scholarly journals Factors affecting treatment strategy, completion of planned treatment and survival in older patients with glioblastoma

2019 ◽  
Vol 21 (Supplement_4) ◽  
pp. iv14-iv14
Author(s):  
Aimee Goel ◽  
Lillie Shahabi ◽  
Ganesalingam Narenthiran ◽  
Kevin O’Neill ◽  
David Peterson ◽  
...  

Abstract Introduction For older patients with glioblastoma (GBM), age, extent of resection, and performance status are prognostic factors. However, an international survey conducted by our Unit found that >40% of neurosurgeons use age alone to discount surgery in older (65+) patients. The aim of this study was to review management in our Unit for 65+ GBM patients, to inform future approaches. Methods Patients 65+ with a new GBM diagnosis in our Unit, between 2014 and 2017, were identified. Demographic data, performance status (PS), comorbidity and frailty indices, together with details of surgical/oncological management and outcome were collected. Results 78 patients were identified. 78% aged 65–74 underwent maximal safe resection, compared with 45% aged 75–84, and 10% aged 85+. Resection was undertaken in 68% PS1, 73% PS2 and 23% PS3 patients. No PS3 patient completed intended radiotherapy, compared with 79% PS1 and 74% PS2 patients. There was a significant difference in frailty scores of patients who completed scheduled oncological therapy compared with those who did not (median score 2 vs 4.5, p=0.0338). Median survival was 10 months for patients 65–74, 4 months for aged 75 -84, and 40 days for 85+ (p<0.0167). Median survival was significantly lower for PS3 patients (44 days) compared with PS1 or 2 (9.5 months and 7 months respectively; p<0.0167). Conclusion There is considerable variability in performance status and frailty of 65+ GBM patients. PS3 patients at diagnosis are very unlikely to complete oncological treatment. These factors, rather than age alone, should be used to guide management decisions.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e21086-e21086
Author(s):  
Geoffroy Bilger ◽  
Anne-Claire Toffart ◽  
Marie Darasson ◽  
Michaël Duruisseaux ◽  
Lucie Ulmer ◽  
...  

e21086 Background: With the growing role of immunotherapy (ICI) as first-line setting for advanced NSCLC, strategies must be redefined after failure. The combination paclitaxel-bevacizumab showed in the ULTIMATE trial a significant superiority versus docetaxel as second or third-line treatment. Limited restropective studies has demonstrated unexpected efficacy of chemotherapy after prior progression on ICI. This combination could be use as salvage treatment following ICI. Methods: This multi-centric retrospective study identifies patients treated with the combination paclitaxel-bevacizumab in metastatic non-squamous NSCLC as second-line therapy or beyond. Main objectives were to describe safety and efficacy of this combination, with a special attention to the sub-group treated just after ICI. Results: From January 2010 to February 2020, 314 patients started the paclitaxel-bevacizumab combination : 55% male, with a median age of 60 years, 27% with a performance status ≥2, 45% with brain metastases. A majority of patients were treated in second (20%) and third-line (39%), and 28% were treated just after ICI failure (88/314). Objective response rate (ORR) was 40% and disease control rate was 77 %. Median progression-free survival (PFS) and overall survival (OS) were 5,7 months [IQ,3,2–9,6] and 10,8 months [IQ,5,3–19,6] respectively. All grades adverse events concerned 82% of patients, including 53% asthenia and 39% neurotoxicity, and 25% of patients continued a monotherapy alone due to toxicity. Median PFS for patients treated after ICI failure (ICI+) was significantly superior compare to those not previously treated with ICI (ICI-) : 7,0 months [IQ,4,2–11,0] vs 5,2 months [IQ,2,9–8,8] p (log-rank) = 0,01. There was not statistically significant difference in term of OS between this two groups. In multivariate analysis, factors associated with superior PFS were previous ICI treatment (ICI+) and performance status. Conclusions: This study confirms an acceptable toxicity profile associated with interesting efficacy of the combination paclitaxel-bevacizumab as second-line treatment or beyond for non–squamous NSCLC patients, particularly after progression with ICI.


