Mortality and Risk Factors for Bacteremia in Patients with Cutaneous T-Cell Lymphoma (CTCL) at Emory University

Introduction: Patients (pts) with CTCL have disruption in their skin barrier and are at increased risk for cutaneous infections. In particular, staphylococcal infections are common in pts with CTCL and are associated with pathogenesis of the lymphoma. Previous studies have identified extra-cutaneous involvement of lymphoma as the most important independent risk factor for recurrent skin infection, bacteremia, and death from infection. However, the risk of mortality with bacteremia and risk factors for developing bacteremia in CTCL have not been fully elucidated. We aimed to explore risk factors for bacteremia and subsequent mortality in pts with CTCL at Emory University. Methods: We conducted a single center retrospective analysis at the Winship Cancer Institute of Emory University analyzing CTCL pts from 01/01/1990 - 06/01/2019. We selected pts from an existing cutaneous lymphoma database and separated them by presence or absence of bacteremia at any point following diagnosis. Bacteremia was defined as identification of at least one microbe in the bloodstream on culture. The primary objective was to assess 90-day mortality among pts with CTCL with bacteremia. Secondary objectives included assessing patterns of care in bacteremic pts, identifying risk factors for bacteremia incidence and for poor outcomes following bacteremia (defined as a composite outcome of intensive care unit stay, mortality at 90 days, or re-current hospitalization within 90 days). Additionally, we explored patterns of oral antibiotic use in the outpatient setting and their association with bacteremia incidence and outcomes. Prophylactic skin antibiotics were defined in the notes as "prophylactic" i.e. not being used to treat active cellulitis or other infections. Categorical variables were analyzed with chi-squared tests. Results: 184 of 549 pts identified from our cutaneous lymphoma database were included in our analysis. Patients were excluded for lack of follow up or missing data. The median age was 57. Most pts had mycosis fungoides (n=137), followed by Sézary syndrome (n=20), CTCL, NOS (n=12), and CD30+ variants (n=6). 85 pts were early stage, and 87 were advanced stage (stage 2B n=41; 3 n=16; 4 n= 30) at diagnosis. 37 of 184 pts (20.1%) developed bacteremia. 95 pts used intermittent skin prophylactic antibiotics in the outpatient setting, 84 did not, and 5 were unknown. A total of 101 bacteremic episodes were noted (range of 1-10 per pt). The most common organisms were Staphylococcus species (sp) (MRSA n=21, MSSA n=10, other staph n=10). Other organisms included Corynebacterium sp., Enterococcus sp., Acinetobacter sp., Pseudomonas sp., and Escherichia-coli. Polymicrobial bacteremias were noted in 23 pts (28.8%). 42 (40%) had concurrent positive skin/wound . 69 pts (86.3%) were taking oral at the time of bacteremia. 71 pts were hospitalized for bacteremia (88.8%), and 41 pts (51.3%) had a recurrent admission within 90 days of discharge. 45 pts (56.3%) had invasive lines prior to bacteremia, and 44 of these had them removed following bacteremia. 71 (88.8%) cases were treated with appropriate antibiotic coverage. 56 pts were receiving active disease therapy at the time of bacteremia (70%), including 33 who were receiving systemic therapy. Intermittent prophylactic antibiotic use was highly associated with development of bacteremia (p < 0.001, table 1), as was advanced stage (12.8% early stage patients developed bacteremia compared to 29.9% of advanced stage, p=0.005). Prior systemic therapy, and in particular chemotherapy was associated with increased incidence of bacteremia (31 of 106 (29.2%) patients treated with chemotherapy developed bacteremia, p=0.0003) Extra-cutaneous disease was not associated with bacteremia in our analysis. The 90-day mortality among CTCL pts developing bacteremia was 11.25%. Conclusions This is the largest study assessing outcomes and risk factors for bacteremia in CTCL in the modern era. We confirmed that bacteremia is associated with high rates of re-admission, recurrent infection, and 90-day mortality, and identified advanced stage and use of chemotherapy as risk factors associated with bacteremia. The positive association of prophylactic antibiotics with bacteremia likely represents increased prescribing of skin prophylaxis among those at higher risk for bacteremia. Uni-variate, multivariate, and survival analyses will be updated at the time of the presentation. Disclosures Lechowicz: Kyowa: Consultancy.

