Prognostic value of change in CA 125 levels after the first cycle of induction chemotherapy for epithelial ovarian cancers: Results of a multicentric French study

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 16017-16017
Author(s):  
J. Riedinger ◽  
J. Basuyau ◽  
N. Eche ◽  
F. Bonnetain ◽  
M. F. Pichon ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Induction Chemotherapy ◽  
Prognostic Value ◽  
Pathologic Complete Response ◽  
Complete Response ◽  
Ca 125 ◽  
Residual Tumour ◽  
Multicentric Study ◽  
Ovarian Cancers ◽  
Second Look

16017 Background: CA 125 assays enable treatment-response monitoring in ovarian cancer. Patients and Methods: This multicentric study was performed to assess the predictive value with regard to pathologic complete response at surgical second look and the prognostic value of the serum CA 125 change (=rease [D], 50%, 25%, < 25%ase) after one or two courses of induction chemotherapy (CT) with platinum salts and cyclophosphamide Of the 494 stage IIc - IV patients who were treated at the French Cancer Centres of Dijon, Bordeaux, Toulouse, Rouen, Reims, Nantes, Angers, Saint Cloud, 397 (80.4%d and 382 (77.3%om cancer. Median (range) follow up time was 34 months (3 - 215 months). Among them, 194 patients had a surgical second look. Results: The CA 125 change after the first, the second and the two first CT courses and CA 125 concentration (> or =-1) before the third CT cycle had an univariate prognostic value for overall survival (OS) (p < 0.0001 for both). In Cox models, CA 125 change after the first CT course (p < 0.0001), residual tumour (p = CA 125 concentration before the second CT course (p =and patients’ age (p =were independent prognostic factors for OS. A normal CA 125 before each of the two first CT courses or a CA 125 decrease higher than 50%e first CT course with a CA 125 =-1 before the second CT course identify patients with good prognosis. Both criteria retained a significant value in predicting second-look findings by univariate and multivariate analysis (p < 0.0001). Conclusion: Among well-established prognostic factors in ovarian cancers, the CA 125 change after the first CT course was independent prognostic factors for both achievement of pathological complete response and OS. No significant financial relationships to disclose.

Development of a Prognostic Scoring System for Secondary Acute Myeloid Leukemia (sAML) Arising from Myelodysplastic Syndromes (MDS), Myeloproliferative Disorders (MPD), or Therapy-Related AML (t-AML).

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 921-921 ◽  
Author(s):  
Sanjay R. Mohan ◽  
Paul Elson ◽  
Cristina Rodriguez ◽  
Rachid Baz ◽  
Matt Kalaycio ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Induction Chemotherapy ◽  
Scoring System ◽  
Cleveland Clinic ◽  
Myeloproliferative Disorders ◽  
Risk Groups ◽  
Complete Response ◽  
Remission Induction ◽  
Prognostic Features ◽  
Multivariable Analyses

