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    Study on the Efficacy and Safety of Carfilzomib in the Treatment of Multiple Myeloma
    ZHENG Boyue, FU Jiyi, WU Jiafei, WANG Jun, LI Hui
    Chinese General Practice    2025, 28 (30): 3806-3814.   DOI: 10.12114/j.issn.1007-9572.2024.0477
    Abstract435)   HTML7)    PDF(pc) (1310KB)(452)       Save
    Background

    Since its introduction in China in 2022, carfilzomib has been widely used in patients with relapsed and refractory multiple myeloma (RRMM), but there is a lack of research on its clinical efficacy and safety in the Chinese population with multiple myeloma (MM) .

    Objective

    To explore the efficacy and safety of carfilzomib in the treatment of MM.

    Methods

    This study included 53 cases MM patients who received at least two courses of carfilzomib treatment from March 2022 to September 2023 at Sichuan Provincial People's Hospital. Baseline data were collected, and all patients were treated with carfilzomib-based regimens. The starting point for follow-up was the first use of carfilzomib, and the endpoint was death, disease recurrence, or the end of follow-up. Patients were followed up through outpatient visits, hospital re-examinations, or phone calls every two months. The number of patients with stringent complete remission (sCR), complete remission (CR), very good partial remission (VGPR), partial remission (PR) and adverse reactions were recorded. The overall response rate (ORR), ≥VGPR rate, best ORR and best ≥VGPR rate were calculated to evaluate the clinical efficacy. The efficacy was analyzed in subgroups according to the number of treatment lines, extramedullary disease, Durie-Salmon (DS) staging, international staging system (ISS), renal function, and cardiovascular disease. The survival curves of progression-free survival (PFS) and overall survival (OS) were drawn by Kaplan-Meier method for survival analysis, and the survival curves were compared by Log-rank test.

    Results

    After 2 courses of treatment, the PR was 17 cases (32.1%), VGPR was 11 cases (20.8%), CR was 4 cases (7.5%), sCR was 8 cases (15.1%), ORR was 75.5% (40/53). The overall efficacy evaluation showed that the best ORR was 84.9% (45/53) and the best ≥VGPR rate was 71.7% (38/53). There was no significant difference in the overall clinical efficacy between the first-line treatment group, the first recurrence treatment group and the third-line and above treatment group (P>0.05). There was statistically significant difference in PFS survival curve among the three groups (P<0.05). There was no significant difference in OS survival curve among the three groups (P>0.05). There were no significant differences in clinical efficacy, PFS and OS survival curves between mSMART standard risk group and high-risk group, DS stage Ⅰ-Ⅲ group, ISS stage Ⅰ-Ⅲ group, extramedullary disease group and non-extramedullary disease group, cardiovascular disease group and non-cardiovascular disease group, normal renal function group and abnormal renal function group (P>0.05). Among 53 patients, 8 cases (15.1%) had infection, 7 cases (1.2%) had adverse reactions such as hypertension, arrhythmia and heart failure, 3 cases (5.7%) had gastrointestinal adverse reactions such as nausea and vomiting, 1 case (1.9%) had liver function damage, and 1 case (1.9%) had renal function damage. The incidence of adverse reactions was 37.7% (20/53) .

    Conclusion

    Carfilzomib-based chemotherapy regimens have good clinical efficacy and high safety profiles, can serve as a preferred treatment option for MM patients.

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    Prevalence of Potentially Inappropriate Medication in Older Adults with Cancer: a Meta-analysis
    XU Jialan, YAN Hong, WEN Jun, ZHOU Zitong, WANG Siyu
    Chinese General Practice    2025, 28 (30): 3815-3822.   DOI: 10.12114/j.issn.1007-9572.2024.0557
    Abstract324)   HTML12)    PDF(pc) (1233KB)(235)       Save
    Background

    The increasing phenomena of multimorbidity and polypharmacy in older adults with cancer predisposes them to potentially inappropriate medication (PIM), which adversely affects patient prognosis.

    Objective

    To systematically evaluate the prevalence of PIM in older adults with cancer.

    Methods

    The Cochrane Library, Web of Science, Embase, PubMed, CNKI, VIP, Wanfang Data, and CBM databases were searched to collect studies related to the prevalence of PIM in older adults with cancer, and the search period was from the inception of the databases to September 2024. The examined literature was independently screened, data extracted, and evaluated, and Stata 17.0 software was used to perform meta-analysis.