Download Full-text

Preoperative Lymphocyte-to-monocyte Ratio and CA125 Level as Risk Factors for Advanced Ovarian Cancer

10.21203/rs.3.rs-77009/v1 ◽

2020 ◽

Author(s):

Ying Tang ◽

Huiquan Hu ◽

Yalan Tang ◽

Fangxiang Tang ◽

Dan Lin ◽

...

Keyword(s):

Risk Factors ◽

Ovarian Cancer ◽

Logistic Regression ◽

Early Stage ◽

Advanced Ovarian Cancer ◽

High Specificity ◽

Advanced Stage ◽

Binary Logistic Regression Model ◽

Lymphocyte To Monocyte Ratio ◽

The Relationship

Abstract Background: Detailed descriptions of the relationship between lymphocyte-to-monocyte ratio alone and combined with CA125 (COLC) and advanced stage of ovarian cancer (OC) have been lacking to date. This study is to analyze the relationship between LMR, CA125 and COLC and advanced stage of OC.Methods: A retrospective clinicopathologic review was performed. The receiver-operating characteristic (ROC) curves of LMR, CA125, and COLC staging OC were constructed. Furthermore, a binary logistic regression model was used to assay the independent risk factors.Results: A total of 225 patients with OC were identified in this cohort. Eighty-five patients with OC were diagnosed at an early stage, and 140 OC patients were diagnosed at an advanced stage. The median of LMR at the early stage was higher than the advanced stage (4.39 vs. 2.78), and the median of CA125 was lower than the advanced stage (80 U/mL vs. 251.25 U/mL). Multivariate logistic regression indicated that LMR (OR=0.314, 95% confidence interval [CI]: 0.143–0.687, P=0.004) and CA125 (OR=4.045, 95%CI: 1.883–8.692, P<0.001) were associated with OC staging. Furthermore, the area under the curve of COLC was higher than that of LMR (0.779 vs. 0.732) or CA125 (0.779 vs. 0.708) in staging OC. The specificity of COLC was higher than that of LMR (87.11% vs. 70.61%) or CA125 (87.11% vs. 61.21%) in staging OC.Conclusions: LMR alone or in combination with CA125 might be associated with OC staging. Besides, as a predictive factor, COLC may have high specificity in staging OC.

Download Full-text

Inapropriate Use of Antibiotics Effective Against Gram Positive Microorganism in Under Restrictive Antibiotic Policies in ICU; A Prospective Observational Study

10.21203/rs.2.21842/v2 ◽

2020 ◽

Author(s):

Hasan Selçuk Özger ◽

Dolunay Merve Fakıoğlu ◽

Kübra Erbay ◽

ASLINUR ALBAYRAK ◽

Kenan Hızel

Keyword(s):

Risk Factors ◽

Antibiotic Use ◽

Quality Parameters ◽

Categorical Variables ◽

Solid Organ ◽

Gram Positive ◽

Inappropriate Use ◽

Positive Spectrum ◽

Surgical Icus ◽

Bed Capacity

Abstract Background Gram-positive spectrum antibiotics such as vancomycin, teicoplanin, daptomycin ,and linezolid are frequently used in empirical treatment combinations in critically ill patients Although they are included in the national antibiotic restriction program, thought to be inappropriate, unnecessary and suboptimal use is high due to their widespread use. In our study, in addition to their widespread use, gram-positive spectrum antibiotics were evaluated due to their use in more limited and clear clinical indications. This study aims to determine the frequency of inappropriate uses of gram-positive spectrum antibiotics and risk factors for inappropriate use according to different quality parameters. Methods This clinical study was conducted prospectively between 01.10.2018 and 01.10.2019 in the medical and surgical ICUs of Gazi University Faculty of Medicine Hospital with a total bed capacity of 55. Patients older than 18 years of age onset of gram-positive spectrum antibiotics (vancomycin, teicoplanin, linezolid ,and daptomycin) were included. Patients under the age of eighteen or immunosuppressed (neutropenic, HIV-infected patients with hematologic or solid organ malignancies) were not included in the study. The demographic and clinical features of the patients were recorded. The treatment was also evaluated and recorded by 2 infectious diseases specialists and 2 clinical pharmacists except for the clinical staff at 24-hour intervals from the first day to the last day of treatment. SPSS software for Windows, version 17 (IBM, Armonk, NY) was used to analyze the data. Categorical variables are presented as number and percentage, and non-categorical variables are presented as mean ± standard deviation. Results In the use of antibiotics, the incidence of non-compliance with at least one of the determined quality parameters was 83%. Multivariate analysis was performed to evaluate risk factors for inappropriate antibiotic use, and creatine values were found to increase the risk of inappropriate antibiotic use. Conclusions In spite of the restricted antibiotic program, inappropriate antibiotic use in ICUs is quite common. In particular, it is necessary to establish local guidelines in collaboration with different disciplines for the determination and follow-up of de-escalation and optimal treatment doses

