Cost-effectiveness analysis of intralesional and perilesional recombinant human epidermal growth factor vs hydrocolloid therapy in venous ulcer treatment in the Colombian context

OBJECTIVE

To perform a comparative analysis of health care expenses and outcomes in response to the question: What is the cost-effectiveness of intralesional and perilesional recombinant human epidermal growth factor (rhEGF) compared with hydrocolloid therapy in patients diagnosed with chronic venous insufficiency without infection in Colombia?

METHODS

A Markov model was used to determine cost effectiveness over a 5-year period, considering the perspective of the health system in Colombia. The study included patients aged >18 years diagnosed with chronic venous insufficiency and used clinical studies to calculate the probabilities of epithelialization, infection, recurrence, and mortality.

RESULTS

RhEGF is more expensive per unit than hydrocolloids, but it is proven to be effective at healing ulcers in 8 to 12 weeks, even in complex cases. Hydrocolloids, in contrast, typically require 29.5 weeks on average, and ≤46 weeks for complex cases. Despite the cost, rhEGF is more cost effective because it achieves results comparable with hydrocolloid therapy at a lower cost per additional quality-adjusted life-year.

CONCLUSIONS

Based on cost-effectiveness analysis, rhEGF is a superior alternative to hydrocolloids for treating venous ulcers in Colombia. Not only is it more affordable, but it also enhances patients' quality of life and streamlines the health care system's resource use.

Progress on the application of growth factor-related drugs in ophthalmology

Vascular endothelial growth factor（VEGF）, fibroblast growth factor（FGF）, nerve growth factor（NGF）, epidermal growth factor and interferon are important endogenous proteins that regulate cell proliferation, differentiation and regeneration. Biological products targeting growth factors are used in the treatment of ocular diseases such as wet age-related macular degeneration, corneal injury and neurotrophic keratitis. Anti-VEGF drugs can regulate the proliferation of vascular endothelia, reduce the edema and exudation of retinal tissue，which are the main therapeutic agents for wet age-related macular degeneration and diabetic retinopathy. The basic FGF (b-FGF) can promote the proliferation, differentiation, and migration of corneal epithelial cells, accelerating the healing of the corneal injury and reduces corneal inflammation；and bovine b-FGF has been approved for the treatment of corneal injuries. The NGF promotes the growth, development, and differentiation of central and peripheral neurons, thus accelerating the repair of nerve damage；and the European Medicines Agency approved the use of nerve growth factor for the treatment of neurotrophic keratitis in 2017. Recent clinical studies show that patients with moderate or severe neurotrophic keratitis achieved complete corneal healing following 8 weeks of NGF therapy. Epidermal growth factor derivative eye drops have been approved for the treatment of corneal epithelial injuries. Recombinant human interferon has been clinically used in the treatment of ocular viral infections. This article reviews the research progress in the development of new cell growth factor drugs for the treatment of ophthalmic diseases, to provide insights for expanding the application of cell growth factors in ophthalmology.

Gene Expression Profiling between Patient Groups with High and Low Ki67 Levels after Short-term Preoperative Aromatase Inhibitor Treatment for Breast Cancer

According to a recent report, a low Ki67 level after short-term preoperative hormone therapy (post-Ki67) might suggest a more favorable prognosis compared with a high post-Ki67 level in patients with hormone receptorpositive/human epidermal growth factor 2-negative (HR+/HER2-) breast cancer with high levels of Ki67. This study aimed to evaluate the pre-treatment genetic differences between these two patient groups. Forty-five luminal B-like patients were stratified into two groups, namely, a group with high (H→H) and one with low (H→L) Ki67 levels after short-term preoperative aromatase inhibitor (AI) treatment. We compared pre-treatment gene expression profiles between the two groups. In gene level analysis, there was no significant difference between the two groups by the class comparison test. In pathway analysis, five metabolism-related gene sets were significantly upregulated in the H→L group (p≤0.05). In the search for novel targets, five genes (PARP, BRCA2, FLT4, CDK6, and PDCD1LG2) showed significantly higher expression in the H→H group (p≤0.05). Several metabolism-related pathways were associated with sensitivity to AI. In the future, it will be necessary to seek out new therapeutic strategies for the poor prognostic group with high post-Ki67.

MCL-1 is a clinically targetable vulnerability in breast cancer

Pro-survival members of the BCL-2 family, including MCL-1, are emerging as important proteins during the development and therapeutic response of solid tumors. Notably, high levels of MCL-1 occur in breast cancer, where functional dependency has been demonstrated using cell lines and mouse models. The utility of restoring apoptosis in cancer cells through inhibition of pro-survival BCL-2 proteins has been realized in the clinic, where the first specific inhibitor of BCL-2 is approved for use in leukemia. A variety of MCL-1 inhibitors are now undergoing clinical trials for blood cancer treatment and application of this new class of drugs is also being tested in solid cancers. On-target compounds specific to MCL-1 have demonstrated promising efficacy in preclinical models of breast cancer and show potential to enhance the anti-tumor effect of conventional therapies. Taken together, this makes MCL-1 an extremely attractive target for clinical evaluation in the context of breast cancer.Abbreviations: ADC (antibody-drug conjugate); AML (Acute myeloid leukemia); APAF1 (apoptotic protease activating factor 1); bCAFs (breast cancer associated fibroblasts); BCL-2 (B-cell lymphoma 2); BH (BCL-2 homology); CLL (chronic lymphocytic leukemia); EGF (epidermal growth factor); EMT (epithelial to mesenchymal transition); ER (estrogen receptor); FDA (food and drug administration); GEMM (genetically engineered mouse model); HER2 (human epidermal growth factor 2); IL6 (interleukin 6); IMM (inner mitochondrial membrane); IMS (intermembrane space); MCL-1 (myeloid cell leukemia-1); MOMP (mitochondrial outer membrane permeabilisation); MM (multiple myeloma); PDX (patient-derived xenograft); OMM (outer mitochondrial membrane); PROTAC (proteolysis-targeting chimeras) TNBC (triple negative breast cancer); UPS (ubiquitin mediated proteolysis system).

