Factors That Determine Overall Survival among Patients (Pts) with Multiple Myeloma (MM) Treated with Zoledronic Acid (ZOL): Lack of Skeletal-Related Events (SREs) and Occurrence of Osteonecrosis of the Jaw (ONJ) Predict Improved Survival.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 4842-4842
Author(s):  
James R. Berenson ◽  
Ori Yellin ◽  
John Crowley ◽  
Herbert Duvivier ◽  
Youram Nassir ◽  
...  
Keyword(s):  
Overall Survival ◽  
Prognostic Factors ◽  
Serum Creatinine ◽  
Serum Calcium ◽  
Treatment Options ◽  
Elevated Serum ◽  
Time Dependent ◽  
Stage Ii ◽  
The Past ◽  
New Treatment

Abstract New treatment options have greatly improved the overall survival for MM pts. Although many baseline prognostic factors have been identified among pts with MM in the past, few studies have evaluated prognostic factors during the past five years when these new treatment options became available. Included in the newer regimens for myeloma pts is the use of monthly infusions of ZOL to reduce skeletal complications for MM pts. During this time of changes in the therapy for MM pts, complications associated with administration of bisphosphonates have been reported among MM pts. The outcome for patients with these complications has not been well-defined. The goal of this study was to identify baseline and on-treatment prognostic factors for determining overall survival of MM pts treated with ZOL. The inclusion criteria for this study included a diagnosis of MM and having received at least one dose of ZOL in our clinic. One hundred consecutive pts were analyzed in this retrospective study. The median survival of this group was 117 months. Risk factors for an earlier death included occurrence of a SRE (hazard ratio [HR] = 3.06), increased serum creatinine (HR = 3.35), elevated serum calcium (HR = 2.60), and ISS Stage II or III at diagnosis (HR = 2.04). Notably, diabetes was found to be a significant risk factor for SREs but not overall survival (P = 0.022). Ten pts developed ONJ, of whom nine are alive and one died in remission (non-MM-related). The 2-year incidence of ONJ was approximately 5%. There was a trend toward increased risk of ONJ for diabetes, smoking, and alcohol use. When evaluating the course of ONJ, only one pt showed progression, while six improved or resolved, and three remained stable. All but one pt with ONJ remain on monthly ZOL therapy. In regards to the disease status of the nine pts surviving with ONJ, five are in complete remission, two with ongoing partial responses, and two have stable disease. The skeletal morbidity rate (SMR) was only 0.16 SRE/year among all 100 pts analyzed. Notably, pts with ONJ had a lower SMR (0.07 SRE/year) than the 90 pts treated with ZOL who did not develop ONJ (0.18 SRE/year). Importantly, overall survival was superior among pts with ONJ versus pts without ONJ in this study when analyzed both by a landmark analysis and in a time-dependent fashion. Thus, development of new SREs, elevated serum creatinine, increased serum calcium and ISS Stage II or III at diagnosis predicted for an earlier death. With active monitoring for ONJ and early input from dental experts, ONJ has been mild to moderate in severity, had minimal impact on overall quality of life, and improved or healed in the majority of pts. In this study, absence of SREs (time-dependent) and occurrence of ONJ were associated with an improved overall survival (P ≤ .01 for each). These results suggest that with proper management, ONJ is a manageable, infrequent complication of ZOL that may be associated with a reduced SRE risk and improved overall survival. This study also suggests the avoidance of SREs is associated with an increased life expectancy; and, thus, reduction in these events through ongoing bisphosphonate therapy is important in the overall management of MM pts.

Factors that determine survival among patients with multiple myeloma (MM) treated with zoledronic acid (ZOL)

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e19519-e19519
Author(s):  
O. Yellin ◽  
J. Crowley ◽  
R. A. Swift ◽  
A. Makary ◽  
D. S. Gravenor ◽  
...  
Keyword(s):  
Overall Survival ◽  
Prognostic Factors ◽  
Treatment Options ◽  
Elevated Serum ◽  
Osteonecrosis Of The Jaw ◽  
Morbidity Rate ◽  
Diabetic Patients ◽  
Increased Risk ◽  
Skeletal Complications ◽  
New Treatment

