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Salvage Therapy

Salvage Therapy: An approach to treating disease when initial treatments have failed or are not tolerated.
It often involves the use of alternative or experimental therapies to manage the condition and improve patient outcomes.
Salvage therapies may be used for a variety of conditions, including cancer, infections, and other chronic illnesses.
The goal is to find effective options when standard treatments have been exhausted, optimizing care and enhancing the chances of a positive clinical response.

Most cited protocols related to «Salvage Therapy»

1
Economic Evaluation of Atezolizumab + Bevacizumab for Hepatocellular Carcinoma
Cited 8 times
Only direct medical costs, including costs of acquiring drugs, costs attributed to the patient’s health state, costs for the management of adverse events (AEs), and costs for end-of-life care, were analyzed (Table 1). The costs are reported in 2019 US dollars and were inflated to 2019 values using the Medical-Care Inflation data set in Tom’s Inflation Calculator.16 According to the IMbrave150 trial report,5 (link) patients in the atezolizumab plus bevacizumab group received atezolizumab (1200 mg) plus bevacizumab (15 mg/kg body weight) intravenously every 3 weeks. Patients assigned to the sorafenib group received sorafenib (400 mg) orally twice daily. Treatment continued until disease progression or unacceptable toxicity or, for the immunotherapy regimen group, until 2 years of follow-up. The prices of atezolizumab, bevacizumab, and sorafenib were collected from public databases.12 ,13 In the US, the prices of ipilimumab, nivolumab, pembrolizumab, and dabrafenib plus trametinib were discounted by 17% to account for contract pricing.17 (link) To calculate the dosage of bevacizumab, we assumed that a typical patient in the US weighed 71.4 kg.18 (link) After disease progression, 69 of 197 patients (35.0%) in the atezolizumab plus bevacizumab group and 73 of 109 patients (67.0%) in the sorafenib group received subsequent active therapy. The costs associated with subsequent active salvage therapy and the greatest supportive care were $108 336 and $37 084 per patient, respectively, which were estimated from a cost-effectiveness analysis of second-line treatments of advanced HCC.14 (link) The monitoring costs for patients with PFD and patients with PD were $245 per month and $15 308 per month, respectively, which were collected from an economic evaluation of sorafenib for unresectable HCC.15 (link) The cost associated with terminal care was $7893 per patient with advanced HCC.14 (link) The analysis included the costs associated with managing grade 3 or higher AEs, which were extracted from the literature (eTable 3 in the Supplement).14 (link),19 (link)Each health state was assigned a health utility preference on a scale of 0 (death) to 1 (perfect health). The PFD and PD states associated with HCC were 0.76 and 0.68,10 (link) respectively, which were derived from a cost-effectiveness analysis considering patients with HCC. The disutility values due to grade 1 or 2 and grade 3 or 4 AEs were included in this analysis.11 (link) All AEs were assumed to be incurred during the first cycle. The duration-adjusted disutility was subtracted from the baseline PFD utility.
Su D., Wu B, & Shi L. (2021). Cost-effectiveness of Atezolizumab Plus Bevacizumab vs Sorafenib as First-Line Treatment of Unresectable Hepatocellular Carcinoma. JAMA Network Open, 4(2), e210037.
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Publication 2021
atezolizumab Bevacizumab Body Weight dabrafenib Dietary Supplements Disease Progression Hospice Care Immunotherapy Ipilimumab Nivolumab Patient Monitoring Patients pembrolizumab Salvage Therapy Sorafenib Terminal Care trametinib Treatment Protocols
2
Metastasis Risk After Prostate Cancer Recurrence
Cited 8 times
Of all men undergoing radical prostatectomy at Johns Hopkins Hospital between July 1981 and July 2010, 1973 developed biochemical recurrence (defined as a postoperative PSA ≥0.2 ng/mL). After eliminating patients who received adjuvant/neoadjuvant or salvage therapies before the detection of metastases (n = 798), and excluding patients with other missing information (n = 533), 642 men remained (Fig. 1). Only 450 men had sufficient data to allow calculation of PSADT, and these patients alone formed our cohort. Patients were followed through December 2010.
This was a retrospective analysis of prospectively collected data from a large cohort of men undergoing prostatectomy for localized disease. Data came from the Johns Hopkins Master Prostatectomy Database which stores clinical, pathological and demographic information under a consent waiver allowing its use for research without disclosing patient identifiers. The database is approved by the Johns Hopkins institutional review board, and meets the requirements of the Health Insurance Portability and Accountability Act.