Download Full-text

Role of Chemotherapy and Targeted Therapy in Early-Stage Non–Small Cell Lung Cancer

American Society of Clinical Oncology Educational Book ◽

10.1200/edbk_175188 ◽

2017 ◽

pp. 630-639

Author(s):

Shirish M. Gadgeel

Keyword(s):

Lung Cancer ◽

Adjuvant Chemotherapy ◽

Systemic Therapy ◽

Early Stage ◽

Small Cell ◽

Advanced Stage ◽

Targeted Agents ◽

Small Cell Lung ◽

Early Stage Nsclc ◽

Platinum Based Chemotherapy

On the basis of several randomized trials and meta-analyses, adjuvant chemotherapy is the accepted standard of care for certain patients with early-stage non–small cell lung cancer (NSCLC). Patients with stage II, IIIA, or large (≥ 4 cm) IB tumors are candidates for adjuvant chemotherapy. The survival improvement with adjuvant chemotherapy is approximately 5% at 5 years, though certain trials have suggested that it can be 8% to 10%. Neoadjuvant chemotherapy also has shown a survival advantage, though the volume of data with this approach is far less than that of adjuvant chemotherapy. The combination of cisplatin and vinorelbine is the most well-studied regimen, but current consensus is to use four cycles of any of the platinum-based chemotherapy regimens commonly used as front-line therapy for patients with advanced-stage NSCLC. Trials to define biomarkers that can predict benefit from adjuvant chemotherapy have not been successful, but results of other such trials are still awaited. On the basis of the benefit observed with targeted agents in patients with advanced-stage disease and driver genetic alterations in their tumors, ongoing trials are evaluating the utility of these targeted agents as adjuvant therapy. Similarly, clinical benefit observed with checkpoint inhibitors has prompted assessment of these drugs in patients with early-stage NSCLC. It is very likely, in the future, that factors other than the anatomy of the tumor will be used to select patients with early-stage NSCLC for systemic therapy and that the choice of systemic therapy will extend beyond platinum-based chemotherapy.

Download Full-text

Thrombosis in Hodgkin Lymphoma Patients: Incidence, Time Points, Risk Factors and Impact of Stage and Treatment

Blood ◽

10.1182/blood.v128.22.4151.4151 ◽

2016 ◽

Vol 128 (22) ◽

pp. 4151-4151

Author(s):

Sven Borchmann ◽

Ida Hude ◽

Horst Müller ◽

Heinz Haverkamp ◽

Carolin Bürkle ◽

...

Keyword(s):

