scholarly journals R-CHOEP-14 Is Associated with Superior Overall Survival Compared to R-CHOP-21 and R-CHOP-14 in Patients with DLBCL ≤70 Years – a Swedish Lymphoma Registry Population Based Study

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 4427-4427
Author(s):  
Tove Wästerlid ◽  
Erzsebet Szekely ◽  
Linda Werner Hartman ◽  
Mats Jerkeman

Abstract Background: The current standard treatment for patients with diffuse large B-cell lymphoma (DLBCL) is Rituximab - Cyclophosphamide, Doxorubicin, Vincristine, Prednisone (R-CHOP). Two large randomised trials have been unable to establish a significant difference in outcome between patients receiving R-CHOP at 21 versus 14 day intervals regardless of age (Cunningham et al Lancet 2013, Delarue et al Lancet 2013). Another means of intensifying R-CHOP is by the addition of etoposide (R-CHOEP-14). As of yet, no randomised study in the rituximab era has been performed specifically evaluating the addition of etoposide. The aim of this study was to compare the chemotherapy regimens used to treat DLBCL in Sweden (R-CHOP-21, R-CHOP-14, R-CHOEP-14) among patients aged ≤70 in terms of overall survival, adjusted for clinical prognostic factors. Methods: The study population was identified through the Swedish Lymphoma Registry (SLR) 2007-2012. Data was analysed using STATA and SPSS. Age was modelled as splines in the multivariable analysis. Results: A total of 1745 patients aged ≤70 were identified in the SLR during the time-frame of this study. Median age was 61 years (range 18-70). Of these, 1331 had received R-CHOP-21 (n=302), R-CHOP-14 (n=872) or R-CHOEP-14 (n=157) and were included in the study. Median follow-up time for surviving patients was 49 months. Three-year overall survival rates were 86.7%, 79.6% and 87.5% for the patients who received R-CHOP-21, R-CHOP-14 and R-CHOEP-14 respectively. There was a significant disparity in the distribution of prognostic factors among patients receiving the various chemotherapy regimens with a lower proportion of patients with elevated serum lactate dehydrogenase (S-LDH), performance status >1, stage III-IV and presence of bulky disease (>10 cm) in the R-CHOP-21 group compared to the other regimens. As expected, the most intensive regimen, R-CHOEP-14 was more frequently given to younger patients (median age 49) with high-risk prognostic features. When adjusting for significant prognostic factors (age, performance status, S-LDH, bulky disease, stage and gender) in a multivariable Cox regression model, R-CHOEP-14 was found to be significantly superior both to R-CHOP-21 (Hazard Ratio (HR): 0.53, Confidence Interval (CI):0.3-0.9, p=0.026) and R-CHOP-14 (HR:0.63, CI:0.4-1.0, p=0.048). No significant difference between R-CHOP-14 and R-CHOP-21 was found (HR: 0.84, CI: 0.6-1.2, p=0.3), consistent with findings from randomised trials performed. Conclusion: In this population based series of DLBCL, the more intensive regimen R-CHOEP-14 was associated with superior overall survival in patients aged up to 70 years, indicating that this may be considered among the standard treatment options for this patient population. R-CHOEP-14 should preferably be compared to R-CHOP-21 in a randomised setting in order to further elucidate which patient groups that benefit the most from treatment intensification. Disclosures No relevant conflicts of interest to declare.

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 4550-4550
Author(s):  
C. Pozzo ◽  
Y. Ohashi ◽  

