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Acknowledgments: Thanks to Professor Visanu Thamlikitkul for his valuable advice. We acknowledge Professor Guy Edwards and Mr. Bryan Hamman for their assistance with the English presentation of the paper. Financial support: This study was supported by the Thailand Research Fund. The Pfizer Company provided Zjthromax and Vibramycin . Authors' addresses: Ploenchan Chetchotisakd and Piroon Mootsikapun, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand. Wipada Chaowagul and Duangkaew Budhsarawong, Department of Medicine, Sapprasitthiprasong Hospital, Ubon Ratchatani, 34000, Thailand. Bandit Thinkamrop, Department of Biostatistics and Demography, Faculty of Public Health, Khon Kaen University, Khon Kaen, 40002, Thailand. Reprint requests: Ploenchan Chetchotisakd, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand.
Sorafenib is an oral small-molecule tyrosine kinase inhibitor TKI ; of cRAF, vascular endothelial growth factor receptor VEGFR ; -2, VEGFR-3, platelet-derived growth factor receptor PDGFR ; -, Flt-3, and Kit.14 Given that some of these kinases are involved in angiogenesis, it is not surprising that sorafenib inhibits angiogenesis in experimental models. Sorafenib has demonstrated the ability to inhibit the growth of human RCC, melanoma, colon, breast, ovarian, and nonsmall cell lung cancer xenografts experimentally implanted in mice.15 Sorafenib received FDA approval in December 2005 for the treatment of patients with advanced RCC. Approval was based on results of two studies: a randomized phase II trial and a phase III trial. In the phase II trial, 202 patients were treated for 12 weeks with open-label sorafenib 400 mg bid.16 At 12 weeks of treatment, patients were evaluated for objective responses. Those with 25% tumor shrinkage continued on sorafenib. Patients with stable disease SD ; or 25% tumor shrinkage were randomized in a double-blind fashion to sorafenib or placebo. Patients with progressive disease went off study. At 24 weeks, significantly more patients in the sorafenib group 16 of 32 patients, 50% ; were progression free compared with the placebo group 6 of 33 patients, 18%; P .0077 ; . Sorafenib treatment also improved median progression-free survival PFS ; Figure 2 ; . As shown in this and other trials discussed in this newsletter, achievement of durable SD is becoming an important treatment goal for patients with RCC. In the phase III Treatment Approaches in Renal Cancer Global Evaluation Trial TARGET ; , patients with unresectable or metastatic RCC who had failed 1 prior therapy within the previous 8 months were randomized to sorafenib n 384 ; or placebo n 385 ; .17 Patients were required to have an ECOG PS of 0 and no brain metastases. The primary end point was overall survival OS ; . This trial had a planned interim analysis of median PFS, a secondary end point. The interim analysis showed that patients in the sorafenib group achieved a median 24-week PFS that compared favorably and abilify.
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This resulted in the divestment of non-core brands in 1998 and 1999. All significant restructuring and integration activities relating to the merger have been successfully completed. Cost savings of approximately CHF 70 million per year resulting from the merger have been identified, and growth opportunities enabled by the merger are being pursued. Novartis Consumer Health is comprised of three business units: OTC, Health and Functional Nutrition and Medical Nutrition. These business units excluding divested brands ; contribute to sector sales as follows: Business Unit OTC Health and Functional Nutrition Medical Nutrition Key Marketed Products OTC The OTC business provides products for in-home diagnosis, treatment and prevention of medical conditions and ailments to enhance people's overall health and well being. The main product categories Sales 1999 % ; 36.6 52.9 10.5. By Charles White Support Group. In many facilities this word, as I quickly learned, is taboo. "There will be no support groups in this institution, " I was told by staff and other prisoners who had gone before me. The mere mention of a "support group" is often associated with security risks including unauthorized organization. So how were we, a small group of prisoners interested in learning about and improving our own health status going to gain access to the information we craved, and in a format not only beneficial, but one we were willing to accept and trust? The answer, no matter what you call it, is the awareness and understanding that is best shared by others who are and who have been where you are now. In other words, a support group. A support group, simply put, is a gathering of peers who bring new information, experience, compassion and a collective voice to the table. This is so important for those suffering from a life-challenging disease such as hepatitis C. Support groups may not be for everyone - there is no mandate that says each and every person affected by Hepatitis C must seek out and involve others in something as personal as one's own health status. However, it can be an especially vital option when information and healthcare is either limited or completely unavailable. Hepatitis C is a very complicated disease. It goes without saying that complications are compounded ten-fold for HCVers living behind bars. How do you know if you are a good candidate for treatment? What type of side effects can I expect and for what duration? Do I have access to the same up-to-date treatment options as people on the streets? Are my healthcare providers knowledgeable and straightforward? If treatment isn't right for me at this time, or isn't being offered because I incarcerated, what can I do to protect my liver and my health? If I need treatment, and I a good candidate for treatment, who will act as a voice for me when treatment is refused? These are all questions that many of us face and without honest and compassionate answers, frustration sets in and our overall health suffers. This is where the support group, whose role is to advocate for increased awareness and recognition of the seriousness of hepatitis C, to help others learn to live with and manage the disease, and to form a collective voice not only for better access to current treatments, but for more effective treatments, cures and vaccines in the future, comes into play. It is that "collective voice" over any issue that immediately catches the attention of prison officials and the administration. Before we address overcoming this obstacle, let's explore some ways to get a support group up and running. First consider who you want involved in your support group. Do you want to limit membership to prisoners only? You may be able to get together and support each other without drawing too much heat, but are you reaping all the benefits a support group can offer by limiting participation to only those incarcerated at the same facility? Without an open and continuous flow of up-to-date factual information, myths and misconceptions can spread like wildfire. However, if a group of peers meeting together to offer support to one another is your only option, go for it. Your group will still be emotionally beneficial and enable members to share important life experiences. You can work together to seek out current information from magazines, newsletters and other periodicals to insure the information brought to the group is current and factual. Perhaps the institution is open to allowing a support group in conjunction with health services? If so, the flow of information into the group, as well as group discussions, will undoubtedly be overseen by a health services staff member. Can your group function within these limitations and is this staff member HCV savvy? Most importantly, does the group respect this person? If not, how will the information they make available be perceived? And, does the group trust this person to act as its collective voice? These are things that must be considered for your group to be effective. You may find that an ideal situation is to involve people from the streets that are not only knowledgeable about hepatitis C, but who are dedicated activists interested in better healthcare for incarcerated persons. Many institutions allow people from the community to come into prisons to work as volunteers. If your access to the free world is too limited to make contact by phone, look in the newspaper for local support groups and start writing letters. Chances are you will soon find the right person willing to become involved, and interested in attending your group sessions. This is an excellent way to stay current with what's going on in the field of hepatitis C. If your institution doesn't allow volunteers, make contact with people on the streets who are willing to advocate for this cost-effective means of staffing an assortment of programs beneficial to both the prisoner and the institution. A great place to start is by contacting the Governor's ombudsman on prisoner issues. Most importantly, if you're shot down the first time, don't give up hope. There are people out here who care about you, your liver and your health. 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