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Prof. Charlie Gourley, 30 Sep 2020

First-line poly(ADP-ribose)polymerase (PARP) inhibitor maintenance therapy significantly increases progression-free survival (PFS) in high-grade ovarian cancer patients. However, questions remain regarding the ability of PARP inhibitors to increase the cure rate, the types of patients most likely to benefit from them, and when it is best to employ them. In a virtual small-group meeting with experts in Hong Kong, Professor Charlie Gourley of the University of Edinburgh, Edinburgh, UK discussed the criteria for optimal patient selection and the positioning of PARP inhibitors in the patient journey.

Dr. Kathleen Moore, 30 Sep 2020
Most patients with advanced ovarian cancer (OC) relapse after standard cytoreductive surgery and platinum-based chemotherapy. At a webcast organized by the Hong Kong Society of Clinical Oncology, Dr Kathleen Moore of the University of Oklahoma in Norman, Oklahoma, US, discussed the results of the SOLO-1 trial, which demonstrated significant progression-free survival (PFS) benefits associated with maintenance therapy using the poly(adenosine diphosphate–ribose) polymerase (PARP) inhibitor, olaparib, in patients with newly diagnosed, advanced BRCA-mutated OC who had complete or partial response (CR/PR) to first-line platinum-based chemotherapy. 
05 Aug 2020
With ageing populations, many countries face increasing healthcare demands associated with the management of diseases and comorbidities common among the elderly, such as cancer, osteoarthritis and rheumatoid arthritis, and the pain associated with these conditions. In recent years, there has been growing evidence supporting the use of sustained-release (SR) oxycodone (OxyContin®, Mundipharma) as a pain management option for elderly patients, particularly those experiencing chronic cancer-related pain. This article summarizes the key points and evidence from two seminal papers – a consensus statement of an international expert panel on opioids and the management of chronic severe pain in the elderly as well as a multicentre, open-label randomized controlled trial investigating the efficacy and safety of SR oxycodone in cancer pain treatment. 
Dr. Thomas Chan, 05 Oct 2020
Current international guidelines on management of chronic lymphocytic leukaemia (CLL) recommend the use of B cell lymphoma-2 (BCL-2) inhibitors, such as venetoclax, in patients with relapsed or refractory (R/R) disease with or without chromosome 17p deletion, based on improvements in progression-free survival (PFS) and overall survival (OS) and a high rate of undetectable minimal residual disease (uMRD). Dr Thomas Chan, Specialist in Haematology & Haematological Oncology in Hong Kong, discussed these recent advances in R/R CLL management with MIMS Oncology.

CRC ESD with 2nd-gen flexible endoscopic robotic system pioneered in HK

Christina Lau
21 Sep 2020
Prof Philip Chiu (left), Prof Simon Ng (right)

Researchers from the Chinese University of Hong Kong (CUHK) have launched the world’s first clinical trial of robotic endoscopic submucosal dissection (ESD) of early-stage colorectal cancer (CRC) using a second-generation flexible endoscopic robotic system developed jointly with investigators in Singapore.

“The new system, known as EndoMaster EASE, is an endoluminal robotic system consisting of an independently designed flexible endoscopic platform, three working channels for two robotic arms and accessories, and an independent water-jet system,” said Professor Philip Chiu of the CUHK Jockey Club Minimally Invasive Surgical Skills Centre.

“Our previous study showed that the EndoMaster robotic system can be used to perform ESD and effectively treat patients with early gastric neoplasia,” explained Chiu. [Clin Gastroenterol Hepatol 2012;10:1117-1121] “The second-generation EndoMaster EASE system is redesigned and developed for performing ESD in the colorectum, which presents a higher level of technical challenge due to the colorectum’s long and winding shape as well as thin wall. It allows tissue retraction with excellent visualization to enhance the safety of submucosal dissection.”

The clinical trial aims to recruit 46 patients with early-stage CRC – a group with growing demand for ESD due to the increasing number of cases identified through CRC screening programmes.

As of 15 September 2020, six patients with early-stage CRC had undergone robotic ESD in the trial. “Negative resection margin was achieved in all six patients, with no perforation or post-ESD bleeding. The mean operation time was 88 minutes, while mean length of hospital stay was 2 days. The patients were able to resume a normal diet 1 day after the procedure,” reported Chiu. “The first patient underwent colorectal ESD with the EndoMaster EASE system at our centre in May 2020. Another two patients are recruited recently into the trial and are to undergo preoperative assessment shortly.”  

