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HIV/AIDS

Odisha: Progress on UN target on AIDS tardy (The Hindu:20170913)

http://www.thehindu.com/todays-paper/tp-national/odisha-progress-on-un-target-on-aids-

tardy/article19674246.ece

A large number of HIV positive persons dont know their infection status

Experiences in Ganjam, the most HIV-infection prone district in Odisha, have hinted that

progress on the 90-90-90 target set by the United Nations Programme on HIV and AIDS

(UNAIDS) has been tardy in the State.

According to Lokanath Mishra, a social activist, working with HIV positive persons in

Odisha, UNAIDS has envisioned to achieve the 90-90-90 target by 2020, which would

result in controlling HIV infection to sustainable limits by 2030. As per the 90-90-90 target,

90% of all HIV infected persons should get diagnosed and know their HIV positive status.

Ninety per cent of these diagnosed HIV positive persons are to be provided regular

Antiretroviral Therapy (ART), and 90% of people taking ART should show signs of viral

suppression, which reduces their scope of infection.

Small section

Ramesh Chandra Dash, founder president of ARUNA, an organisation working for AIDS

control and awareness in Ganjam, said till now only a small section of HIV-infection prone

people have got themselves tested. It means that a large number of HIV-positive persons do

not know their HIV infection status.

As per a study, at any time of the year over five lakh rural males of reproductive age from

Ganjam stay away from their families as migrant labourers outside Odisha.

DAILY NEWS BULLETINLEADING HEALTH, POPULATION AND FAMILY WELFARE STORIES OF THE DayWednesday 20170913

But the total number of persons tested in Ganjam in a year is around 90,000, said Mr. Mishra.

It means most migrant labourers, who have chances of bringing back HIV infection to their

homes in Ganjam, do not get tested.

Mohalla clinics

Govt close to target of setting up 1,000 mohalla clinics: Minister (Hindustan

Times:20170913)

http://paper.hindustantimes.com/epaper/viewer.aspx

NEW DELHI: A week after the Lieutenant Governors rider-laden approval to set up mohalla

clinics, Delhi health minister Satyendar Jain has claimed the government is very close to

achieving its goal.

The Delhi government had set a target of 1,000 mohalla clinics across the national capital.

Currently, there are only around 155 of such clinics.

On Facebook Live on Monday, Jain said, We thought opening the mohalla clinics should be

an easy project and we would be able to do it in one or one-and-a-half years time. However, it

took us that much time to get the approvals alone. We built 100 clinics, showed the world its

benefits and yet the project was stuck. Now, we have crossed the biggest hurdle (of getting

approvals) and the clinics should come up soon.

The minister has refused to give a completion date for the project.

I have realised that whenever I give a date for projects, they try and prevent it from

happening on time, Jain said, blaming political rivals for creating hurdles in delivering good

governance.

LG Anil Baijals nod on September 5 was followed by refusal from municipal corporations to

transfer land.

The civic agencies have said that most sites identified are in premises of primary schools,

community centres, parks, welfare centres and even on roads. They have said that since this

land is already with different departments the municipal corporation cannot transfer the rights

for use to Delhi government.

Of the total 1,000 mohalla clinics, the Delhi government plans to set up 300 inside

government schools.These clinics will help implement school health programmes... there

will be a doctor at hand for all medical emergencies. This (model) is better than (the ones in)

even Western countries where only a trained nurse is posted in schools, the health minister

said.

Assuring childrens safety, Jain said people will be allowed to visit these clinics only after

school hours and there will be a separate entrance.

Pocket ventilator

Engineer develops worlds cheapest pocket ventilator (Hindustan Times:20170913)


AIIMS doctor, who worked with the robotics techie, says the machine is 450 times smaller

than the conventional one and would cost between 15,000 and 20,000

NEW DELHI: The worlds cheapest and smallest ventilator, which looks like a clunky

cellphone and can easily slip into your back pocket, has been developed by a young robotics

engineer in Delhi in collaboration with a neurosurgeon at the All India Institute of Medical

Sciences.

It is almost 450 times smaller than the conventional ventilators and can be moved around

easily, said the 25-year-old inventor Diwakar Vaish.

