Cancer In Switzerland Research Articles

Familial occurrence of colorectal cancer: prevention, aftercare and genetic counseling

Colorectal cancer (CRC) is the third most common type of cancer in Switzerland in terms of annual new cases and cancer deaths. Since most cantons have an organized screening program, more people are recorded with a positive family history of CRC. In the majority, the familial form of CRC is present, a hereditary form is much less common. Relatives of patients with CRC are a heterogeneous group whose CRC risk varies. A good assessment of disease risk can optimize the benefit-risk ratio for more intensive prevention. These recommendations («expert opinion statement») are intended to serve as a basis in clinical practice for planning preventative care, monitoring and human genetic counseling in the presence of a family history positive for CRC.

Assessing the fiscal consequences of novel and existing treatments for triple negative breast cancer in Switzerland by applying a government perspective framework

Background Triple Negative Breast Cancer (TNBC) is an aggressive subtype of breast cancer that can impact patients’ employment and workforce participation. This study estimates how the employment effects of TNBC impact government tax revenue and public benefits expenditure in Switzerland, representing the fiscal burden of disease (FBoD), and likely consequences of introducing new treatment options. Methods A four-state cohort model was used to calculate fiscal effects for two treatments: Neoadjuvant pembrolizumab plus chemotherapy followed by adjuvant pembrolizumab monotherapy (P + C→P) and neoadjuvant chemotherapy alone (C). Lifetime present values of tax revenue, social benefit payments, and healthcare costs were calculated for the average population and those undergoing treatment to assess the FBoD. Results An average TNBC patient treated with C and P + C→P is expected to generate CHF128,999 and CHF97,008 less tax than the average population, respectively, and require increased social benefit payments. Compared to C, 75% of the incremental healthcare costs of P + C→P are estimated to be offset through tax revenue gains. Conclusions This analysis demonstrates that 75% of the additional costs of a new TNBC treatment option can be offset by gains in tax revenue. Fiscal analysis can be a useful tool to complement existing methods for evaluating new treatments.

Emotional and physical aftereffects of cancer Utility and impact of a rehabilitation program

An increasing number of people are surviving cancer in Switzerland : 163,450 people were still alive in 2006 after a cancer diagnosis less than ten years prior, compared to 210,350 in 2016. However, most have to cope with debilitating emotional and physical aftereffects. A new 12-week rehabilitation program aims to restore patients' abilities. It consists of group-led therapies: adapted physical activity, psycho-oncology, dietetics, management of cognitive disorders, and integrative medicine. The first 116 patients who benefited from the program reported a general reduction in symptoms at the end of the program, an improvement that lasts even after 9 months, although fatigue and mood become concerning again. Some express a desire for post-rehabilitation follow-up.

PT34 Impact in Health Outcomes of PD-(L)1 Inhibitors to Treat Early Stages Cancers in Switzerland

PT34 Impact in Health Outcomes of PD-(L)1 Inhibitors to Treat Early Stages Cancers in Switzerland

Cost-Effectiveness of Neoadjuvant Pembrolizumab plus Chemotherapy Followed by Adjuvant Pembrolizumab in Patients with High-Risk, Early-Stage, Triple-Negative Breast Cancer in Switzerland.