e19519 Background: Although the overall survival of MM patients has improved with new treatment options, few studies have evaluated prognostic factors since these new therapies have become available. Monthly ZOL has been incorporated into many of these regimens to reduce skeletal complications. Side effects from ZOL have been reported but their frequency and outcomes have not been well-defined. This retrospective study aimed to identify key baseline and on-treatment prognostic factors among MM patients treated with ZOL. Methods: Three hundred patient charts were consecutively reviewed. Data was collected from the date of MM diagnosis to the date of chart review. Patient chart inclusion criteria required a diagnosis of MM and having received at least one dose of ZOL. Results: The median survival of among patients in this study was 131 months. Significant early risk factors for overall survival included skeletal-related events (SRE), increased serum creatinine, elevated serum calcium, and ISS Stage II or III at diagnosis. Fourteen patients (4.7%) developed osteonecrosis of the jaw (ONJ) after 9–96 months of ZOL treatment. Notably, there was a trend toward an increased risk of ONJ among diabetic patients. Thirteen patients with ONJ remain alive and currently are in remission or with stable disease. One patient with ONJ died while in remission from a myocardial infarction. Among the patients with a follow up of 4–49 months from the diagnosis of ONJ, 2 showed some worsening of this complication, 5 remained stable, while 7 improved or resolved. Patients with ONJ showed an improved overall survival using both landmark and time-dependent analysis. In addition, the overall skeletal morbidity rate (SMR; SREs/year) was 0.16. Notably, patients who developed ONJ had a lower SMR than among patients who did not develop ONJ. Conclusions: These results suggest that skeletal complications are an important prognostic factor for MM. Although ONJ occurs in MM patients, most patients show improvement with proper management and this complication appears to be associated with a reduced risk of SREs and improved overall survival. [Table: see text]

scholarly journals Prognostic factors for pulmonary metastasectomy in malignant melanoma: size matters

2019 ◽  
Vol 56 (6) ◽  
pp. 1104-1109 ◽  
Author(s):  
Jan Viehof ◽  
Elisabeth Livingstone ◽  
Elena Loscha ◽  
Paul Stockhammer ◽  
Agnes Bankfalvi ◽  
...  
Keyword(s):  
Overall Survival ◽  
Prognostic Factors ◽  
Survival Rate ◽  
Malignant Melanoma ◽  
Treatment Options ◽  
Pulmonary Metastasectomy ◽  
Long Term Outcome ◽  
Female Patients ◽  
Novel Treatment ◽  
The Impact

AbstractOBJECTIVESPulmonary metastasectomy for malignant melanoma requires an individualized therapeutic decision. Due to recently developed novel treatment options, the prognosis of patients with melanoma has improved significantly. Validated prognostic factors that identify patients who are most likely to benefit from metastasectomy are urgently needed.METHODSWe retrospectively reviewed all consecutive patients with melanoma undergoing complete pulmonary metastasectomy between January 2010 and December 2016. The impact of age, sex, extrapulmonary metastases, preoperative systemic therapy, number of metastases, laterality and largest diameter of metastasis on survival after metastasectomy was analysed.RESULTSA total of 29 male and 32 female patients were included in the study. The median follow-up time was 25.6 months. The mean number of resected metastases was 1.7 ± 1.1 (range 1–5). Ten patients had repetitive pulmonary metastasectomies. The median survival time was 31.3 months with a 2-year survival rate of 54%. Bilateral metastases or multiple nodules were not associated with a significantly decreased overall survival rate after metastasectomy. Shorter overall survival times were observed in male patients [hazard ratio (HR) 2.9, 95% confidence interval (CI) 1.42–5.92; P = 0.0035] and in patients with nodules larger than 2 cm (HR 3.18, 95% CI 1.45–6.98; P = 0.004). In multivariable analysis, both gender and tumour size remained significant independent prognostic factors.CONCLUSIONSExcellent overall survival rates after pulmonary metastasectomy for melanoma metastases were observed in patients with a metastatic diameter less than 2 cm and in female patients. In view of improved long-term outcome due to novel treatment options, the selection of patients for pulmonary metastasectomy based on prognostic factors will become increasingly important.

Alteration of recurrence patterns and prognostic factors by adjuvant S-1 monotherapy in patients with stage II/III gastric cancer.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 90-90
Author(s):  
Mitsuro Kanda ◽  
Daisuke Kobayashi ◽  
Chie Tanaka ◽  
Naoki Iwata ◽  
Suguru Yamada ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Prognostic Factors ◽  
Tumor Size ◽  
Propensity Score Analysis ◽  
Treatment Options ◽  
Stage Ii ◽  
Significant Prognostic Factor ◽  
Initial Recurrence ◽  
Macroscopic Tumor ◽  
Recurrence Patterns

