Chemotherapy Induced Neutropenic Fever Seen at Emergency Room: A Review of 102 Cases.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 4530-4530
Author(s):  
Joo Han Lim ◽  
Hyeon Gyu Yi ◽  
Moon Hee Lee ◽  
Hoon Kim ◽  
Chul Soo Kim
Keyword(s):  
Blood Culture ◽  
Elderly Patients ◽  
Emergency Room ◽  
Conflicts Of Interest ◽  
Performance Status ◽  
Clinical Manifestations ◽  
Therapeutic Outcome ◽  
Ecog Performance Status ◽  
Risk Of Death ◽  
Major Toxicity

Abstract Abstract 4530 Introduction Febrile neutropenia (FN) is a major toxicity of chemotherapy in cancer patients requiring prompt medical measures. Although the FN is a situation of oncologic emergency, the diagnosis and treatment may vary among institutions, and how fast the patients are being treated often depends on competence of House Officers at Emergency Room (ER). There has been limited data regarding the clinical outcome of patients with FN who were brought to ER. Patients and Methods We evaluated the clinical manifestations, therapeutic outcomes, and risk factors of FN in a retrospective analysis of 102 adult patients who visited ER from January 1, 2006 to March 31, 2009. FN was defined as a body temperature >38°C and a neutrophil count >0.5 × 109/L on the day of fever or the day after. Results The ECOG performance status (PS) was 0 in 15 patients, 1 in 67, and 2 in 20. The patients had a mean age of 57 years (range, 25–84). Fifty four patients were male, 52 female. Underlying diagnosis was lymphoma in 30, and soid tumors other than lymphoma in 72. The mean ANC was 436.8/mm3 (range, 0–1000); 4 patients had an ANC of <10/mm3. Twenty-three patients (22.5%) died of complications related to FN. There was no statistical difference in therapeutic outcome between tumor types, i.e. lymphoma versus non-lymphoma (p=.521), PS (p=.438), sex (p=.099), depth of neutropenia (p=.162), or time intervals from visiting ER to starting antibiotic therapy (p=.414). Age was important prognostic factor in therapeutic outcome. The median age in fatal cases was 62 years where as that of non-fatal cases was 54 (p=.016). Bacteremia was documented in 19 patients among whom 10 (53%) died. Mortality was significantly higher in patients with blood culture proven bacteria than patients whose blood culture yielded no organism (p=.013). Conclusion Cases of FN seen at ER showed substantial mortality especially in elderly patients. Given the rising age in cancer diagnosis as well as therapeutic intervention, higher mortality rate associated with chemotherapy induced FN in elderly patients needs further study seeking the way to reduce the risk of death Disclosures: No relevant conflicts of interest to declare.

Clinical evaluation of recombinant interferon alfa-2a (Roferon-A) in metastatic melanoma using two different schedules .

1987 ◽  
Vol 5 (8) ◽  
pp. 1240-1246 ◽  
Author(s):  
S S Legha ◽  
N E Papadopoulos ◽  
C Plager ◽  
S Ring ◽  
S P Chawla ◽  
...  
Keyword(s):  
Performance Status ◽  
Objective Response ◽  
Eastern Cooperative Oncology Group ◽  
Interferon Alfa ◽  
Fixed Dose ◽  
Ecog Performance Status ◽  
Recombinant Interferon ◽  
Level Of Activity ◽  
Daily Schedule ◽  
Major Toxicity

Based on the reports of activity of interferons against metastatic melanomas, we conducted a phase II study of recombinant interferon alfa-2a (Roferon-A, Hoffmann-La Roche, Nutley, NJ) in 66 patients with disseminated melanoma. All patients had excellent Eastern Cooperative Oncology Group (ECOG) performance status (0 to 1), and no evidence of brain metastases. Thirty patients had previously received chemotherapy and the remainder were untreated. The first 35 patients were treated on a daily schedule starting with a Roferon-A dose of 3 X 10(6) U/d and escalating to a maximum of 36 X 10(6) U/d over a period of 12 days. Because of excessive toxicity, the second group of 31 patients were treated on a fixed dose of 18 X 10(6) U/d [corrected] three times weekly (TIW). Among the 62 evaluable patients, five achieved an objective response for a response rate of 8% (95% confidence limits, 3% to 18%). Four patients had minor regressions and eight patients had stability of disease. The responses were evenly distributed between the two dose schedules. The major toxicity of interferon consisted of a constitutional syndrome of anorexia, fever, weight loss, and fatigue, which required a dose reduction in 75% of the patients on the daily schedule. Our data revealed a modest level of activity, which was not influenced by prior treatment or by the dose or schedule of interferon. Because of substantial toxicity with the daily schedule, we recommend a dose of 18 X 10(6) U/d [corrected] if interferon is used in the treatment of patients with melanoma.

