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Multiple Myeloma – What It Is, Causes and Treatment Options … – Metropolis Healthcare

What is Multiple Myeloma?

Multiple Myeloma, cancer of plasma cells is the second most common blood cancer around the world. Plasma cells are a type of white blood cells, which produce antibodies that protect the body from infection. They are found in the bone marrow, which is the spongy tissue seen in some bones.

In multiple myeloma, the plasma cells clone and proliferate excessively, displacing healthy bone marrow cells that produce red blood cells, platelets, and other types of white blood cells (WBC). This sets off a chain reaction of illnesses and disorders that can harm multiple organs like bones, kidneys, and the bodys capacity to produce healthy red, white, and platelet blood cells. Multiple organ systems are affected, hence the name.

It mainly affects adults in the age group of 65-70 years. Multiple myeloma presents with different kinds of symptoms which can resemble a lot of other conditions. Initially one may not experience any symptoms. This cancer does not cause any lump or tumour.

Some may not experience any symptoms and the condition may be accidental when blood or urine tests show abnormally high protein. This type is called smouldering myeloma.

Rarely, cancer cells concentrate in a particular bone or soft tissue, rather than involving many organs. This is called solitary myeloma/plasmacytoma.

The are many symptoms one can experience:

Researchers are yet to identify the exact cause of multiple myeloma. However, certain risk factors have been identified.

Monoclonal Gammopathy of Undetermined Significance (MGUS) is closely related. Here there is an overabundance of immunoglobulins in the blood. Approximately 1 in 100 individuals with MGUS go on to develop multiple myeloma each year. MGUS has no symptoms, so regular blood tests have to be done.

Currently, multiple myeloma cannot be cured. However, treatment can frequently assist to control the condition for several years. New medications, autologous stem cell transplantation, and improved supportive care have greatly improvedsurvival rates.

For diagnosing and initiating early treatment a set of criteria and defining events are necessary. This involves getting various blood tests and imaging.

Blood tests include:

Managing multiple myeloma requires a multidisciplinary approach of physicians, haematologists, radiologists, physiotherapists, dietitians and psychologists. The staging of the disease and symptoms dictate the treatment.

The therapy includes:

In first-line and relapsed settings, there is a combination of drugs used:

You may feel tired and nauseous and may also experience diarrhoea, constipation, numbness of hands and feet, mood changes, increased hunger, and sleep disturbances. A more thorough knowledge about the side effects can be obtained from your healthcare professional.

Experiences with multiple myeloma will vary from person to person. Some people have years to live with few symptoms. Others see a rapid deterioration in their condition. Using blood tests like albumin and beta-2-microglobulin, DNA tests can predict survival rates. As you discover how to cope with multiple myeloma, connect with doctors and support groups for guidance.

Ans: Yes, Kindly adhere to the doctors advice. It is absolutely important to get regular blood tests and other investigations as advised.

Ans: Eat healthy, exercise, protect yourself from infection and look after yourself. Take rest as and when needed.

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Multiple Myeloma - What It Is, Causes and Treatment Options ... - Metropolis Healthcare

Autism Therapy Market Anticipated to Garner Significant Growth of … – GlobeNewswire

MELBOURNE, April 04, 2023 (GLOBE NEWSWIRE) -- Data Bridge Market Research completed a qualitative study titled "Autism Therapy Market" with 100+ market data tables, pie charts, graphs, and figures spread across Pages and an easy to grasp full analysis. A steadfast Autism Therapy market research report serves to be a very momentous component of business strategy. This report provides important information which assists to identify and analyze the needs of the market, the market size, and the competition with respect to Autism Therapy industry. When the market report is accompanied with precise tools and technology, it helps tackle a number of uncertain challenges for the business. This market research report is one of the key factors used in maintaining competitiveness over competitors. Autism Therapy market report supports the business to take better decisions for the successful future planning in terms of current and future trends in particular product or the industry.

Data Bridge Market Research analyses that the autism therapy market, which was USD 2.05 billion in 2022, would rise to USD 3.42 billion by 2030 and is expected to undergo a CAGR of 6.60% during the forecast period 2023 to 2030. In addition to the insights on market scenarios such as market value, growth rate, segmentation, geographical coverage, and major players, the market reports curated by the Data Bridge Market Research also include depth expert analysis, patient epidemiology, pipeline analysis, pricing analysis, and regulatory framework.

Download a PDF Sample of the Autism Therapy Market @https://www.databridgemarketresearch.com/request-a-sample/?dbmr=global-autism-therapy-market

Autism therapies are the type of therapies that are applied in autistic children or adults to improve or enhance their condition. Different therapies include speech-language therapy, behavior therapy, play-based therapy, occupational therapy, physical therapy, and nutritional therapy. This neurological disorder is related to several disabilities, such as challenges with the individual's behavior or lack of social skills. The diagnosis of autism can be made from a very early age, but the cause is still unknown.

The growing incidence of autism and pervasive developmental disorder (PDD) is essential to escalate market growth. Huge research studies performed by organizations to assess the safety and efficiency of drugs in patients with ASD are anticipated to boost market growth. The stimulants segment dominated the market with a huge revenue share due to the wide availability and ease of accessibility of drugs to patients.

Fundamental Aim of Autism Therapy Market Report

In the Autism Therapy market, every company has goals, but this report focus in on the most important ones, allowing you to gain insight into the competition, the future of the market, potential new products, and other useful information that can boost your sales significantly.

Some of the major players operating in the autism therapy market are:

Recent Development

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The investment made in the study would provide you access to information such as:

Opportunities:

The increasing demand for stimulants is boosting the growth of the market. Adderall, Focalin, Vyvanse, Dexedrine, and Ritalin are some stimulants approved by the U.S. FDA for treating patients who have autism. These drugs improve patient behavior by 80% when administered properly to patients. Therefore, growing efficiency related to the stimulants may attract a new target population and boost market growth.

A growing number of product launches associated with autism therapy boost market growth. For instance, the FDA granted fast-track designation to Curemark's CM-AT specified for ASD in 3-8 years old children in 2022. Furthermore, Indian researchers developed the 6BIO compound in 2021, which has shown the potential to enhance daily activities in the pre-clinical investigation of patients with an autism spectrum disorder. Thus, this factor boosts market growth.

Key Growth Drivers:

The increasing incidence of the autistic population is boosting the market's growth. For instance, France and Portugal have the lowest rates of autism in the world, with approximately 0.69% and 0.71%, respectively, as per the research published by Health Data Exchange. In 2021, the CDC stated that nearly 1 in 44 children in the U.S. is diagnosed with an autism spectrum disorder (ASD). Thus, this increasing prevalence demands high adoption of therapies, boosting the market growth.

Huge research studies performed by organizations to assess the safety and efficacy of drugs in patients with ASD are anticipated to drive the market. The positive outcomes of these studies lead to new growth opportunities for the market. For instance, Stalicla completed phase 1b trials of precision medicine candidate STP1 and witnessed positive results with symptom improvement in patients with ASD in 2022. Therefore, the effective completion of the trial and following product approvals are estimated to drive the market. Thus, this factor boosts market growth.

Read the In-Depth Research Report @https://www.databridgemarketresearch.com/reports/global-autism-therapy-market

Key Market Segments Covered in Autism Therapy Industry Research

Age Group

Type

Treatment Type

Drug

Distribution Channel

Autism Therapy Market Regional Analysis/Insights:

The countries covered in the autism therapy market report are U.S., Canada, and Mexico in North America, Germany, France, U.K., Netherlands, Switzerland, Belgium, Russia, Italy, Spain, Turkey, Rest of Europe in Europe, China, Japan, India, South Korea, Singapore, Malaysia, Australia, Thailand, Indonesia, Philippines, Rest of Asia-Pacific (APAC) in the Asia-Pacific (APAC), Saudi Arabia, U.A.E, South Africa, Egypt, Israel, Rest of Middle East and Africa (MEA) as a part of Middle East and Africa (MEA), Brazil, Argentina and Rest of South America as part of South America

North America dominates the autism therapy market due to increasing R&D activities and the launching several new products through mergers and strategic partnerships in this region. Also, the increasing awareness about the availability of numerous therapies to treat patients with autism spectrum disorders in this region

Asia-Pacific is expected to witness significant growth due to the wide presence of major market players and strategic initiatives undertaken by them to develop and commercialize several new products to treat patients.For instance, Teijin Pharma and Hamamatsu Medical University confirmed the safety, efficiency, and tolerability of oxytocin nasal spray for treating patients with an autism spectrum disorder in 2022

Table of Contents:

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Autism Therapy Market Anticipated to Garner Significant Growth of ... - GlobeNewswire

25 Greatest Impacts in 25 Years: Illumina and the Evolution – CSRwire.com

Published 04-05-23

Submitted by Illumina

Originally published on Illumina News Center

This month, Illumina celebrates a quarter century of innovation, research, and passion. As a genomics pioneer founded in San Diego in 1998, we have provenand continue to provehow unlocking the power of the genome can exponentially improve the human condition.

