P19 Mycophenolate mofetil in paediatric uveitis: an early experience

Rheumatology ◽  
2019 ◽  
Vol 58 (Supplement_4) ◽  
Author(s):  
Amany Tadrous ◽  
Kishore Warrier ◽  
Archana Pradeep ◽  
Nikki Camina ◽  
Satyapal Rangaraj
Keyword(s):  
Mycophenolate Mofetil ◽  
Conflicts Of Interest ◽  
Cystoid Macular Oedema ◽  
Favourable Result ◽  
Topical Steroids ◽  
Second Line ◽  
First Line ◽  
Small Cohort ◽  
Third Line ◽  
Paediatric Uveitis

Abstract Background Juvenile idiopathic arthritis (JIA) is the commonest cause of uveitis in children. Uveitis is a significant cause of visual impairment in children with potential complications such as band keratopathy, cataract, posterior synechiae, glaucoma, cystoid macular oedema and a retinal problems. Following the initial treatment with topical and systemic corticosteroids, a wide variety of immunosuppressant agents have been used in the treatment of non-infective uveitis including methotrexate (MTX) and biologic therapy, most of which are administered parenterally. Mycophenolate Mofetil (MMF) is an oral immunosuppressant that inhibits the proliferation of T and B lymphocytes, which has been tried in children with uveitis with mixed results. We started using MMF in children seen in our paediatric uveitis clinic initially as a third line agent when the inflammation is not well controlled despite therapeutic doses of MTX and Adalimumab, as the NHS England Clinical Commissioning Policy does not recommend the use of Infliximab in uveitis not associated with JIA. Buoyed by some favourable result, we have since then used MMF as second line and even first line agent in children with uveitis. Methods Retrospective analysis of the clinical profile of children with uveitis on MMF at a tertiary paediatric rheumatology centre with focus on response to treatment. Results Of the 8 patients who received MMF, six (75%) were girls. Half of them (4/8) had idiopathic uveitis and the rest, associated with JIA. 2/8 patients had MMF as third line agent on top of MTX and Adalimumab, while five of them had it as second line agent on top of Adalimumab due to either MTX intolerance or needle phobia. One patient was started on MMF as first line agent following topical steroids. 6 (75%) of the patients responded/stayed in remission following the addition of/switch to MMF. Conclusion MMF has shown initial promise in the treatment of uveitis in children with uveitis in this small cohort, in line with some existing evidence. It was initially used in patients who were not keen on injections/intolerant to MTX or had failed all existing options. This is a small cohort of patients and we would welcome more research in this area. Conflicts of Interest The authors declare no conflicts of interest.

Chronic myeloid leukaemia

2020 ◽  
pp. 5213-5227
Author(s):  
Mhairi Copland ◽  
Tessa L. Holyoake
Keyword(s):  
Chronic Myeloid Leukaemia ◽  
Myeloid Leukaemia ◽  
Peripheral Blood ◽  
Fusion Gene ◽  
Signs And Symptoms ◽  
Blood Film ◽  
Second Line ◽  
First Line ◽  
Conventional Cytogenetics ◽  
Third Line

Chronic myeloid leukaemia (CML) has a worldwide incidence of 1 to 2 per 100 000 of the population. Most cases are caused by translocation of the distal end of chromosome 9 on to chromosome 22 which leads to the creation of a fusion protein expressed from the fusion gene formed by juxtaposition of parts of the BCR and ABL1 genes. The resulting oncoprotein is a constitutive tyrosine kinase and appears to operate as an initiator for the development of the leukaemia. Clinical features—many patients are asymptomatic at diagnosis, which is made following a routine blood test. Others present with signs and symptoms including fatigue, sweats, fever, weight loss, haemorrhagic manifestations, and abdominal discomfort (due to splenomegaly). Diagnosis—this is typically made by the examination of a peripheral blood film and the demonstration of the Ph chromosome by conventional cytogenetics in a bone marrow aspirate or peripheral blood sample. Polymerase chain reaction analysis of peripheral blood confirms the presence of a BCR-ABL1 transcript and characterizes the BCR-ABL1 junction. Treatment—the original TKI, imatinib, has had a very significant impact on the first-line management of patients with CML. It induces durable complete cytogenetic responses in the majority of patients and prolongs overall survival substantially. Second- and third-generation TKIs show enhanced potency against BCR-ABL1 activity and are licensed within Europe for first-line (dasatinib, nilotinib) or second-line or subsequent (dasatinib, nilotinib, bosutinib, ponatinib) use in CML. Patients with suboptimal responses to first-line treatment can be offered a different second-line TKI; or a third-line TKI, such as ponatinib; or allogeneic stem cell transplantation—for patients less than 65 years of age and with a suitable donor.