Fludarabine, Cytarabine, and Attenuated-Dose Idarubicin (m-FLAI) Induction for Elderly Patients with Acute Myeloid Leukemia: Results of a Multicenter Phase II Study,

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 3626-3626
Author(s):  
Yoojoo Lim ◽  
Youngil Koh ◽  
Sung-Soo Yoon ◽  
Seonyang Park ◽  
Byoung Kook Kim ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Acute Myeloid Leukemia ◽  
Elderly Patients ◽  
Phase Ii ◽  
Myeloid Leukemia ◽  
Conflicts Of Interest ◽  
Performance Status ◽  
Free Survival ◽  
Induction Regimen ◽  
Acute Myeloid

Abstract Abstract 3626 Introduction: Although there have been remarkable improvements in treatment of acute myeloid leukemia (AML), the prognosis of AML in elderly patients remains poor, and the best induction chemotherapy for these patients remains yet unknown. To devise an effective induction regimen for elderly patients with AML, we conducted a phase II trial to evaluate the efficacy and safety of the modified fludarabine, cytarabine, and attenuated-dose idarubicin (m-FLAI) regimen in these patients. Patients and Methods: Elderly (60 years or older) AML patients who did not receive previous chemotherapy were enrolled. Patients received two consecutive cycles of m-FLAI chemotherapy as an induction. The m-FLAI regimen was comprised of fludarabine (25mg/m2, days 1–4), cytarabine (1000mg/m2, days 1–4), and attenuated-dose idarubicin (5mg/m2, days 1–3). The primary end point was complete remission (CR) rate. Results: A total of 108 patients (median age 68.4 years, M:F=64:44) were enrolled. CR was achieved in 62.9% of patients, and treatment-related mortality rate (TRM) was 25.8%. Median overall survival (OS) was 9.3 months, and median event-free survival (EFS) was 6.6 months. The mortality at 30 and 60 days was 18% and 24%, respectively. Performance status and comorbidity did not have prognostic value in these patients. Bone marrow expression of CD117 was related to long EFS and OS. Conclusion: In conclusion, m-FLAI is a safe and effective induction regimen for previously untreated AML in elderly patients. Bone marrow CD117 expression is an independent good prognostic factor in these patients. (ClinicalTrials.gov number, NCT01247493) Disclosures: No relevant conflicts of interest to declare.

Outcome of Second Allotransplantation for Relapsed Hematologic Malignancies After Stem Cell Transplantation

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 4461-4461
Author(s):  
Tran-Der Tan ◽  
Mau-Ching Wu ◽  
Lun-Wei Chiou
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Conflicts Of Interest ◽  
Performance Status ◽  
Disease Status ◽  
Cell Transplant ◽  
Disease Relapse ◽  
Ecog Performance Status ◽  
Curative Therapy

Abstract Abstract 4461 Background Allogeneic or autologous stem cell transplantation is a curative therapy for hematologic malignant disease including leukemia, lymphoma, and myeloma. However, the most common cause of failure is disease relapse and then the prognosis is grim and life expectancy is limited. For selected patients in second remission after salvage treatment and performance status is good enough, second allotransplant is another chance to achieve durable survival. Method This is a retrospective study in the past 7 years. For relapsed hematolgic malignancy patients after first stem cell transplantation and the ECOG performance status is 0 or 1, we treated with reduced intensity (RIC) or myeloablative conditioning (MAC) regimens directly or after salvage chemotherapy to induce second remission. Results We treated 24 patients with salvage allogeneic stem cell transplantation including 23 underwent second and one underwent third transplant between September 2005 and October 2011. The follow-up period is between 10 and 82 months. Patients median age is 40 with range between 23 and 59 with male to female 15/9. Disease entities include 10 AML, 5 ALL, 1 CML BP, 3 NHL, 4 HL, and 1 myeloma. The median duration between first transplant and disease relapse is 13.1 months (range between 2.5 and 52 months). The median interval between first and second transplant is 17.4 months (range between 5 and 64 months). The 5-year overall survival rate is 37% for all 24 patients and 55% for the 10 AML patients. Conclusion Second allogeneic stem cell transplant is feasable and durable survival is still promising for selected relapsed patients after first transplantation but the treatment modality is very individualized either RIC or MAC allotransplant according to patients disease entity and disease status. Disclosures: No relevant conflicts of interest to declare.

