Yttrium-90 microsphere selective internal radiation treatment (SIRT) with concomitant chemotherapy (Chemo-SIRT) as first/second-line therapy in patients with colorectal cancer liver metastases

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 14589-14589 ◽  
Author(s):  
K. L. Pennington ◽  
D. Bruetman ◽  
G. Mesoloras ◽  
R. Hostetter ◽  
S. A. Gulec
Keyword(s):  
Radiation Treatment ◽  
Absorbed Dose ◽  
Second Line ◽  
First Line ◽  
Internal Radiation ◽  
Colorectal Cancer Liver Metastases ◽  
Line Therapy ◽  
Pet Ct ◽  
Fdg Pet Ct ◽  
Yttrium 90

14589 Background: Yttrium-90 (Y-90) microsphere selective internal radiation treatment (SIRT) has been studied in patients (pts) with colorectal cancer liver metastases (CRCLM) in combination with FUDR and 5FU-LV with promising results. This is a phase II trial of SIRT and concurrent contemporary chemotherapy in the frontline management of CRCLM. Methods: Pts with metastatic disease limited predominantly to the liver were eligible for the study. Other entry criteria included KPS 70 or >, 3 month life expectancy and adequate marrow and renal reserve. Pre-treatment evaluations included the assessment of liver function, CEA level, 18F-FDG-PET/CT imaging, an angiogram and a 99mTc-MAA (macroagregate albumin) scan. SIRT with Y-90 resin microspheres (Sirtex Medical, Lake Forest, IL) was administered on day 2 of the first chemotherapy (Fol-Fox or Fol-Firi) course in either lobar or whole-liver fashion. Chemotherapy was repeated on a biweekly schedule. CEA levels and 18F-FDG-PET/CT based anatomic and functional volume (Vf) changes were used to determine tumor response at 4, 8, and 12 weeks after therapy. CTC v3 toxicity grades were used to classify adverse events. Results: 6 pts were treated as first-line and 2 pts as second-line. 5 pts received single lobe and 3 pts received whole liver treatment. Administered activity of Y-90 microspheres ranged from 0.9 to 3.1 GBq (mean 2.3 GBq). Mean tumor radiation absorbed dose was 203.6 Gy (Range 91.0–351.4 Gy). Mean liver absorbed dose was 47.8 Gy (Range 7.9–85.9 Gy). 6/8 pts had complete/near-complete metabolic response with a mean tumor Vf decrease in target lobe(s) of 98%). The remaining 2 pts demonstrated > 50% reduction in Vf in target lobe(s). A parallel decrease in CEA level was observed in responding pts. Surgical downstaging was attained in 3/8 pts. 2 pts developed grade III toxicity (one gastric ulcer and one alkaline phosphatase elevation). Conclusion: Chemo-SIRT as first-line therapy has a high level of response in CRCLM as measured by reductions in functional tumor volume and CEA level. Further follow-up of these pts is needed to confirm that this response is of clinical significance in terms of improved surgical downstaging and survival. [Table: see text]

Nivolumab As Salvage Therapy in Pediatric Patients with Relapsed and Refractory Lymphomas

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 5414-5414 ◽  
Author(s):  
Nora Naumann-Bartsch ◽  
Daniel Stachel ◽  
Martin Chada ◽  
Torsten Fritscher ◽  
Oliver Rompel ◽  
...  
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Children And Adolescents ◽  
Salvage Therapy ◽  
Fdg Pet ◽  
Second Line ◽  
First Line ◽  
Line Therapy ◽  
Pet Ct ◽  
Fdg Pet Ct