Abstract Background: Patients (pts) with sAML are evaluated together in large AML trials regardless of whether their sAML arises from antecedent MDS vs. from MPD vs. t-AML. Prognostic factors and outcomes may differ among these subgroups, and a prognostic scoring system would be helpful in determining which patients would benefit from induction chemotherapy. Methods: We conducted a retrospective review of all pts with newly diagnosed, pathologically-confirmed AML at Cleveland Clinic between 1997 and 2007 to identify sAML pts treated with cytarabine-based induction chemotherapy. Data on known prognostic factors (age, white blood cell count (WBC) at diagnosis, cytogenetic risk groups (as defined by CALGB 8461), and AML etiology) were collected as baseline characteristics and controlled for in stepwise multivariable analyses. Complete response (CR) and overall survival (OS) were analyzed. A prognostic scoring system for OS was developed based on the number of poor prognostic features present, derived from significant multivariable factors. Pts received 1 point for adverse cytogenetics, 1 point for having 1-10% peripheral blasts, and 1 point for AML arising from MDS or MPD. Pts with 0 points were favorable, 1 point intermediate, 2 or more points unfavorable. Results: Of 584 AML pts identified, 361 were treated with remission induction therapy, of whom 90 had AML arising from MDS, MPD, or t-AML. Thirty-nine (43%) had antecedent MDS, 21 (23%) an MPD, and 30 (33%) had t-AML, and 47% were female. Pts with AML arising from MDS were older at AML diagnosis (median of 67 years) vs. from MPD (61 years) and t-AML (60 years) (p=.02) but a shorter time from antecedent diagnosis/event (7 months, vs. 47 and 37 months, respectively (p<0.001)). Cytogenetic risk categories were favorable in 9 pts (10%), intermediate in 38 (42%), adverse in 27 (30%), and unknown in 16 (18%) and were similar among groups (p=.28). Median WBC at AML diagnosis was also lower for pts with AML from MDS (3.7k/uL, vs. 9.9 k/uL for AML from MPD and 8.9 k/uL for t-AML, p=.04), as were peripheral blasts (11%, vs. 29% for AML from MPD and 23% for t-AML, p=.01). The overall CR rate was 51% and was qualitatively lower for pts with AML from MDS (38%) than from MPD (62%) or t-AML (60%), but not significantly (p=0.11). The overall reinduction rate was 21% and did not differ among groups (p=.76). Median OS was significantly longer for pts with t-AML (15 months) vs. AML from MDS (8 months) or from MPD (11 months, p=.02). Available SNP karyotyping data on a subset of pts (6 from MDS, 1 from MPD, 4 with t-AML) did not reveal any shared or cryptic lesions that would distinguish responders from non-responders. In multivariable analyses, secondary AML etiology remained non-predictive of CR but was an independent prognostic factor for OS. Pts with t-AML had improved OS compared to AML from MDS (p=.01) or from MPD (p=.08). Favorable- or intermediate-risk cytogenetics, compared to adverse, were significant predictors of CR (p<.001) and OS (p<.001). Age <60 years (compared to 360 years) was a significant predictor of CR (p=.02), but not OS. Patients with 1–10% peripheral blasts had worse OS vs. 0% or >10% blasts (p=.01). Using the prognostic scoring system described above, favorable pts (n=16) had a median OS of 40 months vs. 12 months for intermediate pts (n=33) and 4 months for unfavorable patients (n=27, p<.001). Conclusions: Among sAML patients undergoing induction chemotherapy, pts with t-AML have a longer OS than AML from MDS or from MPD. Other important predictors of CR or OS were cytogenetics, age, and peripheral blast %. The sAML prognostic scoring system distinguished patients with improved survival from induction chemotherapy.

Prognostic value of CA 125 and neopterin in women with ovarian cancer undergoing second-look laparotomy

1991 ◽  
Vol 165 (3) ◽  
pp. 779
Author(s):  
Lothar C. Fuith ◽  
Dietmar Fuchs ◽  
Gilbert Reibnegger ◽  
Helmut Wachter
Keyword(s):  
Ovarian Cancer ◽  
Prognostic Value ◽  
Ca 125 ◽  
Second Look

Radiologic and pathologic prognostic factors after neoadyuvant chemotherapy for T3 rectal cancer (RC): 3-year update GEMCAD 0801-trial.

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 643-643 ◽  
Author(s):  
Isidro Machado ◽  
Gina Brown ◽  
Rafael Estevan ◽  
Antonieta Salud ◽  
Mabel Gil ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Multivariate Analysis ◽  
Prognostic Factors ◽  
Neoadjuvant Chemotherapy ◽  
Cumulative Incidence ◽  
Univariate Analysis ◽  
Pathologic Complete Response ◽  
Complete Response ◽  
Tumor Regression Grade ◽  
T3 Rectal Cancer

643 Background: Prognostic factors in RC treated only with neoadjuvant chemotherapy, have not been explored. We analized the prognostic value of clinical-radiological and pathological factors for disease-free, (DFS) and cumulative incidence of distant metastases (DM), for patients treated with preoperative capecitabine, oxaliplatin and bevacizumab (CAPOX-B) within our multicentre phase II GEMCAD 0801 trial. Methods: 46 patients were enrolled to evaluate safety and efficacy of neoadjuvant CAPOX-B followed by surgery. Results have been recently published (Oncologist 2014;19:1-2). Eligibility included baseline magnetic resonance (MR) showing a T3 tumour with mesorectal fascia potentially clear. Clinical, pathologic (ypN+, T or N downstaging, tumor regression grade [TRG], pathologic complete response [pCR]) and radiologic factors both at baseline (mr extramural venous invasion [EMVI]) and post neoadjuvant chemotherapy (ymr TRG, ymr lengh change [RECIST]), were analyzed. Univariate and multivariate analysis was performed. Results: With a median follow up of 36 months, fourteen patients experienced relapse (2 local, 11 distant, 1both). 3-year DFS was 69%. It was 95%/49% for T downstaging/no T downstaging (p=0.0009) and 95%/43% for mrEMVI positive/negative (p=0.0001), respectively. ymrTRG (Mandard) ranging from no regression, TRG 5, to complete response, TRG 1, p=0.0108 and ypN0/ypN+ (p=.02) were also significantly related to DFS in univariate analysis. The same factors and N-downstaging were also significant for cumulative incidence of DM. On Cox multivariate analysis, T downstaging and mrEMVI were the only independent prognostic factors for DM ( p=0.0363 and 0.0111 respectively) and DFS (p=0.0315 and 0.0277 respectively). Conclusions: T3 rectal cancer with MR detected EMVI positive and those without downstaging after neoadjuvant chemotherapy are associated with unfavourable prognosis. This suggests that future strategies for treatment intensification and surveillance could be based on EMVI and T staging. Clinical trial information: NCT00909987.