Survival Comparison Amongst Commonly Used Frontline Regimens in Patients Age 70 Years and Older with Acute Myeloid Leukemia (AML): A Single-Institution Study of over 600 Patients

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 2505-2505 ◽  
Author(s):  
Varun C Dhulipala ◽  
Martine Extermann ◽  
Najla Al Ali ◽  
Jongphil Kim ◽  
Marina Sehovic ◽  
...  
Keyword(s):  
Overall Survival ◽  
Elderly Patients ◽  
Supportive Care ◽  
High Intensity ◽  
Myeloid Leukemia ◽  
Performance Status ◽  
Pairwise Comparison ◽  
Ecog Performance Status ◽  
Treatment Groups ◽  
Low Intensity

Abstract Introduction Treatment of elderly patients with acute myeloid leukemia (AML) is a therapeutic challenge. Elderly patients frequently have more biologically inherent resistant disease, along with comorbidities that together result in poor overall survival (OS). Optimal frontline therapy for elderly patients with AML remains controversial, and choice of regimen varies among clinicians. In this large, single-institution retrospective cohort study of AML patients over age 70, we present survival analysis and comparison amongst a variety of commonly used initial regimens. Methods 602 AML patients aged 70 or greater who received treatment between 1995 and 2014 in a single-large institution were retrospectively analyzed. Patients were categorized into 4 different treatment groups: High Intensity Therapy (defined as daunorubicin/cytarabine or equivalent), Hypomethylating Agent (HMA) Therapy, Low intensity Therapy (defined as low-dose cytarabine or similar without HMAs), and Supportive Care (including hydroxyurea if indicated). Age, type of AML, history of previous hematological disease, cytogenetics, ECOG performance status, comorbidities (Charlson Index), complete blood counts and blast percentage at time of diagnosis were obtained for each treatment category. Pairwise comparison of survival between different treatment groups was performed, using the stratified log-rank test and propensity score matching to adjust for potential treatment indication bias between groups. Within pairwise comparison groups, the stratified Cox proportional hazards regression model was used to assess correlation of the clinical variables with overall survival. Results Median age was 77 years (range 70 - 95) with a male predominance (M:F=68%:32%). ECOG Performance Status was 0 to 1 in 80% and 2 to 4 in 20% of patients. Per NCCN criteria, cytogenetics risk category was intermediate or favorable in 67% and unfavorable in 33%. Baseline median WBC, hemoglobin and platelet counts were 3.31 k/uL, 9.40 g/dL and 43 k/uL respectively. Median baseline bone marrow blast percentage was 35% (range 2% - 95%), and the large majority (445 of 550 patients - 81%) had peripheral blood blasts at the time of diagnosis. The majority of patients had secondary AML (61%) compared with de novo AML (39%). Of those with secondary AML, myelodysplastic syndrome (MDS) was the most common antecedent hematologic disease (97%), for which 36% had received prior HMAs. For frontline therapy, 238 (40%) patients received High Intensity Therapy; 110 (18%) received HMA Therapy, 67 (11%) received Low Intensity Therapy, and 187 (31%) received Supportive Care. Pairwise comparison between HMA Therapy and the 3 other treatment groups individually demonstrated statistically significant superior OS with HMA Therapy (median 13.3 mo; 95% CI 10.6 - 16.8 mo) compared to High Intensity Therapy (median 9.5 mo; 95% CI 7.4 - 10.9 mo), Low Intensity Therapy (median 5.9 mo; 95% CI 4.2 - 7.8 mo) and Supportive Care (median 2.5 mo; 95% CI 2.1 - 3.0 mo.). In addition, pairwise comparisons demonstrated superior OS with high vs low-intensity (p=0.0007), but no significant difference between Low-Intensity and Supportive Care (p=0.10). A pairwise comparison between HMA and High Intensity Therapy in the small subset of patients who had received prior HMA for MDS revealed extremely poor outcomes in both arms, with < 6 month median OS. Conclusion In this analysis of a very large data set of patients over age 70 with AML, using pairwise comparison with propensity score matching, our results indicate a survival benefit with high intensity therapy or HMAs compared to supportive care or low-intensity (non-HMA) therapy. Interestingly, treatment with HMAs also resulted in better OS than traditional high intensity therapy. These data are contributing to an ongoing effort to design a comprehensive decision analysis model comparing treatment effectiveness according to baseline characteristics in AML patients 70 and older. Figure 1. Overall Survival Amongst Treatment Groups Figure 1. Overall Survival Amongst Treatment Groups Disclosures Lancet: Kalo-Bios: Consultancy; Boehringer-Ingelheim: Consultancy; Celgene: Consultancy, Research Funding; Amgen: Consultancy; Seattle Genetics: Consultancy; Pfizer: Consultancy.