Risk Factors ◽

Potential Risk ◽

Early Stage ◽

Significant Risk ◽

Incidence Rates ◽

Comprehensive Analysis ◽

Advanced Stage ◽

Vein Thrombosis ◽

Potential Risk Factors ◽

Prophylactic Anticoagulation

Abstract Thrombotic events are regularly observed in patients receiving treatment for Hodgkin Lymphoma (HL). However, sound data on incidence and risk factors are not known. The aim of the present study was thus to provide a comprehensive analysis of thrombotic events after multimodality treatment for HL. A total of 5,773 patients ≤ 60 years treated within the German Hodgkin Study Group (GHSG) trials HD13-15 between January 2003 and December 2009 were included in this analysis. All reported venous and arterial thrombotic events occurring within 1 year after trial enrollment were evaluated and detailed information on patient characteristics, localizations, time of occurrence and risk factors were collected. We excluded thromboses of superficial veins and thrombophlebitis. Descriptive statistics and logistic regression were used for statistical analysis. A total of 193 thrombotic events occurred for an incidence of 3.3%; there were 11 events in early-favorable, 27 in early-unfavorable and 155 in advanced stage HL, resulting in incidence rates of 0.7%, 1.3% and 7.3%, respectively. The incidence in advanced stage HL was significantly higher than in early stage HL (p<0.001); 175 events were venous and 18 arterial. The most common venous events consisted of arm vein thrombosis in 49.1% (n=86), DVT in 29.1% (n=51), PE in 13.1% (n=23) and sinus vein thrombosis in 1.7% (n=3) of cases. The most common arterial events were MI in 55.6% (n=10), lower extremities arterial thromboembolism in 22.2% (n=4) and CVI in 16.7% (n=3) of cases. 30.6% (n=59) of events were associated with intravenous catheters, 8.8% (n=17) were likely due to tumor compression and 1.0% (n=2) occurred despite prophylactic anticoagulation. We found that 2.6% (n=5), 77.2% (n=149) and 20.2% (n=39) of cases occurred before, during and after chemotherapy respectively. In advanced HL patients treated with 8 x BEACOPPesc, 6 x BEACOPPesc or 8 x BEACOPP-14 , the incidence rates were 6.2% (n=44), 5.5% (n=39) and 10.1% (n=72) respectively. The incidence in patients treated with BEACOPP-14 was significantly higher than in patients treated with the other two regimens (p<0.01). Opposed to rather evenly distributed events during chemotherapy with BEACOPPesc, thromboses during treatment with BEACOPP-14 occurred more frequently at the beginning of chemotherapy. We then analyzed potential risk factors in advanced stage patients using logistic regression analysis, adjusting for treatment in order to identify a high-risk group for developing a thrombotic event. The well-established Khorana score was not associated with a higher risk of thrombosis (odds ratio (OR) per unit [95% confidence interval]: 0.91 [0.76-1.1], p=0.33). Additionally, we screened 21 potential risk factors, including the thrombocyte-to-lymphocyte ratio. Only age (OR per year: 1.02 [1.01-1.03], p=0.01) and smoking (OR: 1.61 [1.07-2.43], p=0.02) emerged as significant risk factors. None of the other following potential risk factors was prognostic: thrombocyte-to-lymphocyte ratio, thrombocytes, leukocytes, lymphocytes, hemoglobin, albumin, WHO activity index, erythropoietin treatment, sex, body mass index, B-symptoms, erythrocyte sedimentation rate, extranodal disease, large mediastinal mass, more than 2 affected areas or Ann Arbor stage (all p≥0.10). Yet, when only including venous events, which are potentially preventable by prophylactic anticoagulation, neither age nor smoking were significant risk factors anymore (p≥0.10). This study is the largest and most comprehensive analysis of thrombotic events in HL patients to date. Compared to both, early-favorable and early-unfavorable HL, advanced stage patients are at higher risk for thrombotic events. The most widely used Khorana score estimating thrombosis risk in cancer outpatients was not prognostic in the HL population investigated here. This is unsurprising considering the young age of the patient population investigated. Other risk factors were also not prognostic. This data does not imply a need for prophylactic anti-coagulation in outpatients treated for early-stage HL. In advanced-stage HL patients, routine prophylactic anticoagulation is not warranted. However, individual patients with additional risk factors that could not be evaluated such as history of thrombosis or reduced mobility might still benefit from prophylactic treatment. Disclosures Engert: Takeda, BMS: Consultancy, Honoraria, Research Funding.

Download Full-text

Risk Factors for Progression from Early to Advanced Stage Mycosis Fungoides: A Single Center Retrospective Analysis at the Winship Cancer Institute of Emory University

Blood ◽

10.1182/blood-2021-146590 ◽

2021 ◽

Vol 138 (Supplement 1) ◽

pp. 1378-1378

Author(s):

Pamela Allen ◽

Ashley Alesia McCook ◽

Jeffrey M. Switchenko ◽

Shaunak Varma ◽

Mary Jo Lechowicz ◽

...

