scholarly journals DOP81 Time to loss of efficacy among patients in remission following induction treatment with tofacitinib 10 mg BID who reduced tofacitinib dose or discontinued tofacitinib in OCTAVE sustain

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S120-S121
Author(s):  
M C Dubinsky ◽  
J W Chou ◽  
C Su ◽  
W Wang ◽  
I Modesto ◽  
...  
Keyword(s):  
Treatment Failure ◽  
Clinical Response ◽  
Median Time ◽  
Induction Treatment ◽  
Phase 3 ◽  
Time To Treatment ◽  
Mayo Score ◽  
Kaplan Meier ◽  
Point Increase ◽  
Time To Treatment Failure

Abstract Background Tofacitinib is an oral, small-molecule JAK inhibitor for the treatment of ulcerative colitis (UC). Safety and efficacy of tofacitinib were evaluated in two Phase 3 induction studies (OCTAVE Induction 1 and 2; NCT01465763, NCT01458951), a 52-week, Phase 3 maintenance study (OCTAVE Sustain, NCT01458574) and an ongoing, open-label, long-term extension study (NCT01470612).1,2 Here, we assess time to treatment failure among patients in remission at the end of OCTAVE Induction 1 and 2 who enrolled in OCTAVE Sustain. Methods In OCTAVE Induction 1 and 2, patients received placebo or tofacitinib 10 mg twice daily (BID) for 8 weeks; clinical responders were re-randomised to placebo, tofacitinib 5 or 10 mg BID in OCTAVE Sustain for 52 weeks. Kaplan–Meier method was used to estimate median time to treatment failure (withdrawal due to insufficient clinical response) in patients who received 10 mg BID in induction studies and entered OCTAVE Sustain in remission (total Mayo score ≤2 with no subscore >1, and rectal bleeding subscore [RB] 0). Treatment failure: ≥3-point increase from baseline total Mayo score, plus ≥1-point increase in RB and endoscopic subscore (ES; centrally read) and absolute ES ≥2 after ≥8 weeks of maintenance therapy. Results Following induction, 156 patients in remission entered OCTAVE Sustain and received tofacitinib 5 mg BID (N = 57) or 10 mg BID (N = 50), or placebo (N = 49). Estimated treatment failure rates are reported in the table. At Week 52, Kaplan–Meier rates of treatment failure were higher in patients who switched to placebo (81.8% [95% confidence interval 67.0, 90.4]) vs. those who continued to receive tofacitinib 10 mg BID (25.6% [14.2, 38.6]) or reduced their dose to 5 mg BID (34.4% [21.8, 47.3]). Median time to treatment failure was 169 days for placebo and >52 weeks for tofacitinib 5 and 10 mg BID (due to the low number of treatment failure events, exact median time to treatment failure was not available for tofacitinib 5 or 10 mg BID). Conclusion For patients in remission following 8 weeks of induction treatment with tofacitinib 10 mg BID, median time to treatment failure for those who continued tofacitinib treatment (5 or 10 mg BID) was >52 weeks. After treatment interruption (remission patients who were re-randomised to placebo), median time to treatment failure was 169 days; this was similar to previously published time-to-treatment-failure data for patients with clinical response (including remission) following 8 weeks of induction treatment with tofacitinib who were re-randomised to placebo.3. References

scholarly journals Microsurgical rhizotomy for trigeminal neuralgia in MS patients: technique, patient satisfaction, and clinical outcomes

2019 ◽  
Vol 130 (6) ◽  
pp. 1877-1888
Author(s):  
Mark G. Bigder ◽  
Sandeep Krishnan ◽  
E. Francis Cook ◽  
Anthony M. Kaufmann
Keyword(s):  
Trigeminal Neuralgia ◽  
Treatment Failure ◽  
Rank Test ◽  
Control Group ◽  
Chi Square ◽  
Time To Treatment ◽  
Pain Scores ◽  
Kaplan Meier ◽  
Time To Treatment Failure ◽  
Chi Square Test