He developed it with Dr Deepak Agrawal, professor of neuroscience at AIIMs, who have

seen scores of such patients living in hospital because the family cannot afford to buy a

portable ventilator, which costs about 2 lakh.

When the pocket ventilator hits the market after clinical trials and approval from the drug

controller general of India, it will cost between 15,000 and 20,000, which is less than the

5-15 lakh that a traditional ventilator would cost.

The cheapest portable ventilator also costs between 2 lakh and 2.5 lakh.

There is an FDA-approved disposable ventilator that costs between 10,000 and 15,000,

but it has a maximum life of four weeks. This will be a one-time investment and since it runs

on room air, and not oxygen, the operational costs are close to zero, said Dr Deepak

Agrawal, professor of neurosurgery at All India Institute of Medical Sciences (AIIMS).

There is no requirement for oxygen cylinders, which cost between 3,000 and 4,000 a

day, said Dr Vaish.

Controlled with an android app, the ventilator uses an artificial intelligence algorithm to

adjust air supply to the normal breathing pattern of the patient.

It works by pushing the atmospheric air into the lungs of the patients who cannot breathe on

their own. The disposable ventilators currently in use also push in air, but they do it at a

fixed frequency that does not necessarily match the patients breathing pattern, which may

cause low oxygen saturation. This device synchronises ventilator air support with the normal

breathing pattern, said Dr Agrawal.

We have successfully used it for a couple of hours on six fully paralysed patients at AIIMS

who have been unable to return home for the want of affordable ventilators, said Dr

Agrawal.

As a safety measure, the ventilators were attached to FDAapproved disposable ventilators

during the trial. India faces a huge shortage of ventilator beds needed to support critically-ill

patients who cannot breathe on their own. According to norms, at least 10% of all hospital

should have ventilators, but even Delhi, which has the best health infrastructure in India, has

200 ventilators for over 10,000 beds.

The oxygen supplied to the patients through conventional ventilators is usually diluted to

40% concentration, air contains 20% oxygen. Nine in 10 of all patients, barring the ones with

severe lung problems, can breathe in the normal atmospheric air because the problem is in

their diaphragm, not lungs, said Dr Agrawal.

For the 10% who need more oxygen, the pocket ventilator can also be hooked to an

oxygensupply system.

Air Pollution

Stunted children: Blame it on indoor air pollution (Hindustan Times:20170913)


Ventilation can considerably mitigate the negative impact of solid fuel smoke exposure on

children

Despite high economic growth in the last few decades, india still has the highest prevalence

of stunting among all south asian economies with the exception of afghanistan.

Worldwide, as many as 4.3 million people die each year due to indoor air pollution. The

conversation on air quality, however, has been focused largely on outdoor air pollution. As

researchers at Evidence for Policy Design, we conducted an analysis of 2005-2006 National

Family Health Survey (NFHS-3) data and found strong evidence that the exposure to indoor

air pollution from burning solid fuels increases the probability of stunting among Indian

children.

A child is regarded as stunted if her height-for-age is below certain thresholds set as per the

World Health Organization Child Growth Standards.

Stunted children tend to have both physical and cognitive developmental delays, including

delayed walking, impeded speech development, and diminished school performance. They

also experience higher rates of mortality and morbidity, including diabetes and hypertension.

According to NFHS-3 data, as many as 43% of Indian children under the age of five were

stunted, as of 2006. Despite high economic growth during the last few decades, India still has

the highest prevalence of stunting among all South Asian economies with the exception of

war-stricken Afghanistan. The sheer magnitude of the problem is apparent in the fact that

India has 61 million stunted children, more than any other country.

While stunting is most commonly associated with poor nutrition, there is an emerging body

of research that links exposure to poor air quality to stunting. In many households in India,

solid fuels such as coal, wood, crop residue and dung are used for cooking. These fuels

release particulate matter, carbon monoxide, formaldehyde and other toxins, at a much higher

rate than non-solid fuels such as kerosene and LPG. Childrens lungs are still developing and

are therefore particularly susceptible to irritation and contamination from the fumes of solid

cooking fuels; when childrens bodies must repeatedly fight off the respiratory infections

these fumes provoke, their growth suffers.

