tbuckley/cabot-search huggingface dataset:
Liquid biopsy of the immune environment: Evaluation of peripheral blood mononuclear cells (PBMCs) with CyTOF and response to trastuzumab (T)-based neoadjuvant chemotherapy (NAC) in HER2+ breast cancer (BC).
Authors: Roberto Antonio Leon-Ferre, Kaitlyn McGrath, Vera J. Suman, Jodi M Carter, Krishna R. Kalari, Richard M. Weinshilboum, Liewei Wang, James N. Ingle, Keith L. Knutson, Stephen M. Ansell, Judy Caroline Boughey, Jose Caetano Villasboas, Matthew P. Goetz
Journal: Journal of Clinical Oncology (2020)

592 Background: Immune responses in the tumor microenvironment have prognostic and predictive value in BC. However, the potential of immune responses observed in peripheral blood as biomarkers in BC remains unclear. We have shown that a higher frequency of circulating monocytes and a lower frequency of antigen-experienced memory CD8+ T cells are associated with response to NAC in triple negative BC (Leon-Ferre et al SABCS 2019). Here, we used cytometry by time-of-flight (CyTOF) to evaluate associations between circulating immune cells, clinical features and response to T-based NAC in HER2+ BC. Methods: PBMC suspensions from 36 pts with stage I-III HER2+ BC were prospectively collected prior to initiation of T-based NAC, stained with 29 metal-tagged antibodies optimized to identify major human immune cell subsets, and acquired in the Helios CyTOF instrument. Differential abundance analysis of immune cells by clinical characteristics and by NAC response was evaluated using Wilcoxon rank sum test. % of immune cell subsets is presented as % of all PBMCs. Results: Most pts presented with ER- tumors (56%), measuring &gt; 5cm (64%) and with nodal metastases (78%). After NAC, 16 pts (44%) achieved pathologic complete response (pCR). Analysis of preNAC PBMCs demonstrated a significantly higher number of B cells (8% vs 5%, p = 0.05) and effector memory CD8+ T cells (CD45RA-/CCR7-, 3 vs 1%, p = 0.02) in pts with pCR compared to those with residual disease. Of the B cell subsets, naïve B cells (CD24-/CD27-) were higher in pts who achieved pCR vs not (7% vs 4%, 0 = 0.04). Regarding clinical characteristics, cN+ pts at presentation exhibited a lower number of peripheral blood T cells compared to cN- pts (47% vs 63%, p = 0.03). Of the T cell subsets, overall CD4+ and naïve CD4+ T cells (CD45RA+/CCR7+) were lower in cN+ vs cN- pts (31% vs 45%, p = 0.05; and 11% vs 24%, p = 0.04). We also observed differences in CD56+/CD16- NK cells by ER status (ER- 1% vs ER+ 3%, p = 0.01), and a moderate negative correlation between age and % circulating CD8+ T cells (rho -0.4669, p = 0.004). Conclusions: Distinct peripheral blood immune cell profiles are observed in HER2+ BC at diagnosis, and are associated with response to T-based NAC and initial clinical characteristics. Notably, pts who later achieved pCR had a relative abundance of B cells and effector memory CD8+ T cells at diagnosis. These data suggest that immune cell phenotyping in peripheral blood may have potential as a biomarker to predict response to NAC in BC.
Primary physicians can also write papers
Authors: 曾昭耆
Journal: BMJ (2010)

工作在基层的医生往往因为个人专业水平较低,工作条件所限,病例少,设备差,很难写出什么文章,所以认为搞科研、写论文是大医院医生的事.特别是近些年,通常把发表论文和晋升挂钩,自己没条件,只能长年累月无声无息地干活。
Nanomaterials augmented LDI-TOF-MS for pancreatic ductal adenocarcinoma diagnosis and classification.
Authors: Yaolin Xu, Dansong WANG, Tiantao Kuang, Wenchuan Wu, Xuefeng Xu, Dayong Jin, Hua Zhang, Sheng Zhong, Yunbing Wang, Wenhui Lou
Journal: Journal of Clinical Oncology (2020)

