Gan to kagaku ryoho. Cancer & chemotherapy
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Gan To Kagaku Ryoho · Mar 2005
ReviewCost-effectiveness of letrozole versus tamoxifen as first-line hormonal therapy in treating postmenopausal women with advanced breast cancer in Japan.
The objective of this study is to evaluate the cost-effectiveness of letrozole compared with tamoxifen as first-line therapy in post-menopausal women with advanced breast cancer in Japan. A Markov analytical model was developed to estimate life-year (LY) expectancies, using key transition probabilities obtained from the results of a multinational phase III trial, a literature review and a Japanese medical expert panel. ⋯ The total expected costs were 3,644,588 yen (33,133 US dollars) for letrozole arm and 3,322,111 yen (30,201 US dollars) for tamoxifen arm, resulting in a mean incremental cost-effectiveness ratio (ICER) of 546,571 yen (4,969 US dollars) per life-year gained, while the 5 th percentile of ICER showed letrozole dominating tamoxifen and the 95th percentile was 2,310,593 yen (21,005 US dollars). The results suggest that letrozole is a clinically beneficial and cost-effective treatment option when compared with tamoxifen in first-line therapy for advanced breast cancer in Japan.
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Gan To Kagaku Ryoho · Mar 2005
Review[Imatinib therapy for patients with chronic myelogenous leukemia].
Chronic myelogenous leukemia (CML) is a clonal hematopoietic disorder caused by the reciprocal translocation between chromosome 9 and 22. As a result of this translocation, a novel fusion gene, BCR-ABL, is created on Philadelphia (Ph) chromosome, and the constitutive activity of the BCR-ABL protein tyrosine kinase plays a critical role in the disease pathogenesis. Imatinib mesylate, a selective BCR-ABL tyrosine kinase inhibitor, was first given to a patient with CML in June 1998. ⋯ Based upon the results of early phase I and II studies, a phase III study (IRIS Study) that was randomized to first-line imatinib (400 mg/day) or to standard treatment with interferon+low-dose Ara-C, was conducted on 1,106 patients newly diagnosed (within 6 months) with chronic-phase CML. After median follow-up of 30 months, imatinib showed significantly superior tolerability, hematologic and cytogenetic responses (major cytogenetic response, 90%; complete cytogenetic response, 82%), and overall survival (95% without censoring allo-HSCT). Although imatinib is the first-line therapy and has changed the paradigm of CML treatment strategy, questions remain as to the meaning of cytogenetic and molecular response, curability, optimal dose, and relation with allo-HSCT.