We analysed NFHS-3 data to identify the main drivers of stunting among Indian children.

Controlling for nutrition, recent illnesses, and other socio-economic factors, living in a

household that burns solid fuels is associated with 6.5% of stunting cases in Indian children

below three years old. In fact, in our analysis, fuel type comes out to be almost half as

influential as malnutrition in terms of impact on stunting.

In May 2016, the Indian government began providing below-poverty-line households with

LPG connections. At the same time, many NGOs and local institutions are working to replace

traditional cooking stoves with more efficient ones, which would reduce the total quantity of

fuel consumed and emissions produced per hour of usage.

Although a transition to cleaner fuels and technology is perhaps the only longterm solution

that addresses the indoor air pollution problem at its roots, there is a second option that has

the potential to tackle stunting. Having appropriate ventilation mechanisms can considerably

mitigate the negative impact of solid fuel smoke exposure on child stunting. The simple

presence of a window in households burning solid fuels is associated with a 3.4% lower

prevalence of stunting. Having separate kitchen and living areas reduces the chance of

stunting by 4%. As the data capture only whether households possess the different ventilation

options and not their actual usage, so the benefits of using ventilation consistently and

strategically are probably greater.

In order to be free of the health risks associated with air pollution, citizens need clean air both

at home and in their communities. A permanent transition to cleaner fuels is perhaps the only

solution that will improve Indias air quality both indoors and outdoors. In the meantime,

low-cost ventilation solutions have the potential to mitigate the impact of solid fuel burning

on stunting, and should be integrated into health promotion campaigns.

Diet/Nutrition

Omega-3 may keep gut microbiota diverse and healthy (Medical News Today:20170913)

http://www.medicalnewstoday.com/articles/319375.php

New research suggests that foods rich in omega-3, such as fish, garlic, nuts, and flaxseed oil,

may help to keep our guts healthy.

A new study published in the journal Scientific Reports finds that people who eat foods rich

in omega-3 fatty acids have more bacterial diversity in the gut, which promotes better overall

health.

Omega-3 fatty acids are essential fatty acids, which means that although we need them to stay

healthy, the human body cannot produce them on its own - so we have to get them from food.

The benefits of a diet rich in omega-3s are well known. The fatty acids seem to lower the

"bad" kind of cholesterol, lower high blood pressure, and improve overall cardiovascular

health.

Some studies have also suggested that omega-3 can reduce symptoms of rheumatoid arthritis

and improve bone strength, as well as protect against age-related cognitive decline and

dementia.

And now, researchers from the University of Nottingham's School of Medicine, in

collaboration with scientists from King's College London - both in the United Kingdom - add

to the long list of omega-3's benefits.

The new study - led by Dr. Ana Valdes, an associate professor and reader at the University of

Nottingham - suggests that the compound can improve the biodiversity of the gut.

A gut with rich and diverse bacteria is key to our overall health. As we explain in one of our

articles, the 38 trillion bacteria that live inside our guts keep our immune systems healthy and

ready to fight.

Conversely, losing microbial diversity has been associated with irritable bowel syndrome and

bowel cancer, to name just a few conditions.

"The human gut is receiving a lot of attention in medical research as it is increasingly linked

to a wide variety of health issues," explains Dr. Valdes.

"Our digestive systems are home to trillions of microbes, most of which are beneficial in that

they play a vital role in our digestion, immune system, and even regulate our weight," she

says.

So, Dr. Valdes and colleagues set out to examine the link between omega-3 intake and the

diversity of the gut's bacteria in middle aged and senior women.

How omega-3 may improve gut health

The researchers analyzed levels of DHA, which is a type of omega-3 fatty acid, as well as

total omega-3 serum levels and microbiome data from 876 twins.

"This cohort of 876 volunteer women had previously been used to investigate the human

genetic contribution to the gut microbiome in relation to weight gain and disease," says Dr.

Valdes.

Microbiome data was analyzed using the 16S ribosomal ribonucleinc acid sequencing

technique. Omega-3 food intake was assessed using a food frequency questionnaire.