“In Hong Kong, about 60 percent of CRC cases discovered through the government’s CRC screening programme are early-stage cases suitable for ESD. At the Prince of Wales Hospital alone, 150 cases of ESD for early-stage CRC were performed in 2019,” said Professor Simon Ng of the Division of Colorectal Surgery, CUHK.  

“However, ESD is technically very challenging, involving a learning curve of 80–100 cases and an operation time of 2–3 hours. If performed by inexperienced endoscopists, the risk of complications is relatively high, with our previous study reporting a 65.2 percent perforation rate and a 56.5 percent bleeding rate,” Ng continued. [Surg Endosc 2010;24:1049-1054]

The researchers therefore see an urgent need to refine the ESD technology, with the use of robotics, for example, to address the increasing demand for ESD for early-stage CRC.

“In our preclinical study involving three ESD expert endoscopists, three ESD nonexpert endoscopists and three nonendoscopist novices, even novices were able to complete ESD procedures in porcine stomach models using the EndoMaster robotic system, with no perforation,” said Chiu. [Endosc Int Open 2015;3:E439-E442]

“Introduction of the second-generation flexible endoscopic robotic system may encourage more endoscopists to provide ESD for treatment of early gastrointestinal cancer in a safe manner,” Chiu suggested.

“The learning curve for ESD with the second-generation flexible endoscopic robotic system may be less steep compared with conventional ESD, but we need more data to confirm,” said Ng.
CU EndoMaster EASE_2
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Most Read Articles
Prof. Charlie Gourley, 30 Sep 2020

First-line poly(ADP-ribose)polymerase (PARP) inhibitor maintenance therapy significantly increases progression-free survival (PFS) in high-grade ovarian cancer patients. However, questions remain regarding the ability of PARP inhibitors to increase the cure rate, the types of patients most likely to benefit from them, and when it is best to employ them. In a virtual small-group meeting with experts in Hong Kong, Professor Charlie Gourley of the University of Edinburgh, Edinburgh, UK discussed the criteria for optimal patient selection and the positioning of PARP inhibitors in the patient journey.

Dr. Kathleen Moore, 30 Sep 2020
Most patients with advanced ovarian cancer (OC) relapse after standard cytoreductive surgery and platinum-based chemotherapy. At a webcast organized by the Hong Kong Society of Clinical Oncology, Dr Kathleen Moore of the University of Oklahoma in Norman, Oklahoma, US, discussed the results of the SOLO-1 trial, which demonstrated significant progression-free survival (PFS) benefits associated with maintenance therapy using the poly(adenosine diphosphate–ribose) polymerase (PARP) inhibitor, olaparib, in patients with newly diagnosed, advanced BRCA-mutated OC who had complete or partial response (CR/PR) to first-line platinum-based chemotherapy. 
05 Aug 2020
With ageing populations, many countries face increasing healthcare demands associated with the management of diseases and comorbidities common among the elderly, such as cancer, osteoarthritis and rheumatoid arthritis, and the pain associated with these conditions. In recent years, there has been growing evidence supporting the use of sustained-release (SR) oxycodone (OxyContin®, Mundipharma) as a pain management option for elderly patients, particularly those experiencing chronic cancer-related pain. This article summarizes the key points and evidence from two seminal papers – a consensus statement of an international expert panel on opioids and the management of chronic severe pain in the elderly as well as a multicentre, open-label randomized controlled trial investigating the efficacy and safety of SR oxycodone in cancer pain treatment. 
Dr. Thomas Chan, 05 Oct 2020
Current international guidelines on management of chronic lymphocytic leukaemia (CLL) recommend the use of B cell lymphoma-2 (BCL-2) inhibitors, such as venetoclax, in patients with relapsed or refractory (R/R) disease with or without chromosome 17p deletion, based on improvements in progression-free survival (PFS) and overall survival (OS) and a high rate of undetectable minimal residual disease (uMRD). Dr Thomas Chan, Specialist in Haematology & Haematological Oncology in Hong Kong, discussed these recent advances in R/R CLL management with MIMS Oncology.