Sir Charles Gairdner Hospital (SCGH) is a teaching hospital in Nedlands, Western Australia.Opened in 1958 as the Perth Chest Hospital and later named in honour of Sir Charles Gairdner, governor of Western Australia from 1951 to 1963, it is part of the Queen Elizabeth II Medical Centre (QEII MC). It is colloquially referred to as "Charlie's".All clinical specialities are provided, with the exception of complex burns, paediatrics, obstetrics, gynaecology and major trauma. It houses the state's only comprehensive cancer treatment centre, and is the state's principal hospital for neurosurgery and liver transplants. The hospital is closely associated with the nearby University of Western Australia as well as Curtin University, Notre Dame University, and Edith Cowan University.Handling over 76,000 admissions annually, SCGH has 600 beds, and treats approximately 420,000 patients each year. As of 2012[update] some 5,500 staff are employed. In 2009, it was the second hospital in Australia to be awarded Magnet recognition by the American Nurses Credentialing Center.
Metastatic disease is a common occurrence in malignancy with certain cancers recognised to have a high incidence of metastases, particularly the liver, lungs, and bones. Tumour-to-tumour metastases are an exceptionally rare occurrence, where a distant malignancy metastasises to a secondary distinct tumour. Breast and lung carcinomas are the more commonly reported origin sites, whilst renal cell carcinomas and meningiomas are the most reported recipient malignant and benign tumours respectively. In this article, we describe an unusual case of a metastatic head and neck squamous cell carcinoma (HNSCC) complicated by tumour-to-tumour metastasis to a benign intramedullary cartilage lesion in the distal femur.
ABSTRACT:Patients with chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) who harbor del(17p) and/or tumor protein p53 (TP53) mutations represent a high-risk population with a historically poor prognosis. To assess zanubrutinib efficacy and safety outcomes in patients with CLL/SLL with del(17p) and/or TP53 mutations (N = 301; n = 132, treatment-naive [TN]; n = 169, relapsed/refractory [R/R]), data from SEQUOIA (phase 3; TN; zanubrutinib; NCT03336333), ALPINE (phase 3; R/R; zanubrutinib vs ibrutinib; NCT03734016), and AU-003 (NCT02343120) (phase 1/2; zanubrutinib) were evaluated. In SEQUOIA (n = 127; median follow-up, 64.8 months), median progression-free survival (PFS) and overall survival (OS) were not reached; estimated 60-month PFS and OS were 70.7% and 82.3%, respectively. In ALPINE (n = 75, each treatment arm; median follow-up, 39.0 months), 36-month PFS rates were 59.2% among patients treated with zanubrutinib and 38.5% among those treated with ibrutinib, and OS rates were 73.6% and 72.5%, respectively. In AU-003 (n = 24; median follow-up, 69.6 months), 10 of 24 patients experienced progressive disease. Rate of response with zanubrutinib in SEQUOIA was 96.9% (95% confidence interval [CI], 95.2-98.8), and in ALPINE was 89.3% (95% CI, 80.1-95.3) with zanubrutinib vs 76.0% (95% CI, 64.7-85.1) with ibrutinib. Responses deepened over time in both TN and R/R populations. The most frequent nonhematologic treatment-emergent adverse events occurring in >20% of patients treated with zanubrutinib with del(17p) and/or TP53 mutations in SEQUOIA and ALPINE were COVID-19, upper respiratory tract infection, arthralgia, diarrhea, and contusion. In conclusion, zanubrutinib demonstrated strong efficacy in high-risk del(17p) and/or TP53 CLL/SLL, with a tolerable safety profile, further supporting use of zanubrutinib in both frontline and R/R settings.