Clinical Characterization of Staphylococcus Septicemia-Associated Hemophagocytic Lymphohistiocytosis

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 4905-4905
Author(s):  
Hongxia Qiu ◽  
Meng Song ◽  
Fang Ni ◽  
Jujuan Wang
Keyword(s):  
Bone Marrow ◽  
Hemophagocytic Lymphohistiocytosis ◽  
Therapeutic Response ◽  
Gamma Globulin ◽  
Conflicts Of Interest ◽  
Laboratory Data ◽  
Clinical Manifestations ◽  
Hepatic Function ◽  
Risk Of Death ◽  
Medical University

Abstract Abstract Objective: To analyze the epidemic characters, pathogenesis, clinical manifestations, laboratory data, therapeutic response, and prognosis in patients with staphylococcus septicemia-associated hemophagocytic lymphohistiocytosis(HLH). Methods A r Objective To analyze the epidemic characters, pathogenesis, clinical manifestations, laboratory data, therapeutic response, and prognosis in patients with staphylococcus septicemia-associated hemophagocytic lymphohistiocytosis(HLH). Methods: retrospective study was performed on 7 patients with staphylococcus septicemia-associated HLH who were admitted to The First Affiliated Hospital of Nanjing Medical University from January 2010 to December 2014. Results Seven out of 633patients(1.11%) with staphylococcus septicemia were confirmed to have HLH. The incidence of HLH in staphylococcus subspecies were:S.caprae, 12.50%;S.warneri, 12.50%;Methicillin-resistant Staphylococcusaureus(MRSA), 3.23%;S.hominis, 1.40%;S.haemolyticus, 1.25%;S.epidermidis, 0.59%, respectively. The main clinical manifestations included persistentfever(100%) and splenomegaly(85.71%). The most prominent laboratory abnormalities werehemocytopenia, abnormal hepatic function, and elevated ferritin. Bone marrow aspirations were performed on 6 patients and all of them hadhemophagocytosis shown in bone marrow smears. Among 7 patients, 4 patientssurvived(57.14%) and 3 patients died(42.86%). All the 4 cured patients were treated with antibiotic plus corticosteroid. And 2 of them used gamma globulin, while one used the COP chemotherapy regimen. Treatment with antibiotic plus corticosteroid was effective in our study. Conclusion Treatment with antibiotic plus corticosteroid was recommended for staphylococcus septicemia-associated HLH, and gamma globulin may also be useful in reducing the risk of death. Disclosures No relevant conflicts of interest to declare.

Efficacy and feasibility of intensive induction therapy in very elderly patients with acute myeloid leukaemia

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 16528-16528
Author(s):  
G. Biaggi ◽  
A. Santagostino ◽  
D. Manachino ◽  
T. Posca ◽  
G. Forti ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Acute Myeloid Leukaemia ◽  
Myeloid Leukaemia ◽  
Performance Status ◽  
Best Supportive Care ◽  
Induction Treatment ◽  
Very Elderly ◽  
Ecog Performance Status ◽  
Leukaemia Therapy ◽  
Acute Myeloid