Optima: A phase II dose and volume de-escalation trial for high- and low-risk HPV+ oropharynx cancers.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 6066-6066 ◽  
Author(s):  
James Melotek ◽  
Tanguy Y. Seiwert ◽  
Elizabeth A. Blair ◽  
Theodore G. Karrison ◽  
Nishant Agrawal ◽  
...  
Keyword(s):  
High Risk ◽  
Neck Dissection ◽  
Induction Chemotherapy ◽  
Phase Ii ◽  
Low Dose ◽  
Pathologic Complete Response ◽  
Poor Response ◽  
Complete Response ◽  
Low Risk ◽  
Grade 3

6066 Background: In this prospective phase II de-escalation study, we used induction chemotherapy to identify favorable HPV+ oropharyngeal cancer (OPC) pts, including those with high-risk tumors, and applied significantly lower radiation or chemoradiation doses than previously reported. Methods: Pts with HPV+ OPC were classified as low-risk (≤T3, ≤N2B, ≤10 PYH) or high-risk (T4 or ≥N2C or > 10 PYH). Pts received 3 cycles of carboplatin (AUC 6, D1) and nab-paclitaxel (100 mg/m2, D1/8/15). 1) Low-risk pts with ≥50% response received low-dose radiotherapy alone to 50Gy (RT50). 2) Low-risk pts with 30-50% response OR high-risk pts with ≥50% response received low-dose chemoradiotherapy to 45Gy (CRT45). 3) All other ( = poor response) pts received regular-dose CRT (CRT75). All pts also received de-escalated RT volumes limited to the first echelon of uninvolved nodes. CRT consisted of paclitaxel, 5-FU, hydroxyurea, and 1.5Gy twice daily RT every other week. Primary site biopsy and neck dissection were performed only after de-escalated treatment (RT50, CRT45) for pathologic confirmation. The primary endpoint was 2-year PFS. Secondary endpoints included pathologic complete response (pCR) rate and toxicity. Results: 62 pts were enrolled. 28 pts (45.2%) were low-risk and 34 pts (54.8%) were high-risk. 71.4% of low-risk pts received RT50 and 21.4% received CRT45. 70.6% of high-risk pts received CRT45. The pCR rate was 94.4% after RT50 and 92.3% after CRT45. Median follow-up is 1 year. The 2-year PFS and OS were both 100% for low-risk pts, and 91.6% and 97.0% for high-risk pts. Significant decrease in the rates of grade ≥3 mucositis (15.8% RT50, 46.4% CRT45, 60.0% CRT75, p = .033) and grade ≥3 dermatitis (0% RT50, 21.4% CRT45, 30.0% CRT75, p = .056) were observed. PEG-tube dependency was improved at 3 months (0% RT50, 14.8% CRT45, 70.0% CRT75, p < .001) and 6 months (0% RT50, 3.7% CRT45, 20.0% CRT75, p = .066) post-treatment. Conclusions: Favorable response to induction chemotherapy appears to be a powerful biomarker for dose and volume de-escalation with 50Gy RT or 45Gy CRT. Outstanding survival and high pCR rates suggest that completion neck dissection may not be necessary. Toxicity and functional outcomes are significantly improved. Clinical trial information: NCT02258659.

Neoadjuvant epirubicyn, oxaliplatin, capecitabine and radiation therapy (NEOX-RT) followed by surgery for locally advanced gastric cancer (LAGC): A phase II multicentric study.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 4066-4066
Author(s):  
Antonino De Paoli ◽  
Federico Navarria ◽  
Elena Torrisi ◽  
Jerry Polesel ◽  
Eleonora Fort ◽  
...  
Keyword(s):  
Locally Advanced ◽  
Survival Rates ◽  
Pathologic Complete Response ◽  
Complete Response ◽  
Phase Iii ◽  
Multicentric Study ◽  
Locally Advanced Gastric Cancer ◽  
Pet Ct ◽  
Phase Iii Trials ◽  
Grade 3

