MONDAY, April 16, 2018 (HealthDay News) — Taking the drug Keytruda after surgery for advanced melanoma significantly reduced patients' risk of their cancer returning, a new study found.
Last May, Keytruda (pembrolizumab) became the first ever drug approved by the U.S. Food and Drug Administration to fight cancers based on specific tumor genetics, rather than where in the body the tumor occurs.
The drug also gained attention after former President Jimmy Carter announced in 2015 that Keytruda had beaten back his brain cancer.
But would it work against advanced melanomas, the deadliest of skin cancers?
"Melanoma has always been considered an 'outlier' cancer in that it does not respond well to classical chemotherapy used for other cancers," noted one specialist, dermatologist Dr. Doris Day, of Lenox Hill Hospital in New York City. She was not involved in the new study.
Day said that "immunomodulating drugs [such as Keytruda] have taken melanoma from a deadly diagnosis to a cancer where we have greater and greater success with long term control and even cure."
The new study was funded by Keytruda's maker, Merck, and included more than 1,000 patients with stage 3 melanoma.
All had undergone a complete surgical removal of their tumors, but they were at high risk of a cancer recurrence.
Patients were randomly assigned to take either a 200-milligram dose of Keytruda every three weeks for a year (total of 18 doses), or a placebo.
After a median follow-up of 15 months, 135 of the 514 patients in the Keytruda group had been diagnosed with recurrent melanoma or had died, compared to 216 of the 505 patients in the placebo group.
The 12-month survival rate without any sign of cancer's return was about 75 percent for patients in the Keytruda group and 61 percent for those in the placebo group.
That meant that statistically speaking, those in the Keytruda group were 43 percent less likely to have recurrent melanoma, the researchers said.
The findings were presented Sunday at the annual meeting of the American Association for Cancer Research (AACR) and they were simultaneously published in the New England Journal of Medicine.
"Patients with stage 3 melanoma have metastatic disease in one or more regional lymph nodes," said researcher Dr. Alexander Eggermont, director general of Gustave Roussy Cancer Campus Grand Paris in Villejuif, France.
"A patient's risk of recurrence depends on the number of lymph nodes affected and the tumor load," he explained in an AACR news release. "Those classified as having a high risk of recurrence have one or more regional lymph nodes with melanoma metastasis [spread]."
Keytruda belongs to a class of drugs called PD1 inhibitors, which work by targeting a cellular pathway that helps the body's own immune system attack the cancer cells. The drug targets tumors with DNA known as microsatellite instability-high (MSI-H) or mismatch repair deficient (dMMR). These gene abnormalities affect repair mechanisms inside the cell.
One expert in caring for melanoma patients said Keytruda could be a breakthrough treatment.
"PD1 inhibitors are part of a class of medications called checkpoint inhibitors, and I cannot overstate the value of these new agents for the treatment of metastatic melanoma," said Dr. Craig Devoe. He's acting chief of hematology and medical oncology at Northwell Health Cancer Institute in Lake Success, N.Y.
"This study further supports the use of this class of medications in the preventative setting," said Devoe, who wasn't connected to the study. He also noted that there are relatively few side effects with these medications. But there is one drawback.
"A major concern is the very high cost of these agents to patients and society," Devoe said, with a typical course of treatment costing more than $150,000.
Currently, the PD1 drugs Yervoy (ipilimumab) and Opdivo (nivolumab) are approved in the United States for treatment of patients with high-risk stage 3 melanoma that has been completely removed by surgery.
"We hope that these data will lead to regulators in the United States and Europe approving pembrolizumab as a new treatment option for these patients," Eggermont said.
For her part, Day said the new findings are encouraging, but "the test will be maintaining results and learning how to combine the drugs in order to minimize resistance and increase cure rates."
The U.S. National Cancer Institute has more on melanoma.
Burkina Faso: Growing Violence Threatens Health Care
Away from the worlds attention, Burkina Faso has been slipping into violence. In less than a year, t..
Away from the worlds attention, Burkina Faso has been slipping into violence. In less than a year, the number of displaced has increased fivefold, from 50,000 last December, to 270,000 in August. As ever, the most vulnerable suffer most: the very young, and the very old.
