scholarly journals Successful concurrent chemoradiotherapy with cisplatin plus etoposide after incomplete resection for advanced thymic carcinoma

2019 ◽  
Vol 2019 (8) ◽  
Author(s):  
Ling Han ◽  
Baozhu Zhang ◽  
Shihai Wu
Keyword(s):  
Multidisciplinary Approach ◽  
Concurrent Chemoradiotherapy ◽  
Thymic Carcinoma ◽  
Complete Response ◽  
R0 Resection ◽  
Incomplete Resection ◽  
First Line ◽  
Disease Free ◽  
Incomplete Surgery ◽  
First Line Treatment

Abstract The optimal therapy for advanced thymic carcinoma has long been controversial. Despite that complete (R0) resection is recommend as the first-line treatment, multidisciplinary approach including chemotherapy and radiotherapy should be considered for patients who lost the operation chance or received incomplete resection. Here, we present a case who received concurrent chemoradiotherapy (CCRT) after cytoreductive surgery. A complete response was observed and the patient has remained disease free for over 4 years. To our knowledge, this is the first report to demonstrate the efficacy of CCRT with cisplatin plus etoposide after incomplete surgery for advanced thymic carcinoma.

scholarly journals Prognostic benefit of conversion surgery for HER2 positive stage IV gastric cancer; a case series study of eleven patients treated with trastuzumab-based chemotherapy

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Koichi Hayano ◽  
Hiroki Watanabe ◽  
Takahiro Ryuzaki ◽  
Naoto Sawada ◽  
Gaku Ohira ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Cancer Patients ◽  
Stage Iv ◽  
R0 Resection ◽  
Conversion Surgery ◽  
First Line ◽  
Her2 Positive ◽  
Stage Iv Gastric Cancer ◽  
Gastric Cancer Patients ◽  
First Line Treatment

Abstract Background Since the ToGA trial, trastuzumab-based chemotherapy is the standard treatment for HER2 positive stage IV gastric cancer. However, it is not yet clear whether surgical resection after trastuzumab-based chemotherapy (conversion surgery) can improve survival of HER2 positive stage IV gastric cancer. The purpose of this study is to evaluate the prognostic benefit of conversion surgery in HER2 positive stage IV gastric cancer patients. Case presentation We retrospectively investigated the medical records of the patients with HER2 positive (IHC3(+) or IHC2(+)/FISH(+)) stage IV gastric cancer treated with trastuzumab-based chemotherapy as the first line treatment. Overall survival (OS) was compared between patients with conversion surgery and without. Eleven HER2 positive stage IV gastric cancer patients treated with trastuzumab-based chemotherapy as the first line treatment were evaluated. Response rate was 63.6%, and 6 of 11 patients could receive conversion surgery. R0 resection was achieved in four patients. In Kaplan–Meier analysis, patients who received conversion surgery showed significantly better OS than those without surgery (3-year survival rate, 66.7% vs. 20%, P = 0.03). The median OS of patients who achieved R0 resection is 51.8 months. Conclusions Conversion surgery might have a survival benefit for HER2 positive stage IV gastric cancer patients. If curative surgery is technically possible, conversion surgery could be a treatment option for HER2 positive stage IV gastric cancer.

Predictive value of systematic inflammatory response biomarkers (NLR, LMR, PLR) in patients with ovarian cancer.

2017 ◽  
Vol 53 (3) ◽  
pp. 139-146
Author(s):  
Urszula Rychlik ◽  
Ewa Wójcik ◽  
Jadwiga Tarapacz ◽  
Katarzyna Brandys ◽  
Zofia Stasik ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Complete Response ◽  
Response To Treatment ◽  
Line Treatment ◽  
First Line ◽  
Lymphocyte Ratio ◽  
Lymphocyte To Monocyte Ratio ◽  
Progression Of Disease ◽  
First Line Treatment

Introduction: The aim of the study was to assess the prognostic value of indicators calculated on the basis of initial hematology test results of neutrophil, lymphocyte, monocyte and platelet counts (NLR – neutrophil-to-lymphocyte ratio, LMR – lymphocyte-to-monocyte ratio, PLR – platelet-to-lymphocyte ratio) in patients with ovarian cancer and their compliance with the overall response to treatment. Materials and methods: Hematological tests were performed before first course of first-line chemotherapy in 145 patients with ovarian cancer. Response to treatment was assessed according to the RECIST1.1 criteria in all patients. Results: After the completion of first-line treatment, 70 (48.3%) patients had a complete response (CR) to the therapy. In this group, progression of disease occurred in 22 (31.4%) patients during 12 months of follow-up. In the CR group with progression, 17 (77.2%) presented high NLR and PLR levels. Among 48 (68.6%) patients with CR without progression after 12 months of follow-up, high levels of NLR and PLR were observed in 21 (43.8%) and 17 (35.4%) of them, respectively. Low LMRs were observed in 16 (72.7%) patients with progression and 16 (33.3%) without progression. Conclusion: High levels of NLR and PLR and low levels of LMR before treatment seems to predict 12-month disease progression in patients with complete response to first-line treatment.

