Wender, M.D., chief cancer control officer, American Cancer Society


Intraperitoninė chemoterapija efektyvesnė.

Nacionalinė Medikų Asociacija paskelbė 2015-03-27 00:10

Išanalizavus 876 pažengusiu kiaušidžių vėžiu sergančių pacienčių gydymo taktiką nustatyta, jog po intraperitoninės chemoterapijos pacientės vidutiniškai išgyveno 61,8 mėnesio, o po intraveninės -51,4 mėnesio. Kiekvienas intraperitoninės chemoterapijos ciklas mirties riziką sumažina 12 proc. Plačiau...


Vaizdas: http://ovariancancer.blogspot.com/

Intraperitoneal Chemo Offers Lasting Benefit in Ovarian Cancer

(HealthDay News) -- Intraperitoneal (IP) chemotherapy offers lasting benefit for patients with advanced ovarian cancer, according to a study published online March 23 in the Journal of Clinical Oncology.

Devansu Tewari, M.D., from the Kaiser Permanente Irvine Medical Center in California, and colleagues examined long-term survival after IP chemotherapy in patients with advanced ovarian cancer. Data were analyzed for 876 patients from Gynecologic Oncology Group protocols 114 and 172, followed for a median of 10.7 years.

The researchers found that median survival was 61.8 months with IP therapy, compared with 51.4 months for intravenous therapy. IP therapy correlated with a reduced risk of death (adjusted hazard ratio [aHR], 0.77; P = 0.002). Among those with gross residual (≤1 cm) disease, IP therapy improved survival (aHR, 0.75 P = 0.006). For each IP chemotherapy cycle completed, the risk of death decreased by 12 percent (aHR, 0.88; P < 0.001). Clear/mucinous versus serous histology (aHR, 2.79), gross residual versus no visible disease (aHR, 1.89), and fewer versus more cycles of IP chemotherapy (aHR, 0.88) were factors associated with poorer survival (all P < 0.001). The IP regimen was more likely to be completed by younger patients; with each year of age there was a 5 percent decrease in probability of completion (odds ratio, 0.95; P < 0.001).

"The advantage of IP over intravenous chemotherapy extends beyond 10 years," the authors write. "Survival improved with increasing number of IP cycles."

One author disclosed financial ties to the pharmaceutical industry.

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