e16761 Background: Pancreatic ductal adenocarcinoma (PAAD) is one type of cancer with poor prognosis. Although CA 19-9 was the most common serological marker for cancer screening and surveillance after treatment, there are still unignorable limitations, including low sensitivity, possible false-negatives/positives owing to confounding conditions. Reliable non-invasive diagnostics is in urgent need. As PAAD is increasingly considered as a metabolic disorder, serum metabolite profiling is becoming critical to reveal important cancer-related bioinformation. This work proposes a novel LDI-TOF-MS technique for PAAD screening and diagnosis. Methods: An LDI-TOF-MS platform was established for cancer screening. All mass spectrum was collected within a mass range of 100 to 1,100 Da, while the spectra were manually examined using the FlexAnalysis 3.4 software (Bruker Daltonics, Bremen, Germany). In a typical process, 0.5 uL of serum samples were spotted on a polished steel target plate MTP 384 and air-dried followed by another 1 uL of GNS or SiNW nanomaterials. The spectra were then acquired in the reflection positive mode with smartbeam-II laser at 355 nm with laser frequency of 1,000 Hz. A random walk of 25 shots at raster spot and 20 different spots were measured for each individual sample, therefore, 500 satisfactory shots were obtained. Results: By taking advantage of 3D nanostructures and machine learning, we applied proposed approach to 94 patients with PAAD, as well as 203 healthy controls (Table). The results demonstrated an average sensitivity of 99% and a specificity over 98% in detecting cancers. 11 of 94 PAAD patients (11.70%) were CA 19-9 negative (CA19-9 &lt; 37U/ml, stage I n = 2, stage II n = 7, stage III n = 1 and stage IV n = 1). LDI-TOF-MS recognized almost all CA 19-9-negative PAAD. The sensitivity and specificity were obviously superior to CA 19-9 in PAAD: only 1 of 94 PAAD (1.06%) were misclassified as healthy controls. In contrast, CA19-9 positive and CA 19-9 negative PAADs were not readily distinguished by this method. Therefore, this method was independent of tumor markers. Conclusions: Result suggested strong potential of proposed technique as a low-cost, superior precision, and high-throughput procedure for PAAD diagnosis and beyond. [Table: see text]
超声导向自动活检术对慢性肝病的诊断价值
Authors: 张启芳, 张海莲, 易珊琳, 陈卓琳
Journal: BMJ (2006)

总结超声导向自动活检术患者的临床资料,分析肝活检的成功率、病理结果及并发症等情况,探讨超声导向自动活检术的安全性、优点及临床应用价值.42例患者的穿刺成功率为100.0%,阳性病理结果获取率为97.6%,除术后出现穿刺部位一过性疼痛外,所有病例均无严重并发症发生.超声导向自动活检术具有取材成功率高、安全、并发症少、操作简单、易于掌握等优点,值得临床推广应用。
Relationship of congenital urogenital abnormalities and chromosomal abnormalities: a report of 200 cases
Authors: Li-na Zhu, Xiao Yang, Ning Ma, Hao Li, Jia Guo, Xue Bai
Journal: BMJ (2013)

A total of 200 outpatients with congenital urogenital abnormalities were recruited. Peripheral blood from each patient had mixed lymphocyte culture and chromosome karyotype was analyzed. Among them, 22 (11%) cases showed abnormal chromosomal karyotypes. The aberrations included abnormal chromosome number (n=13), abnormal chromosome structure (n=8) and sex reversal syndrome (n=1). Chromosomal aberrations are important causative factors of congenital urogenital abnormalities.


Key words: 
Chromosome aberrations; Sex reversal syndrome
加拿大安大略省五大医疗服务的等待时间
Authors: 王健, 祝墡珠, 潘志刚
Journal: BMJ (2008)

在加拿大安大略省的官方网站上,有关于该省五大医疗服务等待时间的具体信息.该网站是2004年12月20日开办的,当时的内容是等待时间的有关策略.2005年10月24日,安大略省第一次将等待时间的信息上网公布,从网站上获得的等待时间数据使访问者能够将其所在地的等待时间和其他省做比较,在和自己的医生商量后,根据自己的情况利用该系统的信息,选择等待名单较短的专家或选择一家可能较快获得服务的医院。
治疗烟草依赖的方法
Authors: 林江涛, 俞红霞
Journal: BMJ (2009)

烟草依赖实际上是一种明确界定的神经精神疾病[1],是一种慢性高复发性疾病,有心理、社会、生理及环境等多种因素的介入.戒烟是一个痛苦、反复和长期的过程,需要持续进行.只有少数吸烟者一次就能完全戒掉,大多数吸烟者均有反复复吸的经历.需要多次尝试才能最终戒烟.实践证明,仅靠吸烟者的个人意志很难戒烟成功(十戒九败),使用有效的药物措施可使戒烟成功率提高2～3倍.治疗烟草依赖必须采取综合、系统、科学的方法,较为理想的戒烟方法是:针对每个吸烟者的不同情况,采取药物疗法+心理行为辅导[2]106-114。
药物加心理治疗灼口综合征21例
Authors: 张凤香, 张利俊, 刘晓娟
Journal: BMJ (2004)