OBJECTIVEPatients with multiple sclerosis (MS)–associated trigeminal neuralgia (TN) have higher recurrence and retreatment rates than non-MS patients. The optimal management strategy and role for microsurgical rhizotomy (MSR) for MS-TN remains to be determined. The aim of this study was to report time to treatment failure (TTF) and pain scores following MSR compared to percutaneous and Gamma Knife procedures.METHODSTime to treatment failure was analyzed after MSR (n = 14) versus prior procedures (n = 53) among MS-TN patients. Kaplan-Meier curves and log-rank test were utilized to compare TTF after MSR versus prior procedures using the same cohort of patients as their own control group. Subsequent analysis compared TTF after MSR to TTF after 93 other procedures among a second cohort of 18 MS-TN patients not undergoing MSR. BNI pain scores were compared between MSR and other procedures among the MS-TN cohort using a chi-square test.RESULTSTTF was significantly longer after MSR than after other procedures in the MSR cohort (median TTF 79 vs 10 months, respectively, p < 0.0001). Similarly, TTF was longer after MSR than after prior procedures in the non-MSR cohort (median TTF 79 vs 13 months, respectively, p < 0.001). MSR resulted in a higher proportion of excellent pain scores when compared to other procedures in the non-MSR cohort (77% vs 29%, p < 0.001). Probability of treatment survival was higher after MSR than after other procedures at all time points (3, 6, 12, 24, 36, and 48 months). There were no deaths or major complications after MSR.CONCLUSIONSTTF was significantly longer following MSR compared to prior procedures in MS-TN patients. Additionally, a higher proportion of patients achieved excellent BNI pain scores after MSR.

A multicenter phase II study of pemetrexed and cisplatin in patients with advanced gastric cancer (AGC)

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 14008-14008
Author(s):  
Y. Bang ◽  
Y. Kim ◽  
H. C. Chung ◽  
W. Kang ◽  
S. Park ◽  
...  
Keyword(s):  
Overall Survival ◽  
Treatment Failure ◽  
Median Time ◽  
Progressive Disease ◽  
Treatment Schedule ◽  
Curative Surgery ◽  
Time To Treatment ◽  
Time To Treatment Failure ◽  
Common Grade ◽  
Grade 3

14008 Background: Pemetrexed is a novel folate antimetabolite, and it inhibits a number of folate-dependent enzymes. This agent has demonstrated activity in a variety of tumor types including AGC. This study was performed to evaluate the combination of pemetrexed and cisplatin in the treatment of AGC. The primary endpoint was response rate, and secondary endpoints were duration of response, time to progressive disease, time to treatment failure, overall survival, and toxicity. Methods: Patients with stage IV AGC not to be amendable to curative surgery and measurable disease were eligible. Pemetrexed 500 mg/m2 and cisplatin 75 mg/m2 were given on day 1, every 21 days. Treatment was supplemented with folic acid, vitamin B12, and dexamethasone. Response was assessed by RECIST, and toxicity was assessed by NCI-CTC v 2.0. Results: From October 2003 to September 2004, 51 patients were enrolled, but 1 did not meet the eligibility criteria. There were 37 men and 13 women with a median age of 56 years (range, 24–69) and an ECOG PS 0/1 for 14/36 patients; all had metastatic disease. Of 50 evaluable patients, there were no complete responses, and 13 had confirmed partial responses (26%; 95% CI, 14.6%-40.3%). Fifteen patients (30%) had stable disease, and 21 (42%) progressed, and 1 (2%) was unknown. Among 13 responders, the median durarion of response was 3.60 months (95% CI, 2.80–9.40). Median time to progressive disease was 2.8 months (95% CI, 2.20–4.40), and median overall survival was 6.6 months (95% CI, 4.80–10.40). The median time to treatment failure was 2.10 months (95% CI, 1.00–2.80). Survival estimates were 32.0% at 3 months and 7.0% at 6 months. A total of 212 cycles were administered to 51 patients (median 4 [range, 1–13]). Based on 51 patients, most common grade 3/4 hematologic toxicities were neutropenia (49.0%), leukopenia (19.7%), and anemia (13.7%); the most common grade 3/4 nonhematologic toxicities were hyponatremia (15.7%), anorexia (9.8%), nausea (7.8%), and vomiting (7.8%). Conclusions: : The combination of pemetrexed and cisplatin in the current dose and schedule has a modest activity and a mild toxicity profile in patients with AGC. Further study is warranted using a different dose and treatment schedule. [Table: see text]