After prostatectomy, patients were generally followed with PSA measurements and rectal examinations every 3 months for the first year, every 6 months for the second year and every 12 months thereafter. Upon biochemical recurrence, PSA was measured approximately every 6 months, and imaging with CT and radionuclide bone scan was generally performed at baseline and then annually (or sooner if symptoms developed, e.g. bone pain). Because many patients did not receive regular postoperative evaluations at Johns Hopkins, follow-up protocols were not always uniform. Metastatic disease was defined as the presence of osseous metastases on bone scan, or visceral (liver, lung, brain) or extra-pelvic nodal metastases on CT scan. Magnetic resonance imaging was sometimes used to re-evaluate indeterminate lesions. Metastasis-free survival (MFS) was defined as the time interval from biochemical recurrence to initial metastasis. Patients were captured at the time of their first positive scan or censored at the time of their last confirmed negative scan. Deaths occurring before metastasis were also censored.
Antonarakis E.S., Feng Z., Trock B.J., Humphreys E.B., Carducci M.A., Partin A.W., Walsh P.C, & Eisenberger M.A. (2011). The natural history of metastatic progression in men with prostate-specific antigen recurrence after radical prostatectomy: long-term follow-up. BJU international, 109(1), 32-39.
Publication 2011
Bones Brain Ethics Committees, Research Liver Lung Neoadjuvant Therapy Neoplasm Metastasis Pain Patients Pelvis Pharmaceutical Adjuvants Physical Examination Prostatectomy Radionuclide Imaging Rectum Recurrence Salvage Therapy X-Ray Computed Tomography
3
Molecular Profiling of Anaplastic Oligodendroglioma
Cited 8 times
Medical chart review, histopathological analysis and molecular studies were performed on patients with newly diagnosed AO, WHO Grade III, seen at the Massachusetts General Hospital and Brigham and Women's Hospital between 1996 and 2005, for whom clinical data were available. None of the patients had a history of a previous low grade tumor or chemoradiation. Of the 87 patients with primary AO in our database, 64 patients had either a loss or maintenance of both chromosome 1p and 19q by the report and further analyses were limited to this cohort while patients with loss of only 1p or of 19q or only polysomy were excluded due to a small sample size of each subgroup. Clinical presentation, neuroradiologic imaging, extent of surgery, adjuvant therapy and follow-up were determined from medical records. Approval from the Dana-Farber/Harvard Cancer Center Institutional Review Board was obtained prior to the initiation of this study.
Progression was defined either radiologically by enlargement of the existing lesion or development of a new lesion, or by clinical deterioration attributed to the tumor. A new lesion in the brain consistent with tumor based on imaging and clinical symptoms was considered sufficient to make the diagnosis of progressive disease when biopsy or resection was not considered clinically indicated. Positive response to salvage therapy was defined as either stable disease or a positive clinical and/or radiographic response.
Progression free survival (PFS) was defined as the time from diagnosis to progression as defined above or the time to death if death occurred without progression. Overall survival (OS) was defined as the time from the initial diagnosis to death.
Snuderl M., Eichler A.F., Ligon K.L., Vu Q.U., Silver M., Betensky R.A., Ligon A.H., Wen P.Y., Louis D.N, & Iafrate A.J. (2009). Polysomy for chromosomes 1 and 19 predicts earlier recurrence in anaplastic oligodendrogliomas with concurrent 1p/19q loss. Clinical cancer research : an official journal of the American Association for Cancer Research, 15(20), 6430-6437.
Publication 2009
Biopsy Brain Chemoradiotherapy Chromosomes Clinical Deterioration Diagnosis Disease Progression Ethics Committees, Research Hypertrophy Malignant Neoplasms Neoplasms Operative Surgical Procedures Patients Pharmaceutical Adjuvants Salvage Therapy Therapeutics Vision X-Rays, Diagnostic
4
Cost-Effectiveness Analysis of EGFR Mutation-Targeted Therapies
Cited 7 times
This analysis considered the setting of the Chinese health care system. Only direct medical costs, including the costs of EGFR mutation testing, first and second-line chemotherapies (including prescription, preparation, and administration), concomitant medications during therapy, management of treatment-related SAEs, and routine follow-up and laboratory testing (Table 3), were included in the model.