When the company began 25 years ago, it was revolutionary just to decode the genome. Since then, genomics has played a crucial role generating insights into infectious disease, cancer, reproductive health, genetic disease, and morewhile improving patient outcomes every step of the way. To date, scientists and researchers have generated more than one billion gigabases of data and sequenced nearly four million people, and potential uses for that data multiply every year. Around the world, our customers and partners are sequencing samples extracted from seaweed, sugarcane, soil, yams, river water, wastewater, gorillas, ancient Nordic bonesthe list goes on. Its not surprising that over 300,000 studies featured in peer-reviewed scientific publications have used Illumina technology. Today, our workforce is 10,000 strong, with more than 8800 patents in 34 locations worldwide. Were celebrating 25 years of growth by looking at 25 of the greatest impacts that Illumina technology has made to date.

1. We advanced sequencing chemistry to be faster, more accurate, and more stable. When we launched the Genome Analyzer in 2007, we introduced the world to Illumina sequencing by synthesis (SBS) chemistry. SBS forever changed how sequencing is done, as it delivers high accuracy and a high yield of error-free reads. In the years leading up to 2022, we created XLEAP-SBS chemistry, which is engineered for longer reads with up to 2 faster incorporation speed and 3 greater accuracy. And because we made this chemistry stable at ambient temperatures, it no longer needs to be packed with dry ice, making it more sustainable as well as accessible to markets that lack the infrastructure for dry ice shipping.

2. We made DNA sequencing more affordable and accessible. In the last 14 years, we helped take the cost of sequencing a human genome from $150,000 to $200, a drop of more than 99%. Getting to the $10,000 genome in 2010 was a major feat, thanks to the Illumina HiSeq 2000. HiSeq made whole-genome sequencing (WGS) possible for labs of all sizes and drove widespread adoption of exome sequencing and noninvasive prenatal testing (NIPT). In 2022, we launched our most powerful and most sustainable sequencers to date, the NovaSeq X Series. The NovaSeq X Plus can sequence more than 20,000 whole genomes per year and enables the $200 genome.

3. We're increasing the diversity of available genomic data to better reflect our world. In 2008, Illumina completed the first-ever sequencing of an African human genome, from an anonymous Yoruban man from Nigeria. From the very beginning we have prioritized diversity, and in the years since, our partnerships with Our Future Health in England, PRECISE in Singapore, All of Us in the US, and OurDNA in Australia have allowed researchers to better target mutations specific to certain populations and deliver on the promise of precision medicine for all. Most recently, we announced an agreement between Illumina, Nashville Biosciences, and Amgen to sequence 35,000 DNA samples from African American patients at Vanderbilt University Medical Center. This is the first announcement from the Alliance for Genomic Discovery, created by Illumina and Nashville Biosciences, to perform WGS on 250,000 de-identified patient samples and make them available to pharmaceutical companies looking to develop new, life-changing therapies.

4. WGS for newborns in intensive care is on its way to becoming a universal standard of care. In the last several years, a handful of institutions have made life-changing advances in diagnosing critically ill babies with lifesaving speed. In 2015, Dr. Stephen Kingsmore, then at Childrens Mercy Hospital in Kansas City and using a HiSeq 2500, set a Guinness World Record for fastest genetic diagnosis, in 26 hours (now at Rady Childrens, he has implemented rapid WGS as a frontline diagnostic). Beginning in 2017, a groundbreaking study went on to demonstrate the value of WGS across five US hospitals. Other programs and studies at institutions from Germany to the United Arab Emirates have begun implementing WGS in their neonatal intensive care units. And in October 2022, NHS England launched the worlds first national genetic testing service, promising to sequence severely ill newborns for diagnosis within days. (Read Baby Fitzs story here.)

5. Patients with rare genetic diseases are getting answersfaster. In high-income countries, genetic disease patients often remain undiagnosed for up to seven years or more, while in low- and middle-income regions, many families never learn the cause of their childs suffering. This diagnostic odyssey costs families time and money, and causes frustration and heartache. But WGS is one way to arrive at a diagnosis within weeks. For 10 years, the Illumina iHope program has facilitated pro bono genome testing for more than 1700 children with suspected rare genetic disease across 24 clinical sites in eight countries. Approximately 40% of them have received a diagnosis and up to 78% received a change in their care management as a result. Based on the success of this program, Illumina recently announced an expansion of iHope to China. Illumina has committed to dramatically expanding access to genome testing outside China through a partnership with Genetic Alliance to develop iHope Genetic Healtha program supported by a $120 million in-kind donation of sequencers, reagents, and software to enable dozens of laboratories to provide genome testing in low- and middle-income communities around the world. This effort will reach up to 50,000 patients a year in five years.

6. NIPT and carrier screening transformed reproductive health for expecting families around the world. The VeriSeq NIPT Solution, released in 2017, provides fetal chromosomal information through a simple maternal blood test, significantly expanding families ability to make informed health care decisions. In 2020, the American College of Obstetricians and Gynecologists amended its guidelines, recommending that all pregnant people, regardless of age or baseline risk, receive testing. Prospective parents can test before conception, and embryos produced through in vitro fertilization can be tested. Further, products such as the Illumina Global Diversity Array with Carrier Screening Content v2 (intended for research use only), can screen for as many as 600 different autosomal recessive disorders.

7. Our arrays ushered in a new era of large-scale genomics. They changed the research and applied market landscape in applications such as genetic disease testing, agrigenomics, population genomics, and epigenetic research. We began developing array technology in 1998 and launched our first product in 2001. Today it is a $400 million business and a core part of how we address cost-sensitive applications and geographies. Innovations such as the Infinium Global Diversity Array with Enhanced PGx and the upcoming EX workflow will enable service providers to process samples in a quicker, more cost-effective manner that ultimately benefits patients, while the expansion of our methylation array portfolio will enable new insights in population cohorts and has the potential to improve outcomes in oncology and genetic disease testing.

8. We helped accelerate the field of precision oncology with comprehensive genomic profiling. In 2018, we introduced a pan-cancer assay designed to identify known and emerging tumor biomarkers. TruSight Oncology 500 (TSO 500) uses both DNA and RNA from subject tumor samples to identify key somatic variants underlying tumor progression, such as small DNA variants, fusions, and splice variants. It can measure tumor mutational burden and microsatellite instability, features that are potentially important biomarkers for immunotherapies. In 2022, we debuted the TruSight Oncology Comprehensive (TSO Comp) in vitro diagnostic kit to help inform treatment for cancer patients in Europe. We also launched the first companion diagnostic for TSO Comp, enabling targeted therapy with Bayers Vitrakvi medicine for patients with NTRK fusion cancer. With Merck, we codeveloped a TSO 500 HRD research assay.

9. Liquid biopsy became possible. The ability to detect cell-free circulating tumor DNA from tumors is growing. Clinical researchers see it as a potential alternative to invasive tissue biopsies, and the breakthrough technology can also help with multi-cancer early detection (MCED). With the help of MCED, catching cancer before it spreads increases the overall cancer survival rate by 400%.

10. We enabled partners to develop the COVID-19 vaccine without a live virus.In a lab at the Shanghai Public Health Clinical Center (SPHCC), researchers used a MiniSeq to sequence the sample of a seafood market worker admitted to the Central Hospital of Wuhan on December 26, 2019. SPHCC was one of the first to publish the viral genomic sequence, and it was this sequence that made vaccine development possible in just 10 months, rather than decades. It was also a catalyst for mRNA technology advancements in oncology testing, HIV, malaria, Ebola, and more.