Dr. Valdes summarizes the findings, saying, "We [...] found [that omega-3 intake], together

with [...] serum levels of omega-3, were strongly associated with the diversity and number of

species of healthy bacteria in the gut."

The association was independent of whether or not the participants also had a diet rich in

fiber.

First study author Dr. Cristina Menni, of King's College London, adds, "We also found that

specific bacteria that have been linked to lower inflammation and lower risk of obesity are

increased in people who have a higher intake of omega-3 fatty acids."

In an attempt to understand the mechanism behind this association, the researchers performed

further tests and found that "high levels of omega-3 in blood [...] correlated with high levels

of a compound called N-carbamylglutamate (NCG) in the gut."

"[NCG] has been shown in animals to reduce oxidative stress in the gut. We believe that

some of the good effects of omega-3 in the gut may be due to the fact that omega-3 induces

bacteria to produce this substance."

Dr. Cristina Menni

"Our study is the largest to date to examine the relationship between omega-3 fatty acids and

the composition of the gut microbiome," says Dr. Valdes.

Alcohol

Could this protein explain why drinking can be so pleasurable? (Medical News

Today:20170913)


A new study has identified a protein involved in the brain changes that promote excessive

drinking.

New research conducted in mice looks at how alcohol engages with the brain's reward center,

and which mechanisms might be set in motion to prevent excessive drinking.

Catching up with friends and family over a glass of wine is a scenario familiar to many of us,

yet alcohol consumption is often a divisive topic. It can be easy to get carried away and have

one drink too many, which can sometimes have unwanted medical consequences.

Recently, Medical News Today have reported on many studies concerned with the effects of

alcohol consumption, with some questioning how much alcohol is safe to drink and others

suggesting that a couple of glasses may even be beneficial.

However, some people tend to engage in excessive drinking on a regular basis, and scientists

are still struggling to understand the mechanism that leads to this excessive consumption.

Now, researchers from the University of California, San Francisco, led by Dr. Dorit Ron,

have used mouse models to study what happens in the brain when alcohol is consumed

preferentially.

It is known that mice, if given alcohol, might eventually begin to prefer it to other beverages,

leading to a pattern of excessive drinking. This allowed the scientists to study the effect of

heavy alcohol consumption on the central nervous system and identify the changes that take

place in the brain.

"There is - rightfully - a lot of media attention right now on opiate abuse and addiction. But

alcohol abuse and addiction are much bigger problems, and the human cost is staggering: 3.3

million people die every year in the world from alcohol abuse," explains Dr. Ron.

"Unfortunately, there are only a few medications on the market to reduce craving and relapse,

and none of them work very well," she says.

The researchers' findings were recently published in the journal Neuron.

Protein complex boosts excessive drinking

Research previously conducted by Dr. Ron and other colleagues pointed to a protein complex

called mTORC1, which regulates protein synthesis, as playing a key role in substance abuse -

including heavy drinking.

Previous studies suggested that drinking too much alcohol stimulates mTORC1 activity in a

part of the brain known as the nucleus accumbens, which plays a key role in the reward

circuit. They also suggested that the increased mTORC1 may be responsible for changes in

this brain region that boost desire for alcohol, thus correlating with alcohol-seeking behavior.

The activity of mTORC1 can be suppressed using rapamycin, which is a compound with

immunosuppressant properties. When researchers administered rapamycin to mice who had

learned to seek alcohol, the animals' preference for alcohol was significantly reduced.

Moreover, their taste for sugar water - a beverage that mice naturally find rewarding - was

not diminished.

But the researchers were interested in finding out whether any drugs could be used to curtail

the craving for alcohol in human adults with a propensity for heavy drinking. Rapamycin,

they noted, has many side effects, so using it to target heavy drinking in humans should be

avoided.

Protein responsible for brain changes

Dr. Ron's team went one step further with the current study and used RNA sequencing, a

technique that allowed them to focus on mTORC1's role in protein synthesis and track the

proteins associated with it, to better understand the mechanism that leads to excessive alcohol

consumption.

The researchers found a link between mTORC1 and 12 different proteins but decided to

target only one: prosapip1, a newly discovered protein that previous studies suggest is

somehow involved with the synapses. Its function, however, remains unclear.