目前灼口综合征(burning mouth syndrome, BMS)的发病机制尚未确定,但BMS患者伴有明显的心理障碍及人格异常已得到多数学者认同,且在更年期或绝经后期妇女中发病率高[1].我们对40例BMS患者随机分组观察,分析如下。
A retrospective observational study on the efficacy and safety of pegylated recombinant human granulocyte-colony stimulating factor and recombinant human granulocyte-colony stimulating factor in patients with lymphoma.
Authors: Lihong Liu, Lili Wu, Chen Huang, Guimin Zhao, Guangyu Ma, Yuhuan Gao, Lanping Diao, Yingzhen Yao, Xiaolin Wu, Zhe Gao
Journal: Journal of Clinical Oncology (2020)

e20066 Background: To evaluate the efficacy and safety of pegylated recombinant human granulocyte-colony stimulating factor (PEG-rhG-CSF) and recombinant human granulocyte-colony stimulating factor (rhG-CSF) in patients with lymphoma. Methods: This retrospective study included patients with newly diagnosed lymphoma who received CHOP ± R (cyclophosphamide, doxorubicin, vincristine, prednisone ± rituximab) between January 2014 to October 2018. PEG-rhG-CSF(brand name: jinyouli) was injected subcutaneously once 24-72 hours after chemotherapy as primary prevention. rhG-CSF was used as prevention or treatment. The primary endpoint was the incidence of febrile neutropenia (FN), and the secondary endpoints included the incidence of grade III/IV neutropenia, the incidence of chemotherapy dose adjustment, the incidence of chemotherapy delay, the rate of antibiotics application and safety. Results: 178 patients with lymphoma were included, of which 76 were in the PEG-rhG-CSF group (256 cycles) and 102 were in the rhG-CSF group (336 cycles). The incidence of FN was 1.17% (3/256) in the PEG-rhG-CSF group and 5.95% (20/336) in the rhG-CSF group, P= 0.003. The incidence of grade Ⅲ/Ⅳ neutropenia and chemotherapy delay in the PEG-rhG-CSF group were significantly lower than those in the rhG-CSF group (12.89%[33/256] vs 50.30%[169/336], P &lt; 0.0001; 3.13%[8/256] vs 9.52% [32/336], P= 0.002). However, there was no significant difference between the two groups in the incidence of dose adjustment (6.25% vs 3.57%, P = 0.128) and the rate of antibiotics application (34.77% vs 33.33%, P= 0.715). And there was no significant difference in the incidence of fever, bone pain and fatigue between the two groups. Conclusions: Compared with rhG-CSF, prophylactic use of PEG-rhG-CSF can significantly reduce the incidence of FN, grade III/IV neutropenia and chemotherapy delay in patients with lymphoma with good safety.
Real-world experience of talimogene laherparepvec in patients receiving immunotherapy in metastatic melanoma.
Authors: Tapas Ranjan Behera, Jung Min Song, Jennifer S. Ko, Michael J. McNamara, Pauline Funchain, Brian Gastman
Journal: Journal of Clinical Oncology (2020)