90 Background: Survival benefit of adjuvant S-1 monotherapy among East Asian patients with stage II/III gastric cancer (GC) has been demonstrated by the ACTS-GC trial. Little is known about the changes in prognostic factors and recurrence patterns after it has become widespread as a standard of care. Methods: We enrolled 171 patients with stage II/III GC, 92 patients who underwent gastrectomy alone, and 79 patients treated with S-1 adjuvant. To balance more strictly the essential variables including stage of progression, we conducted propensity score analysis and 70 pairs of patients were generated from each group. Prognostic factors were compared between the groups and initial recurrence patterns were investigated to explore reasons for the change. Results: In concordance with the previous phase 3 trial, overall and recurrence-free survival were better for the S-1 adjuvant group. In the surgery alone group, carcinoembryonic antigen > 5 ng/mL, total gastrectomy, vessel invasion, pT4, and stage 3 were identified as significant prognostic factors. In striking contrast, macroscopic tumor size > 50 mm was the only significant prognostic factor for the S-1 adjuvant group. The lower overall recurrence rate of the S-1 adjuvant group was attributable mainly to a significant decrease of peritoneal recurrence. Conclusions: Prognostic factors changed substantially after implementation of S-1 adjuvant treatment. Macroscopic tumor size should be considered for patient stratification and selection of treatment options for patients with stage II/III GC.

Immunotherapy of multiple sclerosis

2009 ◽  
Vol 21 (S2) ◽  
pp. 27-34 ◽  
Author(s):  
Sven G. Meuth ◽  
Stefan Bittner ◽  
Heinz Wiendl
Keyword(s):  
Multiple Sclerosis ◽  
Clinical Evidence ◽  
Treatment Options ◽  
Phase Iii ◽  
The Past ◽  
Phase Iii Clinical Trials ◽  
New Treatment ◽  
System Disorder ◽  
Immunomodulatory Therapies ◽  
Ms Therapy

Abstract:Multiple sclerosis (MS) is regarded as a prototypic inflammatory autoimmune central nervous system disorder causing neurological disability in young adults. Recommended basic immunomodulatory therapies of MS are currently interferon beta and glatiramer acetate. Both have proven to be clinically and paraclinically effective and clinical evidence suggests that treatment should be initiated as early as possible.However, despite the fact that therapeutic options for MS have significantly been widened over the past decade there is still tremendous activity in the search for new treatment options for MS.One important development in the field is reflected by the substantial number of promising results for oral therapies. Various phase III clinical trials are currently being initiated or are already underway evaluating the efficacy of a variety of orally administered agents, including cladribine, teriflunomide, laquinimod, fingolimod and fumaric acid. It is hoped that these oral therapies for MS further broaden our armament for MS therapy.

Expanding the role of perfusionists in the era of new treatment options for cardiovascular disease

Perfusion ◽  
2003 ◽  
Vol 18 (4) ◽  
pp. 253-256 ◽  
Author(s):  
Joseph J Sistino
Keyword(s):  
Cardiovascular Disease ◽  
Treatment Options ◽  
Mail Survey ◽  
Surgical Patient ◽  
The Past ◽  
The Future ◽  
The Usa ◽  
Changing Patterns ◽  
New Treatment ◽  
New Applications

Treatment for cardiovascular disease has dramatically changed the surgical patient population over the past 10 years. Advances in medical management and interventional cardiovascular procedures have delayed surgery in many adults, and the surgical pool has begun to decrease despite an aging population. This affects perfusionists in terms of new psychological and technical challenges, and has serious consequences and implications for the future of the profession. This study will review the changing patterns of diagnosis and treatment of cardiovascular disease in the USA over the past 10 years by examining the annual surgical procedure rates and correlating them with the number of practicing perfusionists and new student graduates. The purpose of this review is to project the future employment opportunities for perfusionists. The second part of the paper will look at the alternative roles perfusionists have expanded into as a result of changes in the treatment of cardiovascular disease. The results of an e-mail survey of perfusionists will be presented to identify new applications of perfusion technology.

Evidence-Based Treatments

2017 ◽  
Author(s):  
W. Curt LaFrance ◽  
Laura H. Goldstein
Keyword(s):  
Treatment Options ◽  
Controlled Trials ◽  
Limited Sample ◽  
Future Studies ◽  
Psychogenic Nonepileptic Seizures ◽  
The Past ◽  
Evidence Based Treatments ◽  
Nonepileptic Seizures ◽  
New Treatment ◽  
Functional Neurological Disorders

Psychogenic nonepileptic seizures (PNES) have been in the medical literature for centuries. However, treatments were limited, being based on uncontrolled data, until the past decade. Treatment advances published since 2010 have included pilot controlled trials using psychotherapies, psychoeducational approaches, medications, and combined pharmacological and psychotherapeutic approaches that provide new treatment options for patients with PNES. This chapter describes these controlled trials in detail. It also covers studies of treatments for other functional neurological disorders including PNES. One conclusion from this review is that future studies still need to improve on as-yet limited sample sizes and provide insights into predictors of treatment outcome so that rational decisions can be made about which treatments offer the best outcome and who is likely to best respond to which treatment.