11. We responded quickly to the need for widespread sequencing of SARS-CoV-2. On June 9, 2020, we received the first FDA Emergency Use Authorization for a sequencing-based COVID-19 diagnostic test. The Illumina COVIDSeq Test helped pave the way for large-scale, next-generation sequencing (NGS) COVID-19 testing, just a few months into the pandemic. By summer 2021, most of the resulting test datawhich was being used to identify viral variants, which could help public health agencies manage the pandemicwas coming from large genomic centers. Countries with limited resources to invest in high-throughput sequencers had far fewer submissions to COVID surveillance networks. Illumina launched the COVIDSeq Assay, which allowed small labs to participate in surveillance. Rural regions like the Yucatn peninsula in Mexico, with its influx of tourists and immigrants, were finally able to detect the variants present in the local community.

12. We doubled the number of countries in which we could enable access to genomics. Over the course of the pandemic, it became clear that sending samples across regions and borders to testing labs was not fast or scalable enough to mitigate the spread of new variants. Our customers, particularly global nongovernmental organizations such as the World Health Organization, United Nations Development Programme, and Association of Public Health Laboratories as well as the Illumina Foundation were requesting to have our products available in nearly every corner of the inhabited world. In just over six months beginning in late 2021, a cross-functional, global team at Illumina set up our systems to enable commercial orders and shipments to 88 additional countries and territories across Africa, Asia, Latin America, and Eastern Europe. The feat provided on-the-ground access to genomics to 900 million more people.

13. The world got a crash course in genomics. As the coronavirus pandemic unfolded, terms like PCR and mRNA entered the mainstream lexicon. Public health officials became recognizable figures, and Illumina was at the ready to share our knowledge about the power of genomics to impact human health with government leaders, health care professionals, and society writ large. In February 2021, our CEO, Francis deSouza, penned an essay for The Economist, calling for a global Bio Force to track viruses; two months later, deSouza appeared on the cover of TIME magazine when Illumina was named one of the 100 Most Influential Companies.

14. Pathogen surveillance expanded around the globe. In April 2021, we committed $60 million in sequencing capabilities to a global pathogen genomics initiative, in partnership with public and private entities. It expanded on the Africa Pathogen Genomics Initiative (Africa PGI) announced the previous October, to build critical public health capabilities in areas of need and bring us closer to the vision of an early warning system for disease outbreaks. (In a matter of months, the number of sequencing labs in Africa grew from seven to 40.)

15. Were working to make adverse drug reactions a thing of the past. Were developing pharmacogenomics testing to prevent adverse drug reactions, the most common cause of hospital admissions worldwide and one of the leading causes of death. (Watch Mehris story here.)

16. Millions of pet owners were able to improve their animals health. Our customers brought to market DNA tests to detect canine cancer earlier, and identify a cats breed, traits, and health risks.

17. We are supporting researchers enabling a more sustainable, nutritious food supply.Every year since 2011, we have awarded one Illumina Agricultural Greater Good Initiative grant. The program spurs critically needed research that will increase the sustainability, productivity, and nutritional density of agriculturally important crop and livestock species. Grant recipients receive donations of Illumina products. Our most recent winners are studying yams in Nigeria, mung beans in multiple regions, honeybees in Germany, and, as announced this year, marine algae in Brazil.

18. Genomics began supporting wildlife conservation. Initiatives like our iConserve program have brought the global community together to accelerate environmental and wildlife conservation. Some of iConserves work consists of facilitating research in comparative genomics of various species, which provides structure to cataloging biodiversity in wild and captive populations. This ultimately supports decisions made regarding species conservation and management. In recent years, we have been able to support research into the genomes of the bottlenose dolphin, red ruffed lemur, western lowland gorilla, and African elephants.

19. We convened world and industry leaders to discuss and advance the power and promise of genomics. At the inaugural Illumina Genomics Forum in September 2022, former President Barack Obama, Bill Gates, Nobel laureate Frances Arnold, and other experts shared their insights on genomics and health care.

20. We advocated for reimbursement (and we still do). Since its inception in 2017, our market access team has been working with consortiums, governments, payers, and others to increase insurance coverage for genetic testing. In 2021, the world crossed a significant milestone, with over one billion people across 45 countries reimbursed for genomic tests, cancer therapy selection, genetic disease diagnosis, and noninvasive prenatal testing. The market access team continues to advocate for patient access through innovative collaborations and contracts.

21. Our customers and partners used NGS to help protect the environment. Canadas STREAM project sequences river water and sediment samples to advance watershed health monitoring, Checkerspot is using microalgae to create a sustainable alternative to petroleum, and LanzaTech is turning carbon emissions into valuable material commoditiesits facilities in China have produced over 50 million gallons of ethanol from industrial emissions, which is the equivalent of keeping over 200,000 tons of carbon from entering the atmosphere.

22. The volume of genomic data has explodedand so have the insights. Ever since we acquired Solexa in 2007, NGS data output has increased at a rate that outpaces Moores lawmore than doubling each year and creating immeasurable opportunities. Today, the amount of total genetic data generated around the world exceeds one billion gigabases. Weve made significant improvements to our platforms and product pipeline to provide highly accurate, comprehensive, efficient analysis of this data. We launched Illumina Connected Analytics to empower customers to manage, analyze, and explore large volumes of multi-omic data in a scalable and flexible environment guided by core principles of security and privacy. Illumina DRAGEN Original Read Archive technology performs data compression in the cloud, reducing customers carbon footprint by up to five times.

23. We made big science green science. Last year, Illumina ranked highest in our industry in the Dow Jones Sustainability Index. In July 2022, we were the first genomics company whose plan to meet net-zero targets was approved by the Science Based Targets initiative, which includes validation of our corporate greenhouse gas emissions reduction targets. In 2021, the company met 59% of its energy needs through renewable sources, and by 2030 it aims to use 100% renewable energy and 75% less packaging. By 2050, it aims to become a net-zero company.

24. The next generation of scientists stepped into the lab. We celebrate DNA Day each April, and our 2022 campaign reached more than 90,000 STEM learners, inspiring the next generation of scientists and discoverers. Illumina has reached over 1 million STEM learners since 2019, and we aim to reach 5 million by 2030.

25. We championed a diverse and global workforce. In 2022 alone we received more than a dozen awards and recognitions from companies like Forbes, Newsweek, Bloomberg, and Dow Jones. We also empower our employeesin commemoration of the 25th anniversary, we are providing twenty-five $25,000 grants in communities where we operate, and we have provided $25 to each employee to donate to a cause of their choice.

And in the next 25 yearsor even 25 weeksstarting with the debut of Illumina Complete Long Read sequencing technology, stay tuned for more breakthroughs in cardiovascular disease testing, drug target discovery using AI-based genome interpretation and analysis, and expanded testing capabilities for countries most impacted by tuberculosis. In the meantime, our customers are making strides in research for autism spectrum disorder, PTSD, diabetes, and more.

For a quarter-century, Illumina has been on the forefront of a global genomics movement. We celebrate this milestone with excitement and cant wait to see how many more patients are able to experience better outcomes through the power of genomics. Heres to another 25 years of making even greater impacts in the Genome Era.

Illumina is improving human health by unlocking the power of the genome. Our focus on innovation has established us as the global leader in DNA sequencing and array-based technologies, serving customers in the research, clinical, and applied markets. Our products are used for applications in the life sciences, oncology, reproductive health, agriculture, and other emerging segments.

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25 Greatest Impacts in 25 Years: Illumina and the Evolution - CSRwire.com

Brain Tumours New Horizons, New Thoughts – The Hans India

A century has elapsed since the first successful brain tumour surgery was performed by the "" FATHER OF NEUROSURGERY "" DR HARVEY CUSHING.

In the following 70 years progress was made in all basic aspects of diagnosis and management of brain tumours.

The introduction of CT SCAN in 1971 the brain tumours diagnosis became fast,accurate,specific and easier. The lengthy , laborious,risky and invasive investigative procedures became the things of past.

In INDIA about 40-50,000 people are diagnosed with brain tumours and successfully managed with very good results.