When Alidou Sawadogos elderly mother fell ill, he faced a long and dangerous journey to get treatment for her.
“When she collapsed, a friend called me,” he explains. “By the time I arrived she was already unconscious. I decided to take her to the health center and luckily someone who had a motorcycle helped me. Because of the violence many people who are sick wait at home and die. Everyone is afraid of taking the road to the health center in Barsalogho.”
Across Burkina Faso, the rising insecurity has forced over a hundred health centers to close, or to limit their work. Half a million people now have little or no access to health care. Dedicated health workers, among them Dr Bertrand Dibli in Barsalogho, are struggling to meet the needs, and to stay safe themselves.
“This is one of the few health centers that isnt closed,” he says. “We dont have enough equipment. And the insecurity has caused huge anxiety among health workers. Even coming here to Barsalogho is a huge challenge because the route is so dangerous.”
The ICRC has been working to support Burkina Fasos health professionals, with medical kits, and vaccination campaigns. During his visit to the country, ICRC President Peter Maurer expressed his concern at the multiple challenges facing Burkina Fasos people.
“We are very concerned,” he said. “Very worried about the upsurge in violence, its a vicious circle that is trapping the civilian population between armed groups.”
“We also see,” Mr Maurer added, “that it is not only the violence that is affecting the country, it is also under development, and climate change. Together with the violence that is obstructing the health services, its an accumulation of factors.”
And so the ICRC – jointly with the Burkinabé Red Cross – is also delivering food to the displaced, and helping to improve access to water supplies. All of this, says nurse Jeanette Kientega, is desperately needed by a population uprooted by conflict, and denied access to basic health care.
“By the time they are able to get here, it is often too late” she says. “Sometimes we can help, but if they have already been ill a long time, it is difficult. We try to do what we can.” (more…)
World Bank and WHO Statement on Partnership & Deployment of Financing to WHO for Ebola Response in DRC
WASHINGTON, August 23, 2019—The World Bank and the World Health Organization (WHO), along with the G..
WASHINGTON, August 23, 2019—The World Bank and the World Health Organization (WHO), along with the Government and other key partners, are working in close partnership on the Ebola Crisis Response in the Democratic Republic of the Congo (DRC). Central to this partnership is the assessment of the financing needs, and deployment of resources, with the goal to put an end to the current deadly outbreak.
The World Bank is today announcing that US$50 million in funding is to be released to WHO for its lifesaving operational work on the frontlines of the outbreak. The WHO is announcing that this US$50 million in funds will close the financing gap for its emergency health response in DRC through to the end of September 2019, and is calling on other partners to mirror this generous support in order to fund the response through to December.
The funding comprises US$30 million from the Pandemic Emergency Financing Facility (PEF) and US$20 million from the World Bank. The US$50 million in grant funding is part of the larger financial package of approximately US$300 million that the World Bank announced last month to support the fourth Strategic Response Plan for the DRC Ebola outbreak.
“WHO is very grateful for the World Banks support, which fills a critical gap in our immediate needs for Ebola response efforts in DRC, and will enable the heroic workers on the frontlines of this fight to continue their lifesaving work,” said Dr. Tedros Adhanom Ghebreyesus, Director-General, World Health Organization. “We keenly await further funding from other partners to sustain the response through to the end of the year.”
The DRC government, working in collaboration with the World Bank, WHO, and other key partners, has finalized the Fourth Strategic Response Plan (SRP4), which outlines the total resources needed for the DRC Ebola Crisis Response from July to December 2019. The financing announced today is part of the World Banks previously announced financial package of up to US$300 million and covers over half of SRP4s needs, with the remainder requiring additional funding from other donors and partners.
“The World Bank is working closely with WHO, the Government of DRC, and all partners to do everything we can to put an end to the latest Ebola outbreak,” said Annette Dixon, Vice President, Human Development at the World Bank. “The partnership between our organizations and the Government is critical for responding to the emergency as well as rebuilding systems for delivery of basic services and to restoring the trust of communities.”