e22003 Background: Talimogene laherparepvec (TVEC) is an oncolytic herpes virus approved by the FDA for intralesional therapy in unresectable metastatic melanoma. However, little is known regarding the effectiveness of TVEC+checkpoint inhibition (CPI) outside of clinical trials. We present outcomes of the largest single institution experience with TVEC in the context of different immune checkpoint inhibitors. Methods: All patients with stage III-IV unresectable melanoma having received TVEC were evaluated. Patient demographics, clinicopathological characteristics, TVEC treatment response and outcomes were assessed. Final analysis included those who received TVEC adjacent to CPI with a minimum 6-month follow-up, excluding patients on clinical trials. Response was estimated by sequential measurement of injectable on-target lesions. Results: A total of 62 patients received TVEC from 2016 to 2019, of which 43 remained excluding Merkel cell carcinoma, patients on trials, and TVEC monotherapy. Of 30 patients with available treatment response data and at least 6-months follow-up, median age was 68.5 years (30-99 years), 40% were female, 16 (53.3%) stage IV. Median follow-up was 17.5 months (6-43 months). At 6 months, 20 (67.7%) patients were alive; at 1 year, 17 (56.7%) patients were alive. Eighteen patients received pembrolizumab, 7 nivolumab and 5 ipilimumab/nivolumab. Median number of TVEC doses received was 8 (3-31 doses). Median time on TVEC therapy was 4 months (1-26 months). Overall response rate for on-target lesions was 24 (80%), with complete local response (CR) in 15 (50%), partial response (PR) in 9 (30%), and progressive disease (PD) in 6 (20%). Median time to response was 6 weeks (2-17 weeks); 5 in CR, 6.5 in PR and 5.5 in PD groups. Adverse events were mostly mild and limited to constitutional symptoms. Conclusions: To our knowledge this is the largest real-world experience assessing TVEC in patients receiving CPI. Local overall response rate appears higher in comparison to historic numbers for TVEC monotherapy. The findings demonstrate that TVEC is an effective and safe treatment for metastatic melanoma and has robust outcomes in real-life clinical settings.
子宫破裂致继发性腹腔妊娠一例
Authors: 徐斌
Journal: BMJ (2011)

患者女,33岁.因停经8个月,水肿2个月余,加重半个月于2010年5月6日人院.孕2产1存1,足月顺产1次,平素月经规律.末次月经2009年9月11日.患者停经40余天开始出现早孕反应.孕3个月自觉胎动.2个月前患者出现下肢水肿,半个月前水肿加重,肿及伞身,多次测量血压升高,最高达150/100 mm Hg(1 mm Hg=0.133 kPa),尿常规示尿蛋白(+++),定量3.0 g/L,尿量无异常,门诊诊断为妊娠期高血压疾病,并给予口服药物降血压治疗.孕期无明显不适.既往无高血压及肾炎病史,否认遗传病及传染病史.自述1年前曾因子宫角部妊娠在本院行病灶剜除及宫角修补手术。
以躯体不适为主要症状的抑郁症
Authors: 朱培林, 王苑华, 朱培俊, 张静
Journal: BMJ (2006)

对综合医院门诊患者进行汉密顿抑郁量表(HAMD)及抑郁自评量表(SDS)评分,对分值分别≥18分和≥50分、符合CCMD-Ⅲ抑郁症诊断标准的200例患者给予氟西汀(百忧解)治疗8周,进行疗效评定.结果 显示200例患者有94.0%(188例)的初诊患者第一主诉是躯体不适及睡眠障碍等.百忧解治疗8周,各项评分明显下降.提示及时识别以躯体不适为主诉就诊的抑郁症患者并进行抗抑郁治疗,可有效缓解抑郁症的躯体症状,有利于患者早日康复。
A phase I, dose-escalation and expansion study of TQ-B3139, a novel ALK TKI, in Chinese ALK or ROS1 positive advanced non-small cell lung cancer (NSCLC).
Authors: Yuxiang Ma, Nong Yang, Su Li, Hongyun Zhao, Liu Li, Haiyan Yang, Wenfeng Fang, Yang Zhang, Shaodong Hong, Yi Xiong, Chunhua Zhou, Yongchang Zhang, Liang Zeng, Li Zhang
Journal: Journal of Clinical Oncology (2020)

