scholarly journals P14.16 Complete sustaining radiological response of a multi-recurrent disseminated adult medulloblastoma after antiangiogenic metronomic combined pediatric regimen MEMMAT: a case report

2019 ◽  
Vol 21 (Supplement_3) ◽  
pp. iii69-iii70 ◽  
Author(s):  
A Duran-Peña ◽  
Y Garcilazo-Reyes ◽  
D Frappaz ◽  
L Feuvret ◽  
F Bielle ◽  
...  
Keyword(s):  
Promising Result ◽  
Adult Population ◽  
Prospective Trial ◽  
Hematological Toxicity ◽  
Tumor Control ◽  
Complete Disappearance ◽  
Adult Medulloblastoma ◽  
First Case ◽  
Meningeal Dissemination ◽  
Radiological Response

Abstract BACKGROUND Even if medulloblastoma is considered as a curable disease, recurrent medulloblastoma has a poor prognosis, independently of therapy used. Medulloblastoma is very rare in adults, unlike children, and therapeutic strategies at recurrence are lacking. Nevertheless, adult teams sometimes use as “compassionate” chemotherapy some regimens published in children, such as the MEMMAT metronomic combination. However, this treatment, targeting both endothelial and proliferating tumor cells, has to date not been studied in the adult population. MATERIAL AND METHODS We present the case of a 40-year-old man, suffering from a right cerebellar SHH mutated medulloblastoma initially diagnosed and treated in 2014 by craniospinal radiotherapy associated with 4 cycles of carboplatine-VP16 following complete resection. Since April 2016, date of first relapse, numerous successive recurrences occurred, initially focal, treated by several surgeries (April and November 2016, January 2017), chemotherapy (rechallenge by carboplatine-VP16) then stereotactic radiotherapy. He then developed in October 2017 a new relapse in the posterior fossa, also associated with a meningeal dissemination on lumbar MRI. IK was 90%. He was then treated by TOTEM regimen (Temozolomide-Topotecan) followed by “Packer” regimen (Cisplatin-Belustine-Vincristin), without tumor control. However, because patient was non symptomatic with a KPS of 80%, we decided, according to the AJA French group, to propose what we presumed to be a “compassionate” chemotherapy, by metronomic pediatric regimen “MEMMAT”. For “supportive care” reasons, we decided not to realize the “Intrathecal part” of this regimen and administered to the patient intravenous bevacizumab (10 mg/kg d1-d14-d21), thalidomide (100 mg/d), celecoxib (300 mg bid), fenofibrate (160 mg/d) and etoposide (100 mg/d d1-21), alternating with cyclophosphamide (100 mg/d d22-42). RESULTS Clinical tolerance was very good, except grade 1 heel pain and fatigue; hematological toxicity was mild (transient grade 3 neutropenia, grade 4 lymphopenia); renal impairment, already present at the beginning, was increasing, and justified dose adjustment after 5 cycles and nephrologic explorations, ongoing. Radiological evaluation showed a complete radiological response with complete disappearance of enhancing lesions on first MRIs realized after 3 months (2 cycles); this response was confirmed after 6 months (4 cycles) and 9 months (6 cycles) on both cerebral and spinal MRI. Patient is now receiving the 7th cycle. CONCLUSION We report here the first case of a complete and sustaining response of an adult multi-recurrent metastatic medulloblastoma treated by a pediatric antiangiogenic metronomic regimen “MEMMAT”. This promising result incites to develop a dedicated prospective trial in adults in view to confirm the interest of this strategy.

COMPARING THE STANDARD AND ELECTRONIC VERSIONS OF THE ALZHEIMER’S DISEASE ASSESSMENT SCALE – COGNITIVE SUBSCALE: A VALIDATION STUDY

2019 ◽  
pp. 1-5
Author(s):  
T.M. Solomon ◽  
J.M. Barbone ◽  
H.T. Feaster ◽  
D.S. Miller ◽  
G.B. deBros ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Adult Population ◽  
Prospective Trial ◽  
Electronic Version ◽  
Assessment Scale ◽  
Disease Assessment ◽  
Cognitive Subscale ◽  
Interclass Correlation ◽  
Rater Error

