scholarly journals RADI-37. CLINICAL RISK FACTORS FOR INTRACRANIAL HEMORRHAGE OF SOLID MELANOMA BRAIN METASTASES AFTER RADIOSURGERY

2019 ◽  
Vol 1 (Supplement_1) ◽  
pp. i29-i29
Author(s):  
Catherine Okoukoni ◽  
Michael LeCompte ◽  
Ryan Hughes ◽  
Emory McTyre ◽  
Christina Cramer ◽  
...  
Keyword(s):  
Risk Factors ◽  
Brain Metastases ◽  
Intracranial Hemorrhage ◽  
Imaging Data ◽  
Free Survival ◽  
Kaplan Meier ◽  
Significant Difference ◽  
Melanoma Brain Metastases ◽  
Impact Risk

Abstract PURPOSE: Melanoma brain metastases (MBM) are among the most common solid tumors associated with intracranial hemorrhage (ICH). Our objective is to investigate risk factors for post-radiosurgery intracranial hemorrhage (PRH). METHODS: We collected demographic, clinical, treatment, toxicity, survival, and imaging data for patients with solid MBM who underwent SRS between 2000 and 2016 at our institution. Bleed free survival (BFS) and overall survival (OS) analyses were performed using Kaplan–Meier methods. Logistic regression was used to identify PRH risk factors. RESULTS: From 2000 to 2016, 107 patients with a total of 548 solid MBM received SRS. Median patient age at time of SRS was 63.2 years. Median MBM volume was 2.8 cm3 (range 0.01–21.3 cm3). MBM were in the cortex (n = 431), cerebellum (n= 85), basal ganglia (n= 23), and brain stem (n= 9). MBM were treated to a median dose of 20 Gy (range 14–20 Gy). Seventeen patients received immunotherapy (IT) within 1 year of SRS, 7 patients received concurrent immunotherapy (XR-IT). Median follow-up and OS was 13.5 months and 10.8 months, respectively. Median BFS was 8.3 months. PRH occurred in 123 MBM (22%). MBM volume (p= 0.0001), total MBM volume (p= 0.0006), IT (p= 0.04), and XR-IT (p= 0.03) were associated with increased PRH. PRH cumulative incidence within 24 mo of SRS was increased in MBM > 2.8 cm3 compared with patients with smaller MBM: 27.5% verse 5.3%, respectively. Age, sex, hypertension, MBM location, total MBM number, and marginal dose (p > 0.05) did not significantly impact risk of PRH. No significant difference in 6, 12, or 24 mo actuarial OS rates were observed in patients with PRH (p > 0.05). CONCLUSIONS: Patients with larger MBM volume and IT within 1 year of SRS have the greatest risk of PRH. PRH did not significantly impact OS in this study.

scholarly journals RADT-04. RESECTION CAVITY FAILURE OF MELANOMA BRAIN METASTASES WHEN TREATED WITH SYSTEMIC THERAPY, WITH OR WITHOUT FOCAL RADIOTHERAPY

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii182-ii182
Author(s):  
Matthew S Susko ◽  
Harish N Vasudevan ◽  
Lijun Ma ◽  
Jean Nakamura ◽  
David Raleigh ◽  
...  
Keyword(s):  
Brain Metastases ◽  
Systemic Therapy ◽  
Progression Free Survival ◽  
Free Survival ◽  
Mek Inhibitors ◽  
Resection Cavity ◽  
Kaplan Meier ◽  
Time Period ◽  
Melanoma Brain Metastases