Late Onset Neutropenia like a Complication of Treatment with Anti-CD20.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 4701-4701
Author(s):  
Araceli Rubio-Martinez ◽  
Valle Recasens ◽  
Ana Godoy ◽  
Noelia Padron ◽  
Pilar Giraldo
Keyword(s):  
Combination Therapy ◽  
Cox Regression ◽  
Late Onset ◽  
Demographic Data ◽  
Second Line ◽  
First Line ◽  
Who Grade ◽  
Severe Infections ◽  
Third Line ◽  
Anti Cd20

Abstract Introduction: The occurrence of unexplained peripheral blood cytopenia, particularly neutropenia, has been recently reported after rituximab ®. Its prevalence may be underestimated since it may occur late after treatment (Cattaneo C et al Leuk Lymphoma. 2006 Jun;47(6):965–6, Chaiwatanatorn K et al Br J Haematol 2003). Apparently the risk is higher when R is associated with Fludarabine in combination therapy, producing a decrease in bone marrow precursors. Patients and methods: observational and retrospective study in order to determine the incidence of WHO grade III – IV neutropenia (neutrophils: ≤ 0.6×109/L) and the development of infection complications in patients treated with R-CMF or R-CF in our hospital from 6/8/2003 to 20/3/2006. We have compared these data with the incidence of delayed neutropenia during 621 courses of R or R-CHOP administered as outpatient schedule in the same period. Data source: clinical reports. Variables: demographic data (age, gender), date of diagnosis, histological type, schedule therapy, number of cycles, clinical response (complete remission (CR), partial remission (PR), and non response (NR), prophylaxis with G-CSF, blood counts (leucocytes, neutrophils, hemoglobin and platelets) during all treatment and follow-up, infections and number of admissions in the hospital. Kaplan-Meier survival and Cox regression were calculated. Results: From 78 courses of Immuno-chemotherapy in 16 consecutive patients diagnosed of follicular NHL: 10, B-CLL: 5, mantle NHL: 1. R-CMF (14 patients), R-CF (2 patients). (9 males/7 females), mean age 58.75 (20–78). In first line 8, second line 6 and third line 2. Number of courses received: mean 4,8 (1–6). Response: CR:13, NR: 1, Non valuable: 2. G-CSF prophylaxis during therapy in 50%. 9 patients (56.2%) developed neutropenia during the treatment or in the following year, one of them had also anemia and thrombocytopenia. In 4 patients the combination therapy was administered in first line, 3 as second line and 2 as third line therapy. Patients received 5 (6 courses), 1 (5 courses), 1 (3 courses), 1 (2 courses) and 1 (1 course), 8 developed infections that required admission into hospital (1 died after third course by sepsis). Another two patients developed severe infections without neutropenia. A late and persistent neutropenia after to finish therapy (1–6 months later), was observed in 4 patients (duration:3, 12, 11 and 4 months); 2 patients got over at 11 and 12 months after and in two of them is present now. They were treated with G-CSF, prednisone and cyclosporine in 2 cases without response and reached normal values when we associated IV immunoglobulins extract. OS: mean 26.4 months (6–49), RFS: 10.6 months (1–30). Conclusions: Delayed-onset cytopenia, particularly neutropenia, is a clinically significant complication of rituximab treatment when it is administered in combination with Fludarabine increasing the risk of severe infections.

