Metastatic feline mammary cancer: prognostic factors, outcome and comparison of different treatment modalities – a retrospective multicentre study

2020 ◽  
pp. 1098612X2096441
Author(s):  
Gonçalo Petrucci ◽  
Joaquim Henriques ◽  
Hugo Gregório ◽  
Gonçalo Vicente ◽  
Justina Prada ◽  
...  
Keyword(s):  
Metastatic Disease ◽  
Adjuvant Treatment ◽  
Imaging Techniques ◽  
Treatment Options ◽  
Clinical Signs ◽  
Stage Iv ◽  
Metronomic Chemotherapy ◽  
Maximum Tolerated Dose ◽  
Treatment Modalities ◽  
Number Of Patients

Objectives Although feline mammary carcinomas (FMCs) are highly metastatic, the literature and treatment options pertaining to advanced tumours are scarce. This study aimed to investigate the clinical outcome of metastatic FMC with or without adjuvant treatment. Methods The medical records of 73 cats with metastatic FMC (stage 4) were reviewed and included in this study. Metastatic disease was detected by distinct imaging techniques (radiography, ultrasound and CT) and confirmed by cytology and/or histopathology. Cats with adjuvant chemotherapy treatment (n = 34) were divided into three groups: group 1 (n = 9) cats receiving maximum tolerated dose chemotherapy; group 2 (n = 15) cats receiving metronomic chemotherapy; and group 3 (n = 10) cats treated with toceranib phosphate. The study endpoints were time to progression (TTP) and tumour-specific survival (TSS). Treatment-related toxicity was evaluated according to the Veterinary Co-operative Oncology Group’s Common Terminology Criteria for Adverse Events version 1.1 (VCOG-CTCAE). Results Overall mean TTP and TSS were 23 and 44 days, respectively. Cats with clinical signs at the time of diagnosis had a lower TSS (14 days) than asymptomatic cats (120 days; P <0.001). Cats with pleural effusion had a lower TSS (16 days) than cats without ( P <0.001). Median TSS was 58, 75 and 63 in groups 1, 2 and 3, respectively ( P = 0.197). Toxicity was observed in 66.7%, 20% and 30% of cats in groups 1, 2 and 3, respectively. Conclusions and relevance To the best of our knowledge, this study includes the highest number of patients with metastatic FMC assessed. Despite the overall poor prognosis, some cats survived >6 months, indicating that adjuvant treatment may be an option to consider in metastatic disease. More studies are warranted for better understanding and management of stage IV patients.

Planning for End of Life

2021 ◽  
pp. 104990912110141
Author(s):  
Natasha Ansari ◽  
Eric Johnson ◽  
Jennifer A. Sinnott ◽  
Sikandar Ansari
Keyword(s):  
End Of Life ◽  
Treatment Options ◽  
Stage Iv ◽  
P Value ◽  
Life Planning ◽  
Number Of Patients ◽  
End Of Life Planning ◽  
The Difference ◽  
Alternative Medications ◽  
Patient’S Perception

Background: Oncology provider discussions of treatment options, outcomes of treatment, and end of life planning are essential to care for patients with advanced malignancies. Studies have shown that despite this, many patients do not have adequate care planning, including end of life planning. It is thought that the accessibility of information outside of clinical encounters and individual factors and/or beliefs may influence the patient’s perception of disease. Aims: The objective of this study was to evaluate if patient understanding of treatment goals matched the provider and if there were areas of discrepancy. If a discrepancy was found, the survey inquired further into more specific aspects. Methods: A questionnaire-based survey was performed at a cancer hospital outpatient clinic. 100 consecutive and consenting patients who had stage IV non-curable lung, gastrointestinal (GI), or other cancer were included in the study. Patients must have had at least 2 visits with their oncologist. Results: 40 patients reported their disease might be curable and 60 reported their disease was not curable. Patients who reported their disease was not curable were more likely to be 65 years or older (P-value: 0.055). They were more likely to report that their doctor discussed the possibility of their cancer getting worse (78.3% VS 55%; P-value 0.024), that their doctor discussed end of life plans (58.3% VS 30%; P- value: 0.01), and that they had appointed a health care decision-maker (86.7% VS 62.5%; P-value: 0.01). 65% of patients who thought their disease might be curable reported that their doctor said it might be curable, compared with only 6.7% of patients who thought their disease was not curable (p < 0.001). Or, equivalently, 35% of patients who thought their disease might be curable reported that their doctor’s opinion was that it was not curable, compared with 93% of patients who thought their disease was not curable (p < 0.001). Patients who had lung cancer were more likely to believe their cancer was not curable than patients with gastrointestinal or other cancer, though the difference was not statistically significant (p = 0.165). Patients who said their disease might be curable selected as possible reasons that a miracle (50%) or alternative medicine (66.7%) would get rid of the cancer, or said their family wanted them to believe the cancer would go away (16.7%) or that another doctor said it would (4.2%). Patients who said their disease might be curable said they did so due to alternative medications, another doctor, or their family. Restricting to the 70 patients who reported their doctors telling them their disease was not curable, 20% of them still said that they personally felt their disease might be curable. Patients below 65 years of age were more likely to disagree with the doctor in this case (P-value: 0.047). Conclusion: This survey of patients diagnosed with stage IV cancer shows that a significant number of patients had misunderstandings of the treatment and curability of their disease. Findings suggest that a notable proportion kept these beliefs even after being told by treating physicians that their disease is not curable.