Keyword(s):

Blood Flow ◽

Median Survival ◽

Early Stage ◽

Peripheral Blood Flow ◽

Advanced Stage ◽

Stage At Diagnosis ◽

Risk Of Death ◽

Disease Characteristics ◽

Increased Risk ◽

Emory University

Abstract Introduction: Advanced stage mycosis fungoides (MF) has a median survival of 3-5 years, while early stage MF is a chronic disease typically associated with an excellent prognosis and a median survival of 20 years or more. Prior studies suggest approximately 20% of early stage MF may progress to advanced stage, but risk factors for progression remain poorly studied, particularly among African American (AA) patients. We aimed to identify clinic features associated with progression to advanced stage MF in a large urban medical center. Methods We performed a retrospective review of 388 patients with early stage (1A-2A) MF at the Winship Cancer Institute of Emory University diagnosed between 1970 and 2021. Clinical data collected from the electronic medical record included demographics, laboratory values, disease characteristics, and therapy. Our primary endpoint was to identify variables associated with progression to advanced stage MF. Progression to advanced stage was defined as a highest overall TNMB stage of 2B-4B. Overall survival (OS) was measured from time of diagnosis to date of death or last follow-up. Kaplan-Meier curves for OS were generated for the whole cohort and by progression group. Descriptive analysis was performed for each variable, and a comparison between patients who did or did not progress to advanced stage was performed using ANOVA for numerical covariates and chi-square test for categorical covariates. The association of baseline variables with OS was modeled by Cox proportional hazards model and multivariable analyses were performed on significant variables. Results Among 388 patients, the median follow up was 5 years (range 0-51). There was even distribution among male (49.0%) and female (51.0%) patients. The median age at diagnosis was 53 years (range 8-95). This population included 41.4% AA, 55.0% White, 2.3% Asian, and 1.3% other races. Stage distribution was as follows: 34.2% (n=133) stage 1A, 51.5% stage 1B (n=200), and 14.2% stage 2A (n=55). Forty-nine patients had hypopigmented MF (45 AA), and 9.4% (n=34) patients developing large cell transformation (LCT) during their disease course. Treatment at diagnosis was topical in 52.3% (n=203), systemic in 1.8% (n=7), radiation in 3.4% (n=13), and multimodality in 29.4% (n=114). Overall, 93 patients (24.1%) progressed to advanced stage. Progression to a higher stage was statistically associated with higher overall TNMB stage at diagnosis (p<0.001), T2 tumor stage (p<0.001), nodal involvement (p=0.031), positive blood flow cytometry (<0.001), T-cell receptor (TCR) clonality in the blood (p=0.014), LCT (p<0.001), and elevated lactate dehydrogenase (LDH) (p<0.001). Patients with hypopigmented MF were less likely to progress (hazard ratio 0.32 (95% CI 0.12-0.84) p=0.020), Sex, race, age, blood stage, and white blood cell count were not associated with risk for progression. Univariate logistic regression is summarized in figure 1. Progression to advanced stage was associated with an increased risk of death (4.75 (0.05-7.38), p < 0.001, figure 2). The median survival for patients who did and did not progress were 11 years (95% CI 7, 15) and 31 years (95% CI 25, not reached), p<0.001 respectively. Other factors associated with an increased risk of death included age > 60 (p <0.001), higher TNMB stage at diagnosis (log rank p<0.001), advanced nodal stage, (p=0.005), positive peripheral blood flow (p=0.010), TCR clonality in the blood (p=0.039), LCT (p< 0.001), elevated LDH (p<0.001), and elevated WBC (p<0.001), while hypopigmented MF was associated with a decreased risk of death (0.28 (0.09-0.90), p=0.021). On multivariable survival analysis controlling for hypopigmented MF, LCT, and stage at diagnosis, only age > 60 (3.32 (2.00-5.51), p<.001) and progression to advanced stage (4.02 (2.38-6.79), p<0.001) remained statistically significant. Conclusions We demonstrate that progression to advanced stage is associated with several baseline laboratory and disease characteristics, which bear immediate clinical relevance to the work up and staging of early stage MF. These data suggest that consistent staging and laboratory analyses with imaging for lymph node assessment, peripheral blood flow cytometry, and TCR in all newly diagnosed MF patients may aid in identifying patients at risk for progression to advanced stage disease. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