scholarly journals Successful Use of a Multidisciplinary Approach to Treat a Perforated Duodenal Malignant Lymphoma in an Elderly Patient

2018 ◽  
Vol 2018 ◽  
pp. 1-6
Author(s):  
Tomoko Takagishi ◽  
Yuta Niimi ◽  
Goshi Matsuki ◽  
Shinta Nagano ◽  
Junsuke Hinami ◽  
...  
Keyword(s):  
Malignant Lymphoma ◽  
Multidisciplinary Approach ◽  
B Cell Lymphoma ◽  
Complete Response ◽  
Duodenal Wall ◽  
Abdominal Ct ◽  
Pet Ct ◽  
Life Threatening ◽  
Consolidation Radiotherapy ◽  
Disease Free

Treatment of duodenal malignant lymphoma is difficult due to life-threatening complications such as intestinal obstruction, perforation, and pancreatitis. Thus, multidisciplinary procedures are required alongside surgical intervention. Contrast abdominal CT images of a 75-year-old female suffering from vomiting revealed thickening of the duodenal wall (from the second to third segment). Gastrojejunostomy and biopsy identified the tumor as diffuse large B-cell lymphoma. A diagnosis of stage II duodenal lymphoma was made. The lymphoma continued to grow, resulting in jaundice and intestinal perforation, which was first treated with two cycles of rituximab and antibiotics. Thereafter, less intensive chemotherapy (two cycles each of R-mini-CHP, CHP, and R-CHOP) was administered, which led to significant improvement upon assessment by PET-CT. Residual lymphoma was treated with consolidation radiotherapy (50 Gy in 25 fractions) over 5 weeks after chemotherapy. The patient attained a complete response and has been disease-free for more than 4 years. Thus, duodenal perforated lymphoma can be treated successfully using a multidisciplinary approach that combines surgery, immunochemotherapy, and radiation therapy.

Indirect Comparison of the Efficacy of Melphalan-Prednisone-Bortezomib Relative to Melphalan-Prednisone-Thalidomide and Melphalan-Prednisone for the First Line Treatment of Multiple Myeloma

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 2367-2367
Author(s):  
Yating Yeh ◽  
James Chambers ◽  
Sabine Gaugris ◽  
Jeroen Jansen
Keyword(s):  
Multiple Myeloma ◽  
Meta Analysis ◽  
Indirect Comparison ◽  
Complete Response ◽  
Similar Efficacy ◽  
Line Treatment ◽  
Relative Efficacy ◽  
First Line ◽  
Overall Response ◽  
First Line Treatment

Abstract Melphalan-prednisone (MP) combination has been considered a standard of care for front line treatment of multiple myeloma in patients non eligible for transplant. Melphalan-prednisone-bortezomib (MPV) combination has been approved in the United States in patients non eligible for high-dose chemotherapy (HD-C) and has recently received a positive opinion from the CHMP in Europe. Melphalan-prednisone-thalidomide (MPT) was approved in Europe in patients >65 or not eligible for HD-C. There is no head-to-head trial directly comparing MPV to MPT. The objective of the current study was to compare the efficacy of MPV to MP and MPT as first line treatment of multiple myeloma in patients non eligible for transplant. Six randomized placebo controlled trials investigating the efficacy of MPT (5) and MPV (1) relative to MP were identified with a systematic literature review. The endpoints of interest were overall survival (OS), progression free survival (PFS) and overall and complete response. Relative efficacy estimates of MPT versus MP as obtained from the MPT-MP trials were combined with meta-analysis techniques and simultaneously indirectly compared with the relative efficacy of MPV versus MP from the MPV-MP trial (VISTA). This adjusted indirect comparison was performed with Bayesian fixed and random effects models. As compared to frequentist approach, Bayesian meta-analysis offers a more informative summary of the likely value of efficacy after observing the data and allows for direct probabilistic inferences. Of the three interventions compared, there was an 81% probability that MPV was the most efficacious intervention in terms of overall response and a >99% probability in terms of complete response. With MPV a patient was two times more likely to show a complete response than with MPT (Relative Risk=2.15; 95%Credible Interval (CrI): 0.99–4.45). Both MPV and MPT showed greater OS than MP (HR=0.61; 95%CrI: 0.42–0.88 and HR=0.61; 95%CrI: 0.47–0.78 respectively); the indirect comparison showed similar efficacy in terms of OS between MPV and MPT (MPV vs MPT: Hazard Ratio=1.00; 95%CrI 0.64–1.57). Both MPV and MPT also displayed greater PFS than MP (MPV versus MP: HR=0.61; 95%CrI 0.49–0.76 and MPT versus MP HR=0.51; 95%CrI 0.41–0.63 respectively) and showed similar efficacy (MPV vs MPT: HR=1.19; 95%CrI: 0.87–1.63). In this study, both MPV and MPT are more efficacious than MP in terms of response, PFS and OS. MPV is expected to result in a greater complete and overall response than MPT. No difference in OS or PFS was displayed. Further analyses will need to be undertaken once evidence base data is more mature.