Even then the fear of brain tumour diagnosis and pessimism regarding the surgery outcome are prevalent even today.

The popular impression in general public is that brain tumours are VERY COMMON & all are UNIFORMLY CANCEROUS is without scientific basis.

In fact brain cancers incidence is 2-3% per one lakh population,amounting to LESS than 2% of all cancers in human body.

It is very important to note that only ONE THIRD (1/3)of are all brain tumours are cancerous while there about 125 varieties of such .

Equally important to state that chances of any person to develop a MALIGNANT TUMOUR in their life span is LESS Than 1% .

Presenting symptoms are::

Morning headaches mainly in forehead

Vomitings

Double vision

Epilepsy

Memory disturbances

Loss of vision , smell , hearing particularly ONE SIDE

weakness of one half of body

Swallowing difficulty

Walking disturbance

Unclear speech

Menstrual cycle irregularity

Drowsy or unconscious

INVESTIGATIONS ::

Ct scan brain: PLAIN & CONTRAST MRI BRAIN WITH CONTRAT PET SCAN BRAIN rarely

Causative factors of brain tumours::

For a long time it was said to be UNKNOWN

Now with improved research and surveillance few causes are mentioned like:

1 Stress

2. Exposure to radiation

3. Exposure to chemicals like PESTICIDES, OIL PRODUCTS, RUBBER , CHLORINATED INDUSTRIAL SOLVENTS

4. Genetic factors and family history

5. Life style choices like Wrong diet disrupted sleep Sedentary life style Alcohol SmokingObesity

6. Vitamin deficiency like Vitamin c, beta carotene , folate

Brain tumours can develop in all AGE GROUPS mainly CHILDREN & ADULTS

Brain tumours are mainly two Varieties

PRIMARY & SECONDARY

PRIMARY: Tumours developing in brain , brain coverings & cranial nerves.

SECONDARY: Also known as METASTATIC TUMOURS from other parts of body like THYROID ,LUNG, BREAST , KIDNEY & INTESTINES secondary tumours amount to 40% of total brain tumours.

Once brain tumours are confirmed the line of treatment is SURGERY.

Nowadays tumours of less than 2 CENTIMETRES size are managed with radiotherapy if there is no significant brain compression.

Advances in surgical techniques and surgical equipment like NEURONAVIGATION, ULTRASOUND SURGICAL ASPIRATOR , OPERATING MICROSCOPE, intraoperative MRI and CT Scan, cortical mapping and AWAKE PRECEDURES have made possible access to & total removal of tumours with presentation of vital brain functions.

Of the primary brain tumours there are TWO IMPORTANT DIVISIONS.

1. CANCEROUS or MALIGNANT

2. NONMALIGNANT of BENIGN

BENIGN tumour are mostly removed completely with total CURE to patients. Some residual tumours in a critical brain area are managed with latest radiation methods.

Cancerous tumours are excised to the maximum possible without compromising important brain functions followed by adjuvant latest modalities of treatment.

The most malignant primary brain tumour called as GLIOBLASTOMA MULTI FORME was associated with poor outcome and testing the nerves of affected patients as well as treating neurosurgeons.

In fact almost half of these patients are alive at 2 YEARS an impressive result considering previous survival was thought to be LESS THAN A YEAR!!!!

It is no exaggeration to state that few lucky patients with GLIOBLASTOMA are living for 5,10,20 years

This is possible with advances in several areas like :

MOLECULAR ONCOGENESIS with identification of deletions in chromosome segments 1P &2Q

ADVANCES in imaging like functional localisations,spectroscopy ,diffusion and perfusion measurements ,diffusion tensor imaging to visualise white fibre tracts

Effectiveness of CHEMOTHERAPY and delivery of drugs placing catheters and TARGETED THERAPY

Most recently STEM CELLS have been used to target brain tumours

MULTI DISCIPLINARY approach in addressing the diversity and complexity of brain tumours is the key for successful results

In the few important points to remember:

1. NOT ALL BRAIN TUMOURS ARE CANCEROUS

2. Whole skull is NOT OPENED during surgery

2.brain tumour surgery is reasonably SAFE

3. Most of the times patient is CONSCIOUS after surgery

4. Within 12 hours patients are given feeds

5. Mobilisation at the earliest

6. Early diagnosis and treatment is mandatory for good results

7.Present day RADIOTHERAPY techniques are SAFE DELIVERS HIGHER DOSES IN PRECISE LOCATION & LEAST DAMAGE TO THE SURROUNDING NORMAL BRAIN STRUCTURES

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Brain Tumours New Horizons, New Thoughts - The Hans India

Top 5 Lab-Grown Meat Stocks to Invest In ([month] [year]) – Securities.io

Can Meat Become Animal-free?

Since the dawn of civilization, food has come from two sources only: plants and animals. The hunter-gatherers got plants from foraging and hunting. The later farming culture would plant crops and raise livestock.

Meat consumption has been part of most food cultures ever since. So while veganism is definitely a growing trend, there are a lot of consumers that are very reluctant to give up meat. There are also a lot of vegans avoiding meat consumption over ethical grounds (animal rights) but who would love a suffering-free meat option.

And there is also the environmental concern. Cattle farming is a massive methane producer (a powerful greenhouse gas) and also a massive consumer of land and water.

This is why a new category of innovative startups is working on an alternative, with $2B invested in the sector in 2022. What you could grow in a lab is the final product, animal muscle tissues, without having to ever kill an animal.

Growing a steak directly in a lab is far from an easy task. Muscles are complex tissues that are hard to replicate artificially. And most of the culinary qualities come from an elaborate mix of different tissues, highly specialized cells, and a complex chemical mix.

The first problem is acquiring good stem cell lines. It can be a technical and expensive process.

The next issue is having the muscle cells grow in the form of a solid and tasty steak, instead of a half-liquid mush of cells. The solution is to use scaffolding, using material like cellulose or artificial material to provide the shape of the future meat. The difficulty of missing blood vessels in the meat is an extra complication.

And lastly, there is the question of cost. The lab-grown meat industry uses a lot of high-tech solutions and highly-trained scientists. But it has to compete with just feeding a cow and then killing it.So scaling-up and cost-efficient methods are a must for the product to go beyond a small niche.

This list has been made from a subjective analysis of assessing technology and the financial position of the companies. They are ordered from largest to smallest market capitalization. This is for educational purposes and not investment advice.

Tyson is a giant in food production, especially meat products, providing 20% of the meat consumed in the US. So this is an investment that might be putting off investors seeing it as an ethical issue.

It is nevertheless a large investor in alternatives to meat through its venture capital branch, Tyson Venture.

It includes a 5% stake in plant-based meat substitute Beyond Meat and investments in Future Meat Technologies and Upside Foods. Upside food became a $1B company in 2022 and Future Meat reach a cost of $7.7/pound of chicken in 2021.

Tyson also invested in mushroom fermentation technology, genomic food safety, a food ordering app, and plant-based shrimp products.

Tyson Food is a $21B company, with 2022s revenues of $53B and $3.4B in net income. This makes it a very safe bet for investors looking for exposure to meat-substitute, both plant-based and lab-grown.

If society starts to turn away from conventional meat products, Tyson will be able to rely on its investment to keep its business stable. And if it does not happen, it will continue to benefit from its dominant position in the traditional meat market.

Another meat giant, but from Brazil, with 250,000 employees. While it is primarily focused on meat, it is also involved in afferent business like cold chain, leather products, collagen and logistics, for a total of 42 brands.

The company has invested $100M in 2021 for acquiring Spanish startup BioTech Foods and building an R&D center in Brazil. Commercial production is expected to start in 2024.

In 2021, it also acquired Dutch company Vivera, Europes largest independent plant-based food company, for $341M, adding to a previous similar acquisition of Seara. All significant investments for the $7.8B company.

As for Tyson, this is a bet on dominant meat processors staying the leader of the industry, either with traditional products or with new alternatives. It also provides exposure to South American and European markets.

Agronomics is a venture fund focused on lab-cultivated cells.

This includes lab-grown meat, but also alternatives to leather, eggs, dairy, as well as plant-based alternative, lab-cultivated chocolate, lab-cultivated cotton, and lab-cultivated pet food.

The portfolio is quite diverse, with various geography, segment and startup maturity and the largest investment in one companyjust 11.4% of the total portfolio, and most below 5%.

