Continuous sunitinib treatment in patients with unresectable hepatocellular carcinoma (HCC): A multicenter phase II trial (SAKK 77/06 and SASL 23)

Background: Sunitinib (SU) is a multitargeted tyrosine kinase inhibitor with antitumor and antiangiogenetic activity. Evidence for clinical activity in HCC was reported in 2 phase II trials [Zhu et al and Faivre et al, ASCO 2007] using either a 37.5 or a 50 mg daily dose in a 4 weeks on, 2 weeks off regimen. The objective of this trial was to demonstrate antitumor activity of continuous SU treatment in patients (pts) with HCC. Methods: Key eligibility criteria included unresectable or metastatic HCC, no prior systemic anticancer treatment, measurable disease and Child- Pugh A or B liver dysfunction. Pts received 37.5 mg SU daily until progression or unacceptable toxicity. The primary endpoint was progression free survival at 12 weeks (PFS12) defined as 'success' if the patient was alive and without tumor progression assessed by 12 weeks (±7 days) after registration. A PFS12 of _20% was considered uninteresting and promising if _40%. Using the Simon-two minimax stage design with 90% power and 5% significance the sample size was 45 pts. Secondary endpoints included safety assessments, measurement of serum cobalamin levels and tumor density. Results: From September 2007 to August 2008 45 pts, mostly male (87%), were enrolled in 10 centers. Median age was 63 years, 89% had Child-Pugh A and 47% had distant metastases. Median largest lesion diameter was 84mm (range: 18-280) and 18% had prior TACE. Reasons for stopping therapy were: PD 60%, symptomatic deterioration 16%, toxicity 11%, death 2% (due to tumor), and other reasons 4%; 7% remain on therapy. PFS12 was rated as success in 15 pts (33%) (95% CI: 20%, 49%) and failure in 27 (60%); 3 were not evaluable (due to refusal). Over the whole trial period 1 CR and 40% SD as best response were achieved. Median PFS, duration of disease stabilization, TTP and OS were 2.8, 3.2, 2.8 and 9.3 months, respectively. Grade 3 and 4 adverse events were infrequent and all deaths due to the tumor. Conclusions: Continuous SU treatment with 37.5 mg/d daily is feasible and demonstrates moderate activity in pts with advanced HCC and mild to moderately impaired liver dysfunction. Under this trial design the therapy is considered promising (>13 PFS12 successes).

Number of Inmates with Life Sentences Leveling Off, April 2013, Corrections, Department of

For over three decades, the number of Iowa inmates with life sentences has shown a steady increase. As the chart below shows, that number has risen from 111 in 1980 to 680 in 2012 (data for 1987 is unavailable due to transitioning to new data systems)

Industrial agglomerations and wage gradients: the Spanish economy in the interwar period

This paper gives new evidence on the relationship between integration and industrial agglomeration in the presence of scale economies, by testing directly one of the predictions that can be derived from Krugman (1991), that is, the existence of regional nominal wage gradients and its transformation following changes in trade regimes. Our case study analyzes the effects of the substitution of an open economy by a closed economy regime, exactly the opposite process studied by Hanson (1996, 1997). In Spain, during the interwar period, protectionist policies would have favored the loss of centrality of the coastal location (Barcelona) and the relative rise of central locations (such as Madrid). Our results indicate the existence of a wage gradient centered in Barcelona during the interwar period (1914-1930) and its weakening after 1925.

Special investigation of the Iowa Department of Transportation for the period January 29, 1994 through July 7, 2011

Special investigation of the Iowa Department of Transportation for the period January 29, 1994 through July 7, 2011

Special investigation of the University of Northern Iowa Events Complex Concessions for the period October 1, 2006 through March 31, 2012

Special investigation of the University of Northern Iowa Events Complex Concessions for the period October 1, 2006 through March 31, 2012

Report on a special investigation of the City of Indianola for the period June 1, 2006 through August 31, 2012

Report on a special investigation of the City of Indianola for the period June 1, 2006 through August 31, 2012

Intrathecal drug delivery systems for cancer pain

Introduction: A substantial number of patients with cancer suffer considerable pain at some point during their disease, and approximately 25% of cancer patients die in pain. In cases of uncontrolled pain or intolerable side effects, intrathecal drug delivery system (IDDS) is a recognised management option. Indeed, IDDS offer rapid and effective pain relief with less drug side effects compared to oral or parenteral administration. The aim of this study is to retrospectively review our series of cancer patients treated with IDDS. Method: Data was extracted from the institutional neuromodulation registry. Patients with cancer pain treated with IDDS from 01.01.1997 to 30.12.2009 were analysed for subjective improvement, changes in pain intensity (VAS) and survival time after implantation. Measurements were available for a decreasing number of patients as time since baseline increased. Results: During the studied period, 78 patients were implanted with IDDS for cancer pain. The mean survival time was 11.1 months (median: 3.8 months) and 14 patients (18%) were still alive at the end of the studied period. Subjective improvement was graded between 55 and 83% during the first year. Mean VAS during the first year remained lower than VAS at baseline. Discussion: IDDS has been shown to be cost-effective in several studies. Although initial costs of implantation are high, the cost benefits favour analgesia with implanted intrathecal pumps over epidural external systems after 3 to 6 months in cancer patients. Improved survival has been associated with IDDS and in this series both the mean and median survival times were above the cut-off value of three months. The mean subjective improvement was above 50% during the whole first year, suggesting a good efficacy of the treatment, a finding that is consistent with the results from other groups. Changes in pain intensity are difficult to interpret in the context of rapidly progressive disease such as in terminal cancer. However, mean VAS from 1 thru12 months were lower than baseline, suggesting improved pain control with IDDS, or at least a stabilisation of the pain symptoms. Conclusion: Our retrospective series suggests IDDS is effective in intractable cancer pain and we believe it should be considered even in terminally ill patients with limited life expectancies.

Report on a special investigation of the Lyon County Engineer’s Office for the period August 1, 2006 through May 31, 2012

Report on a special investigation of the Lyon County Engineer’s Office for the period August 1, 2006 through May 31, 2012

Report on a special investigation of the Creston Water Works for the period July 1, 2005 through November 16, 2012

Report on a special investigation of the Creston Water Works for the period July 1, 2005 through November 16, 2012

Report on special investigation of the Department of Inspections and Appeals, Office of the State Public Defender, for the period August 31, 2007 through March 31, 2011

Report on a special investigation of the State Public Defender’s Office for the period August 31, 2007 through March 31, 2011

Iowa Turkey Marketing Council Independent accountant’s report on applying agreed upon procedures for the period January 1, 2011 through December 31, 2012.

Agreed upon procedures report on the Iowa Turkey Marketing Council for the period January 1, 2011 through December 31, 2012

Report on special investigation of the City of Farmington for the period July 1, 2009 through November 30, 2012

Special investigation of the City of Farmington for the period July 1, 2009 through November 30, 2012

Examination report on the City of Gilbert, Iowa for the period May 1, 2012 through April 30, 2013

Examination report on the City of Gilbert, Iowa for the period May 1, 2012 through April 30, 2013

Report on a special investigation of the City of Grand River for the period July 1, 2004 through March 7, 2012

Report on a special investigation of the City of Grand River for the period July 1, 2004 through March 7, 2012