2016 ◽  
Vol 31 (2) ◽  
pp. 63-68 ◽  
Author(s):  
Erin Cizek ◽  
Patrick Kelly ◽  
Kathleen Kress ◽  
Mildred Mattfeldt-Beman

Maintaining good health is essential for touring musicians and singers. The stressful demands of touring may impact food choices, leading to detrimental effects on health and performance. This exploratory pilot study aimed to assess factors affecting healthful eating of touring musicians and singers. A 46-item survey was used to assess food- and nutrition-related attitudes, knowledge and behaviors, and environmental factors, as well as lifestyle, musical background, and demographic data. Participants (n=35) were recruited from a musicians’ assistance foundation as well as touring musical theater productions and a music festival. Results indicate that touring musicians and singers had positive attitudes regarding healthful foods. Of 35 respondents, 80.0% indicated eating healthful food was important to them. Respondents reported feeling confident selecting (76.5%) and preparing (82.4%) healthful foods; however, they showed uncertainty when determining if carbohydrate-containing foods should be consumed or avoided. Respondents indicated environmental factors including availability and cost of healthy food options and tour schedules limited access to healthful foods. Venues (73.5%), fast food restaurants (67.6%), and airports (64.7%) were the most frequently identified locations in need of offering more healthful food choices. Respondents (52.9%) indicated more support from others while touring would help them make healthier food choices. More research is needed to develop mobile wellness programs as well as performance-based nutrition guidelines for musicians and singers that address the unique demands associated with touring.


2021 ◽  
Author(s):  
Jianda Xu ◽  
Homma Yasuhiro ◽  
Yuta Jinnai ◽  
Tomonori Baba ◽  
Zhuang Xu ◽  
...  

Abstract The aim of this study was to evaluate the role of Charlson comorbidities index (CCI) and cofactors on 2-year mortality in older patients with intertrochanteric fractures. 60 cases with unilateral intertrochanteric fracture were retrospectively analyzed and divided into Low-CCI group (CCI: 1-4) or high-CCI groups (CCI: 5-6). All the patients’ electronic hospital records were reviewed. The preoperative situations (demographic data, comorbidities and fracture conditions), perioperative situations (wait time, operation time, implant choice, blood loss, transfusion or not) and postoperative situations (complications, first time out of bed, function about 1-/2- week and 2-year mortality) were recorded. 51.67% were in low-CCI group and 48.33% in high-CCI group. The survival rates in low- and high-CCI group were 93.5% and 86.2 % respectively. According to the functional results of 1- or 2- week after operation, no significant difference was found (P=0.955, 0.140). Log-rank analysis showed that the main prognostic factors were blood loss, first time out of bed and complication (P<0.05). Multivariate analysis confirmed that complication and first time out of bed were significant factor on survival rate (P=0.029, 0.010). Charlson comorbidities index maybe not the indicator of 2-year mortality in older patients with intertrochanteric fractures. In order to improve the prognosis, more attentions should be paid to reduce the complications and encourage postoperative earlier excise out of bed.


2020 ◽  
Vol 3 (3) ◽  
pp. 351-359
Author(s):  
Petros Grivas ◽  
Elizabeth R. Plimack ◽  
Arjun V. Balar ◽  
Daniel Castellano ◽  
Peter H. O’Donnell ◽  
...  

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 4497-4497 ◽  
Author(s):  
Wanlong Ma ◽  
Francis Giles ◽  
Susan O’Brien ◽  
Iman Jilani ◽  
Xi Zhang ◽  
...  