16528 Background: Intensive Induction Treatment (IIT) increases chances of longer survival in acute myeloid leukaemia (AML). Our aim was to improve outcome and to evaluate safety and tolerability of IIT in very elderly patients (pts). Otherwise they have a median surviving time of 11 weeks without treatment. Methods: From October 2003 to November 2005 we treated 23 pts, 16 Males (M) and 7 Female (F); median age 75.5 years (range 68–95). According FAB classification they were 1 M0, 10 M1, 5 M2, 6 M4, 1 M5. ECOG performance status (PS) was 0 in 6 pts, 1 in 5 pts, 2 in 7 pts and 3 in 5 pts. All pts underwent IIT with different schedules: only a female 95 years old had less intensive treatment. Immune-chemotherapy was also admitted. Schedules were: 3+7 IDA+ARA-C in 8 pts; MY-FLAI in 7 pts; VP+ARA-C 1 = ≥ 5 in 2 pts; IDA+ARA-C 1 = ≥ 2 in 4 pts; ARA-C + 6TG in 1 pt. Eleven pts underwent second line treatment. Results: Five pts are alive and 18 dead. We obtained 7 complete responses (CR) (32%) and 1 partial response (PR) (RR 36%);. The median CR duration was 7.5 months (range 1–12).Throughout IIT we observed 5 toxic deaths (23%) because of infections and 2 deaths not leukaemia therapy related (heart failure). The median Overall Survival (OS) was 9 months. Conclusions: Despite the toxic deaths due to the treatment, we obtained in 32% of the pts CR longer compared to palliative or best supportive care; also the median OS was longer than we can expected without chemotherapy. Our data support in our opinion the feasibility and the utility of an IIT in very elderly patients with good PS. No significant financial relationships to disclose.

Personalized surveillance and prognostication of patients undergoing kidney cancer surgery: The 15-year UCLA experience

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 5045-5045
Author(s):  
A. S. Belldegrun ◽  
S. Riggs ◽  
N. Zomorodian ◽  
A. J. Pantuck ◽  
T. Klatte ◽  
...  
Keyword(s):  
Cox Regression ◽  
Tnm Classification ◽  
Performance Status ◽  
Clinical Manifestations ◽  
Disease Specific Survival ◽  
Ecog Performance Status ◽  
Renal Masses ◽  
Fuhrman Grade ◽  
Tnm System ◽  
Disease Specific

5045 Background: Renal cell carcinoma (RCC) is a heterogeneous disease with varying biology, clinical manifestations, and outcome. An evolving understanding of prognostic factors for patients is leading toward individualized surveillance as well as treatment. We reviewed our large single center experience trying to maximize prognostication and surveillance for each patient. Methods: The charts of 1,825 patients with renal masses from 1989–2006 were reviewed and 263 variables/patient were recorded. 1,492 underwent partial or radical nephrectomy with the final histology being RCC. Statistical analysis was performed via Cox regression and concordance models. This enabled us to investigate the Surveillance & Prognosis University of California Integrated Staging System (S&P-UISS), a 3-tiered group system for based on low (LR), intermediate (IR) and high risk (HR) categorization separately for both non-metastatic (NM) and metastatic (M) patients, and to compare its prognostic accuracy with the current TNM classification. Results: Of all patients analyzed 66% were male. A Fuhrman grade of 1, 2, 3 and 4 was assigned to 179 (12.3%), 675 (46.5%), 485 (33.4%), and 114 patients (7.8%), respectively. ECOG performance status was 0, 1, 2 and 3 in 768 (52.1%), 652 (44.3%), 51 (3.5%), and 2 (0.1%), respectively. The disease-specific survival (%) for NM LR (n=326, 22%), IR (n=464, 32%), and HR (n=121, 8%) patients was, respectively, 97, 81, 62 at 5 years; 92, 46, 41 at 10 years; 92, 45, 20 at 15 years. For M LR (n=78, 5%), IR (n=406, 28%) and HR (n=58, 4%) survival was 41, 18, 8 at 5 years; 31, 7, 0 at 10 years; and 31, 0, 0 at 15 years, respectively. Based on concordance statistics, S&P-UISS predicted disease-specific survival better than the 2002 TNM system. Conclusions: The S&P-UISS system is a highly reliable and reproducible predictor of mortality following surgical therapy for localized and metastatic RCC. Surveillance and personal treatments should be individualized for a particular patient based on risk group categorization following surgery for their primary tumor. Accurate prognostication allows personal tailoring for treatments as well as allocation into clinical trials. No significant financial relationships to disclose.