Abstract OBJECTIVES Brain metastases are a common sequelae of advanced melanoma, and can lead to significant morbidity and mortality. Systemic therapy, inclusive of BRAF/MEK inhibitors and immunotherapy, are increasingly being utilized for metastatic melanoma brain metastases. This study sought to evaluate the clinical outcomes of resected melanoma brain metastases treated with systemic therapy, with or without focal radiotherapy. METHODS Patients at a single institution who underwent resection of a melanoma brain metastasis were retrospectively identified and reviewed. Patients were required to have received immunotherapy or BRAF/MEK inhibitors in the 3-month perioperative time period. This cohort was then analyzed by receipt of focal radiotherapy, including SRS and brachytherapy, for resection cavity failure, distant CNS progression, and adverse radiation effect, using the Kaplan Meier method. RESULTS From 2011-2020, 43 resections for melanoma brain metastases were performed, of which 29 patients and 37 resection cavities met criteria for analysis. Median MRI follow up was 15 months (IQR: 6-38). Twenty-two (59%) lesions were treated with focal radiotherapy and systemic therapy, and 15 (41%) were treated with systemic therapy alone. 12-month freedom from local recurrence was 64.8% (95% CI: 42.1-99.8%) for systemic therapy alone, and 93.3% (95% CI: 81.5-100%) for focal radiotherapy with systemic therapy (p=0.01). 12-month CNS progression free survival was 35.7% (95% CI: 17.7-72.1%) for systemic therapy alone, and 31.8% (95% CI: 17.3-58.7%) for focal radiotherapy (p=0.51). UVA demonstrated focal radiotherapy (HR: 0.10; 95% CI: 0.01-0.85; p=0.04) was the only significant factor associated with reduction of risk for surgical cavity recurrence. CONCLUSIONS Use of focal radiotherapy with systemic therapy for resected melanoma brain metastases significantly reduced surgical cavity recurrence compared to systemic therapy alone. Focal radiotherapy did not delay initiation of systemic therapy and should be the preferred treatment option for optimal local control of the surgical cavity in melanoma brain metastases.

Abstract MP7: Multicenter Study of Intracranial Hemorrhage and Death Risk and Predictors in the Untreated Course of Brain Arteriovenous Malformation Patients

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Helen Kim ◽  
Jeffrey Nelson ◽  
Charles McCulloch ◽  
Steven Hetts ◽  
Christopher Hess ◽  
...  
Keyword(s):  
Risk Factors ◽  
Arteriovenous Malformation ◽  
Intracranial Hemorrhage ◽  
Cox Regression ◽  
Current Model ◽  
Venous Drainage ◽  
Age At Diagnosis ◽  
Imaging Data ◽  
Brain Arteriovenous Malformation

Background: Accurate and reliable models of intracranial hemorrhage (ICH) risk in the untreated course of brain arteriovenous malformation (BAVM) patients are needed to help weigh the risk-benefit of treatment. We present preliminary estimates of rates and risk factors for ICH or death in the Multicenter AVM Research Study (MARS), which is the largest individual patient data meta-analysis (IPDMA) of cohort studies of unruptured BAVM. Methods: Longitudinal data from 9 cohorts comprising 2,839 unruptured BAVM at time of diagnosis were included: UCSF (n=557), Macquarie (n=462), Kaiser Permanente Northern California (n=354), Columbia (n=335), Barrow Neurological Institute (n=324), Tiantan Hospital (n=303), Mayo Clinic-Rochester (n=244), Scottish Intracranial Vascular Malformation Study (n=194), and Toronto Western Hospital (n=66). Clinical and angiographic data were collected using standardized definitions across cohorts. Cox proportional hazards analysis of time-to-event (ICH or death) in the untreated course after diagnosis was performed, censoring at first treatment or last visit. Baseline hazard rates were stratified by cohort to account for different rates and follow-up times. Results: The combined cohort was 49% female, 72% white race, and 17% Hispanic ethnicity; mean age at diagnosis was 37±17 years and mean follow-up was 3.4±7.0 years. The most common presenting symptom was seizures (43%). Mean AVM size was 3.5±1.9 cm and 46% were Spetzler-Martin grade I-II. Overall, 123 ICH and 131 deaths occurred over 9,608 person-years (PY) for an event rate of 2.64 per 100 PY [95% CI: 2.34-2.99]. Cox regression analyses adjusting for age at diagnosis (HR=1.67 [1.54, 1.82], P<0.001) identified cerebellar location (HR=1.73 [1.03-2.93], P=0.040) and exclusively deep venous drainage (HR=1.83 [1.09-3.09], P=0.022) as predictors. Conclusion: Our current model identified increasing age, exclusively deep venous drainage, and cerebellar location as risk factors for ICH or death in the untreated course of unruptured bAVM patients. Review of imaging data, multiple imputation of missing angioarchitectural data, and additional data from pending cohorts will provide greater power to search for additional risk factors in this ongoing IPDMA.