Abstract The programmed death-1 (PD-1) inhibitor nivolumab has shown substantial activity in adults with relapsed or refractory Hodgkin's lymphoma (HL). Various clinical trials are currently ongoing to evaluate efficacy and safety of PD-1 blocking antibodies in other lymphoid malignancies as well. However, only limited experience has been obtained in children and adolescents so far. Here, we report the clinical course and striking response to nivolumab salvage therapy in 3 pediatric lymphoma patients. Patients of age 11, 17, and 15 years were diagnosed with classical HL (#1), mediastinal gray-zone lymphoma (#2), and diffuse large B-cell lymphoma (#3), respectively. They underwent first-line therapies according to national pediatric standard treatment recommendations. All patients achieved initial remission, but #1 and #2 relapsed soon after, #3 already during first-line therapy. Relapse in #2 presented as classical HL. Second-line therapy resulted in remission in #1 but relapse occurred again shortly after high-dose chemotherapy followed by autologous stem cell transplantation and responded poorly to further treatment. Relapses in patients #2 and #3 were already refractory to extensive second-line regimens. All patients had very poor prognosis with fast progression of disseminated disease as confirmed by FDG-PET/CT imaging. High PD-ligand 1 expression in lymphoma specimens supported the decision to initiate off-label nivolumab therapy after obtaining informed consent. Nivolumab was administered at a dose of 3 mg/kg at weeks 1 and 4 followed by biweekly courses (Ansell et al., N Engl J Med, 2015). Already following the first infusion, a remarkable improvement of clinical symptoms was observed in all individuals. Rapid responses were proven by FDG-PET/CT in week 5 after only 2 applications, demonstrating metabolic partial remission in patient #1 and already complete remission (CR) in #2 and #3. Patient #1 eventually achieved CR after 8 nivolumab administrations. Therapy was continued and follow-up imaging confirmed durable CR status in all 3 individuals. Treatment has been well tolerated and no adverse events have occurred. Patient #1 proceeded to unrelated donor allogeneic hematopoietic stem cell transplantation (allo-HSCT) after a total of 11 nivolumab applications and remains in CR >4 months post allo-HSCT without significant side effects. Patients #2 and #3 are scheduled for allo-HSCT, having received 11 and 5 courses nivolumab to date. The reported cases suggest that nivolumab can be highly effective and safe in children and adolescents with different relapsed lymphoma types, refractory to previous intensive chemo- and radiotherapy. Early and sustained CR status was achieved in all 3 patients following nivolumab initiation. Our observations may encourage further clinical studies and implementation of anti-PD-1 antibodies in therapy strategies for pediatric lymphomas. Disclosures No relevant conflicts of interest to declare.

scholarly journals Hodgkin’s lymphoma in remission after first-line therapy: which patients need FDG–PET/CT for follow-up?

2010 ◽  
Vol 21 (5) ◽  
pp. 1053-1057 ◽  
Author(s):  
U. Petrausch ◽  
P. Samaras ◽  
P. Veit-Haibach ◽  
A. Tschopp ◽  
J.D. Soyka ◽  
...  
Keyword(s):  
Fdg Pet ◽  
Hodgkin’S Lymphoma ◽  
Hodgkin's Lymphoma ◽  
First Line ◽  
First Line Therapy ◽  
Line Therapy ◽  
Pet Ct ◽  
Fdg Pet Ct

Hodgkin Disease: Diagnostic Value of FDG PET/CT after First-Line Therapy—Is Biopsy of FDG-avid Lesions Still Needed?

Radiology ◽  
2007 ◽  
Vol 244 (1) ◽  
pp. 257-262 ◽  
Author(s):  
Niklaus G. Schaefer ◽  
Christian Taverna ◽  
Klaus Strobel ◽  
Cathrin Wastl ◽  
Michael Kurrer ◽  
...  
Keyword(s):  
Fdg Pet ◽  
Diagnostic Value ◽  
Hodgkin Disease ◽  
First Line ◽  
First Line Therapy ◽  
Line Therapy ◽  
Pet Ct ◽  
Fdg Pet Ct

scholarly journals Risk-adapted FDG–PET/CT-based follow-up in patients with diffuse large B-cell lymphoma after first-line therapy