Source: Agronomics

The company was a pioneer in the field, starting in 2018.So far, gross IRR (Internal Rates or Returns) have been an excellent 23%, with Agronomics Limited leading 14 funding rounds.

This company offers an interesting option for diversified exposure to the sector, while letting VC specialists handle the research and pick what they consider the most interesting deals.

Another venture focused on innovative food products. The company was founded by Brendan Braziers, one of the co-developer of the Beyond Meat burger.

It is currently invested in 18 companies, including Eat Just, the first company in the world to have commercialized lab-grown meat (approved in 2020 in Singapore). The rest of the portfolio includes lab-grown meat, eggs, coffee, seafood, dairy, honey, gelatin, and chocolate.

Like for Agronomics Limited, as it only invests in pre-revenue startups, it is too early to use earnings or cash flow as a metric. It is a bet that lab-grown meat will reach the point where it is widely consumed and is profitable thanks to a decrease in costs and technological improvements.

Together, these 2 venture investments can offer very diversified exposure to lab-grown food products.

Also formerly known as MeaTech 3D Ltd. The company has 80 employees, with a presence in Israel, Belgium, and the USA, and raised a total of $54M. It is also one of the rare lab-grown meat companies that have not been acquired by a larger company and chose to be publicly listed.

Steakholder relies on tissue 3D printing for the production of its meat and submitted 18 patents on that topic (4 patents granted so far). It should allow it to fully replicate the look and texture of full-animal meat, aka structured meat.

The company is aiming to submit its products to regulators in early 2023 in Singapore and in late 2023 for the USA and EU. So the company is, for now, pre-revenue but could reach commercialization soon.

With barely a double-digit market cap, Steakholder is a bet that their 3D printing technology can allow for a superior product, quick growth and more fundraising.

The company had $11M in cash in Q3 2022, for a quarterly loss of $2.5M. The stock listing might be forced to move from NASDAQ to the OTC market as it has recently been trading below $1/share.

Investors interested in that sector can choose between a few different strategies.

The first one is to count on the dominant meat sellers to keep their grip over the market, through their marketing firepower, distribution network, and deep pocket. In this context, lab-grown meat would not really change the market structure, just the products sold.

Another option is to hope for newcomers to be more innovative and efficient, and able to create a whole new segment that they will come to dominate. In that case, if the bet is on the sector in general, investment in diversified venture firms allows to not have to pick a winner and just let VC do the leg work of research and due diligence.

Lastly, investing directly in individual companies is an option. For now, the choice is quite limited, but many of the currently private cultured meat companies will try to IPO in the future. This can be riskier, but also more profitable if the stock selection turns out to be the right one.

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Top 5 Lab-Grown Meat Stocks to Invest In ([month] [year]) - Securities.io

When to Use Second-Line CAR T-cell Therapy for Relapsed … – Targeted Oncology

Gilles Salles, MD

Chief of Lymphoma Service

Steven A. Greenberg Chair

Memorial Sloan Kettering Cancer Center

New York, NY

Targeted OncologyTM: How do the National Comprehensive Cancer Network (NCCN) guidelines recommend treating patients with relapsed/refractory diffuse large B-cell lymphoma (DLBCL) based on the outcomes of first-line therapy?

SALLES: [Looking at] the NCCN guidelines, for patients with the intention to proceed to autologous stem cell transplant (ASCT), second-line therapy is divided by complete responders with ASCT, partial responders [who] usually go to CAR [chimeric antigen receptor] T-cell therapy, and those with progressive disease who will go to salvage therapy or CAR T-cell therapy.1 Patients with relapsed disease within 12 months, or primary refractory disease, should envision CAR T-cell therapy and the nontransplant candidates will go to a couple of suggested regimens.

If we go back to those patients with the intention to treat with CAR T-cell therapy, we have to think of patients a little differently from [the way one is] used to thinking. Were used to seeing patients [in terms of being] eligible or ineligible for ASCT. [Now,] for these [patients relapse] early, [we have to ask if they] are eligible for CAR T-cell therapy and decide who is more [optimal] for CAR T-cell therapy. Thats probably a good discussion [to have]. In this case, we have both axicabtagene ciloleucel [axi-cel; Yescarta] and lisocabtagene maraleucel [liso-cel; Breyanzi] available for patients.

At what point can CAR T-cell therapy be used for patients with relapsed/refractory DLBCL?

Regarding their [FDA] approvals, axi-cel was approved for patients who are refractory to first-line therapy or relapse within 12 months of first-line chemoimmunotherapy.2 The way we all interpret that is 12 months from the end [of first-line therapy], though initially some of the trials [did otherwise]. Liso-cel has a slightly different label: refractory disease or first-line relapse within 12 months of first-line therapy, then there is an addendum which is based on the study: refractory disease to first-line chemoimmunotherapy or relapsed after first-line chemoimmunotherapy and not eligible for ASCT.3

For axi-cel, the ZUMA-7 trial [NCT03391466] was taking patients from the time of relapse, [performing] apheresis on the patient, bridging them with steroids but not with chemotherapy, which may make [a difference].

What were the efficacy outcomes of the phase 3 trials investigating second-line CAR T-cell therapy?

[There were] 3 trials [of CAR T-cell therapy for DLBCL], ZUMA-7, BELINDA [NCT03570892], and TRANSFORM [NCT03575351].4-6 Patients were in the range of 55 to 60 years of age [on these trials]. They had the same criteria of eligibility; all these patients [relapsed after] less than 12 months. In ZUMA-7, the only bridging therapy was steroids whereas BELINDA, the one with tisagenlecleucel [tisa-cel; Kymriah] and TRANSFORM with liso-cel were offering the possibility of 2 or 3 cycles of chemotherapy as bridging therapy.

Two-thirds to three-quarter of patients were refractory, [and approximately] 25% were relapsed [across these studies]. The median follow-up was quite different; [approximately] 2 years for ZUMA-7, 10 months for BELINDA, and 6 months at the time of publication of TRANSFORM. The complete response [CR] rate to CAR T-cell therapy in ZUMA-7 was 65%, and the CR rate with ASCT was 32%.4 With BELINDA there were no difference between the 2 groups, a CR of 28% [in each arm],5 and with TRANSFORM [the liso-cel had a] 66% CR rate which is identical to ZUMA-7 and 39% with ASCT.6

Two of the studies were positive, the third one is negative. If you want to know why is the third one was negative, is it a question of product, is it a question of trial design, is it a question of delays in manufacturing the product? I think there were many explanations raised. I personally think there was not one single explanation; it was a mixture of different explanations. Tisa-cel [is an effective] primary CAR T-cell therapy for children with acute lymphoblastic leukemia, so its a good [therapy], but in this DLBCL setting it may be inferior, and there are some data from a registry study coming from [France] suggesting that it is inferior to axi-cel.7

[For ZUMA-7, the PFS [progression-free survival] rate at 24 months was 46% for axi-cel versus 27% for ASCT.4 In BELINDA [PFS data were] not provided, [so PFS in both arms were] not reached,5 and [for TRANSFORM] we have a 12-month PFS rate of 50% vs 33%, so a highly significant difference for 2 [of these trials].6 So its a significant change for early relapse, and potentially for later [relapse].