scholarly journals Evaluation of the Use of CT Attenuation for the Prediction of Subsequent Vertebral Fracture in Patients with Osteoporosis

2021 ◽  
pp. E493-E500
Keyword(s):  
Risk Factors ◽  
Computed Tomography ◽  
Back Pain ◽  
Vertebral Fracture ◽  
Roc Curve ◽  
Vertebral Augmentation ◽  
Hounsfield Units ◽  
Free Survival ◽  
Kaplan Meier

BACKGROUND: Subsequent vertebral fracture (SVF) is one of the most common complications of percutaneous vertebral augmentation (PVA), which leads to lower back pain in patients. Low bone mineral density (BMD) is an independent risk factor for SVF. BMD measured using computed tomography (CT) trabecular attenuation correlates closely with BMD. OBJECTIVES: This study aims to analyze the risk factors of SVF after PVA and to estimate the predictive role of CT trabecular attenuation. STUDY DESIGN: A retrospective review. SETTING: Department of spinal surgery in an affiliated hospital of a medical university. METHODS: A total of 515 patients were retrospectively enrolled between January 2015 and December 2019 into a 5-year follow-up investigation. Trabecular attenuation (Hounsfield units [HU]) was retrospectively measured at L1 on preoperative lumbar or thoracic CT scans, and the receiver operating characteristic (ROC) curve was used to evaluate its value for the prediction of SVF. Kaplan–Meier analysis and Cox proportional hazards regression were performed to identify the risk factors for SVF. RESULTS: A total of 166 patients (32.2%) experienced SVF. ROC curve analysis demonstrated that an L1 trabecular attenuation of <= 95 HU has a sensitivity of 70.5% and a specificity of 79.9% for the prediction of SVF. Kaplan–Meier analysis showed that L1 trabecular attenuation <= 95 HU was significantly associated with lower SVF-free survival (P = 0.001; log-rank test). Multivariate analysis demonstrated that advanced age (hazard ratio [HR] = 1.03, P = 0.022), low body mass index (HR = 0.83, P = 0.001), diabetes status (HR = 1.50, P = 0.024), antiosteoporosis drugs use (HR = 0.65, P = 0.031), and decreased L1 trabecular attenuation (HR = 0.95, P = 0.001) were risk factors for SVF. LIMITATIONS: A single-center retrospective study of a consecutive cohort of patients may include the inevitable bias. We periodically reviewed the full-length x-ray of the spine at every 3 months of follow-up visit, which we may miss some patients with SVF without low back pain. CONCLUSIONS: SVF is highly prevalent in patients with osteoporotic vertebral fracture who undergo single-level PVA. Low L1 trabecular attenuation is associated with a significant reduction in SVF-free survival, and when their L1 trabecular attenuation is <= 95 HU, patients may be at higher risk of SVF. KEY WORDS: Computed tomography, Hounsfield units, vertebral fracture, osteoporosis, percutaneous vertebral augmentation

scholarly journals Predictive factors of relapse after dose reduction of oral 5-aminosalicylic acid in patients with ulcerative colitis in the remission phase

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0255620
Author(s):  
Akira Madarame ◽  
Masakatsu Fukuzawa ◽  
Yoshiya Yamauchi ◽  
Shin Kono ◽  
Akihiko Sugimoto ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ulcerative Colitis ◽  
Dose Reduction ◽  
Clinical Relapse ◽  
Aminosalicylic Acid ◽  
Relapse Free Survival ◽  
Free Survival ◽  
Kaplan Meier ◽  
Significant Difference ◽  
History Of