This study assessed the cost-effectiveness of neoadjuvant pembrolizumab plus chemotherapy followed by adjuvant pembrolizumab versus neoadjuvant chemotherapy plus placebo followed by adjuvant placebo for patients with high-risk, early-stage, triple-negative breast cancer (TNBC) from a Swiss third-party payer perspective over a lifetime horizon (51 years). A transition model with four health states (event-free, locoregional recurrence, distant metastasis, and death) was developed to assess the cost-effectiveness of pembrolizumab plus chemotherapy versus chemotherapy alone for the treatment of high-risk, early-stage TNBC. Data were utilized from the KEYNOTE-522 randomized controlled trial (ClinicalTrials.gov, NCT03036488). The incremental cost-effectiveness ratio (ICER) was calculated, which was reported as cost per life year or quality-adjusted life year (QALY) gained. A one-way deterministic sensitivity analysis, a probabilistic sensitivity analysis (PSA) and scenario analyses were conducted to assess the robustness of the model results. Base-case results estimated an ICER of 14,114 Swiss francs (CHF)/QALY for pembrolizumab plus chemotherapy versus chemotherapy alone. Results were most sensitive to changes in the extrapolation of event-free survival (EFS). All sensitivity and scenario analyses generated ICERs below the willingness-to-pay threshold of CHF100,000/QALY, and the PSA showed a 98.8% probability that the ICER would be below this threshold. Due to the limited follow-up period in the KEYNOTE-522 trial, EFS data were extrapolated over the lifetime horizon to inform transition probabilities. Extensive validation and scenario analyses ensured the results were robust. The model demonstrated that neoadjuvant pembrolizumab plus chemotherapy followed by adjuvant pembrolizumab was cost-effective versus chemotherapy alone in patients with high-risk, early-stage TNBC in Switzerland.

Autodigit-RAD: Towards an automation of the radon’s concentration dataflow in a new and innovative building

Radon is a noble, natural, and radioactive gas coming mainly from the ground which might accumulate indoors and lead each year to 200-300 deaths from lung cancer in Switzerland. A brand new and innovative living lab will be built as of 2023 in Fribourg (Switzerland) which will allow to tackle the built environment and the relationship with its occupants. Among a large panel of environmental parameters, radon gas will be continuously monitored under and around the building as well as in the building envelope. This paper aims to present the overall process of the radon dataflow: 1) design of the sensor probes, 2) implementation of the radon sensor probes in the ground and 3) go-live with the data sharing platform with the building users. Such an infrastructure will bring the opportunity to researchers to lead new and innovative radon-related research.

Cost-effectiveness of risk-based low-dose computed tomography screening for lung cancer in Switzerland.

Throughout Europe, computed tomography (CT) screening for lung cancer is in a phase of clinical implementation or reimbursement evaluation. To efficiently select individuals for screening, the use of lung cancer risk models has been suggested, but their incremental (cost-)effectiveness relative to eligibility based on pack-year criteria has not been thoroughly evaluated for a European setting. We evaluate the cost-effectiveness of pack-year and risk-based screening (PLCOm2012 model-based) strategies for Switzerland, which aided in informing the recommendations of the Swiss Cancer Screening Committee (CSC). We use the MISCAN (MIcrosimulation SCreening ANalysis)-Lung model to estimate benefits and harms of screening among individuals born 1940 to 1979 in Switzerland. We evaluate 1512 strategies, differing in the age ranges employed for screening, the screening interval and the strictness of the smoking requirements. We estimate risk-based strategies to be more cost-effective than pack-year-based screening strategies. The most efficient strategy compliant with CSC recommendations is biennial screening for ever-smokers aged 55 to 80 with a 1.6% PLCOm2012 risk. Relative to no screening this strategy is estimated to reduce lung cancer mortality by 11.0%, with estimated costs per Quality-Adjusted Life-Year (QALY) gained of €19 341, and a €1.990 billion 15-year budget impact. Biennial screening ages 55 to 80 for those with 20 pack-years shows a lower mortality reduction (10.5%) and higher cost per QALY gained (€20 869). Despite model uncertainties, our estimates suggest there may be cost-effective screening policies for Switzerland. Risk-based biennial screening ages 55 to 80 for those with ≥1.6% PLCOm2012 risk conforms to CSC recommendations and is estimated to be more efficient than pack-year-based alternatives.

Is Following a Cancer-Protective Lifestyle Linked to Reduced Cancer Mortality Risk?

