Sirtex (Australia)

ObjectivesMalignant mesothelioma (MM) is a rare and generally fatal cancer, usually caused by asbestos, although about 5%–10% of cases report no asbestos exposure. This study aimed to identify sources whereby people in Western Australia (WA) may be unknowingly exposed to asbestos or to other exposures which may cause MM.MethodsCases with no known asbestos exposure were selected from the WA Mesothelioma Register. Matched controls were selected from hospital patients admitted for conditions unrelated to asbestos. Occupational histories were coded by an industrial hygienist. Data were analysed using conditional logistic regression.ResultsEligible cases were far fewer than anticipated. After 9 years there were 38 MM cases (from a total of more than 400 reported cases of MM over the same time period), 65 other cancer controls and 69 medical controls recruited. Odds ratios did not differ by type of control so both sets of controls were combined. Thirty-eight MM participants and 134 controls were recruited. Risk of MM was increased (OR=3.1, 95% CI 1.0–9.6) after no known, but likely, exposure to asbestos at work.ConclusionsBecause of its widespread use, very few people in WA have never been exposed to asbestos and careful elucidation of occupational and environmental histories usually uncovers likely exposures sufficient to cause MM. This study suggests that most cases of MM in people with apparently no known exposure to asbestos occur, at a low rate, among the large numbers of people who have had small amounts of incidental asbestos exposure.

Malignant mesothelioma (MM) is a rare and generally fatal cancer, usually caused by asbestos, although about 5-10% of cases report no asbestos exposure. This study aimed to identify sources whereby people in Western Australia (WA) may be unknowingly exposed to asbestos or to other exposures which may cause MM. Cases with no known asbestos exposure were selected from the WA Mesothelioma Register (WAMR). Matched controls were selected from hospital patients admitted for conditions unrelated to asbestos. Occupational histories were coded by an industrial hygienist. Data were analyzed using conditional logistic regression. Thirty-eight MM participants and 134 controls were recruited. Risk of MM was increased (OR = 3.1, 95%CI 1.0-9.6) after no known, but likely, exposure to asbestos at work. Because of its extensive use, few people in WA have never been exposed to asbestos. Unrecognized exposure may cause most MM cases initially regarded as "no exposure." Am. J. Ind. Med. 60:432-436, 2017. © 2017 Wiley Periodicals, Inc.

Introduction: Non-steroidal anti-inflammatory drugs (NSAIDs) are among medications most commonly prescribed and used world wide mainly in the developed countries. Variation in terms of drug utilization pattern and adverse events may exist in different population and healthcare centres. The objective of the study was to determine consumption pattern of NSAIDs at the Klang health district primary healthcare clinics in Malaysia. Methods: A retrospective cohort study of medical records of patients prescribed with NSAIDs over a period of 12 months (January to December, 2013) was conducted at Klinik Kesihatan Anika, Bukit Kuda and Pandamaran, Klang Health distrct primary healthcare clinics, Malaysia. Results: Records of 852 eligible patients were included for the study. Based on the WHO Defined Daily Dose (DDD), the most commonly used NSAIDs were Diclofenac (1.5725), Mefenamic Acid (1.4108), Ibuprofen (0.0166) and Meloxicam (0.0016). Up to 17.6% of the NSAIDs users, had chronic diseases such as diabetes mellitus hypertension and other cardiovascular diseases. 1.8% to 22.9% of NSAIDs users were concurrently taking antihypertensive, whereas, 8.6% experienced potential drug-drug interaction with NSAIDs. Conclusion: The NSAIDs utilization pattern among the patients at the primary healthcare clinics is appropriate based on the symptoms presented. However, concomitant administration with other drugs and use in patient with chronic disease poses risks of adverse drug reactios and drug-drug interaction.

Objective:Selective internal radiation therapy (SIRT) using SIR-Spheres® 90Y-labeled resin microspheres has been shown to be a well-tolerated, effective treatment in patients with inoperable liver-dominant chemotherapy–refractory metastatic colorectal cancer (mCRC). This study estimated the cost-effectiveness of 90Y-resin microspheres compared to best supportive care (BSC) from a UK perspective.Methods:Survival data from a comparative retrospective cohort study was analyzed and used in a state-transition cost-effectiveness model, using quality-adjusted life years (QALYs) gained as the measure of effectiveness. The model incorporated costs for the SIRT procedure, monitoring, further treatment, adverse events, and death. Utility values, reflecting patient quality-of-life, were taken from a published source.Results:SIRT using 90Y-resin microspheres compared to BSC improved overall survival by a mean of 1.12 life years and resulted in a cost per QALY gained of £28,216. In sensitivity analysis, this varied between £25,015–£28,817.Conclusion:In an area of large unmet need, treatment with 90Y-resin microspheres offers a clinically effective and cost-effective treatment option.

Radioembolization aims to selectively target radiation to all liver tumors while limiting the dose to normal liver parenchyma. The deposition of yttrium-90 ((90)Y) microspheres delivered through the hepatic artery are preferentially implanted within liver tumors in a 3:1 to 20:1 ratio compared with a normal liver. The principles and mode of action of radioembolization are fundamentally different from the conventional embolization of liver tumors through transarterial embolization or chemoembolization. A meticulous work-up, involving computed tomography scanning, contrast-enhanced magnetic resonance imaging, and transfemoral hepatic angiogram, is essential to assess the appropriateness of the patient for treatment. A simulation of the treatment, done with technetium-99m-labeled macroaggregated albumin particles, which approximate the size of microspheres, is used to identify the shunting of microparticles to the lungs or gastrointestinal tract, thus helping to determine patient selection. Whole-liver or unilobar treatment approaches are chosen according to the anatomic distribution of the tumors, concomitant factors affecting liver function, and institutional preferences. Optimal periprocedural care, discharge planning, and follow-up care are essential to assess treatment response and ensure that short-term side effects of radioembolization are adequately managed. The expanding literature on radioembolization shows that this is an effective treatment for the management of both primary and metastatic tumors.