scholarly journals Treatment beyond progression with anti-PD-1/PD-L1 based regimens in advanced solid tumors: a systematic review

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Francesco Spagnolo ◽  
Andrea Boutros ◽  
Federica Cecchi ◽  
Elena Croce ◽  
Enrica Teresa Tanda ◽  
...  
Keyword(s):  
Systematic Review ◽  
Solid Tumor ◽  
Progressive Disease ◽  
Partial Information ◽  
Clinical Activity ◽  
Advanced Solid Tumor ◽  
Fda Approval ◽  
Number Of Patients ◽  
Treatment Beyond Progression ◽  
The Impact

Abstract Background Treatment beyond progression with immunotherapy may be appropriate in selected patients based on the potential for late responses. The aim of this systematic review was to explore the impact of treatment beyond progression in patients receiving an anti-PD-1/PD-L1 based regimen for an advanced solid tumor. Methods A systematic literature search was performed to identify prospective clinical trials reporting data on overall response rate by immune-related criteria and/or the number of patients treated beyond conventional criteria-defined PD and/or the number of patients achieving a clinical benefit after an initial PD with regimens including an anti-PD-1/PD-L1 agent which received the FDA approval for the treatment of an advanced solid tumor. Results 254 (4.6%) responses after an initial RECIST-defined progressive disease were observed among 5588 patients, based on 35 trials included in our analysis reporting this information. The overall rate of patients receiving treatment beyond progressive disease was 30.2%, based on data on 5334 patients enrolled in 36 trials, and the rate of patients who achieved an unconventional response among those treated beyond progressive disease was 19.7% (based on 25 trials for a total of 853 patients). Conclusion The results of our systematic review support the clinical relevance of unconventional responses to anti-PD-1/PD-L1-based regimens; however, most publications provided only partial information regarding immune-related clinical activity, or did not provide any information at all, highlighting the need of a more comprehensive report of such data in trials investigating immunotherapy for the treatment of patients with advanced tumors.

scholarly journals Research Insights on Neural Effects of Auditory Deprivation and Restoration in Unilateral Hearing Loss: A Systematic Review

2020 ◽  
Vol 9 (3) ◽  
pp. 812 ◽  
Author(s):  
Jolijn Vanderauwera ◽  
Elisabeth Hellemans ◽  
Nicolas Verhaert
Keyword(s):  
Systematic Review ◽  
Hearing Loss ◽  
Auditory Processing ◽  
Onset Time ◽  
Unilateral Hearing Loss ◽  
Auditory Input ◽  
Number Of Patients ◽  
Magnetic Resonance Imaging Mri ◽  
Functional Neuroplasticity ◽  
The Impact

Neuroplasticity following bilateral deafness and auditory restoration has been repeatedly investigated. In clinical practice, however, a significant number of patients present a severe-to-profound unilateral hearing loss (UHL). To date, less is known about the neuroplasticity following monaural hearing deprivation and auditory input restoration. This article provides an overview of the current research insights on the impact of UHL on the brain and the effect of auditory input restoration with a cochlear implant (CI). An exhaustive systematic review of the literature was performed selecting 38 studies that apply different neural analyses techniques. The main results show that the hearing ear becomes functionally dominant after monaural deprivation, reshaping the lateralization of the neural network for auditory processing, a process that can be considered to influence auditory restoration. Furthermore, animal models predict that the onset time of UHL impacts auditory restoration. Hence, the results seem to advocate for early restoration of UHL, although further research is required to disambiguate the effects of duration and onset of UHL on auditory restoration and on structural neuroplasticity following UHL deprivation and restoration. Ongoing developments on CI devices compatible with Magnetic Resonance Imaging (MRI) examinations will provide a unique opportunity to investigate structural and functional neuroplasticity following CI restoration more directly.

Efficacy of High-Dose Sequential Chemotherapy and Autograft for Transformed Non Hodgkin’s B Cell Lymphoma: Results of a Retrospective Analysis from GITIL (Gruppo Italiano Terapie Innovative nei Linfomi).