Download Full-text

COMPARISON OF POLYMORPHISM rs2070672 CYP2E1 GENE PROPORTION IN EARLY AND ADVANCED STAGE OF UNDIFFERENTIATED TYPE NASOPHARYNGEAL CARCINOMA IN BALINESE

INTERNATIONAL JOURNAL OF NASOPHARYNGEAL CARCINOMA (IJNPC) ◽

10.32734/ijnpc.v2i01.2652 ◽

2020 ◽

Vol 2 (01) ◽

pp. 10-12

Author(s):

I Ketut Suanda ◽

I Gde Ardika Nuaba ◽

Ni Putu Ayu Wiarni Susanthi

Keyword(s):

Risk Factors ◽

Nasopharyngeal Carcinoma ◽

Early Stage ◽

Advanced Stage ◽

Chi Square ◽

Cross Sectional ◽

Cyp2e1 Gene ◽

Undifferentiated Type ◽

Chi Square Test ◽

Common Malignancy

Introduction: Nasopharyngeal carcinoma is the most common malignancy in the ENT field. The cause of nasopharyngeal carcinoma is multifactorial. One of the risk factors for an increase in nasopharyngeal carcinoma is the rs2070672 polymorphism of the CYP2E1gene. Purpose: To determine the rs2070672 CYP2E1gene polymorphism proportion in early and advanced stage undifferentiated type NPC subjects in Balinese. Method: This research is a cross sectional comparative study. The case population were all subjects with undifferentiated type NPC in the ENT outpatient clinic at Sanglah General Hospital Denpasar. This study uses 65 samples. Data collected in the form of subject characteristics and rs2070672 CYP2E1gene polymorphisms which examined by ARMS-PCR technique. Results: The average age of the sample was 48.1 years, the most were male as many as 48 subjects (73.8%), and the highest was advanced stage as many as 56 subjects (86.2%). In the chi square test the proportion of polymorphisms in the advanced stage was 2.357 times higher than the early stages. The results of multivariate analysis using logistic regression proved that the rs2070672 CYP2E1gene polymorphism at advanced stage was 7.469 times higher than early stage. Conclusion: There is a difference in the proportion of rs2070672 CYP2E1gene polymorphism in undifferentiated type NPC of Balinese, where advanced stage is higher than early stage.

Download Full-text

Inapropriate Use of Antibiotics Effective Against Gram Positive Microorganism in Under Restrictive Antibiotic Policies in ICU; A Prospective Observational Study

10.21203/rs.2.21842/v1 ◽

2020 ◽

Author(s):

Hasan Selçuk Özger ◽

Dolunay Merve Fakıoğlu ◽

Kübra Erbay ◽

ASLINUR ALBAYRAK ◽

Kenan Hızel

Keyword(s):

Risk Factors ◽

Antibiotic Use ◽

Quality Parameters ◽

Categorical Variables ◽

Solid Organ ◽

Gram Positive ◽

Inappropriate Use ◽

Positive Spectrum ◽

Surgical Icus ◽

Bed Capacity

Download Full-text

Perceptions of vascular access for intravenous systemic therapy and risk factors for lymphedema in early-stage breast cancer— a patient survey

Current Oncology ◽

10.3747/co.25.3911 ◽

2018 ◽

Vol 25 (4) ◽

Cited By ~ 2

Author(s):

N. LeVasseur ◽

C. Stober ◽

M. Ibrahim ◽

S. Gertler ◽

J. Hilton ◽

...