The Alzheimer’s Disease Assessment Scale (ADAS-Cog) has become the de facto gold-standard for assessing the efficacy of putative anti-dementia treatments. There has been an increasing interest in providing greater standardization, automation, and administration consistency to the scale. Recently, electronic versions of the ADAS-Cog (eADAS-Cog) have been utilized in clinical trials and demonstrated significant reductions in frequency of rater error as compared to paper. In order to establish validity of the electronic version (eADAS-Cog), 20 subjects who had received a diagnosis of probable Alzheimer’s disease (AD) at a private US Memory Clinic completed a single-center, randomized, counterbalanced, prospective trial comparing a version of the eADAS-Cog to the standard paper scale. Interclass Correlation Coefficient on total scores and Kappa analysis on domain scores yielded high agreement (0.88 – 0.99). Effects of order and mode of administration on ADAS-Cog total scores did not demonstrate a significant main effect. Overall, this study establishes adequate concurrent validity between the ADAS-Cog and eADAS-Cog among an adult population with diagnosed AD.

scholarly journals Paramyxovirus Outbreak in a Long-Term Care Facility: The Challenges of Implementing Infection Control Practices in a Congregate Setting

2017 ◽  
Vol 38 (4) ◽  
pp. 399-404 ◽  
Author(s):  
Steven Schaeffer Spires ◽  
H. Keipp Talbot ◽  
Carolyn A. Pope ◽  
Thomas R. Talbot
Keyword(s):  
Infection Control ◽  
Older Adult ◽  
Adult Population ◽  
Care Facility ◽  
Control Measures ◽  
Nasopharyngeal Swab ◽  
Term Care ◽  
Infection Control Measures ◽  
First Case ◽  
Older Adult Population

OBJECTIVEWe report an outbreak of respiratory syncytial virus (RSV) and human metapneumovirus (HMPV) infections in a dementia care ward containing 2 separately locked units (A and B) to heighten awareness of these pathogens in the older adult population and highlight some of the infection prevention challenges faced during a noninfluenza respiratory viral outbreak in a congregate setting.METHODSCases were defined by the presence of new signs or symptoms that included (1) a single oral temperature ≥ 37.8°C (100.0°F) and (2) the presence of at least 2 of the following symptoms: cough, dyspnea, rhinorrhea, hoarseness, congestion, fatigue, and malaise. Attempted infection-control measures included cohorting patients and staff, empiric isolation precautions, and cessation of group activities. Available nasopharyngeal swab specimens were sent to the Tennessee Department of Health for identification by rT-PCR testing.RESULTSWe identified 30 of the 41 (73%) residents as cases over this 16-day outbreak. Due to high numbers of sick personnel, we were unable to cohort staff to 1 unit. Unit B developed its first case 8 days after infection control measures were implemented. Of the 14 cases with available specimens, 6 patients tested positive for RSV-B, 7 for HMPV and 1 patient test positive for influenza A. Overall, 15 cases (50%) required transfer to acute care facilities; 10 of these patients (34%) had chest x-ray confirmed pulmonary infiltrates; and 5 residents (17%) died.CONCLUSIONSThis case report highlights the importance of RSV and HMPV in causing substantial disease in the older adult population and highlights the challenges in preventing transmission of these viruses.Infect Control Hosp Epidemiol 2017;38:399–404

Folfox 2 Regimen in Heavily Pretreated Patients with Advanced Colorectal Cancer

2002 ◽  
Vol 88 (4) ◽  
pp. 270-272 ◽  
Author(s):  
Gabriele Luppi ◽  
Francesca Zanelli ◽  
Antonio Di Stasi ◽  
Federica Bertolini ◽  
Micol Pifferi
Keyword(s):  
Colorectal Cancer ◽  
Partial Response ◽  
Phase Ii ◽  
Stable Disease ◽  
Advanced Colorectal Cancer ◽  
Phase Ii Study ◽  
Hematological Toxicity ◽  
Tumor Control ◽  
Heavily Pretreated ◽  
Colorectal Cancer Patients