Effectiveness of Repeat Glycerol Rhizotomy in Treating Recurrent Trigeminal Neuralgia

Neurosurgery ◽  
2011 ◽  
Vol 70 (5) ◽  
pp. 1125-1134 ◽  
Author(s):  
Matthew Bender ◽  
Gustavo Pradilla ◽  
Sachin Batra ◽  
Alfred See ◽  
Neal Bhutiani ◽  
...  
Keyword(s):  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Treatment Failure ◽  
Median Time ◽  
Retrospective Cohort ◽  
Cox Regression ◽  
Time To Treatment ◽  
Cox Regression Analysis ◽  
Sensory Change ◽  
Time To Treatment Failure

Abstract BACKGROUND: Percutaneous glycerol rhizotomy (GR) is used to treat trigeminal neuralgia (TN), with satisfactory pain relief lasting 2 to 3 years in most patients after the first intervention. The efficacy of subsequent GRs, however, has not been studied. OBJECTIVE: To compare the pain relief and durability achieved by the first GR with those obtained after subsequent GRs in a retrospective cohort of TN patients. METHODS: Between 1998 and 2010, 548 patients with TN underwent 708 GRs. After exclusions, 430 initial GRs (GR1) and 114 subsequent GRs (GR2+) were compared in terms of initial pain relief, durability, sensory change, and complications. Durability was assessed by determining median time to treatment failure for all GRs achieving complete pain relief without medications (n = 375: 264 failures, 111 censored). Predictors of initial pain relief were assessed by logistic regression, and predictors of failure were assessed by Cox regression analysis. RESULTS: After GR1, pain relief results were as follows: 285 patients (66%) were pain free without medications, 26 (6%) were pain free with medications, 66 (15%) improved, and 53 (12%) were unchanged. After GR2+, results were as follows: 90 patients (79%) were pain free without medications, 6 (5%) were pain free with medications, 7 (6%) improved, and 11 (10%) were unchanged (P = .03). Median time to treatment failure was 26 months after GR1 and 25 months after GR2+ (P = .34). On multivariate analysis, prior GR was a positive predictor of initial pain relief (odds ratio, 2.067; 95% confidence interval, 1.243-3.437; P = .005) and had no effect on durability. CONCLUSION: TN patients experienced greater pain relief and equivalent durability after GR2+ beyond the initial treatment.

Dose Reduction of Thalidomide in Multiple Myeloma: A Feasible Option without Reducing of Efficacy.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 5129-5129
Author(s):  
Peter Haas ◽  
Ulrich Denz ◽  
Gabriele Ihorst ◽  
Monika Engelhardt
Keyword(s):  
Multiple Myeloma ◽  
Side Effects ◽  
Treatment Failure ◽  
Dose Reduction ◽  
Median Time ◽  
Maintenance Treatment ◽  
High Dose ◽  
Time To Treatment ◽  
Time To Treatment Failure ◽  
Feasible Option