The Government of DRC requested US$30 million from the PEF Cash Window to be paid directly to WHO. The PEF Steering Body approved the request bringing the PEFs total contribution to fighting Ebola in DRC to US$61.4 million. The PEF is a financing mechanism housed at the World Bank; its Steering Body is co-chaired by the World Bank and WHO, and comprises donor country members from Japan, Germany and Australia. The quick and flexible financing it provides saves lives, by enabling governments and international responders to concentrate on fighting Ebola—not fundraising.
Borno State launches first Malaria Operational Plan, reawakens fight against malaria
Maiduguri, 13 August 2019 – Following recommendations from malaria interventions in Borno State Nige..
Maiduguri, 13 August 2019 – Following recommendations from malaria interventions in Borno State Nigeria, the Malaria Annual Operational Plan (MAOP) was developed and launched on 08 August 2019 with technical support from the World Health Organization (WHO) and partners. Aligned to the National Malaria Strategic Plan (2014 -2020), MAOP was developed through a broad-based stakeholders workshop involving malaria stakeholders, reviewed on different thematic areas and endorsed by the Commissioner for Health and Permanent Secretary, Borno State Ministry of Health.
Speaking during the launch, the Borno state Malaria Programme Manager, Mr Mala Waziri described the MAOP as the first to be endorsed and disseminated in Borno State. “WHO has made us proud by supporting the first ever Malaria Operational Plan right from development, review, printing to dissemination.”
Dr Ibrahim Kida, the Ministerial Secretary Borno State Ministry of Health and Incident Manager of the state, described the launch as “an historic event as stakeholders across the health sector made commitments to use the document as an implementation guide for all malaria programs”. The plan was also described as an advocacy tool for planning domestic funds mobilization.
The MAOP has seven objectives among which are: provide at least 50% of targeted population with appropriate preventive measures by 2020; ensure that all persons with suspected malaria who seek care are tested with Rapid Diagnostic Test (RDT) or microscopy by 2020 and all persons with confirmed malaria seen in private or public health facilities receive prompt treatment with an effective anti-malarial drug by 2020.
The MAOP will further ensure that at least 50% of the population practice appropriate malaria prevention and management by 2020, ensuring timely availability of appropriate anti-malarial medicines and commodities required for prevention, diagnosis and treatment of malaria in Borno State by 2020.
In addition, it seeks to ensure that all health facilities report on key malaria indicators routinely by 2020 and finally strengthen governance and coordination of all stakeholders for effective program implementation towards an A rating by 2020 on a standardized scorecard. These strategic objectives have specific targets and the MAOP takes into account the humanitarian response.
“Malaria remains a leading cause of poor health in Nigeria. According to the 2018 WHO Malaria Report, 53million cases are recorded annually in Nigeria, roughly 1 in 4 persons is infected with malaria contributing 25% of the global burden,” says Dr Nglass Ini Abasi, WHO Malaria Consultant for the North East.
“Furthermore, 81,640 deaths are recorded annually (9 deaths every hour), which accounts for 19% of global malaria deaths (1 in 5 global malaria deaths) and 45% malaria deaths in West Africa. The Nigeria Malaria Strategic Plan (NMSP) 2014-2020 has a goal to reduce malaria burden to pre-elimination levels and bring malaria-related mortality to zero and WHO is working assiduously with Government to ensure the burden is reduced accordingly.”
Results from WHO’s Early Warning, Alert and Response System (EWARS) week 30 report from 223 sites, (including 32 IDP camps) show that malaria was the leading cause of morbidity and mortality accounting for 35% of cases and 46% of reported deaths. In addition, results from the Nigeria Humanitarian Response Strategy (NHRS 2019-2021) indicate 7.1million people are in dire need of healthcare and 6.2million are targeted for immediate attention.
Despite recent improvements, insecurity remains a challenge limiting access to the functional health facilities. Easily preventable and treatable diseases such as malaria, acute respiratory infection and diarrheal diseases account for the greatest proportion of morbidity and mortality among the vulnerable population. Furthermore, Malaria is endemic in North East Nigeria and the transmission is perennial with a marked seasonal peak from July to November every year. (more…)
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