Medical Treatment of Hepatocellular Carcinoma: Any Progress?

1994 ◽  
Vol 80 (5) ◽  
pp. 315-326 ◽  
Author(s):  
Marco Colleoni ◽  
Fernando Gaion ◽  
Guido Liessi ◽  
Giorgio Mastropasqua ◽  
Patrizia Nelli ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Treatment Options ◽  
Arterial Embolization ◽  
Percutaneous Ethanol Injection ◽  
High Response Rate ◽  
New Drugs ◽  
Treatment Modalities ◽  
Ethanol Injection ◽  
Hormonal Manipulation ◽  
Number Of Patients

Background Hepatocellular carcinoma (HCC) remains one of the most common neoplasms worldwide. Curative treatment options include liver transplantation or resection. Unfortunately, most patients still have unresectable or untransplantable HCC due to disease extension or comorbid factors and are therefore candidate only for palliative treatments. Methods In this review we have analyzed the different medical approaches employed in the treatment of HCC in an attempt to better define their roles. Results Palliative medical treatments including systemic chemotherapy, immunotherapy or hormonal manipulation rarely influence survival of the patients. Although a high response rate is often reported with new local therapies such as transcatheter arterial embolization, intraarterial chemotherapy or percutaneous ethanol injection, the real impact of these treatment modalities on patient survival remains to be determined. Conclusion One way to improve the diagnosis of HCC patients would be an appropriate approach to evaluate new drugs or treatment modalities. To answer all the open questions, further trials, possibly randomized, should be conducted on a substantial number of patients with homogeneous prognostic factors.

Circulating tumor cells (CTCs) as a predictor of metastatic disease in patients with biochemical recurrence (BR) of prostate cancer with equivocal scan results.

2012 ◽  
Vol 30 (5_suppl) ◽  
pp. 239-239
Author(s):  
Jeanny B. Aragon-Ching ◽  
Samuel J. Simmens ◽  
Steven R. Patierno ◽  
Robert S. Siegel
Keyword(s):  
Prostate Cancer ◽  
Tumor Cells ◽  
Circulating Tumor Cells ◽  
Metastatic Disease ◽  
Bone Biopsy ◽  
Treatment Options ◽  
Primary Treatment ◽  
Testosterone Levels ◽  
Number Of Patients ◽  
Bone Scans