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 3440-3440
Author(s):  
Massimo Di Nicola ◽  
Liliana Devizzi ◽  
Alessandro Rambaldi ◽  
Manuela Zanni ◽  
Fabio Benedetti ◽  
...  
Keyword(s):  
B Cell ◽  
Progressive Disease ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
High Dose ◽  
Bulky Disease ◽  
Number Of Patients ◽  
Sequential Administration ◽  
Histological Transformation ◽  
The Impact

Abstract Background - Follicular lymphoma (FL) transforms in a more aggressive lymphoma in 25–60% of patients representing the outgrowth of a more malignant subclone. Transformation is usually associated to a rapidly progressive clinical course, refractoriness to treatment, and short survival. To define the impact of high dose sequential (HDS) therapy and peripheral blood stem cell (PBSC) autograft on outcome of transformed FL (TFL), we analyzed a consecutive series of 66 pts with a confirmed diagnosis of TFL registered at the GITIL centers from March 1988 to September 2004 and treated with the HDS regimen. Methods - Biopsy-proven histological transformation (HT) in diffuse large B cell lymphoma (DLBCL) was observed at diagnosis (n=24; 36%) or at relapse after a treatment for FL (n= 42; 64%). Main patient characteristics were as follows: male/female 36/30; median age 51 yrs (range 33–66), stage I-II/III-IV 8/58, IPI score 0–1/≥2 28/38. HDS regimen included: i. 3 APO or 3 DHAP courses (for patients relapsed after anthracycline-containing regimens); ii. sequential administration of hd-CTX (7g/mq), hd-Ara-C, (2g/mq q12h for 6 days) hd-Etoposide (2.4 g/mq), with PBSC harvests following hd-CY and hd-Ara-C; iii. myeloablative regimen with hd-Mitoxantrone/L-Pam (n=28) or BEAM (n=28 pts who could not receive additional anthracycline), or TBI-PAM (n=3); iv. PBSC autograft; v. consolidation radiotherapy on bulky disease. From January 1999, hd-CTX and hd-Ara-C has been supplemented with Rituximab (RHDS; n=34) with in-vivo purging intent. Results - Overall 59 patients achieved a complete remission (CR; 89%), 1 patient responded partially and underwent allogeniec bone marrow transplantation, 6 patients died for progressive disease while on therapy (PD; 9%). With a median follow-up of 67 months (range 23–170), 42 patients are alive (63.6%), 24 patients relapsed and died for progressive disease (n= 23) or toxicity (n= 1). Five-year event free survival (EFS) and overall survival (OS) are 53.0% and 63.6%, respectively. No significant differences in OS and EFS were observed between patients with HT at diagnosis or at relapse, with IPI O-1 vs IPI >2. Of note, pts treated with R-HDS showed an improved clinical outcome (OS: 76% vs. 50%; EFS: 67.6 vs. 37.5 respectively), with a large difference that did not reach statistical significance because of the limited number of patients. Conclusion - Our data strongly suggest that HDS regimen, in particular when supplemented with rituximab (R-HDS), is a very effective regimen in transformed B cell lymphoma.

Hepatitis B reactivation in patients with solid tumors: A systematic review and meta-analysis.

2016 ◽  
Vol 34 (7_suppl) ◽  
pp. 138-138 ◽  
Author(s):  
Lisa K. Hicks ◽  
Jordan J. Feld ◽  
Ronak Saluja ◽  
Judy Truong ◽  
Adam E. Haynes ◽  
...  
Keyword(s):  
Systematic Review ◽  
Hepatitis B ◽  
Solid Tumors ◽  
Solid Tumor ◽  
Odds Ratio ◽  
Meta Analysis ◽  
Hbv Reactivation ◽  
Antiviral Prophylaxis ◽  
Chronic Hbv ◽  
The Impact