Dr. Ron and her team found that prosapip1 is responsible for the structural changes that take

place in the nucleus accumbens following heavy drinking over a long period of time.

The team also wanted to see what would happen if the production of this protein was

genetically inhibited. They observed that, in this situation, fewer brain changes that dictated

alcohol-seeking behavior took place following heavy alcohol consumption.

Also, given the choice between alcohol and water, the mice involved in the experiment

preferred water more often than alcohol. Once more, the mice's taste for sugar water was not

impacted.

"We have identified a new protein that plays a crucial role in changing the landscape of

neurons in the nucleus accumbens, which then leads to escalation of problem drinking. These

findings open up research into the protein's role in neural plasticity, and also into how alcohol

and other drugs of abuse alter our brains."

Dr. Dorit Ron

The scientists hope that these findings will pave the way for research into novel treatments

not just for alcohol abuse but also for other substance abuse disorders.

"I've been doing research on the molecular neurobiology of alcohol abuse for many years and

this is the first time I've seen a signaling molecule that appears to be shared by many drugs of

abuse. I think in a way this may be a gateway to understanding drug addiction - it's a very

exciting time," concludes Dr. Ron.

Eye Blindness

Central heterochromia (two different eye colors): Causes and types (Medical News

Today:20170913)


Heterochromia is the term used to describe a difference in a person's eye color. Someone with

central heterochromia has different colors within the same eye. Complete heterochromia is

when they have two different colored eyes.

Heterochromia of the eye is caused by variations in the concentration and distribution of

melanin, the pigment that gives color to the skin, hair, and eyes.

The word "heterochromia" is derived from ancient Greek where "heteros" means different

and "chroma" means color. The condition is also known as heterochromia iridis or

heterochromia iridum.

Contents of this article:

What determines eye color?

Causes

Types of eye heterochromia

Identifying heterochromia

Diagnosis

Treatment

Notable people with central heterochromia

Fast facts on central heterochromia:

Less than 200,000 people in the United States have heterochromia. Some types of

heterochromia are common in dogs, cats, and horses.

There are three main types of heterochromia of the eye.

An ophthalmologist can diagnose heterochromia and investigate why it has occurred.

Treatment for heterochromia is about managing the underlying causes.

What determines eye color?

Central heterochromia

Central heterochromia refers to a combination of colors in one eye, and occurs due to uneven

distribution of melanin.

Eye color is a result of melanin deposits in the iris, which is the part of the eye responsible for

dilating and constricting the pupil to control the amount of light that enters. Blue eyes have

small amounts of melanin while brown eyes are rich in melanin.

Iris color may not stay constant throughout a person's life. For example, many babies are born

with blue eyes that darken within the first 3 years of life. This change occurs as melanin

develops.

Uneven distribution of melanin leads to central heterochromia and other types of

heterochromia.

Causes

Most cases of heterochromia are present from birth when the condition is called genetic

heterochromia.

Research suggests that most cases of heterochromia in humans are benign and occur without

any underlying abnormality.

According to the Genetic and Rare Diseases Information Center, most cases of heterochromia

of the eye occur sporadically in people with no family history of the condition.

However, some cases of genetic heterochromia are linked to diseases and syndromes,

including:

Bloch-Sulzberger syndrome

Bourneville disease

Hirschsprung disease

Horner's syndrome

Parry-Romberg syndrome

Sturge-Weber syndrome

von Recklinghausen disease

Waardenburg syndrome

Heterochromia that develops later in life due to illness, injury, or medication, is known as

acquired heterochromia. This is less common than the genetic form.

Heterochromia diabetes

Diabetes can lead to acquired heterochromia.

Causes of acquired heterochromia include:

diabetes

eye surgery

glaucoma

injury to the eye

iris ectropion syndrome

pigment dispersion syndrome

Posner-Schlossman syndrome

swelling of the eye

tumors of the iris

In addition, a medication called latanoprost, which is used to treat glaucoma, has been

associated with changes in eye color in up to 33 percent of those taking it for 5 years or

longer. Latisse, which is a drug once used to treat glaucoma but now primarily used to

thicken eyelashes, may also account for a change in eye color.