2010 ◽  
Vol 21 (8) ◽  
pp. 1694-1698 ◽  
Author(s):  
U. Petrausch ◽  
P. Samaras ◽  
S.R. Haile ◽  
P. Veit-Haibach ◽  
J.D. Soyka ◽  
...  
Keyword(s):  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
First Line ◽  
First Line Therapy ◽  
Large B Cell Lymphoma ◽  
Line Therapy ◽  
Pet Ct ◽  
Fdg Pet Ct ◽  
Large B Cell

Efficacy and Toxicity of Addition of Bevacizumab to Chemotherapy in Patients with Metastatic Colorectal Cancer

2019 ◽  
Vol 21 (10) ◽  
pp. 718-724 ◽  
Author(s):  
Wen-Cong Ruan ◽  
Yue-Ping Che ◽  
Li Ding ◽  
Hai-Feng Li
Keyword(s):  
Colorectal Cancer ◽  
Adverse Event ◽  
Metastatic Colorectal Cancer ◽  
Line Treatment ◽  
Second Line ◽  
First Line ◽  
Second Line Therapy ◽  
Clinical Prognosis ◽  
Line Therapy ◽  
Significant Difference

Background: Pre-treated patients with first-line treatment can be offered a second treatment with the aim of improving their poor clinical prognosis. The therapy of metastatic colorectal cancer (CRC) patients who did not respond to first-line therapy has limited treatment options. Recently, many studies have paid much attention to the efficacy of bevacizumab as an adjuvant treatment for metastatic colorectal cancer. Objectives: We aimed to evaluate the efficacy and toxicity of bevacizumab plus chemotherapy compared with bevacizumab-naive based chemotherapy as second-line treatment in people with metastatic CRC. Methods: Electronic databases were searched for eligible studies updated to March 2018. Randomized-controlled trials comparing addition of bevacizumab to chemotherapy without bevacizumab in MCRC patients were included, of which, the main interesting results were the efficacy and safety profiles of the addition of bevacizumab in patients with MCRC as second-line therapy. Result: Five trials were eligible in the meta-analysis. Patients who received the combined bevacizumab and chemotherapy treatment in MCRC as second-line therapy showed a longer overall survival (OS) (OR=0.80,95%CI=0.72-0.89, P<0.0001) and progression-free survival (PFS) (OR=0.69,95%CI=0.61-0.77, P<0.00001). In addition, there was no significant difference in objective response rate (ORR) (RR=1.36,95%CI=0.82-2.24, P=0.23) or severe adverse event (SAE) (RR=1.02,95%CI=0.88-1.19, P=0.78) between bevacizumab-based chemotherapy and bevacizumabnaive based chemotherapy. Conclusion: Our results suggest that the addition of bevacizumab to the chemotherapy therapy could be an efficient and safe treatment option for patients with metastatic colorectal cancer as second-line therapy and without increasing the risk of an adverse event.

scholarly journals International recommendations for personalised selective internal radiation therapy of primary and metastatic liver diseases with yttrium-90 resin microspheres

2021 ◽  
Author(s):  
Hugo Levillain ◽  
Oreste Bagni ◽  
Christophe M. Deroose ◽  
Arnaud Dieudonné ◽  
Silvano Gnesin ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Absorbed Dose ◽  
Steering Committee ◽  
Selective Internal Radiation Therapy ◽  
Internal Radiation ◽  
Selective Internal Radiation ◽  
Internal Radiation Therapy ◽  
Resin Microspheres ◽  
Yttrium 90 ◽  
Strong Agreement