Aims and Background To determine the efficacy and safety of the FOLFOX 2 regimen in patients with pretreated advanced colorectal cancer. Methods In this single-arm phase II study, 28 patients with heavily pretreated advanced colorectal cancer received the following drug combination: oxaliplatin (100 mg/m2 for 2 hrs on day 1), folinic acid (250 mg/m2 for 2 hrs on day 1) and 5-filuorouracil (1500 mg/m2 for 22 hrs continuous infusion on days 1 and 2) every 2 weeks (one cycle). The treatment was continued until unacceptable toxicity occurred or at most for 10 cycles. Results Nine patients (32%) had a partial response and 5 (18%) stable disease, with a median duration of tumor control of 24 weeks (range, 8-44). The median survival of patients with a partial response or stable disease was 32 weeks (range, 12-52), whereas the median overall survival was 32 weeks (range, 8-72). A clinical benefit was achieved in 32% (9/21) of the patients. Severe (grade 3-4) non-hematological toxicity included diarrhea (1 patient), nausea/vomiting (7%) and peripheral neuropathy (1 patient). Severe hematological toxicities were rare (4%). Conclusions Our phase II study confirmed the therapeutic effectiveness and safety of the FOLFOX 2 regimen in pretreated advanced colorectal cancer patients.

Interim analysis of the largest prospective trial to date in adult CD20-positive post-transplant lymphoproliferative disorder (PTLD): Introducing risk-stratified sequential treatment (RSST).

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 8030-8030 ◽  
Author(s):  
Ralf Ulrich Trappe ◽  
Daan Dierickx ◽  
Petra Reinke ◽  
Ruth Neuhaus ◽  
Franck Morschhauser ◽  
...  
Keyword(s):  
High Risk ◽  
Overall Response Rate ◽  
Prospective Trial ◽  
Low Risk ◽  
Sequential Treatment ◽  
Tumor Control ◽  
Transplant Recipients ◽  
Risk Patients ◽  
Related Mortality

8030 Background: The prospective, multicenter international phase II PTLD-1 trial of sequential treatment (ST, 4 cycles of weekly rituximab followed by 4 cycles of CHOP-21 + G-CSF) in adult CD20-positive PTLD demonstrated excellent efficacy (90% overall response rate, ORR) and safety (11% treatment-related mortality, TRM). As the response to rituximab predicted overall survival (OS), the trial was amended in 2007 introducing risk-stratified sequential treatment (RSST) according to the response to rituximab (NCT00590447). Methods: Following rituximab on days 1, 8, 15 and 22, RSST consisted of 4 3-weekly courses of rituximab monotherapy for patients (pts) in complete remission (CR, low risk) while all others (high risk) received 4 cycles of R-CHOP-21 + G-CSF. Key exclusion criteria were CNS involvement, HIV infection, severe organ dysfunction not related to PTLD, and ECOG > 2. Primary endpoint was ORR. This is an analysis of the first 91 patients treated with RSST. Results: 79/91 pts had monomorphic, 12 polymorphic PTLD. 41/91 pts were kidney, 27 liver, 12 heart, 7 lung or heart+lung, 3 heart+kidney and 1 kidney+pancreas transplant recipients. Median age at diagnosis was 60 years (range 20-82). 73/91 pts had late PTLD and 39/85 PTLDs were EBV-associated. 1 pt died before initiation of treatment; 5 pts discontinued treatment after 4 cycles rituximab. TRM of RSST was 7/90 (8%) including 5 deaths with unknown remission status. ORR was thus 74/80 (93%, 95%CI: 84-97%; CR: 62/80 [78%]). 24/90 pts (27%) achieved CR with 4 cycles of rituximab. After a median follow up of >3 years, relapse rate in low risk pts was not increased by rituximab consolidation in RSST compared to CHOP consolidation in ST (3/23 vs. 5/14, p=0.104]). In patients in PD after rituximab, R-CHOP was more effective than CHOP in achieving CR (15/23 vs. 3/11, p=0.038). OS at 3 years was higher with RSST (70%, 95% CI: 60-82%) compared to ST (61%, 95%CI 49-72%) but this difference was not significant. Conclusions: With RSST 27% of pts were classified as low risk and achieved durable tumor control without chemotherapy while R-CHOP seems more efficient than CHOP in in high risk patients.

scholarly journals Pediatric sellar solitary fibrous tumor/ hemangiopericytoma: A rare case report and review of the literature

2020 ◽  
Vol 11 ◽  
pp. 238
Author(s):  
Hammad Ghanchi ◽  
Tye Patchana ◽  
Eisha Christian ◽  
Chao Li ◽  
Mark Calayag
Keyword(s):  
Solitary Fibrous Tumor ◽  
Vision Loss ◽  
Adult Population ◽  
Tumor Resection ◽  
The Body ◽  
Subtotal Resection ◽  
Adjuvant Radiation ◽  
Sellar Region ◽  
First Case ◽  
Fibrous Tumor