Thalidomide in Haematology Practice at an UK District General Hospital - A 6 Year Experience.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 5511-5511
Author(s):  
Anil V. Kamat ◽  
Raphael Ezekwesili ◽  
Majid Kazmi
Keyword(s):  
Multiple Myeloma ◽  
Side Effects ◽  
Patient Survival ◽  
District General Hospital ◽  
Myeloproliferative Disorder ◽  
Second Line ◽  
First Line ◽  
Oral Ulceration ◽  
Loss Of Response ◽  
Third Line

Abstract Introduction-This is a retrospective audit of thalidomide use in haematology practice at a district general hospital in UK over past 6 years from 2000 to June 2006. Thalidomide is not yet licensed in the UK. Audit summary-Thalidomide was administered to 44 patients (31 males 13 females). The median age range was −71–80 years (n=19). None of the 13 females had childbearing potential. Only one patient was enrolled in a clinical trial - Myeloma IX. Thalidomide usage ranged from 4–682 days (multiple myeloma),2–443 days (non – Hodgkin’s lymphoma),72–856 days (myeloproliferative disorder/myelofibrosis), 21–134 days (myelodysplastic syndrome) & 2239 days in a patient with oral ulceration secondary to Behcets disease. Thalidomide was administered alone (n=12), in combination chemotherapy (22) [Thalidomide/Dexamethasone 6, Thalidomide/Prednisolone 2, attenuated Cyclophosphamide/Thalidomide/Dexamethasone (CTD) 3 & CTD 11] & both (10). Minimum & maximum tolerated dose was 50 mg alternate day & 300 mg od, respectively. 20 patients needed dose reductions. Multiple Myeloma (n=20) First line of treatment in one patient (survival post initiation 16 months +), second line 5 patients (6days to 38 months), third line 5 patients (15 days to 19 months), fourth line 6 (6months to 19 months+), fifth line 2 patients (1 ½ months to 4 ½ months) & sixth line 1 patient(66 months+). Outcome-loss of response (n=15), good response/minimal residual disease (3), partial response (1) & side effects (14).13 patients died. Non Hodgkin’s Lymphoma (n=13) Second line of treatment in one patient (survival post initiation 2 days), third line 4 (20 days to 14 months +), fourth line 4 (13 days to 31 months +), fifth line 1 (7 ½ months) & eighth line 2 (9 days to 4 months). Outcome-side effects (8), stable disease (1) & progressive disease (9). 10 patients died. Myeloproliferative disorder/Myelofibrosis (n=6) First line of treatment in one patient (survival post initiation 14months+), second line 2 (12 to 17 months+), third line 2 (26 months to 31 months) & fourth line 1 (10 months). Outcome - loss of response (4), no response (1) & side effects (6). 4 patients died. Myelodysplastic syndrome (n= 4) Second line of treatment in 1 patient (survival post initiation 53 months +), third line 2 (11 to 27 months), fourth line 1 (13 months). Outcome-no response (1), disease progression (1) & side effects (3). 3 patients died. Oral ulceration secondary to Behcets disease later complicated by myelodysplasia (n=1) First line treatment. Outcome-loss of response (survival post initiation 74 months). Side-effects (31 of 44 patients)-Paresthesia n=13, somnolence 6, tiredness 6, constipation 6, neutropenia5, giddiness 4, unsteady gait 3, bodyache 3, deep vein thrombosis 3, tremors 3, nausea 2, , anorexia 2, visual blurring 2, dry skin 2, sepsis 2, unconfirmed pulmonary embolism 1 & other 11.16 patients discontinued thalidomide. There were 4 venous thromboembolic episodes (3 DVT, 1 unconfirmed pulmonary embolism) in 3 patients. Conclusion- Analysis of thalidomide usage offers a better understanding of it’s utility by identifying practice, outcome & safety concerns.