Objectives Useful indices to determine whether to reduce the dose of 5-aminosalicylic acid (5-ASA) in patients with ulcerative colitis (UC) during remission remain unclear. We aimed to analyze the rate and risk factors of relapse after reducing the dose of oral 5-ASA used for maintenance therapy of UC. Methods UC patients whose 5-ASA dose was reduced in clinical remission (partial Mayo score of ≤ 1) at our institution from 2012 to 2017 were analyzed. Various clinical variables of patients who relapsed after reducing the dose of oral 5-ASA were compared with those of patients who maintained remission. Risk factors for relapse were assessed by univariate and multivariate logistic regression analyses. Cumulative relapse-free survival rates were calculated using the Kaplan–Meier method. Results A total of 70 UC patients were included; 52 (74.3%) patients maintained remission and 18 (25.7%) patients relapsed during the follow-up period. Multivariate analysis indicated that a history of acute severe UC (ASUC) was an independent predictive factor for clinical relapse (p = 0.024, odds ratio: 21, 95% confidence interval: 1.50–293.2). Based on Kaplan–Meier survival analysis, the cumulative relapse-free survival rate within 52 weeks was 22.2% for patients with a history of ASUC, compared with 82.0% for those without. the log-rank test showed a significant difference in a history of ASUC (p < 0.001). Conclusions Dose reduction of 5-ASA should be performed carefully in patients who have a history of ASUC.

scholarly journals Mycophenolate mofetil for methotrexate-resistant juvenile localized scleroderma

Rheumatology ◽  
2020 ◽  
Author(s):  
Giorgia Martini ◽  
Laura Saggioro ◽  
Roberta Culpo ◽  
Fabio Vittadello ◽  
Alessandra Meneghel ◽  
...  
Keyword(s):  
Assessment Tool ◽  
Inactive Disease ◽  
Rank Test ◽  
Localized Scleroderma ◽  
Relapse Free Survival ◽  
Free Survival ◽  
Kaplan Meier ◽  
Significant Difference ◽  
Juvenile Localized Scleroderma

Abstract Objectives To investigate safety and efficacy of MMF in patients with severe or MTX-refractory juvenile localized scleroderma. Methods Consecutive juvenile localized scleroderma patients undergoing systemic treatment were included in a retrospective longitudinal study. Patients treated with MMF because they were refractory or intolerant to MTX (MMF-group) were compared with responders to MTX (MTX-group). Disease activity was assessed by Localized Scleroderma Cutaneous Assessment Tool and thermography. Disease course was established on the number of relapses and treatment changes. Relapse-free survival was examined by Kaplan–Meier analysis. Results MMF and MTX groups included 22 and 47 patients, respectively. No significant difference in demographics, follow-up duration and treatment before diagnosis was observed between groups. The most represented clinical subtypes in the MMF-group were pansclerotic morphea and mixed subtype (P = 0.008 and P = 0.029, respectively), and linear scleroderma of the face in the MTX-group (P = 0.048). MMF was started because of MTX resistance (18 patients), relapse during MTX tapering/withdrawal (3 patients) and anaphylaxis to MTX (1 patient). After mean 9.4 years of follow-up, 90.9% of patients on MMF and 100% of those on MTX had inactive disease. No significant difference in relapse-free survival between the groups was found (P = 0.066, log-rank test), although MMF likely induced more persistent remission. MMF was well tolerated and combination of MMF and MTX did not increase its efficacy. Conclusion The present study adds strong evidence on the efficacy and tolerance of MMF in severe and/or MTX-refractory juvenile localized scleroderma. Further controlled studies are needed to prove its efficacy as first line treatment.

Anatomical Predictors of Flared Limb Complications in Endovascular Aneurysm Repair

2019 ◽  
Vol 26 (4) ◽  
pp. 550-555 ◽  
Author(s):  
Rodolfo Pini ◽  
Gianluca Faggioli ◽  
Giuseppe Indelicato ◽  
Enrico Gallitto ◽  
Chiara Mascoli ◽  
...  
Keyword(s):  
Risk Factors ◽  
Regression Analysis ◽  
Stent Graft ◽  
Endovascular Aneurysm Repair ◽  
Aortic Aneurysms ◽  
Complication Rates ◽  
Free Survival ◽  
Kaplan Meier ◽  
Aneurysm Repair