Subanalysis of the StiL NHL 1–2003 Study: Achievement of Complete Response with Bendamustine-Rituximab (B-R) and CHOP-R in the First-Line Treatment of Indolent and Mantle Cell Lymphomas Results in Superior Survival Compared to Partial Response.

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 2724-2724 ◽  
Author(s):  
Mathias J. Rummel ◽  
Norbert Niederle ◽  
Georg Maschmeyer ◽  
G.-Andre Banat ◽  
Ulrich von Grünhagen ◽  
...  
Keyword(s):  
Complete Response ◽  
Line Treatment ◽  
First Line ◽  
Female Patients ◽  
Significant Difference ◽  
Mantle Cell ◽  
Male Patients ◽  
The Impact ◽  
First Line Treatment

Abstract Abstract 2724 Background: The NHL 1 study, a prospective, multicenter, randomized, phase 3 study which compared B-R and CHOP-R as first-line treatment in indolent lymphomas and mantle cell lymphoma (MCL), demonstrated a significant benefit in progression-free survival (PFS) as well as improved tolerability for B-R compared with CHOP-R. Here we present an analysis of the impact of response quality on outcome. Methods: 514 patients (pts) with indolent or MCL were randomized to receive B-R or CHOP-R for a maximum of 6 cycles. Results: The overall response rate in the 514 pts (261 B-R; 253 CHOP-R) was 92.7% and 91.3% in the B-R and CHOP-R arms, respectively (as presented at the last ASCO meeting, J Clin Oncol 30, 2012 (suppl; abstr 3). A complete response (CR) was observed in 39.8% in the B-R arm and in 30% in the CHOP-R arm (p=0.021). The achievement of CR was associated with a significantly prolonged PFS and overall survival (OS) (Table 1). Analysis by treatment arm revealed a trend for superior PFS and a significantly improved OS for patients achieving CR following treatment with B-R. In the CHOP-R arm, patients in CR had a significantly superior PFS compared to those in PR with a trend to superior OS. Regardless of the quality of response, PFS was superior with B-R versus CHOP-R: For patients in CR, the median PFS was not reached with B-R, whereas for CHOP-R it was 53.7 months (p=0.0204). In patients achieving PR, treatment with B-R resulted in a median PFS of 57.2 months, and this was 30.9 months with CHOP-R (p=0.0002). We noted a statistically significant difference in CR rates between male (n=272, median age 63 years) and female (n=242, median age 64 years) patients. The CR rate was 28.6% in male patients and 42.1% in female patients (p=0.0016). Female patients had a longer median PFS (51.4 months) compared to male patients (38.6 months), however, this difference was not statistically significant (p=0.0866). Conclusions: Patients in CR following first-line treatment in our study had a significantly longer PFS and OS compared to those achieving a PR. Therefore, our results strongly suggest an association between quality of response and outcome. Disclosures: No relevant conflicts of interest to declare.