Abstract The central goal in improving multiple myeloma (MM) treatment is the achievement of higher complete remission (CR) rates and prolonged progression free (PFS) and overall survival (OS). Maintenance treatment after high-dose regimens has been one approach to attain this goal. As one of these maintenance agents Thalidomide (Thal) is used, since it leads to the inhibition of fibroblast growth factor (bFGF) and monocyte-derived TNF-alpha, reduced vascularisation, immune response upregulation and others. Response rates with single Thal are 30% and can be increased up to 60–70% with combined Dexamethasone (Dex) use. Maintenance treatment has shown an improved 3-year PFS rate of 15% after tandem autologous stem cell transplantation (auto-SCT). Although Thal is well tolerated compared to regular cytotoxic drugs, side effects occur in about one third of patients (pts), most disturbing being fatigue, polyneuropathy and deep venous thrombosis. As these are dose dependent, a dose-reduction has evolved from 800mg to 200mg/day (d). In this study, we analyzed, whether the Thal dose of 100mg/d is feasible and effective: 38 consecutive MM pts received Thal at our center between 5/01 and 6/05. The time to treatment failure was calculated from treatment start to death, relapse or therapy modification due to side effects. The median age of all pts was 62.4 years; 27 were male and 11 female. All pts had stage II and III MM according the DurieIgG was the most frequent MM subtype in 23 pts. Twelve showed deletion 13q14. The median time from initial diagnosis to Thal therapy was 3.9 years (range; 0–18.7). Pts had received a median of 2 treatment lines (range 0–3), three pts had received Thal as first-line treatment. Twenty-six pts (68.4%) underwent SCT prior to Thal treatment (23 pts single auto-SCT, 1 pt tandem auto SCT, 1 pt sequential auto- and allo-SCT and 1 pt with 2 allo-SCT). The median Thal dose was 125mg/d (range 50–800mg/d), 22 pts received more than 200mg/d and 16 pts less. The median Thal duration was 7 months (range; 0.3–37.8). Nineteen pts received Thal as a single-agent, 16 pts in combination with Dex or melphalan (Alexanian). Remission before Thal was PD in 21 pts, SD in 9 pts, MR in 1 pt, PR in 4 pts and CR in 3 pts. Causes for treatment failure were side effects in 10 pts, relapse in 18 pts and death in 1 pt. The median time to treatment failure (TTF) was 7.6 months. Subgroup analyses showed an advantage for pts without deletion 13q14 (8.2 vs. 2.8 months; p=0.054) and for the combination therapy with Thal/Dex or Thal/Alexanian (8.7 vs. 4.5 months; p=0.0554). Other parameters tested in univariate analysis (age, stage, remission status, prior Tx) showed no difference in TTF. Of note was that different dose-levels (&lt;200 vs. ≥200mg/d) revealed no difference in TTF (7.5 vs. 8.2 months; p=0.087). We conclude that a Thal dose of 100/d is efficient, which can be increased with combined Dex or other effective anti-MM usage. This is of importance since side-effects show a dose-relation and often lead to treatment discontinuation. The strategy to lower the Thal dose with persistence of high efficacy rates is a promising approach to optimize MM-treatment and make it a feasible option for more pts.

scholarly journals 236. Insight of Polymicrobial Prosthetic Joint Infections at a Referral Hospital

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S227-S228
Author(s):  
Diana Fernández-Rodríguez ◽  
María de Lourdes García-Hernández ◽  
Guillermo Cerón-González ◽  
Claudia Adriana Colín-Castro ◽  
Melissa Hernández-Durán ◽  
...  
Keyword(s):  
Treatment Failure ◽  
Referral Hospital ◽  
P Value ◽  
Time To Treatment ◽  
Joint Infections ◽  
Kaplan Meier ◽  
Prosthetic Joint ◽  
Prosthetic Joint Infections ◽  
Time To Treatment Failure