Purpose: To evaluate possible predictors of complications with flared iliac stent-graft limbs for ectatic common iliac arteries (CIAs) associated with abdominal aortic aneurysms treated with endovascular aneurysm repair (EVAR). Materials and Methods: A retrospective comparative analysis was conducted of 533 EVAR patients (mean age 75 years; 442 men) treated between 2012 and 2017 who had complications associated with the stent-graft limbs (n=1066). Complications, including type Ib endoleak, type IIIa endoleak, and limb occlusion, were compared between patients with nondilated (<16 mm) CIAs treated with standard iliac limbs (SLs, n=808) vs patients with ectatic CIAs treated with flared limbs (FLs, n=258). Follow-up included a duplex scan at 3, 6, and 12 months and yearly thereafter; computed tomography angiography was performed in case of iliac complications. Risk factors for iliac complications in FLs were investigated using Cox regression and Kaplan-Meier analyses; results of the regression analysis are presented as the hazard ratio (HR) and 95% confidence interval (CI). Results: Overall, no iliac complications occurred at 30 days, but over a mean follow-up of 38±8 months, there were 10 (1%) events (4 limb occlusions, 6 type Ib endoleaks): 7 (3%) in FLs and 3 (0.4%) in SLs (p=0.20). Kaplan-Meier analysis found no differences at 5 years in SLs vs FLs for freedom from limb occlusion (99%±1% vs 98%±1%, respectively; p=0.30) or type Ib endoleak (96%±3% vs 97%±1%, respectively; p=0.44). Similarly, the overall 5-year iliac complication rates were similar in SLs vs FLs (96%±3% vs 95%±2%, p=0.21). Regression analysis found CIA length ≤30 mm (HR 4.7, 95% CI 1.02 to 21.6, p=0.04) and a diameter ≥20 mm (HR 7.8, 95% CI 1.05 to 64.8, p=0.03) to be independent predictors of iliac complications in FLs. Kaplan-Meier estimates of iliac complication–free survival in FLs were significantly worse when the CIA length was ≤30 mm (79%±9% vs 98%±1%, p=0.003) or the diameter was ≥20 mm (85%±7% vs 99%±1%, p=0.02). The combination of both risk factors produced significantly poorer iliac complication–free survival compared with cases in which there was one or no risk factor (67%±19% vs 96%±2% vs 99%±1%, respectively; p<0.001). Conclusion: Iliac limb complications are infrequent in EVAR, regardless of the type of iliac limb chosen; however, CIAs ≤30 mm in length or ≥20 mm in diameter significantly increased the risk of late iliac complications in FLs. If both characteristics were present, this risk was further elevated.

scholarly journals P135 Proximal Extension of lower rectal Ulcerative Proctitis

2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S223-S223
Author(s):  
T Yokoo ◽  
S Yoshikawa ◽  
T Masuda ◽  
S Terauchi ◽  
H Uchida ◽  
...  
Keyword(s):  
Lower Rectum ◽  
Free Survival ◽  
Exact Test ◽  
Ulcerative Proctitis ◽  
Kaplan Meier ◽  
Significant Difference ◽  
Proximal Extension ◽  
One Year ◽  
Disease Location