    Results

    A total of 36 studies with 54 prevalence estimates were analyzed, including 95 290 patients. Meta-analysis indicated that the prevalence of PIM in older adults with cancer was 44.5% (95%CI=39.2%-49.8%). The results of subgroup analysis showed that the prevalence of PIM in older adults with cancer aged 60-70 and >70 years was 44.4% and 46.1%, respectively; the prevalence of PIM in elderly male and female patients was 40.9% and 42.5%, respectively; the prevalence of PIM in patients with ≤5 and >5 diseases was 34.4% and 47.1%, respectively; the prevalence of PIM in patients with≥5 and <5 medications was 39.9% and 30.4%, respectively; the prevalence of PIM in patients with lung cancer, gastrointestinal cancer, hematologic malignancies, breast cancer, and prostate cancer was 45.6%, 39.4%, 42.0%, 39.4%, and 42.6%, respectively; the prevalence of PIM among older adults with cancer in Asia, Europe, North America, and South America was 50.2%, 45.8%, 35.7%, and 51.4%, respectively; the prevalence of PIM in patients from hospitals, databases, Dana-Farber Cancer Institute, and cancer centers was 47.6%, 43.0%, 34.6%, and 34.5%, respectively; the prevalence of PIM screened by the Beers criteria, DAE, STOPP/START criteria, EU (7) -PIM list, and the 2017 Chinese criteria was 46.6%, 16.5%, 44.6%, 60.0%, and 39.3%, respectively; the prevalence of PIM published in 2020 and before and after 2020 was 36.1% and 52.5%, respectively.

    Conclusion

    The prevalence of PIM is relatively high in older adults with cancer, at 44.5%. The prevention, screening, and intervention of potential inappropriate medication among relevant populations should be emphasized to lay a solid foundation for the health in older adults with cancer.

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    Timing of Administration and Combination Therapy of Non-steroidal Anti-inflammatory Drugs for the Prevention of Post-endoscopic Retrograde Cholangiopancreatography Pancreatitis
    WU Xiangpeng, LI Enjun, LI Xiongwei, WANG Haihong, CUI Wei, WU Xiangli, QI Weihua, HOU Senlin
    Chinese General Practice    2025, 28 (30): 3823-3830.   DOI: 10.12114/j.issn.1007-9572.2024.0716
    Abstract157)   HTML3)    PDF(pc) (1092KB)(40)       Save
    Background

    Endoscopic retrograde cholangiopancreatography (ERCP) is a standard method for the diagnosis and treatment of biliary and pancreatic diseases, but post-ERCP pancreatitis (PEP) is one of the serious complication. Non steroidal anti-inflammatory drugs (NSAIDs) may play a role in the prevention of PEP due to their anti-inflammatory and analgesic effects. To explore the appropriate timing of medication and the effect of combined medication can help reduce the risk of PEP occurrence.

    Objective

    This study aimed to evaluate the administration timing and influencing factors of NSAIDs in PEP prevention, in order to determine the best application in clinical practice.

    Methods

    A total of 866 patients who underwent ERCP in the Department of General Surgery and Oncology of Handan Central Hospital from December 2021 to December 2023 were included as the research objects. According to the random number table method, they were divided into preoperative medication group (431 cases) and postoperative medication group (435 cases). Among them, the preoperative medication group was divided into the preoperative medication alone subgroup (210 cases) and the preoperative combined medication subgroup (221 cases), and the postoperative medication group was divided into the postoperative medication alone subgroup (247 cases) and the postoperative combined medication subgroup (188 cases). In the preoperative medication alone subgroup, 75 mg diclofenac sodium was intramuscularly injected 30 min before ERCP, and in the preoperative medication combination subgroup, 100 mg indomethacin suppository was added to the anal plug at the same time; The single drug group was given 75 mg diclofenac sodium intramuscularly immediately after ERCP, and the combined drug group was given 75 mg diclofenac sodium intramuscularly and 100 mg indomethacin suppository anal plug simultaneously after ERCP. All interventions were single dose. The main outcome measures included the incidence and severity of PEP, the incidence of postoperative perforation, bleeding, and cholangitis. Multivariate Logistic regression was used to analyze the influencing factors of PEP.

    Results

    There was a statistically significant difference in the incidence of PEP among the four subgroups (P<0.05). The incidence of PEP in the preoperative medication alone subgroup was lower than that in the postoperative medication alone subgroup and the postoperative combination subgroup (P<0.05), and the incidence of PEP in the preoperative combination subgroup was lower than that in the postoperative medication alone subgroup and the postoperative combination subgroup (P<0.05) ; There was no significant difference in the severity of PEP and the incidence of adverse reactions among the four subgroups (P>0.05). The results of multivariate Logistic regression analysis showed that, BMI≥24 kg/m2 (OR=3.751, 95%CI=2.293-6.136), alcohol abuse (OR=2.624, 95% CI=1.520-4.529), diabetes mellitus (OR =2.687, 95%CI=1.559-4.634), intubation time >10 min (OR=4.229, 95%CI=2.531-7.066) and the use of double guide wire technology (OR=3.542, 95%CI=2.159-5.809) were the independent risk factors of PEP (P<0.05), B-ultrasound showed that extrahepatic bile duct dilatation was a protective factor for PEP (OR=0.573, 95%CI=0.347-0.947, P<0.05) .

    Conclusion

    BMI≥24 kg/m2, alcohol abuse, diabetes, intubation time >10 min and the use of double guide wire technology are independent risk factors for the occurrence of PEP. Preoperative prophylactic use of indomethacin suppositories and diclofenac sodium before ERCP can effectively reduce the risk of PEP.

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