Outcome of Patients with CML Treated with Dasatinib or Nilotinib after Failure of Second Prior TKIs

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 2294-2294
Author(s):  
Antonella Russo Rossi ◽  
Massimo Breccia ◽  
Fausto Castagnetti ◽  
Luigiana Luciano ◽  
Antonella Gozzini ◽  
...  
Keyword(s):  
Median Time ◽  
Conflicts Of Interest ◽  
Cell Uptake ◽  
Second Line ◽  
The Third ◽  
Line Therapy ◽  
Third Line ◽  
New Mutations

Abstract Abstract 2294 Background. The TKIs Nilotinib and Dasatinib offer additional therapeutic options for patients with CML who are resistant or intolerant to Imatinib. These agents, active against the majority of Imatinib resistant BCR-ABL mutated clones, have a different pattern of kinase target selectivity, pharmacokinetics parameters, cell uptake, efflux properties and adverse events profiles. Preliminary results suggest that some patients may respond to a second TKI used as third line therapy, but little is known about the long term benefit of such an approach.Aim of this collaborative Italian study was to verify the response (rate and duration) and the clinical outcome in patients with CML treated with a third TKI after sequential failure of the previous ones. Methods. We evaluated 66 patients with CML, resistant/intolerant to Imatinib and treated with Dasatinib or Nilotinib, then switched to a third- line TKI after treatment failure. Of these, 29 patients were treated with dasatinib after imatinib/nilotinib failure and 37 with nilotinib after imatinib/dasatinib failure. Patients were monitored with complete blood counts, cytogenetic analysis, bone marrow aspiration RT-PCR and mutational analysis. Results. A total of 66 patients (median age 63 years, range, 33–85 years) were treated with sequential TKIs; 40 (61%) patients had received interferon-a before starting Imatinib; 26 (39%) patients received imatinib as first line therapy. The median time on imatinib therapy was 47.5 months (range 4–101 months). At the start of nilotinib as second line, 27/29 (93%) patients were in CP, 1 (3.5%) in AP, and 1 (3.5%) in BP. 9 patients (31%) had developed mutations before starting treatment. The median time on second line TKI was 8 months (range 2–36 months). In the resistant patients 4 new mutations were identified (F359V in two patients, T315I, Y253H+F359V). At the start of dasatinib as second line, 33/37 (89.2%) patients were in CP, 4 (10.8%) in AP. 7 patients (18.9%) had developed mutations before starting treatment. The median time on second line TKI was 14 months (range 4–59 months).In the resistant patients 5 new mutations were identified (F137L in three pts, M318T, M244V+F317L). At the start of the third TKI, 60/66 (90.9%) patients were in CP, 5 (7.6%) in AP, and 1 (1.5%) in BP. Of these, 7 patients (18.9%) on dasatinib and 7 (24.1%) on nilotinib had mutations before starting treatment. The best response to the third line treatment with TKI was 10 (15.2%) MMR, 10 (15.2%) CCyR, 8 PcyR (12.1%), 5 (7.5%) mCyR, 24 (36.4%) CHR and 9 (13.6%) No Response (NR). In the dasatinib group, 9 (31%) patients discontinued treatment because of toxicity versus 17 (45.9%) patients in the nilotinib group.Two new mutations (F317L, E255V) emerged with dasatinib as third line therapy.After a median follow up of 13 months (range 2–37 months) 50 patients (48 CP, 2 AP) are continuing therapy (33 on nilotinib, 17 on dasatinib).Since the start of the third TKI, 61 patients (92.4%) are still alive for a median overall survival of 110 months (range 15–300) (52 CP, 7 AP, 2 NA); the 5 deaths (7.6%) were caused by disease progression and spread of the gene mutation T315I. Discussion. In our study, about one third of patients derived benefit from the use of three sequential TKIs; patients with better, longer response (28.7%) to third TKI were the same patients with a better response to the Imatinib and 2TKIs therapy. All these patients had taken interferon therapy before the Imatinib. In this subset of patients (good responders: CCyR and MMR) 5 patients developed mutations that were sensitive to the sequential treatment.The lack of a durable cytogenetic remission could be explained by the emergence of new kinase domain mutations as patients are exposed to sequential TKI; a change of therapy resulted in an adequate response. In our series, patients with poor prognosis showed mutations not sensitive to the TKIs treatment. Conclusions. Although allogeneic SCT is the treatment of choice in all patients failing 2 TKIs who are suitable candidates for this approach, alternative strategies are required for ineligible patients. The use of a third TKI after failure of two previous TKIs induces response in some patients. Longer follow up of a larger series of patients is needed to determine the long term impact of the response. Disclosures: No relevant conflicts of interest to declare.