Abstract Background Previous studies have shown proximal extension (PE) rate of ulcerative proctitis (UP) is approximately 50%. This rate teach us the importance of treating UP adequately. Basically, we have to treat them with topical 5-ASA. But in clinical practice, we sometimes experience the case whose inflammation remain endoscopically, even though the symptoms have been relieved. Should we strengthen our treatment at this situation, especially inflammation at lower rectum? We aimed to know PE rate of lower rectal UP and optimize the treatment. Methods We retrospectively investigated the medical charts of patients with UP from 2010 to 2020 at Kenseikai Nara Coloproctology Center. We excluded the patients with UP shrinking from left-sided or pancolitis as a result of the treatment. The cases with missing value were excluded too. Variables of interest included gender, onset age, disease location, initial mayo endoscopic subscore (MES) and treatment, and the time to PE. To compare the cohorts we used Fisher’s exact test and Mann-Whitney test. Proximal extension free survival (PEFS) was calculated using the Kaplan-Meier method. Results Sixty-five patients were recruited. Mean age was 42 years old, the ratio of males to females was 1.17. The number of lower rectal UP patients at first examination was 24. We observed MES 1 inflammation for 30 patients, and MES 2 for 35. Median follow-up duration was 73.5 months. PE occurred in 34 patients: 28 patients had left-sided colitis and 6 had pancolitis. Fifty-four patients were medicated and other 11 patients were just observed. Among the patients medicated, 23 patients were took only topical drugs, 18 were took only oral drugs and other 13 were took both. We couldn’t find any relationships between initial medication and PE rate. The multivariate analysis revealed that having peri-appendiceal red patch and lower rectal UP were reduce the risk of PE. MES was not related to PE (table 1). PEFS at 1 year, 2 year are 81%, 81% for lower rectal UP (Rb group), and 66%, 61% for the patients having the disease beyond middle Houston’s valve (Not-Rb group), though we couldn’t find significant difference (Fig.1). Among 34 patients having PE, we used biologics for only five patients and got their inflammation under control. Conclusion Patients with lower rectal UP is less likely to extent their disease location. There’s no difference between the route of treatment and PE rate, but it’s important to carefully check PE within first one year.

HIV may indirectly accelerate coronary artery disease through enhancing the effects of conventional and non-conventional cardiovascular risk factors

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Kolossvary ◽  
E.K Fishman ◽  
G Gerstenblith ◽  
D.A Bluemke ◽  
R.N Mandler ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
Hiv Infection ◽  
Cardiovascular Risk Factors ◽  
Agatston Score ◽  
Funding Source ◽  
Significant Difference ◽  
Ascvd Risk ◽  
Artery Disease

Abstract Background/Introduction Cross-sectional studies are inconsistent on the potential independent adverse effects of human immunodeficiency virus (HIV)-infection on coronary artery disease (CAD). Furthermore, there is no information on the potential effects of HIV-infection on plaque volumes. Also, only the independent effects of HIV-infection on CAD have been investigated. Purpose In a prospective longitudinal observational cohort, we wished to assess whether HIV-infection accelerates CAD independently, or by acting in synergistic fashion with conventional and nonconventional cardiovascular risk factors to accelerate disease progression as assessed by clinical and volumetric parameters of CAD on coronary CT angiography (CCTA). Methods Overall, 300 asymptomatic individuals without cardiovascular symptoms but with CCTA-confirmed coronary plaques (210 males, age: 48.0±7.2 years) with or without HIV (226 HIV-infected) prospectively underwent CCTA at two time points (mean follow-up: 4.0±2.3 years). Agatston-score, number of coronary plaques, segment stenosis score were calculated, and we also segmented the coronary plaques to enumerate total, noncalcified (−100–350HU) and calcified (≥351HU) plaque volumes. Linear mixed models were used to assess the effects of HIV-infection, atherosclerotic cardiovascular disease (ASCVD) risk, years of cocaine use and high-sensitivity C-reactive protein on CCTA markers of CAD. Results In univariate analysis, there was no significant difference in CAD characteristics between HIV-infected and -uninfected, neither at baseline nor at follow-up (p&gt;0.05 for all). Furthermore, there was no significant difference in annual progression rates between the two groups (p&gt;0.05 for all). By multivariate analysis, HIV was not associated with any CAD parameter (p&gt;0.05 for all). However, among HIV-infected individuals, each year of cocaine use significantly increased all CAD parameters (p&lt;0.05 for all), while ASCVD risk score was significantly associated with CAD parameters except for Agatston-score (p&lt;0.05). These associations were only present among HIV-infected individuals. Conclusion(s) Instead of directly worsening CAD, HIV may promote CAD through increased susceptibility to conventional and nonconventional cardiovascular risk factors. Therefore, aggressive management of both conventional and nonconventional cardiovascular risk factors is needed to reduce cardiovascular burden of HIV-infection. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): National Institutes of Health, National Institute on Drug Abuse

The Efficacy of Etoposide-Based Therapy in Adult Secondary Hemophagocytic Lymphohistiocytosis