Background: Solitary fibrous tumor (SFT)/hemangiopericytoma (HPC) is a rare tumor which originates from the walls of capillaries and has historically been thought to be able to occur anywhere in the body that blood vessels are found. It is rarely found in the sellar region. Case Description: InS this report, we present the first case of this tumor occurring in the sellar region of a pediatric patient. This 12-year-old male presented with progressive vision loss which prompted surgical resection after a sellar lesion was discovered on imaging. The initial transsphenoidal approach resulted in subtotal resection and the patient experienced reoccurrence within 3 months. He underwent an orbitozygomatic craniotomy to achieve gross total tumor resection. Conclusion: We conducted a literature review of intracranial SFT/HPC in the pediatric population and found it to be an extremely rare occurrence, with <30 cases reported. The incidence of SFT/HPC occurring in the sellar region for any age group was also found to be a rare entity. Treatment recommendations for this tumor are also scarce, based on retrospective chart reviews from the adult population. The role for adjuvant radiation has mixed results.

scholarly journals Adult Medulloblastoma Demographic, Tumor and Treatment Impact since 2006: A Canadian University Experience

2021 ◽  
Vol 28 (4) ◽  
pp. 3104-3114
Author(s):  
Maria Camila Quinones ◽  
Karl Bélanger ◽  
Émilie Lemieux Blanchard ◽  
Bernard Lemieux ◽  
Jean-Paul Bahary ◽  
...  
Keyword(s):  
Adjuvant Chemotherapy ◽  
Chemotherapy Regimen ◽  
Adult Population ◽  
Extent Of Resection ◽  
Primary Brain Tumor ◽  
Adult Patients ◽  
Adult Medulloblastoma ◽  
First Line Therapy ◽  
Adjuvant Chemotherapy Regimen ◽  
Impact On Survival

Medulloblastoma is an aggressive primary brain tumor that is extremely rare in adults; therefore, prospective studies are limited. We reviewed the information of all MB patients treated at the CHUM between 2006 and 2017. We divided our cohort by age and further divided adult patients (53%) in two groups, those diagnosed between 2006–2012 and 2013–2017. In our adult population, median follow up was 26 months and SHH-activated MB comprised 39% of tumors. Adult 5yOS was 80% and first-line therapy led to a 5yPFS of 77%. The absence of radiosensitizing chemotherapy (100% vs. 50%; p = 0.033) negatively influenced 5yPFS. 96% of adult patients received radiotherapy and 48% of them received concomitant radiosensitizing chemotherapy. Complete surgical resection was performed on 85% of adults, but the extent of resection did not have a discernable impact on survival and did not change with time. Adjuvant chemotherapy did not clearly affect prognosis (5yOS 80% vs. 67%, p = 0.155; 5yPFS 78% vs. 67%, p = 0.114). From 2006–2012, the most common chemotherapy regimen (69%) was Cisplatinum, Lomustine and Vincristine, which was replaced in 2013 by Cisplatinum, Etoposide and Cyclophosphamide (77%) with a trend for worse survival. Nine patients recurred and seven of these (78%) were treated with palliative chemotherapy. In conclusion, we did not identify prognostic demographic or tumor factors in our adult MB population. The presence of radiosensitizing chemotherapy was associated with a more favorable PFS. Cisplatinum, Lomustine and Vincristine regimen might be a better adjuvant chemotherapy regimen.

Dose-dense first-line chemotherapy in advanced ovarian cancer: How to select the patients?