Keyword(s):

Breast Cancer ◽

Risk Factors ◽

Vascular Access ◽

Systemic Therapy ◽

Perceived Risk ◽

Early Stage ◽

Patient Survey ◽

Early Stage Breast Cancer ◽

Evidence Based ◽

Central Catheter

Background The choice of vascular access for systemic therapy administration in breast cancer remains an area of clinical equipoise, and patient preference is not consistently acknowledged. Using a patient survey, we evaluated the patient experience with vascular access during treatment for early-stage breast cancer and explored perceived risk factors for lymphedema.Methods Patients who had received systemic therapy for early-stage breast cancer were surveyed at 2 Canadian cancer centres.Results Responses were received from 187 patients (94%). The route of vascular access was peripheral intravenous line (IV) in 24%, a peripherally inserted central catheter (picc) in 42%, and a surgically inserted central catheter (port) in 34%. Anthracycline-based regimens were associated with a greater use of central vascular access devices (cvads— that is, a picc or port; 86/97, 89%). Trastuzumab use was associated with greater use of ports (49/64, 77%). Although few patients (7%) reported being involved in the decisions about vascular access, most were satisfied or very satisfied (88%) with their access type. Patient preference centred mainly on avoiding delays in the initiation of chemotherapy. Self-reported rates of complications (183 evaluable responses) were infiltration with peripheral IVs (9/44, 20%), local skin infections with piccs (7/77, 9%), and thrombosis with ports (4/62, 6%). Perceived risk factors for lymphedema included use of the surgical arm for blood draws (117/156, 75%) and blood pressure measurement (115/156, 74%).Conclusions Most patients reported being satisfied with the vascular access used for their treatment. Improved education and understanding about the evidence-based requirements for vascular access are needed. Perceived risk factors for lymphedema remain variable and are not evidence-based.

Download Full-text

Approaching the tumor microenvironment in patients with advanced hepatocellular carcinoma using needle biopsy samples.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.3_suppl.334 ◽

2021 ◽

Vol 39 (3_suppl) ◽

pp. 334-334

Author(s):

Hiroaki Kanzaki ◽

Sadahisa Ogasawara ◽

Keisuke Koroki ◽

Kazufumi Kobayashi ◽

Soichiro Kiyono ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Tumor Microenvironment ◽

Hepatic Resection ◽

Systemic Therapy ◽

Needle Biopsy ◽

Early Stage ◽

Pathological Examination ◽

Advanced Hepatocellular Carcinoma ◽

Advanced Stage ◽

Advanced Hcc

334 Background: Currently, combined immunotherapy of atezolizumab (anti-PD-L1 antibody) plus bevacizumab (a humanized anti-VEGF monoclonal antibody) is the standard first-line treatment in patients with advanced hepatocellular carcinoma (HCC). At the threshold of this new era, there is limited information about tumor microenvironment (TME) in advanced HCC. Several studies on TME in HCC have analyzed samples obtained via hepatic resection. In general, hepatic resection is indicated for patients with limited size and number of intrahepatic nodules, i.e., early stage HCC. In contrast, most patients who have an indication for systemic therapy have developed macroscopic vascular invasion (MVI) or/and extrahepatic metastasis, namely in advanced stage HCC. Progression from an early stage HCC to an advanced stage HCC involves a lengthy clinical course, therefore, the TME at the time of initial diagnosis may differ from that at the time of systemic therapy indication. The present study was aimed to analyze the TME by using needle biopsy samples obtained prior to initiation of systemic therapy in patients with advanced HCC. Methods: Between March 2019 and May 2020, 80 patients underwent liver tumor biopsy at the time of indication for systemic chemotherapy. HCC was confirmed via pathological examination in 70 patients and their samples were analyzed. Microsatellite instability (MSI) was evaluated using polymerase chain reaction. Programed death-ligand 1 (PD-L1) expression and the levels of tumor-infiltrating lymphocytes (TIL) were evaluated using immunohistochemical staining. PD-L1 expression was defined as per the tumor proportion score (TPS; the number of PD-L1-positive cells/total number of tumor cells) and was classified as low (TPS < 1%) or high (TPS >1%). Levels of TIL were defined as the mean number of CD8-positive lymphocytes in the tumor per 1 mm2 and classified as low or high using the median value. Results: Out of the 70 tumors, one was MSI-high and 69 were MSI-negative. The PD-L1 expression was < 1% in 50 samples, 1%–10% in 12, 11%–20% in 7, and 21%–30% in 1. The median level of TIL was 266/mm2. PD-L1highTILhighwas present in 20.0%, PD-L1lowTILlowin 38.5%, PD-L1highTILlowin 8.6%, and PD-L1lowTILhighin 32.9%. In the MSI-high tumor, PD-L1 expression was < 1% and the level of TIL was 142/mm2. High PD-L1 expression and high levels of TIL were associated with hepatitis C virus infection, high alpha-fetoprotein levels, and presence of MVI respectively. We are currently performing RNA-sequencing in order to obtain more details about TME in patients with advanced HCC. Conclusions: MSI-high advanced HCC was detected in 1.4% patients and was not necessarily associated with a “hot” immune microenvironment. PD-L1 expression and levels of TIL were associated with some clinical parameters. In the present study, we also reported the changes in the TME over time.