Glaucoma: Types, causes, and symptoms

Glaucoma: Types, causes, and symptoms

Glaucoma is a common eye condition that can lead to acquired heterochromia. Learn more

about it here.

Types of eye heterochromia

The different types of heterochromia of the eye include:

Central heterochromia

Central heterochromia is characterized by having two different colors in the same iris.

Usually, the outer ring of the iris is one color while the inner ring is another.

The inner ring often seems to have "spikes" of different colors that radiate from the pupil or

the black circle at the center of the iris. Eyes that have this pattern may be referred to as "cat

eyes." The outer color is considered to be the true iris color in people with central

heterochromia.

Central heterochromia tends to occur in irises that have low levels of melanin.

Complete heterochromia

People with this condition have two different-colored eyes. For example, they may have one

blue eye and one brown eye.

Sectoral heterochromia

In people with sectoral heterochromia, also known as partial heterochromia, one part of the

iris is a different color from the rest. Sectoral heterochromia often resembles an irregular spot

on the iris of the eye and does not form a ring around the pupil.

Identifying heterochromia

Heterochromia of the eye is easy to identify. The person will have two different colored eyes

or color differences within one or both eyes.

Color differences may be slight and may only become apparent under certain lighting

conditions or in photographs.

Aside from variations in eye color, there are usually no other signs and symptoms of

heterochromia. However, if a medical condition or trauma is responsible for the

heterochromia, other signs and symptoms may be present.

Diagnosis

Optical test heterochromia

An optical test can rule out any underlying causes for heterochromia.

Most cases of central heterochromia are benign. They are not linked to medical conditions

and do not affect vision or lead to complications. However, a checkup is necessary to rule out

other medical conditions.

People who acquire heterochromia and people whose genetic heterochromia changes in

appearance should see an eye doctor.

An eye examination will usually be necessary, and other tests, including blood tests and

chromosome studies, may be needed.

Treatment

According to the American Academy of Ophthalmology, if no other issues are present,

treatment is not usually necessary. Colored contact lenses may be used for cosmetic reasons

if a person with heterochromia wants to alter how their eyes look.

Notable people with central heterochromia

Several celebrities and public figures have forms of heterochromia.

The actors Olivia Wilde, Idina Menzel, and Christopher Walken all have central

heterochromia, where the inner ring of the iris is a different color from the outer ring.

Notable people with complete heterochromia, where their two eyes are different colors,

include:

Jane Seymour, actor

Alice Eve, actor

Max Scherzer, professional baseball player

Josh Henderson, actor

Mila Kunis, an actor who acquired the condition as an adult

Sectoral heterochromia, seen in only part of the iris, affects:

Kate Bosworth, actor and model

Henry Cavill, actor

Elizabeth Berkley, actor

Skin Cancer

Advanced melanoma: Groundbreaking trials could transform treatment (Medical News

Today:20170913)


The results of two groundbreaking new trials could change the way in which melanoma is

treated.

Results from two international clinical trials could transform the treatment of advanced

melanoma, the deadliest skin cancer type. But at present, melanoma patients whose cancer

has spread face an uncertain and often bleak future.

But now, experts reporting the trial results say that the newly tested therapies should reduce

the chances of the disease recurring and improve survival for many patients.

The researchers recently presented the findings of the trials at the European Society for

Medical Oncology 2017 Congress, held in Madrid, Spain. They are also published in the New

England Journal of Medicine.

Studies have already shown that immunotherapies and targeted therapies can successfully

treat melanoma patients whose cancer has reached an advanced stage (stage IV) but cannot be

surgically removed.

Immunotherapies are treatments that boost the immune system, and targeted therapies target

specific disease genes or proteins associated with them.

However, the two new trials are the first in the world to offer melanoma patients the option of

treatment at an earlier stage of the disease with the goal of preventing spread and relapse.

"Results from these clinical trials suggest we can stop the disease in its tracks - effectively

preventing it from spreading and saving lives," says study author Prof. Georgina Long, chair

of melanoma medical oncology and translational research at the University of Sydney in

Australia, who worked on both trials.