Objectives: This study investigates the association between a cancer protective lifestyle (defined based on the revised World Cancer Research Fund (WCRF) and the American Institute for Cancer Research (AICR) cancer prevention recommendations) and mortality in Switzerland. Methods: Based on the cross-sectional, population-based National Nutrition Survey, menuCH (n = 2057), adherence to the WCRF/AICR recommendations was assessed via a score. Quasipoisson regression models were fitted to examine the association of adherence to the WCRF/AICR recommendations with mortality at the Swiss district-level. Spatial autocorrelation was tested with global Moran's I. Integrated nested Laplace approximation models were fitted when significant spatial autocorrelation was detected. Results: Participants with higher cancer prevention scores had a significant decrease in all-cause (relative risk 0.95; 95% confidence interval 0.92, 0.99), all-cancer (0.93; 0.89, 0.97), upper aero-digestive tract cancer (0.87; 0.78, 0.97), and prostate cancer (0.81; 0.68, 0.94) mortality, compared to those with lower scores. Conclusion: The inverse association between adherence to the WCRF/AICR recommendations and mortality points out the potential of the lifestyle recommendations to decrease mortality and especially the burden of cancer in Switzerland.

EE215 Pharmacoeconomic Analysis of Adjuvant Nivolumab for Patients With Resected Esophageal or Gastroesophageal Junction Cancer in Switzerland

Switzerland recently approved and reimbursed nivolumab as the first adjuvant treatment for patients with resected esophageal cancer (EC) or gastroesophageal junction cancer (GEJC). A phase 3 randomised controlled trial (CM577) comparing nivolumab with placebo in patients with resected EC or GEJC found that nivolumab was associated with 31% lower risk of recurrence or death and double the median disease-free survival compared with placebo. We evaluated the cost-utility of nivolumab compared with placebo from a Swiss compulsory health insurance system perspective.

Predicting the burden of cancer in Switzerland up to 2025.

Predicting the short-term evolution of the number of cancers is essential for planning investments and allocating health resources. The objective of this study was to predict the numbers of cancer cases and of the 12 most frequent cancer sites, and their age-standardized incidence rates, for the years 2019-2025 in Switzerland. Projections of the number of malignant cancer cases were obtained by combining data from two sources: forecasts of national age-standardized cancer incidence rates and population projections from the Swiss Federal Statistical Office. Age-standardized cancer incidence rates, approximating the individual cancer risk, were predicted by a low-order Autoregressive Integrated Moving Average (ARIMA) model. The contributions of changes in cancer risk (epidemiological component) and population aging and growth (demographic components) to the projected number of new cancer cases were each quantified. Between 2018 and 2025, age-standardized cancer incidence rates are predicted to stabilize for men and women at around 426 and 328/100,000, respectively (<1% change). These projected trends are expected for most cancer sites. The annual number of cancers is expected to increase from 45,676 to 52,552 (+15%), more so for men (+18%) than for women (+11%). These increases are almost entirely due to projected changes in population age structure (+12% for men and +6% for women) and population growth (+6% for both sexes). The rise in numbers of expected cancers for each site is forecast to range from 4.15% (thyroid in men) to 26% (bladder in men). While ranking of the three most frequent cancers will remain unchanged for men (1st prostate, 2nd lung, 3rd colon-rectum), colorectal cancer will overtake by 2025 lung cancer as the second most common female cancer in Switzerland, behind breast cancer. Effective and sustained prevention measures, as well as infrastructural interventions, are required to counter the increase in cancer cases and prevent any potential shortage of professionals in cancer care delivery.