Download Full-text

Impact of the COVID-19 pandemic on staging at presentation of patients with invasive melanoma.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e21579 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e21579-e21579

Author(s):

Saba Shaikh ◽

Xi Yang ◽

Dylan Fortman ◽

Hong Wang ◽

Diwakar Davar ◽

...

Keyword(s):

Systemic Therapy ◽

Early Stage ◽

Stage I ◽

Stage Iii ◽

Categorical Variables ◽

Early Stage Disease ◽

Metastatic Recurrence ◽

Stage Disease ◽

Significant Difference ◽

The Impact

e21579 Background: The COVID-19 pandemic has impacted cancer care beyond the direct implications of viral infection. Delays in presentation and diagnosis may lead to more advanced disease and worse patient outcomes. We evaluated the impact of the pandemic on patients (pts) with melanoma (mel). Methods: A single-institution, retrospective comparison of pts with newly diagnosed invasive mel or metastatic recurrence prior to (pre-cohort, n = 246) and after (post-cohort, n = 246) declaration of the COVID-19 pandemic on March 11, 2020. 492 pts were evaluated between March 1, 2019 and January 12, 2021. Key variables collected included demographics, pathology, stage at diagnosis, surgical management, receipt of adjuvant or systemic therapy, and follow up. Categorical variables were compared using the two-sided Fisher’s exact test, continuous variables were compared using the two-sided Wilcoxon rank sum test, and survival endpoints were evaluated with the Kaplan-Meier method. This study was exempt from review by the IRB. Results: 200 (81.3%) pts presented with early-stage disease and 46 (18.7%) pts presented with metastatic disease in the post-cohort, compared to 209 (85%) and 37 (15%) pts in the pre-cohort, respectively. In the post-cohort there was a significant decrease in stage I pts (28.5% vs 40.7%, p = 0.006), a significant increase in stage III pts (30.5% vs 21.1%, p = 0.023), and a significant increase in pts with metastatic recurrence (7.7% vs 3.3%, p = 0.046) compared to the pre-cohort. There was also a significant increase in pts with brain metastases (BM) in the post-cohort (6.5% vs 1.6%, p = 0.010). For pts with early-stage disease, there was a significant increase in median Breslow depth (2.0 vs 1.4 mm, p = 0.047) and mitotic rate > 1 (78.1% vs 66%, p = 0.008) in the post-cohort. There were trends toward increased ulceration, lymphovascular/perineural invasion, and microsatellite presence. Pts receiving adjuvant therapy in the post-cohort were significantly more likely to receive oral targeted therapy (37.6% vs 27.5%) compared to IV immunotherapy (62.4% vs 72.5%), p = 0.034, perhaps reflecting an attempt to minimize in-person visits. There was not a significant difference between the 2 groups in the type of systemic therapy administered in the metastatic setting. Median progression-free and overall survival were not reached due to a limited number of events in each arm. Conclusions: There was a significant decrease in pts with stage I mel along with a significant increase in pts with stage III mel, metastatic recurrence, and BMs presenting to our institution during the pandemic. Findings are likely related to delays from both the patient (to avoid interaction with the healthcare system - including primary care, dermatology, and oncology) and from the system itself, with some clinics potentially evaluating pts in a limited capacity. These data reaffirm the importance of early detection and evaluation of melanoma.

Download Full-text