4550 Background: Advanced or recurrent stomach cancer remains an incurable disease. Several drugs and different combinations of chemotherapy have been investigated but very often with small sample sizes making definitive conclusions difficult. The GASTRIC project is an individual-patient-data (IPD) based meta-analysis in the advanced disease setting to quantify the potential benefit of various chemotherapies. We used this large database to study the role of various prognostic factors and potential interactions with chemotherapy. Methods: All randomized clinical trials (RCT) closed to patient accrual at the end of 2004 were eligible. Radiotherapy, intraperitoneal chemotherapy, or immunotherapy was excluded. The primary endpoint was overall survival (OS). Baseline variables included sex, age, performance status (PS), diseases status at entry, prior surgery, number of organs involved at entry, location of metastasis, TNM stages, histology, operative procedures, and geographic area. The hazard ratio (HR) and 95% confidence interval (CI) was calculated by the multivariate Cox analysis to assess of the prognostic factors for their relationship to OS. Results: Fourty-nine eligible RCTs (7,120 patients) were identified. As of December 2008, IPD from 21 trials (3,619 patients) with a median follow- up of 7.3 months were available for OS. There was no statistically significant difference between 5FU-based, anthracycline-based, platinum-based, taxane-based, or irinotecan-based regimens versus any other CT. In the multivariate Cox regression analysis stratified by trial and treatment arm, PS of 2 (HR, 2.43; 95%CI, 2.02 to 2.94) compared to PS of 0, metastatic (HR, 1.29; 95%CI, 1.01 to 1.64) compared to local advanced, many number of organs, and location of metastasis (especially with peritorium; HR, 1.75; 95%CI, 1.23 to 2.48) compared to none were strongly associated with lower survival. Conclusions: Our interim results could not show an overall survival benefit in favour of 5FU-, anthracycline-, platinum-, taxane-, or irinotecan-based regimens compared with a regimen without the specific chemotherapy. We confirm the impact of PS, diseases status at entry, number of organs involved, and location of metastasis on OS. No significant financial relationships to disclose.


2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e18038-e18038
Author(s):  
David Deng ◽  
Winson Y. Cheung

e18038 Background: Timeliness of adjuvant chemotherapy is an important predictor of survival for patients with breast and colorectal cancer whereby long delays has been shown to detrimentally impact outcomes. The effects of adjuvant treatment timing remain largely unknown for early pancreatic cancer. This study aims to identify independent predictors of treatment timeliness and overall survival in this patient population. Methods: We conducted a retrospective, population-based analysis of 179 patients with resected pancreatic cancer who subsequently started adjuvant chemotherapy between 2008 and 2014 at any 1 of 6 cancer centers across British Columbia, Canada. Logistic regression was used to identify predictive factors for adjuvant chemotherapy timing. Prognostic factors for survival were ascertained using multivariate Cox proportional hazards models. Results: Our study cohort included 91 men (51%) and 88 women (49%). At time of diagnosis, 145 patients (81%) had nodal involvement and 107 patients (60%) had good ECOG performance status (ECOG 0-1). The median age of diagnosis was 67 (range 37-85) years. The median interval between surgery and start of adjuvant chemotherapy was 70 (range 19-46) days. Abnormal bilirubin was the only factor significantly correlated with delayed chemotherapy (OR, 3.89; 95% CI, 1.55-9.73; P = 0.004). Median overall survival was 468 days following resection (95% CI, 425-538). Multivariate survival analysis showed that high CA 19-9 levels (HR, 2.44, 95% CI: 1.36-4.40, P = 0.003) and abnormal bilirubin (HR, 0.40; 95% CI, 0.22-0.73; P = 0.003) were prognostic factors for overall survival. Median survival for patients who waited up to 35, 70 or 105 days for chemotherapy following resection were 588 days (95% CI, 270-776), 490 days (95% CI, 360-688) and 466 days (95% CI, 432-538) respectively. Overall, timeliness was not predictive of survival (HR, 1.12; 95% CI, 0.64-1.97; P= 0.70). Conclusions: Patients with hyperbilirubinema experienced delays in adjuvant chemotherapy, likely due to the need for relief of biliary obstruction and subsequent recovery. However, timeliness of adjuvant chemotherapy did not influence outcomes, suggesting that treatment should still be considered irrespective of timing.


2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Paolo A. Ascierto ◽  
Antoni Ribas ◽  
James Larkin ◽  
Grant A. McArthur ◽  
Karl D. Lewis ◽  
...  