138 Background: Hepatitis B virus (HBV) affects over 250 million people worldwide. Most people with chronic HBV (HBsAg positive) have no signs or symptoms of infection. However, when exposed to immunosuppression they are at risk of HBV reactivation which can cause hepatitis, liver failure and death. The risk of HBV reactivation in patients receiving chemotherapy for solid tumors, the efficacy of antiviral prophylaxis, and the clinical impact of HBV reactivation in this setting are uncertain. Primary Aim: To estimate the risk of clinical HBV reactivation (increased HBV DNA + transaminitis) among HBsAg-positive patients administered chemotherapy for a solid tumor. Secondary Aims: To estimate the efficacy of anti-viral prophylaxis and the risk of death from HBV reactivation in patients receiving chemotherapy for solid tumors. Methods: A systematic review and meta-analysis of the English language literature on HBV reactivation was completed (OVID Medline, 1946 to Aug 2013). All citations were reviewed by two or more authors. Data from patients with hematologic malignancies were excluded. Pooled probabilities of HBV reactivation risk, death from HBV reactivation, and odds ratio for the impact of anti-viral prophylaxis were estimated with a random effects model. Results: 2,667 citations were identified; 19 were eligible for inclusion. The pooled estimate for clinical HBV reactivation in HBsAg-positive patients receiving chemotherapy for a solid tumor was 21.9% (95% CI; 16.5% to 27.3%) in those not receiving anti-viral prophylaxis, and 2.4% (95% CI 0.7% to 4.2%) in those receiving anti-viral prophylaxis. The odds ratio for clinical HBV reactivation with antiviral prophylaxis compared to no prophylaxis was 0.12 (95% CI 0.06 to 0.25). In the absence of viral prophylaxis, the risk of dying from HBV reactivation in HBsAg-positive solid tumor patients was estimated at 1.3% with a 95% CI of 0.3% to 2.3%. Conclusions: Patients with chronic HBV who are administered chemotherapy for a solid tumor appear to be at substantial risk of clinical HBV reactivation; this risk may be mitigated by anti-viral prophylaxis. In the absence of anti-viral therapy, patients may experience a small but important risk of dying from HBV reactivation.

scholarly journals The Impact of Rapid Response Team Activation on Unplanned Transfers to the ICU

2021 ◽  
Author(s):  
Erica Nelson
Keyword(s):  
Systematic Review ◽  
Rapid Response Team ◽  
Rapid Response ◽  
Healthcare Improvement ◽  
Number Of Patients ◽  
Pubmed Database ◽  
Response Team ◽  
Hospital Morbidity ◽  
Unplanned Admissions ◽  
The Impact

Rapid Response Teams (RRTs) were addressed by the Institute for Healthcare Improvement (IHI) as a means for improving inpatient hospital morbidity and mortality. There implementation was encouraged nationwide with the goal to decrease inpatient cardiopulmonary arrests, mortality rates and unplanned admissions to the Intensive Care Unit (ICU). The purpose of this systematic review was to evaluate the impact of RRTs on unplanned transfers to the ICU. A comprehensive literature review was performed using the PubMed database focusing on RRTs and unplanned ICU transfers. The Donabedian model was used as the theory for this review in conjunction with the PRISMA framework. Study specific data and data outcomes were extracted from individual studies and recorded in tables. Critical appraisal of the included studies was performed utilizing the CASP Checklist for cohort studies. Cross study analysis was then performed to compare outcomes of individual studies against one another in the form of a table. The findings of this systematic review addressed the impact of RRT on ICU admissions with varying outcomes in regards to number of patients admitted to the ICU after RRT review, APACHE scores, length of stay, and mortality. Results of this study address limitations of the identified research and recommendations and implications for the role of the advanced practice nurse.

scholarly journals PSYCHOLOGICAL STRESS AND BREAST CANCER INCIDENCE: A SYSTEMATIC REVIEW

2018 ◽  
Vol 91 (1) ◽  
pp. 18-26 ◽  
Author(s):  
Valentina-Fineta Chiriac ◽  
Adriana Baban ◽  
Dan L. Dumitrascu
Keyword(s):  
Breast Cancer ◽  
Systematic Review ◽  
Stressful Life Events ◽  
Negative Impact ◽  
Meta Analysis ◽  
Breast Cancer Incidence ◽  
Epidemiological Studies ◽  
Stressful Events ◽  
Number Of Patients ◽  
The Impact

Objective. Breast cancer is the world's leading cause of cancer mortality in women. Stress is an imminent risk factor with a documented negative impact on neuro-endocrine and immune system.  Numerous epidemiological studies have investigated the link between stress and cancer, reporting contradictory results from no association to a close causal link. The impact of the topic and the lack of conclusion compelled this systematic review.Methods. A systematic review was carried out, including all literature studies from 1966 to 2016, investigating the relationship between stress and the occurrence of breast cancer. Of the 1813 articles identified in the PubMed/Medline database, 52 were eligible and included in the analysis.Results. A number of 17 retrospective, 20 limited prospective and 15 prospective studies were analyzed. The number of patients exceeded 29,000, for a total number of more than 700.000 women recruited from hospital, screening cohorts or population registers. We identified 26 positive articles linking personal traits, stressful events and breast cancer, 18 negative articles that did not confirm their hypothesis and 8 articles that could not be classified. Facing heterogeneity, all possible misguiding factors such as: study design, information gathering, stress type, moment of exposure, individual susceptibility and personality, were discussed independently.Conclusions. Qualitative analysis of articles has revealed a possible association between stress and cancer, especially regarding stressful life events. In the absence of a meta-analysis and taking into account the methodological heterogeneity of the studies, the results are difficult to interpret and the role of chance is difficult to exclude.