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e16509-e16509
Author(s):  
Alexandra Tjulandina ◽  
Marina Stenina ◽  
Ilya Pokataev ◽  
Mikhail Fedyanin ◽  
Alexey Tryakin ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Prospective Trial ◽  
Advanced Ovarian Cancer ◽  
Hematological Toxicity ◽  
Optimal Cytoreduction ◽  
First Line ◽  
Optimal Interval ◽  
Dose Dense ◽  
Conventional Ct ◽  
Line Chemotherapy

e16509 Background: First line dose-dense (dd) regimens improve PFS in patients (pts) with advanced ovarian cancer, but also increase hematological toxicity, peripheral neuropathy and usage of G-CSF. Nowadays it is unknown which pts benefit from this treatment. Methods: The analysis included 156 pts with ovarian carcinoma stages Ic-IV, who received paclitaxel (Ptx) and platinum agents in first line chemotherapy (CT) from 1996 to 2010 in our center. Retrospective group contained 91 pts, who were administered standard regimens (Ptx 175 mg/m2 + Carboplatin (C) AUC5-6 /Cisplatin (DDP) 75 mg/m2 every 3 weeks). Prospective group included 65 pts. Forty of them received 9 cycles Ptx 150 mg/m2+DDP 50 mg/m2 every 2 weeks, 25 pts were given 6 cycles Ptx 80 mg/m21,8,15 days + C AUC6 every 3 weeks. Results: Median PFS in the dd (12.5 months) and the standard arms (13.3 months) were not statistically significantly different (p = 0.6, HR 0.9; 95% CI 0.61-1.37). Multivariate analysis revealed the optimality (p=0.006) and time (p = 0.008) of cytoreduction were found as the strongest factors exerted on PFS and could take effect on choice of CT regimen. Median PFS was longer in pts with primary optimal cytoreduction (26.3 months) than in group with primary non optimal, interval debulking or without any surgery treatment (10.9 months) (p < 0.0001, HR 0.28; 95% CI 0.23-0.55). The dd regimens prolonged PFS in comparison with the standard arm in pts with favorable prognosis (primary optimal cytoreduction): median was not reached vs 15.1 months respectively (p = 0.02, HR 0.36; 95%CI 0.13-1.2). Meanwhile, median PFS in unfavorable prognostic group was not different between 2 arms: 10.3 vs 11.5 months respectively (p = 0.4 HR 1.26; 95% CI 0.8-2.02). Conclusions: First-line dd statistically significantly prolong PFS in pts with primary optimal cytoreduction comparing with standard conventional CT. It is necessary to validate this predictive factor in prospective trial.

Eosinophilic meningitis triggered by implanted Gliadel wafers: case report

2016 ◽  
Vol 126 (6) ◽  
pp. 1783-1787 ◽  
Author(s):  
Kiyotaka Saito ◽  
Kouji Yamasaki ◽  
Kiyotaka Yokogami ◽  
Asya Ivanova ◽  
Go Takeishi ◽  
...  
Keyword(s):  
Positive Reaction ◽  
Sudden Onset ◽  
Brain Parenchyma ◽  
Local Tumor Control ◽  
Tumor Control ◽  
Lymphocyte Stimulation Test ◽  
Eosinophilic Meningitis ◽  
First Case ◽  
Ventriculoperitoneal Shunting ◽  
Consciousness Disturbance

Although carmustine (Gliadel) wafers improve local tumor control and extend the overall survival in patients with malignant glioma, adverse effects have been documented. The authors report the first case of eosinophilic meningitis triggered by the placement of Gliadel wafers. A 61-year-old man with a history of alimentary allergy and glioblastoma in the right frontal lobe underwent resection followed by the implantation of Gliadel wafers. Three weeks later he suffered the sudden onset of headache, vomiting, and progressive consciousness disturbance. Computed tomography revealed enlargement of the ventricular system and subdural space on the side of the tumor. His CSF leukocyte count increased up to 3990 cells/mm3; 95% of the cells were eosinophilic granulocytes (EGs), suggesting eosinophilic meningitis. Laboratory examination showed the patient to have various elevated allergy indicators. The administration of corticosteroids failed to improve his condition. Despite the insertion of a lumbar drain his symptoms failed to improve. He underwent a second surgical intervention to remove the Gliadel wafers. Histologically, EGs had assembled around the wafers. Eosinophilic infiltrate was present in the brain parenchyma around small vessels. After ventriculoperitoneal shunting his course was favorable. A drug lymphocyte stimulation test against the Gliadel wafers failed to demonstrate a positive reaction; polifeprosan, the wafer matrix without 1,3-bis(2-chloroethyl)-1-nitrosourea, yielded a positive reaction. These findings strongly suggest that although extremely rare, polifeprosan (the wafer matrix) can elicit an allergic reaction. When eosinophilic meningitis is suspected after the implantation of Gliadel wafers, their immediate removal should be considered.

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