Abstract Background Approximately one-third of the prosthetic joint infections (PJIs) are polymicrobial. They are difficult to treat and there is an urgent need of clinical evidence that help to guide current protocols. We aimed to define the clinical characteristics and outcomes of patients with polymicrobial PJI. Methods We conducted a retrospective cohort study of patients with polymicrobial PJI treated at a referral hospital in Mexico City. Clinical data was retrieved and analyzed. Time to treatment failure, was evaluated for all cases. Results We identified 166 patients with a polymicrobial PJI from July 2011 to October 2020. The median follow-up period was 3.24 years (IQR, 1.45-6.42). Fistulae (77.7%) and pain (76.5%) were frequent. Patients required a median of 2 (IQR, 1-3) hospitalizations and 3 (IQR, 1-5) surgeries. Relapse, reinfection, and amputation ocurred in 21.1% (35), 10.2% (17), and 7.2% (12) of the cases, respectively. At 1-year follow-up 38.47% (63) patients failed to control the infection. At 2 and 5-year follow-up this rate increased to 50% (83) and 68% (112), respectively. The main infecting microorganisms were Staphylococcus epidermidis (51.8%), Enterococcus faecalis (47.6%), and Staphyloccocus aureus (34.9%). Anaerobes were identified in 38 (22.9%) cases. At 1 and 5-year follow-up, 39.31% (34) and 71.1% (61) of patients with S. epidermidis experienced treatment failure. On the other hand, those with S. aureus showed lower rates (log-rank p-value=0.03): 24.85% (14) and 50% (29), accordingly. Patients affected by anaerobes and E. faecalis exhibited similar trends, between them (log-rank p-value=0.73). Table1. Clinical findings of patients with polymicrobial PJI. Frequency distributions of sociodemographic factors, comorbidities, clinical presentation, outcomes, out-patient treatment, and etiology in patients with polymicrobial PJI. Data is presented as absolute frequency followed by relative frequency enclosed in parenthesis, otherwise specified. Abbreviations: SXT, Trimethoprim/Sulfamethoxazole. Figure 1. Kaplan‒Meier survivorship curve illustrating the time to treatment failure among patients with polymicrobial PJI. The shaded areas surrounding the gross line represent the 95% CI. Figure2. Kaplan‒Meier survivorship curves illustrating the time to treatment failure among patients with polymicrobial PJI, according to the infecting microorganisms.. Patients affected by S. epidermidis, E.faecalis, S. aureus, and anaerobes are represented with red, blue, green, and black lines, respectively. Conclusion Our study showed 61.53% of the patients with polymicrobial PJI controlled the infection at 1-year follow-up. This rate decreased over the years. These patients required a considerable number of hospitalizations and surgeries. Likewise, presenting with fistulae and pain ensured a high suspicion of PJI. S. epidermidis, E. faecalis, and S. aureus were the most frequent infecting microorganisms. The stratification of our cohort suggested the microbiology of polymicrobial PJI could have driven to differences in rates of treatment failure. Disclosures All Authors: No reported disclosures

scholarly journals P.023 Clinical and patient satisfaction outcomes after partial sensory rhizotomy for refractory trigeminal neuralgia among MS patients

2018 ◽  
Vol 45 (s2) ◽  
pp. S21-S21
Author(s):  
M Bigder ◽  
S Krishnan ◽  
EF Cook ◽  
AM Kaufmann
Keyword(s):  
Patient Satisfaction ◽  
Trigeminal Neuralgia ◽  
Treatment Failure ◽  
Control Group ◽  
Rank Tests ◽  
Time To Treatment ◽  
Pain Scores ◽  
Kaplan Meier ◽  
Time To Treatment Failure ◽  
N 93

Background: MS related trigeminal neuralgia (MS-TN) is associated with high recurrence and retreatment rates. Optimal treatment and role for partial sensory rhizotomy (PSR) for MS-TN remains to be determined. Methods: We analyzed time to treatment failure (TTF) after PSR (n=14) versus other prior procedures (n=53) among 12 consecutively treated MS-TN patients. Kaplan-Meier curves and Log-Rank tests were utilized to compare BNI pain scores and TTF after PSR vs prior procedures using the same patient cohort as their own control group. Subsequent analysis compared TTF after PSR to other procedures (n=93) among a second cohort of 18 MS-TN patients not undergoing PSR. Results: TTF was significantly longer after PSR compared to prior procedures among the PSR cohort (p<0.0001) with median TTF of 79 vs 10 months respectively. Similarly, there was a longer TTF after PSR compared to prior procedures among the MS-TN cohort with median TTF 79 vs 16 months respectively (p<0.001). PSR resulted in a higher proportion of excellent pain scores when compared to prior procedures in the MS-TN cohort (77% vs 29%, p<0.001). Conclusions: TTF was significantly longer following partial sensory rhizotomy compared to other prior procedures in MS-TN patients. A higher proportion of patients achieved excellent BNI pain scores after PSR.

Results of a salvage treatment program for relapsing lymphoma: MINE consolidated with ESHAP.