Improving communication about prognosis on an academic inpatient solid tumor oncology consult service.

2018 ◽  
Vol 36 (34_suppl) ◽  
pp. 46-46
Author(s):  
Chrystal Ann Landry ◽  
Alaina J Kessler ◽  
Aarti Sonia Bhardwaj ◽  
Cardinale B. Smith
Keyword(s):  
Cancer Patients ◽  
Advanced Cancer ◽  
Advance Care Planning ◽  
Solid Tumor ◽  
Hospital Death ◽  
Care Planning ◽  
Post Intervention ◽  
Number Of Patients ◽  
Advance Care ◽  
The Impact

46 Background: As the number of patients living with cancer increases, a growing proportion of hospital inpatients will have an advanced cancer diagnosis. Data suggests that an unscheduled hospitalization for a patient with advanced cancer strongly predicts a median survival of less than 6 months. As hospitalists more frequently become the primary team taking care of admitted cancer patients, communication between a patient's oncologic care team and inpatient primary providers is crucial. We sought to implement and assess the impact of improved oncology consult documentation of patient prognosis on outcomes of advanced cancer patients admitted to our hospitalist medicine teaching services. Methods: We implemented an EMR-based oncology consult note template which required documentation of prognosis, potential future treatment options (if available), and advance care planning. We reviewed all patients with stage IV solid tumors admitted to the hospitalist teaching service for 8 weeks prior and 8 weeks post-template implementation for comparison. We utilized descriptive statistics and chi-squared testing as appropriate for analysis. Results: We evaluated 51 patients in the pre- and 36 patients in the post-intervention groups. Post-intervention, there was an improvement in documentation of prognosis (29.4% vs. 52.8%, p = 0.03), advanced care planning (37.2% vs. 83.3%, p < 0.0001), and in number of palliative care consults (58.8% vs. 83.3%, p = 0.02). On average, goals of care conversations occurred 2 days earlier in the post-intervention group (11 vs 9 days). Similarly, there was a decrease in inpatient chemotherapy administration (3 cases vs. 0), unit codes (2 vs. 0) and in-hospital death (23.5% vs. 11.1%). Conclusions: Creation of an oncology consult note template which incorporates current oncologic prognostic information improved documentation of prognosis and advance care planning as well as outcomes for advanced solid tumor oncology patients and enhanced inter-service communication. Based on these results, continued and targeted interventions are planned to further improve interservice communication.

scholarly journals The impact of the COVID-19 pandemic on cardiology services

Open Heart ◽  
2020 ◽  
Vol 7 (2) ◽  
pp. e001359 ◽  
Author(s):  
Omar Fersia ◽  
Sue Bryant ◽  
Rachael Nicholson ◽  
Karen McMeeken ◽  
Carolyn Brown ◽  
...  
Keyword(s):  
Performance Indicators ◽  
Service Provision ◽  
Recovery Phase ◽  
Community Services ◽  
Outpatient Clinics ◽  
Clinical Activity ◽  
Single Centre ◽  
Number Of Patients ◽  
The Uk ◽  
The Impact

ObjectiveThe COVID-19 pandemic resulted in prioritisation of National Health Service (NHS) resources to cope with the surge in infected patients. However, there have been no studies in the UK looking at the effect of the COVID-19 work pattern on the provision of cardiology services. We aimed to assess the impact of the pandemic on cardiology services and clinical activity.MethodsWe analysed key performance indicators in cardiology services in a single centre in the UK in the periods prior to and during lockdown to assess reduction or changes in service provision.ResultsThere has been a greater than 50% drop in the number of patients presenting to cardiology and those diagnosed with myocardial infarction. All areas of cardiology service provision sustained significant reductions, which included outpatient clinics, investigations, procedures and cardiology community services such as heart failure and cardiac rehabilitation.ConclusionsAs ischaemic heart disease continues to be the leading cause of death nationally and globally, cardiology services need to prepare for a significant increase in workload in the recovery phase and develop new pathways to urgently help those adversely affected by the changes in service provision.

