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68-Ga DOTATATE Approved for Imaging of Neuroendocrine Tumors
Most well-differentiated neuroendocrine tumors arising in the gastrointestinal tract, pancreas, bronchus, and other sites express somatostatin receptors, and they can be imaged using radiolabeled somatostatin analogs. Uptake of radiolabeled somatostatin analogs is predictive of a clinical response to somatostatin analogs such as octreotide, and a positive scan can also identify an otherwise occult primary site in patients presenting with metastatic disease. Newer positron-emitting somatostatin analogs such as 68-Ga DOTATATE have emerged which, when combined with high-resolution positron emission tomography (PET) scanning, are more sensitive than conventional 111-In pentetreotide imaging (OctreoScan) for detection of small lesions. A kit for preparation of 68-Ga DOTATATE injection as a radioactive diagnostic agent for PET imaging (Netspot) was approved by the US Food and Drug Administration in June 2016. Due to its greater sensitivity, 68-Ga DOTATATE PET may be preferred over conventional 111-In pentetreotide scanning in certain clinical settings (eg, small volume disease), where available.
Checkpoint Inhibition Immunotherapy of Uncertain Benefit for Uveal Melanoma
Checkpoint immunotherapy with antibodies targeting PD-1/PD-L1 and CTLA-4 has represented a major advance in the treatment of advanced cutaneous melanoma. However, patients with uveal melanoma were generally excluded from the phase III trials with these agents. In a retrospective series of 58 patients with metastatic uveal melanoma that was presented at the 2016 American Society of Clinical Oncology (ASCO) meeting, only two partial responses were observed in patients treated with pembrolizumab, nivolumab, or atezolizumab. Thus, any potential clinical benefit in patients with metastatic uveal melanoma is much more limited than with cutaneous melanoma, and treatment of these patients should focus on clinical trial participation.
Management of Vaginal Cytology Results
Vaginal cancer is a rare disease, and screening with vaginal cytology is advised only for selected women at high risk (eg, prior hysterectomy and history of high-grade cervical intraepithelial neoplasia). The American Society for Colposcopy and Cervical Pathology (ASCCP) has published new guidance regarding the management of vaginal cytology results (algorithm 2). Indications for vaginal colposcopy were provided and included: high-grade squamous intraepithelial lesion (HSIL), atypical squamous cells cannot exclude high-grade lesion (ASC-H), or atypical glandular cells (AGC); atypical squamous cells of undetermined significance (ASC-US) with human papillomavirus (HPV) 16/18-positive; and follow-up testing for ≥ASC-US or HPV-positive. This is the first guideline to address management of vaginal cytology results.
Diagnostic Criteria for Opioid-Induced Constipation
Constipation is the most common and persistent side effect of opioid analgesics. Diagnostic criteria for opioid-induced constipation are now available (the Rome-IV criteria), which are based upon reduced bowel frequency, development or worsening of straining, a sense of incomplete evacuation, or a patient's perception of distress related to bowel habits.
H. Pylori Eradication and Risk of Gastric Cancer
It has been unclear if eradication of Helicobacter pylori infection reduces the risk of gastric cancer among asymptomatic individuals in populations that are not at high risk for gastric cancer. A meta-analysis of 27 studies included approximately 48,000 individuals, among whom 4800 were infected with H. pylori and approximately 700 had incident gastric cancers. Individuals with eradication of H. pylori had a lower incidence of gastric cancer compared with those who did not receive eradication therapy. H. pylori eradication was associated with a greater reduction in the incidence of gastric cancer in patients from populations with higher baseline rates of gastric cancer than in those from populations with lower baseline rates of gastric cancer.