Gemcitabine in metastatic breast cancer

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 10735-10735 ◽  
Author(s):  
A. Bensalem ◽  
K. Bouzid
Keyword(s):  
Breast Cancer ◽  
Metastatic Breast Cancer ◽  
Clinical Benefit ◽  
Objective Response ◽  
Metastatic Breast ◽  
Complete Response ◽  
Hematologic Toxicity ◽  
Line Treatment ◽  
First Line ◽  
First Line Treatment

10735 Background: Gemcitabine (GEM) has shown efficacy in metastatic breast cancer (MBC). We conducted studies with GEM-based regimens to assess the efficacy and toxicity of GEM combined with other drugs in MBC. GEM was combined with docetaxel (DXL) in pre-treated MBC with an anthracycline-based regimen and GEM was combined with doxorubicin (DXR) in chemonaive patients (pts) with MBC. The studies’ objectives were to show clinically relevant hematologic toxicity and response rates among pts treated with GEM-DXL either in combination in pre-treated pts with anthracycline regimen or GEM-DXR in chemonaive pts with MBC to assess the efficacy of GEM in MBC either in neoadjuvant or first-line treatment. Methods: For GEM-DXL: 42 pts were enrolled; GEM: 1250 mg /m2 D1 & D8, DXL: 75 mg /m2 D1, every 21 days with classical premedication for DXL. For GEM-DXR: 51 pts were enrolled; GEM: 1250 mg /m2 D1 & D 8, DXR: 25 mg/m2 D1 & D8, every 21 days. Results: See table below. In the GEM-DXR group, surgery was performed in 30 pts, and 13 (43.2%) had histologically complete response. The median TTP in this group was 13.3 months (range, 2–53). Conclusions: GEM in MBC is very efficient and produced an interesting objective response and clinical benefit. This activity is consistent in either chemonaive pts or in pts with relapsing breast cancer. [Table: see text] No significant financial relationships to disclose.

Secondary resection in a general mCRC population with cetuximab-based first-line treatment: Interim analysis of the German noninterventional study ERBITAG.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e14532-e14532
Author(s):  
Ulf P Neumann ◽  
Thomas Goehler ◽  
Gernot Reich ◽  
Michael Schwerdtfeger ◽  
Patrick Stuebs ◽  
...  
Keyword(s):  
Interim Analysis ◽  
Response Rate ◽  
Performance Status ◽  
R0 Resection ◽  
Line Treatment ◽  
Resection Rate ◽  
First Line ◽  
Ecog Performance Status ◽  
Noninterventional Study ◽  
First Line Treatment

e14532 Background: Resection of liver and/or lung metastases (LM) are a potentially curative option for patients with mCRC. Cetuximab in combination with irinotecan- or oxaliplatin-based chemotherapy has shown to increase the resection rate of primarily unresectable LM in mCRC patients. After approval of cetuximab in Germany for first-line treatment of pts with unresectable mCRC, this noninterventional study was initiated to evaluate safety and efficacy of cetuximab in combination with various first-line chemotherapy regimens in patients with unresectable mCRC. Methods: We conducted an interim analysis of the first 124 fully documented pts to evaluate the response rate (RR) and resection rate of LM. Enrolment was restricted to pts with mCRC with proven KRAS wildtype mutation status without prior systemic treatment in the metastatic stage. Predefined endpoints were amongst others RR, LM resection rate, TTF, PFS, OS, and safety. Results: From May 2010 to May 2012 360 eligible pts were enrolled at 109 sites (75% office-based physicians), documentation for 124 was finalised (data cut-off for this analysis 03 May 2012) and evaluated. The median age was 68 [range 34-84] years, ECOG performance status was 0, 1, 2 in 29%, 60%, and 9% of pts, respectively, in 2% of pts ECOG performance status was missing. Resection rate was 18.5% (n=23) performed at 18 sites with 16.9% R0 resections (n=21). 42% of pts (n=52) had liver-limited disease (LLD). Resection rate in pts with LLD was 34.6% (n=18) with a 30.6% R0-resection rate (n=16). Median treatment duration from start of cetuximab-based therapy to resection of LM was 3.7 months [0.7-12.0]. Objective response rate was 46.8% (CR 4.8%, PR 41.9%) and 59.6% (CR 5.8%, PR 53.8%) for pts with LLD. Conclusions: In a clinical practice setting cetuximab-based first-line treatment of an unselected population with KRAS wildtype mCRC resulted in an R0-resection rate of 16.9% overall, and 30.6% for LLD pts. These data compare fairly well with data from clinical trials: CRYSTAL, OPUS, and CELIM.

BEATcc (ENGOT-Cx10/GEICO 68-C/GOG3030/JGOG1084): A randomized, open label, phase III study of cisplatin and paclitaxel chemotherapy with bevacizumab (CTx plus B) with or without atezolizumab (Atz) as first-line treatment for metastatic, persistent, or recurrent (m/r) carcinoma of the cervix (CCx).