Gemcitabine, Vinorelbine and Dexamethasone (GVDexa) As Second-Line Salvage Regimen in Relapsed and Refractory Hodgkin's Lymphoma

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 3948-3948
Author(s):  
Anjana Joel ◽  
Prasanth Ganesan ◽  
Tenali Gnana Sagar ◽  
Krishnarathnam Kannan ◽  
Trivadi Ganesan ◽  
...  
Keyword(s):  
Stem Cell ◽  
Hodgkin’S Lymphoma ◽  
Hodgkin's Lymphoma ◽  
Second Line ◽  
First Line ◽  
Line Therapy ◽  
Baseline Characteristics ◽  
Third Line ◽  
Grade 3 ◽  
Stem Cell Collection

Abstract INTRODUCTION: Traditional platinum-based salvage regimens like DHAP, ICE are effective in relapsed Hodgkin's lymphoma (HL), but are more toxic. Gemcitabine based regimens are equally effective in salvage of lymphomas, but are less toxic and allow better stem cell collection for subsequent high dose therapy (HDT). There is limited data on the usefulness of gemcitabine based salvage regimens after the failure of salvage therapies like DHAP and ICE. At our center, we used a combination of gemcitabine, vinorelbine and dexamethasone (GVDexa), a non-platinum containing regimen in those patients who failed DHAP/ ICE based salvage treatment. METHODS: The records of patients with relapsed and refractory Hodgkin's lymphoma, who were treated with GVDexa, were reviewed. The regimen consisted of Gemcitabine 1000mg/m2 IV (D1,8), Vinorelbine 25mg/m2 IV (D1,8) Dexamethasone 40mg oral (D1-4) given as outpatient. It was given for 2-3 cycles until best response or till the patient underwent HDT. RESULTS: Between July 2010 to Jun 2015, 25 patients received GVDexa. The median age was 23 years (Range: 11 to 45 yrs) and 64% were males. Baseline characteristics are summarised in Table 1. Twenty-one patients (84%) had previous exposure to salvage therapy with DHAP/ ICE and GVDexa was given as third line treatment. The overall response rate was 48% (12/25) with complete response in 20% (5/25) and partial response in 28% (7/25). Toxicity: A total of 61 cycles [Median: 2 (Range: 1-6)] were delivered among 25 patients. Grade 3/4 haematological toxicities (neutropenia and thrombocytopenia) occurred in 9/61 (14.7%) cycles and febrile neutropenia occurred in 2 (3.2%) cycles. Grade 3/4 non-haematological toxicities were rare (paralytic ileus in 1 patient). There were no toxic deaths. Stem cell collection: Stem cell harvesting for HDT was attempted in 12 patients and was successful (> 2 million CD34 positive cells/kg) in 8 (67%) patients. Seven of these patients successfully completed HDT. Two patients who failed stem cell collection underwent reduced intensity conditioning allogeneic transplant. CONCLUSIONS: GVDexa, when used as third line therapy in relapsed and refractory HL shows promising response rates, with minimal toxicity. The high response rates achieved despite failure of first line platinum based salvage, points to the potential usefulness of this regimen as first line salvage therapy in refractory HL. GVDexa could emerge as a safe and effective non-platinum containing alternative regimen for second-line therapy in HL. Table 1. Baseline characteristics (N=25) PARAMETER Number (Range/Percentage) Age (median, range) 23 yrs (10 to 45 yrs) Male sex 16 (64%) Prior exposure to DHAP/ICE chemotherapy 21 (84%) Previous lines of chemotherapy (median, range) 2 (1 to 4) Time from 1st diagnosis to relapse (median, range) 31.5 months (4.3 to 153.7 months) Primary progressivea/refractory 13 (52) Stage III/IV at relapse 20 (80) Haemoglobin < 10g/dL at relapse 12 (48) a. Progressed within 3 months of completion of first line chemotherapy Disclosures No relevant conflicts of interest to declare.