Effects of Recombinant Human Epidermal Growth Factor Eye Drops Combined with Phacoemulsification on Short- and Long-Term Visual Acuity Recovery and Related Dry Eye Complications in Patients with Senile Cataract

Objective

To investigate the effects of recombinant human epidermal growth factor eye drops combined with phacoemulsification on short- and long-term visual acuity recovery and related dry eye complications in patients with senile cataract.

Methods

Sixty patients with senile cataract cured from January 2019 to January 2021 were enrolled in our hospital. The patients in the control group were arbitrarily assigned into the control and the research group. The former group received phacoemulsification, and the latter group received recombinant human epidermal growth factor (RhEGF) eye drops combined with phacoemulsification. The curative effect, the incidence of xerophthalmia, short-term and long-term vision improvement, changes of corneal endothelial cells, serum factors, and life quality scores were compared.

Results

The effective rate of the research group was 90.00%, and the effective rate of the control group was 66.67%; the curative effect of the research group was higher than that of the control group (P < 0.05). The incidence of dry eye in the research group was lower than that in the control group (P < 0.05). The short-term and long-term visual acuity improvement effect of the research group was better than that of the control group (P < 0.05). After treatment, the density of corneal endothelial cells in the research group was higher than that in the control group, while the proportion of hexagonal cells and the coefficient of variation of corneal endothelial cells in the research group were lower than those in the control group (P < 0.05). After treatment, IL-6 and TNF-α in the research group were lower than those in the control group (P < 0.05). Compared with the control group, the physical function, psychological function, social function, and healthy self-cognition scores of the research group were all lower (P < 0.05).

Conclusion

Cataract is the leading cause of blindness in the world. With the continuous improvement of cataract phacoemulsification technology, the incidence of some serious complications has gradually lessened. Xerophthalmia is one of the most obvious and predictable complications after cataract surgery and may affect the recovery of postoperative visual acuity. Recombinant human epidermal growth factor eye drops can effectively enhance the visual acuity of patients, promote the curative effect, and strengthen the life quality.

Palbociclib in combination with endocrine therapy versus capecitabine in hormonal receptor-positive, human epidermal growth factor 2-negative, aromatase inhibitor-resistant metastatic breast cancer: a phase III randomised controlled trial-PEARL

BACKGROUND

Palbociclib plus endocrine therapy (ET) is the standard treatment of hormone receptor-positive and human epidermal growth factor receptor 2-negative, metastatic breast cancer (MBC). However, its efficacy has not been compared with that of chemotherapy in a phase III trial.

PATIENTS AND METHODS

PEARL is a multicentre, phase III randomised study in which patients with aromatase inhibitor (AI)-resistant MBC were included in two consecutive cohorts. In cohort 1, patients were randomised 1 : 1 to palbociclib plus exemestane or capecitabine. On discovering new evidence about estrogen receptor-1 (ESR1) mutations inducing resistance to AIs, the trial was amended to include cohort 2, in which patients were randomised 1 : 1 between palbociclib plus fulvestrant and capecitabine. The stratification criteria were disease site, prior sensitivity to ET, prior chemotherapy for MBC, and country of origin. Co-primary endpoints were progression-free survival (PFS) in cohort 2 and in wild-type ESR1 patients (cohort 1 + cohort 2). ESR1 hotspot mutations were analysed in baseline circulating tumour DNA.

RESULTS

From March 2014 to July 2018, 296 and 305 patients were included in cohort 1 and cohort 2, respectively. Palbociclib plus ET was not superior to capecitabine in both cohort 2 [median PFS: 7.5 versus 10.0 months; adjusted hazard ratio (aHR): 1.13; 95% confidence interval (CI): 0.85-1.50] and wild-type ESR1 patients (median PFS: 8.0 versus 10.6 months; aHR: 1.11; 95% CI: 0.87-1.41). The most frequent grade 3-4 toxicities with palbociclib plus exemestane, palbociclib plus fulvestrant and capecitabine, respectively, were neutropenia (57.4%, 55.7% and 5.5%), hand/foot syndrome (0%, 0% and 23.5%), and diarrhoea (1.3%, 1.3% and 7.6%). Palbociclib plus ET offered better quality of life (aHR for time to deterioration of global health status: 0.67; 95% CI: 0.53-0.85).

CONCLUSIONS

There was no statistical superiority of palbociclib plus ET over capecitabine with respect to PFS in MBC patients resistant to AIs. Palbociclib plus ET showed a better safety profile and improved quality of life.