Icotinib at a dose of 375 mg per day or gefitinib at a dose of 250 mg per day was assumed to be administered to patients positive for an EGFR mutation until disease progression [23 , 25 (link)–27 (link)]. Chemotherapy (pemetrexed, 500 mg/m2 of body surface area (BSA), plus cisplatin, 75 mg/m2) was administered every 21 days for four cycles. Because generic pemetrexed was widely used in Chinese clinical practice, we used the cost of generic pemetrexed in the base-case analysis. In the pemetrexed strategy, pemetrexed treatment (500 mg/m2 every 21 days) was continued in patients who did not progress after four cycles of induction [24 (link)]. After disease progression, salvage chemotherapy and supportive care were prescribed; in this model, 56.6% (26%-72%) of patients received salvage treatment regardless of the first-line therapy [24 (link), 38 (link)–42 (link)]. The costs of utilizing resources related to salvage chemotherapies, management of SAEs, supportive care and palliative care in end-of-life were derived from a previously published study [43 (link)]. The costs for management of SAEs from each strategy were calculated as the cumulative probability-weighted average of SAE costs from the first-line control strategy using the following formula: cost of SAEs from the platinum-based chemotherapy per cycle × cumulative probability of SAEs from the corresponding strategy / cumulative probability of SAEs from the platinum-based chemotherapy [43 (link)]. To calculate the dosage of chemotherapeutic agents, we assumed that a typical patient had a weight of 65 kg and a height of 1.64 m, resulting in a BSA of 1.72 m2. The cost of EGFR mutation testing per patient was provided by the laboratories of local hospitals. The treatment costs were estimated based on a clinical study.
Because of the high costs of icotinib and gefitinib, as well as the limited wealth of patients in China, the icotinib and gefitinib Patient Assistance Program (PAP) was implemented for Chinese patients positive for ALK gene rearrangement. Currently, the PAP requires patients to pay US $11,538 for gefitinib and US $11,077 for icotinib, after which they receive icotinib and gefitinib for free until disease progression. Therefore, the impact of the PAP was evaluated in scenario analyses.
The utility scores of PFS and survival after progression were obtained from previously published studies (Table 2) [44 (link), 45 (link)]. The reported disutility caused by SAEs was also considered in the current analysis [44 (link)].
Lu S., Ye M., Ding L., Tan F., Fu J, & Wu B. (2016). Cost-effectiveness of gefitinib, icotinib, and pemetrexed-based chemotherapy as first-line treatments for advanced non-small cell lung cancer in China. Oncotarget, 8(6), 9996-10006.
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Publication 2016
Antineoplastic Agents Body Surface Area Chinese Cisplatin Disease Progression EGFR protein, human Gefitinib Gene Rearrangement Generic Drugs Hospice Care icotinib Mutation Patient Care Management Patients Pharmacotherapy Platinum Salvage Therapy Therapeutics
5
Radiofrequency Ablation for Dysplastic Barrett's Esophagus
Cited 7 times

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Publication 2011
Biopsy Blood Coagulation Disorders Catheters Congenital Abnormality Crossing Over, Genetic Endoscopes Endoscopy Endoscopy, Gastrointestinal Esomeprazole Esophageal Neoplasms Esophagectomy Esophagitis Forceps Institutional Ethics Committees Intubation Lymphadenopathy Malignant Neoplasms Medical Devices Parent Patients Pregnancy Safety Salvage Therapy Stenosis Stomach Treatment Protocols Ultrasonography, Endoscopic Varices

Most recents protocols related to «Salvage Therapy»

1
Maintenance Therapy After Anti-CD19 CAR T-Cells
Approximately 60 days after anti-CD19-CAR T-cell infusion, when the adverse
events (AEs) and the subsequent aGVHD disappeared, patients who obtained CR or
CR with incomplete count recovery (Cri) and had previously preserved frozen stem
cells, received DSI (DSI group) as maintenance therapy. The other patients who
reached CR/CRi received DLI (DLI group) as maintenance therapy. The cells in DLI
therapy were not previously frozen, but were collected by hemapheresis without
mobilization by granulocyte colony stimulating factor (G-CSF) in every DLI
maintenance therapy. All DSI/DLI was the same donor used for the original
hematopoietic stem cell transplant. The interval time between the two DSI/DLI
therapies was generally 1 month. If the patients develop severe aGVHD, DSI/DLI
maintenance therapy would be discontinued. Moreover, one patient who reached
CR/Cri received a second allo-HSCT following DLI therapy (Fig. 1). One patient who did not reach
CR/CRi after anti-CD19-CAR T-cell therapy received DSI as a salvage therapy. Two
other patients who did not reach CR/Cri died because of disease progression
within a short time.
Li Q., Lyu C., Liu M., Wang J., Mou N., Jiang E., Zhang R, & Deng Q. (2023). Donor Hematopoietic Stem Cell/Lymphocyte Maintenance Treatment After CAR T-Cell Therapy in Patients With B-Cell Acute Lymphoblastic Leukemia Relapse Following Stem Cell Transplant. Cell Transplantation, 32, 09636897231158155.