REFERENCES

1. NCCN. Clinical practice guidelines in oncology. B-cell lymphomas, version 2.2023. Accessed March 23, 2023. https://bit.ly/3TEXEqA

2. FDA approves axicabtagene ciloleucel for second-line treatment of large B-cell lymphoma. News release. FDA. April 1, 2022. Accessed March 23, 2023. https://bit.ly/3ngfNPF

3. FDA approves lisocabtagene maraleucel for second-line treatment of large B-cell lymphoma. News release. FDA. June 24, 2022. Accessed March 23, 2023. https://bit.ly/3TBFcPE

4. Locke FL, Miklos DB, Jacobson CA, et al. Axicabtagene Ciloleucel as Second-Line Therapy for Large B-Cell Lymphoma. N Engl J Med. 2022;386(7):640-654. doi:10.1056/NEJMoa2116133

5. Bishop MR, Dickinson M, Purtill D, et al. Second-Line Tisagenlecleucel or Standard Care in Aggressive B-Cell Lymphoma. N Engl J Med. 2022;386(7):629-639. doi:10.1056/NEJMoa2116596

6. Kamdar M, Solomon SR, Arnason J, et al. Lisocabtagene maraleucel versus standard of care with salvage chemotherapy followed by autologous stem cell transplantation as second-line treatment in patients with relapsed or refractory large B-cell lymphoma (TRANSFORM): results from an interim analysis of an open-label, randomised, phase 3 trial. Lancet. 2022;399(10343):2294-2308. doi:10.1016/S0140-6736(22)00662-6

7. Bachy E, Le Gouill S, Di Blasi R, et al. A real-world comparison of tisagenlecleucel and axicabtagene ciloleucel CAR T cells in relapsed or refractory diffuse large B cell lymphoma.Nat Med. 2022;28(10):2145-2154. doi:10.1038/s41591-022-01969-y

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When to Use Second-Line CAR T-cell Therapy for Relapsed ... - Targeted Oncology

Rise in Prostate Cancer Cases Contributes to Challenges in Care – Targeted Oncology

Murugesan Manoharan, MD, FRACS

Troubling news about prostate cancer emerged from the American Cancer Society (ACS) in January. In its Cancer Statistics 2023 study1, published in the journal CA: A Cancer Journal for Clinicians, ACS scientists announced:

These findings are due in part to the US Preventive Services Task Forces 2012 recommendation to cease PSA screening in all men. Since then, early diagnosis and treatment of prostate cancer has dropped, while advanced prostate cancer cases have begun a steady rise.

I have observed several factors in play at Miami Cancer Institute as we respond to the challenge of prostate cancer.

Cost of PSA Screening

I concur with the ACS recommendation that men of all ages should have an opportunity to make an informed decision about whether prostate cancer screening is right for them. Balanced and unbiased counsel from the physician is vital. However, the cost of testing may be a barrier for some patients, as many insurance plans do not cover it. I have observed that wealthier patients in urban areas are more likely to have access to timely screening, while lower-income and minority individuals do not. The latter group includes many of my patients in the Haitian American community, who have a significant incidence of aggressive prostate cancer.

Plentiful Treatment Options

The array of prostate cancer treatments includes robotic surgery, external beam radiation including proton beam therapy, brachytherapy, cryotherapy, high-intensity focused ultrasound (HIFU), laser ablation, hormone and other drug therapy, chemotherapy, immunotherapy, and more. Direct-to-consumer marketing touting these various treatments can confuse and overwhelm patients. Again, careful consultation with an unbiased urologic oncologist is critical.

Image Credit Sheitipaves [stock.adobe.com

FDA Reviews

While the US is quite advanced in prostate cancer treatment, The FDAs ultra-cautious approach to approvals results in a lag in new-technology adoption.

For example, prostate specific membrane antigen (PSMA PET Imaging, which can accurately detect the spread of prostate cancer spread using a radioactive tracer, has been in use internationally since around 2014, but the FDA delayed its broad national approval of this technology until 2021.

High Intensity Focused Ultrasound (HIFU) therapy was studied as early as the 1940s and researchers focused on HIFU for the prostate in the 1990s. The treatment was approved in more than 20 countries, including Canada and Australia, before finally receiving FDA approval in 2015.

Last, the NanoKnife system, which employs low-energy, direct-current electrical pulses to destroy cancerous cells,was first made commercially available in 2009 but the FDA approved a pilot study only in 2019.

These technologies were widely used in cancer centers around the US prior to full FDA approval but since they werent covered by insurance, they were out of reach for many patients who could have benefited.

Promoting Good Quality-of-Life

Death isnt the only outcome of a prostate cancer diagnosis. The statistics dont account for the pain, suffering, and inconvenience patients may endure while undergoing treatment. My team and I focus on helping patients maintain a good quality of life while we work towards a cure. Our patients express several priorities as they prepare for prostate cancer treatment:

A quick recovery: patients want to get back to work and everyday living. Technological advances such as minimally invasive surgery (sometimes with a single small incision) help make this possible. Many patients go home 24 hours after surgery. Once their pain can be managed without narcotics, they can usually resume driving and other daily tasks.

Reliable urinary function: patients frequently express concerns about incontinence. Twenty years ago, some 10 percent of patients were left incontinent by prostate surgery. Because we are now able to better protect the nerve bundles and urinary sphincter during surgery, 98 percent of patients do not need pads one year after surgery.

A healthy sex life: while measuring sexual potency is subjective, I advise patients that if they are potent before surgery, theres a 75 to 90 percent chance they will remain potent after nerve-sparing surgery.

Managing treatment: traditional radiation treatments can require up to 6 weeks of daily hospital visits, a burdensome task for patients who are trying to hold down a job. Hyperfractionated radiotherapy uses higher doses of radiation spread over fewer days, allowing patients to keep a regular work schedule. Ablation therapy requires even less of a time commitment.

Novel treatment strategies

Novel treatment like theranostics are on the rise. Theranostics combines therapeutic, radioactive pharmaceutical particles with diagnostic imaging to examine cancerous cells. In prostate cancer patients, a PSMA PET scan is done to evaluate for metastatic disease. PSMA, or prostate-specific membrane antigen, is expressed by virtually all prostate cancers and its presence locates the cancerous cells accurately. When these cells and receptors are located, a theranostic medicine such as Lutetium-177 in combination with PSMA is administered, which binds to and kills the cancerous cells. Its use is currently limited to prostate-specific membrane antigen-positive metastatic castration-resistant prostate cancer.

Training

As prostate cancer diagnoses continue to rise, todays physicians have a duty to prepare the next generation in the fight. Miami Cancer Institute, in concert with Florida International Universitys Herbert Wertheim College of Medicine, offers a two-year Urologic Oncology fellowship covering all treatment modalities.

We also work with Year 3 and 4 medical students who havent yet chosen a specialty. Its my job to introduce them to the challenges of our super-specialty and pique their interest in pursuing urologic oncological surgery.

Lastly, we support working physicians who desire to continue their education in the specialty. My colleagues and I offer surgical observation opportunities for local physicians as well as participate in international training programs.

The advent of teleconferencing has created exciting new training opportunities. We offer bimonthly telemedicine webinars through Baptist Urological Academy to an international audience. Many participating physicians and fellows become recognized urologic oncologists in their own countries.

Managing prostate cancer starts with screening and early diagnosis but extends into the effective management of prostate cancer. It requires constructive participation of all involved in the prostate cancer management including the government, health institutions, physicians, health care staff and most importantly, the patients.

REFERENCES

1, Siegel RL,Miller KD,Wagle, NS,and Jemal A, A.Cancer statistics, 2023.CA Cancer J Clin2023;73(1):17-48. doi:10.3322/caac.21763

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Rise in Prostate Cancer Cases Contributes to Challenges in Care - Targeted Oncology

MRI-guided Radiation Therapy Systems Revenue to Top US$2.89 … – GlobeNewswire

Rockville, March 27, 2023 (GLOBE NEWSWIRE) -- The market for MRI-guided radiation therapy systems is currently valued at US$ 545.1 million and is anticipated to generate US$ 2.89 billion in sales by the end of 2033. According to Fact.MR study, sales of MRI-guided radiation therapy systems will significantly increase at a 18.1% CAGR over the next 10 years.

Since MRI-guided radiation therapy systems are widely used in the treatment of cancer, the rising incidence of various malignancies is anticipated to significantly boost market growth over the course of the forecast period. It is also projected that rising capital spending on establishing healthcare infrastructure in developing economies would increase shipments of MRI-guided radiation therapy equipment in the future.

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Drivers

Restraints

Trends

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Regional Landscape:United States is expected to account for a substantial share in the market. Various factors such as developed healthcare infrastructure and the significant presence of reimbursement policies in the United States are expected to boost the adoption of MRI-guided radiation therapy systems.

Competitive LandscapeMRI-guided Radiation therapy systems market is highly consolidated. Companies such as Elekta AB and ViewRay are dominating the global market and currently, account for around 80% of the global market share.

In addition to this, companies are receiving FDA approvals to expand their sales potential across various countries.