Abstract Background We sought to identify patient subgroups with distinct postprogression overall survival (ppOS) outcomes and investigate the impact of original treatment assignment and initial postprogression treatment (ppRx) on ppOS. Methods Recursive partitioning analysis (RPA) was performed to model relationships between prespecified covariates and ppOS in patients with BRAFV600-mutated metastatic melanoma who had experienced progressive disease (PD) following treatment with cobimetinib plus vemurafenib, vemurafenib monotherapy, or dacarbazine in the BRIM-2, BRIM-3, BRIM-7, and coBRIM studies. Prognostic subgroups identified by RPA were then applied to pooled treatment cohorts. The primary endpoint was ppOS, defined as time from first PD to death from any cause. Results RPA identified baseline lactate dehydrogenase (LDH), baseline disease stage, Eastern Cooperative Oncology Group performance status at PD, and ppRx as significant prognostic factors for ppOS. Median ppOS was longest in patients with normal baseline LDH, stage M1c disease at baseline, and ppRx with immunotherapy or targeted therapy (12.2 months; 95% CI 10.3–16.1) and shortest in those with elevated baseline LDH > 2 × upper limit of normal (2.3 months; 95% CI 1.8–2.7). Original treatment assignment did not impact ppOS. Across treatment cohorts, patients treated with immunotherapy or targeted therapy after PD had better ppOS than those given other treatments. Conclusion A combination of factors at baseline (LDH, disease stage) and PD (performance status, ppRx) impact ppOS outcomes. ppRx with immunotherapy or targeted therapy is an independent prognostic factor for improved overall survival following progression regardless of original treatment. Trial registration The trials included in this analysis are registered with ClinicalTrials.gov: NCT00949702 (BRIM-2), NCT01006980 (BRIM-3), NCT01271803 (BRIM-7), and NCT01689519 (coBRIM).


Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 3651-3651
Author(s):  
Anne Ortved Gang ◽  
Michael Pedersen ◽  
Francesco d'Amore ◽  
Lars Møller-Pedersen ◽  
Bo Amdi Pedersen ◽  
...  

Abstract Abstract 3651 Introduction: Diffuse large B-cell lymphoma (DLBCL) is the most common type of lymphoma accounting for 35–40%. Since the 1990s, The International Prognostic Index (IPI) has served as useful tool in daily treatment decision algorithm and in the design of clinical trials. In the last decade, improvement of overall survival (OS) has been demonstrated with R-CHOP-like regimens. In addition, the median life expectancy has increased substantially since the 1980'ies and more intensive treatment options like autologous BMT are performed successful up to 70 years of age. Thus, prognostic factors, including age, are susceptible to change over time. Material and methods: Patients with DLBCL diagnosed in the period 2000–2010 treated with Rituximab and CHOP-like chemotherapy were extracted from the Danish population-based Lymphoma Registry that covers > 97% of Danish lymphoma patients. Clinical and laboratory data at time of diagnosis were analysed, leaving out factors with < 75% completeness. Patients with transformed lymphoma, CNS involvement and HIV+ patients were excluded from the analysis. Results: 1990 patients (M:F ratio 1.26) were extracted from the LYFO database. The median age was 65 years, median follow-up was 54 months. Overall median survival was 9.7 years, with a 5 year OS of 65%. Analysis of age using 60, 65, 70, 75 years as cut-off, revealed 70 years as the optimal cut-point. Univariate analysis was performed including age, gender, stage, performance status, extranodal disease, LDH, albumin, immunoglobulin G, bulky disease, lymphocytes and haemoglobin. Only significant factors were included in a Cox proportional hazards model. Results for the entire patient cohort are shown in table I, and for patients <= 70 years in Table II. Survival analysis of patients with 0–1, 2–3 and 4–6 risk factors showed 5-year survival values of 90%, 71% and 45% respectively (left figure). For patients <= 70 years, the corresponding values were 90%, 81% and 62%, respectively (right figure). Conclusion: Two decades after the introduction of the IPI, age, performance status and LDH are still some of the most powerful prognostic factors in DLBCL. Age cut-off at 70 years is meaningful in reflecting clinical practice and, in our analysis, albumin and IgG added significant prognostic importance. In addition, for patients younger than 70 years, male gender is an adverse prognostic factor. Disclosures: No relevant conflicts of interest to declare.


2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 2071-2071
Author(s):  
M. Vinjamuri ◽  
R. Adumala ◽  
R. Altaha ◽  
J. Hobbs ◽  
E. Crowell

2071 Background: TMZ and radiation as initial treatment has become the standard of care for GBM. There are no randomized studies comparing TMZ to BCNU in GBM. Methods: We did a retrospective analysis of all 100 GBM patients (pts) diagnosed by our pathology department in the last 10 years. 20 pts were excluded, in 12 pts no chemotherapy was given and there was no data available for 8 pts. BCNU treatment was given in earlier years than TMZ generally. Overall survival (OS), progression free survival (PFS) and four prognostic factors were compared between BCNU and TMZ treated groups. Results: Results show that there is no significant difference in OS and PFS between the two groups. Survival curves were superimposable. This is despite the fact that tumor size and ECOG performance status were worse, though not significantly so in the BCNU group. Age was the only variable that correlated with survival. After correcting for age there was still no difference in PFS and OS between the BCNU and TMZ group. Conclusions: Our study fails to shows superiority of TMZ over BCNU despite the fact that the BCNU group had worse prognostic factors. A randomized comparison of these two agents seems justifiable. [Table: see text] No significant financial relationships to disclose.