The impact of COVID-19 on surgical volume and surgical training at a high-volume pelvic oncology centre

2021 ◽  
pp. 039156032110628
Author(s):  
Wissam Abou-Chedid ◽  
Gregory J Nason ◽  
Andrew T Evans ◽  
Kohei Yamada ◽  
Dimitrios Moschonas ◽  
...  
Keyword(s):  
High Volume ◽  
Annual Number ◽  
Clinical Activity ◽  
Prostate Brachytherapy ◽  
Robotic Assisted ◽  
Period 2 ◽  
Urological Oncology ◽  
Number Of Patients ◽  
Oncology Centre ◽  
The Impact

Introduction: The coronavirus (COVID-19) pandemic has overwhelmed most health services. As a result, many surgeries have been deferred and diagnoses delayed. The aim of this study was to assess the effect of the COVID-19 pandemic at a high-volume pelvic oncology centre. Methods: A retrospective review was performed of clinical activity from 2017 to 2020. We compared caseload for index procedures 2017–2019 (period 1) versus 2020 (period 2) to see the effect of the COVID pandemic. We then compared the activity during the first lockdown (March 23rd) to the rest of the year when we increased our theatre access by utilising a ‘clean’ site. Results: The average annual number of robotic assisted radical cystectomy (RARC) and robotic assisted radical prostatectomy (RARP) performed during period 1 was 82 and 352 respectively. This reduced to 68 (17.1% reduction) and 262 (25.6% reduction) during period 2. The number of patients who underwent prostate brachytherapy decreased from 308 to 243 (21% reduction). The number of prostate biopsies decreased from 420 to 234 (44.3% reduction). The number of radical orchidectomies decreased from 18 to 11 (39% reduction). The mean number of RARC and RARP per month during period 2 was 5.5 and 22. This decreased to 4 and 9 per month during the first national lockdown but was maintained thereafter despite two further lockdowns. Conclusion: There has been a substantial decrease in urological oncology caseload during the COVID pandemic. The use of alternate pathways such as ‘clean’ sites can ensure continuity of care for cancer surgery and training needs.

Standardizing documentation and improving communication on an academic inpatient solid tumor oncology consult service.

2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 171-171
Author(s):  
Chrystal Ann Landry ◽  
Alaina J Kessler ◽  
Aarti Sonia Bhardwaj ◽  
Cardinale B. Smith
Keyword(s):  
Cancer Patients ◽  
Advanced Cancer ◽  
Advance Care Planning ◽  
Solid Tumor ◽  
Hospital Death ◽  
Care Planning ◽  
Post Intervention ◽  
Number Of Patients ◽  
Advance Care ◽  
The Impact

171 Background: As the number of patients living with cancer increases, a growing proportion of hospital inpatients will have an advanced cancer diagnosis. Data suggests that an unscheduled hospitalization for a patient with advanced cancer strongly predicts a median survival of less than 6 months. As hospitalists more frequently become the primary team taking care of admitted cancer patients, communication between a patient's oncologic care team and inpatient primary providers is crucial. We sought to implement and assess the impact of improved oncology consult documentation of patient prognosis on outcomes of advanced cancer patients admitted to our hospitalist medicine teaching services. Methods: We implemented an EMR-based oncology consult note template which required documentation of prognosis, potential future treatment options (if available), and advance care planning. We reviewed all patients with stage IV solid tumors admitted to the hospitalist teaching service for 8 weeks prior and 8 weeks post-template implementation for comparison. We utilized descriptive statistics and chi-squared testing as appropriate for analysis. Results: We evaluated 51 patients in the pre- and 36 patients in the post-intervention groups. Post-intervention, there was an improvement in documentation of prognosis (29.4% vs. 52.8%, p = 0.03), advanced care planning (37.2% vs. 83.3%, p < 0.0001), and in number of palliative care consults (58.8% vs. 83.3%, p = 0.02). On average, goals of care conversations occurred 2 days earlier in the post-intervention group (11 vs 9 days). Similarly, there was a decrease in inpatient chemotherapy administration (3 cases vs. 0), unit codes (2 vs. 0) and in-hospital death (23.5% vs. 11.1%). Conclusions: Creation of an oncology consult note template which incorporates current oncologic prognostic information improved documentation of prognosis and advance care planning as well as outcomes for advanced solid tumor oncology patients and enhanced inter-service communication. Based on these results, continued and targeted interventions are planned to further improve inter-service communication.

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