Bulletin du cancer
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Dosing of anticancer drugs in adults is mostly adjusted to estimated body surface area or body weight. Dose normalisation to body size is assumed to decrease the interindividual pharmacokinetic and pharmacodynamic variability. This approach is rarely validated before approval. ⋯ Moreover, the abandon of body surface area in dosing of new drugs in phase I trials has been recommended. At the present time, body size continues to be used in the dosing of new agents in adult patients. This review presents the concepts and the limits of weight and body surface area-based dosing of anticancer drugs in adult patients.
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Trastuzumab (Herceptin), a recombinant, humanised, monoclonal-antibody that targets human epidermal growth factor receptor 2 (HER2), has been approved as an adjuvant therapy for HER2-positive early breast cancer. The aim of this study was to assess the incremental cost-effectiveness ratio of this treatment compared with adjuvant therapy alone in the French setting. A cost-effectiveness analysis was performed using a Markov state transition model. ⋯ For 1 000 patients with a 10-year follow-up, an adjuvant therapy with trastuzumab would avoid 49.7 loco-regional recurrences, 179.5 distant recurrences and 133.4 deaths. The incremental discounted cost of trastuzumab therapy over a lifetime horizon was estimated at 27594 euro per patient in association with a discounted gain of 2.27 life-years. In accordance with the techniques of economical evaluation, the utilization of trastuzumab as an adjuvant therapy in patients with early HER2 positive breast cancer improves patient survival with an acceptable cost-effectiveness ratio in the French setting (incremental cost-effectiveness ratio of 12,148 euros /LYG).
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Malignant cutaneous melanoma is the cancer which has the most increased these last ten years. His prognose is linked with melanoma thickness, tumoral ulceration and lymph node metastasis. ⋯ However, his therapeutic interest remains discussed. We discussed the used of the sentinel lymph node biopsy for malignant cutaneous melanoma with the last publications.