Bevacizumab (Bmab) in combination with uracil-tegafur (UFT) and oral leucovorin (LV) in elderly patients (≥ 75 years old) with metastatic colorectal cancer (mCRC): A multicenter phase II trial (J-BLUE study).

2014 ◽  
Vol 32 (3_suppl) ◽  
pp. 588-588
Author(s):  
Mitsuo Shimada ◽  
Tomohiro Nishina ◽  
Jun Higashijima ◽  
Toshikazu Moriwaki ◽  
Toshiki Masuishi ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Elderly Patients ◽  
Phase Ii ◽  
Performance Status ◽  
Progression Free Survival ◽  
Open Label ◽  
Effective Treatment Option ◽  
Ecog Performance Status ◽  
Eligibility Criteria ◽  
Ecog Ps

588 Background: Now fluoropyrimidine plus Bmab is considered a recommendable option to the majority of elderly mCRC patients who are deemed inappropriate for the standard doublet chemotherapy with biologics. Our previous phase II study of UFT/ LV in elderly mCRC patients (≥75 years old) had demonstrated acceptable safety and efficacy (overall response rate [ORR] 33%, progression-free survival [PFS] 5.3 months, overall survival [OS] 18 months). The aim of the present study was to investigate the efficacy and safety of Bmab in combination with UFT/LV for elderly mCRC patients. Methods: This study was designed as a single-arm, open-label, multicenter, cooperative group (SGOSG-TCTG) clinical trial (trial registration: UMIN000003515). Key eligibility criteria included age ≥75 years, ECOG performance status (PS) 0 or 1, first-line chemotherapy, measurable lesions, and preserved organ functions. Patients received UFT 300mg/m2/day and LV 75mg/body/day on days 1-21 followed by 7 days rest, and intravenous administration of Bmab 5mg/kg on days 1 and 15. Treatment repeated every 28 days. The primary endpoint was PFS, and secondary endpoints were ORR, OS, and safety. Results: A total of 55 patients were enrolled from 15 institutions between Aug 2008 and Mar 2012. Among them, 52 eligible patients were evaluated. Median age was 80 years (range: 75-87). ECOG PS 0 was 73%. Median PFS was 8.2 months (95% confidence interval [CI], 6.2-10.3, events in 86.5%). Confirmed ORR was 40.4% (95% CI, 27.0-54.9%). Median OS was 18.7 months (95% CI, 10.3-27.0, events in 48%). The most common grade ≥3 treatment-related adverse events were hypertension (11.5%), fatigue (7.7%), nausea (5.8%), and diarrhea (5.8%). The treatment-related death occurred in 2 (3.8%) patients. Main reasons for discontinuation of treatment were disease-progression (62.5%) and toxicity (27.1%). Conclusions: Bmab in combination with UFT/LV is tolerable and effective treatment option for elderly patients (≥75 years old) with mCRC. Further trial with Bmab plus UFT/LV targeting elderly mCRC patients would be warranted. Clinical trial information: 000003515.

XELOX with bevacizumab in elderly patients age 75 or older with metastatic colorectal cancer: Results of a planned interim analysis for multicenter phase II ASCA study.

2013 ◽  
Vol 31 (4_suppl) ◽  
pp. 502-502 ◽  
Author(s):  
Keiichiro Ishibashi ◽  
Yoshinori Munemoto ◽  
Masaki Matsuoka ◽  
Taishi Hata ◽  
Michiya Kobayashi ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Renal Function ◽  
Elderly Patients ◽  
Metastatic Colorectal Cancer ◽  
Phase Ii ◽  
Performance Status ◽  
Primary Objective ◽  
Open Label ◽  
Ecog Performance Status ◽  
Grade 3