Trends in incidence and mortality of lung cancer in Switzerland: Possible explanations and open questions

BackgroundUsing US population-level data, it has been suggested that novel treatment advances, particularly targeted therapies, have contributed to a sharp fall in NSCLC mortality.Switzerland is a high-income country, with a universal, highly performant health care system, easy access to novel drugs but with different dynamics concerning the smoking epidemic than the US. MethodsWe use population-based data from Swiss cancer registries to analyze the trends in incidence, mortality and survival and relate them to recent drug approvals. ResultsThe incidence of NSCLC and SCLC was stable from 1980 to 2018. We noted an important difference between sexes, with an important decrease in men and increase in women, especially for NSCLC. 1-y and 5-y survival have improved for NSCLC between 2004 and 2008 and 2014–2018. ConclusionThese findings should be regarded as the results of a multifactorial improvement in care and it is difficult for us to pinpoint a unique cause explaining the reduction in mortality

153P Safety profile and associated costs of therapies for relapsed small cell lung cancer in Switzerland

Small cell lung cancer (SCLC) is an aggressive disease with poor prognosis, in particular in the relapsed setting. Treatments for relapsed SCLC remain limited with no new recent approvals in Europe. Lurbinectedin was granted FDA accelerated approval for patients with SCLC with disease progression after platinum containing therapy. Differences exist with respect to adverse events (AE) among therapies for 2LSCLC. Our aim was to compare the cost of managing adverse events in 2L treatment of SCLC with recommended therapies and with lurbinectedin in Switzerland. The relevance of guideline-adherent comparators in routine clinical practice was verified by Swiss clinical expert opinion. AE ≥ grade 3 related to treatment were derived from RCTs of 2L SCLC with topotecan (oral and IV), CAV (cyclophosphamide + doxorubicin + vincristine), etoposide + carboplatin and from the phase II B-005 trial of lurbinectedin monotherapy in 2LSCLC. Resource use and unit costs were obtained from published literature, national tariffs and clinical expert opinion. Scenario analysis with upper and lower limits of incidence of AEs and costs associated with each AE were constructed. Base case results for costs of AE management were CHF 9,238 (€8,421) per patient per treatment course (typically 4 cycles) for oral topotecan, CHF 8,608 (€7,847) for IV topotecan; CHF 5,155 (€4,699) for etoposide plus carboplatin, CHF 4,942 (€ 4,505) for CAV and CHF 1,346 (€1,227) for lurbinectedin. Scenario analyses: lower limit (LL) CHF 1,067 (€973) for lurbinectedin, CHF 2,716 (€2,476)-CHF 5,582 (€5,088) for standard treatments. Upper limit (UL) CHF 1,625 (€1,481) for lurbinectedin, CHF 5,853 (€5,335)-CHF 12,895 (€11,755) for standard treatments. The most frequently used treatments for 2L SCLC in Switzerland are carboplatin + etoposide and CAV, followed by IV topotecan. On average, lurbinectedin was associated with cost savings of 81% (74%-85%) compared to standard treatments. A subanalysis limited to recent trials (published 2020-2021) showed reproducibility of results. Lurbinectedin is associated with substantially lower cost for AE treatment compared to existing 2L SCLC treatments in Switzerland.

133P Trends in incidence and mortality of lung cancer in Switzerland: Possible explanations and open questions