Key Companies Profiled

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Key Questions Covered in the MRI-guided Radiation Therapy Systems Market Report

Check out more related studies published by Fact.MR Research:Hormone Replacement Therapy Market Size: The global hormone replacement therapy market size is estimated at USD 18.4 Billion in 2022 and is forecast to surpass USD 32.8 Billion by 2032, growing at a CAGR of 5.9% from 2022 to 2032.

Dual Therapy Stent Market Sales: The global duel therapy stent market sales valued at USD 11.09 Billion in 2022. The market is estimated to surpass a valuation of USD 23.07 Billion by 2032. The forecast duration of this report is 2022- 2032.

Rheumatoid Arthritis Stem Cell Therapy Market Share: The global rheumatoid arthritis stem cell therapy market share account for a share of USD 23.42 Billion in 2022. The market is anticipated to surpass the valuation of USD 33.30 Billion by end of the forecast period i.e. 2032. The rheumatoid arthritis stem cell market is expected to grow with a CAGR of 4.5 %.

Dual Antiplatelet Therapy Market Growth: Emergence of more effective oral and other anticoagulants may also hamper the market growth. In addition, high cost associated with the therapy and lack of its awareness in various regions across the globe will possibly confine the dual antiplatelet therapy market growth.

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Second-line Axi-cel Elicits OS Benefit in Relapsed/Refractory LBCL – OncLive

Image Credit: Dr_Microbe - stock.adobe.com

Axicabtagene ciloleucel (axi-cel; Yescarta) produced a statistically significant improvement in overall survival (OS) compared with standard-of-care (SOC) therapy in patients with relapsed/refractory large B-cell lymphoma (LBCL) within 12 months of completion of first-line therapy, according to data from the primary OS analysis of the phase 3 ZUMA-7 trial (NCT03391466).1

Investigators plan to present full results from the OS analysis at an upcoming medical meeting.

Prior data from ZUMA-7 supported the FDA approval of axi-cel for the treatment of adult patients with LBCL that is refractory to first-line chemoimmunotherapy or relapses within 12 months of first-line chemoimmunotherapy in April 2022.2

Findings for the primary end point of event-free survival (EFS) showed that at a median follow-up of 24.9 months, axi-cel generated an estimated median EFS of 8.3 months (95% CI, 4.5-15.8) compared with 2.0 months (95% CI, 1.6-2.8) with SOC treatment (HR, 0.40; 95% CI, 0.31-0.51; P <.0001). The estimated 18-month EFS rates in the experimental and control arms were 41.5% (95% CI, 34.2%-48.6%) and 17.0% (95% CI, 11.8%-23.0%), respectively.

Additionally, axi-cel elicited an objective response rate (ORR) of 83% (95% CI, 77%-88%) vs 50% (95% CI, 43%-58%) for SOC.

The randomized, open-label, global, multicenter, phase 3 ZUMA-7 study enrolled 359 patients with relapsed/refractory LBCL within 12 months of first-line therapy.3 First-line treatment needed to consist of an anti-CD20 monoclonal antibody, unless the investigator determined that tumor was CD20 negative, and an anthracycline-containing chemotherapy regimen.

Patients were excluded from the trial if they had a history of malignancy other than non-melanoma skin cancer or carcinoma in situ unless they were disease free for at least 3 years; received more than 1 line of therapy for LBCL; or had a history of autologous or allogeneic stem cell transplant.

Patients were randomly assigned 1:1 to a single infusion of axi-cel or SOC treatment with platinum-containing salvage chemotherapy followed by high-dose therapy and autologous stem cell transplant in responders.

Along with the primary end point of EFS, OS was designated as a clinically important prespecified key secondary endpoint. Other secondary end points included ORR, patient-reported outcomes, and safety.1

Regarding safety, findings from ZUMA-7 showed that axi-cel displayed a safety profile consistent with previous studies. Among the 168 patients evaluable for safety who received axi-cel, grade 3 or higher cytokine release syndrome (CRS) was reported in 7% of patients, and neurologic events occurred in 25% of patients. In the SOC arm, 83% of patients had high-grade adverse effects, mostly consisting of cytopenias.

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Second-line Axi-cel Elicits OS Benefit in Relapsed/Refractory LBCL - OncLive

Roundtable Discussion: Krishnan Debates the Rationale For … – Targeted Oncology

Amrita Krishnan, MD (Moderator)

Director of the Judy and Bernard Briskin Center for Multiple Myeloma Research

City of Hope

Duarte, CA

CASE SUMMARY

A 60-year-old White woman was diagnosed with stage II multiple myeloma. She has a history of being a heavy smoker, with a gain (1q21) of cytogenetics and an ECOG performance score of 0. At the time, she was treated with bortezomib (Velcade), lenalidomide (Revlimid), and dexamethasone (VRd) induction therapy, followed by autologous stem cell transplantation. She achieved a complete remission with VRd and transplant and was minimal residual disease negative, then placed on lenalidomide maintenance therapy.

At a follow-up after 2 years on lenalidomide maintenance, the patient reported having severe fatigue and pain in her back and legs, which was disrupting her ability to continue working full time. A PET scan shows vertebral fracture at L1, lesions in both femurs, and an ECOG performance score of 1. Her current lab levels are now the following:

KRISHNAN: We have [a case here] with a biochemical and clinical progression.

Some of the [factors] to talk about are [whether] they are early vs late relapse, and [whether] that influences your decisions in terms of therapy?

CHHABRA: I tend to think patients who receive lenalidomide [Revlimid] maintenance, if they progress less than 36 months, [are considered an] early relapse patient. If they did not receive maintenance, then 18 months [is when I would consider them an early relapse patient]. Thats been my rule of thumb.

Although Ive also heard that 24 months is a good cutoff between early and late relapse. My preferred second-line regimen is not influenced by early vs late relapse, because Ive been using daratumumab [Darzalex]-based therapy, typically in combination with carfilzomib [Kyprolis] and dexamethasone [DKd]. If I have a clinical trial that is specifically for patients in the high-risk category, early relapse [is considered] less than 18 monthssuch as the allogeneic transplant trial, [with patients who] had less than 18 months from transplant.

KRISHNAN: Lets see [whether] every-one else agrees with you in terms of [the following]: (1) early relapse and (2) it sounds like youre a big DKd fan. Dr Lashkari, are you on the DKd bandwagon for first relapse?

LASHKARI: I would certainly recognize this as being a more aggressive relapse in a patient. I think youre right, [that] if this patient were treated initially, we would consider giving a daratumumab-based induction therapy, but she did very well, which is interesting. She had a complete response, and one can argue that if someone became [minimal residual disease] negative, it almost doesnt matter how you get there if you get there, because that in and of itself tends to portend a good prognosis. Considering someone relapsing within a couple years; invariably, this patient relapsed within 2 years because we see an M spike of 1.98 g.

Biochemical progression would have been defined as having greater than 0.5 g/dL, and that may have developed within a year from time of transplant. I would consider this patient to be an early relapse with aggressive clinical features, but I would certainly rebiopsy them to see what other clones are present.

In terms of treatment options, its interesting to get the information to come back. I dont know [whether] we can guide based on the information that comes back necessarily, unless perhaps they had an 11;14 translocation, in which case you can consider a venetoclax [Venclexta]-based treatment. I probably wouldnt even consider that for such a patient if they havent received a CD38 antibody. DKd is reasonable, and another option would be to go to daratumumab, pomalidomide [Pomalyst], and dexamethasone [DPd] as another option.

KRISHNAN: [Are there] any other takers for DPd instead? It sounds like everyone would agree with daratumumab, but its really what the partner would be. Would anyone pick DPd?

CHAND: I tend to use more DPd compared [with] DKd, because in my experience, scheduling and monitoring is a little easier on this regimen. It tends to work well in patients who are refractory to lenalidomide. I just find it more tolerable. The cytopenias are a little bit less compared [with] the DKd, too.

AMBIKA: I tend to use more DPd, toofor the same reasons as [others mentioned]and use carfilzomib, cyclophosphamide, and dexamethasone [KCd] as the next-line [treatment], like carfilzomib plus cyclophosphamide. I went through that route in a few patients and they did OK.