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. TPS5594-TPS5594 ◽  
Author(s):  
Ana Oaknin ◽  
Laurence Gladieff ◽  
Nicoletta Colombo ◽  
Guillermo Villacampa ◽  
Mansoor Raza Mirza ◽  
...  
Keyword(s):  
Checkpoint Inhibitors ◽  
Unmet Need ◽  
Data Monitoring Committee ◽  
Local Therapy ◽  
Complete Response ◽  
Phase Iii ◽  
Line Treatment ◽  
First Line ◽  
Open Label ◽  
First Line Treatment

TPS5594 Background: The combination of CTx plus B is first line treatment for most patients (pts) with m/r CCx not amenable for local therapy based on GOG240 results. GOG240 regimen showed an improvement in overall survival (OS) compared to CTx alone: 16.8 vs. 13.3 months (HR 0.77, 95% CI 0.62–0.95, p = 0.007). However, further improvement in first line therapy outcomes is an unmet need. Immune-checkpoint inhibitors are breakthrough therapies in several tumor types, and their development in CCx is supported by a strong scientific rationale. Human papillomavirus infection (HPV) causes more than 90% of CCx cases. PD-L1 is a HPV biomarker and is found frequently up-regulated in CCx. Nivolumab and pembrolizumab (Pb) (anti-PD-1 antibodies) have shown response rates of 26.3% and 14.3%, respectively, in pretreated m/r CCx. This has led to the recent FDA approval of Pb in pretreated PD-L1+ m/r CCx. The BEATcc trial (NCT03556839) evaluates the addition of the anti-PD-L1 agent Atz to GOG240 regimen as first line treatment for m/r CCx, following the synergistic rationale between anti-VEGF agents and PD-1/PD-L1 blockade. Methods: Eligible pts: m/r CC with adequate organ function. Pts will be randomized 1:1 to either Arm A (control): C 50 mg/m2 + Tx 175mg/m2 + B 15 mg/kg (CTx plus B) i.v. D1 Q3W or Arm B (experimental): CTx plus B + Atz 1200 mg i.v. D1 Q3W. Stratification factors: prior chemo-radiation, histology and Chemotherapy backbone (CTx vs carboplatin-Tx). Treatment is planned until disease progression, unacceptable toxicity or withdrawal of consent. Pts with a complete response after ≥6 cycles or those with unacceptable CTx toxicity may be allowed to continue only on biologics therapy. An Independent Data Monitoring Committee will analyze the safety of the first 12 pts in the experimental arm completing 2 treatment cycles. The primary endpoint is OS. The study started enrolling in October 2018 and will enroll approximately 404 pts across Europe, Japan, and the US. Clinical trial information: NCT03556839.

First-line CyborD treatment for graft ineligible multiple myeloma patients: Real-life efficacy and tolerability.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e20516-e20516
Author(s):  
Dominic Duquette ◽  
Marie-Michelle Germain
Keyword(s):  
Multiple Myeloma ◽  
Elderly Population ◽  
Renal Toxicity ◽  
Real Life ◽  
Complete Response ◽  
High Rate ◽  
First Line ◽  
Grade 3 ◽  
First Line Treatment

e20516 Background: CyborD is a regimen that was widely adopted in Canada around 2010 despite very little data supporting it’s use. The aim of the study is to describe the efficacy and tolerability of First line CyborD regimen for graft ineligible myeloma patients. Methods: This is a retrospective study at two centres in the CHU de Québec for patients with graft ineligible multiple myeloma patients treated with first line CyborD regimen between 2013 and 2018. The objectives are to describe the efficacy and tolerability of CyborD and to document PFS and OS. Results: 51 patients were included in this study with a median follow-up of 31 months. Partial response or better (≥ PR) was obtain in 84% of patients and 63% of patients achieved a very good response or better (≥ VGPR). A high rate of 26% of complete response (CR) was also obtained. A median PFS of 30 months was obtained while 75% of patients were still alive at that time. Estimated survival at 48 months was 63%. Severe toxicities (grade 3 or 4) were seen as anemia (20%), neutropenia (10%), bacterial infection (16%), diarrhea (12%) and renal toxicity (4%). Side effects related to dexamethasone in this fragile patient population reached 69% of patients but only 28% needed a dose reduction. Conclusions: First-line CyborD treatment was highly effective for graft ineligible multiple myeloma patients and this is a very well tolerated regimen. It compares favorably to RD regimen making it still an excellent first-line treatment for this elderly population. [Table: see text]

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