Abstract The ubiquitin-proteasome pathway is responsible for multiple pathways in cancer cells; proteasome inhibition causes rapid apoptosis of tumor cells. Three different types of peptidase activities have been reported for proteasomes: chymotrypsin-like (Ch-L), trypsin-like (Tr-L), and caspase-like (Cas-L) (postglutamyl peptide hydrolytic-like). Various proteasome inhibitors affect each of the 3 activities differently and at different concentrations. For example, NPI-0052 inhibits Ch-L and Tr-L activities at lower concentrations than does bortezomib, while bortezomib inhibits Cas-L at lower concentrations than does NPI-0052. These enzymatic activities are usually measured in normal or tumor cells to monitor therapy with proteasome inhibitors. Because rapidly proliferating leukemic cells pour their proteins, DNA, and RNA into the circulation, we developed fluorogenic kinetic assays using peripheral blood plasma. The assays used peptide-AMC (7-amino 4-methylcoumoran) substrates to measure Ch-L, Tr-L, and Cas-L activities. We measured proteasome activities in plasma from 188 patients with acute myeloid leukemia (AML) and 58 patients with myelodysplastic syndrome (MDS) and assessed their correlations with clinical behavior. Significantly (P &lt; 0.001) higher Ch-L, Tr-L, and Cas-L activities were seen in AML patients (medians: 1.39, 1.51, and 2.40 pmol AMC/sec/mL, respectively) and MDS patients (medians: 1.16, 1.40, and 1.67 pmol AMC/sec/mL, respectively) than in healthy volunteers (n=42) (medians: 0.80, 0.74, and 0.81 pmol AMC/sec/mL, respectively). The difference in Cas-L activity between AML and MDS was significant (P &lt;0.001). While there was no significant difference between Ch-L and Cas-L activities in healthy controls, there was a significant difference between the 2 activities in both AML and MDS. Cas-L and Ch-L, but not Tr-L, correlated with WBC count and lactic dehydrogenase in AML and MDS patients. In AML patients, higher levels of Ch-L and Cas-L were associated with poor response to a variety of therapies (P = 0.004 and P = 0.001, respectively). Cas-L correlated strongly with survival in AML patients when used as an activity-dependent variable (P &lt;0.001) or when the median was used as a cut-off (P = 0.004). This was independent of cytogenetic abnormalities, age, and performance status. Patients with intermediate-risk cytogenetic abnormalities and Cas-L activity &gt;3 pmol AMC/sec/mL had significantly shorter survival (P = 0.04). Ch-L activity was also predictive of survival in AML independent of age and cytogenetic and performance status, but not independent of Cas-L. In MDS, higher levels of Cas-L, but not Ch-L, correlated with shorter survival and this was independent of cytogenetic abnormalities. The increased cell-free circulating proteasome activities most likely reflect the leukemic cells and may be a marker not only for disease, but also potentially for monitoring therapy. These data also suggest that patients with AML may benefit differentially from proteasome inhibitors depending on the specific therapeutic effect of the inhibitor.


2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 18036-18036
Author(s):  
J. W. Singer ◽  
F. B. Oldham ◽  
B. Bandstra ◽  
L. Sandalic ◽  
J. Bianco ◽  
...  

18036 Background: CB is an estrogen-influenced lysosomal cysteine protease produced by tumor cells and tumor-associated macrophages; tumor tissue CB protein levels and proteolytic activity are prognostic in NSCLC (Anticancer Res. 2004; 24:4147–61). The prognostic value of serum CB has not previously been evaluated in NSCLC. Here we evaluate the impact of pretreatment CB levels on survival in pts from 2 phase III trials in advanced NSCLC, STELLAR 3 and 4. These trials compared paclitaxel poliglumex (PPX) against commonly used regimens. As the intratumoral metabolic pathway of PPX is characterized by the CB-mediated release of paclitaxel (P) from a polymeric backbone (Ca Chemother Pharm. 2006. Epub ahead of print), correlation of CB levels with PPX efficacy was assessed as well. Methods: Pretreatment serum samples from 450 chemo-naive pts with advanced NSCLC and PS 2 enrolled in STELLAR 3 (P + carboplatin (C) v. PPX + C) (N=315) and STELLAR 4 (vinorelbine or gemcitabine v. PPX) (N=135) were assayed for CB by ELISA (ICON Labs). Values were assessed by quartiles and there was a clear breakpoint at the median. Pts were categorized as high or low CB based on values above or below the median (64 ng/ml). The effect of CB levels on survival was evaluated by log rank for pooled pts from the studies. Results: As detailed in the table , median survival for non-PPX-treated pts was worse if CB was high; in contrast, median survival for PPX-treated pts did not differ by CB level. Pts with high CB receiving PPX showed a trend towards better survival compared to those receiving control regimens. Conclusions: The data suggest that serum CB may be prognostic biomarker for NSCLC. Retrospective analysis suggests a trend towards improved survival in patients with high CB receiving PPX; prospective studies are required to confirm this observation. [Table: see text] No significant financial relationships to disclose.