239 Background: Staging for BR is challenging since the yield of computed tomography (CT) and bone scans are low, especially in patients with low prostate specific antigens (PSA) levels. We examined the utility of circulating tumor cells (CTCs) to predict metastatic disease in a cohort of patients who presented with BR (Aragon-Ching, et. al. ASCO GU 2011;abstr 60). Methods: 33 pts enrolled from May 2010 to September 2011 with BR, defined as patients (pts) who have undergone primary treatment with PSA rise to >/= 0.2 from a prior undetectable level for prior prostatectomy or > 2 mg/dl rise from post-nadir radiotherapy, were included. PSA doubling time (PSADT), scan results, Gleason scores, age, testosterone levels were all obtained. CTCs were evaluated in 7.5 mL of peripheral blood using the CTC CellSearch test. BR patients with equivocal CT and/or bone scan results who were biopsiable and consentable underwent bone biopsy to confirm metastatic disease. Results: The median age for 33 patients was 71 y/o (range: 51 – 91), median PSA of 1.7 ng/mL (range 0.2 – 65.8), testosterone levels of 315.5 ng/dL (range: 31 – 727), Gleason score of 7, hemoglobin of 13.78 g/dL, BMI of 27.72 and alkaline phosphatase of 68 IU/L. Prostatectomy was the primary treatment in 23 pts, radiotherapy in 9 pts and Cyberknife in 1 pt. Median PSADT varied between 0.35 to 55.2 months. Only a small number of patients had either biopsy confirmed metastatic disease (n=2) or detectable CTC (n=3). Both of the 2 patients with metastatic disease had detectable CTC (sensitivity = 1.00, 95% CI: .34, 1.00). For the patients without signs or confirmation of metastatic disease, 30/31 had no detectable CTC (specificity = .97, 95% CI: .84, .99). Conclusions: While most pts with BR have negative blood CTCs, patients with detectable CTCs and equivocal findings on scans should raise suspicion and prompt a search for metastatic disease, given increasing available treatment options for metastatic prostate cancer. However, the limited number of patients may preclude reliable statistical evaluation of CTCs in this population. Supported by IRG-08-091-01 from ACS to GWU Cancer Institute.

scholarly journals Features of community-acquired pneumonia treatment with 3rd generation cephalosporins in combination with azithromycin and as monotherapy

2012 ◽  
Vol 93 (2) ◽  
pp. 278-281
Author(s):  
R F Khamitov ◽  
I V Grigoreva
Keyword(s):  
Treatment Options ◽  
Laboratory Data ◽  
Clinical Signs ◽  
Community Acquired Pneumonia ◽  
Shortness Of Breath ◽  
Course Of Disease ◽  
Number Of Patients ◽  
The Difference ◽  
Clinically Significant ◽  
Severe Community Acquired Pneumonia

Aim. To refine the indications for oral administration of a combination of 3rd generation cephalosporins together with azithromycin and also as monotherapy in patients with moderate and severe community-acquired pneumonia. Methods. A questionnaire was developed to evaluate the clinical and laboratory data on the 1st, 3rd, 5th, 7th and 10-14th days of treatment. The patients were included in the study if clinical signs of pneumonia were present, the disease occurred outside a hospital, and if there was radiological verification of lung tissue infiltration. The study included 77 patients (32 women and 45 men) aged 16 to 84 years. In 56 patients (73%) pneumonia had signs of a moderate course, in 21 (27%) - a severe course. Results. As a result of treatment the number of patients without shortness of breath significantly increased. The difference in comparison with the time of hospitalization was statistically significant starting from day 7 of treatment in patients treated with ceftriaxone and azithromycin (31 and 69%, p 0.05). Intergroup differences also became significant on the same time since treatment initiation (43% of patients on monotherapy, p 0.05). The increase in the proportion of patients without shortness of breath, receiving only ceftriaxone in comparison with the beginning of treatment became significant only by the 10th day (18 and 54%, p 0.05). Conclusion. A combination antibiotic therapy is indicated for patients with a severe course of disease and clinically significant dyspnea, as well as for women with a moderate community-acquired pneumonia with a productive cough. No significant differences in the safety and tolerability of the studied variants of treatment options have been revealed.

scholarly journals Nitric Oxide Deficiency in Mitochondrial Disorders: The Utility of Arginine and Citrulline

2021 ◽  
Vol 14 ◽  
Author(s):  
Mohammed Almannai ◽  
Ayman W. El-Hattab
Keyword(s):  
Nitric Oxide ◽  
Treatment Options ◽  
Mitochondrial Diseases ◽  
Symptomatic Improvement ◽  
Mitochondrial Disorders ◽  
Treatment Modalities ◽  
Acute Administration ◽  
Randomized Controlled Studies ◽  
Number Of Patients ◽  
Nitric Oxide Deficiency

Mitochondrial diseases represent a growing list of clinically heterogeneous disorders that are associated with dysfunctional mitochondria and multisystemic manifestations. In spite of a better understanding of the underlying pathophysiological basis of mitochondrial disorders, treatment options remain limited. Over the past two decades, there is growing evidence that patients with mitochondrial disorders have nitric oxide (NO) deficiency due to the limited availability of NO substrates, arginine and citrulline; decreased activity of nitric oxide synthase (NOS); and NO sequestration. Studies evaluating the use of arginine in patients with mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes (MELAS) presenting with stroke-like episodes showed symptomatic improvement after acute administration as well as a reduction in the frequency and severity of stroke-like episodes following chronic use. Citrulline, another NO precursor, was shown through stable isotope studies to result in a greater increase in NO synthesis. Recent studies showed a positive response of arginine and citrulline in other mitochondrial disorders besides MELAS. Randomized-controlled studies with a larger number of patients are warranted to better understand the role of NO deficiency in mitochondrial disorders and the efficacy of NO precursors as treatment modalities in these disorders.

