Pediatric Glioma Learning Project

Details

Pediatric low-grade glioma (pLGG) is the most common type of solid tumour of the central nervous system in pediatrics, with an estimated Canadian incidence of 1.41 cases per 100,000 person years. Some children with pLGG can be cured with surgery, depending on the location and features of the tumour. However, many children will experience a chronic disease course requiring chemotherapy and/or targeted treatments, and sometimes radiotherapy. Treatment of this condition is associated with challenges for patients, their families, and the health system.

Raltitrexed in patients with dihydropyrimidine dehydrogenase (DPD) deficiency

Details

Question

  1. What is the clinical effectiveness of raltitrexed in patients with complete DPD deficiency?
  2. What is the safety of raltitrexed in patients with complete DPD deficiency?

Key Message

This review identified limited evidence regarding the clinical effectiveness of raltitrexed for patients who had previously experienced adverse events following treatment with fluoropyrimidines. These studies had several limitations, most notably lacking a separate control group; therefore, the effectiveness of raltitrexed in this population is uncertain.

Limited evidence was found about the safety of raltitrexed for patients who had previously experienced adverse events with fluoropyrimidine treatment. Reported adverse events included cardiac or vascular adverse events, anemia, and nausea and vomiting. No treatment-associated deaths were reported in the studies included in this review.

No studies were identified that compared the clinical effectiveness of raltitrexed to other therapies, placebo, or no treatment comparator groups for treatment of patients who had experienced adverse events from fluoropyrimidine therapy.

This review identified evidence for people who had previously experienced severe adverse events, primarily cardiotoxicity, following treatment with fluoropyrimidines. It is unclear if these findings are appliable to patients with a complete dihydropyrimidine dehydrogenase deficiency.

Transanal Total Mesorectal Excision for Adult Patients with Rectal Cancer

Details

Question

  1. What is the clinical effectiveness of transanal total mesorectal excision for adults with rectal cancer?
  2. What is the cost-effectiveness of transanal total mesorectal excision for adults with rectal cancer?

Key Message

Transanal total mesorectal excision may result in lower rates of conversion to open procedure and a better circumferential resection margin compared with laparoscopic total mesorectal excision in adults with rectal cancer.

Transanal total mesorectal excision may be comparable to laparoscopic total mesorectal excision for cancer recurrence, survival, death, and short-term safety outcomes in adults with rectal cancer.

Total mesorectal excision may be more cost-effective than laparoscopic and open total mesorectal excision in adults with rectal cancer, but this is uncertain.

Breast Cancer Screening

Details

Question

  1. What is the clinical utility of breast cancer screening versus no screening in people at average risk for breast cancer aged 40 years and older?
  2. What is the clinical utility of breast cancer screening with different screening techniques, approaches, or intervals in people at average risk for breast cancer aged 40 years and older?
  3. What are the evidence-based guidelines regarding the use of breast cancer screening in people at average risk for breast cancer aged 40 years and older?

Key Message

We found 1 systematic review about the clinical utility of breast cancer screening versus no screening in people at average risk for breast cancer aged 40 years and older.

We found 1 systematic review about the clinical utility of breast cancer screening with different screening techniques, approaches, or intervals in people at average risk for breast cancer aged 40 years and older.

We found 1 systematic review and 9 evidence-based guidelines about the use of breast cancer screening in people at average risk for breast cancer aged 40 years and older.

Low-Dose Ipilimumab in Combination With Nivolumab or Pembrolizumab for the Treatment of Advanced Melanoma

Details

Question

  1. What is the clinical effectiveness of low-dose ipilimumab in combination with nivolumab for the treatment of advanced melanoma?
  2. What is the clinical effectiveness of low-dose ipilimumab in combination with pembrolizumab for the treatment of advanced melanoma?
  3. What is the cost-effectiveness of low-dose ipilimumab in combination with nivolumab for the treatment of advanced melanoma?
  4. What is the cost-effectiveness of low-dose ipilimumab in combination with pembrolizumab for the treatment of advanced melanoma?

Key Message

The review did not find any studies exclusively on the clinical effectiveness and safety of low-dose ipilimumab in combination with nivolumab for the treatment of advanced melanoma that met the criteria for this review.

The review found limited evidence, from 1 single-arm phase II trial of 70 adults and 1 retrospective cohort study of 9 adults, on the clinical benefits and safety of low-dose ipilimumab in combination with pembrolizumab (or nivolumab for an unspecified number of patients in the retrospective cohort study) for the treatment of advanced melanoma.

In the single-arm study, 20 of 70 enrolled patients (29%) achieved a confirmed response, including 5 complete (7.2%) and 15 partial responses (21.4%). In the retrospective cohort study, 3 of 9 patients (33%) achieved a partial response.

The review did not find any studies on the cost-effectiveness of low-dose ipilimumab in combination with nivolumab or pembrolizumab for the treatment of advanced melanoma that met our criteria for this review.

An Overview of Comprehensive Genomic Profiling Technologies to Inform Cancer Care

Details

An essential tool in precision medicine is companion diagnostics, which are medical devices used to assess critical information about the safety and effectiveness of corresponding drugs or biologic products. However, most conventional companion diagnostics are limited by their inability to test multiple genes or assess a broad range of genomic changes that can inform disease identification and care decisions.

Virtual Oncology Visits

Details

Question

  1. What are the benefits and harms of virtual oncology visits?
  2. What are the evidence-based guidelines regarding virtual oncology visits?

Key Message

Two systematic reviews, 3 randomized controlled trials and 9 non-randomized studies were identified about the benefits and harms of virtual oncology visits.

Four evidence-based guidelines were identified about virtual oncology visits.