Publications by authors named "R A Schmerling"

Purpose: The availability of drugs and national public policies for patients with rare cancers, including sarcomas, varies in different parts of the world.

Methods: In this manuscript, we have conducted a comprehensive analysis to evaluate rare cancer policies in Latin American countries' national policy documents. Additionally, we have reviewed the approvals for sarcoma drugs in selected Latin American countries and compared them with US Food and Drug Administration (FDA) and European Medicines Agency (EMA) approvals.

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As a developing region, Latin America faces unique cancer control and prevention challenges, which are intensified when considering rare cancers, including sarcomas. Sarcomas are a group of malignancies that arise in the connective tissues of the body-such as muscle, fat, nerves, blood vessels, and bones-accounting for a diverse range of tumours that, although rare, require specialized attention. Sarcoma care and research in Latin America require a comprehensive approach that includes deeper epidemiologic knowledge, diagnostic capacity building, access to innovative treatments, increased patient advocacy, and strengthening of clinical research capacity.

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Melanoma represents an increasing public health burden with extensive unmet needs in Latin America (LA). A mutation in the gene is present in approximately 50% of all melanomas in White populations and is a target of precision medicine, with the potential to dramatically improve patient outcomes. Thus, increased access to testing and therapy is LA must be explored.

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Background: Checkpoint inhibitors are effective in the treatment of several types of cancer, either being used separately or in combination. Ipilimumab pioneered the treatment of metastatic melanoma, and nowadays, it has been used more frequently in combination with anti-PD-1. Since the development of anti-PD1 for melanoma, rechallenge with ipilimumab has not been considered, although its use was considered in early trials.

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Article Synopsis
  • The study examined autoimmune events in 554 patients treated with immune checkpoint inhibitors (ICIs) from 2012 to 2019, finding that 123 developed immune-related adverse events.
  • Of those with adverse events, 17% had pre-existing autoimmune diseases, and 26% had to temporarily stop ICIs due to autoimmune symptoms; the most common issues involved endocrine and skin disorders.
  • Overall, while autoimmune diseases occurred in patients on ICIs, the complete stop of treatment due to these issues was rare, and efficacy was notably better in melanoma patients who experienced immune toxicity.
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