The Role of Peg-Interferon (P-IFN) in Salvaging Patients with Chronic Myeloid Leukemia Chronic Phase (LMC-CP) in Molecular Resistant (MolRes) to Second- Generation Tyrosine Kinase Inhibitors (TKIs)

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 5461-5461
Author(s):  
Manuel Ayala ◽  
Antonieta Chavez ◽  
Jacqueline Domínguez
Keyword(s):  
Second Generation ◽  
Kinase Inhibitors ◽  
Conflicts Of Interest ◽  
Age At Onset ◽  
Chronic Phase ◽  
Hematologic Toxicity ◽  
Molecular Response ◽  
First Line ◽  
Change Behavior ◽  
Third Line

Abstract Introduction.- Interferón for two decades was the gold standard in the treatment of CML, with the beginning of the era of ICTs, their role was secondary or even abandoned its use, combination with ICTs in the first line, has controversial and had toxic effects that limit their use results, however some clinical trials have shown advantages in the molecular response, even less explored yet, this use in molecular resistance (MolRes) to second-generation TKIs. Objective.-Get as molecular response major (MMR) in CML-CP patients with MolRes to nilotinib or dasatinib management. Material and methods.-A total of 146 CML-CP patients treated with nilotinib or dasatinib in second or third-line, twenty six patients with MolRes included a minimum of 18 months of treatment, to receive P-IFN 90 or 180 mcg SC weekly and evaluated quarterly by q-PCR to reach the MMR. Results.-26 CML patients (13 male and 13 female) were included, the median age at diagnosis was 34.5 years (19-60), 8 patients received first-line treatment as P-IFN and 12 patients (60%) imatinib by a median of 30 months (18-52), presented half resistance cytogenetic and half MolRes, being treated with second-generation TKIs (17 nilotinib and 9 dasatinib), wherein MolRes over 18 months of treatment (19-62), they synergize with P-IFN at a dose 90 to 180 mcg weekly, with a median age at onset of the P-IFN synergizers 42 years (18-67), reaching RMM to a median of 3 months (range 3-9), including 5 patients with undetectable molecular response (uMR), achieving the goal of MMR 62% of patients (65 and 56% for nilotinib and dasatinib respectively). La toxicidad hematológica y no hematológica fue evaluada, no siendo significativa, ni una limitante para su uso. Hematologic and non-hematologic toxicity was assessed not to be significant, or limit its use. El 100% de los pacientes sigue vivo y mantienen respuesta molecular mayor 13 pacientes (65%) a una mediana de 8.5 meses (4-20). Conclusiones.-El manejo con nilotinib en 2da línea, ofrece en nuestra experiencia en pacientes con LMC-FC en 2da (90%) o 3ª línea (10%), respuestas citogenéticas en resistentes citogenéticos en un 77% y un 50% alcanzan la RMM, en los casos con fracaso a ese objetivo, la conducta es cambiar de ICT o realizar un trasplante alogénico cuando se dispone de un donador histocompatible, a la sinergizacion 10 pacientes (71%) de 14, lograron la RMM, para un global de RMM del 60% (22% en RMi), los resultados actuales demuestran que es posible retrasar un cambio en la mayoría de los pacientes combinando con P-IFN, recuperando con esta estrategia la RMM en 2/3 de esos pacientes. All patients still alive (except for one patient with dasatinib/P-IFN who died of a heart attack) and remain major molecular response in 15 patients (58%) at a median of 18 months (4-20). Conclusions.- management with nilotinib in 2nd line offers our experience in patients with CML-CP in second-line (90%) or 3rd line (10%), they are achieved complete cytogenetic cytogenetic responses in 77% and 50% reach the RMM, in cases of failure to this goal is to change behavior TKIs or make an allogeneic transplant, when you have a histocompatible donor, the synergizers 11 patients of 17, achieved the MMR, for a global MMR 62% (22% in uMR), the current results show that it is possible to delay a change in the majority of patients with P-IFN combining, recovering with this strategy the MMR in 2/3 of these patients. Disclosures No relevant conflicts of interest to declare.