1995 ◽  
Vol 13 (7) ◽  
pp. 1734-1741 ◽  
Author(s):  
M A Rodriguez ◽  
F C Cabanillas ◽  
W Velasquez ◽  
F B Hagemeister ◽  
P McLaughlin ◽  
...  
Keyword(s):  
Treatment Failure ◽  
Median Time ◽  
Prospective Trial ◽  
Salvage Treatment ◽  
High Dose ◽  
Low Grade ◽  
Intermediate Grade ◽  
Time To Treatment ◽  
Time To Treatment Failure ◽  
Hodgkin's Lymphomas

PURPOSE We report the results of a prospective trial in which patients with relapsing non-Hodgkin's lymphomas were sequentially treated with two regimens (mesna, ifosfamide, mitoxantrone, and etoposide [MINE], and etoposide, methylprednisolone, cytarabine, and cisplatin [ESHAP]) if they had no history of disease resistance to these drugs. PATIENTS AND METHODS Ninety-two patients received MINE (mesna 4 g/m2, ifosfamide 4 g/m2, mitoxantrone 8 mg/m2, and etoposide 195 mg/m2) for a maximum of six courses followed by ESHAP (etoposide 240 mg/m2, methylprednisone 500 mg/d, high-dose cytarabine 2 g/m2, and cisplatin 100 mg/m2) for three courses to consolidate complete response (CR) or for a maximum of six cycles after a partial response (PR) or no response to MINE. Pretreatment serum levels of lactate dehydrogenase (LDH) and beta 2-microglobulin (beta 2M) were documented in 80 of 92 patients. RESULTS The response rate to MINE-ESHAP was 69% (48% CRs and 21% PRs), with a median survival time of 24 months and median time to treatment failure of 12 months. The median time to treatment failure according to histology was as follows: low-grade histologies, 16 months; low-grade transformed to intermediate-grade, 8 months; and intermediate-grade, 5 months. The most serious complication was myelosuppression, which resulted in two deaths due to neutropenic sepsis. A risk factor model based on beta 2M and LDH levels before salvage treatment showed three categories of risk, with 36-month survival rates as follows: low (beta 2M < 3 mg/dL and LDH normal), 61%; intermediate (beta 2M > or = 3 mg/dL or LDH above normal), 23%; and high (beta 2M > or = 3 mg/dL and LDH above normal), 0%. CONCLUSION MINE-ESHAP is an effective salvage strategy for patients with recurrent lymphoma. Toxicity was acceptable. Factors that determine prognostic categories at relapse merit further study.

Treatment of Post-Transplant Lymphoproliferative Disorder (PTLD) with Rituximab or Chemotherapy: The University of Pennsylvania Experience.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 936-936 ◽  
Author(s):  
Rebecca L. Elstrom ◽  
Charalambos Andreadis ◽  
Nicole Aqui ◽  
Donald E. Tsai
Keyword(s):  
Overall Survival ◽  
Prognostic Factors ◽  
Treatment Failure ◽  
Median Time ◽  
University Of Pennsylvania ◽  
Advanced Stage ◽  
Time To Treatment ◽  
Time To Treatment Failure ◽  
The University