A population-based analysis of prognostic factors in patients with advanced hepatocellular carcinoma treated with sorafenib.

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 163-163
Author(s):  
Alan D. Smith ◽  
Winson Y. Cheung
Keyword(s):  
Hepatocellular Carcinoma ◽  
Overall Survival ◽  
Prognostic Factors ◽  
Elevated Serum ◽  
Advanced Hepatocellular Carcinoma ◽  
Clinical Factors ◽  
Conventional Chemotherapy ◽  
Sorafenib Treatment ◽  
Advanced Hcc ◽  
Staging Systems

163 Background: Available clinical prognostic scoring systems for advanced hepatocellular carcinoma (HCC) were developed in the era of conventional chemotherapy. In 2008, the molecularly targeted agent sorafenib became the new standard of care for advanced HCC due to its survival benefit. The utility of these prognostic models in the setting of sorafenib is unclear. Our aims were to assess for new prognostic factors in patients treated with sorafenib and compare these with known prognostic systems. Methods: All patients diagnosed with advanced HCC from 2008 to 2010 in British Columbia, Canada and treated with sorafenib at any 1 of 5 regional cancer centers were eligible. Based on the established Okuda, CLIP, Barcelona, and French staging systems, we collected baseline demographic and disease characteristics of patients prior to receipt of sorafenib. Multivariate logistic regression models were constructed to examine for associations between these clinical factors and overall survival. Results: Of 183 patients identified, 152 were evaluable: median age was 63 years, 78% were men, average number of sorafenib treatment was 5.3 cycles, and median overall survival was 9.6 months. The prevalence of hepatitis B, hepatitis C, and alcohol-related liver disease were 32%, 15%, and 11%, respectively. Univariate analyses showed that poor performance status, presence of clinical ascites, as well as elevated serum AST, GGT, ALP, bilirubin and platelet levels were each associated with worse overall survival (all p<0.05). In multivariate analyses, however, none of these clinical factors continued to be independently predictive of outcome (all p>0.05). Conclusions: Traditional clinical prognostic factors developed in the era of conventional chemotherapy do not appear to have the same prognostic utility in this contemporary Western cohort of advanced HCC patients treated with sorafenib. This observation underscores the need to identify molecular biomarkers that provide better prognostic information.

New Treatment Options in Advanced Squamous Cell Lung Cancer

2019 ◽  
pp. e198-e206 ◽  
Author(s):  
Paul K. Paik ◽  
Rathi Narayana Pillai ◽  
Christopher S. Lathan ◽  
Sylvia A. Velasco ◽  
Vassiliki Papadimitrakopoulou
Keyword(s):  
Squamous Cell ◽  
Immune Checkpoint ◽  
Checkpoint Inhibitors ◽  
Treatment Options ◽  
Substantial Improvement ◽  
Lung Cancers ◽  
The Past ◽  
New Treatment ◽  
Line Setting ◽  
Rapid Shift

The past few years have witnessed a rapid shift in the treatments for patients with squamous cell lung cancers (SQCLCs) after the U.S. Food and Drug Administration approval of a number of immune checkpoint inhibitors as second-line therapies for patients with non–small cell lung cancers. These series of approvals marked the first substantial improvement in overall survival for patients with SQCLC in over a decade. Further gains have been made more recently with the incorporation of immune checkpoint inhibition in the first-line setting, either as monotherapy or in combination with chemotherapy. These advances have, however, exposed existing deficiencies in the management of this disease. Despite a deeper understanding of the genomic alterations that characterize SQCLCs and years of trial work targeting these alterations, personalized therapies remain out of hand. Future studies will continue to focus on identifying targeted approaches to expand the treatment options for our patients.

New Treatment Options for Lymphangioma in Infants and Children

2002 ◽  
Vol 111 (12) ◽  
pp. 1066-1075 ◽  
Author(s):  
Chantal M. Giguère ◽  
Nancy M. Bauman ◽  
Richard J. H. Smith
Keyword(s):  
Lymphatic System ◽  
Clinical Presentation ◽  
Treatment Options ◽  
Therapeutic Interventions ◽  
Lymphatic Malformations ◽  
Diagnostic Measures ◽  
The Past ◽  
New Treatment ◽  
In Infants And Children

Lymphangiomas are congenital malformations of the lymphatic system. These lesions occur most often in the head and neck area, and their treatment continues to be a challenge. Fortunately, a number of advances have occurred in the diagnosis and management of lymphatic malformations in the past decade. The purpose of this article is to clarify the embryology, pathogenesis, histopathology, and classification of these lesions, as well as to describe their various forms of clinical presentation. We provide a complete review of the diagnostic measures available and thoroughly discuss new therapeutic interventions proposed to treat lymphangiomas.

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