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Bedke J.,University of Tübingen | Gauler T.,University of Duisburg - Essen | Grunwald V.,Hannover Medical School | Hegele A.,University of Marburg | And 8 more authors.
World Journal of Urology | Year: 2016

Purpose: Current systemic treatment of targeted therapies, namely the vascular endothelial growth factor-antibody (VEGF-AB), VEGF receptor tyrosine kinase inhibitor (TKI) and mammalian target of rapamycin (mTOR) inhibitors, have improved progression-free survival and replaced non-specific immunotherapy with cytokines in metastatic renal cell carcinoma (mRCC). Methods: A panel of experts convened to review currently available phase 3 data for mRCC treatment of approved agents, in addition to available EAU guideline data for a collaborative review as the plurality of substances offers different options of first-, second- and third-line treatment with potential sequencing. Results: Sunitinib and pazopanib are approved treatments in first-line therapy for patients with favorable- or intermediate-risk clear cell RCC (ccRCC). Temsirolimus has proven benefit over interferon-alfa (IFN-α) in patients with non-clear cell RCC (non-ccRCC). In the second-line treatment TKIs or mTOR inhibitors are treatment choices. Therapy options after TKI failure consist of everolimus and axitinib. Available third-line options consist of everolimus and sorafenib. Recently, nivolumab, a programmed death-1 (PD1) checkpoint inhibitor, improved overall survival benefit compared to everolimus after failure of one or two VEGFR-targeted therapies, which is likely to become the first established checkpoint inhibitor in mRCC. Data for the sequencing of agents remain limited. Conclusions: Despite the high level of evidence for first and second-line treatment in mRCC, data for third-line therapy are limited. Possible sequences include TKI-mTOR-TKI or TKI–TKI-mTOR with the upcoming checkpoint inhibitors in perspective, which might settle a new standard of care after previous TKI therapy. © 2016 The Author(s)


PubMed | University of Tübingen, Hannover Medical School, Onkologie Westerstede, Gemeinschaftspraxis fur Onkologie und Hamatologie and 7 more.
Type: | Journal: World journal of urology | Year: 2016

Current systemic treatment of targeted therapies, namely the vascular endothelial growth factor-antibody (VEGF-AB), VEGF receptor tyrosine kinase inhibitor (TKI) and mammalian target of rapamycin (mTOR) inhibitors, have improved progression-free survival and replaced non-specific immunotherapy with cytokines in metastatic renal cell carcinoma (mRCC).A panel of experts convened to review currently available phase 3 data for mRCC treatment of approved agents, in addition to available EAU guideline data for a collaborative review as the plurality of substances offers different options of first-, second- and third-line treatment with potential sequencing.Sunitinib and pazopanib are approved treatments in first-line therapy for patients with favorable- or intermediate-risk clear cell RCC (ccRCC). Temsirolimus has proven benefit over interferon-alfa (IFN-) in patients with non-clear cell RCC (non-ccRCC). In the second-line treatment TKIs or mTOR inhibitors are treatment choices. Therapy options after TKI failure consist of everolimus and axitinib. Available third-line options consist of everolimus and sorafenib. Recently, nivolumab, a programmed death-1 (PD1) checkpoint inhibitor, improved overall survival benefit compared to everolimus after failure of one or two VEGFR-targeted therapies, which is likely to become the first established checkpoint inhibitor in mRCC. Data for the sequencing of agents remain limited.Despite the high level of evidence for first and second-line treatment in mRCC, data for third-line therapy are limited. Possible sequences include TKI-mTOR-TKI or TKI-TKI-mTOR with the upcoming checkpoint inhibitors in perspective, which might settle a new standard of care after previous TKI therapy.


Hermes-Moll K.,Wissenschaftliches Institute der Niedergelassenen Hamatologen und Onkologen WINHO | Klein G.,Wissenschaftliches Institute der Niedergelassenen Hamatologen und Onkologen WINHO | Buschmann-Maiworm R.E.,Wissenschaftliches Institute der Niedergelassenen Hamatologen und Onkologen WINHO | Baumann W.,Wissenschaftliches Institute der Niedergelassenen Hamatologen und Onkologen WINHO | And 6 more authors.
Zeitschrift fur Evidenz, Fortbildung und Qualitat im Gesundheitswesen | Year: 2013

The aim of the WINHO indicators project is to describe and enhance the quality of outpatient oncology care in Germany with indicators. This paper deals with the development of a set of evidence- and consensus-based meaningful indicators to assess the quality of outpatient oncology care in Germany. These indicators are intended to be applied in assessments of quality of patient care in oncology practices, in quality reports and in peer-to-peer benchmarking. A set of 272 already existing indicators was identified through internet and literature searches. After redundancy reduction and addition of newly developed indicators for areas of ambulatory oncology care that were not yet covered, a preliminary set of 67 indicators was established. The further development of the indicator set was based on a modified version of the two-step RAND/UCLA expert evaluation method, which has been internationally established for developing quality indicator sets. The indicators were modified after the first round of ratings. After completing and assessing the second round of ratings, a set of 46 homogeneously positively rated quality indicators is now available for outpatient oncology care in Germany.


Hermes-Moll K.,Wissenschaftliches Institute der Niedergelassenen Hamatologen und Onkologen WINHO GmbH | Baumann W.,Wissenschaftliches Institute der Niedergelassenen Hamatologen und Onkologen WINHO GmbH | Zimmermann A.,Wissenschaftliches Institute der Niedergelassenen Hamatologen und Onkologen WINHO GmbH | Kleeberg U.R.,Hamatologisch onkologische Praxis Altona HOPA | And 2 more authors.
Gesundheitsökonomie & Qualitätsmanagement | Year: 2014

Aim: Measuring quality of care is increasingly accomplished with quality indicators, such as the WINHO quality indicators for oncology practices. Aim of this article is to present results of a feasibility analysis of indicators of process quality that base on data from patient charts. Method: Implementation of a feasibility questionnaire to analyze which data are available and can be collected in oncology practices for the WINHO quality indicators. 2176 questionnaires were sent to 295 doctors of WINHO partner practices, 1089 questionnaires were answered. 20 to 27 answers are present for each of the 46 WINHO quality indicators. Results: There is a large variety of documentation habits within the group of office-based cancer specialists. Altogether around 80 % of the data needed to calculate the indicators are documented. Less than 30 % of the data can be fully retrieved electronically. Much information is in continuous text, for example in physician's reports. Conclusion: Measuring quality of care with data from patient records is aggravated by low retrievability of data, despite good data availability. The results for office-based hematologists and oncologists can be viewed as an example for the difficulties of quality measurement with data from patient records - similar obstacles are to be expected in special and general medical practices as well as in hospitals. © Georg Thieme Verlag KG.

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