scholarly journals New Therapeutic Perspectives in the Treatment of Uveal Melanoma: A Systematic Review

Biomedicines ◽  
2021 ◽  
Vol 9 (10) ◽  
pp. 1311
Author(s):  
Mario Damiano Toro ◽  
Lucia Gozzo ◽  
Luciano Tracia ◽  
Marco Cicciù ◽  
Filippo Drago ◽  
...  
Keyword(s):  
Systematic Review ◽  
Adverse Events ◽  
Phase I ◽  
Uveal Melanoma ◽  
Metastatic Disease ◽  
Treatment Options ◽  
Therapeutic Options ◽  
Treatment Modalities ◽  
New Therapeutic Approaches ◽  
New Treatment

Uveal melanoma (UM) is a rare disease, but the most common primary intraocular cancer, mostly localized in the choroid. Currently, the first-line treatment options for UM are radiation therapy, resection, and enucleation. However, although these treatments could potentially be curative, half of all patients will develop metastatic disease, whose prognosis is still poor. Indeed, effective therapeutic options for patients with advanced or metastatic disease are still lacking. Recently, the development of new treatment modalities with a lower incidence of adverse events, a better disease control rate, and new therapeutic approaches, have merged as new potential and promising therapeutic strategies. Additionally, several clinical trials are ongoing to find new therapeutic options, mainly for those with metastatic disease. Many interventions are still in the preliminary phases of clinical development, being investigated in phase I trial or phase I/II. The success of these trials could be crucial for changing the prognosis of patients with advanced/metastatic UM. In this systematic review, we analyzed all emerging and available literature on the new perspectives in the treatment of UM and patient outcomes; furthermore, their current limitations and more common adverse events are summarized.

scholarly journals Therapeutic Strategies for Dry Mouth Management with Emphasis on Electrostimulation as a Treatment Option

2021 ◽  
Vol 2021 ◽  
pp. 1-21
Author(s):  
Amela Tulek ◽  
Aida Mulic ◽  
Martine Hogset ◽  
Tor Paaske Utheim ◽  
Amer Sehic
Keyword(s):  
Salivary Gland ◽  
Treatment Options ◽  
Clinical Effectiveness ◽  
Dry Mouth ◽  
Treatment Modalities ◽  
Study Selection ◽  
Number Of Patients ◽  
Positive Treatment ◽  
Salivary Gland Hypofunction ◽  
Gland Function

Objectives. Xerostomia is a subjective sensation of dry mouth. It is commonly associated with salivary gland hypofunction. Both changes in the composition of the saliva and a reduction in the quantity secreted may be an objective finding of dry mouth. Although there are no currently available cures for the conditions resulting in dry mouth, there are several treatment options that give hope for patients who suffer from xerostomia. Individuals with some residual salivary gland function, which are contraindicated to pharmacological therapies, would benefit the most from identifying novel, alternative effective methods for stimulating production of saliva. The aim of this study was to give an overview of the latest and most relevant data related to treatment modalities for the management of dry mouth conditions. Data Resources and Study Selection. The present review was prepared by searching the National Library of Medicine database using the relevant medical terms and their combinations. A total of thirty-three studies met the inclusion criteria. Data were extracted by one author and verified by another. Conclusion. A number of patients showed positive treatment outcomes, and the adverse effects of both electrical stimulation (ES) and acupuncture have been reported as mild and transient. In patients who have undergone radiotherapy, acupuncture is shown to increase salivation. However, in patients with Sjogren’s syndrome, the effects of ES devices seem to be elusive. Moreover, due to the instability of the findings in relation to longevity of clinical effect, patient satisfaction, quality of life, and clinical effectiveness of such treatments, the results remain vague.