2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii183-ii183
Author(s):  
Kevin Fan ◽  
Nafisha Lalani ◽  
Nathalie Levasseur ◽  
Andra Krauze ◽  
Lovedeep Gondara ◽  
...  

Abstract PURPOSE We aimed to investigate whether systemic therapy (ST) use around the time of brain radiotherapy (RT) predicts overall survival for patients with brain metastases (BM). We also aimed to validate the Diagnosis-Specific Graded Prognostic Assessment (DS-GPA) in a population-based cohort. METHODS We used provincial RT and pharmacy databases to retrospectively review all adult patients in British Columbia, Canada, who received a first course of RT for BMs between 2012 and 2016. We used a randomly selected subset with complete baseline data to develop a multivariate analysis (MVA)-based nomogram including ST use to predict survival after RT and to validate the DS-GPA. RESULTS In our 3095-patient cohort, the median overall survival (OS) of the 999 recipients of ST after RT was 5.0 months (CI 4.1-6.0) longer than the OS of the 2096 non-recipients of ST after RT (p&lt; 0.0001): targeted therapy (HR 0.42, CI 0.37-0.48), hormone therapy (HR 0.45, CI 0.36-0.55) and cytotoxic chemotherapy (HR 0.71, CI 0.64-0.79). The OS of patients who discontinued ST after RT was 0.9 months (CI 0.3-1.4) shorter than the OS of those who did not receive ST before nor after RT (p&lt; 0.0001). A MVA in the 200-patient subset demonstrated that the traditional baseline variables: cancer diagnosis, age, performance status, presence of extracranial disease, and number of BMs predicted survival, as did the novel variables: ST use before RT and ST use after RT. The MVA-based nomogram had a bootstrap-corrected Harrell’s Concordance Index of 0.70. In the 179 patients within this subset with DS-GPA-compatible diagnoses, the DS-GPA overestimated OS by 6.3 months (CI 5.3- 9.8) (p= 0.0006). CONCLUSIONS The type and timing of ST use around RT predict survival for patients with BMs. A novel baseline variable “ST planned after RT” should be prospectively collected to validate these findings in other cohorts.


2017 ◽  
Vol 27 (9) ◽  
pp. 1804-1812 ◽  
Author(s):  
Tine H. Schnack ◽  
Estrid Høgdall ◽  
Lotte Nedergaard Thomsen ◽  
Claus Høgdall

ObjectivesWomen with endometriosis carry an increased risk for ovarian clear cell adenocarcinomas (CCCs). Clear cell adenocarcinoma may develop from endometriosis lesions. Few studies have compared clinical and prognostic factors and overall survival in patients diagnosed as having CCC according to endometriosis status.MethodsPopulation-based prospectively collected data on CCC with coexisting pelvic (including ovarian; n = 80) and ovarian (n = 46) endometriosis or without endometriosis (n = 95) were obtained through the Danish Gynecological Cancer Database. χ2 Test, independent-samples t test, logistic regression, Kaplan-Meier test, and Cox regression were used. Statistical tests were 2 sided. P values less than 0.05 were considered statistically significant.ResultsPatients with CCC and pelvic or ovarian endometriosis were significantly younger than CCC patients without endometriosis, and a higher proportion of them were nulliparous (28% and 31% vs 17% (P = 0.07 and P = 0.09). Accordingly, a significantly higher proportion of women without endometriosis had given birth to more than 1 child. Interestingly, a significantly higher proportion of patients with ovarian endometriosis had pure CCCs (97.8% vs 82.1%; P = 0.001) as compared with patients without endometriosis. Overall survival was poorer among CCC patients with concomitant ovarian endometriosis (hazard ratio, 2.56 [95% confidence interval, 1.29–5.02], in the multivariate analysis.ConclusionsAge at CCC diagnosis and parity as well as histology differ between CCC patients with and without concomitant endometriosis. Furthermore, CCC patients with concomitant ovarian endometriosis have a poorer prognosis compared with endometriosis-negative CCC patients. These differences warrant further research to determine whether CCCs with and without concomitant endometriosis develop through distinct pathogenic pathways.