Using US population-level data, it has been suggested that novel treatment advances, particularly targeted therapies, have contributed to a sharp fall in NSCLC mortality. Switzerland is a high-income country, with a universal, highly performant health care system, easy access to novel drugs but with different dynamics concerning the smoking epidemic than the US. We use population-based data from Swiss cancer registries to analyze the trends in incidence, mortality and survival and relate them to recent drug approvals. Decreases in lung cancer incidence-based mortality rates were observed from 2004 to 2018 (29·3 [26·7;32·2] vs 24·7 [22·7;26·9]. However, sex differences were apparent with a steep mortality decrease for men (46·7 [41·8;52·2] vs 33·4 [30·0;37·3]) and a modest increase in women (15·4 [12·9;18·5] vs 17·1 [14·8;19·9]) These modest decreases in mortality rates were observed for NSCLC (23·1 [20·9;25·7] vs 20·6 [18·7;22·6]) and for SCLC (6·1 [4·9;7·7] vs 4.1 [3·3;5·2]). Yet, in men there was a decrease in mortality due to NSCLC (37·2 [32·9;42·1] vs 28·1 [25;31·7]) and SCLC (9·5 [7·3;12·3] vs 5·3 [4;7·1]), while in women, mortality rates increased slightly for NSCLC (12·1 [9·9;14·9] vs 13·9 [11·9;16·5]) and remained stable for SCLC (3.·3 [2·2;5·2] vs 3·2 [2·2;4·7]). When comparing the 2004-2008 and 2014-2018 periods, we observed a significant increase in 1-year (45·7% [44·7;46·7] vs 55·8% [55·1;56·5]) and 5-year (17·3 [16·5;18·1] vs 27·9 [27;28·7]) lung cancer survival. Increases in survival were observed for NSCLC (1-year: 47·2 [46·1;48·3] vs 58·1 [57·4;58·9]; 5-year: 19·1 [18·2;20] vs 30·5 [29·6;31·4]) but were less evident and not statistically significant for SCLC ( 1-year: 36·3 [33·6;38·9] vs 39 [36·5;41·6]; 5-year: 6·7 [5·2;8·5] vs 10 [8·1;12·1]). The same trends were not different according to sex. This analysis shows a steeper reduction in incidence-based mortality than in incidence. While true improvements may be driven by early detection., better multidisciplinary care including surgery, radiotherapy, systemic treatments, and palliative and supportive care These findings are the results of multifactorial improvement in care rater than a unique cause to lower mortality.

Management and Outcome of Young Women (≤40 Years) with Breast Cancer in Switzerland.

Simple SummaryData on the outcome and treatment of young women with breast cancer (BC) in Switzerland is scarce. We conducted a retrospective cohort study to evaluate treatment and outcome of women aged ≤ 40 years, diagnosed with stage I-III BC in Switzerland between 2000–2014. We found that the majority of patients were treated according to international guidelines, however we identified differences in quality-of-care score across the two Swiss linguistic/geographic regions (Swiss Latin and Swiss German). Survival was high: 91.4% (95% confidence interval (CI) 90.2–92.5) at 5 years and 83.1% (95% CI 81.2–78.5) at 10 years. After adjusting for multiple clinicopathological factors only tumor characteristics and treatment period remained independently associated with survival. We concluded that national guidelines for young women with BC should be implemented to standardize treatment in Switzerland and awareness should be raised among young women and clinicians that BC does not discriminate by age.Background: An increase in breast cancer (BC) incidence in young women (YW) as well as disparities in BC outcomes have been reported in Switzerland. We sought to evaluate treatment and outcome differences among YW with BC (YWBC). Methods: YW diagnosed with stage I-III BC between 2000–2014 were identified through nine cancer registries. Concordance with international guidelines was assessed for 12 items covering clinical/surgical management, combined in a quality-of-care score. We compared score and survival outcome between the two linguistic-geographic regions of Switzerland (Swiss-Latin and Swiss-German) and evaluated the impact of quality-of-care on survival. Results: A total of 2477 women were included. The median age was 37.3 years (IQR 34.0–39.4 years), with 50.3% having stage II BC and 70.3% having estrogen receptor positive tumors. The mean quality-of-care score was higher in the Latin region compared to the German region (86.0% vs. 83.2%, p < 0.0005). Similarly, 5- and 10-year overall survival rates were higher in the Latin compared to the German region (92.3% vs. 90.2%, p = 0.0593, and 84.3% vs. 81.5%, p = 0.0025, respectively). There was no difference in survival according to the score. In the univariate analysis, women in the Latin region had a 28% lower mortality risk compared to women in the German region (hazard ratio 0.72; 95% CI 0.59–0.89). In the multivariable analysis, only stage, differentiation, tumor subtype and treatment period remained independently associated with survival. Conclusions: We identified geographic disparities in the treatment and outcome of YWBC in Switzerland. National guidelines for YWBC should be implemented to standardize treatment. Awareness should be raised among YW and clinicians that BC does not discriminate by age.