Outcome after liver transplantation compared with chemotherapy in colorectal cancer patients with nonresectable liver-only disease.

2014 ◽  
Vol 32 (3_suppl) ◽  
pp. 531-531
Author(s):  
Svein Dueland ◽  
Tormod Kyrre Guren ◽  
Morten Hagness ◽  
Bengt Glimelius ◽  
Pål-Dag Line ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Second Line ◽  
First Line ◽  
Liver Malignancies ◽  
Data Set ◽  
The Difference ◽  
Third Line ◽  
Colorectal Cancer Patients ◽  
Clinical Trial Information ◽  
Line Chemotherapy

531 Background: Surgical treatment of colorectal liver metastases (CLM) is the only treatment option with curative potential; however, only about 10-20% of the patients are candidates for surgical resection. The majority of CLM patients has non-resectable disease, and receives palliative chemotherapy. These patients have poor prognosis with median OS of about 20-24 months after starting first-line chemotherapy and only about 10% survive five years. Methods: Individual data from patients with non-resectable liver only disease who had received liver transplantation (Ltx) (SECA-study, Hagness et al., Ann Surg. 2013) were compared to a similar group of patients with non-resectable liver only metastases included in the NORDIC VII study (first-line Flox chemotherapy ± Cetuximab, Tveit et al., J Clin Oncol. 2012). Twenty one patient included in the Ltx study were compared to 47 patients with liver only metastases included in the NORDIC VII study. All patients in the NORDIC VII study started first-line chemotherapy, whereas 57% of patients in the Ltx study had received second- or third-line chemotherapy at time of Ltx. Results: Median age of the Ltx group was 56 years (range 45-65 years) and 57 years (range 34-65 years) in the Nordic VII study. Median tumor size was 4.5cm (range 2.8-13.0cm) and 5.0cm (range 1.4-16.0cm) in the Ltx and Nordic VII groups, respectively. 5 year OS in the Ltx group was 60% compared to a 5 year OS of 9% in the NORDIC VII group. The 5 year OS of the 21 patients in the NORDIC VII data set with the longest OS was 19%. The patients in the Ltx study who had received only first-line chemotherapy at time of Ltx had a 5 year OS of 80%. Patients in the NORDIC VII study had an OS from end of second-line chemotherapy of 6-7 months. In comparison, patients with progressive disease on second-line/third-line chemotherapy at time of Ltx, had a median OS of 39 months and a 5 year OS of 30%. Conclusions: Patients with non-resectable CLMonly, has a dramatic improved OS after Ltx compared to chemotherapy. The difference could not be explained by patient selection. Selected patients with CRC obtain OS similar to Ltx patients transplanted for primary liver malignancies. Selected CRC patients should therefore be considered for Ltx. Clinical trial information: NCT01311453.

Analysis and follow-up of the patients diagnosed with metastatic gastric adenocarcinoma in the Parc Taulí Hospital, Sabadell, between 2010 and 2013.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 169-169
Author(s):  
Marta Ferrer ◽  
Carles Pericay ◽  
Ismael Macias ◽  
Emma Dotor ◽  
Aleydis Pisa ◽  
...  
Keyword(s):  
Gastric Adenocarcinoma ◽  
Clinical Information ◽  
Gastric Body ◽  
Second Line ◽  
First Line ◽  
Kaplan Meier ◽  
Secondary Endpoints ◽  
Third Line ◽  
Line Chemotherapy