2021 ◽  
Vol 20 ◽  
pp. 153303382110365
Author(s):  
Zhangheng Huang ◽  
Zhiyi Fan ◽  
Chengliang Zhao ◽  
He Sun

Background: Chordoma is a rare malignant bone tumor, and the survival prediction for patients with chordoma is difficult. The objective of this study was to construct and validate a nomogram for predicting cancer-specific survival (CSS) in patients with spinal chordoma. Methods: A total of 316 patients with spinal chordoma were identified from the SEER database between 1998 and 2015. The independent prognostic factors for patients with spinal chordoma were determined by univariate and multivariate Cox analyses. The prognostic nomogram was established for patients with spinal chordoma based on independent prognostic factors. Furthermore, we performed internal and external validations for this nomogram. Results: Primary site, disease stage, histological type, surgery, and age were identified as independent prognostic factors for patients with spinal chordoma. A nomogram for predicting CSS in patients with spinal chordoma was constructed based on the above 5 variables. In the training cohort, the area under the curve for predicting 1-, 3-, and 5-year CSS were 0.821, 0.856, and 0.920, respectively. The corresponding area under the curve in the validation cohort were 0.728, 0.804, and 0.839, respectively. The calibration curves of the nomogram showed a high degree of agreement between the predicted and the actual results, and the decision curve analysis further demonstrated the satisfactory clinical utility of the nomogram. Conclusions: The prognostic nomogram provides a considerably more accurate prediction of prognosis for patients with spinal chordoma. Clinicians can use it to categorize patients into different risk groups and make personalized treatment methods.


2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Alejandra Ivars Rubio ◽  
Juan Carlos Yufera ◽  
Pilar de la Morena ◽  
Ana Fernández Sánchez ◽  
Esther Navarro Manzano ◽  
...  

AbstractThe prognostic impact of neutrophil-lymphocyte ratio (NLR) in metastatic breast cancer (MBC) has been previously evaluated in early and metastatic mixed breast cancer cohorts or without considering other relevant prognostic factors. Our aim was to determine whether NLR prognostic and predictive value in MBC was dependent on other clinical variables. We studied a consecutive retrospective cohort of patients with MBC from a single centre, with any type of first line systemic treatment. The association of NLR at diagnosis of metastasis with progression free survival (PFS) and overall survival (OS) was evaluated using Cox univariate and multivariate proportional hazard models. In the full cohort, that included 263 MBC patients, a higher than the median (>2.32) NLR was significantly associated with OS in the univariate analysis (HR 1.36, 95% CI 1.00–1.83), but the association was non-significant (HR 1.12, 95% CI 0.80–1.56) when other clinical covariates (performance status, stage at diagnosis, CNS involvement, visceral disease and visceral crisis) were included in the multivariate analysis. No significant association was observed for PFS. In conclusion, MBC patients with higher baseline NLR had worse overall survival, but the prognostic impact of NLR is likely derived from its association with other relevant clinical prognostic factors.


2010 ◽  
Vol 29 (04) ◽  
pp. 121-125 ◽  
Author(s):  
Leonardo Welling ◽  
José Carlos Lynch ◽  
Celestino Pereira ◽  
Ricardo Andrade ◽  
Fabiana Polycarpo Hidalgo ◽  
...  

Abstract Objective: To study if the prognosis variables such as age, the Karnofsky Performance Status (KPS), extension of tumor removal by surgery, radiotherapy and tumor volume influenced the survival of patients with glioblastoma multiforme (GBM). Method: Retrospective analysis of GBM patients operated at Hospital dos Servidores do Estado between 1998 and 2008. Results: We could observe that age, the KPS and radiotherapy influenced the survival. The other variables did not have any prognosis implications. Conclusions: Despite many researches and many improvements regarding the diagnosis and the surgical techniques, the survival of patients with GBM has not changed in the last 30 years and is a therapeutic challenge. The surgical resection followed by radiotherapy is the standard treatment for patients with GBM. The importance of each variable in the patient's prognosis is still to be established in the multivariate analyzes.


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