TOPO1 expression in primary and metastatic GI cancers.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 643-643
Author(s):  
Michael Castro ◽  
Rebecca Feldman ◽  
Sandeep K. Reddy
Keyword(s):  
Metastatic Disease ◽  
Epithelial Mesenchymal Transition ◽  
Stage Iv ◽  
Stage Iii ◽  
Small Bowel Adenocarcinoma ◽  
Exact Test ◽  
Mesenchymal Transition ◽  
Number Of Patients ◽  
Metastatic Setting ◽  
Gi Cancers

643 Background: Irinotecan failed in Stage III colon cancer, but succeeds in Stage IV, to prolong survival. We propose that TOPO1 over-expression is a phenomenon of metastatic disease, and perhaps part of the epithelial-mesenchymal-transition (EMT) associated with metastatic phenotypes. Methods: 5029 colorectal (CRC), 3016 pancreatic, 848 gastric and 309 small bowel adenocarcinoma (SBA) patients were included in the study and tested centrally at a CLIA laboratory (Caris Life Sciences, Phoenix, AZ). A threshold of ≥ 2+ and ≥ 30% (intensity and percent staining) and TOPO1 (1D6) clone was utilized. TOPO1 was examined in primary and metastatic specimens. Two-tailed Fisher’s exact test was performed to test where proportions of positive results were different by subgroup (p ≤ 0.05). Results: See table below. Conclusions: The EMT associated with the transition from primary to invasive metastatic disease appears to include upregulation of TOPO1, in some GI cancers, including CRC, pancreatic and gastric cancer. The paradoxical failure of adjuvant irinotecan in stage III, the epithelial phase of the cancer, may be due to a smaller fraction of patient's whose cancers express this biomarker of response in that setting. A re-examination of irinotecan makes sense for a portion of stage III patients whose cancer expresses high levels of TOPO1 in the primary lesion. The recent superiority with regard to response rate and survival or FOLFOXIRI over FOLFOX alone in the stage IV setting raises renewed interest in whether patients with non-metastatic disease could derive a superior cure rate if suitably selected for FOLFOXIRI with a biomarker approach. At the same time, a large number of patients fail to express TOPO1 in the metastatic setting and perhaps should be spared irinotecan-based approaches including the use of FOLFOXIRI. [Table: see text]

scholarly journals Rare Case of Intracardiac Renal Cell Carcinoma Metastasis with Response to Nivolumab: Case Report and Literature Review

2018 ◽  
Vol 11 (3) ◽  
pp. 861-870 ◽  
Author(s):  
Jawaher Ansari ◽  
Sumaya Alhelali ◽  
Zakariya Albinmousa ◽  
Ashraf Farrag ◽  
Arwa M. Ali ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
Cytotoxic T Lymphocyte ◽  
Imaging Techniques ◽  
Treatment Options ◽  
Vena Cava ◽  
Treatment Modalities ◽  
Rare Presentation ◽  
First Line Therapy

Intracardiac metastases in the absence of inferior vena cava involvement is a rare occurrence in patients with metastatic renal cell carcinoma (mRCC). There is limited evidence regarding the efficacy and safety of standard treatment modalities for mRCC patients with intracardiac metastases. Presence of intracardiac metastases is known to indicate poor prognosis and may potentially increase risk of treatment-related complications. Recent advances in RCC management have integrated nivolumab, a programmed death-1 (PD-1) receptor inhibitor, as a preferred treatment option in the second-line setting after failure of prior anti-angiogenic therapy; or in combination with ipilimumab, an anti-Cytotoxic T-lymphocyte antigen-4 antibody as first-line therapy for intermediate to poor risk patients with mRCC. The efficacy and toxicity of nivolumab in patients with mRCC and intracardiac metastases has never been reported previously. We herein present the first reported case of mRCC with intracardiac metastasis and a resultant excellent response to nivolumab treatment and discuss the imaging techniques and treatment options for this rare presentation.

scholarly journals The management of low-stage non-seminomatous germ cell tumors

2012 ◽  
pp. e19
Author(s):  
Louise Lim ◽  
Thomas Powles
Keyword(s):  
Germ Cell ◽  
Active Surveillance ◽  
Metastatic Disease ◽  
Adjuvant Treatment ◽  
Germ Cell Tumors ◽  
Stage I ◽  
Retroperitoneal Dissection ◽  
Number Of Patients

The prognosis of patients with stage I non-seminomatous germ cell tumors is in general very good. However, a large number of patients relapse with metastatic disease after orchidectomy Therefore, adjuvant treatment, in the form of either chemotherapy or retroperitoneal dissection is recommended, although active surveillance has been found to be as good a way of treating these patients with overall excellent results.

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