Metastatic melanoma much harder to treat

Melanoma is predominantly a cancer of the skin, but it can also arise elsewhere in the body,

such as the eyes. It begins in cells called melanocytes, which produce melanin - the pigment

that gives skin, hair, and eyes their color. Exposure to ultraviolet light, such as from the sun

or tanning beds, is a major risk factor for melanoma.

Although it is less common than many other skin cancer types, melanoma is "more likely to

grow and spread." Most cancer deaths result from metastasis, which is a disease stage

wherein cancer cells from the original tumor escape and give rise to harder-to-treat secondary

tumors in other parts of the body.

In the United States, the rate of new cases of melanoma doubled between 1982 and 2011, a

year in which more than 65,000 people discovered that they had the disease and more than

9,000 died of it.

In Australia, where Prof. Long is also conjoint medical director of Melanoma Institute

Australia, the rate of melanoma is one of the highest in the world. In 2017, nearly 14,000

people in the country are expected to be diagnosed with the disease and more than 1,800 are

expected to die of it.

If detected early, there is a very good chance of curing melanoma through the surgical

removal of the primary tumor. However, in around 10 percent of cases, the cancer is detected

too late and has already produced secondary tumors (metastases).

Melanoma patients at high risk of relapse are often given drugs to try to prevent metastases

after initial cancer treatment, such as after surgery. The two trials tested two different kinds

of adjuvant therapy for advanced melanoma.

COMBI-AD trial

In the COMBI-AD trial, researchers tested a combination of two drugs - dabrafenib and

trametinib - against a placebo as a post-surgery treatment for patients with advanced

melanoma (stage III), mutations in the BRAF gene, and thought be at high risk of recurrence.

The results showed that compared with a placebo, the combination led to "significantly lower

risk of recurrence" and improved survival. They also showed no new toxic effects from the

drugs used in combination.

The double-blind, placebo-controlled trial randomly assigned the 870 patients to receive 12

months of either a combination of dabrafenib (at an oral dose of 150 milligrams twice daily)

and trametinib (at an oral dose of 2 milligrams once daily), or two matched placebo tablets.

The results showed that 58 percent of patients survived a median of 2.8 years with no relapse,

compared with 39 percent in the placebo group - a reduction in risk of 53 percent.

The combination therapy group also showed an improved overall 3-year survival rate (that is,

a risk reduction of 43 percent), "improved distant metastasis-free survival, and freedom from

relapse."

CheckMate 238 trial

In the CheckMate 238 trial, the team found that the drug nivolumab was safer and more

effective in treating patients who have had surgery for advanced melanoma (stage III and

stage IV) than the current standard of care drug ipilimumab. It also found that nivolumab

resulted in "significantly longer recurrence-free survival."

Both drugs are immune checkpoint inhibitors approved for the treatment of advanced

melanoma. They target a switch on immune cells to boost their attack on cancer cells.

For the double-blind trial, researchers recruited 906 patients who were undergoing surgery to

completely remove stage III or stage IV melanoma and were considered to be at high risk of

relapse.

They were randomly assigned to receive intravenous infusions of either 3 milligrams of

nivolumab per kilogram of body weight every 2 weeks, or 10 milligrams of ipilimumab per

kilogram every 3 weeks for four doses and then every 12 weeks, for up to 1 year.

The committee monitoring the trial stopped it because the interim results showed clear

evidence of the benefit of nivolumab compared with ipilimumab. At 18 months, the rate of

relapse-free survival with nivolumab was 66.4 percent, whereas with ipilimumab it was only

52.7 percent.

Principal investigator Jeffrey S. Weber, deputy director of the Perlmutter Cancer Center at

the New York University School of Medicine, says that these results show that "nivolumab is

more effective in treating patients with stage III and IV melanoma, cutting the risk of relapse

by a third."

As Prof. Long concludes, "Our ultimate goal of making melanoma a chronic rather than a

terminal illness is now so much closer to being achieved."

"Results like this will change how we practice medicine."

(Dainik Jagran:20170913)

http://epaper.jagran.com/ePaperArticle/13-sep-2017-edition-National-page_9-958-17823-

262.html

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