Selecting treatment foci in clinical case formulations: Estimating the clinical benefits of modifying causal variables.

Summary: We review the rationale for behavioral clinical case formulations and emphasize the role of the functional analysis in the design of individualized treatments. Standardized treatments may not be optimally effective for clients who have multiple behavior problems. These problems can affect each other in complex ways and each behavior problem can be influenced by multiple, interacting causal variables. The mechanisms of action of standardized treatments may not always address the most important causal variables for a client's behavior problems. The functional analysis integrates judgments about the client's behavior problems, important causal variables, and functional relations among variables. The functional analysis aids treatment decisions by helping the clinician estimate the relative magnitude of effect of each causal variable on the client's behavior problems, so that the most effective treatments can be selected. The parameters of, and issues associated with, a functional analysis and Functional Analytic Clinical Case Models (FACCM) are illustrated with a clinical case. The task of selecting the best treatment for a client is complicated because treatments differ in their level of specificity and have unequally weighted mechanisms of action. Further, a treatment's mechanism of action is often unknown.

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Durable response after immunotherapy discontinuation for delayed and severe immune-related adverse event: a case report

Immunotherapy ◽

10.2217/imt-2021-0085 ◽

2021 ◽

Author(s):

Guido Pesola ◽

Veronica Murianni ◽

Sara Elena Rebuzzi ◽

Giuseppe Luigi Banna ◽

Luigi Cerbone ◽

...

Keyword(s):

Lung Cancer ◽

Renal Cell Carcinoma ◽

Immune Checkpoint Inhibitors ◽

Clinical Case ◽

Renal Toxicity ◽

Checkpoint Inhibitors ◽

Durable Response ◽

Disease Outcomes ◽

Clinical Benefits ◽

Metastatic Rcc

Recent studies have shown that immune-related adverse events (irAEs), occurring even after the discontinuation of immune checkpoint inhibitors (ICIs), may be associated with favorable disease outcomes, particularly in patients with melanoma and lung cancer. However, a few clinical cases have been described on the correlation between irAEs and ICIs efficacy in renal cell carcinoma (RCC) patients. This study reports the clinical case of a metastatic RCC patient who has experienced severe immune-related renal toxicity after 19 months of nivolumab use. Despite immunotherapy discontinuation, the patient has maintained clinical benefit and disease progression-free for 3 years. We examined the correlation between the occurrence and the severity of irAEs, treatment discontinuation and clinical benefits. The evidence on ICI retreatment following ICI discontinuation due to irAEs was also reviewed.

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