2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e20531-e20531
Author(s):  
Y. Manikyam ◽  
G. G. Hanna ◽  
R. J. Harte ◽  
P. G. Henry ◽  
R. F. Houston ◽  
...  

e20531 Background: The survival advantage for combination chemotherapy in advanced gastroesophageal adenocarcinoma is well documented. Epirubicin and cisplatin in combination with either 5FU (ECF) or capecitabine (ECX) result in response rates of 35–46% and a median survival of around 9 months in RCT. We report the impact of socioeconomic status on the outcome of ECF and ECX treatment in advanced gastroesophageal cancer patients in Northern Ireland between 2000 and 2007. Methods: All patients with advanced esophageal (O), gastric (G), or esophagogastric junction (OGJ) adenocarcinoma, receiving palliative chemotherapy from January 2000 to August 2007, were identified from our institutional database. Baseline demographics, clinical characteristics, treatment details, and clinical outcomes were recorded. Patients receiving chemotherapy in a clinical trial were excluded. Survival was estimated using the Kaplan-Meier method. Deprivation was assessed using the patient's home address deprivation index (DPI) (Northern Ireland Multiple Deprivation Measure 2005; May 2005. Northern Ireland Statistics and Research Agency. www.nisra.gov.uk ). Results: 274 eligible patients (m=200, f=74, O=114, OGJ=19, G=141) were identified. Median age was 62 years (range 22–83). 172 (62.8%) had ECOG performance status 0 or 1. 231 patients (84.3%) had metastatic disease, 43 (15.7%) had locally advanced disease. 216 (78.8%) patients received ECF and 58 (21.2%) patients received ECX. Overall median survival was 7.3 months. Treatment response and performance status were strong predictors of survival, however disease extent did not influence survival. Median survival was significantly longer in those with DPIs in the upper two quintiles than the lower 3 quintiles (9.5 months vs. 6.8 months, p=0.032). Conclusions: Outcomes achieved with palliative ECF/ECX treatment are similar to the reference clinical trials. Socioeconomic deprivation is significantly associated with reduced survival in this group of patients and is unrelated to disease extent at presentation; however it may be related to nutritional status and comorbidity and requires further investigation. No significant financial relationships to disclose.


2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 7068-7068
Author(s):  
Tapan M. Kadia ◽  
Naval Guastad Daver ◽  
Farhad Ravandi ◽  
Elias Jabbour ◽  
Naveen Pemmaraju ◽  
...  

7068 Background: Older patients with AML have poor tolerance to intensive chemotherapy and poor prognosis. Omacetaxine is active in AML and is part of standard combination chemotherapy in China under the name of homoharringtonine. Methods: The aim of the study was to evaluate the efficacy of low intensity therapy with omacetaxine and LD-ara C in newly diagnosed older patients (>/= 60 years) with AML or myelodysplastic syndrome (MDS). Older patients with AML not fit or who refuse intensive chemotherapy were eligible. Normal organ functions and performance status </= 2 were required. Other eligibility criteria were standard. Induction therapy consisted of omacetaxine 1.25 mg/m2 subcutaneously twice daily for 3 days and ara-C 20 mg subcutaneously twice daily for 7 days. Maintenance therapy was with the same induction schedule, repeated every 4-6 weeks for up to 2 years. Dose adjustments for prolonged myelosupression or severe non-hematologic toxicities were made by reducing the number of days of omacetaxine (-1 day by level) and cytarabine (-1 to 2 days by level). Results: 30 patients have been treated, with a median age of 71 years (range 64-81); 60% were age 70 years or older. AML post MDS in 20%; chromosome 5 and 7 abnormalities were present in 23%. Overall, 9 patients achieved CR (30%), 5 had CRp (17%) and 1 had PR (3%), for an overall response rate of 50%. Induction mortality was noted in 4 (Day 5, 27, 27, and 70 from start of therapy; 13%); resistant disease in 8 (27%); too early in 4 (13%). With the median follow-up time of 10 months the median survival is 9.3 months and the estimated 1-year survival rate 42%. No serious drug related adverse effects were observed with the combination. Conclusions: Low-intensity therapy with omacetaxine + LD-ara C shows promising activity and is safe in older patients with AML not fit for intensive chemotherapy. Clinical trial information: NCT01272245.


2014 ◽  
Vol 21 (3) ◽  
pp. 348-356 ◽  
Author(s):  
Camilo A. Molina ◽  
Christopher P. Ames ◽  
Dean Chou ◽  
Laurence D. Rhines ◽  
Patrick C. Hsieh ◽  
...  