Does hospital volume affect outcomes after abdominal cancer surgery: an analysis of Swiss health insurance claims data

BackgroundMedical treatment quality has been shown to be better in high volume than in low volume hospitals. However, this relationship has not yet been confirmed in abdominal cancer in Switzerland and is relevant for referral of patients and healthcare planning. Thus, the present study investigates the association between hospital volumes for surgical resections of colon, gastric, rectal, and pancreatic carcinomas and outcomes.MethodsThis retrospective analysis is based on anonymized claims data of patients with mandatory health insurance at Helsana Group, a leading health insurance in Switzerland. Outcome parameters were length of hospital stay, mortality and cost during the inpatient stay as well as at 1-year follow-up. Hospital volume information was derived from the Quality Indicators dataset provided by the Swiss Federal Office of Public Health. The impact of hospital volume on the different treatment outcomes was statistically tested using generalized estimating equations (GEE) models, taking into account the non-independence of observations from the same hospital.ResultsThe studies included 2′859 resections in patients aged 18 years and older who were hospitalized for abdominal cancer surgery between 2014 and 2018. Colon resections were the most common procedures (n = 1′690), followed by rectal resections (n = 709). For rectal, colon and pancreatic resections, an increase in the mean number of interventions per hospital and a reduction of low volume hospitals could be observed. For the relationship between hospital volume and outcomes, we did not observe a clear dose-response relationship, as no significantly better outcomes were observed in the higher-volume category than in the lower-volume category. Even though a positive “routine effect” cannot be excluded, our results suggest that even hospitals with low volumes are able to achieve comparable treatment outcomes to larger hospitals.ConclusionIn summary, this study increases transparency on the relationship between hospital volume and treatment success. It shows that simple measures such as defining a minimum number of procedures only might not lead to the intended effects if other factors such as infrastructure, the operating team or aggregation level of the available data are not taken into account.

Research on occupational diseases in the absence of occupational data: a mixed-method study among cancer registries of Western Switzerland.

The contribution of occupation-related diseases to the global burden of disease is greatly underestimated, mainly due to a shortage of occupational exposure data. This problem is particularly salient in Switzerland, where no estimates of occupation-related disease burden exist, even for the well-recognised occupational cancers, such as malignant pleural mesothelioma and lung cancer. To overcome this situation, we launched a research project "Examining Cancers and Labour Indicators to assess the Burden" (ExCaLIBur). Within this project, we aimed to assess the need for and quality (i.e., completeness, accuracy and precision) of occupation registration in all cancer registries of Western Switzerland. We also aimed to find a relevant and feasible strategy to collect this information in the future. We applied a mixed research method. We observed that, independently of the level of precision (5-3-2-1-digit aggregation level), the accuracy was lesser in the registries that were able to actively search and verify occupational information. Overall, the distinction of occupations based on the 3-digit code presents an acceptable compromise in terms of precision. Having such occupations registered in all, or most, Swiss cancer registries routinely would obviously be valuable for epidemiological surveillance of occupational cancers in Switzerland. However, it seems less obvious how these data could fulfill the research objectives, since a better precision than 3-digit occupational coding is challenging to achieve. Currently, the collection of occupational data by the Swiss cancer registries remains feasible in the frame of specific research projects on occupational cancers. However, available data sources, as well as lack of financial and human resources, will continue to affect quality of the collected occupation data. Therefore, the usage of the standardised questionnaire retracing the individual occupational history to enable further assessment of individual exposure to potential occupational hazards is recommended. However, this approach will disable the Swiss registries to insuring their epidemiological surveillance mission with respect to occupational cancers in Switzerland, for which national statistics remain limited.

Management of Elderly and Old Cancer Patients – Geriatric Oncology

Aging is a major risk factor for cancer development. Indeed, 60% of people with cancer in Switzerland and worldwide are older than 65 years. However, the indication for treatment choice should not be based on chronological age alone but instead driven by the patient's biological age, physiological and functional status, and the biological and morphogenetic tumor signature. This article provides an overview of the current challenges in treating elderly and old cancer patients, specifically the reasons for a less-than-optimal treatment and care and the added value of performing comprehensive geriatric assessments in this unique population.