Publication 2023
Apheresis Freezing Granulocyte Colony-Stimulating Factor Patients Salvage Therapy Therapeutics Therapies, CAR T-Cell Tissue Donors Transplantations, Stem Cell
2
Blinatumomab for Relapsed/Refractory BCP-ALL
From March 2009 to February 2021, we analyzed 197 patients with R/R BCP-ALL who were treated with conventional chemotherapy or blinatumomab as salvage therapy at Catholic Hematology Hospital in Korea. In 2016, Korean National Health Insurance approved blinatumomab for patients with Ph-negative BCP-ALL who failed induction chemotherapy or relapsed after chemotherapy or allo-HCT. And then we were able to use blinatumomab for salvage in Ph-positive BCP-ALL patients beginning in 2019. The Institutional Review Board of The Catholic University of Korea approved this study, and written informed consent was obtained from all patients and the details were also de-identified (KC21RISI0613). The study was conducted in accordance with the Declaration of Helsinki. The reporting of this study conforms to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement.
Yoon J.H., Kwag D., Lee J.H., Min G.J., Park S.S., Park S., Lee S.E., Cho B.S., Eom K.S., Kim Y.J., Kim H.J., Min C.K., Cho S.G., Wook Lee J, & Lee S. (2023). Superior survival outcome of blinatumomab compared with conventional chemotherapy for adult patients with relapsed or refractory B-cell precursor acute lymphoblastic leukemia: a propensity score–matched cohort analysis. Therapeutic Advances in Hematology, 14, 20406207231154713.
Publication 2023
blinatumomab Ethics Committees, Research Induction Chemotherapy Koreans National Health Insurance Patients Pharmacotherapy Roman Catholics Salvage Therapy
3
Blinatumomab vs Conventional Salvage Therapy
The main end point was CR rates. End points of OS, disease-free survival (DFS), cumulative incidence of relapse (CIR), and NRM rates were also compared between the blinatumomab group and conventional salvage group. For efficiency evaluations of CR rates between the two salvage groups, we used a conditional method to calculate sample size. At least 42 patients were needed for each group. In this study, we conducted a propensity score–matched cohort analysis using age, cytogenetics at relapse including Philadelphia (Ph) chromosome, CR duration before relapse, line of salvage, and history of previous allo-HCT. Response rates were compared using Fisher’s exact test. OS curves were plotted using the Simon–Makuch method, considering the effect of allo-HCT as a time-dependent covariate. DFS was plotted using the Kaplan–Meier method for patients who achieved CR after each salvage therapy. CIR and NRM rates were calculated using a cumulative incidence estimate to accommodate competing events, and subgroups were compared with Gray tests. The prognostic significance of covariates affecting OS was determined by a Cox proportional hazards regression model in which allo-HCT was a time-dependent covariate. The prognostic significance of covariates affecting CIR and NRM was determined using Fine-Gray proportional hazards regression for competing events. Multivariate analyses were performed using variables with a p-value < 0.10 in prior univariate analyses. All statistical analyses were performed using R software, version 4.0.3 (R Foundation for Statistical Computing, 2020). Statistical significance was set at a p-value < 0.05.
Yoon J.H., Kwag D., Lee J.H., Min G.J., Park S.S., Park S., Lee S.E., Cho B.S., Eom K.S., Kim Y.J., Kim H.J., Min C.K., Cho S.G., Wook Lee J, & Lee S. (2023). Superior survival outcome of blinatumomab compared with conventional chemotherapy for adult patients with relapsed or refractory B-cell precursor acute lymphoblastic leukemia: a propensity score–matched cohort analysis. Therapeutic Advances in Hematology, 14, 20406207231154713.
Publication 2023
blinatumomab Patients Philadelphia Chromosome Relapse Salvage Therapy
4
Corticosteroid Duration and CAPA Risk
All statistical analyses were conducted with JMP 16 software (SAS Corporation, Cary, North Carolina). Baseline characteristics and health outcomes were compared between corticosteroid duration groups using the χ2, Fisher exact, or Wilcoxon rank-sum tests as appropriate. Steroid duration was assessed as an independent predictor of CAPA using logistic regression. First, univariate logistic regression was used to identify which baseline characteristics were associated with CAPA at a threshold of P < .2. Significant univariate covariates were then entered as covariates in a multivariate logistic regression model to generate adjusted odds ratios (ORs) and 95% confidence intervals (CIs). Covariates that achieved P < .05 were considered significant independent predictors of CAPA in the final model. CAPA was also assessed as an independent predictor of mortality using a multivariate logistic regression model that included the following variates: age, steroid duration, salvage therapies for ARDS, PaO2/FiO2 ratio, SOFA score, secondary infection, and duration of ventilation. Additional analyses were conducted to examine the relationship between corticosteroid duration as a continuous variable and CAPA risk. Median total steroid duration was calculated for those who did and did not develop CAPA and was compared between CAPA groups using the Wilcoxon rank-sum test. The duration of steroids that most accurately predicted CAPA was assessed using a logistic regression model with CAPA as the dependent variable and steroid duration as the independent variable to generate the area under the receiver operating characteristic (ROC) curve (AUC). The cutoff was determined by the duration with the highest positive likelihood ratio (ie, sensitivity – [1-specificity]).