9585 Background: TQ-B3139 is a novel ALK inhibitor with activity 3-7 folds higher than Crizotinib against a broad range of ALK mutations. This phase I study (NCT03099330) is to investigate the safety, and determine the recommended phase II dose (RP2D), and pharmacokinetic (PK), clinical efficacy of TQ-B3139 in Chinese NSCLC patients. Methods: Patients with advanced NSCLC and failed at least one systemic anti-cancer treatment were enrolled. TQ-B3139 was administered orally from 50mg~100mg qd and 200, 300, 400, 500, 600 and 800mg bid, using a PK-guided modified Fibonacci 3+3 dose escalation design. The dose-escalation evaluated patients in 28-day cycles, dose limited toxicities (DLTs) was observed at first cycle. Dose-expansion phase started at dose level which objective response occurs. Treatment was continued until disease progression, death or unacceptable toxicity. Results: Between July 2017 and May 2019, totally 63 patients (59 ALK+, 4 ROS1+) were enrolled. Sixteen patients had prior ALK inhibitor therapy (11 Crizotinib, 5 Ensartinib), and 23 (36.5%) with baseline brain metastasis. Totally, 62 (98.4%) patients experienced treatment-related adverse events (TRAEs), grade 3-4 TRAEs were observed in 21 (33.3%) patients. One DLT occurred in the 800mg bid dose cohort (grade 3 nausea and vomiting). Top 3 common TRAEs were nausea (all grade 87.3%; grade 3-4 3.2%), diarrhea (84.1%, 6.4%), transaminase elevation (65.1%, 4.8%). AUC and C trough at steady state increased proportionally from 200mg to 600mg bid. Absorption saturation was observed in 800mg bid. Base on the safety and PK results, PR2D was decided at 600mg bid. Overall ORR was 73.0% (2 CR, 44 PR); DCR was 85.7% (8 SD). Objective response was observed from dose level 200mg bid cohort, ORR and DCR at ≥200mg bid was 78.0% and 89.8%. For ALK TKI-naïve and -resistant patients, the ORR was 78.7% (37/47) and 56.3% (9/16) respectively. For patients with measurable baseline brain metastasis, the ORR for brain lesions was 80.0% (8/10). At data cut-off (23 Jan 2020), 32 events (50.8%) occurred, the median PFS for all patients was 12.1 months (95%CI 8.5-15.6), for patients at ≥200mg bid dose was 12.2 months. The median PFS was not reached for -naive patients (6 months PFS rate 74.5%, 95%CI 68.1-80.9), and 5.6months (95%CI 1.6-9.5) for ALK TKI-resistant patients. Conclusions: TQ-B3139 was well tolerated in Chinese NSCLC patients with high antitumor activity. RP2D was established at 600mg bid. A randomized phase III trial of TQ-B3139 versus Crizotinib in advanced ALK-TKI naïve NSCLC patients is underway. Clinical trial information: NCT03099330 .
Lipid lowering therapy in cardiovascular disease: From myth to molecular reality
Authors: Philipp Mourikis, Saif Zako, Lisa Dannenberg, Amir M. Nia, Yvonne Heinen, Lucas Busch, Hannah Richter, Thomas Hohlfeld, Tobias Zeus, Malte Kelm, Amin Polzin
Journal: Pharmacology & Therapeutics (2020)
A phase II, multicenter study of encorafenib/binimetinib followed by a rational triple-combination after progression in patients with advanced BRAF V600-mutated melanoma (LOGIC2).
Authors: Reinhard Dummer, Shahneen Kaur Sandhu, Wilson H. Miller, Marcus O. Butler, Christian U. Blank, Eva Muñoz-Couselo, Howard A. Burris III, Michael A. Postow, Bartosz Chmielowski, Mark R. Middleton, Carola Berking, Jessica Cecile Hassel, Anja Gesierich, Cornelia Mauch, Joseph Kleha, Ashwin Gollerkeri, Allison Harney, Michael D Pickard, Paolo Antonio Ascierto
Journal: Journal of Clinical Oncology (2020)

10022 Background: LOGIC2 evaluates the benefit of a 3rd agent added to encorafenib (enco)/binimetinib (bini), selected at progression based on the genetic tumor evolution. Methods: In part I/run-In, pts were treated with enco/bini until disease progression (as defined per RECIST v1.1). Foundation One NGS was applied on a baseline sample and on a PD sample. Based on the genetic evolution between the biopsy at inclusion (bxI) and at progression (bxPD) and clinical considerations, pts entered part II and received one of four 3rd agent additions to enco/bini combinations: A. LEE011 (CDK4/6 inhibitor), B. BKM120 (PI3K inhibitor), C. INC280 (c-Met inhibitor), or D. BGJ398 (FGFR inhibitor). An adaptive Bayesian logistic regression model (BLRM) guided by the escalation with overdose control (EWOC) principle was used to make dose escalation decisions. Assessments include objective response rate (ORR), disease control rate (DCR), progression-free survival (PFS), and safety. Data cutoff for this analysis was May 12, 2019. Data is as is. Part 1 of study is ongoing. Part 2 of study is closed to enrollment. Results: 58 pts enrolled into part II (group A=38; B=6; C=13; D=1). 29 pts were assigned to treatment based on bxPD results (Table). In groups A, B, and C, the confirmed ORR was 5.3%, 0%, and 0%, and the DCR was 26.3%, 16.7%, and 15.4%, with median PFS of 2.1, 1.6, and 2.2 months, respectively. Safety was consistent with known profiles of the individual agents. Conclusions: Triple therapy is feasible when a 3rd agent is added to enco/bini at progression based on genetic alterations, although activity observed was low. Further exploration to identify patterns of resistance susceptible to the addition of a 3rd agent is needed. Gene alterations for enrollment into part 2. Clinical trial information: NCT02159066. [Table: see text]
Difficulties and suggestions for diagnosis and treatment of tinnitus
Authors: Lisheng Yu
Journal: BMJ (2016)