2021 ◽  
pp. 1-9
Author(s):  
Leonard Naymagon ◽  
Douglas Tremblay ◽  
John Mascarenhas
Keyword(s):  
Hemophagocytic Lymphohistiocytosis ◽  
Proportional Hazards ◽  
Multivariable Analysis ◽  
Cox Proportional Hazards ◽  
Rank Test ◽  
Kaplan Meier ◽  
Hazard Ratios ◽  
Significant Difference ◽  
The Impact

Data supporting the use of etoposide-based therapy in hemophagocytic lymphohistiocytosis (HLH) arise largely from pediatric studies. There is a lack of comparable data among adult patients with secondary HLH. We conducted a retrospective study to assess the impact of etoposide-based therapy on outcomes in adult secondary HLH. The primary outcome was overall survival. The log-rank test was used to compare Kaplan-Meier distributions of time-to-event outcomes. Multivariable Cox proportional hazards modeling was used to estimate adjusted hazard ratios (HRs) with 95% confidence intervals (CIs). Ninety adults with secondary HLH seen between January 1, 2009, and January 6, 2020, were included. Forty-two patients (47%) received etoposide-based therapy, while 48 (53%) received treatment only for their inciting proinflammatory condition. Thirty-three patients in the etoposide group (72%) and 32 in the no-etoposide group (67%) died during follow-up. Median survival in the etoposide and no-etoposide groups was 1.04 and 1.39 months, respectively. There was no significant difference in survival between the etoposide and no-etoposide groups (log-rank <i>p</i> = 0.4146). On multivariable analysis, there was no association between treatment with etoposide and survival (HR for death with etoposide = 1.067, 95% CI: 0.633–1.799, <i>p</i> = 0.8084). Use of etoposide-based therapy was not associated with improvement in outcomes in this large cohort of adult secondary HLH patients.

scholarly journals Cetuximab versus bevacizumab following prior FOLFOXIRI and bevacizumab in postmenopausal women with advanced KRAS and BRAF wild-type colorectal cancer: a retrospective study

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Chunlong Huang ◽  
Xiaoyuan Gu ◽  
Xianshang Zeng ◽  
Baomin Chen ◽  
Weiguang Yu ◽  
...  
Keyword(s):  
Postmenopausal Women ◽  
Survival Benefit ◽  
Progression Free Survival ◽  
Wild Type ◽  
Free Survival ◽  
Primary Endpoints ◽  
Significant Difference ◽  
Inductive Treatment ◽  
Advanced Colorectal Carcinoma

Abstract Background An upgraded understanding of factors (sex/estrogen) associated with survival benefit in advanced colorectal carcinoma (CRC) could improve personalised management and provide innovative insights into anti-tumour mechanisms. The aim of this study was to assess the efficacy and safety of cetuximab (CET) versus bevacizumab (BEV) following prior 12 cycles of fluorouracil, leucovorin, oxaliplatin, and irinotecan (FOLFOXIRI) plus BEV in postmenopausal women with advanced KRAS and BRAF wild-type (wt) CRC. Methods Prospectively maintained databases were reviewed from 2013 to 2017 to assess postmenopausal women with advanced KRAS and BRAF wt CRC who received up to 12 cycles of FOLFOXIRI plus BEV inductive treatment, followed by CET or BEV maintenance treatment. The primary endpoints were overall survival (OS), progression-free survival (PFS), response rate. The secondary endpoint was the rate of adverse events (AEs). Results At a median follow-up of 27.0 months (IQR 25.1–29.2), significant difference was detected in median OS (17.7 months [95% confidence interval [CI], 16.2–18.6] for CET vs. 11.7 months [95% CI, 10.4–12.8] for BEV; hazard ratio [HR], 0.63; 95% CI, 0.44–0.89; p=0.007); Median PFS was 10.7 months (95% CI, 9.8–11.3) for CET vs. 8.4 months (95% CI, 7.2–9.6) for BEV (HR, 0.67; 95% CI 0.47–0.94; p=0.02). Dose reduction due to intolerable AEs occurred in 29 cases (24 [24.0%] for CET vs. 5 [4.8%] for BEV; p< 0.001). Conclusions CET tends to be superior survival benefit when compared with BEV, with tolerated AEs.

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