The study was approved by the University of Texas Health Science Center at San Antonio institutional review board and the University Health research department (HSC20200207EX).
Shah M., Reveles K., Moote R., Hand E., Kellogg III D., Attridge R.L., Maselli D.J, & Gutierrez G.C. (2023). Risk of Coronavirus Disease 2019–Associated Pulmonary Aspergillosis Based on Corticosteroid Duration in Intensive Care Patients. Open Forum Infectious Diseases, 10(3), ofad062.
Publication 2023
Adrenal Cortex Hormones Episodic Ataxia, Type 2 Ethics Committees, Research Hypersensitivity Respiratory Distress Syndrome, Adult Salvage Therapy Secondary Infections Steroids
5
Analgesia for Iliac Crest Biopsy
All patients were lying face down with their hands positioned under the head (based on the French Society of Hematology guidelines) [28 ]. Local anesthesia was performed with a lidocaine injection (1 vial containing 20 mL had a concentration of 10 mg/mL). Biopsy was then performed on the posterior iliac crest with a classic trocard (Jamshidi or Monoject bone marrow biopsy needle).
In the MEOPA group, administration was started at the same time as the local anesthesia. In the VR group, a 5-minute demonstration session was proposed on the day of randomization to assess tolerance before the biopsy, and the program was started 5 minutes before anesthesia with a maximum duration of 40 minutes. In cases of intolerable pain during the procedure, salvage treatment with a second local injection of lidocaine and/or paracetamol (1 g) or alprazolam (0.25 mg) was proposed.
Le Du K., Septans A.L., Maloisel F., Vanquaethem H., Schmitt A., Le Goff M., Clavert A., Zinger M., Bourgeois H., Dupuis O., Denis F, & Bouchard S. (2023). A New Option for Pain Prevention Using a Therapeutic Virtual Reality Solution for Bone Marrow Biopsy (REVEH Trial): Open-Label, Randomized, Multicenter, Phase 3 Study. Journal of Medical Internet Research, 25, e38619.
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Publication 2023
Acetaminophen Alprazolam Anesthesia Biopsy Bone Marrow Face Head Iliac Crest Immune Tolerance Lidocaine Local Anesthesia Meopa Needles Pain Patients Salvage Therapy

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More about "Salvage Therapy"

Salvage therapy, also known as rescue therapy, is a crucial approach in the medical field when initial treatments have failed or are not well-tolerated.
This alternative or experimental approach aims to manage various conditions, including cancer, infections, and other chronic illnesses, when standard treatments have been exhausted.
The goal is to find effective options that can optimize care and enhance the chances of a positive clinical response.
Salvage therapy often involves the use of novel or repurposed drugs, as well as innovative treatment protocols.
For example, the EZNA™ Blood DNA Midi Kit can be utilized to extract high-quality DNA for genetic analysis, which may inform personalized salvage therapy decisions.
Additionally, the MiSeq platform can be employed to perform advanced genomic sequencing, helping to identify potential targetable mutations or pathways that can be addressed through salvage interventions.
Statistical software like SPSS Statistics version 19, SAS version 9.4, and SPSS version 18.0 (including SPSS for Windows) can be utilized to analyze data and inform the development of salvage therapy protocols.
Tools like JMP 8.0 can also be leveraged to visualize and interpret complex data sets, supporting the optimization of salvage therapy approaches.
Medications like Thymoglobulin and Osimertinib have been utilized in salvage therapy regimens, demonstrating the diverse pharmacological options available to clinicians.
The integration of artificial intelligence, as seen in PubCompare.ai, can further enhance the identification of the most effective salvage therapy options by analyzing the latest research, pre-prints, and patents.
Overall, salvage therapy represents a critical avenue for patients when standard treatments have been exhausted.
By leveraging advanced technologies, statistical analysis, and innovative pharmacological agents, clinicians can strive to provide the best possible outcomes for individuals facing challenging medical situations.