Abstract Purpose A multidisciplinary expert panel convened to formulate state-of-the-art recommendations for optimisation of selective internal radiation therapy (SIRT) with yttrium-90 (90Y)-resin microspheres. Methods A steering committee of 23 international experts representing all participating specialties formulated recommendations for SIRT with 90Y-resin microspheres activity prescription and post-treatment dosimetry, based on literature searches and the responses to a 61-question survey that was completed by 43 leading experts (including the steering committee members). The survey was validated by the steering committee and completed anonymously. In a face-to-face meeting, the results of the survey were presented and discussed. Recommendations were derived and level of agreement defined (strong agreement ≥ 80%, moderate agreement 50%–79%, no agreement ≤ 49%). Results Forty-seven recommendations were established, including guidance such as a multidisciplinary team should define treatment strategy and therapeutic intent (strong agreement); 3D imaging with CT and an angiography with cone-beam-CT, if available, and 99mTc-MAA SPECT/CT are recommended for extrahepatic/intrahepatic deposition assessment, treatment field definition and calculation of the 90Y-resin microspheres activity needed (moderate/strong agreement). A personalised approach, using dosimetry (partition model and/or voxel-based) is recommended for activity prescription, when either whole liver or selective, non-ablative or ablative SIRT is planned (strong agreement). A mean absorbed dose to non-tumoural liver of 40 Gy or less is considered safe (strong agreement). A minimum mean target-absorbed dose to tumour of 100–120 Gy is recommended for hepatocellular carcinoma, liver metastatic colorectal cancer and cholangiocarcinoma (moderate/strong agreement). Post-SIRT imaging for treatment verification with 90Y-PET/CT is recommended (strong agreement). Post-SIRT dosimetry is also recommended (strong agreement). Conclusion Practitioners are encouraged to work towards adoption of these recommendations.

Influence of Baseline Positron Emission Tomography in Metastatic Gastroesophageal Cancer on Survival and Response to Therapy

Oncology ◽  
2021 ◽  
pp. 1-6
Author(s):  
Ahmed Abdelhakeem ◽  
Madhavi Patnana ◽  
Xuemei Wang ◽  
Jane E. Rogers ◽  
Mariela Blum Murphy ◽  
...  
Keyword(s):  
Positron Emission Tomography ◽  
Response To Therapy ◽  
Emission Tomography ◽  
Gastroesophageal Cancer ◽  
First Line ◽  
First Line Therapy ◽  
Line Therapy ◽  
Positron Emission ◽  
Pet Ct ◽  
Metastatic Burden

<b><i>Background:</i></b> The value of baseline fluorodeoxyglucose-positron emission tomography-computed tomography (PET-CT) remains uncertain once gastroesophageal cancer is metastatic. We hypothesized that assessment of detailed PET-CT parameters (maximum standardized uptake value [SUVmax] and/or total lesion glycolysis [TLG]), and the extent of metastatic burden could aid prediction of probability of response or prognosticate. <b><i>Methods:</i></b> We retrospectively analyzed treatment-naive patients with stage 4 gastroesophageal cancer (December 2002–August 2017) who had initial PET-CT for cancer staging at MD Anderson Cancer Center. SUVmax and TLG were compared with treatment outcomes for the full cohort and subgroups based on metastatic burden (≤2 or &#x3e;2 metastatic sites). <b><i>Results:</i></b> We identified 129 patients with metastatic gastroesophageal cancer who underwent PET-CT before first-line therapy. The median follow-up time was 61 months. The median overall survival (OS) was 18.5 months; the first progression-free survival (PFS) was 5.5 months. SUVmax or TLG of the primary tumor or of all metastases combined had no influence on OS or PFS, whether the number of metastases was ≤2 or &#x3e;2. Overall response rates (ORRs) to first-line therapy were 48% and 45% for patients with ≤2 and &#x3e;2 metastases, respectively (nonsignificant). ORR did not differ based on low or high values of SUVmax or TLG. <b><i>Conclusions:</i></b> This is the first assessment of a unique set of PET-CT data and its association with outcomes in metastatic gastroesophageal cancer. In our large cohort of patients, detailed analyses of PET-CT (by SUVmax and/or TLG) did not discriminate any parameters examined. Thus, baseline PET-CT in untreated metastatic gastroesophageal cancer patients has limited or no utility.

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