502 Background: Combination chemotherapy of capecitabine plus oxaliplatin (XELOX) with bevacizumab is commonly used as standard chemotherapy for metastatic colorectal cancer (mCRC). A previous meta-analysis showed that there was no difference between two age groups of <65 years and ≥65 years on overall survival (OS) after treatment with chemotherapy with bevacizumab. However, the safety and efficacy of XELOX with bevacizumab in elderly patients (pts) ≥75 years with mCRC remain unclear. Methods: This study was an open-label multicentre phase II study to evaluate the efficacy and safety of XELOX with bevacizumab in pts ≥75 years with metastatic CRC. The primary objective was to assess progression-free survival (PFS). The secondary endpoints were the safety, response rate (RR), time to treatment-failure (TTF) and OS. Results: 36 pts were enrolled. Pts characteristics were; median age 78 (range 75-86); male/female, 21/15; ECOG performance status 0/1, 30/6; colon/rectum 24/12, creatinine clearance (CCr) 60.2 ml/min (range 32.6-84.6). Median follow-up period was 220 days. RR was 55.6% and median TTF was 209 days. The median PFS and median OS are not reached. Grade 3 or 4 adverse events (AEs) were reported in 22 pts (62.8%). Common grade 3 or 4 AEs were hypertension (11.4%), leukopenia (20.0%), peripheral sensory neuropathy (14.3%), hand foot syndrome (8.6%), and fatigue (8.6%). Examining the relationship between renal function (CCr) and AEs, the incidence of Grade 3 or 4 AEs in the lower CCr group was significantly higher than that in the higher CCr group (61.6% vs. 47.8%; p=0.013); hematological toxicities (87.5% vs. 14.8%; p=0.0003) and non-hematological toxicities (61.5% vs. 11.1%; p=0.018). Conclusions: XELOX with bevacizumab is safely administered in elderly patients ≥75 years. Renal function (CCr) could be a good predictive marker for grade 3 or 4 AEs. Clinical trial information: UMIN000003500.

End-of-life care and prognosis of elderly patients with advanced cancer in palliative care unit.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e23011-e23011
Author(s):  
Shuji Hiramoto ◽  
Tomoko Tamaki ◽  
Hori Tetsuo ◽  
Ayako Kikuchi ◽  
Akira Yoshioka ◽  
...  
Keyword(s):  
Palliative Care ◽  
Prognostic Factor ◽  
Elderly Patients ◽  
End Of Life ◽  
Advanced Cancer ◽  
Performance Status ◽  
Significant Prognostic Factor ◽  
Ecog Performance Status ◽  
Consciousness Level ◽  
Number Of Patients

e23011 Background: Prognosis of end-of-life characteristics, which are indicators of palliative care, especially in elderly cancer patients, remains unclear. Methods: We retrospectively analyzed 510 patients who died of advanced cancer at our hospital from August 2011 to August 2016. The patients were divided into two groups: elderly patients (over 80 years old, N = 140) and non-elderly patients (under 80 years old, N = 370). The number of patients (306 male and 204 female) with gastro-esophageal, biliary-pancreatic, colorectal, lung, breast, urological, gynecological, hepatocellular, and other cancers were 114, 98, 82, 84, 25, 36, 20 and 51, respectively. The primary endpoint of the study was to analyze the relationship of end-of-life symptoms, treatment, and chemotherapy with age. The secondary endpoint was to identify the prognostic factors in elderly patients with advanced cancer at the end-of-life. Results: ECOG Performance Status of 0.1 was recorded for 12 patients and 2-4 for 498 patients. The prevalence rate of cancer pain in elderly patients was 19.3%, which was significantly lower than that in non-elderly patients (31.4%). Fatigue in elderly patients was 27.9%, which was significantly lower than that in non-elderly patients (37.6%). Continuous deep sedation usage in elderly patients was 12.9%, which was significantly lower than that in non-elderly patients (28.9%). The mean opioid dose in elderly patients was 23.3mg/day, which was significantly lower than that that in non-elderly patients (43.8mg/day). The rate of more than one line of chemotherapy for elderly patients was 44.4%, which was lower than that for non-elderly patients (65.4%). The rate of use of more than one type of cytotoxic agent in the last regimen for elderly patients was 13.3%, which was lower than that for non-elderly patients (30.8%). Consciousness level was recognized as a significant prognostic factor (HR 1.714, p = 0.048) using multivariate analysis of prognosis in elderly patients at the end-of-life. Conclusions: End-of-life symptoms and the intensity of end-of-life treatment, including chemotherapy, were lesser in elderly patients as compared to non-elderly patients. Consciousness level was a significant prognostic factor in elderly patients at the end-of-life.

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