169 Background: The primary endpoint of this study was to know the incidence and treatment of gastric carcinoma in our area. Other secondary endpoints were percentage of treated patients, overall survival (OS), survival in subgroups, and more frequent treatments. Methods: Since 2010 to 2013 all the patients diagnosed with metastatic gastric adenocarcinoma and treated at the hospital Parc Taulí from Sabadell were registered. The clinical information was compiled and analyzed. Survivals curves were determined with Kaplan-Meier functions Results: 168 patients were studied, with 79 metastatic (47%). 56% men and median age 67 years. Localizations were gastric body 52%, gastro-esophageal junction 20%, and antrum 25%. OS of the series was 5,05 months (95% CI, 2,99-7,10). 60% of the patients were treated with first line chemotherapy (CT). From them, 42% had a second line and 25% a third line. DFS were respectively 6,62 months (4,06-9,17), 4,29 months (2,28-6,30), and 2,88 months (1,12-4,64) for every line of treatment. OS of the patients that received chemotherapy was 9.7 months (6,40-13,00). CT more used in first line were triplets of fluropyrimidines, platinum and taxanes, in 45% (21 patients). Also just fluoropyrimidines and platinum without taxanes, in 38%. As a second line the predominant CT is also platinum and fluoropyrimidines (37%), and irinotecan (30%). In third line, 50% are combinations based on irinotecan. Conclusions: The OS of the patients who received CT is significantly prolonged respect the ones who didn’t. The data obtained matches the data already published in the literature, even the more frequent chemotherapy.

Treatment of metastatic colorectal cancer (mCRC) according to age.

2020 ◽  
Vol 38 (4_suppl) ◽  
pp. 49-49
Author(s):  
Laura Ortega ◽  
Gabriela Torres Pérez-Solero ◽  
Marta Arregui Valles ◽  
Manuel Alva Bianchi ◽  
Inmaculada Aparicio Salcedo ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Event Rate ◽  
Young Patients ◽  
Progression Free Survival ◽  
Adverse Event Rate ◽  
Second Line ◽  
First Line ◽  
Old Patients ◽  
Free Survival ◽  
Third Line

49 Background: Elderly patients with mCRC are underrepresented in clinical trials. For this reason, the optimal treatment in this population is uncertain. The aim of this study is to compare efficacy and safety outcomes in patients with mCRC treated in our institution according to age (<65 vs ≥65 years). Methods: We conducted a retrospective analysis of 482 patients with mCRC attended in the Hospital Gregorio Marañón (Spain) between January 2010 and 2018. Results: Patients characteristics table. First-line: chemotherapy (CT) 98.7% vs 97.3% respectively (p=0.324), biologic agents (BA) 81.2% vs 79.0% (p=0.585). Significantly more <65-year-old patients received FOLFOX (60.5% vs 44.4%) and more ≥65-year-old patients XELOX (9.2% vs 17.5%) or capecitabine (2.0% vs 7.5%). Second-line: CT 64.9% vs 63.5% (p=0.764), BA 60.4% vs 51.1% (p=0.055). Significantly more <65-year-old patients received FOLFIRI (67.0% vs 54.5%) and more ≥65-year-old patients irinotecan (2.0% vs 8.6%). Third and subsequent lines: Significantly more young patients received a third-line (CT: 41.6% vs 31.0%; BA: 24% vs 21.6%), fourth-line (CT: 22.1% vs 11.9%; BA:16.2% vs 6.4%) and fifth-line of treatment (CT: 11.7% vs 5.8%; BA: 4.5% vs 3.6%). More young patients underwent metastasis resection (74.0% vs 58.1%, p=0.001). There were no differences in rate of post-operative complications (p=0.840). There were no differences in overall survival (36.05m vs 28.06, p=0.142), progression-free-survival (first-line: 12.73m vs 11.78m, p=0.139; second-line: 8.78m vs 62.71m, p=0.254) or adverse event rate (73.4% vs 73.6%, p=0.967). Conclusions: Intensive treatment could be an effectiveness and safe option in selected elderly patients. [Table: see text]

Sign in / Sign up

Export Citation Format

Share Document