4066 Background: This study evaluates the feasibility, safety and efficacy of a trimodality treatment, with surgery postponed after neoadjuvant chemotherapy (CT) and chemoradiotherapy (CRT), in LAGC. Methods: Patients (pts) with cT3-4 and/or N+ LAGC were eligible. Staging included endoscopic ultrasound, PET-CT and laparoscopy. Three cycles of EOX (Epirubicyn 50mg/m2,q21 days, Oxaliplatin 130mg/m2,q21 days, and Capecitabine 625mg/m2 bid, by continuous oral administration (c.a.), followed by IMRT with 45Gy/25 frs, concurrent Capecitabine 625mg/m2 bid c.a. and weekly Oxaliplatin 30mg/m2 for 5 wks, was planned. Early PET-CT was performed after the 2nd EOX cycle to assess response or disease progression. Restaging was repeated after CT and CRT. Surgery was planned 4-6 wks after CRT, 22 wks from the start of NEOX-RT. Pathologic complete response (pCR) was the primary endpoint. Results: From November 2008 to March 2016, 51 pts (5 G-E Junction, 17 Cardia, 15 Corpus, 14 Antrum) entered the study. The NEOX-RT program was completed in 46 pts (90%) who proceeded to surgery and are assessable. Grade 3-4 toxicity (NCI-CTC criteria v.3) occurred in 13/51 pts (25%) during EOX, including 1 toxic death, and 9.5% CT cycles required dose modification, resulting in a CT compliance of 90%. No pts had progression during CT. Persistent G2-G3 toxicity occurred in 32/46 pts (69%) during CRT. However, 41/46 pts (89%) received the planned 45Gy with Capecitabine at dose ≥75% and 4-5 cycles of weekly Oxaliplatin in 52% pts. Curative resection (R0) rate was 89%; 4 pts (8.7%) had peritoneal carcinomatosis at surgery done after a median of 23 wks. pCR was reported in 9/46 pts (19.6%). Major postop complications occurred in 5 pts (11%). At median f-up of 62 mos (23-109), 5-yr OS and DFS in all and pCR pts were 58%, 100% and 51%, 75%, respectively. Conclusions: This trimodality program was feasible and safe. Most pts completed the planned treatment. The pCR rate of 19.6% was remarkable and met the hypothesis of pCR = 20%. A high R0 rate was also reported and delayed surgery didn’t increase complications. The notable survival rates are available to be compared with ongoing phase III trials. Clinical trial information: 2008-002715-40.

Efficacy of three-drug induction chemotherapy followed by preoperative chemoradiation in patients with localized gastric adenocarcinoma (GAC).

2019 ◽  
Vol 37 (4_suppl) ◽  
pp. 106-106
Author(s):  
Dilsa Mizrak Kaya ◽  
Graciela M. Nogueras-Gonzalez ◽  
Prajnan Das ◽  
Mariela A. Blum Murphy ◽  
Fatemeh Ghazanfari Amlashi ◽  
...  
Keyword(s):  
Induction Chemotherapy ◽  
Pathologic Complete Response ◽  
Complete Response ◽  
Preoperative Chemoradiation ◽  
R0 Resection ◽  
Platinum Compound ◽  
Entire Cohort ◽  
Preoperative Chemoradiation Therapy ◽  
Drug Induction

106 Background: Preoperative induction chemotherapy followed by chemoradiation yields better R0 resection rates, pathologic complete response (pCR) rates and improved survival for localized GAC.Previous studies with two-drug induction chemotherapy showed 70-80% R0 resection rates and 20-30% pCR rates. We report the effect of three-drug induction chemotherapy on a large cohort of localized GAC patients. Methods: We identified 97 patients with localized GAC who received three-drug induction chemotherapy followed by preoperative chemoradiation therapy. We assessed various endpoints (overall survival [OS], recurrence-free survival [RFS], R0 resection and pCR rate). Results: The median follow-up time was 3.5 years (range; 0.4-16.7). Most of the patients were men (60.8%) and the median age was 60 years (range; 21-89). The induction chemotherapy regimen was a fluoropyrimidine and a platinum compound (cisplatin or oxaliplatin) with a taxane (docetaxel or paclitaxel) for 95% of patients. Seventy-three (75%) out of 97 patients underwent planned surgery. R0 resection and pCR rate were 93% and 21%, respectively. Pathologic partial response (< 50% residual carcinoma) rate was 50.7%. The median OS was 6.43 years (95% Cl 3.27-12.36) for the entire cohort and 11.1 years (95% Cl 7.1-not estimable) for patients that underwent surgery. The estimated 2- and 5-year OS rates were 72% (95% CI 62-80) and 54% (95% CI 43-64) for the entire cohort and 83% (95% CI 72-91) and 66% (95% CI 53-76) for patients that underwent surgery. Pathological lesser stage (stage I/II vs. stage III/IV) (p = 0.001) and R0 resection (p = 0.019) were independently associated with longer RFS in the multivariate analysis. Conclusions: Our data show that three-drug combination is feasible without providing substantial advantage in this setting of preoperative induction chemotherapy followed by chemoradiation and surgery.

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