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Alexandra Smith,1,* Jeffrey Mathew Boby,2,* Steve Joseph Benny,3,* Nadia Ghazali,4,* Elke Vermeulen,1 Mathew George1 1Tamworth Hospital, Hunter New England Local Health District (NSW Health), Tamworth, NSW, Australia; 2Government Medical College, Kozhikode, Kerala, India; 3Government Medical College, Thrissur, Kerala, India; 4Calvary Mater Newcastle, Newcastle, NSW, Australia*These authors contributed equally to this workCorrespondence: Alexandra Smith, North West Cancer Centre, Tamworth Hospital, Dean Street, Tamworth, NSW, 2340, Australia, Email Alexandra.smith2@health.nsw.gov.auPurpose: Immunotherapies have revolutionized cancer treatment; however, relatively little is known about their efficacy and toxicity in the elderly, a cohort accounting for more than half of total cancer cases. In this review, we aim to provide insight into the current knowledge base regarding the clinical utility and side effects of immunotherapies in the geriatric population as well as identify key gaps in the literature where further research is essential.Methods: We conducted a rapid critical review of available literature, focusing on studies reporting on use of immunotherapy in cancer patients aged ≥ 65 years. The review assessed studies that included different types of cancer, were of multiple study types (although predominantly retrospective), had different study duration, and reported different outcomes of interest. Owing to this heterogeneity, meta-analysis and a direct comparison between studies were not feasible.Results: Overall, the review findings indicate that certain malignancies have shown comparable survival rates in younger and older age groups when managed with immunotherapeutic drugs, the incidence of immunotherapy-related side effects varies only slightly by age groups, and in general there is a lack of studies on the determinants of the clinical outcomes of immunotherapy in or including geriatric patients.Conclusion: Enhanced clinical benefits along with better tolerability associated with immunotherapies make it an attractive alternative to conventional chemotherapeutic drugs, especially in elderly patients. There is currently a limited number of studies assessing the clinical outcomes of immunotherapies, particularly in the elderly. Overall, our findings reflect a need for further prospective studies focussing on geriatric patients representative of the real-life population, in order to derive a more precise understanding of the clinical utility, toxicity profile, and cost-effectiveness of immune checkpoint inhibitors in older patients with cancer.Keywords: cancer treatment, immunotherapies, geriatric oncology, toxicities

Introduction: Orofacial cleft is one of the many congenital malformations that often occur in human, leaving it at the fourth level of the most common orofacial birth defect findings. The incident rate is one in 700-1000 deliveries, where without therapeutic and surgical interventions, children with an orofacial cleft may have problems with speech, nutrition intake, and growth. Bone morphogenetic protein 2 (BMP-2) gene play essential roles in the migration and proliferation of neural crest cell of the early head formation and regulate mineralised tissues such as maxillary, mandible, palate and teeth. This study was aimed to analyse the BMP-2 polymorphism and its potential association with orofacial cleft in an Indonesian population. Methods: Cross-sectional study was conducted towards 128 samples, 32 samples of orofacial cleft patients and 96 samples of control. Extracted genotype and allele was determined with PCR-RFLP method using stored DNA samples from 32 orofacial cleft patients, and 96 healthy control. Results: The TT genotype was showing the p-value = 0.001, OR = 2.43% in orofacial samples (71.4%), which was significantly higher than in control groups (28.6%). The allele distribution was also considered statistically significant (p = 0.036, OR =1.89%. Conclusion: There is a significant association of rs235768 A>T polymorphism of the BMP-2 gene on non-syndromic orofacial cleft patients in Indonesia.

The rising cost of cancer care has shed light on an important aspect of healthcare delivery. Financial toxicity of therapy must be considered in clinical practice and policy-making. One way to mitigate the impact of financial toxicity of cancer care is by focusing on an approach of healthcare delivery that aims to deliver value to the patient. Should value of therapy be one of the most important determinants of cancer care? If so, how do we measure it? How can we implement it in routine clinical practice? In this viewpoint, we discuss value-based care in systemic therapy in oncology. Strategies to improve the quality of care by incorporating value-based approaches are discussed: use of composite tools to assess the value of drugs, alternative dosing strategies, and the use of Health Technology Assessment in regulatory procedures. We propose that there must be a greater emphasis on value of therapy in determining its use and its cost.