Abstract Background: PTLD is a rare but life-threatening side effect of organ transplantation. While some patients respond to reduction in immunosuppression (RI), in many patients this approach is ineffective or impractical. Chemotherapy and anti-B cell monoclonal antibody therapy have been explored for treatment of such patients, but most reports include small numbers of patients. We report the results of treatment of patients with PTLD with rituximab and/or chemotherapy at the University of Pennsylvania Medical Center. Methods: Data were collected using retrospective chart and database review. Patients were evaluated for baseline characteristics as well as response to therapy, time to treatment failure, and overall survival. Prognostic factors were identified by univariate analysis. Results: 35 of 117 adult solid organ transplant patients diagnosed with PTLD that were refractory to RI underwent treatment with rituximab and/or chemotherapy. Median time to PTLD was 4 years (range 3 months to 23 years), and most patients presented with advanced stage (57%) and extranodal involvement (74%). 71% had elevated LDH. There were no significant baseline differences between patients receiving rituximab and those receiving chemotherapy. 22 patients underwent treatment with rituximab. The ORR was 68% (CR 59% and PR 9%). Median time to treatment failure (TTF) was not reached at median follow up of 19 months (range 0.8–51 months), and estimated OS was 31 months (1.5–51 months). EBV positivity was a favorable prognostic factor for achievement of response and TTF (p&lt;0.01). LDH elevation predicted shorter overall survival (0.04). No patient died due to rituximab toxicity, and all 8 patients who either did not respond or relapsed were able to undergo further treatment with chemotherapy. 23 patients received chemotherapy, 22 of whom were evaluable. ORR was 74% (CR 57% and PR 17%). At a median follow up of 27 months, median TTF was 10.5 months (0.4–54 months), and estimated OS was 42 months (0.4–70 months). Adverse prognostic factors for response included advanced stage (p=0.02), elevated LDH (p=0.01) and allograft involvement by tumor (p&lt;0.01). These factors, in addition to lack of achievement of CR, also predicted poor overall survival (p&lt;0.05 for all factors). 26% of patients receiving chemotherapy died due to treatment-related toxicity. Conclusion: Rituximab and chemotherapy are effective treatments in patients with PTLD who fail or do not tolerate RI. While rituximab is generally well tolerated, chemotherapy is associated with marked toxicity. When possible, PTLD patients requiring therapy beyond RI should be considered for rituximab, especially those with EBV-positive disease. Chemotherapy should be reserved for those patients who fail rituximab, have EBV-negative tumors, or need a rapid response.

SPEAR-Bladder (Study informing treatment Pathway dEcision in bladder cAnceR): Influence of treatment sequencing on time to treatment failure and overall survival in the United States.

2019 ◽  
Vol 37 (7_suppl) ◽  
pp. 453-453
Author(s):  
Gurjyot K. Doshi ◽  
Mairead Kearney ◽  
Murtuza Bharmal ◽  
Hemant Phatak ◽  
Marley Boyd ◽  
...  
Keyword(s):  
Overall Survival ◽  
Treatment Failure ◽  
Univariate Analysis ◽  
Locally Advanced ◽  
Disease Status ◽  
The United States ◽  
Future Research ◽  
Time To Treatment ◽  
Kaplan Meier ◽  
Time To Treatment Failure

453 Background: With the introduction of immunotherapy (IO) for locally advanced or metastatic urothelial carcinoma (mUC), optimal treatment sequence should be considered. This study aimed to compare time to treatment failure (TTF) and overall survival (OS) among these patients (pts) treated with first-line (1L) systemic chemotherapy followed by second-line (2L) IO ( C-IO) vs 1L and 2L chemotherapy ( C-C) sequence within the US community oncology Network (USON). Methods: This was a retrospective study of adult locally advanced or mUC pts who initiated systemic therapy between 1/1/15 – 4/30/17 within USON and had a minimum of two-month follow-up. Descriptive analyses were performed, with Kaplan-Meier used for comparisons between pts who received C-IO vs C-C sequence. Pts considered for this analysis did not receive a third-line treatment. Regression analyses were performed to assess variables associated with TTF and OS. Results: 117 pts were included in the analysis ( C-IO n = 79, C-C n = 38). Median age (range) was 69 years (38, 90+), with 74.4% male. Baseline demographic and clinical characteristics were similar between the groups. The median (range) duration between start of 1L and start of 2L therapy was significantly longer among C-IO vs C-C pts (29.0 [4.1, 102.1] vs 20.0 [0.1, 63.1] weeks; P = 0.0047). Median TTF and OS were longer among C-IO vs C-C pts but the trends were not significant (Table). The duration between initial diagnosis and advanced disease status was associated with TTF (P = 0.0124) in univariate analysis. Conclusions: These results suggest that patients receiving C-IO demonstrated greater (>30 weeks) but statistically non-significant improvement in OS versus those receiving C-C. Considering these OS trends, future research should explore prognostic characteristics of IL chemotherapy treated pts who may benefit from an earlier switch to IO therapy. [Table: see text]

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