INTRODUCTION:Older people face higher risks of medicine-related harm due to polypharmacy and the use of potentially inappropriate medicines. Current treatment guidelines rarely specify when to stop medicines, leading to medicines often being continued indefinitely without a clear deprescribing plan. While deprescribing guidelines exist for some medicine classes, limited guidance is a major barrier to deprescribing. These new guidelines address this gap by providing structured recommendations that complement more detailed drug-specific deprescribing guidance, disease-specific therapeutic guidelines and non-pharmacological management resources. These guidelines were developed by a team of 72 experts, including consumer representatives, and were further shaped by feedback from public consultation and independent reviewers. MAIN RECOMMENDATIONS:The guidelines are intended for all healthcare professionals involved in prescribing, dispensing or administering medicines to older people. The guidelines specifically address polypharmacy and medicines commonly dispensed for regular use in people aged ≥ 65 years, as well as other medicines where there is evidence to consider deprescribing in this cohort. The guidelines provide 185 consensus-based recommendations and 70 good practice statements, covering both specific medicine categories and general deprescribing principles. The guidelines are structured into four areas: (1) when to deprescribe; (2) ongoing treatment needs; (3) how to deprescribe; and (4) monitoring requirements. CHANGES IN CARE AS A RESULT OF THE GUIDELINE:This guideline emphasises deprescribing as an integral part of the prescribing continuum. Applying a deprescribing approach encourages prescribers to consider the ongoing need for a medicine each time a prescription is re-issued, to balance benefits and harms as they evolve over time, and to ensure treatment decisions reflect an individual's goals through shared decision-making. The guideline was developed based on currently available evidence for deprescribing and expert multidisciplinary and consumer input. It supports health professionals in reviewing regular medicines, minimising harm and planning ongoing treatment or monitoring. The detailed guideline is available at https://deprescribing.com.
INTRODUCTION:Mantle cell lymphoma (MCL) represents a distinct subtype of mature B-cell lymphoma, considered incurable with a pattern of recurrent relapses and suboptimal responses to subsequent therapies that portend poorer prognosis with each recrudescent disease. AREAS COVERED:Covalent and non-covalent Bruton tyrosine kinase inhibitors (BTKi) have transformed the therapeutic landscape of relapsed/refractory (R/R) MCL as monotherapies though these drug classes may emerge to be more effective as combinations with B-cell lymphoma-2 (BCL-2) inhibitors and immunotherapy. Immune-leveraging therapies, including chimeric antigen receptor (CAR) T-cell therapy and T-cell engaging antibodies, are gaining momentum, with the former demonstrating durable responses in a subset of patients, while the latter being evaluated in various combination regimens. Allogeneic hematopoietic stem cell transplants remain a potentially curative option for selected patients. EXPERT OPINION:This review seeks to navigate this increasingly complex therapeutic landscape while providing a suggested treatment and sequencing algorithm that may be tailored to individual patients.
BACKGROUND:Pulmonary exacerbations pose a significant clinical burden on people with cystic fibrosis (pwCF). Whether management of exacerbations should change in the context of modulator therapy is unclear. We describe the characteristics, treatment and lung function outcomes of pulmonary exacerbations requiring intravenous antibiotic therapy (PERITs) in a contemporary Australian cohort of pwCF, in an era of rapidly broadening access to modulator therapy. METHODS:PwCF receiving care at 11 Australian specialist centres were prospectively enrolled between 14 October 2020 and 9 October 2024. Spirometry data and treatments received during a PERIT were collected systematically. RESULTS:A total of 982 pwCF were enrolled, with 593 PERITs recorded in 323 individuals. The median (interquartile range) age at PERIT start was 12 (7-17) years and the mean±sd baseline forced expiratory volume in 1 s (FEV1) % predicted across PERITs was 80±21%. Approximately 62% (n=366) of PERITs occurred in people receiving modulator therapy. Intravenous tobramycin (63%) and piperacillin-tazobactam (43%) were the most frequently used antibiotics. Among participants with spirometry at baseline and at Day 7 (n=296) or Day 60 (n=383), 41% (n=120) and 44% (n=169) were below their baseline at Day 7 and Day 60 after commencing treatment, respectively; 8% were >10% below their baseline FEV1 % predicted at both time-points. Recovery patterns were consistent regardless of baseline lung function, Pseudomonas aeruginosa colonisation or modulator use. CONCLUSION:The pattern and magnitude of lung function impairment during PERITs is similar among those receiving and not receiving modulator therapy. This underscores the continued need for evidence to help clinicians balance treatment burden against the risk of irreversible loss of lung function.