Quality Variation in Switzerland: Analysis of Mammary Resections for Breast Cancer using the Quality Indicator of Breast Preservation

The aim of the study was to investigate whether there are regional differences in the treatment results of elective mammary resections for breast cancer in Switzerland and, if so, whether a possible cause could be found in the hospital planning by the cantons. Using the Inpatient Quality Indicators (CH-IQI), the quality of outcomes was analysed at the level of the Swiss cantons and compared with the cantonal requirements for carrying out this treatment. Cantonal differences became apparent both in the quality of results based on the quality indicator of breast preservation and in the level of detail of the requirements for structural and process quality. The quality of treatment in Switzerland can hardly be compared in a transparent manner; interpreting the available quality information is demanding and hardly possible for patients. In order to reduce the quality differences shown, hospital planning should be intercantonal, as is the case in highly specialised medicine.

Results of a 10-year web-based health promotion campaign against skin cancer in Switzerland.

Skin cancer is the most common malignancy with rising incidence. Although early detection can be lifesaving, prevention programmes are under-utilized. In 2008, a group of board-certified dermatologists in Switzerland established a website aimed at educating about skin cancer risk factors and providing guidance on self-assessment. To present the data of this programme over the last 10 years with regards to representation of the targeted groups and sustained impact on primary skin cancer prevention. A comprehensive web-based health promotion campaign was established for education and guidance on self-assessment. Teledermatological evaluation was offered and participants were then interviewed. In total, 11,171 digital photos were evaluated during 2008-2018; 54.3% (n = 6,067) from females and 45.7% (n = 5,104) from males. In 26.7% (n = 2,983), clinical examination was recommended. Of the participants, 1,874 replied revealing 103 malignancies (9.2% of the lesions were presented to a physician): 34 melanomas in situ, six squamous cell carcinomas, 53 basal cell carcinomas and 10 malignant lesions (not further specified). Of the participants, 40.5% (n = 683) changed their attitude towards sun exposure, 48.7% (n = 820) used more sunscreen, and 57.5% (n = 966) improved sunscreen measures. Web-based educational programmes raise public awareness, enhance prevention, and support early diagnosis of skin cancer. Teledermatology might contribute to reducing skin cancer mortality rates.

Metastatic Pancreatic Cancer: Current Treatment Options for Swiss Patients

Despite oncological advances over the past years, survival outcomes for patients with pancreatic ductal adenocarcinoma (PDAC) remain poor. For most PDAC patients, the disease is often asymptomatic at early phases and is therefore typically diagnosed at the advanced or metastatic stage. As a result, up to 85% of the cases are unresectable, and systemic chemotherapy is the predominant treatment modality for this patient population. While the current therapeutic strategies for the local disease include surgical resection and adjuvant chemotherapy, FOLFIRINOX and gemcitabine plus nab-paclitaxel regimens are the frontline standard of care in the unresectable locally advanced and metastatic settings. In Switzerland, nanoliposomal irinotecan (nal-IRI) is currently the only regimen approved in the second line following progression on gemcitabine plus nab-paclitaxel, based on the results from the phase III NAPOLI-1 trial. Recently, olaparib, a poly (ADP-ribose) polymerase (PARP) inhibitor, and larotrectinib, a first-in-class tropomyosin receptor kinases (TRK) inhibitor, were added to the treatment armamentarium of patients with a molecularly-defined subset of metastatic adenocarcinoma of the pancreas. This article provides an overview of the current treatment landscape of pancreatic cancer in Switzerland. In addition, we report a case of a long-term survivor with advanced pancreatic adenocarcinoma who achieved a notably good response to nal-IRI plus 5-FU/LV after progression on gemcitabine plus nab-paclitaxel.