DEKKER: I typically use carfilzomib. [Patients] come to [the] infusion center already, so they will get carfilzomib as well. Plus, carfilzomib is a potentially more powerful agent, and I use it once a week. If [patients] develop cardiac toxicities [within the first 2 or 3 weeks], I back off. If they dont, they typically would do well and tolerate it for a long time.

CHAUDHARY: Myelosuppression is less with DPd, in my experience, if you dose reduce the pomalidomide.

KRISHNAN: It sounds like were pretty much split [between] DPd and DKd, both being valid regimens in that early 1- to 3-[year] relapse setting. What Im hearing from people is to pick your adverse events [AEs], as well, and Im guessing [that] if someone had prior cardiac history, more clinicians would [choose to use] DPd. But let me ask a more challenging question. Ive not heard a single person say IPd [isatuximab-irfc (Sarclisa), pomalidomide, dexamethasone] or IKd [isatuximab, carfilzomib, dexamethasone]. Is anyone using isatuximab?

MURAD: Thats our preferred drug, but thats definitely a reasonable option. I dont think theres any problem with carfilzomib.

DEKKER: I use daratumumab and isatuximab. Clearly, subcutaneous administration is a plus, but I had a few patients who had a cutaneous reaction or had skin conditions, so I decided to go with isatuximab.

KRISHNAN: Do most [of you] feel theyre comparable, or do [you] feel that theres a difference?

DEKKER: I think theyre probably comparable. I do think [that] sometimes later products may have some advantages, because they know the issues with the original product and tried to tweak the molecule a little bit. So theoretically, I would say isatuximab may be a bit better, but the problem is daratumumab is good enough on its own, so Im doubtful we will find much of the difference. We could keep analyzing the data and find a subtype, a subgroup here or there, or a special population that will be beneficial. But for both [medications, it is] likely all the data will come down to the same ballpark.

KRISHNAN: Im just curious, Dr Dekker, when you say you think isatuximab is better, is it in terms of [AEs] or efficacy?

DEKKER: Both, because again, they look at the molecule, they see off-target effects, and they see where the escape mechanisms are. So when they manufacture the molecule, all this minor tweaking in the design may help to both improve efficacy and decrease toxicity. But how clinically significant that is, how truly that will translate into something meaningful in clinical practice without head-to-head datathat will be impossible to determine.

KRISHNAN: So if I could summarize, most [of you] are convinced [of using] CD38 antibody without, and finding them interchangeable depending on their practice and some specific patient issues. Then its really the partner to that antibody, right?

MUKHERJEE: Yeah, Im comfortable with using daratumumab now and usually do introduce that in the second line. Depending on the other comorbidities of the patient, if they have cardiac issues, then I would go with pomalidomide. If not, then carfilzomib. Im comfortable with daratumumab, but Im not that comfortable with isatuximab yet.

KRISHNAN: Thats interesting. I will give you a look to the future. Theres a phase 3 trial ongoing, [comparing] DPd[with] teclistamab-cqyv [Tecvayli], pomalidomide, and dexamethasone, so that will be interestingthe T-cell engager, the new drug that just got approved, then being moved into that early relapse setting. I think many of you are familiar with the CARTITUDE-1 trial [NCT03548207], also in the earlier relapse setting.1

What will be interesting [is that in 2024 or 2025], myeloma may look completely different. We [may] see T-cell engaging therapy moved up earlier, in part because the CD38 antibodies are [also] going to be moved up even earlier, in terms of their use in induction therapy. I think that is the challenge in myeloma.

DISCUSSION QUESTION

KRISHNAN: I think the [PFS data for these regimens are] what people responded to, [those] who wanted to use carfilzomib as the partner to CD38. In the IKEMA trial [NCT03275285], which compared IKd vs Kd [carfilzomib and dexamethasone], the PFS is decent and youre getting almost 3.5 years out of a first relapse regimen [From the Data2].

In the CANDOR trial [NCT03158688], [the PFS is approximately] 2.5 years, [comparing DKd vs Kd].3 And then [the PFS] goes down from there in the CASTOR [NCT02136134], ICARIA-MM [NCT02990338], APOLLO [NCT03180736], and OPTIMISMM trials [NCT01734928].4-7 Interestinglyand I use a lot of DPdif you compare the PFS, its not as great at [approximately 1] year based on the APOLLO study, and IPd is the same at [approximately 1] year.5,6

DISCUSSION QUESTION

KRISHNAN: This patient did have some mild renal impairment, [as well as] the genetic risk with the [1q21 gain]. It sounds like that would push you a little bit more, as well.

LASHKARI: The 1 issue I think a lot of us have who see these patients with myeloma is that carfilzomib is a great drug, but its not without some of its own AEs in terms of cytopenias, fluid retention, and sometimes infusion reactions. And for the [patients who] are just in your office all the time, I feel for them. Thats another potential barrier, especially if youre dealing with patients who may not be as robust as others.

That is a big factor that plays into my thinking for maybe not using carfilzomib at this time. Maybe I should be changing my mind if the dataas we saw with the 2 trials evaluating carfilzomib with daratumumab or isatuximabare truly what you get out of it. Maybe that is a better option, but it may be a slightly harder sell for patients, especially those [who] value their quality of life and the amount of time that theyre not spending at your office.

KRISHNAN: I do think its a potent regimen. I tend to use it in younger patients, because I do think, in the CANDOR study, [most] of the deaths were in patients [older than] 65 [years], and more infectious death.3 In older patients, I tend to be a little more cautious about using it, and I only do it in older patients when my back is against the wall and they have really aggressive disease.

Otherwise, I do use it in younger patients with aggressive disease. In other younger patients, I try to, but to your point, a lot of younger patients tend to still be working, and coming into the office even once a week can be challenging. So lifestyle and patient preference also play an important role.

REFERENCES

1. Martin T, Usmani SZ, Berdeja JG, et al. Ciltacabtagene autoleucel, an anti-B-cell maturation antigen chimeric antigen receptor T-cell therapy, for relapsed/refractory multiple myeloma: CARTITUDE-1 2-year follow-up.J Clin Oncol. 2022;JCO2200842. doi:10.1200/JCO.22.00842

2. Moreau P, Dimopoulos MA, Mikhael J, et al. Isatuximab, carfilzomib, and dexamethasone in relapsed multiple myeloma (IKEMA): a multicentre, open-label, randomised phase 3 trial.Lancet. 2021;397(10292):2361-2371. doi:10.1016/S0140-6736(21)00592-4

3. Usmani SZ, Quach H, Mateos MV, et al. Carfilzomib, dexamethasone, and daratumumab versus carfilzomib and dexamethasone for patients with relapsed or refractory multiple myeloma (CANDOR): updated outcomes from a randomised, multicentre, open-label, phase 3 study.Lancet Oncol. 2022;23(1):65-76. doi:10.1016/S1470-2045(21)00579-9

4. Spencer A, Lentzsch S, Weisel K, et al. Daratumumab plus bortezomib and dexamethasoneversusbortezomib and dexamethasone in relapsed or refractory multiple myeloma: updated analysis of CASTOR.Haematologica. 2018;103(12):2079-2087. doi:10.3324/haematol.2018.194118

5. Richardson PG, Perrot A, San-Miguel J, et al. Isatuximab plus pomalidomide and low-dose dexamethasone versus pomalidomide and low-dose dexamethasone in patients with relapsed and refractory multiple myeloma (ICARIA-MM): follow-up analysis of a randomised, phase 3 study. Lancet Oncol. 2022;23(3):416-427. doi:10.1016/S1470-2045(22)00019-5

6. Dimopoulos MA, Terpos E, Boccadoro M, et al. Daratumumab plus pomalidomide and dexamethasone versus pomalidomide and dexamethasone alone in previously treated multiple myeloma (APOLLO): an open-label, randomised, phase 3 trial.Lancet Oncol. 2021;22(6):801-812. doi:10.1016/S1470-2045(21)00128-5

7. Richardson PG, Oriol A, Beksac M, et al. Pomalidomide, bortezomib, and dexamethasone for patients with relapsed or refractory multiple myeloma previously treated with lenalidomide (OPTIMISMM): a randomised, open-label, phase 3 trial.Lancet Oncol. 2019;20(6):781-794. doi:10.1016/S1470-2045(19)30152-4

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Roundtable Discussion: Krishnan Debates the Rationale For ... - Targeted Oncology

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