Object Chordomas involving the mobile spine are ideally managed via en bloc resection with reconstruction to optimize local control and possibly offer cure. In the cervical spine, local anatomy poses unique challenges, limiting the feasibility of aggressive resection. The authors present a multi-institutional series of 16 cases of cervical chordomas removed en bloc. Particular attention was paid to clinical outcome, complications, and recurrence. In addition, outcomes were assessed according to position of tumor at the C1–2 level versus the subaxial (SA) spine (C3–7). Methods The authors reviewed cases involving patients who underwent en bloc resection of cervical chordoma at 4 large spine centers. Patients were included if the lesion epicenter involved the C-1 to C-7 vertebral bodies. Demographic data and details of surgery, follow-up course, exposure to adjuvant therapy, and complications were obtained. Outcome was correlated with presence of tumor in C1–2 versus subaxial spine via a Student t-test. Results Sixteen patients were identified (mean age at presentation 55 ± 14 years). Seven cases (44%) cases involved C1–2, and 16 involved the subaxial spine. Median survival did not differ significantly different between the C1–2 (72 months) and SA (60 months) groups (p = 0.65). A combined (staged anteroposterior) approach was used in 81% of the cases. Use of the combined approach was significantly more common in treatment of subaxial than C1–2 tumors (100% vs 57%, p = 0.04). En bloc resection was attempted via an anterior approach in 6% of cases (C1–2: 14.3%; SA: 0%; p = 0.17) and a posterior approach in 13% of cases (C1–2: 29%; SA: 0%; p = 0.09). The most commonly reported margin classification was marginal (56% of cases), followed by violated (25%) and wide (19%). En bloc excision of subaxial tumors was significantly more likely to result in marginal margins than excision of C1–2 tumors (C1–2: 29%; SA: 78%; p = 0.03). C1–2 tumors were associated with significantly higher rates of postoperative complications (C1–2: 71%; SA: 22%; p = 0.03). Both local and distant tumor recurrence was greatest for C1–2 tumors (local C1–2: 29%; local SA: 11%; distant C1–2: 14%; distant SA: 0%). Statistical analysis of tumor recurrence based on tumor location was not possible due to the small number of cases. There was no between-groups difference in exposure to postoperative adjuvant radiotherapy. There was no difference in median survival between groups receiving proton beam radiotherapy or intensity-modulated radiotherapy versus no radiation therapy (p = 0.8). Conclusions Compared with en bloc resection of chordomas involving the subaxial cervical spine, en bloc resection of chordomas involving the upper cervical spine (C1–2) is associated with poorer outcomes, such as less favorable margins, higher rates of complications, and increased tumor recurrence. Data from this cohort do not support a statistically significant difference in survival for patients with C1–2 versus subaxial disease, but larger studies are needed to further study survival differences.


2020 ◽  
Author(s):  
hui zhou ◽  
Li Yang ◽  
Ming Lu ◽  
Xqing Deng ◽  
Mming Yang

Abstract Background :We analysed outcomes of cerebral glioblastoma patients undergoing awake craniotomies combined with multimodal techniques for tumour resection, with regards to the extent of resection, functional preservation, and prognosis. Methods : A retrospective analysis was conducted on adult glioblastoma patients who underwent an awake craniotomy from September 2010 to August 2018 under anaesthesia combined with multimodal techniques. Results: In total, 81 glioblastoma patient charts were analysed. The most common lesion sites were the frontal lobe (n=36), temporal lobe (n=17), and parietal lobe (n=6). The main symptoms were headache (n=51), dyskinesia (n=11), speech disorder (n=9), and epilepsy (n=10). The extent of resection was gross total for 91.36% patients, subtotal for 7.41%, and partial for 1.23%. No deaths occurred 30 days post-operation. Intracranial haemorrhage occurred in 2 patients, seizures in 5 patients, and intracranial infections in 3 patients. There was no significant difference between preoperative and postoperative Karnofsky Performance Status scores (P>0.05). There were no significant changes in postoperative neurological function in 50 patients. Symptoms improved in 24 patients. Three patients exhibited motor dysfunction, 2 exhibited speech deficits, and 2 exhibited sensory deficits. The average duration of hospitalization was 6.89±2.66 days. The shortest survival time was 4 months, the longest survival time was 26 months, and the median survival time was 12 months. Conclusions: Awake craniotomy using multimodal techniques such as neuronavigation, intraoperative ultrasound, electrophysiology, and tumour fluorescence during an operation can maximize safety during the cerebral glioblastoma resection, thus protecting brain function and improving surgical efficacy and patients’ postoperative quality of life.


Sign in / Sign up

Export Citation Format

Share Document