困扰耳科医生的3大顽症即耳聋、耳鸣、眩晕中，耳鸣的诊治是难中之难。其原因在于耳鸣发病原因众多、缺乏有效的客观检查手段、耳鸣的发病机制不明、治疗无从下手。通过对这几个难点进行分析，提出听觉系统以及非听觉系统在耳鸣的发生中都起重要的作用，要从多方面寻找耳鸣的病因，对于部分病因不明的耳鸣则可以按照病程进行治疗，以此为临床耳鸣的诊治提供参考。
糖耐量低减者高敏C反应蛋白和白细胞介素6的变化
Authors: 孔令文, 代俊合, 邓芳, 刘培跃, 冯茂盛, 张婷, 宋成
Journal: BMJ (2005)

检测糖耐量低减者血清高敏C反应蛋白(hs-CRP)和白细胞介素6(IL-6)水平,并与2型糖尿病组、正常对照组进行比较.结果显示,糖耐量低减组血清hs-CRP 、IL-6水平高于正常对照组,低于2型糖尿病组;hs-CRP 和IL-6两者呈正相关;随着患者体重指数的增加,血清hs-CRP和IL-6逐渐升高.提示炎症因子是糖耐量低减的危险因子之一,糖耐量低减期间血清IL-6可能参与诱导C反应蛋白的合成。
Establishing the six-month resource utilization and cost-of-care for the treatment of first-line metastatic BRAF (V600) melanoma with combination BRAF and MEK inhibitors.
Authors: Shiraz Halloush, Stephen Huber, Hanna Kim, Jim M. Koeller
Journal: Journal of Clinical Oncology (2020)

e19396 Background: Comparative data on cancer therapy health care resource utilization (HCRU) and associated cost will be helpful as value-based healthcare moves forward. BRAF &amp; MEK inhibitor combinations are considered first-line treatment for BRAF (V-600) metastatic melanoma (MM), although head-to-head trials are lacking. We aimed to establish the real-world HCRU and 6-month (mo) cost-of-care in V-600 MM treated with BRAF &amp; MEK inhibitor therapy. Methods: A single data team in 2018 performed a multicenter, retrospective chart audit of adult patients with BRAF V-600 MM. Four institutions from across the US with patients who had received either dabrafenib + Trametinib (DT) or vemurafenib + cobimetinib (VC) were enrolled. In the most recent 12 mo period, data was captured from the start of therapy for 6 mo or until therapy was stopped. Dose change or stoppage was accessed for cause (toxicity, disease, death, other). Variables included hospitalization, emergency room (ER), all clinic visits (routine + extra), scans, labs, and treatment drug (AWP). Medicare reimbursed rates were applied for cost estimates. Utilization and costs were measured on per patient per month (PPPM) bases and the total cost over 6 mo for each combination. Results: Of the 42 patients included, 34 and 8 were initiated on DT and VC, respectively. Proportions of patients with extra clinic visits and hospital admissions were 79%, 15% and 75%, 13%, respectively for DT and VC. PPPM hospitalization was the lowest among the resources utilized 0.24 for DT and 0.17 for VC. A higher proportion of VC patients (75%) had a dose reduction due to drug toxicity compared with 29% of patients treated with DT (P &lt; 0.05). Discontinuation rates were the same between both combinations (0.26). 32 patients had completed 6 mo of treatment (26 DT and 6 VC). For those DT, the mean total costs including drug and the mean monthly total costs were $157,253 and $26,209 compared to $107,240 and $17,873 for VC, respectively. The mean total costs for hospitalization were $10,562 for DT and $7,456 for VC. The mean total costs for the drug were $145,012 for DT and $97,924 for VC. Conclusions: The 6-month total cost-of-care for the treatment of first-line V-600 MM with DT was $157,253 and $107,240 for VC, mostly attributable to drug cost. In a value-based healthcare system, total 6-month cost-of-care may help distinguish between equally effective regimens.